June 1, 2023


Hi folks this is dr rob cyvis i am the carb addiction doc and today i’m going to talk about something that i’m using more and more in my practice as a little hack is a little gimmick but it’s actually so darn effective and i’m almost embarrassed to talk about it because i this is the antithesis of my form of practice but one of the things we look at is the majority

Of my patients have insulin resistance which results in obesity diabetes metabolic syndrome they have ill health related to insulin resistance which is high insulin levels and the inability to effectively use and store sugar as fat or as a as glycogen and use it so the dynamics are related to insulin resistance in the use of glycogen and glucose and as such um

A lot of our insulin resistant patients what happens with them is two things first of all paradoxically because of insulin resistance there’s this disconnect between glucagon and insulin that should be working opposite to each other so you’ve got insulin trying to get the excessive amount of sugar that you’re eating into your cells to be stored and the paradox

Is that under the influence of insulin you should have very little glucagon glucagon produces sugar primarily in the liver and releases fat well the paradox of insulin resistance is you’ve got high levels of insulin and high levels of glucagon it’s called paradoxical gluconeogenesis so you’ve got production of insulin sorry production of sugar in the face of high

Blood sugar and that’s really problematic because it starts to damage blood vessels start to damage red blood cells will become fat and diabetic that’s the paradigm so how do we stop that well the modern thinking is not stop people from eating carbohydrates because that would be asking someone to do something and as a species we become pathetic so we don’t ask

People to change their lifestyles we’ve got a pill for that we’ve got a pill for that you don’t need to do anything here’s a pill so one of the common pills that are used for diabetes management is metformin and i love metformin the reality is we have no idea what the hell metformin does we think we know we think metformin partially blocks the production of sugar

By the liver but we really have no idea but every diabetics on metformin metformin every type 2 here’s metformin every gestational diabetic and it works but it’s like fighting against thunder it really is an adjunct but you’ve got to stop eating carbohydrates with it and i love metformin i prescribe it a fair amount got a lot of gi upset a lot of people can’t

Tolerate it but a lot of people swear by it now when you go to the ada website the american diabetes association website there are 99 medications for the treatment of diabetes and they do not advocate for a ketogenic diet they say reducing carbohydrates might help you but they’ve now also changed their mindset that remission from type 2 diabetes is possible

So we’ve played around with some of these medications and they are horribly dangerous ones out there the sglt2 inhibitors like giardians are terrible medications when you start a ketogenic diet because they can cause diabetic ketoacidosis so as soon as i see a new patient on that we try to take that away but what we’ve learned and what we’ve seen is there is

One particular medication that i am a huge advocate for and contrary to my normal beliefs when i find something that works when i find something biologically i can understand i embrace it i try it on myself usually and we’re using it more and more in our insulin resistant patients that’s kind of off label because it’s only supposed to be used for diabetes but

It is a wonderful drug and we see weight loss we see correction of insulin resistance and we see a drop in blood sugar and ultimately what i’m looking for is normalization of blood sugar as the largest evil in terms of disease creation is elevate chronically elevated blood sugar that’s that the quarterback of so many diseases so what are we talking about well if

You look at insulin dynamics when you eat food there are several hormones that get released in response to certain types of food and one of those hormones that gets respond released in response to eating in the upper intestines stomach and duodenum is a hormone called glp-1 glucose-like peptide number one and it goes because it’s a gi release hormone goes into

The portal venous system circulates around and comes back to the pancreas and glp1 activates insulin release so that as you starting to absorb that food glp1 gets released early triggers insulin so the insulin is kind of waiting for this load of sugar coming in okay so glp1 is a very important hormone glp1 is also one of the dominant satiety hormones glp1 is

Highly activated by saturated fat and gives you a sense of satiety a sense of fullness so glp1 controls appetite gives you early feedback so you eat less you also stay kind of queasy so you have this queasy nauseated feeling when you overdo it and glp1 prevents you from eating i feel terrible i don’t feel like eating so it’s great in that it reduces how much you

Eat and also reduces how often you eat which results in weight loss as well as triggering insulin release which helps to clear the blood sugar bring your blood sugar numbers down and because you’re not eating it’s easier to get into ketosis now glp one can be manufactured as an injectable and you’ve seen this on tv folks and it’s advertised the the drug companies

Are advertising like crazy because it costs a ton of money and they’re making ridiculous profits very cheap to make glp one uh agonist something that promotes glp one release very easy to make very cheap to make and yet they’ve marked this up through the roof and they’re ad anytime you see on an ad on tv on tv for a medication it’s because they’re making a ton

Of profit on it and i hate that but i love this drug the drug we’re talking about is a glp-1 agonist it creates it triggers the release of glp-1 and one of them that you’ll see is a zem-pek there are others there’s ribelius there’s trulicity there is victoza but this over here this ozempic is an injectable drug and the cool thing is it comes in a little pen you

Dial in the dose and you jab it into your thigh your belly and it lasts for a week so you inject it and it works it’s a slow release molecule it lasts for a week we start at a low dose and we slowly go up on the dose i stopped my ozempic at 0.5 trellisville 3.75 slightly different dosing regimen i love this drug i love this drug i tried it myself first it worked

Amazingly well even at low doses i wore a cgm even though my insulin sensitive my blood sugars are good i was able to drop my blood sugars by about 10 or 15 points my patients will drop their blood sugars 20 or 30 points which is perfect my blood sugar is running in the high 60s low 70s about 10 or 15 points lower and because i just i felt queasy i didn’t feel

So good didn’t eat very much easy to do a prolonged fast very easy to do a prolonged fast and um it helped me to drop about eight to ten pounds and i already used it for a short period of time in fact a funny story and i’m a doctor i know not that smart but i jabbed it into my leg and i pushed the button and released it that’s not how you’re supposed to give

It you’re supposed to jab it and keep your finger on the on the button for at least six seconds until you get the full dose you know of course being male and being a doctor i know better so i didn’t read the instructions you know you cut once and then measure after that and realize you measured wrong no carpenter you cut twice and you measure twice and cut once i

Didn’t read the instructions done me so please read the instructions so i did that and i thought oh god i screwed this up so i hit myself with a second dose i double dosed for a week because once it’s in youtube for a week i felt like crap i had a perpetual sense of nausea i didn’t hardly ate for a week lost a ton of weight and you get better but that’s the beauty

About this now i was overdosed even if it gives me a slight nausea slight that slight effect it’s useful but the second reason i like it for my carnival patients is because here’s the thing when you eat a steak when you eat fat and protein goes into your stomach gets absorbed as amino acids your body doesn’t immediately see sugar so there’s no insulin response

There’s no insulin response and even if glp1 goes up your blood sugar doesn’t respond because you’re not immediately right during and after a meal seeing the spike in sugar as you would with carbohydrates that protein is being burnt turned over into sugar two three four hours later when you’re not eating if you’re a carnivore and therefore you’re not getting that

Glp bump you’re not getting that insulin bump and now in my insulin suppressed patients we’re seeing that elevation of sugar that their bodies are unable to use and they’re hyperglycemic so the cool thing about ozempic the cool thing about trulicity as a gp jlp1 agonist is there all the time and when that blood sugar does go up we do see a rise in insulin we see a

Clearance of that sugar especially if you’ve been physically active so the cool part about this it’s a great great drug there’s more to be told in the story there’s certain men type ones that that are there’s certain rare conditions that you want to be aware of but we are using this more and more and more in our insulin resistant patients or in our patients that

Are recovering to type two diabetes but still can’t quite get their blood sugars below that hundred hundred and ten ninety two hundred and ten hundred and twenty range this drops you by twenty or thirty points i advocate its use with a cgm but i never found even in me that my blood sugars went dangerously low so i’m a currently i may change my mind because i learn

But over the last probably six to eight months we’ve been using this more and more and i love the medication however it is expensive and it’s difficult to get hold of particularly if you don’t meet their stringent diabetic criteria but if you can get hold of it and we will prescribe it for you however you get hold of it is up to you i love love love this medication

And it serves a positive purpose not forever but we use it for three to six months to really do that final recovery from insulin resistance into insulin sensitive and then we withdraw the medication slowly so you can go up on the dose and then slowly withdraw it if you want to look into it if you’re interested do your google research and then come and ask us

Questions set up a visit text us at 561-517-0642 we’ll get your blood work we’ll talk about the diet that’s associated with we’ll talk about everything and we will prescribe this medication if it is clinically appropriate and beneficial in my humble opinion don’t just use it because you heard this video i will decide based on my knowledge and my evaluation of

Your blood work and where you are whether i believe i am comfortable ethically prescribing it to you but i love this medication i wanted to share this with you because it is kept out there for the diabetics and there’s no difference between diabetes and insulin resistance it’s just a continuum so i am the carb addiction doc if you’re interested in this give me a

Shout 561-517-0642 let’s set up a visit but give me your feedback if you used it if you hate it if you love it give me your feedback and i think i talked earlier about metformin i am preferring this medication to metformin or perhaps as an adjunct to metformin in a lot of my diabetic patients so give me a shout but if leave comments hit the like button hit the

Dislike button leave comments i personally have a philosophy that’s opposed to medication but sometimes there’s benefit for a short period of time think we’ll talk again you

Transcribed from video