November 5, 2024 • 39 mins
In Episode 48 of the Pound of Cure Weight Loss podcast, Dr. Matthew Weiner and Zoe Schroeder explore the future of compounded GLP-1 medications, the dangers of the health halo effect, and debunk common diet myths that often lead to confusion for those trying to lose weight.
Compounded GLP-1 Medications: A Controversial Solution on the Brink of Extinction
Dr. Weiner and Zoe kick off the discussion by addressing the fate of compounded GLP-1 medications. Medications like Zepbound and Wegovy, FDA-approved for obesity, have faced shortages, leading to the rise of compounded alternatives. These non-FDA-regulated versions, sourced from China and mixed in US compounding pharmacies, have been a lifeline for patients who can't access the brand-name medications.
However, Dr. Weiner highlights that these compounded versions may soon become unavailable due to regulatory changes. Compounded GLP-1 medications can only be produced during shortages of the original drugs and with supply stabilizing, their production may soon be banned. Patients currently relying on compounded alternatives will need to explore other options, such as the Pound of Cure Weight Loss Platinum Program.
Diet Myths: Dispelling Common Misconceptions
Dr. Weiner and Zoe also tackle pervasive diet myths, particularly the belief that weight loss is simply a matter of calorie counting. This outdated “calories in, calories out” philosophy ignores the body’s hormonal responses to food. They explain that hormones like GLP-1, ghrelin and leptin play crucial roles in regulating hunger and metabolism, which is why focusing purely on calorie restriction often leads to failure.
Another myth they address is the idea that fat is the enemy. While processed and animal fats should be avoided, healthy fats from sources like avocados, nuts, and seeds are vital for long-term weight management. Additionally, Zoe clarifies that not all carbs are bad — distinguishing between refined carbs and whole-food sources like vegetables and legumes is key for sustained energy and weight loss.
The Health Halo Effect: How Marketing Tricks Consumers
The health halo effect is another topic of discussion, focusing on how food marketing can deceive consumers into making poor health choices. Labels such as “organic,” “vegan,” “low-carb” or “gluten-free” often create the illusion of health, even when the products are filled with sugar or unhealthy ingredients.
Dr. Weiner and Zoe stress the importance of avoiding these traps by focusing on real, unprocessed foods like vegetables, lean proteins, fruits, nuts, beans and seeds. This approach helps ensure that you’re making choices that genuinely support your health and weight loss efforts, rather than falling for misleading marketing.
Conclusion
In this episode, Dr. Weiner and Zoe offer valuable insights into the future of compounded GLP-1 medications, clarify persistent diet myths, and explain how the health halo effect misleads consumers. As the regulatory landscape changes and food marketing continues to evolve, staying informed and focusing on a balanced, whole-food diet is crucial to achieving long-term success in your weight loss journey.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Weiner (00:00):
One of the biggest problems with alcohol is that we
don't have a way to turn it off.
So if you go out to a party andyou have a couple of drinks and
you're a little bit tipsy,imagine if you could take a pill
sober up in 20 minutes anddrive home.
I mean, it would be agame-changing medication if you
could somehow do that.
My theory about this drug isthat it might do that for
(00:22):
marijuana.
Zoe (00:29):
All right, welcome back friends.
Here we are at the Pound ofCure Weight Loss Podcast.
Is this the end of GLP-1compounded meds?
Dr. Weiner (00:35):
It might be.
It might be yeah.
Zoe (00:37):
You predicted this right.
Dr. Weiner (00:38):
I did predict this.
We had an episode.
Not a lot of people watchedthat episode.
I thought that was like some ofour best stuff that we put out
there.
Zoe (00:47):
Go back and watch it if you haven't.
Dr. Weiner (00:48):
Yes, it was Because we're going to actually check in
and see how we did.
We made, I think, 10predictions for the new year and
actually, as I kind of think, alot of them, I think we were on
, and one of them we predictedthat this year, glp-1 meds would
the compounded GLP-1 meds,which is the kind of Chinese
(01:13):
knockoff drugs that we've talkedabout which have pros and cons,
that they would no longer beavailable, and so we've gotten
some news and we'll cover this alittle bit later in this
episode that that may actuallybe the case.
There's been a brief stave offof execution, but I think that
the die is cast on this one.
We'll talk more about it.
Zoe (01:30):
Yeah, very interesting.
So what do we have for In theNews?
Dr. Weiner (01:35):
So our In the News segment is about a new weight
loss drug that's come out.
It comes from the Global NewsWire and it says that Novo
Nordisk and the name of the drugis, uh, man, man, luna, bunt,
and it's they just completed aphase 2a trial and they
successfully demonstrated thatthis medication, which is a pill
(01:57):
, does cause weight loss.
Um so again, the drug isMonlunibant.
Zoe (02:03):
It sounds.
Dr. Weiner (02:03):
German.
No, the drug is named how doyou say this Monlunibant.
Yeah, monlunibant, and it's asmall molecule.
And what's interesting aboutthis is that it is not a GLP-1
agonist like all, like Monjaro,zempik, all these other meds.
This is a totally differentclass of medications.
(02:25):
There's a lot to be excitedabout when we're talking about a
different class of medications,because there's only so many
different GLP-1s you can put outthere.
But that's like one pathway.
But they see this in cancertreatments.
With cancer treatments, whatthey look for is agents that
work in different ways, and whathappens is when you combine
(02:47):
them, you can kind of use it totweak the side effects, and so
maybe bring the dose of the onedown that's causing the worst
side effects and use another onethat has a different side
effect profile.
Zoe (02:59):
But still going at it from different pathways.
Dr. Weiner (03:02):
Exactly so the idea if we could have multiple
pathways for these medicationsand we weren't just, it wasn't
just GLP-1s, we had another way,and that's how bariatric
surgery works.
Bariatric surgery doesn't justwork along the GLP-1 pathway.
There's probably I thinkthey've identified five or six
different biochemical pathwaysthat are changed and altered by
(03:22):
bariatric surgery, and that'swhy it's a more successful
weight loss tool than themedications.
So this is interesting becauseit targets the cannabinoid
receptor.
Now there's two different typesof cannabinoid receptors
there's a small molecule and alarge molecule.
There's actually anothercompany working on a large
molecule, but this medication isan inverse agonist.
(03:44):
So an inverse agonist means itbinds to the receptor and it
actually causes the receptor toact opposite of the way it
normally does.
So essentially, to some degreeit's a blocker, but
biochemically it's not exactly ablocker, and I don't know that
anybody out there?
listening really needs todifferentiate between the two.
I can barely differentiatebetween the two.
(04:05):
So it's the cannabinoidreceptor.
Do you know what another thingthat's out there that triggers
the cannabinoid receptor?
Zoe (04:11):
Hmm, let me think.
Dr. Weiner (04:14):
Cannabis.
Yes, marijuana triggers thecannabinoid receptor, so this is
working on one of the receptorsthat are altered when you use
marijuana.
Zoe (04:24):
Very interesting.
Dr. Weiner (04:25):
So Novo Nordisk purchased this drug from another
company for a billion dollars.
I think another important pieceof news here is the company.
This is Novo Nordisk, and sothe problem is that we really
have a duopoly right now.
Right, we've got Eli Lilly andwe've got Novo Nordisk, and they
control the entire obesity andreally the two best diabetes
(04:46):
drugs as well, and so whatreally needs to happen for the
market to open up, for there tobe more competition, is for us
to get other companies in there.
If we saw Pfizer or Roche havea drug out there, that would be
really exciting to me, becausenow we start to see some
competition between these largecompanies.
Competition is going to bringthe price down, but this is
(05:08):
unfortunately, owned by NovaNordisk, so we're not going to
get that same competition.
So these meds?
The other really interestingthing about this is it's a pill,
not an injection.
Zoe (05:18):
And I think that's something that a lot of people
have talked about beinginterested in learning about.
Dr. Weiner (05:23):
One of the theories.
I don't think it's going tohold up, but one of the theories
is that you're going to losethe weight with the injections
and then switch to a pill forthe weight maintenance.
There's been no clinicalevidence to support that, but
that's something people arethinking about.
Zoe (05:39):
I'll be honest with you.
Dr. Weiner (05:40):
We have a lot of people using these injections.
Zoe (05:43):
Nobody really minds yeah, it's not that big, yeah, I don't
think it's a big deal.
Dr. Weiner (05:46):
They don't hurt.
It's once a week.
It was.
Every day that's a little bitdifferent, but once a week it
takes, I think, about 30 secondsto do an injection.
So I think we're probablyputting a little bit more into
this injection problem than weneed to.
Zoe (06:06):
Well, maybe one of the other benefits would be that you
wouldn't have to keep it coldand it's cheaper to make.
Dr. Weiner (06:10):
That's the big.
Yes, you're right.
The storage, the transport, allof that is much simpler and the
half-life is going to be longer, and that it's cheaper to make
as well.
Zoe (06:20):
So anyway this medicine.
Dr. Weiner (06:24):
They ran this trial.
It was a phase 2A trial, whichbasically means they're starting
to dig around different dosesand they're looking for safety
and they're looking for efficacy.
What were the side effects anddid people actually lose weight?
And so this receptor, thismedication, triggers these
receptors, and they saw 6.5%total body weight loss at 16
(06:49):
weeks, which is okay.
Yeah, that's not great.
Zoe (06:52):
What would it compare to some of the GLP-1?
Dr. Weiner (06:55):
Well, Ozempic and again they stopped the study
after 16 weeks.
So we don't know.
But if we look at semaglutide,we're looking at about 15% total
body weight loss.
If we look at semaglutide,we're looking at about 15
percent total body weight loss.
If we look at terzepatide,there's some studies out there
showing up to 25 percent totalbody weight loss.
It's definitely over 20.
That's at a year.
But most people lose I wouldsay they're probably losing
(07:18):
about half the weight in thefirst um 16 weeks.
They also didn't talk aboutplateau or not.
There's been some studies thatsaid, oh, they did it for 12
weeks and there were no weightplateaus.
They don't comment on whetherthere's weight plateaus or not.
My suspicion is that thispathway is not going to be as
effective as GLP-1.
So there's been some concernabout these drugs in the past
(07:42):
and the concern has been thatthere's been an increased risk
in depression and suicidalitywhen taking these medications.
And they did see some non-GIside effects.
The majority of the sideeffects were GI and they're the
typical ones that we see.
They're heartburn, diarrhea,nausea, vomiting, and so there
were GI side effects for sure.
(08:04):
But there were also non-GI sideeffects and we've seen this too
with the GLP-1s, the GI sideeffects people can kind of work
through.
It's the insomnia, it's thedepression, it's the fatigue,
and they're less common,thankfully.
But those side effects tend tonot go away.
They tend to be a little bitmore lifestyle alteringing and
(08:24):
we're seeing more people comingoff the drugs for that.
So anyway, they saw anxiety,irritability, sleep disturbances
with these meds.
Zoe (08:35):
Which is kind of the opposite, because some GLP-1
studies are showing theimprovement of depression.
Dr. Weiner (08:41):
They absolutely do.
But they also show in somepeople that it worsens
depression, and so you know thething about it.
When you're dealing with sideeffects, it's can be.
You know, our tolerance forside effects depends on what
that side effect is.
Zoe (08:56):
Right.
Dr. Weiner (08:56):
If one out of every a hundred people who took takes
GLP, ones end up, you know,getting so like suicidally
depressed.
That's bad.
Even if five have animprovement in their mood if one
becomes suicidal.
We tend to weigh the sideeffects much more than we weigh
the benefits, and that's alwaysa tricky discussion with
(09:18):
patients.
I mean, the nice thing aboutmeds is that you can stop them
and typically the effect goesaway.
Yeah, but yes, there wasanxiety, irritability and sleep
disturbances.
Now I have a theory about thisyes so I just want to
you know, every time medicinecomes along a lot of things like
(09:38):
you know.
Classic examples viagra, right,was originally going to be used
as a hypertension, high bloodpressure medicine.
Turns out it has this othereffect that people you know got
very excited about.
Yeah, and so now here it is, asan erectile dysfunction
medication.
My theory is that this probablyisn't going to be a great
weight loss med, that the sideeffects won't be great, the
(10:01):
weight loss won't be great.
Whether we can combine it withthe GLP-1s that data, I mean, if
all of a sudden this wasaugmented, a GLP-1 response,
that might be interesting.
My suspicion is we're not goingto see this as a really great,
amazing, game-changing weightloss method, but I think it
might have another purpose.
So just kind of humor me onthis one.
Zoe (10:25):
I'm listening, I'm all ears .
Dr. Weiner (10:27):
Drinking and driving is a huge problem, huge problem
.
And so one of the biggestproblems with alcohol is that we
don't have a way to turn it offRight and, like you got to
sleep it off, it's only time.
Time is the only way to makeyourself less drunk.
So if you go out to a party andyou have a couple of drinks and
(10:47):
you're a little bit tipsy,imagine if you could take a pill
, sober up in 20 minutes anddrive home.
That pill would be solife-saving.
Zoe (10:57):
Yeah, absolutely.
Dr. Weiner (10:59):
And it would allow you know it would potentially
reduce motor vehicle accidents,drunk driving, I mean it would
be a game-changing medication ifyou could somehow do that.
My theory about this drug isthat it might do that for
marijuana.
First of all, look at the sideeffects.
They're like the opposite ofthe effects of marijuana.
Instead of being like chill,you have anxiety right.
(11:22):
Although marijuana can alsocause anxiety and can worsen it.
Instead of being like relaxed,you're irritable.
Instead of being like sleepyyou're, you have sleep
disturbances.
Home, they could take a pilland be able to drive home safely
(11:46):
and kind of have the effectswear off.
That would to me, that wouldactually as much as that kind of
seems crazy.
And you can talk about themoral responsibility and I've
talked about my thoughts aboutharm reduction.
Right, I mean we can talk about, you know, and I've talked
about this with alcohol useafter bariatric surgery and
talking about it compared tomarijuana, and so marijuana is
(12:06):
less harmful than alcohol.
It doesn't mean I support theuse of marijuana.
I don't think people out thereshould be using marijuana if
they can avoid it, but I alsoknow people do and so- we live
in the real world, we live inthe real world Exactly, and so
my idea is maybe that's whatthis drug is going to end up
doing Just a little bit of aloose tear.
Maybe I'll throw that into my2025 prediction episode.
Zoe (12:27):
Oh, there you go.
Well, I wonder what theturnaround time would be for
that.
Do you think like a decade?
Dr. Weiner (12:32):
It'd be a while.
It'd be a while, althoughthey're going to move forward
with this drug.
They're going to do a phase 2Bstudy, and the way they figured
out Viagra was they gave thisblood pressure pill and they
were measuring everybody's bloodpressure and the blood pressure
was like barely budging and solike, oh, scrap this drug, it's
(12:53):
a waste.
And so then they called all thepeople like I'm sorry, we're
going to cancel the trial andthe people like whoa whoa whoa,
whoa.
What are you doing here, buddy?
Don't do that, Come on.
I like this drug, drug andthat's how they kind of figured
this out.
So I guarantee it in one ofthese trials someone's going to
use marijuana at some point, belike, oh, it doesn't work
anymore, or something alongthose lines, and so anyway, that
(13:16):
just my theory about this, butbut anyway, the more drugs we
have, the better.
I wish this was not nova nordisbut another drug company, not
eli lily, a third drug company.
Um, my take on this pathway isit's probably not going to be a
super valuable pathway, butmaybe a secondary adjunct Anyway
, all right.
So what do we have fornutrition this week?
(13:37):
Zoe?
Zoe (13:37):
Yes, well, we have an article from New York Times and
the title of the article is 10Nutrition Myths Experts Wish
Would Die.
So all of them, I think, arevery valuable.
Dr. Weiner (13:49):
They were good ones, they were all really good.
Zoe (13:51):
For the sake of time we're not going to talk about all of
them, but I picked out threethat I figured we could dig a
little bit deeper into that arereally aligned with what we tell
our patients and what we'retelling you, listening with what
we recommend with nutrition.
So the first one is myth numberthree calories in, calories out
(14:12):
is the most important factorfor long-term weight gain, and
we just know this simply not tobe true.
I picked out a little blurbhere and said what's needed for
maintaining a healthy weight isa shift from counting calories
to prioritizing healthy eatingoverall.
Quality over quantity.
That's the money piece rightthere Quality over quantity.
(14:34):
And we talk about that all thetime with the metabolic reset
diet.
That's why we don't have ourpatients counting calories or
hitting a specific calorietarget, because if we can work
with the body metabolism, hungercues satiety signals in order
to eat the volume of food thatyou know most people want to
(14:55):
feel full and if they're feelinghungry, then you're going to
keep thinking about food, right.
Dr. Weiner (14:59):
Right.
Zoe (15:00):
But focusing on those whole real unprocessed foods, so that
quality over the quantity, andI think we couldn't agree more
with that I love to see that innew york times yeah, oh, you
know what, actually, just beforethis, I was on a support group
and, uh, somebody was askingabout a specific like a, a
protein chips or protein bar,something like that, and I just
(15:23):
kind of pulled, pulled somenumbers out of thin air, right,
and said, okay, for this numberof calories, this amount, blah,
blah.
And you have this small littlebag of chips, protein chips, and
then let's put on this otherplate, let's put on three ounces
of chicken and two cups ofbroccoli and maybe even throw on
there, you know, half a cup ofquinoa and a quarter of an
avocado or whatever, a quarterof an avocado or whatever.
(15:48):
How would you feel if you atethat plate of food, as opposed
to those 15 chips in that tinylittle bag?
And for the same amount ofnutrition?
Quote, quote, nutrition, right,the calories and the
macronutrients, but thedigestion, the micronutrients,
the fiber, all that other stuff,it's so much better for that
long-term weight maintenance and, of course, weight loss.
(16:10):
Yeah.
Dr. Weiner (16:11):
I, I, sometimes I joke about um, you know the a
hundred calorie snack pack,right?
We all know those a hundredcalorie snack packs.
Or Oreos, right?
It's not, even it's not a realOreo cookie.
I think it's just the outsidepart.
It doesn't have any of the the,the white part of the Oreo, and
it's like four of them.
I mean there's like so few ofthese things in there.
(16:32):
And then I also joke well,there's 100 calorie snack pack
of spinach.
Has anyone ever seen it?
It's one pound, it's a hugeCostco bag of spinach has 100
calories in it, of spinach has ahundred calories in it, and so
again, comparing, how you'regoing to feel if you ate that
(16:54):
entire bag of spinach you wouldbe like oh my God, and you eat
those four Oreo little, you knowjust the outside parts and
you're like what's next?
Zoe (16:58):
It does nothing for your satiety, you eat four more of
those little hundred caloriepackets.
That's a reminds me of anotherexample I like to use a lot in
our increasing your veggieintake support group that we
have on the schedule, and it'slike visualizing a slice of
pizza.
Now, of course it's going tovary a lot depending on the
pizza and what's on it and yadayada, but if we think about
(17:18):
let's call it, 400 calories forthat slice of pizza.
That's why it's easy to eat.
People eat three or four slicesof pizza because you want to
feel full from it.
You don't feel full from that,but it's so calorie dense, Right
?
Do you want to guess how manycups of?
I bet you can guess, but howmany cups of broccoli it takes
to get 400 calories?
Dr. Weiner (17:41):
I would guess I'm going to guess that a cup of
broccoli has 40 calories.
That's my guess.
So times 10, 400.
Zoe (17:49):
how'd I do so?
You want to say 10?
10, 10 yeah, it's about like 8to 10.
Yeah, yeah, and then like thinkabout that on a on a plate,
just like you're 10 cups yeahyou can't I.
I have a stomachache justthinking about it yeah so,
thinking about that nutrientdensity as opposed to caloric
density, that doesn't mean thatyou can't have a slice of pizza,
but maybe it's OK.
(18:10):
I know that I'm not eating thepizza for the fullness, for the
satiety, for the volume, but Ican add.
Maybe I add two cups ofbroccoli to it, or a side salad
or something like that, to kindof get both.
Dr. Weiner (18:22):
It's some other interesting things too.
Both.
It's some other interestingthings too, um the, if you think
of the largest mammals right,think about just cows, giraffes,
um what?
do they eat grass, grass, leaves, leaves yeah, that's all I mean
.
They eat it all day long, butthat's all they eat.
So a lot of people like well,you can't get protein, you can't
(18:44):
build muscle, but the largestanimals are vegetarian, and so I
think that's interesting andand the one of the reasons for
that is that, calorie forcalorie, spinach has more
protein than steak I did notknow that.
Yes, that's so interesting,yeah because again, a hundred
calories of spinach is thisgiant costco bag right but a
(19:07):
hundred calories of spinach.
Is this giant Costco bag Right?
Zoe (19:10):
But 100 calories of steak is like three bites.
Yeah, exactly Right.
Dr. Weiner (19:12):
Especially if you you know especially a more
marbled piece of steak Right,it's going to have fat in it and
no protein that you're going toactually get more protein from
100 calories of spinach.
Now, again, that doesn't meanmean, you know, ounce per ounce,
steak has a lot more protein,but calorie per calorie, if you
measure it out by calorie, yeah,anyway.
(19:33):
So so I'm I'm really happy tosee this.
I think we're starting tofinally get some some
penetration into the, theknowledge base that measuring
calories is probably wastefuland not necessarily going to get
out there.
But there's still theseInstagram guys who are like you
need to be in calorie deficitand if you're not in calorie
deficit, then you're not goingto lose weight.
(19:55):
And there's three things yougot to do to lose weight Calorie
deficit is one, calorie deficitis two and calorie deficit is
three.
They're out there, right?
They're always young men.
Zoe (20:04):
Yeah.
Dr. Weiner (20:04):
You notice that?
Yeah, notice that?
Yeah, maybe shirtless what?
It's always the young men whoare um, who are pushing and
promoting calorie restriction asa means of weight loss, because
nobody can nobody has it easierwhen it comes to losing weight
than young men.
No, that's true, yeah, so yeah.
Zoe (20:22):
So you know, quality over quantity, people.
We say that all the time.
So then you know we kind ofalready touched on this with
talking about the other one.
But myth number eight is theprotein in plants is incomplete.
And it's not actually that theprotein in plants is incomplete.
They have all of the 20 aminoacids that you need, but the
(20:44):
difference is that theproportion of those amino acids,
so that means you need to havea variety, that the proportion
of those amino acids, so thatmeans you need to have a variety
, which I mean, if we think of,culturally, rice and beans going
together, that creates acomplete protein.
So it's, you know, like youwere just saying, biggest
mammals are, you know,plant-based, and so you know,
yes, if you are not eating anyanimal protein, we need to have
(21:08):
a variety of those plant basedprotein sources.
Dr. Weiner (21:12):
So I mean, essentially the idea is, if
you're going to get plant basedprotein, you should get some
from beans, some from nuts,Right, Some from even grains
like rice.
So this has always bothered me,this idea that you know that
there's and there's a certainnumber of essential amino acids.
There's 20 amino acids.
Amino acids are these littlemolecules you know that make up
(21:35):
all the protein.
You string them together andyou make protein, and so so we
can make these, some of these,but we also can't make some of
these.
So we think, and so I thinkthere's, first of all, but we
also can't make some of these.
So we think, and so I thinkthere's, first of all, there's a
limit to what we know about ourbiochemistry, and I think a lot
of times this theserecommendations are made by
(21:55):
someone who like took likebiochem 101 and like, oh, they
told me this in biochem 101.
So now I know it and it's true,but I think it's a complex
issue and I think there areprobably pathways and ways that
we can make some of thesenon-essential amino acids and
out of carbohydrates, out ofother compounds, and so that's
always kind of bothered me alittle bit about that because I
(22:18):
wonder if it is really true.
I think that you probably canget by.
Zoe (22:23):
Yeah, Well, I get, and I mean that leads directly into
the last myth, Nimeth.
Number 10 that I pulled isfundamental.
Nutrition advice keeps changinga lot and there's a lot that we
don't know Right and thescience is ever evolving.
Nutritional sciences is arelatively young, you know study
.
Dr. Weiner (22:43):
Right.
Zoe (22:44):
Right.
But if we think about the main,this is the, this is the quote
here.
Eat food not too much, mostlyplants.
Dr. Weiner (22:51):
Yeah, that's from Michael Pollan.
I think he said that.
Uh yeah, uh, omnivores dilemma.
Oh, okay, I think that's whereit came from.
Zoe (22:59):
So I mean, the bottom line is that, yes, it's an evolving
science, but if we boil it downto what we always say is try to
eat as much whole, real,unprocessed food as much as
possible, and this is alignedwith that.
And, yes, it can be complicated, especially with everything
online and different influencers, and you're getting information
(23:22):
about this diet and you needthat supplement, and it is
confusing and it is overwhelmingwhen we are taking all of these
.
You know all that white noise,right, um, taking up space.
But if we boil it down to, like, keeping it simple, it really
doesn't need to change, itdoesn't have to be complicated
it's.
Dr. Weiner (23:41):
It's sometimes it's the stuff your grandmother told
you to do.
That's really still, I think,the best nutritional advice eat
your vegetables.
Right, right, that's that wasbeen like, you know, in the
fifties.
That was like the big, the bigadvice.
Don't eat a lot of sweets,right, and maybe don't eat the
fattiest greasiest meats Thingsalong those lines.
(24:02):
Well those lines.
Well, and portions, I mean,think about the portion sizes in
the 50s versus now, absolutely.
But but yeah, I, you know, tome I think part of the there's
two problems with it.
The first problem is that doinglike hard nutrition science
double, you know, randomized,double-blinded, controlled
trials is like impossible, right, like you would literally have
(24:24):
to like keep someone captive andonly feed them certain food.
I mean, we have institutionalreview boards that review any
type of scientific study that'sdone to make sure that it's
ethical.
And if you're going to really dohard science on nutrition, I
don't think it would pass themustard of any of these IRB
(24:45):
boards.
Nutrition, I don't think itwould pass the mustard of any of
these IRB boards.
So it's just impossible toconstantly because we eat all
through the day, no-transcriptaccurately, right, right, yeah,
it's just not possible.
So I think the ability to getthat, that kind of definitive
(25:06):
answer that we can get withmedications, we can get with
surgery, we can get into otherhealth fields, it's so much
harder nutrition, so much harder.
I think that's the first thing.
The second thing is what youalluded to, which is that
there's too much money to bemade in selling processed crap,
and it's just, it's such a greatbusiness model to take
(25:27):
something heavily processed thatpeople like to eat and somehow
apply a health halo like youalways talk about to that
heavily processed food andsomehow leverage some obscure
scientific or pseudoscientificarticle that says somehow this
would be helpful and good, likeLenny Curb and Chromium Right
(25:49):
that there's.
So it's so easy to make moneydoing this and then strap a nice
little marketing package on topof it, get some influencers
behind it and cha-ching.
Zoe (26:00):
Yeah.
Dr. Weiner (26:00):
Right, I mean, it's just such a reliable way to make
money, and so that just cloudsall the advice out there.
So this is what's being pushedin front of us instead of good,
old-fashioned advice.
Like the green jolly, the jollygreen giant, like where's he?
Yeah, where's he been?
And I don't think he's.
You know, offering milliondollar influencer deals?
(26:20):
Yeah, you know something?
Offering a million dollarinfluencer deals.
Zoe (26:22):
Yeah, you know something I was just thinking about as we
were talking about, like in the50s.
We think about the obesitytrend, how much it has risen
over the decades.
Any graph in front of me but Iwould.
(26:46):
I would put money on the factthat that graph mirrors the rise
in diet trends and differentfad diets and and that sort of
thing.
And we know that going on andoff diets is one of those
predictors of weight gain.
Right, and it's, and that'spart of the machine that is diet
culture and this multi-billiondollar industry.
It's sell a product or aprogram to somebody knowing that
(27:08):
it's, and then they fail, theyfeel like they're a failure, but
it's ultimately that thatfailed them, that failed them,
and then it creates a morevulnerable and prey worthy
individual to continue buyingmore of these different products
(27:29):
.
Like it's just so sad.
Dr. Weiner (27:29):
You know what that's , that we need an infographic,
that infographic of trytemporary diet fail, become more
susceptible to to next diet fad.
Zoe (27:41):
try and that and that, that circle and then the weight goes
it's like a spiral up, like alittle pigtail that probably
describes 95 of the peoplelistening to this podcast right
now.
Dr. Weiner (27:51):
Yeah, we need to put something like that together.
I bet I bet chat gpt couldprobably make that happen like
that.
Yeah, all right, so let's moveinto the economics of obesity
segment, and this is where ourtitle comes from.
So here's what's happenedrecently.
On October 2nd, the FDA hassaid that terzapatide is no
(28:14):
longer on shortage.
I think we've covered this indetail on a number of episodes
in the past and the 503Bcompounding pharmacies, which is
who makes most of thesecompounded drugs.
Again, quick primer oncompounded medications these are
not produced by Eli Lilly orNovo Nordisk, which are the
(28:36):
companies that hold the patents.
They are produced overseas,almost exclusively in China, at
FDA-approved facilities, but theproducts do not go through the
same testing process thatZepbound and Wegovi go through,
and so there's a lot of it's agray market area.
But because both terzapatideand semaglutide are on shortage,
(29:00):
these 503B compoundingpharmacies are allowed to import
the medication from China, notfrom the patent-holding
manufacturer, mix them togetherwith something to make a novel
compound and then sell it.
And so they mix it with B12 orthiamine or something like that,
and the truth is that addsabsolutely nothing to the effect
(29:22):
, but it allows them to sell it.
Now, as soon as the shortage isresolved, this becomes illegal
and it is a patent violation.
So all of the compoundingpharmacies want the shortage to
last as long as possible, and ofcourse, eli Lilly and Novo
Nordisk want this shortage over,and we've talked about this
about recently in the release ofvials, and so now Monjaro and
(29:47):
Zepfoun are available to lowerdoses as vials as opposed to the
injector pens, and that allowedEli Lilly to meet their
manufacturing needs, becauseit's not the drug that's on
shortage, it's the injector pensof all things.
Yes, um, so so the 503pcompounding pharmacies are no
longer able to produceterzepatide.
(30:10):
This now, semaglutide, is stillum on the shortage, but only
for one dose, I think, only forthe 0.25 or the 0.5 and, and you
can check the FDA proof.
So this is all like coming toan end.
Zoe (30:23):
And they're going to be like legally pursued.
Dr. Weiner (30:27):
You think yeah.
Zoe (30:29):
Well, especially if they have Eli Lilly and Novo Nordisk
up, you know lighting a fireunder their butt.
Dr. Weiner (30:34):
They already have.
I mean Eli Lilly and NovoNordisk have made it very clear
that they will pursueaggressively with filing legal
actions any physician's officeor compounding pharmacy that is
breaking their patent laws.
I mean, they want no part ofthis.
Zoe (30:53):
And that means all of the like med, spas and weight loss,
Clint like that you can go andget If you're not getting your
medication from an actualpharmacy.
Prescribing provider.
Dr. Weiner (31:07):
You get a prescription, it goes to CVS,
walgreens, your Safeway, kroger,wherever you're getting your
prescriptions from.
If you're not getting it fromthere, then it's very close to
being no longer available Months.
But there's a little bit ofaction here.
There's a little bit of stuffgoing on.
Zoe (31:25):
More than getting your prescription from a doctor.
Dr. Weiner (31:29):
So the Alliance for Pharmacy Compounding actually
filed a lawsuit saying that no,you've prematurely, the FDA was
unfairly influenced by Eli LillyLilly and you prematurely put
this drug and taking this drugoff the shortage list when it's
still going to be on shortage,because look at all these people
(31:50):
on compounding meds.
There's no way you have themanufacturing capabilities to
meet all of these people on thecompounding meds.
So they filed this lawsuit andit's been filed in federal court
and actually they got like astate of execution yeah.
So the FDA said you know what?
We're going to reevaluate this.
So it's still okay for the 503Bpharmacies to continue to
(32:14):
produce and sell terzapatide.
Zoe (32:16):
I feel like I've been on a roller coaster listening to this
.
What's going to happen next?
Dr. Weiner (32:24):
So, but here's the thing.
They're going to probably beable to push this off another
month or two.
Zoe (32:31):
Well, that's it.
Dr. Weiner (32:33):
Six months maybe, I don't know, but not 10 years,
right, this whole compoundingthing will be part of history,
but it will not be the way thatpeople get these medications,
not in the United States.
There's other stuff we're goingto talk about happening in
other countries that areinteresting.
We'll cover those in futureepisodes, but as of right now,
(32:55):
yes, they did get a little bitof a break, but it literally is
a stay of execution.
Did get a little bit of a break, but it's, it literally is a
stay of execution.
It is not a long-term winthat's going to allow them to
continue to produce thesecompounded medications for a
long period of time.
Um, lily and nova nordis willwin this battle.
They are, I mean, in terms ofjust scale.
(33:17):
They are a hundred, a thousandtimes, um, wealthier than these
compounding pharmacies.
Um, and they have the, and alsothe law is on their side.
I mean, they do hold the patentright, and so they're gonna win
.
Zoe (33:33):
That's probably bad for patients yeah, um, I'm just
thinking about how many peoplewho utilize compounded yeah.
Dr. Weiner (33:41):
so so let's say you're out there and you're
using compounded meds, so let'stalk about what you can do.
So I think we're going to seethis happen with terzapatide
before we see it withsemaglutide, I think.
So the compounded.
There's places that haveterzapatide, there's places that
have semaglutide, there'splaces that sell both.
If you're using compoundedtrisepatide, I think you know
(34:04):
potentially looking at moving tosemaglutide might be the right
thing to do right now.
It's just going to kick the candown the road.
It's not going to solve theproblem in a long time, but it
is.
We've talked about this in thepast.
We definitely work withpatients creatively.
We call them, you know, ourlittle code word for this is
creative dosing strategies, andwe do have people from all over
(34:26):
the country reaching out to usand we do have a program.
It's called our PlatinumProgram.
There's a little bit of anupcharge but truthfully, it's
probably the same, if notcheaper, than using compounded
meds.
Zoe (34:36):
Well, you broke down the cost in a previous episode of
compounded versus know whatever,and you know, it's really not a
big difference, it's not thatbig of a difference when you, if
you, if you get creative withit, yeah, and so we.
Dr. Weiner (34:51):
So, like I said, even with our upcharge for the
program fee, it probably stillis, over the long run, cheaper
and it's gonna.
This is to us.
This is a strategy we think wecan continue for years, right,
um, without, and we're notbreaking any laws or or rules or
anything and it's not gonnalike you know, you know, be
legally taken away at the job Idon't think so.
(35:11):
No, I mean, you know the systemis screwed up and when a system
is screwed up, you can sometimestake advantage of that to
benefit you, even though youknow it's a lot of what's
happening is bad for patients.
It can also be good for you ifyou kind of think creatively.
So anyway, that's what we do inour platinum program.
I think the third thing toconsider is if you know, if you
(35:36):
understand the metabolic effectsof GLP-1 meds and how metabolic
treatments are so much moreeffective than you know strictly
lifestyle mindset, diet andexercise type things that we've
been doing all along untilsurgery and meds came along.
Then there's another metabolictreatment and that's bariatric
(35:56):
surgery.
And the nice thing aboutbariatric surgery is they can't
take it away from you right Onceyou have it.
It's there there and so that'sa way to get off the glp-1
roller coaster.
We see that a lot with ourpatients.
They're like you know what?
I don't want to be on medsforever.
I'm.
I see it, it works.
I understand obesity is adisease.
I understand there's metabolictreatments.
I don't want to be dealing withthese meds and the cost and
(36:19):
getting them and all that kindof stuff.
So I'm going to look at surgeryand I think we're going to
start to see that as thedecision making is whether you
want to be on the meds long termor whether you want a surgery
that kind of fixes it once andfor all.
The nice thing about surgery iswe can do it so safely Less
than a 1% serious complicationin our practice for these
surgeries.
(36:39):
So anyway, I do think that thecompounded GLP-1s this is their
final loop around the spiral andthat at some point in the near
future we're not going to havethem.
I don't know if I'm going tomake my January 1st deadline,
but I think we'll come close fora prediction episode.
Zoe (36:58):
We'll have to check back in about that when we do that.
Dr. Weiner (37:01):
Absolutely All right .
Zoe (37:04):
All right.
Well, that's our show today.
Thank you so much for listening.
I hope this was helpful, and ifit was, we would love to have
you share it with somebody thatyou think would find this show
valuable as well.
Our whole mission is to getthis information out to as many
people so we can help as manypeople as possible.
Dr. Weiner (37:19):
And we've been asking for reviews.
We actually have a bunch ofreviews now, yeah, and they're
actually pretty good.
Zoe (37:24):
So that makes me happy.
Dr. Weiner (37:26):
So thank you all of you for your reviews that you
put out there on Apple Podcastsor Spotify or wherever you're
listening.
And again, if you like this,please share it with other
people.
See you next time.
One of the biggest problems with alcohol is that we
don't have a way to turn it off.
So if you go out to a party andyou have a couple of drinks and
you're a little bit tipsy,imagine if you could take a pill
sober up in 20 minutes anddrive home.
I mean, it would be agame-changing medication if you
could somehow do that.
My theory about this drug isthat it might do that for
(00:22):
marijuana.
Zoe (00:29):
All right, welcome back friends.
Here we are at the Pound ofCure Weight Loss Podcast.
Is this the end of GLP-1compounded meds?
Dr. Weiner (00:35):
It might be.
It might be yeah.
Zoe (00:37):
You predicted this right.
Dr. Weiner (00:38):
I did predict this.
We had an episode.
Not a lot of people watchedthat episode.
I thought that was like some ofour best stuff that we put out
there.
Zoe (00:47):
Go back and watch it if you haven't.
Dr. Weiner (00:48):
Yes, it was Because we're going to actually check in
and see how we did.
We made, I think, 10predictions for the new year and
actually, as I kind of think, alot of them, I think we were on
, and one of them we predictedthat this year, glp-1 meds would
the compounded GLP-1 meds,which is the kind of Chinese
(01:13):
knockoff drugs that we've talkedabout which have pros and cons,
that they would no longer beavailable, and so we've gotten
some news and we'll cover this alittle bit later in this
episode that that may actuallybe the case.
There's been a brief stave offof execution, but I think that
the die is cast on this one.
We'll talk more about it.
Zoe (01:30):
Yeah, very interesting.
So what do we have for In theNews?
Dr. Weiner (01:35):
So our In the News segment is about a new weight
loss drug that's come out.
It comes from the Global NewsWire and it says that Novo
Nordisk and the name of the drugis, uh, man, man, luna, bunt,
and it's they just completed aphase 2a trial and they
successfully demonstrated thatthis medication, which is a pill
(01:57):
, does cause weight loss.
Um so again, the drug isMonlunibant.
Zoe (02:03):
It sounds.
Dr. Weiner (02:03):
German.
No, the drug is named how doyou say this Monlunibant.
Yeah, monlunibant, and it's asmall molecule.
And what's interesting aboutthis is that it is not a GLP-1
agonist like all, like Monjaro,zempik, all these other meds.
This is a totally differentclass of medications.
(02:25):
There's a lot to be excitedabout when we're talking about a
different class of medications,because there's only so many
different GLP-1s you can put outthere.
But that's like one pathway.
But they see this in cancertreatments.
With cancer treatments, whatthey look for is agents that
work in different ways, and whathappens is when you combine
(02:47):
them, you can kind of use it totweak the side effects, and so
maybe bring the dose of the onedown that's causing the worst
side effects and use another onethat has a different side
effect profile.
Zoe (02:59):
But still going at it from different pathways.
Dr. Weiner (03:02):
Exactly so the idea if we could have multiple
pathways for these medicationsand we weren't just, it wasn't
just GLP-1s, we had another way,and that's how bariatric
surgery works.
Bariatric surgery doesn't justwork along the GLP-1 pathway.
There's probably I thinkthey've identified five or six
different biochemical pathwaysthat are changed and altered by
(03:22):
bariatric surgery, and that'swhy it's a more successful
weight loss tool than themedications.
So this is interesting becauseit targets the cannabinoid
receptor.
Now there's two different typesof cannabinoid receptors
there's a small molecule and alarge molecule.
There's actually anothercompany working on a large
molecule, but this medication isan inverse agonist.
(03:44):
So an inverse agonist means itbinds to the receptor and it
actually causes the receptor toact opposite of the way it
normally does.
So essentially, to some degreeit's a blocker, but
biochemically it's not exactly ablocker, and I don't know that
anybody out there?
listening really needs todifferentiate between the two.
I can barely differentiatebetween the two.
(04:05):
So it's the cannabinoidreceptor.
Do you know what another thingthat's out there that triggers
the cannabinoid receptor?
Zoe (04:11):
Hmm, let me think.
Dr. Weiner (04:14):
Cannabis.
Yes, marijuana triggers thecannabinoid receptor, so this is
working on one of the receptorsthat are altered when you use
marijuana.
Zoe (04:24):
Very interesting.
Dr. Weiner (04:25):
So Novo Nordisk purchased this drug from another
company for a billion dollars.
I think another important pieceof news here is the company.
This is Novo Nordisk, and sothe problem is that we really
have a duopoly right now.
Right, we've got Eli Lilly andwe've got Novo Nordisk, and they
control the entire obesity andreally the two best diabetes
(04:46):
drugs as well, and so whatreally needs to happen for the
market to open up, for there tobe more competition, is for us
to get other companies in there.
If we saw Pfizer or Roche havea drug out there, that would be
really exciting to me, becausenow we start to see some
competition between these largecompanies.
Competition is going to bringthe price down, but this is
(05:08):
unfortunately, owned by NovaNordisk, so we're not going to
get that same competition.
So these meds?
The other really interestingthing about this is it's a pill,
not an injection.
Zoe (05:18):
And I think that's something that a lot of people
have talked about beinginterested in learning about.
Dr. Weiner (05:23):
One of the theories.
I don't think it's going tohold up, but one of the theories
is that you're going to losethe weight with the injections
and then switch to a pill forthe weight maintenance.
There's been no clinicalevidence to support that, but
that's something people arethinking about.
Zoe (05:39):
I'll be honest with you.
Dr. Weiner (05:40):
We have a lot of people using these injections.
Zoe (05:43):
Nobody really minds yeah, it's not that big, yeah, I don't
think it's a big deal.
Dr. Weiner (05:46):
They don't hurt.
It's once a week.
It was.
Every day that's a little bitdifferent, but once a week it
takes, I think, about 30 secondsto do an injection.
So I think we're probablyputting a little bit more into
this injection problem than weneed to.
Zoe (06:06):
Well, maybe one of the other benefits would be that you
wouldn't have to keep it coldand it's cheaper to make.
Dr. Weiner (06:10):
That's the big.
Yes, you're right.
The storage, the transport, allof that is much simpler and the
half-life is going to be longer, and that it's cheaper to make
as well.
Zoe (06:20):
So anyway this medicine.
Dr. Weiner (06:24):
They ran this trial.
It was a phase 2A trial, whichbasically means they're starting
to dig around different dosesand they're looking for safety
and they're looking for efficacy.
What were the side effects anddid people actually lose weight?
And so this receptor, thismedication, triggers these
receptors, and they saw 6.5%total body weight loss at 16
(06:49):
weeks, which is okay.
Yeah, that's not great.
Zoe (06:52):
What would it compare to some of the GLP-1?
Dr. Weiner (06:55):
Well, Ozempic and again they stopped the study
after 16 weeks.
So we don't know.
But if we look at semaglutide,we're looking at about 15% total
body weight loss.
If we look at semaglutide,we're looking at about 15
percent total body weight loss.
If we look at terzepatide,there's some studies out there
showing up to 25 percent totalbody weight loss.
It's definitely over 20.
That's at a year.
But most people lose I wouldsay they're probably losing
(07:18):
about half the weight in thefirst um 16 weeks.
They also didn't talk aboutplateau or not.
There's been some studies thatsaid, oh, they did it for 12
weeks and there were no weightplateaus.
They don't comment on whetherthere's weight plateaus or not.
My suspicion is that thispathway is not going to be as
effective as GLP-1.
So there's been some concernabout these drugs in the past
(07:42):
and the concern has been thatthere's been an increased risk
in depression and suicidalitywhen taking these medications.
And they did see some non-GIside effects.
The majority of the sideeffects were GI and they're the
typical ones that we see.
They're heartburn, diarrhea,nausea, vomiting, and so there
were GI side effects for sure.
(08:04):
But there were also non-GI sideeffects and we've seen this too
with the GLP-1s, the GI sideeffects people can kind of work
through.
It's the insomnia, it's thedepression, it's the fatigue,
and they're less common,thankfully.
But those side effects tend tonot go away.
They tend to be a little bitmore lifestyle alteringing and
(08:24):
we're seeing more people comingoff the drugs for that.
So anyway, they saw anxiety,irritability, sleep disturbances
with these meds.
Zoe (08:35):
Which is kind of the opposite, because some GLP-1
studies are showing theimprovement of depression.
Dr. Weiner (08:41):
They absolutely do.
But they also show in somepeople that it worsens
depression, and so you know thething about it.
When you're dealing with sideeffects, it's can be.
You know, our tolerance forside effects depends on what
that side effect is.
Zoe (08:56):
Right.
Dr. Weiner (08:56):
If one out of every a hundred people who took takes
GLP, ones end up, you know,getting so like suicidally
depressed.
That's bad.
Even if five have animprovement in their mood if one
becomes suicidal.
We tend to weigh the sideeffects much more than we weigh
the benefits, and that's alwaysa tricky discussion with
(09:18):
patients.
I mean, the nice thing aboutmeds is that you can stop them
and typically the effect goesaway.
Yeah, but yes, there wasanxiety, irritability and sleep
disturbances.
Now I have a theory about thisyes so I just want to
you know, every time medicinecomes along a lot of things like
(09:38):
you know.
Classic examples viagra, right,was originally going to be used
as a hypertension, high bloodpressure medicine.
Turns out it has this othereffect that people you know got
very excited about.
Yeah, and so now here it is, asan erectile dysfunction
medication.
My theory is that this probablyisn't going to be a great
weight loss med, that the sideeffects won't be great, the
(10:01):
weight loss won't be great.
Whether we can combine it withthe GLP-1s that data, I mean, if
all of a sudden this wasaugmented, a GLP-1 response,
that might be interesting.
My suspicion is we're not goingto see this as a really great,
amazing, game-changing weightloss method, but I think it
might have another purpose.
So just kind of humor me onthis one.
Zoe (10:25):
I'm listening, I'm all ears .
Dr. Weiner (10:27):
Drinking and driving is a huge problem, huge problem
.
And so one of the biggestproblems with alcohol is that we
don't have a way to turn it offRight and, like you got to
sleep it off, it's only time.
Time is the only way to makeyourself less drunk.
So if you go out to a party andyou have a couple of drinks and
(10:47):
you're a little bit tipsy,imagine if you could take a pill
, sober up in 20 minutes anddrive home.
That pill would be solife-saving.
Zoe (10:57):
Yeah, absolutely.
Dr. Weiner (10:59):
And it would allow you know it would potentially
reduce motor vehicle accidents,drunk driving, I mean it would
be a game-changing medication ifyou could somehow do that.
My theory about this drug isthat it might do that for
marijuana.
First of all, look at the sideeffects.
They're like the opposite ofthe effects of marijuana.
Instead of being like chill,you have anxiety right.
(11:22):
Although marijuana can alsocause anxiety and can worsen it.
Instead of being like relaxed,you're irritable.
Instead of being like sleepyyou're, you have sleep
disturbances.
Home, they could take a pilland be able to drive home safely
(11:46):
and kind of have the effectswear off.
That would to me, that wouldactually as much as that kind of
seems crazy.
And you can talk about themoral responsibility and I've
talked about my thoughts aboutharm reduction.
Right, I mean we can talk about, you know, and I've talked
about this with alcohol useafter bariatric surgery and
talking about it compared tomarijuana, and so marijuana is
(12:06):
less harmful than alcohol.
It doesn't mean I support theuse of marijuana.
I don't think people out thereshould be using marijuana if
they can avoid it, but I alsoknow people do and so- we live
in the real world, we live inthe real world Exactly, and so
my idea is maybe that's whatthis drug is going to end up
doing Just a little bit of aloose tear.
Maybe I'll throw that into my2025 prediction episode.
Zoe (12:27):
Oh, there you go.
Well, I wonder what theturnaround time would be for
that.
Do you think like a decade?
Dr. Weiner (12:32):
It'd be a while.
It'd be a while, althoughthey're going to move forward
with this drug.
They're going to do a phase 2Bstudy, and the way they figured
out Viagra was they gave thisblood pressure pill and they
were measuring everybody's bloodpressure and the blood pressure
was like barely budging and solike, oh, scrap this drug, it's
(12:53):
a waste.
And so then they called all thepeople like I'm sorry, we're
going to cancel the trial andthe people like whoa whoa whoa,
whoa.
What are you doing here, buddy?
Don't do that, Come on.
I like this drug, drug andthat's how they kind of figured
this out.
So I guarantee it in one ofthese trials someone's going to
use marijuana at some point, belike, oh, it doesn't work
anymore, or something alongthose lines, and so anyway, that
(13:16):
just my theory about this, butbut anyway, the more drugs we
have, the better.
I wish this was not nova nordisbut another drug company, not
eli lily, a third drug company.
Um, my take on this pathway isit's probably not going to be a
super valuable pathway, butmaybe a secondary adjunct Anyway
, all right.
So what do we have fornutrition this week?
(13:37):
Zoe?
Zoe (13:37):
Yes, well, we have an article from New York Times and
the title of the article is 10Nutrition Myths Experts Wish
Would Die.
So all of them, I think, arevery valuable.
Dr. Weiner (13:49):
They were good ones, they were all really good.
Zoe (13:51):
For the sake of time we're not going to talk about all of
them, but I picked out threethat I figured we could dig a
little bit deeper into that arereally aligned with what we tell
our patients and what we'retelling you, listening with what
we recommend with nutrition.
So the first one is myth numberthree calories in, calories out
(14:12):
is the most important factorfor long-term weight gain, and
we just know this simply not tobe true.
I picked out a little blurbhere and said what's needed for
maintaining a healthy weight isa shift from counting calories
to prioritizing healthy eatingoverall.
Quality over quantity.
That's the money piece rightthere Quality over quantity.
(14:34):
And we talk about that all thetime with the metabolic reset
diet.
That's why we don't have ourpatients counting calories or
hitting a specific calorietarget, because if we can work
with the body metabolism, hungercues satiety signals in order
to eat the volume of food thatyou know most people want to
(14:55):
feel full and if they're feelinghungry, then you're going to
keep thinking about food, right.
Dr. Weiner (14:59):
Right.
Zoe (15:00):
But focusing on those whole real unprocessed foods, so that
quality over the quantity, andI think we couldn't agree more
with that I love to see that innew york times yeah, oh, you
know what, actually, just beforethis, I was on a support group
and, uh, somebody was askingabout a specific like a, a
protein chips or protein bar,something like that, and I just
(15:23):
kind of pulled, pulled somenumbers out of thin air, right,
and said, okay, for this numberof calories, this amount, blah,
blah.
And you have this small littlebag of chips, protein chips, and
then let's put on this otherplate, let's put on three ounces
of chicken and two cups ofbroccoli and maybe even throw on
there, you know, half a cup ofquinoa and a quarter of an
avocado or whatever, a quarterof an avocado or whatever.
(15:48):
How would you feel if you atethat plate of food, as opposed
to those 15 chips in that tinylittle bag?
And for the same amount ofnutrition?
Quote, quote, nutrition, right,the calories and the
macronutrients, but thedigestion, the micronutrients,
the fiber, all that other stuff,it's so much better for that
long-term weight maintenance and, of course, weight loss.
(16:10):
Yeah.
Dr. Weiner (16:11):
I, I, sometimes I joke about um, you know the a
hundred calorie snack pack,right?
We all know those a hundredcalorie snack packs.
Or Oreos, right?
It's not, even it's not a realOreo cookie.
I think it's just the outsidepart.
It doesn't have any of the the,the white part of the Oreo, and
it's like four of them.
I mean there's like so few ofthese things in there.
(16:32):
And then I also joke well,there's 100 calorie snack pack
of spinach.
Has anyone ever seen it?
It's one pound, it's a hugeCostco bag of spinach has 100
calories in it, of spinach has ahundred calories in it, and so
again, comparing, how you'regoing to feel if you ate that
(16:54):
entire bag of spinach you wouldbe like oh my God, and you eat
those four Oreo little, you knowjust the outside parts and
you're like what's next?
Zoe (16:58):
It does nothing for your satiety, you eat four more of
those little hundred caloriepackets.
That's a reminds me of anotherexample I like to use a lot in
our increasing your veggieintake support group that we
have on the schedule, and it'slike visualizing a slice of
pizza.
Now, of course it's going tovary a lot depending on the
pizza and what's on it and yadayada, but if we think about
(17:18):
let's call it, 400 calories forthat slice of pizza.
That's why it's easy to eat.
People eat three or four slicesof pizza because you want to
feel full from it.
You don't feel full from that,but it's so calorie dense, Right
?
Do you want to guess how manycups of?
I bet you can guess, but howmany cups of broccoli it takes
to get 400 calories?
Dr. Weiner (17:41):
I would guess I'm going to guess that a cup of
broccoli has 40 calories.
That's my guess.
So times 10, 400.
Zoe (17:49):
how'd I do so?
You want to say 10?
10, 10 yeah, it's about like 8to 10.
Yeah, yeah, and then like thinkabout that on a on a plate,
just like you're 10 cups yeahyou can't I.
I have a stomachache justthinking about it yeah so,
thinking about that nutrientdensity as opposed to caloric
density, that doesn't mean thatyou can't have a slice of pizza,
but maybe it's OK.
(18:10):
I know that I'm not eating thepizza for the fullness, for the
satiety, for the volume, but Ican add.
Maybe I add two cups ofbroccoli to it, or a side salad
or something like that, to kindof get both.
Dr. Weiner (18:22):
It's some other interesting things too.
Both.
It's some other interestingthings too, um the, if you think
of the largest mammals right,think about just cows, giraffes,
um what?
do they eat grass, grass, leaves, leaves yeah, that's all I mean
.
They eat it all day long, butthat's all they eat.
So a lot of people like well,you can't get protein, you can't
(18:44):
build muscle, but the largestanimals are vegetarian, and so I
think that's interesting andand the one of the reasons for
that is that, calorie forcalorie, spinach has more
protein than steak I did notknow that.
Yes, that's so interesting,yeah because again, a hundred
calories of spinach is thisgiant costco bag right but a
(19:07):
hundred calories of spinach.
Is this giant Costco bag Right?
Zoe (19:10):
But 100 calories of steak is like three bites.
Yeah, exactly Right.
Dr. Weiner (19:12):
Especially if you you know especially a more
marbled piece of steak Right,it's going to have fat in it and
no protein that you're going toactually get more protein from
100 calories of spinach.
Now, again, that doesn't meanmean, you know, ounce per ounce,
steak has a lot more protein,but calorie per calorie, if you
measure it out by calorie, yeah,anyway.
(19:33):
So so I'm I'm really happy tosee this.
I think we're starting tofinally get some some
penetration into the, theknowledge base that measuring
calories is probably wastefuland not necessarily going to get
out there.
But there's still theseInstagram guys who are like you
need to be in calorie deficitand if you're not in calorie
deficit, then you're not goingto lose weight.
(19:55):
And there's three things yougot to do to lose weight Calorie
deficit is one, calorie deficitis two and calorie deficit is
three.
They're out there, right?
They're always young men.
Zoe (20:04):
Yeah.
Dr. Weiner (20:04):
You notice that?
Yeah, notice that?
Yeah, maybe shirtless what?
It's always the young men whoare um, who are pushing and
promoting calorie restriction asa means of weight loss, because
nobody can nobody has it easierwhen it comes to losing weight
than young men.
No, that's true, yeah, so yeah.
Zoe (20:22):
So you know, quality over quantity, people.
We say that all the time.
So then you know we kind ofalready touched on this with
talking about the other one.
But myth number eight is theprotein in plants is incomplete.
And it's not actually that theprotein in plants is incomplete.
They have all of the 20 aminoacids that you need, but the
(20:44):
difference is that theproportion of those amino acids,
so that means you need to havea variety, that the proportion
of those amino acids, so thatmeans you need to have a variety
, which I mean, if we think of,culturally, rice and beans going
together, that creates acomplete protein.
So it's, you know, like youwere just saying, biggest
mammals are, you know,plant-based, and so you know,
yes, if you are not eating anyanimal protein, we need to have
(21:08):
a variety of those plant basedprotein sources.
Dr. Weiner (21:12):
So I mean, essentially the idea is, if
you're going to get plant basedprotein, you should get some
from beans, some from nuts,Right, Some from even grains
like rice.
So this has always bothered me,this idea that you know that
there's and there's a certainnumber of essential amino acids.
There's 20 amino acids.
Amino acids are these littlemolecules you know that make up
(21:35):
all the protein.
You string them together andyou make protein, and so so we
can make these, some of these,but we also can't make some of
these.
So we think, and so I thinkthere's, first of all, but we
also can't make some of these.
So we think, and so I thinkthere's, first of all, there's a
limit to what we know about ourbiochemistry, and I think a lot
of times this theserecommendations are made by
(21:55):
someone who like took likebiochem 101 and like, oh, they
told me this in biochem 101.
So now I know it and it's true,but I think it's a complex
issue and I think there areprobably pathways and ways that
we can make some of thesenon-essential amino acids and
out of carbohydrates, out ofother compounds, and so that's
always kind of bothered me alittle bit about that because I
(22:18):
wonder if it is really true.
I think that you probably canget by.
Zoe (22:23):
Yeah, Well, I get, and I mean that leads directly into
the last myth, Nimeth.
Number 10 that I pulled isfundamental.
Nutrition advice keeps changinga lot and there's a lot that we
don't know Right and thescience is ever evolving.
Nutritional sciences is arelatively young, you know study
.
Dr. Weiner (22:43):
Right.
Zoe (22:44):
Right.
But if we think about the main,this is the, this is the quote
here.
Eat food not too much, mostlyplants.
Dr. Weiner (22:51):
Yeah, that's from Michael Pollan.
I think he said that.
Uh yeah, uh, omnivores dilemma.
Oh, okay, I think that's whereit came from.
Zoe (22:59):
So I mean, the bottom line is that, yes, it's an evolving
science, but if we boil it downto what we always say is try to
eat as much whole, real,unprocessed food as much as
possible, and this is alignedwith that.
And, yes, it can be complicated, especially with everything
online and different influencers, and you're getting information
(23:22):
about this diet and you needthat supplement, and it is
confusing and it is overwhelmingwhen we are taking all of these
.
You know all that white noise,right, um, taking up space.
But if we boil it down to, like, keeping it simple, it really
doesn't need to change, itdoesn't have to be complicated
it's.
Dr. Weiner (23:41):
It's sometimes it's the stuff your grandmother told
you to do.
That's really still, I think,the best nutritional advice eat
your vegetables.
Right, right, that's that wasbeen like, you know, in the
fifties.
That was like the big, the bigadvice.
Don't eat a lot of sweets,right, and maybe don't eat the
fattiest greasiest meats Thingsalong those lines.
(24:02):
Well those lines.
Well, and portions, I mean,think about the portion sizes in
the 50s versus now, absolutely.
But but yeah, I, you know, tome I think part of the there's
two problems with it.
The first problem is that doinglike hard nutrition science
double, you know, randomized,double-blinded, controlled
trials is like impossible, right, like you would literally have
(24:24):
to like keep someone captive andonly feed them certain food.
I mean, we have institutionalreview boards that review any
type of scientific study that'sdone to make sure that it's
ethical.
And if you're going to really dohard science on nutrition, I
don't think it would pass themustard of any of these IRB
(24:45):
boards.
Nutrition, I don't think itwould pass the mustard of any of
these IRB boards.
So it's just impossible toconstantly because we eat all
through the day, no-transcriptaccurately, right, right, yeah,
it's just not possible.
So I think the ability to getthat, that kind of definitive
(25:06):
answer that we can get withmedications, we can get with
surgery, we can get into otherhealth fields, it's so much
harder nutrition, so much harder.
I think that's the first thing.
The second thing is what youalluded to, which is that
there's too much money to bemade in selling processed crap,
and it's just, it's such a greatbusiness model to take
(25:27):
something heavily processed thatpeople like to eat and somehow
apply a health halo like youalways talk about to that
heavily processed food andsomehow leverage some obscure
scientific or pseudoscientificarticle that says somehow this
would be helpful and good, likeLenny Curb and Chromium Right
(25:49):
that there's.
So it's so easy to make moneydoing this and then strap a nice
little marketing package on topof it, get some influencers
behind it and cha-ching.
Zoe (26:00):
Yeah.
Dr. Weiner (26:00):
Right, I mean, it's just such a reliable way to make
money, and so that just cloudsall the advice out there.
So this is what's being pushedin front of us instead of good,
old-fashioned advice.
Like the green jolly, the jollygreen giant, like where's he?
Yeah, where's he been?
And I don't think he's.
You know, offering milliondollar influencer deals?
(26:20):
Yeah, you know something?
Offering a million dollarinfluencer deals.
Zoe (26:22):
Yeah, you know something I was just thinking about as we
were talking about, like in the50s.
We think about the obesitytrend, how much it has risen
over the decades.
Any graph in front of me but Iwould.
(26:46):
I would put money on the factthat that graph mirrors the rise
in diet trends and differentfad diets and and that sort of
thing.
And we know that going on andoff diets is one of those
predictors of weight gain.
Right, and it's, and that'spart of the machine that is diet
culture and this multi-billiondollar industry.
It's sell a product or aprogram to somebody knowing that
(27:08):
it's, and then they fail, theyfeel like they're a failure, but
it's ultimately that thatfailed them, that failed them,
and then it creates a morevulnerable and prey worthy
individual to continue buyingmore of these different products
(27:29):
.
Like it's just so sad.
Dr. Weiner (27:29):
You know what that's , that we need an infographic,
that infographic of trytemporary diet fail, become more
susceptible to to next diet fad.
Zoe (27:41):
try and that and that, that circle and then the weight goes
it's like a spiral up, like alittle pigtail that probably
describes 95 of the peoplelistening to this podcast right
now.
Dr. Weiner (27:51):
Yeah, we need to put something like that together.
I bet I bet chat gpt couldprobably make that happen like
that.
Yeah, all right, so let's moveinto the economics of obesity
segment, and this is where ourtitle comes from.
So here's what's happenedrecently.
On October 2nd, the FDA hassaid that terzapatide is no
(28:14):
longer on shortage.
I think we've covered this indetail on a number of episodes
in the past and the 503Bcompounding pharmacies, which is
who makes most of thesecompounded drugs.
Again, quick primer oncompounded medications these are
not produced by Eli Lilly orNovo Nordisk, which are the
(28:36):
companies that hold the patents.
They are produced overseas,almost exclusively in China, at
FDA-approved facilities, but theproducts do not go through the
same testing process thatZepbound and Wegovi go through,
and so there's a lot of it's agray market area.
But because both terzapatideand semaglutide are on shortage,
(29:00):
these 503B compoundingpharmacies are allowed to import
the medication from China, notfrom the patent-holding
manufacturer, mix them togetherwith something to make a novel
compound and then sell it.
And so they mix it with B12 orthiamine or something like that,
and the truth is that addsabsolutely nothing to the effect
(29:22):
, but it allows them to sell it.
Now, as soon as the shortage isresolved, this becomes illegal
and it is a patent violation.
So all of the compoundingpharmacies want the shortage to
last as long as possible, and ofcourse, eli Lilly and Novo
Nordisk want this shortage over,and we've talked about this
about recently in the release ofvials, and so now Monjaro and
(29:47):
Zepfoun are available to lowerdoses as vials as opposed to the
injector pens, and that allowedEli Lilly to meet their
manufacturing needs, becauseit's not the drug that's on
shortage, it's the injector pensof all things.
Yes, um, so so the 503pcompounding pharmacies are no
longer able to produceterzepatide.
(30:10):
This now, semaglutide, is stillum on the shortage, but only
for one dose, I think, only forthe 0.25 or the 0.5 and, and you
can check the FDA proof.
So this is all like coming toan end.
Zoe (30:23):
And they're going to be like legally pursued.
Dr. Weiner (30:27):
You think yeah.
Zoe (30:29):
Well, especially if they have Eli Lilly and Novo Nordisk
up, you know lighting a fireunder their butt.
Dr. Weiner (30:34):
They already have.
I mean Eli Lilly and NovoNordisk have made it very clear
that they will pursueaggressively with filing legal
actions any physician's officeor compounding pharmacy that is
breaking their patent laws.
I mean, they want no part ofthis.
Zoe (30:53):
And that means all of the like med, spas and weight loss,
Clint like that you can go andget If you're not getting your
medication from an actualpharmacy.
Prescribing provider.
Dr. Weiner (31:07):
You get a prescription, it goes to CVS,
walgreens, your Safeway, kroger,wherever you're getting your
prescriptions from.
If you're not getting it fromthere, then it's very close to
being no longer available Months.
But there's a little bit ofaction here.
There's a little bit of stuffgoing on.
Zoe (31:25):
More than getting your prescription from a doctor.
Dr. Weiner (31:29):
So the Alliance for Pharmacy Compounding actually
filed a lawsuit saying that no,you've prematurely, the FDA was
unfairly influenced by Eli LillyLilly and you prematurely put
this drug and taking this drugoff the shortage list when it's
still going to be on shortage,because look at all these people
(31:50):
on compounding meds.
There's no way you have themanufacturing capabilities to
meet all of these people on thecompounding meds.
So they filed this lawsuit andit's been filed in federal court
and actually they got like astate of execution yeah.
So the FDA said you know what?
We're going to reevaluate this.
So it's still okay for the 503Bpharmacies to continue to
(32:14):
produce and sell terzapatide.
Zoe (32:16):
I feel like I've been on a roller coaster listening to this
.
What's going to happen next?
Dr. Weiner (32:24):
So, but here's the thing.
They're going to probably beable to push this off another
month or two.
Zoe (32:31):
Well, that's it.
Dr. Weiner (32:33):
Six months maybe, I don't know, but not 10 years,
right, this whole compoundingthing will be part of history,
but it will not be the way thatpeople get these medications,
not in the United States.
There's other stuff we're goingto talk about happening in
other countries that areinteresting.
We'll cover those in futureepisodes, but as of right now,
(32:55):
yes, they did get a little bitof a break, but it literally is
a stay of execution.
Did get a little bit of a break, but it's, it literally is a
stay of execution.
It is not a long-term winthat's going to allow them to
continue to produce thesecompounded medications for a
long period of time.
Um, lily and nova nordis willwin this battle.
They are, I mean, in terms ofjust scale.
(33:17):
They are a hundred, a thousandtimes, um, wealthier than these
compounding pharmacies.
Um, and they have the, and alsothe law is on their side.
I mean, they do hold the patentright, and so they're gonna win
.
Zoe (33:33):
That's probably bad for patients yeah, um, I'm just
thinking about how many peoplewho utilize compounded yeah.
Dr. Weiner (33:41):
so so let's say you're out there and you're
using compounded meds, so let'stalk about what you can do.
So I think we're going to seethis happen with terzapatide
before we see it withsemaglutide, I think.
So the compounded.
There's places that haveterzapatide, there's places that
have semaglutide, there'splaces that sell both.
If you're using compoundedtrisepatide, I think you know
(34:04):
potentially looking at moving tosemaglutide might be the right
thing to do right now.
It's just going to kick the candown the road.
It's not going to solve theproblem in a long time, but it
is.
We've talked about this in thepast.
We definitely work withpatients creatively.
We call them, you know, ourlittle code word for this is
creative dosing strategies, andwe do have people from all over
(34:26):
the country reaching out to usand we do have a program.
It's called our PlatinumProgram.
There's a little bit of anupcharge but truthfully, it's
probably the same, if notcheaper, than using compounded
meds.
Zoe (34:36):
Well, you broke down the cost in a previous episode of
compounded versus know whatever,and you know, it's really not a
big difference, it's not thatbig of a difference when you, if
you, if you get creative withit, yeah, and so we.
Dr. Weiner (34:51):
So, like I said, even with our upcharge for the
program fee, it probably stillis, over the long run, cheaper
and it's gonna.
This is to us.
This is a strategy we think wecan continue for years, right,
um, without, and we're notbreaking any laws or or rules or
anything and it's not gonnalike you know, you know, be
legally taken away at the job Idon't think so.
(35:11):
No, I mean, you know the systemis screwed up and when a system
is screwed up, you can sometimestake advantage of that to
benefit you, even though youknow it's a lot of what's
happening is bad for patients.
It can also be good for you ifyou kind of think creatively.
So anyway, that's what we do inour platinum program.
I think the third thing toconsider is if you know, if you
(35:36):
understand the metabolic effectsof GLP-1 meds and how metabolic
treatments are so much moreeffective than you know strictly
lifestyle mindset, diet andexercise type things that we've
been doing all along untilsurgery and meds came along.
Then there's another metabolictreatment and that's bariatric
(35:56):
surgery.
And the nice thing aboutbariatric surgery is they can't
take it away from you right Onceyou have it.
It's there there and so that'sa way to get off the glp-1
roller coaster.
We see that a lot with ourpatients.
They're like you know what?
I don't want to be on medsforever.
I'm.
I see it, it works.
I understand obesity is adisease.
I understand there's metabolictreatments.
I don't want to be dealing withthese meds and the cost and
(36:19):
getting them and all that kindof stuff.
So I'm going to look at surgeryand I think we're going to
start to see that as thedecision making is whether you
want to be on the meds long termor whether you want a surgery
that kind of fixes it once andfor all.
The nice thing about surgery iswe can do it so safely Less
than a 1% serious complicationin our practice for these
surgeries.
(36:39):
So anyway, I do think that thecompounded GLP-1s this is their
final loop around the spiral andthat at some point in the near
future we're not going to havethem.
I don't know if I'm going tomake my January 1st deadline,
but I think we'll come close fora prediction episode.
Zoe (36:58):
We'll have to check back in about that when we do that.
Dr. Weiner (37:01):
Absolutely All right .
Zoe (37:04):
All right.
Well, that's our show today.
Thank you so much for listening.
I hope this was helpful, and ifit was, we would love to have
you share it with somebody thatyou think would find this show
valuable as well.
Our whole mission is to getthis information out to as many
people so we can help as manypeople as possible.
Dr. Weiner (37:19):
And we've been asking for reviews.
We actually have a bunch ofreviews now, yeah, and they're
actually pretty good.
Zoe (37:24):
So that makes me happy.
Dr. Weiner (37:26):
So thank you all of you for your reviews that you
put out there on Apple Podcastsor Spotify or wherever you're
listening.
And again, if you like this,please share it with other
people.
See you next time.
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