December 8, 2025 • 33 mins
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We share a quick life update, welcome our first guest Mike Rozanski, and clear up the Michelin Guide origin story before shifting to a focused guide on starting GLP-1 medications. Practical strategies cover injections, nausea, constipation, muscle protection, and adjusting other meds safely.
• board certification in obesity medicine and motivation to destigmatise care
• guest segment on Michelin guide history and Philly’s recent stars
• what GLP-1 meds are and how auto-injectors work
• portion sizing to prevent nausea and early side effects
• fiber with fluids to prevent constipation
• protein targets and simple strength training to protect muscle
• when to adjust blood pressure and diabetes medications
• key takeaways and encouragement to start small and follow up
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Production and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN
Artwork Rebrand and Avatars:
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Website: https://www.vantagedesignworks.com/
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Original Artwork Concept: Olivia Pawlowski
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:01):
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 to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_00 (00:16):
And I'm Cola Ruffel.
I'm a nurse.
SPEAKER_02 (00:18):
And we are so excited you were able to join us
here again today.
So one little piece of banterthat we have is that I passed my
obesity medicine boards.
You did.
Um, with flying colors, I mightadd.
Yeah.
SPEAKER_00 (00:32):
I guess your whole summer of ignoring me to study
was well worth it.
SPEAKER_02 (00:36):
I think it was.
The 99th percentile said so.
Um that's not true.
But um, so I I'm very excitedabout that.
Um, you know, first year ofattending hood and have, you
know, the certification is likethe thing that you get at the
end of a fellowship.
And I did a different pathwayfor the education for obesity
(00:57):
medicine um through continuingmedical education.
Did it while I was a residentand in the early parts of being
an attending, took the boardsand now certified day before our
wedding.
Took the boards the day beforethe wedding, which is not talked
about enough.
Probably not talking.
SPEAKER_00 (01:11):
You just casually did that.
SPEAKER_02 (01:13):
Yeah.
Um, it needed to get done.
Um, otherwise I would have hadto wait a year.
Uh, but now I am board certifiedin obesity medicine and look
forward to helping out as manypeople as I can and also working
to destigmatize this thingbecause far too often people
feel like it's their fault orthere's not enough help or
they're just left to their owndevices with no productive way
(01:36):
to help themselves.
So I am so looking forward totrying to help wherever I can
with everything I've learned.
All right.
Well, um, you are not feeling100% on the day that we are
meant to do this, and that isokay because if if we are to
maintain consistency, we have tohave backup plans.
(01:56):
Um, but can you say hello to thegood people?
SPEAKER_00 (01:59):
Hello, good people.
SPEAKER_02 (02:02):
So um what we're going to do instead is we are
going to I'm gonna ask for somehelp.
What's that?
SPEAKER_00 (02:09):
Well, we have some sort of banter.
SPEAKER_02 (02:10):
We do have some sort of banter.
Well, why don't we do a littlebit of banter?
Tell talk to me.
What's you what's on your mind?
SPEAKER_00 (02:16):
Well, I have a piece of Nikki's corner.
I'm gonna test your knowledge ofthe goings-on in the world and
see where we are.
SPEAKER_02 (02:25):
Great.
Okay, give it to me.
SPEAKER_00 (02:26):
Well, this is a big one that just happened.
And I honestly would be shockedif you actually had no clue that
this happened, but Netflixacquired Warner Brothers.
SPEAKER_02 (02:39):
Yep, didn't know, didn't know.
You didn't know that?
No, I had no idea.
SPEAKER_00 (02:42):
Oh, yeah, which includes HBO and HBO Max for a
total enterprise value of$82.7billion.
SPEAKER_02 (02:52):
That's crazy.
Yeah.
Wow.
That's I guess it's not TV moneyanymore, but that's big
streaming money, if you will.
I know.
That's crazy.
I had no idea.
No, Nikki's corner got me again.
SPEAKER_00 (03:05):
Nicki's corner.
That's my only update that Ihad.
I guess there could have beenmore, but it's okay.
SPEAKER_02 (03:13):
You're not feeling it today, and that's okay.
SPEAKER_00 (03:15):
It's Ollie's ninth birthday today.
SPEAKER_02 (03:18):
It is Ollie's ninth birthday.
SPEAKER_00 (03:19):
And he is a stomach bug.
So we were up a lot of the nightwith him.
Yeah.
And now we're off.
Didn't sleep well.
Our appetite dysregulation isgoing crazy.
We just had to make a middayground cheese.
SPEAKER_02 (03:38):
Some would call it lunch, but you know, and it'd be
a reasonable thing to consume.
Yeah.
Um we love our intern, but more,moreover, he's our little buddy.
He's so precious to us, andevery moment we have with him is
amazing.
I do wish he was feeling alittle bit better today.
SPEAKER_00 (03:56):
I know.
We'll have to do birthdayactivities another day this
week.
SPEAKER_02 (03:59):
Yeah.
We'll take him to um his one ofhis favorite stores.
He sits out front.
Um but really anytime we'reoutside and someone passes him,
I am not shy to let them knowthat I'm like, it's his birthday
today.
I know.
And I think they think it'scute, and he gets all excited,
and then they get excited, andit's just a nice experience, but
he's like the best.
I am my first and best doggy.
SPEAKER_00 (04:19):
We were supposed to finish Christmas shopping today,
but that's okay.
SPEAKER_02 (04:24):
That's okay.
You know, we would have beenaway and then we would have been
away from him for longer than weintended.
We booked in two hours, and itwas not gonna take two hours.
SPEAKER_00 (04:35):
Yeah, but yeah.
SPEAKER_02 (04:37):
Well, um, happy birthday to Big Big Lid as well.
She's a faithful supporter ofthe show.
She's always putting this thingon her Instagram.
Really appreciate that.
SPEAKER_00 (04:50):
Ollie and Big Lid have the same birthday.
Oh, Maggie, Pat's girlfriend.
Her birthday's today, too.
SPEAKER_02 (04:55):
Yes, yes, it is.
I saw that.
I wish them a happy birthday onum via Instagram.
Yeah, happy day.
Maggie, big day.
It's also Pearl Harbor.
SPEAKER_00 (05:04):
Yeah, okay.
SPEAKER_02 (05:06):
Yeah, yeah, yeah.
It seems like people haveforgotten that one.
SPEAKER_00 (05:09):
And it's um I always remember because it's my
cousin's wedding anniversary.
They got married on Ollie'sfirst birthday.
Well, his first birthday?
SPEAKER_02 (05:19):
Oh man, but that's wonderful.
Well, we'll keep it lightbecause we have a very special.
It's actually our first guestappearance.
It's not how I thought thiswould happen, but in a pinch,
um, my near dear friend pitchedin to help settle an issue that
you and I are.
SPEAKER_00 (05:40):
Our very loyal listener.
SPEAKER_02 (05:41):
Our very loyal listener.
His name is Mike Rosansky.
And he is joining us today as acontent expert for our banter
section.
Um, if you don't know Mike, he'sone of the funniest people you
could possibly ever meet.
SPEAKER_00 (05:55):
Yeah.
You know, he and Sam are bothlike so funny.
Yeah.
And like Sam, especially, Idon't know what it is about her,
but like she'll say somethingjust like so deadpan.
And it's so funny, but she'slike not trying to like they're
(06:16):
just so funny.
SPEAKER_02 (06:20):
It just brings out the cables.
It is we got to see it for awhole two-hour car ride right in
front of her.
SPEAKER_00 (06:26):
Like feed like feeding off of each other.
It's like even more funny.
SPEAKER_02 (06:31):
It is.
I know.
I think we actually it's likeintellectual humor too.
It is.
Like we're just idiots.
SPEAKER_00 (06:37):
I feel I feel like we're very lucky and have a lot
of funny people in our life.
SPEAKER_02 (06:43):
Truly.
SPEAKER_00 (06:44):
Don't you think?
SPEAKER_02 (06:44):
Oh, yeah.
Like, even like especially withlike how our experience this
week this weekend, like thiscollection of humans, and I just
didn't stop laughing.
And even beyond them, we have soI know it's great.
I'm gotta keep the people whoare around you laughing and then
laugh you laughing with them.
It's great.
SPEAKER_00 (07:04):
Um anyway, so back to our loyal listener, Mike.
SPEAKER_02 (07:06):
So he he is also known as the Prince of
Glassboro, born and raised inGlassboro, New Jersey.
Um, his degree is from RowanUniversity.
GoPro's GoPro.
Um, he currently um works in Iwould say upper management at a
worldwide betting company.
(07:27):
And he is one of my absolutebest friends.
And so he subbed in today inthis separate little interview
to help settle a debate that wehad.
Um, something that you broughtup two weeks ago in your first
Well, I don't know that it was adebate.
SPEAKER_00 (07:42):
It's a bit dramatic.
SPEAKER_02 (07:43):
I know I'm trying to set it up, you know.
Oh, yeah, yeah.
SPEAKER_00 (07:46):
That I have no idea what what you guys said.
SPEAKER_02 (07:50):
Well, we talked about Michelin.
Right.
And you knew what you were inyour maiden voyage of Nikki's
Corner.
What?
Was that a hmm because I cut youoff?
No.
Oh.
Um, in the maiden voyage ofNikki's Corner, we it's all
about restaurants.
And I was like, is this the sameas the the you know Pillsbury
doughboy looking guy who sellstires?
(08:11):
And you're like, no.
And it came to pass.
SPEAKER_00 (08:14):
Okay, you know why?
Because you always are likewaiting with baited breath for
like a stupid dad joke.
Yeah.
And I was like, no, this is justone of your stupid dad jokes.
SPEAKER_02 (08:28):
This one isn't but like I just got lucky.
SPEAKER_00 (08:30):
Then when I was like watching this stuff, like the
Michelin guy is up there.
But then I'm like, is this justa bit you know?
No, I guess I wasn't educatingmyself properly for Nikki's
corner, and for that, Iapologize to the good people,
and I'll do my due dil duediligence going forward.
SPEAKER_02 (08:50):
But boy, do we have a special treat for you.
So what you'll hear next is myone-on-one interview with Mike
Rosanski from his basement,where he listens to your checkup
podcast, and we discuss theMichelin lineage.
Enjoy.
(09:13):
Okay, so this is very exciting.
Uh, this is well, not how Iexpected this to happen, but we
have our first guest, and he'shere joining us.
We already heard hisintroduction.
Can we hear from our firstguest, Mike?
Do you have anything to say?
SPEAKER_01 (09:32):
Well, hi, hi, uh, your checkup listeners.
Uh, this is really an honor.
Um again, like Ed said, this isuh not something we planned.
SPEAKER_02 (09:41):
For anyone who's been listening over the course
of the last two weeks knows thatwe started a segment, Nikki's
Corner, and with her feeling alittle under the weather today
and having a limited role, Ineeded some backup for our
banter section.
And so I thought, who else tobring, who will better to bring
in than Mike?
(10:01):
Because he was the one whoinformed me about Michelin and
their lineage, the family story.
But maybe we can dive into alittle bit more about that.
What do you think, Mike?
SPEAKER_01 (10:13):
Yeah, no, I'm I'm happy to uh to educate the the
listeners on something that um Iknow a lot about.
I think I should start maybe bygiving my qualifications about
why I should be talking aboutthis then.
Do you think that's the one?
SPEAKER_02 (10:26):
Yeah, I think from your perspective, sure.
I'm going, yeah.
What tell me.
SPEAKER_01 (10:31):
Okay, so uh personally, I've never been to a
Michigan Star restaurant before.
Um I was curious about thistopic a couple years ago, and I
looked it up online.
So uh I will give some contextto the listeners.
Um, I had the opportunity toread back into it, but I'm gonna
(10:51):
go off of what I remember fromwhen I looked this up three
years ago.
SPEAKER_02 (10:55):
That's what we want.
That's really what we want.
SPEAKER_01 (10:58):
I think that's uh because your check-up is all
about you know having accurate,up-to-date information.
Your listeners are gonna learnsomething, so why not uh you
know just completely risk?
SPEAKER_02 (11:08):
Yeah, completely risk the reputation.
That's why we have two sections,you know, the banter section and
the educational section.
So um how it's like aneditorial.
Exactly.
How did we get from tires torestaurants?
SPEAKER_01 (11:25):
So that's that's a great question.
So uh Michelin started as a tirecompany, uh, as many people know
it today, uh, of course.
Uh there were two brothers thatowned it.
Uh it was a French tire company.
Now, this was early 1900s, Ibelieve, maybe, maybe late
1800s.
(11:45):
Not a lot of cars on the road atthat time, as you might recall.
I might recall.
Um so it was kind of tough.
And of course, people didn'thave things like Google Maps,
where uh you know you have theentire world at your disposal
and you know what's going on allover the place.
If someone wanted to travelsomewhere, you got to do a lot
of research.
(12:05):
So, what Michelin did was puttogether this free guide, uh,
and it was called the Michelinguide.
So uh people who own cars wereable to pick this up.
It has information about hotelsand, of course, restaurants.
Uh so for Michelin, it was kindof a way to say, like, hey, when
(12:25):
you're on your fun little roadtrips, here is a place that you
can stop.
Uh, and you know, if it happensto be a couple hundred miles
away and you get some work andcarry your tires, come come back
to Michelin.
We're gonna give you some moretime, right?
So you you can see why it was intheir interest to put this
together.
SPEAKER_02 (12:43):
I see it now.
SPEAKER_01 (12:44):
Well, yeah, and now eventually this thing really
took off.
Uh, and more and morerestaurants were vying to get
these Michelin recommendationsand Michelin stars.
Uh so Ed, do you know thedistinction between uh the
different uh Michelin accolades?
SPEAKER_02 (13:01):
I think oh no.
Um it is not something I'mconfident in.
Can you help us?
SPEAKER_01 (13:07):
Uh yeah, yeah, sure.
So again, uh I I can'tconfidently say it as well, but
there are there's the three.
I know there's the three stars.
Uh the one star is a great,great meal.
Now, relatively speaking, it isprobably like a one-star
(13:27):
Michelin restaurant is probablythe best meal most people have
ever had in their entire lives.
Wow.
Uh, but in the world of finedining, it's it's it's good,
right?
SPEAKER_02 (13:35):
Yeah.
SPEAKER_01 (13:36):
Uh and for Michelin, it's uh, hey, if you're on your
road trip and you see thisplace, it's worth a stop.
Two stars uh is kind ofexcellent food, uh, and they go
above and beyond other things,so the service is probably
great.
Three stars is basically forMichelin, is you should plan
your trip around this place.
(13:56):
Um, there's also Michelinrecommended places.
There is a French term for it.
I do not remember what that is.
I think it begins with a B.
So uh you might you can splicethis in if you look it up
afterwards.
Um, but that's essentially likesolid, solid value according to
the Michelin people.
So when they came to Philly, um,people might know Angelos uh uh
(14:20):
in uh on on South Street rightoff of South Street.
So they have great cheesesteaks,great pizzas.
They have this Michelindistinction.
So they don't have a star, butit's basically them giving their
props to Angeles and some otherplaces like that.
So yeah, fun uh fun enough.
Both the tire company and therestaurant people, the same
(14:40):
Michelin.
SPEAKER_02 (14:42):
Thank you so much for clearing up something that
gave our household such strifefor the last two weeks.
And now we understand.
And um, I'm seeing here a couplenew one-star restaurants in
Philadelphia.
You correct me if I'm wrong.
Um, Her Place Supper Club.
That's one cut that was uhbrought up in Nikki's corner two
(15:02):
weeks ago.
Is that correct?
SPEAKER_01 (15:04):
That is one of them, yep.
SPEAKER_02 (15:06):
Friday, Saturday, Sunday.
Is that another one?
SPEAKER_01 (15:09):
Another one, yeah.
And then the third should be oh,actually, I don't even know the
name of it.
I think it's a Korean placethough.
That's it.
That's it.
Uh I had actually never heard ofthat until they got their
Michelin star, which is reallycool.
Uh, because now I'm sure youknow they're they're blown up
and you probably can't get areservation there for two years.
(15:30):
But uh no, it's really cool tosee Philly, you know, have uh
you know the actual Michelinratings now because for so long
it's been known as this greatfood city, but now it's kind of
bigger on a national stage.
SPEAKER_02 (15:43):
Yeah, you I mean you and Karthik taught me the um I
don't know, he went to one inNew York and he was like, oh, I
finally I went to a Michelinrestaurant.
And I was like, I have no ideawhat that means.
And now it's taken over my lifeto some degree, so much so that
we have our first ever guest inan unexpected way on
unbelievable.
But I'm so grateful.
(16:04):
Thank you so much for your time.
I'm going to literally see youin probably three hours.
SPEAKER_01 (16:10):
But yeah, no, we are yeah, we are going to see the uh
the Sixers Lakers game.
SPEAKER_02 (16:16):
And we will no one will know because the episode
will be done by then, but it'llbe a good time had by y'all.
And it's just a Mike weekend,much like the restaurant Friday,
Saturday, and Sunday.
SPEAKER_01 (16:27):
Look at that.
Look at that.
Well, that's incredible.
Uh well, yeah, thank you againfor having me on.
SPEAKER_02 (16:34):
You are so welcome.
Thank you.
And I'm sure everyone is gonnabe, you know, so excited.
Share it with your family andfriends, and looking forward to
more.
SPEAKER_01 (16:45):
Yeah, and by the way, if you want any um health
tips from someone that does notwork in the healthcare industry,
uh, I'm I'm your guy.
Just, you know, I can make somestuff up about that too if you
want.
SPEAKER_02 (16:54):
We know where to find you.
We hope you have fun in yourbasement.
SPEAKER_01 (16:57):
This is getting cut.
This is getting cut.
Oh, thank you, Ed.
Thank you.
You are so welcome.
SPEAKER_02 (17:02):
All right, thank you, Mike.
So, what are we gonna talk abouttoday, Nick?
SPEAKER_00 (17:06):
Today we're talking about starting GLP One Med.
SPEAKER_02 (17:10):
Yeah, this is um since Nikki's feeling under the
weather, this is going to benotably a one-sided episode.
Um, but I recently got myobesity medicine certification.
And so now I have a little bitof uh credibility to back up the
things that I try to teachpeople.
Um, this episode is specificallymeant for people who are going
(17:33):
to be or starting to think abouttaking these medicines.
And I it's they're very powerfultools.
It is like wielding a chainsawpractically when it comes to
treatment of obesity.
And not everyone just getshanded a chainsaw.
You need a coach, you needsomeone who is right there with
you to help teach you how to usethat tool.
(17:56):
And so what I've been doingrecently is like having a very
scripted visit with people whenthey come back after prescribing
them.
And then I thought to myself,oh, well, what great fodder for
an episode.
And so for these next coupleminutes, what we're going to do
is talk about some of those tipsthat I go over in those visits.
And we will get started.
(18:18):
So these GLP1 receptor agonistmedications or otherwise called
they're always also callednutrient stimulating hormone
therapies, but they're notthat's not called that in the
common media.
These are they just go by thenames, brand names, uh Zeppbound
and Munjaro for the activeingredient terzepitide, and
(18:39):
Ozempic and Wagovi for theactive greedy uh the active
ingredient semaglite.
Um, they are once weeklyinjectable medications, most
commonly.
And what I've been finding isthat word injectable makes some
people feel immediatelyuncomfortable.
But there's some good news.
Um a lot of people end uptelling me like that was way
(19:01):
easier than I expected when theycome back and tell me how
they've been using the medicine.
Often you don't even see theneedle.
Um, they make these so simple asan auto injector pen.
And the way that it works, andthere are several videos from
the companies that make thesemedicines teaching people how to
use them.
And once you get the hang of it,it really is second nature.
(19:21):
Um, so you press the pen againstyour skin.
I usually tell people to gowithin two centimeters of their
belly button.
And you press that pen againstyour skin after cleaning the
area with an alcohol wipe, andyou hear you press the top and
you hear the first click and youkeep holding it there.
And then you hear the secondclick sometime after.
After that second click, you'redone.
(19:43):
But what's happening between thetwo clicks is the actual
mechanism of the pen isdelivering medicine inside in
the subcutaneous tissue.
And that's it.
It's once a week.
And you don't have to thinkabout this.
Actually, you do.
We're gonna talk about how muchyou have to think about.
It but practically speaking,moment to moment, that's it.
(20:05):
Rinse and repeat next week.
Some people choose to take it inthe morning, others at night.
Um, really, truly, there's noperfect time, but a lot of my
patients like nighttime dosingbecause if any nausea shows up,
they may sleep through it.
Um, they may sleep through theworst part of it.
And one another practicalimportant tip is that these
(20:26):
medicines should be stored inthe refrigerator to keep their
longevity.
So I mentioned nausea and whypeople might take it in the
evening to avoid that.
So here are a few tips to helpstave off nausea.
It happens to be one of the mostcommon side effects when people
are starting these medicines,especially early on or during
dose increases.
(20:46):
And there's a couple key ideasthat I want you to remember.
A lot of the nausea comes fromovereating while your stomach is
emptying more slowly for a shortperiod of time.
In general, these medicationswork mainly through appetite
hormones that get translatedthrough communication with the
brain in a very complicated way.
(21:08):
And early on, they also slow howfast food leaves your stomach.
So if you eat a normal portionsize the way you used to right
away, that stomach can feeloverfilled.
And that distension is when thenausea shows up.
And so the most practical tip tothink about is when you start
taking the medicines, cut yourportion size in half on purpose
(21:31):
ahead of time to try to avoidany of that.
Truly, like you can always goback for more if you want to,
but if you start with too much,you can't really undo that.
And then you get that full,heavy feeling, that distension
that may feel like nausea.
Many people also tend todescribe a feeling of prolonged
fullness, which is part of thenature of the medicine.
(21:53):
And they say things like, I atehours ago and I still feel full.
Early on, that's very commonwith the medicine.
That's fine and normal.
And it usually improves as yourbody adapts to the medicine.
So the next thing we're going totalk about is managing another
common side effect,constipation.
Um, this is very common.
It is very real, to becompletely honest, and it is
(22:14):
also fixable.
So if you are very proactive,you can prevent this using what
I'll describe as three ways.
Fiber is the first one.
To begin with, most people don'tget enough fiber throughout the
day, even before starting totake these medicines.
And so when people go on a GLP1receptor agonist, that's kind of
augmented and amplified.
(22:36):
Um, the upper limit of mostfiber goals should be about 35
grams per day.
And I would take a bet that alot of people don't get that.
And that's okay.
I also probably don't get that.
And an easy way to start doingthat is asking your doctor,
going to the pharmacy andgetting a fiber supplement.
It can be in a pill or there aresome powders out there that are
(22:58):
flavored or unflavored.
And you can just add them inuntil you find delicious foods
that you can add in that aremore reasonable and more overall
nutritious.
I'm thinking it doesn't have tobe boring, it could be things
like beans, berries, certainvegetables, whole grains, and
seeds all have a little morefiber, and like I said, it can
be delicious.
(23:19):
So the next thing is water.
Um, taking fiber without wateractually can make constipation
feeling bloating worse.
So the two things must gotogether.
So if you weren't doing thisbefore, you really should
prioritize hydration.
And the third is thatmedications, when needed, um,
there are medicines that canhelp with constipation.
(23:39):
Um, we have a whole episode onconstipation that you can refer
back to, but sometimes even withgood fiber and water, people
still struggle.
And so that's when the doctormay prescribe a medicine to help
your bowels move more regularly.
And this also goes hand in handwith the nausea as well.
Um, you know, at those doseinitiation or increases, a very
(24:00):
reasonable thing to ask is can Ihave a medicine that helps with
the nausea?
I don't think many people wouldhave a problem helping you out
if they commonly use thesemedicines.
But that's also another veryreasonable way when you're
getting used to using thesemedicines.
So the next tip is aboutmanaging muscle and a lot.
So these medicines are veryeffective at what is described
(24:24):
in the literature as total bodyweight loss.
Unfortunately, the mainlineclinical trials didn't look at
what percentage of the totalbody weight loss is from muscle.
Other reviews and things did,and we did a whole episode on
this, and we found that it's notthe majority.
It is some minority of the totalbody weight loss can be from
(24:49):
muscle.
We were also seeing things thatthe muscle quality could improve
on these medicines while theoverall lean mass reduces
because sometimes there's fatdistribution within the muscle
that gets cleared up with themedicines.
Um, this is an evolvingconversation, but in a practical
sense, to try to keep andmaintain as much muscle mass as
(25:12):
possible.
It is a daily adjustment.
So you use the medicine once aweek, but this is a daily
adjustment that needs to bemade.
And there are two things tothink about protein intake and
strength training.
So there are a few studies thatorganize and say about 1.3 grams
of protein per kilogram of idealbody weight per day, as long as
(25:35):
your kidneys can handle it.
That is something you probablyshould ask your doctor and not
just take from a guy you'relistening to on a podcast, even
though he's an obesity medicinespecialist.
Um, it doesn't need to beperfection, but I would say get
an idea of how much protein youhave in your diet.
If you're less than that andyou're starting these medicines,
there's probably some room forimprovement.
(25:55):
So it's not necessarily aboutthe exact numbers, but it's more
about concepts and things thatyou practically have every day
in the kitchen.
Like what meals are you havingfor breakfast, lunch, and dinner
and your snacks, and how are youspending your food?
While we're talking about food,the idea is to try to optimize
(26:16):
the whole nutrition, your wholenutrition as best as possible,
because these medicines in alarge way work by appetite
regulation.
It takes the entire bandwidth ofthe food you eat every day and
mutes it because you're going toeat less of it.
So it stands to reason that ifyour nutrition is suboptimal,
(26:36):
that you're going to just haveless of suboptimal nutrition,
which looks like more processedfoods, but and you know, more
processed foods that aren't sonutritious or more junk food.
So now is the time to reallythink about where you can have
more vegetables, where you canhave more lean proteins and keep
(26:58):
your diet well balanced, becausewe also find that many people
feel motivated to make thesechanges once they start these
medicines, which right now isjust an anecdotal thing.
Maybe we'll get more researchabout why that motivation
changes.
But that's something that wenotice.
People get the kick in the buttthey need.
And they're like, oh, I'm gonnastart making all of these
changes all together to improvemy health.
(27:19):
But to think about protein, moreconcepts than numbers.
Just try to improve and optimizethe amount that you have.
So while we're still talkingabout strength training and
muscle maintenance, what youshould probably know is that for
the average adult, it'srecommended across the board
that at least two days per weekof strength training is good for
(27:41):
your health.
But the for people on GLP1medicines, it is a good idea to
do more and probably at leastthree days per week.
And so that may be intimidating.
You could be someone who's like,oh, you know, I look in the
mirror and I'm like, I'm reallygetting started on this health
journey, but I don't strengthtrain at all.
It doesn't have to be fancy.
(28:02):
It can be bodyweight workouts,it could be dumbbells,
resistance bands, machines,even.
Um, some things you don't evenneed any equipment for.
It could be air squats, and youjust do three sets of 10 a few
times during the day.
That's a start.
It's not about the end goal.
It is about the day-to-dayprocess and the journey you're
on to improving your health.
(28:25):
You know, the reason muscle alsomatters is because it sends
powerful signals to yourmetabolism.
It helps with long-term weightmaintenance and protects against
weight regain.
It improves your energy, itimproves blood sugar control,
prevents you from gettinginjured and falls, and helps you
maintain your independence.
So maintaining muscle is a hugedeal when someone enters into
(28:50):
the like, I am starting to takea GLP1 receptor agonist for
whatever reason.
So that's muscle, superimportant.
And then the other thing that Ireally like to, you know, harp
on and let people know ahead oftime is that other medicines may
need to change.
It's critically important andyou know, unfortunately, too
(29:13):
often overlooked, especiallywhen someone goes online and
just gets their like justgetting the medicine from
someone, not someone who looksat their whole holistic health.
So as you lose weight, your bodycomposition changes.
And the need for othermedications may need to change
too.
I think of two really commonexamples.
(29:35):
I think of blood pressuremedications, and I think of
insulin and diabetesmedications.
If these aren't adjustedproperly as body composition
changes, it can lead to lowblood pressure, dizziness from
low blood pressure, falls fromlow blood pressure, or
hypoglycemia, which is also lowblood sugar.
(29:55):
And that is why follow-upmatters.
Because if the medication, thesemedications don't work in
isolation.
They affect everything.
And so if you are feelingthings, you should tell someone.
You should let your, let theperson who's prescribing your
medicines know.
Let your primary care doctor orwhoever you're whatever
clinician you're seeing knowthat you're feeling something.
(30:17):
Maybe they can offerreassurance.
Maybe it takes a visit.
But, you know, while people arestarting these medicines,
there's lots to think about.
There's a lot of moving parts.
They're very helpful.
They're groundbreakingpractically.
But we do need to make sure thatit's safe.
And that also goes with liketaking going too far, like if
someone's on too high a dose ofa medicine and loses too much
(30:39):
weight.
So there's always a sweet spot.
And like I said, we're dealingwith a chainsaw here.
Very powerful, but a veryimportant tool.
And so let's talk big takeaways.
The GLP1 receptor agonists arepowerful tools, and the best
results, the safest results,come when you pair the
medications with smart portionawareness, fiber and hydration,
(31:03):
protein and strength training,and close medication monitoring
of other things.
Truly, it's not aboutperfection.
It is about starting small,making day-to-day choices that
are more healthy for you thanless healthy.
So if you're starting one ofthese medications or thinking
about it, I want you to knowthat you are not behind, you're
(31:25):
not broken, you're not takingthe easy way out.
You are being treated for achronic disease with real
evidence-based medicine.
And if you found this episodehelpful, you can share it with
someone who's also just gettingstarted.
We have episodes about any sortof topic that you could imagine.
And if you want to hear anythingmore or less, please just let us
(31:45):
know.
So thank you for coming back toanother episode of Your Checkup.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
You can find us on Instagram.
You can send us an email at yourcheckuppod at gmail.com.
If you found this helpful, areview really does go a long way
for a like on whatever appyou're listening to us on.
(32:06):
But even if one person foundthis helpful, we feel like the
job got done.
So we hope you had some funtoday and learned something.
But most importantly, stayhealthy, my friends.
Until next time, I'm Ed Delesky.
SPEAKER_00 (32:16):
I'm Nicole Arifo.
SPEAKER_02 (32:17):
Thank you and goodbye.
SPEAKER_00 (32:18):
Bye.
SPEAKER_02 (32:25):
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.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(32:47):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
I am not your nurse.
And make sure you go get yourown checkup with your own
personal doctor.
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 to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_00 (00:16):
And I'm Cola Ruffel.
I'm a nurse.
SPEAKER_02 (00:18):
And we are so excited you were able to join us
here again today.
So one little piece of banterthat we have is that I passed my
obesity medicine boards.
You did.
Um, with flying colors, I mightadd.
Yeah.
SPEAKER_00 (00:32):
I guess your whole summer of ignoring me to study
was well worth it.
SPEAKER_02 (00:36):
I think it was.
The 99th percentile said so.
Um that's not true.
But um, so I I'm very excitedabout that.
Um, you know, first year ofattending hood and have, you
know, the certification is likethe thing that you get at the
end of a fellowship.
And I did a different pathwayfor the education for obesity
(00:57):
medicine um through continuingmedical education.
Did it while I was a residentand in the early parts of being
an attending, took the boardsand now certified day before our
wedding.
Took the boards the day beforethe wedding, which is not talked
about enough.
Probably not talking.
SPEAKER_00 (01:11):
You just casually did that.
SPEAKER_02 (01:13):
Yeah.
Um, it needed to get done.
Um, otherwise I would have hadto wait a year.
Uh, but now I am board certifiedin obesity medicine and look
forward to helping out as manypeople as I can and also working
to destigmatize this thingbecause far too often people
feel like it's their fault orthere's not enough help or
they're just left to their owndevices with no productive way
(01:36):
to help themselves.
So I am so looking forward totrying to help wherever I can
with everything I've learned.
All right.
Well, um, you are not feeling100% on the day that we are
meant to do this, and that isokay because if if we are to
maintain consistency, we have tohave backup plans.
(01:56):
Um, but can you say hello to thegood people?
SPEAKER_00 (01:59):
Hello, good people.
SPEAKER_02 (02:02):
So um what we're going to do instead is we are
going to I'm gonna ask for somehelp.
What's that?
SPEAKER_00 (02:09):
Well, we have some sort of banter.
SPEAKER_02 (02:10):
We do have some sort of banter.
Well, why don't we do a littlebit of banter?
Tell talk to me.
What's you what's on your mind?
SPEAKER_00 (02:16):
Well, I have a piece of Nikki's corner.
I'm gonna test your knowledge ofthe goings-on in the world and
see where we are.
SPEAKER_02 (02:25):
Great.
Okay, give it to me.
SPEAKER_00 (02:26):
Well, this is a big one that just happened.
And I honestly would be shockedif you actually had no clue that
this happened, but Netflixacquired Warner Brothers.
SPEAKER_02 (02:39):
Yep, didn't know, didn't know.
You didn't know that?
No, I had no idea.
SPEAKER_00 (02:42):
Oh, yeah, which includes HBO and HBO Max for a
total enterprise value of$82.7billion.
SPEAKER_02 (02:52):
That's crazy.
Yeah.
Wow.
That's I guess it's not TV moneyanymore, but that's big
streaming money, if you will.
I know.
That's crazy.
I had no idea.
No, Nikki's corner got me again.
SPEAKER_00 (03:05):
Nicki's corner.
That's my only update that Ihad.
I guess there could have beenmore, but it's okay.
SPEAKER_02 (03:13):
You're not feeling it today, and that's okay.
SPEAKER_00 (03:15):
It's Ollie's ninth birthday today.
SPEAKER_02 (03:18):
It is Ollie's ninth birthday.
SPEAKER_00 (03:19):
And he is a stomach bug.
So we were up a lot of the nightwith him.
Yeah.
And now we're off.
Didn't sleep well.
Our appetite dysregulation isgoing crazy.
We just had to make a middayground cheese.
SPEAKER_02 (03:38):
Some would call it lunch, but you know, and it'd be
a reasonable thing to consume.
Yeah.
Um we love our intern, but more,moreover, he's our little buddy.
He's so precious to us, andevery moment we have with him is
amazing.
I do wish he was feeling alittle bit better today.
SPEAKER_00 (03:56):
I know.
We'll have to do birthdayactivities another day this
week.
SPEAKER_02 (03:59):
Yeah.
We'll take him to um his one ofhis favorite stores.
He sits out front.
Um but really anytime we'reoutside and someone passes him,
I am not shy to let them knowthat I'm like, it's his birthday
today.
I know.
And I think they think it'scute, and he gets all excited,
and then they get excited, andit's just a nice experience, but
he's like the best.
I am my first and best doggy.
SPEAKER_00 (04:19):
We were supposed to finish Christmas shopping today,
but that's okay.
SPEAKER_02 (04:24):
That's okay.
You know, we would have beenaway and then we would have been
away from him for longer than weintended.
We booked in two hours, and itwas not gonna take two hours.
SPEAKER_00 (04:35):
Yeah, but yeah.
SPEAKER_02 (04:37):
Well, um, happy birthday to Big Big Lid as well.
She's a faithful supporter ofthe show.
She's always putting this thingon her Instagram.
Really appreciate that.
SPEAKER_00 (04:50):
Ollie and Big Lid have the same birthday.
Oh, Maggie, Pat's girlfriend.
Her birthday's today, too.
SPEAKER_02 (04:55):
Yes, yes, it is.
I saw that.
I wish them a happy birthday onum via Instagram.
Yeah, happy day.
Maggie, big day.
It's also Pearl Harbor.
SPEAKER_00 (05:04):
Yeah, okay.
SPEAKER_02 (05:06):
Yeah, yeah, yeah.
It seems like people haveforgotten that one.
SPEAKER_00 (05:09):
And it's um I always remember because it's my
cousin's wedding anniversary.
They got married on Ollie'sfirst birthday.
Well, his first birthday?
SPEAKER_02 (05:19):
Oh man, but that's wonderful.
Well, we'll keep it lightbecause we have a very special.
It's actually our first guestappearance.
It's not how I thought thiswould happen, but in a pinch,
um, my near dear friend pitchedin to help settle an issue that
you and I are.
SPEAKER_00 (05:40):
Our very loyal listener.
SPEAKER_02 (05:41):
Our very loyal listener.
His name is Mike Rosansky.
And he is joining us today as acontent expert for our banter
section.
Um, if you don't know Mike, he'sone of the funniest people you
could possibly ever meet.
SPEAKER_00 (05:55):
Yeah.
You know, he and Sam are bothlike so funny.
Yeah.
And like Sam, especially, Idon't know what it is about her,
but like she'll say somethingjust like so deadpan.
And it's so funny, but she'slike not trying to like they're
(06:16):
just so funny.
SPEAKER_02 (06:20):
It just brings out the cables.
It is we got to see it for awhole two-hour car ride right in
front of her.
SPEAKER_00 (06:26):
Like feed like feeding off of each other.
It's like even more funny.
SPEAKER_02 (06:31):
It is.
I know.
I think we actually it's likeintellectual humor too.
It is.
Like we're just idiots.
SPEAKER_00 (06:37):
I feel I feel like we're very lucky and have a lot
of funny people in our life.
SPEAKER_02 (06:43):
Truly.
SPEAKER_00 (06:44):
Don't you think?
SPEAKER_02 (06:44):
Oh, yeah.
Like, even like especially withlike how our experience this
week this weekend, like thiscollection of humans, and I just
didn't stop laughing.
And even beyond them, we have soI know it's great.
I'm gotta keep the people whoare around you laughing and then
laugh you laughing with them.
It's great.
SPEAKER_00 (07:04):
Um anyway, so back to our loyal listener, Mike.
SPEAKER_02 (07:06):
So he he is also known as the Prince of
Glassboro, born and raised inGlassboro, New Jersey.
Um, his degree is from RowanUniversity.
GoPro's GoPro.
Um, he currently um works in Iwould say upper management at a
worldwide betting company.
(07:27):
And he is one of my absolutebest friends.
And so he subbed in today inthis separate little interview
to help settle a debate that wehad.
Um, something that you broughtup two weeks ago in your first
Well, I don't know that it was adebate.
SPEAKER_00 (07:42):
It's a bit dramatic.
SPEAKER_02 (07:43):
I know I'm trying to set it up, you know.
Oh, yeah, yeah.
SPEAKER_00 (07:46):
That I have no idea what what you guys said.
SPEAKER_02 (07:50):
Well, we talked about Michelin.
Right.
And you knew what you were inyour maiden voyage of Nikki's
Corner.
What?
Was that a hmm because I cut youoff?
No.
Oh.
Um, in the maiden voyage ofNikki's Corner, we it's all
about restaurants.
And I was like, is this the sameas the the you know Pillsbury
doughboy looking guy who sellstires?
(08:11):
And you're like, no.
And it came to pass.
SPEAKER_00 (08:14):
Okay, you know why?
Because you always are likewaiting with baited breath for
like a stupid dad joke.
Yeah.
And I was like, no, this is justone of your stupid dad jokes.
SPEAKER_02 (08:28):
This one isn't but like I just got lucky.
SPEAKER_00 (08:30):
Then when I was like watching this stuff, like the
Michelin guy is up there.
But then I'm like, is this justa bit you know?
No, I guess I wasn't educatingmyself properly for Nikki's
corner, and for that, Iapologize to the good people,
and I'll do my due dil duediligence going forward.
SPEAKER_02 (08:50):
But boy, do we have a special treat for you.
So what you'll hear next is myone-on-one interview with Mike
Rosanski from his basement,where he listens to your checkup
podcast, and we discuss theMichelin lineage.
Enjoy.
(09:13):
Okay, so this is very exciting.
Uh, this is well, not how Iexpected this to happen, but we
have our first guest, and he'shere joining us.
We already heard hisintroduction.
Can we hear from our firstguest, Mike?
Do you have anything to say?
SPEAKER_01 (09:32):
Well, hi, hi, uh, your checkup listeners.
Uh, this is really an honor.
Um again, like Ed said, this isuh not something we planned.
SPEAKER_02 (09:41):
For anyone who's been listening over the course
of the last two weeks knows thatwe started a segment, Nikki's
Corner, and with her feeling alittle under the weather today
and having a limited role, Ineeded some backup for our
banter section.
And so I thought, who else tobring, who will better to bring
in than Mike?
(10:01):
Because he was the one whoinformed me about Michelin and
their lineage, the family story.
But maybe we can dive into alittle bit more about that.
What do you think, Mike?
SPEAKER_01 (10:13):
Yeah, no, I'm I'm happy to uh to educate the the
listeners on something that um Iknow a lot about.
I think I should start maybe bygiving my qualifications about
why I should be talking aboutthis then.
Do you think that's the one?
SPEAKER_02 (10:26):
Yeah, I think from your perspective, sure.
I'm going, yeah.
What tell me.
SPEAKER_01 (10:31):
Okay, so uh personally, I've never been to a
Michigan Star restaurant before.
Um I was curious about thistopic a couple years ago, and I
looked it up online.
So uh I will give some contextto the listeners.
Um, I had the opportunity toread back into it, but I'm gonna
(10:51):
go off of what I remember fromwhen I looked this up three
years ago.
SPEAKER_02 (10:55):
That's what we want.
That's really what we want.
SPEAKER_01 (10:58):
I think that's uh because your check-up is all
about you know having accurate,up-to-date information.
Your listeners are gonna learnsomething, so why not uh you
know just completely risk?
SPEAKER_02 (11:08):
Yeah, completely risk the reputation.
That's why we have two sections,you know, the banter section and
the educational section.
So um how it's like aneditorial.
Exactly.
How did we get from tires torestaurants?
SPEAKER_01 (11:25):
So that's that's a great question.
So uh Michelin started as a tirecompany, uh, as many people know
it today, uh, of course.
Uh there were two brothers thatowned it.
Uh it was a French tire company.
Now, this was early 1900s, Ibelieve, maybe, maybe late
1800s.
(11:45):
Not a lot of cars on the road atthat time, as you might recall.
I might recall.
Um so it was kind of tough.
And of course, people didn'thave things like Google Maps,
where uh you know you have theentire world at your disposal
and you know what's going on allover the place.
If someone wanted to travelsomewhere, you got to do a lot
of research.
(12:05):
So, what Michelin did was puttogether this free guide, uh,
and it was called the Michelinguide.
So uh people who own cars wereable to pick this up.
It has information about hotelsand, of course, restaurants.
Uh so for Michelin, it was kindof a way to say, like, hey, when
(12:25):
you're on your fun little roadtrips, here is a place that you
can stop.
Uh, and you know, if it happensto be a couple hundred miles
away and you get some work andcarry your tires, come come back
to Michelin.
We're gonna give you some moretime, right?
So you you can see why it was intheir interest to put this
together.
SPEAKER_02 (12:43):
I see it now.
SPEAKER_01 (12:44):
Well, yeah, and now eventually this thing really
took off.
Uh, and more and morerestaurants were vying to get
these Michelin recommendationsand Michelin stars.
Uh so Ed, do you know thedistinction between uh the
different uh Michelin accolades?
SPEAKER_02 (13:01):
I think oh no.
Um it is not something I'mconfident in.
Can you help us?
SPEAKER_01 (13:07):
Uh yeah, yeah, sure.
So again, uh I I can'tconfidently say it as well, but
there are there's the three.
I know there's the three stars.
Uh the one star is a great,great meal.
Now, relatively speaking, it isprobably like a one-star
(13:27):
Michelin restaurant is probablythe best meal most people have
ever had in their entire lives.
Wow.
Uh, but in the world of finedining, it's it's it's good,
right?
SPEAKER_02 (13:35):
Yeah.
SPEAKER_01 (13:36):
Uh and for Michelin, it's uh, hey, if you're on your
road trip and you see thisplace, it's worth a stop.
Two stars uh is kind ofexcellent food, uh, and they go
above and beyond other things,so the service is probably
great.
Three stars is basically forMichelin, is you should plan
your trip around this place.
(13:56):
Um, there's also Michelinrecommended places.
There is a French term for it.
I do not remember what that is.
I think it begins with a B.
So uh you might you can splicethis in if you look it up
afterwards.
Um, but that's essentially likesolid, solid value according to
the Michelin people.
So when they came to Philly, um,people might know Angelos uh uh
(14:20):
in uh on on South Street rightoff of South Street.
So they have great cheesesteaks,great pizzas.
They have this Michelindistinction.
So they don't have a star, butit's basically them giving their
props to Angeles and some otherplaces like that.
So yeah, fun uh fun enough.
Both the tire company and therestaurant people, the same
(14:40):
Michelin.
SPEAKER_02 (14:42):
Thank you so much for clearing up something that
gave our household such strifefor the last two weeks.
And now we understand.
And um, I'm seeing here a couplenew one-star restaurants in
Philadelphia.
You correct me if I'm wrong.
Um, Her Place Supper Club.
That's one cut that was uhbrought up in Nikki's corner two
(15:02):
weeks ago.
Is that correct?
SPEAKER_01 (15:04):
That is one of them, yep.
SPEAKER_02 (15:06):
Friday, Saturday, Sunday.
Is that another one?
SPEAKER_01 (15:09):
Another one, yeah.
And then the third should be oh,actually, I don't even know the
name of it.
I think it's a Korean placethough.
That's it.
That's it.
Uh I had actually never heard ofthat until they got their
Michelin star, which is reallycool.
Uh, because now I'm sure youknow they're they're blown up
and you probably can't get areservation there for two years.
(15:30):
But uh no, it's really cool tosee Philly, you know, have uh
you know the actual Michelinratings now because for so long
it's been known as this greatfood city, but now it's kind of
bigger on a national stage.
SPEAKER_02 (15:43):
Yeah, you I mean you and Karthik taught me the um I
don't know, he went to one inNew York and he was like, oh, I
finally I went to a Michelinrestaurant.
And I was like, I have no ideawhat that means.
And now it's taken over my lifeto some degree, so much so that
we have our first ever guest inan unexpected way on
unbelievable.
But I'm so grateful.
(16:04):
Thank you so much for your time.
I'm going to literally see youin probably three hours.
SPEAKER_01 (16:10):
But yeah, no, we are yeah, we are going to see the uh
the Sixers Lakers game.
SPEAKER_02 (16:16):
And we will no one will know because the episode
will be done by then, but it'llbe a good time had by y'all.
And it's just a Mike weekend,much like the restaurant Friday,
Saturday, and Sunday.
SPEAKER_01 (16:27):
Look at that.
Look at that.
Well, that's incredible.
Uh well, yeah, thank you againfor having me on.
SPEAKER_02 (16:34):
You are so welcome.
Thank you.
And I'm sure everyone is gonnabe, you know, so excited.
Share it with your family andfriends, and looking forward to
more.
SPEAKER_01 (16:45):
Yeah, and by the way, if you want any um health
tips from someone that does notwork in the healthcare industry,
uh, I'm I'm your guy.
Just, you know, I can make somestuff up about that too if you
want.
SPEAKER_02 (16:54):
We know where to find you.
We hope you have fun in yourbasement.
SPEAKER_01 (16:57):
This is getting cut.
This is getting cut.
Oh, thank you, Ed.
Thank you.
You are so welcome.
SPEAKER_02 (17:02):
All right, thank you, Mike.
So, what are we gonna talk abouttoday, Nick?
SPEAKER_00 (17:06):
Today we're talking about starting GLP One Med.
SPEAKER_02 (17:10):
Yeah, this is um since Nikki's feeling under the
weather, this is going to benotably a one-sided episode.
Um, but I recently got myobesity medicine certification.
And so now I have a little bitof uh credibility to back up the
things that I try to teachpeople.
Um, this episode is specificallymeant for people who are going
(17:33):
to be or starting to think abouttaking these medicines.
And I it's they're very powerfultools.
It is like wielding a chainsawpractically when it comes to
treatment of obesity.
And not everyone just getshanded a chainsaw.
You need a coach, you needsomeone who is right there with
you to help teach you how to usethat tool.
(17:56):
And so what I've been doingrecently is like having a very
scripted visit with people whenthey come back after prescribing
them.
And then I thought to myself,oh, well, what great fodder for
an episode.
And so for these next coupleminutes, what we're going to do
is talk about some of those tipsthat I go over in those visits.
And we will get started.
(18:18):
So these GLP1 receptor agonistmedications or otherwise called
they're always also callednutrient stimulating hormone
therapies, but they're notthat's not called that in the
common media.
These are they just go by thenames, brand names, uh Zeppbound
and Munjaro for the activeingredient terzepitide, and
(18:39):
Ozempic and Wagovi for theactive greedy uh the active
ingredient semaglite.
Um, they are once weeklyinjectable medications, most
commonly.
And what I've been finding isthat word injectable makes some
people feel immediatelyuncomfortable.
But there's some good news.
Um a lot of people end uptelling me like that was way
(19:01):
easier than I expected when theycome back and tell me how
they've been using the medicine.
Often you don't even see theneedle.
Um, they make these so simple asan auto injector pen.
And the way that it works, andthere are several videos from
the companies that make thesemedicines teaching people how to
use them.
And once you get the hang of it,it really is second nature.
(19:21):
Um, so you press the pen againstyour skin.
I usually tell people to gowithin two centimeters of their
belly button.
And you press that pen againstyour skin after cleaning the
area with an alcohol wipe, andyou hear you press the top and
you hear the first click and youkeep holding it there.
And then you hear the secondclick sometime after.
After that second click, you'redone.
(19:43):
But what's happening between thetwo clicks is the actual
mechanism of the pen isdelivering medicine inside in
the subcutaneous tissue.
And that's it.
It's once a week.
And you don't have to thinkabout this.
Actually, you do.
We're gonna talk about how muchyou have to think about.
It but practically speaking,moment to moment, that's it.
(20:05):
Rinse and repeat next week.
Some people choose to take it inthe morning, others at night.
Um, really, truly, there's noperfect time, but a lot of my
patients like nighttime dosingbecause if any nausea shows up,
they may sleep through it.
Um, they may sleep through theworst part of it.
And one another practicalimportant tip is that these
(20:26):
medicines should be stored inthe refrigerator to keep their
longevity.
So I mentioned nausea and whypeople might take it in the
evening to avoid that.
So here are a few tips to helpstave off nausea.
It happens to be one of the mostcommon side effects when people
are starting these medicines,especially early on or during
dose increases.
(20:46):
And there's a couple key ideasthat I want you to remember.
A lot of the nausea comes fromovereating while your stomach is
emptying more slowly for a shortperiod of time.
In general, these medicationswork mainly through appetite
hormones that get translatedthrough communication with the
brain in a very complicated way.
(21:08):
And early on, they also slow howfast food leaves your stomach.
So if you eat a normal portionsize the way you used to right
away, that stomach can feeloverfilled.
And that distension is when thenausea shows up.
And so the most practical tip tothink about is when you start
taking the medicines, cut yourportion size in half on purpose
(21:31):
ahead of time to try to avoidany of that.
Truly, like you can always goback for more if you want to,
but if you start with too much,you can't really undo that.
And then you get that full,heavy feeling, that distension
that may feel like nausea.
Many people also tend todescribe a feeling of prolonged
fullness, which is part of thenature of the medicine.
(21:53):
And they say things like, I atehours ago and I still feel full.
Early on, that's very commonwith the medicine.
That's fine and normal.
And it usually improves as yourbody adapts to the medicine.
So the next thing we're going totalk about is managing another
common side effect,constipation.
Um, this is very common.
It is very real, to becompletely honest, and it is
(22:14):
also fixable.
So if you are very proactive,you can prevent this using what
I'll describe as three ways.
Fiber is the first one.
To begin with, most people don'tget enough fiber throughout the
day, even before starting totake these medicines.
And so when people go on a GLP1receptor agonist, that's kind of
augmented and amplified.
(22:36):
Um, the upper limit of mostfiber goals should be about 35
grams per day.
And I would take a bet that alot of people don't get that.
And that's okay.
I also probably don't get that.
And an easy way to start doingthat is asking your doctor,
going to the pharmacy andgetting a fiber supplement.
It can be in a pill or there aresome powders out there that are
(22:58):
flavored or unflavored.
And you can just add them inuntil you find delicious foods
that you can add in that aremore reasonable and more overall
nutritious.
I'm thinking it doesn't have tobe boring, it could be things
like beans, berries, certainvegetables, whole grains, and
seeds all have a little morefiber, and like I said, it can
be delicious.
(23:19):
So the next thing is water.
Um, taking fiber without wateractually can make constipation
feeling bloating worse.
So the two things must gotogether.
So if you weren't doing thisbefore, you really should
prioritize hydration.
And the third is thatmedications, when needed, um,
there are medicines that canhelp with constipation.
(23:39):
Um, we have a whole episode onconstipation that you can refer
back to, but sometimes even withgood fiber and water, people
still struggle.
And so that's when the doctormay prescribe a medicine to help
your bowels move more regularly.
And this also goes hand in handwith the nausea as well.
Um, you know, at those doseinitiation or increases, a very
(24:00):
reasonable thing to ask is can Ihave a medicine that helps with
the nausea?
I don't think many people wouldhave a problem helping you out
if they commonly use thesemedicines.
But that's also another veryreasonable way when you're
getting used to using thesemedicines.
So the next tip is aboutmanaging muscle and a lot.
So these medicines are veryeffective at what is described
(24:24):
in the literature as total bodyweight loss.
Unfortunately, the mainlineclinical trials didn't look at
what percentage of the totalbody weight loss is from muscle.
Other reviews and things did,and we did a whole episode on
this, and we found that it's notthe majority.
It is some minority of the totalbody weight loss can be from
(24:49):
muscle.
We were also seeing things thatthe muscle quality could improve
on these medicines while theoverall lean mass reduces
because sometimes there's fatdistribution within the muscle
that gets cleared up with themedicines.
Um, this is an evolvingconversation, but in a practical
sense, to try to keep andmaintain as much muscle mass as
(25:12):
possible.
It is a daily adjustment.
So you use the medicine once aweek, but this is a daily
adjustment that needs to bemade.
And there are two things tothink about protein intake and
strength training.
So there are a few studies thatorganize and say about 1.3 grams
of protein per kilogram of idealbody weight per day, as long as
(25:35):
your kidneys can handle it.
That is something you probablyshould ask your doctor and not
just take from a guy you'relistening to on a podcast, even
though he's an obesity medicinespecialist.
Um, it doesn't need to beperfection, but I would say get
an idea of how much protein youhave in your diet.
If you're less than that andyou're starting these medicines,
there's probably some room forimprovement.
(25:55):
So it's not necessarily aboutthe exact numbers, but it's more
about concepts and things thatyou practically have every day
in the kitchen.
Like what meals are you havingfor breakfast, lunch, and dinner
and your snacks, and how are youspending your food?
While we're talking about food,the idea is to try to optimize
(26:16):
the whole nutrition, your wholenutrition as best as possible,
because these medicines in alarge way work by appetite
regulation.
It takes the entire bandwidth ofthe food you eat every day and
mutes it because you're going toeat less of it.
So it stands to reason that ifyour nutrition is suboptimal,
(26:36):
that you're going to just haveless of suboptimal nutrition,
which looks like more processedfoods, but and you know, more
processed foods that aren't sonutritious or more junk food.
So now is the time to reallythink about where you can have
more vegetables, where you canhave more lean proteins and keep
(26:58):
your diet well balanced, becausewe also find that many people
feel motivated to make thesechanges once they start these
medicines, which right now isjust an anecdotal thing.
Maybe we'll get more researchabout why that motivation
changes.
But that's something that wenotice.
People get the kick in the buttthey need.
And they're like, oh, I'm gonnastart making all of these
changes all together to improvemy health.
(27:19):
But to think about protein, moreconcepts than numbers.
Just try to improve and optimizethe amount that you have.
So while we're still talkingabout strength training and
muscle maintenance, what youshould probably know is that for
the average adult, it'srecommended across the board
that at least two days per weekof strength training is good for
(27:41):
your health.
But the for people on GLP1medicines, it is a good idea to
do more and probably at leastthree days per week.
And so that may be intimidating.
You could be someone who's like,oh, you know, I look in the
mirror and I'm like, I'm reallygetting started on this health
journey, but I don't strengthtrain at all.
It doesn't have to be fancy.
(28:02):
It can be bodyweight workouts,it could be dumbbells,
resistance bands, machines,even.
Um, some things you don't evenneed any equipment for.
It could be air squats, and youjust do three sets of 10 a few
times during the day.
That's a start.
It's not about the end goal.
It is about the day-to-dayprocess and the journey you're
on to improving your health.
(28:25):
You know, the reason muscle alsomatters is because it sends
powerful signals to yourmetabolism.
It helps with long-term weightmaintenance and protects against
weight regain.
It improves your energy, itimproves blood sugar control,
prevents you from gettinginjured and falls, and helps you
maintain your independence.
So maintaining muscle is a hugedeal when someone enters into
(28:50):
the like, I am starting to takea GLP1 receptor agonist for
whatever reason.
So that's muscle, superimportant.
And then the other thing that Ireally like to, you know, harp
on and let people know ahead oftime is that other medicines may
need to change.
It's critically important andyou know, unfortunately, too
(29:13):
often overlooked, especiallywhen someone goes online and
just gets their like justgetting the medicine from
someone, not someone who looksat their whole holistic health.
So as you lose weight, your bodycomposition changes.
And the need for othermedications may need to change
too.
I think of two really commonexamples.
(29:35):
I think of blood pressuremedications, and I think of
insulin and diabetesmedications.
If these aren't adjustedproperly as body composition
changes, it can lead to lowblood pressure, dizziness from
low blood pressure, falls fromlow blood pressure, or
hypoglycemia, which is also lowblood sugar.
(29:55):
And that is why follow-upmatters.
Because if the medication, thesemedications don't work in
isolation.
They affect everything.
And so if you are feelingthings, you should tell someone.
You should let your, let theperson who's prescribing your
medicines know.
Let your primary care doctor orwhoever you're whatever
clinician you're seeing knowthat you're feeling something.
(30:17):
Maybe they can offerreassurance.
Maybe it takes a visit.
But, you know, while people arestarting these medicines,
there's lots to think about.
There's a lot of moving parts.
They're very helpful.
They're groundbreakingpractically.
But we do need to make sure thatit's safe.
And that also goes with liketaking going too far, like if
someone's on too high a dose ofa medicine and loses too much
(30:39):
weight.
So there's always a sweet spot.
And like I said, we're dealingwith a chainsaw here.
Very powerful, but a veryimportant tool.
And so let's talk big takeaways.
The GLP1 receptor agonists arepowerful tools, and the best
results, the safest results,come when you pair the
medications with smart portionawareness, fiber and hydration,
(31:03):
protein and strength training,and close medication monitoring
of other things.
Truly, it's not aboutperfection.
It is about starting small,making day-to-day choices that
are more healthy for you thanless healthy.
So if you're starting one ofthese medications or thinking
about it, I want you to knowthat you are not behind, you're
(31:25):
not broken, you're not takingthe easy way out.
You are being treated for achronic disease with real
evidence-based medicine.
And if you found this episodehelpful, you can share it with
someone who's also just gettingstarted.
We have episodes about any sortof topic that you could imagine.
And if you want to hear anythingmore or less, please just let us
(31:45):
know.
So thank you for coming back toanother episode of Your Checkup.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
You can find us on Instagram.
You can send us an email at yourcheckuppod at gmail.com.
If you found this helpful, areview really does go a long way
for a like on whatever appyou're listening to us on.
(32:06):
But even if one person foundthis helpful, we feel like the
job got done.
So we hope you had some funtoday and learned something.
But most importantly, stayhealthy, my friends.
Until next time, I'm Ed Delesky.
SPEAKER_00 (32:16):
I'm Nicole Arifo.
SPEAKER_02 (32:17):
Thank you and goodbye.
SPEAKER_00 (32:18):
Bye.
SPEAKER_02 (32:25):
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.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(32:47):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
I am not your nurse.
And make sure you go get yourown checkup with your own
personal doctor.
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