Speaker 2: Hello.
Speaker 1: This is the Itchy and Bitchy Podcast because being itchy
Speaker 1: is bitchy and our medical system sucks. I'm doctor Keith Nolica,
Speaker 1: a vetnary, allergist and dermatologist.
Speaker 2: And I'm Stephen Miller, a doctor of nursing practice and
Speaker 2: a Q Care nurse practitioner.
Speaker 1: Send us your questions at ask at itch not dot com.
Speaker 1: We love you, but we're not your doctors. The information
Speaker 1: we discuss is not direct medical advice. Please talk to
Speaker 1: your provider who is the expert on your care. The
Speaker 1: Itchy and Bitchi podcast is sponsored by doc Itchy Medical
Speaker 1: Pets supplements designed to optimize your pet's health with the
Speaker 1: latest veterinary medical research. Visit docichi dot com or find
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Speaker 1: send us a question at it ask at itchn dot com.
Speaker 1: Thanks hello, and welcome back to Itchy and Bitchy podcast.
Speaker 1: How are you, doctor Miller?
Speaker 2: We are so good?
Speaker 1: Okay, So this is our first first episode of questions
Speaker 1: that we got from our listeners, and we actually probably
Speaker 1: Karen has listeners from all over the world actually, so
Speaker 1: we definitely have some from the United States, but we
Speaker 1: also have dozens of listeners in Australia about Canada, Europe, Alaska.
Speaker 2: Hello out there.
Speaker 1: Yeah, big wide world. So hello to everyone, and thank
Speaker 1: you guys for listening to us.
Speaker 2: Thank you, yeah, thanks for listening.
Speaker 1: So we got some questions from our listeners and we're
Speaker 1: gonna ask us many our answer as many as we
Speaker 1: can as we go along. We don't want to make
Speaker 1: this too tedious, but we picked out some of the
Speaker 1: most interesting and useful to answer. Doctor Miller also got
Speaker 1: a screenshot of us recording and we're wearing our Puerto
Speaker 1: Rican San Jose bling. We have a studio set up
Speaker 1: in Puerto Rico that we visit sometimes, so that's why
Speaker 1: we're all decked out in our Puerto Rican attire.
Speaker 2: So we are we support the island.
Speaker 1: If you're interested in that, you can check out our
Speaker 1: website at where would the website be Itchy and Bitchy.
Speaker 2: Dot combitchi dot com or please go on and like
Speaker 2: I and b Podcast on Facebook.
Speaker 1: Yep, okay, so ready, So we're gonna divide this up
Speaker 1: and we're gonna have a few breaks. We're going to
Speaker 1: try to get to as many questions as we can.
Speaker 1: Are you ready care, captain, We're ready to roll. Okay,
Speaker 1: So the first question is from Tiffany from Atlanta. She's
Speaker 1: fifty six years old female, and she asked us that
Speaker 1: her doctor. She said, my doctor started me on GLP
Speaker 1: one and HRT simultaneously, so at the same time. And
Speaker 1: then she says Reddit went crazy and she wants to
Speaker 1: know am I over medicating? And so my opinion is, doctor,
Speaker 1: Reddit is not a thing, So check with your provider.
Speaker 1: Your provider is the expert on you, and that would
Speaker 1: be my first response to that. Probably there's some medical
Speaker 1: data as far as GLP ones and HRT.
Speaker 2: Yeah, so it's worrisome, but you know, when you and
Speaker 2: your particular situation have a therapy change and you put
Speaker 2: that out there in the world, and so then all
Speaker 2: kinds of people with varying opinions weigh in, and so
Speaker 2: I think it's important to definitely trust your provider and
Speaker 2: at least balance ideas and questions off your provider. Now,
Speaker 2: on the hormone side, it is the interesting More and
Speaker 2: more information is coming out on the GLP one ras
Speaker 2: and in women with PCOS, which is polycystic ovarian syndrome
Speaker 2: which can be tied to obesity and hyperinsulinism. In this
Speaker 2: and that there is an issue related to testosterone levels
Speaker 2: rising as part of PCOS and so lyriglue tide is
Speaker 2: found to reduce serum testosterone levels over about a three
Speaker 2: month period, which then it leads to improved androgen profiles.
Speaker 2: And so it's important to remember too with weight loss
Speaker 2: that all the six hortomones are fat soluble hormones, so
Speaker 2: there's this shift that happens. This particular study came from
Speaker 2: a systematic review of glp ones in patients that had
Speaker 2: metabolic syndrome.
Speaker 1: Okay, so that was a lot of information. So what
Speaker 1: I got from that is that the hormones and the
Speaker 1: glp ones are definitely interacting. When you start losing weight,
Speaker 1: some of the hormones that have been deposited in the
Speaker 1: fat are going to be released. You're going to have
Speaker 1: fluctuations there. It sounded to me like you need to
Speaker 1: have an expert that would be your provider monitoring hormone
Speaker 1: levels and checking and really doing a frequent revisit monitoring
Speaker 1: rather than in every six months kind of situation.
Speaker 2: Yeah.
Speaker 1: It also you mentioned and polycystic ovary disease. How common
Speaker 1: is that?
Speaker 2: It's extremely common, certainly as BMI goes up, people start
Speaker 2: to develop pcos and then there's also some reproductive repercussions
Speaker 2: that come from that. And so the GLP one a
Speaker 2: is also are thought to impact estrogen mediated pathways and
Speaker 2: reduce viseral fat, which then can potentially have impact on
Speaker 2: gonatal effects and weight loss mediated effects for reproduction.
Speaker 1: Yeah, so previously we did an episode and I compared
Speaker 1: this whole hormone pituitary cascade, like having fifteen toilets interlinked,
Speaker 1: and you have all of these water flows and crazy
Speaker 1: ups and downs and feedback loops and everything, and it
Speaker 1: really is a very very complicated system just with the
Speaker 1: HRT and the hormone issue, but then you add on
Speaker 1: to that the GLP one which can have some dreg
Speaker 1: influence on hormones, but also as you start degrading the
Speaker 1: fat and losing the weight, then that also changes the
Speaker 1: water level and the tanks and the hormone levels. So
Speaker 1: it gets really really complex. So would you would have
Speaker 1: if this were your patient, and we're not your we're
Speaker 1: not your doctors, but it would have been better to
Speaker 1: do one for six months and then do the other,
Speaker 1: or is it bad to do both at the same time?
Speaker 1: If they're not, you know, and this depends on.
Speaker 2: How I think it met it possible to make that
Speaker 2: call because we just don't have enough information on this
Speaker 2: particular evaluate the patient, and so I think a full
Speaker 2: evaluation with full hormone levels. I do think that we
Speaker 2: underestimate the impact of weight gain, and certainly even among men,
Speaker 2: there's been some association with gp one ras and increases
Speaker 2: in testosterone levels as people lose weight as well.
Speaker 1: So definitely contact your your doctor. Taught asked these questions
Speaker 1: to them. But Reddit is not really a great source.
Speaker 1: You know, I've been involved in Reddit and various marketing
Speaker 1: and science and data and you know, I have a
Speaker 1: textbook that I've written, and Reddit is public source and
Speaker 1: there's some usefulness in that. But these are not people
Speaker 1: that know your situation. They can say, you know, space
Speaker 1: aliens came down and stole your ovary and there's just
Speaker 1: no you know, rhyme or reason to some of the
Speaker 1: stuff on Reddit. So talk to your provider. Definitely, there
Speaker 1: can be some interactions. If you're definitely having any symptoms
Speaker 1: that seem a typical, absolutely get evaluated again. Okay, any
Speaker 1: last thoughts on on.
Speaker 2: Tiffany Tiffany Yeah, thank you so much for engaging with us.
Speaker 2: And I think you are certainly inquisitive and would like
Speaker 2: more information, so make sure that you follow up with
Speaker 2: your hormonal expert that you're seeing perfect.
Speaker 1: Yes, So Reddit's not a doctor and we're not your
Speaker 1: experts on you your provider, so seek more information. Okay, we're
Speaker 1: going to do one more question, then we're going to
Speaker 1: take a break. So this is from Luke, who's fifty
Speaker 1: nine years old from New York and this is actually
Speaker 1: a guy, so that's good. So mainly we have women
Speaker 1: listening to the podcast because of all the work Karen's done.
Speaker 1: So Luke wants to know do I have brain fog
Speaker 1: or Alzheimer's And he doesn't really give much more detail
Speaker 1: than that. So definitely, we're not your provider. We're not
Speaker 1: your doctor, so seek medical assistance. But I think this
Speaker 1: is a really common question. I'm fifty eight. I think
Speaker 1: maybe fifty nine. I'd have to calculate. I'm not so
Speaker 1: great at math. But I actually ask this to my
Speaker 1: groc I have a Tesla so it comes with free
Speaker 1: groc Ai and I couldn't remember what day of the
Speaker 1: week it was, like, I really had trouble remembering if
Speaker 1: it was Thursday or Friday. I have a housekeeper that
Speaker 1: comes on Friday, so that's important if I have to
Speaker 1: get the house set up. I really couldn't remember, so
Speaker 1: on the way to work, I actually used the AI
Speaker 1: in the car and asked, do I have early on
Speaker 1: set dementia or Alzheimer's if I can't remember what day
Speaker 1: of the week it was? And it said, what do
Speaker 1: you think?
Speaker 2: It said doctor Miller, Well, I mean dementia among our
Speaker 2: age group, early dementia is very rare, very rare.
Speaker 1: Correct, so statistically probably not. And then it also said
Speaker 1: that really most likely not, that you're probably stressed, fatigued,
Speaker 1: overwhelmed with other issues. That true, Alzheimer's is not necessarily
Speaker 1: dementia is not really forgetting where you park the car,
Speaker 1: but it's totally forgetting that you have a car and
Speaker 1: that you can drive, like way more serious.
Speaker 2: And the issue really comes down to figuring out what
Speaker 2: the root cause is. Right, So root cause of that
Speaker 2: scenario in a fifty year old man would be something
Speaker 2: like anxiety and depression and chronic stress or sleep disorder. Medication, polypharmacy,
Speaker 2: metabolic and indricin causes chronic alcohol substance use and then
Speaker 2: is subjective cognitive declimb. But again the point being that
Speaker 2: it's important to do a root cause and make sure
Speaker 2: that you're following up with someone to if it becomes
Speaker 2: a persistent problem.
Speaker 1: Yes, so I actually for two weeks about horribly uncontrolled
Speaker 1: migraine headaches because my insurance company wouldn't cover my Ajovi,
Speaker 1: which was working great for a year. That's a whole
Speaker 1: another episode of why this system sucks. But so my
Speaker 1: not being able to remember what day of the week
Speaker 1: it was is probably related to stress activities and work,
Speaker 1: but also my severe migraines for two weeks. Yeah.
Speaker 2: Yeah, so certainly we've got to get that evaluated and
Speaker 2: checked out.
Speaker 1: Yeah, Okay, we're going to take a break and then
Speaker 1: we'll come back and we'll answer a couple more questions. Anything,
Speaker 1: last comments before we take a break. No, great question, perfect, Yes,
Speaker 1: And just those questions, Luke and Tiffany, we really appreciate them. Okay,
Speaker 1: we're back. I hope you hung with us after the break,
Speaker 1: And so we have a couple more questions from our listeners. Again,
Speaker 1: these are probably actually Karen's listeners, but thank you very much.
Speaker 1: I hope you hang with the podcast as we transition
Speaker 1: and make the transition. And so I mentioned that we
Speaker 1: have people all over the world listening to us, mainly
Speaker 1: from the United States. So this next question is from
Speaker 1: Violet from Dallas, and Violet didn't say how old she
Speaker 1: is or what the exact situation she is, but she
Speaker 1: said my dog is fat, that she have menopause, And
Speaker 1: we tend to answerpomorphize that means we put human characteristics
Speaker 1: on dogs. And so this is kind of thinking, Okay, well,
Speaker 1: I'm getting older and maybe having some menopause symptoms. Probably
Speaker 1: I don't know how old Violet is or her situation.
Speaker 1: I'm not her provider, and you know, kind of transposing
Speaker 1: this onto the dog who's also gaining weight. And it
Speaker 1: turns out dogs don't have menopause. So the way they
Speaker 1: go through cycles and the way they're ovaries and uterus
Speaker 1: work is that they never really extinguish all of the
Speaker 1: population of eggs and hormones and have the depletion of
Speaker 1: the ovaries and hormones, which then caused the feedback loops
Speaker 1: of the pituitary to go crazy. So the weight gain
Speaker 1: in dogs. Unfortunately in America, we tend to have really
Speaker 1: heavy dogs, and that is also reflected in the human population.
Speaker 2: But so I'm curious like that, how do we know
Speaker 2: if a dog has Yeah, so menopause, So we're not
Speaker 2: so menopause.
Speaker 1: I thought you were going to ask me if they're
Speaker 1: overweight or not. So if they're overweight dogs, you should
Speaker 1: be able to feel their ribs, but not see their
Speaker 1: ribs as kind of a good standard, they shall also
Speaker 1: have a little bit of a waste, but for menopause.
Speaker 1: So we actually and dogs can do really things that
Speaker 1: you can't do in people. So a lot of studies.
Speaker 1: We can actually put them in a kennel and for
Speaker 1: twenty four hours, seventy two hours, seven days. We can
Speaker 1: know exactly how many calories we're giving them. We can
Speaker 1: collect their p and poop so we know exactly what's
Speaker 1: coming out of them. We can do culture's DNA analysis
Speaker 1: on the feces. We can do like crazy things analysis.
Speaker 1: So we can also do hormone levels and actually do
Speaker 1: monitoring of hormone levels every hour for seventy two hours
Speaker 1: and every week for five years in a research setting,
Speaker 1: which would be really really difficult to do in humans.
Speaker 1: So we actually have much much more fine granular data
Speaker 1: in a lot of our animal species because we can
Speaker 1: do better, more detailed research that you really could never do.
Speaker 2: In a huge female.
Speaker 1: Dogs have estrogen, yes, so they do cycle and they
Speaker 1: have eggs. But the whole menopause system is that the
Speaker 1: ovaries get depleted and then they stop producing the hormones,
Speaker 1: which then the pituitary gland goes crazy and tries to
Speaker 1: get the body to produce more and more sex hormones
Speaker 1: because the ovaries have kind of burned out, and dogs
Speaker 1: never get to that burned out station. There are situations,
Speaker 1: so you can actually have a very old dog that's
Speaker 1: still going through heat cycles metabolically. They may not be
Speaker 1: able to get pregnant because of the nutrition and variety
Speaker 1: of other reasons, but they can still cycle, so they
Speaker 1: still have the hormones at the appropriate levels. And so
Speaker 1: menopause is not really the lack of reproduction. It's the
Speaker 1: lack of sex hormones and the balance in the body.
Speaker 2: And those sex hormones among older dogs start to drop
Speaker 2: off just the same way as with they do.
Speaker 1: But yeah, so in humans, as we age, our hormones
Speaker 1: and males and females drop and pretty much all the
Speaker 1: hormones drop, so melatonin and thyroid and everything, and that
Speaker 1: absolutely does happen in dogs. Dogs only live nowadays about
Speaker 1: fifteen years, but absolutely there's an age related decline, and
Speaker 1: some of that we don't even understand. So now we
Speaker 1: have a geriatric hormone imbalance that seems to respond to melatonin.
Speaker 1: So it's a geriatric hymns is what we've been calling it.
Speaker 1: But that's still not a menopause situation. So for instance,
Speaker 1: twenty percent of large breed dogs over thirty pounds will
Speaker 1: have true hypothyroidism, and up to forty fifty percent of
Speaker 1: small breed dogs as they get older will have cushions
Speaker 1: or atypical cushions, which we now cause this call this
Speaker 1: a geriatric hymns melotonin responsive hormone imbalance, but it's not
Speaker 1: true menopause.
Speaker 2: To me, it seems like we don't really know. No,
Speaker 2: I think we absolutely do. Flashes and all of those
Speaker 2: symptoms you can't really assess in a dog, right, I mean.
Speaker 1: Correct, I mean they can't tell us if they're having
Speaker 1: a hot flash, but they're not panting and things like that,
Speaker 1: except our older dog, which that's another story. But we
Speaker 1: actually do know for sure. So if you call menopause
Speaker 1: like the symptoms of menopause, they can't really tell us that.
Speaker 1: But if we look at the hormone levels and what's
Speaker 1: happening with the ovaries, the uterus, and the pituitary, we
Speaker 1: know that what's happening in human primates and whales is
Speaker 1: very very different than what's happening in dogs, cats, horses, cows,
Speaker 1: so very very different. So the overweight from Violet who
Speaker 1: asked the question, going back to the original is from
Speaker 1: calories in calories out, American lifestyle, not menopause.
Speaker 2: And so that was a violent just maybe should cut
Speaker 2: back on the feeding a bit.
Speaker 1: Yeah, calories in calories out, so you know, it would
Speaker 1: be good to get up and move for both Violet
Speaker 1: and puppy dog. That's always good. So that would be excellent. Okay,
Speaker 1: so you want to do one more question or take
Speaker 1: a quick break here and come back.
Speaker 2: Who can do another question?
Speaker 1: I take that. The next question is from Amy who
Speaker 1: is in Alaska. So thanks for listening to us, Amy
Speaker 1: and Alaska, and she's fifty nine years sorry, fifty two
Speaker 1: years old. And this is pretty typical maybe for the
Speaker 1: Canadian and Alaska listeners, but Amy's question is is drinking
Speaker 1: as bad as people say or is this just another
Speaker 1: health panic? And I think this actually goes back to
Speaker 1: Tiffany's question, which is interesting that Tiffany is the one
Speaker 1: that's on GLP one and HRT and is taking Reddit
Speaker 1: seriously and very worried about what Reddit says, doctor Reddit,
Speaker 1: and Amy is the opposite, wanting to ignore the information
Speaker 1: from people. We don't really know who the people is,
Speaker 1: but it sounds like Amy wants to keep drinking. So
Speaker 1: I guess the question is is alcohol how much alcohol
Speaker 1: is good and bad? My belief I drink. I do
Speaker 1: love wine oftentimes this we have a podcast. Sometimes we
Speaker 1: have a glass of wine. But it is a neurotoxin
Speaker 1: alcohol absolutely.
Speaker 2: And the current recommendations is actually moved toward greater caution.
Speaker 2: And you know, the only entirely risk free behavior is
Speaker 2: no alcohol at all. Now, the reality of it is
Speaker 2: that the dietary guidelines for Americans from they did an
Speaker 2: evaluation from twenty twenty to twenty twenty five, and for
Speaker 2: men it's less than are equal to two drinks per day,
Speaker 2: and for women it was less than one drink per
Speaker 2: day and one drink equal a twelve ounce beer, five
Speaker 2: ounces of wine, or one and a half ounces of
Speaker 2: some distilled liquor. And the reason that there are differences
Speaker 2: among sexes is because there was a trending toward cancer
Speaker 2: among women who went beyond one alcoholic beverage day. So
Speaker 2: it's important to point out that, you know, the US
Speaker 2: Surgeon General Advisory says, this is a toxic substance that
Speaker 2: you're taking into your body.
Speaker 1: So two added little comments here. So one is five
Speaker 1: ounces of wine is not very much. When we go
Speaker 1: to restaurants, they all ask us if we want to
Speaker 1: see sounds for nine ounce poor so they don't even
Speaker 1: offer a five ounce por So the amount of alcohol
Speaker 1: that's considered safe is really small compared to what most
Speaker 1: of us drink. The other kind of funny thing I
Speaker 1: think about this, we have various acquaintances, and you know,
Speaker 1: if you're taking vitamin supplements or going to the METI
Speaker 1: spot to get IV treatments so that you can drink
Speaker 1: more wine and more alcohol, you know, you're kind of
Speaker 1: taking a toxin and then you know, over amping the
Speaker 1: recovery phase on the back end, and that's kind of
Speaker 1: an illogical process. So if you really want to be
Speaker 1: as healthy as possible, don't drink alcohol.
Speaker 2: Well, major healthcare organizations have shifted their opinions, and those
Speaker 2: opinions have shifted more recently. The American Heart Association basically
Speaker 2: says avoid alcohol entirely, and the American Cancer Society says
Speaker 2: it's best not to drink alcohol. The World Health Organization
Speaker 2: says there's no level of alcohol consumption that's safe for
Speaker 2: your health, and of course, the American Diabetes Associated advises
Speaker 2: against drinking it, the point being that it is a toxin,
Speaker 2: and if you are going to drink alcohol, you should
Speaker 2: do it in moderation and certainly take into consideration the
Speaker 2: current findings from our recommendations from the dietary guidelines.
Speaker 1: So I used to lecture for a living traveling all
Speaker 1: over the country and internationally, and one of the things
Speaker 1: I would point out is with various medications for allergies
Speaker 1: and dogs have a lot of side effects. And so
Speaker 1: I'd ask the audience, well, you know, this is like
Speaker 1: asking your provider how many cigarettes is safe? So what's
Speaker 1: the different way? How many cigarettes is safe? Doctor Miller? Zero? Okay,
Speaker 1: So how many drinks are safe?
Speaker 2: The shift is now towards zero. Now it's interesting for our.
Speaker 1: So we like wine and we like to drink, is
Speaker 1: why we are so hesitant to give up. But the
Speaker 1: answer the question is zero.
Speaker 2: Well, it's also interesting for our Canadian listeners, which I
Speaker 2: think they'll find this interesting. Is at in twenty twenty three,
Speaker 2: Canada their guidelines went to a continuum of risk approach
Speaker 2: rather than a single threshold approach, so they consider the
Speaker 2: Canadian entities consider low risk less than two standard drinks
Speaker 2: per week week, moderate risk was three to six drinks
Speaker 2: per week, and increased high risk was greater than are
Speaker 2: equal to seven drinks per week. So kind of differing
Speaker 2: opinions around the world on this topic, but culturally.
Speaker 1: The ultimately how many cigarettes are saved zero? How many
Speaker 1: drinks of alcohol are safe? Zero?
Speaker 2: Alcohol is a Grade one carcinogen.
Speaker 1: There you go, So okay, we're going to take a
Speaker 1: quick break and when we come back, we're going to
Speaker 1: go a little bit faster and try to get as
Speaker 1: many questions in as we can. Thank you very much,
Speaker 1: Amy and Violet for sitting us questions and Alaska from Amy,
Speaker 1: I think that's just kind of part of Canada. So
Speaker 1: there you go saying okay, listen stay tuned, come back,
Speaker 1: and we'll be right back. All right, we're right back.
Speaker 1: We're going to take a few more questions and a
Speaker 1: couple of breaks in between, but we're going to go
Speaker 1: a little bit faster. So this next question is from
Speaker 1: Brenda from Baltimore, who's actually says she's turning sixty this week,
Speaker 1: so bretty birthday, Happy birthday, Brenda. So Brenda wants to
Speaker 1: know can I get addicted to my GLP ones?
Speaker 2: Yeah, there's been no evidence at this point to show
Speaker 2: that GLP one is having any addictive property at all.
Speaker 1: So that I think going taking a step back is
Speaker 1: what's the definition of addiction. So if you stop taking
Speaker 1: the GLP ones, will you have withdrawal and get sick
Speaker 1: like a heroin addict? No? Probably not, most likely not
Speaker 1: based on everything we know.
Speaker 2: But if you have not modified your diet your exercise regimen,
Speaker 2: then clearly once the GLP one A washes out, then
Speaker 2: certainly dositiety and diet and exercise returning to get and
Speaker 2: you have to continue to moderate that.
Speaker 1: So if you lost weight with the GLP one and
Speaker 1: you stop it, you will gain weight unless you've changed
Speaker 1: your lifestyle with exercise, food and all of those things.
Speaker 1: So is that addiction? You know, again, the definition of
Speaker 1: addiction can be flexible. The other definition of addiction it
Speaker 1: relates to abuse. And what is this o zimpic face
Speaker 1: that I've been seeing on social media and TikTok A's
Speaker 1: that skeletal face when you take too much ozimpic or
Speaker 1: any of the GLP ones. I'm not just picking on ozimbic.
Speaker 2: Well, I mean, I think there are some patients who
Speaker 2: are pursuing utilization of GLP one a's who clearly need
Speaker 2: to pull back on therapy healthy therapy, which.
Speaker 1: Is kind of the pfinition of abuse. Is that if
Speaker 1: you're damaging your body by using a drug or product,
Speaker 1: then that's also a flexible version of addiction.
Speaker 2: Well, and they are FDA regulated drugs with FDA indications,
Speaker 2: and so if you are on them, you need to
Speaker 2: be routinely seeing your a provider to evaluate the dose
Speaker 2: response and where you are health wise, you know you
Speaker 2: are you below and optimal weight and now looking malnourished.
Speaker 2: But so I think that all has to be tethered
Speaker 2: with the having accountability.
Speaker 1: So I would divide this question into three answers. I
Speaker 1: would say, are you addicted that's the question. I would
Speaker 1: say that if you stop the drug, will you likely
Speaker 1: gain weight? Yes, you are. You probably going to require
Speaker 1: the drug to maintain the low level or weight loss
Speaker 1: that you've had. So yes, you stop the drug, the symptom,
Speaker 1: the weight gain will come back. So that's one definition.
Speaker 1: Are you will you suffer symptoms of withdraw and have
Speaker 1: physical discomfort or pain like a heroin addict from the
Speaker 1: stopping the GLP one? No? And then psychologically, are you
Speaker 1: using the drug for sort of abnormal physical appearance or
Speaker 1: body morphism or problems that you're having that you're dependent
Speaker 1: on the GLP one psychologically, but it's not a true
Speaker 1: chemical dependence, and that definitely can be So, you know
Speaker 1: a lot of people are taking glp ones that don't
Speaker 1: really meet the FDA guidelines and they're taking it for
Speaker 1: cosmetic reasons and that can easily go too far.
Speaker 2: Well, and then you also have to take into account
Speaker 2: that people are food addicted, and so the class is
Speaker 2: that it tends to have some impact on addictive substances
Speaker 2: and for example, decreases an alcohol intake. And from that so,
Speaker 2: I mean, I think it's important to weigh that in
Speaker 2: a bit. If someone has an underlying eating disorder.
Speaker 1: So will that addiction come back? That and it could
Speaker 1: be shopping addiction, por an addiction, whatever kind of addiction
Speaker 1: definitely seems to go away with the GLP ones or
Speaker 1: at least diminish, and that would come back if you
Speaker 1: stop the GLP one.
Speaker 2: But seeking proper care to address the eating addiction I
Speaker 2: think is more important, So that focus on.
Speaker 1: So the answer is how you define addiction. So, okay,
Speaker 1: we're going to take a quick break and then answer
Speaker 1: another question and hang tight. Will be here on the
Speaker 1: other side. All right, we're back. We're actually going to
Speaker 1: do two questions real fast here and then say goodbye.
Speaker 1: So the next question is from Jason and they and
Speaker 1: say where or how old? But they wanted to know
Speaker 1: why does every woman I know have autoimmune disease? And
Speaker 1: maybe that's why they didn't tell us where they're from.
Speaker 1: That seems a little snarky. I don't think every woman
Speaker 1: has autoimmune disease unless he's working in a loopus room
Speaker 1: and toward arthrotists practice or something. So we're actually going
Speaker 1: to do an episode. The next episode is going to
Speaker 1: be on autoimmune diseases like lupus, pemphigus and we'll talk
Speaker 1: about the risk rates and statistics in women and men,
Speaker 1: in older, younger, middle aged people. So listen for the
Speaker 1: next episode and we'll answer that question. So then our
Speaker 1: final question comes from Becky from Canada. So you mentioned
Speaker 1: Canada before, so thank you very much Canadians. Becky is
Speaker 1: fifty five year old woman and she says, or wants
Speaker 1: to know that I've been taking probiotics every day for
Speaker 1: two years and I have no idea if it's helping.
Speaker 1: How do I know if they're working? And this is
Speaker 1: actually one of my favorite pet peeves is that the
Speaker 1: whole gut neuro skin axis, the gut immune system axis
Speaker 1: is definitely a known thing. We have hundreds of species
Speaker 1: of bacteria in our gut, over a trillion organisms, and
Speaker 1: the probiotics that we have are very few probiotics, and
Speaker 1: they're based on really limited understanding of how we influence
Speaker 1: the gut bacteria. So we know that there's a problem,
Speaker 1: we know that there's a link between inflammation, neurology, skin
Speaker 1: allergies even but we really don't know how to fix it.
Speaker 1: So we're at the infancy of really understanding how to
Speaker 1: modulate the gut bacteria and then how that affects the
Speaker 1: disease and symptoms that we're having. In dogs, we actually
Speaker 1: have a few more studies than they do in people. Again,
Speaker 1: we can do kind of weird dog research that they
Speaker 1: couldn't do in people. So, for instance, we have organisms
Speaker 1: that we know improve dental tartar. We have organisms that
Speaker 1: we know improve infections and allergies of the skin and ears.
Speaker 1: We know, so we have very select bacteria, species specific
Speaker 1: bacteria that affects certain diseases and symptoms in the body.
Speaker 2: Right. And then also for our audience, I mean veterinary medicine,
Speaker 2: their studies are very very small ye, and so the
Speaker 2: confidence intervals are a little wider on that data set. However,
Speaker 2: it is important to remember that probiotic supplementation is not
Speaker 2: recommended just for generalized daily use in the US. It's
Speaker 2: strained specific, and it is indication specific, and we just
Speaker 2: really don't understand a whole lot but sort of indications.
Speaker 2: You know, you're looking at things like, you know, antibiotic
Speaker 2: associated diarrhea or C deficile you know.
Speaker 1: Yeah, so after you disinfect your GI tract then repopulating
Speaker 1: it with bacteria, it's not a bad idea. So one
Speaker 1: of the other questions I'm sure you do this as well,
Speaker 1: is when I have patients in the room and they say, hey,
Speaker 1: I've given this or supplement or whatever it is, and
Speaker 1: they say, what do you think about that? And I
Speaker 1: asked them, well, do you think it helped? And if
Speaker 1: you can't tell it helped, I say, we'll try stopping
Speaker 1: it and see what happens. And if you can't really
Speaker 1: tell a difference between taking it and not taking it,
Speaker 1: then you know, probably it's not doing anything obviously good.
Speaker 1: The good news with probiotics is that they don't seem
Speaker 1: to be harmful. We don't have a lot of side
Speaker 1: effects that we know of, so you're not doing any
Speaker 1: damage as far as we know. But are you really
Speaker 1: having benefit? Maybe maybe not, So you can try stopping them. Again,
Speaker 1: we're not your provider. Check with your provider, but you
Speaker 1: may be wasting your time and money, or you may stop.
Speaker 1: They will take a few weeks to really kind of
Speaker 1: kick in, and also the benefits to kind of clear out.
Speaker 2: There actually are two conditions where the American Gaess Rentrology
Speaker 2: Association Association recommends against using probiotics, and that's with Crohn's
Speaker 2: disease and all sort of colidis. So it gets complex
Speaker 2: when you start getting in the weeds on this.
Speaker 1: Is that because of the absorption that your barrier is
Speaker 1: broken down, you can absorb the bacteria more directly than
Speaker 1: get septic made.
Speaker 2: So there are multiple reasons to take probiotics. Certainly follow
Speaker 2: someone that you're seeing. That's a healthcare person's advice, but
Speaker 2: you know there's some impact with cardiovascular risk factors and
Speaker 2: gut microbiotom modulation and immune factors and vational health and
Speaker 2: mental health and autoimmune disease.
Speaker 1: Potential benefits really amazing. My prediction is that in five
Speaker 1: to ten years, we're going to know that if you
Speaker 1: have this disease, these symptoms, you take this bacteria the species,
Speaker 1: and you'll know the dose and the duration, and that
Speaker 1: it'll be very specific. Basically a biological treatment for a
Speaker 1: disease and a symptom set. We are nowhere near that yet,
Speaker 1: but you know, I would I would tell that if
Speaker 1: you're not sure, tries stopping them and see what happens.
Speaker 1: But as always, talk to your provider. Okay, any last
Speaker 1: words were We ran out of time for our Legit
Speaker 1: and Bullshit section. So any wrap up comments, Doctor Miller.
Speaker 2: Yeah, I would just say, don't just go out and
Speaker 2: start popping pills randomly off the countertop because TikTok or
Speaker 2: whoever talked or TikTok. I just think we are over supplemented.
Speaker 2: I have had patients in the past who are on
Speaker 2: five indicated pills, medications that are prescribed, and then in
Speaker 2: addition to those five, they are on ten or fifteen
Speaker 2: supplements for which they haven't brought them into the office
Speaker 2: and had those adjudicated. So just use caution.
Speaker 1: Yeah, I mean a lot of these supplements we don't know,
Speaker 1: and the lack of information does not mean that we
Speaker 1: have good information or bad information. It's just no information.
Speaker 1: So do they help? Maybe? Do they hurt? Maybe? Do
Speaker 1: they interact with other medications you're taking?
Speaker 2: Maybe interesting, it's a lot of money to spend either
Speaker 2: to poop it down or pee it down the drain.
Speaker 1: You know, that's a lot of audiomens. If you take
Speaker 1: too much that you just kind of pee or poop
Speaker 1: them out is where that comment comes, you know. But ultimately,
Speaker 1: if you can't tell a difference, then I would definitely
Speaker 1: be suspicious. That would be my trigger. Any last words
Speaker 1: all right, so thank you for listening. Sorry we ran
Speaker 1: out of time for legitter bullshit. If you really liked
Speaker 1: that episode or that segment, let us know. Send us
Speaker 1: an email at ask at itch not dot com. As always,
Speaker 1: stay safe, stay well, and get up and move Okay,
Speaker 1: bye bye guys,