Latest / The Body Pod / Obesity, Hormones & GLP-1s: Dr. Spencer Nadolsky on Ozempic, Wegovy, Mounjaro, and Women’s Health

Transcript

Obesity, Hormones & GLP-1s: Dr. Spencer Nadolsky on Ozempic, Wegovy, Mounjaro, and Women’s Health · The Body Pod

0:00
Speaker 1: Hi everyone. My name is Haley and this is Laura
0:02
Speaker 1: and welcome to the body Pod. Welcome back to the
0:13
Speaker 1: body Pod. Today we have the privilege of interviewing doctor
0:16
Speaker 1: Spencer Nigdalski, also known as the Doc who Lifts. He
0:20
Speaker 1: is an obesity and lipid specialist physician and believes lifestyle
0:25
Speaker 1: is medicine. His mission is to help you cut through
0:27
Speaker 1: the noise, ditch the gimmicks, and get the real science
0:31
Speaker 1: back strategies that actually improve your health and your life.
0:35
Speaker 1: He is also the founder of Join Vineyard, which is
0:38
Speaker 1: an online virtual weight management and metabolic health program that
0:43
Speaker 1: offers comprehensive care, including access to GLP one medications and
0:48
Speaker 1: support from a dedicated team of doctors and dietitians. They
0:52
Speaker 1: focus on personalized approach to weight loss, aiming for sustainable
0:56
Speaker 1: results through a combination of medication, life style changes, and
1:01
Speaker 1: ongoing support. Just to be clear with this episode today
1:05
Speaker 1: at the Body Pod, we are no way promoting GLP ones,
1:09
Speaker 1: but simply providing education so that you can make informed choices.
1:14
Speaker 1: Join us for this great discussion with doctor Spencer Nadalski.
1:24
Speaker 1: Doctor Spencer Nadalski, Welcome to the body Pod.
1:28
Speaker 2: Thanks for having me on we are, so we're.
1:31
Speaker 1: Super stoked because this conversation comes up all of the time.
1:35
Speaker 1: So our listeners are all women over the age of
1:38
Speaker 1: thirty five forty and pretty much it's all that I
1:42
Speaker 1: work with in my app and just in the courses
1:45
Speaker 1: that I run. So the GLP one doc here one
1:50
Speaker 1: of the main ones or one of the main ones
1:52
Speaker 1: that we follow. I'm super excited to dive into this
1:57
Speaker 1: subject because I don't I'm sure you know, it's pretty
2:01
Speaker 1: it can be pretty polarizing. Yeah, your instagrams and so this, uh,
2:09
Speaker 1: there's some strong opinions about this. And you know, while
2:14
Speaker 1: we're here and we we have you, I really want
2:17
Speaker 1: to pick your brain and if there's anything female specific,
2:20
Speaker 1: if it differs from you know, anything in the menopause
2:24
Speaker 1: kind of space and that age group, or if it's
2:28
Speaker 1: just the same for all men and women. I'm super
2:31
Speaker 1: curious about that too, as far as treatment and how
2:34
Speaker 1: you approach it. But let's start off with well, I
2:38
Speaker 1: just have to ask you before we dive into that.
2:40
Speaker 1: So you have the doc who lifts podcasts with your
2:43
Speaker 1: brother and he's a physician as well. That's right, Okay,
2:48
Speaker 1: So was your dad a physician because I saw your
2:50
Speaker 1: post or did he take you to the teacher?
2:52
Speaker 2: He was a biology teacher, and my mom was an
2:55
Speaker 2: elementary school teacher. My dad was our wrestling coach. He's
2:59
Speaker 2: also a football coach as well. So we are really
3:01
Speaker 2: big into athletics and academics when we were younger.
3:04
Speaker 1: Yeah, yeah, awesome. And then your little bro just like,
3:08
Speaker 1: did you both know that you wanted to be physicians
3:10
Speaker 1: or that just kind.
3:11
Speaker 2: Of no, just kind of happened. I wanted to be
3:12
Speaker 2: an astronomer. And then when I went to the counselor
3:16
Speaker 2: and freshman year in high school, they're like, they make
3:18
Speaker 2: like thirty thousand dollars a year, and I was like,
3:20
Speaker 2: I'm not going to be all that. My parents as
3:22
Speaker 2: teachers make a little bit more than that. I can't
3:25
Speaker 2: came out Yeah.
3:27
Speaker 1: Well awesome, So okay, I just had to get that
3:30
Speaker 1: off my chest because I was dying to know. So
3:32
Speaker 1: if we look at this world of GLP once and
3:37
Speaker 1: I saw that you posted a few days ago like
3:40
Speaker 1: that that some post about did diet? Did GLP once
3:45
Speaker 1: kill diet and exercise? Let's just start there because it's
3:50
Speaker 1: also you know, I hear about it and people with
3:54
Speaker 1: the strong opinions will say, it's cheating. What's cheating?
3:58
Speaker 2: Yeah?
3:59
Speaker 1: Do you that way?
4:01
Speaker 2: Yeah? I mean, like you think about technology. Is it
4:06
Speaker 2: cheating to use an iPhone instead of a rotary cone?
4:08
Speaker 2: You know? Is it? Is it? You know, is it
4:11
Speaker 2: cheating to you know, if you want to get into
4:14
Speaker 2: the vaccine thing? Is it cheating to prevent a vaccine
4:17
Speaker 2: preventable disease versus going it without one and getting that disease?
4:22
Speaker 2: That type of thing. So, like we use technology and
4:25
Speaker 2: we try to better ourselves and make our lives better
4:27
Speaker 2: in multiple different ways. Is it cheating to use a car,
4:31
Speaker 2: a nice brand new car or versus using a buggy,
4:37
Speaker 2: you know, like with a horse? Is it? Is it
4:40
Speaker 2: cheating to use a jet with nice amenities versus you know,
4:47
Speaker 2: hiking across the country whatever, Oregon trail, getting typhoid, dying
4:53
Speaker 2: in the river, whatever, So favor.
4:57
Speaker 1: Growing up there?
4:58
Speaker 2: Oh yeah, right, you don't be the banker. You'll be
5:02
Speaker 2: the banker. You get all that money, but you're gonna die,
5:05
Speaker 2: not like the poor farmer who figures it out anyway,
5:11
Speaker 2: So it's not cheating, it's it's it's also if you
5:16
Speaker 2: say it's cheating. We're moralizing weight. It's not like it's
5:19
Speaker 2: some sort of competition, you know, where it's like you
5:22
Speaker 2: try to keep it fair because then the competition then
5:25
Speaker 2: if you cheat, you can actually cheat in a competition,
5:28
Speaker 2: you get an unfair advantage that the other person didn't
5:31
Speaker 2: have that isn't allowed. So performance enhancing drugs would be
5:36
Speaker 2: cheating in the context of a competition. Are anabolic steroids cheating, Yeah,
5:43
Speaker 2: in a competition when they're not a use, when they're
5:45
Speaker 2: not supposed to be used, But in general sense, they're not. Really,
5:49
Speaker 2: it's not cheating unless we're moralizing muscle building or something
5:53
Speaker 2: like that. So I don't like it when people say
5:56
Speaker 2: it's cheating. It's just completely negates the idea of this
6:00
Speaker 2: idea of obesity as a chronic disease. Uh, it completely
6:06
Speaker 2: ignores the biological aspects of obesity. It doesn't mean and
6:11
Speaker 2: this is what people say, but it's a calorie deficit.
6:12
Speaker 2: I'm like, yeah, yeah, it's a calorie deficit, but they're
6:15
Speaker 2: biological drivers to push you away from a calorie deficit,
6:18
Speaker 2: eating fewer calories and you burn. So no, it's not
6:21
Speaker 2: it's not cheating. Yeah, that's ug enough myself the soapbox
6:26
Speaker 2: for a second.
6:28
Speaker 1: No, I love that. And when you like, let's go
6:31
Speaker 1: back to that first question of did the GLP one
6:34
Speaker 1: killed diet?
6:35
Speaker 2: Oh yeah, I did it kill it? You know, so
6:37
Speaker 2: like here's the thing it changed. It changed it because
6:40
Speaker 2: here's I mean, you know, I worked at Weight Watchers.
6:44
Speaker 2: They bought my first company, Sequence, which is kind of
6:49
Speaker 2: a way to get access to these medicines. Uh, you
6:52
Speaker 2: see Neom. You see all these other diet companies out there,
6:59
Speaker 2: They're struggling. They're all struggling. And the reason is is
7:03
Speaker 2: because people aren't just gonna sit here and white knuckle
7:08
Speaker 2: and will power their way through diet and exercise anymore.
7:11
Speaker 2: There is a small percentage of people that will be
7:13
Speaker 2: successful doing that alone, but in general, people are kind
7:18
Speaker 2: of fed up with having to kind of white knuckle
7:21
Speaker 2: themselves and feel miserable while trying to lose weight and
7:24
Speaker 2: keep it off. So it doesn't negate it though, because
7:27
Speaker 2: even with the medicines, like, you still need nudges in
7:31
Speaker 2: the direction of optimizing your nutrition. I mean, you don't
7:35
Speaker 2: have to if you want to just take the medicine
7:37
Speaker 2: and just eat fewer calories of whatever you're eating without
7:41
Speaker 2: exercising technique, You can technically do that. I strongly recommend
7:46
Speaker 2: not doing that for optimal purposes, but you could technically
7:50
Speaker 2: do that. So if that's if we're just trying to
7:54
Speaker 2: change the scale and just eat fewer calories and not
7:58
Speaker 2: pay attention to the quality your composition of our diet
8:01
Speaker 2: or physical activity. Yeah, if that's all at the window,
8:05
Speaker 2: then yeah, sure, I guess it killed killed diet and
8:08
Speaker 2: exercise because we're just not gonna we're not going to
8:10
Speaker 2: look at those other things. But I think it more
8:12
Speaker 2: changed it to where like, hey, now you don't have
8:15
Speaker 2: to white knuckle and grin and bear it, and now
8:18
Speaker 2: you can focus on the quality of your lifestyle habits
8:23
Speaker 2: and as opposed to just like grin and bearring being
8:26
Speaker 2: miserable while doing it. So like it changed it. So
8:29
Speaker 2: there's no exercise in a pill or injection. They're trying
8:33
Speaker 2: to make it. By the way, there's new injections. They're
8:37
Speaker 2: combining them with these GP one medicines to basically block
8:42
Speaker 2: one of the governors on our muscle growth called myostatin.
8:45
Speaker 2: And these have been big. This idea concept has been
8:49
Speaker 2: big since the nineties. Once I was in high school.
8:51
Speaker 2: They're trying to figure out supplements to block myostatin, and
8:54
Speaker 2: everybody talked about it. You can see these animals that
8:59
Speaker 2: had their genetics modified to where it blocks their milestat
9:03
Speaker 2: in gene and they're just huge, just jacked animals. Wendy
9:10
Speaker 2: the whip It dog was just this jack dog. You
9:12
Speaker 2: can look up and in Belgium blue as a type
9:14
Speaker 2: of Uh, everybody's seen it. I mean you col probably
9:18
Speaker 2: you've probably seen him. Some people would think that they're fake,
9:22
Speaker 2: but they're they're real. You can modified and some humans
9:25
Speaker 2: probably have some modifications. I always joke about my brother
9:28
Speaker 2: having lacking his milestand because he's short and stocky and
9:33
Speaker 2: just yoked. He works really hard though, but he's always
9:38
Speaker 2: been pretty pretty pretty checked. But anyway, they're trying to
9:41
Speaker 2: they're trying to develop this. It's not but right now
9:45
Speaker 2: we don't have any replacement for exercise. And I always
9:49
Speaker 2: tell people we need to brand exercise differently. My buddy's
9:52
Speaker 2: an OBC doctor Yoni Friedhoff up in Canada. He kind
9:56
Speaker 2: of said this, we need to rebrand exercise. Instead of
9:59
Speaker 2: thinking about it as like a weight loss endeavor, we
10:03
Speaker 2: got to think of it as a cardio respiratory fitness endeavor,
10:06
Speaker 2: a body shaping composition endeavor as opposed to US pounds
10:11
Speaker 2: on the scale endeavor. So they you can't get those
10:17
Speaker 2: things from an injection or pill yet. I mean maybe
10:19
Speaker 2: in the future, maybe maybe we'll see it someday and
10:22
Speaker 2: nobody will have to do anything other than take all
10:25
Speaker 2: a few different injections. It's very it's not completely out
10:28
Speaker 2: of the realm, but.
10:30
Speaker 1: It's not terrifying. I feel like that's wally.
10:33
Speaker 2: It's scary. It's scary to think it's a good thought process.
10:36
Speaker 2: Though it starts getting your mind going, like what like
10:40
Speaker 2: what if we just injected and that's it. I don't know.
10:44
Speaker 2: I enjoy the process of it.
10:45
Speaker 1: Yeah, yeah, So these drugs are not going away. Do
10:50
Speaker 1: you foresee them going away at any point?
10:53
Speaker 2: No, So everybody's been waiting for the other shoe to drop,
10:55
Speaker 2: because what it seems like is like these things will
10:58
Speaker 2: do everything, including doing your dishes and taking your doing
11:02
Speaker 2: your laundry and taking out the trash. Because like it's
11:04
Speaker 2: it's like, okay, how can these drugs be so good
11:08
Speaker 2: at everything? And everybody's waiting, whins the weird cancer going
11:11
Speaker 2: to come out? Win's the weird x y Z side
11:14
Speaker 2: effect coming out. There are a few, you know, you
11:16
Speaker 2: see these case reports, you see some rare things of
11:19
Speaker 2: like different causes of blindness that they're that they're trying
11:23
Speaker 2: to look extremely rare things. Though, in large clinical trials
11:27
Speaker 2: that are randomized against placebo, we see a lot of
11:31
Speaker 2: benefit and these are in thousands of people. When you
11:33
Speaker 2: start putting them on millions of people, you start seeing
11:35
Speaker 2: these rare things like, oh, that's interesting, there are a
11:39
Speaker 2: few more people that got x y Z because we
11:42
Speaker 2: wouldn't have picked it up in the thousands of people
11:44
Speaker 2: randomized trials. You start picking up when millions of people
11:47
Speaker 2: are on them. But in general, benefits are just vastly superior,
11:54
Speaker 2: higher than the risks. So these rugs I don't think
11:58
Speaker 2: are going anywhere that The first one has developed FDA
12:02
Speaker 2: approved in like two thousand and five, called Bayeta, So
12:05
Speaker 2: we've had them for two decades now they are different.
12:07
Speaker 2: Now they're bigger, stronger, bigger, faster, stronger than you want
12:11
Speaker 2: I want to say that. Yeah, So that these things
12:14
Speaker 2: are only going to get better. They're going to find
12:16
Speaker 2: ways to hit the receptors in different ways that may
12:18
Speaker 2: not cause that nausea that you get. So you know,
12:22
Speaker 2: so for anybody listening, the GLP one it's a natural
12:25
Speaker 2: hormone that comes from our own testines. The issue is
12:28
Speaker 2: that we break it down within a minute or two.
12:30
Speaker 2: Our own bodies have enzymes that break it down so quickly.
12:34
Speaker 2: So researchers found ways to modify it. And now we
12:38
Speaker 2: can modify it in ways that it's less longer in
12:42
Speaker 2: our body and maybe hit the receptors that then have
12:46
Speaker 2: downstream effects different than our own human natural GLP one.
12:52
Speaker 2: So what that means is that maybe it maybe it
12:56
Speaker 2: goes down a different stream once it hits that receptor,
12:58
Speaker 2: it gets really complicated. But like essentially it's there. Like
13:02
Speaker 2: you said, they're going to get smarter and better, and
13:06
Speaker 2: then they're going to hit different words, They're going to
13:07
Speaker 2: find all that they're finding all these different things that
13:09
Speaker 2: hit different similar types of receptors that will then have
13:13
Speaker 2: different downstream effects. And you can imagine the permutation se
13:17
Speaker 2: multiple different types of combinations you could come up with.
13:20
Speaker 2: And I I don't take the medicine, but it's possible
13:23
Speaker 2: in the future. I'm taking one. People that don't have
13:26
Speaker 2: much weight to lose one I know a lot of
13:28
Speaker 2: people are doing it now, but I think what we're
13:30
Speaker 2: going to see is all that research on it, and
13:33
Speaker 2: I think in the future, might we might all be
13:35
Speaker 2: taken one.
13:36
Speaker 1: I was just going to ask you that, do you
13:39
Speaker 1: see us all on this like in the future, Well
13:42
Speaker 1: do you?
13:43
Speaker 2: Yeah? Because Okay, So I was going to say, imagine
13:46
Speaker 2: so like because people people get really upset by that
13:48
Speaker 2: idea because they want what we should be just doing
13:52
Speaker 2: diet exercise. I agree we should all be doing diet exercise,
13:54
Speaker 2: but think about the reality is that. Let's imagine you
13:58
Speaker 2: get two parents to struggle their weight, maybe it's genetic whatever,
14:04
Speaker 2: and you see that the kid is they're eighteen twenty
14:08
Speaker 2: years old and they don't have technically that obesity yet,
14:11
Speaker 2: but you can see they're going on that trajectory zoop.
14:14
Speaker 2: You put them on the medicine, you prevent it. All
14:16
Speaker 2: of a sudden. You just prevented obesity and probably prevented
14:20
Speaker 2: heart attacks and strokes and kidney disease and liver disease
14:22
Speaker 2: and every other disease that's related to obesity. We don't
14:27
Speaker 2: use them for prevention yet, but I could totally see that.
14:30
Speaker 2: So that's that's kind of a world, I think, unless
14:33
Speaker 2: another shoe drops and we notice, oh god, yeah, this
14:36
Speaker 2: is another fen fen. But I don't. I would put
14:39
Speaker 2: the farm on it really well.
14:42
Speaker 3: I feel like it would be very powerful for prevention
14:45
Speaker 3: and people who are truly obese how it's changed their life.
14:51
Speaker 3: I mean, I think the strug is incredible. I have
14:54
Speaker 3: a question, do you think that. Do you have a
15:00
Speaker 3: lot of clients that are at their ideal body weight
15:02
Speaker 3: and they're taking it for other benefits? What other benefits
15:06
Speaker 3: do you see people taking the drug for because I
15:11
Speaker 3: know people who are microdosing for the other benefits.
15:18
Speaker 2: Yeah, So my practice mostly revolves around those with an
15:23
Speaker 2: indication of obesity or type two diabetes the FDA indications.
15:28
Speaker 2: Now having said that, those patients when like, I'll take
15:34
Speaker 2: a patient with soriatic arthritis, for example, she's on multiple biologics,
15:40
Speaker 2: different drugs that are out there for her storiatic arthritis.
15:46
Speaker 2: And it wasn't until she started toure Zeppetite, which brand
15:49
Speaker 2: name is zep bound or Manjaro Monjaro's type two diabetes
15:52
Speaker 2: version but set bound for the weight management version, and
15:56
Speaker 2: it wasn't until that where she noticed a large improvement
16:00
Speaker 2: in the storiatic arthritis symptoms, you know, and when you
16:04
Speaker 2: see these and all sorts of autoimmune inflammatory disorder that's
16:08
Speaker 2: with the chrones, all sort of colitis, rheumatoid arthritis, all
16:14
Speaker 2: those different things, I'm seeing the same thing. So I
16:16
Speaker 2: think Big pharm is smart. They want to make but
16:19
Speaker 2: they're making a ton of money right now. They want
16:21
Speaker 2: to make more money, and they're starting to see it.
16:23
Speaker 2: I know they are, because if I'm seeing it, they're
16:26
Speaker 2: definitely getting reports of this, and they are studying these things,
16:29
Speaker 2: and so what they're going to try to do is
16:31
Speaker 2: find all sorts of indications. They want to put everybody
16:33
Speaker 2: in the drug too, so because it's incentivizing to them
16:38
Speaker 2: to make more money and put their drug benefits. So
16:41
Speaker 2: I think that you are seeing Yeah, So I think
16:44
Speaker 2: these anti inflammatory autoimmune types of improvements. We've already seen
16:50
Speaker 2: the cardiovascular disease reduction event reductions in people with a
16:57
Speaker 2: history of type two diabetes and cardiovascular disease, and that
17:01
Speaker 2: is likely separate from the weight loss that occurs from it.
17:04
Speaker 2: So it's a it's a weight It likely has some
17:08
Speaker 2: weight dependent effects for the cardiovascar event reduction, but it's
17:16
Speaker 2: a lot of it's independent, meaning you don't have to
17:18
Speaker 2: lose weight, you'll just protect yourself from a heart attack
17:20
Speaker 2: in the future from taking this medicine. So those types
17:24
Speaker 2: of things I'm obviously addictive, like behaviors. Alcohol cessation is huge.
17:29
Speaker 2: I get a lot of patients that love it for that.
17:32
Speaker 2: They don't even want alcohol anymore, even thinks biting their nails,
17:37
Speaker 2: all sorts of different things.
17:41
Speaker 3: So what about improved cognitive fund.
17:44
Speaker 2: Yeah, not so much. It's not as much. They some
17:47
Speaker 2: people feel anti anxiety properties from it. But I believe
17:51
Speaker 2: the anxiety improvement comes from a lack of worrying about
17:55
Speaker 2: food all day. So people don't think about food all
17:58
Speaker 2: day anymore. That food, it's what everybody talks about, is
18:01
Speaker 2: that it's not a hunger craving issues. It's literally just
18:05
Speaker 2: when am I going to eat? How much is going
18:07
Speaker 2: to be? Is there going to be enough food for
18:09
Speaker 2: me to eat? Then? What is it going to be?
18:11
Speaker 2: It doesn't have to be anything. It could be a
18:13
Speaker 2: healthy food, like a not junk food or anything like that.
18:16
Speaker 2: It could be just any food. So I believe a
18:20
Speaker 2: lot of the anxiety improvement comes from that. All quieting
18:24
Speaker 2: down whether it's a true anxiolytic anxiety reducing effect beyond that,
18:31
Speaker 2: I don't know, but that's we see a lot of that.
18:35
Speaker 2: I do caution though, high doses sometimes we see a
18:39
Speaker 2: dampening of the mood and motivation. So those cognitive effects
18:44
Speaker 2: can actually it can put not like thinking straight, but
18:49
Speaker 2: like motivation wise can be reduced when you get to
18:52
Speaker 2: high doses of tures appetite and some aglutide. I see that.
18:57
Speaker 1: Okay, so I'm going to take a detour really quick.
19:00
Speaker 2: Yeah, detour away.
19:03
Speaker 1: And I know this is this is a very this
19:06
Speaker 1: could come across as very political, but the perfect well
19:10
Speaker 1: let's go, I know what what is like? Is it
19:19
Speaker 1: Is it terrifying that big pharma would have this much control? Yeah,
19:24
Speaker 1: from the big pharma that we know in the United
19:26
Speaker 1: States today.
19:28
Speaker 2: Yeah, I think I think that's that's everybody's concern. That's
19:32
Speaker 2: why they're like, man, you're a big pharma shill. I'm like, yeah, Like,
19:35
Speaker 2: I don't know what to tell you. It's and people
19:39
Speaker 2: are like, oh, they must be in cahoots with big
19:41
Speaker 2: food because in the big food and then you bring
19:43
Speaker 2: in the big farm and then they're all making tons
19:45
Speaker 2: they are making tons of money. It is, it is.
19:50
Speaker 2: It would be concerning that they have that much power,
19:51
Speaker 2: and that's that is the issue, because we want them
19:54
Speaker 2: to be incentivized to come up with these new therapies.
19:56
Speaker 2: But then all of a sudden, it's like you're charging
19:59
Speaker 2: what for these life saving therapies? Like, come on, you
20:01
Speaker 2: guys would be just ridiculously rich. If you lowered the
20:06
Speaker 2: price tenfold, they could make some I mean it was
20:12
Speaker 2: twelve hundred dollars to go to the pharmacy. Now they
20:14
Speaker 2: have this Lily Direct thing. Eli Lilly and Novo Nordice
20:17
Speaker 2: did this too, the two big ones. But twelve hundred
20:20
Speaker 2: dollars at the pharmacy. The net cost is something like
20:24
Speaker 2: six hundred dollars if you don't have the PBM. So
20:26
Speaker 2: then they do this thing called Lily Direct and you
20:28
Speaker 2: can get it for three hundred and forty nine dollars
20:31
Speaker 2: for the lowest dose and then four hundred and ninety
20:33
Speaker 2: nine dollars a month for the other doses. So it's
20:36
Speaker 2: cheaper than twelve hundred dollars.
20:38
Speaker 1: But that's not cheap, No, that's still a lot of
20:40
Speaker 1: money for.
20:41
Speaker 2: Its still out of reach for most people. So you know,
20:45
Speaker 2: they're they're how much it costs them to manufacture. There
20:48
Speaker 2: are reports out there it might be like five to
20:50
Speaker 2: ten dollars a month for them at the most. Of course, Yeah,
20:54
Speaker 2: so you can imagine they could go, all right, why
20:57
Speaker 2: don't we just they can make it ninety nine dollars
21:00
Speaker 2: And that's what you see at other countries, ninety nine
21:01
Speaker 2: bucks for a month, and here we are suckingd wind
21:05
Speaker 2: in the United States. So that is a concern. What
21:09
Speaker 2: I would hope though, is capitalism kicks in, we get
21:13
Speaker 2: these other I mean, there are tons of these things
21:16
Speaker 2: on the horizon. What's funny though, is that you see
21:19
Speaker 2: Lily and Novote they're trying to jump in and buy
21:22
Speaker 2: some of these places out. You kind of see it.
21:25
Speaker 2: But I believe what we're going to see is a
21:27
Speaker 2: few other players jump in. They're going to undercut them,
21:31
Speaker 2: and then everybody's going to have to start lowering their prices.
21:34
Speaker 2: That's what I think. I have to believe that that's
21:36
Speaker 2: how that's how it works. They don't have a monopoly.
21:40
Speaker 2: There's other companies come into play soon because now everybody's like, oh,
21:45
Speaker 2: these things work, let's develop our own.
21:47
Speaker 1: Yeah. Well, if somebody were to come, okay, somebody has
21:52
Speaker 1: has weight to lose, they're ready to go on a
21:55
Speaker 1: GLP one. They can't afford that, can they trust? I mean,
21:59
Speaker 1: I'm sure that they're There's a lot of scammers out
22:01
Speaker 1: there too that are selling products that are GLP one
22:04
Speaker 1: but compounded in a way that maybe it's not even
22:09
Speaker 1: the real thing. I mean, so that's a huge issue
22:11
Speaker 1: as well.
22:12
Speaker 2: Yeah, I don't trust any of those people. I think
22:14
Speaker 2: they're all a bunch of scammers. And like, here's the thing.
22:18
Speaker 2: They're to say that all compounded versions are terrible would
22:21
Speaker 2: be a lie as well. I've I know of a few.
22:25
Speaker 2: There are different types of compounding pharmacies too. You can
22:29
Speaker 2: get mom and pop compounding pharmacy. There's five O three A,
22:33
Speaker 2: and then there's these five oh three bs that can
22:35
Speaker 2: do mass marketing. And some of these five O three
22:38
Speaker 2: b's are even trying to develop their own generic version
22:41
Speaker 2: for future submission to the FDA. So like I would
22:45
Speaker 2: trust those The problem is they were only available during
22:48
Speaker 2: the shortages that made them It made it legal for
22:52
Speaker 2: them to copy the patentent drug. So now the shortages
22:56
Speaker 2: are over, it's not now the five O three A
22:58
Speaker 2: pharmacies who aren't supposed to be doing mass production of
23:02
Speaker 2: the medicines. Uh, they're able to make uh customized versions
23:08
Speaker 2: of them. So if they change the dosing. So instead
23:10
Speaker 2: of let's say we'll take some maglutide, for example, with
23:15
Speaker 2: we go V, you have to go from point to
23:19
Speaker 2: five milligrams and the point five milligrams and you go
23:21
Speaker 2: to one milligram, then you get to one point seven
23:23
Speaker 2: and two point four. So let's say that you don't
23:27
Speaker 2: tolerate the jump from a point five milligrams to the
23:30
Speaker 2: one milligram, So they're going to do a point seventy
23:32
Speaker 2: five milligram custom dose for you. And that's technically allowed,
23:37
Speaker 2: And honestly, I think it's smart. If Novo Nordisk were smart,
23:40
Speaker 2: they would make their they would make it to where
23:43
Speaker 2: which you can do this in other countries on their
23:45
Speaker 2: little pen. In fact, I got my little sample pen
23:48
Speaker 2: here because I'm a big pharmashill allow they allow you
23:53
Speaker 2: to adjust the in between doses and you can actually
23:57
Speaker 2: do it the no zepic pen. This is a sample
23:58
Speaker 2: we govy pen, but in other countries you can other countries.
24:06
Speaker 1: Yeah, yeah, it's everywhere now, right.
24:09
Speaker 2: It's everywhere, everywhere you look. So that's the thing. So
24:13
Speaker 2: these compounding pharmacies, I don't. I don't trust like I
24:17
Speaker 2: always take. Would I send my family? Would I give
24:19
Speaker 2: it to my family member? No? Would I give it
24:22
Speaker 2: to myself? I wouldn't do it?
24:23
Speaker 1: Yeah, I know, how does the consumer know?
24:26
Speaker 2: You wouldn't? You wouldn't. You'd have to go out and
24:28
Speaker 2: test every batch yourself, or you're just gonna You're gonna
24:31
Speaker 2: trust that that place you're getting from is fine, and
24:33
Speaker 2: you see, you'll see a lot of influence. I'm sure
24:35
Speaker 2: there's people listening to this that are definitely taken compounded
24:38
Speaker 2: and they're like that doctor and Adolski's definitely getting paid
24:41
Speaker 2: by big Farmer to say this. I I'm just telling
24:43
Speaker 2: you what I would personally do. If you want to
24:45
Speaker 2: take your risk. There are people getting it on the
24:46
Speaker 2: gray market. I'm sure there's people listening to this who
24:49
Speaker 2: get it from research peptide companies online where I always joke.
24:55
Speaker 2: So I'm in some of these doctor obesity doctor groups
24:58
Speaker 2: on Facebook, and I always talk about bathtub terms churs epetite,
25:04
Speaker 2: So I make a joke about bathtub chursepetite dot com
25:07
Speaker 2: and where you can get your churs appetite, because like
25:12
Speaker 2: because you can go out there and it's you get
25:15
Speaker 2: research grade peptides. Now, some people have tested and they're
25:18
Speaker 2: they're extremely pure at some of these places. But I'm
25:21
Speaker 2: not going to take that chance. If you inject something
25:23
Speaker 2: that not that it isn't pure and isn't done correctly,
25:28
Speaker 2: you can die. So I'm not messing around. But people
25:31
Speaker 2: do that out there, so I would urge not to
25:34
Speaker 2: do that. I do understand the cost is an issue
25:37
Speaker 2: because then what they're they're going to say is like,
25:39
Speaker 2: look at you, you rich doctor. Of course you can
25:43
Speaker 2: afford it. And I get it, Like I understand, I
25:46
Speaker 2: get it, So I understand why people are desperate and
25:48
Speaker 2: wanting to get a more affordable option. So I don't
25:51
Speaker 2: I don't blame them. I would just say, like, just
25:54
Speaker 2: know there's a risk.
25:56
Speaker 1: Well, and maybe some of those those risks that people
25:59
Speaker 1: are like when's this sh you going to drop? Like
26:01
Speaker 1: of all these other issues and diseases are something maybe
26:04
Speaker 1: that comes from the compound that you have no idea
26:07
Speaker 1: if it's.
26:08
Speaker 2: There, that's there, and that's being there. They're rumblings around
26:12
Speaker 2: like what like some of the reporting being done at
26:16
Speaker 2: the FDA about like what I've seen some weird stuff,
26:18
Speaker 2: but you never know that could also you could also
26:20
Speaker 2: have some big Pharma propaganda trying to make it look
26:23
Speaker 2: like some of these places are bad. I get it.
26:26
Speaker 2: There's corruption everywhere. So I'm not going to say that
26:28
Speaker 2: Big Pharma is not corrupt.
26:31
Speaker 3: So you recommend people doing just the name brund is
26:34
Speaker 3: what you're saying, Like just from.
26:36
Speaker 2: The would that would be my advice, the safest that
26:40
Speaker 2: would be my advice. I don't get paid, not yet
26:42
Speaker 2: by big Pharma. I am going to be on an
26:44
Speaker 2: advisory board here soon. I I never took Big pharm
26:48
Speaker 2: of money. But I asked my patients and followers, I'm like,
26:50
Speaker 2: what would you think. They're like, well, your haters will
26:53
Speaker 2: just say, see, you're a big Pharma shill, but we
26:55
Speaker 2: want you to go and try to voice your opinion
26:58
Speaker 2: to try to try to get them the lower So
27:02
Speaker 2: I said, okay, what if I what if I like
27:04
Speaker 2: took that money and donated it. So I was like,
27:06
Speaker 2: all right, I'm running some studies. So basically what I'm
27:08
Speaker 2: going to do is take that money and if people
27:12
Speaker 2: are going through one of my studies and runs out
27:14
Speaker 2: of insurance coverage for the medicine. I will then get
27:17
Speaker 2: them the medicine with that money. So that's what I'm
27:21
Speaker 2: going to do.
27:22
Speaker 1: That's cool. I love that, all right, So I want
27:27
Speaker 1: to shift the conversation. There's nine hundred tabs open in
27:31
Speaker 1: my brain of where I want to go with this.
27:34
Speaker 1: But I really liked the post that you just did
27:37
Speaker 1: with the physician about MHT and how that plays into
27:44
Speaker 1: GLP ones and if taking MHT helps with I don't know,
27:50
Speaker 1: more significant weight loss because this is this is all
27:53
Speaker 1: the depot. The conversation in our world is do you
27:58
Speaker 1: take MHT do you not? And then there's that whole
28:01
Speaker 1: pendulum of women that have gone through this, But now
28:05
Speaker 1: we're adding a GLP one? What do you think?
28:07
Speaker 2: Yeah? So, I mean the issue is the Women's Health
28:09
Speaker 2: Initiative that came out. It really pushed like people not
28:13
Speaker 2: to prescribe it at all. That's that was wrong. And
28:17
Speaker 2: now but we're seeing menopause influencers and I just there
28:20
Speaker 2: shouldn't be like that. Shouldn't there shouldn't be a thing.
28:23
Speaker 2: We should just be like evidence based doctors promoting indicated
28:29
Speaker 2: therapies and going against false information. So women who are
28:35
Speaker 2: struggling and I will never go through menopause. That's the
28:39
Speaker 2: elephant in the room. They're like, you don't understand. You're like, well,
28:42
Speaker 2: I do understand because I have a ton of patients.
28:45
Speaker 2: I have hundreds of women on the stuff, and they've
28:47
Speaker 2: been ignored by their other doctors because they were too
28:50
Speaker 2: scared to do it. It's like, no, it's clearly an
28:52
Speaker 2: indication to use menopausal hormonal therapy to alleviate all the
28:57
Speaker 2: symptoms that occur during menopause. But I do have a
28:59
Speaker 2: lot of women that never had symptoms and they feel
29:01
Speaker 2: great that went through menopause whatever. Lucky them, you know.
29:06
Speaker 2: So then what you see now is that like, in
29:09
Speaker 2: order to promote it even more, even without menopausals, phasomotor
29:13
Speaker 2: symptoms or anything else like that, they're feeling great. It's
29:16
Speaker 2: kind of this big push to like take menopausal hormonal
29:19
Speaker 2: therapy to help you lose weight. And it's like, m
29:22
Speaker 2: I don't it's never been studied like that. There was
29:26
Speaker 2: a retrospective, what we call retrospective, so they looked back
29:29
Speaker 2: at the patient charts and it looked like last year,
29:34
Speaker 2: those who took somemaglutide by itself. People say semi glue tide.
29:39
Speaker 2: It's actually semaglutide. Nobody pronounces it correctly.
29:42
Speaker 1: Now that you're saying it that way, real Campbell says
29:45
Speaker 1: that that way, I'm like I was saying, get wrong guarantee.
29:49
Speaker 2: People are going to say, why should we listen to
29:50
Speaker 2: he's not even pronouncing it right. I'd be like, well,
29:52
Speaker 2: screw you. Uh, I pronounced it correctly. I talked to
29:56
Speaker 2: Nova Nordak. This is how this is how it's pronounced.
29:59
Speaker 1: I think way better though, blue tide.
30:02
Speaker 2: Some magnetide anyway. So they look back at the charts,
30:06
Speaker 2: people are like, why this guy is a real asshole
30:10
Speaker 2: some magnetide. They looked at who took some magnetide by itself,
30:13
Speaker 2: and then they looked at oh, look look at the
30:15
Speaker 2: people that took menopausal hormonal therapy with some magnetide. It
30:20
Speaker 2: looked like the people that took both lost a lot
30:23
Speaker 2: more weight. Now, the thing is, when you look at
30:25
Speaker 2: a retrospective design, they're looking back at just kind of
30:27
Speaker 2: what happened, as opposed to what we'd like to do
30:31
Speaker 2: as a prospect of a design and randomized placebo trial
30:37
Speaker 2: the reason retrospective designs are bad. You can get all
30:41
Speaker 2: these different what's called biases put in, like why did
30:44
Speaker 2: that person get prescribed the menopausal hormonal therapy though, and
30:48
Speaker 2: what what makes them different compared to the people that
30:51
Speaker 2: didn't get prescribed it. There's all sorts of different things.
30:54
Speaker 2: And so that's why you got to do a placebo
30:57
Speaker 2: blinded trial, because then people on a placebo may do
31:01
Speaker 2: just as well. In the study, though it was tiny,
31:05
Speaker 2: it was a small, tiny, tiny, little there were only
31:07
Speaker 2: sixteen people who took the menopausal hormonal therapy with the samagnetide.
31:12
Speaker 2: And so the doctor we had on our podcast, she
31:15
Speaker 2: did an analysis of the surmount trial and that's the
31:19
Speaker 2: one looking at chru zeppetide versus a placebo. And what
31:23
Speaker 2: they did was they looked at the various reproductive phases
31:27
Speaker 2: throughout throughout the women's life, and it looked like no
31:32
Speaker 2: matter what, there wasn't a major difference in how well
31:36
Speaker 2: or how much weight people lost percentage wise throughout the
31:40
Speaker 2: different reproductive phases. So premenopausal, perimenopausal, postmenopausal, and they tried
31:45
Speaker 2: to look at differences. It's hard to look at it
31:47
Speaker 2: like who was on the menopausal hormonal therapy versus who not,
31:51
Speaker 2: who wasn't birth control and all these different things, but
31:55
Speaker 2: it looked like no matter which way you spliced and
31:57
Speaker 2: diced it, there wasn't much of a difference. The thought though,
32:02
Speaker 2: is that maybe estrogen does have this leptin sensitizing maybe effect.
32:07
Speaker 2: So it's because there was maybe a signal in some
32:09
Speaker 2: other studies that postmenopausal women do worse than pre menopausal
32:14
Speaker 2: and we all know, well, I don't know, maybe people
32:16
Speaker 2: don't know, actually women do better than men on these drugs.
32:20
Speaker 2: It's I always make a joke like you know how
32:21
Speaker 2: the meme is where man I I cut out, I
32:25
Speaker 2: only eat basically carrots and lettuce and some chicken all day.
32:29
Speaker 2: My husband cut out looking at French fries and he
32:32
Speaker 2: lost ten pounds and I always I only lost one.
32:35
Speaker 2: You know, have you seen that joke? I mean, everybody
32:37
Speaker 2: talk about how their husband can just do whatever and
32:39
Speaker 2: lose twenty pounds. Of the women's just it's finally the
32:43
Speaker 2: first time it's like, wow, women are they in every
32:47
Speaker 2: aspect there beating men with weight loss with these drugs.
32:50
Speaker 2: And the newer drug were tatritide. Everybody calls it red
32:54
Speaker 2: a true tide attritize right if it's I and unless
33:00
Speaker 2: they change the way it pronounced, because if it follows
33:02
Speaker 2: the same trures epetide, it's some aglutide, liraglutide anyway, that
33:08
Speaker 2: one too. It looks like similar women do better. So
33:12
Speaker 2: the thought is maybe there's something about the estrogen that
33:16
Speaker 2: is sensitizing. No, I'm not going to sit here and
33:19
Speaker 2: say that, Nope, there's no effect. Stop being silly. It's
33:25
Speaker 2: very possible. There's a fact. I always just urge caution
33:28
Speaker 2: in saying like, look, I wouldn't prescribe menopausal hormonal therapy
33:32
Speaker 2: for the very for the only indication of weight loss.
33:36
Speaker 2: Only what I would say, though, if a woman is
33:39
Speaker 2: coming in and clearly has the perimenopausal and menopausal symptoms,
33:45
Speaker 2: unless there's a weird contry, there's some sort of contraindication
33:50
Speaker 2: that is going on, you prescribe them the hormonal the
33:53
Speaker 2: menopausal hormonal therapy regardless. So like, here's what I wouldn't do, though,
33:59
Speaker 2: if if a woman comes in and she's postmenopausal, she
34:03
Speaker 2: stopped having a period a year ago, she's fifty one
34:06
Speaker 2: and wants to go on trus epetitis semagnetide. I wouldn't say,
34:11
Speaker 2: all right, here's your turrus epetite and semaglutide. You don't
34:14
Speaker 2: have any symptoms of menopause, the vasomotor symptoms, nothing, zero,
34:19
Speaker 2: they're feeling great. I wouldn't go, here's also your menopausal
34:22
Speaker 2: hormono therapy to augment it, because there's we basically have
34:26
Speaker 2: very small, retrospective, non randomized, placebo controlled data on it.
34:34
Speaker 2: If they plateaued. Let's say, okay, let's say they're fifty one,
34:37
Speaker 2: they've been on some magnetide trus epetite and they got
34:41
Speaker 2: you know, ten to fifteen percent weight loss. We want
34:43
Speaker 2: them to get twenty. For whatever reason, I wouldn't also
34:46
Speaker 2: put them on menopausal hormonotherapy unless they had those symptoms,
34:51
Speaker 2: because I don't believe that the data is not strong enough.
34:54
Speaker 2: It's possible, though, if they do a randomized trial and
34:57
Speaker 2: the way that I was set up, I'd be I'm
34:58
Speaker 2: going to be really interested. Someone's probably I've told somebody's
35:02
Speaker 2: trying to do this trial. I'm going to be interested
35:04
Speaker 2: in the design because what I wouldn't set it up
35:08
Speaker 2: with you imagine you have two groups of postmenopausal women.
35:12
Speaker 2: Who are both having vasomotor symptoms. Nice, whit's ear to
35:17
Speaker 2: build all the different things, all the terrible things that
35:19
Speaker 2: are going on. You put them both on whatever, pick
35:23
Speaker 2: your poison, turzepetide, and one of them has a turuzepetide
35:27
Speaker 2: plus a placebo, and the other one has a terzepetide
35:30
Speaker 2: plus menopausal hormonotherapy. I wouldn't run it like that that
35:33
Speaker 2: other person that you're confounded, because the people that get
35:37
Speaker 2: the placebo, they're not going to have their vasomotor symptoms improved.
35:41
Speaker 2: So the only way I would do this trial is
35:44
Speaker 2: if you'd have to recruit postmenopausal therapy women or postmenopausal
35:49
Speaker 2: women who don't have any symptoms of menopause, no, no vasomotors, nothing.
35:55
Speaker 2: I think that, and then you got to then you
35:57
Speaker 2: can do a placebo blinded turs epi tide plus menopausal
36:01
Speaker 2: hormonal therapy versus trzepetide anaplacy boat. That's the way that
36:05
Speaker 2: I would run it. I've thought about this a lot
36:07
Speaker 2: over the past few months because I actually think it
36:10
Speaker 2: would be a really cool study because maybe there's an effect.
36:14
Speaker 1: I think it's probably a couple of years out until
36:16
Speaker 1: we have a ton of research about them.
36:19
Speaker 2: Yeah, yeah, because then because the other thing that what
36:21
Speaker 2: people will say is that menopausal hormonal therapy and there's
36:24
Speaker 2: some people saying this it's it can prevent heart attacks
36:28
Speaker 2: and heart disease. Well, there's a suggestion that that could happen.
36:31
Speaker 2: We just can't say that definitively the way that the
36:33
Speaker 2: studies have been so I think, you know, if they
36:37
Speaker 2: want to start making that claim, they get it, you're
36:39
Speaker 2: gonna have to have somebody pay for it. Because is
36:41
Speaker 2: big Pharma gonna pony up the money to pay for
36:44
Speaker 2: that huge trial when you can get these drugs generically,
36:49
Speaker 2: I don't know. I don't think that that's the issue.
36:51
Speaker 2: Someone's got to pay for it too. I do think
36:53
Speaker 2: it should be done though, because it would be really
36:55
Speaker 2: cool to see, well maybe maybe we go back and
36:58
Speaker 2: the pendulum does swing back and everybody should go on
37:01
Speaker 2: metapausal hormonotherapy. But like, we just can't make those claims
37:06
Speaker 2: right now.
37:06
Speaker 1: I think that it's beautiful though, that it gives women
37:09
Speaker 1: because I'm in a different space. Obviously I'm not a physician,
37:13
Speaker 1: but women will come to me and they're just they're
37:16
Speaker 1: at their width end. Like there's all of these changes happening,
37:20
Speaker 1: and they're just like help somebody, help me, just help me.
37:24
Speaker 1: And if you're in the camp that you don't want
37:26
Speaker 1: to take MHT or you're in the camp that you do,
37:30
Speaker 1: it's so refreshing for the women to be like, oh,
37:33
Speaker 1: I don't have to do this if I don't want
37:36
Speaker 1: to go on this, but I do want to take
37:38
Speaker 1: a GLP one great that works for me if I
37:41
Speaker 1: If I do want to take it, and you know
37:44
Speaker 1: whether it changes anything or not, which we don't. It
37:46
Speaker 1: sounds like we don't know at this point. Then they
37:50
Speaker 1: there's options, there's not just like one way, which is
37:53
Speaker 1: usually where the confusion comes when we're streamlining one way
37:57
Speaker 1: only to anything.
38:00
Speaker 2: Yeah, a good physician should be able to have these
38:03
Speaker 2: risk benefit discussions with the patient. The system's kind of
38:10
Speaker 2: broken though. That's why I left the system. I do
38:12
Speaker 2: like a it's I don't call it concierge. It's a
38:14
Speaker 2: direct care model. It's just one hundred and fifty dollars
38:17
Speaker 2: a month. I try to you know, with a dietitian
38:19
Speaker 2: and a strength coach and all the different things. But
38:22
Speaker 2: like a regular model, you get like five to ten
38:24
Speaker 2: minutes with your doctor. You see them every once a
38:26
Speaker 2: year you try to get in. It's every awaiting you know,
38:30
Speaker 2: weight period of three to six months type of thing.
38:32
Speaker 2: So it's really terrible system because women are like I
38:37
Speaker 2: get a ton of women that are like, man, I swear,
38:40
Speaker 2: I'm not going crazy. The doctor wanted to put me
38:42
Speaker 2: on antidepressants, but it's because they didn't have enough time
38:46
Speaker 2: to explain their symptoms. And it was metopause. It was
38:50
Speaker 2: literally metopause. It's like, no, So that's that's the system's broken.
38:54
Speaker 2: I don't I don't know how to fix it. Outher
38:55
Speaker 2: then I just had to leave. So I was like,
38:57
Speaker 2: all right, whatever.
38:59
Speaker 1: But how long have you? And it's called Vineyard, right.
39:02
Speaker 2: Yeah, so this one. So I left the system in
39:04
Speaker 2: twenty sixteen. It was with a few startups Ahead Sequence,
39:09
Speaker 2: which was in bought by weight Watchers. That's more of
39:11
Speaker 2: like a again, you just it's more of just access
39:15
Speaker 2: to the medicine versus now I'm like, no, I want
39:18
Speaker 2: a full spectrum cardio metabolic health program where you can
39:23
Speaker 2: spend time with patients. They get your own dietitian. We
39:27
Speaker 2: have a strength training program. Everything that the person would
39:29
Speaker 2: ever need is in this program. Now like, if you
39:33
Speaker 2: have your good PCP, you don't really need them for
39:35
Speaker 2: much and you see him once or twice a year
39:38
Speaker 2: and it's just like a refills. You may not find
39:40
Speaker 2: as much value out of my program. But if it's
39:43
Speaker 2: like not, I want to. I know when I message in,
39:45
Speaker 2: I want to get a response within a day, and
39:47
Speaker 2: I know it's personalized and if I need a next
39:49
Speaker 2: day appointment or jumping on the call with a doctor,
39:52
Speaker 2: that would be like my program. So I started that
39:55
Speaker 2: in January.
39:57
Speaker 1: Just this year.
39:59
Speaker 2: Yeah, it's going really well. People really like it. Again,
40:02
Speaker 2: if if you don't value having direct access to a
40:05
Speaker 2: doctor and a dietitian and all that stuff and you
40:07
Speaker 2: don't really need much, some people don't find as much value.
40:10
Speaker 2: But if you're like, no, I want to have someone
40:12
Speaker 2: there when I'm having side effects, I want my zofrans
40:15
Speaker 2: sent in that day. I want to I want like,
40:18
Speaker 2: oh I'm having hair loss. We can do some you know,
40:22
Speaker 2: your various testing, and we can put you on monoxid
40:24
Speaker 2: to all these different things to basically personalize your care.
40:30
Speaker 1: Wow. Okay, so let's go back to the obesity, because
40:35
Speaker 1: is this like this sounds like the population that you've
40:38
Speaker 1: spent a large amount of your time working with is
40:42
Speaker 1: there like the obesity gene FTO, and I think there's one,
40:46
Speaker 1: what's the other one m M something MC four.
40:49
Speaker 2: There's a bunch of them, So FTO is a small
40:52
Speaker 2: like is related. There's polygenic obesity where you have multiple
40:58
Speaker 2: genes kind of pushing you in one way. And then
40:59
Speaker 2: there's that's what most people have. Then there's monogenic where
41:03
Speaker 2: you have a mutation in your leptin or your MC
41:07
Speaker 2: four POMC, or you have a few other there's a
41:10
Speaker 2: couple other syndromes that are genetic. Those are the things
41:13
Speaker 2: where it's like the GLP one might actually help a
41:16
Speaker 2: little bit, but you may need some other other therapies
41:21
Speaker 2: like what what would be other? Yeah, there's one called
41:24
Speaker 2: set melanotide in sivery. It's only approved for these what's
41:29
Speaker 2: called monogenic obesity issues. So, and they're upstream in the brain,
41:34
Speaker 2: these these upper order neurons that are related to satiety
41:38
Speaker 2: and energy metabolism. So when if you have like a
41:42
Speaker 2: severe mutation or deletion in one of those, like you,
41:47
Speaker 2: that's where they're young, Like you see these two hundred
41:50
Speaker 2: pounds young, very young kids and they're just voracious appetite.
41:54
Speaker 2: It's likely they have that that's where the parents were getting,
41:58
Speaker 2: you know, accuses of child abuse. And it's only been
42:01
Speaker 2: in the past, you know, a couple of decades where
42:04
Speaker 2: it's like and still even people don't understand it very well.
42:08
Speaker 2: But they're like, oh, yeah, that was genetics. Sorry, so
42:11
Speaker 2: hopefully you're not in jail, you know. Yeah, so those
42:16
Speaker 2: are monogenetic, but like you see, most people have just
42:19
Speaker 2: small little variations in their genes that kind of push
42:23
Speaker 2: them in another direction. And people this is the argument
42:26
Speaker 2: people like because if you look at the studies, actually
42:30
Speaker 2: you can prevent obesity, and people that have not the
42:33
Speaker 2: monogenic but polygenic forms of obesity, you can prevent the
42:39
Speaker 2: weight gain in the first place. And you're like, it's
42:42
Speaker 2: not a destiny. If you have a monogenic you're you're
42:45
Speaker 2: pretty much destined. It's it's almost impossible without treatment to
42:49
Speaker 2: prevent and treat that obesity. But if you have the polygenic,
42:54
Speaker 2: you know, it's not destiny.
42:57
Speaker 1: Okay, So then this is the million dollar quiestquestion that
43:01
Speaker 1: people are going.
43:01
Speaker 2: To ask really and probably.
43:04
Speaker 1: For so for for people women, not women, but just
43:10
Speaker 1: people in general out there that are that have the
43:13
Speaker 1: there they are in the camp. You're eating too much
43:16
Speaker 1: and you're not moving enough, and this is how you've
43:19
Speaker 1: become obese.
43:20
Speaker 2: Yeah, okay, so this is this is why I say,
43:22
Speaker 2: I'm like, sure, it's an energy balanced thing. Even the
43:25
Speaker 2: people with monogenetic obesity, it's an energy balanced thing. So
43:28
Speaker 2: it's it's what's causing the energy imbalanced though. So the
43:34
Speaker 2: people with let's say we'll go back to the monogenic
43:37
Speaker 2: just because it's severe, it's like, okay, they have a
43:40
Speaker 2: gene that is giving them a voracious appetite, like they
43:44
Speaker 2: have to lock the cabinets sometimes when they're younger, they
43:47
Speaker 2: just I mean, I see it. Brothers and sisters, fraternal twins,
43:53
Speaker 2: young kids. You'll see one who's thinner, who will stop
43:56
Speaker 2: at a birthday party, who will stop at like a
43:58
Speaker 2: half of a cupcake, and then the other twin who
44:03
Speaker 2: looks it's like a little bit heavier, eats two cupcakes,
44:07
Speaker 2: maybe three, same same upbringing, same everything else. So clearly
44:12
Speaker 2: there's something going on. So you have certain genes that
44:15
Speaker 2: might push you in a direction in terms of appetite,
44:19
Speaker 2: and that is causing them to eat more. In general,
44:23
Speaker 2: the genetics of obesity are they're in the central nervous system.
44:27
Speaker 2: They're related to appetite. People like to moralize appetites that
44:31
Speaker 2: makes them not feel good. They want it to be
44:32
Speaker 2: their metabolism being lower. But in general it's appetite related.
44:37
Speaker 2: But the other thing is, you can have slower metabolism.
44:40
Speaker 2: Some people have genetics that may and of course nurture
44:45
Speaker 2: comes into this as well. But let's say that nurture
44:48
Speaker 2: doesn't you may have genetics that make you not maybe
44:51
Speaker 2: enjoy physical activity as much. So there's you know, there's
44:54
Speaker 2: little variations there, but a lot of it's appetite related. Now,
44:58
Speaker 2: the other thing that comes into play, why do some
45:01
Speaker 2: people store fat in certain areas versus other people? Unfortunately,
45:06
Speaker 2: some people store fat more around their abdomen versus some
45:09
Speaker 2: people store fat and their button thighs. Actually, storing fat
45:13
Speaker 2: in your button thighs is actually really healthy versus storing
45:18
Speaker 2: their abdomen. And people have heard that the apple versus
45:20
Speaker 2: the pair shape. But that's genetically that's genetically determined. So eating,
45:28
Speaker 2: you know, eating too much, moving too little? Yeah, sure,
45:33
Speaker 2: but what's the what caused that in the first place?
45:39
Speaker 2: And then you know someone that stores their fat in
45:41
Speaker 2: a certain way, like it's going to be hard to
45:44
Speaker 2: modify that, and that's we all have different kind of
45:46
Speaker 2: body shapes and so. And then there's other people. There's
45:50
Speaker 2: some people that walk around in life that don't try
45:53
Speaker 2: at all. They're not trying to. We all see them.
45:56
Speaker 2: They like shit, they don't care about their exercise. They
46:01
Speaker 2: don't care at all, and yet they look great and
46:06
Speaker 2: they don't care. And so it's like, well that's not
46:09
Speaker 2: really fair. And people are like, well they have fast metabolisms.
46:12
Speaker 2: Well no, if you watch them, they eat some crappy food,
46:16
Speaker 2: but that's like all they eat all day, and it's
46:18
Speaker 2: a smaller amount than usual. There can be changes in
46:21
Speaker 2: the differences in the metabolism. Actually, there's some interesting genetics
46:25
Speaker 2: of how much they'll absorb. They may actually poop out
46:28
Speaker 2: more calories, just all sorts of stuff. Yeah, where it's like, oh, man,
46:32
Speaker 2: what the heck. And other people are just like they
46:35
Speaker 2: look at French frise and they gain five pounds in
46:37
Speaker 2: their app theman it's like thinks a lot.
46:40
Speaker 1: I had a friend like that, seriously, the second in
46:43
Speaker 1: high school. She was done eating anything. She was like,
46:46
Speaker 1: well gotta go, And I was like, how many times
46:49
Speaker 1: had they been going but super thin and just like
46:54
Speaker 1: never dieted, never had to worry about what she ate.
46:58
Speaker 1: So is that where appetite dis regulation? Is that what
47:01
Speaker 1: you're meaning? Yeah, what do you mean by that? And
47:03
Speaker 1: can you explain that because most listeners won't know.
47:05
Speaker 2: Yeah, So think think about someone that gets done with
47:09
Speaker 2: their meal, normal sized meal and feels good, doesn't want
47:13
Speaker 2: anything afterwards. Another person they're eating enough for what their
47:18
Speaker 2: activity and body size is, and they want more, and
47:22
Speaker 2: they want more and they want they want high calorie dessert,
47:27
Speaker 2: whatever types of foods afterwards, when it's like no, this
47:30
Speaker 2: person like they should they should be done. The appetite
47:34
Speaker 2: disregulation it's and it's we have our environment. These foods
47:39
Speaker 2: are designed in a way that make us want to
47:44
Speaker 2: eat more, and just trying to figure out exactly what
47:48
Speaker 2: about them makes us eat more, but it doesn't matter.
47:50
Speaker 2: We eat more of them, you know, think about I
47:52
Speaker 2: always talk about like the the think about tortilla chips
47:56
Speaker 2: that elson they're adding a hint of line. They're doing
47:58
Speaker 2: all sorts of things that you get, you got the savor,
48:00
Speaker 2: you got sweet, you got crunchy, salty, fat, and just
48:03
Speaker 2: in perfect combinations to make it, you know, want more.
48:06
Speaker 2: I love that stuff too versus, so we got the
48:09
Speaker 2: environment working against us. Once we gain that weight, though,
48:14
Speaker 2: there can be inflammatory changes, and they've kind of seen
48:18
Speaker 2: this with like functional MRIs and PET scans of the
48:21
Speaker 2: brain to kind of see how it fires and dopamine
48:24
Speaker 2: signals and all these different things. It seems to be
48:26
Speaker 2: those with obesity have more of the develop what looks
48:30
Speaker 2: like dysfunctioned or dysregulation. And we can see it when
48:34
Speaker 2: people like they lose one hundred pounds or whatever, and
48:38
Speaker 2: their appetite just ramps up where it's like, Okay, they
48:42
Speaker 2: lost one hundred pounds. Now they're at a weight that
48:44
Speaker 2: should be healthy for their height, let's say, and their
48:48
Speaker 2: appetite makes them want to eat so much more to
48:51
Speaker 2: where they regain a lot of that weight back, if
48:54
Speaker 2: not more. So that's that's kind of the appetite dysregulation.
48:57
Speaker 2: That's why these medicines work so well. They come and
49:01
Speaker 2: hit the receptors and basic shut off that high appetite level.
49:07
Speaker 2: So yeah, that's the gist.
49:09
Speaker 4: Well, what did you do before you before the GLP ones,
49:13
Speaker 4: because you were a physical practicing physician before that, did
49:16
Speaker 4: you have people come in that really weren't eating a
49:22
Speaker 4: ton and still just could not lose weight, that were
49:26
Speaker 4: at an obese weight and they were not moving the
49:29
Speaker 4: needle with diet and exercise.
49:31
Speaker 2: Yeah, all the time. We have older drugs. There's fentermine,
49:34
Speaker 2: if you've heard of that one. It's a nor edge. Yeah,
49:38
Speaker 2: so fenturmine was the component of fen fen that didn't
49:41
Speaker 2: cause heart valve issues. It was the fen fluramine component
49:44
Speaker 2: that they're like, ah, this thing. It was a serratinergic
49:47
Speaker 2: drug and it hit a receptor on the valves. It
49:50
Speaker 2: doesn't really matter. But fentermine by itself seemed to be safe.
49:54
Speaker 2: But it's an amphetamine, like it's got simp what it
49:57
Speaker 2: called sympathomimetic properties, kind of like an that helped a
50:00
Speaker 2: lot of people, but like you know, the upper component
50:04
Speaker 2: gave a lot of side effects. We had a drug
50:06
Speaker 2: called contrave. They combined buproprin, which is a dopamine nouropinephrine
50:12
Speaker 2: reuptake inhibitor. It helps with depression and smoking cessation. They
50:16
Speaker 2: combine it with now treksone, which is used for an
50:19
Speaker 2: opioid blocker used for alcohol cessation, and they work synergistically
50:23
Speaker 2: in the brain. To help with appetite. It doesn't work
50:25
Speaker 2: that well, but for some did okay. So you know,
50:31
Speaker 2: we had some of these drugs that were okay, and
50:33
Speaker 2: then we had bioatric surgery. So it was it was frustrating.
50:35
Speaker 2: People come in and like, I'm trying really hard, I
50:38
Speaker 2: can't lose the weight. Now, the thing is, everybody will
50:40
Speaker 2: say that they're eating twelve hundred calories. But if they're
50:42
Speaker 2: three hundred pounds and they see they're eating twelve hundred calories,
50:46
Speaker 2: it's not possible. It's literally impossible. But you see, I
50:50
Speaker 2: hear it all the time, and I can't just sit
50:52
Speaker 2: there and say you're a liar, because that's not nice. Yeah, yeah,
50:56
Speaker 2: it's just and it's not helpful. So what I usually say, yeah,
51:00
Speaker 2: I bet you're trying really hard, because I guarantee they
51:02
Speaker 2: are training hard. They have a very what's called a
51:04
Speaker 2: high perceived level of effort, meaning they feel like they're
51:08
Speaker 2: eating twelve hundred calories. It's not possible that they're eating
51:11
Speaker 2: actually twelve hundred calories. They're eating a lot more than that.
51:13
Speaker 2: But so that's why these drugs, they basically make it
51:18
Speaker 2: to where that perceived level of effort just lowers so
51:22
Speaker 2: much to where then all of a sudden they are
51:24
Speaker 2: able to eat that. You know, however many calories. It's
51:27
Speaker 2: not necessarily twelve hundred, but it could be fifteen hundred two. Thought,
51:30
Speaker 2: whatever it is, it is that the reason I love
51:33
Speaker 2: these drugs so much is just finally the patients feel
51:37
Speaker 2: like they have hope, They feel good, they can finally
51:40
Speaker 2: do the things that they always wanted to do and
51:43
Speaker 2: just couldn't and felt like they were gas lit by
51:45
Speaker 2: doctors all the time.
51:46
Speaker 1: Well, I mean, and again just my own little world here.
51:50
Speaker 1: When I have somebody come into a course that's just
51:53
Speaker 1: you know whatever, and I figure out through the numbers
51:58
Speaker 1: that they're obese, I don't want it to be one
52:01
Speaker 1: extra step of them not getting results, Like there's this
52:06
Speaker 1: huge psychological component as well, coming in and having one
52:12
Speaker 1: more failure from not being able to do it. But
52:16
Speaker 1: then these you know, now, in the last couple of
52:18
Speaker 1: courses that I have, there's been a handful or more
52:22
Speaker 1: of women that are on a GLP one and they're like,
52:25
Speaker 1: for the first time, I don't have food noise running
52:28
Speaker 1: through my head, and now I'm motivated to go to
52:31
Speaker 1: the gym and motivated to eat better. Like it kind
52:35
Speaker 1: of comes full circle. Do you see that?
52:37
Speaker 2: Yeah, that's exactly that they finally feel like they can
52:40
Speaker 2: do all those things.
52:41
Speaker 3: That's why I feel like it's not cheating to do it.
52:44
Speaker 3: I think it's a tool in your tool products and
52:46
Speaker 3: if anything, it motivates people to work harder and eat better.
52:51
Speaker 2: Yeah, it takes all that. It helps the mental space
52:56
Speaker 2: that they had that was committed towards just worrying about
52:59
Speaker 2: food and everything to nows and they can focus and
53:01
Speaker 2: get things done.
53:04
Speaker 1: So you would put if you had a family member
53:07
Speaker 1: that was struggling significantly with weight, you would have no
53:12
Speaker 1: problem putting that.
53:13
Speaker 2: Yeah, I have some of them. I try to put
53:15
Speaker 2: them on if they don't listen to me, but I try.
53:18
Speaker 1: If you give it to him for a Christmas present.
53:20
Speaker 2: Shoot them up when they're sleeping. No, I'm kidding obviously,
53:23
Speaker 2: but of course I would only do consent. But no
53:26
Speaker 2: I did. That's a but yeah, yeah, yeah, no, I.
53:30
Speaker 1: Are they all the same?
53:32
Speaker 2: Are all of them? The medicine? No, some magnetide is
53:38
Speaker 2: a GLP one receptor agonist, only to Resteputite is a
53:41
Speaker 2: GLP one which is gone like peptide. Slash g IP
53:46
Speaker 2: GluN uh or glucose uh in glucose dependent insulinotropic polypeptide.
53:53
Speaker 2: It's a mouthful and every time I always have to
53:56
Speaker 2: think about it. But they hit two different receptors. There's
54:00
Speaker 2: gonna be more that hit different receptors. It's going to
54:03
Speaker 2: be quite so.
54:04
Speaker 3: Do you feel like people need to try different ones
54:07
Speaker 3: to see what works best for them?
54:10
Speaker 2: Generally, put people to churs eppetite first because it's better tolerated,
54:14
Speaker 2: works it's stronger, but once in a while they don't
54:17
Speaker 2: tolerate that one. I'll try that we go VI or
54:19
Speaker 2: some magnetide, but a lot of people that are on
54:21
Speaker 2: some magnetide didn't tolerate it, and they actually do better
54:24
Speaker 2: on the terz epetide, So that's my go to in
54:27
Speaker 2: the future. It's going to be interesting because I think
54:29
Speaker 2: we're going to see with the different receptors we're gonna
54:34
Speaker 2: it's it will it'll be more of a of a
54:36
Speaker 2: game of figuring out what people tolerate best.
54:39
Speaker 1: Interesting if we're wrapping this up and really there's sounds
54:45
Speaker 1: like there's a few a small percentage of people that
54:49
Speaker 1: it might not be a good option for and probably
54:52
Speaker 1: for the uh, the side effects that they're experiencing. So
54:57
Speaker 1: there's no contraindications for someone with like a liver, I
55:01
Speaker 1: don't know anything like that.
55:02
Speaker 2: No, the only contriunications can't be pregnant. I mean maybe
55:07
Speaker 2: in the future just put everybody including the baby on it,
55:10
Speaker 2: but not right now. We don't want to do that.
55:13
Speaker 2: Contriunications medullary thyroid cancer. And the reason is is because
55:16
Speaker 2: they saw it in rats. Rats have different receptors on
55:19
Speaker 2: their thyroid C cells. Humans don't have them or don't
55:22
Speaker 2: readily have them, but they saw the signal in rats,
55:26
Speaker 2: so we don't put it on any with a specific
55:29
Speaker 2: It's a rare type of thyroid cancer, medullary thyroid cancer,
55:32
Speaker 2: or something called multiple endocrine neoplasia type two. And the
55:37
Speaker 2: reason is that because it also arises medullary thyroid cancer.
55:42
Speaker 2: Those are like the big contridications reasons you can't take it.
55:46
Speaker 2: People always like, well I had pancreatitis before, Well, if
55:48
Speaker 2: it was just from your gallbladder, you can get gullstone
55:50
Speaker 2: pancreatitis or alcohol or triglyceride induced pancreatitis, not a contraindication.
55:57
Speaker 2: Just some of those things are caution So also breastfeeding,
56:01
Speaker 2: it's not known. A little bit might get in the milk,
56:05
Speaker 2: but if they're if the baby's getting it, orally, it's
56:08
Speaker 2: probably getting broken down. So actually people think that it's
56:11
Speaker 2: probably safe, but on the label of the medicine it's
56:15
Speaker 2: like caution. I tend to be more risk averse, so
56:18
Speaker 2: I don't do it. But it's I think in the
56:21
Speaker 2: future we're probably going to be like, it's probably fine,
56:24
Speaker 2: but I don't personally just yet. I don't want to
56:27
Speaker 2: get sued.
56:29
Speaker 1: Nobody wants to get sued. Okay, So if someone is
56:33
Speaker 1: coming to you because concierge care, there's a lot of
56:36
Speaker 1: physicians now starting to do concierge care for good reason. Yeah,
56:40
Speaker 1: a good reason for everything you say. But I mean
56:44
Speaker 1: that can range up to eight hundred to one thousand
56:48
Speaker 1: dollars a telehealth visit.
56:50
Speaker 2: Yeah some people. Some people charge thirty five hundred and
56:54
Speaker 2: a couple of you know, fifteen hundred dollars or whatever
56:57
Speaker 2: for follow ups for no So I want I want
57:00
Speaker 2: mine to be subscription because I want long lasting relationships
57:04
Speaker 2: with patients, like instead of just like, all right, I'm
57:06
Speaker 2: gonna make a lot of money. Now it's I'm thinking
57:08
Speaker 2: about this as like doctors that care about medicine go
57:11
Speaker 2: into it to develop relationships with patients, and you want
57:15
Speaker 2: to get it. Makes it my job easier. Once I
57:17
Speaker 2: get to know somebody, I'm like, I can be myself.
57:20
Speaker 2: I don't have to be this sterile doctor or whatever.
57:22
Speaker 2: I can make jokes, you know, laugh and whatever. So
57:25
Speaker 2: that's that's the way I That's why I make it
57:27
Speaker 2: the way I do.
57:29
Speaker 1: Okay, so people can find you at Vineyard what's the
57:32
Speaker 1: what's the joint?
57:33
Speaker 2: Yeah, join vineyard dot com. Apparently someone owned Vineyard because
57:36
Speaker 2: there's probably a wine uh.
57:39
Speaker 1: I was thinking vineyard store.
57:42
Speaker 2: Yeah. Well yeah, there's a whole story of why I
57:44
Speaker 2: chose I basically wanted to see there's some of these
57:46
Speaker 2: places out there. They're so cheap and it's a race
57:48
Speaker 2: to the bottom. Uh. So I want it to be
57:51
Speaker 2: like a little bit higher upscale version of what you
57:54
Speaker 2: see online. And so I was like Vineyard. It sounds
57:57
Speaker 2: like a classy, nice name, and nobody owned us. So
58:00
Speaker 2: I was like, all right, I'm going with that. So
58:02
Speaker 2: that's why I chose the name. And I was like, yeah,
58:04
Speaker 2: be a place where i'd want to hang out with
58:06
Speaker 2: people at a Vineyard drinking wine, even though if you're
58:08
Speaker 2: taking the medicine, you're not going to be one a
58:10
Speaker 2: drinking wine. But like that's kind of the top busied.
58:14
Speaker 2: Let's get the medicine for a week so we can
58:17
Speaker 2: drink a little bit of wine. But yeah, so join
58:19
Speaker 2: vineyard dot com. I only hire obesity trained doctors. You
58:26
Speaker 2: get direct connection with them. There's no a lot of
58:28
Speaker 2: these other places. They have a care coordinator, so you're
58:30
Speaker 2: talking to a care coordinator and not the actual doctor,
58:34
Speaker 2: and they sound like bots. So I small patient panels.
58:37
Speaker 2: It's just it's very it's supposed to be white glove,
58:40
Speaker 2: but it's not white glove prices where you're paying a
58:43
Speaker 2: thousand dollars a month or whatever.
58:45
Speaker 3: Ye.
58:45
Speaker 1: Wow, fascinating. Well, thank you so much Spencer for coming on.
58:50
Speaker 1: And I've been wanting to chat with you for a
58:54
Speaker 1: long time because I told you I met you like
58:56
Speaker 1: fifteen years ago at a gym when Alex Brice.
58:59
Speaker 2: Was yeah you don't remember, still my strength coach. So
59:04
Speaker 2: it's good he is. Yeah, Yeah, he's my He does
59:07
Speaker 2: my lift r X program which everybody gets for free,
59:10
Speaker 2: and Vineyard Yeah.
59:12
Speaker 1: He wrote program.
59:13
Speaker 2: I love. He's great.
59:16
Speaker 1: He's great. Well, thank you for joining us, and thank
59:18
Speaker 1: you for your time and for what you are bringing
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Speaker 1: to the space. I know our our audience is really
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Speaker 1: going to appreciate it, so thank you so much.
59:28
Speaker 2: Thanks for having me on.
59:30
Speaker 1: Thanks for listening everyone.
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Speaker 3: If you enjoyed this episode, please consider giving us a
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Speaker 3: five star rating and sharing the body Pod with your friends.