Metabolic Flexibility: A Fullscript Forward Preview

In this episode, Dr. Kate Kresge sits down with Dr. Rob Downey and Monique Class, two functional medicine clinicians who presented at Fullscript Forward 2025, to explore how precision approaches are reshaping metabolic and longevity care. Dr. Downey shares how he uses metabolic phenotyping, stress and HRV context, and gut function to organize evaluation rather than applying one protocol to everyone. Monique describes her clinical approach to GLP-1s as a potential bridge during lifestyle change, including lower starting doses, titration to effect, and planning a slow taper from the start. Together they cover body composition tracking, medication reviews during weight loss, and the habits that help patients maintain their gains.

3 Key Takeaways

• Plan the off-ramp at the on-ramp. One year after stopping semaglutide and lifestyle intervention, STEP 1 participants regained about two-thirds of their prior weight loss. (Wilding 2022). Monique builds habit "scaffolding" and gradual tapering into her plans from day one.
• Phenotype before you protocol. Dr. Downey uses body shape, lifestyle context, and lab trends to identify patterns, so foundational interventions come before advanced ones.
• Measure what matters. Both guests track lean mass, visceral fat, and phase angle rather than scale weight alone, and pair GLP-1 use with resistance training and protein at meals. (Mozaffarian 2025)

Guest: Dr. Rob Downey, MD, IFMCP, is a functional medicine physician at Seaworthy Medicine in Alaska who focuses on phenotyping, stress physiology, and gut-metabolic foundations in complex cases. Monique Class, FNP, IFMCP, is a family nurse practitioner with more than 35 years in functional medicine whose work centers on whole-person frameworks for weight management, inflammation, and longevity.

Clinical FAQ

Which labs come up most?

Fasting insulin, fasting glucose, HbA1c, optional CGM patterns, a lipid panel, triglycerides, uric acid, thyroid and sex hormones as indicated, plus stool and micronutrient testing where applicable.

How do the guests approach GI side effects on GLP-1s?

They address reflux, constipation, and dysbiosis before initiation, and discuss hydration, magnesium citrate, buffered vitamin C, ginger or bitters, gradual fiber, and stool positioning. (Mozaffarian 2025)

Why review other medications during weight loss?

As weight, intake, and vital signs change, blood pressure, glucose-lowering, lipid, or psychiatric medications may need adjusting, with attention to orthostasis and hypoglycemia risk. (Moiz 2026)

Timestamps

00:00 – Intro and Fullscript Forward overview

01:54 – Guest introductions

03:15 – Dr. Downey's journey from autoimmunity to metabolic health

10:20 – Phenotype and hormonal pattern assessment

13:18 – Sequencing foundational interventions

15:39 – Labs for assessing metabolism

19:22 – GLP-1 tapering and off-ramp planning

22:26 – Lower-dose GLP-1 protocols and titration

30:31 – Metabolic rebound: drivers and mitigation

43:03 – Whole-person care and healthspan goals

Ready to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript helps clinicians bring supplement dispensing, lab ordering, and patient education into one centralized workflow. For more practitioner education on supplements, nutrition, and evidence-informed clinical care, visit Fullscript Academy at academy.fullscript.com.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.