July 11, 2025 • 30 mins
GLP-1s — they’ve been called the biggest breakthrough since Viagra, but their cultural impact may be even greater. What exactly are they, and how did they become such a game-changer in the world of health and wellness? Manny Munoz sits down with Dave Knapp, host of On The Pen podcast and author of Decoding GLP-1: A Guide for Friends and Family of Those On The Pen, to break it all down.
Then, as students prepare to head off to college, it’s the perfect time to talk about meningitis. Manny speaks with Dr. Aprel Barnes, a pediatrician, and John Grimes, a meningitis survivor, about what parents and students should know about this potentially life-threatening illness.
Then, as students prepare to head off to college, it’s the perfect time to talk about meningitis. Manny speaks with Dr. Aprel Barnes, a pediatrician, and John Grimes, a meningitis survivor, about what parents and students should know about this potentially life-threatening illness.
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Speaker 1 (00:01):
Welcome to iHeartRadio Communities, a public affairs special focusing on
the biggest issues in facting you this week.
Speaker 2 (00:09):
Here's Many Munio's and welcome to another edition of Iheartradios Communities.
As you heard, I am Manny Muno's and I would
love a follow from you on Instagram at iod manny
as my handle at iod m a n n Y.
GLP ones it's arguably the hottest drug since viagra, and
(00:32):
without a doubt, leaving a bigger influence on our country's
population and culture than viagra. But what is it and
how did it become such a phenomenon. We're joined by
Dave Nappio's The on the Pen podcast, the author of
Decoding GLP one, a guide for friends and family of
those on the Pen. Dave, I appreciate the time.
Speaker 3 (00:52):
Manny, I really appreciate the line and the opportunity to
talk a little bit about my favorite topic, and that
would be obese medicine and the topic of GLP one. Specifically,
the jingle that is in everybody's head and sort of
in the zeitgeist of America right now is the ozepic jingle.
Speaker 2 (01:10):
Yeah, well, let's talk about that, because I think most
of the listeners would recognize the GLP ones because of
those TV commercials, whether it's Ozepic or Majarro or whatever.
But what exactly is a GLP one.
Speaker 3 (01:24):
The great question. So, GLP one is a hormone that
your body releases in response to nutrient intakes. So, in
other words, when you eat food, there are cells in
your digestive tract that since the nutrients that you've eaten,
which sets off a cascade of hormonal release. And one
(01:47):
of those hormone classes is called incretin hormones, and GLP
one is the most prominent of the inencretin hormones. It
is responsible for stimulating the beta cells in your pancreas
to release insulin in response to that nutrient intake. It
slows down the rate at which your body digests food,
(02:09):
and then it actually acts in the part of your
brain that is responsible for satiety.
Speaker 2 (02:15):
There are differences between all of these though, right, all
of the different glp ones. What are the differences?
Speaker 3 (02:21):
Yeah, So, the earliest glp ones, contrary to what people
actually think, have been around for about twenty years. The
first one was called exenotide. Believe it or not. The
early researchers that were looking into GLP one hormones found
a peptide in the venom of a HeLa monster that
looked structurally very similar to native human GLP one. Native
(02:45):
human GLP one, which is something that can become disregulated
in the bodies of those living with the disease of
obesity and type two diabetes. There's actually an enzyme produced
by gut bacteria called DPP four that just lived to
the destroy that endogenous or native GLP one, and they
found that the half life of this peptide in the
(03:06):
HeLa monster venom lasted longer and was a little bit
more resistant to that DPP four. So they thought, if
we can isolate that turn it into a drug, we
might be able to help diabetics, and so the first
medication was exendant four or exendotide, and that was brought
to the market under the brand name Baieta, and I
believe Baieta was a twice daily shot, so it had
(03:27):
a very short half life, which led to the development
of other GLP ones. From Novo Nordis. They brought liri
glue tide, which was Saxenda, and Victoza for both diabetes
and obesity, respectively, because they learned that once you could
kind of control and regulate this hormone in the human body,
that it created an environment that was a little bit
(03:48):
more conducive to weight loss. The development of that led
to trillicity from Eli Lilly, which was the first once weekly.
So you see, the half life just starts to get
extended better that they can sort of hone and on
these peptids, which led to ozepic and wigov and ultimately
the new one that everyone's talking about, which is Munjaro
or the obesti version.
Speaker 2 (04:09):
Zep found what was it was there was there one moment,
Was there one thing which really you know, spurred this
thing to become the cultural phenomenon that it is in
our country, because I remember just a few years ago
there were times where people who actually needed it for
their diabetes to treat their diabetes couldn't get it because
so many other people were buying it up to use
(04:31):
it just to would lose weight.
Speaker 3 (04:33):
Yeah, their first indications were four type two diabetes, but
the greatest precursor to type two diabetes is that of obesity.
And so what they found was that if they could
help to regulate appetites in this sort of control center
in your brain. By essentially restoring that signaling in patients
(04:59):
who were obese, that they that they ended up being
able to lose a lot of weight. And so they
were brought to market initially as diabetes, but very quickly
brought to market for the treatment of obesity as well.
And yeah, there has been kind of this tug of
war because obesity is a problem they believe it or
not affects obesit or overweight effects one hundred million Americans
(05:21):
a loom, So you get a sense of the vast
size and scope of this issue that we're facing in
the country. And when you think about these injector pens,
the manufacturers that make these call them, you know, and
I'm quoting the CEO of Eli Lily, some of the
most complicated things on the planet to manufacture because there
are a lot of moving parts in these pens, and
(05:43):
of course everything has to remain sterile because you're injecting medication.
So they were really struggling to scale these drugs based
on their popularity at first, which kind of created this
tension between diabetic patients and patients living with obesity. But
of horse, for patients living with obesity who are able
to get their weight down, they greatly reduce their risk
(06:05):
of developing type two diabetes. In a recent clinical trial
that Eli Lilly ran ninety nine percent of pre diabetic
patients who were treated with Munjaro, which is it's GLP
one plus another incretin hormone that we talked about called
gip uh, ninety nine percent of the patients in that
trial did not develop type two diabetes. So you're seeing
(06:28):
an astounding probolaxis against diabetes, which if you look at
the numbers, cost our health care system a tremendous amount
of money.
Speaker 2 (06:36):
No question about it, and it's almost become a contest,
right you had. I think ozepic was the first really
really big one that blew up, and they you know,
on average people on that lost a certain amount of weight,
and then the Manjarro study came out saying well we
lose even more weight, and so people were switching those drugs.
We have a few more minutes here with Dave Knapp.
He hosts the on the Pen podcast. He's author of
(06:59):
the Cooing GLP Want a guide for friends and family
of those on the Pen. You've talked a lot about patients,
what inspired you to write this book. Did you have
some sort of personal journey that influenced you?
Speaker 3 (07:13):
So? I think the main thing for me, Manny, was
when I started creating content, I wanted to be able
to connect with information that was out there about these
medications and other people who were on the same journey.
And what I found very quickly was not everyone was
as willing to share their story because there's a great
deal of shame and stigma still tied to living with obesity.
(07:34):
You know, we've seen now from a scientific side that
obesity is a chronic, relapsing disease. There are a whole
cascade of metabolic issues that are presented with people living
with obesity. Part of the reason that you see people,
you know, gaining and relosing and gaining and relosing their
whole life because there is a biological element to it.
And once science started treating this as a disease, now
(07:55):
we have treatments that are effective that can actually you know,
put the disease into remission. But so many people still
believe that their moral failures. So many people believe that
people will judge them that they don't want to share.
And I know that the number one thing that can
combat the stigma associated with this is simply educating well
(08:16):
meaning people on the science of this stuff, and that
is really the heart behind the book, to allow people
to give this book if they are quote on the
pen if they give this book to their loved ones,
that their loved ones in a quick, you know, hour
two hour read can really get a handle on the
fact that it's quite an experience to live with the
(08:38):
disease of obesity, and that these treatments are just mimicking
basically biological things that happen naturally in our body that
are deficient in people living with these chronic diseases.
Speaker 2 (08:50):
Along those lines, what misconceptions do you find people have
about GLP ones.
Speaker 3 (08:58):
The biggest misconception I believe is that they are a
magic pill, that they are a magic silver bullet, and
that they are cheating people's way out of obesity. And
two things I would say there. First of all, these
are just a couple of hormones that these specific new
(09:19):
medications are targeting, but they're not going to be the
ticket for absolutely everyone living with obesity, because obesity is
an incredibly nuanced disease. There's genetics involved and deficiencies with
many hormones, but for many people they do work really well.
I think from the aspect of folks thinking that people
(09:42):
are cheating their way to being thin, I think there's
just a lack of understanding of the fact that people
living with obesity are really fighting against broken biology. There's
a disconnect between the gut and the brain brought on
by a combination of genetics brought on by a combination
of our toxic food environment and the things that we're
(10:03):
exposed to in the standard American diet that really serve
to you know, transform our gut and really interrupt that
gut brain connection via these hormones. And so these hormones
are simply designed to level the metabolic playing field and
give people a fighting chance with OBEs TOV they not
only get their weight down, but to keep it down.
Speaker 2 (10:25):
That being said, there is such too much of a
good thing is not necessarily a good thing, right, And
we have seen people where you just look at them
and they don't look well after obviously using this and
using it for too long.
Speaker 3 (10:40):
So that is I would say more associated with weight
loss in general. You see a lot of people who
you may use to be seeing at a certain weight,
all of a sudden within a six month period or
a twelve month period, they lose one hundred pounds. And
what happens is, you know, you lose a lot of
those fat deposits in your face or wherever you are
(11:02):
carrying that. But a lot of people will lose those
fat deposits in their face, which can lead, especially with
rapid weight loss, to a lot of loose and saggy skin,
which which for many people can give off the appearance
that they're ill or not well. You know. I would
say the biggest challenge with these medications as they proliferate
around the world is that they need to be accompanied
(11:26):
by very close and very communicative relationships between doctors and patients.
In other words, these medications ought not be prescribed and
then let people just sort of run wild with them.
They need to have that doctor patient supervision, not only
to make sure that the medication is working right, that
the proper dosage and titration schedule is followed, but to
(11:48):
make sure that weight is lost in a safe manner.
We want to get weight down in people who are
living with obesity, but we also want to manage some
things along the way. We don't want them to lose
weight at the expense of the loss of muscle mass
and then muscle tissue. That can happen if people aren't
taking these the right way, aren't supplementing with the right
nutrition and resistance training. So having that close patient doctor
(12:12):
relationship is going to be the key in making sure
that people who have access to these medications are actually
having long term benefits from their health and not just
dramatic weight loss for the sake of weight loss.
Speaker 2 (12:23):
Right that being said, because of the success of these
GLP one drugs, we have seen this explosion of somebody's
ability to just go online and you have a quote
virtual you know, medical consultation and then they just send
you the pens. Or you have all of these clinics
popping up with their own formulation of these drugs, which
(12:44):
I'm not sure how safe many of those are. Have
you found a concern for those kinds of things.
Speaker 3 (12:51):
My concern is more along the lines of just accessibility.
Like I mentioned an out of this interview, there are
one hundred million people in the United States who could
potentially benefit from treatment of obesity medicine that is never
going to be able to be met. That problem is
never going to be able to be met and addressed
(13:14):
given our current issues that we're having with staffing in clinics,
with staffing medical doctors and prescribers. We need technology to
scale and to advance to meet a problem that demands
it having that technology and that access to care scale
with what we just previously previously spoke about, the proper guidance,
(13:36):
the proper nutrition, the proper and the proper everything is keenly,
keenly important in this dynamic of this discussion, and so
I think my main concern is not necessarily with the
compounded versions, because the compounded versions are typically copies of
what's what the active pharmaceutical and ingredient is from the
(13:58):
branded medications. This is a whole other topic that we
could go down, and we do discuss it at length
on our substack, on our podcast, et cetera. So I
won't be labored here, but mainly, access to care is
to me the bigger issue besides the proliferation of online prescribing.
(14:19):
Of course, it can there are ways that it can
be done sure safely and ways it can be done
not so safely. But I think that that extrapolates out
to the brick and Mortar Clinic as much as it
does to the online community as well.
Speaker 2 (14:32):
In our final thirty seconds here, so what is the
next step in this whole GLP one process.
Speaker 3 (14:39):
Yeah, it's a great question. Right now we have really
great tools to get weight down, but what we don't
have are really great tools to get weight down and
do things like intentionally preserved muscle mass. And so the
future of obese medicine is looking at the quality of
weight loss in the terms of you want that weight
(15:01):
loss to come from fat, especially visceral fat. You don't
want to have it come in the form of lean
muscle mass and lean tissue. So future medications will target
this pinpoint this and that's exactly what we cover and
look forward to it.
Speaker 2 (15:15):
On the Pin is Dave Knapp, host of the On
the Pen podcast and the author of Decoding GLP one,
a guide for friends and family of those on the Pen. Dave,
I appreciate your time, best of luck with the.
Speaker 3 (15:29):
Book, Manny, my pleasure, thanks for having me.
Speaker 2 (15:31):
Just a reminder if you have any questions or comments,
you could follow me on Instagram at iod Manny is
my handle at iod m a n y meningitis. You've
likely heard the term, but do you know what it is?
Let's discuss it as we bring in doctor A. Pearl Barnes,
a pediatrician, and John Grimes, he's a meningitis survivor. I
(15:54):
appreciate you both for joining us. Thanks so much, great
to be here many Doctor Barnes. Let's start off with
I guess the simple question explain exactly what meningitis is
and how serious it could be.
Speaker 4 (16:08):
So, meningitis is an uncommon but serious bacterial infection that
can lead to long term complications and even depth, sometimes
within twenty four hours. So one in ten of those
that can trackt meningitis will die even with the proper treatment,
and one in five of the survivors can have long
term complications and that includes brain damage, hearing loss, or
(16:29):
lemb amputation, and so anything that a parent can do
talking to their physician about what vaccinations are available for
their team can help with helping to protect them against meningitis.
Speaker 2 (16:42):
There are different kinds of meningitis as well. Is that right.
Speaker 4 (16:46):
There is there's bacterial, there's viral. Any infectious disease can
cause meningitis, but the bacterial ones are particularly concerning, mainly
because even with the proper treatment, you can still die
as well as the long term complications that.
Speaker 3 (17:02):
You can have.
Speaker 2 (17:03):
John, you are not only an advocate and a speaker,
but you're a survivor of meningitis. Explained to me what
happened to you, how you dealt with it, and how
you are now.
Speaker 1 (17:15):
Well. Manny. I was nineteen years old as a sophomore
in college, and like I was a typical student, like
most teenagers, felt like I was ten feet tall and bulletproof.
And then I got sick and thought I had like
the flu or something. So I took some medicine and
went to bed and woke up eight days later in
(17:35):
the hospital. Wow, blind, disoriented, and more than just a
little lucky to be alive. Really, it was quite miraculous.
My fraternity brother found me on the floor in my
bedroom and I was immediately rushed to the hospital. So
I'm one of the lucky ones, Manny.
Speaker 2 (17:54):
Doctor Barnes, how do you how does somebody get meningiis?
First of all, I guess if it's viral or bacterial depends.
Speaker 4 (18:02):
Right, Yeah, it depends. And for a bacterial meningitis or
meninjoccle disease usuly, it's spread by a bacteria through commentine
behaviors actually, so kissing, coughing, sharing drinks, utensils, or living
in close quarters.
Speaker 2 (18:21):
What are some of the early symptoms that we should
watch for. John obviously had effects that were so strong
that he was just out and didn't wake up for
eight days. But other than the cold systems that the
symptoms that he mentioned, what are some of the usual
symptoms that we should watch out for.
Speaker 4 (18:38):
So they can have severe headache, they can have high fever,
they can have stiff necks as well as a rash
and sensitivity to light.
Speaker 2 (18:49):
And obviously, as in John's case, this could but this
could develop very quickly and warrant medical attention. Where is
that line? Because most of us might get a headache
or flu like symptoms, we're not going to run to
the doctor, much less the hospital.
Speaker 1 (19:05):
Yeah.
Speaker 4 (19:05):
So typically if there is a very severe headache, if
there's a sudden, very high fever, those would be reasons
to at least go to your primary care physician to see.
But if you get stiff neck, if you get sensitivity
to light, those are things that I would say go
to the marriage.
Speaker 1 (19:23):
The fever room.
Speaker 2 (19:23):
For John. What were you told after you recovered. After
you came to I guess after a daze about what
you'd been through and the fact that that you managed
to survive it and we're still alive.
Speaker 1 (19:38):
Well, I learned what meningitis was. That was the first
time I'd ever heard of meningitis. This is when I
emerged from the coma for eight days, But it was
a pretty foggy return, Manny. The first thing I saw
was darkness again. I was disoriented by the darkness. There
was a tube in my nose. I'd lost control of
(19:58):
all my muscles. Speaking was out of the question. I
was irritated, exhausted, confused. I didn't know what was going on,
so trying to explain meningitis to me at that time
it was not going to do anybody a good. But
since then, obviously I've learned quite quite a bit about it.
It's been over twenty eight years, but I've lived with
(20:19):
invisible disabilities since that day. I've lost most of my sight.
I have permanent neurological damage throughout my body, which includes
a bladder that doesn't function normally. So the emotional and
mental toll that it took on me, but really not
just me. It was my parents, my family and really
(20:39):
the community that had to rally around me to bring
me to where I am today, because we quickly realized
that survival wasn't the end of a journey, it was
just the beginning.
Speaker 2 (20:52):
Were all of these long lasting symptoms that you are
facing and still dealing with today so many years later?
Was that because you kind of passed out in your
room and weren't discovered because it wasn't treated quickly, or
is this something that everybody who contracts meningitis is at
risk of.
Speaker 1 (21:11):
Well, I can only speak in terms of my case.
I don't actually really even know the details of how
long I was unattended and unconscious for my roommates were
not I had roommates and they weren't there. When It's
kind of a long story, and I'm super interested in
talking about and telling it, but for purposes of the
time we have here, whatever happened to me happened between
(21:34):
the time that I took that medicine and went to
sleep and arrived at the hospital. Was diagnosed with menichcackle
meningitis through a spinal tap and then treated with the
appropriate antibiotics to stop it, so that I mean I
was treated within twenty four hours for meningitis. But I
(21:55):
was in a medically induced coma for my body to
eradicate the disease from my and then try to bring me.
Speaker 2 (22:02):
Back, doctor Barnes. Is there a certain age where kids
are more prone to contract meningitis than others? Is it everywhere?
From children to grown ups?
Speaker 4 (22:14):
So anybody can contract meningitis, but the sixteen to twenty
three age range those are particularly at risk from meningitis
B Why is that because of common teene behaviors that
they're doing in that sixteen to twenty three age range.
So they're kissing, they're coughing, they're sharing drinks and utensils,
and they're potentially living in close quarters like college dorms
(22:37):
and military.
Speaker 2 (22:38):
There there's a vaccine for meningitis, is there not?
Speaker 4 (22:44):
There are several different vaccinations that protect against the different strains.
There are five, ABC, W and Y, and so depending
on which strain you're trying to protect against, there are
vaccinations that protect against them.
Speaker 2 (22:58):
Yet, and are these Is this something that a teenageer
or somebody they go for their yearly checkup that a pediatrician,
a general practitioner would recommend that they get. Is it
part of the schedule.
Speaker 4 (23:13):
So typically it may be recommended based on the age
and based on the risk factors. But even if it
isn't brought up, I would say that a parent should
bring it up and ask what their teen's risk factors are,
if they've been vaccinated against meningitis, and if they are
vaccinations that they would be able to receive for it.
Speaker 2 (23:30):
And I imagine this is a good time of the
year for a parent to inquire about that, in between
school years or before kids go away to college.
Speaker 4 (23:39):
Absolutely, and sports seasons are starting as well, they're on buses.
I mean, it's just so many different factors and so
definitely back to school time is a really good time
to bring this up to your primary care physician or
medical professional to talk about that.
Speaker 2 (23:56):
A couple more minutes here with doctor a prol Barnes,
she's a pediatrician and John Grimes. He is actually a
survivor of meningitis who has shared some of the life
changing effects contracting the disease had on him. What made
you decide that you wanted to be such an advocate
and speaker for I guess meningitis vaccination as you.
Speaker 1 (24:20):
Kind of heard what it did to my life, Manny.
Nobody expects it, including me, and I had never heard
of it. So the more I can do to spread awareness,
to encourage people to have the conversations with their doctors
and their teens doctors, the fewer people and we're hoping
(24:40):
to get to zero that ever have to go through
something like what I'm going through today.
Speaker 2 (24:45):
As you've heard of you were listening to the conversation earlier,
potentially life threatening John almost lost his life. One in
ten people who contract meningitis will die despite appropriate treatment,
sometimes very quickly, with in twenty four hours. Doctor Barnes
tell me about this Ask to Be Sure campaign.
Speaker 4 (25:05):
So Ask to Be Sure started in twenty twenty one
just to provide awareness but also to armed parents with
the information that they needed to ask questions of their
medical professional about meningitis, vaccination, risk factors and ways that
they can help protect their team. So the website is
ask Ask number two letter be suresri dot com, and
(25:31):
on that website it has information about risk factors, about
meningitis itself and about the questions that parents can ask.
Speaker 2 (25:38):
You're a pediatrician in West Columbia, South Carolina. I'm sure
you are well aware of the increase in vaccine hesitancy
because of the pandemic, but we've seen less children getting
their usual scheduled vaccines. What are some of the things
you've had to deal with with trying to reassure parents
(25:59):
who might be has it about getting their kids vaccinated
for meningitis.
Speaker 4 (26:03):
So I really start with letting the parent know that
we are a team. It's me and the parent share
decision making, me providing information, the parent providing the final
say about what they would like to do. I ask
I answer any of the questions that the parents may have,
and really just providing information and just building relationship. I
(26:28):
think a lot of hesitancy comes from people getting different,
different information from a lot of different places, and so
just making sure that you have a good relationship with
your healthcare professional, someone that you can trust and ask
questions and, like I said, asked to be sure about meningitis,
vaccination and different things. Just to start the conversation.
Speaker 2 (26:52):
John, you mentioned that when you woke up after eight
days in the hospital, you'd never even heard of meningitis.
Do you think there's enough awareness, enough education about meningitis
in our community, in our country.
Speaker 1 (27:06):
Well, I think there can always be more. And I
think a great example of that is this movie pretty
hurts the Lifetime original. It is a very powerful way
of delivering poignant awareness and really shining a light on
meningitis awareness. And there's a scene in the movie that
is very emotional for me where the doctor is discussing
(27:30):
with the mother of the patients about meniged cockle disease.
And it's these types of stories, the stories that I share,
the stories that other survivors, other family members share, that
will get people talking and start the conversations that can
help prevent meningitis. I think this movie is a tremendous
(27:51):
way to do that.
Speaker 2 (27:52):
Doctor Barnes, the history of meningitis vaccines long and safe.
Speaker 4 (27:58):
We're here to talk about to take meningitis B. But
everything has risks and benefits, and so that's why it's
important to talk to your teen's doctor about what the
particular risk and benefits are for your particular team and
the best way to move forward.
Speaker 2 (28:13):
I always say, if you can't trust your doctor, who
can you trust? So let's close it out by what
advice you have specifically as a pediatrician for parents who
might be unsure about their children, or whether their kids
should be protected.
Speaker 4 (28:29):
I think the biggest advice I would say is you
know you are your team's major advocate, and you and
your healthcare professional, physician or otherwise you are a team
to help protect your team. So make sure that you
know what meningitis vaccinations your team has already had. Make
sure you know your team's risk factors and if there
(28:50):
are any vaccinations that they would be eligible to receive,
and then make sure you complete the series that you start,
whether for ACWY or for B I always.
Speaker 2 (29:00):
Say knowledge is power. Right. The website ask the number two,
the letter b sure dot com Ask to be sure
dot com and the movie is titled Pretty Hurts. It's
on Lifetime coming up Saturday, June twenty eighth at eight o'clock.
Doctor A Prelbarnes, pediatrician in South Carolina and John Grimes,
(29:21):
an advocate and survivor of meningitis. I thank you both
very much for your time for sharing your experience and
your knowledge, and John best of luck moving forward.
Speaker 1 (29:31):
Thanks Manny, great man.
Speaker 2 (29:34):
As always, I'd love a follow on Instagram and I
follow back at iod Manny is my handle at iod
m A n n Y and that'll do it. For
another edition of Iheartradios Communities. I'm Manny Muno's until next time.
Welcome to iHeartRadio Communities, a public affairs special focusing on
the biggest issues in facting you this week.
Speaker 2 (00:09):
Here's Many Munio's and welcome to another edition of Iheartradios Communities.
As you heard, I am Manny Muno's and I would
love a follow from you on Instagram at iod manny
as my handle at iod m a n n Y.
GLP ones it's arguably the hottest drug since viagra, and
(00:32):
without a doubt, leaving a bigger influence on our country's
population and culture than viagra. But what is it and
how did it become such a phenomenon. We're joined by
Dave Nappio's The on the Pen podcast, the author of
Decoding GLP one, a guide for friends and family of
those on the Pen. Dave, I appreciate the time.
Speaker 3 (00:52):
Manny, I really appreciate the line and the opportunity to
talk a little bit about my favorite topic, and that
would be obese medicine and the topic of GLP one. Specifically,
the jingle that is in everybody's head and sort of
in the zeitgeist of America right now is the ozepic jingle.
Speaker 2 (01:10):
Yeah, well, let's talk about that, because I think most
of the listeners would recognize the GLP ones because of
those TV commercials, whether it's Ozepic or Majarro or whatever.
But what exactly is a GLP one.
Speaker 3 (01:24):
The great question. So, GLP one is a hormone that
your body releases in response to nutrient intakes. So, in
other words, when you eat food, there are cells in
your digestive tract that since the nutrients that you've eaten,
which sets off a cascade of hormonal release. And one
(01:47):
of those hormone classes is called incretin hormones, and GLP
one is the most prominent of the inencretin hormones. It
is responsible for stimulating the beta cells in your pancreas
to release insulin in response to that nutrient intake. It
slows down the rate at which your body digests food,
(02:09):
and then it actually acts in the part of your
brain that is responsible for satiety.
Speaker 2 (02:15):
There are differences between all of these though, right, all
of the different glp ones. What are the differences?
Speaker 3 (02:21):
Yeah, So, the earliest glp ones, contrary to what people
actually think, have been around for about twenty years. The
first one was called exenotide. Believe it or not. The
early researchers that were looking into GLP one hormones found
a peptide in the venom of a HeLa monster that
looked structurally very similar to native human GLP one. Native
(02:45):
human GLP one, which is something that can become disregulated
in the bodies of those living with the disease of
obesity and type two diabetes. There's actually an enzyme produced
by gut bacteria called DPP four that just lived to
the destroy that endogenous or native GLP one, and they
found that the half life of this peptide in the
(03:06):
HeLa monster venom lasted longer and was a little bit
more resistant to that DPP four. So they thought, if
we can isolate that turn it into a drug, we
might be able to help diabetics, and so the first
medication was exendant four or exendotide, and that was brought
to the market under the brand name Baieta, and I
believe Baieta was a twice daily shot, so it had
(03:27):
a very short half life, which led to the development
of other GLP ones. From Novo Nordis. They brought liri
glue tide, which was Saxenda, and Victoza for both diabetes
and obesity, respectively, because they learned that once you could
kind of control and regulate this hormone in the human body,
that it created an environment that was a little bit
(03:48):
more conducive to weight loss. The development of that led
to trillicity from Eli Lilly, which was the first once weekly.
So you see, the half life just starts to get
extended better that they can sort of hone and on
these peptids, which led to ozepic and wigov and ultimately
the new one that everyone's talking about, which is Munjaro
or the obesti version.
Speaker 2 (04:09):
Zep found what was it was there was there one moment,
Was there one thing which really you know, spurred this
thing to become the cultural phenomenon that it is in
our country, because I remember just a few years ago
there were times where people who actually needed it for
their diabetes to treat their diabetes couldn't get it because
so many other people were buying it up to use
(04:31):
it just to would lose weight.
Speaker 3 (04:33):
Yeah, their first indications were four type two diabetes, but
the greatest precursor to type two diabetes is that of obesity.
And so what they found was that if they could
help to regulate appetites in this sort of control center
in your brain. By essentially restoring that signaling in patients
(04:59):
who were obese, that they that they ended up being
able to lose a lot of weight. And so they
were brought to market initially as diabetes, but very quickly
brought to market for the treatment of obesity as well.
And yeah, there has been kind of this tug of
war because obesity is a problem they believe it or
not affects obesit or overweight effects one hundred million Americans
(05:21):
a loom, So you get a sense of the vast
size and scope of this issue that we're facing in
the country. And when you think about these injector pens,
the manufacturers that make these call them, you know, and
I'm quoting the CEO of Eli Lily, some of the
most complicated things on the planet to manufacture because there
are a lot of moving parts in these pens, and
(05:43):
of course everything has to remain sterile because you're injecting medication.
So they were really struggling to scale these drugs based
on their popularity at first, which kind of created this
tension between diabetic patients and patients living with obesity. But
of horse, for patients living with obesity who are able
to get their weight down, they greatly reduce their risk
(06:05):
of developing type two diabetes. In a recent clinical trial
that Eli Lilly ran ninety nine percent of pre diabetic
patients who were treated with Munjaro, which is it's GLP
one plus another incretin hormone that we talked about called
gip uh, ninety nine percent of the patients in that
trial did not develop type two diabetes. So you're seeing
(06:28):
an astounding probolaxis against diabetes, which if you look at
the numbers, cost our health care system a tremendous amount
of money.
Speaker 2 (06:36):
No question about it, and it's almost become a contest,
right you had. I think ozepic was the first really
really big one that blew up, and they you know,
on average people on that lost a certain amount of weight,
and then the Manjarro study came out saying well we
lose even more weight, and so people were switching those drugs.
We have a few more minutes here with Dave Knapp.
He hosts the on the Pen podcast. He's author of
(06:59):
the Cooing GLP Want a guide for friends and family
of those on the Pen. You've talked a lot about patients,
what inspired you to write this book. Did you have
some sort of personal journey that influenced you?
Speaker 3 (07:13):
So? I think the main thing for me, Manny, was
when I started creating content, I wanted to be able
to connect with information that was out there about these
medications and other people who were on the same journey.
And what I found very quickly was not everyone was
as willing to share their story because there's a great
deal of shame and stigma still tied to living with obesity.
(07:34):
You know, we've seen now from a scientific side that
obesity is a chronic, relapsing disease. There are a whole
cascade of metabolic issues that are presented with people living
with obesity. Part of the reason that you see people,
you know, gaining and relosing and gaining and relosing their
whole life because there is a biological element to it.
And once science started treating this as a disease, now
(07:55):
we have treatments that are effective that can actually you know,
put the disease into remission. But so many people still
believe that their moral failures. So many people believe that
people will judge them that they don't want to share.
And I know that the number one thing that can
combat the stigma associated with this is simply educating well
(08:16):
meaning people on the science of this stuff, and that
is really the heart behind the book, to allow people
to give this book if they are quote on the
pen if they give this book to their loved ones,
that their loved ones in a quick, you know, hour
two hour read can really get a handle on the
fact that it's quite an experience to live with the
(08:38):
disease of obesity, and that these treatments are just mimicking
basically biological things that happen naturally in our body that
are deficient in people living with these chronic diseases.
Speaker 2 (08:50):
Along those lines, what misconceptions do you find people have
about GLP ones.
Speaker 3 (08:58):
The biggest misconception I believe is that they are a
magic pill, that they are a magic silver bullet, and
that they are cheating people's way out of obesity. And
two things I would say there. First of all, these
are just a couple of hormones that these specific new
(09:19):
medications are targeting, but they're not going to be the
ticket for absolutely everyone living with obesity, because obesity is
an incredibly nuanced disease. There's genetics involved and deficiencies with
many hormones, but for many people they do work really well.
I think from the aspect of folks thinking that people
(09:42):
are cheating their way to being thin, I think there's
just a lack of understanding of the fact that people
living with obesity are really fighting against broken biology. There's
a disconnect between the gut and the brain brought on
by a combination of genetics brought on by a combination
of our toxic food environment and the things that we're
(10:03):
exposed to in the standard American diet that really serve
to you know, transform our gut and really interrupt that
gut brain connection via these hormones. And so these hormones
are simply designed to level the metabolic playing field and
give people a fighting chance with OBEs TOV they not
only get their weight down, but to keep it down.
Speaker 2 (10:25):
That being said, there is such too much of a
good thing is not necessarily a good thing, right, And
we have seen people where you just look at them
and they don't look well after obviously using this and
using it for too long.
Speaker 3 (10:40):
So that is I would say more associated with weight
loss in general. You see a lot of people who
you may use to be seeing at a certain weight,
all of a sudden within a six month period or
a twelve month period, they lose one hundred pounds. And
what happens is, you know, you lose a lot of
those fat deposits in your face or wherever you are
(11:02):
carrying that. But a lot of people will lose those
fat deposits in their face, which can lead, especially with
rapid weight loss, to a lot of loose and saggy skin,
which which for many people can give off the appearance
that they're ill or not well. You know. I would
say the biggest challenge with these medications as they proliferate
around the world is that they need to be accompanied
(11:26):
by very close and very communicative relationships between doctors and patients.
In other words, these medications ought not be prescribed and
then let people just sort of run wild with them.
They need to have that doctor patient supervision, not only
to make sure that the medication is working right, that
the proper dosage and titration schedule is followed, but to
(11:48):
make sure that weight is lost in a safe manner.
We want to get weight down in people who are
living with obesity, but we also want to manage some
things along the way. We don't want them to lose
weight at the expense of the loss of muscle mass
and then muscle tissue. That can happen if people aren't
taking these the right way, aren't supplementing with the right
nutrition and resistance training. So having that close patient doctor
(12:12):
relationship is going to be the key in making sure
that people who have access to these medications are actually
having long term benefits from their health and not just
dramatic weight loss for the sake of weight loss.
Speaker 2 (12:23):
Right that being said, because of the success of these
GLP one drugs, we have seen this explosion of somebody's
ability to just go online and you have a quote
virtual you know, medical consultation and then they just send
you the pens. Or you have all of these clinics
popping up with their own formulation of these drugs, which
(12:44):
I'm not sure how safe many of those are. Have
you found a concern for those kinds of things.
Speaker 3 (12:51):
My concern is more along the lines of just accessibility.
Like I mentioned an out of this interview, there are
one hundred million people in the United States who could
potentially benefit from treatment of obesity medicine that is never
going to be able to be met. That problem is
never going to be able to be met and addressed
(13:14):
given our current issues that we're having with staffing in clinics,
with staffing medical doctors and prescribers. We need technology to
scale and to advance to meet a problem that demands
it having that technology and that access to care scale
with what we just previously previously spoke about, the proper guidance,
(13:36):
the proper nutrition, the proper and the proper everything is keenly,
keenly important in this dynamic of this discussion, and so
I think my main concern is not necessarily with the
compounded versions, because the compounded versions are typically copies of
what's what the active pharmaceutical and ingredient is from the
(13:58):
branded medications. This is a whole other topic that we
could go down, and we do discuss it at length
on our substack, on our podcast, et cetera. So I
won't be labored here, but mainly, access to care is
to me the bigger issue besides the proliferation of online prescribing.
(14:19):
Of course, it can there are ways that it can
be done sure safely and ways it can be done
not so safely. But I think that that extrapolates out
to the brick and Mortar Clinic as much as it
does to the online community as well.
Speaker 2 (14:32):
In our final thirty seconds here, so what is the
next step in this whole GLP one process.
Speaker 3 (14:39):
Yeah, it's a great question. Right now we have really
great tools to get weight down, but what we don't
have are really great tools to get weight down and
do things like intentionally preserved muscle mass. And so the
future of obese medicine is looking at the quality of
weight loss in the terms of you want that weight
(15:01):
loss to come from fat, especially visceral fat. You don't
want to have it come in the form of lean
muscle mass and lean tissue. So future medications will target
this pinpoint this and that's exactly what we cover and
look forward to it.
Speaker 2 (15:15):
On the Pin is Dave Knapp, host of the On
the Pen podcast and the author of Decoding GLP one,
a guide for friends and family of those on the Pen. Dave,
I appreciate your time, best of luck with the.
Speaker 3 (15:29):
Book, Manny, my pleasure, thanks for having me.
Speaker 2 (15:31):
Just a reminder if you have any questions or comments,
you could follow me on Instagram at iod Manny is
my handle at iod m a n y meningitis. You've
likely heard the term, but do you know what it is?
Let's discuss it as we bring in doctor A. Pearl Barnes,
a pediatrician, and John Grimes, he's a meningitis survivor. I
(15:54):
appreciate you both for joining us. Thanks so much, great
to be here many Doctor Barnes. Let's start off with
I guess the simple question explain exactly what meningitis is
and how serious it could be.
Speaker 4 (16:08):
So, meningitis is an uncommon but serious bacterial infection that
can lead to long term complications and even depth, sometimes
within twenty four hours. So one in ten of those
that can trackt meningitis will die even with the proper treatment,
and one in five of the survivors can have long
term complications and that includes brain damage, hearing loss, or
(16:29):
lemb amputation, and so anything that a parent can do
talking to their physician about what vaccinations are available for
their team can help with helping to protect them against meningitis.
Speaker 2 (16:42):
There are different kinds of meningitis as well. Is that right.
Speaker 4 (16:46):
There is there's bacterial, there's viral. Any infectious disease can
cause meningitis, but the bacterial ones are particularly concerning, mainly
because even with the proper treatment, you can still die
as well as the long term complications that.
Speaker 3 (17:02):
You can have.
Speaker 2 (17:03):
John, you are not only an advocate and a speaker,
but you're a survivor of meningitis. Explained to me what
happened to you, how you dealt with it, and how
you are now.
Speaker 1 (17:15):
Well. Manny. I was nineteen years old as a sophomore
in college, and like I was a typical student, like
most teenagers, felt like I was ten feet tall and bulletproof.
And then I got sick and thought I had like
the flu or something. So I took some medicine and
went to bed and woke up eight days later in
(17:35):
the hospital. Wow, blind, disoriented, and more than just a
little lucky to be alive. Really, it was quite miraculous.
My fraternity brother found me on the floor in my
bedroom and I was immediately rushed to the hospital. So
I'm one of the lucky ones, Manny.
Speaker 2 (17:54):
Doctor Barnes, how do you how does somebody get meningiis?
First of all, I guess if it's viral or bacterial depends.
Speaker 4 (18:02):
Right, Yeah, it depends. And for a bacterial meningitis or
meninjoccle disease usuly, it's spread by a bacteria through commentine
behaviors actually, so kissing, coughing, sharing drinks, utensils, or living
in close quarters.
Speaker 2 (18:21):
What are some of the early symptoms that we should
watch for. John obviously had effects that were so strong
that he was just out and didn't wake up for
eight days. But other than the cold systems that the
symptoms that he mentioned, what are some of the usual
symptoms that we should watch out for.
Speaker 4 (18:38):
So they can have severe headache, they can have high fever,
they can have stiff necks as well as a rash
and sensitivity to light.
Speaker 2 (18:49):
And obviously, as in John's case, this could but this
could develop very quickly and warrant medical attention. Where is
that line? Because most of us might get a headache
or flu like symptoms, we're not going to run to
the doctor, much less the hospital.
Speaker 1 (19:05):
Yeah.
Speaker 4 (19:05):
So typically if there is a very severe headache, if
there's a sudden, very high fever, those would be reasons
to at least go to your primary care physician to see.
But if you get stiff neck, if you get sensitivity
to light, those are things that I would say go
to the marriage.
Speaker 1 (19:23):
The fever room.
Speaker 2 (19:23):
For John. What were you told after you recovered. After
you came to I guess after a daze about what
you'd been through and the fact that that you managed
to survive it and we're still alive.
Speaker 1 (19:38):
Well, I learned what meningitis was. That was the first
time I'd ever heard of meningitis. This is when I
emerged from the coma for eight days, But it was
a pretty foggy return, Manny. The first thing I saw
was darkness again. I was disoriented by the darkness. There
was a tube in my nose. I'd lost control of
(19:58):
all my muscles. Speaking was out of the question. I
was irritated, exhausted, confused. I didn't know what was going on,
so trying to explain meningitis to me at that time
it was not going to do anybody a good. But
since then, obviously I've learned quite quite a bit about it.
It's been over twenty eight years, but I've lived with
(20:19):
invisible disabilities since that day. I've lost most of my sight.
I have permanent neurological damage throughout my body, which includes
a bladder that doesn't function normally. So the emotional and
mental toll that it took on me, but really not
just me. It was my parents, my family and really
(20:39):
the community that had to rally around me to bring
me to where I am today, because we quickly realized
that survival wasn't the end of a journey, it was
just the beginning.
Speaker 2 (20:52):
Were all of these long lasting symptoms that you are
facing and still dealing with today so many years later?
Was that because you kind of passed out in your
room and weren't discovered because it wasn't treated quickly, or
is this something that everybody who contracts meningitis is at
risk of.
Speaker 1 (21:11):
Well, I can only speak in terms of my case.
I don't actually really even know the details of how
long I was unattended and unconscious for my roommates were
not I had roommates and they weren't there. When It's
kind of a long story, and I'm super interested in
talking about and telling it, but for purposes of the
time we have here, whatever happened to me happened between
(21:34):
the time that I took that medicine and went to
sleep and arrived at the hospital. Was diagnosed with menichcackle
meningitis through a spinal tap and then treated with the
appropriate antibiotics to stop it, so that I mean I
was treated within twenty four hours for meningitis. But I
(21:55):
was in a medically induced coma for my body to
eradicate the disease from my and then try to bring me.
Speaker 2 (22:02):
Back, doctor Barnes. Is there a certain age where kids
are more prone to contract meningitis than others? Is it everywhere?
From children to grown ups?
Speaker 4 (22:14):
So anybody can contract meningitis, but the sixteen to twenty
three age range those are particularly at risk from meningitis
B Why is that because of common teene behaviors that
they're doing in that sixteen to twenty three age range.
So they're kissing, they're coughing, they're sharing drinks and utensils,
and they're potentially living in close quarters like college dorms
(22:37):
and military.
Speaker 2 (22:38):
There there's a vaccine for meningitis, is there not?
Speaker 4 (22:44):
There are several different vaccinations that protect against the different strains.
There are five, ABC, W and Y, and so depending
on which strain you're trying to protect against, there are
vaccinations that protect against them.
Speaker 2 (22:58):
Yet, and are these Is this something that a teenageer
or somebody they go for their yearly checkup that a pediatrician,
a general practitioner would recommend that they get. Is it
part of the schedule.
Speaker 4 (23:13):
So typically it may be recommended based on the age
and based on the risk factors. But even if it
isn't brought up, I would say that a parent should
bring it up and ask what their teen's risk factors are,
if they've been vaccinated against meningitis, and if they are
vaccinations that they would be able to receive for it.
Speaker 2 (23:30):
And I imagine this is a good time of the
year for a parent to inquire about that, in between
school years or before kids go away to college.
Speaker 4 (23:39):
Absolutely, and sports seasons are starting as well, they're on buses.
I mean, it's just so many different factors and so
definitely back to school time is a really good time
to bring this up to your primary care physician or
medical professional to talk about that.
Speaker 2 (23:56):
A couple more minutes here with doctor a prol Barnes,
she's a pediatrician and John Grimes. He is actually a
survivor of meningitis who has shared some of the life
changing effects contracting the disease had on him. What made
you decide that you wanted to be such an advocate
and speaker for I guess meningitis vaccination as you.
Speaker 1 (24:20):
Kind of heard what it did to my life, Manny.
Nobody expects it, including me, and I had never heard
of it. So the more I can do to spread awareness,
to encourage people to have the conversations with their doctors
and their teens doctors, the fewer people and we're hoping
(24:40):
to get to zero that ever have to go through
something like what I'm going through today.
Speaker 2 (24:45):
As you've heard of you were listening to the conversation earlier,
potentially life threatening John almost lost his life. One in
ten people who contract meningitis will die despite appropriate treatment,
sometimes very quickly, with in twenty four hours. Doctor Barnes
tell me about this Ask to Be Sure campaign.
Speaker 4 (25:05):
So Ask to Be Sure started in twenty twenty one
just to provide awareness but also to armed parents with
the information that they needed to ask questions of their
medical professional about meningitis, vaccination, risk factors and ways that
they can help protect their team. So the website is
ask Ask number two letter be suresri dot com, and
(25:31):
on that website it has information about risk factors, about
meningitis itself and about the questions that parents can ask.
Speaker 2 (25:38):
You're a pediatrician in West Columbia, South Carolina. I'm sure
you are well aware of the increase in vaccine hesitancy
because of the pandemic, but we've seen less children getting
their usual scheduled vaccines. What are some of the things
you've had to deal with with trying to reassure parents
(25:59):
who might be has it about getting their kids vaccinated
for meningitis.
Speaker 4 (26:03):
So I really start with letting the parent know that
we are a team. It's me and the parent share
decision making, me providing information, the parent providing the final
say about what they would like to do. I ask
I answer any of the questions that the parents may have,
and really just providing information and just building relationship. I
(26:28):
think a lot of hesitancy comes from people getting different,
different information from a lot of different places, and so
just making sure that you have a good relationship with
your healthcare professional, someone that you can trust and ask
questions and, like I said, asked to be sure about meningitis,
vaccination and different things. Just to start the conversation.
Speaker 2 (26:52):
John, you mentioned that when you woke up after eight
days in the hospital, you'd never even heard of meningitis.
Do you think there's enough awareness, enough education about meningitis
in our community, in our country.
Speaker 1 (27:06):
Well, I think there can always be more. And I
think a great example of that is this movie pretty
hurts the Lifetime original. It is a very powerful way
of delivering poignant awareness and really shining a light on
meningitis awareness. And there's a scene in the movie that
is very emotional for me where the doctor is discussing
(27:30):
with the mother of the patients about meniged cockle disease.
And it's these types of stories, the stories that I share,
the stories that other survivors, other family members share, that
will get people talking and start the conversations that can
help prevent meningitis. I think this movie is a tremendous
(27:51):
way to do that.
Speaker 2 (27:52):
Doctor Barnes, the history of meningitis vaccines long and safe.
Speaker 4 (27:58):
We're here to talk about to take meningitis B. But
everything has risks and benefits, and so that's why it's
important to talk to your teen's doctor about what the
particular risk and benefits are for your particular team and
the best way to move forward.
Speaker 2 (28:13):
I always say, if you can't trust your doctor, who
can you trust? So let's close it out by what
advice you have specifically as a pediatrician for parents who
might be unsure about their children, or whether their kids
should be protected.
Speaker 4 (28:29):
I think the biggest advice I would say is you
know you are your team's major advocate, and you and
your healthcare professional, physician or otherwise you are a team
to help protect your team. So make sure that you
know what meningitis vaccinations your team has already had. Make
sure you know your team's risk factors and if there
(28:50):
are any vaccinations that they would be eligible to receive,
and then make sure you complete the series that you start,
whether for ACWY or for B I always.
Speaker 2 (29:00):
Say knowledge is power. Right. The website ask the number two,
the letter b sure dot com Ask to be sure
dot com and the movie is titled Pretty Hurts. It's
on Lifetime coming up Saturday, June twenty eighth at eight o'clock.
Doctor A Prelbarnes, pediatrician in South Carolina and John Grimes,
(29:21):
an advocate and survivor of meningitis. I thank you both
very much for your time for sharing your experience and
your knowledge, and John best of luck moving forward.
Speaker 1 (29:31):
Thanks Manny, great man.
Speaker 2 (29:34):
As always, I'd love a follow on Instagram and I
follow back at iod Manny is my handle at iod
m A n n Y and that'll do it. For
another edition of Iheartradios Communities. I'm Manny Muno's until next time.
Host
Manny Munoz
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