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Speaker 1: 0:00

<silence> Welcome to the Metabolic MD. Health means everything. We all seek optimal health, but most of us do not know how to achieve it. Dr. Paul Kloza has spent a career in the emergency department now, he helps his patients avoid ever ending up there. During these podcasts, you'll learn how you can lose weight and prevent and reverse disease through new technology, a modified diet, and the use of some new recently approved FDA medications. This information is not meant to be medical advice. Please seek consultation from your own medical provider. Let's listen in.

Speaker 2: 0:36

Alright , folks, we're back. It's another episode of the Metabolic MD with Dr. Paul Kozik . We are heading in toward the holiday season, which means it's D-Day for gaining weight. Is that correct, Dr. Paul?

Speaker 3: 0:51

That's the way it is. And then comes the New year and New Year's resolutions

Speaker 2: 0:54

And that they all go together, don't they ? You , you , you become a glutton and then you pay the price in January. I understand how that works so well.

Speaker 3: 1:02

Hopefully you don't become a glutton.

Speaker 2: 1:04

Well, okay . No, not , not with you watching me all the time, <laugh>. It doesn't happen . So I'm very excited today to talk about , uh, this topic we're gonna cover. So why don't you kind of tell us a little bit about the topic and then we'll go from there.

Speaker 3: 1:18

Well, there's all this news out there of these new weight loss medications, the new FDA approved weight loss medications, the medication of the stars, because you hear all about these Hollywood personalities that have lost all this weight. But there's a lot of confusion out there about these medications as well. What's the difference between Ozempic and Wegovy? Uh , what is the generic of that? What about , uh, the new medication that is called Zep Bound, which is really just an iteration of Monro . So you're hearing all these words out there and there's a lot of confusion about what these medications are, a lot of cost issues. So I thought we would talk about that.

Speaker 2: 2:00

Well, I , I gotta agree with you. Every single time it seems like I'm watching TV with my wife. We're watching the news, we're watching Inside Edition, we're watching Entertainment Tonight. There's a segment about how people are using these medications to lose weight. It seems like it's, it's the hot topic. And not only that, I saw a show just the other day where they said, these medications are gonna have a bigger impact on society than ai.

Speaker 3: 2:27

Yeah.

Speaker 2: 2:28

Because of the way it'll help improve weight , weight loss, or obesity will be reduced. Health issues will be reduced. Yeah. So this conversation that we're having today is probably the most important one we've ever

Speaker 3: 2:39

Had. Yeah . Yeah. I don't know a lot about ai, but I do believe these are gonna become the most prescribed medicines in the history of the world, bigger than statins, which have been used huge for the last 20 years. So I think it's important for people to understand what they do , uh, what the upsides and what the downsides are of these medications.

Speaker 2: 2:58

So for somebody joining us for the very first time, let's just go over a little bit about your background and why you're probably considered the area expert on these medicines. So can , can you tell us a little bit about what you've done in your past and how you got here?

Speaker 3: 3:13

So, my background is as an emergency physician, and I got tired of seeing people in the emergency department over 25 years that had all these health issues due to obesity and quite honestly, just high blood sugar, you know, high blood sugar results and inflammation in your arteries, and then all the vascular problems that pre-diabetics and diabetics have, like peripheral vascular disease and kidney failure and heart attacks and strokes. And so after , uh, working in the emergency department for 25 years, I became proactive about seven years ago and opening my own metabolic health practice and helping people address those issues. Reversing pre-diabetes, decreasing medication requirements in diabetes, or even putting diabetes in remission for a period of time. And then of course, helping people lo lose weight with the insulin resistance model of weight loss, which has to do with keeping your blood sugar under control so you can burn fat and lose weight.

Speaker 2: 4:14

Alright , so you're not just a doctor who's gonna say, Hey, come see me, I'm going to prescribe you one of these numerical drugs. Right ? That's not what you're

Speaker 3: 4:22

About. Yeah, that's not gonna happen. We're gonna talk about the appropriate use of these medications, but I don't feel it's right for somebody to come to me that wants these medications and say, oh, that's fine. I'm gonna prescribe you these. Good luck with them. You'll be on 'em for the rest of your life. We work with people with the other aspects of a comprehensive program, which I think are critical. You know, these medicines are expensive. You don't want Oh yeah . Have to pay that cost for the rest of your life. And you want to use 'em prudently. They're good medicines. Um, but you , you don't want to be completely dependent upon those. And, you know, I've been working with people, you know, helping them lose weight and improve metabolic health with low carb diets and continuous glucose monitors and other aspects of a comprehensive program for seven years. So this is just another piece of the puzzle that should be utilized prudently.

Speaker 2: 5:12

Alright . So let's get into this a little bit more. Let's talk about the medicines themselves. You , you , you keep referring to them as GLP one, right? What is a GLP one?

Speaker 3: 5:22

So a GLP one is a glucagon like peptide.

Speaker 2: 5:26

Oh, sure. Who doesn't know that?

Speaker 3: 5:28

Yeah, who doesn't know that? Ba basically, just think of it as a dietary hormone, a gastrointestinal system hormone. It is produced in the lining of the stomach, and when you eat, it gets redu , it gets released.

Speaker 2: 5:44

This is a natural thing. We all ,

Speaker 3: 5:45

It's a natural thing. Everybody's got it. Okay. Okay. And without complicating thing , there's a second hormone involved in some of these medicines called GIP as well. But I , I don't, you know, that's a minor issue. People are going to hear that related to Monro and the generic of that tirzepatide. But they basically, those two hormones have the same action, and those actions are to decrease gastric empty. And that's a fancy way of saying your stomach will stay full longer. So food moves from the stomach into the intestine at a slower pace. It lowers blood sugar, which has been a focus of my practice for years. Because if you can keep your blood sugar a little bit lower, then your organs will turn to burning fat as a source of energy, and that will help you lose weight. And then these medications, thirdly, have a direct effect on the brain. The fancy term is hypothalamic effect, which means it acts on that hypothalamus in the brain, which is the hunger center of the brain to decrease hunger. And there's no question in my experience with patients that these medicines can decrease hunger, vary significantly.

Speaker 2: 6:50

So all these medicines we're talking about, wegovy, ozempic, zep bound, all of the , they're all GLP ones. They're

Speaker 3: 6:58

All

Speaker 2: 6:58

GLP ones because they reproduce that hormone

Speaker 3: 7:00

Because Yeah, yeah. They basically help act with that hormone to cause those effects, which cause people to lose weight.

Speaker 2: 7:10

Okay. So let's talk a little bit about these because , um, I get confused. There's so many names out there. Which ones, okay ? Which one should I be using if I'm trying to lose weight?

Speaker 3: 7:21

Yeah, so let's go through that. Okay. So these medicines originally were created for diabetics. So basically because they're great medicines, because they keep your blood sugar low, but they lower, but they don't drop your blood sugar into a very low range, which is the hypoglycemic range. You know, hypoglycemia is that condition where your blood sugar's really low and you might feel lightheaded or jittery. These medicines don't do that, but they lower it from high ranges to normal to low ranges. So they're great medicines for that reason. They were used originally for diabetics. The first one, if you're familiar with this name was Saxenda. Another one for diabetics in this weight class or , or in this classification was Trulicity. Um, and these basically lower your blood sugar. So they were used for diabetics, but then the drug companies that produce them, notice people lose weight on these medications too. So they went back and got approval, focus strictly on weight loss. So to classify the medications, there was initially sex Senda and Trulicity and a few others. But the ones that really got a lot of notoriety first was Zabe, which was, which is the medication used for diabetics. But Novo Nordisk, who makes this, the drug company, went back and got approval as wegovy for weight loss.

Speaker 2: 8:43

It's the same

Speaker 3: 8:43

Thing, exact same medicine.

Speaker 2: 8:45

So it's just , uh, the different commercial you're seeing on tv, it's the same thing that, that that pin or that insulin , uh,

Speaker 3: 8:52

File . So when you hear oh , oh , oh , ozempic , yeah , you can also think Wegovy. Okay, <laugh> . And then there is a compounded medication, which is available at a lower cost, which is not exactly equivalent to the generic, but if you want to think about how medicines are named , uh, this name is Semaglutide. So basically Wegovy, Ozempic, semaglutide, all the same medicine, Ozempic for diabetics, wegovy for weight loss, semaglutide is the compounded medicine.

Speaker 2: 9:25

And a semaglutide is basically like an ibuprofen, basically. There's just, there's a generic,

Speaker 3: 9:31

It's not exactly equivalent, equivalent to a generic, but I think people can think of it as that way.

Speaker 2: 9:37

Alright , so , uh, the question I would have if I walked into my doctor today, there's, there's five or six of these things out there. Yeah. I wanna lose weight. Which one would they prescribe and why? What , what , what's the difference? Okay,

Speaker 3: 9:49

So let's go. We just talked about there's Ozempic, wegovy, semaglutide, right? The other common option now is Monro , initially for diabetics as well. Um, now being marketed, you're gonna hear a lot about this in the coming months, Zep bound.

Speaker 2: 10:06

So it's the same thing,

Speaker 3: 10:07

Exact same medicine . So

Speaker 2: 10:08

They're taking the same thing, right ? They're just rebranding it. Right . Doing some cute commercials with clever songs. Yeah. It's the same medicine, right? Does it cost the same ,

Speaker 3: 10:17

Uh, the , the , actually when it's prescribed for weight loss, it's usually more expensive. Really. Yeah. Yeah. And , uh, and , uh, we're gonna talk a little bit about this because the expense issue is a big issue. A lot of patients come to me and they're interested in these medicines, but , um, they aren't covered by their insurances. Insurance, you know, insurance companies and , and , and private companies that provide insurance to their employees are struggling to deal with the cost of these medications because , uh, Ozempic wegovy , um, Monro , Zep bound, you know, if it's not covered, it's so they're all over a thousand dollars a month outta pocket .

Speaker 2: 10:56

But, but d doesn't it make sense for these insurance companies that if this is true, this is gonna be the biggest thing since ai Yeah . Are bigger than ai. Yeah . That will reduce the burden of insurance.

Speaker 3: 11:07

I , I , I get it. And I think long term that is true, but you know, insurance companies are looking at the next quarter's profit results because it relates to their stock price. Yeah. Okay . Um , and you know, we , we , we can't really afford to dish out, you know, 30% more in healthcare costs this month. Uh, even though it might be a good thing five years from now.

Speaker 2: 11:29

So, okay. Getting back to the different medicines I'm in my doctor's , uh, waiting room, waiting for a long time, by the way. Um, and he walks in , not in

Speaker 3: 11:37

My office. You don't? No . Not in your

Speaker 2: 11:38

Office. That's right. But , uh, so he walks in, I go, Hey, I want some of these new weight loss medicines. Which one will he

Speaker 3: 11:45

Prescribe? Okay. So let's talk about that. Okay. If you're diabetic ozempic Yeah . For pure weight loss, wegovy , if you have coverage.

Speaker 2: 11:52

Okay . So what are these other guys doing ? And then what , what is the difference between the new ones that are coming out?

Speaker 3: 11:56

Well, they're , they're similar. Actually, I mentioned Monja . Let , let's go through this. Okay. Okay. Ozempic, if you're diabetic, wegovy for weight loss, compounded semaglutide , um, very similar medicine , um, just

Speaker 2: 12:09

Cheap or less expensive,

Speaker 3: 12:10

Less expensive if you don't have coverage. Um, and then montero for diabetes. Okay . Okay. Zep , which you're gonna hear a lot about literally in the next couple months because the advertising's gonna start is Z-E-P-B-O-U-N-D. Okay . Um , but again, if you don't have coverage, both those medicines are over a thousand dollars a month. Um, Zep balance specifically for weight loss. And then there is the compounded tirzepatide. Tirzepatide is the same medicine as , um, Monro and Zep .

Speaker 2: 12:42

So that's a generic term. Yeah . For what they're doing. Yeah. So are , are they , do they have generic zpi ? How do you say that again? I'm sorry.

Speaker 3: 12:50

Uh, tirzepatide.

Speaker 2: 12:51

Tirzepatide. Yeah . Do they have generics of that?

Speaker 3: 12:53

It , it's not generic. It's a compounded medicine, which means it's mixed with other medicines like vitamin B12.

Speaker 2: 12:59

Okay. Um,

Speaker 3: 13:01

But the cost is lower. Alright . For people that are paying out of pocket . So

Speaker 2: 13:04

Which one's better? Which one's gonna let me lose weight faster? Which one's gonna have less side effects? So what's going on?

Speaker 3: 13:11

So this , this is a good question. So the studies have shown , uh, that Monro zba Tirzepatide , uh, because of that extra hormonal component, the GIP component , uh, will cause you to lose a little bit more weight. Uh , I will give you my personal opinion on this is that if you're doing the other things that you should be doing in association with this medicine , um, such as in my office, guided low-carb diets, usually using a continuous glucose monitor, some intermittent fasting strength training, because all these medicines can cause you to lose muscle mass if you're doing the other things that you should be doing. The difference between these medicines is minimal. You know, now if, if you want to get on the internet and just find somebody that'll send you some medicine , um, and not do anything else, then yeah, you're probably gonna get a little bit better result with Mandu , zeba , tirzepatide. But , um, those are a little bit more expensive than , for example, a zenbeck Wegovy semaglutide. And in , and in my practice, if you're doing the other things that we're guiding you and doing , um, then the weight loss difference is not that significant. Basically, the weight loss difference in the studies with , uh, Monro , um, Zep bound Tirzepatide was you , you know, like two or 3% more weight loss. So we're talking the difference between, you know, 12 or 14% weight loss, verse 15 and 16% weight loss.

Speaker 2: 14:43

Alright. So maybe I'll get a little bit better results with , uh, zep bound. What are my side effects? Are they the same side effects that I would have with, with semaglutide?

Speaker 3: 14:54

Yes . Side effects are pretty similar. So let's talk about how you take these medicines. They're a once a week shot and you take them in an escalating dose over a period of time. So you take the same dose for four weeks and then the dose gets bumped up for four weeks. You do that for four weeks, dose gets bumped up again for four weeks, and you do that for four weeks. The reason this dose is gradually escalated is because of side effects. Um, and nausea is the most common side effects. I have not had patients that have had significant problems other than nausea. Um, but you gotta escalate the dose slowly for that reason. And then there are both indications and contraindications for the medications. You know, if you're following all the rules about when they should be prescribed, you know, somebody comes to you with a body mass index of 23 and wants to get to 20, that's not an appropriate use of these medications. The indications are a body mass index of 27 with a metabolic health issue, which is an issue such as hypertension or high cholesterol or cardiovascular disease. Right . Or A BMI body mass index over 30 with no indications just for weight loss alone. So let

Speaker 2: 16:02

Me, let me pause you real quick. Yeah . Because I'm not the smartest guy in the world. Yeah. But every time somebody tells me BMI yeah . I go, what the hell's that? Yeah . How do you figure that out?

Speaker 3: 16:11

Yeah. Body mass index is just a ratio of height and weight , um, that suggests you , you know, you're healthy or not. So a normal BMI is under 25.

Speaker 2: 16:23

Um , and do , do you know what that would be by weight and height? Or is it just a rate ? So if I'm so tall, I

Speaker 3: 16:27

Can be , well , it depends upon how tall you are. Yeah . And you know how much you weigh, but it's very, I mean, you just plug in numbers in into calculators Okay . That give you the BMI or you look at a graph. Okay. Um, so the , those are the indications. And then there are a few contraindications. For example, if somebody has recurrent gallbladder problems, they should not be on these medications. Um, if you don't have a gallbladder, it's fine to use 'em . But if you're having, if you have recurrent gallbladder problems, if you have a couple strange type of cancers, either personally or that run in your family, one unusual type of thyroid cancer or a very , uh, strange type of cancer where you get multiple different primary cancers called multiple endocrine neoplasia, then you shouldn't be on 'em. But the contraindications, in other words, reasons you should not be on medication are actually fairly limited. And , and then there are con you know, just like any other medicine you get on the internet and you look at the potential complications, you know, gallbladder pros , pancreatitis, you know, the list is like 15 long. But , uh, other than nausea, I really haven't had patients that have had significant side effects or complications. So

Speaker 2: 17:35

Let's talk a little bit about the health benefits because , um, you know, again, everybody's saying this is gonna be the biggest impact since ai. What are some of the health benefits that come along with these medicines?

Speaker 3: 17:46

So as any good drug company would do, they're doing additional studies looking at what other things these, you know, whether medical conditions that this medicines might help. So first of all, you know, decrease BMI, there's a benefit of that. Sure. You know, control of blood sugar, you know, 60% of the people in America have some insulin resistance. Um, so , uh, so if you're controlling your blood sugar a little bit, you're decreasing that vascular inflammation that we alluded to. So that's a health benefit. And now the new studies are coming out that the drug companies are doing, for example, there was one, you know, two months ago saying that if you have a heart condition, if you've had a heart attack previously , um, that this will, these medicines will decrease your risk of a subsequent heart attack study came out last week saying , uh, say saying that if you have fatty liver disease, this medicine will help control your, and maybe eradicate your fatty liver disease. Since I have y you know, some background in the area of addiction medicine as well. Um, there , there is now some news coming out, which I believe, 'cause I see this experience in my patients , uh, semaglutide , uh, helping with decreasing alcohol cravings. And I have lots of patients that really don't have alcohol problems, but you know, they're drinking a little bit more than they want to be drinking. Right. And then they get on these medicines and their alcohol , uh, consumption decreased significantly. So, you know, the , the a perfect patient for this, and this is just conjecture, there's no studies on, you know, decreasing alcohol use. But I'll say anecdotally, there's no question that it happens. So if you've got an overweight patient that's drinking a little bit too much, these medicines are really a good fit for those patients. So

Speaker 2: 19:36

Will the general doctor , uh, doctor generic, let's just call 'em you go see. Yeah. Does he know all this?

Speaker 3: 19:44

Um, you know, I think y you know, because of the way I've used these medicines and integrated them into comprehensive program, which I'd like to talk a little bit more about. Sure. Um, you , you know, I've just gained expertise. You know, my , my finger was on the pulse of this when it first became evident that zenbeck causes weight loss. Yeah.

Speaker 2: 20:03

But how does a , how does a nor uh , generic doctor learn about these benefits? How are they finding, is it the sales guy walking in the door saying, here, you gotta use this because Yeah ,

Speaker 3: 20:12

I think you gotta have a special interest in this. And, and we've talked about this before, Terry. You know, you want to go to somebody that has a big knowledge base in this area and knows how to use these medicines. And, you know, primary care doctors are great, but they're time pressured. You know, you know, you go into the office, oh yeah. They're behind their computer pounding away. You get 15 minutes with them, you know, maybe for a six month visit. You know, it's like, we will adjust your hypertension medicine a little bit. You know, they , they can prescribe these medicines. Um , but I don't think that they know in general how to integrate this in with a comprehensive program, which is what we

Speaker 2: 20:52

Do . So what kind of doctors should they , if somebody's somebody listening out there, hopefully they are . Yeah . Who do they look for? What's the name of the

Speaker 3: 20:58

Doctor? Yeah . I look for a metabolic health specialist, metabolic

Speaker 2: 21:01

Health

Speaker 3: 21:02

Specialist. So I'm licensed in Ohio, Indiana, Florida, and Arizona. I do most of my work by telemedicine. Right. As you're aware , um, there's a society, a couple websites you can get on , uh, the Society of , uh, metabolic Health Practitioners, SMHP. You can get on, there's providers you can find in your state. There's another organization, I'm members of both these organizations. I was a founding member of the Society of Metabolic Health Practitioners, but another organization called Low Carb , uh, USA . You can go to those organizations, you , and you can find people in your state that have expertise in this area. But what I'm opposed to, and obviously they're a competitor, is, you know, people just getting on the internet and finding a provider that will send you medicine and then, you know, you can use that for six months without any monitoring or guidance or ongoing adjustments. Because what is critical, I believe, with these medicines is that you use low doses to the extent you can. Right. So you can then titrate back off the medicine as opposed to just being thrown medicine. And then you go up to the highest doses and you become depe . I mean, they, these medicines are not psychologically addicting, but they certainly can be, excuse me, can , are not physically addicting, but they certainly can be psychologically addicting. And so what you want to do is use low doses, titrate up slowly, and then titrate down. And the way you do that is by doing other things, lifestyle changes, things that help you make sure that you can continue to keep your weight down in the future. Complications of these medicines, weight gain, recurs when you go off the medicine. Right . Unless you've , uh, made comprehensive changes like we've discussed. And then you also lose muscle mass. And that's why strength training is an integral part of the , uh, programs that I do with my patients.

Speaker 2: 22:57

All right . So one of the things that I was, I took one shot one time, right. I'm a diabetic. Right. And they tried to put me on it , it was years ago. Yeah. I , it , it made me a little nauseated and , and , and it took away any craving I had to eat. Yeah. That's kind of what this is, right? It's just taking away the craving that you wanna get up, go to that closet and pull out that bag of chips and start eating because you just don't want to do it.

Speaker 3: 23:18

Right. Right. And, you know, in that case, for example, what what we do is hands-on guidance where we're making dosage adjustments all the time. If I have a patient that starts it , um, and they do have some nausea problems, we will back off on the dose, or we'll stay at a lower dose for a longer period of time until they adjust for that. Or we'll provide them nausea medicine for the first couple shots in that four week period of time till they're adjusted to it, get over the nausea and then we'll titrate up slowly with the intention of titrating down.

Speaker 2: 23:51

Okay. So , uh, we're running outta time on this podcast, but I wanna make sure we cover some of the cost issues because you really shocked me when you told me it's a thousand dollars Yeah. A month. Yeah. And if it's not covered by insurance, right. Who, who's affording that? Yeah . Why are they doing such a great marketing campaign when they can't, nobody can afford to buy these

Speaker 3: 24:10

Medicines? Yeah . I think that , you know, if you have a limited market penetration and those uses, the , their companies obviously are still making money. Uh, even though it's the coverage is not as widespread. Some people, you know, can do that pay out of pocket . You know, the compounded versions are about a third of that.

Speaker 2: 24:26

So a com , you know , so , uh, so again, I I hate to go back and harp on this, but the normal doctor sitting in his , uh, practice in a suburb area, right? Yeah. Do they know about Compounded Glide ? They compounded

Speaker 3: 24:40

Tirzepatide. They're not set up to, to do that . So

Speaker 2: 24:42

They don't know , they don't even know it exists .

Speaker 3: 24:44

You , you have to have a , a relationship, excuse me, needs to be a provider that has a relationship with special compounding licensed state licensed pharmacies that can do that. And

Speaker 2: 24:54

That's something you've done.

Speaker 3: 24:54

That's something we've done as well. So you can, you know, again, knock the price down by a third or so,

Speaker 2: 24:59

But it's the same thing. But this is a , this is in a vial versus a pen , correct?

Speaker 3: 25:04

Yeah , you have to draw it up. We walk all our patients through that.

Speaker 2: 25:07

Okay.

Speaker 3: 25:07

Yeah. But can I go back and emphasize again, limited dosing, you know, limited periods of time with in association with the diet and exercise program. So we focus on low carb diets. You know, I've helped patients lose, you know, 15, 20% of their body weight just with a focus on low carb diets and using continuous glucose monitors. And then you integrate that some intermittent fasting. And we aren't talking about you gotta fast for four days. We're talking about, you know, let's work up to a 12, 14, 16 hour daily fast. Right? And then the other component is this muscle mass issue. By

Speaker 2: 25:46

The way, go back to fast because I don't think people realize that when you're sleeping, you're fasting. Absolutely. Right ? So it's not like you're sitting from 8:00 AM to 8:00 PM No , not eating, it's, you're just not eating from 8:00 PM till 8:00 AM right? Yeah . So it's that window,

Speaker 3: 26:02

Or maybe we push it back to, to 10:00 AM or noon, or, you know, this thing about me , breakfast being the most important meal of the day, you know, for people that have insulin resistance, which is the majority of overweight adult Americans, you gotta compound in insulin resistance. And the way to do that is with a low carb diet and , uh, some intermittent fasting. And then the third leg of the stool here, the third component critical for people on this medicine is strength training. Because number one, strength training decreases insulin resistance because you're increasing the quality and receptivity of the insulin receptors on your muscles. So in and of itself, that's valuable. Um, and , and then, you know, you're increasing your muscle mass, so you're increasing your energy expenditure a little bit, not only when you're working out, but when you're resting. And then for middle-aged women, in particular for everybody, all of us lose 7% of our muscle mass per decade as we get older. So for everybody, but particular, particularly with women, because of the hormonal issues, if you're on these medicines, you've gotta be strength training because you're gonna be losing muscle mass. And that relates to the issue of osteoporosis as you get older.

Speaker 2: 27:13

Oh wow, I didn't know I lose 7% of my muscle mass every 10 years. So

Speaker 3: 27:16

Think about that from the time you're 35, you know , you're

Speaker 2: 27:19

Going downhill, is what you're saying. You're

Speaker 3: 27:21

Good . So, you know, I mean, you know, I've, I do tiktoks and one of the tiktoks I did was get off the go darn expletive cardio machines got over a million hits. Um, but basically it's saying, do your basic amount of cardiovascular training every week, but really middle aged and older people should be spending the majority their workout time doing strength training. And I'm not talking about, you know, you , you , you , you gotta be a meathead , you know, pushing free weights in the gym. You know, I'm just talking about, you know, use pilates, use bands, use body weights, doing pushups and pull-ups, you know, and then when you get comfortable at home, then you can move on to the gym with some free weights. But y you know, you don't have to be killing yourself. You just need to be doing 45 minutes to an hour of strength training exercises three to four times a week.

Speaker 2: 28:11

Okay. So where do we wanna leave this? Because we've kind of reached our limit of time here. What, how do we leave? What's, what's something we haven't said or we need to say?

Speaker 3: 28:19

Well, I , I think really more than saying anything new, I think we just reiterate, reiterate that these can be effective medicines. We sorted out the different names of them. Um, but they need to be integrated into a comprehensive program with a provider that knows what they're doing with them. Because you don't wanna start taking these medicines and all of a sudden be dependent upon them to control your weight for the rest of your life, basically be psychologically addicted to them. So I would include , I would encourage people , uh, to work with a knowledgeable provider and somebody that's gonna help you reach other health maintenance goals while you're on the medicine so you can eventually get, meet your goals and then get off the medicine.

Speaker 2: 29:03

So real quick, you , you brought up something that , uh, would, I would have to think about. So if I wanna find a provider that does this, do I need a referral from my nor ? Uh , my, no . I , I can just call the provider, say, Hey, I'm interested in learning more about this. Yeah.

Speaker 3: 29:17

I mean, the people that come to me , um, their , their primary care doctors usually are thrilled when I've reversed their pre-diabetes, I've lowered or, or given them the opportunity to go off their diabetic medication. Their blood pressure is improved, their cholesterol was lower. So no, the the docs, the , the primary care docs that my patients go to are very happy that they have come to me. So you can independently go to a metabolic health provider and they provide a different role often than your primary care doctor. Um, and again, I see patients in Ohio, Indiana, Florida, and Arizona by telemedicine. So it's u usually, usually I meet with people once a month. I have a health coach that meets with patients a as well. So we can work on those other aspects of the program rather than just taking a shot every week.

Speaker 2: 30:09

Alright . So as we end this, we cannot get off the podcast without doing a plug for your book. You're now, it's considered this , it's a top seller on Amazon for the topic of CGM or continuous glucose

Speaker 3: 30:24

Monitors, continuous glucose monitors, top seller on Amazon for , uh, the topic of , uh, continuous glucose monitors. The book was published about six months ago, doing really well, quite honestly, just about everything we've talked about in this podcast is in the book. Right. Um , there is a chapter on semaglutide as well. You , you know, suggesting it be used as we have talked about. Um, but the book has been a fun endeavor for me and, and how it's doing really well. Um , but people can get a good idea what we do and how to use these medicines correctly. Uh, by looking through the book and, and an emphasis of the book, again, is the name, the Continuous Glucose Monitor Revolution for Non-Diabetics. And it's about using those devices on the back of diabetics arm originally used to help dose insulin, but great tools in non-diabetics and pre-diabetics to help diagnose your level of insulin resistance to begin with, and then guide your low carb diet.

Speaker 2: 31:21

So for the , if somebody's joining us for the very first time, it , I , I highly recommend you get this book because I wear A CGM and it really has changed my life because I now know when, when my blood sugar's going up and when it's going down. And , uh, that does have a big impact on your weight gain or weight loss. Yeah .

Speaker 3: 31:40

So more information about the book and about the practice at our website, metabolic MD s.com. M-E-T-A-B-O-L-I-C-M-D s.com. And you know, if people just have questions, they're welcome to reach out to us through the website , um, and we can provide you , you know, at least some direction about finding somebody in your state or, you know, reiterate some of the things we've talked about here about how to use these medicines correctly.

Speaker 2: 32:05

All right . So I'm gonna sign us off, but I do have a great idea for a future podcast. Yeah . Right . There's so many things that we're seeing now Come , come on the line called Keto Yeah . Keto products, right? Yeah. I think we do a live taste test, right? Right here, you and me, we're gonna line up keto stuff Alright . And we're gonna taste it live. Okay . And we're gonna say okay . That , that was a , that was great. Alright . You sucked. We're we'll never have that again. That would be a fun podcast. Yeah, I agree. And you get to pay for the all the keto products.

Speaker 3: 32:32

Be happy to Terry .

Speaker 2: 32:33

Okay. Alright guys, that's been it for the Metabolic MD with Dr. Paul Klas . I'm Terry O'Brien and this is Tri-Level Productions here. We'll see you soon. Bye.

Speaker 1: 32:44

Thank you for joining us on this episode of the Metabolic MD with Dr. Paul kic . Please join us again for the next episode to hear how your metabolic health means everything, and to learn tips on how to lose weight and possibly reverse some serious health conditions. This information is not meant to be medical advice. Please seek consultation from your own medical professional.

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How to get the same Ozempic benefits but at a lower cost.

DR. PAUL KOLODZIK

SEASON: 2

EPISODE: 19

DescriptionTranscript

Speaker 1: 0:00

<silence> Welcome to the Metabolic MD. Health means everything. We all seek optimal health, but most of us do not know how to achieve it. Dr . Paul Kloza has spent a career in the emergency department now, he helps his patients avoid ever ending up there. During these podcasts, you'll learn how you can lose weight and prevent and reverse disease through new technology, a modified diet, and the use of some new recently approved F D A medications. This information is not meant to be medical advice. Please seek consultation from your own medical provider. Let's listen in.

Speaker 2: 0:36

Alright , everybody, welcome back to the Metabolic MD with Dr. Paul Kozik . I'm Terry O'Brien here at Tri-Level Studios, and we are gathered here today to talk about a lot of fun topics. That topic today is gonna be ozempic. We're gonna talk about that, right?

Speaker 3: 0:50

Right. And supply issues and cost issues and how people really can gain access to that medicine. So

Speaker 2: 0:56

Everything you wanted to know about Ozempic, we're gonna try to cover here in this short podcast. But before we do that, let's, let's go through a few things that are going on in the metabolic world, at least your metabolic world, right? Right. You have another , uh, seminar coming up on September 14th, right at 7:00 PM

Speaker 3: 1:13

September 14th , uh, 7:00 PM Eastern Standard Time. We're gonna do another metabolic seminar where I'm gonna go ahead and go through topics such as insulin resistance, low carb diets, intermittent fasting. I'll do that quickly in 20, 25 minutes. And then we're gonna have plenty of time for questions for this hour long seminar. I

Speaker 2: 1:33

Will tell you after that last seminar, we had a great turnout. We had about 50 people. Um, and every single one of those people just hung in there the whole time. No drop offs. It was amazing. Yeah. Um, and I think they all got a lot out of it. So, so I think if you're interested in learning more, asking questions to Dr. Paul about what he can do or you can do to help lose weight or become more healthier , uh, please join us September 14th at 7:00 PM and you can find information about that at metabolic MDs s metabolic mdss.com. And we will also be sending out some emails and things like that. Yeah.

Speaker 3: 2:09

Registration required. So go to the website and please register. No cost.

Speaker 2: 2:14

And another thing, I just , I was just out there looking at the Facebook No , the Google ads, right. And we, you just kind of hit a milestone, didn't you? You have 55 star reviews. Every single one of 'em is a five star review. Yeah.

Speaker 3: 2:27

I'm very proud of this. Five star reviews. 100%, five star reviews . So I don't know how you get, you know, 50 people to agree on every, on anything. You can't, but, yeah. But , um, we did. And that's that , uh, you know, our patients have been very supportive of our practice, feel that we're providing a good service. So again , uh, I take care of patients in Ohio, Indiana, Florida, and Arizona. Right. Lots of information on the Metabolic MDs website. But it's satisfying to me as a clinician that people think we're doing a good job and having success with their weight loss and metabolic health improvement.

Speaker 2: 3:04

I think it's fantastic. So, again, not everybody knows if you're online, the odds are you actually filling out a review form is low. So to get 50 Right. And you haven't been doing this that long. This is a tremendous milestone. Yeah. Yeah.

Speaker 3: 3:17

Well , I'm very happy with that result. And it's just, it's encouragement and positive feedback that we're doing the right thing.

Speaker 2: 3:23

All right . So let's get into the topic of the day . Ozempic, the expense, the supply, the dosing, all that kind of stuff. So where do you wanna start this conversation? Well,

Speaker 3: 3:32

Let's, let's go ahead and just do a little review about what these medicines are. Okay . What formulations they come in. And then we'll talk about the big issues right now, which is the supply chain issues associated with this medication and the cost for patients and the lack of insurance coverage in most situations. All right . Um, but the history again is these medicines were developed , um, for diabetics di they were found to be effective in lowering blood sugar for diabetics. But then it was noticed that these diabetics also lost 12 to 15% of their body weight. And how

Speaker 2: 4:04

Long ago was this?

Speaker 3: 4:05

This was three to four years ago.

Speaker 2: 4:07

Okay. So it's relatively a newer drug. Yeah. Okay.

Speaker 3: 4:10

Yeah. And then the , uh, drug company that manufactures this medicine, Novo Nordisk , went back and did additional studies on non-diabetics finding that they also lost weight. And you know, the rest is kind of history in terms of the craze with these medications. Um, they work three ways. One is they slow gastric empty , which means your stomach stays full or longer. They lower blood sugar, just like we talked about. Right. And that helps people lose weight. 'cause when your blood sugar is lower, you're burning fat for energy as opposed to blood sugar. And then third one is they have a direct effect on the brain, a hypothalamic effect on the hypothalamus of the brain. And we'll get to this a little later on. And what I have found is that sometimes you can get these effects even at lower doses, which is important in terms of providing access to people for medication because the lower doses can cost less . So we'll get into that detail a little bit later on.

Speaker 2: 5:06

All right . So let's, let's go into , um, a little bit about this thing. It's , it's a weight loss medicine for the stars, right? Yeah. How did it get that name? Is it people in Hollywood found out about this? And next thing you know, it's a rage across the country,

Speaker 3: 5:19

Right? And I mean, you know, the celebrities take the medicine and they have weight loss and that gets publicized a lot. Um, the medicine comes in three formulations, ozempic, which is only for diabetics. You really can't get it approved unless you're diabetic. Wego V , which is the weight loss medicine, which is the medicine that is expensive out of pocket with limited insurance coverage, with significant supply chain issues. Now, so

Speaker 2: 5:45

Wait, let's pause on that. 'cause there's ozempic, which is for diabetics. Yes. And then they took that yellow pin , that injectable pin painted it blue, put a label in there called wavy . Right. And then they're selling it as a weight loss medicine.

Speaker 3: 5:58

Correct. And you , and you can't prescribe ozempic to non-diabetics, at least in terms of insurance coverage because it , the insurance company won't accept that the doctor has to do a prior authorization and vouch that this is a diabetic patient that needs this medication. So that really can't be done. And then with wego , ovy , there's limited insurance coverage. And of course the out-of-pocket cost is, you know, 12 to $1,400 a month. So

Speaker 2: 6:24

Let , let me poke at this real quick , uh, because again, is if the insurance companies see you lose weight, losing weight means you're probably less likely to end up in your emergency room. Right? Right. Yeah. Isn't it better for them to stop this before they end up in your emergency room?

Speaker 3: 6:39

It's very good long-term thinking, Terry .

Speaker 2: 6:42

I'm a long-term

Speaker 3: 6:43

Thinker. Okay . But y you know, insurance companies are public companies and they're worried about what next quarters earnings look like. Got it. Um, and I think that, you know, these medicines will eventually have widespread use, but the , the cost really is kind of overwhelming to start. And let me give you an example. Some , uh, self-insured large organizations, and the one I saw a recent article on was the University of Texas Health System. Um, they had coverage for wago v uh , last year, actually, I should say this year in 2022. Right. They are changing their formulary and taking Wago off their formulary, which means it will no longer have coverage. And the reason they did that is because they were spending tens of millions of dollars on this medicine during 22 and it was breaking the bank. And of course, that eventually is gonna roll down to premium costs for individuals. Sure. So, and , and I've seen this with a number of patients in my practice. They come to us for the compounded semaglutide, the generic , uh, version of Semaglutide because , um, they were previously prescribed. Wavy had some coverage for it. Um, but their plan has now changed and it's been taken off the formulary. Hmm . So this is a fairly common practice. Again, I think over a period of years , uh, the coverage will increase with these medicines. Um , but right now it's a problem for a lot of patients.

Speaker 2: 8:08

So if you had to guess if something costs $500, what's an average insurance gonna pay for that?

Speaker 3: 8:14

Um, you mean if you just guess like if the , if the pen ,

Speaker 2: 8:17

If the , if the pen costs you 500 bucks for the , the shot per the , for the month or whatever, what would insurance usually cover?

Speaker 3: 8:22

Okay, well, well, okay. The way to look , first of all, it , it costs more than that. The medicines cost . Yeah , absolutely. Yeah . 12 to $1,400. We have some patients that have had copays that have been as little as $25. Wow . And we have had some patients where their formulary says it's covered, but the copay is almost the whole $1,200 <laugh> . So there's huge variability out there. And this is why a lot of patients are going to the compounded generic form, which we provide to our patients. 'cause generally that's available at about a third, the cost that is not an F D A approved medication, but very, very widespread use now. And it cuts the cost to about a third of that 12 to $1,400 out-of-pocket monthly cost .

Speaker 2: 9:09

So it's a generic version of wago V . Correct. Basically they, they put some supplemental vitamin B or something like that . Correct . Yeah . And then they release it as a generic. Right. And how much cost difference is there between the generic and the , uh,

Speaker 3: 9:23

Branded? It , it's about a third, a third, you know, it , it depends on the dosing. And we're gonna get into this at lower dosing. Yeah . The cost is less, but at higher dosing, because it's more medicine, the cost goes up. So one of the themes that we have in our practice right now is trying to work with patients on lower doses, because lower doses are better, I think, for a variety of reasons. Uh, and it keeps the cost down as well.

Speaker 2: 9:47

Okay. And, and when we met this morning, we were covering the topic of a little bit about this was the demand, right? Yeah. And I didn't realize this until you brought it up that this thing is off the charts, people can't find it because it's so popular. Right ? Right. And now is that the same thing with generics or is that different?

Speaker 3: 10:06

Much , much less. So , uh, with wavy , I have patients that are started at a low dose and they wanna move to the higher doses , um, as is the standard protocol for that medicine. Um, and they can't find it. I had a patient yesterday that we started at 0.25 milligrams, moved no to 0.5 milligrams. They're ready to go to one milligram and, you know, call 12 pharmacies and nobody has it. That's

Speaker 2: 10:32

Amazing. Yeah . So is that something, have you heard that that's something the manufacturer's trying to address?

Speaker 3: 10:36

Oh, they are. Yeah . Or

Speaker 2: 10:37

Do they, like some manufacturers like this thing where the demand's so high, they can't keep track , it's good for their stock prices , all that stuff.

Speaker 3: 10:44

No, the , the drug companies are trying to ramp up their production. They're trying to get there. Um, but it , you know, I , that could take months pro maybe even I think years for that to happen.

Speaker 2: 10:55

And generic, because you are an a physician, you're able to prescribe a generic, but most doctors wouldn't be doing this because it's not in their toolkit .

Speaker 3: 11:03

Well, you have to have a special relationship with compounded licensed pharmacies to be able to do this. Okay . And we've developed those relationships with several pharmacies over the course of the year.

Speaker 2: 11:14

Just curious, I remember you're licensed in Ohio, Indiana, Florida, and Arizona. Correct. That means you can only prescribe to those people in those states?

Speaker 3: 11:23

In those states.

Speaker 2: 11:23

Right. Now is that, is that something easy to get changed if you wanna go to Oklahoma or someplace like that? I ,

Speaker 3: 11:29

I , I need to apply and obtain a medical license. Okay. And , and I'm looking at additional states as well. Got it.

Speaker 2: 11:35

Okay. So , uh, let's just real quickly cover the , the supply issue. Again. How do people get around this supply issue? Is there a way around it today?

Speaker 3: 11:45

Um, well, for the branded medicines, there's not a way around it that I'm aware of today. Okay. So the way around it is to look at considering compounded medication. So first of all, let's talk about how these medicines are taken. You start a low dose, some of these medicines have side effects. Oh yeah.

Speaker 2: 12:02

I

Speaker 3: 12:02

Remember you . Nausea EP being the primary side effect. Yeah . So you start at a low dose, it's one shot per week, and then you, you use the same dose for four weeks when you start, generally that's 0.25 milligrams. And then after four weeks, you bump the dose to 0.5 milligrams and you do that. So you can kind of get used to those side effects, go to the next dose, might have a little bit of side effects, 0.5 milligrams. And then you , you continue that process, one shot a week at the same dose for a month, and then it bumps up continually to a milligram milligram and a half, even 2.4 milligrams. Um, and I actually in general, do not agree with going with those higher doses because people become more dependent upon the medication if you do that.

Speaker 2: 12:48

So if you, if you start low and stay low, it gives you, is the benefit relatively the same?

Speaker 3: 12:54

Um, it depends. It's a , there's a patient by patient variability. Uh , but one of the big points I wanted to get across in this podcast is I have a lot of patients that are at 0.5 milligrams or one milligram. A lot of patients at 0.5 milligrams that we keep at a low dose and they get very good appetite suppression at those lower doses. There's no need to go to the higher doses. And remember, unless you're having a patient come to you and you're saying, you know what, we're just gonna start this medicine and you know, you're gonna be on it for the rest of your life. Right. You know, unless you're prudent in saying, I want to control the dose, I want to titrate it up slowly because I wanna put you in a position to titrate it down slowly. So that does two things. Number one is you, you can keep the patient at a , at a point where they can eventually get off the medicine. And number two is you can keep the cost down because the lower doses are less cost.

Speaker 2: 13:53

So , uh, what's interesting is this is a tool in your tool bag of many tools, right .

Speaker 3: 13:58

Of many tools. Right.

Speaker 2: 14:00

This is one of those things that you get along, you get, you're , you're trying to change the way they live, the way they think, the way they eat, the way they behave. At the same time you're giving them this little aid that kind of is a shot once a week and then eventually say, let's get you off that shot because you now are on a better path to health. Right. And that's kind of your , your philosophy. Correct? Correct.

Speaker 3: 14:20

Yeah. And if you, if you drive people up to those higher doses, you're , you're really is , it is just a medication program. It's not really a comprehensive program. So the other things we do, which we feel are the foundation of a program like this is an appropriate diet. And of course, you know, I'm a big advocate of low carb diets , um, because that decreases insulin resistance, which is the problem for most overweight middle-aged Americans. Yes. So we use continuous glucose monitors and, you know, so I , I believe in continuous glucose monitors for non-diabetics so much. You know, Terry , I wrote a book about it. You did

Speaker 2: 14:57

Write a book about it , which we'll talk about here at the end. Okay.

Speaker 3: 15:00

Um, so we use low carb diets, intermittent fasting, and then strength training. Strength training is real important for two reasons. Number one, when you increase your muscle mass a little bit, you're increasing the quality and receptivity of the insulin receptors on your muscles. So you're soaking up more insulin, you're lowering your blood glucose. When your blood glucose is lower, your body turns to burning fat and that's when you lose weight. Um, so that's really one of the very important reasons. And then the other important reasons is when you're losing weight, especially on these medicines, you're losing muscle mass. And that's an issue for all of us as we get older. Sure. You know, so you're losing 7% of your muscle mass a decade. So we want to have our patients on strength training routines, both to decrease insulin resistance and to help maintain those mu that muscle mass, muscle mass. Very important issue, especially for women because of the risk is of osteoporosis as you get older. So if you're gonna be looking , anybody on these medicines really at any dose, I believe should be doing strain training as well. Alright .

Speaker 2: 16:06

And you, you've , you've seen a ton, and I mean a ton of patients and most of them , how many of the patients you say ever get on this medicine? Is it ,

Speaker 3: 16:14

You know, for me it's a minority of patients. We have patients come in and establish those lifestyle changes first. Um, basically the low carb diet, the intermittent fasting, the strength training. And then for people that either want to add this medicine in or hit a stall and want to add the medicine in, then we, we vary judiciously, add the medicine in at low doses, for example, I , I , I really don't have patients on high doses. I keep patients on moderate doses so that I can titrate them off the medicine eventually. Um, and the other reason is to keep the cost down and to talk about the cost issue. The , the reason the cost is lower with lower doses is because there's literally less medicine that has to be purchased. Sure. Um, and, and you can reduce the cost . Um, you know, the compounded medicine is , uh, excuse me, the brand name medicines are, you know, 12 to $1,400 out of pocket for mo for most people. Not doable. Have

Speaker 2: 17:13

We ever looked at Canada? What , what goes on in Canada? Do they pay the same fee? Or is it , does it, you know , how people go

Speaker 3: 17:18

Across the board countries? It's, it , the , the , the costs are cheaper, but, you know, I don't think that issue's gonna be solved anytime soon,

Speaker 2: 17:25

<laugh> . No, I don't either.

Speaker 3: 17:27

Okay. Um , so there's that 12 to 14. Yes . Um , 12 to $1,400 per month issue for , uh, the compounded medicine, when you start out, it's a lower cost, but when you, if you move to those moderate to high doses, it can still be, you know, $450 a month. Wow. Um, so it can still be not doable for a lot of people, but if you stay at the lower doses, which I do with many, if not a majority of my patients , um, then you , you can actually provide this medicine for as little as $75 a week. Wow. So if you, if you stay at 0.25 or 0.5 milligrams , um, is just a little boost to this comprehensive program because the patients are doing other things. Correct. You can really, really keep the cost down. Now ,

Speaker 2: 18:17

What happens when somebody knocks on your door and says, Hey, I want this Hollywood shot doc and you give it to me. Do you say maybe, but you gotta do all these fo following things? Yeah.

Speaker 3: 18:27

I want people to , I , I feel that I'm not doing a service to patients if , uh, I'm just y you know, sending them a medicine and saying Good luck. You know, all you gotta do is Google semaglutide the generic name or ozempic, and, and you'll get all kinds of places that will do that popup on the internet. Yeah . Meet with a provider for 15 minutes and they'll send you the medicine. But again, I I , I think you're committing people to potentially a lifetime worth of medicine when there's a better way to do this in terms of integrating this useful tool as part of a comprehensive program to get people to their goals and then hopefully, you know, get them titrated off the medicine eventually. And, and you know, I mean, based on the Google reviews, which you've seen, our patients have had great success with that approach,

Speaker 2: 19:14

That that is true. Is there anything we didn't talk about for Ozempic before we land this podcast?

Speaker 3: 19:20

No, no. Other than I think people that are looking at this need to do it again as part of a comprehensive program. And I'd like to emphasize the value of lower doses , um, for most people, not only for the cost considerations of keeping that dose that that cost down, but also in terms of your, your long-term health , uh, and maintaining , uh, uh, optimal lifestyle long-term with the other components of the program. Alright .

Speaker 2: 19:50

Well for those folks who are, even if they're not your patient, right, they could be in a state where you don't provide service. Yeah. That information's very valuable to those folks who are, who are interested in this Yeah . Who see entertainment tonight and they see these things.

Speaker 3: 20:02

Don't get lured in to just, you know, starting the medicine, not doing other things, going to higher dosing, you know, every , everybody wants a shot to fix everything. But, but quite honestly, from a medical standpoint and a personal standpoint in terms of you , you know, your long-term health and happiness, I , I don't think it's the right thing to do. So comprehensive program, lower doses, lower cost . Alright ,

Speaker 2: 20:28

Well this is the time of the podcast where we get to do our shameless book plug. Alright . So what's going on with the book? How's that going so far?

Speaker 3: 20:35

The book sales are going great. It's been a lot of fun, you know, writing a book and then getting it out there. The , the , uh, topic of the book, the title of the book is the Continuous Glucose Monitor Revolution for Non-Diabetics. So we use CGMs and non-diabetics to help guide low carb diets. Um, and the reason we do that is because, again, if you can decrease your carb intake, you can keep your blood glucose lower . Um, rather than having excess blood glucose in your system that goes to the liver and becomes fat, you have lower blood glucose in your system. So your organs are looking around for another source of energy, and that's those fatty acids that fat around the middle. So that gets broken down to help you lose weight . So continuous glucose monitors, which you've seen on the back of the arms of diabetics, are tremendously useful in non-diabetics as well. And you know, again, I believe in this so much. I wrote a book about it and we have various chapters on these different topics that we've talked about today. Low carb, intermittent fasting , uh, strength training, right? Even semaglutide, the , uh, the , the, you know, GLP one weight loss medications that we just talked about. So there's really a comprehensive information in there for patients on, on how to make significant lifestyle changes, lose weight and improve your metabolic health. So

Speaker 2: 22:00

One , one question I've, I've kind of wanted to ask for a while, and I keep forgetting to ask this question. If you're walking through the mall, and this is a hypothetical, right? And the mall's packed full of, you know, folks who are a little overweight or are greatly overweight, what's the odds of them being diabetic are needing to monitor their glucose with the C G M?

Speaker 3: 22:20

Okay, so, so these are the numbers. Um, you know, about 12% of American adults are diabetic, of course most of them are overweight. Yep . Another 30% are pre-diabetic.

Speaker 2: 22:33

So 12%, 30%, that's 42, right?

Speaker 3: 22:35

That's 42% of American adults and , um, uh, half of the pre-diabetics do not know they're pre-diabetic. And this is what we , you know, this is another reason the CGMs are very effective, right. You'll see it because I , I have patients come in and their , their goal, they come to me because I wanna lose 20 or 25 pounds. I say, well that's great, we'll help you do that. And then we put a C G M on them for a week , uh, and they see that it's not just a weight loss issue, right. That they are pre-diabetic. I have patients that come in C G M for the first time, they find out they're diabetic for the first time. Yeah. Spiking blood sugars on the cgm, which gives you a 24 7 blood glucose reading , um, to , uh, to 2 20, 2 30. And , and so people, once they see those curves on the app on their phone, because these devices , uh, connect to the app on your phone, you , you know, once you see those curves spike and it can be life changing for people. Oh, absolutely. You know, they , they don't un they have not understood up to that point what's going on with their body and their blood glucose. And then after we use the CGMs diagnostically, we can then use them therapeutically to help guide their low carb diet and help them lose weight in the manner we just discussed. So

Speaker 2: 23:50

Last question, again, being a scientist kind of , not engineering kind of guy, 42% are either pre-diabetic or diabetic. What percentage of the population are overweight?

Speaker 3: 23:59

60% of American adults are overweight. So as

Speaker 2: 24:02

You're walking through the mall, odds are really, really high. That overweight person is either diabetic or pre-diabetic and may not know it.

Speaker 3: 24:10

Right. And then, and then if you have a family history of diabetes in your family, the numbers go up. So you , you know, the issue here is getting a good assessment of your blood glucose, getting a good assessment of your level of insulin resistance because that's why people are pre-diabetic and diabetic because they have insulin resistance. Um, and then attacking that insulin resistance with a low carb comprehensive approach.

Speaker 2: 24:36

Well, sorry for the bonus question, but I just, I just remembered I always wanted to ask that question and uh, I thank you for the answer. Alright, well this has been another thrilling episode of the Metabolic MD with Dr. Paul Kozik . Dr. Klok , thank you very much. Thanks Terry. And we're gonna see you again in a week or two and we'll do another episode. I don't know what the topic will be, but I'm sure it's gonna be just as fun as this one. Alright guys. Terry O'Brien with Tri-Level Records signing off.

Speaker 1: 25:02

Thank you for joining us on this episode of the Metabolic MD with Dr. Paul Kozik . Please join us again for the next episode to hear how your metabolic health means everything, and to learn tips on how to lose weight and possibly reverse some serious health conditions. This information is not meant to be medical advice . Please seek consultation from your own medical professional.

Speaker 1: 0:01

Welcome to the Metabolic MD. Health means everything. We all seek optimal health, but most of us do not know how to achieve it. Dr . Paul Klok has spent a career in the emergency department now. He helps his patients avoid ever ending up there. During these podcasts, you'll learn how you can lose weight and prevent and reverse disease through new technology, a modified diet, and the use of some new recently approved FDA medications. This information is not meant to be medical advice. Please seek consultation from your own medical provider. Let's listen in.

Speaker 2: 0:36

We are back here at the Metabolic MD here , tri-Level Studios in Dayton, Ohio. Hello, Dr . Paul.

Speaker 3: 0:42

How are you doing?

Speaker 2: 0:43

We're back for another episode, but I'm excited because we have somebody joining us in the studio today. That is Kelly. Kelly is a 49 year old male who's starting weight Before this process started was 263 pounds. Kelly, say hello.

Speaker 4: 0:59

Hello.

Speaker 2: 1:00

All right . So Kelly , we're gonna , we're gonna talk today about your journey from 263 pounds to where you are today, which is where ,

Speaker 4: 1:08

Uh , 1 94.

Speaker 2: 1:09

1 94, you've lost a whole human, basically what's what you're telling me, <laugh> . So, Dr . Paul, tell me how Kelly came into your life.

Speaker 3: 1:17

Well, I think Kelly was referred to us from a friend of his who had done our program and had some success. And he was at a point in lo in his life, I think, where he had lost some weight, a little bit of weight successfully on his own, but then kind of stalled and was looking for some more insight as to how he could modify his lifestyle in order to meet his overall weight loss and metabolic health goals.

Speaker 2: 1:40

All right . So, Kelly, is that true? You've , you had a friend who, who was using Dr. Paul , and all of a sudden he says, you gotta go talk to this guy. Is that what happened?

Speaker 4: 1:47

Yeah. Yeah. And uh , actually he had an event at , uh, the gym in Centerville. Right. And I came up and, and listened to it, and then Mo I , it kind of molded over for it probably took me about a month, month and a half, and I was like, oh, I can do this . And I just kind of got into a yo-yo phase and said, you know , uh, it's worth an investment in myself to have a better future. And that , that was kind of ,

Speaker 2: 2:12

So why, what , what , what made you wanna make this change? Were you having struggles with , uh, with health? What was, tell us what's going on in your life at this time? I

Speaker 4: 2:20

Just a , a gradual progression of a1c slowly getting higher and higher. Right. Uh , my family has a history of diabetes. I , it was just kind of a , I'm, I'm for a big guy. I was pretty active. I , I was, you know, I do these long bike rides and stuff, but every year I was a little heavier and a little, and it just got harder and harder to keep up. And, and I thought, man, I'm putting in all this work. I was like, it sure would be nice to see the results instead of just getting caught in these yo-yo phases. And previously I went, I , I , I had lost some weight , uh, got down to some pretty good numbers, but it was through pure physical heart , I mean Right . Three hours a day in the gym. And that just, that's not sustainable. I hurt, ended up hurting my back. Right. All the weight came back on within a year. So

Speaker 2: 3:14

What was your weight in high school?

Speaker 4: 3:16

Um , about 1 90, 180. 180 to one 90.

Speaker 2: 3:20

About where you are right now. So this is your high school weight? Yeah. Not far at 49 years old. That's pretty good.

Speaker 4: 3:23

I remember, I remember the first time I went over 200 pounds in 1999, I , I'd moved to Killeen , Texas. It was at Fort Hood. Yeah . And I remember seeing the scale, say, 200 pounds. And I was like, wow. And it's , uh, all right . Haven't seen under that since then.

Speaker 2: 3:38

<laugh> . So when you knocked on Dr. Paul's door, Dr. Paul , tell us what you saw, what you did. Tell us the steps that got into this process.

Speaker 3: 3:45

Well, Kelly can talk about this, but what we do with all our patients is do a two week period where we're check the critical labs related to their metabolic health. Um, Kelly mentioned a1c, probably one of the most important things we do as a fasting insulin level to determine level of insulin resistance, do a routine medical history intake, physical exam. But probably one of the most important things we do, and Kelly can speak to this, is put a continuous glucose monitor on patients which give their , um, blood glucose reading 24 7. And often that is eye-opening , uh, to patients. And I think it was for Kelly .

Speaker 2: 4:24

Yes , absolutely . So, Kelly , tell , talk about that. You got this thing punched on your arm. You started monitoring with a phone or with a device. What'd you see on the first few, few tests? Yes , it

Speaker 4: 4:33

Was kind of, the interesting thing is, is , you know, I , a little , it was a little high I knew on my A1C and stuff was up , but , um, just some of the things you'd eat, like things that I was, you know, I kind of, I told , talk to Paul, I , I used to kind of watch my calories. Right. Well, you know, 50 calories of potatoes will put you through

Speaker 2: 4:54

The roof. Oh yeah. It's just amazing what rice and potatoes can do.

Speaker 4: 4:57

Yeah. And you're seeing how these, my body's reacting to these foods and I'm like, well, here's, here's why I'm yo-yoing is my, my body's, you know, it's not, I'm not giving it a chance to function and Right. You know, process foods. And, and I was like, cuz I've got it working overtime just trying to process through these carbs and these starches that I'm putting in it. And

Speaker 2: 5:19

It wasn't the cookies, it's is the potatoes, isn't it? It's like things you don't think about. Yeah .

Speaker 3: 5:24

You know , often, often it is, you know, Kelly, first of all, and way background, I think Kelly was diagnosed as pre-diabetic when he came to us, just so you know, kind of where his starting point was. Um, and he alluded to the fact that there's basically two schools of thought related to metabolic health and weight loss. It's the , you know, law of thermodynamics. Kelly's an engineer, so he, he knows all this, which is energy is neither created or destroyed energy in energy out, which I don't think is a sustainable model. And I think Kelly found it was not a sustainable model, or there's the hormonal model that has to do with insulin resistance, really . And , and that's when you monitor carb intake as opposed to calorie intake primarily. Um, and I think that is a very effective model, and that's the model that we use for our patients. All

Speaker 2: 6:14

Right . So after the two week period, you wore this thing in your arm, you tested it all the time. Right.

Speaker 3: 6:18

And you were, I gotta interject, you were spiking into the diabetic range. Yeah, I , with that , I

Speaker 4: 6:23

Was up in , probably up in the mid 200 s

Speaker 3: 6:26

So I , I just want to emphasize this , um, and then I'll let Kelly speak, but the CGM two week period is eye-opening for people. Oh yeah . All kinds of patients that come in and they say, I wanna lose 20, 30, 40 pounds. And then we put the CGM on 'em and they see they're spiking sugars to, you know, 180 didn't know they were pre-diabetic and they are pre-diabetic or two 40 didn't know they were either pre-diabetic or diabetic, but in fact they are diabetic. So that is an enlightening phase, I think.

Speaker 2: 6:53

Yeah, yeah. Is that what you saw? You, you were kind of

Speaker 4: 6:56

Shocked on the whole thing ? Well , and just the , like, the size of the spikes and I mean, it was just, they weren't little spike . I mean, I , there was some time and , and things like , like I still want 'em up . The most mindblowing one was eating raisins.

Speaker 2: 7:09

Oh yeah. Raisins.

Speaker 4: 7:10

Come to find out raisins are pure sugar. Yeah.

Speaker 2: 7:13

They'll , they're , they're good to get your blood sugar back up when it's slow , that's for sure. Yeah . So at the end of the two weeks, you go back in and you , you have a meeting, is that correct? Yeah. Yeah. So what goes on at that meeting?

Speaker 3: 7:24

So we discuss , uh, his CGM patterns, which is how high is he spike, what is his average daily pattern, you know, what is the variability that occurs there? Because the variability in and of itself can be draining in terms of decreasing energy and brain causing brain fog. And then we go over labs as well. The most important one being an assessment of insulin resistance. And I think we assessed , um, Kelly, I think you have the numbers there, that you had significant insulin resistance, right?

Speaker 4: 7:53

Yeah. Yeah. I believe , uh, uh, just looking at my , uh, my fasting insulin , uh, over the, over the course. I mean, I went from 15 three to five seven,

Speaker 2: 8:09

I don't know what that mean. What do those

Speaker 3: 8:10

Notes ? So , so that means that, that he cut his level of insulin resistance by two thirds . So, you know, he , we knew he had some insulin resistance, he was pre-diabetic, he's got a family history of diabetes. We knew this is gonna be an issue. But, but for the majority of Americans, the issue with the fact that 60% of us are overweight or this issue of insulin resistance, you know, people worry about their cholesterol all the time. Right. The majority of people should be worrying about their insulin resistance. So that gives us a baseline with Kelly so that then we can attack the insulin resistance issue with a low carb diet and some other techniques.

Speaker 2: 8:46

So two questions. Are you monitoring the CGM at the real time with him, or are you waiting for him to come back in two weeks later? And then you look at the results ?

Speaker 3: 8:53

So this is kind of, kind of a big brother issue. You know, how, how closely are we watching him ? For a lot of patients knowing that we're remotely monitoring their numbers is helpful that that can help some people with their behavior. But I think for Kelly , he was just self-motivated on his own. We want to bring those spikes down. We want to average things out, we follow the numbers, but I usually don't intervene with patients unless it's, you know, three, four days where there's a problem. Um, you know, usually people self-correct when they see there's a problem.

Speaker 2: 9:24

Okay. Kelly , I'm gonna step back real quick. When you were at 2 63, what kind of health issues were you having?

Speaker 4: 9:30

Um, I had , it was , it seemed like new one every time. A new one. Every time It was a , you know, well at one , like it said , the weight on my back, my spine, yeah. Uh , back issues. I , I at one point had to go get , uh, nerve uh , nerve blocking shots in my back. Were

Speaker 2: 9:48

You tired?

Speaker 4: 9:49

Um, yeah. I , so I, I, I had this thing every time I'd eat , I , I'd , I'd almost have to go lay down, take a nap. Okay. Uh , if I , if I ate anything more , like at lunch, I'd have to eat a small meal, otherwise I'd have to go lay down. Yeah. That's again , and so I kind ,

Speaker 2: 10:05

And that's because the blood sugars are

Speaker 3: 10:06

Spiking. So what's happening there is you , you eat a meal that has carbs , blood sugar spikes, insulin gets released, the insulin often overshoots the mark that decreases blood sugar, drives the blood glucose into your cells, and so then you drop out. So, so you go from being hyperglycemic, high blood sugar to in the hypoglycemic range in the , into the low range. Right. Um, and , and that causes a drain in energy. That's often where the brain fog comes from as well.

Speaker 2: 10:34

And what is , is it normally an hour after you eat ? What is the normal course of hype when you, when you reach your peak? Yeah,

Speaker 3: 10:40

It's usually the peak comes in an hour to two hours and then you bought 'em out after

Speaker 2: 10:44

That. Okay. So you had some health issues. So you met with 'em two weeks later, you saw the numbers. What did you do?

Speaker 3: 10:53

When we put a plan together, and I'll let Kelly speak to this, but that plan usually consists of how many carbs a day are you gonna target, how are you gonna monitor that? And Kelly can speak to using an app that we use with our patients to help monitor primarily decrease carbon intake and adequate protein intake. We put a fasting plan together. Um, and then we talk about strength training, cuz strength training also increases , uh, or excuse me, strength training also decreases insulin resistance. So it sounds kind of strange coming from a doc , but it's like, you know, cardiovascular fitness is important, but quite honestly, for most of my patients with insulin resistance, I carry more about strength training because that helps decrease their insulin resistance and will help them lose weight.

Speaker 2: 11:35

Okay. So Kelly, is that what happened ? Basically,

Speaker 4: 11:38

It , it is, I I was a reluctant strength trainer, reluctance trainer . I was , I , uh, it took me a little while. Like I, I, I kind of almost just had to convince, like I I , I've told them the first week I made myself go to the gym. I might go sit in the hot tub, <laugh> <laugh> , but I ha I , I wanted to develop a routine. A routine, right. And , and once I kind of got that, then, then , and , and I did, I had to start initially with, you know, going in and getting on an elliptical, going in because I , i , I kind of, after hurting myself, the last time I had tried to lose weight, I was kind of scared to get into the gym. And , uh, so it was like , I just kind of had to build confidence and, and you know, it , at first it worked just coming in and getting the , the exercise and then, and then I kind of, I kind of slowed down and was like, okay. And then reluctantly it was like, okay, well let's do, let's do the resistance training. And, and as I started adding more resistance training and , and I found it doesn't have to be me sitting in a gym for three hours lifting weights . Right . You know, I do a lot of, I , I really, I'm really into cycling. I would do these high intensity. I mean every , you know, just not, not so much cardio, but just so much resistance. I could barely move pedals. And I mean, I could just , afterwards my legs, I, I could barely walk sometimes int it. But it was fantastic. And then all of a sudden the more I introduced this, the more I was able to push into some actual weights and training and stuff and, and start doing this resistance training. And, you know, all of a sudden I realized what was happening, what as I did this, it , it took a minute and then all of a sudden it started going down. But I realized what was actually happening was my body composition was changing as I started adding this re insulin resistance. And, you know, all , all of a sudden this muscles developing. And then once kind of everything started going, then I , then it kind of, then it's just kind of in a great downhill slide since then, went watching just kind of, I've been on a real level or a real steady downhill with

Speaker 3: 13:39

My point . So out he has more muscle mass at 1 94 than he had at 2 63.

Speaker 2: 13:44

That's impressive. Yeah. Yeah. I bet you , you , you feel , again, going back to high school, how do you feel compared to high school? You feel better, worse?

Speaker 4: 13:51

Um, I , I was, I was a wrestler. I was , I , I close, that's probably okay about the same, but I , I was , I , I was a wrestler in high school. Yeah. And I , I grew up very active.

Speaker 2: 14:04

So two weeks after you go meet him, you talk what you , you suggested what to him, just to make sure I got this

Speaker 3: 14:10

Right . So , so we talked about the cgm, low carb diet. We targeted I think 50 grams. You went lower. Yeah .

Speaker 4: 14:15

Daily . Did 50 net . Yeah . And I , I actually sat more, I really, even today I sat kind of the , I tried to keep it 30 to

Speaker 3: 14:24

Ish. Okay. And then speak to your, you know , both your , speak to your intermittent fasting component, how we worked on that together.

Speaker 4: 14:32

Um, well , so that was, so we kind of worked through , uh, I , I used to, I used to eat these huge breakfasts. Yeah . And I'd be tired all the time. And, and , uh, I, I kind of , I was like, well , you know, I had a , I had a friend that that was doing it and he , and he was doing these one , he was eating once a day. And I was like, that, that's not realistic for me. I, I'm , I mean, that just wasn't

Speaker 2: 14:58

What you were

Speaker 4: 14:58

Going to do , how I function. Right. And , and , and so I, I tried, like, I tried, you know, I tried, started to start off a little bit early more . I tried to do, I kind of picked an eight hour window. Uh, and I was like, okay, well let's see. And I , and I , and I moved it around until I found what worked and

Speaker 2: 15:14

What , what works for ,

Speaker 4: 15:15

For me. I, I actually, my, my, I eat between the hours of 11:00 AM and 7:00 PM So

Speaker 2: 15:21

You have a early lunch and then a late dinner and that's it.

Speaker 4: 15:25

You're done . I go into work pretty early. Yeah ,

Speaker 2: 15:27

Sure.

Speaker 4: 15:28

I understand . So I'm kind of , I've kind of an ear tend to be on the earlier side of the day, but in the morning, I mean, I still have my cup of coffee. Right. Uh , I mean, I'm just a good cup of black coffee and by the time I kind of settle down and get ready, you know, it's 10 o'clock anyway. And, you know, an hour later I have, I , I'm eating my lunch and

Speaker 2: 15:47

Okay, so let's let , let's, let's make sure I, I got this right cause I wanna make sure I don't lose my train of thought. From the two weeks you meet him, he tells you to do a few things, you go away <laugh> Right. And you try to implement these things and then you come back to him again. And how

Speaker 3: 16:03

Often? I meet monthly. And then my , uh, nutritionist trainer meets every two weeks with patients as well.

Speaker 2: 16:11

Okay. So ,

Speaker 4: 16:12

So I kind of threw a little loop in that, that the week after I met him, I went and rode my bike from Kansas City to St . Louis

Speaker 2: 16:20

<laugh> . Oh , okay. How'd you do that for

Speaker 4: 16:22

<laugh> ? I , it had been planned about a year in advance. Oh ,

Speaker 2: 16:25

Okay . Six

Speaker 4: 16:25

Months in advance. So, and , and so we , uh, and that's really where I said, okay, well we talked about using a semiglutide to , because of my sugar spikes. And so I kind of put that all off until I was done with my bicycle

Speaker 2: 16:39

Bike ride . Okay.

Speaker 4: 16:40

So I , I mean, like I said, I had, I'm , I was an active person. I just never lost weight.

Speaker 2: 16:44

And how , and how big of an impact, I understand the exercise of strength resistance training and things like that. How, how big of a change was going on a semiglutide? Was that a big notice? Notice ?

Speaker 4: 16:58

Um, it's immediately, I mean, it was a , it was a buildup. I , I mean, it , it's, it , we started with a very low dose to let your , I mean, your body kind of needs to acclimate cuz it's, it's , uh, I , I feel, you know, a everybody I've talked to, I, I feel like I had a very nice transition with it. I, I, you know, I never had issues. I never, some people like I've , I've heard some people feel a little full or feel a little, they're getting nausea at the first. I , I really didn't have any of that.

Speaker 2: 17:28

Did he start out full strength or did you go,

Speaker 3: 17:30

So just so the , the listeners know Semaglutide is the same medicine as Wogo and Oza. We provide it to patients also as a compounded generic medicine because of cost issues. But we always started a low dose. It , it's a once weekly injection. Um, you increase the dose monthly over a four to five month period. We start a lots because side effects, nausea, constipation. Sure. I help my patients avoid that. And then we move very slowly and we've talked about this before, you know, it , it's helpful for somebody like, you know, he had numbers spiking into the diabetic range mm-hmm . <affirmative> , so he would really be Yeah . You know, an appropriate candidate for this medicine. So it helped him both control his shoulders and helped with his weight loss. Yeah. Um, but, you know, we want to be careful with this because Yeah . Um, you, you know, you eventually go off the medicine as I think is gonna happen here shortly

Speaker 2: 18:23

Either . So you're still on it

Speaker 4: 18:24

Right now? Yeah, I'm on, I am actually this , I'm , I'm tomorrow will be half of my regular

Speaker 2: 18:31

Dose. Half your , so you're weaning down.

Speaker 4: 18:34

I am taking steps just because I'm, I'm doing that just to make sure that I do have the proper tools in place. But Okay. Now like I said , it helps with satiation. Not, not, so people are like, oh, it makes it so you're not hungry. No, I still get hungry.

Speaker 2: 18:51

Okay.

Speaker 4: 18:52

I just, when I eat and , and I , and I feel like one of my big problems , I , I've realized over time is one of my big problems, man, I used to eat so fast and now and , and I would just eat . And then by the time I felt full, I'd eaten incredibly too much

Speaker 2: 19:10

Food. So now is is one of the tricks to slow down how , what you eat or put it on smaller plates . What , what is the , what are we talking about here?

Speaker 4: 19:17

I so , so , so now as I eat, like , uh, I feel full , it helps you , it kind of makes you feel full quicker. But

Speaker 2: 19:26

Now, so we'll govie though . Assume a glut tide . Yeah.

Speaker 4: 19:29

Yeah. But now I've developed this routine where I naturally just so I can kind of go out, like when I go out and eat with friends, I have to slow down my eating. Otherwise I'll take, I'll be done eating in about a minute. Wow.

Speaker 2: 19:43

So that's interesting. Okay.

Speaker 4: 19:44

So now, you know, now I've , I've , I'm developing these habits where I go out and eat then and , you know, I'll , I'll eat a little , I'll also have a few bites and some wa have a drink of water and, you know, en kind of enjoy my food and stuff . I , I enjoy it more. I get more flavor and taste. I'm not eating just cuz it's in front . I'm , I'm if I, you know, I, I don't eat everything on my plate just cuz it's there. That's

Speaker 2: 20:08

A great , that's a great message. I think that's, that's something we haven't heard before. How it slows you down and unless enjoy

Speaker 4: 20:15

Talking to or or else you'd take a minute of your life, you'd eat and be done.

Speaker 2: 20:20

So , so what can he expect as he's weaning himself back

Speaker 3: 20:23

To Yeah, this is a great point. One of the things about working with the doc that understands this medicine is that you can titrate up slowly avoid the side effects. You don't have to go to a full dose and then you titrate back down. Yeah . Um, as opposed to, you know, somebody that just gives you the medicine and says good luck. It really needs to be used in the context of a comprehensive lifestyle change. Yeah . Like Kelly is done because there's a issue of weight regain when you go off. So you're trying trading down slowly, but he's made the lifestyle changes, so he's not gonna have a significant problem with weight regain.

Speaker 2: 20:58

It'll be interesting to talk to you again. You know, now once you go off it , just so the listeners can understand

Speaker 3: 21:04

The journey, he's gonna be fine . I've had many patients like him, he's gonna be fine. Yeah. Be , be because of what he has done with his lifestyle.

Speaker 4: 21:11

Well , and, and I have really, if I do the rest of my life, I'm fine with tracking. I I love my food tracker. Right. I, I see what I , I see . I mean,

Speaker 2: 21:22

Do you still need to see GM or you gonna go off that?

Speaker 4: 21:25

Um, they'll come a point that I will probably introduce more fruits. I I , I have some fruits I eat. They're generally low sugar, very low glycemic fruits.

Speaker 2: 21:39

J just so I know, what are those? So I'm curious ,

Speaker 4: 21:41

Um , for me, like my, my go-to fruits are barran , uh, like , uh, you know, raspberries , uh, just, just kind of really just staying away . I mean I've , I've learned very, very, like blueberries are pretty high in calories . The , some of 'em like bananas. I kind of, that's one of mine that , that's probably been my hardest thing is to, you know, I, I don't, it's not that I don't eat bananas, but like I I , I use a, a protein shake ca chava . Sure. I , I put half of half a half a frozen banana in it now instead of the one and a half . And, and I do that like once a week or so.

Speaker 2: 22:21

So lemme that's a great question. I know that we talked before about me drinking protein. Right. And the little boost things and I do that and it does really avoid peaks and valleys. Mm-hmm. <affirmative> it , I don't know what it's doing, but it's doing something great. Do you subscribe the that to people's love ?

Speaker 3: 22:37

The protein shakes? Yeah. Yeah. Protein shake. You know, I target two numbers. Make sure your carbs are under this number, usually 30, 40, 50. And try and get your protein in terms of a hundred grams to 125 grams per day. I , I personally don't really care about fat. Um, but to answer your question related to the shakes, usually you need some protein shakes , um, in order to get your protein up and protein is satiating as well. Um, so that can help with the hunger issues as well. Yeah.

Speaker 2: 23:05

I notice it's , when I drink those things, I'm not very hungry at all. So Yeah . They're

Speaker 4: 23:09

Pretty cool. Yeah. And it's, for me, it's kind of a, like I said, I'm, I I , I get a lot of protein just generally, so I kind of back it up and that's almost becomes a dessert for me. Sure. It's , it's this chocolate shake and like I said, sometimes I'll put a with the banana in it just to , you know, maybe once a week just to , cuz that's probably my favorite. And that's what , and so when I get to the point where I'm off the semi luta and I, and , and I'm gonna go through a , a phase of introducting ducty food. I have, I have a monitor I'll put on, on , uh, for, for two weeks just to see. I'm gonna do a sample where I introduced some, you know, I, I like from the first two weeks I learned some things I thought were great, weren't, and some things I thought weren't great are okay. So it's just

Speaker 2: 24:00

Kind of a Yeah . Are now are you still using a CGM

Speaker 4: 24:02

Right now? I am not.

Speaker 2: 24:03

When , when did you go off that ?

Speaker 4: 24:05

About a month. Yeah . It's been a little , probably a little over a month

Speaker 3: 24:08

Ago . And , and that's typical of our patients. Once they get things down over a period of months, they can kind of use 'em intermittently and use them to test additional foods down the road is Kelly's alluding to.

Speaker 4: 24:19

And , and the amazing thing is, is I can, I can tell you what my body's doing. Not that intermittent. I mean Yeah . I I know

Speaker 2: 24:25

The same ,

Speaker 4: 24:25

The same . Yeah . Where like when I eat something I, I'm , I'm very aware of what my body's doing now and I, and it , it's , it's kind of , you know, at some point you're just scanning it cuz it's on there. Right. Uh, but you know, I've, I've been very controlled and consistent on what I'm eating right now and on what I put in my body and , and you know, there there'll come times when I'm gonna expand to new things and Yeah.

Speaker 2: 24:53

Well the funny thing about CGM, and I think we might have talked about this, is it's uh , it's a great motivator cuz you think, Hey, I can have that. And you go think and you go, I'm at this. I can't eat that right now. And it stops you from doing something stupid. Yeah ,

Speaker 3: 25:08

Yeah. The 24 7 monitoring is great. Yeah . Hey Kelly , can we talk about your lab numbers and the change that some of those have gone through ? Oh , I'm through . Yeah. Um, so this , this is what I have, and I know you have some numbers in front of you before, but you know, you , your fasting blood glucose initially was, you know, in the one twenties and I think your last one was around 79 or something like that.

Speaker 4: 25:32

Is that Yeah, actually I , uh, in , uh, that's march of last year. I was actually almost at one 40. I was 1 38 and uh, my , uh, I was at 79 at Okay . 70 end of

Speaker 3: 25:47

January. Yeah . He, he's gone from basically, I call this diabetes in remission. You know, he's gone from being diabetic to having normal blood sugars now doesn't mean that that his insulin resistance has completely gone away forever. Um, but it means that it , it's very well controlled now. Uh, your hemoglobin A1C numbers were what?

Speaker 4: 26:08

Uh, so , uh, I went from six eight, well last year I , I , and then this was, like I said, this was after my exercising stuff. I was at six eight and then down to five four in January. Wow.

Speaker 2: 26:21

Okay . That's

Speaker 3: 26:22

Impressive. Amazing. Let's talk about your lipid profile. Uh , I think, and I , this is what I see on low carb, high fat diet. So remember when you go in low carb , you're going higher fat usually. Yeah. So I think your cholesterol stayed about the same. Yeah. But you really had a remarkable change over time in triglycerides, right?

Speaker 4: 26:39

Yeah. Yeah. And that's , uh, over the past year it went from about 1 75 down to 59.

Speaker 3: 26:48

Wow. So , and that's , so just if I can speak to this, so this is what I usually see with low carb, high fat diet . So a lot of people are worried about their cholesterol when they really should be worried about their insulin resistance. Um, his cholesterol stayed about the same. I think what I, the numbers I have here is cholesterol went from 180 2 to 180 7 over the six month period that we're we're providing him treatment. Yeah . Um, and his , uh, and his triglycerides went down. Would you say 1 75 is

Speaker 4: 27:16

1 75 to 59

Speaker 3: 27:17

To 59. The reason for that is, is that when you lower blood glucose, you lower the fuel that creates triglycerides. Triglycerides are created from the conversion of blood glucose to fat in the liver. When there's less blood glucose around, then there's less fuel for that process. And so triglycerides, triglycerides get lower. I see this almost in all my patients, that triglycerides go way down. So the point here is, is that even though you're on a low carb, high fat diet, your lipid profiles improve.

Speaker 2: 27:49

Well , it's , it is an amazing story. Kelly , I know we're coming about the end of our time. Yeah . Is there anything, any last words of wisdom for our listeners that you might wanna share?

Speaker 4: 27:58

Uh , kind of, kind of at our, my last point with Dr. Paul, the thing I really told him was if I could tell everybody it's , uh, I told him it's , it's like working in , working in your garden. You know, you can go out there and you can dig by hand, but man, if there's these amazing tools available, it's a lot easier to dig a garden with, with , with the tools, with the shovel, with a , so

Speaker 2: 28:22

The tools he's providing really kind

Speaker 4: 28:23

Of helped you . I mean, I still gotta do, I I can do

Speaker 2: 28:26

Work , right . You gotta do the work.

Speaker 4: 28:27

But, but all of a sudden here's these tools that make that work pay off.

Speaker 2: 28:31

Well, I , I will tell you , we're gonna leave it right there cuz that's a great way to end this story. Kelly , I want to thank you for joining us today here on the Metabolic MD with Dr. Paul Klok , our Dr. Colo . Dr. Coli , when any last words of wisdom before we say so long ? No ,

Speaker 3: 28:44

Other than I really appreciate Kelly coming in and telling his

Speaker 2: 28:47

Story. All right guys, well thank you very much. We'll see you again on the Metabolic MD with Dr. Paul Kloza . Thank you.

Speaker 1: 28:56

Thank you for joining us on this episode of the Metabolic MD with Dr. Paul Kasik . Please join us again for the next episode to hear how your metabolic health means everything, and to learn tips on how to lose weight and possibly reverse some serious health conditions. This information is not meant to be medical advice. Please seek consultation from your own medical professional.

Speaker 1: 0:01

Welcome to the Metabolic MD. Health means everything. We all seek optimal health, but most of us do not know how to achieve it. Dr. Paul Kaloi has spent a career in the emergency department now. He helps his patients avoid ever ending up there. During these podcasts, you'll learn how you can lose weight and prevent and reverse disease through new technology, a modified diet, and the use of some new recently approved FDA medications. This information is not meant to be medical advice. Please seek consultation from your own medical provider. Let's listen in.

Speaker 2: 0:36

Well , hey folks. Welcome back to the Metabolic MD with Dr. Paul Kasik RS as we like to call him

Speaker 3: 0:43

Dr.

Speaker 2: 0:44

Colo , Dr . Colo , aka a Dr. Colo . All right , so in the past we've covered many, many topics on weight loss, keto diets, semiglutide , uh, CGMs, things like that. Today we're talking about the good, the bad, and the ugly as Semiglutide. Is that correct?

Speaker 3: 1:02

That's correct.

Speaker 2: 1:03

All right . So for those folks who are joining us for the very first time, and if, if you are welcome, this is one of the fastest growing podcasts out there. Uh, and what, what I'd love to do is let's start with a little bit of background about what is a semiglutide, what is Wago V what is Ozempic? What are those things?

Speaker 3: 1:20

So Semaglutide is the new FDA-approved weight loss medications just approved in the last 18 months or so, have become very popular, starting to be called one of the Medicines of the Stars, cuz the people out in Hollywood are using it a lot, but it's effective for weight loss. But it has some good upsides, but it has some downsides as well.

Speaker 2: 1:39

Okay. So basically Semaglutide is the generic brand for Wago V and Ozempic, correct?

Speaker 3: 1:45

Yeah. And the story behind that is that this medicine originally was formulated as Ozempic used in diabetics for a number of years. It was found that that medicine not only helped control their blood sugar, but had helped 'em lose weight. So the pharmaceutical company that made the medication went back and did studies on non-diabetics. Uh , and it found that they lost weight as well with this medication. And so then it was marketed as Wogo V . So now for weight loss available as Wogo V but also available , um, through selected physicians like Metabolic MD as a compounded medicine , uh, which means it can be made available at much lower cost to people.

Speaker 2: 2:24

Yes, I I saw just an episode of Inside Addition where this was the topic that they were discussing how people out in Hollywood are using , uh, semiglutide for weight loss and, and maintaining their , their , their weight. Now, this has caused a shortage for diabetics like me who need the , the medicine because these guys are gobbling it all up. And I know that's an issue that they're trying to address, but how does it work? So , and briefly tell us how this thing affects me as a person.

Speaker 3: 2:50

Yeah, just very briefly, it's a once weekly shot. It , it has the dose that increases over the course of many months. So you start, take a single dose for a week and then you bump that dose, take that higher dose for a week, go ahead and bump the dose again. And over a period of months it continues to increase until you get to the appropriate level. Um, but what , uh, the way it works is by three mechanisms of action. And that is , uh, that it slows gastric empty and that means it keeps your stomach full longer. There's a little valve between the stomach and the intestines called the pyloric valve. And this medicine kind of tightens up that valve so your stomach stays fuller longer. And then it has a couple other mechanisms of action as well. It lowers blood glucose and as we have talked a lot, if you can lower your blood glucose , you can burn fat as a source of energy and that will help you lose weight. And then the third effect is it has a direct effect on the brain, the hypothalamus in the brain. Uh, so it can decrease hunger directly that way.

Speaker 2: 3:53

All right . So since this is the good, the bad and the ugly for semiglutide, let's start with the UGLi . What are the risk and the things, the side effects that go along with

Speaker 3: 4:02

This drug ? So the first ugly really is there are certain people that can't take this medication. So if you have a family history of a certain type of thyroid cancer called medullary thyroid cancer or a strange kind of cancer that's very rare called multiple endocrine neoplasia that runs in families, then this medicine is contraindicated. Or what that means is you shouldn't take it. And then patients with some other problems like recurrent pancreatitis, inflammation of the pancreas or recurrent gallbladder problems shouldn't take it as well. If your gallbladder's out, it's not a problem, you can use the medicine. Um, so there are a few conditions like that that are also contraindications.

Speaker 2: 4:43

Okay. So that, is that the ugly, is that all their ugly parts bec before we get to the bad ?

Speaker 3: 4:47

Well the , the other ugly part is the potential side effects of these medications. What are those? Um , so the one I see in my patients most of the time is nausea. So as you can guess, if you get on the internet and look at side effects of semaglutide, you're gonna see a laund laundry list of problems. But usually I only see a few things and that's nausea, rarely progressing to vomiting. Sometimes a little bit of abdominal cramping, sometimes a little bit of a c constipation. Um, but one of the good things about working with the provider that understands this medicine and quite honestly also working with the compounded semaglutide, is that the dose can then be titrated. If I have a patient that has too much nausea, then we just back off on the dose. That's not necessarily true with wogo V or the standard pens cuz they're dosages. These injection pens have standard dosages in 'em and you're kind of committed to that regimen. But with a compounded semaglutide, you can draw up different amounts from the vial, you can titrate the dose depending on the patient's symptoms and you can help them progress without having any significant problems.

Speaker 2: 5:51

Yeah, I was just, I know in a previous podcast we talked about how you start out with a low dose and build it up so they they tolerate it better. That's kind of what you were talking

Speaker 3: 5:59

About then . Right? And occasionally even I have patients that are low dose don't have any problems at all and we can actually acc excel accelerate the dosing more rapidly.

Speaker 2: 6:08

Okay. So let's , we've talked about the ugly, let's talk about the bad, which seems like it's about the same as the ugly, but go ahead. What is are the bad parts about this?

Speaker 3: 6:17

Okay, well it's not, the bad isn't quite as bad as the ugly, so okay , <laugh> . Alright , um, but the bad really is the weight regain that can occur when you re when you stop this medicine. So yeah, a lot of press now great medicine helps people lose weight, but unless you're planning on being on this medicine for the rest of your life, you gotta think about what's gonna happen when you come off it. And all the studies that have been done on semaglutide have shown that there is weight regain when you stop the medicine. But

Speaker 2: 6:46

Can you be on it for the rest of your life? Is that, is there an issue with that?

Speaker 3: 6:49

Um, you can be on it right now. Again, this medicine has only been used for uh , you know, a number of years. So you're always worrying about long-term , very long-term side effects. But yeah, you can go on this medicine for the rest of your life, but you know, do you want to be giving yourself a shot every week for the rest of your life or do you want to use, or , or you want this to be an opportunity to change some lifestyle things that will help you sustain weight loss in a normal weight in metabolic health after you've stopped the medicine.

Speaker 2: 7:20

So, so make sure I got this right. What you're kind of prescribing is let's use this as a tool to kickstart this approach and then through changing some of the things you eat, some of the, the ways you behave , uh, then you can wean yourself off of it is what you're kind of talking through. Right?

Speaker 3: 7:35

Yeah. So I always use this medicine as part of a comprehensive weight loss and metabolic health program. We've talked a lot about it. A lot includes low carb diets, guided by a continuous glucose monitor, and we use continuous glucose monitors and non-diabetics and pre-diabetics, not just diabetics. Um , but we use then this medicine to either kickstart this process or once in a while. I have patients that get stalled after a while and then this will kind of goose the process along. So it is the CGM guided low carb diet, some intermittent fasting. And then we've talked about strength training cuz that helps decrease insulin resistance, which is the reason the majority of overweight Americans have weight issues. Got

Speaker 2: 8:19

It. Okay. So are we ready to progress to the good yet? Have you , have we covered all the

Speaker 3: 8:23

Bad, there's one more bad. Go ahead. And that is that when you lose weight on this medicine, you don't only lose fat, you lose muscle mass as well. Um, and so you gotta be very careful on this medicine. That's a big issue for all of us as we age, cuz we lose muscle mass as we age anyways. For women, it's a big deal because if you lose muscle mass, then, then that can cause worsening problems with osteoporosis. So you gotta be careful of this issue of losing muscle mass on this medication. So all our programs, as I kind of just alluded to, includes strength training for our patients because you can counter that muscle loss with strength training and actually as part of your diet, not only being low card , but also higher in protein.

Speaker 2: 9:05

So you're not saying I'm gonna go bench press a thousand pounds . You're just basically telling people not the cardio machines as much as maybe pick up some of the lighter dumbbells just to kind of, you know, pump it up a little bit. Just a little

Speaker 3: 9:18

Bit. Right, right, right. You just want to add , you wanna make sure you aren't losing muscle, maybe add a little muscle tone. You know , sometimes the women are worried about, oh , that's gonna bulk me up, you know, hundreds of patients in my practice and I have not women in my practice and I have not seen that issue. Most of them are very happy when they, you know, pick up this new habit of lifting weights and they see a little bit more tone in their

Speaker 2: 9:40

Body. Oh, good. So now have we covered the bad? Are we ready to go to the good? I don't wanna get to the good. I

Speaker 3: 9:46

Think

Speaker 2: 9:46

We're ready, let's go. What are the good aspects of this? Well,

Speaker 3: 9:50

The good aspect is the weight loss. Um, all the studies have shown at 12 to 15% body weight loss in patients that are also doing some dietary regimen and an exercise regimen. But 12 to 15% of weight loss can be a big deal and oh yeah . That really can help people meet their goals. Um, and then the other is that this can improve your overall metabolic health status. So, you know, if you have a high blood sugar pre-diabetic , um, you can lower your blood sugar, it can help with blood pressure and cholesterol. There have been some studies that have shown even in patients that are not pre-diabetic or diabetic, the use of this medicine, even before they would even reach that phase, can help confer Yeah . A lifelong protection of some of those serious metabolic problems. So in other words, you can head off potentially having pre-diabetes down the road or cholesterol issues down the road, or hypertension down the road just by using this medication.

Speaker 2: 10:51

Haven't I seen commercials for maybe it's wago or ozempic where it actually improves heart health? Is that, is am I mis , am I wrong? As I saw that

Speaker 3: 11:01

By those mechanisms, you know, by improving blood pressure, by improving cholesterol, I think the numbers you saw in the commercials are a1c , uh, which is a measure Yeah . Of, you know, do the amount of blood glucose in your system over a long period of time. Uh , but this medicine very much helps control blood glucose as well.

Speaker 2: 11:19

Maybe, I swear, and I couldn't apologize listeners , uh, I thought it was reduce a risk of stroke.

Speaker 3: 11:25

Oh, that's true. Yeah. Yeah . Uh , I I you're making a good point. Yeah, it reduce , so I talked about it reducing, you know, issues of hypertension and high cholesterol, but the endpoint of all of that, of course is the crises that it can occur with, you know, stroke or a heart attack or, you know, bad peripheral vascular disease, the things that I've seen in the emergency department over 30 years that we've talked about

Speaker 2: 11:48

Before. Yeah . So let's go, let's make sure I got this right. So if I'm a , a male or a female and I'm, I'm 200 pounds and I'm overweight , um, a 10% reduction would be close to , uh, 20 pounds. Correct? Correct. So by using this medicine along with some of the other things you're prescribing, they can expect to lose maybe 20 pounds, maybe more. Yeah. I ,

Speaker 3: 12:10

I'll be honest with you, my patients do better. Yeah . Um , you know, and , and that's the reason is that I just don't give them this medicine and say good luck. Right. You know, we give them the medicine and say, okay, what's your dietary program gonna be? Here's your continuous glucose monitor, let's monitor your carb intake. What's your intermitent fasting program gonna be? Let's talk about getting with my trainer and what's your strength training gonna be? So yeah, patients can do better than that if they're within a structured program.

Speaker 2: 12:39

So it's a complete plan. It's kind of what your approach, you're just not saying, here's a prescription, go away, come back in six months, you're saying? Yeah . If, if the doctor's really involved in your medical or your , your , your , your health healthcare plan, right? You wanna see them more often, you wanna be involved in other aspects, just not how the

Speaker 3: 12:56

Prescription's going . Right. And there are those services out there where you can just do a, you know, 10 minute visit with, you know, a medical provider online and they will send you semaglutide. But I really think that that's not as service to patients because again, the majority are gonna be coming off. Um, and , uh, the medicine eventually, and this medication can have UNT tower side effects like we've talked about. And so you really need to put this in the context of a comprehensive medical program that, that a clinician is monitoring with

Speaker 2: 13:26

You. So you're, I know you do telemedicine for, oh , you're , well, you're based in Ohio, but you do Florida, Indiana, and Arizona.

Speaker 3: 13:33

That's correct.

Speaker 2: 13:34

Yeah. So, so do you have patients in those areas that they're able to, at least you're just not prescribing, but then you do follow up telemedicine calls?

Speaker 3: 13:41

Yeah, telemedicine's become very common. I see patients monthly, my trainer and nutritionist talks to them weekly, either with a Zoom , uh, you know, visit Right . Or on the telephone. So really, it's almost like being in my office and, you know, since covid, this is becoming increasingly common. I, I gotta say , uh, that , that I'm flattered that I even have patients that are not in those states that have arranged to drive into those states because the telemedicine laws, they physically have to be in a state where I, I'm licensed, but I've actually had patients in adjacent states drive into those states where I'm licensed. I've even had a couple get on a plane to get into a state where I'm licensed so that I can go ahead and provide care

Speaker 2: 14:24

For them. So one of the , one of the things I , we weren't really didn't prepared to talk about this, but the CGMs allow doctors to monitor how things are going remotely. Right? Exactly. Do you ever do that with your patients? You ever see their CGM results? Like, like they'll send you graphs or you are able to

Speaker 3: 14:40

Log in ? No, I do that with all my patients. Okay. So we put, we put the continuous glucose monitors, and again, this focuses not only on diabetics, but pre-diabetics and , and non-diabetics. And, you know, from the time they put the monitor on, I can be following their numbers remotely 24 7. Now I don't, I don't bother them that often. I don't hassle them that often, but I do follow trends and after a few days, if they're getting off track, they're gonna hear from me , um, or my , uh, nutritionist. And that's the way most patients want this. It doesn't happen a lot because the CGMs are such great tools to guiding diet y . You know, if you decrease your car intake on the cgm, you're gonna lower those glucose curves and you can see exactly what's happening with your body based on your dietary intake. So these are great tools to help guide diet.

Speaker 2: 15:31

All right . Well, it sounds like you're, you're , you're really a coach in this whole thing. You're there, you're monitoring your , the progress there to take care of issues. If they're falling behind, you're helping 'em get , get back up and, and run the last leg of the mile. Okay. So we've talked to Good, we've talked to bad, we've talked to ugly. What else should we be talking about before we wrap up this semiglutide podcast?

Speaker 3: 15:54

You know, I , I , I think it's just that when you approach weight loss, you , you gotta do it with a mindset that you're also trying to achieve improved metabolic health. Um, and , and what I mean is that a lot of patients have subtle health problems. They aren't aware of whether that be a blood sugar where you've been told, oh , just it's a little bit high. Keep an eye on it. Let's watch it for another year. Yeah . So it , it's truly not an aesthetic thing in my mind. It's not that you want to lose weight because you want to look better. I mean, yeah, that's part of it. But what we're really trying to do is help people maintain healthy and active lives indefinitely into the future as they get older.

Speaker 2: 16:35

All right . Well, I think that's a great place to wrap this one up. So I want to thank you again for joining us here on the Metabolic MD with Dr. Paka lasik , R A K A ,

Speaker 3: 16:44

Dr. Colo

Speaker 2: 16:46

<laugh>. This is Terry O'Brien with Tri-Level Productions, and we'll see you again soon. Thank you.

Speaker 3: 16:51

Thanks.

Speaker 1: 16:52

Thank you for joining us on this episode of the Metabolic MD with Dr. Paul Colo . Please join us again for the next episode to hear how your metabolic health means everything, and to learn tips on how to lose weight and possibly reverse some serious health conditions. This information is not meant to be medical advice. Please seek consultation from your own medical professional.

Speaker 1: 0:01

Welcome to the Metabolic MD. Health means everything. We all seek optimal health, but most of us do not know how to achieve it. Dr Paul Kaladzi has spent a career in the emergency department. Now he helps his patients avoid ever ending up there. During these podcasts, you'll learn how you can lose weight and prevent and reverse disease through new technology, a modified diet and the use of some new, recently approved FDA medications. This information is not meant to be medical advice. Please seek consultation from your own medical provider. Let's listen in.

Speaker 2: 0:35

Hey everybody. This is Terry O'Brien here at Tri-Level Studios in Dayton Ohio. We're here with Dr Paul Kaladzi for another fun filled episode of the Metabolic MD Dr. Can you hear me over there?

Speaker 3: 0:49

I can hear you.

Speaker 2: 0:51

All right. So we got a lot going on with Metabolic MD and we're here to talk about a few things. One of those is you're going to do something that you have not done before, which is a live over the internet Zoom presentation, question and answer session coming up here. Is it July 11th? Is that correct?

Speaker 3: 1:12

Yeah, July 11th at 7 pm, We're doing a virtual seminar over Zoom to talk about metabolic health, weight loss, use of CGMs, semi-glutide, ozambic, decreasing insulin resistance really what I've been doing in my practice for the last seven years.

Speaker 2: 1:31

All right. So this is open to anybody who wants to come in and listen. You'll be answering your questions about what the heck's going on out there. So how do they register? They go to your website, is that correct?

Speaker 3: 1:43

Yeah, If you go to metabolicmdscom, right on the first page there's a registration. We need to have everybody register. We're especially inviting people in Ohio, Indiana, Florida and Arizona, which are the states that I have licenses in. Okay, And we're going to talk, for I'm going to talk for probably 20 minutes or so about metabolic health and then we're going to answer everybody's questions.

Speaker 2: 2:07

All right. So if you got questions out there, folks about you know, is ozambic something I can do or is low carb diet something that's doable, plus the CGM? you wrote a book. Let's talk a little bit about the book that you just released. How's that going?

Speaker 3: 2:24

The book is going great, the sales are going great, the ratings are great, so I'm really excited about it. It really just outlines the program that I've been doing with patients over the course of the last again seven years or so, and so, chapter by chapter, we kind of go through that plan. My patients have had great success And the book really just discusses that, and so it's being very well received. I'm actually at 4.8 out of five stars on Amazon right now. You can you can find the book on Amazon. You can Google my last name, google search. My last name on Amazon or the name of the book is the Continuous Glucose Monitor Revolution for non diabetics, and it basically tells people how to use a continuous glucose monitor to guide their low carb diet as part of a comprehensive weight loss and health improvement program. All right.

Speaker 2: 3:19

So you're going to cover some of that in this Zoom presentation, which, by the way, it's free. You don't charge anybody to do this right.

Speaker 3: 3:25

No, no, yeah So July 11th.

Speaker 2: 3:28

Well, what time is it? Is it 7pm?

Speaker 3: 3:31

July 11, 7pm for an hour. If we need to go over a little bit because of questions, that's fine. And just so the listeners know, i've done this seminar in person. We've had, you know, several time rooms full of people. They've been received very well. So we're excited about the opportunity to do it virtually.

Speaker 2: 3:49

Okay, well, great. So if anybody's out there listening wants to come, go to the website metabolic mds with com or Dr Paul or it's actually Dr Colos, another website you can get to the same thing, right.

Speaker 3: 4:02

Right Dr Docto Rko locom.

Speaker 2: 4:06

All right, we'll have to have a whole conversation about your, your nickname there, but we'll come back to that. And before we jump into semi-glutides and what's going on, you do have a new website and people want to see that they should go to those previously mentioned URLs. correct, Right?

Speaker 3: 4:23

So a lot of things going on Virtual seminar here, new book is out, and then we've got our new website up and running. It provides reviews on our practice from both experts in the metabolic health field and patients. We talk about Osembic and metabolic health and use of continuous glucose monitors, which are kind of the three foundations of our program. There is a media tab where you can see my YouTube videos. You can see the podcast that we've done with with you, terry, the metabolic MD podcast, but also the national podcasts that I've done, and then actually the book is reviewed as well. There's an entire sample chapter for the book on the website as well. We've got, you know, a handful of videos that outlines our program, so there's a lot of good information there.

Speaker 2: 5:16

Alright. So now the big question why we're doing this podcast is what is going on with Osembic? Every time I turn on the TV Sunday morning programs CBS News, cnn they're doing these segments on Osembic and how people are using it to lose weight, and it feels like it was for, you know, the Hollywood stars. But that's not the case. Is that true?

Speaker 3: 5:41

Well, these are medicines that have been out for four or five years, originally used for diabetics to lower blood sugar, and the drug companies that make them, and we're talking about specifically Osembic, which is for diabetics, wigovii, which is specifically for weight loss, and then Monjuro is another medicine for diabetics, but it's currently in trials for weight loss as well And what was found is, yeah, this was a good medicine for lowering diabetics blood sugar, but they also lost weight using these medications as well, and once the drug companies realized that the patients were successfully losing weight and actually reversing other metabolic health problems, they did studies and now they're approved for weight loss as well.

Speaker 2: 6:28

So you're not again. I want to make sure people understand your program. It's not about here's some prescription go away, lose some weight. Call me if you need me. You actually are providing a CGM so you understand how your body, your metabolic system, is working. You're monitoring that. You're also providing some low carb diet guidance, right, and then you have coaches and people who are involved all along this journey to make sure they're not abusing the product or getting off of the wrong track. That's what you're doing, correct.

Speaker 3: 7:00

Yeah, we usually start not with the medicine. We usually start with a review of metabolic health. We assess a patient's insulin resistance. We do that by measuring fasting insulin levels, which is rare for primary care docs to do, but I think it's one of the most important tests that can be done, because the reason most middle-aged Americans 60% of middle-aged Americans are overweight is because of insulin resistance. So we start out assessing insulin resistance by determining a fasting insulin level and an exact level of insulin resistance. And then, of course, we use the CGMs for a couple of weeks so people can actually follow where their blood sugars go And are they spiking to 130 or 140, which is okay Or are they spiking to 160 or 220? And people look at those graphs on their phone with the CGMs and they begin to understand their metabolism almost immediately. Just to back up, a CGM is those devices that you see on the back of people's arms continuous glucose monitor. There you go, diabetics like you wear those And they provide 24-7 readings of your blood glucose. So whenever you eat something you can see immediately what's going on with your blood glucose. And so my patients first use those for a couple of weeks diagnostically to see exactly where they are related to insulin resistance. And then we often use them long-term to help guide their low-carb diet And, terry, as you know, i'm a big advocate of low-carb diets. That's the insulin resistance model of weight loss. I think by far and away that approach is a better approach than the calories in, calories out approach of just trying to take in fewer calories than you expand, which I don't think is sustainable over a period of time. And just the basic physiology is let's use a low carb diet to lower your blood glucose. When your blood glucose is lower, then that means there is a need for energy by your muscles, your organs. So those organs start looking around for another source of energy because you're keeping your blood glucose low on a low carb diet. And where do they find that energy? Well, they find it in the visceral fat and the fat around the middle. So those fatty acids get broken down and people lose weight. It's just like the bear in winter when it's hibernating for four or five months. It was out in the fall forging and eating a lot of carbs, fattened up, but now it's not eating for six months and it's living off fatty acids and losing weight. Of course we don't hibernate for four or five months, but we certainly can tap those fatty acids to lose weight and improve health. And it's not just about weight loss. It's about reversing prediabetes or decreasing medication requirements and diabetes, or reversing hypertension or decreasing cholesterol or reversing GERD or fatty liver disease. So it's really about not just weight and not just about aesthetics you know how somebody looks it's about improved health.

Speaker 2: 10:11

Okay. So, getting back in, I'm trying to figure out why this is becoming such a popular thing right now. Is it just the momentum over the time that you know, the Kim Kardashian's and Elon Musk are all using this ozymbic to lose weight and now it's just kind of catching on and the whole world wants to do it. Is that what's going on?

Speaker 3: 10:34

Yeah, i got to tell you. I saw a comic the other day. It was like the far side comic and it had two windows that people were lining up at And one was pills and surgery and there was a big line for people in that, and the other one was lifestyle change and there was nobody in that line And really what we try and do is integrate the two. You know, people like a new medication If it's going to, you know, help, you know, facilitate their weight loss. But in these are good medications. Let me first talk about that. They're effective because they slow gastric emptying, they keep your stomach full longer, they lower your blood glucose so people lose weight taffady asses, just like we talked about And then they have a direct hypothalamic effect on the brain which decreases hunger. So they are good medicines but they come with a catch. The catch is, unless you plan on being on this medicine for the rest of your life, then you better put other lifestyle changes in place, like we've talked about diet, exercise, those approaches. Unless you decide, i'm going to go ahead and start taking this medicine and I'm going to be on it for the next 30, 40 years. You better have those other items in place. And then the other caveat is, when you're losing weight on those medicines, you are not only losing fat, you're losing muscle mass. So about 25% of the weight lost on these medications is muscle mass. So, again, this is why you need to have a comprehensive plan, which is again what I've been doing for the last seven years, which is CGM, low carb diet We use intermittent fasting as well And then strength training. We really emphasize strength training because that helps decrease insulin resistance as well. And then, of course, if you're on these medications, you got to be doing strength training because you know we're all losing muscle mass just as we age anyways, and so if you're on these medicines, then there's two reasons you could be losing muscle mass, so you really got to be strength training as well.

Speaker 2: 12:42

So I know that ozymbics are brand name. What Gov is a brand name. I know that Monjuro is a brand name, right, You see, every time you turn the TV on they're running an ad, somebody singing and dancing about this stuff. Yeah, What's going on with the generics? I understand that the generics are available, but they're they're being kind of tampered down by the big boys.

Speaker 3: 13:03

Yeah, yeah, there is a compounded semi-gluteide that's available at a lower cost And it's not FDA approved. It is not the brand name medicine But many people are using it because you know out of pocket costs, ozambic will gov, you know, if you, first of all, if you aren't diabetic, you can't get prescribed ozambic or Monjuro because those are only for diabetics. There's usually what's called a prior authorization process where the doc has to vouch that you're diabetic. So you can't really a doc really shouldn't or can't be prescribing those if it's a non diabetic. And then for Wagov insurance coverage is limited. So there's this alternative compounded semi-gluteide.

Speaker 2: 13:50

Okay And so, but you're one of the people who know how to prescribe that, because it's a combination of semi-gluteide and B12. Is that what it is?

Speaker 3: 14:00

Yeah, so there's that medicine available. But you know, what we do is we work with our patients to see what their insurance covers And then we look at all the alternatives for treatment.

Speaker 2: 14:09

All right. Well, i think that about wraps this one up. This was going to be a short podcast because we want to talk about the this giant boom of semi-gluteide slash ozambic marketing blitz that's going on there on all these TV shows. So I thought, because this is your avenue, this is your alley, we want to hear from you, the expert, about what that's going on with this stuff.

Speaker 3: 14:30

Well thanks, i appreciate that. But just you know, globally, the way to look at this, i believe, is go ahead and get an evaluation of insulin resistance. You know we have cholesterol phobia in this country. Low carb diets are usually high fat, so I think people worry a lot more about cholesterol than they should And don't worry about insulin resistance the way they should. 30% Americans are pre diabetic. Half of those people that are pre diabetic don't know it. So get a full metabolic health evaluation to start, and then I suggest weight loss programs should begin with a CGM low carb diet, intermittent fasting, the strength training component that we just talked about And, terry, i've treated people for many years with just those components before this medicine came out And then you can layer in these GL they're called GLP one medications, the medications we've been talking about. You can layer that in kind of as needed, but I don't think it's the first thing that you should grab when you're looking for weight loss. I think you really got to look at a comprehensive program. One thing we offer is accountability. The CGM data can be monitored remotely So I can follow people's blood glucose 24 seven, and then of course, i meet with people on at least a monthly basis. My personal trainer, nutrition coach checks in with people on a weekly basis, so we key tabs on people in terms of structuring their program, make sure they have the knowledge base to follow their program effectively. And then accountability, because they know we're checking and we're following their numbers.

Speaker 2: 16:09

So you're you're. Let me verify two things. If your patient has a piece of cake, they're gonna get a spike on their CGM. Yeah, not calling them within the air going.

Speaker 3: 16:18

Hey what'd you do? No, no people. You know people usually stuff correct And I'll tell you there. There are some people that really want me looking at their numbers. They want that accountability, they want me following them. There are other people that are managing it themselves and they just use that information themselves And the answer is no. I don't call somebody on 830 on a Friday evening when they just went out for a birthday dinner. But if they're off track over two, three, four days, they're going to hear from either my nutrition coach or me with just a polite inquiry what's going on? What can we do to get you back on track? Because, remember, if that blood glucose is up, they aren't burning fatty acids And so really their progress is going to get stalled.

Speaker 2: 17:05

Well, it's good. I'm glad to see you're not sending Tony out with a baseball bat to their door, should they? should they stray off with a piece of cake, rocky, all right? So let me. Let me kind of wrap this up. Your, your practice, the metabolic MDs available in Ohio. You're based out of Ohio, but you do telemedicine in Florida, arizona and Indiana, correct?

Speaker 3: 17:27

Yeah, and most our work is by telemedicine. Even for my patients in Ohio things have evolved since COVID and most people you know love doing telemedicine. It's very convenient, there's no travel time And I'll tell you, with this type of practice, which is really a consulting, advisement practice, you know it's very, very effective. And of course we can get people medication by calling it into their pharmacy. We can get them CGMs by calling the CGM prescription into their pharmacy. So the telemedicine approach is very convenient All right?

Speaker 2: 18:01

Well, doc, thanks very much. This is our first video. I'm used to having you in the same room. where we can, we can talk afterwards, but this is our very first video conference.

Speaker 3: 18:12

It's been a pleasure, let me. Let me do a couple more plugs, though. Again, july 11, 7pm, virtual zoom. You got to sign up at metabolic mdscom spaces limited, but we'd love to have you join us, especially those patients in the state's high practice Ohio, indiana, florida and Arizona or people that are just interested in this topic. And then the book is just out the continuous glucose monitor revolution for non diabetics, available on Amazon Kindle version for just 10 bucks. Would love for people to have a look at that.

Speaker 2: 18:47

All right. Well, again, this is our very first video podcast. We're going to see how it goes. Let us know what you guys think out there in the metabolic podcast world. Hopefully we'll do this again And I have a much better face for radio than I do for video like this. But thank you for joining us here on the metabolic MD with Dr Paul Colossik And we'll see you guys all soon. Thanks much Bye.

Speaker 1: 19:14

Thank you for joining us on this episode of the metabolic MD with Dr Paul Colossik. Please join us again for the next episode to hear how your metabolic health means everything and to learn tips on how to lose weight and possibly reverse some serious health conditions. This information is not meant to be medical advice. Please see consultation from your own medical professional.

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