Please note: transcript not 100% accurate.
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00:00
This is a true modern medical miracle. It deserves a lot of respect and we can use this to undo a lot of disease. It does not mean that it needs to be the only thing we need to do.
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Welcome to Uncover Your Eyes, where we break down the most pressing health topics shaping lives today. Obesity is a condition that is often misunderstood and stigmatized, but it is affecting millions worldwide. With groundbreaking medication and treatments, will this help us in the fight against obesity?
00:48
I am excited to have Dr. Alexandra Sowa, a physician in internal and obesity medicine and the author of a bestselling new release, The Ozempic Revolution. Welcome Dr. Sowa. Thank you so much, Dr. Sowa, for being on today. Really appreciate your time, especially being so busy with the launch of the book. Yes, it’s been a really exciting week. We launched a week ago today, but I’m so excited to talk to as many people as possible and
01:16
spread the word. I’m on a mission to just educate. So thank you for having me. I love that. So, you know, talk to me about obesity. Like, I don’t think people bring light to this common condition as often as they should. So the science behind it and how many people are obese. Oh gosh. Okay. So just to like, I’m sure you included this in the intro, but I’m an obesity medicine doctor. So I’ve made this my whole specialty my whole life.
01:45
because I feel like it’s so under discussed and it is a disease state. And that’s so shocking to hear, but excess weight in excess, weight in excess leads to a lot of downstream diseases. And I was very disillusioned in my medical training that so much of our education was spent on managing end of disease states and instead of focused on
02:15
And in the field of obesity medicine, I’m able to really affect long-term change and prevent and reverse disease. So that’s my perspective on this. Obesity and metabolic dysfunction affects a vast majority of the population. So in the United States, we are approaching 50% obesity rates and up to 70% fall into
02:44
metabolic dysfunction plus excess weight. So their BMI is in the overweight with the comorbidity, meaning a health condition related to weight or in the obesity category. Even more shocking is the fact that only 12% of American adults meet criteria for full metabolic health. Wow. Yeah. So 88% experience some level of metabolic health dysfunction and that leads
03:12
disease. So we’re seeing cholesterol abnormalities, waist circumference that’s too large, blood sugar that’s too elevated, and it’s a big predictor of future risk of health. So we have a big problem. It’s not just isolated to the United States. It’s global. It’s a global pandemic. It is the entirety of the world has changed how we eat, how we work, how we vacation, our hobbies or lack thereof. We sit on it.
03:41
couch or a computer, we’re talking through a computer screen right now, which is great, but there’s a lot of sedentary lifestyle behavior. And we don’t eat all that great. And I’m not placing the blame on the individual here. Really it’s a societal level and it really is about how we’re feeding people and the economics of scale of food have really come crashing down on us in the past 40 years.
04:07
So obesity is a problem because it affects a lot of people and it is tied to the vast majority of chronic disease. So everything from 16 types of cancer to heart disease, to stroke, to type two diabetes, to kidney disease, to dementia, to sleep apnea, like the list goes on and on. So.
04:33
The good news is though, if you’re able to treat obesity and treat it like a chronic condition, you are able to reverse and prevent all of those downstream diseases. So I find it to be the most important specialty in medicine. Of course. It’s more healthy, but it’s a big issue. And if it doesn’t personally affect you, I’m positive that everyone listening to this has a patient, has a friend, has a family member who’s dealing with it.
05:02
So we also need to learn how to have that conversation beyond ourselves and to rewire some of the weight bias and stigma that we’ve all kind of grown up with too. Right, so on that note, like it’s a stigma to be called obese or to discuss it. And a lot of patients who are suffering from obesity are afraid to go into their family doctors even to.
05:29
you know, just be told they’re obese, you know? And so what are the challenges that they face and how can they overcome that? Yeah. So the first chapter, the intro chapter to my book, The Ozumbic Revolution is called Why Doctors Have Failed Us and How They Failed Us. Unfortunately, it has been very hard for traditional medicine to help a patient with obesity.
05:57
And that has translated into a lot, for lack of a better word, but really it is the word trauma to the individual patient because what do we hear? We hear that someone with, who is suffering from excess weight goes in and says, I have a sore throat. And instead of someone checking them out for strep throat or reflux or just saying, you gotta lose weight. It’s like, hold on. Like we can, yes, it might be an important part of health, but we really need to look at the individual.
06:25
This is like the third time I’ve actually heard this today. I am seeing patients and then I saw patients this morning and I’m talking to you and people were like, I just haven’t wanted to go to the doctor for so long. I’ve been so embarrassed. Don’t be, don’t be, find the right doctor. And if someone has made you feel like this, time to move on. It’s not you, it is them. Unfortunately, there is just a lot of weight bias. When I started my medical training, remember telling people that I wanted to do this.
06:52
And it was an unknown field at the time, not too long ago, but unknown. And people would be like, Oh, why do you want to work with those sort of people? And I’m like, what do you mean those sort of people? Like what, I don’t know. I couldn’t even wrap my head around it. Um, but unfortunately it exists. It exists in medicine. Weight bias exists within all of us. I even carry some of it with me, even though this is what I’ve dedicated my life to, I’m society at large. Like we’re surrounded by weight bias, but.
07:22
These medications are helping us strip away at it. I’m positive because people are starting to finally see that weight, excess weight is a disease. It’s a chronic disease and people are willing to share their stories. Now, social media has been so amazing. So many people are like, I’m taking a shot and I’m gonna share it with you. And this is amazing. And I always thought this was my problem, but it’s not because this is helping fix something that was so deregulated in my brain. And now I can do all the things that everyone always told me to do and I have the bandwidth to do it.
07:52
And so they have really, truly, these medications have been a revolution in starting to change the whole conversation about how we treat obesity. Yeah. And I think that’s why I was interested in it because a lot of times patients who are obese, I mean, you must go through this. It’s not easy to lose weight. Being told and actually doing it are two different things, right? Let’s talk about the meds. Like, I want to call them the magic drugs, but you know, you call them what you want.
08:20
I want to say that the regulators or whatever they are, but what are they and what are they doing? Yeah. Okay. So I’m going to quickly talk about one other thing before we get into the meds. Let’s talk about why it is so hard. It is so hard to lose weight. Ideally, we live in a world where we get to prevent waking, but once waking comes on in significant way, and we’ve held onto it for many years, we have significant neurohormonal
08:50
our hormones become severely disrupted and our brain and our endocrine hormones, including fat, do not respond the right way to signals. So we have everything from insulin resistance to leptin resistance, and it doesn’t matter how well you eat or how much you work out, your body’s gonna be like, well, I got that upregulation signal to store fat, so I’m just gonna keep storing fat. So…
09:17
If that’s why people come to me and they say, I’ve been doing everything possible and nothing is budging and the weight keeps going up and the weight keeps going up. So GLP-1 medications are part of this amazing fix really to this neurohormonal dysregulation. So I talk about this in the book, but I try to break it down from the very beginning. I want people to understand everything we’re talking about. So we go through the science of obesity and we talk…
09:46
about the hormones that become disrupted. And there are about eight main hormones, really have about 40 to 100 that are at play here. But the big ones that we’ve identified, one of them is actually GLP-1. GLP-1 is a hormone that is created natively in our body. The problem is, like the hormones insulin and leptin, they become…
10:12
dysregulated, they do not do their job as they should as we start to put on weight. It’s not even the act of putting on weight. A lot of times it’s the food we eat, the hyper palatable food, the junk food as it were, that surrounds us from every single angle. Even if you try your best, it disrupts the balance between GLP-1 and our brain. And it actually damages our brain in these foods. It really does. It goes down to that sort of level. It’s not just…
10:40
calories or poor food choices. So GLP-1 medications are like these hormones that we make in our body, but they’re a thousand times stronger. And so they help us fix and override what has become resistant. The medications through the years, they’ve been around since 2005 actually GLP-1 medications. People don’t realize that.
11:08
But every few years we’ve had a better and more effective and better tolerated iteration of the drugs. And recently with the rise of Ozempic, we go V, Monjaro and Zep-bound, so semagulatide or trisepatide. They are weekly injectables of a GLP-1 analog. So they mimic the hormone in our body and they’ve gotten very close to how our hormones exist in the natural state, but they…
11:37
are so much more effective because they last a long time. Native GLP-1 in our body lasts only a few seconds and then degrades. These medications have a very long half-life and that’s why we only have to dose them once a week. So they’re just much more powerful. And they work at the level of the brain. They work at the level of the digestive tract, slowing down our food so that our hormones are be…
12:04
better able to respond and we have a sense of fullness. And they talk to us at the level of the pancreas and they make our body a lot more insulin sensitive and regulate blood sugar. They’re super powerful. And beyond the weight loss benefits or the type two diabetes blood sugar management benefits, we have a lot of other benefits that are coming from these medications because we have GLP-1 receptors all over the body, the heart.
12:31
brain, the kidneys. We’re just seeing improvement all over the place. They are truly a modern miracle in what they’ve been able to do for us, but that does not mean everyone should be on them. Which I do want to talk about later as well, but you mentioned the main mechanisms of actions. You talk in the book, I think about them being there’s a few superpowers that you truly believe are
13:01
exactly what we had just gone through. So they talk to our brain and they really quiet the food noise. And that’s a term coined by social media, but it’s so true. People just say, I just don’t think 24 seven about my next about food. You know, I’m not eating one meal and thinking about my next meal. My brain has just given me space back. And they work on the level of the pancreas. And again,
13:28
the level, on blood sugar, it’s very, very powerful because the majority of chronic disease comes from inflammation from excess blood sugar. So it keeps our blood sugar nice and stable. And when you take in a carbohydrate or any sort of food and it breaks down, these medications help us regulate very quickly. And then at the level of digestive tract and just telling us to not be as hungry, they’re very powerful. And anyone who’s been on these
13:58
that it just profoundly changes the way that they approach food and healthy lifestyle. So a lot of patients are on drugs like metformin. That’s probably one of the most common drugs. You don’t have to go through the whole mechanism of action, but what is the main difference between somebody taking metformin versus someone taking one of these drugs? I love metformin. I like it for a lot of reasons. It is well studied. It’s been around for a very long time and it’s affordable.
14:27
and it’s effective. The big difference is that metformin, it works at the same level of making your body more sensitive to the insulin that it already produces. And that’s great because it’s really good blood sugar stabilizer. And because of that, metformin is actually an effective weight management tool, but it has a limit. So we can use that, but we’re going to have much smaller percentages of weight loss and we’re not going to see it across the board like we do with GLP-1s.
14:57
is isolated to its benefits in blood sugar. Now, those downstream benefits that we were talking about, if you can reduce blood sugar, you reduce all sorts of other chronic inflammation and disease. And so metformin in many circles is kind of seen as a great longevity tool and has been for a long time. What we’re seeing with GLP-1s though is that they work more systemically and more…
15:22
dramatically and on weight loss percentages, they’re very different. So for metformin, which in the United States is not approved as a weight management tool, but you can see around 6% of total body weight loss in a year on it. With these other medications, we’re seeing upwards of 15 to 25% of total body weight loss. So they’re just really playing in different fields. Wow. So, you know, you mentioned it’s not for everybody.
15:49
So who, I mean, I want to be on this drug. So who is it not for? So in the book, I talk the patient through thinking about their health holistically because I do think a lot of people are seeking out this prescription or getting this prescription, especially in the United States, potentially just a little willy nilly. And I want people to be getting their baseline labs. I want them to be looking at-
16:18
where we’re starting to know where we’re going and why we’re doing this. I think that we need to understand if someone has any metabolic dysfunction. Do you have insulin resistance yet? Are you in the pre-diabetes range? Are you beyond that when we’re starting these medications? What else is going on in your life? Let’s do a sleep inventory. Let’s look at sleep apnea. Let’s look at stress levels. Let’s look at diet. I mean, we haven’t talked about diet yet, but it’s…
16:46
A third of my book is about how to eat because these meds aren’t a magic wand. They aren’t magic. You have to put in the work. So let’s look at how you’re eating and how you’re thinking and is your relationship with food emotional? And I have a whole way for a patient to take themselves through this process because truth is, most doctor’s offices do not have knowledge base of this or the time. You know, there’s so much to deal with when you go into your short doctor’s visit, even waiting months for it.
17:15
So we have to kind of do that inventory first to understand. Now by the United States FDA, there are very clear guidelines that have really set the precedent for how this drug is delivered throughout the world. And that is for weight management, you have a BMI or body mass index greater than 30, or a body mass index greater than 27 with something called the comorbidity, which is a health related issue related to weight. So…
17:45
high blood pressure, high cholesterol, osteoarthritis, pre-diabetes. And you would be like, well, that sounds fine, but that doesn’t mean, that’s not me. Often people don’t understand what a BMI of 27 looks like and really are missing some of the underlying health ramifications that come with that. So that’s kind of how the FDA sets it out. I think that the field of obesity medicine
18:14
might start to widen the scope of who we treat, one, based on that holistic outlook. If you’re someone who had a very low BMI for your entire life and in a year’s time because you were put on a medication or you experienced menopause or something and you very dramatically put on a significant weight in your midsection that’s causing insulin resistance, you might meet criteria for this disease beyond what the FDA says, using something off-label. I also think it’s really important to start looking up.
18:44
body fat mass and body composition as a tool, because often that’s a much, I mean, not often, it is a much better evaluation of how someone is metabolically. Like BMI is really inexact, it’s just weight versus height, and that can be very different person to person. Body composition doesn’t lie. And so if we’re starting to look at body fat percentages, that’s very different. Unfortunately, it’s a little expensive and hard.
19:11
to get that number, and that’s why we use this easy basic screening tool. So really, that’s kind of how we set this out for weight management, but there is room for nuance. But with that said, this medication really shouldn’t just be used to go from thin to thinner or- Yes. That’s the part where I’m starting to get really worried about and why I wrote this book being like, you need to understand if this is right for you, because if you start this medication, you will likely need to be on it for the very long term.
19:40
And so we shouldn’t just be using this willy-nilly and kind of handing it out like candy for a couple of pounds or a health issue that you might be able to reverse through lifestyle loan first. So that’s a great segue. Like Mike, next question would be, how long do you have to be on this drug for it to be effective? No one wants to hear this, but this drug is approved for long-term use.
20:09
and all of our randomized controlled trials, which I lay out in the books so people can see the evidence, really do show that for the overwhelming majority of people, 95% who lose weight on these drugs, they need to stay on these drugs. And if you take away the medication, the weight comes back. Yeah.
20:33
So this is a very important thing for people to understand. They shouldn’t be scared of it because again, we’re not scared when someone says, hey, listen, your blood pressure is getting to a place that’s causing harm. We should use a medication and you’re probably gonna have to be on this for life. Same thing with cholesterol management. We want to really, I mean, my ideal world, even though I wrote the book on this, is that ideally in a generation or two.
21:00
we’ve been able to use this medication as a tool to really reverse all of our habits and reset our world and think about prevention differently. And hopefully we get to be a place where we’re preventing from the beginning. But if we get to a place where the disease is starting to take over, we have to consider starting this drug and then you have to be aware that you might need to continue it. And I’m seeing a lot of misinformation on social media about this. I think a lot of people are trying to sell their plans of join me on my med free maintenance or, you know.
21:30
Once you’re there, and a lot of doctors will tell my patients, oh, good, you got your goal weight, now you can stop. And that’s not how it works. I mean, you have to be very careful about that because if we stop, the same thing that happens with yo-yo dieting, which is up and down and up and down, every time you lose weight, it gets harder to lose weight. The next time, why? Because we mess with our basal metabolic rate, and every time we gain weight, we’re putting on more fat mass, which makes it harder.
21:55
to then lose weight the next time and we need less calories. And so if you stop this med, regain and have to go on the same med again, it might not have the same efficacy because weight loss is going to be harder and we might be putting you in more health deficit. So if this isn’t something mentally, physically, financially, you can see yourself starting and maintaining for the foreseeable future. We need to have a conversation if this is the right fit for you. So okay, did I hear you correctly?
22:24
You need to pretty much be on it the rest of life if you’re going to start on it. And then if you stop it, you will gain all the way back. Yeah. Like, not maintaining it. I thought it was like maintain it. So you know, it helps you kind of get on track and then you can stop it. And then with all your, you know, lifestyle changes that you’re planning to make, it will help you kind of stay on that weight track.
22:49
Yeah, we should just eliminate the first part of this conversation and just start here because this is the biggest misconception. And it’s really important for people to understand. So the same neurohormonal dysregulation we were talking about, the hormone is getting disrupted. If we are able to fix that with this synthetic hormone, which is a GLP-1 med, same thing. Like if you were treating hypothyroidism, just because we get your thyroid levels down, we don’t take away the Synthroid.
23:16
the lab with the rocks and so same thing we need this because this is fixing an imbalance. With that said, there are some people who can come off of it and I write about this in the book, the case studies are the people that are most able and I’ll tell some people this, I’ll say at the beginning, I think you’re going to be a good candidate for coming off this medication and that will should be our goal. You might need it again in the future and if we can’t come off of it, it’s not a failure, you know, but I think you might be that person.
23:46
That typically tends to be people who, for the majority of their life, were lean and of a normal weight and something happened. So it could be treatment with another medication that was weight gaining, health illness, health condition, life circumstance. This happened a lot in COVID. People were like, I just put on 40 pounds in COVID. I don’t even know what happened. I was so stressed out. And then they would come to me. I was able to use tools like GLP-1s.
24:16
get back to just some normalcy and then go off of the medications. Pregnancy, IVF often puts a lot of weight on. And so after a pregnancy and a successful pregnancy, we might need to use these medications because your body just doesn’t understand itself anymore. And those are the patients who I’m most likely able to take off these meds. Now they also need to do the work of eating properly, which I outline in the book about exactly what that means. They’re getting an adequate protein. They’re really…
24:45
looking at a whole foods diet and strength training. So as we’re losing weight, we’re not just losing, we’re increasing our muscle mass ratio and strength training is a big part of that. So it’s going to take a work. And even if you put in the work and you can’t come off the meds, it’s not a failure of you. It is truly just biology. So a lot of people are afraid of these drugs or going on it, even if their doctor recommends it that they’re an ideal candidate.
25:14
I hear about the horrible side effects. Can we speak to those? The majority of users will experience some side effects. That is expected and it’s a byproduct of how the drug works. If you’re in the United States, you can actually try out a product line that I developed specifically for GLP-1 users. It’s called Sowell. We have a GLP-1 support system because if you just know what to take and how to eat and how to prevent some of these side effects and how to manage them, they’re very manageable.
25:43
but a lot of people aren’t getting the support. In the book, I have exactly how to get on top of constipation and diarrhea and what to ask your doctor for, what to buy at the grocery store, at the pharmacy, what supplements might you need to help with constipation, to help with nausea. They’re there, but they’re very manageable. And I do find that the majority of people who have terrible side effects are not eating well. And no one told them, hey,
26:11
You really have to watch that you don’t eat to a point of fullness. And you’re going to want to make sure that you’re really eating whole foods. And if you eat processed carbs, you might have instant diarrhea. If you’re eating too leafy, too healthy, to be honest, if you’re eating too many vegetables at the beginning, it can really hurt your stomach because there’s not enough volume for the foods you do need. And you can get a lot of bloating and stomach discomfort. The other side effects that are.
26:38
pretty high up there, some fatigue that can be expected. It’s usually a relative hypoglycemia. It’s not too low of blood sugar, but it’s a little bit lower than where you operate it. So your body tracks it as fatigue. Generally the side effects get better as we go on. And I encourage people not to go up on their dosage is if they’re feeling the GI side effects, your body might need some more time to regulate. These drugs are not made to make you miserable. So if you’re miserable,
27:07
we’ve got to pivot. And I have a lot of tips and tricks in this because in my practice, nobody has to stop these meds. With that said, those are not… I don’t even really consider them side effects. They’re like nuisance. They’re just like nuisances. They’re very manageable. The other side effects that we have to think about, one of the big things, and I call this out, it’s a byproduct of weight loss, not of these drugs, but a big weight loss. We can develop gallstones.
27:35
And so we have to watch out for gallstone formation, gallbladder pain, and gallstones that can potentially get stuck in the biliary tree and cause pancreatitis. So kind of walk patients through knowing what that looks like. There are some other potential things we have our eye on that might kind of have to monitor people on these drugs, but overall they are very, very, very, very, very safe.
28:04
I honestly would say that there are very few medicines that I have in my whole toolkit as a doctor that have less kind of need to monitor things or long-term side effects or these are very, very safe. And we’ve studied them on such a large level at this point. I mean, I’ve pulled all of the data into the book so people can see it, but the fear mongering about these meds
28:31
I truly believe is rooted in weight bias more than anything else because the safety data is really there. What is like, you know, you mentioned the long-term safety. So, you know, these drugs have been around for, you know, 20 years, I want to say, more so in the last 10 years for weight loss, I guess, but 20 years for diabetes. What is like the worst complication you have seen long-term with long-term use of this
28:56
I know you mentioned the gallstone things. Would that be the worst you would say? I would actually say yes, but the good thing is that’s very treatable and it’s also preventable if we stay on top of our symptoms. So I had a patient who was ignoring her symptoms, even though I’m her doctor, and she’s like, oh, I’m just getting pain in my great upper quadrant after eating, but I’m on vacation and I want to ignore it. And then she came back.
29:20
and we got her an ultrasound and she had some gallstones. And then she was ignoring it even more, even though she knew she had the gallstones. And one of those gallstones got stuck in the biliary tree and needed intervention. So she had her gallbladder out, but then she needed a little procedure to get the gallstone out. You know, it’s not benign to have that happen to you, but we are able to generally go in and fix that. And so she’s doing well. And she’s actually back on the drugs now, because it wasn’t, again, it wasn’t the drugs and you don’t have to have a gallbladder to have these medications. So that’s one of the things we look out for.
29:50
I’d say in your field, I’d be curious to hear what you think about the new data on Nion, non-arteritic ischemia in the eye. Some new data is coming out that potentially at night there’s some hypotension in particular use case scenarios where there’s not enough blood pressure, blood pressure really to the eye and it’s causing some problems. But I would say the data on that is…
30:17
very sparse and we’re now monitoring it. Anytime something like this comes up, it goes out to a much larger population of hundreds of thousands and we look at the data. And everything that’s kind of come up, like everything from thyroid cancers or pancreatitis, anything that’s been a concern at the large population scale is not a concern. So we take the drug companies really do, and the FDA and the United States really takes this seriously.
30:46
I know a lot of people don’t believe it, but I’ve really dug into all of the studies and anytime there’s a little concern, they go out to a much, much, much larger population and study it widely. So I’d say we got to stand on top of it and keep looking and everyone’s unique and individual, but on a population scale, these are very, very safe. Thank you for mentioning the eyes. I actually did have a patient who’s on Ozempic and did have an NA-ION and actually did have loss of vision. But I mean, I haven’t seen that in a long time and that was more recent.
31:16
And you know what, even if we had seen it before, I don’t know if we would have made that connection, but it’s important for us to warn our patients on Ozempic of these symptoms so that we can be on top of it earlier rather than later. Exactly. And I think that’s about it. It’s really about warning and knowing that it is very small, but we should just be prepared. And so we have monitoring and surveillance. Is there anything else I’ve seen? No. I mean, really, the worst probable thing is that someone…
31:45
totally accidentally, even though it was very clear about how to take the medication, like way overdosed themselves on the first shot and they felt terrible. You’re not going to die. You just feel horrible and had to go to the ER for some hydration because they really couldn’t keep anything down and they needed some IV hydration. But then after a few days they were totally fine. And then we went back to the actual real true starting dose.
32:10
Are there any, like, I know we covered a lot of the myths and you kind of debunked a lot of them. Is there something that you feel there’s another myth that you feel is very common? Yeah, I think the most common myth I see is that this is a magic wand and like you just take a shot and you move on and people are like, well, you’re taking the easy way out. My book lays out all of the work that needs to go into this to make this truly healthy, truly sustainable, truly effective. And it involves…
32:38
habits, daily habits and learning how to habit stack. And we talk about being emotionally neutral about stepping on the scale, right? We need to rewire a lot of our behaviors that led us to this place in the first place. We need to put in significant work into nutrition. It doesn’t need to be oppressive. It doesn’t need to feel like a diet, but we need to change things. And then we also need to really stay on top of how our brain is thinking about this, how it’s sabotaging itself.
33:07
how you’re responding to the stimuli from the outside world and how you’re dealing with things like emotional eating. We need to do the work to fix that. And then also the lifestyle elements like strength training and working out. So truthfully, nobody comes into my practice and just gets a prescription. I’m crazy about the fact that this needs to be lifestyle top down. And I really felt like people needed to hear this and to see it and to know that this is the responsible and the effective.
33:34
but most effective way to take this medication. It’s not the easy way out. This has been a horrible struggle for people suffering with obesity for the majority of their life. It’s been nothing is easy about it. And the fact that we’re able to give them something now that will help them finally do these things that they’ve been beating themselves up for years about not being able to do, that’s amazing. But there’s still a lot more work. So yeah.
34:04
Is it just cost? I mean, do they all have the same method of action or is there one you prefer versus the other? So the two main classes of GLP-1 drugs right now. So GLP-1 is at the base of all of them, but we have semagulatide and then we have trisapatide. Semagulatide is ozempic and migovi, type 2 diabetes indication, weight management indication. Ozempic goes up to a full dose of 2 milligrams. Migovi goes up to 2.4.
34:29
So it goes up a little higher. We actually need some higher dosages in the weight loss trials to really get to the weight loss beyond what we need for good blood sugar management. The dual agonist, so GLP-1 plus GIP hormone is terzepotide. Now we have a triagonist in development that will probably be out by the end of this year. So more hormones in one. So there are a lot of new drugs in development, but the terzepotide drug
34:57
ZepBound is for weight loss and Menjaro is for type 2 diabetes. They are literally the exact same. The dosing is the exact same. There’s nothing different about them. Their names are just different in the United States. The dual agonists are more effective across the board at type 2 diabetes management and weight loss. I don’t necessarily… And I’ll also say in their favor, there are a lot of positives for the dual agonists. They are better tolerated GI side effect wise, but…
35:24
It does not mean everyone to start there. I’ve had people thrive on smegulotide only for years before I had the dual agonist. And I think we will start to see kind of targeted intervention of who gets what and what they need based on how much weight loss, comorbidities, tolerability. I don’t necessarily think we always have to jump to the next new medication, even if it shows more efficacy, some of these drugs that have been around a little bit longer.
35:52
have a lot of value. I talk about this on the book. I compare them to the old anti-obesity medications. I talk about what you can expect with these newer versions of what might be right for you and what you as a clinician. I mean, really, I think this is like a must read for every clinician, just kind of knowing what the journey is, the emotional part of it, but also just like the science facts of like, you should expect this, and then you can expect this on this drug, and I’m looking at the science. So.
36:18
Is Ozempic, you know, you talk about, the book is called The Ozempic Revolution. So is this the future, like, do you foresee as this the future of healthcare, you know, in terms of obesity? Yes. Just very plain and simple. Yes. This is a true modern medical miracle. It…
36:39
deserves a lot of respect and we can use this to undo a lot of disease. It does not mean that it needs to be the only thing we need to do. I get a lot of pushback and I see around me in the media a lot of talk of, well, we should just, if we could just give every person, you know, clean meals, they would be able to fix this. We know that’s not actually true. Once the disease comes on,
37:04
The cure for the disease, the treatment for the disease needs to be different than the prevention. So yes, this is the future of obesity care. I hope this gives us time and space to start to fix the things that got us into this predicament in the first place. You gave me goosebumps when you said that. That’s amazing. Thank you so much for everything, Dr. Soa, today. Can you tell our listeners, viewers, where they can find your book?
37:31
Yes, well you can find me on social media @AlexandraSowaMD across all platforms. And you can find the book wherever books are sold. Amazon might be best for our international friends and I think Indigo Books. Yes. I should be canvassing it soon. So you can also just request, the more that we request this book and support your local bookstores, they’ll be able to get it in and we’ll get it in more places. Thank you so much, Dr. Zowa. Thank you. Thank you, listeners and viewers, for tuning in.
37:59
If you want to catch more episodes of Uncover Your Eyes, make sure to Follow or Subscribe on your favorite podcast platform and on YouTube. To learn more about me, follow me on Instagram @Dr.MeenalAgarwal Until next time, keep those eyes uncovered.!