Skincredible

Ozempic and Beyond- A Doctor and Pharmacist Explain GLP1s!

• Elizabeth Swanson, M.D. • Episode 18

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In this episode of the Skincredible podcast, we dive deep into the world of GLP-1 and GIP medications with a Boise-based family medicine physician and clinical pharmacist. If you’ve been hearing nonstop about Ozempic, Wegovy, Zepbound, “weight loss shots,” or even pills, this is your medically grounded guide to what’s real, what’s hype, and some of what you need to know.

We break down how GLP-1 receptor agonists work for weight loss, including appetite suppression, delayed gastric emptying, and their effects on the brain’s reward system. You’ll learn the differences between semaglutide vs tirzepatide, pill vs injection options, and why some medications may be more effective or better tolerated than others.

We also cover:

  • Common GLP-1 side effects (nausea, constipation, diarrhea, heartburn)
  • The truth about muscle loss, hair loss, and nutrition
  • Microdosing GLP-1s—does it work or is it just a trend?
  • The risks of compounded medications and online “GLP alternatives”
  • How to safely access these medications through proper medical care
  • Insurance coverage, cost breakdowns, and why prices vary so much
  • Mental health considerations, including depression and mood changes
  • Why feeling hungry is normal—and necessary—even on GLP-1s

We also tackle bigger-picture topics like:

  • Is GLP-1 use changing beauty standards and body image culture?
  • Why obesity is a chronic medical condition—not a personal failure
  • The stigma around using weight loss medications
  • What happens after you reach your goal weight (maintenance dosing)

Whether you’re considering GLP-1 therapy, taking it, know someone who is, or just trying to understand the buzz, this episode gives you expert insight, practical advice, and honest conversation about one of the most talked-about topics in modern medicine.

Keywords: GLP-1 medications, Ozempic, Wegovy, Zepbound, tirzepatide, semaglutide, weight loss drugs, GLP-1 side effects, microdosing GLP-1, compounded semaglutide, obesity treatment, appetite suppression, gastric emptying, weight loss injections, GLP-1 safety, insurance coverage weight loss drugs, GLP-1 mental health, hair loss weight loss, muscle loss GLP-1, medical weight loss Boise, Allodynia, Retatrutide

Chapters

00:00 Intro and Welcome
01:30 What does a clinical pharmacist do?
02:00 2 Likes 2 Dislikes
07:30 Koalas and Chlamydia
09:45 How do GLP-1s work?
10:40 Side effects of GLP-1s
13:00 GLP-1s and Cravings
13:40 Depression Warning
15:20 Dose Titration
16:50 The Art of Medicine & Studies
17:40 Types of GLP-1s
19:30 Pill vs. Injections/Shots
21:30 GIP
23:30 Microdosing
27:00 Where People Are Getting GLP-1s
32:30 GLP Support Supplements
34:00 Compounding GLP with Additive
35:45 Retatrutide
36:30 Muscle Loss & Malnutrition
38:00 Being Hungry is Normal
39:30 Natural Ways Our Bodies Make GLP
40:30 Obesity is a Medical Condition and Chronic Disease 
41:30 Society and Standards of Beauty
46:00 Loose Skin
49:00 Thank you and Goodbye: Being Hungry is OK

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The information shared on this podcast is for educational purposes only and is not a substitute for personalized medical advice. Always consult your  physician regarding your health.

SPEAKER_02

Welcome to Skin Credible, where we tell you what you should know about your skin and how to blow.

SPEAKER_00

Because your skin's incredible.

SPEAKER_03

Hello, everybody, and welcome to another fun-filled episode of the Skin Incredible Podcast. I have two very special guests here, and we are going to have a GLP Palooza today, you guys. So I want to introduce you to Dr. Stacia Munn and clinical pharmacist Gabby. Go ahead and introduce yourselves, guys.

SPEAKER_00

Hi, I'm Stacia Munn. I'm a family medicine physician that works here in Boise. So I do primary care for people throughout their lifetime from little babies to your 99-year-old grandmother. The whole spectrum.

SPEAKER_03

Diaper to diaper.

SPEAKER_01

And Gabby, tell everybody about yourself. Yeah, my name's Gabby. I'm a pharmacist. I actually work at the same clinic as Stacia. So the patients she's seeing, I'm seeing mainly diabetes, blood pressure, a lot of weight loss. Right. Yeah. A lot of cholesterol management. Lots of that chronic disease stuff that just needs extra attention.

SPEAKER_02

Yeah.

SPEAKER_01

I love it. I love it.

SPEAKER_03

I love that you guys, I think it'd be cool if we had a clinical pharmacist in our office. I think that would help us out. Yes. That would help us out so much.

SPEAKER_00

Yeah, it's pretty rare. So it's not a pharmacy where you go and you get your prescription. She's in the office to do like a visit and a consult. Yes, yes.

SPEAKER_01

And patient counseling, I assume you help with that. Yeah. Yes. The way I sum it up to patients when they're a little confused is I can do everything Dr. Munn does except diagnose you for this disease that we're talking about or addressing today. Yes, yes. I love that.

SPEAKER_03

Well, I also thought it would be fun. So I have recently been watching season four of Love on the Spectrum, which is one of my favorite shows. So heartfelt, so wonderful. And one of my favorite parts is when they introduce somebody new to the program, they say that person's two likes and two dislikes. And so I thought it would be fun for us to share our two likes and two dislikes, and I'll start. So I like panda bears. Panda bears are the best. I got to see the pandas at the National Zoo last year, and they were fantastic. Love pandas, such interesting creatures. And then my other like would be peanut butter. Love peanut butter. Can't live without peanut butter. My two dislikes are meanness, hate and meanness, especially online. Yeah. Everybody, yes, just be nice to one another. And salad. I'm not into salad. Can't do it. Don't like it. Not into it. Interesting. Yeah. Gabby, what are your two likes and two dislikes?

SPEAKER_01

Ooh, this is tough. Okay. I love elephants. Elephants are my favorite animal. Yes. I studied for a month in Sri Lanka in undergrad and I loved it. And they were just elephants wandering the streets. Wow. It's incredible. Um, I also really like pasta. It's just my favorite food in the world. Dislikes. I hate loud chewing. Isn't there a name for that? Like misophonia or something. I think it has a name. Yeah. Yeah. Yeah. It's like it'll be all I can hear. If even if we're talking, having a conversation, if you're chewing loud, not yeah, nothing's registering. Yeah.

SPEAKER_03

So if Stace is enjoying her fiber one cereal that we were talking about earlier, exactly. That's like your nightmare. Yeah.

SPEAKER_01

If she's over here, just I'll just sit here. What are we talking about? I don't know. Um, and then I also dislike, not to steal yours, I also dislike meanness. I know, right? Yeah.

SPEAKER_03

Why be mean? Why just be nice?

SPEAKER_01

And online, everyone's so much tougher than in real life.

SPEAKER_03

Oh, it's so true. It's so true. Yeah. Um, I have an elephant story. So I was giving a talk at a conference in Orlando, and it was at this hotel that had this conference center kind of adjacent to it. And we were, there was a wedding that weekend at the same hotel, and we were in the line for lunch, which was in this kind of atrium of the conference center, and there were all these windows. And right outside was an elephant, a full-sized elephant. I love it for the wedding. It was an Indian wedding, Indian wedding. And I was like, it was crazy to see him up so close, and they were feeding him Starburst jelly beans. Oh, what? Apparently that's what elephants are into. Oh, I love elephants. Because he was loving it. He was loving it. Yeah. And like when they left, there were just like Starburst jelly beans like all over the ground.

SPEAKER_01

That's amazing. I know, I know. It was incredible. He must have a sweet tooth because when we would see them on the side of the road, we would just like give them sugar cane. Really? Yeah. Oh my gosh. They seem like nice animals. I read sometimes that they look at humans the way we like look at dogs. But I don't know if that's true.

SPEAKER_00

I don't know, right? Because the women, the men and women just separate themselves. Yeah. And the women have their little patriarchal groups. So maybe they're mean to the other gender. I don't know. Gotcha.

SPEAKER_03

Gotcha. Like pandas, actually. They're very solitary animals. They don't really hang out with each other. And even when they're at a zoo together, they have a boy and a girl panda, but they have separate enclosures. And pandas are endangered. They have actually no known predators. They're endangered because they're so bad at reproducing. The females go into heat for like two or three days a year. Oh man. And so the panda bears are really struggle to like have baby pandas. But this is important news. On the news in the past couple of weeks, they have started to witness flirting at the national zoo. They have a window between them that they call a howdy window. And they've noticed the male pandas like going up there, like, hey, sugar, like what's up? And the girl is starting to express a little bit of interest.

SPEAKER_00

Interesting.

SPEAKER_03

I know. So love is in the air at the National Zoo.

SPEAKER_00

Yes. Your two likes and dislikes. And they also like elephants, but I'll have to do something different. So my likes are sort of competing with each other, but I really like to travel. Yeah. And I really like to be home. Oh yeah. Just like do puzzles and read books and work in my yard and like sit on my couch. So they sometimes compete, but they can run in parallel together.

SPEAKER_03

You know what I heard? Tell me if I'm wrong. I heard that if you do a puzzle and you listen to an audiobook, I do that all the time. Something happens in your brain that's like very good.

SPEAKER_00

Well, it must be happening because those that's like my favorite thing to do.

SPEAKER_03

Yeah, yeah, yeah. That sounds fun. I would like to get a table in my house just for puzzles. Do it. A puzzle table. Yeah.

SPEAKER_00

And then invite me over.

SPEAKER_03

Yes, yes. Listen to an audiobook. Yeah. Yeah. Yeah. And then your dislikes.

SPEAKER_00

Dislikes, I think, since this is a skin podcast, don't I dislike too much facial and lip filler. I don't know if it's just being a physician. I look at people's lips and I'm afraid they're having an allergic reaction or like something.

SPEAKER_03

It can definitely go too far. Yeah.

SPEAKER_00

Yeah. And I also hate bad lighting. This room has amazing lighting. This room is very, very lots of warm light bulbs, but I hate a room that has like really cool light bulbs. Yes. Nobody looks good.

SPEAKER_03

Nobody looks good. It's like a hospital. Yes. I feel like when I was young, I didn't necessarily care or appreciate the quality of the lighting. And now as I'm older, like it's like the most important thing.

SPEAKER_00

Yeah. Or once I had an exam room that had one warm light bulb and one cool light bulb in the same room.

SPEAKER_03

So that's like that episode of Seinfeld where I had immediately changed it. I was like, this has to this has to stop. There's an episode of Seinfeld where this woman either looks fantastic or yes. Exactly. You could go from beautiful statia to another kind of statia. Yeah. Yeah. Um, well, those were wonderful. Thank you for sharing you guys. I think the audience knows you better. We should have an episode just about like animals we love. Like elephants, pandas, sperm whales. I will gladly come back for that. Right? Me too.

SPEAKER_00

Do you have elephants are my favorite? Yeah. Yeah. Have you guys I like a really lazy animal too? That's just like huge and pandas are actually really lazy too. Yeah. Yeah. Great.

SPEAKER_03

They're very koalas. Eat koalas, sleep like 20 hours a day. They're off dying because of chlamydia.

SPEAKER_00

I know. They do get a lot of chlamydia.

SPEAKER_03

Oh my gosh. Is it sexually transplanted in the koalas? It is.

SPEAKER_00

Yeah. Oh my gosh. Can they can't they treat it? Yeah, but not in the wild. Yeah, yeah. But at the zoos. Yeah. Just like pump boxycycline into the air. It is, it does come from the ground.

SPEAKER_03

But yeah. So there was a movie that was set to film on this island off the coast of either California or Washington, I forget what. And so they brought a whole bunch of buffalo out to the island for the purpose of this movie. But then the movie ended up not happening. And nobody brought the buffalo back. So this island was full of all these buffalo who were then reproducing. And there was no known predator. So it was just like buffalo, buffalo, buffalo. And so they were like, how do we solve this? And what they ended up doing was they started like basically harpooning the buffalo from a distance with progesterone.

SPEAKER_00

Yeah. A double prepared blow dart.

SPEAKER_03

That's amazing. Yeah. So maybe there could be a um like a chlamydia antibiotic blow dart for the koalas. We'll we'll come up with this.

SPEAKER_01

I think azothromycin, because I mean in humans, it's just one dose. Oh, there you go. One big dose. So a dart of azithromycin would take care of things.

SPEAKER_03

Let's do it. And yeah, I'm desperate for listeners in Australia. So hopefully this attracts them to the pod. Um because I'm a huge, oh yes, and I'm a huge blueie fan. Um, love bluey. Studied abroad in Australia, and so I got to see some of the koalas. So Australia, if you're listening, we care. We care about it. Happy to come help you out. We will take a trip down under and help you out. Well, I brought you all together because I wanted to give the audience and myself a better understanding and education about the GLP ones. They're everywhere. It seems like everyone is on them, and it seems like people can get them from almost anywhere.

SPEAKER_00

Yeah.

SPEAKER_03

But they seem also like maybe they're not really being properly understood. And some people might even start them without a good understanding of the safety profile or what they're really getting into. So to start out with, Gabby, how do these medicines do what they do for weight loss?

SPEAKER_01

How do they work? Yeah. Two main mechanisms in regards to weight loss, just increased satiety, right? So it works on our central nervous system. GLP is a hormone we produce naturally, right? These are agonists, meaning they help the body make more and they mimic it. And that goes straight to our brain and says, hey, we're full. We're not hungry right now. And then the other way is it delays gastric emptying. So everything we eat is hanging out in our stomach longer than usual. That makes us feel full faster and full for longer. And that's kind of how I lead into side effects a lot of times. Right. Talking with patients about it just because if you overdo it, that's when you feel sick.

SPEAKER_03

Yes. Yes. And so maybe that segues nicely into a conversation about common side effects. What do you warn patients about, both of you? What do you what kind of things do you tell them?

SPEAKER_00

Yeah, most of them are gastrointestinal. I think like up to 86% of people have some gastrointestinal side effects. Like only about 10% of people end up stopping the medicines. So they're usually mild and annoying, but most people, if they're losing weight, are able to tolerate them. A lot of times it's getting full faster, which is partly how they work, nausea, worsening heartburn. Some people can get really significant constipation and then also diarrhea sometimes too. It's hard to know who's going to be.

SPEAKER_01

What makes sense in my head with the diarrhea is a lot of times I'll ask patients, like, did you eat before this diarrhea episode? And a lot of times it's something super greasy. So I wonder, and obviously this is a very non-scientific way to describe it. Yeah. I wonder if with the delayed gastric emptying, that grease is slipping out, everything else is coming.

SPEAKER_02

Oh shit.

SPEAKER_01

Right. Everything else is staying in the stomach. Yes. And that sense run people run into the restroom. That makes sense. That makes sense.

SPEAKER_03

And so if somebody already struggles, say they struggle with heartburn anyway, would a GLP one not be good for them?

SPEAKER_00

I actually think that one's one of the hardest because weight loss helps heartburn. So I I tell people we sort of have to see what happens. I think initially it might be worse, but if they lose 40 pounds, their heartburn's gonna be better.

SPEAKER_02

Oh godcha.

SPEAKER_00

So they might struggle at the beginning. I get more nervous for people that have severe heartburn that have like esophageal scarring or they've their esophagus dilated. Yeah. Um they probably aren't great candidates. Yeah. It's uh but again, it's like you have to do small meals, stay upright, so don't eat a lot before you go to bed. But I think it can kind of go either way for people that have heartburn.

SPEAKER_01

Yeah. It also helps with food choices though, too. Once people actually start the medication. Oh, yeah. So if they're having heartburn because they're eating flaming hot Cheetos covered in hot sauce, yeah, you know, some squirting lime all over it, make it real acidic. Yeah. Right? Yeah. If they're doing that, then then they start their GLP therapy and they don't really have those cravings anymore and are making better choices. Yeah. It's it's kind of like, you know, what was causing it? Right.

SPEAKER_03

So what do you guys think about the cravings thing? Like I've heard that it reduces cravings not only for food, but sometimes even people on GLP1s, they they don't want to drink alcohol anymore. They're even studying it for patients with alcohol abuse disorders and stuff like that. What do you make of that? How do you think it's doing that?

SPEAKER_00

It does work in the hypothalamus. So that's like a like primitive brain stem, and it controls lots of things, like how many times a minute you breathe, what your body temperature is, what your weight. So I think it's partly that. I I suspect it's also working in the reward system. So the part of our brain that gets really happy when we eat that like flaming hot Cheeto that we love.

SPEAKER_03

Yeah. Yeah. Interesting. So it's like you're kind of inherently satisfied all the time. So you're not craving what used to bring you happiness.

SPEAKER_01

Yeah. Yeah. And GLPs do have a warning of worsening depression and or suicidal ideation.

SPEAKER_03

Wanted to talk about that because I was at a conference recently and I was talking to a group of dermatologists, and one of them is on a GLP one, and he he's on one of the shots, and so he takes it once a week. And he said when he takes it like that day, he's like super down. It gets better. So talk more about the depression stuff. Yeah.

SPEAKER_01

I think it has to do with that reward system in our in our bodies and our brain. And you know, I actually have had a couple patients that are like, I just don't feel like myself on this. Yeah. You know, I want to stop. Yeah. And even if it is working really well for weight loss or for diabetes or whatever they're taking it for. So it's a warning for a reason. Yeah. Yeah. Doesn't mean it'll happen, but it's a risk.

SPEAKER_03

If there's a patient who already suffers from depression, how would you counsel them about the decision to go on a GLP one?

SPEAKER_00

I oh man, I think depression's complicated and weight's complicated and they're sometimes intertwined. So very true.

SPEAKER_03

If you're depressed, you probably well, maybe your weight struggles are contributing to your depression. And then if you're depressed, maybe you're not wanting to be as physically active to try to help with the weight issue. And you might be turning towards food for happiness and things like that. So maybe in turn a GLP one could help manage some of the depression.

SPEAKER_00

It could be positive for some. And you're supposed to be doing these like right with supervision and starting at slow doses and titrating up. Theoretically, this should be something that's like an ongoing conversation. Yes, yeah. Which is another great reason for me to have Gabby because I'll see people like every three months, but she can see them more often. Yeah. Like in the beginning, we try to do at least once a month. Yeah.

SPEAKER_03

Yeah. And talk to me about the the doses. You start with low dose. Do you always creep up? Do you creep up based on what the patient is experiencing? Or how do you how do you guys titrate that?

SPEAKER_01

When we break it down percentage-wise, most folks on these medications are aiming for one to two pounds of weight loss a week. Okay. So that's healthy. Yep. Healthy, right? I mean, it's steady. You're losing weight, but also we're not wasting away. Yeah. Right? Yeah. Um, and it's sustainable, right? It's more likely if we lose at a rate like that, we're not gonna gain it all right back. If people are steadily losing, there's no need for a dose increase. And then once they kind of hit a plateau, then we can increase it. I think a common misconception with these medications is oh, I take it, I lose weight, I stop, or I continue to take it and I just keep losing weight. Right. But with all of the GLP ones, it's a percentage of weight loss that they've seen folks have, right? So that, you know, 15 to 20 percent of body weight lost. I mean, once you hit that, you kind of stop. Right. Right. So really each dose we hit, yeah, if we use it until we plateau, that's how we get the biggest benefit out of the medication. Gotcha. Okay. Use it to plateau. Yep. And then we can increase it, right? Yeah. Once you do hit that plateau. Oh, sure, sure, sure. Yeah. Okay, okay. Yeah. So like if you're losing weight consistently on a low dose, and then all of a sudden you go two weeks and you're like, hey, it's things have stopped. Yeah. Okay, hey, let's go up in dose if you're tolerating it well. Yeah, yeah. Okay.

SPEAKER_00

I think some of the dosing falls into the art of medicine realm because we have most of our data from the clinical trials that had very specific dose titrations. Like they increased every month until they got to the max dose, and then they kept people on there. I think the trial was like about a year. Okay. And so that's where almost all our dosing information comes from, but that just doesn't work for people. Like some people would be incredibly sick and nauseous if you just like ramped them up. So some of this is like, I think we'll get this data later. Yeah. Yeah.

SPEAKER_01

Let me make that clear. That was more of the art, not the clinical trial.

SPEAKER_00

But I think that's interesting because no one's gonna want to wait 10 years for that trial. So a lot of this stuff is just let's see how we do it in real life.

SPEAKER_03

Talk shared decision making, talking with the patient. We have a lot of choices in the GLP1 family. I wrote them down here because it always helps me to see the names. What is the difference? So we, you know, we have the semaglutides, and then we have the terzepatides, and then we have the new one, which kind of sort of seems to be in a class a little bit on its own, but I wasn't quite sure. So I kind of separated on the list. What are the pros, the cons of each of these? What's the difference between pill or shot administration? What are your guys' thoughts?

SPEAKER_00

Most people know the word ozembic. I know. Right. And I think it's used the most as like Kleenex, sort of. Like it refers to any type of coke. Yeah. Yeah. Um, but ozembic actually is only for type 2 diabetes. So if someone came to me and they wanted their insurance to cover ozembic and they don't have diabetes, it's not gonna happen. So its generic name is semaglutide. It's the exact same medicine, it's got different branding. Wagovi is a weight loss pill. Is the dosing a little bit different between Ozempic and Wagovi?

SPEAKER_03

They're this both semaglutide.

SPEAKER_00

The diabetes dosing actually stops at two milligrams, where the weight loss dose used to stop at 2.4, but it like within the last couple of months, the dose can now be increased to seven. Wow.

SPEAKER_01

Which oddly enough, 7.2. And oddly enough, side effect-wise, yeah, one of the kind of one-off ones is alodynea. So just that like super sensitive sensations. Yeah, things feel painful even when they weren't, you know, before. Isn't that weird? I actually had someone on the two milligram dose of semaglutide that really struggled with it. And then that side effect specifically increased a ton with the 7.2 milligram dose compared to the lower doses.

SPEAKER_00

Interesting. And then there was a pill version of semaglutide, the rebelsis that was for type 2 diabetes, but not for weight loss. So that's also confusing. And then Wigovi initially was only an injectable and is now in pill form.

SPEAKER_03

And between like, since Wigovi is both pill and shot, what do you notice between the two forms of administration? The clinical data shows they're about the same. Okay, great. So if people are like, I don't really want to do a shot, they can feel comfortable taking the Wigovi pill that they're gonna get equal efficacy. Yeah. The data shows.

SPEAKER_01

What's tricky is the Wigovi pill, right? GLP is a peptide. So anything that we're taking orally, yeah, as a if it's a peptide, it's gonna be difficult to absorb in the body. Right. Without our stomach acid and juices hitting it and just disintegrating it. Yeah. So with the Wigovi pill, it's pretty specific. I mean, empty stomach, 30 minutes before anything else, no more than four ounces of water. Wow. So very specific dosing. And that's kind of where that new one on there, the foundadeo, comes in. Cause that's kind of the leg up it's got on the Weigovy pill. Okay. Is you can do it with food, without food. You can have more than four ounces of water. You could have five if you want to. Oh so that's kind of where like that place in therapy is for that one. Yeah. Because when it came out, I was like, well, what's the point? Yeah. We have the Weigovy pill. Yeah. Um, so that's the biggest, I guess, peel factor for that new one.

SPEAKER_03

Okay.

SPEAKER_01

And um, back to the question.

SPEAKER_00

I think I have some people that just really get side effects at low doses. So the injectables you can go below, but I don't think you can cut the pills in half. So you're sort of like stuck at the exact pill doses where the injectables you can titrate that if someone's really sensitive to the doses.

SPEAKER_03

Trazepatide. Zetbound is the brand name product that is used for weight loss, approved for weight loss. And it's my understanding that they did a study, Zetbound versus Wagovi, and that Zetbound was more effective. And better tolerated. And better tolerated. Interesting. Sometimes more efficacy ends up meaning less tolerability, but it this was better working and more tolerable. Yes.

SPEAKER_01

Well, terzepatide works on two receptors instead of just one. Yes. Explain that to me because I saw like the GLP one, but then also something else. Yes. GIP, which is in our digestive system, in our intestinal tract. I basically, when patients ask about it, I'm like, hey, it just is working in an additional way in the body. And that's why it's going to work a little better. But it's also thought that maybe that's why tolerance is better as well, is because of that second receptor.

SPEAKER_00

What does GIP stand for? Glucose dependent insulinotropic polypeptide. Wow. So that's the biggest. Yeah, rolls around the top. Oh, thank you. I see why they abbreviate it. Yeah.

SPEAKER_02

Yes, yes.

SPEAKER_00

Okay. And all these are like called incretins. So they're hormones that we make when we eat. So when the food enters the gut, the gut releases them. So the GLP one's usually in the first part of the gut, the duodenum, and the GIPs in the lower part of the gut, called the uh like the jejunum or ileum. And so they and they're supposed to work together. Yeah. So like GIP by itself wouldn't make you lose weight, but they have to they have to cooperate. Yeah. Sort of like the pandas. They gotta work well together. Yes, yes.

SPEAKER_03

Pandas working together. That's when the magic happens. Okay. So that gives us a nice landscape. And then for some reason, I think with Foundado, the new pill, for some reason I equate it with Zetbound. I think because they're made by the same company. But it is a different molecule, right? It's this big long name. I don't even know how to pronounce it. And so does that target GLP1 and GIP?

SPEAKER_01

I believe that one's just a GLP one. Oh, yeah. I'd have to I could have to double check. I would have to double-check, but I think it's just GLP1.

SPEAKER_00

The main difference is like, yeah, because we digest peptides. Like that's why people can't take oral insulin because we digest them because they're little teeny tiny proteins and we're designed to eat proteins.

SPEAKER_02

Yeah.

SPEAKER_00

So the Wagovi, they had to make a special special package in the pill that helps you absorb it. But with this medication, you can just absorb it as it is, and then it works on the receptor. Gotcha. But yeah, I'm not like it just came out this month, so I'm not sure if it does both.

SPEAKER_01

I think I thought it was yeah, I don't remember off the top of my head.

SPEAKER_03

And then microdosing. People are microdosing everything. Microdosing Accutane in my world. Oh, interesting. Micro dosing. Does that work? It actually does. Oh, good to know. She does. Yep. And it's used for like acne, of course, but also like oily skin or and also for anti-aging. Yeah. To just like microdose.

SPEAKER_00

Through a dermatologist, I'm hoping. Or provider. Okay. Because like I'm just hoping people aren't getting accutane like they're getting GLP1 so it's okay.

SPEAKER_01

Yeah, you can't. That would be kind of scary.

SPEAKER_00

Yes.

SPEAKER_03

So Accutane is heavily regulated through a government program called the eyePledge program because of the teratogenicity of it. It hurts babies if a woman were to get pregnant on it. So you can't really get that on the black market. But the closest thing to it, some people online are telling other people to take high dose vitamin A. Because Accutane is a derivative of vitamin A. So like, oh, just take vitamin A. But vitamin D is vitamin A is incredibly toxic when you take it at the levels that are required to even have any impact on acne and stuff. So definitely audience members do not take a lot of vitamin A. Um, and so that's kind of our black market version, I suppose. But no, you have to get accutane from a dermatologist. Yeah.

SPEAKER_00

Well, I think with the microdosing, like that's not really a a medical term. Yeah. I mean, it means you're taking a small dose. So technically it's a medical term, but none of the clinical trials looked at microdosing. So I think people are just getting sold lower doses. Yes.

SPEAKER_03

Do you think it was really like like the hims and hers and like all those people that kind of created this microdosing thing? Good question.

SPEAKER_00

I think they and I d like they actually cap out their dose at lower than what the highest recommended dose is, but I don't know why. Okay. Um, but I think it's more more fringe even than that. Like I had a patient like just last week who was getting it from a company I never heard of. I looked it up and all over the website, it's like not for human consumption, but totally marketed for human consumption. Oh my gosh. That's for weight loss. Yeah. So it's like, oh, so people are just getting it from weird places, but really it just means you're taking a low dose. Taking a low dose. And we would do, and that goes back to like, yeah, we see how things are going. Yeah because if you take a low a microdose and you're not losing weight, then that's just a waste of your money.

SPEAKER_01

Right, right.

SPEAKER_00

Yeah.

SPEAKER_01

I think money is a big driver of how microdosing came to be too. Because when people were paying cash at the pharmacy for Ozempic, yeah, instead of a full dose of 0.25, they were doing a couple clicks, which is I do not recommend. Those clicks are not standardized. Right. You can't depend on that. A point. So you have no idea what you're getting. Yeah. So, and this is this might be a hot take. I feel like I feel like microdosing is safer in a sense with a compound if you're drawing up the dose yourself, because that's a set concentration of medication in that vial. You know what you're getting. Right. Your pharmacist or your doctor can actually calculate and know what amount you're taking each week. Yes, yes.

SPEAKER_03

So if somebody's interested in microdosing of a GLP one, talk to your doctor, talk to your medical professional.

SPEAKER_00

But also, if it's not working, it's because you're taking too little of a dose. Like the initial dose of the studies of 0.25 for the first month is just to make sure you don't have bad side effects. And like for trzepid, that's 2.5 milligrams, where most of the time you need a slightly like the second or third or fourth month dose in order to have sustained weight loss. So also if it's not working, yeah.

SPEAKER_03

Yeah. Okay. And then that segues nicely into a talk of where people are getting these medicines and the safest way to get these medicines. And like you said, Gabby, I think cost was a driver here. At first, when these medicines came out, everybody wanted them, but insurance wasn't covering it and the costs were high. And so they went to these alternative sources. But now nobody has to do that anymore. Like A, your medical professional can try to get it covered by insurance. Although Stacia, you were mentioning that for a diaper obesity, it's very limited. Yeah. But very difficult to like spice prior ops and like to spend.

SPEAKER_01

I'd say for weight loss, the only time it's going to be covered by insurance is if you've got those other FDA-indicated comorbidities. Sure. Like sleep apnea for the Z-bound. But it has to be moderate to severe. And it has to be moderate to severe. Or for semaglutide, so for the weak OV, fatty liver or history of a major cardiovascular event.

SPEAKER_03

Okay. Okay. And some people would meet that criteria. And so it can be worth a try to get insurance to cover it.

SPEAKER_00

But I'm yet to get fatty liver covered because we have other cheaper medications. So they usually deny it and say you have to try this other one. So that may come down the road.

SPEAKER_01

Because fatty liver is a fairly new indication for the we go fee. So it can take time for the insurance companies to get their formula.

SPEAKER_00

And some of it is like it's very they're very expensive. So the FDA approved ones. And for whatever reason in the United States, we get charged way more than everyone else. So they were like$1,000 to$1,600 a month, where it was maybe like$300 and a foreign. Like so there's no real reason why we get charged five times as much. And so when you're at that level, like if everyone in America who qualified for them, which is basically a BMI over 27, like the money that we would spend on GLP1s, I think would be more than all other medications combined, including like our really expensive biologics for strices and all that. So like your insurance companies actually can't approve them for everyone, or the whole system's gonna collapse. Yeah.

SPEAKER_01

I mean, there was a couple insurance companies that were covering them. Yeah. I'm like, oh my gosh, you have so-and-so. Yeah. Like, yeah, let's do it. That bounds covered. And then all of a sudden, a couple months later, I mean, I'd say one way.

SPEAKER_00

Like midway through their enrollment cycle.

SPEAKER_01

They're like through enrollment cycle. Hey, never mind. Like, we are losing way too much money on these.

SPEAKER_00

Yeah.

SPEAKER_01

You're done.

SPEAKER_00

Yeah. Yeah. I'm hoping that'll change because now the pill forms are like the FDA approved pill forms are cheaper. So the starter doses, right? They get advertised at like$150, but that's a starter dose where most people are gonna need a the higher dose, which is$300 a month. Gotcha. So that's a lot less than$1,600 a month. And the I mean insurance covers a lot of other medicines in that price range. So I'm hoping down the road we can get people better insurance coverage, but it's still pretty low. Like it's very difficult to get it covered.

SPEAKER_03

Yeah, yeah. Well, and the$15,300, that's like the price that is sent to the insurance company to cover, or that's the drug company reducing the price for cash pay patients. Exactly.

SPEAKER_00

So it's like it's another part of our weird system where like if your insurance covers it, like the drug company actually charges your insurance company more. Right. Because they'll cover it. But if you go and say my insurance company won't cover it, they'll charge you less for cash price. But what that means is like you're that charge is then gonna get rolled over into your premiums next year. So if you actually go through your insurance, you're long term, it's increasing your cost. So it's just another weird, complicated layer to how prescriptions get covered.

SPEAKER_03

But I think, I mean, the one good thing from it is these programs with drug companies so that people can choose to just pay cash and get the medicine in a safe way, in a way that's in conjunction with their medical professional. I feel good about that. The compounding pharmacy stuff scares me a little bit.

SPEAKER_00

Well, and I think the the at least right now, they're still the ones through the drug company are still more expensive overall than using the compounding ones for a while. Like Zetbound through Lily Direct was$600 a month at the maintenance. So it was$300 a month to get started, but$600 is a lot. Yeah, yeah, we're compounding somewhere between like$150 and$300. Yeah. And yeah, so I think most people that are on these medications are on compounded versions. Also, what happens is they're in glass vials most of the time, which is how we used to do insulin, and you have to draw them up yourself with a needle. So they're switching over to some compounding pharmacies are doing pens. But if you know anyone on it and they're drawing it up from a glass vial, like that's a compounded version, most likely. Oh, you can get that from Lily, but most of the time. Okay. I think the biggest potential liability with using compounded versions is people dose themselves incorrectly and they have no idea what dose they're on because it's in milligrams, which is how we think of things, but it's a liquid, so it's also in milliliters. And then we use needles that have units.

SPEAKER_01

We have insulin syringes to draw them up. So then those are in units. Wow.

SPEAKER_00

So there's like milligrams, milliliters, and units, and people say, I'm on 12, but yeah. Yeah. It's 12 units, which might be a ton of room for error. Yes. Yes, which is a lot.

SPEAKER_01

So yeah.

SPEAKER_00

Yeah. I think that's probably the biggest risk for using it through the one of the biggest risks.

SPEAKER_01

I think the other biggest risk is just using an unreliable pharmacy. Yeah. I mean, a lot of these pharmacies are really good about doing purity and potency testing and sterility testing. Yeah. Which is great. Right. Right. And a lot of times they'll have that, if they are doing it, data available for practitioners to see if needed. But I'm always a little suspicious of when patients come in and they're like, I got it off this website. Right. And not for human consumption. Not for human consumption on it.

unknown

Yeah.

SPEAKER_01

But I did it anyway. Yeah. Yeah. Or they're sticking like fake. I've seen this a lot with like GLP support supplements, right?

SPEAKER_00

Oh, I saw a commercial for that today. And I was like, what is that? Well, like, right? It's this has to be a prescription. So if you are purchasing it without a prescription, you're not getting it. Right. Exactly. Yeah. Yeah.

SPEAKER_01

I know I had like one of the cutest little ladies come in and she thought that she was buying Ozempic, but it was like a GLP support drop. Oh, yeah. And I went on the website and she was like, it's real. It's real. And there was like a watermarked photo of like just some people in white coats, and it's like Harvard medicine approved and fake FDA labels. Whoa. And I was like, I see how this could totally get someone. Yes. Yes.

SPEAKER_03

Yeah. Well, because everybody has GLP on the brain. And then they see something and like the price is right. And they're like, oh, I could do it this way. Oh my gosh. Yeah.

SPEAKER_00

And I think the the typical pathway is the drug companies manufacture the pens for the FDA approved. And then the FDA is in charge of making sure that there's quality control. Like the dose is right, it's sterile. So compounding pharmacies can purchase the beginning starter part of the medication, but they don't have the FDA like review of their final product. So it just like comes out of their pharmacy. Compounding pharmacies have other like supervision. So like making sure it's a state licensed pharmacy, yeah. Other things, right? The drug companies and the compounding pharmacies are not getting along, which isn't surprising. So there's a lot of lawsuits. So I think April 2025. Yeah. It was around here. Basically, it was a copyright law sort of thing where you can't get the medicine semaglutide by itself. So all the compounding have to have an additive added to it, which typically is like a vitamin. Like B6 is common, B12 is common, glycine, NAD plus. And so those we don't have any data on the medicines being injected with those at the same time. Right. It's probably fine, but we really don't have that data. So that's like one other element. There's also like a salted version of the starter. It's like a semaglutide salt, is what people were getting, which is different from the one that was getting studied. So the compounded version is not the same as what we have all of our like safety and clinical trials on. So that's another element. But they and we could talk about this too, like the other added benefits. There's like we know there's known risks to obesity, and there's tons of benefits. So I think the risk from like we use compounded versions of this all the time. Yeah. I feel like the relative risk is very low compared to the benefit.

SPEAKER_02

Yeah.

SPEAKER_03

You guys just personally send the prescription to a compounding pharmacy here in Idaho. Yeah. And they make it up and then they deliver it to the patient or the patient comes to pick it up. Okay. Okay. So done in the proper way. I shouldn't be afraid of compounding.

SPEAKER_00

Well, you use it a lot for skin. I do it a ton of. Yeah, I mean great compounded version. So I think it feels scarier when you're injecting it. Right. Versus a compounds feel scarier.

SPEAKER_03

Yeah, because we do a lot of compounding of topicals and stuff, and that doesn't seem that scary to me, but like the injectable seems a little bit scary.

SPEAKER_00

But probably pretty similar because it's just going right into the fat into the skin. Yeah. Where the meds are getting absorbed. Yeah. Yeah.

SPEAKER_01

This does make me think of one, it's not missing because it's not FDA approved yet. Yeah. But retatrutide. Oh, what is it? And that one actually works on three receptors.

SPEAKER_02

Yeah.

unknown

Oh.

SPEAKER_01

And it's new. And what's crazy is somehow some patients are getting it. And I'm like Already. And it's brand new. Yeah. I'm like, are you part of the clinical trial? That's another weird thing.

SPEAKER_00

Like, how are you?

SPEAKER_01

Yeah, somehow some patients have got their hands on it. Wow. And that one works on GIP, GLP, and glucagon receptors. Oh my gosh. And it's a pillar shot. A shot. A shot. Yeah. Okay. Yeah. So that's new, brand new. Yeah. I think it's in phase, I forget. It's far enough along. Yeah, it will be not released yet. Yeah.

SPEAKER_03

Not FDA approved yet. Yes. But in the pipeline and pretty soon. Yeah. Yes. And I know when that comes out, everyone's going to want it. Right? Right? It'll be the best one on the block. Yeah. Yeah. Oh my gosh. So so interesting. So interesting. Well, let me see. I have read about things like muscle loss and even malnutrition on the GLP1s. What do you counsel your patients about who are going to start these medicines to help prevent that?

SPEAKER_00

Well, I think some of the like muscle mass or lean body mass is just related to weight loss. Yeah. But there is a like a higher proportion of it with the GLP1s versus if you did it with like calorie restriction and exercise. So the they not surprising, but exercise makes things better. So they work better in tandem with exercise. So if someone's not exercising at all, just like gradually increasing, trying to get like 150 to 200 minutes of cardio a week. And then it's about 60 to 90 minutes of some sort of strength or resistance training, like two to three times a week, should be enough to like mitigate it. The muscle loss.

SPEAKER_01

And keep eating protein. Yeah. Right. And I encourage patients to meet with a dietitian.

SPEAKER_03

Yes. Right. Because if they're eating less, they need to make whatever food they eat mean something.

SPEAKER_01

Exactly. And that's kind of where one of the side effects we didn't talk about was hair loss. I know. Right. Yeah. So, you know, a lot of times that's because we need maybe we're not getting enough nutrients. I know also it's a result of weight loss. So it's kind of tough to completely mitigate, but eating as much nutritious food as possible, nutrient dense foods.

SPEAKER_03

Yeah, the hair loss might not be a consequence of the mechanism of action of the drug, but just the mechanism of action of losing weight and consuming fewer things, and maybe you're not making the best choices with what you do put in your body. Exactly. You know, in the lesser components. Yeah.

SPEAKER_01

And I think one of the biggest things in regard to adequate calorie intake on a day-to-day basis is I find myself reminding patients that it is okay to feel hungry. Being hungry is a normal physiologic, human thing. Yes. Yeah. Yes. Like if you weren't. So yes, this can suppress appetite, but it's not supposed to completely demolish hunger. Right. Right. So, you know, some patients will come in and they're losing two pounds a week, steady. And they're like, hey, I need an increase because they might be losing even more than that. Right. And they're like, I need an increase because I felt hungry yesterday. That's okay. I'm like, that's okay. Like, did you eat? Right. Right? Yeah. We still need to eat. Yes. So I think that's a very common misconception, is like these just, hey, you won't eat at all. Right. Right. Yeah. That's not that's not the point. Yeah. Yeah.

SPEAKER_00

Okay. I think weight's really complicated, but like this is these are chemicals we make on our own. The main difference is these medications are a long acting version. So when we make GLP1 or GIP, it's for like seconds to minutes while we're digesting things. So it's it's slightly different. But things that make you make them naturally are eating fiber. Fiber fixes everything like exercise. Yeah. Um, like the Mediterranean diet's more likely to do it. Right. Um, uh like adequate protein, like monounsaturated fats and polyunsaturated fats are more likely to make it naturally. So like the ultra-processed, high-fat, like simple sugar foods actually mess up how GLP1 and GIP work naturally. So it is important. It's not just like, oh great, I can do whatever I want and just take these shots. Yeah, yeah. We really need to be cautious. Doing all the things. Yeah, yeah. Doing all the things. But I think it's an interesting question is like, why are GLP and GIPs messed up to start with, right? Yeah. Why so many Americans obese? I think it's an interesting question. I don't know if we know the answer to.

SPEAKER_03

Yeah, yeah, yeah. Is it our diet, or did our diet cause it? Or are we?

SPEAKER_00

But also like being obese messes it up. So like once the weight's on, it gets messed up. It's really complicated. Yeah.

SPEAKER_03

Yeah. Yeah. Stacia, when we were preparing for this, you said something that I think is important. Like thinking of um being overweight as more of a medical condition that deserves a medical treatment. Yeah. Rather than um blaming the person for for being that way. A lot of this is genetically inherited. A lot of this is outside of a person's control. It is a medical condition, just like you can be diagnosed with any medical condition. And so these medicines are designed to help them treat that medical condition, not to make them feel bad. And so I think that's a really good thing and a really important point.

SPEAKER_00

Yeah, and it's more of like what we call a chronic disease, like diabetes, blood pressure, cholesterol. It's not like getting strep throat for a week. Right, right. So it's also it's not something you have for 12 weeks and then stop it and it magically goes away. This is a long-term thing that has lots of influencing factors.

SPEAKER_03

I wanted to close in our final minutes talking about some kind of society things, trends that I'm kind of observing as the GLP ones have worked into our space. And some of them are interesting and some of them are a little bit scary. And I wanted to get you guys' thoughts. So, one, are we potentially returning the idea that being stick-thin is the epitome of beauty? I remember in the 90s, I was a teenager in the 90s, and everybody wanted to be stick-thin. And then in the early 2000s, like appreciating your body and what it does for you, appreciating your curves, all of that became much more mainstream and much more like good. I think it was a good thing. Now it seems like you watch Hollywood and all the actresses who were thin to begin with, who are now clearly on some of these medicines. And um, it's kind of a a dangerous level of thin. Do you think these medicines are changing our idea of beauty?

SPEAKER_00

I feel like our idea of beauty's been there for a long time. I think it's just like contributing to it.

SPEAKER_02

Yeah.

SPEAKER_00

Yeah. Or but I think it's a little different. Cause I think also that standard of beauty came with, so you need to do this next thing. Like you need to exercise more, or you need to eat these non-fat foods, which actually didn't help. Like I feel like a lot of that also came with a and here by this, whatever. Yeah. Yeah. Right. There's that's also when like weight loss just marketing increased various products. So I think it was tied into that plus selling you stuff.

SPEAKER_01

Yeah. Yeah.

SPEAKER_00

But I think culture, that's just like complicated. Like video studios are different.

SPEAKER_01

I mean, I know you don't like lip filler too much. I said too much. Too much, too much.

SPEAKER_00

Too much is where I think you're having a medical problem. Yeah, yeah. Yeah.

SPEAKER_01

Anaphylaxis looking lip filler. Yeah. So I but you know, that's like kind of in right now. So I it's just true. It's kind of like trends just come and go. And I'm not sure if this is a fad or a trend, or if yeah, I think I was just born like 400 years too late.

SPEAKER_00

Yeah. At one time it was good to be chubby pale and have a high forehead. I think I just like I was made for Elizabethan England and not like so you're beautiful. Yeah, yeah. But I mean, that just changes all the time. You're right. We also have like our American standards, which are different from very true. Very choices. Because we get sold all this like stuff that makes us not meet our own beauty standards, which is sort of interesting.

SPEAKER_01

Yeah, yeah. I find myself reassuring patients a lot more than usual, though, in visits.

SPEAKER_02

Yeah.

SPEAKER_01

With patients coming in, especially with weight loss, and they're like, well, you know, and it it kind of alters things, right? Like they're convinced they need to get down to a certain 105. Right. Yeah. Because they were that way back in the fourth grade. Right. Right.

SPEAKER_00

Or I think also they don't want to tell anyone they're on it.

SPEAKER_03

Right. That's that was on my list. Like, what is, you know, there are numerous celebrities that are open about it. Like, yep, I'm on this, or I was on this, or whatever. And then there are other celebrities that we know are on it, but they're not being vocal about it.

SPEAKER_02

Yeah.

SPEAKER_03

Um, what is the best way to handle it? You know, if I see I one thing I have run into, if I see a colleague that I haven't seen in maybe a year, and it's obvious they've dropped serious weight, you know, like 50, 60 pounds. It's a noticeable thing. I feel like I'm a little bit like, do I do I compliment them? That's a good question. Are they gonna be open about it to me? I I never really know what to do in that situation. Can you like typically we praise people, right? Like a job. Very true.

SPEAKER_00

Which implies that you were doing a bad job before. So I feel like that is interesting. Like, do you tell somebody?

SPEAKER_01

I don't know. And a lot of patients, like, well, especially ones that maybe really could benefit from a GLP one. Yeah, because we know obesity is a chronic disease state, right? They feel like taking a GLP is cheating.

SPEAKER_02

Oh and they feel bad about it.

SPEAKER_01

And I'm helping them do their first shot. Yes. And they're just so stressed because they feel like they're cheating. Yeah. Right. And so I think in that sense, a lot of people are ashamed to, and you know, the way I look at it, my perspective is this is a medication for your chronic disease. Yeah. Right? Yeah. Just like I need my inhaler before I work out. Yeah. Yeah. Like, you know, it's it's nothing to be ashamed of. No. Right? No. And if this, I mean, it's part of your journey. It's how you got to wherever you're hoping to be.

SPEAKER_03

Yeah. Yeah. It's a medicine for a condition just like your inhaler is for asthma and insulin is for diabetes. And you know, you manage that condition.

SPEAKER_00

Um, although I'd love your the loose skin is definitely a thing. Yeah. I don't know if you have any like afterweight loss.

SPEAKER_03

I know. Um, like some people, you know, the osempic face um on the face, and then also just if you've been overweight for a while, your skin stretches out, and then you can get laxity. There's no easy way to solve that. There's, I mean, some people are doing fillers for the facial loss, but even still, like, I don't know. I I don't think we've solved it. I was at a conference recently and a cosmetic dermatologist went up there and said that she's loving this GLP one mania because there are so many patients coming to her for help with these things. And so some people out there are doing the fillers and stuff to help minimize it, but it's a hard problem to solve.

SPEAKER_00

But also something that people are gonna get sold a lot of. Yeah. Oh, take this or use this weird device. Yeah. So to probably save your money on that for now.

SPEAKER_03

Yes, very true. Very true. I've heard people talking about anorexia GLP osa, where people get kind of hooked on the GLP one, even when they've lost a lot of weight and sometimes even too much weight, and they can't stop thoughts. I mean, somebody is continuing to prescribe this for them. Yes. And and maybe that's where this problem needs to be addressed, is with whoever is continuing to kind of feed the habit. Yeah.

SPEAKER_00

Those are some of my hardest conversations. Cause you're like, as of now, like I have data and it's approved for people with a BMI over 27. So I don't have safety data for people less than that, but they are getting it. Yeah. I mean, once people are on it and now they're no longer a BMI of 27, like continuing that is fine. But it's really hard when someone comes in and they're menopausal and they put on 10 pounds, but their BMI is 24. But if I don't, and I don't prescribe it, but I know they get it somewhere else. Somewhere else.

SPEAKER_01

I think this is where that like art of dosing and art of medicine kind of comes in too, right? Because the clinical trials, if we're gonna follow those dosing recommendations, let's say someone gets titrated up to Z bound 15 milligrams, they hit their goal weight, they're continuing it for maintenance, right? However, they keep losing weight, even though they've hit their goal weight. Yeah. Right. That's kind of where that art comes in, where it's like, let's find you a maintenance dose where your weight stays exactly the same and we're not worried about continuous excessive weight loss. Yeah. Right. Yeah. So, you know, that's another thing I do on the day-to-day is like, let's find a maintenance dose for you. Let's try a month of one dose lower. Oh, you're still losing weight. Let's try, you know, the next one down. But yeah, that's something that the trials haven't looked at. Yeah. Right. So it's kind of where that art, I guess, comes in again.

SPEAKER_00

Yeah. Well, and it's hard because like menopause also alters how your GLP one and GIP stuff. So my suspicion is they'll be very helpful, but I don't have any data that to use it in a normal weight menopausal woman. And that's probably gonna take five, 10 years. Yeah. Which is really hard for someone struggling at the time. But right, we're just like we're held to different standards where we just, I'm like, I'm sorry, I can't do it.

SPEAKER_03

Oh menopause sucks.

SPEAKER_00

Yeah.

SPEAKER_03

We should do an episode on that. Yeah. Let's do it. Everything changes. It's like a second puberty. Like an embodiment. Yeah. Well, thank you guys so much for coming on. I think the audience will find this very, very useful as they think about the the future of GLP1s and weight loss for themselves or for their family members. And I think we've shed a lot of light on the various options and the acceptability. This is a medical treatment for a medical condition, and people should do what's right for themselves and for their general health. Any other thoughts in the closing moments? Being hungry is okay. Being hungry is okay. That's that's just the goal should not put not be complete absence of hunger.

SPEAKER_01

Yeah, complete absence of hunger and complete absence of food is not good, and it actually will make it harder to lose weight. So please eat. Yes. And eat lots of fiber.

SPEAKER_03

And eat fiber one. This episode is sponsored by fiber. Well, thank you guys so much for tuning in. We hope you enjoyed it and please continue to watch future episodes. Thanks, guys. Thank you. Thanks.