Latest / Motherhood Alliance Podcast / GLP-1s: Friend or Foe? A Functional Medicine Perspective w/ Alicia Barkholtz | Forum Health
Transcript
- Britney Suttner: Hi, we are Britt and Dreya from motherhoodalliance.com and we are excited to welcome you to a four episode series with Alicia Barkholtz, a board certified family nurse practitioner who specializes in integrative women's health, thyroid support, bioidentical hormones and medical weight loss. Alicia is passionate about helping women better understand their bodies and she believes healthcare should be personalized because no two women or health journeys are alike. Her journey into integrative medicine began after a close family member experienced a serious illness that traditional medicine could not fully explain. Finding answers through an integrative provider completely changed her perspective on healthcare and inspired the path she's on today. Alicia now works virtually with patients, combining functional and holistic approaches to help women feel their best from the inside out. And outside of her work, she enjoys running, spending time outdoors, baking, and making memories with her husband, daughter, and their spring or spaniel, Kip. Let's get started. Andrea Renkas: Hey everybody, welcome back to the Motherhood Alliance podcast. We are here with Alicia. She's a nurse practitioner at Forum Health. Welcome back. Alicia Barkholtz: Thank you. So excited to be here for the last topic. Andrea Renkas: Yes, yes. And we have had some amazing conversations talking all about women's health hormones balancing progesterone, estrogen, testosterone, all the things right and cycle syncing was the last one. But we're going to kind of switch topics a little bit here a little and we're going to be talking about GLP once so If you are listening to podcasts, if you're watching TV, if you're listening to the radio, anything, this is like a, if you're on social media, anything, GOP ones is like a hot topic. They're everywhere. like Brittany alluded to in the last episode, they are, you know, kind of something that us who, those of us who are a little bit more naturally minded are kind of like, ah, I don't know if this is the right, the right thing. Like they're very skeptical. So we're kind of here to set the, the this GLP-1 thing straight with you. So I guess first of all, what is GLP-1s? Why are they called that? And what do they do for us? Alicia Barkholtz: So GLU ones are peptide. And when we think of peptides, peptides are strings of amino acids, which we have in our body all over, and they're kind of like building blocks. So they help to build things in our body. So that's kind of the backstory on what a peptide is. And what GLP ones are is they are working on specific receptors in our pancreas to help with glucose metabolism and with insulin production. So really honing in on insulin resistance and things like that. Peptides, you know, this is something that really has like taken over the world because it helps with weight loss, right? And it's been used a lot for weight loss drugs and things like that. And people are kind of skeptical of a peptide, so we've used peptides for years. This just kind of got taken by the media and, you know, got blown up and now is such a big thing. But there are peptides for everything. And I do utilize GLP-1s. I utilize GLP-1s a lot for patients. I have used it for insulin resistance. I have used it for weight loss for people who are struggling with weight loss and haven't had success. But I also use it in my endometriosis and PCOS patients. Now why, what correlation is there with that? Well, one, for PCOS, a lot of times we do see insulin resistance, so to kind of help combat that. But also these peptides are known to have anti-inflammatory effects and they help with inflammation incredibly. So a lot of times people who get started on these That's the first thing they say they're like I feel so much less inflamed like my joints feel better my Bloating is gone like before even any weight loss and a lot of people I'll just like micro dose So maybe we're not even gonna have you lose any weight, but we're really just targeting inflammation and PCOS and endometriosis are very very high inflammatory issues that a lot of women struggle with so I will utilize GLP one peptides for for those patients as well for something completely different than just weight loss, which is what everyone just thinks that they're used for. Britney Suttner: Can you dive a little bit more into insulin resistance and like, what's actually happening with it? Because I think a lot of people, they hear that, they're like, well, clearly these people are just eating too much carbs and sugar, right? And it's been Alicia Barkholtz: Mm-hmm. Britney Suttner: a lifelong pattern and now it's led to insulin resistance. Is that always the case? Like what's actually happening with it? And then scientifically, let's get a little nerdy. Like how are GLP-1s reversing that? Alicia Barkholtz: So insulin resistance is when our body produces way more insulin, but it's not functioning. So we have all of these insulin receptors and they're not doing what they're supposed to. They're not pulling glucose. They're resistant to what they're supposed to do. So insulin resistance, that's what it means. They're resistant to doing what they're supposed to. So they're resistant to taking glucose into the cells, metabolizing the way that it's supposed to. So then a lot of times we harbor that glucose into fat cells. It's got to go somewhere. So if it's not being metabolized like it's supposed to, we start to gain more weight. Now, could it be environmental? Yes. Like if you're constantly overloading your body with sugar, your body can only metabolize so much glucose and eventually the receptors are going to be like, we quit. Like you overused us. Like we're not. So yes, that definitely can happen. But it doesn't have to be in a lot of times, even with hormonal shifts. So with PCOS, is, that's a really, really tricky. diagnosis, but with PCOS, we see a lot of times like increased testosterone, increased estrogen, increased insulin, and that they all just become kind of resistant. And those people might never eat a lot of sugar. It's more of a hormonal driven thing. Autoimmunity is another really big one. So if you have any type of autoimmune issue, that can affect the insulin receptors and things like that. Women moving into menopause. there I read somewhere and I really really loved it. It said that women in menopause can develop type 3 diabetes. Now this is not a medical term, but it happens. As women move into menopause, our receptors for estrogen and progesterone may start to fade away. Well, so do our insulin receptors. They're just kind of like, okay, we've done what we're supposed to. We're done. And now we develop insulin resistance. So it can happen through all different stages of the life cycle. And it doesn't necessarily just mean it's driven from sugar intake also family history. So you have a family history of diabetes. Like some of those things we can't avoid. And so we just have to work through them and try to support the body the best that we can from that standpoint. And what these peptides are doing is they're helping to open up those receptors. So they're helping to make the insulin receptors. If you're not producing enough, they're going to help to stimulate the production of more. And then they're also going to help them function the way that they're supposed to. So we kind of wake up those insulin receptors, get them working the way that they're supposed to. And that way you're going to be able to metabolize glucose better you know, in return feel better, less inflammation because too much glucose can cause inflammation as well. So like there's that tie in there as well. So once we start metabolizing things are supposed to, our inflammatory markers go down a lot as well. Andrea Renkas: Wow, there's a lot of benefits with GLP ones than just weight loss and that's amazing. Alicia Barkholtz: Yeah, mean, there's even heart health is another big one. So there's a lot Andrea Renkas: Yeah. Alicia Barkholtz: of benefits and research being done on it supporting the heart and cholesterol levels. I've seen patients cholesterol levels come down significantly being on a GLP one. So there's there's so much benefit from these. And one of the questions I get asked all the time is, would you take it? Would you put it in your body? Hands down, 100 percent, I would. The only reason I'm not on a GLP one right now is because my husband and I aren't done having babies. And there's the talk that you have to be off of it for three months before getting pregnant. And it's just something that I don't want to have to like track and manage. But once I know for certain that I'm done having babies, 100%. And it won't even be for weight loss, but it will just be for those other effects. Because I have a very strong family history of diabetes. I have a very strong family history of cardiac disease. So just knowing that this peptide is going to help with that. to do something low dose, 100%. I have friends and family on this peptide as well. So I do find it very safe, very effective, and there's always research coming out about it. So just staying up to date on the research is important. Britney Suttner: how are these consumed and then what are these made Alicia Barkholtz: you Britney Suttner: out of? Because I think that's a really big skepticism piece is always like what are the ingredients? Alicia Barkholtz: So you have to know where it's coming from, right? So the scary thing with these peptides is you can get them from anywhere. Like I've heard the horror stories of people just like getting them online. And I mean, you don't even know what's in them. You dose them how you want to dose them. Like nobody's following you for it. That's scary. We get it from a compounding pharmacy, They compound them right there. And then a lot of times they compound it with something else to help the effect. efficacy of it. So sometimes it's B12. We compound ours with another amino acid called glycine. And what glycine does is it helps to maintain muscle. It also aids in glucose metabolism. And it also helps with, it can help with like skin elasticity and things like that too. So I have chosen to kind of compound it with that. But those should be your only ingredients. So that and then obviously the solution that is coming in. Ours that we utilize are injectables. So it comes in a vial and our patients draw it up to whatever dosage and then they inject us a once a week injection. Now there are some that are coming out orally. In the beginning, the efficacy of these were not great because a lot of it get broken down in the GI tract. So you're really not getting as much benefit from it. I would say if oral is something that you're more interested in, making sure it's coming from a compounding pharmacy is going to be the best. It's compounded right there. The compounding pharmacies don't use all of the fillers that a lot of big pharma and synthetic companies utilize. So oral is kind of up and rising. I'm kind of 50-50 on the efficiency of that right now, but I think over time it'll probably get better. Britney Suttner: I want to circle back to how you said that even though your goal would not be weight loss, you're like, oh, once I'm done having kids, I'm just, I'm just going to take these because of the other benefits. Obviously these are a peptide, not a vitamin, but is it, is that kind of almost the mentality is like, this has, this is just good for my body. It's something that my body naturally creates. And I just want to make sure that I'm getting enough of it. Is that kind of the mentality when you say that? Alicia Barkholtz: Yeah. Yep. great peptides And I think that this opened the door to showing a lot of other great peptides we can utilize. And I think you had alluded to that perfectly, that this is something. Our bodies produce peptides, so we're just giving it, our bodies also. know, we have vitamin C, we have magnesium in our body, but we also supplement with that, right? To help support it and things like that. So I think peptides can work very, very similar to that. As long as you know what you're doing, it's being followed by a practitioner, all of those types of things, and you do your research and you know, you feel comfortable with that. But yeah, I don't look at it like a prescription medication. I look at it as more of something to like help aid the body. Andrea Renkas: Do you think at some point that GLP ones, peptide therapy is going to be more of a mainstream as far as like just helping with the benefits outside of weight loss? Alicia Barkholtz: I think it will. think just peptides in general, like the usage of peptides in general is going to be more mainstream, probably not in traditional healthcare. I don't know if insurance will ever cover it. I'm going to be completely Andrea Renkas: Mmm. Alicia Barkholtz: honest, probably not. But I think more in like holistic integrative clinics and things like that, you might start to see more. And like I said, a lot of places are offering other peptides too. So it's just this kind of opened the world to peptide therapy by this one being one that helps you lose weight and stuff like that. But I do think that it's something that will be more mainstream and eventually like it would be great if you know traditional pharmacy or traditional practitioners picked up on it. I don't know if that will be the case. But like I said even before like when I was working as a nurse 10 years ago like the doctor that I was working with he was using peptides this is not peptides are not new. It's just this GLP one is new because it's like exploded the internet essentially but peptide therapy has been around for years and years and years. Britney Suttner: I have a question regarding the weight loss side of things, since that is what they're typically marketed for. Let's say somebody wants to lose their, their, their personal in their head. like, I'd love to lose a hundred pounds. Maybe they've dabbled in some lifestyle changes, but lifestyle changes can be also very difficult. And can be a process. And some people have insulin resistance and it's stubborn. And so they decide to try this and they start seeing results with weight loss. Even for someone like you, if you're taking them more for more so for health benefits, maybe you lose a little bit of weight too. But when it comes to weight loss, when does it stop? Like, can these can these become dangerous to the point of making you lose too much weight? Obviously, like you said in your I don't want to say the word concoction because that sounds wrong. But what you're putting with it, like you Alicia Barkholtz: Yeah. Britney Suttner: also have the the piece that's keeping the muscle, because I think that's a huge factor that people are worried about. But if somebody is on this long term, does a body have like a happy set point that it would just like stop losing weight at or how does that work? Alicia Barkholtz: So that's a couple of answers to that. So one, sometimes dependent on how much weight you're looking to lose. Sometimes you do hit a plateau where your body has kind of gotten used to the peptide. It's done what it can. And then we might need to switch gears and look at something else. My biggest thing with using this for weight loss is one, making sure that you're following a practitioner who does this for weight loss. Because our goal when I see people utilizing this peptide for weight loss is one to two pounds a week. That's not a lot. I mean, that's eight pounds a month, right? But we want it to be slow because that's how your body keeps up with it. If you lose weight too fast and you lose like 20 pounds in a month, you will most likely gain that back because your body went, that was really cool that we lost all this weight. I have no idea how we did it and I have no idea how we're going to keep it off. So slow weight loss is the best way to go. And it's the most adaptable. in order to make lifestyle changes along with this because with this peptide, not only is it working on kind of a molecular level, but it does change your perspective on food. So people do notice more appetite suppression. So they're starting to eat less cravings are much better controlled. Food noise is quieted a lot. So people can't believe how, you know, they're just not always feeling like they need to reach for a snack like they're content. So by doing this process, you're also changing lifestyle. without even really knowing it. Like you're eating less. And when people come off, they're like, yeah, I'm sustainable by eating less. Like I was way overeating. So there's a lot of lifestyle changes that get made through the process. The other thing is you have to find a weight that's maintainable. So I have a lot of women that come in and they're like, I was this number in high school and that's where I want to be. And then I go, probably not. because we've had a lot of changes happen throughout our life. Like from high school, you might have had kids, now you're in menopause. Like, no, like your body is not going to Andrea Renkas: you Alicia Barkholtz: continue at 120 pounds when you were a five-star athlete in high school. Like that's not reasonable, but let's find a weight that is, that's reasonable and maintainable for where your hormones are at, you know, for where your thyroid function is at. So really pulling all of that into the piece is really, really important as well. Not just focusing on a number because many women especially women, that's primarily who I see, are so surprised when they get to a weight, and I'll just use like 150 pounds as an example, and they're like, I actually feel really, really good at this weight. Like I, my clothes fit well. I feel really confident. Like in the beginning, they thought they wanted to get down to like 135, but they got to a weight and they're like, I actually feel really, really good here. And then at that point we talk about, okay, I don't recommend like coming off the peptide right away. Just because there are so many things that it's helping with. It's not something you have to wean off of by any means. You can stop it and you're not going to withdraw or anything like that. But kind of just slowly tapering off of it and then you kind of maintain that weight and you're happy and healthy. And if you want to stay on it, low dose for the other health benefits by all means, I think it's great. And that's one of the things I get asked all the time too. Is it safe? Do we know the long-term side effects? Do you know the long-term side effects for like 100 years from now? No, but we don't really know that with any medication that comes out, right? Any big pharma medication too. But when you think of what it's designed for in as far as being used for type two diabetes or insulin, like this is a lifelong medication for those types of people to help with insulin production and glucose metabolism and things like that. So from a safety standpoint, if you stayed on at low dose long-term, I think that... that kind of speaks for itself, how these patients being used for diabetes would be on a long term. Britney Suttner: As you're helping somebody using this, and obviously I love that you're like supervising them, right? Like they're helping them along. And I'm assuming that's the recommendation is don't do this unless you have somebody alongside you, right? But as you're doing this, you talked about how it can be like an appetite suppressant. It can kind of help them look at food differently. But I also think about if they lower their dose or they go off it completely, are you also working on like lifestyle habits? Because I think rebounding and regaining the weight back is always, anytime somebody does anything other than like a completely 100 % natural weight loss process, that's always a thought is that they're going to gain it back. So how else are you supporting them outside of the GLP one to make sure that that doesn't happen? Alicia Barkholtz: Yep, so definitely like you said, focusing on lifestyle changes. So as you're noticing like this appetite suppression and things like that, really focusing on portion control and what your body actually needs versus what you were probably eating before is a really big one. then we also tie in those health coaches. So with our programs that we do for this, if you're going to start at 4-way at-last, you get those health coach visits and they really focus in on, like this was your lifestyle habits before. this is where you are now, how can we change and adjust that? then there also are supplements, like oral supplements, if you want to come off the peptide that are available that do help to support this same process. It's obviously just not as strong because it's not injectable, but I do have different things that can be offered to take orally, kind of like a vitamin essentially, to kind of help continue this process and help with that. Britney Suttner: Are there, is there anyone that this is not for? Or like contraindications? Alicia Barkholtz: Yes, so pregnant or nursing, it is not advisable. If you've had type 1 diabetes, obviously we don't really have those receptors, so we can't work on If you've had issues with your pancreas, so pancreatitis is a big one just because this peptide is working on specific pancreatic receptors. And then there's a very specific type of thyroid cancer that is contraindicated to starting this peptide. Britney Suttner: I hate to circle back to it, but I feel like people are going to be asking this question if we don't ask it. In our prior episode, or maybe it was a couple of them ago, I don't remember now, but we had talked about how progesterone when it comes to bioidentical hormone replacement is pulled from something like yams, like a natural product. Is there any sort of natural product you can point to as to the source of these yuppie ones? Alicia Barkholtz: No, that goes way deeper than my pay grade of how these are Andrea Renkas: Hahaha Alicia Barkholtz: processed and where they come from. All I can say is on that standpoint, can't say exactly how peptides are formulated, but really, the compounding pharmacies that we use, you can literally call them and ask and they will tell you. We have done so much research in finding accountable... pharmacies and things like that that will answer all of these questions because all peptides are derived a little bit differently, dependent upon they're being used for and things like that. So I don't want to speak too much to that just because I don't want to give false information far as kind of how that's derived. But definitely calling a 503b, like if you really want to get to the nitty-gritty science behind it, call the pharmacy. They will be the ones to tell you. And if they don't, probably don't go. that pharmacy. Britney Suttner: No, that's actually really helpful because I think people aren't necessarily always looking exactly for the answer, but they want to know how they can find it. Right. And so that's, that is helpful. Are there extra trainings you've had to go through regarding this? Because I would assume that most family practice people could prescribe these, but they may not have gone through additional training. So if somebody is looking for a professional, what credentialing should they look for? Alicia Barkholtz: So I've definitely done a lot of extra things. I don't have any extra letters behind my name because of that. And I don't have like a peptide certificate because of it. GLP-1s through traditional healthcare, which does get covered, can get covered by insurance. Those are generally people who are type two diabetics and then you're just prescribing it as a medication. And then you're getting that as like a pre-filled pen is generally kind of what happens in the traditional sense. So they are being prescribed traditional healthcare. And honestly, if I have, but if I have patients coming to me who do have type two diabetes and it is way out of their pocketbook to be able to do it through a compounding pharmacy, but they can get it covered by insurance. I do believe that some is better than none. So, you know, I will say, you know, if you can get it prescribed by your prescriber, like. go ahead and do that because you are still getting some of the benefits from it. So that's kind of a big piece of that. Britney Suttner: to, go one step deeper on that, I keep taking steps down and down and down and deeper and deeper. But in our prior episodes, when we talked about bioidentical hormone replacement, there's also synthetic hormone replacement. like birth control versus doing bioidentical, which is created from plants. So when you're saying that they're getting GLP ones as like a, as like a medication through their provider, are there different types when it comes to synthetic versus natural on this as well? Alicia Barkholtz: So yes, I believe there is. The peptide itself is going to be virtually the same, but the prescribed one is most likely gonna have a lot more fillers in it, right? So the peptides we do, they're good for 90 days and they expire. Those pre-filled pens are good for a lot longer than that. Well, why is that? Because they have extra fillers in them. Andrea Renkas: you Alicia Barkholtz: So like I said, it really comes down to each patient. And if I believe that they need the peptide itself, They can handle some of the fillers. They can't afford it any other way. Like there's just very specific circumstances for that. But I generally would recommend trying to do it from a compounding pharmacy. The ingredients are right on the bottle, right? Like it's the ingredients are right there so you can see exactly what it is. And that's something that I recommend too for any type of supplements. There's supplements everywhere. If you get to the list of other ingredients and you can't understand them, they're probably a junkie supplement. because that's just extra fillers to help them their shelf stability be longer. So really just knowing where your stuff is coming from and especially for something like this because it is a little bit scarier, right? Like, it's an injectable, like it's a peptide. So really knowing where it comes from is super important. Britney Suttner: Okay, Andrea Renkas: Yeah. Britney Suttner: thank you for helping us feel a little bit more comfortable about this topic and this conversation. This was a great episode, all four of them were, and we really appreciate you taking the time with us. So one final Andrea Renkas: Mm-hmm. Britney Suttner: question to finish out all four episodes in this series. What does the future hold for you and what are you most excited about for your career future? Alicia Barkholtz: So right now I work part time. So I like to say I'm a full time mom and a part time nurse practitioner and I love it. I work completely virtually, which is awesome. So I work from home so I can see people from everywhere, which is really, really nice. And obviously if we have more kids, like just really staying part time. I love my job, but I do love being a mom more. So that comes Britney Suttner: you Alicia Barkholtz: first and foremost. But I still, even only working part time, am attending different seminars and things like that, really diving into hormones and women's health. And honestly, think someday, and this probably is five or 10 years down the road, I would love to get even deeper into infertility and how to support that holistic and integrative side of things. know a lot of women struggle with infertility and I think there's just a lack. of it coming from more of a holistic, integrative side of like really getting to the root cause of it versus just, you know, trying to get pregnant. But like, why? Like, what is hindering and like causing the hindrance? Is it autoimmunity? Is it, you know, different things like that? I said, it'll probably be quite a bit down the road, but that is something that I would love to explore and get more proficient in and then hopefully help women from that standpoint as well. Britney Suttner: I love it. Andrea Renkas: that. Britney Suttner: Thank you for what you're doing. Thank you for, you know, sharing your talents, even though you have littles, because that's a really hard season of life for you. And thank you for sharing your expertise in all four of these episodes. Andrea Renkas: Mm-hmm. Alicia Barkholtz: Thank you so much for having me. I've loved every minute of it.