GLP 1, Mounjaro, Wegovy & Ozempic: How These Affect Weight Loss & Metabolic Health | Dr. Rob Lustig

this is a Band-Aid it's not fixing the metabolic dysfunction because it's not targeted to do so it's acting in a different place and it's basically creating a different problem than the one you had you had obesity now you got starvation how good for you is starvation not so good with a whole lot of side effects to go with it okay one third of the patients who go on these medicines come off them within a very short period of time because of the side effects not because of the cost I don't see this as being the answer to our metabolic Health crisis one hello and welcome to a whole new level this is Dr Casey means and I could not be more excited to be sitting here with the Incredible Dr Robert lustig if you are a part of the levels ecosystem you know this incredible human being as the author of so many incredible books hacking of the American mind metabolical fat chance he's written over 135 peer-reviewed papers he's a professor emeritus of pediatric neuroendocrinology at UCSF he's a levels advisor uh he contributes to so many press articles and writes opinion pieces and major Outlets uh he is absolutely one of the most incredible and smartest humans uh I know and is absolutely um one of the reasons that I'm here today and absolute inspiration for me and my journey through medicine and today we are going to talk about one of the hottest topics uh right now in the press and taking over the world which is glp-1 agonists including ozempic for weight loss and diet diabetes and get Dr lustig's take on the potential of these medications what they are what they do and whether they are really going to solve the metabolic Health crisis so welcome to a whole new level Dr lustig first of all Casey thank you for that very kind introduction none of it's true it's all a lie but having said that I do have some opinions on the subject Unfortunately they are opinions rather than facts because this is a field that is still in process you know we don't know most of what we think we know well I think that in and of itself is so interesting because so many Americans are taking these medications now and the fact that there isn't that really hard clear science is very telling in itself so let's Jump Right In for people who just are trying to kind of understand the landscape um you know you are an endocrinologist so you can really speak to this what is glp1 what is a glp-1 Agonist medication and how are these medications how have they been used traditionally and then how are they being used uh now wow what a complex question all right here we go um endocrinologists have known about a hormone called glucagon for decades glucagon is the hormone that we give to diabetics when their blood glucose goes too low when they're in hypoglycemia we give them a glucagon shot to raise their blood glucose because glucagon goes to the liver and basically gets the liver to release all the stored glucose in order to correct the hypoglycemia so we've known about glucagon forever what we learned back in the early 1980s is that there's this bigger protein called pre-pro glucagon and that the pancreas the alpha cells of the pancreas that make it have a different way of chopping it up into making different pieces for different purposes and so people started looking at well what are these pieces and it turned out that they found pieces that seemed to cause the beta cell to release more insulin not less and they called these glucagon like peptides because they look like glucagon but they're a little bit different and those then got to the pharmaceutical industry and they started making the first glp-1 agonists now the first successful glp-1 Agonist was actually obtained from The Gila monster from Gila monster spit okay and it's one of the reasons why the Gila monster is poisonous and that uh peptide was called xenotide also marketed under the trade name baeta and we started using baeta in Pediatric Endocrinology and adult Endocrinology for taking care of diabetes because it seemed to kick the beta cell to release more insulin and so that was a good thing for a while and baida you know had a reasonable success as an adjunct to diabetes therapy for several years and over the course of time as you'd expect the pharmaceutical industry started making better longer lasting more potent agonists that would do the same thing in terms of being able to treat diabetes and they came up with one called semiglutid or ozempic back in about 2017-2018 the data started rolling in that ozempic was a better adjunct for diabetes therapy than baeta was and what they saw was that there was a modicum of weight loss as well and so some brilliant guy at Novo Nordisk said well if this is causing weight loss maybe we can give a bigger dose and it will cause more weight loss and so that resulted in this you know branded uh version called wagovi so both ozempic and wilgovi are the same medicine they are both semiglutid they are both glp-1 agonists they look like glucagon but they're not and they bind to a specific receptor and that receptor exists in several places in the body one is in the pancreas to increase the amount of insulin which then controls blood glucose better that's why it's used for diabetes but the fun part if you will of this molecule is that there are receptors for glp1 in the brain in the brain stem not hypothalamus but lower in the brain stem mostly in the nucleus tract is solitarius and what it does is it glp-1 analog goes to those binds to those receptors and basically tells your brain you've eaten so this is actually part of the satiety signal and what we're doing is we're basically hijacking it and because we have these longer acting medicines than what the you know our own glp-1 did it can last longer so it basically reduces total food intake and this ultimately results in weight loss and so Nova Norris got approval for both ozempic and for wacovi Eli Lilly is working on their own medicine which is a glp-1 analog but also has secondary effects on a second receptor that's involved in satiety called Gip which is gastric inhibitory peptide so it has double duty and that one is called terpezatide also known as Manjaro and that's coming out you know very shortly and has you know been approved by the FDA for weight loss as well so these are now available and yeah they work and people are like whoa the first medicine that actually works and you know they're good data you know and lots of double-blind placebo-controlled trial data that show that you can lose 16 percent of body weight with you know these medicines and so obviously everybody and his brother wants it and you know unfortunately it's thirteen hundred dollars a month so only the people in Hollywood are getting it and in fact there's a shortage because everyone in Hollywood's on it maybe that's why you moved to LA Casey only kidding you look fantastic and I know it's not because of ozempic I promise the body is that is not why okay I love Casey she is not the most tempting addict well I have to say Rob the number of times it has come up I've lived in La for two months the number of times it has come up people saying it I mean is the ultimate like conversation starter in L.A people are like oh are you on ozempic are you trying I mean it is wild I can tell you in Bend Oregon no one was talking about osepe but in L.A it's literally everywhere doctors talking about it um it's it is sort of the it's a tidal wave which is one of the reasons why I wanted to talk to you about it so just to make sure I understand the science because medical school is a long time ago um so I understand that glucagon naturally in the body it it raises blood sugar but it also stimulates the beta cells to secrete insulin so I'm confused about how those two things kind of happen together like I would imagine that if it was stimulating more insulin secretion well three things I'm a little confused about if it's stimulating insulin secretion why wouldn't that lower blood sugar well it does lower blood sugar so it but what is the glucose raising effect that you were mentioning so the glucagon was Raising it but the glp-1 is not because it's actually stimulating insulin to keep the glucose low which is why it works in diabetes okay but it's acting as an Agonist that's right so I think at the glp-1 receptor not at the glucagon receptor those are two different receptors got it okay so its main point is to stimulate insulin secretion so then I guess the second question I have is how is that conducive physiologically to weight loss if it's yes because I would imagine we know like from your work and big men's work and others that excess insulin hyperinsulinemia is gonna you know potentially contribute to insulin resistance and storage of fat so how's that working totally so this is the dichotomy of this and and one of the reasons we don't understand this very well for just that reason you know when you ask the question why why why does this work you know the answer is we don't really know to this day we still don't know and that is exactly right because if you are actually increasing insulin release which these medicines do then you should be forcing more energy into fat but yet people are losing weight okay so how does how do you square that how do you rationalize that and the answer is we don't really know except except that people who take these medicines eat much less and so they are losing weight because they are eating less irrespective of the fact that they're increased insulin secretion should be driving more fat gain now the question is are these people losing weight because they're losing fat or are these people losing weight because they're losing muscle or are they losing something else entirely so the data on this is very clear you put these people in dexa Scanners so you can look at body composition changes and what you can see on people who are taking ozempica you know Manjaro is that they are losing equal amounts of muscle and fat now the question is is that a good thing and the answer is absolutely not that is by far and away not a good thing so when you lose both muscle and fat that's what starvation does so your body composition is changing in a way that is consistent and indicative of starvation now if you're a 65 year old or older and you lose muscle you're gonna die okay sarcopenia which is loss of muscle mass is one of the Hallmarks of Aging in one of the Hallmarks of early death and just read Peter attia's book you know outlive about how important it is to maintain muscle mass well this drug is not maintaining muscle mass you are losing equal amounts of muscle and fat now does that improve how you look in a bathing suit sure but does that improve how long you're going to live not a bit so this is a major issue for this now when you look at people who've taken ozempic number one you can actually like see it because their muscle just sort of dissolves from their face they kind of look like they had lipodystrophy like the people who were on protease Inhibitors you know for HIV yeah it's called ozempic face you know for that reason because they're losing muscle out of places that they shouldn't be losing muscle out of so this is a big issue in addition and one of the things that I'm most concerned about yes ozempic and magovi they basically tell your brain you've eaten and okay that's good but they tell your brain you've eaten and they make your GI tract think that you've basically stuffed yourself and so you have lots of side effects related to nausea vomiting rare cases but nonetheless you know well documented cases of pancreatitis there's a concern about thyroid cancer there's a concern about pancreatic cancer at least with the old versions of glp-1 analogs like baeta there was a definite relationship to pancreatic cancer that has not yet shown up with ozempic and wogovi but I don't think we've it's been out on the market well enough for us to be able to see that in post-marketing studies so that's a cons continued concern um I just read this morning about a set of cases of patients who now have gastroparesis they have paralyzed intestinal tracts paralyzed stomachs that can't move food through the intestine at all even though they've been off the medicine for six months to a year so you know these are things that happen in post-marketing you know once it's available to the entire country or even the entire world that you know weren't necessarily obvious in uh the original you know studies to get it approved because there was a you know much smaller population so I don't think the final story on ozempika mcgovia is written there are you know people who are absolutely excited about it because it's the first time that a drug has actually worked for weight loss I mean every other drug for weight loss has been pulled off the market for side effects well guess what this one has side effects too different kind of side effects than before but nonetheless side effects so this is not something for the squee Mission it is not something you know just to fit in a bathing suit you know does it make a difference for people who are morbidly obese can it improve their lives yeah sure but you're bypassing the problem you're not fixing the problem the problem is not that you have glp-1 deficiency no one has glp-1 deficiency that's been looked for there is not one case of glp-1 deficiency you are not treating a hormone deficiency with a hormone like if you have diabetes you're treating it with insulin okay that makes sense because you're actually fixing the problem here we're bypassing the problem we're basically telling your brain yeah you're fat so starve and an emaciated fat person is not a thin person you've heard me talk on other podcasts before you know that I believe that tracking your glucose and optimizing your metabolic health is really the ultimate life hack we know that cravings and mood instability and energy levels and weight are all tied to our blood sugar levels and of course all the downstream chronic diseases that are related to blood sugar are things that we can really greatly improve our chances of avoiding if we keep our blood sugar in a healthy and stable level throughout our lifetime so I've been using CGM now on and off for the past four years since we started levels and I have learned so much about my diet and my health I've learned the simple swaps that keep my blood sugar stable like flax crackers instead of wheat based crackers I've learned which fruits work best for my blood sugar like I do really well with pears and apples and oranges and berries but grapes seem to spike my blood sugar off the chart I'm also a notorious night owl and I've really learned with using levels how if I get to bed at a reasonable hour and get good quality sleep my blood sugar levels are so much better and that has been so motivating for me on my health Journey it's also been helpful for me in terms of keeping my weight at a stable level much more effortlessly than it has been in the past so you can sign up for levels at levels.link Health get access to a continuous glucose monitor and the level software that helps you really dial into a lot of these strategies for your life and your body the question that's just been you know Weighing on me and one that I've been trying to sort of pick apart research papers see if I can answer this question but I don't think I have a clear answer which is do glp-1 agonists actually improve metabolic Health in any way that we know and first of all maybe you can answer that question by defining on a biomarker level how you would Define metabolic health and we have an episode that we did on that uh in the past talking about some of the key bio markers and what what whether we know whether these medications actually are improving those critical biomarkers of metabolic health and like basically does this improve our mitochondrial function improve you know our oxidative stress improve the things in our cells that are actually going to make us fundamentally metabolically healthier is there a clear understanding of this so the answer to that is that's not this Drug's job is not to improve metabolic health yes if you lose weight you are losing fat and you're losing fat from places that are metabolically relevant like for instance your visceral adipose tissue your liver and so there are studies that show reductions in visceral adipose tissue and reductions in liver fat with Jose and and Manjaro and that's good okay but it's because of starvation so the loss of liver fat the loss of visceral fat the things that improve metabolic health are also coming along with the loss in muscle mass which of course is where most of your mitochondria are burning up your energy anyway okay and you are losing muscle in a way that is potentially unhealthy and you know even downright dangerous long term now does it improve mitochondrial function if it reduces the sugar content of your diet because you are eating less and so you're eating less sugar well then that would be a good thing and that would improve mitochondrial function but what if you were taking ozempic or mcgovi to lose weight okay but you were eating you you decided to go on a dessert diet and so you're applying yourself with extra sugar that sugar is still the same mitochondrial toxin whether you're on ozympic or agovi or not because it still has to get metabolized and it's still going to interfere with amp kinase and acad L and cpt-1 in your mitochondria and so you are still going to have mitochondrial dysfunction these drugs do not fix that what they fix is your overeating okay can you stop your overeating and still be metabolically unhealthy absolutely it's not going to fix that but if you eat less that's at least less burden on your liver and on your pancreas so yes there are improvements in metabolic parameters related to weight loss but not related to dietary Improvement that's what it comes down to the fact the matter is that these medicines are unbelievably expensive they are thirteen hundred dollars a month at the moment if everyone in America who qualified for ozempic or wagovi or Manjaro got it you know that would be a total of 2.1 trillion dollars a year to the Health Care system now the current health care System currently expends 4.1 trillion dollars a year so this would be an a greater than 50 percent increase in order to get a 16 weight loss and a mild Improvement in metabolic dysfunction you can get a 16 weight loss with a 70 percent Improvement in metabolic dysfunction if we just got sugar consumption in this country down to USDA guidelines and instead of spending 2.1 trillion we would save 1.9 trillion so to me this is a Band-Aid it's not solving the problem it's not fixing the metabolic dysfunction because it's not targeted to do so it's acting in a different place and it's basically creating a different problem than the one you had you had obesity now you got starvation now how good for you is starvation not so good with a whole lot of side effects to go with it you know the nausea and the vomiting there are a lot of people who go on one of these drugs and you know they're on it for a weekend they come right off it okay one third fully one-third of the patients who go on these medicines come off them within a very short period of time you know within a two months because of the side effects not because of the cost but because of the side effects now the cost doesn't help so I don't see this as being the answer to our metabolic Health crisis both from a physiologic level from a side effects level and also from an economic level I think this is a Band-Aid okay it's a good Band-Aid it's a better Band-Aid than what we had before but no this I this is not going to be the answer we're not there so what I'm hearing you say is that there's almost essentially a four trillion dollar Delta between if we go triple down on this uh spend 2.1 trillion dollars potentially on giving this to everyone who qualifies for it and of course that may not really reduce any health care costs so we're adding basically 2.1 trillion dollars to the system versus if we focused on food and getting the sugar out of the food getting people access to the real whole unprocessed food that feeds the gut supports the liver uh we could actually cut 1.9 trillion dollars from our 4.1 trillion dollar health care costs so we're really looking at just a like Monumental kind of um misinvestment in resources potentially that could go towards something else but of course feed the pharmaceutical Industries bottom line and it's been so interesting to see how you know Nova Nordisk and uh the the incredible amount of payments they've made you know Consulting fees and payments to doctors of the past few years really trying to I think really influence the the primary care and obesity medicine and okronology landscape and you know you can't help but wonder what's happening there like if and the real push towards classifying obesity as a chronic disease and um a real push towards federal funding and insurance coverage for these medications like it really feels like there's a big Force Happening Here to essentially use you know taxpayer money to go towards a pharmaceutical intervention rather than a food intervention and I think a lot of people say like well the food is too hard it's too hard to do but I step back and think like if we have if we're talking about trillions of dollars here you know is it really that hard like could we not figure this out with trillions of dollars how to give people you know whole food and you know get rid of the sugar and so I just it just feels like a a really interesting interplay of sure like Advanced science and technology which you know all for Innovation but also just real really a distraction from the core issues that we're facing that's how I view this I view this as a distraction unfortunately I wish it were not you know I wish there were a better answer um you know what I see is that there are people who are in extremists because of their obesity and they need help okay I'm a scientist but I'm also a doctor and I also have compassion and I recognize that there are people who actually need help and this should be available for them so I am not against these medicines help I used by eight I I mean I'm retired now so I haven't used the these uh newest glp-1 analogs but I used to use the other one um you know for the right patient okay and I'm not against this you know for the right patient but you know to ex you know sort of throw this out willy-nilly is you know sort of missing the point this is exactly what we did with bariatric surgery and what we found was that when we did bariatric surgery on a whole host of people and not in a clinical research study you know being done but rather just out in the in the community okay fully one-third patients gain the weight back and the reason was because their problem was not one that bariatric surgery could fix they had food addiction or they had stress eating and in fact the bariatric surgery didn't fix those things bariatric surgery will fix hunger it won't fix reward or stress so you have to screen patients for who's who who the best patient to use it in is we're not doing that we're basically treating them all like they're all the same basically like they all have a moral failing and that's the whole story and that's complete utter garbage and I'm I've spent my entire career debunking that notion unfortunately there are still doctors out there who you know think that obesity is a moral failing and so they're going to say well you know you haven't responded to anything else that's because you haven't actually you know dealt with the problem okay so here's this medicine and you know there you go and look the medicine does work and as soon as you stop it all the way comes right back so like how good is that and is that going to solve any problem all you're going to do is waste all this 2.1 trillion dollars a year okay and it only works as long as you're on it and as soon as you're off it all the way comes roaring back just like if you did a starvation diet and then stopped all the weight would come roaring back so this is you know something you have to be very circumspect about you have to know your patient you have to evaluate your patient for whether or not this is the right thing to do whether there's any other way to deal with this now I will tell you until we fix the food we're not going to fix this problem we have to fix the food to fix this problem and by the way when we do fix the food we'll also fix climate change too so you get two for one so fixing the food is where I've spent you know my entire retirement is trying to do that ozembic and mogoby is not fixing the food and yes it will help some people but it may actually make more people worse for the reasons I've mentioned one one question I have is about the type 2 diabetes population who are have been taking semi-glutide for for diabetes management do we does the research suggest that taking this um does uh like improve metabolic parameters as well as over the long term as well as improve survival and reduction of uh other comorbid diseases that may cause premature like mortality like cardio cardiovascular disease and stroke uh cancer and chronic liver disease like what does it seem to prevent some of those outcomes and extend life or is it mostly improving the like parameters like glucose levels uh like and I guess more more broadly does it improve insulin sensitivity in a type 2 diabetic patient or does it just reduce blood sugar levels these are really really good questions Casey and we don't have the answer to those okay that's like a really really important question so what you got here is a give and take you got to trade okay so yes you're losing fat but you're also losing muscle you're you know and and and probably micronutrients that you need because you're eating less so you know there's going to be some good things out of reducing your weight and they're going to be some bad things out of reducing your weight and ultimately those events and mortality we don't have the answers to those yet okay drugs haven't been around long enough to be able to look at that this is this is very similar to the question that we have with bariatric surgery okay those bariatric surgery improve lifespan and the answer is in some patients not in everybody in fact bariatric surgery increases the risk of alcoholism by a lot and the reason is because those people were sugar addicts before and now you've made it so that they can't get their fix because you put a you know something in there to keep you know you from being able to consume it okay and so instead of eating their uh their fix they're gonna drink it all right now I've heard about people going on ozempic and mcgovi I've seen you know at least uh anecdotal uh uh reports that it's increasing the risk of depression and it's increasing the risk of suicidal ideation because it's interfering with your ability to generate reward so if you're a sugar addict then you're supposed to be you know I mean the only thing that's keeping you you know from from the abyss is you know your next dose and you now are not consuming it you know maybe that's going to be a problem in terms of reward think about the the medication back in 2006 that was put up for uh approval at the FDA called ramanabant do you remember Ramana band Casey your monavant also known as accomplia okay was she was put marketed by sanofi in Europe and was approved by the European drug Commission um it was an endocannabinoid antagonist so it bound to the same uh receptors that marijuana binds to the endocannabinoid receptor because we have endocannabinoids in our brain you know 2ag and another one I've forgotten the name of right now the bottom line is people who went on Ramana band lost a lot of weight and the reason was because you suppressed reward by using these medicines well you suppress rewards so you suppressed food intake and you also increased the number of people who jumped off Bridges okay massive depression 21 of all patients who took ramonabant ended up with major depressive disorder and a lot of them committed suicide and the U.S never approved the drug I had sort of been under the impression that some of this this mental health the Rumblings about this maybe impacting mental health and negative way were potentially due to like uh gut and microbiome issues and who knows but I I hadn't made the link between the reward that that is so interesting um for me I'm just like you can't you don't mess with the gut and and not expect something to happen like the gut is everything right guys I preach the choir but it's like you know I I just that that to me feels like a Pandora's Box so we'd want to understand before Mass prescribing to kids as young as 12 which it's now is you know approved for um so that's that's so interesting about the reward circuitry um one question that I'm sure people will want to double click into that you touched on earlier was this idea that people regain the weight after they get off this medication can you can you speak to two things like what does the data say about weight regain after stopping this uh like how many people are getting it back if you stop it it comes back that's it's that simple so basically going on this means you're staying on it forever and the reason is because you're not solving the problem you are bypassing the problem the problem is still there so with the experience be like for patients you've had who have maybe gone on in Singapore that you get off it and are you like insatiably hungry or like what is that experience like that is what I Hear What I Hear is you it you you basically put the weight on back on within like a month or two so you know this is really you know just sort of a stop Gap measure and you know as it as soon as you stop it it will uh you know Roar back it it's not solving the problem it's band-aiding the problem so now in some cases do you need a Band-Aid sure okay but you have to be very circumspect about you know who you're going to use this in and right now we're not doing that because you know it's new so everyone uses it all these early adopters and then we find out oh not so much and then the whole pendulum switches you know swings back the other direction nobody should be on it and you know and ultimately it will find someplace in the middle you know where it will settle in because that's the nature of how all new therapies you know get uh rolled out uh you know it gets uh used then it gets overused then it gets underused then it comes back to center right now we're in the overuse state so given the fact that there are going to be millions of Americans on this medication and there are kind of people probably a lot of people who have an Awakening about the fact this is not a Panacea it's not a silver bullet they might have horrible side effects they want to get off it what would you I think there's probably going to be a huge opportunity for essentially plans for people to while they're on the medication also set themselves up for success for getting off it and maybe use the medication as a jump start to get the motivation and energy to then do the things that actually get to the root cause so let's say someone's listening who's Ono's epic this episode's kind of freaking them out a little bit and they're thinking they might want to eventually get off it what do you think are some of the steps that someone could take to like really set themselves up for Success when weaning right so I I couldn't agree more I think that ultimately these medications will be good jump starts in other words that means that they will be adjuncts to other therapies okay ways of getting people to have early success so that they can basically feel some self-efficacy some agency that they can actually do something to help themselves and ultimately be able to carry that forward I'm for that I'm totally for that and if that is ultimately how ozembic and mcgovia are used I will likely be a proponent for for them that's not how they're being used now all right but if you can see that changing your diet will basically be something that you can actually do and follow through on and you know ozempic and would go be help you get there all right to that point where you can actually like change what's in your pantry and you know you'll be able to sort of uh subdue the cravings and you know so that you don't fall backwards I think that would be a fine uh uh way to do it um so it could be sort of a short-term you know uh jump start and then come off it and you know use it in that respect with that with that in mind but that means that you need a nutritionist involved that means that you're going to need your primary care physician to really sort of take command and help you navigate how to do this and how to navigate the grocery store going forward you know so I could see you know these drugs being an adjunct to you know more codified lifestyle program and you know then then maybe there will be a good value too yeah I mean I'm I'm just thinking let's say there's someone who you know is morbidly obese and they're really just don't have the energy or motivation to kind of get started they get some early success the medication like this get more energy they're able to move more I can I can imagine a situation in which like that's at that moment if they're able to get a support team around them exactly what you said like learn how to cook shop at the grocery store prepare Whole Foods start a resistance training program so they don't you know lose as little of the lean muscle mass as possible maybe even build some um you know really dialing on protein and amino acids and kind of you know prevent the sarcopenic effect you know work on the mental health piece and then maybe you know it's like it's it helps them kind of then eventually just move from one state to a much better future and get off the medication eventually but I I just don't see a situation in which if none of that happens there's no resistance training there's continuing to eat Ultra processed foods just less of them that the the body so the body getting less of something crappy is not the equivalent of Health right if something is toxic then less of something is less toxic but that doesn't make it healthy well okay so I so you have some of the most I think amazing perspective on on actually like evidence-based like the actually evidence-based ways for sustained weight loss especially in children and I know you've done some research in your work on this so the American Academy Pediatrics recently and their obesity guidelines that were released in January made a recommendation that these medications and other pharmacologic agents for obesity could be used in children as young as 12. um I wonder if you could just speak to some of your research about weight loss in children about what are the factors that actually allow children to lose weight in a sustainable way and and maybe just your commentary generally on the AAP guidelines right well so the AAP guidelines that came out earlier this year said two things and one I agree with and the other one I disagree with so what did it say it said that obesity is a problem I agree obesity is a problem they said that pediatricians have far too long ignored obesity in their children in the children that they see and that by saying to parents oh it's just baby fat it'll go away you're actually perpetuating the problem so they called the pediatricians on the carpet you know for basically ignoring the problem as the problem festered under their feet that part of the AAP guidelines I agreed with then was the second part which I disagree with what it said was because obesity is such a problem and because it is a disease and because kids aren't getting better you are entitled and rightfully appropriately commissioned to use medication as young as 12 years old now look I used medication when I was head of the OBC program at UCSF fully one quarter of the patients that I took care of were on Metformin and the reason that they were on that foreman was because metformin was targeted at the problem these kids had insulin resistance they needed their insulin to go down I knew that as long as their insulin stayed up they were going to continue to gain weight because insulin is the energy storage hormone get the insulin down and Metformin was the drug that we had at our disposal at that time that kids could take that would get the insulin down and the reason was because it worked at where the insulin problem was the liver it was targeted to the liver to improve insulin sensitivity at the level of the liver by increasing the enzyme amp kinase ampicinase is the fuel gauge on the liver cell it is the thing that tells your liver to make more mitochondria so if you increase ampicinase activity you're going to make more mitochondria which means you're going to burn energy better and faster and you're going to improve insulin sensitivity and you have then a chance to get your insulin down and you know have weight loss that's why we used it because it was directed to the correct problem I also knew from my own studies from back in the 90s when I met Foreman first came out that if the kids consume soft drinks metformin was useless did not work and the reason was because they were poisoning that amp kinase so you can't raise your amp kinase when it's being poisoned it doesn't work all right so soft drinks were the antithesis of Metformin activity and I had to get people off the soft drinks before the metformin would work all right I had to do both I had to stop the soft drinks and do the metformin but when I did that then it would work and I had plenty of good data to show that and I you know published this I you know this was out in the out in the world how many people did it you know how many the pediatricians adopted that you know only the ones who listened to me you know which is not not enough all right now can we ultimately you know get kids to change their diet so that they don't need medicine and the answer is no we can't because the food environment that they find themselves in is so unbelievably toxic we have to fix the food environment in the schools we have to fix the food environment in the grocery store so that the food environment at home can ultimately be fixed and the parents you know we expect them somehow to be The Gatekeepers and the problem is they can't be it's too difficult that we've made it too difficult and of course that's the food industry's goal is to make it too difficult in addition most of those parents are sugar addicts themselves so how are we going to fix the food for the kids if we haven't fixed the food for the parents how do you expect the kids to get better when the parent is the Sugar Act and it's still bringing the you know Oreos into the house what you know what's that about all right that so so to me that doesn't work it requires a much bigger effort and not expecting that the parent alone is going to be able to solve this problem so giving drugs to kids is not the right answer even though I did it but I did it for the right patient for the right reason at the right organ all right but just throwing ozempic and mcgovi at kids is not the answer to this problem oh uh wow um feel like we need to end on a more uplifting note because this is I mean I know we're working on both of us you know eat real is an amazing organization that's trying to change food in schools we are we are fixing K to 12 food in schools because because it's actually cheaper to make real food than it is to make processed food if you know how and that's what eat real does so everybody out there eat real dot org look it up support it get your school cafeteria food services director to call us absolutely Nora la Torre the founder is just an amazing Powerhouse and I think that organization is just it's at the Nexus of Children's Health family health school food and environment because of the way we're growing food and it's so powerful um I got two female forces in nature I got you you're a redhead and I got Nora she's a blonde okay I'm looking for a brunette yeah we gotta find one well Rob thank you so much I mean I think um this has been such an interesting conversation and yeah no I mean I'm just I'm pretty pissed at the AAP about this guidelines because honestly you know the recommendations are that pharmacologic intervention for kids for weight as well as bariatric surgery and it's like we're gonna we're gonna say that bariatric surgery and drugs are are the answer instead of fixing food even though it would be cheaper in the long run to fix food and call it they're saying it's a you know it's a social justice issue which is true and that's why we have to lean on medications and surgery because it's almost easier but it's like if we if the AAP yeah if they got on a grandstand and said you gotta fix the food so it's like why isn't every doctor on that panel on every platform possible screaming for better food we all have voices like why is that not happening why is that not happening so on that note rob it has been such a pleasure this episode I learned so much I think a lot of people are going to learn so much I'm so grateful for you and every single thing you're doing in the world you are um changing the world with every word you say and everything you do and I'm so grateful for you thank you so much for being on the episode I'm grateful for you [Music] foreign [Music]

Channel: Levels

Views: 174,359

Keywords: metabolic fitness, metabolism, metabolic health, metabolic, cgm, continuous glucose monitoring, glucose monitoring, cgm life, biowearables, biohacking, cgm sensor, cgm glucose monitor, glucose, glucose test, levels, insulin resistance, blood glucose, nutrition, levels kitchen, weight loss, is wegovy safe, metabolic health and nutrition

Id: AKNnxKAaONc

Length: 50min 48sec (3048 seconds)

Published: Thu Aug 17 2023