Ozempic Explained: Separating Fact from Fiction in the New Era of Weight Loss Drugs

Everywhere you look, it seems like everyone is talking about Ozempic at dinner parties, on social media, and in the headlines. But behind the hype, confusion swirls about what these medications really are, who should be taking them, and what the risks might be. In this episode of Infinite Health, Dr. Maran will unravel the complex world of GLP-1 medications. She'll break down what GLP-1s actually do in the body, how Ozempic became a household name, and the differences between popular medications like Ozempic, Wegovy, and Mounjaro. Dr. Arasi Maran will explore the verified science and benefits, the risks and side effects that don’t make it into glossy ads, and the realities of new digital health frontiers and gray-market access. Whether you’re curious, skeptical, or just want to separate the evidence from the noise, this episode is your guide to one of medicine’s fastest-moving frontiers.

00:00 The Ozempic phenomenon explained

04:49 Discussing weight loss medications

07:47 Triple agonists and clinical trials

12:34 Discussing oral semaglutide benefits

14:17 Comparing injectable vs. pill methods

19:39 Balancing weight loss and muscle health

22:49 Side effects of weight loss meds

24:36 Safety and mindset in weight loss

27:42 Concerns about compounded peptides

33:00 India's role in metabolic health market

35:31 Risks of widespread medication use

38:32 Understanding Medications and Health Hype

Transcript

SPEAKER_01 0:00

Zempic, ozempic, ozempic, and it sometimes truly chokes you with the amount of information and misinformation there is out there about this product. It almost seems like people love to love it or love to hate it, and there's no balance about it, and it's become like this magical that everyone wants to be on. If you just take these medications without working on your brain, and when you stop these medications, all the food noise, everything comes, and the psychological dependence and the identity, who you become when you're on GLP1 also plays a big role. It's just really, really not a medication like a vitamin tablet that you can just go outside over the counter, pop it, and think you're gonna be okay and you're gonna look a certain way.

SPEAKER_00 1:16

We've all been hearing this word all over the place all the time. A few weeks ago, a friend actually told me that she had ordered a compounded version online from a website that she had never heard of. And she wasn't really sure exactly what was in it, but she knew that people were losing weight and didn't want to miss out. And that's kind of where we are right now. One brand name has become shorthand for an entire category of medications, a wave of new science, and frankly, a lot of confusion. So today we're going beyond the headlines with Dr. Moran. She's gonna map out the entire GLP landscape, separate what's verified from what's hyped, explore the risks people aren't talking about, and look at what's coming next in one of the fastest moving areas in medicine. I'm super excited to get into this episode, Dr. Moran. I mean, like we said, we hear OZempic all over the place. I have several friends who have ordered it from random online websites, and there's a lot of confusion about it. So I'm excited to hop in with you and get into it. But it's again, before we hop in, it's a pleasure to see you. I haven't seen you in a while. It's great to see you. How are you? How's everything going?

SPEAKER_01 2:12

I'm doing good, Leila. And I think you've hit on a very, very obvious and a very common and very relevant topic. It's like you said, it's everywhere. Uh it's either Ozempic mind, or Sempic face, or Sempic body, it's Osempic, Osempic, Osempic, and it sometimes truly chokes you with the amount of information and misinformation there is out there about this product. It almost seems like people love to love it or love to hate it, and there's, you know, no balance about it. And it's become like this magic pill that everyone wants to be on, and there's this fear of missing out if you're not on a Zempic. So it's it's crazy. Either people are on it and love it, or people are not on it and don't like that people are on it. You know, it's creating a strife in a society, I would say.

SPEAKER_00 3:01

Absolutely. I think because it is so it's become so mainstream, and everyone knows the name without really knowing much about it. So everyone has some sort of opinion, especially when you hear something so frequently. I feel like I know a lot about this at this point from doing it, or you know, having conversations with doctors and my own experience and research and things like that. But let's kind of just start off and set the table. So people say Ozempic, like it's this one magic thing. But what actually is a GLP1 and why has one brand name really swallowed the whole category, if you will?

SPEAKER_01 3:33

Okay, love it. So let's start with the basics because once you understand the mechanism, the hype may make more sense, and the risks and the benefits become a little bit clearer. Okay, GLP1 stands for glucagon-like peptide one. It's a hormone your body naturally produces in your intestines when you eat, and it has three main jobs. First, it tells your pancreas to release insulin when your blood sugar goes up. That's the glucose regulation, it keeps your blood glucose stable. Second, it slows down how fast your stomach empties. This is extremely important. It means food stays in your stomach for longer, so you feel full longer. Therefore, you eat less. Not because you now have new willpower which you didn't have a week ago, but because your body is signaling fullness differently. Okay? And the third is it goes to your brain and affects the hunger center, it reduces appetite at a neurological level. Literally, you don't want to eat as much. So a GLP1 medication mimics this natural hormone. It does what your body already does, but just in a more concentrated way. All right. But now, why Ozempic? And what is OZMPIC? Ozempic is a GLP1 medication made by the drug company Novonautisk. It's been around since 2016 and it's been originally approved for the treatment of type 2 diabetes. But people started noticing that they are losing weight and significant amounts of weight, and it got attention. The celebrities started taking it and then it became a cultural shothand. But here's the thing Ozempic is not even the weight loss version. Nova Daughters released a compound called Vegovi, the same medication, semaglutide, but at higher doses, marketed specifically for weight loss. Then, of course, there's Manjaro from Ilila Lee, which has a GLP1 and a GIP, dozens of others in development also. But Ozempic was not designed for weight loss, it was designed for type 2 diabetes. The version Vegovi is the one designed for weight loss and marketed for weight loss, even though it's the same medication.

SPEAKER_00 5:55

That's so interesting. Because yeah, I feel like I hear the names all the time: Ozempic, Wagovi, Manjaro, semiglutide. I'm blanking on more. I know there's more out there. There's so many, but you know, you hear about them and it's like Ozempic does kind of is what everyone really refers to. But I always thought that they were just different in terms of like the amount of weight you wanted to lose. So to my what I've heard is that Manjaro, you lose a significant amount of weight, where Ozempic, you might not lose as much. But I guess that's not right. That's just what I've heard.

SPEAKER_01 6:25

You're right and not right all at the same time. So think of, you know, you have the tissues, which we use to wipe our nose and wipe uh minor spills or whatever, but Kleenex became the brand name for tissues, right? You don't say pass me a tissue, you say pass me a Kleenex, okay? Bandage for simple cuts and something. You don't say give me a bandage, you say give me a band-aid. So once the brand got famous, it became the shorthand and it just seems to cover everything. Yes, you have Kleenex, you have puffs, and you know, it's all the same thing, but just different marketing names. Um, so I think we should map out, you know, what actually got approved and you know what is available right now. What do you think about that?

SPEAKER_00 7:09

Absolutely, yeah. Can map that out for us. So, what actually is approved and what's available right now, and what should listeners really think about the growing list of names that they're hearing?

SPEAKER_01 7:19

Okay, so let's start with the first generation. Okay, that is the GLP1 agonist. Okay, it basically mimics the naturally formed GLP1 hormone. It's a single target, it just affects the GLP1 receptors. Those medications are the semaglutide, ozempic for diabetes, and vegov for weight loss that came out by no-nordisk. In the same manner, you had the lyraglutide, which is Victosa for diabetes, sexenda for weight loss, again by noonordisk. Then you have the dulaglutide or trulicity from Eli Lilly. Then you have the trizepide, Monjaro for diabetes and Zeppound for weight loss, also by Eli Lilly. These are all FDA approved, they are all available with a prescription and they all have safety data. So Monjaro or trizeptide, it's a little bit different. It's a dual agonist, unlike semaglutide or neuroglutide or duroglutide. Okay, trize is a dual agonist, it contains GLP1 and GIP. We'll talk about that in a minute. Okay, these are the injectable formulations which are FDA approved. To add to this confusion, there are also oral formulations. Or you have oral semaglutide called the ribal cys, approved for diabetes, and then you also have a second form called the orfloglipron, okay? And there are others also in clinical trials. These are compounds in development, and then on top of it, you also have the triple agonists, a combination of GLP1, GIP, and glucocon, the triple G. Again, there are trials happening. This is important to know that because these GI, the triple Gs, the chemical version of it, that is just that peptide, comes from different gray market areas, kind of laced with contaminants, etc. And it's causing havoc in the general population, but it does not come through the actual drug pipeline of safety efficacy data from these pharma companies.

SPEAKER_00 9:28

Interesting, because I that's something I also think there's a lot of confusion about. Because I always hear, for example, a single agonist, dual agonist, triple agonist. So now that you kind of talked about those a little bit, can you break it down a little bit more in terms of what they actually mean? And for example, does more targets actually mean that it's a better drug?

SPEAKER_01 9:44

Okay, so that's a great, it's a very complicated question. Just because there are more targets does not mean it's much more better. It's the biology is way more nuanced than that. Okay, a target is just a cellular receptor, right? A lock that a medication fits into. So when you say GLP1, it's a single target, these medications target the GLP1 receptor, that's it. They do that really well. And as a result of it, they regulate the blood sugar, they slow the gastric emptying, they reduce the appetite. So semaglutide, luraglide, dulaglutide, well-proved mechanism, well studied. We have over 10 years of experience with this. Okay. The second sector, which is the dual targets or the dual agonis, are GLP1 and GIP. GIP is another naturally occurring peptide, glucose-dependent, insulinotropic polypeptide. It's just another hormone that affects both blood sugar and appetite. By hitting both these receptors, it's more potent on weight loss and metabolic health. So Manjaro or the prisepatite is a dual agonist and it is shown to produce more weight loss than the single GLP1. But there's no free launch because it is more potent and affects more receptors, it does tend to have more side effects, particularly gastrointestinal side effects, gallbladder, gallstones, etc. Then I talked about the triple G, the triple agonist, GLP1, GIP, and glucagon. So why glucagon addition is important is glucagon raises the blood sugar and therefore also increases your energy expenditure. In animal studies, the triple agonists showed even more weight loss. But this is a critically important point. The triple agonists are still in trial. We don't have long-term human safety data as yet. We know the mechanism. We see promising results, but promising results isn't the same as safe and effective in humans for years. So coming back to your question, does more targets automatically mean better? No. More targets mean more potent effects, which means more weight loss, but also potentially more side effects. A more powerful tool is useful, but it requires more careful handling. The right medication depends on the person, their metabolic situation, their tolerance for side effects, and their goals, and who is prescribing them, and how much of follow-up and how much of oversight they are giving for the patient.

SPEAKER_00 12:24

Interesting. And then I think previously, or maybe it's changed more recently, talking about Ozempic and, for example, all these GLP ones, it's always been an injection, but now there's a pill. So I think there's a lot of excitement around the pill instead of the injections as well. So why does that matter so much? And how might it really change access to the treatment? Okay.

SPEAKER_01 12:44

This matters for multiple reasons, right? First, psychology and adherence. If you remember, the most important issue in medicine is patient compliance. Patients, a lot of patients don't like to inject themselves and they kind of feel that that's very intrusive. There are people with actual fear of needles, etc. So while some people are fine with once a week injectables, some people are not. So an oral medication is easier psychologically to take and also to remember. Second, pills can also be manufactured at scale more easily than injectables. The supply chain is simpler, packaging is cheaper, distribution is easier. This means the medication could be more affordable to more people. Finally, or the third point is a side effect profile. We don't know yet if oral semaglutide has the same efficacy or the same side effect profile as the injectables. The early data suggests slightly lower efficacy with the oral, but you still get the weight loss, but not to the extent with the injectables. As an effect of that, because it is slightly less effective, the side effects are also less and maybe more tolerable. We are still learning with that. Then the market dynamics, you know, you know, the if oral versions work less, there might be less barrier to entry and more manufacturers and more competition and potentially, bottom line, lower prices. But the tension for me here is the medication which have the most data, the ones doctors are most confident about are the injectables. The oral versions are newer and we are still collecting long-term data. So, from a practical standpoint, if you are getting or if you are considering a GLP1 medication from your doctor, it's better to go with the injectable version and see how things go for you and wait and see how the oral medications work and convert later on if you need to.

SPEAKER_00 14:48

And I'm curious talking about that, because I know with the injectables, every like week or every two weeks or whatever it may be, you up the dose of the medicine. So with pills, I'm wondering how that would work. I don't even know if that's information that's available, but would it be like different?

SPEAKER_01 15:05

It will be about the same, and those are the nuances we have to figure out, right? Most people, like for when you're doing the injectable, the way we do the prescription is we stick with the dose for the first 30 days and then we up the dose, and then, you know, depending on how patient side effect responses, you up the dose. My problem with the pill is you have to voluntarily take it, right? So let's say you are planning to go out for dinner and it's a it's your favorite restaurant and you love the food there. If you've taken your injection, you're going to still eat less. But with the pill, you might get into fall into the trap of I'll skip the pill tonight because I just want to have this one good meal. And I feel you'll get back into the trap of food noise in your head, and the neurological benefits of being on the injectable forms may not be there. So I think we have to wait and see how effective weight loss and also the compliance factor with the oral forms and based on you know the side effect profiles and things like that. With the injectable, there's no off button. Okay, your the medication is going to be in, you're gonna have a peak on day four, day five, and then it's gonna come down. Then you take your next week's dose and it keeps the on is all there. But with the orals, you're gonna go on, off, on, off, on, off. And I'm concerned the food noise might not completely go away. Makes sense.

SPEAKER_00 16:32

I could definitely see how you'd be able to easily feel like you could easily skip the pill versus the injection. And okay, so cut through the noise for us. So, what's genuinely verified about the medications today, and what parts of the conversation do you think are mostly hype?

SPEAKER_01 16:47

I love it when you ask me to show you the scientific evidence over and over again. Let's go for it. So here's what the evidence shows clearly. On weight loss, GLP1 medications work. The data is solid, people lose weight, an average of 5 to 15%, depending on the medication and the person. Because you do have to, there are side effects to these medications. Dual agonists tend to produce more weight loss than the single agonist. This is real, it's measured, it's consistent across studies. Okay? Now, on blood sugar, these medications were developed for type 2 diabetes, and they work well for that. They lower blood sugar, they improve hemoglobin A1C, reduce the progression of diabetes, and we've known this for over a decade. Okay, this is extremely strong evidence. Now, on the cardiovascular outcomes, this is where I get super excited. The GLP1 medications show cardiovascular benefits beyond just weight loss. That is, even if you don't lose any weight with a low dose of GLP1, you are still getting the cardiovascular benefits. That is, you have reduced cardiovascular events with uh lyratutide, semaglutide, etc. There's reduction in the heart attacks and strokes. These are huge effects. This is absolutely real. And for that, if you have a diabetic patient or a patient with existing cardiovascular disease, GLP1 appears to reduce the risk of future events. This is like a micro moment, and therefore it is extremely these medications are extremely important in my line of work. Here's what we don't know yet. Long-term safety in otherwise healthy people. You don't have diabetes, you don't have heart disease, you just have a weight loss problem. Okay. What happens to you? Like you, you know, and you are taking it for several years, you know. So if there are very healthy 30-year-olds taking this for just for weight loss, I think we're in an unknown, less studied territory, okay? And weight gain after stopping, the data shows that when people stop GLP1 medications, they do regain weight. Most of it, most of the time. We don't have a 10-year data on what happens, someone goes on and goes off and goes on and we don't know the real world studies on that. And what happens to the long-term metabolism of these patients? We know people who go on yo-yo dieting, their metabolism gets completely screwed up, it's crippled. So if we are doing the same with these medications, going on and going off and going on and going off, what happens to your metabolism? What happens to your gastric emptying? Okay, because you're slowing your stomach, you're making it function normal. You're slowing your stomach, you're making it function normal. What happens to your gut bacteria, which is extremely, you know, crucial to all our hormonal health, our psychological health, our cardiovascular health. So we are learning about all of this. Now, another big, big issue, effect on muscle mass. Okay. When people stop eating, we ideally want them to just lose fat. But because of the gastric epithine fullness and the lack of appetite stimulation, people kind of reduce their amount they eat. That is, if you normally have, I don't know, a foot-long sandwich from subway, now you're eating a half of a six-inch subway. Okay, so you're dramatically reducing the amount of food you eat. And if you haven't worked on the other parameters, why are you eating so much? Or why is there so much food noise? And you're not doing adequate strength training along with this, you will lose both fat and muscle. So, and you know, we've had this conversation before. Muscle mass is the most important metabolic uh gift you have. So if your muscle mass comes down and you become sarcopenic, and but you have a normal BMI, you're not necessarily getting healthier. You're just, you know, switching one problem for another. So we need to be very careful about that. So the verified part, weight loss, improved glucose control, cardiovascular benefits in people with existing cardiac disease. The less clear part, long-term safety, long-term effects, long-term outcomes after stopping effects on healthy people without metabolic disease, and you know, optimal use protocol. People are just buying it from, you know, random people. People are buying it from, you know, not endocrinologists, not cardiologists, not internal medicine doctors. They're buying it from people who have never actually dealt with real patients for a long time. And, you know, these concierge centers. I'm not sure uh how that is going to play out.

SPEAKER_00 21:38

Absolutely. And yeah, I actually had a friend who bought some sort of compounded semiglutide on groupon and wound up getting super sick. And it's like, I don't think I would trust buying something like that, like a medication on Groupon. You don't know where it's coming from. And it's things like that are super, super common. Like they're they're just, you know, able to find it all over the place, and it's not. Particularly safe. And then speaking about that, speaking about the risks, so you touched a little bit on side effects, but are there any other risks involved and things that maybe nobody puts in the glossy ads and the and the marketing around it? And what should patients really understand before they decide to really start one of these medications?

SPEAKER_01 22:18

Very important point, and let's spend a few minutes on this. I really want to, you know, a deep dive into this and be very clear. These medications are not without side effects. Okay, so you have to be mentally, emotionally prepared for the side effects of it. Okay. The most common side effect is nausea and vomiting. Definitely happens. You've not been pregnant before, Layla, so you may not know what morning sickness feels like. I've gone through three pregnancies, and the morning sickness you get with pregnancy, where the sight of food, the smell of food, or any of your food, you just get nauseous. That's how it feels like. Okay. That can be the first three weeks for you, or it can be every time you escalate the dose. Okay. Some people have diarrhea, some people get constipation, and sometimes they have both. You can get abdominal pain, okay? And there is an intense loss of appetite. That's by design, but some people can have excessive loss of appetite. Now, most of us cannot clearly differentiate between hunger and thirst. And with the lack of appetite with any of these medications, you can get a profound loss of thirst. And patients don't drink enough water, or even the stretch of your stomach with water can initiate a nauseous response, and people stop drinking water and can get profoundly dehydrated. Okay. So this is a true real problem. You have to be extremely mindful. And this is where you need like a proper oversight with the clinician who's dealt with GLP1 medications or a Manjaro, etc., to walk you through it. Okay. And so the more bigger, you know, these are immediate things which happen, the bigger one is the metabolic effect on muscle loss. If you rapidly lose weight, that is, if you don't slowly escalate your dosage, but you just go every two weeks to increase your dose, then you're going to very rapidly lose weight and you're going to lose a lot of muscle mass. Muscle is metabolic, you lose your strength, you lose your function, you lose your long-term metabolic health. So it's extremely important to not kind of focus on your muscle mass itself. So after muscle loss, there is a life-threatening condition called pancreatitis. And people have to know about that. It's acute pancreatitis can be fatal. FTA has issued warnings. Is it causal or coincidental? The data is mixed. But if you have abdominal pain which is not getting better, you need to seek medical treatment. Then when you have rapid weight loss, you can trigger gallstone formation to the extent where people need gallbladder removal because of that. Okay? Then there is also a black label warning on patients with familial history of metathyroid cancer. It's there in the animal trials. Whether it translates to human, we don't know. Then there's also weight loss plateau, right? People, your body wants to wants you to be well fed, wants calories in excess. So when you drastically reduce your calories, your body is going to adapt in a certain way that your weight loss plateaus and it's again uncharted territory. And finally, the most important thing is your mindset. If you just take these medications without working on your brain, then when you stop these medications, your all the food noise, everything comes. And the psychological dependence and the identity which you who you become when you're on GLP1 also plays a big role. So you need to think about that. So it's just really, really not a medication, like a vitamin tablet that you can just go outside over the counter, pop it, and think you're gonna be okay and you're gonna look a certain way, etc. It's a very complex medication. So so please don't do it without actual medical oversight.

SPEAKER_00 26:29

I definitely had never even thought about the the mental aspect of it. That's that's interesting too. And it's it's also like a little bit with body dysmorphia, I think too. People look at themselves and they don't even recognize who they see sometimes, too. I've I've heard I've heard that part too. You take the medication, you look different, you feel different, but sometimes your mind doesn't catch up to where you are physically as well, which is something that I've heard about. And so we touched on this a little bit, but let's refer to it as the gray market. So the compound inversions, the online peptide sellers, the social media shortcuts, and we obviously know there's risk involved, but how worried should people be? And what's your stance on that? I know you just emphasize how important it is to do it with a medical professional, but aside from that, is there anything that you're really worried about? Absolutely.

SPEAKER_01 27:14

I'm very concerned about the gray market, as you said, okay. Here's what's happening the demand is massive, okay? Insurance often won't cover these medications for weight loss. They cost $900 to $1,500 out per month out of pocket. And even in a market like India, where you it's cheaper, but the compounded versions are even more cheaper, right? So people want them. There are online pharmacies like what you said your friend did. There are peptide suppliers, the compound pharmacies, they're just trying to fill the gap. Compounded versions are made by pharmacies without any FDA oversight using active pharmaceutical ingredients. The ingredients might be real, but the dosing might not be accurate, the sterility might be questionable, storage conditions might be completely wrong, and you have no recourse if something goes wrong. And they are also trying to combine more than one peptide. I've we've done an entire episode on my take on these unofficial peptides. So they try to combine it so that the number of injections can be reduced. And I have seen compounded GLP ones cause severe infections, allergic reactions, side effects, because the product wasn't what the label said it was. There was a recent expose done by BBC where these so-called compounded medications did not have any of the key ingredients they advertised that they would be. So, you know, research peptides and overseas suppliers, they are just extremely diluted, often contaminated. And I just think, you know, these telehealth platforms have adopted a prescribe first, ask questions later model. They send you a prescription without proper assessment. They're not measuring your body composition. There is no close monitoring. It's just dangerous. And of course, there's these social media enhancers, n equals 1 experimenters who just promote GLP1. I mean, I have followed patient influencers who were talking about keto diet, low-carb diet, whole food diet, now have changed their social media channels to GLP1 journeys and stuff like that. It's just too crazy. If you have obesity as a problem, that's a medical diagnosis, and you need to be treated by someone who actually treats patients and sees them on a regular basis and not follow some hypers or crazy websites or you know, things like that. Please be careful about this.

SPEAKER_00 29:48

It's your body. Absolutely. And touching on that, I think that another thing that has really emerged so much alongside medications is this entire digital ecosystem, right? So, for example, telehealth platforms, coaching apps, wearables, glucose monitors, AI assessments, even, and really endless online programs built around GLP therapies. So, what's genuinely helpful and what should make people really stop and take a pause?

SPEAKER_01 30:14

Yeah. This is the infrastructure that's so grown, I mean, it's grown so rapidly. It's important to evaluate critically, okay? What's potentially helpful? Telehealth platforms with actual oversight. If a telehealth service is requiring labs, medical history, contraindication screening, ongoing monitoring by a doctor where you're talking to them, you know, even if it's through the digital platform, you're actually talking to a doctor. That's valuable. It increases access to care for people who need it and cannot see an endocrinologist very easily. Coaching or support apps that focus on protein intake, strength training, the food noise, that's very crucial. When you are on a GLP1 and you're losing weight rapidly, you need adequate protein to preserve muscle and you need to do resistant training to maintain strength and bone health. Apps that prompt this are extremely helpful. Continuous glucose monitor for people with metabolic disease. If you're a diabetic or pre-diabetic and you're on a GLP1, I think a continuous glucose monitor can be interesting. Okay? It can show how different foods can affect your blood sugar. That's educational and useful, but I don't think you need a CGM for the rest of your life. You may need a CGM for the two weeks to understand how your body responds to different foods. And you take those insights and apply them to the rest of it. You don't need to be them on all the time. Wearables that track sleep, recovery, you know, sleep impacts everything. So if a wearable helps you optimize sleep, that's valuable. What should make people pass? Platforms that prescribe without proper assessment, red flag. Sign you up and you have an asynchronous conversation, not a synchronous conversation. That is, you put in your symptoms and you get a message from somebody. You don't even have an actual conversation with the real person. For me, that's a red flag. Apps that make inflated claims that they will optimize your GLP1 experience. What do they mean by that? What is the data? Okay. CGMs are continuous glucose monitors on people without any metabolic disease. If you're metabolic healthy, what is CGM going to do for you? If you eat a cake, your blood sugar will go up. You don't need a CGM to let you know about that. So, you know, just use common sense for God's sake. Then all these AI optimization protocols, like I feel like if you use the word attach AI to anything right now, it sells very fast. And therefore, AI is used everywhere. AI coach is not a substitute for a real coach, at least for now. So be careful. My framework always asks who profits from this. Is there evidence behind the claims? Is there real actual medical oversight? If the answer is it's complicated or not really, be skeptical, okay? The best digital tools are the ones that support good medical care, not the ones that try to replace it.

SPEAKER_00 33:22

Absolutely. And you mentioned India earlier, and I think that there's one of the most fascinating things in this space is what's happening in India. So I know in such a short period of time, India went from kind of watching the global GLP conversation to becoming one of the most important markets for affordability and access. So we've seen the arrival of headline medications, like we talked about Manjaro and Wagovi and the emergence of lower cost semi-glutide options and aggressive price competition that simply just doesn't exist in many other countries. So, in your perspective, what opportunities does that create for improving metabolic health and also what risks emerge when powerful medications become such become so widely accessible at a lower cost? Do you think that India could become a real-world test case for whether broader access translates into better population health outcomes?

SPEAKER_01 34:11

It's a very interesting question. India's story is truly, you know, very, very intriguing, right? It tells us something important about where this is heading. So GLP1 medications became popular globally, but the India's pharmaceutical industry started producing them just recently. We've seen the arrival of semaglutide, tryzepatide, headline medication at a fraction of a global price. In the US, a month of semaglutide costs about $900 to $1,500. In India, it's $3,200, depending on the formulation and the supplier. Okay? Why does this matter? First, access. At that price point, metabolic medications become accessible to people who could never afford them at the Western prices. That's potentially positive for public health. Second, quality. India's pharmaceutical manufacturer is highly regulated. We are not talking about compounded garage operations. We're talking about pharmaceutical companies that export to other countries meeting international standards. Third, innovation. Affordability at scale drives innovation. Manufacturers start thinking about cost-effective delivery, different formulation, manufacturing efficacies. But there's always a but there are also risks. First, regulatory variation. India's pharmaceutical industry is strong. Regulation of how these medications are prescribed and monitored in less developed countries is very different. So you could have widespread use of these medications without adequate medical oversight, even worse than what's happening in the US. Second, informed consent. These medications become cheaply and readily and widely available, and there's not adequate patient education about the risk, side effects, the need for protein intake, strength training, etc. And as you know, the Indian population already struggles with poor muscle mass. So this leads to the third point: off-label use without guidance. Powerful medication used without medical oversight is going to put a lot of Indians in a medical quagmire of complications and side effects. But here's what's interesting and exciting. India could become a real-world test case. What does it look like when you give broad access to these medications to a large population without adequate medical infrastructure in urban areas? Do metabolic outcomes actually improve? What happens to health equity between urban and rural areas? What side effects emerge at scale? What works in terms of monitoring and patient experience? If India's experience shows that broad access with good effects, good oversights leads to improved metabolic health outcomes, the conversation changes globally. But if it shows that without proper education oversight, the outcomes are worse, we learn it, learn from that too. So I think we have to wait and see to see how the Indian market performs with the GLP one because India is a dichotomous economy. There are the haves and there are the have nots, and both of them have access to GLP ones right now.

SPEAKER_00 37:28

That's so interesting. I'm so interested to see where it goes and what really develops from that. And I think that one thing that really does stand out from today's conversation is that the story is so much bigger than just weight loss. And there's, I'm sure there's so many other things that we can dive into in future episodes on this topic as well. But before we do wrap up this episode, is there anything else that you want to add or maybe tell the listeners that we haven't mentioned so far?

SPEAKER_01 37:54

I think the most important point I would like to stress is these medications are not just weight loss medications. From a cardiologist's perspective, these are extremely important metabolic medications which change the way your heart behaves, your brain behaves, your liver behaves, and your kidney behaves. So if we can improve metabolic health at scale in a large population, it has a cascade effect on cardiovascular disease, diabetes, and ultimately our overall health span. So it needs to be done thoughtfully. So please, if you are even remotely considering maybe I should be on a GLP 1, or is GLP1 needed for me? Is it good for me? Talk to a doctor who practices medicine, who sees patients on a regular basis. That would be my biggest takeaway in this episode.

SPEAKER_00 38:47

Absolutely. And I think also these medications are definitely changing how we think about obesity and diabetes and cardiovascular risk and metabolic health. They're important tools, but I think that that's the key thing to say is that they're important tools, but they are still tools. They're not magic, which is, I think, a lot of the hype that people are assuming that they are. So I think the challenge for patients is really learning how to separate evidence from marketing, long-term health from short-term health, and real medical care from internet shortcuts. Thank you so much for really helping us make sense of such a rapidly changing landscape. I think that this was such a good conversation. And I'm excited to see where this goes in the future as well. So if you liked this conversation, if you got some really good insight from this conversation, also make sure that you're following the show. Share and subscribe. And everyone is talking about this topic right now. So share it with someone. Everyone wants to hear this. And Dr. Moran, thank you so much for really helping clear this up and shedding some light on such a common topic right now. So it's a pleasure speaking with you as always, and I can't wait to talk to you again soon.