There’s a pattern I’ve seen too many times now to call incidental. A patient starts a GLP-1RA, often semaglutide or tirzepatide and within weeks, things are objectively better: less inflammation, less food noise, easier weight loss, improved metabolic markers, and yet, something feels off. Sleep is lighter, energy is less stable, mood is flatter or slightly edgy. There’s a sense of being not quite as resourced, as sovereign. This is confusing because the story they’ve been told is simple: “This will help you feel better,” and in many ways, it does. And for a certain subset of patients, especially high performers, the early phase can feel like a step sideways or even slightly backward. This is physiology recalibrating.

These patients were never “overfed.” They were overextended.

The people who tend to feel this most are not the ones struggling with basic adherence. In fact, they are disciplined, productive, adapted to pushing through, often under-recovered relative to output, and quietly using food to keep themselves regulated. This normal-appearing, dysregulated body is often running a little sympathetic, a little undernourished for their output, a little dependent on reward cycles to stay balanced. Food for them is infrastructure.

GLP-1s remove friction… and also remove support

When a GLP-1 works well, it reduces appetite, reduces reward from food, simplifies decision-making around eating, and the less visible effect is this: It removes one of the primary nervous system buffers. Less dopamine from food, less evening carbohydrates, less ritual, less predictability and iIf nothing replaces that, the system becomes more exposed.

The body doesn’t care that your labs look better

This is where clinical reality diverges from simplified narratives. A patient can have better glucose, lower inflammation, improved weight and still feel more wired at night, less deeply rested, and slightly more fragile under stress. The body is optimizing for perceived safety and resource availability. It doesn’t know about lab values. If intake drops quickly, or reward drops quickly, or rhythm changes abruptly, the body may interpret that as instability, and it responds accordingly.

“Worse” is often just “less buffered”

So, when someone says: “I don’t feel as good as I expected,” what they often mean is: “I don’t have the same support I used to have.” Less food, less reward, less sedation, less distraction. They’re actually experiencing their physiology more directly.

Dopamine, drive, and the quiet flattening

GLP-1 signaling influences reward pathways, particularly those tied to food motivation and for many patients, that’s a relief. For some, especially those who rely on reward to sustain high output, it can feel like loss of pleasure and subtle emotional flattening. If you don’t name that, patients will think something is wrong with them. But nothing was wrong with them, the signal changed.

This phase is where most people make the wrong decision

They either push harder (“I just need to power through”) or abandon the medication prematurely and miss the opportunity either way. This phase is actually where the deeper work becomes available.

What actually helps patients move through this well

Better interpretation, a reframe held first by you as the provider and then targeted adjustments: ensure they are not under-eating relative to output, reintroduce intentional structure around meals, especially dinner. Slow dose escalation when needed, acknowledge the loss of food as a regulatory tool, actively support autonomic balance (neural therapy, EMDR, IFS therapy…), rather than assuming it will self-correct. This is about helping the system reorganize at a higher level.

The opportunity most people miss

GLP-1s are often framed as a shortcut. In reality, they’re more like a Truth Accelerator. They make patterns visible faster. If someone was over-relying on food, under-recovering, and running a dysregulated nervous system, they will often see that more clearly, sooner. That can feel worse before it feels better. Because on the other side of that adjustment is often more stable energy, less dependence on external regulators, and a system that is actually more resilient. We can help them understand what they’re seeing if we’re anticipating alongside them.

She was 70 years old and had just had a knee replacement. I was a young physician-to-be still figuring out what I wanted medicine to be, and what I remember most is not the procedure or the recovery timeline. It is standing there hearing her tell about climbing her apple trees ten days after surgery, not walking to them but climbing them, and feeling something settle into place that has never left.

That image has stayed with me for twenty years because it is the clearest picture I have ever seen of what we are actually doing here: not managing a body but giving someone back the life they were built to live.

Twenty years ago this month, Vine Medical was just an idea I could not stop thinking about. This past weekend marked the anniversary of that idea becoming something real, and I find myself wanting to sit with that for a moment before we run toward whatever comes next.

When I Left the System That Made Me

I started in traditional family medicine, seeing somewhere between 30 and 40 patients a day. If you’ve never practiced medicine at that pace, let me tell you what it actually feels like: you are moving fast enough to address the obvious and almost never fast enough to ask the second or third question, the ones that tend to matter most. The system is not broken because the people inside it are careless, but because it was designed to process volume, and healing does not happen at volume.

In 2007, I made the first real leap and stopped being an employee practicing inside someone else's vision, taking ownership of my own. That shift sounds clean in retrospect, but it was not. Ownership means accountability in a way that employment never does, and starting something from nothing asks more of you than you expect. What it clarified, though, was everything. When you are building something that carries your name and reflects your values, you stop tolerating the gap between what you believe medicine should be and what it currently is.

The Leaps That Changed Everything

By 2015, I had made the second major shift, moving from conventional family medicine into membership-based care, and with it went from seeing 30-40 patients a day to seeing 6-10. Read that again, because the math is the whole point. When you have 60-90 minutes with a patient instead of 12, you stop treating symptoms and start seeing people. You ask the question behind the question, learn what they are actually afraid of, understand what their days look like and what they have already tried and why it did not work. That luxury is medicine.

In 2021 came the third leap: walking away from insurance entirely. That decision was not about revenue or positioning. It was about what the insurance model was doing to the quality of care I could provide. When a reimbursement structure determines what you are allowed to do for a patient, the structure is practicing medicine, not you. Leaving it meant I could offer what actually works, not just what gets approved.

The fourth leap is the one I am still in the middle of. Learning to lead from the CEO seat rather than doing everything myself has been the most disorienting transition of all, not because the practice was not ready for it, but because I was not. Finding the right people, trusting them with the work, and genuinely getting out of their way has changed what is possible here in ways I could not have engineered on my own.

The idea for me is to no longer wait for a patient to get sick and show up at my door, but instead to preemptively see them every three months, prepare them for what the next season might hold, and then allow them to take the reins with their own health and be empowered to be well in everything they do.

The Part That Makes All of It Mean Something

A few years ago, one of my closest friends and patients was hardly functioning. She had been battling mono and a toxic business partner for the better part of two years, and what it had taken from her was staggering: the brain fog, the complete absence of energy, the slow erosion of her ability to do the work she was built to do. She is one of the most capable people I know, and she had been sidelined by a body that had stopped cooperating.

We worked through it together, using procaine and the full range of what Vine Medical had available, and she did her part too, which matters as much as anything I can offer. Watching her come back to herself, and then watching her build a consulting firm (and leave the toxic partner) that now helps other businesses rise and do work that is genuinely hers in a way that only happens when you have earned it through the fire, that is the whole mission in a single story. She is a world changer, and she is back to changing the world.

I have stories like this for every year of the last twenty, and they don’t get old.

What Growing Has Actually Meant

The version of me that started this practice and the version writing this are not the same person. Every modality I have added over the years, from functional medicine to bioidentical hormones to peptide to EBOO to neural therapy, came from a genuine hunger to understand more than I currently did, to have more to offer, and to meet patients where they actually were rather than where the standard of care assumed they would be. That hunger came from sitting across from people who deserved better answers than I had at the time.

The more I have grown as a person, the more present I have been able to be as a provider. Not busier, not more impressive, but more genuinely useful to the people who trust me with their health. I believe that is what faithful stewardship of this calling looks like: staying open, staying curious, and refusing to let what you already know become a ceiling.

What I Want You to Take from This

The quality of care any physician can offer is directly tied to who they are becoming as a human being. If you are a patient here, you are not only benefiting from training and credentials. You are benefiting from twenty years of refusing to stop growing, twenty years of leaps that were uncomfortable before they were clarifying, and twenty years of patients who showed me exactly what was possible when the medicine was allowed to match the person.

That is the standard I hold myself to, and it is also what I ask of my patients in return. We meet you there, but you have to come to the party.

What Comes Next

Twenty years is not a finish line. If anything, it feels like arriving at base camp after a long climb, taking stock of what you have learned, and looking up to see how much more there is. The practice is stronger than it has ever been, the team is the best it has ever been, and the medicine we are doing now is genuinely tip-of-spear in ways I could not have imagined when I watched a 70-year-old woman climb her apple trees and decided that was what I wanted to do with my life.

To every patient who has trusted me over these twenty years: you are the reason Vine Medical exists. I'm so grateful. 

What does "getting back to your life" look like for you right now? I would love to hear it in the comments.

This content is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease or medical condition. Please consult with your physician or qualified healthcare provider before making any changes to your treatment plan.

When the Seesaw Stops Moving

The autonomic nervous system governs the balance between your sympathetic nervous system (fight, flight, or freeze) and your parasympathetic nervous system (rest and digest). I like to describe it as a seesaw, and in a healthy state that seesaw moves freely. Stress arrives, you respond, the threat passes, and the seesaw swings back so that you sleep deeply, recover, and show up the next day with something left in the tank.

The problem for so many high performers is that the seesaw has stopped swinging. Chronic stress, infection, physical or emotional trauma, toxin exposure, running a global business for two decades with your nervous system in fifth gear, any of these can lock the sympathetic side of that seesaw in the down position, and when that happens the parasympathetic system gradually loses its ability to rise at all. Deep, restorative sleep is a profoundly parasympathetic state, and a nervous system locked in sympathetic overdrive cannot get there regardless of how disciplined the bedtime routine.

When a patient comes in with near-zero deep sleep on their wearable and they have already done the lifestyle work, I skip over their bedtime routine and start thinking about their autonomic nervous system.

What Neural Therapy Does, and What It Does Not

Neural therapy uses procaine, a short-acting local anesthetic, to reboot the autonomic nervous system, and the goal is not to suppress the sympathetic nervous system or swing the seesaw hard in the opposite direction; the goal is to restore balance. I describe it as adding a little WD-40 to that fulcrum so the seesaw can swing appropriately again, in response to whatever the day actually requires.

Procaine works at the level of the cell membrane. When the sympathetic nervous system has been chronically overactivated, nerve fiber cells lose their normal electrical potential and get locked into a state of permanent excitability, and procaine stabilizes those membranes by restoring the cell’s ability to regulate sodium and potassium properly, creating what we call an irritation pause. Think of it as a reboot: turning off and restarting it so it can function the way it was designed to function.

What Happened After His Treatments

After his first neural therapy session, his deep sleep numbers did not change, and that matters for anyone considering this treatment. The nervous system does not always respond on the first attempt, and a system that has been locked in sympathetic overdrive for years is not going to reorganize after a single session. That is not how biology works and setting that expectation clearly is part of good medicine. Very few people are going to feel dramatically different after the first treatment, which is exactly why coming back is the most important thing a patient can do.

After his second session, his Oura Ring showed 35 minutes of deep sleep in a seven-hour night.

Is 35 minutes ideal? Not yet, and we would want to see considerably more over time. What those 35 minutes represent, though, is his parasympathetic nervous system finding enough of a window to surface, his body finally getting a chance to breathe. Deep sleep is when the brain clears metabolic waste, tissue repairs itself, and the stress hormones from the previous day get processed, so for someone carrying the cognitive and physiological load he carries, even a modest restoration of that recovery window begins to compound in ways that matter enormously.

The Part That Stayed with Me

The next day, I heard from his partner. She reached out to tell me how excited she was, not just about his sleep data, but about who she could see herself becoming because of this shift. The word she used to describe him was pleasant.

Thirty-five minutes of deep sleep did not just affect him. It affected his family, his team, the suppliers partnering with his company, the people who depend on his business to function well. When I say we help world changers get back to changing the world, that is the moment I am describing. One nervous system finding its way back to balance sends a ripple far beyond what any wearable can measure.

For Providers: Learning This in Your Own Practice

If you are a provider reading this and you are intrigued by what neural therapy can do for the patients on your panel who are not responding to your standard toolkit, this is a learnable skill, and we offer hands-on training at Vine Medical on a quarterly basis. The providers who attend consistently tell us it is one of the most clinically impactful courses they have taken, and many of them leave incorporating neural therapy into their practices immediately. If you want to learn more or find registration information for an upcoming training, you can visit www.vinemedical.com.

A Reflection for Anyone Reading This

If your wearable is telling you that your body is not recovering, and you have already done the work to address sleep hygiene, stress management, and lifestyle, there may be a deeper layer worth exploring. Your autonomic nervous system may need direct support to find its way back to balance, and that is something we can work toward together.

If something in this piece resonated with your own experience, I would love to hear about it in the comments. What has your body been trying to tell you that the standard answers have not addressed?

This content is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease or medical condition. Please consult with your physician or qualified healthcare provider before making any changes to your treatment plan.