Let’s talk about Ozempic

April 7, 2023

 

Episode 89 | 04 April 2023

On this episode of the Alix Turoff Nutrition podcast, Alix is back with a new season!

She starts the season off with a bang by talking about the medication that’s on everyone’s mind… Ozempic. She also discussed Mounjaro (tirzepatide). She’s talking about everything from how these medications work, who they might be appropriate for, and the social media storm surrounding them.

Speaker 1 (00:04):

Hello everyone. I’m back with a new season of the podcast. My hiatus was longer than expected and I’m gonna fill you in on why that is now, and we’ll be talking more about this as time goes on because I really want to get to the topic of the day, which if you saw the episode title you already know. And I know you guys really, really, really wanna talk about this. I haven’t talked about this anywhere else, aside from in my one-on-one coaching programs with my clients, because it’s a safe container there. I haven’t put anything out into the social media dumpster fire. But I’m doing it here on the podcast because on the podcast we can go into things in more detail. And I know all of you who listen really like the details and that’s why you’re here. So before we jump into the Ozempic episode… where have I been? 

Speaker 1 (01:01):

Back in November, my dad’s kidney function was starting to decline. We knew that his kidneys were failing for a little bit now. But as a family, I don’t think we were as aware of how soon that could happen and what that really meant. As a healthcare professional, I have worked in a dialysis setting, I’ve worked in a renal setting, I’ve taken courses on chronic kidney disease. So I’d like to think I had more knowledge than the rest of my family and more knowledge than the general population. My husband’s a physician. He actually can put dialysis access in for a patient, but when it’s your own family, it’s different. SAnd I’m gonna get to why this is relevant  throughout this episode, but long story short, my dad wound up needing emergency dialysis starting in November, a little bit before Thanksgiving. 

Speaker 1 (02:05):

He was hospitalized twice in a row and had a quite lengthy hospital stay of about 10 days each. The first time he was discharged home and we were going to start making arrangements for dialysis. And before we could even get anything off the ground, he was back in the hospital. And this time his labs were just so bad that they were going to have to start emergency dialysis. Why emergency dialysis? Because he did not have a decision made prior to this about whether he was going to do hemodialysis or peritoneal or whether he was going to be doing in clinic or home. None of this was decided. And for any of you with parents, you know how they are. Everything is so nonchalant, they don’t tell you the scary things that are going on because they don’t want to scare you. 

Speaker 1 (03:01):

But in hindsight, and the reason I’m talking about this is because I’ve had so many amazing conversations since I’ve shared some of this. I want people to be more proactive and so many people struggle with chronic kidney disease or acute kidney disease, or any combination of things that might require dialysis. And the numbers are staggering as to how many people start dialysis and require emergency dialysis. And it is just so much more traumatic than it has to be. If you are ready and you are in end stage kidney failure, you know you’re going to have to start dialysis at some point. I just wish that physicians made it more clear what needs to be done to prepare you. But that is another topic. Either way, when we found out he was in the hospital, they were dialyzing him. And while awful, it’s an incredible thing that we have this technology and science…it’s a lifesaver. 

Speaker 1 (04:04):

It’s amazing, but it was still really traumatic for our family. A day later, after he is admitted to the hospital, he goes for an angiogram. So as part of the process of getting on the kidney transplant list, you have to first go for an angiogram. And in that angiogram they found that he had a couple major blockages in his heart and was going to require quintuple bypass surgery. So we got the news about the dialysis, and then two days later he’s going in for open heart surgery on top of it. And it was a lot, it was really scary. It was traumatic, it was emotional, and we had to kind of come to terms with the fact that things were going to change. So he’s been on dialysis for the last five months. He was going in center hemodialysis for this period of time, and it was really, really starting to get to him. 

Speaker 1 (05:07):

I mean, feeling like absolute crap all the time. Really, really just not positive. The only positive thing wass that it was keeping him alive, which is incredible. But, you know,  there’s all that sort of existential conversation about like, is this the rest of my life? And it’s a major thing. So, long story short, last week we found out that he was off the kidney transplant list and that a kidney was ready for him at NYU. And the way the transplant list works is you have to be ready to jump at any moment. You have to pick up your phone at all times. And I get like bajillion spam calls, so I never pick up my phone if I don’t know the number. But when you’re on the transplant list you have to pick up your phone to everyone.

Speaker 1 (06:
00):

You never know when it’s gonna be that call that a kidney is ready. And even if you get the call that a kidney is ready, there’s still a lot that can go wrong in that period of time. But thank God everything went well. He has a new kidney, which is incredible. It’s from a deceased donor. I wish I knew who the family was so I can thank them.We are going to write a letter to the family, so it’s possible that they might want to  get in contact with us. But it is such an incredible gift to donate your organs. I never knew, I never had to think about this and I was so lucky not to have to think about this, but this has completely changed how I look at it. So thank you to anyone who has done that and I would love to hear your stories and create community around it. 

Speaker 1 (06:45):

So if you want to share anything with me or if you have a family member who is awaiting a transplant, if there’s anything I can help with, questions I can answer, I am here for that. So please just send me a message, send me a DM on Instagram and we’ll talk. I’ve already connected with so many of you and it’s truly incredible. There’s a lot of details  I’m skipping because I want to get into the episode, but I will definitely be doing another episode on the entire process of getting a transplant. We had Jen Hernandez from Plant Powered Kidneys on a while back and at that time I knew my dad was going to be on dialysis at some point, but we didn’t really get into all of that. So if this is something that has touched your life in some way, go back and listen to that episode. 

Speaker 1 (07:32):

But for today, I’m back. I feel like a massive weight has been taken off my shoulders. It’s been a lot having to keep it together for family and running my business. And so I just didn’t have the bandwidth for this podcast and because it, it’s not a necessary part of my business, it was something that I kind of had to decide to take a step back from to prioritize mental health, family and all of that. But I’m so happy to be back here with you because  I do truly love podcasting and, we’ve got a lot of crap going on lately. So we have to  get into it. Okay, so let’s just jump right in. We’re gonna talk today about Ozempic, Wegovy, Mounjaro, all of these new drugs that are coming out to treat obesity. And the way this is gonna work is I’m going to give you some background, then we’re going to get into what these medications are, how they’re used, how they work in the body, side effects. 

Speaker 1 (08:40):

And we’ll get into a little bit of the supply and demand issues, who these are for, who these are not for. And then of course, we’ll gossip a little bit, right? So buckle up, hang in. I will provide all citations in the show notes if you are interested in the research studies that I will be talking about. But the reason I really wanted to do this is because I wanted to add a different voice to the conversation because many voices are in the conversation who probably shouldn’t be. And it’s a mess. And I think that there’s a lot of nuance when we talk about these medications. And I want to try to provide as unbiased of a roundup here and education so that you can go out and make your own decisions and, and even more so, so that you can understand what these drugs are. 

Speaker 1 (09:41):

And so we can stop some of the stigma nonsense and media circus that has come up over these drugs and the TikTok nonsense. I just want to cut to the chase here. What are these drugs? Who are they for? And are they good or bad? And like with most things, that’s not really an easy thing to answer, but we’re going to try to get down to it. So the first thing that I want to talk about is whether we view obesity as a chronic disease. So in 2012, the American Association of Clinical Endocrinology designated obesity as a chronic disease. Like other chronic diseases, obesity has a pathophysiology that’s complex and it involves interactions among genes, biology, the environment, behavior, lifestyle. It’s not so cut and dry. It also meets the three criteria that constitute a disease which is established by the American Medical Association, or the AMA.. 

Speaker 1 (10:48):

They say that in order for something to constitute a disease, there has to be these three criteria that are met. So obesity meets these three criteria. So number one, a disease has to have outward signs or symptoms. Number two, it has to cause morbidity or mortality. So either some kind of illness or death. And number three, it has to involve impaired function of one or more tissues in the body. So as far as criteria number one, um, patients with obesity have an increase in adiposity, which is fat commonly assessed using the BMI. Yes, I know there are issues with it. We’ll get into that. It’s the primary outward sign or symptom. It also is associated with multiple complications that can lead to morbidity and mortality. So that satisfies the second criteria for something to be a disease. And then finally, how does it impact one or more tissues? 

Speaker 1 (11:50):

Here are just two ways that it does that, but there are many. So as fat tissue or adipose tissue becomes inflamed, it results in alterations in metabolism and vascularity. So your blood vessels as well as the progression of cardiometabolic disease. And number two, it, there are interactions that involve satiety hormones and central nervous system feeding centers that are abnormal, which can result in an increased caloric intake. Okay? So in 2013, the American Medical Association also designated obesity as a chronic disease. Now
the question is can we cure it? So the reason why I mentioned earlier why this is even more near and dear to my heart is because my dad is living with chronic kidney disease. He just had a quintuple bypass, he has diabetes, he has high blood pressure, he has cardiovascular disease, he has all kinds of things. 

Speaker 1 (12:54):

And he underwent a lap band surgery, which is a bariatric surgery about 10 years ago now, which led to quite a significant amount of weight loss, which really did halt a lot of the disease progression he was experiencing. But it was too late. Things already were happening. And so when we talk about diabetes, we’re gonna talk about diabetes a little bit today as well, because these medications have also been used to treat diabetes, we have to understand that it’s not something that is just, you have it and you’re fine, you can be fine, but left untreated or mistreated or mismanaged, it can lead to really, really, really scary long-term consequences. And they are of no fault of the patient or person living with obesity. So I wanna make that really, really clear is that by pretending that obesity is not a disease, we are creating even more stigma for people living with obesity. 

Speaker 1 (13:58):

And that’s not cool in my book because I work with many people living with obesity and I understand how complex it is from a genetic standpoint, from a biology standpoint, from a lifestyle standpoint, from an access and economic standpoint. So when we just diminish these things to Kim Kardashian trying to lose weight for the Met Ball, we are now creating even more stigma for the people who these might be a lifesaving intervention for. So I really want to lay that foundation as we go and talk about this because the way we’re going to talk about this today is, is can this be a treatment for obesity? We will get into the nonsense that we see of people using this to lose 10 pounds and all of that stuff. But the reality is these medications are not meant for those people. And by only focusing on that, we are hurting the people who might benefit from these, the people who might not ever need to go and have bariatric surgery because these medications are the first line of defense that may never have to go on dialysis for a family not to have to deal with that whole hardship. 

Speaker 1 (15:09):

Right? So let’s bring it back to that. So there’s so many ways that weight Sigma hurts people living in larger bodies. There’s judgment that about getting medical treatment for obesity, whether that’s bariatric surgery or now using these FDA approved weight loss medications, it can be seen as a crutch or the easy way out. It is so not a crutch or the easy way out and it’s so important to recognize that. So these medications and we’re going to focus specifically on Ozempic and Wegovy, which is the same medication in different doses. And Mounjaro, which is a tirzepitde. These drugs have been the result of decades of research and development. The first GLP-1 agonist, which is what Ozempic is, Semaglutide was approved in 2005 and since then a bunch of new compounds have hit the market. So we’ve had Saxenda, Victoza, Trulicity, and now we have Ozempic, Wegovy and Mounjaro. 

Speaker 1 (16:10):

So Ozempic is actually Semaglutide. Ozempic is the brand name. It’s an anti-diabetic, anti-obesity drug developed in 2012 by Novo Nordisk. It was first approved by the FDA in 2017 for diabetes treatment. So the Ozempic compound is semaglutide. It was approved in 2017 for diabetes. No mention of weight loss at this time. Okay, so what is semaglutide? There is both an oral and injectable form of semaglutide. The oral form is not currently indicated for weight loss. It can only be used for diabetes. That’s not to say that down the road it won’t be. But right now Wegovy, which is the higher dose of ozempic, is done through a subcutaneous injection. So Ozempic is the brand name for Semiglutide in the dosage that’s used for type two diabetes. I see a lot of nonsense about this. 

Speaker 1 (17:21):

Wegovy is not a different drug than Ozempic, it’s the same drug, but Ozempic is in a lower dose and Wegovy is in the higher dose. If you are just treating diabetes, you use ozempic. If you are treating obesity, which might also be treating diabetes, we use Wegovy. And so this is an injection given one time a week, either in the arm, thigh or stomach, whichever you prefer. As far as injecting yourself with medication. I also see a ton about this like, oh my God, how could you inject yourself with a medication? I am on a medication called Stelara. I have to inject myself. It’s not that big of a deal. I was on Humira before this, I had to inject myself every other week. It’s not that big of a deal. If that’s the delivery of the medication, that is what it is. 

Speaker 1 (18:12):

Of course it sounds scary like you’re injecting yourself with something, but realistically it’s not that scary. Okay, so who should be using these medications? Adults with an initial BMI of 30 or greater which is considered obesity or A BMI of 27 or greater, which is considered overweight, but with the presence of at least one weight related comorbid condition such as hypertension, which is high blood pressure, type two diabetes or any sort of lipid issue. So high cholesterol, high triglycerides, et cetera. So if you are at a BMI of 27 or above, but you also have one other condition, you can be eligible for that medication. Or you can have a BMI of over 30 with no other comorbid conditions and be eligible. And pediatric patients 12 years and older with the BMI at the 95th percentile or greater can also be eligible. 

Speaker 1 (19:13):

We’re not really going to get into that today. Pediatric obesity is not my specialty. I’m going to leave that for the experts. But just know it has been approved in that population and that’s a bigger conversation. So how does it work? How do these medications help you to lose weight? So semaglutide is a GLP-1 agonist, which means that it acts like GLP-1 in the body. What is GLP-1, you may ask? GLP-1  is a hormone that is naturally produced in your body and its job is to send signals to the brain to tell it that it’s full. So it sends satiety signals, it says, Hey brain, you’re full stop eating, right? So how does that work? So this medication acts like the hormone GLP-1, your body thinks it’s the hormone, it binds to the receptor in a cell and it works the same way that GLP does. 

Speaker 1 (20:15):

Now these medications not only tell you that you’re full, but they also help your pancreas produce insulin, which can lower your blood sugar, which is why they’re used for people with type two diabetes. A quick aside… this would not be something for a type one diabetic because their pancreas is not making any insulin. So this isn’t going to help. But for a type two diabetic where their pancreas is sort of sleeping…it’s being a little lazy. This is going to help the pancreas to produce the right amount of insulin to lower blood sugar. So it does that by increasing insulin secretion and decreasing glucagon secretion, which lowers blood sugar levels. It also slows gastric emptying, which is the rate at which your stomach empties out. And why is that important? Because the slower it takes your stomach to empty, the longer you’re going to feel full. 

Speaker 1 (21:21):

Once your stomach’s empty, you feel hungry again. So this can lead to feeling more satisfied or less hungry, which causes you to eat less. And then you lose weight. Again, you’re still eating less. This isn’t magically doing anything without eating less, but it’s helping you to eat less. Semaglutide or ozempic has a much longer half life than natural GLP-1  in the body. So it lasts longer, which means it can help you feel fuller much longer than our natural GLP-1. Keep in mind, because the conversation is that, people who are taking these medications are taking them away from people with diabetes who need them. This is not a medication that’s used alone for people with type two diabetes. It’s usually an add-on therapy to other diabetes medications such as metformin or a sulfonylurea. It’s not recommended as a first-line therapy to treat type two diabetes. 

Speaker 1 (22:21):

So not only that, but the compound, the dosing that people are taking for obesity is actually Wegovy. It’s not ozempic. So this isn’t keeping people from getting their lifesaving diabetes medication. Insulin is a lifesaving diabetes medication. This is not the same thing. So people who take these medications describe the effects as what it would feel like to feel normal around food. Like the way someone who never struggled with their weight feels. They still enjoy food, but they don’t feel this compulsion to have more and more and more. And the reason is that the GLP-1 hits certain parts of the brain that impacts satiety. So it hits these reward centers and people start to lose interest in food or they’ll have a few bites of something and they feel good, but it sort of cuts that off. 

Speaker 1 (23:21):

It can help people navigate through this obesogenic environment that we live in. This environment makes it even that much harder to control our weight and then add in the genetic factors and the biological factors and all of that. So people who think that you’re giving people a crutch don’t really know what medication can allow someone to do who has been struggling for a long time. Now, how is it dosed? The ozempic, which is the diabetes dose, starts at 0.25 milligrams for four weeks and then is slowly increased for four weeks up to 0.50 mg. And then 2.0 mg  is the max recommended dose for type 1 diabetes. And then Wegovy, which is the weight loss dose, starts at the same 0.25 milligrams and then it goes up to 0.50 mg, 1.7, and then the max dose is 2.4 mg. So let’s talk about side effects. Side effects are largely dose dependent. So at the lower dose people don’t experience as many side effects as they do at the highest dose. 

Speaker 1 (24:39):

The most common side effect is going to be GI symptoms. In people who got up to that 2.4 milligram max dose, in clinical studies, 44% reported nausea, 30% reported diarrhea, 24% reported vomiting. And the makers of this drug say it is really important that people slowly taper up and follow the recommended dosing schedule to avoid these symptoms. So what they’ve found is that if you start at the lowest doses, these adverse effects are much lower, even in the single digits. And they do find that the side effects often resolve in a few weeks of taking the medication. What I will say is I’ve worked with many people who take these medications and it’s very different across the board. For some people, the side effects really don’t resolve at the higher dose and they really can’t titrate up all the way. 

Speaker 1 (25:43):

They have to stay at a lower dose and then there are&n
bsp; other people who have no side effects. So it really just depends. Another thing, it is encouraged to discontinue ozempic in women at least two months before a planned pregnancy. So this is not something that you would take while pregnant. And then there are some rare adverse effects which must be mentioned. There is a box warning for patients with risk of thyroid related tumors. This medication is contraindicated for these patients and certain types of thyroid cancer. From what I’ve seen is, doctors kind of feel that this might not be an issue. But in rodents, it did cause thyroid C cell tumors. It’s not clear in humans yet. So if you have a family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type two, this might be contraindicated for you. 

Speaker 1 (26:48):

There is a very, very small risk of other things: pancreatitis, changes in vision, kidney issues, gallbladder problems…those are the the main ones that we have to watch. And then there are some risks for hypoglycemia, which is low blood sugar. If you are using this, it’s possible that you might experience very low blood sugar, but it is encouraged that you are monitoring your blood sugar. If you are using a sulfonylurea or insulin in conjunction with these medications, you do have to be more careful. And there is a learning curve for that. Another question… do you have to be on this for your whole life? That’s what everyone wants to know. Is this something that’s going to work if you get off of it and the answer is we don’t necessarily know yet because we don’t have all the data of people who take this medication, successfully lose weight and then come off of it. 

Speaker 1 (27:52):

Do they maintain that weight loss over years? We don’t know. It is thought that these medications will need to be something you take forever, smilar to a blood pressure medication or cholesterol medication, they’re meant to be taken indefinitely and there are potentially some people that can wean themselves off these medications. And then there are others that might be able to stay at a very low dose, but that is between you and your physician. And I would encourage a dietitian as well, especially if you are considering coming off these meds. Insurance coverage is a major issue. Again, another way tjhat weight stigma and the misconception that obesity is purely a lifestyle issue continues to harm people. Very important that using these meds requires the oversight of a qualified doctor. Do not go to a med spa and get these things. 

Speaker 1 (28:49):

Do not go to a doctor who’s going to send you to a compounding pharmacy. If you are considering these medications, please go to a obesity medicine specialist and and really take this seriously. And like I said, I would also recommend working with a dietitian and I think that is something that people don’t understand. It’s something that you really can use to help you do the things your dietitian suggests. So a lot of times when I’m working with people I might make suggestions, but if they’re not able to execute on those suggestions, it doesn’t matter. But this medication might help them to execute on those lifestyle changes. So it is still worth it to work with a professional. 

Speaker 2 (29:40):

As far as doctors getting kickbacks from big pharma companies,  you can look this up. I mean, I’m married to a doctor. He does not get kickbacks from anything (I wish he did). Just kidding. But no seriously, most doctors are not shills for big pharma. Most doctors want to help you become healthier. There’s major issues in the medical field. We’ve talked about that before. There’s systemic changes that need to be made, especially in our country, in the United States. But most doctors who are treating patients with obesity are not getting kickbacks. They’re doing it because they believe that this medication will help you. As far as the weight regain, these meds are studied and they are approved for long-term use. Most people will probably have to be on this indefinitely. Some might be able to come off, but more research is needed. 

Speaker 2 (30:42):

Okay, so we said that. Now what’s the deal with access… why can’t anyone get this? It literally comes down to the supply chain. Everything comes down to the supply chain these days, right? So the issue though is that people are turning to compounding pharmacies, which are basically pharmacies which can mix different formulations in-house. So this route doesn’t actually contribute to the shortage of this medication, but still the compounding drugs are not technically FDA approved. So it’s not something I would recommend. As far as I know, the problem with Wegovy is that Nova Nordisk, the manufacturer screwed up the manufacturing process and there’s a big shortage. But it does look like recently, supply issues are improving and should be figured out by April, according to the manufacturer. 

Speaker 2 (31:42):

So now that’s ozempic. Let’s  touch on what Mounjaro is and what these other medications are. So Wegoby  is again, Ozempic, Wegovy and Ozempic, same thing. Wegovy is just the higher dose. Trizepatide is another compound. So Semaglutide is Ozempic and Wegovy. Trizepatide is the brand name Mounjaro. So why is this medication interesting? How is it different? So Trizepitide is a combination GLP-1 agonist like semaglutide and GIP, which is gastric inhibitory polypeptide. So now we’re adding in another thing. So if one is good, two is better. It works by enhancing the activity 

Speaker 3 (32:38):

of both GLP-1 and GIP, which both stimulate the release of insulin. So when put together this medication can have an even stronger effect on blood sugar and appetite. Right now, it is only indicated for people with type two diabetes. It has not been approved for obesity yet, but it was approved for type two diabetes in May of 2022. And it’s currently been fast tracked by the FDA to be approved. It’s likely that it’ll be approved for obesity in 2023. There’s one big study that they’re sort of waiting on for that approval. But how does it work? So it acts as GLP-1, just like semaglutide. It mimics that hormone. It also mimics GIP which like GLP-1 triggers insulin secretion. So while there’s some debate about this, the addition of GIP in this case could even increase the effectiveness of GLP-1 and provider an added weight loss effect. 

Speaker 3 (33:45):

It helps regulate glucose metabolism and insulin secretion in the body. It’s also going to slow the absorption of glucose from the gut, which helps keep blood sugar levels stable. It also slows the GI tract, which leads to the feeling of fullness. It does seem to be more powerful than wegovy because it employs more weight loss mechanisms. So again, this is also a one-time weekly subcutaneous injection. Usually the starting dose is 2.5. You can go up every four weeks by 2.5. The max dose is 15 milligrams. The primary target dose for weight loss is starting at five milligrams. So five milligrams, 10 milligrams and 15 milligrams. It’s been shown in studies to reduce hemoglobin a1c in the ballpark of two points. So a reduction from 9% to 7%, which is amazing in three months. Incredible. Much like the GLP-1 agonist Mounjaro can cause GI upset and other GI adverse effects like diarrhea, nausea, vomiting. We have the same box warning for the increased risk for thyroid tumors as semaglutide. Pancreatitis, very similar. Again, we don’t have a ton of long-term evidence in patients who’ve been on this medication for two or more years. So if you are someone who you is concerned about that, it is true. We don’t have a ton of data yet. 

Speaker 1 (35:36):

As far as what comes next, these are just the beginning and there are going to be so many new medications that come out and they’re going combine these compounds and hit multiple receptors in the body and the brain related to appetite, metabolic rate, lean muscle mass tissue. There’s so many things being researched right now with the goal that each new drug that’s released can even be more effective than the one before. They’re also going to be working on things that can be taken less frequently. So there’s all kinds of things coming up and in the pipeline. Now, there are a bunch of clinical studies that I will link in the show notes, but a few things that I want to highlight. The SUSTAIN and PIONEER trials found semaglutide beneficial for cardiovascular diseases. 

Speaker 1 (36:37):

It lowers risk of cardiovascular disease, which is also exciting because many patients living with obesity, diabetes is a risk, cardiovascular disease is a risk and it’s not uncommon for all three of these things to be present at once. So that’s great. A big 2017 human randomized control trial found semaglutide to be highly effective for patients with type two diabetes who are inadequately controlled with other oral anti-diabetic drugs. And again, the PIONEER trial which is a double blind trial found semaglutide effectively reduced hemoglobin a1c  when used with insulin in type two diabetes patients. And then a 2020 study in humans found semaglutide can lead to significant weight loss while also preserving muscle mass, which is always our goal. So these things are very exciting. 

Speaker 1 (37:46):

Now to wrap this up, I understand the madness about this medication because you have people popping this stuff like it’s candy. You have everyone running to go get it. You have all your friends who are talking about being on it and it can feel like “why am I trying to do this, the “old fashioned way”?. But understand that there are people who truly can’t do it that way and these medications might save their life potentially. So keep that in mind. I do think it’s absolutely ridiculous and I think people should have their medical license revoked if they’’re giving it to someone who’s coming in to lose 5-10 pound or if someone is at a normal body weight.

Speaker 3 (38:34):

If you’re prescribing these medications and you’re not screening for eating disorders, you’re not really going into lifestyle factors. I think that’s completely inappropriate and I do know it’s happening and that’s a major problem. Again, I just don’t want this conversation to lead to even more stigma because the conversation is nuanced. Two things can be true at the same time. These shouldn’t be taken recreationally. These shouldn’t be taken just to lose a couple pounds. These things do have side effects. We still don’t know all about long-term effects. And then at the same time, these things can be a really amazing therapy for people who need it. And they do seem to be safe from what we know. Now, the side effects, again, at lower doses don’t seem to be an issue at all and at higher doses, it really is dependent on the person but many people can have a lot of success with these medications. 

Speaker 3 (39:24):

But it goes
back to the fact that you can’t trust the media because the headlines are just so crazy and there’s very little nuance in any of these articles. And it all has to do with this algorithm that we’re all trying to figure out and the more crazy, the better and feeding the algorithms. So you have these crazy TikTok videos and articles and social media posts that are getting popular and they’re completely not researched. These people should not be speaking about this. It’s just creating more of a mess and it riles people up. And then we get all crazy. And I’ve come to not trust anything that I read because I see how much nonsense is put out there in the mainstream media about nutrition. 

Speaker 3 (40:32):

So I can’t trust anything else. If I read an article about, let’s say makeup,  like this whole clean beauty thing, which from the scientists that I trust seems to be also completely bogus. But how can I trust an article about clean beauty if I see how much nonsense there is about like clean food and an organic food? So again, it goes back to this media circus and the social media and the stuff that gets popular. And then I get cynical and I’m like, why am I doing this? Why am I speaking? Why do I even bother? Because you’re gonna spend hoursresearching something, putting all the resources together and citations and a couple people are gonna hear it, but then in one second someone on TikTok puts out a video and it gets gajillion views and gets passed around and it’s not even true. 

Speaker 3 (41:30):

But then I come back to my dear friend Dr. Adrian Chavez, he was on the podcast awhile back. I love him. He’s like, you have to, it’s your duty as a dietitian and a healthcare professional who’s evidence-based to put out this information. And I do know, like I see the numbers, people are listening, it’s not like Joe Rogan level, but you guys are listening and I’m so grateful for that and I thank you for being here and I hope that you share this with your friends and your family because I want people to have a source of information they can trust and understand. It is nuanced. There is madness going on with people taking this when they don’t need it. But at the same time, there is merit to these medications and they can be really incredible and life changing for some people. 

Speaker 3 (42:20):

So I hope that this added some context to the conversation. I’d love to hear your thoughts. I’m happy to do any follow up on this. So as always, send me a message, send me a dm, let me know what you think. I will link all of those studies in the show notes for you if you’re curious about reading them. And I will be back with a bunch of new episodes and guests and topics. So if there’s anything that you wanna hear about, let me know because I really, really value the feedback from my podcast listeners, you guys are the real ones. I know if you’re listening to this and you’re taking the time to sit there, whether it’s in your car on a run, to get through a lengthy episode, you’re super interested in this stuff and I love it. I love to nerd out with you guys. So thank you for being here. Thank you for hanging in with my hiatus and thank you for letting me share my dad’s story. Again, if any of you are living with  kidney disease or a family member who has chronic kidney disease and you want someone to talk to, I am here as a friend, as a dietitian, whatever you need, just let me know. And with that guys, thanks for joining me today and I will see you next week. Bye.

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