today's episode requires that you have an open mind because we're going to talk about some very nuanced approaches some unconventional ways that experts like my guest Dr Tina Moore are using some magati OIC gp1s to treat things like cognitive decline arthritis addiction brain fog prevention of dementia and midlife weight loss so if you've been kind of sitting on the fence or curious about how these drugs seem to be so popular and why everyone's talking about them yet at the same time you're Terri ified about all of the side effects you've been hearing about today's conversation is going to open your mind we are going to talk about micro doing the very lowest dose of some of these drugs in a way that's super affordable as little as $30 a month and not necessarily for weight loss although that it can be used for weight loss but my guest today is a very outspoken Advocate not just for the use of these drugs but for the proper use of these drugs and in fact she's probably one of the loudest voices on the internet that I can think of who saying that most doctors are overprescribing these drugs they're giving people too high of a dosage and that is why we're seeing such negative side effects in some parts of the population but we're going to break it all down today so if you've been wondering about the side effects if you've been wondering if in fact you might be a candidate and how people are being able to afford these drugs and can you get them from a compound pharmacy all of those questions and more will be answered here today on the shelene show Dr Tina Moore my guest is a licensed naturopath physician she has spent several decades studying longevity and regenerative medicine she's an expert in metabolic and regenerative health and she's become one of the most well-known advocates for the unconventional use of OIC and she's here with us today to break it all down why is it that people seem to be more divided over the conversation regarding um OIC gp1s I mean even more divided over this than it seems they are Pol it's interesting isn't it it's been a really wild ride truly all consuming like this is all I've been looking at hardcore and how it relates to anything and everything I can um look up when it comes to health and Physiology and hormones and you name it and I've been talking about it on my platform which is you know not as big as yours but it's a decent size and the divisiveness is crazy it was really shocking to me at first and even when I bring up benefits of glp1 that have nothing to do with weight loss and the word weight loss is nowhere in the post or the content people still cannot get away from that and I think honestly I think it's reflective of obesity bias that we have in this country there's there's a whole lot of speculation that I have in my brain on both sides but I think that people get really uncomfortable when the idea of there being some kind of easy out in their brains that's the way they're seeing it and they don't understand the Nuance of what's really happening Downstream when people are utilizing these peptides appropriately so I I really do I think it comes down to a Frank obesity bias which I know is going to make some people listening very mad when I say it but I don't know how else to explain it I I would agree with you it seems to be that um so magati is it are we correct in calling it a drug or is it really a hormone is it a peptide and what is the difference between those things so it's a signaling peptide hormone which is confusing but it basically anything in the body so it's it's a chain of amino acids that's what a peptide is so MCU Tide Is bioidentical to the gp1 that is naturally occurring in our body with one caveat it's been tweaked so that it has a longer Half-Life naturally occurring glp1 is secreted in our gut and in our brains and they have actions it has actions throughout the entire body for various reasons we can talk about but the stide version tepati these more adulterated versions are bioidentical other than the fact that they have a longer halflife so stide will last a week in the body instead of a matter of you know minutes or even shorter so hormones are meant to signal in a various you know various different ways throughout the body and their actions are meant to be brief and potent and so when we supplement with a peptide version an injectable peptide version we're asking the peptide to stay in the body longer so that it has its impact for longer with that in mind does it make sense that we start to include um some magti gp1s even in a compound form and perhaps even in different dosages does it make sense that we start including that when we're talking about bioidentical hormone replacement especially for midlife women absolutely so the way that I got interested in this is I was hitting a wall with my health and I like you have always been really fit and active and you know kept my appearances up and was doing really well at it and utilizing bioidentical hormones early on I mean I've always been doing very small appropriate physiologic doses of hormones even in my 30s because I I'm someone who has endured a tremendous amount of stress in my life and I burned myself out very early so I needed some of these hormones a long time ago and that was during the time period clinically in my practice too where you know 20 years ago that that Women's Health Initiative study came out saying that hormones were dangerous and going to kill us and those of us in the new no knew that was a garbage study like we knew where it was flawed and we were like well we're just going to keep prescribing because our patients are having phenomenal benefits and now just recently I don't know if you saw but they just came out using the same data set saying that study was garbage and flawed and hormones are not only yeah it's not only are they safe but they're necessary and it's really unsafe to not be on them it's like gee I didn't know so I you know we all ignored it we're like we're going to keep dosing our patients and giving them the benefits they need cuz we know better and when I started researching gp1s I was like I think there's a deficiency happening here and so I looked into it and it turns out that there's a deficiency in those who are the ones using it most diabetic type two diabetics those who are obese those with fatty liver and I was like well I wonder if there's a low-grade deficiency happening in others and what would the side well not the side effects but what would the symptoms of that be like what would that look like and as I was hitting this wall in my health as my hormones were shifting um I I endured a tremendous amount of stress the past few years because I pushed back on the narrative really hard with a big platform so it was not a fun time and the cortisol that I was bathing in from all of that stress was destroying my metabolic health and I was having happened to me what I was seeing in so many of my patients which was this sort of middle-age thickening I call it and you've probably seen it with so many of your girlfriends it's like all of a sudden you just sort of yeah like you thicken up and you're like what the heck is going on I'm doing everything right and erroneously we try harder I know I saw I've seen your content recently where you're like I'm pulling back on the intensity because it's just driving that cortisol bus yeah and whether I tried harder or less hard it didn't matter I could not seem to figure out what the heck was going on and the way I kept describing it to my friends was I know that this peptide has impacts in the brain I found all the data it's neuro regenerative it quells neuroinflammation I know from my experience clinically and and the medicine that I do in the medicine I've studied that the downstream impacts of brain inflammation especially in middle age that's really what's driving a lot of hormonal imbalances menopause starts in our brains it does not necessarily start in our ovaries it starts in signals from our brains and so I kept telling everyone I feel like I need to flip the switch on the breaker you know like when in your house when you blow a fuse or you blow a breaker and you go and flip it and the whole room comes back on I was like I need to reset the switch and nothing I'm doing is working and I have access to stuff that most people don't have access to my whole background is in the regenerative medicine space so I I have things I can put in my veins you know that have miraculous properties none of it was working and so I decided that if this was a signaling peptide hormone much like other signaling peptide hormones in the body like oxytocin insulin leptin gin all of these are in the same family they're not steroid sex hormones but they are similar in the way that they signal and the way that they are used in the body neurotransmitters are signaling peptide hormones they're all kind of in that same family I thought what if I supplemented a physiologic dose and what would happen to address a potential deficiency and so that's what I started doing the time was there any research like were you like was there somebody who was uh I guess um Paving the way or talking about this and because it feels like a lot of people now are talking about micro doing it and all the other benefits depending of course on who it is you're working with and the program protocol they're putting together for you but I I feel like a lot of bioidentical or sorry a lot of biohackers are talking about this now but at the time when you started doing this for yourself you're just looking at the research and the mechanisms and saying to yourself it would just make sense that this would work was that a little sketchy I were you nervous you were kind of like making yourself a guinea pig well so I couldn't find anyone that was micro doing it now people say they're micro doing but they're actually just lowd doing I'm talking micro doing like talking starting with tiny little doses here and and seeing what happens right I also know better you can't just use these as monotherapy and isolation g1's Standalone is not the solution this was what is can you repeat that phrase so just monotherapy where you utilize one thing and hope for the best it would be like if you put on estrogen and you were like I'm going to do bioidentical hormone replacement I'm going to do estrogen at a low dose it's like yeah no you have to have all the hormones right we need the progesterone and the testost we don't just use gp1s as a standalone there's other peptides we use we want to we want to make sure most certainly that people are on bioidentical hormone replacement we have data that just came out recently it was a small study showing that women on bioidentical hormone replacement had significantly better outcomes with somac glutide than women who were not on bioidentical hormone replacement so we know that these things harmonize so for me it was just adjunctive like it was just something I wanted to add in and so I called up all of my friends that I knew all my colleagues that I knew were using it in clinic and all of them did not know what they were like what are you talking about and I said how are you using it they're like well we're using it at low doses for weight loss everybody was using it at low doses for weight loss or weight maintenance and I called the compounding pharmacy friends same thing same story they're like yeah and my theory was if someone's really metabolically sound like women like us who are active we lift weights we take our walks we get our sleep we mitigate our stress we eat our protein you know we get our sunlight my theory was that we would just need a touch like a very small amount and that might just sweeten the deal because what that thickening is is its insulin resistance at the end of the day it's cellular insulin resistance it may not show up on labs for a year or two but it will eventually and so my theory was well I'm just going to take a small dose because what could it hurt right like there's literally no side effects at low doses all of the side effects were happening at high doses and so I thought well I've got nothing to lose here I'm going to give it a go and it was miraculous I also most importantly was using it because I have psoriatic arthritis and my autoimmune disease was cranking my brain fog was like some Next Level stuff and I like you am a boss babe and I have a lot of business to run and I have a lot to do and my brain was not keeping up with what I needed to have happen and my team was starting to be like Tina are you okay you're you know you're not remembering everything on time and my ADHD was starting to go into overdrive and so I was using it for reasons outside of weight loss sure I had 152 pounds I wanted to take off just kind of throughout the midsection but more importantly I just wanted my brain back and my body to stop hurting and so that's what I was asking my colleagues and none of them had any clue what I was talking about none of them were using it for that straight up I mean I've since then I have friends who are now doing it but at the time everyone was like what you're going to use it for what I'm like this study just came out on cardiovascular disease we have data on this we have data on this we have data on kidney disease like what about using it for brain fog for depression for pain you know and that was I feel like I was really the one who just decided to you know go out on a Ledge and give it a go so yeah so let me ask you this um what mechanism is it that's having an impact on for example autoimmune disorders like arthritis for example what is the mechanism that's making that happen so there's glp1 receptors in our bones our muscles our cium which is the covering of our joints our cartilage like there's go1 receptors everywhere there's also leftin receptors and Insulin receptors and ins uh estrogen receptors so like our bones and our joints and our muscles are very active much more so than we've given them credit we kind of look at them as just like mechanistic tools in our body to move things and so gp1s have an anti-inflammatory impact on the brain which Downstream is going to have a huge impact on pain and on your immune system overall and because like I said everything really starts centrally second secondly it has an anti-inflammatory impact throughout the body and it sits on our immune cells which is wild it literally binds our immune cells which that part was the most fascinating for me when I figured that out I was like game on I'm trying this I really am excited because as we hit middle age we have a shift in our immunologic function and some of our immune cells shift to a more inflammatory pathologic version and that's what starts the whole Cascade of that insulin resistance is we become it's called inflammaging so we just it just happens even with our best efforts it just happens to us and the more fat you pack on through that process the more inflamed you become because fat is really pro pro-inflammatory at the end of the day as those fat cells get full so it's just kind of a hot mess that feeds forward and I was trying to figure out how to aate it like how do I flip the lever and and make this stop and I can honestly say that gp1s are doing it really beautifully so much of the I guess push back and the negative press that you're we're seeing about gp1s by whatever name they're going by I think I've heard you say many times it's not the GOP 1s it's the way that we're dosing them it's the way they're being prescribed it's the lack of a protocol uh from practitioners who are just like handing these out like candy without regard to the whole person can you speak to that a little bit because you know even even when I I told my audience I was going to be speaking with you today and asking them for their questions it's the same kinds of things we're seeing in the headlines over and over again you know like um just as fear first of all that there's a shortage that uh you're going to gain back all the weight and a lot more and and then all the negative side effects and the risks Associated the things that we again they grab us because we see them in the headlines so can you talk to us a little bit about like what's the difference in the way you're talking about using these as a tool versus what you're seeing the general population being subjected to I think people are being overdosed straight up so if you look at any of these peptide signaling peptide hormones I mentioned and you were to overdose somebody on them they would die and we would not blame the I guess some would blame the peptide but more often we blame the dosage and the management of that prescription right or conversely uh abuse of it is it the doctor writing an Abus of prescription the patient abusing it and and not being compliant there's a whole piece of patient compliance no one's talking about everybody wants to put blame on the peptide and I'm like how about the people who haven't changed their eating habits whatsoever and are not lifting weights but we can get to that so I think that there is an overdosage situation happening I don't think that most people need these high doses what happens with the brand names is they come in pre-filled pens that are dispensing pens and those Pens have a predetermined dosage you can't play with them very much and so you have to take what you get I believe that the starting dose with most of these pens is too high for a lot of people not everyone some people actually are so deficient in glp1 that the starting dose of these pens is very appropriate but for many it's too high and then they're ramped up very quickly over a period of 16 weeks where the dose is essentially doubled every month way up into very high doses that I think are sending people over the edge and so somewhere in there they're getting their appetite crushed and when you crush someone's appetite completely they stop eating or they just eat less of what they're used to eating so instead of eating three bags of Doritos and some cheeseburgers they might eat one they're just eating less of the garbage foods and so we have a real mess there because those folks sadly uh at the end of the day they come into this metabolically busted and then you know 2018 data showed that 94% of us adults were met metabolically busted and I can't imagine what was that number what percentage 94% and that was 2018 data so imagine what's happened since 2020 it ain't good I live on the west coast we were locked down a long time and a lot of people gained a lot of weight so and the stress of all of it right the stress of all of it drives the cortisol so everybody came out of that period of time I think we were forced indoors the gyms were closed the beaches were closed like anything that related to health we were not didn't have access to right so I think a lot of people you know what do you do when you're home and you're terrified you bake and you eat Comfort prepare and eat comfort food right so I'm not putting blame on anyone but we all came out of it with like the co 15 covid 20 even with the best efforts and just the sheer cortisol bath of that will drive this metabolic dysfunction so anyway we've got people sitting in this realm the people most often getting these peptides are going to be prescribed in a conventional manner are going to be those who are obese diabetic type two diabetes I want to clarify it is also helpful for type 1 diabetes and they aren't necessarily being councell on diet nutrition I will say though I have watched every single webinar I could get my hands on that's been put out by any medical establishment and all of them emphasize lifestyle management nutrition exercise first and foremost and then adding in these peptides adjunctively just because not every doctor is doing that doesn't inherently make the whole system evil I want to give credit to the doctors who are because there's a lot of doctors trying patients are not compliant trying to get a patient to lift weight I've been trying to get people to lift weights and eat meat for like decades and it is like pulling teeth people don't want to do it they don't know how to start they're scared of it they're intimidated you understand and so I think that people are not being given the proper tools or maybe the tools are just not available or the education isn't available and they're not protecting their muscle if you crush your appetite you eat a bunch of you eat just less garbage food than more and you don't protect your muscle at the end of this journey of using OIC wobi whatever they're going to be so much more metabolically fried out than they how they started so they're not going into it good and they're going to come out the other side wasted away with absolutely no muscle and then without exercise so the data is actually really compelling in the last few months we've had really good studies coming out showing that those who exercised during their Journey actually had better outcomes when it came to going off of the peptide titrating down they did not regain all the weight the ones regaining all the weight are the ones who essentially did not nothing they just took a peptide wasted away and then regained all the weight once they stopped if I understand what you're saying it's not that the peptide is wasting away the muscle it's the lack of Lifestyle it's the okay I'm I'm taking this gop1 that is suppressing my appetite I'm eating less in many cases kind of less of the not so great food uh I haven't changed my lifestyle I'm not lifting I'm not prioritizing that because like why would I right now I'm I'm losing weight and it's kind of easy um and so it's it's not the it's not the drug it's not the peptide that's causing people to lose money it's the lifestyle or the lack thereof the lack of change to Lifestyle is that accurate yes because any calorically restricted diet sustained for long enough will result in 20 to 30% of lean mass loss bariatric surgery this is on par with bariatric surgery there's a 20 to 30% lean mass loss and that doesn't necessarily mean muscle loss also it's Mass loss that they're often analyzing the O the other part we no one's talking about is when you have fatty infiltrate in your muscle due to metabolic dysfunction it is very common for your liver to get fatty your pancreas to get fatty and your muscle to get fatty your muscle becomes marbled as you go down this pathway towards type two diabetes when insulin resistance is getting resolved so these peptides are regenerative healing and anti-inflammatory they're literally healing the person's metabolism while they're on it it's not just a Band-Aid like take this drug and you get these results and you go off and the results are gone it's actually healing them for the Long Haul they will come out the other side better than they started in a more healed State a more metabolically healed state which I think no one's talking about and is really compelling and exciting is that pretty Universal or is that depend again depend again upon dosage and treatment I think that that's Universal I just think some people are getting way overdosed and so you know they're getting thrown over the other side of things but no it's it is 100% regenerative and healing and what is it that what is the uh regenerative mechanism what are we what are we permanently making those changes or improvements well so peptides in of them themselves are often regenerative and anti-inflammatory so whether you're looking at bpc 157 or you know any of the others they they insert themselves where they need to go and then they do their job and so the way that this works is it actually makes your cells more insulin sensitive so that insulin resistance that leptin resistance all of that slowly but surely gets addressed your leptin can't work properly without out enough glp1 in the system so I think a lot of folks are having other things remedied in their body which is leading to weight loss it's not just the appetite suppression it's a whole Orchestra of other things that are happening that are favorable in the body that are leading overall to a healed metabolic State and so some of these folks need to stay on this a long time because they've been in the metabolic hell for a long time right and so it's not just go on it a few months get off and everything's good they might need to be on it for a long time or maybe life they may have fried out their metabolism but getting the dose right is the key this these can be used long term and just like any other hormone I would cycle them um but let me get back to that because I want to talk about the muscle when you address insulin resistance in a patient one of the first things that happens especially if they start lifting weights is that the fat in their liver starts to dissolve most people don't realize they're walking around with fatty liver it's a huge epidemic and it's very dangerous and so and leads to liver cancer ultimately so it burns the fat off in the liver you burn the fat off in the pancreas you're also burning the fat off that's marbling the muscle so of course the muscle going to end up weighing less at the end and they can the muscles can become dehydrated because the one side effect of this is it does sort of make you forget to drink water which I will say can happen so when these folks are remeasured they're being in the studies they're being measured with less fat marble infiltrate and less potentially water in their muscles which is going to make it way less so people are screaming muscle loss these are regenerative to the muscle they've actually been shown to help with angiogenesis so to bring more vasculature to and throughout the muscle which is amazing which will deliver more nutrients when the person's eating nutritiously dense food like protein full of amino acids which will lead to muscle protein synthesis the anti-inflammatory impact on the muscle and then there's actually cellular signaling Pathways that are stimulated that lead to muscle protein synthesis so these peptides really in essence when you look at how they work are muscle regenerative not muscle wasting the wasting is due to the caloric restriction okay so from what I understand people generally reach a plateau or there's almost a a generic titrating up of the medication so once someone starts as you mentioned they're going to continually increase their dose and I assume it loses its Effectiveness over time is that accurate so for these people that have to be on indefinitely are they indefinitely titrating up no they stick to a dose and what the studies are showing is that four years out even people are maintaining their weight loss I think and without increasing the dose so 2.4 is the max height of dosage but a couple things I think that it long term I think it's healing the metabolism so their metabolic system starts to work better hopefully they can titrate down or maybe just stay on a very low dose that's what's happening I think in a lot of clinics is people are hitting their goal their weight loss threshold goal which I'm also arguing of using it for totally different reasons but if weight loss is the conversation they're hitting their goal and then smart doctors are tight trating them back and finding the minimum dose necessary to keep them at that goal and as that metabolic Health starts to heal and maintain that healing State their bodies are working better they are better machines they are better metabolic machines they go back to a more healthy normal State than you know that was in some of these folks are being born this way I mean that's a whole other conversation but if a mother's metabolic health is a disaster her offspring are cated like they're epigenetically coded and with a significant increase risk for obesity and diabetes down the line so we're looking we're a couple Generations into this mess right um so no the dose doesn't keep going up and hopefully people aren't just staying at that high of dose and there actually was some data that came out of Italy it hasn't been published yet but I was so happy to read it last week if they finally said why are we dosing everyone so high why don't we just give them the minimum dose necessary to achieve the results we want and I know there's a lot of smart doctors out there doing this too because I see them on YouTube I talk to them you get the person the goal that they need things are working right everything's working we're achieving what we want whatever that may be maybe it's uh lowering of blood pressure maybe it's reversal of PCOS maybe it's weight loss we hit that goal uh dosage and then we keep them there and then we start looking at how can we cycle this like we do other hormones and also how can we titrate this back to what's the minimum necessary dose to achieve the results to continue to achieve the results that we're looking for so I think it can be used very differently and I think doctors are starting to realize that I'm hoping this message gets out more and more and more people will start to consider that because I think they were just going with the standard of like well this is what the study said to do so this is what we're going to do that doesn't necessarily mean that's the best dose for everyone not everybody needs to go up to 2.4 by any means and smart doctors know that I think that there is um I'm sure you would agree there's this excitement in the medical community um where people are just excited to prescribe it to everybody because it's it's a bit of a money grab to some extent and I hear a lot of the comments I'm reading from my community just saying like but what about long-term studies GOP 1s we've been using them for far longer than what most people realize I mean I I they weren't on my r are until probably a year and a half ago but they have been used for many many years so what do we know about their long-term Effectiveness or the risks long term so santi's been out for a couple of years tepati is newer and I hear those people's concerns and I I have heard that from Physicians as well we don't know what they do the family of glp1 agonists has been around for 20 years in clinical practice with millions of prescriptions written on drugs like exenatide lactide there's other drugs that came before this they unfortunately required like daily injections and they you know compliance was very low cuz who wants to do that who can even remember to do that the newer drugs have longer half-lies so they don't need to be injected as long now there's oral pill form which I have not seen amazing data yet on if the pill works better than the shots and but I have a feeling that they're going to create something that is going to be a very inexpensive easy to administer pill and then not to near future and we have safety data going back on gp1 agonists very far so for decades so this isn't like a totally new thing it's just a more modern version it's like you know a drug grows up and they hone it in a bit better so the side effects are less it's a little more elegant with each iteration and then tepati is a dual Agonist and so you've got a different mechanism piggybacking on top of the gp1 agonism which is showing really great impacts on visceral fat and overall weight loss metabolic function you know it's just kind of a step up from there it's not always better some people have actually worse times on tepati than they do on seacu tide but either and it's much more expensive in some cases but either way I think both are especially if we start talking about some of these lower Doses and to answer your question about longevity I think that with any hormone we're going to see receptor insensitivity if we bombard a cell with any hormone or any peptide for too long The receptors will start to cleave off and I although I'm not seeing it in the data and some of the Obesity doctors I've talked to are not complaining of it I am hearing about it from some compounding pharmacists that are saying people are calling saying it's not working anymore they want to bring the dose up when I talk to folks and I like I just got off the phone with a colleague and she was saying you know I've got two patients they've hit a plateau she's doing very very low dose but she's like they've hit a plateau do I bring up the dose and I said are they lifting weights and hitting their protein macros and are you using you know bioidentical hormone replacement in conjunction and she said no and I was like well if they won't comply you cut the the prescription off of the glp1 because like they're going to be effed at the end of this if they don't start lifting weights and and really protecting that muscle and why would we crank up the one like I go back to that monotherapy conversation why would we crank up just the one peptide when we're trying to we're try I as a longevity holistic physician and trying to be the conductor of an orchestra I don't just want a bass drum and OIC is a great big bass drum but we need all the other instruments working in harmony so we need to be doing all the things and they're all non-negotiable in my book I love that approach that's how we have the longevity of it working I want to keep this at the lowest dose possible I want to cycle it so I can use it for the longest time Peri I want to be on this for life because it's doing remarkable things for me that I haven't found anything and the price when you're when you're low dosing it on a compounded version it's very very affordable so like what well gosh I mean it depends on the dose but I think for me I'm paying like 30 bucks a month wow yeah so can you share with us some of the unconventional ways that you are applying this as a treatment for uh your clients your people you care for yeah so I've only got one person on it that we actively trying to reduce weight and treat type 2 diabetes and that's my dad and he's a big guy and he's really you know he had gone way way way too far down that pathway and what I don't think most people understand is when you go into the doctor and they tell you you have type two diabetes all that is is a magic number it's a number that has been brewing for 10 20 years you have been walking down the path of metabolic dysfunction for a long time at the end of that pathway if you survive the hurdles of cardiovascular disease kidney failure blindness toe and lower extremity amputation ultimately it will lead to dementia and cancer so when people are finally diagnosed at type 2 diabetes and this is not to upset anyone but you have significantly [ __ ] your metabolism by then like it has significantly been destroyed it's not a subtle thing I know it's been normalized because it's so common and I know a lot of doctors themselves have it and so they say oh your fatty liver is normal your insulin resistance normal oh and now you just hit type two diabetes here some met Foreman that is a disaster of metabolic and mitochondrial Health at that point and so my argument always is why aren't we treating people on the front end when the woman shows up in my clinic the 50-year-old woman shows up and she's built like you and she's been doing everything right for a long time and we know she's got all the other you know assets on board with the you know hormone replacement everything else and she says I gained 20 PBS out of nowhere she's going to gain another 10 PBS or more in the next decade and and on it goes and in our system we treat people when they're way over here I treat people over here I get them early I get them when I see the glimmers and so I'm using gp1s at very low doses in women like you and I when we get that 20 pounds of bloat I'm also using which I know somebody will argue but I'm using compounded I'm not taking away from the supply issue there's plenty of compounded smly tied out there the supply is actually with the pen if I understand that correctly I understood a year ago I can imagine it's probably changed I know they just had a big fire at like literally a week ago there was a huge fire at noo Nordisk at their I think it was their offices I don't think it was their plant but like something's going on I don't know and also you know you know capitalism if you decrease Supply you increase demand so who knows who knows um but I I do want to argue for the fact that I would like to address a woman or a man or any patient when they're starting to have the glimmers of insulin resistance that's where I intervene because I don't need them to get heart disease I don't we don't give somebody blood pressure medication after they've had a heart attack you know we address it when the blood pressure starts to creep up so it's preventative medicine that's the medicine I practice um I'm also using it for PCOS inflammatory bowel disease really oh yeah like amazing results with crohn's and ulcerative colitis I'm using it for depression cognition um high blood pressure just cardiovascular health in general um early onset dementia glimmers of dementia something that people don't appreciate is when one of your loved ones or yourself starts to get very staunch and stringent in your mindset meaning that they become less adaptable they become less willing to try to you know like a a good example is when my mom can't make the computer work and instead of even trying or I know she's a smart woman instead of even trying she just immediately forget it I'm I can't do this that kind of that's an early sign intolerance for frustration yes that's an early sign of dementia and it it's because you don't have plasticity working in your brain which I want to talk about really quick these peptides have a neuro regenerative impact and an anti-inflammatory impact in the brain we don't have anything that does that that well this is really phenomenal and what happens with that and what nobody is appreciating is when a person goes on a gop1 and they start to have this neuro regenerative impact not only does a lot of the noise go away uh the ADHD symptoms for me improved significantly I actually started losing the I hate to I don't know how to describe it I I would ruminate on things and I didn't even realize I was ruminating one example is I would overpack all the time and now I don't feel any need to overpack um I don't feel I don't feel the need to do a lot of things I used to do that I didn't realize were problem but that was my brain getting too strict on me it was I was losing plasticity and neuroplasticity is the ability to learn new things to wire new Pathways and these peptides allow for neuroplasticity to occur and so when the person's on it they're actually in a window of time that they are having a neuroplasticity experience and so that's the of the most awesome opportunity to start implementing new Lifestyle Changes right this is when we start to really get people to hone in on taking better care of themselves because they're hardwiring new Pathways and it gives them also the onus of control gets return to the driver's seat that's something no one's talking about when people are on gp1s they suddenly feel far more in control of their lives their bodies their eating habits everything um we're seeing alcohol cessation smoking cessation drug use sensation online shopping my me my followers are messaging me saying I used to have a severe online shopping habit it's gone so it's really phenomenal and if we use this as a window to to hardwire good habits right that's the ticket so while you're on them if you continue just to eat garbage food but eat less you're not rewiring anything let's rewire folks while they're on it for better habits that's a really phenomenal opportunity that I don't know of any other drug or peptide that does that so there's a lot of good benefits here that people not hearing or discussing or even understanding it's nuanced and I don't think most doctors prescribing it know most of this stuff so and the doses levels that you're talking about um are you finding that your patients are experiencing some of the common side effects we're hearing like nausea and uh vomiting and gastroparesis not at all and do you think that's dosage dependent it's completely dosage dependent yeah so that is well now your nausea Center of your brain do have glp1 receptors and I think some folks have a richer supply of receptors so a richer bed of receptors so they may experience more nausea from it but the gastro pris issue is we need to talk about this those at highest risk for gastr pris are type two diabetics because their vagus nerve is being sugared and it's being destroyed and I think a lot of these folks are sitting on the edge of gastro prus already low grade they're experiencing it as burping distension they're getting put on you know the little purple pill and being told to you know avoid a acidic Foods or whatnot and then you give them a wng dose of a gp1 which is the standard and boom they get pushed over the edge now that gastroparesis is transient in most cases it just resolves itself as the glp1 gets out of the system so I haven't heard of anybody being permanently damaged I know the headlines like to say that but you know if you've per you could permanently get yourself there just through your type two diabetes is my point um but you keep the dose Slow and Low and I had a few patients who it was funny I had two patients they both said the same thing they were like yeah I threw up the other morning and then I threw up again and I was like well that's the gop1 and they go oh I didn't even think of that I thought I ate something bad I'm like yeah yeah yeah we got to back the dose down so it's you know we don't need to go into these crazy lands of of high doses I will say though if they're not metabolically optimized the low doses don't work what does that mean explain to us what you mean by metabolically optimized so if you don't have good muscle mass if you're not doing all the things that you and I promote all the time then you don't get the results with the low Doses and so those folks hit a wall they may lose a few pounds and then they plateau and they're like well it's not working anymore doc we got to up the dose and I'm like oh no no you need to do all the things and when you get all the things handled then the weight loss will resume we can slowly titrate up the dose but I'm not keen I don't have anybody even on the starting dose except one patient my dad who's we've got and even him we've gone very slow and low and he's not up to 2.4 so but he's not doing anything he's sitting in his chair still so until he gets off his butt you know nothing's going to the needle's not going to move or I'm pulling the peptide but for most folks they lose sort of the bloat that they need to lose on when they're on a very low dose they lose the bloat and then they get to what I call their fighting weight they're just like I'm good now if we want to crank the dose and induce some nausea and induce some constipation or induce some vomiting we probably could get extra weight off but that weight doesn't want to come off or they're needing to metabolically optimize themselves better they need to work harder on the other things let me go back to a conversation that I had recently with an individual who is really overweight um clinically obese and they were talking to me about their concerns related to a glp1 and related to the risk of cancer the risk of you know all the things that we've talked about um and the fact that we we just don't know longterm the side effects and of course this wasn't someone asking for my opinion it was just conversation we were having but in my mind I was thinking but we do know for a fact the long-term risks associated with staying at the weight that you're at we do know all that adapost tissue around your midsection you are at risk of all cause mortality and there's there's no question about that so it was just like to in my mind of course I was they weren't asking for my opinion but in my mind I'm thinking I don't understand you you've been carrying around this much weight in his own uh explanation for more than 20 years so you you know you're at risk of you know heart disease and fatty liver and you know the list goes on and on and on and I I guess it's maybe the media has done such a great job of saying like these risks we don't know and and covering up the fact that obesity is in and of itself one of the most dangerous things you can do and we know that yeah so obesity that's that's the thing okay so let's talk about the thyroid cancer the pancreatitis the gastroparesis all of these things that this is the part no one's telling everyone pancreatitis the number one cause of pancreatitis is throwing a gallstone the number two cause of pancreatitis is fatty pancreas which comes from being obese and having busted metabolic health and the third cause is from rapid weight loss so we're talking about a group of people who are already sitting on the edge of pancreatitis because those who are most at risk for throwing a gall stone are your curvy high estrogen women women who are a bit you know overweight and they've you know I think of them more the way we learned it in medical school is like more of that cherub kind of shape and you know curvy and high estrogen fertile you know middle-aged kind of that that woman which is so many women right that woman is a at high risk for gall stones and so when you put somebody on a very calorically restricted diet and they stop eating so that we shouldn't we don't need to get the dose up where we crush the appetite we shouldn't be doing that they should still be wanting to eat but it happens right that's what's happening crush the appetite decrease the intake of food as the caloric restriction incurs the gallbladder sludges up because it's not being asked to work as often and then these people might still be crushing really high fat foods high fat foods on gp1s don't mix well so they might still be crushing high fat Foods their poor GLW bladder is like dude we're already sludgy and slow we've already got some stones in here and then bam they throw a stone into the pancreas pancreatitis but in the select study the study that was just finished up at the end of last year that showed profound reductions in cardiovascular disease um the pancreatitis risk was as high or equal to the control group so that conversation sort of been put to bed that is a side effect of it being done wrong and a person not being closely monitored or a patient not being compliant um the thyroid cancer the group most at risk for thyroid cancer is folks who are obese that's the biggest group of that risk for thyroid cancer the second biggest group is type two diabetics so we've got folks who are already again at risk but the it's been put to bed like the data that just came out in the past few weeks is showing there's just no correlation between thyroid cancer and taking gp1s even longer term like they're looking at they're doing met analysis on all the studies and they're just not finding a causitive link the thyroid cancer blackbox warning that everybody gets so excited about it's funny because like it's on rats and it's on rats that were given super high doses and these rats already are prone to developing this type of very rare meary it's rare in humans meary thyroid cancer very common in rats and rodents and in fact the control group also got meary thyroid cancer it's it's very rare in humans and we have no cases of it happening in humans again there's correlative data but they're looking at people who are already at high risk for thyroid cancer you see what I'm saying here so anyway if you have a family history of thyroid cancer or you yourself have had any type of thyroid cancer of course everybody talk to your Physicians and be concerned if you've had any history of gallbladder issues or gall stones be concerned and and you can do this but that doesn't mean you throw the baby out with the bath water it means close monitoring which all doctors should be doing like people shouldn't be buying the stuff off the internet and shooting it into them and hoping for the best I've seen people do that I have actually many friends who've done that since my podcast came out and they all end up in a world of trouble so a little too much of this if you don't need it can really lock your stomach down for a few days and it's very uncomfortable that's not gastroparesis that's just your gut slowing down severely and you having a lot of dyspepsia so there's also the um I just read a study that big jamama study that came out that said like 900% increased risk of of pancreatitis and 400% increased risk of this and that they actually did a counter study to that that just got published and their argument was all of this data was on Patients health charts they weren't they were just looking at icd10 codes diagnostic codes over a long term of this sect of patient charts out of this one group and they it was correlative it wasn't causitive interestingly the one doctor finally said what I was thinking he was like well how are these people even being diagnosed were they officially diagnosed through Imaging or was the doctor just palpating this upper right quadrant and saying oh you got Gall gallbladder issues you know what I mean like we can make diagnoses off of symptoms for sure we don't need always need Imaging but it just it's it's not good sound data to be making these very extreme claims about is was the point of this recent study that came out that countered it pretty darn well basically everything that everyone's concerned about that the media has been going on and on about has been put to bed by the most recent data that I've been looking at so and we'll do our best to link to as many of those studies as possible because I know there's people who are watching listening and and they actually want to see those studies so we'll we will link to those in our show notes um a reduction in cardiovascular disease is that a mechanism of the glp1 or is that because of the weight loss and the reduction of inflammation all those other biomarkers it's probably both the group in the select study were middle-aged overweight folks who did not have diabetes which I find to be a little bit of an oxymoron because I bet if they looked at their insulin levels and some other other metabolic markers they would see that they probably had pre-diabetes because you really and I'm not saying this to judge anyone you really cannot live with obesity for very long before It ultimately will turn into metabolic dysfunction it's just how it goes that's the natural course of the process you get inflame you get fat cells to fill and they get inflamed and they become insulin resistant that's just so they were looking at potentially pre-diabetic folks but anyway they found a 20% reduction in severe cardiovascular outcomes which was very exciting and I totally agree with you the question is was it the weight loss was it the peptide I think it's both but they actually just came out which I'll get you the link for they just came out and announced that irrespective of weight loss these folks were having improvements in cardiovascular health and that's what I've been trying to say is a lot of the things that I'm sharing yes decreasing obesity is going to have wonderful outcomes on a variety of systems in your body but the impact and the way that the mechanism of these peptides work and the way they bind is independent of fat loss and weight loss so I think you're getting both I think it could be both right we're we're seeing because we know that for every inch your weight your waist circumference increases your brain shrinks a centimeter about I mean that's kind of the going knowledge so and if you have obesity and type 2 diabetes you will you have a four times increased risk of developing all Alzheimer's and Dementia so I think it's both talk to us about the myth of um type two diabetes like I I think there's this uh General consensus that um you it's definitely someone who just really looks obese if I'm if I if I'm not dramatically overweight I don't have to worry about diabetes it's not true so there's this concept of skinny fat or thin on the outside fat on the inside and that's how I used to be I was very thin and I was in my 30s and I felt like if I fell down I was going to shatter and I had just come out of like doing two medical programs concurrently and raising my daughter by myself and yeah it was just a really tough time and I remember getting my labs back and seeing glimmers of metabolic dysfunction and when I say glimmers I mean you look at all of the values together a good functional medicine doctor will be able to do this they look at them all together and they're like you are headed down this path it doesn't mean it's Frank and it's there yet it means all of these things are adding up to you being on the path and that that path ends with all those terrible things I mentioned so I thought well [ __ ] I've got metabolic dysfunction I mean for you know and what was the number one solution put muscle on it's that simple like when you're just sitting in the glimmers of it I was already low carb I was already eating high protein low carb which in actually in and of itself a low protein diet sustained for too long like the carnivore diet done too long can actually induce insulin resistance so I probably was was doing that a little bit coupled with severe stress and then add to it I had no muscle mass I was just fat and Bone I still fit in my prom dress from high school but I was just bone and fat right so that I think that's around the time I started following your content and I was like I got to lift some weights I got to learn to deadlift and squat and build a booty you know this is not going to go well if I don't have some muscle and I knew going into menopause that I wanted to be muscled up because I knew it was going to be a bit of a bumpy ride having watched my mom go through it and you know other people in my family that I loved I was like I that sounds like a disaster waiting to happen so I want to go into it strong and with a good slab of muscle on my body you know speaking of um inflammation and insulin and and cortisol um when I was kind of in the end years of per menopause um and experiencing that like that you know thicker through the middle like my face was rounder I just like okay I'm I'm going to work out even harder I'm not going to tell anyone that I'm like doing all this hit training but I'm just going to like double down the hit training I'm going to do super intense boxing classes and you know I just went crazy on the high-intensity workouts and then I ran across some research where they were looking at high-intensity athletes athletes who are also sustaining a super high heart rate for long periods of time and the study showed that their insulin levels their cortisol levels were that that almost mirrored someone with Cushing's Disease oh no and I'm like you know I I no matter how much we worked on my cortisol with my naturopathic doctor I just couldn't get my cortisol down and I when I saw that study I'm like I know I'm not like considered an athlete but I'm training like one you know what I mean and so what if I just stop my body I'm not saying that everyone needs to stop doing high-intensity interval training but I had reached a point at which it was um it just didn't have the same impact I did on other people that should reduce your cortisol levels for me it was increasing my cortisol levels I've been doing it for too long and the body just that's how it responded and so once I stopped doing all the interval training that I think made a big difference in My overall uh cortisol amongst other things too I want to interrupt for just a moment to say if you are someone who's trying to figure out what you need to do differently because you're dealing with all the things that we've been talking about in this episode you want to get your cortisol down you're sick of doing the high impact or like you've tried all the workouts and you you just need to reduce your stress I'd love to invite you to become part of my two-e challenge it's called myself again because you want to feel like yourself again maybe even better it's very simple we're just going to walk together and I'm going to help you reduce your cortisol it's free all you have to do is enter your email address when you go to myself.com okay back to the show about the question of cortisol and inflammation like what comes first do you find that if we can reduce inflammation we can it's we have an easier time of reducing cortisol I think the cortisol is driving the inflammation OT most cases so you were doing very what I've done it to myself and I've seen so many patients come in I can't tell you how many patients I would tell them you have to stop going to Orange Theory like it immediately has to stop like this high intensity nonsense has to stop this is why I love strength training because strength training can be as slow and low as you want it to be right like it can you can have as much rest time between sets you can play with the weight there's lots of variables to be played with that don't rev that metabolic process it's really damaging when especially you know it's interesting I've seen patients with very low cortisol I tend to run very low cortisol I've sort of fried out the circuits completely just the slightest surge of cortisol it just sends me into a you know tissy it it just derails my hormones and then there's the other schools of thoughts where they want you to do high-intensity interval training because we need to get the cortisol receptors to respond so we got to crank the cortisol and I have just found across the board that women just puff up when they are driving their cortisol and you know you have to look at the fact that like for you you had just come out of that situation with your father-in-law I mean a tremendous amount of stress right we we're enduring especially women especially middle a I know your kids were growing and like flying the coupe like my daughter you know moved she's an adult I have a 24 God she's 24 um you know it's just it's like there these are transition periods and we may have been getting our oxytocin and our hormones balanced in a way of being caretakers to our children and now they're gone for me I closed my practice and so I was no longer actively doing what I was doing every day I was over here doing much more computer work and online stuff and these transition periods I think are very hard on middle-aged women especially as our hormones shift and then we're just trying harder and harder and harder and I think that cortisol revving is driving the inflammation and that ultimately is just crashing just crushing totally crushing our metabolism and so for me I'm like I'm doing everything right my labs look perfect I'm doing everything right and I'm clearly insulin resistant my waist circumference is increasing if your waist circumference I mean the magic number is take your height divide it by two whether it's centimeters or inches who cares take your height divide it by two you want your waist circumference to be less than that that number is the Red Flag Zone and so as I was creeping up to that number I'm like dude this is insulin resistance straight up how do I get the insulin resistance down and also the other thing is that gp1s actually play on our dope energic system they play on our HPA axis we don't entirely know how but I have noticed a significant reduction in my cortisol surges since I've been on it I don't run around with that like low-grade anxiety I had all the time that I didn't know I had until it was gone and so I think there's other factors at play and it's not as simple as getting cortisol down or inflammation down again we have to harmonize the orchestra and look at all the players and exercise is a big one like you have to find what works for you I think the one thing consistently across the board that all middle-aged women should be doing is strength training the intensity of that really depends on the individual in front of me because some people cannot handle any intensity and others need much more of it right it it just really depends on how much Vitality they're coming to the show with and I I have little piles of Ash on top of my kidneys that should be adrenal glands I'm not coming with anything so I'm just trying to preserve what I've got and if you work out you find yourself puffing up and swelling you find yourself exhausted you find it uh disregulated your sleep all of that is going to you know you maybe you want more wine maybe you I for me I start to Crave if I overdo it with exercise I actually start to crave sweets and alcohol and things that I wouldn't normally have a drive as much for and um that's a big signal that you're probably driving the cortisol ship too hard wow I hear so many people saying that these GOP ones are kind of a a miracle drug do you think if they're used and dosed properly if they are you know if you're doing it the right way and you've got a whole series on that don't you I do I do okay so then before I forget because you know I will um C how can somebody you you've got like a three-part series about like how to do this the right way and is this for practitioners or is it for the general population it's for everyone it's it's actually a four-part video series so part one I talk about Beyond weight loss I talk about a lot of the different benefits that gp1s bring that have nothing to do with weight loss part two is the big scaries I dispel a lot of the big scaries part three is that the dose makes the poison so I dive a bit deeper into that conversation they're all pretty short videos and then part four I talk about the big pitfalls people are doing wrong which is really is just they're not protecting their muscle um but it's a great series and it it'll be more elaborate than what we've done here so people can grab that it's on my website it's at Dr tina.com it's t na and you can also find it on my Instagram at same Dr Tina and then I've got a whole pod series on my show the Dr Tina show where I have gone into a lot of literature I did a whole one on Orthopedic concerns you know knees joints bones I've I I basically just take the cool studies and talk about them and so there's I think six different episodes there that you can listen to they're so good too thank you I'm trying I just I really feel to me I feel like there's a propagandized push to vilify these peptides and we could speculate on where it's coming from we know for a fact that the snack food companies are concerned fast food companies are concerned uh joint replacement companies are concerned dialysis clinics are concerned all of them have come out and said this because when you correct for metabolic dysfunction that's something I need to say I've been beating this drum for a long time my mentor who passed away in 2013 um he brought to my attention the importance of metabolic Health back in the 90s so I have been beating this drum for as long as I can remember this peptide to me was like this thing that came out of nowhere that fit perfectly into my entire platform of what I've been talking about I know a lot of my followers were like what is she talking about what she's talking about OIC she's been telling us to strength train and go outside and eat meat like what's going on and I'm like yeah guys used appropriately in conjunction with all the things it's really a freaking Miracle peptide and done appropriately I think it has the potential honestly I think it has the potential to to save the trajectory that we are on as humans because we are on an Extinction path and I know people don't want to hear that but we are very much running into some devastating consequences down the line and I think we're starting to see it most notably with our Boomers and we're seeing it manifest as you know they're either dying of heart disease or they're ending up with dementia and they're not remembering our names but this next wave this Gen X wave are you Gen X you're probably in there with me yeah I mean man our group is a mess our age cohort is a hot mess and the long-term results of this are going to be devastating and not to mention what's happening like I said with our children coming up and I'm not saying everybody should be on gp1s but with a prudent physician who knows what they're doing and I I've had a lot of followers say you know my doctor really wanted to put me on this and said I was a great candidate and I was so scared until I listened to all your content and it changed my mind and now I'm doing it and I'm 6 months in and I am forever changed thank you like women this woman found me on the street the other day and started crying she was like thank you for what you're doing you are saving Our Generation and I was like whoa that's a heavy one but thank you but I think that just getting the information out there's a way to do this differently it's not the peptide's fault it's a management and dosing issue I have to say that um it's really remarkable how unafraid you are how Unapologetic you are about speaking up regarding something that like you said has been vilified and and which other people at face value might think this doesn't even make sense related to all the things that you've been teaching for all these years but it's it's about looking at this from a very nuanced point and I love that about you like that's why I dove into all of your content I'm like it's facts over fear it's looking at it's nothing is black and white nothing is and it is whole person and we have to look at everything in that way instead of just like shutting our ears and you know refusing to listen to other possibilities other and those nuances that are frankly can save lives really can I'll I'll leave with this you know the data coming out around Parkinson's and Alzheimer's is phenomenal and for the people who are beating the drum of how terrible this is and how angry they are about it and they're so seemingly concerned about everybody else which I don't know about you but my health information I've shared I've been very transparent but like it's nobody's business if I don't want it to be and what you do with your body and your health is nobody's business either and we're not talking to anyone about their risk tolerance because you just said it living with obesity especially severe obesity is really really devastating on everybody in the family so um I really hope that these people who are so militantly against this who just have such a staunch you know Line in the Sand like these are evil and this is the lazy way out I really hope those people don't ever end up with any of the conditions that this gp1 has been so remarkably treating well you know like I I really pray for them that they're never put in that position where their doctor says you know it would be a really great therapeutic for you right now is you're losing your memory a glp1 but they're they can't hear it right they're so vehemently against it they won't be able to hear it I don't want that to happen and I don't want it to happen for the people around them because that's what's happening my followers are messaging me telling me that they're constantly being shamed for using it even though it's changed their life significantly and they're having to deal with their office workers and their family and their friends everybody's shaming them and I'm like it's no one's freaking business like that's their um for those who are interested in working with you following you I'm going to put all of your contact information in our show notes Etc but for the person who's who's listening watching is like I am very curious I I want to work with a physician who understands these nuances who understands how to start me on the lowest dose possible and maybe even they're looking at it for reasons other than weight loss how do you suggest that they find a practitioner who's as um who's as caring and perhaps even as knowledgeable as you it's a hard question I I was hesitant to even ever talk about this stuff because I'm like oh man finding a doctor to do this right is going to be tough but I do have a program at the end of that four-part series I have a course and this course is going very well and it's about 50% doctors that are in there right now or healthc Care Professionals trying to learn more there's a whole module in there on how to find a physician and I I think education is the so the better educated a patient can become go listen to all my free content because there's at least 10 hours of free content right go listen to all that and present the argument to your doctor come in kindly and come in educated and doctors are usually Keen to listen I know that there's been a very big push and I have my reasons why I think it might be but um the compounded vergins are being vilified as well they seemingly do not want people on them and so a lot of the tradition standard MDS are staunchly saying no I will not prescribe a compounded but some people are able to start on the standard you know brand name drugs with or peptides at a very low dose at the starting dose and they're doing just fine they're having great results there so that might be an option for some people if you really want a compounded version and you're looking for this more complete protocol my course is a great place to get educated also looking for a naturopathic physician a longevity medicine doctor these doctors are generally going to be out of pocket and the other peptides that they're going to use and the hormones are generally out of pocket and so this can be a little bit cost prohibitive but that doesn't mean you can't start I've got plenty of people in my program that are starting with their General primary care physici they're getting the lowest dose possible of the pens of the brand name prescription and they're doing beautifully and then they're learning all the other things themselves because a lot of the stuff is available over the counter the like the other peptides that I like to use in conjunction so there's ways to do this is my point but it starts with the patient becoming very educated you can't just call up a pharmacy and say hey do you micro do and you can't call up a doctor and say hey do you micro do they'll think you're crazy and I'm getting a ton of calls from pharmacies and doctors saying are you crazy why what are you talking about what are you telling these people so I'm trying to navigate this myself and stay out of trouble but your best bet as a as a patient always is to become empowered through education and then come in kindly to your doctor and present what you have and if they won't let listen to you go find another doctor and if they will great you guys can get more educated together but it's a process and I think that's the case that you know you know with any physician you got to do your homework you got to come in with your knowledge base and you have to be an advocate for yourself first and foremost Dr Tina Moore thank you so much for sharing your knowledge with us I will put links to how to reach out to her how to make sure you're following her especially on YouTube great show there as well as Instagram again thank you so much for sharing your wisdom with us today thank you so much for having me this was so fun and I'm so glad to connect with you finally [Music]