Latest / This Is My Journey | The GLP-1 Podcast / S2 E3: Starting GLP-1s Safely: Maintenance, Misinformation & Black Market Risks (with Hira Malik, Oushk Pharmacy)

Transcript

S2 E3: Starting GLP-1s Safely: Maintenance, Misinformation & Black Market Risks (with Hira Malik, Oushk Pharmacy) · This Is My Journey | The GLP-1 Podcast

• 0:00
  So with more people than ever considering GLP-1 medication, we're also seeing a lot more confusion, misinformation, and in general, risk. So from black market sellers and injections to unsafe prescribing, rushed decisions, and unclear expectations about what comes next around maintenance, the way people are starting these medications really, really matters. So today's episode is all about safety, education, and just doing this journey the right way. So if you're thinking about starting a GLP-1,
• 0:28
  or you're maybe already on one, or you're wondering what comes next once you reach goal, this conversation is for you. So let's roll the intro and I'll introduce you to today's very special guest.
• 0:41
  Welcome to This Is My Journey, the podcast where real people share real stories of transformation, resilience, and growth. I'm Mark, and after navigating my own path through major lifestyle change, I created this space to open up honest conversations around identity,
• 0:59
  mindset, and what it really takes to evolve. So along the way, we'll also hear from professionals, from pharmacists to psychologists and fitness experts who help us make sense of the science and support behind these journeys. So whether you're just starting out deep in the process or you're finding your footing after big change, you are not alone. This is your place. This is my journey. Let's walk it together.
• 1:27
  Welcome back to This Is My Journey. And today I'm joined by Hira Malek, chief pharmacist and co-founder of Ushk Pharmacy, who works closely with patients at every stage of their GLP-1 journey. So from first consideration right through to maintenance and long-term planning. So Hira brings a vital pharmacy-led perspective to this conversation. And she previously joined us for season one for one of our most listened to episodes. So I'm really, really excited.
• 1:50
  To have her back for season two, her work focuses really on helping patients understand what safe prescribing looks like, how to avoid common risks, and how to navigate the growing amount of misinformation online. So this episode is going to be all about clarity, safety, and empowering people, you the listeners, to make informed decisions. So Hera, thank you so much for joining me again today. Thank you so much for having me. I'm very excited to be here.
• 2:13
  Yeah, no, I'm so excited to have you back. Can't believe, well, I told you before we started this, that your episode was one of the most listened to ones, which is no surprise because realistically, like it's, it's was a really information led episode that really helped people navigate the start of this journey for sure. In terms of all the information that really needed to know that key information, I think.
• 2:33
  So, so yeah, so for anyone really who might be new to the podcast or hasn't managed to catch that episode in season one, could you maybe tell us a little bit about your background and sort of the work you do with patients every day who are considering or using GLP-1 medication?
• 2:47
  course. My name is Hira, obviously. I started East Pharmacy about two years ago. And I think the whole purpose behind it was I was working for other people, really working in weight loss, but I really felt that there was a lack of education alongside medication. And that was something I was very passionate about because I did feel that, you know, weight loss is a long-term condition, but without the right support, sometimes patients are not getting the results. So this is pre-Manjaro days, pre-Vigori days. You know, the only thing that we did actually have was 6th Fender at that time. And I think we were doing a ZenPIC off-license at that time as well, which is a bit naughty. Yeah.
• 3:16
  So I've been in weight loss for about five years and so many things have changed. The ideas about weight loss has changed. The idea about GLP-1s has changed. So even since we last spoke, I think today will be a completely different conversation. I think we have so many newness coming into the world of weight loss. And so scary, but coming into the world of weight loss as well. So now I'm excited to see what happens and what we can talk about today.
• 3:37
  So excited to have you on again. It's going to be another really information led episode that people are going to find real value in. So yeah, again, thank you so much for joining me today and yeah, let's get into it. So really the first thing I kind of wanted to ask, and I think that'd be really, really important from, you know, your perspective as a pharmacist, what do you wish more people understood before they really started at JLT1?
• 4:01
  I think more so than anything else, it's important to know that GLP-1 are just, you know, it's more than just taking the injection. It's about kind of understanding that this is a commitment that you will be making. This is treating a condition, like I said, it's a long-term condition. It's a relapsing condition. It's a chronic condition. So people who have suffered with obesity, they know they've tried it multiple, multiple times. So when you're, you know, accepting something like a GLP-1 into your life, because it's not an easy decision to make, so either. It's a very expensive one at that.
• 4:24
  So if you are really thinking about starting this, just know that this is not a quick fix. It's not something that will solve all your issues. It's something that will require commitment from you. It will also require a little bit of management of your own time and planning that really, really helps you get the best results that you can do.
• 4:40
  again, GLP-1s are not going to replace your behaviors. So, you know, if you go on these medications, yes, it may help you with the craving side of things and maybe you're eating a little bit less, but if you're still making the wrong choices or if you're still not eating correctly or you're not moving enough, then unfortunately those results may not last and you may find that your results are not anywhere close to what other people are getting out of it. So it's not that medication is not working, it's that you haven't committed to it. So I think anyone who's either on it in the early stages or thinking about starting these, just know that you have to put the work in yourself and
• 5:08
  A lot of the times this is where we will come in because, you know, sometimes patients don't know what they need to do and what the correct way to do it is. There is so much misinformation out there. There are so many thousands and thousands of diets out there. No one really knows what they need to be doing. So please know that prescribers are here to help you support this through. Your pharmacies can help you with this as well. And I'm not saying we are better than anyone else. Just find a pharmacy that you feel will be able to give you enough support. Or if you're going to a GP, just know that they are open to this and they will be able to support you through. They understand you as a person.
• 5:35
  And they can provide the correct kind of leading you through this journey as well.
• 5:38
  you touched on something there I think everybody is very different and everybody's needs are very different too so I think it's just about finding what's you know good for you and what what support it is that you need as a as an individual you know I've seen online you know you have to you know there's a lot of excitement around these medications but also there is a lot of fear too I think and there's a lot of myths and a lot of lies and a lot of misinformation and misconceptions and stuff out there what are the most common ones that you've you know you can kind of think of off the top of
• 6:08
  I think the biggest one would be that everyone gains the weight back. Everyone gains, I think it's been in the media recently, like even today, we were like getting reports in where people are saying, oh, people on GLP ones are gaining four times the weight of anyone else. And again, it just kind of goes back to that behavior side of things. If you're going into this treatment without making any of those behavioral changes, then unfortunately, yes, you will be ending up in that category where you do gain the weight back. Because as with any other diet, yes, there's a risk that you will gain the weight back. However, not everyone will do that. So if you're making the correct choices, you're really utilizing this time while on treatment, right?
• 6:37
  to change yourself, change your relationship with food, understand how you are eating as a person. I think a lot of the times, until you go on these medications, you don't realize how big your portions are. Because then you're surviving on one fifth of what you used to eat, and you're still okay, and you're full of energy, and everything's still working fine. That's when you start to realize, actually, maybe I was eating a little bit too much.
• 6:54
  So, you know, utilize this time, really, really put into practice everything that you know about health. And honestly, we've had patients who've done amazingly well after coming off the medications. Some of them may have gained a couple of pounds here and there, but there is nowhere near to that four times more weight that you will gain back. Same goes for the diets. Yes, there's a risk. But if you really, really commit to it and change your behavior while you're on this treatment, then...
• 7:15
  It can be lifelong. It can be lasting. And you can get amazing, amazing results, even if you don't decide to stay on the medication for long term. So I think that's the biggest misconception and the scary part of it. I think it's one of those media things that everyone's picking on right now. Oh, you're all just getting weighed back. You're wasting your time. You're wasting your money. No one is. If you do it properly, then I think you'll be fine. Other than that, I guess the side effects side of things. I think that's quite a scary misconception that everyone will get side effects or you will end up with your gallbladder issues or you will have like...
• 7:43
  you know, gastroparesis and things like that. Reality is, yes, these are medications. Of course, there are side effects associated with it. But again, it's about understanding the safety side of things, knowing when to move up the dose. Again, getting the correct support. So as soon as you start to feel anything, speak to your prescribers, see if they can help you, support you through and manage your side effects properly. Not everyone will get side effects. If anything, we see maybe less than 10% of people picking up side effects. Most of them ending up being
• 8:04
  constipation, nausea, very easily manageable side effects. Extreme side effects, you know, thank God, we've not really had cases where people have ended up in hospitals and things like that. So again, just us as one pharmacy dealing with thousands of patients is very, very rare for anyone to have such an extreme side effect. And sometimes people fail to realize that things like gallstones is sometimes because of the obesity.
• 8:25
  And you may have had them previously. It's just that they've just been aggravated because you've lost the weight too quickly. And it's not possibly just linked to the GLP-1. It's just that you've lost the weight too quickly. And same can happen if you were on a normal diet, if you've had a gastric bypass. So it's not all linked to the GLP-1s. A lot of the times media likes to show that it is.
• 8:40
  Yeah, that's them clickbait titles they all love and everybody falls for it. You know, obviously neither of us are saying that these things don't happen, but I think they're highly exaggerated in the media a lot of the time, I think. I suppose then for anybody that's maybe in that world where they're considering it, but they haven't made that leap yet, you know, into starting on a GLP one, whatever one that may be,
• 9:02
  What steps would you say as a pharmacist that works, you know, your GPHC registered pharmacy, you know, what steps would you advise patients to take, you know, to make sure they're prescribed this medication safely? You know, is there red flags that people should look out for if they're going with another pharmacy, for example?
• 9:21
  I think the first one you've covered as well, just make sure that the pharmacy you're going to is regulated. So every pharmacy in the UK should be registered with GPHC. Some online prescribers are registered with GPHC, but if they are also supplying the drug, they have to have GPHC registration. And it's super easy for you to go check it. You just log into the website, put the name of the pharmacy in, and it will come up with all the records. So you can check the pharmacist, you can check the pharmacy as well to make sure it's coming from a legitimate source. Mm-hmm.
• 9:43
  Another thing I would say, I always say this, I think sometimes online, if you find that something is too easy to get, GLP ones should not be easy to get. So if you find that there is no clinical questions, there is like, you know, almost like an Amazon type of thing where you just click a button and you add into the basket and check out, then that's the biggest red flag you can come across because it's a prescription medication. It's...
• 10:00
  regulated enough for us to actually ask you all the questions. Last year, GPAC also introduced guidance that, you know, as prescribers, we should be checking and verifying patient's weight and BMI. So again, if a pharmacy isn't really necessarily doing that, then it's not the biggest red flag because I think some pharmacies are just introducing that, but that has been introduced almost a year ago. So by now, I think the pharmacy who's properly prescribing should be verifying your weight as well.
• 10:22
  Other than that, if people are not asking your IT, they're not asking for your GP details. Again, those are just like simple little things that you can pick up. If you have placed an order and there is no customer service that you can speak to, or you're sending them messages, they're not replying to anything. If they're taking you off the website and then dealing with you on WhatsApp and things like that, sometimes that's a little bit of a red flag as well. Because again, as part of the GPHC, we have to have a functioning website and everything should be going there. Through that, because then we can audit it. On WhatsApp, there is no auditing there. Mm-hmm.
• 10:48
  Again, you know, it's a little bit of a risk there. If you are someone who's been offered maybe using half doses, skipping doses, using, given a higher dose pen to say that actually you can tweak it and use it differently. Again, that's not correct practice and not many prescribers, to be honest, most of the prescribers I know would not offer that kind of service. So again, just know that that's a little bit of a red flag. If they're not asking you your family history, your current history, any medication that you're dealing with, or if you've been with them and some side effects have happened and you can't reach to them and they don't know the answers, then again, I think big red flag. So I think I've covered most of it.
• 11:18
  So, you know, it sounds silly enough because I think it's so popular everywhere and everyone's talking about it. So it feels like, oh, actually, if everyone's able to just get it so easily, so should I. But just know that if a prescriber does say that actually, no, you shouldn't get this medication or it's not appropriate for you, then do listen. At the end of the day, it's your life. It's a risk that you're taking. These medications are strong medication. So if it's not suitable for you, that doesn't mean that you just go and find someone who would then offer it to you. It just means that actually, maybe you just bite your tongue this time and wait for something as an alternative. Yeah.
• 11:47
  So yeah, so I suppose many people, we've kind of touched on this, you know, there's people there that think this medication itself does all the work. Like you don't have to do anything else alongside it. So what role do you think education or do you, what's your opinion, I suppose, on, you know, people educating themselves in this and on, you know, what role does that ongoing support play in long term success? So obviously you've got fantastic maintenance plans. What's your kind of thoughts on that?
• 12:18
  I think education is so, so, so important, especially like the ongoing support that you need as well. But also, again, I keep going back to the behavior side of things. It's so important to go in with that mindset that, yes, medication is going to do maybe the 60% of the job, but I need to do the 40%. And a lot of that is going to be like actually keeping a focus on maybe eating enough protein, building muscle or maintaining your muscle, like how to build a daily routine, how to think about
• 12:38
  organizing meals and what is like smaller portions look like for you how to identify what my true hunger is or what is a response to an emotional trigger for instance you know all of this medicine is not going to fix that will just a little bit easier for you to control your appetite and reduce the cravings but a lot of the emotional side of things a lot of that real life situations where you're going out with your friends socially how do you change how do you maintain all of that that is something that you will have to teach yourself and that is something that you will have to learn yourself
• 13:04
  And again, when something goes wrong, for instance, or you stop losing weight and you've hit a plateau, how to deal with that or how not to give up those situations. So, you know, there is so much that goes into it. Again, when you've got to your maintenance, for instance, how what the next plan is, what are you doing next? Are you coming off the medication? Do you think this is something long term for you? So, again, it's about planning at that point as well. I've always said maintenance is harder than the actual journey on the route. So, you know, when you're getting towards maintenance and you would know this because you're on maintenance.
• 13:30
  You need so much planning because now you can't rely on the medication. And yes, medication is helping. But now this shift has changed. You know, now it's like 80% of you and maybe 20% of the medicine. Yeah. So I think, yes, medication can help lower the barriers, but the support is what builds the habits. Yeah. And I think definitely maintenance is something that, you know,
• 13:50
  People rarely talk about at the beginning. And I think, you know, people are coming around to the idea of what maintenance is. Like I get it all the time, you know, talking online and people are like, what's maintenance? What are you talking about? And I think it does really need to form part of that conversation at the very start as well. I think it's so important that people know.
• 14:06
  you know yes once you get to that point or get to your goal weight you know that's great but actually that's what you do after that that's that's so so important and I think for me it's something I never really considered whereas now I think definitely you know for me being on this journey now it's something I'm really trying to talk about more and and yeah I just think it's so it's so important if you do want to maintain them results so there's pharmacy due to maintenance
• 14:34
  does that look like with GLP-1s or without GLP-1s? To be honest, you're still correct in saying that a lot of the times when people are starting these journeys, they're not thinking about maintenance because a lot of the times they've tried to lose weight and they've never got to a point where they think, oh, actually, I'm here now. And, you know, as people who have suffered with obesity, sometimes they don't know what the end goal looks like or where is it that they will feel happy.
• 14:54
  they are just, the aim is just to lose weight. And they don't think as far as, okay, I've lost the weight, what happens next? And I think until you get really, really close to where you want to be, that's when you start thinking, okay, what's the next steps now? Do I have to come off the medication? Will I gain all the weight back? Am I ready for this? And I think this is why the maintenance conversation becomes so, so, so important because you've said it before, not everyone's the same. Not everything is going to apply to each individual. So the best thing you can do is maybe kind of listen to other people's stories, see what they're doing. Of course, like, you know, they can follow someone like you, understand what you're going through.
• 15:23
  Or they can just book a call with prescribers. Again, just understand, because from our point of view, we're dealing with thousands of patients who listen to so many stories. And honestly, every time I've spoken to a patient, I've learned something new. So, you know, we are constantly learning ourselves as well. So I can't expect any patient who's just started this journey to know the end results. In terms of maintenance, so maintenance is basically...
• 15:40
  All about, I've lost the weight, how do I keep this weight off? The last thing you want to do after this journey is to go back to that yo-yo habits of kind of losing the weight, gaining the weight, losing the weight, gaining the weight. That's not healthy for anyone. Especially when you go into GLP-1, sometimes because the weight loss happens a little bit faster compared to traditional ways, you do end up losing a little bit more of the muscle. So the last thing you want to do is lose all that muscle, but gain all the fat back when you're kind of gaining the weight again.
• 16:02
  So it's so, so, so important, again, just to build those habits up while you're on this journey. And then to understand you as an individual, are you someone who has struggled with obesity all your life? One of the best things would be to just look back into your childhood to say, actually, was I a bigger child? Did I struggle with that? Was it because of when I turned into a hormonal teenager? Or is it because of, was it triggered by my menopause? Or, you know, is it just because I've had...
• 16:23
  a bad episode of something currently in my life that's triggered me eating a little bit more. So if you are someone who struggled with obesity most of your life and you've gone through up and downs of cycles, then you know that there's a high chance that you are someone who actually has a chronic disease. And if that's the case, then that possibly means that we need to treat this disease lifelong or chronically long-term. And if that's the case and you feel like GLP-1s is the only thing that's actually helped, then possibly you may need to stay on the GLP-1s for a
• 16:48
  Again, this is something that's coming out of the research and media loves to say this. Oh, if you're on the LP1s, you'll have to stay on it lifelong. Unfortunately for some people, yes, that might be true, but that doesn't mean that we can stigmatize this. That doesn't mean that it's a negative reason to stay on the medication and not at all. Like people who have other lifestyle conditions such as diabetes, type two, there's hypertension, there's high cholesterol, all of those, yes, they can be dealt with medication. They can be also dealt with lifestyle, but that doesn't mean just because someone's off it that we, or audit for a long term, that we kind of say like, oh, actually you shouldn't be on it lifelong. Like, you know,
• 17:17
  to be on those medications metabolically for a long term. So same should apply to obesity. So if you are someone who actually suffers from the disease, then you can be on this lifelong. So that's one of the plans that we offer, which is called the CONTI plan, which is continuous use of medication. It's not necessarily of the same strength after anything like that. Of course, we can change the strength as your needs are. Ideally, yes, we want the patients to be on the lowest possible dose that will help them maintain without gaining anything, without losing anything further. So then we can kind of keep their weight within a good balance of what healthy looks like for that individual. Okay.
• 17:43
  Other patients we will have are people who possibly gained weight after, like I said, something happened in their life and they possibly just went through a bad period. But, you know, historically, they probably haven't dealt with ups and downs of weight loss most of their life. And that means, OK, actually, maybe biologically, they are able to maintain their weight and want to lose it, but they're not quite ready to come off the medication. So this is mainly for patients who possibly are on the higher doses.
• 18:05
  So if you're on the higher doses of medication, I wouldn't advise anyone to come off the medication straight away. We ask people to taper off the medication. Again, this is not done at a certain pace or, you know, there's no routine for this. It's very much a patient-led decision alongside us helping them decide what's correct for them. So if you're on the higher doses, we wouldn't advise you to go straight off the medication. We would probably say, okay, if you're on 15 milligram of Manjaro, let's try a 12.5 for a couple of weeks, months, and then possibly reduce it down to a 10. Then you can go to a five. And if you're coping well on a five milligram, then that means maybe you're ready to come off the medication and we can do it at a slower pace for them.
• 18:35
  that. Whether that takes you three years, three months, it doesn't matter. It's again at your own pace. If you get down to five milligram from 15 and then you're like, actually, I'm really struggling already, then you know that you're not ready to come off the medication and maybe we need to do that a little bit longer. So it's a little bit, a lot of flexibility still available, but it's more in the mindset that actually we are hoping to come off the medication at some point.
• 18:55
  And then when you're ready to come off the medication, we offer the last plan, which is the Flexi plan. I think this is probably one of my favorites because I love to see a patient try lifestyle on their own to see how things will go when they do come off the medication. However, what we do is we still offer them nutritional support. We still offer them prescriber support.
• 19:10
  They don't order any medication. They just try life on its own, try all the behavior changes they've made to see how things go. Now you can be on the Flexi plan for as long as you need to. And if any point you feel that actually I need to restart my medication because I'm really stuck to struggling or my weight is creeping up again, then you will be able to restart that medication at any point with us because you're under our supervision still.
• 19:29
  But then, you know, the dose and everything will just depend on how long the gap has been. But it just allows patients to, again, just try to see how things go. And even if your BMI is a little bit on the lower end, but obviously not high enough to restart treatment elsewhere, because you are with us on the supervision of a flexi plan, you will be able to restart medication.
• 19:44
  So yes, that's the three plans. I've been talking for ages. No, if anyone does want to understand maintenance a little bit more or find out about the plans that we offer, then they're all available on the website as well. So you're more than welcome to read about it or you can email us and we can kind of go through it as well. Yeah, that's just something that popped into my head that...
• 19:59
  I was thinking, because I have seen it and people do ask me this all the time, why on such a high dose? It doesn't necessarily mean you can't be on maintenance on them higher doses. What would you say to them people? Obviously, everybody's individual and everybody's different. So that's one aspect. Yeah, quite a bit.
• 20:14
  Yeah, I know everyone's got a different body. Everyone responds to medication completely differently. We've had patients who've been on 2.5 and they completed the whole journey on 2.5 because they've never had to increase their dosage and now they're maintaining on 2.5 as well. Doesn't mean that because that was their losing weight that they have to now lower the dose, you know. Same goes with 15 milligram. If this is what your body has accepted and body has adapted to and this is where you're getting the results, there's no point then forcing yourself to lower the dosage and not getting the results that you're required to maintain.
• 20:38
  Now, we are monitoring you. We understand that you're not doing this for the purpose of keep losing weight. You're not. And these stages are where you say, actually, if you feel that the higher dose is what's going to give you the control that you require to make those better decisions, then we will find a way to actually find that balance. Whether that's increasing your calories on the side, whether that's focusing your shift on maybe like the exercise side of things and maybe doing more muscle lifting than cardio and things like that. So again, that's where the support comes in to say, actually, how do we make sure this is the correct dose for you, but also it's the correct dose for you to maintain on?
• 21:06
  So you don't gain and you don't lose any further weight. And the funny thing is when they actually did the studies, they didn't have everyone drop the medication after they reached the goal weight. So after, you know, when they started, they had four groups of people. So they had a 5 milligram group, a 10 milligram group and a 15 milligram group. And everyone eventually started getting to the goal, you know, where they needed to be. And the last group of obviously was a placebo. Mm-hmm.
• 21:26
  And the 15 milligrams, they stayed on 15 milligrams. You know, they never were reduced at any point or they were not told that you have to stop now. They were still continuing on the 15 and it's perfectly safe to do so. So that's exactly how maintenance works. But again, if you can't tolerate it, then fair enough. You can see on the lower doses, not everyone has to get to the higher dose. But there's nothing to say that higher dose is way more, I don't know, stronger or more effective for weight loss. It can actually be used for maintenance too. Yeah.
• 21:50
  No, it's interesting because I'd seen that online. So I'd wondered where it had come from, but it's obviously that study, you know, because a lot of places or a lot of, you know, articles that I was reading, you know, talking about maintenance and saying that the maintenance doses were generally 5, 10 and 15. So I wondered where that had come from, but obviously it's that study that you were talking about. Yeah, it's just because they were the ones that were studied in long-term use and that's why they'd call the maintenance doses, but you can maintain on any dose at all. Oh, that's interesting. So I suppose just then,
• 22:16
  ending off that conversation, is it realistic to think that somebody could actually go on to maintenance without some sort of plan? What tends to happen when they do if they come off without that plan? Because for me, that plan has been crucial for me maintaining my weight. It just becomes really, really difficult to maintain the weight because as soon as you start to come off the medication, of course, within four or five weeks, the hunger will come back and it will almost hit you like a tunnel break. Yeah.
• 22:42
  Because you've not had that feeling for such a long time and all of a sudden all this hunger's back and, you know, the noise has returned and you just don't know what to do and how to deal with it because you've not had that plan or you've not got things prepared in the fridge for you to kind of, you know, snack on or eat properly or the potion controls are not there. So it's very easy to slip back into the older habits that actually gained all that weight in the first place.
• 23:01
  again, the emotional eating side of things, a lot of our patients unfortunately suffer from the emotional eating side of things. And again, if you have not dealt with that while on the journey, then unfortunately that can resurface. Fatigue can happen because you're eating, a rapid rise of like in your old habits, like I said, they can come back as well. So it's,
• 23:16
  You know, it's a scary way to put it, but I definitely think even if you're on a 2.5 and you're thinking of coming off the medication, you definitely need a solid plan to rely on because it's kind of replacing what you had with GLP-1 with lifestyle. But if you don't have anything to rely on, then unfortunately, very quickly people can reverse back to their older habits.
• 23:32
  crucial, I think, for anybody that is starting just to kind of know all this information before they kind of start, because, yeah, it's something that is talked about, but, you know, it's been key to my success. So there's definitely truth in it. So, yes, so kind of moving on then to the big topic of the moment, the black market and a lot of
• 23:50
  scary stuff happening. So, you know, we're seeing a lot of people sourcing the medication outside of the regulated channels. Why is the black market becoming such a big issue?
• 24:04
  I think it's like a combination of demand, misinformation, and accessibility. So people are seeing like these incredible transformations online. They're seeing that some people are talking about the higher prices, their shortages, their long waiting times. So sometimes people are just finding the easiest way to get access to this. That's probably number one side of things. I think another is a big bit of a controversial one.
• 24:23
  I think a social media kind of allowing people to normalize unsafe behavior is probably another reason. You know, we are seeing people who are influencers as such promoting these injections and selling like, you know, saying, oh, actually just WhatsApp me or DM me and I will get you like access to my dealer and things like that. They're almost talking about it as dealers. There's something, you know, we get a big,
• 24:43
  RetroTriot, for instance, it's not even in the phases of MHRA even approving it. But if you open your TikTok, open Facebook marketplace, you will see people selling this. And it's just normalizing and getting people so comfortable with seeing it again and again and again, that it almost becomes a norm and it's not seen as a black market product. It's just seen as actually, it's just there, let me just click it. So it's,
• 25:01
  It's a scary world we are in because pharmacies are so regulated and so tightened up. And then we compare that to availability in the black market, which is completely unregulated. There's no safety checks. There's no security. You know, there's no insurance to say that actually the product that you're getting is even real.
• 25:16
  But people are willing to risk it all because people do want to see the results. But at the same time, I always say this, you know, if you had a child and the child was ill and they needed some paracetamol or Calpol and someone just offered a bottle with just like no label on it and said, oh, yeah, this is Calpol. You wouldn't do that. Give it to your child. But why are people so willing to inject themselves with things which are not regulated, which have no correct labels? They'd have nothing on there to say that it's actually the real medication.
• 25:41
  The scary thing for me is it could be full of insulin, it could be full of anything in there. And if you're injecting yourself with this, you're actually risking it, you're losing your life. And then, but people are okay, people are just so keen to maybe just save that five pound extra, but they're just not worried about the risks and the harm that it causes as well.
• 25:58
  Definitely, definitely. I think the government needs to get involved. I think, you know, these platforms are doing their best by taking these things off. But a lot of the times because the pharmacies, which are more regulated, unfortunately, they get all the negative side of things, but unregulated stuff just stays. And it's making it harder and harder for us to kind of provide the education, you know, for pharmacies speak openly about it again, because the way that.
• 26:18
  even ASA and, you know, like promotions and things like that. As pharmacies, we can't openly talk about these medications and we can't show people the real way and what does it, you know, I couldn't go sit on TikTok and open a box of Majora and say, this is how it is. So because people are not getting the correct information, unfortunately, they're ending up with all the wrong information. So it's a scary world out there. But I guess the more we talk about it, maybe hopefully we can start educating people a little bit more on it as well.
• 26:42
  I know everything you've just said there is like totally, I think, like really, really important for anybody to hear. I see it all the time too, like doing social media. And it does really, it annoys me too, seeing all the, because I do everything the right way, what I consider the right way, and try to communicate that. And when you see people that don't, and they're still allowed to do it, it really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really,
• 27:03
  You get my frustration guys listening, but it really, really annoys me. But yeah, it's just, you know, it's one of them things. I definitely think the platforms themselves need, you know, they do, they are trying, I think, but I think there is more work that can be done there to try and limit the sale of that sort of stuff. Because I don't know, hopefully, hopefully in time that all that will...
• 27:20
  start to come down. But yeah, I suppose for anybody that is listening, you know, what are them? You know, we've talked about the risks, but what are them real risks? The unregulated, you know, counterfeit GLP-1s, you know, that people may not fully understand.
• 27:35
  Just to be honest, like what the active ingredients are, sometimes there may be no active ingredients. What if it's just water mixed with other bits and you don't know if you're just injecting water? What if there is too much of the active ingredient as well? Again, we don't know where the source of this is. So anyone who's currently selling retitutide, we have no idea what's inside it because no one's released the formulas for this. No one knows what actually goes into this. So how is anyone able to make a drug and sell it and say, you know, we've had people saying, oh, it's coming from EU, it's coming from China, it's coming from America.
• 28:01
  No one in the world has access to it. So there is not a single reason why that drug would be available in the market right now. And no one knows what the active ingredient will look like. So it's a possible mix of too much active ingredient of a completely different drug, which again is super scary. If the other drug is maybe, we don't even know if the other drug is a GLP-1. Sometimes, you know, we've come across syringes and things like that, which had insulin in it. So insulin is very, very scary if you're not a diabetic. Mm-hmm.
• 28:26
  And it's very unfortunate that, you know, some people do end up really, really poorly with it if they are injecting insulin when they're not diabetic and if they don't need to be. So, again, that can be something that we do often see in these drugs. And again, there is no safety associated with it. So we don't know whether there's a fungal growth in there, whether it's a bacterial growth in there. Like, what are the storage requirements for this? Are they keeping it in a safe place? So there's so much that goes into it. And it's just so scary to me that people are willing to take these drugs, which are provided to them in little vials.
• 28:53
  in the corner streets. You know, sometimes I just feel like, do people realize that they're sneakily going into their beautician who is hiding some needles in a pack of tissues and passing it on to you? How are you okay taking that? Like, do you not understand what you're doing? No, it's just, I think people really, really need to
• 29:09
  understand that you can become so ill with this because these are unlicensed products from unlicensed sources. No one is monitoring your dosages. You know, there is, it's not a, it's a very serious medication that requires proper titration, that requires proper monitoring of the side effects and the results. You know, even people who are on GLP-1 with us, we still have to educate them on like, you know, the side effects side of things, the dehydration side of things.
• 29:31
  even recognizing the signs of like low blood sugars and things like that so when you're buying these off random people they're not going to provide you that support and unfortunately if something goes wrong there is no one to blame but yourself so it's a very yeah it's a very scary thing that people are taking a risk with and if you're not thinking about yourself think of other people around you yeah no 100 it's so funny because i have a family member that's a biomedical scientist and i was explaining to her about what people were doing because she was curious about what i was talking about one day and when i explained you know what people were doing she was
• 30:00
  It was the bacteria in the needle and all that sort of stuff that just completely freaked her out. She was like, do people not know the things that can happen when you inject that kind of stuff into your body? People are sharing needles. Come on, we've all grown up knowing never to share needles. People are so happy to share needles. I had someone ask me, oh, I can't get the medication out. Can I drink it? Like, come on, people. Come on.
• 30:23
  it's just so so scary and like we can laugh about it but unfortunately it's it's a very scary world out there i think in the social media side of things you know social media plays a huge role in this and it's so important that people who are doing it properly are able to support but also provide the correct information out there yeah
• 30:40
  Yeah, no, totally. So we're nearly coming to the end of, again, what has been another absolutely fantastic episode. So really, I kind of just want to finish up with two more questions for you. So if you don't mind answering the first one really is one, I think for anybody that is listening, that maybe feels very, I suppose, unsure or maybe unsupported with whoever they're currently with or whatever, what steps would you, you know, encourage them to take right now?
• 31:07
  I think if you are unable to speak to your prescriber and if you feel that they're not supporting you, then that's not the correct prescriber for you. There are so many good pharmacies out there. Please reach out to someone who genuinely will listen and they care about you as an individual. So it's not hard. You can email, for instance, if you wanted to speak to someone at OUSH, you could just literally email, you can set yourself an appointment. You don't even need to be our patient to book an appointment with us to speak to a prescriber. It's all
• 31:31
  available there. And as pharmacists, number one duty for us is to look after a patient. So if you feel that you have been trying to get in touch with someone and you've never heard back from them or they're taking weeks and weeks to get back to you with not correct information or everything is chart GPT or automated, then that's not the correct support that you require, especially in the world of online pharmacies. If you went to your doctors and this is what doctors were doing to you, you wouldn't really continue to go to them again.
• 31:53
  So just know that if you are with someone and you started off with someone, it doesn't mean that you have to stay with them. There is a lot of great pharmacies out there who will be able to support your journey much better. Again, I think if you're buying it from your GPs and things like that, or if you have a local pharmacy and you feel like, actually, I want to sit down, just request a review, just say like, actually, could I have five, 10 minutes? I just want to speak through about it. Then you can do that.
• 32:14
  I mean, social media can be a great source of information as well, but just make sure that you do your own research. Please don't follow what everyone tells you online. You have to do your own research. Again, take control of yourself, understand what you're injecting. You know, social media sometimes can tell you all these scary things about like, oh, actually, I moved up really, really quickly. I'm getting faster results because I'm the higher doses. You know, just because it's working for them doesn't necessarily mean it won't work for you. So understand what your needs are, understand that your body is completely different and
• 32:40
  Just go with the mindset that actually you're doing something really special for yourself, but you have to put yourself first in all of this. And I've always said if you're getting side effects, if you feel like it's actually taking over your life or you're not getting, but you're not happy with it, then don't force yourself to stay on it either. So, you know, just know that prescribers, your pharmacist should be your number one. If anything goes wrong, just know that they should be available there. And secondly, just do your research yourself as well.
• 33:02
  That's really, really, really good advice. And I suppose then just on the other side of it, so we'll talk about people who are maybe on it. So anybody that is just considering it, you know, what advice would you give somebody at the very, very start of their journey? You know, what would be your top tip or tips for somebody that's just literally wanting to start right now?
• 33:21
  I would say start slow. Don't rush into this decision. Again, do your research. Be patient as well. I think a lot of the times we're seeing massive weight losses online and people compare themselves too quickly. So be patient, start slow, know that this is your own journey that you need to be on. Really utilize this time to build those habits. And you know, I can't put enough emphasis on this. We've spoke about behavior so many times in this call as well, but really, really take this time, utilize this opportunity to put new routines in.
• 33:46
  because you know the medication will quieten your hunger and it will help you do that this is probably the best time to do it this one time focus on your protein increase your steps don't just completely rely on the medication itself because it will become really hard for you to then change all these things around when you're closer to coming off the medication again it's such an expensive medication you don't really want to waste this opportunity not do it properly the first time because it's a guarantee that it will help or it will work the next time around
• 34:11
  So, you know, if you are really, really thinking about this, know that you have to put the effort in and know that you have to plan this out as well. Nutrition still plays a massive part and exercise still plays a massive part. Even drinking water plays a massive part. So do your research. Don't compare yourself to others. And always know as soon as you need help, please reach out to your prescribers.
• 34:30
  Yeah, well, all that's really left. Thank you so much for sharing all your knowledge again. And I think people will find real value in it. So, yeah, I really appreciate you taking the time to share that with us. And, yeah, for anybody that is listening that wants to reach out, I'll drop all the handles and stuff to you guys in the caption. And, yeah, people can reach out for support if they need it. And, yeah, all that's really left for me to say is thank you so much for joining me today. Thank you so much for having me. Yes. Thanks for having me.
• 34:57
  Hopefully we'll have a record to keep here with this one. So hopefully this one then for season two is going to be up there too. But I'll come back to that maybe on season three. But yes, thank you so much here.
• 35:06
  No, honestly, thank you so much. And I think the last thing I will just say is that the goal for this journey shouldn't be just to get skinny. It should be to get the healthiest that you can do. So and health is much more than the number on the scales. It's about you genuinely feeling the best that you can do. So just really keep a focus on that and stay positive. And sometimes it won't be as easy as what other people may make it seem like, but know that you will overcome it and there is enough support around you to be able to get to the results that you need to.
• 35:32
  But yeah, don't give up and stay positive. And again, thank you so much for having me and I look forward to our next season.