Episode 68: Post-Surgery Pitfalls, GLP-1 Plateaus, and How to Get Back on Track

In this episode of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoë discuss the recent updates to their podcast, including a new app launch and the integration of AI in weight loss strategies. Discover how AI is transforming the way we approach weight management, offering personalized guidance and amplifying the effectiveness of traditional methods. From meal planning to surgical decisions, learn how AI is set to provide answers and strategies that rival expert advice, paving the way for a more accessible and efficient weight loss journey. Tune in to understand the future of weight loss with AI and how it can support your health goals. They delve into various listener questions regarding GLP-1 therapy, post-surgery nutrition, and the implications of vaping on health. The conversation emphasizes the importance of a holistic approach to weight loss, combining medication, surgery, and lifestyle changes.

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Transcript

Zoë (00:04)
and welcome back to the Pound of Cure Weight Loss Podcast. Dr. Weiner, happy Friday.

Matthew Weiner, MD (00:10)
You know, the podcast is always the last thing that I do every Friday. And after that, it's the weekend. so that's another reason why I love recording the podcast so much is it's just the perfect way to get out of the week and into the weekend.

Zoë (00:25)
with a little cherry on the top of the week.

Matthew Weiner, MD (00:27)
There you

go.

Zoë (00:28)
But we are, even though we're recording on Friday and we usually release on Friday, we are actually changing our release days. So keep an eye out for Mondays because Mondays are gonna be our new release days. Cause we wanted to give you the entire week to listen to the podcast, you know, during your commute to work or your morning walks or whatever it is versus going into the weekends. We know everyone's busy. So we wanted to give like a better opportunity to listen as many people as possible.

Matthew Weiner, MD (00:55)
you

Yes, absolutely. And since our last recording, we have actually released the app. We've been in beta testing for a while. We ran it through all of our patients. If you're one of our beta testers, thank you so much for your participation. We couldn't have done it without you. We really got great feedback on that and they helped find all the little bugs and we fixed them, most of them at least. ⁓ And so the app is available on both the App Store and the Google Play Store. Just search for Pound of Cure. It has kind of our Pound of Cure.

green and it's pretty easy to find. And so, you know, I'm really, really excited about this app. I put so much energy into this thing. I probably put some of my best work I feel like I've ever done in my entire career into this app. And the real feature of it is the AI. And so this is kind of this crazy time in my life where the GLP-1s and the AI have kind of come together at the same moment. And it's allowed me

to essentially take all of the things I've been teaching people about and working with patients on and amplify it by using AI to provide our Pound to Cure approach. so I right now, well, actually by the end of the year, I think that our AI will be able to provide answers to questions, guidance and strategy that's about 90 % as good as what I can do.

And I think that by the end of 2026, it will be able to provide better guidance and information and answers to questions than I can currently. And so that's pretty exciting.

Zoë (02:37)
Imagine how many more people we as a practice can serve and help if it doesn't rely on your time as the rate limiting factor.

Matthew Weiner, MD (02:41)
Right.

Totally, absolutely. Yeah, so I was working with a patient on this today and we were trying to decide about should the patient have a sleeve or should they take GLP-1 meds and how would we decide on that? And so I said, I was showing her the app and I was saying like, here you can ask any question, meal plans, recipes, questions about surgery, questions about meds, side effects, all of it. We've trained it with pretty much everything we've ever put out there. And so it provides pretty good answers.

And so I said okay, I'm trying to decide between meds and a sleeve. Why would somebody do a sleeve plus meds instead of ⁓ just meds alone?

And so the AI basically said the correct answer, which is that it's just you're going to get more weight loss. It's a more powerful tool. What it didn't add, which is what I add, is that we're able to use lower dose of the medications, which will save you money and also reduce your side effects. But it did talk about how important it was to combine it, how much more powerful the weight loss. really gave, I thought, a pretty good answer. The patient was like, yeah, that's kind of what you said, because I told him, I'm like,

okay here's the answer now let's see what she says and she was like I think it got it so yeah so we're excited so if you have questions burning questions and this is ironic because we're doing our question and answer we might have to get rid of this session right ⁓ so this is our question and answer if you if you miss it or you know you could just plug the question into Sage and see what she has to say

Zoë (04:01)
That's so exciting.

That's right. And I mean, I think that's something that's really cool about specifically Sage, our AI.

chat bot is that it's not just like chat gbt where it's pulling everything from the internet and you don't know if you can trust what it says necessarily this is all of your education materials that you've put together for the past from the past 20 years probably about and everything that you know i tell patients all of our recipes everything that we say

we've helped train Sage to do. So it's not as like scary and wild wild west out there as maybe chat GPT. So that's why we really like to direct, you know, users, patients, not just patients, anybody who wants to get on the app to there. So you can really follow the pound of cure approach.

Matthew Weiner, MD (05:12)
Yeah,

she's going to give you the Pound-A-Cure answer. That's one thing that we made really sure about. And you can put a lot of guardrails on AI. And that's what we did. And you're not going to get keto answers. You're not going to get high protein answers. You're going to get Pound-A-Cure answers. And it's going to address meds and surgery. And it also does a nice job, I think, of not overstepping its bounds. And so it doesn't go and give you

Zoë (05:15)
Right, the packet curators are.

Mmm.

Matthew Weiner, MD (05:40)
you know, silly, it doesn't answer questions that could potentially have substantial side effects or issues. gives you, it's going to be like, hey, listen, you got to talk to Dr. Wang and Zoe about this one. It's very quick to do. Yeah, exactly. Yeah.

Zoë (05:53)
What's on my scope of practice? Yeah,

so like you said, this is the Q &A of episode. So we have questions from all across our social media, YouTube, Instagram, TikTok, Facebook. I also did ⁓ get some questions in from our Instagram story that I put on earlier this week. So we'll address those. So are you ready to get into it, Dr. Weiner?

Matthew Weiner, MD (06:18)
Let's go for it.

Zoë (06:19)
Let's go for it. All right, I'll read the questions, okay? So first question is from Instagram story. At what point after gastric bypass should a patient start considering GLP-1 therapy?

Matthew Weiner, MD (06:31)
Yeah, I mean, this is our bread and butter. This is the kind of stuff that I'll deal with this question, you know, five, six, seven times a day, easy. So it's a very difficult question to answer. And it depends on so many different factors. I think that, you know, it's...

It's a little easier to answer now that we're kind of integrating GLP-1s up front in our program and having that conversation from the very beginning ⁓ where we kind of set guidelines. One thing that I do with every patient who has bariatric surgery is I put them into the calculator and we do have this calculator available on our website. So you can put your stats in and it'll predict how much weight you're gonna lose after surgery. And so I think the first thing is that I look

look

at that and if the patient's off and we do have some guidelines and we've addressed this in past podcasts but at about three to four months you should have lost half of that weight and about six months about two-thirds of that weight and so depending on where they are on that timeline if they're falling behind their weight loss curve and let's say you know they were 200 pounds overweight I would probably be getting that patient on pretty early. If their BMI was 35.1

and we did surgery on them and their goal was to get to 120, but I was seeing that it looked like they were gonna track more to say 140. I don't know that I'd be quick to be starting medications in that situation. Zoe, how would you use someone's diet or nutritional experience to answer that question?

Zoë (08:12)
Yeah, I definitely would want to take a look at what their nutrition and exercise and other lifestyle habits at that point are looking like, right? There's definitely that portion control trap that not a lot of our patients, but some people fall into where it's, you know, just relying on that volume restriction after surgery to lose weight, but not necessarily changing how they're eating. That's something that's really important to us, especially during that honeymoon period so that, you know, we can really maximize

Matthew Weiner, MD (08:26)
Yep.

Zoë (08:41)
So let's look at what you're doing nutritionally. Are there tweaks we can be making? Are you relying on, you know, maybe only processed proteins, you know, bars and shakes all throughout the day, and you are feeling more snacky because you're not nourishing and satisfying your body with fiber and that sort of thing. And so you're kind of maybe going into some of those old snacks and trigger foods and that kind of thing. So yeah, you could be reaching your protein goal, but could

we optimize it and shift it more towards a whole foods approach that will not only help you get your protein in, but help you feel satisfied and filled up and nourished and be promoting that whole foods approach, which will ultimately push that weight loss in a more sustainable way as well. So that's what I would look at.

Matthew Weiner, MD (09:29)
Yeah,

that's a great point that sometimes people might look at the GLP-1 meds as the solution to the portion control trap. Hey, I was eating one piece of pizza and it was great and now I'm eating two, so give me the GLP-1 so I can go back to eating one. And that's certainly not our recommended strategy. And so I think that you're right. That's a great example of when you should not use the GLP-1s. That person should be focusing on changing the diet.

Zoë (09:38)
Yep.

Matthew Weiner, MD (09:59)
I think there's meds, there's surgery, and then there's ⁓ nutrition. And you wanna be pulling as many of these levers as hard as you can to drive the most amount of weight loss. And so if you're not pulling the nutrition lever as hard as you can, I don't know that that means that it's time to add the GLP-1s, especially with the gastric bypass, but we have a decent chance of not needing GLP-1s.

Zoë (10:24)
Right, and something that I talk

with patients a lot about as well is.

Yeah, at first you're going to be experiencing that significant volume and appetite restriction after your bypass. But just like any honeymoon period, you know, the honeymoon period after surgery does not last forever. And it's it's OK. And I want people to be expecting the fact that you will start to feel hungrier. You will start to be able to eat more food. And I want you to eat more food. I want you to honor your body and honor that hunger. But it's about let's add more of those nutritious whole foods because that gives you

glimpse into maybe long term or maintenance where you are eating more food and that's okay. Don't be afraid of eating more food, but really be intentional about what you're filling up more on.

Matthew Weiner, MD (11:02)
Yeah.

Absolutely. Yeah, good question though.

Zoë (11:12)
Yeah, great question. Okay, our next question is also from the Instagram Story Box we put up the other day. And the question reads, any suggestions on day five or six after my Manjaro shot, after my appetite and food noise starts to come back? Can I take the shot a day or two early if I feel like its effects are wearing off?

Matthew Weiner, MD (11:34)
So that question to me, it's a little bit of a tricky question. First of all, if you're taking the shot with the standard pens, and I'm just, I have a hunch this person is not. have a hunch they're using our kind of creative dosing strategies. But if you're using the standard prescription pens, you get four a week and you can't do this.

So I think that's the first thing is that you're gonna be limited if you're using the traditional dosing, which in your insurance covers it is great, but if you're spending $650 a month, you're probably spending way more than you should. Or even $500 a month through Lilly Direct, you can generally get it for patients for substantially less than half the price with our creative dosing strategies. And so, I personally,

like the idea of weekly dosing. I've moved away from that. In the past when we only had the pens and we didn't have the ability to give more frequent dosing or change that dose to like a smaller increment instead of say 2.5 to 5, we can go from 2.5 to 3 or 3.5. When we didn't have that, the only thing we could change was how often people were taking it. I now...

because if we are using our creative dosing strategies and we can dial the dose into whatever we want, I do like ⁓ to just to work on the dose and try to go to one once a week dose and get to that kind of constant blood levels. It's not always possible, but I would favor more a dose adjustment than a frequency adjustment.

Zoë (13:16)
And you know, I work with people on this as well, which is, know, those first couple days you feel the usually the highest effect of the medication and as time goes on, it's expected that you start to feel it wear off. And so work with your body in that way, similar to our last question, you know, as you start to feel hungrier and as you start to have that food noise come back, okay, honor your body, honor your hunger, eat more food, but add more fiber. Fiber is nature's food noise quieter. So yeah, give

Matthew Weiner, MD (13:28)
Right.

Zoë (13:46)
yourself permission to eat more food but if you're following the pound of cure approach and trying to be on the metabolic reset diet as closely as possible this is your time to shine.

Matthew Weiner, MD (13:55)
Yeah.

Another.

little plug for our app is our Caloratio food logging system, which really it doesn't measure grams of fiber per se, which if I, truthfully, if there was one number I was going to measure to determine how healthy someone's diet is, I probably would pick fiber. But our Caloratio food logging system is going to promote you to the more fiber you eat, the higher your score is. And so I think if you're, you know, eating a relatively low Caloratio diet, meaning a more processed diet,

Zoë (14:01)
Mm-hmm. ⁓

Matthew Weiner, MD (14:26)
then that like you said that would be a I'd be working on getting that Cal ratio score up rather than playing with the dose. ⁓

Zoë (14:35)
Right.

And like you said, yes, you would like to see fibrograms, but that's something that's built into the calorie ratio. It's not necessarily fibrograms, but it's the ounces of veggies. So you have the little veggie counter, and you know you're working towards a pound of veggies a day. And if you're at the beginning of the week, maybe only getting eight ounces of veggies in, can you try to get that little carrot to turn green by the end of the week?

Matthew Weiner, MD (14:47)
Right. ⁓

think the strategy that we're both really talking about is that we want to use as low of dose as possible and maximize nutrition as much as possible. And so I think in this situation, if this person is not doing that, then that's what they should do. If they are doing that, then I would favor a higher dose with weekly.

changes. A lot of times when people start the meds for the first few weeks, there's a lot of fluctuation in how the med makes them feel, but once they're on it for three, six months or longer, then they just kind of reach this steady state where the dose interval doesn't change things as much. So I think I rather than kind of because what I don't like about this is this idea of like, I'm hungry, I need a shot. And that's the mentality I really want people to move away from.

Zoë (15:43)
way.

And it really does reinforce what we say all the time, which is this is a tool, not a magic pill. It's not the end all be all. It's the tool to help facilitate easier behavior change. The behavior change of changing your diet, the behavior change of making it easier to establish those really positive habits while you're getting the positive reinforcement from the tool, making your weight loss easier, making your food noise last.

but it's not gonna be a cure. Yeah. Okay, great. Next question says, and this is ⁓ from an Instagram comment a while back. I'm trying to find out if weight loss surgery is best for me. I'm scheduled on Monday, but I've lost 70 pounds on GLP-1s. I'm 30 pounds away from my goal and haven't reached the highest dose of meds. Would you say it's best to continue the GLP-1 medications?

Matthew Weiner, MD (16:22)
Absolutely. All right, what's our next question?

Yeah, I mean, think I would. I think you're 30 pounds away from your goal. And you know, first of all, where does that goal come from? We could do a whole podcast on setting a weight goal. But first of all, is that goal realistic or is that an unrealistic goal?

Zoë (17:05)
arbitrary

number that they have in their head that I want to weigh this amount because that's what I weighed in high school and it's like completely unrealistic sometimes.

Matthew Weiner, MD (17:13)
Right, most likely it's 199

pounds, right? Yeah, that's the most common goal we see. So I think...

that if you're 30 pounds away and aren't on the highest dose of the meds, again, this would be more questions. What's your calorie ratio score? What are you doing on your diet? How are we doing on maximizing the nutrition? The highest dose of the meds, and again, I'm assuming, I don't know what med, and my answer might be different if this is WeGoVee versus ZepBound. If it's WeGoVee, I would probably say maybe raise the dose and go for it. If it's ZepBound, I might be a little more hesitant.

I have a lot of concerns about those higher Zet-Bound doses. Most of our patients are on 7.5 milligrams or less. We do have people on higher doses for sure and I will go up absolutely but I go up very carefully because I'm starting to see some patients who've been on high doses for a long period of time almost get this like overdose situation and it's just this is very anecdotal. Please don't take this as like a know warning my god you're to get a terrible problem. It's not

Zoë (17:55)
Hmm.

Matthew Weiner, MD (18:21)
a problem means we just have to stop the med and back off on it. It's pretty unpleasant, but I'm really seeing, I'm only seeing this on people on 10, 12 and a half, 15 milligrams, really 12 and a half and 15 almost, not so much 10. ⁓ So I'm very much against relying on those higher doses. So to me, I would look at the med type and again, Wigobi, because it's just not as strong of a med, I don't think 2.4 Wigobi is going to cause the same issue as 15 azep-bound. It's just a lot.

more powerful, does that matter? So ⁓ yeah, tricky, tricky question, but I don't know that I'd be lining this patient up for surgery personally.

Zoë (19:01)
Mm-hmm. Mm-hmm.

Okay, good. All right, next question is from YouTube. I had a gastric, we've got some background, so buckle up. So we gotta set the scene. Okay, so I had gastric sleeve 11 months ago and just learned I have a mild hiatal hernia. I experienced mild burping after eating, have mild difficulty swallowing capsules, and have very mild constipation here and there. It seems to get better with time, especially when I eat fibrous foods.

That, I'm like ding ding ding. I do not have any other symptoms. I also have never experienced pain, nor do I experience heartburn. Can this condition get worse? Should it be treated right now? What treatments are available? What steps should I take to manage this lifelong condition? Is it dangerous? And can it affect my health negatively in any way?

Matthew Weiner, MD (19:31)
Thank you.

So yeah, this is an incredibly common question. I hiatal hernia to me seems like one of the most mysterious topics to patients and people like, because they're so common.

And people are like, my God, I have a hiatal hernia. Like, oh no, like losing sleep over it. What am I going to do? Do we need to operate? Like, come on, Dr. Watt. They're calling me at two in the morning. I have a hiatal hernia. We got to operate. You know, people have so much anxiety over this term, hiatal hernia. First, let's define what it is. So we have a diaphragm. That's this big, thick muscle that separates our chest from our abdomen. And we have a tiny little hole and our esophagus goes through it because our esophagus is in our chest, our stomach.

is in our abdomen, we have different cavities just like an ant, right? Ants have thoracic cavities and abdominal cavities, so do human beings. And we have our chest cavity and we have our abdominal cavity. And there's a hole because it's one tube and it goes, it's partly in the thoracic cavity and partly in the abdominal cavity. And so what can happen is that hole can stretch out a little bit and the sleeve or the stomach can slide up. Now, because the sleeve is such a skinny tube, it's so likely to slide.

The stomach is a little fatter, there's the shape of it and when we do a sleeve we kind of disrupt some of the anchoring of the stomach and so that makes it more prone to sliding up. So a small hyaluronia after a sleeve in my mind is something like, ⁓ yeah I got it. How does that affect anything? It does not affect anything at all. I think some of the other questions are more important which is what's going to happen long term?

And that's an answer we don't know for this person. We generally know heidel hernias will increase over time. But I don't necessarily look at the size of the heidel hernia as the primary determinant of whether or not we need to fix it or operate on it or convert the sleeve to a bypass or do any of those surgeries. I look at the patient's symptoms. So what I found was interesting is I have mild burping.

mild difficulty swallowing capsules, mild constipation, nothing to do with any of this, right? Constipation is the colon not the stomach. ⁓ So I'm hearing more the sleeve working the way the sleeve is supposed to work. Zoe, how would you counsel this patient? She comes in and she's had a sleeve. I would tell you forget about the hiatal hernia. Let's just talk about how she's eating with her sleeve and what adjustments would you have her make in order to address these mild

symptoms because to me that's how I would approach this is behavior.

Zoë (22:37)
Yeah.

Right, absolutely. And so what sticks out to me is like the burping or maybe some discomfort with eating. immediate question would be how fast are we eating? Right? Eating too quickly, maybe not being mindful when you are eating and stopping at that first sign of satisfaction and maybe spacing it out more, having smaller and more frequent meals throughout the day and really making sure that you are

Matthew Weiner, MD (22:53)
Right.

Zoë (23:11)
paying attention to how your body is responding. Because when we are eating mindlessly or if we're distracted, whether working through lunch and eating or sitting on the couch watching TV and eating dinner or driving and eating or scrolling on your phone, social media, there, mean...

Most people eat distracted more times than they are present with their meal, right? And so when your attention is on something else, you're not paying attention to how your body is responding. So that would be something I would really work with the patient on is how can we optimize how you're eating and not just worry so much about the other things. Because the how will help facilitate the how much.

Matthew Weiner, MD (23:33)
Absolutely. Yeah.

I think there's enough, the thing too that's a little different is burping. And so what normal, if you have a normal stomach, the stomach actually is shaped like half of a heart. And so there's a part of the stomach that kind of sits up and it was essentially designed to collect air. And you can either push that air through in which case it comes out as phlatus or gas, or it can sit there and come back up as a burp.

Now, when we do a sleeve, we remove that portion of the stomach. And so when you swallow air, it doesn't have this reservoir that can be managed with maybe one burp and instead there's a bunch of small burps. And so that typically gets better over time as your body kind of learns to pass the air through, but it's a little different after a sleeve. So mild burping after a sleeve, that is standard and usual.

Zoë (24:36)
Well.

Matthew Weiner, MD (24:54)
That to me is not even like an unpleasant side effect. That is what a sleeve does, particularly in the first year or two. Over time, there's just some adjustment and those symptoms tend to go away. But yeah, those little baby burps are very common after a sleeve and will typically go away over time.

Zoë (25:12)
And so that swallowing of the air, you know, obviously that can come from, it's not, you know, it's part of having a sleep, but swallowing more air comes from eating too quickly. But also why we recommend patients stay away from drinking out of straws right away and carbonated, like sparkling waters right away. Now that's not something that you have to completely eliminate forever, but especially at that beginning stage when you're learning your new body and how you're responding to it, that's another way to minimize

Matthew Weiner, MD (25:23)
Totally.

Zoë (25:42)
that internalized

All right, I think we're ready for our last question of the day. Okay, so this is also from YouTube. I quit smoking cigarettes by vaping zero nicotine flavor pods. It's not the nicotine I enjoy, but the physical act of smoking. The only ingredients in the flavor pods is vegetable glycerin and food grade flavoring. Am I okay to have a bypass since I do not consume any nicotine?

Matthew Weiner, MD (26:13)
Yeah, so great question. First of all, I love that this person knows you can't smoke with a bypass. Like I've done my job. That is to me and I'm actually right now we have a, I have a patient in the hospital. She made a deal with me. She's like, I'm going to quit smoking. I swear Dr. Weiner. And then we found out she wasn't and now she has perforated ulcer. And I think we're going to get away without operating. But anyway, you know, these are tough, tough problems. And so

⁓ I'm glad that people understand you just cannot smoke tobacco.

after a gastric bypass. Now, vaping is tricky. The first thing is it's not the nicotine I think that's the problem. It's the what 78 carcinogens that exist in inhaled tobacco smoke. It's just all of the stuff together and it's probably not nicotine per se that causes the ulcers or causes the problems. We do see some issues in people who vape after a gastric bypass, but I'm not seeing this perforated ulcer

ulcers that are impossible to heal and that require surgery and are very, challenging problems. I'm not seeing them as much with vaping. I see kind of more mild nothing ulcers we can treat with medication. So I think if in this situation I would say, you know, again, not rationalizing that vaping is okay. I think the best option is to quit vaping.

But I would say, yeah, that probably in my mind would not exclude a gastric bypass. We test everybody for nicotine before a gastric bypass for sure and sometimes a sleeve depending on the factors. But, you know, this person will test negative because they're not using nicotine. So Zoe, you're not so much a smoking cessation expert, but you are a behavioral change expert. So this person is kind of vaping socially.

Zoë (28:01)
Thank

Easy.

Matthew Weiner, MD (28:10)
sounds like. So how would you encourage them to change their behavior?

Zoë (28:17)
Yeah, so what immediately comes to mind, and this is something that I talk with people a lot about in terms of like snacks or after dinner snacks or whatever, ⁓ is we just remove.

you're gonna feel that emptiness, you're gonna feel that hole, right? That void. So how can we replace it? If it's the flavor, can we replace it with, ⁓ you know, maybe fruit infused water? Or if there's something else, if it's the hand to mouth movement, is there something, can you drink tea? Can we do something else that has some of that replacement that's not going to be...

detrimental to your health, for example. ⁓ So that's what I would recommend looking into. And also if there are any specific specific triggers or maybe anchor habits that cause that desire and how can we take a look at the environment and change up some of those triggers and the routine so that you're kind of doing that pattern disruption.

Matthew Weiner, MD (29:16)
Yeah, so you know, every habit essentially has a trigger, a behavior and a reward, right? The trigger is stress, social situation, connection, like, you know, it can be anything. The behavior is whatever you're doing, in this case, vaping, and the reward is this person must enjoy vaping. It probably feels good to them. They like the way it feels. And so you can disrupt any part of that chain. ⁓

Zoë (29:32)
I'm telling you.

Matthew Weiner, MD (29:40)
Eliminate the trigger, change the behavior, somehow remove the reward. maybe, you know, I don't know what flavor they're vaping, but change to a flavor you don't like. That was always an advice I would give to people who couldn't, like Dr. Winer, I can't quit smoking. And I'd be like, well, what kind of cigarettes do you smoke? it was either menthol or non-menthol. That was what I paid attention to because what I learned is that menthol smokers don't like non-menthol cigarettes and non-menthol smokers don't like menthol cigarettes.

And so I would be like, switch to menthol or switch to regular cigarettes. Like just, if you can't do anything, just do that and maybe that'll help along the way. So yeah, think that this is, to me, that I wouldn't give up so quick on quitting this. You know?

Zoë (30:26)
Mm-hmm.

I wanted to ask you, ⁓ I remember hearing some things, and again, like you already said, I'm definitely not a smoking sensation expert, but I wanted to know your thoughts if you have heard any research or if you know anything about ⁓ the occurrence of lung conditions for people who were vaping because of all that water vapor and that of fluid accumulation in their lungs kind of having some pretty detrimental effects because of it. Do you know much about that?

Matthew Weiner, MD (30:57)
Well, there was like a couple years ago all these people got that popcorn lung.

Zoë (31:01)
Right.

Matthew Weiner, MD (31:01)
And I

was like, oh my God, vaping's terrible. They found out it was like one specific ingredient which they shouldn't have been added and it was added at some sketchy smoke shop. you know, it was definitely kind of a sketchier situation and not quite so indicting. But you know, vaping is epidemic now, especially with our young people. mean, you walk around by U of A, you walk around U of A and kids are just walking around with a vape, like breathing, they're breathing oxygen through a vape as they walk around.

And

so I don't follow the literature. I really kind of just look at it as it relates to bariatric surgery. I just can't believe that it's okay.

Zoë (31:43)
Right.

Matthew Weiner, MD (31:43)
Right?

It's just, it's just, there's too much weird stuff. And, and, you know, I think they said it was vegetable glycerin, which is a relatively innocuous molecule, but inhaled into your lungs. I don't know. Right. And food grade flavoring. Well, what's in food grade flavoring? I don't know about 42,000 different compounds. So, so I think that there is a lot of, of variability and you can't just look at that and say, it's totally safe. I don't know what the data.

but I would bet at some point we're gonna figure out this stuff isn't so good for you.

Zoë (32:18)
Yeah, yeah. Well, all right, a great Q &A show. Dr. Weiner and for all of our listeners out there, if you have a burning question, drop us a line. can put a comment on our social

course, we're on social media at a pound of cure. We'd love to hear your questions and...

Do us a favor, test out our new app, go into your app store, search a pound of cure, it'll pop up, you'll see our little veggie head. We're really excited about it and to have you test it out and let us know your feedback.

Matthew Weiner, MD (32:48)
Yeah, and also, you know, a lot of the features in the app are free. And if you are in our practice and in our nutrition, but I had a patient was like, you're trying to get more money out of me, Dr. Wynne. I'm like, no, all of our whatever you signed up for, the app is like all included in it. So if you are already a member of our nutrition program, the app is completely paid for already and included in and you won't have to pay a dime to get full access to it. So

Zoë (33:17)
Yeah, absolutely. All right, well, until next time, have a really great rest of your day and we'll talk to you soon.

Matthew Weiner, MD (33:23)
See you next time.