Epic Showdown: Ozempic Debate Explodes

Julie Michaels. I swear it's like every few months I'm either talking about Bill Maher or Jillian Michaels. Today we've got a hot one. Jillian and everybody's like oh she's irrelevant now it's like well I don't know she's on TV making these claims so let's just bust the claim. Big to big big fight. She did ask us to be on her podcast so maybe we'll be able to talk to her directly and it'll be like Rocky 4. Hello there!

Now I can see them. Okay. Dr. Karl Nodoski is a board-certified endocrinologist and he specializes in obesity medicine. And Professor Nodoski is in fact the medical director for a telehealth company that sells GLP-1 drugs called C-quants.

They've been arguably my top critics, trolling me on the internet, and others like me, who have significant concerns regarding these GLP-1 drugs. I don't know how much data you've looked at from that. A lot. I'm probably booked, but I know a lot more than you.

So like always I wanted to take it head on maybe there's something we can learn today Maybe I am wrong in all the doctors who've advised me. Maybe they're all too magically wrong But there's so many things to hash out. I want to stay in order So we've set the stage Let's see how this goes keeping it real with Jillian Michaels

So first thing is welcome. And thank you for coming on and being willing to have this debate. Not a lot of people do that. So I appreciate it. And I want to say that right off the top. Yeah, thanks for inviting us. Yeah, we do these little.

You know, looking at your little video on our thing and doing a response video on podcasts and whatever, but it's nice to have a face-to-face conversation, although digitally face-to-face. Yeah. And, you know, there's a lot more nuance to this than black and white. So it'll be a good conversation. We hope you'll enjoy it. I'm open-minded. I'm open-minded. We said, let's start. I want to try to first find

the things that we can agree on, right? But you guys have taken umbrage with my insinuation that there's a money incentive. She finally responded to me on Facebook saying, well, I assume you guys profit from this.

Yeah, no, we don't, we don't make money. So anyway. Now, Spencer, you, you are the head medical director of sequence. When you go online sequence, comprehensive prescription weight loss program. This is your whole job. Is you sell these drugs? No, that's, yeah. So obviously it's a, you know, the thing is, the way I equate it is, is any other doctor, the same way they would get paid a salary to

just see patients. So I don't make money off the medicines, but from a service level, you would pay

to see me to get evaluated, to get these types of medicines. But it's not that these medicines are the ones that we only prescribe either, but... Yeah, they're virtual clinics a little bit. It's a hinting on concierge without being concierge. It's just like any other medic, you know, like a lot of the doctors that are going more towards direct care as opposed to like, I only do, you know, insurance and taking care of, you know, pretty sick populations, et cetera, in my job. Whereas there's just because

One thing I'll bet you we agree on is the dysfunction of our health care in the United States. Oh, 100%. I have 100%. And so some of that you guys had a problem with is that I implied there was a financial incentive and you were like, absolutely not. But that's when tomorrow, what would happen to sequence?

Yeah, so, so yeah, like I can, I'll make money as a doctor regardless of if these, if these drugs, if they came out that like, oh my gosh, there's a big safety signal with these drugs. This is what, this is what I always tell everybody. I'm like, people seek me out for my diet and exercise advice. Don't worry about my finances. I'll be fine. I could. So then why not just do that?

Well, I do. So I do like, I try to do both. Like if people need the medicine, that's what I give them. But I also always like, and you'll, we'll talk about it. Okay. Okay. And it does. It goes to one of my points that I would, you know, I'd love to bring up with you. Cause again, kind of the.

the concept that two things or many things can be true. All these things are not going to get it back. But there's so many things to hash out, I want to say in order here. Yeah, no. So just at this stage, real quick, I just, you guys know who Laura Sorenson is, correct?

Because he was the CEO of Nova Nordisk and he said, and I quote, obesity is primarily a social and cultural problem. It should be solved by means of a radical restructuring of society. There is no business for Nova Nordisk in that area. Then he was forced to step down.

This was in a book called Novo Nordisk by Kurt Jacobson, which has subsequently been removed for purchase anywhere in America. So that's, I mean, that doesn't strike you as odd, not even a little. It's not not odd. So here's my quick take on that again.

that I don't know why he would say there's no business for. And then you can find out on acquired which is a podcast. And I don't deny that. I mean, maybe that's the case. However, if we look at obesity as a disease, yes, it is a hugely environmental issue, right? Our obese, a genetic environment. You ever hear the term genetics loads the gun? Yes.

But I had that conversation with Dr. I gets in a particular lifestyle, pulls the trigger. I completely, I, then this is, I agree. It's all true. And obesity is a, it is a disease just by definition. It's a very complex neuro hormonal disease process with a lot of variable, what we call heritability. So there's a lot of different genes involved.

And if we could have perfect lifestyle for everybody with a perfect environment, it is the environment that's changed, right? Yeah. I was going to say, was this disease back in 1950? Exactly. Only the severely genetic people had it. It was there. It was there. It was just much more rare. And there are some very rare, severe genetic causes of obesity. So you ever hear about the kids that are

severely obese with a rare outliers absolutely in the Pima Indians and I fully understand that. But you can see American medical associations own group of experts actually advised against considering obesity a disease and they called it an adaptation in 2013.

I'm sorry. It was the American Medical Association. Yeah. Yeah, we know. It was like, no, it's not a disease. It's an adaptation, but then they did it anyway. Yeah, under the pretense of being able to trust for it, which I'm not opposed to, but the narrative that it's a disease is bothersome. It's still it's still hotly debated. I see it's a man. So, okay, so there's a I don't think so.

I want to talk about the, the, the false dichotomy. You probably don't check out my memes, but sure. But no, it's a false dichotomy to, to say like,

environment versus drugs. And this is what I always say. It's like, we absolutely should be and, you know, I can't speak for whoever know who an artist can anybody else. But we absolutely should be working on the environment. There's the analogy of like, if you have a dirty fish tank, would you just give them antibiotics or medicine? Or would you clean them? That's how he means. Yeah, pat him on the show too.

We should give the medicine to the diseased fish, but also clean the fish bowl. It's a false dichotomy to not work on both. And so that's our stance. We are huge proponents of lifestyle medicine and fixing environment. I don't know what it's going to take to fix the environment. Legislation, there's going to be a lot of flashback.

We agree that there's issues with big food and a lot of money flowing around here. But as clinicians, we still have to help the patient in front of us. I understand. Completely understand. I think I totally understand that. And I agree that that help is needed.

just to go back to the disease. Again, this is kind of definition stuff. So the criteria for a disease is I'm going to go down this impairment of normal functioning. Okay. So that's why it causes that. Yes, but it isn't because of that. Now, I, I, I spoke to a geneticist about this in particular. And the argument is that yes, obviously there's a predisposition. I have four markers for obesity.

You guys don't. You guys claim to have had, if I can quote directly, abs in utero. I don't. That's really fine. I don't. So I have a genetic. I have. Well, why if I have this, this genetic predisposition, then why am I not obese without the drug? It does. And it doesn't actually do a good job of predicting. Okay. We'll develop it. So and lifestyle.

Uh, but I listen down, regulates, I get it, but then that would be my argument, right? That we should live a better lifestyle. Again, these are not mutually expensive concepts. So they hear the ability, the genetic predisposition. It's like 40 to 70%, but it's so variable. And it doesn't have to be that you're going to develop. And, and you know, there's a chance that if I lived, uh, you know, a hundred thousand years ago, maybe I would have died because I didn't have that, uh, evolutionary sense of holding onto my adipose tissue during times of famine or something.

I think he's got some Neanderthal genes in him. Yeah, as well. You'll notice. Okay. All right. Well, anyways, characteristics, signs, or symptoms, and harm overbitty. Those are the characters of disease. And it really does. The impairment of normal functioning, it is because of the neuroendocrine control and the dysfunction that happens because of genes.

and environmental triggers. So obesity itself is a disease with a variable outcome. And what harm does it mean? I've heard opposites to the contrary that it results in disease, but in fact, there are people. And if you look up what the experts say from the AMA,

They say that another reason why it shouldn't be labeled as a disease, because people who are larger and have more body fat are not necessarily sick at all. That was another reason that they said it wasn't a disease. But we can move, I'll leave this one up to people to decide for themselves because we could be here for a while on that one.

Well, hold on, but you are right that the consequences of obesity, so it's variable, right? So prediabetes, type two diabetes, atherosclerotic disease, fatty liver, the risk of fibrosis, sleep apnea. And also mental health, so mental metabolic and physical health are all downstream consequences of obesity. Whether or not we call it a disease, it doesn't matter. Let other people decide upon it. It's still driving the

Agree with you, I'm there 100%. I'm with you 100%. Can we agree that a calorie deficit, I'm not saying health, I'm not even going to talk about that a calorie deficit will facilitate weight loss. Can we agree on that one? Okay, good. We're there on that one. All right. Can we agree that there are no negative side effects for reasonably restricting calories, not a very low calorie diet and exercise?

Okay, good. So we're there on that one. Okay, because my personal, and I, and what we're going to get to, I know what we disagree on is you think people cannot engage in that, or many people cannot engage in that without medicines. And I disagree with you there. We'll get into that. Everyone can't do it. No matter what. But then you bring me right back to then why? Then why the drugs?

So that's the, that's of the, that's the did rising. I mean, I, I, I don't think the disease is a big fan disease. A group of people that, that is very severe because you were intimately involved in it. It's been a long time. I know, but the biggest loser. And I don't know how much data you've looked at from that.

A lot, but I know a lot more than you, and I can tell you. Very, very extensive stuff you guys were doing, dramatic weight reduction. I don't know if any of those people had any severe consequences, because they were relatively young, I think. Ish? I can tell you that all of the people I worked with, and we can definitely get into Biggest Loser, even though we're meant to be talking about Ozambic, but the people that I worked with, I worked with maybe 100 people over the course, me personally, over the course of that show. 35% of them have kept the weight off.

In real life, you guys know that 95% of the people that lose a large amount of weight put it back on with a 5% success rate. And we can do a whole other segment on biggies. Okay, so that's the basic stuff. And then some of the data talking about. So we can get to that one. We can do biggies, loser. But we're on the ozemic drugs right now. All right. So blah, blah, blah. Can we agree?

on the fact that these drugs are successful in taking osenberg I think 15% body weight and tricepatide please correct me if I'm wrong up to 23% body weight well there's some nuance that because okay hit me osenberg is was approved back in 2000 oh go at me am I getting it diabetes so right same drug some agitide

But people with obesity complicated by type 2 diabetes, which is very much an obesity-driven disease process, they don't lose as much weight no matter what the treatment, whether it's purely diet exercise, lifestyle, other medications, or these new really good medications. So relatively, so it does kind of matter. So in the in the diabetes trials, obesity with type 2 diabetes, they don't lose as much weight. They don't lose as much as quickly or in total. No, in the long run, overall.

I've never experienced that and I've worked with.

No, that's just many, many, many people. Are you basing this on what? The carbohydrate model, carbohydrate is the model of obesity? No, no, no. Like, so for example, someone, so in a trial that compared the placebo and lifestyle intervention with one milligram ozempic. Okay. Yeah, somagletide versus two milligram somagletide or we go V. Oh, okay. You were talking about what you're looking at. Okay, so then explain this to me.

over the course of this trial. How long was it? How much weight did the diabetic person lose versus the diabetic person on ozempic? So these are all people with type 2 diabetes for this trial, specifically. So the placebo group, lifestyle intervention, lost a little over 2%. The one milligram ozempic got 4.5% more weight reduction than the lifestyle group. And then the 2.4 milligram, we go V group,

got another 3% more than... But what was the total weight loss for the Wigovee group? About 10%. 10%. Okay, so 10%. Team, it's sweater weather. So I am here today to talk to you about Quince, known for their Mongolian cashmere sweaters from $50 and up. And it's not just that. All Quince items are priced 50 to 80% less than similar brands.

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So if I am, if I am, if some people do better, whatever. I mean, 10%, if I have somebody I'm helping right now, friend, he's five foot six, maybe five foot seven, don't hate me if you're listening Chuck. 250, no, no, sorry, we started at 230, my bad. And we want to get down to 170, we need to lose way over 10%.

Now, he's already lost, I think, 20 pounds walking 10,000 steps a day and eating 1,600 calories with unlimited greens. And I wish I could call him in here. I think we've been doing this two and a half, three months. It's where to hit your number. And that's walking 10,000 steps and eating less. Plus, I mean, I've had, but my point is simply he knew all of this without it.

And that's the thing. That's what the studies show you. Not everyone can. Not everyone can. All right, not everyone can. All right, I'm willing to go with it. Not everyone can. I'm willing to entertain not everyone can. Everyone I've ever worked with has been able to, you know, where they can't keep it off, generally comes down to psychological issues.

They utilize the food as a coping mechanism, a defense structure. It means something to them so significant that they're unwilling to give it up. And I've interviewed a lot of biology though. So yeah, what we would argue is that it's a biological appetite driving them to eat.

more. And we have the data to support that. And same with the weight reduction issue. So we have all these intensive lifestyle programs from really, really, really intensive with your biggest loser efforts to all the different diabetes prevention programs for those who have obesity and prediabetes, not type two diabetes, and the look ahead trial with type two diabetes, where again, the weight reduction was a little bit less. They're doing intensive coaching, intensive

low fat, low carb, meal replacements, all the things that we know can do. And there are data from Roy Taylor in the UK where he does protein shakes and vegetables. And they do. Some people lose enough to put their diabetes in a remission, but it just doesn't sustain and they regain the weight. But it's still even in these, these med trials that we're talking about, they, they have intensive therapy trials where the intensive group gets an average of

you know, six, seven or more percent weight reduction, again, average, right? So some people respond very well, 10, 15, 20 percent weight reduction, but then the medications still end up adding more. Other than actually these new ones we're talking about, it ends up not being a lot different, mostly probably because they, these medications support the dietary efforts. The body's biology drives people

How does it do that by blunting appetite, correct? It just facilitates people's ability to eat less. So it doesn't really do anything else. Well, it does, it helps to eat less. So there's no other magic mechanism, guys, correct? Well, not other than for diabetes and heart. I'm not talking about diabetes yet. I'm not, I'm not even getting into, I would make a case that the one of the best ways to resensitize the body to insulin would be exercise.

Oh, yeah. You know, OK, but we'll table that one. All right, so you could give me an absolutely on that. So that's that's good. But I mean, OK, I mean, we couldn't just eat a little bit less without it because that's the magic. You're saying, oh, no. All right. OK, with diabetes, OK.

We were the same. When we first started going through, we thought we were going to fix everybody with nutrition exercise. We're the docs who lift. That's our podcast name. That's when you talk about what are we? We're we're sure that you love lifestyle medicine, which why I cannot understand how come you and I are having this fight because I think

I think the problem is these are not mutually exclusive. We even wrote an article for MedPage today several years ago because so many people out there say, oh, doctors just, you know, give medicine and the, you know, mainstream medicine. They just want to give medicine. All mainstream evidence-based clinical practice guidelines from the leading experts that are very science-based. Paid by Nuvo, of course.

lifestyle. Every study you guys reference paid by novo and I've got many others but it's but it's not funded by no one the number one recommendations always like so but it's always even though the medicines help people get into a calorie did they literally just help people get into that calorie deficit yeah so we're not arguing energy balance we're not arguing the carbohydrate and not even most your people's ability to get into a calorie deficit without the medication that

That's the biology that's fighting against too many people in this obesogenic environment we live in. I do appreciate that. I'm sorry. I know you're right. Go ahead. Please continue. Yeah. So if we could snap, you know, like Thanos or whatever and change the environment to where people had no choice but to eat.

the vegetables and highly high feeling nutrient dense foods, that would shift the environment back and the population level back to a lower level of obesity. The problem is we got to do that. How do we do that? We all educate. You educate. We educate. We do the best we can with that.

It's to know the reality. The way these drugs work, they hit these receptors in the brain that basically come. There's some of the psychological stuff you talk about. People can't stop thinking about food. And there's probably a physiological driver behind it. It's not very well known. Also addictive, guys. I mean, we know for a fact, they engineer this stuff to be addicted. We know this. We also want to help. We're not arguing against it. So the medicines basically turn out the signal to want to eat those foods. Obviously,

Just like, just like the analogy, we should clean the fishbowl. Okay. Okay. Let's do limitations first. Before we talk about, I want to talk limitations with these things now. Let's presume everybody needs them. And, um, okay. So, and there's no side effects. Put a side to side.

To set the background, though, the reason we're even doing this is because I was like, Jillian went on Bill Maher and they talked about all the bad things. But there are side effects. Right. All medicines have side effects. And not everyone should just get beyond the medicine. So that's the background. Focus on the benefit risk, benefit ratio and all those. Just like so.

Look, I want to do that. That's exactly my point. So, like, if you came to, or somebody came to me, I've even recommended this for friends. Chantics, which I'm sure is, like, the devil. I've never looked into it personally, but I can only imagine the list of side effects must be hell on Earth. However, if somebody, I have had people come to me and be like, I cannot quit. I've tried for years. I tried the vapor. I tried the patch. I tried blah, blah, blah. I hypnotherapy.

Okay. It's a finite period of time. It has a 35% success rate, and you get off of it. So, with these drugs, you never can come off of them. What is it? Like an infinite tassel bone amount of people that don't gain the weight back?

Some patients know it's about 10 to 15. Maybe 20% can come off of it. I mean, you'd have to send me that trial. I didn't see that. Yeah. Well, two thirds gain it back in the first year and then some yo-yo on crack quote unquote, because of muscle loss. What is it? Dysfunctional vagus nerve. I mean, I could go on and on with all the things I've heard from different doctors about this. But the bottom line is the majority gain it back if they get off, correct?

Let's take it off. Yeah, that's right. Change it off. It's a marriage, not a fling. That goes back to the biology that this is treating. Again, it's this is not, these are, this is not black and white. There is the biology that's driving the weight reading, just like if we do it with your intensive diet, and that's okay. Hypertension, same way. Type 2 diabetes. And those are all obesity-driven disease. So if you get off those, the common analogies for blood pressure. So yeah, if you try to do lifestyle, take your blood pressure lower,

Oh, shoot, it's not working. Let's go ahead and start an ACE inhibitor, some sort of medicine. Blood pressure normalizes the doctor after a month goes, all right, let's take you off your blood pressure medicine and also the blood pressure comes back up. Still trying to do life now, by the way. Again, the underlying issue is an appetite dysregulation. So it's not... If you remove the dysregulating components,

Yeah, so ideally we would. That's what we're saying. We're not. You're saying they can do it is what you're saying. Like you have to. Environment, it's, it's, it's going to be extremely difficult. Okay. Even if they, even if we're able to transplant their environment, it would still, they would probably still eat more of those foods. Yeah, they would. Some of them.

Yeah, but in the interim for complexities and more nuances is that people have published studies about like obesity's because of all the different potential environmental triggers that range from things that even I'm like almost skeptical about like viruses and I don't understand that we could talk about that on another show, but I have heard that. Yeah, right? You know, so but I guess the point is there are so many different factors that are part of these environmental triggers to the genetic foundation that everyone has different. Imagine a kid

gaining weight throughout childhood and having obesity younger versus more recently someone had a pregnancy and had kids and it disrupted their lifestyle or the pandemic disrupting somebody's lifestyle. I have a feeling their biology is different than someone who had it predisposed as a kid. So you know what I mean? Like their habits got disrupted later versus as a kid. There may have been more of a genetic factor with that appetite dysregulation and that's what we see.

I wean people off these medicines. We haven't have to. Yeah, we have to because it burns 100, whatever. Well, I like there are absolutely. And this is where I think it's a false dichotomy. We hear obesity doctors saying like, no, obesity is a disease. Everybody's got to take these medicines forever. That's not true. That's not true.

Julie Michaels is in the news again for recommending against extremely effective anti-obesity medicine. She says these drugs have serious side effects and the results are not lasting. This is the case of tell me you know nothing about these obesity medicines without saying you know nothing about these obesity medicines. There's a common myth about these obesity medicines that they're a quick fix, they're a crutch.

that they're abandoned, that you stop them and you regain the weight. It's absolutely true that if you stop them, you will gain the weight back. However, these medicines are meant to be taken chronically, just like any other therapy for a chronic disease.

So because we have this issue where, yeah, some people who truly should, we haven't even talked about who really should be getting these. I know. And I, I think we would agree on that too. Cause like the bad, but I, and I appreciate your position on it. I want to get, okay. Well, you know what? Tell me, I, cause I do agree with you here. Please tell me who you think. So when we, so I'm talking to people about, you know, who are on these medications, doing very, very well, okay, putting diabetes or their prediabetes, their fatty liver into remission, sleep apnea, and they feel, first of all, there's a mental health benefit. There are some mental health concerns that you brought up, but there are,

There's a huge benefit because they say, oh, my God, I don't think about food all the time. I feel great. I'm physical. Now I'm exercising, by the way, and that's all we can talk about later. But then now they're scared because there is a cost issue. The insurance companies are getting upset and we know they're going to end up getting off of it. So we talk about, okay, here are the data that show what habits can help people maintain.

exercise volume above and beyond what, what they were doing to get down to weight, maybe using meal replacement shakes, minimally processed whole food diets, all these things, but you got to find a way to keep the habits. We talk about the biology might make you start to drive for regain and it might make you hungry and have cravings. So maybe there are some cheaper options we can use, but we're, we're going to work on it. I don't want them to fall through the cracks show up a year later, regain 50 pounds and have their type two diabetes and, and all the complications of that.

So we are talking actively about how can we work on maintenance primarily through lifestyle. What does the future hold for business? Ask nine experts and you'll get 10 answers. Inflation's up or down.

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Now, who's the person that you recommend this for? So, for example, you guys, through social, it's like, are you, you don't know your tag manager or trainer? I then said, are you aware that I interviewed four doctors a month and have for

Five years. I mean, they're all different kinds of doctors from endocrinologists, nephrologists. I mean, I have cardiologists. Do they even lift? Peter at the lifts. I know you've bashed him too, but yes, he's quite the lifter. PhD is like Lane Norton. I mean, he's a world cloud. Lane Norton's my boy.

So, I mean, I talk to all these people. So, okay, hold on. The ones that I really respect will come down to the fact that they're like, well, for an extremely obese patient who's got advanced CKD or heart disease and fatty liver disease and type 2 diabetes and we've tried everything. We've tried everything. We've tried everything. We've tried everything. We need a desperate life or death intervention here

Then I'm like, well, okay, they were already presenting with all these diseases. The side effects, when even compared to what's already going on, maybe, you know, twist my arm. Like I personally have helped people like that, which is where, you know, it comes down to a rub, because that's actually what I do. And I can show I've done it and I have a 35% success rate where the people have worked on and within those categories. However, I'd be like, oh, okay.

I'll go on this one, but that's not what's happening. And you've now, that's not what would go these forwards for weight loss. And it's not. Yeah, no, you're, you're, you're right. And you and I are now, you might say that example sounded a bit more extreme than maybe what I would make it, but I'm kind of the same page. So absolutely the severity of disease should help guide the intensity of therapy from their surgery for those who have

significant obesity type two diabetes heart disease. Cause we know it's going to reduce those risks. When we talk about the amount of weight reduction that, you know, that 10, 15% you're like, God, that guy already got it. That's where we have those data. That's nothing. The data are though. I can't help with the data. Well, data outside of 10%, 50%.

7% to 10% weight reduction is the goal for diabetes prevention when you have prediabetes. You start getting over 10% weight reduction. You start getting rid of hypertension, dyslipidemia. But I say more. Why are you going to need more? I'm sorry. I interrupted you again. My bad. Chris is going to come in.

I don't think that's enough. Now, I understand the argument is we're seeing all this improvement. And admittedly, I was not crazy. I was not a crazy fan of the doctor on the biggest loser because he was ripping contestants off of their medications so quickly. In some cases, things like antidepressants and he was practicing different subspecialties of medicine.

that I didn't think he was qualified to practice. And he was pulling contestants off of Metformin and all kinds of stuff. And I was like, hold on a minute. I think this is crazy. And he was doing it within the first month. And the reason I thought it was crazy is because obviously I work with

I would have bust selling book with an endocrinologist by the name of Christine Darwin. I thought advice from her and other relevant doctors in those subspecialties would have been better than one guy making all these decisions. But point being he was taking these people off of it within the first month. They were losing 10% within the first month. And because they were actively eating better and actively moving more, there were improvements.

So I understand what you're saying, like, this is enough to see improvements. But if you've got a guy, like the gentleman that I'm working with casually right now, who's lost that, and we got a ways to go, now what? This is where you're getting a girl.

clinical, what are his clinical, what's his clinical status? Cause that's what I'm talking about. So if you have type two diabetes, over 15% weight reduction, I know, and this is where we have to tell people, we have to sort of modulate their goal, their expectations sometimes because it is hard. But when, you know, so someone weighs 300 pounds and they have, let's just say they have all the criteria for prediabetes and they have fatty liver and all these things. They don't have type two diabetes. Cause that does take you into another level of advanced. I understand. But maybe they even have had a heart attack.

That's where the studies show that over 15% weight reduction. And yes, we're going to work hard to keep that muscle, by the way. We'll talk about that later, but, but 15% weight reduction. That's where you put those things into remission, prevent it, even if.

They only get 45 pound weight loss. And I always tell people, hey, anything more than that, it's, it's the cherry on drag, but, but that's our, that's our clinical goal. Okay. Because that's what correlates to the clinical book. So I tell people it's literally what's on the inside that counts. Mental metabolic physical health and those weight loss. I don't care about their weight.

You know, the way that I don't care about what does that correlate to what's it like a surrogate for and we're going to hammer those things out with all the tools that we need to as necessary, but going back to who needs it, the more advanced disease, the more severe that the disease, the more aggressive we should be.

By the time they get to me as an endocrinologist and obesity specialist, they try. What I would argue though is there a lot of people that come to me, they don't have the severe disease. They've had they've had obesity for a while and they've tried these lifestyle things so many different times. So then it's kind of like, all right, we could try it again. And then what you just let them continue to have their obesity. I heard this. Okay, you've progressed. I okay, I admit that I cannot tell you how many people, including

The gentleman that I am casually working with who is like, I've tried everything. He's one of the producers here. So that's why I keep looking after this. Oh, okay. They're running from the storm and yelling me. With that said, I've tried everything. I've tried everything. I've tried everything. Okay. What have you tried?

I eat healthy. And guys, they're not tracking calories. They don't know what the fuck they're talking about. I was told not to drop it in the beginning of the show because of the YouTube. I hear them. I think you're good now. But I mean, you know, you are doctors. You might want to be careful. I have less to lose. I do lunges for a living here. But my point simply is that I do hear I've done it all and done it all. But yet when I sit down with them and I'm like,

Get all that. Don't worry about keto. Don't worry about carnivore. Don't worry about car. Just we got to cut the calories. Here are some strategies to manage it. Let's include volume, right? Go crazy with volume and water and protein and let's try to help manage the tidy and let's remove all this stuff. Blah, blah, blah. When I can explain the very simple science of calories and calories out, I'm generally pretty successful pretty quick.

And we don't disagree with that. Okay, so just to play devil's advocate, you've said you had 35% success rates. So then if you have 65% of people that don't respond the way that you're talking about, what do you do with them? Okay, I hear you. But my argument is, okay, I don't disagree with you. My argument is, though, on that show, you're dealing with individuals that have such severe trauma

I'm talking about a woman who lost her entire family in a car accident, a newborn, her two young children on top of the newborn and her husband. I'm talking about a woman whose mother was a heroin addict that would turn tricks for heroin while she was locked in a closet. I mean, I'm not going to be able to solve that on biggest loser.

But these are the kind of individuals I was dealing with on that show because these are the kind of people that get up to 300, 400, 500 pounds. Now, that said, in some of these cases, I have these people for a week.

sometimes too. So again, if you look at the people I was able to work with directly and how long I was actually able to work with them and the fact that I was missing arguably the appropriate team of doctors, okay, and a psychoanalyst who could help these people with the deeper stuff, I'm confident I could have had a much bigger number.

This is just me alone. So unfortunately, that's true. And I'll tell you, I've made some posts because it's heartbreaking in the real life. Like you just said, you're seeing those. It's prevalent out there. Not a week goes by because we do weight histories. When did the weight start? OK. And a lot of times, we're looking for that youth on set. It's a real strong genetic. And sure, shooting. I get kind of tingly thinking about it because not a week goes by where

oftentimes a female with significant trauma that like you just said sexual trauma abuse I mean it's horrible and and it's and you know it breaks my heart every time and and and luckily I'm lucky to have a pretty good team you know dietitians we have some you know counselors you know psychologists and stuff and yeah we got to do better as a society too I mean absolutely that and that sucks oh yeah beyond you Jillian so like okay let's say you're the

The greatest lifestyle counselor ever, and you have a high response, but even in these randomized control trials, the gold standard, you know, the average is somewhere around six, seven percent average body weight loss over the course of a year average. There's about 15 or so percent that will get the we go V type results, but the rest of them.

Well, it's less than 10% weight loss. And then over time, they start regaining the weight. So then like, what about those people that just like you just leave them? But I don't think we just leave them at all. But I don't think that this provides a permanent solution. So then so getting to this next one. And this is where I think we're, you know, there are limitations with these drugs. This is my point is that you will stop. You'll plateau on them. And then

Dr. Fatima Cody Stanford had an article in Medpage where it's like, okay, so wouldn't they plateau give them centromine and this one and that drug and this drug and that and the drug list is like this effing long. I'm like, so this is your answer? And a double agonist, a triple agonist, up button drugs, up button drugs, more pharmacology.

Yeah. Well, so here's, here would be my take on this. And again, I'm, you know, I can't expunge some of, so I know we went back and forth about conflicts and I'm, I'm going to die in the hill if I don't mind getting lunches, by the way, but, but I'm not going to be paid by pharma to do it, especially the ones I'm an expert in. And I do write them, constantly. It's under, what is it? Oh, I'm open payments. I can't even pull up 2023 yet.

It's okay. That's nothing. It's my point. I write some guidances. I can't get into more of that. But I have some thoughts on what you just brought up. So it goes back to that clinical severity and how aggressive do we need to be and for what reason. So if somebody has type 2 diabetes,

Let's say they have a little bit of advanced fatty liver and they have high risk of fibrosis I know that's not what you get into but distrust me on that I guess and they really need and they let's say they lose

14% of their weight on, or we go over your zap bound or whatever, because those, those would be appropriate medications for that person, prediabetes, fatty, liberal, all these things, right? And, and we get close to our clinical goals, but we need a little bit more weight reduction. Sure. Maybe something else, but I'll tell you what, there are other medications that have other benefits. Also other side effects, all medications have benefits and side effects that we have to consider. The diet next to us don't.

Have they not? Everyone should just be on it. The three of us, they might need surgery. Not yet, but yeah, they might need surgery, but there are other things. The surgery has less side effects. I mean, but we can get into that one little bit. Anyway, go on, go on. You're not bad. Yeah. We don't know how to answer that. Basically, what are you saying? The more severe the disease, you might need to do all the things. The more aggressive you're going to have to be to get you. Here's where Spencer and I debate on even our own podcast about because my issue and one of the reasons the insurance companies are going to quit

covered because, first of all, the cost, that's a whole different issue that we can all like probably go crazy about. But, but I don't think people who have low severity of disease should get these expensive, more aggressive medications that should be reserved for people with severe disease who are going to get the most benefit. There was a cost effective analysis recently that compared, essentially, we go V versus an endoscopic procedure for kind of like making a sleeve, but it's not a sleeve, not surgical thing.

And, um, and it was a cost effectiveness, but it was for like a middle age guy with obesity, but no complications, like he didn't have prediabetes, diabetes or anything like that, right? It was a kind of a mathematical thing. And the, the procedure was like three times. Do you mean a mathematical thing? I'm so sorry.

Well, this gets into cost-effective analysis. Oh, you're saying you're talking about money? Like, he utilized that as a solution because it's a one-shot deal, arguably, and not an ongoing, multiple, thousands of dollars a year. It'll be awesome these things is one.

extraordinary problem. Yes. And it's in the United States more than any other place. So that's a different debate. We could all probably get on the same soapbox of that, all problems with that stuff. Well, let's talk about that because that's a problem because now we've started and we have to get off. So I believe Spencer, you said it's in single digits, the amount of people that don't stick to this from initial side effects of nausea, vomiting, diarrhea, constipation, which is upwards of 50%.

But the flow trial itself said it was 17% that had to get off because they couldn't tolerate side effects. That's almost, that's a fifth that can even tolerate it. And when you look at, then there's another one that just a report that came out in Reuters, which is an analysis by prime therapeutics and they're owned by Blue Cross, Blue Shield. They manage the pharmacy benefits of 38 million people.

And they said that in the first year, only 32% of the people taking GLP ones, including Mozambic, were still taking the medication a year later, citing side effects, plateau, and third cost. So that's what I'm saying, 66%. That's not single digits.

That analysis is flawed for multiple. That's why you have to look at randomized control trials. 38 million people. So that the way they do the analysis, they could be going out and getting compounded version. They could be going on paying cash for these things. What does it have to do with it though? If it's compounded, it's cheaper.

I know, so it won't be in that report though. That's what I'm saying. So it will look like they stopped it. 17% is still three different ones. I'd have to look at the flow trial. That's the one that just came up. 17% left the trial because they couldn't tolerate side effects.

I'm looking at it right now. It was 7% in the semagletide group versus 3% discontinued. It's literally, I was telling, I'll make sure to pull it up. 17% flow illustrated, 17% left the trial because they couldn't tolerate the side effects.

And remember, that one was for just simply looking at chronic kidney disease. We're looking at the actual obesity trial. Well, you're suggesting that the side effects aren't bad and that single digits, correct. And I'm not saying that they're not saying that people do get severe nausea and stuff. I will say that it's almost my observations. Tell me you will take my week over your zap found from my cold dead hand. Do not ever try to stop this from. No, some people do want to get off of it. Something they try to lean off of. But like most people

when they, like, even despite a little mild nausea. However, a small percentage of... What about if she vomited so much her teeth cracked? One woman says it was so bad at center to the emergency room several times. She says she vomited so much that she lost teeth.

That was in a podcast that was through the Wall Street Journal. This also highlights why you have to be very careful in titration. Some people keep cranking, some doctors keep cranking up the dose. You want to have good dietitians who will help with the lifestyle modifications to help minimize side effects as well. Because if people eat heavy meals, like a pizza,

And the medicine should help them eat fewer, but they try to stress test these medicines. They eat a pizza. They feel pure diet is so important on these. So version quality, if you keep the sometimes we actually go down in a dose because they don't tolerate it. And so sometimes in these trials, they just have protocols where they just keep cranking it up.

And then in the real world, these people that don't know how to use these medicines, the doctors crank it up because they don't know any better and the patients come back. And then that's where they end up in the hospital. They need to get an IV. They need the anti-emetics and that type of thing. We try to keep them out of the hospital. And but we're not going to deny that our nausea is by far the most common thing we see. Yeah, absolutely. And we try to counsel our patients. And part of the mechanism that the, you know, not nausea is a side, not everyone gets nausea. I know. But but the.

50% of these people are experiencing something to that right. Which we'll get to. Which we'll get to. You bring up delayed gastric emptying. And I must admit, when I was on real time, I did in fact make a mistake about pancreatitis.

She claimed 400% increase on the show, then on the Facebook page that when she responded to me, she said 900% increase. What do the actual data show? They said you were 400 times more likely. That was intestinal blockage. The answer is 900% more likely. And this is coming. So the guy that you love to rip on, Mark Hyman,

We're sure to send me the study from the University of British Columbia. And that was the study. So I can send you that study, University of British Columbia. So that's why you have to look at it. Guys, there are numerous studies, by the way. I got up. OK, study published in JAMA. Studies have found increased risk of gastrointestinal adverse events, biliary disease, pancreatitis bowel destruction, gastroparesis. It's not a randomized control trial.

You know how many there are? Randomized trials examining efficacy of GLK1 agonists for weight loss. We're not designed to capture these events due to small sample sizes and short follow-up. There are dozens of these guys of which you look... I've used it about... Hold on, here's your... This one's great. This is my favorite. Okay, so this one's from the Curious Journal of Medicine.

You guys realize this is all sent to me by endocrinologists, the ones that aren't qualified. But why are the expert endocrinologists, literally, with the ones who publish these data, kind of, you know, the trial that you're referring to is a no vote trial. Sustain six. Okay. So this is from the Curious Journal of Medical Science.

No competing interests, by the way, not funded by NOVA. The semaglutide and cardiovascular outcomes in patients with type 2 diabetes sustained six trial. Illustrated subcutaneous semaglutide was associated with acute pancreatitis at similar rates to placebo controls. However, other studies have shown conflicting results.

I have a list of them, by the way, in this lab show. It goes on and on and on. It's on the box. I mean, in fact, there have been numerous reports linking JLP1. But just there's a reason. And this is... I have to say, there's a new thing that's been studied for, like, 30 years now. There are numerous reports in Exenetide, Lyra Glutide. It goes all the way back.

And it's a huge trials. Do not show a statistically significant problem. That's why I'm telling you. I'm thinking of huge, huge trials. I can't wait until we get to the next trial. And I'll send you all of these. I mean, my God, a meta analysis of serious adverse events reported with the Xenetite lyric group glue tried a cute pancreatitis and cancer. Pancreatitis, there's literally

What are you doing? There are dozens of them. The most recent meta-analysis of some magnetized specifically. Yeah, they're just going to... Stance six? Is this a sustained six? And that's a single RCT. Yeah, but also select. The huge 17,000 person for each... There's a huge problem with select. I cannot wait to get into select. Should we jump ahead with select? That one's awesome. I mean... There's still a ton of food. Yeah.

I actually wanted to go thyroid next, but I have no problem going over all of the criticisms I received on the select trial, all from these non-existent doctors that I supposedly don't talk to who aren't credentialed, like Peter and Mark, but none of them are qualified.

Let's just say two years that I've been discussing this with doctors. None of them are qualified. None of them? I don't know. I don't know. I'm not looking at the data though. I don't have site priming because he's a... I have to say, I mean, there are gastroenterologists. They're...

The other Cleveland Clinic doctor. I'll hide it. Okay, okay, okay. So let's look at the thyroid. So hold on a second. This one's really interesting because I will absolutely say yes. It's where Spencer and you said on the Primal Kitchen podcast,

We don't have the same receptors as rodents. Right. These proliferative C cell, maybe rodent-specific GLP-1 receptors have been demonstrated on normal rodent C cells. Okay. But we do actually have much lower, much lower, but we do happen to have these GLP-1 receptors on our thyroid. That's just not true. So... They aren't there. They're not readily available or not readily there.

Well, there was a signal, then you said there's been no signal for thyroid issues. There was a signal. There was no RCT. There's been some mixed observational data that's really fun. People are looking too much here. Let me show you. Let me show it. Let me tell you, because as an endocrinologist, so we talk about thyroid. He's the one that checks thyroid cancer. Because the European Medicines Agency put up a signal and there's a whole, I have a whole study here and it's bad.

And then it, but it's not. Okay, the increase risk was higher. Okay. And then when they've redone all this stuff and they look at all the trials, this, this concern was brought up because of the rat trial, right? This has been a black box concern. And some people are concerned, all doctors are concerned about it too, for the past 20 years since that since biota, the exenitide was approved.

So we think about it, but never was there in any trial, a real signal of that medullary thyroid cancer is a big deal. So we do not give this to anybody with a history of a family history of MTC. It's not called the MEN2, these syndromes that people like I would see. The previous birthright of the seemingly rare.

What people are actually seeing when they start looking, it's similar to South Korea several years ago. This gets into thyroid stuff. So, papillary thyroid cancer is a pretty common thyroid cancer. Do you ever hear about people say, well, if you had to have cancer, you pick whatever cancer?

That's kind of like papillaries, thyroid cancer, generally speaking, not that severe. But what South Korea did was they decided, well, we're going to start screening people for it. And what happened was the minute they started screening people with ultrasounds and stuff, the incidents went way up. Suddenly, everyone had papillaries, thyroid cancers.

You know what happened to the risks of it though, the death from it stayed at like 0.0 or sorry, you know, 0.0, not 0.0, but you know, whatever it was. Okay. And so in these, you know, post-marketing vigilance trials or studies, they, you know, people are just looking for it sometimes inappropriately. So because people are paranoid about it because of the black box.

This one did not sound inappropriate. So, okay, this one, this research was done by a gentleman in France. So another thing that I have been taught by all the doctors that aren't educated is that to get a more accurate assessment of information to search the European database for information and Canada.

So this one was done by this guy in France named Jean-Luc Felé. I don't know if I can pronounce this name properly, but Professor of Medical Pharmacology at the University Hospital of Montpellier, also in charge of the National Pharmacovigilance Survey of these drugs, the French Medicine Agency. Jean-Luc Felé explained that for several years, it's been known that when GLP1 agonists are given to rats and mice, they have shown an increased risk of thyroid cancer.

It's also known that human beings have GLP1 receptors in their thyroid tissue. So it's conceivable that messaging with GLP1 might mess with your thyroid. He decided to look into it. Francis, one of the largest medical databases in the world. So they went back and they analyzed the data for all the patients with type 2 diabetes who had taken these drugs for one to three years.

In the period between 2006 and 2018, they then compared those patients to a sample of diabetics who'd not taken the drugs. The findings were startling. Quote, we show there was an increased risk about 50 to 75% more of you developing thyroid cancer. And the increased risk was higher one to three years of GOP use. And if it were made elevated for three years. Yeah, that was the one in the game. Yeah, that was the one in the game. I mean, but there's diabetes. I'm sorry, diabetes.

Diabetes, obesity, and metabolism, a meta-analysis of randomized clinical control trials to investigate whether there's an association, conclusion. Diabetes, metabolism, and syndrome 1, 1, 2, 3. It's a huge meta-analysis of 37 randomized trials.

said not one case. I'm not saying it is. Not more than placebo. Not more than placebo. Not more than so. You said on this podcast that we don't know the receptors. That's not true. Then you said there hasn't been one case. That's not true.

The thing that people worry about is thyroid cancer because there's a big black box warning that says thyroid cancer. It's seen in rats, rats have these different cells in their thyroid that actually have receptors for GLP1, whereas humans don't have these receptors.

So it's an interesting thing. The rats did have what's called hyperplasia, increasing in cells in those specific type of thyroid cells. And it's a very rare type of thyroid cancer called medullary thyroid cancer, very rare. So it's seen in rats and it hasn't been seen in humans. Most people ask about the black box warning.

which is medullary thyroid cancer. People are like, I'm going to get thyroid cancer taking this medicine. That's probably the most common thing we see people worried about. And they found it in rodents. Medullary thyroid cancer is a very rare type of thyroid cancer. It comes from these C cells, specific cells in the thyroid. Rats have GLP1 receptors on their C cells.

And they found what hypertrophy hyperplage, I believe, in rodents and then a higher incidence of major thyroid cancer in rodents. So it's like big black box warning. It's never been found in humans. Well, she also mentions thyroid cancer again.

thyroid. We have talked about this again at nauseam. It is the exceedingly rare medullary thyroid cancer that was only seen in rodents who have higher GLP1 receptors on their their sea cells and their thyroid. And it has not been shown in humans. We were treated 64 trials 26 of which reported at least one incident of thyroid cancer.

Never said there is not one case. You did? Yeah. I mean, I didn't say, I know I didn't say that. It's only in odds. Listen, listen, biggest meta-analysis just recently published. Guys, I'm not saying it isn't.

rare, a rare side effect. Obviously, it is rare, but you're like, no, not a thing. That my placebo is so important, randomized, no increases of neoplasm, pancreatic or thyroid cancer with some agitide. And now all these studies. Okay, so we've changed 64 trials, 26 of which reported at least one incident case of thyroid cancer.

G real treatment was associated with a significant risk. It is compared to placebo. Obviously, that's the point. Right. So in nature, we're not taking the drugs. Hold on a second. When you have to understand what a detection bias is, if there's a big black box warning on the medicines to look out for thyroid cancer, exactly what my brother is saying, you get screened more often. The more often you screen, the more often you're going to see things that were already there.

That's what we're saying. That's why you have to do randomized control trials. We're not saying it's but also it's still drugs. It's still this is where we agree. It is still. Don't just people. The people take it in Hollywood. The people taking compounded stuff that nobody knows what's in that. The people getting it prescribed when they shouldn't really be getting it when the benefits don't outweigh. Now these

If, let's just say there is a statistically significant risk. The one thing that is real is always not show statistically significant. It just shows it's a concern. There's something, right. Okay. So let's just say, but there is one thing that comes up in all these trials that actually is a hint statistically significant. And that's gallbladder disease from that can be gallstones from that could cause pancreatitis, but also by the way, I'm sorry. They're listing now. In fact,

I went to put a pancreatician, pancreatic, doctors, and I was like, explain to me, outside of this, what is the mechanism for pancreatitis? And hang on, because I'm going to pull away from my friggin email here. Hyperplasia was the answer. So the answer is the concern.

Jill, by stimulating GLP1 receptor cells in pancreatic islet beta cells, and endocrine duct cells, this can cause hyperplasia, which is an overgrowth of cells. It can cover small ducts, aka, or duct occlusion, slash duct occlusion, increased pancreatic weight, subsequent acute or chronic pancreatic inflammation.

That has nothing to do with a gallbladder though. That's why, that's why this is even a thing. That's why it's been monitored so much. It's just gallbladder sass. It's like, no, no, no. I'm saying, one is, one is, so listen. I'm saying that. I just, it's not statistically more significant in the medicine than placebo. So, but that's why. I mean, it is in numerous studies that I've listed for you already, including the one that was 900 percent.

But I was trying to tell you is the one real risk that is statistically significant is the gold bladder disease. So what I was going to say is that's a real it's it's like one and a half to less than 1%. That's a real. It's there. It's small, small for all matter.

Yeah, so gallbladder disease. So what I'm saying is we have to consider risk. We have to consider the side effects that are real. You're going to see 1% studies have shown that 10 to 25% of a very low calorie diet community develop gallstones. Well, when you're on, you're on another 2022 study found that ozemic and similar drugs are responsible for gallstone blockages, blah, blah, blah. And then I have it at 10 to 25%. That's not 1%.

Well, I'm just, I'm going based on big, huge, like a randomized. Yeah, I know. But no go trials. Right. But yet there are dozens not funded by no vote, but somehow managed to be in conflict. Randomized. Randomized. Yeah. I just thought they were random, but there was an analysis of what was it? 64 randomized trials. Well, I guess my regardless, my point is the goalbladder thing is statistically significant. I'm talking about randomized trials where we can see it compared to placebo.

because those things are very prevalent in anybody with obesity, diabetes, and stuff anyways. Also surgical patients, maybe I don't know if he had any in the biggest loser, rapid way, but it happens. We had one. I had one. All my contestants, a guy named Mark.

One, all drugs, all drugs, including supplements, by the way, you know, a lot of people, we even got into try to, you know, get into some evidence based supplements at one point. Supplements that do anything, drugs that do anything, they're all drugs. If they have a physiologic effect, which is why I established early on that diet and exercise don't have side effects.

But well, you can get all stuff. What is like? Very low calorie diet starvation. That's not a reasonable calorie restriction. I established that early on with you. I said we outside with early calorie. We are so.

obsessed with that stuff. People thought he was too obsessed with it because they were worried people were going to fall through the cracks and not yet. My first quarter evaluation as a doctor in residency, they thought I was a lifestyle zealot. And I said, you know what? Too extreme. You guys are underzealous about lifestyle. And I came back. And then my third year.

After I won the Legend Award, they said, you know what? You were right. We are always kind of like, we are. I'm a little point. Here's the thing. I feel that you have dramatically minimized the risk. And you've gone after me. You're like, ah, she's so full of shit. No, no, no. She's out. I mean, she doesn't know what she's talking about. Are you kidding me? All I need to do is talk to doctors, Lelish.

the way who truly need it and get benefit here on that and I see the severe like very sick people who really benefit. So okay because I do even need to get into all these other side effects because the stomach paralysis intestinal blockage and all that shit is scary as hell. Do you want to go down that road? The bezel our conversation is horrifying.

statistically similar minimal compared to the benefit. They're not. Another study found that 23 people who took these meds, four of them had moderately large gastric bezelwars. When they looked at people who weren't on GLP ones, none had a bezelwars, zero out of 77. And oh my God, this was done. I could pull this one up. Consider the statistics. So gastric six out of 23.

It's a clinically relevant gastric delay. And some of that is part of the mechanism of action. It is definitely, but you don't think there's side effects to that? Like anybody who understands that complex. We're not denying side effects. That's why you- It's so serious guys. That side effects.

They help drugs have potential risk. You have to balance the benefits. This is why you come here to benefit. And so it's like all that need the matter. All right. So then so that we don't have to go over or we do have any particular because you guys are like, ah, there's no thyroid. She's full of shit. And oh, there's no this. She's full of shit. I mean, OK, so so we're going to move on. We agree that there are side effects then. Sure. Yeah, there can be. Okay. So so then it seems like where we get out and here's where I will I have given the arm twist.

multiple times on the extreme case argument.

Where do you net out the, like, what does that mean for you? Because as you know, the majority of people, they want to put 50% of the population on this drug in the next 10 years, guys. They're advocating it now for six-year-olds. The, what is the American Academy of Pediatrics, which is essentially a subsidiary of Big Pharma. It's a front-line of defense for children starting at 12. Are you really there on this?

It's, it's, again, it's, it's risk benefits. Those with severe disease, we have a severe disease, a six year old has severe disease. That person probably needs to have genetic testing, though, very severe early onset, monogenic or syndromic obesity, which may respond to these because we don't want them to get diabetes. It doesn't mean they shouldn't be all over nutrition and exercise stuff. You know how you ever heard here, people like that, who the parents have to like lock the cupboards?

because their kids will not stop eating. Yes, but the parents shouldn't have it in the house. And I do understand. I've listened to your kids. I completely understand that these kids are getting addicted to the food. I was one of those kids. I understand that it's environmental. I understand there's a genetic predisposition. And I would argue that I am that person. I was overweight as a kid. I have four markers that I'm not happy about, including an ApoE4 gene, which I'm super pissed.

I mean, I have a family, I have a heart disease, like, I'm that girl. But my argument is, you claim you're not. You're genetically lucky. Even though I would argue, based on everything I've seen, you work hard. You work hard. Absolutely. You work hard. So do I. But that makes me really exclusive.

They're just not. I do. We know why. Our parents were educators. Maybe that there are people who can defy the laws of thermodynamics that they just. We're not going to argue. No, no, no. We are lifestyle shows. I try to play the part. I try to be a good role model for patients. I work out all the time. I try to eat the way I teach them just what we've been talking about, minimally processed. But I also enjoy some treats. I'm not to an extreme either.

I eat, I relatively try to eat a minimally processed more Mediterranean pattern diet in general high fiber. I have my treats, I work hard, and I've always done that consistently. And that is what we want everyone to do no matter what the problem is.

And we're on the same page. I guarantee it. It just doesn't necessarily mean that some people don't need medicine. And no, not 50% of the population should be on it. Absolutely not anywhere near it. We got to do better as a group, as a team. We're all on the same team. You and us, we're all on the same team. You attack like pretty much everyone that has any criticism of these drugs. But it's because we, but the problem is when people see that it's scare monitors. We don't want to do it. It's scary.

Well, it's all drugs, but they scare me. I should take drugs if I don't need to. Yeah, they need to talk to about it. Real as a specialist instead of, you know, getting stuff from YouTube and at the TikTok and all the things, even though we try to do that to combat the misinformation, there's just so much misinformation because people are scared. And there's also politics and other money involved. It's not just big pharma, but it's, you know, big food, you know, big supplement, trying to, you know, the big supplement people are mad about the drugs working well. I mean, I don't know the supplement that claims to deliver

weight loss right now at this time. I can't think of one at the moment, but I mean, I just saw a thing on TV the other night about being something they don't want to say this. I think the bottom line is that, like he said, it's a false dichotomy to say like only drugs and only lifestyle or only surgery. Yeah, even in medicine, people debate surgery versus drugs. And I'm like, Oh my God.

The real experts are like, hey, these are all on a continuum. It's all about patient care. We have to absolutely address the environment. Doctors who are doing all these policies and stuff, they talk about how can we improve policy? Well, unfortunately, our political system is so defined.

So we have huge problems with that. We don't disagree. It's a problem. Yeah, it is. I don't, you know, I have an answer for that. I wish I did. I really respect you guys coming on and I respect you being so open to this debate and tell people where they can get, I freaking do not want them to go see you Spencer, but tell them what they can do. Well, well, because I really don't want them going to see you. But tell them, they can get more.

I mean, you know, just Instagram is fine. Doug, you're a Spencer and Adelsian. I like to make funny memes. And I'm like- And Edgy, again, I'm Dr. Carl and Adelsian. We have our Docs Who Lift podcast, and we'll talk about these points, you know, with you and stuff. And, you know, we really appreciate you're inviting us to talk about this. And most people don't. They're like- And it was certainly the answer. I don't know. I always want to learn. And I really want, if you could do more investigating on this virus situation for me, I would love to learn.

I do know who would be the right. I want to let that we talk about the potential virus. Yeah, it's what's his name? Parkinson's. Yeah. We know who we've maybe we'll do a podcast with him someday. Yeah. All right. All right, guys. Thank you so much. Have a good one. Appreciate it.

First, let me just say that I really respect and appreciate the fact that these guys came on. How they got on, I don't respect and appreciate, use trolling people, especially when you're wrong, is probably not the classiest way of going about things.

Especially when you suggest you're gonna beat someone up like Rocky IV. I don't know how that went for them. I definitely think the opposite is I was Hulk Hogan in this case. Janice, was that Rocky III? No, I think it was five. Was it five? Okay.

I didn't even get to, by the way, we didn't even get to sarcopenia, like the extraordinary muscle loss that people experience on these drugs, which I'm going to be sure to list in the show notes. I might even do a separate segment so that they can bash, but Spencer himself after coming after me and guys like Dr. Peter Atia, who have talked about muscle loss on these drugs,

said himself in an interview with Half Line Magazine that he was surprised to see 38% muscle loss in the weight loss associated with these drugs. We didn't even touch upon intestinal blockage, stomach paralysis. And the reason is because honestly, the more we would go down the list, the more they somehow walked back, all of their criticisms that these things weren't concerned.

I mean, he very clearly said, oh, they're not wanting the human incident of thyroid cancer. Oh, no, no, concerns of pancreatitis. We didn't even get rid into all of the issues with the select trial, which I think, you know what? I'm going to do a separate segment on that. Yeah, stay tuned.