The GLP-1 Problem No One Is Talking About: A New Metabolic Approach

GLP-1 receptor agonists have transformed the way we approach obesity and metabolic disease. The results can be remarkable. But as their use continues to expand, I think we need to be asking a bigger question: what does long-term metabolic health look like beyond weight loss?

In this episode of New Frontiers, I sit down with Dr. Sanjay Bhojraj and Dr. Alexis Gonzales to explore a completely different way of thinking about metabolic intervention. Rather than systemically suppressing appetite or altering hormonal signaling, we look upstream at digestion itself, specifically whether changing the rate at which carbohydrates and fats are absorbed can have positive effects on postprandial glucose, visceral adiposity, lipids, and body composition.

We dig into the fascinating mechanism behind the novel SiPore silica technology, the results of the randomized, placebo-controlled SHINE trial, and where this approach might fit clinically, including for patients transitioning off GLP-1s, those who need to discontinue them for fertility treatment or surgery, and even metabolically healthy patients navigating the occasional high-carbohydrate meal.

This is not an anti-GLP-1 conversation. It’s a conversation about expanding our metabolic toolbox and thinking more deeply about what happens before, during, and after these powerful drugs. I think you’ll find the mechanism particularly interesting. ~ DrKF

In this episode of New Frontiers in Functional Medicine, Dr. Kara Fitzgerald sits down with Dr. Sanjay Bhojraj and Dr. Alexis Gonzales to explore an emerging approach to metabolic health that works very differently from GLP-1 receptor agonists. The conversation examines SiPore, an engineered silica-based intervention designed to act locally in the gastrointestinal tract, where it interacts with the digestive enzymes amylase and lipase to slow the breakdown and absorption of carbohydrates and fats.

They unpack findings from the randomized, double-blind, placebo-controlled SHINE trial, including changes in A1c, visceral adipose tissue, waist circumference, lipids, and lean mass, and explore what those findings could mean clinically. The discussion also tackles some of the more challenging questions surrounding GLP-1 therapy, including lean mass preservation during weight loss, what happens when treatment stops, and strategies for supporting patients transitioning off these medications or temporarily discontinuing them in preparation for pregnancy, IVF, or surgery.

From postprandial glucose excursions and CGM data to PCOS, insulin resistance, body composition, and metabolic flexibility, this conversation offers a broader framework for thinking about metabolic health beyond weight loss alone.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. And, of course, today is no exception. I am really excited to be talking to two big voices in the functional medicine space who also happen to be dear colleagues of mine. And we’re gonna be talking about some cool science translated into clinically-actionable, clinically-useful stuff. Today with me is the amazing cardiologist moving into functional medicine, Dr. Sanjay Bhojraj and Dr. Alexis Gonzales. Dr. Bhojraj is helping redefine what cardiovascular preventative and longevity medicine can look like through a functional lens. And Dr. Gonzalez has a remarkable talent for taking emerging research and turning it into immediate practical clinical strategies. They both speak really plain language and, you know, I think we covered a lot of information that’ll be useful to you in clinical practice almost immediately.

Dr. Kara Fitzgerald: Today’s episode is sponsored by Sigrid, the makers of the amazing product SiPore, and we’re going to be taking a dive into that, the origin story of SiPore, the preclinical and the clinical science behind SiPore and why, you know, likely it’s something you’ll be considering using in your clinical practice as I am doing in mine. So whether you’re interested in metabolic health, precision medicine, or you really love just seeing innovation in action and how we translate it into clinic, I think you’re going to enjoy this episode.

Dr. Kara Fitzgerald: You know, I’ve had the opportunity to really experiment with SiPore. And one of the things that I say to my patients all the time, actually, you know, to my family, to my mom who’s always saying, “Should I take this? Shouldn’t I? How do I know if it’s working, et cetera?” Right? Is that not a question we get all the time? “How do I know if it’s working?” I say, “Ma, mark your calendar when you start, reconvene in a month, and just track. Don’t change the…” And I say this to my patients as well, maybe not quite as casually as I do my mom, but so SiPore is one of those products that I one million percent recommend we all need to kick the tires on. I and my team and my patients have really had a good time exploring the power of it.

Dr. Kara Fitzgerald: And so, I’m excited to be with you both again here in the podcast setting. You know, we did a webinar a little while ago and it was really highly well-received. So I’m excited to get this message out to an even bigger audience about SiPore. So Lexi, I want to start with you on, you know, just give me a little bit of the backstory. Like, why am I so interested in this? And then we’re gonna jump into mechanism and some of the science. So what is it and why do we need to know?

Alexis Gonzales, ND, MS, IFMCP: Yeah. And I think you hit the nail on the head quite poignantly in that it’s super easy to use. It’s actually one of the, I would say, you know, I don’t know if this is the best word, but the funnest interventions to try because you can pair it on to basically your current regimen without making very many changes. You can take it with whatever medications and food. But essentially it’s a, I think Sanjay describes it perfectly, it’s a perfectly-engineered sand particle in that it’s a silica particle that’s been specifically engineered, not just on the size of the particle, but the actual pores on that particle. And what they’ve been able to achieve is that particular size selectively binds to digestive enzymes in our body, which blocks that ability of the digestive enzymes to break down food that we eat into macronutrients, which then cause what we would consider glucose spikes or issues with lipids on the back end.

Alexis Gonzales, ND, MS, IFMCP: And so, what we’re really trying to do is buffer the metabolic stress that we typically get from food. What silica or what SiPore is, is essentially you take this meal level intervention and it allows you to buffer that metabolic stress on the back end. And so, this technology was created by Tore Bengtsson in Sweden. And essentially what he was trying to do is solve this issue of how we actually support people that are in this pre-diabetic range from progressing to diabetes. And so, it started out with this initial calling from him to actually discover a pharmaceutical that would be this effective for managing this type of patient case. And what he found is, you know, we don’t necessarily need to create a drug, but there’s actually something really interesting about silica in and of itself that we can manipulate in order to work with our own physiology. And so, what they did is they took the individual silica particles, they made it a very specific size, which was micron size, which is just big enough for it to not be absorbed systemically. So this is a locally-acting intervention. Then they took that micron-size particle and put in nano pore size pores on that particle all over.

Alexis Gonzales, ND, MS, IFMCP: So if you look at the particle, it has all these very individual pores on there. Then they put it in two forms. So either in a powder form in a capsule or in a gel packet, which is their liquid form. And so, when you take that with the first bite of food, it actually binds to amylase and lipase selectively and only those two enzymes, no other fat-soluble vitamins, none of your other enzymes, no other food particles. And it actually blocks the ability of amylase and lipase to break down carbohydrates and fats. And so, those carbs and fats that are sitting in your food actually go through your GI system undigested so that way you don’t get those glucose spikes or the absorption of fats. And so, we can go through all of the science deeper, but that’s really the main takeaway is it’s super easy to take. It’s non-systemic, it’s locally-acting. And it pairs really well with all of the other lifestyle interventions that we typically recommend for this audience, which is, you know, lifestyle, dietary interventions and movement.

Dr. Kara Fitzgerald: And if you have a CGM on, which I would recommend for any clinician or layperson listening, you can pay attention. You can do immediate tests. Here’s meal with, here’s a meal without SiPore. And you can just look at your data. It’s pretty extraordinary. It’s actually wildly motivating. But you don’t, I just want to, I want to just clarify with you, you’re not completely inhibiting the absorption of carbs and fats. They’re not going away. I mean, that would be a massive problem. You’re slowing them down.

Alexis Gonzales, ND, MS, IFMCP: Correct. So there’s a really cool phrase that we talk about when we think about SiPore that I think patients really latch onto, which is you’re slowing down fast food. And when we say fast food, we’re really talking about modern food that isn’t necessarily the whole plant-based foods that we typically think about. So when we think about fast food, we’re thinking, you know, very processed, high in inflammatory fats, super high in simple carbohydrates. So, but just to your point, the ability to slow that down so that way you’re not getting those really rapid spikes, and the breakdown of these processed foods is really where SiPore shines.

Dr. Kara Fitzgerald: I want to just throw in there, because I feel like there’s some clinicians out there thinking this, that, well, if it’s gonna slow down the absorption of carbs, you’re going to be having some gut issues promptly. We’re gonna circle back and you’re gonna drill into that in a minute. But the extraordinary thing is, if this is in your head, clinicians, that actually doesn’t happen. And there’s some very cool science around that that we’re gonna get to in a minute. But before we do, I just, Lexi, I want you to give us a little bit of the publications and we will link to the publications on the show notes. And then we’re gonna jump over to Sanjay, you know, and talk about using these clinically, and specifically, you know, in the context of the GLP-1 generation we’re finding ourselves in. So go ahead, give me a little bit of the science.

Alexis Gonzales, ND, MS, IFMCP: Yeah. So what they essentially did it the right way or what we would hope every supplement company and medical food would do the thing when they bring these products to market to clinicians and patients. So once they engineered the silica particle, they did some preclinical studies to actually confirm, okay, is this actually selectively binding to the enzymes that we think it’s going to? And so, what they were able to achieve in these preclinical studies, in-vitro studies is that yes, the silica particle selectively binds to amylase and lipase. We also can see that it helps to curb those glucose spikes and how quickly carbs and fats are actually absorbed. Then they transitioned into preclinical studies in mice where they actually showed, you know, some indicators that we would see some reductions in visceral body fat, some increases in lean muscle mass, and then reductions in biomarkers like hemoglobin A1C and some improvement in lipid markers. So they used that data to then say, “Okay, let’s take this into humans and prove that there’s a safety profile to your point, that it’s not gonna cause any GI issues.” And also, right, for the SiPore liquid, we’re getting up to nine grams per day of the silica material.

Alexis Gonzales, ND, MS, IFMCP: So can we prove that it’s safe and that they’re not just taking in all of these silica particles as they’re taking it in with food? So they were able to rule out that it’s systemically absorbed in these initial human studies. They were able to prove that there were minimal adverse effects. And then I see this also personally with taking SiPore with every meal and that my GI symptoms actually improved post-prandially, like less bloating, less of that like gut heavy feeling, especially after you have a super greasy carb-heavy meal. And they were actually able to show that in those initial human studies. And just recently, which is super exciting, they actually were able to publish their first randomized controlled double-blind placebo-controlled trial in humans, the SHINE study in The Lancet journal.

Alexis Gonzales, ND, MS, IFMCP: So I want to drill down into that paper a little bit more because there’s a lot of exciting clinical takeaways for our audience. But the culmination of all of that was to say, “Hey, when we take this SiPore liquid, we see improvements in the biomarkers like A1C, visceral adipose tissue, waist circumference, sagittal abdominal obesity. And we also see improvements in lean muscle mass, LDL cholesterol, and total cholesterol.” So all of the things that we typically think of when we want to put someone on a GLP-1, except there’s no injectable, they don’t necessarily have to make major changes in what they eat outside of the basic, you know, lifestyle changes. And what’s super interesting about the SHINE study is there was no recommendation to change anything about what they ate or how they exercise. So it was really attached to the introduction of this SiPore liquid which was just taking one of those packets with every meal, breakfast, lunch, and dinner.

Dr. Kara Fitzgerald:  Thank you for that. And again, we’ll link to the show notes, we’ll link to the publications on the show notes. Sanjay, I know you are pretty excited about the SHINE too, and so, if you want to bring any more of your thoughts in it, that would be fine. And one of your thoughts is the whole muscle conversation. So talk about that. But just link it into, you know, everybody is talking about GLP-1s or wants to be on GLP-1s. They want a micro, they want a macro, everything GLP in the water, whatever. And you’ve got thoughts on that as a cardiologist and just as a functional medicine, just, you know, a brilliant thinker. But then also too on the SHINE, I want to circle back to the whole muscle loss issue, which is one of the big problems with GLPs.

Sanjay Bhojraj, MD, FACC:  Yeah. And I mean, I think one of the, well, thank you for that, Kara, great to be here. Always just a pleasure to hang out with you and have conversations. You know, as I look at just healthcare in general, right, and we think about taking care of people, one of the focuses that I have is less chemistry and more biology, right? We need less exogenous chemicals and really work a lot more with optimizing our own biology. And now having been in practice for over 20 years, I’ve seen cycles of these medicines kind of come and go, right? There was the fat blockers, so you can’t digest fats. And that led to, you know, gas with oily discharge famously is what I thought was like a Saturday Night Live commercial, right, when they first started direct to consumer ad. And then, you know, and it gets kind of even scarier when we start then talking about bariatric surgery, which was very effective initially. And I’ve had, you know, anyone who’s been practicing during this era has probably had, you know, hundreds of patients that have had bariatric surgery.

Sanjay Bhojraj, MD, FACC: But oftentimes what we’re seeing is if we’re not dealing with the lifestyle issues first, right, those kind of those very foundational functional medicine things, oftentimes those patients that undergo whatever version of bariatric surgery, Roux-en-Y or gastric lip bands or whatever they’re doing, you know, will often have a precipitous gain back of that weight, right? But at the expense of the muscle mass that they lost through malnutrition, right? And now, they’ve gained so much more fat and it just makes it difficult for them. So, you know, as I look at GLP-1s and this, you know, revolution, I mean, you know, I see the same thing, right? I’ve seen this history repeat itself again and again, that when you just rely on pharmacologic therapy or a structural therapy alone without optimizing the diet, without optimizing the lifestyle, without optimizing the mindset, you’re just gonna reverse. And we are now seeing that in the clinical datas. You know, I think I read something, 71% of people are no longer on GLP-1s after a year, right?

Sanjay Bhojraj, MD, FACC: The cardiovascular benefit and all of that stuff reverses after 18 months and we see that people actually gain weight faster when they’ve come off of GLP-1 meds than had they never been on one in the first place. So, you know, we’re seeing this initially, and now when we look at the mechanism of action, and particularly the one that scares me the most is the CNS, the central nervous system, affecting the pleasure and the reward system of the brain. So now we’re seeing people with anhedonia and you can’t fall in love and you’re not happy anymore. And we are fundamentally altering humans in not a great way, right?

Sanjay Bhojraj, MD, FACC: So, I’ll just preface this by saying with GLP-1s, I see them as a slingshot that maybe for a few months, three months, six months, like, to kind of get you that initial kick, but this is not a lifelong therapy in my mind, right? It’s like saying, “Well, you know what? Like, I was on chemotherapy for this cancer, so I’m just gonna stay on the chemo for the rest of my life because why not? I got rid of the cancer,” right? I think we have to be a little bit more intentional. And as you look at the practitioners, particularly the non-medical people who are giving this out, I think it kind of falls into the category, kind of my hot take. Good for business, bad for patients, right? So I’m just gonna leave that as it is. So what do we need to do, right? When we look at people who have successful-

Dr. Kara Fitzgerald:  Wait a minute. Wait a minute.

Sanjay Bhojraj, MD, FACC: Oh.

Dr. Kara Fitzgerald:  That was a mic drop. I just want to thank you. That was so brilliant, very meaningful. Many, many, many of us have gotten aggressively onto the bandwagon. And I think you and Jeff Bland are the two voices I’m hearing saying, “Whoop, whoop, whoop, caution.” You know, and now some of these longer-term data coming in are, you know, what you’re pointing out, that’s very concerning.

Sanjay Bhojraj, MD, FACC:  And anybody who understands biology, like, this is not a surprise, right? I mean, like-

Dr. Kara Fitzgerald: That’s right.

Sanjay Bhojraj, MD, FACC:  And then when we look at, you know, what happens, I mean, I kind of famously call GLP-1s a medically-induced eating disorder, right? Like, you are, if you’re not doing it with intention, you’re getting malnourished, right? Like, and kind of the reason my hot take exists is I had surgeon colleagues in the operating room when these medicines first came out telling me they were getting more bleeding complications intraoperatively because patients were no longer absorbing vitamin K, and they couldn’t make clotting factors, and we would check bleeding times, and they would be prolonged. Like, you know, this is not a panacea. We need to be very cautious with this, right?

Sanjay Bhojraj, MD, FACC: And so, in my clinical practice then, I’m looking for, okay, what are things, what are wins that we can give patients where they’re feeling better, but they’re not putting them systemically at risk? And that’s why, you know, getting back to SiPore, I think it’s just such a brilliant molecule because it is, you know, first of all, chemically-inert, it’s silica, right? It entraps these digestive enzymes. And, remember, with your, and for the clinicians out there, remember, you don’t just dump a bunch of amylase and lipase into your gut as soon as you eat. I mean, there’s a period of time through which you’re secreting, you know, throughout your digestive process, amylase and lipase. So when we instruct patients how to use this, you take a few bites, you take the gel pack, which is like a power gel if anybody’s a runner or endurance athlete that you would do, has a citrus-y flavor.

Sanjay Bhojraj, MD, FACC: And so, you’re blunt, you know, you’re entrapping those digestive enzymes up front, but you’re not blocking, to Lexi’s point, the digestion because your body’s still gonna secrete amylase and lipase. We’re just blocking that initial dump of enzymes, so to speak. So we are now prolonging that time through which you’re digesting. We’re slowing down that initial phase. And as we look at what I think is one of the greatest tools that we’ve been given in the metabolic world, continuous glucose monitors, right? We’re learning so much about glucose velocity. It’s not just about the level or the spike, it’s about how fast you’re getting there, or how quickly you’re resolving your time in range, time out of range, these new average glucose exertions, all of these derivative data that we’re seeing that we never saw before, if you remember as I do, during the old stick your finger three times a day, you know, that’s like looking at a speedometer and saying, “Okay, when I was in my driveway, I was at zero miles an hour. When I was at the parking lot, I was zero miles per hour. How did I get here?” Right? There’s a lot that happens in between.

Sanjay Bhojraj, MD, FACC: And now we’re able to get better insight, better data into what’s happening during that in-between time. And we’re realizing that these spikes are not benign, right? These excursions are not benign. And we call it metabolic stress, right? What precedes metabolic syndrome is putting your body through so much in the same way that, if you’re an endurance athlete, right? I know you’re a cyclist, Kara. So imagine cycling 100 miles without stretching out your hips, right? That’s a lot of stress on your joints. And so, essentially that’s what we’re doing with our metabolic system is we’re giving it these foods that dump glucose and therefore require a quick insulin hit. And we are wearing out our bodies in the same way if you had a paperclip and you wanted to break it, right? You’d put it under stress back and forth. But now, by tamping down those excursions, right, by cutting down those spikes, keeping in range longer with the same meal as Lexi mentioned, we’re not even asking you to change what you eat, which I think is so important that I’ll get to in a minute.

Sanjay Bhojraj, MD, FACC: But just doing what you’re doing, but making it kind of more physiologic, easier for your body physiologically to address the food that’s going in. We’re seeing some remarkable, remarkable data, as you mentioned that SHINE trial, and you pointed out, Kara, one of the things that I think is the most important is we actually saw an increase in lean muscle mass, right? In that trial, which if you think about it, we’re not calorie-restricting, right? But what we’re doing is almost making your digestion protein forward because we’re blunting fat digestion with lipase, carb digestion with amylase, but the proteases are working just fine, right? So you’re able to break down the proteins, get them to where they need to go. So it’s almost the physiologic manifestation of when we tell people to eat protein first in your meal, right? So now we’re actually doing that, and our bodies, at least in our clinical trial participants, are enriched by that. And we’re actually seeing-

Dr. Kara Fitzgerald:  And you weren’t-

Sanjay Bhojraj, MD, FACC: Physiologically.

Dr. Kara Fitzgerald:  You didn’t bump up the protein. And this is, of course, in stark contrast to GLP-1s in the muscle loss, the pronounced muscle loss. It’s just so interesting to me. The other piece I want to just layer in there, two thoughts. One is people who are eating more protein to keep that, to bump up their muscle mass can have digestive distress. And I just want to hit home the really cool finding that this has not been associated with that. So even though you’re moving up, you’re basically putting them on a protein-forward diet to use [your term], it’s not necessarily high protein, but it’s acting almost like high protein. And they’re doing fine with it. The other point I wanted to make, and then I’m gonna turn it back over to you, Sanjay, is just to remind folks, ’cause we moved through this quickly, that no, this product doesn’t influence vitamin D absorption. It doesn’t influence your omega-3 absorption. And if you want to speak to that, Sanjay, as you talk more about it, you certainly can, but I just want to remind you of it because I know that’s in folks’ minds. On the webinar, I think we got maybe, we got that question at least a dozen times. So it’s-

Sanjay Bhojraj, MD, FACC:  Yeah. And I think that’s such an important point, right? Because we don’t, I mean, for me, again, you know, I’m trying to influence biology here, not just chemistry, and we want to make sure that we’re still getting what we need to get. And this is a mealtime replacement. So, you know, if you’re really concerned, you can alter your supplementation around that, right? So that if you’re taking your vitamin D supplement in the morning, you know, not within the window of taking a Sigrid, you know, a SiPore pack, you’re still gonna get the normal absorption, right? And in the clinical trials that we did, we did look at fat-soluble vitamins and nutrition profiles, and we did not see any nutritional deficiencies or vitamin deficiencies as a result of the use of SiPore.

Sanjay Bhojraj, MD, FACC: So that’s something that we are very concerned about, but we’ve shown in clinical trials that that doesn’t happen. And I know that unfortunately, people think it just stops absorption completely or stops digestion completely. Just to be clear, that is not the case, right? We’re slowing down the absorption, so you’re still gonna get your carbs, you’re still gonna get your fats, just not with that same load, not with that same upfront kind of spike. And, you know, clotting factors, fat-soluble vitamins, all that stuff will still get in there, just not as quickly. And to Lexi’s point, you know, it’s making fast food slow, right? And so, you’re getting them in, you’re just not gonna have those huge bumps and excursions and spikes that we see with the current level of diet. And can I just-

Dr. Kara Fitzgerald: It doesn’t call. Yeah, go ahead.

Alexis Gonzales, ND, MS, IFMCP: Can I just double click on that slowing down fast food? Because I want to make it super clear because this is also a common question we get. It’s not actually affecting motility at all. So when we say slowing down your food, it’s really just slowing down that absorption of the carbs and fats without any effect on your motility itself. And so, even though this wasn’t an outcome that they were looking for in the SHINE trial, they actually saw benefits to the gut microbiome by delivering these like undigested carbs to the colon because you had slowed down that breakdown. And so, they’re going to drill down into those results with some post-publication analysis of that cohort. But something exciting to look forward to just because I know that’s a question that we’ve all had is, you know, what are the long-term effects on the gut microbiome? And how do we think about this in the context of SIBO with how we’re adjusting absorption of these macronutrients? So I just wanted to double click on that point because it’s important for those that are concerned about constipation or some of those GI effects with GLP-1s.

Dr. Kara Fitzgerald: Yeah. No, it’s awesome to distinguish it from SIBO just by bringing up the whole motility point. It’s not manipulating motility. And Sanjay, to your point as well, this is not a gastric band, you know, and it’s not GLP-1. You know, when you brought that up, that correlation, I just, I, as I’m sure many listening, you know, flashed to the patients that I’ve cared for who are malnourished because they can’t absorb, because their stomach is kind of no longer existent.

Sanjay Bhojraj, MD, FACC:  I mean, cutting up your stomach? Like, are you serious? That seemed like a good idea to us?

Dr. Kara Fitzgerald:  Profound, yeah, profound malnourishment. And it’s not a part, nobody’s tracked, nobody’s tracked for the duration of the influence of that surgery. So I think it probably happens across the board.

Sanjay Bhojraj, MD, FACC: And probably in the conventional system goes unrecognized as a source of that.

Dr. Kara Fitzgerald:  Yeah, oh, for sure. That was my experience.

Sanjay Bhojraj, MD, FACC:  Why am I getting demented? Maybe it’s because of B12 deficiency, right?

Dr. Kara Fitzgerald:  Yeah, right, right, right. Crazy neuropathies. Yeah, that’s right. I mean, I think they pay attention to it in the very short-term, but then-

Sanjay Bhojraj, MD, FACC:  And, I mean, that’s a great point, Kara, because when we look at long-term data, right, in these clinical trials, it’s five years, but people don’t live five years. They live 50 years after surgery, right? So, you know, again, to anybody who understands biology, it’s the most obvious thing. Like, it’s the most predictable thing in the world, right? It’s like when I tell my daughters it’s gonna be cold outside and like, “No, but the sun is shining.” I’m like, “Yeah, but it’s 40 degrees outside. You can have sun when it’s cold outside, right?” Like, they don’t have that frame of reference, so they go outside and they shiver. And I’m like, “Okay, you’ll not make that mistake again.” Right?

Sanjay Bhojraj, MD, FACC: I think what I do when I look at patients is, all right, “I’m seeing you today, but also if I’m a longevity physician, like, I’m trying to get you to 100, right? So what are the things that we’re doing today in 2026 that will keep you healthy in 2056,” right? And I don’t want to paint myself in a corner today that I wish I’d get out of. And it just takes a moment to think, right? Or maybe some time to kind of understand the long-term consequences of what you’re really doing. And I just don’t think that, you know, unfortunately, it’s top of mind for a lot of patients because they just want to experience what they see whatever their star is on TV that they’re watching and, you know, it’s up to us.

Dr. Kara Fitzgerald:  Huge.

Sanjay Bhojraj, MD, FACC: “This is what you need to understand about that,” right? Or “This is the team they have behind them, making sure their nutrition is up to par, you know, that we need to make sure that you’ve got that knowledge as well, because it’s not just about giving yourself an injection.” And it never should be.

Dr. Kara Fitzgerald: Yeah. Yeah. Thanks, Sanjay, for hitting that home. And you can keep doing it. I want to round robin on using it clinically. So I want to start with you, Sanjay, on bringing it into your patient population. A lot of folks with pre-diabetes, metabolic syndrome, on up to diabetes. So what that looks like. And then over to you, Lexi, on women’s health, and how are you using it there? And then I’ve got a couple, you know, of thoughts from my own experience using it with patients. So go ahead, Sanjay.

Sanjay Bhojraj, MD, FACC:  So for me, I’m a cardiologist by training, and now I focus on functional medicine approaches to cardiometabolic and cardiac diseases. So this is a bulk of the patients that I see. And when I explain what’s going on, first of all, I think that my patients in particular are appreciative that it’s not like a medicine, right? It doesn’t affect your mitochondria or it doesn’t affect secretion of insulin or whatever, right? And what they also appreciate is that I’m initially not asking them to change their diet, right? I’m just like, “Just give it a go.” And I think you kind of hit this in the intro. “Give it a go, you know, take it for a test spin and see how you feel, right, after a meal.

Sanjay Bhojraj, MD, FACC: Like, do you have to have that nap, right? Do you feel just kind of spent? Do you feel tired? Do you feel gross,” right? And that felt experience of taking it is, I think, very different because, honestly, you don’t feel different when you take 500 of Metformin, right? You don’t feel different when you take a statin, right? Whatever it may be. But here you actually feel something different without actually changing your diet. And I end up seeing a lot of Southeast Asian patients in my practice being Indian. And the hardest thing to do is to try to change somebody’s diet, particularly of my parents’ generation, because they’re so entrenched and I won’t call out a specific family member, but I have a specific family member that I don’t want to get in trouble on podcasts. Luckily, they probably don’t listen to me. They don’t really believe that I’m a doctor anyway, but you know, but like, you know, so I said, you know, I don’t think, you know, she’s like, “I can’t lose weight. You know, my joints always hurt,” this, that, and the other.

Sanjay Bhojraj, MD, FACC: And I said, “Okay, well, look at your diet. You’re eating a bunch of fried carbohydrates. Like, it’s no wonder that your thyroid, you know, antibodies are high and your joints hurt and all this stuff. And, you know, let’s move to a little bit more fresh fruits, some more vegetables,” which by the way, are part of the Indian diet. But, you know, she just throws her hands up. She goes, “Well, what am I gonna do? I’m just gonna die. I don’t want to eat it, I can’t eat anything.” I’m like, “God, like, it doesn’t have to be that dramatic, right?” But I think anyone who has Indian patients, we watch a lot of Bollywood movies, so that’s where the drama comes from. But then it was so nice to say, “All right, don’t change anything that you’re doing, right? But now just take this gel, right, and see what happens and see how you feel.” And she felt better. I mean, I’m not saying that her autoimmune issues went away and all that stuff, but she said, you know, like, because I’m always trying a new supplement with her. And she goes, “Yeah, you know, this time I felt different. Like, after, I didn’t,” she said, “I felt light.” Like she just felt lighter after the meal.

Sanjay Bhojraj, MD, FACC: And I think that’s that felt experience. And so, particularly as we try to get those wins, early wins with patients, when they can feel better by having a very low risk intervention, that’s a win, right? And with that particular family member, I was like, “Okay, let’s just kind of stick with this for a while and then we’ll slowly start to incorporate other things.” And it gave them, it gave her that buy-in to say, “Okay, you know what? Something that Sanjay’s doing is actually now working, you know, so I’m gonna,” you know, right. And so, you know, I think that’s very helpful. And then I think of, you know, I have another family member who’s diagnosed with diabetes. You know, initial A1C in one year climbed from like 6.1 or whatever to 7.2. And the intervention that was taken by his conventional doc was, “Go see an ophthalmologist and a podiatrist because we need to do diabetic foot checks and retinopathy checks.” And then he called me and was like, “Hey, what do you think about this?” I’m like, “I think this is stupid because there’s so much that we can do.”

Sanjay Bhojraj, MD, FACC: Particularly with the trial, you know, the data that we have from SHINE, you can actually, you know, get people from that insulin resistant phase out of insulin resistance. So you can act in that A1C 5.7 to 6.4 kind of phase, but you can actually see hemoglobin A1C reductions and it’s retraining the body, right? And I think that’s such an important thing that’s missed in the conventional world. So, clinically, you know, I love it as a first line intervention as I’m working on diet, as I’m working on lifestyle, which by the way is what we’re supposed to be doing in the guidelines anyway, right? But actually giving people then that felt experience where they can feel the win. And when you’re dealing particularly with patients that are used to taking meds that never make them feel better, right? But you can now say, “Hey, you know, with this supplement, you’re gonna experience this and they actually experience it and see the difference. It’s so important.”

Sanjay Bhojraj, MD, FACC: And then if we can get them on a CGM, which I think is just one of the most important drivers of change that we see in metabolic disease is that we can say, “Hey, look at the same exact meal,” right? And this is, on the webinar, we talked about our founder who went out and had a burger on day one and then a burger, and which is kind of funny because they’re probably not accustomed to eating hamburgers, right? But like, had a burger at, you know, day one, then took SiPore, had burger day two, and we see the complete difference in the glucose response on a CGM. You know, you can see that difference and now you can feel that difference. So remember my parking analogy where you have zero miles per hour at the park in their driveway and zero in the destination. Well, now you’ve got the speedometer data from everything that happened in between.

Sanjay Bhojraj, MD, FACC: And that’s really when you start to look at that and then, as we’ve talked about, Kara, before, looking at more advanced CGM metrics above and beyond just how many milligrams per deciliter you’ve got of glucose, but actually looking at time in range, time out of range, spikes, all of these things that are now these derivative datas that we’re now learning the power of, right? You can really start to combine and make a difference. And I think that’s really what shapes behavior is, you know, people seeing when I eat a bowl of ice cream, but I work out, this happens, but when I eat, you know, when I have a protein shake or whatever and do that, you know, so they can start to make those real-time correlations, and that’s really where change happens. It doesn’t happen looking at a lab three months after an event happened, right? It’s like time of flight, real-time data. And that’s the experience that people are really getting with SiPore.

Dr. Kara Fitzgerald: In the studies, like, when do we expect to see a drop in A1C? Or is there a range?

Sanjay Bhojraj, MD, FACC:  Well, remember, A1C is your average glucose over 90 days, right? So I think that, you know, and depending on which CGM you use, a lot of them will have, like, calculated, you know, approximations of A1C. So, you know, I mean, certainly, you’ll see glucose changes pretty quickly. I think they probably take, I would guess, and Lexi, you may know, you know, I would assume they have like seven to 10 days of data that they need to collect before they can make that estimation calculation of the A1C. So, you know, you would see the glucose change pretty quickly. But that A1C change, again, would take some time, but anyone who’s been in the clinical world, you get that, right? You take an intervention, you have to wait not three months, but six months to see what happened three months ago. So it tracks what we’re already doing clinically anyway.

Dr. Kara Fitzgerald: Yeah. Anything to add to that, Lexi?

Alexis Gonzales, ND, MS, IFMCP: Yeah, I was just gonna say what’s cool is that in addition to having easy wins I also think about them as being compounded wins, right? ‘Cause you can see the meal by meal difference where you could say, “Oh, I’m actually, you know, blunting those glucose spikes.” Then you take it out to a week and you’re like, “Oh, I’m actually getting less spikes per week. I’m spending more time in range. I’m not having as many spikes while I’m sleeping.” So by the time they get their A1C run, you know, every three months, they’re expecting a good result because they have all of the-

Dr. Kara Fitzgerald:  ‘Cause they’ve seen the data.

Alexis Gonzales, ND, MS, IFMCP:  Yeah, and they’re making changes before that, right? Because they’re like, “Oh, this is working. I’m more motivated to actually engage with this plan.”

Dr. Kara Fitzgerald:  I think the other, you know, the big, crazy experience for me was basically repeating the founder’s experience of the hamburger. For me, it was my daughter’s pancakes, which I stayed away from. I don’t eat them, but I decided to. I’ve indulged in more challenges perhaps than I feel like admitting these days. But it’s right there. If I’ve got a CGM on, the data are right there and it’s very, very exciting. The other piece that I just want to kick this back, I think, actually we’re going, Sanjay, if you have more to add, you can. Otherwise, we’ll go to Lexi and talk about women’s health. But the satiety is something you also observed with this, right, Sanjay?

Sanjay Bhojraj, MD, FACC:  Yeah. And again, that makes sense biologically, right? Is that if you’re keeping food in the intestines longer, that longer digestive time, you’re gonna feel more full. That’s why whole foods make you feel more full than fast food, right? And so, we are now kind of mimicking that. But then also remember the signals that it sends to the brain, right? I think that when we’re eating a ton of fast food, those satiety signals, you know, the leptin and all of the ghrelin and all that stuff, like, that chemistry, that biology gets messed up, right? And so, now, we’re almost, I guess, in a weird way, simulating or creating what should actually be happening, but then continuing those networks, letting the brain know that you’re full, right?

Sanjay Bhojraj, MD, FACC: Allowing time for digestion, that transit time so that you’re not hungry for the next meal. We’re not blunting or we’re blunting those spikes, I think those big spikes then lead to that crash. Kind of famously, that’s why I say I think donuts come in dozens because you get that initial spike and then 45 minutes later you kind of feel like garbage. So to get through the day, you have to have another donut, you know, and so, you’re just kind of pushing yourself through the day. But we are blunting all those responses, you know, allowing that satiety, allowing your body to experience nutrition and digestion the way that it’s designed to. And it just, you know, the system just works a lot better.

Dr. Kara Fitzgerald:  For the majority of your patients, you’re prescribing a packet with three main meals?

Sanjay Bhojraj, MD, FACC:  Yeah. I mean, remember, I’m seeing cardiometabolic patients that are pre-heart disease, pre-diabetic, right? So I don’t kind of play it. I think that’s the place that I’m most comfortable starting. And again, it’s not much to ask. We’re not asking them to do 20 jumping jacks, right? It’s just before every meal, right? It’s just, you know, take this pack of pills.

Dr. Kara Fitzgerald: It’s easy.

Sanjay Bhojraj, MD, FACC: It’s easy. And it almost becomes, I mean, if you’ve used it, you kind of know. It almost feels weird that the first time you forget. It’s like walking out without a belt on, you’re just like, something feels- Nothing bad is happening, but something just feels off. And, again, the form factor is so easy. You can put it in a jacket pocket or a purse or whatever, so it’s not like some weird thing. And, you know, whenever we go to these functional medicine meetups or, you know, everyone’s got their whole row of supplements pre-meal, right? That, you know, well, I’m taking this and I’m… You’re not asking them to do a lot, right? And so, it just works and it’s like mobile and heat stable and all this stuff. So it’s an easy thing to incorporate into your daily life.

Alexis Gonzales, ND, MS, IFMCP:  I do have a pearl because I have a couple of patients and I’m guilty of this too, who eat, get distracted, and leave half their meal and then go do something, come back and eat. And so, what I found is if you take the whole packet with that first bite of food, you may not capture that second part of your meal if you get distracted halfway through. So if you’re a distracted eater like I am and many of my patients are, I may have them actually split the liquid packet or the capsules. If they end up noticing that their meals are spread out over like an hour or so and they’re kind of nibbling throughout it. So you may not see as significant of glucose, curbing the glucose spikes if you eat in that way and just take the packet with the first bite of food.

Dr. Kara Fitzgerald:  That is a good pearl.

Alexis Gonzales, ND, MS, IFMCP: One pearl is just to kind of split it out if you need to and you’re that type of habitual eater.

Dr. Kara Fitzgerald:  Talk about your patient population and how you’re using it.

Alexis Gonzales, ND, MS, IFMCP:  Yeah. So, you know, my patients would love to be on GLP-1s, but I primarily see a lot of patients who are trying to get pregnant or getting ready for surgery for endometriosis. And so, because of that, you know, we often have the initial conversation of if they want to start GLP-1s, but we also talk about the washout period that’s needed, right? If you’re trying to get pregnant or preparing for surgery. So SiPore is actually my favorite tool to give them because it’s a really nice bridge where they don’t have to add another thing onto their stack, which oftentimes plans for fertility and endo are just inadvertently massive because we’re covering so many nodes of the matrix.

Alexis Gonzales, ND, MS, IFMCP: So to be able to provide them a tool that allows them to keep doing everything else that they’re doing and we don’t have to have a washout period before they get ready for surgery or go through IVF is a gift that I am able to give to my patients. So, you know, specifically for PMOS for, or PCOS was the previous name. For those patients that are, you know, in the pre-diabetic range or, you know, have type two diabetes, SiPore is super effective mainly because they’re already working so hard to adjust their diet, but there are those sneaky things that they’re just having those glucose spikes to that they’re just not aware of. So we put the CGM on and they’re able to identify which of those foods are actually causing those spikes. And then we can give them an easy intervention to actually curb that immediately where they don’t have to pursue an injectable.

Alexis Gonzales, ND, MS, IFMCP: The other part of my patients, you know, are super interested in pursuing those direct to consumer GLP-1 sites because it’s so easy, right? A lot of them don’t qualify to get the GLP-1s covered by insurance. So I have a lot of patients coming to me already on GLP-1s that they got through, you know, a website because they could just get it within a week and they didn’t have to go through any pre-authorizations or it was super affordable. So getting them off of that medication, knowing that they did not have the lifestyle or dietary support as they were onboarding onto that medication, SiPore to me is the perfect bridge for them to get off of it super easily where it’s not as stressful for them to get those appetite signals back as we taper them down, but we don’t have to worry about, you know, the downstream effects of tapering them off and them not changing their diet too much. So I like it a lot for a bridge and then also as an alternative to GLP-1s.

Dr. Kara Fitzgerald:  Okay. Awesome. Yeah, you’re working with patients. Anything additional you want to…

Sanjay Bhojraj, MD, FACC:  I mean, I think, you know, that’s a great point about splitting meals. It’s funny, I talk a lot about mindful eating. I was like that guy that, you know, I had 10 minutes to eat and I just kind of slammed it down and get called out to this emergency, that emergency. But again, that’s bad for our digestive kind of vibe anyway, right? So I think that, you know, as we look at those, like, I get it, life is life, right? But, you know, you can take 20 minutes to just sit and eat.

Dr. Kara Fitzgerald:  You know, my population, ever since we conducted our research looking at epigenetic age, you know, using our diet and lifestyle intervention, my population has really shifted from just a typical functional medicine demographic to people who are biohackers, you know, longevity seekers. I mean, it really, it’s changed quite a bit, and it’s been very fun. I enjoy it, but I enjoyed, you know, my practice prior too. But, you know, sometimes they’re referred to as the worried well, this population. And one of the ways that I’ve used it, so they’ve already got, they’re already metabolically flexible for the most part. I mean, there might be some underlying issues that, I mean, actually, usually there are some underlying things we’re working with, but it’s not the same kind of lift because they’re putting a lot of intention into their health. And I still think SiPore has a place with this population because we can–

Dr. Kara Fitzgerald: I mean, it’s almost like a spot use format. So they’re not, they’re metabolically flexible, they’re not moving towards diabetes, but if they’re doing a lot of traveling or if they want to indulge, or if they’re doing their kids’ pancake test or whatever, I mean, SiPore can just keep them dialed in. And I just, I mean, I absolutely love it. I mean, it makes sense. And most of these people are already periodically using a CGM so they can see when they have their transgressions and, you know, again, immediately get feedback on using it. So I like the spot use scenario that fits in with my population. And, you know, for me, quite frankly, you know, to your point earlier, Sanjay, I have some in my bag. You know, I’ve got one of those little itty-bitty, like, what are they called? Fanny packs, like the modern fanny pack. And I can throw some in there and I have them with me. So I think all, you know, all of our patient demographic, there’s a place to use these appropriately, wisely, safely, et cetera.

Sanjay Bhojraj, MD, FACC:  Yeah, I think I would just say with the spot use is that we just, we don’t really know long-term what that does, right? So mechanistically, I totally get it. It’s just, you know, I don’t know that, you know, that’s like saying I’m gonna take some glutathione gout for a night of drinking. Like that night of drinking will still have an effect on your liver, right? And so, you know, but I think it does open up for the biohackers or that, you know, I think it’s just cool when you have a product like this to see kind of how it gets used in the real world, right? There’s still a lot of real-world knowledge and information that we can get from that. So yeah, it’s interesting. Or athletes, you know, that’s another one that we’ve talked about as well, kind of how this is gonna play out in athletes right now.

Dr. Kara Fitzgerald:  Super interesting. Yeah, absolutely.

Sanjay Bhojraj, MD, FACC:  We have the data from the data that we have, right? And so, we don’t use this. But as this kind of filters out, like, it’ll be very interesting to see how this gets used and, again, I think that when we look in terms of therapies, there’s, you know, a very large therapeutic window here in the sense that you can’t overdose. I mean, as far as we can tell, right? Like, we want to stay within zones, but, you know, I think that the market, the right patient for this is such a wide demographic of people, right?

Dr. Kara Fitzgerald:  Yes.

Sanjay Bhojraj, MD, FACC: And it’s really, again, I just focus on the fact that this is not an internal, this is not a chemical that’s working on your body to cause this interleukin to go up or down or whatever it may be, or this kinase or whatever, but rather just working on a very simple thing. It’s a very elegant solution to what’s going on, and we’ll just see how this plays out.

Dr. Kara Fitzgerald:  And what if you’re, you know, what if you’re somebody who’s APOE 4/4, you know, and you’re fine, you’re healthy, but you’re really mindful of what’s going on. And one of the most effective and important ways we do that is keeping ourselves as metabolically strong and flexible as possible. So could this have a preventative place as well? And I want to, I’m gonna kick this over to you, Sanjay, because this was a question I was going to ask anyway. You know, what about using this in the context of a keto diet or, you know, it’s, I mean, kind of the sky’s the limit for helping with compliance on some of these difficult dietary patterns, but also maybe furthering the power of the ketogenic effect.

Sanjay Bhojraj, MD, FACC:  Yeah, I mean, I think, first of all, you know, and you said it correctly, I think, is that, you know, ketogenic, it’s an effect, it’s a biochemical effect, right? So anything that you can do to prolong that effect or improve that effect will then show the anti-inflammatory and all the benefits that we know from a ketogenic diet. So, you know, there’s no contraindication to a ketogenic state, you know, in that sense. Now, I think that the use case, you know, why would you use it in a ketogenic diet if somebody is, you know, maybe eating off keto, right? Because I think keto is like a marriage, right? You cheat once and it’s over forever. So, you know, you have to be very, very, like, clear on keto, right? Like, what we’re doing. So, you know, would changing the dynamics of the absorption of fat in the diet affect the ketogenic state? I don’t know that anybody knows the answer to that. Certainly, you know, certainly is not contraindicated. It’s just one of those things that I think opens up for future study, right? Because maybe this keeps you in ketogenic states.

Sanjay Bhojraj, MD, FACC: Again, maybe, I don’t know, conjecture, you know, but, you know, maybe this keeps you in ketogenic states for a little bit longer. Maybe this allows then if you do have a little bit of a slip-up on keto to maintain that ketogenic state, you know, we haven’t checked, we haven’t done that study, but, you know, mechanistically, again, it’s just one of the most elegant solutions. So, you know, I think there is a very interesting use case, you know, athletes, you know, that need to be glycogen kind of enriched for endurance work, right? Like, you know, but at the same time, you know, are you getting it to the right place? So I think of that, you know, big bowl of spaghetti you have before you run a marathon. You’re probably not really holding onto most of that. You’re probably just letting it go out of your system. So does this allow for a more efficient glycogen load? You know, will this change, you know, as you’re holding onto lean muscle mass as a lifter? You know, I’m like, well, will this kind of improve my muscle glycogen to help me lift more? I don’t know, I don’t know the answer to that. I think we’re very early on in the clinical trials of all this, and those are kind of very niche markets. But at the same time, you know, when we look at just the general cardiometabolic patient, the PMOS patient, you know, that person that we are just struggling with in the clinics, it’s a very easy intervention to get some improvement.

Dr. Kara Fitzgerald:  And is it possible to be able to turn the volume down on the quantity of protein you’re consuming because you’re no longer competing for absorption with the other macros? So that is interesting as well. I mean, the whole keto data, we can get those data as easily. Well, we don’t have continuous keto monitors at this point, but you can get keto data pretty easily actually. And, you know, you can just use a urine dip if you want to. So you could begin, although that’s not quite that sensitive. So maybe if you’re doing blood ketones, you can, and you want to. You know, somebody out there has that data and if you’re willing to, certainly email me. I’d really like to know or make a comment wherever you’re listening to it. I’d super like to know.

Dr. Kara Fitzgerald: But to your point, I do think it’s gonna be really cool for us to, as clinicians, begin to experiment and maybe circle back with you both in another year and see what other research has come out. We’ll look at the microbiome data and, you know, we’ll have all sorts of clinician experience, you know, broadly in our space and beyond. Anything else that you guys want to add as we just, as we wrap up this conversation today? It’s been really interesting, kind of, it’s always fun to kind of wax, you know, future and hypothesize on how we might use it. And it’s safe, you know, so first do no harm and which makes these conversations really that much enjoyable. But anything to add in our final moment, Sanjay?

Sanjay Bhojraj, MD, FACC:  I think for me, you know, very few interventions are not systemically absorbed, right? Remember, the GI tract exists outside of our body, right? So it’s not even inside of our body. So we’re seeing that effect there. We’re not absorbing it into our bloodstream. We’re not changing the microbiome in any significantly bad way. But we are seeing improvements in A1C, which I think we all think are important. We are seeing improvements in cholesterol. We are seeing improvement in weight management. We are seeing improvements in muscle mass, right? And I think that, you know, with very little toxicity, safe enough to use in that pre-pregnancy, you know, fertility kind of space, safe enough to use, you know, prior to any surgery, elective surgeries or anything like that.

Sanjay Bhojraj, MD, FACC: So I think that it all becomes, you know, it’s a very safe intervention that makes you feel different. And that, again, I just moved back to that felt experience. When you feel that difference, when you feel that improvement, it’s just gonna build on itself, right? When the pants fit a little bit looser, then you’re more likely to stick to your diet. Now, we’re seeing that again and again. You don’t have to have a CGM, right? You just experience your life, don’t change anything, you’ll feel better, and then you’ll get your patients, you know, you’ll work with your patients to make those changes. And it’s just been a really fun thing for me to see in practice.

Dr. Kara Fitzgerald:  Right, right. All right, Lexi, no pressure, final word with you. Take us home.

Alexis Gonzales, ND, MS, IFMCP: Yeah, I would say, you know, try it. I think it’s like one of the very few things where you just get such a quick and fast and dramatic response to when you take it, whether you have a CGM on or not, that it motivates you to try it again and see how you can compound those positive effects. And so, that would be my biggest takeaway, is if you have the option to just try it even with one meal for one day, and then you compound that to a week, and then your three months for your A1C, you will see changes in those glucose spikes and then the metabolic parameters that Sanjay just outlined. So it’s highly, highly encouraged doing an experiment on yourself because it is fun, it is interesting, it’s enlightening and it’s motivating that you can actually get there without making these, like, super strict changes in your lifestyle.

Sanjay Bhojraj, MD, FACC:  And I guess if nothing else, you can get two days of pancakes out of it.

Dr. Kara Fitzgerald: Two days of your daughter’s cold pancakes.

Sanjay Bhojraj, MD, FACC: Waffles forever, yes.

Dr. Kara Fitzgerald: Floppy pancakes. You know, and I just popped into my mind, so I guess we’re having other last words, but, you know, this doesn’t mean, this doesn’t mean you’re stopping the berberine. It doesn’t mean that you’re stopping the metformin. Like, all of the other interventions we’re using, the various probiotics that are beneficial, you know, along, well, different mechanisms, but in terms of satiety and so forth and controlling blood sugar. All of those interventions, we don’t just stop them. I know that those are thoughts in people’s minds, but, you know, the clinician can pay attention, you know, and adjust as you see benefit and move things around. So both always, thank you so much. I look forward to seeing you both in real life, probably in December. And to continue, we’ll continue this conversation. It’s an important one.

Sanjay Bhojraj, MD, FACC: Absolutely.

Alexis Gonzales, ND, MS, IFMCP: Thanks for having us.

Dr. Kara Fitzgerald: Did you enjoy that conversation I just had with Dr. Sanjay and Dr. Alexis? I mean, was it not interesting? And did it get the wheel spinning? Please, you know, any ideas you have, if you’re already using SiPore in practice, if you’re thinking, if you might bring it in, if you’re, you know, working and prescribing restrictive dietary interventions and you think SiPore might help, I would just love to get your thoughts. If you enjoyed the podcast, anybody, please hit the Like button, forward it to another colleague. And yeah, again, tell me what you’re thinking about, how you might be using it. We are a community, and I do very much appreciate hearing from you, getting your ideas. And don’t forget to jump over to the show notes for today’s episode. You will get the transcription for free. And, of course, the citations from Sigrid will also be there. We’ll see you next time on New Frontiers in Functional Medicine.

Sanjay Bhojraj, MD, FACC is an interventional cardiologist and Fellow of the American Academy of Anti-Aging Medicine specializing in cardiometabolic health, longevity medicine, and precision cardiovascular prevention.

He’s the founder of the Laguna Institute of Functional Medicine. His programs focus on reversing metabolic dysfunction, improving resilience, and reducing cardiovascular risk through lifestyle optimization and advanced diagnostic testing.

Dr. Alexis Gonzales (“Dr. G”) is OvationLab’s Senior Clinical Implementation and AI Specialist, translating breakthrough research into practical clinical workflows, and holds advanced degrees in biochemistry (Saint Mary’s), biotechnology (Johns Hopkins), and naturopathic medicine (Bastyr).

She provides concierge functional medicine care at her private practice in California, focusing on endometriosis, fertility, PCOS, and menopause, while distilling emerging research into practical frameworks at conferences to make integrative solutions accessible.

People mentioned

Tore Bengtsson
Researcher and co-founder of Sigrid Therapeutics whose work contributed to the development of SiPore technology.

Jeffrey Bland, PhD
Functional medicine thought leader.

Research

SHINE Trial — SiPore21

STAR Trial — SiPore15

Additional Sigrid Research

Bio Age Self Assessment Quiz

Younger You book

Better Broths and Healing Tonics book