1
00:00:11,560 --> 00:00:14,880
Speaker 1: Hello, this is the Itchy and Bitchy Podcast because being

2
00:00:15,080 --> 00:00:19,640
itchy is bitchy and our medical system sucks. I'm doctor

3
00:00:19,719 --> 00:00:23,079
Keith Milica, a vetnary, allergist and dermatologist.

4
00:00:22,519 --> 00:00:25,399
Speaker 2: And I'm Stephen Miller, a doctor of nursing practice and

5
00:00:25,480 --> 00:00:27,039
a Q Care nurse practitioner.

6
00:00:27,399 --> 00:00:31,519
Speaker 1: Send us your questions at ask at itch not dot com.

7
00:00:32,200 --> 00:00:34,640
We love you, but we're not your doctors. The information

8
00:00:34,759 --> 00:00:38,520
we discuss is not direct medical advice. Please talk to

9
00:00:38,560 --> 00:00:42,520
your provider who is the expert on your care. The

10
00:00:42,560 --> 00:00:46,240
Itchy and BITCHI podcast is sponsored by doc Itchy Medical

11
00:00:46,280 --> 00:00:49,799
Pets supplements designed to optimize your pets health with the

12
00:00:49,880 --> 00:00:54,920
latest veterinary medical research. Visit docichi dot com or find

13
00:00:55,000 --> 00:00:58,600
us on Amazon and please click that follow button and

14
00:00:58,679 --> 00:01:06,359
send us a question at a at itchno dot com. Thanks, hello,

15
00:01:06,959 --> 00:01:08,640
doctor Miller, how's it going.

16
00:01:08,879 --> 00:01:12,599
Speaker 2: Hi? Welcome to all of our listeners. I'm so glad

17
00:01:12,599 --> 00:01:13,439
we're back together.

18
00:01:13,920 --> 00:01:17,239
Speaker 1: Yes, and we're now posting on Mondays, so look for

19
00:01:17,280 --> 00:01:19,159
the uploads on Monday morning.

20
00:01:19,079 --> 00:01:21,840
Speaker 2: And we hope that you will go on our Facebook

21
00:01:21,920 --> 00:01:25,239
site which I and B Podcast.

22
00:01:24,840 --> 00:01:27,959
Speaker 1: And send us a question that ask at itch not

23
00:01:28,159 --> 00:01:30,200
dot com Okay, so.

24
00:01:30,560 --> 00:01:31,200
Speaker 3: Are you ready?

25
00:01:31,359 --> 00:01:33,359
Speaker 1: Yeah, Okay, this is going to be a whirlwind because

26
00:01:33,400 --> 00:01:37,439
this is the craziest, most amazing thing I can think of.

27
00:01:38,239 --> 00:01:41,920
There are three major events that I know of in

28
00:01:41,959 --> 00:01:46,480
my lifetime sort of in my lifetime that absolutely revolutionized

29
00:01:46,760 --> 00:01:48,359
medicine as we know.

30
00:01:48,439 --> 00:01:50,840
Speaker 3: It just totally changed the human species.

31
00:01:51,120 --> 00:01:53,480
Speaker 2: Detail it soundsl.

32
00:01:53,079 --> 00:01:56,799
Speaker 1: So the first is antabotics. What have antibotics done for humans?

33
00:01:56,840 --> 00:02:06,079
Doctor Miller cured like death, repentuated eighty percent society, So antibotics.

34
00:02:06,239 --> 00:02:11,199
The second most tragic, crazy thing that happened total misadventure

35
00:02:11,360 --> 00:02:14,080
is the lidamide. So this was in the nineteen fifties

36
00:02:14,080 --> 00:02:17,719
and sixties during the valium culture. Mother's Little Helper, make

37
00:02:17,800 --> 00:02:22,719
you happy, and so thalidamide was an anti vomit morning

38
00:02:22,759 --> 00:02:27,599
sickness drug and it turned out to cause horrible birth defects.

39
00:02:27,960 --> 00:02:31,319
Luckily our FDA, which some people don't like very much,

40
00:02:31,360 --> 00:02:34,120
but they did not approve in the United States, so

41
00:02:34,560 --> 00:02:38,639
a lot of American babies were spared from the limb deformities.

42
00:02:39,000 --> 00:02:42,240
But thalidamide was this amazing feel good drug in the

43
00:02:42,240 --> 00:02:46,680
fifties and sixties for pregnant women, but caused horrible birth

44
00:02:46,719 --> 00:02:51,599
defects and a whole generation of birth defects. So horrible,

45
00:02:51,639 --> 00:02:57,240
horrible misadventure. But what's crazy amazing, like the best of

46
00:02:57,319 --> 00:03:01,080
times the worst of times, is this gel one revolution.

47
00:03:01,759 --> 00:03:05,719
And I have not seen any other drug or treatment

48
00:03:05,840 --> 00:03:10,000
that falls into this kind of crazy madness of exploration

49
00:03:10,879 --> 00:03:13,639
and benefits. And so we're going to talk about GLP

50
00:03:13,759 --> 00:03:18,719
ones again. This is an updated version. Karen Nicol did

51
00:03:18,759 --> 00:03:22,319
a really good episode previously, check that out if you

52
00:03:22,360 --> 00:03:27,719
would like. But things have changed in months, definitely within

53
00:03:27,719 --> 00:03:31,159
the last year. But every week there's new and new things.

54
00:03:31,240 --> 00:03:33,680
So we're going to divide this episode into sort of

55
00:03:33,680 --> 00:03:37,560
an introduction and then what GLP ones are actually approved

56
00:03:37,680 --> 00:03:40,520
for and how that sort of got started, and then

57
00:03:40,520 --> 00:03:42,400
we're going to take a break and come back and

58
00:03:42,439 --> 00:03:46,080
talk about all of the possibilities and the proposed mechanisms.

59
00:03:46,400 --> 00:03:48,879
A lot of them are thought of and sort of

60
00:03:49,240 --> 00:03:53,439
hinted at by response to therapy, but not documented in

61
00:03:53,560 --> 00:03:58,000
really good clinical statistical trials. And then we're going to

62
00:03:58,319 --> 00:04:01,240
have a last segment of the possible side effects, which

63
00:04:01,360 --> 00:04:05,280
are kind of interesting when you start thinking about mechanisms

64
00:04:05,639 --> 00:04:07,759
of how the GLP actually works.

65
00:04:07,960 --> 00:04:11,199
Speaker 2: And for our listeners, that don't know. What GLP one

66
00:04:11,400 --> 00:04:17,360
receptor agonists are is glucagon like peptide receptor agonists, and

67
00:04:17,439 --> 00:04:23,160
so these offer all kinds of benefits for metabolic, cardiovascular, renal,

68
00:04:23,240 --> 00:04:26,040
and weight related benefits. So we'll we'll dive in.

69
00:04:26,279 --> 00:04:29,920
Speaker 1: Yeah, so glucagon is produced in the liver, and agonist

70
00:04:30,040 --> 00:04:33,040
means that we're going to stimulate the receptors and so

71
00:04:33,240 --> 00:04:36,279
molecularly that's how these things work.

72
00:04:36,720 --> 00:04:38,399
Speaker 3: And so we started off.

73
00:04:38,759 --> 00:04:41,040
Speaker 1: Do you remember when they first got approved three years

74
00:04:41,040 --> 00:04:42,360
ago maybe four?

75
00:04:42,839 --> 00:04:44,000
Speaker 3: Yeah, so so.

76
00:04:44,079 --> 00:04:46,319
Speaker 1: Not that long ago in the grand scheme of things,

77
00:04:46,600 --> 00:04:49,319
and they were first approved. You remember the first drug

78
00:04:49,360 --> 00:04:50,000
that was approved.

79
00:04:50,199 --> 00:04:53,319
Speaker 2: The first one was sex Sinda and.

80
00:04:53,319 --> 00:04:57,360
Speaker 3: It was approved for weight loss. Weight lossbetes that.

81
00:04:57,680 --> 00:04:59,720
Speaker 2: They are a glue tide. It was indicated for what

82
00:04:59,759 --> 00:05:05,680
loss Victosa, which was the branded other version. With all

83
00:05:05,720 --> 00:05:08,720
of these classes, they get branded in different ways, and

84
00:05:08,759 --> 00:05:11,480
so the branding of Victosa was to decrease cardio event

85
00:05:12,079 --> 00:05:18,639
cardiovascular event reduction in patients with diabetes and established cardiovascular disease.

86
00:05:18,759 --> 00:05:22,800
Speaker 1: So very specific prescribing guidelines, and so I would bet

87
00:05:22,839 --> 00:05:24,920
that when it first came out, you didn't really prescribe

88
00:05:24,920 --> 00:05:27,079
it to a huge number of patients.

89
00:05:27,040 --> 00:05:31,399
Speaker 2: On the cardiology side. We didn't dive in initially.

90
00:05:31,519 --> 00:05:34,879
Speaker 1: That's accurate, okay, So and this is just kind of

91
00:05:34,920 --> 00:05:37,000
back up a step, and then we're going to take

92
00:05:37,000 --> 00:05:39,759
a short break and come back with more detail. But

93
00:05:39,920 --> 00:05:42,800
to back up a step, this is one of the peptides.

94
00:05:42,839 --> 00:05:46,560
And peptides are all trendy now, but you need to

95
00:05:46,639 --> 00:05:49,680
kind of understand what peptides are. They're simply proteins that

96
00:05:49,720 --> 00:05:52,959
are found in the human body and interesting like other

97
00:05:53,120 --> 00:05:57,560
drugs that are patented and drug companies like Pfizer or

98
00:05:57,639 --> 00:06:01,639
Eli Lilly can have a patent on it. The Supreme

99
00:06:01,680 --> 00:06:05,199
Court decided that these peptides are human proteins because they're

100
00:06:05,279 --> 00:06:10,279
part of the human normal anatomy system, that they're not patentable.

101
00:06:10,399 --> 00:06:14,279
So these peptides are very specific and they have pros

102
00:06:14,319 --> 00:06:17,600
and cons They have benefits and side effects depending on

103
00:06:17,680 --> 00:06:20,439
exactly what the peptide is and what it does. So

104
00:06:20,519 --> 00:06:22,399
we're going to take a short break here and then

105
00:06:22,399 --> 00:06:26,439
we're going to come back and talk about the proposed

106
00:06:26,720 --> 00:06:32,560
and approved guidelines and treatment possibilities for these glp ones.

107
00:06:32,600 --> 00:06:33,240
Speaker 3: Stick with us.

108
00:06:33,519 --> 00:06:37,759
Speaker 1: It gets really interesting and really crazy from here. It's

109
00:06:37,759 --> 00:06:41,040
magical medicine moments. So hang with us.

110
00:06:52,240 --> 00:06:55,360
Speaker 3: All right, we're back. I hope he stayed with us.

111
00:06:55,759 --> 00:06:57,439
Speaker 1: So now we're going to talk about all of the

112
00:06:57,480 --> 00:07:03,079
different proposed treatments and treatments for these GLP ones and

113
00:07:03,720 --> 00:07:07,120
it gets it gets really interesting. So just as crazy

114
00:07:07,560 --> 00:07:11,839
as antibotics and pholidamide, where these GLP one started off

115
00:07:11,879 --> 00:07:15,319
with this little bitty niche kind of treatment protocol and

116
00:07:15,399 --> 00:07:19,079
now it is just crazy what they're showing to have

117
00:07:19,120 --> 00:07:24,839
benefits for. So from the data side of things, Stephen,

118
00:07:24,920 --> 00:07:27,600
what what are they actually used for and prescribed for?

119
00:07:27,839 --> 00:07:28,279
Speaker 3: Right now?

120
00:07:28,519 --> 00:07:31,160
Speaker 2: Yeah, so follow me into the weeds a moment.

121
00:07:31,600 --> 00:07:33,959
Speaker 3: Yes, I like weeds. Yeah, data is good, give me

122
00:07:34,000 --> 00:07:34,560
a good action.

123
00:07:34,600 --> 00:07:38,040
Speaker 2: And so initially we talked about sex and and nick tosa,

124
00:07:38,120 --> 00:07:42,240
and then the next generation was seema glue tide, which

125
00:07:43,360 --> 00:07:49,399
was ozimpic, and then Rightbelsa's and we go by and

126
00:07:49,439 --> 00:07:53,879
they're all it's interesting how as they've been branded, they

127
00:07:54,120 --> 00:07:58,480
the branding has has been approved for certain different indications.

128
00:07:58,920 --> 00:08:01,959
And so this is why people will meet barriers at

129
00:08:01,959 --> 00:08:04,920
the pharmacy counter if the drugs not written under the

130
00:08:05,040 --> 00:08:09,240
certain indication that it's approved for. And so for example,

131
00:08:09,279 --> 00:08:13,759
we go V is for weight management and obesity with

132
00:08:13,879 --> 00:08:18,279
weight related comorbidities, which is kind of a broad label and.

133
00:08:18,199 --> 00:08:22,240
Speaker 1: That could be anything from diabetes, pre diabetes, even cancer

134
00:08:22,360 --> 00:08:23,519
is related to abusie.

135
00:08:23,680 --> 00:08:28,800
Speaker 2: It is also indicated for cardiovascular event reduction and obese

136
00:08:28,839 --> 00:08:34,320
patients with established cardiovascular disease, so anybody with atherosclerosis. And

137
00:08:34,360 --> 00:08:39,320
then it is also indicated for metabolic dysfunction with fatty

138
00:08:39,360 --> 00:08:43,720
liver disease, specifically looking more into fibrosis of the liver.

139
00:08:43,879 --> 00:08:47,879
Speaker 1: So glucagon is liver produced and so that's where this

140
00:08:48,000 --> 00:08:49,759
whole mechanism kind of.

141
00:08:51,279 --> 00:08:54,519
Speaker 3: Resides in the body. So how do they so all

142
00:08:54,559 --> 00:08:57,720
of these peptides are similar in cross reaction.

143
00:08:57,879 --> 00:09:02,200
Speaker 2: Yeah, so it wasn't done because they have to give indications.

144
00:09:01,320 --> 00:09:05,080
Speaker 1: Right, but do the pharmacist and the providers if so,

145
00:09:05,159 --> 00:09:08,159
if they have a lot of overlap, but are they prescribing?

146
00:09:08,919 --> 00:09:12,440
You want you want treatment A, and so you do

147
00:09:12,600 --> 00:09:14,759
drug A, and you want treatment B, so you do

148
00:09:14,879 --> 00:09:17,320
drug B even though both drugs will do A.

149
00:09:17,559 --> 00:09:18,120
Speaker 3: That's great.

150
00:09:18,480 --> 00:09:24,080
Speaker 2: And so in the clinical setting, if you are prescribing,

151
00:09:24,519 --> 00:09:30,320
say for example, you're prescribing zep bound, which is tears

152
00:09:30,360 --> 00:09:34,279
zeppatide and it's approved for chronic weight management and obstructive

153
00:09:34,360 --> 00:09:39,399
sleep apnea. And if the patient doesn't have those disease processes,

154
00:09:40,120 --> 00:09:44,480
but yet they may have cardiovascular disease, then they would

155
00:09:44,480 --> 00:09:47,879
be covered for we go Vy, which has the cardiovascular indication.

156
00:09:48,000 --> 00:09:50,720
Speaker 1: So that becomes an insurance paperwork kind of thing. But

157
00:09:50,919 --> 00:09:53,480
as far as the drug is actually the mechanism of action,

158
00:09:53,600 --> 00:09:56,639
does it really matter which one tick and then some

159
00:09:56,759 --> 00:09:59,480
maybe once you're next summer, once a day. They now

160
00:09:59,519 --> 00:10:02,720
have oral drugs because it's much cheaper and easier to administer,

161
00:10:03,000 --> 00:10:05,759
so their injecting devices are actually quite expensive.

162
00:10:06,000 --> 00:10:09,159
Speaker 2: Yeah, so there's oral we go Vi, which is now available.

163
00:10:09,200 --> 00:10:15,039
There's Rybelsis, which is semaglutide as well, and it has

164
00:10:15,080 --> 00:10:18,759
the indications for diabetes cardiovasco or men reduction in patients

165
00:10:18,759 --> 00:10:20,360
with type two diabetes melitis.

166
00:10:20,399 --> 00:10:22,799
Speaker 1: So we're kind of in this situation where we have

167
00:10:22,879 --> 00:10:27,039
lots of different drugs and the paperwork kind of regulates

168
00:10:27,080 --> 00:10:31,440
which drug gets which diagnosis and which treatment, but in reality,

169
00:10:31,679 --> 00:10:34,559
all of the drugs kind of do similar things and

170
00:10:34,600 --> 00:10:37,720
they have an expanding list of benefits.

171
00:10:37,879 --> 00:10:41,360
Speaker 2: Yeah, so patients just need to discuss this with their

172
00:10:41,519 --> 00:10:45,519
prescribing provider to make sure that whatever drug is written

173
00:10:45,799 --> 00:10:49,120
is written under the labeling that's appropriate.

174
00:10:49,679 --> 00:10:51,639
Speaker 1: Okay, otherwise you're going to get pushed back from your

175
00:10:51,639 --> 00:10:52,440
insurance company.

176
00:10:52,480 --> 00:10:54,320
Speaker 3: That's right. So I'm going to.

177
00:10:54,240 --> 00:10:58,600
Speaker 1: Read a list of all of the proposed theoretical benefits

178
00:10:58,639 --> 00:11:01,519
that may or may not have been proven with really

179
00:11:01,559 --> 00:11:05,799
good statistical studies based on tens of thousands of people.

180
00:11:06,080 --> 00:11:09,200
But I want you first to tell me what the

181
00:11:09,360 --> 00:11:11,559
actual approved indications are.

182
00:11:11,840 --> 00:11:17,639
Speaker 2: So really you want to break the benefits down into

183
00:11:18,399 --> 00:11:22,639
three major categories, or four major categories. One is glycemic.

184
00:11:22,000 --> 00:11:24,440
Speaker 3: Control, which is sugar dibe.

185
00:11:24,240 --> 00:11:28,159
Speaker 2: Like glucose, and the other is weight loss, The other

186
00:11:28,360 --> 00:11:35,279
is cardiovascular benefits, and then of course renal protection, and

187
00:11:35,320 --> 00:11:39,559
then I left off one, which is the fatty liver indication.

188
00:11:40,000 --> 00:11:43,679
Speaker 1: Okay, So those are the indications. But what gets really

189
00:11:43,759 --> 00:11:47,120
crazy and why this drug is so amazing is that

190
00:11:47,159 --> 00:11:51,759
it's one of the moments in medicine where the expected

191
00:11:51,840 --> 00:11:57,039
benefits were fairly narrow and limited, and then what the

192
00:11:57,120 --> 00:12:02,799
patients are actually experiencing has just exponentially exploded. So under

193
00:12:02,840 --> 00:12:06,559
weight loss, for instance, your joints get better. Under weight loss,

194
00:12:06,600 --> 00:12:12,000
your libido gets better. So it's just this crazy exponential,

195
00:12:12,559 --> 00:12:17,799
expansive list of benefits that these drugs have, even into depression, anxiety,

196
00:12:18,039 --> 00:12:18,720
drug addiction.

197
00:12:18,960 --> 00:12:22,200
Speaker 2: So on my end, I really pitt because I'm work

198
00:12:22,519 --> 00:12:28,039
in cardiology. You look at just so, cardiovascular death as

199
00:12:28,080 --> 00:12:31,159
the number one leading cause of death in the United States, right,

200
00:12:31,519 --> 00:12:36,120
So they did this meta analysis, which was ten clinical

201
00:12:36,159 --> 00:12:39,759
trials looking at seventy three hundred and fifty one patients.

202
00:12:39,759 --> 00:12:43,200
That's a huge number of patients. And so major adverse

203
00:12:43,240 --> 00:12:47,279
cardiovascular events such as stroke, cardiovascular death, and non fatal

204
00:12:47,360 --> 00:12:52,519
am I were reduced by fourteen percent, heart failure hospitalizations

205
00:12:52,559 --> 00:12:56,679
were reduced by fourteen percent, and then all cause mortality

206
00:12:56,720 --> 00:12:59,960
for dying from anything was reduced by about twelve percent.

207
00:13:00,200 --> 00:13:04,600
So just looking at the one indicated group, the major

208
00:13:04,960 --> 00:13:08,879
reductions in depth are impressive with this drug class.

209
00:13:09,000 --> 00:13:12,200
Speaker 1: Yeah, and anything above ten percent is really pretty significant.

210
00:13:12,240 --> 00:13:14,120
So Okay, we're going to take a short break and

211
00:13:14,120 --> 00:13:16,279
then we're going to come back and talk about the

212
00:13:16,480 --> 00:13:19,480
other benefits. So if they look at these studies and

213
00:13:19,480 --> 00:13:21,320
they're more and more of them, So we have now

214
00:13:21,440 --> 00:13:25,320
hundreds of thousands of patients globally that are on these medications,

215
00:13:25,759 --> 00:13:27,879
and what they do is they say, well, what else

216
00:13:27,960 --> 00:13:31,399
is happening in these groups of patients? So anything above

217
00:13:31,440 --> 00:13:33,919
ten percent is really impressive. But when we come back,

218
00:13:33,960 --> 00:13:37,440
we're going to talk about some of these unexpected things,

219
00:13:37,480 --> 00:13:40,440
like a thirty percent reduction in cancer risk.

220
00:13:40,519 --> 00:13:42,759
Speaker 2: And I think it's really really important for our listeners

221
00:13:42,799 --> 00:13:47,279
to understand that when we're looking at some of these benefits,

222
00:13:47,600 --> 00:13:50,720
that most of those things are coming out of subgroup

223
00:13:50,759 --> 00:13:53,039
analysis from these studies. So it may not be the

224
00:13:53,080 --> 00:13:56,879
indication for the drug, but certainly benefit was seen and.

225
00:13:56,799 --> 00:13:59,240
Speaker 1: More evidence is needed before it's a proven So we

226
00:13:59,279 --> 00:14:02,279
have correlation but not causation yet. Okay, we're going to

227
00:14:02,320 --> 00:14:03,600
take a break and then we're going to come back

228
00:14:03,639 --> 00:14:07,799
and talk about these kind of amazingly weird, crazy things

229
00:14:07,799 --> 00:14:11,879
that this drug therapies can do. Okay, hang tight and

230
00:14:12,000 --> 00:14:27,519
join us on the other side. Hey, I hope you

231
00:14:27,559 --> 00:14:28,399
made it back with us.

232
00:14:28,840 --> 00:14:30,159
Speaker 3: So what we're going to do is I'm going.

233
00:14:30,080 --> 00:14:32,639
Speaker 1: To read a list of all of the proposed benefits

234
00:14:32,679 --> 00:14:35,360
and doctor Miller here is going to chime in with

235
00:14:35,399 --> 00:14:40,440
some data if he has any kind of opinion about it.

236
00:14:40,480 --> 00:14:43,399
So I looked up on Claude. Actually is what I've

237
00:14:43,399 --> 00:14:46,759
switched to you now from chat, and I came up

238
00:14:46,759 --> 00:14:51,799
with sixty five different proposed benefits of GLP one and

239
00:14:51,840 --> 00:14:57,080
they're grouped into kind of specific organ systems. So cardiovascular

240
00:14:57,600 --> 00:15:00,000
benefits are pretty well done.

241
00:15:00,080 --> 00:15:02,080
Speaker 2: So we already yeah, we already touched on.

242
00:15:02,080 --> 00:15:05,279
Speaker 1: That, and that's that's even down to like reduced hospitalization

243
00:15:05,440 --> 00:15:10,759
visits associated reduced hypertension, and then metabolic benefits, which are

244
00:15:11,200 --> 00:15:13,399
global and these are going to be related to weight

245
00:15:13,480 --> 00:15:17,600
loss and sugar insulin diabetes, and when you start affecting

246
00:15:17,799 --> 00:15:21,919
in a beneficial manner, that whole pathway, it pretty much

247
00:15:21,960 --> 00:15:27,200
relates to everything else. It relates to sex, drive, to joints, exercise,

248
00:15:28,360 --> 00:15:32,679
just pretty much whole morbidity, which is your overall disease.

249
00:15:34,279 --> 00:15:39,240
Accumulation is improved. Hepatic disease. So you mentioned fatty liver disease,

250
00:15:39,440 --> 00:15:42,360
but actually liver enzymes will go down, so if you

251
00:15:42,399 --> 00:15:46,000
have any kind of associated with liver issues.

252
00:15:45,799 --> 00:15:48,759
Speaker 2: And the day Lily is strong on that in that

253
00:15:49,000 --> 00:15:53,960
the indication for these drugs is there for fatty liver disease.

254
00:15:54,159 --> 00:15:57,759
You skipped over the whole renal I'm.

255
00:15:57,600 --> 00:16:00,559
Speaker 1: Getting there, okay, yeah, okay, So and we'll come back

256
00:16:00,559 --> 00:16:03,799
to renal disease. So you know, kidneys, Like, who would

257
00:16:03,799 --> 00:16:06,519
think that kidneys are I wouldn't think that kidneys are

258
00:16:06,559 --> 00:16:10,039
associated with like weight loss drug But so how are

259
00:16:10,080 --> 00:16:10,919
kidneys benefited?

260
00:16:11,120 --> 00:16:14,440
Speaker 2: Yeah, so GLP one a's decreased micro albumin area or

261
00:16:14,519 --> 00:16:19,320
albuminary and slow EGFR decline. There's a particular study called

262
00:16:19,320 --> 00:16:22,759
the Flow trial which looked at semaglue tide and it

263
00:16:22,840 --> 00:16:26,679
showed there was a twenty four percent reduction in kidney

264
00:16:26,720 --> 00:16:30,480
outcomes such as EGF to our decline, kidney failure, and

265
00:16:30,639 --> 00:16:35,080
kidney slash cardiovascular death. So pretty four percent.

266
00:16:35,360 --> 00:16:38,519
Speaker 1: So he said a lot of that's really he works there. Yeah,

267
00:16:38,519 --> 00:16:41,679
anything about ten percent is impressive. So what he's basically

268
00:16:41,720 --> 00:16:44,960
talking about is how well the kidney processes fluids and

269
00:16:45,080 --> 00:16:51,679
toxins and GFR is glomyl glomerular filtration rates, and that's

270
00:16:51,759 --> 00:16:53,919
kind of what the kidney does, It filters out.

271
00:16:54,320 --> 00:16:56,159
Speaker 2: And there was a meta analysis, by the way of

272
00:16:56,200 --> 00:16:59,399
all of that data, which is a huge It still

273
00:17:00,279 --> 00:17:04,720
seventeen percent reduction and composite kidney outcomes across the class.

274
00:17:04,839 --> 00:17:07,359
So that's a fairly impressive.

275
00:17:07,039 --> 00:17:10,160
Speaker 1: And who would have thought kidneys so neurologic disorder, so

276
00:17:10,680 --> 00:17:13,720
alcoholism and liver disease. That kind of makes sense that

277
00:17:13,759 --> 00:17:17,000
if you're improving liver function, that doesn't mean We were

278
00:17:17,000 --> 00:17:19,400
talking with our friends last night who are into all

279
00:17:19,440 --> 00:17:22,920
of these vitamin supplements to improve their health, and I

280
00:17:23,000 --> 00:17:25,200
pointed out that the biggest improvement would be to stop

281
00:17:25,279 --> 00:17:27,440
drinking alcohol, which is a neurotoxin.

282
00:17:27,680 --> 00:17:30,079
Speaker 2: YEA, So I will point out to our audience that

283
00:17:30,200 --> 00:17:34,599
they're yes in the subgroup analysis there, which means not

284
00:17:35,519 --> 00:17:38,319
the primary outcome for the trial, but they broke down

285
00:17:38,359 --> 00:17:41,279
the subgroups and they looked at people's alcohol intake, and

286
00:17:41,720 --> 00:17:46,160
early signals were found for reducing alcohol and substance use,

287
00:17:46,200 --> 00:17:50,440
although this is not totally clear and needs further investigation.

288
00:17:50,640 --> 00:17:52,960
Speaker 1: So I was talking about liver health and the effect

289
00:17:53,000 --> 00:17:56,559
of the toxic alcohol, and we're recording this as we're

290
00:17:56,599 --> 00:17:58,599
having a glass of wine, so we definitely are not

291
00:17:58,839 --> 00:18:02,799
anti alcohol, but so the liver health benefits. But you're

292
00:18:02,799 --> 00:18:05,960
actually talking about behavior and addiction. So the amount of

293
00:18:06,000 --> 00:18:09,559
alcohol consumed, and this also happens with weight, that the

294
00:18:10,039 --> 00:18:15,640
food drive, the annoying, obsessive, compulsive food thoughts get reduced,

295
00:18:15,640 --> 00:18:17,480
and this is a huge impact on addiction.

296
00:18:17,640 --> 00:18:21,359
Speaker 2: Yeah, the central nervous system effects are not clearly understood

297
00:18:21,480 --> 00:18:23,720
yet and so certainly need further investigation.

298
00:18:23,880 --> 00:18:28,960
Speaker 1: Yeah, but the benefits for addictive behaviors, even shopping addiction,

299
00:18:29,200 --> 00:18:33,279
porn addiction, There are all of these sort of hints

300
00:18:33,319 --> 00:18:35,119
that these drugs may be beneficial.

301
00:18:35,240 --> 00:18:37,920
Speaker 2: So again in the subgroups where we looked at trends

302
00:18:37,960 --> 00:18:41,200
on the forest plots, we saw that the data trended

303
00:18:41,240 --> 00:18:44,640
toward the SGLT two our GLP one.

304
00:18:44,519 --> 00:18:48,559
Speaker 3: A yeah crazy, so okay, And what about Alzheimer's.

305
00:18:48,720 --> 00:18:54,279
Speaker 2: So neuro degenerative disease. The preliminary evidence suggests some potential

306
00:18:54,319 --> 00:19:00,480
benefits in preventing dimension improving Parkinson's disease. Again, these are

307
00:19:00,559 --> 00:19:05,200
investigational poorly understood, but when you looked at subgroups, certainly

308
00:19:05,400 --> 00:19:08,839
there was some indication that this needed to be evaluated further.

309
00:19:09,759 --> 00:19:11,319
Speaker 3: Do we have a proposed mechanism?

310
00:19:11,400 --> 00:19:11,559
Speaker 2: Is it?

311
00:19:11,880 --> 00:19:12,200
Speaker 3: We don't.

312
00:19:12,839 --> 00:19:15,640
Speaker 2: Again, the whole central nervous system impact of this class

313
00:19:15,720 --> 00:19:16,640
is poorly understood.

314
00:19:17,200 --> 00:19:19,079
Speaker 1: And this is just what blows my mind is that

315
00:19:19,319 --> 00:19:23,039
you know, this was launched for a very narrow, limited

316
00:19:23,799 --> 00:19:27,279
diagnosis set and just the potential impact. I mean, there

317
00:19:27,279 --> 00:19:30,759
are even discussions if you know entire populations. If every

318
00:19:30,799 --> 00:19:34,880
American citizen or Australian or Canadian should be put on

319
00:19:34,960 --> 00:19:39,599
these drugs just for overall health and well being, it's

320
00:19:39,720 --> 00:19:43,559
just amazing. So okay, respiratory impact. So you mentioned sleep apnea,

321
00:19:43,880 --> 00:19:46,279
So how is that benefit.

322
00:19:46,039 --> 00:19:50,680
Speaker 2: Tears zeppetide is approved for obstructive sleep apnea? Is a

323
00:19:50,720 --> 00:19:54,039
web bound Well we don't know. Again, so there's the

324
00:19:54,039 --> 00:19:56,839
whole central nervous system piece that we don't understand. But

325
00:19:56,880 --> 00:20:01,160
then there's also that with obesity comes this pickwick in physiology,

326
00:20:01,200 --> 00:20:05,000
which is where the diaphragm so they really excurred and

327
00:20:05,079 --> 00:20:06,240
so then it's nine.

328
00:20:06,039 --> 00:20:09,599
Speaker 1: Predominal fat and you just mechanically can't breathe.

329
00:20:09,920 --> 00:20:13,640
Speaker 2: Yeah, So it's indicated for moderate to severe abstruct restrictive

330
00:20:13,680 --> 00:20:16,400
sleep apney and patient in adults with obesity.

331
00:20:16,680 --> 00:20:21,480
Speaker 1: So even going to like arthritis and knee osteoarthritis and

332
00:20:21,559 --> 00:20:25,920
pain and cartilage degeneration. And that's probably related to weight

333
00:20:26,039 --> 00:20:29,680
that if you lose one hundred pounds with these drugs,

334
00:20:29,720 --> 00:20:32,319
then that's one hundred pounds less that your knees have

335
00:20:32,359 --> 00:20:32,880
to absorb.

336
00:20:33,039 --> 00:20:36,519
Speaker 2: Yeah, So there is symptomatic improvement with this class in

337
00:20:37,839 --> 00:20:44,000
knee specifically knee osteoarthritis, and we think that is probably

338
00:20:44,039 --> 00:20:49,079
related to, you know, just the weight tension on the joint,

339
00:20:49,119 --> 00:20:50,240
although we just don't know.

340
00:20:50,519 --> 00:20:55,599
Speaker 1: Okay, women's mental stricles become more stable and predictable and regulated.

341
00:20:55,640 --> 00:20:57,079
Speaker 3: What the hell's up with that?

342
00:20:57,119 --> 00:21:00,000
Speaker 1: Like, how does a weightless drug cause better menstrual suz.

343
00:21:00,000 --> 00:21:02,319
Speaker 2: So if you just think about it, that is where

344
00:21:02,359 --> 00:21:05,920
hormones are stored, right, and so then you start reducing

345
00:21:06,720 --> 00:21:09,720
fatty tissue in central obesity, and then you start shifting

346
00:21:09,759 --> 00:21:14,319
hormones and so people do have some hormonal shift that occurs.

347
00:21:15,200 --> 00:21:17,160
Speaker 1: Again, this just blows my mind. This is one of

348
00:21:17,200 --> 00:21:21,640
the most amazing things I've ever even contemplated. We talked

349
00:21:21,680 --> 00:21:26,160
about neurodegenerative diseases like Alzheimer's.

350
00:21:26,200 --> 00:21:28,680
Speaker 3: What about stroke reduction? Is there any benefit for that?

351
00:21:29,599 --> 00:21:35,680
Speaker 2: The drugs are indicated for cardiovascular event reduction, which includes stroke,

352
00:21:36,599 --> 00:21:40,880
so of all cardiovascular disease, so that's included there yet Okay.

353
00:21:41,039 --> 00:21:44,000
Speaker 1: And then I've talked about my chronic migraines. This is

354
00:21:44,440 --> 00:21:47,519
researching this. I learned this that there's actually some evidence

355
00:21:47,599 --> 00:21:52,839
that migraines become less severe and less episodic, so fewer

356
00:21:52,920 --> 00:21:55,599
migraines per month on these trucks.

357
00:21:55,799 --> 00:21:59,400
Speaker 2: Yeah, so this is evidence coming from the subgroup analysis

358
00:21:59,480 --> 00:22:05,039
and again poorly understood, not absolutely indicated, So make sure

359
00:22:05,039 --> 00:22:08,279
our audience understands that, but also knowing that there is

360
00:22:08,319 --> 00:22:12,519
some potential potential for improvement in those symptoms.

361
00:22:13,279 --> 00:22:17,119
Speaker 1: Just so I've rethought starting to take these. I'm not

362
00:22:17,599 --> 00:22:20,759
terribly obese, and actually I'm very sensitive to the side effects,

363
00:22:21,279 --> 00:22:23,200
which we're going to cover in the next section. But

364
00:22:23,599 --> 00:22:27,640
I've actually restarted these for my migraines. I've had horribly

365
00:22:27,759 --> 00:22:34,319
uncontrolled migraines. Okay, so then what about reproductive benefits. We

366
00:22:34,400 --> 00:22:38,079
talked about the menstrual cycles that reproductive fertility seems to

367
00:22:38,119 --> 00:22:39,200
be increasing in this way.

368
00:22:39,279 --> 00:22:42,440
Speaker 2: Yeah, so again, you know, you look at something when

369
00:22:42,519 --> 00:22:47,119
you look at a syndrome like PCOS polycystic ovarian syndrome,

370
00:22:47,160 --> 00:22:52,359
which can contribute to some infertility issues, and it's kind

371
00:22:52,400 --> 00:22:57,240
of a pre diabetic state and that impacts fertility. Again,

372
00:22:57,640 --> 00:23:02,119
fatty tissue stores hormones and shifts hormones, and so we

373
00:23:02,240 --> 00:23:06,799
just don't really know, but there is some some data

374
00:23:06,920 --> 00:23:09,440
and evidence in the subgroups to indicate there might be

375
00:23:09,480 --> 00:23:15,279
some benefit there. Just mind blowing, well, I think, yeah,

376
00:23:15,519 --> 00:23:20,359
so I think that they're at my pliants. So we

377
00:23:21,440 --> 00:23:25,720
in the US, all food is readily available everywhere. You

378
00:23:25,799 --> 00:23:27,839
drive down the highway and there are signs everywhere, and.

379
00:23:27,799 --> 00:23:29,519
Speaker 3: We eat French fries for a week more.

380
00:23:29,599 --> 00:23:31,400
Speaker 2: Then we go to a restaurant and we're served a

381
00:23:31,440 --> 00:23:36,920
three person portion and we continue to eat that way

382
00:23:37,039 --> 00:23:41,680
and our bodies can't, uh can't keep up, and so

383
00:23:41,839 --> 00:23:44,519
then there's this shifting of hormones that all of the

384
00:23:44,519 --> 00:23:52,799
obesity problem does impact neuroentocrine system, central nervous system, cardiovascular system.

385
00:23:53,160 --> 00:23:56,680
And so this impact is what we're trying to understand better.

386
00:23:56,759 --> 00:23:59,920
Speaker 1: And then what actually stimulated us researching this and do

387
00:24:00,039 --> 00:24:03,400
in this episode was recent information that was just released

388
00:24:03,400 --> 00:24:08,119
on cancer rates. Yeah, so anything above ten percent is impressive,

389
00:24:08,240 --> 00:24:12,759
and the recent data looks at reduction in cancer all

390
00:24:12,799 --> 00:24:17,599
sorts of cancer, prostate, ovarian, breast cancer of twenty to

391
00:24:17,640 --> 00:24:18,319
thirty percent.

392
00:24:18,440 --> 00:24:23,480
Speaker 2: So again, the latest information on this particular evidence is

393
00:24:23,519 --> 00:24:27,839
that we don't really know. An Umbrella review found no

394
00:24:27,880 --> 00:24:33,240
substantial association between GLP one ra's use and cancer risk

395
00:24:33,319 --> 00:24:41,079
across thyroid, pancreatic, and overall cancer outcomes. So we don't know,

396
00:24:41,519 --> 00:24:44,480
and I think it's important for people to really understand

397
00:24:44,720 --> 00:24:50,599
that in that certainly port eating can cause all kinds

398
00:24:50,599 --> 00:24:52,000
of GI cancers and this and that.

399
00:24:52,799 --> 00:24:55,279
Speaker 1: So one of the reason he mentioned thiraid is one

400
00:24:55,319 --> 00:24:58,160
of the contraindications in the next section. We're going to

401
00:24:58,160 --> 00:25:00,559
take a break and come back with side of But

402
00:25:00,640 --> 00:25:03,559
one of the contraindications of this drug was a genetic

403
00:25:03,680 --> 00:25:07,559
tendency towards thyroid cancer, and so they were specifically looking

404
00:25:07,599 --> 00:25:10,359
at does this drug really cause an increase in thyroid

405
00:25:10,400 --> 00:25:14,440
cancer with people with this genetic trait, And it turns

406
00:25:14,480 --> 00:25:18,319
out that a huge meta analysis of ninety different studies

407
00:25:18,319 --> 00:25:22,319
that there's no correlation. So that's not specifically talking to

408
00:25:22,359 --> 00:25:25,480
the reduction in breast cancer. That's just talking about one

409
00:25:25,480 --> 00:25:28,160
of the potential side effects. So we're going to take

410
00:25:28,160 --> 00:25:29,559
a break here and then we're going to talk about

411
00:25:29,559 --> 00:25:33,319
the side effects when we come back. Sound good, Okay,

412
00:25:33,440 --> 00:25:36,559
we'll be right back. Hang with us again. Mind blowing

413
00:25:37,319 --> 00:25:41,759
crazy therapy, Alice in Wonderland, magic medicine kind of stuff.

414
00:25:41,920 --> 00:25:54,839
We'll be right back. Okay, we're back. I hope you

415
00:25:54,960 --> 00:25:58,079
stayed with us. So now we're kind of in the

416
00:25:58,119 --> 00:26:00,960
side effect the benefits of all of these things are

417
00:26:01,000 --> 00:26:05,160
expanding and in ways that are again mind blowing for me.

418
00:26:06,119 --> 00:26:10,440
But so the two big really scary things three probably

419
00:26:10,519 --> 00:26:14,079
that were associated with these therapies was the genetic risk

420
00:26:14,160 --> 00:26:16,880
of thyroid cancer, and you just mentioned that, studies now

421
00:26:16,960 --> 00:26:20,559
show that's probably not as significant as what it was

422
00:26:20,599 --> 00:26:21,400
initially thought.

423
00:26:21,519 --> 00:26:21,759
Speaker 3: That is.

424
00:26:22,319 --> 00:26:26,279
Speaker 1: The other big issue was retinal blindness associated with our

425
00:26:27,240 --> 00:26:33,400
arteritis so vessels in the retina, and huge large meta

426
00:26:33,440 --> 00:26:36,720
analysis multiple studies show that the risk of blindness with

427
00:26:36,799 --> 00:26:39,200
these drugs is also pretty negligible.

428
00:26:39,319 --> 00:26:42,079
Speaker 2: So I think it's important also to point out that

429
00:26:41,519 --> 00:26:45,519
that very same meta analysis that was done showed there

430
00:26:45,599 --> 00:26:49,799
was no significant increase for hypoglycemia. So people get all

431
00:26:49,839 --> 00:26:52,599
caught up because they're on all these things, and so

432
00:26:52,640 --> 00:26:55,839
they're concerned about their blood sugar dropping. And certainly if

433
00:26:55,839 --> 00:26:56,759
you can.

434
00:26:56,680 --> 00:26:59,799
Speaker 3: Cause you to feint to pass out, have car accidents.

435
00:26:59,319 --> 00:27:04,920
Speaker 2: If you are on insulin or diabetic agents, certainly at warrants,

436
00:27:05,039 --> 00:27:08,759
as you lose weight, that your requirement for insulin will

437
00:27:08,759 --> 00:27:12,519
go down, or your requirement for those medications may go down.

438
00:27:12,559 --> 00:27:15,920
So it's really important to keep monitoring and discuss that

439
00:27:15,960 --> 00:27:17,119
with your provider if.

440
00:27:17,000 --> 00:27:22,640
Speaker 1: You're disabetic doing these drugs, you absolutely need very frequent monitoring.

441
00:27:22,119 --> 00:27:26,160
Speaker 3: By your provider. Also, that's exactly what these drugs affect.

442
00:27:26,319 --> 00:27:29,799
Speaker 2: That meta analysis also did not show an increase in

443
00:27:29,839 --> 00:27:33,160
the risk of retinopay or pancreatic events, and so that

444
00:27:33,960 --> 00:27:38,839
really was reassuring to the population that those were not

445
00:27:39,039 --> 00:27:42,839
going to be issues unless you had a previous history

446
00:27:43,079 --> 00:27:45,160
of some pancreatic you know, right.

447
00:27:45,279 --> 00:27:51,319
Speaker 1: So, pancreatitis is the pancreas produces digestive enzymes that get

448
00:27:51,359 --> 00:27:54,319
released in the small intestine and they help break down

449
00:27:54,359 --> 00:27:59,279
proteins and carbohydrates and absorb various nutrients. So when you

450
00:27:59,359 --> 00:28:02,559
have like a really really bad faty meal, or if

451
00:28:02,559 --> 00:28:07,119
you're predisposed and you have leaking of these gastric pancreatic enzymes,

452
00:28:07,400 --> 00:28:10,480
you get a parrotinitis and really severe pain, and it

453
00:28:10,519 --> 00:28:13,960
can be life threatening. So that was one of the

454
00:28:14,079 --> 00:28:17,920
potential side effects, and I will say that that is

455
00:28:17,960 --> 00:28:20,880
still probably the group of side effects that are most prominent.

456
00:28:20,960 --> 00:28:25,720
Speaker 2: Well, the most prominent are nausea, vomiting, and diarrhea.

457
00:28:25,079 --> 00:28:27,839
Speaker 1: Which I'm very very sensitive to these drugs. I've been

458
00:28:27,960 --> 00:28:30,799
I tried to go on various different ones over the

459
00:28:30,839 --> 00:28:33,279
course of a couple of years, and I'm trying them

460
00:28:33,279 --> 00:28:36,759
again for my migraines, but I am extremely sensitive to

461
00:28:36,799 --> 00:28:42,599
the nausea aspect. My daughter, genetically related to me, actually

462
00:28:42,599 --> 00:28:44,799
tried these drugs. She was probably one hundred and fifty

463
00:28:44,799 --> 00:28:48,200
pounds overweight, ended up in the hospital with chronic vomiting

464
00:28:48,240 --> 00:28:52,160
for three days that she couldn't control. And those side

465
00:28:52,200 --> 00:28:54,920
effects are the most common and they can definitely be

466
00:28:56,799 --> 00:28:58,440
diminished by dose.

467
00:28:58,279 --> 00:29:03,240
Speaker 2: Regulation, so you can mitigate most of the nausea, vomiting,

468
00:29:03,279 --> 00:29:08,559
and diarrhea. BA gradual dose titration is very effectively kind

469
00:29:08,559 --> 00:29:11,599
of you know, microdose at the front end and work

470
00:29:11,640 --> 00:29:14,200
your way up, which is what is recommended and certainly

471
00:29:14,240 --> 00:29:17,559
within the labeling of these drugs. And then as we

472
00:29:17,599 --> 00:29:23,279
move forward, some of the emerging concerns, which we will

473
00:29:23,319 --> 00:29:26,160
dive into a bit is potential loss of muscle and

474
00:29:26,200 --> 00:29:28,240
bone mass with weight loss.

475
00:29:28,319 --> 00:29:31,319
Speaker 1: Yeah, so this is the ozimpic face, is what it's

476
00:29:31,359 --> 00:29:36,039
been called on Doctor TikTok, where you lose fat and

477
00:29:36,640 --> 00:29:39,400
some muscle, but mainly the fat in the muscle, and

478
00:29:39,440 --> 00:29:42,119
then you start looking kind of skeletal, and a lot

479
00:29:42,200 --> 00:29:45,759
of celebrities we're just talking to our other daughter on

480
00:29:45,920 --> 00:29:49,519
this is Father's Day when we're recording this, and we're

481
00:29:49,519 --> 00:29:53,119
showing pictures of celebrities that look pretty skeletal.

482
00:29:53,319 --> 00:29:55,200
Speaker 3: Yeah, and that's definitely one of the side effects.

483
00:29:55,240 --> 00:29:58,119
Speaker 1: So how does that happen, Like, what's the mechanism of

484
00:29:58,240 --> 00:29:59,559
that skeletal appearance.

485
00:29:59,640 --> 00:30:03,640
Speaker 2: Well, so there's some concern of true muscle loss. But

486
00:30:03,720 --> 00:30:05,079
then also, and.

487
00:30:05,039 --> 00:30:08,359
Speaker 1: We talked previously that muscle mass is a huge metabolic

488
00:30:08,519 --> 00:30:11,079
organ and if you're losing muscle mass, all sorts of

489
00:30:11,319 --> 00:30:12,319
bad things can happen.

490
00:30:12,359 --> 00:30:13,279
Speaker 3: So we like muscle.

491
00:30:13,440 --> 00:30:17,359
Speaker 2: So there's muscle tissue, skeletal muscle tissue, but then there's

492
00:30:17,400 --> 00:30:23,200
also the fat. As we get fatter, deposits into muscle

493
00:30:23,240 --> 00:30:27,880
tissue and so then the muscle gets more lean. Additionally,

494
00:30:28,000 --> 00:30:31,640
then you've got the loss of subcutaneous tissue and so fat.

495
00:30:31,759 --> 00:30:34,559
Speaker 1: Yeah, most of your dormis or that if you can

496
00:30:34,880 --> 00:30:37,680
pinch your skin, most of what you're pinching is actually fat.

497
00:30:37,799 --> 00:30:41,359
Speaker 2: And there are ongoing studies looking at that particular issue.

498
00:30:41,440 --> 00:30:43,640
So I think we just need to make sure that

499
00:30:43,920 --> 00:30:49,079
we know that you know, when we're losing weight, we

500
00:30:49,160 --> 00:30:52,240
want to achieve healthy weight loss. We want to make

501
00:30:52,240 --> 00:30:57,480
sure we keep our protein intake high while we're losing weight.

502
00:30:57,640 --> 00:31:00,200
Speaker 1: So then one of our friends the other night brought

503
00:31:00,279 --> 00:31:04,440
up could you take other peptides like a growth hormone

504
00:31:05,000 --> 00:31:09,640
analog to then stimulate muscle development, And we talked about

505
00:31:09,680 --> 00:31:12,640
all of these peptides having benefits and side effects, and

506
00:31:12,680 --> 00:31:15,920
the problem with growth hormone therapy is that it can

507
00:31:15,960 --> 00:31:19,480
cause diabetes. So you know, you want to be careful

508
00:31:19,519 --> 00:31:22,359
what you're mixing and matching here that if you're having

509
00:31:22,359 --> 00:31:25,440
a side effect of muscle loss, you know, don't necessarily

510
00:31:25,480 --> 00:31:28,799
rely on another treatment quick and easy fix, because that

511
00:31:28,799 --> 00:31:33,559
can have side effects too. So interesting, before we get

512
00:31:33,599 --> 00:31:36,559
into weird things, any other kind of documented side effects

513
00:31:36,559 --> 00:31:37,440
that you'd like to talk about?

514
00:31:37,720 --> 00:31:39,599
Speaker 2: Those are the big ones. I did have a question

515
00:31:39,680 --> 00:31:42,720
for you, Keith in that in the bitinery medicine world,

516
00:31:42,799 --> 00:31:47,039
what is the space looking like for animal health and

517
00:31:48,160 --> 00:31:51,400
are we using GLP one ris for animals and are

518
00:31:51,440 --> 00:31:54,839
they documenting the same side effects that we're having and

519
00:31:55,279 --> 00:31:57,480
clearly some are not documentable.

520
00:31:57,640 --> 00:32:00,480
Speaker 1: But yeah, so let me answer that in a second

521
00:32:00,519 --> 00:32:02,480
after I talk about the other kind of weird human

522
00:32:02,559 --> 00:32:03,160
side effects.

523
00:32:03,920 --> 00:32:06,240
Speaker 3: The other weird thing that's.

524
00:32:06,039 --> 00:32:09,160
Speaker 1: Happening with these drugs and side effects that we really

525
00:32:09,279 --> 00:32:13,279
don't quite know and understand relates to the gastric motility.

526
00:32:13,359 --> 00:32:17,799
So all of these drugs, you know, affect gastric motility, appetite,

527
00:32:17,839 --> 00:32:22,240
eating calories in bulk fiber. Just you're eating less, you're

528
00:32:22,240 --> 00:32:25,880
pooping less, your gi system slows down, and what that

529
00:32:26,039 --> 00:32:30,279
seems to be doing is decreasing the absorption of some drugs.

530
00:32:30,400 --> 00:32:34,240
Speaker 2: Yeah, so he's speaking to gastroparesis, which is one of

531
00:32:34,279 --> 00:32:38,680
the potential side effects flowing down of the gut. And

532
00:32:39,400 --> 00:32:42,119
certainly when the gut slows down and you take other

533
00:32:42,160 --> 00:32:47,440
medications and then the transit time for those medications in

534
00:32:47,559 --> 00:32:53,400
the gut is decreased and so absorption is higher.

535
00:32:52,759 --> 00:32:54,039
Speaker 3: Usually lowers the concern.

536
00:32:54,359 --> 00:32:57,759
Speaker 1: So the problem with this, and it could be higher too,

537
00:32:57,799 --> 00:33:00,440
But the problem is that if you're on certain drugs

538
00:33:00,440 --> 00:33:03,880
that are really really important, like statins for your cholesterol,

539
00:33:03,920 --> 00:33:07,839
and suddenly your drug dose goes down or up, that's

540
00:33:07,839 --> 00:33:10,680
a problem. Birth control. If you're taking birth control and

541
00:33:10,759 --> 00:33:14,039
it becomes less effective, less absorbed, and you get pregnant,

542
00:33:14,160 --> 00:33:15,440
that's a pretty big side effect.

543
00:33:15,480 --> 00:33:17,559
Speaker 2: So the point that I was making with the higher

544
00:33:17,640 --> 00:33:21,519
absorption drug is that the pharmacode dynamics have now changed

545
00:33:22,119 --> 00:33:23,119
and we don't.

546
00:33:22,880 --> 00:33:25,039
Speaker 3: Know yet, so you have to be careful though. Yeah.

547
00:33:25,759 --> 00:33:28,720
Speaker 2: Yeah, so I think more information needs to come forth about,

548
00:33:29,160 --> 00:33:33,559
you know, dosing with other medications on board. However, if

549
00:33:33,559 --> 00:33:36,599
antibotics for NOMEN in their studies, you know, the drug

550
00:33:36,680 --> 00:33:39,880
drug interactions are not super impressive.

551
00:33:39,960 --> 00:33:41,640
Speaker 3: So yeah, but it's a concern.

552
00:33:41,680 --> 00:33:43,960
Speaker 1: I mean, certainly if one of the side effects is

553
00:33:43,960 --> 00:33:46,160
getting pregnant, that you know, we need to kind of

554
00:33:46,200 --> 00:33:48,839
know about that. The other thing that we really don't

555
00:33:48,880 --> 00:33:51,559
know is what's going to happen in thirty years when

556
00:33:51,599 --> 00:33:54,640
you stop these drugs the weight gain returns?

557
00:33:54,720 --> 00:33:55,279
Speaker 3: Is that correct?

558
00:33:55,480 --> 00:34:00,720
Speaker 2: It does? And so the point being that if certainly

559
00:34:00,960 --> 00:34:04,920
for the indicated use, what we don't know and what

560
00:34:04,960 --> 00:34:08,239
we hope to have more information on is maintenance dose.

561
00:34:08,440 --> 00:34:10,480
Is there a maintenance dose or do we stop?

562
00:34:10,639 --> 00:34:11,800
Speaker 3: Yeah, could you use this?

563
00:34:11,920 --> 00:34:14,440
Speaker 2: So we just don't know that we don't have or

564
00:34:14,440 --> 00:34:14,719
take it.

565
00:34:14,719 --> 00:34:16,519
Speaker 3: We don't have once a year, or we.

566
00:34:16,480 --> 00:34:19,960
Speaker 2: Don't have you know, twenty year studies to look at

567
00:34:20,079 --> 00:34:24,719
outcomes that far out. And so these are question unanswered

568
00:34:24,800 --> 00:34:26,079
questions on the human side.

569
00:34:26,199 --> 00:34:28,760
Speaker 1: Yeah, So going back to veterinary medicine. We're talking with

570
00:34:28,800 --> 00:34:32,440
some friends about this last night, and there are a

571
00:34:32,480 --> 00:34:35,679
lot of medications that on the veterinary side we can

572
00:34:35,840 --> 00:34:38,199
use them because they have a lot of side effects.

573
00:34:38,239 --> 00:34:41,760
But the dogs only live fifteen years, where humans live

574
00:34:41,840 --> 00:34:44,960
potentially ninety years, and so if you're on a drug

575
00:34:45,000 --> 00:34:47,119
for thirty years, that's a lot different than being on

576
00:34:47,159 --> 00:34:50,679
a medication for three years. So there is a there

577
00:34:50,760 --> 00:34:53,800
is an absolute difference in a lot of medications in

578
00:34:53,840 --> 00:34:56,719
the veterinary world that we can use and avoid the

579
00:34:56,719 --> 00:35:00,320
side effects simply because the lifespan is much short. And

580
00:35:00,320 --> 00:35:03,280
that's sad, but that's just the reality. The other question

581
00:35:03,480 --> 00:35:05,719
that you had asked before is are we using these

582
00:35:05,800 --> 00:35:08,679
drugs in veterinary medicine, And the answer is that we're

583
00:35:08,840 --> 00:35:12,519
beginning to. They're very expensive, and so a cost price

584
00:35:12,920 --> 00:35:14,320
threshold is a little bit of.

585
00:35:14,239 --> 00:35:17,800
Speaker 2: A So are there any studies among dogs or cats?

586
00:35:17,960 --> 00:35:21,480
Speaker 1: Is actually where most of the interesting information is. So

587
00:35:21,599 --> 00:35:25,360
most indoor cats are obese as they get older. And

588
00:35:25,400 --> 00:35:27,880
what's also interesting is that they have a lot of

589
00:35:28,760 --> 00:35:35,039
very annoying OCD food seeking behavior tendencies that drive you

590
00:35:35,039 --> 00:35:37,760
own are crazy. So my daughter's cat when we go

591
00:35:37,840 --> 00:35:42,880
visit non stop, is begging, meowing, buying at your ankles,

592
00:35:42,920 --> 00:35:47,679
wanting food and very healthy weight cat but just once food,

593
00:35:47,719 --> 00:35:49,719
NonStop and if you give it food, then it vomits

594
00:35:49,719 --> 00:35:52,639
because it ate too much food. So these drugs, actually

595
00:35:52,800 --> 00:35:55,679
they're not big studies. So we have like six animals here,

596
00:35:55,719 --> 00:35:59,400
ten animals here, very very small compared to the human side,

597
00:35:59,519 --> 00:36:04,199
but they are showing benefit in obesity and diabetes is

598
00:36:04,239 --> 00:36:06,719
not that common in dogs, much more common in cats,

599
00:36:07,079 --> 00:36:11,639
and so definitely this is something that's being explored across species,

600
00:36:12,119 --> 00:36:14,639
and you know, it seems to have a lot of benefit.

601
00:36:14,920 --> 00:36:21,159
But again mind blowing crazy, you know, unpredictable. Human medicine

602
00:36:21,239 --> 00:36:26,000
had no glimpse of where this drug was headed in the.

603
00:36:25,960 --> 00:36:29,800
Speaker 2: Potential, so in animal size, it looks like exanatide is

604
00:36:29,840 --> 00:36:31,159
the drug that's being used.

605
00:36:31,199 --> 00:36:32,440
Speaker 3: I was just looking at me.

606
00:36:32,679 --> 00:36:34,840
Speaker 1: We use a lot of compounded drugs, so the Supreme

607
00:36:34,880 --> 00:36:38,960
Court said that you can't patent these or trademark copyright

608
00:36:39,000 --> 00:36:42,000
these drugs, and so there are a lot of compounded

609
00:36:42,880 --> 00:36:46,880
drugs available. If we're using brand names, it gets really expensive.

610
00:36:46,960 --> 00:36:52,000
Speaker 2: It appears in cats there was a forty percent diabetic

611
00:36:52,119 --> 00:36:56,639
remission versus twenty percent in control, so kind of again about.

612
00:36:56,360 --> 00:36:59,119
Speaker 1: Ten percent how many cats though, so it was it

613
00:36:59,159 --> 00:37:00,000
was a small stuff.

614
00:37:00,119 --> 00:37:01,000
Speaker 3: Yeah, and that's the problem.

615
00:37:01,039 --> 00:37:04,360
Speaker 2: So the confidence intervals are really wide and so trusting

616
00:37:04,480 --> 00:37:05,440
that data is.

617
00:37:05,880 --> 00:37:08,000
Speaker 3: Based on the human data. I mean, it definitely looks

618
00:37:08,000 --> 00:37:09,360
like it has a lot of potential.

619
00:37:09,039 --> 00:37:11,719
Speaker 2: Sport to five cats by the way, five cats, Yeah,

620
00:37:11,719 --> 00:37:16,280
that's not really a well that's medic caase study case report.

621
00:37:16,440 --> 00:37:20,559
Speaker 1: Okay, So that's our update on the GLP ones. Please

622
00:37:20,639 --> 00:37:23,719
send us any questions or comments to ask at itch

623
00:37:24,000 --> 00:37:27,960
dot com. As always, visit our sponsors. Our primary sponsor

624
00:37:28,039 --> 00:37:32,280
is dot itchy dot com medical Pets supplements for your

625
00:37:32,360 --> 00:37:37,840
dogs and cats, and visit our websites at itchy and

626
00:37:38,000 --> 00:37:39,760
bitchy dot com or.

627
00:37:40,119 --> 00:37:44,440
Speaker 2: Our Facebook page which is I n B Podcast And

628
00:37:44,599 --> 00:37:49,239
so like the page and then rate us. We invite

629
00:37:49,280 --> 00:37:51,519
you to rate us and follow us. We really want

630
00:37:51,519 --> 00:37:54,320
your feedback and we're so thrilled that you've chosen your

631
00:37:54,320 --> 00:37:56,480
week to join us.

632
00:37:56,880 --> 00:38:01,079
Speaker 3: Stay well, stay safe, get up and move Okay, Bye

633
00:38:01,079 --> 00:38:01,599
bye guys,