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Well, howdy y'all.

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Welcome back to another episode of You're A Mom on Drugs.

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Uh, my name is Josh Klaus.

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And I'm Jennifer Seltzer.

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The aforementioned mom on drugs, but not that she's doing them, but she is talking

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about them because my dear mother is a doctor of pharmacy from the University of

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Texas at Austin, Hook and Horne's.

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And, uh, I am just a lowly bachelor of science, you know, and also have, I do

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have my master's in public health, but I do not have the knowledge of the

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pharmaceutical world like my mother does.

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Um, we decided today, um, that today will be a fun day to delve into the realm of,

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uh, semi-glutites, um, or semaglutides, semaglutides.

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Yeah.

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Or it's actually GLP-1 receptor agonists.

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That's true.

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Um, if you haven't known anything about these, these are the common names

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are like Ozimbic and Wegovi.

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You've probably seen them in the news as being weight loss drugs.

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And we thought that these were interesting molecules because obviously

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people being overweight and obese in this country is quite prevalent.

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Um, and so I think these drugs are obviously getting a lot of attention.

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Um, and I think a lot of people are, including myself, are very confused

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of their mechanism of action.

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So I decided to ask the mom on drugs to walk us through, um, these GLP-1 agonists.

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Um, so Dr.

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Seltzer, AKA mom, uh, you want to give us a introduction of what these drugs

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are and what they are used for and let us know what, what, what's going on here.

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Well, whenever I start a, when I was in drug information, it was always, you

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kind of give a little bit of background about the disease state first before

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you really kind of dove into the medication that was being, um, addressed.

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And so first of all, I want to talk about the fact that sometimes medications

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are approved for one particular use by the food and drug administration, but

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a new indication or a new use might be discovered, um, in addition to whatever

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it was FDA approved for.

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And so that's what has happened with as initially with Ozempic and it was due to

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some of its mechanisms, which we'll get into, um, in a little bit.

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So, uh, Ozempic, although it is, it's actually FDA approved for managing

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type two diabetes mellitus.

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Um, it also then became, um, noted as a significant, um, uh, effective

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medication for, for weight loss in patients with obesity.

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Yeah, I think they noticed that in those patient populations that there was

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significant weight loss.

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Yes.

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And there's some reasons for that.

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We'll get into in just a little bit.

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Um, and again, it's caused, um, some media coverage.

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We've, I think that there have been celebrities using it for weight loss.

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I believe I read some in like a, you know, throwaway journal that it was,

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there was some, uh, whoever was it, Jimmy Fallon that hosted the Academy

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awards or whatever, made some comment about everybody looking good.

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Cause they were on there as Zempic or something.

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So, yeah.

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So, um, so people with obesity might require other methods to help with

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their weight loss in addition to diet and exercise changes and stuff.

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So we'll get into that a little bit more.

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Um, there was, there was a poll done by Gallup in March of 2024 of the, well,

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this year, it showed that 6% of all us adults that was about 15.5 million

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adults in the U S have used or are using an injectable anti-diabetes medication.

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And 3% of them stated they were specifically using it for weight loss.

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So, um, and those, those, those agents that are used for weight loss are

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primarily Ozempic, Wigovia and sexinda.

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So in the last three months of 2022, there were over 9 million prescriptions

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for Ozempic and Wigovia and they were primarily written for weight loss.

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And that was a prescription volume increase of 300% from the end of

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2020 to the end of 2022.

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Um, and it had, it has caused some medication shortages in these medications.

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So, um, you know, for using Ozempic for a non FDA approved medication versus

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somebody actually needing it to manage type two diabetes, um, you know, it can

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be kind of, you know, tricky and stuff as far as they're both conditions that

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are, you know, that can need medication help, but, um, so actually, as I read,

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there is actually a free tracker that people can utilize to find out whether or

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not these agents are available in their area.

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This is what I thought.

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That was really useful.

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So that's really cool.

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Also, interestingly too, and this, this is probably a no brainer, people with

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private insurance or generous health plans or people with wealth are more

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likely to receive GLP one receptor agonist for weight loss than anybody

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with a medicator Medicare plan because they're not covered by Medicare Medicare.

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Yeah.

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I, I just, I have an anecdote because I was mentioning to somebody that

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we were doing this episode and they mentioned, uh, they said, Oh, I've

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actually used these GLP one agonist, uh, specifically some, uh, some agglutine.

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Okay.

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And I was like, Oh, how'd you get it?

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Cause she wasn't obese.

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I was like, how did you get it?

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And she's like, Oh, well, I'm not sure.

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Well, there is this compound pharmacy in Canada that essentially will make it.

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And then they will distribute the vials.

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And I mean, essentially it's drug dealing.

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I mean, it's basically, it's just, it's just, you take this drug and then you

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sell it, you know, whatever the market price is, because in the United States,

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at least you can really only get it legally via prescription, which is only

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available for people who have type two diabetes or have a BMI over 27.

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Um, so she was telling me that she was doing this and, um, and you know, watching

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people take it because she also said that there are a lot of these quote unquote

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weight loss clinics that will offer and say that they're offering these, these

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semakotides, but actually all they do is they get a vial, let's say from these

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compound pharmacies, which are under the radar and they, they're not regulated

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by the FDA, they're just kind of doing whatever they want to do.

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It's the wild west out there.

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And, um, and they'll just dilute the dose.

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So technically they are giving you, um, you know, uh, Ozempic or

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Wigovie, but actually they just water it down.

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So it's basically just like, um, homeopathy or, uh, it's like this idea

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of like this really dilute substance.

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That's not really doing anything.

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Maybe it has a placebo effect, but there's such a hunger for this and the,

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the supply hasn't kept up with the demand from what I've heard.

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It's technically demanding to make these molecules.

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Um, so you just aren't able to make them as quickly as people want them.

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So just want to talk a little bit more about those, um, compounding pharmacy,

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um, manufacturing things in a little bit.

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That sounds great.

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Uh, but, but as far as, so the average wholesale cost of one milligram of Ozempic

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and the dose of Ozempic that, um, people shoot for, I believe is three milligrams.

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Um, a week and put a one milligram dose that it would be a one month supply.

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So a one month supply of a one milligram dose is $1,162.

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And that's the average wholesale cost.

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Now that if you have insurance, then you don't pay that.

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But if you had to pay out of pocket, that's pretty hefty price tag.

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And Wigovie is higher than that.

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It's a, it's over $1,600.

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Yeah.

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So you basically paying close to 12 to $14,000 higher than that, maybe like

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$15,000 a week.

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Yes, a year for this medication.

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Yes.

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So, so, so let's, so let's, let's dive a little bit into obesity.

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Um, and because that's really the target of what these medications have been, um,

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uh, used for, you know, as far as what we're talking about today.

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So obesity is really a serious and it's a common and it's a costly chronic disease

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in the United States and it's observed in one in five children and two in five adults.

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Um, adults, um, that are primarily affected with obesity are going to be those that

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may have less education.

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And again, this is just the demographics of this disease.

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They're non Hispanic black adults that are having more problem with this.

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Also, um, they may have concurrent serious health conditions like heart disease or

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diabetes, um, and they may have other diseases as well.

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And children, it's one of the most, interestingly, it's one of the most common

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chronic pediatric diseases.

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And it's multifactorial, so it can be socio ecological.

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So it's like the environment that they live in, um, what, um, you know, what's

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what they're, uh, how much money their parents make, what, what are the, what

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kind of foods they get as well as generic factors and stuff.

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And it's again, more, more common in children who have been poverty or don't

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have as many resources and stuff.

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And so, so children especially will benefit from behavioral health

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modifications, um, as far as, and lifestyle treatments for their eating

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habits, that's going to help them because obesity has long lasting negative

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health consequences.

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And you would hopefully then carry this into their adult, um, uh, adult life

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that they would continue to have those kinds of practices in place.

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Um, the prevalence of obesity and what prevalence means is that it's the

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proportion of a population with a specific characteristic over time.

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With a specific characteristic over given time periods.

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So that's what prevalence is.

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And so the prevalence of obesity in the United States increased from 30.5% to

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almost 42% over a 10 year time period from 1999 to 2020, um, and Texas has an

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obesity prevalence of 20, of 35 to 40%.

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So they're right there in that higher level.

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Do love our brisket and beer in this state and tortillas.

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Yes.

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Um, prevalence really doesn't change so much based on age, except that the lowest,

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you know, age population, like the two to five year olds, it's kind of stabilized,

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but even five year olds and older can have increasing prevalence of obesity.

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So that's interesting.

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So the, the, the age cohort, like between two to five has risen to a certain

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percentage, you know, like from, let's say from 1999 to 2000 to this date.

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And it's kind of stayed there.

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It's plateaued.

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Interesting.

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Yeah.

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Yeah.

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So it's, you know, I think we also should mention that when we mention a lot of

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these, um, socioeconomic factors, that these are more correlations, not causal

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factors, like just because you're poor, it doesn't mean that you're going to be obese.

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Right.

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We, it could be a healthy user bias.

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Like, like my mom said, it's like, if you have more resources, then you might be

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able to have more free time to be able to go exercise or shop for foods that might

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satiate you more than eating some of the, the processed foods that tend to be

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that tend to lead towards non, not being satiating and you just tend to eat more

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of those.

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Um, so a lot of these factors are kind of all bundled together.

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Um, but we don't mean to hold.

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They're never implied.

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A lot of these factors are causally related.

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That's a great point.

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Yeah.

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That's a great point.

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Um, in 2019 dollars, the cost of obesity was almost $173 billion.

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So yeah, I did some, I did some basic math cause I was like, well, what if we

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gave some of these drugs cause they're around, let's say $1,200 a month.

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If we gave them, let's just say that the government said, you know, this is a

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huge problem.

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It's costing us $173 billion a year.

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Um, even at the current price of the drug, if we gave it to every obese person,

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it would still be more to pay for the drug than the cost of obesity itself.

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So, um, we're still waiting for the price of those drugs to go down, for it to be

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cost-effective because I do think we'll get into this later about the mechanism

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of action and what the drug actually does.

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But if you're looking at it from a public health or a cost-effective standpoint,

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if you're able to give people these drugs and say, Hey, we're going to give

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you this drug, it's going to increase your, you know, your, your quality of life,

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life expectancy.

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It's something we don't appreciate in health.

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It's not just about lowering mortality, also morbidity and this idea of like,

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you want to be able to run and play with your grandkids.

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Like you want to be able to walk up a flight of stairs without being winded.

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And, um, and some of that doesn't get captured by dollars as well.

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Um, but so sometimes, you know, making these calculations, like is the

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juice worth the squeeze?

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Um, and, but I'm hoping that over the next, and maybe my mom and I maybe might

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debate the merit of giving a bunch of people pharmaceuticals, but I think

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sometimes you have to debate, like giving people this drug and paying for it now,

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which might be really expensive and people might be up in arms about, you

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know, Medicare, Medicaid paying for these drugs, but it's like, we're paying for

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it anyway in our healthcare system.

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So we might as well prevent it before it gets further.

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But that's just my point about like, it's just, it doesn't seem cost-effective

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at the, at the moment.

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Right.

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Yeah.

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So, but yeah, there's like, like you said, it's so complicated because there's

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so many other factors, cause like, what if you were able to give them this drug

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and then you reduce their diabetes complications or their heart disease

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complications, then they extend their life and then they are more contributable

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member of our society for longer and stuff.

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Right.

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What price tag do you put on that?

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Able to be a grandparent and affect, you know, a child's life that, you know,

234
00:13:52,720 --> 00:13:55,200
might make them a better citizen as well.

235
00:13:55,200 --> 00:13:55,440
Right.

236
00:13:55,440 --> 00:13:58,400
There's all these dynamics when people die and get sick, it has this

237
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incredible ripple effect, um, that you're trying to always prevent.

238
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Right.

239
00:14:02,400 --> 00:14:06,840
So, so why does obesity occur?

240
00:14:06,880 --> 00:14:09,040
Well, it's not just a behavioral problem.

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Cause sometimes we want to look at people and say, oh, they just need to get off

242
00:14:12,400 --> 00:14:17,920
their sofa, you know, but it's not, and in some patients it is like that, but it's

243
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a really complex metabolic disease.

244
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And so you, you actually, we're not going to go, I mean, Josh may go into the

245
00:14:24,400 --> 00:14:29,360
actual details of all the pathways of the disease state, but, um, it's, it's

246
00:14:29,360 --> 00:14:33,760
really, obesity is really a dysfunction of the normal pathways that regulate body

247
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weight and, and specifically body fat.

248
00:14:36,680 --> 00:14:41,560
And so, so what happens with obesity is so you, you end up with increased energy

249
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storage resulting from an imbalance between energy intake and expenditure over

250
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time.

251
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So that makes sense.

252
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It's like we take in more than we're burning out, burning up and stuff.

253
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So, but it is multifactorial.

254
00:14:54,280 --> 00:14:58,600
And so, um, and there can be other underlying health conditions and sometimes

255
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medications and a small percentage of patients can help to contribute to

256
00:15:02,560 --> 00:15:06,200
obesity as well, but that's not the main reasons for it.

257
00:15:06,760 --> 00:15:10,360
And, um, and so a lot of, there are a lot of factors that can regulate

258
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appert, appetite and energy balance because appetite interestingly is

259
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affected by many neurotransmitters in the brain.

260
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So, yeah, it's really well, I mean, just as, uh, my mom definitely hinted on it

261
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of talking about a little bit of the pathophysiology of this condition.

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I think it's so well said to call it a metabolic disease rather than a disease

263
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of like weak will.

264
00:15:31,680 --> 00:15:38,440
Um, um, it, it, you have to think about what humans were like prior to

265
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civilization, like the idea that we, we were constantly either hunting or

266
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gathering and food was very scarce.

267
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Like the idea of like bacon is just it, then that concept does not exist in, in

268
00:15:53,560 --> 00:15:55,800
ancient human, human existence.

269
00:15:56,360 --> 00:16:02,880
So our, our system was basically, you know, cultivated to say, if we get

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something that's really calorically dense, let's say like we find a beehive

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with honey in it, we're never going to find that again in probably a couple of

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months, because you know, there's a lot of competition out there with nature.

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Um, and so your body is primed to store this because you know that there's going

274
00:16:20,720 --> 00:16:24,440
to be a lot of scarce food out there in the real world.

275
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So your body is really good about winning, getting a caloric excess.

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As my mom alluded to the first law of thermodynamics, there's no

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perpetual motion machine.

278
00:16:33,680 --> 00:16:37,160
The energy you put in is going to be the energy that comes out and is either

279
00:16:37,160 --> 00:16:42,040
going to come out as heat, which makes us, you know, uh, exothermic endothermic

280
00:16:42,360 --> 00:16:47,200
organisms, or it's going to get stored in some way, either as glycogen or

281
00:16:47,200 --> 00:16:49,400
fat or some other thing.

282
00:16:49,400 --> 00:16:53,720
And, and he, and we, we have evolved essentially just to be these creatures

283
00:16:53,720 --> 00:16:57,000
that are really good at storing stuff for the winter.

284
00:16:58,520 --> 00:17:03,560
As anyone knows who lives in a modern society, we have food everywhere.

285
00:17:03,640 --> 00:17:08,880
I mean, you can get, you, you could go into a gas station and get 2000

286
00:17:08,880 --> 00:17:11,200
calories for maybe $10.

287
00:17:11,640 --> 00:17:12,800
Like it is incredible.

288
00:17:12,840 --> 00:17:15,480
The amount of progress that we've made on food abundance.

289
00:17:15,480 --> 00:17:20,200
I mean, we've solved, especially in the West, we've followed starvation.

290
00:17:20,360 --> 00:17:24,680
Um, but we now have, I think on average, the, uh, people in the West

291
00:17:24,720 --> 00:17:26,600
consume 3,500 calories a day.

292
00:17:27,520 --> 00:17:31,520
And if you think about that, like a bank account, if you do that every day,

293
00:17:31,880 --> 00:17:33,520
that's going to add up over time.

294
00:17:33,520 --> 00:17:36,720
And it makes, it makes a lot of sense that people would put on a

295
00:17:36,720 --> 00:17:38,480
couple of pounds every year.

296
00:17:38,560 --> 00:17:38,720
Yeah.

297
00:17:38,720 --> 00:17:41,640
Cause you think of what would you have to do to burn off 3,500 calories a day?

298
00:17:41,640 --> 00:17:42,440
That is correct.

299
00:17:42,480 --> 00:17:45,040
And it's actually quite amazing because you can actually do that relatively

300
00:17:45,040 --> 00:17:47,720
easily and we're going to get to that mechanism later.

301
00:17:47,760 --> 00:17:50,720
Um, but you just have to think about it like accruing debt.

302
00:17:50,800 --> 00:17:55,000
It's like you're, you're putting your body into debt and the debt is

303
00:17:55,000 --> 00:17:58,360
collected as fat and, and it's marginal.

304
00:17:58,360 --> 00:18:02,120
So most people they collect, you know, a pound or two a year, but if you do

305
00:18:02,120 --> 00:18:06,720
that over 20 years, you're going to gain, you know, potentially 20 to 40 pounds.

306
00:18:07,160 --> 00:18:11,720
Um, and that's how you get something like being overweight or obese.

307
00:18:11,720 --> 00:18:15,400
So just, just to say that like our bodies were designed to basically

308
00:18:15,800 --> 00:18:20,240
store this material and it was something that was really beneficial 200,000

309
00:18:20,240 --> 00:18:24,480
years ago, um, when we were hunter gatherers, but now in modern society,

310
00:18:24,520 --> 00:18:26,640
um, it is causing a lot of downstream consequences.

311
00:18:26,960 --> 00:18:32,040
So, so, um, obviously, I mean, the clinical presentation of obesity is,

312
00:18:32,080 --> 00:18:34,000
is it can be fairly obvious.

313
00:18:34,040 --> 00:18:39,520
It's usually, you know, readily apparent in people, people, interestingly,

314
00:18:39,520 --> 00:18:44,120
people usually don't seek help for obesity unless there's another obesity

315
00:18:44,120 --> 00:18:45,480
associated health condition.

316
00:18:46,120 --> 00:18:51,920
Um, and obesity can be measured by two, uh, uh, two techniques.

317
00:18:51,920 --> 00:18:55,400
One is called, um, body mass index or your BMI.

318
00:18:55,400 --> 00:18:56,960
And certainly people have heard of that.

319
00:18:56,960 --> 00:19:01,400
And when you calculate your body mass index, it's your weight and kilograms

320
00:19:01,840 --> 00:19:05,040
divided by your height in meters squared.

321
00:19:05,040 --> 00:19:06,400
So it's excuse me.

322
00:19:06,400 --> 00:19:08,480
It's kilograms per meter squared.

323
00:19:08,480 --> 00:19:11,520
And you can do it in pounds per inches as well, too.

324
00:19:11,520 --> 00:19:14,600
There's a different calculation for that as well, but there's different

325
00:19:14,600 --> 00:19:20,080
interpretations for how you, you interpret your BMI for both adults and kids.

326
00:19:20,480 --> 00:19:25,440
So for an adult to be overweight, as Josh alluded to earlier, your BMI is

327
00:19:25,440 --> 00:19:31,240
going to be from 25 to 30 kilograms per meter squared, whereas obesity is over

328
00:19:31,240 --> 00:19:33,960
30 kilograms per meter squared.

329
00:19:33,960 --> 00:19:40,560
With kiddos, your obesity, um, target is going to be your, your BMI is going

330
00:19:40,560 --> 00:19:46,560
to be greater than the 95, 95th percentile for your age and sex.

331
00:19:46,600 --> 00:19:52,480
So if you are, if your BMI is greater than the 95th percentile, there was

332
00:19:52,480 --> 00:19:55,040
this growth chart that you plot kids on.

333
00:19:55,040 --> 00:19:59,400
Then can you explain to people maybe who not know what the 95th percentile would be?

334
00:19:59,680 --> 00:20:00,280
So, yeah.

335
00:20:00,280 --> 00:20:03,720
So when, so when you, when you, when you, when you, when you,

336
00:20:03,720 --> 00:20:08,720
so there are these graphs for kiddos and it, I believe it's, they're, they're

337
00:20:08,720 --> 00:20:14,560
male and feel, male and female, um, uh, uh, differences.

338
00:20:14,600 --> 00:20:17,960
I mean, there's a, there's a graph for males and graph for females because

339
00:20:17,960 --> 00:20:19,840
girls and boys grow differently.

340
00:20:20,320 --> 00:20:23,680
And it's, it's plotted based on height and weight.

341
00:20:24,080 --> 00:20:30,160
And so there is a, so when you, when you, and so there's going to be an average

342
00:20:30,160 --> 00:20:36,080
weight and an average height for kiddos based from birth to 18 years of age.

343
00:20:36,520 --> 00:20:40,720
And so then there's a graph that's created, um, with, and, and so when, if

344
00:20:40,720 --> 00:20:44,320
you, the average is going to be 50% because you know, right in the middle

345
00:20:44,320 --> 00:20:48,840
is going to be 50%, so they call that the 50th percentile and then they.

346
00:20:49,440 --> 00:20:51,520
Gradated down and up.

347
00:20:51,880 --> 00:20:56,240
So you've got 10 percentile 95th percentile and it's kind of these

348
00:20:56,240 --> 00:21:01,120
lines that kind of parallel that 50th percentile they curve because it goes,

349
00:21:01,440 --> 00:21:06,040
it kind of like, looks kind of like an S as kiddos get older and stuff, but it's

350
00:21:06,040 --> 00:21:11,120
based on their age and their weight and their height and stuff, as far as how

351
00:21:11,120 --> 00:21:12,280
that, how they're growing.

352
00:21:12,280 --> 00:21:15,000
So you want to, you're, you're catching kids that either are going to have

353
00:21:15,000 --> 00:21:19,640
issues with underweight or some growth issues or whatever, or the, or overweight

354
00:21:19,640 --> 00:21:24,720
as well too, so the 95th percentile is going to be the, the top level in this

355
00:21:24,720 --> 00:21:29,760
growth chart and stuff, so yeah, so that, so yeah, so, um, so does that, does that,

356
00:21:29,840 --> 00:21:31,800
hopefully that makes sense to people and stuff.

357
00:21:31,840 --> 00:21:32,000
Yeah.

358
00:21:32,000 --> 00:21:35,480
It's like, I mean, I always say like, if you picture a room with a hundred people

359
00:21:35,760 --> 00:21:40,680
and most of those people, let's just say it's height, for example, most of the

360
00:21:40,680 --> 00:21:44,920
people are going to end up close to the middle, like let's say it's, you know,

361
00:21:45,400 --> 00:21:47,240
let's say we have a hundred people, they're probably going to end up around

362
00:21:47,240 --> 00:21:50,840
five, six, if they're adults and that's going to be the average, but then you're

363
00:21:50,840 --> 00:21:53,520
going to have a couple of people who are like six, four, or a couple of people

364
00:21:53,520 --> 00:21:57,840
like myself or, or five, four, or like you four 11, you know, so you're going

365
00:21:57,840 --> 00:22:02,280
to be in the fifth percentile of height, which is basically, you know, basically

366
00:22:02,280 --> 00:22:06,520
the bottom of, of, on the other side of the curve and then someone who's an NBA

367
00:22:06,520 --> 00:22:09,400
basketball player is going to be in the 95th percentile, which is the top.

368
00:22:09,400 --> 00:22:15,040
So these outliers, but as my mom mentioned over time, the prevalence has

369
00:22:15,040 --> 00:22:21,720
changed, so these averages shift, you know, that's why like, um, so you can

370
00:22:21,720 --> 00:22:26,760
have a BMI that's why it's these, these measures are sensitive to changing

371
00:22:26,760 --> 00:22:27,720
averages, right?

372
00:22:27,720 --> 00:22:33,600
Because like you can have someone who's like myself, like five foot four, 160

373
00:22:33,600 --> 00:22:40,120
pounds, but if the mean or the average is that, then I'm not going to have a BMI

374
00:22:40,160 --> 00:22:45,560
over extended, but if you're comparing it to like the 1930s BMI, then I'd probably

375
00:22:45,560 --> 00:22:49,480
be overweight or obese, but you're always kind of comparing it to the population

376
00:22:49,480 --> 00:22:51,840
today and that can be a bit problematic, right?

377
00:22:51,840 --> 00:22:55,960
Because if you're trying to get to an ideal or what they should be, um, if the

378
00:22:55,960 --> 00:22:59,640
average is always shifting and tending up, if we're kidding, continuing to

379
00:22:59,640 --> 00:23:03,040
getting more obese or more overweight, then that average is shifting up.

380
00:23:03,320 --> 00:23:07,520
So you want to kind of get back to one that is somewhat healthy, right?

381
00:23:07,640 --> 00:23:11,440
And, uh, um, and that's going to lead to our next metric as well, which I think

382
00:23:11,440 --> 00:23:14,880
is, I think is a better way to measure.

383
00:23:14,920 --> 00:23:18,760
It's a better, so the other metric is, is waist circumference and waist

384
00:23:18,760 --> 00:23:20,000
circumference is measured.

385
00:23:20,360 --> 00:23:24,200
If you think about, if you can feel your waist and you can feel kind of the top of

386
00:23:24,200 --> 00:23:28,440
your hip bones, then that's kind of where you want to measure, you want to take a,

387
00:23:28,520 --> 00:23:32,200
uh, a measuring tape and put it around that particular area.

388
00:23:32,600 --> 00:23:37,840
And so a high risk waist circumference for men is greater than 40 inches and one

389
00:23:37,840 --> 00:23:39,880
for women is greater than 35.

390
00:23:40,240 --> 00:23:44,360
So you, obviously you want your waist circumference to be smaller, but your

391
00:23:44,360 --> 00:23:49,800
waist circumference, um, should be measured in concert with your BMI.

392
00:23:50,040 --> 00:23:58,080
If your BMI is between 25 and 34.9 kilograms per meter squared above that, it

393
00:23:58,080 --> 00:24:02,040
doesn't really give you a whole lot of extra information, but below in that

394
00:24:02,040 --> 00:24:06,400
range, it can help, it can help assess additional metabolic risk cause it could

395
00:24:06,400 --> 00:24:12,000
be that somebody doesn't look really obese or overweight, but they're carrying

396
00:24:12,000 --> 00:24:16,280
around extra weight that could then contribute to some potential other health

397
00:24:16,440 --> 00:24:18,760
issues that you're trying to identify.

398
00:24:18,800 --> 00:24:19,680
Yeah, that's a good point.

399
00:24:19,680 --> 00:24:23,520
Like for example, I'm always going to refer to myself, but I'm a very stocky

400
00:24:23,920 --> 00:24:29,920
muscular guy and so like most of my weight is primarily a muscle, so I might

401
00:24:29,920 --> 00:24:33,680
have a high BMI, but it doesn't really tell me a lot about the fat content

402
00:24:33,720 --> 00:24:38,240
inside of my body and yeah, supposedly there could be a really skinny person

403
00:24:38,240 --> 00:24:44,000
who like I do have a friend who just drinks and eats a lot of alcohol more

404
00:24:44,000 --> 00:24:46,840
than me and he's really, he's always skinnier than me, but I'll bet if I

405
00:24:46,840 --> 00:24:49,720
looked at his liver, it would not be as healthy as mine.

406
00:24:50,200 --> 00:24:54,960
So sometimes these are just rough metrics to help get people into to see

407
00:24:54,960 --> 00:24:58,600
a physician or a medical professional so that more steps are like, Hey, should

408
00:24:58,600 --> 00:24:59,560
we actually take a look?

409
00:24:59,920 --> 00:25:02,600
But I just want to let all my skinny folks out there just because you're

410
00:25:02,600 --> 00:25:04,360
skinny doesn't mean that you're healthy.

411
00:25:04,360 --> 00:25:07,920
This is a metabolic disease, which most of the time happens on the inside.

412
00:25:07,920 --> 00:25:10,840
But sometimes the outside does give you an idea of what's actually

413
00:25:10,840 --> 00:25:12,200
going on on the inside.

414
00:25:12,760 --> 00:25:18,800
So, so we all know this, the general management strategies for weight

415
00:25:18,800 --> 00:25:26,000
loss are going to be managing your diet and eating healthy as well as getting

416
00:25:26,000 --> 00:25:32,360
exercise and then also some people do need behavior modification because

417
00:25:32,360 --> 00:25:37,440
people, and we all know we all either have experiences personally or know

418
00:25:37,440 --> 00:25:43,080
someone where we use food as a compensatory mechanism for our emotions.

419
00:25:43,280 --> 00:25:49,280
And so that then can contribute to, you know, gaining weight and stuff.

420
00:25:49,280 --> 00:25:50,960
So you just want to be careful of that as well.

421
00:25:50,960 --> 00:25:52,280
So you can get help with that as well.

422
00:25:52,280 --> 00:25:56,840
So you learn to not just be able to say no to food and maybe yes to a walk

423
00:25:56,880 --> 00:25:58,440
when you're feeling kind of down and stuff.

424
00:25:58,440 --> 00:26:02,640
So, so now we're going to turn the corner and we're going to start talking about

425
00:26:02,640 --> 00:26:07,640
these medications that have been discovered to be used for weight loss.

426
00:26:07,960 --> 00:26:12,520
And they are called GLP-1 receptor agonists, and it stands for

427
00:26:12,520 --> 00:26:16,240
glucagon-like peptide-1 receptor agonists.

428
00:26:17,120 --> 00:26:22,720
What they do is that they mimic something that's called an incretin.

429
00:26:22,760 --> 00:26:26,200
This is something that we have in our body and it's a hormone.

430
00:26:26,200 --> 00:26:31,080
And it's actually a group of hormones that are released in our gut after we eat.

431
00:26:31,320 --> 00:26:36,360
And they're going to stimulate our pancreas to release insulin in response

432
00:26:36,360 --> 00:26:38,360
to the food that we take in.

433
00:26:38,760 --> 00:26:42,920
And the insulin is released from the beta cells in the pancreas and it's going to

434
00:26:42,920 --> 00:26:45,480
help manage our glucose intake.

435
00:26:45,480 --> 00:26:48,440
So it helps to lower our blood glucose levels.

436
00:26:50,040 --> 00:26:56,080
These, these GLP-1 receptor agonists also help to stimulate our pancreas

437
00:26:56,080 --> 00:27:01,200
slow gastric emptying and they reduce food intake.

438
00:27:01,560 --> 00:27:06,160
Interestingly, there are also these GLP-1 receptors in several areas of the brain

439
00:27:06,160 --> 00:27:08,160
that regulate the appetite.

440
00:27:08,160 --> 00:27:12,760
So it's going to lower our weight, it's going to lower our weight with greater

441
00:27:12,760 --> 00:27:16,520
fat mass loss rather than lean mass loss.

442
00:27:17,000 --> 00:27:19,480
And it helps to fight against this weight loss plateau.

443
00:27:19,480 --> 00:27:21,880
Joshua kind of alluded to this earlier.

444
00:27:21,880 --> 00:27:26,200
So our bodies want to fight against continued weight loss.

445
00:27:26,200 --> 00:27:30,040
And it's very, very normal for our bodies to do that because our body wants to

446
00:27:30,040 --> 00:27:31,920
determine what a good weight is for us.

447
00:27:31,920 --> 00:27:35,760
And it's even if our BMI says otherwise, because they want to, it's a defense

448
00:27:35,760 --> 00:27:38,760
mechanism of our body to stave off starvation.

449
00:27:39,000 --> 00:27:39,200
Yeah.

450
00:27:39,200 --> 00:27:40,800
And also to maintain homeostasis.

451
00:27:40,800 --> 00:27:42,000
We just like to be in balance.

452
00:27:42,000 --> 00:27:45,240
And so if you're at a certain weight and you've been there for a long time, your

453
00:27:45,240 --> 00:27:47,400
body's pretty good at maintaining that balance.

454
00:27:47,400 --> 00:27:47,680
Yes.

455
00:27:47,680 --> 00:27:53,560
So, so this, for this weight, weight loss plateau, your body is going to send

456
00:27:53,560 --> 00:27:54,560
hunger hormones.

457
00:27:54,560 --> 00:27:58,920
So that's going to, that's going to help you reduce the fullness hormones and

458
00:27:58,920 --> 00:28:00,720
decrease metabolism.

459
00:28:00,720 --> 00:28:03,880
So it will keep your weight stable so that you're kind of going to keep the

460
00:28:03,880 --> 00:28:06,560
blood glucose higher rather than lower and stuff.

461
00:28:07,160 --> 00:28:12,520
But GLP-1 receptor agonists can, can also change your body functioning to help

462
00:28:12,520 --> 00:28:15,400
maintain and improve weight loss.

463
00:28:15,400 --> 00:28:17,480
They don't just make you want to eat less.

464
00:28:17,480 --> 00:28:20,440
So there's some physiologic things that are going on behind it as well too.

465
00:28:21,160 --> 00:28:21,480
Yeah.

466
00:28:21,480 --> 00:28:25,960
I mean, this is a cool molecule because as my mom alluded to, it says

467
00:28:25,960 --> 00:28:27,480
glucagon like peptide.

468
00:28:27,640 --> 00:28:31,000
And the reason they call it that is because there is an actual molecule called

469
00:28:31,080 --> 00:28:35,640
glucagon in your body that is released and actually does get released by your

470
00:28:35,640 --> 00:28:41,320
gut to promote insulin secretion in your body, but it's very short lived.

471
00:28:41,720 --> 00:28:43,400
And, am I saying that right?

472
00:28:43,440 --> 00:28:44,840
I, I'm not sure you're saying that right.

473
00:28:44,840 --> 00:28:50,200
So glucagon is released to stimulate glucose, increase glucose levels and

474
00:28:50,200 --> 00:28:57,560
stuff, whereas insulin is released to stimulate, it helps to, it helps to

475
00:28:57,600 --> 00:28:59,680
lower your blood glucose and stuff.

476
00:28:59,680 --> 00:29:04,200
So glucagon helps to increase your blood glucose and insulin is released to help

477
00:29:04,200 --> 00:29:05,480
lower your blood glucose.

478
00:29:05,720 --> 00:29:06,040
Okay.

479
00:29:06,040 --> 00:29:10,080
So I guess it's, so it's just really, it's, it's attaching to the receptor.

480
00:29:10,160 --> 00:29:10,640
Right.

481
00:29:11,000 --> 00:29:11,320
Okay.

482
00:29:11,320 --> 00:29:11,960
I see what you're saying.

483
00:29:11,960 --> 00:29:16,320
So it's competing against glucagon to get on the receptor.

484
00:29:16,400 --> 00:29:16,760
Right.

485
00:29:16,800 --> 00:29:17,200
Okay.

486
00:29:17,640 --> 00:29:23,720
So there are these natural ones in your body that are like GLPs, right?

487
00:29:23,880 --> 00:29:24,360
Right.

488
00:29:24,640 --> 00:29:24,960
Okay.

489
00:29:25,000 --> 00:29:25,400
Right.

490
00:29:25,760 --> 00:29:30,080
Um, and from the way that I understand it is that they're very short lived

491
00:29:30,200 --> 00:29:34,200
because there's an enzyme, I think it's called DD4 that breaks it down

492
00:29:34,200 --> 00:29:35,280
really, really readily.

493
00:29:36,080 --> 00:29:38,640
Um, and so it has this very short half-life in the body.

494
00:29:38,640 --> 00:29:44,040
Um, so what the novo Nordis did, what they did, the people who developed this drug,

495
00:29:44,360 --> 00:29:49,560
um, first, I think lyraglutide before semaglutide, um, is that they added,

496
00:29:50,040 --> 00:29:53,760
um, to basically two modifications to the molecule.

497
00:29:53,920 --> 00:29:57,880
One was that they made it so it would dissolve into something called albumin.

498
00:29:58,560 --> 00:30:04,160
Um, which essentially is really good for maintaining its circulation in the

499
00:30:04,160 --> 00:30:09,280
blood flow and also to deny getting excreted out by your kidneys.

500
00:30:09,280 --> 00:30:12,720
Cause you, you think about it, it's in your blood, your kidney is always

501
00:30:12,720 --> 00:30:16,040
filtering things out of your blood to get it out, but if it's dissolved in

502
00:30:16,040 --> 00:30:20,880
albumin, it has a much longer half-life in your body and also they had an

503
00:30:20,880 --> 00:30:23,760
addition so it wouldn't get degraded by this enzyme.

504
00:30:23,800 --> 00:30:27,760
So it allows it to have basically have a half-life or a shelf life in your body

505
00:30:27,760 --> 00:30:32,760
of seven days, um, which is why we're going to get to this, the, how often

506
00:30:32,760 --> 00:30:36,480
you dose yourself with some aglutide, you can basically take an injection once

507
00:30:36,480 --> 00:30:40,080
a week, which is what correlates to being seven days in your body.

508
00:30:40,520 --> 00:30:43,040
I just thought that was so cool that they designed it to be that way.

509
00:30:43,040 --> 00:30:44,400
Just these two little fixes.

510
00:30:45,360 --> 00:30:49,800
Um, and so that, that it would survive, um, obviously with the goal of, of

511
00:30:49,800 --> 00:30:53,560
releasing more insulin, but then we have all these other side effects as well

512
00:30:53,640 --> 00:30:56,920
that we didn't know what we're going to happen when we gave it to people.

513
00:30:57,120 --> 00:30:58,480
So a really cool molecule.

514
00:30:58,480 --> 00:30:59,080
It is really cool.

515
00:30:59,080 --> 00:31:04,600
So, so there are actually several GLP-1 receptor agonists available.

516
00:31:05,080 --> 00:31:09,640
Um, they are, they were initially primarily FDA approved or most of them

517
00:31:09,640 --> 00:31:12,720
are primarily FDA approved to manage type two diabetes.

518
00:31:13,360 --> 00:31:17,480
Um, some of the names you've heard are ozempic or trolicity.

519
00:31:17,760 --> 00:31:21,280
That's dilaglutide or biota is exenitide.

520
00:31:21,600 --> 00:31:25,400
Um, also, um, uh, liraglutide is Victoza.

521
00:31:25,400 --> 00:31:29,360
So they've all started out by being agents that were used to treat type two

522
00:31:29,360 --> 00:31:36,400
by diabetes, but liraglutide and semaglutide are the only two GLP-1 receptor

523
00:31:36,400 --> 00:31:38,400
agonists that are approved for weight loss management.

524
00:31:38,680 --> 00:31:43,240
So note that I didn't say ozempic because they created with govee for

525
00:31:43,440 --> 00:31:47,040
weight loss management, but ozempic is actually not FDA approved for

526
00:31:47,040 --> 00:31:50,560
weight loss management, but it's the same medication, the same generic

527
00:31:50,560 --> 00:31:52,960
drug, semaglutide, they just have a different trade name.

528
00:31:53,160 --> 00:31:54,200
I think they have to do that.

529
00:31:54,200 --> 00:31:56,800
Cause I think wasn't the same with, uh, Viagra, right?

530
00:31:56,800 --> 00:32:01,040
Like it was, it was, it was originally designed to be an angina, uh,

531
00:32:01,080 --> 00:32:03,120
yeah, pulmonary hypertension or something.

532
00:32:03,120 --> 00:32:03,320
Yeah.

533
00:32:03,320 --> 00:32:07,280
So they discovered this side effect that men tend to like, and then they had to

534
00:32:07,480 --> 00:32:11,120
basically go through the same FDA process, but you have to call it by a

535
00:32:11,120 --> 00:32:15,280
different brand name, uh, because it has a different, uh, you have a different

536
00:32:15,280 --> 00:32:16,840
health outcome that you're searching for.

537
00:32:16,840 --> 00:32:17,120
Right.

538
00:32:17,120 --> 00:32:18,480
No, that's why you can't.

539
00:32:18,480 --> 00:32:24,080
Well, anyway, um, so, um, so, um, so one of the ways that you can

540
00:32:24,080 --> 00:32:29,480
determine whether obesity treatment is successful is, um, the surrogate

541
00:32:29,480 --> 00:32:30,720
marker of weight loss.

542
00:32:30,720 --> 00:32:37,840
And so what, what, what I'm seeing by that is that we're looking for at least a 10% loss,

543
00:32:38,160 --> 00:32:46,520
uh, 10% or greater body weight loss to determine that a drug that's for obesity

544
00:32:46,520 --> 00:32:50,880
treatment is being successful to help with obesity associated complications.

545
00:32:50,880 --> 00:32:56,680
Often patients that are, are seeking out a medication to help with weight loss, have

546
00:32:56,680 --> 00:33:01,200
to show their public or private payer that they've tried other methods like

547
00:33:01,200 --> 00:33:06,920
lifestyle management changes, including weight law, I mean, uh, um, uh, food, um,

548
00:33:06,960 --> 00:33:10,520
diet, exercise, and maybe to show them their gym membership and be like, I've

549
00:33:10,520 --> 00:33:13,800
been trying the fridge full of lettuce.

550
00:33:13,800 --> 00:33:14,600
Yeah, really?

551
00:33:14,760 --> 00:33:15,080
Yeah.

552
00:33:15,080 --> 00:33:16,440
Whatever and stuff.

553
00:33:16,440 --> 00:33:20,640
So, but, um, so, so, so, so, so, so, so, so, so, so, so, so, so, so, so, so, so, so,

554
00:33:20,640 --> 00:33:27,120
so, so now, so, but so our GLP one receptor agonist, um, the, so I, I think

555
00:33:27,120 --> 00:33:29,000
this is important for people to know.

556
00:33:29,000 --> 00:33:35,520
So Saxenda, which is liraglutide is FDA approved as an, listen to this.

557
00:33:35,680 --> 00:33:41,200
It's an adjunct to a reduced calorie diet, as well as an increased physical activity.

558
00:33:41,320 --> 00:33:42,040
It's an adjunct.

559
00:33:42,040 --> 00:33:45,440
So that means you're using it together with those for chronic weight management

560
00:33:45,440 --> 00:33:51,320
and people with a BMI of 30 kilograms per meter squared or greater, or they have

561
00:33:51,320 --> 00:33:55,880
one that's greater than 27, but they have some other weight related comorbid

562
00:33:55,880 --> 00:34:00,840
conditions, such as heart disease or diabetes is also indicated for pediatric

563
00:34:00,840 --> 00:34:06,480
patients, 12 years old and older with a weight above 60 kilograms and an initial

564
00:34:06,480 --> 00:34:10,640
BMI that corresponds to 30 milligrams per meter squared or greater for adults.

565
00:34:10,800 --> 00:34:14,560
So, um, so it is indicated for both kids and adults.

566
00:34:14,560 --> 00:34:21,720
Um, Ozempic is only indicated for, um, maintaining blood glucose control in

567
00:34:21,720 --> 00:34:23,520
addition to diet and exercise.

568
00:34:23,520 --> 00:34:27,320
So it does not have a weight loss indication.

569
00:34:27,400 --> 00:34:31,640
It's also indicated for reducing risk of major cardiovascular events.

570
00:34:31,640 --> 00:34:34,000
And we're going to talk a little about that in just a minute too.

571
00:34:34,600 --> 00:34:38,600
Um, and it, it's also that, and specifically it's major cardiovascular

572
00:34:38,600 --> 00:34:42,040
events in patients with type two diabetes and established cardiovascular disease.

573
00:34:42,040 --> 00:34:48,800
And with GOVI, which is the same generic drug as Ozempic is indicated for a

574
00:34:48,800 --> 00:34:52,960
reduction in risk of major cardiovascular events in people with established

575
00:34:52,960 --> 00:34:58,040
cardiovascular disease and either obese or overweight in combination with

576
00:34:58,040 --> 00:35:05,320
exercise and, and, and, uh, diet improvements, or it is also indicated for

577
00:35:05,320 --> 00:35:10,960
just weight loss for people who are adults and in patients, 12 years old and older.

578
00:35:10,960 --> 00:35:13,360
Um, so it has both of those indications.

579
00:35:13,360 --> 00:35:17,880
So, so again, we go V is for the cardiovascular improvement and for weight

580
00:35:17,880 --> 00:35:22,880
loss, whereas Ozempic is primarily for type two diabetes and for

581
00:35:22,880 --> 00:35:24,040
cardiovascular events.

582
00:35:25,280 --> 00:35:30,680
Um, so, uh, Joshua alluded to this earlier for sex endo or liraglutide.

583
00:35:31,200 --> 00:35:31,800
It's dose.

584
00:35:31,800 --> 00:35:36,080
It was the initial medication, the, the GLP one receptor agonist that

585
00:35:36,080 --> 00:35:37,360
was approved for weight loss.

586
00:35:37,360 --> 00:35:42,880
It is actually dosed daily and it's a subcutaneous injection once daily.

587
00:35:43,200 --> 00:35:48,520
And you, for these medications, you have to titrate the dose upward and titrate

588
00:35:48,520 --> 00:35:53,120
means you start with a smaller dose initially, and then you go to a different,

589
00:35:53,760 --> 00:35:57,840
uh, an increased dose every week because we're going to get to the side effects

590
00:35:57,840 --> 00:36:00,320
of these drugs and that's primarily why we do that and stuff.

591
00:36:00,320 --> 00:36:04,960
So, so again, this is going to take, it takes about six weeks to get to the

592
00:36:04,960 --> 00:36:07,480
target dose with liraglutide or sex endo.

593
00:36:07,800 --> 00:36:11,720
And if you have some adverse effects, you may have to slow the titration

594
00:36:11,720 --> 00:36:15,640
upward to get what you, what you, to get to your, your targets.

595
00:36:15,680 --> 00:36:16,000
Yeah.

596
00:36:16,000 --> 00:36:21,480
The example that pops into my head is, um, I love coffee now, but I did not like it

597
00:36:21,480 --> 00:36:25,480
when I was 15 and I remember the first time I tried it at my grandmother's house.

598
00:36:25,880 --> 00:36:29,520
I was so disgusted by it that I poured basically like a half a bottle of

599
00:36:29,520 --> 00:36:31,920
chocolate syrup in it, put some whipped cream on it.

600
00:36:31,920 --> 00:36:34,960
I basically invented a Frappuccino and I was like, oh, I like this now.

601
00:36:35,280 --> 00:36:39,080
So the dose that I got of caffeine was marginally less.

602
00:36:39,120 --> 00:36:42,840
And then I just titrated myself up now and I just drink black coffee now.

603
00:36:43,200 --> 00:36:47,440
So you're always, and you're, you're, you're putting a substance into your body

604
00:36:47,440 --> 00:36:50,960
that your body hasn't seen or at a dose that is not used to.

605
00:36:51,080 --> 00:36:55,800
So you're essentially just like mom said, your body is once maintained.

606
00:36:56,040 --> 00:36:58,080
It, it's always trying to maintain.

607
00:36:58,160 --> 00:37:01,320
And so when it's at the target, it's always trying to maintain.

608
00:37:01,320 --> 00:37:04,400
So when it's out of balance, it's going to try to, so you're basically trying

609
00:37:04,400 --> 00:37:08,400
to give it a small enough dose that it can maintain, and then you work your way up.

610
00:37:08,520 --> 00:37:13,280
So, and you do this by a clinical trials and you figure out which doses are better

611
00:37:13,280 --> 00:37:14,960
and which increments you increase by.

612
00:37:14,960 --> 00:37:18,960
So you can give it to a population, but of course everybody's different and you

613
00:37:18,960 --> 00:37:21,920
might be a little smaller like myself, and you might even need to start off with

614
00:37:21,920 --> 00:37:23,880
it even smaller or even larger dose.

615
00:37:23,880 --> 00:37:26,560
But your physician should be working with you on that one.

616
00:37:26,560 --> 00:37:27,520
If you have these drugs,

617
00:37:27,520 --> 00:37:31,680
we don't talk a lot about clinical trials in our podcast, but I did want to just

618
00:37:31,680 --> 00:37:36,520
mention that there are definitely been studies with liraglutide or sex enda

619
00:37:36,760 --> 00:37:41,720
that showed that not only did it improve blood glucose levels, which is kind of

620
00:37:41,720 --> 00:37:47,520
for treating diabetes type two diabetes, but the mean weight loss that were seen

621
00:37:47,520 --> 00:37:53,800
in these clinical trials with sex enda were 5.2 kilograms after a year of

622
00:37:53,800 --> 00:37:58,480
treatment of weight loss, which is equivalent to about 11 pounds.

623
00:37:58,480 --> 00:38:03,400
And it was a little bit less in adolescence and that was greater than placebo and stuff.

624
00:38:03,400 --> 00:38:07,720
And so, but interestingly, too, 10% of patients that took this medication

625
00:38:07,720 --> 00:38:12,880
discontinued it due to adverse effects, especially gastrointestinal effects.

626
00:38:12,880 --> 00:38:14,280
And we're going to talk about that in just a minute.

627
00:38:14,280 --> 00:38:18,280
And that's again the reason for this dose titration because these medications have

628
00:38:18,280 --> 00:38:20,680
a lot of GI side effects associated with them.

629
00:38:20,680 --> 00:38:22,360
Let me just get through the dosages.

630
00:38:22,360 --> 00:38:25,640
Let me just get through the dosages of some aglutide and then we'll talk about

631
00:38:25,640 --> 00:38:26,640
those adverse effects.

632
00:38:28,160 --> 00:38:30,840
As Joshua mentioned earlier, the dose.

633
00:38:30,840 --> 00:38:38,280
So ozempic is not FDA approved for weight loss, but so its doses are, you know,

634
00:38:38,280 --> 00:38:39,880
for type two diabetes.

635
00:38:39,880 --> 00:38:43,760
But there have been clinical trials that have used ozempic and weight loss, and

636
00:38:43,760 --> 00:38:49,360
they've shown improvement in weight loss compared to placebo with doses anywhere

637
00:38:49,360 --> 00:38:55,080
from 0.5 milligrams, that's the lower end, to 1.6 milligrams subcutaneously weekly.

638
00:38:55,080 --> 00:38:58,880
Ozempic or some aglutide is dosed weekly, as Joshua alluded to, because of the way

639
00:38:58,880 --> 00:39:00,080
the molecule was created.

640
00:39:01,200 --> 00:39:06,200
So, Wigovie, the difference between Wigovie and ozempic are that the dosages

641
00:39:06,200 --> 00:39:09,840
in the dosage forms are a little bit higher in Wigovie.

642
00:39:09,840 --> 00:39:15,920
So you start out, and this, although you titrate with a dose of 0.25 milligrams

643
00:39:15,920 --> 00:39:20,640
in the first week, actually for the first four weeks, you titrate it in 0.25

644
00:39:20,640 --> 00:39:26,360
milligram increments over a 16 week time period.

645
00:39:26,360 --> 00:39:32,360
You're targeting, you want to get to a dose of 1.7 to 2.4 milligrams on a weekly basis.

646
00:39:32,360 --> 00:39:37,720
So, in the clinical trials that have compared some aglutide to placebo or to

647
00:39:37,720 --> 00:39:44,760
other GLP-1 receptor agonists, primarily liraglutide, have shown that some

648
00:39:44,760 --> 00:39:50,120
aglutide is the most effective weight loss agent that we have on the market to date.

649
00:39:50,120 --> 00:39:55,000
You can lose about 14, almost 15% of your body weight with it.

650
00:39:55,000 --> 00:39:56,600
So that's about 34 pounds.

651
00:39:56,600 --> 00:39:58,080
That's just wild.

652
00:39:58,080 --> 00:39:59,720
That's a 68 week treatment.

653
00:39:59,720 --> 00:40:03,080
And that means, and again, remember, we're talking about in addition to changes

654
00:40:03,080 --> 00:40:04,400
in your diet and exercise.

655
00:40:04,400 --> 00:40:06,400
Yeah, we always say this is compared to placebo.

656
00:40:06,400 --> 00:40:08,680
So people were still getting injected.

657
00:40:08,680 --> 00:40:13,480
They thought that they were getting this drug, but they were just getting a placebo.

658
00:40:13,480 --> 00:40:13,840
Right.

659
00:40:13,840 --> 00:40:19,320
And then compared to the people who actually got the some aglutide, I mean, a 15 point,

660
00:40:19,320 --> 00:40:20,640
what was the percentage?

661
00:40:20,640 --> 00:40:22,680
It was 15%, almost 15%.

662
00:40:22,680 --> 00:40:23,160
Amazing.

663
00:40:23,160 --> 00:40:25,280
So 35 pounds, you know, and stuff.

664
00:40:25,280 --> 00:40:32,360
So, but in addition, it also, some aglutide also provides significant improvements in

665
00:40:32,360 --> 00:40:37,440
your blood pressure as well as your cholesterol readings as well.

666
00:40:37,440 --> 00:40:40,240
And so, again, it has a mechanism.

667
00:40:40,240 --> 00:40:51,520
See, these GLP-1 receptor agonists have mechanisms that help with controlling blood glucose and

668
00:40:51,520 --> 00:40:54,480
also some mechanisms that help with controlling weight.

669
00:40:54,480 --> 00:40:58,360
But they also have some mechanisms that improve cardiovascular outcomes.

670
00:40:58,360 --> 00:41:08,360
They reduce inflammation in your system that contribute to cardiovascular, adverse cardiovascular

671
00:41:08,360 --> 00:41:12,160
outcomes and some other things as well, too, lowering cholesterol as well, too, which also

672
00:41:12,160 --> 00:41:19,120
has a negative impact on your, like, causing clogged arteries and things like that.

673
00:41:19,120 --> 00:41:23,920
So lowering your blood pressure, all these things help you to have healthier outcomes

674
00:41:23,920 --> 00:41:25,760
and stuff.

675
00:41:25,760 --> 00:41:31,880
But there are more GI adverse events with some aglutide versus placebo.

676
00:41:31,880 --> 00:41:36,160
And some of the studies, they've averaged, there were more GI, there were about 50 to

677
00:41:36,160 --> 00:41:40,400
60 percent of patients had GI adverse events with some aglutide versus 10 percent with

678
00:41:40,400 --> 00:41:41,800
placebo.

679
00:41:41,800 --> 00:41:46,320
And three to four percent of patients would discontinue some aglutide treatment.

680
00:41:46,320 --> 00:41:53,240
But some aglutide has been shown to be greater than loraglutide in lowering weight much more

681
00:41:53,240 --> 00:41:54,240
significantly.

682
00:41:54,240 --> 00:42:03,220
I believe the change in weight from baseline, so the start level when you started the study,

683
00:42:03,220 --> 00:42:08,920
there was a change in weight of about 15.8 percent with some aglutide versus about 6.4

684
00:42:08,920 --> 00:42:10,200
percent with loraglutide.

685
00:42:10,200 --> 00:42:13,800
So it was almost twice.

686
00:42:13,800 --> 00:42:19,000
So let me just mention these adverse effects that are associated with GLP-1 receptor agonists

687
00:42:19,000 --> 00:42:22,800
because they have to do with the mechanism of the medication.

688
00:42:22,800 --> 00:42:29,040
Remember I talked about the fact that it lowers, it slows gastric emptying and causes, like,

689
00:42:29,040 --> 00:42:32,240
satiety or, you know, lowers your appetite and stuff.

690
00:42:32,240 --> 00:42:40,200
And so because it does the slower gastric emptying, so it, and because the GLP-1 receptors

691
00:42:40,200 --> 00:42:46,400
in your brain affect your appetite, it can cause nausea, vomiting, constipation, and

692
00:42:46,400 --> 00:42:47,400
diarrhea.

693
00:42:47,400 --> 00:42:55,720
And there can be some, you know, in kind of the package inserts, the kind of the conglomerate

694
00:42:55,720 --> 00:43:01,080
of information as far as percentages that these things are seen in is that you can see

695
00:43:01,080 --> 00:43:06,400
about 39 percent nausea in sexinda, which is loraglutide.

696
00:43:06,400 --> 00:43:12,000
You can see about 44 percent incidence of nausea with Wigovie.

697
00:43:12,000 --> 00:43:16,880
With Ozempic, the data that I could find, it was between 15 and 20, but those were lower

698
00:43:16,880 --> 00:43:21,520
doses of Ozempic than the higher doses of Wigovie.

699
00:43:21,520 --> 00:43:27,200
Diarrhea the same, it's 20 to 30 percent with sexinda and Wigovie versus 8 to 9 percent

700
00:43:27,200 --> 00:43:29,200
with Ozempic.

701
00:43:29,200 --> 00:43:36,160
Constipation, 19 to 24 percent vomiting, 15 to 24 percent with sexinda and Wigovie.

702
00:43:36,160 --> 00:43:41,040
So these GI adverse effects can be problematic for patients.

703
00:43:41,040 --> 00:43:48,160
I have known a couple of people that have tried to take Ozempic for either type 2 diabetes

704
00:43:48,160 --> 00:43:52,720
or for weight loss associated with diabetes, type 2 diabetes, and they can't tolerate it

705
00:43:52,720 --> 00:43:55,200
because it causes too much nausea and vomiting.

706
00:43:55,200 --> 00:43:57,360
So it's patient independent.

707
00:43:57,360 --> 00:44:06,720
Yeah, I wonder, do you think that's due to the dosing or is it due to?

708
00:44:06,720 --> 00:44:08,480
This was at the lowest dose.

709
00:44:08,480 --> 00:44:12,200
I think it's just that everybody's different and they just can't.

710
00:44:12,200 --> 00:44:18,600
You get this signal to your body as far as just nausea and stuff and some people just

711
00:44:18,600 --> 00:44:19,600
can't handle it.

712
00:44:19,600 --> 00:44:22,080
I just wonder if there's a point, I don't know if we have any literature of like if

713
00:44:22,080 --> 00:44:27,680
you push, if people who did experience nausea, if there was a point at which that nausea

714
00:44:27,680 --> 00:44:29,920
stops, you know what I mean?

715
00:44:29,920 --> 00:44:34,520
Because like you said, if your body is changing, that might be that your body's defense.

716
00:44:34,520 --> 00:44:37,240
I don't know if there's any literature.

717
00:44:37,240 --> 00:44:41,600
In some patients that does happen, so they may experience the nausea, but it's tolerable

718
00:44:41,600 --> 00:44:45,640
to begin with and then they develop it.

719
00:44:45,640 --> 00:44:48,880
It's uncomfortable to begin with, but then they develop a tolerance to it and then there's

720
00:44:48,880 --> 00:44:53,320
just that percentage of patients that can't for whatever reason.

721
00:44:53,320 --> 00:45:00,120
Sometimes you might be able to, pharmacists really, and I can't speak for physicians,

722
00:45:00,120 --> 00:45:04,480
but pharmacists really don't like to treat an adverse effect with another medication,

723
00:45:04,480 --> 00:45:09,360
but if you really needed this, there's the potential that you could treat with some anti-nausea

724
00:45:09,360 --> 00:45:14,240
medications and see if you could tolerate these agents, but that's going to be with

725
00:45:14,240 --> 00:45:18,360
your physician just kind of working through that.

726
00:45:18,360 --> 00:45:23,400
So just know that I think one of the reasons that, and there's some physiologic reasons

727
00:45:23,400 --> 00:45:32,320
behind why these agents work to lower weight, but there's also, so due to that mechanism

728
00:45:32,320 --> 00:45:36,640
also is there's some adverse effects that also are contributing to that as well too.

729
00:45:36,640 --> 00:45:40,440
Because if you don't feel like eating, then you're not going to eat and stuff.

730
00:45:40,440 --> 00:45:44,680
So then sometimes that's good and sometimes you still need nutrients in your body as well

731
00:45:44,680 --> 00:45:45,680
too.

732
00:45:45,680 --> 00:45:49,840
Yeah, 100%, but I think a lot of times like you said, I mean your body's going to get

733
00:45:49,840 --> 00:45:55,400
those nutrients from somewhere and they're probably using the glycogen stores and they're

734
00:45:55,400 --> 00:46:00,120
also using the fat stores that are in your adipose tissue.

735
00:46:00,120 --> 00:46:05,400
And I assume, I don't know a lot about this physiology of going from different fuel sources,

736
00:46:05,400 --> 00:46:11,080
but I imagine going from a purely glucose driven fuel source to one that's either driven

737
00:46:11,080 --> 00:46:15,400
by fat or by glycogen probably does feel different in the body.

738
00:46:15,400 --> 00:46:20,920
And I wonder if that transition is part of the reason why people feel this thing.

739
00:46:20,920 --> 00:46:26,680
Because I'm of the firm opinion that a lot of this is due to the fact that a lot of the

740
00:46:26,680 --> 00:46:29,600
calories that you would be eating are not being eaten.

741
00:46:29,600 --> 00:46:35,600
And I think when you look at people who consume an optimal amount of calories, which is the

742
00:46:35,600 --> 00:46:39,720
daily diet, which is like 2000 a day on average.

743
00:46:39,720 --> 00:46:45,400
And if you're used to eating 3500 a day, that is a 1500 calorie difference.

744
00:46:45,400 --> 00:46:50,200
And of course that's going to have massive effects in your body.

745
00:46:50,200 --> 00:46:56,160
And I think it's hard to parse which of these are related to actually taking the drug versus

746
00:46:56,160 --> 00:47:02,760
is the drug preventing you from eating in mass excess that would cause these lowering

747
00:47:02,760 --> 00:47:06,120
of the blood pressure, lowering of blood glucose, et cetera.

748
00:47:06,120 --> 00:47:08,440
And I think it can do that.

749
00:47:08,440 --> 00:47:15,760
I know I, my personal experience is not with Ozempic or with Wigovie, but years ago I took

750
00:47:15,760 --> 00:47:19,600
a medication to help prevent migraine headaches.

751
00:47:19,600 --> 00:47:24,600
And one of its adverse effects was it caused kind of satiety or you know, you've, you know,

752
00:47:24,600 --> 00:47:30,360
not, you know, you loss of appetite and it really did cause a loss of appetite due to

753
00:47:30,360 --> 00:47:34,260
its mechanism and it's neurologically based in your brain.

754
00:47:34,260 --> 00:47:38,120
And so, you know, I lost several pounds and I don't necessarily need to lose several pounds.

755
00:47:38,120 --> 00:47:41,600
But if I took Ozempic, I don't know what would happen to me.

756
00:47:41,600 --> 00:47:48,600
So, you know, so I think there is definitely a physiologic reason behind why people don't

757
00:47:48,600 --> 00:47:51,000
eat as much when they're taking one of these medications.

758
00:47:51,000 --> 00:47:52,840
Yeah, no, I totally agree.

759
00:47:52,840 --> 00:47:57,780
I think what I was pointing to is like some of the positive health outcomes, how much

760
00:47:57,780 --> 00:48:03,320
of what percentage could you give to the drug itself versus these, like, for example, we

761
00:48:03,320 --> 00:48:06,480
always say the exercise is like the fountain of youth, right?

762
00:48:06,480 --> 00:48:09,040
So like running itself isn't good.

763
00:48:09,040 --> 00:48:12,480
It's all the things that running does inside of your body.

764
00:48:12,480 --> 00:48:14,880
And obviously when you're running, you don't have time to eat.

765
00:48:14,880 --> 00:48:15,880
Right.

766
00:48:15,880 --> 00:48:16,880
So it's like, right.

767
00:48:16,880 --> 00:48:17,880
Or you change.

768
00:48:17,880 --> 00:48:19,880
Yeah, you change your, which parts of these things are contributing.

769
00:48:19,880 --> 00:48:23,720
And my guess is that the majority of the benefits from these drugs are the fact that you're

770
00:48:23,720 --> 00:48:27,240
not eating as much as you normally would.

771
00:48:27,240 --> 00:48:32,440
Just because, yeah, when you, when you, especially if you're a person who is overweight or obese,

772
00:48:32,440 --> 00:48:35,880
I could even speak to this myself because I've definitely been in times in my life where

773
00:48:35,880 --> 00:48:39,800
I've been, I've weighed more than I do now.

774
00:48:39,800 --> 00:48:45,120
And when I eat less, for some reason during the pandemic, I ate a lot less and I lost

775
00:48:45,120 --> 00:48:46,120
a lot of weight.

776
00:48:46,120 --> 00:48:48,960
And, and so I just, I just felt better.

777
00:48:48,960 --> 00:48:54,560
I just had better metrics all around and, and I don't even know how it happened.

778
00:48:54,560 --> 00:48:56,120
It just, you know, the pandemic was weird.

779
00:48:56,120 --> 00:48:59,440
I think it was because I slept a lot more and I was just, I didn't have a lot of stress

780
00:48:59,440 --> 00:49:02,680
in my life because I didn't know anything to do.

781
00:49:02,680 --> 00:49:08,600
So there was, there's something really interesting about that when you take away that urge to

782
00:49:08,600 --> 00:49:12,840
eat and that always consuming calories because food is so palatable.

783
00:49:12,840 --> 00:49:13,840
I mean, it's so delicious.

784
00:49:13,840 --> 00:49:16,980
We're about to go have lunch after this and it's going to be great.

785
00:49:16,980 --> 00:49:18,680
So we just don't want to eat too much of it.

786
00:49:18,680 --> 00:49:26,120
Well, and you think about too, when you exercise, you, your body is generating heat and utilizing

787
00:49:26,120 --> 00:49:33,000
calories and, and burning off fat and stuff, so it is going to change your, your,

788
00:49:33,000 --> 00:49:38,440
But the amount that you would have to exercise, like for example, if I went for a run, I might,

789
00:49:38,440 --> 00:49:41,680
let's say a 15 minute run, I might burn 200 calories.

790
00:49:41,680 --> 00:49:44,880
I could get all that back in a chocolate chip cookie.

791
00:49:44,880 --> 00:49:45,880
Absolutely.

792
00:49:45,880 --> 00:49:54,400
So it's, most Americans, I think the recommended exercise is 15 minutes a day for a week.

793
00:49:54,400 --> 00:49:56,400
Most people don't meet those requirements.

794
00:49:56,400 --> 00:50:02,280
So it's like the idea that we're going to beat this epidemic with exercise is, I just

795
00:50:02,280 --> 00:50:03,280
don't think it's ideal.

796
00:50:03,280 --> 00:50:04,280
I mean, it's idealistic.

797
00:50:04,280 --> 00:50:06,040
I would love that.

798
00:50:06,040 --> 00:50:08,440
People have kids, they've got jobs, they've got lives.

799
00:50:08,440 --> 00:50:10,240
Or it gets stinking hot.

800
00:50:10,240 --> 00:50:12,240
And it gets, yeah, here in Texas.

801
00:50:12,240 --> 00:50:15,120
But some people just don't have the time to donate.

802
00:50:15,120 --> 00:50:18,040
There's a lot of these influencers out there who are like, oh, you just got to go to the

803
00:50:18,040 --> 00:50:20,560
gym and these people are in the gym for like an hour or two.

804
00:50:20,560 --> 00:50:25,600
And I was like, these are single people who probably don't have many other responsibilities

805
00:50:25,600 --> 00:50:30,640
other than getting on social media saying you should be more fit and shredded like them.

806
00:50:30,640 --> 00:50:32,300
And it's just not practical.

807
00:50:32,300 --> 00:50:39,120
So this seems to be like a tool more for most people who they've tried everything, they've

808
00:50:39,120 --> 00:50:44,040
tried exercise, but within the limits of their life, they need something more practical.

809
00:50:44,040 --> 00:50:45,040
Right.

810
00:50:45,040 --> 00:50:48,620
And again, remember, we're talking about people that need these medications for weight loss

811
00:50:48,620 --> 00:50:52,900
are going to be those that have tried other mechanisms.

812
00:50:52,900 --> 00:50:56,120
And it's a really serious condition that they've got here.

813
00:50:56,120 --> 00:50:57,120
Right.

814
00:50:57,120 --> 00:50:58,120
I agree.

815
00:50:58,120 --> 00:51:03,280
There are some contraindications for these GLP-1 receptor agonist uses.

816
00:51:03,280 --> 00:51:04,280
What's a contraindication?

817
00:51:04,280 --> 00:51:06,640
Contraindication is that you shouldn't use it.

818
00:51:06,640 --> 00:51:08,320
You shouldn't use it.

819
00:51:08,320 --> 00:51:15,520
So like if you have pancreatitis or pancreatic issues, issues with your pancreas, you shouldn't

820
00:51:15,520 --> 00:51:20,120
take it because that's part of the mechanism of the medication to release insulin from

821
00:51:20,120 --> 00:51:27,120
your pancreas to lower blood glucose and stuff for the diabetes part of it and stuff.

822
00:51:27,120 --> 00:51:30,080
So kidney disease because it gets eliminated by your kidneys.

823
00:51:30,080 --> 00:51:33,080
So if your kidneys aren't working well, then you could increase your side effects from

824
00:51:33,080 --> 00:51:36,840
the medication if you've got to, you know, you won't get rid of it.

825
00:51:36,840 --> 00:51:40,400
If you have type 1 diabetes, these medications are not for that.

826
00:51:40,400 --> 00:51:41,400
So they don't...

827
00:51:41,400 --> 00:51:44,960
Yeah, because type 1, your body literally doesn't have the genetic capability of making

828
00:51:44,960 --> 00:51:45,960
insulin.

829
00:51:45,960 --> 00:51:46,960
Right.

830
00:51:46,960 --> 00:51:48,880
So that whole mechanism is just kaput.

831
00:51:48,880 --> 00:51:51,000
Whereas type 2, it's brought on by behavior.

832
00:51:51,000 --> 00:51:52,800
A lot of different factors, yes.

833
00:51:52,800 --> 00:51:55,880
And you can bring that back with lifestyle and medication.

834
00:51:55,880 --> 00:51:56,880
Right.

835
00:51:56,880 --> 00:52:01,600
If you have diabetes-related retinopathy, that's an eye condition, that's an eye irritant.

836
00:52:01,600 --> 00:52:05,240
And so if you take these drugs they found in some of the clinical studies that it actually

837
00:52:05,240 --> 00:52:09,680
increases the risk of this so that they shouldn't take it.

838
00:52:09,680 --> 00:52:13,640
Every clinical trial, every package institute will tell you that if you're pregnant or breastfeeding,

839
00:52:13,640 --> 00:52:15,400
you can't take it unless it's been proven in it.

840
00:52:15,400 --> 00:52:19,960
And so if you're younger than 18 years of age, although that's not... that really shouldn't

841
00:52:19,960 --> 00:52:23,840
be there because we do have some of these agents that are actually indicated for kids

842
00:52:23,840 --> 00:52:26,080
less than... that are 12 years old and older.

843
00:52:26,080 --> 00:52:27,080
Yeah, I agree.

844
00:52:27,080 --> 00:52:28,080
And then there's...

845
00:52:28,080 --> 00:52:30,880
That will probably change over the next 5 to 10 years.

846
00:52:30,880 --> 00:52:31,880
Right.

847
00:52:31,880 --> 00:52:37,360
And then there are some weird conditions, medullary thyroid cancer and multiple endocrine

848
00:52:37,360 --> 00:52:38,360
neoplasia.

849
00:52:38,360 --> 00:52:42,640
You'll hear those on the... when you listen to the way Govee add on TV, they're just some

850
00:52:42,640 --> 00:52:47,600
weird cancers that if you have those then you shouldn't take these drugs.

851
00:52:47,600 --> 00:52:51,840
So as I was preparing for it to come up here, because I live in New Braunfels and Josh lives

852
00:52:51,840 --> 00:52:52,840
in Austin, Texas.

853
00:52:52,840 --> 00:52:56,920
And so I was thinking about this the other day and I thought, oh yeah, we need to really

854
00:52:56,920 --> 00:53:02,980
talk about what happens if you stop taking a GLP-1 receptor agonist?

855
00:53:02,980 --> 00:53:03,980
What happens to your weight?

856
00:53:03,980 --> 00:53:06,000
Is your weight maintained?

857
00:53:06,000 --> 00:53:07,000
What happens?

858
00:53:07,000 --> 00:53:09,280
And so I looked at that, this a little bit.

859
00:53:09,280 --> 00:53:14,160
And so there have actually been studies that have shown that patients can regain their

860
00:53:14,160 --> 00:53:16,840
weight after they stop the medication.

861
00:53:16,840 --> 00:53:21,160
And again, you think about the mechanism behind the GLP-1 receptor agonist.

862
00:53:21,160 --> 00:53:26,520
And so it hasn't been actually documented clearly why this happens, but that it could

863
00:53:26,520 --> 00:53:29,840
be that you then end up with a hormone imbalance.

864
00:53:29,840 --> 00:53:32,040
Remember, those increments are hormones.

865
00:53:32,040 --> 00:53:37,560
If you're not putting those GLP-1 receptor agonists in there to help kind of mimic that,

866
00:53:37,560 --> 00:53:41,800
then there's an imbalance with those when the drug is discontinued.

867
00:53:41,800 --> 00:53:48,040
Yeah, we should mention like an agonist, that word means that it's a molecule that has an

868
00:53:48,040 --> 00:53:56,040
affinity for a receptor that your body naturally creates a protein or molecule for.

869
00:53:56,040 --> 00:53:59,840
So I think it's 90% similar to the other one.

870
00:53:59,840 --> 00:54:02,480
So that means that it binds really well with this receptor.

871
00:54:02,480 --> 00:54:06,560
So if your body's seeing that this other thing is binding to it, it might just say, hey,

872
00:54:06,560 --> 00:54:10,960
we're not going to make the natural one anymore because like it's already the, your body has

873
00:54:10,960 --> 00:54:12,720
all these feedback loops inside of it.

874
00:54:12,720 --> 00:54:16,160
So this could be a potential mechanism for why that rebound happens.

875
00:54:16,160 --> 00:54:18,160
Why you start gaining weight after you stop.

876
00:54:18,160 --> 00:54:19,160
Absolutely.

877
00:54:19,160 --> 00:54:27,460
It also could be that the cells in your central nervous system or in your brain, they forget

878
00:54:27,460 --> 00:54:33,000
how to regulate weight gain in the absence of these GLP-1 receptor agonists.

879
00:54:33,000 --> 00:54:37,480
So again, they could kick back in and then you've got the whole like, you don't have

880
00:54:37,480 --> 00:54:38,840
fullness anymore.

881
00:54:38,840 --> 00:54:42,000
You increase appetite stimulation and stuff.

882
00:54:42,000 --> 00:54:44,660
And so it could compensate for that.

883
00:54:44,660 --> 00:54:53,200
Or your beta cells in your pancreas could malfunction and they could start, they could

884
00:54:53,200 --> 00:54:58,480
produce, or they could not produce insulin.

885
00:54:58,480 --> 00:55:01,920
So you would increase with more glucose and substance so you could gain weight that way

886
00:55:01,920 --> 00:55:04,240
because it will turn into fat.

887
00:55:04,240 --> 00:55:09,400
Or interest, this was interesting too, your gut microflora can be changed.

888
00:55:09,400 --> 00:55:15,920
Studies have shown that your gut flora or your gut, the bacteria inside, we all have

889
00:55:15,920 --> 00:55:18,180
natural bacteria in our gut.

890
00:55:18,180 --> 00:55:20,080
They do good things for us and stuff.

891
00:55:20,080 --> 00:55:26,080
And so if they, and they've been, it's been shown that these, and that the GLP-1s and

892
00:55:26,080 --> 00:55:34,000
as well our regular gut bacteria can help us to feel full and help us to have blood

893
00:55:34,000 --> 00:55:35,800
glucose is maintained and stuff.

894
00:55:35,800 --> 00:55:42,040
And so if you, and it comes by GLP-1 secretions.

895
00:55:42,040 --> 00:55:46,560
So if the more GLP-1 there is and the more this happens with these gut bacteria, so if

896
00:55:46,560 --> 00:55:50,320
you pull the GLP-1 receptor agonists out there, then they're going to stop doing that as well

897
00:55:50,320 --> 00:55:51,320
too.

898
00:55:51,320 --> 00:55:53,320
None of this has been actually proven.

899
00:55:53,320 --> 00:55:55,740
Yeah, these are just potential.

900
00:55:55,740 --> 00:56:01,960
And I did see one study, it was, forgive me for not exactly remembering all the exact

901
00:56:01,960 --> 00:56:08,200
details, but it was comparing, I believe it was loraglotide and exercise and then both

902
00:56:08,200 --> 00:56:09,880
of them together.

903
00:56:09,880 --> 00:56:13,540
And then you stopped them.

904
00:56:13,540 --> 00:56:19,960
And what the studies showed that was that, I believe it was like that you had more weight

905
00:56:19,960 --> 00:56:29,800
loss maintained with the loraglotide and, but weight gain, I mean, I'm sorry, I think

906
00:56:29,800 --> 00:56:30,800
I said that wrong.

907
00:56:30,800 --> 00:56:32,400
Let me, let me do that again.

908
00:56:32,400 --> 00:56:37,240
So loraglotide and exercise and then loraglotide plus exercise.

909
00:56:37,240 --> 00:56:43,600
And what was shown was that if you exercise, it maintained your weight loss maybe as much

910
00:56:43,600 --> 00:56:48,600
as, well, maybe not as much, but better than loraglotide alone.

911
00:56:48,600 --> 00:56:54,040
I think it was loraglotide and exercise compared to exercise and they did better at maintaining

912
00:56:54,040 --> 00:56:58,360
your weight loss, but you still do gain some weight back after the drug has discontinued.

913
00:56:58,360 --> 00:56:59,360
Yeah.

914
00:56:59,360 --> 00:57:00,360
And I think that makes a lot of sense.

915
00:57:00,360 --> 00:57:05,200
They even did one where they had a cohort study where they put a certain population

916
00:57:05,200 --> 00:57:09,880
on some aglotide and one on placebo and then they switched them mid.

917
00:57:09,880 --> 00:57:13,840
And you just literally see the graph flip where so the people that were losing weight

918
00:57:13,840 --> 00:57:16,920
and they got the placebo, they just gained it right back.

919
00:57:16,920 --> 00:57:21,640
So you, again, I'm, I have an opinion and this is just my opinion, but it's like, if

920
00:57:21,640 --> 00:57:26,080
you don't have those satiety signals being sent anymore, then you're just going to eat

921
00:57:26,080 --> 00:57:27,080
again.

922
00:57:27,080 --> 00:57:31,480
So if you don't have, I kind of view eating kind of like drug addiction.

923
00:57:31,480 --> 00:57:37,640
I mean, food is so good because it releases, I mean, our brains are just designed to have

924
00:57:37,640 --> 00:57:42,480
these dopamine receptors that respond really well to food because it's, dopamine is this

925
00:57:42,480 --> 00:57:48,120
anticipation of reward and reward means that you live because eating food is good for you.

926
00:57:48,120 --> 00:57:54,480
So you, so you're, you're basically your body, your body wants this stuff and you want

927
00:57:54,480 --> 00:57:58,400
this stuff because most of the time food is good, but too much is bad and your body doesn't

928
00:57:58,400 --> 00:58:01,300
know that because it just wants more.

929
00:58:01,300 --> 00:58:09,420
So if you don't have these compensatory mechanisms like exercise or, you know, basically knowing

930
00:58:09,420 --> 00:58:13,480
your buying patterns of like, okay, maybe I should have half as much in my fridges as

931
00:58:13,480 --> 00:58:14,840
I, as I normally do.

932
00:58:14,840 --> 00:58:18,760
Or, and I've talked to some friends, this is all anecdotal evidence, but once they were

933
00:58:18,760 --> 00:58:23,800
on these drugs and then they went off, they still felt their appetite come back, but they're

934
00:58:23,800 --> 00:58:26,780
like, well, I know I can live on less.

935
00:58:26,780 --> 00:58:30,720
Like there's this, like this idea that you need to eat as much as you did.

936
00:58:30,720 --> 00:58:35,240
And then when you have this experience, like, Oh, I was totally fine eating almost nothing.

937
00:58:35,240 --> 00:58:39,360
So obviously you have to live between those extremes.

938
00:58:39,360 --> 00:58:44,560
So for me, I think a lot of this is, I think the common root of a lot of this is just people

939
00:58:44,560 --> 00:58:49,560
who overeat and we can talk about the gut microbiome, but we don't even know what bacterial

940
00:58:49,560 --> 00:58:51,080
species are good or bad.

941
00:58:51,080 --> 00:58:56,600
We know it's good and we know it's bad in some regards, but to tailor make it for us,

942
00:58:56,600 --> 00:58:58,600
we're not, we're not that air.

943
00:58:58,600 --> 00:59:03,680
We just don't even know what species are, you know, are, are good in certain environments.

944
00:59:03,680 --> 00:59:09,240
So I think, I think a lot of this is, is yeah.

945
00:59:09,240 --> 00:59:14,200
Can you get on it very much like you would try to wean somebody off of a narcotic.

946
00:59:14,200 --> 00:59:16,560
Let's just use opioids, for example, with Narcan.

947
00:59:16,560 --> 00:59:21,400
And then you would try to get them into behaviors and having coping strategies so they wouldn't

948
00:59:21,400 --> 00:59:23,280
want to reuse again.

949
00:59:23,280 --> 00:59:24,280
Yeah.

950
00:59:24,280 --> 00:59:29,120
We're just, we're just stimulated by a lot and to have strategies to be able to deal

951
00:59:29,120 --> 00:59:32,320
with that stimulation is tough.

952
00:59:32,320 --> 00:59:37,240
But I think this is such a great tool to help people start that journey.

953
00:59:37,240 --> 00:59:40,960
So I would really like, hopefully over the next five to 10 years, we study people who

954
00:59:40,960 --> 00:59:47,400
maybe go on and off this and which strategy is going to be the best to, I don't want

955
00:59:47,400 --> 00:59:48,400
people to be on this forever.

956
00:59:48,400 --> 00:59:49,400
Right.

957
00:59:49,400 --> 00:59:50,400
And it's very expensive too.

958
00:59:50,400 --> 00:59:51,400
So yeah.

959
00:59:51,400 --> 00:59:57,560
Um, and I, so it's like, what is going to be the best combination of like use versus

960
00:59:57,560 --> 01:00:02,280
behavioral intervention that's going to help people not just keep weight off, but like

961
01:00:02,280 --> 01:00:07,720
you want to encourage people to exercise and, um, because exercise is just such a great

962
01:00:07,720 --> 01:00:11,320
tool to have a better, longer life.

963
01:00:11,320 --> 01:00:15,240
Um, especially when you're later in life, because you just lose a lot of cognitive ability

964
01:00:15,240 --> 01:00:20,440
and when you get older and to be able to exercise really helps stave off a lot of that.

965
01:00:20,440 --> 01:00:23,760
I would just, I would just, um, modify that a little bit.

966
01:00:23,760 --> 01:00:31,080
If, if you are taking a GLP one receptor agonist, not only for weight loss, but for, you know,

967
01:00:31,080 --> 01:00:34,760
improving cardiovascular events or reducing the risk of cardiovascular events, or you've

968
01:00:34,760 --> 01:00:38,920
got type two diabetes, then it will be a lifelong medication, you know, as well.

969
01:00:38,920 --> 01:00:42,520
I mean, unless you need to modify your treatment for other things, but yeah.

970
01:00:42,520 --> 01:00:45,640
So there are some patients that would actually need to take it lifelong and stuff.

971
01:00:45,640 --> 01:00:46,640
So, but yeah.

972
01:00:46,640 --> 01:00:48,600
Well, I'm going to ask your opinion on this.

973
01:00:48,600 --> 01:00:54,880
Um, let's assume that we have an infinite supply of these GOP one agonist.

974
01:00:54,880 --> 01:01:02,160
Do you feel like it would be okay for folks who are not obese or, or have type two diabetes

975
01:01:02,160 --> 01:01:03,960
to use them?

976
01:01:03,960 --> 01:01:12,040
Well, I, um, no, because I mean, well, I guess, let me take that back.

977
01:01:12,040 --> 01:01:16,400
Based on the literature and based on what studies have been done and based on how the

978
01:01:16,400 --> 01:01:20,800
food and drug administration have approved these medications, there's no indication that

979
01:01:20,800 --> 01:01:25,560
they should be used for someone that's not overweight or has obesity.

980
01:01:25,560 --> 01:01:29,640
It's for those three indications, depending on which medication you're looking at either

981
01:01:29,640 --> 01:01:33,900
for unless they need improvement in cardiovascular events.

982
01:01:33,900 --> 01:01:38,120
And there are a few that are approved for that, or you've got type two by diabetes,

983
01:01:38,120 --> 01:01:40,280
or you've got a weight weight issue.

984
01:01:40,280 --> 01:01:45,520
So I don't know why you'd want to take it otherwise, you know, and so I think some people

985
01:01:45,520 --> 01:01:47,440
and I think this gets to prevent weight loss.

986
01:01:47,440 --> 01:01:48,800
I mean, to prevent weight gain.

987
01:01:48,800 --> 01:01:53,280
I would think that's, I think, I think that would be a very expensive and potentially

988
01:01:53,280 --> 01:01:59,280
unpleasant, you know, or uncomfortable way to do that.

989
01:01:59,280 --> 01:02:03,240
I think exercise and modifying food would be a whole lot better, but that's again, just

990
01:02:03,240 --> 01:02:04,520
my personal opinion.

991
01:02:04,520 --> 01:02:05,520
Yeah.

992
01:02:05,520 --> 01:02:11,000
So, so if someone, let's just say that they, they have a poor body image of themselves

993
01:02:11,000 --> 01:02:16,240
and they think that taking this is going to shave off that, that, you know, three to five

994
01:02:16,240 --> 01:02:20,400
pounds that you want to have, so they take this.

995
01:02:20,400 --> 01:02:22,920
So you would say probably not a good idea.

996
01:02:22,920 --> 01:02:28,720
No, I think that they need to, you know, get with some friends or if they need counseling

997
01:02:28,720 --> 01:02:33,720
or whatever, as far as just like, let's get, let's get that, let's get an improvement

998
01:02:33,720 --> 01:02:38,880
in, in, you know, how you're viewing life and how you're viewing, you know, yourself

999
01:02:38,880 --> 01:02:39,880
and stuff.

1000
01:02:39,880 --> 01:02:43,560
And this whole crazy thing of, you know, I mean, not certainly struggle with that as

1001
01:02:43,560 --> 01:02:45,880
far as, you know, oh my gosh, I gained a pound.

1002
01:02:45,880 --> 01:02:46,880
You know, it's like, but it's crazy.

1003
01:02:46,880 --> 01:02:50,120
You know, a couple of pounds, we're going to, you know, fluctuate and stuff and that's

1004
01:02:50,120 --> 01:02:52,480
just the way it is and stuff.

1005
01:02:52,480 --> 01:03:00,200
So, and so we always end our podcast by talking about the common myths or misunderstandings

1006
01:03:00,200 --> 01:03:03,960
associated with the medication that we're talking about.

1007
01:03:03,960 --> 01:03:08,920
So today we're going to talk about the common myths or misunderstandings associated with

1008
01:03:08,920 --> 01:03:12,640
GLP-1 receptor agonists and weight loss.

1009
01:03:12,640 --> 01:03:16,760
First one is that GLP-1s are a new class of drugs and that's not the case.

1010
01:03:16,760 --> 01:03:19,480
They've been around for over 15 years.

1011
01:03:19,480 --> 01:03:22,360
So it's not like it's a new medication.

1012
01:03:22,360 --> 01:03:27,520
It's just that we've kind of narrowed in on this particular aspect of it, of weight loss

1013
01:03:27,520 --> 01:03:29,760
that's been available since the beginning of it.

1014
01:03:29,760 --> 01:03:34,520
Now the second one is that Ozempic is FDA approved for weight loss and hopefully you've

1015
01:03:34,520 --> 01:03:39,680
gotten, you've gotten that, you've gotten, you've figured out or you've been, it's been

1016
01:03:39,680 --> 01:03:44,760
reinforced that Ozempic is not FDA approved for weight loss, but studies have been used

1017
01:03:44,760 --> 01:03:46,960
to show it can be effective for weight loss.

1018
01:03:46,960 --> 01:03:53,280
But Wagovi is the semaglutide form, form that is the FDA approved agent for weight loss.

1019
01:03:53,280 --> 01:03:54,280
Yeah.

1020
01:03:54,280 --> 01:03:58,800
And also just because we've, we've, we've been using it for 15 years, we also have pretty

1021
01:03:58,800 --> 01:04:00,920
good longevity data of that.

1022
01:04:00,920 --> 01:04:02,360
It's relatively safe and effective.

1023
01:04:02,360 --> 01:04:08,400
There's not a lot of long-term consequences are going to be caused by this.

1024
01:04:08,400 --> 01:04:12,720
And then the third one is due to shortages with these medications that people with type

1025
01:04:12,720 --> 01:04:23,120
two diabetes may not have access to Ozempic or loraglutide since, since providers are

1026
01:04:23,120 --> 01:04:24,520
prescribing them for weight loss.

1027
01:04:24,520 --> 01:04:29,760
And it's possible, but because there is that free tracker, it's, I think it's useful in

1028
01:04:29,760 --> 01:04:32,800
helping you find out where these medications are available in your area.

1029
01:04:32,800 --> 01:04:34,920
Might have to take a road trip.

1030
01:04:34,920 --> 01:04:36,200
Might have to take a road trip.

1031
01:04:36,200 --> 01:04:38,120
So, or get it shipped to you.

1032
01:04:38,120 --> 01:04:39,120
Yeah.

1033
01:04:39,120 --> 01:04:40,640
That's also true.

1034
01:04:40,640 --> 01:04:45,360
The fourth one is that taking a GLP-1 drug will guarantee significant weight loss.

1035
01:04:45,360 --> 01:04:47,360
And it's not necessarily true.

1036
01:04:47,360 --> 01:04:51,720
Most, most patients will have weight loss associated with these medications, but there

1037
01:04:51,720 --> 01:04:53,880
is a small percentage where it doesn't work.

1038
01:04:53,880 --> 01:04:55,640
So it's patient specific.

1039
01:04:55,640 --> 01:04:58,480
So darn thing with averages, like you want to assume that you're probably going to be

1040
01:04:58,480 --> 01:05:02,880
one of the people in the average, but you could be on either side, you know, either

1041
01:05:02,880 --> 01:05:06,640
with significant weight loss is not a lot or a lot.

1042
01:05:06,640 --> 01:05:08,440
And remember too, it takes time.

1043
01:05:08,440 --> 01:05:11,000
You know, it's not, you're not going to lose 35 pounds in one week.

1044
01:05:11,000 --> 01:05:15,040
You know, it's, it's over usually a year or so that you're looking for this, this,

1045
01:05:15,040 --> 01:05:16,040
this overall weight loss.

1046
01:05:16,040 --> 01:05:18,600
And you have to be consistent with your treatment.

1047
01:05:18,600 --> 01:05:19,600
Absolutely.

1048
01:05:19,600 --> 01:05:20,600
Yeah.

1049
01:05:20,600 --> 01:05:24,920
The next ones are that you don't have to change your diet or exercise.

1050
01:05:24,920 --> 01:05:30,240
And when you're taking a GLP-1 receptor agonist, and that's not true, remember that all of

1051
01:05:30,240 --> 01:05:35,320
these agents were approved in conjunction with a modified or improved diet and improved

1052
01:05:35,320 --> 01:05:36,320
exercise.

1053
01:05:36,320 --> 01:05:37,320
Yeah.

1054
01:05:37,320 --> 01:05:41,680
Even if you look at the placebo arm of these trials, they'll actually show that the people

1055
01:05:41,680 --> 01:05:46,360
who got placebo, they got health and nutrition diet advice.

1056
01:05:46,360 --> 01:05:50,240
And they also, in average, like around two, two and two and a half percent of their body

1057
01:05:50,240 --> 01:05:51,240
weight.

1058
01:05:51,240 --> 01:05:55,000
So even with someone telling them this advice, there's something called the Hawthorne effect,

1059
01:05:55,000 --> 01:05:58,960
which is this idea of like when you're being observed, you behave a lot better.

1060
01:05:58,960 --> 01:06:03,120
I experienced this when I was at home as a kid with my mom.

1061
01:06:03,120 --> 01:06:04,120
Not always.

1062
01:06:04,120 --> 01:06:08,640
I was an angel when she was watching, but then whenever she looked away, yeah.

1063
01:06:08,640 --> 01:06:15,360
So there's this idea of like being monitored really helps you do better behaviors.

1064
01:06:15,360 --> 01:06:20,560
So obviously we did that in both groups, but the drug was much more powerful.

1065
01:06:20,560 --> 01:06:23,120
But this idea that, yeah, actually it does have an effect.

1066
01:06:23,120 --> 01:06:26,600
It's definitely not as pronounced, but it does help.

1067
01:06:26,600 --> 01:06:28,000
Yes.

1068
01:06:28,000 --> 01:06:32,800
The next one is that the side effects to GLP-1 receptor agonists are either unbearable or

1069
01:06:32,800 --> 01:06:34,720
no big deal.

1070
01:06:34,720 --> 01:06:39,880
And there's no way to put a label on that and the impact that the medication is going

1071
01:06:39,880 --> 01:06:41,360
to have on every patient.

1072
01:06:41,360 --> 01:06:42,360
Everybody's different.

1073
01:06:42,360 --> 01:06:46,320
So some people are not going to be able to tolerate it, even with modifications in dosage

1074
01:06:46,320 --> 01:06:47,320
or slower titration.

1075
01:06:47,320 --> 01:06:50,040
And some people are going to breeze through it and have no problems.

1076
01:06:50,040 --> 01:06:53,000
So it's patient specific.

1077
01:06:53,000 --> 01:06:57,840
The next one, and Joshua alluded to this earlier in our conversation about using compounded

1078
01:06:57,840 --> 01:07:04,120
forms of GLP-1 receptor agonists and that they're just as safe as brand name medications.

1079
01:07:04,120 --> 01:07:07,920
And that is not necessarily true.

1080
01:07:07,920 --> 01:07:11,880
Remember the brand name medications are Food and Drug Administration approved.

1081
01:07:11,880 --> 01:07:16,080
And when you have a drug that's approved by the FDA, that means they've gone through rigorous

1082
01:07:16,080 --> 01:07:18,080
trials.

1083
01:07:18,080 --> 01:07:21,000
They've looked at safety as well as efficacy.

1084
01:07:21,000 --> 01:07:25,920
That's why it costs millions of dollars to get a medication approved because they've

1085
01:07:25,920 --> 01:07:28,160
got all these trials that they have to do.

1086
01:07:28,160 --> 01:07:35,320
So compounded drugs don't go through that same rigorous evaluation strategy.

1087
01:07:35,320 --> 01:07:43,040
And so a compounded medication may have either more drug in it than is labeled.

1088
01:07:43,040 --> 01:07:47,720
It could have less drug in it, way less drug in it, no drug in it.

1089
01:07:47,720 --> 01:07:48,720
You don't know.

1090
01:07:48,720 --> 01:07:52,540
And the other thing too is that you could get a different amount every time you get

1091
01:07:52,540 --> 01:08:00,160
a compounded medication because FDA approved medications are created and manufactured so

1092
01:08:00,160 --> 01:08:05,440
that they are pretty much the same, plus or minus 10%, the same amount of medication in

1093
01:08:05,440 --> 01:08:06,440
every dose.

1094
01:08:06,440 --> 01:08:10,360
And that's not the same thing with compounded medications.

1095
01:08:10,360 --> 01:08:15,640
So if you get a compounded GLP-1 receptor agonist, you could get really sick with one

1096
01:08:15,640 --> 01:08:17,400
dose and not so much with another.

1097
01:08:17,400 --> 01:08:22,200
Or you could see some good effects one week and not so much depending on how much drug

1098
01:08:22,200 --> 01:08:23,200
is in the medication.

1099
01:08:23,200 --> 01:08:25,240
So yeah, that's such a good point.

1100
01:08:25,240 --> 01:08:30,840
I mean, not to incriminate anybody, but anyone who's ever bought an illegal substance, whether

1101
01:08:30,840 --> 01:08:38,200
it be marijuana or mushrooms or cocaine, the danger in all of those is that you don't know

1102
01:08:38,200 --> 01:08:39,560
where they're coming from.

1103
01:08:39,560 --> 01:08:45,320
And as we've seen with the recent opioid epidemic, we have things that are laced with things

1104
01:08:45,320 --> 01:08:46,360
like fentanyl.

1105
01:08:46,360 --> 01:08:50,480
And fentanyl is 50 times more potent than a standard opioid.

1106
01:08:50,480 --> 01:08:55,400
And if you take that thinking that you're going to be taking a standard just, you know,

1107
01:08:55,400 --> 01:08:57,520
Quaalude, then you could die.

1108
01:08:57,520 --> 01:08:58,960
And a lot of people have.

1109
01:08:58,960 --> 01:09:02,560
So the idea of, I know there are a lot of people who just don't like regulations, but

1110
01:09:02,560 --> 01:09:07,240
regulations are the idea of you have a standard operating procedure so that there's a realm

1111
01:09:07,240 --> 01:09:10,240
of consistency in the product that you're getting.

1112
01:09:10,240 --> 01:09:13,000
And a fun anecdote, there's this great book out there.

1113
01:09:13,000 --> 01:09:18,460
I can't remember the name of the book, but it was basically saying like this author basically

1114
01:09:18,460 --> 01:09:23,980
went throughout the world and said thank you to every person who was a part of the supply

1115
01:09:23,980 --> 01:09:26,280
chain for coffee.

1116
01:09:26,280 --> 01:09:28,980
And you just interact with hundreds of people.

1117
01:09:28,980 --> 01:09:32,280
There's so many people involved in a cup of coffee.

1118
01:09:32,280 --> 01:09:38,120
But one of the things he mentioned was back in the day, coffee, when it was getting popular

1119
01:09:38,120 --> 01:09:43,360
as a alternative to tea and other beverages is that a lot of coffee manufacturers would

1120
01:09:43,360 --> 01:09:48,960
actually stuff the grounds and they would basically fill it with other things.

1121
01:09:48,960 --> 01:09:52,520
So if they were selling you a bag of coffee, be like, oh, we have this amazing coffee,

1122
01:09:52,520 --> 01:09:55,000
but maybe 20% of it was coffee.

1123
01:09:55,000 --> 01:09:59,120
And the other stuff was just like maybe rat hay or rat droppings.

1124
01:09:59,120 --> 01:10:03,880
Like it's this idea, like they do exactly the things that compound pharmacies are doing

1125
01:10:03,880 --> 01:10:04,880
now.

1126
01:10:04,880 --> 01:10:08,040
They'll just fill it with other things and they'll call it the standard thing because

1127
01:10:08,040 --> 01:10:09,040
they're not being regulated.

1128
01:10:09,040 --> 01:10:14,320
They're there to make a profit and also undercut the price against the competition.

1129
01:10:14,320 --> 01:10:17,520
And if there's no one there to say, hey, you're actually selling me a bogus product, and there

1130
01:10:17,520 --> 01:10:24,400
are compound pharmacies out there that do operate under the FDA procedure, but it's

1131
01:10:24,400 --> 01:10:29,300
technically not legal to do that outside of a prescription.

1132
01:10:29,300 --> 01:10:33,620
So you just have to be mindful of that when you're taking, if you're buying drugs from

1133
01:10:33,620 --> 01:10:35,120
a compound pharmacy.

1134
01:10:35,120 --> 01:10:36,120
Right.

1135
01:10:36,120 --> 01:10:41,080
The next one is that your insurance is going to cover the cost of your GLP-1 receptor agonist

1136
01:10:41,080 --> 01:10:43,600
if you are a prime candidate to receive that.

1137
01:10:43,600 --> 01:10:45,560
And that's not necessarily the case.

1138
01:10:45,560 --> 01:10:50,720
We talked about the fact that Medicaid and Medicare patients, they don't cover, Medicaid

1139
01:10:50,720 --> 01:10:53,280
and Medicare don't cover these for weight loss.

1140
01:10:53,280 --> 01:10:57,120
And then it just depends on your insurance as to how good it is as to whether or not

1141
01:10:57,120 --> 01:11:02,160
they'll cover this, especially for an off-label use.

1142
01:11:02,160 --> 01:11:07,560
Another myth is that all GLP-1 medications are the same, and we've shown that that's

1143
01:11:07,560 --> 01:11:08,560
not the case.

1144
01:11:08,560 --> 01:11:11,600
They're similar, but they're not identical.

1145
01:11:11,600 --> 01:11:17,260
The next one is that, and Josh alluded to this by the fact that these agents have been

1146
01:11:17,260 --> 01:11:20,280
around for a long time, these GLP-1 receptor agonists.

1147
01:11:20,280 --> 01:11:26,840
There used to be some anti-obesity medications that caused severe cardiac problems.

1148
01:11:26,840 --> 01:11:29,880
They were Redux and FenFen.

1149
01:11:29,880 --> 01:11:34,880
They were from, I think the 1990s, I think.

1150
01:11:34,880 --> 01:11:39,640
And those are stimulants, and so they would cause things that go along with the stimulant

1151
01:11:39,640 --> 01:11:47,120
as far as heart racing and myocardial infarction and stuff because of just that stimulant effect

1152
01:11:47,120 --> 01:11:49,240
that stimulants have on the heart.

1153
01:11:49,240 --> 01:11:52,280
But that's not been the case with GLP-1 receptor agonists.

1154
01:11:52,280 --> 01:11:56,120
They have been around and they've not shown any life-threatening events.

1155
01:11:56,120 --> 01:12:00,000
There has been some, the thing that has been noted primarily with the heart is there can

1156
01:12:00,000 --> 01:12:05,080
be some increases in your heart rate, but not the significant adverse events that we're

1157
01:12:05,080 --> 01:12:07,600
seeing with those agents from the past.

1158
01:12:07,600 --> 01:12:15,320
And the last one is that sometimes people will receive bariatric surgery for being obese.

1159
01:12:15,320 --> 01:12:20,360
You know, that's your gastric stapling, those types of surgeries and stuff that help to

1160
01:12:20,360 --> 01:12:27,200
also provide satiety by, you know, limiting what goes into your stomach.

1161
01:12:27,200 --> 01:12:30,960
And so if you have that surgery, it talks about that you might not need medications

1162
01:12:30,960 --> 01:12:33,560
to maintain weight loss, and that's not necessarily the case.

1163
01:12:33,560 --> 01:12:40,040
It may be that bariatric surgery is done in conjunction with other things as well, too.

1164
01:12:40,040 --> 01:12:47,680
So to wrap it up, we've seen that semaglutide and loraglutide are effective in weight loss

1165
01:12:47,680 --> 01:12:52,760
in addition to being agents that help to control blood glucose and type 2 diabetes mellitus

1166
01:12:52,760 --> 01:12:55,720
with semaglutide having greater efficacy.

1167
01:12:55,720 --> 01:12:57,600
They're not for short-term weight loss.

1168
01:12:57,600 --> 01:13:00,320
That's not what they're approved for use for.

1169
01:13:00,320 --> 01:13:01,320
This is long-term.

1170
01:13:01,320 --> 01:13:04,440
This is over a long haul, you know, because it took a long time to get here.

1171
01:13:04,440 --> 01:13:09,600
It's going to take a long time to manage this, and it's just something that needs to, you

1172
01:13:09,600 --> 01:13:14,400
need a new paradigm shift in how to manage your weight, and this is one way to help get

1173
01:13:14,400 --> 01:13:16,400
that done.

1174
01:13:16,400 --> 01:13:21,840
It's not, these agents are not without adverse effects, and they are to be used in combination

1175
01:13:21,840 --> 01:13:24,320
with lifestyle modifications.

1176
01:13:24,320 --> 01:13:26,440
They are expensive.

1177
01:13:26,440 --> 01:13:30,200
And there are other medications that are available to help with obesity that are not quite as

1178
01:13:30,200 --> 01:13:31,200
pricey.

1179
01:13:31,200 --> 01:13:33,960
They may not be quite as effective, but there are some other agents that are available as

1180
01:13:33,960 --> 01:13:34,960
well.

1181
01:13:34,960 --> 01:13:39,760
And not everyone is going to need a GLP-1 receptor agonist to manage obesity as well,

1182
01:13:39,760 --> 01:13:40,760
too.

1183
01:13:40,760 --> 01:13:50,120
Yeah, I mean, this is such a great comprehensive overview of these agonists.

1184
01:13:50,120 --> 01:13:58,720
I mean, I just, I'm so, this makes me so hopeful because we've just seen obesity rates, not

1185
01:13:58,720 --> 01:14:04,320
just in America, but across the world, really skyrocket.

1186
01:14:04,320 --> 01:14:09,920
And to have a tool like this that could potentially help people, I just think is really powerful.

1187
01:14:09,920 --> 01:14:18,920
So, I mean, if you told me, like imagine if I was 300 pounds, and you said for $15,000,

1188
01:14:18,920 --> 01:14:26,200
you could lose potentially 10 to 20% of my weight in a year.

1189
01:14:26,200 --> 01:14:31,080
I don't know, that sounds like a decent price to pay, but of course, everybody's different,

1190
01:14:31,080 --> 01:14:32,440
especially people who are poor.

1191
01:14:32,440 --> 01:14:33,920
They probably can't pay for that.

1192
01:14:33,920 --> 01:14:34,920
Right.

1193
01:14:34,920 --> 01:14:42,440
And I think also as citizens of this country, it's like, should we pay for that now?

1194
01:14:42,440 --> 01:14:45,520
Like we're talking about for Medicaid, right?

1195
01:14:45,520 --> 01:14:47,800
Yeah, Medicaid, Medicare.

1196
01:14:47,800 --> 01:14:50,960
Yeah, Medicaid's for people of the lower social economic.

1197
01:14:50,960 --> 01:14:52,240
And Medicare is for older people.

1198
01:14:52,240 --> 01:15:00,080
So for, it almost just seems like that would be a great low-hanging fruit to help people

1199
01:15:00,080 --> 01:15:04,100
in that status.

1200
01:15:04,100 --> 01:15:08,960
Even if you don't help all obese people, like if you just help people who are poor who have

1201
01:15:08,960 --> 01:15:11,120
this condition, I just don't know.

1202
01:15:11,120 --> 01:15:12,720
I mean, that would be relatively expensive.

1203
01:15:12,720 --> 01:15:13,720
Right.

1204
01:15:13,720 --> 01:15:14,720
And then where's the money going to come from?

1205
01:15:14,720 --> 01:15:19,840
And which part of the pie from the governmental funds are we going to take it from?

1206
01:15:19,840 --> 01:15:22,160
And it's just one of the, it's just complex.

1207
01:15:22,160 --> 01:15:23,160
Right.

1208
01:15:23,160 --> 01:15:25,640
But if you're, I think that you just have to make sure the math works out.

1209
01:15:25,640 --> 01:15:29,800
It's like, if you're already paying for it in the healthcare system, then it's like,

1210
01:15:29,800 --> 01:15:36,640
well, we might as well just pay for it upfront or even pay a little less, you know, to maybe

1211
01:15:36,640 --> 01:15:37,640
offset that.

1212
01:15:37,640 --> 01:15:44,720
Like, I think a similar thing is like, I'm sure we give people statins for blood pressure

1213
01:15:44,720 --> 01:15:45,720
and it's like we-

1214
01:15:45,720 --> 01:15:46,720
For cholesterol.

1215
01:15:46,720 --> 01:15:47,720
For cholesterol.

1216
01:15:47,720 --> 01:15:52,480
And we give that to them because we think it's a good thing to-

1217
01:15:52,480 --> 01:15:54,400
Studies have shown that it's beneficial.

1218
01:15:54,400 --> 01:15:58,120
And we pay for that because it's going to prevent adverse effects in the future.

1219
01:15:58,120 --> 01:16:03,160
So I just think we need to get to a conversation where this, if these drugs turn out to be

1220
01:16:03,160 --> 01:16:08,240
as powerful as they are, which they seem to be, that this seems to be one in our arsenal

1221
01:16:08,240 --> 01:16:11,200
to fight chronic disease.

1222
01:16:11,200 --> 01:16:18,680
But I wanted to ask your opinion about, we were talking a little bit earlier about people

1223
01:16:18,680 --> 01:16:21,000
being overweight.

1224
01:16:21,000 --> 01:16:25,200
And we talked a little bit earlier about people taking it who weren't overweight or weren't

1225
01:16:25,200 --> 01:16:26,920
obese.

1226
01:16:26,920 --> 01:16:33,960
And I wanted to get your opinion on why you think people, if they kind of freak out if

1227
01:16:33,960 --> 01:16:42,000
they gain a pound or if they lose a pound, like where that kind of comes from.

1228
01:16:42,000 --> 01:16:43,080
Is it a cultural thing?

1229
01:16:43,080 --> 01:16:44,920
Is it a gender thing?

1230
01:16:44,920 --> 01:16:50,760
Like, what is the reason why you think that people who seem relatively healthy or relatively

1231
01:16:50,760 --> 01:16:57,520
thin, they would like to take these medications to shave off a couple pounds?

1232
01:16:57,520 --> 01:17:05,840
And I think that with me being in my 60s, I don't hear a lot of 60-ish year olds taking

1233
01:17:05,840 --> 01:17:08,000
this for body image.

1234
01:17:08,000 --> 01:17:10,960
It's going to be more for health reason.

1235
01:17:10,960 --> 01:17:15,120
So you would have to speak more to the 30-ish year old and stuff.

1236
01:17:15,120 --> 01:17:19,840
But I'm thinking from a female perspective, I think it's like what you get fed as far

1237
01:17:19,840 --> 01:17:25,640
as what we look like has gotten drilled into us since we were little girls.

1238
01:17:25,640 --> 01:17:30,520
Or I guess probably middle school, adolescence, that type of thing.

1239
01:17:30,520 --> 01:17:36,920
And being OK with how you look needs to be OK.

1240
01:17:36,920 --> 01:17:40,720
And so those fluctuations, our body weight fluctuates and stuff.

1241
01:17:40,720 --> 01:17:49,280
But just you get like that either through movies or social media or friendships or

1242
01:17:49,280 --> 01:17:57,040
proposed friendships or purported friendships or relationships with guys or whatever, as

1243
01:17:57,040 --> 01:18:00,920
far as just what they tell you as far as how you look or whatever and stuff.

1244
01:18:00,920 --> 01:18:12,120
And so I think that you've got to be OK with who you are and stuff and not let it dictate.

1245
01:18:12,120 --> 01:18:17,140
So much easier for me to say that now in my 60s than when I was in my 20s or 30s and stuff,

1246
01:18:17,140 --> 01:18:22,400
because you get so influenced by who's around you and what the message is being said.

1247
01:18:22,400 --> 01:18:23,520
Well, that's a good point.

1248
01:18:23,520 --> 01:18:28,400
So obviously, we hope that some of these young women and men will be in their 60s one day

1249
01:18:28,400 --> 01:18:30,720
if they're not already.

1250
01:18:30,720 --> 01:18:32,960
So this is some wisdom that you can pass on to them.

1251
01:18:32,960 --> 01:18:38,920
So if you could tell your younger self a little bit of advice, because it seems like what

1252
01:18:38,920 --> 01:18:42,960
you're talking about, there's a way to look at your weight in terms of health and there's

1253
01:18:42,960 --> 01:18:48,200
a way to look at weight in terms of your aesthetics or how you present to other people.

1254
01:18:48,200 --> 01:18:53,200
And it seems like you're saying like actually focusing on your health is so much more important

1255
01:18:53,200 --> 01:18:57,020
than the aesthetics, because the aesthetics is like how people see you.

1256
01:18:57,020 --> 01:19:01,800
And do you want people to only associate you with how you look rather than the content

1257
01:19:01,800 --> 01:19:02,800
of your character?

1258
01:19:02,800 --> 01:19:03,800
Great, I would agree.

1259
01:19:03,800 --> 01:19:04,800
OK.

1260
01:19:04,800 --> 01:19:05,800
And it's you.

1261
01:19:05,800 --> 01:19:09,480
It's like, you know, a few pounds is not going to change your clothing size.

1262
01:19:09,480 --> 01:19:11,240
You know, it's not and stuff.

1263
01:19:11,240 --> 01:19:15,280
But so I'd say that if you had to buy a whole new wardrobe, that could be like a factor

1264
01:19:15,280 --> 01:19:17,920
as far as how much weight you've gained and stuff and all that.

1265
01:19:17,920 --> 01:19:20,000
You know, it's just it's like.

1266
01:19:20,000 --> 01:19:25,280
But I'd say for for the whole, I think it's just a matter of, you know, being OK with

1267
01:19:25,280 --> 01:19:31,040
how you're created, realizing, too, that as you do get older, as the decades pass, you

1268
01:19:31,040 --> 01:19:34,720
know, your body does slow down and burning out burning up fat.

1269
01:19:34,720 --> 01:19:40,800
And you just you either modify how you eat or you get you get used to having a few extra

1270
01:19:40,800 --> 01:19:42,520
pants to carry around, you know, and stuff.

1271
01:19:42,520 --> 01:19:44,520
So yeah, yeah, that's a good point.

1272
01:19:44,520 --> 01:19:46,640
So yeah, yeah, I totally agree.

1273
01:19:46,640 --> 01:19:51,720
I mean, on the younger side, I think, at least for me personally, there's an association

1274
01:19:51,720 --> 01:19:55,400
with like you want life to be a little bit easier.

1275
01:19:55,400 --> 01:20:01,040
So like you just notice that pretty thin people just get more attention and you notice that

1276
01:20:01,040 --> 01:20:07,680
they get maybe more opportunities, doors open for them easier than somebody who's not.

1277
01:20:07,680 --> 01:20:11,840
And to compensate for that, like, for example, I learned to play guitar and sing because

1278
01:20:11,840 --> 01:20:14,960
I was like, well, I have to get girls attention somehow.

1279
01:20:14,960 --> 01:20:18,040
So I can't just be this tall strapping guy.

1280
01:20:18,040 --> 01:20:21,640
So I had to actually was a benefit that I that I didn't do that because I wouldn't

1281
01:20:21,640 --> 01:20:25,600
have had the skill that I have today.

1282
01:20:25,600 --> 01:20:27,480
But I think there is this kind of desire.

1283
01:20:27,480 --> 01:20:32,140
And I think it's a foolish desire to think that life will be better once it's easier.

1284
01:20:32,140 --> 01:20:37,400
And I think when the more the older I get, actually, the more difficult I shouldn't say

1285
01:20:37,400 --> 01:20:40,640
difficult, but the more challenges are the way that you learn.

1286
01:20:40,640 --> 01:20:45,880
You know, you kind of push yourself actually makes life a little more interesting because

1287
01:20:45,880 --> 01:20:50,840
if everything came easy to you, there would be no incentive to learn and to grow and to

1288
01:20:50,840 --> 01:20:56,040
and to be a modified version of yourself because people just give you free stuff just for being

1289
01:20:56,040 --> 01:20:57,040
you.

1290
01:20:57,040 --> 01:21:01,160
So it almost seems like a bit of a curse, even though it's a very alluring curse for

1291
01:21:01,160 --> 01:21:03,800
things to wanting to be easy all the time.

1292
01:21:03,800 --> 01:21:09,080
And I think my generation, probably the generation below me, is growing up with the Internet

1293
01:21:09,080 --> 01:21:11,760
where everything's kind of instantaneous gratification.

1294
01:21:11,760 --> 01:21:17,060
Like you can just if you're pretty, you can just post a picture online and just get strangers

1295
01:21:17,060 --> 01:21:19,060
telling you that you're beautiful.

1296
01:21:19,060 --> 01:21:24,000
And that's going to be intoxicating and scary and scary, especially I imagine as young women

1297
01:21:24,000 --> 01:21:28,920
who they probably want attention from a certain percentage of those admirers, but not for

1298
01:21:28,920 --> 01:21:29,920
most of them.

1299
01:21:29,920 --> 01:21:31,500
I think it's true of most of us.

1300
01:21:31,500 --> 01:21:37,600
So it's this really interesting tightrope of going to like, how much of life do I want

1301
01:21:37,600 --> 01:21:40,520
to be easy versus how much do I want to be challenging?

1302
01:21:40,520 --> 01:21:46,000
I think too, with being overweight or obese, too, if you're able to shed a few pounds

1303
01:21:46,000 --> 01:21:51,400
or if you're able to just keep your weight in a good range, I mean, your mobility is

1304
01:21:51,400 --> 01:21:54,280
improved and just you can breathe better.

1305
01:21:54,280 --> 01:21:58,960
I mean, just just natural things happen versus, you know, getting up and out of a chair is

1306
01:21:58,960 --> 01:22:00,400
going to be easier and stuff.

1307
01:22:00,400 --> 01:22:04,760
And it's I mean, it's like, again, we again, we go back to the fact that obesity is a metabolic

1308
01:22:04,760 --> 01:22:05,760
disease.

1309
01:22:05,760 --> 01:22:07,840
It's not necessarily just a behavioral choice.

1310
01:22:07,840 --> 01:22:14,000
And so it's just a matter of, you know, there are things that you can do to help go in a

1311
01:22:14,000 --> 01:22:15,000
positive direction.

1312
01:22:15,000 --> 01:22:18,040
We've got so many more tools now than we used to have.

1313
01:22:18,040 --> 01:22:19,200
That's a really good point.

1314
01:22:19,200 --> 01:22:20,200
Yeah.

1315
01:22:20,200 --> 01:22:24,200
And then to use those tools to help folks like that have a better quality of life, right,

1316
01:22:24,200 --> 01:22:25,200
which is what life's all about.

1317
01:22:25,200 --> 01:22:26,200
There you go.

1318
01:22:26,200 --> 01:22:27,200
Yeah.

1319
01:22:27,200 --> 01:22:28,200
They can go have lunch with their mom.

1320
01:22:28,200 --> 01:22:29,200
There you go.

1321
01:22:29,200 --> 01:22:30,200
That's right.

1322
01:22:30,200 --> 01:22:36,320
Well, y'all, thank you so much for joining us today on a really interesting and hopefully

1323
01:22:36,320 --> 01:22:39,040
fun topic that you found educational.

1324
01:22:39,040 --> 01:22:41,960
And we'd love your thoughts and what you think about these drugs.

1325
01:22:41,960 --> 01:22:46,200
And if you're even if you're taking them, we'd love your your experience just to hear

1326
01:22:46,200 --> 01:22:51,280
what it's like, because this is definitely a new frontier in terms of medicine.

1327
01:22:51,280 --> 01:22:54,600
So with that being said, my name is Josh Klaus and I'm Jennifer Seltzer.

1328
01:22:54,600 --> 01:22:57,080
And this has been another episode of Your Mom on Drugs.

1329
01:22:57,080 --> 01:23:00,280
See you next time.