Navigating the World of GLP-1 RA for Weight Loss - Ozempic, Trulicity, Wegovy, Victoza, Saxenda, Rybelsus, Mounjaro, Zepbound

[00:00:02] What you want, when you want it, where you want it. This is The MESH. Hey I'm Amy Chang. I'm a nationally board certified health and wellness coach and this is Healthy AF. In this podcast I'll be bringing you all things health. From the newest health strategies to how to tackle those personal roadblocks that just will not let you move forward.

[00:00:26] So buckle in. We're going to be inspired and instructed and dadgum we're going to have a little fun on Healthy AF. Hey everybody and welcome to another episode of Healthy AF. I am very excited to do this episode actually because it seems the universe is bringing me a need for this podcast.

[00:00:50] We are going to be talking about today weight loss drugs, specifically GLP-1 receptor antagonists and you're going to see me going through a whole bunch of notes. So what do I mean when the universe when I say the universe is bringing this to me. When I do this podcast by the way. I listen for what my community is questioning.

[00:01:18] What they want to hear what specifically they're wondering about or a little lost on or want some guidance. So as you all know, I probably who knows, maybe you don't. I'm a registered nurse. I've been a registered nurse since 95. Holla. And an NP, but I gave that up when I had children. So I have to do continuing education yearly to keep my registered nurse and also to keep my national board certification in health coaching.

[00:01:47] It's sort of a pain, but actually I love it because I love learning stuff. And this weekend, this past weekend, I actually spent three hours getting some continuing education on these weight loss drugs. Because my people are asking me about them or they're beginning to use them. And I felt like that I had a knowledge gap there and wanted to know more. So I went ahead and took my three hour course.

[00:02:16] It was fascinating. I learned some very practical things. And then I had a friend call like literally yesterday and say, oh, yeah. So I've decided to start ZetBound. And I talked to my doctor about it. And when he prescribed it, he I said, is there anything that I need to look out for or side effects? And he's like, no, it's a great drug.

[00:02:47] And I was like, excuse me, wait. So I was like, clearly there are some things that we need to probably talk about. So I asked my friend like, hey, I just did some continued ed on this. Do you want to just take 10 minutes and hear what I know? And she was like, yeah, that'd be great.

[00:03:11] So I thought, well, crap, probably some other people out there need to have 10 minutes to hear what I know, too. And I'm going to use my notes. And if you like the sources, because there are a billion research articles that went into this presentation, please just DM me and I'll be happy to send you the either the reference list or that specific study so that you can go research it yourself.

[00:03:37] If you love to be informed, there's no better way to be informed than to understand how to read research. And how to decide to apply it or not to yourself or your patient population. Everybody's different. Everybody's different.

[00:03:58] I'm not going to respond the same as a 52 year old white woman to a drug that a 85 year old male would. So you need to make your own decisions and be informed. All right. So let's just get started. So the drugs I'm talking about today are in the GLP one receptor agonists.

[00:04:24] And in the U.S., they currently include Trulicity, Ozempic, Wagovi, Victoza, Saxenda, Ribelsis, Mongero and Zepbound. Okay. So that's what we're talking about today. The very first thing I want to tell you is these drugs are not cheap.

[00:04:51] So good news for Zep bound users. If you've ever been diagnosed with obstructive sleep apnea, moderate to severe obstructive sleep apnea. That's for those of you who don't know, it's where the tongue actually occludes the airway when you're sleeping. And you might know you have obstructive sleep apnea if you snore really loudly.

[00:05:18] You might also know you have obstructive sleep apnea if you do the this thing, that thing. If the person laying in bed beside you says, hey, you stop breathing at night a few times. That's how you know that you probably need to have that tested.

[00:05:44] Also, if you feel fatigued when you get up, you know, a lot of times it's because you're not sleeping well because you're not breathing. Imagine that you got to breathe while you sleep. And Zep bound as of December 20, 2024 has been FDA approved for the treatment of moderate to severe obstructive sleep apnea in adults with obesity to be used in combination with a reduced calorie diet and increased physical activity.

[00:06:11] So the good news is here now you can ask your insurance company to pay for your Zep bound. Probably have to do some testing first and get some things approved as always. But as we know, Zep bound and all of these drugs can be really costly. In fact, I'm going to talk about that next. I'll skip a skip a few slides.

[00:06:30] There was a study that said more than 50% of patients on Rax, Saxenda and Wagovi ended their treatment too early to realize meaningful health benefits. Stinks, huh? And it was because of cost.

[00:06:58] So if you're considering going on these drugs. It's good to take a moment to look at your wallet. And just see how long do you think you're going to need to be on this drug? And do you have the resources to pay for it? Now, the prices worldwide. Have this chart too. It just is mind boggling, right? If you're listening to this and you live in America and you've always lived in America,

[00:07:27] like I've always lived in America, we seem to think that stuff that happens in America is just like normal and it's the way that it happens. But that's not true. Like there's a whole big globe out there and they do things differently. So average cost for Ozempic in the US per month is $964. For Mongero per month is $1,061.

[00:07:58] Lowest price listed here for Ozempic per month is in France and it's $83. So that's $964 in the US, $83 in France. The highest, closest to US is Japan. Japan, a month of Ozempic is $169 and Mongero is $319.

[00:08:24] So I'm not getting into politics and socialized medicine and all that jibbery jabbery. But there's some different ways to do prescriptions and health care that we currently don't employ here in the US. So I'm not telling you to go get fake drugs. Please do not do that.

[00:08:50] Just be aware of the cost and budget that in as you try to make your decisions on whether or not these drugs are right. These right for you. OK, let me get rid of that paper. I want to make sure I got on my paper. All right. All right. Let's talk about what you might need to do when you go on these drugs.

[00:09:14] OK, it's important to realize that when you go on these this class of weight loss drugs. Your caloric intake is going to go down severely. Which means your nutrient intake is going to go down severely. We already know that here in America, we have a pretty hefty toxic chemical load in our food.

[00:09:44] We eat an ultra processed diet is the Western diet. That's us. And the soil. That we grow our food in doesn't have the same nutrients that the soil that our great grandparents grew their food in.

[00:10:02] So we already know that even the organic and grass fed and pasture raised, all of those foods compared to the same foods, you know, 80 years ago, 100 years ago, maybe. Totally different nutrient density, I guess, is the best way to say that.

[00:10:29] Now we're taking down our calorie load and our nutrient load again. I said to my friend, it's kind of the equivalent of asking your car, hey, car, I want you to run all the errands and do all the things that I usually do in a week. But I'm going to give you half the gas. You know, how's that going to feel? And how are you going to run? So my recommendation is. Increase.

[00:10:58] The quality of gas you're putting in your tank. So you're really going to be looking for those nutrient dense things and you might even want to use some supplements. Now, I do have one friend who has done a lot of work with a lot of patients on weight loss drugs and he loves them. And he has a very long list of supplementation that he highly recommends that people use. Supplements.

[00:11:27] The caveat about supplements, please understand, is that you need good quality supplements. Supplements are not the manufacturing is not regulated by the FDA. So there are companies who manufacture up to those standards. There are companies who manufacture in the US. Plus, you've got to buy quality supplements.

[00:11:53] So not only do you need quality nutrients, you also need them from a quality manufacturer. OK, so we're not talking about like just hit the CVS and pick something up. That's that's not what we're talking about. I really like two companies that I'm sure there are more. If you need to just order something online quick and easy. I like the one supplements that's T H O R N E. And I also like a company called Life Extension.

[00:12:22] Super easy. Lots of information to get on their websites if you need it. So my first recommendation to you would be if you're taking a GLP one or a receptor agonist, make sure the nutrients you are getting are dense and quality because you're not going to be getting a lot of them in. Second note is beef up to protein.

[00:12:52] So when we cut calories on our body, our body doesn't selectively say like, oh, she only wants to lose the muffin top. So we're just going to burn the muffin top. That doesn't happen when you just straight up cut calories and you don't do anything else.

[00:13:12] Your body loses from everywhere it can lose from because it's burning all kinds of additional fuel sources because you're not eating any fuel sources. So it's going to burn your fat. It's also going to burn your muscle. There's also some question about bone loss. So two things. A, increase your protein intake. And we're going to talk about numbers here in just a minute.

[00:13:40] But B, increase your physical activity, particularly your loaded physical activity. Walk with a weight vest. Go to the gym and start deadlifting, back squatting, front squatting, shoulder pressing. Whatever you can do to pick up a weight is going to protect your muscle mass and protect your bone density. The body is such a beautiful machine.

[00:14:08] If we ask her, hey, I need to move this heavy load on a regular basis. She'll keep the muscle mass to do it. But if we never ask her to move anything heavy or pick anything up, it's likely she'll be like, oh, I don't need that. That quadriceps muscle. So I'm just going to burn it off because I don't have any calories. OK, so let's talk muscle mass here.

[00:14:34] Underlined and in bold, it says early intervention is central to treating muscle mass loss in patients losing weight with a GLP-1 RA. Two key approaches are increased physical activity and protein intake. The recommended dietary allowance for protein is 0.8 grams per kg for most adults. Now.

[00:15:02] It's going to be higher for that when you're taking one of these drugs. So it suggests 1.1 to 1.6 grams per kg will help you with your muscle mass loss. So I'm going to say that again and help you with that calculation.

[00:15:32] 1.1 to 1.6 grams per kg of body weight. So the first thing you need to do is calculate your body in kg. It's quick and easy if you just want to, if you just put in your brain that your pounds are about 2.2 times your kg. So I know that I weigh 150 couple.

[00:15:59] So on a quick and dirty calculation, I can be like, oh, well, it's half of 150-75. So I can get a good ballpoint estimation on my kg. Or you can ask your Siri, like, hey, Siri, calculate my weight in kg. And then you need to eat an equivalent of 1.1 to 1.6 grams of your protein. So if I'm about 150, that makes me about 75 kg.

[00:16:28] That means I need a little bit more than 75 up to 75 and a half, up to about 105. And I'll tell you that my health coach, without me being on any of these drugs, is telling me I need more than that as a perimenopausal woman. So you might want to bump up that protein. Now you can use protein shakes. I would not count collagen supplements in your protein intake.

[00:16:57] Throw those on there because they're going to help your skin and your joints. Because as you lose that 50 pounds, you also may see some skin sagging that you don't appreciate. OK, so start your collagen now and fingers crossed that will help, especially if it has a little hyaluronic acid in it. OK, so you want to really try to boost up the hydration of those skin cells. All right. All right. I think that's enough about protein.

[00:17:30] OK, no, it's not. Sorry, I have one more thing. Yeah, one more thing. This is from the New England Journal of Medicine.

[00:17:41] And it says current guideline applies to physically active patients rapidly losing weight on GLP-1-GIPRA for building muscle mass and for maintaining muscle mass through a positive muscle protein balance.

[00:18:00] So overall daily protein intake in the range of 1.4 to 2.0 grams of protein per kilogram of body weight per day is sufficient.

[00:18:15] So over here we have this one that says, yeah, studies show that if you're 1.1 to 1.6, you're going to preserve more muscle mass than if you are at an intake of 0.6 to 0.9 gram per kilogram. And this one here says really, though, 1.4 to 2. That's a lot of protein if you're not used to eating it.

[00:18:43] So 1.4 to 2 grams of protein per kilogram per body weight. And that's from the New England Journal of Medicine. And please, again, DM me and I'll be happy to send you the sources. OK, let's look at more dietary intakes for patients on these drugs. You want to have over two to three liters a day. My friend said, like, does that count coffee? I'm like, no, no, that's your waters. That's nothing caffeinated. You really can't count a soda in that.

[00:19:13] You maybe count like a Gatorade or something. But I would say that's your waters. OK, if you stick to that water, you're going to be much better off. Greater than two to three liters a day. Fiber, 21 to 25 grams a day for women and 30 to 38 grams for men. Now, I'm just going to say right now. I think that's a little low.

[00:19:40] One thing we know about these drugs is that you can become constipated because you're not eating a lot. And the way the bowel works is it's a stretch response. So if you put a big bolus of food in there, then the bowel will stretch even in your esophagus. Right. Will stretch. And that's its signal that it needs to mechanically start the squeeze and stretch, squeeze and stretch.

[00:20:10] And it's going to push that bolus of food soon to become absorbed, soon to become poop. It's going to push that through your system. That's the way the gut works. Right. While it absorbs all the nutrients, it's mechanically sort of squeezing that poop all the way down the down the hose, if you will. If you don't have a large enough amount in your intestinal tract.

[00:20:38] It doesn't get that stretch. So it doesn't know to push through. And if you're not eating fiber, then you're really taking the bulk out of your diet. So for me, my goal is 25 to 40 milligrams of fiber a day. Does it right? Grams. Yeah, grams. Sorry. A day. Now this recommends 21 to 25 for women and 30 to 38 grams of fiber for men a day.

[00:21:06] If you're taking a GLP-1 medication. So fiber is going to be really important. And remember, if you want to poop, you need fluid and you need fiber. Because that large intestine's job is to take the fluid out of the poo.

[00:21:25] So if you have ever been constipated and when you finally go, you push out this tiny little rock-like poop, it's because it has sat in your colon and your colon has continued pulling water out of it. And it just gets smaller and smaller and shriveled and shriveled and more hard. Nobody likes a hard, small, shriveled up poop. It's horrible.

[00:21:54] So if you want to take these drugs, make sure you already have a water habit and a fiber habit. And if you don't, you're going to want to get one quick. Okay. Let's talk about while we're talking about poop. So this little slide popped up and it just blew my mind and really, really had me feeling very protective of especially our young women.

[00:22:18] This slide was on influencers on social media actively promoting. It says budget Ozempic, which is not Ozempic at all, but just laxatives and stool softeners. It says in September, there was actually a shortage of laxatives due to the budget Ozempic trend in which TikTok promoted taking laxatives, particularly Miralax, daily to lose weight.

[00:22:48] I don't even know what to say about that. Honestly, it makes me pretty speechless. Taking laxatives on a regular basis to maintain your weight is more like bulimia than it is like healthy food relations. And if you're in that cycle, I just want you to know, A, you're not alone. B, you don't have to stay there.

[00:23:17] And C, that's an unhealthy cycle. Okay. When you speed your food through your gut so that you poop it out quickly so that you don't absorb any of the calories, you also don't absorb any of the nutrients, and you screw up your electrolytes.

[00:23:44] And your electrolytes, remember, are what helps your cells function. So when we talk about, let's see, this one says long-term use can lead to calcium, potassium, calcium, magnesium, and chloride levels, which can lead to, for those of you who aren't in the medical field, heart rhythm changes, weakness, confusions, and seizures. Yeah.

[00:24:14] You don't want to mess up your electrolytes because they'll, it hits your brain functioning and it hits your heart functioning. So if you have been tempted to just regularly use laxatives for weight loss, I'd say, please don't do that. Please don't do that. Um, that's a dicey game.

[00:24:40] And if, if you're a young woman listening to this, you probably aren't, but you might be in the car with your mom listening to it. That's not a healthy trend. Okay. Let's talk about the effectiveness of this weight loss. This is where I really wanted to get to with my friend. Um, so how effective are these drugs at having people lose weight? Oh, they're great.

[00:25:10] You will be losing some weight. Okay. Um, for me being a health coach, it's, is it going to stay off? And, um, what else do we need to do to make sure that they are effective? So this study is about, um, the GLP ones versus bariatric surgery.

[00:25:34] So bariatric surgeries would be your, uh, basically your gastric sleeve or your gastric band. Okay. It's what they typically call them. Um, there are other fancier names, a Rue and Y. And what they looked at is, um, post-surgery, post-surgery, about 50% of the patients who went under a bariatric surgery regained the weight.

[00:26:03] So you might think like, oh my gosh, well, I'm glad I'm not getting that surgery. I'll do a GLP. But actually, also about 50% of the people who did a GLP 12 months after stopping regained the weight. So here's the fantastic little chart that was presented to me this weekend. And this is lots of numbers. And so if you're anything like me, you might have a hard time, uh, getting these numbers in your brain through your ears.

[00:26:33] But I'm going to give them to you anyway. And again, DM me if you want the source. Uh, at 12 months after stopping semiglutide. Okay. So this is, you've done the medicine, you've had the weight loss, and now you've been off of it for 12 months. About 20% of people doubled their loss.

[00:26:58] So if they lost 30 pounds while they were on it, they, in the year following discontinuation, they lost 30 or more pounds. About 20% did that. Um, about, we'll call it 15-ish. It's 17%, but let's say 15 because the math is easy. Uh, had an additional loss 12 months after stopping.

[00:27:24] So let's say they lost that 30 pounds, uh, while they were on the med, they stopped it. And 12 months later, they were down like another 20. They were down anywhere from, oh, it's a quarter. Uh, they were down anywhere from like eight pounds to like 29. Okay. 20% maintain the loss. So if you lost 30, you kept 30 off. So when you look at those numbers, that's really like 20, 20, 40.

[00:27:51] That's about 65-ish, 66-ish percent of the people who took a GLP-1. That's not true. It was a semi-glutide, um, lost or maintained their loss. 61%. That's not true. 66%. Ooh, I got a lot of not trues in this podcast.

[00:28:18] So that leaves us room for the other 44%. So 44% basically either, uh, gained some or gained all plus. And that's broken up into two categories too. 26% gained, um, 25% to 99% and, uh, 18% gained a hundred percent plus of the weight that they lost.

[00:28:45] So you're giving yourself a heads up on like 66% of us are going to keep the weight loss or lose more. And 44% of us are going to put some or all or more than all back on. And that's where, um, I really get passionate about it.

[00:29:10] There's a lot of benefits to losing weight from your blood glucose to your reflux disease, to your obstructive sleep apnea, infertility in females, remission of type two diabetes. There's a lot of benefit to losing weight. And, and these benefits aren't even like you have to do it in a certain way. No, this is just anytime you lose weight, your health gets better.

[00:29:37] If, if you have weight to lose, your health gets better, right? But why do we get big in the first place? These drugs will help you if, and you'll keep the weight off. If you address the why while you're on drug and adjust some of your habits.

[00:30:06] So this was a super interesting slide. And if you're looking at the YouTube, you can see that it's got four circles that are overlapping. If you're listening to me through your ears, you're going to have to trust me. It's four circles overlapping. And it says, um, this is from the Mayo Clinic. In 2024. They looked at, um, basically genetic profiles.

[00:30:31] They looked at people with obesity and they categorized them into four genetic profiles as to why they were struggling with obesity. Um, and the profiles had some overlap, but here, here's what they are. A hungry brain, which is abnormal satiation, which means your brain doesn't know you're full. Okay.

[00:30:57] So your brain is telling your body to eat and you eat and you eat more than you should. And you gain weight because your brain is telling you to. Emotional hunger. This is hedonic eating. This is, um, I am upset. I am celebrating. I am comforting myself. This is Amy Chang all over up one side and down the other. This is why I had to give out sugar, right? Because it's emotional eating.

[00:31:25] A hungry gut. Um, which is an abnormal, um, feeling of fullness and a rapid stomach emptying. So the food goes down through your gullet into your tummy and it just goes straight up into the, um, small intestine and it doesn't stop long enough. So you don't feel full.

[00:31:51] So your tummy, your guts are saying to you eat more food when actually you don't need more food. And the last category was a slow burn, which is a decrease, decrease metabolic rate, which is just like, you know, your body just doesn't burn fast. So I'm going to give those four to you again. Something in your brain is telling you you're hungry when you don't need calories. Your emotions are saying, please eat.

[00:32:20] I need to be comforted. Your tummy is saying, I'm not full yet. Keep eating. Or you're eating appropriate amounts, but your body can't burn through it. So this study found that there are, uh, genetic profiles that predispose you to these, uh, whys for your obesity.

[00:32:46] The drug will help you take off the weight, but you need to address these reasons because that's how you're going to sustain your weight loss. So if you're an emotional eater and you take those drugs and you think it's just awesome salts and you lose a hundred pounds and you're walking around and feeling great and you stop

[00:33:14] that drug, then the next time you get sad and you eat that whole row of Oreos, you are well on your way to packing that stuff back on. My advice would be really look at why you eat what you eat. And why your body is struggling with maintaining a healthy weight and address that while you were on your GLPs.

[00:33:41] If you don't do that, there's a 44% chance that you're going to pack it all on and more. I've seen this with, uh, bariatric patients too. And I've seen it with just general people who want to lose weight and they lose the weight. And for about two weeks, it's great. And then it starts packing back on. It's simply because we either didn't address the issues that had us gain the weight in the first place.

[00:34:12] Or because we think that when we accomplish that weight loss, all of a sudden we're going to feel something that, uh, actually we're not going to feel. I have a friend who recently lost like 25 pounds and her clothes don't fit. And she feels like she's walking around like in ill-fitting baggy, sloppy looking clothes. And she's like, I don't feel good about the way I look.

[00:34:42] And yet all she's talked about for, I don't know, a couple of years is, well, if I could lose the weight, if I could lose weight, well, now she's lost the weight. But she doesn't feel the way she was associating losing the weight with. So there's some looking there and getting straight with yourself on what having a smaller body means and what it does not mean. Okay.

[00:35:10] If you don't feel confident in your larger body and you don't address that, then when you have your smaller body, you're likely to find something wrong with it and not be confident in it either. It might be the sagging skin. It might be, um, a change in the, in body shape curves where they used to be or weren't. And now they are.

[00:35:37] I think the GLPs, uh, are a good tool, but they are not a miracle fix. They're a good tool to use with other tools. I don't know what you've gotten out of this podcast, but I hope you've gotten something. And I hope you've got questions. So please send them to me.

[00:36:01] Always work with your care providers on, um, on your body, on your decisions, on what you want to put in your body, what tools you want to use for your body. And a health coach is a great tool to use while you're transitioning and losing this weight. Give yourself some grace because you're going to need it all the time, every day. And thanks for joining in. I'll see you next time on Healthy AF.

[00:36:32] Thank you so much for listening to this episode of the Healthy AF podcast. I hope that it has helped you create a new possibility for your health and sets you into action to go get it. If you want more information or if you want to connect with me, visit my website at myhealthylife.coach. And don't forget to hit the subscribe button so that each new Healthy AF episode will be sent directly to you.

[00:36:58] Let's take you from where you are to where you want to go. You've been listening to The Mesh, an online media network of shows and programs ranging from business to arts, sports to entertainment, music to community. All programs are available on the website as well as through iTunes and YouTube.

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