GLP-1s Are Not Just for Weight Loss Anymore
And honestly, that's the part nobody's really talking about.
We're going to dive into GLP-1s, but not the way you've been hearing about them. We're going beyond weight loss. Because saying GLP-1s are just for weight loss is kind of like saying a smartphone is just for making phone calls. It really has so many things that it signals on a regular basis.
In the podcast, I briefly mentioned the SELECT Trial, but I want to slow down for a moment and give you a little more context because this study truly changed the conversation around GLP-1 medications.
In 2023, the SELECT Trial (published in the New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMoa2307563) followed more than 17,000 adults who were overweight or obese and had established cardiovascular disease, but importantly, they did not have diabetes. Participants were given semaglutide at the 2.4 mg dose (the dose used for weight management) and were followed for several years. What researchers found was significant: those taking semaglutide had about a 20% reduction in major cardiovascular events like heart attack and stroke compared to placebo.
This was a pivotal moment. Until then, GLP-1 medications were largely discussed in the context of blood sugar control or weight loss. The SELECT data demonstrated that these medications may also play a meaningful role in cardiovascular risk reduction even in patients without diabetes. That shifted cardiology conversations from “weight loss drug” to “cardiometabolic therapy.”
And not only that, that signaling trickles down. Because we know how important sugars and insulin responses are on the whole entire rest of the body. It affects inflammation, heart disease, cholesterol, immune balance, and even brain chemistry.
So let's dive in.
They're Anti-Inflammatory and That's a Big Deal
This is one of the biggest benefits, I think, because really just controlling that insulin response changes everything.
GLP-1 is a natural gut hormone released right after meals. When signaling properly, it actually improves insulin sensitivity, reduces insulin production, and lowers inflammatory signals from cytokines. Those are the cells that call in the inflammatory troops. When you have chronically high insulin, that signal is turned on all the time. You get this chronic inflammatory response which over time can stimulate the immune system to be overactive.
So just in controlling sugars and controlling the inflammation from an insulin perspective, we are actually modulating the whole inflammatory response cascade.
And I love my numbers. So what are we seeing go down in the data?
CRP, which is a generalized inflammatory marker. Triglycerides. ApoB, which is that sticky dense cholesterol. Liver enzymes, because high insulin and sugars allow sugar to get stored around our liver and that creates organ fat or belly fat. Those ALT and AST fatty liver numbers are going down. Ferritin, another marker that comes from elevated inflammation. Cytokines, inflammatory signals, like IL-6 and TNF-alpha. All going down.
What do people actually notice? Less puffy. Joint stiffness goes down. Fatigue is less. Brain fog is clearer. Skin rashes and skin inflammation decrease. Even some osteoarthritis from systemic metabolic inflammation can improve.
And here's the key. We're seeing all of these reductions in symptoms and numbers with data from low micro-dose GLP-1s. Not at the doses that are so high for weight loss.
Why? Because we want no side effects. We want people to still eat adequate protein and not lose muscle mass. We just want enough for the anti-inflammatory benefit. This is about metabolic regulation, not appetite shutdown.
Autoimmune and Immune Balancing
We know the gut is the driver of the immune system. So again, just getting that insulin response down and those sugars lower decreases the inflammatory signaling pathway and reduces the triggers on the gut over the long term.
It reduces visceral fat. It lowers leptin resistance so we can actually tell our bodies we have enough. It improves insulin signaling and decreases cellular and immune activation. Our body is not thinking as many things are foreign. That immune system on the other side of the gut is not constantly being triggered toward foreign activation.
What happens when our body's immune system is overburdened? It gets confusing. And when it gets confused, we become autoimmune.
What are we seeing clinically? Fewer flares of autoimmune disease. Lower autoantibodies like thyroid antibodies. Less swelling. Better recovery. More stable energy.
We're seeing this across many conditions. Rheumatoid arthritis. Psoriatic arthritis. Psoriasis. Inflammatory bowel disease. I see a huge reduction in symptoms with my inflammatory bowel patients, especially at micro doses. I don't want to dose them so much that their bowels slow down. I want to actually do it so that their inflammation is cut in half.
Autoimmune thyroid disease. Even those air-quotes "fibromyalgia" patients, we're seeing a lot of that flare activity go down.
But this goes back to a low dose, small personalized dosing scale. When you get too high, it can actually work against us. The dose can be too fast. Cortisol can get a little aggravated. And if it worsens fatigue for an autoimmune patient, they're not going to be happy, especially when their sugars drop too low or they're not getting adequate nutrient density.
We want immune balance, not complete metabolic burnout. Low and slow with a micro dose is key.
Heart and Lipid Protection
This is probably where GLP-1 has some of the strongest data right now, and it's the furthest along. We know that GLP-1 receptors are in blood vessels and in the heart. Because they are located there, the inside lining of those blood vessels, that endothelial function, actually improves. It gets less irritating. It's more elastic. It's more responsive.
It also dilates those blood vessels, gives better blood flow by increasing nitric oxide, reduces the inflammation inside the vessel, and lowers the oxidative stress inside those vessels. And oxidative stress is actually what starts to make plaque unstable, especially from a coronary artery or vascular disease standpoint.
If we can reduce that inflammatory process and oxidative stress, we're going to give you cardiovascular protection. We're going to stabilize plaque, improve the endothelium, dilate those blood vessels, bring blood pressure down, and improve blood flow not only cardiovascularly but also for peripheral vascular disease. For legs. For people who have intermittent claudication and peripheral vascular disease in the legs and feet.
What are we seeing in the numbers? Triglycerides going down. LDL and ApoB going down. Fasting insulin and blood pressure going down.
We're modifying atherosclerotic cardiovascular disease risk factors. We're making those sticky dense LDL particles less sticky, less dense, less oxidized. We're decreasing hypertension, which is linked to insulin resistance. And we're bringing down type 2 diabetes risk because we're bringing down sugars and insulin.
I will say, dosing matters here too. I've actually seen cholesterol go up transiently from GLP-1s, especially when you advance the dose too quickly because the liver can't metabolize the lipids fast enough. The lowest effective dose is the best way to go, especially when we're trying to reduce vascular inflammation and avoid muscle loss. In the aging population, muscle is really important. We need to maintain it.
Most physicians and cardiologists will agree that GLP-1s are probably one of the best things that have come out in the area of cardiovascular disease prevention for mortality and morbidity improvement in the last 15 to 20 years.
Brain, Mood, and Addiction Pathways
This one is really interesting.
GLP-1 receptors are deeply involved in the brain's reward and impulse systems. Think of it kind of like an SSRI or a medication you'd take to raise serotonin, but it acts in the hypothalamus and on the dopamine pathways. The feel-good pathways.
It reduces food noise by putting these blinders on. And we know that works for weight loss. But it also improves satiety and fullness through leptin pathways and dopamine, that positive reinforcement pathway. It decreases reward-driven cravings and stabilizes stress and emotional eating habits.
We are seeing such a shift in people's thought process around food. Instead of using it as a social event, they're using it as a sustenance event. They eat when they're hungry, not because they crave it or have to have it. Same thing with alcohol. We're seeing emerging research on the reduction of alcohol cravings and compulsive behavior.
We know that neuroinflammation, gut inflammation, and insulin response can be linked to mood disorder. When we calm down that neuroinflammation by calming down the whole inflammatory pathway, we can actually help some mood disorders with GLP-1s.
What are patients seeing? Lower anxiety, especially around food. Fewer binges. Reduced alcohol. Improved focus. When you have a more stable insulin and sugar response, you're going to have a more stable focus anyway. But now we're seeing neuroinflammation decrease on top of stable sugar levels. My ADHD patients love being on a GLP-1 because they can focus so much more efficiently. And even my hormonal patients that are still having trouble despite progesterone with that brain fog, I'm seeing a huge improvement.
The early research is really positive for alcohol abuse and other drug abuse disorders, compulsive eating disorder behaviors, and mood instability. And obviously insulin-resistant associated cognitive fog. I see this all the time in patients who eat sugar, then get hypoglycemic right after. Their sugars drop, they get these fog episodes.
Again, dosing matters, especially for the brain. At too high of a dose, you drop sugars too significantly. The brain does not want to work off a low glucose state very quickly. If anyone's gone on a keto diet, we know what that keto fog feels like. Low and slow is the way to go for mood and brain.
Sleep and Metabolic Flexibility
This is the piece I think we miss talking about.
When insulin and sugars are not stable, the whole metabolic rhythm is disrupted. When you stabilize inflammation and bring it down, you actually improve metabolic rhythm. And that improves cortisol, sleep, and melatonin. All the things that help us relax our brain.
GLP-1s give you fat burning in between meals, which gives you a higher metabolic flexibility. Think of it like those HIIT workouts that keep you burning longer. Your mitochondria are more efficient. Your powerhouses are actually working more efficiently.
We also want that cortisol rhythm. A spike of cortisol in the morning, then it goes down as the day goes on. If we're not getting that cortisol spike and trough, we're not going to sleep appropriately and we're not going to have a good morning wake up. This is where insulin and cortisol and sugar all come into play. We can get metabolic flexibility with GLP-1s at low doses. We can absolutely achieve stability with blood sugar and cortisol rhythm.
And then once you start sleeping, everything else starts to get better. It's kind of like fixing the gut. You fix the gut, the immune system starts to get better. You fix the sugars, the inflammation goes down, cortisol gets regulated. You start to sleep, and the whole internal reset starts to work. That's what we want eventually. Our body has to reset itself.
What are we seeing? People sleeping through the night. Not waking up in the middle of the night. Able to fall asleep. More stable daytime energy. Fewer crashes from sugar and glucose fluctuations. And less nighttime snacking, which means no more glucose spikes before bed and crashes in the middle of the night that keep you awake.
The Big Picture
What I talked about today is really about balance. I'm not talking about pharmaceutical companies being bad and compounding being good. It's about personalization of protocol and dose. We don't have that flexibility with pharmaceutical pen dosing. They're designed for trials. They're designed for FDA approvals for a given condition. And some people thrive there. But most do better with slower titration, slower dose adjustments, and finding the lowest effective metabolic dose for what we're trying to achieve.
GLP-1s should support physiology, not overwhelm it and drive it to the other extreme.
They are metabolic signaling therapies that:
Lower inflammation
Support immune balance
Protect the heart and vascular system
Lower hypertension
Improve lipids and liver function
Stabilize the brain and mood
Help with focus, brain fog, and sleep
Reduce cravings and impulsive behaviors
Weight loss is just the visible side effect of deeper metabolic healing. Yes, do we need weight loss? Yes. But we can always back off to the minimum dose needed to keep these inflammatory, autoimmune, and cardiovascular pictures in check without going overboard.
In longevity medicine, it's not about the highest dose. It's about the right dose for your biology.
And that's how we keep you truly aging your way.
Ready to See If GLP-1s Are Right for You?
I am a big tester, not a guester. That's one of my mottos. We will do labs and we will see the best way for you to use GLP-1s or other peptides to get the best metabolic response and the best version of you possible.
Start here:
Share this with someone you think would benefit. This is not just about weight loss. This is about metabolic healing.
And it's about aging your way.
Comments
Post a Comment