Tread with Caution: The world of compounded weight loss drugs

Promising Weight Loss Drugs

As the new year unfolds, many of us are embracing resolutions, especially those related to health and weight loss. We totally understand the battle around sustained weight loss and want to recognize the huge potential around trending weight loss drugs approved by the FDA for helping pre-diabetic and diabetic patients. In my opinion, this is a very exciting time to hopefully see the obesity epidemic curbed in a big way. We’re seeing at risk individuals achieve substantial weight loss and improve their overall health. This could create a huge dent in our overall medical care costs across the globe. It’s also exciting to see that in many cases, the results patients are having from taking the drug inspire and motivate them to eat healthier and move more as a way to safeguard this better health.

Wagovy, Ozempic, Mounjaro, oh my!

Semaglutide medications like popular Wagovy and Ozempic are typically prescribed for individuals with type 2 diabetes to help manage blood sugar levels and signaling to the brain “fulllness”.

Before considering any medication, including semaglutide, it's wise to consult with your doctor. While these drugs are promising, the collected data around them only extend about 20 years, making what we know about long term effects, quite limited. It is best to have your doctor assess your health status, consider your medical history, and determine the most appropriate treatment plan based on your specific needs.

Enter Compounded Semaglutide

I started getting one email after another from boutique fitness clubs in Chattanooga and Atlanta and NYC and from med spas all over advertising their new “medical weight loss fitness program”. And what I discovered from digging a bit more is that many of these programs were packaging compounded semaglutide drugs into their program, making it easier for the general public to get the weight loss drug. And this is where I throw up my red flag and say, if this intrigues you, tread with caution.

So what is compounded semaglutide?

Compounded semaglutide refers to the practice of combining or altering the commercially available medication, semaglutide. Compounding drugs can be very helpful in shortage situations or in situations where it can address a patients allergy to a specific ingredient in the commercially available drug. But, compounding medications also introduces potential risks.

1. Effectiveness Concerns: Compounded medications may lack the precise formulation and quality control of commercially available drugs. This raises concerns about the effectiveness of compounded semaglutide in managing blood sugar levels as intended.

2. Dosage Accuracy: Achieving accurate dosage in compounded medications can be challenging. Variability in dosage may lead to inadequate blood sugar control or, conversely, increase the risk of side effects.

3. Safety Profile: Commercially available medications undergo rigorous testing to establish their safety profiles. Compounded semaglutide may lack such comprehensive safety data, making it difficult to assess potential risks and side effects accurately.

4. Contamination and Stability: Compounding introduces the risk of contamination and instability. Improper handling or storage of compounded semaglutide could compromise its effectiveness and safety.

5. Lack of Regulatory Oversight: Unlike commercially available medications, compounded drugs may not be subject to the same level of regulatory scrutiny. This absence of oversight can pose challenges in ensuring product quality and patient safety.

Patients considering compounded semaglutide should consult their healthcare providers to thoroughly discuss the potential risks and benefits.

…more on this from the FDA

The Bottom Line

I’m excited about the potential these weight loss drugs have to create a huge impact on the obesity epidemic and the ripple effect we will likely see it have on choosing to move more and eat healthier to sustain the results from taking the drug. The wellness expert in me says “BRING IT ON!”

But, I’m cautious and concerned for anybody that chooses to take semaglutide or its’ compounded versions without consulting their doctor and doing the research needed to make sure that the product they are getting is safe and legitimate. We still don’t know what happens with long term drug use on the population it was intended for, and we absolutely don’t know what long term effects it will have on a population for whom the drug was not intended for. It’s so tempting to want to use semaglutide to lose those last 5 or final 10 lbs, but will the side effects and potential long term effects be worth it? We just don’t know yet.

What are your thoughts on this? Please add your comments below. I know this topic can absolutely stir up a lot of emotions and opinions. I’m curious what your experiences have been with any of these drugs, what other questions you have around it, and what feedback you can share with us all.

Pickleball, What’s with the hype?!

Okay, who’s played it? Who loves it? We do. And here’s a little on why we’re hooked.

But first, for those who aren’t familiar, what even is pickleball?!

Pickleball is a dynamic paddle sport with roots in badminton, tennis, and table tennis. For all you history intrigued friends out there, it was actually invented not too long ago. It was birthed on Bainbridge Island, Washington, in 1965. Contrary to what some might believe, it wasn't named after pickled cucumbers. Instead, the sport was invented by three fathers, as a way to entertain their bored children. Hah!

So what about the name, why PICKLEball? There are 2 main theories, it turns out. Some say it was named after their dog, Pickles, who loved chasing the ball. Others believe it comes from the pickle boat in crew where oarsmen are chosen from the leftovers of other boats. So who really knows?! But it sure is a name that sticks!

Over the years, pickleball spread beyond the boundaries of Bainbridge Island. By the 1990s, it had established itself across the US, and in the 21st century, it expanded globally! 

Why do we love it so much? We mostly love that it’s a friendly competitive sport that can be appropriate for all ages and even athletic ability. BUT, we strongly believe you should include a good warmup (shared below) and even start including some agility work in your workouts if you want to stay injury free because pickleball injuries are on the rise!

Here are 3 health benefits that we associate with playing:

1. It’s a full-body workout! Pickleball gets you moving – from quick lateral moves to gentle sprints and volleys, it exercises a variety of muscle groups. The continual movement provides cardiovascular benefits, helping to increase endurance over time. During these movements, we target different muscles, offering a well-rounded physical activity sport.

2. Improves Reflexes and Balance. The gameplay involves quick decision-making and reflex action. This not only keeps the brain engaged but also helps in refining hand-eye coordination. With the repeated change in direction and short sprints, it’s common to improve our balance and agility, which is so important as we age!

3. Low Impact Yet Effective.  One of the charms of pickleball is that it's easier on the joints compared to a lot of other sports/exercises. This makes it suitable for older individuals or those recovering from injuries. The game provides an intense workout without putting too much stress on the body, promoting longevity and reducing the risk of injury, which is key!

Wait one more…4) it’s so much FUN! Talk about a little friendly competition…this game can quickly become an addictive activity, one you don’t want to stop playing (especially until you win! ;)

See you on the court :)

Pickleball Warmup

When More Is Not Better

“You either need to start eating more, or cut back on your exercise.”

When I told this to one client who wanted to lose fat and build more muscle, she told me she hard a hard time wrapping her head around that idea. Isn’t the goal to push harder and eat less when you want to lose weight and build muscle?

More exercise is only better if we can meet the demands of more. If more is leaving us always sore, prone to injuries, in constant pain and feeling “heavy” all the time, irritable and anxious or unable to mark improvement in our workouts and in making body composition changes, we may be doing too much. Or, I could also share the perspective that if you may not be over training, but you may be under recovering.

When we consider the balance of movement and recovery, we have to remember that if we are exercising more, our recovery needs to be even more intentional and meet the demands of what we’re asking our body to do, otherwise, we send our body into a stress response that can prevent us from feeling our best and meeting fitness goals like weight loss and strength gains.

On average, most of us benefit best from training 3-5 days per week of moderate to intense workouts. You can certainly exercise 7 days per week but likely some of those days should be mobility focused or lower intensity.

If you’re participating in the BUILD program in the BBH Online Studio, you’ve already noticed that even though we schedule out 6 days of workouts for you each week, we want you to focus on meeting the 3 priority days workouts first! If you’re recovering well from those 3 workouts, you’re invited to complete our supplementary workouts. Always included are mobility focused workouts and recovery focused workouts. Every single workout shouldn’t crush you.

If you’re hitting these recommendations and not seeing results and notice your body is always exhausted, you likely need to prioritize recovery better to meet the demands of your moderate/intense workouts with these tips:

• Fuel Better: Often when I have clients track their nutrition to help troubleshoot why they aren’t seeing results from all of their hard work, I find a lack of nutrients and proper hydration. Not enough protein is a big culprit for a lot of women but also lack of energy from very low-carb diets with frequent exercising contribute to lack of results.

• Sleep Better: Ya’ll, I cannot stress the importance of this one for better recovery. Get on a schedule. Go to bed earlier. And try to keep the routine at least most weekends too.

• Consider your program: Stop over doing it! If you’re training 6-7 days per week and doing a heavy full body workout or HIIT workouts every single workout, you may want to consider varying your workouts to include recovery based workouts, lower intensity cardio and mobility focused workouts between heavy days to give your muscles more time to recover.

• Supplement: Many times, lack of important minerals from for example an insufficiently nutrient dense diet can lead to deficiencies that aid in better muscle tissue repair. Start with a basic multi-vitamin if you haven’t already!

If you feel like you need more guidance, it’s not too late to join the BUILD program on the BBH Online studio. As a member of the BBH Online studio, you can expect the availability of more personalized coaching just by reaching out to your BBH trainers any time you have a question.

What I’ve Learned About Correcting Movement, Balancing Hormones & Improving Your Fitness

I’ve always tried my best to commit to a growth mindset. In an industry where science is still being uncovered, we must accept that we don’t know it all. I’ve continued to evolve my training practices around the latest science but also around daily discoveries I make with each individual client. 

I want to share a few things I was confronted with this year that really challenged what I know about correcting movement, balancing hormones, and improving your fitness.

Is Corrective Exercise Overrated? 

I have been a self proclaimed “form police” type of trainer. I’ve always believed one of my biggest responsibilities as a trainer is to fix my clients muscle imbalances through corrective exercises. There’s a very big message in our industry claiming that we are broken and we need to be fixed or else we’ll get injured. Well, that’s not necessarily true and that messaging with clients only instills fear of movement. It can prevent many from even getting started on their fitness journey. In reality, we are not as fragile as we may believe.

I recently dove into numerous published studies around movement dysfunction and their relationship to injuries. Excuse me while I grossly summarize these findings for the sake of this article- I’ve cited sources below for reference if you are interested. 

In these prospective design approaches where we look at the outcome (injury) first to hypothesize a causation (why it happened), we see that joint dysfunctions was not the likely cause for injury. Clients rehabbing from injuries got stronger and became pain free over time simply by following a gym strength training program EVEN THOUGH they showed no change in the way they moved. So they got better, but still moved the same way.

So how does this change the way that I train? I still demand better form from clients, but I am less rigid about it. While we can still agree that major muscle imbalances can create problems over time, it appears that some degree of imbalance is totally safe. If the movement isn’t absolutely “perfect”. I’m less hung up on addressing it solely through corrective exercise before moving forward. I confidently lean more into the “where do you feel this exercise? Or “how does this exercise feel” question I always ask my clients. If the exercise is eliciting a muscle burn in the intended muscle group, we’re moving in the right direction. We can “correct” and strengthen at the same time. And what seems to be more important for becoming pain free, is to prioritize getting stronger using heavier load.

Sources: 

Swain et. al, 2020 PMID 31451200

Menezes Costa et. al, 2011 PMID 20655254

Alfonso et. al, 2021 PMID PMC C8067745

Pardos-Mainer et. al, 2021 PMID 33419178

Hormonal Health. 

For the past two years I’ve been on a more in depth journey to see if there was anything new I could discover around women and their hormonal health at every stage of life. I completed multiple online continuing education courses and soaked up information from experts in the field hoping to uncover some new truths.

The biggest truth remains unchanged, and that’s that our first line of defense for creating a more flexible metabolism and balancing our hormones to maintain a healthy weight, achieve weight loss, gain energy and to build muscle at any age, boils down to managing stress through diet and exercise (specifically strength training). 

That’s not to oversimplify the fact that our hormones fluctuate depending on our monthly cycles and reproductive age, but regardless of whatever stage we are in, a healthy diet and focus on strength training should be our first approach to encouraging a more flexible metabolism.

My mission in 2023 is to help women become more in sync with their own biofeedback so we can translate it into what their exercise and nutritional approach should look like. You may be eating too much, you may be eating too little. You may be over training, you may be under training. You may need more recovery. You may need to focus on a few lifestyle habits to combat insomnia and improve energy. In the new year, I’ll be focusing more on coming up with easy methods for interpreting our hormonal cues to be able to implement more effective training and nutritional strategies. 

Focus on PROTEIN and Improve Your Fitness.

I’ve wavered from not really paying much attention to protein (just paying attention to eating whole foods and keeping it healthy), to (after reading Proteinaholic) believing we get way too much protein and in the next year limiting animal protein to no more than one meal per day or less, and now swinging back around to the power of protein for faster recovery and more efficiently achieving body recomposition. 

Whether you choose to get your protein primarily from plants or from animal sources is your own choice but I do wholeheartedly believe that getting animal protein has incredible advantages. Animal protein is more bioavailable, it’s a lower total caloric whole food protein option, and holds unique micronutrients you can’t find as available in plants. 

If you have goals to lose weight more easily and build muscle for better metabolic health, then eating enough protein must be a priority for reaching those goals more easily. 

We’ve explored prescribing protein rich diets in our BBH Nutrition Corner for our online studio clients as well as encouraged clients in the studio to track protein and in every case where the client has been compliant consistently, we’ve witnessed them achieve body recomposition goals. They have lost fat AND built muscle at the same time which is typically no easy task! If you want to become MORE FIT in 2023, prioritize protein. Don’t know where to start? Well, I’d say reach out for a personalized evaluation. Or start by following our BUILD program featured for the next 3 months this year.

“The more you know. The more you realize you don’t know.” - Aristotle 

Keep on learning in 2023.