Episode 78: Why We STOPPED Prescribing This $200 Weight Loss Pill (Wegovy Oral vs. Injectable Truth)

After getting completely hacked and losing our entire social media presence, we're pivoting HARD - and it might be exactly what we needed.

In this raw, unfiltered episode, Dr. Matthew Weiner and Zoe break down:

- WHY we stopped prescribing the "new" Wegovy pill (spoiler: it's 5 years old and we have data you need to hear)

- The GLP-1 medication coming in 2026 that could change everything - Retatrutide clinical trial results revealed

- How to get REAL Eli Lilly medication for $150/month (not compounded) through a program most people don't know exists

- The AI-powered weight loss app Dr. Weiner is coding himself that does what he does in the office (beta testers wanted!)

- Why we're ditching Instagram for Reddit and YouTube - and the surprising reason long-form content beats 30-second clips

PLUS: Real patient stories including a VSG + breast cancer + GLP-1 combination success, the truth about oral vs. injectable semaglutide, home-ground flour health claims investigated, and why that "bulge" when you cough isn't what you think it is.

If you're on GLP-1s, considering them, or just tired of BS weight loss advice - this episode cuts through the noise with real data, real experience, and real talk.

Like, subscribe, and share with someone who needs to hear this (since we can't share it on Instagram anymore)

Transcript

Zoe (00:20)
Welcome back friends. We are here with another episode of the Pound of Cure Weight Loss Podcast. We are excited for today's conversation. We appreciate, first off, I just wanna say, I appreciate you being here and listening because we've had a lot of chaos going on and we are making it, despite the chaos, we still wanna show up for you and still have these conversations. So we appreciate you still showing up and engaging with them and listening.

Matthew Weiner (00:49)
Yeah. So what's the chaos? It's always chaotic, I thought.

Zoe (00:52)
Haha Yeah, there's

always spaghetti being thrown around ⁓ Well, you know if anybody follows us on social media we got hacked and It is not looking good. We're not getting it back. I don't think

Matthew Weiner (00:57)
Right, for sure.

Totally.

I don't think we're getting it back. Yeah, they shut down. I mean, the Facebook page I've had for like over 10 years, ⁓ and that got taken over by some, I don't know, AI, who knows what they were doing, and Instagram is gone. ⁓ I don't think that Facebook is gonna give it back to us. And obviously that was very frustrating. We've put a ton of time and energy into this, but I kind of look at things like this that happened as...

Zoe (01:24)
Yeah, completely gone.

Mm-hmm.

Matthew Weiner (01:36)
Sometimes it's the universe redirecting you and maybe pointing out, hey, you're on the wrong track. so I think that this is probably gonna result in a pivot in terms of what we do and how we kind of angle our internet presence, if you will. ⁓ We've talked about this a lot, Zoe, in terms of what's the best outlet. I personally have never felt comfortable on Instagram.

or really Facebook for that reason. I've always felt like YouTube is kind of my place, ⁓ just because I think that our approach and the strategies that we apply, they're complicated. I can't tell you what to do in 30 seconds. I can't. I don't see patients in 30 seconds. I'm not one those doctors who sees 60 people in a day.

I spend time with people. I just think that when we're talking about your weight, your health, it's the idea that I'm gonna somehow give you something that will fix it in 30 seconds. It's totally unrealistic. ⁓ So anyway, what do you think about all this, Zoe? mean, you've been really in charge of our social media for all this time, so ⁓ this was tough on you too. You put a lot of energy into these channels.

Zoe (03:03)
Yeah, I mean speaking to your

there's so much nuance and context that goes into obviously medicine and nutrition but also specifically weight loss right because it's not just what's happening in this one moment. It's oftentimes somebody's entire life that's kind of that has been putting

It's just so much more nuanced and so much more context that's needing to be discussed, whether it's us talking about nutrition and medical weight loss things here on the podcast, or you and myself in our appointments really gathering that full picture from the patient. And so having this platform for long form content, right? Being able to dig further into these conversations, I...

I think we've gotten good feedback. I think that this is what people really connect with us on as well. Like you said, I slash we have put a ton of energy and effort into social media, Instagram, TikTok, like a lot of years and a lot of consistency. And it just has not ever.

quote, taken off, if you will, not that that's necessarily our goal. We are not trying to go viral. We're trying to convey information, but at the same time, it's frustrating when we're putting so much time and energy into something that's just not landing. And so I fully agree. I mean, we're gonna look back on that moment of getting hacked, even though it's frustrating or was frustrating. I think it really will be that kind of tipping point. We'll be able to go back and say, ⁓

This is what helped us pivot to this other next chapter of how we spread our information and how we engage with people all over the country.

Matthew Weiner (04:58)
Yeah, I mean, think it'll be interesting that our healthcare system is just in a complete and total freefall right now and how people get care and all of it. The whole payment system, I've talked for a while now, I think is gonna collapse in the next couple of years. We're actively working on new payment models and I think this kind of segues a little bit into ⁓

what we're working on in terms of our app. But we do have an app, it's the Pound of Cure app. And I think something a lot of people don't know about me ⁓ is that I'm a software developer. I've been developing code for a lot longer than I've been a doctor actually. And I really love computers. I just kind of love that idea of creating these systems. And if you follow our set point methodology, you really see there is a system underlying this. There's a strategy, it's very concrete.

I think it's very repeatable. think this is something that, you this isn't something only I can do. This is something I think any provider can learn how to do and how to implement. And that's really been my lifelong goal is to take this strategy, this kind of non-judgmental approach, looking at someone's obesity, identifying the causes of it, pointing it out to them because I talk to patients all the time and they say, hey, you know, this is all my fault. I did this to myself and you know what I.

and this incredibly negative self-defeating attitude. And I point out, well, actually you had breast cancer and you were put on this weight gaining medication. And then when you were in a car accident, you were immobilized for six months, that resulted in 20 pounds of weight gain. And we kind of pieced together this history. And when we're done, we can account for pretty much every single pound of this patient's weight gain and identified factors that were fully beyond their control. And so,

But yet this person has spent their entire life blaming themselves for their weight gain. And that to me has always just been, it's been so sad to see. And I've seen it thousands of times. And my goal has kind of been always to create this system, this approach that allows us to help explain these things to people so they don't feel so defeated. They don't feel so at fault for their own weight gain. ⁓

That system is something I really have kind of obsessed over. And now I've got the software tools as AI is coming out to kind of put these things together. And the first version of the app was a start. think it was, it served its purpose, but it's very clumsy. It was my first real smartphone app.

But I have and I have it on my phone right now. We'll be looking for beta testers out there. If you're interested, reach out. We're eager to have some people beta test it. But I've put a lot more time into how this app can do what I do in the office. How can it systematically evaluate your weight gain, your struggles in the past, the things that you've succeeded at, the things you've failed at. And you know, now,

we can identify what causes it, but we also have the treatments. And that's been a real, real change. We have the GLP-1s, we have bariatric surgery, which is safer than ever. And we have the combination of the two, which is kind of almost magical. And so it is possible, especially in our crazy healthcare system where you can't talk to a doctor for less than $800, that maybe we can create an app.

with an AI product that is really guided but also has an affordable way to see experts like Zoe, like me, like other providers we're starting to work with who can provide this care at a cost that doesn't seem crazy and you actually get really good care and you know how much it's gonna cost, it's not some mystery. And so that's really my goal and I'm so excited because I think we're gonna pull this off.

I really, really do. think this new app is definitely a huge step forward. We're still gonna use Cali Ratio, but I think we've made a lot of changes to that. That's very AI powered. ⁓ And then we've got some really cool ways to bring the live in-person visits together where you actually get an individual visit, but you don't have the waiting and the appointment times and you can fit it in with your schedule.

So this app is coming out, we're gonna start talking about it more and more. I don't know if you'll see it on Instagram. However, if you are on Instagram and you're ⁓ interested, we will have an affiliate program. So if that's something that you're interested in, we can do that. ⁓ But yeah, we're really looking ⁓ for ideas and ways to do it and some beta testers and we're a small outfit, but we're pretty passionate about what we do. So Zoe, you've seen the new

Zoe (10:08)
And

my gosh, it's amazing. it's not just beyond what it does. It's so easy to use. know, that's something that I know that you've put you, cause you're doing the actual coding and software development for it. And, know, us as a practice and as a team kind of doing these iterations and doing the testing, but it has taken time to get easy to use. this next

version is very intuitive and you just kind of follow you just have a conversation with the the algorithms and the AI that you have built in there and it makes it very very user friendly and I think people are gonna just not only love it for that aspect but just see how much easier and more streamlined actually getting the care can be where you when you don't have to fight with insurance companies or just trying to

get a hold of somebody and having that more on-demand care is going to be amazing.

Matthew Weiner (11:11)
I believe that you can get in our app, it will be possible to get in front of a provider on less time than it will take to get a human being to answer the phone when you call most doctors' offices. I think we're gonna be able to pull that off and that to me is really kind of revolutionary. so stay tuned for that because we're excited and we're gonna go for it.

Zoe (11:32)
Mm-hmm.

Matthew Weiner (11:39)
⁓ Maybe you'll see it on Reddit. I'm really into Reddit now. ⁓ I'll tell you what I love about Reddit. It's, the trolls and that you're a terrible person and those back and forth horrible fights and the shame and the blame. There really isn't a lot of that. There's a lot of respect and their whole upvoting system.

takes advantage of the fact that something that I've ⁓ really believed my whole life is that there's a small percent of people who are really awful, terrible people. But the overwhelming majority of us are good people who want to treat each other fairly. And so when you have this kind of majority rule, this very non-invasive, almost simple way, just up vote, hey, you know what, that was a smart thing. I like what that person said. I just up voted.

And so you get the majority of people pushing the helpful, good, useful content up to the top and the trolley stuff gets buried, you know? And you downvote something and when you downvote it, it doesn't show up. And so you can actually silence the trolls that way. And I love that. And I also think that there's just a lot more thought and research.

and consideration and respect for others. I'm starting to, I've just, right now I'm just a viewer, but ⁓ I'm really intrigued by Reddit. ⁓ And I think it may be that kind of social media version of YouTube where you can have those deep, thoughtful conversations. So, yeah.

Zoe (13:12)
Mm-hmm.

Yeah, I was gonna say it's like the long you get that platform for more longer form Content like we do with these videos on YouTube and the podcast but in a in written more maybe Everybody digests information differently. So being able to get that information in written form versus in the audio or visual

Matthew Weiner (13:40)
Yeah.

I think it's also a lot more, a lot more structured on more consensus building as opposed to I'm right and you're wrong. I think that's something, you know, in our office, we have a really great team, Deidre and Sierra and you Zoe, and that's something we really work toward in the office is like, how can we, all four of us kind of add our thoughts, everybody gets to be heard, everybody gets to contribute.

because we find that when all four of us contribute to something, we get a better product than when it's just, know, Dr. Weiner, he's the boss, he does it. And so I think Reddit really does that too, where people are open to changing their mind and open to learning a different approach than the mindset they came in with. And I think if all of us started to do that a little bit more,

probably three quarters of the problems we have right now as a country would disappear. ⁓ And so that, know, I'm really hopeful that things like this do start to get more and more attention and we do start working together again, as opposed to, you know, turning against each other in this kind of tribalistic approach we've got going on in our country right now, which is a little frustrating for all of us, a little scary.

Zoe (14:43)
Yeah. ⁓

Matthew Weiner (15:05)
⁓ But anyway, all right, we're getting a little sidetracked there, huh? We've been known to do that though.

Zoe (15:06)
Mm-hmm.

Well, we've been known to do that. And I think it's

important conversation at the root of it. We care about our patients, we care about the world and we care about helping it be better. And so I think even though it's maybe not necessarily on topic, it's still relevant and still

Matthew Weiner (15:29)
Yeah,

it gets back to our mission to helping people lose weight and keep it off. Health and happiness through sustainable weight loss, that's our practice's mission. That's our, you know, everything we do is really centered on that. And so that kind of segues into the next topic, ⁓ the brand new five-year-old We Go V-Pill. And everyone's like, well, why is it five years old?

Zoe (15:36)
Yep.

Yeah.

Matthew Weiner (15:56)
Well, this pill that's come out, and the great thing about this pill is it's pretty affordable. It's like less than 200 bucks a month, depending on the dose. I think starting doses are like 149. ⁓ It's semaglutide in oral form. Semaglutide is the active ingredient in ozampic and Wegovi, which sounds revolutionary, except it was released, I think, about five years ago in the form of ribelsus for the treatment of diabetes, and we've been prescribing it in our practice for a long time. ⁓ And we have actually...

more or less phased it out of our practice because we found it not nearly as helpful as the injectable forms. ⁓ Yeah, so what have you heard about WeGoBe? Have you talked to anyone who's taken it?

Zoe (16:40)
think a lot of

No, but I know that there's so much buzz around it. And I think that we're going to see just like in the space, like I definitely can see a big rush of people wanting to take it and try it. ⁓ From my understanding, and I would love to hear your thoughts about like why you've kind of phased it out mostly ⁓ in the practice, but you know, people get more GI ⁓ symptoms, right? There are more side effects.

Matthew Weiner (16:48)
Yeah.

That's been our experience with it. And I think this is, know, 2025, 2026, 2027, I think the crazy thing that we're going to see in these couple of years is that traditional paradigms will not hold true. And one of the traditional paradigms in the pharmacology industry, in the pharma industry, is that

pill has far more adoption than an injection by orders of magnitude. And so that's why you've seen such a big push toward the oral formulations. And there's this huge belief that injections are, people don't do injections, that we don't have widespread adoption because it's not a pill. And the problem is, with that assumption, is that people aren't considering

the fact that the relationship that our patients have with these medications actually becomes deeply personal. And I would really love to hear from people out there and their comments because we've seen this a lot with Ozempic and Zepfound. And most people we have on Zepfound, we've talked a lot about how we like that medicine better, the data's much stronger. But I'll tell you, I've got a handful, and it's not a small handful, I got a bunch of patients

who have done way better on semaglutide. And so this idea that one medicine is better, everybody responds the same, I'll talk to 20 people in a day, they're all on one of the medications, and I'll hear 20 completely different stories. And how this medicine, how your weight responds, the side effects, how it interfaces with your lifestyle, these are all really critical pieces of the puzzle.

I think they're far more important than whether it's an injection or a pill. And so I have a lot of concerns about this drug because I prescribed it before. It's not a new drug to me. They've got new doses, right? You can start at a lower dose. Okay. You can go to a higher dose. ⁓ okay. ⁓ There are people who've done great on ribelsis and I've seen tons of weight loss and a lot of great success, but certainly not anything like what I've seen with the injectables.

Zoe (19:17)
Mmm.

No.

Matthew Weiner (19:41)
And my prediction is we'll see more side effects, as you mentioned, and less weight loss. And in general, I find that most people in the end, because weight loss and weight maintenance and feeling in control of your weight is so critically important to people that the format that they take the medication in doesn't really matter nearly as much as those other factors. So it'll be interesting.

Zoe (19:48)
you.

And something else is

that ⁓ the injection is like at the most frequently once a week. And so the pill would be every day, right? And so like you were saying, it being so personal. And I think that's something that our practice and you and Deidre's work does so well is it really...

Matthew Weiner (20:21)
Yeah.

Zoe (20:34)
You listen to the individual person and there can be those tweaks made based on how their body is responding and again reinforcing that personal relationship and putting them in the driver's seat of You know, how am I responding? How am I feeling and adjusting it from there? ⁓ But I also think that maybe we talked about this in the last episode. I can't remember but basically potentially having a lower dose of the oral form might be a better more it ⁓

Matthew Weiner (20:41)
Yeah.

Zoe (21:02)
easily to adhere to long-term maintenance strategy, maybe using the injectables for the initial weight loss and then switching over. I'm not sure. It'd be interesting to kind of see how people play out with that.

Matthew Weiner (21:05)
Yeah.

Yeah, I mean, that's something we haven't tried in our practice. ⁓ There's no question that, you know, in my mind, weight maintenance for the pill is a more likely use than weight loss, but if you really get back to our set point model.

where it's really just about an equilibrium and reaching that equilibrium. And the set point model is not 100 % accurate 100 % of the time. And there's variations in situations where it may not hold true. But my approach and my thought process on this is that when you take a long look at weight loss is that you take a certain medication at a certain dose and it causes your set point to go to a certain amount and you adjust the dose.

or the frequency and that can adjust the set point. And so if you take a pill that works less effectively at a lower dose, eventually that set point will creep up to that new pill level instead and you'll lose that injectable level set point weight loss. that's my theory and you know, theories are great, data is better, ⁓ but you know, data is also sometimes flawed too.

I think we have some time before I feel like I'll really be able to speak directly about that, that this is a good strategy, this is a bad strategy, or this strategy works half the time, three quarters of the time. I don't know that I can give people guidance. think it's really just an individual conversation that we'll have to have as time goes. And when you see 20 patients in a day instead of 60, you get to have those conversations.

Zoe (22:41)
Mm-hmm.

Mm-hmm. Yeah.

Matthew Weiner (23:05)
⁓ Yeah,

the Wegoly pill will be interesting, but it's not new and it's not revolutionary. I think that's an important thing for people to understand. ⁓ Orforaglopron, which is coming, Yeah, yeah, well, I mean, the injectables people were doing so much better with them. Yeah, Orforaglopron is another oral formulation that's coming out later this year. That'll be interesting. ⁓ That'll be... ⁓

Zoe (23:12)
Yeah, and you stopped prescribing it for a reason.

Matthew Weiner (23:29)
That's a different pill and so that might work. I I'm not against oral formulations. I'm just against my experience with this drug in the past, ⁓ right? Because that's all you get is your experience. And I think every form you take it in, every new drug is gonna be different. And ⁓ ultimately we'll have a lot of choices which will be great for patients and great for cost.

Zoe (23:52)
Yeah.

And also just knowing that everybody can potentially respond so much differently. So being able to have so many more options to try versus just, you know, two or three.

Matthew Weiner (24:00)
Yeah.

Yeah, there may be a time when we'd say, remember when there were non-responders to the meds? ⁓ Because if you don't respond to Zepbond, you don't respond to Ozempic or Wegovi, maybe you'll respond to Orphoroglipron or Rettetrutide. So eventually we may have enough options that everybody gets to be a responder, which would be awesome too. So why don't we move into our questions

Zoe (24:28)
Yeah.

Matthew Weiner (24:30)
what's our first question here, Zoe?

Zoe (24:32)
Yeah, actually all of our questions today come from YouTube. So thanks to the YouTube for all of the great questions. The first one. That's right. We're not going to be getting any questions from Instagram. That's for sure.

Matthew Weiner (24:38)
Yeah, I don't think we'll find him on Instagram anymore. Yeah.

Zoe (24:46)
All right, so the first question says, I had VSG in early 2022, lost about 45 pounds, then was diagnosed with breast cancer in late 2022. Had a double mastectomy, lots of surgeries and medications in 22 and 24, resulting in regaming almost all of my weight. Started trisepatide compounded in November 2025, and I am now down 10 pounds. Hoping that the VSG in 22 and the GLP-1 will help me finally

me reach my goals. ⁓ So much good hearing on your productions.

Matthew Weiner (25:23)
Yeah, I mean this is kind of a classic story that we see all the time. I think I talked about it a little bit earlier is that this was most like the weight regain was first of all caused by the sleeve. Sleeve patients regain weight. That's a fact. In the past I've always looked at that as a real downside of the sleeve. Now I look at it as a point of education because the GLP-1s are so good at treating sleeve weight regain.

Zoe (25:36)
Mm-hmm.

Matthew Weiner (25:51)
really, really great. ⁓ And where this used to be kind of a difficult problem to solve, now it's just like, here's the medicine that's gonna solve it for you. This and nutrition and we got it. Yeah, this one, we can fix this one. Give me a tough one. ⁓ And so, yeah, I'm sure she was put on most likely tamoxifen. And so that's a weight gainer. The mastectomy, the stress, the...

Zoe (25:52)
Mm-hmm.

Here's the answer to your problem. ⁓

Matthew Weiner (26:18)
the surgeries, the downtime, all that stuff, it's just inevitable you're gonna regain that weight. And so what I liked about this question is that there was not a lot of self-blame in this, so good job there, kind of recognizing that this really was circumstances beyond your control. ⁓ I don't know that there's much role for compounded medications these days with Lilly Direct offering the high volume. ⁓

Zoe (26:29)
Yes

Matthew Weiner (26:45)
at $450, which allows us to get patients on these medications for $150 a month through our dilution program. I can almost guarantee that this person's paying a lot more than $150 a month for compounded meds. And that's the real stuff from Eli Lilly. So that would be my one comment. I think the other really important comment is

It's not, the evidence isn't really there yet, but I think we're going to find out that taking a GLP-1 will markedly reduce her risk of breast cancer recurrence. And so that is another clear reason why this is a great decision. So I love that this person has essentially figured it out for herself. And so anyway, ⁓ yeah, I think that you're on the right track.

My only advice would be to switch over to the real Lilly Direct product. It's gonna be the same, probably less expensive, and for a reliable product that you don't have to question its providence.

Zoe (27:44)
Yeah.

And keep us updated. We'd love to hear, know, in a couple months or, you know, in a year from now where you're at and how you're feeling. So.

Matthew Weiner (28:05)
Yeah.

Zoe,

what do you think about nutritional changes for preventing cancer?

Zoe (28:17)
Well, you I think so many things can ultimately be boiled back down to the basics, but the diet culture, wellness world wants to make things so much more complicated than it needs to be. If we're thinking about cancer prevention nutrition, or just, know, so with that, I'm thinking decreasing inflammation, right? And also having that high...

Matthew Weiner (28:38)
Yeah, that's 100%.

Zoe (28:42)
High antioxidant, right? There's a buzzword for you. High antioxidants, anti-inflammatory. Guess what that is? A lot of fruits and vegetables, unprocessed limiting added sugar, limiting ⁓ extra sodium. And so getting back to eating whole, real unprocessed foods, just like the metabolic reset diet, is pretty much the answer to so many of these, ⁓ even just medical nutrition.

Matthew Weiner (28:46)
Yeah.

Zoe (29:12)
diets that we might be looking at, ultimately, you know, thinking about like diabetes or high blood pressure or, you know, decreasing inflammation. All of this can be really rooted in eliminating processed foods and eating a high produce diet.

Matthew Weiner (29:26)
Yeah, absolutely. So I think that's a really important person, ⁓ important thing for this patient as well. All right, what's our next question?

Zoe (29:33)
Yeah.

All right, this next question says, I've been learning about the extreme health benefits of freshly ground flour and replacing the dead white flour breads with homemade breads and muffins. What are your thoughts on health benefits of home ground flours? So this I think is really interesting. And I was doing a little bit of just looking into it and researching it because we've kind of maybe heard about doing this before, but I wanted to know nutritionally,

what are the benefits, not benefits, but nutritionally, what are the differences if there is a significant difference? And I think if we're thinking about grand scale of things, potentially nutrient to nutrient, it's not necessarily a huge difference, but you are gonna likely see a little bit higher protein, little bit higher fiber. But ultimately what I like is that it is less processed, right? And you are in control of it.

whether you're making your own oat flour and you're starting with that grain and you're turning it into something that you can use to make the breads and that sort of thing. mean, ultimately you're in control. You're going to be making sure that it's ⁓ those good ingredients going into it. So is it necessarily going to be so much lower carb or super higher protein? No, but it is minimizing that processing.

Matthew Weiner (30:58)
Yeah, I think another piece that I think is more important than how it's ground, because mechanical grinding is, there's only so many different ways you can do that. And I just don't know, like, to me would almost be like, ⁓ a ninja blender makes healthier smoothies than a Vitamix. They're blenders, they blend it up, you you grind it up, you take the wheat, you grind it up. I think the grain itself is much more important to pay attention to.

and these ancient grains, all kind of, those pictures of amber waves of grain, right? You see, and you imagine someone walking through a grain field that's like up to their head. If you were to walk through a grain field now, it would be at your knees. mean, grain is, they've mutated it down to these dwarf versions because they can get a lot more grain out of it. It's a lot easier to process, less labor intensive.

Zoe (31:27)
Mm-hmm.

Mm.

Matthew Weiner (31:55)
And so we've just completely and totally mutated grain to the most easily harvested and processed state. And in doing so have reduced fiber, reduced protein. And so I would be much more interested in looking and talking about the type of grain that you're using to make that flour as opposed to how it's ground. That's just my take on that question.

Zoe (32:21)
Mm hmm.

Right, like doing quinoa flour, for example, will get you higher protein than doing rice flour or something like that. that, definitely doing barley or yeah, really cool. And, know, also like playing around with what else you need to add to it. Maybe, maybe you need a little extra baking powder because now you have a a denser flour that you're using. So you need a little bit more of the leavening agent.

Matthew Weiner (32:32)
Right. Yeah. Yeah.

for sure. All right, what's our next question?

Zoe (32:52)
Mm-hmm. Yeah.

yeah. All right. Next question says, was a participant in the Retrutatide Cardiovascular Trial, lost 37 % of my body weight, BMI dropped from 36.2 to 22.5, off all blood pressure medications plus cholesterol and thyroid meds, reduced no heart issues. Wow, this is great.

Matthew Weiner (33:16)
Yeah, you know, Reta-Trutide is an interesting drug for sure. ⁓ It's the only thing out there that compares to Zep-Bound and is actually, the early data, it might even be better than Truz-Apetide or Zep-Bound. So it's really, really intriguing from that perspective. I think, as I kinda talked about earlier, are people gonna respond to this who didn't respond to Zep-Bound?

⁓ Is it gonna be ⁓ different enough that we'll see ⁓ people where there's no, who respond to one but not the other? I've talked about this a lot, and again, this is total speculative. is speculation. This is not something where there's data, and I'm really interested to see what we come up with in this cardiovascular trial. ⁓ So, ⁓ retinotrute tide is a triple agonist, right? ⁓

Semiglutide is a single agonist, GLP-1. Terzepotide or ZepBound is a dual agonist, GLP-1 and GIP. Again, just different receptors in the same pathway. And ⁓ Rettutrutide is a triple agonist, GLP-1, GIP, and then also glucagon. Glucagon is the opposite of insulin. Insulin is a fat storage hormone. Glucagon is essentially a fat burning hormone.

but it's similar to epinephrine. It's essentially a stimulant of type. And pure glucagon can cause cardiac events. And so how it triggers it, how it binds, there's a lot of variables. So please don't take this as Dr. Weiner says that Ritatrutide's gonna cause heart attacks. What it says to me is that this is something we need to look at. And because we're also gonna see such great

cardiovascular risk reduction from the weight loss and the other metabolic changes, it may mask some of that. But we're gonna have to look really carefully at cardiovascular risk reduction from semaglutide, from terzapotide, from retitrutide, and get a real sense of it. And I think as we get further along in our GLP-1 metabolic experiment, we'll have a better sense of which drug is best for which purpose.

We know that these drugs reduce cardiovascular risk even without weight loss. And so how does that work? And it's very possible we might see semaglutide as the best at reducing your risk of heart attack, even though it's the worst for weight loss. And we're gonna start to separate these things out, separating sleep apnea from fatty liver, from...

Zoe (35:57)
Mm.

Matthew Weiner (36:03)
cardiovascular risk reduction, from weight loss, and being able to tailor these drugs, perhaps even combining them, kinda cool, ⁓ to come up with the best cocktail for each individual that gets them those health benefits. So this is gonna be a really, really interesting evolving space. ⁓ But it seems like, know, what I've heard about Ritatrutide is that this is a real drug. This, and I think 2026, we're gonna see it.

Zoe (36:11)
Mmm.

Matthew Weiner (36:31)
When this comes out, this is the breakthrough of 2026. You're gonna hear a lot of talk in this space, but the thing to follow, the thing that may really transform things is Reddit True Time.

Zoe (36:36)
Mm.

I was just gonna ask when you think we might see it really start to take the market by storm.

Matthew Weiner (36:50)
I think soon, I mean, you the problem is take the market by storm. There's no such thing anymore because insurance coverage and all of that stuff is gonna be so difficult. It'll drive the price of semaglutide way down, which will be good.

Zoe (37:06)
Well, know how I

feel like we saw this big wave of Zip Bound and then all of a sudden everybody wanted to switch to Zip Bound and try Zip Bound. So I guess that that's kind of like I wonder you think maybe it's gonna be this year that we see that same sort of thing happening with Red2Chide.

Matthew Weiner (37:15)
Yeah.

Yeah, and I think in our insurance payment space, it's just gonna be very complicated. I think that what will be interesting to me, and I have no idea what the answer is gonna be, is what's the self-pay price for this? ⁓ And if this comes out at a competitive self-pay price, I think you're gonna see a massive shift over toward it. ⁓ If not, I don't know that we'll see it.

Zoe (37:31)
Hmm.

Seems kind of unlikely following the trend of other self-pay, but maybe that's what they're gonna do differently. They saw the trend, they said we're gonna do it differently and maybe we'll be surprised. Yeah, all right, so next question.

Matthew Weiner (38:02)
Yeah, yeah, yeah, we'll see. Okay.

Zoe (38:09)
is also a kind of fiber related question. Do you have an opinion on the flora fiber bar developed by Jenny, previously of Jenny's Ice Cream? I try to eat many whole foods, leafy greens, for much of my fiber, but find these flora bars are helpful for me. So when I first saw this question, I had not yet.

I had not yet seen these bars. So I looked it up. So I just pulled up the website right here. Cause I want to read off for our listeners, the nutrition facts. So for one bar, it's 140 calories, five grams of fat, 28 grams of fiber. I'm sorry. 28 grams of carbohydrate, 13 grams of fiber.

only one gram of added sugar and two grams of protein. And so the ingredients are apple paste, flora seed blend. So it's white chia seeds, pumpkin seeds, quinoa, prebiotic fiber. basically lots of whole food ingredients in here. So something to keep in mind is that with it all being my opinion is if it's all in a bar like this,

and you're getting those 13 grams of fiber, okay, great. You're getting those 13 grams of fiber, you have a quick bar, but how satisfied are you actually feeling from that bar versus if you were to eat maybe the two apples that would come in from that ⁓ based on how much apple paste was in there or what have you. ⁓ So thinking about it from the lens of maybe a good snack or something to help boost your fiber, but.

you're not getting much protein in there. Of course, it's not a protein bar, but, and you know, you're also not getting the same level of satiety as if you were eating all of those produce, all of those, you know, produce ingredients that were in there.

Matthew Weiner (40:05)
Yeah. So how much is that bar? How much does it cost?

Zoe (40:06)
What are your thoughts?

It looks like you can get a box of 10 for $33. So a bit over $3 a pop.

Matthew Weiner (40:18)
So $3.50

or $3.30 a bar. Okay, so it's apple, the ingredients are apple paste, right?

Zoe (40:30)
Apple paste,

⁓ basically chia seeds, pumpkin seeds, quinoa, prebiotic fiber, apple fermented watermelon rind, cantaloupe, honeydew, mango and pineapple, almond chicory root inulin, apple concentrate rice bran oil, cassava root syrup,

vegetable juice for color, vanilla bean, natural flavor, salt, rosemary extract, and tea leaf.

Matthew Weiner (41:05)
I mean, they did a pretty good job keeping it about as natural as you can. In my mind, yeah, take some applesauce, some Greek yogurt, some chia seeds, play around a little. What's that gonna cost you? That's 10 bucks for probably twice as much of the actual stuff, you know? you know, that, I'd love to see people working more in that space.

Zoe (41:09)
That's what I thinking, yeah.

Right.

of your own home grind,

w-pean-wa flower.

Matthew Weiner (41:35)
⁓ stone ground flour, yeah, right. ⁓

Yeah, so, but you know, that, and I get it, like it's convenient and this probably is not a bad choice when you're looking at bars, right? Yeah, better than most for sure. But.

Zoe (41:47)
Right.

better than

most. also like the RX, obviously there's not as much fiber, but I do like the RX bars as you know, again, in a pinch, the ingredients are a whole foods, get the you get you do get protein in there because they use egg, but egg whites and nuts and those sorts of things. So bars in general can be kind of dicey, in my opinion, but when you find ones that have pretty much

Matthew Weiner (42:02)
Yeah.

Zoe (42:15)
All natural ingredients are pretty much whole food based ingredients. You know, it's gonna be a better choice than the other ones

Matthew Weiner (42:17)
Yeah.

Yeah, certainly one of the better products I think we've seen, but I'm still a bigger fan of doing it yourself. But I'm a DIY kind of guy, so I code my own apps. All right, our final question of the show, what do we got?

Zoe (42:27)
Mm-hmm.

Yeah. Yeah.

All right, we've said, this next question says, every time I cough, a ball forms. I just push it back down over and over. I don't know if I've had it a long time and just now the symptoms are starting to exacerbate.

Matthew Weiner (42:57)
So ⁓ this came out on a hiatal hernia video. so hernias are, essentially what a hernia is is it's a hole, right? A hole in ⁓ a muscle layer that should be intact. And ⁓ with a hiatal hernia, where the stomach is sliding into the chest, that hole is in your diaphragm.

And the diaphragm is not something you can touch. You can't, you know, not without making a big incision. ⁓ And so you're never going to be able to feel a bulge or a hyaluronic. Patients all the time say, you know, I've got a hyaluronic, just look right here, it's a bulging. ⁓ You cannot see a hyaluronia from the outside. You must do some form of imaging study, an endoscopy, a CAT scan, ⁓ even an ultrasound, you really can't see it.

because it's so deep in there and ⁓ so you need an imaging study. So what this person is describing where there's a bulge and it pops out and pops back in is an abdominal wall hernia and there's like 10 different flavors, know, inguinal in the groin, umbilical, epigastric, xiphoid hernias, ⁓ incisional hernias. So there's all these different types of hernias out there and.

you know, we didn't get specifics, but this cough and it pops out and comes back in, that's certainly something that needs some medical attention. And the answer might be to leave it alone. And I tell patients all the time, if it doesn't bother you, it doesn't bother me. But it does require some thought. There are some situations when that's a true statement and others when it's not a true statement. And so this kind of bulging thing, because they can incarcerate and testing can get stuck in them and that can be a very dangerous situation.

You know, that requires a careful history and a thoughtful conversation before you kind of say, well, we're gonna leave it alone. But that is not a hiatal hernia. A hiatal hernia is different. It's associated with acid reflux or ⁓ food getting stuck. ⁓ That's a surgery I do a ton of. ⁓ you know, it's a very difficult, ⁓ it's not a difficult thing to diagnose. It's just not something you can diagnose on physical exam.

So good questions.

Zoe (45:22)
Yeah. All right. We covered a lot of ground today. I enjoyed the variety. I gotta keep them on their toes.

Matthew Weiner (45:26)
⁓ yeah, a little scattered. We were all over the place, huh? We got politics, nutrition, GLP-1s, hernias,

surgery, hacking, software development. We covered all of it today, right? We covered all of it today. So a little glimpse inside my brain. ⁓ Yeah. All right, well.

Zoe (45:39)
Yeah. I know we got it. ⁓ gosh.

Well, we,

since we won't be distributing this on social media, we ask that you send it to somebody that you think would find it helpful. We're still gonna keep showing up, doing the podcast, doing what we do

into the nuance, having the conversations to help you live a healthier and happier life through sustainable weight loss.

Matthew Weiner (46:13)
Absolutely, we'll see you next time.