Season 4, Episode 5: Optimizing Weight Loss: The Role of Functional Medicine and GLP-1 Medications with Dr. Latisa Carson

Evelyne: We’re going to dive into all things GLP-1 today. We’ll talk about Ozempic, such a hot topic right now, and it’s come up on the show before with various guests, and we’ll continue to talk about it because I’m sure you’re working with patients or clients who are using them, whether you are the one prescribing them or not. So I wanted to have this conversation to learn more about Dr. Carson’s experience using GLP-1 receptor agonists with her patients. Latisa Carson is a board-certified obstetrician gynecologist and medical weight loss specialist. Okay, this next part is unbelievable and amazing. She is the only female African-American obstetrician gynecologist in solo private practice in the entire county of San Diego. Unbelievable.

Latisa Carson: Yeah.

Evelyne: Yeah. Her residency training was completed at Southern Illinois University. Her internship was spent at Martin Luther King Charles Drew Medical Center in Compton. She’s a graduate of the University of Kansas School of Medicine, and she’s a fellow of the American College of Obstetricians and Gynecologists, as well as a diplomat of the American Board of Obesity Medicine.

She has a special interest in helping her community achieve healthier weight and active lifestyle. She offers physician-supervised medically-supported weight loss programs, and these individualized programs offer nutrition education, behavior management, weight loss medications, and exercise guidance. She is a member of the Obesity Medicine Association and the Institute for Functional Medicine. She served on the board of directors for the Horn of Africa, a nonprofit organization that assisted African refugees and immigrant families. She has been recognized for her leadership and community service by various organizations, I won’t name them all. She has so many accolades. She provides an annual college through the Ebony Pearls Foundation.

And personally, she’s married to her college sweetheart. They have two children and enjoy traveling to national and state parks. What a resume and just what an honor to know you. I’ll never forget the first day we met, which may or may not come up. But how did you get into medicine in the first place? What’s your story?

Latisa Carson: My mother is a nurse, and so in high school I would shadow her sometimes in the summertime, and I just saw the care that she gave patients. Even after they were graduated from the home health agency, she still would go and see about them, and she felt like they needed a little extra care even though she wasn’t getting paid. And so one of the first nurse practitioners that I met worked in an OB GYN office here in San Diego, and I was just really inspired that a nurse could actually see patients in the office. And I said, “Wow, I didn’t know that this could happen and how do you do this?” And so actually I was admitted to nursing school at first.

And my mother was always pushing me. She says, “Oh, no, no, no, I think you can be the doctor. You can be the doctor.” And so I changed my major close to my junior year. I had to start all over with some of my pre reqs, but I was able to get it done. I just didn’t want to do the math, the math. So I did what I had to do. I had quite a few tutors in college because that math was killing me, but I was able to get it done.

Evelyne: That’s amazing. I love that. And recently you’ve also gotten into functional medicine. Tell us a little bit more about that.

Latisa Carson: When I first started to get into obesity medicine was when I realized that my postpartum patients weren’t getting their weight off and they were actually what we call weight stacking. After each pregnancy, they would gain 25, 30 pounds with a pregnancy. They wouldn’t quite lose that pregnancy weight, get pregnant again, stack on another 25, 30 pounds. And so I wanted to try to find a way to help them lose their weight. Also, my menopausal patients, pre-menopausal patients, they were starting to gain weight and were kind of asking for advice on weight loss. I think what really pushed me a lot was that I had a colleague who was a cardiologist, and he would tell his patients, “Look, you need to lose 15 pounds and when you get back in three months, I want you to lose 15 pounds.”

And they would come to me and they’d be like, “Oh, Dr. Such and such said I had to lose 15 pounds.” I said, “Well, did he tell you how to do it?” “Well, no.” I’m like, oh. And then I thought to myself, do I know how to tell you how to do it? So that’s when I started doing some research and taking courses, some of the courses that the Obesity Medicine Association would offer, and eventually I became board certified. That was not my intention to become board certified on obesity medicine. I just wanted to educate myself on what I needed to do to help my patients. Then when I wanted to really grow my practice, I hired a couple of business coaches. And when I met with them, I found out that they were functional medicine doctors, and I said, “Well, what is functional medicine?” And when they told me what they did and how they went about their studies, then everything began to click. Because when I named my practice, I also named it and Wellness Center, and it just all fell together.

I said, “Oh my God, my wellness center is the functional medicine.” I said, “Well, how do you do this and what do you do?” So they told me about Designs for Health. I said, “Well, where is that and how do I get somebody?” And they told me how to do it. And then you showed up and I was… I’ll never forget that day because you had made the little website for my functional supplements. It had my colors and my picture, and I was so excited I kicked the trash can in my office. I like, oh my God! So it’s just been… And then you told me about the Institute of Functional Medicine. And I went on the website, I think before you left or right after you left. And I just was completely drawn in. I said, “Oh my God, Evelyn, thank you so much. This is what I need.” And then I did the applied functional medicine for clinical practice, and it’s just been a wonderful journey actually. And for you to be a part of that, it’s been tremendously exciting for me.

Evelyne: Aw, thank you. Well, I feel like the seed was already planted for you and I just helped water it, or provided some fertilizer and then you just sprouted.

Latisa Carson: Yes, I’ve grown one leaf.

Evelyne: I think you’ve grown a little more than that. So let’s set the stage for this conversation a little bit and start with some basic definitions. So what is GLP-1 and what are GLP-1 receptor agonists?

Latisa Carson: Well, GLP-1 itself actually is an incretin hormone that’s made by the gut. And so the GLP-1 receptor agonists are basically, they mimic that hormone and they attach to that receptor in the gut so that you make more of GLP-1 by taking the medication itself. So that is what GLP-1. People say GLP-1, but that’s what it is.

Evelyne: And it stands for?

Latisa Carson: Glucagon-like peptide one.

Evelyne: Okay. And tell me a little bit more about the differences in the medication. And I’m also curious if you can describe the difference between just the GLP-1 drugs like Ozempic, and then we also have the dual agonist drugs like tirzepatide. So those are the Mounjaro and Zepbound, that work on GLP-1 and another receptor. What are the differences?

Latisa Carson: It’s just different receptors in the gut and in the brain. Same area, same idea, to increase that hormone, that peptide so that it would increase your satiety and send signals to your brain to decrease cravings. So semaglutide was the… We’ll call it Ozempic, semaglutide was used for diabetes. And during the studies of semaglutide, they saw that the patients were losing substantial amounts of weight. So when I saw some of the initial studies in the phase two and phase three trials when I was going to obesity medicine conferences, I knew. I said, “Oh my goodness, this medication is going to be used for weight loss.” And we knew that the weight loss caused them to lose their diabetes, so that’s why they repackaged it as Wegovy naming it something different and giving it the indication of weight loss. But it’s definitely been an extremely exciting time in obesity medicine to have these types of medications enter the market and be able to help people substantially.

Because before we used to say, “Oh, a substantial amount of weight loss is 5%.” 5% really isn’t that much weight loss, but it’s still used as a measure to say, hey, you’ve had significant weight loss. If you lose 5%. Because you know that patients that lose 5%, they can actually turn around their blood pressure, they can turn around their diabetes, they can turn around their fatigue and these kinds of things. So the tirzepatide goes to two different receptors, which boosts the hormones even higher. And I think it allows patients to lose a little bit more weight than the semaglutide because the studies have shown that you can lose a little bit more weight taking the tirzepatide and your side effects might be a little less, and I think going to two different receptors maybe helps your body adjust. And so some of the side effects are a little bit better with tirzepatide.

And the three receptor is probably going to be released maybe in 2025. And there are going to be other medications on the market that are going to be oral medications for weight loss. So it’s definitely started a tsunami of new meds that are going to enter the market, that are going to be helpful to support the patient in their weight loss journey.

Evelyne: That’s a great explanation, thank you. And what’s the difference between using the brand names versus say, compounded semaglutide, and then injection versus oral? What are you using in practice?

Latisa Carson: Well, currently I am using semaglutide compounded. As a gynecologist, I’ve used compounded medications and I’ve had a relationship with the compounded pharmacy for over 20 years. So I’m very comfortable with compounded medications. You just have to be careful, kind of know your pharmacist, know the company, know the rep, know what you’re getting into when you use compounded meds. Hopefully the compounded pharmacy is using their products from an FDA approved manufacturer, which is important for safety measures. So when you use the branded medication, it’s gone through the clinical trials, it’s gone through the FDA approval. With the compounded medications, they haven’t gone through studies or all of testing and things the that branded medication has gone through. But the FDA does allow compounded pharmacies to make a medication if it is on the drug shortage list. So that is why compounded pharmacies are able to make semaglutide into tirzepatide because they’re currently on the drug shortage list.

So the FDA really would not allow compounded pharmacies to make a branded med if it wasn’t acceptable. So I’m very comfortable using the compounded. It comes at a fraction of the cost. I can wrap around a complete comprehensive medical weight loss program with the medication, and it’s still less than if they would’ve had to pay for the medication cash. So I think that’s a great benefit for patients who don’t have the benefit of either having a medication that’s covered for weight loss by their health plan, or even that’s covered for diabetes, and they can’t find the medicine. The medicine is on shortage. A lot of times patients are running around all over the city or they’re off meds for several weeks because they can’t find the medication. So getting it compounded, I always have it available.

Evelyne: And is it true that it’s hard sometimes to even get it approved by insurance as well?

Latisa Carson: Well, what happened to a lot of patients and my newer patients in the practice this year, is that their doctors have always, from the beginning of time, used medications off label, if we find out that that medication does something else. So that’s what doctors were doing. They were like, “Oh my goodness, this is really helping my patients lose weight.” And they were prescribing it to patients that didn’t have diabetes. So the health plans, because the drug is so expensive in the United States, they decided a lot of them, January one of this year that if you didn’t have diabetes, you couldn’t get Ozempic or Mounjaro, and then they don’t cover the weight loss, Zepbound or Wegovy. So then patients were caught in a loophole. And so that’s where the compounded is just so important so that patients can be in program and continue to lose weight.

Evelyne: How long have you been using the compounded semaglutide now in practice?

Latisa Carson: I have been using it for about 18 months, I think.

Evelyne: Okay. So in that time, you must have some great data because you see so many patients and you still take insurance, so you do see probably more patients than the average physician. So I’m curious, what are the adherence rates to staying on semaglutide and what are the success rates? And how long does it typically take to reach their goal weight? And then I have some follow up questions based on those.

Latisa Carson: It depends on how much weight a patient needs to lose. If you are 325 pounds, it’s going to take you a substantial amount of time to get to your weight loss goal. If you only need to lose 30 or 40 pounds, it’s going to take you a shorter amount of time. So everyone is different, and that’s why I love that I’m able to individualize the program to whatever that patient need. Because I’m finding a lot of my colleagues… Actually, my weight loss practice is a cash program. I take insurance for my GYN practice. So it really frees me up to be able to individualize the management of the patients. I’m not ‘forced’ or questioned about why I keep a patient on a certain dose for a certain amount of time instead of titrating them up. Or why is this patient still on the meds? Is this patient responding? Are they not responding? Okay, then we’re not going to cover the medication any longer. So this frees me up to be able to individualize and really be able to help the patient on my own terms and on their body’s own terms as well.

Evelyne: I have a follow up question to what you just said in terms of dosing and titration. Can you tell us a little bit more about that?

Latisa Carson: So the medication is titrated up to optimize the weight loss. So we started 0.25, and usually after four weeks we might titrate up to 0.5. After four weeks, up to 1.0. After four weeks, 1.7. After four weeks, 2.4. So not everyone reaches the highest doses. I have patients who lose weight on 0.5, and they don’t ever have to go up higher. Or they lose weight on 0.1 and they don’t have to go up higher. Sometimes you’re limited by the side effects. And the common side effects are nausea, constipation, diarrhea, fatigue. So if they have a lot of nausea on 1.0, we go back to 0.5 just to see how they do. So it’s individualized in that way. Sometimes when we go up on the dose, when we’re titrating up is when we might within the next 24 hours or so, get some of those side effects, and then it usually will dwindle off. And all of that has to be managed with their hydration and with their protein intake and all these things. All these things are advised and recommended along the way.

Evelyne: Okay. I want to dive more into some of those side effects and some of the things that you do alongside those. I do have a question, you mentioned that dosing, is that a weekly injection?

Latisa Carson: It is a weekly injection, yes, the semaglutide

Evelyne: Okay. And then I’m assuming that… Well, of course every patient is different, so some people might stay on it longer. Generally, now that you’ve been doing this for a while, are you keeping patients on it once they’ve reached their goal weight or do you then titrate back down? How does that work?

Latisa Carson: We just individualize that approach. And part of it is just this is a new frontier in medicine and a lot of us are learning what it is that we can do to help support the patient. So some patients go off code. And I’m starting to kind of advise patients, maybe we don’t want to go off code, maybe we just want to titrate backwards and see how that works. But some patients go off code and they do just fine. The studies have shown that 80% of the patients will regain their weight after they get off the medication.

Evelyne: Did you say 80%?

Latisa Carson: 80%.

Evelyne: That’s really high.

Latisa Carson: It is really high. So it’s like, well that 20% that doesn’t regain the weight, what is it? What is the special sauce? What is magical about them? What are they doing? So I think there are going to be some studies in the future about that 20%, and what do we need to do to get that 80%, get this back, widen this out a little bit better? And I think that’s why using conventional medicine and using functional medicine has been very helpful for me. Because I can use my functional medicine toolkit, toolbox, to try to help patients transition out of the pharmaceutical medication or help support them along their journey.

Evelyne: And I’m curious, because you’ve done the medical weight loss programs for a long time. You were using one program, like a lower calorie program, and then using some of our shakes actually in conjunction with a diet plan. Are you still doing that, or is that now a separate program from the patients who are doing a semaglutide program with you?

Latisa Carson: You know what, it all builds upon itself. So I think what has been exciting, because I’ve been doing medical weight loss for about 12 years. So I think what’s been exciting is everything that I’ve been able to add to tool kit to help. So in the beginning, my weight loss program was a calorie deficit diet, and I was also using some supplements and some protein shakes and things like that to help the patient. They were on a Mediterranean diet, and they actually did very well, a lot of them did. But some of them needed a little bit more. And that’s when I started doing pharmaceutical medications to help with weight loss. So I distribute Phentermine out of the office, and then I would prescribe FDA approved medications for weight loss, and then the semaglutide is just added on top.

So the foundation of the weight loss program is lifestyle change. How can we get you to make better choices? So I partnered with a functional nutritionist and she actually helped me design a diet plan for the patients that’s a Mediterranean diet. The Mediterranean diet is the most steady diet on the planet, and it’s one of the most heart healthy diets. So that is the foundation of the program, trying to get people to make lifestyle changes and then support them along the way with supplements, and protein shakes, and behavior modification, and exercise and all the things that they will need to maintain their weight loss. Because people think, I’m just going to take this medicine and this weight’s going to drop off and I’m going to be good. Those are the people that do the worst in the program. They’re not following anything. They didn’t even open the app for the diet. It’s like, no, we know you haven’t opened the app. So just trying to get people on programs. Sometimes they just need a little push.

Evelyne: Yeah. I’m curious, since you have used the Well World app much, are you using it still in conjunction with the semaglutide now too?

Latisa Carson: Oh, absolutely. So it’s part of the foundation of the program. It’s all part of it. So the Well World app is what we use. I can add their functional supplements into that Well World app. Part of our program is the pure pea shake, that is our protein shake in the program. So everyone gets that as part of their little uniquely fit kit when they first start. So yes, Designs for Health, the Well World app, they’re just all part of my program.

Evelyne: That’s great. And sometimes we don’t mention what we use at all, but hey.

Latisa Carson: Oh, I’m sorry-

Evelyne: In this case, no, no, no, no, no. In this case, I think it was perfect. So let’s talk a little bit more, actually no, before we go to side effects, I have an additional question. So when patients get into a program with you, what does that look like? Is there health coaching as well? Are there meetings with you? Are there meetings with other people? How often do they come to you? What does that look like in a comprehensive support program?

Latisa Carson: So for me, my staff has fully bought into the program, and actually they have been patients in the program themselves. So I invested in them. So I helped them become Health Coach certified.

Evelyne: I love that.

Latisa Carson: My office manager and my medical assistant are Health Coach certified, so they really help with the patients. The patients love to see them and love to come in. Patients can come in as much as they want, they can come every week. So that’s the difference between an insurance-based program, because insurance-based program, I think you only get 10 visits per the year. So with our program, you can come every week. If you want to come more often and come in here and cry on shoulder or whatever it is, we’re here for them. So I really like that part because it doesn’t limit the amount of times I can see a patient.

And the studies have shown that the more touch points that a patient has in a weight loss program, the more successful they are. And sometimes they just drift off. And I know that the primary care doctors are strapped. It’s very hard to do primary care and weight loss at the same time, and the patients may only have an appointment every three months. Well, my God, I mean, that is a long time to not see a patient to see how they’re doing, if they’re even sticking to it or they’re not getting strategies for weight loss, or strategies to manage their side effects. And so this way, I think we just have a really comprehensive, very close program. It just brings a lot of joy to all of us because we get to know the patients very well. We see them so often. That is one good part about my practice.

I have another colleague who has kind of a mirror image of my practice up in Corona. Well, people have to travel two to three hours to get to her office because of the traffic in LA. So those patients tend to come once a month and then take their injections home. So about 80% of her patients actually take their injections home. About 20% of my patients take their injections home. So it’s just amazing how we can offer the same kind of program and how patients engage differently. But I would love to see our data. Because I think that my patients probably lose more weight than hers.

Evelyne: You’ve got to track that, yeah. That’s amazing. If she wants to compare.

Latisa Carson: If she wants to compare. Comparison is the thief of joy.

Evelyne: But it’s great data to have. And I love what you said about… I mean I think we instinctively know this, but I’m sure there are studies because you’ve been in this for so long. The more touch points we have, the better the results and the more the weight loss. So that’s great. And then when patients come to you and see your staff or you, is that then when you’ll do a dosing adjustment or just kind of diet advice? Or this is the amount of protein that you should be ingesting every day? What does that look like?

Latisa Carson: It’s kind of all those things. So we do have a body composition scale, and that is very helpful because we see where they’re losing the weight. So it tells us their percentage of their body fat, their free fat mass, their water, their muscle, their BMI, their metabolism. So we’re able to see that every visit because they get on the scale every visit, so we know what’s happening. And if we see that they’re losing quite a bit of muscle… And muscle loss is expected with weight loss. In fact, the studies are showing that to lose even 20% of muscle is normal. And they’re saying that that muscle loss does not decrease the function or the strength of the muscle, which is encouraging. Because I know a lot of people get very concerned about muscle mass loss, but that’s where you’ve got to do the strength training. You’ve got to do the exercise and you got to get the protein in. That’s why you have to do all the pillars of health and weight loss. You can’t just take the medicine and run out.

Evelyne: And I have a follow up question on that. Because I know that’s a concern that we’ve been hearing a lot. Oh, it causes all this muscle loss. But just weight loss, even not using semaglutide medications also leads to muscle mass loss, correct?

Latisa Carson: Yes it does.

Evelyne: If you’re not exercising. Okay. And getting into some of the side effects. I know that we’ve heard about some of the extreme side effects, often because that’s what we usually hear in the media is the extreme things. Do you find that you’ve seen that a lot in patients? Is that common like gastroparesis or even the Ozempic face?

Latisa Carson: I haven’t seen that in high percentages in my practice, no. Have I had a few patients drop out of the semaglutide program because of the side effects? Yes. That’s not all we offer. And if you look at the studies that go head to head with Phentermine and Contrave, and Qsymia, and tirzepatide, semaglutide, over the years period, yes. Semaglutide, tirzepatide, they lose a lot more weight. But on those oral medications, they can lose just close to as much weight in a year’s time as those that are taking the injection. It just comes off a lot slower.

It’s very encouraging, especially when you are of a larger size, to see yourself lose a lot of weight, especially in the beginning because it encourages them to stick to it. I had a patient who was 325 pounds and she lost 11 pounds the first week. That was very encouraging to her because she could see herself getting closer to 300, which was amazing for her. So I just think that it’s just the tolerability and most patients are able to tolerate it, but some are not. And yes, there are some extremes of side effects or complications. A lot of those mostly happen in patients who are diabetic. The diabetics are the ones that are a higher percentage. They get gastroschisis, excuse me, gastroparesis, that’s the obstetrician, pardon me. Gastroparesis and bowel obstruction. The patient that does not have diabetes is at a lower risk for those kinds of complications.

Evelyne: Why is that?

Latisa Carson: We don’t know.

Evelyne: Okay.

Latisa Carson: We think that maybe it has to do with inflammation, but we don’t know why.

Evelyne: Oh, in your diabetics, do you also… Or actually just in anyone, do you see that their blood sugar at any point goes too low, that they get hypoglycemic?

Latisa Carson: No, because if you make sure that they’re checking their sugars regularly and that they’re titrating back on their diabetic medications, they usually don’t have any issues.

Evelyne: Okay. So you just said something interesting. You’re having them track sugars. So some follow up questions on that. Is it because they’re diabetic, they’re already using the finger prick? Are you having them use continuous blood glucose monitors? And also, I didn’t realize that they’re still on other diabetic medications. I guess I would assume that if they’re taking this, then that would be the medication to manage the diabetes.

Latisa Carson: Yeah, so what I use, I tell them that I don’t manage their diabetes, just to keep things simple and to keep them with touch points with their primary care doctor. But I usually recommend that they go off their medicines and check their sugars and see how we’re doing. And they usually do just fine because they’re on… Obviously this medicine is used for diabetes, so they usually do very well. But some patients do continue to take Metformin as we go along. It just depends on what is going on with their management.

Evelyne: And then do you have them use finger prick or do you have them use blood glucose monitors?

Latisa Carson: They’re just using finger prick.

Evelyne: Okay. Earlier you also mentioned some of the previous weight loss medications that you used to use. And just really quickly, because I’m actually not familiar with any of the ones that you mentioned, I’m sure a lot of listeners are. But just very quickly, some of those that you used to use, how are those different? What mechanisms were those working on?

Latisa Carson: Actually again, when we talk about doctors using medications off label, these are medications that were used for other things, that we found out that patients could actually lose weight on. Phentermine has been used for over 50 years. It is the old school, first line method. It is a appetite suppressant, but it can cause an increase in blood pressure in people with anxiety. So a lot of times we weren’t able to use that with people with hypertension or anxiety. The next medication is Topiramate, which is a medication that’s used for migraine headaches. But we found out that patients got a little bit of appetite suppressant, they were able to lose weight. And so we were able to give Topiramate, put it together, Phentermine and Topiramate is called Qsymia branded. You can separate those and prescribe those separately to make your Qsymia.

Contrave is a medication that’s also used. It’s a great medicine, especially if you have hypertension, and it is Naltrexone and Wellbutrin, which are medications that are used in psychiatry for addiction. So helps patients stop smoking. Also, it was used for depression. So if you put them together, then they help kind with the addictive part because a lot of times people do have food addiction when they carry extra weight and it helps with their depression, helps them feel better. And it did a little bit of appetite suppressant.

So those are kind of the oral medications that are still used. I still use them. There are patients that come and just do the foods only, that do the foods and the nutritional and the functional supplements, the nutraceuticals. Or they do the pills. So I can do it all. And that’s why I like the program because you don’t have to come in and use the semaglutide, although a lot of patients are coming in for it because they’ve heard it on TV and heard Oprah talk about it and whoever, whatever. But maybe they don’t qualify or maybe they can’t tolerate the medicine. So these are the other things that we can offer.

Evelyne: Interesting. Let’s talk about the side effects a little bit more, just some of the little ones. How are you… Well, not little, but maybe not as drastic as the ones I mentioned earlier. But some of the things like the nausea and constipation and how are you managing those generally?

Latisa Carson: Well, usually we try to figure out when the patient’s eating, make sure they’re eating enough, make sure they’re getting enough protein in and make sure they’re staying well hydrated. Otherwise I can start prescribing medications or supplements for their nausea or for their constipation or for their diarrhea, whatever it might be.

Evelyne: That’s great. And then something I’ve heard from some people too is that they just have no appetite whatsoever. So is that just that they have… They’re on too high of a dose and that needs to be backed down, or is that pretty common during treatment?

Latisa Carson: Most patients don’t say they don’t have an appetite at all, although there are some. I mean, I do have some in the practice and that’s when we remind them, you have to eat and you have to eat. You have to get your protein in, you have to get your water in, you have to do the things that you need to do. But that’s the part that the medicine that we want to work and that lets us know that they’re going to be a responder. There are patients that take the medicine, they have no side effects and they don’t lose weight. So maybe that is not their obesity path because obesity is very complicated and we’re still doing quite a bit of research in the area. So maybe their obesity pathway’s another way. And maybe some of these newer medicines that are coming out the next two or three years will be their pathway for success. So we’ll just see what the future brings as far as some of the medications as well.

Evelyne: That’s such a great point. Just one more thing on the side effects, I did want to mention that we did create some protocols that are available to practitioners to assist with patients who are on GLP-1s. So both during treatment to potentially manage some of the side effects, and then as people taper off. So I just want to throw that in there. When you were talking about the other drugs, the addictive part came in and I think this is super fascinating, some of the research that we’ve seen on these GLP-1 medications and their effects on addictions like alcohol, maybe addictive shopping and all of that. So I’m curious about your experience in practice seeing some of this.

Latisa Carson: Personally, because most of the patients that come into my practice are coming in because they want to lose weight. They may or may not have other addictions. But like you said, some of the literature is showing with other addictions such as alcoholism and smoking and other issues. So it may be help with the patient with those other things if that is another issue for them. And Ozempic just got the… It might’ve been Wegovy, same medicine, pharmaceutical companies are smart. But they did get the indication for cardiovascular protection. So if you have a patient who has a risk for cardiovascular disease, they may qualify for Wegovy from their health plan.

Evelyne: Oh, interesting. Okay. And have any patients just mentioned to you that even just cravings for other things lessened? If it wasn’t maybe a clinical addiction… I’m not even sure I’m using the right terms. I think, you know what I mean?

Latisa Carson: Yeah, I think what has been for them exciting is the food chatter is gone, so they don’t walk into the grocery store and hear the brownies calling their name from the corner. So I think that has been very good. Other addictions, maybe something they haven’t particularly revealed to me that they have and that is helping them. But it’s not something that we’ve talked about extensively with the patients in the weight loss practice.

Evelyne: You know when you say things like that, sometimes I just want to try it just for a little bit because I do have lot of the food chatter too, and I wonder-

Latisa Carson: Oh no.

Evelyne: What that would be like.

Latisa Carson: Oh, but I think that I could recommend CraveArrest.

Evelyne: I know, I know. Well, I guess one of the running jokes is that there are so many products that we always talk about and then I always think, oh, I need to be on that. I need to be on that. And then I have my regulars. But you’re absolutely right, I do need to give that another try. So I know that you said that it’s individualized to each person, but what are some of the guidelines that you use to either taper people off? Do you have people just stay on it long term? And do you find that your patients with your program are more successful in being able to either stay off of it or stay at a lower dose?

Latisa Carson: Actually, for the most part, a lot of the patients have done very well, unless they just haven’t come back to tell me. So those that… Maybe because there’s a lot of shame in weight loss and a lot of people feel like they have personally failed. So a lot of times they’re just kind of hiding and then they’ll come back if they’re having some issues. So for the most part, so far, because I’ve been doing it only for 18 months, most of the patients have done well. And some of them do begin to gain their weight back and do rejoin the program, whether it is oral medications or if they go back on the semaglutide. So right now we’re just trying to figure out what works for each patient individually. Are they going to have to come every 10 to 14 days for an injection instead of every seven days? Can they go to once a month?

So we’re just trying to see what works and just try to support them with our other supplements and things to see if we can help them. My personal goal as a physician and especially as a functional medicine physician is I really would love to get them all off of the medicine and be able to maintain on supplements and lifestyle and diet only. But is that realistic for everyone? No. Some people are going to need medicine for a lifetime. Just obesity is a disease just like hypertension and diabetes and thyroid disorder or whatever else, autoimmune disorder someone may have, that may have to be managed their entire lifetime. So we’ll see, how the patients respond and what works for some may not work for others.

Evelyne: Yeah. I have some follow up questions based on some things you just said. So with the dosing too, there’s a lot of talk, especially in our community about micro dosing. Is that something that you have experimented with in your practice?

Latisa Carson: Not yet, but at one of the national conferences recently in some of the breakout sessions, some of the doctors talking about microdosing, I don’t know that they’d actually done it yet, but we were all in discussion and trying to see how we were going to implement that in our programs, if we thought that the patient was appropriate for it.

Evelyne: And I think that’s the key word, again, it’s all about that individualized medicine. I’m also curious about the mindset aspect. You sort of alluded to that, but how are you addressing the mindset of the patient? Because it’s still about the person, not just like the medication.

Latisa Carson: So I think for me, if a patient comes in for a gynecology visit and we start discussing their weight, you just kind of have to figure out where they are in their mindset as far as are they just contemplative? Is this something that they’re just inquiring about or have they decided that, hey, I want to do something about this and I want to show up. The good part about Denovo patients that I call them, patients that find me, that Google, they’re looking for this. They have already decided, I am doing this thing. I’m coming in, I’m going to get this done.

So that’s the part that I enjoy about that practice is because the mindset is already geared in the direction that it needs to be in. But there is a mindset about weight loss and committing to it, because it’s a daily commitment and everything that they do from waking up and drinking that first 12 ounces of water and trying to get half of their weight of water and ounces in a day. I mean, you’ve got to be intentional about what you’re doing. And so that does require a certain mindset. So we try to help with that. The behavior modification is an important part of the practice and trying to give them strategies to stay on track.

Evelyne: And then speaking of obesity medicine in general, since you are an expert in obesity medicine, something that’s come up maybe a few times on the podcast but not deeply is, obesity is multifactorial. And so where does trauma come into play with all of this? We’re not just physical bodies. There’s that aspect, almost the spiritual aspect, but then there’s also the trauma, and we know that ACEs, the adverse childhood experiences are associated with obesity later in life. Can you speak to some of that?

Latisa Carson: Well, I think that I find that a lot of patients who are carrying extra weight are just carrying trauma from childhood, and this is a way for them to escape and to get comfort in food. So we kind of discuss their childhood, their background, their family a little bit. Did obesity run in the family? How do people see food in the family? That kind of thing. So those things are very important, and a lot of times the patients that are actually food addicts are coming from trauma. And so I definitely encourage therapy for a lot of the patients to try to get to the bottom of what is going on with them and how they’re using food to manage their mental health. And so I definitely try to partner with, or try to get them to partner with a therapist to get them the assistance that they need.

Evelyne: Yeah, that’s really great. Thank you for sharing that. I’m curious, as a physician who still is working in the conventional world, and you were delivering babies for how many years up until recently?

Latisa Carson: Oh, wow. Yeah, I actually delivered babies in my private practice until 2022. I still deliver babies, but now deliver them on my own terms. So I do a little hospital call to cover patients that show up without a physician or that show up without care, or a local federally funded clinic, I take call for them. So that gets me my OB fix because it brings me a lot of joy. It is a little different than my personal private patients because I knew them for generations being here for more than 20 years. I know their sister, their aunt, their cousin. What would be fun is the father of the baby, sometimes they would get divorced and he’d bring his new wife.

So it just kind of shows just how bonded we became, even with the fathers of the babies. I mean, to me that was one of the ultimate compliments was for him to bring his second wife or both wives. Sometimes when they come here from other countries and they have two wives, I’ve had two wives come. So that part I miss, the closeness, feeling like I was part of their family. But I still get a lot of joy at delivering babies at the hospital, for the clinic and for the hospital.

Evelyne: I’m curious, since you are still doing that, what do you wish was different in the hospital? And maybe it’s not the best question because delivering babies is a little bit different from maybe other things that people do in the hospital, or other conventional physicians. But do you feel like it’s possible to incorporate some of what you’ve learned in the integrative and functional medicine into that model? Is there a way that you would’ve done it differently had you learned some of this earlier?

Latisa Carson: Oh, I think that it would’ve definitely made a difference in the way I delivered care and the way that I counseled patients. But I always knew that diet and nutrition and exercise were important from the very beginning. So I always incorporated that. I always found a compounding pharmacist, partnered with them to treat my patients, my gynecology patients in my practice. So it was always part of who I was and my practice philosophy. But being able to find functional medicine, I can’t even begin to tell you the satisfaction. And then to be able to merge them in my practice has been amazing.

And the hospital has talked to me a little bit about the obesity medicine program that they currently have going on more of a global way, not really at our location itself. But there are things that are happening, that have been exciting for conventional medicine. We have a couple of new chefs at the hospital now, and they’re cooking up some gluten-free meals, some vegetarian options, and she’s running up against the system a little bit because they want her to pick from their things. But I saw her the other morning and she was just on fire for health. I told her she’s one of my most favorite people in the hospital, the new chef. And so I think that they’re open to some things. You’ve got to just introduce it slowly. You can’t come with a hammer at the system a lot of times, but there have been some changes recently at the hospital.

Evelyne: That’s really exciting to hear. I love that. Change is coming, I love it. Just keep trying.

Latisa Carson: That’s right. I don’t ever give up.

Evelyne: I love that. I’m trying to think of if there’s anything we haven’t covered. Actually, when you just said functional medicine again, I was thinking of one of the big things we talk about is environmental contributions to health, right? And detoxification. And I know that whenever there’s fat loss, some of the toxicants that are stored in our fat can cause issues because they’re all being released when somebody loses fat. Is that something that you’re also working on with patients in terms of addressing that detox? The detox pathways?

Latisa Carson: Yeah, and it just depends on where we go. I try to get patients when they start the program to first detox, before we even start the weight loss. Which a lot of times they’re anxious to get started on the weight loss, but I tell them look, you’re going to be way more successful if we can just detox a little bit first. So we try to, “Hey, let’s do seven days. Let’s do seven days of detox and then start your weight loss program.” And a lot of them are open to it, and they find that actually, they come back in a week, they’ve done the detox and they’ve lost two to seven pounds.

I’ve had patients lose 11 pounds, the first week on detox alone, and they’re like, “Oh my God, you were right.” And yes, when you lose fat, you do release those toxins into your bloodstream. So definitely, the water is important. The hydration is important. Fiber is important to help get rid of those toxins. So definitely those are things that we consider.

Evelyne: And then based on what you’ve seen in your patients, what are… Maybe that we haven’t talked about yet, some of the biggest successes and maybe something that you’ve seen that was not a good thing, that was a negative that you didn’t expect. Do you have any other experiences that you can share with us?

Latisa Carson: Not necessarily, not a negative that I didn’t expect. Because I did expect it to be a challenge. So I think some of the most positive things have been for people to stay on program, or if they got off program and get back on and get to their weight loss goal. If they plateau for us to be here to tell them, “Hey, this is what we’re going to do. We’re going to do some intermittent fasting.” Or we’re going to detox, or we’re going to stop the program. Let’s stop for two weeks and let’s restart again. So there are things and strategies that we use and that’s why it’s so important to be in a comprehensive program with multiple touch points. One patient that I knew was going to be a challenge was someone who had lost 80 pounds the previous year, had gone from 320 to 240, about 240, and she had gained a significant… At the change of the year, she found out that she couldn’t get her medicines any longer because she was getting Ozempic for weight loss and not Ozempic for diabetes.

So then she struggled to try to figure out how am I going to get the Ozempic, and found out it was going to cost her like $1,200 a month or so at the 2.4 to afford it. She couldn’t really afford it. So she tried semaglutide orally, Rybelsus, but it can be compounded at the compounded pharmacy. She thought that because she was on a 2.4 injection, that the two milligrams oral was the same, and it was not.

Evelyne: Tell me more about that.

Latisa Carson: Well, the studies have shown, there’s going to be some oral medication. There’s going to be an oral Rybelsus that’s going to be of a stronger milligram dosage. But we find that it’s actually… What she should have been taking orally, and this is one of the studies that I saw at the Obesity Medicine Association National Conference, 50 milligrams orally, not two milligrams.

Evelyne: Oh, wow.

Latisa Carson: Yeah. So basically she was taking nothing for those three months and she gained about 25 pounds. Very, very upset about it. So when she came, I told her, “Look, your body has seen this medicine before. You were at the highest dosage and you lost a substantial amount of weight losing 80 pounds in a year’s time, your body’s going to be like, Uh-Uh, you’re starting again. We’ve got to start all over. We can’t start at 2.4. We’ve got to start at 0.25 because you haven’t seen the medicine in 16 weeks.” She was really upset that she had to start at 0.25. I said, “Just hang in there.” And I just couldn’t get her to hang in there. I mean she wasn’t losing weight in the beginning. She actually gained two, three pounds after a month. But guess what? She decided to come once a month and pick up three injections.

So she had, not the touch points, she didn’t have the encouragement, she didn’t have the behavior modification, she wasn’t following the diet. So I knew that it was going to be tough. And I really, really wanted her to be successful, but I can’t force people to be present and to come in. But I haven’t given up on her yet. I’m going to get her… Because I hate to lose. And so I’m going to get her. And I think that she can be successful again, she just needs to hang in the program and let us work with her. So that’s been my only one that sticks out.

And like I tell patients, if you’ve seen the medicine before and you’ve got to start all over, it’s going to take you longer to lose the weight. And you’re going to have to get up to the highest dose again over time. And you’re going to have to add all the… You’ve got to do all the things, the pillars of health. You’ve got to do the exercise, you’ve got to drink the water. You’ve got to change your diet and lifestyle. You have to manage your stress. You have to sleep seven to nine hours a night. All of these things are part of weight loss. You can’t just do one or two things.

Evelyne: Right. And thank you for sharing that experience, I really appreciate it. And also throughout our conversation today, what stands out to me is how nuanced all of this is and how individualized. I just have a couple more questions that we ask everyone on the show. The first one is, what is something you’ve changed your mind about through all of your years in practice?

Latisa Carson: Wow. What have I changed my mind about in all these years of practice? I decided to step outside of the box.

Evelyne: I love that.

Latisa Carson: Oh my god, yeah. And when you could talk to conventional doctors about functional medicine, oh, they start talking about quackery and snake oil and blah, blah, blah, and they’re just totally off. I think what I love about living in both worlds is that I can go to the Obesity Medicine Association and listen to all their stuff and listen to them say, “Oh, that compounded medicine is horrible.” I just sit there and listen. Yeah, it’s horrible. And then I can go to IFM, Institute for Functional Medicine two weeks later, and they’re like, “Why are all these people on meds? Metformin, what are you talking about? You need to get be on akkermansia”. It’s like, oh gosh. So I can take both worlds, the best of both. Take the meat, throw away the bones of both, and try to combine it into something that’s going to be amazing for my patients and something that I think that I can live with as far as helping people.

So yeah, that was just stepping outside the box, stopping obstetrics. Oh my God. When my colleagues were like, “What are you doing?” I think they were waiting for me to fail. “How can you not do obstetrics?” Watch me, watch me not do obstetrics out of my private practice. So doing obstetrics on my own terms is out of the box and talking about functional medicine and studies in functional medicine that’s out of the box. But man, it’s becoming a little bit more mainstream, a little bit. I would’ve never thought that so many people were taking turmeric. I mean, come on. But now things are starting to become ethnic cultures, ethnic herbs and remedies and things are becoming more mainstream. So I really enjoy that part.

Evelyne: Yeah, I love that answer. And I just love your passion for this as well. It’s just amazing. What are your three favorite supplements? Just generic names for yourself. Unless you take something with Designs for Health and you really wanted to mention it, you could.

Latisa Carson: I know, I actually took a picture for you the other day with my hand, with my supplements in it. So after this is over, I’m going to send it to you. But personally, for some reason, and I haven’t done it yet, I can’t take a multivitamin, but I can take a bunch of things separately. So I love Cal Mag. I love Vitamin D, probiotic and glucosamine, chondroitin, something for my hot flashes, something that might sound like FemGuard. So all these things, those are my favorites. And usually what my favorites are is kind of what I recommend to the patients. So yes, the Omega threes and those kind of things. So those are my favorite. Those are my top four or five, I’ll call them foundational supplements for health.

Evelyne: Great. And then what are your favorite health practices that keep you healthy and resilient and ready to see patients every day?

Latisa Carson: Oh my gosh. My patients always ask me, “Oh, how do you look so young?” Well, first is genetics. I have to give that that to my mom. But I think hydration and prayer are number one, trying to stay hydrated and stay prayerful. Some type of meditation, some type of gratefulness type of thing. So those are the kind of things that I practice. Definitely have a tribe. So I have a tribe, a couple of different tribes on my phone that I text advice for if I’m stressed or something upset me, a group that I call my tribe. So I have my functional tribe, I have my OB tribe, I have my family tribe. So everyone has their purpose in my life.

Evelyne: I love that. That’s beautiful. We all need friends around us, I think that’s one of the greatest gifts in life. Strong friendships.

Latisa Carson: Absolutely.

Evelyne: Well, thank you so much, Latisa. You are amazing. And I honestly, I’m just so lucky to know you, truly. So thank you.

Latisa Carson: I’m lucky to know you because you have changed my practice tremendously. I’m not just trying to say this because this is Designs for Health, but it is definitely my favorite nutraceutical company, and it’s helped me, really helped my patients, and I’m just glad to have met you because it has been just life-changing for me and my patients.

Evelyne: Wow. Thank you so much. Where can people learn more about you?

Latisa Carson: Oh my goodness, so I’ve had to do the handles and stuff. I’m of an older generation, but I have my websites, uniquehealthcareforwomen.com and uniquelyfitmedicalweightloss.com. On Instagram I’m @Dr.latisascarson. I’m @UniquelyFitMD on Instagram. Twitter, I’m @Dr.latisascarson. So I try to do the handles. I’m not on Snapchat.

Evelyne: Oh, I don’t go on Snapchat, except to do the filters to make myself laugh or do it with my nieces.

Latisa Carson: That’s cute.

Evelyne: Well, thank you so much again, and thank you for tuning into Conversations for Health. Check out the show notes for resources from this conversation. Please share this podcast with your colleagues, follow, rate or leave a review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based cutting-edge research and practical tips.