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Peptide and GLP Pep Talk

She Lost 12 Pounds. But It Still Didn’t Feel Like Enough.

A message from Dr. Maki

“You’ve lost 12 pounds!”

“It’s not that much.”

“I could lose more.”

“I want to lose more, faster.”

“Can you increase my dose?”

“I still want to lose more.”

More. More. More.

I understand it. When you finally start losing weight after struggling for years, it’s tempting to want every extra pound gone right now.

But there comes a point when we have to ask:

Are we still pursuing healthy weight loss, or are we simply pursuing a lower number on the scale?

Losing weight is only part of the goal. How you lose it matters.

We want you to lose excess body fat while protecting the things you don’t want to lose: muscle, bone, strength, energy, and metabolic health.

That’s where our approach to GLP-1 medications is a little different.

Our approach: Low-Dose GLP-1 Cycling

Rather than automatically pushing the dose higher and higher, we often use lower doses of GLP-1 medication and cycle the dose based on your response and goals.

Why?

Because the goal isn’t to suppress your appetite so much that you barely eat. And it isn’t to see how quickly we can make the number on the scale drop.

We want enough GLP-1 support to help with appetite, cravings, portion control, and weight loss, while still making sure you’re eating enough protein and nutrients to help protect your muscle, bone, strength, and metabolism.

As you lose weight, we reassess. Sometimes the dose needs to go up. Sometimes it doesn’t. And sometimes we can cycle down or use a lower maintenance dose rather than assuming more medication is always better.

We can help you lose weight without:

• Automatically escalating your GLP-1 dose just to make the scale move faster
• Suppressing your appetite to the point that you can’t adequately nourish your body
• Ignoring muscle and bone while focusing only on pounds lost
• Treating the number on the scale as the only measure of success
• Assuming you need the highest dose to get results

GLP-1 medications can be a powerful tool. The key is knowing how to use them thoughtfully.

Our goal is not simply to help you weigh less. It’s to help you lose fat, protect muscle and bone, and find the lowest effective GLP-1 dose that works for your body. We are licensed to prescribe in WA, CA, UT, AZ and HI. Respond to this email if you have more questions.

Why Do I Keep Getting UTIs After Menopause?

Welcome to the Land Down Under
Dr. Valorie Davidson

What is GSM (genitourinary syndrome of menopause)?

GSM is a collection of symptoms that can occur in menopause due to the decline in estrogen. No, it's not happening because you are getting older; it’s happening because of low estrogen levels.

We're going to start with one common, but not often talked about symptom of GSM:

• "Why do I keep getting UTIs, or feel like I have one when I don't?" And what you can do about it.

Frequent UTIs...or feeling like you have one when you don't.

One of the most common complaints I hear from women in menopause, and also perimenopause, is, "I keep getting UTIs," or "It always feels like I have one, but my urine cultures are negative." Both can be related to estrogen. Declining estrogen in menopause and the ups and downs in peri.
​

Estrogen helps maintain the health of the entire lower urinary tract, including the:

• Urethra: The short tube that carries urine from your bladder to the outside of your body.
• Bladder neck: The "funnel" or opening where the bladder empties into the urethra.
• Trigone: A small triangular patch of tissue on the inside floor of the bladder where the two ureters enter, and the urethra exits. It has a high concentration of estrogen receptors and is particularly sensitive to declining estrogen

Less Food for Lacto:

As estrogen declines, several changes occur that make urinary symptoms more common.

• The vaginal lining becomes thinner and produces less glycogen (AKA: food).
• Glycogen is an important fuel source for all the beneficial bacteria (Lactobacillus) that help maintain a healthy vaginal microbiome (a more acidic pH).
• Lactobacillus crispatus is generally the most protective species.
• L. jensenii and L. gasseri are also common and beneficial.
• L. iners
• L. acidophilus is not typically a dominant vaginal species, although it can be present in some women and is commonly used in probiotics.
• As Lactobacillus levels decline, the vaginal pH becomes less acidic, making it easier for bacteria such as E. coli to grow and migrate into the urinary tract. This is one reason recurrent UTIs become more common after menopause, particularly following intercourse.
• So basically:
  • Less estrogen = Less food = Less lacto = More “baddies” = more UTIs

Urethral Health: Your bladder’s gatekeeper (password is estrogen)

Estrogen also helps keep the urethra healthy.

Without adequate estrogen, the urethral lining can become:

• Thinner,
• Blood flow decreases
• Mucus production declines, and the
• Tissue becomes less elastic.

This means there is less protection against bacteria traveling into the bladder. It’s like the doors to your house are not just unlocked, but wide open.
​

My Sad Bladder:

When estrogen declines, your bladder itself is also affected.

• The trigone of the bladder contains a high concentration of estrogen receptors.

Less estrogen can lead to an unhappy bladder, such as:

• Bladder sensitivity, discomfort
• Urinary urgency
• Urinary frequency
• Getting up multiple times during the night to urinate (nocturia)

These symptoms can closely mimic a urinary tract infection, even when urine dipsticks and cultures are completely normal.

Estrogen is good for your immune system:

Estrogen supports the body's natural immune defenses.

• Healthy Lactobacillus bacteria: Beneficial bacteria that help protect the vagina.
• Antimicrobial peptides: our body's natural bacteria-fighting proteins.
• Secretory IgA: Protective antibody that helps block germs from attaching.
• The acidic vaginal environment also helps protect against infection.

Less estrogen means fewer good bacteria, weaker natural defenses, and more opportunity for the troublemakers to move in.
​

Learn what you can do to:

• Reduce your UTIs
• Create a healthy vaginal microbiome
• Doses for localized estrogen therapy

You've learned why recurrent UTIs become so common during menopause. Now let's talk about what you can do.

Unlock the full article to explore my complete clinical approach to restoring the vaginal microbiome, supporting urethral and bladder health, and helping reduce recurrent UTIs and urinary symptoms.

Upgrade to the paid article

Bad Sleep = Bad Mood

I’m a crab if I don’t sleep well.

I know life is busy and we have so much to do. But really, turn off the email, messages, and suspenseful TV shows a couple of hours before bed.

• Activates the HPA axis and sympathetic nervous system:
  • Increasing cortisol and adrenaline at exactly the time you want those alerting signals quieting down.
• Darkness tells the brain’s master clock, the suprachiasmatic nucleus, that night has arrived
  • Allowing melatonin to rise.
  • Bright evening light can suppress that melatonin signal and shift your circadian clock later.
  • Wrong combination at bedtime, too much “stay alert” signaling and not enough “it’s nighttime.”
• During perimenopause and menopause, sleep is tough enough that protecting that evening wind-down becomes more important.
• It's not shame and blame. I know my sleep last night wasn’t great, and feeling a little crabby right now. But Lioness season 3 is so good.

Disclaimer

All content found in this newsletter, including text, images, audio, video, or other formats, was created for informational purposes only. The purpose of this website and blog is to promote consumer/public understanding and general knowledge of various health topics. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concern regarding this topic, then it is time to find a new doctor.