September 29, 2026 • 30 mins
GLP-1s have become one of the biggest stories in health and weight loss. But beyond the headlines and social-media hype, what do we actually know?
Trace Dominguez breaks down how GLP-1 medications work with obesity medicine specialist Dr. Sean Hashmi, while online influencers Todd Masterson and Ashley Gibson share their experiences, including changes in appetite, weight, and what some people call “food noise.”
Then we go beyond weight loss. Researchers are investigating GLP-1s for sleep apnea, osteoarthritis, addiction, and other conditions. Some of the findings are intriguing. Others are preliminary. And some claims circulating online don't have enough evidence behind them yet.
We also get into GLP-1 side effects, compounded medications, long-term treatment, weight regain, and the next generation of drugs.
Because when it comes to GLP-1s, the science is moving quickly. The challenge is knowing the difference between what we know and what we hope might be true.
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Speaker 1 (00:07):
So I first heard about GLP-1s a few years ago
when Mindy Kaling was on it because she kind of
left the public eye for a little bit and then
came back and was dramatically skinny. And she just tried
to say that she had lost the weight by walking
around her neighborhood in Hollywood.
Speaker 2 (00:23):
In the time that I was able to only lose
six pounds without a GLP-1 medication, I lost 55 pounds
on a GLP-1 medication. Nothing changed about my lifestyle. Nothing
changed about the way I was working out. Nothing changed
about the way I was eating.
Speaker 3 (00:39):
When you go on a GLP-1, the first six to
12 months that you're on it are going to seem magical.
Speaker 4 (00:45):
GLP-1s or glucagon-like peptide ones. You've heard of them, right?
It seems like we're bombarded with before and after images
online of dramatic weight loss with the hashtag GLP-1. And
everyone seems to have strong opinions about them. Drug names
like Ozempic and Zepbound come up in conversation. Maybe you're
on a GLP-1. You likely know someone on one, even
(01:06):
if they haven't told you about it. Roughly one in
nine Americans take the weekly shot to lose weight. But
scroll through social media and another picture emerges. You'll start
to hear people talk about using a GLP-1 for things
other than weight loss. Like Todd Masterson, who went on
a GLP-1 as a treatment for sleep apnea, a common
sleep disorder where your breathing repeatedly stops and starts for
(01:28):
10 seconds or more throughout the night.
Speaker 1 (01:30):
The one that I'm on is approved for sleep apnea.
But the only reason I got approved for sleep apnea
is because I did everything else. I did a sleep
study and then I did a CPAP machine for 90 days.
Speaker 4 (01:42):
And Ashley Gibson, who takes a GLP-1 as part of
her treatment for PCOS.
Speaker 2 (01:47):
Or polycystic ovarian syndrome.
Speaker 4 (01:49):
Which is now known as PMOS.
Speaker 2 (01:52):
Or polyendocrine metabolic ovarian syndrome, a.
Speaker 4 (01:56):
Common hormonal and metabolic disorder that affects people of reproductive age.
The condition involves multiple hormone systems and metabolic health. One
of the many symptoms is weight gain or significant difficulty
with losing weight. GLP-1s are sometimes used off-label as a
treatment for PCOS or PMOS. So should GLP-1s stick to
(02:17):
what they do best, weight management and diabetes treatment, or
are there other things that we can treat with them?
We invited AMA physician Sean Hashmi, a board-certified nephrologist and
obesity medicine specialist with Kaiser Permanente, to help us find
the answers.
Speaker 3 (02:32):
Obesity has been so difficult and it's been up and down,
up and down, that anything new that comes on the
market that says it's going to help us to lose weight,
that immediately draws people because they feel like we have
not been successful.
Speaker 4 (02:47):
Welcome back to Health vs. Hype with the American Medical Association.
I'm your host, Trace Dominguez. Today, we're talking about GLP-1s,
specifically what they can do and can't do and what
claims the evidence supports, and what science is still learning
about them. Join me as we find out whether GLP-1s
are all health or just hype. So, Todd, I wanted
(03:24):
to start with you because you tried a few things
to help with your obstructive sleep apnea, but you finally
landed on terzepatide, a type of GLP-1. What was that like?
Speaker 1 (03:35):
I'm a huge advocate for it. I literally do say
that it's a miracle drug. Weight loss is the biggest,
most visible side effect of the drug, but it helps
with so much more. So the path that I took
to get it was through my doctor. He prescribed me terzepatide.
I was approved for it for sleep apnea. And I
(03:55):
was like, well, heck yeah, let me try that. But
then I also really wanted the weight loss.
Speaker 4 (04:01):
To clarify, Gizepatide, which you may know of as Zepbound,
is approved for sleep apnea, but only in adults with obesity,
likely because obesity is a risk factor for sleep apnea.
We'll get the facts about that later from Dr.
Speaker 3 (04:14):
Hashmi.
Speaker 4 (04:15):
So Todd, what did you notice once you started?
Speaker 1 (04:19):
It almost instantly started working with the side effects that
people said would happen, which is the quieting of the
food noise, the suppression of appetite, the energy, the inflammation,
it reduces inflammation. And so literally my joints felt better,
my muscles felt better, my, you know, everything just like
felt better. It was like my body stopped physically hating
itself so much. Almost all of that started within the
(04:41):
first week after the first shot of just like the
baseline of the medication.
Speaker 4 (04:45):
And it was.
Speaker 1 (04:46):
Almost scary how fast it worked and how good it
worked and how I was like, oh my God, everybody
was right. Because the biggest thing is the food noise.
We're like, you know, as an obese person, as a
chronically fat kid my whole life, I didn't realize how
much I thought about food. Once I started taking this medication,
all that went away. And I realized how much time
(05:07):
of my day I spent thinking about food and now
I'm not thinking about it anymore.
Speaker 3 (05:10):
And I was like, oh my God.
Speaker 4 (05:12):
Food noise, while not an official scientific term, is understood
as persistent thoughts about food that a person perceives as
unwanted or distressing and that may cause social, mental or
physical problems. Ashley describes what it feels like.
Speaker 2 (05:29):
The best way to describe it is, let's say that
you have a fire detector going off in your house.
you know you need to change the battery of the
fire detector it keeps dinging in the background and it's
getting on your nerves you know it's there you know
you need to turn it off but you can't get
up to change it because you need to get a
(05:50):
ladder so like think about it that way it's something
that's constantly going off every couple of minutes where you're
thinking about food or drink or snacks or something and
that's probably the best way to describe how food noise
affects you.
Speaker 4 (06:05):
Wow I mean that sounds awful It's not great.
Speaker 2 (06:08):
I mean, it's just one of those things where, you know,
people always say that the hardest part of a weight
loss journey is willpower, but you can't out willpower your brain.
You really can't. You can't out willpower your hunger pangs.
It's unlike anything that I think that people who have
a healthy body type or healthy metabolism or healthy relationship
(06:29):
with food can even comprehend because they've never had to
live with the brain of somebody whose body is constantly
fighting against the natural reaction that they are.
Speaker 4 (06:40):
Supposed to have. How did it feel once it finally
went away? It was quiet.
Speaker 2 (06:44):
It was so quiet. I finally, and I tell this
to everyone, in my first year being on a GLP-1 medication,
I read 150 books. Because I was not constantly chasing
the next meal or thinking about, am I allowed to
eat this?
Speaker 4 (07:00):
Can I eat this?
Speaker 2 (07:02):
Staying up late because I'm like, I'm so hungry, I
can't fall asleep, even though I know I just ate
a full meal at 8 p.m. The amount of brain
power that goes into constantly thinking about your next meal,
if you take that out of the picture, just think
about all the things.
Speaker 4 (07:17):
That you could do. I want to bring in our physician, Dr. Hashmi,
so we can get a fuller picture of what a
GLP-1 actually is and how it works to quiet food noise.
Speaker 3 (07:28):
So food noise is so important to understand. In MRI scans,
if let's say I'm somebody who's dealing with this disease
obesity and you're not, and we do an MRI of
both of our brains, you'll find that just looking at,
let's say something sugary, let's say it's a donut, just
looking at it, you'll see my brain light up far
(07:49):
more than yours. It's a crazy concept. So food noise
is a medical condition. It is not a psychological condition
that's just in your head. It is real to our patients.
For the longest time, I think there were a lot
of issues on how we framed obesity. We turned the
idea of obesity into a willpower issue. So the common
(08:12):
statement of why don't you eat less? Why don't you
move more is going to fix everything. The challenge with
relying on those kind of statements, which, by the way,
are not incorrect from a physiology perspective because we're dealing
with a numbers game. But the reason they don't work
is obesity is one of those really cruel diseases that
never takes a day off. It doesn't care if it's
(08:32):
your birthday. It doesn't care if it's Christmas, New Year's.
And as a result of it, willpower's ability to last
is very fickle. It starts, it fades. And as a result,
every success lets you have more success. But every failure...
sort of goes back to that same concept of, hey,
I just can't do this. I can't believe I did
(08:54):
it again. I blame myself. And getting rid of blame
and shame out of the equation of obesity is one
of the most important things that we focus on. The
goal is put the patient in the middle, start the
conversation by letting them know it's not your fault.
Speaker 4 (09:12):
Can you tell people who may not know when they
think about obesity, when they think about weight loss right now,
GLP-1s are at the top of the conversation. So what
is a GLP-1? How does it work?
Speaker 3 (09:24):
So GLP-1s are nothing more than peptides. And the history
behind them, you know, we have been using GLP-1s for
several decades. The difference now is we weren't using them
at the doses we use now. Those are the doses
we finally started linking them to weight loss. The uses
of GLP-1 before primarily was around diabetes. The three sort
(09:47):
of big things about GLP-1s to really understand, there are
so many different mechanisms. But when you start from your
mouth and going down, I tell my patients they create
sort of a traffic jam in your stomach, which means
that food sits in your stomach longer. And as a result,
you feel full sooner when you're able to get the
food in your body. GLP-1s cause the pancreas to shoot
(10:10):
out more insulin. So now you have the secondary mechanism.
The third mechanism is they tell the liver not to
pull so much glucose into the blood. But these are
the physiological mechanism. Then there's this, what I call the
one ring to rule it all, so to speak. The
fourth mechanism is in the brain, where it's acting on
the pleasure centers of the brain.
Speaker 4 (10:32):
And that brings us to a bigger picture. What exactly
are peptides? Well, I'm glad you asked. Peptides are short
chains of amino acids, or the building blocks of proteins.
They act as signaling molecules in the body, and they
can essentially tell cells what to do, which is why
researchers are studying them for everything from metabolism and muscle
(10:52):
growth to healing and, of course, weight loss. We talk
about GLP-1s as a kind of high-level concept. And then
the drugs that are name brand are generic from that.
Are all the GLP-1 peptides the same thing or is
it like a family of peptides?
Speaker 3 (11:08):
GLP-1s is exactly that. It's one agent in there. GLP-2
or the upcoming GLP-3s, each one of those things that
I've mentioned does something that's very different and unique. And
because of that, we went from a stage of telling
the brain not to feel hungry to starting with things
like GLP-3s where glucagon is actually going to cause the
(11:29):
breakdown of fat cells. Right now, as you know, there's
a race. And the race is, can we create bigger, better, stronger?
And because that's happening, what we're doing is we're forgetting
about the patient in the middle. What we don't want
to do is create a situation where a patient starts
with a GLP-1, goes to a GLP-2, then they fail
(11:50):
that one, and they're waiting on a GLP-3. Now, in studies,
there's 35 different agents that are being studied in a
variety of phases already. In the next three to five years,
I would guess probably a dozen or so will come out.
Speaker 4 (12:05):
GLP-1, GLP-2, and GLP-3 can sound like they're simply different
versions of the same thing, right? But they're not. GLP-1
and GLP-2 are naturally occurring hormones in the body with
different functions. GLP-1 helps regulate blood sugar, slow digestion, and
reduce appetite, which is why drugs that mimic GLP-1... which
(12:27):
includes semaglutide and trizepatide, can promote weight loss. The GLP-2 pathway, meanwhile,
plays an important role in the health and repair of
the intestinal lining. But it isn't for weight loss, and
there are GLP-2 medications like teglatide. But then there's the GLP-3,
in big ol' quotes. Because GLP-3 isn't a human hormone
(12:49):
pathway or an official drug class at all. GLP-3 is
an informal nickname for a set of experimental drugs that
target three different hormone pathways involved in metabolism and weight loss, GLP-1, GIP,
and glucagon. And because it targets three pathways, including GLP-1 pathways,
it's sometimes called a GLP-3, although hopefully it's clear that
(13:13):
that name is a little misleading. GLP-3s have not been
approved by the FDA, and clinical trials are still needed
to determine their longer-term benefits and risks. And this is
all kind of why you're going to want to talk
to your doctor before taking any of these. So, Dr. Hashmi,
we know that there are FDA-approved GLP-1s, which may be
(13:33):
covered by insurance. And then there are compounded versions, which
people can pay out of pocket for. Both require a prescription.
But let's listen to Ashley, who talked about this just
a little bit.
Speaker 2 (13:44):
Well, I always feel like if providers actually are prioritizing
their patients and their patient care, they should always advocate
for the resource that is available to their patients, whether
it is the name brand, if they have insurance that
covers it, or the compounded versions of patients who do
not have access to insurance or can't afford the pharmaceutical version.
(14:05):
I think that if more providers took that approach with
a compounding pharmacy, that we would actually see more patients
have less fear. Compounding is actually the original form of pharmaceuticals.
I mean, we've had compound pharmacies since, I think, earliest
of times. You know, if you even think back to witch.
Speaker 4 (14:23):
Doctors, right? Okay, so compounded GLP-1 drugs are now widely available.
They're made by specialized pharmacies that are separate from the
manufacturers of brand name medications. They are intended to be
similar to FDA approved GLP-1 drugs, but they themselves are
not FDA approved generic versions of those medications. Dr. Hashmi,
(14:47):
I'm curious about your reaction to what Ashley just shared.
Speaker 3 (14:51):
It's a great and relevant point because the cost of
the drugs make it very, very difficult for some people
to have access to. I understand the cost aspect, but
I'll start with a simple statement, which is my first
job is to first do no harm. And so when
we talk about using an FDA approved drug, when we
(15:13):
talk about going to a place where we know the
drug is appropriately tested, it matters. When we have looked
at peptides, not just the GLP-1s, but all sorts of
peptides that are being sold right now, we have found
that some of the compounded pharmacy, they don't even contain
a single ounce of what it says on the label.
So if it says it was, let's say, a certain...
(15:36):
triple agonist that's going to come out next year, that's
being sold right now on the black market and people
are buying it from compound pharmacies. When they have studied it,
they found it didn't even contain, some of the products
didn't even contain that. Some had very high level of contaminants.
When you get the actual vial and you're going to
inject it in your body, how do you know that
it went through the rigorous standards to make sure that
(15:57):
it doesn't have any bacterial contamination in there? You're putting
it into your body. So as a physician, it's not
that we're against compounding. We're against anything that jeopardizes a
patient's safety. Now that gets misconstrued as saying, well, you
know what, the doctor is working for the drug company. No,
(16:18):
we are working to save your life.
Speaker 4 (16:21):
Ashley also talked a bit about a GLP-1 being one
of the many tools she uses to manage her weight.
Speaker 2 (16:29):
There are a lot of people who take a GLP-1
medication and utilize it as a crutch instead of a tool.
And to that I say, if you don't have proper
weight loss behaviors outside of a GLP-1 and you don't
bring those into taking a GLP-1, you're not going to
see the success that you are hoping for. You still
(16:49):
have to drink your water. You still have to manage
your caloric intake. You still have to move your body.
It is not just a cure-all thing. You can be lazy,
sit on the couch and lose all this weight. I mean, sure,
there's probably a good portion of people who can do that.
But is your physique, is your body going to thank
you at the end of that? Probably not.
Speaker 3 (17:12):
If you just think of it as here is a
GLP-1 and go on your way, you have actually set
up the patient for failure.
Speaker 4 (17:20):
Dr. Hashmi, why is that?
Speaker 3 (17:22):
So the first thing you have to understand is when
you go on a GLP-1 diet, The first six to
12 months that you're on it are going to seem magical.
So I have stories of patients losing so much weight.
Then they come back and say, you know, doc, when
I started the drug, it seemed like for the first
time in my life, the food noise quieted. There was
no obsession over food. I didn't feel like I had
(17:43):
to run and get something all the time. And it
was magical. But now I don't think it works the
same way. I don't know what changed. So the first
part of this is how do you take a patient
and set them up for success? So you have to
make sure you start by realistic understanding. First one is
a GLP-1 is a tool alongside everything. Preparing a patient
(18:04):
means that this is our opportunity to now have some
help so we can help you to start eating better.
We can help you to start sleeping better. You know,
it's a fascinating thing. Most people don't focus on sleep.
But did you know if you sleep less than seven
hours of quality sleep a night, you end up actually
craving sugar and salt the next morning. So how important
(18:26):
is that, that if you're not sleeping one enough to regular,
that you're actually sabotaging your success on a GLP-1. So
what we do is, yes, we use GLP-1s, but we
wrap the patient around what I call a moat. We
set them up for success by explaining this entire strategy
(18:47):
of helping you to be the best version of yourself
and not thinking that GLP-1 is magical, but it's a
tool in our tool belt and we want to use
it wisely.
Speaker 4 (18:58):
Can you talk a little about the side effects?
Speaker 3 (19:01):
When you start to look at what happens when you
take a GLP-1, there's all sorts of side effects. The
biggest side effects are nausea, vomiting, diarrhea, constipation. About half
the people that go on this are going to have those.
Two thirds of the people at 12 to 18 months
quit because of these side effects. So if you want
to minimize that, you have to understand the more they
(19:23):
try to force into their stomach, the likelihood is it's
coming back because of the traffic jam. There's a couple
of simple foods that really trigger this, which is simple sugars,
white bread, white pasta, cookies, candies, cakes, juices, sodas. All
of these are going to trigger foods. If you don't
set up the patient and they've quit the drug, once again,
(19:45):
you lost the opportunity or worse yet, you didn't help
them to change their lifestyle. So now the drug magically
for six to 12 months, now it stopped working and
guess what? We're right back in the same place. But
I would argue that when a patient fails a GLP-1,
we actually put them in a spot that's worse than
before they ever started. It's a fascinating concept.
Speaker 4 (20:08):
I was going to ask, like, what happens when you
stop taking it? And it's interesting to say that that
might put someone in a worse position. Why is that?
Speaker 3 (20:15):
Here's why. When you lose a bunch of weight, a
couple of things happen. Not all that weight is fat.
So with it, you lose muscle. And we said early on,
depending on the study you lead, 30 to 40 percent
of it could be muscle. So in other words, you
not only lost weight, you lost a bunch of muscle.
There's some thoughts and some data that that as you're
(20:36):
losing muscle, you're also losing bone with it. So now
the patient gains all that weight back. You know, the
problem is they're not gaining the muscle and bone back.
They're replacing what was lost with fat. So their metabolic
rate is lower. They now actually have a greater percentage
of fat. So the problem is, is if you don't
set up the patient for success, You have to understand
(20:59):
when they start to regain, they're not regaining the same
weight back. They're regaining a different proportion of weight back.
And that's why every failure makes success harder. So our
job is small wins lead to bigger wins.
Speaker 4 (21:17):
Dr. Hashmi, both Ashley and Todd talked about this perception
that taking a GLP-1 is taking the easy way out.
Take a listen.
Speaker 2 (21:28):
I think that there's a big misconception out there of,
you know, oh, you're taking the easy way. Oh, why
don't you just count calories? Oh, why don't you just
do this? Why don't you just do that? As if
people who have been chronically obese or overweight didn't already
do those things and not have the results they were
looking for. I think it's a little insulting. But there
(21:49):
is tons of GLP-1 stigma.
Speaker 1 (21:51):
I see a lot that's really frustrating. It's just the whole, like,
easy way out thing.
Speaker 4 (21:57):
And.
Speaker 1 (21:58):
The whole like, well, you got to take it forever.
And I'm like, okay, so does it make me a
cooler person if I take blood pressure medication for the
rest of my life? Does it make me a better
person because I'm doing it that way and taking a
drug every day for the rest of my life? Or
can I take this drug once a week for the
rest of my life and be okay? I enjoy my
life so much more now because I don't feel like
(22:18):
trapped in my body anymore. And this medication has done that.
So yeah, happy to take it forever.
Speaker 4 (22:24):
I don't care. Okay, so Dr. Hashmi, those people who
think it's the easy way out, what would you want
them to know?
Speaker 3 (22:32):
We still classify it as a willpower issue. And that's
why the stigma is, is that you took the easy
way out by taking a GLP-1. We wouldn't say that to,
God forbid, a cancer patient. We wouldn't say that to
any other disease, somebody suffering from kidney disease. We don't
turn around and tell them, hey, you took the easy
way out. That's why you're on dialysis. We know it's
(22:55):
a real devastating disease. Well, obesity destroys families with the
shaming and blaming. Listen, at the end of the day,
your journey is yours alone. And how powerful would it
be that if you are able to use yourself as
an example to empower the people that are suffering? If
you're on a GLP-1, don't just talk about how GLP-1
(23:18):
is miraculous. Talk about how it gave you the opportunity
to fix your sleep, to move more, to work on
your stress, to eat healthier foods. How are you able
to be the change? I love that idea of being
the change because if you want to change something, Just
got to start with yourself. You can't do this thing
(23:39):
about hiding and not telling people. It's okay to be
on a GLP-1. It's okay to have bariatric surgery. It's
okay to go on a diet.
Speaker 4 (23:49):
Todd had a question for you, Dr. Hashmi. Take a listen.
Speaker 1 (23:53):
I have said that I will happily take this medication forever,
but I'm just wondering what the science and the recommendation
is of the dose I should be taking. Do I
need to take this shot every Tuesday for the rest
of my life? Do I need to be at 15 milligrams?
Or can I like go back down to 7.5 and
do it every two weeks? Doesn't sound like anyone has
like an exact recommendation of like what we're doing for maintenance,
(24:16):
the maintenance phase of this. Do I need to take
it once a week forever? Or can I mix it
up and do it every two weeks? Or do I
take a lower dose every couple days? Like what's the
current recommendation for maintenance phase? This is the ultimate question.
Speaker 3 (24:29):
And in our organization, we're actually starting the research studies
on this as well, because what we know once again
is when people stop the drug, they'll put back on
all their weight and then some. And in earlier in
the conversation, I had mentioned that you can actually find
yourself in a worse place than you ever started. So
what does that mean in terms of the tapering strategy?
There's several ways to look at this. First one is,
(24:51):
is There's a very small study that came out. It's
only 30-some people. And what it was able to show,
and there was no control to it, but what they
were able to show is that switching patients who had
stabilized on their weight from every week dosage to every
other week dosage allowed them to maintain their weight just fine.
So that is a viable strategy. We're looking at that
data now. We're looking to do studies on it and
(25:14):
figure out, does that make sense for our patients? Number
two is there's other ways to do it. We actually
have lower step-down therapies. For example, when we look at GLP-1s,
that's the only thing everyone knows. But there's actually non-GLP-1
oral drugs that have been out for quite a long time.
And they're still part of our arsenal and tool belts.
(25:34):
So in other words, we can do a de-escalation therapy
and be able to do that. What we're also looking
at is how do we create a mechanism where as
they're de-escalating, We have a wraparound strategy where we can
have comprehensive lifestyle programs that are intensive so we can
actually come up with a strategy to take you completely
(25:55):
off these drugs. All of these conversations are in the
works because the thing that once again, as a physician,
I would like to see not happen is I would
like to see that GLP-1s don't become permanent. If 20
years down the line, and I'm still here on this
planet with a blessing, If I'm still around and I
(26:16):
find out, God forbid, there's some rare side effect we
didn't know, the question I have to ask myself is,
did I do everything to use the drug, the least
effective dosage, for the right amount of time, and then
help the patients to go live their life? That's the
ultimate goal for all of us.
Speaker 4 (26:33):
Is there anyone who shouldn't take a GLP-1?
Speaker 3 (26:37):
Yeah, there's a lot of sort of relative contraindications, absolute contraindications.
For example... If somebody has specifically certain types of thyroid cancer,
that's a contraindication to be able to use them. There's
other things like pancreatitis, for example. That's a real risk,
and we get concerned about it.
Speaker 4 (26:57):
I want to get to the other uses for GLP-1s,
but first, can you address the online claim that GLP-1s
can help with inflammation?
Speaker 3 (27:04):
I think inflammation is a buzzword. And people use inflammation
as a way on social media to say, you can
do this, take this tonic, take this herb, take this pill.
It'll lower it. But if you look at the data,
the greatest improvement in inflammation you can get starts by
what we do and what we put in our bodies.
(27:25):
It sounds like a broken record, but before you're going
on drugs, are you sleeping effectively? Is your regimen good?
How are you working on that? Are you making sure
you're exercising?
Speaker 4 (27:35):
Makes sense. So a GLP-1 wouldn't be your first line
of defense against inflammation. Okay, so let's address some of
the other uses for GLP-1s that are being explored. What
studies are being done?
Speaker 3 (27:48):
We know that these drugs act on the reward centers
of your brain. That's why you've seen that they're good with,
for example, in some reports, people helping them to quit alcohol.
Some reports show that they can even help people quitting smoking.
Speaker 4 (28:04):
Why?
Speaker 3 (28:04):
Because the reward pathways are similar. No, so there's so
much exciting data that's coming out. And remember, a study
by itself is helpful, but it's not definitive because you're
limited by the population it was studied on, you're limited
by the duration, you're limited by the control. You have
all of these variables. Same thing for obstructive sleep apnea.
(28:26):
We were talking today about a particular person who improved
their obstructive sleep apnea on a GLP-1 and did really well.
But what we forget about obstructive sleep apnea is a
two-way cycle. So in other words, excess weight causes obstructive
sleep apnea. It increases fat around the airway. But then
(28:47):
you turn it around and did you know obstructive sleep
apnea causes weight gain? And now there's interesting data on
osteoarthritic pain that's starting to come out. So people who
have chronic knee pain, GLP-1s, irrespective of weight loss, are
being shown to help. There's some interesting data on colon
cancer where there's a reduced incidence of it. There's some
(29:08):
new data on infections and inflammatory conditions where these actually
may be protected. So a lot of really fascinating, of course,
the brain data we're all waiting on to see if
it'll be something that's promising.
Speaker 4 (29:21):
So where does this leave us? GLP-1s are a powerful
tool for weight loss and other established health benefits. But
the excitement around them has also created a lot of
questions about what they might do next. Some of those
possibilities are promising. Some are still being studied. and some
are simply hype. But take away, when it comes to GLP-1s,
(29:44):
the science is moving fast, and it's worth learning the
difference between what we know and what we hope might
be true. Thanks again to Dr. Sean Hashmi for helping
us to understand GLP-1s better. And thanks again to Ashley
Gibson and Todd Masterson for sharing their stories and experiences
with us. If you haven't already, please hit the subscribe
(30:04):
or the follow button and join us next time on
Health vs. Hype with the American Medical Association. For more
information on all the topics we're covering, visit amahealthvshype.org. That's amahealthvshype.org.
Health vs. Hype is a production of Ruby Studio from
iHeartMedia and the American Medical Association. I'm Trace Dominguez. Our
(30:27):
producer is Pamela Lawrence. The show is engineered and features
original music by Matthew Ernest Filler. Health vs. Hype is
intended for educational and informational purposes only and does not
constitute medical advice, diagnosis, or treatment. Always seek the advice
of your physician with any questions you may have regarding
a medical condition.
So I first heard about GLP-1s a few years ago
when Mindy Kaling was on it because she kind of
left the public eye for a little bit and then
came back and was dramatically skinny. And she just tried
to say that she had lost the weight by walking
around her neighborhood in Hollywood.
Speaker 2 (00:23):
In the time that I was able to only lose
six pounds without a GLP-1 medication, I lost 55 pounds
on a GLP-1 medication. Nothing changed about my lifestyle. Nothing
changed about the way I was working out. Nothing changed
about the way I was eating.
Speaker 3 (00:39):
When you go on a GLP-1, the first six to
12 months that you're on it are going to seem magical.
Speaker 4 (00:45):
GLP-1s or glucagon-like peptide ones. You've heard of them, right?
It seems like we're bombarded with before and after images
online of dramatic weight loss with the hashtag GLP-1. And
everyone seems to have strong opinions about them. Drug names
like Ozempic and Zepbound come up in conversation. Maybe you're
on a GLP-1. You likely know someone on one, even
(01:06):
if they haven't told you about it. Roughly one in
nine Americans take the weekly shot to lose weight. But
scroll through social media and another picture emerges. You'll start
to hear people talk about using a GLP-1 for things
other than weight loss. Like Todd Masterson, who went on
a GLP-1 as a treatment for sleep apnea, a common
sleep disorder where your breathing repeatedly stops and starts for
(01:28):
10 seconds or more throughout the night.
Speaker 1 (01:30):
The one that I'm on is approved for sleep apnea.
But the only reason I got approved for sleep apnea
is because I did everything else. I did a sleep
study and then I did a CPAP machine for 90 days.
Speaker 4 (01:42):
And Ashley Gibson, who takes a GLP-1 as part of
her treatment for PCOS.
Speaker 2 (01:47):
Or polycystic ovarian syndrome.
Speaker 4 (01:49):
Which is now known as PMOS.
Speaker 2 (01:52):
Or polyendocrine metabolic ovarian syndrome, a.
Speaker 4 (01:56):
Common hormonal and metabolic disorder that affects people of reproductive age.
The condition involves multiple hormone systems and metabolic health. One
of the many symptoms is weight gain or significant difficulty
with losing weight. GLP-1s are sometimes used off-label as a
treatment for PCOS or PMOS. So should GLP-1s stick to
(02:17):
what they do best, weight management and diabetes treatment, or
are there other things that we can treat with them?
We invited AMA physician Sean Hashmi, a board-certified nephrologist and
obesity medicine specialist with Kaiser Permanente, to help us find
the answers.
Speaker 3 (02:32):
Obesity has been so difficult and it's been up and down,
up and down, that anything new that comes on the
market that says it's going to help us to lose weight,
that immediately draws people because they feel like we have
not been successful.
Speaker 4 (02:47):
Welcome back to Health vs. Hype with the American Medical Association.
I'm your host, Trace Dominguez. Today, we're talking about GLP-1s,
specifically what they can do and can't do and what
claims the evidence supports, and what science is still learning
about them. Join me as we find out whether GLP-1s
are all health or just hype. So, Todd, I wanted
(03:24):
to start with you because you tried a few things
to help with your obstructive sleep apnea, but you finally
landed on terzepatide, a type of GLP-1. What was that like?
Speaker 1 (03:35):
I'm a huge advocate for it. I literally do say
that it's a miracle drug. Weight loss is the biggest,
most visible side effect of the drug, but it helps
with so much more. So the path that I took
to get it was through my doctor. He prescribed me terzepatide.
I was approved for it for sleep apnea. And I
(03:55):
was like, well, heck yeah, let me try that. But
then I also really wanted the weight loss.
Speaker 4 (04:01):
To clarify, Gizepatide, which you may know of as Zepbound,
is approved for sleep apnea, but only in adults with obesity,
likely because obesity is a risk factor for sleep apnea.
We'll get the facts about that later from Dr.
Speaker 3 (04:14):
Hashmi.
Speaker 4 (04:15):
So Todd, what did you notice once you started?
Speaker 1 (04:19):
It almost instantly started working with the side effects that
people said would happen, which is the quieting of the
food noise, the suppression of appetite, the energy, the inflammation,
it reduces inflammation. And so literally my joints felt better,
my muscles felt better, my, you know, everything just like
felt better. It was like my body stopped physically hating
itself so much. Almost all of that started within the
(04:41):
first week after the first shot of just like the
baseline of the medication.
Speaker 4 (04:45):
And it was.
Speaker 1 (04:46):
Almost scary how fast it worked and how good it
worked and how I was like, oh my God, everybody
was right. Because the biggest thing is the food noise.
We're like, you know, as an obese person, as a
chronically fat kid my whole life, I didn't realize how
much I thought about food. Once I started taking this medication,
all that went away. And I realized how much time
(05:07):
of my day I spent thinking about food and now
I'm not thinking about it anymore.
Speaker 3 (05:10):
And I was like, oh my God.
Speaker 4 (05:12):
Food noise, while not an official scientific term, is understood
as persistent thoughts about food that a person perceives as
unwanted or distressing and that may cause social, mental or
physical problems. Ashley describes what it feels like.
Speaker 2 (05:29):
The best way to describe it is, let's say that
you have a fire detector going off in your house.
you know you need to change the battery of the
fire detector it keeps dinging in the background and it's
getting on your nerves you know it's there you know
you need to turn it off but you can't get
up to change it because you need to get a
(05:50):
ladder so like think about it that way it's something
that's constantly going off every couple of minutes where you're
thinking about food or drink or snacks or something and
that's probably the best way to describe how food noise
affects you.
Speaker 4 (06:05):
Wow I mean that sounds awful It's not great.
Speaker 2 (06:08):
I mean, it's just one of those things where, you know,
people always say that the hardest part of a weight
loss journey is willpower, but you can't out willpower your brain.
You really can't. You can't out willpower your hunger pangs.
It's unlike anything that I think that people who have
a healthy body type or healthy metabolism or healthy relationship
(06:29):
with food can even comprehend because they've never had to
live with the brain of somebody whose body is constantly
fighting against the natural reaction that they are.
Speaker 4 (06:40):
Supposed to have. How did it feel once it finally
went away? It was quiet.
Speaker 2 (06:44):
It was so quiet. I finally, and I tell this
to everyone, in my first year being on a GLP-1 medication,
I read 150 books. Because I was not constantly chasing
the next meal or thinking about, am I allowed to
eat this?
Speaker 4 (07:00):
Can I eat this?
Speaker 2 (07:02):
Staying up late because I'm like, I'm so hungry, I
can't fall asleep, even though I know I just ate
a full meal at 8 p.m. The amount of brain
power that goes into constantly thinking about your next meal,
if you take that out of the picture, just think
about all the things.
Speaker 4 (07:17):
That you could do. I want to bring in our physician, Dr. Hashmi,
so we can get a fuller picture of what a
GLP-1 actually is and how it works to quiet food noise.
Speaker 3 (07:28):
So food noise is so important to understand. In MRI scans,
if let's say I'm somebody who's dealing with this disease
obesity and you're not, and we do an MRI of
both of our brains, you'll find that just looking at,
let's say something sugary, let's say it's a donut, just
looking at it, you'll see my brain light up far
(07:49):
more than yours. It's a crazy concept. So food noise
is a medical condition. It is not a psychological condition
that's just in your head. It is real to our patients.
For the longest time, I think there were a lot
of issues on how we framed obesity. We turned the
idea of obesity into a willpower issue. So the common
(08:12):
statement of why don't you eat less? Why don't you
move more is going to fix everything. The challenge with
relying on those kind of statements, which, by the way,
are not incorrect from a physiology perspective because we're dealing
with a numbers game. But the reason they don't work
is obesity is one of those really cruel diseases that
never takes a day off. It doesn't care if it's
(08:32):
your birthday. It doesn't care if it's Christmas, New Year's.
And as a result of it, willpower's ability to last
is very fickle. It starts, it fades. And as a result,
every success lets you have more success. But every failure...
sort of goes back to that same concept of, hey,
I just can't do this. I can't believe I did
(08:54):
it again. I blame myself. And getting rid of blame
and shame out of the equation of obesity is one
of the most important things that we focus on. The
goal is put the patient in the middle, start the
conversation by letting them know it's not your fault.
Speaker 4 (09:12):
Can you tell people who may not know when they
think about obesity, when they think about weight loss right now,
GLP-1s are at the top of the conversation. So what
is a GLP-1? How does it work?
Speaker 3 (09:24):
So GLP-1s are nothing more than peptides. And the history
behind them, you know, we have been using GLP-1s for
several decades. The difference now is we weren't using them
at the doses we use now. Those are the doses
we finally started linking them to weight loss. The uses
of GLP-1 before primarily was around diabetes. The three sort
(09:47):
of big things about GLP-1s to really understand, there are
so many different mechanisms. But when you start from your
mouth and going down, I tell my patients they create
sort of a traffic jam in your stomach, which means
that food sits in your stomach longer. And as a result,
you feel full sooner when you're able to get the
food in your body. GLP-1s cause the pancreas to shoot
(10:10):
out more insulin. So now you have the secondary mechanism.
The third mechanism is they tell the liver not to
pull so much glucose into the blood. But these are
the physiological mechanism. Then there's this, what I call the
one ring to rule it all, so to speak. The
fourth mechanism is in the brain, where it's acting on
the pleasure centers of the brain.
Speaker 4 (10:32):
And that brings us to a bigger picture. What exactly
are peptides? Well, I'm glad you asked. Peptides are short
chains of amino acids, or the building blocks of proteins.
They act as signaling molecules in the body, and they
can essentially tell cells what to do, which is why
researchers are studying them for everything from metabolism and muscle
(10:52):
growth to healing and, of course, weight loss. We talk
about GLP-1s as a kind of high-level concept. And then
the drugs that are name brand are generic from that.
Are all the GLP-1 peptides the same thing or is
it like a family of peptides?
Speaker 3 (11:08):
GLP-1s is exactly that. It's one agent in there. GLP-2
or the upcoming GLP-3s, each one of those things that
I've mentioned does something that's very different and unique. And
because of that, we went from a stage of telling
the brain not to feel hungry to starting with things
like GLP-3s where glucagon is actually going to cause the
(11:29):
breakdown of fat cells. Right now, as you know, there's
a race. And the race is, can we create bigger, better, stronger?
And because that's happening, what we're doing is we're forgetting
about the patient in the middle. What we don't want
to do is create a situation where a patient starts
with a GLP-1, goes to a GLP-2, then they fail
(11:50):
that one, and they're waiting on a GLP-3. Now, in studies,
there's 35 different agents that are being studied in a
variety of phases already. In the next three to five years,
I would guess probably a dozen or so will come out.
Speaker 4 (12:05):
GLP-1, GLP-2, and GLP-3 can sound like they're simply different
versions of the same thing, right? But they're not. GLP-1
and GLP-2 are naturally occurring hormones in the body with
different functions. GLP-1 helps regulate blood sugar, slow digestion, and
reduce appetite, which is why drugs that mimic GLP-1... which
(12:27):
includes semaglutide and trizepatide, can promote weight loss. The GLP-2 pathway, meanwhile,
plays an important role in the health and repair of
the intestinal lining. But it isn't for weight loss, and
there are GLP-2 medications like teglatide. But then there's the GLP-3,
in big ol' quotes. Because GLP-3 isn't a human hormone
(12:49):
pathway or an official drug class at all. GLP-3 is
an informal nickname for a set of experimental drugs that
target three different hormone pathways involved in metabolism and weight loss, GLP-1, GIP,
and glucagon. And because it targets three pathways, including GLP-1 pathways,
it's sometimes called a GLP-3, although hopefully it's clear that
(13:13):
that name is a little misleading. GLP-3s have not been
approved by the FDA, and clinical trials are still needed
to determine their longer-term benefits and risks. And this is
all kind of why you're going to want to talk
to your doctor before taking any of these. So, Dr. Hashmi,
we know that there are FDA-approved GLP-1s, which may be
(13:33):
covered by insurance. And then there are compounded versions, which
people can pay out of pocket for. Both require a prescription.
But let's listen to Ashley, who talked about this just
a little bit.
Speaker 2 (13:44):
Well, I always feel like if providers actually are prioritizing
their patients and their patient care, they should always advocate
for the resource that is available to their patients, whether
it is the name brand, if they have insurance that
covers it, or the compounded versions of patients who do
not have access to insurance or can't afford the pharmaceutical version.
(14:05):
I think that if more providers took that approach with
a compounding pharmacy, that we would actually see more patients
have less fear. Compounding is actually the original form of pharmaceuticals.
I mean, we've had compound pharmacies since, I think, earliest
of times. You know, if you even think back to witch.
Speaker 4 (14:23):
Doctors, right? Okay, so compounded GLP-1 drugs are now widely available.
They're made by specialized pharmacies that are separate from the
manufacturers of brand name medications. They are intended to be
similar to FDA approved GLP-1 drugs, but they themselves are
not FDA approved generic versions of those medications. Dr. Hashmi,
(14:47):
I'm curious about your reaction to what Ashley just shared.
Speaker 3 (14:51):
It's a great and relevant point because the cost of
the drugs make it very, very difficult for some people
to have access to. I understand the cost aspect, but
I'll start with a simple statement, which is my first
job is to first do no harm. And so when
we talk about using an FDA approved drug, when we
(15:13):
talk about going to a place where we know the
drug is appropriately tested, it matters. When we have looked
at peptides, not just the GLP-1s, but all sorts of
peptides that are being sold right now, we have found
that some of the compounded pharmacy, they don't even contain
a single ounce of what it says on the label.
So if it says it was, let's say, a certain...
(15:36):
triple agonist that's going to come out next year, that's
being sold right now on the black market and people
are buying it from compound pharmacies. When they have studied it,
they found it didn't even contain, some of the products
didn't even contain that. Some had very high level of contaminants.
When you get the actual vial and you're going to
inject it in your body, how do you know that
it went through the rigorous standards to make sure that
(15:57):
it doesn't have any bacterial contamination in there? You're putting
it into your body. So as a physician, it's not
that we're against compounding. We're against anything that jeopardizes a
patient's safety. Now that gets misconstrued as saying, well, you
know what, the doctor is working for the drug company. No,
(16:18):
we are working to save your life.
Speaker 4 (16:21):
Ashley also talked a bit about a GLP-1 being one
of the many tools she uses to manage her weight.
Speaker 2 (16:29):
There are a lot of people who take a GLP-1
medication and utilize it as a crutch instead of a tool.
And to that I say, if you don't have proper
weight loss behaviors outside of a GLP-1 and you don't
bring those into taking a GLP-1, you're not going to
see the success that you are hoping for. You still
(16:49):
have to drink your water. You still have to manage
your caloric intake. You still have to move your body.
It is not just a cure-all thing. You can be lazy,
sit on the couch and lose all this weight. I mean, sure,
there's probably a good portion of people who can do that.
But is your physique, is your body going to thank
you at the end of that? Probably not.
Speaker 3 (17:12):
If you just think of it as here is a
GLP-1 and go on your way, you have actually set
up the patient for failure.
Speaker 4 (17:20):
Dr. Hashmi, why is that?
Speaker 3 (17:22):
So the first thing you have to understand is when
you go on a GLP-1 diet, The first six to
12 months that you're on it are going to seem magical.
So I have stories of patients losing so much weight.
Then they come back and say, you know, doc, when
I started the drug, it seemed like for the first
time in my life, the food noise quieted. There was
no obsession over food. I didn't feel like I had
(17:43):
to run and get something all the time. And it
was magical. But now I don't think it works the
same way. I don't know what changed. So the first
part of this is how do you take a patient
and set them up for success? So you have to
make sure you start by realistic understanding. First one is
a GLP-1 is a tool alongside everything. Preparing a patient
(18:04):
means that this is our opportunity to now have some
help so we can help you to start eating better.
We can help you to start sleeping better. You know,
it's a fascinating thing. Most people don't focus on sleep.
But did you know if you sleep less than seven
hours of quality sleep a night, you end up actually
craving sugar and salt the next morning. So how important
(18:26):
is that, that if you're not sleeping one enough to regular,
that you're actually sabotaging your success on a GLP-1. So
what we do is, yes, we use GLP-1s, but we
wrap the patient around what I call a moat. We
set them up for success by explaining this entire strategy
(18:47):
of helping you to be the best version of yourself
and not thinking that GLP-1 is magical, but it's a
tool in our tool belt and we want to use
it wisely.
Speaker 4 (18:58):
Can you talk a little about the side effects?
Speaker 3 (19:01):
When you start to look at what happens when you
take a GLP-1, there's all sorts of side effects. The
biggest side effects are nausea, vomiting, diarrhea, constipation. About half
the people that go on this are going to have those.
Two thirds of the people at 12 to 18 months
quit because of these side effects. So if you want
to minimize that, you have to understand the more they
(19:23):
try to force into their stomach, the likelihood is it's
coming back because of the traffic jam. There's a couple
of simple foods that really trigger this, which is simple sugars,
white bread, white pasta, cookies, candies, cakes, juices, sodas. All
of these are going to trigger foods. If you don't
set up the patient and they've quit the drug, once again,
(19:45):
you lost the opportunity or worse yet, you didn't help
them to change their lifestyle. So now the drug magically
for six to 12 months, now it stopped working and
guess what? We're right back in the same place. But
I would argue that when a patient fails a GLP-1,
we actually put them in a spot that's worse than
before they ever started. It's a fascinating concept.
Speaker 4 (20:08):
I was going to ask, like, what happens when you
stop taking it? And it's interesting to say that that
might put someone in a worse position. Why is that?
Speaker 3 (20:15):
Here's why. When you lose a bunch of weight, a
couple of things happen. Not all that weight is fat.
So with it, you lose muscle. And we said early on,
depending on the study you lead, 30 to 40 percent
of it could be muscle. So in other words, you
not only lost weight, you lost a bunch of muscle.
There's some thoughts and some data that that as you're
(20:36):
losing muscle, you're also losing bone with it. So now
the patient gains all that weight back. You know, the
problem is they're not gaining the muscle and bone back.
They're replacing what was lost with fat. So their metabolic
rate is lower. They now actually have a greater percentage
of fat. So the problem is, is if you don't
set up the patient for success, You have to understand
(20:59):
when they start to regain, they're not regaining the same
weight back. They're regaining a different proportion of weight back.
And that's why every failure makes success harder. So our
job is small wins lead to bigger wins.
Speaker 4 (21:17):
Dr. Hashmi, both Ashley and Todd talked about this perception
that taking a GLP-1 is taking the easy way out.
Take a listen.
Speaker 2 (21:28):
I think that there's a big misconception out there of,
you know, oh, you're taking the easy way. Oh, why
don't you just count calories? Oh, why don't you just
do this? Why don't you just do that? As if
people who have been chronically obese or overweight didn't already
do those things and not have the results they were
looking for. I think it's a little insulting. But there
(21:49):
is tons of GLP-1 stigma.
Speaker 1 (21:51):
I see a lot that's really frustrating. It's just the whole, like,
easy way out thing.
Speaker 4 (21:57):
And.
Speaker 1 (21:58):
The whole like, well, you got to take it forever.
And I'm like, okay, so does it make me a
cooler person if I take blood pressure medication for the
rest of my life? Does it make me a better
person because I'm doing it that way and taking a
drug every day for the rest of my life? Or
can I take this drug once a week for the
rest of my life and be okay? I enjoy my
life so much more now because I don't feel like
(22:18):
trapped in my body anymore. And this medication has done that.
So yeah, happy to take it forever.
Speaker 4 (22:24):
I don't care. Okay, so Dr. Hashmi, those people who
think it's the easy way out, what would you want
them to know?
Speaker 3 (22:32):
We still classify it as a willpower issue. And that's
why the stigma is, is that you took the easy
way out by taking a GLP-1. We wouldn't say that to,
God forbid, a cancer patient. We wouldn't say that to
any other disease, somebody suffering from kidney disease. We don't
turn around and tell them, hey, you took the easy
way out. That's why you're on dialysis. We know it's
(22:55):
a real devastating disease. Well, obesity destroys families with the
shaming and blaming. Listen, at the end of the day,
your journey is yours alone. And how powerful would it
be that if you are able to use yourself as
an example to empower the people that are suffering? If
you're on a GLP-1, don't just talk about how GLP-1
(23:18):
is miraculous. Talk about how it gave you the opportunity
to fix your sleep, to move more, to work on
your stress, to eat healthier foods. How are you able
to be the change? I love that idea of being
the change because if you want to change something, Just
got to start with yourself. You can't do this thing
(23:39):
about hiding and not telling people. It's okay to be
on a GLP-1. It's okay to have bariatric surgery. It's
okay to go on a diet.
Speaker 4 (23:49):
Todd had a question for you, Dr. Hashmi. Take a listen.
Speaker 1 (23:53):
I have said that I will happily take this medication forever,
but I'm just wondering what the science and the recommendation
is of the dose I should be taking. Do I
need to take this shot every Tuesday for the rest
of my life? Do I need to be at 15 milligrams?
Or can I like go back down to 7.5 and
do it every two weeks? Doesn't sound like anyone has
like an exact recommendation of like what we're doing for maintenance,
(24:16):
the maintenance phase of this. Do I need to take
it once a week forever? Or can I mix it
up and do it every two weeks? Or do I
take a lower dose every couple days? Like what's the
current recommendation for maintenance phase? This is the ultimate question.
Speaker 3 (24:29):
And in our organization, we're actually starting the research studies
on this as well, because what we know once again
is when people stop the drug, they'll put back on
all their weight and then some. And in earlier in
the conversation, I had mentioned that you can actually find
yourself in a worse place than you ever started. So
what does that mean in terms of the tapering strategy?
There's several ways to look at this. First one is,
(24:51):
is There's a very small study that came out. It's
only 30-some people. And what it was able to show,
and there was no control to it, but what they
were able to show is that switching patients who had
stabilized on their weight from every week dosage to every
other week dosage allowed them to maintain their weight just fine.
So that is a viable strategy. We're looking at that
data now. We're looking to do studies on it and
(25:14):
figure out, does that make sense for our patients? Number
two is there's other ways to do it. We actually
have lower step-down therapies. For example, when we look at GLP-1s,
that's the only thing everyone knows. But there's actually non-GLP-1
oral drugs that have been out for quite a long time.
And they're still part of our arsenal and tool belts.
(25:34):
So in other words, we can do a de-escalation therapy
and be able to do that. What we're also looking
at is how do we create a mechanism where as
they're de-escalating, We have a wraparound strategy where we can
have comprehensive lifestyle programs that are intensive so we can
actually come up with a strategy to take you completely
(25:55):
off these drugs. All of these conversations are in the
works because the thing that once again, as a physician,
I would like to see not happen is I would
like to see that GLP-1s don't become permanent. If 20
years down the line, and I'm still here on this
planet with a blessing, If I'm still around and I
(26:16):
find out, God forbid, there's some rare side effect we
didn't know, the question I have to ask myself is,
did I do everything to use the drug, the least
effective dosage, for the right amount of time, and then
help the patients to go live their life? That's the
ultimate goal for all of us.
Speaker 4 (26:33):
Is there anyone who shouldn't take a GLP-1?
Speaker 3 (26:37):
Yeah, there's a lot of sort of relative contraindications, absolute contraindications.
For example... If somebody has specifically certain types of thyroid cancer,
that's a contraindication to be able to use them. There's
other things like pancreatitis, for example. That's a real risk,
and we get concerned about it.
Speaker 4 (26:57):
I want to get to the other uses for GLP-1s,
but first, can you address the online claim that GLP-1s
can help with inflammation?
Speaker 3 (27:04):
I think inflammation is a buzzword. And people use inflammation
as a way on social media to say, you can
do this, take this tonic, take this herb, take this pill.
It'll lower it. But if you look at the data,
the greatest improvement in inflammation you can get starts by
what we do and what we put in our bodies.
(27:25):
It sounds like a broken record, but before you're going
on drugs, are you sleeping effectively? Is your regimen good?
How are you working on that? Are you making sure
you're exercising?
Speaker 4 (27:35):
Makes sense. So a GLP-1 wouldn't be your first line
of defense against inflammation. Okay, so let's address some of
the other uses for GLP-1s that are being explored. What
studies are being done?
Speaker 3 (27:48):
We know that these drugs act on the reward centers
of your brain. That's why you've seen that they're good with,
for example, in some reports, people helping them to quit alcohol.
Some reports show that they can even help people quitting smoking.
Speaker 4 (28:04):
Why?
Speaker 3 (28:04):
Because the reward pathways are similar. No, so there's so
much exciting data that's coming out. And remember, a study
by itself is helpful, but it's not definitive because you're
limited by the population it was studied on, you're limited
by the duration, you're limited by the control. You have
all of these variables. Same thing for obstructive sleep apnea.
(28:26):
We were talking today about a particular person who improved
their obstructive sleep apnea on a GLP-1 and did really well.
But what we forget about obstructive sleep apnea is a
two-way cycle. So in other words, excess weight causes obstructive
sleep apnea. It increases fat around the airway. But then
(28:47):
you turn it around and did you know obstructive sleep
apnea causes weight gain? And now there's interesting data on
osteoarthritic pain that's starting to come out. So people who
have chronic knee pain, GLP-1s, irrespective of weight loss, are
being shown to help. There's some interesting data on colon
cancer where there's a reduced incidence of it. There's some
(29:08):
new data on infections and inflammatory conditions where these actually
may be protected. So a lot of really fascinating, of course,
the brain data we're all waiting on to see if
it'll be something that's promising.
Speaker 4 (29:21):
So where does this leave us? GLP-1s are a powerful
tool for weight loss and other established health benefits. But
the excitement around them has also created a lot of
questions about what they might do next. Some of those
possibilities are promising. Some are still being studied. and some
are simply hype. But take away, when it comes to GLP-1s,
(29:44):
the science is moving fast, and it's worth learning the
difference between what we know and what we hope might
be true. Thanks again to Dr. Sean Hashmi for helping
us to understand GLP-1s better. And thanks again to Ashley
Gibson and Todd Masterson for sharing their stories and experiences
with us. If you haven't already, please hit the subscribe
(30:04):
or the follow button and join us next time on
Health vs. Hype with the American Medical Association. For more
information on all the topics we're covering, visit amahealthvshype.org. That's amahealthvshype.org.
Health vs. Hype is a production of Ruby Studio from
iHeartMedia and the American Medical Association. I'm Trace Dominguez. Our
(30:27):
producer is Pamela Lawrence. The show is engineered and features
original music by Matthew Ernest Filler. Health vs. Hype is
intended for educational and informational purposes only and does not
constitute medical advice, diagnosis, or treatment. Always seek the advice
of your physician with any questions you may have regarding
a medical condition.
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