Happiness in a Syringe?

In this episode of the Pound of Cure Weight Loss Podcast, we dive into the surprising mental health benefits of GLP-1 medications. We discuss recent studies that debunk the myth of increased risk of suicide and highlight the positive impact these medications have on reducing depression, curbing alcohol and binge eating disorders, and slowing the progression of Parkinson’s. 

We dive in to the exorbitant cost of GLP-1 medications and explore potential solutions for affordability. We compare the cost of compounded medications to the FDA approved meds to see whether or not the compounded medications are actually less expensive.

Another key topic covered in this episode is the importance of reframing self-talk to overcome barriers to healthy behaviors. Zoe shares strategies for shifting from justifications like "I don't have time" to a more empowering mindset, encouraging listeners to prioritize their health and wellness.
 
 Finally, we address practical concerns about fruit intake for diabetics, why GLP-1 medications are not suitable for losing the last 10 pounds unless there is a significant medical indication, and the ever-changing insurance coverage for GLP-1 medications.

Tune in to learn more about the transformative potential of GLP-1 medications, practical advice on managing costs, and strategies for reframing your mindset to support your weight loss journey.

Transcript

Dr. Weiner: 0:17

There were some initial thoughts with GLP-1s that there was an increased risk of suicide if you were taking Ozempic. That was a big thing that came out. That was kind of rumored and there was very, very flimsy evidence to support it. There was a ton of deep dives and really a lot of analysis into whether this is true. It turns out not only is it not true, but the opposite is true.

Zoe: 0:45

Well, hello and welcome back to our show, the Pound of Cure Weight Loss Podcast.

Dr. Weiner: 0:56

We are on episode 35, happiness in a syringe. What makes you happy, huh? I mean, for me it's family is kind of the first thing. Just I, I just love spending time with my family, just whatever I can just get them alone, no phones, no nothing. All four of us are kind of stuck together. Even if it sucks, that makes me happy. They're like thanks, dad, but you know, I, just being around with my family, where that's all we's all we're doing, is just spending time with each other, that kind of makes me really happy.

Dr. Weiner: 1:25

I just read an article. I thought that was really interesting. It was someone who was fairly successful in life and they kind of look back at some times in their life when they were the happiest and they comment on the fact that it wasn't now, when they were so successful, that they were actually the happiest. It was when they were younger and they I think this person went on a mission trip. They were Mormon and they went, you know, the two-year mission trip, and they were just dedicated to serving others, just completely and totally dedicated to the cause.

Dr. Weiner: 1:54

And I think something that I also makes me really happy is like if I'm in surgery and it's a really hard surgery really challenging. But I'm just super dialed in and focused and it's going well and I see, I see what's going to happen. I I know all the steps, I know what needs to be done, I know it's going to come out the way I want it to be. That just I love that. That just makes me so happy to know that, first of all, I'm you know I'm super focused, I'm putting a ton of energy in, but I know I'm going to solve this, just this problem for this person that has just been, you know, terrifying them and and causing them so much grief and misery, and I know it's going to come out Okay.

Debra: 2:35

And I love that.

Sierra: 2:36

I love that moment.

Dr. Weiner: 2:38

I love that moment. Anyway, what makes you happy?

Zoe: 2:40

Yeah Well, I mean, I think we all can kind of feel that sense of happiness and fulfillment in that, in that same thing, your, your, your family. I don't have a family of my own quite yet, but kind of do yeah, Got a husband Well yeah, um, but no, thinking about, you know, spending time with the people that you love, whether it's my husband, my parents, my sister, my best friends. It's like that sense of having people who you love and that you know you can just be. They have your back, exactly, yeah.

Dr. Weiner: 3:17

Now at your wedding, I really felt that you have a lot of those people actually. Very, very yeah, you have a lot of those people in your life and they just, they were all just so happy for you and they just all had your back. Just being with those people who you just, you don't have to question it. You know that they, they have nothing but your best interest. Just spending time with those people being, you know, around them, that that really that's happiness.

Debra: 3:38

Yeah.

Dr. Weiner: 3:39

You can't. Consumption's not going to get you there.

Zoe: 3:42

No.

Dr. Weiner: 3:43

Everybody tells us that.

Zoe: 3:44

And also the helping other people, the servitude to other people. You were explaining the like moment in surgery. That like brings you a lot of joy when people whether it's our patients or other people that you know just basically come to me and share how much I've changed their life. There's nothing that beats that feeling and knowing that, the passion and the love that I have for what we do, and seeing that translated into somebody's life being changed, I mean that is a true feeling of joy that I yeah, every week.

Dr. Weiner: 4:25

We have someone this week who that's exactly what she's going to say, exactly so, all right.

Zoe: 4:30

Well, enough about our happiness and we would actually love for you to comment what makes you happy. So, if you're watching on YouTube or wherever you're consuming this, if you can leave a comment and share with us what makes you happy, what brings you joy, we'd love to hear from you Love to hear that for sure.

Dr. Weiner: 4:45

All right, let's talk about your happiness, and specifically in the news article is from New Scientist and it's something that we've been hearing a ton about, and it's a surprising mental health and brain benefits of weight loss drugs and what this article talks about.

Dr. Weiner: 5:02

This is something we've been seeing a ton of, because we spend all day really speaking to a lot of patients either who've had bariatric surgery or who are on GLP-1 medications, and these medications definitely have some impact. There were some initial thoughts with GLP-1s that there was an increased risk of suicide if you were taking Ozempic. That was a big thing that came out, and so that was kind of rumored and there was very, very flimsy evidence to support it, and so there was a ton of deep dives and really a lot of analysis into whether this is true, and it turns out not only is it not true, but the opposite is true, and so there are GLP-1 receptors throughout your brain, and so this article points to a study that was done in the Boston area, and they took EPIC records. So EPIC is the electronic medical record that's used by most people.

Zoe: 5:57

We used to use it. We used to use it.

Dr. Weiner: 5:59

I use it in the hospital, our hospital uses it, so we still use it. We used to use it, I use it in the hospital, our hospital uses it, so we still use it. But there's a huge, just an enormous amount of data in Epic, and so they looked at diabetics who were taking semaglutide or Ozempic and they found that they were 37% less likely to be diagnosed with depression. So a lot of doctor's offices, when you have a visit, they'll send you a little questionnaire and it's like do you feel sad, do you feel hopeless, do you feel you know all these things? And my doctor, I get a survey like that probably every six months or so. And so they looked at these surveys and they looked at and they found that if you are taking semaglutide, you're less likely to answer that survey in a manner consistent with someone with depression, less likely to be diagnosed with depression and given a prescription for a new depression medication. So that's pretty fascinating. And so the question is why? Why is this true? You know, first of all this is again we've talked about this before this is correlation. It doesn't prove causation. But whenever you see correlation, you always want to ask yourself, you know, is there a reason a reasonable pathway where this could be true, and so we do know that glp-1 medications increase flow of blood to the brain. They also reduce oxidative stress. So there's a lot of talk now and some studies being done about Parkinson's disease and Alzheimer's, and there's one study that followed people with Parkinson's disease over a year and they found no progression in their symptoms. In the control group, their symptoms worsened. So we're seeing evidence that this can slow the progression of Parkinson's, which is essentially an inflammatory disease of the brain. And I think another thing to keep in mind about all these meds is that not all GLP-1 meds cause weight loss. So we are all focused on Ozempic, semaglutide and terzepatide, but the truth is there's probably another dozen or so of these meds and they don't cause weight loss, and so that's also something interesting to keep in mind is that some of these meds may be great for patients who we don't want to lose weight, but we do want some of these Parkinson's, alzheimer's, depression effects. So NovoNordis does have a trial coming out in 2025 looking at Alzheimer's, and the likely result is that these meds will reduce the progression of Alzheimer's disease. These meds will reduce the progression of Alzheimer's disease. In another study there's 80,000 medical records.

Dr. Weiner: 8:25

Semaglutide was associated with a 50% lower incidence of alcohol use disorder. So we've talked a lot about alcohol on the show. We talked about it last episode. We have absolutely seen this. Actually, just today I had a patient, really complicated patient. He came in with a bleeding ulcer from alcoholism after a gastric bypass. I saw him six months ago I think. I did a surgery six, no, actually probably a year ago. I did a surgery and so he had this bleeding ulcer and so we had two options we could either kind of revise and resect the ulcer and re revise the gastric bypass. What I talked to him about was reversing the gastric bypass, and so we reversed the gastric bypass and he's actually now alcohol free, and today we just got him started on WeGoV as an adjunct to help some of the weight gain that happened after reversal but also to help reduce his desire for alcohol use.

Dr. Weiner: 9:25

So we have seen that over and over again that these meds will reduce your drive for alcohol. They're also really interesting being shown to reduce binge eating disorder, and so there is a drug available for treatment of binge eating disorder. It's Vyvanse, same thing used for ADHD and in a study of comparing liraglutide, which is also known as succenda or Victoza, and it's the daily use. It's kind of one notch down from Ozempic in terms of efficacy. They saw 40% reduction for cravings for opioids at a residential drug treatment center. That's huge. So people in a drug treatment center trying to recover 40% reduction in cravings for drugs.

Dr. Weiner: 10:10

So we're seeing all of these things and I think another crazy, interesting and really really important component of this is that up until now, pretty much all of the medications that we have to treat bipolar disorder, depression, carry some risk of weight gain. Not all of them, but we've talked a lot about weight gaining medications and psych medications are at the top of the list. Medications like Seroquel, abilify, geodon all of these medications can cause weight gain, and so now we may have some options for treating depression that not only don't cause weight gain but they cause weight loss. And so these are really really interesting findings. And to me I think number one there's a physiologic mechanism. So I think that's that's important.

Dr. Weiner: 11:02

You want to make sure that whatever you're seeing, that it makes sense medically. And number two, it also is what I'm seeing in the office and that's something I've kind of learned over the years is like the research should also. You should be observing some of that in your office. Like you're smart enough. We see enough patients. We can pick up on what's happening. We listen to our patients and so we're seeing this in the office. We're seeing people talk to us about less drive for alcohol. We're using it truthfully for patients who are over-consuming alcohol. So fantastic, fantastic study, really interesting. It just shows you that these medications are going to transform healthcare.

Zoe: 11:46

Absolutely, and it'll be really interesting to see over the next several years what availability access, availability coverage, might look like for some of these other diseases that you know, whether it's used for weight loss in addition to or not just kind of what that looks like over the next decade.

Dr. Weiner: 12:03

I mean it's, it's going to be interesting, it's we're in for a wild ride, huh yeah. So our patient story today is is um, debra, and and she's actually a first nutrition only patient, and and our philosophy in our office is that we're really looking to drive positive metabolic changes. Um, we're looking to drive these through bariatric surgery, we're looking to drive these through GLP-1 medications and we're looking to drive these through lifestyle, through exercise and also through nutrition, and I think we're going to hear from Debra some of the positive effects that nutrition has had on her. So, welcome Debra.

Zoe: 12:39

All right. Well, I'm super excited to welcome you to the show. Thanks for making it in.

Debra: 12:45

Thanks for inviting me.

Zoe: 12:46

Yeah, of course, we've spent a lot of time together on Zoom, but this is our first time seeing each other in person.

Debra: 12:52

That's right, that's right.

Zoe: 12:54

We'd love to have you just kind of tell us your story, what brought you to the practice and kind of what brought you to where you're at right now.

Debra: 13:03

Okay, well, a friend of mine is a patient of Dr Weiner and spoke very highly of you and the practice and you as well.

Zoe: 13:14

She's been on the podcast.

Debra: 13:16

I just saw that. I just saw that. I can't wait to watch the whole thing. Yeah, so I've been pretty much a lifelong dieter and most of the time discouraged with my progress. And when Bev told me about the Pound of Cure book I thought, okay, I'll check it out. So I read the whole thing and I thought it was a lot of really good information that really made sense to me. But when I looked over the metabolic reset diet I thought, wow, you know, it's pretty restrictive. I don't know if I can do this or if I can do it for that long, because with other diets I'd maybe do it for a week or two and then just blow it off, get discouraged. So in February I started the Pound of Cure diet and I really like it.

Debra: 14:29

I realized how few vegetables I was eating. I always think of myself as a healthy eater, but I realized I was eating a lot of stuff that was addictive and a lot of processed food. I mean, I wasn't the worst eater, but I realized that there's a lot of stuff I needed to cut out and it's not been that hard to cut those things out. I was really hooked on Diet Coke. I was really hooked on Diet Coke, and the book is really good. It gives you good ideas of why you don't want to eat or drink these things, Because I always thought, well, there's no calories, what's the big deal? And I can tell. Now, once in a while, I may have one and it's like I instantly want to have another one. Yeah, and so I'm really glad that you know I'm not hooked on that anymore so you think you've been able to break some of these addictions to food.

Dr. Weiner: 15:39

Yes, talk to us a little bit more about that. Like what were you addicted to? What was easy to break, what? What do you still struggle us a little bit more about that. Like, what were you addicted to? What was easy to break, what do you still struggle with a little bit?

Debra: 15:47

Well, sugar is my biggest addiction Me too. It's a tough. It's a really tough one. I've tried a lot of things, and I was using artificial sweeteners a little bit, and now I really do not like the taste. And I was using artificial sweeteners a little bit, and now I really do not like the taste. Once in a while I'll end up eating something and it's like, oh no, it tastes really bad, so I don't want to eat that. I've been really happy with the unlimited fruit aspect, especially peach and nectarine season.

Dr. Weiner: 16:29

Yes, I love peaches and nectarines and cherries and cherries.

Debra: 16:32

Cherries are great, yeah, but they're so high in sugar. Yeah, I know they're so fattening. Yes, you're learning, yeah, but it helps me not to be craving the full-on processed sugar and ice cream and those kinds of things. That being said, I do treat myself special occasions because I've learned that it's okay, you don't have to do this 100%. That's one thing that got me so discouraged on other diets and programs I've tried is there's there just seemed to be a lot of a sense of failure and just feeling like I can't do it, I'm never going to get it. What's wrong with me? You know? Why am I so addicted to food? Well, now I've learned that a lot of the addiction is in the processing and the salt and the sugar.

Dr. Weiner: 17:41

So give us some examples of what you're eating. I think a lot of people on the metabolic reset diet they kind of get into it and they get into this rut where they're just eating the same thing over and over and over again. What are some dishes that you found that are easy to make and really convenient and that you really enjoy?

Debra: 18:50

Well, for breakfast, most of the time I eat two eggs and six to eight ounces of veggies. Yeah, either cooked in with the eggs or steamed and then eaten separately. Yeah, because I just have to get that bolus of vegetables going early to make the 16 ounces.

Dr. Weiner: 19:17

Have you tried kale and eggs?

Debra: 19:20

No.

Dr. Weiner: 19:21

Kale and eggs is delicious.

Zoe: 19:22

I haven't had that.

Dr. Weiner: 19:23

Yeah.

Debra: 19:25

Does when you cook it with the eggs?

Dr. Weiner: 19:26

does it kind of break down the no, I do like over easy eggs and then I'll kind of like steam the kale on the side, Maybe like the tiny use a little bit of the butter that I use for the egg to kind of also saute the kale. Kale and eggs is delicious.

Debra: 19:44

Well, I do fresh spinach.

Dr. Weiner: 19:46

Yeah, same idea. Some tomatoes and some peppers, that's a great breakfast. I mean, what a great breakfast, what a good way to start your day. Get a little bit of protein right, zoe I have veggie and eggs almost every morning.

Zoe: 19:59

Same. Thing.

Debra: 20:00

And it holds me for hours.

Dr. Weiner: 20:04

Yeah, because you get the protein. What's your magic formula? Protein plus fiber. Amen, yes.

Debra: 20:09

Yes, for sure, and I usually have a piece of fruit after each meal. So a lot of times at lunch I'm really not that hungry and so I'll have like an apple and two tablespoons of peanut butter. And Zoe suggested, you know, maybe adding some boiled eggs to that to get a little protein in there. But then at dinner I've been doing different recipes from the book, the Bariatric Surgery book. I got that too, and some recipes I've gotten from you, and I went to a class at one of the local hospitals and they had speakers on plant-based diet. Oh yeah, and it was really good. A lot of information and a lot of recipes. So I've made a few of those. But, um, fortunately I love beans, um, so it's easy, for I can just open a can and just eat them as is.

Debra: 21:22

They don't have to be yeah doctored up at all um, but I like making um soups really. I've always loved soups, and so chili and just lots of vegetables and sweet potatoes and maybe some quinoa, some peppers.

Dr. Weiner: 21:44

That's a great thing about soup is you can just put whatever you want in it.

Zoe: 21:47

I had some leftover soup that I made like in November that I had in the freezer.

Debra: 21:51

And.

Zoe: 21:51

I was like well, this is what I'm having for lunch today.

Dr. Weiner: 21:54

There you go.

Zoe: 21:55

It tasted old. Well, I just I'm really glad that you were able to come and share your experience and I just think that, like I said, you've really been able to modify this for your life in a sustainable way and you've seen all of these really great positive benefits, and I think that's really wonderful.

Dr. Weiner: 22:15

All right. Well, thank you so much for coming, debra. This was awesome. I'm so proud of everything you've accomplished. I think you know everybody kind of assumes, as you get older, that you're supposed to get less and less healthy, and I think you're showing that that doesn't have to be the case, that you can turn your health around. You can feel younger at an older age, so congrats on that.

Debra: 22:36

Well, I am really motivated to stay healthy because there's a lot of things I still want to do and I have four pretty young grandkids oh fun and it takes a lot of energy to keep up with them. Yeah, yeah.

Zoe: 22:57

That's a strong why?

Dr. Weiner: 22:58

Yes, there you go. Yeah, all right.

Zoe: 23:01

Well, thanks, I'll see you on Zoom, okay.

Debra: 23:04

Thank you so much. Thanks for being here, for everything.

Zoe: 23:07

That was great, loved it. I really love spending my time with Debra because she's been so participatory in the nutrition program and I just love how she's been able to change her, her whole style of eating and see so many great benefits metabolically and mentally too, you know.

Sierra: 23:24

Yeah.

Zoe: 23:25

So, moving on to our nutrition segment, today, it has to do with a reframe. Today it has to do with a reframe. So a lot of what I do is obviously nutrition and exercise, but also a piece of the puzzle that I find really powerful and important is working towards healing the relationship with food and our mindset and our self-talk and all of these kind of more self-talk and all of these kind of more complicated and ingrained thoughts that we have about food and how we talk to ourselves. So many times I offer reframes to patients, and so one that I have been helping a lot of people through lately that I wanted to share on the show today is think about a barrier to maybe exercising or a barrier to meal prepping. Right.

Zoe: 24:18

A lot of times it's I don't have time, right, I'm too busy. I would like to go for a walk, but I'm too busy. I'd like to go to the grocery store, I want to go to the gym, but I don't have time, or whatever it is right. So I encourage you to reframe that, swap out that phrase of I don't have time, or whatever it is right. So I encourage you to reframe that, swap out that phrase of I don't have time or whatever. That piece is right and replace it with it is not my priority. So I wanna go to the gym but it's not my priority.

Sierra: 24:48

Whew, yeah, all of a sudden that's different. Right it hits different.

Zoe: 24:55

So I've had a couple of people come back and tell me like I actually used that the other day and I was like no, actually it is my priority and so I'm going to go do it. So just kind of think about that next time you're kind of running through these excuses in your mind or you feel like you don't have time and if it truly is not your priority, then fine, then you're not going to do it. But if you want to make it your priority, you need to change the language and your thought patterns around it.

Dr. Weiner: 25:23

Yeah, I think that's also really important. And, again, not to kind of stereotype the relationships and families. But for moms, right, because moms essentially look at it like, okay, my priority is everybody else's priority. Well, that's my number one, two, three, four priorities, right. And moms are kind of constantly putting everybody before themselves and their needs before their own, and I think it's so important that moms also you got to put your own oxygen mask on first and so looking at it as a priority, not like this impossible thing, which I think is a great idea. I love how you've done that. It really works well in that scenario.

Zoe: 26:03

Absolutely. I always like to say you can't pour from an empty cup. You, if you're a mom, you want to show up for your kids, your family, you're, you want to be the best version of you that you can be. But you cannot do that if you're not first taking care of yourself.

Dr. Weiner: 26:17

Yeah, and I think a lot of people think well, I want my child to exercise and to love physical fitness and so I'm going to take them to soccer practice and take them to gymnastics and do all this stuff. That's probably a lot less likely to make your child be physically fit and active than just you exercising and showing. You know, kids don't listen to a word you say, but they watch everything you do. And so if you want your child to be physically fit and physically active, I think that's a great thing is, if I want my child to eat well, I should eat well. If I want my child to be physically fit, I should be physically fit. And so making those things your priority is actually helping your children.

Zoe: 26:57

Absolutely. I love that perspective.

Dr. Weiner: 26:59

Yeah, all right. So our economics of obesity segment is something we talk about a lot, and it's compounded medications. So I did a little bit of research on what's available in terms of compounded medications, and so I looked at two companies. The first is Henry Meds and the second is Rho, and these are both pretty popular options and they're all over Google and social media and everything, and some of them. They have decent programs and my guess is, because they're spending so much money on advertising, they're probably heavily funded by somebody. I don't know if they're profitable or not, but there's money there, that's for sure. Whether they're making it or just being given it, I don't know, but there is money. So first let's look at Henry Meds.

Dr. Weiner: 27:48

So the first thing about Henrymeds is that they dose semaglutide by unit. The traditional way that semaglutide is dosed is by milligram. When you buy Ozempic or Wegovi, it's 0.25 milligrams, 0.5, 1 milligram. I'm immediately suspicious when something is dosed by unit. A unit is more of like an enzymatic measurement, so they would talk like the amount of enzyme to create this many chemical reactions. That's kind of how units are typically used in medicine. Like insulin is dosed as units, and the reason for that is because it's a preparation, and preparations are, to some degree, have some impurity, and so you measure the activity and that's how you dose it, and so that ensures that if the insulin is made one way versus the other, if it comes from a pig versus a cow source, or wherever they're getting the insulin, that you can compare them as apples to apples.

Zoe: 28:55

Because you might have a different number of milligrams in each unit based on the source.

Dr. Weiner: 28:59

Exactly so. There's no reason to use units for semaglutide. All of the research, everything's been done on milligrams. If it's a pure compound and you're doing it on on that, then it should be dosed on milligrams. So immediately I don't like it. It's like what's going on here. There's only one reason to put units up, and it's to somehow hide something. And so that to me, just that alone. I've looked at that and that is very worrisome. Now they say and I looked through their website to try to find some like how many units is a milligram? It's like buried somewhere, it's not that easy to find. But they say five units is a milligram. It's like buried somewhere, it's not that easy to find. But they say five units is 0.25, 10 units is 0.5, and 20 units is one milligram. And they mix it with cyanocobalamin. Do you know what cyanocobalamin is called?

Zoe: 29:52

B12?.

Dr. Weiner: 29:53

Yes, b12. I figured you'd know that one. So they just they mix it with. They call it cyanocobalamin, right, but it's vitamin B12, like you can get at the drugstore for pennies, right. And so they have to do that because that's how they get around the patent regulations. And again, we've talked about compounding a lot, and I'm not violently opposed to it. I understand the role for it. I understand why it's out there. I'm not saying it has to go away. It just makes me a little nervous for my patients. It's not something I've chosen to prescribe. So it costs $197 for the first month and then $297. If you go over 20 units it's $397. So let's call it $300 a month for either 0.5 or 1 milligram. If we look at row meds, they do dose it by milligrams. So I think that gives them a heads up. It's pricey. It's $145 a month. That does not include the meds.

Zoe: 30:52

So what does that include?

Dr. Weiner: 30:53

That's just the visits and the nutrition and whatever they offer. That makes our nutrition program look super cheap. Yeah, yeah, um. And then it's 299 a month for the compounded semaglutide and they, they, um, only go up to um, one milligram, I believe, uh. And so you're spending at this point you're spending five, uh, 300, 445 dollars for the compounded per month to participate in Rho. That's a lot of money. Let's say we just go and we've talked about counting clicks in the past If we go on GoodRx and we buy an eight milligram pen, that's the highest dose, and again you got to find a doctor who's willing to prescribe you this and allow you to participate in the counting clicks thing. But it's $975 for 8 milligrams and if we do the math on that, if we're at 0.25 milligrams, which is the starting dose, the five units in the Henry meds, it's only $125 a month.

Zoe: 31:52

But most people don't see results on 0.25.

Dr. Weiner: 31:54

They do not, you're right. So if we go up to 0.5. It's 16 doses, almost four months. It's 250 bucks a month. So you can get real Ozempic. If you're on 0.5 of Romeds, you can get real Ozempic for cheaper.

Zoe: 32:10

If you can get it filled on Amazon.

Dr. Weiner: 32:12

Well, no, on GoodRx, the Ozempic pen is available.

Dr. Weiner: 32:15

Oh it is. Yeah, the Ozempic 8 milligram pen is widely available. We're not seeing any shortages there. If we go to the 1 milligram, then it goes up to 500 bucks a month, and so their 300 bucks a month is a little cheaper. But the thing I'd say is, if you're on Romeds and you're on the 0.25 or the 0.5, you're better off getting the actual Ozempic FDA approved and using a counting click approach to it. If we look at terzepatide, we can go all the way up to 15 milligrams of terzepatide using the coupon for 550 bucks a month On row. It's 450 bucks a month and that's at the lowest doses. And so you know, I think that when I look at these I don't see that they're that much less expensive, and so you're taking this risk of this compounded drug. But you're really not saving a huge amount of money. You know you're probably most likely to.

Dr. Weiner: 33:11

The way it works is a lot of people start these meds and don't finish them, and so they're probably getting people on these higher price programs at low doses.

Dr. Weiner: 33:20

They'd be better off just working through their primary care doctor doing an Ozempic pen counting some clicks, and would probably be a lot cheaper. That way They'd use your insurance for the visits and $125 a month for the starter, $250 for the 0.5. So you could definitely get going up and running with your PCP I think for much less money than these programs. And so I think when you're looking at the compounded stuff, really do your homework and compare it, because if you can get FDA approved meds same price, that to me is a no brainer. There's no reason to use a compounded med instead of the FDA approved stuff. You're taking risk unnecessarily. You're getting it in units, which means you may not even be getting what you think you're getting. So I'm looking at these two programs. It's not something that I would recommend out there for anybody. There may be other places that do compounding for less expensively than this, but I think I'd be cautious looking at these programs.

Zoe: 34:18

Do you help people count? Clicks.

Dr. Weiner: 34:20

We do. Yeah, no, I have no problem helping people count clicks. The big problem with that is that there's a couple of issues. The first is the manufacturer, I believe, recommends disposing of the pen after either two or three months once you open it, and so you have to be careful with that. There's a tiny bit of risk with that, but I think if a patient decides to accept that risk, I wouldn't you know, wouldn't refuse to work with them. I just counsel them.

Dr. Weiner: 34:48

I do bariatric surgery. There's risk. I mean, you know everybody's taking risks. There's no way around this. There's risk of not doing anything. So I look at that as a very small risk for patients. The big issue is that they give you five pen needles and if you count clicks you might need 10, 12, 16 pen needles. You could buy a hundred pen needles for eight bucks on Amazon. Most states you don't need a prescription. So, yeah, we work with counting clicks with patients and you know I don't have a problem. There's even we can even get things less expensive through our quote unquote creative dosing strategies.

Zoe: 35:20

Yeah, so so it sounds to me like if somebody's considering, or even on the Henry or Rowe compounded meds they're already paying. All of this Sounds like they could potentially be a good candidate for the pound of cure platinum program.

Dr. Weiner: 35:34

It's possible that it might actually be cheaper to work through us on that? Yeah, certainly possible.

Zoe: 35:39

Something to consider, yeah.

Dr. Weiner: 35:40

All right, sierra. What questions do we have this week?

Sierra: 35:44

Okay, first question is from one of our Instagram reels, from Charles. His GLP-1 has definitely gotten him back on track. He says it's quite frustrating, though, that next year Blue Cross and Blue Shield will not be covering it. What's your take on this, and do you think there will be any changes?

Dr. Weiner: 36:02

Well, there's always going to be changes, right? I mean, I think we absolutely know that whatever things are now, they're going to change. We've been prescribing GLP-1 medications pretty regularly for over two years now and, I swear, every quarter we have to change something. So this is always changing. So I'm not sure exactly what you're referring to, because I don't believe that Blue Cross, across the board, every Blue Cross plan has said we're not covering these meds.

Dr. Weiner: 36:33

The big news I've heard out of Blue Cross is from Blue Cross of Michigan and the way Blue Cross works. It's not state by state. There's a couple of states that bind together but there may be 30 or 40 different Blue Cross companies and so there may be 30 or 40 different policies for Blue Cross. So if you have Blue Cross of Arizona, it doesn't matter what Blue Cross of Michigan is doing. It's totally different.

Dr. Weiner: 36:59

The rules for bariatric surgery are different. All the coverages are different, different companies, different entities. So what I've heard from Blue Cross Michigan is they've changed their criteria and required. Essentially, they've made the criteria almost identical to what we see for bariatric surgery. So anybody who's had bariatric surgery knows you got to do three months, six months, and one insurance company is six months and another is two months. And some require well, almost all require psych evals. Some require this blood test, Others require clearance by a pulmonologist Everybody they just come up with. They sit in a room, come up with crazy rules, put it in the policy, and then we run around trying to follow these rules, add a hoop.

Zoe: 37:38

Yeah, exactly.

Dr. Weiner: 37:39

So Blue Cross of Michigan has essentially changed their policy to very similar to bariatric surgery. They've made it very restrictive. I'm not aware that any Blue Cross policy has said we're not covering these meds at all. But let's just say they did. I'll just run a little thought experiment by everybody. I'll just run a little thought experiment by everybody.

Dr. Weiner: 38:05

If there was no insurance coverage for this and all of the not for diabetes but just for the treatment of obesity, it was only self-pay, that would probably increase access to the medications. Maybe not at first, while we have some of these shortages, we probably would still see a lot of problems. But I believe that we would see the market expand. We'd see a couple of different companies start competing on price. We get some market forces like we get in everywhere else. We went to buy a new TV the other day. Have you bought a TV lately? No, they are so cheap it's crazy. I remember when I was a kid a TV was like a huge purchase. It was like a huge amount of money. You can get like a 50-inch TV for like $2.99 or something. I mean they're so inexpensive because there's these powerful market forces. There's lots of competition. The technology is getting better. Medicine follows the exact opposite rule, right. Everything just gets more expensive every year in medicine, up twice the rate of inflation every year. It never gets cheaper to have healthcare in this country. It has not for 20 plus years since I've been a doctor. And so my argument is is maybe the insurance companies artificially keep the price high and that if we made this only self-pay, then we would see actually less access? And so people are going to say to me well, but dr weiner, my insurance pays and I get it for 25 bucks. Well, that's great, but your insurance company is is being paid by your, and your employer is paying $1,000 to you instead of paying you $1,000 in wages. So if this was brought out of it, that could allow for insurance prices to go down, if they would, if the insurance companies would allow them. But again, some market forces could allow insurance prices to go down. People would get more in wages that they could then use to buy GLP-1 medications.

Dr. Weiner: 40:03

So I'm not certain that insurance coverage for all is the best approach, because the pharma companies will get as much as they can and we've got the PBMs dipping in and taking huge fees. That all disappears if this is all self-pay for obesity coverage. So again, I'm not saying that no insurances should ever pay for that. That's not what I'm saying. I'm just saying that when insurance doesn't cover it, it may not be the worst thing for your ultimate access. It will impact it now. But we just talked before about counting clicks and some of our creative dosing strategies and some of the things we do to bring these medicines into an affordable range for people, and that's always an option. So I don't know that I would be terrified of insurances no longer covering these meds. I think it hurt us in the short run, but within six months we'd probably start to see some better options out there. So my two cents on that. All right, sierra. What's our next question?

Sierra: 41:05

Okay, this one is from our metabolic reset diet class. From the nutrition program it says unlimited fruit, but my sugars have been way higher the past three days. I am diabetic and I'm concerned that I might be eating too much fruit.

Zoe: 41:19

Good question, cause I do talk about fruit. I know there's still a lot of fear around fruit, especially with people who have a history of, like the keto diet, fruit fear. I love that we haven't used that term before fruit here, right, um? So, as as you may know, on the Metabolic Reset Diet, you are the listener, not you my co-host, because you wrote the freaking book, but the fruit is unlimited on the Metabolic Reset Diet. However, the caveat I always like to mention is you need to be eating more vegetables than fruit.

Dr. Weiner: 41:54

Yeah, that's a great adjustment to it. I like that.

Zoe: 41:58

So that's my first recommendation is Are you eating more vegetables than fruit?

Zoe: 42:04

And the answer is no, then let's flip-flop that. And then, if you are diabetic and you are struggling with, maybe, higher blood sugars when you're eating fruit, never eat naked fruit. So what I mean by naked fruit is fruit by itself, without a protein, because adding that protein in with it. So maybe it's yes, you have a banana and but that banana by itself, if you're just having that as a snack, as a diabetic, that might shoot your blood sugar up. But if you're having that banana with some almonds, then that protein helps to slow that rate of increased blood sugar. Or if you're having an apple, maybe put some peanut butter with it. Or if you're having berries, maybe you have it with some Greek yogurt. So you can see the theme of never eating naked fruit. So pairing that fruit with a protein and making sure that you're eating a much larger volume of vegetables than the fruit, and that can definitely help not only manage those blood sugars but if you are experiencing a maybe slower rate of weight loss as well, that could help.

Dr. Weiner: 43:07

Yeah, Every study I've seen shows that the more fruit you eat, the lower your A1C is. So the only time, the only places where I've seen that your A1C goes up is when they they lump fruit and fruit juice together.

Zoe: 43:21

Oh, like in a smoothie where they use fruit juice as the base, or they just the study says how much.

Dr. Weiner: 43:25

When they measure fruit, they measure fruit juice and fruit together. It's like not the same. Yeah, it's so not the same. That's the only time I've ever seen there be any evidence that it may be actually bad for your sugars. But every study I've ever seen says the more fruit you eat, the lower your blood sugar.

Zoe: 43:41

Well, and something that is like you. You never see somebody who's gotten overweight by eating too much fruit, so end the fruit fear.

Dr. Weiner: 43:50

Yes, absolutely All right. What's our last question, Sierra?

Sierra: 43:55

Okay. Final question is from our YouTube video, episode 20. I'm a Roux-en-Y gastric bypass patient. I'm down to 121 from 205. I want to be 110. I want to try moon jar or we go v. Am I a candidate? The food noise is back so 110 pounds.

Dr. Weiner: 44:16

we don't have the weight, the height, but I'm guessing it's not, you know, four foot five or four foot six.

Dr. Weiner: 44:22

I mean assuming that this person likely has a bmi of you-20s high, 20s, depending on their height, maybe low 20s. I think we have to look at these medications and recognize that they are not for 10 pounds of weight loss and that these medications are for patients with clinically significant obesity. Now, if this person were to gain from 120 to 130, then I might change my answer on this, which is that using these medications to preserve weight loss after bariatric surgery makes a lot of sense. But to get those final last 10 pounds because in my mind I don't believe that these medications, that that final 10 pounds, is going to improve their health much at all, I really would turn. If this patient was in my office, I would say I really don't think that is the right medication for you, even self-paying and whatever. However they do it, I would not be super in favor of that. I would 100% turn them over to you. So, zoe, what does this person do to lose those last 10 pounds?

Zoe: 45:29

Yeah, my first question would be why that number?

Dr. Weiner: 45:34

There you go.

Zoe: 45:35

This is a discussion that we had in one of our support groups earlier this week and I think it sparks a lot of really great thought. Ask yourself you have that number 110 in your head, but why?

Dr. Weiner: 45:48

Where's that number?

Zoe: 45:50

Is it that's what I weighed in high school or that's what puts me in the normal? I don't think that this applies for this specific patient, but in the discussion it was. That's what would put me into the normal category for BMI, or I don. You know, I don't know why. I just like that number. I think I should weigh that number. So I would do a little bit of digging in terms of why is that number significant and would you rather see a specific number on the scale or would you rather feel good in your body, feel confident in your skin, like the way you look, have energy, etc. So really kind of doing some soul searching on what's the significance of that number and how important it actually is to you to reach that number. And if at that point it all checks out and it's like, okay, we want to hit that number, then we can potentially look at, of course, your nutrition adjustments, potentially your exercise.

Zoe: 46:54

Maybe it's not a matter of hitting a specific number on the scale, but maybe it is. I don't really love the way that I look in the mirror at the 121. So maybe it's more so a conversation of changing body composition, which would be resulting in muscle building and losing fat, which lifting weights would be helpful with that, making sure your nutrition is dialed in with that, and maybe your weight stays at 121, but maybe you have a very different look in the mirror with that change of body composition. So there's a lot to kind of dig into. But my first and foremost question would be having you reflect on why do you want to be 110?

Dr. Weiner: 47:32

Yeah, there's so many good thoughts there. I think the other thing that I see, too, is this you're in this mindset of like I'm 205, then I'm 204, then I'm 203, and you're getting on the scale and there's this moment of happiness every time you get on the scale and the number's going down. The number's going down. At some point that ends right. The goal weight is not zero. At some point the scale will stop providing that reinforcement and it's possible that this person is just looking for those last little bits of reinforcement when instead they should be finding them in other places. You talk about this, I think, in your measuring success support group, right, and actually that's where this conversation stemmed from.

Zoe: 48:10

On Monday's session of the measuring success class or support session, we were discussing about why that number. So that's where that came from. But what you just said of seeing that reinforcement another piece of the conversation was, I feel like the reason why I step on the scale every day and obsess about it is because I'm chasing the high right, chasing the high of seeing a lower number because, like what you were saying, from 205, you, you get that positive reinforcement. So it's how can we again have a reframe? How can we shift that focus to? Where can I obtain positive reinforcement and that feeling of success and pride in my journey, aside from the scale?

Dr. Weiner: 48:54

And it's usually exercise right. Can you do a real push-up? How many push-ups can you do? Count those right, because you can go from one to two to three to ten to twenty. You know you can. There you go. There's going to be a huge, huge amount.

Dr. Weiner: 49:09

Like how fast can you run a mile? Exactly All of these things start. You know it's time to shift at some point. Once you get to that, that honey, the end of that honeymoon phase, it's time to shift the measurement away from the scale and toward the activities, the behaviors, the exercise goals.

Zoe: 49:25

Well and, like you said, goals. So it's maybe you've had this goal, you're working towards weight loss. You have like that drive to reach a goal. You reach the goal and then it's like, okay, now what? Now we need to again shift that perspective, have a new, non-scale, related goal to be working towards. Maybe it's I want to run a 5K. Maybe it's I want to run a 5k. Maybe it's I want to do a full pushup. Maybe it's I want to, whatever it is, and having that and it's okay to reach that goal and then find another goal. You know that's what's going to help propel you on this change of a lifestyle for the rest of your life, um, rather than viewing it as just another diet that you lose weight and it doesn't actually stick as a long lasting lifestyle change.

Dr. Weiner: 50:10

Yeah, I love it All. Right, great episode, great episode.

Zoe: 50:14

Getting all fired up.

Dr. Weiner: 50:15

Yes, all right. So this podcast is produced by Sierra Miller and Rhiannon Griffin and the editing is done by Autogrow. A special thanks to our guest, debra, and congratulations on her success. And, if you enjoy the podcast, check us out on social media. Share the podcast with a friend who you think might enjoy it. Check out our website, join our online nutrition program or even our platinum program if you're looking for some personal assistance. We will see you next time.