[Music] Welcome back to Coffee Break, the audio equivalent of reading the small print before jumping on the van wagon. GLP1 meds, they're all over the headlines, originally made for diabetes now being used for weight loss. But are they American? Are they a shortcut or just another tool? Now they can help some people, but they are not for everyone and they are definitely not a free pass. We cover how they work, do therefore and why they need to be used responsibly. They're making headlines for weight loss and showing up all over the internet but not all of it's legal or even real. Counterfeit versions are out there, some are sold online, some in gyms, some being sold on social media, without a prescription and certainly no safety checks. You have no idea what's in them and the risks are genuinely quite serious. So we'll also talk about how to spot dodgy meds, why regulation matters and how to get proper help with your struggling with weight. That's all in this time's coffee break. I'm Dr Geoff Ham and I'm Dr Sam again me. This is season one of Coffee Break. We are two general practitioners from beautiful dogs that are in the United Kingdom and we are happy to have you here with us for another coffee break. In our show we give you helpful and useful health and wellness information in short and easily digestible episodes. That's right and hopefully in a fun and enjoyable way as well. In today's VARSEE of Health Information we hope to be your trusty island of reliable and impartial independent unbiased information. And we may even have some guests with us to help. So sit back and enjoy. Hey Coffee Break. Welcome back and happy new year. Indeed, don't forget to have a listen to our podcasts all about AI. Yeah, our last show was all about AI. If you're not listening to it, it's definitely worth a listen and the see if you can see what the twist is in it. Yes. I think we have to say thank you to our listeners for this particular show. This was a listener suggestion and if you have any ideas of shows you want us to do or talk to you want us to cover, then email us at
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[email protected]. Indeed, I'm excited because Geoff just told me an idea for this October's podcast. Yeah, definitely. We have a Halloween episode lined up already, can you believe it? That is still 10 months away. And the interview about Halloween already. Anyway, today we are talking about geography once for weight loss. This is a very hot topic, isn't it? It's rapidly evolving. So what we do have to say is actually what we say on the show today, the information may change. It may not be up to date by the time you listen to it, but in general, all the information we give you today should still be quite valid. Yes, indeed. And also we are discussing GLPs specifically for weight loss, aren't we? Not for the context, for example, of diabetes, which some people, many people are starting. Definitely. And we would say if you have diabetes and you consider yourself in geography, you're probably going to definitely do need to talk to your clinician first of all. We're also, it's a board saying we're not talking about availability of geography once for weight loss on the NHS. That's another hot topic. And it's just so fluid, it's changing so much the guidelines for who is eligible to changing all the time. And certainly to sort of locally endorse it as things stand at the time of recording, there is no access to geography once for weight loss. And so other areas of country may be different than it's so it's very difficult to try and cover that and cover everybody in this show. Yeah, absolutely. So should we talk about how these medications work? Yeah, definitely. So I think the big picture is geography ones or the geography one injections, they mimic an actual process. So think of it like this. When you eat a meal, you all got naturally releases a whole load of hormones, a host of hormones to manage and deal with the food that you've just eaten. And one of the most important of these is a hormone called GLP1, that sounds like a glue-cogon-like peptide one. It's a, it's a bit like a master controller, it tells your body, food here, let's get on with it. But the natural GLP1 that our bodies make only lasts for a few minutes before it's broken down. So really simplistically, the genius behind these GLP1 injections is that there's synthetic versions of this hormone and they last much longer. They can last for a day, they can last for a week. And this extended actually is what makes their effects so powerful and blood sugar, but really importantly for today's episode on weight. And there are four key mechanisms I think, aren't there Sam? There are. We actually are going to call it the four-pronged approach. Yeah, definitely. So we are going to be looking at the pancreas, stomach, brain and liver as the areas that it works on. Okay, let's look at the pancreas mechanism of action. So here we're looking at a smart insulin release process that's happening. And this is actually the original reason that they were developed, wasn't they? Because they were made for, well, developed for people with type 2 diabetes. And then it's extended and exploded from there. So how does it work? When blood sugar levels rise after a meal, the GLP1 agonists stimulate the pancreas to release insulin into the body. And this is where it gets really smart because the effect of this release is dependent on the glucose that's in that meal. And this means that they don't tell the pancreas to release insulin if your blood sugar is already low. So that's really clever, isn't it? That's how that works. And it's actually a really important safety feature that reduces the risk of your blood sugar dropping too low, what we call hypoglycemia, which is actually a very dangerous thing to have. So the fact that we're protected from that is good. So really it's a bit like a smart firmness that for insulin, isn't it? So it's reliant on the levels, but able to avoid overproducing the insulin. Definitely. The second way these work is out on our stomachs and what they do is actually slow down our digestion. And this is where they're really good for weight loss. So what they do is they slow down gastric emptying. And this is the rate at which food leaves your stomach. So because of the food stays in your stomach for longer, you'll feel physically full for a longer period of two weeks. And this increased satiety that will actually make you eat small portions and therefore consume more calories, consume fewer calories. So you can think of it a bit like turning the drain of your stomach down to a triple rather than a gush. You'll make you feel full, it'll make you feel satisified. So that's really interesting because that leads us on to how it works in the brain because there's also links to feeling satisfied, but it's in a different way. So in the brain, where fast and in a fascinating way, there are also GLP1 receptors, the medicine reduces appetite and craving. So these GLP receptors that are present in the brain are particularly present in the areas that control appetite and the reward system. And so the drugs affect those receptors. And then essentially, you receive a powerful, I'm full signal directly in the brain and that reduces those hunger feelings and those cravings, which kind of links to the other way it's working, stomach is making you feel full, but there's a different way. And so what a lot of people report is that reduction in what we call a food noise. So those intrusive, well, I just found to see that snack or extra little thing to eat. Those are reduced, actual, they're thought processes reduced. And so we would say that this is a sort of a neurological process that actually turns down the volume of your hunger. So we've had three ways so far. It acts on the pain press. So it helps the our pain press release insulin to deal with the sugar. Insulates our stomach emptying down to make this feel full of longer. So we're not going to feel hungry and we can eat them less therefore. It affects our brain, the works on those receptors in the brain, it's basically signal through our brains that we're full as well. So that's two ways it tells you before. And the last way it acts on our liver is what it does is it holds the excess sugar production from our livers, which is really another important mechanism for blood sugar control. So they do this by suppressing the release of an other hormone in our system called glucagon. And glucagon's job is to say to the liver, release stool sugar into the bloodstream because we need more energy. So by inhibiting glucagon, GLP1s prevent the liver from dumping unnecessary sugar into the blood, especially between meals or overnight. And this kind of helps keep blood levels, blood sugar levels more stable. Interesting. So what GLP1 medications are there? Let's go through the list, shall we? So the first one is the drug name is semaglotide and this comes as branded names that we may have all heard of, EZMPIC, which is used for diabetes, WIGOV, which is being offered for weight loss and then REBELSIS, which is a pill, a tablet version of the medicine, the other two were injections, aren't they? And it's important that a ZMPIC is purely licensed for diabetes, so you don't use a ZMPIC for weight loss when GIVES license for weight loss and REBELSIS you can use for both. But you have to die of diabetes. There's also a regular type, so I'm so big tozer, again used for diabetes and sacsend for weight loss. There are other preparations available.
available and also if you're one of our global listeners, there may be other brand names for these medications as well as important things. Yes. And then perhaps the most latest, famously well-known one at the time of recording is Mungiaro, which is a drug named Tezepatide, which is also an injection. Yeah, that's right. And most of these are weekly or daily injections. Yeah. So you mentioned Mungiaro or Tezepatide. Let's talk about that. And that is the star of the moment, I'm trying everybody to serve Mungiaro. It's a next generation drug and it's called a dual agonist. So it actually works on GIP1s, which was just taught about, but also another hormone called GIP. This makes it more potent. So what's GIP then? Well, in short, it's another gut hormone. And when you combine it with the action of GIP1, it makes a really powerful synergistic effect on blood sugar and fat metabolism. And this is what makes Tezepatide more potent. Yes. And GIP actually stands for glucose dependent insulotropic polypeptide. That's a nice long word. And just like GIP1s, GIP is an incretin hormone. So this means it's released by cells in your intestine when you eat. And its main job is to help manage incoming nutrients, especially sugar based on this. Yeah. And it has some primary roles, which is. And the first one is stimulating insulin release. So its most well-known function is signaling the pancreas to release insulin after meal. This is very similar to what GIP1 does. And combining the hormones, it makes a much stronger and more effective response. Interestingly, GIP1 also appears to increase the body sensitivity insulin, meaning insulin reduced by a pancreas, which is more efficient. So the other action is promoting fat storage. And this sounds like a slightly odd thing to say, isn't it? But certainly for a weight loss drug. But GIP plays a role in telling a dippercytes, which have fat cells, to safely absorb and store energy from the food you've just eaten. And so by improving the way these fat cells function, we're preventing fat from being stored in unhealthy places such as the liver or around the pancreas, for example, or in normal muscles. That's right. And they do have an effect on fat metabolism. And this can enhance the breakdown of fat for fueling as well. Yeah. And essentially, it makes the body a little more efficient than handling fat stores. Yeah. And it's important because both GIP and GIP are incredible. So you can think of Mangerot, is appetite as a twin-cracking power-up. It's got two incredible actions. But however, it is still a single molecule designed to activate both GIP1 and GIP receptors. And that's what makes them so more very potent, acting in a complementary and synergistic way via a very highly effective team. OK. So it sounds like these medications are the panacea. These are the medication that lots of people are looking for. Surely everybody needs to be on them and they sound like a wonder drug. It sounds really simple, doesn't it? To have an injection, loose some weight and crack on, and the rest of your life is simple. Yeah. Definitely. But I suppose everything has its downside and there are some side effects. Yes, indeed. Let's go through, I suppose there's some common ones we already know about. And I think an important thing is that because they are so novel these agents, we don't know sort of long-term effects, do we? Yes. So common side effects, gastrointestinal. So because you are slowing the stomach down, essentially, you are going to create potentially some symptoms relating to that. So that could be nausea, vomiting, constipation, and ironically also diorib because you're causing the gut to respond differently and to receive different speeds of nutrition, I suppose, aren't they? And the good news is that these short-lived symptoms side effects often improve over time as the body gets used to the medication. So you do have to be careful not to try and out-eat the GLP ones. So you have to be careful with things like spicy foods or foods that irritate the GI tract because everything is slowed down and to be very careful with how you eat. You have to listen to your body, I think, if your body is telling you you're full, even you may look at your plate of ink. I haven't eaten it most of this. You can't eat it. We will become poor, though. But this is a good time, I think, to talk about not only the side effects of some of the safety and usage guidelines as well. Because there are safety guidelines for GLP1 medications, and we have a huge list of them here. So we'll just go through them one by one. So first of all, anesthesia risk. In late 2024, the regulatory body issue new warnings because these drugs load digestion is a risk of what we call pomegranate aspirations. That's where food from your stomach comes back up and then enters your lungs giving you an ammonia essentially. And this happens normally when you're put under anesthesia. So if you're going to have an operation, it's really important that you're an ecstasy nose that you're taking these medications because you'll probably need to stop them days if not weeks before the procedure so you don't have this risk. If you're also going to have something like a gastroxyptopheoroclonuscabeur because it slows, you've got to transit down, you'll definitely need to make them aware because otherwise you risk having a procedure that they're not able to go through and you'll have to be postponed. Yeah, I'm trying to have a risk of sensitive. Interesting. And then secondly to that, we were talking about how it slows down the way that food is received into the body in process but it also applies to medication, doesn't it? So there was a warning put out about contraception and pregnancy. It's really important actually. So the guidance says that because the medication can either slow the way you process another medication, in this case contraception, or because you could have vomiting or diarrhea, you may have reduced effectiveness of your oral contraceptive pill and so they may not work correctly. And so your increased risk of pregnancy. So the official guidance that we take from the UK's MHRA, which was received in some last June, 2025, is for women on all contraceptives to add a barrier method, so a condom, for example, or switch to a contraceptive that is a non-oral option such as the coil or the implant for four weeks after starting the drug and for four weeks after every dose increase. Yeah, that's right. That's really important, isn't it? Because you mustn't use these drugs during pregnancy or when you're trying to conceive, there's a lack of safety data. As you said, these are so novel, there's just no way that there's either historical data and there's certainly no way you could do trials to see the safety of these medications of pregnancy. And if you are trying to conceive, depending on the drug you're taking, you will have to stop taking these for up to two months depending on the drug before you're trying to conceive. And this is a huge problem. And the as anything baby trend is actually a real phenomenon with actually many people experiencing surprise pregnancies, as the contraception failed. And it isn't just contraception because as you say, it's all medication, so it affects important medications as blood thinners. Yeah. And then breastfeeding as well. The advice is that you must not breastfeed if you are taking these medicines. In a similar vein, HRT, there's also new warnings, very similar to contraception guidance, given the decreased oral absorption from your HRT tablets. You definitely need to speak to a doctor if you're going to take a GLP1 on your own HRT. You would likely need an extra HRT to cover dose increases when you start a GLP1 or increase your dose. But you definitely speak to a doctor about that. Yeah. Okay. And the next one sounds probably more scary than it is so far, but thyroid tumors have were shown to be associated with the use of GLP1s, but predominantly in the initial rodent based trials, isn't it? So in trials with rats, essentially. There seem to be an increase rate of thyroid cancers in those studies. They've kind of transferred that into large scale human studies, haven't they? And so far, there's been no clear cause or link for the two. So we think it may be something called detection bias. So people on these drugs are getting more medical scans. And so we're just finding pre-existing thyroid issues for other reasons. So all of that means that the risk is not zero. And there is a real warning here, isn't there? And as he is contraindicated, as in, you must have taken it if you or a family member has had the history of a thyroid cancer called a medullary thyroid cancer or a rare condition called multiple endocrine near plazia syndrome type 2. Pancreatitis and gallbladder disease, these are quite important. And if you get pancreatitis, which is a sudden painful and dangerous inflammation of your cancer, all gallstones or gallbladder disease that significantly increase risk of both of these and inflammation of the gallbladder, which can lead to surgery. Both of these mean that if you either had pancreatitis or gallbladder disease, you shouldn't take a gel if you want. But if you're taking a gel if you want and you start to develop uprapped on your pain or back pains, then you definitely need to let your clinician know as soon as possible, because you will need to start taking these drugs. And vision disturbance, vision issues, I think this is quite probably a big area isn't it. We highly recommend you have a vision check before you start a gel P1. And if you get any hint of vision change, you should get yourself checked immediately and consider stopping the drug. And lastly I suppose we should talk about long-term body and mind.
And what happens during an after treatment? So what happens when you stop? So they're really important. They you need to have some expectations of what happens. When you stop these medications, these troubles are for chronic condition. Therefore, you will take them for a long time, condition of obesity or losing weight. They don't cure it. And studies show that after stopping these medications, most people regain 50% or sometimes more of their loss to weight within a year. There's also something called sarcopenia, which is muscle loss. And when you lose weight rapidly, and that's not just because you take a GLP1, this happens for any reason you lose weight. You don't just lose fat, do you? You also lose lean muscle mass. And some studies have suggested you lose up to 40% of your lean muscle mass. And this actually is counterproductive, because losing this much muscle serves in metabolism, and that makes it easier to gain weight. That leads to sarcopenia, and then you become weak. And you can become frail with it as well, especially in older adults. And the recommendation is that you need to do resistance training. It's a central, really, resistance training. Lean muscle mass. And you really do need to make sure you're eating a sensible level of protein in your diet. Okay, that's fascinating, isn't it? And maybe I should add in my anecdotal one of, I have seen a few people coming about hair loss recently. And there is a link between rapid loss of hair due to rapid loss of weight, which is reversible. It's not the same as true alopecia. So it does calm down, usually whilst you're taking it over, if you stop it, but it's just something to put out there. Because people do come in a worry about that, don't they? I think it's important, because not all of these are purely because you're taking a medication. And also, this is seen with, as we say, any form of rapid weight loss. However, you've achieved that. When it's your body's response to that, mass of changing. Yes. It's your body's response to that changing weight. And the stress that's only happening. Yes, exactly. So what's coming over the highs and? Well, as you might imagine, the field has been moving at an incredible pace. The last couple of years have been transformative. And as we kind of mentioned at the beginning, or we hinted at the beginning, these medications are moving now just beyond diabetes and weight loss. We've seen them being used for a lot more things and we're going to see them used more widely for many other conditions, forwards. Yeah. But in terms of weight loss and what's in the pipe, like, well, we've talked about gel p1s. We've talked about tezephytide, which is a dual agonist, gel p1 and gip. There's a triple agonistide as well. Oh, we get this. So the buzz at the moment is about a drug called retagletide. And this actually targets gip1, gip. So the same as tezephytide. And glupigone. This in clinical trials, it's shown even more dramatic weight loss with some patients in phase two trials, averaging over 24% that's caught of their body weight. That's an amazing amount. These isn't after 48 weeks. And phase three trials are currently underway. And the rate is on to create a tablet that works as well as injections. This would take away the fear of needles. It would make drugs more accessible, easier to keep you not going to keep you in the fridge. And there are two big contenders at the moment. So there's a medication called ophorglyprom, which is a daily pill, not peptide, that is showing weight loss results in trials. And there's also high dose, also magulatide, the higher dose of rebalces, which is specifically mean that we have a bad for a beast, do. OK. So I think that leads us onto the last sort of safety warrior one. Yes. So let's say you've thought carefully, you've decided you're going to go on one of these glp1 treatments. And you want to know where to get it from. Yeah. This is a brilliant, important area. So you go on your search engine and you see the price of these medications. Maybe a friend from the pub or the lady at the hairdresser's friend might be the cheaper way to go if you wonder. This is the biggest safety area. So high demand of the medicine and coupled with shortages has meant that there has been an absolute flood of fake counterfeit or what we call compounded versions of the drugs, especially from online sources. Yeah. And the MHRA here in the UK and the FDA in America issued multiple warnings that these unapproved products are incredibly dangerous. They can contain the wrong active ingredients. They can contain different salt forms. So for instance, some agitites sodium can be found, which is different from the approved salt base they make it with that aren't studied or not approved for use. They may actually be no active ingredient at all. Or they could actually be things like half a bacteria or unknown impurities in it. Yeah. And even more wearingly, you can buy medications that aren't even released yet. So we talk about retaglititis. The medication is in trial, the triple agonist. You can go onto the internet and you can purchase what is being sold as retaglititis. You and I know there's no way that this drug is available. This is a drug that's a trial drug. The only people have access to this and the trial people and the pharmaceutical companies and yet somebody or people are selling something that they say is retaglititis. It's just crazy isn't it? So this is more than just a brand name versus generic issue isn't it? There have been no approved generics buying from an unregulated online source or MedSpar or research site is going to be a huge gamble and just not worth it. They really should be obtaining these via proper prescription from a licensed provider and dispense that a legitimate pharmacy. Yeah and when you buy these medications legally, they all come in a pre-full pen, which you attach a needle to. They never come as a powder that you've got to dilute. They never come in individual clear plastic syringes. However, be careful because counterfeit pre-full pens have now been seized which contain counterindulcations. So in the UK, if you're purchasing a gel, you want online, make sure you buy from a registered pharmacy, including those trading online with a prescription issued by a healthcare professional. This is the only way to guarantee you receive a genuine unsafe GLB warm medication. Yeah, absolutely. Now if you're living in England, we have put links to the General Pharmaceutical Council's website and if you know a Northern Ireland links to the Pharmaceutical Society of Northern Ireland's websites in the show now, it's just for your reference. Yeah. [MUSIC PLAYING] So, Sam, have you got to take home message for today's episode? Yeah, I think my turn came would be-- and we said it right at the start, it didn't really actually-- jumping on the bad bandwagon is so easy. You might know someone that's buying a new car and you think, oh, I'm going to jump on the bandwagon and really fancy this because someone else has got it. And actually, you just need to do your research properly. And certainly don't be tempted to cut corners and go through the proper channels. And don't forget, you can always talk to your doctor about the concept of starting it. We need to understand it at the time of recording this, particularly endorse it. If you didn't endorse it, we can't help you start them, Edison. We don't have it available to give you. But we would always be interested to talk to you about it as part of your wider health. Absolutely. I think I've probably got two take home points. I think the first thing I'd say is I think this is the start of a new phase in medicine. I think the issue of obesity-- and we look at obesity in healthcare-- is changing rapidly. I think we are now looking at obesity as a chronic health condition and everything associated with it. And I think this is the start of that. But I think it's also important because I think some people are either shamed about using the medication for weight loss, like jumping on, or the combined dual agnist. I think some people may look at people who use them and they won't cheat. But these medications are designed for that. You're not using the medication for something that they're not designed to. It's not like you're using some medications that may be misused for weight loss. They're not licensed. And they're certainly not safe for weight loss for some people who do them, use them. And I think we've got a long way to go with the stigma of obesity and how we treat it. And I think that's reflected by how many people cry really purchase these medications to try out and win weight loss. But yes, and I agree we've seen huge costs to someone's health, but also the actual direct money cost of obesity on the whole, haven't we? And so investing at this end with the right safeguards in place and the right support around it could be a huge change in the world. [MUSIC PLAYING] This has been an episode of Coffee Break, and we hope you've enjoyed it. And if you have, then I hope you'll join us for another Coffee Break soon. Remember, if you want to get in touch with us or if you have any ideas or suggestions, then please feel free to email us at the show. At
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The content does not constitute medical or healthcare advice. The content is valid in England at the time of recording. The content should not be relied upon as a substitute for professional medical or healthcare advice applicable to your specific circumstances. We advise that you always consult a qualified medical professional for any medical matters.
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