GLP-1 Weight Loss Drugs: Not Just for Diabetes Anymore?

Healthcare guidance, pricing, and availability may change. This episode is for educational purposes only and is not medical advice.

Rebecca: I was too busy getting my tea off the floor. I

Tristin: Your tea. Oh, you spilled your tea?

Rebecca: no. I set it on the floor and forgot about it

Tristin: Oh. You just went, "Oh, shit," and then I didn't know what happened

Rebecca: Welcome to Please Health Me. I'm Tristan, and each week I bring real health questions from around the internet to my mom, Rebecca, a board-certified family nurse practitioner with 45 years of experience. Together, we try to make healthcare a little easier to understand so you know more about what's happening, what questions to ask, and what options you might have.

We're here to educate, not diagnose or treat medical conditions. What we discuss should never replace advice from your own healthcare provider.

Tristin: before we get started, a quick note for our listeners. We're an independent podcast. We're not affiliated with any hospital, health system or sponsor, and we're fully self-funded, so the topics and opinions you hear are entirely our own.

Okay, the hot topic of GLPs is on deck today. I feel like I can't get away from the ads online, literally every other commercial and all the celebrities are taking them and talking openly about how much they love them. I think this was a topic that we couldn't ignore. So let's start with the basics. what the heck does GLP even stand for and what is it?

Rebecca: GLP stands for glucagon peptide receptor agonist.

Tristin: Wow. That sounds super friendly. that's a mouthful. No wonder everyone just says, Ozempic,

Rebecca: the name, yes, or the name

Tristin: yeah, like the brand name that they might be on,

Rebecca: it's actually called GLP-1, and the one just stands for the type of peptide it is. It's really a hormone that your gut makes throughout the day. So when eating, it lets all your organs know that you're full and have food in your stomach that's ready to be used.

So it tells your body to digest and process the calories. So, in obesity and in people with type 2 diabetes, this system often doesn't work well, which makes it harder to regulate appetite and blood sugar levels

Tristin: So basically it's hard to stop eating. Like, how does that even work? Because we got a question from Dana in Charlotte, North Carolina, who writes, "My sister started Ozempic a few months ago, and she says she's just not hungry anymore. She literally forgets to eat lunch. how can a once-a-week shot change your appetite that much?"

Rebecca: it works in about three different ways, okay?it slows the food moving from your stomach into your intestines. So doing that, it makes you feel full for longer,

Tristin: 嗯。

Rebecca: the nutrients from your food. It also helps the pancreas release insulin.

Insulin tells the body to absorb sugar from the bloodstream. So in diabetes, many times the pancreas is not functioning properly, so insulin is not released correctly when blood sugar spikes and blood glucose levels rise. It also acts on the brain centers that tell you,you're full.

that's a real big one because, they're finding that it helps, people report that it just helps with their preoccupation with food. It-- They call it food noise. They're just not thinking of food all the time. food can be a type of addiction. if you're not hungry, then you're not thinking about your next meal or snack, so you eat less.

So those three ways help people eat less and

weight, lose weight.

Tristin: I like food noise. I've never heard that term until we started kinda looking at this, research for this episode, but it, it makes a lot of sense. And the idea that a medication can, like, quiet that constant chatter about your next snack is honestly kind of amazing. so that if that's what that does, the next big question is how do you actually take it?

We got a question from, this from, uh, Jenna in Boise, Idaho. She says, "My doctor brought up starting a GLP-1, but I keep hearing so many names," like we were just saying, Ozempic, Wegovy, Mounjaro, Zepbound. "Are they all the same thing?" I can't even keep up with these names. Can you help us out?

Rebecca: sure. and there are a lot of names, and in fact, when I was,researching things, it said that a lot of providers don't have them all straight. that they would decide to change somebody just-- and ask somebody to, "Should I change them to this?" And it was the same exact drug, 'cause there's just too many names and too many generics, right?

Rebecca: so there are basically, there's three injectables, that are now available, and they have wild names. It's, the, the basic active ingredient name is called semaglutide, and that's the Ozempic. That's the other better-known name. It's a weekly injection used for diabetes, and the other semaglutide is called Wegovy, and that is basically more used for obesity.

they're the same drug. That's why there's confusion. It's exactly the same drug, but they're given at different doses for each condition, whatever the condition is. Then there's, something called liraglutide, known as Saxenda for obesity and Victoza for diabetes, and that's a daily injection, and it's u- usually considered less potent than the semaglutides that we just talked about. And there's tirzepatide, known as Mounjaro for diabetes and Zepbound for obesity. it's different than those, it- because it con-contains a second compound, so there's kind of a two-for-one in that, and it mimics another gut hormone, and it's a do-dosed as a weekly And of course, drug companies are already working on a lot more.

Tristin: right. I'm already lost in the brand names, but keep going. Are there, are injectables the only option or are there others? 'Cause I think a lot of people hate needles

Rebecca: sure they do.we find that out with, vaccines, don't

Tristin: Yeah.

Rebecca: But, yeah, there are two oral medications on the market right now, but, I wouldn't get too excited, uh, because,two of 'em, one-- the first one, oral for glipron, known as Fon- fondue for obesity, is a once a day pill, and that can be taken at any

Tristin: Угу

Rebecca: and there's another f- oral form of semaglutide. again, the semaglutide is the Ozempic and Wegovy, and that's one I think that people key in on because it's-- they think, "Oh, well, I won't take the injection. I'll take this pill." And it's for diabetes and obesity. but the catch is it has super strict directions for how you use it.

It has to be taken just so all these little things, and so it's hard to adhere to in a busy life. And the worst part is that you really only absorb 1% of this drug when you do take it And that's why you're hearing people go, "Well, I took the oral Ozempic. It's just not working for me."

Well, it sounds like it doesn't work that quickly or well for

anyone.

Tristin: Yeah, the, the oral medications maybe are not working as effectively as, say, the injectables

Rebecca: They definitely don't. And,it's too bad because I know a lot of people got excited about that. and that might change, that they might figure that out. But right now they're they're not they're

not what you think they

Tristin: Yeah, and I'm sure they'll be working on that again. The, this-- there's a lot of money involved here. So I guess the, the question everyone also wants answered is how much does this stuff cost? uh, Monica in Philadelphia, Pennsylvania asked, "I'd love to try GLP-1, but I keep hearing they cost a fortune and some people stay on them for life.

What does it actually cost, and what if my insurance won't cover it?"

Rebecca: Yeah, costs are a big challenge. some of these drugs are covered by insurance, and if your insurance covers one, then that's the one you'll likely be started on by your provider. If you don't have insurance, then it's always a good place to start at GoodRx.that's an online, platform that tells you the prices of drugs.

You can just type in your drug, and it'll tell you in your local area at your different pharmacies, what the prices can run. So that's always a good place to go.it just helps a lot. But, I went on, last few days, I went on GoodRx and tried to look up some of this stuff. and Ozempic is, has three different doses, so that, you know, your price is gonna vary with that.

So it, anywhere from 149 a month to 299 a month. and Wegovy, which is the similar to Ozempic, is the same. Saxenda is $372. That's the lowest I found. And Victoza is anywhere from 95 to 203. And then Mounjaro, forget about it if you don't have insurance. It's over $1,000.

Tristin: wow

Rebecca: Zepbound is 300 a month, Fontedo 104-- That's the oral, 100 and, 49, and also oral Ozempic is And, so it's really-- That's just some basics, and it's really hard, because the, of different dosing, how you take it. You might be upped, within a month's time, you might be upped on it, then you can have to get more. and everyone responds differently to these drugs. you may lose more on one drug than another or have more side effects with one than another. So, I mean, that's truly why you need to be managed by a provider. it's not just take this pill or take this injection and you're good to go. There's a lot of, monitoring that needs to be done 'cause it needs to be maybe titrated or

changed

Tristin: Titrated. Can you translate for the people? Meaning, like, the dose gets adjusted up and down over

time?

Rebecca: Yeah, exactly. titrating a dose means you, you mi- you need to change it a little bit. It might go up, it might go down. It depends on side effects and, if it's working for you. So it's just changing the dose, adjusting the dose

Tristin: okay. And so who are these actually meant for? Because my social feed makes it seem like it's for everyone.

Rebecca: Yeah.so the FDA has approved it, in six different diseases right now. So it is, it is approved by the FDA in six types of situations. obviously the first one is type 2 diabetes,and for all the reasons we mentioned. Plus it has been shown to slow the progression of diabetic kidney disease, which is huge. number one is diabetes.number two, would be chronic weight management, and that's in obese patients. and also, they have a caveat in there that it's for obese patients with a chronic weight-related disease.not only do you have to have obesity, you have to have some chronic illness to go along with it.

and then they approve it. and I was thinking about that we should kind of go over what we really call obese or the class of overweight, that kind of thing. so overweight, an overweight person has a BMI of 25 to 29.9. And then there's three classes of obesity. class I is a BMI of 30 to 34.9, and class II is 35 to 39.5, and class III is 40 or greater.and, BMI is lots of times done when you go into your provider or it's in these EHRs, it automatically goes in, it just works it out for us. But you can also go online and put your weight and height in, and there's plenty of sites online, and just find your BMI if you don't know it

Tristin: Yeah. Yeah. I think BMI is a number most of us have at least heard at the doctor's office. Like you mentioned, it's kind of calculated and probably mentioned. but you hear all the time that extra weight affects, you know, way more than like how your jeans fit, especially your heart. Do these meds actually help with that too?

Rebecca: right, they do, that's why it's been approved for heart disease. and people who have already had a stroke, a heart attack, or have peripheral artery disease, that's, your veins, it reduces inflammation. And many people don't realize that obesity leads to chronic inflammation, and chronic inflammation leads to heart disease, can cause it.

So in obesity, fat cells enlarge with excess storage and it causes a lot of cell stress and death, and that, that causes the body to react with inflammation. So this was another big, huge thing about GLPs. It helps in that way. one recent study of 17,000 patients on GLPs who had cardiovascular disease and obesity, but they had no diabetes, it had reduced major cardiac events by 20%. we just always think of diabetics and they're more prone to heart disease, but, if it's-- if you have no diabetes and you're just obese, same thing.so if you're obese, you're at risk for heart disease and stroke, whether you have diabetes or not. That's a reason to take a GLP.

Tristin: Yeah. I mean, a 20% drop is huge.

So that's, yeah, that is nothing.so it's not just about, you know, a number on the scale, it's actually protecting your heart, and I don't think many people know that. But what about the rest of the body? You keep mentioning inflammation. Does it help anywhere else?

Rebecca: yeah. it helps in fatty liver disease. I think that's something a lot of people know about too. They'll go and they'll get their blood work done and,the doctor will say, "Well, your-- some of your liver enzymes are up," and, I just think it's, fatty liver disease. the f-fat will encase around the liver, and then that causes inflammation. so that'll help with that.sleep apnea. people who are obese many times have sleep apnea, and that's due to the excess weight and around the neck. actually, when we did CDL exams in the office, that's an exam to get your, license if you're a truck driver,we had to measure the neck circumference 'cause that, that was part of the exam to make sure that they had a certain level.

and if that was above the, allowed level, measurement, they would have to go and get a sleep apnea test. so because the repeated drops in oxygen with sleep apnea, it can spike blood pressure and stress the heart, and of course, obviously affect your performance 'cause you get poor

sleep.

another big one, uh, number six, it would be pre-diabetes. And, um, that's...That is, it's definitely indicated to use in pre-diabetes. People are on the cusp. their A1C,would be between 5.7 to 6.4%. And if you don't know, an A1C blood test tells you your average blood sugar level for the past two or three months.

It's the gold standard test for diabetes. A1C result below 5.7 is normal, 5.7 to 6.4 is pre-diabetes, and 6.5 or higher is diabetic

Tristin: Wait, so how can one blood test know what my blood sugar was doing three months ago? That feels like witchcraft.

Rebecca: know. It sounds that way, doesn't it? so when glucose enters the bloodstream, what it does is it attaches itself to a protein inside your red blood cells. It sticks to the red blood cell and stays there for the life of the red blood cell. So a red blood cell lives about three months. So the A1C measures the percentage of red blood cells that have glucose stuck to them.So, and that gives us a number. Soobviously, the higher the percentage, the more glucose was in your bloodstream over that period of three months

Tristin: Hmm. So it's like your red blood cells are little donuts rolling around in powdered sugar for three months. The more sugar in the bowl, the more coated they get, and then the A1C just counts how sugary the donuts are?

Rebecca: Well, it's not more coats of sugar it-- on the donuts, it's more donuts getting a coat of sugar, right?

Tristin: Yeah. Okay.

Rebecca: so that covers what the FDA officially is approved for, but there are other conditions where doctors are already using them. This happens all the time. When we get a new drug, it's approved for certain things, and then, we start using them and then we think, "Well, gosh, it might work in this."

And then, we try that out And pretty soon you find that it would work really well in other diseases, but it doesn't really have the approval yet. that takes time. So, it hasn't approved it in women with PCOS, which is polycystic ovarian syndrome, which is a hormonal metabolic disorder.

But providers have been using the medication for this disease ' cause it goes hand in hand with insulin resistance and being overweight, so it fits

perfectly. And so that helps that disease

Tristin: so this next one surprised me. Marcus in Columbus, Ohio writes, "I keep seeing headlines that people on Ozempic are less likely to develop drinking or drug problems. Is that real or is that just hype?"

Rebecca: Well, this is another very interesting area that it's not approved yet, but I think it definitely will be observational studiesthat,people drink less, smoke less, and use drugs less when they're on GLPs. So,40% reduction in cravings for opiates, 50% reduction for alcohol.kind of makes sense. The brain releases dopamine, right? The feel-good hormone when we consume these things, and GLP medications act in the same way by releasing dopamine

Tristin: So a weight loss drug might end up being a craving drug.

Rebecca: it would be, yeah. I mean, it would really be, great if this,you know, if it gets approved for this, that's really something to try for people.

Tristin: Yeah. All right, so let's get into the not so glamorous part. Priya in San Antonio, Texas says, "I'm three months in. The scale is moving, but nobody warned me about the sulfur burps and the constipation. What's normal and what can I do about it?" Wow, Priya, thank you for your bravery. Sulfur burps, mom.

Rebecca: that's, that's not pleasant.the most common side effects are mostly gastrointestinal, for sure. You, you can have nausea, vomiting, diarrhea, constipation, acid reflux. Nearly all patients have some side effects, and virtually 100 percent of patients have some nausea, some-- in the start. This is the start of taking it.

There is an adjustment, for sure. You don't just take it and get excited about the scale. You know, it takes some time to get used to,and it, it takes a little work. But your body will adapt, and side effects will subside most of the time.this is why being managed by a provider, again, is important and helpful.

The dosing is tricky. It's individual. you need to, you know, just take it slow. some ways to help these side effects i- is eating small, small meals more frequently. hydration, of course, for constipation. Don't eat hard-to-digest foods, especially in the beginning. Eat enough protein, and add exercise and weight training because you're gonna-- if you lose fast, you're gonna lose muscle mass.

And importantly, start slow. Don't be in a hurry to lose a lot of weight in a short time, because the lower the dose, you'll have fewer side effects, and then you can just ease up if you need to. But you wanna start low.we now have a large population to study, and there'll be-- studies will be ongoing with this, so-- but so far, they find that 50% of people choose to stop taking the medication within the first year, and that's due to side effects, cost, or preference.

But it's a, good reason not to get overly excited. Get on them and just take them as directed and s- and just do it slowly so that it'll

work for you.

Tristin: Wow. Okay, half. That's-- So that's a big question. Oprah has said publicly she'll probably be on these for life after she stopped and, gained the weight back. and Kayla in Denver, Colorado wrote in, "I came off Zepbound six months ago, and I've kept the weight off with protein and lifting, but I still had a stressful stretch where I comfort ate.

Do most people regain once they stop?"

Rebecca: it's like anything like this. Yeah, they do have that tendency. You can regain it, but the hope is you've learned how to eat more healthy foods, smaller amounts of food, and maybe even have been exercising, especially if you'd been too overweight to do so in the past, you know? also the way you look may really motivate you to continue trying these things without the

meds

Tristin: Yeah. It's-- So it sounds like Kayla's on the right track. the medication can give you a head start, but the habits you build while you're on it are what help you keep that weight

Rebecca: Right.

Tristin: Uh,

yeah.So, okay, I wanna shift to the part that honestly makes me a little nervous, and that's what we still don't know about these drugs.

Are there any side effects that we're only starting to learn about?

Rebecca: Oh, sure. And, you know, it's like any new drug. it's a brand new drug, so we don't have history with it. It's gonna take time to see if there's anything that comes out of it that's not so great, right? so I mean, gallbladder and biliary disease, meaning gallbladder, liver, and bile duct disease, has, has popped up. a study of 100,000 showed an increased risk of 1.5 times that of placebo. So we know that something's going on there. And a decline in bone density, which is not something great either, but that's also very individual. they discovered that at about 52 weeks, which is-- needs more research. And then there's conditions that have popped up, and they just don't have conclusive studies. they haven'tproven to be connected, but they need to study them further. That's, retinopathy, optic nerve disorders, bowel obstructions, pancreatic cancer, thyroid cancer. they're looking at all these. you know, it takes time. It takes years to study, if things really are connected. and they're ongoing. They're doing it, constantly studyingthe risks and the benefits of this medication

Tristin: Yeah.

Rebecca: But

there's plenty of studies on this, but there are no studies being done on normal weight to only

slightly overweight people

taking these drugs, which there are a lot of people doing

Tristin: that one is a lot of we don't know yet, which is honestly a little reassuring and a little really more a little scary at the same time. But there's one risk that also keeps popping up in the news, and I think it ties kinda right back to what you said about these drugs slowing down your stomach. Rob in Tampa, Florida asks, "I'm on Wegovy and have knee surgery coming up next month. I saw a study saying people on these drugs have a much higher risk of throwing up or breathing in stomach contents under anesthesia even when they fast. Should I be worried and what should I do?"

Rebecca: the concernis that this, again, this med slows the emptying of your stomach contents. So the risk of aspiration, meaning that you may vomit and then the contents go into your lungs is, a risk. Everyone says, "Well, I'll just stop it before surgery." Well, the drug is designed to stay in your system a week or even two weeks, so it's not enough to stop the medication a few days before or even a week before.

They still don't trust that. So,the reason you're on it affects the protocol. Obviously,if you're on Wegovy, a single med,ongoing studies show that people taking that with an additional med, the compound we mentioned in Mounjaro, Zepbound,they have been found to have a higher incidence of aspiration.

So if you're just on one GLP alone, the risk is not that great. And,what you're taking, why you're taking it, it helps the surgeon and anesthesiologist to use the right protocol, 'cause they are coming into using a protocol for this now to prevent things. also, if you have GI symptoms or disease, that's important. if you're a diabetic, then if you have to stop your medication, your glucose level's gonna go up. So those are all things they, need to watch. sincea lot of people are on these meds instead of, insulin, then it's a lot easier to, use insulin during surgery than it is to have these on board, so.

because that's a short-term thing, right? They can control that.one thing they've been doing, if they're unsure, they can do an abdominal ultrasound right before surgery. That tells them if there, is there anything in the

stomach or not

Tristin: Oh, that's cool. Yeah, that would just appease it right then and there and you don't need to worry about

Rebecca: If there's-- Yeah. I mean, If for some people they probably do that 'cause, some people have notstopped their med because they're diabetic. but they can just always do that and make sure

Tristin: Hmm. That's great. So we have one last question. Taylor in Boston, Massachusetts asks, "Isn't this just a new diet pill? I see people with maybe 10 pounds to lose taking it as a shortcut without changing anything else. Should I be worried?"

Rebecca: yes, of course, there's a lot of people doing that. they've been become very popular with people who just want to lose a few pounds. We have seen this all over social media with people, with celebrities, and unfortunately, we're seeing it on college campuses all over the country.since the medication is not approved for this, at least not yet, it may be difficult to obtain from a provider.

It depends on the provider. You know,it's not indicated for somebody who wants to lose four pounds. so that tends to then encourage people to go to online sites to obtain the med, and there are certainly plenty of black market sites selling unauthorized, counterfeit, or unverified GLPs.

It's a dangerous way to obtain them because, there's no oversight for you, and you don't know where these meds came from. So,it's not a great thing to do, but it's going on.I also-- I kinda worry when people are doing it, you know, they're going on them and losing their weight, and then they love how they look and they think, "Well, maybeI should lose a little more."

And they'll just continue to lose beyond what is a healthy weight. I mean, in a in a way, they can get addicted to the medication because they are addicted to their weight loss, right? They begin to lose sight of how they actually look, like someone who's an anorexic. They have a distorted view of their body

Tristin: Yeah. Yeah. so buying mystery shots off the internet, bad. Doing it with a real provider who's actually watching, good. Noted. okay, so quick recap so my brain can keep up. GLP-1s copy a hormone in your gut that your gut already makes. They slow digestion, they help with insulin, and they quiet the food noise. they're approved for a lot more than just weight loss. Side effects are mostly in your gut, and they usually ease up if you manage that kind of with some of the tips that you gave. And the real work, protein, movement, habits is what sticks around after the meds.

Rebecca: And be managed

by a provider.

Tristin: Yes, and be managed by a provider. So thank you to Dana, Jenna, Monica, Marcus, Priya, Kayla, Rob, and Taylor for the questions. If you have a health question you've been too embarrassed or too confused to ask, send it our way at pleasehealthme.com or @pleasehealthmepod on Instagram. Thanks for listening to "Please Health Me."

Rebecca: Bye

everyone.

Tristin: Bye

Thanks for listening to Please Health Me. If you found this episode helpful, pass it along to someone else who might too. And if there's a health question you want us to talk about, send it our way at pleasehealthme.com. We'd love to hear what you're wondering about, because chances are, other people are wondering about it too.

And as always, this podcast is for education only. It is not medical advice, and it shouldn't replace the care from your own healthcare provider. If you enjoyed today's conversation, be sure to follow Please Health Me so you don't miss future episodes. You can also visit our website for all our episodes, show notes, and additional resources.