Hello, Sarah and Grant, and welcome back to the Rev Up Health Podcast. Thanks for having us back. We're super excited to talk about peptides today — it's a big buzz that we're hearing more and more about. There's a lot of information out there, a lot of false information, and myths that exist, so hopefully we can shed a little light and let people know it's a tool. It's okay — it's something that can help you bridge a gap.
What Is a Peptide?
People are coming to us talking about peptides, but let's back up — what is a peptide, and what's the intended purpose? For starters, we have thousands of peptides in our body, so it's not a foreign substance. Basically, you can think of them as proteins — made up of amino acids, like a chain with a bunch of different links. Most peptides have between two and 50 amino acids in that chain.
They differ from hormones: hormones are cholesterol-driven, while peptides are amino-acid-driven — just chains of amino acids put together. I like to think of peptides like the cogs on a key — different little cogs open a lock, but these keys control many functions. They're neuromodulators. A peptide won't necessarily do just one thing — some suggest they can do anything from four things all the way up to thousands. They control hundreds of thousands of processes in our body, turning on or off, upregulating or downregulating processes depending on what that specific peptide is formulated to do.
How GLP-1s Work
The big one we're hearing about is GLP-1s, GLP-2s, and other weight-loss types. What are they upregulating or downregulating? Even insulin is a peptide. GLP-1s upregulate the body's ability to have better control over insulin levels. The best way to think of a GLP-1 is as an appetite-control peptide. It upregulates the pancreas to produce insulin and downregulates glucagon production (which the liver uses to produce glucose). It also affects the brain — there are GLP-1 receptors there — so it curbs appetite. And it slows down the GI tract, creating satiety, so your stomach doesn't empty and you just don't feel hungry. It has multiple points of contact to control appetite.
Customizing Peptides for Each Person
One thing we circle around is the pros and cons, because everything is customizable — what works and what dose works for each person. How do you customize peptides so people have a positive experience? That's key. Just because a peptide works really well for one person doesn't mean it will for you or me — your dose may be different than mine to get the same response, or maybe you have more side effects, more constipation or nausea at the same dose, and why? You just do. That's where modifying the dosages helps a lot.
One thing we've seen is that when you're getting a GLP-1 through the regular pharmacy with your primary care doctor, they're often on a protocol where you keep increasing the dose even when you were seeing results at a lower dose — because that's what the insurance needs to provide the product. So it's not always the best thing for the patient; it's a way the pharmaceutical company can generate a profit.
When Side Effects Appear
For someone who hits that wall of not feeling great, what do you recommend? That's where it gets sticky, especially right now, because compounding pharmacies aren't as able to work with providers changing doses. When it's possible, come back down in dose — don't stay at that high dose. Get to the smallest dose you need to still maintain or see slow, steady results. It gets tricky for folks getting it through insurance, because insurance won't approve it if they're not increasing the dose.
A big issue people don't understand: this is a tool to initiate control over your appetite and change your body composition. The unfortunate thing about body composition is that you want to maintain muscle. You're going to lose muscle *and* fat on GLP-1s, because appetite control isn't selective about where it draws calories from — it's not just fat calories, it's the entire body's calories. So you need to support muscle growth to maintain strength and integrity. Your basal metabolic rate changes too as you lose weight, so if you plateau, maybe you need to look at what and how you're eating. And hormone balance is important. Don't forget these GLP-1s, like any peptide, have modulating effects throughout the system — GI, brain, hypothalamus. So we start by looking at the whole person: your hemoglobin, electrolytes, fluid intake, hormone levels, thyroid.
Who Is (and Isn't) Right for a Peptide
When people come to us, the goal is to think about wellness holistically. We point people back to their physician to have blood work drawn first, then decide if a peptide is right. Is there someone who isn't right for a peptide, or who benefits more? Sometimes people have digestive issues, and it's like — don't jump onto a GLP-1 right away.
First, we've got to make sure the person's GI tract is working right. We can't have absorption or constipation problems, because it's going to do nothing but get worse. So let's get your gut cleaned up first — that starts with diet, lifestyle, alcohol, smoking. It's not the first step; it's great to know where you are from a lab perspective before you get started, because so many things could be contributing. Get that starting point, create good habits around nutrition and exercise, and you've stacked the deck in your favor so that if you still don't see results, you can add this in as an even better tool.
A lot of people who want to initiate GLP-1s truly have other metabolic problems to address, because they're at higher risk for heart disease, type 2 diabetes, dementia, even osteoporosis. We've got to get the rest of you healthy to get the best effect. And to mention quickly — GLP-1s started as a treatment for type 2 diabetes. In that context, it's a tool to help get control of blood sugar so it's easier to make changes in nutrition and exercise. Looking at it as a bridge: once you stabilize things from a place where your weight is up and blood sugar is out of control, it sets you up to exercise and make better nutritional choices.
Red Flags When Sourcing GLP-1s
You see these everywhere — med spas, IV places, a billboard down the street offering $100 for a month. What red flags should listeners watch for? For starters, if they're going to guarantee you something, walk out the door — there's no guarantee in anything, and guaranteed weight loss is not an option. These places often don't know what your liver or kidneys are doing, whether you have a history of hypertension, or what your gut health is like. You want a provider looking at those things, getting baseline labs, interested in your blood pressure, asking those questions. If they're not asking, look elsewhere. That's usually what we tell people — "Did they ask about your lifestyle?" "No, I went in, told them I wanted this, and they said they'd get me set up next week." That's probably not where you want to start.
Unintended Consequences and Long-Term Habits
The FDA hasn't approved all these peptides, and there can be unintended consequences, especially when people think the idea is just to lose weight rather than long-term wellness, optimization, and longevity. How do you advise people about the habits that go along with it? It boils down to starting in the right space — laying a solid groundwork of proper health, nutrition, and movement. The problem is people think, "I can just do this GLP-1 and not have to exercise or get off the couch." That can't be the mindset. It's been proven over and over that activity, exercise, and muscle growth are the best things you can do for longevity and health span.
Another red flag would be if someone gives you a GLP-1 without talking about prioritizing protein and maintaining muscle. As you're on this journey — if you don't intend to be on the medication forever — you have to have that groundwork so that when you taper off, you have a metabolism in place to support it. It can be as simple or detailed as you want: how are you eating that meal? Same macronutrients, but calm down the carbs, push the protein, and eat in the right order — don't eat the high-glycemic bread before the rest. It's a simple way to redirect how you eat, and we work a lot on that.
FDA Approval and Other Peptides
A lot of peptides that are FDA-approved are approved for things they don't even get used for. I heard a statistic that around 80% of medications that go through FDA approval don't get used for what they're approved for — that's just the avenue taken to get them marketed. Other peptides out there — like sermorelin and ipamorelin, or BPC-157 and TB-500, which have a lot of buzz — literally don't have enough (or any) human studies; they're animal-based, so it's an assumption that what it does in a mouse will translate to humans.
The GLP-1s have gained a significant amount of interest in what peptides do, and there's a lot of acceptance. There are benefits of the anti-inflammatory effect of a GLP-1 in low doses, and they're considered very safe in that respect.
Sourcing and Purity
As people get less access to these, they'll need to be careful where they source their peptides. There are black and gray markets with impurities to consider. Even if you get your GLP-1 down the street for $100 — what's in it? There are lipopolysaccharides in some of these that can create chronic inflammatory autoimmune diseases and endotoxic effects. It may not happen right away, but chronic use can build up. So be cautious, especially getting it really cheap from an unknown source.
The Different Brands and Shortages
Give us a breakdown — Ozempic, Zepbound, Wegovy — what are the differences, and why are there shortages? It all started about 20 years ago when this stuff hit the market, initiated as type 2 diabetes treatment and progressing into weight loss. The older GLP-1s created more nausea, so they'd add or subtly change a compound, then rebrand and re-patent it as a new product.
You have semaglutide, which is Ozempic (and Wegovy), and then Zepbound is tirzepatide, which is the combination GLP-1 and GIP — it does an extra part to help control glucose production. The difference is in the patenting. Tirzepatide was compounded during a shortage, so compounding pharmacies could produce it; then the shortage went away, and because it's patented, the pharmaceutical company is fighting the compounding pharmacies from compounding it. Tirzepatide was the first with issues, and semaglutide is very similar, just the second to come. There will be more coming — some with three or even four different components — so within a year we'll see more hitting the market, and this pendulum will swing back so we can get hold of them more easily. It's all about reducing side effects while maintaining the weight-loss benefit.
Beyond Weight: Food Noise and Other Benefits
I tell clients not to chase the massive appetite suppressant — it's about appetite control. I have some clients with eating disorders on it, and I was fascinated to hear how it's helped them. I'd have thought it would be scary for someone with an eating-disorder history, but one client said the right dosage helps her with other aspects and keeps her in control — she's not chasing a massive appetite suppressant, she's chasing quieting the food noise. There are even studies showing alcoholics can curb their desire for alcohol with GLP-1s — a lot of people on them subsequently find they don't enjoy alcohol anymore. There's a difference between actual hunger and just wanting something to eat, which is interesting and can benefit certain people.
Again, just chasing pounds on the scale concerns us, but it can benefit certain people in certain ways. Our goal is always to talk through diet and nutrition first, then point people back to clinicians for blood work and supplements that support their situation. It shouldn't be secretive — if you want to use it and it makes sense for you, that's great; that's why we have medication. The benefits are amazing, and the gut-brain connection is huge — GLP-1 is really great for your gut.
Muscle Mass Is the Priority
We could spend hours on all the types of peptides. People at bariatric surgery centers say the drug "feels like cheating," and I say going in and cutting out part of your intestines or stomach is way more of a cheat. Several clients pay a monthly cost people think is a lot, but with the control and cutting back on drinking and food, it balances out against the grocery bill and $18–$30 restaurant meals. As trainers, people sometimes assume we think it's cheating or that you're not doing it right. I say there's a lot more to it than that — technically we all have a cheat code that works for us (my body loves avocados, and dark chocolate). If you're just looking to lose weight, maybe it could be considered cheating, but we're trying to open the dialogue and help people get on the right track with the best long-term habits.
Sarah and I can often tell when clients are on it, because we see a diminishing return on their strength — they've lost weight, but now they can only do five push-ups instead of 10. Her mindset is always to move and continue to move and enjoy life. So let's have a conversation about whatever caused you to lose 15 pounds in four weeks, because not moving and feeling lethargic isn't the name of the game. Sarah works with a lot of older clients who are moving better in their 80s than in their 60s and 70s, wishing they'd started sooner.
People get caught up in the numbers, wanting to lose a lot of weight as quickly as possible — but one to two pounds a week is great and gets the job done. If people understood the benefit of muscle mass to longevity, they'd think twice — there's a real risk-reward: you can lose weight, but there's risk in long-term losing that much muscle mass. Preserve muscle mass. I heard the other day that the new 401(k) for people over 40 is muscle mass — start counting the muscle mass in your body instead of your dollars. We start losing muscle at age 30, and it's harder to build and maintain — think about how much protein it takes just to maintain muscle. That conversation is so important with GLP-1s, because your appetite is gone. As hard as it is to get enough protein without a GLP-1, it's another thing to be mindful of on one — and if you're nauseous, the last thing you want is meat or eggs. So put a plan together.
What a First Visit Looks Like
Run us through the protocol — Mrs. Jones comes to you; what do you want her to do before getting to a GLP-1? A first visit with us is an extensive lab panel — sex hormones, thyroid health, autoimmune markers, inflammatory markers, and basic metabolic markers. We do an exam, vital signs, a body composition, and a pretty extensive history — we sit down for about two hours and go through everything from stress to sleep to exercise to nutrition. At the end, we talk about beneficial supplements and lifestyle changes — exercise, nutrition, stress, sleep — and potentially hormone optimization if needed.
It's more about optimizing people. Unfortunately, a lot of people go to their doctor, get labs drawn, and are told everything's "normal" — but "why am I still tired, fatigued, unable to sleep, constipated, having night sweats?" The reason is that 93% of the population is metabolically unhealthy, so when you test yourself against that group's "normal" range, throwing out the highs and lows, we ask instead: where do we want to be optimally? We see so many people with elevated insulin levels — which never get drawn — that tell if they're on their way to type 2 diabetes or insulin resistance. It's incredible how high the "normal" they call it is when it's not optimal. So we focus on optimal levels, and we'll do that for a good three to six months, maybe longer, before we really start talking about a GLP-1. It depends on where a person is in their health journey — just starting, or trying to tweak things to get more optimized, or wanting to get off a statin or blood pressure med. We meet them where they are and go from there.
Thanks again for opening up the conversation. Our goal is always to help people be well and live a long, prosperous life. There will be more around peptides as the months and years go by, so we'll talk about another one in the future. Just keep the questions coming — we love the curiosity and interest. Thanks, guys.