Click, Click, Click. The Sound of Lower Cost Ozempic!
Mar 13, 2024Episode 16
Matthew Weiner, MD and Zoe Schroeder, RD
Embark on a journey with us as we explore a new weight loss medication by Viking Therapeutics. We delve into a comparison between it and established drugs like Ozempic, and peek into the pipeline of potential game-changers from Pfizer, AltImmune, and Amgen.
Stir up your culinary creativity with our Greek yogurt and apple protein bowl recipe, a delectable treat that hits the sweet spot without the sugar crash. We also tackle the cost-saving strategies for extending the life of your Ozempic pen. Listen closely for the inside scoop on economical health hacks without compromising safety, and round out the episode with 3 questions from our listeners. Join us on this balanced adventure through the realms of health, nutrition, and economic savvy.
Embark on a journey with us as we explore a new weight loss medication by Viking Therapeutics. We delve into a comparison between it and established drugs like Ozempic, and peek into the pipeline of potential game-changers from Pfizer, AltImmune, and Amgen.
Stir up your culinary creativity with our Greek yogurt and apple protein bowl recipe, a delectable treat that hits the sweet spot without the sugar crash. We also tackle the cost-saving strategies for extending the life of your Ozempic pen. Listen closely for the inside scoop on economical health hacks without compromising safety, and round out the episode with 3 questions from our listeners. Join us on this balanced adventure through the realms of health, nutrition, and economic savvy.
Zoe:
Welcome back to the Pound of Cure Weight Loss podcast. We are on episode 16. Click, click, click the sound of lower cost of Zephyr.
Dr. Weiner:
I came up with that title.
Zoe:
It's clever.
Dr. Weiner:
So I went to in Phoenix the Extra Innings concert. It was a music festival, probably the first music festival I've been to in over a decade and it was the big names. There was Cheryl Crowe, who I loved oh she's so good, she was so good. And then Noah Kahn, who apparently is a very big thing.
Zoe:
How was he live?
Dr. Weiner:
He was amazing. Actually, I honestly I enjoyed him the most. I thought he was fantastic. And then Dave Matthews band. They finished out with how fun. Yeah, it was really a great concert and we were there, like honestly, about eight hours. There was not a single healthy thing to eat there.
Zoe:
I was going to ask if you had your water.
Dr. Weiner:
They sold water. I didn't. You couldn't bring water because you couldn't bring anything in. So, yeah, they sold water, but yeah, a lot of unhealthy food. I had a little bit of a treat day, I'm not going to lie.
Zoe:
Well, I like that vocab choice.
Dr. Weiner:
I learned it from you.
Dr. Weiner:
All right, Zoe, let's get into the show.
Dr. Weiner:
Our first segment is in the news and it's from Reuters and the title of the article is Viking Therapeutics Weight Loss Drug Succeeds Midstage Study.
Dr. Weiner:
So with new drugs coming out, there's essentially kind of the first animal testing. Then you get into the midstage, which is really about figuring out the dose and the safety and just seeing if it works, and then finally you get into the stage three trials, which are what are required in order to get FDA approval. And that's with a lot more people in it where you kind of have your final hey, this is the drug we're going to release, this is the dose we're going to release it at, and you show the safety and you show the efficacy. So this drug is in the stage two, it's in the midstage trial, so they're not ready to start applying for FDA approval, but it is. The name of the drug is very creatively titled VK2735. I'm going to guess they're going to come out with some more names as well, but it works very similarly to herzepotide Monjaro Zepbound, in that it binds both the GLP1 receptor and also the GIP or gastric inhibitory polypeptide receptor.
Zoe:
So that's kind of comparing the OZMPIC. Why we see better results with the Zepbounds because it binds to more receptors.
Dr. Weiner:
Exactly, yeah. So OZMPIC, like you said, only the GLP1 receptor. This binds to two receptors and so we get a little bit better activity. So this showed 15% total body weight loss in a 13-week trial. That's a lot of weight loss in a relatively short period of time. And also what they showed was that they weren't starting to see weight plateaus at 13 weeks. So that means that you're probably going to lose more weight. So this drug looks like it has the potential to drive about as much weight loss as the terzepotide, Monjaro and Zepbound drug does.
Dr. Weiner:
We've got a bunch of other drugs coming out. Pfizer has a pill we talked about on one of the previous episodes. That's intriguing because it's a pill. Ultimune has a drug that's very similar to this, VK2735 or terzepotide that's coming out. Amgen has just a straight-up GLP1 agonist.
Dr. Weiner:
What's exciting about the Amgen drug is that they're showing longer weight loss maintenance, and so we've always kind of talked about how these drugs need to be taken long-term. Their initial studies are showing that hey, maybe they don't need to be. My suspicion is it has a longer half-life and they just haven't looked at it long enough. But that to me is going to be something really interesting, because there's kind of the weight loss phase, and then there's the weight maintenance phase. And what if you could take a drug once a month for weight maintenance? I think there'd be a lot of interest in that as well.
Dr. Weiner:
So there's stuff coming out, but it's going to be a slow roll and our health care policies are a little crooked right now, and so that's going to keep us. I think it's going to be a while before we have access to these medications at a lower cost, unfortunately. So certainly some good news, but I think the big story really has some change, which is these meds are extremely expensive, extremely hard to come by, and it can be a real significant cost for a lot of our patients. Anyway, all right, let's hear about your nutrition advice for this week.
Zoe:
Yes, well, I wanted to share this week about my go-to dessert lately, because if anybody has worked with me, come to my sessions. You know I've got a bit of a sweet tooth.
Dr. Weiner:
I do too, by the way.
Zoe:
So it's for me and what I like helping people is about. How can we find creative ways to maybe pick more nutritious choices but still satisfy that sweet tooth, because sometimes you just need something sweet after dinner. So what I've been doing lately is taking plain Greek yogurt, mixing it with some chocolate protein powder. Now, that's optional, you can do unsweetened cocoa powder if you would prefer. I like to boost up the protein a little bit. Some powdered peanut butter, so that's just dehydrated peanut butter. Make sure you pick the ones with no added sugar. Mix that all together. And then my fiance and I have been splitting a chopped apple, so we've done it with each having our whole apple. It's kind of too much. So dice up an apple into a little bite size, mix that in with the Greek yogurt and then you've got this kind of Reese's flavored yogurt bowl. But the key is that you get the protein, so it's really satisfying. But then you get the volume and the fiber from the apple, so it's really filling.
Dr. Weiner:
So I've been telling everybody about that so Greek yogurt, apple protein, chocolate protein powder and dehydrated peanuts or peanut butter powder.
Zoe:
Yeah, you could also use like regular peanut butter. Yeah, that's what I would use.
Dr. Weiner:
Regular peanut butter? What kind of apple?
Zoe:
Honeycrisp.
Dr. Weiner:
Honeycrisp when they're on sale. Yeah, they're so expensive, oh my god.
Zoe:
They were 99 cents at fries the other day and I was just like we're getting honeycrisp.
Dr. Weiner:
Get the cart, Matt. Have you tried the Cosmic Crisp?
Zoe:
No.
Dr. Weiner:
It's. I think they're better than honeycrisp.
Zoe:
No way, I swear to God, they're not quite as they're not you can find.
Dr. Weiner:
I find we get them at Trader Joe's a lot. I see them a lot. So it's a mixture of a red delicious apple and a honeycrisp, so it's not quite as sweet. Okay, they're huge.
Zoe:
Yeah.
Dr. Weiner:
And they got that same texture, that same crisp of a honeycrisp. That's delicious. I think we'll have to share that recipe somehow, yeah, so we'll see if we can get that out to you. So let's move into our economics of obesity segment.
Dr. Weiner:
I want to talk about something that is a pretty common practice in our practice and there's a lot of pros to it. There's a few cons I think you have to be aware of, and some people do this quite a bit and other practices don't really do it. But it really only applies to ozempic. So each of the different medications have a different delivery system. Most of the delivery systems are what are called single use, which means and this is WeGoV, this is Monjaro, this is Zep bound it's just a button you press and boom, it gives you the whole dose all at once, and then you throw away the pen when you're done.
Dr. Weiner:
Ozempic is a multi-use dispenser pen and it has a dial at the end and you click, click, click as you turn the dial. You click, click, click all the way to the end, and different size pens will have different settings and you're supposed to turn it until you get to the 0.25 milligram or the 0.5 milligram or the 1 milligram dose. Now, when we deal with the higher dose pens they're designed to give, let's say that the highest dose pen has eight milligrams of medication in it and each dose is two milligrams. So there's four doses in one pen. So the cost of the eight milligram pen is the same as the cost of the four milligram pen and is the same as the cost of the two milligram pen. We've talked about this before on the podcast, that some reason you can get four times as much medication for the same price.
Zoe:
Don't make no sense.
Dr. Weiner:
Yeah, it doesn't make any sense, but that's you know. Listen, this is how it works. So you can use GoodRx and get an ozempic pen, typically for somewhere between 900 to $1,000. Now the eight milligram pen is, as far as I know, only available in the United States. In Canada, I think, the highest dose pen you can get is four milligrams. It's about half the price but half the medication. So it kind of works out.
Dr. Weiner:
But it turns out that some hackers out there have figured out that it is 72 clicks all the way to the very end. So if you count clicks to 36, you'll get half of that two milligram dose or one milligram. If you count to 18, you'll get 0.5 milligrams and the pen will last longer. Now it turns out that they only give you four or five needles with each pen, and if you do it this way let's say you're dosing at 0.5, you're going to need 16 needles. You can buy these needles on Amazon for about 10, 15 bucks for 100. So the needles are very easy. It's something called a pen needle Standard, easy to find, very inexpensive.
Zoe:
Make sure they're sterile.
Dr. Weiner:
Yeah, they come sterile and they have like a little kit. This is yeah, don't chince on those, they're cheap, they're 15 bucks for 100. So. But they come kind of prepackaged and they're designed for insulin pens primarily and so you can purchase these pen needles and you can get essentially 16 weeks of the 0.5 milligram dose for the cost of one pen. All of a sudden, that $900 lasts you three, four months instead. Now the price goes up. Of course, the cost goes up.
Dr. Weiner:
The other thing is that the pens are supposed to be discarded after 56 days or eight weeks. If you use this and try to extend it to 16 weeks, technically you are taking a little bit of a risk of contaminating the specimen. So my official recommendation is discard the pens after 56 days, because that's what my lawyer says. I have to say the risks of not doing that are probably fairly small and I think, if you understand, you're taking some risks and it's going to save you four or 500 bucks. A lot of people might take some small risks. So counting clicks is a very reasonable way to get this and I think this is particularly useful for our weight regain patients, where we often see that our weight regain patients are able to lose weight a substantial amount of weight with relatively low doses of the meds, and so, especially if you're a bariatric surgery weight regain patient, you may find this as a very economical way to get access to the medication you don't otherwise have access to. All right, Sierra, what do we got?
Sierra:
Okay, first question is from our YouTube of Episode 14, dr Weiner, you really need to research oil more. It's not good for your heart. In fact, damage is the endothelium. Look up Dr Esselstein. Esselstein is the director of heart disease reversal program at the Cleveland Clinic.
Dr. Weiner:
So I am super aware of Dr Esselstein's research. Also, it syncs very much with Dean Ornish's research as well. In fact, in my first book, pound of Cure the final station I go through that book 12 changes you can make to improve your diet and the final one is to reduce oil, and I wrote them in order of what I think is importance. And so we get off of sugar and process carbs much earlier. We add vegetables first in that program and we reduce oil in the end. I think there's some debate about the weight-gaining effects of oil and also the heart disease. I'm going to defer to Zoe on the weight-gaining effects of consuming oil. I'm just going to address the heart disease. There's no question that following an extremely low-fat diet can help reverse heart disease, and Dean Ornish showed it probably the most convincingly, and this is really what I think this user is talking about with Dr Esselstein's research. But following a diet where you eat almost no oil and almost no animal fat is a really restrictive diet, and so my approach to this would be if this is something you're interested and want to pursue there's data there this would be a great way to help reverse heart disease and it is a solid nutritional program. The problem is in my practice. If that was what I pushed and promoted avoiding oil and all animal fat as much as possible I would probably have about a 1 or 2% compliance Zoe. You probably know as well as I do Most people are not going to be able to follow that program, and so when we look at programs, you really have to, as you talk so often about individualized treatment plans for people.
Dr. Weiner:
If this is something that works for you, go for it. If this is something that does not work for you, then maybe don't go for it and let's look at maybe adding a little more oil, because that can make the food a little bit more palatable, a little bit more enjoyable and make you more likely to stay on the program for a while. There also is, however, some conflicting evidence in support of the use of particularly olive oil in reducing heart disease and resulting in longevity, and it's from the Blue Zone study, greece. An area in Greece called Acarya consumes large amounts of olive oil. They follow a Mediterranean-style diet and yet they still remain active well into their 90s and generally live relatively heart disease-free. So I think I'm aware of this research and there's definitely some solid science behind it. I'm not sure that everybody needs to follow an extremely low-fat diet in order to reduce heart disease. So let's talk about weight gain and oil. What are your thoughts on that?
Zoe:
So we think about foods in terms of we're not counting calories, but I always like to say we want to have some sort of calorie awareness when we're thinking about these, which is why we want to be eating high-volume, high-fiber, low-calorie foods, such as non-starchy vegetables in unlimited quantities, but something such as olive oil, which is lower volume, higher calories it's called more calorie dense.
Zoe:
We need to be conscientious of the serving size because if you're willy nilly, pouring some olive oil on everything and having half a cup of olive oil with your salad, then that, without really feeling that level of fullness, is going to shoot up the your calorie intake and, like we said, we're not counting calories but having that calorie awareness. But the other thing I wanted to mention is having a very low fat diet impact your nutrients absorption, it impacts your hormonal production, it impacts your your brain health. So making sure that you have some healthy fats and the olive oil, the avocado, the disease, etc. Like the like in the Mediterranean diet and like in the metabolic reset diet and what we promote, I think is is important. But if we're looking towards specifically the weight loss aspect, then being conscientious of serving size can help. Yeah.
Dr. Weiner:
Yeah, all right, sierra. Next question.
Sierra:
Okay, this one is from Lily on Facebook. I was on Monjaro for 18 months and lost over 100 pounds, but now my insurance has denied it. I've been trying not to gain the weight back. I've increased my walking and exercise, but still have already gained about 10 pounds back. What do you recommend? I've thought about gastric bypass.
Dr. Weiner:
Yeah, so this is something we see. I see this over and over and over again, and so what I urge patients to do in this situation is to take stock and to understand, hey, what's my insurance coverage, what are my options, what do I have coverage for? And to explore everything out there. Do you want to have a gastric bypass procedure? I'm sure you don't, but, on the other hand, your experience with Monjaro has shown you that your obesity is a metabolic disease that is treatable. The medication that was initially working is no longer available to you, and so, if the bariatric surgery is available and you do have insurance coverage and that is a feasible option, find someone who does a lot of these, who has a very low complication rate and has a fantastic support program. You know anybody like that. But, yeah, find someone who does these procedures. Seek out that metabolic treatment if losing and maintaining that 100 pounds of weight is important to you, and so, yeah, I think a gastric bypass is probably a very good idea. All right, zoe. Last question Okay.
Sierra:
Last question I have a cold pressed juicer. As long as I use the vegetable based recipes and light on the fruits, is it okay to use it before and after a gastric sleeve? I also use some recipes from an anti-inflammatory cookbook and from a bariatric smoothies book. Thank you.
Zoe:
All right. So here's the thing Juicing is much different than eating or even blending, because the whole thing, the whole benefit, one of the main benefits of eating vegetables is the fiber. Right, you feel full. It takes up room in your stomach. Delayed gastric emptying yes, you get these micronutrients and these phytonutrients Amazing, yes, you do get that with new juicers, but you don't get any of the fiber. So there's a big difference between eating a pound of vegetables and juicing a pound of vegetables. You're not going to feel full, you're not going to get all of that great benefit. Now, you did mention making some recipes out of a bariatric smoothie book, which is great. If those are going into a blender, you're blending it up, you're keeping the fiber in there and then you're drinking it Beautiful. But if it's, you're juicing it and then you're tossing all that pulp.
Dr. Weiner:
That's the good stuff.
Zoe:
Yeah, yeah, all right. Another great episode in the books. We got a great patient story. A lot of good topics covered today. So if this was interesting to you, share it with somebody that you love and also leave us a question or a comment. We'd love to answer your question next time.
