Science Vs - Ozempic: Is It Scarier Than We Thought?

Episode Date: March 14, 2024

We looked at this class of weight loss drugs a year ago, and they've only gotten more popular — and more controversial. We’re hearing that these kinds of drugs can be tough on your stomach, and that the weight loss comes with worrisome loss of muscle. We’ve also heard claims that they might increase your risk of suicide. So — should we be freaking out here?? We talk to endocrinologist Dr. Vibha Singhal, neuroscientist Dr. Nora Volkow, and gastroenterologist Dr. Michael Camilleri.   This episode does deal with depression and suicidal thoughts. Here are some crisis hotlines:  United States: US National Suicide Prevention Lifeline Dial 988 (Online chat available); US Crisis Text Line Text “HOME” to 741741 Australia: Lifeline 13 11 14 (Online chat available) Canada: Canadian Association for Suicide Prevention (See link for phone numbers listed by province) United Kingdom: Samaritans 116 123 (UK and ROI) Full list of international hotlines here  Find our transcript here: https://bit.ly/ScienceVsOzempic2Scarier  Chapters: In this episode, we cover: (00:00) What are the fears around these weight loss drugs?  (04:46) Do these drugs melt your muscles? (11:49) Do these drugs increase the risk of suicidal thoughts?  (16:15) Can they really paralyze your stomach? (30:25) Some good news! (33:36) How Did You Find the Bezoar? CREDITS This episode was produced by Rose Rimler, with help from Wendy Zukerman, Meryl Horn, Michelle Dang, and Joel Werner. We’re edited by Blythe Terrell. Fact checking by Erica Akiko Howard. Recording assistance from Selena Seay-Reynolds. Mix and sound design by Bobby Lord and Peter Leonard. Music written by Bumi Hidaka, Emma Munger, Peter Leonard, So Wylie and Bobby Lord. Thanks to all of the researchers we spoke to for this episode, including Dr. Kristen Beavers, Dr. Ellen Fallows, Dr. Joseph Henson, Dr. Dimitrios Papamargaritis, Prof. Roger McIntyre, Prof. Russ Waitman, Dr. Sahib Khalsa,, Dr. Travis Masterson, and Dr. Etienne Wang. Thanks also to Bryant Smith and Lori Segal. And special thanks to the listeners on these medications who checked back in with us.    A special thanks to the Zukerman Family and Joseph Lavelle Wilson. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus. Today on the show, we're looking into the latest fears around drugs like Ozempic. And before we jump in, in this episode, we are talking a little bit about suicidal thoughts. So please take care while you're listening and we're going to put some mental health resources in our show notes. Okay, let's get started. Last year, just as drugs like Ozempic were gaining steam, we did our first episode about them. But since then, a lot has happened. Prince Charles became King Charles, Twitter rebranded to X. And Taylor Swift joined the NFL. Yay!

But one thing that hasn't changed, these weight loss drugs are still big news. One hot topic everyone in Hollywood still seems to be talking about is Ozempic. And it's not just Ozempic. There's a bunch of similar drugs out there, like Wegovi, Monjaro and Zepbound. And something we keep hearing about them is that they're causing these weird and very

scary side effects. The Ozempic hype is starting to wither, replaced with the reality that it and similar drugs are very risky, even deadly. Last year, there were all these stories of people becoming suicidal soon after taking these weight loss drugs. Regulators are looking into reports of suicidal thoughts. I remember thinking to myself, my family would be so much better off without me because I was so, just so depressed. There are now fears that these drugs are sapping our bodies of muscle, which we're told can be incredibly dangerous.

You're losing equal amounts of muscle and fat. Now, does that improve how you look in a bathing suit? Sure. But does that improve how long you're going to live? Uh-uh. Not a bit. And some claim that drugs like Ozempic have paralyzed their stomachs, leading to awful side effects. Debilitating gastric issues, vomiting daily,

hospitalised repeatedly. A year ago, when we first looked at these kinds of drugs, they looked pretty safe. But did science miss something here? As millions and millions of people are being put on these kinds of drugs, how worried do we need to be? Today on the show, we're looking at the cutting edge research

on these new weight loss meds to find out, are they scarier than we first thought? When it comes to Ozempic, there's a lot of... The Ozempic hype is starting to wither. But then there's science. That's all coming up after the break.

It's really not important to me to have a lot of things to show off. Fancy cars, you know, a giant home. Those things are just not part of who I am. But I've been coached and I've learned through my advisor that it's not one size fits all. Everyone has their own preferences. Everything that I do with Edward Jones is tailored to who I am. Edward Jones. We do money differently. Visit edwardjones.ca slash different. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist?

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And this is... Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back to the show. Today, we're finding out if weight loss drugs like Ozempic are scarier than we once thought. Okay, so last year when we talked about Ozempic, we looked at how these kinds of drugs work, which is to mimic this hormone that makes you feel full. So it's basically like an appetite suppressant.

And when it comes to losing weight, these drugs really, really do work. They help a lot of people lose a lot of weight. But the question we're asking today is, are they safe? What do we know now? And to tell us all about this, is the producer at Science vs. Rose Rivla. Hey, Rose. Hi, Wendy. So, Rose, as you've been seeing these headlines of like muscle wastage, suicide risk, stomach paralysis, like what has been going through your head every time these headlines pop up? I'm a little—I'm very curious, but I'm a little skeptical

because I know people just love to talk s*** about these drugs. The last time we covered this, they actually seemed pretty safe. There were some concerns about pancreatitis and gallstones and thyroid cancer, but there were a lot of it was kind of theoretical, seen in rats or very rare. So it seemed pretty safe. Actually, the biggest problem was that a lot of people get GI issues, like stomach upset, nausea on these drugs. And that's kind of where we landed last time. And I hear you, that you could definitely feel in the air that people want to talk about these drugs. It doesn't feel like you can lose this much weight and not have some consequence. Yeah. But at the same time,

a lot more people are taking these drugs. And it does sort of feel like maybe science missed something here in the early clinical trials, which can happen. It could totally happen. Right. So, Rose, let's start with this thing that we've both been hearing a lot about, which is this idea that Ozempic can mess with your muscles. And basically that you're not just losing fat, which is the goal for many people,

but you're also losing a ton of muscle on these drugs. So here, let me read you some headlines that I have read recently. The race is on to stop Ozempic muscle loss. Another one, Ozempic may cause dangerous muscle loss. And perhaps my favorite, are fat loss shots a ticking time bomb? Doctors warn Ozempic and Wagovi are shrinking patients' muscles. Yeah, I've heard this too. And I've heard a lot of people talk about it on podcasts, you know, those bastions of misinformation. You got to watch out for those. And I specifically have heard this claim that the muscle wastage that happens when people are on these medications can also melt muscle off

your face and make you look like gaunt and weird and they call that ozempic face oh god it has its own name now ozempic face yeah ozempic face okay so like how freaked out do we need to be about this well if it's true that the ozempics are melting your muscles away, that would be a big deal because, you know, our muscles aren't just there to yank our bones around, which is kind of how I think I have previously thought about it. Yeah. It's actually a very important organ and it's a very active organ. So one thing they do is they pull sugar from our blood and then store the sugar. Oh, that's cool. I didn't know muscles did that.

Yeah. And I talked about this with Vipa Singhal. She's a doctor and scientist at Harvard. Even when we are sitting, muscle is sort of sucking up all the glucose. Like almost like, you know, the vacuum machine, it can just suck away all the glucose. So muscle is sort of a storehouse of energy. And to maintain healthy blood sugars, healthy metabolic state, a healthy muscle is very, very important. So the less muscle you have, the less efficient this whole thing is. Mm-hmm.

This is all part of what's called insulin sensitivity. And so just to really land this point, one study took healthy people and had them stay in bed for a week. And because they were inactive for a week, they lost about three pounds of muscle. And their insulin sensitivity plummeted. It went down by 30%. Oh, whoa. And that's bad. Like, that can lead to a whole bunch of problems.

Type 2 diabetes, but also high blood pressure, heart disease, yada, yada, yada. So hearing all this, you want to keep your muscle, right? Yes. Love, love my muscles. So does Ozempic melt them away? Okay, so straight away, you need to know that every time someone loses weight, they lose muscle. In fact, studies that have looked at weight loss generally find that on average, 20 to 50% of the weight that people lose comes from their lean tissue, which is mostly muscle.

So if somebody loses 10 kilos, two kilos of that could be muscle, to up to five kilos, which is a lot. That is substantial. That is substantial. And one reason for this is because when you're losing weight, because you're taking in less energy by eating less, your body is going to look for energy in other places. It's going to try

to get sugar. And one place it can get that sugar? From your muscles. Okay, so every time we lose weight, some of that weight is muscle because your body is searching for energy, eating away at things, including your muscle. And on average, about 20% to 50% of the weight that you lose is muscle. Is that right? Yeah. So then the question becomes, when you're on these meds, are you losing more muscle than you normally would? Right. That is the question. So to find that out, researchers have pulled people into these scanners that can measure how much of your body is fat, how much is bone, how much is lean tissue, muscle. Okay. And so they scan people before they start these medications, and then again after they've been on them for a while and lost a bunch of weight.

And here's what they have found. So in one trial for trizepatide, which is the stuff in Manjaro and Zepbound, out of all the weight that people lost on average, about 25% of that was muscle. And then in another trial for semaglutide, that's the stuff in Ozempic and Wagovi, almost 40% was muscle. Oh, almost 40% and then 25%? So that is exactly what you would expect.

Is that right? It's exactly what you'd expect. So there's nothing special happening here. Not as far as we can tell, no. But there's so much vitriol around Ozempic and the muscle wastage problem. Like, I haven't read any headlines that were worried about muscle wastage when people were losing weight through other means.

Like, why all this focus on these drugs? Yeah, it's weird, right? Well, FIPA thinks that there's just a spotlight on these medications. So any little thing that they do is going to be breathlessly reported on. So this is how we wind up with these discussions about like, quote unquote, ozempic phase. When you lose weight, you lose weight from everywhere. Including your face. Including your face. So I don't believe in ozempic phase. It's the weight loss phase. So when it comes to muscle wastage or whatever, like, I don't know, is there anything to particularly worry about with these drugs?

Yeah, as far as I know. I mean, I haven't seen any evidence that the way people's weight comes off on these medications is different than from any other means of weight loss. But that being said, I mean, it is a fair point that people should be aware of this whole muscle loss thing. But people do lose weight on these medications or otherwise. They should be trying to preserve muscle, build muscle. So, you know, that looks like getting plenty of exercise and eating enough protein.

Right, right, right, right. And the best exercise for this is resistance exercise. So that's stuff like lifting weights. But Vipa says that any exercise that you do consistently will help some. I have one family that, you know, they like to dance as a family for 30 minutes every evening. Great. Whatever gets you moving works. That's really sweet.

That's cute. I like that. All right. So dance for 30 minutes if you're on Ozempic. Love that. That's the takeaway. Yes. So Rose, what's next? So the next thing I want to dive into is pretty scary sounding, actually.

So there have been hundreds of people who have reported that after they started one of these weight loss medications, they got really depressed. And some people have even reported feeling suicidal. That's so scary, the idea of you take a drug and then your whole attitude and life switches over, because that's the claim, right? Yeah, the claim is that the medications were causing depression, causing suicidal thoughts. And there are enough reports of people saying this was happening to them that the FDA decided to look into it. And that made the news. Other countries decided to look into it, too.

And so all the media around that, that's actually where our next guest first heard about this. That's really when it captured my attention. This is Nora Volkoff, and she's a neuroscientist and director of the National Institute on Drug Abuse. Why did it capture your attention? Because so many people are taking these medications. I mean, so many people are being exposed to them. This could be bad. Yeah. And it's not wild to think that this could happen, like that a weight loss medication could cause depression and suicidal thinking. In fact, there is actually a warning on these drugs that says people should watch out for depression or suicidal

thoughts. Are you serious? Yeah. I mean, Wagovi and Zetbound both have this warning. And I asked the FDA about that. They told me the reason it's there is that there have been weight loss drugs in the past that have been linked to feeling suicidal. In fact, there was one drug that was pulled off the market because of this. Whoa. So what do we know here? Did these new drugs increase your risk of suicidal thoughts? So Nora and her team decided to dig into that question.

So they pulled medical records from people from across the United States, and they combed through them to see who had been prescribed semaglutide. That is the stuff in Ozempic and Magovi. And they were looking over a period of about a year and a half. Okay. And they also pulled medical records from people who had been prescribed a different kind of weight loss medication over that same period. Great.

That was the control group. Loving this study. This is exactly what we need. Thank you, Nora. So in the end, they had more than 100,000 people in this part of the analysis. Mm-hmm. And when they crunched the numbers to see were people on semaglutide more likely to feel suicidal, they found no. Mm-hmm.

No. Okay. In fact, Nora told me they found something really unexpected, which was that the people on semaglutide had lower rates of suicidal thoughts than the other group. Oh! Actually, we were very surprised because we, based on what the accounts were saying, we were expecting them to be higher. So we were surprised when we saw that they were significantly lower. Oh, wow. And, you know, in fact, scientists are digging into this whole other question of whether it's possible that this class of drugs can have antidepressant effects. What? And that evidence is very preliminary.

It's mostly from rat studies, but there's some suggestion that this could be happening. So that's pretty interesting. Well, this is quite a switcheroo from science. It is a switcheroo. Yeah. And no one's saying that those reports of people feeling suicidal aren't real. The ones that triggered this whole thing. Yeah.

So, like, what's going on there? It's possible these were coincidences. It's also possible it does happen as a result of these meds, but it's very, very rare. But overall, in January, the FDA said they concluded that there's no clear relationship between these medications and feeling suicidal based on current evidence. And here's how Nora put it. The evidence right now does not support that these medications will increase by themselves the risk of suicidal thinking or behaviors.

Mm-hmm. Okay. Well, this is great news for the many people on these drugs. Yeah. But the episode isn't over yet. No. So everything might not be quite this rosy from here on out. I'm going to tell you why after the break. Welcome back.

Today on the show, we are looking into fears around Ozempic. Rose, this choo-choo train, Ozempic train has hit which station? That's not even a pun. It's not even a pun. It's not really anything. We can go with it.

We go being where next? That's good. Thanks. That's good. Thank you. Where are we going? Where are we going next? To the guts.

Okay. Next stop, the guts. Choo-choo. So, last time, we heard that it was pretty common for people to get stomach aches. Sorry. All right. Choo-choo. Last time.

So, last time we heard it was pretty common for people to get stomach issues on these drugs. So like nausea, especially when they first started taking them. Yes, yes. I remember that person you interviewed who ate some fried chicken and then vomited it all up immediately after. Yes, that kind of thing. Very common.

Right. But she got over it and it wasn't too bad for her. So now what's in the news is people who are having something way more serious happen to them. Okay. And in fact, there are a bunch of lawsuits right now on behalf of people who say that these medications really messed up their stomach. Including claims from some people saying that their stomachs were paralyzed after taking these drugs. What does that mean exactly? That they weren't moving.

Your stomach has to move to get food crunched up and, like, on its way out the door. Uh-huh. But what these claims are is that the stomach has stopped moving or is moving so slowly that people have these, like, terrible symptoms. One woman says it was so bad, it sent her to the emergency room several times. She says she vomited so much that she lost teeth. Oh, God. Oh, God. All right. That's the claim. So

let's dig into this. I called up Michael Camilleri. He's a gastroenterologist and a researcher at the Mayo Clinic. So we actually have done some studies here and with one of these weight loss medications and we examined the patient's stomach emptying at baseline and after treatment. Michael is not grossed out about this stuff, but I am. And so for the life of me, I cannot figure out why I'm always sitting here

in this chair talking to you about disgusting semi-digested food stuff. How does this keep happening? Why do I do this to myself? There is nothing disgusting about a good shit. So what is going on here? So Michael and his team did this study to better understand what happens in the stomachs of people who are on these kinds of medications.

So they got 124 people into the lab. About half of them were on a drug like Ozempic. Actually, it was an earlier version, but it works in a similar way. For everybody, they cooked them up a very nice breakfast. At Mayo, we use real scrambled eggs. So we use two eggs, a glass of skim milk, a slice of brown bread.

But then Michael adds a special ingredient. And then the small amount of isotope, which is a very small amount of radioactivity. Excellent. And why is he spiking their breakfast with a small amount of isotope? Because adding an isotope lets Michael follow the food as it's moving through people's digestive tracts. Oh. Because if you point a special kind of camera called a nuclear camera at people and take pictures of them,

you can see the food glowing through the gut. Oh. So Michael's team took pictures of people with this glowing breakfast as it moved along and then timed how long it took food to get squeezed out of the stomach. And I've seen the pictures, and it's funny because you can't see the person. You can just see the chewed up food in their stomach, kind of glowing, and the picture's, it's white. It's a black and white picture.

And you could just see it going down, down the gut. At one hour, at two hours, at three hours, like less and less is in the stomach and it's like moving into the small intestine. Okay, so is that process of like moving food through the gut getting scrambled by these weight loss meds? Did you get that pun? The scramble?

Yes. Great. Got it? Registered? Excellent. There's no need to like laugh at all. It's like, it's just a thing. I know we're it? Registered? Excellent. There's no need to, like, laugh at all. It's like, it's just a thing. I know we're beyond that, you know. Okay, exactly.

We're much more sophisticated than laughing. A hundred percent. To show appreciation for a pun. So. Quiet appreciation. Mm-hmm. It's kind of where I'm at these days. It's beautiful.

So, when Michael carefully watched what happened to that radioactive meal, when the people on the medication were digesting it, here's what he saw. It was significantly slower. So it was a good almost an hour longer to get half the meal out of the stomach. And what Michael thinks might be happening here is that on the medication, the stomach isn't contracting the way it typically does. So instead of contracting, let's say, two or three times a minute after the meal, it might only contract once a minute or once every two minutes. So the whole stomach as like a muscular bag is not squeezing the way it's supposed to.

That's exactly right. Oh, interesting. And this happened to around 30% of the people in Michael's study who were on these drugs, meaning that their digestion slowed down and stayed slowed down. And for some people, not everyone, but for some people, this can be bad. It can lead to something called gastroparesis, which is another way of saying paralyzed stomach. So your stomach isn't moving properly. And the symptoms for that are people feel really bloated

or they're unable to eat or it might make you vomit. Right, the woman who vomited so much she lost teeth. Oh, God. Yeah, that's really terrible. You know, Wendy, we reached out to the drug companies to ask about this gut stuff and the lawsuits that are going on. So we talked to Eli Lilly, they make Zepbound and Novo Nordisk, they make Wigobi. And they both say that they're always monitoring, evaluating and reporting safety stuff. And Eli Lilly also told us that yes,

there can be bad GI reactions to these meds. But they said that health care providers know about those risks. And both companies told us that they're vigorously defending against the claims and the lawsuits. Okay. So then I guess my next question is, how common is it to get really, really nasty GI symptoms from these drugs? Like from Michael's study, it looks like a lot of people get the sort of slowing down of their stomach. But what about the stomach paralysis? Yeah, Michael said we don't have a fantastic study yet to ask that question.

But I looked around and I think we do have some clues. So, for example, there's one paper that looked at bad gut reactions from people taking semaglutide. And researchers of that study, they looked specifically for reports of gastroparesis. And they looked at more than 600 people who were taking semaglutide. Okay. And they found that only four of them got gastroparesis. Okay. So four out of 600-ish.

All right. So if you've got thousands of people on this drug, you're going to get some with this. It's going to pop up. It's going to pop up. Yeah. But it's not all that common as far as we can tell. And actually what Michael and other experts think is the more common problem from this whole stomach slowdown thing is actually about what can happen if you have to have surgery. So, you know, normally before you have surgery, you're asked to fast.

And the reason is that they don't want you to throw up when you're under anesthesia and choke. Well, researchers are finding more and more often that people on this class of medication still have food in their bellies, even after they fasted. Like they've actually poked cameras down into people's stomachs and like seen, whoops, there's food in there.

And sometimes, Wendy, they even find this thing called a bezoar. What's a bezoar? Yeah, that's what I asked Michael. First of all, bezoar, I mean, that sounds medieval. That's a real thing? A bezoar basically is a collection of non-digestible food that remains in the stomach. So Wendy, do you ever put veggies in a food processor or a blender? Have you ever made like a kale smoothie and there's like a chunk of the kale that just like won't break up? It's just like not getting caught up in the blades?

Obviously, I have never made a kale smoothie, but I do understand the concept. Yes, yes, yes. When there's still like a chunk of stuff in the food processor. That is what a bezoar is. It's a chunk of stuff. What does a bezoar look like? Have you ever seen one?

Yuck, yes. Did I finally find something that grosses you out? Nothing really grosses you out if you're a gastroenterologist. I want to say, I want to say it. Yes, I have a picture for you and I'm sending you the link now. Okay. I am opening the link. Ooh.

Ooh. Oh, wow. It's like a marble, small, brown piece of shit is what it looks like. Piece of crap. It's like a black, slimy stone. Yeah. Like I can imagine it in a tide pool. I don't really want to imagine it in my stomach. Wow, and it's just stuck there? Yeah. It has to get broken up.

And does it get broken up? Well, a doctor might have to do it. They might have to go in and, like, chunk it up and then pull it out. Or you know what, Wendy? Another way that they heal bezoars is with Coca-Cola. Oh, really? They have, like like a tube. They put like a tube of Coca-Cola and you get admitted to the hospital

and they run Cokes through your nasal passages like up into your stomach and up and around and around and around and it like breaks it up. Wow, because Coke is so acidic and gross that it can break up a bezoar. Wow. Wow. I don't know how they figured this out, but I know your next question. Yes, Diet Coke works too. Okay.

Okay. Whoa. So why do they have to like flush it through your nose over and over again? Like, can you just drink it? I mean, you can't. Okay, you can also just drink it. But my favorite way is the stomach pumping with a Coke. Yeah, great, great. I mean, that's way better, right? And so people on Ozempic and similar drugs are probably at a higher risk of getting bezoars than other people.

Yeah, I mean, you can get bezoars for other reasons. A lot of people get them from eating persimmons. Fun fact. But for people, you know, specifically getting them from being on these medications, we don't really know how common it is. But there is a paper where surgeons specifically looked in people's stomachs before they had a surgery for bezoars and found that of 23 people who took this kind of medication, four had a bezoar. Right. And that's higher than you'd expect from a general population? Well, when they looked in the stomachs of a bunch of people who weren't on these medications,

none of them had bezoars. Right. So it seems like there could be a higher risk here. Mm-hmm. So are we about to have like a bezoar epidemic? I don't know. We need to have, I hate to say this, we need more studies. Of course we do. But we really don't have more information on the Bezoar thing. This is kind of a new concern.

But I thought it was worth bringing up because we know that Bezoars can do things like they can obstruct your stomach, they can cause stomach bleeding, and they need to be removed with coke or surgery. So, you know, it could be a real issue if that happens to people. Okay, all right. So jokes aside, Bezawah headlines may await us. This could be serious. What are we to make of this? I don't know.

We'll see. I'm going to keep following it. Yeah, don't worry, everyone. I'm on the case. Good to hear. No, yeah, I think everyone. I'm on the case. Good. Good to hear. No, yeah. I think the jury's out on how serious this is. But one thing that has come up within the last year is that experts are now a little bit more aware of this stomach slowdown thing and how it could be a problem for surgery, like I mentioned.

And so now the official recommendation is that if you're on one of these medications and you have to have a surgery, you skip a dose before you go under the knife. That's one implication here. Another one is that like if you have a really bad gut reaction, gastroparesis, and maybe you get a bezoar, you might have to go off these medications. And so that means that there's a chunk of people out there that the supposed game-changing weight loss drug is not going to work for them. Mm-hmm. Interesting.

Interesting. Okay. And now, I guess we've spent a lot of the episode talking about the fears and side effects around Ozempic and drugs like it. But what about the good stuff? I mean, obviously, it is helping a lot of people who want to lose weight, lose weight.

But are we hearing about anything else? Yeah, I mean, the big one was a clinical trial of people who were on semaglutide for weight loss who had heart disease. And this paper made a big splash. And the reason is because it didn't just measure like, how much weight did you lose? Or how much, how did your cholesterol change, your blood pressure change.

This one actually measured how many heart attacks people had and how likely they were to die and it found that people on these medications had fewer heart attacks and were less likely to die. So, I mean, death, that's a pretty, lack of death is a pretty spectacular outcome, right? Yeah, yes, exactly.

And so like, all over social media, you just see a lot of scaremongering about these drugs. But you know, then there's studies like this. I mean, that's huge. Less heart attacks. Yeah. The whole thing is, it's all about the pluses and the minuses, right? Like all medications. And so Vipa, who's the doctor that we talked to earlier in the episode about muscle loss,

this is one thing that she and I talked about. And she said that at the end of the day, we know that for a lot of people and a lot of her patients specifically, the pluses here outweigh the minuses. My pet theory is that like the people are overstating some of these downsides because they're morally opposed to the medications because it looks like it's an easy way out. What do you think? Do you agree with that? I agree. I agree. You know, there are definitely, even in amongst my colleagues, you know, physician colleagues who it's a new concept. These are tools. They're no magic wand, but they're a beautiful tool and should be used appropriately.

Yeah, right. Because just to summarize what we've learned today, when you look at muscle loss, yes, it does happen on these drugs, but it's nothing special. It's just part of losing weight. The fears around having suicidal thoughts doesn't seem to be panning out. And then the stomach issues, I mean, we're going to have to wait and see what's going on with those bezoars. And yes, stomachs do seem to be slowing, but like really, really nasty symptoms, they seem to be quite rare. And so, like if we as a society could separate out our emotions about these drugs and the facts around them, it'd probably be a good thing. If we could separate, if we as a society could separate out our emotions from what facts are,

then you and I would be out of a job, Wendy. That's true. Well, lucky for us, then, I guess. Thank you, Rose. Thanks, Wendy. Hey, Rose, so we're going to try out a new segment on this show called How Did You Find the Bezoar? Bing.

Wow. Is that going to be a recurring segment? How did you find the bezoar? How did you find the bezoar? Who knows? Who could say at this point? In every episode? I just have to ask you, how did you find the bezoar?

I saw the paper where four out of 23 people, when they stuck an endoscope down their throat, they found bezoars. And was that paper, was like the headline of that paper, like bezoars, or was it hidden deep? Oh, it was in the headline. That was it. That was an easy click for me. And did you know what a bezoar was at that point? Okay, well, that delighted me because there's like a scene in Harry Potter where a bezoar is used as an antidote to a potion. It's like something about like a medieval remedy when there's a stone of a goat stomach or something. So I thought of it as like A, extremely old-fashioned, B, kind of magical, and C, something that happens to goats. So I had a lot to learn about bezoars.

And then that brought you to the Coca-Cola how? Some paper I was reading about bezoars, every paragraph was more absurd than the preceding paragraph. It was like bezoars, goats, poison, they're real, they can be cured with Coca-Cola. I was like, excuse me? And then the next paper was like, other researchers tried this with Diet Coke. And I was like, Diet Coke?

And it was just too good to leave behind. Well, that caps off our inaugural segment of How Did You Find a Bezoar? Can't wait to see what people talk about on the second segment. I think we've pretty much covered it. Yeah. And Rose, while you're here, how many citations are in this week's episode?

65. Yes. And if people want to find them, where should they go? They can check the link to the transcripts, which they'll find in our show notes. Excellent. And if people want to follow us on social media, we are on all the social medias. We're really giving it a go, aren't we? We're at science underscore BS on Instagram.

I'm on TikTok at Wendy Zuckerman. Come and say hello. We'd love to hear from you. Love to hear what you thought about this episode. And if you want to see a photo of a bezoar, we will put one or several on Instagram. And we've got some other fun stuff for Instagram too. Yeah.

All right. We'll see you there. Thanks, Rose. Thanks, Wendy. This episode was produced by Rose Rimler with help from me, Wendy Zuckerman, Meryl Horn, Michelle Dang and Joel Werner. We're edited by Blythe Terrell. Fact-checking by Erica Akiko Howard.

Recording assistance from Selena C. Reynolds. Mix and sound design by Bobby Lord and Peter Leonard. Music written by Bumi Hidaka, Emma Munger, Peter Leonard, So Wiley and Bobby Lord. Thanks to all of the researchers that we spoke to for this episode, including Dr. Kristen Beavers, Dr. Ellen Fallows, Dr. Joseph Henson, Dr. Demetrius Papamargaridis, Professor Roger McIntyre, Professor Russ Waitman,

Dr. Saib Khalsa, Dr. Travis Masterson and Dr. Etienne Wang. A special thanks to all of the listeners that we chatted to about how they're going on these weight loss meds. We really appreciate all the time that you took. And thanks to the Zuckerman family and Joseph Lavelle Wilson. Science Versus is a Spotify Studios original. Listen to us for free on Spotify or wherever you get your podcasts. Yes, Science Versus is a Spotify Studios original. Listen to us for free on Spotify or wherever you get your podcasts. Yes, Science Versus lives everywhere. But if you are listening on Spotify,

then follow us and tap the bell icon and then you'll get notifications every time a new episode pops up. I'm Wendy Zuckerman. Back to you next time.