Miracle Med or Short-Term Fix? The GLP-1 Debate

Welcome to your life reset, a Verta Health podcast where bold stories meet breakthrough ideas. From massive weight loss wins to exploring the latest research, discover what's possible when science meets real life. Hey there listeners, I'm Teresa Link and this is your life reset. GLP1s, Wiggoi, Ompic, Zepbound, Mangaro, they are everywhere. You've seen the ads. You've heard the hype. And let's be honest, those commercials make them look like a lot of fun. They can deliver big weight loss at first, but what happens after? Do you have to stay on them forever, or is there a better path forward? That's what we're exploring today with Dr. Jeff Stanley. No shame, no judgment. If you're wondering how to step off the medication train and maintain your health gains, this episode is for you. Plus, I'll put Doc Stanley in the hot seat. Get ready for real talk and lots of laughs. Let's dive in. All right. Well, Dr. Stanley, thanks for coming back on our podcast. Let's get into the topic today, which is everyone's favorite GLP1s. They are everywhere, right? Every other commercial I see about GLP1s. Um, so we're going to start with what are they and how do they actually work? So, explain this to us. — Yeah, I mean I think like everyone they I have the OMIC uh theme song Jingle stuck in my head. Feels like every time I get in the car, it's on the radio. You know, everybody's talking about these medications. But kind of more broadly for a background the you know official name are GLP1 agonists which stands for glucag glucagon like peptide agonists and they're more or less um a synthetic version of uh similar to a hormone called glucagon that everybody has in their body. And more or less, you know, the common brand names that you would recommend or that you would recognize rather are, you know, things like Ozic, uh, Trulicity, and then now with some of the weight loss medications, you know, WGO and Zepbound. Um, so again, I'm sure 10 jingles probably popped into your head. So I mean in terms of how the medications work, it's interesting because you know originally they were developed for diabetes and the thought was that the main mechanism was basically that they sort of slowed down absorption of food from the stomach. Um, in addition, glucagon or the GLP1, they cause a little bit of insulin release um when you eat, which then can help bring down blood sugar due to the insulin and the insulin sort of just spikes around the time of a meal. So, it was originally for diabetes. Um, you know, basically they started to see sort of as a side effect and then a realization that it would be kind of a cash cow is while these meds tend to cause a fair amount of weight loss. Um, and as they've explored that more, they think that, you know, slowing down food, emptying from the stomach does help you feel more full. It can help you eat a little bit less, but it seems to be that there's more of a effect on the brain. And so kind of this unexpected and you know I think to this point still somewhat unexplained benefit is that people tend to feel less hungry on the medications um have less cravings um and just be able to you know kind of control their appetite or what's being called now food noise kind of that feeling like you're just constantly thinking about food or needing your next meal. It is interesting because there's been some data that comes out or a lot of sort of anecdotal experiences of people that it may also just sort of reduce enjoyment of a number of things. So, you know, people saying like um you know, less enjoyment from shopping or drinking alcohol or you know, even things um like romance, you know, that actually sometimes those things may tie into some of the same reward centers in the brain. And the medications can reduce that which you know in some cases can be helpful if it reduces your online shopping but in other cases if it's you know making you sort of — enjoying life less or engaging with things less um that that's definitely a possible downside or something that we have seen. — Oh for sure. Um well we'll kind of dive a little bit more into some of those pros and cons. you know, they do seem to work pretty well, quite well in some people at first. Um, we'll kind of

talk a little bit more about some of the long-term, you know, uh, long-term information later, but what are some of those real pros and potentially cons that people can experience that, you know, you've seen in the wild, not necessarily in clinical studies, but, you know, what have you seen or heard others, you know, see? — Yeah. I mean, I think the benefits have been pretty well publicized, right? They seem, you know, particularly when you compare them to uh, you know, prior weight loss medications which tended to be things like stimulants or, you know, other medications that could have some nasty side effects or a lot of people probably remember like fenfen where it actually was very effective but it caused significant heart issues. So, you know, the medications have been sort of touted as this major step up in that regard. Um, which again, compared to those medications, they have been um and you know, definitely I think a lot of excitement as one of the first medications for weight loss that you know, seems to be fairly effective. Uh, I think when it comes to the cons, those have maybe been a little bit I mean, you know, you might hear them spit at you rapid fire at the end of the commercial or, you know, read about some horror stories and things, but I mean, some of the things that I've seen are, you know, first of all, they can cause some pretty significant nausea in people. And, you know, most people, I think, would rate nausea as one of their, you know, least enjoyable sensations. And so, you know, having — some people it's a constant level of low-level nausea. For some people, it can actually be really severe, you know, leading to vomiting. Um, you know, issues like diarrhea. Um, and even, you know, people like having to go to the emergency room for stomach pain or for not being able to stop vomiting. Um, so it's not without it its risks. — All right. So the nausea, the vomiting, the potent all of the lovely GI side effects that are not terribly uncommon with these medicines. Of course, varying degrees of how bad they are. Um, one of the things I've also heard quite a bit about is with the rapid weight loss can also be a lot of uh loss of lean tissue or muscle. Can you talk to us about that and what that maybe means in terms of risks? Yeah. So that that's been one of the areas that I think wasn't initially well publicized or understood u but has become I think more prominent and is definitely a concern. So you know a number of the clinical trials when they have done uh called DEXA scans where they basically can look at muscle mass, bone mass, fat mass and sort of differentiate what's lost. Um have shown that with um some of the medications there can be sort of a exorbitant amount of muscle mass that's lost. um you know in comparison to what might be expected if you lost weight more through you know nutritional changes or other means not totally understood why um you know it see again it seems to be a little bit out of proportion but I think the big concern that I've had is you know someone goes on a medication like ompic or zeppeli they lose a substantial amount of weight and that weight is going to be fat it's going to be some muscle muscle, even some bone mass as you're supporting less weight. Um, and so if you're losing higher proportion of muscle mass and then let's say you stop the medication, um, the risk there is that you regain the weight, but the weight that you regain is more likely to be fat than it is to be, you know, regaining the muscle mass that you had. It's tends to be more difficult to lose toh to gain muscle. And so, you know, I think the the worst case scenario is you lose a bunch of weight, you likely maybe spend a lot of money out of pocket, um then you stop the medication, one year later, you're back to square one from your weight, but you actually have a higher percentage of fat than you had to begin with. and you know the potentials for sort of lowering your metabolic rate or all the things that can happen you know when people have this kind of yo-yo weight change. — Yeah. So if you stop you could potentially be in a worse spot than you were before you even started possibly. — Yeah. I mean, and we've seen that like with The Biggest Loser and the sort of dramatic, you know, starve yourself and exercise to the point of exhaustion where when they tracked those folks, they lost a ton of weight, not surprisingly initially, but a few years

later, many of them were back at their baseline weight and they did metabolic studies and actually saw that their, you know, their metabolic rate had gone down. Um, which again is just makes it even harder in the future to maintain your health and to lose weight again. — So the ads say lose weight and keep it off. Let's say you just stop taking it. Does it last a long time or what is what are we typically seeing? Do you have to be on these meds forever to maintain that benefit? — Yeah, I mean that still kind of remains to be seen. But what I would say is that the clinical trial data is not promising in terms of people being able to stop the medication and then keep the weight off. Um you know especially without any kind of ongoing support or without changing some of the baseline nutrition and lifestyle issues that you know may have um helped contribute in the first place. So you know in the clinical trials basically you know people can lose a substantial amount of weight but in many of them you know a year later after stopping the medication they tracked folks and found that you know they had regained the majority of the weight that they had lost. You know some people even going past what their baseline was. Um you know many others you know losing sort of le less than 5% of their body weight from where they started. So again a pretty and pretty rapid regression um in terms of that weight regain and you know in the real world I think what's been seen is that you know first of all the weight loss with these medications is not as dramatic as it is in the clinical trials which is not surprising I mean that happens a lot where the clinical trial there's higher level of supervision everybody's getting the correct dose they're taking it every week as directed there's all this monitoring but in the real world it's a little bit of the west where a lot of people are they're coming on and off the med. They have no support from, you know, someone telling them how to change their diet, how to add in exercise. And so what's being seen in the real world is I think even sort of a more dramatic version of that where people are losing less weight than would be expected from the clinical trials and then with without any real you know even less support than they had on an ongoing basis and the trial the weight loss um or so the weight regain seems to happen pretty quickly and dramatically. And I think I heard a recent statistic uh about a you know we survey a survey of people um either you know on GLP1s or were considering GLP1s that said um I think it's like one in five people actually want to stay on their GLP1 in the long run. So you've got four out of five people that don't want to stay on it long term. So you've got what 80% of those folks that are at high risk for weight regain um you know high risk for kind of reversing a lot of those health benefits they had. So that's you know that's not exactly promising when we're talking about being able to maintain these health benefits which I actually want to get into now. You know, I heard you I heard uh some whisperings earlier about nutrition and support and how those things can be a powerful either alternative or adjunct to GLP1. So what talk to us about that? What is the alternative? Is there one? And is it a better path? — Yeah. So, I mean, even since my days working as a primary care doctor, I' I've always really believed in the power of nutrition and particularly when someone has the adequate support to make those changes, you know, in terms of being a way to really drive lasting health benefits. And you know, I think what I've seen with thousands of patients over the years is that, you know, by helping people to not have that biggest loser focus on, you know, again, just eating like a bird and exercising like crazy, reducing the processed sugars, reducing the processed carbohydrates, um getting plenty of healthy fats, getting enough protein, um and then moving your body, you know, those seem to be able to drive benefits that can rival the GLP ones. Um but they can also do it in a way where people are set up for long-term success. So, you know, you're not just, you know, using a band-aid or taking a short-term medication without changing some of the underlying behaviors. Um, and so by

doing that, again, whether you're on the medication for a period of time, whether you aren't interested or don't like the idea of being on a medication, um, I think building that foundation of good evidence-based, easy to follow nutrition, um, that kind of sets people up for success across the board. — Yeah. And we know that the vast majority, something like 80% don't want to be on these meds for the long run. So really, they need to be thinking about what additional things can I do to maintain my health gains um after I stop since I want to stop. Yeah. Most people don't want to be on medications. — Absolutely. And I think that's actually really interesting because, you know, I think particularly around these medications, but I think there's traditionally been a little bit of a um a myth or a feeling that, you know, everybody just wants a magic pill or everybody just wants this magic injection. They don't want to quote unquote work hard. change their lifestyle. But, you know, in my conversations with people, while that can, you know, be the case in a minority of people, I would say the majority of folks say, you know, I want the support to be able to, you know, change my health and I don't actually like the idea of being dependent on or on a medication for years or possibly the rest of my life. And I think it doesn't matter what the medication is. I think when you ask most people, would you like to take this thing for the rest of your life? I think you know, most people would say no. — You know, going back to some of those side effects, right? Let's pretend I'm taking this medication and I'm not changing anything else. It's just I am forced to eat less. I eat less and I'm losing weight, right? Uh, I have trouble imagining that if I just eat I keep eating a bacon double cheeseburger with fries and, you know, I finish it off with a large Coke. I just I have a hard time thinking you're going to feel good doing that. So, I think it's probably maybe at first you're like, "This is great. I can just keep eating what I want and my body stops me automatically. " But to your point, you keep that up. That's you're not going to see the same benefit. And also I doubt you feel very good doing that. So I believe you a lot of people probably do want to make changes. They just may not know, you know, where to start or what to do. — Yeah. For sure. I mean, I think that there are some folks that again take the medication and basically change nothing other than eating a smaller prop portion of the unhealthy food that they were eating before. And, you know, that still comes with, you know, things like the cardiovascular risk or I think to your point just feeling lousy. I mean, we've all eaten a meal like that where maybe it tastes delicious and then, you know, the rest of that day or longer you kind of just feel awful. So, I think that emphasis on saying like this can help you eat less, you know, in the right person, in the right patient. Um, but if it's done without any of these additional changes, first of all, the health benefits are going to be sort of blunted. Uh but also you're not setting yourself up for long-term success, you know, especially if things change, right? Like we don't know will your insurance continue to cover this medication for the long term. They're very expensive. We're seeing that a lot of employers and health plans who decided initially to cover the medication actually had to pull it back because they were seeing their cost double or they were having to pass on that in terms of premiums to all of their employees or others. So yeah, I mean I think it's so important to ideally if you can do it without the medication, I think most people would prefer that, but they do need a plan to do it and the support and sort of the you know real world troubleshooting that has to happen in order to make it there. — I'm going to take you to the hot seat. We've talked about GLP ones. I want to hear just kind of rapid fire — what you think. So the first question, what's the biggest myth that you've heard about GLP-1s? This could be, you know, either positive or negative. — Yeah, I would say the biggest myth is that this, you know, these medications uh represent the end of obesity. Yeah, I think we've heard that said before. Um, you know, again around that messaging around the magic pill or magic injection. And I think it's actually important to note that, you know, even with the

outcomes being very impressive and again it being a sort of a big step in obesity medications, there's still a limit to what they can do. And when you look at the weight loss, again, in the clinical trials, it might be somewhere 15 to 20% of body weight. In the real world, it's coming, you know, somewhere, you know, five to maybe, you know, 12 13% at the most. And a lot of the published data. — All right. Okay. I'm going to give you that first one, but really, Doc Stanley, you are breaking the rules of the hot seat. This is supposed to be rapid fire. — Rapid fire. Okay. All right. I'll do it. Okay. — What's your go-to tip for navigating cravings after stopping a GLP-1? — All right. Rapid fire. So, I would say prioritizing protein, getting plenty of the green veggies, um drinking plenty of water. Those would be the quick and easy tips. — All right. Protein, veggies, water. Done. Got it. Um what's a line that you'd use to kick off a conversation with your primary provider if you're considering stopping a GLP1? A lot of what I would say is my preference is to avoid taking these medications or I'm worried about taking this for the long term and I would really prefer to, you know, work on nutrition to work on lifestyle and I'd love to, you know, see how you could support me in that. — Awesome oneliner. Okay. Now, when it comes to success, what should people be paying attention to maybe more than the scale? So the scale can be cruel and also fluctuate quite a bit, right? So I would say the things to pay attention to are all about functionality. So how do you feel? How's your sleep? Um are you able to do the things that you enjoy with the people you love? So you know getting playing with your kids, playing with your grandkid, playing a sport. Um those are I think great markers. — Yeah, those non-scale victories. Uh yeah. Uh, so bottom line, in your opinion, should people be thinking about stopping a GLP-1? — Yes. Again, as I mentioned, sometimes out from areas outside of your control, the medication may not be covered. You may not be able to afford it. I think it's always good to have a backup plan or this foundation of nutrition in place. Um, and then in addition, if you're not keen on taking a medication for life, it's fine to say that and it's fine to figure out what an alternative is um so that you don't need to take it. — All right, last question. The most crucial question of all. What's one trend that you confidently rocked that you would never do again? — All right, this is a good one. Um, so it's funny with my son um entering middle school um thinking back to my middle school days um in the 90s and it would definitely be the um short bleached blonde hair and the uh ultra wide enormous jeans. Um so that probably that com I mean either one on its own was terrible, but I think the combination was um particularly bad. — Well, the '9s are back. uh 90s fashion. So, I think you need to get that bottle of bleach and uh maybe go out and buy a new pair of those uh widelegg jeans um and rock that trend again. You know, you said you wouldn't, but I think you can do it. I think you can. — Yeah. I mean, it has the uh has the added benefit of embarrassing my kids quite a bit, which is um I can think maybe an underappreciated part of parenting is uh the joy you could get from that. Well, on that note, we're going to close things out for the day. Uh, Dr. Stanley, thank you so much for joining us again. It was wonderful to have you back. Uh, kind of part two of our GLP-1 discussion. Um, enjoyed getting to chat with you. Enjoyed getting to share stories, laugh, and also hear a lot of really good sciency information and go-to tips for our listeners. So, thanks again for being here. — Oh, thanks. It was great. If you enjoyed this episode, be sure to subscribe and leave us a review on Apple or Spotify. And if you'd like to regain control of your metabolic health and feel like yourself again, check us out at verda. com. That's vir. com. Your life reset is forformational purposes only and shouldn't be considered a substitute for professional medical advice, diagnosis, or treatment. Contact your provider if you suspect you have a medical problem. I'll chat with you all again soon. Until then, stay inspired, my friends.