transcript

Speaker 1:
[00:00] I want to stop right there and make a huge point, because what they lost is muscle mass. That is the dark side of this medication. I'm going there, I'm going to go there. Me being from a border town in Mexico, I compare the food industry with the cartels. They don't drop just the physical weight, they drop shame, guilt, trauma.

Speaker 2:
[00:23] Wow, you don't hear people talk of that much.

Speaker 1:
[00:25] Well, we have to.

Speaker 2:
[00:27] I'm so excited for this episode. GLP-1s are on fire, and there's so much confusion around them. On one hand, they offer great hope. On the other hand, there seems to be complications and ramifications, and there are celebrities walking the red carpet who look like you may see it at waves, and we think there may be GLP-1s. I think I have the world's top expert here to unravel this mystery and to set things straight. Thank you, Dr. Rocio. Congratulations. Congratulations on your new national bestseller, Weightless.

Speaker 1:
[01:01] Thank you.

Speaker 2:
[01:01] Fantastic book. Makes GLP-1s accessible to everybody. We're going to talk about it right here. So for people who know GLP-1s, maybe Biozempic or Wigolvi, can you tell us exactly what a GLP-1 is?

Speaker 1:
[01:15] Definitely. GLP-1 is a hormone, right? It's like any other hormone that we make in our body. It has a function. Hormones take messages to different places in our body to execute different functions, and this is what GLP-1s are. So we naturally make it in our gut, in the small intestine, by the passage of food, especially carbs or glucose. When you eat, we release GLP-1 naturally, and this helps to control our glucose. But the problem with our own GLP-1, it's not that we don't make enough, we don't have a GLP-1 deficiency, is that it's broken down within two to four minutes. So it only lives in our system no more than four minutes because it's degraded by an enzyme, the DPP-4 enzyme. What we have commercially as GLP-1 that we know as Osempy, Wegobi and all of them, they're engineered to be long-acting drugs versus our own that lasts four minutes, Osempy lasts seven days, right? So we can use it once a week. So that's the major difference. And because it's broken down so rapidly in our body, it doesn't get to cross the blood-brain barrier quick enough to have effects centrally in the appetite control, which the engineered version, the synthetic ones do because of their long-acting half-life.

Speaker 2:
[02:35] You were telling me that the, originally it was isolated from a reptile.

Speaker 1:
[02:42] Yes. So, and also it's important to say that GLP-1 hormone was discovered by a woman, by a scientist, Dr. Svetlana Mokchov at the Rockefeller Center. But she isolated the endogen as the human one, which was broken down quickly. Now, Dr. John Eng and the VA Hospital in the Bronx, an endocrinologist and researcher interested in pancreas and glucose and insulin was investigating this lizard found in the south of the US., the north of Mexico.

Speaker 2:
[03:16] The Gila monster.

Speaker 1:
[03:17] The Gila monster. And what interested him is that the Gila monster's venom would heal its prey with pancreatitis. It will cause pancreatitis. So him being a scientist, researcher, interested in the pancreas, wanted to know what does it do in the pancreas, the venom. And that's where he isolated the GLP-1 long-acting version of the human version. And very interesting story. When he found this, he went to the VA to patent. The VA said, we're not interested. He actually went to several pharmaceuticals to patent. Nobody believed in him. He had to mortgage his house and he paid for his own patent. And after that, he went to a conference with a small abstract and then an amylin back then, which combined with a Lillie, saw it and bought it.

Speaker 2:
[04:09] Well, but he's living in a penthouse now.

Speaker 1:
[04:12] Well, I don't know for how much he sold it, but it's amazing.

Speaker 2:
[04:15] What's the connection between pancreatitis and GLP-1?

Speaker 1:
[04:19] The GLP-1 main function is to regulate glucose by increasing the production of insulin. So that's what GLP-1 is. We have receptors of GLP-1 hormone in the pancreas that improve or increase the production of insulin when the glucose is high. So basically, your glucose has to be elevated to act in the pancreas. So hyperglycemia and the GLP-1 acts there. But if your glucose is normal, then it doesn't touch the pancreas, right? So it's glucose dependent, that response. That's why we can use it in patients that don't have diabetes. So it's not going to cause hypoglycemia on somebody who doesn't have diabetes. It's not insulin. Insulin, if it's there, it just drops everything. But GLP-1, your sugar actually has to be elevated above normal.

Speaker 2:
[05:07] So, what happens in the body when you injected GLP-1? Or I guess you can microdose it now. But in general, what does it feel like for those of us who've never tried it? Never?

Speaker 1:
[05:18] I tell my patients, when I tell them the first time they come to me and I tell them, this is what you're going to feel, they look at me like I don't understand. And I tell them, in your second visit, we're going to have a different conversation once they experience it, right? So what I can describe it is normally if you would take a whole plate to feel full with this medication, you'll reach half of your plate and you'll be physically content, right? Many times at the beginning when a patient starts the medication, they're like, I need more food, I couldn't be full with this. And then if you overeat your fullness, then you feel sick. So it almost comes like a mechanical restriction of how much you can eat. So that's one effect. The other effect is in our brain, and it basically removes the anticipation of our reward for food. So if somebody is anticipating going to their favorite restaurant and they say, I'm going to order this lasagna, that, oh, I love it.

Speaker 2:
[06:13] Oh, my, I have that all the time.

Speaker 1:
[06:14] So with this medication, you see the lasagna, and it's like you're seeing a book, you're like, oh, I don't need it.

Speaker 2:
[06:21] That is so interesting.

Speaker 1:
[06:22] It can happen with alcohol, it can happen for, it's usually processed food that creates that reward response, right? So immediately you stop consuming half or less than that of pro-inflammatory processed food that are made to give you that reward, right?

Speaker 2:
[06:37] I totally get the feeling that I'm gonna be prematurely full with my minestrone. I make a great minestrone. But I actually, hours before I eat my minestrone, I have minestrone every day for lunch, I start thinking about it, and I salivate. And it seems like a completely different mechanism that would make me feel full and the one that would remove my anticipatory desire. How does it remove that anticipatory desire?

Speaker 1:
[07:07] So it blocks the receptors that we have in our brain and the amygdala in the hedonistic eating area of our brain. That's where we have receptors for the GLP-1, and it just blocks that release of dopamine of you salivating for your food. It's that anticipation of that dopamine that is how you're going to make you feel when you have that meal, right? So it blocks those responses.

Speaker 2:
[07:32] So let's back up a little bit and try to understand how we got to where we are. So over 70% of Americans are overweight or obese. And that's about triple from what it was in the 1980s. How do we get here? Why are so many people struggling with their weight or obese?

Speaker 1:
[07:52] And it's getting worse. The WHO said by 2035, half of the world population will have obesity. So we're talking more than 4 billion people with obesity and more than 400 million children with obesity by 2035. So it's getting worse, right? We know now that obesity is not willpower, right? It's not a poor lifestyle choice of somebody. We know that it's multifactorial and that's what God says here, right?

Speaker 2:
[08:23] I think we should stop on a point here because I think a lot of Americans think it is a fault of an individual. It is a lack of willpower. It is your responsibility to eat the right food. If you're fat or obese, you have a moral failing. But science doesn't tell us that, does it?

Speaker 1:
[08:43] This is one of the reasons that I wrote my book because, and I wrote my book starting with an apology letter as the introduction as a physician to my patients that I told that for years, that I doubted, that I thought, oh, if I go to their house, they're really not eating what I told them to eat. I'm sure they're not exercising. They're lying to me. I'm sure I'm going to find them in McDonald's. And that was every single doctor. And still to this day, many doctors believe that healthcare physicians is the number one bias in obesity. But playing the devil's advocate, we didn't know the science, right? We didn't know what we know now. We know now that even a transgenerational obesity exists, meaning we can inherit two generations back a gene for developing obesity. Trauma is a huge contributor to somebody gaining weight or having obesity. It could be personal trauma, sexual abuse, physical abuse, but also transgenerational trauma, right? So we know the parents' weight impact the offspring's weight, right? So we're talking even beyond when the patient was conceived. They already were going to be born with 50% probability of having obesity. Then we add that environmental factors. And I know you're big on this, right? Endocrine disrupting chemicals, environmental factors, where we live, how we live, industrialization, sedentaryism. We have to talk about the food industry, right? The food industry, ultra-processed food, more quantity, less quality. That also contributes to obesity. It changes our genes. They mimic our hormones. They're called endocrine disrupting chemicals because they disrupt the normal production of hormones that promote obesity. Then we go through lifestyle, life ages, right? Changing perimenopause, menopause, purity. That also can contribute and slow down our metabolism. Then we go into medications. Many medications that we take today to control chronic diseases that were more likely caused by obesity can promote waking. Anti-diabetic medications, anti-hypertensive medications, anti-psychiatric medications, anti-depressant can produce waking. So it's like we almost are every possible way that we can save ourselves. Being blocked even by environment, genes, age, medications, and then lifestyle, right? Lifestyle is a small part, but I see many, and this is a huge awakening for me. When I heard patient after patient coming to my clinic and telling me I'm exercising, I'm doing this diet and that diet and five diets, and I go to a fat camp, and since I'm 10, I've been on a diet. And it was, to me, shocking to understand and learn that patients were doing everything that we were asking them and beyond. And they were still not losing weight because that was not the cause of it.

Speaker 2:
[11:46] So, I mean, trauma is nothing new. I mean, there's been 25,000 generations of the human species. You know, generation before us, they had World War I and then World War II, and sexual abuse has been an issue, and people getting battered and bullied. These aren't new problems. What is it about our environment today that is exacerbating the obesity epidemic mostly? What are the big culprits that are different?

Speaker 1:
[12:14] So, trauma has existed all the time, right? But we've never associated with obesity. For many patients, let's talk about sexual abuse or child abuse. They rely on food many times for them to feel better, right? When they cannot control anything else in their environment. So, that's the precipitating factor. But then we have the environment that will feed into that, having the availability of ultra processed food. Good food, healthy food is very inaccessible, unfortunately, which should be the opposite, right? But, let's say somebody would tell them, eat vegetables, eat fruits, but if they're not, then we go into pesticides, then we go into endocrine disrupting chemicals. So, it's like a vicious cycle that we have no escape. It's very hard, especially in the United States, to get good quality, high quality food. So, having the precipitation of trauma plus the availability of that type of food, I think is one of those reasons that we can see a higher increase in obesity.

Speaker 2:
[13:25] If you had to rank order them, and I know you're kind of shooting from the hip, you're an endocrinologist, but you talked about these endocrine disruptors. You talk about different drugs that can add to obesity. You talk about our food environment and the glut of ultra processed food. Which ones would you rank for the population and explaining the 70% plus people being overweight? What are the biggest culprits?

Speaker 1:
[13:54] Food industry.

Speaker 2:
[13:55] Number one.

Speaker 1:
[13:56] Number one, food industry. I think the food industry should be held accountable for obesity as the tobacco industry was held accountable. But me being from a border town in Mexico, I compare the food industry with the cartels. Too much money to be made that it will not be changed. So I will put number one as food industry, number two.

Speaker 2:
[14:18] And wait, before you go on to one, what are the foods that are most, the biggest culprits for most Americans?

Speaker 1:
[14:24] High in sugar and high in salt and high in fat.

Speaker 2:
[14:27] Okay.

Speaker 1:
[14:28] So those are the foods that are the cheap, the easy and the quick for the masses and the ones that are made to create an addiction in the reward system. High sugar creates our reward, high salt creates our reward. So those are the main culprits in our food industry.

Speaker 2:
[14:45] Thank you. And number two.

Speaker 1:
[14:47] Environment, industrialization, how we live, how we work, we don't sleep. We work all day. We commute two, three hours a day. We work from home, right? We survive in plastic, BPAs, toxins in our paint, while we're breathing. And it sounds, I'm not granola, but these are very real things that affect our physiology and our metabolism. So definitely industrialization and environment will be number two.

Speaker 2:
[15:19] So what are they? And where-

Speaker 1:
[15:21] Plastic, so Forever Chemicals, the PPAs.

Speaker 2:
[15:24] So drinking out of a plastic bottle, for example.

Speaker 1:
[15:26] Exactly. The microplastics, right? So they mimic our own hormones.

Speaker 2:
[15:32] And is that really a problem or is that just something that-

Speaker 1:
[15:35] Huge problem.

Speaker 2:
[15:36] Really?

Speaker 1:
[15:37] We have guidelines with them, right? So we cannot solve a problem truly from their root if we don't talk about that, right? Endocrine disrupting chemicals are real and we can find it also in ultra processed food, right? In animal that is fed with not the right food, not pasture raised animal, not breastfed.

Speaker 2:
[16:03] I'm sure a lot of the listeners are getting overwhelmed.

Speaker 1:
[16:05] I know. I'm sorry.

Speaker 2:
[16:06] And first of all, this information is great, but let's just go back to plastic for a minute. I'm a mom and I have three kids and I don't want my kids eating, being exposed to plastic, which could lead to obesity down the road.

Speaker 1:
[16:24] And infertility.

Speaker 2:
[16:25] And infertility. What are the biggest sources of plastic in my diet and what's the most effective thing I can do to keep those plastics out?

Speaker 1:
[16:34] Drinking from plastic water bottles, number one.

Speaker 2:
[16:36] That's the worst.

Speaker 1:
[16:37] That's the most common. I mean, everybody is carrying a plastic bottle of water. Containers in our home, food containers being plastic. But even in the water, we have microplastics. Right? So I personally have children. So steel, because we found plastic even in glass, so it's not even now moving to glass containers. So stainless steel is always better for water. Never heating anything in plastic in the microwave because that leaks the BPA into your food. Right? Also containers for food delivery or when you're taking takeout, all that plastic, plus the heat of the food, leaks the BPA in the food. So there are simple things that we can do in our life that can also prevent that.

Speaker 2:
[17:27] So let's just say I am heating up my hot dish in a plastic container and then drinking from a warm plastic bottle. What does that plastic do in my body?

Speaker 1:
[17:39] So BPA is the chemical from the plastic. They can block, and we know this for fertility, we know that plastics can cause infertility in both women and men. It's specifically talking about women, BPA acts as estrogen in our body. It mimics our estrogen. It goes to the receptor of the estrogen where the estrogen should go, it blocks it, but it doesn't execute the same function as estrogen would. So when estrogen hormone goes to that receptor, it's occupied already by the plastic who pretended to be estrogen. So that's what endocrine-disrupting chemicals do.

Speaker 2:
[18:17] And how does that make us fat?

Speaker 1:
[18:19] Well, also they promote obesity. It's difficult to get into satiety, right? So our gut hormones that will promote satiety, that will alert us from fullness, they can mimic all those types of hormones too, and prevent, inhibit the proper functions for health.

Speaker 2:
[18:36] So we have processed and ultra-processed food. The big culprit, number two, are these chemicals that are ubiquitous in our food. What's number three?

Speaker 1:
[18:47] Hereditary, right? So if our parents, either mom or dad, was overweight or had obesity, preconception, it increases my risk, almost 40 to 50% of me struggling with my weight. So we go back to, I like to, whenever a patient comes, I like to go three generations behind. Okay, tell me your weight as a child, what were your parents and your grandparents and immediate relatives, uncles, aunts, cousins, because I want to see where this is coming from. And I would say the majority of people have family history already in obesity and overweight.

Speaker 2:
[19:24] And number four, you mentioned some drugs, anti-psychotics, anti-

Speaker 1:
[19:28] Antidepressants, anti-hypertensives, beta blockers, right? All the SSRIs.

Speaker 2:
[19:34] Oh, really?

Speaker 1:
[19:35] Beta blockers? Metoprolol can cause weight gain. And then we go with all the diabetes medications. Insulin. Insulin promotes growth. It's a growth hormone, promotes appetite, increases weight. So there are many medications that also can be discussed with your doctor to be switched to weight neutral drugs, right? There's always weight increasing medications, but they're weight neutral medications. So in a patient with obesity or overweight, we need to have the discussion to see if it's possible to switch them to a weight neutral drug.

Speaker 2:
[20:08] That is a big takeaway. And it's something I think everybody listening, struggling with their weight can do is check your medications for a weight gaining side effect. Is there a number five? What's five?

Speaker 1:
[20:21] Lifestyle. Lifestyle, right?

Speaker 2:
[20:24] What does that mean? I always have a problem with lifestyle.

Speaker 1:
[20:28] I would say if you have a sedentary life, right? If you eat more than what your body needs or consumes as energy, that can also promote weight gain, right? Definitely if you're consuming more calories than what your body burns, then also that can stores as fat in our system, right?

Speaker 2:
[20:46] I'm just going to refer to one through four. You know, if I have plastic in my diet and I live in this even toxic food environment and my medicins are making me hungry.

Speaker 1:
[20:57] And my parents were overweight.

Speaker 2:
[20:59] Well, wait, it's hard to, well, I'm not hungry.

Speaker 1:
[21:01] What responsibility do I have in my weight?

Speaker 2:
[21:04] Yeah, I just, yes, I sort of give Americans a pass. I have started one of my books, Blue Zone Kitchen, with if you're overweight and unhealthy in America, it's probably not your fault. Why? Because if you go back to 1980, one-seventh as many people were suffering from type 2 diabetes, and a third as many people were suffering from obesity. And that's not because there were better diet programs. That's not because our parents necessarily had a better sense of individual responsibility. In fact, my mom used to feed me like wieners and Cheez-Its. And she thought that was, yeah, of course, Crisco. You know, that was horrible. And so something else has happened that I just don't think you, I just don't think it's fair to blame the average American who's out there in a sea of fast food restaurants and Doritos and Coke.

Speaker 1:
[22:00] And I can tell you, I have not met a single patient with obesity that wants to have obesity.

Speaker 2:
[22:08] There you go. And the fact they're showing up in your office means they want to do something.

Speaker 1:
[22:13] And you know what the sad thing about this, all of this, is that some patients that I see in their 60s, they've struggled with this since they're 8, since they're 9. So we're talking about decades that they're consume around that plate in front of them, that they live with shame, with guilt, that they're not trying enough, that they should try a different way. It consumes them. So when we talk about the heaviness of the physical weight, we're not talking about the heaviness of the mental weight that the patients carry. And that's the reason that I think these medications are so powerful, right? We're not getting into the medications yet, but what I see in my patients, and that's the name of my book, Weightless, because they don't drop just the physical weight. What I see in them, they drop shame, guilt, trauma. They truly become weightless.

Speaker 2:
[23:06] That's such a great metaphor. I think a lot of people put GOP1s in the same category as Botox. And their people are just, you know, you see the red carpet in Hollywood. And we know, we don't have to say their names, but there are several actors and actresses out there who are shockingly thin all of a sudden. And we can probably guess, maybe you can see which ones are GOP1. They're doing it for cosmetic reasons, but GOP1s really transcend cosmetics, don't they?

Speaker 1:
[23:40] Unfortunately, due to some celebrities, some irresponsible providers or prescribers, they are trying to show them as supplements, right? As just take it for a week, take it for a month, like it's a supplement, but it's a prescription drug that requires medical supervision, right? When the studies were done on those drugs, they were proof to show safe. Why? Because they were under control supervision. But if you use it as a supplement, then you really don't associate it as a drug that you need to go to your doctor and see what's happening. When I see those patients or they're not patients, when those celebrities in the red carpet or people that are misusing this medication, I think metabolic catastrophe. Because what they lost is muscle mass, right? That is the problem. That's the dark side of these medications when they're not done responsibly. We can't leave our patients sicker than when they came with us with excess body weight. Having sarcopenia or low muscle mass increases all cause mortality. We don't say that from high body fat. Obesity does not increase all risk mortality. Sarcopenia does. If you're on this medication and you're not doing the proper supervision with body composition, then your patient is probably losing 30, 40, 50% of muscle mass. So you are-

Speaker 2:
[25:16] Wow, and how long? A year?

Speaker 1:
[25:19] It could be in four months, depends how they're used, right? So if-

Speaker 2:
[25:22] 50% of your-

Speaker 1:
[25:23] So let's say if a patient goes somewhere-

Speaker 2:
[25:25] That is scary.

Speaker 1:
[25:26] It is scary. So let's say you go with, you get your medication online. Nobody, you're filling a form, you get your medication in the mail, you're going by the number on the scale. You said, oh, I lost five pounds per week. I'm losing 30 pounds in two months. This is great. Guess what? 30% or more was muscle mass.

Speaker 2:
[25:46] Wow.

Speaker 1:
[25:47] Right? So that is the problem. And that's a metabolic catastrophe because muscle is our organ of longevity. Muscle consumes 80% of the glucose in your blood and it utilizes for energy. Muscle burns fat for energy. So muscle is an insulin sensitizer. So we're talking about hyperinsulinemia and insulin resistance. Muscle is the best prescription for it, right? So if you drop the muscle, you're making somebody metabolism unhealthy, insulin resistant and prone for type 2 diabetes. So you may be 110 pounds, but guess what? You have type 2 diabetes now, right? So that is the problem. And then if you lose muscle, you're losing bone. If you're losing muscle, you're losing bone, you're losing hair, you're losing collagen. So it's just a downhill from there. So now you probably have the age of a 90 year old in the body of a 45 year old female with 100 pounds weight.

Speaker 2:
[26:46] Wow. You don't hear people talk of that much.

Speaker 1:
[26:48] Well, we have to.

Speaker 2:
[26:49] If you're listening to us right now, you're in the audience and you're overweight, how do you know the time is right to look into a GLP-1?

Speaker 1:
[26:59] If weight loss is a full-time job for you. If weight loss takes over your life, to lose even those 10 pounds to maintain your weight or to lose weight, then you could probably benefit from a GLP-1 because it shouldn't be consuming your life to lose weight or lose those extra 10 pounds.

Speaker 2:
[27:19] So I've been trying to lose five pounds for the last five years and they're still there. I mean, should I be looking into GLP-1s?

Speaker 1:
[27:28] Well, I would say, let's start with a body composition, right, because maybe you think it's five pounds, but many times when I do a body composition, surprise, surprise, it's 15 or 20 pounds, right? Because we don't know.

Speaker 2:
[27:40] And what's the right amount of body fat? What's the right percentage?

Speaker 1:
[27:43] So for women, we ideally want percentage body fat below 28%. So anywhere from 18 to 28% of your total body weight should be fat. And for men, we want a fifth of your body to be fat. So between 10 to 20% should be your body fat. And then visceral fat, it should be less than 1.5 liters, which is a normal amount.

Speaker 2:
[28:06] How do you find out what visceral fat is?

Speaker 1:
[28:08] So we do either by a DEXA scan or impedance machine or an MRI. It's a gold standard, but we're not going to do MRI on every patient. So impedance machines and doctor's offices are great.

Speaker 2:
[28:18] Very good answer. This is really great, Rocio. And if I'm just feeling overweight, but my body, I have the right amount of visceral fat, the right amount of body composition, and we show up to your office, you're going to say I'm not for you?

Speaker 1:
[28:35] If your muscle mass is high, then you're good to go. You're getting all the other benefits that you think you're missing out from using a GLP-1, because that still matters. Having a healthy body composition still matters.

Speaker 2:
[28:49] Americans spent last year between $72 and $73 billion a year on GLP-1s. You might have another more up-to-date number. These Blue Zones that I found, five of them around the world, where people are living about a decade longer, fewer than 5% of people were overweight or obese, fewer than 2% had type 2 diabetes, and not a lot of them indulged in GLP-1. They ate mostly a whole food plant-based diet. They lived in walkable neighborhoods. They were socially connected. Shouldn't we be taking maybe this $72 billion and investing it in creating a food system where people are eating healthier naturally and moving more as opposed to this kind of shortcut?

Speaker 1:
[29:40] What was my number one reason that I put in number one in causes of obesity?

Speaker 2:
[29:45] You put the food environment into your credit, yes.

Speaker 1:
[29:47] Food environment, what is it what you're finding in the Blue Zones? The food, the right food environment. Ideally, yes, that's what we should do. But even if we change the food industry today, we still have this problem to fix. Changing the food industry today will prevent maybe the next two or three generations to develop obesity. But what do we do for the 4 billion people that are going to have obesity in the next few years? That's what we do GLP-1. Now, improving the food industry will be one solution. The patients that have currently obesity, if we treat them with GLP-1 medications, their next generations will have a healthier weight, and then they have the right environment with the good food environment, that's where we go back to having a healthy normal weight. So right now is greater than just fixing our food industry. It has to start, but it's going to take a few generations for us to see the effect in health.

Speaker 2:
[30:50] I might be reading between the lines a little bit, but are you saying to me as a parent or as somebody who wants to become a parent, if I can get my weight under control, go from obese to normal weight, my child will have a lower genetic propensity to be obese?

Speaker 1:
[31:10] Bingo, yes. Really? And that's why all my patients that are thinking fertility, I go over this conversation with them and I said not only are we reducing the risk of complications in your pregnancy from obesity and pregnancy, but you're also giving your child the best possible case of not struggling with their weight as you did.

Speaker 2:
[31:30] And that's an epigenetic change.

Speaker 1:
[31:31] That's epigenetics, exactly.

Speaker 2:
[31:33] Wow, see I always was of the opinion that if I got healthier, which means that instead of having a coke on my kitchen table for dinner, I'm serving water to my family, and we're eating beans and grains instead of burgers and fries, that the environment that I'm raising my child up in is going to impact his or her chance of becoming an obese adult. But you're saying it's actually a genetic or epigenetic. Yeah, epigenetic.

Speaker 1:
[32:02] We have studies that show that hyperpalatable genes are transferred to the offspring.

Speaker 2:
[32:08] Oh, my God. Hyperpalatable means your desire to eat sugar and sweet. Sugar and processed foods.

Speaker 1:
[32:14] Yeah, and processed food. Exactly. And then it's really unfair when we talk about childhood obesity and blame the parents, right, because-

Speaker 2:
[32:23] Or the kids, for that matter.

Speaker 1:
[32:24] Or the kids, because, again, we almost, almost, and I don't want to sound too doom, but we're almost set to failure, right? We're almost set to fail in our health, giving our food industry and our environment and how we live at this moment.

Speaker 2:
[32:41] None of you thinks that this drug is just a band-aid for a larger systematic problem?

Speaker 1:
[32:47] Well, we talk about the larger systematic problem. GLP-1 is not going to take care of the food industry. It is changing the food industry, right? Where people are consuming less, people are drinking less, people are spending less in restaurants, people are buying less processed food when they're on a GLP-1. Again, because that drive of the reward system is controlled. But GLP-1 is going to help us fix our current problem and prevent chronic disease, right, by decreasing body fat and body weight and visceral fat. But we need to work governmental externally with our food environment, right? GLP-1 is not going to do that.

Speaker 2:
[33:28] I love that insight that GLP-1's shift the demand away from junk food and hyper-palatable food. I want to talk about the benefits and also the cautions around GLP-1. So, I work with a longevity expert, a biologist named Steve Osted, who actually thinks that GLP-1 may have some secondary or tertiary impacts on longevity, one of them being maybe lower rates of type 2 diabetes or maybe some epigenetic changes. Are you aware of any other ancillary benefits from GLP-1s that might help us live longer?

Speaker 1:
[34:08] Definitely. I mean, the root cause of many disease, chronic disease, is our weight, right? It's obesity. Obesity is a driver of many chronic diseases, including type 2 diabetes, pre-diabetes, hypertension, hypercholesterolemia, osteoarthritis. It is a high risk for more than 13 obesity-related cancers, including breast, colon, prostate, stomach, pancreas, thyroid.

Speaker 2:
[34:36] So people on GLP-1 have lower chances of these cancers.

Speaker 1:
[34:39] Exactly. And let's talk about why. This is what I love about this. What in our weight makes us sick? Let's take a big step back. What in our weight makes us sick? Why do we want patients to lose weight? High body fat, specifically, visceral fat, causes a chronic, low-grade inflammation in your body. Right? There's always inflammation in your body if you have high visceral fat. If you have high visceral fat and you have low muscle mass, well, that's a double whammy because muscle is an anti-inflammatory organ that produces anti-inflammatory hormones. So if you have high body fat, you're in inflammation. If you have low muscle mass, you're in inflammation. Inflammation is the driver of most of the diseases that we have beyond acutal, like an infection, right?

Speaker 2:
[35:31] Chronic.

Speaker 1:
[35:31] Inflammation is a root cause of dementia, of Alzheimer's, of heart disease, of metabolic disease, and many types of cancers. What happens when our body is in inflammation? We have a system. It's called the immune system. Antibodies to protect us from any hazardous cells, tumor cells, virus, bacteria that come into our body, it goes and protects us. But when your body is in chronic inflammation, guess what your immune system is doing? It's preoccupied fighting that high fat inflammation and low muscle that is leaving the door open for cancer cells to reproduce, for bacteria to come in from virus to come in. What happened in COVID? COVID is the perfect example because before COVID, there was a questionable people with obesity, do they have inflammation or not have inflammation? Patients with obesity during COVID pandemic, higher mortality, higher ICU states, and higher chronic lung complications from COVID. Why? Because their body was preoccupied fighting the inflammation of obesity. I had patients in my office in common and tell me, I need to lose weight, I don't want to die from COVID. So what happened in COVID? People got the message that if you have obesity, you don't have to wait 20 years to develop type 2 diabetes. A virus out of nowhere can come and you can die from it. So people got the message that having obesity is not body positivity, you're actually in chronic inflammation and it came a virus and you were higher chances to die. So the acceptance was there and we had the medication to treat. So boom, that was the bomb of what we're seeing now, of the boom of these medications because GLP-1s are available since 2005. We've been prescribing them since 2005. So many people tell me, why now COVID? We had the demand, we had the knowledge and we had the therapy.

Speaker 2:
[37:29] My listeners are really interested in what they can do. And I just think it's such a powerful revelation to tell them that their chances of cancer go up because of their, the amount of fat in their body.

Speaker 1:
[37:43] And before we start saying that GLP-1s are an anti-inflammatory drug, let's correct that, right? There is a mild, direct anti-inflammatory effect from the GLP-1, but its greatest anti-inflammatory effect is indirect by decreasing percentage body fat and decreasing visceral fat, decreasing the consumption of pro-inflammatory food, which is the ultra-processed food, right? So that's the way that they act as an anti-inflammatory drug. So when somebody is on a healthy weight and they say, oh, I want to use a microdose of a GLP-1 for the anti-inflammatory effects, well, if your body composition shows that you have high muscle mass, low percentage body fat, low visceral fat.

Speaker 2:
[38:20] It's not doing the job.

Speaker 1:
[38:23] You're having all the effects there, right? You're not going to get anything extra. The benefits is by decreasing the visceral fat and you increasing your muscle mass. That's how we see the benefits.

Speaker 2:
[38:32] And the worst fat is visceral fat.

Speaker 1:
[38:34] It's the visceral fat.

Speaker 2:
[38:36] In our, around our organs, in our mids. How, yes.

Speaker 1:
[38:39] That fat is not a dead tissue. It's not just sitting there. It's actually an active tissue that produces chemicals.

Speaker 2:
[38:46] And the trigger for a woman is what? And the trigger for a man is what? When it comes to visceral fat.

Speaker 1:
[38:51] So for women below 1.5, for men below 1 liter.

Speaker 2:
[38:56] 1.5 liters? Yeah.

Speaker 1:
[38:58] And for, and depending on the machine that you're going to use, like in pedants, they may use a scale. The in-body uses a scale, and it should be below 9 in the scale of your visceral fat. Anything above 9, then you have high visceral. Now, high visceral fat is going to cause fatty liver, it's going to cause insulin resistance. So I can tell somebody has fatty liver or insulin resistance without doing blood work if they have high visceral fat.

Speaker 2:
[39:23] How?

Speaker 1:
[39:24] Because if they have high visceral fat, they have insulin resistance. Insulin resistance promotes visceral fat. Visceral fat promotes insulin resistance and then you get into this vicious cycle.

Speaker 2:
[39:34] This may be a dumb question, but is there something I can do specifically to get rid of my visceral fat as opposed to overall fat?

Speaker 1:
[39:42] So visceral fat is driven by insulin, right? More insulin in your body, more visceral fat. More visceral fat makes you insulin resistant, so then you have to make more insulin to have the same effect. But then more insulin promotes visceral fat, and then more visceral fat promotes insulin resistant, and then you get into that vicious cycle. So we need to give our pancreas a break, basically, if we want to decrease our visceral fat, because we're overworking our pancreas, and that's producing the visceral fat. So definitely what we consume, if we consume constantly ultra processed food, then we're overusing our pancreas that can promote also visceral fat, right?

Speaker 2:
[40:24] Or feeding that vicious cycle.

Speaker 1:
[40:26] What breaks the vicious cycle? Protein, right? Protein in our body reduces insulin, hyperinsulinemia, in those spikes of insulin. So we have a very poor protein dense diet in the United States. It's mostly carbs, sugars, simple carbs, sugars, salt, fat, right? But when we incorporate protein, we really give more of a stable glucose in our blood that doesn't require those high spikes of insulin as something high in sugar, a simple sugar, a simple carb will just shoot up your insulin level.

Speaker 2:
[41:03] Yes. Well, my Blue Zone responsibility requires me to chime in here. In Blue Zones, people aren't eating a lot of protein, as we say, about five times a month. What they are eating, lots of plant proteins, they're eating lots of beans and whole grains and greens and garden vegetables.

Speaker 1:
[41:24] And that's what we call a complex carb, right? Because it has a fiber. So it's harder for our body to break down. So it produces a more consistent low release of insulin. But if you eat a piece of candy or, I don't know, something high in sugar, a donut, exactly, your body breaks it down very quick. It produces a high spike of glucose that requires a high spike of insulin. And when you do that consistently, then your body every time has to make more and more insulin to have the same effect as it did before.

Speaker 2:
[41:57] Right. I just want to be clear on, and see if we're in sync on this. You don't necessarily need a high protein diet. Maybe you think we need a high protein diet. But can you also have a high complex carbohydrate diet? Or can we get our protein from plant-based source?

Speaker 1:
[42:14] So this is, I'm going there. I'm going to go there because I have to, and because I see it in my patients. Let's talk about my vegan patients, patients that don't consume any animal protein. Sarcopenia and osteoporosis is very high in this patients. Why? Because we need full complete protein that has all the amino acids to make muscle protein synthesis and the bone collagen, right? And collagen for your skin and your hair and nails, right? But if we don't have that basic 20 amino acid, full complete protein, we don't have anywhere to build. And I see this so often in my patients that are complete vegan, vegetarian and plant based. Now, we can say they're healthier, but there's no single study looking into plant based diet with body compositions. Show me one single study that promotes muscle gain when you're on a plant based diet. I want to see the bones, I want to see the muscle mass, and I want to see the visceral and percentage body fat of those patients. So my patients that are plant based are very high in starches, right? Starches convert into glucose in our body, right? And I want to say all extremes are bad. I'm not promoting fully only protein diet, but I'm also not promoting a fully plant based protein diet, right? The extremes, even if they're good, they're going to be bad. So I'm not talking black and white here, but it's important and many of my patients, when they see their numbers and when they see their bones, they get it and they incorporate gradually some animal based protein and that's where we start seeing the muscle gain.

Speaker 2:
[44:03] Well, I have to speak up for my community. Being plant based myself, I think that the healthy plant based eaters probably aren't showing up at your office. And there's lots of bodybuilders who never touch a piece of meat, but and I knew several centenarians who never ate meat, but I, to your credit, when you live in America, you try to be a vegan and you're promoted, these baked burgers and these fake meat. And I think the most unhealthy diet in America is a processed vegan diet.

Speaker 1:
[44:39] 100%.

Speaker 2:
[44:41] You know, I've stayed true to what I believe on or what I've observed in the longest of cultures in the world, they're eating mostly whole, they're eating mostly peasant food, beans and corner tortilla, for example, as we see in Nicoya. Meat is a celebratory food, but no processed food.

Speaker 1:
[44:58] Going back to the reason number one that I think that I put in number one is the quality of the food, right? I mean, and I think it's coming here and talking to you and knowing the work that you do, it goes back to the simple things, right? The simple food. That's gonna be wholesome and that will prevent obesity, right? But the current problem that we have, we can use medication for it, right? And again, I never support anything in extreme because I think both extremes are not good. I think it's more of a balance type of diet.

Speaker 2:
[45:34] Let's talk about the downside. So we hear six drive is diminished and ability to enjoy other things in life besides food. Does that show up in your practice or is it myth?

Speaker 1:
[45:48] Well, if it's done the right way, that will not happen. And I close my book with, the benefit of the drug and the side effects of the drug are going to depend of the expertise on who's giving you the medication, right? If you're going with somebody who just wants to be part of the movement, then it's going to give you the drug because you're asking for it and doesn't know nothing about dosage. And you're going to put you on a high dose. It's going to suppress everything very quickly, including maybe your sex drive, including things that give you pleasure, right? So you have to know who to go to, right? When you are going to use this medication. Make your due diligence when you're going to pick your prescriber. They're not supplements. They're a prescription drug that if it's used the right way, you'll have minimal to none side effects.

Speaker 2:
[46:42] For a listener right now, struggling with their weight, interested now in GLP-1s, how do you find the right doctor? Does it have to be an endocrinologist or?

Speaker 1:
[46:53] So just to give you some stats, there's currently one... So besides an endocrinologist, I'm also an obesity board certified physician. So above endocrinology, I learn more with obesity. There's currently one obesity specialist for every 9,000 patients with obesity without counting overweight. Right? So the level of demand is going 100 miles per hour greater than the level of trained physicians in this specialty. So there's a huge mismatch, right? And that's one of the reasons that I wrote my book. If you have the book, even if you don't have the right doctor guiding you, you can have the right results. The book is also written for physicians that want to prescribe this medication, that they can do it the right way.

Speaker 2:
[47:40] The book again is Weightless, A Doctor's Guide to GLP-1 Medications, written for everyday people. So are you saying that if I want to explore GLP-1s, I'm overweight, pick up the book, read the book, and the book along with my average doctor, I can safely go on the drug or do I need a specialist?

Speaker 1:
[48:05] No, you probably will do better even if you go to some endocrinologist that may not have the experience on a GLP-1 medication, right? In the book, I give you even a flow sheet on how to pick the right provider, what questions to ask when you call to make that first appointment that are going to give you green flags or red flags. I really walk you through why am I struggling with weight? Why do I have obesity? To the psychological part of weight loss, which is something that we're not talking about, and that's one of my proudest parts of my book, is we are currently doing a disservice to patients with obesity and on weight loss medications because we as doctors, we're concentrating on numbers, right? I want to improve your number, I want to decrease your risk of disease, I'm concentrating on numbers, but we're doing nothing about the psyche, we're not giving patients the tools for when they get to a special weight. For many patients, they've never been on this weight after they lose the weight in their life. Many patients have never seen themselves physically in that new weight.

Speaker 2:
[49:15] I would think it would be euphoria.

Speaker 1:
[49:16] For the majority are, but for some patients, the physical weight gets lost faster than the patient can adapt psychologically to the weight loss, just to put it like that, right? Many patients are confronting with the idea of, why am I treated differently now? Why are they opening the door for me now than before, if I was the same person? So my partner didn't met me like this. My partner doesn't want to go out to dinner with me. When I go in a social setting, I'm not the fan anymore, right? People are saying why you're not as fun as you're not drinking anymore. You're not eating as much. Believe me, for the majority, and they wouldn't go back. I haven't met a patient that said, I'd rather gain the weight back, right? But we also have to give them tools for this. It's not fair for them to not tell them, okay, this is happening. This is what you're going to encounter. This is how you can be in certain situations. This is how you can talk to your partner, to your loved ones, if you want to share or don't want to share. The best way to allow a patient to adapt to the new body is to allow them to lose their weight slowly, right? Then they'll be adapting gradually to how their body feels, to how people look at them versus if you have somebody lose 50 pounds in three months, it's going to be a metabolic shock and a psychosocial shock for the patient too.

Speaker 2:
[50:42] For most people, what's a healthy weight loss per week?

Speaker 1:
[50:47] So, what I've seen through body compositions, that you're not losing a significant amount of muscle, is going to be between half a pound to a pound per week. Per week. So, if you're losing that, rest assured that you're not losing more than 10% of your muscle mass. But if you're losing three pounds per week, you're losing 20% of your muscle mass. If you're losing four pounds per week, you're losing more percentage of muscle mass.

Speaker 2:
[51:14] So, beware of fast weight loss.

Speaker 1:
[51:16] Exactly.

Speaker 2:
[51:17] Do you put people on a weight training regimen along with GLP-1s?

Speaker 1:
[51:22] From day one.

Speaker 2:
[51:23] From day one.

Speaker 1:
[51:23] From day one, you have to have the comfort. And that's one of the green flags that I gave in the book. If your doctor is talking to you about what exercises you need to do, what's the nutrition that has to come along with a GLP-1, then you're with the right doctor. But if they don't have those discussions with you, run away.

Speaker 2:
[51:39] Wrong guy, wrong guy.

Speaker 1:
[51:40] Get out of that office.

Speaker 2:
[51:41] Any other negative ramifications of GLP-1s?

Speaker 1:
[51:45] People's judgment, people's attitudes towards it, right? And to clarify something, this is not an easy way out for patients. Don't think that at least my patients that go on a GLP-1, they're just sitting there waiting for the weight to fall off. For some, they're never lifting weights, and now they're lifting weights. Now they're watching what they eat. Now they're being careful about what they eat. When you remove the pressure of weight loss on exercise, it changes the perspective of the people and the patient, right? When I tell them, you have to work out, but not to help the weight loss, they stop, and they look up, like they take a second look, like what?

Speaker 2:
[52:25] Unless they don't have to lift all that fat.

Speaker 1:
[52:27] It's so foreign for somebody to go, especially for somebody who struggles with weight, to go to do exercise with that weight loss being the outcome of you exercising. And when you remove that, it's beautiful to see how people embrace exercise for other reasons.

Speaker 2:
[52:42] How do I maintain it? Do I have to stay on GLP-1s for the rest of my life?

Speaker 1:
[52:46] So, the length of treatment really depends on your personal story that took you to use the medication. So, if you're somebody who are in your 50s and you struggle with weight since the age of eight, that's a chronic condition. Most likely, you will require this medication long term for the maintenance. But let's say you're a woman that never struggled with weight, you don't have family history of obesity, you got pregnant, you gained too much weight, then you hit perimenopause. Maybe you will use it and won't need it long term, right? But if that same person has a strong family history of obesity, now they're in midlife, they're in perimenopause and menopause, well, maybe now you will require the medication long term. And I always like to flip it. It's not a negative that we have something to maintain weight loss. This was the Holy Grail, right? This is what any other diet cannot do. Many diet can take you there, but to keep you there was always, they never worked, right? I also like to tell patients, your biggest bet to not needing the medication long term or using the lowest dose long term is your muscle mass, right? Because if you lose your muscle, then you become almost dependent on the medication. The medication is doing 90% of the effort. So if you gain muscle, then the muscle starts taking some of the effort of the maintenance that ideally at the end for maintenance, the medication should feel like it's 30 or 40% of the effort. The rest is your muscle mass and the nutrition that you're having. But if you don't, if you don't gain muscle and you lose all your muscle, you are going to depend on very high doses of the medication long term.

Speaker 2:
[54:24] It's very hard for a 50 year old to gain muscle mass.

Speaker 1:
[54:27] It's not impossible. I've had seven year old female gain muscle while on a GLP on medications and eat a lot of protein lifting weights. Exactly.

Speaker 2:
[54:37] Once you go off it, doesn't the weight usually thunder back for people?

Speaker 1:
[54:43] Well, there's different ways to see this. First of all, you never should stop.

Speaker 2:
[54:46] You're so good.

Speaker 1:
[54:48] You should never stop this medication called turkey, right? Because let's say you're on a high dose of the medication, so that's suppressing your appetite 70 percent, right? You stop it the next day, your appetite is going to go back and it's going to feel like it's 200 percent. Right? So, ideally, we need to decrease the dose gradually as ideally it went up. So, to allow your body to get acclimated a little bit more appetite every time that they decrease the dose. That's number one to prevent significant weight reeking. Number two, muscle mass is your biggest bet to not have a huge weight reeking. But if you did, if you lost a lot of muscle and you didn't gain the muscle, yeah, the medication was doing all the job for you, right? And also, if this is a chronic condition for you, then this is not a cure, right? All those factors weren't removed by being on a GLP-1 medication. And most medications work while you take them.

Speaker 2:
[55:44] How about you hear this term microdosing GLP-1?

Speaker 1:
[55:48] Microdosing is by the wellness community. And I can tell you how, because I saw this, how it came about microdosing. Microdosing came from inexperienced providers, clinicians, med spas, PAs, nurse practitioners, that didn't know how this medication worked. They gave it to their patients. They came back with severe side effects, ended up in the hospital, and they said, well, then maybe if I give you a lower dose, you won't have those side effects. That's where the microdosing term came about, right? But if you're doing it the right way and you know what the hell you're doing, you can use the regular dose. Because the regular dose were the therapeutic doses that were found in the studies to exert an effect, the desired effect, either to decrease your glucose or to decrease your body weight. So there's no need to microdose. If you need the medication, you need the full dose. If you have a body composition and you're in a healthy weight with good muscle mass, you don't need to microdose. You're not getting anything extra benefits. But if you use the medication and you say, but even if with a microdose, I feel great, most likely you need the medication full dose, right?

Speaker 2:
[56:54] So the bottom line, microdose is not a good idea.

Speaker 1:
[56:57] It's not necessary.

Speaker 2:
[56:58] How about after the holidays? People always gain extra five, 10 pounds after the holiday. Okay to go on GLP-1 to get rid of that body fat quicker or easier or maybe more?

Speaker 1:
[57:13] If it's just from the holiday weight, no. I mean, if it's something that you've been struggling, carrying with, then yes. But just for like that, we're going back to thinking of it as a supplement, right? I wouldn't take an anti-hypertensive for four weeks just because you're going to lose weight, right? So don't think of this medication as something that you get on the over-the-counter. This medication-

Speaker 2:
[57:36] Serious drug.

Speaker 1:
[57:37] It's a serious drug. It needs a prescription medication.

Speaker 2:
[57:40] And probably a long-term commitment for most people. Be aware. And it's not cheap, is it?

Speaker 1:
[57:45] It's getting cheaper, but how much has an individual, and I can see this in my patients, spent on diets, books, programs, trainers, supplements, hocus pocus, thousands and thousands and thousands and dollars without long-term results. So we also have to re-educate the consumer on where they spend their money too, right?

Speaker 2:
[58:07] The whole premise of Blue Zones is we all know we should move more. We should eat better. We should socialize more. We should sleep more. We should know our purpose and live our purpose. But how do you do it for long enough to make a difference? And I have my own answer with Blue Zones, but we gloss over the how. Because marketers want to sell us the thing that's going to do the trick. And I think GOP in a way falls in that category, the panacea. But unless you know how, you miss more than half of the story.

Speaker 1:
[58:46] To be able to make something sustainable long-term, it has to be easy.

Speaker 2:
[58:52] Yes.

Speaker 1:
[58:53] If I give a patient, okay, you have to do this and this and this and follow this and wake up at this time and take this medication at this time and the next, if I complicate it too much, I'm going to get results, but they're going to be temporary. They're not going to be sustainable because if the patient has to modify or become another job to sustain that, it's not going to be long-term. They're going to drop it. And the way that I talk in my book, the language that I use is also very similar. Like I need you to, I'm going to talk to you in a very easy way that you're going to be able to understand and understand the why. Because what I found through my years as a doctor is that people want to get informed. People want to know about their disease. People want to be participants of their treatment, right? So and I always say the patient that knows more does better.

Speaker 2:
[59:41] That's a good insight. When people are on a GLP-1 even though their appetite is curbed, aren't they just often eating the same junk food they were eating before?

Speaker 1:
[59:51] No, because the junk food gives you a reward.

Speaker 2:
[59:54] So it decouples the reward from the food. So do you see in your patients what their eating changes?

Speaker 1:
[60:00] A hundred percent.

Speaker 2:
[60:01] What do people generally eat on GLP-1?

Speaker 1:
[60:03] Healthy food.

Speaker 2:
[60:04] They like...

Speaker 1:
[60:05] When you have the conversation with the patient, when you educate with the patient regarding muscle mass, body composition, the concentration, the focus from weight loss changes the direction for muscle preservation and muscle gain. Because I tell them, the drug is doing the fat loss for you. Your homework, your duty is to maintain and build your muscle.

Speaker 2:
[60:29] But going back to this idea of desiring food and enjoying food, this image comes to mind. I go to this Blue Zone, Icaria, and I go to a place called Thea's Guest House, and she's got this terrace overlooking the Aegean. And every night, she assembles her family and local villagers, and we sit around a giant table, and it's mostly greens, salads, greens baked into pies, bean dishes are big there, there might be some fish, but it's this huge Mediterranean banquet. And there's so much joy at that table, and part of the joy is the joy of eating, the joy of this ancient primal activity, which is sitting around a table with good friends, good conversation and good food. And are we taking a third of that away?

Speaker 1:
[61:26] I wanna stop right there and make a huge point. You will still enjoy your food when you're hungry, you eat and you enjoy the food that you're eating, then you get fuller and then you stop. What is removing is the reward from ultra process pro-inflammatory food that we shouldn't be eating to begin with, right? So you will still enjoy whatever food you're eating when you're on a GLP-1. This is not like you are dead, you're not feeling anything, you're just fueling yourself. No, otherwise people will not be on it, right? They wouldn't last on it. You still enjoy what you eat, you're just going to eat 60, 40% less of what you normally ate, and you're not going to crave the high sugar, the high fat, ultra processed food, right? And I love this comparison of the Blue Zones because what is it in the Blue Zones? The simple life, the simple food, is not the industrialization, is not the food industry, is not the processed food, is not the overworking, is not the no community, is not the not walking, it's opposite of how we live, right? So yes, that's the ideal, that's the ideal way that we should live. Do we live like that? Unfortunately, for the majority of people, we don't.

Speaker 2:
[62:49] Not enough.

Speaker 1:
[62:49] Not enough.

Speaker 2:
[62:51] And not to get too nuts and bolts, but how do you pay for it?

Speaker 1:
[62:57] Thankfully, as more competition comes, prices will drop, right? Because right now, we have a monopoly between Novo Nordisk and between Eli Lilly. Those are the only two companies that are making GLP-1 medication. So as most competition comes, their prices will drop. Now, both pharmaceuticals, now they offer direct-to-consumer pharmacy, meaning that they're bypassing health insurance, the PBM, which is a company between the health insurance and the pharmacy, and then the pharmacy costs. So that really decreases the price. If your insurance doesn't cover it, if you're paying out of pocket, you should use the direct pharmacies. Nobody this day should be paying full price for any of the FDA approved GLP-1 medications. If you have insurance and your insurance is not covering it, you have a commercial coupon that decreases the price for half. If your insurance doesn't cover it or you don't have insurance, you use one of the direct pharmacies that brings the cost to one-fourth of it, right? Or if you're lucky enough and your insurance covers it, well, it's $25 for you.

Speaker 2:
[64:00] How can people engage with you?

Speaker 1:
[64:03] My social media, my Instagram handle. I mean, honestly, and it's not because you know you don't make money in books. It's because I made this book. It's like me in the book, walking you through everything. So if you have the book with you and the book is designed for you to read it back and forth, to go back to certain chapters, that book is me, the specialist that you see here, with you at home or at your doctor's office. So the next second best thing for me is really my book.

Speaker 2:
[64:33] Waitlist. And you don't even need an appointment.

Speaker 1:
[64:36] Then you don't need an appointment because it's like until four or five months waiting, so you don't have to wait.

Speaker 2:
[64:42] This is so fantastic. Thank you very much.

Speaker 1:
[64:44] No, thank you so much too.