The Ozempic Phenomenon: Miracle or Menace?

[00:00:00] Today, we're diving into a hot topic that's been making waves in the health and wellness community, OZMPIC, a medication that's been praised for its weight loss benefits but also comes with its fair share of concerns.

[00:00:13] That's right Mary, OZMPIC or semi-glutide is a GLP1 receptor agonist that has shown promising results in helping people to manage their type 2 diabetes and weight loss. However, it's not without its risks and side effects and we'll discuss these today.

[00:00:28] We'll explore how OZMPIC and drugs like it work, what are their risks, what are their benefits and we're going to draw insight from Johan Hari's latest book Magic Pill which sheds light on not only the extraordinary benefits of medications like this but the disturbing

[00:00:44] risks associated with these new drugs and which really emphasizes the need for a balanced perspective. Yes, and we're thrilled to have a special guest today, Denise Felatic who is a patient of mine and has gone through her own personal journey with OZMPIC over the last two years

[00:01:03] and so Denise is going to share with Mary her triumphs and struggles as she's experienced them with OZMPIC to give us a lot of insight into this medication and whether to help people decide better if this is something for them.

[00:01:18] So before we dive into all that, it's important to remember that weight management and health are multifaceted. Whether or not you choose to take medications on your weight loss journey, there are three essential components that must be in place for successful and permanent weight loss.

[00:01:36] Dr. Ted, what are those components? These three components are... You're listening to Take On Health Care with Ted Souzeleis and Mary Sheehan. Do you wish there were a magical chemical to help you quickly and easily lose weight?

[00:01:50] The new weight loss medications promise to be just that, but are they really? On today's podcast, we take on weight loss medications like OZMPIC. Today we are taking on drugs like OZMPIC that are classified as GLP1 agnes.

[00:02:07] Now OZMPIC is the one we're going to use because it's done such a great job of being like the face of all of the medications in this class. There's several however. No one knows OZMPIC.

[00:02:18] It's got that catchy but corny jingle from the TV commercial and all the social media attention. Celebrities influencers really love medications like this. And I don't know that everyone in the medical community is quite as enamored as the celebrities,

[00:02:36] which is why I thought it would be a good thing for us to take on. So why are you happy that we're taking on this topic? I just think it's so important to help people to understand because there are lots and lots

[00:02:48] of people that are getting on this medication. And we'll talk about the statistics a little bit later in the episode, but over the last couple of years OZMPIC and these other GLP1 agnes has skyrocketed.

[00:03:04] And so from my perspective, A, I want to make sure that people understand the risks and the benefits and make sure that they're making the right decision for them. And now you as a naturopathic doctor practicing in the state of Ohio, you don't prescribe medications like this.

[00:03:22] And you are kind of like me neither for nor against. What we're really interested in is this medication as part of a much bigger problem in this country, which is BDs and obesity. I've heard the term diabetes city, which I really like because it's describing a metabolic

[00:03:43] situation, a metabolic problem that unfortunately does not have a quick fix as an answer. But neither one of us are opposed to using a medication such as this as part of a bigger plan for people.

[00:04:00] We just want to explain it to people so we're not for or against. We're not giving medical advice. We're not encouraging people to stop it, to use it, always talk to your healthcare provider. We just want to dive into it as part of the bigger problem. Right.

[00:04:15] Because I mean as a naturopathic doctor when I'm looking at my patients sometimes they need medications. Sometimes people need that extra. They can't do it on their own and it doesn't say anything about the patient but it's everybody is it in a different place.

[00:04:33] And so yes we want to look at the safest and least invasive therapies first but sometimes those therapies aren't going to be good enough and we need to move into those medications. Yeah, I love your approach to meeting people where they are.

[00:04:52] I think what we both like to do is help people even begin to think about well where am I in this journey as opposed to being pulled in a direction because of an outside influence. Be that outside influence you, me or social media.

[00:05:09] Like always look within to see where you are in your journey. So like we said we're going to use ozempic but it's really there's several medications like it. It's one of the GLP1 receptor agonists and we'll go into the really cool way that they work inside the body.

[00:05:25] So there are other medications that are in that same class, Ogovi. That's a brand name. It's another form of semi-glutide which is what ozempic is, semi-glutide. It's higher amounts though than ozempic and Ogovi is the only one really approved for weight loss.

[00:05:42] So ozempic doesn't really have a weight loss indication but like we said before so people are confused often times when you have excess body fat you are in the category of pre-diabetes so that's your diagnosis. But technically if you're not pre-diabatic but you're overweight then technically the

[00:06:04] indication but it's the same chemistry is my point. And also too there are conditions when the doctor's right for it to get that prescription to be paid for by the insurance. It's not only that you have the one for the Ogovi for weight loss you also have

[00:06:17] to have a comorbid condition though I don't know how you could not but you have to have that documented like heart disease for example. So let's start by discussing what ozempic actually is. Ozempic is the brand name. The generic name is semi-glutide.

[00:06:31] It's a medication that was initially developed for type 2 diabetes management. It's one of the GLP1 receptor agonists and we'll talk about exactly how those work in the body but to be complete there are other medications that are GLP1 receptor agonists.

[00:06:48] For example there's Ogovi which is another form of semi-glutide. So it has the same chemistry as ozempic but there's higher amounts in it and it's the only one indicated for weight loss. But in order to get Ogovi covered for weight loss you have to have a comorbid condition.

[00:07:08] So the doctor has to document the patient also has say heart disease for example. Right. And you were saying that makes a lot of sense. Well yeah because you have to have some guardrails in place. We're talking about medications that have side effects and it's something

[00:07:29] if you...we'll talk later about all of that but these are medications that if A. you don't take properly and eventually you go off of it you're going to gain all of that weight back and more.

[00:07:42] But also we have to make sure people in our country are so starved for weight loss at all sizes that you can see if we don't have those proper guardrails in place you're going to have people that are

[00:07:59] technically a healthy weight yet their doctor is going to prescribe them Ogovi and they're just to lose those couple of extra pounds or have them forbid somebody with eating disorders that want to go way below a healthy weight. Good point. And so we need the...we need some...

[00:08:19] The guardrails I love that. Yeah. So it's okay that I know people get frustrated when the insurance companies or the drug companies put up caveats for who can and cannot but that is for your safety. Right. Okay. Right. Munger is another one that's tears of peptide,

[00:08:35] tru-licity, du-l-glut-d-glut-d-ride, bi-ed-a, exan-etide, vict-to-za, lyroglut-ide. All of those are for type 2 diabetes, sex-senda, sex-senda or lyroglut-ide is for weight loss. That got a weight loss indication and then there's actually an oral medication rib-elsis, semiglut-ide which is for diabetes.

[00:08:57] So mostly what I see in the pharmacy for weight loss that weight loss indication is the Wagovii. Okay. All right, mechanism of action. Who wants to...I think you should talk about mechanism of action. Sure. Even though I know that stuff but you say it in a more

[00:09:14] like...I think user-friendly way. Right. Definitely. We want to...because I think that's really important as we were studying for this episode. Every definition, even if it was in more of a consumer journal or something, or article was very clinical. Somebody that doesn't have a medical experience

[00:09:34] isn't going to really understand what's happening. And we have to understand that's where people are getting the information about medications like this. They're not really getting it from healthcare providers. Right. Okay. Right. So like you said, these GLP-1 agonist drugs

[00:09:54] are ozempic and all of these other related medications. And so GLP-1 stands for glucagon like peptide 1. So this is a hormone that's produced in the intestines and the small and large intestine naturally. Naturally, our bodies do it. Yes. Okay. When it's released into the bloodstream, this

[00:10:17] hormone goes to the pancreas and it will stimulate insulin secretion. And so insulin, when insulin is secreted, it tells the cells of your body to accept sugar, glucose, to lower your blood sugar. And so I want to cover again basics of what a hormone is.

[00:10:42] We've talked about this in previous. Yes, please do. Because people don't really understand what hormones are. They don't. They think it's estrogen or testosterone. It's simply a chemical messenger. Right. So I always like to give the analogy of the hormones.

[00:10:58] So this GLP-1 peptide, let's say it is uber eats. Okay. And this is a messenger. It comes to your house, rings your doorbell and you open the door and you get the food. I like that. So just like the insulin gets produced, it goes through

[00:11:22] the body, cells get that signal and they open up to receive glucose, the sugar. So it feeds the cell. And we want our sugar in the cell because the sugar is outside the cell that's in the blood. Your blood sugar, when blood sugar is high,

[00:11:39] it's not getting into the cells where it's used. That's when you have problems. Right. And too much can be a problem too, but that's why that's not the only mechanism here. Of how it works. Of how this drugs and the hormone work. The medication mimics this. Correct. Okay.

[00:11:57] And that's why I want to talk about what the actual hormone does. Yes. And obviously we're going to get back to our back and forth. Oh yeah, which is great. But the other main action in the pancreas is that it inhibits secretion of glucagon. Which is?

[00:12:13] So glucagon is another hormone that raises your blood sugar. So it tells your liver to make more sugar to put into your bloodstream. Okay. So when we do that, then it helps for both to get the sugar into the cells but then slow down the

[00:12:32] body's ability to make more sugar. In the gut. Like that's slowing down in the gut. Right, in the liver. Yes. Oh, in the liver. And so that's two of the different functions. Okay. The third function is that it slows down your stomach from emptying.

[00:12:51] That's where I'm getting the gut thing. Okay. Yes, so then you retain food in your stomach longer, which makes you feel more full and gives you a prolonged sense of fullness. And this is again, this is naturally what happens. Right. And this, the body that makes natural GLP1,

[00:13:09] the body that makes it, where is it made? It's made in our guts, right? Yeah. So in the small intestine and the large intestine is where that... Which is why I put it if I were making a gut. Of course. Right?

[00:13:21] That's where we put it because in the food comes in and all the absorption of nutrients happens in the small intestine. Correct. So that's where all this kind of chemical information needs to be happening for the body. And so that's your body saying, okay, we

[00:13:37] have food here and it's sending out these messengers to tell the pancreas and the stomach and other organs what to do. What to do? It's genius. Right. And I think it's amazing. It is such a... It's a hormone with so many different activities.

[00:13:52] It is no wonder that researchers started to look there. Right. Because before that, it was all about how to get the glucose into the cell better. Right. Or yeah, and whatever mechanism that is, it's kind of like a deeper mechanism now that

[00:14:08] we're going for with medications like this. Right. And then the fourth part is that it does affect the brain to help you feel more full. So how does it get into the brain? So the hormone... Just goes up there too. Yeah. So it does its thing down...

[00:14:24] It's pretty amazing really. Right. Does all of these things down here and then goes to your brain and says, we're full now. Right. You can stop eating. Right. Because the brain is involved. Right. So it goes up there to tell you you're full. Yes.

[00:14:37] You have the stomach that's still full a lot longer. And then the brain also saying, we're good. I love that. I just love a good chemistry... A good chemistry lesson. It just makes me so happy. Yeah. And so when we think about that happening

[00:14:50] naturally as a hormone, that's a good thing that's important for our bodies. Right. Some of people's... Some obesity could be because they don't produce enough of this hormone. Do we know that for sure? No, we don't. We don't. But that's where they're thinking. They're thinking, okay, overweight...

[00:15:08] Being overweight is not lack of... At least we understand this now. It's not lack of willpower. It's not anything wrong with your psychology necessarily. But perhaps your chemistry's off. Yes. You don't have enough GOP-1. Right. What can we do? They think. Yes.

[00:15:24] So but when we look at that in order to have the effects that these medications have, we're talking about much, much higher levels of this hormone than what's naturally produced. And so just like any other hormone, when there's too much, you could have different side effects. Right.

[00:15:40] Because the body knows how to manage its own chemistry, right? There's things that probably turn it off, turn it on, other things we don't even know about yet. Right. Okay. But every hormone has its side effects if you have too much. Makes sense.

[00:15:54] It doesn't matter what hormone we're talking about. Correct. Because they're all chemical messengers. Okay. So blood sugar regulation, appetite control. We talked about that. Where are we with this? I think you just, I think we're just summarizing it. Right.

[00:16:13] So when you eat something, GOP-1, your gut makes helps to increase insulin release. Insulin gets the sugar into the cells, which then decreases the amount of sugar that your liver makes. Right. So you're going to lose the stomach, which helps control appetite and your weight and also

[00:16:31] goes to your brain and kind of shuts off, I guess it stimulates satiety. Saty. That's how you say that. Okay. All right. So how does this then, okay, so then to use a medication that mimics that GOP-1 that does all of these things, right?

[00:16:50] How does then an approach like these medications take line up with a more holistic approach to health? Yeah. So I mean, that is kind of a tricky question because on one hand it does improve diabetes. It helps lose weight. So you have a whole host of different benefits.

[00:17:12] Benefits. Every practitioner wants, doesn't matter what allopathic, naturopathic, whatever. Like we all agree. Yeah. So they lose weight and get their metabolism better. Correct. And with that, we are, well, we're mimicking a hormone.

[00:17:29] Now that's the tricky part because we know that there are a lot of synthetic hormones that aren't exactly like your body's hormones that do tend to have a lot more side effects. So for example, like could we use, is it a good parallel to say when somebody has

[00:17:45] low thyroid and we give levo thyroxine? It's, it's not quite exactly how the body does it. So you have to be careful with the balance of it. With this, it's not really about, it's about the balance, but it's more about like messing

[00:18:03] up a lot of different situ pathways. Right. So it's, I would, they, the other hormone that I would look at more is progesterone. Oh, how so? Because when the synthetic progesterones, if they're not given with an estrogen increases your risk for uterine cancer and different other cancers.

[00:18:25] Which we know that now, but back in the day we didn't know that everybody was put on synthetic progesterone for many reasons. And then years down the road were like, oh gee, when we messed with this. And I remember thinking, but it's not exactly progesterone. Right.

[00:18:41] But the marketing around it and the things people are talking about it, but it is, but it's really not. So it's kind of like this, right? It is kind of like a supplementation. Right. But it's not exactly. Right.

[00:18:54] And so like with progesterone, natural progesterone doesn't have those same side effects. Right. So when we're looking at conventional medicine, medical doctors are very reluctant to prescribe progesterone. And it's a hormone that can be very helpful in menopause yet because they look at it.

[00:19:14] Well, if we're not giving an estrogen with it, then we can increase your risk for cancers. Where if somebody is getting the USP progesterone, the bioidentical form, you don't have those risks so you can give a very safe hormone that helps to reduce some of those side effects

[00:19:31] of menopause. Yeah. So when you're really on in menopause, when we have the ovaries, they're starting to shut down. They produce estrogen and progesterone. Your adrenal gland still will produce about 40% of your estrogen. Which is so nice of them to pitch in. Right. Exactly.

[00:19:49] But there's nowhere else to really produce the same progesterone level. So what I see with a lot of patients is that progesterone level is dropping first and that's where a lot of those menopausal side effects are. Gotcha.

[00:20:01] So I mean, it's probably safe to assume in 10, 5 years when we have this conversation again about the GOB1 agnes, who knows what we're going to be saying. Who knows? We might find that it's perfectly safe but we might not. But we don't know. Right.

[00:20:15] That's a big point that we want people to understand that there are some clinical trials that drugs like this help manage blood sugar. They do show weight loss. So that has been studied and shown.

[00:20:30] And then doctors could use these off-label for weight loss diabetes and kind of like the overlap there because they go hand in hand. And I think it's a great point to make. I think we should make this point.

[00:20:43] When people have this diagnosis, this drives me crazy, of pre-diabetes to me, this just seems like slick marketing. It's diabetes. Right. I mean, it's metabolic disorder. Let's just call it like it is.

[00:20:54] So then in a way, I feel like we're not being aggressive enough when we tell people they have pre-diabetes because they hear that and say, well, at least I don't have diabetes. Type 2. But really you're kind of on the way to that. Right.

[00:21:08] And so that's supposed to be the signal to, hey, I need to get my act together so that I can get my blood sugar under control so that I don't get diabetes. Right. Because that leads to heart disease, cancer and Alzheimer's. Huge killers in this country. Okay.

[00:21:25] I just want to make that point that we should be taking, well, you do take it seriously and people should take it seriously. But again, like when I hear myself say this, okay, you've been diagnosed with pre-diabetes, understand how serious it is.

[00:21:38] And then I feel like, okay, then am I contributing to people saying, well, I need the magic pill and I need it now and I need to get well now? Right. Like I need this weight loss now.

[00:21:49] Which these medications can really make people lose weight very, very quickly. Right. And so, yeah, that's the big negative is that we're not, with this it gives the idea that you no longer have to worry about dying and exercise.

[00:22:09] You can just eventually get to the point where we take this medication and it will all be better. Which is not true. Correct. And I think anyone would agree that that is just simply not true. Right. Right. And it needs to be a bridge and not a destination.

[00:22:25] Right. Because if you don't take care of the underlying problems, and we'll go through this a little more later, but if you don't go through and take care of the underlying problems along with doing the medication, you're bound to gain the weight back.

[00:22:42] Or you're going to have to stay on this medication for the rest of your life in which case it increases these potential risks that we don't know about. We don't even know. Right. And it turns. Right.

[00:22:54] And you're setting yourself up for something you just don't know what you're setting yourself up. So although you, which we all agree, losing weight can be a very good thing for your body, helps you psychologically, socially, you reduce your risk of all these diseases, but

[00:23:07] at what cost down the road? Right. Because the oldest one of these medications is Bayetta, which was... Oh, I remember Bayetta. ...was released in 2005. That's pretty old. So 19 years ago. Okay. And by say 2010, there were but less than a million scripts written for these types of medications.

[00:23:29] Which is not a lot. No. People have to understand that's not a lot. By 2021, now we were looking at over 20 million. So 20 times as many prescriptions between 2010 and in those 11 years. So it just shows we're rapidly increasing this.

[00:23:47] And even though it was released 19 years ago, we still don't have a lot of data yet. Because there weren't that many people. Right. Honest. Yeah. You need... Sometimes you need large amounts of people in these studies to be able to pick up small

[00:24:02] risks that only certain people have. True. That's a very good point too. And you don't know if you're going to be one of those people. Right. So then where does that bring us, Ted? That part of our slide show, are we on right now?

[00:24:16] We've gone off on some really good points. Right. So I think it would be good to talk about side effects for the medication. And can I also say that side effect is also a marketing term. Side effect is just an effect. Right. Right? It's just an effect. Yeah.

[00:24:34] And I bring that up because when... Because we use that like, ah, it's just on the side. It's just a side effect. It is an actual effect of the medication that is undesirable. Exactly. But the poor chemistry is just doing its chemistry thing.

[00:24:47] And that is part of the risks that everybody from what we know needs to be aware of. So yes, let's talk about side effects. Yeah. So I mean, the most common side effects that are listed are nausea, vomiting, diarrhea, and constipation. None of those sound like much fun.

[00:25:05] No. No. But because it's almost like your own GLP-1 rarely would make you nauseated or mess up your GI tract. Correct. So there must be something that it's like your own chemistry but different enough to cause these kinds of things. Right.

[00:25:26] But then I also think people are probably like, well, I'm nauseous. This is good. I don't want food. Right. But taking the route of talking about other hormones like we have, too much estrogen for women right before their period causes all of their PMS symptoms. True.

[00:25:44] Most of the time. I mean sometimes it's... There's other factors but simply, yeah. And so there are a lot of other side effects that aren't really listed that we see time and time again that most people have. Like what? So fatigue is a huge one. Yes.

[00:26:00] It's the one you hear people talk about. It's listed but yeah, that's a problem because then I think, okay, you're tired. Then are you going to want to go to the gym and work out?

[00:26:12] Because these medications cause you to lose weight but part of the weight is also muscle mass. Right. Yeah. That to me is like very alarming that you would lose muscle mass. Yes. I mean, let me find the statistic here. Yes.

[00:26:29] It's between 10 and 30% of weight loss comes from lean body mass which is mostly muscle loss for people on these medications. Okay, that seems like something that really should be talked about a lot. So it's not just making people lose adipose tissue.

[00:26:48] So then I can't help but wonder, okay, if you lose weight without any medication, you take whatever path you take, there's no artificial anything. Do you lose muscle mass too? That is a potential, correct? Right, correct. If you don't have enough protein or are there other factors involved?

[00:27:09] There are a lot of factors involved. For one, you've probably heard that you can't lose more than one to two pounds of fat per week. Okay. So you can't or you shouldn't? You mean it's- You can't. So your body won't allow it?

[00:27:24] Your body can't burn that many calories. People, I've never heard of put that way. I always thought you shouldn't. So when you see weight loss greater than that, it's not your adipose tissue that's leaving. It's also some muscle. Correct.

[00:27:38] Well, yes, and it depends on how large the person is. Okay, like what the VMI is? When we have really severely obese people because when we're looking calorie-wise, you say the typical woman needs about 1500 calories a day to maintain their weight. Okay.

[00:27:59] You need to cut about 500 calories a day to lose a pound a week. That feels so extreme to me. Yeah, so for exercise that's walking, jogging, running five miles and keeping making sure you keep your food the same. Yeah, because you can't be wasting calories. Right, right.

[00:28:22] You don't have that many. Right, so if you to burn two pounds a week then that same woman has to be at 500 calories a day. That's not healthy. And then you go to three pounds a week, you're looking at a net zero.

[00:28:39] Which is going to jack up your chemistry in the body. It's not going to allow for that anyway. So if you're morbidly obese like what we saw on The Biggest Loser, people are six, seven, 800 pounds.

[00:28:50] Well they can be at a calorie negative deficit because they have so much fat to burn that they can do that better. Because their fat is burned and the body will do what it needs to do with that.

[00:29:02] Right, right, because their calorie requirements are going to be a lot more to keep them where they're at. I got you. So say somebody- They're basic metabolic rate. That's what I call that. Exactly, the basic metabolic rate. It could be at say 3000 calories versus 1500.

[00:29:17] So it's a lot easier to burn more pounds per week than a typical somewhat normal person. So that just brings to mind that if you're burning more than that, if you're losing more than that, you're not going to be able to just burn fat.

[00:29:34] You're going to be breaking down muscle too. Which is bad because we do have data that shows a nice percentage of skeletal muscle on your body is really good for your overall wellness and longevity. So many benefits having muscle. It's part of your metabolism too.

[00:29:51] So you lose muscle mass and then you go off the medication and your metabolism then is much, much weaker. That's why it's so easy to gain weight back again because you don't have as much muscle mass to burn calories 24 seven no matter what you do.

[00:30:09] That's something people really need to think about. So then I heard some discussions then. Can we counteract that loss of muscle with medications like this by working out, by lifting weights? Some, yeah.

[00:30:22] Some can be but if you don't have the energy to do that, but it can be. But I don't think we have enough long term like studies to really show okay here are people that are on a glip one agonist that did this amount of weight training.

[00:30:37] Here's your people that here are people that did not or here are people that also did yoga whatever. I don't think we've seen that. But well, there's been some studies but it's not just about the weight. It's the weight training. It's about your diet too.

[00:30:50] If somebody is on these medications and just eating carbohydrates and they're not giving proteins to give back to the muscles, you're going to burn a lot more muscle mass quicker. It's such a good point. And then with the decrease in appetite from these medications and how it makes

[00:31:08] you feel full so quickly are people not then getting enough protein because they don't want to eat. Yeah, so that's where I've seen several people, not patients but certain people like my wife, stepdad is on one of these medications.

[00:31:22] I'm not exactly sure which one but when we were staying with them in Florida over the Christmas holidays, he also has a continuous glucose monitor on him and so he wouldn't eat all day but then he'd have at night because he needed to eat something.

[00:31:36] He'd have some cookies and chocolate milk. And pass out and his glucose monitor is going off because his sugar goes up. I don't mean to laugh but it's like the absurdity of it. Right, right. The absurdity of living like that without really...

[00:31:54] And I'm just afraid that that's going to become kind of a way the people are going to be if they really don't fully understand what's happening within their own bodies with medications like this.

[00:32:06] But that's a big part of why we wanted to take this subject on to help people to understand these risks and how if they choose to use these medications, how to do it safely and effectively. Right, always not with the healthcare provider, not just by purchasing them,

[00:32:23] not by circumventing the system. Okay, what other side effects we have? Okay, let's talk about other side effects like electrolyte imbalance because I've heard this too. Yeah. It can throw off your electrolytes. Is it simply because people aren't able or willing or whatever to have

[00:32:41] a nutrient dense diet or is it doing something else to like potassium, for example? I think it's that they're not getting enough of those minerals back into their body to replenish. So potassium you need foods like potatoes, sweet potatoes, bananas, avocado, spinach.

[00:33:04] We have certain vegetables that are high in potassium. So if you're not eating any high potassium foods, then it makes it harder to replenish it. Same with magnesium is another mineral electrolyte that's so important. Yes, and our food supply is so diminished in.

[00:33:20] So lots of people are somewhat deficient, but you go on a starvation diet where a lot of people doing with this because their dosage is a certain way that it's going to just increase that. So people may not even know what their baseline is.

[00:33:37] Are they taking an electrolyte panel before they put people on medications? That will make a difference because when you look at your blood electrolytes, you have to keep it in a very narrow range. So the best example is calcium for people.

[00:33:52] So I have a lot of patients, they'll get their comprehensive metabolic panel, they'll see their calcium is in the normal range and they say, oh, I don't need extra calcium. But doesn't work that way because if your calcium goes a tiny bit too high

[00:34:09] or a tiny bit too low, it causes major health problems. And so if you don't ingest enough calcium, your body will pull from your bones to keep that calcium level in your blood normal. If you're eating too much calcium, well then your body will,

[00:34:27] in order to keep that level very narrow, it'll pack more into the bones. OK. So that's where getting those, I mean, over time, monitoring those blood electrolytes can show that maybe you're in a severe deficiency, but it's not going to show up unless you're in a severe deficiency.

[00:34:44] Gotcha. OK, that makes sense. And also, too, like if you've got the GI side effects like nausea or diarrhea, that would also deplete, right? Deplete you. Yes. And even though you might think, oh, this is great. I'm losing weight and it's not so great.

[00:34:57] So I think that's such a good point to think about your chemistry and what potentially could be happening. Right. Right. OK. So some other more, rare, more concerning side effects, pancreatitis, because obviously that is in the warnings. So obviously this medication, as we talked about,

[00:35:14] has two different ways that it works on the pancreas OK to help stimulate insulin and to reduce glucagon. So it's so with that, your pancreas can get irritated. That can cause more nausea, more vomiting, more abdominal pain.

[00:35:31] And some of that might not be necessarily realized right away, too, until it becomes really severe. And that's that could be very bad. Right. Right. And thyroid, too. So there's thyroid, there's thyroid disclaimers on all of them. Right. So it's there and I haven't looked at the studies.

[00:35:47] It's rats mostly talking to some people. Yeah, that's what I thought was just rats. And it's not really well, not really well delineated. But there is they're showing a small risk for thyroid tumors. Why do you think that is?

[00:36:00] Because if I'm just a person who's trying to lose weight, I mean, and I'm worried about what's happening down here, I'm thinking, what does my thyroid have to do with anything? How did it get involved? No one asked its opinion. Right.

[00:36:12] So that link is if any of like I said, we don't know. But the link could be that when you're in a very calorie deprived diet, it slows your metabolism. That's what we talk about the fatigue, the constipation. Which are signs of thyroid hypothyroid.

[00:36:34] So it's your thyroid hormone helps improve your metabolism. See, you can't really you can't ask any of the body systems to bow out. Right. They're always going to be participating. All of you is always participating in your own chemistry and whatever you decide to do.

[00:36:52] Yeah. So some other side effects, gallbladder disease, including increasing gallstones. That makes sense, right? That's logical to me. OK, kidney damage. And that's going to from what I've read, it seems to be a lot more because of dehydration is well,

[00:37:08] for one, people are on these medications with diabetes. So they're already have a higher risk of kidney disease. And then if they're dehydrating themselves, that's going to damage their kidneys more. So you could definitely do a kidney panel, though, to see where your kidney health is.

[00:37:23] And I would assume doctors are doing that. They should be. Yeah. OK. But that should be just part of that whole diabetic panel that they're monitoring. If you're pre-diabetic, you're going to have all that time as well as your eyes. You're going to see a pediatricist.

[00:37:35] You're going to go to the eye doctor. You're going to have all these things. OK. And it also could increase the diabetic retinopathy, the diabetic eye disease too. What? The medications like this? Yeah. Yeah. That's one of the side effects listed. Why? I have no idea. Interesting.

[00:37:50] Yeah. You think it'd be the because you think, OK, that diabetic retinopathy is as goes part and parcel with pre-diabetes, diabetes. So if you're if you're intervening on that and helping that, that would decrease. You would think so. We just don't know.

[00:38:04] Right. Right. And it could be that's the thing. Some of these side effects seem to be when everything isn't working properly. So if they're not eating properly, the medication is increasing their insulin. Well, too much insulin is part of the damage to the kidneys and the eyes.

[00:38:23] Great point. Excellent. OK. And so obviously low blood sugar can be a concern. Sure. Because you're increasing your insulin to help get the sugar into the cells. You're telling your liver not to make so much sugar so your blood sugar could definitely drop.

[00:38:42] I wonder if it makes people crave sugar then or you just don't crave anything. That's what's so great about it. That's the problem is that you don't have your guardrails again. Yes. So you're you're you're numbing your body's internal signaling, right?

[00:38:55] Which I think is always very scary. Right. Right. When you mess with your own signals because your body has so much to tell you. Right. Right. Also osteoporosis. Yeah. Because if you're depleting your calcium, then the bones are going to get weak. Right. Right.

[00:39:08] That's that's something to think about. Yeah. And then also there's a lot of mental health issues that can be tied to it. Should we talk about that? Is it a good time? Have we done the 50? Have we done like the physical side effects?

[00:39:22] Because yeah, with those psychological things are so much more right to discuss. OK. So let's talk about it. OK. Go ahead. So what are the documented side effects? So that's the thing that there's not really a ton truly documented. It's talking to people or that what was,

[00:39:41] Johan, so he talks about the fact that when he was on started on this medication, one of his one of the reasons why he gained all the weight to make to allow him to need the medication we was because of emotional eating. And so right.

[00:40:00] He had a bad day and went to one of his normal places that he would eat a binge meal. And all these taking this medication while he's taking the medication and then he gets really sick and can't eat most of the meal. But then also that removes his

[00:40:18] his coping mechanism to deal with the stress. I think that's such an excellent point. It could to me that goes parallel with if you're decreasing your appetite, you've got to make sure you eat nutrient dense food. So you need that education. Right. If you rely on food

[00:40:36] to meet a need, an emotional, psychological need and you haven't dealt with what else can I do? You're really putting yourself you're being very mean to yourself. Right. Right. And so definitely can increase that depression and also suicidal thoughts and ideology and possible actual suicide.

[00:40:53] And that's been documented. I don't it's in. It's in some literature. I know Harry's and it's in his book. And he is a journalist. So he and so and a lot of times he writes about personal experiences

[00:41:06] that cause him to like to go down a path where I need to know everything about this. Right. And then he brings it to the forefront. And I think that's something that people really do need to be aware of.

[00:41:16] Because we get we tend when it comes to being overweight and we want to lose weight so badly for many reasons, we become very focused on that one thing and anything else that may come in like, well, you may have this body side effect.

[00:41:32] You may have this psychological side effect. You may want to consider this. We don't want to see that. Right. Because it's just too much. We just want what we want and we want it to now. Yeah. And this medication seems to promise that.

[00:41:44] But as we've been talking this whole time, we can mitigate a lot of these side effects by doing the process properly. The process, meaning learning how to eat well. Right. When you should be doing that. Right. That'd be a great help.

[00:42:01] And then also the piece that's beyond your expertise in mind, too, like the psychological parts, but we just want to bring it up so that people know if there is something, an emotional aspect you're eating, you really want to make sure to address that in whatever way.

[00:42:18] Right. Because that medication is not going to solve that for you. No, no. And definitely along with eating disorders, too. Right. But it does solve a piece of it like the piece where people are constantly thinking about food.

[00:42:31] Maybe they don't have it like a kind of a diagnosis of an eating disorder or they don't necessarily need it. It could help more with somebody has bulimia so that they're not going to binge. But the inter-exics do everything they can to not think about food.

[00:42:47] And so this just helps to feed into what they're already trying to accomplish. So that would not be a help for overall healing. Right, right. So you really kind of have to know yourself and where you are with that.

[00:42:59] And it's just it's one of those things that needs to be put into place when doctors are prescribing these medications to know. And that's and that's where we have to look at getting more information and having more strict guidelines on how to prescribe the drug. Right.

[00:43:18] And make sure people have access to all these other things that they need. Right, right. Like everything weight loss and wellness, it's you have to approach it from many facets. Yeah, yeah. And I have another thought about about how the fatigue

[00:43:36] and things on that end are do share. Yeah. So think about what we're doing. We're starving the body. So your body's metabolism is going to drop. So in response, in response. Sure. So you're putting your body in almost like a hibernation mode. OK. Oh.

[00:43:55] So so it would be natural to go to sleep. Right, right. And so there is a theory about our health in the cells called cell danger response. OK, where when you're exposed to certain infections or chemicals or metabolic problems that the cells in order to survive

[00:44:21] and to keep your body to survive, it reduces what the cells are doing. So it reduces some of those extra things. So like thinking, right? Right, right. So when you because you feel tired, right? So how do you think? How do you function? Right, it'll be very challenging.

[00:44:39] Right. So and that's just like lots of different chronic infections and things where fatigue is so big because the body is sort of shutting down in some ways because it wants to focus on defense and repair. Yes, it's so smart, the body, defense and repair.

[00:44:57] Everything else is extraneous. Right, shut it down. Exactly. The intelligence of the body. Right. And I am not sure what the workaround is for that. Maybe you would know, like with supplementation or something like that. Well, yeah.

[00:45:09] But that's also where you have to put everything into place properly. You can do the supplementation. But if people aren't eating right and exercising, then then you're going to get into more trouble too. Right, right. OK, anything else about that?

[00:45:25] No, I think it's I think we're at a good place to get into Denise's interview that you did. OK, we could do that. But before we do, can I just say also the fact we feel that bears are peating because people are inundated with the opposite message.

[00:45:43] There is no quick fix for anything. Weight loss, wellness is a journey. It is work. There are things worth it. Right. Worth the fight, absolutely. But there is no quick fix. And yeah, I think Denise made that point very well. Right. As we will hear.

[00:46:01] As we will hear from your patient and my new friend, Denise. Yes. OK. So joining us today is Denise Felatic. So happy to have you here for so many reasons. Thank you. Because you've been a patient, a doctor, Ted, so you've tried some alternative things.

[00:46:20] You're a nurse, so you understand chemistry and medications and you're into alternative stuff too. And you have a personal experience with with Osempic. Sure. And I would just love to get into a little bit about your experience that goes right in line

[00:46:37] with what we're trying to say here, which is this is this could be very helpful. It can be harmful. How do we like find the balance? I love what you just said that we've been what did you say? We've been chasing this dream.

[00:46:48] We've been chasing the weight loss dream for years, honestly. Like all of us. Yes. Like what, especially women, could not relate to that. It's like the big elusive. Well, I think where society tells us what we should look like with the magazines, the social media.

[00:47:04] We're always trying to measure up. Everybody's always constantly judging us, whether you're heavy, whether you're skinny, if you're heavy, then you're lazy and you're sitting around eating bonbons all day on a couch. I joined a support group two years ago when I started the Osempic.

[00:47:19] These are the hardest working men and women I've ever seen. They're constantly in the gym. They're they're trying to find new alternative ways to cook our food. It's it's amazing. None of us are lazy. We're not sitting around waiting to be thin.

[00:47:33] It's we're all struggling looking for that holy grail. That's magic. Magic wand, I guess. Everybody wants it. They all want to look like a celebrity like next weekend. Yes, I blame social media for all of that. But OK, so such great points, such great points.

[00:47:48] So how many years ago you found yourself at like what weight? If you're comfortable telling us you are how many years ago at what weight and then what was your driving force to want to lose weight? Because for you, it wasn't about vanity.

[00:48:02] No, it was about saving my life. I was pre-diabetic March of 2022. I was almost 300 pounds. I could take my socks and shoes off after a shift. It was I literally had to put my feet out so my husband could take my socks off.

[00:48:16] It was just I thought my liver was going to crush as I'm bending over. There was this huge stomach and I was winded. I had to do the steps a lot and I had to try and be healthy so I can watch my daughter graduate.

[00:48:28] So at that point, I was actually contemplating flying to Belgium to try an experimental surgery that's not available in the US. OK, that's big. Like you were seriously considering that? Yes, you fly up to Toronto and then fly into Belgium. I mean, was that like a first-rate surgery?

[00:48:45] No, no, no. OK, OK. I've been on diet stuff for years. I mean, we started back with I met Dr. Ted in 2006. I was constantly sick. I guess I was fighting a food allergy that I had. I'm allergic to aloe vera. And I was ingesting it every day.

[00:49:01] How blue is weight? Well, no, it was just I thought it was supposed to be something healthy. OK. This fit the daily vitamin. And I guess I was fighting the allergy every day and I was just constantly fatigued.

[00:49:12] And my primary is like, there's nothing wrong with you Denise. And I'm like, I don't buy that. Something's wrong. I met him at a conference for a holistic and he got me on the blood type diet and got me off of wheat, corn and dairy.

[00:49:24] And I lost 10 pounds right around Christmas, which is huge about that time. Right. I lost another 10 pounds the next month, kept following up with him, lost another five pounds. So I think about 25 pounds in three months. I'm feeling really good. Just just changing. Just changing.

[00:49:37] Just what you ate. Yeah, exactly. A few things, simple things. Not buying anything extra necessarily, except perhaps he prescribed some balancing supplements. There was some supplements, some protein shakes to keep my protein up. And we got pregnant out of the blue after 10 years of trying infertility treatments.

[00:49:53] And my daughter, it was a picture perfect pregnancy. But unfortunately, I did put 42 pounds on with her. But she was perfectly healthy, seven pounds, six ounces. She is the love of my life. And I really want to be there to watch her grow up.

[00:50:08] And so just did some crazy diets. And then our girlfriends would run out to PA and go get fenetramine. And every time you get it around here, it's like insurance wouldn't pay for it. Which is ridiculous. That expensive. Oh, it was ridiculous.

[00:50:23] And that's a stimulant for people who don't know. It just kind of works in the front part of your brain to kill your appetite. And it works really well. It also makes you very jittery. And then when you stop taking it, because you can't afford it any longer,

[00:50:34] it's uncontrollable binging. You can't stop it. You know it's happening and you can't stop it. Wow, that's such a thing. An interesting point is almost like the body knows that you've messed with me. And now I'm going to kind of... I'm going to get you back on this.

[00:50:50] Because you've hit a part where you need to either keep going or you need to get stuff under control. But it doesn't act to the point where you can get it to stop you. But you see yourself, you're binging. And it did some damage to my heart.

[00:51:06] I have a valve that wasn't... Because of the phantareum. I mean, that was why they pulled it a long time ago. Oh, that's very true. I had a regurgitation leaking in the aorta. So I'm like, you find yourself with the cardiologist

[00:51:18] and he's yelling at me to lose weight. How do you think I got to you? I'm chasing this dream of trying to be smaller. But that's not the originals. The original would probably have been depopravera in 1997. I was taken for migraines.

[00:51:33] I put 52 pounds on it in two years. I think goodness, they don't do that anymore for migraines. I was like, I went from a size 8 to a size 18. I was the same size as my husband when he met me. Because that was messing up your hormones. Absolutely.

[00:51:45] And everything is all connected. You're either fat and happy or skinny and miserable. So... Trade off. Yeah. In 1922, I just became fat up and I was looking for any kind of alternative. I really hadn't heard about it.

[00:52:01] And I literally threw my bag of bankruptcy on my doctor's desk. That's what I called it. It was a little bag of every lotion potion, patch or pill. I tossed it on his bed or on his table and I was in tears.

[00:52:12] I said, I can't do this anymore. I need to get this weight off of me. My cholesterol was ridiculous. My weight was almost 300. My heart, migraines were off the charts and no matter how much you try and clean up your

[00:52:25] diet it was like, I can't get any of the weight off. You could get a couple pounds off here and there. So finally by June he came in and after me crying and being in pain in the butt, he

[00:52:36] did call in Osepik and like anybody else, I just picked it up and I took it. Was it covered for you? Yes and no. A one month subscription cost me about $251. Okay. That was your insurance go pay? Yeah. I believe it's $1300 a pen.

[00:52:53] Yeah, I know what it costs to get it in the pharmacy. Yeah. So I didn't realize that at the time but I thought and I didn't even tell my husband I have started this because I'm like, oh my gosh here I am wasting money again and something

[00:53:03] else it's not going to work. I'll throw it in my bag later but then it was like it shuts down all the food noise. I know people talk about food noise, that constant chatter of what am I eating? What looks good? What am I fixing?

[00:53:16] Yeah, I love that phrase. I hadn't heard that until recently doing research for this food noise and I think, correct me if I'm wrong but part of food noise is also I want it but I can't have it. I want it but I can't have it.

[00:53:28] I have to like avoid certain places that might make me crave something. Sure. Like the cravings are so like just a part of life that's a struggle. It is. Wouldn't it be nice to wake up without that? It's wonderful. Let me tell you. Yeah.

[00:53:43] I think you know this, it's a GLP1 is the medication that's in this Osepik which is just the brand name but it hits the pleasure center in the frontal cortex. The id that I have to have, I want, I need.

[00:53:54] I can walk through a bakery and not feel a thing which is amazing. So you don't really feel hunger when you do eat something. I treat it like a game show. Like the moment I feel full, forked down. Like you have to be done.

[00:54:06] You can't just, I sat at the table for years having to finish my plate for my mom. Oh. Can't even tell you how many years I lost sitting there throwing peas on the

[00:54:15] floor to the dog because I didn't want to finish something but you had to clean your plate because there were starving kids in China. Yes, it's true. I heard about the kids too.

[00:54:24] But I was, when you are on this medication, you have to stop eating the moment you feel full. You have to stop because it sits in your stomach for hours. I think that would be hard for people. It's frustrating.

[00:54:37] Because what you said about the programming, like it's really hard to override your own programming even when you feel full because I don't know, I found myself in this position too like in normal life without any kind of chemical adding to my body.

[00:54:52] I know I'm full but I still want to eat. Oh, oh, oh. That's what I'm saying. Because I just don't want to eat. I think when you get to a certain point you don't know when to stop eating. Right. We've numbed our signals.

[00:55:03] I think our internal signals culturally. Oh yeah. For maybe there's things in the food. Maybe it's psychology, maybe it's biology, maybe it's a lot of things. But with a medication like that, aren't there consequences if you push past that? Oh yeah. Oh yeah.

[00:55:20] When I joined the support group I didn't know anybody on this medication and so you're asking like okay I'm nauseous because I didn't eat today or I'm nauseous because I ate too much. Oh, so you get nauseous if you don't eat. Oh absolutely. Because you'll forget.

[00:55:34] Because there are times you can go all day and be like oh my gosh I haven't eaten anything today. Oh my gosh. You get so busy. Oh my gosh. A hundred people. Yeah. It's crazy because you don't have to get rid of like large sections of food.

[00:55:47] You just have to eat smaller and thoughtful. So there's less thinking then. Absolutely. As opposed to I'm only eating this or I'm eating that or I'm portioning this or portioning that, it's none of that.

[00:55:57] You eat because you kind of want to but you're eating to live not living to eat. So at that point you can make better choices. You don't have that constant hunger saying I have to eat this right now or I have

[00:56:10] to run through this drive-thru and get something because I'm absolutely starving. Because it's been just driving you. Absolutely. The cravings are driving you. Oh yeah. And so without there's no cravings driving you. Exactly. So that's free to eat for you.

[00:56:22] But if you don't eat your nauseous and if you do eat your nauseous. Yes and sometimes if you overindulge the things that are like fatty or cheesy. I hear folks have vomited they get bowel blockages. Those are some of the side effects.

[00:56:36] And this is from like being on the support group and just hearing people talk about it. Absolutely. So did your doctor go over any of this with you? Oh no. No. Okay. No. Or your pharmacist? No.

[00:56:49] They just they called it in and when I went to go pick it up she goes you do realize how expensive it is. I'm like yeah I saw it on the website and I said I'm going to try it.

[00:56:54] I threw it on a credit card and yeah I didn't even tell my husband until I lost 17 pounds and it was time to go get another shot because it lasts. You lost 17 pounds in a month? Yes. Okay that's fine. It was crazy.

[00:57:06] And did you have these like nauseous side effects? Oh yeah. Okay you did. Oh yeah. Anything else like in the first month? A lot of headaches, a lot of headaches all the time anyway. So it was hard to say what that was about. Yeah exactly.

[00:57:17] So fatigue is a big point. Even in the first month? Oh yeah. As soon as you start taking it you feel fatigue. You're tired. People some of them push through and they go to the gym. Some of them get B12 injections. It's different from everybody.

[00:57:32] Different who's keeping track of you but I remember going. And your doctor was? Well let me ask you that did they want to see your weight loss, see how fast you were losing weight?

[00:57:41] Did they want to see you more frequently so they could weight you and maybe take your electrolytes? Is any of that happening? For me no. But other people are exactly. I think his... Because you're a nurse.

[00:57:51] Absolutely he thinks I know what's going on but you know he's been wonderful about it. Yeah. And actually to the point where I wanted to be done taking the medication I wanted to wean off. I said is there a maintenance program?

[00:58:03] And he goes I don't know it's so new we don't really have a maintenance schedule. So why when you said you wanted to be done how much time had you been giving yourself these injections? A year or two?

[00:58:13] I'm going to say it was I've been on let's see 101 pounds in 17 months. Wow. So that's what. Okay so in 21 months or 90 weeks I lost 109 pounds. So 81 weeks on Osepik I lost 110 pounds.

[00:58:35] And it was at that point that you wanted to wean off the medication because I'd lost so fast the second year I have skin hanging and it's not toning as fast so I just kind

[00:58:47] of wanted to slow down for a little bit to see if this is maintainable. I don't know. That was smart. So you really didn't look like it look at it like this is my life moving forward giving

[00:58:57] myself a giving myself a shot every month for the rest of my life. You were thinking let's see what happens. Is this sustainable in the future? Yes. Because I know my patterns. I know my patterns and I know there are people sitting back waiting like oh she's

[00:59:12] going to put it back on. I mean yeah. Interesting. But you wanted to get you wanted to taper off. Yes because I wanted to slow down the weight loss. Yeah. I wanted to try initial yes because at that point I'm thinking oh why should go to the gym.

[00:59:25] It didn't sound so horrible at that point. Did you have energy too or you wanted your energy back to? Starting to get some energy back. Oh you were starting then okay because yeah you weren't carrying around as much. Exactly. Pound. Exactly.

[00:59:38] And there's many pounds so you want to go to the gym that would probably help with everything over our toning and energy and you felt better by yourself. Yes. You wanted to go to the gym this makes perfect sense to me.

[00:59:46] So you go to the doctor and you say okay let's go on the tapering plan because surely there is one. Yeah but there wasn't. There isn't really. And actually at the time I'm the only one that he knew had lost over 100 pounds.

[00:59:58] So that was kind of like pat myself on the back kind of thing. For sure. But honestly I'm thrilled. I would do it again in a heartbeat. Yeah there were some side effects. Did you taper then? You did taper. I am tapering now.

[01:00:09] So what does that look like for you? Not that we'd give anybody any advice on tapering on their own but for you and your doctor what did you and your doctor work out? Well as of January my insurance has decided that I no longer need the medication

[01:00:22] even though I wasn't done taking it. They've decided that I'm done with it. So I do have one pen left so I have about four weeks left if I stay at the point five zero which is the milligram that I'm at right now.

[01:00:34] So the hunger has started back up some which was a shocker. I forgot what that felt like. For real? Yes. So I was trying to tune into okay am I hungry and my bored and my lonely. Am I depressed? Do I really need to eat?

[01:00:48] These are such good questions. To be able to dial back and look at myself like what kind of hunger am I looking at not that I'm ravenous and I need to eat a buffet full of stuff. It was am I really hungry or am I just dehydrated?

[01:01:02] Am I thirsty? Oh good point. Like is this the point where it's like okay go take a walk or go find something to do or go get a healthy snack but to be able to pick something

[01:01:12] healthy instead of reaching for cookies because I make some really good cookies I just not interested in eating them. So even but you're still taking the medication. Yeah I have about four weeks left. And it's every week so you have four weeks left.

[01:01:23] Like this morning I took my last one on my lap my one pen so I have one pen left. And then that's it? Yeah. Wow. Yeah I'm not sure what I will do. I feel like there should be a ceremony after that one pen. I know.

[01:01:35] But it's okay so then you have a plan I that's a huge part of your plan I just want to acknowledge that you're asking yourself these questions. Yes. What kind of hunger is this? Yes. What kind of hunger are there? What kinds of hunger?

[01:01:48] Well I mean all get channelled into food. Yeah well have you ever sat in an amazing meal and you're still hungry. Like you plowed through everything on the thing but your stomach is still signaling that you're hungry. I don't remember what that's like.

[01:02:03] I'm sure it's coming back soon because I'm sure that this medication is tapering all that down so that ought to be interesting to see how that works. Are you in the gym or have you gone to the gym? I do. I do. I do. Does that help?

[01:02:18] Does that help to move your body? That's such a good distraction for me sometimes. I don't enjoy it. I have a lot of injuries. I was a massage therapist for 23 years so my hands are pretty

[01:02:29] shot so doing push ups you have to make sure you do them a certain way or like the carpal bones again like really sore and then I can't pick up a cup of coffee or things hurt a lot. I'm old so things hurt a lot.

[01:02:41] You are not old. Okay that makes sense. We walk. My husband and I walk about two and a half to three miles. Every day? Not every day. We try and when we get some time we sort out the world's problems our problems. Yeah.

[01:02:55] That feeds a certain kind of hunger right? Absolutely. Because it seems like you're very smart and you're a very good problem solver so I think that would be a some energetic food to give yourself. Other side effects that you've had? Social aspects. I have lost some friends.

[01:03:10] This is fascinating to me. I have lost some friends. I've gotten comments of oh you're taking the easy way out. Why can't you just go to the gym and do this on your own? So lazy if you're overweight and if you fix it then you're

[01:03:22] taking the easy way out. Absolutely. You can't win. You can't and everybody's going to judge you whether you want to or not. It's the point of okay do I have enough self-confidence to get through this next comment. Everybody has something to say whether it's nice, whether

[01:03:36] it's kind of well meaning, whether it's I'm very proud of you. I've gotten a lot of your mom would have been so proud. I would have been nice if they had this medication for her. Did she die from being overweight? Like complications?

[01:03:48] Well she did have cancer but she had had the lap band and I watched her struggle with that. Oh yeah, that was all the rage. Yeah at that point you had to do like a psyche valve beforehand and counseling before you actually did the surgery.

[01:04:01] Which is a great point but you don't have to do that with this medication. Oh no you can go to the med spa and get this stuff now. You don't even have to go through your primary. Well if the med spa is run by an MD.

[01:04:09] Yeah but then they have the online ones too. She's constantly on the support group going different type I'm not even going to throw any names out there but there are some online stuff you can actually talk to some nurse. A virtual nurse practitioner.

[01:04:21] And they will write you the script and then mail it to your door. Pretty easy but that's expensive is it not? Oh gosh this is expensive. But it's an option. It is. So it's accessible, it's very accessible, more accessible than lap band surgery was in the day or

[01:04:36] even is but less of the other kinds of support that people need. Because I think losing friends would be really hard. It is frustrating. That's one social aspect and you also mentioned the social aspect of everything we do revolves around food.

[01:04:49] Yes you get together what are we eating and it usually isn't healthy. It's like who's coming over what do you want me to fix what can I bring. You're like let me run to the store and go grab something and you throw it on the table and then

[01:05:00] you start grazing and then there's of course alcohol and everything that's high sugar, high fat. What about alcohol in this medication? The S? It's usually a no no. Do they tell you that? Anybody tell you that? I don't think your doctor does.

[01:05:14] It might be in that fine print when you pull up. I'll have to check that out next time I'm at the pharmacy. The support group it's been interesting reading some of the comments of people who've tried to have drinks or gone and cruises and had you know unlimped.

[01:05:25] You can't, it makes you sick what happened. For me it there's no room. Like if I were to have a beer there's no space capacity in my stomach for it all to just sit there for hours. I try to couple like mixed drinks over the summer.

[01:05:40] Yeah what about that? Like a smaller volume. So it was just a junky Bacardi and Coke and I had had two of those we're playing Uno, I went to bed, I woke up the next morning and had a bite of banana and burped a Bacardi.

[01:05:52] It sat in my stomach all night long like literally so you don't get buzzed. That's part of oh you don't. No you don't really feel the alcohol buzzed like that initial okay I feel excited, I'm relaxed, you really don't feel that it just sits in your stomach.

[01:06:08] But the food sits there too. Oh absolutely, absolutely. It would be very unpleasant I would think. Well you need to figure out like when you need to stop eating for like whatever shift you're working I happen to work an afternoon shift

[01:06:18] so it's frustrating to come home at about 11 o'clock and be like a little bit of hungry or realize I hadn't eaten all day and try and put something in my stomach but realize that it's gonna sit there all night long

[01:06:29] and not but to have a like cause I'm sleeping and then not but to have a like because the GLP-1 medication. Social ramifications and how about something else physically you mentioned when you came in the studio about your hair and then you told a story about electrolyte imbalance.

[01:06:44] Oh okay so after about 30 pounds I started to lose a lot of hair, you won't notice it at the first but once you start showering you get a lot of hair and like to the point where you could just roll it up and put it on the side.

[01:06:54] Do we know why that happens to you as a nurse? Do you like did you ever look into that like is that a hormone, is there some sort of hormonal? I think it's a protein issue. Like it's not getting enough protein.

[01:07:05] I'm not quite sure what's happening in the body to the point where I've always had thin hair. I figured I was probably going to wear a wig one day, my mom wore a wig, my grandma wore a wig so I was prepared, I've never had thick hair

[01:07:16] so I think that that took me for a loop for a little bit and not having, you could literally see my scalp it was very very thin so you need to work on getting the right proteins, getting the right nutrients it's not just filling your stomach up

[01:07:29] it's picking the right foods. I think you'd have to be so careful if you only have this much room or this much desire it has to be very nutrient dense. Exactly, you have to make smart choices. But I don't know that we're telling people that.

[01:07:40] Yeah and that's the problem is our food is filled with preservative for the middle American that can afford good grease. Inflation is ridiculous nowadays but they're filled with preservatives hidden sugars things that you're not thinking about it's like that are just putting weight on

[01:07:58] we're not even talking about, we're talking about we want to lose weight and we want to look good and we want to be healthy but we're not talking about the food that we have access to. Well that's a whole other, Yeah exactly, exactly.

[01:08:10] whole other like months worth of podcasts but yeah you're absolutely right and that is I think an excellent point to consider plus I would think too if we told people that and we gave them up a nutrient dense food plan

[01:08:23] then wouldn't it be easier when you're off of it than you already know how to eat nutrient dense food? Well I think that what caught me the one time is I had gone to see my neurologist and she was talking about the headaches

[01:08:35] but I constantly get I've had them since fifth grade but she was thinking maybe mindfulness trying to work that way she goes well do you eat healthy? Well it depends on how you think about that. I'm eating the standard American diet

[01:08:46] I don't know that it's healthy any longer it depends on what we're talking about. What I have access to with my paycheck is not what celebrities can afford they can afford chefs and personal trainers and people that bring in all fresh organic produce

[01:09:00] us average American's that can actually afford this medication without going bankrupt can you know with less choices exactly, exactly. Less access, less choices and with the cost of produce I mean I was at a farm market the other day and strawberries were $7 a container

[01:09:18] but if I go over to all of these as a $1.99 I was like I don't know. Yeah. So I'd love to say that I eat healthy I don't oh you can't eat out because the portions are too large so if you're looking at an appetizer menu

[01:09:30] everything is either fried, has sausage in it has cheese on it, sauce and then it's enough for a bunch of people. So if you're ordering a meal you have to take it home and realize you're gonna eat that for the next three days

[01:09:43] because you don't wanna throw it out. And so much of the socialization that we do in this culture involves eating out drinking out, being out and it's tough when you're not drinking people are like they hand you drink I'm not drinking right now

[01:09:56] it's just like I don't really want to. Which is this fun because then you're kind of left out? Sure, sure. So what about the electrolyte imbalance because you really had a I would think a frightening experience. Yeah well this last summer the doctor opt my dose

[01:10:09] and it was like two milligram which is I'm not even sure. I don't think it's the highest. I don't think so either so I did start it and then in July I realized I was losing weight rapidly so at one point I'd lost 15 pounds in 17 days.

[01:10:23] So I was at a friend's house I woke up in six in the morning and I flexed my feet and had dual Charlie Horses in both my calves where I fell out of bed I hit the lamp on the floor and as I'm on the floor

[01:10:35] I get another Charlie Horses in my mid back so it looks like I'm actually having a seizure. Gosh. So trying to get rehydrated well then later in the afternoon I came down with a migraine we had walked in the heat I passed out and I couldn't figure out

[01:10:48] I don't even remember hitting the floor so at that point it was a little bit scary so I called the doctor and said I don't know what's going on and so it ran some blood work my potassium was low my electrolytes were off because losing weight so rapidly

[01:11:02] it can mess with all your sodium potassium chain that makes the muscles contract I'm like goodness like you could literally fall and kill yourself God forbid well yeah but so I think about all these people that are like I got I gotta lose weight fast

[01:11:14] I gotta lose weight fast everybody wants it done next week be careful what you wish for because you could have some bizarre thing happen due to the fact that it's too fast for your body absolutely it's like and then you have skin hanging at that point

[01:11:26] it's just like everybody says oh I'm not losing fast enough I'm not they're comparing themselves to other people your own adventure is your own adventure and I call it an adventure because I hate to call it diet it's just Oh I like that

[01:11:38] I'm going to be adopting that yes it's just you know it I would do it again in a heartbeat honestly I have never felt so good in my skin as I do now because of the weight loss well yeah in spite of every like this

[01:11:52] the hair and the scare with the muscle cramping and the social implications because you feel so good in your skin for you on the risk versus benefit side of the equation which all drugs are for each individual you would say you're on the benefit side

[01:12:08] yeah I would definitely do this again because of the opportunities is given me I went back and got an echo and I don't have the regurgitation in my heart any longer so I got the all clear from the cardiologist that's amazing yeah I'm no longer diabetic

[01:12:22] my A1C is 5.1 now instead of 7.1 it's amazing my cholesterol compared to what the borderline is it's up there but you know that's life and but in spite of that you do plan on doing life without it yes I do plan on getting off of it

[01:12:38] in about four weeks okay we'll see what happens well I have to follow up with you and yeah I know there are I know there are people watching so that you can sit here and I can judge you absolutely because that's what friends do right I would never

[01:12:49] no it's just so hard and I think you've highlighted just a lot of good points that like Dr. Ten I just want people to make your own decision of course absolutely think about what you're doing and I think that's so much about what you're about too

[01:13:04] the fact that you're on the the the socials helping people supporting people on these support groups sure talking very honestly about it about what your experience is and you're here to help not to judge oh absolutely I think that's great I've been there and it's like

[01:13:19] and I know what it's like but my my adventure is not like your adventure I don't know what your background is and I I don't pretend to know what you're going through but like the social aspect things that we're not thinking about the way people treat us

[01:13:30] the way our relationships work you can drift apart your people completely turn their backs on you just being out and about with other people people are nicer to you I noticed people get the doors for me now because you're smaller I know isn't that crazy

[01:13:43] I used to get tattoos because I wanted people to judge my tattoos before they judged how obese I was and now it's just it's cheaper than a corvette it's my midlife crisis and and I don't care what anybody thinks which is wonderful I don't want to say that

[01:13:57] that's sweet, sweet freedom not caring what people think is sweet freedom and then everyone's on their own journey absolutely be true to yourself in your own journey you just need to be smart about it be kind to yourself then that was my New Year's resolution is

[01:14:10] the things that I said in my head to myself I wouldn't tell a friend ever but my mental dialogue was so negative I needed to break that pattern I needed to be nicer to myself this is the only body I'm getting and I need to get it

[01:14:25] to where it's supposed to take me it's like I want to see my girl succeed I want to see her graduate and do what she wants to do and I don't want her worried about oh my mom can't keep up or she's over

[01:14:36] and she can't get up the steps or she can't get out of bed or things like that I didn't want to be that mom I wanted to be healthy to be there to be present to watch it all in full because I'm living vicariously through her

[01:14:48] she's the best thing I ever did with my life it is great to live vicariously through young people we share our wisdom with them absolutely they share their youthful experiences with us oh yeah she's figuring out myself on better than I am so yes we need the kids

[01:15:02] and they need us absolutely so thank you so much for sharing all of this thanks for listening to us we really appreciate you helping us we appreciate you helping us take this on absolutely this big topic it's more than just I think you would agree just an injection

[01:15:17] it's a bigger topic that's affecting so many of us we really appreciate you thank you so much I appreciate it well that was a really great interview with Denise I'm glad you had that idea to bring her on because I think it really highlighted all of the things

[01:15:34] that we're talking about and she's kind of like us like has a foot in both worlds she's a nurse she understands naturopathic medicine she incorporated a lot of things just to hear about her struggles and her success it was a great interview success and failures right

[01:15:54] and that was a great summary I think for everything that we've touched on right and the one thing that we really haven't touched on yet which we can touch on now is the ethical considerations and concerns right with this with medication like this it's quite expensive

[01:16:11] it's not always covered by insurance which limits accessibility yes so from a holistic and ethical standpoint what does this mean for people who could benefit from treatments like this well for one obviously we're looking at two different groups here okay we're looking at the diabetes

[01:16:33] which is a lot more likely to be covered that's true if you have a diagnosis of type 2 diabetes you can access medications like this yes and hopefully you would lose weight as your underlying metabolic disorder gets straightened out right okay but obviously with that too

[01:16:49] a lot of the insurance is going to cap it at like two years even if you have type 2 diabetes right because even they understand it's a lifestyle related illness right well no they're just cheap and they don't want to pay for it oh okay too much credit given

[01:17:01] okay right yeah so we have that but then we have the weight loss part which because not all of them are indicated and the ones that are have various criteria right and I would assume that for weight loss the insurance companies still may not even if it's indicated

[01:17:18] most likely yeah a lot of people don't understand that just because a medication is indicated for something and it's a branded drug which all of them are branded there's no generics yet unless you go to a compounding pharmacy which is a could be a good option for people

[01:17:32] right they insurance companies can still choose not to cover them yeah in which case unless you have that kind of money like it costs I don't know a couple a thousand or plus yeah right around thousand dollars a month we need to get it in the pharmacy

[01:17:46] like a little bit under that okay so if I have any markup your markup is very little it is anyway right right yeah so just like insurance won't cover other procedures so say for instance somebody their doctor thinks they have a rotator cuff injury okay instead of

[01:18:06] doing an MRI right away to properly diagnose it they need to go through at least one or two rounds of physical therapy okay and that's do you think that's fair? well I mean maybe not so fair for some people right but it's but we're

[01:18:24] but I'm just saying it's the same thing where the insurance companies can choose that you do or other things before they're going to pay for a medication so they could they could at some point say that well you need to go through diet and exercise counseling for

[01:18:44] a year first before we're going to cover this medication no and is that bad? depends on the person right and it depends on the kind of counseling we're talking about and that's the problem is medical doctors don't really know how to they don't understand nutrition for the

[01:18:59] by and large they don't yeah so then I guess they could cover a nutritionist or a dietitian in a gym membership maybe yeah but that's the thing the dietitian their most of the time they're not that helpful either because they're just doing the same things that

[01:19:16] the conventional medical model taught them okay so you so there's still we're still talking about people that are within the confines of the medical model right and that the insurance companies are really running the show right I think people don't understand no and I think is unfortunate

[01:19:32] but they're doing that for cost savings and these drugs are expensive but I think to myself okay if you've got somebody that's overweight and there would be a good candidate for this medication then by losing weight wouldn't the insurance company save money down the road by not

[01:19:48] having to pay for all of the things that being overweight could cause but they I don't think they think like that no about this before it's very short term thinking right right in the end you have to like we talked about having the the guardrails on who can

[01:20:05] receive the medication so for the weight loss and the things so so there should be just like with say when people had to have the lap band or other gastric bypass surgery you had to be at least a hundred pounds overweight

[01:20:20] I don't remember that's yeah I guess that is true right which is a lot it is a lot of overweight to get to right right but but that's the thing is if you're at a certain point say you're twenty five thirty what who where is that line

[01:20:37] your twenty five pounds overweight your fifty pounds overweight your seventy five pounds overweight person to just like you said yeah yeah like ten or fifteen pounds could be could be very detrimental somebody not detrimental to another person at all

[01:20:52] depending on who they are right but the system is a very cookie cutter system it's really not designed for the individual right right and that's where and that's why it's so hard for to understand this and also you have conditions like sarcopenia which is like a

[01:21:12] a skinny fat person where interesting have low muscle mass but high fat mass which is unhealthy right right so somebody look a certain way they might look a certain way they might have a bmi that's in the normal range but they're taking time bomb

[01:21:29] because they all they look okay and our societies only measure for health is wait wait yeah well that's a whole other problem right how do we measure these things how do we measure health how do we measure wellness i feel like we have a long way to go

[01:21:45] yeah and so i mean really we should be doing better with looking at measuring body fat because yes most medical clinics do not do that i'm glad you brought that up because don't you measure that yes as part of your initial assessment it's not

[01:22:04] not always on my no depending on the person depends on the person okay but you have that capability right to do that in an office and i mean i use a consumer level scale that only a couple hundred bucks so it's not like so it's not perfectly

[01:22:21] with not them perfect accuracy although the only perfect accuracy is a huge dunk tank yes very accurate that's what the celebrities would be using in the athletes i would assume but so but having ways to look at that body fat percentage

[01:22:37] can give you a much better picture of how overweight somebody truly is makes sense so you may have so you could have a better range of say a woman is at fifty percent body fat based on their age maybe they should be under thirty four maybe they're

[01:22:57] say fifteen percent body over on body fat so there there could be some kind of measure that way some kind of metric to make that better that would be more even right right that would be more balanced and fair for

[01:23:10] people right who really do can benefit from it but it's not covered because they don't meet this criteria point really goes to where are criteria right because you can have a female athlete that's six five six six and she's technically a hundred pounds overweight but

[01:23:31] based on you have a lot more muscle versus somebody that's five two and a hundred pounds technically a hundred pounds overweight based on the height weight scales right and it's a huge difference as far as where you truly are right

[01:23:48] right and then so that's that's that's a concern the way the way it's measured and it would leave out people that needed and can afford it by and large is what we're talking about but anybody who has the means right can get it right and so that does

[01:24:04] bring in those ethical questions of a two-tiered system where yeah we have the elite that can afford whatever means they can pay thousand dollars a month out of pocket and not blink an eye and so they can do whatever they need to do and then most

[01:24:22] most of the population can't afford that extra thousand dollars a month which i think brings which brings to mind this consideration that the way we live and how incredibly unhealthy our environment is on many levels we've created like a society where just to put it bluntly

[01:24:43] only the wealthy can be well right putting the well and wealthy I mean it's just it's crazy to think about that is an implication for our system by and large but but also we we have other means that aren't so expensive

[01:24:59] to let's talk about that well but we've talked about that i have the exercise other people can do not not make it that's like a big thing that I don't want to disempower people so i'm saying exactly because isn't this this isn't the end all be all

[01:25:14] and that's what i don't want to let's go back to that right like oh my goodness because i can't afford this class of medication i am doomed to a life of being on the city and diabetes and heart disease right at all yeah

[01:25:31] okay that's it that is that is a great point but i do think it is i think it's good of us to just acknowledge that that is not where we think the health care system should go right it should be more fair and balanced

[01:25:48] okay what about special populations so i think we should talk about that because our kids are getting so overweight and I've read some articles and the pediatricians are trying to get it covered mm-hmm all that's that's definitely goes under ethics right

[01:26:01] right so yeah there was actually a jama article released this week on this on timely yeah these the GOP one in receptor drugs and so 30,947 adolescents between the age of 12 and 17 have already been dispensed this these drugs okay between 2020 and 2023 the number of adolescents and young adults so

[01:26:30] adolescents would be 12 to 17 young adults would be 18 to 25 okay so between 2020 and 2023 the amount of people prescribed this drug has increased almost 600 percent so from 8,722 people to 60,567 people and these are people where that that population are included in drug studies right so they are the study

[01:27:03] right they are the guinea pigs yes and i'm sure again though it's risk versus benefit we know a kid that is overweight is gonna be facing these many health challenges and potential problems pain suffering early death etc so we know that

[01:27:19] so then i can understand why they would want to intervene with something like this right but we really really don't know the risks of it we don't especially with people this age are still growing and developing we don't know how that's going to stunt

[01:27:35] their development if at all right their chemistry is so different plus if you're intervening with these quick fix medications like this at such an early age when they are going to have much higher metabolisms and can do a lot more with diet and exercise

[01:27:56] you're almost dooming them to never be responsible for their health down the road i think that's a really interesting point it's like it's like a messaging we don't want the message to be being overweight and the things that come with

[01:28:11] it are good for you no nor do we want the message to be you have you need something outside of yourself to take control of your health right so that's a really tough thing for a kid whose brain is forming and is

[01:28:25] getting messages and is too young to give consent right right and they're so inundated with messages from the social media and the celebrities and everybody who are using medications like this and they probably are already like predisposed to thinking well this

[01:28:41] has got to be the answer for me right nor are they old enough to buy their own groceries so there's no it there's just so many things to to take on when it comes to a special population like a child and

[01:28:54] maybe yeah maybe that's yeah so i mean it comes down to we really first and foremost we need to be educating kids that are overweight and unfortunately it's the it's the parents that aren't a lot of times aren't doing the job and they're being

[01:29:10] they're being the um the role model you can't you can't eat horribly and not exercise yourself but then tell your kid that well they need to stop eating and exercise so they're not so big it's so true and and even not just like the

[01:29:28] parent child but people that live in the home but i've also read something where a good end a good predictor of whether or not you're going to be overweight is are the people you hang out with overweight right so it's obviously environment food

[01:29:42] and overeating over consuming you pick up those habits like people that say well my parents are overweight my sister's overweight my cousin it's genetic there's nothing i can do yeah but it has to also do with yeah they've learned certain habits

[01:29:57] learned behaviors right habits right so it'd be something that the whole family needs to take on right and yet again like we we're fair about this we're not blaming anybody no we're definitely not blaming the kids we're not blaming the parents but we're having this conversation

[01:30:13] yeah just to think about these are things that we need to be mindful of yes and it is like i think back now to when because i struggled with eating disorders when i was a teenager and had to just it was such a fight and a long

[01:30:28] fight and levels of healing and i always was very cognizant of then what messaging am i giving to my kids right when it comes to body girls and weight and i also thought about that when i was

[01:30:42] talking to denise about being judged and i watch myself like did i look at somebody and just kind of like oh like in my mind even judge them a little bit for how they looked or their their their how much room they took up how right right

[01:30:59] and i think about i think about that a lot and in the messages that we give and receive and and the things that i can do consciously and that i've done for decades is i never ever

[01:31:15] ever with very few exceptions comment on people's weight right that means if i have a family member that lost weight i don't say oh you look so great well why don't you it's so encouraging because they are more than their body

[01:31:31] they're more than the number on the scale i would much rather say to one of my female relatives or friends talk about what have you accomplished lately what are your hopes and dreams can we connect on something other than how

[01:31:42] we look right and think about it it's they're not probably going to take that the right way i know when i have people that tell me oh have you lost weight i think oh they must have really thought i looked fat

[01:31:56] before oh your mind goes there yeah okay see my mind doesn't necessarily go there there was a time when i lost weight and i was mad that no one at the gym noticed and and then there was a woman at the

[01:32:07] gym who i really noticed had lost some weight and i don't really know her well but i just commented on she goes thank you so much i've worked so hard to lose this weight i can't believe no one noticed

[01:32:19] i'm like well maybe they just aren't they didn't feel comfortable saying anything so i obviously broke my own rule i just said i never do that but i there's differences like if it's somebody at the gym and you've seen

[01:32:28] how hard they're working or feel it from her like can you just please notice right that i have worked so hard and this means so much to me and is still able to perform so you could tell that she was

[01:32:38] doing it very purposefully and she was maybe getting tired carrying around the extra weight and not being able to do a pull-up because of the extra weight which is my motivation i just wanted to do a pull-up which i still can't do but

[01:32:50] that's what i wanted to do i wanted to have less weight to pull up right but i also like say i have patients that come into the office and maybe i haven't seen them a while and they have lost a lot of weight

[01:33:02] i'm going to say something because i want to understand what's happening so not as a judgment or anything else but that's part of your relationship exactly how could you not they hired you to help them get well

[01:33:13] they've lost weight which will help them get well so of course you have to right but we also have to make well what if something else is going on maybe the truth like like jenice said with some of the people that would talk to

[01:33:22] her oh do you have cancer or there's a lot of other reasons why people could lose weight and we need a couple pounds where where which might change a little bit of how you look isn't important and i

[01:33:35] and that's where i would never say something but yeah i see a significant weight loss i want to know what's happening so either a is there something wrong that we need to address or b have they done something really right and we need to celebrate that

[01:33:49] i love that tad yeah that seems like it's a good place to is that a good place to end on no i think we still need to talk a little more about the psychological part you love to talk about that i know i do not love to

[01:34:03] talk about that so that's why we're here together to push each other all right so what i wanted to come back down to and i know that this was something when you saw that when you read about

[01:34:16] yohan harry's thing he talked about this being the next opioid crisis oh yes see when i hear that i think okay now we're going to deceive people with slick marketing we're going to cause all kinds of problems because that's what

[01:34:30] the opioid crisis was about really good marketing and healthcare providers believed lies the marketing was so good we believed a lie and we don't remember that we believed it right we didn't believe it we did right and it caused a big big problem but

[01:34:46] we're being here we are again where we're being sold these miracle drugs yes and i don't really think that's the big part the marketing part isn't the big part right i it's the here's where i see the correlation in the parallel is when we've talked about people

[01:35:03] not doing it properly they don't do the diet and the exercise part they don't take care of the psychological part because opioids in and of themselves are not bad right they were never bad it was just inappropriate use right right but so you have a situation

[01:35:19] where somebody after two years being on the medication well they can't afford it with their insurance anymore right so isn't there the possibility that we're going to start seeing a black market where people are going to go into people's

[01:35:33] houses and steal their ozempic or their grandmother's ozempic that they know they take and sell it to other people or use something else that something somebody will develop something that's like a street drug right that maybe has other ramifications right so that's where i see

[01:35:49] that's the big okay that's where you see the parallel yeah and and to me like i like to stay because it's so devastating and that i don't want anything too i don't know what my problem is with comparing everything anything to the opioid crisis because i'm so

[01:36:05] invested in it with my work with ohio can and i and i see the suffering and and could we pass could we could anything touch this level of suffering maybe that's that's it but i do think that that's it it's a concern to get people

[01:36:23] kind of dependent on something that really isn't the answer but seems like the answer right to create problems down the road and he makes that point in his book i gotta read that book i've read all

[01:36:34] of his other books i should read well i'm not i haven't had a chance to read the book i've just interviewed but i that's just me thinking about it that's where i draw those parallels with that that's fair that's very fair okay yeah yeah something to

[01:36:49] to consider but again everything that you do for your health should be begun with the end in mind right right okay i'm gonna stop this at some point i'm gonna stop this medication at some point

[01:37:00] well what does that look like then for me what am i doing now for future me right right yeah yeah so i think that comes down to our big takeaway here oh what is it so i'm so in it i've forgotten about

[01:37:13] what's our big takeaway so we've we've talked about this throughout the whole episode but haven't put it all quite together do that for us too so we're talking about the when we're optimizing weight loss whether it's with or without ozampic whether there there are three big

[01:37:33] pieces we need to work on yes how could we have forgotten right so number one is definitely healthy eating so yes with especially with these glp1 drugs we talked about we need that protein so and with any weight loss program you

[01:37:52] need that protein need that protein so with the studies that have been looked at that help reduce weight mass the the muscle mass loss they're looking at 25 to 30 grams of protein per meal which is realistically within that normal range of what people need

[01:38:09] to be able to get the proper amount of protein so that they can keep their muscles strong and lose a lot more fat and less muscle simple love that number two is consistent exercise so making sure you're exercising 30 minutes a day

[01:38:27] five days a week it doesn't necessarily have to be heavy weight-led lifting or resistance training it could even just be at least walking walking is so great for many reasons right so that's another important piece and then the third piece which we've

[01:38:46] touched on but haven't really pulled it together is that healthy mindset which is so important yes okay how do you define this is so great because i was thinking about the sign-off that we forgot so we'll do it for sure but how would you define a healthy mindset

[01:39:05] so when it comes to this topic specifically so with this yes so when we're talking and i like to i wanted to include all types of weight loss so because we're talking about these medications but we're also talking about how they may not be the right

[01:39:20] answer for some people yes so number one is having realistic goals oh i love that you need to have a good realistic goal like like we talked about earlier if you're losing weight too quickly you're going to negatively affect your metabolism by losing too much muscle

[01:39:41] you're going to be weaker you're going to have much higher risk of gaining it back yes so if you have that in your head if you have you set yourself up for success right but what is realistic right what is healthy what is sustainable right for me

[01:39:55] right so we talked about one to two pounds a week so a lot of people both of my patients when they're working on weight loss they come in back into the office and oh i only lost five or six

[01:40:10] pounds this week oh that's a lot but that's the thing is you know one to two pounds a week so you're talking about four to eight pounds in a month so it's breaking that mindset too of a quick fix quick and fix

[01:40:23] yes so breaking your so get your mind around the fact that that is a fallacy right okay and because you're never going to be able to stick with the plan to get to your goals if you think that

[01:40:39] that's not enough i'm not i'm not losing quick enough i must not be doing this right so i might as well just give up yes and then you give up on yourself right and that's very mean yes to yourself yes and the second one that i always talk

[01:40:53] about is having a good strong motivation oh no why what is your why exactly what is your why the best one that i've ever seen that has worked better than anything else is a mother that well a woman who can't get pregnant because they're overweight

[01:41:13] and like tenice talked about exactly she had a lot of good wise right oh yeah definitely yeah those maternal instincts but when i was listening to her why is there's such a force there right that could really help you if people know their why exactly and and

[01:41:29] that sometimes takes some really uh some deep thought and soul searching yeah worth the journey right to search that soul right because you're going to give up much quicker if you don't know really why you're doing it yes it's like a spiritual aspect of it

[01:41:44] right that's something you that you tap into when things are getting hard remember why right so it's personal yes powerful for you great point and i'm so glad you wanted to bring this up okay yes

[01:42:00] and then the third one is for a lot of people they might need some kind of professional mental health support you need to be able if you have some kind of emotional or psychological factors that are related to your weight

[01:42:15] you need to work on those factors or else you're not going to be successful either right or like we talked about you can be on these medications and it can make those mental emotional factors a lot worse which is more suffering for you exactly

[01:42:30] unkind as well right right do you have a good resource for people that have a needing disorder that haven't really talked to somebody or undergone any therapy are there good resources here well i mean you have to

[01:42:40] find you have to find the right counselor for you yeah for you yeah yeah i don't suggest people that specialize in a needing disorder do you think that's not necessarily i don't i don't tend to have a ton of

[01:42:53] patients that need to refer that way i was just curious and just with i tend to to be able to to work with them in some some factors with that too got you okay good good to know all

[01:43:06] so the three things were that we promised in the beginning yes eat a healthy diet right exercise exercise and get your mind right right okay yeah all right now are you happy with where we've taken this i'm definitely happy now okay see now then i feel like

[01:43:21] we need to go back to remember the little sign-off that i liked which is eat a vegetable take a walk think a happy thought yeah i love that now yeah not to say i but see now i feel like

[01:43:31] we can't say that just by thinking happy thoughts are gonna like be the source of all your mental wellness no no we never deny or overlook or a polyana approach but it's just a nod to getting your mind right exactly i think you and i both agree

[01:43:47] that what true wellness has to include all of you your mind body and your spirit yes all right well thanks ted this is great thank you take on health care was created and associated by ted suzeleis and mary shean the information contained in this podcast

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