Episode Transcript
[00:00:00] Speaker A: Hi, welcome to It's a Kinetic thing with Karen K. Today we're going to talk about some more weight loss subjects.
[00:00:06] Speaker B: So today I wanted to get a little more in depth on the actual weight loss injections. And we know what they are, but you might just want to do a brief description for those that don't know. Exactly.
[00:00:16] Speaker A: Yeah. So the once a week injections, now there's basically at this time there's Tirzepatide which goes by the brand name Mongero or Depthbound. And then there is Semaglutide, which goes by the brand name Wegovy or Ozempic. And how they work, all of them is basically one, they slow your digestive tract so you get full sooner and you stay full longer. Two, it lowers your insulin resistance so those that insulin can bind to those receptor sites on your cell and let you burn your food more efficiently and less likely to store it as fat. And then fourthly, it works on that glucose pleasure center in our brain that makes us crave things like sugar and carbs and so it helps quiet cravings and things.
[00:01:03] Speaker B: Now, are those drugs interchangeable?
[00:01:05] Speaker A: They are not exactly interchangeable. They're not dosed exactly the same, handled the same. I would say for the majority of people, the Semaglutide, Ozempic, Wegovy work great.
There are some people that have more issues with nausea, vomiting, constipation and or are more insulin resistant. And then it seems like those people do better with the Tirzepatide or Mangero or Zepbound. It's really very patient specific. I have people that have lost a ton of weight on Semaglutide, feel great, never got nauseated. I have others that can't take even a small dose, but they can take max dose of Tirzepatide. So it just kind of really depends. Usually I'll try to start people on semaglutide unless they have a specific reason why they don't want that. Just because it's a little bit easier to obtain right now and it's a little less expensive.
[00:02:04] Speaker B: And then how, I mean, it's kind of the new thing now everybody's on it. Is there a limit on how long you can be on that, that it's not going to affect you negatively?
[00:02:12] Speaker A: No, there's not. You know, but all of these meds were really made for type 2 diabetics. And as you know, you never, you can control your blood sugar, but once you're a diabetic, you're a diabetic. It never goes back. So those meds were made be lifetime meds. They just kind of found as an extra bonus that people were losing weight with it. And so it's not like some of the older meds that were amphetamine based or stimulant based where you had to come off of them for 90 days so you didn't get dependent on them. This is not like that.
[00:02:44] Speaker B: And how long have they been around? I mean, we hear about them because of the weight loss piece of it, but how long has it been around?
[00:02:51] Speaker A: They think they've been around three or four years, probably maybe five. But in the last couple years is when they really found the weight loss benefits and that they really became popular and exploded across the market.
[00:03:06] Speaker B: Diabetics have been taking them for at.
[00:03:08] Speaker A: Least five years or so, around five years, I believe. I don't know the exact date.
[00:03:12] Speaker B: Are there any concerns with how the medicines will affect, like if we do long term, if someone is on it, long term, hormonal balance in women or with like periods or pregnancy down the road or fertility, menopause, all the things.
[00:03:28] Speaker A: I mean, really haven't seen any published studies that have any negative effects. Obviously if you lower your insulin resistance, you lose weight. Sometimes women that are very overweight or obese and because they're very insulin resistant may have a hard time conceiving.
So on these meds, when your insulin resistance is lower, you, you're losing fat. You know, you're losing weight, you may be more fertile. You know, as that happens, I guess the other thing is, obviously if somebody was dosing you and you're underweight, you're a female and you lose all your body fat or almost all your body fat, that can negatively affect fertility.
[00:04:09] Speaker B: And then menopause, obviously when you're in menopause, you tend to gain weight.
[00:04:13] Speaker A: So you do.
Yeah. And anytime you start gaining weight in your, on your middle, in your abdominal area, which is where we tend to get it with the menopause, that increases your insulin resistance.
[00:04:26] Speaker B: And can you give a little bit more specific on insulin resistance and how that, what that actually means and how that, how the shots affect that insulin resistance?
[00:04:35] Speaker A: Yeah. So, you know, all of us have a pancreas with, just to be very simplistic, type one diabetics, they just don't make insulin or hardly any insulin. And so those people generally are diagnosed as children, juvenile diabetics, and they're on insulin for the rest of their life. Usually with type 2 diabetes that comes from insulin resistance, metabolic unbalance, weight gain, things like that, then your pancreas is still making insulin, but your cells aren't letting it in to do its job. So there's little receptor sites on your cells, and they're kind of like a lock, like a deadbolt. And in order to get in that cell, we need the key to open that lock. And so that's what most diabetic, especially type 2 diabetes meds are aimed at, is getting that key in that lock open, in that receptor site so that insulin can get inside the cell and do its work.
[00:05:40] Speaker B: So all your cells need insulin?
[00:05:42] Speaker A: They do.
[00:05:42] Speaker B: But people that are resistant, they're just not getting in. So the cells aren't benefiting from the insulin.
[00:05:47] Speaker A: Correct.
[00:05:48] Speaker B: And this makes the insulin stronger, it creates more insulin.
[00:05:52] Speaker A: Or your. Your pancreas is taking, cranking out the same amount. It's just kind of like letting your body use what it works. So I guess maybe the best metaphor I can come up with is if you have a car with a good motor, but you have a gas filter that's all clogged up, the gas is there, but it's not getting where it needs to go to get you up the hill, on down the road. And it's kind of the same. Your body's got the insulin, but if it's not getting where it needs to be because that filter clogged, it's not doing its job.
[00:06:23] Speaker B: Okay, makes sense. Is there a risk of dependency or you're going to get addicted to it and you can't get off of it?
[00:06:30] Speaker A: There's not any risk of, like, actual chemical dependency, like an opioid, you know, those illegal narcotics. Obviously, if your weight's lower, your insulin resistance down, you're not inflamed metabolically. If you come off the meds and you don't control your weight and you don't control your food intake, then you're going to come back to feeling the way you felt before. You know, once you put that weight back on and quit eating right and.
[00:06:58] Speaker B: Things like that, you hear about muscle loss and those impacts and the rebound weight gain and even changes in digestion. Is that serious?
[00:07:07] Speaker A: Yeah, you definitely want. You want to start at the lowest dose and stay on the lowest dose that's possible, you tolerate, and that you're still getting good results. Obviously, the lower the dose you are, you know, you're losing weight, you're doing great. The less likely you're going to have some of those complications of muscle loss instead of fat loss, and more likely maybe to have problems like a bowel obstruction or Kidney failure, intractable nausea and vomiting if you just start on big doses or you go too quickly on escalating your dose.
[00:07:42] Speaker B: So how does that work with someone that's going to have surgery? Because you always hear when you're going in for surgery you have to stop eating by midnight, so your stomach's empty the next morning. What do they do with weight loss injections?
[00:07:52] Speaker A: They want you to stop it for two weeks. Seems to be the gold standard now just because it does slow your GI tract down so much. And like you said, they always have you not eat or drink from midnight the night before. They want your stomach empty so you're less likely to vomit and have a pneumonia or something from that. And you know, one of the complications of anesthesia and surgery is that your gut shuts down and you end up with a bowel obstruction. And so that's why they want you off of it for two weeks before any major surgery.
[00:08:21] Speaker B: So I guess that's a new question added to the forms or when you go see your doctor about surgery, they're going to start asking, yeah, are you on the injection?
[00:08:29] Speaker A: Yeah. Initially they were asking for a week and they were finding they were still having complications, so they've moved it to two weeks.
[00:08:37] Speaker B: Oh, really?
That's so funny. So it could it really, once you stop taking the shot, it's about a two week process to get the food through your system.
[00:08:45] Speaker A: Yes.
[00:08:46] Speaker B: And does that cause any.
I think about like, you know, my dad had colon cancer and they made him change completely the way he ate because of the food sitting in your colon.
If it's not the right kind of food. So does do you think that's going to be down the road where all of a sudden now there's issues because the food's staying in your stomach longer?
[00:09:04] Speaker A: Well, I think if you don't pay attention to what you're doing. You know, one of the things we always tell people when we put them on it is we want a lot of water intake.
I like, unless they have a heart failure or something, at least 64 ounces of water a day. I want to make sure they're having fiber and green leafy vegetables and roughage in their diet.
Anyone, when you slow the GI tract down, could get a bowel obstruction.
And so if you're doing things to make sure the food is moving through the GI tract and that you're not going three, four, five days without having a bowel movement, um, you should be fine. But if you don't pay attention to that, you could get Yourself in an, in an issue.
[00:09:46] Speaker B: Okay. And then what about like probiotics? Is that something that plays well with this or.
[00:09:51] Speaker A: It does. And I like to put all of my weight loss injection patients on a probiotic because again, that just keeps that gut stool moving through the gut waste moving out and keep you from having that setting around in your colon for a while.
[00:10:06] Speaker B: So kind of to change the subject a little bit, there's always been such a stigma around the shots. Like it's the shortcut, it's the easy way out, but you still have to work really hard when you're on the shots. It doesn't just fall off if you, once you start taking the shots.
[00:10:18] Speaker A: No. And that's such a common misconception in the public. It's that, hey, I took my shots. I don't understand why I'm losing, I'm not losing weight. Well, you are still having alcohol every day. You're still overeating, you're still eating junk food. You, you're still eating more calories than you burn on a daily basis. I don't care what diet you do, if you don't have a calorie deficit, you're not going to lose weight. The thing with the shots is it makes it easier to go into a calorie deficit because you don't have that feeling that you're starving to death and that you're just, you know, self sacrificing. You eat enough, you just learn not to overeat. And then you're not constantly having those feelings in your brain that, I need a piece of chocolate or I need a bag of chips.
[00:11:06] Speaker B: Cravings are gone.
[00:11:07] Speaker A: Yeah. Yeah. So it's, it's a tool in your toolbox, but it's not a magic shot.
[00:11:13] Speaker B: And I think there are people that probably have lost weight really fast on it, probably because they have gotten sick and they, they aren't eating because they just don't feel like it based on their nausea.
[00:11:23] Speaker A: Right.
[00:11:23] Speaker B: I remember a guy saying to me that he, his friend's wife was dropping weight on like crazy on the shot and she's right now, you know, eating Mexican food.
[00:11:33] Speaker A: Yeah.
[00:11:34] Speaker B: I mean, obviously that's not the norm and you can't do that and lose the weight. But I think there are people that have. And then they're out there talking about it. So then everybody thinks, oh, well, you go on the shots, it's an easy loss.
[00:11:44] Speaker A: Well, that's true. And what they, you know, people like that don't take into account in consideration is yes, they may be eating Mexican food, but they may be eating a fourth of a plate where they used to eat a whole plate.
And for me, I think talking to my patients too, that's one thing the shot really does, is we in America are so bad about overeating and being taught to clean our plates and don't waste food.
And it becomes more of a habit than a need for sustenance. And so, you know, what I tell people is when you're on the shot, it's going to take you a few weeks and you're going to make yourself sick because you're going to be down to, you know, half of your sandwich and you feel like you need to take three or four more bites so you're not wasting it.
And yeah, you, you learn. And I tell them the second your brain, you get the smallest twinge that says, I'm done, push your food away.
And that's a habit that's going to, you know, follow you even when you're off the shots.
[00:12:47] Speaker B: Yeah, that's true.
[00:12:48] Speaker A: You really do learn what's an appropriate portion. You know, I, I had a little lady come see me yesterday and she's on her third month and she said, you know, I was miserable the first month and she said I finally figured out I was full and I kept eating. I didn't know what that felt like.
[00:13:06] Speaker B: Oh, wow.
[00:13:07] Speaker A: He said I was overeating. And now that I realize what I feel like when I'm full, it's not that I'm sick, it's that I was overeating.
[00:13:15] Speaker B: Yeah.
[00:13:15] Speaker A: Yeah.
[00:13:16] Speaker B: And I think I know I was talking to a friend that doesn't drink water like she should because it makes her feel so bloated because she's on the shots.
And I said, I think you have to keep doing that and just figure out, like, maybe spread it out further throughout the day. Not drink a big glass of it all at once.
[00:13:32] Speaker A: Yes.
[00:13:33] Speaker B: Because she said I'd be so miserable on that one glass of water. I got to where I didn't want to drink it.
[00:13:37] Speaker A: Yes.
[00:13:37] Speaker B: But I think it's that you have to learn your own body.
[00:13:40] Speaker A: Yeah.
[00:13:40] Speaker B: As you process it.
[00:13:41] Speaker A: Yeah. And just learn, you know, don't try to go three 32 ounce cups, you know, a day.
[00:13:47] Speaker B: Yeah.
[00:13:48] Speaker A: At 1 1, you know, every eight hours, try to sip on a 32 ounce cup over eight hours and just do it slowly.
[00:13:55] Speaker B: Yeah, yeah. That makes total sense. And so we've talked about this, I think before, but I want you to kind of talk about it again how, where you see this going in five to 10 years. Obviously there's new products coming out. It's kind of always changing. But what do you see this as?
[00:14:09] Speaker A: I really think this is probably one of the biggest medical advances in the US in 100 years.
I think, you know, right now it's very uncommon if you're over 40 to not be on a lipid or statin lowering drug.
Almost everybody's on Lipitor or Atorvastatin or something like that because we found it. You know, they believe it's preventative and it's good for everyone's overall general health. And I see the shots going that way. You know, in the next 10 years, I think just probably 90% of people over 40 are going to be on it.
Hopefully with the US starting to start cleaning up the food sources a little more, that should help the situation.
But, you know, they're finding there's benefits to your heart and lungs on the medication, there's a benefit to your liver and kidneys on the medication, not to mention just, you know, diabetes and weight loss. So I think we're going to find more and more uses. I actually went to a talk recently where two physicians were using it in addiction medicine because it does quiet those cravings in their brain. And so they are finding it's very useful in that arena as well. I've got a few patients who actually hit their goal weight and are doing very well maintaining their weight loss.
But they both have some history of anxiety, depression, and they say that their mood is so much more stable on the meds and that they don't want to completely come off. They're just weaning down to lower, less frequent doses because they really feel like it supports their mental health.
[00:15:58] Speaker B: And do you think it's, it's not going to replace a statin or would it replace it?
[00:16:02] Speaker A: No, I don't think so.
[00:16:03] Speaker B: It's just something that people will be on because it's just beneficial all aspects of your health.
[00:16:08] Speaker A: Yeah, I think if you've got heart, lung, kidney problems, maybe liver problems, you're going to get put on it. If you're slightly overweight, if your labs are showing you're insulin resistant, I think, you know, we're going to see a much wider spread use of it in the future.
[00:16:27] Speaker B: What's the number that says your insulin resistance that people would know that?
[00:16:31] Speaker A: Well, you would measure? The best way to do it is a fasting insulin level would be your best way. Of course, we also look at hemoglobin A1C.
So if you're in that range with your hemoglobin A1C where you're not diabetic yet, but you're higher than normal, then that's insulin resistance. They also, you know, when that A1C comes up above normal, but not quite to the diabetic range. Some people call it pre diabetic, but it's definitely insulin resistance.
[00:17:03] Speaker B: Back to your original. The other question about the being everybody being on it, do you think the drug companies are going to have to get on board with that, with pricing or insurance companies? How. What are your thoughts on that? How's that work?
[00:17:16] Speaker A: Yeah, I mean, I, I think obviously when drugs are first brought out, they're new, they still have an active patent on them. They're always going to be harder to get, more expensive. Right now, the companies aren't ramping up production, so they can't keep up with demand. I think probably we'll see more insurance coverage for conditions other than type 2 diabetes. Right now, that's about all you see insurance coverage for is type two diabetics.
Um, so we may start to see it for other things like obesity, like hypertension, like chronic kidney disease. We might start seeing more insurance approval for those type of diagnosis.
[00:17:56] Speaker B: I know hormones play a lot of it, and I know you obviously all of it plays a part in weight. I gain weight when I'm stressed because I don't eat. And then how does that play into that layer of just hormones? I know you look at hormones when they come in, when you run the blood work and how that plays into it.
[00:18:13] Speaker A: Yeah. Well, if your hormones are unbalanced, your thyroid's not working adequately, then those things can cause you could be another reason why you were on the shots and they're not working because your body wants to be normal and stable. And if it's those are out of balance, you may have a lot harder time losing weight and burning fat. And when you're stressed all the time, your cortisol levels are high. We know high cortisol levels can cause belly fat. You know, poor sleep can cause belly fat. So you do definitely want to take care of those issues as well.
[00:18:51] Speaker B: So would you have someone come in, run their blood work and then say, really, we should put you on hormones first and let's get your hormones balanced and then try the shot. Or do you do them simultaneously?
[00:19:01] Speaker A: I prefer to do them simultaneously. Now, some people just for whatever reason, either they want more research or maybe it's a financial issue, they can't do everything at once. And then we kind of prioritize ties and then. And I explain. Okay, we can try just the shots first. That's, you know, where you're at. But no, it may take bigger doses, it may take longer. The weight loss may come off slower than if we could do it all together.
[00:19:32] Speaker B: So your goal with the, with the shots just to kind of touch on that is to really get them losing weight at a lower dose, not go up to the max dose.
[00:19:41] Speaker A: Yeah, yeah. I mean, it's individualized. Everybody's different.
People with more insulin resistance, people with more weight to lose, they may need bigger doses. Women tend to not lose as fast as men, of course, which always infuriates us. But I think the best route is the lowest effective dose with the least side effects for you is the right path that we should take.
[00:20:06] Speaker B: I know you've had a lot of people lose a lot of weight that reach their goal. Do you see a different. I mean, obviously everybody changes. And I'm thinking If you've lost £150, you're a different person inside and out.
[00:20:16] Speaker A: Yeah.
[00:20:17] Speaker B: How do you ever talk about that piece of the. Once they've lost all that weight, how their life would change or. Yeah, we do mentally what that takes.
[00:20:26] Speaker A: Yeah, we do talk about the mental sum because it's really interesting, especially my people that have lost 50, 100. I've got one that's lost over 150 pounds.
[00:20:35] Speaker B: That's crazy.
[00:20:35] Speaker A: But they don't recognize their self. They're walking, you know, along shopping center and they see their self in the mirror and they do a double take of who that is, you know, and then there's always that I lost £150 and I thought this was going to be great and make me happy. And now I have some hanging skin I don't like or this or that. So we do talk about those things. And you know, obviously while we're in the weight loss mode, I'm talking, I'm coaching them on getting their protein and all those things so we have less of that, making sure they're on the right supplements for them. But then, you know, we talk about, like, what are some aesthetic possibilities? You know, some people may need a full tummy tuck. There's the, you know, like the, like micro laser fat removal. If you don't have a ton of hanging skin but little, it might be better to go somewhere like, you know, that route. We might could add a little filler to the face to lift your cheeks back up versus a full facelift.
[00:21:31] Speaker B: I could see how someone could really be affected. I Remember that show, the Biggest Loser? And when they're, when they've lost all the weight, then they deal with other issues that come along with the weight loss, just because it's a new, whole new role for them, a look and feel. So I think that's pretty cool that you focus on that. I don't know that everybody else does. I think everybody's so caught up in the loss that they don't think about what happens after the loss and where they go from there. Yeah, so I think that's good. Do you run blood work throughout the weight loss or do you do it? I mean, how often?
[00:22:01] Speaker A: Yeah, it depends on the person and what we're doing.
If all we're doing is weight loss and all their labs were normal in the beginning, I probably won't check their lab again a year.
But if we're working on their thyroid too, we're working on their hormone levels as well. Maybe we're lowering that insulin resistance. They were in that pre diabetic, diabetic stage. I'm probably gonna be checking their lab every 90 days and seeing how we're doing, lowering those elevated levels and making sure we're balancing hormones and thyroid and things.
[00:22:34] Speaker B: And then talk about your scale a little bit and how that works that you have in your office.
[00:22:38] Speaker A: Yes, we. We have the STYKU body scanner. And it's interesting. It tells us a multitude of factors. It not only tells us your weight, but what percent of your weight. How many pounds of that is fat versus lean muscle. It tells you how many calories you burn a day at rest. So that's how we come up with the calorie deficit that you need to be on. It measures you from your neck to your calves.
So, you know, sometimes in the beginning, people may lose inches and they don't lose pounds so much. It may take several months for the pounds to catch up.
But we keep them motivated because they see the inches are coming off in those problem areas.
[00:23:21] Speaker B: And then do you see going forward? You know, we've talked about potential new drugs coming out along the same lines. Do you think that's just going to be ever changing as we go through this process?
[00:23:32] Speaker A: I think so. You know, we're doing a lot of research and development of peptide therapy, which the weight loss shots are considered peptide therapy. We're seeing more advances in other peptides. So peptides are just short chains of amino acids that occur naturally in our bodies, and we're getting to where we can identify those more, we can replicate them and we can replace them. And so I do see more and more. You know, the first round of the GLP1s hit one insulin receptor site.
The newer second round, they hit two insulin receptor site. There's one coming out that's probably going to hit three or four receptor sites. And so the more receptor sites you hit, the more open those cells come to that insulin, the better. You burn your food, more likely you're going to lose more weight, more fat. So I think we'll see more advances in this nature.
[00:24:28] Speaker B: What do you mean by receptor site?
[00:24:30] Speaker A: So we talked about insulin resistance and how the receptors like a lock, and you need the key to open it up to get in, in that cell. So that's the receptor sites where that insulin docks on there.
[00:24:43] Speaker B: Okay, so if they offer. If they hit more than one. Yeah, like four of them would be obviously, maybe fat or.
[00:24:50] Speaker A: Yeah, something else. Do you have one lock on your front door or do you have two or three locks? You know, it's just more. More safety, more ability to get in where you want to go or lock people out, if you want to lock people out.
[00:25:02] Speaker B: Okay, and so you're currently offering the two that are available, you can get them from your clinic?
[00:25:09] Speaker A: Yes, we get them compounded. Some of them have other additives along with them. We're actually getting ready to come back, compound a combination of the two together. So we'll be interested to see how that works. Well, but you can call us at 918-574-2376. You can look us up at www.kineticclinic.net and we'd be happy to take care of you.
[00:25:34] Speaker B: All right. Thank you.
[00:25:35] Speaker A: Thank you.
