Ever wondered how to shed those extra pounds without undergoing surgery or medications? We’ve got you covered. Together with my co-host, Zoe Schroeder, we’re thrilled to share an inspiring story of a patient who lost over 50 pounds through The Pound of Cure nutrition program. We dive into the role of nutrition for both bariatric surgery and GLP-1 medication patients and the significance of accountability and support for long-term weight loss success.
The battle against diabetes and obesity can be daunting. With the ongoing supply chain limitations for GLP-1’s and the advent of compounded alternatives, we take you through the complexities of treating these conditions. While the compounded versions seem promising, we’ve got vital insights about their safety concerns and the importance of their source and quality. Embrace our quest to healthier eating habits as we explore plant-based protein sources such as hemp protein, focusing on using minimal non-scientific ingredients.
Weight loss after gastric sleeve surgery can be a roller-coaster ride. We debunk myths and shed light on the importance of lifestyle factors over the number on the scale for long-term success. Got any questions about faux meats? You’re not alone. We share our thoughts on them, advising against highly processed options due to an extensive ingredient list and high levels of sodium and saturated fat. Lastly, we tackle the use of GLP-1 medications for managing weight and diabetes, including potential side effects and solutions. Join us next week for more discussions.
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Transcript
Dr. Weiner:
Hi, I’m Dr Matthew Weiner. I am a bariatric surgeon and non-surgical weight loss specialist here at the Poundicure Weight Loss in Tucson, Arizona.
Zoe:
I’m Zoe Schroeder, the registered dietitian and leader of the nutrition program.
Dr. Weiner:
And this is the Poundicure podcast, which is a roadmap for your weight loss journey. And this is our second episode. I thought the first one came out okay. I was really happy with it. We’ve been working hard on this.
Zoe:
The setup is key and I think we have a process and we’re getting there.
Dr. Weiner:
We are getting there for sure. So for those of you who don’t know about us, we practice in Tucson, arizona, and we’re a weight loss surgery practice. We also prescribe GLP-1 medications and we have what I believe is the best nutrition program in the Southwest, if not the country. So we just tell us a little bit about how our nutrition program works.
Zoe:
Right. So something that we really talk a lot about is how important accountability and support is for long-term success, and so our nutrition program is based on that premise. So we offer Zoom and in-person. But because we’re on Zoom, we’re able to help people all over the country and world, and so we have support groups, we have educational, more learning style classes, as well as one-on-ones all times throughout the day, nights, weekends, whatever you want it, we got it.
Dr. Weiner:
And I’m on there a couple of times a week too. So if you have any questions that you’d like answered by a weight loss surgeon, maybe even a quick second opinion about something, that’s also an option as well, and the program is super affordable. And we really made it our aim to make sure that there’s really no weight loss surgery patient left behind and at this point now, with the widespread use of the GLP-1 medications, no GLP-1 medication patients left behind. I think the bariatric surgery community has done a really great job in providing nutritional guidance for our patients and really emphasizing the importance of nutrition. I’m not seeing that in the GLP-1 medication community and I think a lot of people are out there thinking I’m going to take the medication and then I’m going to lose the weight and not recognizing the importance of nutrition.
Zoe:
Thinking it’s a magic pill.
Dr. Weiner:
Yeah, well, injection.
Zoe:
Right.
Dr. Weiner:
So our nutrition program is really designed to help fill that gap that we’re seeing. So, zoe, what are we going to cover today?
Zoe:
Okay, so what we’re going to be discussing on today’s episode? A lot of hot topics. I think you’ll find very interesting Overseas pharmacies, a patient who couldn’t find Wagowi but still found weight loss success, compounded GLP-1 medications. Slow weight loss after a street sleeve, gastrectomy, depression and headaches on GLP-1 medications, hemp, protein powder, faux-meat and tapioca starch.
Dr. Weiner:
Yes, absolutely A lot to cover. There’s, I think, some really important topics. For those who didn’t catch our first episode, we get most of the ideas from our podcast on social media. So if you’re asking questions on social media, we’re going to take those questions and we’re going to answer them in depth on the podcast. So our next segment, to begin with, is we’re going to tell a patient’s story, and I think there’s so much that you can find from other people’s success and that’s one of the great things about social media and about our practice is getting people to connect with each other and share their stories and their successes, their difficulties, and so let’s talk about this is the patient who couldn’t find Wagowi but did find weight loss success. So why don’t you talk to us a little bit about Joey Sure? Not his real name, by the way.
Zoe:
Yeah, we’re going to call him Joey. So Joey came to us about 350 pounds right. And unfortunately wasn’t able to get Wagowi because, as we know, it’s a very difficult medication to get. But I think you said something that really kind of got under his skin.
Dr. Weiner:
So we reviewed his dietary history which I do with every patient I meet with and honestly it wasn’t great. And a lot of people think, oh, you know, dr Wainey, you wrote these books on nutrition, you’re a baritric surgeon, you want patients who really eat great, absolutely In the end. I do no question about it. But when you come to me with not a great diet, I like that. But I told Joey, I said, listen, you know, the way you’re eating it’s not going to work out for you with weight loss. You know, very blunt and matter of fact, whether you want surgery, whether you want to use the medications, whether you’re going to do this without either of those things. You just can’t keep eating the way you are right now. And he told me in a follow-up visit that I kind of pissed him off a little bit. But you know, I think he also recognized that he needed to hear that and sometimes you just have to be very blunt with patients and I think anybody who knows me or is seeing me in the office knows that I’m probably overly guilty of that at times. So, yeah, so he worked on the nutrition programs. So we talked to him about some of the metabolic reset diet changes he made.
Zoe:
Right, and, like you mentioned, we get excited when somebody has a you know, a lot of room for improvement, because that means they’re going to see a lot of success given the fact that they follow our recommendations. And so, of course, we had him do the metabolic reset diet. He was coming to support groups regularly, really building that connection Like you were talking about before, and he’s lost over 50 pounds without surgery or medication.
Dr. Weiner:
Right, he couldn’t get the Wigowi because it was on back order.
Zoe:
And we see most people plateauing when they work with nutrition and lifestyle changes by themselves, without the help of the tool that we like to say the medication or surgery. Generally people do plateau around that 10% of their total body weight. But Joey, he didn’t. He was able to push through that and continues and he’s still seeing great success. Yeah, he’s still losing four or five pounds a month, which is great, and it’s a sustainable rate of weight loss as well.
Dr. Weiner:
The idea here is that we’re trying to lower people’s set point. Your body regulates your weight at a certain amount and our goal is to bring that set point down to a lower value. Joey accomplished this by changing the quality of his diet. He was eating a highly processed diet to begin with. He changed over to eating a plant-based whole foods fruit, vegetables, nuts, seeds and beans predominant diet, little bit of lean animal protein essentially our metabolic reset diet. He made those changes and lost the weight and I think he’s kind of lowered his set point through that. Now he’s going to have to maintain that type of eating pattern to maintain the weight loss. But he did plateau more than 10%. I think we see that in young people a little bit more. You’re in your 20s and 30s, men a little bit more. We see more than that 10% total body weight. And then there’s just some people who lose weight easier than others.
Zoe:
Right and we’ve got the stories of couples where the husband and wife make the exact same changes and the husband has lost 20 pounds and the wife is like ah. I gained weight.
Dr. Weiner:
We see it after GLP-1 medications. We see it after baritric surgery. Men lose weight more easily than women. That’s an unfortunate truth and we just kind of have to work around it, and I think it’s critical that we educate our patients about that, because you’re right, when the husband and wife work together on weight loss, it’s never even.
Zoe:
But I think the moral of this story is that you can really make a lot of great progress when you are coming at it from the perspective of I’m going to change the way I eat, not I’m going on a diet for two weeks. It’s like how can we make this mindset shift in? This is the person that I choose to embody and the way I choose to live my life for the rest of my life.
Dr. Weiner:
Right. Permanent change is opposed to a temporary change. Permanent change gets permanent weight loss, temporary change we know far too well about that. Next segment is we’re going to talk about what’s in the news. So this came to us through Reuters and it talks about Belgium temporarily banning the use of ozempic for weight loss in 2023. And they’ve restricted the use of ozempic to type 2 diabetes only. So just kind of a little bit of backstory here. Ozempic is also known as semi-glutide. It can also be called wegovi. They’re the exact same medication. Ozempic and wegovi are both semi-glutide. The dose is the same. There’s no difference. One is not stronger than the other Exactly the same. So people use them interchangeably and, honestly, in our practice, we will frequently prescribe off-label ozempic if the insurance coverage is going to permit that for weight loss, and that’s a totally legal and actually very common thing for people to do to prescribe off-label for many, many other conditions as well. In Belgium they’re trying to ban this and they’ve essentially made some recommendations. They’re even looking at putting some penalties on physicians who are prescribing ozempic for weight loss. Now I think my comment about this really is how it relates to obesity bias. There’s no other world where you’re going to compare two diseases and say, oh well, this is the worst one. We’re going to make sure we use the medication only for this one. I treat patients with both diseases all the time. I treat people with diabetes. I treat people with obesity every single day. You give me a choice between diabetes and obesity and I will take diabetes. I think obesity is a far more burdensome disease. I think it decreases your quality of life much more. First of all, diabetes thoughts and prayers right. Everybody’s on your side. What can I do? We’re going to help you through this. We’re going to get you treated. Everybody’s on your side. When you got diabetes, when you’re overweight, it’s the exact opposite. What do you do to yourself? Why can’t you control yourself? This is something, a condition that you’ve brought on yourself.
Zoe:
Just stop eating so much.
Dr. Weiner:
Exactly See, that’s what I do. I just eat less and I’m naturally thin.
Zoe:
Just exercise more.
Dr. Weiner:
The public scrutiny, the social support that you get when you’re struggling with obesity is so much less than diabetes. Also, you’re walking around diabetes. Everybody knows it. That’s your own little secret. You don’t have to share with anybody Obesity everybody knows, everybody can see it. So you don’t get to kind of keep your own health history to yourself, and so I obviously I disagree with this. I think we need to be much more creative to address this supply chain issue we’re having. That’s limiting our ability to get ozempic, and the costs are through the roof. I mean, this is something we battle with every single day, right? So that actually leads in very nicely to our first question. So this is from Amy on Instagram, and she asks what are compound GLP ones?
Zoe:
So what a great question yeah.
Dr. Weiner:
I mean, if we don’t answer this question four times a day, I think you know I’d be surprised. So compounded GLP ones. Well, let’s first talk GLP one is the class of medication. They’re technically GLP one agonists, which means they trigger the receptor. Glp one glugon, like peptide, and this makes you feel full. It actually, when you reduce your calorie intake, you normally slow down your metabolism. You don’t. In this case. It prevents your metabolism from slowing down to compensate for decreased calorie intake, so it lowers your set point, brings the weight down. Now they’re typically produced and in the United States we have something called the FDA and they are the ones who regulate it and they really look for three things. So, and all of us kind of feel this when we go purchase a medication. So I go purchase a medication at the pharmacy, I want to make sure if it says 50 milligrams, I’m getting 50 milligrams In the US, most of us appreciate that. You want to make sure it’s safe, that if it says it’s telmasartan blood pressure medication it’s really telmasartan and you want to make sure it’s not contaminated in some way. There’s not bacteria or anything on it. This is particularly important for GLP ones where we’re injecting it underneath the skin.
Zoe:
I think maybe we take it that for granted as well, those three really important things. Absolutely we just kind of automatically assume that the medications are going to hit those three points.
Dr. Weiner:
Yeah, that’s what we assume. Now compounded GLP ones are not FDA-proof medications, so they’re coming directly from the manufacturer. Now, right now they come from China because China does not look at international patents in the same way that most of the rest of the world does, and so these medications have international patents Monjaro, terzepetide and Semi-glutide, which is Osempic, and Wegovi they’re patented. There’s international patents. So very, very few countries have. They have to have first of all, the legal system, where they don’t observe these patents, and second of all, the manufacturing capabilities, and that really comes down to China. Now, the truth is, most drugs have some part of them made in China in some way. Or you know, china continues to be the world’s manufacturing plant. So these medications are manufactured in China and they are shipped over to a compounding pharmacy which is essentially able to mix the powder with saline and distribute and adjust these medications. They’ll often mix them with something like thiamine or B6. So it’s a novel compound and that kind of gets around the US patent restrictions, and then they’ll sell these medications for cash. No insurance companies will pay for them.
Zoe:
This is kind of where we see a lot of like kind of the med spa type medications coming into play, right?
Dr. Weiner:
Yes, yeah, when you’re getting Terzepetide Semi-glutide from your med spa, you’re coming in, they’re giving you the injection. That’s the history of these medications. So are these good or bad? You know, and the medical industrial complex has been very quick to say these are bad, these are dangerous, and they may be. There may be batches of these things out there that are either. If they say it’s 10 milligrams, it’s only three, and you’re paying for 10 milligrams but you’re only getting three. They may be contaminated with bacteria. They may have heavy metals or other toxins in them that make them unsafe. The truth is, with GLP ones, you don’t know what they are, but there are things that you can test, you can look at. So I wouldn’t describe GLP ones as all bad or all good. I think the medical industrial complex doesn’t like them. I get it. They make their money through the traditional channels. I don’t work for the medical industrial complex. I’m part of it, but I’m certainly not owned by any large company or pharmaceutical industry or hospital or anything like that, and so I don’t have to play that game. But I think it’s important, if you are using GLP one medications, that you really consider where these things are coming from, and the cheapest option is probably not your best option, and so these medicines may play a role in the future. I think we’re probably headed for some dark days in terms of GLP one access over the next three to six months. January 1st, I think, could be a rough start to the new year for millions and millions of patients.
Zoe:
It’s going to get interesting.
Dr. Weiner:
It’s going to get very interesting, so these medications may be a lot of people’s only realistic options. We’re seeing self-pay at $1,000 a month. That’s just not a reasonable amount of money.
Zoe:
Considering the markups. That, yeah, yeah.
Dr. Weiner:
You know I certainly have very mixed feelings about GLP ones. In a perfect world, there’d be no need for them because we would be able to meet demand. We would be able to provide access to those people who need them. But we’re not living in a perfect world in the healthcare system right now.
Zoe:
So it sounds like maybe, if somebody is considering getting a compound GLP one, to look for those three components you’re talking about before making sure it’s tested for the purity, for the safety and that is, you know.
Dr. Weiner:
I think that’s exactly the take home point. So absolutely.
Zoe:
So let’s move on to the next question. So we had a question over on our website from Cheryl asking about hemp protein in her smoothies. She says I know it’s processed, but it seems minimally so. There’s only one ingredient rock-hold-milled hemp powder. Will this raise my set point? I’m having one per day. Should I apply the principle of the fewest non-scientific list of ingredients I applied to my decision to use hemp? Yeah, let’s talk about hemp protein, because it’s coming from a plant. It is going to be much higher in fiber, which we are going to talk more about later on, I believe in the next episode actually so stay tuned for that, but with it being a high fiber plant-based protein. Now, like you mentioned, looking for as few ingredients as possible is what I always recommend, so if there’s one ingredient, I think that’s great. You’re going to feel a bit more satisfied and full because of that fiber. Now, do keep in mind there’s going to be less protein in it than perhaps a way isolate or even some other plant-based proteins out there. However, it sounds like it’s something you enjoy. It’s a great addition to your smoothie and I don’t have a problem with it.
Dr. Weiner:
Fantastic. All right Hemp yeah.
Zoe:
Hemp yeah.
Dr. Weiner:
Use hemp? Yeah, next question this is from YouTube and it’s the name of the video was small weight loss after gastric sleeve. Patient says day of surgery weight was 227 pounds. I’m five foot four, three months post stop and I’m 198 pounds. I’m terrified that my surgery is unsuccessful. Am I correct in thinking that the short answer is absolutely not. You actually sound to me to be fairly close to on track. So let’s talk about the weight loss curves that we see after sleeve gastrectomy and what you can expect. The first thing I’d say is I would direct everybody to my website. We do have a calculator for how you can calculate how much weight you’ll lose after sleeve and a gastric bypass. We’ll drop it into the YouTube notes as well so that anybody who’s interested can look and just put in your stats. Hey, I started out 227, five foot four. This is how old I am and it’ll give you some predictions on your total weight loss. Now, most calculators are going to predict weight loss at one year, and that’s a long time to wait. We know from the data that at two months after surgery you can tell who’s going to lose a lot of weight and who’s not. So when you get off to the races really quickly. This is not a tortoise in the hare kind of situation. In this race the hare wins. You lose weight quickly at the beginning. Most likely you’re going to lose a lot of weight. But there’s a lot of other factors to consider. So the first factor is did you lose a lot of weight preoperatively? If you lose 20 pounds preoperatively let’s say this patient was 247 before they started their weight loss journey and had surgery at 227, they’re actually going to lose a little less weight than someone who started 227 without that preop weight loss. Now we’re seeing GLP-1 medications. If you were on GLP-1 medications, stop them prior to surgery and don’t restart them for a few months after. You’re going to have slower weight loss from the beginning. So it’s getting more and more complicated as we put some additional factors in. But a sleeve gastrectomy patient, I’d have to roughly guess would lose somewhere in the neighborhood of about 55, 60 pounds. It’s going to depend on their age and again, some of those other factors. But in starting at 227, I would guess 55, 60 pounds. Again, our calculator can give you a more accurate amount, but we see about 50% weight loss at three months A predicted amount A predicted- amount. So if you were going to predict 60 pounds at three months, you’re going to lose 30. It’s essentially where this person is. So I would actually think that this person is right on track for the predicted weight loss. I don’t see any issues, and so this was actually a while ago. So if this person happens to watch this, please update us on how you’re doing and whether that’s synced up.
Zoe:
Yeah, definitely, and something I’d like to add is we know that weight loss is never perfectly linear. There’s going to be a sauce. We think it’s going to be this perfectly linear downhill slope and that’s just not the case. You’re going to have to drop, it’s going to go up. It’s going to stay the same. We know that’s the hardest part. It stays the same. But look if we can zoom out. Get out of the weeds. Look out the trend over time. Get out of those zigzags. Stop worrying about it so much. Keep controlling what you can control, which are your lifestyle factors that we know are important for that long term success.
Dr. Weiner:
So how often do you tell people to weigh themselves after surgery?
Zoe:
Well, I am really more so in the camp of no more frequently than once a week, and a lot of people become so obsessive with that number on the scale. I actually have a whole class called measuring success and how we can see progress, feel successful aside from that number on the scale, because, as we know, that skill is not always going to do what we think it should. So that would be the goal. Thanks, abigail. We should definitely look at some other factors as well.
Dr. Weiner:
Yeah, I think once a week. I mean it’s impossible for a lot of patients. Oh, sure. I think that’s great advice. All right, what do we got next, Zoe?
Zoe:
All right. So we have another question from our website, also from Cheryl. I’m not sure if it’s the same Cheryl or a different Cheryl, I’m not sure, but anyway. So she says I have been eating some faux meats on my journey because I worry so much about getting enough protein as a post-menopausal woman. Are there any faux meats that you would recommend? So I don’t. I’m not trying to burst your bubble here. However, I’m personally not a huge fan of the highly processed faux meats. If you take a look at the ingredients list, generally they’re about a mile long and they are highly processed. A lot of them have a ton of sodium and do tend to be very high in fat, in fact saturated fat. With all of that being said, that doesn’t mean I don’t want you to be eating non-animal based proteins. We do want you to be prioritizing plant-based proteins, but just more so the whole food version. So, yeah, add in more beans, maybe make your own black bean burgers or edamame or chickpeas there are, so you have a great recipe for hummus. So there are a lot of ways to get your protein in through plant-based sources, but that are less processed and have less stuff in there.
Dr. Weiner:
To me, it’s always important to ask yourself what’s driving this whole faux meat thing. Is it truly an environmental movement? No, these companies are publicly traded. They’re the darlings of venture capital for a while. There’s a huge commercial drive to creating these products because there’s a market for it, but that doesn’t make them healthy. That doesn’t necessarily make them better choices, In my mind. I’d much rather see us putting a lot of energy into responsible farming techniques, cutting back on our animal protein consumption, eating higher quality animal protein, rather than seeking out these faux meats.
Zoe:
Well, and I’ll just put a little plug. If not a plug, it’s just a product that I use all the time and I love the lentil pastas. Have you ever had that?
Dr. Weiner:
Oh yeah.
Zoe:
One ingredient lentil flour or the chickpea ones. I talk about these all the time because I just love them so much.
Dr. Weiner:
Yeah, they’re delicious. Next question this is on YouTube Am I too old for weight loss surgery video? What is your advice regarding dealing with insomnia Any preferred medication while on GLP GLP1 medication? Then the second is and this is kind of related Hi, dr Wainer, read both your books and I recommend it to my other bariatric friends. I have been on Osempic since August, get severe headaches and mild nausea after taking it, but I also get incredibly depressed. I don’t mind the headaches and nausea, but the depression is very bad. So there’s two really great questions here, because the truth is, if you are not sleeping and you are depressed, then these medications are not working well for you. We start people on GLP1 medications. We’re not necessarily saying we’re going to do it for three months, six months a year. There may be some opportunity to wean people down on their dose, and a few people may even be able to get off of it, but the majority of people will require using this long term, and so committing yourself to a life of headaches and insomnia is not something that I would recommend to anyone, and so let’s talk about what you can do. I think we talk a lot about, and I just had a video that we put out a week or so ago about diet and dose, and that’s really the key to these medications. The first is the diet the GLP1 diet. I’ll let you talk about that in just one second, about what you recommend for people on GLP1 medications. But if you’re eating processed foods, it’s going to be unpleasant, you’re going to have more side effects. And the second is dose. So the first thing I would do for both of these patients is decrease the dose. There’s going to be a dose where you have no side effects. We also know that tolerance can develop over time, and especially with some of the, with Osempic, where you can really click it into any dose, there’s an opportunity if 0.5 is too much and 0.25 is too little, you can do 0.375 by counting the clicks in between, and so I would come back on the dose. A second thing that I would mention is the administration site. So some people talk about the arm resulting in a different absorption pattern which may produce a different set of side effects or fewer side effects than ejecting into the stomach or the buttock or the thigh or wherever you have some extra subcutaneous fat. So moving the injection site around also can be very helpful. Zoe, what do we do in diet wise for GLP-1 medications?
Zoe:
I think, first off, to keep in mind we were I think she mentioned something about, you know the nausea as well. So after considering the dose and that sort of thing, but to keep in mind nausea is one of the most common side effects with these medications. But we can help mitigate that with proper nutrition. So think about what foods generally make nausea worse greasy, fatty foods and in fact I was helping somebody a couple of weeks ago who was talking about this really severe nausea she was having. But you know she was going to in and out but she wasn’t having the bun, she was just having the cheeseburger in the lunch. But here’s the thing it’s so greasy, it’s so fatty, it’s going to sit in her stomach so heavy. These medications, as we know, decrease the motility, slows down digestion, and so if we think about that grease sitting, oh, combined with delayed gastric emptying, it’s just a recipe for disaster. So, besides avoiding those greasy, fatty foods that will make the nausea worse, we want to prioritize I’m gonna sound like a program whole, real, unprocessed food. Now, because of the volume restriction that most people experience on the medications, we do want to prioritize lean, whole food, protein and I always like to say, filling in those gaps, getting as much produce as you can vegetables and fruit but ultimately working towards eating as much unprocessed food as possible.
Dr. Weiner:
Yeah, keeping cutting down on the fat unprocessed and the metabolic reset diet was originally designed for post-operative, for post-periatric surgery patients. It’s really important to recognize that post-periatric surgery patients and GLP-1 medication patients. They got the same, they’re very similar, same physiology going on, and so it really is that kind of unprocessed diet. And the way I kind of figured out this whole eating program was just listening to my post-op patients talk about how their diet has changed after surgery. And you’re gonna see the same thing when you’re on GLP-1 medications. You’re gonna be gravitate towards some of these healthier foods and it’s your job to really embrace that change. There’s other places you can go besides in and out without the bun. There’s Chipotle, we have salad and go locally in Tucson. So there’s gonna be options that you can have just the same kind of drive-through experience but get a much healthier product. That’s gonna cause a lot fewer side effects and be more helpful.
Zoe:
And something that I absolutely love to hear patients say post-op and while on the medications, is that they crave fruit.
Dr. Weiner:
Or they crave vegetables Like when can I have vegetables?
Zoe:
And they say that they have that taste bud change which I think is just so dang cool.
Dr. Weiner:
It makes our job a lot easier, doesn’t?
Zoe:
it does, yeah.
Dr. Weiner:
All right, so I think that wraps up our show. I hope that you guys learned a lot. We’re having a good time doing this, and if you have questions for us, please reach out to us through social media. We are collecting them and trying to organize them and answer as many of them as we can, either on social media or through the podcast, and so we hope this was helpful. If you wanna hear more from us, please tune in next week and subscribe to us on your favorite social media channel.
