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    Episode 230 - Ozempic

    enJune 24, 2024

    Podcast Summary

    • History of weight loss medicationsDespite the buzz around Ozempic and related weight loss meds, Fenermine and Qsymia, a combo of fenfluramine and topiramate, have proven track records for significant weight reduction and overall health benefits when used as part of a comprehensive approach

      Ozempic and related weight loss medications have become a buzzword in the public discourse, often being perceived as a miracle cure or a boogeyman. However, according to our expert guest, Dr. Carl Nadalski, the history of weight loss medications goes way back with a jaded track record. He mentioned that Fenermine, a tried and true medication with a good track record, has been around for a long time. Another medication, Qsymia, a combination of fenfluramine and topiramate, has been approved for long-term use and has good overall benefits for weight reduction. The goal is to achieve over 10% weight reduction, which can lead to significant health benefits, including putting diabetes into remission and reducing the risk of fibrosis. It's important to remember that these medications should be used as part of a comprehensive approach to weight loss, which includes nutrition and lifestyle changes.

    • Medications for obesity and related conditionsOlder and newer medications, such as incretin-based drugs, metformin, terzepatide, and semaglutide, play significant roles in managing obesity and related conditions like type 2 diabetes and binge eating disorders by targeting different pathways and improving insulin sensitivity and glucose control.

      There are various medications, both older and newer, that play a significant role in managing obesity and related conditions like type 2 diabetes and binge eating disorders. These medications work in different ways, some targeting the dopamine reward pathway for cravings, while others improve insulin sensitivity and glucose control. For instance, incretin-based medications like exenatide (biata) and liraglutide (Victoza) have been used for decades and have shown promising results in weight reduction and glycemic control. Metformin, another widely used medication, works primarily on the liver and muscles to improve insulin sensitivity and has a cost-effective role. However, newer medications like terzepatide (Mounjaro) and semaglutide (Ozempic) offer more significant weight loss benefits and target multiple receptors in the body. The speaker's personal experience with semaglutide (Mozambique) has been positive, with improvements in A1C levels, weight loss, and reduced food cravings. Overall, understanding the role of these medications in managing obesity and related conditions can lead to better treatment outcomes and improved patient care.

    • Ozempic side effectsOzempic and similar medications can have side effects, and potential risks may outweigh benefits for those without significant disease or obesity-related complications. Personalized approaches and professional guidance can help mitigate side effects and maximize benefits.

      Ozempic and similar medications can be effective tools for managing weight and improving health outcomes, especially for those with diabetes or insulin resistance. However, their use should be carefully considered, as side effects can occur and potential risks may outweigh benefits for those without a significant disease process or obesity-related complications. Personalized approaches, including proper dosing and dietary adjustments, can help mitigate side effects and maximize benefits. Additionally, these medications should be prescribed and administered under the guidance of a healthcare professional.

    • Diabetes medications and weight lossNewer diabetes medications like ozempic and semaglotide not only manage blood sugar but also aid in weight loss and appetite reduction, with semaglotide showing impressive results in clinical trials.

      The newer diabetes medications, such as ozempic and semaglotide, offer significant benefits beyond just managing blood sugar levels. These medications, which work by targeting GLP-1 receptors in the brain, not only help reduce weight but also improve appetite and reduce satiety. In clinical trials, semaglotide showed impressive weight loss results, with some patients achieving over 20% reduction. These medications are particularly effective for those with obesity and pre-diabetes, helping them put their condition into remission. While these medications have been around for a few years, they are not a magic bullet, and maintaining weight loss can be challenging. However, the benefits are worth the effort, as they can lead to improved overall health and reduced need for diabetes medications. If you're considering these medications, it's important to discuss them with your healthcare provider to determine if they're right for you.

    • Ozempic side effects and procedure preparationOzempic and similar medications have side effects including gastrointestinal issues and potential risks for thyroid cancer, pancreatitis, gallstones, and gallbladder disease. Recommendations for holding the medication before procedures are evolving, and patients should discuss any concerns with their healthcare providers.

      While Ozempic and similar medications offer significant benefits for managing diabetes and other health conditions, they come with side effects such as nausea, diarrhea, and constipation. More serious concerns include potential risks for thyroid cancer and pancreatitis, though evidence suggests these risks are relatively low. Another issue is the potential for gallstones and gallbladder disease. Regarding procedure preparation, there have been anecdotal reports of difficulty performing certain procedures due to food remaining in the stomach despite holding the medication beforehand. Current recommendations for holding Ozempic before procedures are evolving, and further research may be needed to determine if longer hold times are necessary. Overall, it's essential to weigh the benefits against the risks when considering these medications and to discuss any concerns with healthcare providers.

    • Risks of treatmentsAll treatments, including medications and supplements, carry risks, and it's essential to be well-informed, work closely with healthcare professionals, critically evaluate sources, and ensure transparency in healthcare provider relationships.

      While medications for conditions like diabetes and obesity can have side effects, it's important to remember that all treatments, including supplements, carry risks. The media sometimes sensationalizes individual cases, but large-scale studies provide valuable data on the benefits and risks of various treatments. It's crucial for healthcare professionals to be well-informed and for patients to work closely with their doctors to make informed decisions. The online world can be a source of misinformation, and it's essential to critically evaluate sources and consult reliable data. Additionally, the relationship between healthcare providers and pharmaceutical companies should be transparent, with providers maintaining their expertise and making decisions based on evidence rather than marketing efforts.

    • Pharmaceutical reps in medical settingsDoctors should be aware of potential influences from pharmaceutical reps and maintain ethical practices, while recognizing the educational benefits they can provide.

      While the presence of pharmaceutical representatives in medical settings can provide educational benefits, it's essential for doctors to be aware of potential influences and maintain ethical practices. The speaker shared their experience of their residency program banning farm reps, leading to a decrease in meal quality but an eventual understanding of its importance in avoiding undue influence. They emphasized the need for constant self-reflection and questioning the impact of these interactions on medical decisions. Additionally, the speaker discussed Terzepitide or Monjaro, a medication with impressive glycemic control and weight reduction capabilities for people with obesity and type 2 diabetes. The selection of patients for this medication depends on individual circumstances and the balance between potential benefits and side effects.

    • Type 2 diabetes medicationsNew medications like terzepatide, rebelsis, and orthoglopron show promising results in reducing A1C levels, leading to significant weight loss, and improving lipids and blood pressure, with relatively well-tolerated side effects.

      Terzepatide, a new medication for type 2 diabetes, showed impressive results in reducing A1C levels (a measure of blood sugar control) by up to 2.4%, even surpassing the efficacy of other diabetes medications and insulins. Additionally, it led to significant weight loss, ranging from 7.5% to 11%, with associated health benefits such as improvements in lipids and blood pressure. The medication's adverse effect profile is relatively well-tolerated. Coming soon, there are oral versions of similar medications, like rebelsis (a pill version of ozempic) and orthoglopron, as well as combination therapies like chagrissema (cagrulin-tide and agletide). These medications could potentially offer liver benefits, which is crucial for addressing fatty liver disease, a common issue for many Americans.

    • Diabetic health managementBoth Type 1 and Type 2 diabetics should work together in managing their health conditions. Strength training can help mitigate muscle mass loss from certain medications, and clinical benefits still apply even with muscle loss.

      Despite the differences between Type 1 and Type 2 diabetics, they are all part of the same team in managing their health conditions. The discussion also emphasized the importance of strength training, as it can mitigate concerns about potential muscle mass loss from certain medications. The data on these medications should be viewed in context, and the clinical benefits still apply even if muscle mass is reduced. Lastly, both George and Carl were encouraged to continue sharing their medical knowledge and entertainment on their respective Twitter handles. It's important to remember that this podcast is not a substitute for professional medical advice and to always consult a healthcare provider for individual health concerns.

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