October 18, 2024 • 43 mins
For the final episode of the season, Francesca and Louise are discussing one of the hot topics of lifestyle and wellbeing at the moment - weight loss drugs. Ever since Ozempic hit the market in the US, it's all anyone can talk about - but how do these drugs work, and can you even get them in New Zealand?
To discuss this, they are joined by Professor Jeremy Krebs to answer all your questions.
See omnystudio.com/listener for privacy information.
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Episode Transcript
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Speaker 1 (00:08):
Hello, I'm Francisca Udkin and I'm Louise Area. And this
is season three of our New Zealand Herald podcast, The
Little Things.
Speaker 2 (00:14):
The podcast where we talk to experts and find out
all the little things you need to know to improve
all areas of your life and cut through the confusion
and overload of information out there.
Speaker 1 (00:23):
So join us today as we explore a topic that
has come up a couple of times this season from
two different healthy experts. From I suspect two different points
of view. Weight loss drugs, whether a zempic or any
other brand. They've been labeled miracle drugs. Are these the
answer to obesity and all the associated health impacts? Or
have they been appropriated by perfectly healthy people seeking to
(00:44):
shed a few kilograms?
Speaker 2 (00:45):
And I have a funny feeling the answer is yes,
both of those things. It's been more than six years
since ozimpak first became sort of this global phenomenon, or
it came onto the market. Celebrities who were bigger became slim,
Celebrities with slim have become impossibly thin, and we're hearing
all these sort of phrases like oceenpick face. They're all
being banded around. So these drugs have been used to
(01:08):
manage conditions like diabetes for many years, but suddenly it
is everywhere as a weight loss drug. It has been
said it could be as significant as the introduction of contraception,
or as revolutionary as the invention of the mobile phone.
Speaker 3 (01:24):
God, it's a bit tiring, isn't it.
Speaker 2 (01:25):
I know, well, it is a really intriguing topic because
I believe it could completely and utterly change health systems.
It could allow them to work so much better and
so much more efficiently. It could give New Zealanders with
an obesity problem a much better quality of life. It
(01:47):
could have a huge impact on people who really need it.
Not worried about them, worried about the ones that probably
don't quite so much need it.
Speaker 1 (01:55):
Yeah, and look, you know, not judging anybody. Do what
you need to do for your I am as intrigued
as you are, and I'm really on the fence. I
just I personally wouldn't take a drug I don't need.
That's for me because we still you know, there's probably
still a lot to find out.
Speaker 3 (02:13):
I'd want to know a lot more about it. I
want to know, you know.
Speaker 1 (02:16):
I just sort of think and we have talked about
menopause await game. We're not either of us are fans
of it. No, but we have also had expects on
the show who have shown us the way there too,
to you know, what we actually need to do to
kind of get rid of that middle tummy fat. But
if I was pre diabetic, that could be a different story.
Speaker 2 (02:36):
Yeah, No, Okay, So we are going to get to
the bottom of kind of what is available in New Zealand,
how you access it, who it's for, who should take it,
what the risks are we going to get all this
information from. Professor Jeremy Krebs now Doctor Krebs is an
intercrinologist with a specialist interest in obesity and diabetes. He
is the clinical leader of indo Chronology and Diabetes at
(02:56):
the Capitol and Coast District Health Board, where he leads
the research. He's also professor at the University of Targo
and part of the Edgar Diabetes and Obesity Research Center.
Speaker 4 (03:06):
He joins us.
Speaker 2 (03:07):
Now welcome, Professor Krebs. Thank you very much for joining
us on the little Things.
Speaker 5 (03:11):
Thank you very much for asking me to join you.
It's a very interesting topic.
Speaker 2 (03:14):
It certainly is, and maybe we should start with the
medical application of weight loss drugs, who they're aimed at,
who they're right for, and who they're help with.
Speaker 4 (03:24):
Looking at what's been available up to.
Speaker 5 (03:26):
Now, sure, well, I think probably the first thing to
go back to is why would you want to prescribe
someone a weight loss drug? And that really stems from
the fact that being over weight or obese increases your
health risks for a number of outcomes, including diabetes, cardiovascular disease,
(03:47):
joint problems, fertility, all manner of health outcomes that are
related to being overweight, and increasingly it's been realized that
actually trying to help people to lose weight is very
fundamental to reducing those risks and improving those people's outcomes.
So that's the why of what we'd want to do.
(04:08):
The difficulty has been over the last forty or fifty
years while people have been trying to achieve that from
a medical perspective, is finding a medication or a drug
that is effective and is safe. And we have a
legacy of weight loss drugs that have come and gone
that have either not met either of those bars. And
(04:31):
I think why there's so much excitement around this new
class of medications is because it does really appear to
seem to meet both those briefs, which is great.
Speaker 1 (04:41):
So we produce glucagon like peptide ourselves, right.
Speaker 5 (04:46):
That's right. So glucagon like peptide one is a hormone
and it's made in the lower small and testine and
it's released when we eat food and that does a
number of important biological functions. And it was discovered that
GOLP one was important in terms of glucose regulation in
(05:10):
the body, and that was how these agents were first
discovered and developed up because what they do is they
stimulate the release of the hormone insulin, which people will
be very familiar with from the pancreas when food is
eaten and is passing by the pancreas and through the liver.
(05:31):
And so it was realized that this hormone GLP one
wasn't doing its job properly and people that had type
two diabetes, and so trying to harness that biology was
how these medications were first developed. And they're very effective
at that and they're an important part of our armory
(05:52):
for managing type two diabetes.
Speaker 1 (05:55):
So this development of something that mimics it is that
something that in them is in the most recent weight
loss drugs. That is news. Se glue tide is that
the new innovation and weight loss.
Speaker 5 (06:08):
Drugs, that's right. So sema glue tide is the name
of one of these drugs and they belong to a
class of drugs called GLP one agonists. Now, what that
means is that they work in the same way as
our natural hormone GLP one. But the important difference about
these medications is that they have been altered in the
(06:29):
laboratory so that they don't get broken down by the
enzyme in our body that normally breaks down our natural
GLP one. And that's very important because the GLP one
that we all make is broken down very very quickly
by an enzyme in the body, and so to bypass that,
the clever drug companies have altered the protein structure and
(06:53):
made these this class of medications and they're all very similar,
but they do have some differences. In semi glue tide
is one example of that.
Speaker 2 (07:02):
Jeremy, you mentioned before the issues that come with obesity.
So here we have the strug that could work. Could
this be a game changer for the health system?
Speaker 5 (07:10):
That's the burning question, really, isn't it? I think what
we know is that not only at an individual level,
but that at a societal level, the cost of obesity
is enormous. It places burden on individuals, on their well being,
their productivity, It places enormous burden on the healthcare system.
(07:34):
And therefore, anything that can turn around this juggernaut epidemic
or whatever you want to call it an obesity would
surely seem to be a good thing. And so if
we have a class of medicines which are safe and
effective in that, then yes, it absolutely could be a
game change. I think there's a few thorns in that potentially.
Speaker 2 (07:56):
And that's probably a good moment to actually find out
what we do have available here at the moment in
New Zealand.
Speaker 5 (08:04):
So, as I say the GLP one hormone or agonists,
there is a class of them, and semi gluetide is
one that's perhaps received the most attention, and that's because
it has been used widely in America, particularly by celebrities
and people like Elon Musk. But there are earlier forms
of this class of medication, ones called gelaglatide. The other
(08:29):
is called leraglatide, and they have been licensed in New
Zealand for the management of diabetes, and in the case
of liraglatide has been licensed for the management of obesity.
Semagluetide has been licensed here for diabetes but not for
weight loss, but simply isn't available in New Zealand. The
(08:52):
two medications in this class that are available are laaglotide
and dula glutide, but they are very difficult to get
hold of anyoney.
Speaker 3 (09:00):
Sorry, So the brand ozen pic is that which is
which one.
Speaker 5 (09:04):
Is slues IDEA. So I get very confusing, doesn't it.
Because medics, like me, we like to talk use the
actual proper drug name, and of course they get marketed
under a brand name, and that brand name can even
be different in different countries. And in the case of
the ragulatide, for example, it's branded as sex Ender is
a weight loss medication, but as a Victosa for a
(09:27):
diabetes medication, same drug, just branded differently.
Speaker 1 (09:31):
Yeah, I think we're getting to the point where it's
going to be like band aid or one of those
you know those, if it was going to just calling
it ozen pic when it may have some of the
same active ingredients but it's a different product.
Speaker 2 (09:42):
And to clarify, do we have ozempic available in New
Zealand at the moment.
Speaker 5 (09:45):
No, okay, no, it has been licensed for diabetes management,
not funded, but it's not even available. The company is
simply not even bringing it into the country. Corst Why not, Well,
it's because of Elon and his mates in in America. Basically,
there is a worldwide shortage of this whole class of
(10:06):
medication and that's had massive impacts for us. Actually because
the people with type two diabetes have waited for over
a decade to get access to funded medications of this class,
which are incredibly effective, and because they're all made in
the same factories. Basically that there is a shortage of
(10:27):
even these older agents which we can't get our hands
on enough of them for those with diabetes.
Speaker 2 (10:33):
So, Jeremy, if I went into my GP and I said, look,
I'm seriously concerned, I'm obase. What are the drugs that
are available to help me? What are the names that
they will offer me? The brand names that's available in
New Zealand at the moment.
Speaker 5 (10:46):
The only medication of this class that's a licensed for
prescription for ob city management is Saxender, which is leraglatide. Now,
the other medications so juda glue tide. It could be
used for weight management, but it would be off license.
Speaker 3 (11:04):
So you'd be paying privately for it, do you mean or.
Speaker 5 (11:08):
So, yes, you would be paying privately for either of
those medications. There is no funded weight loss medication in
New Zealand.
Speaker 2 (11:15):
And then if are okay, So even if you your
GP prescribed you the sex cender, you're still paying for.
Speaker 5 (11:20):
That, absolutely, and it's about five hundred dollars a month.
Speaker 1 (11:23):
And we didn't even go past this. It's not a pill.
Is that it's an injection?
Speaker 5 (11:27):
Correct? Yeah? So all of these medications, because they are proteins,
if you take them by mouth, they rapidly get digested
by the stomach acids and so therefore they are almost
always given as an injection. The companies are working on
ways of giving it as a tablet, and indeed semi
glue tide is available as a tablet internationally, but you
(11:50):
have to give something like fifty times the dose of
it to get it through the through the stomach acid.
So essentially these are all injectable agents.
Speaker 2 (11:58):
So what are some of the known side effects when
it comes to the weight loss drugs that we know about?
Speaker 5 (12:05):
What I didn't say earlier, is that in terms of
the mechanism of GLP one agonists, which is why they
are used as weight loss medications, the two principal actions
are feeding back to the hypothalamus in the brain to
turn off appetite. That's its fundamental action. And the second
thing is to slow down what we call gastric empty
(12:27):
in other words, how quickly food is emptied from the stomach.
And so you could imagine that one of the most
common side effects therefore of this class of medications is
nausea or vomiting or abdominal discomfort. Those are really the
principal side effects of this class of medication.
Speaker 1 (12:47):
I have heard somebody describe it as feeling in those
early stages of pregnancy like morning sickness quite a lot
of the time, which I could say, yeah, is quite
hard to eat through morning sickness, isn't it?
Speaker 2 (12:59):
Absolutely Yeah, I wouldn't want to go back to morning sickness.
Speaker 4 (13:05):
Long term impacts do we know what they are?
Speaker 2 (13:07):
I mean, obviously there's been a lot of study around
these drugs to do with diabetes, but is there any
difference when it comes to weight loss?
Speaker 4 (13:12):
Using them for weight.
Speaker 5 (13:13):
Loss, Yeah, that's where things get tricky, I think, because
the short answer is no. All of the clinical trials
that have been done with these medications, in what are
called randomized controlled trials, were you're comparing it to a
placebo or a dummy drug, which is the gold standard
of testing. These things only go out as far as
two years or five years at most, and therefore we
(13:36):
simply do not know what the implications of someone taking
this medication for ten years, twenty years, which is conceivably possible,
We don't know that at all.
Speaker 1 (13:48):
So and on that note, do you have to keep
taking it to keep it? Doesn't do any permanent change
that we're aware of that would help you keep weight
off once you stop using it.
Speaker 5 (14:00):
That's an extremely good point. The short answer again to
that is no, you do need to keep taking it.
But I think individuals people that struggle with weight struggle
with weight for all manner of reasons, and so I
think there would be some people who might find that
after a year two years of using one of these
(14:20):
medications they've been able to reset all of the things
that are contributing to their weight being high and might
be able to keep that off in the long term.
But I think what's critical is that if you made
a choice to go onto these medications to control your weight,
you shouldn't expect that that would be the case. This
is not a I can take it for a month,
(14:41):
six months, fix the problem, and come off them and
it's gone away.
Speaker 2 (14:46):
Because we had a friend who said to us, can
you just find out if I take it for like
a year or so and I use it really to
sort of kickstart my new regime, and when you dart
my new exercise program and then I come off it,
will it work.
Speaker 5 (14:59):
Yeah, So that's the point. Yes, it will help you
to get to that goal. But unless you fundamentally are
able to change the behaviors that have driven the weight
in the first place, then it's going to come back on. Now,
that's not necessary to say that that is a totally
wrong thing to do. Now, let's you know, for example,
if you are a person that it has pre diabetes,
(15:22):
you're in that stage where you're almost going to get diabetes,
and you can get fifteen kilograms of weight loss, that
diabetes is going to go away. It's going to go
into remission. It's going to stay away. Now, it might
still come back ten years later, but you've bought yourself
a lot of good health in that process. So I
don't want to give the impression that we shouldn't do this,
But it's just that you mustn't go into taking these
(15:45):
medications expecting that it's a quick fix and a permanent fix,
because it's not.
Speaker 3 (15:49):
Yeah, and I do worry a little bit.
Speaker 1 (15:50):
I think you know, it depends on the soup piecewomen, Right,
If you're living in an environment where access to healthy,
good nutritious food is difficult, or you're working a couple
of jobs, you know, to keep the family afloat, you
can't necessarily change everything about your life to engineer a
better result for your health. So there will be people
(16:13):
for whom this is the potentially the perfect answer if
they can, if it can be funded, and if they
can get it.
Speaker 5 (16:20):
Look, I totally agree with what you're saying, and I
think that's the essence of These are expensive drugs, and
you know supply and demand under such the drug companies
aren't going to reduce the costs anytime soon. They can't
keep up with the demand, and so they're going to
remain expensive probably, I think until they come off patent
and you get companies elsewhere in the world that are
(16:41):
able to make them in bioequivalents.
Speaker 1 (16:45):
It's also that investment thing, isn't it If it's costing
us heaps? If obesity is costing us and the health
system a hell of a lot of money, are we
better to front end it with something like this?
Speaker 5 (16:54):
That's right. I mean you only have to think, you know,
you prevent one hip replacement event, one person developing diabetes
and going onto dialysis. You reduce the whole kind of
metabolic risk that's happening for women during pregnancy that then
gets translated into the next generation. You know, there's there's
lots of good arguments you can make for it, but
(17:17):
you know, gosh, health systems are pretty creaky at the moment.
Heading on, what about.
Speaker 3 (17:23):
Compared to the cost of beriatric surgery though.
Speaker 5 (17:25):
Yeah, so that's that's another interesting we I often have
this conversation with patients because the crossover point is at
about ten years. If you if you've fund these self,
fund these medications at about ten years, you will have
been better to have paid for the full cost for
your bariatric surgery.
Speaker 2 (17:45):
Okay, but what about also the nature of bariatric surgery
as an intervention compared to taking an injection in a drug.
Speaker 5 (17:54):
Yeah, so it's horses for courses, isn't it. I I
think yeah, bariatric surgery as the best long term evidence
for sustained weight loss and improved health outcomes, and that's
because we've been doing it for longer and we've got
better long term data. It fundamentally changes a person's life.
(18:14):
I mean, I don't have to tell you guys, and
your listeners will know that. If you suddenly have a
stomach that's the side of your little finger, then that
changes your whole life in terms of what you can eat,
when you can eat, who you can eat, with all
of those social things as well. Whereas with an injection, yes,
(18:35):
it reduces your appetite, but you can generally speaking eat
a normal type of diet and socially interact in that way.
You're just not as hungry and you eat less of it,
so there's less impact I think in some of those ways.
But again, as I say, what we don't know, We
simply don't know what the outcomes for people taking a
GLP one. Again it's for ten years, fifteen years, twenty
(18:56):
years are Whereas we do have those data for directric surgery.
Speaker 1 (19:00):
Maybe by the time it's funded in easialinal who have
better data.
Speaker 2 (19:06):
Possibly Jeremy, Is there anyone who shouldn't take a weight
loss strike?
Speaker 4 (19:11):
Are there any risk factors that we should be aware of?
Speaker 5 (19:14):
So when it comes to this class of medicines, there
are two groups of people that we need to be
very careful about. There's a very rare form of thyroid
cancer called medullary thyroid cancer, and it was found in
the early development when the rodent studies were being done
with this class of medicines, that rats were more likely
(19:37):
to develop this type of cancer, which is very strange.
It is no particularly good biological reason why that would be,
and it needs to be remembered that in those early
stages they are exposed to ten twenty one hundredfold doses
of compared to what we use for humans. Nevertheless, there
is that slight concern probably more commonly because that's a
(19:58):
very rare condition. More commonly is the issue of pancreatitis,
so that's an inflammation of the pancreas, and there has
been some data to suggest that this class of medications
can cause pancreatitis. It's quite debatable, controversial, but nevertheless, if
someone's had a history of pancreatitis, particularly recurrent pancreatitis. We
(20:21):
would be very nervous about prescribing these medications for them.
Speaker 2 (20:25):
You're listening to the little things and I guess on
the podcast today as Professor Jeremy Krebs, DTOR. Crebs is
an interocronologist with a specialist interest in obesity and diabetes.
We'll be back shortly after this break. As middle aged women,
we're quite keen on our lean muscle mass.
Speaker 4 (20:43):
What does it do if you've got.
Speaker 2 (20:44):
On a weight loss drug and you're losing all this
weight and I know that ozen Peck promotes that you
lose up to fifteen percent of your body weight.
Speaker 4 (20:51):
Do you lose muscle?
Speaker 5 (20:53):
Whenever someone loses weight, they lose both lean mass and
fat mass. OK, so yes is the answer. You do
do some lean mass. What you want to do is
to try and preserve that lean mass as much as possible,
and the best way to achieve that is to maintain
your physical activity. And you know, one of the bonuses
I think for people who are trying to lose weight
(21:15):
and struggling is that it's quite hard to exercise when
you're overweight. Absolutely, and as your weight comes down your
capacity in your enthusiasm and your enjoyment of exercise actually increases,
and so therefore that makes that possible. So that's the message,
really is that as you're losing weight, really work hard
to maintain your physical activity.
Speaker 1 (21:38):
Hey, maybe again I'm just grasping its straws here, but
I have also heard that the drugs that mimic GLP
one can reduce the release of the dopamine we get
when we eat but also when we drink alcohol.
Speaker 3 (21:55):
Is there any can you talk to that at all?
Speaker 5 (21:59):
I can't talk to it. And two of the quality
of the science around it, but certainly there is some
there's a small amount of evidence and certainly anecdotal reports
of that. And that's probably because the GLP one is
acting in the same areas of the brain where the
positive effects of alcohol are working, and it interacts with
(22:20):
that path those pathways in the brain. So certainly I've
seen that that information and there has been some evidence
that that's the case.
Speaker 1 (22:29):
I'm listening to you, and I'm still always fascinating because
we know this. We've talked to lots of experts about
this as well. Over the course of the three seasons
of the little things, but that relationship between the gut
and the brain, it's undeniable.
Speaker 5 (22:42):
Right, absolutely absolutely. I mean there's we could go off
into a whole different tangent around the microbiome and you've
probably had had sessions on this, but that's another very
fascinating area where there's a link between the gut and
the brain. There's these hormonal links that include g'll P one.
There are other hormones as well, but it's a very
(23:03):
strong and very potent interaction and relationship.
Speaker 2 (23:06):
Absolutely so aside from just finding a way to drink least,
which is something that Louise is often interested in, I'm not.
Speaker 3 (23:14):
I'm not that much of a better I'm just he
protests us too much.
Speaker 2 (23:19):
The other thing you're quite interested in, Louise is micro
dosing as well.
Speaker 1 (23:23):
Oh well, no, I just people have when we've talked
about this, a monkstands and so do you reckon? You
can microds o zempic and I don't know because it
comes in a vial, right, presume you have to use
the whole thing or just a little can you use
a little bit of it?
Speaker 3 (23:37):
It seems like a very expensive exercise to me.
Speaker 5 (23:40):
Yeah, yeah, look, I probably don't want to get drawn
in on that. That's that's extending out towards witchcraft as
far as I'm consented, right, the I mean the clinical
trials has been done for a reason that these drugs
are developed up with dose ranging studies to find out
what the men are effective doses are, what the maximum
(24:02):
effective doses are, and then finding the sweet spot of
all of that, and that's why we end up with
the regimens that we end up with.
Speaker 1 (24:10):
She's not at all dodgy, I promise you no, I
don't know. I'm not microdizing mushrooms or anything, Jeremy.
Speaker 2 (24:17):
I think what it comes down to it is we
hear so much about how much good this can do.
You know, we had doctor Kara Wozziwitch on Cardiologists talking
about how it could revolutionize healthcare when it comes to
health in New Zealand. But you know, it's not funded,
so I worry about access for those who need it
(24:38):
and could hugely benefit from it. At the same time,
if you've got the money and you want to pay
for it, there's potentially people who don't need to be
on a drug for the rest of their lives who
are accessing it.
Speaker 3 (24:50):
It's a bit dystopian.
Speaker 4 (24:52):
Really, yeah, it is.
Speaker 2 (24:53):
I can't quite work out how I feel about these
drugs because I think that they could be just play
such a major part and us having New Zealand is
having healthier lives and us having a better health system.
But at the same time, the way it's all kind
of unfolding, it's kind of creating this two tiered health system.
Speaker 5 (25:12):
It's a really interesting philosophical discussion, this isn't it, I think.
And we're caught up as a country and a global
market for this. And as I mentioned before, finally farmac
are funding these agents for people with diabetes who for
whom there's enormous evidence of the benefit of them, or
(25:35):
not only diabetes control, but also heart health and kidney
health and all of these things. And yet we can't
even get them for those people for whom we are
prepared to fund them. And that's because of this global pressure,
which is exactly what you're talking about, where people who
can afford, who do have the means, are paying for
them and you know, questionably may or may not be benefiting.
(25:58):
You know, I think there's real benefit for people who
are significantly obese to lose weight with these drugs, but
you'd have to really question the use of them for
people who are of normal weight or close to normal weight,
using these agents just to get into their you know,
one size less stress for their daughter's wedding type concept.
Speaker 3 (26:19):
Oh yeah, yeah, exactly.
Speaker 1 (26:20):
So in terms of prescribing it, who can prescribe these things?
Like a like frontis much of the GP before, But
do you are they able to prescribe it?
Speaker 5 (26:31):
So any any medication that's licensed in New Zealand can
be prescribed by the health practitioners. So absolutely we can
prescribe them. As I say, at the moment, the problem
is that even if I gave a person a prescription
for semi glue tide, they wouldn't be able to get it.
It's not actually in the country.
Speaker 3 (26:47):
That will frustrate them.
Speaker 1 (26:48):
Men a pausal woman trying to lose some weight because
you can't get a right shirty.
Speaker 5 (26:51):
I was going to say, they'll be learning about the
pharmacy with swords for the hid as well.
Speaker 2 (27:00):
We'll all be sharing it like we do with the
HRT cutting up patches.
Speaker 4 (27:03):
Here's half I share my injection with you. I mean
we really shouldn't laugh.
Speaker 2 (27:10):
About it, but I mean we have heard of menopausal
women who are using it to help weight.
Speaker 3 (27:13):
Gain in life.
Speaker 4 (27:14):
Would would you recommend that from a medical point of view?
Speaker 5 (27:18):
Well, it's a very interesting concept, that isn't it Because
unquestionably one of the problems that women face with menopause
is weight gain, some women more than others. But it
is something that happens and is observed and then carries
with it those health consequences as well, And if you
could predictably prevent that, then you could make the argument that, yes,
(27:42):
that would be a good thing to do. There may
have been, but I'm not aware of a study which
has specifically asked that question. Because I think that's what
you'd want to do, is to actually take a group
of women at the sort of perimenopausal stage and randomize
them to receiving one of these drugs or not, and
then actually demonstrating those benefits before you could make a
(28:04):
public statement about it.
Speaker 2 (28:06):
But there's a thing, you see, you'd be so gutted
you'd know how quickly would you see a difference in
your way if you started taking it. How quickly would
you know, oh, I'm on the Blasibo, Well I got
the drugs.
Speaker 5 (28:18):
Yeah, you begin to see within two to three weeks,
and because predictably the side of the nausea does happen
upfront and often will settle down after a few weeks,
but predictably people do get some nausea at the start.
And so when we were lucky enough to be a
(28:39):
site in Wellington for some of the early controlled trials
for these drugs and diabetes, and it was although we
were blinded to who was on what, it was very
obvious very quickly as to who was on the active agent.
Speaker 3 (28:52):
So no good placebo effect with that one.
Speaker 2 (28:54):
Then, sadly not, I think probably the one reason why
I wouldn't consider a drug like this, and this is
just my personal opinion. Is I really enjoy food. I
enjoy eating, I want to savor a beautiful meal, or
appreciate the fact that my children cooked me a meal,
or I like I don't. And what I hear from
(29:15):
people who are on it, they're like, oh, you have
three or four bites of food and you're kind of
done all of a sudden. Food isn't It feels like
food isn't really part of your life anymore. Is that
a good description of it?
Speaker 5 (29:28):
That's a beautiful description of it. It is very variable.
So I've had people say exactly the same sort of
phrasing that you've expressed there and converse here. I've had
others who have said, look, it's made absolutely no difference
to my appetite.
Speaker 1 (29:42):
Wow, and they still lose weight.
Speaker 5 (29:45):
But some of those people do still lose weight, they
are subconsciously not eating as much. But then you have
those people like you've just described, where they're very aware
of the effect that's had on their appetite.
Speaker 1 (29:59):
I think it will penned on the cost benefit though, Francesca.
If you're only looking for five keyloads a weight loss,
you go while I still I don't want to not
enjoy my meals five. If you're looking at you know,
a kilos, it's it's probably a little bit different. I
have heard that that has wiped off some of the
profits that restaurants and things are making because people in
(30:23):
La for example, are eating less.
Speaker 5 (30:25):
They're probably drinking best too, which is where most of
their profits.
Speaker 4 (30:28):
Yeah, and that's the thing.
Speaker 2 (30:30):
You know that brands like Ozenpek have made a name
for themselves due to such high profile celebrity use.
Speaker 4 (30:38):
Is that profile and awareness a good thing or a
bad thing? Do you think.
Speaker 5 (30:42):
Again. I think that's an interesting philosophical question, and it's
a double edge to it. I think that anything that
increases the awareness of the health consequences of being overweight
and the potential pathways to reduce that is a good thing.
But where it's used potentially, where that profile potentially means
(31:07):
that people are reaching for it for a few kido's
weight loss. Here as I say, to get into the
address with the daughter's wedding or those types of scenarios,
then you have to say, well, that's actually not socially
a good a good thing that we're seeing.
Speaker 2 (31:22):
Jrummy, do you know I have any black market supply of
white drugs? And New Zealand, said exerts.
Speaker 5 (31:28):
Quite possibly. No, I'm not aware. But if you've got
any context, I shouldn't say that that was ri I
withdraw that comment fair enough.
Speaker 1 (31:39):
It probably wasn't a fair question either, I guess, but
we were curious. I mean, it's black markets plus for everything, surely. Look,
it's just it's I think you're right. I think this
is a philosophical question. Almost everything you know about this
is kind of deeparly philosophical. But I guess my angel
and devil on each shoulder is and you know, I
(32:01):
really do get concerned about those who would like to
access or who need to access and at the moment
in New Zealand anyway, and we do seem to be
how many other first of all, countries are there that
aren't funding this because I feel like they are in Australia.
Speaker 3 (32:13):
I could be wrong.
Speaker 5 (32:15):
I so certainly they're funding this class of medications for
diabetes and we would have to be one of the
last countries to do that. I'm not aware whether they're
funding it for obesity are.
Speaker 1 (32:29):
Yeah, that might be the key point. And that's something
you've clarified beautifully for us today.
Speaker 4 (32:34):
Yeah.
Speaker 2 (32:35):
I was reading in the UK, I think it was
the House Secretary has just announced that he thinks that
ozimpac could be a brilliant way to get people back
to work and he would like to use it on unemployed.
Speaker 4 (32:49):
How do you feel about that.
Speaker 5 (32:51):
That this morning?
Speaker 1 (32:51):
Yeah?
Speaker 5 (32:52):
I mean I think it's really fascinating, isn't it. And
if you could be specific and quantify the extent to
which obesity was preventing people getting back to work, then
you could, you know, you could drill down to that
discussion and argument a bit better. I think it's it's
slightly political speak that statement, but not beyond the realms
of what might be a good public health measure. Potentially.
(33:13):
I'm not saying we should, but I'm saying potentially. I
think you need to drill down to it a bit more.
Speaker 1 (33:18):
First, Yeah, no, I won't get on my high horse
about the food food chain, supplies and availability of healthy
food to people, you know, from every socioeconomic group. I
just to get on my high horse. But I hire
the ambulance at the bottom of the cliff, you know.
Speaker 5 (33:34):
Yeah, yeah, yeah, Look, I join you on that horse
by the way too.
Speaker 4 (33:37):
You howd to put your foot in the stirrup and
thought about leafing front?
Speaker 5 (33:41):
You know?
Speaker 2 (33:42):
I hear also ozenpeck gets rid of fifteen percent of
body weight. There are two more drugs which are about
to come out. I think one is branded Mingaro. They're
claiming they're going to get rid of twenty percent. Then
there's Triple G which is apparently going to be out
next year, which is claiming to get rid of twenty
four Are we heading into dangerous territory here?
Speaker 5 (34:05):
Yeah? Even better question. So those new drugs ones called
ta zeppatide, and I can't quite remember the name of
the other one, but they are slightly different to the
ones we've been talking about today. So the ones we've
been speaking about act purely on the GLP one glucur
and like peptid one receptor. As I mentioned earlier, there
(34:27):
are other gut hormones that are involved in food regulation.
And what these newer classes of agents are doing are
combining agents that are working on different hormone receptors, and
we're going to see more of these coming out. And
by doing that, you are increasing the potency or the
(34:48):
effectiveness of the change on body weight. And you're absolutely right.
So the newer classes are now up to that twenty
five plus percent weight life loss on average in the
clinical trials. And it's not everybody, of course, but you
know you're getting you're getting a quantum again greater weight
loss that takes you into the territory of what you
(35:11):
see with a gastric bypass operation barretric surgery, and so
you were really then getting equivalent weight loss with a
medication that we've never had before. Again, who knows what
the implications of that is. After five years, ten years,
fifteen years, we simply don't know it's crystal ball gazing,
but it does open up another whole avenue of research
(35:36):
and questions.
Speaker 3 (35:36):
You know.
Speaker 1 (35:37):
Yeah, it's fascinating, and I guess you know, we've just
looked to Hollywood to see what happens in five, ten,
twenty years.
Speaker 5 (35:45):
Maybe that's our study, that's our I think.
Speaker 2 (35:49):
I think it probably is where you would get your
cohort from. But you see that that in itself I
find really depressing. We have been fighting for so long
to encourage people, and I'm not talking about people with
health issues and obesity, but the general population. It's absolutely
fine that we all look different and we all have
different bodies.
Speaker 4 (36:05):
We've worked so.
Speaker 2 (36:05):
Hard to get to that place where you're just comfortable with,
you know, being a healthy weight, and I feel like
we're throwing this sort of Yeah, as I said before,
I feel really positive about what it can do for
the house system, but then I feel like we're just
throwing this bomb into the middle of the population.
Speaker 4 (36:19):
Just who knows what in Peper's going to have.
Speaker 2 (36:22):
Absolutely, yeah, Jeremy, I know that we had to drag
you onto this podcast, so I am hugely grateful that
you that you have come on board because that information
is excellent. We now have a really good understanding of
what's available in New Zealand and how it works and
things and lots to think about around this.
Speaker 4 (36:39):
Thank you so much.
Speaker 5 (36:40):
You're very welcome, and I very much enjoyed the conversation
having been dragged to these.
Speaker 3 (36:46):
We really did. Thank you so much.
Speaker 2 (36:54):
How great was it having Professor Krebs with us today.
What a nice guy, really nice and just such a
good communicator of the information. And it's just kind of
explained where we're at because we're hearing so much about this,
but it's a lot of it is coming from global
media and news and celebrities, so it's nice to kind
of get a bit of an idea about what is
actually happening here in New Zealand, what was available.
Speaker 1 (37:15):
I was super grateful for explaining the setting in New
Zealand because it actually wasn't what I expected. I assumed
that we had some funding for obese.
Speaker 4 (37:27):
People if they need.
Speaker 2 (37:28):
We're not struck totally, and we should write. I believe
we should, and I think that there should be standards
in place for when people's lives are unable to live
a healthy, productive life, and it is impacting on their heart,
their limbs and fertility, all the things that Jeremy had mentioned,
that we should be able to provide them with an option.
Speaker 4 (37:50):
And I say it's an option.
Speaker 2 (37:51):
It's totally up to an individuals to whether they want
to actually go down that path and take it.
Speaker 1 (37:55):
Oh absolutely, I mean there is I know that you
do have to for some people, they have to lose
a certain amunt of wakeful. They can even have gastric
sleeve or beriatric syndery. And I'm kind of late, well,
where does it leave those people when there is something
available that works.
Speaker 2 (38:09):
Big farmer anyway, Big Farmer. And it was interesting too,
that whole the supply and demand. I've heard a lot
about this that and this is the thing. You know,
those who can afford it are accessing it and raving
about it, while the majority of us it's just.
Speaker 4 (38:23):
Gone for another run and there's nothing wrong with it.
Speaker 3 (38:27):
Oh no, God no.
Speaker 1 (38:28):
And I mean I think that is one of my
concerns is health and wellness. You know, for a lot
of us should start with going for that walk or
lifting those weights or whatever it is, or reducing our
intake of fatty foods or alcohol, whatever you know, I don't.
Speaker 3 (38:43):
That's my other concern about this, is it.
Speaker 1 (38:45):
So yeah, it is a deeply philosophical issue as we
discuss more and hopefully when we can talk about again sometime.
Speaker 4 (38:51):
I hope.
Speaker 5 (38:51):
So.
Speaker 2 (38:52):
Hey, so we're at the end of season three. What
have been some of your sort of highlights. I see
the wings that you've turned up for the last episode
of the season with the very fancy haircut.
Speaker 4 (39:05):
Which is the haircut of the year, is it?
Speaker 1 (39:08):
And I mean the one haircut of the I asked
a last quite lovely woman at Blaze, Eliza. Thanks you
big big unsponsored shout out to Eliza from Blaze for
my gorgeous haircut. But no, I actually had one in May.
My hair does grow really really fast. But yeah, no,
I probably should do more than two a year. Yeah,
(39:28):
in fact, I absolutely should do more than two and year.
Sure it was your advice, Francisca. You said in the
hair episode, my mother or grandmother always said, if you're
going to have long hair, catual car Well.
Speaker 3 (39:40):
I cut it off because I don't look after.
Speaker 2 (39:45):
You're not supposed to be listening to me. You're supposed
to be listening to the experts.
Speaker 4 (39:48):
That's the whole that's the whole point.
Speaker 3 (39:50):
Anyway, I'm much happier.
Speaker 2 (39:51):
I'm very pleased to say that I have one of
my outtakes from the season was after talking about heart health,
I realized I wouldn't know how to do CPR, and
so I'm going to do a first aid course and
I am in the process of booking that. The problem is,
I'm taking my eighteen year old son because he doesn't
know how to do first aid or cpror anything like that,
and I feel as he's about to head off into
the world next year, leaving home to go to university.
(40:13):
It's a gift that I want to give him, and
as you can imagine, always, it's not a gift that
he's readily open arm with, accepting with open arms. So
we're just trying to lock in a day to go
and spend a day together learning first aid. I said
to my fifteen year old daughter, do you want to
come as well? And she goes, I can do CPR,
I can remember it, and then she launched into some
song while pumping with the hands, and then she started
to tell me something else about what you do, and
(40:34):
I said, oh, did you learn that in first day?
And she said, no, Gray's anatomy, So I'm slightly concerned
about actually how well prepared she is.
Speaker 1 (40:40):
But if there is anyone listening that's responsible for curriculums
in high schools, first aid.
Speaker 2 (40:46):
Well, that's where she did it. She did it a
year ten or something. She has done it at school.
Oh okay, they other kids must Hey, anything else? Any
other episodes really kind of resonate with you.
Speaker 4 (40:56):
I mean, I know they all did, but with.
Speaker 1 (40:58):
Well Eron's one, As I sent a photo to you,
I've I've rearranged my dancety sort of area in my
house to make it easier for me to have space
less obstacles for me to go down there and do
some breathing meditation. And I'm, in fact I have done
that a couple of times since then. Stacy obviously just
reminds me of Oh.
Speaker 4 (41:19):
Stacey's great.
Speaker 2 (41:19):
I don't even think about food anymore now. I've just
you know what you're eating, She's given you the guidelines.
It's all there at works. Yeah, yeah, yeah, very much
to say. Do you know I think it's this season.
I think it's some of the less sexy topics we've
talked about, which I've taken a lot from and I
know that a few people have said to me that
was the podcast I didn't know I needed. And I'm
(41:41):
talking about when we spoke to Esther Periam about how
to look after people and older age. Oh yeah, I
just think huge, really great practical advice there about a
really difficult phase that so many of us are in,
the Sandwich generation. Also the I Love Joe crib when
we were talking about the value of women in middle
age in the workplace and the and she sort of
(42:03):
validated the unpaid work that women do. I thought she
was just really positive about what women can offer. The
same with heart health when we spoke to doctor Kara Wozziwitch.
I just thought, really great practical information that we all
know a way to look after ourselves. Yeah.
Speaker 4 (42:18):
So I think those podcasts are some that really kind
of hit a nerve with me.
Speaker 1 (42:22):
I'll leave you with one thought that my husband sent
me a photo and a little text yesterday and it
was probably a bid for connection.
Speaker 3 (42:32):
And I wrote back and said, why did you send
me this?
Speaker 2 (42:36):
I was just going to say, I was just going
to ask how you're managing your forty close to dear friends.
Speaker 1 (42:43):
I got more and more since I did this podcast,
they keep coming out of the woodwork.
Speaker 4 (42:47):
It's hilarious. I love that, like such a loser.
Speaker 2 (42:51):
In the friendship episode, she said, look, how many really
good close friends do you have?
Speaker 4 (42:54):
And I'm like, oh, maybe six sixty teen and you
go forty and I'm like, oh man.
Speaker 1 (43:00):
I'm obviously I'm talking about wider and wider circles.
Speaker 3 (43:03):
But anyway, it's all been good.
Speaker 1 (43:05):
I loved it as always a pleasure, Louise Oh definitely Friendshisca.
Thanks for joining us on our New Zealand Herald podcast
series The Little Things.
Speaker 2 (43:14):
This is the final episode of season three. Thank you
so much for listening and following us. We've loved your
feedback and hope to be back for season four.
Speaker 4 (43:22):
Hey, if you.
Speaker 2 (43:23):
Joined the party late, please feel free to listen to
our previous episodes. There's some fabulous and timeless episodes there
for you to enjoy.
Speaker 1 (43:30):
You can follow this podcast on iHeartRadio or wherever you
get your podcasts, and for more on this and other topics,
head to end zed Herald dot co dot NZ
Speaker 2 (43:40):
And we'll catch you next time on the Little Things.
Hello, I'm Francisca Udkin and I'm Louise Area. And this
is season three of our New Zealand Herald podcast, The
Little Things.
Speaker 2 (00:14):
The podcast where we talk to experts and find out
all the little things you need to know to improve
all areas of your life and cut through the confusion
and overload of information out there.
Speaker 1 (00:23):
So join us today as we explore a topic that
has come up a couple of times this season from
two different healthy experts. From I suspect two different points
of view. Weight loss drugs, whether a zempic or any
other brand. They've been labeled miracle drugs. Are these the
answer to obesity and all the associated health impacts? Or
have they been appropriated by perfectly healthy people seeking to
(00:44):
shed a few kilograms?
Speaker 2 (00:45):
And I have a funny feeling the answer is yes,
both of those things. It's been more than six years
since ozimpak first became sort of this global phenomenon, or
it came onto the market. Celebrities who were bigger became slim,
Celebrities with slim have become impossibly thin, and we're hearing
all these sort of phrases like oceenpick face. They're all
being banded around. So these drugs have been used to
(01:08):
manage conditions like diabetes for many years, but suddenly it
is everywhere as a weight loss drug. It has been
said it could be as significant as the introduction of contraception,
or as revolutionary as the invention of the mobile phone.
Speaker 3 (01:24):
God, it's a bit tiring, isn't it.
Speaker 2 (01:25):
I know, well, it is a really intriguing topic because
I believe it could completely and utterly change health systems.
It could allow them to work so much better and
so much more efficiently. It could give New Zealanders with
an obesity problem a much better quality of life. It
(01:47):
could have a huge impact on people who really need it.
Not worried about them, worried about the ones that probably
don't quite so much need it.
Speaker 1 (01:55):
Yeah, and look, you know, not judging anybody. Do what
you need to do for your I am as intrigued
as you are, and I'm really on the fence. I
just I personally wouldn't take a drug I don't need.
That's for me because we still you know, there's probably
still a lot to find out.
Speaker 3 (02:13):
I'd want to know a lot more about it. I
want to know, you know.
Speaker 1 (02:16):
I just sort of think and we have talked about
menopause await game. We're not either of us are fans
of it. No, but we have also had expects on
the show who have shown us the way there too,
to you know, what we actually need to do to
kind of get rid of that middle tummy fat. But
if I was pre diabetic, that could be a different story.
Speaker 2 (02:36):
Yeah, No, Okay, So we are going to get to
the bottom of kind of what is available in New Zealand,
how you access it, who it's for, who should take it,
what the risks are we going to get all this
information from. Professor Jeremy Krebs now Doctor Krebs is an
intercrinologist with a specialist interest in obesity and diabetes. He
is the clinical leader of indo Chronology and Diabetes at
(02:56):
the Capitol and Coast District Health Board, where he leads
the research. He's also professor at the University of Targo
and part of the Edgar Diabetes and Obesity Research Center.
Speaker 4 (03:06):
He joins us.
Speaker 2 (03:07):
Now welcome, Professor Krebs. Thank you very much for joining
us on the little Things.
Speaker 5 (03:11):
Thank you very much for asking me to join you.
It's a very interesting topic.
Speaker 2 (03:14):
It certainly is, and maybe we should start with the
medical application of weight loss drugs, who they're aimed at,
who they're right for, and who they're help with.
Speaker 4 (03:24):
Looking at what's been available up to.
Speaker 5 (03:26):
Now, sure, well, I think probably the first thing to
go back to is why would you want to prescribe
someone a weight loss drug? And that really stems from
the fact that being over weight or obese increases your
health risks for a number of outcomes, including diabetes, cardiovascular disease,
(03:47):
joint problems, fertility, all manner of health outcomes that are
related to being overweight, and increasingly it's been realized that
actually trying to help people to lose weight is very
fundamental to reducing those risks and improving those people's outcomes.
So that's the why of what we'd want to do.
(04:08):
The difficulty has been over the last forty or fifty
years while people have been trying to achieve that from
a medical perspective, is finding a medication or a drug
that is effective and is safe. And we have a
legacy of weight loss drugs that have come and gone
that have either not met either of those bars. And
(04:31):
I think why there's so much excitement around this new
class of medications is because it does really appear to
seem to meet both those briefs, which is great.
Speaker 1 (04:41):
So we produce glucagon like peptide ourselves, right.
Speaker 5 (04:46):
That's right. So glucagon like peptide one is a hormone
and it's made in the lower small and testine and
it's released when we eat food and that does a
number of important biological functions. And it was discovered that
GOLP one was important in terms of glucose regulation in
(05:10):
the body, and that was how these agents were first
discovered and developed up because what they do is they
stimulate the release of the hormone insulin, which people will
be very familiar with from the pancreas when food is
eaten and is passing by the pancreas and through the liver.
(05:31):
And so it was realized that this hormone GLP one
wasn't doing its job properly and people that had type
two diabetes, and so trying to harness that biology was
how these medications were first developed. And they're very effective
at that and they're an important part of our armory
(05:52):
for managing type two diabetes.
Speaker 1 (05:55):
So this development of something that mimics it is that
something that in them is in the most recent weight
loss drugs. That is news. Se glue tide is that
the new innovation and weight loss.
Speaker 5 (06:08):
Drugs, that's right. So sema glue tide is the name
of one of these drugs and they belong to a
class of drugs called GLP one agonists. Now, what that
means is that they work in the same way as
our natural hormone GLP one. But the important difference about
these medications is that they have been altered in the
(06:29):
laboratory so that they don't get broken down by the
enzyme in our body that normally breaks down our natural
GLP one. And that's very important because the GLP one
that we all make is broken down very very quickly
by an enzyme in the body, and so to bypass that,
the clever drug companies have altered the protein structure and
(06:53):
made these this class of medications and they're all very similar,
but they do have some differences. In semi glue tide
is one example of that.
Speaker 2 (07:02):
Jeremy, you mentioned before the issues that come with obesity.
So here we have the strug that could work. Could
this be a game changer for the health system?
Speaker 5 (07:10):
That's the burning question, really, isn't it? I think what
we know is that not only at an individual level,
but that at a societal level, the cost of obesity
is enormous. It places burden on individuals, on their well being,
their productivity, It places enormous burden on the healthcare system.
(07:34):
And therefore, anything that can turn around this juggernaut epidemic
or whatever you want to call it an obesity would
surely seem to be a good thing. And so if
we have a class of medicines which are safe and
effective in that, then yes, it absolutely could be a
game change. I think there's a few thorns in that potentially.
Speaker 2 (07:56):
And that's probably a good moment to actually find out
what we do have available here at the moment in
New Zealand.
Speaker 5 (08:04):
So, as I say the GLP one hormone or agonists,
there is a class of them, and semi gluetide is
one that's perhaps received the most attention, and that's because
it has been used widely in America, particularly by celebrities
and people like Elon Musk. But there are earlier forms
of this class of medication, ones called gelaglatide. The other
(08:29):
is called leraglatide, and they have been licensed in New
Zealand for the management of diabetes, and in the case
of liraglatide has been licensed for the management of obesity.
Semagluetide has been licensed here for diabetes but not for
weight loss, but simply isn't available in New Zealand. The
(08:52):
two medications in this class that are available are laaglotide
and dula glutide, but they are very difficult to get
hold of anyoney.
Speaker 3 (09:00):
Sorry, So the brand ozen pic is that which is
which one.
Speaker 5 (09:04):
Is slues IDEA. So I get very confusing, doesn't it.
Because medics, like me, we like to talk use the
actual proper drug name, and of course they get marketed
under a brand name, and that brand name can even
be different in different countries. And in the case of
the ragulatide, for example, it's branded as sex Ender is
a weight loss medication, but as a Victosa for a
(09:27):
diabetes medication, same drug, just branded differently.
Speaker 1 (09:31):
Yeah, I think we're getting to the point where it's
going to be like band aid or one of those
you know those, if it was going to just calling
it ozen pic when it may have some of the
same active ingredients but it's a different product.
Speaker 2 (09:42):
And to clarify, do we have ozempic available in New
Zealand at the moment.
Speaker 5 (09:45):
No, okay, no, it has been licensed for diabetes management,
not funded, but it's not even available. The company is
simply not even bringing it into the country. Corst Why not, Well,
it's because of Elon and his mates in in America. Basically,
there is a worldwide shortage of this whole class of
(10:06):
medication and that's had massive impacts for us. Actually because
the people with type two diabetes have waited for over
a decade to get access to funded medications of this class,
which are incredibly effective, and because they're all made in
the same factories. Basically that there is a shortage of
(10:27):
even these older agents which we can't get our hands
on enough of them for those with diabetes.
Speaker 2 (10:33):
So, Jeremy, if I went into my GP and I said, look,
I'm seriously concerned, I'm obase. What are the drugs that
are available to help me? What are the names that
they will offer me? The brand names that's available in
New Zealand at the moment.
Speaker 5 (10:46):
The only medication of this class that's a licensed for
prescription for ob city management is Saxender, which is leraglatide. Now,
the other medications so juda glue tide. It could be
used for weight management, but it would be off license.
Speaker 3 (11:04):
So you'd be paying privately for it, do you mean or.
Speaker 5 (11:08):
So, yes, you would be paying privately for either of
those medications. There is no funded weight loss medication in
New Zealand.
Speaker 2 (11:15):
And then if are okay, So even if you your
GP prescribed you the sex cender, you're still paying for.
Speaker 5 (11:20):
That, absolutely, and it's about five hundred dollars a month.
Speaker 1 (11:23):
And we didn't even go past this. It's not a pill.
Is that it's an injection?
Speaker 5 (11:27):
Correct? Yeah? So all of these medications, because they are proteins,
if you take them by mouth, they rapidly get digested
by the stomach acids and so therefore they are almost
always given as an injection. The companies are working on
ways of giving it as a tablet, and indeed semi
glue tide is available as a tablet internationally, but you
(11:50):
have to give something like fifty times the dose of
it to get it through the through the stomach acid.
So essentially these are all injectable agents.
Speaker 2 (11:58):
So what are some of the known side effects when
it comes to the weight loss drugs that we know about?
Speaker 5 (12:05):
What I didn't say earlier, is that in terms of
the mechanism of GLP one agonists, which is why they
are used as weight loss medications, the two principal actions
are feeding back to the hypothalamus in the brain to
turn off appetite. That's its fundamental action. And the second
thing is to slow down what we call gastric empty
(12:27):
in other words, how quickly food is emptied from the stomach.
And so you could imagine that one of the most
common side effects therefore of this class of medications is
nausea or vomiting or abdominal discomfort. Those are really the
principal side effects of this class of medication.
Speaker 1 (12:47):
I have heard somebody describe it as feeling in those
early stages of pregnancy like morning sickness quite a lot
of the time, which I could say, yeah, is quite
hard to eat through morning sickness, isn't it?
Speaker 2 (12:59):
Absolutely Yeah, I wouldn't want to go back to morning sickness.
Speaker 4 (13:05):
Long term impacts do we know what they are?
Speaker 2 (13:07):
I mean, obviously there's been a lot of study around
these drugs to do with diabetes, but is there any
difference when it comes to weight loss?
Speaker 4 (13:12):
Using them for weight.
Speaker 5 (13:13):
Loss, Yeah, that's where things get tricky, I think, because
the short answer is no. All of the clinical trials
that have been done with these medications, in what are
called randomized controlled trials, were you're comparing it to a
placebo or a dummy drug, which is the gold standard
of testing. These things only go out as far as
two years or five years at most, and therefore we
(13:36):
simply do not know what the implications of someone taking
this medication for ten years, twenty years, which is conceivably possible,
We don't know that at all.
Speaker 1 (13:48):
So and on that note, do you have to keep
taking it to keep it? Doesn't do any permanent change
that we're aware of that would help you keep weight
off once you stop using it.
Speaker 5 (14:00):
That's an extremely good point. The short answer again to
that is no, you do need to keep taking it.
But I think individuals people that struggle with weight struggle
with weight for all manner of reasons, and so I
think there would be some people who might find that
after a year two years of using one of these
(14:20):
medications they've been able to reset all of the things
that are contributing to their weight being high and might
be able to keep that off in the long term.
But I think what's critical is that if you made
a choice to go onto these medications to control your weight,
you shouldn't expect that that would be the case. This
is not a I can take it for a month,
(14:41):
six months, fix the problem, and come off them and
it's gone away.
Speaker 2 (14:46):
Because we had a friend who said to us, can
you just find out if I take it for like
a year or so and I use it really to
sort of kickstart my new regime, and when you dart
my new exercise program and then I come off it,
will it work.
Speaker 5 (14:59):
Yeah, So that's the point. Yes, it will help you
to get to that goal. But unless you fundamentally are
able to change the behaviors that have driven the weight
in the first place, then it's going to come back on. Now,
that's not necessary to say that that is a totally
wrong thing to do. Now, let's you know, for example,
if you are a person that it has pre diabetes,
(15:22):
you're in that stage where you're almost going to get diabetes,
and you can get fifteen kilograms of weight loss, that
diabetes is going to go away. It's going to go
into remission. It's going to stay away. Now, it might
still come back ten years later, but you've bought yourself
a lot of good health in that process. So I
don't want to give the impression that we shouldn't do this,
But it's just that you mustn't go into taking these
(15:45):
medications expecting that it's a quick fix and a permanent fix,
because it's not.
Speaker 3 (15:49):
Yeah, and I do worry a little bit.
Speaker 1 (15:50):
I think you know, it depends on the soup piecewomen, Right,
If you're living in an environment where access to healthy,
good nutritious food is difficult, or you're working a couple
of jobs, you know, to keep the family afloat, you
can't necessarily change everything about your life to engineer a
better result for your health. So there will be people
(16:13):
for whom this is the potentially the perfect answer if
they can, if it can be funded, and if they
can get it.
Speaker 5 (16:20):
Look, I totally agree with what you're saying, and I
think that's the essence of These are expensive drugs, and
you know supply and demand under such the drug companies
aren't going to reduce the costs anytime soon. They can't
keep up with the demand, and so they're going to
remain expensive probably, I think until they come off patent
and you get companies elsewhere in the world that are
(16:41):
able to make them in bioequivalents.
Speaker 1 (16:45):
It's also that investment thing, isn't it If it's costing
us heaps? If obesity is costing us and the health
system a hell of a lot of money, are we
better to front end it with something like this?
Speaker 5 (16:54):
That's right. I mean you only have to think, you know,
you prevent one hip replacement event, one person developing diabetes
and going onto dialysis. You reduce the whole kind of
metabolic risk that's happening for women during pregnancy that then
gets translated into the next generation. You know, there's there's
lots of good arguments you can make for it, but
(17:17):
you know, gosh, health systems are pretty creaky at the moment.
Heading on, what about.
Speaker 3 (17:23):
Compared to the cost of beriatric surgery though.
Speaker 5 (17:25):
Yeah, so that's that's another interesting we I often have
this conversation with patients because the crossover point is at
about ten years. If you if you've fund these self,
fund these medications at about ten years, you will have
been better to have paid for the full cost for
your bariatric surgery.
Speaker 2 (17:45):
Okay, but what about also the nature of bariatric surgery
as an intervention compared to taking an injection in a drug.
Speaker 5 (17:54):
Yeah, so it's horses for courses, isn't it. I I
think yeah, bariatric surgery as the best long term evidence
for sustained weight loss and improved health outcomes, and that's
because we've been doing it for longer and we've got
better long term data. It fundamentally changes a person's life.
(18:14):
I mean, I don't have to tell you guys, and
your listeners will know that. If you suddenly have a
stomach that's the side of your little finger, then that
changes your whole life in terms of what you can eat,
when you can eat, who you can eat, with all
of those social things as well. Whereas with an injection, yes,
(18:35):
it reduces your appetite, but you can generally speaking eat
a normal type of diet and socially interact in that way.
You're just not as hungry and you eat less of it,
so there's less impact I think in some of those ways.
But again, as I say, what we don't know, We
simply don't know what the outcomes for people taking a
GLP one. Again it's for ten years, fifteen years, twenty
(18:56):
years are Whereas we do have those data for directric surgery.
Speaker 1 (19:00):
Maybe by the time it's funded in easialinal who have
better data.
Speaker 2 (19:06):
Possibly Jeremy, Is there anyone who shouldn't take a weight
loss strike?
Speaker 4 (19:11):
Are there any risk factors that we should be aware of?
Speaker 5 (19:14):
So when it comes to this class of medicines, there
are two groups of people that we need to be
very careful about. There's a very rare form of thyroid
cancer called medullary thyroid cancer, and it was found in
the early development when the rodent studies were being done
with this class of medicines, that rats were more likely
(19:37):
to develop this type of cancer, which is very strange.
It is no particularly good biological reason why that would be,
and it needs to be remembered that in those early
stages they are exposed to ten twenty one hundredfold doses
of compared to what we use for humans. Nevertheless, there
is that slight concern probably more commonly because that's a
(19:58):
very rare condition. More commonly is the issue of pancreatitis,
so that's an inflammation of the pancreas, and there has
been some data to suggest that this class of medications
can cause pancreatitis. It's quite debatable, controversial, but nevertheless, if
someone's had a history of pancreatitis, particularly recurrent pancreatitis. We
(20:21):
would be very nervous about prescribing these medications for them.
Speaker 2 (20:25):
You're listening to the little things and I guess on
the podcast today as Professor Jeremy Krebs, DTOR. Crebs is
an interocronologist with a specialist interest in obesity and diabetes.
We'll be back shortly after this break. As middle aged women,
we're quite keen on our lean muscle mass.
Speaker 4 (20:43):
What does it do if you've got.
Speaker 2 (20:44):
On a weight loss drug and you're losing all this
weight and I know that ozen Peck promotes that you
lose up to fifteen percent of your body weight.
Speaker 4 (20:51):
Do you lose muscle?
Speaker 5 (20:53):
Whenever someone loses weight, they lose both lean mass and
fat mass. OK, so yes is the answer. You do
do some lean mass. What you want to do is
to try and preserve that lean mass as much as possible,
and the best way to achieve that is to maintain
your physical activity. And you know, one of the bonuses
I think for people who are trying to lose weight
(21:15):
and struggling is that it's quite hard to exercise when
you're overweight. Absolutely, and as your weight comes down your
capacity in your enthusiasm and your enjoyment of exercise actually increases,
and so therefore that makes that possible. So that's the message,
really is that as you're losing weight, really work hard
to maintain your physical activity.
Speaker 1 (21:38):
Hey, maybe again I'm just grasping its straws here, but
I have also heard that the drugs that mimic GLP
one can reduce the release of the dopamine we get
when we eat but also when we drink alcohol.
Speaker 3 (21:55):
Is there any can you talk to that at all?
Speaker 5 (21:59):
I can't talk to it. And two of the quality
of the science around it, but certainly there is some
there's a small amount of evidence and certainly anecdotal reports
of that. And that's probably because the GLP one is
acting in the same areas of the brain where the
positive effects of alcohol are working, and it interacts with
(22:20):
that path those pathways in the brain. So certainly I've
seen that that information and there has been some evidence
that that's the case.
Speaker 1 (22:29):
I'm listening to you, and I'm still always fascinating because
we know this. We've talked to lots of experts about
this as well. Over the course of the three seasons
of the little things, but that relationship between the gut
and the brain, it's undeniable.
Speaker 5 (22:42):
Right, absolutely absolutely. I mean there's we could go off
into a whole different tangent around the microbiome and you've
probably had had sessions on this, but that's another very
fascinating area where there's a link between the gut and
the brain. There's these hormonal links that include g'll P one.
There are other hormones as well, but it's a very
(23:03):
strong and very potent interaction and relationship.
Speaker 2 (23:06):
Absolutely so aside from just finding a way to drink least,
which is something that Louise is often interested in, I'm not.
Speaker 3 (23:14):
I'm not that much of a better I'm just he
protests us too much.
Speaker 2 (23:19):
The other thing you're quite interested in, Louise is micro
dosing as well.
Speaker 1 (23:23):
Oh well, no, I just people have when we've talked
about this, a monkstands and so do you reckon? You
can microds o zempic and I don't know because it
comes in a vial, right, presume you have to use
the whole thing or just a little can you use
a little bit of it?
Speaker 3 (23:37):
It seems like a very expensive exercise to me.
Speaker 5 (23:40):
Yeah, yeah, look, I probably don't want to get drawn
in on that. That's that's extending out towards witchcraft as
far as I'm consented, right, the I mean the clinical
trials has been done for a reason that these drugs
are developed up with dose ranging studies to find out
what the men are effective doses are, what the maximum
(24:02):
effective doses are, and then finding the sweet spot of
all of that, and that's why we end up with
the regimens that we end up with.
Speaker 1 (24:10):
She's not at all dodgy, I promise you no, I
don't know. I'm not microdizing mushrooms or anything, Jeremy.
Speaker 2 (24:17):
I think what it comes down to it is we
hear so much about how much good this can do.
You know, we had doctor Kara Wozziwitch on Cardiologists talking
about how it could revolutionize healthcare when it comes to
health in New Zealand. But you know, it's not funded,
so I worry about access for those who need it
(24:38):
and could hugely benefit from it. At the same time,
if you've got the money and you want to pay
for it, there's potentially people who don't need to be
on a drug for the rest of their lives who
are accessing it.
Speaker 3 (24:50):
It's a bit dystopian.
Speaker 4 (24:52):
Really, yeah, it is.
Speaker 2 (24:53):
I can't quite work out how I feel about these
drugs because I think that they could be just play
such a major part and us having New Zealand is
having healthier lives and us having a better health system.
But at the same time, the way it's all kind
of unfolding, it's kind of creating this two tiered health system.
Speaker 5 (25:12):
It's a really interesting philosophical discussion, this isn't it, I think.
And we're caught up as a country and a global
market for this. And as I mentioned before, finally farmac
are funding these agents for people with diabetes who for
whom there's enormous evidence of the benefit of them, or
(25:35):
not only diabetes control, but also heart health and kidney
health and all of these things. And yet we can't
even get them for those people for whom we are
prepared to fund them. And that's because of this global pressure,
which is exactly what you're talking about, where people who
can afford, who do have the means, are paying for
them and you know, questionably may or may not be benefiting.
(25:58):
You know, I think there's real benefit for people who
are significantly obese to lose weight with these drugs, but
you'd have to really question the use of them for
people who are of normal weight or close to normal weight,
using these agents just to get into their you know,
one size less stress for their daughter's wedding type concept.
Speaker 3 (26:19):
Oh yeah, yeah, exactly.
Speaker 1 (26:20):
So in terms of prescribing it, who can prescribe these things?
Like a like frontis much of the GP before, But
do you are they able to prescribe it?
Speaker 5 (26:31):
So any any medication that's licensed in New Zealand can
be prescribed by the health practitioners. So absolutely we can
prescribe them. As I say, at the moment, the problem
is that even if I gave a person a prescription
for semi glue tide, they wouldn't be able to get it.
It's not actually in the country.
Speaker 3 (26:47):
That will frustrate them.
Speaker 1 (26:48):
Men a pausal woman trying to lose some weight because
you can't get a right shirty.
Speaker 5 (26:51):
I was going to say, they'll be learning about the
pharmacy with swords for the hid as well.
Speaker 2 (27:00):
We'll all be sharing it like we do with the
HRT cutting up patches.
Speaker 4 (27:03):
Here's half I share my injection with you. I mean
we really shouldn't laugh.
Speaker 2 (27:10):
About it, but I mean we have heard of menopausal
women who are using it to help weight.
Speaker 3 (27:13):
Gain in life.
Speaker 4 (27:14):
Would would you recommend that from a medical point of view?
Speaker 5 (27:18):
Well, it's a very interesting concept, that isn't it Because
unquestionably one of the problems that women face with menopause
is weight gain, some women more than others. But it
is something that happens and is observed and then carries
with it those health consequences as well, And if you
could predictably prevent that, then you could make the argument that, yes,
(27:42):
that would be a good thing to do. There may
have been, but I'm not aware of a study which
has specifically asked that question. Because I think that's what
you'd want to do, is to actually take a group
of women at the sort of perimenopausal stage and randomize
them to receiving one of these drugs or not, and
then actually demonstrating those benefits before you could make a
(28:04):
public statement about it.
Speaker 2 (28:06):
But there's a thing, you see, you'd be so gutted
you'd know how quickly would you see a difference in
your way if you started taking it. How quickly would
you know, oh, I'm on the Blasibo, Well I got
the drugs.
Speaker 5 (28:18):
Yeah, you begin to see within two to three weeks,
and because predictably the side of the nausea does happen
upfront and often will settle down after a few weeks,
but predictably people do get some nausea at the start.
And so when we were lucky enough to be a
(28:39):
site in Wellington for some of the early controlled trials
for these drugs and diabetes, and it was although we
were blinded to who was on what, it was very
obvious very quickly as to who was on the active agent.
Speaker 3 (28:52):
So no good placebo effect with that one.
Speaker 2 (28:54):
Then, sadly not, I think probably the one reason why
I wouldn't consider a drug like this, and this is
just my personal opinion. Is I really enjoy food. I
enjoy eating, I want to savor a beautiful meal, or
appreciate the fact that my children cooked me a meal,
or I like I don't. And what I hear from
(29:15):
people who are on it, they're like, oh, you have
three or four bites of food and you're kind of
done all of a sudden. Food isn't It feels like
food isn't really part of your life anymore. Is that
a good description of it?
Speaker 5 (29:28):
That's a beautiful description of it. It is very variable.
So I've had people say exactly the same sort of
phrasing that you've expressed there and converse here. I've had
others who have said, look, it's made absolutely no difference
to my appetite.
Speaker 1 (29:42):
Wow, and they still lose weight.
Speaker 5 (29:45):
But some of those people do still lose weight, they
are subconsciously not eating as much. But then you have
those people like you've just described, where they're very aware
of the effect that's had on their appetite.
Speaker 1 (29:59):
I think it will penned on the cost benefit though, Francesca.
If you're only looking for five keyloads a weight loss,
you go while I still I don't want to not
enjoy my meals five. If you're looking at you know,
a kilos, it's it's probably a little bit different. I
have heard that that has wiped off some of the
profits that restaurants and things are making because people in
(30:23):
La for example, are eating less.
Speaker 5 (30:25):
They're probably drinking best too, which is where most of
their profits.
Speaker 4 (30:28):
Yeah, and that's the thing.
Speaker 2 (30:30):
You know that brands like Ozenpek have made a name
for themselves due to such high profile celebrity use.
Speaker 4 (30:38):
Is that profile and awareness a good thing or a
bad thing? Do you think.
Speaker 5 (30:42):
Again. I think that's an interesting philosophical question, and it's
a double edge to it. I think that anything that
increases the awareness of the health consequences of being overweight
and the potential pathways to reduce that is a good thing.
But where it's used potentially, where that profile potentially means
(31:07):
that people are reaching for it for a few kido's
weight loss. Here as I say, to get into the
address with the daughter's wedding or those types of scenarios,
then you have to say, well, that's actually not socially
a good a good thing that we're seeing.
Speaker 2 (31:22):
Jrummy, do you know I have any black market supply of
white drugs? And New Zealand, said exerts.
Speaker 5 (31:28):
Quite possibly. No, I'm not aware. But if you've got
any context, I shouldn't say that that was ri I
withdraw that comment fair enough.
Speaker 1 (31:39):
It probably wasn't a fair question either, I guess, but
we were curious. I mean, it's black markets plus for everything, surely. Look,
it's just it's I think you're right. I think this
is a philosophical question. Almost everything you know about this
is kind of deeparly philosophical. But I guess my angel
and devil on each shoulder is and you know, I
(32:01):
really do get concerned about those who would like to
access or who need to access and at the moment
in New Zealand anyway, and we do seem to be
how many other first of all, countries are there that
aren't funding this because I feel like they are in Australia.
Speaker 3 (32:13):
I could be wrong.
Speaker 5 (32:15):
I so certainly they're funding this class of medications for
diabetes and we would have to be one of the
last countries to do that. I'm not aware whether they're
funding it for obesity are.
Speaker 1 (32:29):
Yeah, that might be the key point. And that's something
you've clarified beautifully for us today.
Speaker 4 (32:34):
Yeah.
Speaker 2 (32:35):
I was reading in the UK, I think it was
the House Secretary has just announced that he thinks that
ozimpac could be a brilliant way to get people back
to work and he would like to use it on unemployed.
Speaker 4 (32:49):
How do you feel about that.
Speaker 5 (32:51):
That this morning?
Speaker 1 (32:51):
Yeah?
Speaker 5 (32:52):
I mean I think it's really fascinating, isn't it. And
if you could be specific and quantify the extent to
which obesity was preventing people getting back to work, then
you could, you know, you could drill down to that
discussion and argument a bit better. I think it's it's
slightly political speak that statement, but not beyond the realms
of what might be a good public health measure. Potentially.
(33:13):
I'm not saying we should, but I'm saying potentially. I
think you need to drill down to it a bit more.
Speaker 1 (33:18):
First, Yeah, no, I won't get on my high horse
about the food food chain, supplies and availability of healthy
food to people, you know, from every socioeconomic group. I
just to get on my high horse. But I hire
the ambulance at the bottom of the cliff, you know.
Speaker 5 (33:34):
Yeah, yeah, yeah, Look, I join you on that horse
by the way too.
Speaker 4 (33:37):
You howd to put your foot in the stirrup and
thought about leafing front?
Speaker 5 (33:41):
You know?
Speaker 2 (33:42):
I hear also ozenpeck gets rid of fifteen percent of
body weight. There are two more drugs which are about
to come out. I think one is branded Mingaro. They're
claiming they're going to get rid of twenty percent. Then
there's Triple G which is apparently going to be out
next year, which is claiming to get rid of twenty
four Are we heading into dangerous territory here?
Speaker 5 (34:05):
Yeah? Even better question. So those new drugs ones called
ta zeppatide, and I can't quite remember the name of
the other one, but they are slightly different to the
ones we've been talking about today. So the ones we've
been speaking about act purely on the GLP one glucur
and like peptid one receptor. As I mentioned earlier, there
(34:27):
are other gut hormones that are involved in food regulation.
And what these newer classes of agents are doing are
combining agents that are working on different hormone receptors, and
we're going to see more of these coming out. And
by doing that, you are increasing the potency or the
(34:48):
effectiveness of the change on body weight. And you're absolutely right.
So the newer classes are now up to that twenty
five plus percent weight life loss on average in the
clinical trials. And it's not everybody, of course, but you
know you're getting you're getting a quantum again greater weight
loss that takes you into the territory of what you
(35:11):
see with a gastric bypass operation barretric surgery, and so
you were really then getting equivalent weight loss with a
medication that we've never had before. Again, who knows what
the implications of that is. After five years, ten years,
fifteen years, we simply don't know it's crystal ball gazing,
but it does open up another whole avenue of research
(35:36):
and questions.
Speaker 3 (35:36):
You know.
Speaker 1 (35:37):
Yeah, it's fascinating, and I guess you know, we've just
looked to Hollywood to see what happens in five, ten,
twenty years.
Speaker 5 (35:45):
Maybe that's our study, that's our I think.
Speaker 2 (35:49):
I think it probably is where you would get your
cohort from. But you see that that in itself I
find really depressing. We have been fighting for so long
to encourage people, and I'm not talking about people with
health issues and obesity, but the general population. It's absolutely
fine that we all look different and we all have
different bodies.
Speaker 4 (36:05):
We've worked so.
Speaker 2 (36:05):
Hard to get to that place where you're just comfortable with,
you know, being a healthy weight, and I feel like
we're throwing this sort of Yeah, as I said before,
I feel really positive about what it can do for
the house system, but then I feel like we're just
throwing this bomb into the middle of the population.
Speaker 4 (36:19):
Just who knows what in Peper's going to have.
Speaker 2 (36:22):
Absolutely, yeah, Jeremy, I know that we had to drag
you onto this podcast, so I am hugely grateful that
you that you have come on board because that information
is excellent. We now have a really good understanding of
what's available in New Zealand and how it works and
things and lots to think about around this.
Speaker 4 (36:39):
Thank you so much.
Speaker 5 (36:40):
You're very welcome, and I very much enjoyed the conversation
having been dragged to these.
Speaker 3 (36:46):
We really did. Thank you so much.
Speaker 2 (36:54):
How great was it having Professor Krebs with us today.
What a nice guy, really nice and just such a
good communicator of the information. And it's just kind of
explained where we're at because we're hearing so much about this,
but it's a lot of it is coming from global
media and news and celebrities, so it's nice to kind
of get a bit of an idea about what is
actually happening here in New Zealand, what was available.
Speaker 1 (37:15):
I was super grateful for explaining the setting in New
Zealand because it actually wasn't what I expected. I assumed
that we had some funding for obese.
Speaker 4 (37:27):
People if they need.
Speaker 2 (37:28):
We're not struck totally, and we should write. I believe
we should, and I think that there should be standards
in place for when people's lives are unable to live
a healthy, productive life, and it is impacting on their heart,
their limbs and fertility, all the things that Jeremy had mentioned,
that we should be able to provide them with an option.
Speaker 4 (37:50):
And I say it's an option.
Speaker 2 (37:51):
It's totally up to an individuals to whether they want
to actually go down that path and take it.
Speaker 1 (37:55):
Oh absolutely, I mean there is I know that you
do have to for some people, they have to lose
a certain amunt of wakeful. They can even have gastric
sleeve or beriatric syndery. And I'm kind of late, well,
where does it leave those people when there is something
available that works.
Speaker 2 (38:09):
Big farmer anyway, Big Farmer. And it was interesting too,
that whole the supply and demand. I've heard a lot
about this that and this is the thing. You know,
those who can afford it are accessing it and raving
about it, while the majority of us it's just.
Speaker 4 (38:23):
Gone for another run and there's nothing wrong with it.
Speaker 3 (38:27):
Oh no, God no.
Speaker 1 (38:28):
And I mean I think that is one of my
concerns is health and wellness. You know, for a lot
of us should start with going for that walk or
lifting those weights or whatever it is, or reducing our
intake of fatty foods or alcohol, whatever you know, I don't.
Speaker 3 (38:43):
That's my other concern about this, is it.
Speaker 1 (38:45):
So yeah, it is a deeply philosophical issue as we
discuss more and hopefully when we can talk about again sometime.
Speaker 4 (38:51):
I hope.
Speaker 5 (38:51):
So.
Speaker 2 (38:52):
Hey, so we're at the end of season three. What
have been some of your sort of highlights. I see
the wings that you've turned up for the last episode
of the season with the very fancy haircut.
Speaker 4 (39:05):
Which is the haircut of the year, is it?
Speaker 1 (39:08):
And I mean the one haircut of the I asked
a last quite lovely woman at Blaze, Eliza. Thanks you
big big unsponsored shout out to Eliza from Blaze for
my gorgeous haircut. But no, I actually had one in May.
My hair does grow really really fast. But yeah, no,
I probably should do more than two a year. Yeah,
(39:28):
in fact, I absolutely should do more than two and year.
Sure it was your advice, Francisca. You said in the
hair episode, my mother or grandmother always said, if you're
going to have long hair, catual car Well.
Speaker 3 (39:40):
I cut it off because I don't look after.
Speaker 2 (39:45):
You're not supposed to be listening to me. You're supposed
to be listening to the experts.
Speaker 4 (39:48):
That's the whole that's the whole point.
Speaker 3 (39:50):
Anyway, I'm much happier.
Speaker 2 (39:51):
I'm very pleased to say that I have one of
my outtakes from the season was after talking about heart health,
I realized I wouldn't know how to do CPR, and
so I'm going to do a first aid course and
I am in the process of booking that. The problem is,
I'm taking my eighteen year old son because he doesn't
know how to do first aid or cpror anything like that,
and I feel as he's about to head off into
the world next year, leaving home to go to university.
(40:13):
It's a gift that I want to give him, and
as you can imagine, always, it's not a gift that
he's readily open arm with, accepting with open arms. So
we're just trying to lock in a day to go
and spend a day together learning first aid. I said
to my fifteen year old daughter, do you want to
come as well? And she goes, I can do CPR,
I can remember it, and then she launched into some
song while pumping with the hands, and then she started
to tell me something else about what you do, and
(40:34):
I said, oh, did you learn that in first day?
And she said, no, Gray's anatomy, So I'm slightly concerned
about actually how well prepared she is.
Speaker 1 (40:40):
But if there is anyone listening that's responsible for curriculums
in high schools, first aid.
Speaker 2 (40:46):
Well, that's where she did it. She did it a
year ten or something. She has done it at school.
Oh okay, they other kids must Hey, anything else? Any
other episodes really kind of resonate with you.
Speaker 4 (40:56):
I mean, I know they all did, but with.
Speaker 1 (40:58):
Well Eron's one, As I sent a photo to you,
I've I've rearranged my dancety sort of area in my
house to make it easier for me to have space
less obstacles for me to go down there and do
some breathing meditation. And I'm, in fact I have done
that a couple of times since then. Stacy obviously just
reminds me of Oh.
Speaker 4 (41:19):
Stacey's great.
Speaker 2 (41:19):
I don't even think about food anymore now. I've just
you know what you're eating, She's given you the guidelines.
It's all there at works. Yeah, yeah, yeah, very much
to say. Do you know I think it's this season.
I think it's some of the less sexy topics we've
talked about, which I've taken a lot from and I
know that a few people have said to me that
was the podcast I didn't know I needed. And I'm
(41:41):
talking about when we spoke to Esther Periam about how
to look after people and older age. Oh yeah, I
just think huge, really great practical advice there about a
really difficult phase that so many of us are in,
the Sandwich generation. Also the I Love Joe crib when
we were talking about the value of women in middle
age in the workplace and the and she sort of
(42:03):
validated the unpaid work that women do. I thought she
was just really positive about what women can offer. The
same with heart health when we spoke to doctor Kara Wozziwitch.
I just thought, really great practical information that we all
know a way to look after ourselves. Yeah.
Speaker 4 (42:18):
So I think those podcasts are some that really kind
of hit a nerve with me.
Speaker 1 (42:22):
I'll leave you with one thought that my husband sent
me a photo and a little text yesterday and it
was probably a bid for connection.
Speaker 3 (42:32):
And I wrote back and said, why did you send
me this?
Speaker 2 (42:36):
I was just going to say, I was just going
to ask how you're managing your forty close to dear friends.
Speaker 1 (42:43):
I got more and more since I did this podcast,
they keep coming out of the woodwork.
Speaker 4 (42:47):
It's hilarious. I love that, like such a loser.
Speaker 2 (42:51):
In the friendship episode, she said, look, how many really
good close friends do you have?
Speaker 4 (42:54):
And I'm like, oh, maybe six sixty teen and you
go forty and I'm like, oh man.
Speaker 1 (43:00):
I'm obviously I'm talking about wider and wider circles.
Speaker 3 (43:03):
But anyway, it's all been good.
Speaker 1 (43:05):
I loved it as always a pleasure, Louise Oh definitely Friendshisca.
Thanks for joining us on our New Zealand Herald podcast
series The Little Things.
Speaker 2 (43:14):
This is the final episode of season three. Thank you
so much for listening and following us. We've loved your
feedback and hope to be back for season four.
Speaker 4 (43:22):
Hey, if you.
Speaker 2 (43:23):
Joined the party late, please feel free to listen to
our previous episodes. There's some fabulous and timeless episodes there
for you to enjoy.
Speaker 1 (43:30):
You can follow this podcast on iHeartRadio or wherever you
get your podcasts, and for more on this and other topics,
head to end zed Herald dot co dot NZ
Speaker 2 (43:40):
And we'll catch you next time on the Little Things.
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