July 7, 2025 • 48 mins
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On this episode discuss the side effects of GLP-1 medications like Ozempic and Wegovy, Zepbound, and Mounjaro offering practical strategies to manage these effects while still benefiting from the medications.
• GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound) help manage type 2 diabetes, obesity, and can reduce cardiovascular risk
• Most common side effects are gastrointestinal: nausea, vomiting, diarrhea, bloating, and constipation
• "Sulfur burps" are a frequently reported side effect that some manage with Pepto-Bismol
• Start with low doses and increase slowly to minimize side effects
• Eat smaller portions, avoid greasy/spicy foods, and practice mindful eating to reduce GI symptoms
• Stay hydrated and increase fiber intake to prevent constipation
• Gallbladder problems and pancreatitis risk may increase with rapid weight loss
• Some evidence suggests potential vision changes requiring regular eye check-ups
• Medications like insulin or blood pressure drugs may need adjustment when on GLP-1s
• Most side effects improve with time as your body adjusts to the medication
Send us an email at yourcheckuppod@gmail.com or visit our Instagram or website to stay updated with weekly episodes released every Monday.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine doctor in the
Philadelphia area.
Speaker 2 (00:23):
And I'm Nicole Ruffo.
I'm a nurse.
Speaker 1 (00:25):
And we are so excited you were able to join us here
again today.
As promised on the last episode, we did watch the poop cruise.
Speaker 2 (00:35):
Yeah, we did.
Speaker 1 (00:36):
We did.
What did you think?
Speaker 2 (00:39):
Um, what did?
I think Everyone was kind ofweird that they interviewed.
Am I allowed to say that?
Yeah, you're out to say thatyou're all weird and I mean, is
pooping in a red bag really thatawful?
Thank you yeah, I feel likeit's not thank you.
Speaker 1 (01:01):
I, that's really where I like came to it, like
you're on a floating vessel foranyone who, like isn't gonna
watch this but is curious tocatch up.
Um, there were these peoplethat left from like in the gulf
of mexico.
They left from somewhere Idon't know.
They were on a cruise galvestonmaybe and they left on a cruise
it was carnival cruise and theywent over to mexico, stayed
(01:23):
there for a day or two and thencame back and, like the engine
caught on fire and then led toseveral different like power
problems throughout the ship,including the toilets, and they
were out there for like a weekor so and so there were like no
working toilets and they had to.
Like the people on the boatwere like, oh, you need to poop
(01:45):
in these red bags he's likebiohazard bags and then we'll
dispose of them and, like somepeople just like refused to do
that and then they pooped in theplumbing and like wouldn't you
know what happened?
it overflowed like well, likewe're talking like that, like I
don't know if they were close topassing away or this was close
(02:06):
to being like a really, reallybig tragedy.
Get over yourself.
Speaker 2 (02:11):
Poop in the bag, come on in the bag.
Poop in the bag, I mean peoplepoop on our street.
Speaker 1 (02:15):
So Excellent point, yeah, so I couldn't help.
But like it was then, like thetugboat came along and changed
the angle of the cruise, thatwas sick, that actually was
sickening.
So, with all these peoplepooping and peeing in the like
not functioning plumbing, whenthe ship tilted a little bit, so
did, like its equilibrium andall of the, the contents, the
(02:39):
contents, if you like.
Pick up what I'm putting down,smelling what I'm stepping in.
Speaker 2 (02:44):
Yeah, that was gross.
I don't think I like needed anymore endorsement to not go on a
cruise, because I just don'tthink that's for me.
Speaker 1 (02:57):
They tend to look very crowded.
Speaker 2 (02:59):
Yeah, I feel like claustrophobic thinking about
them.
Yeah, like all those people ona boat, and then you're just
stuck in the middle of the ocean.
Speaker 1 (03:08):
It does seem like a lot.
Yeah Right, I'm like, and thenthere are always something to do
.
It seems like touch land.
Speaker 2 (03:13):
I mean I know you like get off and like do things
and then get back on, but Idon't know, I don't think it's
for me.
Speaker 1 (03:19):
Maybe it's not, so if you're curious what we're
talking about here, maybe you gocheck it out.
It's on Netflix the poop cruise.
Yeah, I can't help but thinkthat this ties in well to what's
happening in Center City.
Speaker 2 (03:33):
Center City, actually all of Philadelphia, has turned
into a poop cruise Because whatare they called District 33.
The union is on strike and partof that union includes all of
the sanitation workers.
So there is no trash collectionin Philadelphia.
And it's been three days, twodays.
Speaker 1 (03:58):
I actually think today was the first day that
there would have been trashcollection, but like the word's
been out there that this hasbeen happening since like
tuesday at midnight or so, andno tuesday, because over that
way their trash is on tuesday oh, oh, yeah.
So then this has been happeningsince then.
(04:18):
Yeah, it's, it's not bad yet.
Um, there were definitely somepeople who didn't get the get
the word, so they put out theirstuff yeah, I'm wondering how
long it's going to be on our.
Speaker 2 (04:28):
It's like we're, we're like our house is on the
corner.
Yeah, so that's where they puttheir trash.
Speaker 1 (04:33):
So I wonder how long it's going to be sitting in
front of our house for probablyum, if there was any excuse to
get out of the city um we'releaving promptly after work
tomorrow 20 hours from now.
Speaker 2 (04:47):
Um from the time this time tomorrow we'll be at the
beach.
Yeah, I will be settled intothe beach.
Speaker 1 (04:53):
It's late, it's already 8 30 yeah, I, I hope
they figure this out.
I hope that, like, by the timethis comes out, they like have
this settled already.
Um, they have an alternativesetup for anyone wondering like,
what will they do?
Speaker 2 (05:09):
like they're apparently like several
different places to go drop yourstuff off yeah, I don't know if
that's getting collected,because it looks like it's all
just sitting there yeah, ifthere was an opportunistic waste
management group, likeprivately that wanted to rake it
in.
I don't know who's going to payyou, but no, I don't either.
Bill the mayor.
Speaker 1 (05:30):
It's her fault.
You could probably get thelocals to pitch in to a private
fund of all the people on anystreet that you can get them to
just come by and do it.
Maybe they would do that.
Speaker 2 (05:43):
I think that would be a prime business opportunity
we'll see what it's like when wecome back after oh, the fourth
of july.
Speaker 1 (05:49):
That was gonna be awful but for the moment you've
been waiting for where did yougo?
Because we left them off on acliffhanger last week.
We're gonna get into our dinnerreview, uh, part of the episode
here before we break into themeaty part of the side effect
episode of glp ones.
Where did I take you for dinner?
Speaker 2 (06:09):
we went to kaleia, which is a thai restaurant, and
it was I feel like we say thisevery time we go somewhere it
was like one of my favoritedinners we've ever had.
It's up there with saraya andthey're in the same actually.
Soraya and they're in the sameactually end picnic and they're
in the same group, which I thinkwe talked about last week.
(06:29):
But whatever they got going onat what is it?
Divine hospitality?
Speaker 1 (06:34):
Is that?
Speaker 2 (06:35):
what it's called.
Whatever they have going onthere Like.
Speaker 1 (06:38):
I love it.
They're winning, it's for us.
Speaker 2 (06:40):
And the um, I don't know who she was.
She was like the HBIC of therestaurant and she kind of
reminded me of the grandmotherfrom Crazy Rich Asians.
She gave that energy and shewas just like walking around, I
don't know.
She was like the owner.
Speaker 1 (06:57):
Yeah, I think she was the owner of the chef, because
like when you, when they cameout with the bill and you
flipped it over, it was like apicture, yeah out with the bill
and you flipped it over.
Speaker 2 (07:07):
It was like a picture , yeah, and like the menu was,
it was all inspired by placeswhere, like the main chef's
grandmother or mother was fromin thailand.
So I wonder who that was.
Speaker 1 (07:15):
But that's always like a nice touch when, like the
owner or like oh my god someonelike because she was like
thanks for coming in right, likegoing around to everyone, like
seeing how everything was.
Speaker 2 (07:26):
Yeah because that's what?
Um, when we were in ashville,when we went to curate the oh, I
forget her name that the likechef owner person like was like
going around to everyone ohreally yeah, don't you remember
no, this was like that was soearly on in, like the restaurant
experience, like going to thisplace and he's never been to a
(07:47):
restaurant, no, butno, but like I now, having lived
here, yeah, because rememberthat restaurant like won some
award or like she won somethingspecifically and I only knew
that because I was like lookingup on their instagram and stuff
before, and then I was like ohmy god, that's her.
Speaker 1 (08:02):
And she just like thanked us for coming in yeah,
no, I that was so early on in mylike lived experience of
enjoying food like this so therewas no way that I remembered
that I would love to go back andto like relook at the menu and
take a different perspective.
But to bring it back to kalea.
Our server was great, he wasawesome.
(08:23):
Michael michael was awesome,very warm welcoming.
As soon as you sat down youwent in big space, big like,
bright space, lots of windows.
I tried to deke you out alittle bit and make you think
that we weren't going there bylike.
Speaker 2 (08:36):
I knew exactly where we were going when you said one
thing.
I know, you picked me up fromwork and I was like okay, so
like what time do we need to beready to go?
And you like said the time andyou're like, yeah, you know,
give us time to like get upthere and get parking.
So you said get up there andthere there are like two places
up there that we haven't been.
(08:58):
The only thing I knew is thatwe haven't been to this
restaurant, that we haven't been, that we've talked about and
that we've wanted to try I knowI was like oh my god, are we
going to kalaya?
Speaker 1 (09:06):
there's like no way to get.
Speaker 2 (09:07):
Can you try to play it off?
Speaker 1 (09:08):
I did.
I was like trying so hard andlike I I'm so impressed that you
can just like snap it out ofthin air and just like find
where we're gonna go.
It's.
It's a little demoralizing totruly like surprise you, um, but
all in all, terrific.
So the very bright and openthey were all like bright-eyed
(09:29):
and bushy tail when you walk inum, sit down very cozy and you
know, nice tap water.
Tap water was great, um, butlet's get into it, I mean.
So the beverages were delicious.
We've gotten some comments thatwe talked too much about
beverages here, so we'll leaveit at that.
Speaker 2 (09:48):
Yeah.
Speaker 1 (09:49):
Um, but the take me through your feelings on the
dumplings cause.
It's only going to go up fromhere.
Speaker 2 (09:55):
Yeah, we got some sort of like dumpling.
What was it?
It was a chicken.
It was like a little spice.
They were blue.
That was interesting.
Yes, they were tasty.
Speaker 1 (10:05):
Super tasty, glad we did it.
Speaker 2 (10:07):
Yeah, they had a couple other like dumpling
things that we probably will tryagain.
Yeah, but they were good.
And then the appetizers we got.
Oh, here we go.
Well, first it was this likecoconut rice something.
Speaker 1 (10:24):
Which was great.
I don't know, it was delicious.
Speaker 2 (10:27):
I loved it.
And then the best appetizer,which was probably our favorite
thing.
What was actually?
I'm going to pull up the menu.
Speaker 1 (10:36):
Give them credit so that they can find it if they're
going to go.
Speaker 2 (10:39):
I haven't ever had anything like this.
It was the best thing.
I would go back, kalaya oh myGod, am I okay, kalaya?
Ever had anything like this?
It was the best thing.
Like I would go back.
Wait, kalaya, oh my god, am Iokay, kalaya?
Um, I would go back just forthis appetizer.
Speaker 1 (10:58):
Okay, menu, so, and then, if you can, leave that up
so that we can talk about it,not just butcher these names um,
oh, here it is.
Speaker 2 (11:10):
Okay, I don't know how you pronounce it.
It's the first appetizer on themenu.
It's crispy, garlic, chive ricecakes with a spicy, sweet soy
sauce.
So we saw rice cake and wethought it was going to be like
a thin, crispy situation thatyou like put soy sauce on, which
also sounds good.
(11:31):
But this crunch it was like abrick.
It was like three square bricks, crispy on the outside, and
then you, I don't know what'sinside there was some like
spinach, something happening itwas like sounds gross, it was
delicious, it did not taste likespinach and it was like gooey
in the middle, and then you putthis soy sauce on it.
Speaker 1 (11:52):
It was the best soy sauce that was just like spicy
sweet soy sauce.
Speaker 2 (11:56):
I don't know what's in it, but it was not your
average soy sauce.
It was delicious and it was ohmy god, it's so good yeah, I
would go back for that, likethat has to be on the thing when
you go there yeah that, likeyou got to try it.
Speaker 1 (12:10):
That was amazing.
Speaker 2 (12:10):
I loved that and I mean, that was just the
beginning, yeah they do have atasting menu, which we we
typically love a tasting menu.
We just decided not to do itthis time because there were
things off of the tasting menuthat we wanted to get more, yeah
, so we just like did that, butthe tasting menu also looked
(12:31):
good and the people next to usoh, yeah, yeah.
We're like interruption of thereview here for this I just like
, sometimes I'm like you, justlike, don't know how to act in
public to people and like they,the royal, you right.
Speaker 1 (12:46):
The royal, you, yeah, yeah.
Speaker 2 (12:49):
People and okay, like tasting menus.
Sometimes on a tasting menu youyou get the options of like
pick from this, like thissection, this section and this
section.
This tasting menu was set andlike this is what you got on the
tasting menu.
And then people next to us arelike I don't eat beans, can I
sub this with this?
(13:10):
And they're subbing like fourout of the seven things on the
tasting menu.
Like what?
Speaker 1 (13:15):
Yeah.
Speaker 2 (13:15):
Just order off the menu.
That's not like.
The tasting menu is curated,like by the people for a reason.
That's what it's for Yeah'swhat it's for.
Speaker 1 (13:25):
Yeah, like, if you're gonna.
Speaker 2 (13:26):
If you're gonna order whatever you're gonna order,
just you should probably justorder your own dish.
Speaker 1 (13:32):
I get it like one off or asking yeah, they went in a
couple times.
Speaker 2 (13:38):
I don't eat this, I don't eat beans, I don't eat
this.
Okay, maybe you should go to adifferent restaurant it was the
tone of the delivery too.
Speaker 1 (13:45):
It was.
Michael was very gracious.
Speaker 2 (13:48):
And Michael had to wait on them too.
He did.
Speaker 1 (13:51):
Look it was.
There are people with dietaryrestrictions out there and, like
you know, they want to go onthe tasting menu too.
But there was the delivery andthe like going in multiple times
.
Dip in like.
Can I change four out of theseven?
It's a little too much.
Speaker 2 (14:11):
Okay, back to our full food review.
So then we got a curry.
That was also so good.
Speaker 1 (14:19):
So delicious.
Speaker 2 (14:20):
It was the yellow curry with chicken, and then
served with something else thatI can't pronounce and the like
coconut turmeric rice.
This, that rice, was so goodtoo.
Speaker 1 (14:32):
I mean, I didn't know rice could be like different
and amazing, but it was.
I loved how she like invited usto be like.
Oh, do you want to like knowhow you should eat this Please?
Speaker 2 (14:42):
Yeah, there's a whole experience to putting it
together with the rice and thenthey give you a boiled egg and
you like crush that egg downcrush the egg into the rice and
then you put the chicken andthen like the curry over it.
Wow, it was so good it was alittle spicy.
Speaker 1 (14:57):
It was like the medium spice option on the menu.
It seems it was pretty spicy.
Um, so just be mindful of thatif you're gonna go.
It was, I can't stop thinkingabout it.
And the chicken two restaurantsin a row with chicken, I know
um, amazing.
Uh, it was delicious.
We meant to go there withkarthik and mike.
Speaker 2 (15:16):
Um, at an I have to say, mike, if you're listening
to this in your basement doingbasement things, I'm I think you
would enjoy it.
However, I'm so happy eddie didnot go with you and karthik to
kalaya, so I could enjoy it.
Speaker 1 (15:32):
Yeah, that would have been a tough one to come back
from, because you went to laserwolf and then they gave me some
like reviews and like it.
Speaker 2 (15:38):
We aren't jumping to go there, it sounds like it was
great, but like this one wasbetter than laser well, I would
have felt guilty coming backafter this.
Speaker 1 (15:48):
Yeah, that was, that was something.
Do you have any more love notesfor the yellow curry chicken?
Speaker 2 (15:53):
no, all around 10 out of 10.
And then we got whateverthey're, like crab fried rices,
which I think is like a popularmenu item it seemed that was
also delicious.
Oh, did you eat that today?
Speaker 1 (16:07):
no, we still haven't.
It seems a little misleadingbecause it's like written as
colossal crab, and maybe that'sjust me like.
Maybe colossal crab meanssomething else than a giant hunk
of crab.
It was absolutely delicious.
I have no notes on it.
Speaker 2 (16:23):
I can't make anything like that I feel like I don't
know everything we got.
I would maybe get a differentdumpling just to try another one
.
Yeah, but everything I wouldjust order that same thing.
Speaker 1 (16:34):
I think I may I may be interested in trying, because
I'm really happy we got thatcoconut rice and then now
knowing that there was rice thatcame with the curry chicken,
like I may, we did have a lot ofrice, there's a lot of rice and
then now, knowing that therewas rice that came with the
curry chicken, like I may.
Speaker 2 (16:46):
We did have a lot of rice.
Speaker 1 (16:48):
There's a lot of rice and I may explore different
options, but that was just likeout of this world.
Somehow it always feels like asuperlative comes out of these
meals, which really just makesme feel amazing about the city
of Philadelphia and like comingin here nearly four years ago
being like oh yeah, the foodscene is great is what they say?
Speaker 2 (17:12):
no, it really no it truly is.
Speaker 1 (17:15):
It is truly great.
Speaker 2 (17:17):
I know every.
I was saying this to you lastnight when we left.
Speaker 1 (17:19):
Like every time we go somewhere, there's always
something that's like the bestthing we've ever had, like the
crispy rice cakes, like bestthing we've ever had yeah, I
like, I mean, and then, howoften do you like these are
experiences that like we feelcompelled to talk about and
remember, and you know, I thinkwe do a great job of keeping
(17:39):
pace and trying to like exploreand do new things, but like it's
, I mean, there's a lot of themtoo.
Like we got to go to pizzeriabadia.
Same like yeah, that's on thelist that like does all of this
stuff.
Speaker 2 (17:51):
So like I'm gearing up for what may be the best
pizza of my life I think theyalso have people say I think
it's there, I have to check, butI think they have this like
sweet cream, ice cream orsomething.
I think it's there and I thinkthat's what it is.
Speaker 1 (18:06):
And if it's?
Speaker 2 (18:07):
not, then I just sound dumb.
But also people say it's likethe best.
Speaker 1 (18:11):
Oh, wow, and we didn't even get the chance to
have like a dessert because wewere so full, which is totally
fine.
We enjoyed a cookie when wecame back.
Speaker 2 (18:22):
We did.
Maybe we'll spend your summerbreak trying a new restaurant
every week.
It's for work technically.
Yeah, it's for the podcast.
It's for the podcast.
Speaker 1 (18:32):
This is not for anything else.
This is academic andexploratory is really what it is
.
All right, I think that'severything on my list.
Is everything on the?
Speaker 2 (18:43):
list.
I think so All right.
Well, let's watch love island.
I have to see why everyone'sbeing mean to our queen amaya.
Oh, poor lady everyone justwants her to win.
Did we talk about this realquick, about love island, that?
not since the last time werecorded um amaya is like the
only one besides jalen becausehe didn't have social media.
(19:05):
She's the only one who, becauseeveryone else like, they go on
love island and then they giveone of their friends their
instagram login so that they canlike, post stuff about it and
like when there's like votingand stuff, so like, all their
instagrams are still active andthen is that how that works?
They'll like repost storiesthat people are posting and like
tagging them in because theydon't have their phones.
Speaker 1 (19:25):
Right.
Speaker 2 (19:25):
One of their friends is doing it and like she's the
only one that hasn't like herInstagram isn't active and she's
like the only one whoeveryone's like.
She's the only one who didn'tgo on there for more followers
and she actually just wants tofind love.
Speaker 1 (19:42):
Oh wow, no kidding, I didn't realize that that was
how that worked.
I was curious how these peopleare.
Yeah, their friends are doingit Okay.
Some of them are in full-onsponsorships already and
advertising for itemsinfluencing Well, some of them.
Speaker 2 (19:58):
So Nick was like I saw him in like a figs ad, like
he was doing like model stuff.
And sierra was like a microinfluencer in like wherever she
lives.
But then she's also fishybecause she's friends with um,
(20:20):
this girl who's like problematic, but then she was like a huge
fan of the show.
She had a love island themedbirthday a couple years ago.
One of her good friends was onit.
It was like a whole thing.
So everyone's like oh, you justcame on here to like which,
honestly, like, if I was tryingto make the trajectory of my
(20:43):
life being an influencer, I willgo on Love Island.
Sure, it doesn't even matterabout the money, cause when you
leave Love Island now you have amillion followers, right, and
like I mean the money from LoveIsland.
It's a hundred thousand dollarssplit between two people, so
you get like 25 grand of that.
You're going to make that in asponsorship, yeah.
Speaker 1 (21:04):
If you have a million followers, you know what
happens after.
Yeah, yeah I, I mean, I don'tbegrudge anyone for, but not our
sweet amaya.
Speaker 2 (21:12):
No, she's just a nurse from new york city
especially this show.
Speaker 1 (21:16):
I mean, like love is blind.
I would feel more strongly likethat one hurts that people go
on there to do the wholeinfluencer life, Like it's not
what it was in the beginningwhere people actually did it.
This one who's actually?
I don't I'm kind of with Maryon this one Like that.
I don't actually think peopleare going on there with the true
(21:38):
intent aside from Amaya andJalen to like find the love of
their life.
Speaker 2 (21:43):
I mean, yeah, no one goes on reality tv to to like
not be in the public eye sure,but like although the people
from season six are like stilltogether and then there's like
tommy and molly from a coupleyears ago.
Speaker 1 (21:56):
You know, but it does .
I feel like it, like it doesbox you into this certain life,
or like you're with these peoplewho have this like
understanding of what you allwent through, which creates this
common ground.
That's very relatable.
It's like going to the samehigh school with someone being
like, oh yeah, I remember when,and then like there's like only
(22:18):
so many memories you havebecause, like, you went to high
school with them and like youcall back on those like, oh yeah
, remember when we were in fiji.
I don't know, but I hear youthough.
No, I'm excited to.
I mean, we'll see what happens.
I'm excited to see why peopleare now trashing her, not our
queen amaya, but sierra oh, I doknow why oh, don't tell me me.
Speaker 2 (22:42):
It doesn't have to have with the can't talk.
It doesn't have anything to dowith last night's episode.
Speaker 1 (22:49):
Oh, it's like outside of all of this.
Speaker 2 (22:51):
They've like discovered something about her.
Yeah, I'll tell you.
I'll tell you offline.
Speaker 1 (22:54):
Okay, all right.
Why don't we dive in?
All right.
So what are we going to talkabout today, nick?
Speaker 2 (23:01):
Today we're talking about something people love
talking about, for sure, ingeneral, which are side effects,
but today we're talking aboutthe side effects of GLP-1
medication.
Speaker 1 (23:14):
That's actually not where I thought you were going
to go with it, but what?
Speaker 2 (23:17):
did you think I was going?
Speaker 1 (23:19):
to say you were going to be like oh yeah, everyone
loves GLP-1s, we're going totalk about them.
Speaker 2 (23:23):
But no, everyone loves GLP-1s.
We're going to talk about them,oh no.
Speaker 1 (23:24):
Everyone loves a side effect they do.
Everyone loves the side effect.
Speaker 2 (23:27):
They love to forget, nobody loves an effect.
They all love the sides.
Speaker 1 (23:31):
Correct you know, yep , no one likes the main dish,
everyone likes the side dish.
Yeah, no-transcript.
(24:06):
So, like Nikki said, we aretalking about these GLP-1
medications and if someonehasn't had the chance to
interact or understand with whatthese medications are, they are
medications that go by thenames of Ozempic, mogovi,
zepbound, moonjaro, and they aremedications that are used to
(24:26):
manage type 2 diabetes andmanage the chronic disease of
obesity.
They also have some otherindications that are being used
far and wide, includingcardiovascular risk reduction,
treatment of sleep apnea, thelist goes on and on.
At this point, what we do knowis that they help lower blood
sugar and they can supportpeople by helping them lose
(24:48):
weight as well, and, as we areseeing more and more, these are
becoming prescribed all the time, all over the place, because
these tend to be very widespreadissues that people deal with,
and so, like you were saying,these medicines have effects.
We were kind of going throughwhat those effects are a little
bit there, but, like allmedicines, they also cause a
(25:11):
side effect, and that's reallywhat we want to get down to the
nitty gritty of today, so we cantalk about them and we can shed
some light, because that, Imean, this is all over the place
.
We've probably spent our mosttime on threads and like this,
they're also entire Facebookgroups of people and the side
(25:32):
effects for GLP-1 medicationsPeople talk about all the time.
Speaker 2 (25:37):
Yeah, they love it.
Speaker 1 (25:39):
They do, can you?
One other disclaimer is thatwe're going to talk about the
most common side effects.
We won't be hitting everysingle side effect that someone
has experienced or discoveredunder the sun.
These are just the mostfrequent ones that come up, and
also things come up more as welearn more about medications and
people are on them for longerperiods of time.
(26:00):
But without further ado, whydon't we get into it and talk
about the most common sideeffects?
Nick, is there a certain classof side effects that come up
most frequently with these meds?
Speaker 2 (26:13):
Yeah, the most common are that I'm sure you've heard
about are the gastrointestinalside effects, and that's because
the GLP-1 medication slows downyour digestion.
And that's because the GLP-1medication slows down your
digestion, which is great forweight loss, but not so much or
not as great for your stomach atfirst.
No-transcript.
Speaker 1 (27:05):
Because that's like how it's working Right.
Yeah, some of it is a lot of.
It is the appetite regulationin the brain.
That happens as thesemedications work and for a
period of time they do slow downthe gastric emptying, but that
eventually goes away.
And so when someone eats a lotof food, really quickly it
distends their stomach and thatcan give the sensation of nausea
.
But those symptoms, right there, are exactly what people may be
experiencing most frequently.
(27:25):
Really quickly, it distendstheir stomach and that can give
the sensation of nausea, butthose symptoms, right there, are
exactly what people may beexperiencing most frequently.
There's also another class.
It's heartburn and acid reflux.
These can be slightly morecommon with these medications.
There are also some types ofbariatric surgery that lead to.
While these are not bariatricsurgery, the types of bariatric
surgery like lead to that.
While these are not bariatricsurgery, the types of bariatric
(27:46):
surgery like a sleevegastrectomy can lead to
increased GERD or acid refluxsymptoms, so those also bother
people.
Their gallbladder problems havebeen described in the literature
.
Specifically gallstones canhappen, especially if you're
losing weight really quickly andthat's just a function of how
your body is changing.
If you go much above the one totwo pounds a week, you can
(28:11):
possibly end up with gallstoneissues.
However, that's relatively rare.
Low blood sugar is somethingthat can happen.
These specific medicationsthemselves aren't branded to
cause hypoglycemia, butoftentimes people are put on
these medications while theymight be on other medications
(28:31):
and those together can cause lowblood sugar or hypoglycemia.
Another side effect peoplemight get isn't related to the
medicine, but it's related tothe way that most of them are
administered, with an injectionsite reaction which can look
like redness, swelling, itchingat the site of injection, and so
basically anytime you putsomething into your body,
(28:53):
there's a chance that it reactsless than ideally.
Even if you're putting a needlethrough your skin, it can
become irritated, and somethingthat we're going to probably
bounce out and do a wholedifferent episode on is that
there is a hint in theliterature that there are some
vision changes that can happenretinopathy.
(29:28):
So we already have it.
Or people who get really quickresolution or correction of
their blood sugar are atincreased risk of developing
some eye problems and, morespecifically, the rapid
correction can maybe worsendiabetic retinopathy.
There is some signal in theliterature that that might
happen, and there is this otherentity that people have probably
(29:49):
seen headlines about callednon-arteritic anterior ischemic
optic neuropathy it was amouthful for me to say too.
It's abbreviated to NAION, andthere also is a small signal
that a lot of ophthalmologicjournals are looking into
(30:10):
thinking do these medicinesincrease the risk of this?
A little bit Right now there'sa signal for it, meaning that
it's something to think about,but the American Diabetes
Association doesn't say this isa reason to not try this
medicine.
But it's something to thinkabout.
But the American DiabetesAssociation doesn't say this is
a reason to not try thismedicine.
But it's something to keep aneye out.
If you have an eye doctor, youshould probably let them know
(30:32):
that you're taking this medicine.
And this is an evolvingsituation, with papers coming
out monthly about what thesethings are.
How should we think about them?
Is there anything else going on?
What these things are, howshould we think about them?
Is there anything else going on?
And for the most part, I meansome things we didn't cover were
(30:52):
like any associated muscle lossthat might happen from taking
these medications, which alsomight just be an effect.
That's something that wealready talked about in a
different episode, so I'm goingto go back and forth Some of the
next part of the episode.
We're going to talk about thereal meat of this.
We talked about what the sideeffects might be we didn't cover
an exhaustive list but we'regoing to talk about how to ease
(31:14):
the side effects or maybe evenprevent them, which will be a
really interesting thing andhelpful for people at home.
I'll start us off here.
So the first thing to do wouldbe to start low and go slow.
There really is no need to rushwith these medicines.
This is the long game You'regoing to.
A gradual dose escalation isthe most favorable way to go.
(31:36):
That's why you see the pace oflike maybe trying out a dose for
a month, but it doesn't evenhave to be that fast, like you
can go longer than that beforeyou go up and your body gets
used to it, so it doesn't haveto be every four weeks.
This is something that's onyour own personal body.
There's a lot of schools ofthought that may invite that you
try to squeeze out everythingyou can out of a certain dose
(31:58):
before going up on the next one,which is something to do.
So if you're thinking aboutZepBound 2.5 milligrams, some
people would say you need to tryto get as much as you can out
of that dose before going up tothe next dose.
Some people try to escalate upand get up as high as they can,
as fast as they can, and thatmay predispose them to having
(32:25):
some side effects.
So the big takeaway there isstart low and go slow.
You don't need to rush.
So the next thing is thinkingabout eating small meals and
slowly eating.
The idea here is that this canhelp with the nausea, maybe some
bloating and feeling overlyfull.
One key piece of it not advice,but key thing to think about
would be to cut the portion sizeof your meal in half
(32:48):
preemptively, so that you aren'tover distending your stomach.
So you see what your plate has.
Cut it in half and that mayhelp stave off some of that
nausea from that over distension.
Something that we think about alot is mindful eating, and by
this I mean like be presentwhile you are eating what you
are eating, because when you'renot, we have a tendency to go
(33:12):
further along than we need to.
Like if I'm standing watchingyou eat soup and I'm shoveling
chips into my mouth and I'm justlike looking at you, like I'm
mindlessly eating.
So when you're trying to dothis, don't eat.
Don't eat while you're likewatching TV, maybe, or don't be
on your phone while you'reeating.
Again, these are all very easythings to say but harder things
(33:33):
to do in practice.
But they could help not toovereat, which can lead to that
nausea and that bloating.
There are some over-the-countermedications and some medications
that may be prescribed fromyour doctor.
It's a reasonable thing tothink about anti-nausea
medicines.
If you're taking your firstcouple doses or you're going up
on the doses and things aren'tgoing your way and you're
(33:56):
feeling nauseous, you can ask.
There are options out therethat might help, and there are
over-the-counter medications foranti-diarrhea as well, so you
can think about those if thesemedications are giving you
diarrhea.
But the good thing is, mostlythe side effects go away.
They should.
They should go away as you'reon a longer period of time.
(34:19):
This next side effect to talkabout, which I was kind of
interested to see, doesn't havea lot of formal literature about
it, but it's something that'spresent online a lot, which are
these sulfur burps, like peopledescribe, like they eat food and
then like for hours laterthey're sitting there and
they're just like burping upwhat smells like rotten eggs.
(34:40):
Yeah, it just seems like areally nasty side effect and I
looked this up and I looked itup in a lot of different ways on
a lot of different tools, andthere isn't a lot of formal
literature out there.
There also isn't.
We think that the idea is thatthere's prolonged digestion
happening when food is sittingin your stomach longer and this
leads of reducing sulfurbyproducts with a medicine very
(35:04):
easily available over thecounter.
Remember what that medicine was?
(35:24):
me yeah, yeah, pepto yeah, whatwould I have?
You know, there's nothing inthe literature about maybe using
pepto for sulfur burpsassociated with glP-1 receptor
agonists.
Speaker 2 (35:40):
Maybe we should do a study on it.
Speaker 1 (35:50):
Right, look into this .
Just recruit a bunch of peoplewho have these self-proclaimed
sulfur burps and say if you tookPepto, did it make you feel
better?
This is a question I have.
So I also incognito went intoone of these Facebook groups to
see if people were out heredoing this and I, like, went
(36:10):
anonymous and I asked thequestion like is anyone out here
using Pepto to manage thesesulfur burps?
And there were a couple ofpeople who were like, yeah, use
Pepto, I've used it and it'shelped and it works yeah.
That's what they've said, so Ithought that was very
interesting.
There's no evidence to backthis up whatsoever, but
(36:31):
something to consider.
Can you take us through?
Speaker 2 (36:42):
a couple of different dietary adjustments or things
we can think about that mighthelp avoid some of these
annoying GI symptoms.
Yep, so not rocket science, butwe're avoiding greasy and spicy
food because that's not goingto make any kind of GI symptom.
You're having better, andhydration is your friend.
Drink lots of water.
Let's be honest.
You're probably not drinkingenough, so start drinking more.
Speaker 1 (37:05):
Yeah, some of my thoughts there are that, like,
greasy and spicy foods bother alot of people anyway, and I
think they end up being peopleend up being more susceptible to
being bothered by those whenthey're on these medications
anyway, and it's like a foodthat already bothers someone is
now extra, making them bothered,and so if you have to avoid
(37:26):
something for a little while,maybe you try to like gently add
it back into your diet.
I really don't like making likebig changes with people where
they're like oh, I have toeliminate this completely, but
it may come to it.
Something that didn't make itto our outline is constipation.
So many people get constipationon here with these medications
(37:47):
and it really invites anopportunity to think about, like
you mentioned, the water andincreasing your fiber intake.
People definitely need way morefiber than they usually are
taking and there's a specificamount of fiber for your body
weight and who you are as aperson.
There are fiber supplements.
Our intern is like gnawing awayat a bone, like this entire
(38:09):
time.
I don't know if it'll be pickedup on the mic, but there are
fiber supplements while you'retrying to get more fiber into
your natural diet because that'smore delicious and more fun and
more inviting.
One other side effect thathappens, and we talked about
vomiting and diarrhea vomitingmainly as a function of nausea,
and so we talked about usingsome medicines.
(38:30):
But one thing to really thinkabout is remaining hydrated in
these moments.
In a few previous episodeswe've talked about having
diarrhea and vomiting beingdangerous, as it relates to your
kidney health, and if youdeplete the volume in your body
enough, then you may harm yourkidney.
So the idea is to remain ashydrated as possible, but also
(38:52):
with electrolytes and more fluidthat looks a little bit more
like the stuff flowing throughour body.
I'm not saying go drink blood,but, like you know, pedialyte
looks more like theconcentration with solute in our
body than water does simplySame thing with Gatorade, too.
Something else to think aboutis GLP-1 receptor agonists and
(39:17):
medications that you're taking.
So if you're taking insulin oryou're taking a medication
called sulfonylurea, it may beworth a conversation with your
doctor to make some doseadjustments to make sure that
you're not getting low bloodsugar, as we talked about.
We said that the GLP-1 receptoragonists don't themselves
(39:38):
typically cause low blood sugar,but they overall lower the tide
and increase the sensitivity toinsulin.
So if you're on insulin, it maybeg that you have a lower dose.
I've also seen it where,separately, outside of diabetes
medicines, blood pressuremedicines may need to be
adjusted.
I have a specific story of agentleman who had sleep apnea
(40:06):
and he lost about 30 pounds onMoonjaro and he also had
hypertension.
He had pretty poorly controlleddiabetes and he was on the
Moonjaro and he was doing reallywell, lost the weight.
He said that his partner waslooking at him when he was
sleeping and that he was likenot stopping breathing as one
would with sleep apnea.
And I would get messages backsaying and we put him on a blood
pressure medicine initially andhe said that like, oh, my blood
(40:30):
pressure is this, I'm feeling alittle dizzy and my blood
pressure is this, and it wasmuch lower than it was ever in
the office.
But that's part and parcel ofthese medicines is that they're
affecting so many different bodysystems where we're treating
his sleep apnea by also treatinghis underlying obesity and his
type two diabetes.
So now that his sleep apnea isbetter, his blood pressure is
(40:52):
better and so that bloodpressure medicine that he was on
because his whole bodycomposition is different now he
may not need it.
So we pulled back on the dose aton and seeing how things go,
but this is also a very realthing.
That happens.
All right, can you take usthrough the next couple of
things?
What can we do to avoidinjection site reactions?
Speaker 2 (41:17):
Well, it makes it more tolerable if you're
rotating the injection site.
So do like your stomach onetime I mean, this is only like a
weekly thing, but it stillhelps like your stomach and then
a leg and then your arm, sothat helps.
Speaker 1 (41:36):
Yeah, that's helpful.
Also good to probably make sureit's clean, right.
Speaker 2 (41:42):
Yeah.
Speaker 1 (41:44):
No, any risk of infection or anything.
Speaker 2 (41:47):
Yeah, basic injection prep things.
So what should someone belooking out for if that rare
gallbladder stuff happens?
Speaker 1 (41:59):
So the gallbladder lives in the right upper
quadrant.
So if you're to kind of touchyourself in your belly, right
there, right under your rib cage, is where the gallbladder lives
, and if you have belly pain inthat area, if you have a fever
or you happen to be noticingyellowing of your eyes or skin,
you should call your doctor andlet them know.
And this is just an FYI aboutwhen to reach out or go present
(42:21):
for some in-person care thatmight be helpful.
A similar thing there has beenexplained that there's some risk
of pancreatitis from thesemedications themselves.
Sometimes that's related to thegallstones in general.
But the word of caution here isto don't overdrink alcohol.
I had one colleague who askedme like oh, this guy was on a
(42:43):
GLP-1 receptor agonist, he wasat his daughter's graduation, he
was having a grand old time,and then he landed in the
hospital because he was drinkinga lot of alcohol that day.
And so they make you moresusceptible to pancreatitis,
this inflammation of thepancreas.
That can be very dangerous andvery painful.
So just be mindful of that whenyou're thinking about those
(43:04):
next steps and things to do orthings to do less of.
Speaker 2 (43:09):
So let's talk about eye health.
Can you remind us what we cando about that?
Can you remind us what we cando about that?
Speaker 1 (43:16):
So if someone has diabetes, they should be getting
yearly eye exams with an eyedoctor, and so this becomes way
more important when people areon these medications, because if
you have pre-existing diabeticretinopathy, you should be
getting them checked regularly.
So there's no pun intended here, but just keep an eye out for
(43:38):
vision changes.
There is a signal in theliterature that there is
possible worsening of a fewdifferent ones, like diabetic
retinopathy, maybe some signalof worsening macular
degeneration or some worseningof this NAIO.
The goal of this is to not getyou to understand the inner
(43:59):
workings of our very complicatedoptic system, but maybe you
should have a relationship withan eye doctor.
Maybe you ask your doctor aboutthat, especially if you're on
this for diabetes management,and if you have any vision
changes, ask.
That's all it is.
It's something to think about,something to keep to look out
(44:25):
for, and one last side effectthat we're going to cover here
today is something that isn'tdescribed in the literature
significantly right now, but Iexpect it to be.
Is this side effect ofanhedonia or this just feeling
of blah?
I don't want to do anything,and it's been described with
these medicines.
If anyone was to go online oryou're to ask a few people, they
(44:46):
might just feel well.
I think it has some somethingto do with like how, like the
appetite regulation and thepleasure system in the brain is
working, not necessarily theamount of calories that you're
like taking in.
That may invite thinking aboutthe dose that you're currently
on, and is it too high, orshould we go down a dose?
(45:07):
Or is there another medicinethat might be able to help you
in these times?
And all I'm saying there isjust, keep an open mind.
If you're listening to this andyou're like, oh, I might
actually feel some of that, askBecause it's out there, it's a
real thing, it's being figuredout.
Some of this comes up in timeand then more research needs to
be done to figure this stuff out.
So if you do feel this way,think twice and maybe just reach
(45:30):
out and ask for help, becauseit is a real thing, you're not
crazy, all right.
And so in this last little bitwe're just going to do a couple
highlights about when you shouldreach out.
If you have severe, persistentnausea or vomiting, you should
probably reach out because maybesomething needs to change.
If you have signs ofpancreatitis, which is a belly
pain in the upper belly thatshoots to the back, maybe you
(45:52):
should probably reach out.
If you're having thosegallbladder symptoms that you're
thinking about in that rightupper quadrant of your belly,
maybe you should reach out forhelp.
If you're having vision changes, you should probably reach out
for help, and anything thatfeels unusual to you or doesn't
improve over time is probablysomething that you should reach
(46:15):
and ask for help.
But overall, most side effectsdo improve over time, which is
great news.
These medications remainpowerful tools for your health,
but there are risks and benefitsto various different things and
everything we do practically.
So thank you for coming back toanother episode of your Checkup
.
Hopefully you were able tolearn something for yourself, a
(46:36):
loved one or a neighbor withside effects.
You can send us an email atyourcheckuppod at gmailcom.
You can visit our Instagram orour website and make sure that
you follow the show so that yousee when other episodes come out
.
They come out weekly on Mondays.
And, most importantly, stayhealthy, my friends, until next
(46:56):
time.
I'm Ed Dolesky.
I'm Nicola.
Rufo Thank you and goodbye.
Speaker 2 (46:59):
Bye.
Speaker 1 (47:10):
This information may provide a brief overview of
diagnosis, treatment andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
(47:31):
Thank you.
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
You.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine doctor in the
Philadelphia area.
Speaker 2 (00:23):
And I'm Nicole Ruffo.
I'm a nurse.
Speaker 1 (00:25):
And we are so excited you were able to join us here
again today.
As promised on the last episode, we did watch the poop cruise.
Speaker 2 (00:35):
Yeah, we did.
Speaker 1 (00:36):
We did.
What did you think?
Speaker 2 (00:39):
Um, what did?
I think Everyone was kind ofweird that they interviewed.
Am I allowed to say that?
Yeah, you're out to say thatyou're all weird and I mean, is
pooping in a red bag really thatawful?
Thank you yeah, I feel likeit's not thank you.
Speaker 1 (01:01):
I, that's really where I like came to it, like
you're on a floating vessel foranyone who, like isn't gonna
watch this but is curious tocatch up.
Um, there were these peoplethat left from like in the gulf
of mexico.
They left from somewhere Idon't know.
They were on a cruise galvestonmaybe and they left on a cruise
it was carnival cruise and theywent over to mexico, stayed
(01:23):
there for a day or two and thencame back and, like the engine
caught on fire and then led toseveral different like power
problems throughout the ship,including the toilets, and they
were out there for like a weekor so and so there were like no
working toilets and they had to.
Like the people on the boatwere like, oh, you need to poop
(01:45):
in these red bags he's likebiohazard bags and then we'll
dispose of them and, like somepeople just like refused to do
that and then they pooped in theplumbing and like wouldn't you
know what happened?
it overflowed like well, likewe're talking like that, like I
don't know if they were close topassing away or this was close
(02:06):
to being like a really, reallybig tragedy.
Get over yourself.
Speaker 2 (02:11):
Poop in the bag, come on in the bag.
Poop in the bag, I mean peoplepoop on our street.
Speaker 1 (02:15):
So Excellent point, yeah, so I couldn't help.
But like it was then, like thetugboat came along and changed
the angle of the cruise, thatwas sick, that actually was
sickening.
So, with all these peoplepooping and peeing in the like
not functioning plumbing, whenthe ship tilted a little bit, so
did, like its equilibrium andall of the, the contents, the
(02:39):
contents, if you like.
Pick up what I'm putting down,smelling what I'm stepping in.
Speaker 2 (02:44):
Yeah, that was gross.
I don't think I like needed anymore endorsement to not go on a
cruise, because I just don'tthink that's for me.
Speaker 1 (02:57):
They tend to look very crowded.
Speaker 2 (02:59):
Yeah, I feel like claustrophobic thinking about
them.
Yeah, like all those people ona boat, and then you're just
stuck in the middle of the ocean.
Speaker 1 (03:08):
It does seem like a lot.
Yeah Right, I'm like, and thenthere are always something to do
.
It seems like touch land.
Speaker 2 (03:13):
I mean I know you like get off and like do things
and then get back on, but Idon't know, I don't think it's
for me.
Speaker 1 (03:19):
Maybe it's not, so if you're curious what we're
talking about here, maybe you gocheck it out.
It's on Netflix the poop cruise.
Yeah, I can't help but thinkthat this ties in well to what's
happening in Center City.
Speaker 2 (03:33):
Center City, actually all of Philadelphia, has turned
into a poop cruise Because whatare they called District 33.
The union is on strike and partof that union includes all of
the sanitation workers.
So there is no trash collectionin Philadelphia.
And it's been three days, twodays.
Speaker 1 (03:58):
I actually think today was the first day that
there would have been trashcollection, but like the word's
been out there that this hasbeen happening since like
tuesday at midnight or so, andno tuesday, because over that
way their trash is on tuesday oh, oh, yeah.
So then this has been happeningsince then.
(04:18):
Yeah, it's, it's not bad yet.
Um, there were definitely somepeople who didn't get the get
the word, so they put out theirstuff yeah, I'm wondering how
long it's going to be on our.
Speaker 2 (04:28):
It's like we're, we're like our house is on the
corner.
Yeah, so that's where they puttheir trash.
Speaker 1 (04:33):
So I wonder how long it's going to be sitting in
front of our house for probablyum, if there was any excuse to
get out of the city um we'releaving promptly after work
tomorrow 20 hours from now.
Speaker 2 (04:47):
Um from the time this time tomorrow we'll be at the
beach.
Yeah, I will be settled intothe beach.
Speaker 1 (04:53):
It's late, it's already 8 30 yeah, I, I hope
they figure this out.
I hope that, like, by the timethis comes out, they like have
this settled already.
Um, they have an alternativesetup for anyone wondering like,
what will they do?
Speaker 2 (05:09):
like they're apparently like several
different places to go drop yourstuff off yeah, I don't know if
that's getting collected,because it looks like it's all
just sitting there yeah, ifthere was an opportunistic waste
management group, likeprivately that wanted to rake it
in.
I don't know who's going to payyou, but no, I don't either.
Bill the mayor.
Speaker 1 (05:30):
It's her fault.
You could probably get thelocals to pitch in to a private
fund of all the people on anystreet that you can get them to
just come by and do it.
Maybe they would do that.
Speaker 2 (05:43):
I think that would be a prime business opportunity
we'll see what it's like when wecome back after oh, the fourth
of july.
Speaker 1 (05:49):
That was gonna be awful but for the moment you've
been waiting for where did yougo?
Because we left them off on acliffhanger last week.
We're gonna get into our dinnerreview, uh, part of the episode
here before we break into themeaty part of the side effect
episode of glp ones.
Where did I take you for dinner?
Speaker 2 (06:09):
we went to kaleia, which is a thai restaurant, and
it was I feel like we say thisevery time we go somewhere it
was like one of my favoritedinners we've ever had.
It's up there with saraya andthey're in the same actually.
Soraya and they're in the sameactually end picnic and they're
in the same group, which I thinkwe talked about last week.
(06:29):
But whatever they got going onat what is it?
Divine hospitality?
Speaker 1 (06:34):
Is that?
Speaker 2 (06:35):
what it's called.
Whatever they have going onthere Like.
Speaker 1 (06:38):
I love it.
They're winning, it's for us.
Speaker 2 (06:40):
And the um, I don't know who she was.
She was like the HBIC of therestaurant and she kind of
reminded me of the grandmotherfrom Crazy Rich Asians.
She gave that energy and shewas just like walking around, I
don't know.
She was like the owner.
Speaker 1 (06:57):
Yeah, I think she was the owner of the chef, because
like when you, when they cameout with the bill and you
flipped it over, it was like apicture, yeah out with the bill
and you flipped it over.
Speaker 2 (07:07):
It was like a picture , yeah, and like the menu was,
it was all inspired by placeswhere, like the main chef's
grandmother or mother was fromin thailand.
So I wonder who that was.
Speaker 1 (07:15):
But that's always like a nice touch when, like the
owner or like oh my god someonelike because she was like
thanks for coming in right, likegoing around to everyone, like
seeing how everything was.
Speaker 2 (07:26):
Yeah because that's what?
Um, when we were in ashville,when we went to curate the oh, I
forget her name that the likechef owner person like was like
going around to everyone ohreally yeah, don't you remember
no, this was like that was soearly on in, like the restaurant
experience, like going to thisplace and he's never been to a
(07:47):
restaurant, no, butno, but like I now, having lived
here, yeah, because rememberthat restaurant like won some
award or like she won somethingspecifically and I only knew
that because I was like lookingup on their instagram and stuff
before, and then I was like ohmy god, that's her.
Speaker 1 (08:02):
And she just like thanked us for coming in yeah,
no, I that was so early on in mylike lived experience of
enjoying food like this so therewas no way that I remembered
that I would love to go back andto like relook at the menu and
take a different perspective.
But to bring it back to kalea.
Our server was great, he wasawesome.
(08:23):
Michael michael was awesome,very warm welcoming.
As soon as you sat down youwent in big space, big like,
bright space, lots of windows.
I tried to deke you out alittle bit and make you think
that we weren't going there bylike.
Speaker 2 (08:36):
I knew exactly where we were going when you said one
thing.
I know, you picked me up fromwork and I was like okay, so
like what time do we need to beready to go?
And you like said the time andyou're like, yeah, you know,
give us time to like get upthere and get parking.
So you said get up there andthere there are like two places
up there that we haven't been.
(08:58):
The only thing I knew is thatwe haven't been to this
restaurant, that we haven't been, that we've talked about and
that we've wanted to try I knowI was like oh my god, are we
going to kalaya?
Speaker 1 (09:06):
there's like no way to get.
Speaker 2 (09:07):
Can you try to play it off?
Speaker 1 (09:08):
I did.
I was like trying so hard andlike I I'm so impressed that you
can just like snap it out ofthin air and just like find
where we're gonna go.
It's.
It's a little demoralizing totruly like surprise you, um, but
all in all, terrific.
So the very bright and openthey were all like bright-eyed
(09:29):
and bushy tail when you walk inum, sit down very cozy and you
know, nice tap water.
Tap water was great, um, butlet's get into it, I mean.
So the beverages were delicious.
We've gotten some comments thatwe talked too much about
beverages here, so we'll leaveit at that.
Speaker 2 (09:48):
Yeah.
Speaker 1 (09:49):
Um, but the take me through your feelings on the
dumplings cause.
It's only going to go up fromhere.
Speaker 2 (09:55):
Yeah, we got some sort of like dumpling.
What was it?
It was a chicken.
It was like a little spice.
They were blue.
That was interesting.
Yes, they were tasty.
Speaker 1 (10:05):
Super tasty, glad we did it.
Speaker 2 (10:07):
Yeah, they had a couple other like dumpling
things that we probably will tryagain.
Yeah, but they were good.
And then the appetizers we got.
Oh, here we go.
Well, first it was this likecoconut rice something.
Speaker 1 (10:24):
Which was great.
I don't know, it was delicious.
Speaker 2 (10:27):
I loved it.
And then the best appetizer,which was probably our favorite
thing.
What was actually?
I'm going to pull up the menu.
Speaker 1 (10:36):
Give them credit so that they can find it if they're
going to go.
Speaker 2 (10:39):
I haven't ever had anything like this.
It was the best thing.
I would go back, kalaya oh myGod, am I okay, kalaya?
Ever had anything like this?
It was the best thing.
Like I would go back.
Wait, kalaya, oh my god, am Iokay, kalaya?
Um, I would go back just forthis appetizer.
Speaker 1 (10:58):
Okay, menu, so, and then, if you can, leave that up
so that we can talk about it,not just butcher these names um,
oh, here it is.
Speaker 2 (11:10):
Okay, I don't know how you pronounce it.
It's the first appetizer on themenu.
It's crispy, garlic, chive ricecakes with a spicy, sweet soy
sauce.
So we saw rice cake and wethought it was going to be like
a thin, crispy situation thatyou like put soy sauce on, which
also sounds good.
(11:31):
But this crunch it was like abrick.
It was like three square bricks, crispy on the outside, and
then you, I don't know what'sinside there was some like
spinach, something happening itwas like sounds gross, it was
delicious, it did not taste likespinach and it was like gooey
in the middle, and then you putthis soy sauce on it.
Speaker 1 (11:52):
It was the best soy sauce that was just like spicy
sweet soy sauce.
Speaker 2 (11:56):
I don't know what's in it, but it was not your
average soy sauce.
It was delicious and it was ohmy god, it's so good yeah, I
would go back for that, likethat has to be on the thing when
you go there yeah that, likeyou got to try it.
Speaker 1 (12:10):
That was amazing.
Speaker 2 (12:10):
I loved that and I mean, that was just the
beginning, yeah they do have atasting menu, which we we
typically love a tasting menu.
We just decided not to do itthis time because there were
things off of the tasting menuthat we wanted to get more, yeah
, so we just like did that, butthe tasting menu also looked
(12:31):
good and the people next to usoh, yeah, yeah.
We're like interruption of thereview here for this I just like
, sometimes I'm like you, justlike, don't know how to act in
public to people and like they,the royal, you right.
Speaker 1 (12:46):
The royal, you, yeah, yeah.
Speaker 2 (12:49):
People and okay, like tasting menus.
Sometimes on a tasting menu youyou get the options of like
pick from this, like thissection, this section and this
section.
This tasting menu was set andlike this is what you got on the
tasting menu.
And then people next to us arelike I don't eat beans, can I
sub this with this?
(13:10):
And they're subbing like fourout of the seven things on the
tasting menu.
Like what?
Speaker 1 (13:15):
Yeah.
Speaker 2 (13:15):
Just order off the menu.
That's not like.
The tasting menu is curated,like by the people for a reason.
That's what it's for Yeah'swhat it's for.
Speaker 1 (13:25):
Yeah, like, if you're gonna.
Speaker 2 (13:26):
If you're gonna order whatever you're gonna order,
just you should probably justorder your own dish.
Speaker 1 (13:32):
I get it like one off or asking yeah, they went in a
couple times.
Speaker 2 (13:38):
I don't eat this, I don't eat beans, I don't eat
this.
Okay, maybe you should go to adifferent restaurant it was the
tone of the delivery too.
Speaker 1 (13:45):
It was.
Michael was very gracious.
Speaker 2 (13:48):
And Michael had to wait on them too.
He did.
Speaker 1 (13:51):
Look it was.
There are people with dietaryrestrictions out there and, like
you know, they want to go onthe tasting menu too.
But there was the delivery andthe like going in multiple times
.
Dip in like.
Can I change four out of theseven?
It's a little too much.
Speaker 2 (14:11):
Okay, back to our full food review.
So then we got a curry.
That was also so good.
Speaker 1 (14:19):
So delicious.
Speaker 2 (14:20):
It was the yellow curry with chicken, and then
served with something else thatI can't pronounce and the like
coconut turmeric rice.
This, that rice, was so goodtoo.
Speaker 1 (14:32):
I mean, I didn't know rice could be like different
and amazing, but it was.
I loved how she like invited usto be like.
Oh, do you want to like knowhow you should eat this Please?
Speaker 2 (14:42):
Yeah, there's a whole experience to putting it
together with the rice and thenthey give you a boiled egg and
you like crush that egg downcrush the egg into the rice and
then you put the chicken andthen like the curry over it.
Wow, it was so good it was alittle spicy.
Speaker 1 (14:57):
It was like the medium spice option on the menu.
It seems it was pretty spicy.
Um, so just be mindful of thatif you're gonna go.
It was, I can't stop thinkingabout it.
And the chicken two restaurantsin a row with chicken, I know
um, amazing.
Uh, it was delicious.
We meant to go there withkarthik and mike.
Speaker 2 (15:16):
Um, at an I have to say, mike, if you're listening
to this in your basement doingbasement things, I'm I think you
would enjoy it.
However, I'm so happy eddie didnot go with you and karthik to
kalaya, so I could enjoy it.
Speaker 1 (15:32):
Yeah, that would have been a tough one to come back
from, because you went to laserwolf and then they gave me some
like reviews and like it.
Speaker 2 (15:38):
We aren't jumping to go there, it sounds like it was
great, but like this one wasbetter than laser well, I would
have felt guilty coming backafter this.
Speaker 1 (15:48):
Yeah, that was, that was something.
Do you have any more love notesfor the yellow curry chicken?
Speaker 2 (15:53):
no, all around 10 out of 10.
And then we got whateverthey're, like crab fried rices,
which I think is like a popularmenu item it seemed that was
also delicious.
Oh, did you eat that today?
Speaker 1 (16:07):
no, we still haven't.
It seems a little misleadingbecause it's like written as
colossal crab, and maybe that'sjust me like.
Maybe colossal crab meanssomething else than a giant hunk
of crab.
It was absolutely delicious.
I have no notes on it.
Speaker 2 (16:23):
I can't make anything like that I feel like I don't
know everything we got.
I would maybe get a differentdumpling just to try another one
.
Yeah, but everything I wouldjust order that same thing.
Speaker 1 (16:34):
I think I may I may be interested in trying, because
I'm really happy we got thatcoconut rice and then now
knowing that there was rice thatcame with the curry chicken,
like I may, we did have a lot ofrice, there's a lot of rice and
then now, knowing that therewas rice that came with the
curry chicken, like I may.
Speaker 2 (16:46):
We did have a lot of rice.
Speaker 1 (16:48):
There's a lot of rice and I may explore different
options, but that was just likeout of this world.
Somehow it always feels like asuperlative comes out of these
meals, which really just makesme feel amazing about the city
of Philadelphia and like comingin here nearly four years ago
being like oh yeah, the foodscene is great is what they say?
Speaker 2 (17:12):
no, it really no it truly is.
Speaker 1 (17:15):
It is truly great.
Speaker 2 (17:17):
I know every.
I was saying this to you lastnight when we left.
Speaker 1 (17:19):
Like every time we go somewhere, there's always
something that's like the bestthing we've ever had, like the
crispy rice cakes, like bestthing we've ever had yeah, I
like, I mean, and then, howoften do you like these are
experiences that like we feelcompelled to talk about and
remember, and you know, I thinkwe do a great job of keeping
(17:39):
pace and trying to like exploreand do new things, but like it's
, I mean, there's a lot of themtoo.
Like we got to go to pizzeriabadia.
Same like yeah, that's on thelist that like does all of this
stuff.
Speaker 2 (17:51):
So like I'm gearing up for what may be the best
pizza of my life I think theyalso have people say I think
it's there, I have to check, butI think they have this like
sweet cream, ice cream orsomething.
I think it's there and I thinkthat's what it is.
Speaker 1 (18:06):
And if it's?
Speaker 2 (18:07):
not, then I just sound dumb.
But also people say it's likethe best.
Speaker 1 (18:11):
Oh, wow, and we didn't even get the chance to
have like a dessert because wewere so full, which is totally
fine.
We enjoyed a cookie when wecame back.
Speaker 2 (18:22):
We did.
Maybe we'll spend your summerbreak trying a new restaurant
every week.
It's for work technically.
Yeah, it's for the podcast.
It's for the podcast.
Speaker 1 (18:32):
This is not for anything else.
This is academic andexploratory is really what it is
.
All right, I think that'severything on my list.
Is everything on the?
Speaker 2 (18:43):
list.
I think so All right.
Well, let's watch love island.
I have to see why everyone'sbeing mean to our queen amaya.
Oh, poor lady everyone justwants her to win.
Did we talk about this realquick, about love island, that?
not since the last time werecorded um amaya is like the
only one besides jalen becausehe didn't have social media.
(19:05):
She's the only one who, becauseeveryone else like, they go on
love island and then they giveone of their friends their
instagram login so that they canlike, post stuff about it and
like when there's like votingand stuff, so like, all their
instagrams are still active andthen is that how that works?
They'll like repost storiesthat people are posting and like
tagging them in because theydon't have their phones.
Speaker 1 (19:25):
Right.
Speaker 2 (19:25):
One of their friends is doing it and like she's the
only one that hasn't like herInstagram isn't active and she's
like the only one whoeveryone's like.
She's the only one who didn'tgo on there for more followers
and she actually just wants tofind love.
Speaker 1 (19:42):
Oh wow, no kidding, I didn't realize that that was
how that worked.
I was curious how these peopleare.
Yeah, their friends are doingit Okay.
Some of them are in full-onsponsorships already and
advertising for itemsinfluencing Well, some of them.
Speaker 2 (19:58):
So Nick was like I saw him in like a figs ad, like
he was doing like model stuff.
And sierra was like a microinfluencer in like wherever she
lives.
But then she's also fishybecause she's friends with um,
(20:20):
this girl who's like problematic, but then she was like a huge
fan of the show.
She had a love island themedbirthday a couple years ago.
One of her good friends was onit.
It was like a whole thing.
So everyone's like oh, you justcame on here to like which,
honestly, like, if I was tryingto make the trajectory of my
(20:43):
life being an influencer, I willgo on Love Island.
Sure, it doesn't even matterabout the money, cause when you
leave Love Island now you have amillion followers, right, and
like I mean the money from LoveIsland.
It's a hundred thousand dollarssplit between two people, so
you get like 25 grand of that.
You're going to make that in asponsorship, yeah.
Speaker 1 (21:04):
If you have a million followers, you know what
happens after.
Yeah, yeah I, I mean, I don'tbegrudge anyone for, but not our
sweet amaya.
Speaker 2 (21:12):
No, she's just a nurse from new york city
especially this show.
Speaker 1 (21:16):
I mean, like love is blind.
I would feel more strongly likethat one hurts that people go
on there to do the wholeinfluencer life, Like it's not
what it was in the beginningwhere people actually did it.
This one who's actually?
I don't I'm kind of with Maryon this one Like that.
I don't actually think peopleare going on there with the true
(21:38):
intent aside from Amaya andJalen to like find the love of
their life.
Speaker 2 (21:43):
I mean, yeah, no one goes on reality tv to to like
not be in the public eye sure,but like although the people
from season six are like stilltogether and then there's like
tommy and molly from a coupleyears ago.
Speaker 1 (21:56):
You know, but it does .
I feel like it, like it doesbox you into this certain life,
or like you're with these peoplewho have this like
understanding of what you allwent through, which creates this
common ground.
That's very relatable.
It's like going to the samehigh school with someone being
like, oh yeah, I remember when,and then like there's like only
(22:18):
so many memories you havebecause, like, you went to high
school with them and like youcall back on those like, oh yeah
, remember when we were in fiji.
I don't know, but I hear youthough.
No, I'm excited to.
I mean, we'll see what happens.
I'm excited to see why peopleare now trashing her, not our
queen amaya, but sierra oh, I doknow why oh, don't tell me me.
Speaker 2 (22:42):
It doesn't have to have with the can't talk.
It doesn't have anything to dowith last night's episode.
Speaker 1 (22:49):
Oh, it's like outside of all of this.
Speaker 2 (22:51):
They've like discovered something about her.
Yeah, I'll tell you.
I'll tell you offline.
Speaker 1 (22:54):
Okay, all right.
Why don't we dive in?
All right.
So what are we going to talkabout today, nick?
Speaker 2 (23:01):
Today we're talking about something people love
talking about, for sure, ingeneral, which are side effects,
but today we're talking aboutthe side effects of GLP-1
medication.
Speaker 1 (23:14):
That's actually not where I thought you were going
to go with it, but what?
Speaker 2 (23:17):
did you think I was going?
Speaker 1 (23:19):
to say you were going to be like oh yeah, everyone
loves GLP-1s, we're going totalk about them.
Speaker 2 (23:23):
But no, everyone loves GLP-1s.
We're going to talk about them,oh no.
Speaker 1 (23:24):
Everyone loves a side effect they do.
Everyone loves the side effect.
Speaker 2 (23:27):
They love to forget, nobody loves an effect.
They all love the sides.
Speaker 1 (23:31):
Correct you know, yep , no one likes the main dish,
everyone likes the side dish.
Yeah, no-transcript.
(24:06):
So, like Nikki said, we aretalking about these GLP-1
medications and if someonehasn't had the chance to
interact or understand with whatthese medications are, they are
medications that go by thenames of Ozempic, mogovi,
zepbound, moonjaro, and they aremedications that are used to
(24:26):
manage type 2 diabetes andmanage the chronic disease of
obesity.
They also have some otherindications that are being used
far and wide, includingcardiovascular risk reduction,
treatment of sleep apnea, thelist goes on and on.
At this point, what we do knowis that they help lower blood
sugar and they can supportpeople by helping them lose
(24:48):
weight as well, and, as we areseeing more and more, these are
becoming prescribed all the time, all over the place, because
these tend to be very widespreadissues that people deal with,
and so, like you were saying,these medicines have effects.
We were kind of going throughwhat those effects are a little
bit there, but, like allmedicines, they also cause a
(25:11):
side effect, and that's reallywhat we want to get down to the
nitty gritty of today, so we cantalk about them and we can shed
some light, because that, Imean, this is all over the place
.
We've probably spent our mosttime on threads and like this,
they're also entire Facebookgroups of people and the side
(25:32):
effects for GLP-1 medicationsPeople talk about all the time.
Speaker 2 (25:37):
Yeah, they love it.
Speaker 1 (25:39):
They do, can you?
One other disclaimer is thatwe're going to talk about the
most common side effects.
We won't be hitting everysingle side effect that someone
has experienced or discoveredunder the sun.
These are just the mostfrequent ones that come up, and
also things come up more as welearn more about medications and
people are on them for longerperiods of time.
(26:00):
But without further ado, whydon't we get into it and talk
about the most common sideeffects?
Nick, is there a certain classof side effects that come up
most frequently with these meds?
Speaker 2 (26:13):
Yeah, the most common are that I'm sure you've heard
about are the gastrointestinalside effects, and that's because
the GLP-1 medication slows downyour digestion.
And that's because the GLP-1medication slows down your
digestion, which is great forweight loss, but not so much or
not as great for your stomach atfirst.
No-transcript.
Speaker 1 (27:05):
Because that's like how it's working Right.
Yeah, some of it is a lot of.
It is the appetite regulationin the brain.
That happens as thesemedications work and for a
period of time they do slow downthe gastric emptying, but that
eventually goes away.
And so when someone eats a lotof food, really quickly it
distends their stomach and thatcan give the sensation of nausea
.
But those symptoms, right there, are exactly what people may be
experiencing most frequently.
(27:25):
Really quickly, it distendstheir stomach and that can give
the sensation of nausea, butthose symptoms, right there, are
exactly what people may beexperiencing most frequently.
There's also another class.
It's heartburn and acid reflux.
These can be slightly morecommon with these medications.
There are also some types ofbariatric surgery that lead to.
While these are not bariatricsurgery, the types of bariatric
surgery like lead to that.
While these are not bariatricsurgery, the types of bariatric
(27:46):
surgery like a sleevegastrectomy can lead to
increased GERD or acid refluxsymptoms, so those also bother
people.
Their gallbladder problems havebeen described in the literature
.
Specifically gallstones canhappen, especially if you're
losing weight really quickly andthat's just a function of how
your body is changing.
If you go much above the one totwo pounds a week, you can
(28:11):
possibly end up with gallstoneissues.
However, that's relatively rare.
Low blood sugar is somethingthat can happen.
These specific medicationsthemselves aren't branded to
cause hypoglycemia, butoftentimes people are put on
these medications while theymight be on other medications
(28:31):
and those together can cause lowblood sugar or hypoglycemia.
Another side effect peoplemight get isn't related to the
medicine, but it's related tothe way that most of them are
administered, with an injectionsite reaction which can look
like redness, swelling, itchingat the site of injection, and so
basically anytime you putsomething into your body,
(28:53):
there's a chance that it reactsless than ideally.
Even if you're putting a needlethrough your skin, it can
become irritated, and somethingthat we're going to probably
bounce out and do a wholedifferent episode on is that
there is a hint in theliterature that there are some
vision changes that can happenretinopathy.
(29:28):
So we already have it.
Or people who get really quickresolution or correction of
their blood sugar are atincreased risk of developing
some eye problems and, morespecifically, the rapid
correction can maybe worsendiabetic retinopathy.
There is some signal in theliterature that that might
happen, and there is this otherentity that people have probably
(29:49):
seen headlines about callednon-arteritic anterior ischemic
optic neuropathy it was amouthful for me to say too.
It's abbreviated to NAION, andthere also is a small signal
that a lot of ophthalmologicjournals are looking into
(30:10):
thinking do these medicinesincrease the risk of this?
A little bit Right now there'sa signal for it, meaning that
it's something to think about,but the American Diabetes
Association doesn't say this isa reason to not try this
medicine.
But it's something to thinkabout.
But the American DiabetesAssociation doesn't say this is
a reason to not try thismedicine.
But it's something to keep aneye out.
If you have an eye doctor, youshould probably let them know
(30:32):
that you're taking this medicine.
And this is an evolvingsituation, with papers coming
out monthly about what thesethings are.
How should we think about them?
Is there anything else going on?
What these things are, howshould we think about them?
Is there anything else going on?
And for the most part, I meansome things we didn't cover were
(30:52):
like any associated muscle lossthat might happen from taking
these medications, which alsomight just be an effect.
That's something that wealready talked about in a
different episode, so I'm goingto go back and forth Some of the
next part of the episode.
We're going to talk about thereal meat of this.
We talked about what the sideeffects might be we didn't cover
an exhaustive list but we'regoing to talk about how to ease
(31:14):
the side effects or maybe evenprevent them, which will be a
really interesting thing andhelpful for people at home.
I'll start us off here.
So the first thing to do wouldbe to start low and go slow.
There really is no need to rushwith these medicines.
This is the long game You'regoing to.
A gradual dose escalation isthe most favorable way to go.
(31:36):
That's why you see the pace oflike maybe trying out a dose for
a month, but it doesn't evenhave to be that fast, like you
can go longer than that beforeyou go up and your body gets
used to it, so it doesn't haveto be every four weeks.
This is something that's onyour own personal body.
There's a lot of schools ofthought that may invite that you
try to squeeze out everythingyou can out of a certain dose
(31:58):
before going up on the next one,which is something to do.
So if you're thinking aboutZepBound 2.5 milligrams, some
people would say you need to tryto get as much as you can out
of that dose before going up tothe next dose.
Some people try to escalate upand get up as high as they can,
as fast as they can, and thatmay predispose them to having
(32:25):
some side effects.
So the big takeaway there isstart low and go slow.
You don't need to rush.
So the next thing is thinkingabout eating small meals and
slowly eating.
The idea here is that this canhelp with the nausea, maybe some
bloating and feeling overlyfull.
One key piece of it not advice,but key thing to think about
would be to cut the portion sizeof your meal in half
(32:48):
preemptively, so that you aren'tover distending your stomach.
So you see what your plate has.
Cut it in half and that mayhelp stave off some of that
nausea from that over distension.
Something that we think about alot is mindful eating, and by
this I mean like be presentwhile you are eating what you
are eating, because when you'renot, we have a tendency to go
(33:12):
further along than we need to.
Like if I'm standing watchingyou eat soup and I'm shoveling
chips into my mouth and I'm justlike looking at you, like I'm
mindlessly eating.
So when you're trying to dothis, don't eat.
Don't eat while you're likewatching TV, maybe, or don't be
on your phone while you'reeating.
Again, these are all very easythings to say but harder things
(33:33):
to do in practice.
But they could help not toovereat, which can lead to that
nausea and that bloating.
There are some over-the-countermedications and some medications
that may be prescribed fromyour doctor.
It's a reasonable thing tothink about anti-nausea
medicines.
If you're taking your firstcouple doses or you're going up
on the doses and things aren'tgoing your way and you're
(33:56):
feeling nauseous, you can ask.
There are options out therethat might help, and there are
over-the-counter medications foranti-diarrhea as well, so you
can think about those if thesemedications are giving you
diarrhea.
But the good thing is, mostlythe side effects go away.
They should.
They should go away as you'reon a longer period of time.
(34:19):
This next side effect to talkabout, which I was kind of
interested to see, doesn't havea lot of formal literature about
it, but it's something that'spresent online a lot, which are
these sulfur burps, like peopledescribe, like they eat food and
then like for hours laterthey're sitting there and
they're just like burping upwhat smells like rotten eggs.
(34:40):
Yeah, it just seems like areally nasty side effect and I
looked this up and I looked itup in a lot of different ways on
a lot of different tools, andthere isn't a lot of formal
literature out there.
There also isn't.
We think that the idea is thatthere's prolonged digestion
happening when food is sittingin your stomach longer and this
leads of reducing sulfurbyproducts with a medicine very
(35:04):
easily available over thecounter.
Remember what that medicine was?
(35:24):
me yeah, yeah, pepto yeah, whatwould I have?
You know, there's nothing inthe literature about maybe using
pepto for sulfur burpsassociated with glP-1 receptor
agonists.
Speaker 2 (35:40):
Maybe we should do a study on it.
Speaker 1 (35:50):
Right, look into this .
Just recruit a bunch of peoplewho have these self-proclaimed
sulfur burps and say if you tookPepto, did it make you feel
better?
This is a question I have.
So I also incognito went intoone of these Facebook groups to
see if people were out heredoing this and I, like, went
(36:10):
anonymous and I asked thequestion like is anyone out here
using Pepto to manage thesesulfur burps?
And there were a couple ofpeople who were like, yeah, use
Pepto, I've used it and it'shelped and it works yeah.
That's what they've said, so Ithought that was very
interesting.
There's no evidence to backthis up whatsoever, but
(36:31):
something to consider.
Can you take us through?
Speaker 2 (36:42):
a couple of different dietary adjustments or things
we can think about that mighthelp avoid some of these
annoying GI symptoms.
Yep, so not rocket science, butwe're avoiding greasy and spicy
food because that's not goingto make any kind of GI symptom.
You're having better, andhydration is your friend.
Drink lots of water.
Let's be honest.
You're probably not drinkingenough, so start drinking more.
Speaker 1 (37:05):
Yeah, some of my thoughts there are that, like,
greasy and spicy foods bother alot of people anyway, and I
think they end up being peopleend up being more susceptible to
being bothered by those whenthey're on these medications
anyway, and it's like a foodthat already bothers someone is
now extra, making them bothered,and so if you have to avoid
(37:26):
something for a little while,maybe you try to like gently add
it back into your diet.
I really don't like making likebig changes with people where
they're like oh, I have toeliminate this completely, but
it may come to it.
Something that didn't make itto our outline is constipation.
So many people get constipationon here with these medications
(37:47):
and it really invites anopportunity to think about, like
you mentioned, the water andincreasing your fiber intake.
People definitely need way morefiber than they usually are
taking and there's a specificamount of fiber for your body
weight and who you are as aperson.
There are fiber supplements.
Our intern is like gnawing awayat a bone, like this entire
(38:09):
time.
I don't know if it'll be pickedup on the mic, but there are
fiber supplements while you'retrying to get more fiber into
your natural diet because that'smore delicious and more fun and
more inviting.
One other side effect thathappens, and we talked about
vomiting and diarrhea vomitingmainly as a function of nausea,
and so we talked about usingsome medicines.
(38:30):
But one thing to really thinkabout is remaining hydrated in
these moments.
In a few previous episodeswe've talked about having
diarrhea and vomiting beingdangerous, as it relates to your
kidney health, and if youdeplete the volume in your body
enough, then you may harm yourkidney.
So the idea is to remain ashydrated as possible, but also
(38:52):
with electrolytes and more fluidthat looks a little bit more
like the stuff flowing throughour body.
I'm not saying go drink blood,but, like you know, pedialyte
looks more like theconcentration with solute in our
body than water does simplySame thing with Gatorade, too.
Something else to think aboutis GLP-1 receptor agonists and
(39:17):
medications that you're taking.
So if you're taking insulin oryou're taking a medication
called sulfonylurea, it may beworth a conversation with your
doctor to make some doseadjustments to make sure that
you're not getting low bloodsugar, as we talked about.
We said that the GLP-1 receptoragonists don't themselves
(39:38):
typically cause low blood sugar,but they overall lower the tide
and increase the sensitivity toinsulin.
So if you're on insulin, it maybeg that you have a lower dose.
I've also seen it where,separately, outside of diabetes
medicines, blood pressuremedicines may need to be
adjusted.
I have a specific story of agentleman who had sleep apnea
(40:06):
and he lost about 30 pounds onMoonjaro and he also had
hypertension.
He had pretty poorly controlleddiabetes and he was on the
Moonjaro and he was doing reallywell, lost the weight.
He said that his partner waslooking at him when he was
sleeping and that he was likenot stopping breathing as one
would with sleep apnea.
And I would get messages backsaying and we put him on a blood
pressure medicine initially andhe said that like, oh, my blood
(40:30):
pressure is this, I'm feeling alittle dizzy and my blood
pressure is this, and it wasmuch lower than it was ever in
the office.
But that's part and parcel ofthese medicines is that they're
affecting so many different bodysystems where we're treating
his sleep apnea by also treatinghis underlying obesity and his
type two diabetes.
So now that his sleep apnea isbetter, his blood pressure is
(40:52):
better and so that bloodpressure medicine that he was on
because his whole bodycomposition is different now he
may not need it.
So we pulled back on the dose aton and seeing how things go,
but this is also a very realthing.
That happens.
All right, can you take usthrough the next couple of
things?
What can we do to avoidinjection site reactions?
Speaker 2 (41:17):
Well, it makes it more tolerable if you're
rotating the injection site.
So do like your stomach onetime I mean, this is only like a
weekly thing, but it stillhelps like your stomach and then
a leg and then your arm, sothat helps.
Speaker 1 (41:36):
Yeah, that's helpful.
Also good to probably make sureit's clean, right.
Speaker 2 (41:42):
Yeah.
Speaker 1 (41:44):
No, any risk of infection or anything.
Speaker 2 (41:47):
Yeah, basic injection prep things.
So what should someone belooking out for if that rare
gallbladder stuff happens?
Speaker 1 (41:59):
So the gallbladder lives in the right upper
quadrant.
So if you're to kind of touchyourself in your belly, right
there, right under your rib cage, is where the gallbladder lives
, and if you have belly pain inthat area, if you have a fever
or you happen to be noticingyellowing of your eyes or skin,
you should call your doctor andlet them know.
And this is just an FYI aboutwhen to reach out or go present
(42:21):
for some in-person care thatmight be helpful.
A similar thing there has beenexplained that there's some risk
of pancreatitis from thesemedications themselves.
Sometimes that's related to thegallstones in general.
But the word of caution here isto don't overdrink alcohol.
I had one colleague who askedme like oh, this guy was on a
(42:43):
GLP-1 receptor agonist, he wasat his daughter's graduation, he
was having a grand old time,and then he landed in the
hospital because he was drinkinga lot of alcohol that day.
And so they make you moresusceptible to pancreatitis,
this inflammation of thepancreas.
That can be very dangerous andvery painful.
So just be mindful of that whenyou're thinking about those
(43:04):
next steps and things to do orthings to do less of.
Speaker 2 (43:09):
So let's talk about eye health.
Can you remind us what we cando about that?
Can you remind us what we cando about that?
Speaker 1 (43:16):
So if someone has diabetes, they should be getting
yearly eye exams with an eyedoctor, and so this becomes way
more important when people areon these medications, because if
you have pre-existing diabeticretinopathy, you should be
getting them checked regularly.
So there's no pun intended here, but just keep an eye out for
(43:38):
vision changes.
There is a signal in theliterature that there is
possible worsening of a fewdifferent ones, like diabetic
retinopathy, maybe some signalof worsening macular
degeneration or some worseningof this NAIO.
The goal of this is to not getyou to understand the inner
(43:59):
workings of our very complicatedoptic system, but maybe you
should have a relationship withan eye doctor.
Maybe you ask your doctor aboutthat, especially if you're on
this for diabetes management,and if you have any vision
changes, ask.
That's all it is.
It's something to think about,something to keep to look out
(44:25):
for, and one last side effectthat we're going to cover here
today is something that isn'tdescribed in the literature
significantly right now, but Iexpect it to be.
Is this side effect ofanhedonia or this just feeling
of blah?
I don't want to do anything,and it's been described with
these medicines.
If anyone was to go online oryou're to ask a few people, they
(44:46):
might just feel well.
I think it has some somethingto do with like how, like the
appetite regulation and thepleasure system in the brain is
working, not necessarily theamount of calories that you're
like taking in.
That may invite thinking aboutthe dose that you're currently
on, and is it too high, orshould we go down a dose?
(45:07):
Or is there another medicinethat might be able to help you
in these times?
And all I'm saying there isjust, keep an open mind.
If you're listening to this andyou're like, oh, I might
actually feel some of that, askBecause it's out there, it's a
real thing, it's being figuredout.
Some of this comes up in timeand then more research needs to
be done to figure this stuff out.
So if you do feel this way,think twice and maybe just reach
(45:30):
out and ask for help, becauseit is a real thing, you're not
crazy, all right.
And so in this last little bitwe're just going to do a couple
highlights about when you shouldreach out.
If you have severe, persistentnausea or vomiting, you should
probably reach out because maybesomething needs to change.
If you have signs ofpancreatitis, which is a belly
pain in the upper belly thatshoots to the back, maybe you
(45:52):
should probably reach out.
If you're having thosegallbladder symptoms that you're
thinking about in that rightupper quadrant of your belly,
maybe you should reach out forhelp.
If you're having vision changes, you should probably reach out
for help, and anything thatfeels unusual to you or doesn't
improve over time is probablysomething that you should reach
(46:15):
and ask for help.
But overall, most side effectsdo improve over time, which is
great news.
These medications remainpowerful tools for your health,
but there are risks and benefitsto various different things and
everything we do practically.
So thank you for coming back toanother episode of your Checkup
.
Hopefully you were able tolearn something for yourself, a
(46:36):
loved one or a neighbor withside effects.
You can send us an email atyourcheckuppod at gmailcom.
You can visit our Instagram orour website and make sure that
you follow the show so that yousee when other episodes come out
.
They come out weekly on Mondays.
And, most importantly, stayhealthy, my friends, until next
(46:56):
time.
I'm Ed Dolesky.
I'm Nicola.
Rufo Thank you and goodbye.
Speaker 2 (46:59):
Bye.
Speaker 1 (47:10):
This information may provide a brief overview of
diagnosis, treatment andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
(47:31):
Thank you.
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
You.
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