Episode 62: To Zepbound or Not to Zepbound, that is the question!

In this episode of the Pound of Cure Weight Loss Podcast, hosts Matthew Weiner, MD, and Zoë engage in a Q&A session addressing listener-submitted questions. They discuss various topics including the importance of dietary choices post-bariatric surgery, the implications of protein shake consumption, the recurrence of hiatal hernias after gastric bypass, the role of GLP-1 medications in weight management, and the differences between type 1 and type 2 diabetes. The conversation emphasizes the need for personalized care and long-term support in weight loss and health management. In this conversation, Dr. Matthew Weiner discusses the impact of GLP-1 medications on diabetes management, particularly focusing on their role in weight loss and insulin sensitivity. He explains the complexities of treating type 1 and type 2 diabetes and introduces the Platinum Program designed to streamline patient care and reduce costs. The discussion also touches on the integration of AI in diabetes management tools and the challenges faced in enhancing these technologies.

Learn more about our Platinum Program here!

Transcript

Zoë (00:18.888)
All right.

Welcome back to the Pound of Cure Weight Loss Podcast. We are so happy you are here. We're happy to be here. And we've, yeah, we've got a really great episode. We have another amazing Q &A episode for you today. What's great about the Q &A episodes, I don't know about you, Dr. Weiner, but I really like these questions because they are submitted from our listeners. So.

Matthew Weiner, MD (00:27.954)
Absolutely.

Zoë (00:44.278)
If you're listening and you have a question, submit your questions to us. You can do that on the podcast page of our website or leave a comment on any of our social media platforms. We'll add it to the list, but this is the opportunity for real listeners to get their real questions answered right here on the podcast. So buckle up because we've got a lot of great questions for you today.

Matthew Weiner, MD (01:07.839)
For sure. Zoe, you know where I'm going tomorrow?

Zoë (01:10.574)
Why didn't you tell us?

Matthew Weiner, MD (01:12.149)
I'm going to Guatemala.

Zoë (01:13.947)
heck yeah, that's for your yearly mission trip, right?

Matthew Weiner, MD (01:16.917)
Yeah, from I think it's either my fourth or my fifth year that I'm going and I go down there and I do, you know, 90 % of my practices is bariatric surgery and weight loss, but I've always done general surgery. I've been doing this for 20 years, know, hernias and gallbladders. I can do those in my sleep at this point. And so one of my best friends goes down there every year and he invited me, said, Hey, we need a general surgeon. Will you come down? So it's like one of my best friends from residency. So we were like, you know, these kids like

Zoë (01:34.392)
Mm-hmm.

Matthew Weiner, MD (01:46.001)
learning from everybody and trying to figure everything out. And now we're the ones who are kind of in charge and going down to Guatemala. And also plus I'm kind of sick of the US healthcare system. So maybe getting out of the country and practicing healthcare someplace where it's a little simpler. I'm up for that. But yeah, leave first thing, I got a 5 a.m. flight tomorrow morning. So yeah.

Zoë (02:00.078)
Mm-hmm.

Zoë (02:05.667)
wow. Amazing. And how long are you? You're just there for the whole week, right?

Matthew Weiner, MD (02:10.697)
I'm there for a week, yeah. It's very like, it's very regimented. I kind of like that. I mean, I don't know how you feel, but like, just having that tradition, that thing, you know, the first day you do this, the second day you do this, on the last night you have this reception and they always serve these meals and you're with the same people and just that regiment. I don't know what it is. Yeah, there's something about doing something year after year that you enjoy, that's...

Zoë (02:31.608)
Predictable.

Matthew Weiner, MD (02:39.093)
comes the same way you can look forward to it. It's like you look forward to it, but you're not going to be surprised. Maybe as you get older, the surprises are like, yeah.

Zoë (02:45.166)
you

Zoë (02:48.718)
No, I'll take a no on the surprise. so do you see a lot of the same people in terms of who there's to assist you and work with you on the trip?

Matthew Weiner, MD (02:58.099)
Yeah. Yeah.

Yeah, and it's like, a lot of them are like kind of, you know, there's a lot of like college kids and then they kind of get into med school and you kind of follow their trajectory a little bit and you get to know them. And then there's, you know, nurses and other doctors and you become friends with all of them. And so, yeah, like it's like, I would say I probably already know 80 to 90 % of the people who are going to be on the trip and we've worked together before. And so we all kind of understand and know how it's all going to go down.

So it's really a great trip and I think any physicians listening doing this type of missionary work is really fantastic and I would encourage anybody to do it. And last year I took my daughter with me which was really cool.

Zoë (03:45.76)
Yeah, I think I remember us actually talking about that as we were recording a podcast episode and how you excited you were to have her come.

Matthew Weiner, MD (03:53.557)
Yeah, that was really fun and she sent me a text like, say hi to everybody for me. So, yeah.

Zoë (03:58.498)
that's great. All right, so should we jump into the questions today? Let's do it. So our first question is actually a DM on Instagram. And the question reads, should I be drinking protein shakes six years out? So I'll take this question. So my recommendation is to if you are relying on processed protein shakes still six years out, to me,

Matthew Weiner, MD (04:03.101)
Let's go for it!

Zoë (04:25.3)
you are kind of setting yourself up for future weight gain. And the reason why I say that is because sure, you're still getting your protein in, which we know is important, but relying on these not very satisfying processed protein shakes, not only do they have a ton of ingredients, which we know we wanna try to reduce the amount of artificial and processed food in our diet,

But specifically with being six years out, you're probably in maintenance, you probably can eat more food, you probably feel hungrier. And so my main motto is, I want you to eat as much food as you need to to feel full, but it's a matter of what you're eating more of. So think about a protein shake, right? We'll just call a Premier Protein Shake, 160 calories and 30 grams of protein. Okay, for that same nutrient breakdown.

Imagine a plate that has a serving of chicken on it and a big serving of broccoli because it's probably going to be pretty similar in terms of nutrient breakdown and how much more full and satisfied you'd feel, right? Totally different. Say, I always like to use that example with protein bars too, right? Because you pound that shake and then you move on with your day and then maybe you're hungry again a little bit later. And if you're not working with your body and you're changing,

Matthew Weiner, MD (05:33.011)
or different,

Zoë (05:49.208)
hunger cues as you continue to move further away from surgery, you are not expected nor should you try to eat the same small amount and just follow what you did immediately after surgery during your honeymoon period, because that's not what's going to be sustainable in the long term. So here and there, a protein shake to help fill in the gaps when you need to, fine, but relying on protein shakes for most of your protein throughout the day.

It's a no for me.

Matthew Weiner, MD (06:20.093)
Yeah, I mean, I agree with everything you said there. I think the reason why this is still such a big thing is really one of the fundamental issues with bariatric surgery and long-term support. And quite frankly, it all kind of stems from the financial model that exists where the surgery is very financially rewarded and the aftercare is really not.

And that's just true of kind of everything in our healthcare system. And so what happens is, is we put all this energy around the immediate perioperative phase, your pre-op diet, your post-op diet. And that's what everybody thinks about when they think about bariatric nutrition. I patients come in and say, I hear you can't even eat solid food after the surgery. What do mean you can't eat? You can't eat solid food for like a month. But...

Zoë (07:09.902)
Right.

Matthew Weiner, MD (07:10.505)
then things change. And so because there's so much emphasis on this immediate post-operative period that we don't think about what happens at six months, 12 months and six years out. And anybody who's had the surgery will tell you it's so different at six years out. It's so different. And so we have to be able to provide guidance and counseling to get people out of this protein first phase.

which is critically important in those first few months and into the produce first phase, the pound of cure phase, which really should represent their eating for the rest of their life. And, you know, I think one thing that we have coming out is this Caloratio tool. And I'm really excited and we're going to talk a lot more about that as it's released. But I'm just, really excited about how it, it forces you to think differently about food and about eating.

It's not a restrictive.

Look at eating. It's a it's almost an abundance It's like you talk about as much as you can the more healthy foods you eat the better and so I think this is you know I understand why this question is being asked and this is certainly not the first person who's asking it But yeah, I agree. There's no role for this and and it really in my mind represents failure of Long-term support now that we have these GLP one meds We have patients coming back into our practice and kind of looking at us say hey you can help me

And that's been really refreshing to me too that we have these really powerful tools to help people with their weight after surgery.

Zoë (08:50.69)
Yeah, and also we have people who join our practice who got their surgery with a different doctor because of the lack of that post-op care. And so maybe they had their surgery in a different state or somewhere else and they join our program for that support and guidance for that long-term post-op care. So if you're out there and you're listening and maybe you didn't have surgery with Dr. Weiner but you are lacking that post-op support, we welcome you with open arms.

Matthew Weiner, MD (09:20.373)
And pretty soon there will be an app for that.

Zoë (09:22.702)
There's an app for that. Exactly, exactly. All right, next question comes to us from TikTok. Dr. Weiner, this one's for you. Is hiatal hernia recurrence high after gastric bypass?

Matthew Weiner, MD (09:35.861)
Alright, so let's first talk about what a hiteal hernia is. The stomach should be in the abdomen, but the stomach is attached to the esophagus, and the esophagus starts up in your neck and runs all the way through your chest cavity and then goes through a tiny hole in the diaphragm.

and then becomes the stomach. And you should have actually just like an inch or so of esophagus inside the abdominal cavity. So our body is kind of broken up into cavities. Our abdomen is everything below the diaphragm. The thoracic cavity is everything above the diaphragm. So what can happen is over time, especially when you suffer from obesity and have increased intra-abdominal pressures, is it can push that stomach up. And over time and over years,

that will push the stomach up through that hiatus, which stretches and widens. And eventually you can have the entire stomach pop up through that. So, I mean, this can end up being a pretty substantial condition, but what we see most of the time is kind of small to medium sized hiatal hernias. And these are often, so let's say you have a hiatal hernia. Do you need to have it fixed? No, typically not. You don't need to have it fixed.

unless it's causing severe acid reflux. And if it's causing severe acid reflux and really interfering with your lifestyle, then we can address it. So now let's transfer that information into bariatric surgery.

And when we repair a hyaluronia and we do it very often during surgery because if that stomach sliding up in the chest, first of all, you can imagine if you're doing a gastric bypass, you have to get to the very top of the stomach. If that top of the stomach is up in the chest, you can't do it. And so you have to free it up and bring it down just to do the surgery successfully. Same thing applies for a sleeve. And so we have to fix it during surgery sometimes, but it's just a muscle. you know, in the past we haven't used mesh.

Matthew Weiner, MD (11:34.539)
have some mesh that I think is much safer and we're much more willing to use mesh in repairing these and get a stronger repair. But in essence, it's just not the strongest tissue in the human body and hide a hernia recurrences are very common. And so the big question is, is it going to be a small hide a hernia recurrence and what's the consequence? Or is it going to be a big hide a hernia recurrence? If it's a big hide a hernia recurrence, it's going to be a problem after bariatric surgery. No question about it.

So there really isn't a difference in the hiatal hernia recurrence rate after a gastric bypass or a sleeve. It's pretty substantial. Almost everybody, you repeat imaging a year, two years, five years after surgery, you'll see it's just slid back up a tiny bit. If it slides back up a tiny bit after a gastric bypass, it...

virtually causes almost no symptoms because the primary symptom is acid reflux and a gastric bypass diverts the acid away from the esophagus so that there really is very little acid that can reflux. So there's a tiny bit of acid and if a tiny bit refluxes up, it's a tiny bit of heartburn and know, something we all experience on a regular basis. If you have a small hyaluronia after a sleeve,

that can be much more of a problem and it can make your acid reflux much worse because there is still the acid there and the change in the stomach size, we all know sleeves can cause acid reflux. So you put a hydal hernia in there too and now we've got two causes. And so I think the important question is, it common? Yeah, totally common. But is it consequential? And the answer is after a gastric bypass very, very rarely.

I might repair one hyaluronidone a year after a gastric bypass, where I see sleeve patients much more commonly having it. So it's common, but not consequential after a bypass. After a sleeve, it is much more consequential and leads to that post-op acid reflux that we see quite frequently.

Zoë (13:33.688)
Do you think that the decrease of obesity, because you were saying that, you know, obesity and that intra-abdominal pressure can cause the hiatal hernias or make them worse, do you think that with the decrease of obesity and with weight loss over time and that decrease of intra-abdominal pressure, does that impact the recurrence, you think, or?

Matthew Weiner, MD (13:56.245)
It absolutely does. And so, you this is a fight we've been having with one of the insurance companies who basically said, we won't pay for both at the same time. You can have a gastric bypass, you can have a hyaluronic repair, but you can't have both. We won't pay for it. Gotta break it up. I mean, it's...

Zoë (14:12.935)
So silly. We want you to go into the hospital two different times. We want to pay for two different hospital stays. Like what?

Matthew Weiner, MD (14:17.245)
I need.

But I think your point about the obesity, it gets, it's a total catch-22 because I just said you can't do a gastric bypass without getting to the top of the stomach. So that would mean you really would have to do the hiatal hernia to fix it, but you're still obese.

And so it comes back and now you're operating in the presence of a recurrent hiatal hernia, which is much more complicated. And so, yes, you are right. The best way to handle it is to do it both at the same time, unless it's just like the entire stomach's up in the chest or something very extreme, which we see infrequently for sure. But absolutely reducing the interabdominal pressure reduces the recurrence rate to the point where anyone with a BMI over 35

The general recommendation is you have a gastric bypass if you're suffering from acid reflux, not a hiatal hernia repair, Nissen funda application, or one of the other surgical methods that we use to control acid reflux.

Zoë (15:21.068)
Hmm, interesting. All right, next question is actually from a previous episode, episode 43, Bariatric Secrets. And the question is, I'm 13 years post gastric bypass, initially lost 111 pounds and regained 60. I started taking ZetBound and I'm back to my initial weight loss again.

What should I do if my doctor wants me to wean off of ZepBound? They believe my lifestyle changes will maintain my weight loss and also have concerns about the long-term effects of GLP-1 medications.

Matthew Weiner, MD (15:56.889)
I mean, do we not, we kind of face this situation every day. I answer this question every single day in the office. And you know, I think here's the mistake that is made. It's been made for 20, 50 years. It's been made for as long as we've been trying to treat obesity. We think it's simple.

Zoë (16:03.661)
Yeah.

Matthew Weiner, MD (16:22.133)
We think we just need to eat a little less, exercise a little more, and these pesky extra pounds are gonna disappear. obesity in 2025 is totally treatable. You bring me a 500 pound person.

and I can get them to a normal weight. I know exactly how to do it. We have the tools, we have the strategies, we have all the resources in our practice. I could do that with like 90 plus percent success rate. Never in the history of medicine have we been able to say that. However, the method that is required

To do that is very complicated and involved. It requires working with you and making these massive lifestyle changes, which when you put someone on the meds is very doable. And then we get tons of weight off and now they're at a sensible weight to operate where we're not doing this crazy high-risk surgery and we do the surgery and we keep them on the medication for the rest of their life. And that's a lot, but it works.

which is way better than doing something that doesn't work.

Zoë (17:34.572)
going on and off and on and off and you...

Matthew Weiner, MD (17:36.181)
So these medications with few exceptions are for long-term use.

Zoë (17:43.51)
A treatment, not a cure.

Matthew Weiner, MD (17:45.845)
Yes, absolutely. A treatment, not a cure, like high blood pressure meds, like diabetes meds, like cholesterol meds, like every other chronic disease. so the bigger question I think we need to answer is, is there a different dosing strategy for maintenance than for weight loss?

And I think for many patients there is. The one thing that I've really picked up on as well is there's a huge variation in how people metabolize these drugs. And when I talk to patients, I try to figure out, are they a fast metabolizer or are they a slow metabolizer? And there are patients who tell me like, for the first few days after my dose, I'm a little nauseous, I don't feel great. And then after day four,

I'm like starting to be hungry and by like the time when it's time for my next dose, I'm like starving. And that's someone who's metabolizing this drug very quickly. You know, it's a weekly drug, but is it a weekly drug for everybody? Should it be? I don't think so. I have other patients who tell me I take it every couple of weeks and I don't really notice much difference. You know?

After a couple weeks, two, three weeks, I might notice I'm starting to think about food a little more. I take another dose. That's a very slow metabolizer. And so that slow metabolizer, we could potentially space out to longer dosing. There's a lot of different strategies. We've had tons of patients on the podcast. And I bet you if you looked at each one of those patients and kind of outlined what their dosing strategy is, they're all doing something a little different in weight maintenance mode. So yeah.

Zoë (19:25.814)
Yeah, absolutely. And I feel like that really emphasizes a point that we've talked about before, which is everybody likely requires a slightly different, unique dosing strategy, unique to them, right? And that's where that individualization comes in because getting your GLP-1 from a primary care physician,

where there's not as much nuance or it's not as much of a thorough conversation or they don't do it every day like somebody like you, Dr. Weiner. And I think it just really shows, it proves the point that these drugs and the medication management, it's so much more detailed than just, getting a prescription and giving yourself the shot.

Matthew Weiner, MD (20:16.211)
Yeah, I think there are primary care doctors who are super into this.

and who get it. I mean, I've had conversations with primary care doctors. I've been like, come work for me, man. You really, you totally see it. You understand it. You've read a lot. You've reviewed the studies. And so there are, I would never say, know, because someone's a primary care doctor, they're not qualified to do it, but they have to have a special interest in it. They have to put the time in and make sure, you know, they have to understand that this is a chronic disease, this concept of your set point and this lowered set point.

And I think that telling someone that lifestyle changes will work is setting someone up for failure. I wouldn't tell them it wouldn't and it might be worth a shot, but I would probably wean it down a little.

I wouldn't just go cold turkey, potentially lose your prescription, have to deal with getting prior auth again. I would be real careful. This decision is tricky and nuanced, as you pointed out. And just, yeah, you reached your goal, time to stop. That's really the opposite of what the data shows us.

and certainly the opposite of what my experience shows us. You can't keep it off for a couple months though, and so what ends up happening, you keep it off for six months, especially in those long metabolizers, who it might take three months to clear all the drug out of their system. And they might bust their butt and maintain it for three months, and it might be six months, nine months, a year later, they start to gain the weight, and who are they gonna blame for that weight gain? They're gonna blame themselves. You know, and that is...

Matthew Weiner, MD (21:55.461)
I see this so often when someone tells me their whole story and they're like, and it's my own fault. I just can't control my eating. I know I could do better if I could just get my eating under control. I'll be like, you had a baby at age 39. You were on Depo Provera for 15 years. Both of your parents weigh over 300 pounds. Why are you blaming yourself for this?

There are very clear physiologic events and genetic events in your life that have caused this weight gain. And it's not your lack of trying. And so I think that's what's so important as you wean someone off is that we're not setting someone up and pushing them off this emotional cliff. And...

That's my concern about stopping these medications and sending a message like, you can do it. Because when the weight gain comes back, which it often will in this circumstance by the mere physiology of how fat storage works, the person will blame themselves and that will cause a lot of emotional harm.

And so I think this is a very tricky decision. And again, I'm not treating this patient, but I'd be real careful with how I phrase that and how I would wean this person off their medications. Yeah.

Zoë (23:21.676)
All right, ready for the last question? All right, here we go. This one is actually from the YouTube video. Somebody left a comment on episode 41 that says, can you explain why type one diabetics can't take Ozempic? Well, I'll first explain the difference between type one and type two diabetes, and then maybe you can go into a little bit of the medication interaction there. So type one diabetes, most people are,

Matthew Weiner, MD (23:23.859)
Let's do it.

Zoë (23:48.098)
Okay, so in a nutshell, the difference between type one diabetes and type two diabetes is that type one diabetes, maybe you've heard of it before as juvenile diabetes because it generally presents in those early years. And that's where your body just doesn't make insulin.

Matthew Weiner, MD (28:12.501)
All right, give it another shot. Sorry, give another shot. Yeah.

Zoë (28:36.162)
whether for whatever reason those beta cells are killed off or damaged where you need to add in and take and supplement the insulin in order to help utilize that glucose and have a functioning pancreas. Then with type two diabetes, it's more so related to high animal fat or highly processed diets where those insulin receptors

basically have ear muffs on where they need to be shouted at much louder and then there's a ton of extra insulin there which causes more fat storage as it's holding on to that extra glucose to save it for later.

Matthew Weiner, MD (29:22.035)
Yeah, yeah, it's, it's, very different diseases that cause, that have the same symptom. know, type one is you just can't make insulin. And type two is you make plenty insulin. You're actually making way more insulin than everybody else, but your body, your other cells don't respond.

and so they're not able to use the sugar that you're eating in an efficient way, and it ends up often with fat storage. And so they're very different diseases. And type 1 diabetes, so will Ozempic help with type 1 diabetes? And the answer is no, not much at all. If we're talking about strict type 1 diabetes, let's say in an eight-year-old kid who just recently developed diabetes,

They have normal receptors and they respond appropriately to insulin. They just don't make any. And so you would not use Ozempic in that situation. But as these children, you know, in the past, this was a fatal disease. In the past, this was a fatal disease. But now with the discovery of insulin and our ability to treat it,

Matthew Weiner, MD (30:42.805)
In the past, this was a fatal disease. But with the discovery of insulin, which was one of the great early medical breakthroughs, I think it's about 100 years old now, we're able to treat it and we're able to get these kids to become adults. And that's who's most likely writing this question. It's not an eight year old kid who put this question out there, but probably a 40 or 50 year old person. And what happens is from years, decades of exogenous insulin, meaning taking extra insulin,

and just life where you gain weight. the insulin is a fat storage hormone, so it causes weight gain. So you take a type one diabetic, you take a non-type one diabetic, you feed them both the same diet, and the type one diabetic's gonna gain more weight. so if they eat the American diet and take all this insulin, they're gonna gain weight, and what happens when they gain weight? They get type two diabetes. And so,

When I work with a type 1 diabetic, the most important determinant I use to determine whether they should take Ozempic or another GLP-1 medication is how much insulin are they taking? And now we've got these pumps and these CGMs and we've got this great technology that allows, you know, I'll ask a patient that question and they'll pull out their phone and they'll be like, this week I used 68 units of insulin. Well.

If you have a fully normal set of insulin receptors, you don't have any type two diabetes, you'll produce somewhere, you'll need 20 to 30 units of insulin a day. And so if someone's taking 65 or 70, that tells me they have type two diabetes stacked on top of that type one diabetes. And so that person would probably benefit

Zoë (32:29.966)
Hmm.

Matthew Weiner, MD (32:34.297)
from a GLP-1 medication to help reduce their A1C because it'll take less insulin, they'll be more responsive and things will just work better and also likely help them lose some weight.

Now that leads us into the second type of question, which is how much weight do diabetics lose on the GLP-1s? And I'm going to save the details of this for another episode, but the answer is less, substantially less. And so I think when I work with type 1 diabetics, and I have put plenty of type 1 diabetics on these meds, and I'm generally pretty pleased with how they do. And there is some weight loss, and there is some improvement in the A1C, but I'm selective, and I

Zoë (33:00.674)
Good.

Matthew Weiner, MD (33:16.983)
really look for those patients who are taking at least twice the physiologic amount of insulin, so 50 plus units a day. Those people are gonna do much better on these meds. If you're just taking 25 or 30, there's probably not gonna be a lot of benefit for taking this medication. But it's a really, that's a tricky one for sure. And managing a type one diabetic, that's something I'm gonna be reaching out to their endocrinologist and talking to them about as well. But it's a complicated question.

sure.

Zoë (33:48.128)
I was going to actually ask you, but you ended up answering the question, was if somebody with type 1 diabetes could also get type 2 diabetes. So that's really interesting.

Matthew Weiner, MD (33:58.887)
Absolutely, in fact they're almost destined to because of all the insulin. mean, and when you talk to type two diabetics and this is kind of pre-GLP one days. So, you what I found also quite remarkable is I would earlier on before Ozempic came out, we've had GLP ones for like 20 or 25 years, but we haven't had good ones.

for like I think about 2017 Ozepic came out. And then it came out at a low dose and it wasn't until they started upping the dose that we really started seeing this work. But it was like, I would see every day a couple of type two diabetics who take insulin. And that was just, you took metformin, you took gliburide, we got some other stuff like Giardia and Sforsica, which they help a tiny bit, but.

at some point the type 2 diabetics would all get put on insulin and as soon as they got put on insulin they gained 20 or 30 pounds. And so that's another wonderful thing about the GLP-1s is they don't get put on insulin, they get put on Ozempic or Monjaro and they lose weight and their A1C goes down and we're not giving them, instead of giving them a drug that causes their diabetes to get worse because insulin causes, makes type 2 diabetes get worse, ironically.

and Ozeptic and Monjaro makes type 2 diabetes get better. And so that's why these drugs are so revolutionary.

Zoë (35:29.422)
Does that work by helping to remove the earmuffs or how do the GLP ones actually help decrease the type 2 diabetes if you can kind of summarize.

Matthew Weiner, MD (35:43.027)
I, that, you know, that is a tough question. I, first of all, I don't think we fully know the answer to that. GLP-1s work on like every system. They work on your liver. They work on your pancreas. They work on your fat cells. But it's my belief that they primarily work on your brain. And it's, you know, by decreasing our drive for these highly palatable foods. And also,

causing some of these other physiologic changes at the same time that make our metabolism more effective, ultimately the insulin receptors start to react better. But I don't know that they directly work on the receptors themselves, but they work on things, the things that are causing the insulin resistance, they work to prevent that from continuing.

Zoë (36:37.858)
Hmm. Okay.

Great questions today all over the board. yeah, so listening if these spurred any questions to you, feel free to drop us a line, ask us a question and we'll add it to the list. But also keep in mind we do our monthly webinars. Dr. Wyner, you wanna talk a little bit about the monthly webinars?

Matthew Weiner, MD (36:43.007)
Fantastic questions. Yeah.

Matthew Weiner, MD (37:01.683)
Yeah, so you know.

We have a platinum program. is something we've developed. It's available for anybody out of state. It's either out of state or out of network. if you are not in one of the insurance networks that we accept or if you're out of state, then you can join our platinum program. And in my mind, it's kind of like, OK, I have been doing this a long time. I know how I can help people. I want to break down as many barriers both in our office in terms of

billing, insurance, collecting and dealing with all that nonsense. And also to respect your time as well, because what ends up happening is this, if you're going to kind of work with patients on these medications is, well, you know, there's a lot of little questions. Can I increase my dose? Hey, I need another prescription. I need a refill. And what happens in most practices when you kind of follow this insurance billing mechanism is, well, you've got to come in for an appointment.

and we have to have an appointment. And a lot of times it's in person, so you're taking time off of work just to get a refill on your script. It's like this whole routine. You both know, you know, the doctor knows. It wasn't really important that you come in, but it's just how the financial engine works so that that doctor can pay his or her employees and can pay their rent and their amount of practice and all these other expenses. And it's just, that's how it works. Neither the doctor nor the patient

had very much to do with the creation of that system but that's what they created. And so this system we don't take insurance but we've come up with a pretty fair monthly price and if you need to be seen, if we need to have a conversation, we have a conversation. If you need a prescription

Matthew Weiner, MD (38:50.451)
you send me a portal message and I send you a portal message back in a prescription. And if you need to meet with you Zoe and talk about some nutrition stuff, they meet with you. And you want to join a group as we develop our app, if you want to use our AI to answer some questions and get some recipe ideas, you use the AI. And so we're trying to make it so that you get what you need without having to go through this kind of dance of let's come in for an office, let's bill your insurance, you pay the

copay and take time off of work and you know get the blood world.

Zoë (39:24.248)
Path of least resistance.

Matthew Weiner, MD (39:26.037)
Yes. So that's what this program is. So if you're out there struggling, and I think most importantly too is we can save you a lot of money on the meds and we're really working through and this is just, it's an evolving thing after compounding is over. And I, you know, we're on the verge, I think of having a really patient friendly and efficient way to get people on these medications, get them losing weight for somewhere in the neighborhood of 150 to $250 a month, which is still a decent amount of money.

but a lot better than $6.50 a month, is what the self-pay price is now.

Zoë (40:01.438)
And also a lot better than what people are shelling out. I know a lot of patients who are shelling out a lot of money and they are very happy to switch on over to the platinum program for sure.

Matthew Weiner, MD (40:10.025)
Yeah, yeah. People are paying a lot more for compounding, like four and 500 bucks a month. And, right. And no guarantee they're getting the actual medicine, where we only use real medicines. We've always only used the branded named medicines. Because if I'm gonna work with you, we've talked so much about the dosing, I can't help you.

Zoë (40:15.36)
Yeah, with no support, no doctors visits, nothing like that.

Right. Yeah.

Matthew Weiner, MD (40:37.267)
figure this out if I don't know what's in the pen? Are you not responding because it's a bad batch or because it's the wrong dose? It can't help somebody if you don't know that.

Zoë (40:51.188)
we need to limit the amount of variables as much as possible. And when we know where the medication is coming from, that's one less variable you have to worry about. Yeah, absolutely. All right, well, I think that basically wraps up our show today. Thank you so much for listening. Be sure to be following us along on all of your favorite social media platforms. And I will put the link to the Platinum program in the show notes in case you wanna learn more about.

Matthew Weiner, MD (40:59.774)
Absolutely, yeah.

Matthew Weiner, MD (41:17.951)
Fantastic, we'll see everybody next time. Bye bye.