The Risk of Taking Compound GLP-1s

Posted on August 20, 2026 by Patrick Hercules

Over the past few years, GLP-1 medications, such as semaglutide and tirzepatide, have become a popular way to help people lose weight.

However, some patients and healthcare providers have turned to compounded versions of semaglutide and tirzepatide called compounded GLP-1 antagonists.

Glucagon-like peptide-1 or GLP-1 antagonists are a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. In 2024, nearly one in three Americans taking a GLP-1 drug said they were getting it from a compounding pharmacy.

Compounded GLP-1 antagonists are custom-mixed weight loss medications made by certain pharmacies, not drug companies, and use the same active ingredients as the brand names, but they don’t have approval from the U.S. Food and Drug Administration (FDA) for safety or effectiveness, and some compounded GLP-1 drugs have additional ingredients or alternate chemical forms of the active drugs.

This is why the FDA has warned against taking compounded versions of semaglutide and tirzepatide, as they don’t undergo regulatory testing for safety, quality, or effectiveness. They also issued a warning about a spike in overdoses and adverse side effects largely attributed to dosing errors with these drugs, due to them coming with syringes for people to draw the medications themselves, unlike brand-name GLP-1 injections that come in prefilled pens.

In 2024, the FDA raised concerns about the increased risk of dosing errors, improper storage, and fraudulently labeled GLP-1s from compounding pharmacies. Consequently, hundreds of people reported serious problems, including dangerous dosing mistakes, where patients got five to twenty times more than the proper dose.

By April of 2025, the FDA had logged over 520 reports linked to compounded semaglutide and 480 for compounded tirzepatide.

Additionally, U.S. poison centers have seen a nearly 1,500% increase in calls related to overdose or side effects of injectable weight-loss drugs since 2019. What’s more, as of April 30th, 2025, poison centers have managed 3,633 GLP-1 agonist-related exposure cases and 22,966 cases from 2019-2025.

The common side effects of GLP-1 antagonist poisoning include:

Nausea and vomiting
Constipation and diarrhea
Abdominal pain

Other symptoms and side effects to watch out for include:

Signs of severe dehydration such as fainting and confusion or not urinating for eight hours.
Pancreatitis, which usually feels like sharp pain in your upper abdomen and back.
Gastrointestinal symptoms that don’t improve when you eat smaller meals or take anti-nausea medications.
Gastrointestinal symptoms that grow worse rather than easing the longer you’re on the drug.

However, there are instances when it might be appropriate for a person to take a compounded drug, such as when a patient’s medical need can’t be met by an FDA-approved drug, or the FDA-approved drug is not commercially available.

If taking a compounded GLP-1 is your only option, it is important to confirm if it is coming from a 503B-registered outsourcing facility, rather than an unregistered seller, and that you remain under close medical supervision while using it.

Other clues that your compounded prescription may not be legitimate:

It does not require a prescription.
The pharmacy is not located within the U.S.
The medication arrives in packaging that is damaged, open, labeled in a foreign language, or has no expiration date.
Unusual delivery methods. Delivery methods other than injections and oral pills, such as sublingual drops and dissolving tablets, have not been tested in clinical trials.
Vague or proprietary ingredient lists. Products marketed as “personalized” blends with added vitamins or other ingredients, without a clear clinical rationale, are often designed to promote those additions to sidestep regulations rather than to benefit the patient.

If you need help locating a licensed online pharmacy, you can use the FDA’s BeSafeRx program. For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Wellness Wednesday Tip: Staying Physicall Active

Posted on August 12, 2026 by Patrick Hercules

Life can move fast, and we may not have enough time to exercise as much as we would like to. Most people spend half of their day sedentary. The more you sit, the more your large muscles aren’t using glucose, the body’s main source of energy. Sitting for long periods of time can cause blood sugar levels to rise, triggering the body to release insulin.

Over time, sedentary habits cause the body to become less sensitive to insulin, resulting in insulin resistance.

Regular physical activity is one of the most important things you can do for your health. What’s more, any kind of exercise can reduce fatigue and improve sleep, decrease anxiety and depression, improve weight management, and promote brain health. It can also help prevent and reduce the risk of long-term health problems, such as heart disease, type 2 diabetes, high blood pressure, and obesity.

Additionally, regularly moving your body lowers your risk for some types of cancers, fatty liver disease, chronic pain, arthritis, and even dementia.

According to the Centers for Disease Control and Prevention (CDC), adults need at least 150 minutes of moderate-intensity physical activity each week. Moderate-intensity physical activity can be any activity that gets you to breathe harder and your heart beating faster, such as:

Brisk walking

Dancing

Swimming

Roller skating

Jogging

Riding a bike

Playing a sport

Moving your body doesn’t always have to involve working out in a gym. You can also climb the stairs, garden, or play with your children or pets.

Whether you are just starting or haven’t been physically active for a while, there are ways to get started. Here are some tips to help you add more physical activity to your daily life:

Look for ways to make physical activity a part of your daily routine, such as walking the dog or walking in place during commercial breaks while watching TV

Start with activities, locations, and times you enjoy

Find a place near your home or work to be physically active

Try activities with friends or family that you enjoy together

If you lack the time, space, energy, skill, or if something else is preventing you from being more physically active, such as a fear of injuring yourself, here are ways to overcome these obstacles:

Add physical activity to your daily routine, such as parking farther away from your destination or taking the stairs instead of the elevator

Schedule physical activity for times in the day or week when you will feel more energetic

Invite a friend or family member to exercise with you regularly

Choose activities you can do safely, and increase the amount you do gradually as your confidence and abilities grow

Be sure to warm up and cool down before walking to avoid injury

Regular physical activity is one of the most important things you can do for your health. Everyone can experience the health benefits of physical activity, as it gets your body moving and your heart beating faster.

It is recommended that you consult your doctor before starting or adding new exercises to your routine. You can schedule an appointment with a doctor at Flushing Hospital’s Ambulatory Care Center by calling (718) 670-5486.

GLP-1 Microdosing

Posted on May 27, 2026 by Patrick Hercules

Glucagon-like peptide-1 or GLP-1 antagonists are, however, a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. Medications, such as semaglutide and tirzepatide, have become popular over the past few years to help people lose weight.

Recently, however, some people have been microdosing GLP-1 medications as their preferred way to take these medications. Microdosing means taking much smaller doses than those approved by the Food and Drug Administration (FDA).

People may microdose GLP-1 medications for many reasons, including:

They have hit their target weight goal

They have concerns about the cost of the medications

They are sensitive to the side effects of the medications

They want to just suppress their appetite

They are worried about the supply of the medications

Microdosing GLP-1 medications can come with real risks, including:

Inaccurate doses

Reduced effectiveness

Unpredictable outcomes

Possibility of regaining weight

No data on the long-term effects of microdosing

Minimal oversight

Large clinical trials have confirmed that the standard GLP-1 doses work well when helping people lose weight and manage Type 2 diabetes. What’s more, precise doses have proven benefits for heart, liver, and kidney health. Taking very low doses may not provide the same results.

Additionally, smaller GLP-1 doses may help reduce symptoms such as nausea or an upset stomach. However, microdosing may prevent you from reaching the effective dose needed to make significant changes in your body weight or blood sugar levels. In many cases, the side effects of GLP-1 treatment are temporary. GLP-1 dosage schedules are intended to increase doses gradually to help balance their benefits and potential side effects.

GLP-1 medications affect people differently. Some people may see substantial benefits even at lower doses. However, other people may not see their benefits at full doses.

Before you consider microdosing GLP-1 medications, it is important to speak with a healthcare provider who is knowledgeable about these treatments. Here are some things to consider:

If the GLP-1 medication is off-label, it is an unproven treatment

The health benefits for those who don’t have Type 2 diabetes or a high body mass index (BMI) are unproven

Taking smaller doses doesn’t make them risk-free

As an alternative to taking GLP-1 medications, here are some proven ways to support metabolic and overall health naturally:

Exercising regularly

Eating a healthy, balanced diet

Managing stress

Getting enough restful sleep

Eating certain foods and taking supplements

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

Metabolic Syndrome and How it Can Lead to Heart Disease

Posted on April 29, 2026 by Patrick Hercules

Metabolic syndrome is a group of conditions that increase the risk of heart disease, stroke, type 2 diabetes, and other health problems.

The number of people with metabolic syndrome is increasing, as up to one-third of adults in the U.S. have it.

When a person is diagnosed with metabolic syndrome, they have three or more risk factors, such as:

High blood pressure

High blood sugar

Low levels of HDL, or good cholesterol

High triglyceride levels in the blood

A large waist circumference or an apple-shaped body

Although each of these conditions is a risk factor for cardiovascular disease, when a person has three or more of them and is diagnosed with metabolic syndrome, the chances of them developing a serious cardiovascular condition increase.

There are several underlying causes of metabolic syndrome, such as:

Being overweight and being obese

Having an insulin resistance

Being physically inactive

Genetic factors

Increasing age

Metabolic syndrome is a serious health condition; however, there are ways to reduce your risk of developing it, such as:

Being more physically active

Losing weight

Eating a heart-healthy diet that is rich in:

Whole grains

Fruits and vegetables

Fish

Another way to reduce your risk of developing metabolic syndrome is working with your healthcare team to monitor and manage your blood sugar, blood cholesterol, and blood pressure.

If you or a loved one is experiencing symptoms of metabolic syndrome, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Things You Should and Shouldn’t Do After Bariatric Surgery

Posted on April 23, 2026 by Patrick Hercules

Bariatric surgery is a life-changing procedure. Following your doctor’s post-operation instructions and making healthy lifestyle changes are essential to avoiding complications and achieving long-term weight loss success.

Patients should expect to have a new lifestyle that combines healthy eating, exercise, and attending regular visits with their healthcare providers. They should also consider these dos and don’ts after bariatric surgery:

What you should do after bariatric surgery:

- Eat slowly and chew food well

- Aim to drink 64oz of fluids daily, taking small sips

- Eat 60g or more of protein daily, starting every meal with it

- Make fruits and vegetables the priority of your diet

- Start walking for five minutes every hour after surgery

- Aim for a goal of 30 minutes of exercise daily after it is allowed to do so

- Take all medications and supplements as prescribed, they will need to be taken for the rest of your lifetime

What you shouldn’t do after bariatric surgery:

- Skip any meals

- Eat red meat early in recovery

- Engage in any strenuous activities

- Lift any objects over 10 lbs. for the first four to six weeks after surgery

- Eat fast food

- Eat or drink anything with natural sugar

- Drink liquids within 30 minutes after eating

- Eat bread, rice, pasta, bagels, or dumplings

- Allow yourself to get too hungry

- Take a bath or go swimming for two weeks after surgery

- Smoke cigarettes or drink alcohol

- Eat snacks loaded with empty calories

- Get pregnant for 12 to 18 months after surgery

- Stop taking medications as directed by your healthcare provider

Bariatric surgery can be a life-changing and life-altering event for those who are trying to lose weight and live a healthier lifestyle. Making diet changes, modifying exercise routine, and following the guidelines set by your healthcare provider and surgical team can lead you to long-term success.

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

Losing Muscle As We Age

Posted on March 19, 2026 by Patrick Hercules

As we age, we start to lose muscle mass gradually. This is called sarcopenia.

Sarcopenia, a type of atrophy, is the age-related progressive loss of muscle mass, function, and strength.

Everyone loses muscle mass over time; however, people who have sarcopenia lose it more quickly. Sarcopenia usually begins around the age of 35 and accelerates between the ages of 65 and 80. Rates of this acceleration vary; however, as much as 8% of muscle mass is lost each decade.

The natural aging process is usually the main cause of sarcopenia as the body doesn’t produce the same number of proteins the muscles need to grow, which causes them to get smaller. However, researchers have discovered other possible risk factors of the condition, including:

· Physical inactivity

· Obesity

· Chronic diseases such as chronic obstructive pulmonary disease (COPD), kidney disease, diabetes, cancer, and HIV

· Rheumatoid arthritis

· Insulin resistance

· Malnutrition or inadequate protein intake

· Reduction in hormone levels

· Decrease in the ability to convert protein to energy

· Decline in the number of nerve cells that send messages from the brain to the muscles telling them to move

Sarcopenia affects the musculoskeletal system and is a major factor in increased frailty, falls, and fractures. These conditions can lead to hospitalizations and surgeries, which increase the risk of complications, including death.

This condition can also affect people with a high body mass index (BMI), which is called sarcopenic obesity. People suffering from obesity and sarcopenia have a greater risk of complications than those with obesity or sarcopenia alone.

The most common symptom of sarcopenia is muscle weakness. Other symptoms may include:

· Decrease in muscle size

· Difficulty performing daily activities

· Poor balance and falls

· Loss of stamina

· Trouble climbing stairs

· Walking slowly

A healthcare provider may diagnose sarcopenia after they perform a physical exam and ask you about your symptoms. They may also ask you to complete a questionnaire based on your self-reported symptoms called the SARC-F, which stands for:

· Strength

· Assistance with walking

· Rising from a chair

· Climbing stairs

· Falls

You score each factor with a number between 0 and 2, with the highest maximum and total SARC-F being 10. A SARC-F score of 4 or more warrants more testing.

There is no single test that can diagnose sarcopenia. A healthcare provider may recommend several tests to help diagnose and then determine the severity of sarcopenia. These tests include:

· Muscle tests:

Handgrip test
Chair stand test
Walking speed test
Short Physical Performance Battery (SPPB)
Timed-up and go test (TUG)

· Imaging tests for measurement of muscle mass

Dual-energy X-ray absorptiometry (DEXA or DXA)
Bioelectrical impedance analysis (BIA)

The treatment for sarcopenia usually includes lifestyle changes, as they can treat and help reverse the condition. These lifestyle changes include:

· Physical activity, which includes resistance-based strength training

· A healthy diet

Sarcopenia is not fully preventable. However, there are steps you can take to slow the progression of the disease, including:

· Making healthy food choices

· Exercising regularly

· Attending routine physicals

If you or a loved one is experiencing symptoms of sarcopenia, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Holiday Eating Tips After Bariatric Surgery

Posted on December 19, 2025 by Patrick Hercules

It’s the holiday season, and as we spend time with our family and friends, we enjoy each other’s company over delicious meals. Unfortunately, the holiday season can be a time when we run into problems with weight gain. It can be especially challenging after bariatric surgery. Fortunately, there are many ways to manage our weight during the holiday season. Here are 10:

Don’t save your calories. It may be tempting to skip meals to save calories for holiday treats, but it is better to stick to your regular eating patterns. You are more likely to overeat if you arrive at a holiday function hungry

Remember the basics. Just because it is the holidays doesn’t mean you can’t maintain the same healthy eating habits you had during the rest of the year. Pay attention to your portion sizes, start with protein, eat slowly, and track what you eat. Keeping these basic rules in mind can help you avoid overeating

Be mindful of how much you are eating. Eating while socializing can easily lead to eating too much. Enjoy the company and conversation and save eating for a time when you can focus on your meal

Avoid the buffet table and the kitchen. Standing close to where the food is being served may result in mindless noshing. Carefully select the food you truly want to try, and then walk away

Limit alcohol consumption. Drinks containing alcohol are full of empty calories. It is better to eat your calories than to drink them. Additionally, alcohol doesn’t just add calories; it can also dehydrate you. Be aware that alcohol can affect you differently after bariatric surgery. You may feel the effects much sooner, even after consuming less alcohol. You are also more likely to overeat at the buffet table after a couple of drinks

Stay hydrated. It is important to drink plenty of water and plan ahead. This ensures that you can avoid drinking within 30 minutes of eating and still get in the recommended 64 ounces a day

Exercise. The holiday season can be a busy time, and our exercise routines may suffer because of it. It is easier to get out of the habit of exercising than it is to get back into it after the holidays. Consider creating a workout schedule or organizing activities for the family that get everyone moving

Bring a healthy dish to share. This will ensure that there is a healthy food option at the gathering

Find healthy alternatives for your favorite recipes. Look for healthier substitutions that cut the fat and calories of recipes. Some examples include:

Using skim milk instead of whole milk in mashed potatoes

Using fat-free creamed soups in recipes rather than full-fat versions

Replacing sugar with unsweetened apple sauce or noncaloric sweeteners in desserts

Adding flavor with garlic, spices, and herbs rather than fats such as butter and gravy

Combining ¼ cup of Greek yogurt with ½ cup of butter to replace 1 cup of butter in a recipe

Replacing each egg with two egg whites and substitute evaporated skim milk in place of heavy cream when baking your favorite holiday treats

Be kind to yourself. You may overeat a bit or sample more treats than you should. However, that doesn’t mean all is lost. It is important to forgive yourself and recommit to healthy patterns and move forward. It is okay to have a treat once in a while.

Undergoing bariatric surgery requires preparation, dedication, and several lifestyle adjustments. Adopting a whole different way of eating can be challenging, and it will take some time to get used to it. Following these tips can help you plan and enjoy your food in moderation.

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

Common Misconceptions About Bariatric Surgery

Posted on October 27, 2025 by Patrick Hercules

Bariatric, or gastric bypass surgery for weight loss, is a surgical treatment for severe obesity that involves making changes to the digestive system. It is performed when diet and exercise haven’t worked, or when a person is at risk for serious health problems due to their weight.

There are several myths and misconceptions about bariatric surgery and its outcomes, including:

Bariatric surgery is unnecessary, and people just need to eat less and exercise more
Bariatric surgery is dangerous
Bariatric surgery will make a person thin
Bariatric surgery and weight loss will make a person happy and improve their relationships
Bariatric surgery will prevent a person from overeating
Bariatric surgery is an easy way out
Most people will gain the weight back after surgery

Bariatric surgery can be a lifesaving solution for many people who are overweight. Bariatric surgery, along with a commitment to lifestyle changes, not only provides long-term weight loss but it significantly improves the health and quality of life for many.

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

How Making Lifestyle Changes Can Reduce the Risk of Chronic Diseases

Posted on September 26, 2025 by Patrick Hercules

According to the World Health Organization (WHO), chronic diseases, also known as non-communicable diseases, are conditions that tend to have a long duration and result from a combination of genetic, physiological, environmental, and behavioral factors.

Chronic diseases are the leading cause of death worldwide. These diseases include:

Cancers
Cardiovascular disease, such as heart attacks and strokes
Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma
Diabetes

A person’s lifestyle and daily habits can increase their risk of developing a chronic disease. About 80% of chronic diseases are driven by a person’s daily habits. These include:

Tobacco use, including the effects of exposure to second-hand smoke
Unhealthy diets, including excess salt, sugar, and fats
Excessive alcohol use
Insufficient physical activity

These habits can contribute to metabolic changes that can increase a person’s risk of chronic disease, including:

Hypertension
Obesity
Diabetes
High cholesterol

Making the following lifestyle changes is one of the best ways to address harmful habits and help prevent chronic diseases.

Dietary changes include eating whole, unrefined, and minimally processed plants. Eating plant-based foods can help reduce diabetes, heart disease, and the risk of cancer
Increasing physical activity by engaging in a recommended 150 minutes of moderate-intensity activity each week
Getting a good, restful night’s sleep of about seven to nine hours. This can be achieved by:
- Having a consistent bedtime and waking up on time, even on weekends
- Being physically active
- Limiting alcohol and caffeine
- Putting digital devices away 90 minutes before bedtime
- Keeping your sleeping area cool, dark, and comfortable
Reducing stress by practicing mindfulness, meditation, and gratitude can help relieve stress and improve your physical and mental health.
Staying socially connected with friends and family can help keep you emotionally and physically healthy.
Quitting smoking, or never starting, lowers the risk of serious health problems, such as heart disease, cancer, Type 2 diabetes, and lung disease, as well as premature death
Limiting alcohol use can reduce health risks that excessive drinking can lead to, such as high blood pressure, various cancers, heart disease, stroke, and liver disease

By avoiding these risks and getting good preventive care, you can improve your chance of staying well, feeling good, and living longer.

For more information on how you can make lifestyle changes, you can schedule an appointment with a doctor at Flushing Hospital Medical Center’s Ambulatory Care Center by calling (718) 670-5486.

The Impact of Ultraprocessed Foods on Your Health

Posted on September 12, 2025 by Patrick Hercules

Ultraprocessed foods, or UPFs, are food products such as frozen pizza, ready-to-eat meals, instant noodles, and many store-bought breads that contain a long list of ingredients, chemical additives, and little to no “whole” foods.

Understanding ultraprocessed foods is tricky, as even experts don’t fully agree on what they specifically are and whether they are good or bad. However, a 2024 study led by researchers at Harvard T.H. Chan School of Public Health also found that a high intake of ultraprocessed foods may increase the risk of early death. Participants who ate the most ultraprocessed foods of any kind had a 4% higher risk of death from any cause and an 8% higher risk of death from neurodegenerative diseases. And according to the Yale School of Public Health, high ultraprocessed food intake has been linked to a 25%-58% higher risk of health issues related to the heart and metabolism, and a 21%-66% higher risk of mortality.

People who eat more ultraprocessed foods may tend to eat more calories overall. Data from the Centers for Disease Control and Prevention (CDC) shows that 53% of the calories that adults consumed daily, on average, came from ultraprocessed foods between 2021 and 2023. For children 18 years old and younger, it is 61.9%. Scientists are studying whether ultraprocessed foods high in saturated fat, added sugars, and sodium may mimic addictive substances in some people, and if they do, how they may do so.

Some ultraprocessed foods may contribute to poorer health outcomes. Examples of this include:

They may displace or replace healthier foods
They could lead to eating too many calories
They may result in eating too much saturated fat, added sugars, or sodium
They may influence how the brain responds to these foods
The changed textures may trigger the brain to stay hungry even after eating
They can potentially disrupt blood sugar
They can potentially disrupt your gut health
They could cause exposure to toxins

The recommendation to limit the intake of ultraprocessed foods reinforces the long-standing nutrition guidance to limit unhealthy fats, added sugars, and sodium. A diet composed mainly of ultraprocessed foods also exposes people to unhealthy additives and increases the risk of chronic inflammatory diseases.

The best way to identify ultraprocessed foods is to read the packaging of the product to see if its list of ingredients contains either food substances never or rarely used in kitchens, such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolyzed proteins. Or it may contain classes of additives designed to make the final product palatable or more appealing, such as flavors, flavor enhancers, colors, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling, and glazing agents.

It is important to note that an overall healthy diet pattern should focus on eating healthier options such as vegetables, fruits, whole grains, beans, nuts, seeds, healthy non-tropical oils, and lean proteins.

The Yale School of Public Health offers four ways to reduce ultraprocessed foods in your diet. They include:

Planning and preparing meals at home in advance that use less processed and ultraprocessed foods
Drinking water and unsweetened beverages such as coffee and tea instead of soda and other sweetened drinks
Eating fresh fruits and vegetables, if they are available to you. If they are not available, choose minimally processed frozen or canned options with no added salt or sugar
Adding an unprocessed fruit or vegetable to your meal if an ultraprocessed food is your only option and you are short on time. And to choose an ultraprocessed food option with less sodium, saturated fat, and added sugar

If you would like to learn more about Flushing Hospital Medical Center’s nutritional services, you can visit the Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.