Episode 21: Semaglutide One Year Later

This is a follow up to a podcast I did last summer with semaglutide in a very novel and unique method over a period of about a year, about 11 months. So as a background, semaglutide, which is known commercially as Ozempic, the form for diabetes, and WeGovy, the form for weight loss is injectables have been around for a handful of years and there's been a shortage of both. They're both listed on the FDA drug shortage lists, so there's been compound versions available. The FDA allows for compounding pharmacists to manufacture or make compound drugs that are not available. So the drugs are considered to be identical or as close to identical as possible. And we did a four month study using semaglutide combined with metformin to assess weight loss. We saw an average of about 12 to 14% body weight reduction in the first three months, followed by a one month holding the weight on metformin. Now, semaglutide works by as an agonist to something called GLP1 glucagon, like peptide type 1. And it accelerates or it helps with weight loss through modifying hunger in the brain, increasing secretion of insulin from the pancreas and chain change in the gut microbiome. Whereas metformin also acts on GLP1 by increasing their levels of GLP1. And because the drug is shortage and it's so expensive, we sought to see if we could combine semaglutide and metformin and use a totally lower amount of semaglutide at much lower cost and get similar effects or what would we see. So the initial portion was our staff in South Carolina. We were buying lunches for them so they'd eat healthy, at least one meal a day. As a Mediterranean type diet that's we ask people to eat when they're taking semaglutide so their body changes their desires and their habits and their cravings for different types of foods. And some in a metformin diet, I'm sorry, Mediterranean diet I've described previously. And basically it's a non processed food, use of extra virgin olive oil, whole grains, vegetables, fruits and lower amount of meat, not much red meat. So we started this in July of 2022 and I'm reporting this in June of 2023. And we had a group of individuals that wanted to lose weight and they were not necessarily the classic individuals who may seek WeGovy, which might be obese or extreme obese. They were between overweight and obese. So we're seeing a group of people that maybe don't qualify for the WeGovy drug because they're not heavy enough. The requirements for WeGovy is a BMI over 30 or BMI over 27 with one obesity related comorbidity. We're also seeing people that really aren't sick or they don't have other comorbidities, in other words, or they're not quite as heavy, but they want to lose, you know, 10, 20, maybe 30 pounds. And this gives them an edge. So we put people on three months of escalating dose of compounded semaglutide, matching the dosage schedule for WeGovy exactly. And then we stopped for one month. We stopped the semaglutide after three months and put them on Metformin. Now to clarify, the dose of semaglutide, which is an Ozempic or WeGovy, starts out at a very small dose and it escalates to where the maintenance dose is 10 times higher than the initial weight loss dose, 10 times higher. And the reason is your body develops rapid tolerance to the drug. If you started out at the higher dose, it make you very sick to your stomach. And if you stayed on the lower dose, your body would basically become tolerant to it. But also that tolerance to the drug rapidly goes away when you discontinue it, sometimes as short as two to three weeks. If you stop your commercial medication, you're actually supposed to start over at the lower doses, which is 1/10 as much. So we gave the people in this group the option of going on metformin for two months and doing a second round of semaglutide, staying on this metformin, using the metformin as needed, or even taking occasional doses of these compounded semaglutide. With the idea being, can we at one year keep the weight off without relying on taking a drug every week for a year? So in our initial grouping, they lost, look at my chart here. It was actually BMI average loss was. Our weight loss was average at 12% body weight. The range was 10 to 14%. That's what happened on the onset. So what occurred in the next 11 months? Well, one individual we did not follow because she became pregnant and we could not continue the medication. And whereas metformin might be used in pregnancy, we didn't want to take over her healthcare at all. And obviously she's gonna gain weight. Related to pregnanc by the other individuals, the total weight loss was ranged between 15 pounds and 73 pounds. Most of the individuals maintained their initial three month weight loss, which is where they wanted to be. They lost an average of about 24 pounds and that's where they wanted to be. And they were able to keep it off long term without going through an entire second round of semaglutide. So I'll give you a couple examples. One individual started out at £149. Her BMI was 26, so I'd be considered just barely overweight. And at the Finish she was 128 pounds, which puts her at a BMI of 22.7. She's five' three, so that was for her, an ideal weight. She stayed right about there. She did not. She went on metformin, but it made her a little sick to her stomach and she maintained her weight within just a few pounds. Another individual started at 197 and finished at 173, so 25 and a half pound weight loss and maintained it for the year with using metformin periodically, not all the time, and did six additional individual doses of semaglutide when he felt he was putting a little bit of weight on. So kept it off for a year and did six weeks during that year of semaglutide with the very low dose. Again, a very inexpensive way to keep the weight off. Another individual started out at 237 and finished the three months at 209. So significant weight loss 28 pounds, but then lost a total of 73 pounds and got down to 164 by going on three months of semaglutide followed by metformin twice a day. And obviously some lifestyle changes. Another individual started 175, lost, I'm sorry, started 200 pounds, went down to 175. So 25 pounds and a year later is at 175. Same weight metformin for four to five weeks, did a second dosage of WeGovy for four weeks, so once a week for four weeks at the lower dose and then went back on Metformin and kept it off. So these are examples of how we can start thinking as clinicians and patients about how can we use the semaglutide's tool of altering GLP1, making us less hungry, making us processed sugar, better process food, better decrease your appetite. Combine that with a lifestyle change, habitual lifestyle change, that might stick, and use the less expensive, very common drug Metformin to help increase the levels of GLP1, which the semaglutide is acting on. Now we hear different stories about how habits take a while to develop and to stick. But we do know very specifically that our gut microbiome, in other words our gastrointestinal tracts, bacteria, largely play a role into whether or not we're normal weight, obese, or able to tolerate fluctuating calories without fluctuating our body weight. And this has been discovered, really studied over the last 10 or 15 years heavily, where we could change the gut microbiome, we can alter people's weight. Well, one way to change your gut microbiome is change the foods that you're eating. So if you eat more, say processed foods, cafeteria style foods, you'll collect a microbiome that's very good at processing the food and getting you as many calories as possible and making you heavier. And if you eat foods that are a little harder to digest, such as vegetables and fruits, eat things like extra virgin olive oil, low on the meats, particularly real low on red meat. Again, grains, legumes will develop a microbiome that favors weight maintenance and even lowers risk of cancer, heart disease and other conditions. Once the gut microbiome is altered, our food cravings change towards the foods that led to the microbiome shift in the first place. And this is being understood as a potential breakthrough way to help control the obesity epidemic that's occurring not just in America, but throughout the world, where we've changed our food sources and we're growing bacteria we can call the fat bug. And this can be altered through changing our lifestyle. And once we change our lifestyle, perhaps it might stick. And we saw in our grouping for about 11 months, a little over 11 months, that people change their lifestyle and it's stuck. They are eating smaller portions, generally not exercising, which we didn't put into the request. We did request them to eat the food that we provided as a company, as we do our employees. And we also requested they try to eat similarly at home and with their families, hopefully make their families more healthy. And we saw no significant weight gain, significant post round of semaglutide, weight loss and generally weight maintenance after just a three month duration of escalating semaglutide followed by metformin as needed and additional low dose semaglutide injections as needed, which the most was six additional weeks over the course of almost a year. So this has been very successful, Far, far less expensive than the commercial drug that costs about $18,000 to $20,000 a year and right now is not even widely available right now, in fact, the manufacturers of the, of the commercial drugs are suing clinics and threatening suing pharmacies that are implying that they're using the commercial drug. So I want to make it really clear. We're using a compounded version of the drug. And the FDA has allowed compounding drugs that are commercially available if they become commercially unavailable. So right now, semaglutide in a commercial form for injectables is on the FDA shortage list. So they can be compounded. How long that'll last, I don't know. Once that they get caught up, we'd have to switch to the commercial version. But now we know we can do it much less expensive than the method that the drug companies wanted us to believe, where you go on this medication and you stay on it forever at 18 to 20 thousand dollars a year. So just as a recap, semaglutide acts by increasing the activity of GLP1. Glucagon, like peptide type 1, metformin acts by increasing the levels of GLP1. These drugs are safe to take together. These are known to be synergistic, meaning they work better together than either one on their own. Metformin as a standalone helps with weight loss. Semaglutide as a standalone helps with weight loss. Both together, they seem to work synergistically. And in this case, we altered them. We used a run of semaglutide without metformin. One of the reasons to do it without metformin in the first place is both of them have a side effect of gastrointestinal, intestinal upset, nausea, that sort of thing. And if you take two of them together, that probably would be a little bit worse. Also, you wouldn't know which one it was. So people might not be compliant. So we did the semaglutide. Everybody tolerated it, and then we added then the metformin. If they decide they want a little bit more semaglutide down the road, they could just stay on their metformin. So we've been doing this in practice for some time and we're finding pretty good weight loss. There are some people that fail that still maintain their weight or gain weight and split of these drugs, but it's very small, probably about 1 to 2%. So maybe 1 out of 101 or 50 people it doesn't work for, and we don't really know why, can't select them out. And the weight loss in this case was £15 and £73. Person losing £15, she maintained an ideal body weight. And a person that lost 73 pounds is at close to an ideal body weight, just slightly overweight, so she wants to lose another 10 pounds or so. So the the this is a way to far less expensively treat weight loss. Most people do not have weight loss drug coverage in their insurance plan. This is also a way to handle weight loss in the face of a drug shortage. Again, wegovy and Ozempic are both listed as drug shortage by the fda. They're not. You might be able to find it, but generally it's kind of hard. And when that gets sorted out and they have abundance, we'll not be able to use compounded semaglutide, most likely, but we'll use the commercial version and do this hybrid system so that people aren't paying 15 or $20,000 a year for their medications. So I'll keep you posted and how this progresses. We're finding that the long term use of semaglutide certainly does work, but you don't lose additional weight. So in the clinical study they saw people lose weight. Most of the weight loss occurs in the first three months. That's the fastest weight loss and it kind of tapers off and then it gets a point where people are just on a maintenance dose. And from a standpoint of health and wellness, we'd like people to be on less drugs, not more, especially when it costs 15 to 20 or 18 to $20,000 a year. And if you could just use this as an opportunity to change your lifestyle so you no longer crave unhealthy food and maybe combine it with a little bit more activity, we can reduce the number of drugs that people are using and make people healthier. We do know that these drugs are safe. There's been a lot of bad mouthing in the press about people losing muscle mass and that sort of thing. It's all. I've discussed this before in prior podcasts. That's a way to mislead the public. Very, very, very disingenuous. It does reduce the incidence of cardiovascular disease, or at least cardiovascular profiles in people that are at risk. It appears to potentially be a longevity drug in some fashions. You know, when you have less weight, you have more factors of long life. There's no studies on epigenetic age or telomeres with semaglutide that I'm aware of. But we'll see these coming out in the future. And again, the cost right now is pretty, pretty tolerable medication. Very tolerable. And the most exciting thing is that we can use this drug periodically to lose weight versus being on it. All the time, so thank you very much.