The Ozempic Revolution with Dr Alexandra Sowa
52:31 Share

Welcome back to the Health Longevity Secrets show with your host, Dr. Robert Lufkin. His book titled, Lies I Taught in Medical School, is a New York Times bestseller. See the show notes for a link to download a free chapter. And now, please enjoy this week's episode as we look at the Ozempic Revolution with Dr. Alexandra Soa.

What if everything you thought you knew about weight management was wrong? Dr. Alexandra Sawa, a board-certified internist and obesity medicine specialist, challenges conventional wisdom in this eye-opening conversation about the true nature of obesity and the revolutionary medications that are transforming its treatment. This episode is sponsored by Rio.Life, who makes GLP-1 agonists available in their programs.

Now, I'm an advisor to Rio, but I also only advise companies that I believe in and would use for myself and my family. Now, the standard advice of eat less, exercise more has failed generations of patients because it fundamentally misunderstands obesity as a willpower problem rather than what it truly is, a disease of neurohormonal dysregulation.

Our modern environment, particularly our food system, has damaged the delicate balance between our brains and hormones, making sustainable weight management virtually impossible for most people through behavioral changes alone. Enter GLP-1 medications like Ozempic, Wegovi, and Monjaro.

These synthetic versions of hormones that our bodies naturally produce are revolutionizing treatment by addressing the underlying dysfunction. Working throughout the body, not only in the stomach, but also in the pancreas and even the brain, they reset hormonal signals, reduce inflammation, and stabilize blood sugar. Perhaps most remarkably, they transform food cravings

at a basic level, making healthy choices feel natural rather than punishing.

The benefits extend far beyond weight loss. Recent studies show these medications can prevent heart attacks and strokes. There's hints that they can even possibly slow dementia progression, treat sleep apnea, and even help with addiction disorders. Dr. Soa calls them longevity medications with potential to add healthy years to patients' life by reducing systemic inflammation and improving metabolic health.

So, are you ready to understand the science behind today's most talked about medications and their potential to transform not just individual health, but society's approach to metabolic disease? This conversation offers both practical guidance for patients and a vision for how we might reimagine our relationship with food, weight, and health.

This episode is brought to you by El Nutra, maker of the Prolonged Fasting Mimicking Diet. If you'd like to try it, use the link in the show notes for 20% off. What's the best imaging test to assess health and longevity? I used to think it was the CT coronary artery calcium score. Well, I don't anymore because now with the same x-ray exposure and time as a calcium score, I can get a complete metabolic heart scan.

This includes not only the CT calcium score, but also calculated arterial age, liver fat quantification, and CT bone mineral density. These key metabolic and cardiovascular markers can detect the actual disease that blood or genetic testing only show the risk for.

This scan is available anywhere in the U.S. without a doctor's prescription. See the attached link and use the code LufkinCT for $100 off. Join the health longevity medical imaging revolution today. And now, please enjoy this week's episode. Hey, Alexandra, welcome to the show. Thank you so much for having me. It's an honor to be here. I'm...

I'm so excited about this topic and also talking about your book, which is a great book. Everyone needs to read this. And also there is CME credit and CE credit for healthcare professionals. So if you read the book, you can actually get credit for it.

And how did we find out about that, by the way? I forgot to ask. Yeah. So the Ozempic Revolution, I wrote it for the individual user, but it's jam-packed so much of science that we got CE credit. So you can actually head over to my Instagram and I have a link and it's free. And we just have to get you to the right place to claim your credit pretty easily. Great.

Well, we'll go over all the links and stuff at the end, but it's a great book, and that's what we're going to talk about today, the Ozempic Revolution, and I can't wait to dive into it. But before we do, maybe you could tell us just a little bit of your story or how you came to be interested in this fascinating area. Yeah.

Thank you. So I am a board certified internist and obesity medicine specialist, and I was always fascinated by the field of public health. I actually went to college specifically to Johns Hopkins because they had a public health program and I was fascinated by the idea of prevention.

And I don't know where I really got that idea, but I was like, wow, if I could help make the world healthier on a large scale, wouldn't that be amazing? So I went to Hopkins and during my time there, I actually worked at the World Health Organization in the HIV AIDS department in Switzerland. And this is so cool. But I think I'd like to learn how to treat the individual first. So I'm going to go to med school.

And I got to med school and I was pretty disappointed by how little energy there was put into prevention. And I thought, okay, well, let me be really global as much as I can be. I'll do internal medicine in my training. And then yet I get to internal medicine training and very, very little prevention, um, and

Even though we learned about screening and things like that, I thought, geez, I feel like most of my education is on end stage disease management. And I wouldn't even call it treatment. It was just like, how do we manage this disease? And inevitably, we kind of know it will get worse. And one of the things that I noticed was that we were telling everyone that generally their disease would be improved if they lost weight. So we'd say, eat less, exercise more. Here's a handout.

But I knew that that was not going to be very effective. And so when I found the field of obesity medicine, which was very, very nascent, I found it in my training.

there was nothing else I could do. I was so lucky I got to work with some of the pioneers of the field and see what they were doing. And I was like, this is so cool. We have actual treatment paradigms and tools that we can give people. And by helping them lose weight, even if it might be with a medication, they are then rolling back tens of other medications and they're improving all of these other cardiometabolic diseases that will progress and cause problems. So it's

That's how I ended up here. I feel very lucky to have been one of the first practicing obesity medicine doctors in the country. And it's really informed, I think, a unique view of the way I see GLP-1 medications.

Yeah, well, before we dive into GLP-1s in particular, you said something that as an obesity medicine expert, the advice that is still given today by my medical school and leading authorities around the world to people who are overweight or obese, which

Today, sadly, is most adults in America and large numbers elsewhere. The advice is given, as you just mentioned, was exercise more and eat less. Why does that not work? It seems, I don't know, makes sense, right? It does make sense. And on some level, it is the balance. You know, my kids run around outside and they eat a lot, right? Like there is at some point our bodies maintain that balance, right?

But what has happened in our modern society is that obesity is a disease of neurohormonal dysregulation. So that means that it's our hormones and our brain that's actually been damaged. That is very, very hard for people to grasp.

Once that pathway becomes burdened and dysregulated, we can no longer maintain that homeostasis of calories in, calories out. And what has led to that neurohormonal dysregulation is the world around us. And in big part, our food sources and the foods that we eat have led to things like leptin and insulin resistance, which I talk about in the book.

And that is so driven by what's happening in your brain and the signals that you get to eat or not move and to get sicker. It's very hard to overcome that with just eat less. You can will yourself while you might, but if your brain is telling you to eat and it's telling you to eat poor sources because your brain has been damaged, that is inevitably going to happen.

Yeah. One more weight question, specifically the general weight question before we get into GLP ones in particular that I, I think everyone's been sort of been struck by the fact that this, this obesity epidemic really took off about in the 1980s or 1990s. I mean, it was always growing, but then there's just a hockey stick uptick. And for the last 40 years, it's,

It's gotten bigger and bigger and hasn't stopped. What you know, there's so many things that could be implicated for that. What's your what do you think cost it?

I think it's multifactorial. I do think it's largely environmental. So it's our food sources, it's corn subsidies, it is toxins in our air, it's the plastics around us. I think that we're bombarded every day. Our hormonal system is bombarded by toxins and we're

we need to take a step back and really think about what we've done because we did something very discreet in the eighties and it is changed and we

I argue that this is a time to really go back and reverse the change in epigenetics that's happened in the past two generations. And we're able to find, we can't just use a medication to treat. I know we're not there, that part of the conversation yet, but we also have to use this opportunity to go back and start to heal our environment. And our food is a big part of that. And ultra processed food, the food that I grew up with,

Gosh, it's just done such damage to us, this idea of low fat, high sugar, high processed, the food pyramid, which hasn't been around for a while, but it's still what unfortunately most adults remember. We really need to work on resetting what it is that we see and define as food. So it's not really, oh, the seed oils or the high fructose corn syrup or the...

Not necessarily any one thing. I don't think it's one thing. Oh, I do. You know, it's really fascinating. There's even, even the fact that we're temperature controlled in our homes has led into a rise in obesity, right? We don't shiver and we don't sweat. And we're so comfortable that our bodies have kind of let go of some of their animalistic instincts. We ride in a lot of cars. We are glued to our tablets. We work, we vacation differently. We go to all you can eat buffets and you know, it's,

There are so many things, but I do think food source is a very important part of it. I don't think we can vilify just one thing, and I don't think we're going to cure the obesity epidemic forever.

with just taking out a dye or taking out a seed oil or banning this or banning that. I think we need to take a much more holistic and rational approach to it. I think just plain and simple, anything that you can buy in a box that's highly pulverized and processed has not helped us very much and it's hurt us. Yeah, yeah. The

The explosion on obesity, obviously the eat less, exercise more is not working. I just saw an article, I think it was a jammer or something, or it was a letter to the editor for the first time. I don't know if you came across it. They were saying for the first time in 40 years, the number of obese patients is...

at least possibly, and it's not clear now, maybe leveling off or, you know, down ticking. And they're attributing it to what we're going to talk about today is these miraculous drugs. It's thrilling. The NHANES data showed that we had a slight downtick in multiple categories of obesity for the first time in 40 years. That is...

Truly a revolution. That's exciting. And maybe just to start to bring our audience up to speed, those of us who are not

fully familiar with GLP-1s. Could you just give us a GLP-1 Ozempic 101 overview? Definitely. So when we talk about GLP-1s, we're talking about GLP-1 agonist medications. It's a synthetic version of a hormone that our body, our gut naturally makes.

big, big difference here is that once you have neurohormonal dysregulation, and your brain does not respond to the hormones, your body's pumping out the short, very short time that that native hormone lasts in your stomach, it degrades in seconds to maybe a minute,

and your gut, it doesn't have the effect that we need. The synthetic version, these medications that we're talking about, last a very, very long time and are very stable in the bloodstream. And there are receptors all over the body because our body naturally makes JLP1. There are receptors all over the body that our body sees big whole body benefit from these medications.

The medications that we talk about right now are the weekly injectable medication. So I call the book the Ozempic Revolution, but really it's the GLP-1 revolution. Ozempic was just the first name that people really started to associate with it. So we have some semagulatide, which is just a GLP-1 medication, a weekly injectable. And it is known as Ozempic for type 2 diabetes management and Wegovi for weight loss medication.

And now we have a newer kind of category of drugs where it's not just a GLP-1 hormone, we also have additional hormones. And in particular with trisapatide, we have GIP hormone.

And these are, again, hormones that naturally occur in the body and we're replacing them at much higher levels and their strength is thousands of times stronger than what we natively make. And we'll have newer class of drugs, which will have three and potentially even four of these hormones and target different pathways. So

That is what it is. And it works all over the body. As I said, we have GLP-1 receptors in the brain and the kidneys and the heart. And this is why we often see big longevity benefits beyond just weight loss or blood sugar control. But

For the purposes of our discussion, the three big ways that these drugs work is that they talk to the brain. So they help with that resetting those hormones that have become diswired. They talk to the stomach and they slow gastric emptying. And in that process, again, hormones are positively affected where your brain is set, tells you, I don't need to eat, I'm full and you're fuller longer.

And then finally, it acts on the level of the pancreas and makes our blood sugar and insulin response very, very stable and effective. And we had talked very briefly about insulin resistance as a big driver of weight and something that will not be solved by just eating less or exercising more.

And up to 88% of Americans have some level of insulin resistance and metabolic dysfunction. And so this is one of those very important places that the medication works. It just makes everything better.

And the body's response to blood sugar just brings that inflammation down right away. And then fat is not created. So it's a very, very effective, powerful tool. And I hope I did a succinct enough job of describing how it works. Yeah, yeah. No, these are, it's fascinating. And then I think, yeah,

When we go from just GLP-1s in the Ozepic to the GLP-1s plus GIP, the two component ones like Terzepatide, Monjaro, those, we get...

In a lot of studies, we're showing even additive effects as far as weight loss or type 2 diabetes control. Is that correct? Oh, yes. So we're getting added benefits even beyond that now. So the FDA has approved triseptide for sleep apnea treatment.

We go V has gotten approval for secondary prevention of stroke, heart attack after cardiovascular disease has set in. We're going to see kidney protective benefits. And so even we're going to probably see,

you know, it's curious which drug companies are going after which FDA approvals. We do tend to see improvement across all cardiometabolic functions with these meds, but some have greater. So trisepatide, we see greater weight loss, we see tighter blood sugar control. And as we add in other hormones, it's going to be very exciting to see kind of like what ratio is for the right person.

Yeah, yeah. So wait a minute, you're saying it's not just weight loss, right? I'm in LA here. It's all, you know, everyone's taking it for weight loss at all. But you're saying now type two diabetes, of course, original indication, but sleep apnea and sleep apnea.

And then there are papers about fatty liver disease, about Alzheimer's disease. And these are just explorations, but they hint at what we may start seeing. So wait a minute, what's going on? How is this related to weight loss and obesity?

Do these effects, is there a place for these drugs in these other indications in people who aren't obese? Because I get it. You know, if you're overweight, then you're at risk for all those diseases that you mentioned. But how about for people who aren't overweight? Are we seeing benefits of these drugs there?

In other areas without having to be overweight? Well, that's a nuanced question. And I think we really need to take it on an individual level. I would say that these medications are really proving to be longevity medications. And we are seeing tremendous outcomes in dementia prevention programs.

progression, not really prevention yet, but progression. We're seeing minimized disease. We're seeing it for treatment of addiction. In PCOS, it can generally be very curative for women who have PCOS and insulin resistance predominancy. It is, we're going to continue to see added and non-benefit. So the question you're asking is about whether it's appropriate for people who don't have a lot of weight to lose. And the answer can be yes.

So let's take it back a step farther. We have traditionally categorized overweight and obesity by BMI. That's an inexact tool. It's a good screening tool on a population level. It's an exact. Better is body composition. There is now more of a movement to better understand how much body fat we have on our bodies and how to test that, whether it's a DEXA scan or a body composition scale.

And I'd say it might surprise you, even in people who technically might not have weight to lose on a BMI scale, may have a predominance of fat and a poor ratio and where this medication might help. I'd also kind of peel it back farther, maybe even before we go to body composition, is just metabolic health.

Only 12% of Americans are meeting full criteria for metabolic health. And to me, this drug is a metabolic health drug. And so we don't want to wait to treat you until you've progressed to type 2 diabetes. We know that we can almost fully prevent the progression to type 2 diabetes with these medications if we catch you in the prediabetes range, in the insulin resistance range. And so

I think we need to take a step back and look at the whole of a body, including their labs, including body composition, including their weight history, their mental health history. You know, if you're perseverating nonstop about what to eat next, and I might be able to help you and free your brain with a small amount of this medication, should I withhold this from you while you continue to suffer? No, I don't think so. But there also have to be some guardrails in place because it's

If we use this tool as a way to just go from thin to thinner, we can have poor outcomes, bone health, muscle health, nutritional deficiencies. We kind of set you up for yo-yo dieting. You know, there are things we have to be careful for. So should everybody in the population be on it? No. But will we see expanded usage in the next 10 years? Absolutely.

I love what you said about it. This class of drugs being potentially a longevity drug. Personally, I find myself getting more and more interested in longevity the older I get. Imagine that, me too. So what is the, you know, their hallmarks of aging and all this stuff, what is the mechanism for longevity? I mean, you'd sleep apnea, obviously, or

What makes people live longer on these drugs, do you think? Or what's the longevity mechanism? It's less inflammation when it comes to the level of more stabilized blood sugar. We've known that for a long time, but it's hard to help people achieve that in kind of the modern world and once metabolic dysfunction has set in. So we know that once you lose weight, you decrease significant inflammation,

through, you know, complicated pathways, but we see decreased inflammation across the board. Even if I just ordered a CRP or an HSCRP on you, we see that fall dramatically with 10% total body weight loss.

And so if weight loss is at play, that's like right in front of us. We are reducing inflammation. But even if there doesn't need to be too much weight loss and it's a smaller amount of weight loss, the blood sugar stabilization prevents coronary artery disease, dementia, cancer. It's that constant pinging of slightly above normal blood sugars that leads to a lot of disease. And this drug is very, very powerful at keeping everything nice and stabilized.

There's a school of thought that lifestyle can reverse metabolic disease. And I talk about it in my book, Shameless Plug, there. But if you're saying, boy, I could take this drug and

And I don't have to worry about lifestyle. Lifestyle involves a commitment. So is this an alternative for just living a healthy lifestyle? I can just take GLP-1s and then do whatever I want? I'm glad you asked because absolutely not. So now shameless plug for my book. We're very much the same school of thought here, which is I'm

I see this class of drugs as a revolutionary tool and really at its core it can do a lot of good, but it is worthless in my opinion if you do not take the changes to really transform your life. And the habit foundations, the food foundations, even the mental health foundations that I walk people through in this book are very, very important.

I set out to write the book actually because I've been doing this for a long time and I had a very holistic practice that did use anti-obesity medications like GLP-1s, but I was very big into what are you eating? How are you eating? Let me find at the core of what's dysregulated. Let's treat that through food and exercise and lifestyle and habits.

And what I noticed was with the rise of these medications, there was this false sense of security that we have a magic shot and everyone should be on it and you're going to get it asynchronously. You'll never talk to a doctor. No one will ever tell you how to eat or how to think or how to move or how to protect your muscles. And that's just fundamentally flawed. You will not. I have never found anyone who ever desires thinness to be successful long term. You know, skinny isn't motivating and skinny does not equate to health necessarily.

What these medications do allow, though, is for people who have struggled with their weight specifically, there has been so much shame heaped upon them by society and medical doctors and themselves that they have failed to do something right. And these medications will free them from that and actually allow them to be successful, potentially for the first time in their lives, and give them space.

to actually focus on all of these important foundational elements in the lifestyle. You can be on this medication, but if you are smoking and drinking and going through McDonald's and you are not working out, I cannot promise that you'll have any longevity benefit, right? This is an augment to a healthy lifestyle and it allows us to achieve that healthy lifestyle.

Yeah, I've heard the example that for people who exist on a diet of junk food and they take GLP-1s, they will eat less, they will lose weight, but if they still eat junk food, they'll still be unhealthy. They'll be thin, but they'll still be metabolically unhealthy. On the other hand, talking to people about lifestyle,

For some people, it's a big ask. It's like, oh, just try harder. Dump the sugar. Go low carb. You're not trying hard enough. And there's an opportunity cost, I think, of lifestyle and bandwidth. I mean, I have a friend who's a very smart guy.

Um, and he, he became, he, he had some heart disease and then he became excited about lifestyle. And now his whole purpose in life is watching the sugar. That's all he focuses on. And he, you know, it's, I mean, it's a good purpose, but I don't want to spend the rest of my life, you know, counting the sugar in my coffee or anything. So it's almost like if this, if this helps people, um,

live healthier and, and maybe that's what I want to talk about next. Yeah. Is the, is the brain effects on what people do when they take GLP ones. I love that. Cause it's true. I mean, we're human. That's what I'm always telling people. Like we can have ideals and then, but we're also human and yeah, we don't want to spend our lives just being perfect. And we can't, especially in the world that we're set up to, you know, that we live in. Um,

These medications are so fascinating because they give people bandwidth. I actually said that exactly in the book. They give you willpower. This disease is not about willpower, but all of a sudden you magically have it. And you're like, I've been trying to get myself to the gym for 15 years. And now that I've lost 15% of my total body weight, I actually have some motivation to go move my body. The most profound thing I see is that this medication

changes what people crave and their taste buds actually change. This is a little known fact that at the level of the tongue, we see changes, real kind of DNA genetic changes and people crave less salty, less sweet, less hyper palatable foods. And in fact, I will have many people come to me and say,

i can't believe it but i'm craving broccoli for the first time in my life i want vegetables i do actually just shop the periphery of the grocery store and it's not hard work and i just kind of look at these things that my kids might be bringing home like the girl scout cookies or christmas cookies and i don't even want it and that's a wild thing so that's

And that's where these medications can really help us restructure, I think, whole family units, grocery stores. On the societal level, I think we have an opportunity actually to start really changing some of the broken things that brought us here because people have a little bit of time and space from them.

And yeah, they crave different things. So what's happening at the level of the brain is that it is starting to heal some of that hypothalamic dysfunction that happens when we get re-exposed to hyperpalatable food over and over again. And the same parts of the brain that light up when someone who's addicted to alcohol or drugs, the same part of the brain that lights up with hyperpalatable junk food, it's

lessened on these medications. We don't have such a large dopamine response and it's pretty profound because even it's not only that the food doesn't, if you tried the food, it won't give you that same high, but you don't even want it, which is pretty remarkable. And that's where people then are like, okay, well, I guess I can food plan now and I'm going to eat protein and it's not going to be like such a punishment. In fact, I see it as something I want.

Yeah, it's amazing. And I understand that junk food makers are freaking out about this as a potential loss of market where people are just they move away from Doritos or cereal or, you know, other junk foods. And now they're actually

hiring GLP-1 experts and engineers to engineer a new generation of junk food that bypasses this effect of GLP-1s that sort of get around it. Of course, of course they will. Of course. And this is where our government really needs to step in and look at regulation. That's a ridiculous thing. I mean, they're being very forthcoming. There was a wonderful article in the New York Times at the end of last year. And these kind of fancy junk food makers were like,

why yes we can re they were asked can you engineer food around these receptors and they're like probably yes maybe so and i just think you'll be careful of that because we have a solution that's right in front of us but we might be able to engineer our way out of it and then we're back to the same problem so yeah and and you you hinted at there the studies they're showing that uh

Half the people on these decrease their alcohol consumption. Not by trying. They're just not interested in alcohol or other addictive behavior. You know, the food noise goes away, the shopping noise, the gambling noise, the porn noise, whatever your noise is. You know, whatever. It's interesting the way that it affects that on us. Yeah.

I wonder if there's a, do you have, go ahead. No, I just, I'm like nodding, nodding, nodding. You know, just yesterday I had a patient write me an email and she was like,

I can't believe what this drug has done to my shopping addiction. You know, it's just profound. It's just that part of the brain just doesn't get the same high. She doesn't even miss it. She's like, well, I'm not as fashionable this season, but my wallet thanks you. My wallet, my waistline. Thank you. Yeah. Yeah. Well, the, um,

Yeah, it's such an interesting effect there. I always wonder, though, that's the good news. Now, looking at potentially downside, people wondered, well, boy, if I don't, you know, all the things that I used to really crave or get excited about, they sort of go away. And that leveling of the reward centers and everything, is there...

Is there any danger of depression and nothing's fun in life anymore? I mean, there's always danger of depression, but I guess what is the evidence? You know, we've heard things about suicide, depression and other side effects. We can talk about those. Which ones we need to worry about, which ones are overstated or not really apparent at all? OK, so I think this comes back to the question before we even get into that evidence of

who should be on this drug? So this is a drug and there are some side effects and this potentially is one of them. And this is why, you know, if you don't have dysregulation or just looking to get skinny or some vague idea of prevention, is this drug great for you? Probably not.

So on a population whole, we actually do not see any increase in depression or anxiety or suicidality. There were a few reports and small studies that sparked some worry. But after a very, very large study of GLP-1 users in Europe and America, there was no causation found.

So, and that's what I would say obesity medicine doctors are seeing that there is actually an improvement in anxiety and an improvement in depression, right? If you've lived with something kind of keeping you from living your best life and now you have a solution for it, generally there is an improvement in feeling and thought. This is less so when you have your why. I talk about in the book, but like you need to find your why. And if your why is just thinness,

then, yeah, I think a little hit to your pleasure centers is probably going to affect you more. But if you are, your why is I want to walk up the subway steps or play on the ground with my grandkids and you start to be able to achieve that, that is such a dopamine boost in and of itself that we don't see that.

What I do find important and one of the things that I want people to work on in their holistic lifestyle is identifying those who use food and alcohol as their only source of pleasure, comfort and socialization.

So these medications might make it so that you really don't want to drink or you don't want to go out and eat in the traditional way. And you have to kind of get ahead of how you're going out with friends or your date night or how you're kind of unwinding at the end of the night if you're not reaching for a bag of chips. What else are you going to do to let your body unwind from the day? And so I'll have people actually log that association at the very beginning before the

How are you using food? Let's recognize this. And then let's actually ahead of time recognize where, hey, we might need to adopt a hobby. Or why don't we suggest to your friends instead of bar night on Saturday, we're going hiking or going bowling. Like, let's do something else. Because the only people that I've ever really found that had some

sadness around the journey of weight loss was that were those whose whole social lives were wrapped up in eating and drinking, and they really needed to kind of reestablish their role in that. I would say anecdotally, I've had a few patients who tell me, I just feel like I'm dampened a little bit, like my sex drive isn't as high. My desire to go out isn't as high. I'm

I'm quieted. I'm okay with it, but I've noticed it. And I receive that and I believe them. But generally the benefits so far outweigh what they might be negatively experiencing. You know, we see this with other psychotropic agents. So even just SSRIs or SNRIs, they might have some side effects and they might dampen how you feel, but their improvement when necessary is so good that people will stay on them.

Yeah, it's such a great point in your great book. The first and still the best book on it. And it's great for people who it's really readable by anyone. It's not a it's not it. It has a lot of good medical information, but don't be frightened of it. This is a great way to learn about GLP-1s. But the interesting point you make is that if we if we have a behavior like this,

we eat too much food or we gamble too much or something and then we take a drug that fixes it if there's an underlying cause of why we do it and we we only fix the behavior then that underlying problem will switch to something else and it's sort of it's beyond the scope of this conversation but you know i'd love to you know it's a great it's a great point that you made

Well, I don't know if it is beyond the scope. I mean, you know, with bariatric surgery, we warn people. It took us a while to figure this out. But with bariatric surgery, what we found was after you took away the ability to eat food for comfort and to get that high, there was an uptick in alcoholism. And we had to start screening everyone who had a potential risk and really warn them about this. They might turn to alcohol. Yeah.

I am not seeing that replacement yet. I have not seen that. Now, time will tell. Maybe there's something else that comes out in a behavioral pattern. But I think what's so different about this tool is that we do have these receptors everywhere and it's more global. It's not just the stomach. It's not just cutting away part of the stomach. It's affecting the brain. It's affecting the gut. It's affecting, you have these receptors everywhere. So it's almost like,

there's nothing that I have not seen this yet in my patients where they turn to something else that's nefarious as a replacement. Yeah. Yeah. Can you speak about strength training or weightlifting? I mean, I'm a, I'm a physician. I just started doing it. I've never touched weights in my whole life decades. And, and I think of my physician friends and,

Unless you're an orthopedic surgeon, you don't lift weights, most of them. And, you know, so it's something that...

I've found to be, it's, it's transformative and it's a great thing, but, but how does that play into these GLP ones? What is it? What is, what is strength training or weightlifting? Why is that so important? Well, you know, your muscles are your longevity organ. I've always, I've believed that and I'm still glad it's getting more attention. Just like fat is an organ, your muscles are an organ too, and they have profound impact. When we lose weight, we,

by any means, we lose muscle in addition to fat. There's no way to just target fat loss. And when you lose large amounts of weight, you lose more muscle. Now, GLP-1s get a bad rap for muscle loss, muscle wasting. There's actually an improved ratio, specifically with trisapatide, of maintaining muscle to fat versus traditional calorie restriction or

surgery. And so we don't have to be afraid of these medications on that front. But what you do need to do is rebuild your muscle. And so if you're just losing weight, especially if you're older over the age of 55, 60, there is a potential for becoming thin, but just becoming full of fat. And we call that sarcopenic obesity, where you just have lost your muscle. And muscle is so crucial for

living a full life. But in this, in the realm of metabolism, it's very important for blood sugar management and for your underlying basal metabolic rate. And so we want to prioritize strength training. Cardiovascular fitness is important and, and, you know, walking, getting your heart rate up, it's important for your heart. But strength training is where I have all of my patients focus on their efforts.

I will say, though, I give people a break from working out when they first start on these medications. I do not need people to overturn their lives and do everything differently from day one. It's like, let's first get a handle on the weight loss part. And then kind of we embrace the strength training. What I will say, though, is so many people have come to associate exercise just by as a means of losing weight, right?

that sometimes people lose a deep motivation for exercise, even if they've done it for years, once they actually start losing weight, it's almost like their brain is like, that was useless. So why do that again? And we really have to work around that. So it's like a little warning to everyone out there. Be careful. I found that your brain is your biggest sabotager when it comes to your health, even when we have an amazing tool like a GLP-1.

And so it's kind of just a non-negotiable. I have to have people reframe it that this isn't about weight loss. This is truly just about being a healthy person. And I'm not in the business of helping people waste away. So let's build those muscles. It's my patients who build muscles too, who have the best shot at coming down or off of these medications and maintaining on a low dose rate.

We haven't talked about this yet, but these medications, once you start this synthetic hormone, it's a hormone that your body will need likely indefinitely to maintain all of these benefits. Studies show that only 5% of people will keep off the weight at five years. And that number probably goes down as we study that population even longer.

So it's important that people that are able to kind of come off of it don't just transform lifestyle. They really focus on body composition and driving down the body fat percentage.

So speaking of that, what is your position on long-term use? Or do we worry about receptor down regulation? Should we take, you know, skip a week here and there? And is there an upper limit to how long we take this? I mean, could you take it for life? Yes. So we have had these medications in clinical use since 2005. And we have studied that population. Now it was used for type 2 diabetes patients.

first in 2005. And these medications are approved for long-term, potentially lifelong use. I find that as we, I progressed with people through decades of use, because at this point now sexenda has been on the market for, which is the first GLP-1 for weight loss for more than 10 years. Um,

I have had to move people through different classes of drugs. It's not quite a fair comparison because the newer medications are easier to tolerate, they're even less expensive, and they're much more efficacious. But I do find that sometimes I have to move people along. Sometimes people stay at a low dose, are able to come off, and then some don't become really tolerant, but they age and their body has different needs.

Is there any evidence for oscillating dosages right now? No. I do think we need to study some of this a little more to understand how we can help, how we receive this medication and, you know, decade three, decade four, like what do we need to do?

I've also interestingly found as people age and they move through different transitions of life, sometimes they just need less of that medication. They come down or off. I'll see women who I treat through their menopause transition. And then after they exit menopause and their hormones are kind of in their new normal and regulated, they don't need this as much. And I think that that's the next frontier of how do we use this medication kind of to

For these longevity of these other benefits and how can we take people off of it. But we shouldn't be fearful of being on this long term. We've studied these drugs from this initial population in 2005. We have cohorts that are just hundreds of thousands of people and we do not see an uptick in any, any.

concerning areas like pancreatic cancer or thyroid cancer. We just don't see that. There was always there was concern and it's kind of been labeled as such, but that's not what we're seeing. And in fact, we see 13 rates of decreased types of cancer, decreased heart disease, decreased all cause mortality. I mean, we go we got this benefit for.

cardiovascular and stroke risk prevention once you already have onset of cardiovascular disease. And the all-cause increased mortality was decreased by 20% at five years. That's remarkable.

So, you know, it's again, benefit risk ratio here. Yeah. Yeah. We talked a little bit offline about how the effective dose for like something like terzapatide was about 2.5 milligrams to begin to see effects. And that's the starting dose that Lily uses. Yeah.

Do you think there's any value in, some people are talking about, quote, micro dosing or low dosing long term. Is there any value doing that? If you're below the effective dose, will you still get inflammation benefits? Or what's your thought on that? We just don't know yet. And I take a pretty party line approach.

And this is where I'm pretty traditional. So we have studied micro dosing in clinical trials when our hypothesis was treating obesity, overweight, cardiometabolic dysfunction, type two diabetes, the micro dosing didn't work. That's how we set the therapeutic doses. I want to see more data at the smaller doses. I don't tend to see, I have had to micro dose a few patients because of either side effects or, you

Some people are just hyper responders. It's not even side effects. It's that they just don't, they feel it lower. But for the general population, I generally don't even see anything in the starting doses of Wegovi and Trezepatide at the very beginning for the vast majority of people. So I think we just need more study. I caution, I see a lot of people using the concept of microdosing just to generally be

feel better. But, you know, we've talked about some of these things. There are some risks. And if we're not really using it for a reason that we can elucidate, I do worry that maybe some of the anhedonia and the mood changes and

you know, muscle loss or bone thinning, you know, things like that. And you're not nutritionally getting what you need. I just, I worry. I mean, I think we need to treat this drug with respect and respect often means clinical trials in a, in a, you know, well-controlled manner.

We were talking offline about a little bit. Maybe you could speak about your practice, because I understand you accept patients from all over the U.S. or certainly in a large number of states where you're certified. So you don't have to be in New Jersey necessarily to work with you if people are interested in becoming your patient. Yes.

Yeah. So the book talks about the so well method and I have a practice that this is where this came from in my last 10 plus years of being an obesity medicine doctor, very unique practice where we, it's all based in education and we really kind of walk people through a program. And so I'm in based in, I'm telehealth, but we serve people in 13 States. Um,

because I couldn't quite get certified in all 50, it's really hard to ask. They make it very hard in this country to get certified in all the states. I have another company called SoWell, and we have metabolic health testing kits that are available for our 50 states. And we have products specifically made for the GLP-1 user that help minimize side effects and maximize your journey so that you're nutritionally getting all of your needs. So we have a

high protein, low carbohydrate pre-made meal service. And we have supplemental products, specifically the GLP-1 support system. So if I'm not in one of these 13 states and you already have a doctor you love, you can still check us out. So our website is GetSoWell.com. And I'm also over on Instagram trying to

trying to educate as much as I can. I'm not on there as much as I don't know where some of these other doctors get their time to be on there, but I try my very best. So I'm at Alexandra Soa MD, and you could find me on all social platforms at that handle.

Well, I know we're short of time before we go. Is there any, what are you most excited about in this space? What are you looking forward to like in a, in a perfect world? Where do you, where will we be in five years or pick your time frame? It's such a good question. What I want this medication to help us do. I don't want it to divide us as a country and as a society. I actually want it to continue to allow us to de-stigmatize the disease of obesity and

But at the same time, realize that something pretty catastrophic has happened in the last 40 years where the majority of Americans are suffering from overweight or obesity. And we need to use the power of this medication. And when we get that sigh of relief from that data going down, that our weights are finally going down, oh, yes, we can't just rely on the med. We need to use it as motivation to make some significant change from a government and population level.

So that's my big hope. And I'm incredibly hopeful that in the longevity space, we start becoming more precision focused on what drug for what person, what dose for what need, and that we really investigate that in a clear and thoughtful way.

Well, the book is "The Ozempic Revolution." Get it? It's a great book if you want to understand this amazing space with these drugs that are going to change the world. They already all are changing the world. Thank you, thank you so much, Alexandra. This has been wonderful, and thank you for the great work you're doing. Thank you. If you are enjoying this program, please hit that subscribe button, or even better, leave a review.

Your support makes it possible for us to create the quality programming that we're continually striving for. Can I start? It's already recording. Oh, sorry! This is for general information and educational purposes only, and it's not intended to constitute or substitute for medical advice or counseling.

The practice of medicine or the provision of health care, diagnosis or treatment, or the creation of a physician-patient or clinical relationship. The use of this information is of their own use as risk.

If you find this to be of value, please hit that like button to subscribe to support the work that we do on this channel. And we take your suggestions and advice very seriously, so please let us know what you'd like to see on this channel. Thanks for watching, and we hope to see you next time! You should say it. You like it? You want to do it one more time? I think that was good. Yes! You need to save the recording.