Season 5, Episode 8: Marketing Longevity and Achieving Business Growth with Lexi Yoo

Evelyne: Thank you and thank you for being a listener. That’s awesome. Lexi is the founder and owner of Yoo Direct Health in Indiana, where she focuses on integrative medicine, anti-aging treatments, and bioidentical hormone replacement therapy. She’s a double board-certified nurse practitioner in the areas of family and pediatric medicine with a passion for providing comprehensive and personalized care to her patients. She’s also an Institute for Functional Medicine-certified practitioner and completed an aesthetic fellowship through the American Academy of Anti-Aging. Her expertise in this area makes her a sought-after national speaker and trainer, sharing her knowledge with other practitioners.

She’s a trainer for Galderma Aesthetics, and beyond her clinical practice, Lexi is committed to research and education. In 2022, she developed an integrative residency program, and then in 2023, the Yoo Direct Health Training, a virtual platform that brings like-minded practitioners together for advanced training. She also has a podcast called A Better Yoo Project, where she explores the synergy between integrative medicine and aesthetics. That is awesome. So, Lexi, thank you so much for being here. First of all, what is lighting you up this week?

Lexi Yoo: Yeah, let’s see here. We’ve started doing some really cool therapies to help our patients with balancing out sympathetic and parasympathetic. It’s a new treatment modality to our practice. It’s not new in medicine. It’s called neuro therapy, and so I’ve had some really cool cases this week especially. So I live in Indiana and we had a time change this week, and so it’s getting darker earlier and just some different cases. I had a case of some PTSD that’s getting better, so it’s really exciting just to see how we can offer some integrative therapies to our patients that they would not have access to and actually seeing other therapies work better with it.

Evelyne: That’s awesome. If we have time at the end, I’d love to go back and talk more about that.

Lexi Yoo: Oh, for sure. Yeah.

Evelyne: Awesome. So I actually would love to dive into the business aspect first. So you became an NP in 2011, right?

Lexi Yoo: Yeah, started then.

Evelyne: That’s awesome. So I know that you’ve grown a lot in the past few years and I’d love to just hear more about what that journey has been like for you. Like when you graduated as an NP, was it your vision to have a brick-and-mortar practice or multiple, and to do online training, or is it something that gradually developed? Just share that journey with us.

Lexi Yoo: Yeah, absolutely. It’s a really weird journey. I never thought I’d end up where I was even just five, six years ago when I opened up my own practice. So I started out in pediatrics and I worked in the most acute care setting you can work in. I worked in peds general surgery and trauma, so wellness and all the stuff that I do was not even on the radar. It was saving babies from all kinds of different things and surgical patients, and so I’ve always loved pediatrics and a passion for children, but ultimately, as I grew up as a mom, and it got really difficult taking care of sick kids. It’s hard to not see your kid when they’re that age, so I decided to leave the acute care setting and I went to go work at a big hospital system like many nurse practitioners do, and I started out as a pediatric urgent care, which I’m also Spanish speaking. And so it was great because I was able to help a lot of the pediatric population who had a language barrier.

The network that I was working for, they approached me. They’re like, “We love you, we think you’re great. We would love for you to start seeing adults.” I’m like, “Well, that’s not really what I’m trained in.” And they’re like, “We’ll send you back. We’ll pay for everything,” which is nowadays, I’m like, “That’s unheard of.” So I seized the opportunity and I love to learn, so I’m like, “I can do this.” So I got post-master’s in family practice and I worked for them for a really long time, which was great. I’m still raising my kids, but at the time I had toddler twins and they’re 15 now, so it’s been quite some time.

And then I had started CrossFit, which really kind of started digging my way into wellness in that they really push clean eating, Paleo, Zone, just really being more mindful of those things. And so I don’t know if you know any CrossFitters, but once you drink the CrossFit Kool-Aid, you’re hooked. So there was an opportunity to go work with a bariatric practice and I was like, “Oh, this might be kind of cool.” So when I started working with this bariatric practice, I got to learn a lot about nutrition. And not necessarily gut health like how we talk about like, “Oh, a 5R Protocol, look at it.” Not like that, but how your gut absorbs nutrients and how that can affect hair loss and skin integrity and nails and all these other things. And so my counterpart was a dietician, so I really got into some of the nutrients, and supplements, and things like that, which I always keep learning more and really looking at food as medicine.

Then there was an opportunity to go work with a do, a doctor of osteopath, and he was a cash pay-only practice, and he was looking for a provider to help them build out a wellness weight loss program. And that’s actually when I started doing the IFM. So I started my functional medicine training, because people are like, “Well, is there a degree that you can get?” Not really when you’re a nurse practitioner. You can become a naturopathic physician. So I had started the IFM program at that point. So that was about 2016, 2017, and then some things changed and I kind of wanted to do things my way. And so in 2018 is when I decided, “I can’t go back to a big network, but I kind of like what I’m doing, but I think I need to do it on my own.”

So in Indiana, we do have to have a collaborative physician, so I have a wonderful collaborative physician, who he’s a DO, so he’s open to a lot of the concepts that I talk about, and I meet with him a couple times a month. We talk very often. And so he oversees our practice. But ultimately, so we started in 2018, I was a single practice provider and it’ll be, it’s like six years next month. And so I have five nurse practitioners, two location, five registered nurses, a medical assistant, 24 employees, a training academy, podcasts, all kinds of things. So I love to learn. Ultimately, I love to teach. Why the academy started was because as I grew in the Midwest, I’m a nurse practitioner and I think it’s almost like other nurse practitioners start watching you and they’re like, “I want to do that, I want to do that.” So it was always this, “Can I pick your brain?” Or, “How do you do this?” Or, “How do you do that?”

And it’s hard because you do want to help build up the profession, but at the same time you’re like, “I’m trying to work on my own stuff.” And so I started doing these classes and right around the pandemic, Zoom was such a boom, and so I was able to figure out how to record it, and I’m a really impatient person, I don’t know if you can tell that, I’m a real impatient person. I’m like, “I’ll figure it out myself. I don’t need anybody’s help. I will figure it out.” So I launched my own podcast. I was the editor, the writer, all the things, distributed. I figured out how to do all it, recorded it. Same with my academy, I figured out how to record it and do all those things and launched it. And so now I have a bigger robust team to help me deal with it, because you can’t do everything.

So that’s kind of how I got to where I am. And then I started speaking, I started to get asked to speak locally and that grew. And just kind of nationally, I do a lot of work with this company. It’s an educational platform called nuBioAge, and they’re focused on a longevity certification. So we really focus on health span. So I’m one of their kind of lectures in their capacity. I teach for Biote, which is a hormone training company. I mean, I’ve been asked to speak lots of different topics in the world of longevity. So I’m very, very fortunate. I love what I do. I still see patients, I do my podcast, I still teach, I have shadows all the time. So I love it. I am very blessed to do all the things I can do.

Evelyne: That’s amazing, Lexi. I hope you sometimes stop to take it all in and acknowledge all of this.

Lexi Yoo: Yeah.

Evelyne: So what would you say are maybe one to two of the biggest things you’ve learned through this process, especially in the last few years that you’ve had your two practices and grew with so many employees, and then maybe your biggest advice to practitioners who want to grow in the same way?

Lexi Yoo: Yeah, I think the hardest part is finding the right people. So we started in a 1,500 square foot space and two years ago I built a building. I own the building that my practice is in and it’s 10,000 square feet.

Evelyne: Wow.

Lexi Yoo: So we went from 1,500 to 10,000. So I have this vision to change healthcare. And so sometimes that can scare people and sometimes people are like, “Yeah, let’s do that.” And so my first advice would be there’s no perfect hiring process to find those people. It’s kind of like dating. You got to go through a couple dates to figure out what you like kind thing. So I think sometimes parting ways with employees who just are not a good fit in certain ways, and that’s completely okay. As you kind of grow up in your business, your culture is going to change a little bit and your vision’s going to change. And that’s okay, and you’re going to find your employees who are going to evolve with you and that’s awesome. And you’re going to have employees where they were good for phase one, but now we’re on phase three, and so that can be kind of scary for them. And so it’s fine to part ways.

So I think that’s a big thing is honestly, I mentor other practitioners, hiring and training is probably the hardest part with that. I would say that’s one piece of advice is the people part. I would say the second piece of advice is that if you keep your intentions pure, the success will follow. And I can’t say that and stress that enough is a lot of times when I get shadows from physicians or NPs or PAs and they’re like, “I have a lot of business questions,” which it’s important to know the business part of it, but I think if you keep your intentions pure and don’t lose sight of why you started this, all the other amazing stuff, it just happens. It kind of just happens because people trust you, and people believe in you, and people, they’re going to try out this crazy new idea that you had because you haven’t steered them wrong yet.

So I can’t stress that enough. Show them who you are. I love that social media has allowed such a free platform to kind of, it can be good and it’s bad, but open my life to people is I love it when people come to shadow and you talk to my other nurse practitioner like, “Oh my God, I feel like I know you guys,” because they see you let them in, which I think gives a very human aspect to it. And people want to do business with people, not organizations. So I think keeping your intentions pure and don’t lose sight of that.

Evelyne: I love that. Those are great pieces of advice. Thank you. And you mentioned you’ve sort of narrowed in on focusing on longevity, and so I’m curious what that means to you. And I’m also curious, how do you, quote, unquote, “Sell longevity”? Are you marketing that or is it that patients see you on social media and they’re like, “Hey, I want to do this longevity program,” or that’s a term that you’re using for all of the other things that people are coming in for?

Lexi Yoo: I think now is a good time to kind of… When I say longevity, it’s encompassing… It’s one thing to live a long period of time, and we call that lifespan. And I know Dr. Attia stresses this a lot, but it’s more about improving health span. So it’s how do we live a long time but have our mind with us still? It’s one thing to live long, but then if you have Alzheimer’s disease or dementia, it’s like, “What’s the quality of life there?” So what I do is it’s not one thing. They’re like pillars. So I don’t want to say it’s like a pyramid because then it implies that something is more important than the next. And that’s not really how I look at things. And so I always say I have foundational stuff which are hormones and thyroid, gut health, which if you start focusing on those little things, then you kind of get to the next layer of it, but ultimately it’s all important.

So really, what I kind of, I don’t want to say sell to the patient, but what I try to make them understand is, “You and I, on the same team here, and I want to know,” and I always say, I tell patients this, “I know this sounds so cheesy, but in your own words, I need to know what your top three goals are in order of most importance to you.” Because if they tell me, “I’m constipated and I poop once a week,” in my mind I’m like, “Okay, gut health.” But if they tell me three other things, I’m like, “Okay, even though that’s my priority, that’s not theirs. So I need to help them get to some of their goals.” But ultimately, if you’re finding the root cause, you’re going to get there anyway.

So it’s about meeting the patient where they’re at and really helping them understand, “You are in charge. And I’m here, I’m just the tool that’s going to help you navigate, how are we going to get to those goals? And then once we’re there, how do we become more proactive with preventing things from escalating, whether it’s your family history.” And we always say genetics loads the gun, but lifestyle pulls the trigger. So how can I help you optimize your health so we don’t turn on those genes or we’re reducing the risk of those genes? So we do a very robust longevity panel where I look at Lp(a), OxLDL, small-dense LDL, APOE, a full kind of battery of tests. That’s not where I start, that’s where I move to. But so people can really understand where are they on this continuum of health and where should we really allocate our first level-one actions, because I think it can be so overwhelming, right?

Evelyne: Absolutely. Since you mentioned the longevity panel, you just listed a few advanced cardiovascular markers, what are some of the other key markers that you consider as part of that panel?

Lexi Yoo: Yeah. So I’ll look at homocysteine, I’ll look at IGF-1, and especially because we do a lot of peptides in our practice, I want to make sure it’s like Goldilocks. I need good IGF-1, but I don’t want to be too high. I look at GGT, which measures your total toxin burden kind of thing. I look at all their hormones, all their thyroid markers to include reverse and TPO antibodies, uric acid. Let’s see here. On the panel that we do, we also look at a cholesterol balance sheet. So we look at are you an overproducer? Are you an overabsorber? Are you neither, are you both? Alpha-lipoic acid, OxLDL, ApoB, that’s on there. LDL. So if you look at really biomarkers of longevity, it’s all on there and then some kind of thing.

Evelyne: Okay. So can you walk me through, say I’m a new patient who comes to see you, say I’m in my 40s, starting to have perimenopausal symptoms for example. Can you describe what that journey looks like in your practice?

Lexi Yoo: Yeah, absolutely. So when we set patients up for an appointment, we have our front office do some of the business-y stuff, so this way they know that we’re already on the same sheet of music and that we’re a good fit. So we’re a cash pay-only practice. We don’t take insurance for care. They can use an HSA, and our staff tells them that. And so we do an intake, and there’s certain things that we are very clear that we do not manage. And our staff will say like, “If you’re pregnant, we actually prefer you to come and see us when you’re done with the pregnancy” kind of thing. Active cancer, we don’t manage anything with that just because there are certain things that that’s not my specialty and I’m really good at what I’m good at, and we kind of defer that out. And that’s fine, and that’s totally fine.

So they’ll schedule their first two appointments. When they come to the office, before that, we set them up with our EMR system. So we use a really great functional medicine EMR system called Cerbo, C-E-R-B-O, and in that they will get an intake ahead of time. So when I’m training practitioners, I’m like, “This is like the 30-second trailer of what you’re about to walk into.” So in there, we actually have a symptom questionnaire. So I have an idea like, “Are they having hot flashes or they’re not having hot flashes?” Let’s say they’ve had a partial hysterectomy. “Okay, so I know they have ovaries, but they don’t have a uterus, so looking at an FSH level is going to be really important.” Let’s say the intake says they have PCOS. So then in my mind as I’m prepping for this, I know I want to check luteinizing hormone, I want to look at an FSH and insulin and an A1C.

So they do an online kind of questionnaire. They come in for their first appointment. So we use a body composition analysis for all of our patients. It’s like a vital sign in our practice, and we use the InBody. And so the InBody helps us look at body composition. And the reason why we do that is because when we optimize hormones, a lot of times we’re going to see some great impact changes on reduction in visceral fat and improving lean body mass. But as we add in peptides, i.e., some of the GLP-1s, I want to make sure that they’re not losing muscle. I want to make sure they’re losing the right kind of weight. Let’s say I add in some other peptides that target visceral adipose tissue like a peptide called Tesamorelin. I want to make sure that they’re losing a visceral adipose tissue. So it helps me gauge where we’re at. Plus, patients love data on themselves. So they come, get an InBody, our support staff do their intake, and then I go in and I ask all kinds of questions.

So if you think about, like in functional medicine, we talk about the matrix, it’s not that in depth. We kind of start at like, “All right, let’s talk about the last 10, 20 years kind of thing, not at birth, unless it’s permanent.” And then we have a lab in-house that we’ve contracted to come in. So we house them in my building, but they are part of their own entity. And so the patient can get labs right here in-house.

Evelyne: That’s amazing.

Lexi Yoo: It’s super convenient, yeah. And they can do Boston, they can do Genova, we carry GI-MAP in-house, NutrEval genes, GeneSight, neurotransmitter. Anything we need, we got it. And then they go to check out, and then we always schedule their first two appointments when we schedule their first one. So they’ll come back usually two weeks later, and then I go, that’s an hour appointment, and I’m going over all their labs. And then we start figuring out like, “Okay, here’s your goals that we got in appointment one, how are we going to connect our diagnostics with what interventions are going to work?”

So that might be a recommendation of maybe we add in some hormones, maybe I recommend a GI-MAP or a gut test or something. Or maybe I say, “Hey, I know that you have a strong family history of dementia and Alzheimer’s. Do you want to check a longevity panel? And maybe we look at your APOE genetic markers kind of thing.” Maybe I add in peptides, maybe they’re here for weight loss. And so I get them on the schedule with one of our nurses to maybe start a Whole30 diet, and then I’m going to be doing their peptides. So it kind of just depends, that second appointment is why are they here?

Evelyne: I love that you schedule the next two visits at the first one. I think that’s such a great little business pearl.

Lexi Yoo: It’s absolute key.

Evelyne: Yeah, that’s amazing. So let’s talk about GLP-1s. You’re a big fan of peptides, GLP-1 receptor agonists are undoubtedly the hottest peptides right now, so I have a bunch of questions around this.

Lexi Yoo: Sure.

Evelyne: So first of all, what are the critical pieces that you are looking at in every patient who comes to you for this? And along with that, is it something that you’re recommending most of the time to them or do your patients actually come in and ask? Like they come in already knowing that they want to be put on one? I’m curious about that.

Lexi Yoo: Yeah, no, that’s a great question. I will say, fortunately for a lot of my nurse practitioners who work here now is I always say like, “I’ve kind of done a lot of the legwork for us.” So a lot of times patients come in because they were referred via a patient who’s already doing all the things. So they come in, they’re like, “I know that I want my hormones and I know that I want to get on Semaglutide and I know that I want an InBody.” Like they already know. A lot of them have already… So in that first appointment, I always recommend my best patients who get the most benefit out of their experience with us, listen to my podcast, because we literally offer so much that I can’t possibly go over all of it with you in one appointment.

We have little QR codes with our podcast, so that first appointment I’m giving out the podcast card. So when they come back they’ll say like, “Oh my God, Lexi, I heard your podcast on ozone therapy and that’s what I want to do.” So it’s kind of like I’ve put these little pieces in place, I don’t want to say on the selling piece, but maybe on the education piece. So patients are empowered, so they know exactly like, “Lexi, I need a GI-MAP. Can I get that here today?” So they know, they know. So I would say that is absolutely crucial.

Now, what’s kind of cool is we have patients who maybe don’t have any friends and they’re like, “I saw this Instagram thing that Lexi was talking about and that’s what I want to do.” So they’ve never met me. But what’s great is I’ve already built a little bit of a relationship because they know a little bit about our practice. So if you’re a business owner and you’re listening to this, the best recommendation I would say is try to build that relationship with the patient before you’ve even met them. And I think that will help so much in you establishing a relationship moving forward for that. But I would say some of them come in, but I always tell patients, “Listen, I’m going to help you lose weight, I promise you that, but we have to look at your hormones, we have to look at your thyroid, because if I just put you on these peptides and you have a crappy thyroid, it’s like trying to brush teeth with Oreos in your mouth. It’s not going to work because your thyroid is crap.”

So when I explain it like that like, “I want you to lose weight and I want you to keep that weight off, but I need to manage these other things. And we can do them at the same time, but this is a must. You don’t get to get on Semaglutide until you’ve done this stuff.” And I tell patients, “If that’s not what you want to do, I completely understand, then we’re probably not a good fit for each other. And that’s okay. That’s okay. But I’m going to be really honest with you, I don’t take new patients. I take special cases, but I don’t take new patients and I’m not taking new… I’m full. And we’ve been on a wait list for two years.” So, you know what I mean? It’s kind of like I want it to be a good fit.

Evelyne: Absolutely. Yeah.

Lexi Yoo: I want it to be a good fit. It’s a relationship. It’s a relationship. Now, it’s hard when you are just starting out, but it’s kind of like once you figure out like, “These are my people, this is who I want to help,” I think it becomes easier.

Evelyne: Yeah. So what are the pieces that you look at for the patient, whether you’ve determined or maybe they’ve determined, that they want to use one of these medications, so you do the InBody. I’d love to talk a little bit more about that, and then what are the other things that you think are really critical to look at?

Lexi Yoo: Yeah, sure. So on their initial panels, everyone gets an A1C. I mean, there’s a lot of labs that we look at, but I check everyone’s liver enzymes. So I want to make sure that… I’m just keeping an eye on these things, glucose A1C, all those things. Some other things I like to, and this I think comes from working in bariatrics, is I like to know their weight loss history. So I’m going to give you an example. Let’s say I had this lady and she’s weighing 200 pounds, and I say, “Okay, what’s your goal weight?” And she says, “I want to get down to 110.” My next question is, “When was the last time you weighed that?” Because if it was just last year, I’m like, “Oh, okay.” If it was, “When I was 20,” and she’s now 60, I’m like, “Okay, ma’am, we’re going to have to reevaluate our goals here.” So that, if they’ve ever had any kind of eating disorder, if they’ve had a resective bariatric procedure.

And I ask that because I have a patient who has, and I’ve actually found that Semaglutide has helped her body absorb nutrients because it’s slowing down that gastric motility, which is great. So great. I ask plans for pregnancy kind of thing. Pregnancies, it’s a contraindication, breastfeeding, personal or family history of thyroid medullary carcinoma. So let me talk about that, because I feel like this is a question I get all time when I speak about Semaglutide, is that a contraindication? So there was one study done in rats using Liraglutide, that used 10 times the dose, and it triggered thyroid medullary carcinoma. There has never been a case today linking Semaglutide at the prescribed recommended doses to thyroid medullary carcinoma. So I think that’s really important to distinguish because papillary carcinoma is the most common type of thyroid cancer, which I have patients who take Semaglutide who have had papillary thyroid cancer and they’re fine. I ask them, I check their thyroid levels, all those things. So I think that’s important to distinguish.

Another one, I’ll give you kind of another little weird case. I have an adult female who has cystic fibrosis, and so I checked her pancreatic enzymes prior and they were already high, and I was like, “Listen, I don’t want to do this.” And I told her, “If you want to get a clearance from your CF doctor and we can do this, at least we’re on the same team.” But the CF doctor wouldn’t clear and I was like, “Unfortunately, I can’t do that.” I do have one, and this is completely off label, but I do have one type one diabetic who I have on Semaglutide, but it is a collaboration. Her endocrinologist is aware and we are working on it together. So there are some kind of outliers, but again, I’m making sure that I’m clearing it with whatever specialist is managing that and they know that we’re on the same page. And I can’t stress that enough.

For functional medicine people, I feel like sometimes we’re on our own little island and it’s like it doesn’t have to be that way. Now, I know that conventional docs will look at us sideways on a lot of the things that we do, but I think if you can show the evidence and really understand the research, I think you have a lot more buy-in from some of those practitioners. So I would say those are probably the contraindications.

Some other things to think about would be if they have a history of fatty liver disease, I would actually prefer Tirzepatide over Semaglutide because there’s more studies showing MASH benefits from that. I have patients who we use Semaglutide for longevity, and so what does that mean? Is that they don’t need to lose any weight, but we want to reduce the risk of amyloid plaque buildup in the brain. So this is another question I get all the time. “Well, how many milligrams does that require?” And my answer is, “I don’t know, because we don’t have a perfect set amount.” What I look at is all the contributing factors that lead to progression of Alzheimer’s disease. So that’s looking at ApoB, and small-dense LDL, and OxLDL. So I say, “Okay, our longevity panel results is what’s going to help us understand how many units or how many milligrams is it going to take for us to keep all your risk factors low.” And not only that, making sure that their hormones are optimized if they are a candidate for hormones.

Evelyne: Yeah, very interesting. I want to go back to something you said about if somebody is wanting to get pregnant, how far out are you talking? Because we’ve read about cases, I haven’t seen the literature per se, but I’ve seen the headlines that there’s increased fertility being on these drugs due to the weight loss, or are there other factors at play?

Lexi Yoo: Yes. So part of it is, so I actually presented in Dallas two months ago on this exact topic because what the study showed specifically in PCOS, you control insulin resistance, you’re going to control the androgen production, which can help with improving fertility. And so what I tell them is kind of like you are going to want to use a backup, like a method of prevention for that. If they’re planning to get pregnant, then I usually try to recommend stopping it for a month prior just because we don’t… I mean, when you’re trying to get pregnant, cycles are like times one. So I will transition them to berberine synergy to help keep that insulin receptor more receptive. But if they’re actively trying to get pregnant, and that’s honestly, I usually try to screen that out of here before they come to us, because I don’t want to have to worry about mom and baby, I just want to worry about the adult. So I usually say about a month prior to that.

Evelyne: Gotcha. And then I’d love to talk more, you and I had a pre-call, or a pre-interview call, and we talked about how you cycle GLP-1s, and so I’m really curious about that and some of the dosing. I know it’s different for everybody, but I’m curious about that.

Lexi Yoo: Yeah.

Evelyne: And you also mentioned something interesting is that you don’t refill that medication without another InBody scan.

Lexi Yoo: Yeah. So in our practice we are huge sticklers. And honestly, I feel like our patients who really believe in what we stand for, they appreciate it. They know the drill. They’re like, “I’m due for a refill, can I come get an…” They know, we’ve got them very trained and conditioned to know, “This is the expectation.” So, to your point, when a patient needs a refill, if they’ve not had an InBody in the last three months, they need to come in. Let’s say they had an InBody and they’re not losing muscle, everything is great. Cool. We go ahead and send an InBody. At minimum, we need to see our patients every four to six months, usually no longer than every six months, but a lot of times they’re coming in more than that.

And then if they’ve lost muscle, we then have a different conversation of, “Okay, we need to start adding in some performance peptides to help build their muscle or some sort of amino acid.” So branched-chain amino acids is a great option. Leucine, Isoleucine, and Valine, building blocks of muscle. So we talk about that, we talk about nutrition, focusing on protein first. So on their InBody, I know how many pounds of lean body mass they have. And I say, “Okay, my protein recommendation is I need one gram per every pound of lean body mass that you have. Not every pound of weight, lean body mass.” And then if they’re like, “Oh, that’s a struggle,” then I say, “Okay, we either need to, one, lower your Semaglutide dose, or two, we need to get you in with one of our staff nurses to give you a protein list, a meal plan,” to give them more support and accountability on the nutrition side, because I’m not in the business of making skinny fat. That’s not what I do.

So there’s that piece of it. We also do a lot of other peptides. So it might be a conversation of, “Hey, come back in and let’s go over some of the growth hormone secretagogue peptides that we can add to your Semaglutide. We call it stacking. So this way we can help your body kind of increase its ability to make more muscle.” So that can be super helpful. When we talk about maintenance dosing of Semaglutide. So let’s say we have a patient, they got to their ideal weight, they don’t want to lose any more weight, then what I do is I start to titrate them down, and I’ll drop their dose by, and I’m going to talk in units because every vial is slightly different depending on where you get it filled. So I might say, “Okay, let’s say you’re at 40 units, let’s go down to 35 units for a week and see how you do, go down to 30 units and see how you do.”

And then we find kind of like a sweet spot where it’s like, “I feel like my hunger is well controlled, I’m maintaining my weight, and I’m not losing any, but I feel pretty good.” I have some patients who either want to stay on 10 to 15 units because they find that it just helps curb their appetite or it just helps them maintain their weight loss. The piece that I always explain is I feel like sometimes when women come in here, they’re like, “I just feel like if I’m getting on Semaglutide, I’m giving up.” And I tell them, “Absolutely not. You’re not giving up. The mechanism that’s happening in your body during perimenopause, menopause, is your body is naturally becoming more insulin-resistant. You can be doing exactly the same resistance training, eating the same protein, paleo, whatever, and you’re like, ‘I’ve changed nothing.’ Unfortunately, your body is changing.” And so that little piece of insulin resistance is why so many of these women can’t lose weight. They can’t lose weight, or they’re insulin-insensitive.

And then the other thing that happens is as women go through menopause and perimenopause is their sleep is crap. So then they start drinking the wine to wind down, and now we’re in this vicious cycle because guess what? Their liver is trying to metabolize that alcohol. And guess what it’s not metabolizing? Estrogen. So then they start to get, “I’m having hot flashes, I’m getting the midline spread, I’m starting to get hips, or heavy periods, fibroids.” It’s like a vicious cycle. So I’m like, “Might I introduce you to a DUTCH test?” It’s so intertwined, and I know that there are a lot of just weight loss centers, and they may be able to treat 80% of the people, but there’s a 20% of people, i.e., like our perimenopause, menopause patients, who need this extra type of lens from a functional person where it’s like you see all the moving parts. And I feel like that’s where functional medicine practitioners who do peptides well and who understand how hormones are interrelated can really make such an impact for so many of our patients.

Evelyne: Absolutely. Great insights. And I have some follow-up questions regarding the nutrition aspect. So you’re telling them to eat approximately one gram per pound of lean body weight. Are you recommending that they track macros also? Are you giving carb and fat recommendations as well?

Lexi Yoo: So I am very much trying to meet the patient where they’re at. So if I’m talking to them and I can already see they’ve got this glazed-over look in their eye, I say, “Listen, just focus on protein. The chips will fall where they lie, but let’s just master protein first.” So, some patients I say, “Are you open to tracking?” Sometimes the thought of tracking for a patient can be overwhelming, and that’s not the name of the game. The name of the game is to try to help the patient just be better than they were yesterday, and eventually we continue to get better.

Some of my patient, yeah, I’m like, “You need this many carbs, this many fat, this many calories.” The nice thing is on the InBody, it gives us a basal metabolic rate. So I tell them, “You cannot drop your calorie content below that.” You cannot drop below that. I usually try to have them eat around 200 calories above their BMR, so that puts them in a comfortable deficit without starving. So it depends on the patient. As far as if I giving them a whole macro plan, if they want one, I will. But a lot of times if I just have them focus on protein, they’re not hungry for all the other stuff because they’re on Semaglutide.

Evelyne: Yeah. And then with the appetite control aspect, some of the things that I’ve heard from people who are on it is that they’re not hungry at all, so it’s really hard to eat.

Lexi Yoo: Right.

Evelyne: Do you see that a lot as well?

Lexi Yoo: I do not in my practice because if they’re telling me that, I’m telling them, “You need to lower the dose. And if you don’t lower the dose, you’re coming off of it.”

Evelyne: Gotcha. Yeah.

Lexi Yoo: So I always say, “If you can’t Semaglutide responsibly, you’re not going to have it.” And, yeah, I’ve had patients who’ve left the practice and I tell them, “It is for the best interest of you. And if you feel like that’s not what you want to do, there are literally offices on every corner. Help yourself.” And that’s probably from a business side like, “Oh, you’re losing a customer.” I’m like, “But it’s for the best interest and I can sleep at night knowing that I’m not contributing to that patient’s loss.” We always say muscle is the currency of aging, and so I’m trying to help them be better. So there’s that.

The other thing is in our practice, I have developed a calculation where I’ll take their last skeletal muscle mass, and I subtract it from their current skeletal muscle mass, and I divide it from the initial. And if it’s greater than a 5% reduction, then they either have to lower the dose, they have to add in a growth hormone secretagogue, and now they have to get another InBody in six weeks showing that they’ve increased their protein, they’ve increased their resistance. And they know the drill, they know the drill. My MA, she’s like, “Think about what you’ve done, you’re going to have to come back in six weeks.” They know, they know, because I’ve set those expectations with my patients.

Evelyne: What are some of the examples? You’ve mentioned twice the hormone secretagogue peptides, which ones are those?

Lexi Yoo: Yeah. So those would be like Sermorelin, CJC-1295 plus Ipamorelin, and then my favorite is Tesamorelin. So those are all different growth hormone secretagogues. Tesamorelin is the most potent one. Sermorelin is probably the least potent one. These are injectable peptides. I know that Sermorelin comes in the oral form, which is not… Because you have to go through first pass through the gut, it is not as effective as just doing an injectable peptide. And so what this is doing is it’s acting on the pituitary gland to help increase its natural production of growth hormone while the Ipamorelin, it’s in there and it’s extending the half-life of it and getting it out to the cells.

This can help with improving lean body mass, this can help with recovery repair. Sleep is a big thing that CJC does really, really well. It can help with skin texture. A lot of my guys notice the recovery piece of it, especially in the gym. A lot of my women say like, “I sleep so much better.” What I noticed about it is they’re not losing their muscle, just the body composition, dropping fat and gaining muscle. That’s the name of the game. So those are great.

Tesamorelin, it was a drug that came to market called Egrifta, which was on the market for HIV lipodystrophy. And so it targets visceral adipose tissue. It also is great for over 60-year-olds improving cognitive function and it can also help reduce triglycerides. So if I have someone on my longevity panel and they’re high, and they’re on TriCor, and they’re in their 60s, I’m like, “You need Tesamorelin.” So it just depends on what the avatar of that patient looks like.

Evelyne: Very interesting. And my thinking is when I hear some of these, I’m like, “We can achieve some of that with supplements as well.” And I do want to get into that, but first I actually want to talk about how you are managing side effects of GLP-1s from a holistic perspective. And we did a podcast on GLP-1s with Dr. Latisa Carson, who’s an OB-GYN. And actually, she doesn’t see as many side effects because she’s using compounded, but that wasn’t on the recording because we talked about it after we had stopped the recording. I’m like, “Why do you think that you’re not seeing all these things that we hear about in the news?” And that’s what I consistently hear from other practitioners here in San Diego, a lot of the naturopathic doctors I work with. Do you find that it’s the same in your practice?

Lexi Yoo: I agree. So I’m going to give you an example. So commercially available, let’s just take Wegovy for example. It goes 0.25 milligrams times four weeks, then you go up to 0.5 milligrams times four weeks, then it’s one milligram. So in month two to month three, you literally have doubled the dose. There’s no 0.75 kind of thing. In our practice, we start at 0.125 milligrams, and then we go to 0.145. So we are making like, patients are almost frustrated like, “My friend, who got their Wegovy…” I’m like, “Okay, I’d be curious to see what their InBody is. Oh, wait. Their primary doesn’t have one.” So I don’t feel like we see a lot of side effects when it comes to dramatic weight loss and what all entails, because we do keep such a close watch on our patients.

I would say the most common would be heartburn, GERD, reflux-type stuff. So I really like to use melatonin at night because that will increase the esophageal sphincter. I love using Mastic Gum/DGL because they probably got a little H. pylori, they’ve got the heartburn. So I love using that. DGL chewables, I really like to use because that kind of soothes that. Aloe vera can coat the interlining of the esophagus, so that’s super helpful. Magnesium citrate to help with bowels. So sometimes if they’re nauseous, I’m like, “When was the last time you pooped?” Because one of the mechanisms, it slows down your gastric motility, so you stay fuller for a longer period of time. On the flip side of that, you can’t poop. So adding in magnesium citrate can be helpful.

There is a certain supplement I love to use. I know I can’t say names, but it’s got some Ayurvedic herbs in there that can help the osmolality. It rhymes with rolling, but maybe doesn’t begin with an R.

Evelyne: Yeah.

Lexi Yoo: Yeah, I was trying not to say the name. Colon Rx. I’m just going to say it, Colon Rx is a great, great, great one. So that’s a great one to manage those side effects. So I’m just trying to think like top-down.

Evelyne: Yeah.

Lexi Yoo: Other one would be like the… Sometimes we see a little bit of a hair loss. And they’re like, “Is it the Semaglutide that’s making me lose the hair?” And I’m like, “Here’s what I’ll tell you, your body don’t like change. So I don’t know necessarily, is it that, is it the lack of amino acids? So do we need to add in some amino acids? Do we add in some collagen, maybe some hair, skin, and nails support? What’s your thyroid doing? So this is why I tell them we got to draw all the labs so when something goes sideways, I’m able to like, “Okay, here’s where baseline was.” I can at least see where the hell is the problem. So I would say those are probably the most common side effects. I’m trying to think. Constipation, heartburn, hair loss. I think that’s about it.

Evelyne: Yeah, I feel like that’s what I most commonly hear, the heartburn and the constipation. And there are so many ways that we can naturally help with that.

Lexi Yoo: Oh, yeah.

Evelyne: Yeah. That’s amazing. Where do you see the future of GLP-1s? I know you were telling me that there’s some combo treatments that you are excited about?

Lexi Yoo: Yeah. So there is another triple agonist that is in clinical trials right now called Retatrutide. So it’s a GLP-1, GIP-glucagon agonist. So that will be coming. And then kind of in the peptide communities that I belong to, supposedly there’s like a quadruple agonist, but I’ve not seen any studies on that. There is also currently another peptide is an amylin-analog called Cagrilintide, and that has been a great add-on to Semaglutide. So you stack the peptides, meaning you’re doing both of them. And I’ve almost felt that I’ve seen better results with, we call it SemaCagri, than I have with Tirzepatide, which is crazy because Tirzepatide in the study showed better weight loss outcomes. Tirzepatide is a dual agonist, so it hits the GIP and the GLP-1 receptor. But if you pair Sema and Cagri together, that’s a dual agonist and now you’re hitting amylin and GLP-1. So when we’ve hit a weight loss plateau, I might add in Cagrilintide for that.

Evelyne: Interesting. And do you decide at some point to take your patients off of it when they reach their goal weight? Do you keep them at a microdose or how do you handle that? I’m sure it’s individual still to the patient, but can you share more?

Lexi Yoo: Yeah, it’s super individual and their budget. I always say, I call it maintenance dosing. Microdose I think was kind of like a fad term, but it’s just a smaller dose, so we might call it maintenance dosing. So I ask the patient, I’m like, “What’s our goal here? Is your goal to come off of it?” What we tend to find is that it can help with keeping your ApoB levels down, and your LDL levels down. And if your goal’s longevity, we want to make sure. Now, can you do it on your own? Absolutely. We just want to make sure we monitor it. So it just depends on the patient.

Evelyne: Yeah. And then what are some of the ways that you might naturally recommend to maintain those results with supplements?

Lexi Yoo: Yeah, so there’s a couple that I really like to use. I really like Berberine. I know I keep going back to old faithful there. Berberine is such a good one to use because it has so many benefits for a lot of different reasons. I think that one can be helpful. Looking at some of the supplements that can help with metabolic dysfunction, I know that there are some supplements, and I know we can’t say the names. I’m trying to think what the ingredient’s in there. Cinnamon bark is one. Oh, gosh.

Evelyne: You can just say it. It’s okay. Sometimes it comes out. You can just say it.

Lexi Yoo: I can see it. Oh, I got… Evelyne Lambrecht: Are you talking about Lucocid cream herbal?

Lexi Yoo: Yes. I’m talking about Lucocid cream. Yeah, I’m like, “I can see it on the shelf. I can’t think of the name of it.” Yeah. So I mean, that can be super helpful. So it’s just a conversation with the patient.

Evelyne: Absolutely.

Lexi Yoo: It’s just like, “What do we want to do?” Yeah, I know there are some great options too. It just depends on the patient and kind of what they want.

Evelyne: Absolutely. Well, thank you for sharing all that. That was so much amazing info about GLP-1s, which I think is also relevant because I’d love to talk about the aesthetics side of it a little bit. And we see that many aesthetic practices are also diving into the GLP-1s, which is interesting because having had this conversation just now, there are so many different factors to consider. There’s so much more to it than just prescribing Semaglutide, right?

Lexi Yoo: Totally. Yeah.

Evelyne: So with the aesthetic side, is this something that, well, I guess you didn’t think a long time ago that that’s what you’d be doing. You’ve only been doing that more recently. So talk to me about some of the nutrition aspects that you think are the most important with the aesthetic side. And is it that your patients were already seeing you for other things and then you’re like, “Hey, I now offer aesthetics,” or are they coming to you for aesthetics and then you’re like, “Let’s talk about the nutrition stuff”?

Lexi Yoo: Yeah. So I started out in functional medicine. I didn’t start out in aesthetics. And what happened is when you get women feeling better, looking better, losing weight, they like their husband again, they can sleep through the night, they’re like, “Well, what else can you do?” You’re like this little magic gnome. And so I had a patient, this was six years ago, so adding aesthetics is not new. I’ve been doing aesthetics since I’ve been in my own practice six years. But she was like, “Can you just learn how to inject and I don’t have to go anywhere? It’s like a one-stop shop.” And at the time, I was not near as busy as what I was now, and I’m like, “Yeah, I liked procedures, I worked in peds surgery.” I was like, “I could probably learn that.” So what I learned in the aesthetics is it’s truly the Wild, Wild West. There is no bar.

So in functional medicine, the IFM, you’ve been to the IFM or you’ve gone through IFM, you know that there’s a standard that you’ve met. That’s not how it is in aesthetics, which is extremely frustrating, which is why I did the fellowship through the Academy of Anti-Aging. So I started offering it to patients. And, again, what’s so amazing with that is when you get a relationship with a patient, it’s really hard to break that bond. And so they were very willing to let me learn on them, practice with them. If I messed up their eyebrow, I had to see them for thyroid follow-up, so they had to tell me. And I don’t do anything lightly. I don’t ever dip my toe in something. If I’m doing it, I’m going in. So that’s kind of where that came from.

And so my patients, they very much focus on the natural aesthetics, so they don’t want to look overfilled. We always say we want the undetectable injectable. And it’s like, “You look better, but I can’t tell what’s better about your face.” So we focus a lot on stimulating collagen is probably one of the biggest things. So we use a lot of PRP, which is Platelet-Rich Plasma, we use a lot of biostimulators. On the aesthetic side, we have an amazing aesthetic nurse. Her name is Carmen, and she will do a skin consult. And so if she sees a woman coming in here, and I know if you’re listening in your car and you can’t see me, I’m pointing to my jawline. If she sees, “Oh, this girl’s got some hormonal acne,” she will probably recommend like, “You probably need to go see one of our functional medicine people, so they could maybe look at your hormones.”

Or if they’re coming in for a hair restoration, she may say, “You probably need to go see one of our providers.” If they come in for acne on the forehead or the cheeks, she might say, “Have you had your gut test done?” And so she might recommend it. So what’s great, because a patient, and so she’s been through a lot of it. Rosacea. That’s another thing. So while on the aesthetic side, we may treat it with topicals and lasers, I’m over here like, “What kind of fungus you got grown in your gut?” So it very much marries well, you just have to know what you’re looking for. And if you’re an aesthetics practice listening to this podcast, because I know that we have some in our academy, is you want to train up your estheticians and your aesthetic nurses to just start. They don’t have to have a functional medicine degree, but just start thinking about, “Okay, if it’s on the face, it’s very likely going in on the gut or somewhere in the hormones.” So that can be helpful.

One of the things that we use a lot in our practice is there is a supplement that is made by a wonderful company and it’s got a blend of some different herbs that help with hormone detox. There is one that just came out, we used it, I’m just going to say it, it was FemGuard, but now I believe it’s Balance. Why I like that one is it’s got a little mix of some of the herbs like DIM, and calcium D-glucarate, and chrysin, which can help with some of the estrogen detox-type symptoms. And it’s also got some good B vitamins. Now, I’m going to just say one thing. You got to be really careful with acne and B vitamins because when people are overdoing it on B vitamins, they can cause acne. So just keeping that in mind.

So I think that there’s a huge opportunity for functional practices to start looking at that if that’s their interest, and aesthetic practices to add in, we call it functional medicine, they call it wellness. But here’s what I will say from a business perspective, you have to love it. And if you don’t love it and you’re just doing it so you don’t lose your patience, you can tell. And I’m saying that from experience and seeing, we have patients who come from other practices and they’re like, “Well, I came here because it seems like you guys do more of it.”

And the other thing is, and I hate to say it, Evelyne, you got to look the part. You got to believe in what you’re doing. So if you’re recommending weight loss, I’m going to tell you like, “You better look the part. You better look like you work out, you better look like you care about certain things.” So I think there’s a great opportunity to marry both worlds, but I think you have to have the right kind of mindset to do that and the right team, to kind of circle back to what I started with, you got to have the right team.”

Evelyne: Absolutely, absolutely. Thank you for sharing that. Just really quick, what would you say are your top nutrients for healthy hair, skin, and nails?

Lexi Yoo: Collagen, omega-3, probably selenium, because selenium is such a key part for the thyroid that I’m like, “It’s probably the thyroid. Just blame the thyroid.” That’s what I do. Selenium, omegas, and probably collagen.

Evelyne: Nice, love that. Well, I’d love to wrap it up with some rapid-fire questions. And actually, the first question that I ask everyone is what are your top three favorite supplements for yourself?

Lexi Yoo: Saccharomyces boulardii, collagen, and berberine.

Evelyne: Awesome. And what are your favorite health practices that keep you healthy and resilient? And you’re a business owner, a mom, doing a lot.

Lexi Yoo: Yeah, prioritizing sleep. So that’s a non-negotiable, non-negotiable. And I started using something called BrainTap, which uses binaural beats and it has these lights that you put over your eyes. And I track my sleep with my aura ring and super nerd out about sleep. So priority number one is sleep, because I feel like if you don’t recover and restore well, that’s when your growth hormone’s being made, that’s when your liver does all its work, the rest of the day is crap. So sleep is number one. Movement in the form of resistance training. I can’t stress that enough in that I weight lift four or five days a week. It’s super important to me. My kids weight lift. I think that that is also a non-negotiable. And then I think the third one is the people who you surround yourself with, I think play a huge role in it, so surrounding yourself with people who want to see you do well and who encourage you and who also can keep you in check when you need to be, I think is important. So having a good network of support.

Because I always say this, people say, “I don’t know how you do it all.” And I tell them, “I don’t do it all. I have a lot of help. You just don’t see them on Instagram, but I have a ton, a ton of help.” So I think as women we’re so hard on ourselves and I think being very honest, and I tell people that, I’m like, “I got my mom lives 10 minutes away, my husband works here with me. I have a ton of help.” So I think who you surround yourself and building a system around you that allows you to be your best self, I think is key.

Evelyne: I love that. What is something that you’ve changed your mind about through your years in this field?

Lexi Yoo: This is a good one. So I think so many times in functional medicine, I love testing. I love testing, especially because you go through the IFM and you’re like, “I learned how to do this and I know how to…” I think sometimes when it looks like a duck and it walks like a duck, do I need that $400 test to confirm what I already know through clinical experience? Maybe not. Maybe we try the interventions. And if it doesn’t work, then we can go back and do the test. So I think financially that can save patients some time and money, which I think is huge. And so, again, I love integrative testing, but I think sometimes we as functional medicine people can overdo it with that and supplements. So I think the older I get into my functional medicine career, I’m like, “I don’t really know if I need that.”

Evelyne: Yeah. And it’s true when you gain so much experience, it’s like you know what to do and what will work.

Lexi Yoo: Yeah.

Evelyne: And then if it doesn’t work, then you can do the test.

Lexi Yoo: Right, sure.

Evelyne: Yeah. And, Lexi, you get a bonus question. Tying it back to where we started with business, I’m curious, what is your vision for the next five years and beyond that?

Lexi Yoo: At some point I would love to whittle down kind of my patient list to, I would call them peak performers of longevity. So people who nerd out like me who want to wear an aura ring like me and who want to BrainTap like me, and I feel very fulfilled. And not only that, I learn so much from those patients that it helps me become a better educator. So I would like to maybe cut back my hours to really focus more on the research part of it, so to speak. The other thing is I love the business building side of it. And so taking the academy that I have and maybe picking one or two practitioners and really helping them build their business.

It’s going to be a while before I can really, I think, focus on doing that because I’ve got five nurse practitioners with a six one on the way and just training them up. And it takes time. It takes time and you can’t rush it because then when things get missed, the only one you have to blame is yourself. So five, 10 years, something like that. Research, longevity, building up other practitioners.

Evelyne: Thank you, Lexi. That is awesome. And you’re such a go-getter and so inspiring. I love it.

Lexi Yoo: Thank you.

Evelyne: Where can practitioners learn more about you?

Lexi Yoo: Yeah, so I do quite a bit on social media. So my handle is @Lexi, spelled L-E-X-I-Y-O-O-N-P, so like nurse practitioner. I have a podcast called The Better Yoo Project, and it’s you spelled Y-O-O. So The Better Yoo Project. I’m on YouTube as YDH Academy. Our training academy is www.ydhacademy.com. So I think those are all the major places you’ll find me.

Evelyne: Great. Well, thank you so much. This has been a really, really fun conversation. I really appreciate it.

Lexi Yoo: Yeah, absolutely. Thank you.

Evelyne: Thank you. And thank you for tuning into Conversations for Health today. Check out the show notes for resources from this episode. Please, share this podcast with your colleagues, follow, rate, or leave 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.