Weight Loss Medication History - GLP1

In this episode of Healthier Ever After, Rick and Greg sit down with pharmacist and pharmacy owner Cliff Holt to unpack the story behind GLP-1 medications and why they have become such a major topic in both diabetes care and weight loss. Cliff shares his background as a pharmacist and explains the difference between a traditional retail pharmacy and a compounding pharmacy, including how compounded medications can be customized for individual patient needs.

The conversation explores the fascinating history of GLP-1s, from their early origins in research inspired by Gila monster venom, to their development as diabetes medications, and eventually to their rise in popularity for weight loss. Cliff explains how these medications moved from a niche diabetes treatment to a mainstream wellness trend, how shortages developed, and why compounding pharmacies stepped in to help meet demand.

Rick, Greg, and Cliff also discuss important safety concerns, including the difference between medications prepared by a reputable compounding pharmacy and cheaper “research grade” products found online. They talk about why dosing matters, how individualized treatment can reduce side effects, and why patients should work with qualified medical providers and trusted pharmacies.

Finally, the episode covers oral, sublingual, and injectable GLP-1 options, breaking down how they differ in absorption, effectiveness, and cost. If you’ve been curious about semaglutide, tirzepatide, compounded GLP-1s, or the role of compounding pharmacies in today’s weight loss landscape, this episode gives a helpful and practical overview.

Disclaimer: This episode is for educational and informational purposes only. Rick and Greg are medical providers, but they are not your medical provider. Always talk with your own healthcare professional before starting any medication, supplement, exercise plan, or treatment.

Transcript

SPEAKER_02 0:00

And here we go. All right. We are live. Welcome back, Greg. Thanks to me back. I'm excited for this episode of Healthier Never After. Before we get started tonight, just another reminder we are medical providers, but we are not your medical provider. We encourage everyone to seek medical care from your own healthcare professional before starting any health regimen, exercise plan, vitamin supplements, or medication. And that's really so that you can be monitored well for that. What we do here is educational and informational only. So please check in with your regular provider and then we'll get going for tonight. I'm super excited. We've got a guest tonight. We've been talking a lot about some GLP1 medications and things. And tonight we've got Cliff Holt with us. Cliff is a uh owns a well, owns a few pharmacies.

unknown 0:49

Yeah.

SPEAKER_02 0:49

And not just the regular firms. We'll talk, I guess, a little bit. Maybe we'll get into that uh on a next episode on what exactly is a compounding pharmacy. But uh Cliff, tell us a little about yourself and kind of your pharmacies, and then let's talk about GLP1s a little bit, uh their story and why that's such a big deal right now.

SPEAKER_03 1:04

Yeah, well, it's good to be with you, Greg Enric. Um, I admire you guys. I've known you guys for several years, and you guys do a great job. Um, I've been a pharmacist for a long time. I always wanted to be a pharmacist, and so I was like the youngest graduate at the University of Utah. Got out of high school at 17, went right to this pharmacy school, got out at 22. And so I'm passionate about this. And um I've uh worked at a hospital, I've worked for chain stores, I've worked for independence. I currently have four independent pharmacies. Our big one is Hurricane Family Pharmacy, and then we have a couple in St. George and one up in Price, Utah, which is the old mining town east of Provo. And so um the Hurricane Store is a retail and a compounding store, both um non-sterile compounding and sterile compounding. So that's what we do.

SPEAKER_02 1:51

Okay, so so just just real quickly, what's the difference between what you would say just a retail pharmacy, regular old like ball greens, and a compounding pharmacy?

SPEAKER_03 1:59

Yeah, that's a good question. So um they look the same at the very beginning. When you walk into our store at Hurricane, it looks like a regular pharmacy, just drugs on the wall. So a retail pharmacy, we carry commercial medications, which means they're made by big pharma, right? And we probably have a thousand different medications in the pharmacy. And we hope that um, or that and the doctor hopes that when they prescribe something to their patient, it's gonna be the right drug and the right uh strength. Now, a lot of times that doesn't work. I mean, any drug, I think the drug that has the most strengths will be like um Symphroid, Libothyroxin, and it comes in like a dozen strengths. Um, but a lot of medications, the commercial medications, come in two, three, four strengths. And you just hope that that uh that fits the patient. And as you know, as providers who have been prescribing for a long time, that doesn't always work, right? There's a lot of exceptions. And it might be we need a different strength, we need a different flavor, we need a different dosage form. Um, and so that's where compounding comes in, where we use art and science, really put them together and create customized medications. So it might be the same active ingredient that it is in a commercial medication, but we might have an autistic child that can't have anything with a red dye in it, or they need a special liquid and it needs to be a special flavor that it can go with them. It might need to be um something um, you know, made in a in a cream form, a topical form, or a suppository. Um, we even make lollipops with medications in them to really, I mean, the goal is to get the medication into the patient to get the desired result. And so we always joke with the providers, hey, if you can think of it, we can make it. Yeah. And if you can't think of it, we'll help you with that too.

SPEAKER_02 3:50

Awesome. Okay, well, that's that's good info. That's that's that's good to know. That's super cool uh what you guys are able to accomplish and do. Uh, so let's talk about GLP1 specifically. They they you know, a lot of people I think don't realize that this is not really a new medication. That like your semaglutide, but they've been around for a couple of decades, right? And so why the tell us tell us kind of walk down that path, like how that went from from obscurity, maybe, uh essentially a diabetes medicine, and then how it's become just the the all the rage.

SPEAKER_03 4:22

Well, this is a funny one. So, so most medications, in fact, all medications at the very beginning are usually found in nature. Aspirin from tree bark, right? And so we don't make aspirin that way anymore. Now what we do is we um we synthetically make it in a laboratory. But when that chemical first comes out back in you know, the in the olden days, when I talk about olden days being back at the beginning of time, you know, drugs were were around then. We used medications back uh, you know, thousands and thousands of years ago, but they were from nature. And so what happened was in the 1980s, they started actually studying a compound that was in gila monster venom. You guys might have heard this story before. That's where GLP1s came from. And so back in the 80s, they were we were looking at this compound and they look and they see, okay, what parts of the body does this chemical affect? And they found that it affected blood sugar. And so, so then they start going. Big pharma says, okay, we might we're looking for a blockbuster drug here. And so they're gonna go and they're gonna take this naturally occurring substance and um and see what they can do and and and refine it, maybe change the chemistry of it a little bit. And that's what they did in the 80s. And at the first GLP1 medication, the brand name was Bietta. And Bieta came out on the mark in the market, I think, around 2003, four, two thousand five. Um, and that was the first um GLP1 medication that came to market. Now, big pharma, it takes a while to get a drug from research phase to market phase. Right. And it takes hundreds of millions of dollars, literally, to do that with all the research, all the drug studies, phase one, two, and three clinical trials. And so once they do that and it takes off, then what happens is all the other big pharma companies want their own blockbuster drug. And so they'll tweak the chemical and make what's called a Me Too drug. So where Biata was the first one, then you get Victosa coming on the market, lyriglutide, and you get some of the other ones like um semaglutide coming on the market, um, which was under the brand name uh with Novo, it was manufactured brand name uh Ozimpic. And then you get uh Lily coming out with their version, which is trzepatide. And if you looked at the chemical structure, these drugs are all very similar, and they're just a little tweak of a molecule on the end of the end of the drug chain to make it so they can get a patent on that, which is important. They get an 18-year patent, which starts at the beginning of uh phase three clinical trials. So they don't have a full 18 years, they usually have a dozen years, maybe 14 years, where they can be exclusivity on that chemical and they can charge what they want. And they do charge what they want. Yeah, and that's a whole other ballgame about how big pharma prices drugs in our country, right? Which is different than anywhere else in the world. That's right. We'll talk about that some other time. Yeah, but anyway, so so all these uh five or six companies now want this GLP one drug. They want a me too drug because they can see that diabetes, you know. Uh here's the here's the crazy thing about diabetes. A fourth of our country has diabetes that know about it. That's the bad, that's not that's not the bad news. That's the good news they know about it. The other fourth of the country has diabetes or prediabetes and they don't know about it. And that's where the damage is being done to the eyes and the nerves and the kidneys. And what that happens is they find out 10 years down the road and the damage has been done. Yeah.

SPEAKER_00 8:03

Right. Yeah, unfortunately, they find out a lot of times when they end up in the ER with us, um, when we're working there. And and um by then, by that time, you know, significant damage has been done to the coronaries and the kidneys and the eyes. Um, and they they didn't even know.

SPEAKER_03 8:19

Yeah, exactly right. The damage has been done. You guys do a workup, and lo and behold, full-blown diabetes, right? And so now we're trying to treat this disease and all the all the the you know, trying to figure out how we can what we can do without damage has been done, right?

SPEAKER_02 8:34

Okay, so so I I I don't know, but uh I don't know how where our listeners are on this. I'm still kind of stuck back on like how does this conversation happen in the 80s where somebody's like, hey, hey, you know what? We I'll bet I'll bet there's something in that Gila monster. Venom diabetes.

SPEAKER_03 8:52

Like I don't tell you how that happens, but but I'm gonna tell you if you go back to the drugs, there are some crazy, crazy stories about where we get compound, where we get the where we figure out the this medication, this chemical structure, right? Right. And it again, it's a lot of them are plant-based, right? A lot of them came from plant-based. Now, some of them came out just in a laboratory, and they figured, hey, we could do this like um like statins. We use those for cholesterol, right? Uh-huh. Nobody's taking statin because they have a statin deficiency. That's not a naturally occurring substance in our body. Yet that's the best practice, right? If you have to prevent coronary blockage. And so with high cholesterol with lipid levels. So um, but there's some crazy things about a lot of our drugs came from nature and from weird sources. I mean, rapamyosin, that's another we ought to have a we ought to have a podcast about rapamycin. That's an incredible drug for anti-aging. And I'll tell you, that came from the Canary Islands, right? And just stumbled across this anyway, that's another story for another time.

SPEAKER_02 9:54

Yeah, no, it's it's fascinating to me. It's fascinating. I actually had a um a professor in college, um, Dr. Paul Cox, he was he was a botanist. Uh, and and he he he went on a sabbatical, a PhD, and for like a year or two in Samoa and and just was like the understudy for the island witch doctor, for lack of a better term, and that that had you know 3,000 years of communal experience working with plants and and and compounds that are all just from the island from nature, and there were some just amazing things and things that were you know effective against certain cancers, all kinds of it just it was just fascinating.

SPEAKER_03 10:31

Um, yeah, how the Amazon the Amazon forest has a lot of drugs come from there, and a lot of a lot of answers are still there we haven't found yet, right? Yeah, yeah. So so we got ghila monster stuff into some big things. Now, hey, just let me time out here for a second. I don't want any of our listeners to think that semaglutide and turzepatide are made from ghila monster venom. That is not, I don't please be very let me be very clear about that. These are these are made in the lab, right?

SPEAKER_02 11:02

Yeah, yeah. So but the but but they have been around for a long time now, like 2003, like what you said, right? So so people have used that for and and specifically for diabetes, like the FBA approved this for use in in diabetics, but but then how what changed over the last few years that brought these things to such the mainstream and with weight loss? Like, like how did how do you get this medication designed to help with blood sugar? Now is all the rage uh for skinny.

SPEAKER_03 11:29

So so it's funny, a class, a phase three clinical trial to get the drug on the market usually involves three to five thousand patients. You think that might be a lot, but that's not a lot. Yeah, and so during those trials, they have to list every side effect that the patient says they think they have. And that's why every drug on the monograph says it can cause a headache and diarrhea and constipation. Now, how can a drug cause both diarrhea and constipation? There's a lot of things that cause those, but people, if they report those, the the drug company has, the FDA requires them to list those as side effects. So what happens is these three to five thousand people, they have a pretty good idea of the side effects because they're going, there's it's a double-blind study, which means the patients don't know if they're taking a drug or a placebo, which means no drug, right? And the clinical um staff doesn't know either. So there can be no that hopefully there's no bias on this. So if you're in, if we're if we're in the drug study, Rick, Greg, and Cliff, and we're all three on a drug study, and actually I did some of these when I was at the University of Utah, they had drug studies on the weekends. We get paid to go in and and take ibuprofen and watch football to look at side effects. But so anyway, we do this, and so you might be taking the active drug, you might be taking just a placebo. So it's pretty clear on some of the most common side effects like nausea and vomiting. Well, placebo isn't gonna cause that. And so, but so you get a side effect profile. But let me tell you, when a million people get on a drug or two million people, then you dial in what the true side effect profile is, and you also dial in how effective this drug really is, and a little bit more information, a lot more information on dosages, right? When the drug first comes on the market, we have an idea. You get a few million people on it, and we have a really good idea. So that's what happened with when these drugs came out, they're they're super expensive, right? They've been when Bietta came out, it was a $500 a month drug, which in 2005 that was a ton of money. But it but it's not twelve hundred dollars or fifteen hundred dollars like it is now, right? And so so it's still super expensive. And so there were things on the market that were a lot cheaper, and so most providers will do step one, step two, step three, and then this expensive one will probably be step four. And so this was a real slow increase on this kind of on the GLP ones. Started getting some pressed. We got a million people on on a couple of them, Big Tosa came out. We started seeing wow, these drugs really are lowering A1Cs. These things are working for diabetes. Now, how do they become skinny drugs? So, the number one side effect, the the most common side effect was weight loss. And it wasn't even like it was close to number two, three, and four side effects. Weight loss was a side effect, and this happened before. This happened with Eli with um with Pfizer, with Viagra. Viagra before it was an ED drug, was a blood pressure drug, right? It worked really well at 20 milligrams. What was the number one side effect? We all know what that was. So all of a sudden, there's some brilliant guy in the marketing department at Pfizer that says, Hey, let's market it for this. So the blood pressure drug, they just left it on the shelf and people used it for that, but not really a lot. Yeah, they started going ED at 50 milligrams and 100 milligrams of Viagra and started jacking the price up to uh $10 to $20 a dose. And that's how they made billions of dollars on that drug.

SPEAKER_02 15:08

Yeah.

SPEAKER_03 15:09

With a side effect.

SPEAKER_02 15:10

Okay, so so we just over time, enough people got on this and noticed that the most common thing that was called a side effect that was happening is they're losing weight. Not only are they controlling their blood sugar better, their A1C is going down, their diabetes is getting better control, but they're losing weight.

SPEAKER_03 15:26

And our type tie type two diabetics are almost always overweight, right? That's part of the issue where insulin is. I was just gonna say that.

SPEAKER_00 15:35

Yeah, Greg. It's like a perfect population. Uh it was unintentional, but it was actually the perfect population to be able to note these side effects and be able to see the weight loss. Yeah.

SPEAKER_03 15:46

Exactly right. And and and it was really obvious, too. These patients didn't have just five or 10 pounds to lose. A lot of times they might have 40, 50, even 100 pounds to lose or more. And so we are seeing these this the weight just melt off of them after a year, uh, 18 months, right? Yeah. So here's what happened. Hollywood saw this, and they started talking about it. And and so all of a sudden they needed to lose 10 pounds, 20 pounds, they'd they'd go on Ozympic. And it was diabetes only, it wasn't indicated for weight loss, but they started doing this about six years ago. And when a drug company is making medications, they have an expiration date on there, and they the whole distribution is really dialed in. I mean, it's got to go from sourcing the raw chemicals to the manufacturer, they've got to produce the product, package the product, get it to the wholesaler who gets it to the pharmacy, who then dispenses it to the patient after the doctor or the provider writes the prescription. So there's a lot of moving parts there. And they don't have unlimited supplies, they have projected supplies. In fact, if you get on any uh earnings call with Big Pharma, they're talking about inventory levels, right? And they want to bleed those down to the end of the quarter, not run out, but they don't want to have a half billion dollars worth of drugs stockpiled. So so it's really dialed in. So it doesn't take much to short a drug or to deplete a drugs uh.

SPEAKER_02 17:20

So so essentially the the demand was artificially and very rapidly inflated by by the the non-diabetic users that were going for just this side effect of weight loss. And then we got kind of caught on because the popularity of of Hollywood or whatever.

SPEAKER_03 17:40

That was one. Hollywood was one, functional medicine number two, anti-aging number three, and of course, there works for all three of these things, and so it's it's very relative there. And so perfect storm and Novo couldn't keep up. All of a sudden, it was backward. And we saw the writing on the wall at Hurricane Pharmacy. We we couldn't get it. We Hurricane Family Pharmacy is a busy pharmacy. We do a lot of retail prescriptions, and we were having to tolerate diabetics. We can't get this, and we're trying to source it from around the country, different wholesalers.

SPEAKER_02 18:12

Is this is this problem you're talking about, like specifically, is this kind of how I've heard some people say, Yeah, I I don't, I don't, you know, I'm I'm uh opposed to using these medications for weight loss because we're stealing from the diabetics who need it.

SPEAKER_03 18:24

Like is that is that kind of how that feeling at first, at first, and and that was really that was a that was an issue five years ago, four years well, four years ago when we started seeing the shortages coming. And so here's the thing where compounding pharmacy, and this is really an issue that that we step in. We make and there's always hundreds of drugs that are short for a lot of reasons. FDA goes in and closes a manufacturing plant down in Puerto Rico. Um, they close a uh a chemical manufacturer, and those are 90% of those are in India and China. Making chemicals is a very environmentally dirty business. And the US got rid of that decades ago, put it offshore, right? And so we're we're beholden to these countries, which now has some other ramifications with political and wars and things like that. But but so we're all there's a lot of things in the process that can make a drug um not available. And so compounding pharmacy has really stepped in a lot of times to make these things. And they could be capsules and tablets, sometimes injectables, hospital medications, and things that have been around forever that are dirt cheap, that just manufacturers aren't making them anymore. And so pharmacy, compounding pharmacy really that's one of the things we do is we step in, not just doing customized medications like we talked about at the beginning of the podcast, but also to step in and help make these help uh take care of the the shortages that are in the marketplace. We can go in and make those.

SPEAKER_02 19:51

So is that you know that you've mentioned that these companies they they invest hundreds of millions of dollars, it's very expensive to get their specific drug, they get a patent, nobody can make it, they're the only ones that can supply it, but but now all of a sudden uh there's a shortage, and so how is it oh how's it okay, or is it legal for to for a company pharmacy to sort of mimic that or make that? I've heard that asked a lot.

SPEAKER_03 20:13

Yeah, that's a valid question. So the FDA has an actual FDA drug shortage list, updated every day. Everybody can go just Google it, and you'll see the hundreds and hundreds of drugs that are in short supply in this country. And some of them you'll recognize, a lot of them you won't recognize. Um, but when it's on that list, FDA says compounding pharmacy can step in and make those, even if they're under patent, like okay like stemaglutide and trustepatite have them.

SPEAKER_02 20:44

So that's how that so that's how you then as a as a compounding pharmacy, that's how you uh fill that that demand gap, essentially. Correct. And allow the medication to get to first and foremost the people who need it for their diabetes, and second, then the the the wannabe skinnies, I guess, is how it's wannabe skinnies.

SPEAKER_03 21:05

Um so here's the thing. We couldn't get this about a little over four years ago. We saw this the writing on the wall. So I started trying to source the chemical, and that was not an easy thing to do. And so I found the the manufacturer that made it for big pharma and talked them into selling me some. And so we then we started doing our whole, we just don't just whip it up and make it and sell it. We we have to figure out the chemistry, we have to figure out stability, we have to figure out preservatives, we have to figure out there's a lot of things, and then we have to test what we think is right for for potency, for endotoxins, for sterility. And so that's about a six month process generally. So we started doing that right away before it was even on the shortage list because we thought that this was probably gonna happen. And it was fortunately, we were we were ready to go. When this got on the shortage list, we were ready to go at hurricane. We started making it and people from across the country were asking us, what are you doing, Cliff? How are you doing this? And um it was just a lot of luck, actually. Good timing.

SPEAKER_02 22:11

It's awesome. Yeah. So so okay, that's that's that's awesome and helpful. Um and it and how long does that last? Like it does it does it get to the point where, okay, the FDA would say, well, all right, we've we've got this being made enough, and now there's not a shortage enough. I mean, does it does it fluctuate like that?

SPEAKER_03 22:27

It can. FDA doesn't want to do that. And so here's the thing. Um we we probably know how to talk about FDA for just a second. FDA, the Food and Drug Administration, was created to control big pharma, and they regulate big pharma. They don't regulate me. Now, there's some rules I've got to abide by, but but we're regulated as pharmacists and pharmacies and doctors and nurse practitioners and PAs. We're regulated by the state, the state we're practicing. So the state of Utah. The Department of Professional Licensing regulates us, they inspect us, they license us. In fact, we just had a huge inspection last week with Doppel coming in to the Hurricane Store, and it was great. They come in, they learn something every time they come in because we're kind of ahead of the game on everything. Yeah.

SPEAKER_00 23:09

Zach said you guys did fantastic.

SPEAKER_03 23:11

Oh, yeah, yeah. I mean, here's the thing they come in, they're gonna usually write you up for something. Couldn't find anything. So, so it was, and look, I'm not bragging here at all. I'm telling you, we've got great processes and we've got great people, and we follow those processes and we don't take shortcuts. And that's why. Thanks. So, so anyway, FDA, that shortage list, there's a lot of drugs on there. And what happened was they were getting huge pressure from Lily to take terzepatite off of there, because when that happens, then they think that compounding pharmacy can't make it anymore. Well, FDA took it off a little bit early, and lawsuits started firing up across the country. And quite frankly, if we if all the compounding pharmacies tomorrow stopped making semaglutide and tersepatide, they'd be on the shortage list again, probably within 30 days, because big pharma still can't keep up with the volume that we're taking care of, right? And that look, there's enough business to go around. They're selling a ton of product too, but they're selling it for $1,500. We're selling it for $100 or $200, right? So there's a big difference, and we don't have all those things to pay for. So so anyway, the shortage list is on there. Now, the next question really makes sense is well, if it's off the shortage list, Cliff, how can you still making it? How can you legally still make that? And here's the answer FDA allows us to compound things that are medically necessary, and usually that's from a different dosage that's needed. Now, if you look at terzepatide, the manufacturer makes five dosages of that. Yeah. And again, can we fit that round peg into a square hole? And we can't. And I'll tell you.

SPEAKER_02 25:01

Yeah, that I mean that just just the terzepatine to talk about these injectable medications and our experience with with patients is is and we told people, you know, we tell people this all the time, is is is that it's it's so interesting that there is like every individual has kind of this sweet spot that that isn't necessarily one of these five doses. Some some people have this take a tiny little dose and have some great effects, and they take a tiny bit more and they get sick as can be. And so they have this sweet spot that does nothing for somebody else. And so it's just yeah, it's really interesting that that there is a there is really wide variety of of what's the right dosage for any one individual.

SPEAKER_00 25:38

And to add to add to that, it kind of what you said earlier is the big pharma obviously tests only certain doses and they have their titration schedule that is pretty rigid. And um, I know in my experience in using um you know compounding pharmacies for these medications for patients, is that customization has been key. Because some patients, I really think we can all agree as being in the medical field is the lowest effective dose. If someone doesn't need a really high dose, then we should be able to have that option for patients to be able to use a lower dose where they're not having side effects, but they're getting the desired effects as far as weight loss or you know, A1C control or whatever it is. Yeah, yeah. That's a good point. That's kind of how you're able to Yeah.

SPEAKER_03 26:20

And to Greg's point, we get to a therapeutic dose where the dose is is causing the effect that we want. We give more drug than that, we're not gonna get a better effect most of the time, but we are certainly gonna get more side effects as those go way up, right? And so, yeah, we cancel our patients look, when you're losing the weight, talk to your provider, but that's where we stop. And it could be anything. So instead of not just five doses, and we do if you think about a uh a 1 ml syringe, would have a hundred units in a syringe, right? If we're using an insulin syringe, we don't just have even a hundred different doses for our patients. We probably have about 120 doses because now we have patients micro dosing it and taking even less than than a than a hundredth of a cc. And so so the doses are all over the place. And you guys are seeing this too with your patients. Absolutely.

SPEAKER_02 27:12

Yeah, that's awesome.

SPEAKER_03 27:13

So compounding, even back to compounding, we customize whatever the dose needs to be. So if the provider says medically necessary, we can compound it, even if it's still under patent, even if it's still commercially available, we can do that. Now, if a provider writes for 10 milligrams of terzepatite and doesn't put that on there, we're dispensing a brand name drug, right? Because there's no reason to dispense the compound. And we dispense a lot of the brand name big pharma drugs in the in the GLP1 space, um uh mostly for diabetics, but we do way more compounded because there's more people that want a different dose than those five.

SPEAKER_02 27:52

So someone a patient provider needs to be aware of that as well, of how to kind of appropriately put an order in that that then would allow you to meet that need.

SPEAKER_03 28:05

Exactly right. It has to say medically necessary, Anna.

SPEAKER_02 28:09

What about um like are there safety concerns with this? I mean, I I know you know you've you've been on a great job, and we'll talk in a little bit about compounding a little more. But uh, what about uh like these research peptides? Or I can get online and get this super cheap, or like are there some red flags that people should look out for?

SPEAKER_03 28:24

Yeah, you need to be careful with that. And and we really ought to have a talk about peptides. That's gonna be changing in the near future. The pep and peptides, GLP ones are peptides, of course, which are just amino blocks of amino acids put together, but there's some other peptides that the FDA put on what call it the naughty list about four years ago. We were able to compound them, and then we were able to when they told us we couldn't compound. That's probably gonna change here pretty quick. Um, and so what happens is if I order a powder, I don't want it to say research grade. That's what the labs use to do testing, animal testing, things like that. And so there's a lot of semaglutide and trzepatite, for instance, to say research grade on it, and it's really cheap. And yeah, we're not gonna touch that. Again, I told you before that we found the source that gives it to Big Pharma. We feel pretty good about that. There's a lot of different uh manufacturers of raw ingredients, the powders themselves, and semaglutide and terzeptide. There's a lot of manufacturers in China that are making this now, and because it's gotten so big, not just in the US, but around the world. And so we're very particular, and not, I mean, we would never use anything that said research grade, because you're gonna get somebody in trouble. Someone's gonna get in trouble with that. It's just not look, we're making sterile medications. These have to be endotoxin-free powders. We need to see a lot of testing from the powder from the manufacturer, as well as our testing as well. That research grade, you're not gonna get all that. You're not gonna get all that.

SPEAKER_02 29:53

Hasn't been through all that same testing that you're you're gonna do.

SPEAKER_03 29:55

Hasn't been through 14 different tests, yeah. And so you got to be super careful with that. So, like retatride, right? Lily's new drug coming out, which works three ways, where turbotite works two ways, right? Uh-huh. And so um, we can get that powder right now, but the only powder you can get right now says research grade on it. Yeah, and so that's why we get asked every day, Cliff, can you make this for us? And the answer is not yet. Not yet. Because we can't find the powder that doesn't say research grade only.

unknown 30:27

Yeah.

SPEAKER_00 30:28

I have a question. I don't want to get you too far off track. I know we're we're talking about GLP1s, but what are, if you can even speculate, what would be the suspected concern with let's say that someone does get research grade um trusepatite or semaglutide? Um, what would you guys suspect be the biggest issue? Would it be a sterility issue? Would it be um that you're just not getting the same amount? Um, like where would be the concern with someone getting a research grade product? I've talked to many patients that have been on the research grade. And, you know, perception-wise is, hey, I'm on the same stuff. It feels very similar to me. Um so why not just pay, you know, 50 bucks online and not run it through a medical provider? I think we all know the answer to that question, but um, but their their question is really like, why? Why would I why would I pay the extra cost to go through um you know Hurricane Family Pharmacy or any other reputable pharmacy for this um compounded when I can just get it for cheap online? Is there anything that you suspect we may not see now, but it'll come to fruition later on?

SPEAKER_03 31:37

That's a great question. And there's a lot of concerns with this. One is if we knew the pharmacy, so here's the let me back up. You should know your pharmacy and be able to talk to a pharmacist in the lab of any compounding pharmacy. If you can't do that, then there's all sorts of things that could happen and go wrong. So, so no matter what compounding pharmacy you're using, you should be able to call up and talk to the pharmacists in there and and ask questions. And if you can't do that, then we have a lot of concerns. Where is it coming from? And so there's a lot of um uh semaglutide, I got the air quotes going here, terzepatide coming in and out of the country. We've seen a lot of this stuff with no GLP1 in it. And then we always worry about well, is there something could be harmful in there? Could it be not even a sterile product? Um, if we take something orally and it's bad for us, we're usually going to throw it up, or we can at least cause that. After you push that plunger in, man, you're the it's there. You're not sucking it out, you're not getting it out of there, right? You you administer that dose, IV, IM sub Q, it's in the body for good or bad.

SPEAKER_00 32:47

Well, you don't really have the GI tract as a uh filter. Right. Right. It's it's in there. You're it's going straight into the bloodstream, and then uh, you know, of course, eventually first pass in the liver. And um, but yeah, there is no there is no barrier, so to speak, um, if there is something in there that um generally speaking wouldn't even necessarily make it in um via the GI tract if if you put it in that way. Correct.

SPEAKER_03 33:13

So I I think we have to be super careful. And look, we're not talking about, I mean, the prices have come down on these things. Um, and so um there's there's I mean, yeah, you can save a few dollars, but gosh, it's you know, and I don't want to offend anybody, but I've got friends that have gone down to Mexico and had their stomach surgery, right? To the sleeves, stomach sleeve surgery. And I've known three or four of them that almost died. That, you know, yeah, it's a little cheaper. It wasn't cheaper for them by the time they came back and tried to find a doctor to to take care of them and get all taken care of. It was way more expensive. They had just done it at a place here in the US. So we've got to be super careful when we talk about our bodies. And it's not, this isn't a commodity. This is again, we're talking art and science to make a compound. And there's there's a lot to it. I mean, when we're first putting formulas together, it's not uncommon for us like Big Pharma to have to go through five, six, seven, eight, nine, ten formulations until we get it exactly right. And we're spending a lot of money testing that with a third-party lab to make sure that it's safe and it's effective and it's the right potency. And um you just we're talking about our bodies here, and it just, gosh, you just don't want to you just don't want to take chances when it comes to that. And it's not every terza, just as it says episode, it does not mean it's the same.

SPEAKER_02 34:34

Yeah, awesome. So and that's and that's why we appreciate good quality. We want to kind of talk about good quality pharmacy. Let's one last question, uh, and then we'll we'll take a break and move on to some other thing of just accompanying in general. On the GLP ones, um, there's a lot of talk lately, I think, about the oral formulations. Um, as opposed to some people that don't like the idea of an injection uh for whatever reason. Um, and and so now there's there are kind of some oral formulations. Are they are they working? Are they helpful? Are they more expensive? Like tell us a little about that.

SPEAKER_03 35:05

Yeah. So um semiglutide, um, the Novo came out with uh with a commercial uh tablet, oral tablet called Rebelsis, and it's been on the market for several years. And if you look at it, so so most peptides get blown apart in the environment of your stomach. The acidity, they won't get through the acidity, so it blows the chemical apart, so you don't get the effect, the your the desired effect. Um, so what they did is they beef these tablets up in milligrams. So if you think about um a semiglutide uh sub-Q dose, you might be talking about a half a milligram to a milligram, maybe up to you know two milligrams. But if you talk about the oral dose, it starts at three, currently goes to 17, and they're coming out with a 24 milligram. And so you can see the dose have to be way higher because a lot of that's not going to get through the GI system, the GI tract. And so, because of what Greg was talking about, that first pass effect with the liver and then the acid environment blowing it apart. What's what's kind of uh confusing is so we made a sublingual version of semaglutide. And people think since it's going in the mouth, it's oral, but there's a big difference here. And um, if we do something sublingually, there's a lot of vasculature in our mouth where it goes right into the bloodstream. We can absorb things in there. And and so there's a lot of times we'll use a tablet sublingual, right? If we want to get it right in the bloodstream quickly, like like on Danzotron makes an oral tablet that just dissolves in your mouth. There's a lot of medications that do that. And so what we do is um uh we make semaglutide into a drop that you just put into your tongue and hold it there. And so anything that's held in there will be absorbed. And so you can do a low dose. Then once you swallow it, it becomes oral. And so not much going to be affected there, right? So we can think about three different doses forms currently available in the market for semaglutide. We have the injectable, which is sub Q, we have uh the oral uh brand name medication, which is a big tablet, not a big size tablet, but a big strong milligram tablet with a lot of drug into it, you're taking orally. And then we have the sublingual version um that you just dissolve in your mouth.

SPEAKER_00 37:27

What's the um do you know off the top of your head absorption-wise, what you're looking at oral versus sublingual? I I couldn't recall that off the top of my head. I think I've asked that.

SPEAKER_03 37:37

Um it's about 10% absorbed orally compared to 10% of the drug orally about, and it could be 10 to 20 depending on different environments, but generally it's around 10% is gonna get through there, and that's why you have to jack that dose up so much. Yeah. Okay.

SPEAKER_01 37:56

But and then, but is it as effective? I mean, does it is it helping people?

SPEAKER_03 37:59

Yeah, it is. Once you get the GLP1 in the bloodstream, it doesn't matter how we get it in there. I mean, we could make GLP1 suppositories if you guys want to start doing that. And those are absorbed really well. So, so once we get it in the bloodstream, it's great. Um, but we just have to, if we're gonna do it orally, that's where we have to give the very most trying to lose a lot of that strength.

SPEAKER_02 38:19

Um does it make it more expensive to to then do it that way because you have to use so much more kilograms.

SPEAKER_03 38:26

Like we we we could make a we could make a GLP1 semaglutide capsule or um or with our new tablet machine, we could make a tablet, but it doesn't make a lot of sense to do that because it isn't gonna be a huge savings. Yeah, yeah. Quite frankly, it's it just makes sense to go the other way.

SPEAKER_02 38:44

Yeah, okay. Uh well, thank you. That I think that's been helpful. Yeah, absolutely. GLP1s and the history, and they don't come from Ghila monsters.

SPEAKER_00 38:54

Nope, nope, don't get worried. There's not a big factory of gila monsters sitting somewhere where they're extracting them. That was the 80s. That was the 80s.

SPEAKER_03 39:05

That's right.

SPEAKER_00 39:06

From someone that has a more creative thought process than I do, it was probably someone like Cliff that uh you know can really think outside the box. Yeah.

SPEAKER_03 39:14

Um I was in pharmacy school, we had a class for uh for a full year called pharmacognosy. Pharmacognosy is the study of weeds and seeds, and it talked about where these drugs came from originally. And and it was the back then it was probably one of the most boring classes. It was the most boring class I took.

SPEAKER_02 39:38

Really?

SPEAKER_03 39:38

Now I would love it because now I mean biochem was another thing. I just could I just got through biochem. Now I'm passionate about biochem. Um I want to know how everything works in the body, right? And so I all my textbooks, my biochem book is the only one I ever get into, still, right?

SPEAKER_02 39:54

That's awesome.

SPEAKER_03 39:54

Yeah.

SPEAKER_02 39:55

All right. Well, we appreciate it. We appreciate you coming on.

SPEAKER_03 39:58

Um, good to be with you.

SPEAKER_02 39:59

Uh we'll wrap it up next time, but we'll uh we're gonna keep you on and kind of do another one.

SPEAKER_00 40:05

Sure. Just remember information per purposes only, we're here just to provide um additional help and information. Talk to your medical provider if you have any specific questions about you know medications you're gonna be using, um, treatment plans, anything like that. Um, we are here to just be a resource for education. Right. So we'll call that a wrap. Yeah.

SPEAKER_02 40:25

We'll clip it there, but we'll