Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with GLP-1s?

Transcript

What's the deal with GLP-1s? · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:01
Speaker 1: Hey, Perry, how you doing.
0:03
Speaker 2: I'm good, Emily.
0:04
Speaker 1: Nice to see you, Nice to see you.
0:06
Speaker 3: Okay, today we are talking about GLP one's. I'm going
0:09
Speaker 3: to ask you some questions. Do you know anyone using
0:12
Speaker 3: a GLP one?
0:13
Speaker 2: Well? Wait, I've never heard of this? What is it now?
0:16
Speaker 2: I'm just kidding. Yes, of course I know people on
0:20
Speaker 2: GLP ones.
0:21
Speaker 1: Do you know people using them off label?
0:23
Speaker 2: Yes?
0:23
Speaker 3: Do you know people who are using other people's GLP
0:26
Speaker 3: ones from their refrigerator?
0:28
Speaker 2: Yes?
0:29
Speaker 1: Do you know people who are micro dosing GLP ones?
0:32
Speaker 2: Yes? Yes?
0:33
Speaker 1: Do you know any wait?
0:35
Speaker 3: Do you know anyone who is micro dosing GLP one
0:37
Speaker 3: so they can focus better at their tech job?
0:41
Speaker 2: Okay, you got me there, I will I will take
0:43
Speaker 2: a drink.
0:44
Speaker 1: I'm a yes on that one.
0:46
Speaker 2: Wow. I want to hear more, but it might have
0:49
Speaker 2: to tap an offline.
0:53
Speaker 3: I'm Emily Oster, I'm an economist and a data expert.
0:56
Speaker 2: And I'm Perry Wilson. I'm a medical doctor.
0:58
Speaker 1: It's Thursday, March six, and this is wellness.
1:02
Speaker 2: Actually, because you're getting a staggering amount of health and
1:06
Speaker 2: wellness information nowadays from every source imaginable, and some of
1:10
Speaker 2: it is awesome and.
1:12
Speaker 1: Some of it is well, actually both.
1:16
Speaker 3: Fortunately we're both people who know how to read studies,
1:19
Speaker 3: how to parse the data, and can tell you what's
1:22
Speaker 3: worth thinking about and what you can safely ignore.
1:25
Speaker 2: But before we dig in, a note that this podcast
1:27
Speaker 2: is for educational purposes and should not be construed as
1:30
Speaker 2: medical advice. We don't know your unique situation, so talk
1:33
Speaker 2: to your doctor for personal health decisions.
1:35
Speaker 3: This week we're asking what's the deal with GLP ones
1:39
Speaker 3: and you will get our highly official thumbs up or
1:43
Speaker 3: thumbs down verdict, and then we'll get to your question
1:45
Speaker 3: of the week. But first, let's do the health news
1:48
Speaker 3: roundup after the break, all right, Perry, So, doctor Mike
2:04
Speaker 3: from the Internet offered RFK Junior one hundred thousand dollars
2:09
Speaker 3: given to the charity of his choice to appear on
2:12
Speaker 3: his podcast. Would you take the one hundred thousand dollars
2:16
Speaker 3: and what do you think about this?
2:18
Speaker 2: Oh? My god, I would take five dollars to appear
2:21
Speaker 2: on doctor Mike's podcast. I've met doctor Mike. I like
2:23
Speaker 2: doctor Mike. He is actually one of these influencers who
2:29
Speaker 2: generally seems to have his head in the right place
2:31
Speaker 2: in terms of science based medicine and things like that,
2:34
Speaker 2: and so I think RFK would be actually quite unwise
2:38
Speaker 2: to sit down with him and have a conversation. I
2:41
Speaker 2: think this is sort of a social media stunt a
2:44
Speaker 2: little bit. It gets some attention, but I'm here for it,
2:48
Speaker 2: you know. I like people like this sort of fighting
2:51
Speaker 2: fire with fire in this space. So good on you,
2:54
Speaker 2: doctor Mike. He's not going to take it.
2:56
Speaker 3: So I actually had a different reaction to this, which
2:59
Speaker 3: is twofold one. I do like doctor Mike very much.
3:03
Speaker 3: I would also be on his podcast for nothing. But
3:06
Speaker 3: one worry I have is that when you platform somebody,
3:09
Speaker 3: you platform and they let them say the things that
3:11
Speaker 3: they think, and in a lot of what RFK thinks
3:13
Speaker 3: doesn't make any sense.
3:15
Speaker 1: And also, what's the charity of choice?
3:18
Speaker 3: Is this going to mean doctor Mike is donating to
3:21
Speaker 3: the anti VACS Alliance?
3:22
Speaker 1: That would be some guardrails.
3:24
Speaker 2: That's a great point. I mean, I regarding platforming, he's
3:27
Speaker 2: the head of Health and Human Services and he's got
3:30
Speaker 2: an adequate platform at this point. But you're right, yes,
3:33
Speaker 2: he could definitely pick a particularly loathsome charity in this case.
3:38
Speaker 2: Let's stick in terms of health news with the government
3:42
Speaker 2: interesting confirmation hearing for doctor Ksey Means, who's been considered
3:48
Speaker 2: to be Surgeon General. At the time of this recording,
3:50
Speaker 2: there has not been an official vote on whether she
3:52
Speaker 2: would be approved to become Surgeon General. Doctor Means is
3:57
Speaker 2: an interesting character, firmly in the wellness space. Just for
4:02
Speaker 2: those of those who don't know who she is, she
4:05
Speaker 2: graduated medical school from Stanford and then went to an
4:09
Speaker 2: eer nos and throat residency program, which she never completed.
4:14
Speaker 2: So the way medicine works, or doctoring works is you
4:16
Speaker 2: go to med school and then you do an internship
4:18
Speaker 2: in residency which is sort of a supervis period where
4:21
Speaker 2: you're under the supervision of a senior doctor, and then
4:25
Speaker 2: you graduate that, you take your board exams, and you
4:27
Speaker 2: become board certified. She dropped out about six months prior
4:33
Speaker 2: to graduation of from the ENT program, which is particularly odd.
4:37
Speaker 2: According to her book, she did it because she became
4:40
Speaker 2: disillusioned with modern medicine and this sort of, you know,
4:44
Speaker 2: culture of treating disease and not preventing it. Because of
4:48
Speaker 2: that narrative, she's sort of become a darling of the
4:51
Speaker 2: alternative medicine space. You know, someone who is deeply entrenched
4:55
Speaker 2: in like the evil world of medicine and escaped. There's
4:58
Speaker 2: an interesting article in Vanity Fair which interviews some of
5:01
Speaker 2: her co residents and a former chair of VNT who
5:05
Speaker 2: actually say she dropped out because of stress. So there's
5:08
Speaker 2: a little bit of ret conning potentially going on here.
5:10
Speaker 2: I want to get your impression on her, but I
5:12
Speaker 2: need to know how you'll respond to this little bit
5:15
Speaker 2: of audio I found. This is not from her confirmation hearing.
5:18
Speaker 2: This is from a podcast, but I'm going to play
5:20
Speaker 2: you some casey means audio to get your reaction.
5:23
Speaker 4: The more specialties we invent in healthcare, the sicker we're getting.
5:29
Speaker 4: The more drugs we prescribe in the United States for
5:32
Speaker 4: these different chronic illnesses, the increase in the rates of
5:36
Speaker 4: these diseases. So the more drugs for the diseases, the
5:40
Speaker 4: higher amounts of these diseases we get, the more specialties,
5:43
Speaker 4: the more diseases, literally, the more research that we publish
5:49
Speaker 4: on these diseases, the worse the diseases are getting.
5:53
Speaker 3: Well, all right, Perry, So, first of all, I think
5:56
Speaker 3: she's confused about reverse causality. That's probably a little more
6:02
Speaker 3: technical than you were hoping to get, but it is.
6:05
Speaker 2: Exactly what I was hoping to get.
6:07
Speaker 3: We do more work on a disease when it is worse,
6:10
Speaker 3: but I think to conclude that it is the research
6:13
Speaker 3: that we do on the disease that makes it worse
6:15
Speaker 3: is perhaps the wrong direction, as opposed to when there's
6:18
Speaker 3: more of a disease we do or research on it.
6:20
Speaker 3: So I don't think the causality goes the direction that
6:22
Speaker 3: she thinks.
6:23
Speaker 2: It's one of the stupidest takes I've ever heard from
6:26
Speaker 2: someone with an MD after their name.
6:28
Speaker 1: It's a stupid take. It's on the stupider side. I agree. However,
6:32
Speaker 1: I will say that I feel like.
6:35
Speaker 3: There's been a lot of credentialing of doctor means and
6:39
Speaker 3: saying she didn't finish her residency and blah blah blah.
6:42
Speaker 3: I am much more concerned about the things she's saying
6:45
Speaker 3: than whether she completed this particular component of her training
6:51
Speaker 3: and if she were saying very sensible things which made
6:54
Speaker 3: sense and were consistent with science. The fact that she
6:57
Speaker 3: left her residency after with six months, like that's sort
7:00
Speaker 3: of that's kind of her business. My much bigger concern
7:04
Speaker 3: is that a lot of what she's saying does not
7:05
Speaker 3: comport with the science that I think the idea of
7:08
Speaker 3: having someone who is America's top doctor, which is one
7:12
Speaker 3: of the ways you think can think of the Surgeon General,
7:14
Speaker 3: to have that person be unwilling to say that vaccines
7:17
Speaker 3: are a good idea and to be unwilling to say,
7:20
Speaker 3: as she was in the confirmation, to be unwilling to
7:22
Speaker 3: say that the flu vaccine reduces flu mortality. I mean
7:26
Speaker 3: that just feels like, really, can we do that?
7:30
Speaker 2: Yeah? And the sort of refrain that she had, which
7:34
Speaker 2: was obviously prepared, was like, oh, well, you should talk
7:38
Speaker 2: to your doctor about this. This should all be a
7:40
Speaker 2: discussion between a patient and a doctor. You know, I'm
7:42
Speaker 2: not saying it doesn't work, but you should discuss with
7:44
Speaker 2: your doctor. It's not my place, and it's like no, no, no,
7:47
Speaker 2: Like actually, when you're the surgeon General, that's your place.
7:50
Speaker 2: That's twice your place, your place. This is what you're
7:53
Speaker 2: here for.
7:55
Speaker 1: Okay, Well we'll see what happens there, all right.
7:57
Speaker 3: Last thing we want to talk about was a new
8:00
Speaker 3: study of football players which is showing multiple neurocognitive deficits
8:08
Speaker 3: in general in this large sample of football players, with
8:12
Speaker 3: dose response effects based on years of play, which is
8:14
Speaker 3: just a fancy way of saying the more years people play,
8:17
Speaker 3: the more neurocognitive deficits we are seeing. I did not
8:23
Speaker 3: find this study very surprising. We have a lot of
8:26
Speaker 3: evidence that repeated concussions, which is probably a lot of
8:30
Speaker 3: what's going on here, or even sort of moderate forms
8:34
Speaker 3: of head trauma that do not elevate to the point
8:37
Speaker 3: of a concussion, that those can have long term effects.
8:40
Speaker 3: But I'm curious if you had different take on this.
8:45
Speaker 2: No, this is a nice study. Four thousand football players
8:49
Speaker 2: from high school players on up, so this wasn't just
8:52
Speaker 2: restricted to NFL players, and as you say, consistent with
8:56
Speaker 2: a lot of prior data. And I love football, like
8:59
Speaker 2: I love watching football. I have been an Eagles fan
9:03
Speaker 2: for a long time. I mean I didn't love it
9:05
Speaker 2: this year particularly, but in general. But it is hard
9:09
Speaker 2: for me to kind of see this data come out
9:12
Speaker 2: over and over and over again and it's clear that
9:15
Speaker 2: something is happening here and it's like we're all doing that.
9:20
Speaker 2: What's that meme of like that I don't know, it's
9:22
Speaker 2: like a rodent or something who just kind of like
9:23
Speaker 2: looks like looks to the side like I am I
9:27
Speaker 2: going to say anything. I don't know. I guess know
9:28
Speaker 2: what that meme is. I don't know. It's like, are
9:32
Speaker 2: we gonna address this or are we just going to
9:34
Speaker 2: kind of be like, Okay, this is how football works.
9:37
Speaker 2: Because it seems like this is how football works.
9:39
Speaker 1: It is a how football works. I mean, I think
9:41
Speaker 1: if you're looking for a.
9:42
Speaker 3: Sort of middle of the road solution from a smart person,
9:46
Speaker 3: I don't. Do you remember Chris Nowinski, who we went
9:50
Speaker 3: to college with.
9:51
Speaker 2: Yeah.
9:51
Speaker 3: Yeah, So Chris runs an organization that studies concussions in
9:56
Speaker 3: football and tries to ameliorate this problem by, for example,
10:02
Speaker 3: not encouraging people to not have tackle football before the
10:05
Speaker 3: age of fourteen, so to say, hey, if there's a
10:07
Speaker 3: jost response, let's like limit the amount of time kids
10:11
Speaker 3: are actually having contact in football and then sort of
10:15
Speaker 3: maybe make some changes to how college football is practiced
10:19
Speaker 3: so there's less head injury. So Chris is doing really
10:22
Speaker 3: really interesting work. We can put a link in the
10:24
Speaker 3: show notes to his organization.
10:26
Speaker 2: I love it. That's awesome. My son did flag football
10:29
Speaker 2: for the past couple seasons. He's thirteen. It's super fun.
10:33
Speaker 1: My kids hate sports, so that's not a concern for me,
10:37
Speaker 1: but I know that it is for some.
10:39
Speaker 2: When we come back, we will ask what's the deal
10:42
Speaker 2: with GLP ones?
10:48
Speaker 1: All right, Perry, glp ones? So I want to set.
10:52
Speaker 3: The stage here a little bit because I think that
10:54
Speaker 3: there's a kind of GLP one one point zero conversation
10:57
Speaker 3: that people can hear, like what are theyse do they
11:00
Speaker 3: work for weight loss? And we will touch on that,
11:02
Speaker 3: but I think at this point this is so ubiquitous
11:05
Speaker 3: that people probably don't want to hear like GLP ones
11:07
Speaker 3: are effective for weight loss. I actually want to focus
11:11
Speaker 3: most of our conversation, if you're up for it, on
11:13
Speaker 3: thinking about the sort of two point zero questions. So,
11:17
Speaker 3: if people have lost weight, what about weight regain? What
11:19
Speaker 3: are the other things this might work for? What are
11:22
Speaker 3: the big concerns people have? What about the long term effects?
11:26
Speaker 3: There are some interesting economic questions which I'm dying to discuss.
11:29
Speaker 2: I love it. This is not freshman year anymore. Welcome
11:32
Speaker 2: to Senior Seminar.
11:33
Speaker 1: Exactly, Senior Seminar glp ones.
11:35
Speaker 3: Okay, but before we get or maybe as part of
11:38
Speaker 3: senior seminar, can we talk about the Gila monster? Is
11:43
Speaker 3: it heal a monster or gila monster is my first question.
11:45
Speaker 3: And can you tell me why it's such an important animal?
11:48
Speaker 2: I say, heal a monster. I don't know if that
11:51
Speaker 2: is correct. You can write to us it wellness actually
11:54
Speaker 2: dot FM and correct everything we say. It is important.
11:57
Speaker 2: This is so interesting. So GLP one is a substance
12:01
Speaker 2: produced by your body and has been known since the seventies,
12:05
Speaker 2: and even its effects were known in the early eighties.
12:09
Speaker 2: So they took people and they gave them infusions of
12:12
Speaker 2: human GLP one, and what they found is that their
12:14
Speaker 2: gastric emptying really slowed down, and they reported more satiety,
12:18
Speaker 2: so they weren't as hungry. But there was this problem,
12:22
Speaker 2: and that's that GLP one that your body makes has
12:24
Speaker 2: a half life of about a minute, and so as
12:27
Speaker 2: long as it's directly infusing into your vein, you don't
12:31
Speaker 2: feel hungry. But once you disconnect the IV you do
12:34
Speaker 2: so not a viable product for weight loss, obviously, And
12:38
Speaker 2: that was the state of things for ten years or so.
12:41
Speaker 2: And then we get to a weird lab at the NIH.
12:46
Speaker 2: A guy named Jean Pierre Routhman was working in John
12:51
Speaker 2: Pisano's NIH lab testing venoms of various venomous animals. This
12:56
Speaker 2: is one of those examples of like basic science, like
12:58
Speaker 2: they had no idea what they were looking for. It
13:00
Speaker 2: was just like venom's interesting, we should know more about
13:02
Speaker 2: venom and great. This guy Raufman's job was to extract
13:08
Speaker 2: venom from the helo monster, and he noticed that when
13:11
Speaker 2: he injected this venom into mice, it did weird things
13:14
Speaker 2: with their blood sugar and their pancreas. He wasn't sure
13:16
Speaker 2: what it was. In nineteen ninety two, a scientist named
13:19
Speaker 2: John Aang isolated the protein and helo monster venom that
13:23
Speaker 2: was causing all these blood sugar issues. It was called
13:25
Speaker 2: exendin four and that was developed into a drug called
13:30
Speaker 2: eccentotide or bieta, the first GLP one drug, which was
13:35
Speaker 2: FDA approved. Do you want to guess one two thousand
13:38
Speaker 2: and five. This is not new science. But what was
13:42
Speaker 2: amazing about the helo monster venom is that protein in
13:45
Speaker 2: the venom, or that peptide in the venom looked like
13:48
Speaker 2: human GLP one bound to the same receptor as human
13:51
Speaker 2: GLP one. But it didn't break down in the blood
13:54
Speaker 2: in a minute. It broke down over the course of
13:56
Speaker 2: about a day, and so you could get away with
13:59
Speaker 2: injecting it or the cleaned up variant that was eventually
14:03
Speaker 2: produced called accentotide once a day, and all of a sudden,
14:06
Speaker 2: this was a viable product.
14:09
Speaker 1: So I just want to be clear. This is a peptide.
14:10
Speaker 3: So for people who listen to the earlier episode on peptides,
14:14
Speaker 3: this is an example of a peptide that is approved,
14:17
Speaker 3: not like the Wolverine stack. So go back to that
14:20
Speaker 3: episode for context there. Yeah, so okay, I think one
14:23
Speaker 3: interesting follow up question before we get to some of
14:26
Speaker 3: these details is actually a question of why now we're
14:29
Speaker 3: discussing this. So if twenty years ago we developed this venom,
14:35
Speaker 3: why is it now that we are seeing so much
14:38
Speaker 3: more of this which feels like it's kind of come
14:41
Speaker 3: up in the last three years, So what is is
14:43
Speaker 3: there another science breakthrough that is more recent?
14:47
Speaker 2: Not really, it's been just kind of a grade as
14:50
Speaker 2: these things kind of go, like once the class is discovered,
14:52
Speaker 2: it's like, okay, this class of chemicals is discovered, there's
14:55
Speaker 2: iterative improvements over time, and basically the improvements have been
14:59
Speaker 2: two things. Number one, increased potency, which means that they've
15:02
Speaker 2: developed peptides that bind a little more tightly to the
15:05
Speaker 2: GLP one receptor in ourselves and to increased half life.
15:08
Speaker 2: So where somemaglutide which also some people say semaglue tide,
15:12
Speaker 2: but I say semaglutide or ozepic came along with a
15:15
Speaker 2: once weekly dose because it was stable in your blood
15:18
Speaker 2: for a much longer period of time, had a much
15:20
Speaker 2: longer half life. That's where you start to get people
15:24
Speaker 2: willing to think about this for treatment of obesity. Most
15:27
Speaker 2: people without diabetes aren't comfortable injecting themselves once a day
15:32
Speaker 2: with a product, and in fact, even people with diabetes don't.
15:35
Speaker 2: No one loves injecting themselves right, and so once a
15:38
Speaker 2: week was a thing. There was another milestone in the
15:42
Speaker 2: obesity literature, which was this magical ten percent weight loss threshold,
15:47
Speaker 2: which had always been the like arbitrary marker of is
15:51
Speaker 2: this drug successful for weight loss? And Bayeta, the first
15:54
Speaker 2: GLP one was not. It led to some weight loss,
15:57
Speaker 2: about two to three percent over the course of a year,
15:59
Speaker 2: but just wasn't potent enough. And it was really it's
16:01
Speaker 2: and still is used for diabetes control blood shirt control.
16:04
Speaker 2: You got the first greater than ten percent weight loss
16:07
Speaker 2: effect with loraglutide, which came out later, and that sort
16:10
Speaker 2: of set off the arms race that we have now
16:12
Speaker 2: where you're just inventing drug after drug that are more
16:15
Speaker 2: potent and more potent, and of course, like the most
16:18
Speaker 2: recent trial, Lily's new drug, which I can't I can.
16:21
Speaker 1: I can even say, don't even try.
16:23
Speaker 2: Retract true Tide had a twenty eight percent year on
16:28
Speaker 2: your weight loss, which is insane.
16:31
Speaker 3: Okay, So right now we find ourselves in a moment
16:33
Speaker 3: where the two medications and people are most commonly using
16:36
Speaker 3: for weight loss are wgov and zet bound.
16:39
Speaker 1: Wagov is semaglutide.
16:42
Speaker 3: It's the ozembic equivalent, but prescribe for weight loss. Zetbound
16:47
Speaker 3: is trizepetide. It's the manjar equivalent, but prescribed for weight loss.
16:51
Speaker 3: Both of these lead to something between fifteen to twenty
16:57
Speaker 3: percent weight loss in the first year in the trial data.
16:59
Speaker 3: They are both served through a weekly injection that people
17:04
Speaker 3: give themselves. And the next thing that's coming is a
17:08
Speaker 3: set of we're going to keep seeing innovation here. The
17:11
Speaker 3: next thing that's coming is an oral form from Eli Lilly,
17:14
Speaker 3: which has a slightly lower amount of weight loss, but
17:16
Speaker 3: my guess is that the up tape will be very
17:18
Speaker 3: high because people would much rather take.
17:20
Speaker 1: A pill than have an injection.
17:22
Speaker 3: So we really find ourselves in a moment this is
17:25
Speaker 3: kind of the ozepic one point zero, where these medications
17:28
Speaker 3: are incredibly effective for weight loss. They're much more effective
17:31
Speaker 3: than pretty much anything we have had in terms.
17:33
Speaker 1: Of diet and exercise.
17:35
Speaker 3: They just work really well, and more and more things
17:38
Speaker 3: that are developed are going to make them work better,
17:42
Speaker 3: to the point I think, you know, you discuss the
17:45
Speaker 3: latest trial with thirty percent weight loss, like people are
17:47
Speaker 3: starting to have a conversation, but like what's too much?
17:49
Speaker 1: Like how much weight loss is too much weight loss?
17:52
Speaker 3: Like thirty percent is a lot in a year, and
17:54
Speaker 3: so we're kind of at the point where probably it's
17:58
Speaker 3: almost enough, although people always like more. But I think
18:01
Speaker 3: it's very clear that these are effective for weight loss,
18:03
Speaker 3: and that is like the science is done on that
18:06
Speaker 3: particular piece. A next interesting question is what about the
18:10
Speaker 3: other benefits, So before we get into like the things
18:13
Speaker 3: we're concerned about, these were originally.
18:16
Speaker 1: Prescribed for diabetes.
18:17
Speaker 3: They are effective for weight loss, but we're starting to
18:19
Speaker 3: see all kinds of claims like this is good for
18:22
Speaker 3: kidney disease, is good for cardiovascular disease. This is good
18:25
Speaker 3: for you know, I don't know, like cancer, cancer, for everything.
18:29
Speaker 3: I mean, which of these things are best supported. I'm
18:32
Speaker 3: going to ask you because I think the one of
18:34
Speaker 3: the best supported one is the kidney's and you are,
18:36
Speaker 3: in fact a kidney doctor.
18:37
Speaker 2: Yeah, all these off kind of off target effects, and
18:40
Speaker 2: I think it's good to think about the non weight
18:43
Speaker 2: non diabetes effects based on whether they are related to
18:47
Speaker 2: a reduction in weight or are they something else entirely.
18:50
Speaker 2: So let's say cancer as an example. So there have
18:53
Speaker 2: been several studies that have shown that the use of
18:57
Speaker 2: these drugs reduces the rate of related cancers. So the
19:01
Speaker 2: classic obest related cancers, cancers that are driven by some
19:05
Speaker 2: of the hormones that come from fat and stuff like that,
19:07
Speaker 2: or like breast cancer, cancers of the GI tract, colon cancer,
19:11
Speaker 2: and the rates of those things do go down. But
19:14
Speaker 2: it's plausible, we always talk about biologically plausibility that the
19:17
Speaker 2: reason they're going down is not because these drugs magically
19:20
Speaker 2: killed tumor cells. It's because people lose weight, and weight
19:23
Speaker 2: is a risk factor for the development of these types
19:25
Speaker 2: of cancers. That's a similar mechanism for like a reduction
19:28
Speaker 2: in blood pressure. For example, if you lose weight in
19:31
Speaker 2: any way, your blood pressure goes down. Same thing for
19:34
Speaker 2: kidney disease. Broadly speaking, the more weight you have, the
19:37
Speaker 2: more metabolically active tissue you have in your body, the
19:40
Speaker 2: more work the kidney has to do. And in general,
19:41
Speaker 2: if you can give the kidney less work to do,
19:43
Speaker 2: it's happy to not have to do as much and
19:45
Speaker 2: they can kind of last longer. I think it's probably
19:48
Speaker 2: similar for cardiovascular disease as well.
19:50
Speaker 3: So I will say that I think that in some
19:52
Speaker 3: of these trials when they're looking at other kinds of
19:55
Speaker 3: cardiovascular disease and so on, there's sort of some discussion
20:00
Speaker 3: that maybe the effects are larger than you would expect
20:03
Speaker 3: based on weight loss alone. So they're sort of trying
20:06
Speaker 3: to do a kind of calibration and then say, well,
20:09
Speaker 3: maybe it's it's like a lot of the weight loss,
20:11
Speaker 3: but then there's something that you get more, although I
20:14
Speaker 3: think that's obviously very hard thing to sort of separate
20:16
Speaker 3: fully in the data.
20:18
Speaker 2: Yeah, and it relies on some assumptions of like you know,
20:21
Speaker 2: how many pounds of weight is equivalent to how many
20:23
Speaker 2: millimeters of mercury of blood pressure that are always like
20:25
Speaker 2: a little bit handwavy. So that's all true. Like the
20:29
Speaker 2: epidemic of obesity in our country and around the world
20:32
Speaker 2: is driving much of the chronic disease epidemic. It just is.
20:36
Speaker 2: And so anything that impacts obesity, whatever it is, is
20:39
Speaker 2: going to reduce the rates of those diseases. That's cool.
20:43
Speaker 2: But what always kind of gets me interested, and I
20:45
Speaker 2: want to ask you this, Emily, are the things that
20:47
Speaker 2: really can't plausibly be related to weight loss. So what
20:52
Speaker 2: do you think about like the fact that people report
20:55
Speaker 2: less smoking or alcohol intake, or gambling like this stuff.
21:00
Speaker 1: Yeah, I mean I think so my senses.
21:02
Speaker 3: Of those things, the one that is most strongly supported
21:05
Speaker 3: in the data is alcohol, partly because that's where we've
21:08
Speaker 3: studied the most, and partly because that's an activity that
21:10
Speaker 3: most people engage in. There's a lot of reports in
21:13
Speaker 3: both the data and just out in the world that
21:15
Speaker 3: people's interest in alcohol declines as a result of this
21:19
Speaker 3: and that other you know, they're interest in smoking, they're
21:22
Speaker 3: interested in all these other kind of maybe what we
21:24
Speaker 3: consider vices goes down. One interpretation of the way these
21:29
Speaker 3: medications work, is that there's something about sort of almost
21:33
Speaker 3: like sort of self control, like inhibition value. And I
21:38
Speaker 3: mean this is consistent with when you talk to people
21:40
Speaker 3: who take these medications. And I have not, but I've
21:42
Speaker 3: talked to a lot of people. One of the things
21:44
Speaker 3: that is very common for people to say is like
21:46
Speaker 3: it turned off the noise.
21:48
Speaker 1: Like my head was full.
21:49
Speaker 3: Of food noise, and I was always thinking about food,
21:52
Speaker 3: and I was always thinking about that, and this made
21:54
Speaker 3: me think about it less.
21:55
Speaker 1: And if you think.
21:56
Speaker 3: About the way that a lot of people feel about alcohol,
21:58
Speaker 3: are smoking or whatever, it is all also that noise.
22:00
Speaker 3: It's like I feel the noise, I want to have
22:02
Speaker 3: a drink, or I feel the noise I want to
22:03
Speaker 3: have a cigarette. You can imagine that whatever is that mechanism,
22:07
Speaker 3: it might work there. Similarly, I know people.
22:10
Speaker 1: Who take this for focus, who micro does like a
22:13
Speaker 1: zep bound for focus.
22:14
Speaker 2: Yeah, talk to me about that. I've never heard that before.
22:17
Speaker 1: I don't know. The guys in Silicon Valley do a
22:19
Speaker 1: lot of weird stuff. Perry, and one of the things
22:22
Speaker 1: that he was is like it really helps you focus.
22:23
Speaker 3: It helps you not be distracted by whatever food noise, alcohol, noise,
22:27
Speaker 3: smoking noise, other kinds of noise. Certainly, I would not
22:31
Speaker 3: say that we have science or data or evidence that
22:33
Speaker 3: supports that piece. But putting all of these things together,
22:37
Speaker 3: it does feel like maybe there's something in there.
22:42
Speaker 1: There's something about the way this is interacting with people's brain.
22:45
Speaker 3: Chemistry that could be consistent with some of these effects.
22:49
Speaker 3: Actually there's someone I believe there are some people thinking
22:52
Speaker 3: about experimenting on providing people GLP once when they leave prison,
22:57
Speaker 3: and one of the outcomes they would look at is recidivism.
23:00
Speaker 3: And one interpretation of that is that basically, if you
23:02
Speaker 3: could turn down people's impulses to engage in alcohol and
23:07
Speaker 3: drugs and so on, they might actually be less likely
23:09
Speaker 3: to return to prison.
23:10
Speaker 2: Wow, So doue fascinating, Totally fascinating.
23:13
Speaker 1: That's interesting. Again, this is like we're on the course.
23:16
Speaker 2: We're way out there.
23:17
Speaker 1: You know, we're way out there.
23:18
Speaker 2: There is plausibility here, though. I mean, one thing that
23:21
Speaker 2: people know I think one point zero people know that
23:24
Speaker 2: GLP one's decrease gas strict to emptying, so that that
23:27
Speaker 2: just feeling of having a full stomach, It really does
23:29
Speaker 2: seem like that is not everything here. I did a
23:34
Speaker 2: quick review of like where GLP one receptor is found
23:37
Speaker 2: in your body, so you know what kind of cells
23:40
Speaker 2: express these receptors and high levels and yes they are
23:43
Speaker 2: throughout the GI tract and pancreas and things like that.
23:45
Speaker 2: But right up there in terms of organ systems is
23:47
Speaker 2: the brain. So your brain has these receptors. We do
23:50
Speaker 2: know that these peptides can cross the blood brain barrier,
23:53
Speaker 2: and once a drug can cross the blood brain barrier,
23:56
Speaker 2: and once you know there's receptors on your neurons for
23:58
Speaker 2: that drug, like it kind of opens the door of
24:01
Speaker 2: anything being possible to some extent, right, So all of
24:04
Speaker 2: these things are definitely plausible.
24:06
Speaker 3: So if one thing people wonder about sometimes is when
24:09
Speaker 3: you're on these and you lose weight, is it quote
24:12
Speaker 3: the same as losing weight in other ways? Is it
24:16
Speaker 3: literally just this makes you eat less, and you eat
24:18
Speaker 3: less and then you lose weight, like to measure it
24:20
Speaker 3: with the way you would lose weight, you know, if
24:21
Speaker 3: you just literally ate less, is there something more than
24:24
Speaker 3: that or is that kind of the whole business?
24:27
Speaker 2: Oh, this is such a good question because so much
24:29
Speaker 2: of what I see online there is like an anti
24:33
Speaker 2: GLP one current that is under there, and typically the
24:38
Speaker 2: arguments do go something like this, like this is not natural,
24:41
Speaker 2: like this isn't the real way to lose weight. And
24:44
Speaker 2: because it's not the real way to lose weight, it
24:46
Speaker 2: does these certain bad things. And I think the one
24:50
Speaker 2: that you hear about the most is probably muscle loss.
24:53
Speaker 2: And people come and are like, oh, no, you're not
24:55
Speaker 2: just losing fat, You're losing muscle. And Emily, I know
24:58
Speaker 2: you've looked into this. Well, I will ask you, is
25:01
Speaker 2: it true that if I lose weight through other means
25:04
Speaker 2: like diet and exercise, that I only lose fat and
25:07
Speaker 2: don't lose muscle.
25:08
Speaker 1: That is not true, Perry.
25:09
Speaker 3: When you lose weight in any way, you lose both
25:12
Speaker 3: fat and muscle. And some of that is like sort
25:16
Speaker 3: of intimately linked because one of the things your muscles do,
25:20
Speaker 3: actually the main thing for most of us our muscles
25:22
Speaker 3: are doing are moving us around in the world. Yes,
25:24
Speaker 3: And so if you are heavier, your muscles are moving
25:27
Speaker 3: more stuff. It's like you're constantly wearing a weighted vest.
25:30
Speaker 3: And when you lose weight, even if you just lost fat,
25:33
Speaker 3: your muscles would be like, great, we don't have to
25:35
Speaker 3: have so much of us anymore, because we aren't moving
25:38
Speaker 3: around so much weight. And so there is like an
25:42
Speaker 3: inherent feature of losing weight where you are going to
25:44
Speaker 3: lose some fat and some muscle. And if you have
25:47
Speaker 3: a lot of fat, you will lose relatively more fat.
25:49
Speaker 3: But no matter how you lose weight, you are losing
25:51
Speaker 3: some muscle. And that is also true on ozepic and
25:54
Speaker 3: actually the study suggests it's no more true on dlp
25:56
Speaker 3: ones than it is with other kinds of diet.
25:58
Speaker 1: Like you just you lose fat and some muscle.
26:01
Speaker 2: Yeah, and typically about thirty to up to fifty percent
26:04
Speaker 2: of weight loss can come from muscle, regardless of what
26:07
Speaker 2: the weight loss is. There is a little wrinkle here
26:11
Speaker 2: that I don't see brought up often, but I'll say
26:13
Speaker 2: it because we're in senior seminar, and that is that
26:16
Speaker 2: the way that muscle mass gets assessed typically in these
26:20
Speaker 2: studies is through a DEXA scan, which is sort of
26:23
Speaker 2: a think of it like an X ray, but you
26:25
Speaker 2: can see muscle tissue, you.
26:27
Speaker 1: Do a whole episode. Influencers love a DEXA scan.
26:29
Speaker 2: Oh interesting, Okay, So DEXA scans don't actually distinguish between
26:35
Speaker 2: muscle and what's called lean mass, just like non fat,
26:38
Speaker 2: non bone mass, So they sort of assume that like
26:41
Speaker 2: everything that isn't bone and isn't fat is muscle, which
26:45
Speaker 2: is obviously not true. You have like organs and stuff
26:47
Speaker 2: like that, but it's it's more than that, which is
26:50
Speaker 2: that fat infiltrates muscle, and DEXA scans cannot determine how
26:55
Speaker 2: much of your muscle is infiltrated by fat. It just
26:58
Speaker 2: looks like more muscle. You can think of this as
27:00
Speaker 2: like the marbling of a steak, right, like if you
27:03
Speaker 2: faten these cows, you get nice prime rib and things
27:06
Speaker 2: like that, and it's really tastes delicious, but it's actually
27:09
Speaker 2: bad for your muscle quality, and so we don't It
27:12
Speaker 2: may be that some of the fat loss is happening
27:14
Speaker 2: within muscle, which is almost certainly a good thing. But yes,
27:18
Speaker 2: you're gonna lose muscle if you lose weight, no matter
27:20
Speaker 2: how you lose weight. So Emily, let's say I don't
27:22
Speaker 2: want to lose muscle, or at least I don't want
27:24
Speaker 2: to lose as much muscle as possible. Can I prevent
27:26
Speaker 2: this or am I you know, doomed?
27:28
Speaker 1: Ye?
27:29
Speaker 3: So one of the totally fascinating like knock on impacts
27:34
Speaker 3: of the OZEMPA craze is the strength training craze. So
27:39
Speaker 3: the idea that you sort of like all of a sudden,
27:41
Speaker 3: you're on the GLP one for weight loss, but now
27:44
Speaker 3: you need to do strength training, and that's actually not crazy.
27:47
Speaker 1: We think about, like, how do you retain and build muscle.
27:50
Speaker 3: You retain and build muscle by exercising, and in particular
27:53
Speaker 3: by exercising in a way that you know, cardio, yes,
27:56
Speaker 3: but also like by lifting stuff. And so there's a
27:59
Speaker 3: kind of combo here where you take the GLP one
28:04
Speaker 3: for weight loss and you exercise for muscle retention, which
28:08
Speaker 3: tends to be a good combo. And interestingly, many people
28:10
Speaker 3: report their willingness to exercise and get up and go
28:13
Speaker 3: to the gym is greater when they're on a GLP one.
28:15
Speaker 3: Getting back to potentially some of the stuff that we
28:18
Speaker 3: talked about before around sort of impulse control. The other
28:22
Speaker 3: thing is prioritizing protein, right, So, like so much of
28:24
Speaker 3: what's happening when people are in GLP ones is they
28:26
Speaker 3: eat less food, like fewer calories, but making sure that.
28:30
Speaker 1: Those fewer calories are actually like you're.
28:32
Speaker 3: Maintaining protein at the amount of protein shouldn't change that much,
28:37
Speaker 3: whereas the amount of other things should change more and
28:39
Speaker 3: kind of thinking about that balance. So there's still like
28:42
Speaker 3: a need to think about diet and exercise even if
28:45
Speaker 3: the GLP one is acting. I will say I was
28:49
Speaker 3: at an influencer dinner at some point a few months ago,
28:52
Speaker 3: and we can get into the economy later, but I
28:54
Speaker 3: think restaurants have really adapted to this because all they
28:57
Speaker 3: serve was protein, Like it was just exclusive protein. There
29:00
Speaker 3: was like one tiny thing of French fries on the table,
29:04
Speaker 3: and like, I like carbs.
29:06
Speaker 2: Yes, you're a carb queen.
29:07
Speaker 1: I was sad.
29:08
Speaker 3: I was sad about It's like, where's the bread service?
29:13
Speaker 1: But the bread service is over at fancy restaurants.
29:15
Speaker 2: Yeah. Yeah, it's just egg white service now and protein.
29:18
Speaker 1: Water, tuna, and egg whites exclusively. Okay.
29:23
Speaker 3: So that is the kind of I think big picture
29:26
Speaker 3: of like sort of what happens initially when people are
29:28
Speaker 3: on this, and what are some of the other things
29:30
Speaker 3: it could work for.
29:31
Speaker 1: I think we should.
29:32
Speaker 3: Get into the things that people raise about that are
29:37
Speaker 3: more concerning, the first of which is weight regain, the
29:40
Speaker 3: question of do I need to be on this forever? Yeah,
29:42
Speaker 3: and I will say, in the trials, the evidence is
29:47
Speaker 3: pretty sharp that when you put someone on a GLP
29:50
Speaker 3: one they lose twenty percent of their body weight. You
29:51
Speaker 3: take them off their GLP one, they gain back about
29:54
Speaker 3: half of their body weight, at least in the trials.
29:58
Speaker 3: So is this a sort of is this a life sentence?
30:01
Speaker 3: And is that a problem? I guess is my secondary quest.
30:05
Speaker 2: I think, yeah, the data is quite clear, but like
30:09
Speaker 2: you know, part of me is a doctor, is like, well,
30:11
Speaker 2: we have lots of medications like this, Like when I
30:13
Speaker 2: treat someone for hypertension and I put them on a
30:15
Speaker 2: blood pressure pill. In general, the expectations like, yeah, if
30:19
Speaker 2: you stop this blood pressure pill, you will your blood
30:22
Speaker 2: pressure will go up again, Like that's your There is
30:24
Speaker 2: some constitutive effect there. One of the things I've seen
30:28
Speaker 2: online from influencers though, who are kind of anti GLP
30:32
Speaker 2: ones is like, oh, but if you lose weight through
30:34
Speaker 2: you know, lifestyle change and changing your habits, then like
30:37
Speaker 2: you'll have that forever. But with GLP one, you're you're
30:40
Speaker 2: stuck for life, and you know this data as well
30:43
Speaker 2: as I do. Emily, like I've ever heard like the
30:48
Speaker 2: data on maintaining weight loss with diet literally offs is abysmal.
30:57
Speaker 3: This is the for me, like the stupidest piece of
30:59
Speaker 3: this discussion, because it sort of presumes like, well, of
31:04
Speaker 3: course we had a way before for people to lose
31:06
Speaker 3: large amounts of weight and keep it off with diet,
31:08
Speaker 3: and now you know we're not using that anymore. It's like, actually, no, yes,
31:13
Speaker 3: it is possible to lose weight with diet, and some
31:15
Speaker 3: people do. And I know because they show up in
31:17
Speaker 3: comments when I talk about this, and they're like, I
31:18
Speaker 3: lost three hundred pounds doing yoga and walking around the
31:21
Speaker 3: block one time. It's like, that's super for you. For
31:24
Speaker 3: most people, that actually isn't effective. Most diets work for
31:29
Speaker 3: a little while and then people gain the weight back.
31:31
Speaker 3: It's very very consistent, and so I'm not sure this
31:34
Speaker 3: is really any different than that. Nor do I think
31:38
Speaker 3: it's very different, as you say, than something like a statin,
31:40
Speaker 3: which people go on and then they stay on forever,
31:43
Speaker 3: and which by the way, you might be able to
31:44
Speaker 3: get off after you're on your GLP one because your
31:47
Speaker 3: cholesterol might improve.
31:48
Speaker 1: So that's another thing to think about.
31:50
Speaker 2: Well, yeah, I think the same thing with my blood
31:52
Speaker 2: pressure pill. I was like, actually, they might be able
31:53
Speaker 2: to come off if they start the GLP one the trials.
31:56
Speaker 2: One of the reasons we even have this data is
31:59
Speaker 2: because most of these trials last basically a year. Some
32:02
Speaker 2: some go out to like a year and three months
32:04
Speaker 2: or so, but that's the extent of the data, and
32:07
Speaker 2: so we just don't know with that degree of fidelity,
32:11
Speaker 2: like what ten years on a GLP one in terms
32:13
Speaker 2: of weight loss. Looks like there's observational data to that
32:16
Speaker 2: effect because the JLP once have been around for so long,
32:19
Speaker 2: but the randomized trial data is limited and in scope.
32:22
Speaker 2: What is interesting is how people in the real world
32:26
Speaker 2: are kind of handling this. So, yes, they lose a
32:28
Speaker 2: lot of weight, they get to a weight they're happy with,
32:31
Speaker 2: and then they're like, Okay, I'm good. And what I've
32:34
Speaker 2: found with patients that I've spoken to is generally not like, okay,
32:37
Speaker 2: I'm going off JLP one, But people are doing this
32:40
Speaker 2: thing that often gets there that's called microdosing. So what
32:44
Speaker 2: do we know about microdosing? Is this the answer like, yeah,
32:46
Speaker 2: you'll be on it, but you're only going to be
32:48
Speaker 2: on a little bit.
32:48
Speaker 3: I don't think we have any idea, and I think
32:50
Speaker 3: the reason is sort of interesting in terms of the
32:52
Speaker 3: of the science. So you know, think about the kind
32:55
Speaker 3: of who is running the trials of these the people
32:57
Speaker 3: are running the trials that people are making the drugs
32:59
Speaker 3: right Nova Noordas Gailli Lily. The makers of the drugs
33:02
Speaker 3: run the trials, and they trial their drug at the
33:07
Speaker 3: dosage that they are going to sell it at because
33:10
Speaker 3: that is what the FDA tells them to do. That's
33:12
Speaker 3: like this like how drug trials work. They don't usually
33:16
Speaker 3: run trials of like and here's exactly how.
33:18
Speaker 1: You're gonna do it in the real world.
33:21
Speaker 3: But in the real world, when people get to this,
33:24
Speaker 3: most of the doctors I know who are using this
33:26
Speaker 3: will do I'm not sure they'd call it microdosing.
33:28
Speaker 1: They call it a maintenance dose.
33:29
Speaker 3: Right that we are like we start with a low dose,
33:31
Speaker 3: we go up to a dose in which you're losing
33:33
Speaker 3: weight in a consistent way. You get to the weight
33:35
Speaker 3: that you would like to be, and then you drop
33:37
Speaker 3: down the dosage until you get to a point where
33:41
Speaker 3: you are maintaining that weight and that feels comfortable. And
33:44
Speaker 3: that's how this is actually operating for most people in
33:47
Speaker 3: the real world. I'm not sure we're going to see
33:49
Speaker 3: trials of that in the short run, because I'm not
33:52
Speaker 3: sure who who would run them, right, So I don't
33:54
Speaker 3: think Nova noordis is going to run that kind of trial.
33:56
Speaker 3: Somebody will eventually, but I think it's and it's also
33:59
Speaker 3: just so in ideal world is sort of so titrated.
34:02
Speaker 3: One of the concerns I think is that people are
34:04
Speaker 3: titrating it themselves, whereas a much better thing would be
34:07
Speaker 3: to TITRATEE under the supervision of your doctor, not to
34:09
Speaker 3: just like take half your dose, which is my sense
34:11
Speaker 3: is what people are actually.
34:14
Speaker 2: Right, And a lot of this has to be done
34:16
Speaker 2: actually through compounding pharmacies, which we've talked about in a
34:19
Speaker 2: prior episode. Has potential safety concerns. The ozepic pen has
34:24
Speaker 2: a little clicky dial that you can turn, which does
34:27
Speaker 2: allow you to change dose. My understanding is that the
34:31
Speaker 2: zep bound pen does not. So the only way to
34:34
Speaker 2: kind of micro dose that is to break the thing open,
34:36
Speaker 2: and like, don't do that. That's a bad idea. So
34:39
Speaker 2: you're kind of going outside the box a little bit here,
34:42
Speaker 2: But I agree, I think this is probably what happens.
34:45
Speaker 2: Like eventually we'll get to a point where, first of all,
34:48
Speaker 2: there will be oral drugs and this will be the
34:51
Speaker 2: kind of thing that you do probably take some lowish dose,
34:55
Speaker 2: probably for an extended period of time, unless you want
34:58
Speaker 2: to gain some more weight.
34:59
Speaker 3: Yeah, okay, so it is a long term medication. But
35:02
Speaker 3: maybe the right frame is this is a long terra
35:04
Speaker 3: medication like you're sat in near blood pressure medication, and
35:06
Speaker 3: not a diet like the time that you tried to
35:09
Speaker 3: lose weight on the all protein diet for six months
35:11
Speaker 3: and then gained it back, which is in fact how
35:13
Speaker 3: people interact with diets.
35:16
Speaker 1: Okay. The second big concern is just are there side effects?
35:20
Speaker 1: Which there are?
35:20
Speaker 3: I think it should be very clear, like this is
35:22
Speaker 3: a drug, it has side effects.
35:24
Speaker 1: The main side effect people.
35:26
Speaker 3: Complain about is nausea and other gastric problems. That is
35:32
Speaker 3: a I think of just a that's a feature. I
35:35
Speaker 3: don't know if it's a feature or a bug. It's
35:36
Speaker 3: a very common side effect. What about some of these
35:41
Speaker 3: more serious things, pancreatitis depression.
35:46
Speaker 2: Okay, probably should go through very quickly, like one by one. Pancreatitis. Yes,
35:52
Speaker 2: rare case reports probably associated with these drugs. We know
35:56
Speaker 2: they act on the pancreas. In fact that heal a
35:58
Speaker 2: monster venom. When a heal a monks or bites a mouse,
36:00
Speaker 2: it causes an acute pancreatitis. So I buy it, Yes rarely,
36:05
Speaker 2: but yes, so people need to know, Like symptoms of
36:08
Speaker 2: that are a deep and painful burning in your upper
36:12
Speaker 2: part of your stomach. Like you'll know this is bad
36:15
Speaker 2: when it's happening. You definitely want to get checked out. Okay,
36:18
Speaker 2: the depression suicide thing, this is really interesting because we've
36:22
Speaker 2: talked already about you know, the ability of these drugs
36:26
Speaker 2: to potentially modulate reward pathways in the brain, and you
36:29
Speaker 2: framed it differently Emily for the first time, and I'm
36:31
Speaker 2: it's like, I'm still kind of grappling with the way
36:34
Speaker 2: you frame this. So the way I hear people frame
36:36
Speaker 2: this is like, oh, it takes away your desire to eat,
36:38
Speaker 2: it takes away your desire to smoke, it takes away
36:40
Speaker 2: your desire to drink alcohol. But like, what it's doing
36:43
Speaker 2: is it's just it's kind of all the pleasure, pleasurable
36:46
Speaker 2: things that your brain wants. It just kind of cuts
36:48
Speaker 2: that off. And then like, are you joyless? Is there
36:52
Speaker 2: no hope in the world? And if so, might it
36:54
Speaker 2: not increase depression and suicidality. RFK Junior himself has raised
36:59
Speaker 2: this issue, and I'll just point out that the current
37:02
Speaker 2: best data is from a meta analysis of twenty seven
37:05
Speaker 2: randomized controlled trials including thirty two thousand people looking at
37:09
Speaker 2: the rates of suicide and self harm from these drugs,
37:12
Speaker 2: and there is no difference in suicide or self harm
37:16
Speaker 2: events between placebo and these drugs. So I do not
37:19
Speaker 2: think that is real. And one of the reasons, like,
37:23
Speaker 2: the way you've reframed this for me is as opposed
37:26
Speaker 2: to saying like, oh, it cuts the reward pathways, like
37:28
Speaker 2: you don't get the high of eating food or the
37:31
Speaker 2: high of drinking alcohol. You've reframed it as like it's
37:34
Speaker 2: not ending that thing, it's giving you this, Like it's
37:38
Speaker 2: giving you control, it's giving you more focus, which is
37:40
Speaker 2: I kind of like, I mean, I don't know if
37:42
Speaker 2: it's true, but that is a different way to think
37:43
Speaker 2: about it that might explain why you get less drinking
37:47
Speaker 2: but not SUICIDEALTG.
37:48
Speaker 1: Yeah, I don't know.
37:49
Speaker 3: I mean I think that is a way that I
37:51
Speaker 3: have heard people try to describe to me what this
37:54
Speaker 3: is like, which I think is a potentially interesting organization
37:58
Speaker 3: of some of these facts, but I don't know. Again,
38:01
Speaker 3: it's like it's always hard to get inside of people's brains.
38:04
Speaker 2: It is. When we talk about enjoyable things that your
38:07
Speaker 2: brain likes to do, something that always comes up is sex.
38:11
Speaker 2: So what do we know about sexual effects of these drugs?
38:15
Speaker 1: Relatively little.
38:17
Speaker 3: You know, there are people who will say, like, this
38:21
Speaker 3: limits your desire to have sex. I don't think there's
38:25
Speaker 3: a lot of evidentiary support for that. What I will
38:29
Speaker 3: say is there are some real issues that you know,
38:32
Speaker 3: people in long term relationships grapple with when they go
38:35
Speaker 3: on these medications, particularly if you know there's New York
38:39
Speaker 3: Times actually had a series of very interesting stories about
38:43
Speaker 3: couples where one person has gone on a JLP one
38:46
Speaker 3: and they sort of said, well, you know, our life,
38:48
Speaker 3: you still revolve around going out to dinner and you know,
38:51
Speaker 3: drinking together and hanging out and like, and now this
38:53
Speaker 3: person doesn't want to do those things anymore.
38:55
Speaker 1: And so you know, maybe you you do want to
38:58
Speaker 1: have sex, maybe you don't want to have sex. But
38:59
Speaker 1: there is another piece of It's not about a lack
39:03
Speaker 1: of interest in physical relationship, or maybe it is, but
39:06
Speaker 1: it's also about changing the relationship, and I actually think
39:09
Speaker 1: that's a really important part of this for a lot
39:12
Speaker 1: of people, that eating is a huge part of our lives.
39:16
Speaker 1: And if you change things so.
39:18
Speaker 3: You aren't going to eat in the same way and
39:22
Speaker 3: you are in a relationship with another person and they're
39:24
Speaker 3: not going to change that, and your body is going
39:27
Speaker 3: to be going through a lot of changes like that
39:28
Speaker 3: is just an adaptation that people should expect and should,
39:33
Speaker 3: you know, think about as part of this. I think
39:35
Speaker 3: it's less about sex and more just just about you know,
39:39
Speaker 3: when you change something totally about yourself and your relationship,
39:42
Speaker 3: it changes and you have to adapt, and relationships are hard,
39:45
Speaker 3: is my fundamental feeling.
39:46
Speaker 2: Yeah, indeed, I agree. There's sort of a disturbing lack
39:50
Speaker 2: of data on this. As I was looking in I'll
39:52
Speaker 2: just say there are like ten times as many studies
39:56
Speaker 2: on male like impotence and and orgasm from GLP one
40:02
Speaker 2: so than there is on female. It's like, all right,
40:05
Speaker 2: researchers like, get with the program here a little bit.
40:08
Speaker 2: Women are more likely to take JLP ones and are
40:10
Speaker 2: more likely to lose a greater percentage of body waight
40:12
Speaker 2: on JLP ones than men. Clearly, this needs to be
40:14
Speaker 2: looked into. I agree, there's nothing terribly compelling. I did
40:18
Speaker 2: find one study that was an observational study looking at
40:22
Speaker 2: rates of a clinical diagnosis of an orgasmia the inability
40:26
Speaker 2: to have an orgasm, which did find that compared to
40:29
Speaker 2: women not on JLP onees, those on GLP one's had
40:33
Speaker 2: that diagnosis code about twofold more often. It's a very
40:36
Speaker 2: rare diagnosis code to get because most people don't talk
40:39
Speaker 2: about this with our doctor in the first place. But
40:41
Speaker 2: that rate was similar to women taking me foreman, which
40:43
Speaker 2: is another drug for diabetes. So this is probably related
40:47
Speaker 2: to the underlying reason that the woman is taking the
40:50
Speaker 2: GLP one as opposed to the GLP one itself. But I,
40:54
Speaker 2: you know, more data, I'd like more data here.
40:56
Speaker 3: Who doesn't want more data on women's sexual function as
40:58
Speaker 3: opposed to men's sexual funk?
41:00
Speaker 1: Should where?
41:00
Speaker 2: Really?
41:00
Speaker 1: We're good, Thanks, it's enough data. We know everything, I
41:04
Speaker 1: got it. We're fine, Okay.
41:06
Speaker 3: I think there are some interesting social and like regulatory
41:09
Speaker 3: questions here, or maybe just social questions that we should
41:12
Speaker 3: make sure that.
41:13
Speaker 1: We hit on.
41:15
Speaker 3: Last thing that I will say, I'm bringing up in
41:18
Speaker 3: part because this is the first thing my father ever
41:20
Speaker 3: asked me about ozempic He was like, have you heard
41:23
Speaker 3: of ozempic face? And then he was like, blah blah
41:26
Speaker 3: blah person that I now has it and I.
41:29
Speaker 1: Have heard of that. So, Harry, have you heard of
41:34
Speaker 1: ozempic face.
41:35
Speaker 2: I've heard of ozempic face. I've heard of ozempic butt.
41:39
Speaker 1: Yeah, so ozempic face.
41:42
Speaker 3: My sense is that when you lose weight, your skin
41:44
Speaker 3: takes some time to tighten back up, which or maybe
41:49
Speaker 3: it doesn't tighten back up, and that you lose a
41:52
Speaker 3: lot of weight in your face then or your butt,
41:55
Speaker 3: it will be saggy. Yep, doesn't matter if it's on
41:58
Speaker 3: a GLP one or in some other Yeah.
42:01
Speaker 2: We don't have that magic bullet that only makes you
42:04
Speaker 2: lose fat like around your belly, but leaves shredded abs behind.
42:08
Speaker 2: Like when you lose weight, your body consumes fat. Fat
42:11
Speaker 2: is there to be a source of energy when you
42:13
Speaker 2: don't take in enough calories, and that's what GLP ones do.
42:16
Speaker 2: They make you eat less, so you expend more calories
42:19
Speaker 2: than you are consuming, and so your body breaks down
42:22
Speaker 2: fat as well as some other tissues as we discussed,
42:25
Speaker 2: to recapture that energy. And they'll take fat from everywhere.
42:28
Speaker 2: What ozebic face is in medically speaking, is mid face
42:32
Speaker 2: volume loss. That's what the plastic surgeons call it. So
42:34
Speaker 2: that sort of cheekbones and cheeks gives kind of a
42:38
Speaker 2: sunken appearance. And you're right, this is what happens with
42:42
Speaker 2: all formed yep at that one social ely for those
42:45
Speaker 2: of you just listening on the podcast is making kind
42:47
Speaker 2: of a fish face. This is what happens with all
42:50
Speaker 2: forms of weight loss. I think the reason it's in
42:53
Speaker 2: the zeitgeist now is that we just never had effective
42:56
Speaker 2: weight loss that was working for the masses. So where
42:59
Speaker 2: you will have I've seen this before is people getting
43:01
Speaker 2: gastric bypass surgery, which was like before the JLP ones
43:05
Speaker 2: was the main way that people could lose a significant
43:07
Speaker 2: amount of body weight. But that's a big surgery. If
43:10
Speaker 2: you think of like Al Roker before and after he
43:13
Speaker 2: had gastric bypass. Before and after that, he looked very different.
43:16
Speaker 2: He had midface volume loss. We didn't call it a
43:18
Speaker 2: zembic face back then because it didn't exist. This is
43:21
Speaker 2: just weight loss face. It is real. In fact, the
43:25
Speaker 2: American Academy of Facial Plastic and Reconstructive Surgeons reported a
43:29
Speaker 2: fifty percent increase in facial fat grafting procedures in twenty
43:33
Speaker 2: twenty four, So people are thinking about it totally.
43:36
Speaker 1: Okay.
43:36
Speaker 3: I think that's a really good segue because I am
43:40
Speaker 3: very interested in a knock on economic effects of these medications.
43:44
Speaker 2: Oh I love when you bring your economic doctorate into
43:47
Speaker 2: this discussion. What's going to happen?
43:49
Speaker 1: So I'm going to tell you and where do I invest?
43:51
Speaker 3: Okay, So if I were an investor, I will tell
43:53
Speaker 3: you number one, I would invest in places that do
43:57
Speaker 3: excess skin removal.
43:58
Speaker 1: I'm not kidding.
43:59
Speaker 3: I think that there is going to be a huge
44:01
Speaker 3: excess demand for skin removal procedures because if people have
44:06
Speaker 3: been overeat for a very long time and you lose,
44:09
Speaker 3: if you lose three hundred pounds, you end up with
44:12
Speaker 3: a lot more skin and people.
44:14
Speaker 1: Can find it.
44:15
Speaker 3: They may not like how it looks, but also it
44:17
Speaker 3: can be uncomfortable and you know, difficult to navigate.
44:20
Speaker 1: And there are procedures that will remove excess skin.
44:23
Speaker 3: And I think that that is an incredible growth area
44:26
Speaker 3: and we will see a growth in the kind of
44:28
Speaker 3: like meds SPA skin removal surgery situations.
44:33
Speaker 2: Okay, those are big surgeries. That's no joke.
44:36
Speaker 3: I realized that, and I but I still I'm still
44:38
Speaker 3: going to go okay, like sting there.
44:40
Speaker 1: Okay. So that's one place.
44:42
Speaker 2: I'm wondering about, like our food industrial complex, right, Like
44:45
Speaker 2: I walk down this supermarket and there's like eighty different cereals,
44:49
Speaker 2: Like are they scared as Kellogg's?
44:50
Speaker 1: Like, uh oh, I think they are. Yeah.
44:52
Speaker 3: So I think it's like two interesting sort of places
44:55
Speaker 3: that that may be affected by this.
44:56
Speaker 1: One is like the snack food complex.
44:58
Speaker 3: Right, if you think about what is going to go
45:01
Speaker 3: from people's meals, I think snacks are likely to go
45:05
Speaker 3: some and so I think we are already seeing impacts
45:08
Speaker 3: on snack foods. We're already seeing restaurants think about, hey, can.
45:12
Speaker 1: We lower the portion sizes? Right, Like for a restaurant,
45:15
Speaker 1: that's good.
45:15
Speaker 3: You'd rather give people smaller portions because it's you know,
45:19
Speaker 3: less expensive for you.
45:20
Speaker 1: And so we sort of I think we may see
45:21
Speaker 1: a little shrinking the place. I think the other the
45:25
Speaker 1: growth area in the other direction is protein snacks. Right.
45:28
Speaker 3: If you think all of a sudden, people are eating
45:30
Speaker 3: fewer calories, but they need a lot of protein. That's
45:32
Speaker 3: where you need your protein popcorn your protein.
45:36
Speaker 2: You know, I was fish so glad there wasn't enough
45:38
Speaker 2: protein snacks.
45:40
Speaker 3: Weren't protein snacks, And now the David bar is coming
45:44
Speaker 3: for you. And so I think it's it's a sort
45:46
Speaker 3: of protein growth carbohydrate snack decline.
45:48
Speaker 1: And so I do.
45:49
Speaker 3: Yeah, I do think that there's some some movement in
45:52
Speaker 3: that space. I'm not exactly sure how I would invest
45:54
Speaker 3: on that, or on any of my ideas.
45:56
Speaker 1: It's a good thing. I don't have a lot of
45:57
Speaker 1: money to invest in my stupid investment.
45:59
Speaker 2: I do, Yes, what about medicine with a capital And
46:04
Speaker 2: like I work in a hospital, I see patients in
46:08
Speaker 2: the clinic. Do you think that this can be transformative
46:10
Speaker 2: enough that like I won't have as many kidney disease patients,
46:13
Speaker 2: I won't have as many heart disease patients. I mean
46:15
Speaker 2: people have to die of something. I guess, right, like eventually,
46:18
Speaker 2: maybe it happens when they're older.
46:19
Speaker 3: Yeah, I mean that's those are much more Those are
46:21
Speaker 3: much slower moving changes. I think there are also a
46:24
Speaker 3: very there's an interesting overlap there with the question of
46:28
Speaker 3: of kind of the cost of these drugs. So these
46:30
Speaker 3: drugs are right now quite expensive. The prices have been
46:33
Speaker 3: coming down a lot, but they're still expensive. They're covered
46:36
Speaker 3: in sometimes intermittently by insurance. But one of the arguments
46:41
Speaker 3: for expansion of access to these medications, especially if we
46:45
Speaker 3: think about like a government payer, is that they will
46:48
Speaker 3: lower people's risk of other things. So you know, you,
46:51
Speaker 3: perry are expensive, somebody comes to see you.
46:54
Speaker 1: You know it costs money.
46:56
Speaker 3: If fewer people have kidney disease because of their GLP ones,
46:59
Speaker 3: I actually sort of offsets the cost of the GLB
47:01
Speaker 3: one to some extent, And depending on how big those
47:05
Speaker 3: effects are, we could see these medications even though they
47:09
Speaker 3: are relatively expensive, and even if they stayed relatively expensive,
47:12
Speaker 3: we could see them like cause overall cost savings in
47:15
Speaker 3: the healthcare market, which would be in part of reduction
47:18
Speaker 3: in sort of need for doctors, but probably would be
47:21
Speaker 3: more significantly a reduction in use of other medications. So
47:25
Speaker 3: if you are a maker of a stat and this
47:27
Speaker 3: may be sort of more bad for you than if
47:30
Speaker 3: you are someone who treats people or a heart attack,
47:32
Speaker 3: which is still something people are going to die of,
47:34
Speaker 3: just maybe maybe they'll die of them later.
47:37
Speaker 2: One of the things that this ties into is, Okay,
47:41
Speaker 2: we've sort of come to the point where we're like,
47:43
Speaker 2: these drugs are going to be in the fabric of
47:45
Speaker 2: our society, whether they're injectable or oral. We've said that
47:48
Speaker 2: you're going to be potentially taking them for in some
47:51
Speaker 2: form or another for a long period of time, and
47:54
Speaker 2: a lot of people are worried about that, saying, like,
47:57
Speaker 2: you know, but we don't know what might happen right that, Sure,
48:01
Speaker 2: they seem to be working great now, but how do
48:04
Speaker 2: we know that if you're not on it for thirty
48:05
Speaker 2: years it causes cancer or something like that. What data
48:08
Speaker 2: do we have to either reassure people or terrify them.
48:11
Speaker 3: Yeah, I mean I think that the short answer is
48:13
Speaker 3: we don't. We can't really fully reassure people about that.
48:16
Speaker 3: You know these first and you say the top the
48:17
Speaker 3: first of these drugs is are proved in two thousand
48:19
Speaker 3: and five. People have been on this for diabetes for
48:21
Speaker 3: a long time. We haven't seen those kind of signals.
48:24
Speaker 3: But it's not exactly the same drugs. It's not the
48:26
Speaker 3: same dosing levels, not for the same indication. So you know,
48:30
Speaker 3: if you want to know what is the impact of
48:31
Speaker 3: these drugs in thirty years, you need to wait for
48:33
Speaker 3: thirty years, and you know, we ultimately, like with almost
48:37
Speaker 3: any new drug, you've got away the sort of known
48:42
Speaker 3: value of the medication against these kind of long term
48:45
Speaker 3: potential risks. I actually think that sort of cost benefit
48:49
Speaker 3: calculation is always an important part of these choices, but
48:53
Speaker 3: he is probably relevant to the extent that some of
48:56
Speaker 3: the usage of these medications is not for indication did purposes. Right,
49:01
Speaker 3: So we are definitely seeing use of GLP ones in
49:06
Speaker 3: populations where people do not need them to treat metabolic disease.
49:09
Speaker 1: Right.
49:10
Speaker 3: This is a medication that is intended to treat obesity
49:13
Speaker 3: or diabetes or complications of obesity. That is the indication
49:17
Speaker 3: for the medication. It's not a medication intended to move
49:22
Speaker 3: your BMI from twenty one to fourteen or seventeen, which
49:26
Speaker 3: is some of how it seems like it's being used,
49:29
Speaker 3: particularly in celebrity circles, and it's always hard to know
49:33
Speaker 3: who's losing weight for what reason. But there's a kind
49:35
Speaker 3: of the part of the cautionary conversation, it feels important
49:39
Speaker 3: to me, is the one where people are sort of
49:42
Speaker 3: using these effectively really off label in a way that
49:47
Speaker 3: changes the conversation around what is an appropriate physical appearance
49:52
Speaker 3: for someone, and we're kind of we lost a little
49:55
Speaker 3: bit of what I thought was probably a good move
49:58
Speaker 3: towards the idea that you know, people could be different
50:01
Speaker 3: sizes and not just size.
50:03
Speaker 2: To thank you for saying that, it's worth noting that
50:09
Speaker 2: fat has value, like it is metabolically important, it is
50:13
Speaker 2: hormonally active tissue in a good way. And being underweight, however,
50:19
Speaker 2: you get to being underweight with this, you know, with
50:21
Speaker 2: this drug or any other way, can have actual long
50:25
Speaker 2: term health consequences. And there's there's any number of studies
50:28
Speaker 2: that actually show that sort of the sweet spot for
50:32
Speaker 2: body weight in terms of longevity and especially resilience against disease.
50:36
Speaker 2: So when you do get sick, you know, being able
50:39
Speaker 2: to sort of bounce back from that is probably in
50:42
Speaker 2: the well we see. You know, the normal weight range,
50:44
Speaker 2: you know, a BMI between twenty and twenty five or so.
50:47
Speaker 2: If you're pushing below that, you are starting to stress
50:50
Speaker 2: your body a little bit more. I just have to say,
50:52
Speaker 2: I have a patient who is telling me that she
50:54
Speaker 2: was taking one of these drugs to get back to
50:56
Speaker 2: her original weight. And I said, what was your original weight?
50:59
Speaker 2: And she said seven pounds fourteen outs.
51:03
Speaker 1: Much.
51:04
Speaker 3: No, I mean, I will say I've started to see discussions,
51:06
Speaker 3: you know, people have started to talk about this a
51:08
Speaker 3: lot in the like endurance sports community, because it is
51:12
Speaker 3: of course true if you are like a runner, that
51:15
Speaker 3: there is some value to being smaller because you're moving
51:20
Speaker 3: less bulk. But actually these medications are really bad for performance,
51:25
Speaker 3: and some of these sort of discussions I think have
51:27
Speaker 3: gotten like a little confused and also ultimately probably not
51:32
Speaker 3: very good for either people's health or in that particular case,
51:35
Speaker 3: for you know, running fast. So if you want to
51:38
Speaker 3: run fast, this is maybe not for you, not for everyone,
51:41
Speaker 3: not for everyone. Yeah, all right, so Perry, before we
51:44
Speaker 3: get to our final feelings on this, let's talk about
51:46
Speaker 3: sort of where this is going, and both in terms
51:49
Speaker 3: of the medications and in terms of kids. So on
51:52
Speaker 3: the question of the medications, you know, my sense is
51:55
Speaker 3: we're just going to keep seeing new versions of this
51:58
Speaker 3: come out that are you know, bad, are in a
52:00
Speaker 3: variety of dimensions, easier to dose oral versus injected, more
52:04
Speaker 3: weight loss in twenty eight percent versus twenty percent.
52:08
Speaker 1: Those are the two big dimensions. What other dimensions are
52:10
Speaker 1: we going to see?
52:11
Speaker 2: Innovation, cost, you know, things will get cheaper, but yeah,
52:15
Speaker 2: I honestly, I think in terms of weight loss, like
52:17
Speaker 2: up at twenty eight percent, I think we're done. Like
52:20
Speaker 2: you're taking a two hundred pound person and bringing them
52:22
Speaker 2: down to one hundred and forty pounds, like this is
52:25
Speaker 2: probably I don't think we need to improve too much
52:26
Speaker 2: on that. So, yeah, you're going to see cost differences
52:29
Speaker 2: as things come off patent, and then the orals are
52:31
Speaker 2: going to be some game changing and there may be
52:33
Speaker 2: like tweaks that improve side effect profile and things like that.
52:37
Speaker 2: We'll see that. The question of kids is really fascinating.
52:43
Speaker 2: So the landscape right now is that ozepic itself does
52:47
Speaker 2: have FDA approval for kids twelve and up. It's the
52:50
Speaker 2: only one. The rest start at age eighteen. I'm ambivalent
52:54
Speaker 2: about this because, for one thing, kids are kids. They're
52:58
Speaker 2: not just small adults. They're their own things. They're growing,
53:01
Speaker 2: and especially for kids who are growing, like calories are
53:04
Speaker 2: important for that, and stunting a kid's growth is a
53:07
Speaker 2: permanent thing that can happen, so I'm very nervous about this.
53:11
Speaker 2: On the other hand, there is an argument to be
53:14
Speaker 2: said that, like you know, the fat tissue that you
53:17
Speaker 2: add as a child does not really go away ever.
53:22
Speaker 2: In fact, as you lose weight, a lot of those
53:24
Speaker 2: cells are just shrinking, not necessarily dying off or evaporating.
53:29
Speaker 2: Is it a possibility that establishing some habits with the
53:33
Speaker 2: use of a drug like this in your youth when
53:35
Speaker 2: you're sort of forming your relationship with food could be
53:38
Speaker 2: beneficial in the long term, or on the other hand,
53:40
Speaker 2: could it be entirely harmful? Like I am really up
53:43
Speaker 2: in the air about this.
53:44
Speaker 1: You're in a rabbital, Yeah, me too.
53:46
Speaker 2: I am. I don't I don't know.
53:47
Speaker 3: I think it's really complicated, because you're right. I think
53:50
Speaker 3: our habits, our taste for foods our form when we
53:52
Speaker 3: are our kids, and that is an argument for forming
53:56
Speaker 3: those habits. Well, I mean, I guess the thing I
53:58
Speaker 3: would say for sure is this be a first line,
54:01
Speaker 3: Like I would really like us to think more carefully
54:06
Speaker 3: about how we can help families develop good food habits
54:10
Speaker 3: with their kids, whether that's like better school lunch programs,
54:13
Speaker 3: better supports you're like, all kinds of things I would
54:16
Speaker 3: like to do before we get to like, let's ever
54:20
Speaker 3: give everybody ozempic when they're twelve, which just feels like,
54:23
Speaker 3: you know, probably there are some people who will benefit
54:25
Speaker 3: from that, and it'll be good to have that as
54:27
Speaker 3: an option, But I don't want to be the first line,
54:30
Speaker 3: and I don't think that that's a good idea. Okay,
54:34
Speaker 3: all right, okay, Perry, We're gonna end with our segment
54:38
Speaker 3: in which we give our yes or no, and I
54:40
Speaker 3: am going to insist that we call this segment smash
54:43
Speaker 3: or paths.
54:44
Speaker 2: All right, I am on board. And for those of
54:47
Speaker 2: you from a generation that is not X, you can
54:50
Speaker 2: google what that means.
54:51
Speaker 1: All right, So, Perry, GLP one smash your path.
54:56
Speaker 2: Smash definitely transformative drugs. I'll be with us for a
55:01
Speaker 2: long time, changing a lot of outcomes. Not for everyone,
55:04
Speaker 2: as you say, but yeah, definite smash for me. How
55:06
Speaker 2: about you?
55:07
Speaker 3: Yeah, I'm a smash if it's the right person on
55:09
Speaker 3: this one. I think for some people, for many people,
55:13
Speaker 3: this is going to be a really game changing solution.
55:15
Speaker 3: It's not for everyone, but I think it's going to
55:17
Speaker 3: represent a really important part of the health landscape in
55:21
Speaker 3: the next several decades.
55:23
Speaker 2: All right, after the break, we'll get to your question.
55:31
Speaker 1: All right, Perry.
55:32
Speaker 3: Mailbag question of the Week is a personal one. What
55:37
Speaker 3: is the dumbest thing or greatest thing in your fridge?
55:40
Speaker 1: Right now?
55:41
Speaker 2: I have such a good dumb thing and like for
55:44
Speaker 2: a podcast about wellness. Just beep this entire segment. Don't
55:48
Speaker 2: listen to what I'm about to say. But you can
55:51
Speaker 2: get from Amazon or any other online store. Do you
55:56
Speaker 2: know the cheese powder that goes in mac and cheese,
55:58
Speaker 2: like the orange? Okay, oh my god, I get a
56:02
Speaker 2: bulk container of that, Perry.
56:05
Speaker 1: That's so gross.
56:06
Speaker 2: Okay, okay, wait, here's what you can do with it. Hey,
56:10
Speaker 2: you can add it to your mac and cheese. It's
56:14
Speaker 2: that much cheesier. But wait, there's more. You can make
56:18
Speaker 2: popcorn and then you can put that stuff on your.
56:21
Speaker 1: Pop that's good. Yeah, you can.
56:23
Speaker 2: You can make pasta sauces out of it. It's so good.
56:27
Speaker 2: It is so bad for you. Please don't do.
56:29
Speaker 1: This anyway, Perry. Why does it have to be in
56:32
Speaker 1: your refrigerator?
56:33
Speaker 2: This is what I don't so Actually it's no, it's
56:35
Speaker 2: it's in my cabinet. But now it's like, why shouldn't
56:38
Speaker 2: it's cheese, like it probably should be in my refrigerator.
56:40
Speaker 1: And no, I don't think that stuff is cheese my friend.
56:42
Speaker 2: Sorry, cheese, it's microplastics. What's the dumbest thing in your refrigerator.
56:48
Speaker 2: I'm so curious about this because Emily's like the healthy
56:50
Speaker 2: one for those of you who don't know both of us.
56:53
Speaker 2: So it's going to be like, oh, I I got
56:56
Speaker 2: tomato juice, but it was like a normal amount of sodium.
57:00
Speaker 1: I like sodia. I drink a lot of sodium.
57:02
Speaker 3: Please, I drink like I put element in my water
57:04
Speaker 3: in the morning. I'm like very into sodium. We can
57:06
Speaker 3: talk about that other time. I have a kind of
57:09
Speaker 3: peanut butter I really like. It's called one Trick Pony.
57:13
Speaker 1: I am.
57:13
Speaker 3: Peanut butter is like one of my core food groups,
57:16
Speaker 3: and unfortunately they have had a jar shortage, and so
57:21
Speaker 3: the only way to purchase this online right now is
57:23
Speaker 3: in a nine pound tub. And so I have a
57:27
Speaker 3: nine pound tub of peanut butter that's on the fridge.
57:30
Speaker 2: Though that's a lot of peanut butter.
57:32
Speaker 1: It's a lot of peanut butter. I go through it
57:33
Speaker 1: surprisingly quickly.
57:37
Speaker 2: That's it for us today. Stick with us next week
57:40
Speaker 2: when we'll ask what's the deal with red light therapy?
57:44
Speaker 3: Wellness actually is produced in association with iHeartMedia.
57:48
Speaker 1: Our senior producer is Tamar Avishai.
57:50
Speaker 3: Our executive producer at iHeart is Jennifer Bassett. Our theme
57:54
Speaker 3: music is by Eric Deutsch and our content is for
57:57
Speaker 3: educational purposes only.
57:58
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58:15
Speaker 2: for our mailback or suggest a topic for a future show.
58:19
Speaker 1: We'll let the influencers have the last word.
58:21
Speaker 2: So I saw commercial for weight Watchers. We're doing glp
58:23
Speaker 2: ones now which is ozembic and stuff that's like a
58:26
Speaker 2: karate dojo selling guns. Realize not what the way is
58:33
Speaker 2: breakthrough in self defense guns