Living A Full Life

How GLP-1 Drugs Change Appetite, Metabolism, And The Brain

• Full Life Chiropractic • Season 3 • Episode 52

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Cravings fade, scales move, and blood sugar steadies—GLP-1 drugs promise a lot. We take you past the hype and into the real mechanics of how these medications work in the gut, the pancreas, and the brain. You’ll hear a clear, plain-English breakdown of glucagon-like peptide-1, why slowing gastric emptying increases fullness, and how glucose-dependent insulin release lowers A1C without the same hypoglycemia risk as older drugs. Then we zoom out to the brain: reward circuits, appetite signals, and the surprising ways long-term use can dampen drive for food and other rewards.

We also trace the modern arc from Ozempic’s diabetes approval to Wegovy’s obesity indication, and why tirzepatide’s dual-action profile captured headlines. That context matters for cost, insurance coverage, and the explosion of compounded products—some safe, some not. We outline a clinician-led plan that starts low and titrates slow, pairs medication with strength training and protein, and tracks labs like A1C, renal function, and thyroid history. The goal: powerful results without sacrificing muscle, motivation, or safety.

No sugarcoating the risks. Nausea, constipation, pancreatitis warnings, gallbladder events with rapid weight loss, dehydration-related kidney injury, and a boxed thyroid warning are all part of the picture. We explain who should avoid GLP-1s, what red flags call for urgent care, and why stopping the drug often brings weight regain unless habits change. If you’re considering GLP-1s for “sugar season” or beyond, this conversation helps you set realistic targets, protect lean mass, and navigate ethics and access with clarity. Subscribe, share with a friend who’s curious, and leave a review to tell us what you want us to explore next.

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Welcome to another episode of Living a Full Life. I'm Dr. Enrico Dolcecori. And each and every week we drop you health and wellness tips for you and your family to live healthier, fuller lives by listening in. And we appreciate each and every one of you. This week's topic, GLP1s. We're getting into weight loss season. You know what that means. New Year's resolutions, end of the year. It's actually sugar season. And I thought this was a perfect time to talk about this stuff because people actually start thinking about this now. This is almost the busiest time of the year for people thinking about weight loss. I think it's from a healthy perspective, from our perspective in the functional medicine and chiropractic realm, is that we get healthy, conscious people that are always ahead of the game. So they're not going to wait till January 1st for a resolution. They know it's sugar season. They're like, what can I do to stay out of trouble? And that's a great preventative way to keep yourself healthy. And I love it. So what a great timing for this. GLP ones have blown up. I think uh Ozempik alone has uh doubled Denmark's gross national product, I mean uh GDP. That's insane, insane. It's like trillion, I think we're approaching trillions, uh, kid with an S on uh how much money this stuff is made at Ozempic and its you know compounds as well. So let's talk about what GLP ones are. And you know how what I'm gonna talk about. I'm gonna talk about the physiology, how it works, what it does in the body, so you get a general understanding because that's how I understand things. So I guess if you listen to my podcast, it's because we are on the same wavelength. If you don't, it's because I'm either way above your head or way maybe too dumb for you. I don't know, whatever it is. But the people who listen do appreciate it. And I try and keep it simple but educational each and every week. This might be one you want to share with people thinking about GLP1s, some aglutides, on it, not on it, maybe had adverse reactions, whatever may be. We're gonna talk about this diving into GLP1s. They are a class of medicines that has exploded into everyday conversation. Uh, we'll explain what they are, how they work in the body and the brain, where they come from, even yes, the history of the Ozempic story, how they should and shouldn't be used, and the risk patients need to know about using them. Whether you treat patients, maybe you're a provider, or maybe you're thinking about using these themselves, or you're just curious about them. Could they be good for me? Could they be good for someone I know? This episode gives you the science and the practical takeaways that I hope you learn some stuff from. So, what is GLP1? What does that stand for? It's glucagon-like peptide dash one. It's nor it's created in the body naturally, it's an incertain hormone released from the gut after you eat. So it's in the lining of the gut, of your stomach, of your gut. Once you eat and you start the digestive process, it releases this hormone and it enhances glucose-dependent insulin secretions. So it suppresses glucagon, slows gastric emptying, and reduces appetite. And that's a good recipe for helping people digest their food, keep blood glucose levels good, lowering A1C, and eating less. And when you do those four things, you tend to lose weight. It's a great side effect. So we'll get into the story later. Physiological mechanism, if you're wondering how this works in the nitty-gritty, they're secreted from intestinal L cells in response to nutrients like endogenous GLP1 acts on GLP1 receptors in the pancreas to insul increase insulin only when glucose is elevated. So for those of us that are insulin sensitive, uh, this helps because it tells the pancreas, hey, there's we're helping, we're nudging you here. Don't don't slack on the insulin. Um, because over time, as we live with higher glucose levels in the blood, our pancreas starts to get lethargic. It gets fatigued, it gets tired, and then it's a little bit less receptive to glucose. And so it's like, uh, do we really need to pump and inject insulin? I've been doing this for 48 years. Do I really need to keep pumping every time you eat a meal? What's up with you and your and your um jellies and marmalades on your toast, man? Like, come on, why do I gotta do this every morning, right? So that's what's going on with the pancreas. So it increases it, makes it more sensitive, and says, yeah, man, you gotta do it. It's like a personal trainer for your pancreas. Like, come on, do it, do your job. And it does it, but only when it's elevated. So we get better control. That glucose dependence reduces hypoglycemia risk compared with other older drugs that we use for maybe diabetes or prediabetes that would just inject insulin into the body. And when you do that, you got to monitor the glucose levels. And if we do too much insulin, it will lower blood glucose to a hypoglycemic level, which can make people faint, pass out, and those things. So, this has been better at doing that for pre-diabetic patients, not for strictly diabetic patients. It also suppresses glucagon release and slows gastric emptying, which helps reduce post-meal glucose spikes and increase satiety, increases your feeling of feeling full. So pharmaceutical GLP1 receptor agonists, exotide, uh, lyriclutide, semaglutide, all these ones are modified to last longer in the body so they can be dosed daily or weekly and achieve sustained effects on appetite and glycemic control. Okay, there you go. That's the physiological mechanism. All receptors in the gut and the pancreas to help control glucose levels in the body by controlling good output of insulin. There you go. That's a summary of the physiology. How did GLP once alter the brain and behavior? This is stuff people don't talk about. We talk about the physiology, we talk about what they do, suppress appetite, helps empty the gut, helps do all this stuff, and helps you eat less and you lose weight. And everyone's I'll take it, I'll buy it. How much is it? 600 bucks a month, I'll do it. And they do it. But the truth is, is what is it doing to your brain? If we're going to talk about hormone receptors binding and competing for receptor sites in the body, you have to involve the brain. The brain is gonna get involved with this. So GLP1 receptors are present in multiple brain regions, not just one. Hypothalamus, your brain stem, your mesolithic reward circuits, it's they're everywhere. So these GLP1 receptors are back and forth. The gut brain connection. We've talked about this many, many times. And this medication, this drug, this peptide, is bringing it to the forefront because the world is using it. So I think we all should understand a little bit more. GLP1R agonists reduce hunger signals affecting melcoratin or POMC and G AGRP pathways in the brain. We won't get into that. That could be a whole hour about how those pathways work with appetite and how we digest food. But they they they reduce the hunger signals in the brain. So you just feel less hungry even after meals. And blunt reward-driven eating. It completely, you know, people are like, I don't even care for the salty snacks in the evening. I don't care about my sugar sweet tooth anymore. I don't care about that stuff. It lessens the wanting for high palatable foods. You lose that need to chew on the chewy gummy or to um crunch the crunchy chip or the cracker, you lose it. All sounds good so far, right? Which together reduce caloric intake overall, reduces snacking, reduces all these things. And you can see how you build a lower calorie intake, which helps people lose weight. They also slow gastric emptying, sending stronger fullness signals from the gut to the brain. So even with smaller portions of meals, you feel satiated, you feel full, those signals get to the brain, the brain's like, yep, you ate enough. That's good, we're good. So there's a lot of stuff there. There's evolving evidence currently that GLP1R agonists can alter cravingslash addiction circuits, which is why researchers are studying them for alcohol, nicotine, and other substance use disorders, emerging area mechanisms still under studies, and that's from PMC. So there is more research going into it. They're using it for other things. And the short history of Ozepic, Wagovi, and why this matters is that Novo Nordisk's semaglutide was first FDA approved as Ozepic for type 2 diabetes officially in 2017. Later, a higher dose formulation marked as Wagobi was approved specifically for chronic weight management for obesity, people at 31% or higher BMIs in 2021. So it's Wagobi that has the obesity FDA approval and OZEP that has the diabetic approval. The diabetes approval noted weight loss as an observed secondary benefit. Subsequent trials led to obesity-specific approval because it was secondary. So they were controlling blood sugar, A1C, and glucose as the drug better, longer lasting, it was as a better drug. And they were like, listen, people are losing a ton of weight, which makes sense. So now it's blown up for weight loss. But really, under insurance code, still in the United States, you have to be diagnosed with either diabetes, prediabetes, high A1C, or uncontrolled blood glucose levels, so which is diabetes. So that is how you get it covered. Otherwise, if you don't fall into that bracket, it's out of pocket through the peptide ways. Other players like lyriclutide, axenotide, and the newer dual G IPGLP1 agonists like terzepitide expanded options. Terzepicide showed very large weight loss effects in obesity trials for people 31% or higher in DMI, which accelerated public attention to these drugs. And that is the short history to it. Underlying studies, both in the United States, Canada, and Europe are showing that the brain barriers that are being blocked for addictive personalities transcend across the brain through the mid-brain and brainstem, showing that any type of behaviors can be suppressed. So we're seeing this as in libido being dropped, want overall, desire going after the goal. You just see people kind of dull down a little bit the longer they use it. And that's what I wanted to highlight a little bit in this podcast is like long-term use of these things alters the brain. And you know, my stance on the brain. It was designed perfectly, well beyond anything we understand by the universe or God, whatever you believe, and it is perfect. And if you keep messing with it, expect the side effects, expect other things to happen. Stop messing with your brains. And we're going to see this research down the road. So that's a little bit, and I don't have anything stamped on you. They're under it right now, they're showing it, and that's why we're getting into nicotine alcoholic um studies is because it is helping people kind of dull down their need and dependency for addictive behaviors and eating and sugar and salt and all these things can be addictive as well. Sugar is more addictive than most drugs out there. So we know this. How do we use these properly? Let's get into the practical guidance of GLP1s. And the indications from the FDA approved way for you know T2D, so various agents and chronic weight management in people meeting obesity criteria like BMI thresholds or BMI plus core morbidity for Wagovie, use should be supervised by a clinician. That's what the FDA guidelines are. You should not be buying this on your own and dosing it on your own. Do not. Do not, do not, do not, because it has to be monitored with blood work and other things as well. The typical approach is to start low and titrate slowly to reduce GI side effects. Nausea is the most common. Weekly semi-glutide, semi-glutide injections have established titration schedules, and clinicians should follow the specific product label, and they will for you, and based on your weight and height and what you've done in the past. There's some important principles to remember with GLP1s. You've got to pair medication with lifestyle changes. So diet, physical activity, and behavior support improve outcomes and are required for long-term success. The fundamentals can't go away. You can't just keep eating fast food and then go on on GLP1 and say, oh, you know, I'm not losing that much weight. Why? Well, we have to change everything. Be mindful of other glucose lowering drugs, and that's why clinicians have to be involved. If you're on metformin, insulin, or anything else. If a patient's on insulin or sulfonal urea, uh reduce doses as needed to avoid hypoglycemia, and that's what your doctor's gonna do, right? So expect that weight trends to be regained if medication is stopped. It says it right on the label. Stop the medication, you're gonna get gain the weight back. You got to treat GLP1 as a chronic therapy when indicated and plan follow-ups. So it's either hyperacute, used in like bodybuilding, athletics, or something like that, to lower body fat percentage a little bit. They're using this. I do I condone it, not so much, but if it's hyperacute, then your body won't get used to anything long term, which I approve. Long-term use is where we run into these issues. Yes, you lose the 45 pounds over the course of 12 months, and then what happens when you get off of this? Well, those receptors start to awaken again. What's gonna happen with that? Do we fall back into old habits, which humans typically do, or have we learned enough new skills to maintain that weight? Could be, could be, but unfortunately, it's like 90% fall back, 10% or less maintain. Main risks and safety signals. So I please listen to this if you're on it or you're thinking about it. These are the things I want you to walk away with today. Common and expected side effects. These are listed right on the bio. Nausea, vomiting, constipation, diarrhea, early satiety, and sometimes transient dizziness. These are usually worse during dose escalation because you're just going to naturally not want food and eat less, and your body's probably not used to that. Now we get into some crazy stuff. Pancreatitis. Yes, we're blocking receptors in the pancreas, which can make it more inflamed because it'll back up other hormone pathways in there as well. Rare, but they are reported. Pancreatitis, patients with severe abdominal pain should stop their NP and be evaluated immediately. There should be no pain with this. Hunger pain, pangs, okay, but no organ pain. Gallbladder disease, rapid weight loss and GLP1 use are associated with gallbladder events like colobestasis, which is gallbladder stones. It can happen because you're burning a lot of fat. Your liver has to metabolize all that fat loss that's happening. There's a metabolist, there's a metabolism process to that as well. Your liver plays a role in that. So all those extra triglycerides being broken down, uh, great for fat loss, but can back up the gallbladder a little bit too. So that's purported in some cases. Thyroid C cell tumors. So it's a boxed warning. Semaglutide has been boxed warning based on rodent studies showing medullary thyroid carcinoma. Human relevance is unclear, but semaglutide is contraindicated in people with a personal family or history of medullary thyroid carcinoma or M2 syndromes. This is an important and prominent safety label item. Kidney injuries. Cause of acute kidney injuries have been reported often related to dehydration from GI side effects, monitor renal function, especially in at-risk patients. So if you've got renal issues, think twice about starting this. Unapproved slash compounded products. That's probably the biggest thing we're running into in the United States with all the compounding pharmacies that have been allowed to do this. Use a reputable pharmacy that has a good track record, and hopefully your clinician is doing that for you. The FDA has warned about unimproved, unapproved compounded GLP1 products and direct to consumer vials that may be unsafe or mislabeled. Patients should avoid purchasing or using unapproved formulations. My biggest advice from what I'm seeing if you see anything super cheap, stay away from it.$59 a month,$100 a month. There's no way a compounding pharmacy can get it or make it for that cheap. So if you're seeing that, you're getting you're probably getting something not good. So be careful on that. And your clinician may or may not know that. Probably not if they're giving it to you. No one out there wants to hurt other people and make just make money. Right? Right? Not America. No way. Monitor and monitoring and red flags. Baseline. Weights, your your baseline weights, your A1C, if you're diabetic, I just check it on everyone, A1C, a renal function, medication list, thyroid slash history or family history, and then counsel about GI side effects and when to seek care is what you should see on your first appointment with any clinician. You're doing this. That's what they should be asking for. They should be sending you for new blood work, not using your old blood work. They can't because things change. Have to see something new or recent. Monitor for persistent severe GI symptoms. That's your job. If anything feels weird, email them, text them, call them immediately, your provider. Say, listen, I feel like this. Severe abdominal pain, that's pancreatitis. We talked about that. Jaundice or signs of cholecystitis, uh, gallbladder, new thyroid nodules by palpating your throat if you feel any nodules in there that are getting bigger or anything, or symptoms that are suggestive of thyroid disease, review other glucose medications to avoid hypoglycemia. And that's your clinician's job. So broader considerations about GLP1s, you know, access, ethics, and how we're using them right now. It's all vanity, of course. That's how the world is right now. It's all about how we look instead of how we actually function, which I get. It's supply and access is the issue right now. So high demand has strained supplies in past years. There are ethical concerns when people without diabetes obtain GLP1s for weight loss, while patients with diabetes may face issues. We saw that in 2024. People with diabetes were not getting the drug, not just because of uh insurance denial, but because the drug was back ordered. Now, that's a problem. You're taking something, it's like almost like sweeping the shelves off of uh uh antibiotics, taking all the antibiotics off the shelf and bringing them home and be like, I'm gonna save these for when my family needs it. And then someone walks in right after you 10 minutes later with a kid with an ear infection and there's no antibiotics. That's insane. That's crazy that we're allowing that. But in America, we wouldn't put money over people, would we? Or harm them, right? Right? Yeah. Uh cost and insurance. Many insurers cover GLP1s for diabetes, coverage for obesity, indications varies and can be limited. And cost can be a barrier too. These drugs aren't cheap. The only way to get them approved is to be diagnosed by a medical doctor, your primary physician, that can diagnose you for that diabetes, and that this would be a good uh drug to help you. Then you can get most of it, if not all of it, covered by insurance. Uh, body image and expectations, maintain realistic expectations is what I tell all my patients. Be realistic. I will see men and women in their 50s and 60s. I ask them what's their goal weight, and they'll tell me their goal weight. I'll say, when was the last time you were like that? And they're like, oh, 21. Like literally college. And I'm like, really? You really think you can get back to college weight? They're like, why not? I should be able to do it. I know why. I'm in this position in the first place. No, you can't get back to 21. I'm sorry. I'm just being completely realistic with you. And if you do, you're gonna hurt yourself. You're gonna you're gonna actually drop a bunch of lean muscle mass to get to that number on the scale and then be worse off than if you were 139 versus 121 pounds when you were 21. I just don't I don't get it. So for clinicians and for patients listening, you know, GLP1 receptor agnes are powerful tools for glycemic control and weight loss and used appropriately under medical supervision. They work with pancreatic effects by changing gut brain signaling to reduce appetite and food reward. But they have side effects and important safety considerations. Use appropriate screening, titration, and follow-ups to make these things work for you the best way possible. So, a couple things. Patient story, you know, that we had a while, someone who used the GLP one under medical care. And in our office, we have our functional medical program that uh from two different doctors that are doing it and getting results. Patients do see the results, it makes it easier when you lose that appetite. It just makes it easier to do that. We can't mistake in GLP1s for fat burners, they're not fat burners. What they do is help with absorption, well, help with emptying for absorption and signal receptors from the gut to the brain about being full or not. That's just really it. They're blood glucose regulators by influencing the pancreas. They're not fat burners, they're not like um increasing heart rate or caffeine or adrenaline or those some of those supplements you take to increase basal metabolic rate, which are also dangerous in themselves, which are supposed to stimulate metabolism and burning fat? They're not that. So by taking that in the bodybuilding world, I just don't know what they're thinking because it's not really promoting that, it's really promoting their gut. And these people that are that athletic are already eating well, they're on like a program of food. So um interesting to see what the results are for them. Does Ozepic cause everyone to lose muscle? Myth or fact? That was one that question that came up and actually spurred me to do this episode. Is it safe if I have a kidney disease? Um, those are those are two things too. So, number one, does Ozepic cause everyone to lose muscle? If you keep doing what you're doing today and you keep moving forward, and 30 days from now, you you book an appointment and you meet with a clinician and you're put on GLP1, some semaglutide, let's say, or trzezepatite, and you start using that and you continue living the exact same life, no real changes. Will you lose muscle mass? The answer is yes. The only way to counteract that, because your your calories are gonna go down, your eating is gonna go down, and your will to do stuff is gonna go down. You're just gonna kind of be taken down a little bit. You'll be like, I don't I don't care. I don't I don't care about watching that movie, I don't care about having sex, I don't care about like I just don't care. It's all gonna go down. So if we don't start working out or start doing some resistance training to offset the lower calorie, our muscles are gonna break down for protein use. So, yes, the answer is yes. So we talked, we saw this ozempic face, ozempic butt. People are losing their glutes, they're losing their muscles in their face because they just haven't done anything. They never did go to the gym, they've started GLP ones, and they never started going to the gym. They just continued living their life working at a desk, taking that, losing the weight, but the weight's coming off everywhere. So the biggest thing we're seeing in and we do red light in the office is skin. More people are coming in for like skin tightening than ever before. Like, I gotta lost all this weight, I gotta tighten the skin. And the real answer to that dramatic weight loss stuff is there's no light in the world or machine in the world that's gonna really tighten the skin enough to make a dramatic improvement. That's gonna require uh liposuction and uh plastic surgery. It really is the only way to do that. So because of the fast weight loss there. So those are some deaths. Is it safe if I have kidney disease? The the fundamental answer is no, it's it's not safe. If you have any type of kidney disease, should be supervised by a clinician. And if a clinician is gonna start you, I'd be a little weary if you had kidney disease and someone said, Yeah, go ahead, you can use GLP1s. So, no, I would say no. Um, that's it. If you are considering GLP1s for you, or you know someone in your family that is, talk to a clinician first, make sure they're reputable, check your medical history. The biggest things are thyroid cancer and a family history of it, and plan for slow dose escalation. And that's typically how everyone, all clinicians will start you, and discuss other diabetes meds, if applicable, if you're diabetic. And commit to lifestyle support. Avoid purchasing unapproved compound products online for a cheaper price. Don't do that. Always do it through your clinician, and you should be pretty safe there. What a world we live in. This is the stuff we're talking about now. One of the most popular things. Look at go and Google search how much Ozempik has made. Uh, is it Denmark or Norway? I'm pretty sure it's Denmark. Go go and look what it's done. Like, it's just unbelievable. I think they're all driving Ferraris in uh Denmark now, just giving people Ferrari checks. Like it's crazy. Or whatever their sports car is in Denmark. Do they make cars? I don't think so. They're not as cool as the Italians. But um that's your podcast for the week. GLP1s, weight loss. We'll do a whole weight loss series again. Healthy stuff, foods. Uh, we've done diet stuff. You can go back and search in our Living a Full Life. Can you believe this is episode number 52 of our third season? So this has been three years of continuous podcasts every single Tuesday for you and your families. I'm not bragging, I'm just telling you, it's not gonna stop. We're just gonna keep going, keeping you up to loop. If you have any questions, this is how I build podcasts. So if you're wondering how I come up with all these ideas and how I can just talk for 20 minutes every week, it's really I do my research first on your questions, and I build podcasts around that. So they're relevant, and that's why we have listeners. Stay well, stay healthy, take care, and have a great week.

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Dr. Enrico Dolcecore

Host
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Dr. Christine Hafer

Co-host