Embark on a journey with us as we explore a new weight loss medication by Viking Therapeutics. We delve into a comparison between it and established drugs like Ozempic, and peek into the pipeline of potential game-changers from Pfizer, AltImmune, and Amgen.
Stir up your culinary creativity with our Greek yogurt and apple protein bowl recipe, a delectable treat that hits the sweet spot without the sugar crash. We also tackle the cost-saving strategies for extending the life of your Ozempic pen. Listen closely for the inside scoop on economical health hacks without compromising safety, and round out the episode with 3 questions from our listeners. Join us on this balanced adventure through the realms of health, nutrition, and economic savvy.
Transcript
Zoe: 0:33
Welcome back to the Pound of Cure Weight Loss podcast. We are on episode 16: “Click, Click, Click. The Sound of Lower Cost Ozempic!”
Dr. Weiner: 0:42
I came up with that title.
Zoe: 0:43
It’s clever.
Dr. Weiner: 0:45
So I went to Phoenix for the Extra Innings concert. It was a music festival—probably the first music festival I’ve been to in over a decade. And they were the big names. There was Cheryl Crowe, whom I loved; she was so good. And then Noah Kahn, who apparently is a very big thing.
Zoe: 1:03
How did he live?
Dr. Weiner: 1:05
He was amazing, actually. Honestly, I enjoyed him the most. I thought he was fantastic. And then Dave Matthews band. They finished out. Yeah, it was really a great concert, and we were there for, honestly, about eight hours. There was not a single healthy thing to eat there.
Zoe: 1:20
I was going to ask if you had your water.
Dr. Weiner: 1:21
They sold water. You couldn’t bring water because you couldn’t bring anything in. So, yeah, they sold water, but yeah, a lot of unhealthy food. I had a little bit of a treat day, I’m not going to lie.
Zoe: 1:31
Well, I like that vocabulary choice.
Dr. Weiner: 1:33
I learned it from you.
Dr. Weiner: 1:34
All right, Zoe, let’s get into the show.
Dr. Weiner: 1:36
Our first segment is in the news, and it’s from Reuters. The title of the article is “Viking Therapeutics’ weight-loss drug succeeds in a mid-stage study.” So with new drugs coming out, there’s essentially the first animal testing. Then you get into the mid-stage, which is really about figuring out the dose and the safety and just seeing if it works, and then finally you get into the stage three trials, which are what are required in order to get FDA approval. And that’s with a lot more people in it, where you kind of have your final “Hey, this is the drug we’re going to release; this is the dose we’re going to release it at,” and you show the safety and the efficacy. So this drug is in stage two; it’s in the mid-stage trial, so they’re not ready to start applying for FDA approval. The name of the drug is very creatively titled VK2735. I’m going to guess they’re going to come out with some more names as well, but it works very similarly to Tirzepatide, Mounjaro, and Zepbound in that it binds both the GLP-1 receptor and also the GIP, or gastric inhibitory polypeptide receptor.
Zoe: 2:41
So that’s kind of comparing the Ozempic. We see better results with the Zepbounds because they bind to more receptors.
Dr. Weiner: 2:48
Exactly, yeah. So Ozempic, like you said, only targets the GLP-1 receptor. This binds to two receptors, and so we get a little bit better activity. So this showed a 15% total body weight loss in a 13-week trial. That’s a lot of weight loss in a relatively short period of time. And also, what they showed was that they weren’t starting to see weight plateaus at 13 weeks. So that means that you’re probably going to lose more weight. So this drug looks like it has the potential to drive about as much weight loss as the Tirzepatide, Mounjaro, and Zepbound drugs do.
Dr. Weiner: 3:19
We’ve got a bunch of other drugs coming out. Pfizer has a pill we talked about in one of the previous episodes. That’s intriguing because it’s a pill. Altimmune has a drug that’s very similar to VK2735 or Tirzepatide that’s coming out. Amgen is just a straight-up GLP-1 agonist.
Dr. Weiner: 3:36
What’s exciting about the Amgen drug is that they’re showing longer weight loss maintenance, and so we’ve always kind of talked about how these drugs need to be taken long-term. Their initial studies are showing that, hey, maybe they don’t need to be. My suspicion is that it has a longer half-life, and they just haven’t looked at it long enough. But that, to me, is going to be something really interesting, because there’s kind of the weight loss phase, and then there’s the weight maintenance phase. And what if you could take a drug once a month for weight maintenance? I think there’d be a lot of interest in that as well.
Dr. Weiner: 4:09
So there’s stuff coming out, but it’s going to be a slow roll, and our health care policies are a little crooked right now, and so that’s going to keep us… I think it’s going to be a while before we have access to these medications at a lower cost, unfortunately. So certainly some good news, but I think the big story really has some change, which is that these medications are extremely expensive and extremely hard to come by, and it can be a real significant cost for a lot of our patients. Anyway, all right, let’s hear about your nutrition advice for this week.
Zoe: 4:38
Yes, well, I wanted to share this week about my go-to dessert lately, because if anybody has worked with me, come to my sessions, you know I’ve got a bit of a sweet tooth.
Dr. Weiner: 4:52
I do too, by the way.
Zoe: 4:53
So it’s for me, and what I like about helping people is how we can find creative ways to maybe pick more nutritious choices but still satisfy that sweet tooth, because sometimes you just need something sweet after dinner. So what I’ve been doing lately is taking plain Greek yogurt and mixing it with some chocolate protein powder. Now, that’s optional; you can do unsweetened cocoa powder if you would prefer. I like to boost the protein a little bit. Some powdered peanut butter, so that’s just dehydrated peanut butter. Make sure you pick the ones with no added sugar. Mix that all together. And then my fiance and I have been splitting a chopped apple, so we’ve done it with each having our whole apple. It’s kind of too much. So dice up an apple into a little bite size, mix that in with the Greek yogurt, and then you’ve got this kind of Reese’s flavored yogurt bowl. But the key is that you get the protein, so it’s really satisfying. But then you get the volume and the fiber from the apple, so it’s really filling. So I’ve been telling everybody about that.
Dr. Weiner: 5:56
So Greek yogurt, apple protein, chocolate protein powder, and dehydrated peanuts or peanut butter powder.
Zoe: 6:05
Yeah, you could also use regular peanut butter.
Dr. Weiner: 6:08
Yeah, that’s what I would use. Regular peanut butter. What kind of apple?
Zoe: 6:11
Honeycrisp when they’re on sale.
Dr. Weiner: 6:12
Yeah, they’re so expensive, oh my god.
Zoe: 6:15
They were 99 cents at Fry’s the other day, and I was just like, We’re getting honeycrisp.
Dr. Weiner: 6:20
Get the cart, Matt. Have you tried the Cosmic Crisp?
Zoe: 6:26
No.
Dr. Weiner: 6:27
I think they’re better than honeycrisp. I swear to God.
Zoe: 6:29
No way.
Dr. Weiner: 6:32
We get them at Trader Joe’s a lot. I see them a lot. So it’s a mixture of a delicious red apple and a honeycrisp, so it’s not quite as sweet. They’re huge.
Zoe: 6:45
Yeah.
Dr. Weiner: 6:47
And they got that same texture—that same crisp of a honeycrisp. That’s delicious. I think we’ll have to share that recipe somehow, yeah, so we’ll see if we can get that out to you. So let’s move into the economics of the obesity segment.
Dr. Weiner: 6:59
I want to talk about something that is a pretty common practice in our practice, and there’s a lot of pros to it. There are a few cons I think you have to be aware of, and some people do this quite a bit, and other practices don’t really do it. But it really only applies to the Ozempics. So each of the different medications has a different delivery system. Most of the delivery systems are what are called single use, which means this is Wegovy, this is Mounjaro, and this is Zepbound. It’s just a button you press, and boom, it gives you the whole dose all at once, and then you throw away the pen when you’re done.
Dr. Weiner: 7:32
Ozempic is a multi-use dispenser pen, and it has a dial at the end, and you click, click, click. As you turn the dial, you click, click, click all the way to the end, and different size pens will have different settings, and you’re supposed to turn it until you get to the 0.25 milligram, the 0.5 milligram, or the 1 milligram dose. Now, when we deal with the higher-dose pens they’re designed to give, let’s say that the highest-dose pen has eight milligrams of medication in it, and each dose is two milligrams. So there’s four doses in one pen. So the cost of the eight-milligram pen is the same as the cost of the four-milligram pen and is the same as the cost of the two-milligram pen. We’ve talked about this before on the podcast—that for some reason you can get four times as much medication for the same price.
Zoe: 8:18
It Doesn’t make any sense.
Dr. Weiner: 8:18
Yeah, it doesn’t make any sense. Listen, this is how it works. So you can use GoodRx and get an Ozempic pen, typically for somewhere between $900 and $1,000. Now the eight-milligram pen is, as far as I know, only available in the United States. In Canada, I think, the highest dose pen you can get is four milligrams. It’s about half the price but half the medication. So it kind of works out.
Dr. Weiner: 8:41
But it turns out that some hackers out there have figured out that it is 72 clicks all the way to the very end. So if you count clicks to 36, you’ll get half of that two-milligram dose, or one milligram. If you count to 18, you’ll get 0.5 milligrams, and the pen will last longer. Now it turns out that they only give you four or five needles with each pen, and if you do it this way, let’s say you’re dosing at 0.5, you’re going to need 16 needles. You can buy these needles on Amazon for about 10 or 15 bucks. So the needles are very easy. It’s something called a pen needle standard; it’s easy to find and very inexpensive.
Zoe: 9:26
Make sure they’re sterile.
Dr. Weiner: 9:27
Yeah, they come sterile, and they have like a little kit. This is, yeah, don’t chince on those; they’re cheap; they’re 15 bucks for 100. But they come kind of prepackaged, and they’re designed for insulin pens primarily, so you can purchase these pen needles, and you can get essentially 16 weeks of the 0.5 milligram dose for the cost of one pen. All of a sudden, that $900 lasts you three to four months instead. Now the price goes up. Of course, the cost goes up.
Dr. Weiner: 9:55
The other thing is that the pens are supposed to be discarded after 56 days, or eight weeks. If you use this and try to extend it to 16 weeks, technically you are taking a little bit of a risk of contaminating the specimen. So my official recommendation is to discard the pens after 56 days, because that’s what my lawyer says I have to say. The risks of not doing that are probably fairly small, and I think, if you understand, you’re taking some risks, and it’s going to save you 400 or 500 bucks. A lot of people might take some small risks. So counting clicks is a very reasonable way to get this, and I think this is particularly useful for our weight regain patients, where we often see that our weight regain patients are able to lose a substantial amount of weight with relatively low doses of the medications. So, especially if you’re a bariatric surgery weight regain patient, you may find this a very economical way to get access to the medication you don’t otherwise have access to. All right, Sierra, what do we have?
Sierra: 10:55
Okay, the first question is from our YouTube video of Episode 14: Dr. Weiner, you really need to research oil more. It’s not good for your heart. In fact, it damages the endothelium. Look up Dr. Esselstyn. Esselstyn is the director of the heart disease reversal program at the Cleveland Clinic.
Dr. Weiner: 11:14
So I am super aware of Dr. Esselstyn’s research. Also, it syncs very well with Dean Ornish’s research as well. In fact, in my first book, Pound of Cure, the final station I go through in that book is 12 changes you can make to improve your diet, and the final one is to reduce oil, and I wrote them in order of what I think is important. And so we get off of sugar and process carbs much earlier. We add vegetables first in that program, and we reduce oil in the end. I think there’s some debate about the weight-gaining effects of oil and also heart disease. I’m going to defer to Zoe on the weight-gaining effects of consuming oil. I’m just going to address heart disease. There’s no question that following an extremely low-fat diet can help reverse heart disease, and Dean Ornish showed it probably the most convincingly, and this is really what I think this user is talking about with Dr. Esselstyn’s research. But following a diet where you eat almost no oil and almost no animal fat is a really restrictive diet, and so my approach to this would be that if this is something you’re interested in and want to pursue, there’s data there. This would be a great way to help reverse heart disease, and it is a solid nutritional program. The problem is in my practice; if that’s what I pushed and promoted, avoiding oil and all animal fat as much as possible, I would probably have about 1 or 2% compliance. Zoe, you probably know as well as I do. Most people are not going to be able to follow that program, and so when we look at programs, you really have to, as you talk so often about individualized treatment plans for people.
Dr. Weiner: 13:02.
If this is something that works for you, go for it. If this is something that does not work for you, then maybe don’t go for it, and let’s look at maybe adding a little more oil, because that can make the food a little bit more palatable, a little bit more enjoyable, and make you more likely to stay on the program for a while. There is also, however, some conflicting evidence in support of the use of olive oil, particularly in reducing heart disease and resulting in longevity, and it’s from the Blue Zone study. An area in Greece called Ikaria consumes large amounts of olive oil. They follow a Mediterranean-style diet, yet they still remain active well into their 90s and generally live relatively heart disease-free. So I think I’m aware of this research, and there’s definitely some solid science behind it. I’m not sure that everybody needs to follow an extremely low-fat diet in order to reduce heart disease. So let’s talk about weight gain and oil. What are your thoughts on that?
Zoe: 14:02
So we think about foods in terms of not counting calories, but I always like to say we want to have some sort of calorie awareness when we’re thinking about these, which is why we want to be eating high-volume, high-fiber, low-calorie foods, such as non-starchy vegetables, in unlimited quantities, but something like olive oil, which has a lower volume and higher calories, is called more calorie dense.
Zoe: 14:29
We need to be conscientious of the serving size because if you’re willy-nilly, pouring some olive oil on everything and having half a cup of olive oil with your salad, then that, without really feeling that level of fullness, is going to shoot up your calorie intake, and, like we said, we’re not counting calories but having that calorie awareness. But the other thing I wanted to mention is that having a very low-fat diet impacts your nutrient absorption, your hormonal production, and your brain health. So make sure that you have some healthy fats like olive oil, avocado, etc. Like the Mediterranean diet and like the metabolic reset diet. And what we promote, I think, is important. But if we’re looking specifically at the weight loss aspect, then being conscious of serving size can help.
Dr. Weiner: 15:25
Yeah, all right, Sierra. Next question.
Sierra: 15:29
Okay, this one is from Lily on Facebook. I was on Mounjaro for 18 months and lost over 100 pounds, but now my insurance has denied it. I’ve been trying not to gain the weight back. I’ve increased my walking and exercise, but I’ve already gained about 10 pounds back. What do you recommend? I’ve thought about gastric bypass.
Dr. Weiner: 15:48
Yeah, so this is something we see. I see this over and over and over again, and so what I urge patients to do in this situation is to take stock and to understand, “Hey, what’s my insurance coverage? What are my options? What do I have coverage for?” And to explore everything out there. Do you want to have a gastric bypass procedure? I’m sure you don’t. But, on the other hand, your experience with Mounjaro has shown you that your obesity is a metabolic disease that is treatable. The medication that was initially working is no longer available to you, and so, if bariatric surgery is available and you do have insurance coverage and that is a feasible option, find someone who does a lot of these, who has a very low complication rate, and who has a fantastic support program. Do you know anybody like that? But, yeah, find someone who does these procedures. Seek out that metabolic treatment if losing and maintaining that 100 pounds of weight is important to you, and so, yeah, I think a gastric bypass is probably a very good idea. All right, Zoe. Last question.
Sierra: 16:53
Last question: I have a cold-pressed juicer. As long as I use vegetable-based recipes and light on the fruits, is it okay to use it before and after a gastric sleeve? I also use some recipes from an anti-inflammatory cookbook and from a bariatric smoothie book. Thank you.
Zoe: 17:09
All right. So here’s the thing: Juicing is much different than eating or even blending, because the whole thing, the whole benefit—one of the main benefits of eating vegetables is the fiber. Right, you feel full. It takes up room in your stomach. Delayed gastric emptying Yess you get these micronutrients, and these phytonutrients are amazing. Yes, you do get that with new juicers, but you don’t get any of the fiber. So there’s a big difference between eating a pound of vegetables and juicing a pound of vegetables. You’re not going to feel full, and you’re not going to get all of that great benefit. Now, you did mention making some recipes out of a bariatric smoothie book, which is great. If those are going into a blender, you’re blending it up, you’re keeping the fiber in there, and then you’re drinking it. But if you’re juicing it and then you’re tossing all that pulp…
Dr. Weiner: 18:04
That’s the good stuff.
Zoe: 18:05
Yeah, yeah, all right. Another great episode in the books. We got a great patient story. A lot of good topics were covered today. So if this was interesting to you, share it with somebody that you love, and also leave us a question or a comment. We’d love to answer your question next time.
Dr. Weiner: 18:23
See you next time!
