What if stubborn weight gain, constant cravings and “food noise” aren't simply a matter of willpower? What if your brain is driving more of your hunger, metabolism and eating behavior than you realize?

Triple board-certified neurologist and obesity medicine specialist Dr. Sara Siavoshi joins Women Road Warriors with Shelley Johnson and Kathy Tuccaro to reveal the connection between the brain, weight gain and weight loss, metabolism, GLP-1 medications, inflammation and healthy aging.

Dr. Siavoshi is the Founder and CEO of DrBrainRx, a nationwide physician-led telehealth platform focused on metabolic health, brain health, longevity and preventive medicine. She also practices clinical neurology and serves as an Assistant Clinical Professor of Neurosciences at UC San Diego.

In this eye-opening conversation, Dr. Siavoshi explains why she considers GLP-1 medications “brain drugs,” how the hypothalamus regulates hunger and satiety, and how dopamine-driven reward pathways can contribute to food cravings and addictive behaviors.

She breaks down the science behind Ozempic, Wegovy, Zepbound, Mounjaro, semaglutide and tirzepatide, including what may happen when people stop taking GLP-1 medications and why maintaining muscle through resistance training and adequate protein are so important during weight loss.

Dr. Siavoshi explores the relationship between obesity, insulin resistance, inflammation and brain health, including why protecting the brain's blood vessels may matter for cognitive health as we age. She also explains how exercise increases BDNF (brain-derived neurotrophic factor), which supports neurons, neural connections and the hippocampus. That’s the brain region critical to learning and memory.

You'll also hear a fascinating discussion about genetics and obesity, fertility and metabolic health, “Ozempic babies,” vitamin D and the nervous system, neuroplasticity after neurological injury, and what science is discovering about GLP-1 medications and addictive behaviors.

In this episode, discover:

• How your brain regulates hunger, fullness, cravings and “food noise”
• Why GLP-1 medications may affect far more than appetite and weight
• How dopamine and the brain’s reward system can influence compulsive eating
• Why researchers are studying GLP-1s in connection with alcohol, nicotine and other addictive behaviors
• Why weight can return after stopping GLP-1 medications
• Why muscle, protein and resistance training matter during weight loss
• What “skinny fat” means—and why appearance doesn’t always reveal metabolic health
• How obesity, insulin resistance and inflammation can affect the brain and its blood vessels
• Why exercise boosts BDNF, supporting memory, neuroplasticity and the hippocampus
• What metabolic health may have to do with fertility and “Ozempic babies”
• The differences between semaglutide, tirzepatide, Ozempic, Wegovy, Zepbound and Mounjaro
• Why vitamin D matters to neurological health

If you've ever wondered why one person seems able to ignore food while another battles cravings all day or why losing weight can feel like fighting your own body this conversation may change the way you think about weight forever.

Healthy aging isn't only about living longer. It's about protecting your brain, preserving your muscle, improving your metabolic health and staying mentally and physically capable as you age.

Listen to Women Road Warriors as Dr. Sara Siavoshi takes us inside the brain-body connection and separates medical science from the wellness hype.

Learn more at www.drbrainrx.com

Learn more about Women Road Warriors at www.womenroadwarriors.com

#GLP1 #WeightLoss #FoodNoise #BrainHealth #HealthyAging #Ozempic #DrBrainRX #DrSaraSiavoshi #ShelleyJohnson #KathyTuccaro #WomenRoadWarriors

This is Women Road warriors with Shelly Johnson and Kathy Tucaro.

From the corporate office to the cab of a truck, they're here to inspire and empower women in all professions.

So gear down, sit back and enjoy.

Welcome.

We're an award winning show dinner dedicated to empowering women in every profession through inspiring stories and expert insights.

No topics off limits.

On our show, we power women on the road to success with expert and celebrity interviews and information you need.

I'm Shelley.

And I'm Kathy.

Have you ever felt as though your brain and body have stopped working together?

You're battling cravings, stubborn weight loss, low energy or brain fog.

And everywhere you turn someone's promising that another diet, injection, supplement or wellness trend will finally fix everything.

But what if lasting change doesn't begin with more willpower?

What if it begins in the brain?

Our guest today, Dr. Sarah Ciavoshi, believes that sustainable results start by understanding the powerful connection between the brain, metabolism, hormones and and the way our bodies age.

Dr. Siavoshi is triple board certified in neurology, headache medicine and obesity medicine.

She's also the founder and CEO of Dr. BrainRx.

That's a nationwide physician led telehealth platform that helps people lose fat, protect muscle, increase energy, sharpen their thinking and live healthier and longer lives.

And she's building this groundbreaking company while continuing to practice clinical neurology, serving as an assistant clinical professor of Neurosciences at UC San Diego.

And she's raising three young children.

Today we're cutting through the noise surrounding GLP1 medications, peptide stacking, food noise, women's hormones, longevity, and some of the biggest wellness myths that have been spreading across social media.

How can we distinguish genuine medical guidance from clever marketing?

We're going to find that out.

Get ready to rethink what healthy aging can look and feel like because it may be possible to reinvent your brain, reinvent your body, and reignite your passion for life.

Kathy and I are excited to welcome Dr. Sarah Ciavoshi.

Welcome, Dr. Sarah.

Thank you so much for having me.

I appreciate that.

And it's very clear that your brain is working so sharply.

I don't know how you did all.

I thought that was a recording.

That was incredible.

Is amazing in every possible way.

And so are you.

Dr. Like, oh my gosh, welcome to the show.

Absolutely.

You're an amazing lady and you're raising three children while doing all of this.

Oh, Lord.

Yeah.

I don't know if my life is insane.

Let me tell you, it's not.

There are three small kids.

I am like in the thick of it.

So, yeah, it's a lot, but, you know, I, I try my best, which is all we can do, I guess.

Well, you've got a wonderful purpose in so many different directions, and this is so wonderful.

You're helping people and, and while you're raising your family too.

It's truly a blessing.

Before we begin, I was wondering maybe you could give us a brief background of what you do and why you decided to go in this direction in healthcare.

Okay.

So I am still a practicing urologist at the University of California, San Diego, ucsd.

And when I started there, you know, I was young and excited and.

It.

Was like the fresh face and it's all optimism and you don't see any of the downside of so much of medicine currently.

There's a huge issue that we have in general with the practice of medicine.

But at any rate, as time went on, I got extremely frustrated by the fact that there's so much bureaucracy in medicine.

So a lot of my time was spent and still is spent when I'm at the university, which is every week writing notes, placing, looking through 5,000 different things until I finally am able to get the patient what they need and want.

And then when I do do that, I'm limited by health insurance and copay costs and just accessibility.

And so I was so over it.

I was like, this is ridiculous.

Um, so that first of all was a huge driver for me to leave practicing traditional medicine full time and wanting to do telehealth where it's direct to, to patient and we don't have to go through an insurance company and making things affordable.

I was just so over everything being so expensive.

I hated it.

It was annoying.

I don't want to deal with insurance anymore.

And then the second driver was me as a neurologist, seeing patients over and over and over, come into my clinic way too young, having memory problems, brain fog, being physically disabled from a stroke at an early age, having problems finding their words again from a stroke at an early age, or from severe degenerative disc disease, arthritis of the spine.

Okay.

And they just had trouble walking.

They were having neuropathy, radiculopathy, all of these terrible things.

And, and I knew that a lot of these things were so preventable, and it really saddened me.

It hurt my heart that, that not enough neurologists were having this conversation of prevention with them.

You know, it was just sort of like, we can't do anything now.

It's a little, it's, it's, it's a little Too late.

And that sucks.

It sucks seeing people develop dementia, develop disabilities, not be able to walk and talk and live long, full lives the way that they deserve to.

So I wanted to go into the preventative side of medicine and not have to deal with insurance, which is exactly what we do with Dr. Brainerx, especially with how preventative the GLP1s are in our general health.

I think so many people think that these are just vanity drugs, right?

They do, yeah.

And that's why the insurance companies have pushed back.

It's kind of been presented that way.

But I understand the GLP1s have been used for what, way over 20 years, haven't they?

Yeah, yeah, I didn't know that.

Well, we've been using them for diabetes, for diabetes type 2.

And it wasn't until Ozempic came out where it was a hard hitting GLP1 agonist, where we saw all of these diabetics lose tons of weight, where, you know, Zempic was the first glp, same class of drug.

You're right, that class of drug has been around for over 20 years now.

But Ozempic was the shining star in this drug class.

And so Oz Epic was incredible, changed the world.

And they said, okay, let's get this, let's get a different name for it and rebrand it for weight loss.

And that's when WeGovy came out, which is also known as Semaglutide.

And then now we have Tirzepatide, which is the second generation and is a dual agonist, GLP1 plus GIP, even more weight loss.

And again, yes, they've been around for a really long time.

They've been doing amazing things for our health for a really long time.

But it's not until more recently that the new and improved versions came out and we started seeing a lot of weight loss again, which is not just a vanity thing.

I mean, these medications, we're seeing huge changes in metabolic health where they are helping us to, to live longer, live better, have healthier brains and so many other things that we can absolutely dive into.

Yeah, it's rather interesting.

I was reading that there was a recent Gallup poll that said 11% of US adults who roughly 29 million people currently take GLP1 medications for weight loss.

So that may have been for maybe diabetes.

But there are a lot of things that GLP1s can work to do on your website you call GLP1s brain drugs.

Why is that?

These medications actually work on a brain level.

And that's, that's part of the reason why I was so intrigued by them.

GLP1 drugs work to decrease hunger on a hypothalamic level.

Not only that, there's.

There's also a very large reason why they're, why, why they're being studied right now for addiction, nicotine addiction, alcohol addiction, and actually people who have addictive eating habits, like binge eating disorders, because those are all very dopamine driven.

Right.

Dopamine is this neurotransmitter, and this drug works to suppress that dopamine, that dopaminergic feedback loop that drives the reward system and drives addiction.

And so it's.

These are brain drugs because they work on that reward pathway, but also because they work on a hypothalamic level to suppress hunger.

So they are absolutely brain drugs.

Not only that, you know, they work to also decrease inflammation within the brain.

We have GLP1 receptors in our brains, and if we can reduce neuroinflammation and microglial activation, which is what these do, and improve insulin signaling within the brain, then we're able to decrease the risk of neurodegeneration.

Right.

Our BRIO will stop shrinking at such a rapid rate and stay fuller longer.

So people, you know, kept on asking, like, what, what the heck is a neurologist doing prescribing these drugs?

Well, I'm neurologist.

I am also a board certified obesity medicine specialist.

But, but it, it is because these are brain drugs.

Yeah.

And that is my primary specialty is neurology.

I did not know that GLP1s are being looked at to treat alcoholism as well as nicotine addiction.

That's amazing.

Yeah, I didn't know that either.

Wow.

Yeah.

Currently the observational studies are super, super promising.

People having much fewer compulsive eating behaviors, less alcohol cravings.

And the larger observational studies are actually showing lower risks of alcohol, nicotine, opioid even.

Right.

Like, we have a huge opioid crisis.

Cocaine is a huge one because it's very, very dopamine driven.

And then even less cannabis use among people who are taking GLPY medication.

So it is just really exciting.

Wow.

That would be amazing if you could do something with opiate addictions, because I've read that that's one of the hardest addictions.

Oh, my God.

I know, I know.

It is extremely hard and it's a very, very big problem.

And then of course, you know, this is an area where I is not my particular area of expertise.

But the psychedelics are so exciting for the opioid addiction problem.

There's some promise in using these psychedelics for that as well.

So we'll see what happens.

But hopefully we find something because it truly is a crisis.

It's very sad.

Yes, it is.

Stay tuned for more of Women Roadblocks warriors coming up.

Dean Michael, the tax doctor here.

I have one question for you.

Do you want to stop worrying about the irs?

If the answer is yes, then look no further.

I've been around for years.

I've helped countless people across the country, and my success rate speaks for itself.

So now you know where to find good, honest help with your tax problems.

What are you waiting for?

Welcome back to Women Road warriors with Shelly Johnson and Kathy Tucaro.

If you're enjoying this informative episode of Women Road Warriors, I wanted to mention k Kathy and I explore all kinds of topics that will power you on the road to success.

We feature a lot of expert interviews, plus we feature celebrities and women who've been trailblazers.

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We want to help as many women as possible.

Our guest is Dr. Sarah Ciavoshi.

She's a neurologist who's also board certified in obesity medicine and the founder of Dr. BrainRx.

You know, you can hardly turn around today without hearing about Ozempic, wegovy, Zeppbound or GLP1 medications.

And most of the attention is on how much weight sometimes somebody lost.

But Dr. Sara looks at these medications through a very different the brain GLP1s work to reduce hunger and cravings.

As a matter of fact, these drugs are also now being studied to treat addictions like smoking, alcohol, drug use or addictive eating habits.

It's because these are all very dopamine driven behaviors and the drug reduces that reward system that drives the Addiction.

So what are GLP1s doing to hunger signals?

The cravings, the reward pathways, how do they suppress hunger?

That constant chatter about food that some people experience all day long.

Dr. Sara is explaining it and that's what makes this conversation different.

We're going beyond what happens on the scale and looking at what may be happening inside the brain and why GLP1s work.

Kathy, you said you had a question for Dr. Sarah.

I'm really curious and I've been wanting to just wondering about this for at least six months, just randomly, when people start these GLP1s and say they, they take it for a year, lose their weight and, you know, feel better, and then they just get tired of injecting themselves so they stop.

Do they regain all the weight that they lost?

Or is this going to be.

Once you start, you're doing it for, you know, the next 10 years.

So I want to remind you of something.

A fat cell lives forever.

Okay, don't tell me that.

No, it is a sad story, my friend.

You never get rid of a fat cell.

You can shrink it, you can shrink it by losing weight, but you will never rid yourself of that fat cell.

And so because those fat cells live forever and, and be, you can, you can grow a whole lot more, but you can't, you cannot lose them unless you do liposuction, which presents a whole, whole bunch of risks, right?

But fat cells live forever.

And so because of that, your genetics, your metabolism is set in a certain way.

This is why people talk about like a, a weight set point.

Your weight set point may be like someone's maybe 180 pounds, right?

And then they lose weight and they get down to 130, they feel good, they look good, and then their body says, no way.

What are you talking about?

£130.

I hate £130.

My set point in my brain, my fat cells metabolically are telling me that my weight set point is 180 pounds.

Number two, from an evolutionary standpoint, what are you doing to my body?

I need to survive on this earth.

You have now starved me.

I am going to find whatever I can to eat, to consume, to bulk, back up, because clearly I'm starving and I am not going to be evolutionary evolutionarily fit enough to survive against my competitors.

And then this is why when people get off of a GLP drug, their weight set point is there.

I mean, in their brain, it's still set.

Their metabolism is still saying, let's go back to 180 pounds.

They get hungry they get hungry and do they gain more weight back than before?

No.

And usually people end up not gaining all of the weight back, but they do end up gaining a pretty good amount back because of exactly what I said.

So, and I hear this all the time where people are like, well, I'm going to get off of the medication and I'm going to gain all the weight back.

Okay, so what was, so what was your alternative to not get on the medication and just stay obese all your life?

Like the alternative is, is to get on the medication, lose a good amount of weight and stay on the medication, keep the weight off and live longer, live with less pain, live with less arthritis, live with a fuller brain or, and, and sorry.

And also include that as a tool to maybe learn to change your, your eating habits and your lifestyle.

Right?

Yeah.

Because I think some, some, some people are so focused on a miracle cure that they forget that it's just a tool that in order to, to sustain, you know, the weight loss.

Well, okay, sure, yes, it helps.

But I mean, if you keep eating, you know, chips and chocolates and pop and, you know, and sodas and pizza and all this, well, of course you're going to gain it back.

It really, in my mind requires a complete change as you do the, the, the injections.

No.

Am I wrong?

No.

Isn't it learning to change your, your, your.

Your mindset and your, your habits and I mean, basically it's almost like, like I, I'm a recovering alcohol alcoholic.

I have 14 years sober, but in, in order when I first started recovery.

They teach you if you want change, you gotta change everything.

And it starts with your mindset.

So wouldn't the eating habits also be required to change?

Yeah.

Yeah, but I'll tell you that.

And I see this is why some people have this negative perception of GLPs, right?

Is that not everyone.

Let, let me take, let me give you a really strong example, okay, Of I have a family member, very close family member, and you know what?

She's even going to know who I'm talking about.

She's fine.

She knows exactly her, her problem.

And I'm not her doctor, so I can give her an example, but I'm not gonna name.

But her problem is, is she was one of the early ones on GLPs, like one of the early ones before this stuff got popular.

She lost so much weight.

I mean, we were just like, all this is what she needed.

And our hope was that the weight loss would drive her to now be motivated enough to start exercising and employ Healthy eating habits.

Okay.

And start resistance training and getting, getting in enough protein.

And she unfortunately never did.

It was so disappointing.

And because she didn't, her weight loss plateaued.

I mean, she just stopped losing weight.

At some point.

Her body said, I don't know what you're doing.

I mean, you know her metabolism.

When you actually lose weight, unless you gain muscle, your metabolism slows.

It's interesting.

Your ability to burn fat slows down.

So a really obese and overweight person has a higher metabolism and more robust fat burning mechanism.

It's really interesting.

But when you.

Wow.

Yeah, it's really counterintuitive.

So when she, when she lost weight, her ability to burn fat, her ability, her metabolism all slowed down and she stopped losing weight.

And this is.

No matter how much we told her, listen, you must lift weights, you must get in enough protein.

She just wouldn't do it.

And so that is like, that is an unfortunate poster child for the people who are anti glp.

Right.

And this is why some, some people have thought of GLPs as a terrible thing, is because they see some people who have relied on it for, you know, just losing weight and not done the things that they were supposed to.

Now, let me tell you this.

If she had not gone to glp, she would still not be lifting weights.

She would still not be getting enough protein and fiber, but she would still be 150 pounds heavier and have a much higher risk of dying early.

So, yes, she's, she's.

Unfortunately, she hasn't done the things that she was supposed to, which I always preach and is part of our, our program.

But she's still actually healthier metabolically.

Right.

She still has a lower risk of many diseases, but the best way to do the glps is to lift weights, increase your muscle so that you're actually increasing your metabolism or maintaining your metabolism, maintaining your muscle while you're losing fat and getting in enough protein.

When you do that, it's, you know, it, it's like the gold standard way of doing things.

I do have many patients who are like me, who are skinny little girls.

Okay.

But skinny fat, we have this skinny fat genetic problem.

We've never been overweight in our lives.

We've never looked overweight, I guess I should say.

But if you look at body fat percentage, I'm in the overweight category.

But I swear, if you see me, you would never guess it.

I look so skinny.

Yeah, I've never heard of that.

That's interesting.

Yes.

And so the problem with the skinny fat people is usually they are not weightlifting enough and they are not making solid food choices.

So for me, this is why microdosing GLP1s is such an awesome concept.

It's like the concept between behind microdosing GLPs is not massive weight loss.

It's to reduce that food noise in your brain so that I'm not grabbing my child's leftover chicken nuggets or their leftover treats, you know, that, that they left in their backpack because I'm starving when I pick them up from school.

It's so that I avoid those things so that when I go home, I'm reaching for something that may not be as palatable, that may not be an addictive processed food, but maybe something high protein, maybe a kale smoothie or maybe, um, a cottage cheese, right?

Like something high protein.

Or at the end of the day, if you haven't got enough protein in, you know, like a protein powder shake or whatever.

But the microdosing concept is awesome because it is doing exactly what point you were trying to make is motivating people to get healthier, to live healthier, to make better choices and to do the things that they were not quite able to do before the glp.

Not necessarily to lose a bunch of weight, but to make better food choices and to start lifting weights and then you are like, super metabolically healthy.

I mean, my DEXA body scan has improved dramatically.

I'm no longer in that skinny fat category, which is so awesome.

But I can tell you something.

My GOP wore off a few days ago because I do a very small dose now.

Spaced apart like more spaced out than normal people do.

And I was so hungry today.

Oh, my God, I made so many terrible food choices.

And I was like, oh, this is why I microdose the glp.

So.

So, yeah, it's.

It's interesting.

Yes, it's really interesting.

Stay tuned for more of women road warriors coming up.

Dean Michael, the tax doctor here.

I have one question for you.

Do you want to stop worrying about the irs?

If the answer is yes, then look no for further.

I've been around for years.

I've helped countless people across the country, and my success rate speaks for itself.

So now you know where to find good, honest help with your tax problems.

What are you waiting for?

Welcome back to Women Road warriors with Shelly Johnson and Kathy Tucaro.

We're back with triple board certified physician, Dr. Sara Ciavosci.

We all know somebody who seems to be able to eat whatever she wants and never worry about her weight.

Meanwhile, someone else can spend half the day thinking about food and fighting cravings.

Maybe we've been looking at that difference all wrong.

First of all, as we've learned in our previous segment, a fat cell lives forever.

That's not too encouraging, but there are ways that we can take control.

Dr. Sarah talks about something she calls the skinny brain.

And once you start looking at weight through the lens of neurology, genetics, hormones, metabolism, and brain signaling, that old idea that some people simply have more willpower starts looking pretty outdoor stated.

Our brains may be influencing far more of this than most of us have ever realized.

Dr. Sarah, maybe if you could kind of clarify, what does the brain actually do?

What is the brain doing that makes us want to eat?

How are we retaining fat cells?

And like you said, fat cells never go away.

That's just not something we want to hear.

Not at all.

But what exactly does the brain do?

So the, the brain has a metabolic control center.

That's, that's what I was talking about earlier, the hypothalamus.

Okay.

It's this, it's this area of the brain that signals your body's energy status.

And it basically says, have I stored enough energy?

Is my blood sugar dropping?

Am I stressed out?

Do I need to conserve energy?

Have I eaten recently?

And the hypothalamus gathers all of that information and then decides whether or not it needs to increase hunger or decrease hunger, whether you're going to go after food or whether you're going to stop eating.

And then it turns on different neurons that then drive hunger pathways.

And so then it sends a signal to your stomach.

There's one called ghrelin.

And you can think of it as like, like your stomach's growling, right?

And basically it's released when your stomach is empty and it makes you feel hunger and it go after food.

And then leptin is another one that tells the brain, okay, listen, I've had enough to eat.

Stop eating.

I'm full now.

So, so sure that that's a very, very simplistic way of describing the brain's role in hunger.

And then you know that that was the hypothalamic pathway.

That was hunger and satiety.

How hunger, it drives hunger and it drives how and drives fullness.

And then there's the mesolimpic dopamine pathway, which is, or dopamine system, which is various areas that, in the brain that are involved in the emotional aspect of eating.

But and because it's involved in that, that's the same system that's involved in addiction.

Okay.

Which is why these medications work on suppressing the addiction to food, suppressing the addiction to various vices like cocaine, alcohol, marijuana, like anything that people become addicted to, which.

But it's interesting because like, you know, marijuana is a little bit controversial in how indicative it is, but.

Right.

There's some people that say it's not addictive at all.

Yeah, exactly.

Yeah.

So.

Yeah.

Different, different controversial conversation for another time, I guess.

So essentially it impacts the pleasure center of the brain.

So there are all kinds of different things that can really run us amok when it comes to eating food.

And the thing is you're damned if you do, damned if you don't.

You have to eat.

But yet if you're addicted to food, that's a tough one.

It really is.

And people can use food as a comfort thing.

You know, it probably depends on how they were raised.

I mean there's so many things that factor into that.

And then what did the GLP1s basically suppress that whole thing?

I mean not the whole thing, but essentially, yeah, they're working on again, just making you feel fuller for longer.

Suppressing that hypothalamic drive to tell your stomach that it's hungry and that it needs to eat.

It is.

And it's working on that mesolimbic pathway to make you less addicted to food.

That's the brain part.

But of course it also works on, on increasing insulin sensitivity, which means that it gets blood sugar out of your blood vessels and decreases inflammation.

And that is huge.

That's a huge part of why it's so anti inflammatory on the brain and body.

So yeah, you know, it works in, in several different ways, but the brain is certainly the biggest, most important one, at least in my opinion.

As if you were going to ask a neurologist.

Right, right.

Well, that's what you study and that, that makes absolute sense.

You know, I was thinking in probably the past 50, 60, 70 years there's been a lot more obesity and it seems like there's been a lot more Alzheimer's.

Is there a correlation there?

And is it something that's happening in the brain as well?

Oh, I mean, remember that obesity is part of the metabolic syndrome.

What does that mean?

You know, metabolic syndrome is people who are overweight or obese who have high Blood pressure, who have high blood sugar and who blood vessels are inflamed and becoming clogged.

So what happens when you've got blood vessels that are inflamed and clogged in the brain?

Your brain starts to shrink.

Okay?

That's what happens.

You get something called small vessel microvascular ischemic disease.

And I've talked about this all the time.

I hated when I would get an MRI of a 40 year old person and I would have to explain to them what all the whites spots on their brain were and they'd be like, do, why do I have white spots?

And I'd be like no, no, no, don't worry about it.

In neurology, in, in medical school, in neurology residency, we are literally taught to tell people the white spots are benign, literally benign.

And the radiologist will read it as benign, benign appearing, chronic white MA matter microvascular ischemia disease.

Which means that they're just little white spots that you should not worry about, about them because guess what?

They are, they are the little blood vessels, small blood vessels that are feeding the deep parts of the brain.

Those blood vessels are becoming inflamed and degraded and then those deep parts of the, of the brain are losing blood flow.

And that's what those white spots are.

It's not good.

And when we see these in older people, we call it, or it becomes advanced, we call it advanced white matter microvascular ischemic disease.

And then we say that, oh, it probably explains their problems with memory and their problems with balance.

But we're taught and trained in neurology to not worry about it when it's not as advanced.

But I want to work, I want to worry about it.

I want, I don't want that as a 40 year old something woman, right?

Like I don't want white spots on my brain because I know that at some point it's going to become advanced and I'm going to have trouble speaking, thinking and walking.

And this is the problem in medicine is like we're not worried, we're not doing enough to prevent the advancement of disease.

And this is why people are developing dementia.

But when you work on preserving your blood vessels and decreasing inflammation in your blood vessels and a huge part of that is blood sugar, which is how the GLP ones work, right?

They're decreasing, they're anti inflammatory in the brain for multiple reasons.

But one of them is decreasing blood sugar by increasing insulin sensitivity in the brain.

And then also of course the like obese people have a, the White spots on their brain are way more confluent and way more present than someone who is not obese.

So again, just another reason why the GLP1s are so effective in preserving brain health.

It's decreasing these white spots on the brain, keeping the brain fuller for longer.

It's, it's a big deal.

It's a big thing that we, we want to, to see.

Stay tuned for more of Women Road warriors coming up.

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Welcome back to Women Road warriors with Shelly Johnson and Kathy Tucaro.

We're with neurologist and obesity medicine specialist Dr. Sarah Ciavoshi, founder and CEO of Dr. BrainRx.

One of the things I find fascinating about this conversation is how often we separate the brain from the rest of the body.

But the brain's our metabolic control center.

It also controls the emotions behind eating.

Our body marches to this tune.

We talk about weight over here, hormones over there, brain fog somewhere else.

And then aging gets its own category.

But your brain and body obviously aren't operating independently.

Metabolism, inflammation, hormones, muscle sleep, movement, appetite and cognition, they all can intersect.

But when you start connecting those dots, healthy aging becomes a much bigger conversation than simply trying to stay thin or live longer.

It becomes about keeping both your brain and your body working for you.

Dr. Sarah is showing us how and explaining how GLP1s can assist.

Dr. Sarah, there's so many wellness myths on social media and so much mis and disinformation, which I'm.

That's why I'm glad you're on the show here because you can clarify some of this, because people really don't understand how all of this works and they're not being told by their doctors, especially if they're being told, oh, don't worry about that.

When in fact, yeah, they really should.

They can do something about it.

They can take a proactive stance with their own health.

Yeah, yeah, that's.

That's exactly right.

That you know, I will tell you something too, and I know that people hear this all the time, but exercise really is so incredibly important.

Right.

Like, people under underestimate the power of exercise.

One thing that people don't realize exercise does is it increases something called bdnf, which is actually fertilized.

It's like called a fertilizer for the brain.

Okay.

It stimulates the growth of new neurons and connections between the brain, synaptic connection.

And it's particularly important in what part of the brain?

The hippocampus, which is the brain's memory center, one of the first regions that's affected in Alzheimer's disease.

So higher bdnf, a better learning center of the brain, more memory, more cognitive resilience.

So memory is huge in prevention of disease, in prevention of Alzheimer's.

But again, right.

Like if you're disappointed in your body, you feel like your diet and exercise have gotten you nowhere with your weight loss, are you going to continue to diet and exercise?

No, you're just, you're done.

So getting on a GLP to jumpstart that path of getting healthy with doing exercise, because you actually feel better, because you can get off the couch, because you have less pain, you're more motivated, is a huge part in just generally improving health.

This is interesting.

I don't think I'd ever heard that BDNF is something that exercise actually stimulates and you have more that and it can actually help in the growth of the hippocampus.

I would think that would be something that people who maybe have suffered a stroke, any kind of debilitating issue, when they can, they should exercise because that would help them, wouldn't it?

Would it help them restore and help maybe the restorative abilities of the brain?

Yeah, yeah, absolutely.

Absolutely.

It depends on how severe your stroke is.

Right.

Like people with severe strokes, unfortunately, sometimes can't.

But a lot of people with unilateral one part of the brain being affected still have ability, at least on one side of their body.

And so absolutely exercising, which is why we're always recommending physical therapy, occupational therapy for these, for this, this type of patient that will absolutely help in that neuroplasticity.

Right.

Like helping to try to build those, rebuild some neural networks that have been.

That have been broken by trauma, whether that's a brain trauma from a severe concussion, a severe traumatic brain injury or a stroke.

Yeah, we're kind of going now down another rabbit hole here.

But I'm thinking of depression, which actually can, that can impact people when they're eating.

They eat when they're depressed or they don't eat when they're depressed.

You can have depression after strokes and that sort of thing.

How does all of that interact?

Is it serotonin?

Are there neurochemicals that are imbalance and how do we work around that?

So actually we should probably put this out there.

There had, there were some articles and then of course it gets.

Because there is so much fear mongering.

And again, you know, to your point of myths on social media where people were saying the GLP1s make you depressed and suicidal, okay.

And the data that came out with large clinical trials show that that is not true.

And large observational studies actually showed that there were lower rates of depression and anxiety among the GLP1 users.

Is that like the cause and effect thing?

Is it because GLP1s are antidepressants or anti anxiety?

Very, very hard to say.

Maybe, maybe not.

But what we do know is that when you see your body changing in a positive way, you can, you're absolutely going to feel better, right?

You're going to feel better about your body.

There are a few, few people who I've treated through my time doing GLP1s and I have treated thousands and thousands and thousands of patients now.

And I've, I've seen a lot of people, but there are very, very few people that have come to me and have said, hey Doc, I'm just feeling depressed on the glp.

And usually I'll ask them, hey, do you have a history of depression?

And usually the answer will be yes.

And so it's difficult to say like, is this part of your depression?

Because depression can ebb and flow throughout time, right?

Like who it, it did, did it just randomly coincide with the onset of starting your GLP1?

So it, you know, it's very difficult to prove the causation.

But then I have, you know, very, very, very, even more rarely a couple patients that said, no, I've never been a depressed person.

And I'm like, huh, that's interesting.

And usually when I ask these people, they say my like addiction to food before the GLP was severe and when they start the GLP one because we're now breaking the cycle of the mesolimbic pathway, the addiction to food.

Now they're no longer relying on that little dopamine surge of happiness from eating an Oreo cookie, right?

Or like a salt and vinegar chip.

I was just naming a few of my favorite snacks by the way.

But, but now, you know, you're They're.

They're breaking that.

That cycle.

And that can temporarily make you feel.

Because it's like a withdrawal from food.

It can temporarily make them feel a little bit depressed.

And so, again, it's rare, but I have seen that happen.

But the overwhelming response that people have is that they feel happier, they feel less depressed, they feel motivated, they feel more confident, and they're able to form better relationships because of all of that.

Interesting.

So it must have some positive effects on the neurochemicals in the brain.

Yeah.

Again, it's hard to know.

Yes.

Whether it's primary or secondary?

We don't know, but yes.

Yes.

Yeah.

We, like, just to clarify, we don't know if it's the GLP1 medication itself causing a shift in neurochemicals or is it the weight loss causing a shift in the neurochemistry of the brain?

Right.

Like.

I don't know.

We don't know yet.

Something's doing it.

Can't tell if it's the chicken or the egg, essentially.

Sure.

That's well said.

So.

Well, you know, just from my own personal journey with weight struggles, weight and my thyroid doesn't work, and just, you know, metabolism and just whatever.

Right.

And depression and my alcoholism and all this stuff going on and trauma.

When I did finally lose weight, it's like, oh, my God, it's.

It changes the chemistry in your brain.

It just does.

Because you feel better, so you want to keep feeling better.

See, well, for me, anyway, my own personal journey is that when I do lose weight is that I want to stay like that and I don't want to go back to where I was before.

So I think it has a big part in even.

I'll speak for my daughter when she.

Look, when she lost, like, 30 pounds on her own, you know, she automatically feels better.

Amazing.

So sorry if I'm.

If I'm being a little intrusive, but you said your daughter did not use a glp, did you?

No, no, no, I did not.

Okay.

And that.

And like, my mother lost almost a hundred pounds, and she just.

By walking and she, like, the transformation in her is just like, oh, my God.

Cr.

So, yeah.

And none of you guys off of the.

Off of the GLP1 not having.

No.

Regain the weight.

No.

It's awesome.

No.

So it does.

Is a lot of this genetics, too, and maybe epigenetics, a combination of both, basically, our genealogy, our heritage, as well as what we're exposed to on our environment.

Is that what dictates a lot of this, too?

You mean Dictates obesity.

Yeah.

And how our body, our metabolism and all of that and maybe how we even interact.

I mean, obviously food is something we have to interact with.

So if there's an addiction that develops with food that's going to aggravate the situation.

Yeah, obesity is.

There's tons of genetics that play a role in obesity.

Absolutely.

Do you know what one of the strongest risk factors for being obese is?

No.

It's your mom's weight right before she conceived you.

Really?

Yeah.

Really?

Yeah.

Yeah.

So why.

Why is that?

I don't know exactly.

It has something to do with the body's memory of the metabolic memory.

But women who are.

This is why we have Ozempic babies now.

Well, first of all, the fertility changes so much.

Fertility increases so much when you lose weight because of the decrease in inflammation.

You're less insulin resistant, you have less inflammation, and your fertility just improves dramatically.

Men's testosterone profiles improve dramatically when they lose weight.

So there's lots of Ozempic babies out there.

But the mom's weight right before she conceives is so important in determining how this baby is going to run the risk of becoming obese in their life.

It's extremely important to be very, very healthy before one thinks about family planning and getting pregnant.

How can that affect the egg?

Because the eggs already exist at birth with a woman when she's an infant.

Quality, though, changes your egg count.

Right.

Like it's there.

Okay.

You're absolutely right.

But the ability for the egg or for the follicle to rupture for the egg to be available, the egg quality, that all changes dramatically depending on your inflammation levels and your overall health status.

That's.

That's ex.

That's a very, very much epigenetic.

Interesting.

And they don't tell patients this, you know.

Yeah.

Yeah.

Well, this is why when you go to a fertility specialist to do IVF or whatever, or to do egg retrieval and they're going to check your.

They don't just take.

Check egg count.

Right.

Like, they're checking ape quality.

And if your ape quality sucks, even though they may have been able to retrieve a bunch of eggs, they're not gonna be able to use your egg.

They then they tell you like, hey, your egg quality was bad.

I want you to do this and this and this to improve your egg quality and then come back in a few months and let's check it again.

And GLPs, by the way, are one of the things that are now being.

Being used to improve egg quality.

Wow.

Yeah, they're using it for all kinds of things.

And it was originally designed or developed for diabetes, am I correct?

Yeah, yeah, that's right.

Exactly.

Yeah.

Interesting.

So what can people find at your clinic?

BrainRx.

Dr. BrainRx.

Yeah, yeah, Dr. BrainRx.

At Dr. BrainRx, we do.

We do it all.

So we do prior authorizations to try to get GLP1s approved through insurance for the appropriate candidate.

So if you've got like a BMI over 30 or you've got a BMI over 27 with comorbidities, we try to get these approved through insurance.

There's also this awesome Medicare bridge program for people who are on Medicare with Part D. This is really, really big.

It rolled out in July and it makes it so that Zepbound is only $50 a month for people on Medicare and who also have Part D if they have a BMI over 35 or a BMI over 30 with certain comorbidities over 20 sediments.

So they have to meet essentially the criteria.

But if they do meet the criteria, it makes the GLP1 incredibly affordable, which is very affordable, which is very exciting.

So we do that stuff, you know, the insurance stuff.

And then we also do just, you know, Lilly Direct Cash Pay brand name.

We do Novo Cash Pay brand name just directly through the manufacturer.

And then we offer the compounded semaglutide tirasepatide as well, which is much more affordable.

But we do it all, we offer it all.

Right.

Sometimes it's like patient preference, they want this, they want that, or if we can get it through insurance for them, that's what we would love for them because it's more cost effective for them and that.

And then we do NAD plus injectables for at home treatment.

We do some peptides like BPC157 and copper peptides for skin and hair.

So we do, you know, we do a lot of different things, but I will say that the shining star is always the GLP one.

And we, and we do that for micro dosing for people, again, who are like me, who just want it at a low dose for lowering inflammation, making better food choices, or at larger doses, slowly going up the dosing ladder for people who have a lot of weight to lose.

Now people can reach out to you and have remote consultations.

Yeah, remote consultations with either me or my team.

And sometimes people decide that they know exactly what they want.

They've already been on terzepatide or some of glutide and they just want to get started and so they can.

They purchase a GLP plan and they can get started automatically after on the back end.

We review their medical history and make sure that everything looks good.

And then they just get their medication shipped directly to their home.

We make it very, very easy.

Is there one brand that's better than another?

And I've noticed there's quite a few different kinds.

Is or are these just basically all the same?

They are not all the same.

Sevaglutide is Ozempic, which is also Wegovy.

The exact.

Those three things are the same thing.

Semaglutide, Wegovy, Ozempic, same exact medication.

Okay, okay, that's version one.

And then version two is Tirzepatide.

Tirzepatide is Zepbound, is Mounjaro.

All again, same exact thing.

The Tirzepatide, Mounjaro, Zep bound stuff, that's version two.

And it is a dual agonist GLP one plus gip.

It's more weight loss, more anti inflammatory.

Some people feel like it also has less side effects.

So the version 2.0 is a little bit more expensive.

Probably like runs you maybe like 100, 150 bucks more a month or something like that, depending on, you know, if you go brand name or compounded or whatever.

But if you.

If budget is not like an option, then I would go Tirzepatide.

It's better.

That's what I.

Here in Canada, we have Saxenda.

Is that the same as Wegovy?

Oh, no, no, no.

Saxenda is what came out before Wegovy.

And it is not as strong and it often has some.

Some more GI side effects.

But it's not terrible.

It's better than nothing.

It is helpful.

It's just not.

It's not as.

It's not as advanced, I should say.

Okay, yeah, interesting.

Yeah.

There's the oral stuff too, or Foclibron.

There's Ribel cyst.

There's these oral GLPs that do not provide as much weight loss as the injectables.

Then you have to take the pill every day.

They also usually have some more GI side effects like nausea, constipation, that kind of stuff, but they're fine.

For people who really hate the injectable, I will say the injection is so easy.

It's just a small, tiny needle.

Very, very painless compared to a lot of other injectables.

And it's only once a week.

But.

Yeah, but the.

But the oral is fine for people who just really are desperate and cannot do a Shot.

So people can reach out to you about all of these issues and certainly they're going to learn a lot from you, the brain, really.

They might learn some prevention and how to feel better about themselves just by reaching out to Dr.

Brain Rx.

Because you've got some supplements here to even help with.

Let me look here.

I'm looking on your website.

You have cognitive support.

You've got various things that people can actually do to improve their cognition, improve how they feel.

Vitamin D3, that's always a good thing.

You've got see how many people are deficient in D3.

Right.

It's insane.

Oh, it really is.

Yep.

Well, especially if you live where there's winter.

I was tested for it a number of years ago and I was deficient.

So I take vitamin D3 on a regular basis.

Can I tell you something crazy?

In neurology, we have Ms.

Patients, multiple sclerosis patients.

And you know, a lot of people don't realize how important D3 is for our Ms.

Patients.

And this is like university setting.

University setting is extremely conservative in recommending vitamins.

Right.

They're like antivitamin, but for our, in a university setting, for Ms.

Patients, we tell our Ms.

Patients that their vitamin D levels should be between like 60 and 100.

The lab value that tells you you're normal is over 30.

So if you're like 40 or I'm sorry, if you're like, you know, 29 or 35, your doctor is telling you, yeah, your vitamin D level is fine.

But for our Ms.

Patients, we want them to be between 60, 100.

Why?

Because vitamin D is so incredibly important for the myelin sheath that surrounds the nerves, that helps your nerve impulses transmit efficiently.

And it's incredibly neuroprotective.

Okay.

So it's like, it kind of, it's kind of sad that, that we're so conservative with certain recommendations for vitamins when like, we know how incredibly anti inflammatory neuroprotective they can be.

Like, vitamin D is just so underrated.

It's an.

It really.

It's good for your immune system too.

Yeah, yeah, exactly.

Exactly.

Well, and that's as an autoimmune disease of the neurologic system.

Yes.

So where do people find your website again?

Doctorbrainrx.com D rbrainrx.com and then they can also find me on Instagram.

Dr. Dr. Brainsd, SD.

Like San Diego.

Because we're in San Diego.

This has been a fascinating conversation.

We've covered a lot of different topics here.

But you've really, I think maybe clarified a lot of the mystery that surrounds things.

And I think people still have a curiosity about the human brain.

You know, I think we're still learning things as we go along, aren't we?

We are learning new things every single day.

There is so much about the human body that we don't know that we are continuing to just try to unravel.

So it's exciting.

Knowledge is ever increasing.

That's wonderful.

And knowledge is power.

Thank you so much Doctor for being on our show.

This has been excellent.

Thank you for having me.

I appreciate you both.

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