What's the deal with GLP-1s?

This week, Emily and Perry discuss GLP-1s, those blockbuster weight-loss drugs that have taken the world by storm -- and not just what you already know about them. From the origins in Gila monster venom to the surprisingly long history of their use, they explore their effectiveness, side effects, lingering questions about long-term usage, and the weird knock-on effects in both the brain (libido?) and our society (protein water?). These drugs are here to stay, so let's understand them from every angle.

Plus: RFK vs. Dr. Mike, a concerning Surgeon General pick, and unsurprising data around football head injuries.

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Episode Transcript

Speaker 1 (00:01):
Hey, Perry, how you doing.

Speaker 2 (00:03):
I'm good, Emily.

Speaker 1 (00:04):
Nice to see you, Nice to see you.

Speaker 3 (00:06):
Okay, today we are talking about GLP one's. I'm going
to ask you some questions. Do you know anyone using
a GLP one?

Speaker 2 (00:13):
Well? Wait, I've never heard of this? What is it now?
I'm just kidding. Yes, of course I know people on
GLP ones.

Speaker 1 (00:21):
Do you know people using them off label?

Speaker 2 (00:23):
Yes?

Speaker 3 (00:23):
Do you know people who are using other people's GLP
ones from their refrigerator?

Speaker 2 (00:28):
Yes?

Speaker 1 (00:29):
Do you know people who are micro dosing GLP ones?

Speaker 2 (00:32):
Yes? Yes?

Speaker 1 (00:33):
Do you know any wait?

Speaker 3 (00:35):
Do you know anyone who is micro dosing GLP one
so they can focus better at their tech job?

Speaker 2 (00:41):
Okay, you got me there, I will I will take
a drink.

Speaker 1 (00:44):
I'm a yes on that one.

Speaker 2 (00:46):
Wow. I want to hear more, but it might have
to tap an offline.

Speaker 3 (00:53):
I'm Emily Oster, I'm an economist and a data expert.

Speaker 2 (00:56):
And I'm Perry Wilson. I'm a medical doctor.

Speaker 1 (00:58):
It's Thursday, March six, and this is wellness.

Speaker 2 (01:02):
Actually, because you're getting a staggering amount of health and
wellness information nowadays from every source imaginable, and some of
it is awesome and.

Speaker 1 (01:12):
Some of it is well, actually both.

Speaker 3 (01:16):
Fortunately we're both people who know how to read studies,
how to parse the data, and can tell you what's
worth thinking about and what you can safely ignore.

Speaker 2 (01:25):
But before we dig in, a note that this podcast
is for educational purposes and should not be construed as
medical advice. We don't know your unique situation, so talk
to your doctor for personal health decisions.

Speaker 3 (01:35):
This week we're asking what's the deal with GLP ones
and you will get our highly official thumbs up or
thumbs down verdict, and then we'll get to your question
of the week. But first, let's do the health news
roundup after the break, all right, Perry, So, doctor Mike

(02:04):
from the Internet offered RFK Junior one hundred thousand dollars
given to the charity of his choice to appear on
his podcast. Would you take the one hundred thousand dollars
and what do you think about this?

Speaker 2 (02:18):
Oh? My god, I would take five dollars to appear
on doctor Mike's podcast. I've met doctor Mike. I like
doctor Mike. He is actually one of these influencers who
generally seems to have his head in the right place
in terms of science based medicine and things like that,
and so I think RFK would be actually quite unwise

(02:38):
to sit down with him and have a conversation. I
think this is sort of a social media stunt a
little bit. It gets some attention, but I'm here for it,
you know. I like people like this sort of fighting
fire with fire in this space. So good on you,
doctor Mike. He's not going to take it.

Speaker 3 (02:56):
So I actually had a different reaction to this, which
is twofold one. I do like doctor Mike very much.
I would also be on his podcast for nothing. But
one worry I have is that when you platform somebody,
you platform and they let them say the things that
they think, and in a lot of what RFK thinks
doesn't make any sense.

Speaker 1 (03:15):
And also, what's the charity of choice?

Speaker 3 (03:18):
Is this going to mean doctor Mike is donating to
the anti VACS Alliance?

Speaker 1 (03:22):
That would be some guardrails.

Speaker 2 (03:24):
That's a great point. I mean, I regarding platforming, he's
the head of Health and Human Services and he's got
an adequate platform at this point. But you're right, yes,
he could definitely pick a particularly loathsome charity in this case.
Let's stick in terms of health news with the government
interesting confirmation hearing for doctor Ksey Means, who's been considered

(03:48):
to be Surgeon General. At the time of this recording,
there has not been an official vote on whether she
would be approved to become Surgeon General. Doctor Means is
an interesting character, firmly in the wellness space. Just for
those of those who don't know who she is, she
graduated medical school from Stanford and then went to an

(04:09):
eer nos and throat residency program, which she never completed.
So the way medicine works, or doctoring works is you
go to med school and then you do an internship
in residency which is sort of a supervis period where
you're under the supervision of a senior doctor, and then
you graduate that, you take your board exams, and you
become board certified. She dropped out about six months prior

(04:33):
to graduation of from the ENT program, which is particularly odd.
According to her book, she did it because she became
disillusioned with modern medicine and this sort of, you know,
culture of treating disease and not preventing it. Because of
that narrative, she's sort of become a darling of the
alternative medicine space. You know, someone who is deeply entrenched

(04:55):
in like the evil world of medicine and escaped. There's
an interesting article in Vanity Fair which interviews some of
her co residents and a former chair of VNT who
actually say she dropped out because of stress. So there's
a little bit of ret conning potentially going on here.
I want to get your impression on her, but I
need to know how you'll respond to this little bit
of audio I found. This is not from her confirmation hearing.

(05:18):
This is from a podcast, but I'm going to play
you some casey means audio to get your reaction.

Speaker 4 (05:23):
The more specialties we invent in healthcare, the sicker we're getting.
The more drugs we prescribe in the United States for
these different chronic illnesses, the increase in the rates of
these diseases. So the more drugs for the diseases, the
higher amounts of these diseases we get, the more specialties,

(05:43):
the more diseases, literally, the more research that we publish
on these diseases, the worse the diseases are getting.

Speaker 3 (05:53):
Well, all right, Perry, So, first of all, I think
she's confused about reverse causality. That's probably a little more
technical than you were hoping to get, but it is.

Speaker 2 (06:05):
Exactly what I was hoping to get.

Speaker 3 (06:07):
We do more work on a disease when it is worse,
but I think to conclude that it is the research
that we do on the disease that makes it worse
is perhaps the wrong direction, as opposed to when there's
more of a disease we do or research on it.
So I don't think the causality goes the direction that
she thinks.

Speaker 2 (06:23):
It's one of the stupidest takes I've ever heard from
someone with an MD after their name.

Speaker 1 (06:28):
It's a stupid take. It's on the stupider side. I agree. However,
I will say that I feel like.

Speaker 3 (06:35):
There's been a lot of credentialing of doctor means and
saying she didn't finish her residency and blah blah blah.
I am much more concerned about the things she's saying
than whether she completed this particular component of her training
and if she were saying very sensible things which made
sense and were consistent with science. The fact that she

(06:57):
left her residency after with six months, like that's sort
of that's kind of her business. My much bigger concern
is that a lot of what she's saying does not
comport with the science that I think the idea of
having someone who is America's top doctor, which is one
of the ways you think can think of the Surgeon General,
to have that person be unwilling to say that vaccines
are a good idea and to be unwilling to say,

(07:20):
as she was in the confirmation, to be unwilling to
say that the flu vaccine reduces flu mortality. I mean
that just feels like, really, can we do that?

Speaker 2 (07:30):
Yeah? And the sort of refrain that she had, which
was obviously prepared, was like, oh, well, you should talk
to your doctor about this. This should all be a
discussion between a patient and a doctor. You know, I'm
not saying it doesn't work, but you should discuss with
your doctor. It's not my place, and it's like no, no, no,
Like actually, when you're the surgeon General, that's your place.

(07:50):
That's twice your place, your place. This is what you're
here for.

Speaker 1 (07:55):
Okay, Well we'll see what happens there, all right.

Speaker 3 (07:57):
Last thing we want to talk about was a new
study of football players which is showing multiple neurocognitive deficits
in general in this large sample of football players, with
dose response effects based on years of play, which is
just a fancy way of saying the more years people play,

(08:17):
the more neurocognitive deficits we are seeing. I did not
find this study very surprising. We have a lot of
evidence that repeated concussions, which is probably a lot of
what's going on here, or even sort of moderate forms
of head trauma that do not elevate to the point
of a concussion, that those can have long term effects.

(08:40):
But I'm curious if you had different take on this.

Speaker 2 (08:45):
No, this is a nice study. Four thousand football players
from high school players on up, so this wasn't just
restricted to NFL players, and as you say, consistent with
a lot of prior data. And I love football, like
I love watching football. I have been an Eagles fan
for a long time. I mean I didn't love it

(09:05):
this year particularly, but in general. But it is hard
for me to kind of see this data come out
over and over and over again and it's clear that
something is happening here and it's like we're all doing that.
What's that meme of like that I don't know, it's
like a rodent or something who just kind of like
looks like looks to the side like I am I

(09:27):
going to say anything. I don't know. I guess know
what that meme is. I don't know. It's like, are
we gonna address this or are we just going to
kind of be like, Okay, this is how football works.
Because it seems like this is how football works.

Speaker 1 (09:39):
It is a how football works. I mean, I think
if you're looking for a.

Speaker 3 (09:42):
Sort of middle of the road solution from a smart person,
I don't. Do you remember Chris Nowinski, who we went
to college with.

Speaker 2 (09:51):
Yeah.

Speaker 3 (09:51):
Yeah, So Chris runs an organization that studies concussions in
football and tries to ameliorate this problem by, for example,
not encouraging people to not have tackle football before the
age of fourteen, so to say, hey, if there's a
jost response, let's like limit the amount of time kids
are actually having contact in football and then sort of

(10:15):
maybe make some changes to how college football is practiced
so there's less head injury. So Chris is doing really
really interesting work. We can put a link in the
show notes to his organization.

Speaker 2 (10:26):
I love it. That's awesome. My son did flag football
for the past couple seasons. He's thirteen. It's super fun.

Speaker 1 (10:33):
My kids hate sports, so that's not a concern for me,
but I know that it is for some.

Speaker 2 (10:39):
When we come back, we will ask what's the deal
with GLP ones?

Speaker 1 (10:48):
All right, Perry, glp ones? So I want to set.

Speaker 3 (10:52):
The stage here a little bit because I think that
there's a kind of GLP one one point zero conversation
that people can hear, like what are theyse do they
work for weight loss? And we will touch on that,
but I think at this point this is so ubiquitous
that people probably don't want to hear like GLP ones
are effective for weight loss. I actually want to focus
most of our conversation, if you're up for it, on

(11:13):
thinking about the sort of two point zero questions. So,
if people have lost weight, what about weight regain? What
are the other things this might work for? What are
the big concerns people have? What about the long term effects?
There are some interesting economic questions which I'm dying to discuss.

Speaker 2 (11:29):
I love it. This is not freshman year anymore. Welcome
to Senior Seminar.

Speaker 1 (11:33):
Exactly, Senior Seminar glp ones.

Speaker 3 (11:35):
Okay, but before we get or maybe as part of
senior seminar, can we talk about the Gila monster? Is
it heal a monster or gila monster is my first question.
And can you tell me why it's such an important animal?

Speaker 2 (11:48):
I say, heal a monster. I don't know if that
is correct. You can write to us it wellness actually
dot FM and correct everything we say. It is important.
This is so interesting. So GLP one is a substance
produced by your body and has been known since the seventies,
and even its effects were known in the early eighties.

(12:09):
So they took people and they gave them infusions of
human GLP one, and what they found is that their
gastric emptying really slowed down, and they reported more satiety,
so they weren't as hungry. But there was this problem,
and that's that GLP one that your body makes has
a half life of about a minute, and so as
long as it's directly infusing into your vein, you don't

(12:31):
feel hungry. But once you disconnect the IV you do
so not a viable product for weight loss, obviously, And
that was the state of things for ten years or so.
And then we get to a weird lab at the NIH.
A guy named Jean Pierre Routhman was working in John
Pisano's NIH lab testing venoms of various venomous animals. This

(12:56):
is one of those examples of like basic science, like
they had no idea what they were looking for. It
was just like venom's interesting, we should know more about
venom and great. This guy Raufman's job was to extract
venom from the helo monster, and he noticed that when
he injected this venom into mice, it did weird things
with their blood sugar and their pancreas. He wasn't sure
what it was. In nineteen ninety two, a scientist named

(13:19):
John Aang isolated the protein and helo monster venom that
was causing all these blood sugar issues. It was called
exendin four and that was developed into a drug called
eccentotide or bieta, the first GLP one drug, which was
FDA approved. Do you want to guess one two thousand
and five. This is not new science. But what was

(13:42):
amazing about the helo monster venom is that protein in
the venom, or that peptide in the venom looked like
human GLP one bound to the same receptor as human
GLP one. But it didn't break down in the blood
in a minute. It broke down over the course of
about a day, and so you could get away with
injecting it or the cleaned up variant that was eventually

(14:03):
produced called accentotide once a day, and all of a sudden,
this was a viable product.

Speaker 1 (14:09):
So I just want to be clear. This is a peptide.

Speaker 3 (14:10):
So for people who listen to the earlier episode on peptides,
this is an example of a peptide that is approved,
not like the Wolverine stack. So go back to that
episode for context there. Yeah, so okay, I think one
interesting follow up question before we get to some of
these details is actually a question of why now we're
discussing this. So if twenty years ago we developed this venom,

(14:35):
why is it now that we are seeing so much
more of this which feels like it's kind of come
up in the last three years, So what is is
there another science breakthrough that is more recent?

Speaker 2 (14:47):
Not really, it's been just kind of a grade as
these things kind of go, like once the class is discovered,
it's like, okay, this class of chemicals is discovered, there's
iterative improvements over time, and basically the improvements have been
two things. Number one, increased potency, which means that they've
developed peptides that bind a little more tightly to the
GLP one receptor in ourselves and to increased half life.

(15:08):
So where somemaglutide which also some people say semaglue tide,
but I say semaglutide or ozepic came along with a
once weekly dose because it was stable in your blood
for a much longer period of time, had a much
longer half life. That's where you start to get people
willing to think about this for treatment of obesity. Most
people without diabetes aren't comfortable injecting themselves once a day

(15:32):
with a product, and in fact, even people with diabetes don't.
No one loves injecting themselves right, and so once a
week was a thing. There was another milestone in the
obesity literature, which was this magical ten percent weight loss threshold,
which had always been the like arbitrary marker of is
this drug successful for weight loss? And Bayeta, the first

(15:54):
GLP one was not. It led to some weight loss,
about two to three percent over the course of a year,
but just wasn't potent enough. And it was really it's
and still is used for diabetes control blood shirt control.
You got the first greater than ten percent weight loss
effect with loraglutide, which came out later, and that sort
of set off the arms race that we have now
where you're just inventing drug after drug that are more

(16:15):
potent and more potent, and of course, like the most
recent trial, Lily's new drug, which I can't I can.

Speaker 1 (16:21):
I can even say, don't even try.

Speaker 2 (16:23):
Retract true Tide had a twenty eight percent year on
your weight loss, which is insane.

Speaker 3 (16:31):
Okay, So right now we find ourselves in a moment
where the two medications and people are most commonly using
for weight loss are wgov and zet bound.

Speaker 1 (16:39):
Wagov is semaglutide.

Speaker 3 (16:42):
It's the ozembic equivalent, but prescribe for weight loss. Zetbound
is trizepetide. It's the manjar equivalent, but prescribed for weight loss.
Both of these lead to something between fifteen to twenty
percent weight loss in the first year in the trial data.
They are both served through a weekly injection that people

(17:04):
give themselves. And the next thing that's coming is a
set of we're going to keep seeing innovation here. The
next thing that's coming is an oral form from Eli Lilly,
which has a slightly lower amount of weight loss, but
my guess is that the up tape will be very
high because people would much rather take.

Speaker 1 (17:20):
A pill than have an injection.

Speaker 3 (17:22):
So we really find ourselves in a moment this is
kind of the ozepic one point zero, where these medications
are incredibly effective for weight loss. They're much more effective
than pretty much anything we have had in terms.

Speaker 1 (17:33):
Of diet and exercise.

Speaker 3 (17:35):
They just work really well, and more and more things
that are developed are going to make them work better,
to the point I think, you know, you discuss the
latest trial with thirty percent weight loss, like people are
starting to have a conversation, but like what's too much?

Speaker 1 (17:49):
Like how much weight loss is too much weight loss?

Speaker 3 (17:52):
Like thirty percent is a lot in a year, and
so we're kind of at the point where probably it's
almost enough, although people always like more. But I think
it's very clear that these are effective for weight loss,
and that is like the science is done on that
particular piece. A next interesting question is what about the
other benefits, So before we get into like the things

(18:13):
we're concerned about, these were originally.

Speaker 1 (18:16):
Prescribed for diabetes.

Speaker 3 (18:17):
They are effective for weight loss, but we're starting to
see all kinds of claims like this is good for
kidney disease, is good for cardiovascular disease. This is good
for you know, I don't know, like cancer, cancer, for everything.
I mean, which of these things are best supported. I'm
going to ask you because I think the one of
the best supported one is the kidney's and you are,
in fact a kidney doctor.

Speaker 2 (18:37):
Yeah, all these off kind of off target effects, and
I think it's good to think about the non weight
non diabetes effects based on whether they are related to
a reduction in weight or are they something else entirely.
So let's say cancer as an example. So there have
been several studies that have shown that the use of
these drugs reduces the rate of related cancers. So the

(19:01):
classic obest related cancers, cancers that are driven by some
of the hormones that come from fat and stuff like that,
or like breast cancer, cancers of the GI tract, colon cancer,
and the rates of those things do go down. But
it's plausible, we always talk about biologically plausibility that the
reason they're going down is not because these drugs magically
killed tumor cells. It's because people lose weight, and weight

(19:23):
is a risk factor for the development of these types
of cancers. That's a similar mechanism for like a reduction
in blood pressure. For example, if you lose weight in
any way, your blood pressure goes down. Same thing for
kidney disease. Broadly speaking, the more weight you have, the
more metabolically active tissue you have in your body, the
more work the kidney has to do. And in general,
if you can give the kidney less work to do,

(19:43):
it's happy to not have to do as much and
they can kind of last longer. I think it's probably
similar for cardiovascular disease as well.

Speaker 3 (19:50):
So I will say that I think that in some
of these trials when they're looking at other kinds of
cardiovascular disease and so on, there's sort of some discussion
that maybe the effects are larger than you would expect
based on weight loss alone. So they're sort of trying
to do a kind of calibration and then say, well,
maybe it's it's like a lot of the weight loss,

(20:11):
but then there's something that you get more, although I
think that's obviously very hard thing to sort of separate
fully in the data.

Speaker 2 (20:18):
Yeah, and it relies on some assumptions of like you know,
how many pounds of weight is equivalent to how many
millimeters of mercury of blood pressure that are always like
a little bit handwavy. So that's all true. Like the
epidemic of obesity in our country and around the world
is driving much of the chronic disease epidemic. It just is.
And so anything that impacts obesity, whatever it is, is

(20:39):
going to reduce the rates of those diseases. That's cool.
But what always kind of gets me interested, and I
want to ask you this, Emily, are the things that
really can't plausibly be related to weight loss. So what
do you think about like the fact that people report
less smoking or alcohol intake, or gambling like this stuff.

Speaker 1 (21:00):
Yeah, I mean I think so my senses.

Speaker 3 (21:02):
Of those things, the one that is most strongly supported
in the data is alcohol, partly because that's where we've
studied the most, and partly because that's an activity that
most people engage in. There's a lot of reports in
both the data and just out in the world that
people's interest in alcohol declines as a result of this
and that other you know, they're interest in smoking, they're
interested in all these other kind of maybe what we

(21:24):
consider vices goes down. One interpretation of the way these
medications work, is that there's something about sort of almost
like sort of self control, like inhibition value. And I
mean this is consistent with when you talk to people
who take these medications. And I have not, but I've
talked to a lot of people. One of the things

(21:44):
that is very common for people to say is like
it turned off the noise.

Speaker 1 (21:48):
Like my head was full.

Speaker 3 (21:49):
Of food noise, and I was always thinking about food,
and I was always thinking about that, and this made
me think about it less.

Speaker 1 (21:55):
And if you think.

Speaker 3 (21:56):
About the way that a lot of people feel about alcohol,
are smoking or whatever, it is all also that noise.
It's like I feel the noise, I want to have
a drink, or I feel the noise I want to
have a cigarette. You can imagine that whatever is that mechanism,
it might work there. Similarly, I know people.

Speaker 1 (22:10):
Who take this for focus, who micro does like a
zep bound for focus.

Speaker 2 (22:14):
Yeah, talk to me about that. I've never heard that before.

Speaker 1 (22:17):
I don't know. The guys in Silicon Valley do a
lot of weird stuff. Perry, and one of the things
that he was is like it really helps you focus.

Speaker 3 (22:23):
It helps you not be distracted by whatever food noise, alcohol, noise,
smoking noise, other kinds of noise. Certainly, I would not
say that we have science or data or evidence that
supports that piece. But putting all of these things together,
it does feel like maybe there's something in there.

Speaker 1 (22:42):
There's something about the way this is interacting with people's brain.

Speaker 3 (22:45):
Chemistry that could be consistent with some of these effects.
Actually there's someone I believe there are some people thinking
about experimenting on providing people GLP once when they leave prison,
and one of the outcomes they would look at is recidivism.
And one interpretation of that is that basically, if you
could turn down people's impulses to engage in alcohol and

(23:07):
drugs and so on, they might actually be less likely
to return to prison.

Speaker 2 (23:10):
Wow, So doue fascinating, Totally fascinating.

Speaker 1 (23:13):
That's interesting. Again, this is like we're on the course.

Speaker 2 (23:16):
We're way out there.

Speaker 1 (23:17):
You know, we're way out there.

Speaker 2 (23:18):
There is plausibility here, though. I mean, one thing that
people know I think one point zero people know that
GLP one's decrease gas strict to emptying, so that that
just feeling of having a full stomach, It really does
seem like that is not everything here. I did a
quick review of like where GLP one receptor is found
in your body, so you know what kind of cells

(23:40):
express these receptors and high levels and yes they are
throughout the GI tract and pancreas and things like that.
But right up there in terms of organ systems is
the brain. So your brain has these receptors. We do
know that these peptides can cross the blood brain barrier,
and once a drug can cross the blood brain barrier,
and once you know there's receptors on your neurons for
that drug, like it kind of opens the door of

(24:01):
anything being possible to some extent, right, So all of
these things are definitely plausible.

Speaker 3 (24:06):
So if one thing people wonder about sometimes is when
you're on these and you lose weight, is it quote
the same as losing weight in other ways? Is it
literally just this makes you eat less, and you eat
less and then you lose weight, like to measure it
with the way you would lose weight, you know, if
you just literally ate less, is there something more than
that or is that kind of the whole business?

Speaker 2 (24:27):
Oh, this is such a good question because so much
of what I see online there is like an anti
GLP one current that is under there, and typically the
arguments do go something like this, like this is not natural,
like this isn't the real way to lose weight. And
because it's not the real way to lose weight, it
does these certain bad things. And I think the one

(24:50):
that you hear about the most is probably muscle loss.
And people come and are like, oh, no, you're not
just losing fat, You're losing muscle. And Emily, I know
you've looked into this. Well, I will ask you, is
it true that if I lose weight through other means
like diet and exercise, that I only lose fat and
don't lose muscle.

Speaker 1 (25:08):
That is not true, Perry.

Speaker 3 (25:09):
When you lose weight in any way, you lose both
fat and muscle. And some of that is like sort
of intimately linked because one of the things your muscles do,
actually the main thing for most of us our muscles
are doing are moving us around in the world. Yes,
And so if you are heavier, your muscles are moving
more stuff. It's like you're constantly wearing a weighted vest.

(25:30):
And when you lose weight, even if you just lost fat,
your muscles would be like, great, we don't have to
have so much of us anymore, because we aren't moving
around so much weight. And so there is like an
inherent feature of losing weight where you are going to
lose some fat and some muscle. And if you have
a lot of fat, you will lose relatively more fat.
But no matter how you lose weight, you are losing

(25:51):
some muscle. And that is also true on ozepic and
actually the study suggests it's no more true on dlp
ones than it is with other kinds of diet.

Speaker 1 (25:58):
Like you just you lose fat and some muscle.

Speaker 2 (26:01):
Yeah, and typically about thirty to up to fifty percent
of weight loss can come from muscle, regardless of what
the weight loss is. There is a little wrinkle here
that I don't see brought up often, but I'll say
it because we're in senior seminar, and that is that
the way that muscle mass gets assessed typically in these
studies is through a DEXA scan, which is sort of

(26:23):
a think of it like an X ray, but you
can see muscle tissue, you.

Speaker 1 (26:27):
Do a whole episode. Influencers love a DEXA scan.

Speaker 2 (26:29):
Oh interesting, Okay, So DEXA scans don't actually distinguish between
muscle and what's called lean mass, just like non fat,
non bone mass, So they sort of assume that like
everything that isn't bone and isn't fat is muscle, which
is obviously not true. You have like organs and stuff
like that, but it's it's more than that, which is

(26:50):
that fat infiltrates muscle, and DEXA scans cannot determine how
much of your muscle is infiltrated by fat. It just
looks like more muscle. You can think of this as
like the marbling of a steak, right, like if you
faten these cows, you get nice prime rib and things
like that, and it's really tastes delicious, but it's actually
bad for your muscle quality, and so we don't It

(27:12):
may be that some of the fat loss is happening
within muscle, which is almost certainly a good thing. But yes,
you're gonna lose muscle if you lose weight, no matter
how you lose weight. So Emily, let's say I don't
want to lose muscle, or at least I don't want
to lose as much muscle as possible. Can I prevent
this or am I you know, doomed?

Speaker 1 (27:28):
Ye?

Speaker 3 (27:29):
So one of the totally fascinating like knock on impacts
of the OZEMPA craze is the strength training craze. So
the idea that you sort of like all of a sudden,
you're on the GLP one for weight loss, but now
you need to do strength training, and that's actually not crazy.

Speaker 1 (27:47):
We think about, like, how do you retain and build muscle.

Speaker 3 (27:50):
You retain and build muscle by exercising, and in particular
by exercising in a way that you know, cardio, yes,
but also like by lifting stuff. And so there's a
kind of combo here where you take the GLP one
for weight loss and you exercise for muscle retention, which
tends to be a good combo. And interestingly, many people

(28:10):
report their willingness to exercise and get up and go
to the gym is greater when they're on a GLP one.
Getting back to potentially some of the stuff that we
talked about before around sort of impulse control. The other
thing is prioritizing protein, right, So, like so much of
what's happening when people are in GLP ones is they
eat less food, like fewer calories, but making sure that.

Speaker 1 (28:30):
Those fewer calories are actually like you're.

Speaker 3 (28:32):
Maintaining protein at the amount of protein shouldn't change that much,
whereas the amount of other things should change more and
kind of thinking about that balance. So there's still like
a need to think about diet and exercise even if
the GLP one is acting. I will say I was
at an influencer dinner at some point a few months ago,
and we can get into the economy later, but I

(28:54):
think restaurants have really adapted to this because all they
serve was protein, Like it was just exclusive protein. There
was like one tiny thing of French fries on the table,
and like, I like carbs.

Speaker 2 (29:06):
Yes, you're a carb queen.

Speaker 1 (29:07):
I was sad.

Speaker 3 (29:08):
I was sad about It's like, where's the bread service?

Speaker 1 (29:13):
But the bread service is over at fancy restaurants.

Speaker 2 (29:15):
Yeah. Yeah, it's just egg white service now and protein.

Speaker 1 (29:18):
Water, tuna, and egg whites exclusively. Okay.

Speaker 3 (29:23):
So that is the kind of I think big picture
of like sort of what happens initially when people are
on this, and what are some of the other things
it could work for.

Speaker 1 (29:31):
I think we should.

Speaker 3 (29:32):
Get into the things that people raise about that are
more concerning, the first of which is weight regain, the
question of do I need to be on this forever? Yeah,
and I will say, in the trials, the evidence is
pretty sharp that when you put someone on a GLP
one they lose twenty percent of their body weight. You
take them off their GLP one, they gain back about

(29:54):
half of their body weight, at least in the trials.
So is this a sort of is this a life sentence?
And is that a problem? I guess is my secondary quest.

Speaker 2 (30:05):
I think, yeah, the data is quite clear, but like
you know, part of me is a doctor, is like, well,
we have lots of medications like this, Like when I
treat someone for hypertension and I put them on a
blood pressure pill. In general, the expectations like, yeah, if
you stop this blood pressure pill, you will your blood
pressure will go up again, Like that's your There is
some constitutive effect there. One of the things I've seen

(30:28):
online from influencers though, who are kind of anti GLP
ones is like, oh, but if you lose weight through
you know, lifestyle change and changing your habits, then like
you'll have that forever. But with GLP one, you're you're
stuck for life, and you know this data as well
as I do. Emily, like I've ever heard like the
data on maintaining weight loss with diet literally offs is abysmal.

Speaker 3 (30:57):
This is the for me, like the stupidest piece of
this discussion, because it sort of presumes like, well, of
course we had a way before for people to lose
large amounts of weight and keep it off with diet,
and now you know we're not using that anymore. It's like, actually, no, yes,
it is possible to lose weight with diet, and some
people do. And I know because they show up in
comments when I talk about this, and they're like, I

(31:18):
lost three hundred pounds doing yoga and walking around the
block one time. It's like, that's super for you. For
most people, that actually isn't effective. Most diets work for
a little while and then people gain the weight back.
It's very very consistent, and so I'm not sure this
is really any different than that. Nor do I think
it's very different, as you say, than something like a statin,

(31:40):
which people go on and then they stay on forever,
and which by the way, you might be able to
get off after you're on your GLP one because your
cholesterol might improve.

Speaker 1 (31:48):
So that's another thing to think about.

Speaker 2 (31:50):
Well, yeah, I think the same thing with my blood
pressure pill. I was like, actually, they might be able
to come off if they start the GLP one the trials.
One of the reasons we even have this data is
because most of these trials last basically a year. Some
some go out to like a year and three months
or so, but that's the extent of the data, and
so we just don't know with that degree of fidelity,

(32:11):
like what ten years on a GLP one in terms
of weight loss. Looks like there's observational data to that
effect because the JLP once have been around for so long,
but the randomized trial data is limited and in scope.
What is interesting is how people in the real world
are kind of handling this. So, yes, they lose a
lot of weight, they get to a weight they're happy with,

(32:31):
and then they're like, Okay, I'm good. And what I've
found with patients that I've spoken to is generally not like, okay,
I'm going off JLP one, But people are doing this
thing that often gets there that's called microdosing. So what
do we know about microdosing? Is this the answer like, yeah,
you'll be on it, but you're only going to be
on a little bit.

Speaker 3 (32:48):
I don't think we have any idea, and I think
the reason is sort of interesting in terms of the
of the science. So you know, think about the kind
of who is running the trials of these the people
are running the trials that people are making the drugs
right Nova Noordas Gailli Lily. The makers of the drugs
run the trials, and they trial their drug at the
dosage that they are going to sell it at because

(33:10):
that is what the FDA tells them to do. That's
like this like how drug trials work. They don't usually
run trials of like and here's exactly how.

Speaker 1 (33:18):
You're gonna do it in the real world.

Speaker 3 (33:21):
But in the real world, when people get to this,
most of the doctors I know who are using this
will do I'm not sure they'd call it microdosing.

Speaker 1 (33:28):
They call it a maintenance dose.

Speaker 3 (33:29):
Right that we are like we start with a low dose,
we go up to a dose in which you're losing
weight in a consistent way. You get to the weight
that you would like to be, and then you drop
down the dosage until you get to a point where
you are maintaining that weight and that feels comfortable. And
that's how this is actually operating for most people in
the real world. I'm not sure we're going to see

(33:49):
trials of that in the short run, because I'm not
sure who who would run them, right, So I don't
think Nova noordis is going to run that kind of trial.
Somebody will eventually, but I think it's and it's also
just so in ideal world is sort of so titrated.
One of the concerns I think is that people are
titrating it themselves, whereas a much better thing would be
to TITRATEE under the supervision of your doctor, not to
just like take half your dose, which is my sense

(34:11):
is what people are actually.

Speaker 2 (34:14):
Right, And a lot of this has to be done
actually through compounding pharmacies, which we've talked about in a
prior episode. Has potential safety concerns. The ozepic pen has
a little clicky dial that you can turn, which does
allow you to change dose. My understanding is that the
zep bound pen does not. So the only way to

(34:34):
kind of micro dose that is to break the thing open,
and like, don't do that. That's a bad idea. So
you're kind of going outside the box a little bit here,
But I agree, I think this is probably what happens.
Like eventually we'll get to a point where, first of all,
there will be oral drugs and this will be the
kind of thing that you do probably take some lowish dose,

(34:55):
probably for an extended period of time, unless you want
to gain some more weight.

Speaker 3 (34:59):
Yeah, okay, so it is a long term medication. But
maybe the right frame is this is a long terra
medication like you're sat in near blood pressure medication, and
not a diet like the time that you tried to
lose weight on the all protein diet for six months
and then gained it back, which is in fact how
people interact with diets.

Speaker 1 (35:16):
Okay. The second big concern is just are there side effects?
Which there are?

Speaker 3 (35:20):
I think it should be very clear, like this is
a drug, it has side effects.

Speaker 1 (35:24):
The main side effect people.

Speaker 3 (35:26):
Complain about is nausea and other gastric problems. That is
a I think of just a that's a feature. I
don't know if it's a feature or a bug. It's
a very common side effect. What about some of these
more serious things, pancreatitis depression.

Speaker 2 (35:46):
Okay, probably should go through very quickly, like one by one. Pancreatitis. Yes,
rare case reports probably associated with these drugs. We know
they act on the pancreas. In fact that heal a
monster venom. When a heal a monks or bites a mouse,
it causes an acute pancreatitis. So I buy it, Yes rarely,
but yes, so people need to know, Like symptoms of

(36:08):
that are a deep and painful burning in your upper
part of your stomach. Like you'll know this is bad
when it's happening. You definitely want to get checked out. Okay,
the depression suicide thing, this is really interesting because we've
talked already about you know, the ability of these drugs
to potentially modulate reward pathways in the brain, and you

(36:29):
framed it differently Emily for the first time, and I'm
it's like, I'm still kind of grappling with the way
you frame this. So the way I hear people frame
this is like, oh, it takes away your desire to eat,
it takes away your desire to smoke, it takes away
your desire to drink alcohol. But like, what it's doing
is it's just it's kind of all the pleasure, pleasurable
things that your brain wants. It just kind of cuts
that off. And then like, are you joyless? Is there

(36:52):
no hope in the world? And if so, might it
not increase depression and suicidality. RFK Junior himself has raised
this issue, and I'll just point out that the current
best data is from a meta analysis of twenty seven
randomized controlled trials including thirty two thousand people looking at
the rates of suicide and self harm from these drugs,

(37:12):
and there is no difference in suicide or self harm
events between placebo and these drugs. So I do not
think that is real. And one of the reasons, like,
the way you've reframed this for me is as opposed
to saying like, oh, it cuts the reward pathways, like
you don't get the high of eating food or the
high of drinking alcohol. You've reframed it as like it's

(37:34):
not ending that thing, it's giving you this, Like it's
giving you control, it's giving you more focus, which is
I kind of like, I mean, I don't know if
it's true, but that is a different way to think
about it that might explain why you get less drinking
but not SUICIDEALTG.

Speaker 1 (37:48):
Yeah, I don't know.

Speaker 3 (37:49):
I mean I think that is a way that I
have heard people try to describe to me what this
is like, which I think is a potentially interesting organization
of some of these facts, but I don't know. Again,
it's like it's always hard to get inside of people's brains.

Speaker 2 (38:04):
It is. When we talk about enjoyable things that your
brain likes to do, something that always comes up is sex.
So what do we know about sexual effects of these drugs?

Speaker 1 (38:15):
Relatively little.

Speaker 3 (38:17):
You know, there are people who will say, like, this
limits your desire to have sex. I don't think there's
a lot of evidentiary support for that. What I will
say is there are some real issues that you know,
people in long term relationships grapple with when they go
on these medications, particularly if you know there's New York

(38:39):
Times actually had a series of very interesting stories about
couples where one person has gone on a JLP one
and they sort of said, well, you know, our life,
you still revolve around going out to dinner and you know,
drinking together and hanging out and like, and now this
person doesn't want to do those things anymore.

Speaker 1 (38:55):
And so you know, maybe you you do want to
have sex, maybe you don't want to have sex. But
there is another piece of It's not about a lack
of interest in physical relationship, or maybe it is, but
it's also about changing the relationship, and I actually think
that's a really important part of this for a lot
of people, that eating is a huge part of our lives.

(39:16):
And if you change things so.

Speaker 3 (39:18):
You aren't going to eat in the same way and
you are in a relationship with another person and they're
not going to change that, and your body is going
to be going through a lot of changes like that
is just an adaptation that people should expect and should,
you know, think about as part of this. I think
it's less about sex and more just just about you know,

(39:39):
when you change something totally about yourself and your relationship,
it changes and you have to adapt, and relationships are hard,
is my fundamental feeling.

Speaker 2 (39:46):
Yeah, indeed, I agree. There's sort of a disturbing lack
of data on this. As I was looking in I'll
just say there are like ten times as many studies
on male like impotence and and orgasm from GLP one
so than there is on female. It's like, all right,
researchers like, get with the program here a little bit.

(40:08):
Women are more likely to take JLP ones and are
more likely to lose a greater percentage of body waight
on JLP ones than men. Clearly, this needs to be
looked into. I agree, there's nothing terribly compelling. I did
find one study that was an observational study looking at
rates of a clinical diagnosis of an orgasmia the inability
to have an orgasm, which did find that compared to

(40:29):
women not on JLP onees, those on GLP one's had
that diagnosis code about twofold more often. It's a very
rare diagnosis code to get because most people don't talk
about this with our doctor in the first place. But
that rate was similar to women taking me foreman, which
is another drug for diabetes. So this is probably related
to the underlying reason that the woman is taking the

(40:50):
GLP one as opposed to the GLP one itself. But I,
you know, more data, I'd like more data here.

Speaker 3 (40:56):
Who doesn't want more data on women's sexual function as
opposed to men's sexual funk?

Speaker 1 (41:00):
Should where?

Speaker 2 (41:00):
Really?

Speaker 1 (41:00):
We're good, Thanks, it's enough data. We know everything, I
got it. We're fine, Okay.

Speaker 3 (41:06):
I think there are some interesting social and like regulatory
questions here, or maybe just social questions that we should
make sure that.

Speaker 1 (41:13):
We hit on.

Speaker 3 (41:15):
Last thing that I will say, I'm bringing up in
part because this is the first thing my father ever
asked me about ozempic He was like, have you heard
of ozempic face? And then he was like, blah blah
blah person that I now has it and I.

Speaker 1 (41:29):
Have heard of that. So, Harry, have you heard of
ozempic face.

Speaker 2 (41:35):
I've heard of ozempic face. I've heard of ozempic butt.

Speaker 1 (41:39):
Yeah, so ozempic face.

Speaker 3 (41:42):
My sense is that when you lose weight, your skin
takes some time to tighten back up, which or maybe
it doesn't tighten back up, and that you lose a
lot of weight in your face then or your butt,
it will be saggy. Yep, doesn't matter if it's on
a GLP one or in some other Yeah.

Speaker 2 (42:01):
We don't have that magic bullet that only makes you
lose fat like around your belly, but leaves shredded abs behind.
Like when you lose weight, your body consumes fat. Fat
is there to be a source of energy when you
don't take in enough calories, and that's what GLP ones do.
They make you eat less, so you expend more calories
than you are consuming, and so your body breaks down

(42:22):
fat as well as some other tissues as we discussed,
to recapture that energy. And they'll take fat from everywhere.
What ozebic face is in medically speaking, is mid face
volume loss. That's what the plastic surgeons call it. So
that sort of cheekbones and cheeks gives kind of a
sunken appearance. And you're right, this is what happens with

(42:42):
all formed yep at that one social ely for those
of you just listening on the podcast is making kind
of a fish face. This is what happens with all
forms of weight loss. I think the reason it's in
the zeitgeist now is that we just never had effective
weight loss that was working for the masses. So where
you will have I've seen this before is people getting
gastric bypass surgery, which was like before the JLP ones

(43:05):
was the main way that people could lose a significant
amount of body weight. But that's a big surgery. If
you think of like Al Roker before and after he
had gastric bypass. Before and after that, he looked very different.
He had midface volume loss. We didn't call it a
zembic face back then because it didn't exist. This is
just weight loss face. It is real. In fact, the
American Academy of Facial Plastic and Reconstructive Surgeons reported a

(43:29):
fifty percent increase in facial fat grafting procedures in twenty
twenty four, So people are thinking about it totally.

Speaker 1 (43:36):
Okay.

Speaker 3 (43:36):
I think that's a really good segue because I am
very interested in a knock on economic effects of these medications.

Speaker 2 (43:44):
Oh I love when you bring your economic doctorate into
this discussion. What's going to happen?

Speaker 1 (43:49):
So I'm going to tell you and where do I invest?

Speaker 3 (43:51):
Okay, So if I were an investor, I will tell
you number one, I would invest in places that do
excess skin removal.

Speaker 1 (43:58):
I'm not kidding.

Speaker 3 (43:59):
I think that there is going to be a huge
excess demand for skin removal procedures because if people have
been overeat for a very long time and you lose,
if you lose three hundred pounds, you end up with
a lot more skin and people.

Speaker 1 (44:14):
Can find it.

Speaker 3 (44:15):
They may not like how it looks, but also it
can be uncomfortable and you know, difficult to navigate.

Speaker 1 (44:20):
And there are procedures that will remove excess skin.

Speaker 3 (44:23):
And I think that that is an incredible growth area
and we will see a growth in the kind of
like meds SPA skin removal surgery situations.

Speaker 2 (44:33):
Okay, those are big surgeries. That's no joke.

Speaker 3 (44:36):
I realized that, and I but I still I'm still
going to go okay, like sting there.

Speaker 1 (44:40):
Okay. So that's one place.

Speaker 2 (44:42):
I'm wondering about, like our food industrial complex, right, Like
I walk down this supermarket and there's like eighty different cereals,
Like are they scared as Kellogg's?

Speaker 1 (44:50):
Like, uh oh, I think they are. Yeah.

Speaker 3 (44:52):
So I think it's like two interesting sort of places
that that may be affected by this.

Speaker 1 (44:56):
One is like the snack food complex.

Speaker 3 (44:58):
Right, if you think about what is going to go
from people's meals, I think snacks are likely to go
some and so I think we are already seeing impacts
on snack foods. We're already seeing restaurants think about, hey, can.

Speaker 1 (45:12):
We lower the portion sizes? Right, Like for a restaurant,
that's good.

Speaker 3 (45:15):
You'd rather give people smaller portions because it's you know,
less expensive for you.

Speaker 1 (45:20):
And so we sort of I think we may see
a little shrinking the place. I think the other the
growth area in the other direction is protein snacks. Right.

Speaker 3 (45:28):
If you think all of a sudden, people are eating
fewer calories, but they need a lot of protein. That's
where you need your protein popcorn your protein.

Speaker 2 (45:36):
You know, I was fish so glad there wasn't enough
protein snacks.

Speaker 3 (45:40):
Weren't protein snacks, And now the David bar is coming
for you. And so I think it's it's a sort
of protein growth carbohydrate snack decline.

Speaker 1 (45:48):
And so I do.

Speaker 3 (45:49):
Yeah, I do think that there's some some movement in
that space. I'm not exactly sure how I would invest
on that, or on any of my ideas.

Speaker 1 (45:56):
It's a good thing. I don't have a lot of
money to invest in my stupid investment.

Speaker 2 (45:59):
I do, Yes, what about medicine with a capital And
like I work in a hospital, I see patients in
the clinic. Do you think that this can be transformative
enough that like I won't have as many kidney disease patients,
I won't have as many heart disease patients. I mean
people have to die of something. I guess, right, like eventually,
maybe it happens when they're older.

Speaker 3 (46:19):
Yeah, I mean that's those are much more Those are
much slower moving changes. I think there are also a
very there's an interesting overlap there with the question of
of kind of the cost of these drugs. So these
drugs are right now quite expensive. The prices have been
coming down a lot, but they're still expensive. They're covered
in sometimes intermittently by insurance. But one of the arguments

(46:41):
for expansion of access to these medications, especially if we
think about like a government payer, is that they will
lower people's risk of other things. So you know, you,
perry are expensive, somebody comes to see you.

Speaker 1 (46:54):
You know it costs money.

Speaker 3 (46:56):
If fewer people have kidney disease because of their GLP ones,
I actually sort of offsets the cost of the GLB
one to some extent, And depending on how big those
effects are, we could see these medications even though they
are relatively expensive, and even if they stayed relatively expensive,
we could see them like cause overall cost savings in
the healthcare market, which would be in part of reduction

(47:18):
in sort of need for doctors, but probably would be
more significantly a reduction in use of other medications. So
if you are a maker of a stat and this
may be sort of more bad for you than if
you are someone who treats people or a heart attack,
which is still something people are going to die of,
just maybe maybe they'll die of them later.

Speaker 2 (47:37):
One of the things that this ties into is, Okay,
we've sort of come to the point where we're like,
these drugs are going to be in the fabric of
our society, whether they're injectable or oral. We've said that
you're going to be potentially taking them for in some
form or another for a long period of time, and
a lot of people are worried about that, saying, like,

(47:57):
you know, but we don't know what might happen right that, Sure,
they seem to be working great now, but how do
we know that if you're not on it for thirty
years it causes cancer or something like that. What data
do we have to either reassure people or terrify them.

Speaker 3 (48:11):
Yeah, I mean I think that the short answer is
we don't. We can't really fully reassure people about that.
You know these first and you say the top the
first of these drugs is are proved in two thousand
and five. People have been on this for diabetes for
a long time. We haven't seen those kind of signals.
But it's not exactly the same drugs. It's not the
same dosing levels, not for the same indication. So you know,
if you want to know what is the impact of

(48:31):
these drugs in thirty years, you need to wait for
thirty years, and you know, we ultimately, like with almost
any new drug, you've got away the sort of known
value of the medication against these kind of long term
potential risks. I actually think that sort of cost benefit
calculation is always an important part of these choices, but

(48:53):
he is probably relevant to the extent that some of
the usage of these medications is not for indication did purposes. Right,
So we are definitely seeing use of GLP ones in
populations where people do not need them to treat metabolic disease.

Speaker 1 (49:09):
Right.

Speaker 3 (49:10):
This is a medication that is intended to treat obesity
or diabetes or complications of obesity. That is the indication
for the medication. It's not a medication intended to move
your BMI from twenty one to fourteen or seventeen, which
is some of how it seems like it's being used,
particularly in celebrity circles, and it's always hard to know

(49:33):
who's losing weight for what reason. But there's a kind
of the part of the cautionary conversation, it feels important
to me, is the one where people are sort of
using these effectively really off label in a way that
changes the conversation around what is an appropriate physical appearance
for someone, and we're kind of we lost a little

(49:55):
bit of what I thought was probably a good move
towards the idea that you know, people could be different
sizes and not just size.

Speaker 2 (50:03):
To thank you for saying that, it's worth noting that
fat has value, like it is metabolically important, it is
hormonally active tissue in a good way. And being underweight, however,
you get to being underweight with this, you know, with
this drug or any other way, can have actual long

(50:25):
term health consequences. And there's there's any number of studies
that actually show that sort of the sweet spot for
body weight in terms of longevity and especially resilience against disease.
So when you do get sick, you know, being able
to sort of bounce back from that is probably in
the well we see. You know, the normal weight range,
you know, a BMI between twenty and twenty five or so.

(50:47):
If you're pushing below that, you are starting to stress
your body a little bit more. I just have to say,
I have a patient who is telling me that she
was taking one of these drugs to get back to
her original weight. And I said, what was your original weight?
And she said seven pounds fourteen outs.

Speaker 1 (51:03):
Much.

Speaker 3 (51:04):
No, I mean, I will say I've started to see discussions,
you know, people have started to talk about this a
lot in the like endurance sports community, because it is
of course true if you are like a runner, that
there is some value to being smaller because you're moving
less bulk. But actually these medications are really bad for performance,

(51:25):
and some of these sort of discussions I think have
gotten like a little confused and also ultimately probably not
very good for either people's health or in that particular case,
for you know, running fast. So if you want to
run fast, this is maybe not for you, not for everyone,
not for everyone. Yeah, all right, so Perry, before we
get to our final feelings on this, let's talk about

(51:46):
sort of where this is going, and both in terms
of the medications and in terms of kids. So on
the question of the medications, you know, my sense is
we're just going to keep seeing new versions of this
come out that are you know, bad, are in a
variety of dimensions, easier to dose oral versus injected, more
weight loss in twenty eight percent versus twenty percent.

Speaker 1 (52:08):
Those are the two big dimensions. What other dimensions are
we going to see?

Speaker 2 (52:11):
Innovation, cost, you know, things will get cheaper, but yeah,
I honestly, I think in terms of weight loss, like
up at twenty eight percent, I think we're done. Like
you're taking a two hundred pound person and bringing them
down to one hundred and forty pounds, like this is
probably I don't think we need to improve too much
on that. So, yeah, you're going to see cost differences
as things come off patent, and then the orals are

(52:31):
going to be some game changing and there may be
like tweaks that improve side effect profile and things like that.
We'll see that. The question of kids is really fascinating.
So the landscape right now is that ozepic itself does
have FDA approval for kids twelve and up. It's the
only one. The rest start at age eighteen. I'm ambivalent

(52:54):
about this because, for one thing, kids are kids. They're
not just small adults. They're their own things. They're growing,
and especially for kids who are growing, like calories are
important for that, and stunting a kid's growth is a
permanent thing that can happen, so I'm very nervous about this.
On the other hand, there is an argument to be
said that, like you know, the fat tissue that you

(53:17):
add as a child does not really go away ever.
In fact, as you lose weight, a lot of those
cells are just shrinking, not necessarily dying off or evaporating.
Is it a possibility that establishing some habits with the
use of a drug like this in your youth when
you're sort of forming your relationship with food could be

(53:38):
beneficial in the long term, or on the other hand,
could it be entirely harmful? Like I am really up
in the air about this.

Speaker 1 (53:44):
You're in a rabbital, Yeah, me too.

Speaker 2 (53:46):
I am. I don't I don't know.

Speaker 3 (53:47):
I think it's really complicated, because you're right. I think
our habits, our taste for foods our form when we
are our kids, and that is an argument for forming
those habits. Well, I mean, I guess the thing I
would say for sure is this be a first line,
Like I would really like us to think more carefully
about how we can help families develop good food habits

(54:10):
with their kids, whether that's like better school lunch programs,
better supports you're like, all kinds of things I would
like to do before we get to like, let's ever
give everybody ozempic when they're twelve, which just feels like,
you know, probably there are some people who will benefit
from that, and it'll be good to have that as
an option, But I don't want to be the first line,

(54:30):
and I don't think that that's a good idea. Okay,
all right, okay, Perry, We're gonna end with our segment
in which we give our yes or no, and I
am going to insist that we call this segment smash
or paths.

Speaker 2 (54:44):
All right, I am on board. And for those of
you from a generation that is not X, you can
google what that means.

Speaker 1 (54:51):
All right, So, Perry, GLP one smash your path.

Speaker 2 (54:56):
Smash definitely transformative drugs. I'll be with us for a
long time, changing a lot of outcomes. Not for everyone,
as you say, but yeah, definite smash for me. How
about you?

Speaker 3 (55:07):
Yeah, I'm a smash if it's the right person on
this one. I think for some people, for many people,
this is going to be a really game changing solution.
It's not for everyone, but I think it's going to
represent a really important part of the health landscape in
the next several decades.

Speaker 2 (55:23):
All right, after the break, we'll get to your question.

Speaker 1 (55:31):
All right, Perry.

Speaker 3 (55:32):
Mailbag question of the Week is a personal one. What
is the dumbest thing or greatest thing in your fridge?

Speaker 1 (55:40):
Right now?

Speaker 2 (55:41):
I have such a good dumb thing and like for
a podcast about wellness. Just beep this entire segment. Don't
listen to what I'm about to say. But you can
get from Amazon or any other online store. Do you
know the cheese powder that goes in mac and cheese,
like the orange? Okay, oh my god, I get a

(56:02):
bulk container of that, Perry.

Speaker 1 (56:05):
That's so gross.

Speaker 2 (56:06):
Okay, okay, wait, here's what you can do with it. Hey,
you can add it to your mac and cheese. It's
that much cheesier. But wait, there's more. You can make
popcorn and then you can put that stuff on your.

Speaker 1 (56:21):
Pop that's good. Yeah, you can.

Speaker 2 (56:23):
You can make pasta sauces out of it. It's so good.
It is so bad for you. Please don't do.

Speaker 1 (56:29):
This anyway, Perry. Why does it have to be in
your refrigerator?

Speaker 2 (56:33):
This is what I don't so Actually it's no, it's
it's in my cabinet. But now it's like, why shouldn't
it's cheese, like it probably should be in my refrigerator.

Speaker 1 (56:40):
And no, I don't think that stuff is cheese my friend.

Speaker 2 (56:42):
Sorry, cheese, it's microplastics. What's the dumbest thing in your refrigerator.
I'm so curious about this because Emily's like the healthy
one for those of you who don't know both of us.
So it's going to be like, oh, I I got
tomato juice, but it was like a normal amount of sodium.

Speaker 1 (57:00):
I like sodia. I drink a lot of sodium.

Speaker 3 (57:02):
Please, I drink like I put element in my water
in the morning. I'm like very into sodium. We can
talk about that other time. I have a kind of
peanut butter I really like. It's called one Trick Pony.

Speaker 1 (57:13):
I am.

Speaker 3 (57:13):
Peanut butter is like one of my core food groups,
and unfortunately they have had a jar shortage, and so
the only way to purchase this online right now is
in a nine pound tub. And so I have a
nine pound tub of peanut butter that's on the fridge.

Speaker 2 (57:30):
Though that's a lot of peanut butter.

Speaker 1 (57:32):
It's a lot of peanut butter. I go through it
surprisingly quickly.

Speaker 2 (57:37):
That's it for us today. Stick with us next week
when we'll ask what's the deal with red light therapy?

Speaker 3 (57:44):
Wellness actually is produced in association with iHeartMedia.

Speaker 1 (57:48):
Our senior producer is Tamar Avishai.

Speaker 3 (57:50):
Our executive producer at iHeart is Jennifer Bassett. Our theme
music is by Eric Deutsch and our content is for
educational purposes only.

Speaker 2 (57:58):
If you like the show, help other people find us.
Leave a rating and review on Apple Podcasts or your
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Speaker 1 (58:19):
We'll let the influencers have the last word.

Speaker 2 (58:21):
So I saw commercial for weight Watchers. We're doing glp
ones now which is ozembic and stuff that's like a
karate dojo selling guns. Realize not what the way is
breakthrough in self defense guns