Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week I had the opportunity to talk with Randy Martin, PharmD/Owner of Heartland Apothecary in Knoxville, Tennessee about some of the controversies surrounding compounded semaglutide.
I’ve used compounding pharmacies my whole career. The more you do functional/integrative medicine, the more you need compounding pharmacies. Compounding pharmacists can provide the exact dose your doctor prescribes along with tailoring to specific needs, such as allergies, intolerance to certain substances, etc. This increases the safety and effectiveness of the medication, and you can feel better, faster. All the big clinics (like Mayo) use compounding pharmacies.
Before we get into the compounding controversies, let’s meet our Compounding Guest.
Randy Martin, PharmD
I’ve known Randy for years and highly trust him. His background story (FYI: I love background stories!) from pharmacist to compounding pharmacist was interesting. Randy started as a pharmacist at Kroger for 7 years, then moved on to Ingles, and a few others after that. In the day to day work, he started to notice that the patients who kept coming back for refills weren’t getting better. They were just putting a bandaid on whatever health issue they had.
As a pharmacist, he wanted more. He wanted to be able to practice on his own and do what he felt his patients needed, not be stuck under the corporate confines. This is when he branched out and worked at a few independent pharmacies before landing his dream job at Heartland Apothecary in Knoxville. Heartland is his calling. He gets to spend time with patients, listen to their concerns, and help get to the root cause of what’s going on.
This is unusual for a pharmacist. In general, most pharmacists blindly become medicine dispensers, in the same way doctors blindly become prescription writers. Unintentionally, of course. It just happens. Cookbook medicine (which is the direction I think most of healthcare is going) is the biggest culprit. I spent the first half of my career writing prescriptions. I know how easy it is to just stay there. But it is important to remember we want patients to get better. To be able to get off the medications they don’t need, and of course, stay on the medications they do need.
To me, it’s about the blend of holistic medicine and traditional medicine. That’s the sweet spot we need to be in and stay in. As you can see, I totally connect with Randy’s journey. Heartland Apothecary allows doctors to treat patients as the unique individuals they are. They customize:
- Bioidentical hormones
- Low-Dose Naltrexone
- Customized thyroid treatments
- Pet and Vet medications (very custom)
They also customize medications for people who have gluten allergies or lactose issues. They can take care of patients with most any type of allergies. My conversation with Randy was mostly about semaglutide, so let’s move on to that.
In my opinion, obesity is the number one medical problem in the United States. Obesity is linked to: type 2 diabetes, high blood pressure, heart disease, stroke, metabolic syndrome, fatty liver disease, some cancers, breathing problems, sleep apnea, osteoarthritis, diseases of the gallbladder, and the list goes on. That is why Performance Medicine focuses so much on weight loss.
Now we have revolutionary incretin based medications that work in natural ways. Note: incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Semaglutide, Ozempic, Mounjaro, to me these are the drugs of this century, so far. A lot of people demonize these drugs, saying you don’t need to use them, just eat less and exercise more. But weight loss is extremely complex, as are these medications.
Semaglutide is a GLP-1 agonist that helps to reduce feelings of hunger. GLP-1 is actually something your body naturally produces, so with semaglutide, your body is just mimicking that structure. It’s not changing your physiology. Patients do really well on this. I’ve never seen a medicine work so well with obesity. It’s also helped a lot of doctors realize obesity is a chronic metabolic disease. It’s not laziness. It’s not a lack of willpower. Obesity is a hormonal, genetic, metabolic disease.
The Best Advice for Semaglutide
Here are a few gems I pulled out of our conversation around semaglutide that I really think will help some of you.
– You need to see somebody who knows what they’re doing when prescribing it. When you go to some of these weight loss clinics, you go in, get a shot, and then go home. They don’t test for gut issues, ask if you’ve been constipated, or are having stomach issues. You don’t want to come out worse than what you were before you started it! The goal is to get better and healthier.
– You need to treat any underlying issues previously. It’s not just taking the shot, and then losing weight. You have to figure out your gut function, hormone functions, insulin resistance, identify thyroid and adrenal issues, sometimes psychological issues, plus you do need to learn how to eat.
– Make lifestyle and dietary changes. Learn how to eat healthy and exercise.
– Everybody is different. Hormone levels, thyroid, adrenals, vitamin D. These all factor in for success with something like semaglutide.
There can be issues with taking semaglutide! Here are a few things to watch out for:
- It makes the body feel satiated. You won’t eat nearly as much, which can mean you aren’t getting some nutrients that you need. Take some multivitamins. Look into organ meat supplements. Make sure you’re getting plenty of nutrients!
- There can be muscle loss. Try taking Branched Chain Amino Acids and make sure you’re getting enough protein. Lift weights.
- Patients have expressed concerns about saggy skin that can come with weight loss. For this, make sure you get plenty of collagen. You can also try a silica supplement.
When getting on semaglutide, there’s a lot to think about! What I love about compounding pharmacists is that most of them think outside the box. For example, if a patient is on the lowest dose of semaglutide and still getting nausea, your compounding pharmacist (or doctor) may suggest you take Berberine or Digestive Enzymes. Note: Sometimes I will switch this type of patient to Tirzepatide.
Remember, you don’t want to be normal. Normal is NOT optimal…
And neither are compounding pharmacies. When you are looking for a compounding pharmacy, make sure they are based and licensed in the United States. Note: If they do steriles, the compounding pharmacy has to go through a rigorous testing process. When I use compounding pharmacies, I visit them, get to know them, and trust them. As I said earlier, I’ve known Randy for years and highly trust him.
And neither is Performance Medicine. We will go to extreme lengths to try and get the brand names (Ozempic and Mounjaro) approved for patients who qualify. However, due to extreme shortages and the fact they aren’t covered well by insurance (making it expensive to purchase), we have found good alternatives in the compounded semaglutide and tirzepatide. Note: I just recently read an article in the Wall Street Journal about how compounding pharmacists have pulled our medical system out of the fire because of all the drug shortages, etc.
Compounding pharmacies, such as Heartland Apothecary in Knoxville, make our job easier. They help us help you get the best treatment! Thank you Randy and all the other compounding pharmacists out there for joining us outside the box!
Stay educated. Stay healthy.
Till next week.