Dynamic Dialogue with Danny Matranga - 271: Weight Loss Medications + Obestiy

Episode Date: March 21, 2023

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Welcome, everybody, to another episode of the Dynamic Dialogue podcast. And in this episode specifically, I'd like to have a thoughtful discussion about obesity and the new class of obesity-specific weight loss medications that have taken the world by storm. We'll talk about some of the medications that were originally popularized for the treatment of diabetes that are taken off label for fat loss and weight loss. This has been a major, major kind of cultural tipping point between the I'm interested in helping people who have obesity fix the problem crew. And I think that everybody who is obese should just eat less and move more crew. And I think that there's a lot of room for nuance and a lot of room for thoughtful discussion on this

topic specifically that has not yet been had. And I wanted to do more research before I even opened my mouth about this because the drugs that we'll talk about today, the way in which they interact with the body can be complicated. And I wanted to try to simplify it to the best of my ability in a non-medical advisory way. So we'll sit down, we'll discuss obesity writ large. We'll chat a little bit about each of these kind of popular, specifically the more common ones you've heard of probably, drugs, what to expect, should you take them, should you not take them,

drugs, what to expect, should you take them, should you not take them, what kind of implications could these have. And again, I'm not a physician, but I do think you'll enjoy this conversation. But if you're considering taking one of these drugs, talk to your physician first. So sit back and enjoy this episode. This episode is brought to you in part thanks to some of our amazing partners like LMNT LMNT makes the best electrolyte product on the market in fact I've actually started drinking my LMNT each and every morning before I have coffee so as to optimize my circadian biology make sure that I'm hydrated and make sure that I'm getting ahead on my water intake throughout the day and not reliant on stimulants, but instead being somebody who's reliant on hydration and the proper balance of minerals and electrolytes. If you want to feel your best all day,

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as athletes like you and I looking to take your fitness to the next level. My favorite flavors are definitely the raspberry and citrus. When I put a box together, I try to load up on raspberry and citrus. And when you put your box together, you can get a free sample pack containing all of Element's amazing flavors like mango chili, citrus, raspberry, orange, and more. To get access to this free gift with purchase, scroll down to the show notes and check out using the special link for dynamic dialogue listeners. Getting into today's discussion, I think the meat and potatoes, of course, is what the heck are these drugs? How good can they possibly be

for fat loss? What are the side effects? Is this crazy? Are we at some cultural tipping point at which we'll never look back? And it's really not even fair, if I'm being totally honest, to have that discussion without first talking about obesity. And I'm not going to sit here and cast judgment or actually, if I'm being completely honest, I'm not even going to attempt to conflate what I believe to be practical solutions for obesity, like enjoyable exercise, protein and fiber centric approach to food, a very active lifestyle, focusing on sleep, minimizing alcohol consumption, right? Like there are no shortage of things we've discussed on this podcast specific to what one can do to

either lose body fat or prevent slash fight slash, you know, work themselves out of obesity. Whether you're dieting from a normative body weight to get ready for a photo shoot, or whether you're dieting to get your body mass index south of 30 so you're no longer considered obese, a lot of the actual nuts and bolts of what one might do, quite frankly, don't change. And these drugs make it easier to adhere to the dietary side of things and do some interesting things, some of them with blood sugar that could make it easier. But at the end of the day, my recommendation for people who wanted to lose body fat, whether they were on these drugs or not, is more or less the same with a few exceptions.

But we can't really have this discussion if we don't first kind of talk about obesity by the numbers and talk about what we're up against. Because in America, if you look at the way that our healthcare system is structured, there's really two big players who make an awful lot of money. The first is, of course, the pharmaceutical industry, which is something that has been discussed as a kind of major culture war issue since 2020, for sure. So I think a lot of people are more aware that pharmaceutical companies have a huge profit margin. I shouldn't say all of them, but many of them, especially the largest of them, have a huge profit margin at the end of the day and pay very little in corporate taxes. So from a societal standpoint, we have a massive entity that is

responsible for the production of drugs that largely help cure mostly preventable, but oftentimes unpreventable diseases or diseases that can't be remedied with lifestyle. So there's obviously a huge trade-off. They make a lot of money because the drugs cost a lot of money and they oftentimes cause problems or side effects, but they also produce life-saving compounds. So frustrations that one might have with big pharma, suffice to say, they make contributions that are at least positive in certain contexts. It's undeniable. And then we also have a massive for-profit insurance system. So this, of course, would be health insurance. Now, much like pharmaceutical companies, there are a few really big players that manage the majority of people's health.

Most healthcare insurance providers are quite large. Some are small, but some are quite large, and they span multiple states. So there's situations where somebody might be paying five, six, seven, eight, 900, a thousand dollars plus just for health insurance, just for healthcare to cover the cost of some of these prescription drugs. Because without insurance, some of the drugs that people need to literally survive, insulin was one that was extremely, extremely difficult to pay for without insurance until just recently the government stepped in and said, look, you got to cap the price at like 35 bucks. You're going to kill people. And that drug wasn't patented by the creator for the specific use case

of getting it to as many people as possible. So two big players here, pharmaceutical companies and the insurance companies. And you could definitely draw a line and say, hey, these companies make more money off of people whom do not maintain a normative body weight. The heavier you are, the more body fat you have, the more hypertensive you are, the more dysregulated your blood sugar, the more obese you might be, the more money these companies stand to make off of you. So why would they produce a compound that helps so effectively fight against fat accumulation and obesity? And it's because I truly believe that while the incentives structurally are misaligned

so that people end up paying a shit ton of insurance and don't have enough money to pay out of pocket for more preventative healthcare measures like coaching, like getting quality food in the house, like gym memberships. I do think that at some level, there are people inside of these companies for sure who want to help and who are developing incredible drugs and compounds that could. And obesity is one of the most glaring epidemics we face globally, but specifically here in the United States. And we need solutions to this. We need solutions to this that I think are greater than simply saying just diet and exercise. Because we've been telling people

that for an awful long time. And a number of people try it for a little while, don't see progress and quit, or they're not in a situation to stick with it, or they stick with it, but they're so dysregulated emotionally, or the way they behave around food is so atypical that they don't see the amount of weight loss they would need to see to get to a more healthy weight. And in the United States, here's what's fascinating. Obesity prevalence from 2017 to 2020 was at 42%. I've seen data more recently that shows that that number is north of 50%. And that shouldn't surprise everybody. Because if you think about it, we were at 42% going into the pandemic. And then we experienced two to three years of relatively considerable lifestyle change and

adjustment that certainly skewed more towards sedentary than it did towards active. And so if you think about it, it makes sense that at a national level, and if you just go out in public, you can probably see it with your own eyes, especially depending on where you live demographically, that obesity and being over fat is affecting about 50% of Americans. So we need some pretty serious solutions. And obesity as a condition itself presents as a distinct risk factor for heart disease, stroke, type two diabetes, multiple types of cancer. Okay. And those are the four leading causes of preventable and premature death. So let's, let's unpack that really quickly. One more time. Obesity affects 50%, approximately 50% of Americans. approximately 50% of Americans. Okay. So how many people live in America? About 375 million, if I'm not mistaken. That's a quick Google away. So let's pull that up. How many people

live in America? This is where I need a show host slash a show producer. So we're looking at 332 million Americans. Okay. So 332 million Americans divided by two is 166 Americans, 166 million Americans, I should say. So that's like four plus Californians worth of people are obese. Think about that for a second. 166 million people in America are obese, which means 166 million people are uniquely predisposed to heart disease, stroke, type 2 diabetes, and multi or various forms of cancer, the four leading causes of premature death. And we have a system, a healthcare system that is heavily reliant on pharmaceuticals

and it's heavily reliant on insurance-based medical practice. We also have a demographic shift happening now where the millennials are representing a larger percentage of living Americans than are the boomers. Because as the boomers age, and as the boomers put a unique medical toll on the system, which is normal and associated with age, I mean, China's dealing with this right now. Japan deals with this because they have a negative birth rate, but when a distinctly large percentage of a population ages and that population needs increased medical care, it then is put on the generation and the generation after that to care for those people.

So if you have a negative birth rate like Japan, you don't have enough young people to take care of your old people. That's scary. China's dealing with something quite similar. In the United States, we're looking at two distinct aging demographics, right? One older than the other, boomers older than millennials, but millennials also suffering from extremely elevated levels of obesity. And so as the boomers age and the generation between them and the millennials age, one of the things that we have to be aware of is the burden on our healthcare system. And what do companies that have been acting at best with some of our

interest in mind, but most of their bottom line in mind do when more people need care than they can treat? They're probably going to increase costs and they're probably going to lower, lower levels of care. I'm not saying that's for sure, but that makes sense to me. If your most important bottom line thing is literally your bottom line thing, your profit margin, which I think both insurance companies and pharmaceutical companies have shown us for decades, then when a system gets to a point where it requires an extreme amount of triage to treat an aging population and a population who is at a 50% clip suffering from increased heart attack, stroke, type 2 diabetes, certain types of cancer. And with that also,

I mean, look at the statistics specific to the most recent pandemic and you'll find that, hey, look, it probably was not in your best interest to be carrying around substantially elevated body fat. So let's say you have another pandemic. Well, it puts us in a societally precarious situation. And I think you need to have a lot of empathy because this is affecting a lot of situation. And I think you need to have a lot of empathy because this is affecting a lot of people. And I just think screaming into the abyss, like everybody who's fat is lazy and not working hard and not watching their diet. They need to eat better. It's so much more complicated than that. And I've done this for 10 years. I used to be the guy that

said that. And it's like one of the least helpful things unless there's somebody out there that's particularly receptive to it. And if I'm being honest with you, the number of people who fall into that category are few and far between. Most people respond better to encouragement, motivation, and being told that any bit is good enough and that they just need to keep stacking small wins. I think that it's easy for those of us who are already thin to discount all of the things we have working in our favor that allow us to maintain that thinness and that leanness and that muscularity, whether it be genetics, whether it be a situation that is specific, like I was just discussing on a coaching call with a prospective client, my caloric intake. And I told her it's north of

4,000 calories a day on average. And I'm able to maintain about 11 to 12% body fat, or I'd say 13 to 14% body fat. I can see visible abs and I'm relatively muscular compared to the average person because I work in a gym. I get 15,000 steps a day because of that. And I literally work in the fitness industry where I have a ton of external pressure to look a certain way. And I can't look somebody in the face and say, this is all you need to do to lose weight. Honestly, if they don't in fact have the same access. So it's like, if I just live like me, that's all it takes. It's like, yes and no. I have a lot of things working in my favor. And it just does not seem to help to just shove people's face in obesity. You need to be providing solutions. You need to

be helpful. You need to be an advocate. You shouldn't condemn people. You shouldn't be crass. You shouldn't be rude. It just doesn't inspire or motivate anybody to do anything. And I want to give you guys some kind of figures here that I think are representative of just how bad this problem is. So like obesity is quite literally bad for America. Obesity in America is bad for America. Okay. It's bad for our kids. It's bad for our adults. And quite frankly, even though most of our like geopolitical conflicts are not fought the way they were during the Second World War and previous to that, it does affect our military readiness. And we'll talk about that statistically. So one in five kids and one in three adults are obese. Two in five young adults, so adolescents,

two in five young adults, so adolescents, are not eligible or physically deemed prepared for basic military training, which is to say, if you had 5 million young people whom you needed to mobilize in an emergency, the way that has been done in the past was something like a draft, 2 million would not be eligible because of their weight. And I'm not saying that everybody needs to literally be in what they used to call fighting shape. You don't need to be in quote unquote fighting shape, but these are alarming figures. Children who are obese are more likely to be obese as adults. That shouldn't surprise anybody, but it has a lot to do with the ways in which our bodies negatively respond to obesity and the way that they often positively respond to proper nutrition and exercise. What's going on, guys? Taking a break from this episode to tell you a little bit about

my coaching company, Core Coaching Method. More specifically, our app-based training. We partnered with Train Heroic to bring app-based training to you using the best technology and best user interface possible. You can join either my Home Heroes team, or you can train from home with bands and dumbbells, or Elite Physique, which is a female bodybuilding-focused program where you can train at the gym with equipments designed specifically to help you develop strength as well as the glutes, hamstrings, quads, and back. I have more teams coming planned for a variety of different fitness levels. But what's cool about this is when you join these programs, you get programming that's updated every single week, the sets to do, the reps to do, exercise tutorials filmed by me with me and my team.

So you'll get my exact coaching expertise as to how to perform the movement, whether you're training at home or you're training in the gym. And again, these teams are somewhat specific. So you'll find other members of those communities looking to pursue similar goals at similar fitness levels. You can chat, ask questions, upload form for form review, ask for substitutions. It's a really cool training community and you can try it completely free for seven days. Just click the link in the podcast description below. Can't wait to see you in the core coaching collective, my app-based training community. Back to the show. So in the same way that exercise and eating certain foods can promote

positive changes in blood cholesterol and positive changes in blood sugar regulation and positive changes in mood. Well, guess what? Being obese and eating too much of the wrong stuff and being mostly sedentary for reasons that are or are not entirely in your control can negatively affect and help obesity kind of stay rooted and stay entrenched, and it can make it a lot harder to get thin. Things start to become dysregulated. If you have poor control of your blood sugar because you've lost your sensitivity to insulin because of the amount of body fat you have, that's going to make regulating your appetite a different experience entirely from somebody who's lean and already working out. And just starting to lose fat and work out doesn't make

that stuff shift. So it makes sense that if children are suffering from obesity, that we take specific consideration in treating them. And we'll talk about why these drugs are being recommended for children. And if in fact, I think that's safe. And again, I'm not a physician. So before we talk about the drugs, again, I want to clarify, I'm trying to approach this from looking at obesity as a public health problem, looking at obesity as a problem that is somewhat influenced by genetics. It's certainly influenced by socioeconomic class, income level. And we have to be honest and acknowledge that there is a certain degree of personal responsibility here. I know that it seems a little right wing, left wing to be like, this is either a personal responsibility thing, or it's like a socioeconomic race and class thing. And this is so clearly a both thing. Okay. It's so clearly a both thing that we need to really be more honest in how we discuss obesity because it's definitely not exclusively personal responsibility. Does taking personal responsibility relentlessly and ruthlessly help a lot of people fix the

problem that is obesity? Hell yes. Is that my preferred path as a coach? Hell yes. But is it foolproof and does it work for everybody? Not in my experience. And I think it's important to paint the right picture here. Adults who are obese have a much higher risk of developing heart disease, type 2 diabetes, and cancer. We talked about that already. Obesity costs the US healthcare system $1.75 billion a year and assuredly counting. counting. Fewer than one in 10 children and one in 10 adults eat the recommended amount of vegetables. I want you to think about that, guys, as there are more and more people on the internet scaring people away from vegetables because they've been quite literally radicalized by garbage data

and what appears to be little more than giant grifters trying to make money selling liver pills. But literally only one in 10 American adults and one in 10 American children eat enough vegetables. Vegetables have a ton of fiber, they have a ton of nutrition, and they generally don't have very many calories. So they're a fantastic food to encourage people to eat if you are living in a country where 166 million people are obese. And don't listen to anybody who's fucking got it out there that they're making a big difference telling people not to eat plants. Oh, I'm saving people by telling them not to eat plants. Plants have plant defense chemicals and they contain pesticides. Dude, really? How much more clear can these numbers be? One in 10 Americans don't eat enough vegetables. Somehow five in 10 of them are obese. But yeah,

sure. Definitely don't eat more of the super nutritious, highly correlated with multiple positive health outcomes like lowered blood sugar, better cholesterol numbers, better brain health. Sure. Skip all of that and worry about the plant defense chemicals because animals certainly don't have defense chemicals. I'm sure every animal that gets slaughtered doesn't pump out a shit load of adrenaline. Of course they do. So the idea is that vegetables are dangerous is a more dangerous idea for anybody who takes it seriously. Okay. Fewer than one in four American children get enough aerobic physical activity and just one in four adults meet physical activity guidelines. These are alarming statistics that I think paint a pretty clear picture of why

having more interventions than just yelling at people like, hey, diet more and take your exercise more seriously. We've got to have other options. We just have to, because a lot of these options can run in conjunction. And we're about to talk about the drugs and what they are, but they mostly fall into a classification known as GLP-1s, which stand for glucagon-like peptide receptor 1s, okay? Essentially, these are peptides that act like the hormone glucagon, okay? Is that fair? These are peptides that many of which act like the hormone glucagon, okay? There's GLP-1s that are short-acting like pieta, adalixin, and rhabelsis, okay? Oral semaglutide is popular. That is known as rhabelsis, okay? The long-acting GLP-1s are the more common GLP-1s. They work for more than a day and they help control blood sugar

around the clock while limiting the way in which food moves through the system. We'll talk about that. You've definitely heard of these. These are Trulicity, which is dilagletide, Victoza, which is loragletide, active ingredients, and Ozempic, the most popular, the most kind of culturally well-known semaglutide. Now, ozempic became very popular after the commercial, oh, oh, oh, ozempic, right? You've probably heard it. And it got extremely popular when celebrities like Elon Musk and Khloe Kardashian started talking about how they were using these compounds to lose weight. Now, we'll talk mostly about some eglatide because I think it's the most

prescribed compound. There are some new compounds like trizepatide that we'll talk about, but we need to discuss the three primary ways in which GLP-1s work. And there are three mechanisms by which these drugs help to regulate blood sugar, appetite, and help with body fat reduction. The first is that these drugs slow the rate at which the stomach digests food. This means that nutrients are released more slowly, blood sugar does not spike as hard after a meal, and the actual mechanical sensors inside the stomach lining that detect changes in pressure detect fullness longer. These drugs do one thing unbelievably well, and that is they make you feel very full. I know this having coached people that

have used them. The second thing that these drugs do very well is they increase insulin production. GLB-1s help your body make more insulin, okay? This is good if you have diabetes because you are insulin sensitive, insensitive, I should say, meaning when you eat something and you should typically see a secretion of insulin to help your body partition those calories and macronutrients appropriately for adequate use. If you are insulin insensitive or you have type 2 diabetes or prediabetes, you're not going to get the same insulin response. These drugs can help normalize these. This is what got these drugs available, was the way in which they can be used to treat diabetes,

okay? Not weight loss. Do they work well for weight loss? Extremely well, from what I have seen. Does that mean that I recommend that you take them? I wouldn't say you should or you shouldn't. I would definitely say that you should probably try using all of the personal responsibility roots of lifestyle, diet, and exercise change before you lean into a pharmaceutical intervention that is mostly intended for the treatment of diabetes, not obesity. The last thing that these compounds do is that they reduce sugar release from the liver, which shouldn't be too surprising because they do act similar to glucagon. And glucagon has a heavy influence on the pancreas and the liver specifically. Okay. So getting a little deeper, talking a little bit more about these drugs specifically,

Ozempic. Okay. Ozempic is the big name, the one you've probably heard the most. Okay. So this is a diabetes drug, but it got really popular thanks to influencers and celebrities. Diabetes drugs taken for weight loss can work, but the side effects of Ozempic are decreased appetite, facial aging, potential kidney failure, going off the drugs can be difficult, and there's definitely a reduced desire to engage with things like food and alcohol. Another issue with these drugs is many insurance companies will not cover them or won't cover them for long. And they are, thanks to the American Academy of Pediatrics,

recommending the utilization of such interventions for the treatment of childhood obesity. So there's a lot of complications that come with taking these drugs. They're far from perfect, although they are effective. And they have cleared everything that one drug company would need lot of complications that come with taking these drugs. They're far from perfect, although they are effective and they have cleared everything that one, a drug company would need to clear for safety, right? So Ozempic or some aglutide is going to lower your blood sugar level. Okay. Help regulate your insulin, which is crucial for people who are type two diabetic, which are, is a huge percentage of the population. Okay. It's very beneficial for people who are obese because a lot of people who are obese are pre-diabetic already. Okay. And it prompts the stomach to

empty a lot more slowly, which is hugely important. And that's why it works for fat loss. The new drug that is going to be approved or likely to be approved is trizepatide. approved is trizepatide. Trizepatide is in a position where it can be approved for weight loss, not approved for diabetes and used off-label by celebrities and people who are fibbing to their doctors for weight loss. Trizepatide specifically is a little bit different than some eglotide, right? But you hear that luteide and zepatide at the end of both. It's because they're both peptides. Now think about this. 50% are obese and at specific risk for type two diabetes or pre-diabetic already. 70% of Americans are overweight. And simply being overweight does increase the risk of the development of diabetes. So it's actually interesting if one of these, trizepatide, were to get cleared for the treatment of obesity or simply being overweight,

it could actually end up reducing the amount people use other drugs like Rebelsis, Trulicity, Victoza, and Ozempic that are often used to treat diabetes because they don't develop it in the first place and they might not need some of the other drugs. So, trisepatide is interesting to me because as I zoom out and think, well, how the heck are these insurance companies going to make their money back if they end up finding a treatment so effective for weight loss that it actually reduces the number of people who need them for all of the other medications that they have for preventable illness? And I'm not inferring that there's some deep, dark conspiracy here. I don't know enough about it, quite frankly, to have too much of an opinion. I just find it to be relatively interesting that if Eli Lilly, which currently has this drug in a phase three clinical

trial, right? You know, we're talking about this thing potentially really helping with weight loss. So, trizepatide was granted approval, is looking to get approval from the FDA sometime within the next year. Okay. There's two other drugs that are approved for weight loss. These are both trizepatide compounds. These are Wagovi and Saxenda. The only one I've ever even seen is Wagovi. And it's basically impossible to get. And this one was made by, those were made by Novo Nordisk. So that's another, that's the manufacturer. Eli Lilly, I think is quite a bit bigger than Novo Nordisk. And I think that Trizepatide could actually get to people more quickly because of the scale. Now, the annual sales of Trizepatide, this is from

NBC News, could hit $48 billion and are estimated to generate $25 billion in annual sales, which would surpass Humira, the number one drug for rheumatoid arthritis in just the first year. So these drugs, not only is there an insane demand, there's a trouble to meet the supply. So much so that some of these are being made on the black market and they're extremely, extremely dangerous and super, super sketch. I've heard people saying, don't even try to get this shit from a compounding pharmacy. It's just not worth it. So like people are trying to get some aglutide and triseptide because these glucagon like peptides make weight loss quite a bit easier. Um, but obviously they come with some drawbacks. We talked a little bit about what I found specific to, um,

specific to complications associated with taking the medication, like side effects that could be, um, you know, let's see here. What did I mention? Uh, obviously changes in taste profile, reduced likelihood to want to drink alcohol, facial aging, and kidney failure were the two weird ones that are like, whoa. But you know, if you listen to the end of any commercial, you're going to hear, you know, like prescription flatuda is really good and it's really happy. And look at how excited the people are in the ads. Take flatuda. And then like at the last 10 seconds, like flatuda has been shown to cause rectal bleeding, intense, you know, cranial pain, discomfort in the abdomen, shrinking of the penis. You know, it's like all this stuff. So they shoot it in their rapid fire. We know that pharmaceuticals, even life-saving ones, come with side effects.

And do we know enough about the side effects in this specific case to say we shouldn't use it? And I'd say not necessarily because we know the dangers of obesity. So I think that this is a decision for sure that should be made between the prescribing physician and the patient with the goal of keeping the weight off. Because that phase three clinical trial that I mentioned on trizepatide found that a high dose help patients lose 22.5% of their body weight or 52 pounds better than any medication on the market. This includes way Govi and Saxenda, which only showed 15 to 5%. That's why trizepter's epitide is super interesting. This is the most effective form of these GLPs for body fat and body weight reduction

that I think we've ever seen. But there might be some side effects like muscle loss. And I've heard a few people talk about this. Now, this would be a meta side effect, meaning like, could you develop facial aging and all these things? Yes. But I think you could like more directly and more quickly develop on a much more likely basis, right? Because like if one in a thousand people in a trial has kidney failure on a drug, you know, that's got to be listed on the side effects. But if a thousand people in a trial has kidney failure on a drug, that's got to be listed on the side effects. But if a thousand people all lose muscle, is that really a side effect or is that a direct effect? And so I think one thing physicians who are in a position to prescribe this drug should

at least consider, and this is, again, as a non-expert on the general thought process that goes into making these prescriptions. So I'm sure many physicians are many steps ahead of me on this, but we should at least consider encouraging any patient, child or adult, who chooses to use these medications to help them fight obesity. They should, in my opinion, certainly be prescribed an equivalent amount or an effective amount of exercise and protein intake to preserve as much lean muscle as possible. Because if these drugs are expensive to make, expensive to take, hard to get your hands on, and we see asymmetrical or quite frankly, dubious incentive structures around the companies that are going to produce them and the insurance companies that may or may

not pay for them. You don't want somebody to take this, lose a ton of weight, have a lot of it be muscle, gain all the fat back, and then maintain their sedentary lifestyle. That's the big trap that I would be worried about with these drugs. Do I believe that that could be a worse long-term health outcome than obesity? I'm not sure. I don't know. I think both could be dangerous. And that's one of the things that I thought I should bring to the table because I'm not in a uniquely expert position to make any kinds of actual like, hey, you should or shouldn't take these things. The only thing I'm an expert on that we've talked about today is muscle growth and body composition.

And I think that body composition is actually really important in the fight against diabetes because what you might see happen is you give somebody one of these drugs, they lose a lot of body fat, but they also lose a lot of muscle and they might see improvements in insulin sensitivity. But then when you can't afford the drug anymore, the insurance companies won't pay for it because it's too expensive. It's too hard to find and they gain body fat back slowly, but they don't have muscle. They might be even more insensitive to insulin. So I think that these drugs are fascinating. They're interesting, and they could help us hopefully make a dent in what I hope I've been able to convince you is a

very serious problem. But I think what you can do as a patient, as somebody who's enthusiastic about helping people, as a physician, as anybody who's in a position to interface with anybody who's looking to improve their body composition, to lose weight and to fight back against obesity, you shouldn't stigmatize them. You shouldn't chastise them. You should encourage them to find meaningful solutions that help them live healthier. And I find oftentimes in doing this, weight starts to come off and momentum starts to get built. So hopefully you guys enjoyed this thoughtful discussion about these drugs. You guys really have asked me a number of questions about this. And I say that with 100% honesty. I think a lot

of influencers say things like, oh, you guys have been blowing me up about what protein powder I take. And I take this, and this is the code for it. It's like, sometimes you guys really do. 60% of the questions you guys have asked me in the last three months have quite literally been about these compounds, creatine, and the ability to grow your ass while losing fat. So this is something a lot of people asked about, and I was not prepared to discuss it too thoughtfully until today. But these drugs are unique. They're incredible. They could help us fight a very serious problem, but I would label them as a handle with care. And I would encourage anybody who's in the market to use them or prescribe them to be thoughtful about the preservation of lean tissue and not just think about fat loss. Thanks so much for tuning in, guys. It would mean the world to

me too if you took two seconds to simply leave a five-star rating or review on Apple Podcasts or Spotify for the podcast. It helps it grow, helps more people find it, and that's how I'm going to grow this thing and make the impact I want to make on people's health. So I need your help just as much as you need mine. Take the one to two minutes, leave the review. It would mean a ton to me and I will catch you on the next episode. Thank you so much.