The Pound of Cure Weight Loss Podcast
Hosted by obesity specialist Matthew Weiner, MD and dietitian Zoe Schroeder, RD, The Pound of Cure Weight Loss Podcast provides a comprehensive approach to weight loss. We cover nutrition, the new GLP-1 medications, and Bariatric Surgery in depth and answer tons of questions from our audience every week. Check out our website for video versions of the podcast: www.poundofcureweightloss.com/podcast
The Pound of Cure Weight Loss Podcast
Is this the End of Compounding?
In Episode 47 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoe Schroeder, RD dive into weight loss topics like compounded GLP-1 medications, ultra-processed foods and their link to heart disease, and processed meat alternatives.
Ultra-processed Foods: Are Some Worse Than Others?
A recent study published in The Lancet found that ultra-processed foods make up a shocking 73% of the U.S. food supply, with significant consequences for heart health.
Dr. Weiner and Zoe discuss how this study highlighted an 11% increased risk of heart disease for those who consumed the most ultra-processed foods. The study particularly focused on the worst offenders: processed meats and sugar-sweetened beverages. These foods were shown to have the strongest links to heart disease.
One fascinating finding from the study is that not all ultra-processed foods have the same impact. When processed meats and sugary drinks are removed from the equation, the difference in heart disease risk between people who eat a lot of ultra-processed foods and those who don’t becomes much smaller. This reinforces the idea that not all ultra-processed foods are equal when it comes to heart disease risk. Avoiding processed meats and sugary drinks can significantly lower your risk, while focusing on healthier food choices can improve your long-term health.
Nutrition and Heart Health: How to Eat Smarter
When it comes to improving heart health, Dr. Weiner and Zoe offer practical advice on what foods to choose instead of processed meats. Zoe emphasizes the importance of focusing on whole, unprocessed foods, such as:
- Fruits and vegetables: These are packed with vitamins, minerals, and antioxidants that help support heart health.
- Lean animal proteins: Opt for fish, chicken, and lean cuts of red meat as alternatives to fatty cuts of red meat and processed meats. These options provide high-quality protein without the unhealthy fats found in processed meats.
- Nuts and seeds: Rich in healthy fats, fiber, and protein, these are great plant-based alternatives to meat.
- Legumes: Beans, lentils, and chickpeas are nutrient-dense and provide a satisfying source of protein and fiber.
The key is to focus on nutrient-dense, whole foods rather than simply trying to restrict calories or follow fad diets. The Pound of Cure philosophy encourages a shift in mindset toward eating for nutrition and long-term health and weight loss rather than fast weight loss which will, ultimately, come back.
Zoe also mentions the importance of minimizing food noise—the constant mental distraction and cravings for unhealthy foods—by incorporating satisfying, high-quality meals into your daily routine. By making smarter food choices, you can naturally reduce your cravings for processed foods and improve both your heart health and overall well-being.
Replacing processed meats with nutrient-dense foods like fruits, vegetables, lean proteins, nuts, seeds, and legumes is a smart strategy for improving heart health and managing weight.
The Role of GLP-1 Medications in Weight Loss
The episode concludes with an in-depth discussion on the role of GLP-1 medications in weight loss, particularly focusing on the recent shortages and their implications. These medications, like Wegovy and Zepbound, have been highly sought after due to their ability to lower the body’s set point. However, earlier shortages led many patients to seek compounded versions of these drugs.
Dr. Weiner explains that compounded GLP-1 medications are custom-made by compounding pharmacies, which mix the active ingredients (Semaglutide or Tirzepatide) with saline, B12 or other additives.
Release the GLP-1 Vials
The shortage of GLP-1 medications, like Wegovy and Zepbound, was primarily caused by the manufacturing of inj
When you leave it to the marketers and the food manufacturers to handle your convenience, you're going to sacrifice the health.
Zoe:And nobody's going to care more about your health than you, especially not food companies trying to make you buy their product.
Dr. Weiner:No, I mean if you go and sit in their meetings. Metrics of the American people's health is not one of the metrics that they're trying to optimize. No, it's sales.
Zoe:Absolutely of the metrics that they're trying to optimize it's sales Absolutely.
Dr. Weiner:Welcome back to the Pound of Cure Weight Loss Podcast. Is this the end of compounding? You know there's a lot of talk about this. This is, yeah, I think. Well, we'll dig into it. You're going to have to hear the whole episode, but I you know we've talked a lot about compounding. It's complicated. Yes, it's complicated. There's pros and cons. There certainly are a lot of people out there having pretty good success on compounded medications. So before we get into that, we're going to talk about our In the News segment.
Dr. Weiner:This comes from the New York Times and the title of the article is Are Some Ultra-Processed Foods Worse Than Others? They talk about a study that was done. It was published in Lancet. Lancet is a UK-based journal. They really focus on more public health, global medical issues, as opposed to getting into the weeds on specific medical problems. It's certainly a very, very well-respected journal In the medical journal world. There are some journals where, when you see an article in there, you can pretty much assure yourself that this is a well-done article. There are others. If you see an article in there, you can pretty much assure yourself that it was rejected by some of the better journals first. You can pretty much assure yourself that it was rejected by some of the better journals first. So this article points out that 73% of the US food supply is considered ultra-processed. That's a lot Three quarters.
Zoe:Yeah, I think we can think about it and know that that's the case.
Dr. Weiner:Yeah, I mean just go to a grocery store.
Zoe:walk around and you'll see that that's how it is you have the produce section you have everything.
Dr. Weiner:So, anyway, this was focused on heart disease. So I think that's the first important thing. This is about heart disease, not about weight loss. But there's some really important things that came out of this study and I think it really syncs a lot with most people's experience out there and what I see in the office every day. They found that those people who consumed the most processed foods so they broke everybody in and said, ok, here's the people who consume the most processed foods and here's the people who consume the least processed foods they found that they had an 11% increased risk of developing cardiovascular disease if you ate a lot of ultra-processed food, which, truthfully, isn't that much. No, yeah, they combined the study. It was actually 1.25 million people in this study, so there was a lot of people in this study.
Dr. Weiner:Most of the people were white and most of the people were actually health professionals and when you look at a lot of the nutritional or longevity public health data, they often target health professionals. One of the reasons is because if you give a health professional a questionnaire to fill out, they're going to be much more accurate with their answers than someone who's not in the health field. So a lot of these kind of large-scale questionnaire-based studies because that's with nutrition, almost no studies are observational, right? What are you going to do? Lock somebody in a closet and here's what you eat for for six months? It's just not feasible to do these direct observational studies the way you can with, say, medications or other medical problems, and so these are mostly healthcare workers, so it's a little bit of a biased group. It's not a cross-section of, say, the American population, and so this study proves correlation, not causation. To prove causation you really need a double-blinded randomized control trial. Hey, here's two treatments. We're going to split them up, nobody knows who's getting which treatment, and then we're going to see what the results are. That's how you prove causation.
Dr. Weiner:That eating processed foods causes heart disease. This just says, hey, if people who eat a lot of processed foods, they tend to also have a higher rate of heart disease. I think when you're dealing with numbers this large and when you're looking at something, I think when you're dealing with numbers this large and when you're looking at something, we kind of know that's true, right, you eat like crap, you have a higher chance of dying of a heart attack. We know that it's very likely that this is causation. They found that there was an 11% increase in your risk of heart disease and they broke it down a little bit. There were some other ways that they analyzed it Broke it down a little bit and there was some other ways that they analyzed it. They got up to, I think, 17% higher risk, but certainly not double or triple the risk. And, very interestingly, they then separated it out into different types of processed foods. What do you think were the two worst processed foods for causing heart disease?
Zoe:Heart disease, definitely processed meats.
Dr. Weiner:Processed meats. No question, how about?
Zoe:the other one. Well, because I read the article, I'm going to go with sugar-sweetened beverages.
Dr. Weiner:Yes, sugar-sweetened beverages. So those were the two foods associated with the higher risk of heart disease. In fact, if you took those two foods out, there almost was no difference. Which? Is crazy, it's crazy, yeah, it's crazy, and so I think that's something that's really interesting. They also found that some foods were protective and foods I wouldn't necessarily have suspected, but they all have. There's two things they have in common. The first is breakfast cereals.
Zoe:Fortification. Right Vitamins and fiber well, some right, depending on the breakfast.
Dr. Weiner:Cereal breakfast here, yeah uh yogurt yeah, protein protein and also probiotics, right. And then popcorn and crackers, fiber, fiber and so I. They showed that people who ate a lot of breakfast cereals tend to have a lower risk of heart disease. Now again, this is not weight loss, right, right and not causation.
Dr. Weiner:And not causation. But I don't think Zoe and I would recommend breakfast cereals, some yogurts, but not a lot of the sugar. Sweetened yogurts, for sure, right. Popcorn, not so bad. Crackers probably best to steer away from as much as possible, but anyway. So some of these foods were protective. So it was really interesting that this, this didn't show. You know, you read all these books and you know, honestly, my book might even be one of these things where you're like, oh my God, if I just ate, right, it's going to cure every disease. It's going to cure diabetes, it's going to cure heart disease. It's amazing, diabetes, it's going to cure heart disease. It's amazing. And as we really dig into it, we find that that might be the case for a small group of people, but for the majority of people it's not the case, unfortunately. So I think, some interesting points here.
Dr. Weiner:There's always been this big debate about nature versus nurture right, is it your genes or is it your environment? What causes heart disease? And we've kind of gone back and forth and for many years we thought, oh, it's pretty balanced. As we start to really dig in, as we get a better understanding of genetics, we can look at DNA. There are certain genes that give you a 50% increase in your risk of heart disease. If you have two family members who've had substantial heart disease by the age of 50, which is pretty early but I think you have like a 600% higher risk of developing heart disease. Wow. So, no matter what you eat, that 11% deduction against that 600% increase, it doesn't make a whole lot of difference. And so I don't want anybody to read this article here to say, oh, I can just eat whatever I want, because that's absolutely not the truth, because right now there's people working on this, but right now our genes are not modifiable.
Dr. Weiner:So if you want to take steps that can reduce your risk of heart disease, then your diet is a big one, and I think also it's important that they looked at all processed foods. But there's this small group of people who eat incredibly well and I don't know that we can say that those people, those strict vegans, those people who eat like really, really perfectly. If that level of diet improvement, maybe that's protective. I don't think the study showed anything about that. So I think if you're out there and you have a history of heart disease, maybe going all the way to that vegan or near-vegan diet I don't know that this study really was sophisticated enough to find out if that makes a big difference, and that might. And there is some other data from Dean Ornish and some other people where there is some suggestion that that really low-fat vegan-type diet is protective.
Dr. Weiner:So I thought this was really interesting because it pointed out that our nutrition, while it plays an important role, it doesn't change everything. It's, and our philosophy and our program is really it's nutrition plus the meds, plus the surgery. That's how we get the reliable results. And again, doing the meds without or the surgery without the nutrition, that's a huge mistake. But doing the nutrition alone for the majority of people, we're just not going to get where you need to be.
Zoe:Well, if we think about the percentages, you know, maybe we'll see a 10% reduction in body weight with nutrition alone, kind of like that 11% reduction in heart disease. So you know, I think again that nature versus nurture.
Dr. Weiner:Right, right, and so many of our patients, so many, have a family history. One question I ask people is hey, if you go to a family reunion, are you shaped like everybody else? And so many people are like, oh my God, we're all shaped exactly the same, you know, and there's just a. You take our processed food environment and you put our genes together and and that we've got the epidemic of obesity. Yeah, so what do we have for our nutrition segment today?
Zoe:Zoe Well keeping with the theme of the, the processed meats. You know if we're thinking about okay, if this is one of the heavy hitters that can cause heart disease, but also we know that it's not great for weight loss and even diabetes and lots of other comorbidities as well. So I wanted to chat through some alternatives to those processed meats. So let's define processed meats Right. It's going to be the bacon, it's going to be the deli meats, the sausages, what else? What are some other processed?
Dr. Weiner:meat, ham, ham, yeah, yeah, anything. They're adding a lot of salt to a meat Exactly Salted meat.
Zoe:Salted meat, salted preserved meat, yeah. So I mean, and then we didn't even kind of discuss the sodium aspect, right, but that plays into that heart disease role. So we think about why somebody might gravitate towards processed meat or at least people in our practice working towards weight loss. Most of the time it's for convenience. Yeah Right, it's like a convenient protein source ready to go, and so I have a couple of tips to get your convenient protein source ready to go that might not be as high in preservatives and high in sodium. That's not necessarily considered. A processed meat is kind of making your own snack packs or your own ready to go protein.
Dr. Weiner:They all have processed meats in them. Yeah, all the snack packs.
Zoe:Yeah, you're right even if they're like chunks of, like chunks of turkey, it's going to be that like deli turkey that's, you know, smushed up and turned out into a different shape. So cooking up your own. For example, I did this last week a crock pot of instant pot of chicken and then portioned it out so that I have some in the refrigerator, some in the freezer easily add for a salad or as part of a meal or a snack or something like that. So doing some of that batch cook prep work ahead of time can be really helpful for having ready to go convenient protein sources, making your own snack pack. So we think about those. What are they? The P3?
Zoe:something, so it has like nuts, cheese and hunks of processed meat. So yeah, make your own little bento boxes that maybe you have some raw almonds, maybe you have some edamame and maybe you have some of your shredded chicken and cherry tomatoes or snap peas. You can buy actually Tupperware that is like those bento box style Tupperwares, so that can be really helpful. Canned tuna is not convenient to open up and get into, but the pouches we don't really want to get, the ones that are seasoned, because again, that's high sodium. You can get them, the plain tuna pouches in water. You can just open it up and start around. You probably wouldn't appreciate it, but you're getting your convenient protein in roasted chickpeas um, you know edamame and our shelled edamame. These are all convenient protein sources that you can do. Just a little bit of prep work, maybe keep it in the freezer, keep it in the refrigerator, have it ready to go so you don't need to lean on those. You know meat sticks.
Dr. Weiner:Yeah, yeah, I mean I think I've always kind of struggled with processed meat because, first of all, I'm not a cardiologist so I'm not really focused on the heart disease, but it takes such a small amount to give you a lot of flavor, true. But I think we do have to acknowledge that and you know, even though we're not, we're talking about weight loss processed meats probably do also dramatically increase your risk of diabetes. I think there's quite a bit of evidence that supports that too. Diabetes is essentially impaired glucose metabolism. We know diabetes and obesity are linked. So I think you know you kind of make a couple of jumps of logic and processed meats are probably also going to cause some weight gain too. I like your idea of those process, of making your own things so that you can really control them Probably much less expensive.
Zoe:Yeah, oh yeah.
Dr. Weiner:Yeah, much less expensive. And also, when you leave it to the marketers and the food manufacturers to handle your convenience, you're going to sacrifice the health.
Zoe:And nobody's going to care more about your health than you, especially not food companies trying to make you buy their product.
Dr. Weiner:No, I mean if you go and sit in their meetings, they're not sitting. The metrics of the American people's health is not one of the metrics that they're trying to optimize. It's sales.
Zoe:Absolutely. And thinking about what you said with the a little bit for flavor. So no, bacon is not going to give you a good source of protein, but if you having half a slice of bacon crumbled up on your salad that you have along with maybe a hard boiled egg and lots of veggies, and you just get that little bit of flavor, well then that could be maybe a way to add it in in moderation, in a way that it doesn't make you feel deprived but that you're not sacrificing your health quite as much yeah, um, okay.
Dr. Weiner:So our last segment is the economics of obesity. This is kind of a little bit of a follow-up when we had Dave on the man on Monjaro and Dave was making a big push for releasing the vial. So, as most people out there know, glp-1 medications are sold in a single-use pen and it's this single-use pen that's responsible for a lot of the shortages out there. Single-use pen that's responsible for a lot of the shortages out there. They actually can make plenty of the medication, but the pen manufacturing is what's holding this up. Shortages are much less of an issue now, but they have been a significant issue in the past. They finally released the vials. You can now get ZepBound in vials as opposed to in a single-use pen. They've had Monjaro in Canada in vial format for a while now, but now in the US they've got ZepBound. So they only released it for 2.5 and 5 milligrams. Why do you think? Why only those two doses?
Zoe:Because people aren't on them for long term.
Dr. Weiner:No think, why only those two doses? Because people aren't on them for long term? No, because that that's what you would think if you were concerned about people. But let's maybe switch that around and make it you're concerned about profit. What's going to happen if you get a 15 milligram vial? What are you going to do? Just take out a little uh-huh very easy to just take that one dose that you paid.
Dr. Weiner:You know people are paying 650 bucks for these things for a month. So they're paying each. Each dose is over 150 dollars. If you could make that dose last, I mean 15 milligrams. The starting dose is 2.5. That's a factor of six. You could take that 150 instead of 150 bucks a week. It's 150 bucks for six weeks, so they're not going to release the vials because and and to me this really shows that this single use pen is not so much about making it easy to inject, but really very much about being able to control the dose and prevent people from stretching it out and kind of making and driving the demand for the product.
Zoe:That's crazy, I didn't even think about that.
Dr. Weiner:No question, that's why they released it, so they do have it. The self-pay price of the 2.5 and the 5 milligram is a little bit lower than the $6.50 that they charge for the remaining ones. It's $400 a month, $3.99 for the 2.5 milligram and $5.49 for the 5 milligram dose. Up until now it's been $6.50 a month for every dose. You want the 15 milligram pen? It's $650. You want the 2.5 milligram pen? It's $650. Pen it's $650. You want the 2.5 milligram pen it's $650. The vials are going to be a little cheaper than that. Eli Lilly's stock price has doubled this year. It's doubled. That company is worth twice as much now than it was.
Zoe:The year's not even over yet.
Dr. Weiner:Yeah. So there's no question that they've been maximizing profits. They've been doing this very, very effectively. And so the president of CEO of Eli Lilly he actually called Dave and was like, hey, we're going to release the vials and they've marketed this like we're doing this great thing to alleviate the shortages. But again, looking back at profits over patients, which I think is what we're seeing with these glp-1 meds, they release these vials, I think also for a very specific reason because it alleviated the shortage, which is good. But they also, if there's no shortage, there's no compounding. So 503b pharmacies, which are the large compounding pharmacies, are only allowed to compound or get medications from someone. Besides, the manufacturer holds the patent if the medication is on the fda shortage list. Guess what's not on the fda shortage list anymore?
Zoe:so now there's no more compounding.
Dr. Weiner:No more compounding of triseptide. People will do it, but now Eli Lilly has a legal basis to go after it. Oh, wow, so I think, and so there was actually. When this all came out, there was a lot of chatter on social media about how this was actually a really bad thing. Huh, there was a lot of chatter on social media about how this is actually a really bad thing, because it signals the end of compounding, at least for terzepatide.
Dr. Weiner:Semaglutide Wegoviozepic is still on the shortage list, but terzepatide is now officially off the shortage list, and so I think, as much as Eli Lilly's marketing, this is like hey, we're doing this great thing, we're listening to the public, we're releasing the vials. There was a lot of strategy, a lot of strategy. They got themselves off the FDA shortage list. They can go after the compounders. It's no secret that these manufacturers are very against the compounders and they've plugged it as a safety issue and there is a little bit of that there really is but I think it's very much that they're protecting their product. These are going to be trillion-dollar drugs.
Zoe:Yeah.
Dr. Weiner:And so they want to be able to capitalize on this. I think, if you think back to the history of the pharma industry, this, if you think back to the history of the pharma industry, one of the first mass-produced pharma products was the polio vaccine. Jonas Salk, when he discovered the polio vaccine, basically said I will not patent this. I want as many people as possible to be able to produce this so that we can have an adequate amount of the vaccine so that we can vaccinate the world and eradicate polio. And they did Right, right, they really did Putting the people first, putting the people first, that idea. Now if someone produced this thing and was like I'm not going to patent it, I want everybody to benefit.
Zoe:That would be like crazy thing and was like I'm not going to patent it. I want everybody to benefit, that would be like crazy.
Dr. Weiner:It would be like what is wrong with this guy? He's a nut job. Like it would never. Something like that would never happen today. It would never happen today. So, anyway, interesting, there's a real interesting history of that.
Dr. Weiner:Do you know where the manufacturing came from, how they got this thing manufactured? They started a charity and they went around they're like, hey, we have this vaccine, we need these companies to manufacture it. And they went to all these people and what happened was a bunch of people would give like a tiny amount, like five cents, 10 cents, and it was through all of these small donations that they got the money together in order to be able to manufacture the polio vaccine. And that became the March of Dimes and that's where the name March of Dimes comes from is that they went around collecting dimes and they took all the dimes and then that's how they were able to fund the manufacturing of the polio vaccine. I thought that was a really interesting story and, looking back at that, versus what we've got now, where we've got Bernie Sanders on September 24th certainly by the time this airs, and we'll cover that testimony in future episodes Bernie Sanders has the CEO of Novo Nordisk coming in and he's got an article out there. Search that letter up that he wrote to the CEO. It's a good letter. It really is a good letter.
Dr. Weiner:But anyway, I think this whole thing to me. They have this fantastic medication. Look at the number of people suffering. Let's just talk about childhood obesity. We've talked about childhood obesity in the past and how there's a socioeconomic component. These meds are, without question, the best weapon against childhood obesity. How many people do you think developed paralysis from polio in the United States in the 40s and 50s per year? Guess, oh, I have no idea. About 20,000. About 20,000 people every year develop polio, became paralyzed.
Zoe:Oh, I know where this is going.
Dr. Weiner:How many kids are suffering from childhood obesity? A lot more than that millions. I wrote it down here somewhere. What did I? What number did I come up with? Definitely not 20 000 million kids 14 million kids in the united states are suffering from childhood obesity. Uh, and so we're really talking about exponentially larger amounts of kids suffering from childhood obesity. And I don't know that obesity is paralysis, but man, it can be close, it can be. Childhood obesity is a cripple. I mean it sets people off on a really difficult emotional path.
Zoe:I was going to say the mental health aspect.
Dr. Weiner:The mental health aspect, the physical aspect, and so I think we have to start to hold the pharma companies accountable. It's time for us to recognize that this pendulum has swung too far toward the pharma company profiting. They did not create this medication all by themselves. They act like it, they're manufacturing it, they're trying to profit like they did. But the science that went into these meds, the science that went into everything that's in their laboratory, the training of the people who are working in their company there was public funding that went into that. This is, to some degree, a public good. We have to get this balance right between incentivizing production and development of medical breakthroughs, but also making sure that people get access to them once they're out.
Dr. Weiner:This medicine costs $5 a month to manufacture. There's been some good articles in science that that have said that that's probably what this costs. We're selling it for fifteen hundred dollars a month. It's crazy, it's gone too far. And I'm not saying we give it away for free, and I'm not saying that, eli lily, should, you know, close up shop and just give the patent away, like Jonas Salk did. Let's just swing it back a little bit more.
Dr. Weiner:Anyway, all right, that was a lot, a lot, but I think we need to be calling these people out. I think we have an election cycle coming up and look carefully at who you're voting for and how they stand and where they are on health care and health insurance reform and pharma. And look at who's're voting for and how they stand and where they are on health care and health insurance reform and pharma. Look at who's giving them money, and if you're seeing a lot of money coming from the pharma industry, from health insurance companies, then you can pretty much be assured that that person is not necessarily going to represent your best interests when it comes to health care. If you're frustrated about not being able to get these meds, look for candidates who are taking a stance against this. There's a few out there. All right.
Zoe:Well, on that note.
Dr. Weiner:On that note.
Zoe:If you've been enjoying our podcast. We would really appreciate it if you would leave us a review. Share it with somebody you think would find it valuable as well. That would be really helpful.
Dr. Weiner:Our mission is to get valid, scientific, clinical information out to you so that you can make good decisions about your health.
Dr. Weiner:For so many years, obesity has been treated as this thing that you just have to outwill and if you only tried harder. And we now understand it's a metabolic disease and it's time for us to get the information together to start mapping out a plan, like we do with all the other medical problems out there. The science is out there. The science with the meds, the science with the surgery, the nutrition all of it's out there. We can pretty much get almost anyone who walks into our office to lose a lot of weight. It's a matter of getting the insurance coverage and getting the information out there so people are able to participate, to walk in with their head held high, to not look at this as something that's shameful or that they should be embarrassed about. They're getting treatment for a medical problem. The deck is stacked against you in terms of trying to lose weight on your own, but now we've got the medicine, We've got the surgery, We've got the nutrition. It's all out there and we want to get that message out to people.
Zoe:Thanks so much for listening and we'll see you next time.
