Going Under: Anesthesia Answered with Dr. Brian Schmutzler

GLP-1s, Explained

• Dr. Brian Schmutzler • Season 5 • Episode 5

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On the latest episode of Going Under: Anesthesia Answered with Dr. Brian Schmutzler, we break down GLP-1s with clear takeaways on how they work, who benefits, and the tradeoffs behind oral vs injectable options. We also dig into muscle preservation, costs and insurance, compounding quality, and the habits that make results last.

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SPEAKER_01:

This is going under Anesthesia Answer with Dr. Brian Schmutzler. I'm Bahid Sader Zade with a very tan Dr. Brian Schmutzler. I don't know what you're talking about. Looks just like normal. Yep. That's what happens when you get out of sub-zero temperatures into warm weather. It was warm-ish. Indiana won the championship and now you're celebrating with warm weather. Warm-ish.

SPEAKER_00:

We are brought to you by the Butterfly Network. All right, I'm going to let you in on something that's completely changed the way I practice. I've been using Butterfly Probes for years. It's a portable ultrasound that plugs right into my compatible smartphone or tablet so I can start scanning at the bedside in seconds. If you've used the older versions, or even if you're new to the handheld ultrasound game, let me tell you why this IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster. Whether it's vascular access, procedural guidance, or just getting real-time insights from my patients. And the tech inside this tiny device is pretty incredible. Biplane imaging lets me see short and long access simultaneously, which is huge for procedural guidance and honestly a great tool for learners. The new needle out of plane preset even shifts the scan plane digitally, so I can see the needle tip sooner, which makes a real difference when precision matters. And the image quality, honestly, the IQ3 holds up against some of the high-end card systems I've used. That's impressive for something this portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now, they're running a special offer. You can get$750 off the latest IQ three. Check it out at ButterflyNetwork.com. So the Butterfly, I was talking actually to a uh new client that we're working with, and I I did disclose that the Butterfly is a supporter of our show, but uh they were looking for a new ultrasound, and I said, you know, you can spend$100,000 on a big cart system. Or, you know, there's a small, small hospital, or you can get like three or four of these. So they're I think they're gonna go with the butterfly.

SPEAKER_01:

Hey, look at you being out there at all. That's right. That's right. I even gave my code just for the$750 off.

SPEAKER_00:

Today on this episode, we are talking something we've never talked about before, you know, learning learning all about it. Uh never heard of them. These these new medics sorry, go ahead.

SPEAKER_01:

G GLP1s.

SPEAKER_00:

Oh, what's that?

SPEAKER_01:

GLP1s. We're gonna talk about weight loss in 2026. Is it becoming the new statin? We're gonna be talking about injectables versus oral medication. We're gonna be talking about muscle loss versus metabolism. We're gonna be talking about is it a fore muscle gain? Is it the forever drug? Do you have to take it forever? Insurance, cost, and access. We're gonna be talking about some of the social media stigmas that come with taking, if there's any. And of course, what doctors wish patients knew before starting. Oh my. The GLP1. First, off the bat, though, Mr. Dr. Brian Schmutzers. Yes, yes, yes. What is a GLP one?

SPEAKER_00:

No, what does it stand for? Uh Ghrelin-like protein one, I believe. Okay. It's glucagon. Sorry. Hang on. Yep. I don't even know. It's all uh blur. It's all a blur at this point.

SPEAKER_01:

We've never talked about it before.

SPEAKER_00:

It's a we've talked about it a lot, but nobody calls it. Uh it's glucagglucagon-like pla Oh my word.

SPEAKER_01:

I think everybody calls it Ozempic, even though it's not. No, they're not all they're not all. They're not all Ozempic, but I feel like people are calling it that.

SPEAKER_00:

It's a GLP1. It is, but it's a brand name. Sorry. We'll get it. We'll get it.

SPEAKER_01:

Glycogen?

SPEAKER_00:

Glucon glucagon-like peptide one. So they're actually they're actually GLP1 RAs. So glucagon-like peptide one receptor act agonists. Receptor agonists.

SPEAKER_01:

So it's supposed to slow down your eating receptor. So the hunger.

SPEAKER_00:

So the way it works for weight loss is that it slows down the transit of food from your stomach into your small intestine. You feel fuller sooner and longer. So that's how it works for weight loss. But they've been used in in diabetes for quite some time because they help regulate blood glucose, right? So diabetics take medications to reduce their blood glucose so they don't get the big spikes in insulin because they either incorrectly produce insulin in type 2 diabetes or when their pancreas is burned out, whether from long-standing type 2 or um or uh or you know autoimmune early onset type 1, that they don't make insulin anymore. So it's a medication that we've used for a long time. We've talked about these kind of ad nauseum as a society, and even even on the podcast, we've talked about them quite a bit. But yeah, they work primarily, at least what they thought initially, is primarily by slowing gut transit. Now, is that totally true? You know, probably now there's a few other things. There's probably some brain mechanisms, there's probably some peripheral mechanisms, there's probably some other things going on besides just making you full. But the way these came about for weight loss is people who were taking them for diabetes noticed this like 10, 15, 20% weight loss, you know, when they were on the drugs. And so just like any brilliant pharmaceutical company, they're like, oh, that's a great side effect that we could use this drug to promote. So um go ahead.

SPEAKER_01:

Well, I was gonna say we've got eight burning questions that we kind of want to file through. So what's number one? So number one is kind of a two-parter. What are we learning in 2026? And is it becoming the new statin?

SPEAKER_00:

So what are we learning in 2026? So we're learning a lot of times these drugs that have any metabolic effect have a lot of other metabolic effects, right? So um it it does probably make sense um this cardiovascular effect that it has. So it reduces cardiovascular risk. You know, they you know, the Ozempic, oh, oh, oh, ozempic, right? The Ozempic trizone. So they've known for a long time the cardiovascular effects are are are decreased. Now, there's there's a lot of reasons why that could be. Probably the one that I buy most is that you're reducing um circulating blood glucose, circulating blood glucose turns into triglycerides, triglycerides, triglycerides go to the vasculature of the heart, they tear up the the endothelium, the the inside part of the of the uh cardiovascular of the of the cardiac arteries, and then you know, basically they cause inflammation there, they cause the the start of a clot, which would cause a heart attack. So that's probably how they work, but they're also reducing overall inflammation from a different mechanism. Not just that there's less, you know, um circulating blood glucose, but there actually is less inflammation in the body overall. How that works, I don't think they're totally sure. But again, reduced inflammation means reduced inflammation in the arteries, which means reduced cardiovascular issues. Um, and then metabolic syndrome makes sense as well because again, your blood sugar is is stabilized, so you're gonna have less of this, you know, the metabolic syndrome, which is high blood pressure, high cholesterol, diabetes, all come together to create this metabolic syndrome. Um, one really, really interesting one is the addiction issue, right? And so they find this with a lot of drugs that come out that have other effects. Like um, for a while they were using naloxone, which is uh which is a um a medication that reverses the effects of opioids to reduce addiction, right? And so they've done some of this with the antidepressants as well. But um, you know, so one one of the things that may be happening is that some portion of this or some um breakdown product of the GLP ones go to the brain and activate the center that decreases cravings, so that may be why you eat less, but also decreases dopamine release, which means less addiction. Okay. Uh some of that is going on as well, probably. Um, all right. So, and then you know, how much of this is real, how much of it is is overhyped. I mean, there's solid studies for the cardiovascular effects, right? So I have zero doubt that that's happening. The addiction stuff is a little less clear, maybe, maybe not. Um, one big thing, probably the best data that's out there right now, at least human data, not in vitro data like in a in a petri dish or a test tube, is increased fertility. So people, there's a huge increase of people who are infertile or have trouble conceiving and then go on a GLP one and get pregnant pretty quickly afterwards. So that that's probably the best data that's out there. Is this the new statin? Um so I think I think that there's some of some of that. Um I think the big problem with the GLP1s is there's a lot of side effects. So a lot of people can't tolerate the bloating, the abdominal pain, the nausea, the vomiting, and then there's a high percentage, and I can't remember, it may be as high as five percent of patients who get uh or people who get pancreatitis from this and just have to stop them. The statin side effects, while annoying, most people get a little bit of muscle soreness and sort of like achiness. Statins overall don't have a whole lot of short-term side effects. Now, if we can discuss the long-term side effects, but short-term they don't have a ton of side effects. So are they the new statin? Not yet. Um, but maybe, and there's some other things we'll talk about that may help with that.

SPEAKER_01:

So in 2026, we're seeing a lot of, and this is the big big one for for right now at least, is we're seeing a lot of oral medications versus injection. Uh now the the Wagovi, that's the brand name that's just come out on the market, is they're they're touting it as$149 for four milligrams. Yep. And they I don't think they have a higher dosage than that, right? Not oral, no, they don't. I've taken both. Yeah. I've taken both the oral and the injection. Yeah, yeah, yeah. And and I will say the oral for me, um, now it may work better, faster, but stomach problems were worse. Were worse. Yeah. You know, like the injectable, it just goes right into your bloodstream and it kind of works like that. The other one goes through your system.

SPEAKER_00:

Yeah. Yeah. So so there is um pretty good evidence that the heartburn and kind of fullness feeling is worse with the oral versus the injectable. Now, that usually goes away within an hour or so. Um, but yeah, that that first hour after after people take it, they don't like it very much. But then there's a whole flip side of people who don't want to inject themselves, right? There's a lot of people who are like, I don't want any needle. Um now there has been semaglutide, which is the active ingredient in Ozempic, has been around in oral form under the medication name ribelsis for a long time. It's just that ribelsis is not on label for weight loss, it's only for diabetes. So Wagovy is the first medication that's been um on label for weight loss as an oral medication. The studies are not out yet in the in the um comparison of efficacy. Now, the comparison of ribelsis, oral semiglutide efficacy, with any of the injectables, including Ozempic, the ribelsis is a little is a little less effective, probably because of of the the efficacy, right? So like the the the dose you would have to take of ribelsis to match the dose, especially max dose of osempic, is like un unimaginably high, and you just can't do it. And so you probably lose a large portion of that medication. The formulation with Wagovy is a little bit different than Ribelsis. So that there'll be some things that'll come out over the next few months or years that'll that'll help us determine this. But I think, at least right now, as a generality, the injectables are more efficacious with less side effects than the orals, but you can't really microdose. There's a lot of people out there microdosing or taking like kind of low doses of these GLP1s because there's good evidence that long-term hypoglycemia or really just keeping your blood glucose controlled and under 100 pretty much at all times increases longevity, right? So there's a lot of people who are taking this not for weight loss, not for diabetes, but low dosing it through a compounding pharmacy for the longevity effects. So all right. Well, and there's a there's a uh famous physician out there who promotes this stuff, but I can't say his name anymore because he was in the Epstein file. So anyway. Um there you 2026. 2026.

SPEAKER_01:

Striking again. Yeah, yeah. I don't mind the injection uh injection. Yeah, honestly, like I I don't like needles. I don't, sure. Um, but it wasn't it wasn't bad. Yeah, I mean, like it's not like a huge gauge needle that you're you know.

SPEAKER_00:

I mean, it's just a there's some people who are deathly afraid of needles and can't do it. Just like there's some people who can't take a pill, you know, the pill's a big pill, so there's some people who can't take it. So it's it's different ways to take the medications, but and insurance coverage-wise, like like you said, you know, Way Govi's supposedly 149 bucks. Now that's just a special coming out of is it Lily that makes that Way Govy? Yes. Yeah, so it's a it's a special coming out of Lily for now until it gets you know more.

SPEAKER_01:

And I'll ask about insurance here down the line because that's the that's a big one for people. I mean, I I think that's the biggest reason that maybe people don't take it.

SPEAKER_00:

Now that the I think the Trump administration negotiated some better prices, right? So it's not quite as expensive as it used to be for the injectables, but you know, we'll quickly touch on this one because we've talked about it before.

SPEAKER_01:

The muscle loss, metabolism, and the trade-off uh associated with again the phase muscle mass loss.

SPEAKER_00:

So so you have to work out if you're taking if you're taking a GLP one, maybe not in the like escalation phase in the first couple of weeks, but you have to work out, otherwise you will lose muscle, right? Weight loss with if you lose, I think the normal person, if you just did just did straight up, you know, a calorie restriction, I think the normal person, I can't remember the exact numbers, but it's about 70% fat loss and about you know 25-30% muscle loss. It inverts if you don't exercise with the GLP one. So you're losing more muscle mass than fat mass. And that's not it's not good again, longevity-wise, that's not good.

SPEAKER_01:

So you've heard the thermosempic phase or whatever, right?

SPEAKER_00:

So the way to avoid that is lots of protein and and strength training, right? And I'm not saying you have to go out and pump iron for two hours, seven days a week, but you need to keep up a level of of muscular and and um and cardiovascular fitness. So, and and you know, I don't think most physicians are counseling the way they should, right? Everybody looks at these medications as like the wonder drug, and I'm just gonna lose a bunch of weight. It is, but it's not necessarily gonna get you where you want to be. Like you most people don't just want to be thin, they want to look good, they want to be thinner and they want to be muscular. So you gotta you gotta stay on top of that.

SPEAKER_01:

The forever drug, right? We went to a bariatric bariatric conference where we we kind of posed the question to people. We said, hey, yeah, how do you get off these things? GLP one or right? I mean, that was the question. And I'll link GLP one or surgery, and they said you're really gonna have to do both because that's that's the way of it.

SPEAKER_00:

And they they even said GLP1s before surgery to lose the initial weight, surgery to lose the big chunk of weight, and then GLP1s after until you get to optimum weight.

SPEAKER_01:

So is it easier Let me think about this question, but is it easier for patients who get bariatric surgery to take the GLP1? So rather than not take the GLP one.

SPEAKER_00:

So you see what I'm saying? So the um the majority of people who have bariatric surgery have um smaller meals because they have a smaller stomach for whatever, whichever bariatric technique you you choose, it basically shrinks the size of the stomach, the amount of food you can eat. So I think they're better with the GLP1s than like you or I would be, because we're used to eating big meals. People who've had bariatric surgery are used to eating tiny meals. So that there's probably help there, it probably helps with that. Um, but you know, uh compliance and and ability to stay on it is is I think about the same whether you've had bariatric surgery or not.

SPEAKER_01:

I think the biggest question for me, right, and nobody knows this because it's so new, how long, how long as a researcher does it take for these medications to finally catch up to the research? Like, does it take 10 years for research, 20 years? Like, when do we know? Hey, there might be some lifelong side effects.

SPEAKER_00:

So so they've looked, they've done retrospective studies with the GLP ones for diabetes, but they weren't using those higher doses, and they also you weren't weren't using it for weight loss. And the side effect profile is is actually pretty good, long-term side effect profile is pretty good. So I would assume it's probably similar to that, but it takes, you know, you're talking about having to have people, you know, acceptance and then getting uh, you know, a critical mass of people who are taking it and then doing the prospective and retrospective studies. I mean, you're probably a decade, 15 years before you uh maybe less than a generation. Yeah, oh yeah, yeah, definitely less than a generation for sure. Um, you know, and but it it takes some time, you know. Uh is any medication without side effects and without risk, no. These seem to be fairly low risk overall. Now, do you have to take it forever? The forever drug. So there are a lot of people out there who are using these protocols to get off the drugs. Um, and what I've read anyway that seems to be the most effective is a tapering and then coming off of them. And if you start to get a rebound, you go back on the low dose for you know a month and then taper back off and back on the it's it's almost like quitting an addiction, right? It's like quitting smoking, right? You got a back down, back down. Oh, well, you know, I'm gonna go back on for a little bit and then off and then on and then off. That's typically the way that people come off of them.

SPEAKER_01:

It's really interesting because I think we the general public, right? And we'll talk about the cost in a second, but the general public, there's almost like this perception out there that this is the fountain of youth pill, you know, like you take it, you live forever. And you know, it's not though, right? It's not not that simple.

SPEAKER_00:

It's not that there is one other side effect that a lot of people don't talk about, and it's relatively rare, and it almost only happens in diabetics, but there's there's retinal changes with the especially the injectables. The orals not as not as much, but the injectables are some retinal changes. People actually can have some blindness, so that's one big thing that if you're diabetic and taking these, you got to be really careful. Any vision change that you notice at all, tell your doctor and potentially get off the medications. So I would be remiss if I didn't at least mention that.

SPEAKER_01:

This is probably the biggest question that people have. It's in my mind the biggest question that I have. Um, and this is the fifth topic. The price. Yeah. Why is it so gosh darn expensive? And if it's so widely used, why are we paying$500,$1,000? Yeah. I picked up, you know, the Wagovi or whatever, and it's like sixteen hundred dollars without the Eli Lilly thing. Why is it and why are insurance companies, if you're not pre-diabetic, right, why are they not offering this at a lower cost?

SPEAKER_00:

Yeah, so so a couple of things. And this was interesting. I actually heard this story um or heard this this description at when I was I was at the ASA Advance conference this two weeks ago now in um in Las Vegas. And so the reason that most insurance companies don't care about long-term benefits of things is that the average person changes insurance every three years. So you either change your job or your job finds a cheaper insurance or whatever. So if you're on, not to pick on anybody, but let's just say you're on Aetna right now, it's likely three years from now you'll be on a United Healthcare. And so Aetna, unless there's benefit, the actuaries find a benefit in those three years, they don't care, right? So there's no reason for them to bring the price down there. And all these insurance companies also own the PBMs, the pharmacy benefit managers, which were supposed to reduce costs and actually increase cost. And we can talk about that. That should be a whole podcast on its own to these far pharmacy benefit managers, vertical integration and all that craziness. But um, okay, so that's why the insurance companies don't care and won't bring the cost down. Why are the pharmaceutical companies increasing the cost? Supply and demand, right? They're the hottest thing out there. It's like saying, like, like during COVID, why was a mask expensive? Because everybody wants a mask, right? So why are why are the GLP ones expensive? Because everybody wants the GLP ones. So that's probably a big part of it. Now, Medicare and Medicaid are covering a portion of it because Trump negotiated some some price costs and did some things. So they are covering a bit of that. Um, so and then the other thing is, you know, it's a little bit touchy because you don't want to be labeled with diabetes if you don't have diabetes, because then that can cause you all kinds of problems down the road. But if by chance you were to have a high blood glucose on two separate readings, your doctor might say, Oh, he's pre-diabetic, and let's get him on a GLP one, and then it would be fully paid for by insurance. So uh now what they're doing again, now what they're doing is they're going back and they're saying, Well, you can't do a GLP1 until you've tried all these other um like blood glucose-lowering medications. There's a thousand other of them out there, but you know, metformin is like the big one. So you got to try metformin for a month, and then you got to try glypazide for a month. This is a whole thing. Um, so that that's what they're doing. You know, the the insurance companies are now doing that. Um, but there are other ways around it that a lot of people have found is the count compounding pharmacies, right? So it's still expensive, but it's not like full on expensive. Because it's not a hundred percent the the name brand. Right, correct. So it's basically doing off label, but okay.

SPEAKER_01:

Yeah, yeah, yeah. So while I was picking up this other brand, I asked the pharmacist. Yeah. I said, What do you think about so-and-so? Man, was she hesitant? Yeah.

SPEAKER_00:

She was like, Yeah, it's less, but I don't necessarily trust those. Well, so compounding pharmacies don't follow all the same rules uh as as let's say FDA approved products, right? And so you don't necessarily know if you have the actual amount that's in the compounding. Now I would not go so far as to accuse them of being an unethical and not putting any in there, but you know you've heard stories. I've heard stories, yeah, exactly. So um so be careful with the compounding. Although there's these national companies like Roe and um what's the other one? Her hers or whatever. Those are probably better because they're a national company that like actually cares if they get a bad review and would get look, you know, multi-million dollar companies that would be sued and have to lose money as opposed to your corner compounding pharmacy. Who what are you gonna do?

SPEAKER_01:

You know, right. Well, and I think the you know, as you look at it, right, it's like okay, they're expensive now, and I'm gonna go a few good men on you. Uh oh. You can handle the truth. In your professional opinion. Yeah. Professional doctor opinion. Uh-huh. I'm a doctor, not your doctor. Correct. Yes. Do you think or foresee with experience, do you think these come down in price?

SPEAKER_00:

Well, they'll come down as soon as they're generic. So I don't know when the patent runs out on semaglutide, but as soon as it does, every company out there's gonna take it. Yeah, and it's gonna usually the price drops ten times. So ten times. So if it's a thousand dollars, yeah. That's usually what happens when something becomes generic. So I mean, we could look it up. I I my guess would be the first line ones like Ozempic and Rebelsis probably go generic in the next four or five years. Okay. Be my guess. Um I mean, uh everybody, I think this is a barrier for a lot of people.

SPEAKER_01:

The cost, absolutely.

SPEAKER_00:

Yeah, it's a barrier for a lot of people, yeah. And so it'll it'll be much less expensive once they go generic, right? That ha this happened with all the the major medications. Once the statins started to go generic, everybody got on a statin. Once um, you know, like the ED drugs went generic, everybody got on ED drugs, so it'll happen.

SPEAKER_01:

Uh the sixth question or topic that we want to tackle here um is mental health around it. Do you think the GLP ones? And we talked a little bit about this, is changing some of our DNA in our brain, and like, you know, is it changing some of our mental and and I don't think it's changing DNA.

SPEAKER_00:

I and I'm I don't know. I don't know all the studies on the on the epigen epigenetics of the GLP ones. I think what it's doing though, it's changing our relationship with food. So the problem we have is we were designed to eat intermittently and to see food not as a social event and something that's around all the time, but food is like you go, you know, kill the woolly mammoth, eat the woolly mammoth, you might not eat again for survival five days or a month or whatever it is. So um I I think what it does is when you're not hungry with these medications, you learn that you eat to live, not live to eat, right? And it's cliche, but that's kind of what happens, right? Is that you're like, okay, well, I should probably eat because you know I'm not super hungry, but I should probably get some protein in, as opposed to people who just like wake up and they're like, All right, I want my latte and I'll have a bowl of cereal, and then as soon as I get to work, I'll have you know three candy bars, and then when I, you know, have lunch, just so you could argue that it's it's helping our relationship with food.

SPEAKER_01:

I think it's helpful.

SPEAKER_00:

I think it's helping our relationship with food in terms of cravings of food, in terms of um timing of food, in terms of realizing what food is actually for. Now, you can go too far into an eating disorder where you just don't eat because you know people say, and I've I've microdosed these too, like you're just not hungry. So you could go a whole day and not eat if you don't think about it. You know, so there I think there are there anything can go too far, right? Um and I th but I do think that it does make you it does make you consciously think about what you eat and when, which we don't do, especially in America. We just grab you can walk any I I can walk outside the studio and eat some candy, and then as soon as I walk in the door at home, there's a bag of chips. Like yeah, they're masa chips, so they're not terrible for you, but you know, a bag of chips. So um I think that there's probably positive effects of these more so than negative effects. We just got to be careful we don't swing too far. Social media, yeah.

SPEAKER_01:

Uh it it's all over the place, right? You mentioned hymns and whatever, right? That some of these companies that are you know going nuts and viral on on social media. How is it helping or hurting you know, the misinformation?

SPEAKER_00:

So there's some things, so the microdosing trend, now this will be maybe a little bit controversial, but the microdosing actually probably makes sense for people who are not obese. So microdosing these, again, one of the one of the biggest predictors of longevity is regulated blood glucose. So if you can microdose these and keep your blood glucose around 100 almost all the time, you're likely to live longer. So there is probably some benefit to microdosing now. How much is that? When do you take it? How long do you take it? Are you becoming hypoglycemic? Like there's some things you have to think about, but microdosing is probably uh probably reasonable. Now, should people be using these to lose that last five pounds? No, right? So you're committing yourself to a drug that has side effects and you know, potentially you'd have to be on for a long time. And the so should you be should you be going from, you know, like for me, my ideal body weight's probably like 170. If I'm at 175, should I be taking a GLP one? No, absolutely not. That's not healthy, right? And so there are a lot of celebrities, and that's kind of the next thing we're gonna talk about, who are like, oh yeah, I just you know, I pop on these for a few weeks and I lose my 10 pounds for the Grammys, and then I drop off of them. Like that's that's an unhealthy way to do it, right? So the celebrity influence. And that's what people are seeing, right? Right. That's that's the problem, right? So if you are obese, even overweight with so if your BMI is like 28 with multiple comorbidities that put you at risk for cardiovascular disease, that's a really good reason, even if you're not obese, to take a GLP one. If you're 20 pounds overweight, even if your BMI is only 26 or 27, probably still a decent reason to take a GLP one. But yeah, like, you know, I can't even think of a celebrity. But if you're a celebrity who's already thin, you want to lose five pounds to fit into something for an event.

SPEAKER_01:

That's just not I mean, we saw what Heidi Klume was wearing last night for the Grammys. I don't know. It was we it was weird. It was weird crap. It was weird. It looked like a knight's outfit, like she couldn't walk. Oh jeez. It was like metal. Yeah.

SPEAKER_00:

I probably shouldn't bring this one up, but there was a there was an there was an interview I saw with one very controversial person interviewing another very controversial person, and one of the controversial people said that the goal of fashion is that the fashionistas hate women and they want to make them look as dumb as possible. I mean, look at what these people are wearing.

SPEAKER_01:

100%. You can go just Google Heidi Klume Grammys, anyway.

SPEAKER_00:

Any of them, what any of these people wear. Like half the time they don't have anything on, which is ridiculous. Or like they've got these goofy, you know, they're supposed to look like a pirate or something. It's like, who thought that? Oh, yeah, that's high fashion to look like a pirate. No, what in the world?

SPEAKER_01:

I'll just stick to my comfort. Yeah, exactly. Exactly. The final question has to do with you, right? Okay. Um what do you wish that patients knew before starting these GLP ones? Okay.

SPEAKER_00:

So, as a physician in general, what I what I wanted, what I would want patients to know is that this is a commitment. This is not just a quick fix-all. This is a commitment. It takes several weeks to months, and there is some dedication to actually either taking the shot or taking the pill. And then if you want to be healthy, not just thin, it takes the commitment of forcing down some protein and exercising. So it's a there's a commitment, right? You're also not gonna go from 500 pounds to 150, right? Like that, that is not reality. It's just not gonna happen. There's gonna have to be some other things that happen, or you might, but it might take you 15 years, right? So on average, people lose about 15% of their body weight in a year. So if you're you know 500 pounds, 15% of that means you're gonna lose 75 pounds, but then that cuts at least in half every year after that. So if you're on a GLP one year one, let's just do something more reasonable, 300 pounds. In year one, you lose 15% of that, right? That's 45 pounds. Year two, you lose another 20. Year three, you lose 10, year four, you lose five, right? So, like it there is diminishing returns. So you're gonna have to do some other things besides just GLP1s, unless you only need to lose 15 or 20% of your body weight, then you're probably fine. Um nutrition-wise, you have to get protein in. You can't, so you're only gonna be able to eat so much, and if you're eating fried chicken and you know, candy all day long, you're not gonna do well. You need to make sure you're getting in like salads, are a big thing to make sure that you're getting the nutrients from that, and then like low-fat high protein meats are super important. Um, so like a a good, not terrible for you beef jerky is a really good thing for somebody on a GLP one to have. Like, if you can get like a low-fat, even like a turkey jerky or a chicken jerky that's not like super processed, there's a few brands out there, that's a good one. Um, and then not everybody's successful. People fail on the GLP ones. So probably the biggest thing that happens, there's several phases of failure, acute failure, meaning right away, is that they can't tolerate the side effects, whether that's pancreatitis, whether that's nausea, um, you know, feelings of fullness, um, even vomiting or because the dosages get higher. Right. So some people get dizzy from it. So there are there are some side effects. So that's your acute. Your subacute is that some people learn how to eat through it. So even though you're on it, if you eat a lot of small meals, like you eat a little bit of something now and then a little bit of something in half an hour, a little bit of something half an hour, a little bit, a little bit, you can eat through it, right? And we've seen this with the with the weight loss surgeries, but people are doing it too with the GLP ones. Um, okay, so and then long-term failure is the rebound from coming off of it, right? So there are like three phases where you could fail with these. The success rate's pretty good with these as compared to a lot of other medications, and again, they're they're pretty good in terms of benefit side effect profile. So like this is not like and no, no, um, no shade on anybody who's taken or who prescribes venteramine or adipex, but that's one that is kind of good initial benefit, but then it goes away pretty quickly, and there's a lot of side effects with that, right? So this this I think has a really nice benefit to side effect profile. Perfect, no, but better. I loved our conversation. This was good. Yeah. This was really, really good. And we've never really talked about the GLP ones before.

SPEAKER_01:

Right. Never, never. And we might not talk about them again, or we will talk about it next season.

SPEAKER_00:

Yeah, exactly.

SPEAKER_01:

Really good to discuss. Um, of course, if you want uh more information on us actually talking to a fitness provider. Oh, yeah, yeah, yeah. We've we've done that in previous seasons. We can link that below as well. You can see that show. Um, so really good conversation. And again, see your doctor. Yes, I am a doctor, but not your doctor. So see your doctor. Dr. Brian Schmutzler, I'm Bahid Sadrzadi. This has been going under anesthesia answered, brought to you by the Butterfly Network. Yes, we are. And we'll see you in the next one.

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Dr. Brian Schmutzler

Host
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Vahid Sadrzadeh

Host