Are GLP-1s Legit? with Dr. Ania Jastrebroff

(soft piano music) Lemonade. - Thanks for listening to Hussam Minhaj Doesn't Know. Listen to and follow Hussam Minhaj Doesn't Know add free on Amazon Music or just ask Alexa. Alexa, play the podcast Hussam Minhaj Doesn't Know on Amazon Music. Also, with Amazon Music Unlimited, you can now listen to your favorite music, podcasts and audio books, all in the Amazon Music app. Listen to Hussam Minhaj Doesn't Know on Amazon Music. - The US military almost launched a strike on a Chinese vessel due to an erroneous AI report, a military report produced with the help of artificial intelligence incorrectly deduced. The Chinese boat was carrying components for nuclear weapons. I read about what was almost World War III on ground news, which is today's sponsor and HMDK's favorite independent news source. Ground news is a platform that shows a breakdown of publications reporting on a story, evaluating potential biases and the factuality of these publishers. It's not about eliminating bias. We've all got biases, right? It's about being a more informed consumer of the news. If you look up the story on ground news, you will see that publications from the left, right, and center are all pretty equally reporting on this story, which just shows this was concerning across the board. The takeaway is, without scrutinization by human beings, we could have started a war. It is important to analyze the details ourselves go to groundnews.com/hussam to subscribe and get 40% off the Unlimited Axis Vantage plan, which breaks down to just five bucks a month with my discount. That's groundnews.com/hussam. We should all be thinking critically. Groundnews can help, so subscribe today. Okay, here's an admission. Despite having an equinox membership, I am not a health expert. A lot of comedians will talk wild shit about doctors, diseases, vaccines, and then, when they're checked on it, backpedal with the, hey, I'm just asking questions, but I, Hussam in Hodge, pledged to you. If I ever ask a question about health, it will be to a doctor, not RFK Junior, not Aaron Rodgers, and not to my friend, who's also a comedian, understood? Awesome, great. Okay, now that that disclaimer is out of the way, I am here to talk to you about obesity, and specifically about one substance that the weight loss community swears by. A miracle drug that will sharpen your jawline and shed six inches off your waist. I'm talking about willpower. - Not what you capable of is what you willing to do. - True fucking willpower. - If you have to ask how to get motivated to go to the gym, you don't want it enough. Get up, get up, stop being lazy. Ask a certain kind of fitness influencer, and they will tell you that the key to achieving 6% body fat is just wanting it. But clearly, and that's ridiculous. There are looks-maxers that do nothing but take gym selfies all day, and there are obese HVAC guys who work 10 hour shifts outside in the sun. Laziness has nothing to do with obesity. I know the thing I won't be doing in this episode, making fun of overweight and obese people, because for one, it's HAC. But also it's bad business. They are statistically more than half of my audience. Seven out of 10 American adults are overweight or obese, and obesity has tripled since the early 1960s. What changed? Not our basic biology. I mean, something possibly happened that made Ed Sheeran lose his balls, but other than that, it's basically been the same. But what drastically changed is what scientists call our Obesogenic Environment. Our foods are more processed. We drive instead of walking, and we are sleeping less and stressing more. Living in America is like living in a first floor apartment that they're doing road work next to. I mean, there's just a fucking jack camera outside your window 24 hours a day, seven days a week on Iran midterms. Lindsey Clancy! Fact is, you cannot willpower yourself to 155 pounds. When all your food is shit, you work in email job, and you are up until 1 a.m. every night scrolling on TikTok, because every time you read a caption that says, wait for it, you cannot physically stop yourself from waiting for it. Goddamn it, the wait for it is never worth it, but I fall for it every goddamn time. And look, not naive, not saying obesity is solely the result of highways in the Macrib, people have been overweight forever. And we know that because people have been trying to lose weight forever. During the 19th century, socialites chugged vinegar to stay thin, and in the 20s, lucky strike promoted the cigarette diet. They were like, reach for a cigarette instead of a suite, which you couldn't do today because people just vape. And all those flavors are sweets. I mean, every time I do a live show, you see someone sucking tiramisu out of a thumb drive, but the fuck they're getting popcorn lung and type two. Anyone my age probably remembers the bullshit fad diets that caught on in the early 2000s. You had paleo, adkins, the South Beach Diet, which, despite the name, is not just cocaine. I'm pretty sure that's a starch. Then of course, they were the diet pills. Everything from bunker busters for your colon to straight up speed. I mean, housewives were chewing crank, like they're the shortstop for the 84 Mets, or a white ninth grader. In the 1970s, the diet pill market got so flooded that companies had to do anything they could to stand out. There was Dexatrim and Hungrex and Dietek in one brand name that definitely got some attention in the 1980s, but not the right kind of attention. - Why take diet pills when you can enjoy AIDS? - I was overweight and looked terrible. The AIDS helped me lose 46 pounds. - With AIDS, I ate less, so the weight came off. To help keep it off when I sometimes want things loaded with galleries, AIDS helps put me in control. - Let the AIDS plan teach you how to take off weight and help keep it off. - Try peanut butter eggs. - Peanut butter, AIDS. Ironically, peanut butter is the best way to get a monkey to suck your (beep) please don't take away my pee bodies. Now, to be clear, weight loss meds can't give you AIDS, but some of them have had some pretty serious problems. You want pulmonary hypertension? Try FENFEN. Suicidal adiation? Pass the Raminobudent. Is it Raminobent or Raminobent? - Raminobrant. - Raminobent. - Pass the Raminobent. So you can understand how in 2017, people were skeptical when Danish company Novo Nordisk rolled out a new drug. - Boom! - Boom! - Oh! (upbeat music) - Do you know 10 people? Well, then you know someone on GLP1's, like ozempic or we go v or zepbound. 12% of Americans take some form of GLP1 more than double the number from a few years prior. Now, before going any further, it is important to say GLP1's may cause diarrhea, constipation, vomiting, pancreatitis, gastroparesis, bowel obstruction, or gallstones, please consult your doctor before taking this medication. And that's only the short-term effects that we know about. We have years of safety data for GLP1's, but we don't have 30 or 40 years of data on people taking these drugs for obesity. This is a cash cow that we are the test subjects for. So you're probably watching this thinking, "Oh, boy." My man, Husson, is about to tear into big pharma because he hates them because they're bad, right? Well, obesity is also really bad. So if you think those GLP1 side effects are alarming, obesity can cause high blood pressure, high cholesterol, heart disease stroke, numerous cancers, please consult your doctor before taking obesity. Extreme obesity is also a dangerous ailment that can shave up to 14 years off your life. That is more life lost than clinical depression or the lucky strike diet. Let's put it this way. I would never tell a depressed person to stop taking their SSRIs even though it's got a shit ton of side effects. The fact is, GLP1's are thoroughly studied medications that predate ozempic by at least a decade. Scientists were looking at Gila Monster spit through a microscope for years to come up with this stuff. Yeah, studying Lizard's Liva led to a huge breakthrough in the development of GLP1's, which is so funny, because doge dudes are always like, why are we spraying rats with piss? And then a month later, they're just like cheap piss for Americans. We need a new deal on piss. It may help to think of GLP1's in the same realm as SSRIs because GLP1's aren't flesh-eating pills. They don't melt pounds off. What they do is change your brain and then your body follows. Think of it this way. Your body weight has something called a set point. It's kind of like a biological range your body defends. In the same way, it keeps your body temperature stable. Whenever you stray from 180, or 300, or whatever your body's set point may be, it's going to send signals to your brain. Eat, motherfucker, get us back to the set point. You ever see a guy in his 50s wearing a kangle hat? Well, that's because 1995 is his fashion set point. It's where he's comfortable. Your body's the same way. GLP1's appear to help lower that weight range that your body defends. These drugs are actually starting to teach scientists new things about obesity, like the concept of food noise. Now, this is something a lot of patients didn't even have a name for before GLP1's, but once they started taking the drug, they said, this is wild. I'm not constantly obsessing about food anymore. They didn't even realize that noise was there until it was gone. That's just another piece of evidence that proves that weight loss isn't about willpower. If we lose weight that puts us below our set point, our brain sends you signals to eat more by making us obsess about food and making us feel hungrier and even changing our metabolism. You can't just tell someone, hey, be less hungry. It's like telling a pervert, be less horny when they see Lola Bunny. It's not up to us. I mean them, it's not up to that person. She's good at basketball, I mean, and she's also very funny. So that's just objectively very attractive. Anyways, let's talk about obesity. Scientists are discovering that GLP1's could potentially help understand and fight other diseases, like kidney disease and addiction, and there could be other second order impacts. Less obesity means less demand for fast food, which means more demand for healthy food, which means companies are going to start using healthier ingredients. So McDonald's might start making the Big Mac out of higher quality tires. And I know some of you like McDonald's unhealthy, but don't worry, and the Diet Coke is still gonna give you Alzheimer's. GLP1's are potentially a game-changing medication, but there's a problem. Most Americans don't see it as a medication for a disease. Obesity, they see it as a weight loss drug, and I get the confusion. This drug has transformed the health of a lot of people through dramatic weight loss. I've lost 70 pounds. Over. about six months. It's just been completely life-altering. I was addicted to food. That was my heaviest weight, about 250 pounds. It was almost like like torture because of that relationship that I had with the food. At this point, Caitlin has lost nearly 120 pounds. To say that this medication has changed my life is an understatement. But even if GLP ones are an effective medication to treat a chronic disease, they are intersecting with a culture that worships thinness and beauty. And the result is widespread overuse, and losers on the internet debating about which celebrities are taking it. But a lot of people in Hollywood are taking ozampic, and honestly, it really doesn't look good. Ozampic is destroying Hollywood! Look at these girls! You ever wonder why all these celebrities that are on ozampic are looking like lizard people? Losing so much weight. Everybody in Hollywood looking like they went through witness protection. It'd be one thing if this was a treatment only pop stars and NEPO kids could afford, but these drugs are becoming increasingly accessible. You can get ozampic prescribed through a f*cking app. The same app where you get hair loss spray and boner meds with two-day shipping, enter promo code GROK for 20% off. That level of accessibility. While great for some has opened the door to misuse, including among people with eating disorders. So it seems like we're not taking GLP ones seriously enough, because we don't take obesity seriously enough. It is medication. It is not a cheap for weight loss, and it is not a shortcut for lazy people. Because again, obese people are not lazy. I get that I'm wishing for a lot here. This is a very complicated thing to do on this show. I am asking for a world that is obsessed with thinness and image that sees obesity as a moral failure to suddenly become enlightened on proper GLP one use. But these medications are going to be around for a long time, and unless people are educated about them properly, they will be misused. And since I am not an expert, just a card-carrying equinox member, I went and got someone that actually can educate you. Dr. Anya Jostrabaugh from the Yale School of Medicine has studied for decades in the field of GLP ones, and she has written a book on the topic called Enough. We talked about how to dispel the willpower myth of weight loss. Willpower has nothing to do with our weight. Biology has everything to do with our weight. The impracticality of using GLP ones as a weight loss aid, instead of an obesity treatment. If you call these medicines weight loss medicines, then people will think that once they plateau, once they stop losing weight, the medicine is not working anymore. That's not the case. And I got her to show solidarity with the IBS community. I've just accepted nausea and diarrhea to just be a part of American life. Well, I'm so sorry to hear that. Allies are an important part of the fight, Anya. Respect. Guys, I have got a riddle for you. What do news junkies, biohackers, and true crime-obsessed wine moms all have in common? They have heard a hell of a lot of zippercrooter ads, because let's face it, zippercrooter is everywhere. Why are they everywhere? Because great candidates for all your different roles are everywhere. 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It should have never been a punchline because obesity is a disease like any other chronic disease. And the way that I explain it is basically, our bodies are incredibly brilliant, incredibly brilliant. Eons ago, they figured out, hey, in order to survive, we have to have a way to store energy, to store fuel. Yes. And we're going to store that fuel as fat. So fat is actually a really good thing. It allows us to survive. Right? But now the question is, well, how much fat to store? How much energy to store? Right. And how does our body decide that? So it turns out that there are these hormones in our body that communicate with our brain that say, hey, I'm hungry. I'm full. I'm storing this much energy. I need more energy. And they basically inform our brain of where we're at. And then our brain controls the amount of energy or the amount of fuel or the amount of fat that we store or we carry. So just so I get this clear, are you saying that we should think of obesity as a brain issue more than a body issue? Yeah. So the brain controls how much fat your body is going to store. So your brain is in control. Your brain sets a fat mass set point. OK. OK. Or an enough point. And it basically says, this is how much fat you should store. This is what you need to do in order to survive. And so your brain sets that. So if it's a brain issue, should we see obesity the same way we see something like, say, addiction? So it's different than addiction because in the setting of addiction, you don't necessarily need that substance, right? So in terms of obesity, we all need to eat food. We cannot survive without food. We cannot survive without having some amount of fat. With addiction, it's a little bit different, right? You can live without alcohol or you can live without, you know, other things that are addictive. So it's a little bit different, but to your point, similar areas of the brain are involved in, in terms of our desire to eat, right? We eat for many different reasons. We eat for hunger, but we also eat for pleasure. We eat because we crave certain foods and those are all stress big stresses big stress is another one. So yes, so we eat for all sorts of different reasons. And so different regions of the brain are involved in that. Yes, let's dig into the biology of this. A typical fitness influencer will tell you, "Look, fitness is simple. It's about calories in, calories out." How does the science challenge that? It's not about calories in and calories out. I mean, if it was about move more and eat less, then most people would not have obesity. The fact of the matter, the truth is that we are actually not in control. Now, all those things that you're referring to are incredibly important for health. They are incredibly important for health. So eating a nutritious diet and exercising incredibly important for health. But for the number on the scale, for the amount of fat that our brain chooses for our body to carry, that's biology and that is controlled by our brain that is not controlled by us. Okay, so just so I'm clear, because I'm riding this down. Yes. Health, vis-a-vis, physical fitness, weightlifting, and what you eat. These are all under the umbrella of health. Yes, and getting great sleep and decreasing stress to the best of our ability. All those things, absolutely. But are you also saying that the number that you see on the scale is not indicative of your health? It is not. It is not. And there's a caveat to that. There's nuance to everything. But what I'm saying is that the number on the scale, which is related to how much fat your body stores, that's not in our control. And again, there's nuance to this, right? But the reason why I say that is because your brain, as we just talked about, your brain influenced by the environment, that's how it decides how much fat we should store. That's how it decides that, not by the physical activity or the amount or the foods that you eat, the nutritious or not nutritious. foods that you eat. One of the things that you talk about in the book is this idea of the internal weight thermostat. What is that? Yeah, so great question. So our bodies love to keep everything in homeostasis. They love keeping everything kind of in an even place, right? So let's think about the example of a house with a thermostat, okay? The house with the thermostat, let's say it's set to 70 degrees. When it's hot outside, what happens? The air conditioning turns on. It's automatic. You don't think about it. You don't go to the AC. You don't turn it on. It just happens. It's automatic. Same thing. If it's cold outside, what happens? The furnace turns on and the temperature set point is maintained. It stays at 70 degrees Fahrenheit. Our body does this with lots of functions within our body. It's all controlled by the brain and it does this. So for example, I'll give you an example, body temperature. Yeah. You are not sitting here and thinking to yourself, I must maintain my body temperature at 98.6 degrees Fahrenheit, right? If you were cold, you would shiver. If you were hot, you would sweat and it's all automatic. It just keeps your temperature exactly where it wants it to be, which is 98.6 degrees Fahrenheit. Okay. It turns out our body does this with fat. So are you saying that at every almost age, when I was eight, I had a particular body thermostat. There was a number. When I was 15, there was a number. 23, 38, so on and so forth. Does it change over time? It does. So we call it the body fat set point or the enough point in the book we called the enough point. So body fat set point or enough point. And basically, what it is is now your brain, just like it set that temperature set point, or the house thermostat set, that temperature set point, your brain sets a fat mass set point, or a body fat set point. And basically it says, okay, this is how much fat I want you to carry right now. And this is it. So when you gain weight or specifically when you gain fat mass, then your brain says, oh, well, you just gain fat mass. I should have a lower appetite and I should burn more, right? And the opposite should happen if you lose weight, if you lose weight, your appetite should go up and you should burn, you know, a different amount of energy, right? But now in this obesogenic environment, in this environment that promotes weight gain, it's like a hot summer day, your brain and your body get confused. They're like, wait a second. I should be storing more fat. And it increases that set point. It increases that enough point. So it's a confused biology. It's a confused biology and basically your set point, your fat mass, your body fat set point is increased. And our bodies and our brains want us to store more fat. So just to have some respectful pushback here, assume that I'm a fitness influencer. I'm not, but I do follow them online. Yes. Okay. What you're talking about with this idea of the set point is this idea of, hey, there's something that's set that's not within your control. Yeah. And the thermostat analogy totally working for me, doctor, by the way, because my dad, oh my god, was a goddamn dictator when it came to the thermostat. So this thing is totally checking out to me. She's like the temperature will be 73 degrees. Yes. Even in the event of my demise, don't you dare touch that thermostat because I will haunt the house. You think I won't? Yeah. You know how petty I was in real life? Oh, you have no idea what I will do in the afterlife. Hell, half no fucking fury. Your brain is just as insistent at keeping the amount of fat that you store, the amount of fat that you carry at that specific place. And to your point, it does change throughout the lifetime, right? So puberty is a time where fat increases, pregnancy is a time where fat mass increases. And it's not that, you know, as an example, it's not that a woman thinks, oh, I should eat more because I need to carry more fat in order to have a healthy baby. Her brain just says, oh, turn it up. Got to store more fat to have a healthy baby to grow a healthy baby, right? So your body fat set point changes throughout your life, depending on your teenager going through a growth curve. Exactly. Teenager going through growth curve. We're going through perimenopause. Exactly. Exactly. I think there's they we should talk about this more. It's menopause as well. Yes, absolutely. Absolutely. And there's there's a lot of changes in terms of how our body stores fat during that time. So let me ask you this. Let's talk about what's within your control because this idea of the set point is out of your control. Yeah. But say I work out five times a week. I'm entering my forties, fifties, and sixties. I'm doing push pull. I'm making sure I'm moving weights with legs. I'm moving metal. And I'm doing zone two cardio at a minimum for 100 plus minutes per week. I'm doing my part. I'm showing up. Yes. And I'm staying consistent with the diet. You're telling me if my set point was 250 pounds, there's nothing I can do. Well, here's the thing. What you're doing is helping to prevent obesity. It's helping to prevent developing overweight or developing type 2 diabetes or developing all the things that you may genetically be predisposed to, right? As a Southeast Asian, you have a predisposition to metabolic disease earlier, or we're at a lower let's say BMI, if we get to talk about weight or BMI, then then others who are not Southeast Asian. So what you are doing is wonderful because you are optimizing and improving your health and hopefully preventing all those other diseases. Okay. Now let's say that at one point or another in your life, your set point or you had gained weight to a certain higher weight. And for your example, 250 pounds, your brain maybe trying to pull you back up, whatever you do, let's say that you lose weight and you're eating less, you're exercising more, you lose weight temporarily. What happens when someone tries to do that? Your appetite goes up and you burn less. So the same amount of food or fuel that you would take in, your body is going to become more efficient. And we call that metabolic adaptation. So basically, appetite goes up, you're conserving energy. So you may be doing exactly what you did before to lose weight, but your body is going to try and slowly gain it back. So I guess bottom line is kudos to you for doing all the exercise and for eating healthfully. It is wonderful. You're keeping yourself as healthy as you possibly can to prevent all those downstream diseases, including obesity. But if you had obesity already, then short term, you may be, you may be able to do that to lose weight. You're still optimizing or improving your health. But in terms of the weight loss, your body would find a way. Your biology is smart. It's going to be like, Hey, you are starving. You are starving. And I'm going to do whatever I can to make you gain it back, even though you're not starving. Think of the example of serena Williams, right? We recently did a podcast with serena Williams and Oprah. I don't know who exercises more than serena Williams. I don't know if you're asking me a question. Yeah. I mean, she's an incredible athlete and she exercises eight hours a day. And yet after her second child, she wasn't able to lose the weight that she had gained, right? So I think serena's example is one that you can exercise for eight hours a day. But if your brain sets your set point, your fat mass set point at a certain level, it's going to fight. It is going to fight to keep you there. And that's what it did with her. All right. So just to put this in SAT terms, our appetite and metabolism to our weight, essentially what sweating and shivering are to our body temperature. It's a good analogy. It's a good analogy. It's appetite and how our body decides to use the energy that it has, you know, metabolism, burning the fuel that we take in. Are you saying will power just has nothing to do with our weight? So what I'm saying is correct. Will power has nothing to do with our weight. And I want to be super clear about this exercise or physical activity and nutritious eating is incredibly important for health. Yes. Incredibly important for health. But our brain is what controls how much fat our body stores, which means that our brain is in control of how much we weigh. So there's two different stories that I've seen. There's one story where it's like eat like the cavemen. Okay. They would have meat. They would graze on berries. And for some reason, they ate almonds every two hours. There's that caveman story. Ten. Yeah. Yeah. But you got to eat every two hours like the cavemen. Yeah. Yeah. Then there's the other caveman narrative, which is cavemen. Oh my god, they had to survive the ice age cavemen. They had to withstand famine. They didn't need for days. You could be like a caveman. So what version is it? Is it the Gandhi? I'm fasting for 17 straight days caveman. Or is it I need to eat more almonds and I didn't need to do it every 120 minutes. Yeah. I don't think we have the answer to that. I do think that the way that our bodies evolve from caveman and cavewoman times is highly relevant. And I do think that that is why our brains defend a certain amount of fuel and a certain amount of fat, no matter what. Okay. And that's also why the default is for us to continue to gain weight. In case there is a famine, in case there's going to be starvation, in case there's times where there's food scarcity. So that's the default. The default is to continue to go up, rather than to lose weight, right? To lose fat, to lose those stores. Because what if there is a famine? What if there is a time of food scarcity? We wouldn't survive as a species. So the way that we evolved, I think, was in a very different environment, where there wasn't, you know, food available 24 hours a day, highly palatable food everywhere. - Right. - Now we're in this environment, where there's food everywhere all the time. Let's divide the internet and let's talk about GLP ones. - Okay. - Are GLP ones basically a software update that corrects our biology for the modern world? - I mean, that question, it's so interesting to basically frame it as a software update, right? What the medicines are doing is they're helping to recalibrate the set point. They're helping that confused biology, that wants us to carry or store extra fuel, extra fat. They're helping to recalibrate it and lower that set point. So that our brains don't want our bodies to carry all this extra fat. - And this lowering the thermostat from my general understanding is, is if you were to eat, let's say, X is 10, you're now eating now 0.3 X, is that essentially what's happening? That's the lowering of the thermostat. - So your appetite does go down, especially in that first phase, that first part where you're losing weight. So basically what happens is, in terms of the brain thermostat of the set point, is that hormones communicate with our brain and they say, this is how much energy you're storing, you're hungry, you're not hungry, you're full, you're not full, what's going on. And then our body does something with that information. The medicines, they basically, what we think they do is they work on those same pathways in our brain that the hormones work on, right? And they basically say, hey, you have enough. Your set point is actually lower. And what happens, or it's recalibrated to a lower place, and what happens is the weight follows. So it's not, these aren't weight loss medicines. They're medicines that target the biology, recalibrate that set point. And basically what happens is you lose weight, almost like a byproduct of your set point being lowered. You're chasing a lower set point. - This is interesting because you've said that you don't consider GLP ones to be weight loss drugs. Why? Because again, I think that they are medicines that target obesity, so they recalibrate the set point. They lower the set point, the fat set point. And basically you're chasing that lower set point. Now let me say another thing about the idea of calling these medications weight loss drugs. One of the most common questions we get from patients is I lost the weight, okay? I lost the weight and I stopped the medicine. Or I lost some weight, but then the medicine stopped working, I lost 30 pounds, but actually I want to lose 60 pounds. So within that, if you call these medicines weight loss medicines, then people will think that once they plateau, once they stop losing weight, the medicine's not working anymore. That's not the case. The medicine recalibrated your set point to a new place. You basically your body was chasing that new lower set point. And now it's at that new lower set point. So it's keeping your weight stable at that place wherever the medicine lowers you to. - So then potentially if you got on GLP ones, would you have to stay on it forever? - Yeah, so patients, so that's a really good question. And again, this comes to this question that patients have. If I take this medicine, well, I have to keep on taking it. Obesities of chronic disease, like any other chronic disease, right? So let's say that you needed, or your father needed to take blood pressure medication. - A statin. - Or a statin, right? Exactly, a cholesterol medicine. Your dad, or you take the statin, your cholesterol gets better, it gets lower, wonderful. Now would you say, oh, can I stop it? Can I stop it? Now, and here's the thing, if you were to stop it, what would happen with your cholesterol would go back up, right? And we're not surprised, like if you're not taking the medicine, it's not gonna work, right? So your cholesterol. - So I'm on it for life, is what you're saying? - Well, so with the medicines, what happens is you take the medicine, you recalibrate, you lower your body fat set point. If you stop taking the medicine. And give me the bad news, I can handle it. You can give me the, I'm a good boy, I can handle it. - Well, it's not bad news, it's biology. - But I have to extend for the rest of my life. - If you want to keep your cholesterol lower, likely yes. And I will say in terms of the taking the medicines, you know, it's a chronic disease in order to control the chronic disease, you have to take the medicine, there is variability in that. Meaning that there are people where we can adjust the dose or change the dose. And look, if a patient comes to me and says, I lost the weight, I really want to stop the medicine. So back to this whole point of, it's everybody's choice, right? Like it's the patient's choice. So if somebody says, I want to stop the medicine, I say, okay, let's talk about a compromise. How about we decrease the dose and then come back in two to three months and let's see how you're doing. Now, if that patient comes back in two or three months, and this is usually what happens, and they've gained back some weight, or they're really, really struggling, right? They're having the food noise again, et cetera. Then we say, hey, let's go back up on the dose. If somebody comes back on that lower dose and they're doing fine, then we continue that lower dose or we try and lower it again. Nine times, actually not even nine times out of 10. I would say 99 times out of 100 people go back up on the dose. - Got it. - Hey, it's Julia Louis-Dreyfus from The Wiser than Meat Podcast, among other things. And I've got a little holiday wisdom for you. Hosting during the holidays means lots of cooking, and that means your trash is gonna be full of smelly, rotting food, yuck. So here's the wisdom. Get a mill food recycler. I did. We've had ours for years, and it has totally transformed our kitchen. It's unbelievable how much cleaner everything is now. Plus, it's so easy to use. You toss in basically any food you don't eat. Peels, pits, meat, dairy bones. Last year we put in a whole turkey carcass, really. While you sleep, mill automatically dries and grinds all your food waste down to about a fifth of its size. That means at night you can fill it after a big, elaborate dinner, and by morning they'll be room for breakfast. Nothing rot, nothing stinks, no fruit flies. And my favorite part, no more of those gross, drippy, mid-dinner garbage runs. If you want a cleaner, calmer kitchen this holiday season, go to mill.com/wizer for an exclusive offer. That's mill.com/wizer. Happy hosting. - So some people have said that we're learning more about obesity from these drugs. - Oh yes. - So how does that happen? - Yeah, so I'll give you an example, food noise. - Okay, what is food? - So food noise is intrusive, disruptive, pervasive thoughts about food. It's you are here in the studio, and you're working on a script with Scott. And you cannot focus on this script. You are thinking about the brownies or the. - American dream. - Oh yeah, or American dream ice cream. You were thinking of American. - American. - Yeah, American. - American. - Yeah, because it does have pieces of cone. - Cone in it, okay, American cone. - Yeah. - So you're thinking about that ice cream in that Ben and Jerry's in the freezer. You cannot focus on the script. And then you finally have some. And the next thing you know, you're thinking about, well, what's for dinner? Right, what's for dinner? I don't know, what's for dinner. What am I picking up for dinner? And so you're constantly thinking about food. You walk past the pantry. And you're like, why am I standing in front of the pantry? - You're welcome. - So it's constant, intrusive, disruptive thoughts of food. So that's food noise. Now we did not know that food noise existed until our patients taking these medicines said, I'm not thinking about food anymore. They had this cognitive load, like this constant thinking about food. And it takes their thoughts away from other things, right? And so there's an important distinction here. So food noise is this disruptive, you know, constant thinking about food and it's intrusive. Being hungry before a meal, that's a good thing, right? If humans didn't have hunger, we would starve, right? So being hungry before a meal, that's great. We don't want people to not have any hunger, right? But constant thoughts about food and you're not able to focus on other things that we don't want. And the reason for the food noise is because it's a manifestation of biology where people are living below their set point. So basically your brain's like, wait a second. You just lost all this weight. You're gonna starve. I'm gonna make you think about food because I want you to eat more food. So it's one of the ways that our brain basically makes us want to eat more food. But why do some people experience food noise and others don't? - Yeah, I mean, everyone, everybody's different to there are different types of obesity's. We just haven't been able to define them yet, right? We're very early in our understanding of obesity overall, but there's not just one type of obesity, right? There's not one type of diabetes. There's not one cause for high blood pressure. So there's many different types of obesity. So some people don't experience food noise, but people who do the description of, oh my gosh, I used to think about food all the time, and now I have this peaceful silence. I can go write a novel. I mean, literally the description is so vivid, and we would not know that until we had the medicines, right? Until we had the medicines, we didn't know that food noise existed. - You've compared the discovery of GLP1s to the discovery of penicillin and insulin. Wow. - Yeah. - Why? - So let's think about insulin. - Sure. - So. So, prior to the discovery of insulin, if somebody had type one diabetes, so type one diabetes is when you have no insulin, so you can't use the sugar, you can't use the food that you're eating basically. People would die, right, until the discovery of insulin. With penicillin, if you got an infection, what are you going to do, right? Now we have antibiotics. Thank you, penicillin. Sure. Thank you for mold growing in a little petri dish by accident, right? Yeah, and now we have zithromax. Yes, exactly. And we have all sorts of things that are much more powerful. Without those discoveries, one, we wouldn't have learned about the disease, the way that we have, right? So insulin taught us a lot about diabetes. There's diabetes where you don't make insulin, type one diabetes. There's diabetes where you are resistant to the insulin that you make. So you have lots of insulin, but it doesn't work as well. That's type two diabetes. That's the type of diabetes that's caused by obesity, right? So we learned about the biology and it was saving countless lives. With these medicines, they're helping us learn about the biology, just like food noise. We did not know food noise existed until people took the medicines and the food noise went away and they experienced the silence, right? And they're going to save countless lives if they haven't already, right? And what do I mean by that? So obesity is associated with 200 other obesity-related diseases and complications. So type two diabetes, heart disease, which is the number one killer of Americans, at least 13 types of cancer, high blood pressure, high cholesterol, all of these diseases are associated with obesity. So if we can effectively treat obesity, this one disease, we can prevent mitigate or treat 200 other obesity-related complications and diseases. This sounds incredible. I can certainly see you are super excited and happy to share this with everyone. And I don't want to be a hater, because you are my guest on my podcast in my studio. Thank you. But what are the long-term side effects, and you can list them out, you don't have to cram them into a 30-second cable spot. Okay, wonderful. So one, I'm so glad that we're talking about side effects. I think a lot of the time there's all this focus on the positive, but there's nothing in life that is all good. And these are medicines, right? So any medicine for any disease has side effects. There's no medicine out there that does not have side effects. There are short and potentially long-term side effects. So actually, I'm going to start with the short term. Yeah, because let's comment the short term. Yeah. Because I've heard about some of the short term ones. Yeah. I've heard about the GI issues. Yeah, the GI issues. That's the short term ones, okay? So short term side effects, most common, nausea, diarrhea, constipation, and in some cases, if the nausea gets really bad, you can have vomiting. Now we never want vomiting, right? But there are some simple ways to mitigate those side effects, okay? The first thing is starting on the lowest dose and going very slowly. As you're working with your doctor to adjust that dose, start at the lowest dose and go up slowly. We know that's the best way to mitigate side effects. And I think what was happening early on when these medicines were newer is that people, with their healthcare provider, they were going really quickly, right? They wanted to lose the weight and they were going really quickly. And let's say you're on a dose and you have nausea. What happens if we increase that dose? You're going to have more nausea and then you're going to have vomiting, right? So there's no requirement for the once-weeklies. There's no requirement to go up once a month on the dose. You can go up as slowly as you'd like. There's also ways that patients can decrease the potential of side effects and they're very easy to do. One is not eating past the point of fullness. So most people will feel full earlier, okay? They'll feel well earlier when they start taking these medicines. So making sure you're not eating past the point of fullness, two is noticing which foods may exacerbate your symptoms. So is it fatty foods? Is it the ice cream? Notice what it is that might exacerbate those symptoms. And three is eating smaller amounts but more frequently. So think about a woman when she's pregnant, right? She eats smaller amounts throughout the day and that feels better for her. So it's the same thing. So basically not eating past the point of fullness, eating smaller amounts more frequently and noticing which foods may exacerbate symptoms. And then the one other way is to make sure that you stay well hydrated. So being dehydrated can actually increase feelings of nausea, okay? And so you want to make sure you stay well hydrated when somebody eats less food, they're actually taking in less water because food has water in it. So you want to make sure that you're drinking plenty of water, keeping your kidneys super duper healthy and strong and all those things are going to be helpful. And the most important thing is I think if you're having side effects, whether it's nausea, diarrhea, anything else, to let your doctor know, let your healthcare provider know because they're there to help you, they're there to help you through all of those side effects. So those are the short term, the most common ones and those are some of the ways to help patients get through that. Dr. Anand, just to be fair, I've just accepted nausea and diarrhea to just be a part of American life. Why is that? Pretty much every pill or medicine that you take, one of the side effects is nausea. Okay. And then now pretty much everything is infected because of the CDC. So whether it's blueberries, strawberries or fucking lettuce, now we're all just getting explosive diarrhea, apparently. And that's just part of the deal. Well, I'm so sorry to hear that, but it is preventable with these medicines. And to your point, you just said a lot of medicines cause nausea. So that proves the point of medicines have side effects. What are the long term side effects? Let's talk about that. Yeah, let's talk about that. You know, there's the what we don't know. We don't even know. That's exactly right. Does that raise concern for you? How do you navigate? Yeah. Yeah. So the first thing is that these medicines, GLP1 receptor agonists have actually been around for the treatment of diabetes for over 20 years, 20 years, 90% of people with diabetes have obesity. So we do have 20 years of data plus the trials that came before that to lead to the medicines approval, right? So we have some decades of data. From all those trials, you know, highly negative things did not emerge. There are some things that can happen though, right? But the point about 20 years of data is we don't have 30, 40, 50, 100 years of data. So regardless of what we know now, we have to continue to be thoughtful. We have to continue to be cautious and we have to continue to monitor the outcomes with these medicines. And that's because when millions of people take anything, they'll be both good and bad effects, right? How do you navigate this with your patients? Because there's this very interesting cost-benefit analysis. The short-term gain. Hey, this is clearly affecting your life. GLP ones could be extremely helpful for you in the short-term, in a weird way, help you live over the long-term. The long-term effects are, oh wow, some of the studies and the reports, they don't even predate 2005, right? So you can't, with certainty, say, oh, I know for sure for sure what's going to be the long-term side effect about this potentially 30, 40 or 50 years from now. Well, what do you know for sure for sure about any medicine? Do you know for sure for sure about any medicine? Tylenol has been around for a long time, right? And if you take too much of it, you're going to cause liver failure. If you take too much aspirin, you can have a bleed in your brain. So yes, we do know that there are detrimental effects of even very common medicines that we take. That's why there are guardrails, right? Those two are not prescription medicines, right? They're over the counter and there's very clear instructions on the bottle of what to take and how much not to take. Who's taking more than two though? Like I'll take two if I have a headache. Who's pop in eight to 12? Well, I hope nobody. I hope so too. I hope so too. Yes, I hope so too. But all that to say is that there are guardrails, whether it's an over-the-counter medication or prescription medicine, which is why it's super important. If you're considering these medications for your health, if you're considering taking these medicines to work with a healthcare provider, I cannot stress that enough. These are not weight loss aids. These are medicines. And any medicine for any disease, there's a risk to benefit ratio. And what you want is to make sure that you are getting more benefit from this than harm. Now let's come back to this long term or other side effects, right? So there are rare side effects that occur with these medicines and we know that they occur. So one of them is gallbladder disease, so developing gallstones. Now if somebody has gained and lost weight multiple times in their life, especially rapidly, they can already have gallstones. You just may not know about it, right? If somebody has bariatric surgery, we know that that increases their chances of having gallstones. With the medicines, the medicines increase the likelihood that you may develop gallstone disease. Now this is very rare, but when it happens, it shouldn't be ignored. So if somebody is taking these medicines and they have severe abdominal pain, they have severe belly pain, they should go to an urgent care or an emergency room to get evaluated to make sure that they don't have gallstones. And if they do, those need to be surgically removed. So we know that that is a rare but a side effect that does occur with these medicines. GLP1s are existing during a very unique time in American history. We have the risk of overuse. We have a culture of pharmaceuticals being heavily advertised. I can't even, I don't even know if CNN is a news program or if it's just a GLP1 service provider. I had Sanjay Gupta on the show, so he could provide it on information. Oh, I heard it out. I played some of the stuff that just played in the ad breaks. Yeah, yeah, yeah. So we have overuse being a problem. You have cable advertising and advertising on social media. being a problem for the pharmaceutical industry. And then of course, you have social media and eating disorders. This all seems like a very dangerous cocktail to the American public at large. How do you navigate that? Yeah, I think we have to begin with and end with the fact that these are medicines. These are medicines. And to your point, there is a lot of access now to medicines without medical oversight. And that is not medical care. Right. You understand where I'm coming from, though, right? There is this very dangerous kind of slippery slope because Zertek is a medicine. Yes. Clarity in D is a medicine. But there isn't this weird celebrity culture around, like, is that pop star on Clarity or not? Are they, is Harry Styles seeing Clarity in Clarity or not? There is this weird celebrity culture in regards to GLP ones. Yeah. That I think a lot of people have glommed on to is he or she on it. Are they on it? Is that cheating? That's right. That's wrong. I don't have the answer to it. Yeah. So one is that a person's health is their business. It's their business with their healthcare provider, right? So that's the first thing. I don't know the health of the people that you're describing, right? The second thing is that we shouldn't confuse medical care for a disease, right? The disease of obesity. We shouldn't confuse that with something else, which is this social desire for thinness. For whatever reason, that is what society is doing right now, rather than if we were in the time of Rubens, then nobody would want to take these medicines, right? But those are two different things. I agree with you. The time of what? Rubens, the artist. He would paint women. He's on Paul Rubens. Yeah. Yeah. 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Get Huel today with my exclusive offer of 15% off online with code Husson15 at Huel.com/Husson15. That is H-U-E-L.com/Husson15. New customers only thank you to Huel for partnering and supporting our show. Do you find it scary the introduction of GLP ones and its intersection with eating disorders? Because as you've mentioned, there's this obsession with thinness and there are many teenagers, people in their early 20s, people who may not need the drugs. And there may be other sort of disorders or problems they may have. That seems like such a slippery slope as well. In terms of medical care, I think it's really important to screen for disorder eating and eating disorders. But is there a chance that GLP ones could make those problems even worse? So that has not, well, let me put it this way. I think that there's not enough guardrails in place in terms of accessing these medications. Where is a healthcare provider would be able to catch something like that and prevent it from going in a certain direction. But the medicines in and of themselves, they don't cause these other things. But if somebody already has a disorder eating or an eating disorder and they're not seeing a healthcare provider, that could get worse. There's no easy answer. What I will also say is that I have patients who have obesity and have, for example, binge eating disorder. And they're getting care for their binge eating disorder from a psychologist and a psychiatrist. And it's not to say that we're not also treating their obesity. We're treating both. We're treating both. And for many patients with these medications, they start to have less inclination to have binge eating episodes. Because they're not pulled to that anymore. So there's definitely a place we just have to be, it's not one or the other, it's taking care of the whole person in terms of any disease that they may have. So you co-authored your book with Oprah. This is a huge deal. Yes. First of all, what does that feel like? I'm incredibly grateful to Oprah because there's no one else who has faced so much public shame and humiliation for having a disease, a disease that is not her fault, a disease that was not her choice. She has more grit than anyone I've ever met in my life. She has the resources to do all the things. And yet, this is something that she struggled with because it is a disease and it was not in her control. By her sharing her stories in such a vulnerable and brave way, she has made it so relatable. She's given people with obesity of voice. She's given them a platform. And I think her contribution to shifting away from shame and blame to compassionate care is just incredible. She is such an interesting character in American pop culture, in American media culture. She's obviously talked about her weight, the way her weight was analyzed in the 80s and the 90s and the 2000s. She even shared some of her personal stories. There's a famous TV moment, the Little Red Wagon moment, where she reeled out, I lost 60 pounds. This is the old me. She's gone on to say, hey, that was a mistake. What have you learned from your conversations with her about all of this? Because American media, being a central focal point, being literally Oprah, the central focal point of American media, and then this idea of weight loss in America. She was at the center of all of those things. She's learned and grown through that. She's on the other side of that in this new media ecosystem. What have those convoes with her been like? A lot of those are captured in the book. The way that the book came about was we were recording a couple of podcasts at her house and we were meant to record for 90 minutes. And four hours into the conversation, we were still talking. And so afterwards, she turned to me and she said, you know, you should write a book and I will help you. And at that moment, you think to yourself, well, this is going to help millions of people living with obesity, millions. So that's how it came about. And the idea of her sharing her incredibly relatable struggle and her incredibly relatable story about what you just described in the media. There's nothing more, I mean, you are in the media all the time. But not like Oprah, I mean, I'm on the ghettos of, I mean, the ghettos of YouTube here. The comments, I can't even imagine, like, comments and trolls and all the, so what she's endured and then to take that pain and to turn it into such a gift for people. And then we have other patient stories in the book as well to basically help guide through the science and to help guide through the biology and to really demonstrate that this is a disease, it's a treatable disease and here are some options if you're seeking treatment. How do you navigate gaining the trust of people with uptake? As you know, you know, big pharma has been something that has peddled many drugs to people. You couple that with big celebrity. Obviously, Oprah is involved, Serena Williams is involved. I'll even implicate myself if Steph Curry told me to take GLP ones, I do it. And so you're, you're asking, well, my question is, is that how do you establish trust outside of the framing of, oh, I've seen the story before. Yeah, there's a big celebrity back in this, are you Oprah? Obviously, big pharmaceutical companies, there's a huge financial incentive for them. Why is this then now a breakthrough moment for the public at large, generally when those first two things are happening? It's an FTX crypto moment. Someone's going to federal prison and bad things are going to happen. And look, it's like something, I would love to have the jawline of Tom Brady, or the IMDB credits of Matt Damon, but FTX turned out to not be a good thing. So here's the thing for any disease, it is your choice whether you take a medicine or not. I am not here, like, I do not try and convince people to do something that they do not want to do, or do not believe in, or do not trust. My job is to say, here are the risks of not treating, and here are the benefits of not treating, and here are the risks of treating, and the benefits of treating. We have that discussion, and then the choice is made with the patient. Have I seen incredible transformations in health in my patients? Yes. The first time that I helped a patient lose more than 100 pounds, which was with the older medicines. It wasn't even with these newer medicines. I was like, what were the older medicines? And they're still around, but I'll just say this, the first time that I helped a person lose more than 100 pounds or a meaningful amount for them, this happened to be, I never wanted to do anything else. Like, this is it. It just literally transformed their life, their health, the way that they existed in the world for that specific person. The older medicines, so there's older medicines that we still use. We add them on to these medications, or if there's insurance barriers or cost barriers, which there are for many, many, many people, and we need to work on improving access. That is a huge, huge problem. We turn to these older medicines. So they include medicines like Naltrexone Puparion. It's a combination. It's FDA-proof for obesity treatment. We also turn to medicines like Topeiramate. That medicine was actually created for treating migraines and for treating seizures. And neurologists notice, hey, our patients are losing weight. So we use different medicines. Metformin is another medicine. It's used for the treatment of type two diabetes, but it can help some individuals with weight. It also helps with insulin and with managing blood sugars, which is why it's used for diabetes. What are some other additional positive impacts you've seen that these drugs have had beyond weight loss on things like addiction, dementia. Is it true? It could also even help with auto immune diseases. Yeah. So all that research is earlier than, of course, our research in terms of diabetes and in terms of obesity. But there are, you know, there's already research studies out there that show that these medicines could potentially help with things like alcohol use disorder. And it brings us back to this idea that the regions of the brain, that these medicines work in are in part these reward and motivation regions of the brain, right? So it would make sense that if a medicine is helping reduce craving or desire to eat certain foods, it may also reduce craving or desire to drink alcohol, right? So those studies are underway. We've seen patients who have decreased in joint pain. And is that related to the, you know, some inflammation or some anti-inflammatory effects of these medicines? But the things that are already known and have been shown in studies are decreased risk of having a second heart attack or a second stroke. Improvements in your liver. So decreasing liver fat, improvements in obstructive sleep apnea, improvements in kidney function. So there's all these different things that have already been shown in studies and there's, there's, there's more and more to come. I'm sure you've gotten this question a million times. But just to close us out here, what do you say to people that go, this is just too good to be true? Nothing in life is all good. So there will be benefits from these medicines potentially helping to create a healthier world, right? If we treat obesity effectively and safely, we can prevent mitigate or treat over 200 obesity-related diseases, changing the health of our nation and of the world. But nothing in life is all good. So when millions of people take anything, well bad things happen. Yeah. Of course. We need to stay vigilant. We need to keep on doing the studies. We need to monitor for any negative impacts of these medicines, right? Just like for anything else in life. Dr. Amia, thank you so much for joining us. Thank you for having me. Hey folks, you can now watch HMDK on Spotify. If you're subscribed to Spotify Premium, you don't get any Spotify ads on my video.