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When the road to wellness seems cluttered with obstacles, our latest Pound of Cure podcast shines a beacon of hope, revealing the twists and turns of obesity treatment advancements. We tackle Pfizer’s paused study on the GLP-1 agonist, Danuglipron, due to its severe side effects, but also cast a promising  light on the horizon with Eli Lilly’s Retatrutide and an upped dose of Novo Nordisk’s Rybelsus. Understanding the quest for the right treatment is as personal as it is complex. We delve into the pharmaceutical industry’s relentless pursuit to offer a spectrum of options that cater to individual needs and preferences.

Amidst the science, we uncover the profound impact of bariatric surgery through the eyes of our guest, whose journey from pre-surgery apprehensions to post-operative triumphs embodies the transformational power of informed health decisions. The conversation extends beyond the operating room, exploring the vital role of education, dietary adjustments, and the indispensable support systems that provide a foundational pillar for sustainable weight management. This narrative isn’t just about the scale’s victory; it’s a testament to reclaimed vitality and the unwavering human spirit.

Rounding out our episode, we share actionable insights for those seeking to maintain a healthy weight and lifestyle. From simple strategies for meal planning to the economic landscape that shapes access to obesity treatments, we address the everyday challenges and victories on the path to wellness. We also respond to listener questions, reassuring one on the importance of health over numbers and highlighting that supplements like Creatine are just one piece of the muscle-building puzzle. Join us as we celebrate successes, advocate for accessible treatments, and provide a dose of motivation, leaving you equipped and inspired to navigate your own health journey.

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Zoe: 0:33

Welcome to a better version of me, episode nine. You are here with us on the Pound of Cure podcast. We are excited. We have a good show today.

Dr. Weiner: 0:42

I think so. For sure.

Zoe: 0:43

Why don’t you start us off by our news segment?

Dr. Weiner: 0:45

Okay, all right. So the news segment is that Pfizer has nixed a study on a twice daily drug. It’s an oral drug, a pill that is being treated for obesity, and it’s on the. The medication is called, I’m going to try not to butcher the name, but it’s a Danuglipron. And are, who comes up with these names? Well, so that’s the, that’s the. You know they have the generic name and they have the trade name. So this is a generic name. This would be like equivalent to Semaglutide or Tirzepatide. It took me a while to even learn how to say Semaglutide. But Danuglipron is a pill, and it is a GLP-1 agonist very similar to Semaglutide or Tirzepatide, and they had a 50% dropout rate. So what happens is they put a drug out there and say, okay, you know, they do all the animal testing, they they prove as much as they possibly can, they’re not going to poison anybody. And then they have people volunteer for the study and I think if you know, if you look around, you can volunteer for studies. I’ve talked to some people who who actually volunteered on the Semaglutide study, and so you know there’s people sign up for this. They’ll usually pay you a couple bucks. It’s not a lot, but they’ll pay you something to participate. And you know, I think they got to pay. 50% of the people dropped out of this study because of severe nausea. And so this isn’t surprising because we already do have an oral GLP-1 medication. It’s Rybelsus, which is oral Semaglutide, and we see quite a bit of nausea with that. We start out at three milligrams, move up to seven, then move up to 14. So they’re not given up on, on Danuglipron. They’re going to move it to a just a once daily dosing with the hope that that will decrease nausea. And if you think about it, when you come up with a new drug you don’t know what the dose is Like. It’s not like, “Oh, let me look at this under a microscope. This is a 10 milligram dose is going to work. So they got to figure out the dose by giving it to people. They probably went a little heavy on the dose in the study and when they do it they have all these arms and this person you know we have. They might have one person on one milligram and someone else on 10 milligrams. You know there’s a lot of variation there and they’ve got some some good approaches so that they minimize harm and they do this safely. And there’s a lot of science behind this to make this process as safe as possible. And you really don’t hear much about someone, “Oh, they had it. They got a new drug, they were in a drug trial and they were poisoned or killed by it or had some terrible complication. I don’t want to tell you that’s never happened, but it’s certainly not something that happens with frequency, which again really points to the success of the FDA in making sure that our drugs are safe. So we did have a significant dropout rate from this, but they’re not going to give up on the medication. And the idea of an oral pill as opposed to a weekly injection is certainly favorable for some people. As other people might say, you know, I’ll do the weekly injection instead of having to worry about a pill every day. So there’s going to be some variation and I think, you know, what we’re finding with these medications, and the decision about medications or surgery is that people have personal preferences.

Zoe: 3:42

Yeah, it’s good to have options for people too.

Dr. Weiner: 3:44

Absolutely, and we actually have a lot of options coming up. So right now we have really there’s three drugs out there. There’s Liraglutide, also known as as Victoza or Saxenda. There’s Semaglutide, also known as Ozempic and Wegovy, and then there’s Tirzepatide, also known as Mounjaro and Zepbound. It’s tough to keep all those straight, you know. But the truth is we’re about to see a huge influx in the next three to five years. We’ve got Retatrutide. This is also from Eli Lilly. It is a triple agonist. So we have kind of the single agonist, that’s the GLP-1. We have the double agonist. There’s two different flavors of the double agonist and then we have the triple agonist. The triple agonist is GLP-1, GIP, which is what Tirzepatide is. It’s a double agonist for GLP-1 and GIP. And then there’s also Glucagon. And so Glucagon is essentially the opposite of insulin and it helps you burn and insulin’s a fat storage and Glucagon is essentially a fat burning hormone. So this is a triple agonist and the theory is that the Retatrutide is gonna be even more effective than Tirzepatide. So we’re seeing 20% total body weight loss with Tirzepatide. We could be seeing 25% with Retatrutide. The initial studies show fairly similar results to Tirzepatide, but again, as they work on the dose and streamline this, they may see more weight loss. We’re seeing Novo Nordisk releasing Rybelsus, which is oral semaglutide, at 25 and 50 milligrams. So the idea is we’re starting, right now they’re in, the introductory is three and they’re gonna move it up to 50. That’s a really big increase and we see a decent amount of nausea with Rybelsus. I think more there’s more nausea when you take it as a pill than you take it as an injection. I was just gonna ask you that. Yeah, that’s what we see anecdotally. I’ll tell you that that’s what is. I don’t know that that’s a scientific fact, but I think we see more nausea with Rybelsus than we do with Ozempic. And so they’re gonna try this at 25 and 50 milligrams, or maybe some people who tolerate them, there’s gonna be a lot of people who don’t tolerate them, but there’s something really exciting about this. And it’s that when you patent a drug, you patent the molecule. Not the dose. So semaglutide, there’s still some battling over the patent and it’s still got a couple more years on the patent. But if this is effective, then we’re gonna have some generic options for semaglutide at this 25 and 50 milligram dose which may be effective. So that’s gonna open up the world for some generics. I mean, obviously Novo Nordisk isn’t doing this so that there’s generics out there. Right, they have their own interests and I’m sure they understand the patent business better than I do, but that’s out there. There’s Pemvidutide, which is from another company, and I think the important thing to see is how many companies are out there. Right now, we got Eli Lilly and we got Novo Nordisk. Novo Nordisk makes both Saxenda and Wegovy. And Eli Lilly makes Zepbound and Mounjaro. But we’ve got Pfizer coming in with Danuglipron. We’ve got another company called AltImmune with Pemvidutide, and then we’ve got Inivit Biologics, which is a Chinese manufacturer, with Mazdutide. And so we’re gonna see dual agonists, we’re gonna see triple agonists, we’re gonna see pills, we’re gonna see injections. We’ve got all these medications coming down the pipeline and this is really interesting. So I wouldn’t look at this news article as necessarily something discouraging. I think we’re gonna see this stuff happening, but the take home point is that there’s a whole pipeline from many different manufacturers. In three to five years we’re gonna see a ton of medications out there available for the treatment of obesity. And my theory is is people have choice in this and we have a strong economic drive for this and a strong demand-driven economic curve, we’re gonna see the price come down with all these increased options. So I think this is probably, as much as it’s a step backward for Pfizer, probably good news that there’s a lot of activity on that, for obvious reasons.

Zoe: 7:30

Yeah, all good, all good movement. This year might be a little hard, but the next couple of years there’s going to be a lot coming down the pipeline.

Dr. Weiner: 7:38

I think this is the, you know, it’s always darkest before the dawn, they say. Yeah, so I think that’s what we’re seeing right now with the decreased access to medications. So let’s move into our patient story. We’ve got Terri here and I think she really tells a very inspirational story, and I’m just going to let her share her words, but it’s great to have her on the show. So let’s hear from Teri.

Zoe: 8:01

Well, teri, we’re so excited that you are here on our podcast our second official ever guest so thank you so much for taking the time.

Terri: 8:13

I’m so happy to be here. I’m just, this whole office is just phenomenal. And Dr Weiner, I just, if I wouldn’t have found him, I would not be where I am today, and so it’s just.

Dr. Weiner: 8:25

I think you had a lot to do with it too Terri.

Terri: 8:27

Well, yeah, but you were the tool that helped my tool help me. And I can’t believe, I look in the mirror and I can’t believe what I see looking back at me. It’s just totally.

Dr. Weiner: 8:40

Tell us your story. You know when we first met. What did you weigh?

Terri: 8:42

When we first met, the highest I weighed was 268. At my highest ever was 277.

Dr. Weiner: 8:49

So this is all before surgery.

Terri: 8:50

Yeah, yeah. Well, I was in the process of getting prepped, you know, going through the process of getting it sent to the insurance company, and then I got sick. And so my surgery got postponed.

Dr. Weiner: 9:03

What happened? Do you mind sharing a little bit ?

Terri: 9:06

I went into septic shock. I didn’t know I was septic at all. I had no idea. I had kept passing out and I had this incredible stomach pain that would not go away. And my husband, after the fifth time I passed out and like fell off the toilet, fell out of bed. He’s like, we are going to the emergency room. I was so sick. I’m like, okay, I didn’t fight him and my blood pressure was 60 over 40.

Dr. Weiner: 9:30

Oh, my God.

Terri: 9:32


Dr. Weiner: 9:32

That’s sepsis.

Terri: 9:33

Yeah, yeah, I didn’t know it and I kept telling him I felt like I had to throw up at nothing. You know I couldn’t and I could barely walk. I don’t remember anything. After I got to the emergency room. My husband said it took them 12 hours to stabilize me, enough to transfer me to the hospital and put me in ICU. I woke up when I remember I had a pick line in and it was just. I knew, before the hospital incident, that something had to change. I’m 58. So I’ve struggled with my weight for 58 years as long as I can remember.

Dr. Weiner: 10:06

I think there’s an important piece there too, which is that while preparing for surgery, you got sick. Yes, and that’s the reason that it took so long. Yes, because, of course, the insurance company requirements. And so the insurance companies put a lot more requirements before patients are able to have bariatric surgery than they do before almost any other surgery, and so, because of this, there is actually a definable complication rate. A definable mortality rate, actually. And over the years, I’ve had a few patients pass away while waiting for surgery. A nd we don’t have to go into details about the cause of your sepsis or anything like that, but we know that the severity of sepsis and a lot of the things that cause sepsis are tightly linked to obesity. These decisions that are made have real consequences B ut to put these artificial barriers and stretch it out longer than it may need to be is actually quite dangerous and prevents people from having the surgery that may actually save their life and reduce these problems that they’re bound to have because of their obesity.

Terri: 11:09

That is very true. I didn’t know what was going to happen. I was on your program. I was in the getting all of the requirements to meet the insurance company requirements to submit it because my body needed something changed so much. I believe that the requirements of the insurance company has the psychiatric evaluation, your psychology evaluation, the loose some weight, meet with the nutritionist. I believe in preparation for a surgery of this magnitude, you have to be prepared for those changes. Your life as you knew it prior to bariatric surgery is over. It is over. It doesn’t exist anymore. You have to change the way you eat, the time that you eat, the kind of foods that you eat, the processed versus unprocessed, the vegetables versus the- I don’t know what people eat in place of vegetables, but not vegetables.

Sierra: 12:07

CHIPS. There you go, there you go.

Terri: 12:11

It just so totally changes. If I wouldn’t have had all this education, I would have come to you, had my surgery and be right back in my same boat. My body just was not responding yeah. Yeah.

Dr. Weiner: 12:28

It didn’t respond to nutritional change.

Terri: 12:32

Totally, I ate healthy. I exercised and I just, regardless of what I did, I just couldn’t lose the weight.

Zoe: 12:41

Why don’t you tell us what surgery you had how long ago, and what has your life looked like since you’ve had surgery?

Terri: 12:50

So I had surgery November 2nd of 2022. So I am just 14 months. I have lost 110 plus pounds. I never thought it was possible. Even when I came to you, Dr. Weiner, and you said working through the surgery and my target goal for you, I anticipate you being between 165 and 175. Actually, last time at your office I weighed 154, 155. That was just a little over a month ago. Right around Christmas time. You gave me the option of the sleeve or the bypass. I have all that information and I chose, it was my personal choice, to do the gastric bypass. I am so thankful that I did. I have not found a food that my stomach doesn’t like, my new stomach doesn’t like. I have not dumped. I allow myself to get a little bit more hungry than I should. I know I’ve got to do better, you know, and I just want that, not even thinking it’s just like I’m hungry, you know, and I’m eating the right food, though.

Zoe: 14:03

So we expand a little bit more on what foods that you are eating now. So versus maybe before surgery, maybe before.

Terri: 14:10

Okay, before surgery? I would. I do have to admit, although I don’t want to, I did rely heavily on process prepackaged food. So post up I. Protein first, protein first. I know how much I’m supposed to have. Then, after I’ve got my protein, okay, it’s time for vegetables. You know, it’s like the only thing I don’t like. Don’t throw any peas at me, no, no, yuck. Broccoli. Salad. I know it’s not nutritional. You know there’s no real nutritional. Well, they say it’s not, it’s empty. You’re still getting fiber.

Zoe: 14:58

Yeah, I would rather you eat as much dang salad as you want than the process, and I do. Let’s not bully the salad, because you’re doing a great job of that.

Terri: 15:11

I’ll tell all those nay sayers out there, “yes, you can eat salad. You know, I put lots of stuff in my salad. I’m not just like a lettuce and tomato and cucumber salad type of person. I like anything that you can put in your salad. So I make sure to eat my vegetables religiously, faithfully, and then if I’m still hungry which usually I’m not, you know then I can have a little bit of carbohydrates not bread, sweet potato, or a little bit of a regular potato but I have to be honest, I don’t miss the carbohydrates. I know my body needs carbohydrates, but I get them during the day, outside of my time.

Dr. Weiner: 15:51

You talked about how you had this strong desire for processed foods before surgery and now, after surgery, here are 14 months out and you have almost no desire for processed foods. Let’s, let’s just kind of switch the narrative a little bit. Instead of a desire for processed foods, let’s pretend it was chest pain. Before surgery, you had this really bad chest pain and every day you had chest pain and it was terrible and cumbersome and interfering with your life and was almost scary because it was interfering with your health. You had sepsis. You had this really scary health and then we do a surgery and you have no more chest pain. We would all say, “what an amazing surgery. Wow, this is so important. What? This is God’s work. This is everybody who has chest pain, every single one of you should have surgery. And so, we have to look at this desire for processed food, this hunger, this craving, this, this difficulty in controlling your eating behaviors, not necessarily as a sign of personal weakness, but as a biologic drive. And we’re seeing, with the meds and with the surgery, how we can quiet that drive and we can take someone who struggles with eating well, eating healthily, their whole life and all of a sudden we flip a switch.

Terri: 17:04

Absolutely, I totally 100% agree with you. Now I’m not saying everybody out there that struggles with their weight should have surgery. Absolutely not. Because it’s not right for everyone. No, it’s not. It is totally not right for everybody.

Dr. Weiner: 17:19

How has this affected your marriage? You hear some bad things about bariatric surgery and divorce and all that kind of stuff. Talk to us a little bit about how your marriage has changed or what’s happened with your relationship there.

Terri: 17:31

Every day leading up to surgery, I told my husband. I asked him instead of me asking myself if this is something I wanted to do, because I knew I wanted to do it 150%. I asked him every day are you sure you’re okay with me getting this surgery. Because I didn’t. I’ve heard so many horror stories about relationships that I didn’t want it to ruin ours. So I kept asking him are you okay? Are you okay? Are you okay with that? He’s like Terri, I’m not going to tell you again. But yes, I am fine. I had him watch your videos on the surgery and all of your videos that you did from Michigan. I had him watch. I showed him exactly the video, what they were going to do, what you were going to do and how it was going to be done. Zoe, your videos, your nutrition classes and things. I had him watch those with me so he kind of knew what the process was going to be like and what to expect. He is so supportive of me because it’s allowed me to be in person. And he said your whole personality has changed and I love it.

Zoe: 18:59

We’re so proud of you. Yes, we are. We’re just so excited that you were here and sharing your story. I think not only is it so inspiring, but just seeing how you are shining from within is just so powerful, and I’m so grateful that we’re a part of your journey. Thank you so much.

Terri: 19:16

Thank you so much. I am so grateful for you guys too.

Zoe: 19:23

Ah, she just like warms my heart. I just absolutely love her sharing her story and hearing directly from her how much this has changed her life. Yeah, absolutely yeah all right time for our nutrition segment of the week. I have a hack for you.

Dr. Weiner: 19:36

Okay, let’s hear it.

Zoe: 19:39

I love the word hack because it’s very enticing, right? Okay, so I wanna set the scene. You’ve made dinner. You’ve made more than you need. Maybe you have the intention to have it for lunch tomorrow. You sit down, you eat, you’re really hungry, so you go kind of quickly. You go, you’re like all right, well, I’m gonna go back for seconds. Right, and I think this is something that many people experience. Right, going back for seconds after you finish eating. You, A. probably didn’t wait the 10 minutes to see if you were actually hungry to go back. Anyway, that’s not kind of the hack. I’m talking about what I want you to do. If this is something that you do regularly and you are working towards being more mindful of your portion size, and you wanna set yourself up for a good lunch the next day by having those leftovers. Instead of waiting until you’re cleaning up the kitchen to put away the leftovers, I want you to put it in a Tupperware when you are serving your dinner, so you serve your dinner, maybe serve your family’s dinner. Don’t let it sit there. You’re gonna put everything away, put it in the refrigerator and then sit down to eat. Because, guess what? There’s a much bigger barrier to going back into the refrigerator, putting it on your plate, heating it up in the microwave to then. If you’re going through all of that, then it sounds like you probably need that second plate. You need a little bit more fuel, but if you are wanting to decrease your portion size, be more mindful about how much you’re eating and have lunch ready to go for the next day. I encourage you to shift your routine during dinner time to don’t sit down to start eating until you put away the food for the next meal?

Dr. Weiner: 21:25

Yeah, but not the vegetables. Keep the vegetables out.

Zoe: 21:27

All right, put the vegetables on the table.

Dr. Weiner: 21:28

Because you can keep eating the vegetables and no guilt. But the main dish, and if there’s anything carbohydrate or starchy, in there, putting that that way, that’s a fantastic trick. And I think it really gets to this idea of your own food environment. We learned, we heard last week from Larry who talked about how when he changed his job, started a company, there was a little bit more socialization and he was exposed to more food and beverages that were causing weight gain, and it was just like he changed his personal food environment. As a result, gained weight. And so this is a way works both ways right. There’s certain food environments that’ll cause weight gain, but there’s also food environments that’ll cause weight loss. So you’re just doing these subtle little things to change your own food environment to trigger some weight loss. So I love that trick.

Zoe: 22:13

Yeah, just kind of piggybacking off of that, and I guess this is maybe a somewhat separate, but I do, I think it’s pertinent and I want to share. So kind of piggybacking off of controlling your food environment. I talk a lot with patients about the difference between willpower versus skill power. Okay so let’s say there’s a plate of cookies on the counter.

Dr. Weiner: 22:34


Zoe: 22:35

Okay, every time you walk past that plate of cookies, does your willpower get stronger or weaker? Are you gonna be more likely to take a?

Dr. Weiner: 22:43

It gets weaker. Exactly yeah.

Zoe: 22:45

Willpower is not a muscle that gets stronger the more you have to exercise it. So controlling your food environment, saying, okay, I’m gonna put these cookies in a cabinet or in a Tupperware in the cabinet, out of sight, out of mind. That is you exercising your skill power, which is a muscle that gets stronger the more that you exercise it.

Dr. Weiner: 23:04

I love that.

Zoe: 23:05

So don’t rely on willpower. I hear people saying all the time I just need more willpower. No, you don’t. You need to exercise your skill power, and controlling your food environment in those different ways we just talked about is a perfect example.

Dr. Weiner: 23:18

I love that. That’s fantastic. Willpower, yeah, willpower. If it’s a willpower, you’re gonna lose. But skill power, that’s a winnable battle. Okay, let’s move into our next segment, the economics of obesity. And again, if you can’t afford a medication, if you can’t afford treatment, if you even can’t afford a nutritional program, then it doesn’t matter, and no other details matter. You’re just not gonna get access to it. You’re not gonna get the benefits of it. So today we’re gonna talk about the Zepb ound coupon. Now, zepb ound is Tirzepatide, also known as Mounjaro. It’s the weight loss version. It was just recently released. It’s now available. The big problem with Zepb ound is it’s not on formulary. So Wegovy, which is the weight loss medicine, we’re seeing more and more access to Wegovy. We’re just seeing people can’t get it because of the shortage. Zepb ound. It looks to me like we’re going to see a lot of availability. We haven’t seen any shortage. They’ve actually taken Mounjaro off the national shortage list. We see zero problems getting Mounjaro in the United States. Canada a little bit, but it looks like they’re solving that too. So Zepb ound is available for $550 per month. Still an incredible amount of money, but it is about half price from what it’s been. So people who have been, and we have some patients who are fairly well off who have been paying $1,000 a month for Mounjaro. This is for four pens, four weeks worth. And again there’s some things that you can do and especially when cost is an issue, there’s things you can do to kind of stretch that out a little bit so that maybe that $550 lasts a little bit longer than four weeks and depends on what dose you’re on and what your dependence is and, of course, what your nutrition is. And I think some of the decreased availability of these meds is probably in some ways a good thing because it’s putting more emphasis on the nutrition. If there’s one thing we learned, it’s that these medications are not magic. They’re tools that, when combined with a good nutritional program, can drive substantial weight loss, and so we’re going to. It’s going to take a while for Zepb ound to get on the insurance formulary. So even if you have coverage for Wegovy, it doesn’t mean you’re gonna have coverage for Zepb ound. When a drug is released, an insurance company reviews the data and the cost effectiveness and negotiates with the drug company on the price. And it takes some time before they say, yes, we’ll cover it. And that’s where we are right now. And I’m sure Eli Lilly is spending a tremendous amount of time working with the insurance companies to get this on their formularies, but insurance companies are gonna be reluctant because they don’t want to spend the money. And so it’s gonna take some time and Wegovy’s still on back order. So in the meantime this may be an option to bridge you toward coverage, so hopefully you won’t have to pay the $550 every month, but for now that’s the best we’ve got in the self-pay space, which is where a lot of patients are right now, especially with this prior auth issue that we talked about last week.

Zoe: 26:10

Right, all right, we’re ready to hear from our social media. Get some questions going that we got submitted through whatever channel. We get them from Instagram, we get them from YouTube videos, we get them from our website. So Sierra, our trusty office manager, extraordinary podcast producer, is here. Let’s hear those questions.

Sierra: 26:33

Okay, first question we have is from YouTube the video which is better, VSG or Rouz- en- Y? This is from Butterfly Wings. Thank you for your advice. I know I want the sleeve, but my only real concern is that I have AFib and I’m on a blood thinner.

Dr. Weiner: 26:52

Okay. So person wants a sleeve and they’re concerned about they have AFib and take a blood thinner. So I actually think this is a really good reason to have a sleeve because, even though it’s fairly uncommon, one of the worst long-term or chronic complications you can have after a gastric bypass is a marginal ulcer; An ulcer at the connection between the stomach and the small intestine. Now, first of all, one of the causes of this ulcer is NSAIDs, non-steroidal inhibitors like ibuprofen and aspirin. And aspirin is a blood thinner and it’s not uncommon for patients with AFib to sometimes, depending on the severity of the AFib and some other factors, to be treated with an aspirin as opposed to a blood thinner like Xarelto. And so gastric bypass patients really may or may not be able to take a baby aspirin. A full aspirin they can’t take. So there’s some contraindications after a gastric bypass to taking aspirin, which is a blood thinner that is sometimes used for the treatment of AFib. But also because if you develop this ulcer and you’re on a blood thinner, so you have an ulcer. There are people who live with kind of minor ulcers and they kind of get through their day and maybe they have a little bit of difficulty eating or reduced appetite, but in general they’re minimally symptomatic. Ulcers become a problem when they do two things. Number one is when they perforate, and that generally is a surgical emergency. A solvable surgical emergency, but a surgical emergency nonetheless.

Terri: 28:17

Sounds painful.

Dr. Weiner: 28:18

Yeah, it is painful and then again, but thankfully I operate on maybe one or two of those a year. And we catch, probably we might have 500,000 people that kind of look at our hospital as their primary hospital, so it’s a pretty uncommon thing to see. And then the other thing that they do is they bleed, and that’s a little bit more common. And if you’re on a blood thinner it may take this minor ulcer which would probably be treatable with some acid blockers and turn into a major deal because the blood thinners cause it to bleed. And so if you’re on blood thinners chronically, then a sleeve is a good option, because there’s really no, we don’t see ulcers with sleeves. I don’t foresee a lot of problems related to being on a blood thinner, so to me this doesn’t change things at all. If anything, it kind of steers you a little bit more toward the sleeve, which is what you’re heading for. So good luck with your surgery.

Sierra: 29:10

Next question is from Rafael, from our website. What is your opinion about the muscle building supplements and products such as creatine?

Zoe: 29:18

Oh, I, like this question. The reason why I like this question is because the supplement industry is crazy.

Dr. Weiner: 29:26

Yes, Right, no question, there are so many quote muscle building supplements.

Zoe: 29:32

There are supplements for everything. I want you guys to know that, unlike the FDA, supplements are not regulated at all. So before we talk about creatine, I want to just give a quick lesson about how to pick safe supplements.

Dr. Weiner: 29:48


Zoe: 29:49

So there are three, third-party seals that you can look for on your supplements, which basically means a supplement company paid a third party to test their product and to basically put their stamp of approval on it, to say, yes, what you say on this label and what is in this product match. Yeah. And it’s good, all good. Okay, so that’s going to be the USP seal, the informed choice seal and the NSF certified for sport. Okay, so those are the three seals I want you to be looking out for if you’re looking at a supplement. Now, if we’re thinking about specifically creatine, creatine is actually one of the very few supplements that has enough scientific research to support its benefits in muscle building, in performance, in speed, in power. However, taking creatine isn’t going to do that if your fundamentals, if your foundation of proper nutrition is not there. Right! You can’t out supplement, you can’t outwork, you can’t out exercise and you cannot supplement a bad diet. Yeah, right. So I very, very, very rarely recommend people start taking creatine because there’s usually so much work nutritionally that can make a bigger impact. If you’re trying to build muscle, we have to think about what’s happening in the body when you’re building muscle. Well, A. we need the muscle to be stimulated, and that’s through strength training, resistance training, weight training, whatever you want to say, and there needs to be a surplus of energy in order to build the lean muscle tissue. So you need enough protein and you need enough calories. So if you are trying to lose weight, that’s kind of it’s a little bit competing, and then can you lose fat and build muscle at the same time. It can be done. But generally they’re kind of done in different phases, right Okay? So if you’re wanting to build muscle, I want you to really hone in your diet and your training before you worry about adding creatine. But if those things, if you’re like, “Zoe, those things are on point, I cannot improve on my nutrition or my training then adding in creatine sure that will help you build muscle.

Dr. Weiner: 32:07

Love it. Okay, great advice.

Sierra: 32:10

Okay. Next question is a DM from Instagram from Julie. Hello, dr Weiner. I am a little over two years out from a Roux-en- Y gastric bypass. I am five feet short and I was 257 before surgery. I now hover between 150 and 160 pounds. I feel wonderful and my blood work is still great. My question is that I am still considered overweight for my height and my surgeon thinks that I need to lose more weight. Do I need to lose more weight or can I be healthy maintaining 100 plus pounds weight loss?

Dr. Weiner: 32:41

So let’s break this down. I love this question. This is a fantastic question. So, based on their height, five feet short, you know I love that. Like, own it, live it. You’re doing a great job there. Your BMI runs between 29 to 31. When we run you through the numbers, we predicted, we would predict and it’s a little hard to say because you didn’t tell your age and some other factors like whether you have diabetes. You didn’t mention your gender, but I’m going to assume it five feet tall, most likely a woman. I don’t know. Her name is Julie. Oh, her name is, Julie. That would definitely give it away. Well, not definitely, but we’re looking like 99% of women here. Okay, so I put woman into the calculator and we’re looking at 163 to 172 pounds. And Sierra, how much is she weighing now?

Sierra: 33:30

She is between 150 and 160.

Dr. Weiner: 33:32

So she has exceeded our predicted weight loss. So we heard from Terri and we talked about how, when she came in and she actually made a, if you listen closely, she made a correction when she spoke. And she talked about how you said I should, but then she changed it to you anticipated, and I love that she did that. And to me it says okay, I did the right, I communicated effectively with her because we anticipate a certain amount of weight loss. So again, I hate to keep beating the same drum. But getting back to our pyramid, we’ve got the nutrition, we’ve got the meds, we’ve got the surgery. And so the question is Julie, have you maximized your nutrition? Have you done everything right? Are you essentially following something similar to the pound to cure program, compliant with your diet, eating kind of the way Terri described for us today? Are you doing that? We haven’t talked about meds. I think for this conversation we can exclude them, especially with a gastric bypass. I’m not sure there’s really a lot of need here for medications, especially based on how she phrased her confidence or her thoughts about her weight. And then we look at the surgery and so we just, we can only do what we can do. We can do the surgery. We can choose whether or not to be on the meds and that’s a personal choice, not necessarily a right or wrong one and then we can do the surgery. You exceeded the predicted weight loss for surgery. To me, you’re doing amazing. Your BMI is above what the insurance tables would say, but unless you’re actually purchasing life insurance, I don’t think using those tables is very valuable. And there’s arguments against even using them with life insurance, because there’s a lot more, there’s a lot of other factors besides BMI in terms of predicting longevity and health. And so what I would say is it sounds to me like you’re doing amazing. You’ve exceeded our predicted weight loss. I don’t care what your BMI is, if your nutrition is dialed in, you’re exercising, you’re living your best life, you’re feeling great, you’re happy in your own skin. To me, your a total success. A nd you should be celebrating that. And whether you lose another 5 or 10 pounds isn’t going to change that at all. And in fact, what we see is that sometimes in that scenario, people start doing crazy stuff, right? Starvation diets, cabbage soup diets, and these things set off this yoyo cycle, which, what’s the result of a yoyo? Weight gain. And so you end up taking steps to lose those last 5 or 10 pounds over exercising, getting hurt. Right?! Another thing that we see and so they take those steps to lose that weight and, in the end, they actually gain weight as a result. So to me, honestly, Julie, I think you nailed it. I think you’re doing amazing. If you’re in my practice, I would say, I would be giving you high fives, I’d be bringing you on the podcast and having you share your story with us. And I would not be telling you you need to lose additional weight. I think you’ve done everything you should have and then some. Just make sure your nutrition and lifestyle is there. If you’re there and you’re not happy in your own skin, for whatever reason, if you feel like, hey, I’d like to lose more weight because of this and this and this and they have to be personal reasons the medications may be helpful. But again, you’re in my practice. I’m not going to talk to you about medications, I’m not going to suggest them. I’d consider you success, mission accomplished.

Zoe: 36:41

The piece that I just want to highlight that she said is she feels good. So, if you’re feeling good and you’re feeling comfortable and you’re happy, like you said, don’t mess with that.

Dr. Weiner: 36:52

Yeah, totally. Yeah, you can do as much harm as good.

Sierra: 36:55

Okay, next question is from Nick from our website. Are Bolt house or Naked smoothies healthy or unhealthy? Strawberry banana, blue machine. They all have three to five grams of fiber per serving.

Zoe: 37:07

They have three to five grams of fiber per serving. But if you were to eat every single, you know how, on the naked bottles on the side, that has like there are five bananas and there are six apples and there are two oranges in this. If you were to eat all of that, you will get a whole heck of a lot more fiber, more satiety. You’d feel more full than if you were to guzzle down one of those juices.

Dr. Weiner: 37:31

Yeah, that’s not that much fiber, is it?

Zoe: 37:33

No, yeah, it’s like the syrup. It’s like, yeah, no, it’s not even like an apple. Basically. So, first off, I would say let’s look at the added sugar. Most of those smoothies have a ton of added sugar. Okay If you’re like, but, Zoe, there’s no added sugar, there’s just 80 grams of total sugar, which means all of that’s coming from natural sugar. Do we care about natural sugar If? Do we care about total sugar if it’s all coming from natural? No, but. If you’re not getting all that fiber, I just want to flip the table. I don’t recommend it. You’re not going to get the benefits. The whole point of eating fruit is to get that fiber, and if you put those fruits in your own smoothie, you’re blending that fiber up, so you’re still getting it. If it’s in a juice that you’re buying in a plastic bottle from the grocery store, most of that fiber is extracted. So great, there are three grams of fiber in there, but you’re not getting all of those other benefits of. If you were to eat the whole fruit and I promise you, if you were to try to sit down and eat all of the fruit that it says it’s in there, you wouldn’t be able to do it. Yeah, so I get a little fired up.

Dr. Weiner: 38:48

This natural sugar versus processed sugar? To me is that’s not the point, Because the truth is, the sugar that’s in fruit is also the sugar that’s in candy and processed foods.

Zoe: 38:59

you get along with it.

Dr. Weiner: 39:00

What do you get along with it? Yeah, sugar is to some degree unhealthy, there’s no question. Even sugar and fruit, whatever, fructose, glucose, all that stuff, sucrose, it’s all not great. But in a fruit it comes packaged with the fiber. It comes packaged with the phytonutrients, and so when you extract that fiber, when you extract those phytonutrients, all you’re left with is a sugar and that’s processed, and so it’s the two together, it’s the combination, and that really only exists in its natural form, in its unprocessed form, like you said, making your own smoothie with it, as opposed to buying a pre-made smoothie.

Zoe: 39:37

Good question though.

Dr. Weiner: 39:38

Yeah, but we don’t like that brand.

Zoe: 39:49

But it’s a heck no! All right. Well, I’d say that was a pretty packed show.

Dr. Weiner: 39:51

Yeah, absolutely.

Zoe: 39:52

We had our guests. We had some really great questions. If you have a question, submit it to us. Maybe we’ll answer it next time.

Dr. Weiner: 39:59

Fantastic. All right, so check us out on social media. We’re on Instagram, Tiktok, YouTube. I think we’re going to start releasing some YouTube shorts as well and if you have questions, reach out to us through social media with your questions or through our website. And if you’re in Arizona, we’re happy to see you either in person or by telemedicine.

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