February 14, 2024 • 39 mins
Join Dr. Tiffany Montgomery and co-host Nick Cuevas in a riveting episode of Demystifying DNA, titled "Exploring Genetics and GLP-1: Unveiling the Connection Between DNA and Appetite Suppression Drugs." This episode embarks on an enlightening journey to uncover how our genetic makeup influences the effectiveness of GLP-1 agonists, a class of medications used for appetite suppression and weight management. Dr. Montgomery, an experienced scientist and epidemiologist, teams up with Nick Cuevas to explore the scientific breakthroughs that are transforming our approach to weight loss and metabolic health.
The discussion highlights the role of pharmacogenomics in tailoring GLP-1 medication plans to an individual's genetic profile, offering a glimpse into the future of personalized medicine. Through engaging dialogue, the episode breaks down complex genetic interactions, making the science behind GLP-1 medications and appetite control both accessible and compelling.
Listeners will gain a deeper understanding of the emerging connections between GLP-1 medications, originally used for diabetes and obesity treatment, and their potential effects on mental health. The episode also addresses the broader implications of integrating genetic testing into mainstream healthcare, touching on financial complexities and the role of insurance in personalized medicine.
This episode of Demystifying DNA is a must-listen for anyone interested in the intersection of genetics, medicine, and wellness. It promises to enlighten and inspire, pushing the boundaries of what we know about DNA's role in health and weight management. Join us as we simplify the science and explore the fascinating world of GLP-1 and genetics.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
P23 Theme (00:04):
P23 Knowledge, access , power.
P23, wellness and Understandingat your fingertips P23.
And that's no cap.
Dr. Tiffany Montgomery (00:20):
Welcome back to Demystifying DNA, your
trusted source for making thecomplexities of genetics
understandable, simple andrelevant to our health and lives
.
I'm your host and friend, DrTiffany Montgomery, scientist
(00:41):
and epidemiologist and just thatcurious lady, joined by my
co-host, Nick Cuevas, in today'sepisode Exploring Genetics in
GLP 1, unveiling the connectionbetween DNA and appetite
suppression drugs.
We're going to learn about howour genetic makeup affects the
(01:07):
effectiveness of appetitesuppression drugs.
I'm so excited to have Nickjoin us again.
Welcome, Nick.
Nick Cuevas (01:17):
Hi Doctor, how are you?
Dr. Tiffany Montgomery (01:20):
I am doing well, Nick.
Thank you for joining us.
I know that you are a healthenthusiast and work out
extraordinaire.
Working out is just somethingthat you're really good at, and
you're motivated by weight loss.
I know that you've lost 100pounds of your own.
(01:41):
Is that correct?
Nick Cuevas (01:43):
Yes, I did.
It wasn't easy.
I've learned a lot in thatjourney, but yes, I did lose a
significant amount of weight andI am a health enthusiast, I
guess.
But it's more about feelinggood, not really looking good at
this point.
Dr. Tiffany Montgomery (02:00):
I have to ask, Nick, did you use GLP 1s
?
Nick Cuevas (02:09):
That's a great question.
No, when I did it, I didn'teven know it existed.
It wasn't the thing that it istoday.
I've heard about it.
Don't know much about it otherthan what I see in the tabloids.
Yeah, I mean, from what I'mhearing, it's an incredible drug
.
I just don't know a lot aboutit.
Dr. Tiffany Montgomery (02:26):
So I am going to enjoy talking to you
tonight, but if you get 1,000likes on this video, do you
promise to come back and tell ushow you lost 100 pounds?
Nick Cuevas (02:42):
Sure, I definitely will.
I'll go in depth if we get1,000 likes.
Dr. Tiffany Montgomery (02:47):
If we get 1,000 likes, you're going to
go in depth on how you lost 100pounds.
This will be straight up, nochasers.
You solemnly promise to tellthe whole truth and nothing but
the truth.
So help you God.
Nick Cuevas (03:01):
Oh, right, hand is raised Facts.
I will even do it again oncamera.
Dr. Tiffany Montgomery (03:08):
Uh-oh, uh-oh, okay, okay, so to go to
that, I'm going to really reallypush this video.
Okay, all right, because I wantto know.
So let me tell you all.
I don't even know all of thethings that Nick did.
I might know just a couplebecause I'm always poking him.
But he is very I won't saysecretive or private.
(03:33):
But not about himself, he's allabout everybody else and how
everybody else is doing andfeeling, and he's more into
others than he is himself.
So this will be fun If we couldget into what's going on with
Nick.
I would love that episode.
For this one we will explore thefascinating world of GLP 1s and
(03:57):
its interactions with our DNA,and break down the scientific
breakthroughs in a way that'saccessible and easy to
understand.
We're here to simplify thescience, uncovering how these
discoveries are revolutionizingour approach to weight
management and metabolic health.
So join us today as we make thecomplex world of genetics easy
(04:22):
to understand.
Starting with today's topic onthe GLP 1, medications and the
genetic factors influencingappetite suppression, let's dive
in.
So, nick, you told us that youdon't know much about GLP 1.
Nick Cuevas (04:44):
Yep, I don't know much.
I just know that somecelebrities are known for using
it.
It's been like a secret in theindustry for a little while and
it kind of popped off in thelast year or two and it sounds
very interesting because a lotof people that I know are using
it.
But I don't really know muchabout it.
Dr. Tiffany Montgomery (05:04):
So I know recently in the news Oprah
Winfrey revealed that she wasusing GLP 1s to maintain her
weight.
So she was on the red carpetwhen they released the color
purple musical here recently andshe looked incredible.
So somebody asked her I believeit was a reporter or something,
(05:26):
I'm not really sure but she wasasked and she was honest and
just came out and said I've beenusing a GLP 1 weight loss drug
and that's my secret behindmaintaining my weight loss.
So with that, that's just onecelebrity that I know has
publicly said a lot of people wedon't know, like, what they're
(05:47):
doing.
They won't tell us, they'relike little nicks in the making.
You know they won't say a word,but we are able to find out
when they do disclose thingslike that and it's been all the
buzz.
So for me it was reallyimportant to help people
understand what GLP 1s are andkind of what they stand for.
(06:08):
We'll kind of talk about it andthen if there are some
questions or Something that youwant me to go back and clear up,
I want you to just go ahead andinterrupt me and I already got
some.
Oh wow.
How do you have questions and Ihaven't even told you what it
is?
Nick Cuevas (06:26):
Well, is it GLP 1s?
Is that like just a broad nameof the drugs?
There's different names for itor is it?
Is that like a classificationof the drug?
Dr. Tiffany Montgomery (06:36):
That's a great question.
So that's a classification.
Okay so it is a drug class.
GLP 1 stands for Glucogon, likepeptide one, which is a hormone
that helps regulate appetiteand blood sugar levels.
Glp 1 agonist are a class ofdrugs that mimic the effect of
(06:59):
this hormone and then are usedin turn to treat type 2 diabetes
and and obesity.
So studies have found recentlyin the news that most weight
loss drugs, including GLP 1agonist, were linked to a lower
likelihood of depression andanxiety diagnosis.
(07:22):
There have been some studiesrecently with newer weight loss
drugs that are GLP 1 agonist.
So the ones that are morepopular are the ones that Eli
Lilly make, which are Wagovi andOzympic.
You hear a lot about that.
They have been facing somesupply shortages because so many
(07:43):
people want those drugs.
One of the other GLP 1s is asemi-glutide.
So as you're driving down thestreet you may see signs that
say we can give you semi-glutideor we have a semi-glutide
compound for weight loss.
Call this number.
It's that popular now.
Yeah and it used to be Years ago.
(08:03):
You would see those signs forfennfin Before we kind of took
fennfin off the market.
There's also a new GLP 1agonist, amg 133, that has
showed some really promisingresults in a phase one clinical
trial and it's beendemonstrating significant weight
(08:25):
loss with favorable safetyprofiles.
So it may even be a saferweight loss option.
But, as I stated, that's aphase one clinical trial, so
usually clinical trials have togo through at least three phases
before they're introduced tothe mass public.
Nick Cuevas (08:44):
Okay, very interesting.
Do you have information on howlong it's been around, because
I'm sure Oprah wasn't taking itlike a year ago.
Sounds like she's been takingit for quite a bit.
Dr. Tiffany Montgomery (08:56):
Well GLP 1s have been used for weight
loss for about the past fouryears at least that's it at
least.
It's become popular and you haveto remember they were
originally used to treat type 2diabetes, so as people were
taking insulin and that kind ofthing.
So how long has that beenaround?
(09:17):
It's from studying the effectsof the drug that we start to
think about other use and otherpurposes.
Here, especially in the US,obesity has become a major
problem, a major issue.
Then you bring into light COVIDand the whole you know US
population been under quarantine.
(09:37):
It was almost like thatfreshman 15 magnified by you
know five.
So during the lockdown periodsand during the periods of
isolation and working from homeand being remote, we used our
bodies less.
But guess what we did?
We ate more.
So whether it was door dash oruber eats or Whatever it was, or
(09:58):
maybe we're home and so we'recooking as we're working from
the computer, these are thingsthat have caused us to gain
weight.
Our children gain weightBecause they weren't doing
recess and they weren't goingout to school.
Everybody's sitting at thecomputer all day long.
So we Compounded our obesityproblem and it was during that
(10:18):
time that we developed theAbility or the understanding or
the correlation to link thosediabetes related drugs to Weight
loss and the other things thatthey could do to help us.
So with the GLP 1s, they'rekeeping that food in your belly
longer, so you're eating, you'refeeling full.
(10:40):
We're activating those genes offullness, those signals of
fullness are going to your brainand then that food is moving
slower through your body, soyou're full for a longer period
of time, you're not eating asmuch, which lowers your Calorie
intake, so that you can burnmore of those stored fats and
(11:01):
calories that you have.
Not only that, but it's becomea safe way to wipe your appetite
out.
Nick Cuevas (11:07):
Okay, so you're basically more satiated for a
while.
But let me ask you anotherquestion then.
Since this basically Goingthrough your digestive system
slower, which I'm assumingthat's why you're full for a
longer period of time Is thatnecessarily good for you or bad
for you, since it's slowing thatprocess?
Is there any data yet back onthat?
Dr. Tiffany Montgomery (11:29):
So there there's a lot of data out and
available.
Glp1 agonists are a type ofmedication that mimics the
effect of a natural hormonecalled Glucogon.
Like peptide one, this hormoneNaturally is naturally occurring
.
It's there.
So what is happening is bytaking this medicine, we're just
(11:51):
increasing that amount ofhormone that your body is
recognizing.
This helps regulate appetiteand blood sugar levels by
stimulating insulin production,insulin production, suppressing
glucagon release and slowingdown gastric emptying.
So that's when we say yourstomach feels full or longer.
(12:14):
So when we slow gastricemptying it's going to slow that
speed so that that food is notmoving through as quick.
That helps you because you'renot trying to take in more food.
You're not feeling like, oh,I'm still hungry, I'm still
hungry, right.
Yeah by doing so, your GLP 1agonist can lower those blood
(12:37):
sugar levels, reduce food intakeand promote weight loss and
people with type 2 diabetes andObesity.
Now there are side effects.
The belief is that those sideeffects are reduced or minimal
(12:57):
because we're simulating anatural Hormone that is
occurring in your body anyway.
Mm-hmm.
You talked about that Satity, orfeeling fuller longer.
It is going to not only happenin your stomach but also in your
brain because it's a hormone.
So, as we're looking at Lookingat what that entails or what
(13:24):
that feels like for your bodyit's a natural process, that's
already happening and it mayhelp.
Obesity is a complex conditionand effective management might
require several therapies.
You might have a GLP one.
We always recommend dietarychanges and an exercise.
(13:46):
There are behavior modificationprograms that you can
participate in and also weightloss surgery.
Glp 1s can be used inconjunction with any of these
activities, and to have aneffective weight loss program
it's going to have to entailmany parts and many pieces.
(14:09):
But I have a feeling, Nick, I'mpreaching to the choir and you
know more than you're telling me.
Hmm.
So there are benefits and thereare side effects.
While I'm not a medical doctor,I am a research scientist, so
I'm able to look at, understandand help clinicians understand
(14:31):
what those benefits and sideeffects are so that they can
weigh them out individually foreach patient.
So for your benefits, you couldhave a lower blood pressure,
you could improve if you havecertain lipid disorders, you
could improve fatty liverdisease, reduce your risk of
(14:52):
heart disease and kidney diseaseand you could delay the
progression of diabetes relatedneuropathy, which is common in a
lot of diabetics.
There are side effects, so youasked me about the side effects.
Nick Cuevas (15:10):
This is what I want to know.
Dr. Tiffany Montgomery (15:12):
Some of the side effects we want, like
loss of appetite, that's a sideeffect.
Of course.
Nasia, vomiting, diarrhea.
Those might not be things thatwe enjoy, but you weigh out
benefit versus risk.
Other side effects couldinclude dizziness, increased
heart rate, infections,headaches, upset stomach, itchy
(15:38):
skin.
And then there are side effectsthat are more rare but also
more severe, and those includepancreatitis, medullary thyroid
cancer, sudden kidney injury anda worsening of diabetes related
retinopathy.
(16:00):
So if you already have diabetes, the inability to see or
changes in your vision is whatthat is.
Well, now, those are rare, butthose are side effects that
studies have shown and disclosedare possible when taking GLP 1s
.
Nick Cuevas (16:19):
Sounds like one of those commercials that we used
to see that would give you likea 30 second monologue on all the
things that you could get whiletaking the prescription to
something.
Well, obviously people are.
You know, those side effectsaren't really on the plateau for
them, because it's like one ofthe most popular things out
right now.
I mean, you hear about iteverywhere right now, especially
(16:41):
in the entertainment industry.
You know, influencers, peopleon social media, they swear by
it, Do you think?
Well, first I want to know howdoes it tie into DNA and
genetics, Because that I had noidea about.
Dr. Tiffany Montgomery (16:57):
So great question, but the first thing
we had to talk about andestablish is what it is.
Now let's get to the fun stuff.
Yeah.
So we talked about GLP 1s, andthey are receptor agonists,
which are a class of medicationsprimarily used in the
management of type two diabetesand obesity.
(17:17):
They work by mimicking theaction of a GLP 1, a hormone
that helps regulate blood sugarlevels and appetite.
While these medications areknown to aid in weight loss, the
extent of weight loss andindividual responses vary based
on genetic factors.
Genetics play a significantrole in how individuals respond
(17:43):
to medications, including GLP 1receptor agonists.
Several genetic variations caninfluence drug metabolism,
efficacy and adverse reactions.
Some studies have even exploredthe relationship between genetic
factors and your individualresponse to GLP 1 receptor
(18:06):
agonists in terms of weight lossand glycemic control.
For example, variations in genesrelated to GLP 1 pathways, such
as genes encoding for the GLP 1receptors or enzymes involved
in GLP 1 metabolism, couldimpact individuals response to
(18:29):
these medications.
Additionally, genetic factorsrelated to appetite regulation,
metabolism and insulinsensitivity may influence the
effectiveness of the GLP 1receptor agonists for weight
loss.
But you have to remember, Nickand we've been saying this
(18:50):
repeatedly it's a layered thing,it's a layered approach.
So we have to know and we haveto just highlight for everybody.
Genetics can provide insightsto how you respond to the
medication, but it's just onepiece of the puzzle.
Other factors, such aslifestyle, diet, physical
activity level, overall health,also play a significant role in
(19:15):
determining the effectiveness ofweight loss interventions,
including your GLP 1 receptoragonists.
It has to be a layered approachand personalized medicine is
going to take into account thosegenetic factors, along with
individual characteristics thatcan help optimize treatment
(19:37):
outcomes for patients prescribedthose medications.
Nick Cuevas (19:42):
My question to you is with the GLP 1 drug, let's
just say, hypotheticallyspeaking, you invented that drug
or that medication and youalready invented a genetic test
that would kind of correlate ormarry with that drug.
Do you think that there shouldbe genetic testing prior to
(20:09):
getting put on that medicationand how would that benefit the
client or the patient?
So if I went into a clinic andI think that I would need this
or I would talk to my primaryphysician and they suggested I
should, or they recommend that Ido it because I have type two
or whatnot, do you think or doyou know if there is any genetic
(20:33):
tests that you can marry intothat, to where it can kind of
help you know more informationon GLP 1 working on you
efficiently?
Dr. Tiffany Montgome (20:43):
Absolutely so, at P 23, because I have to
talk first about P 23,.
That's what I know, and thereare other labs as well.
But P 23 offers apharmacogenomics test.
The nickname is called PGX, soit's really popular and it helps
to understand those genes andthose metabolic pathways.
(21:07):
What's turned on, what's turnedoff.
Not all GLP 1s are the same, norare they created equally.
We've talked about semi-glutide.
We've talked about ozimpy.
We've talked briefly aboutWagovie.
We talked about a new weightloss drug that's a GLP 1 under
stage one clinical trial, whichis AMG 133.
(21:28):
There are going to be differentpathways that each of these
drugs use.
It's manipulating a hormone andthe receptors of the hormone,
is mimicking something that'shappening in your body, and it's
like your math teacher askingyou give me five ways to
generate the answer being anumber four.
(21:50):
Well, you could do one plusthree, you could do three plus
one, you could do two plus two,you could do one times four.
There are so many ways that youcan get to the number four.
So if the goal is to get to themimicking of this GLP 1 agonist
naturally occurring in yourbody, different drug
manufacturers will takedifferent ways to answer that
(22:13):
question.
What we know is that we're ableto look at your genes and the
pathways that they're using,because they'll tell us as
scientists if they're taking oneplus three, if they're taking
two plus two, if they're takingone times four, and we will be
able to say, genetically, basedon this person's personalized
(22:34):
medical report, they wouldbenefit most from a 3 plus 1
approach to getting to 4 becauseof how the pathway works and
how quickly your body will openand close or process that
pathway.
There are several genes that caninfluence individuals GLP-1
drug response and those keygenes that we look at at P23 are
(23:00):
the GLP-1R, which is a genethat encodes for GLP-1 receptor.
That's the primary target of aGLP-1 drug.
Variations in this drug couldimpact the receptor's function
or expression level, affectinghow effectively a GLP-1 drug can
(23:21):
bind and exert their effects.
There's ADR-A2A.
This gene encodes a receptorinvolving regulating
norepinephrine release.
Variance in this gene has beenassociated with different
appetite regulation and responseto GLP-1 agonist.
(23:42):
We've got MC4R, fto, which isone of my favorite ones.
This is a fat mass and obesityassociated protein.
So variants in the FTO genehave been associated with
obesity risk and may impact theresponse to weight loss
interventions, including GLP-1drugs.
(24:04):
There are two others AD, cy3,and GIPR.
So those are the two additionalkey receptors that we look at.
Gipr, which is gastricinhibitory polypeptide receptor.
Although GLP-1 drugs primarilytarget GLP receptors, crosstalk
(24:26):
between GLP-1 and other guthormones, such as gastric
inhibitory polypeptide or GIP,may influence their effects.
So genetic variations in theGIPR could potentially affect
the response of GLP-1 drugswe're looking at.
(24:48):
Depending on which GLP-1 you'reusing, is there crosstalk?
Is your body more prone to thistype of crosstalk?
Will you have maybe results inyour nausea or diarrhea or your
other gastric upset issues?
Some people will take a GLP-1and have really bad nausea,
vomiting and diarrhea.
Other people will take it andtheir body is able to adjust and
(25:11):
they'll be just fine with it.
So those are the types ofthings that we look at Now.
Could you live and functionwith nausea, vomiting and
diarrhea?
Absolutely, is it worth it tolose weight?
It depends on who you ask.
Some people say absolutely.
If your answer is absolutely toboth of them, but you know that
there's a test that could helpyou reduce that and avoid the
(25:33):
risk of having the nausea,vomiting and diarrhea, would you
be prone to take that test?
Those are the types ofquestions that you have to ask
yourself when you really diginto what's going on here.
These are just a few examples.
These are the main variantsthat or gene variants that P23
looks at when we're trying toassess your response to GLP-1
(25:56):
drugs.
Now, pgx testing is notrestricted to just GLP-1 drugs.
There is a lot of valuableinformation for pain management,
psych medication management.
We can help with the drugs thatyou're needing the most to
impact your healthcare,including cardiovascular drugs,
of course, diabetes drugs.
(26:17):
But if you're looking at weightloss drugs, our test even has a
section in it about oralcontraception or birth control,
if you even want to know whichbirth control pills might work
better for you and give you theleast amount of side effects
while achieving that optimalresult.
These are things that can beanswered with the simple PGX
(26:38):
test.
Unfortunately, it is notsomething that a lot of
insurance companies will cover.
They require a lot of what wecall medical necessities or
reasons as to why our insurancecompanies in the US are more
reactive instead of proactive.
If you have a cancer or youhave a problem, they will
approve that testing for you.
(26:59):
Let's say, you have an adversedrug reactions to a drug and
you've tried three or four andeveryone is not working, they
will then approve it.
They will not proactively do itand say this person is
considering taking a drug.
This person has a familyhistory of psychosis.
This person has a familyhistory of cardiology or cardiac
events.
How can we help this personmanage these conditions, if they
(27:22):
happen?
There's no approval process forthat.
Incomes P23.
And while we've introduced moreof a cash pay proactive you take
control of your health.
We're helping you with thecoaching and deciding which
tests you're needing.
You're looking at what willbenefit you and how you use that
information, once you get it,to try to impact your outcome in
(27:46):
a different way.
We believe in a proactiveapproach because it works.
It gives you a healthierquality of life.
That's not where we are as acountry, but it's why we always
say it's time to revolutionizehealthcare, because there are
some changes that need to happenand the more informed we are,
the more we can demand and askand say, hey, we're paying
(28:09):
premiums for this insurance,we're paying out of our pocket
every month.
Nobody wants to pay whenthey're sick.
Help us stay healthy.
If we come together andcollectively, make that our
voice and say insurance company,help us stay healthy or we're
going to cancel our insurance,we're not going to pay our
premiums, I think we'll see somechanges, some serious changes,
(28:29):
being made in the healthcaresystem.
It takes education of knowingwhat's out there.
It takes a collective, it takesmultiple people saying it, not
just one person saying it, andit has to be something that
we're all committed to.
Nick Cuevas (28:46):
You said a lot.
There's a thousand things tounpack.
One thing that stuck with mewas the last couple of things
you said about how the wholeprocess is, about being
proactive and reactive.
And then, as well, I had aquestion regarding those genetic
tests, the PGX tests or anyother tests that another company
(29:07):
has.
When they're giving this drugout to people, for whatever
reason, it's more like a onesize fits all, and if they did
do the genetic testing prior,they could have a more tailored
drug for that person that wouldbenefit them tremendously more.
So what I'm asking you is isthere a reason why they don't
(29:30):
have that included?
You know like, hey, all right,you want to take this.
Well, let me first do this testfirst so I could figure out
which one of these GLP1 drugswould work for you better.
You know, instead of them kindof doing a one size fits all
type thing, Well, you said a lotand you don't even know you
said a lot.
Dr. Tiffany Montgomery (29:47):
That's a difficult question to unpack.
I'll start off by saying mostlaboratories, especially if
they're not cash paying, most ofthe labs, are not just cash
paying.
They're still heavily acceptinginsurance and that kind of
thing.
The first thing that they wantto do is make sure that they are
going to be paid or reimbursedfor any tests that they give you
.
Glp1 proteins or GLP1 genes arenot even in most PGX assays
(30:15):
because they're not reimbursable.
This is not something thatinsurance company is going to
pay for.
Most labs are going to give youexactly what it is the
insurance company paid for andlimit what you see to what the
doctor is saying.
You need it.
So this is a different approach.
Most labs are not going to evenhave this in because it's just
(30:36):
a temporary inconvenience.
So nausea, vomiting, diarrheaalthough we don't like to do
them, nobody wants to have thesethings happen.
They're very temporary.
By the time your stomach getsused to the drug, your body is
used to taking it, these sideeffects could level out or we
could switch you or we couldreduce the dose.
(30:56):
There are other things that wecould do that are not as costly
as this genetic test that couldhelp you understand how to take
that drug or manage the symptomsor live with it.
You could get diarrhea and justsay I'm going to take a modium
AD, so you take another drug tostop the effects of that drug.
There's not a collective outcryfrom people to say, or even
(31:18):
enough people who understand, wedon't have to go through these
things.
So raising awareness and havingthese conversations and making
sure people understand are goingto be key for us.
The purpose we want to makesure people understand is that
the interplay between geneticsand the response to GLP-1 drugs
is complex and multifactorial.
(31:40):
Other research is needed toeluciate the role of genetics
and individual responses tothese medications.
Additionally, genetic testingand personalized medicine
approaches may optimizetreatment outcomes by
identifying individuals who aremost likely to benefit from
GLP-1 drugs.
(32:01):
So we talked earlier about theshortages on the Eagle Eye Lily
drugs for Wigovian ozimpic.
If we were offering this testto people before taking the drug
, we may not have a drugshortage because we may be able
to identify.
We don't even have to writethese for you because these are
not going to work for you and wehaven't interviewed enough
(32:23):
people, but I bet you.
Once we look at the commentsfor our episodes, we'll see
people telling us hey, I took aGLP-1 and it didn't work for me.
Did I take the wrong one?
Or which one did I need to take?
In comes P23.
You may take a semi-glutidecompound which is not Wigovian.
It's a compound, it's like anoff-brand almost and it didn't
(32:46):
work for you.
So you think GLP-1s are bad.
But not all GLP-1s are createdequally.
Not all of them follow the samepathway.
Not all of them will give yourbody the same side effects.
So if you take one and itdoesn't work, that does not
eliminate all.
And if you take one and it doeswork let's say you've been
(33:09):
taking ozympic and there's now ashortage, and so your doctor
says I'm going to write you forsemi-glutide or whatever, and
that one doesn't work, itdoesn't mean that it stopped
working for you.
It means that your body onlyresponds to ozympic or you get
the best response from ozympicin that example.
Now, I'm not endorsing any ofthem.
(33:31):
It's a personal journey.
You need to look at what'sgoing to work for you.
But we have to have thoseconversations.
Nick Cuevas (33:38):
It sounds like it's more costly in the long run,
Because I know the insurancecompanies.
They just want to cut costs,they want to be as profitable as
possible, and that's a wholeother podcast in itself.
But what I'm saying is, sincethey're doing it that way,
they're kind of just slappingyou with whatever drug it is
(33:58):
that they have in stock,basically.
So wouldn't it be in the longrun, mathematically most likely
it would work out better.
It will be more cost efficient.
Or do you think that kind offalls into the cycle of the
healthcare industry or business?
Let's be real.
Dr. Tiffany Montgomery (34:18):
Well, nick, I think we're going to
have to save that question foranother podcast.
It's interesting and Dr T doesnot want to upset any insurance
companies, but we need to havesome honest conversations.
We'll table that and I promiseyou we'll come back, you and I,
and we'll delve into the cost,or the potential cost savings,
(34:40):
of genetic testing, earlytesting, and how this could
impact or improve insurance'sbottom line.
Because it's all based on yourDNA.
We're going into a level wherethings are personal.
Healthcare is personal.
The more we learn about ourbodies, the more we learn about
genetics, the more control wehave over making things
(35:02):
incredibly personal.
Imagine your body is like ahouse with lots of different
rooms.
Each room has a special job todo, like a kitchen for cooking
or a bedroom for sleeping.
Now in your body there are tinyparts called genes.
Genes are like instructionsthat tell your body how to work.
(35:26):
Some genes are like bosses thathelp you decide how to grow,
how you look, how healthy youare.
When we talk about GLP-1 drugs,we're talking about special
medicine that helps your bodycontrol sugar and helps you feel
less hungry.
(35:46):
But not everybody's body is thesame, just like not all houses
are built the same way.
So some people have genes thatmake them respond better to the
special medicine.
These genes help medicine workbetter, like having a superpower
(36:06):
to fight off bad guys.
Other people might have genesthat make the medicine work not
as well, like having a weakersuperpower.
I know with Superman, you knowhe has super strength, but he
has a kryptonite, so it might besomething that acts as your
(36:26):
kryptonite.
These special genes can affectthings like how much weight you
might lose or how well your bodycan control sugar when you take
this medicine.
As scientists, we are stilllearning about these genes and
how they work with the medicine,so they can help people have
(36:48):
better results from thismedication.
Remember, just like everyone'shouse is different, everybody's
body is different too, andunderstanding how our genes work
with medicine can help us stayhealthy and strong.
Well, you know it's time towrap it up, nNick.
(37:10):
We've been going a while as weconclude another insightful
episode of demystifying DNA,exploring genetics and GLP-1,
unveiling the connection betweenDNA and appetizing pressure
drugs.
Both Nick and I, D r.
Tiffany Montgomery, want toexpress our sincere thanks for
(37:33):
embarking on this journey withus.
Today, we peeled back thelayers of the genetic
foundations of appetite controland the promising future of
GLP-1-related treatments.
We've navigated through theforefront of genetic research,
making it understandable andshowing its vital role in
(37:55):
battling obesity and enhancingmetabolic health.
Our mission is to illuminatethe path of genetics in a way
that sparks your curiosity andmakes the complexity of this
field accessible to everyone.
We hope we shed light on thesynergy between our DNA and
(38:20):
innovative medical advancements,inspiring you to delve deeper
into the exciting possibilitiesthat personalize medicine and
metabolic health.
Hold, stay curious, keepengaged and join us again on
demystifying DNA as we continueour quest to make the science of
(38:45):
genetics easy to understand forall.
Together we're exploring thefuture of health and science,
simplifying the intricate natureof DNA to empower you on your
knowledge journey.
We are with you every step ofthe way.
P23 Knowledge, access , power.
P23, wellness and Understandingat your fingertips P23.
And that's no cap.
Dr. Tiffany Montgomery (00:20):
Welcome back to Demystifying DNA, your
trusted source for making thecomplexities of genetics
understandable, simple andrelevant to our health and lives
.
I'm your host and friend, DrTiffany Montgomery, scientist
(00:41):
and epidemiologist and just thatcurious lady, joined by my
co-host, Nick Cuevas, in today'sepisode Exploring Genetics in
GLP 1, unveiling the connectionbetween DNA and appetite
suppression drugs.
We're going to learn about howour genetic makeup affects the
(01:07):
effectiveness of appetitesuppression drugs.
I'm so excited to have Nickjoin us again.
Welcome, Nick.
Nick Cuevas (01:17):
Hi Doctor, how are you?
Dr. Tiffany Montgomery (01:20):
I am doing well, Nick.
Thank you for joining us.
I know that you are a healthenthusiast and work out
extraordinaire.
Working out is just somethingthat you're really good at, and
you're motivated by weight loss.
I know that you've lost 100pounds of your own.
(01:41):
Is that correct?
Nick Cuevas (01:43):
Yes, I did.
It wasn't easy.
I've learned a lot in thatjourney, but yes, I did lose a
significant amount of weight andI am a health enthusiast, I
guess.
But it's more about feelinggood, not really looking good at
this point.
Dr. Tiffany Montgomery (02:00):
I have to ask, Nick, did you use GLP 1s
?
Nick Cuevas (02:09):
That's a great question.
No, when I did it, I didn'teven know it existed.
It wasn't the thing that it istoday.
I've heard about it.
Don't know much about it otherthan what I see in the tabloids.
Yeah, I mean, from what I'mhearing, it's an incredible drug
.
I just don't know a lot aboutit.
Dr. Tiffany Montgomery (02:26):
So I am going to enjoy talking to you
tonight, but if you get 1,000likes on this video, do you
promise to come back and tell ushow you lost 100 pounds?
Nick Cuevas (02:42):
Sure, I definitely will.
I'll go in depth if we get1,000 likes.
Dr. Tiffany Montgomery (02:47):
If we get 1,000 likes, you're going to
go in depth on how you lost 100pounds.
This will be straight up, nochasers.
You solemnly promise to tellthe whole truth and nothing but
the truth.
So help you God.
Nick Cuevas (03:01):
Oh, right, hand is raised Facts.
I will even do it again oncamera.
Dr. Tiffany Montgomery (03:08):
Uh-oh, uh-oh, okay, okay, so to go to
that, I'm going to really reallypush this video.
Okay, all right, because I wantto know.
So let me tell you all.
I don't even know all of thethings that Nick did.
I might know just a couplebecause I'm always poking him.
But he is very I won't saysecretive or private.
(03:33):
But not about himself, he's allabout everybody else and how
everybody else is doing andfeeling, and he's more into
others than he is himself.
So this will be fun If we couldget into what's going on with
Nick.
I would love that episode.
For this one we will explore thefascinating world of GLP 1s and
(03:57):
its interactions with our DNA,and break down the scientific
breakthroughs in a way that'saccessible and easy to
understand.
We're here to simplify thescience, uncovering how these
discoveries are revolutionizingour approach to weight
management and metabolic health.
So join us today as we make thecomplex world of genetics easy
(04:22):
to understand.
Starting with today's topic onthe GLP 1, medications and the
genetic factors influencingappetite suppression, let's dive
in.
So, nick, you told us that youdon't know much about GLP 1.
Nick Cuevas (04:44):
Yep, I don't know much.
I just know that somecelebrities are known for using
it.
It's been like a secret in theindustry for a little while and
it kind of popped off in thelast year or two and it sounds
very interesting because a lotof people that I know are using
it.
But I don't really know muchabout it.
Dr. Tiffany Montgomery (05:04):
So I know recently in the news Oprah
Winfrey revealed that she wasusing GLP 1s to maintain her
weight.
So she was on the red carpetwhen they released the color
purple musical here recently andshe looked incredible.
So somebody asked her I believeit was a reporter or something,
(05:26):
I'm not really sure but she wasasked and she was honest and
just came out and said I've beenusing a GLP 1 weight loss drug
and that's my secret behindmaintaining my weight loss.
So with that, that's just onecelebrity that I know has
publicly said a lot of people wedon't know, like, what they're
(05:47):
doing.
They won't tell us, they'relike little nicks in the making.
You know they won't say a word,but we are able to find out
when they do disclose thingslike that and it's been all the
buzz.
So for me it was reallyimportant to help people
understand what GLP 1s are andkind of what they stand for.
(06:08):
We'll kind of talk about it andthen if there are some
questions or Something that youwant me to go back and clear up,
I want you to just go ahead andinterrupt me and I already got
some.
Oh wow.
How do you have questions and Ihaven't even told you what it
is?
Nick Cuevas (06:26):
Well, is it GLP 1s?
Is that like just a broad nameof the drugs?
There's different names for itor is it?
Is that like a classificationof the drug?
Dr. Tiffany Montgomery (06:36):
That's a great question.
So that's a classification.
Okay so it is a drug class.
GLP 1 stands for Glucogon, likepeptide one, which is a hormone
that helps regulate appetiteand blood sugar levels.
Glp 1 agonist are a class ofdrugs that mimic the effect of
(06:59):
this hormone and then are usedin turn to treat type 2 diabetes
and and obesity.
So studies have found recentlyin the news that most weight
loss drugs, including GLP 1agonist, were linked to a lower
likelihood of depression andanxiety diagnosis.
(07:22):
There have been some studiesrecently with newer weight loss
drugs that are GLP 1 agonist.
So the ones that are morepopular are the ones that Eli
Lilly make, which are Wagovi andOzympic.
You hear a lot about that.
They have been facing somesupply shortages because so many
(07:43):
people want those drugs.
One of the other GLP 1s is asemi-glutide.
So as you're driving down thestreet you may see signs that
say we can give you semi-glutideor we have a semi-glutide
compound for weight loss.
Call this number.
It's that popular now.
Yeah and it used to be Years ago.
(08:03):
You would see those signs forfennfin Before we kind of took
fennfin off the market.
There's also a new GLP 1agonist, amg 133, that has
showed some really promisingresults in a phase one clinical
trial and it's beendemonstrating significant weight
(08:25):
loss with favorable safetyprofiles.
So it may even be a saferweight loss option.
But, as I stated, that's aphase one clinical trial, so
usually clinical trials have togo through at least three phases
before they're introduced tothe mass public.
Nick Cuevas (08:44):
Okay, very interesting.
Do you have information on howlong it's been around, because
I'm sure Oprah wasn't taking itlike a year ago.
Sounds like she's been takingit for quite a bit.
Dr. Tiffany Montgomery (08:56):
Well GLP 1s have been used for weight
loss for about the past fouryears at least that's it at
least.
It's become popular and you haveto remember they were
originally used to treat type 2diabetes, so as people were
taking insulin and that kind ofthing.
So how long has that beenaround?
(09:17):
It's from studying the effectsof the drug that we start to
think about other use and otherpurposes.
Here, especially in the US,obesity has become a major
problem, a major issue.
Then you bring into light COVIDand the whole you know US
population been under quarantine.
(09:37):
It was almost like thatfreshman 15 magnified by you
know five.
So during the lockdown periodsand during the periods of
isolation and working from homeand being remote, we used our
bodies less.
But guess what we did?
We ate more.
So whether it was door dash oruber eats or Whatever it was, or
(09:58):
maybe we're home and so we'recooking as we're working from
the computer, these are thingsthat have caused us to gain
weight.
Our children gain weightBecause they weren't doing
recess and they weren't goingout to school.
Everybody's sitting at thecomputer all day long.
So we Compounded our obesityproblem and it was during that
(10:18):
time that we developed theAbility or the understanding or
the correlation to link thosediabetes related drugs to Weight
loss and the other things thatthey could do to help us.
So with the GLP 1s, they'rekeeping that food in your belly
longer, so you're eating, you'refeeling full.
(10:40):
We're activating those genes offullness, those signals of
fullness are going to your brainand then that food is moving
slower through your body, soyou're full for a longer period
of time, you're not eating asmuch, which lowers your Calorie
intake, so that you can burnmore of those stored fats and
(11:01):
calories that you have.
Not only that, but it's becomea safe way to wipe your appetite
out.
Nick Cuevas (11:07):
Okay, so you're basically more satiated for a
while.
But let me ask you anotherquestion then.
Since this basically Goingthrough your digestive system
slower, which I'm assumingthat's why you're full for a
longer period of time Is thatnecessarily good for you or bad
for you, since it's slowing thatprocess?
Is there any data yet back onthat?
Dr. Tiffany Montgomery (11:29):
So there there's a lot of data out and
available.
Glp1 agonists are a type ofmedication that mimics the
effect of a natural hormonecalled Glucogon.
Like peptide one, this hormoneNaturally is naturally occurring
.
It's there.
So what is happening is bytaking this medicine, we're just
(11:51):
increasing that amount ofhormone that your body is
recognizing.
This helps regulate appetiteand blood sugar levels by
stimulating insulin production,insulin production, suppressing
glucagon release and slowingdown gastric emptying.
So that's when we say yourstomach feels full or longer.
(12:14):
So when we slow gastricemptying it's going to slow that
speed so that that food is notmoving through as quick.
That helps you because you'renot trying to take in more food.
You're not feeling like, oh,I'm still hungry, I'm still
hungry, right.
Yeah by doing so, your GLP 1agonist can lower those blood
(12:37):
sugar levels, reduce food intakeand promote weight loss and
people with type 2 diabetes andObesity.
Now there are side effects.
The belief is that those sideeffects are reduced or minimal
(12:57):
because we're simulating anatural Hormone that is
occurring in your body anyway.
Mm-hmm.
You talked about that Satity, orfeeling fuller longer.
It is going to not only happenin your stomach but also in your
brain because it's a hormone.
So, as we're looking at Lookingat what that entails or what
(13:24):
that feels like for your bodyit's a natural process, that's
already happening and it mayhelp.
Obesity is a complex conditionand effective management might
require several therapies.
You might have a GLP one.
We always recommend dietarychanges and an exercise.
(13:46):
There are behavior modificationprograms that you can
participate in and also weightloss surgery.
Glp 1s can be used inconjunction with any of these
activities, and to have aneffective weight loss program
it's going to have to entailmany parts and many pieces.
(14:09):
But I have a feeling, Nick, I'mpreaching to the choir and you
know more than you're telling me.
Hmm.
So there are benefits and thereare side effects.
While I'm not a medical doctor,I am a research scientist, so
I'm able to look at, understandand help clinicians understand
(14:31):
what those benefits and sideeffects are so that they can
weigh them out individually foreach patient.
So for your benefits, you couldhave a lower blood pressure,
you could improve if you havecertain lipid disorders, you
could improve fatty liverdisease, reduce your risk of
(14:52):
heart disease and kidney diseaseand you could delay the
progression of diabetes relatedneuropathy, which is common in a
lot of diabetics.
There are side effects, so youasked me about the side effects.
Nick Cuevas (15:10):
This is what I want to know.
Dr. Tiffany Montgomery (15:12):
Some of the side effects we want, like
loss of appetite, that's a sideeffect.
Of course.
Nasia, vomiting, diarrhea.
Those might not be things thatwe enjoy, but you weigh out
benefit versus risk.
Other side effects couldinclude dizziness, increased
heart rate, infections,headaches, upset stomach, itchy
(15:38):
skin.
And then there are side effectsthat are more rare but also
more severe, and those includepancreatitis, medullary thyroid
cancer, sudden kidney injury anda worsening of diabetes related
retinopathy.
(16:00):
So if you already have diabetes, the inability to see or
changes in your vision is whatthat is.
Well, now, those are rare, butthose are side effects that
studies have shown and disclosedare possible when taking GLP 1s
.
Nick Cuevas (16:19):
Sounds like one of those commercials that we used
to see that would give you likea 30 second monologue on all the
things that you could get whiletaking the prescription to
something.
Well, obviously people are.
You know, those side effectsaren't really on the plateau for
them, because it's like one ofthe most popular things out
right now.
I mean, you hear about iteverywhere right now, especially
(16:41):
in the entertainment industry.
You know, influencers, peopleon social media, they swear by
it, Do you think?
Well, first I want to know howdoes it tie into DNA and
genetics, Because that I had noidea about.
Dr. Tiffany Montgomery (16:57):
So great question, but the first thing
we had to talk about andestablish is what it is.
Now let's get to the fun stuff.
Yeah.
So we talked about GLP 1s, andthey are receptor agonists,
which are a class of medicationsprimarily used in the
management of type two diabetesand obesity.
(17:17):
They work by mimicking theaction of a GLP 1, a hormone
that helps regulate blood sugarlevels and appetite.
While these medications areknown to aid in weight loss, the
extent of weight loss andindividual responses vary based
on genetic factors.
Genetics play a significantrole in how individuals respond
(17:43):
to medications, including GLP 1receptor agonists.
Several genetic variations caninfluence drug metabolism,
efficacy and adverse reactions.
Some studies have even exploredthe relationship between genetic
factors and your individualresponse to GLP 1 receptor
(18:06):
agonists in terms of weight lossand glycemic control.
For example, variations in genesrelated to GLP 1 pathways, such
as genes encoding for the GLP 1receptors or enzymes involved
in GLP 1 metabolism, couldimpact individuals response to
(18:29):
these medications.
Additionally, genetic factorsrelated to appetite regulation,
metabolism and insulinsensitivity may influence the
effectiveness of the GLP 1receptor agonists for weight
loss.
But you have to remember, Nickand we've been saying this
(18:50):
repeatedly it's a layered thing,it's a layered approach.
So we have to know and we haveto just highlight for everybody.
Genetics can provide insightsto how you respond to the
medication, but it's just onepiece of the puzzle.
Other factors, such aslifestyle, diet, physical
activity level, overall health,also play a significant role in
(19:15):
determining the effectiveness ofweight loss interventions,
including your GLP 1 receptoragonists.
It has to be a layered approachand personalized medicine is
going to take into account thosegenetic factors, along with
individual characteristics thatcan help optimize treatment
(19:37):
outcomes for patients prescribedthose medications.
Nick Cuevas (19:42):
My question to you is with the GLP 1 drug, let's
just say, hypotheticallyspeaking, you invented that drug
or that medication and youalready invented a genetic test
that would kind of correlate ormarry with that drug.
Do you think that there shouldbe genetic testing prior to
(20:09):
getting put on that medicationand how would that benefit the
client or the patient?
So if I went into a clinic andI think that I would need this
or I would talk to my primaryphysician and they suggested I
should, or they recommend that Ido it because I have type two
or whatnot, do you think or doyou know if there is any genetic
(20:33):
tests that you can marry intothat, to where it can kind of
help you know more informationon GLP 1 working on you
efficiently?
Dr. Tiffany Montgome (20:43):
Absolutely so, at P 23, because I have to
talk first about P 23,.
That's what I know, and thereare other labs as well.
But P 23 offers apharmacogenomics test.
The nickname is called PGX, soit's really popular and it helps
to understand those genes andthose metabolic pathways.
(21:07):
What's turned on, what's turnedoff.
Not all GLP 1s are the same, norare they created equally.
We've talked about semi-glutide.
We've talked about ozimpy.
We've talked briefly aboutWagovie.
We talked about a new weightloss drug that's a GLP 1 under
stage one clinical trial, whichis AMG 133.
(21:28):
There are going to be differentpathways that each of these
drugs use.
It's manipulating a hormone andthe receptors of the hormone,
is mimicking something that'shappening in your body, and it's
like your math teacher askingyou give me five ways to
generate the answer being anumber four.
(21:50):
Well, you could do one plusthree, you could do three plus
one, you could do two plus two,you could do one times four.
There are so many ways that youcan get to the number four.
So if the goal is to get to themimicking of this GLP 1 agonist
naturally occurring in yourbody, different drug
manufacturers will takedifferent ways to answer that
(22:13):
question.
What we know is that we're ableto look at your genes and the
pathways that they're using,because they'll tell us as
scientists if they're taking oneplus three, if they're taking
two plus two, if they're takingone times four, and we will be
able to say, genetically, basedon this person's personalized
(22:34):
medical report, they wouldbenefit most from a 3 plus 1
approach to getting to 4 becauseof how the pathway works and
how quickly your body will openand close or process that
pathway.
There are several genes that caninfluence individuals GLP-1
drug response and those keygenes that we look at at P23 are
(23:00):
the GLP-1R, which is a genethat encodes for GLP-1 receptor.
That's the primary target of aGLP-1 drug.
Variations in this drug couldimpact the receptor's function
or expression level, affectinghow effectively a GLP-1 drug can
(23:21):
bind and exert their effects.
There's ADR-A2A.
This gene encodes a receptorinvolving regulating
norepinephrine release.
Variance in this gene has beenassociated with different
appetite regulation and responseto GLP-1 agonist.
(23:42):
We've got MC4R, fto, which isone of my favorite ones.
This is a fat mass and obesityassociated protein.
So variants in the FTO genehave been associated with
obesity risk and may impact theresponse to weight loss
interventions, including GLP-1drugs.
(24:04):
There are two others AD, cy3,and GIPR.
So those are the two additionalkey receptors that we look at.
Gipr, which is gastricinhibitory polypeptide receptor.
Although GLP-1 drugs primarilytarget GLP receptors, crosstalk
(24:26):
between GLP-1 and other guthormones, such as gastric
inhibitory polypeptide or GIP,may influence their effects.
So genetic variations in theGIPR could potentially affect
the response of GLP-1 drugswe're looking at.
(24:48):
Depending on which GLP-1 you'reusing, is there crosstalk?
Is your body more prone to thistype of crosstalk?
Will you have maybe results inyour nausea or diarrhea or your
other gastric upset issues?
Some people will take a GLP-1and have really bad nausea,
vomiting and diarrhea.
Other people will take it andtheir body is able to adjust and
(25:11):
they'll be just fine with it.
So those are the types ofthings that we look at Now.
Could you live and functionwith nausea, vomiting and
diarrhea?
Absolutely, is it worth it tolose weight?
It depends on who you ask.
Some people say absolutely.
If your answer is absolutely toboth of them, but you know that
there's a test that could helpyou reduce that and avoid the
(25:33):
risk of having the nausea,vomiting and diarrhea, would you
be prone to take that test?
Those are the types ofquestions that you have to ask
yourself when you really diginto what's going on here.
These are just a few examples.
These are the main variantsthat or gene variants that P23
looks at when we're trying toassess your response to GLP-1
(25:56):
drugs.
Now, pgx testing is notrestricted to just GLP-1 drugs.
There is a lot of valuableinformation for pain management,
psych medication management.
We can help with the drugs thatyou're needing the most to
impact your healthcare,including cardiovascular drugs,
of course, diabetes drugs.
(26:17):
But if you're looking at weightloss drugs, our test even has a
section in it about oralcontraception or birth control,
if you even want to know whichbirth control pills might work
better for you and give you theleast amount of side effects
while achieving that optimalresult.
These are things that can beanswered with the simple PGX
(26:38):
test.
Unfortunately, it is notsomething that a lot of
insurance companies will cover.
They require a lot of what wecall medical necessities or
reasons as to why our insurancecompanies in the US are more
reactive instead of proactive.
If you have a cancer or youhave a problem, they will
approve that testing for you.
(26:59):
Let's say, you have an adversedrug reactions to a drug and
you've tried three or four andeveryone is not working, they
will then approve it.
They will not proactively do itand say this person is
considering taking a drug.
This person has a familyhistory of psychosis.
This person has a familyhistory of cardiology or cardiac
events.
How can we help this personmanage these conditions, if they
(27:22):
happen?
There's no approval process forthat.
Incomes P23.
And while we've introduced moreof a cash pay proactive you take
control of your health.
We're helping you with thecoaching and deciding which
tests you're needing.
You're looking at what willbenefit you and how you use that
information, once you get it,to try to impact your outcome in
(27:46):
a different way.
We believe in a proactiveapproach because it works.
It gives you a healthierquality of life.
That's not where we are as acountry, but it's why we always
say it's time to revolutionizehealthcare, because there are
some changes that need to happenand the more informed we are,
the more we can demand and askand say, hey, we're paying
(28:09):
premiums for this insurance,we're paying out of our pocket
every month.
Nobody wants to pay whenthey're sick.
Help us stay healthy.
If we come together andcollectively, make that our
voice and say insurance company,help us stay healthy or we're
going to cancel our insurance,we're not going to pay our
premiums, I think we'll see somechanges, some serious changes,
(28:29):
being made in the healthcaresystem.
It takes education of knowingwhat's out there.
It takes a collective, it takesmultiple people saying it, not
just one person saying it, andit has to be something that
we're all committed to.
Nick Cuevas (28:46):
You said a lot.
There's a thousand things tounpack.
One thing that stuck with mewas the last couple of things
you said about how the wholeprocess is, about being
proactive and reactive.
And then, as well, I had aquestion regarding those genetic
tests, the PGX tests or anyother tests that another company
(29:07):
has.
When they're giving this drugout to people, for whatever
reason, it's more like a onesize fits all, and if they did
do the genetic testing prior,they could have a more tailored
drug for that person that wouldbenefit them tremendously more.
So what I'm asking you is isthere a reason why they don't
(29:30):
have that included?
You know like, hey, all right,you want to take this.
Well, let me first do this testfirst so I could figure out
which one of these GLP1 drugswould work for you better.
You know, instead of them kindof doing a one size fits all
type thing, Well, you said a lotand you don't even know you
said a lot.
Dr. Tiffany Montgomery (29:47):
That's a difficult question to unpack.
I'll start off by saying mostlaboratories, especially if
they're not cash paying, most ofthe labs, are not just cash
paying.
They're still heavily acceptinginsurance and that kind of
thing.
The first thing that they wantto do is make sure that they are
going to be paid or reimbursedfor any tests that they give you
.
Glp1 proteins or GLP1 genes arenot even in most PGX assays
(30:15):
because they're not reimbursable.
This is not something thatinsurance company is going to
pay for.
Most labs are going to give youexactly what it is the
insurance company paid for andlimit what you see to what the
doctor is saying.
You need it.
So this is a different approach.
Most labs are not going to evenhave this in because it's just
(30:36):
a temporary inconvenience.
So nausea, vomiting, diarrheaalthough we don't like to do
them, nobody wants to have thesethings happen.
They're very temporary.
By the time your stomach getsused to the drug, your body is
used to taking it, these sideeffects could level out or we
could switch you or we couldreduce the dose.
(30:56):
There are other things that wecould do that are not as costly
as this genetic test that couldhelp you understand how to take
that drug or manage the symptomsor live with it.
You could get diarrhea and justsay I'm going to take a modium
AD, so you take another drug tostop the effects of that drug.
There's not a collective outcryfrom people to say, or even
(31:18):
enough people who understand, wedon't have to go through these
things.
So raising awareness and havingthese conversations and making
sure people understand are goingto be key for us.
The purpose we want to makesure people understand is that
the interplay between geneticsand the response to GLP-1 drugs
is complex and multifactorial.
(31:40):
Other research is needed toeluciate the role of genetics
and individual responses tothese medications.
Additionally, genetic testingand personalized medicine
approaches may optimizetreatment outcomes by
identifying individuals who aremost likely to benefit from
GLP-1 drugs.
(32:01):
So we talked earlier about theshortages on the Eagle Eye Lily
drugs for Wigovian ozimpic.
If we were offering this testto people before taking the drug
, we may not have a drugshortage because we may be able
to identify.
We don't even have to writethese for you because these are
not going to work for you and wehaven't interviewed enough
(32:23):
people, but I bet you.
Once we look at the commentsfor our episodes, we'll see
people telling us hey, I took aGLP-1 and it didn't work for me.
Did I take the wrong one?
Or which one did I need to take?
In comes P23.
You may take a semi-glutidecompound which is not Wigovian.
It's a compound, it's like anoff-brand almost and it didn't
(32:46):
work for you.
So you think GLP-1s are bad.
But not all GLP-1s are createdequally.
Not all of them follow the samepathway.
Not all of them will give yourbody the same side effects.
So if you take one and itdoesn't work, that does not
eliminate all.
And if you take one and it doeswork let's say you've been
(33:09):
taking ozympic and there's now ashortage, and so your doctor
says I'm going to write you forsemi-glutide or whatever, and
that one doesn't work, itdoesn't mean that it stopped
working for you.
It means that your body onlyresponds to ozympic or you get
the best response from ozympicin that example.
Now, I'm not endorsing any ofthem.
(33:31):
It's a personal journey.
You need to look at what'sgoing to work for you.
But we have to have thoseconversations.
Nick Cuevas (33:38):
It sounds like it's more costly in the long run,
Because I know the insurancecompanies.
They just want to cut costs,they want to be as profitable as
possible, and that's a wholeother podcast in itself.
But what I'm saying is, sincethey're doing it that way,
they're kind of just slappingyou with whatever drug it is
(33:58):
that they have in stock,basically.
So wouldn't it be in the longrun, mathematically most likely
it would work out better.
It will be more cost efficient.
Or do you think that kind offalls into the cycle of the
healthcare industry or business?
Let's be real.
Dr. Tiffany Montgomery (34:18):
Well, nick, I think we're going to
have to save that question foranother podcast.
It's interesting and Dr T doesnot want to upset any insurance
companies, but we need to havesome honest conversations.
We'll table that and I promiseyou we'll come back, you and I,
and we'll delve into the cost,or the potential cost savings,
(34:40):
of genetic testing, earlytesting, and how this could
impact or improve insurance'sbottom line.
Because it's all based on yourDNA.
We're going into a level wherethings are personal.
Healthcare is personal.
The more we learn about ourbodies, the more we learn about
genetics, the more control wehave over making things
(35:02):
incredibly personal.
Imagine your body is like ahouse with lots of different
rooms.
Each room has a special job todo, like a kitchen for cooking
or a bedroom for sleeping.
Now in your body there are tinyparts called genes.
Genes are like instructionsthat tell your body how to work.
(35:26):
Some genes are like bosses thathelp you decide how to grow,
how you look, how healthy youare.
When we talk about GLP-1 drugs,we're talking about special
medicine that helps your bodycontrol sugar and helps you feel
less hungry.
(35:46):
But not everybody's body is thesame, just like not all houses
are built the same way.
So some people have genes thatmake them respond better to the
special medicine.
These genes help medicine workbetter, like having a superpower
(36:06):
to fight off bad guys.
Other people might have genesthat make the medicine work not
as well, like having a weakersuperpower.
I know with Superman, you knowhe has super strength, but he
has a kryptonite, so it might besomething that acts as your
(36:26):
kryptonite.
These special genes can affectthings like how much weight you
might lose or how well your bodycan control sugar when you take
this medicine.
As scientists, we are stilllearning about these genes and
how they work with the medicine,so they can help people have
(36:48):
better results from thismedication.
Remember, just like everyone'shouse is different, everybody's
body is different too, andunderstanding how our genes work
with medicine can help us stayhealthy and strong.
Well, you know it's time towrap it up, nNick.
(37:10):
We've been going a while as weconclude another insightful
episode of demystifying DNA,exploring genetics and GLP-1,
unveiling the connection betweenDNA and appetizing pressure
drugs.
Both Nick and I, D r.
Tiffany Montgomery, want toexpress our sincere thanks for
(37:33):
embarking on this journey withus.
Today, we peeled back thelayers of the genetic
foundations of appetite controland the promising future of
GLP-1-related treatments.
We've navigated through theforefront of genetic research,
making it understandable andshowing its vital role in
(37:55):
battling obesity and enhancingmetabolic health.
Our mission is to illuminatethe path of genetics in a way
that sparks your curiosity andmakes the complexity of this
field accessible to everyone.
We hope we shed light on thesynergy between our DNA and
(38:20):
innovative medical advancements,inspiring you to delve deeper
into the exciting possibilitiesthat personalize medicine and
metabolic health.
Hold, stay curious, keepengaged and join us again on
demystifying DNA as we continueour quest to make the science of
(38:45):
genetics easy to understand forall.
Together we're exploring thefuture of health and science,
simplifying the intricate natureof DNA to empower you on your
knowledge journey.
We are with you every step ofthe way.
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