137: GLP Maintenance Dosing and Microdosing

We break down the real middle ground between staying on a full GLP-1 dose and stopping abruptly, using the “ladder, not a switch” mindset for long-term weight loss maintenance. We share what the newest evidence says about lower maintenance doses, spacing injections, tapering safely, and why DIY microdosing can create serious risks. • the ladder approach to GLP-1 treatment decisions • why stopping GLP-1s cold turkey often leads to regain and worsening blood sugar and blood pressure • what Surmount Maintain suggests about low-dose tirzepatide maintenance after a plateau • how maintenance dosing can preserve weight loss and improve A1C in people with prediabetes • the pharmacology behind spacing injections and what early models and small case data show • oral Wegovy dosing options, cost realities, and why access drives real-world choices • slow tapering as a safer off-ramp while monitoring hunger and weight trend • why microdosing by “click counting” lacks solid evidence and raises safety concerns • how insurance coverage changes can force medication switches and disrupt continuity of care You can find us on Threads, Instagram, or send us some fan mail. But most importantly, stay healthy, my friends. Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

We break down what the research says happens after stopping GLP-1 medications like semaglutide and tirzepatide, including the scale, hunger signals, and key lab changes. We explain the biology behind rebound and why weight regain is predictable physiology rather than a willpower problem. • GLP-1s as long-term management for obesity and type 2 diabetes, not a cure • what GLP-1 does in the brain, stomach, and pancreas and what reverses after stopping • STEP 1 extension numbers showing about two-thirds regain over a year after stopping Wegovy • meta-analysis findings on average regain after semaglutide or tirzepatide • why bigger losses often come with bigger rebounds and why regain is typically gradual • body composition concerns, regain tending to be more fat than muscle • what happens to A1C, fasting glucose, blood pressure, and cholesterol after discontinuation • set point, metabolic adaptation, and counter-regulatory appetite signals • legitimate reasons people stop and why stopping should be a planned transition You can find us on Instagram, threads. You can send us an in um a voicemail. Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

We break down what continuous glucose monitors really measure and how to use CGM data without letting a new health metric run your life. We walk through a new primary care study in type 2 diabetes without insulin and talk honestly about benefits, limits, cost, and the questions the research still leaves open. • separating A1C, fingerstick glucose, and CGM trend data • why CGM readings can lag behind finger sticks • what the Kinect trial studied and why it matters for non-insulin type 2 diabetes • A1C changes, time in range, and what “better control” can mean day to day • medication intensification versus behavior change as competing explanations • sponsorship and study design caveats worth noticing • using CGMs to spot meal spikes and guide realistic nutrition choices • consumer CGMs for prediabetes curiosity and time-limited learning • cost, access, and why long-term real-world results may differ You can find us on Instagram, threads, send us an email, send us a voicemail if you'd like Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

We break down the 5:2 diet in plain language and explain why it can work without any metabolic magic. We share what the research actually shows, how to do the low days safely, and who should pause and talk with their doctor first. • what “five normal days, two low days” really means and why the low days should not be back to back • why 5:2 works the same way other weight loss plans work through a weekly calorie deficit • what studies show when 5:2 goes head to head with daily calorie cutting • realistic expectations for weight loss and possible changes in blood pressure and blood sugar • how to set up low days with protein, high-volume foods, fluids, and smart activity • what hunger and other common low-day symptoms feel like and why they usually improve • the real problem with long-term results being stick-with-it time • when to talk to your doctor first including diabetes meds, eating disorder history, pregnancy, and frailty You can find us on Threads, Instagram, or send us an email, or send us a voicemail, fan mail. Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

We trace how a deep vein blood clot forms, breaks free, and lodges in the lungs as a pulmonary embolism, and we explain why symptoms can range from sharp chest pain to sudden collapse. We also lay out what makes us worry, how clinicians test and treat PE, and when you should stop guessing at home and get urgent help. • how DVT risk factors stack over time • why clots from the leg travel to the lungs • ventilation perfusion mismatch and abrupt shortness of breath • how right heart strain can drop blood pressure and cause fainting • common symptom patterns including chest pain with breathing and coughing blood • why a normal pulse ox does not rule out PE • how emergency teams size up risk before imaging • CT pulmonary angiogram, VQ scan, ultrasound, echocardiogram basics • what anticoagulants do and what “blood thinner” gets wrong • when to call 911 and why you should not drive yourself • recovery, follow-up, and prevention after surgery or long travel You can find us on Instagram, find us on Threads, you can send us an email Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

We lay out a practical fall vaccine plan for 2026 by comparing what’s the same and what’s different across flu, COVID, and RSV guidance. We focus on the real-life questions people ask in clinic: when to get vaccinated, who needs extra doses, and how pregnancy and infancy change the RSV plan. • annual flu vaccination for nearly everyone 6 months and older • why flu shots change yearly and why timing still matters • enhanced flu vaccine options for adults 65 and older and when not to delay • when children need one flu dose vs two based on vaccine history • flu shot myths, including why it cannot give you influenza • updated COVID vaccine recommendations for adults, with extra planning for ages 65 and older • pediatric COVID guidance based on age, risk, household exposure, and prior doses • RSV vaccination for older adults and higher-risk adults 50 to 74 • pregnancy vaccination for flu and COVID in any trimester • maternal RSV vaccination timing and infant antibody protection options • expanded RSV protection for some children entering a second season You can find us on Instagram, find us on Threads, you can send us an email, but most importantly, stay healthy, my friends. Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

We walk through why potassium is the quiet partner in blood pressure control, and why focusing only on sodium misses half the story. We break down the safest ways to get more potassium, the research behind potassium-enriched salt substitutes, and the red-flag situations where extra potassium can be dangerous.• how potassium lowers blood pressure through kidney sodium excretion and vessel relaxation • why most adults fall short on potassium while eating too much sodium • the DASH-style “food first” approach and everyday potassium-rich foods • what potassium-enriched salt substitutes are and what stroke outcome trials show • hyperkalemia risks and the highest-risk groups, especially kidney disease • medication interactions that can raise potassium, including ACE inhibitors, ARBs and spironolactone • why over-the-counter potassium supplements are not a go-to blood pressure strategy • two questions to ask your clinician before making changes You can find us on Instagram, you can find us on Threads, send us an email, but most importantly, stay healthy, my friends.Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

A stroke can flip someone’s speech, strength, vision, or balance in seconds and sometimes there’s no pain at all. That’s exactly why people hesitate, wait it out, or try to “figure out what kind it is” at home. We don’t want you doing that. We want you recognizing sudden brain-function changes and calling 911.We walk through the fundamentals of stroke physiology in plain language, including the two major types: ischemic stroke (a blocked blood vessel) and hemorrhagic stroke (bleeding in or around the brain). You’ll learn why symptoms can look similar even though the treatments are very different, what clinicians mean by the ischemic penumbra, and why a non-contrast CT scan is often the first critical test in the emergency department.From there, we get practical: the BFAST warning signs (balance, eyes, face, arm, speech, time), why a transient ischemic attack (TIA) still counts as an emergency, and what “last known normal” means for treatment decisions. We also cover what happens next in the ER, including glucose checks, imaging, clot-busting meds like alteplase or tenecteplase for eligible patients, and when thrombectomy may be an option. Finally, we talk about recovery, rehab, the emotional toll on families, and prevention basics like controlling hypertension through primary care.If this helps you think of one person you love, share it with them. Subscribe, leave a review, and tell us: which stroke warning sign do you think most people ignore?Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

Coffee feels simple until you watch two people drink the same amount and have totally different outcomes. One of us can sip an afternoon coffee and sleep fine. The other can take a similar dose at noon and stare at the ceiling all night. So we slow it down and make it practical: coffee and caffeine are not the same thing, and the best way to understand your own response is to think in three variables we can actually test, the dose, the clock, and the person.We explain what caffeine is doing in the brain, starting with adenosine and sleep pressure, then why caffeine can make you feel more alert without paying back any sleep debt. If you have ever said “coffee makes me feel normal,” we talk through what that might mean, including the possibility of overnight caffeine withdrawal versus a true stimulant effect. We also get specific about dosing: a “cup” is not a dose, decaf is not zero, and caffeine can come from coffee, tea, soda, energy drinks, supplements, and even some medications. We discuss the FDA’s 400 mg per day benchmark as a population-level reference, not a personal target.Then we dig into timing and sleep quality. A key idea is that caffeine may still be in your system after the buzz is gone, and sleep impact is not just about falling asleep, it is also about how the whole night goes and how you function the next day. We talk about metabolism and sensitivity, how tolerance can build, and why symptoms like jitters, anxiety, palpitations, reflux, or disrupted sleep are worth listening to. We also share ACOG’s commonly cited pregnancy guidance to stay under about 200 mg per day and why your personal medical context can change the right plan.We close with what coffee research can and cannot tell us, why observational studies are reassuring but not prescriptions, and a simple self-experiment you can run this week: find the approximate caffeine in your usual drink, place it on your sleep clock, and see what you notice. If this helped, subscribe, share it with a friend who “can drink espresso at night,” and leave a review so more people can find the show.Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

A big weekend can make the scale jump, but that number rarely means you gained pounds of fat overnight. We break down why short term weight fluctuation happens and how to respond without panic or risky “fixes.” • Scale weight reflecting water, fat, muscle, and digestive contents • Why fast changes cannot be reverse engineered from one weigh in • Sodium and fluid retention driving “water weight” • Carbohydrates, glycogen storage, and the water that comes with it • Hard workouts causing temporary water retention during muscle recovery • Food timing, larger meals, and constipation affecting the number • Menstrual cycle related fluid shifts and recurring patterns • Weigh in consistency: same time, same scale, similar conditions • Focusing on trends over time instead of one reading • Returning to normal meals and routine instead of “compensating” • Avoiding laxatives, deliberate dehydration, excessive water intake, or changing meds to force a lower number • When to seek medical attention for swelling, shortness of breath, or chest pain • Heart failure weigh in rules being different and following your care team’s thresholds You could find us on Instagram. You can send us an email, your checkup pod at gmail.com. Send us a (voice ) message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski