September 10, 2025 • 44 mins
If you’ve been hearing all the buzz about GLP-1 medications like Ozempic, Wegovy, or Zepbound, and you’re wondering if they could be the right fit for you at midlife, this is the episode to press play on. We brought on nurse practitioner and health optimization expert Amy Wrenn to demystify what GLP-1s actually are, how they work, who they’re for, and what you really need to know about taking them during perimenopause and menopause. Amy is passionate, informed, and totally relatable—she cuts through the hype to bring clarity to a topic that’s been wrapped in confusion and judgment.
In this conversation, we get real about our own experiences, bust some myths, talk side effects (yep, we go there), and explore the broader context of hormone therapy, weight gain, metabolic dysfunction, and the importance of doing what works for your individual body and life. Whether you’re curious, cautious, or already on a GLP-1, this is a must-listen packed with valuable insights.
Episode Highlights:
[0:00] - Welcoming Amy Wrenn and kicking off our deep dive into GLP-1s
[3:10] - What exactly are GLP-1s, and how do they work in your body?
[5:00] - Understanding insulin resistance, perimenopause, and why midlife changes everything
[6:57] - Real-life examples of "metabolic mayhem" that hits out of nowhere
[8:03] - Challenging the lazy stereotype: GLP-1s are not a quick fix
[10:08] - The far-reaching benefits: inflammation, PCOS, cognitive health, and more
[12:10] - Social media hype vs. safe medical prescribing—know the difference
[13:46] - Compounded medications vs. name-brand prescriptions: what to watch for
[17:33] - Who qualifies for GLP-1s, and what do providers look for?
[20:43] - It's not about skinny—it's about healthy: the real goal of treatment
[22:34] - Common side effects: what to expect and how to manage them
[25:25] - Nutrition matters: prioritizing protein, avoiding high-fat traps
[26:38] - Surprising benefits: reduced alcohol cravings, better food boundaries
[28:12] - Coming off GLP-1s: what it looks like, and when it’s okay to stay on
[31:48] - Does your body adapt over time? Amy explains habituation and dosing
[33:32] - The power trio: GLP-1s, HRT, and resistance training
[36:08] - Hormone therapy explained: symptom relief vs. long-term prevention
[40:51] - Why we’re not getting this info from our doctors—and how to change that
[42:24] - Where to follow Amy and keep learning more
Links & Resources
Follow Amy Wrenn, NP on Instagram: https://www.instagram.com/np_wrenn
If today's discussion resonated with you or sparked curiosity, please rate, follow, and share "Insights from the Couch" with others. Your support helps us reach more people and continue providing valuable insights. Here’s to finding our purposes and living a life full of meaning and joy. Stay tuned for more!
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Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Colette Fehr (00:03):
Marc, welcome to insights from the couch, where
real conversations meet real
Laura Bowman (00:07):
life. At midlife, we're Colette and Laura, two
therapists and best friends,walking through the journey
right alongside you, whetheryou're feeling stuck, restless
or just unsure of what's next.
This is a space for honestconversations, messy truths and
meaningful change.
Colette Fehr (00:26):
And our midlife master class is now open. If
you're looking to level up, getinto action and make midlife the
best season yet. Go to insightsfrom the couch.org and join our
wait list. Now let's dive in. Solet's dive right into this
episode on GLP ones everythingyou need to know about taking
(00:46):
them at midlife, we've got nursepractitioner, Amy Wren, here
with us today. We're so excited.
We're gonna get into it all destigmatize, demystify and give
you all the info you need toknow to make decisions that are
right for you. Amy, welcome andthank you for being here.
Amy Wrenn (01:03):
Thank you. Thank you for having me. I'm so happy to
be here.
Colette Fehr (01:06):
Yeah, we're so excited to talk about this with
you. And maybe you could startout by just tell us a little bit
about yourself for ourlisteners.
Amy Wrenn (01:13):
Sure, sure. So I am a nurse practitioner. I've been in
the medical field for over 20years. I started out my career
in Obstetrics and Gynecology,and I now am in the integrative
med space. I specialize inhealth optimization, so that
(01:33):
looks like anything from weightloss to hormones to peptides,
anything we can do to make yoube the healthiest version of
you, is what I specialize in.
Unknown (01:45):
Oh, I love so cool. I love that. Yeah,
Colette Fehr (01:48):
and are you available online or only in
office?
Amy Wrenn (01:52):
So actually, this past year, I haven't been seeing
patients. I've taken a littledetour, and I am now consulting,
doing education and training forpractitioners, because there is
a huge gap, which I'm sure youguys know, and what patients
want, what they need, and whatproviders understand and know.
(02:16):
So especially in theperimenopause, menopause space,
even in the weight loss spaceproviders are just not taught
this in medical school, and so Iam trying to bridge that gap and
be a resource for providers whowant to do right by their
patients and give them updated,safe medications and treatments.
(02:38):
So I'm really finding that to besuper fulfilling, and it doesn't
mean that I won't be back at thebedside at some point, but just
for the last year I've beendoing this, and I'm loving it.
Colette Fehr (02:50):
That's wonderful.
It's so needed. It's so needed.
Yes, yes, yeah, as you know, allright, so let's dive in and talk
about GLP ones. Can you startout by telling us what they are
like. Let's say a woman's notonly heard about it from her
friends or through thegrapevine. What are these drugs
and how do they work in thebody?
Amy Wrenn (03:10):
Okay? So if you're listening right now, when we say
GOP ones, we're talking aboutthose shots, those diet shots.
So if you've heard of ozempic,or we go V zip bound mongero.
That is what we're talkingabout, these weight loss
injections. And a GLP one standsfor glucagon like peptide one
(03:34):
receptor agonist. That's thelong scientific version of that.
And actually we produce GLP onesin our bodies. All of us produce
GLP ones in our bodies, and theyhave created this medication to
mimic that. So it's the samething that we already have in
(03:55):
our bodies. And you may
Colette Fehr (03:56):
I did not know that. I'm sorry to interrupt
you, but I've been on this I'vebeen on Z bound for a year, and
this is the first I've heard ofthat. So already I've learned
something. Yeah.
Amy Wrenn (04:06):
So you think, Well, why, if we already are making
it? Why do we need it? Well, inlife, if we have metabolic
dysfunction, and metabolicdysfunction can look like
insulin resistance, PCOS, typetwo diabetes. It really hits
women and perimenopause andmenopause, because once we're
(04:29):
not making as much estrogen, wecan become insulin resistant. So
people who have maybe never hadan issue with their weight all
of the sudden are like, I don'tI don't understand what's
happening to me. I haven'tchanged my diet. I haven't
changed my exercise. I'm gainingweight. You know what is wrong?
And it's because our brainsaren't getting the message from
(04:52):
the gut. So the gut creates thispeptide, this GLP, one sends the
message to the brain.
And think of it like a textmessage, like your gut is
sending a text message to thebrain, but the brain needs
glasses and the text is so smallit can't see it. Then you get
this exogenous. Exogenous meansfrom outside the body. So
(05:15):
endogenous is what your bodycreates. Exogenous is something
that we bring in, and you giveyourself a shot of this now that
text message is blown up. Bigbrain has glasses, and it's
like, oh, says we're full, sayswe're full, and it says we're
going to do this with the sugar,and we're going to do this with
our fat. And so it's a tool thatwe have in our toolbox to help
(05:40):
patients lose weight, to helpget that message to the brain
that they weren't receiving. AndI've told a lot of patients that
it's the equivalent of, have youtried unplugging it and plugging
it back in? It just kind ofresets everything in the body.
Laura Bowman (05:59):
Can Can we double click on the piece where you
say, you know, when we go intoperimenopause, our estrogen is
reducing, and all of a suddenour brain isn't getting the
signal. Is that is, is the gateweight gain? Because we're not
getting the same signal andwe're overeating. I mean, are we
changing anything? Or is itliterally like systems in the
(06:21):
body are dealing with the sameamount of food, but they're
dealing with
Amy Wrenn (06:24):
it differently.
They're dealing with itdifferently. And yes, you can
overeat, but it's dealing withit differently, because the
insulin, insulin is a hormone,and the body is not responding
to it anymore, and that iscalled insulin resistance, and
that truly can happen at anyage, but you can take a person
(06:45):
who's never had that, and oncethey enter perimenopause or
menopause, then they will, theywill most likely get that.
Colette Fehr (06:57):
Oh my gosh, Amy, exactly what you're saying, you
guys. I just talked to a goodfriend who was like, I saw her
for the first time in a while,and she said, Oh, my God, I am
going out of my mind. I have puton 25 pounds. She's about 5455
years old. She's been naturallythin her whole life, like she's
(07:17):
never had eating issues. She'snever had to think about eating.
She's just one of those peoplewho genetically has been
relatively thin and not had tofocus on it. She said, I've gone
through all of these hoops whereI've dieted, counted calories,
increased my exercise to five tosix times a week. She said,
Nothing is making me get theweight off. And she said, and
(07:38):
I'm not even overeating oreating any differently, and
she's thinking about GLP onessomething, she said, You know,
I'm really afraid. And I triedto give her some reassurance. I
mean, my experience has beenmostly very positive, but she
said, it's unbelievable hownothing's changed, and I have
never had a weight problem myentire life. So it sounds like
something like what you'redescribing is probably what's
(08:00):
happening for her. She She
Amy Wrenn (08:03):
sounds like the the poster child for this. I've had
so many patients come to me andthey have tried everything, and
that's where I get very I getvery protective of these
patients when I hear people outin the community that have bias
against the medication. Becausethese aren't lazy people.
(08:24):
They're not lazy people. Theseare people who have tried
counting calories, countingmacros, eliminating certain
foods, doing keto, cardio,cardio, all day and night, and
nothing is changing. They andthey and they're going out of
their minds, and they're sodiscouraged and so and a lot of
them have been to a primary carewho just says, Hey, why don't
(08:48):
you eat less and move more? Haveyou tried that? And do
Colette Fehr (08:51):
you know what my primary care told me to do,
like, five years ago to get myfitness pal. I was like, I've
had it for 15 years, yeah, andWeight Watchers, yeah. And I can
only speak, of course, to mypersonal experience, but I have
had weight fluctuations throughmy throughout my whole life. So
(09:12):
this is not unique for me tothis phase of life, but what
I've experienced firsthand beingon these drugs, first of all,
I'm not somebody who has noappetite, even now on GLP ones,
like, I'm still hungry. Like,it's not I still have to be
intentional about what I eat.
It's not just been this magicbullet for me, like you hear out
there, oh, you have no appetite.
(09:34):
That's not my experience. Butwhat is my experience is that my
brain is getting that message ata reasonable place, I'm no
longer thinking about food.
This, for me, has helped somuch, and it doesn't feel like a
crutch in any way. And the ideathat people taking this drug are
lazy is so ridiculous that I ifanyone has that viewpoint like
(09:57):
you, just don't. You have someof these struggles, then good
for you. But like that makes meinfuriated to even think that
anyone could hold that view.
Amy Wrenn (10:08):
Yeah, it drives me crazy, too. And everything that
you were just explaining aboutyourself, that your brain was
not getting the hormonesignaling, right, you know, you
would eat, and then later youwere hungry, so you didn't have
satiety. So there's a lot ofhormones that go with that,
leptin and ghrelin, yes, and sothis helps, like I said, it's
(10:30):
like unplugging it and pluggingit back in. It just kind of
resets all that and improvessignal signaling to your brain,
which, you know that's such athat's such a disadvantage for
people that metabolically havethat issue. Yes, we should be
offering them something if wehave it, to help with that,
(10:50):
because it doesn't just helpwith weight loss. It helps with
inflammation, which is huge. Ithelps with things like PCOS.
They've done more studies now ithelps with cardiovascular
disease, cognitive impairment,fatty liver. It helps with
kidneys, and it helps withaddiction as well. So yeah,
(11:12):
there are a plethora of diseaseprocesses that this medication
is proving to be beneficial for
Laura Bowman (11:21):
I used to hear about these drugs, and it would
be like, ozempic was the firstone, the big Hallmark one. And
then that was for people whowere diabetic. And then they
came out with, like, Zep bound,and we go, V and that was more
for weight loss. Now I'm hearingeverybody literally talk about
wanting to be on some sort ofpeptide. I don't the latest one
(11:43):
is red, a true tide. Have youheard of this one? Yes, red, a
true tide is not FDA approvedyet, and it's still in the study
phase of it. Okay, but what I'mgetting at is like, I feel like
it's now being mass marketed forkind of all people. And I'm just
wondering where you, where youfall down on like, is everybody
(12:04):
in the future going to be onsome kind of, some form of a GLP
one?
Amy Wrenn (12:10):
So no, because not everybody is a candidate for it,
and not everybody will need it.
Yeah, but do people want to useit regardless? I guess I have
turned away patients. I have hadmore than 104 pound patient walk
through my door and want to beon this medication, who I have
turned away. And it was reallyit was very interesting that
(12:33):
particular instance was becauseall of her friends were doing
it, so she wanted to do it aswell. This at the end of the
day, this is a medication, andit needs to be prescribed by a
medical provider. So I justwill, I this is something I
definitely wanted to address.
And since we're already kind ofhere, social media right now is
(12:57):
insane, and there's a lot ofTiktok influencers who are
promoting these medications, andfollow my link and use my code
if you can purchase this.
Colette Fehr (13:10):
Yep, I see it all the time on my feet too.
Amy Wrenn (13:13):
Do not get this medication from a link from an
influencer. That medication theyhave was not made in a pharmacy.
It was made in a lab. It willsay on the bottle, not for human
use, research chemicals andpeople. I know people who are
injecting themselves with thisstuff, so that is my just big
(13:35):
warning. Please don't fall intoa social media rabbit hole. You
need to find a provider whospecializes in this to prescribe
it for you.
Colette Fehr (13:46):
I'm glad you said that. Yeah, that is chilling to
know that that's what's goingon. I see those links all the
time, and obviously I'm onprescription Z bound. I know a
lot of people use compounddrugs, so let me ask you about
that. What I hear anecdotally,from some people. I've heard
from some people, oh, I'm doinggreat on the compound drug, I
(14:08):
micro dose. There are a lot ofpeople going to these medi
clinics where they're givingthem a whole bunch of stuff,
including some kind of GLP onecompound and charging a fortune.
You know, I hear from otherpeople, Oh, I was on zip bound,
and now I'm doing the compoundbecause it got too expensive and
I'm having more side effects.
What's your thought on thecompound versus the prescription
(14:28):
route?
Amy Wrenn (14:31):
The compound will depend on the pharmacy the
quality of your medication. Iuse compounded pharmacies. I
have some that are fantastic.
There are some that I wouldnever use. So your provider
will, hopefully, if they'regoing to use compounded
medications, have a good qualitycompound now, ozempic is
(14:52):
semaglutide. If you go to acompounding pharmacy. You're not
getting the name brand. Soozempic is like the name brand
Kleenex or band aid, right? Itis just a brand name those
medications, when you get itthat is typically needs to be
through your insurance. Noteverybody will be approved
(15:13):
through insurance, and insuranceis a whole nother podcast, but
because people have a hard timegetting approved
Colette Fehr (15:21):
these medications, I couldn't get approved, and I
had an obesity weight, and I'mon zip bound, which is not for
diabetes, so I met theprescribing criteria, and my
insurance, and I have goodinsurance, and they did not
approve
Amy Wrenn (15:33):
it, right? And so Zep bound and mongero, those are the
same medications. Those aretrezepatide and one under a
brand name has been approved fordiabetes and one under a brand
name has been approved forweight loss. It's the same
medication. It's just aninsurance FDA, yes, yes, so you
(15:56):
can get compounded. But thedifference between like
following Tiktok person to theirlink. Those are made in a lab.
If you get compounded, that'sstill a pharmacy. They have to
follow the State Board ofPharmacy. They get inspections.
They have a sterile license.
Those are still safe, good. Theother big difference is that
when you get the commercialbrand, it will come in a pen,
(16:19):
and you just inject it, and it'sone dose. When you get it from a
compounding pharmacy, it comesin a vial, and it's a multi dose
vial. So you can draw up, theycan they can switch up how much
you're taking at a time, so youhave a little bit more leeway
and titrating the medication.
(16:40):
Yeah,
Colette Fehr (16:40):
right, right. And so then we go, V and ozempic are
the same, right? They're thesame drug, yes, some of them,
one is for weight loss and oneis for diabetes, okay? And then
same thing with Manjaro and Zepbound, yes. So it's really key.
What I'm getting from this is toget it from a medical
professional to make sure thatthe medication is indicated for
(17:03):
you, because there are a lot ofpeople, especially women, with
disordered eating patterns, Godknows it's drilled us into us
from society. You know, my BMIwas not normal. I am just now a
year into the drug where I havea B A normal BMI, and I'm still
on the high end of a normal BMIfor my age, and I know BMI isn't
everything, but you know, ifyou're 104 pounds, you probably
(17:26):
don't need to be taking a dietshot. Maybe that's another issue
going on there, right, right?
For
Laura Bowman (17:33):
sure, where is the prescribed like? And when you do
an intake of a new patient,what? What is? Because a lot of
women. I mean, I've even hit aplateau where it's, you know,
I've been kind of the sameweight for a long time, but I
can feel that it's
Colette Fehr (17:48):
harder to lose weight where you're not
overweight. Are you trying tolose weight? I
Laura Bowman (17:52):
mean, I'm not trying to lose weight, but I can
just see that it's, it's gettinga little harder to maintain my
weight, and I'm and I'm justwondering, where is the line,
that line between somebody whowants to lose 20 pounds, or it
just feels like it's harder tolose weight, where you send
somebody away, or you bringsomebody in. So
Amy Wrenn (18:13):
there is a BMI requirement for if you're going
to get it commercial,commercially. And they lower
that BMI to 27 if you havecomorbidities. So if you have,
like, insulin resistance, oryou're pre diabetic, if you use
the compounded method, wheresomebody is paying out of
(18:37):
pocket, you don't have to gothrough insurance. You can get
away from the some of thoseconstraints, what I did,
personally, I was veryfortunate, and I had an in body
scale, because I'm not a fan ofBMI, because it really doesn't
tell us, yeah, it really doesn'ttell us. It only tells us your
height and your weight, but itdoesn't tell me how much fat you
(18:58):
have, and there and there reallyis skinny fat, that that is a
real thing where somebody looksthey look thin, and then when
you put them on that scale, theyhave no muscle. The majority of
their weight is fat. And
Colette Fehr (19:12):
that might be me, that might be me, even still,
I'm gonna change it, but I thinkI'm, I'm almost skinny fat.
Amy Wrenn (19:19):
So, so, yeah, so i i being somebody who was very
fortunate and smaller my wholelife, until I hit 40, and then I
hit that where I started gainingweight and had zero coping
skills, and I did not take theshot at the time, but because I
had had that struggle, I had alot of sympathy for the skinny,
(19:42):
fat girls too, which a lot ofpeople don't have sympathy for
those girls, but those thosewomen are at risk for for having
bones break when they're olderin life. So their bone density
is a real problem too. So Ipersonally would. Treat those
patients who had 20 pounds,because 20 pounds is 20 pounds.
(20:03):
That's not nothing different.
Yeah, and so you're that isgoing to be something that's a
little bit more particular tothe provider that you're seeing.
It really just depends. But I dofeel like there is a place for
those patients as well, becauseat the end of the day, we're not
trying to get skinny, we'retrying to get healthy, right?
And that that is, that is huge,and if you do have 20 extra
(20:27):
pounds of fat that is reallycontributing to inflammation,
and at the end of the day,inflammation can be a precursor
to cancer. So we want, we wantto be the healthiest versions of
ourselves.
Colette Fehr (20:43):
I'm so glad you made that distinction too, that
we're really trying to gethealthy. I mean, I'm not saying
there's no vanity in it. For me,it's affected. It affected my
mental health. It doesn't feelgood to not feel at your best,
or to have your clothes fed, orto never like a picture of
yourself. I mean, there's anelement of that psychologically,
but that is really my biggestmotivation, is I want to feel
(21:06):
good and be healthy in mind andbody. I've lost 30 pounds over a
year, and for me, it was veryslow. I never lost more than a
pound and a half in a week theentire time that I've been good
though, yeah, yeah, I've been ata plateau for a while now, but
regardless, it's just been 30pounds down. It's life changing.
(21:29):
So I think it's really apositive from that front. It's
not just about how you look inthe mirror.
Amy Wrenn (21:35):
I can tell you I would do baseline labs with my
patients, because they werecoming in for all over health.
And so I would look ateverything, and when we would
start this medication, and Iwould do some follow up labs. A
few months later, I was floored,especially when I first broke
into this cholesterol levelswere better. Obviously, blood
(21:58):
sugar was better. People werecoming off their blood pressure
medications, fasting insulin wasbetter, the inflammation markers
were better. Sometimes eventhyroid was better. It really
blew my mind.
Colette Fehr (22:13):
It's really amazing. So let's talk about a
little because it sounds like somany great benefits, but talk to
us a little bit about sideeffects horror stories, like so
many people are afraid, what'sthe real deal with what people
can expect for side effects thatare typical? How scared to
people need to be, that kind ofstuff.
Amy Wrenn (22:34):
So I My advice to providers is that we really need
to go low and go slow, becausethe side effects can be intense.
The number one side effect isnausea. And I cannot figure out
why. Some people get nausea andsome people don't, but most
(22:54):
people get at least a little bitin the beginning. Every once in
a while, you'll have somebodywho is very symptomatic, and
they are vomiting with it. So wereally want to start low and
slow on it. So Nausea is thenumber one. Number two, I would
say, is constipation, because itslows gastric emptying. It slows
(23:15):
down how fast you move that foodfrom your stomach down into your
bowels, and so that can justslow everything down on its way
out as well. Occasionally, somepeople will have diarrhea with
it, but most of my patients hadconstipation with it. Another
key piece of information is whenyou are first starting this
(23:38):
medication. And this may be twoweeks. This may last up to six
weeks, but low energy initially,and that is because your body is
used to running on sugar forfuel, and we are taking its fuel
source away. We are reallydeplenishing the amount of sugar
that your body gets. So yourbody's just like, Are you
(24:00):
kidding me? You want me to what?
You want me to work. You want meto walk. I'm so tired I don't
have my energy. What are youdoing with it? But eventually
the body's like, wait a minute,I'm going to use this fat for
fuel instead of that. Okay, I'mgoing to use the fat for fuel.
And fat is a more efficientenergy source. So you go from
having no energy to having moreenergy than you used to have. I
(24:22):
don't feel like enough providerswarn their patients about the
energy slump in the beginning.
So if you're going to startthis, be prepared for that, and
you can supplement with like Bvitamins to help kind of
mitigate that energy deficit.
There. Another big, importantthing. So I've had patients who
were doing keto, and they lovedketo, and they wanted to stay on
(24:47):
keto. That is okay, but fatbombs are not okay. So in the
Keto world, yeah, I don't knowwhat they will eat. They. Will
make fat bombs, like a buttercoffee or something. Yeah, it
will high, high fat, and theyfeel like that helps them get
(25:07):
into ketosis. Do not do that onthis medication, your body is
going to be burning the fat fromyour body. If you are putting
extra fat into your system, yourgallbladder is not going to have
a nice time.
Colette Fehr (25:25):
I've the times I've gotten sick have been when
I ate like, higher fat food thanI'm normally accustomed to, and
I just couldn't digest it, orjust made me really sick. That's
not happened often, but, but itdoesn't feel good. Yeah,
Amy Wrenn (25:39):
yeah. I had a patient learn that the hard way, and I
didn't know she wasintentionally eating high fat.
So you want to prioritizeprotein while you're on this
medication, because we want tosupport our muscles, and that
is, that is very, veryimportant. So prioritizing
protein, I have even heardanecdotally that it helps with
(26:01):
some of the nausea. With that,other side effects that are kind
of positive are people are Idon't drink as much. I used to
want a glass of wine everynight, and now I don't need the
glass of wine. I'm not cravingice cream after my dinner. I'm
not so it really, it works onthe hypothalamus in the brain,
(26:23):
and it works on cravings, sovaping, smoking, alcohol, all of
those things, not everybody, butmost people tend to not need
those things anymore, because itaffects that reward part of your
brain.
Laura Bowman (26:39):
That's fascinating. So nice, yeah,
yeah, yeah. I have had a coupleof patients. I've had two
clients who have lost theirgallbladder to this process. I
know there's like theirgallbladder, yeah, they had to
Colette Fehr (26:52):
have their gallbladder out. Two clients
lost their gallbladder becauseof taking a GLP. One,
Amy Wrenn (26:57):
yes, this is another reason why you really need to be
with a good provider who's goingto talk to you about nutrition.
I tell my patients, you're notgoing to just take this shot,
sit on the couch and eat nothingbut saltines because you're not
very hungry. You have to bemindful still about moving your
body, and you have to be mindfulabout the things that you eat.
(27:20):
We have really need to focus oneating for nutrition. So if we
can avoid now, I'm not sayingnot to not ever have treats or
fun things, but if most of yournutrition can come from Whole
Foods, so nothing out of a box,a bag or a can, that is what's
going to nourish your body, andthat's what we need to focus on.
(27:41):
Because if you want to come offthis medication one day, we need
to build the habits now, whileyou're on it, while you have
this tool, so that we canmaintain the results
Laura Bowman (27:51):
later. Yes, I've heard, I've heard it be called
renting your results. And it'slike, that's a good way of
putting it.
Colette Fehr (28:01):
I don't see it that way personally,
Laura Bowman (28:03):
but I mean, that's the way, that's the way they
talk about it. Sometimes thatyou don't want to rent your
results. You wanna build and buythem. You wanna buy them. Best
invest
Colette Fehr (28:12):
is the word, yeah, yeah. Okay, I see what you're
saying. So we, let's talk aboutthat, getting off of them.
Because I kind of have toLaura's point, even though I'm
saying I don't see it that way.
I kind of have in my mind, Iguess I feel like I've bought my
results, but that it's like alifetime thing. I am terrified
of the idea of ever going offthis drug.
Amy Wrenn (28:30):
Okay, you don't have to come off of it. Okay, let's
say that first, you don't haveto come off of it. But some
people, some people, need it fora lifetime, and some people
don't, okay. So if that makessense, yes, if you're looking at
20 pounds, that is probablygoing to be a shorter term, and
that might look like anythingfrom six months to even 18
(28:54):
months. And then I like to tapermy patients off. We don't just
pull the plug, and I really handhold during that time, because I
want them to maintain the habitsthat they built. If they stopped
drinking a glass of wine everynight, if they stopped having
ice cream after dinner, if theystopped having a snack at 3pm
(29:16):
you have to maintain thatafterwards. You have to maintain
that when the food noise comesback, because the food noise
will come back if you have foodnoise before. So you really
you've flexed and built thismuscle while on the medication,
and now you have to maintainthat off. And I've always given
(29:37):
my patients, I like them, well,I have them give me a red flag
number, and that number needs tobe more than five pounds, less
than 10 pounds. I'd like them tokeep track of their weights. At
home. They don't have to weighthemselves every day but weekly,
because we want to have an ideaof what's going on. And if you
get to say if you gain sevenpounds. Yeah, and you're there
(30:01):
for at least two weeks becausethere's inflammation, there's
there's different reasons whyyou may gain some water weight.
So we really want to make surethat's fat weight. Then I want
you to come back. And we couldstart on a low dose. It may be
once a month, it may be everyother week, it may be, we're
just going to be on it for twomonths. But I don't want you to
come back at 20 poundsoverweight, and there is a list
(30:24):
of reasons why somebody may gainthe weight back. Maybe you have
somebody in the hospital. Maybeyou broke a leg. Life will come
and punch you in the face, andyou have to You're in survival
mode. You can't think about isthis nutritious? Is I gotta hit
the Chick fil A, because this ismy only opportunity to eat
today. So both in there. Yeah,same. So we have, we want to we
(30:50):
I don't want to just leaveanybody once you're done by, I
want to them to be able to comeback and get back on the
medication if they need to, evenif it's just short term, but you
are safe staying on themedication. There is a group of
people, especially if theystruggle with obesity, that they
will need to be on it long term.
And if you have metabolicissues, then you may need to be
(31:13):
on it long term. And that'sokay. I mean, people are on all
sorts of medications long term.
Yeah,
Colette Fehr (31:21):
it's really more to me a function of the way my
brain works. And that food noisefor me has always been so loud
it doesn't go away when I eatsuper clean. It's reduced a
little when there's nothing I'mnot taking in anything that
makes my brain ping, and I justdon't know that it's super
realistic for me to be off it,but I'm glad to hear you say
(31:44):
that I don't have to be. Andright? So everyone's on their
own journey.
Laura Bowman (31:49):
Is there a habituation effect to the drug,
though? I mean, is it? Do youhave to continually, like, bump
it
Amy Wrenn (31:54):
up? So I feel like on semaglutide, there's less of
that, where I've had patients beable to get to a point, and they
stay there, and they're good ontrizepatide, I feel like people
have had to keep going up on itto maintain the results. That is
just what I've seen andpractice. But most patients,
(32:18):
when they get to a maintenancephase. Can just stay on whatever
they're on. Now, if you have alittle bit more weight that you
want to lose, and I don't knowwhere you are on on dosing, but
you may have to tweak it andbump it up a little bit, and
then you can, once you getthere, you could maybe move it
(32:40):
back down and see how you do onthat. But yes, for and if you
have somebody who's gonna loselike, 100 pounds, they're going
to have to keep moving up thatladder, and they're going to
need to stay on it long term,more than likely.
Colette Fehr (32:56):
Well, I've had to, I've had to on the tours
appetite. I've had to go up andup and up
Amy Wrenn (33:01):
and up I see I see that more with trizepatide than
the semaglutide. But I can tellyou, and I don't know your your
medical history at all, but thepatients who do hormone therapy
in addition to a GLP one, havethe best outcomes per the
studies and for what I have seenand practice. If you add in
(33:24):
resistance training to that,it's it's just out of sight, how
the benefits,
Colette Fehr (33:32):
okay, that's really exciting to hear you say
that if this is an issue foryou, and a GLP one could be
helpful for your situation andyour weight. The total picture
that taking doing HRT, a GLP oneand doing really good resistance
training can be the sweet spotfor women in this phase of life,
Amy Wrenn (33:53):
I have had women who do that, who come to me
afterwards and cry becausethey're like, I'm me again. I am
me again. That's how I feel.
That is like the greatestemotional paycheck I could ever
get is having somebody just cryand be so thankful because they
feel like themselves again.
(34:14):
Yeah, yeah.
Colette Fehr (34:16):
Oh, my God, that's so rewarding for you, right?
Because you're really helpingpeople change their lives,
change how they feel aboutthemselves. And it's true. I
think somehow this, like the itstarted with this ridiculous
Hollywood ozempic thing, and theway it was discussed in the
media is, like all of thesestars who are obsessed with, you
(34:36):
know, we see people like DemiMoore, who looks amazing, and I
don't know what she's done andhasn't done, but it started to
get conflated with this idea ofwomen who are obsessed with
being thin at any cost, and thatthey're willing to, like throw
themselves on the fire ofdangerous practices to be thin,
(34:57):
and that's really not what thisis at all. People, and that was
just a media interpretation ofsomething, perhaps based on an
element of Hollywood, maybe noteven I don't know what those
people's situations are, butwe're talking about something
very different here, which isbeing in the best health you can
be at midlife, and that this maybe something that's really
(35:18):
indicated for you and reallyhelpful, but you've got to have
a true medical practitionerguide you.
Laura Bowman (35:25):
I guess what's coming up for me, because I'm
like, in this, like, weird, noman's land of like, I do weight
training three times a week, andI do run all the time, and I
walk all the time, and I, I cantell that midlife is creeping up
on me. And I wonder, I guess thequestion is, where I was
listening to you talk about thisis like, do I, am I at one point
(35:47):
going to have to be optimized?
Am I going to have to, like, dohormone replacement, some sort
of help, just to, like, I feellike I'm running to stand still,
is essentially kind of where I'mat. And I'm like, is it the only
way you get there eventually isthrough optimization of hormones
and insulin, and can I even dothat naturally?
Amy Wrenn (36:09):
So first of all, nobody, nobody has to do
anything that they're notcomfortable with, but there are
options out there for you, andit does the older you get, I
feel like it's playing Whack aMole. Personally, you fix this,
(36:30):
then that goes, you fix this,then then that goes. But just
speaking from the bio identicalhormone replacement therapy
scope, that is a two parter. Youhave the one part where you have
patients take it because they'revery symptomatic. They might
have intense brain fog. They mayhave intense depression, or even
(36:52):
like slight depression, they mayhave the weight gain, the loss
of libido, and so it'd be hotflashes, and they really want to
treat those symptoms, becauseit's interfering with their
everyday life. So they willstart on some hormone therapy to
(37:12):
help with that. Now, noteverybody is symptomatic. Most
most people are at least alittle bit. But not everybody is
some people are terrible, and sothe people who aren't
symptomatic, but they getstarted on hormone therapy,
those people tend to do itbecause they want to preserve
(37:37):
the last decade of their life.
They have seen a family memberwith frailty, broken hips,
dementia, having to havesomebody else take care of them.
And they want to be vibrant andindependent as long as possible.
And the studies have shown thatif you start hormone therapy
within 10 years really, if youcould get it within five years
(38:01):
of menopause, that you canprevent things like
cardiovascular disease, which,by the way, is leading cause of
death of women. You can preventdementia and Alzheimer's. You
can prevent osteoporosis, whichkills women as well. You can
also prevent UTIs. I think Icould go whole UTI rabbit hole.
But I don't think women realizethat once they are in menopause,
(38:24):
the rate of UTIs and that a UTIis not what it was in your 20s.
It's not like burning and anurgency. It's I'm seeing things,
I'm hearing things. I'mhallucinating. It's a whole
nother ball. So it is to preventthose things. And I would say
(38:46):
that bioidentical hormonetherapy is natural because it is
the same chemical compounds thatthe hormones your body produced.
So it's not like birth control,which is kind of like estrogen,
kind of like progesterone, butit's, it's not the same thing.
(39:10):
And so and it's, it is so strongthat it shuts down your own own
ovaries, where hormone therapyis just a little bit it's just
like a supplement to ease thesymptoms and to help prevent
those long term diseaseprocesses, sorry, rabbit hole,
yeah, we
Laura Bowman (39:33):
have to have you back on to talk all about this,
because I feel like this couldbe its own episode. But I guess
what I'm hearing from it islike, I feel like this again,
it's coming up for me is like,there's going to be a difference
between women who optimize, andyou can make that mean whatever,
like, variation of things youdo, and women who don't like
there's going to be a differencefor sure.
Colette Fehr (39:55):
Yeah. So obviously, menopause is
happening. I'm turning 52 thisyear. So I'm in it. And if I had
known what I've learned sinceLaura and I started the podcast
and started having guests on whoare better educated like
yourself about the realities ofperimenopause and menopause,
we're going to Dr Vonda writesconference on menopause. Those
(40:16):
things opened my eyes to stuff Iwas not getting from my doctors
at all, and you know, I can't doanything about the time I've
lost, but I'm trying to getmyself on track now, and my
personal motive for hormones isreally about exactly what you
said, bone health, heart health.
It's not really so much abouthow I feel right now or my sex
(40:36):
life, and nothing wrong withthat either, but it's really
about the future and wanting todo whatever I can that's the
healthiest for my body. And Ijust didn't understand how
important these hormones are toall of that. Until recently, the
Amy Wrenn (40:51):
misinformation is out of control with social media.
There's there's so much outthere, but Dr Vonda right. She
is fabulous. She's actually my Isee her myself for a hip injury.
She is absolutely wonderful. Andif, if for listeners, you cut
(41:13):
this out if you want, but if youwant to follow somebody on
social media who's really givinglegit information. Dr Vonda
Wright, follow her on on socialmedia, because she puts out so
much and she's she's not agynecologist. She's an
orthopedic but, and she'spassionate about it, because she
(41:37):
sees these frail women with allthese broken bones. So I would
definitely say follow her andanybody she recommends,
Colette Fehr (41:45):
right? And Dr Kelly Casper son, too. She's
amazing.
Amy Wrenn (41:49):
Is my favorite. I know you guys spoke with her,
and I'm so jealous. I would fangirl so hard.
Colette Fehr (41:55):
I definitely love Dr Vonda Wright and the work
that she's doing to bring all ofthese great women to the
forefront. It's so important. Ithink that conference last year
was life changing, yeah, yeah,yeah. We'd love to have you back
on again too, because there's somuch more to discuss. This has
(42:15):
been so helpful. Before you go.
Can you give our listeners anidea of how they can find you,
where they can follow you, thatkind of good stuff.
Amy Wrenn (42:24):
Sure, I am on Instagram at NP Ren, and I think
it's just at NP Wren, and Wrenis spelled W, R, E, N, N, and I
try to put out some educationalmaterial. I'm not great at
putting it out all the time,because I am working with
(42:46):
providers a lot, and I've I'vemade a course recently, a BHRT
course, online course forproviders, and I'm currently
working on an advanced medicalweight loss course for providers
as well. Which GLP ones is apart of it, but it's not the
whole thing, because, certainlythey're not for everybody. Not
(43:06):
everybody's going to qualify.
And I want providers to have allthe resources available to help
their patients. So I'm workingon coursework a lot, but when
I'm not doing that, I do try toput some helpful tips out on
Instagram as
Colette Fehr (43:21):
well. I love your Instagram, and by the way, it is
NP, underscore, W, R, E, N, N,and we'll also have this in our
show notes too. Thank you, and Ihope, selfishly that you'll
start seeing patients again atsome point, because it's needed,
yeah, and that you have thewhole picture, and that's what
is missing in so many providers,even these great, well educated
(43:45):
doctors like you said, peopleare not learning this in medical
school and nursing school in thepast, so we're all trying to get
up to speed, and you know, it'sgoing to be different for
everyone. But we're so gratefulto you for all of this wonderful
information that's going to helpour listeners so much. Thank you
for being here.
Amy Wrenn (44:03):
Great. Thank you guys so much for having me. I
thoroughly enjoyed it. Well
Colette Fehr (44:07):
we did too, and we hope all of you out there
listening got some greatinsights from our couch today.
We will see you next week.
Laura Bowman (44:15):
Bye, guys. You.
Marc, welcome to insights from the couch, where
real conversations meet real
Laura Bowman (00:07):
life. At midlife, we're Colette and Laura, two
therapists and best friends,walking through the journey
right alongside you, whetheryou're feeling stuck, restless
or just unsure of what's next.
This is a space for honestconversations, messy truths and
meaningful change.
Colette Fehr (00:26):
And our midlife master class is now open. If
you're looking to level up, getinto action and make midlife the
best season yet. Go to insightsfrom the couch.org and join our
wait list. Now let's dive in. Solet's dive right into this
episode on GLP ones everythingyou need to know about taking
(00:46):
them at midlife, we've got nursepractitioner, Amy Wren, here
with us today. We're so excited.
We're gonna get into it all destigmatize, demystify and give
you all the info you need toknow to make decisions that are
right for you. Amy, welcome andthank you for being here.
Amy Wrenn (01:03):
Thank you. Thank you for having me. I'm so happy to
be here.
Colette Fehr (01:06):
Yeah, we're so excited to talk about this with
you. And maybe you could startout by just tell us a little bit
about yourself for ourlisteners.
Amy Wrenn (01:13):
Sure, sure. So I am a nurse practitioner. I've been in
the medical field for over 20years. I started out my career
in Obstetrics and Gynecology,and I now am in the integrative
med space. I specialize inhealth optimization, so that
(01:33):
looks like anything from weightloss to hormones to peptides,
anything we can do to make yoube the healthiest version of
you, is what I specialize in.
Unknown (01:45):
Oh, I love so cool. I love that. Yeah,
Colette Fehr (01:48):
and are you available online or only in
office?
Amy Wrenn (01:52):
So actually, this past year, I haven't been seeing
patients. I've taken a littledetour, and I am now consulting,
doing education and training forpractitioners, because there is
a huge gap, which I'm sure youguys know, and what patients
want, what they need, and whatproviders understand and know.
(02:16):
So especially in theperimenopause, menopause space,
even in the weight loss spaceproviders are just not taught
this in medical school, and so Iam trying to bridge that gap and
be a resource for providers whowant to do right by their
patients and give them updated,safe medications and treatments.
(02:38):
So I'm really finding that to besuper fulfilling, and it doesn't
mean that I won't be back at thebedside at some point, but just
for the last year I've beendoing this, and I'm loving it.
Colette Fehr (02:50):
That's wonderful.
It's so needed. It's so needed.
Yes, yes, yeah, as you know, allright, so let's dive in and talk
about GLP ones. Can you startout by telling us what they are
like. Let's say a woman's notonly heard about it from her
friends or through thegrapevine. What are these drugs
and how do they work in thebody?
Amy Wrenn (03:10):
Okay? So if you're listening right now, when we say
GOP ones, we're talking aboutthose shots, those diet shots.
So if you've heard of ozempic,or we go V zip bound mongero.
That is what we're talkingabout, these weight loss
injections. And a GLP one standsfor glucagon like peptide one
(03:34):
receptor agonist. That's thelong scientific version of that.
And actually we produce GLP onesin our bodies. All of us produce
GLP ones in our bodies, and theyhave created this medication to
mimic that. So it's the samething that we already have in
(03:55):
our bodies. And you may
Colette Fehr (03:56):
I did not know that. I'm sorry to interrupt
you, but I've been on this I'vebeen on Z bound for a year, and
this is the first I've heard ofthat. So already I've learned
something. Yeah.
Amy Wrenn (04:06):
So you think, Well, why, if we already are making
it? Why do we need it? Well, inlife, if we have metabolic
dysfunction, and metabolicdysfunction can look like
insulin resistance, PCOS, typetwo diabetes. It really hits
women and perimenopause andmenopause, because once we're
(04:29):
not making as much estrogen, wecan become insulin resistant. So
people who have maybe never hadan issue with their weight all
of the sudden are like, I don'tI don't understand what's
happening to me. I haven'tchanged my diet. I haven't
changed my exercise. I'm gainingweight. You know what is wrong?
And it's because our brainsaren't getting the message from
(04:52):
the gut. So the gut creates thispeptide, this GLP, one sends the
message to the brain.
And think of it like a textmessage, like your gut is
sending a text message to thebrain, but the brain needs
glasses and the text is so smallit can't see it. Then you get
this exogenous. Exogenous meansfrom outside the body. So
(05:15):
endogenous is what your bodycreates. Exogenous is something
that we bring in, and you giveyourself a shot of this now that
text message is blown up. Bigbrain has glasses, and it's
like, oh, says we're full, sayswe're full, and it says we're
going to do this with the sugar,and we're going to do this with
our fat. And so it's a tool thatwe have in our toolbox to help
(05:40):
patients lose weight, to helpget that message to the brain
that they weren't receiving. AndI've told a lot of patients that
it's the equivalent of, have youtried unplugging it and plugging
it back in? It just kind ofresets everything in the body.
Laura Bowman (05:59):
Can Can we double click on the piece where you
say, you know, when we go intoperimenopause, our estrogen is
reducing, and all of a suddenour brain isn't getting the
signal. Is that is, is the gateweight gain? Because we're not
getting the same signal andwe're overeating. I mean, are we
changing anything? Or is itliterally like systems in the
(06:21):
body are dealing with the sameamount of food, but they're
dealing with
Amy Wrenn (06:24):
it differently.
They're dealing with itdifferently. And yes, you can
overeat, but it's dealing withit differently, because the
insulin, insulin is a hormone,and the body is not responding
to it anymore, and that iscalled insulin resistance, and
that truly can happen at anyage, but you can take a person
(06:45):
who's never had that, and oncethey enter perimenopause or
menopause, then they will, theywill most likely get that.
Colette Fehr (06:57):
Oh my gosh, Amy, exactly what you're saying, you
guys. I just talked to a goodfriend who was like, I saw her
for the first time in a while,and she said, Oh, my God, I am
going out of my mind. I have puton 25 pounds. She's about 5455
years old. She's been naturallythin her whole life, like she's
(07:17):
never had eating issues. She'snever had to think about eating.
She's just one of those peoplewho genetically has been
relatively thin and not had tofocus on it. She said, I've gone
through all of these hoops whereI've dieted, counted calories,
increased my exercise to five tosix times a week. She said,
Nothing is making me get theweight off. And she said, and
(07:38):
I'm not even overeating oreating any differently, and
she's thinking about GLP onessomething, she said, You know,
I'm really afraid. And I triedto give her some reassurance. I
mean, my experience has beenmostly very positive, but she
said, it's unbelievable hownothing's changed, and I have
never had a weight problem myentire life. So it sounds like
something like what you'redescribing is probably what's
(08:00):
happening for her. She She
Amy Wrenn (08:03):
sounds like the the poster child for this. I've had
so many patients come to me andthey have tried everything, and
that's where I get very I getvery protective of these
patients when I hear people outin the community that have bias
against the medication. Becausethese aren't lazy people.
(08:24):
They're not lazy people. Theseare people who have tried
counting calories, countingmacros, eliminating certain
foods, doing keto, cardio,cardio, all day and night, and
nothing is changing. They andthey and they're going out of
their minds, and they're sodiscouraged and so and a lot of
them have been to a primary carewho just says, Hey, why don't
(08:48):
you eat less and move more? Haveyou tried that? And do
Colette Fehr (08:51):
you know what my primary care told me to do,
like, five years ago to get myfitness pal. I was like, I've
had it for 15 years, yeah, andWeight Watchers, yeah. And I can
only speak, of course, to mypersonal experience, but I have
had weight fluctuations throughmy throughout my whole life. So
(09:12):
this is not unique for me tothis phase of life, but what
I've experienced firsthand beingon these drugs, first of all,
I'm not somebody who has noappetite, even now on GLP ones,
like, I'm still hungry. Like,it's not I still have to be
intentional about what I eat.
It's not just been this magicbullet for me, like you hear out
there, oh, you have no appetite.
(09:34):
That's not my experience. Butwhat is my experience is that my
brain is getting that message ata reasonable place, I'm no
longer thinking about food.
This, for me, has helped somuch, and it doesn't feel like a
crutch in any way. And the ideathat people taking this drug are
lazy is so ridiculous that I ifanyone has that viewpoint like
(09:57):
you, just don't. You have someof these struggles, then good
for you. But like that makes meinfuriated to even think that
anyone could hold that view.
Amy Wrenn (10:08):
Yeah, it drives me crazy, too. And everything that
you were just explaining aboutyourself, that your brain was
not getting the hormonesignaling, right, you know, you
would eat, and then later youwere hungry, so you didn't have
satiety. So there's a lot ofhormones that go with that,
leptin and ghrelin, yes, and sothis helps, like I said, it's
(10:30):
like unplugging it and pluggingit back in. It just kind of
resets all that and improvessignal signaling to your brain,
which, you know that's such athat's such a disadvantage for
people that metabolically havethat issue. Yes, we should be
offering them something if wehave it, to help with that,
(10:50):
because it doesn't just helpwith weight loss. It helps with
inflammation, which is huge. Ithelps with things like PCOS.
They've done more studies now ithelps with cardiovascular
disease, cognitive impairment,fatty liver. It helps with
kidneys, and it helps withaddiction as well. So yeah,
(11:12):
there are a plethora of diseaseprocesses that this medication
is proving to be beneficial for
Laura Bowman (11:21):
I used to hear about these drugs, and it would
be like, ozempic was the firstone, the big Hallmark one. And
then that was for people whowere diabetic. And then they
came out with, like, Zep bound,and we go, V and that was more
for weight loss. Now I'm hearingeverybody literally talk about
wanting to be on some sort ofpeptide. I don't the latest one
(11:43):
is red, a true tide. Have youheard of this one? Yes, red, a
true tide is not FDA approvedyet, and it's still in the study
phase of it. Okay, but what I'mgetting at is like, I feel like
it's now being mass marketed forkind of all people. And I'm just
wondering where you, where youfall down on like, is everybody
(12:04):
in the future going to be onsome kind of, some form of a GLP
one?
Amy Wrenn (12:10):
So no, because not everybody is a candidate for it,
and not everybody will need it.
Yeah, but do people want to useit regardless? I guess I have
turned away patients. I have hadmore than 104 pound patient walk
through my door and want to beon this medication, who I have
turned away. And it was reallyit was very interesting that
(12:33):
particular instance was becauseall of her friends were doing
it, so she wanted to do it aswell. This at the end of the
day, this is a medication, andit needs to be prescribed by a
medical provider. So I justwill, I this is something I
definitely wanted to address.
And since we're already kind ofhere, social media right now is
(12:57):
insane, and there's a lot ofTiktok influencers who are
promoting these medications, andfollow my link and use my code
if you can purchase this.
Colette Fehr (13:10):
Yep, I see it all the time on my feet too.
Amy Wrenn (13:13):
Do not get this medication from a link from an
influencer. That medication theyhave was not made in a pharmacy.
It was made in a lab. It willsay on the bottle, not for human
use, research chemicals andpeople. I know people who are
injecting themselves with thisstuff, so that is my just big
(13:35):
warning. Please don't fall intoa social media rabbit hole. You
need to find a provider whospecializes in this to prescribe
it for you.
Colette Fehr (13:46):
I'm glad you said that. Yeah, that is chilling to
know that that's what's goingon. I see those links all the
time, and obviously I'm onprescription Z bound. I know a
lot of people use compounddrugs, so let me ask you about
that. What I hear anecdotally,from some people. I've heard
from some people, oh, I'm doinggreat on the compound drug, I
(14:08):
micro dose. There are a lot ofpeople going to these medi
clinics where they're givingthem a whole bunch of stuff,
including some kind of GLP onecompound and charging a fortune.
You know, I hear from otherpeople, Oh, I was on zip bound,
and now I'm doing the compoundbecause it got too expensive and
I'm having more side effects.
What's your thought on thecompound versus the prescription
(14:28):
route?
Amy Wrenn (14:31):
The compound will depend on the pharmacy the
quality of your medication. Iuse compounded pharmacies. I
have some that are fantastic.
There are some that I wouldnever use. So your provider
will, hopefully, if they'regoing to use compounded
medications, have a good qualitycompound now, ozempic is
(14:52):
semaglutide. If you go to acompounding pharmacy. You're not
getting the name brand. Soozempic is like the name brand
Kleenex or band aid, right? Itis just a brand name those
medications, when you get itthat is typically needs to be
through your insurance. Noteverybody will be approved
(15:13):
through insurance, and insuranceis a whole nother podcast, but
because people have a hard timegetting approved
Colette Fehr (15:21):
these medications, I couldn't get approved, and I
had an obesity weight, and I'mon zip bound, which is not for
diabetes, so I met theprescribing criteria, and my
insurance, and I have goodinsurance, and they did not
approve
Amy Wrenn (15:33):
it, right? And so Zep bound and mongero, those are the
same medications. Those aretrezepatide and one under a
brand name has been approved fordiabetes and one under a brand
name has been approved forweight loss. It's the same
medication. It's just aninsurance FDA, yes, yes, so you
(15:56):
can get compounded. But thedifference between like
following Tiktok person to theirlink. Those are made in a lab.
If you get compounded, that'sstill a pharmacy. They have to
follow the State Board ofPharmacy. They get inspections.
They have a sterile license.
Those are still safe, good. Theother big difference is that
when you get the commercialbrand, it will come in a pen,
(16:19):
and you just inject it, and it'sone dose. When you get it from a
compounding pharmacy, it comesin a vial, and it's a multi dose
vial. So you can draw up, theycan they can switch up how much
you're taking at a time, so youhave a little bit more leeway
and titrating the medication.
(16:40):
Yeah,
Colette Fehr (16:40):
right, right. And so then we go, V and ozempic are
the same, right? They're thesame drug, yes, some of them,
one is for weight loss and oneis for diabetes, okay? And then
same thing with Manjaro and Zepbound, yes. So it's really key.
What I'm getting from this is toget it from a medical
professional to make sure thatthe medication is indicated for
(17:03):
you, because there are a lot ofpeople, especially women, with
disordered eating patterns, Godknows it's drilled us into us
from society. You know, my BMIwas not normal. I am just now a
year into the drug where I havea B A normal BMI, and I'm still
on the high end of a normal BMIfor my age, and I know BMI isn't
everything, but you know, ifyou're 104 pounds, you probably
(17:26):
don't need to be taking a dietshot. Maybe that's another issue
going on there, right, right?
For
Laura Bowman (17:33):
sure, where is the prescribed like? And when you do
an intake of a new patient,what? What is? Because a lot of
women. I mean, I've even hit aplateau where it's, you know,
I've been kind of the sameweight for a long time, but I
can feel that it's
Colette Fehr (17:48):
harder to lose weight where you're not
overweight. Are you trying tolose weight? I
Laura Bowman (17:52):
mean, I'm not trying to lose weight, but I can
just see that it's, it's gettinga little harder to maintain my
weight, and I'm and I'm justwondering, where is the line,
that line between somebody whowants to lose 20 pounds, or it
just feels like it's harder tolose weight, where you send
somebody away, or you bringsomebody in. So
Amy Wrenn (18:13):
there is a BMI requirement for if you're going
to get it commercial,commercially. And they lower
that BMI to 27 if you havecomorbidities. So if you have,
like, insulin resistance, oryou're pre diabetic, if you use
the compounded method, wheresomebody is paying out of
(18:37):
pocket, you don't have to gothrough insurance. You can get
away from the some of thoseconstraints, what I did,
personally, I was veryfortunate, and I had an in body
scale, because I'm not a fan ofBMI, because it really doesn't
tell us, yeah, it really doesn'ttell us. It only tells us your
height and your weight, but itdoesn't tell me how much fat you
(18:58):
have, and there and there reallyis skinny fat, that that is a
real thing where somebody looksthey look thin, and then when
you put them on that scale, theyhave no muscle. The majority of
their weight is fat. And
Colette Fehr (19:12):
that might be me, that might be me, even still,
I'm gonna change it, but I thinkI'm, I'm almost skinny fat.
Amy Wrenn (19:19):
So, so, yeah, so i i being somebody who was very
fortunate and smaller my wholelife, until I hit 40, and then I
hit that where I started gainingweight and had zero coping
skills, and I did not take theshot at the time, but because I
had had that struggle, I had alot of sympathy for the skinny,
(19:42):
fat girls too, which a lot ofpeople don't have sympathy for
those girls, but those thosewomen are at risk for for having
bones break when they're olderin life. So their bone density
is a real problem too. So Ipersonally would. Treat those
patients who had 20 pounds,because 20 pounds is 20 pounds.
(20:03):
That's not nothing different.
Yeah, and so you're that isgoing to be something that's a
little bit more particular tothe provider that you're seeing.
It really just depends. But I dofeel like there is a place for
those patients as well, becauseat the end of the day, we're not
trying to get skinny, we'retrying to get healthy, right?
And that that is, that is huge,and if you do have 20 extra
(20:27):
pounds of fat that is reallycontributing to inflammation,
and at the end of the day,inflammation can be a precursor
to cancer. So we want, we wantto be the healthiest versions of
ourselves.
Colette Fehr (20:43):
I'm so glad you made that distinction too, that
we're really trying to gethealthy. I mean, I'm not saying
there's no vanity in it. For me,it's affected. It affected my
mental health. It doesn't feelgood to not feel at your best,
or to have your clothes fed, orto never like a picture of
yourself. I mean, there's anelement of that psychologically,
but that is really my biggestmotivation, is I want to feel
(21:06):
good and be healthy in mind andbody. I've lost 30 pounds over a
year, and for me, it was veryslow. I never lost more than a
pound and a half in a week theentire time that I've been good
though, yeah, yeah, I've been ata plateau for a while now, but
regardless, it's just been 30pounds down. It's life changing.
(21:29):
So I think it's really apositive from that front. It's
not just about how you look inthe mirror.
Amy Wrenn (21:35):
I can tell you I would do baseline labs with my
patients, because they werecoming in for all over health.
And so I would look ateverything, and when we would
start this medication, and Iwould do some follow up labs. A
few months later, I was floored,especially when I first broke
into this cholesterol levelswere better. Obviously, blood
(21:58):
sugar was better. People werecoming off their blood pressure
medications, fasting insulin wasbetter, the inflammation markers
were better. Sometimes eventhyroid was better. It really
blew my mind.
Colette Fehr (22:13):
It's really amazing. So let's talk about a
little because it sounds like somany great benefits, but talk to
us a little bit about sideeffects horror stories, like so
many people are afraid, what'sthe real deal with what people
can expect for side effects thatare typical? How scared to
people need to be, that kind ofstuff.
Amy Wrenn (22:34):
So I My advice to providers is that we really need
to go low and go slow, becausethe side effects can be intense.
The number one side effect isnausea. And I cannot figure out
why. Some people get nausea andsome people don't, but most
(22:54):
people get at least a little bitin the beginning. Every once in
a while, you'll have somebodywho is very symptomatic, and
they are vomiting with it. So wereally want to start low and
slow on it. So Nausea is thenumber one. Number two, I would
say, is constipation, because itslows gastric emptying. It slows
(23:15):
down how fast you move that foodfrom your stomach down into your
bowels, and so that can justslow everything down on its way
out as well. Occasionally, somepeople will have diarrhea with
it, but most of my patients hadconstipation with it. Another
key piece of information is whenyou are first starting this
(23:38):
medication. And this may be twoweeks. This may last up to six
weeks, but low energy initially,and that is because your body is
used to running on sugar forfuel, and we are taking its fuel
source away. We are reallydeplenishing the amount of sugar
that your body gets. So yourbody's just like, Are you
(24:00):
kidding me? You want me to what?
You want me to work. You want meto walk. I'm so tired I don't
have my energy. What are youdoing with it? But eventually
the body's like, wait a minute,I'm going to use this fat for
fuel instead of that. Okay, I'mgoing to use the fat for fuel.
And fat is a more efficientenergy source. So you go from
having no energy to having moreenergy than you used to have. I
(24:22):
don't feel like enough providerswarn their patients about the
energy slump in the beginning.
So if you're going to startthis, be prepared for that, and
you can supplement with like Bvitamins to help kind of
mitigate that energy deficit.
There. Another big, importantthing. So I've had patients who
were doing keto, and they lovedketo, and they wanted to stay on
(24:47):
keto. That is okay, but fatbombs are not okay. So in the
Keto world, yeah, I don't knowwhat they will eat. They. Will
make fat bombs, like a buttercoffee or something. Yeah, it
will high, high fat, and theyfeel like that helps them get
(25:07):
into ketosis. Do not do that onthis medication, your body is
going to be burning the fat fromyour body. If you are putting
extra fat into your system, yourgallbladder is not going to have
a nice time.
Colette Fehr (25:25):
I've the times I've gotten sick have been when
I ate like, higher fat food thanI'm normally accustomed to, and
I just couldn't digest it, orjust made me really sick. That's
not happened often, but, but itdoesn't feel good. Yeah,
Amy Wrenn (25:39):
yeah. I had a patient learn that the hard way, and I
didn't know she wasintentionally eating high fat.
So you want to prioritizeprotein while you're on this
medication, because we want tosupport our muscles, and that
is, that is very, veryimportant. So prioritizing
protein, I have even heardanecdotally that it helps with
(26:01):
some of the nausea. With that,other side effects that are kind
of positive are people are Idon't drink as much. I used to
want a glass of wine everynight, and now I don't need the
glass of wine. I'm not cravingice cream after my dinner. I'm
not so it really, it works onthe hypothalamus in the brain,
(26:23):
and it works on cravings, sovaping, smoking, alcohol, all of
those things, not everybody, butmost people tend to not need
those things anymore, because itaffects that reward part of your
brain.
Laura Bowman (26:39):
That's fascinating. So nice, yeah,
yeah, yeah. I have had a coupleof patients. I've had two
clients who have lost theirgallbladder to this process. I
know there's like theirgallbladder, yeah, they had to
Colette Fehr (26:52):
have their gallbladder out. Two clients
lost their gallbladder becauseof taking a GLP. One,
Amy Wrenn (26:57):
yes, this is another reason why you really need to be
with a good provider who's goingto talk to you about nutrition.
I tell my patients, you're notgoing to just take this shot,
sit on the couch and eat nothingbut saltines because you're not
very hungry. You have to bemindful still about moving your
body, and you have to be mindfulabout the things that you eat.
(27:20):
We have really need to focus oneating for nutrition. So if we
can avoid now, I'm not sayingnot to not ever have treats or
fun things, but if most of yournutrition can come from Whole
Foods, so nothing out of a box,a bag or a can, that is what's
going to nourish your body, andthat's what we need to focus on.
(27:41):
Because if you want to come offthis medication one day, we need
to build the habits now, whileyou're on it, while you have
this tool, so that we canmaintain the results
Laura Bowman (27:51):
later. Yes, I've heard, I've heard it be called
renting your results. And it'slike, that's a good way of
putting it.
Colette Fehr (28:01):
I don't see it that way personally,
Laura Bowman (28:03):
but I mean, that's the way, that's the way they
talk about it. Sometimes thatyou don't want to rent your
results. You wanna build and buythem. You wanna buy them. Best
invest
Colette Fehr (28:12):
is the word, yeah, yeah. Okay, I see what you're
saying. So we, let's talk aboutthat, getting off of them.
Because I kind of have toLaura's point, even though I'm
saying I don't see it that way.
I kind of have in my mind, Iguess I feel like I've bought my
results, but that it's like alifetime thing. I am terrified
of the idea of ever going offthis drug.
Amy Wrenn (28:30):
Okay, you don't have to come off of it. Okay, let's
say that first, you don't haveto come off of it. But some
people, some people, need it fora lifetime, and some people
don't, okay. So if that makessense, yes, if you're looking at
20 pounds, that is probablygoing to be a shorter term, and
that might look like anythingfrom six months to even 18
(28:54):
months. And then I like to tapermy patients off. We don't just
pull the plug, and I really handhold during that time, because I
want them to maintain the habitsthat they built. If they stopped
drinking a glass of wine everynight, if they stopped having
ice cream after dinner, if theystopped having a snack at 3pm
(29:16):
you have to maintain thatafterwards. You have to maintain
that when the food noise comesback, because the food noise
will come back if you have foodnoise before. So you really
you've flexed and built thismuscle while on the medication,
and now you have to maintainthat off. And I've always given
(29:37):
my patients, I like them, well,I have them give me a red flag
number, and that number needs tobe more than five pounds, less
than 10 pounds. I'd like them tokeep track of their weights. At
home. They don't have to weighthemselves every day but weekly,
because we want to have an ideaof what's going on. And if you
get to say if you gain sevenpounds. Yeah, and you're there
(30:01):
for at least two weeks becausethere's inflammation, there's
there's different reasons whyyou may gain some water weight.
So we really want to make surethat's fat weight. Then I want
you to come back. And we couldstart on a low dose. It may be
once a month, it may be everyother week, it may be, we're
just going to be on it for twomonths. But I don't want you to
come back at 20 poundsoverweight, and there is a list
(30:24):
of reasons why somebody may gainthe weight back. Maybe you have
somebody in the hospital. Maybeyou broke a leg. Life will come
and punch you in the face, andyou have to You're in survival
mode. You can't think about isthis nutritious? Is I gotta hit
the Chick fil A, because this ismy only opportunity to eat
today. So both in there. Yeah,same. So we have, we want to we
(30:50):
I don't want to just leaveanybody once you're done by, I
want to them to be able to comeback and get back on the
medication if they need to, evenif it's just short term, but you
are safe staying on themedication. There is a group of
people, especially if theystruggle with obesity, that they
will need to be on it long term.
And if you have metabolicissues, then you may need to be
(31:13):
on it long term. And that'sokay. I mean, people are on all
sorts of medications long term.
Yeah,
Colette Fehr (31:21):
it's really more to me a function of the way my
brain works. And that food noisefor me has always been so loud
it doesn't go away when I eatsuper clean. It's reduced a
little when there's nothing I'mnot taking in anything that
makes my brain ping, and I justdon't know that it's super
realistic for me to be off it,but I'm glad to hear you say
(31:44):
that I don't have to be. Andright? So everyone's on their
own journey.
Laura Bowman (31:49):
Is there a habituation effect to the drug,
though? I mean, is it? Do youhave to continually, like, bump
it
Amy Wrenn (31:54):
up? So I feel like on semaglutide, there's less of
that, where I've had patients beable to get to a point, and they
stay there, and they're good ontrizepatide, I feel like people
have had to keep going up on itto maintain the results. That is
just what I've seen andpractice. But most patients,
(32:18):
when they get to a maintenancephase. Can just stay on whatever
they're on. Now, if you have alittle bit more weight that you
want to lose, and I don't knowwhere you are on on dosing, but
you may have to tweak it andbump it up a little bit, and
then you can, once you getthere, you could maybe move it
(32:40):
back down and see how you do onthat. But yes, for and if you
have somebody who's gonna loselike, 100 pounds, they're going
to have to keep moving up thatladder, and they're going to
need to stay on it long term,more than likely.
Colette Fehr (32:56):
Well, I've had to, I've had to on the tours
appetite. I've had to go up andup and up
Amy Wrenn (33:01):
and up I see I see that more with trizepatide than
the semaglutide. But I can tellyou, and I don't know your your
medical history at all, but thepatients who do hormone therapy
in addition to a GLP one, havethe best outcomes per the
studies and for what I have seenand practice. If you add in
(33:24):
resistance training to that,it's it's just out of sight, how
the benefits,
Colette Fehr (33:32):
okay, that's really exciting to hear you say
that if this is an issue foryou, and a GLP one could be
helpful for your situation andyour weight. The total picture
that taking doing HRT, a GLP oneand doing really good resistance
training can be the sweet spotfor women in this phase of life,
Amy Wrenn (33:53):
I have had women who do that, who come to me
afterwards and cry becausethey're like, I'm me again. I am
me again. That's how I feel.
That is like the greatestemotional paycheck I could ever
get is having somebody just cryand be so thankful because they
feel like themselves again.
(34:14):
Yeah, yeah.
Colette Fehr (34:16):
Oh, my God, that's so rewarding for you, right?
Because you're really helpingpeople change their lives,
change how they feel aboutthemselves. And it's true. I
think somehow this, like the itstarted with this ridiculous
Hollywood ozempic thing, and theway it was discussed in the
media is, like all of thesestars who are obsessed with, you
(34:36):
know, we see people like DemiMoore, who looks amazing, and I
don't know what she's done andhasn't done, but it started to
get conflated with this idea ofwomen who are obsessed with
being thin at any cost, and thatthey're willing to, like throw
themselves on the fire ofdangerous practices to be thin,
(34:57):
and that's really not what thisis at all. People, and that was
just a media interpretation ofsomething, perhaps based on an
element of Hollywood, maybe noteven I don't know what those
people's situations are, butwe're talking about something
very different here, which isbeing in the best health you can
be at midlife, and that this maybe something that's really
(35:18):
indicated for you and reallyhelpful, but you've got to have
a true medical practitionerguide you.
Laura Bowman (35:25):
I guess what's coming up for me, because I'm
like, in this, like, weird, noman's land of like, I do weight
training three times a week, andI do run all the time, and I
walk all the time, and I, I cantell that midlife is creeping up
on me. And I wonder, I guess thequestion is, where I was
listening to you talk about thisis like, do I, am I at one point
(35:47):
going to have to be optimized?
Am I going to have to, like, dohormone replacement, some sort
of help, just to, like, I feellike I'm running to stand still,
is essentially kind of where I'mat. And I'm like, is it the only
way you get there eventually isthrough optimization of hormones
and insulin, and can I even dothat naturally?
Amy Wrenn (36:09):
So first of all, nobody, nobody has to do
anything that they're notcomfortable with, but there are
options out there for you, andit does the older you get, I
feel like it's playing Whack aMole. Personally, you fix this,
(36:30):
then that goes, you fix this,then then that goes. But just
speaking from the bio identicalhormone replacement therapy
scope, that is a two parter. Youhave the one part where you have
patients take it because they'revery symptomatic. They might
have intense brain fog. They mayhave intense depression, or even
(36:52):
like slight depression, they mayhave the weight gain, the loss
of libido, and so it'd be hotflashes, and they really want to
treat those symptoms, becauseit's interfering with their
everyday life. So they willstart on some hormone therapy to
(37:12):
help with that. Now, noteverybody is symptomatic. Most
most people are at least alittle bit. But not everybody is
some people are terrible, and sothe people who aren't
symptomatic, but they getstarted on hormone therapy,
those people tend to do itbecause they want to preserve
(37:37):
the last decade of their life.
They have seen a family memberwith frailty, broken hips,
dementia, having to havesomebody else take care of them.
And they want to be vibrant andindependent as long as possible.
And the studies have shown thatif you start hormone therapy
within 10 years really, if youcould get it within five years
(38:01):
of menopause, that you canprevent things like
cardiovascular disease, which,by the way, is leading cause of
death of women. You can preventdementia and Alzheimer's. You
can prevent osteoporosis, whichkills women as well. You can
also prevent UTIs. I think Icould go whole UTI rabbit hole.
But I don't think women realizethat once they are in menopause,
(38:24):
the rate of UTIs and that a UTIis not what it was in your 20s.
It's not like burning and anurgency. It's I'm seeing things,
I'm hearing things. I'mhallucinating. It's a whole
nother ball. So it is to preventthose things. And I would say
(38:46):
that bioidentical hormonetherapy is natural because it is
the same chemical compounds thatthe hormones your body produced.
So it's not like birth control,which is kind of like estrogen,
kind of like progesterone, butit's, it's not the same thing.
(39:10):
And so and it's, it is so strongthat it shuts down your own own
ovaries, where hormone therapyis just a little bit it's just
like a supplement to ease thesymptoms and to help prevent
those long term diseaseprocesses, sorry, rabbit hole,
yeah, we
Laura Bowman (39:33):
have to have you back on to talk all about this,
because I feel like this couldbe its own episode. But I guess
what I'm hearing from it islike, I feel like this again,
it's coming up for me is like,there's going to be a difference
between women who optimize, andyou can make that mean whatever,
like, variation of things youdo, and women who don't like
there's going to be a differencefor sure.
Colette Fehr (39:55):
Yeah. So obviously, menopause is
happening. I'm turning 52 thisyear. So I'm in it. And if I had
known what I've learned sinceLaura and I started the podcast
and started having guests on whoare better educated like
yourself about the realities ofperimenopause and menopause,
we're going to Dr Vonda writesconference on menopause. Those
(40:16):
things opened my eyes to stuff Iwas not getting from my doctors
at all, and you know, I can't doanything about the time I've
lost, but I'm trying to getmyself on track now, and my
personal motive for hormones isreally about exactly what you
said, bone health, heart health.
It's not really so much abouthow I feel right now or my sex
(40:36):
life, and nothing wrong withthat either, but it's really
about the future and wanting todo whatever I can that's the
healthiest for my body. And Ijust didn't understand how
important these hormones are toall of that. Until recently, the
Amy Wrenn (40:51):
misinformation is out of control with social media.
There's there's so much outthere, but Dr Vonda right. She
is fabulous. She's actually my Isee her myself for a hip injury.
She is absolutely wonderful. Andif, if for listeners, you cut
(41:13):
this out if you want, but if youwant to follow somebody on
social media who's really givinglegit information. Dr Vonda
Wright, follow her on on socialmedia, because she puts out so
much and she's she's not agynecologist. She's an
orthopedic but, and she'spassionate about it, because she
(41:37):
sees these frail women with allthese broken bones. So I would
definitely say follow her andanybody she recommends,
Colette Fehr (41:45):
right? And Dr Kelly Casper son, too. She's
amazing.
Amy Wrenn (41:49):
Is my favorite. I know you guys spoke with her,
and I'm so jealous. I would fangirl so hard.
Colette Fehr (41:55):
I definitely love Dr Vonda Wright and the work
that she's doing to bring all ofthese great women to the
forefront. It's so important. Ithink that conference last year
was life changing, yeah, yeah,yeah. We'd love to have you back
on again too, because there's somuch more to discuss. This has
(42:15):
been so helpful. Before you go.
Can you give our listeners anidea of how they can find you,
where they can follow you, thatkind of good stuff.
Amy Wrenn (42:24):
Sure, I am on Instagram at NP Ren, and I think
it's just at NP Wren, and Wrenis spelled W, R, E, N, N, and I
try to put out some educationalmaterial. I'm not great at
putting it out all the time,because I am working with
(42:46):
providers a lot, and I've I'vemade a course recently, a BHRT
course, online course forproviders, and I'm currently
working on an advanced medicalweight loss course for providers
as well. Which GLP ones is apart of it, but it's not the
whole thing, because, certainlythey're not for everybody. Not
(43:06):
everybody's going to qualify.
And I want providers to have allthe resources available to help
their patients. So I'm workingon coursework a lot, but when
I'm not doing that, I do try toput some helpful tips out on
Instagram as
Colette Fehr (43:21):
well. I love your Instagram, and by the way, it is
NP, underscore, W, R, E, N, N,and we'll also have this in our
show notes too. Thank you, and Ihope, selfishly that you'll
start seeing patients again atsome point, because it's needed,
yeah, and that you have thewhole picture, and that's what
is missing in so many providers,even these great, well educated
(43:45):
doctors like you said, peopleare not learning this in medical
school and nursing school in thepast, so we're all trying to get
up to speed, and you know, it'sgoing to be different for
everyone. But we're so gratefulto you for all of this wonderful
information that's going to helpour listeners so much. Thank you
for being here.
Amy Wrenn (44:03):
Great. Thank you guys so much for having me. I
thoroughly enjoyed it. Well
Colette Fehr (44:07):
we did too, and we hope all of you out there
listening got some greatinsights from our couch today.
We will see you next week.
Laura Bowman (44:15):
Bye, guys. You.
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