Tom Rountree DO (00:02.018)
This is a bit of a guide to success with GLP-1 medications. So first off, what are these medications? GLP-1 stands for glucagon-like peptide-1, a hormone your small intestine naturally produces after eating. And it does three powerful things. It triggers insulin release, it slows digestion, and signals your brain that you're full.
These GLP-1 medications mimic this naturally produced hormone, but they last much longer than the natural version, which breaks down literally in minutes. The injectable version lasts a full week. GLP medications such as Ozempic, Wigovium, and Charles Zeppon and others, these help control blood sugar and support weight loss by reducing your appetite and helping you feel full.
However, the one thing that most of you don't talk about is you need to combine this with healthy lifestyle habits. Yes, you need to embrace the suck and change your life. It's going to be difficult. And I had to do it when I wanted to become a doctor. And then again, as a CrossFit instructor, I had to go through and deal with the worst situations that a human
can imagine. So I came out, I was much better, I was a new person. And so many times people losing weight go along this similar type of journey. Now if you want to follow along, this podcast has an accompanying handout that you can find in the link down below. It's my GLP One Success handout. I suggest printing it out and taking it with you to your first weight loss consultation.
Tom Rountree DO (02:08.822)
Okay, getting started. What can you expect? Your dose should start low and gradually increase over several weeks to reduce the chance of side effects. Nausea is common when starting, but usually this improves over time. It's a little bit tough the first week, second week, just a little bit, and third week it's usually gone. Now there are four things that I tell my patients to do. Make your first meal
half the normal size. Whatever that is, consider making it half. Eat healthy food, right? Start out with chicken, like baked chicken, asparagus, and then maybe some apple cuts, right? Like some apple bites that you've chopped up yourself. And drink plenty of water because this helps to reduce nausea as well. And then also, as a little bonus, take one anti-nausea pill.
In this case, I personally prescribe Zofran, also called Undancetron, to reduce the nausea because I know it will actually help. And remember, if these side effects are bothersome, like they're interrupting your life, you can slow down the dose increases. And in my clinic, we can go below the suggested starting dose. Now, another thing that can happen is
vomiting and this can lead to acute kidney injury. So you may have heard these medications aren't good for the kidneys, but that's because they can cause vomiting. But if you follow the above little protocol, it becomes highly, like very uncommon. I've seen it once in the beginning of starting to prescribe these medications, but it's very rare now.
There is an odd thing that happens when people start this medication. They have a hard time differentiating between hunger, fullness, and nausea because this medication actually forces you to become slightly hungry. And that is a good thing because we should start to feel that. Many times we go through life, we just shovel food in our face and we just eat.
Tom Rountree DO (04:26.632)
know, dumpster trash food, and because that's what's available at these gas station stores. This medication makes you stop and think. And sometimes many people tell me that they're punished by this medication whenever they eat bad food like fried fish or chips, and they also feel like that they're punished a little bit if they eat too much. So it causes you to pause and
think about what you're eating and actually kind of helps you understand what is good food. And remember satiety is a positive feeling that helps you eat less. And you have to learn to recognize when you're comfortably full and then stop eating at that point. So how do you actually eat on these medications? How do you eat well? Right? The first thing is protein is highly essential.
And you want to aim for 60 to 75 grams of protein daily for women and then 75 to 90 grams for men. And this can also depend on your weight as well. And I highly suggest downloading the app. It's called My Fitness Pal and it will break down your meals for you in the amount of protein that you're eating. And so why do you need to this? Why am I saying concentrate on protein? Because
you are essentially eating less calories. When you eat less calories, your muscles will naturally waste away. They'll deteriorate. And you have to counter this by eating good protein and doing the next thing we'll talk about, which is exercise. So you want to aim for including protein at every meal to maintain muscle mass. And it's better to eat at
So eating three times a day will deliver better and more protein to your muscles than just eating once or twice a day. So you want to eat good, lean meats, right? Lean steak, lean chicken. You want to cut the fat off the chicken when you're prepping it. You want to eat healthy fish, as well as eggs, Greek yogurt, beans, and if you're adventurous, some tofu. I do not eat...
Tom Rountree DO (06:50.19)
tofu personally. And you want to choose nutrient-dense foods, right? These are foods that actually have tons of nutrients in them because sometimes when you're not eating as much, your nutrients can drop a little bit lower. We'll talk about supplements in just a second. So you want to fill your plate with fruits and vegetables and you want to choose whole grains over refined grains. You want healthy fats like olive oil, nuts, avocados, and fatty fish.
And yes, once again, you're have to change your eating habits. And some people are like, I never grew up eating vegetables or fruits. And I said, well, do you wanna stay that person or do you want to become the new person? Because you're gonna love the new person. As people told me, I never knew doc how good good felt. So that new person is awesome. And if you want to look up some nutrition,
diets that are really healthy, that's a Mediterranean or DASH diets. So what about meal timing and portions? You want to eat smaller, more frequent meals or snacks. You want to eat slowly and mindfully, right? Try not to just ram it down the gullet. You don't want to do that. You want to eat mindfully and slowly. TV is off, right? Family is around. Or you're eating with coworker, right? Mindfully.
and then listen to your body and stop eating when you feel full. Even if there is food that is on that plate, you need to, I'm speaking to my Italians here because that's what I grew up with. had a friend who was Italian and he would just continue eating when the plate was, when he was full, but the plate still had food on it. So I had to talk to him, you know, and help him understand that this is simply
A cultural thing that we learn. And that's what we're fighting against. Culture and marketing, both those things. They're out to get you. So try to stop eating a little bit. Now try to eat at regular times each day. Right? Try to eat meals, you know, A, B, and C, right? Breakfast, lunch, and dinner. And so this will deliver a very high level of nutrients
Tom Rountree DO (09:17.698)
and protein and carbs to your body so that you feel satiated and aren't tempted to eat things at work that are like garbage, right? Like donuts and things like this. I suffer from that too, right? I go to work, some rep or somebody has brought some food, donuts, and I'm like, look, that's what I, I feel like eating that. And so I need to eat some eggs and sausage beforehand to prevent that from happening.
So what foods should you be limiting? You want to limit your high fat fried foods. This can worsen nausea. Spicy foods. This can increase stomach upset. You want to get off the sugary drink train. You want to get rid of that, throw out the processed snacks from your food, from your house. Whoever is the gatekeeper of food, they need to control what comes into the house. You need to throw those things out. Those are absolute garbage that will turn you into a landfill.
So alcohol, get that out of the house. You don't need it. You can have it when you're celebrating somewhere, right? Use it as a celebratory or celebration drink instead of an everyday, weekly or nightly drink. So like I said before, to help with nausea, I do a little review because it's important. Eat smaller portions, avoid greasy, fried or spicy foods.
Don't lie down two to three hours after eating. This is why it's important to eat a little bit earlier, maybe 6 p.m. or something like this. Ginger tea can help. Now, for constipation, you can try some fiber gummies and you can also try some fruit. Some dragon fruit is heavy on the cellulose and fiber. Vegetables are very good and whole grains.
drink plenty of water, right, for constipation, that will help you as well. And here is a super key point and one of the pillars of lifestyle medicine, staying physically active. This increases your sympathetic drive and causes you to poop more. So that's what you can do for that. Now, also, over-the-counter stool softeners may help if you actually need them. Now, for diarrhea, this doesn't normally happen, but
Tom Rountree DO (11:44.478)
It's more rare, but it can happen. If you have diarrhea, you want to avoid your high fat foods like pizza. Get off the pizza. You don't need as much of it as you think you need. And you want to stay hydrated. And most importantly, contact your doctor. If the diarrhea is severe or persistent, or if the nausea is severe or persistent, then be sure to contact your doctor.
I don't know how many people come in, Doc, I've been having diarrhea for two weeks. I'm like, that wins you some labs instead of just, you know, winning you some change in diet or medication. So as you let things go on, you win the higher cost of medical care. So get in there upfront and get it taken care of. And you want to drink at least eight to 12 cups of water daily.
You can drink less, it's okay, six to eight, but just know that this medication can reduce your thirst. So drink even sometimes when you don't feel thirsty. So I will do this to myself in the morning, I will drink water or a little bit of milk because I know that I need it, right? need it, soon as that hits my mouth, I feel 10 times better. But sometimes I'm just not thinking about it. Now fruits and vegetables are also water rich.
And these can help with supplementing water.
Tom Rountree DO (13:17.07)
So some signs of dehydration, if it goes on too long, include things like dark urine, dizziness, or dry mouth. And those are side effects, okay? Now, let's get into the actual lifestyle habits. I also list these in my GLP-1 Success handout, you can download in the show description below. So physical activity, right?
150 minutes of moderate activity per week, like,
brisk walking, okay, but that doesn't cut it, like you'll see in the handout, does not cut it, okay? Walking does not cut it. You need to strength train. You need to get out those weights and do something with them, right? Two to three times per week to maintain your muscle. And, you know, I have a little program that I give to my patients, I call it Strong 20, because it only takes them 20 minutes. Now,
Any movement is better than none. If you're a couch potato, standing up, you know, makes you a couch chip, right? You've gotten rid of a lot of potato, simply by standing up and walking around a little bit, then sitting on the couch, the ultimate ambulator killer, and watching Netflix, right? Getting up and doing something will help you to change that significantly.
Now why do you want to work out? Why do you want to do resistance training as well as walking? Because likely you're on these medications because you have a problem with your body. So this can include things like diabetes, hypertension, obesity, as well as multiple other things, right? Maybe you have been smoking and you need to improve that as well. So the
Tom Rountree DO (15:21.038)
Benefit of resistance training is that it preserves your muscle mass during weight loss. One of things you can get is called a DEXA scan. DEXA scan will tell you, this is how I look. This is how I look on the inside. What percentage of muscle mass, fat, bone, and things like this. DEXA scan is what you get if you have osteoporosis, but I think it's very helpful for people to see where they're at and maybe where they need to be in terms of muscle mass.
Resistance training will also improve blood sugar control. Even my diabetics, I assign them resistance training three times a week. They come back and tell me, Doc, this is the best my sugars have ever looked. They look like, you know, in the 150s instead of the 200s now, or 140s instead of 200s. It also enhances cardiovascular health. The main thing to reverse foot pain, leg pain, and chronic smokers is walking.
On top of that, resistance training. It will also boost your mood and energy. It is your Prozac. It is your Wellbutrin. It is your Effexor. It produces those chemicals in the brain. Now, the next thing is, because this is a common question, vitamins and supplements. Normally, you do not need these medications or do not need supplements if you're eating pretty well.
if you're eating your vegetables and fruits and lean meats. But because this medication reduces appetite, you may need a daily multivitamin. A multivitamin I recommend is a once daily. So, or like a men's multivitamin once daily or women's multivitamin once daily. They do make 50 plus, so you can look at that as well. But what you in general need is vitamin D and calcium, especially if your dairy intake is low.
You need B12, especially for those with diabetes. Sometimes you need iron if you're at risk for anemia. But you should talk to your doctor about which supplements are right for you. One thing I actually also include is magnesium to help with sleep sometimes. Because as you reduce your intake of bad foods, you will find your energy goes up. And what happens is sometimes people can't sleep very well. They're like, I can have a little bit insomnia.
Tom Rountree DO (17:44.654)
But it goes away, but it's like I have a little bit of a hard time falling asleep. And magnesium can help this. Magnesium can also help with muscle recovery after adding in the resistance training. Now, what are other important lifestyle factors? Sleep, okay? When people tell me, I don't need sleep, I only need like four to six hours, they win themselves an EK gene because I know that their blood pressure's gonna be high,
I know that their heart may be undergoing some remodeling. And nine times out of 10, this is true unless they're very young. And then they may also win a sleep study because we know across millions and millions of people who wear Fitbits that this data shows that people need sleep. Otherwise it ramps up your cortisol, ramps up your sympathetic nervous system and causes your blood pressure to go through the roof as well as anxiety.
So you need seven to nine hours of quality sleep each night. And if you don't, this interferes actually with weight loss and your blood sugar control. So if people are like, I'm having a wedding coming up, I tell them, if you are stressed and not getting good sleep, then this can contribute to slower weight loss than the medication advertises.
Which brings me to my next thing, stress management. This is another pillar. You have to find healthy ways to manage stress. Meditation, deep breathing, or, and this is especially important, talking with a counselor. So at my clinic, we offer 10 free sessions and this is what needs to happen.
Finally, you want to avoid, like I said before, tobacco, right? One of the interesting things about this medication, new results are showing, new studies show the decreasing of cravings, not only with food, but also things like tobacco and even some opioid medications or opioid withdrawals, things like this. It helps curb those cravings. But especially talk to your doctor about quitting
Tom Rountree DO (20:05.08)
programs. There are some very good books to listen to on Amazon, which have helped with thousands of people get off smoking and vaping. Vaping is bad too. Don't confuse that it's not. So when should you contact your doctor? If you make any changes, right? Don't just take my word for it. You need to go see your doctor. That's extremely important. I am not your doctor and
Someone hopefully is. So you need to contact them if you have persistent nausea, vomiting or diarrhea, severe abdominal pain, dehydration, vision changes, symptoms of low blood sugar, difficulty swallowing or severe heartburn, and any other concerns about side effects. Extremely important to talk to them.
So the lifestyle habits that I mentioned above, and I'm going to make a separate podcast about this, they can help you get off these medications. Many people come off after about 12 months or so, sometimes sooner, but these lifestyle habits will help you come off of these medications. You need to build, sometimes, a long-term success. So if you feel that this podcast was useful,
Feel free to click the link below to download my follow along handout and that includes all of these tips I've listed. So long-term success, right? The habits you build now will help maintain your health improvements. So the GLP ones are like a little booster, a little mental booster, which will then cause you to make other lifestyle habits that improve your life. So you wanna continue eating your regular balanced meals.
Stay physically active. Monitor your weight so you understand where you've reached the goal that you want and don't go below into the unhealthy range as well because I've seen that happen. I've had to stop people on it. Keep up with your medical appointments. Don't just, you know, say, I'm doing good now. I don't need to go see my doc because they may find something that is not good and needs to be prevented before long term damage happens.
Tom Rountree DO (22:23.084)
And more importantly, this is another pillar of lifestyle medicine, build a system of family friends or support groups. And this will make you last much, much longer. And this can include like coworkers, right? Maybe you have some type of challenge to lose weight. Talk to your boss. All three of you go in there, talk to the boss and say, hey, can we get these medications on our insurance plan so we can get them?
That way you now have a support group to go with you through this journey. Remember, GLP-1 medications, they work best when combined with healthy lifestyle changes. So embrace this difficulty and you'll start to see a new you.
