By Kerry Pieri

Dr Tyna Moore is revolutionizing how GLP-1s, or the commonly called Ozempic, are utilized. She’s looking into conditions including “PCOS, high blood pressure, depression, cognitive decline, and as a therapeutic to aid in dealing with autoimmune conditions across the board,” she told Agent Nateur during a recent phone interview. A podcast the naturopathic and chiropractic physician recently did with Dr. Mark Hyman went viral in part because Ozempic, the pharmaceutical name for the GLP-1 peptide seems to be all anyone is talking about lately. But are they talking about it for the right reasons? It’s taken pop culture by storm, mostly for shrinking some of your favorite A, B and C list celebrities rapidly, but in truth, it may just be a miracle drug. Below, Dr. Tyna breaks down what exactly GLP-1s are, the two major varieties offered as prescriptions, the actual side effects and those that may be misunderstood, how the media may wrongly be criticizing it, why Ozempic face can be (mostly!) avoided, and of course, how to dose and utilize it correctly. 

Usually I start these by asking who you are and what do you do? 

I am a naturopathic and chiropractic physician, and I have been in practice for well over 15 years. I've been in the naturopathic medicine world for well over 30 years. I've been in medicine, period, for well over 30 years. When I was in my busy clinical practice, I specialized in regenerative medicine, so regeneration of joints with natural substances.

And what led you to GLP-1s? 

When I realized this was a peptide, I jumped on it because I was like, "Oh, that's my wheelhouse. Stem cells, PRP, peptides, that's my jam," so that's why I got interested in it. And then once I realized how many lies we were being fed and how many people were believing it…I don't like propaganda, so I was just pushing back against it just out of spite, but then I started using it clinically and personally and the results have been profound.

The first data I pulled up was basically showing really profound impacts on neuro-inflammation and having regenerative impacts in the brain. I've never seen anything like it. And I was shocked like, "This isn't what I'm hearing all over Instagram and all over the news." And then I just kept digging and digging. And now I'm sitting on mountains of data going back 20 years…This truly is, if done appropriately, profoundly life-changing for so many people. And I know this not from the small selection of patients I work with (my practice is small now), but it's the followers' messages that I'm getting. I have hundreds of thousands of followers on Instagram, and I get hundreds of messages a month from people saying, "Thank you so much for shedding light on this. This has changed my life significantly, and here's how." And just stories you wouldn't believe.Things that I wouldn't have believed were possible 10 years ago. It truly could be a very life-changing, miraculous peptide if used correctly. And the smear campaign around all of the horrific side effects, half of those are not true or accurate. And the other half are, like I said, those are folks who are on, I believe, way too high of a dose.

What is GLP-1,  what is it most commonly prescribed for, and what is the off-label use?

GLP-1 is a naturally occurring signaling peptide hormone in our bodies, and we produce it in the brain and the gut, and it is known to be deficient—per the data—in those who are suffering with obesity, diabetes, fatty liver, and other conditions in that realm. So they basically created a bioidentical version. GLP-1 naturally occurring has a very short half-life and it breaks down in the body quickly, so they synthesized one, they tweaked one little segment of this string of amino acids. That's what a peptide is, a string of amino acids. It's not a drug, it's a peptide. And they tweaked it so that it could have a longer half-life.

And there have been several generations of these going back 20 years, but the latest is the ones that we're hearing about Semaglutide and Tirzepatide. Semaglutide is FDA approved for both type 2 diabetes and for weight loss. It is mainly offered as an injectable. But there is also an oral version. Tirzepatide is more than just a GLP-1 agonist, it's a GLP-1 agonist and a GIP agonist, which is a little complicated to explain, but it's what they call a dual agonist. Per the data so far, it has a more profound effect on type 2 diabetics and with weight loss, with less side effects than the Semaglutide. So those are the two big players that we're hearing about.

Are type 2 diabetes and obesity most often tied together?

Yes, very often. It's kind of a chicken and egg, and that's a complicated conversation, but it's hard to say what started first. But in most cases, the metabolic dysfunction that comes with type 2 diabetes is so extreme that obesity is often considered a side effect of it. But if a person's living in a state of obesity for long enough, they usually will end up with a pretty busted metabolism, which puts you on the path to type 2 diabetes. A study that came out in 2021, but it was based on 2018 data, showed that about 94% of US adults are cardio-metabolically busted.

So that's a huge percent of the population. And that's a spectrum, anywhere from really minor disturbances in metabolism, all the way up through insulin resistance and into type 2 diabetes. And by the time people get to type 2 they're on quite the journey, they're really in a pickle at that point. It’s become very normalized, but it's pretty severe.

So with that said, I think in the beginning people thought, "This is a diabetes drug that people are now taking for weight loss," but that's not actually true anymore. It is absolutely an obesity prescription?

It is. And it's actually shown such profound cardiovascular benefits that it is now, I believe, through Medicare, it is now approved for cardiovascular disease as well. So it's making waves, and I think we're going to see more and more approval for different conditions as they start to show efficacy with it.

And what are some of the long-term effects of staying on a GLP-1?

Does everyone need to stay on it long term? That depends. I don't love the way that it is being prescribed in the conventional model. The conventional brand names by the big pharma companies come in a pre-filled pen that has controlled dispensing on it so you can't play with the dose. And so I believe that most folks are being started at too high a dose and they're being ramped up too quickly and taken up to too high a dose overall. I'm finding great efficacy at very low doses, but that's only from a compounded version, so that's a longer conversation too.

But long term it heals your metabolism, that's what peptides do. Peptides insert themselves where they need to go, they heal, and they regenerate. And that is exactly what these peptides do. They're getting a bad rap because I think people are being dosed way too high and then thrown into some pretty terrible side effects. And that's all we're hearing about from the media, is these horrendous side effects.

If we put somebody on too high levels of insulin, insulin is a peptide, they'd die. And if we put somebody on any other hormone at high doses, we would have really terrible outcomes and we would blame the dosing and the management, not the peptide. But for some reason, the minute this came out as a weight-loss tool, there's been a whole lot of media coverage and a whole lot of, I believe, a propagandized smear campaign. Because it's potentially cutting into a lot of big industries in a way that some people are not so thrilled about, because it has an impact on the brain and it gives people back the onus of control.

I saw something in your Dr. Mark Hyman interview that you both talked about the “stomach share” companies. I thought that was an interesting term.

Yes, there's just so many industries that are being impacted that are paying attention. Big Food is concerned. I'm sure the fast food industry is being impacted. These have shown efficacy with alcohol abuse syndrome, with smoking cessation. So there's some industries that are probably keeping an eye on things.

If people were interested in trying the approach of a lower dose, would they have to go through a functional medicine doctor? Because if they just went to a standard GP for a script, they would most likely have to get the general injection dosage, correct?

Right. That's challenging because I came up with this concept of dosing low outside of weight loss. Yes, it does impart weight loss, which is awesome, but really it seems to get people just down to their fighting weight. If you keep the dose low enough, they land where they feel best and where they maybe were before the bout of stress or the perimenopause hit or what have you. Cranking up the dose to get people to lose those last five, 10 pounds, that's vanity weight, that's not what I'm going for. So getting it dosed low they'd have to get it compounded and they'd have to find, yes, probably a functional medicine doctor, a longevity doctor, somebody who's willing to work with a compounding pharmacy because a lot of doctors are not willing to go that route. So their family doctor, their primary care doctor, is probably not going to be too keen on it.

Then this concept of dosing low, I don't know of any doctors—aside from the ones I've talked to or the ones taking my program—that are really understanding it. Some doctors are keeping dosages low for weight loss, but that's the only application I've ever heard anybody talk about using it for. I'm using it for all kinds of conditions, PCOS, high blood pressure, depression, cognitive decline, and as a therapeutic to aid in dealing with autoimmune conditions across the board.

PCOS can affect much younger women while a perimenopause situation would obviously be for somebody in their mid-forties. Are you finding that this could really work across the board for a lot of different age groups and men and women?

Absolutely. Because I think that beyond the studies that we have showing that there are certain subsets of people who are GLP-1 deficient, like I mentioned, I think that some folks are actually GLP-1 deficient perhaps genetically or struggling with it for various different reasons. It doesn't necessarily have to be that they are diabetic or obese to get there.

And so I think of it as almost like any other hormone. If we have a hormonal deficiency, as a bioidentical hormone replacement doctor, I want to supplement physiologic doses. And that's totally different for everyone across the board. We just want to get them back to where they feel good. And so I'm using it in lieu of antidepressants. I'm using it in lieu of all kinds of medications that patients were previously on for different reasons because they maybe were GLP-1 deficient. This is my hypothesis, this is totally my opinion. I've been asked before, "Who is this best for," and I was like, "Whoever needs it."

That was my next question, who is GLP-1 ideal for?

Whoever needs it. And I'll preface that with saying that the conversation I've been trying to have is outside of weight loss because the impacts that we're seeing are independent of weight loss. People want to say, "Oh, well, if you lose weight, of course your cardiovascular system's going to get better." Or, "Of course your brain's going to work better. Of course you're going to feel better." Yes, but we have mechanisms of this peptide working completely independently of weight loss. It binds cellular receptors all over the body. It binds your immune cells. It's shown efficacy against COVID. It’s crazy. So I think that we don't totally understand how it works yet because people aren't really looking into it as deeply as maybe we need them to in the scientific literature, around some of these conditions. Right now we're seeing studies happening for Alzheimer's, Parkinson's, cardiovascular disease, kidney disease, pancreatic issues. So they're starting to. 

But when we go back to the weight loss conversation, the thing that I'm trying to get across is that when someone comes into my clinic, regardless of what age they are and they say, "You know what? I put on 15 pounds out of nowhere. Nothing else has changed and I don't know ... I've never been the same since." Those are the folks that I want to intervene early with. Why are we waiting until they're way down the path to severe obesity and severe type 2 diabetes? Which like I said, is a severe case of metabolic dysfunction that's been normalized. Why are we waiting until then before we intervene and help? They are headed down that pathway. There's some kind of insulin resistance happening at the cellular level, that's why they just put on 15 pounds out of nowhere. I'm all about, ‘hit it early.’

Going back a bit, because I want people to understand this based on what we’re seeing in pop culture, we’re all obviously familiar with the Real Housewives Ozempic face. Does GLP-1 affect collagen production, what is the cause of that?

That's a good question. I think most of that is probably the loss of fat pads in the face. I think especially if folks go on a high dose and they have an extremely fast weight loss and their body is not able to adapt, they are going to see loss of fat in the face. And we know that a little bit of fat in your face does impart an anti-aging effect. So being very thin as you age is not great on your face, whether you're using Ozempic or not, it's just the way it goes. So keeping a little fat on your body as you age can really help keep that youthful look in the face.

With that said, I think that some folks, even if they go about this very slowly, still might have some sagging and some structural loss because of loss of fat. Every time I lose weight, I look older. It's just the way it is, no matter how I went about doing it. But there's no data to show that GLP-1 causes any collagen loss whatsoever. And in fact, we don't have any data showing that it stimulates the deposition of collagen, but it seems to modulate collagen better.

Do GLP-1s affect fertility?

They do it in a good way. We don't have any good data on pregnant humans or breastfeeding humans. And so in those cases I tell people, "If you want to go with what the data says, listen to your doctor." There's not a ton of safety data. There was one study that just came out of Harvard, and they looked at all the other data that had already been brought about, and they didn't find any increased risk for women who were on GLP-1s who ended up pregnant. So if someone's on them prior to and then ends up pregnant, it doesn't seem to be too problematic. And there is a lot of data showing that it improves fertility because it balances and heals the metabolic health, and the main cause of most infertility is a busted metabolic system.

Basically, whether it is in males and their testicles and the quality of their sperm, or in females, the Ozempic baby thing is real. People are getting pregnant on it because it's really giving them that metabolic health boost. I discussed this recently in a podcast. 

When someone comes to you with an issue that you believe GLP-1s may be able to help with, what is the process, do you begin with lifestyle changes, or maybe suggest, "Let's start low doses of this and see how you do." 

The concept of dosing it very low, which is what I'm in favor of, only works on someone who's metabolically healthy. It doesn't seem to work well on those who need more help in that department. So I've got a couple of patients who are either not strength training at all, or they're not eating well, I have one patient with type 2 diabetes. Those folks need a higher dose, that's more standard dosing. And so this concept of micro-dosing for longevity, for regeneration, for healing, for the anti-inflammatory impact, that's a different story. And so of course we would expect them to do all the lifestyle interventions, but I'm not opposed to bringing peptides in early. I always treat each individual comprehensively. I bring in any tool that I need to bring in that I have access to and I have a license to prescribe. Then I tell the patient, "None of this is going to work for very long and you're not going to feel great for very long if you're not compliant with all the other parts of this treatment plan." Which is strength training, sleep, stress reduction, eating a nutritionally-dense diet, cutting out the ultra-refined carbohydrates, all the things.

If you are able to prescribe someone this low dose situation and they respond well to it, is it a situation where people need to stay on it forever? 

It depends. If you ask any woman who's on bioidentical hormone replacement if she wants to stay on it forever, she'll tell you yes. So it depends, it's case by case. If we're using it for immunomodulation or we're using it for other conditions that we may need to cycle it back in, depending on the person's health. You can get someone out of an autoimmune state, but that doesn't mean they're not going to go headlong into it the next time stress gets high or they go through some kind of infectious process or trauma. So we use it as a tool as needed, just like we do any peptides. You never put someone on any peptide forever. You cycle it, you cycle it in and out. It's all dependent on the patient and what their goals are.

Are there any negative effects to even cycling through it for the long-term?

We don't know because it has not been around long enough, but the data around all the things that everyone's so terrified of, it's nuanced. So we have absolutely no proof whatsoever that it causes thyroid cancer. There's just absolutely no proof in human beings that it causes thyroid cancer. That black box warning that pops up, it was on rats— a type of cancer that rats are very prone to getting, whether they are on GLP-1s or not.

Interesting. Any other side effects to think about?

It’s important to note that the rats in the study were given crazy high doses, and the control group also got the spontaneous medullary thyroid carcinoma. It's a very rare type of thyroid cancer in human beings, although common in rats. And we have absolutely no causative data whatsoever in human beings showing that it causes thyroid cancer. So I'm not worried about that one. But that comes down to someone's risk tolerance, their family history, they've got to talk to their doctor. So far as the gastrointestinal issues, they're real. But again, I think that's a dosing and management issue in most cases. And something that the media is not telling anyone is that pancreatitis, gallstones, and gastroparesis are super common in the group most being prescribed this, which is diabetics and obese folks. Those are not uncommon conditions. Thyroid cancer is not an uncommon condition in those groups either. And so that's the part of the story I don't think is being told, is that the group most likely to be taking these at high doses are the same groups that are most likely to have those conditions.

Pancreatitis and gallstones can also be induced when there's too rapid weight loss. So there's a lot of factors here that I don't think people are being told. Again, those are management and dosing issues at the end of the day. The prescribing doctor needs to be keeping tight tabs on their patients, and the patients need to be compliant and not go out and think they can crush a bunch of cheeseburgers and fatty junk food and eat the same way they've always been eating. We've got compliance on the patient side, and we've got management and dosing on the doctor's side, and those aren't always lining up, and then the media's running away with it.