GLP-1 Supplement Scams

Episode 30 of The Pound of Cure Weight Loss Podcast is titled, GLP-1 Supplement Scams.
 
 In our In the News segment, we cover an article in Today titled, Poppi Prebiotic Soda Brand Faces Class-Action Lawsuit Over Gut Health Claims. Poppi is a brand of soda marketed as a prebiotic and this lawsuit is questioning the validity of the claim. 
 
 In our Patient Story segment, we talk to Graham who had a highest weight of 311 pounds. He opted for the gastric bypass and we included GLP-1 medications along the way. He is now comfortable sitting at 168 pounds. Not only did he embrace the medical treatments we offered but he also embraced strength training as another tool to help maintain that weight loss. His story is very poignant for anyone interested in sustainable weight loss. 
 
 In our Nutrition segment, we dive into another product review. Biocare is a supplement being marketed to GLP-1 users offering to, “Scientifically Help Reduce Side Effects, Preserve Lean Muscle Mass & Provide Essential Nutrition.” Does it work? Tune in to find out!
 
 Anytime a new FAD diet emerges, the food, beverage, and service companies scramble to create products to fit the new trend. And, over the past year or so, we’ve seen this happen in the GLP-1 space. So, in our Economics of Obesity segment, we dive further into the growing market of GLP-1 supplements and services. 
 
 Finally, we answer 3 of our listeners questions including, our thoughts on Phentermine, when to start taking your vitamins post-op, and how to navigate the GLP-1 shortages. 

Transcript

Dr. Weiner: 0:17

They're marketing it like the more poppy you drink, the healthier you get, and that's not true. And it's not true for the overwhelming majority of foods and generally it's not going to be true for any food that's marketed, unless it's the Jolly Green Giant doing the marketing.

Zoe: 0:39

Okay, welcome back to the Pound of Cure Weight weight loss podcast. We have made it to episode 30. Today is GLP-1 supplement scams.

Dr. Weiner: 0:50

Yeah, I don't know. Zoe, did you know that there happens to be a lot of scams out there in the weight loss industry? Have you stumbled across any in your years of practice?

Zoe: 0:59

Not a one. I think this is our first one ever yeah, how about that? So you just recently got back from a trip. Tell us about your Guatemala trip.

Dr. Weiner: 1:08

Oh my God, what a trip. So I do this trip every year. My practice is here in Tucson, is about 95%, maybe 90%, bariatric surgery. That's certainly what I focus on and what we do the most of. But I also you know, I trained as a general surgeon, so hernias, gallbladders, that kind of stuff. I've done that for years and still every now and then do some of those, particularly on our bariatric surgery patients.

Dr. Weiner: 1:33

But one of my best friends from residency goes down and he's one of these plastic surgeons who like recreates people's jaws from your fibula, bones and your legs and he does just crazy things. He's an amazingly talented surgeon and so he for the last three years I've been going down with him to Guatemala and we spend a week and I do all the general surgery, he does the plastic surgery, and so I, just for a week I take out hernia, take out gallbladders after gallbladders after gallbladders, and hernias, hernia repairs and it's pretty, it's really rewarding. I get to spend a lot of time kind of speaking and working with the Guatemalan people and it's just a great trip. This year I took my daughter along. Now you've met my daughter. She's not medical at all, but you know we discussed it and we thought it was a great way for us to spend some time, because nobody is Surgery and operating is such a huge part of my life, but yet my family has no idea.

Zoe: 2:29

You can't really share it with people.

Dr. Weiner: 2:30

No, it's not like I can be like, hey, lauren, my wife, why don't you come in and watch me operate? That's not allowed. You don't bring other people into the operating room. It's kind of a sacred space. There's a lot of credentialing and process involved in that. So no one in my family, none of my children, none of my wife, knows at all what surgery is about.

Dr. Weiner: 2:48

And surgery generally is pretty straightforward and with bariatrics there's really not a lot of stress involved. But sometimes surgery can be stressful and there were actually some moments down in Guatemala because you know a lot of these people. They've been living with their gallbladder disease or their hernia for five, ten years, kind of looking for someone to get treatment. And the longer something like that is going on, the more difficult it is to repair. The bigger the hernia, the more inflammation around the gallbladder. So it got a little bit hairy. So my daughter got to kind of see some of the stress and she said to me boy, dad, you have a really stressful job. So anyway, it was great to spend time with my family, great to kind of get away, great to give back and I look forward to going next year.

Zoe: 3:33

Yeah that's really cool.

Dr. Weiner: 3:34

Yeah, a lot of fun. And I think anybody out there, if you're a medical person and really it's not doctors that are really in need, it's it's a nurse, anesthetist, it's techs, it's nurses, it's anybody with any healthcare background I would, I would strongly encourage you to go on a mission trip and and help in an underserved country. It's very rewarding, really, really great thing to spend your time doing.

Zoe: 3:58

Yeah, that's amazing. All right, well, switching gears to our in the news segment.

Dr. Weiner: 4:03

Yeah, why don't you take this one, zoe? I think this is much more up your alley.

Zoe: 4:06

Yeah, well, it's funny. So I sent this to you because we actually reviewed Poppy the prebiotic soda on the podcast per one of our listeners' questions, so that was fun. But they're being sued. So in an episode from today, poppy Prebiotic Soda brand faces class action lawsuit over gut health claims. So I mean I think we were pretty clear when we reviewed. I mean it's still soda, you're not going to get a bunch of, you know, magical healthy gut. But basically what's happening is that Poppy is being sued for their health claims but the claims come down to you would have to drink four of these sodas every day for at least 21 days in a row to see some little bit of benefit. And at that point all of that extra added sugar comes into play at least 21 days in a row to see some benefit, some little bit of benefit.

Graham: 5:01

Right.

Zoe: 5:02

And you know, at that point all of that extra added sugar comes into play. You know, ultimately it boils down to poppy. Yeah, it's better than Coca-Cola, Sure.

Dr. Weiner: 5:13

Totally.

Zoe: 5:14

We know that because there's less added sugar, Is it going to be a supplement or like a complete replacement for your healthy prebiotic foods from those whole fermented foods that we've talked about that can help with your gut? No, and I think that's pretty much. Hopefully that was well understood. But what I did find interesting was that actually on a TikTok said that they have taken away the slogan be gut happy, be gut healthy off of their website. So that's nowhere to be found anymore.

Dr. Weiner: 5:48

Yeah. So this is where the scams come in, and in my first book, a Pound of Cure, I outlined all the different foods and put them on a spectrum. There's kind of some foods where the more of them you eat, the healthier you get, and then other foods you should eat. The least amount possible Doesn't mean you have to eat none, as you talk about with your planned indulgences. And so what happens with this scam is that we take poppy and I think we very clearly placed it on the eat as little of this or drink as little of this as possible, but if you have to, it's not the worst decision. We put it on that right side, that kind of as little as possible side. They're marketing it. On the other side, they're marketing it like the more poppy you drink, the healthier you get.

Dr. Weiner: 6:38

And that's not true, and it's not true for the overwhelming majority of foods and generally it's not going to be true for any food that's marketed, unless it's the Jolly Green Giant doing the marketing, because it's really that left side of that spectrum where it's the foods that are that the more of them you eat, the better, the healthier you are. There's very few of them, right? It's vegetables, of course, fruit. I think I would put under that category. I think it's really hard to overeat fruit. Would you agree with that?

Zoe: 7:10

I like to say as long as you're eating more vegetables than fruit, have as much fruit as you want.

Dr. Weiner: 7:15

Beans, I think it's hard to overeat. Beans, nuts and seeds are debatable, and I think we're starting to get into that space. Colorful, starchy vegetables like sweet potatoes and beets. All of a sudden we're kind of getting into that. That's closer to that line where we shift from eat as much as you can to eat as little as you can, but they're trying to promote this as something that's super healthy and it's not true and it's not going to be true for any processed, marketed food.

Dr. Weiner: 7:40

All right, well, let's move on to our patient story. We've got Graham. Graham's an awesome patient. He's moved away, he's left Tucson, but he still stays in touch. I still see him on telemedicine and I think this is part of our practice's mantra, which is, if you're a patient of our practice, you're a patient for life, and so let's hear from Graham. He let's hear from Graham. He's got a fantastic story and has just made such incredible health gains in the last few years after surgery. So, graham, why don't you tell us a little bit about your weight loss story, where you started and what kind of brought you in to meet with us in the first place and what you tried before you met with us?

Sierra: 8:16

Sure.

Sierra: 8:18

So I struggled with weight for most of my life since adolescence and I had tried a bunch of different things.

Sierra: 8:28

When I was growing up I did the sort of food diary and a variety of different exercise approaches when I was away in school like college, I would say, I think things. You know, my eating habits were not terribly great, but also, you know, I kind of would on and off diet and when I graduated I started a regimen of low carb, lots of cardio, and I lost about 75 pounds over the course of a year. That was my first real serious experience with like significant progress, and then spent about eight years after that sort of slowly gaining it back. It wasn't until about two, a little over two years ago that my doctor really said to me I think you should seriously consider surgery. And I had encountered, met a lot of people actually in Tucson who had had very successful surgery, and so I came in and met with Dr Weiner and talked about the different options and ultimately decided that gastric bypass was the right choice for me, and that was the beginning of my journey.

Dr. Weiner: 10:44

What was your starting weight and what are you weighing now, if you don't mind sharing that with us?

Sierra: 10:49

For sure. I started, my highest weight was 310 or 311 pounds and after the yo-yoing that was really my highest ever weight and as of this morning I am 168 pounds. I got down at one point to about 160. And I tend to fluctuate between 165 and 173, sort of depending on a variety of things.

Zoe: 11:21

And how long ago was your surgery?

Sierra: 11:27

was September of 2022. I think that's right. 2021. Let me think, yeah, 2021, september 2021. And I had achieved my full weight loss sort of results by about a year after surgery.

Zoe: 11:53

So you've been hitting maintenance, you've been hanging out in maintenance for the past almost two years. Tell us a little bit more about what life has been like and maybe what your nutrition has been like different now that you are in maintenance 100%.

Sierra: 12:05

So for me, I followed very carefully the guidance that I got, both from Dr Weiner and also from you, zoe Zoe.

Sierra: 12:17

I took very seriously the need to move toward a protein focus and meet protein goals throughout the weight loss journey and then when I moved into maintenance I started to shift from that into much more of a produce focus and in parallel with that I also began doing some pretty significant physical training with the trainer. So twice a week I was going in for a combination of weightlifting and movement and balance training and because of all of that I was able to overcome one of the big challenges from the weight loss, which is I lost pretty significant muscle mass too, and so I've been able to really begin the journey of building that back. And now, from a nutrition perspective, I'm sort of at this interesting point where I'm still trying to maintain a certain level of significant protein in order to facilitate and sort of power the muscle gain and maintenance, but also really being very produce focused and not really meeting all the protein goals that I was during the intense weight loss, but still trying to supplement that during the intense weight loss, but still trying to supplement that.

Dr. Weiner: 13:32

Graham, what does exercise look like, and I think this is something I see a lot of confusion about. Oh, I'm in muscle building mode because I lifted a five-pound dumbbell 10 times a day. What does exercise right now look like for you? What does muscle building look like? Just give us a sample workout that you might do, and then the frequency and amount of time you spend lifting weights and doing other forms of exercise.

Sierra: 13:57

Yeah, so I'm doing the weightlifting and strength training. Twice a week I go for a one-hour session with my trainer and what's been really helpful about that is I did not know my way around the gym beforehand. I mean, I had gone in before and done cardio for sure and done like a machine here or there to think that I was following the instructions and doing it right. But just to get the form right and to understand better the combination of exercises to do. That's been huge and the trainer that I found they do sort of more holistic training which is based off of a model similar to physical therapy. So I'm doing a variety of things like a farmer's carry and you know a lot of sort of physical. I'm pushing a sled or pulling a sled or crawling backwards on the floor with chains, right. These are all like um, meant to not just develop the muscle but also your coordination and your balance and sort of a more holistic view. I do still do the typical, you know, exercises to build my chest, like pushups or, um, abdominal crunches, but I don't do them in a traditional sit-up fashion. I might do like a um, uh, sort of a, a standing uh position and a pull down with weights that would, uh, facilitate more of the ab building. Or I'll do oblique exercises with a medicine ball Um, you know again which is meant to sort of facilitate a growing of mobility as well.

Sierra: 15:29

So a typical workout for me will include a focus in a particular area, usually that my trainer kind of makes sure that I am rounding out. So I'll do chest, I'll do back, I'll do arms and sort of those areas of focus. But always there's a warm up which is about balance and mobility and sometimes a little bit of cardio, and usually there's some sort of a cool down at the end as well. I do a lot of rows and chest presses and sort of those more traditional things, and lately we've been adding in things like calf raises and other stuff to sort of fine tune or muscles that I haven't been working with as much. Other stuff to sort of fine tune or muscles that I haven't been working with as much.

Sierra: 16:18

I will say like for me my shoulders and back I've seen the definition in much more quickly than like my abs, where I still have some leftover skin that I may at some point decide I want to have surgery on or deal with in a different way. But my hope is that with a lot of the body recomposition that I'll need less of that over time as I continue to sort of maintain and grow the muscle. And then the rest of the week I try to get out and walk for 30 to 45 minutes at least five days a week and I do that in a variety of different ways. Sometimes my boyfriend and I just go for a walk in the neighborhood, or sometimes we'll build an activity around it a hike, a trip to the mall, but sort of like make sure that I get that 30 to 45 minutes of active walking in as well.

Zoe: 17:02

That's great, and I wanted to just say that I remember before you, when you were getting ready for surgery, we had a lot of discussions. When you were getting ready for surgery, we had a lot of discussions. You came with a lot of really great questions and you were just so dedicated from the beginning and clearly you've been so successful and you've really embodied this whole new lifestyle and implementing it into your daily routine. So I just want to say how proud you must be and how proud we are, because you really took our guidance and instruction and ran with it and made it work for your life and you've clearly just knocked it out of the park. So kudos to you.

Dr. Weiner: 17:44

I think I want to follow up with a question because because you, you know, like Zoe said, man, you did it exactly right. Like if there was some. If I'm like when I think of, like what patient just was so dialed in, did everything just exactly right? Like it's a short list, You're at the top of that short list. Where'd that drive come from? You know, you put a tremendous amount of energy and effort into this. Like, what allowed you to do this? Like if there's someone out there who's kind of considering the surgery and they're thinking like, all right, am I going to be able to put all this energy and put all this time and effort into this? What allowed you to do this? Where'd that come from?

Sierra: 18:26

that's a great question. I would say, um, like I'm a naturally a rule follower and you guys gave me a bunch of very clear rules from the outset of the process, things that were going to be prohibited after surgery, things that I needed to do in the lead-up to surgery in order to meet the various requirements and expectations. Um, all throughout recovery you know how I needed to walk as quickly as possible afterwards and I needed to do a water challenge before I could even leave the hospital, and for me those things were all really helpful and motivating and I always I was like driven and I am just like a driven person in general to sort of meet and exceed external expectations, driven person in general to sort of meet and exceed external expectations. So I think there was a certain psychological component of that in me, like the desire to make good on what I was being told. It was hard for me, for example, to imagine a world where I was going to live up to the expectation of a completely non-processed food diet in perpetuity, especially living in America. I remember talking to both of you about that separately, about like I don't know how I'm supposed to do that. I, you know, eat in restaurants, I eat out in the world. I can't always control what I'm. I don't cook that much Like. How do people do this? Um, and it was valuable for me to, you know, figure out how I could strike a compromise of what would be sustainable going forward, but also to make sure that I was leveraging the tools in the best way, and I think that would be the other biggest thing.

Sierra: 19:57

You told me very early on in the process that the surgery was a tool and that you were going to give me a set of other tools.

Sierra: 20:04

The GLP-1s were like a huge part of that as well.

Sierra: 20:11

Tools the GLP-1s were like a huge part of that as well, and it was really important to me to make sure that I utilize those tools to the best of their ability and then brought as much of myself and from myself to the table to like advance and support and sustain what those tools were able to help me do.

Sierra: 20:25

And the most significant outside advice that I got was from someone who had done the surgery 20 years before me who said you know, the one thing that you have to do is, as soon as you finish your principal weight loss, really do the strength training, really take seriously the muscle building, because that's what will help make things different forever, and the combination of those things and also the availability of GLP-1s, which really I think has been also like a turning point for me, just because it really silences the cravings in such a powerful way and it really helped me to take command and control of what I could and to not have the sort of undermining and chipping away that those things otherwise bring back into the equation so significantly.

Sierra: 21:14

That is what has made all the difference. So now that I have been able to bring myself to the place of having these better habits, of having the regular exercise and the strength training and finding all the other benefits, in that that come the adrenaline and all the positive hormones that that releases in your body, I think that has been the winning combination.

Dr. Weiner: 21:34

Yeah, it's really no surprise to see the success, because this is kind of the perfect example of how to do this right. You had surgery, gastric bypass surgery which is an incredibly effective, powerful surgery. We added in GLP-1 medications and then you dialed in the lifestyle like nobody else, and I think the amazing thing is that that combination it's kind of like what do you want to weigh? We'll get to anybody, to a normal weight with that combination, and I think that to me, is one of the most exciting things about bariatric surgery and just obesity treatment in general is that the tools are there. Now like we've got this, the science has been established and if you apply all these things together, we can get you to wherever you want to go, and I think this is, you know, a perfect example. Graham, is your Could?

Sierra: 22:27

I add just one other thought.

Sierra: 22:32

It really strikes me that you get a lot of feedback as a patient, a participant in this process, from the rest of the world that leads you to believe that the obesity that you've been suffering with is from a lack of willpower and a lack of determination and a lack of willingness to do what's hard and not having that sort of stamina.

Sierra: 22:56

And in reality, the truth is that the deck was really significantly stacked against me and these tools have been incredibly transformative because they've been able to lift the barriers that I constantly found myself up against and sort of like failing from.

Sierra: 23:12

But a big part of it, too, was that I had to recognize and acknowledge for myself that I would continue to get that feedback from the world. I would continue to see people who would look down on me for using GLP-1s or who would look down on me for thinking that I took the easy way out by getting surgery instead of doing the really hard thing. And the truth is that there's nothing easy about what I did or am doing or will continue to do through this process and anyone else who follows this path too. I just I hope that you give yourselves permission to let go of the judgments that other people bring to the table and recognize and acknowledge that the science says that this is not just about your willpower and stamina, but it's about many other factors, and take advantage of the tools that you can have at your disposal, but know that it's going to be a combination of those tools and your hard work and consistency that are going to make the difference.

Dr. Weiner: 24:05

I mean, mic drop, totally right there, right there. Yes, graham, I mean that was beautiful and and I think that you know I'm just to hear you say that makes me so proud to be a part of this journey for you, and I love that you've come there, that you're there right now. I mean because so many people spend their entire life suffering from obesity and never get to where you are right now and I'm just so happy to be a part of it and I'm so proud of everything you've accomplished, everything you've done. I mean you know just an amazing, amazing example of what the appropriate medical treatment can do and how much it can change someone's life. So congratulations, graham, you deserve every bit of it.

Zoe: 24:50

All right. Well, that was so great to hear from Graham and wish him all the best For sure.

Dr. Weiner: 24:56

All right, zoe. What do we have in our nutrition segment this week?

Zoe: 24:59

Well, we actually were sent this product, so I thought it would be kind of fun for us to do another product review on the podcast today.

Dr. Weiner: 25:08

Right, because the poppy went so well oh my gosh, that's so funny. We went back and listened to the poppy. We didn't say anything wrong on that. I don't think we misled anybody.

Zoe: 25:18

Yeah, we completely, you know.

Dr. Weiner: 25:20

Well, so what's this one?

Zoe: 25:21

So this is BioCare, a dietary beverage specifically marketed to people using GLP-1s. How?

Dr. Weiner: 25:28

about that.

Zoe: 25:29

So I think we're going to see a lot of this emerge in the food industry, and I mean supplements too, but making food products for specific trends. We see this all the time. Right, the keto pizza, the-.

Dr. Weiner: 25:44

Atkins. Paleo right yeah. Low fat, you know, before your time. The snack well cookies. The snack well cookies, right yeah. So this is something that's happened. You know over and over and over again, right? Is that the food industry just tags onto whatever the latest crazes in the diet industry and they start making food supplements that use this health halo? And people think, oh, this is great, I'm I'm using, I'm taking a GLP-1. So I should be drinking bio care.

Zoe: 26:13

Correct. So that they can make more money. Yes, all right. So let's take a look at the nutrition facts here. So they come in individual packets. Let's see here Little packets like this and we've got, for one packet, 150 calories. Okay, 20 grams of protein.

Dr. Weiner: 26:32

Reasonable.

Zoe: 26:33

Yep, 13 grams of carbohydrate, of which six grams of fiber, okay, and two grams of added sugar.

Dr. Weiner: 26:42

Okay, so the fiber counts in that, carbohydrate or not?

Zoe: 26:46

Yeah, so actually something I talk about. This is kind of a side note, but I get a lot of questions about net carbs.

Dr. Weiner: 26:52

Okay.

Zoe: 26:52

So net carbs is again a marketing ploy for specifically keto people and products. Right, so it's. Basically, if you're not sure what net carbs are, net carbs are the total carbohydrates minus the grams of fiber. Okay, that gives you net carbs.

Dr. Weiner: 27:09

Okay.

Zoe: 27:09

And the kind of marketing story behind it is that fiber isn't digested, so those carbs don't count. I say don't pay attention to net carbs, right? We want to optimize fiber, but specifically through whole food sources.

Dr. Weiner: 27:23

Right.

Zoe: 27:23

So this product has six grams of fiber, which is a decent amount of fiber. Yeah, this product has six grams of fiber, which is a decent amount of fiber.

Dr. Weiner: 27:28

Yeah.

Zoe: 27:30

However, it's not really doing what. From my perspective, the fiber in supplements? It's going to be a highly processed form of fiber, right? Why do we want to increase our fiber intake? To help us feel full, to add bulk to our stool, to help move things along, specifically for that satiety. Well, this is a powder with a highly processed fiber source. It's not doing those things.

Dr. Weiner: 27:57

Yeah.

Zoe: 27:58

So it's kind of like oh yeah, let's put some fiber in here.

Dr. Weiner: 28:00

It'll be interesting too to taste it, because you can generally tell how much fiber is in a drink when you drink it, like metamucil. When you drink metamucil, there's no doubt that there's fiber in it. When you drink it, right, you just taste that kind of pulpy thickness to it, and so I'm interested to see if this has any kind of any pulp or thickness, or my guess is, it's a highly soluble fiber, like you mentioned, and it's just, like you said, not going to make someone feel full. What about sugar? How is it on sugar?

Zoe: 28:30

Yeah, so there are a total of four grams of sugar, of which two grams of added sugar, which is more than most protein shakes that we recommend. It is noteworthy that there's quite a lot of micronutrients in here. They did put in some probiotics as well, so I think they're trying you know, really trying to market it towards being a more holistic supplement. For those folks on GLP-1s, there's three grams of fiber or, I'm sorry, three grams of fat, which isn't a ton, but we do know that we want to not have super high fat, so if someone's drinking these all day long, that actually could be enough fat for them to feel a little icky. I'm not sure, but should we give it a try?

Dr. Weiner: 29:13

Yeah, so they have actual sugar in it, right?

Zoe: 29:18

Let's see.

Dr. Weiner: 29:18

I think sugar's right here, yep so there's more sugar than stevia. And stevia Among fruit. So it's going to have that bitter aftertaste that I hate so much, and it's whey protein.

Zoe: 29:29

So if somebody has a milk allergy, then but not the isolate.

Dr. Weiner: 29:33

Oh, some isolate and some concentrate.

Zoe: 29:35

Right, okay, so a mixture.

Dr. Weiner: 29:36

We'll save that conversation for another nutrition segment in the future.

Zoe: 29:39

Let's give it a try.

Dr. Weiner: 29:41

Pour it out.

Zoe: 29:42

We, Dr Weiner, did the honors of preparing this according to the instructions. So, the proportions are correct, okay.

Dr. Weiner: 29:55

It does look thick. It does have a little thickness to it. It almost looks like you make it looks like there may be some fiber in it, Cheers.

Zoe: 30:06

It has that thick fibery. Yeah, you can actually see it For those watching on YouTube. You can kind of actually see the fiber.

Dr. Weiner: 30:13

The legs right, the legs of the protein shake sticking to the glass. I mean it doesn't taste. It tastes like a protein shake to me.

Zoe: 30:21

Yeah, from my perspective, I would rather see higher protein, lower on the calories and get my fiber from fruits and vegetables.

Dr. Weiner: 30:32

Yeah, Just like something we talked about with gram. There's kind of the weight loss and the weight maintenance phase, and unless you're really exercising aggressively in the weight maintenance phase, I'm not so sure you need to really be pushing the protein supplements. So I think, even if you are considering something like this and I'm not sure I would give this a strong recommendation for someone to use while taking GLP-1 medications. But if you did want to use it, I would use it more during the weight loss phase and less in the weight maintenance phase. I think the other thing is and we've seen this for years with bariatric surgery is that marketers want you to think, because you're a bariatric surgery patient, like everything is so different for you compared to everyone else, which is why you need their special bariatric product. But, as we've talked about, with the exception of iron, there really isn't much different about a bariatric surgery patient than there is a non-bariatric surgery patient in the weight maintenance phase, and so I think that we're going to find that that's true for the GLP-1s as well.

Zoe: 31:34

Yeah, do you feel like a weird kind of like mouthfeel.

Dr. Weiner: 31:37

It's the stevia, that bitter stevia taste. I don't know, I'm not a fan of stevia. All right, so just more along the same theme, in our economics of obesity segment, we're going to talk about this growing market for GLP-1 supplements, but really, more specifically, services. So we started prescribing these medications in our practice sometime in 2021. And as soon as I started seeing how patients were doing on GLP-1 meds, I knew that the diet industry, the weight loss industry, was about to pivot hard toward GLP-1 medications because they were safe and they were super effective, and so it should come as no surprise that all of these companies that had made a great living by selling these weight loss services they were going to be left out in the dark unless they got on board, like, for instance, weight Watchers. Weight Watchers has had a huge business over decades and is kind of one of the most well-known weight loss programs in the world. And then GLP-1 meds came along and all of a sudden, what's the point of Weight Watchers? Right?

Zoe: 32:45

Well, that's why Weight Watchers pivoted and started doing GLP-1s.

Dr. Weiner: 32:48

So Weight Watchers bought Sequence Health and now they're avidly prescribing GLP-1 meds. And Oprah, when she did her special on Ozempic her GLP-1 special she sold her stock in Weight Watchers so people didn't think that she was trying to push and promote the telemed services prescribing GLP-1s and we've talked a little bit about this in the past. Costco offers GLP-1 medications through Sesame and again, some of these telehealth companies and some of them do a nice job they really do. But I think a lot of these more commercial companies are just kind of jumping in, because this is where the business is going and trying to adapt their business rather than kind of being an organic company designed around the prescription of GLP-1 medications. The idea that your metabolic thermostat or your body weight set point is the predominant component that drives sustainable weight loss and targeting therapies designed at set point lowering. I think that to me is really what the ideal GLP-1 prescribing company really looks at, as opposed to hey, we know a little bit and we have a prescription pad and we've hired some nurse practitioners and put them through a weekend training course and we're going to prescribe the meds for you.

Dr. Weiner: 34:06

And so we've also seen a number of companies fail. So Herbalife stock has gone from 50 to 10. And Herbalife is one of these multi-level marketing things where it's like hey, zoe, you should sell some Herbalife, and when you sell something I get 10% of your sales, and so on down the pyramid. You could argue that it is a pyramid, but anyway. So Herbalife stock went from 50 to 10. And when multi-level marketing companies start to go down, they tend to go down pretty quickly. I'm going to predict that Herbalife isn't around in another year or two.

Zoe: 34:40

Yeah, I'm surprised. I feel like it's been hanging on by a thread.

Dr. Weiner: 34:43

Yeah, they still have a few diehards out there, and Jenny Craig just closed last year as well and so we've seen a complete and total paradigm shift and the idea that GLP-1s are a trend or a fad. We've seen that. When paleo came out and keto came out, I think all of us said, oh yeah, it's been Atkins before, like low carb, it's just another, it's all low carb, and this is going to come and go until the next fad comes along. I'm not sure GLP-1 meds are a fad because they work so much better than anything else. And there's science and physiology. It's like were antibiotics a fad? No, they weren't, and I don't know that GLP-1s are going to be a fad. I don't think we're going to see things pivot or change, and I think this is the new direction of weight loss services and so it's going to open up and there's going to be new companies coming in. Whether Weight Watchers is going to be able to successfully pivot and become this massive GLP-1 medication powerhouse or not, my prediction is they're probably not. They're going to be replaced by somebody else out there, and so I think we're going to start to see, over the next few years, a couple of companies really rise to the top and start prescribing these medications and really become the predominant way that people get access to these meds, and then we'll start to see generics come out and it's just going to be a wild ride these next few years when it comes to weight loss services. But I think they're all going to center around GLP-1 medications and bariatric surgery.

Dr. Weiner: 36:19

I think initially there was a lot of concern that bariatric surgery was going to disappear with the GLP-1 meds. I'm not so certain. I think, certainly for people with severe obesity, that's going to remain a mainstay of therapy and our practice. While we saw a little bit of a dip initially when we started, we're still doing more bariatric surgery than ever, and so I think that it's important also to recognize, like we talked about, the weight loss versus the weight maintenance phase and the different nutritional requirements in those two phases.

Dr. Weiner: 36:51

So I think the bottom line is, when it comes to GLP-1 medications, please don't confuse specifically designed with specifically marketed and the overwhelming majority of what you're going to see is specifically marketed and the overwhelming majority of what you're going to see is specifically marketed. I don't know if there's a specifically designed GLP-1 or bariatric surgery approach. The pound to cure diet, the metabolic reset diet, came from listening to bariatric surgery patients, and so it's kind of almost the observation of the physiologic changes we see with bariatric surgery, which are probably very similar to what we're seeing with GLP-1s, and so that's where our program comes from. Of course we're biased, we think our program is the best, but again, don't confuse specifically designed with specifically marketed.

Zoe: 37:39

It's another scam.

Dr. Weiner: 37:41

Another scam? Yeah, all right. So let's hear from Sierra, who can read some questions that have come in over social media. Again, if you're interested, we're on TikTok, instagram, youtube, facebook, even still, and so feel free to follow us on your favorite social media platform. Sierra, what's our first?

Graham: 38:01

question comes from Marla, from our YouTube, episode 26,. Ablation, conflation and Healthcare Inflation. Would like to know what you think about fentermine. Since my insurance doesn't pay for other medications, my bariatric doctor suggested this.

Dr. Weiner: 38:18

So fentermine is essentially speed. It's amphetamine and kind of a close cousin of methamphetamine, the obviously illegal drug. It's been around for a long time. There's tons and tons of weight loss centers that prescribe it. They'll often sell it to you. Phentermine is dirt cheap. It's like $10, $12 at the pharmacy for a month's supply. A lot of these weight loss companies would mark it up to $100. And it does work particularly well for the first month or two that you use it.

Dr. Weiner: 38:50

I've always looked at Phentermine as what I call like the wedding drug. Like if you want to lose 10 pounds for your wedding, phentermine's a great option. You've got this set date, you understand that the weight loss is going to be temporary and so you take the medication to lose the weight in preparation for this event, understanding that at some point shortly after that event you will regain the weight. You'll have to stop taking the medication. There's a lot of talk about holidays with Phentermine and how you can't take it for more than three months or six months sometimes, and people are constantly pushing the envelope and sometimes lowering the dose. But in general, fentramine, in my mind, is not a drug that drives sustainable, long-term weight loss. It's a drug that can help you lose weight over a short period of time. You've seen some people on fentramine over the years. What do you think, zoe?

Zoe: 39:45

Yeah, I mean it seems like people who are on fentramine. You've seen some people on Phentermine over the years. What do you think, zoe? Yeah, I mean, it seems like people who are on Phentermine to me seem like they're trying to get off of it, but they're just looking for that option. I was going to ask what is your experience? Is it pretty highly addictive?

Dr. Weiner: 40:00

You know I haven't seen a ton of addiction with it. The biggest issue is mood change. So I remember a patient and his wife were in the room. He was a bariatric surgeon. He was actually a sleeve patient and was starting to have some of the weight regain and this was probably seven or eight years ago, before GLP-1s were out or were really an option, and he was starting to gain the weight back and we were talking about medication options and I said you know, maybe we should try a little phentermine.

Dr. Weiner: 40:32

And his wife goes oh please, no, he's such a jerk when he's on phentermine and he was like the nicest guy ever, like such a nice guy. And they had a wonderful marriage, you could kind of tell, and I've actually stayed in touch with him over the years and talked to him very recently. Wonderful marriage, you could kind of tell, and I've actually stayed in touch with him over the years and talked to him very recently, still happily married, everything you know. But she really commented on how much it changed his personality. And so you know people have trouble sleeping, they're quick to anger.

Zoe: 40:59

Like that racing heart, feeling that anxiety.

Dr. Weiner: 41:02

Yeah, and so I think that it's not my favorite drug. I think, if you want to experiment with it, pretty much every weight loss patient has tried Phentermine at some point or another, so be careful as you get older also, you have to be careful with it because of the cardiac arrhythmias. But not my favorite drug by any means and I've never seen anyone have long-term weight loss with it.

Zoe: 41:27

They aren't able to lower their metabolic thermostat, it's just temporarily being their weight dropped down.

Dr. Weiner: 41:32

Stretching that rubber band. Yeah, yeah, you're just stretching the rubber band away from your set point. That's exactly right. Yeah, all right. What's the next question, sierra?

Graham: 41:40

Okay, this one is from YouTube on our post-op diet 2024 video from Danelle which week do you recommend starting bariatric?

Zoe: 41:50

vitamins? Oh, great question. I talk about this almost every day.

Dr. Weiner: 41:53

I would imagine.

Zoe: 41:55

So, first off, pre-op, we want you to start at the latest during your pre-op diet, so that one or two weeks before surgery, depending on when, you start your pre-op diet just to build up some reserves, like we do talk about in that YouTube video actually. But if we're thinking about specifically post-op, we have three priorities in those early stages right Fluid being number one, protein being number two and then vitamins being number three. So there's not a specific week or day that we recommend that you start your vitamins on, because it's so individualized. Everybody's on their own timeline, as I like to say. So with that, how do we know that it's time for you to start taking your vitamins? If you're getting in all of your fluids, if you're getting in all of your protein and you're able to do so, tolerating, just fine, try out your vitamins. If that significantly impacts your ability to then get all your fluid in and all of your protein, because you just feel full, perhaps from that vitamin being in your stomach, then we'll want to hold off a little bit.

Dr. Weiner: 42:54

Yeah, yeah, I think if you don't take your vitamins, you'll have a problem, maybe in three to six months. That's when we'll start to see some issues, and so that's a pretty big runway. Protein protein we can see issues in a month. Fluids we can see issues in a couple of days, and so it's important to keep those timelines in mind when you're adjusting your diet after surgery and make sure that your vitamins aren't compromising your fluid or protein intake, as you just mentioned. So, yeah, super common question. I think pretty much everybody who's post-op has asked that question at one time or another. All right, sierra, we got one more question.

Graham: 43:30

Okay, this is a long one. Buckle in this. One's from Elizabeth via email. I am six years post-Ru and Y gastric bypass and I have reactive hypoglycemia. I put on 40 pounds over about a year because I was chasing the highs and lows. I was prescribed GLP-1 med six months ago and I've had great results. I maintain my blood sugars and eat healthy carbs without crashing and lost what I had gained. My question is, knowing that this med helps me live a more normal life, how do I navigate the shortage? Is there another alternative to a weekly shot, and how do I get insurance to cover it? I rely on the med, not for weight loss but for blood sugar, and it's costing me $550 a month. I can't keep that up forever.

Dr. Weiner: 44:17

Any help is appreciated, all right, so let's kind of pass over the hypoglycemia, because we've covered it so often in the past. You have a Navigating GLP-1 Shortage Support Group, so what are you talking about in that support group? What do you cover? How do you address this issue?

Zoe: 44:29

So if we're thinking about a shortage being maybe temporary, right.

Zoe: 44:34

So we're just looking to bridge that gap. There are a couple of things that we can do, one being exploring those maybe less powerful weight loss meds like fentramine. That's something that I always have them defer, obviously, to their prescribing provider, but okay, we're trying to do these different medications, fine, not what I necessarily want to care about so much. It's about doubling down on your nutrition. What are those things that we can control to help you bridge that gap between dosing? And the other thing, too, is creative dosing strategies to talk about with you and our nurse practitioners on their appointments.

Dr. Weiner: 45:15

Yeah. So the metabolic reset diet is kind of our ideal way of eating and getting as close to that as you possibly can. So the first thing is is that for the overwhelming majority of patients probably 90, 95%, if not higher use of GLP-1 medications will be necessary in one form or another in order to maintain the weight loss. And so the question that everybody who's taking these medications has to ask themselves and I think there's kind of two questions here is the first is does she want to stop taking the medication because she doesn't want to be taking a medication for the rest of her life? And if that's the case, then I don't know if I have an answer for you, because I don't think that the science is supporting the idea that you can start these medications and then stop them and maintain the weight.

Zoe: 46:03

Right, it's like kind of weighing that pros and cons. Like your desire to not being on a medication long-term, does that outweigh your desire to maintain your weight?

Dr. Weiner: 46:12

Yeah, I mean it's a pro and a con. Nobody wants to be on a medication for the rest of their life. Nobody wants to be 50 pounds overweight either, and it's really a matter of deciding which of those two factors is more important to you. I think if it comes down to the cost, that's where we can be a little bit more helpful. And so you're paying 550 bucks a month I'm assuming that this person's using the coupon and paying for ZepBound, because that's what we see with ZepBound and the answer is we do offer some kind of creative dosing strategies.

Dr. Weiner: 46:43

I don't go into those in detail on the podcast for a number of reasons, but it really depends on what dose you're on. So if you're on the highest dose, there's probably not a ton that we can do to help you reduce the cost. But we see that each increment of the dose does not drive the same amount of weight loss Meaning. When we look at patients who do well, we see often at 2.5 or 5 milligrams if I'm using ZepBound, which is the lowest dose, we'll often see a really good response to just those low doses. And if you look at some of this a great graph of this that I've talked about in some past episodes. That talks about how most of the weight loss comes at the lower doses and as we increase the dose we get more weight loss. Don't get me wrong. But it becomes. Each increment drives a little bit less weight loss than the dose increase before.

Zoe: 47:37

And is that because their body has kind of gotten used to it?

Dr. Weiner: 47:40

It's hard to say why it is. It's just, you know, pharmacodynamics is complicated and we're overwhelming the GLP-1 receptors and as you add more and more and more, there's fewer and fewer available receptors. So we see that with pretty much all drugs is that at some point increasing the dose doesn't really have more of an effect because you've kind of maximized the body's effect. So if you're on a lower dose we can probably help you. We do have a platinum program. There is an additional cost, but we do see people from all over the country and we may be able to help you save some money if you're on a lower dose. If you're on a higher dose I don't know I think at that point I would probably see what I can do to work with Zoe increase the nutrition, drop the dose a little bit, see if you can come up with maybe not coming off of it but taking less of a dose, and then, once you're on a lower dose, then maybe we can come up with some ways to help you save some money.

Dr. Weiner: 48:38

We don't offer compounded medications in our practice. We don't prescribe them for reasons we talked about at length in the past. So we really only offer the real medication. But if you want to get creative, and it's a little tricky, but there are things that you can do. So the goal, really, if you want to save money, is get yourself on the lowest dose possible that works for you, and you're only going to accomplish that by really doubling down on the nutrition, working with Zoe on that, and then, once we have you on the lower dose, maybe we can save you some money.

Zoe: 49:04

But and then once we have you on the lower dose maybe we can save you some money.

Dr. Weiner: 49:06

But really good question and certainly something we see a ton of patients asking us about.

Zoe: 49:11

Well, I think that pretty much wraps us up for today. Great episode. I think we covered a lot.

Dr. Weiner: 49:17

A lot. Hopefully people won't be getting scammed by some of these GLP-1 supplements out there.

Zoe: 49:23

Know what to look out for. And if you are curious about a specific product or a specific, maybe perceived scam, send it our way and we will review it on the podcast.

Dr. Weiner: 49:32

Yeah, you can send us stuff through our website or also through any of our social media channels, so we hope to see you out there soon, and until next week.