The Shocking Truth About Ozempic & The Effects It Has On The Body | Calley Means & Tyna Moore

These peptides have been shown to heal heart tissue and to reverse heart failure. So I've got one patient on it for high blood pressure, tiny little dose, high blood pressure, blood pressure is down. I personally take it because I have psoriatic arthritis and I have crippling pain from tip to toe. It doesn't matter how clean of a life I live, it doesn't matter how clean my fish tank is, menopause hit me.

So tiny little doses mitigates my autoimmune.

Conditions like nothing I've ever used.

All right, welcome Tina and welcome Callie. It's great to have you both on the show.

Pumped a beer.

Thank you.

Okay, so this is such a rich topic and it's so deep and I spent probably 15 hours preparing for this podcast, my reading everything that both of you written, reading study after study after study, looking at the data very carefully. And I can honestly say that after not just reading the headlines, but between the lines, reading the research, I've come to understand that this is a very nuanced conversation. It's not just good or bad, it's not just we should do it or we shouldn't do it. It's really about understanding one, the bigger social context in which this is happening. The bigger social context six is we are facing a metabolic health and obesity crisis that's never been seen before in the history of humanity. There's over a billion people who are obese, up two billion people overweight in the world. We have in America, it's even worse. We have 42 obese, we have 75 overweight and 93.2% metabolic and healthy, meaning they're on the spectrum of some poor metabolic dysfunction, which is making them on their way towards pre-diabetes and type two diabetes. And the costs are staggering. We know our healthcare costs are now $4.3 trillion in direct costs. Probably 80% of that is for chronic disease, mostly caused by our food and primarily driven by this phenomenon of insulin resistance, which is part of what Ozempic and these drugs purport to fix. So, as we start to think about how do we solve this problem, I've been thinking about it from the very macro view, which is how do we deal with the food environment, the toxic food environment that's caused us to be in this situation? this is not a genetic problem. There may be genetics that load the gun, but the environment pulls the trigger and the environment has changed in the last 50 years so dramatically that it's led to an abundance of toxic food, ultra processed food, high starch and sugar in our diet, ingredients we've never had before that are destroying our microbiome, that are destroying our nutritional resilience, that are causing important metabolic health and are really at the root of so much of what's going on. So I focused on policy issues. I wrote my book, Food Fix, which is an attempt to kind of lay out why this is happening. Because I realized I couldn't cure diabetes in my office. on the farm, it's cured in the factory where they make the food, it's cured by, you know, in the grocery store, in the kitchen. That's where diabetes is cured. And ultimately, I realized I had to go upstream to deal with the root causes, which is our bigger food system. And we're going to get to talk about that with Callie because he's been talking about and thinking about it for a long time. And I think his new book, Good Energy, addresses a lot of these issues around metabolic health. It's his sister, Casey Means, who's been on the show. Now, I often get them confused. Callie, Casey is-- you- got it. I don't know what their parents were thinking. I think I've sorted it out, you know. And Tina has a very different perspective. which is really around the micro, not the macro, which is how do we deal with individuals struggling with metabolic dysfunction who've tried everything, done everything, hit the wall, can't make it work, struggle, white knuckle, and just can't get their bodies back into a state of good metabolic health. And we're going to talk about how she does that, why it's different than the traditional approaches to the use of these drugs and why we need to rethink how we're doing this. So this is going to be a very interesting conversation. I'm really excited to dive in. And so first we're going to start with the macro and start with Callie because I want you to set the stage for the situation we're in around our poor metabolic health and obesity and what this is doing to us as a society economically, socially, politically, even in terms of our social divisions and conflict, all driven by the effect of these things on our physical and mental health. So, can you kind of unpack for us, Callie, how you see the current state of affairs in the realm of weight and obesity? Now, I realized just read an article this morning and said, it's not okay to say someone's obese. You have to say the there's someone with obesity. I get it, but we gotta have to set up to take a hard look at this. And so tell us from your perspective, how should we be thinking about this problem at a macro level?

Thank you so much for giving this conversation. Dr. Deane has had a huge impact on me, and I really think this is important to have a long-form, nuanced conversation that goes over the micro and the macro. And as you said, I've been really focused on the macro. I think there's some really important macro considerations that patients need to know before thinking about Ozempic. And that is that this is really about the median American and the median American child. 94% of the country is metabolically dysfunctional. Something has happened all at once, as you point out so well in Food Fix. Just looking at kids, 20 to 25% of young adults having fatty liver disease, 50% of young adults being overweight or obese, by some counts 33% of young adults having pre-diabetes, It's a moral stain on our country where I think through very observable and very definable situations we're poisoning our kids. We're poisoning them chiefly by food, the rise of ultra-processed food, which was close to 0% 100 years ago, and now up to 70% of a child's diet by some counts.

I go back to... It all started with like, what, Crisco in 1911?

Yeah, and it started with good intentions after World War II to kind of feed the world and make ultra-processed food, but it's been weaponized. And, you know, food companies now are one of the largest employers of of scientists to weaponize our food against us. And I can't go to a playground with my two-year-old without seeing almost every kid there drinking Coke, drinking sugary drinks. So fundamentally, this is a question about what is the solve for this metabolic health crisis and the different branches on that crisis, the diabetes crisis, the heart disease crisis, the obesity crisis. And I think my main point is that the medicalization siloing of chronic disease has been an utter failure.

Yeah.

Now, I'm not saying a doctor shouldn't prescribe a statin or metformin if that's the case and that's the determination, but the overall default to isolating and medicalizing a chronic condition has been bad. The world would be a better place if we actually didn't go this route of seeing heart disease as a statin deficiency, seeing diabetes as a metformin deficiency, seeing high blood pressure as an inhibitor deficiency, seeing depression as an SSRI deficiency.

My argument, I actually think the data is clear on this.

If those drugs were- you- mean depression is not a Prozac deficiency?

Yeah.

Exactly. And my argument, I think the data is clear on this. If you actually took those drugs off the table, if they didn't exist, and the medical system actually asked, what's the root cause of these conditions? What should we spend $4.5 trillion on actually solving these conditions? It would actually go to the things you talk about, about core lifestyle habits. And the issue and what the obesity epidemic represents with 80% of American adults now being overweight or obese is that we really have a dirty tank. We have a fundamentally lost our way in crony capitalism rigging the system, basically poisoning the American people. And is that an Ozempic deficiency? Should we do more of the same in the really the most pronounced chronic condition for the median American, for the median child, should we be prescribing the Ozempic? And I really think when you reel that back, the answer is no, right? I'm not talking about, you know, 400 pound, extremely diabetic person. That's between the patient and the doctor. But when the American Academy of Pediatrics is saying that the average 12-year-old should be on a zempic when this is being pushed on six-year-olds who have an obesity crisis. That gets over 20% of kids in the US have childhood obesity. And in Japan, it's 3 to 4%, right? We have unique dynamics happening in America and it completely takes our eye off the ball to say that's no zempic deficiency.

Novo Nordisk right now is the 12th most valuable company in the world. It's the most valuable company in Europe.

It's the biggest contributor to GDP in.

Denmark, the country that- But interestingly, their revenue and profits aren't coming from Europe. Is it true they don't allow OZempic to be sold in Denmark?

Is that true? It's not the standard of care. First off, in Denmark it's under $100 and they are making all their money off Americans where they charge $16 to $1,800. A month. They're taking advantage of Americans, but it's not the standard of care in Denmark. I was in Denmark last year. They have sound food policies, people are biking, walking around, and actually if you have obesity, the doctor is able to prescribe exercise and a keto diet that's subsidized by the government. OZempic is not the standard of care for obesity. if you actually look at the stock analysis, 80 to 90% of profit expectations are coming from the United States. They're taking advantage of the United States. So we have a dirty fish tank, right? The problem is not an ozempic deficiency. The problem is when are we going to say we're going to stop poisoning kids.

They're talking about using this in kids, but we're filling the schools with ultra-processed junk food that these kids are eating for lunch and that the school lunch program is so messed up that these kids aren't getting healthy, nutritious food that's helping them Right. Be metabolically healthy or mentally healthy. Right.

So then we look at, okay, how would he use this for? The instructions on Ozempic is as a lifetime drug. It actually, though, there's a warning. So let's just look at what Novo Nordisk says. They said, this is not like a quick use. This is not for a kickstart. This is a lifetime drug and there's actually some serious warnings if you go off the drug and gain the weight back and actually unknown metabolic effects. So that's what Novo Nordisk says. And they're actually saying with the help of the American Academy of Pediatrics, which early in my career I helped pay by pharma companies, this is a subsidiary of pharma companies. This Danish company is one of the top contributors to it. They're saying that a 12-year-old, it should be the first line of defense. It shouldn't be after dietary interventions fail. It says if a 12-year-old gains a.

Little bit of weight, put them on this drug for life.

So the American Academy of Pediatrics doesn't have first line therapy as lifestyle. They're saying that they need urgent, quick interventions on surgery and Ozempic and not after dietary interventions fail. That's what the recent press release and guidance from the American Academy of Pediatrics said. Well, that seems pretty messed up. The American Academy of Pediatrics has not spoken out about Coca-Cola machines in pediatric wards and classrooms. They've not spoken out about the fact that 10% of food stamp funding goes to Coca-Cola. They've not spoken out about our agriculture subsidies, but they have said that if your 12-year-old gains a little bit of weight, they need to be on this injection for the rest of their life. Now, what's the problem with this, right? As we know from your work, that if you're not taking the opportunity to train that child on metabolically healthy items, to train them on exercise, to train them on healthy food, to train them on having on curiosity for what they're putting in their body, they're going to continue to rack up comorbidities. If somebody is anorexic, their LDO levels are probably going to go down right away, but that's not a sustainable long-term strategy. That's essentially what Ozempic does. It's a crash course calorie deficit. Not training that child for any type of R curiosity or lifestyle change that's needed, even if they're eating and on this drug for life, they're fundamentally still sedentary like our kids are and still putting ultra processed food, which is going to lead to other metabolically healthy items. What doctors are saying now is that, and I think you've said this, that you have to exercise. You have to, and actually Novo Nordisk is even admitting this. They're saying you have to shift your weight.

I've seen when they're studying that they.

Lose significant muscle mass. Right, they're saying that it's a huge disaster if you take this drug and don't exercise four to five times a week with weight training and shift to a non ultra-processed food high protein diet. My message is this. Let's start with that first. Let's start with steering the trillions of dollars of incentives of a medical system to doing that first before we're drugging anyone. 'Cause it's a contradiction 'cause what's actually happening is you have doctors at Harvard and the American Academy of Pediatrics saying the reverse. They're saying that obesity is now genetic. They have to define obesity as genetic in order to get taxpayer funding for this drug. You actually have the leading obesity research at Harvard Dr. Fadima Cody Stanford saying, Throw willpower, throw diet, throw exercise out the window. So on the one hand, you actually.

Have doctors arguing that this is a.

Genetic condition and basically a drug deficiency. Isn't she conflicted a little bit? And she's paid so we can get into the corruption. So when we have a dirty tank, when you have this massive societal issue, the biggest branch of the tree of metabolic dysfunction, when are we gonna say that our healthcare policy needs to go towards metabolically healthy habits. In this case, Ozempic is a problem for two ways. Number one, it's a distraction. It's once again saying the cure is in the medication. We're telling 50% of 12-year-olds who are overweight or obese, you,'re okay. The doctors aren't saying that the kid has to work out four times a week and shift their diet. That's not what anyone is saying to that kid. He says that in school. You're saying you're saved now from this drug. That's why I think this problem is one of the biggest issues in the country. Ozempic is a disaster if the drug was perfect. because it's giving the wrong message when it's not the solve to the problem, and there's a massive opportunity cost where for $15 to $1800 a month, we could change our agriculture system to regenerative ag, we could give every obese child in the country a card to buy organic whole food. So it's a disaster from that perspective. It's also medically extremely problematic. This actually, to my estimation, you tell me, I think it's actually the highest and most pronounced side effects of any drug widely approved in modern American history. 80% of people on this drug have nauSea and 30% have extreme vomiting. It has a black box warning, which we should take seriously. If we take the other studies seriously, we should take that very seriously, a black box warning for thyroid cancer. And the issues are so pronounced for mental health because it's disrupting our microbiome, which produces 95% of our serotonin. The EU, which is actually much more quizzical about this drug, is launching a massive investigation for suicidal ideation.

I looked at that data and I think there's some questions about it.

Well, this is short term data. Well, this is exactly back you the point, actually. This is extremely short-term indicators. They approved this drug on a 68-week RIG study to prove for 12-year-olds for life. The research, if it's showing any leading indicators that Novo Nordisk has to admit, that's a serious problem because all their studies are funded by Novo Nordisk and very Russ. So if there's any indicator whatsoever which necessitates that black box warning, the other thing I'll say is let's just back up and go to what I've learned from you. which is that what is our body telling us? If 80% of the people have nausea, if 30% are throwing up, that's telling us that this drug is producing some unknown metabolic issues throughout our body and really has some interconnected problems that we fully don't even understand. That's what it tells me. I think it's true there are a lot of side effects if you take.

It in a way that actually is prescribed currently. But there are other ways of using the drug. We're going to talk about with Tina that mitigate a lot of the side effects that avoid a lot of the problems you're talking about and that aren't using the product that's from the pharmaceutical industry, it's from compounding pharmacies, which is a kind of a left field thing that people don't know about. But what's really striking is you can get these drugs for $20 a month if you get them from compounding pharmacies and at doses that are far lower that may be effective without a lot of the complications and side effects and combined within a lifestyle. It made me think about the MAPS work, which is psychedelic research. And probably this year, MDMA therapy with psychotherapy is going to be approved. So, it's bundled. You can't get MDMA without also having psychotherapy. You shouldn't be able to get ozempic or any peptide like that that's driving this problem without actually having a bundled service of an aggressive lifestyle change, including dietary and exercise training and services.

Well, I think the maps and what's happening with MDMA approval is one of the most important events in the country and probably for another podcast, I just say, and I'm excited about this nuanced conversation, but working for the pharma companies, I do think this nod to exercise and healthy eating, it is a joke. The pharma companies are laughing about that, right? They know, fundamentally, we're incentivizing the American people with trillions of dollars to eat poison and then be drugged. The largest industry in the country, every lever of it makes money on interventions on people that are sick, and there's a high for people to stay sick, and that's been the history of the post-World War II chronic disease complex. So what we have to do is clean the tank. What do you mean by clean the tank? We have an ability today to take the $4.5 trillion that we spend on healthcare, and when somebody comes in with obesity or when a child comes in with obesity for the standard of care to be actually incentivizing and medically recommending diet and exercise, as we're already admitting that has to be done on Ozempic already. My point is this, every patient should know this. Ozempic, everyone agrees that this drug is highly problematic unless you do 4 to 5 days a week of intense strength training and shift your diet to non-ultra processed food, high protein. Do that first and by cleaning the tank, and this is what TrueMed's doing, this is what we're lobbying for, we can steer medical dollars. It's the incentives that are damaging us in this country. Again, in Japan, look at the obesity rates, look at the childhood obesity rates, look at the diabetes rates. This is a unique problem based on the incentives of America that we can fix, but it's not shoving an injection into 50% of US children.

Let's look at this from a different perspective because I think all the things you're saying are accurate and I think we need to look at this from the perspective of the paradox between an incredibly toxic food environment because you're saying eat better, exercise, but if 67% of kids diets is ultra-processed food, some estimates by some studies show it's 73%. And we live in a toxic nutritional landscape where it's almost impossible to do the right thing. We live in a society that fosters a sedentary lifestyle that has no incentives in school for healthy eating or for movement for kids. We have to change the structural phenomena that are driving this. Paul Farmer talked about structural violence. What are the social, political and economic conditions that drive disease? That has to be dealt with. But at the same time, and that's what we're doing, that's what you're doing in Washington, that's what I'm doing in Washington with the Food Fix Campaign, trying to change the policies that are driving this from marketing of junk food to kids to subsidizing the commodity crops that are turning junk food to food stamps that are paying for junk food. I mean, the list goes on and on. For paying for nutrition services in medicine, for changing Medicare reimbursement, changing all the things that we know need to be changed to actually drive a bigger societal systemic change. But there is a paradox here because we are already metabolically, as you say, busted, Tina. And when you have someone who's metabolically screwed up from being in this toxic soup of processed food and junk food and sugar and starch that has caused them to become metabolically obese and metabolically busted. It's really hard to get people out of that. It's like they're stuck. One of my professors, Sidney Baker, who's one of the, I think, most brilliant scientific minds in medicine in the 20th century and 21st century said, you know, sometimes you need a hundred horses to get people who are really stuck, unstuck. So we have these really chronically ill patients with multiple dysfunctions metabolically, inflammatory, get issues, gut issues, immune issues. It takes a lot of effort to pull them out of the mud. And sometimes you need a whole team of 100 horses. And so the question is how do we both deal with the things you're talking about, which is the corruption of pharma and the corruption of medicine? And this has happened, by the way, you talk a lot about this, Cali, how $27 million spent by Ozyembic company manufacturer Novo Nordisk to fund doctors and others who are promoting this drug. So there's a lot of corruption in the system. They're funding the NAACP. so they come out in favor of opioids and they say it's a great solution, if you don't prescribe it. But at the same time, we have to deal with all this corruption from the pharma industry and from internally in medicine, how things are done. We have to also accept that we're in this incredible crisis where people are struggling and they can't get better, even if they want to and they try.

I would just say we have to solve that. We have to assess that crisis. It's the biggest issue we face. The fact that we're getting sicker, more depressed, more infertile at an increasing rate is the biggest issue in the country. 100%. And nobody would look at that issue and say, that we should keep letting that happen and then jab 50% of 12-year-olds with the drug. There's no evidence that this helps kickstart. This is a lifetime drug, but as many doctors have noted, the second you go off a crash course diet, this is an injectable kind of calorie deficit crash course diet. The data is very clear. The second you go off this drug, you gain the weight back. You have to get to the root cause. You have to get people exercising and food. There's nothing without that.

True, that can work, but for some people, it still doesn't. And as a doctor seeing patients, with all the best intentions, people struggle. Even if they know what to do, even if they're educated, even if they're doing it, I've seen people struggle. And so the question is, is there a way to think about this class of drugs differently? Is there a way to think about it not from the pharma point of view, which is lifelong drugs, which is high doses, which is pharmaceutical injections that cost $1,700 a month that nobody can afford that's going to bankrupt society, Is there another way to actually think about using these drugs to help people who really struggle and what are the pros and cons and what is the science behind it and how does this work? And I think this, I would love to sort of, Tina, do you start by talking and we're gonna get into all the details because I see you like in your chair waiting to get going and I'm gonna come and get you like oh, come in a minute. Because I think Cali laid out beautifully how we're in a really screwed up political system a corporate corruption system with Pharma, how they operate and how they fund things like the promotion of these drugs at wide scale through co-opting professional societies like the American Academy of Pediatrics by funding Harvard and other institutions to do the studies which they get huge amounts of money from. I mean, there's so much corruption in the system. But there is another way to think about helping people who really struggle with with their weight and with the metabolic consequences. And, and as, you know, as I was sort of reading your stuff, Tina, and thinking about what, what your perspective is, and we talked briefly yesterday on the phone, it really, it really brought up the question of why are so many people having trouble? And is there something that is regulating the appetite that's so dysregulated? The GLP-1. And we're going to talk about what is GLP-1? What does it do in the body? How does it work? Because I think this is important for me to understand. We're going to get a little sciencey here, but if, if you understand that maybe Maybe, like we have a crisis of hyperinsulinemia, we also may have a crisis of low GLP-1, which is a peptide in the body naturally occurring that helps to regulate appetite. Why are people unable to control their appetite? Why are people so stuck in knowing what to do and not being able to do it? Is there merit here to this concept that maybe because of factors that we're going to talk about, that have come recently in the last 50, 60 years that have influenced our biology that have made us low in GLP-1 that's driving us to overeat and overconsume and accelerate this obesity crisis. So, Tina, why don't you start by helping us and we're going to let you kind of wind up and get in a home run here. But why don't you start out by telling us, what is GLP-1? What does it do? why is it important in the body and how does it work? Because I don't think most people understand what this is about. And then we can get into the idea of, well, maybe there is something going on really with this GLP-1 deficiency concept and we'll talk about why. I mean, I just read a paper yesterday that GLP-1 deficiency is really common in people with fatty liver disease. Now, fatty liver disease is a consequence of our high sugar, starch, giant, ultra-processed food. It affects probably 90 million Americans, which is a precursor to heart disease and cancer and diabetes and a whole bunch of other stuff. Even kids as young as 15 are needing liver transplants from fatty liver disease. So we know that at least in fatty liver disease, there is a GLP-1 deficiency. So let's talk about what is it, unpack it, what does it do, and then let's talk about this concept of GLP-1 deficiency.

Sure. So thank you for having me. Of course. I'm a huge fan of your work too, Kelly. I think we're all saying, I just.

Wanna say, we don't agree on everything, but we actually like each other and we're all friends. So this is good, this is good. This is like what America is missing is nuanced conversations that take different perspectives and actually come up with a place where we can all learn from each other and actually be open to each other's ideas and have a conversation that isn't just black and white.

Well, the first thing I thought when I got invited onto this podcast was, well, I totally agree with those guys. So what am I gonna do here? but I do have some nuanced information I want to share. So my background is I have been in medicine either working in the field or in practice for nearly 30 years. I've been in naturopathic medicine for 16 years. I was honored to have an incredible mentor for decades who was an amazing naturopathic physician and a very busy practice. And he taught me early on way back in the 90s. all about metabolic health, all about insulin resistance, all about type 2 diabetes. That was back when Syndrome X was coming on the scene, which is pre-diabetes metabolic syndrome. Yeah, we didn't even have metabolic syndrome as a diagnosis at the time. And so that's right when I dropped into his world. He taught me about keeping your waist circumference low. He taught me about fatty liver. He taught me about strength training over cardio. He taught me all the things. My whole platform is about metabolic and doing all the things and all the things being, you know, mitigate your stress, get your sleep in, protect it, strength train, build muscle, high protein, low carb, get good healthy fats, get sunlight, circadian rhythm, all the things.

Don't forget the vegetables.

Yes, of course. I know you like your vegetables and I try. But this whole thing blew up this last summer with this Ozempic and I thought, well, these have been around for 20 years, these GLP-1 agonists, so why all of a sudden But Ozempic was just approved in 2017. Yes, but why all of a sudden with the backlash? And it really raised some flags for me. So I started researching and my background is in regenerative medicine, so regenerative musculoskeletal medicine. I help people rebuild their joints naturally with natural substances, stem cells, PRP. Been doing that for a long, long time. And so the first thing I did was research GLP-1 and its regenerative properties. I always look up things according to what my brain knows. My brain understands pain, I understand regeneration, and neuroinflammation, all of those things always interest me greatly. And I found so many studies showing impacts on some of the older versions of GLP-1s and the current versions impacting neuroinflammation very positively. I found data supporting its potential use in Alzheimer's and Parkinson's. I found data showing regenerative properties in joints, in cartilage, in ligaments. And I mean, the list goes on and on. I found data showing used early, it could because it actually heals the pancreas. It can reverse type 1 diabetes if used early and started early, semacutide specifically. And I thought, this is not at all what I'm hearing. Like, this is not at lining up at all with what I'm hearing. So, of course, I got super interested. I did a podcast. The feedback was incredible. I had people from all over the world messaging me, telling me, I do all the things you say. I do all the things you preach. I mean, I was severely severely censored during COVID for telling people to go outside in the sun, lift weights, and eat meat.

I mean, God, how radical you are.

I was deplatformed for the work I was pushing back then.

Clearly, that's misinformation, right? Eating healthy and exercising and being in the sunlight, God forbid.

The hashtag Sunlight was banned in 2020 off of Instagram. So I have been on this journey of sort of bucking the norm for a long time, and I thought, okay, I'm not what I'm finding is not lining up with what I'm hearing from everybody. And then of course all the health influencers had to come out against it. And everybody was really quite hot on my tails about it. I was getting a lot of hate for even mentioning that there might be other impacts that they have on the body. It's regenerative, it's healing, and it's anti-inflammatory throughout the body. There's GLP-1 receptors throughout the entire body, including the brain. It's not just made in the gut.

It's a steroid, or I'm sorry, it's not a steroid, it's a, peptide signaling hormone. Yeah. And for people background, peptides are things that our bodies make, and they're the communication Networks. And there's tens of thousands of these molecules. And insulin is one of them. And people are using peptides like thymus and alpha one or BP157 for sports injuries. These are things that, that are available. Something in a prescription, like Ozempic. There are other ones like by Lisi, which is a prescription for sexual arousal in women and men. So there's a lot of things out there that are used. as in traditional medicine, over 70 of these peptides have been approved. And they're things that the body uses naturally. So there are not things that are pharmacological agents. They're actually things that the body has and uses as part of its normal physiology. So GLP-1 is that. And so when we say GLP-1 agonist, which is what these class of drugs are, it means they work to stimulate.

The GLP-1 receptors to have the effects of GLP-1. Correct. However, semaglutide and tirzepatide are actually very closely, well, Turmeric, turmeric's a little bit different. That's one jar for people listening. Yeah, curcuminoid is almost bioidentical to GLP-1. It's simply got as little tinkering on one of the amino acids to keep the half-life longer. So GLP-1 is produced naturally in the body. It's produced by the L cells of our gut. It's also produced in the brain, in the medulla. If it's produced in the brain, I immediately thought, well, it must have use in the brain. And it sure does. It actually has impact on neuroinflammation beyond apetite signaling beyond any of that. We've got it sort of in this box of being, it slows gastric motility, it decreases appetite by slowing gastric motility, very sort of basic kindergarten version, and then in the brain it inhibits appetite. And that's how people have got it. Well, I start looking into it and I'm like, this is a signaling peptide hormone. Why would we macrodose a hormone? You'd feel awful if you were cranking high levels of thyroid or testosterone or estrogen.

And those are sex steroid hormones.

Still hormones.

High doses of insulin, which was one of the first peptides ever synthesized and.

Is, you know, obviously been around for a long time. Right. You die if you took high doses, too high of a dose. So I got to thinking, well, why don't we just dose physio. I do bioidentical hormone replacement by dosing physiologic doses, which are much, much lower, even than some of the standard dosing. So I've always been a fan of starting people very slow and low on any hormone, and I ramp them up and I titrate them up. until they get tissue saturation and until their symptoms resolve. And then that's the dose. And then I test to make sure I'm not causing them any harm. And that's how I manage patients on hormones. We've got leptin and ghrelin. Those are peptide signaling hormones. Turns out leptin and ghrelin, so leptin for the audience listening is secreted by your fat. It goes to your brain. It tells your brain you're full. It tells your brain, it's basically the thermostat of the brain. It lets the body know energy status, right? Ghrelin is secreted by the stomach and it goes to the brain and tells you you're hungry. I always think grrr, ghrelin, right? that's how I remember the two.

Yeah.

Ghrelin and leptin don't work if GLP-1 isn't present. The receptors actually don't even come to the cellular surface. So I was like, well, this is very interesting.

Then I started- but ghrelin doesn't work because ghrelin seems to make you hungry.

So see, people are hungry even when they're overweight and maybe GLP-1 deficient. The receptor signaling of, and this was just in rats, but the receptor signaling of the whole orchestra of how these work together, it's much more nuanced, I think, than we understand. The orchestra doesn't work. if GLP-1 isn't there. So then I thought, I wonder if we have GLP-1 deficiency. I wonder if that's a thing, right? It is mechanistically it's a thing in those with fatty liver, those who are obese, and those with type 2 diabetes. And then I thought, is this a chicken or egg? Is it due to the chronic insulin resistance and the damage to the vagal nerve and on and on in the leaky gut and the damage to the gut mucosa and the damage to the microbiome? That is what is inducing the GLP-1 deficiency.

Environmental toxins, who knows, right?

Then I started talking to my friends who were like the nerdy genetic people. They love their genetic mutations and they started telling me that there's SNPs that code for GLP-1 and that they're seeing deficiency in those or they're seeing mutations in those SNPs in a lot of people. And in fact, one of my friends runs a diabetes clinic, has done so for decades, Functional Medicine Diabetes, and he said that 95% of the patients he's seeing have of this genetic SNP mutation.

And does that mean like 75% of the people who are overweight in America have this mutation?

I don't know. So what's happening?

It seems unlikely that's true. It seems like probably a larger portion of maybe they're severely obese might have that, right? Are we gonna say Kelly?

Well, we talk a lot of the genetic arguments brought up a lot and obviously Did genetics change in the last 50 years? Obesity has absolutely taken over our country.

Gene expression changes, right? So I think that's the thing that happens. Every genetic change. I think genes are complicated. There was Darwin, which is genes changed by natural selection over millennia. And then was Lamarck who said traits can be passed from generation to generation. And Lamarck was kind of dismissed and Darwin won the day. But the truth is they're both right because Darwin is about gene changes and Mark is really talking about epigenetic changes which can happen from generation to generation. And I think one of the things we're seeing now is generations of kids who are born to obese parents. And the consequences of that, the epigenetic changes in the womb that happen from the environment that the baby is bathed in from processed food and sugar and starch and lack of exercise and stress and all the things environmental toxins, all of that is programming these children, we know this data from many, many epigenetic studies, is programmed these children to be obese, have heart disease, have diabetes, end up with cancer, and many other problems. And they're kind of screwed before they're even born. So these kids come into the world and then they're more likely to be obese or more likely to have these programmed epigenetic changes that maybe are affecting the expression of the genes. So genes don't change, but the expression changes. And that's an important point. And I agree, Kelly.

But they could change if that child is provided a whole- that's right. I think genetic changes can be- exposed to sunlight. So we have an Orwellian situation where we have such a crisis in America that children are in utero developing metabolic dysfunction because we're being, our food is so toxic and our, we've had a sedentary lifestyle and aren't looking at the sunlight and being, you know, sleeping, dysregulated sleeping, chronic stress with our phones. So we have such a bad metabolic health environment that we have an epidemic of kids being born born with metabolic dysfunction. So it is societally vital. There's nothing more important than this. So we have an opportunity, it's not a both and. Are we going to, as a matter of public policy and as a matter of focus in that country, change that dynamic of changing our USDA guidelines to say that that two-year-old shouldn't be eating sugar?

100% of us.

When you go the route of Ozempic, When you go the route that this is so bad that we need to jab those children at six, that's a different route. That's a different prioritization.

It's not both. I'm for giving kids six years old those vaccines. That's another conversation. I think that's a little extreme.

But if we agree with the idea, if we actually agree with the science and that this drug is good and should be used as a standard of care, why not?

I don't think any drug is good or bad. You're thinking from public policy, social I'm a doctor, Tina's a doctor. We're both thinking about the patient we see in our office who's stuck as you know what, and how do we help them? And I've had patients who have lost 200 pounds, 150 pounds, 110 pounds, 116 pounds, 138 pounds, just using food as medicine. But it's tough for them. They can do it, but the question is, is there something else that could be done in a way that actually is like Tina was saying, is physiologic, that doesn't use this kind of heavy-handed pharmacological approach to actually help people with fixing some of the metabolic and biochemical things that are going on. And, I think this is an open question. I think we need more data on this, but I think what you're saying, Tina, is really interesting that there are effects of this natural peptide that are different than just regulating weight.

Absolutely.

They may be working through other mechanisms. You know, I had a patient once say, to me recently, can I just take phentermine? And that's basically an appetite suppressant. Crack. It's basically, yeah, it's basically speed or crack, yeah. Basically, yeah, it's like crackheads are so skinny 'cause they wanna eat 'cause they're appetite suppressant. But it's basically speed. And I said, no, no, no, this is really not good because it's gonna cause you to be anxious, palpitations, and have all these issues of sleep. And I think it's not a good idea. But then we talked about Ozempic maybe being a solution because it can be done in a way that is different that works physiologically and works on some of these other pathways that I think people aren't aware of. Like the neuroinflammation is a big one. And I think what we're seeing is sometimes decreased suicide rates, we're seeing decreased depression, we're seeing a lot of other things with these drugs. And I think, well, how is that happening? And what's probably happening, in my view, is people are eating less of the crap because they don't want it. And so their brain and their body inflammation is going down. And maybe some of the effects of the GLP-1 drugs are anti-inflammatory by mechanism. They are. And they are. And so if that's true, then the neuroinflammation crisis, and I've talked a lot about this on the podcast and written a whole book about it called the UltraMind Solution, is our brains are on fire and our brains on fire lead to depression, anxiety, suicide, aggression, societal division, Alzheimer's, Parkinson's, I mean the list goes on and on. Anything that affects the brain is about inflammation. So these drugs may modulate that. It's very fascinating. So they're being studied for Alzheimer's and many other things. Now, I, I think the idea that we should just, like, fall in love with this drug and it's great for everybody and we should put in the water. I don't think Tina or anybody, I think, who is, is smart about this, thinks that. But, but for the select patient in a way, given in a way that can, can actually regulate some of these Pathways, I'm not so sure it should be thrown out. It's like any, any tool. It's like any tool we have in medicine. It's for the right person at the right time.

The right person. Just generically.

I'm just curious. Well, that's, that's a great question. Let me finish what I was trying to tell you guys. I started using this in patients and I have only one who is using it for weight loss. Everybody else is on it for a different reason. And I'm using it at a fifth of the starting dose, compounded droplets. And when I started doing this, my colleagues who listened to my podcast all started also microdosing GLP-1s in their clinics. And we've all reported back to each other and we're seeing phenomenal results in all different kinds of conditions. That leads me to believe that we may actually be able to do away with a lot of the pharmaceuticals that people are using. So people are on other drugs for life, such as high blood pressure meds or statin drugs. These peptides have been shown to heal heart tissue and to reverse heart failure. So I've got one patient on it for high blood pressure, tiny little dose, high blood pressure, blood pressure is down. I personally take it because I have psoriatic arthritis and I have crippling pain from tip to toe. It doesn't matter how clean of a life I live, it doesn't matter how clean my fish tank is, menopause hit me, the brain fog was real and the pain came with it and I knew it was due to neuroinflammation. So tiny little doses mitigates my autoimmune conditions like nothing I've ever used without any side effects. None of the people I'm using it on, none of the people, none of the patients that my colleagues are using it on are having any side effects. You keep the dose low. The nausea, the vomiting, the terrible side effects, the muscle loss, that is all a dosing and management issue. and brand names start in a pre-filled pen. I don't use them. They're too high of a dose. We are mono dosing at high doses, mono therapy, a hormone. And that's why we're seeing these horrific side effects, which I completely agree with. I've listened to your argument on different podcasts, and I'm like, I totally agree with them. I totally agree with what's happening there. But we wouldn't throw out thyroid if all the doctors were overdosing their patients on thyroid. It's a management and dosing issue on the doctor's part. And then how so compliant are patients, right?

Why is pharma starting the dose so high? I mean, the ejection first dose is 0.5 milligrams and it goes to one and two. You're talking about using 0.1 or 0.08.

As a start, which is a fifth of that. Tiny, because they're dealing with severely metabolically busted people already. And the people I'm dealing with are.

Doing all the things and are generally metabolically healthy. If you had someone who was meeting American's metabolic.

What would you do if you had.

Someone come in who was like 350 pounds?

Or the average American.

So you give them a leg up. I have a license to prescribe, so I prescribe things to give people a leg up. I do use Prozac as needed at very low doses. And the way that I have been taught by my mentor is when a patient comes in and here's their pharmacological profile and here's their lifestyle, you lower this as much as humanly possible or get them off is the goal. The reason I became a naturopathic physician in the state of Oregon so I can prescribe is to get people off drugs. and then you bring them up.

You have to have a license to put them on and to take them off.

You bring up their lifestyle, right? And so you hopefully get this as low as possible, but I'm not opposed to keeping people on tiny little doses. This is not the first drug I microdosed. I microdosed Prozac in patients. I've microdosed statins. I microdosed all kinds of drugs to give them, you get a different mechanism of action when you use things at.

Tiny little dosages than when you macrodose them. Macro dosing a drug gives you a different pharmacologic impact on the body. And do they work at that low dose for people? Yeah. What if for your patients who are not really doing it for weight issues, I understand.

Everybody lost weight.

But what about for people who are like 300 pounds? Did you start with the same dose?

So I have one patient who is morbidly obese. He's well over 300 something pounds and can't move in so much pain he can't move. He sleeps in a lazy boy, spends all day in a lazy boy, doesn't get up, doesn't move, cognition's off, has had too many strokes. I don't even have him at the starting dose yet and it's been months.

And he is very happily, very slowly shedding the weight.

Yeah, the starting dose, the pharmacological starting dose. Yes. So I've got him at a fraction of that and his cognition has improved. The cognitive impacts have been huge. I've seen it eradicate depression. I've seen it reverse PCOS. I've seen people walk straight into fertility after decades of infertility issues from PCOS or just decades of PCOS.

And this is all at microdoses. I'm talking droplets. So this compound, which our body makes, maybe is deficient because of why? Why is it because of epigenetic programming? Is it because of our microbiome changing? Is it because of toxins in the environment?

I think all of it. You know, the massive toxic soup we live in. I mean, we live in a toxic soup period. Epigenetically, like you said, mothers, the data around maternal diabetes and metabolic inflammation and the offspring, do you know potting jars cats? Did you guys ever hear about potting jars cats. So Pottinger in the 30s took cats and he fed them, he was a veterinarian, he fed them cooked meat and pasteurized milk. That's all he did was change it. And within one to three generations, they were completely infertile, their intestines were inflamed and boggy, their livers were enlarged and fatty infiltrate, and it took him multiple generations with optimal cat diet, which is raw milk and raw meat, multiple generations to reverse to a fertile, healthy animal. So, I'm 50. I watched all of this happen. I've seen it. I remember when there was like one kid in school who truly had a glandular problem who was overweight. I've watched this.

Erica, my class.

Yes, I've watched this whole thing unfold. I've watched food change. I've been battling against it too for long, long time. But we're in a pickle. And I think I am actually a few generations into potting, at least one into the Pottinger's cats. The boomers had the convenience foods. Crisco oil came into play and here we are. And my daughter- That was Margarine. That was when I lived on when.

I was a kid.

Yeah, me too, and Wonder Bread and bologna. But my daughter's, my daughter's 24 next week and her generation is a mess. It's a mess.

Because of the pharmaceutical industrial complex and treating everything at silos.

I totally agree.

But this is treating obesity at silos.

I'm not talking about treating obesity.

You see a world where it's not not either or. There may be a role for using these drugs in patients to help along with an intensive lifestyle intervention and a functional medicine approach to correct some of the problems that may have been driving the GLP-1 deficiency and not have them on it forever.

Let me give my high level respect on that and then go into certain patient archetypes and cases. I'm really skeptical and I think viewers and listeners just need to make up their own mind. I'm very skeptical at the billing of this drug as a miracle drug for all chronic conditions. There has never, by my account in American history, been a chronic disease pharmaceutical product that's lowered rates of the chronic disease it's ostensibly trying to treat. More statins, more heart disease, more metformin.

More diabetes, more SSRIs, more depression.

You can go down the list. It's not a drug. Because people don't change their lifestyle. Exactly. It's a moral hazard. I talk about my mom a lot. My mom was on five different medications when she was diagnosed with cancer. she would have certainly been on Ozempic. She had trouble losing the baby weight and was never obese but obese after she had me. And she was on the statin on the metformin. And there's a choice a doctor has, right? They can follow your work and when the person has an elevated waistline or has elevated cholesterol or has elevated blood sugar, they can open your book and talk about how they have to go on a path of curiosity and a path of metabolic to get their biomarkers and get their underlying metabolic health more under control. And that cannot be injected and it cannot be pilled. And frankly, I would argue that it's very clear from the data and experience that putting the savior in a lifetime chronic disease treatment has been a total failure because inevitably what happens.

I agree. In a perfect world, we'd have a healthy environment in the country where we had all the defaults being healthy, where there wasn't processed food, where people were moving naturally, where we had lower stress, where we we weren't having being sleep deprived where we weren't exposed to a load of environmental toxins. I want that world 100. We don't live in that world. And I, what's our policy? And I see patients, for example, who, who have had complications from conditions. And for, for example, we're doing clearly heart scans, looking at AI interpreted coronary angiograms. We're seeing people with lots of plaque and dangerous plaque and risk plaque. And those people, I will put on medication. It's not the solution to someone who's younger, who doesn't have a solution. problem to prevent it. But there may be a time for medications in people's lives that actually can be used in a way that helps reverse the problem. And as I said at the beginning.

I'm not concerned with that patient. I'm not concerned with that edge case. I'm concerned with the average person listening. I'm concerned with the average American who's overweight or obese. I'm concerned with the average American teen right now who is overweight or obese. I'm concerned with that person. I'm not concerned with the person on the edge cases. Is this the treatment for obesity? And all you need to do is look at JP Morgan their stock analysis for the Novo Nordisk stock, they project an increase in obesity over the coming 10 years. They project as this drug is prescribed widely and approved and government funded, they assume that obesity is going to go up. You just have to ask why that is. Why is that? One more quick thing, and I think this is really helpful. Why would they say that? Because there's never been a chronic disease drug, and this is a drug in history that has lower rates of the chronic diseases trying to treat. It is a moral hazard. Obesity is not an ozempic deficiency. Alzheimer's, heart disease isn't an ozempic deficiency. The message of this drug, whether you do it a low dose or high dose, quite frankly, because if you start at a low dose, you have to take it for life in order to maintain the weight loss. No, you don't. You absolutely have to take it for.

Life unless you dramatically change your lifestyle habits in which case the drug is unnecessary. I think we're on the same page here because I don't think anybody believes that you can use a drug without lifestyle and sometimes people need a bridge. For example, some people need a leg up who are just so stuck. And I am humbled as a doctor because it's one thing to have a philosophy based on a really a very pure idea of what we should be doing, but the reality is there are real people with real issues who struggle and even with their best efforts, they can't succeed. And so that's a problem I see. And it may be because of the things that are not within their control. In other words, in other words, there may be things that are going on biologically with the drastic change in our microbiome and environmental toxins, which I think are the two biggest things going on that make it hard for people to actually correct those things without some help.

Mark, respect, your books and your teachings have changed my life and we're on this path. And I just have to say, we need to be clear to the American people, people listening to this, if they're facing metabolic dysfunction, try not eating ultra.

Processed food, try cutting that from your diet. Have you had a patient in front of you who's dealing with chronic mold or sirs? or severe trauma and adverse childhood events and it doesn't work.

So I want to go through two patient archetypes, okay? If you are the median American who is on a couple of chronic disease medications and overweight or slightly obese, right? Let's go through this. If you go on Ozempic at whatever dose, right? It's only going to work and you can only go off of it if you radically change your lifestyle habits. So we're all agreeing with that. Correct. You can only go off of it.

So shouldn't you radically change?

Unless you radically change, I just want to make sure we're all on the same page. 100%. So there's no point in really taking it unless you're going to radically change your habits for life, not a crash course, not a jumpstart, but actually really have almost a spiritual reset in your life to change your habits.

I agree.

Okay. If you go off of it, if you just do it and go off of it and don't change your habits, you're going to gain the weight back.

Correct.

So if you're going, if we need a massive, and I'm talking for the median person listening, if we need a massive, almost revolutionist country where we have to change our metabolic habits, whether we're taking the drug or not, why not start with that? Why do we need this drug? Is there any, I agree. Is there any evidence that it gives a kickstart?

If we have a society where all that's possible, great. We just don't.

What is the evidence that the drug helps if we're not changing our habits?

It gives you the ability, well, first of all, the ability to change your habits. Lose five to 10% of your body weight. and see what happens. You start moving more, you feel better, you have less pain, you're more inclined. Most people that I'm seeing on it don't actually want to start changing things significantly until about the two-month mark. And all of a sudden, they start talking about, Hey, Doc, what should I do for exercise? What should I be doing beyond walking? The hedonic urge to eat the junk is gone.

It comes back when you go off of it, doesn't it?

Not always. It actually is having a regenerative impact. There is a long-term regenerative impact and a healing impact from the peptides and we have the data on it. I'm not sure what data you're looking at, but the data I'm looking at.

Is not showing exactly the same thing. And I would say Callie has PEP just to understand pharmacology versus physiology. So, someone has a thyroid dysfunction, they have low thyroid hormone, we give them thyroid hormone for life.

Now, some people can get off it.

If you change a lot of things. And some people can't. Some people can't. You know, if you take a pharmacologic substance, it's working in ways that are are inhibiting blocking or are somehow interfering with normal physiology. Peptides are things that our body uses to regulate its function. I personally use peptides for my own health. I use peptides in my patients for all sorts of different things, from tissue repair to hormonal support to immune support to anxiety and brain health. And they're quite effective. And I don't shy away from using those in the right patient in the right way. As a class of compounds, they're different than pharmacological compounds, even though they've been co-opted by the pharmaceutical industry. Now, the FDA is trying to shut down the use of peptides because they're so effective and they're physiologic. I always think of something when I treat somebody, is this nature-made or man-made? If it's nature-made, I tend to think that it's working with the body rather than against the body. The question is, if you give something like vitamin D, which is nature-made, at massive doses, it's going to cause a lot of harm. But if you give vitamin D to those who are deficient in it and a physiologic dose, it may actually help them function better. So I'm always kind of thinking about medicine in that perspective. I worked, for example, with a woman who struggled for a long time for decades with weight and she tried, she tried, she knew what to do. She'd been a victim of terrible trauma when she was younger. She saw her mother literally stabbed to death in front of her by her stepfather. She was kidnapped and driven to a car. She was raised by an abusive aunt. I saw the amount of trauma she had and she pulled herself up by her bootstraps and she was very successful, but she struggled with her weight around this. This is what we call adverse childhood events. And for her, I think she tried this medication and it really helped her to kind of get back to a level where she could get off the 50, 60, 70, 80 pounds that she needed to get off. And so, it's humbling as a doctor to know when when you can't get people to do the right thing for some reason. There's their trauma, whether it's their emotional state, whether it's their brain functioning or their brain inflammation. Sometimes these compounds can be helpful. So I kind of like to not just do all good, all bad and go, I think we can all agree that the way that the pharmaceutical industry is doing this is bad. I don't think any of us have any argument about that. I don't think any of us have an argument that farmers shouldn't be driving all the research, it shouldn't be driving all the, the marketing that should be driving all the co-opting of, of the research institutions, the professional associations, Physicians promoting it, you know, the government lobbyists, you know, I mean, you know, they're trying to get approved for Medicare. I'm like, well, gee, you know, for Medicare Part D, which is the drug benefit, the total benefit for all, everybody and all drugs in all America is 145 billion. If just the obese people in Medicare got this, it would be, I think, 267 billion, which is more than all the rest of the drug benefit put together. So that is not a solution. We're working, for example, in Washington to try to get Food is Medicine covered. We're going to get there, but it's a decade long fight. In the meantime, we're heading into some crazy period of metabolic disaster in America that we need to do something. So I would like to kind of go back to Tina and talk to Tina about her approach with her patients because I was, to be just honest, I was pretty skeptical. I was like, I don't know. I think I prescribed it maybe one or two times in very select patients who really had to get the weight off. They were, had Alzheimer's or they had something really serious. And I, and I used it very carefully. But, but I really had a, a very similar perspective to you, Kelly, that this is something that we should, we should really not be using, that lifestyle works better, that, that, you know, that if you, if you look, for example, the studies of gastric bypass, which is the other treatment, which is by the way far cheaper if you're paying retail for these things. If you give someone a gastric bypass and then you have someone eat the same diet as if they had a gastric bypass, there was no different in the outcomes. So, to paraphrase Bill Clinton, it's the food stupid, right? And I was like, wait a minute, if people just did a study, they haven't, I've never done this study because I looked to see if there was a study done. Was there a study comparing diet, aggressive diet intervention, the same diet people would eat on a GLP-1 agonist with a GLP-1 agonist and looked at all these effects. Would neuroinflammation go down? Would fatty liver improve? Would heart failure reverse? I think it would. I don't know how this study worked, but I had a patient like this. She was 66 years old. She had heart failure, liver, fatty liver, she had diabetes, she had all these problems. We didn't use a semaglutide. We just used food and she was off all her medications in three months. She lost 43 pounds in three months, 116 pounds in a year. and she got reversal of all these inflammatory things. So, would she have been helped even more with those I don't know. So, this is a question I have and I kind of want Tina to you to talk through how you use this with your patients because it's a very different approach than I think we're talking about what's happening wide scale in the country. It's like you go to the doctor, you give those impact, now you can buy it online, you can go to Ozempic websites and they talk to you for five minutes, they give you the drug, and it's like a prescription mail that I think should be illegal. But I think in the right patient, in the right way, tell us what you're seeing.

Well, first of all, I don't use anything in isolation. So the foundations are always the foundations, right? Diet, lifestyle, exercise, sun, all of those are always critical. Sometimes people aren't ready to implement all of those things, and it's quite a bit overwhelming, as you've seen with your patients. You got to start with one thing. I also never use peptides in isolation. I like you use a multitude of them with patients. And I also usually bring in some bioidentical hormone replacement as needed, depending on their age and their condition. And so this is just but one tool in a comprehensive tool belt. And when done that way, I found that you can keep the dose significantly low. And then I cycle it. So just like a hormone.

So not on it for life.

No.

On and off.

Off, just like I do a hormone. So that off period may be one week out of the month. It may be a month out of every quarter. It may be go off for a period of time and go back on when you need it. And do they gain the weight back.

When they do that?

Not if they're metabolically optimized. So I really think that peptides in general work best in folks who are metabolically optimized. So I'm not defending this for strictly weight loss. I'm using it as an adjunctive tool in a comprehensive toolbox to get people that leg up so that they they have the energy, they start to drop the weight, they start to do all the things, or they do better at doing all the things, right? It might be the patient is doing all the things, but they've got a crazy sugar addiction, or who knows, who knows what it is. Again, mold exposure, Lyme disease, it could be a myriad of things that's keeping their glucose elevated. They are doing everything perfectly and their blood sugar's still elevated. I've seen patients like that. You're like, how is this? How are we still dealing with this elevated hemoglobin A1C? You're lean, you're fit, you're doing everything right, you're eating like a saint, a touch, just a little touch of something. I don't, it's not always a GLP-1, but there's something that they need. And when we give that, we give what the body needs, it responds in favor and they improve. And I'd like to say most women I know on bioidentical hormone replacement will tell you we don't mind taking it for the rest of our lives. I don't plan on getting off thyroid. I have no desire to get off thyroid. I have no plan of getting off of my estrogen. I have no desire to. Well, let's talk about this because I.

Think what's in the literature and concerns me is some of the side effects, right? And I think Kelly, maybe that's what you were about to say.

So, I hear you on the metabolically optimized person, but for somebody, like more than 50% of American adults by some measures up to 60% have pre-diabetes, I think 80% or so don't know it. Most people listening are, you know, have indicators of metabolic dysfunction. generically, if it's better for metabolically functional people, which is a very small percentage of the country, what's the high level? Well, no, what that you were saying.

Was peptides work better in all peptides. They work in everyone, but they work.

Best when you're in that you can keep the dosage low when folks are generally healthy. Now, geosmin.

Those very insulin, if someone's very insulin resistant and type two diabetic, they need a lot of insulin to lower their blood sugar, but if someone's insulin sensitive.

They need a tiny bit metabolic dysfunction will need a good deal more? Not necessarily.

It depends on when they start implementing lifestyle changes. Some people need some help getting there. And the other piece is that I don't think people need to be on them for life at high. I certainly don't think people need to be high-dosed the way that they're being dosed. I think that was just the way the studies were ran. We're also dealing with a population when we're talking about diabetes and obesity who are already prone to pancreatitis, they're already prone to thyroid cancer, they're already prone to gastroparesis. I mean, the number one risk factor for gastroparesis Type 2 diabetes. Type 2 diabetes. And the number one risk factor for thyroid cancer generally is diabetes and obesity. So you have two times the risk. So I'm talking about intervention because these peptides actually, they don't act as just a band-aid, Callie. They heal your metabolism. They heal your pancreas. They heal your liver.

They heal your metabolism. That's an interesting concept because like for example, I use BP-157 when I have like a, and I work out and I get a little strain of muscle. I just pop it in there and it's better. So, it regenerates tissue, it repairs tissue. I had a guy who was an elite athlete and he pulled a muscle in his calf and he couldn't do all the things he had to do. I just popped a peptide in there. Someone else said, tennis elbow, I popped a BP-157 GHK peptide in there and it did maybe a couple of times and it resolved the problem. Now, I think GLP-1 agonist may be a little bit different, I don't know, but they do have a regenerative capacity. That's what these peptides are meant to do in the body. So, they're different than drugs. And, I think that the pharmaceutical approach is concerning to me because that doesn't include a holistic approach. You and I do that, obviously, and there are some doctors around the country who are focused on that. But most of the people getting these drugs are just getting them. And then they have some significant issues. So at the dose that we're seeing that people are getting, there's very high rates of nausea, very high rates of diarrhea, constipation, like 20-25%, probably 67% of nausea. It tends to go away after a little bit, but it still is a problem. And 80% discontinue them after for, I think, a couple of years or a year or two, which is an interesting phenomenon, whether it's cost or side effects or maybe, I don't know what. And then there's the risk of some of these other issues. Now, the absolute number is small because these are rare conditions, but when you look at the data, published data, there's 450% increased risk in bowel obstruction and 900% increased risk in pancreatitis. They seem not trivial. And if you scale it out on the population, and the incidence of this, it might be if, you know, I don't know, 100 million people are taking it, it might be 500,000 people with it, which is not trivial. So, how do you think about these side effects? How do you see these being different in the patients that you use the microdosing, as you call microdose? I wouldn't call microdose, I'd call it low dose. Yeah, it's low dose. Microdose is like micro. But low dose, I think you're using low dose, which is, I think, an interesting concept. And by the way, people, you cannot get low dose through the drug companies.

No, the brand name can't.

Compounding pharmacies. And we're going to talk about that and the challenge with that, but there's a way to get it and do it, but it's tricky and you need to be with the right practitioner. But given these side effects, can you talk about what you think about these? Are they as bad as we think? Are they just in the people who are on high doses? Do you see this in the population who are using smaller doses as you're talking about?

I'm not seeing it in any of my patients. the study that you're referencing, you're right, it was a small, I mean, I think it was like seven out of 600 and something got the bowel obstruction. You know, seven people, which looks terrible as a hazard ratio. And when you scale it out, yes, I agree, but I think we're talking management and dosing being the problem. And when you overdose somebody on a peptide or anything, I mean, when I take too much BPC-157, I swell and I get swollen throughout my body, I get edema. So overdosing somebody on a GLP-1 is, I think, is what's happening. And then we're taking already brittle, they're metabolically brittle, their vagus nerve is damaged already, their muscle tissue is already pathologic and full of fatty infiltrate. And then we're slamming them. Ribeye, wagyu ribeye.

Yeah, and then we're slamming them with monotherapy, high dose GLP-1s. I think it's a disaster. So for listeners, if they listen to this and go to their doctor and get the prescription of those medications. They're not saying often that is an overdose.

It's actually very dangerous. I don't think it's very dangerous. I think in the wrong person it could be. Yeah, it tends to have more side effects. Yes, you're going to get more side effects. And the gastroparesis is not permanent, regardless.

Of what the clickbait headlines are telling us. Meaning when your stomach kind of stops.

Working, if you stop the drug, it'll come back to normal. Yeah, it comes back online. The thyroid cancer is correlative at best. It's been in rats. It's been in rats that black box.

Warning is in rats that were given.

Like cancer that doesn't even occur.

You're saying you're downplaying that black box warning? No, it's in rats.

But you're saying there's no human case. There's literally no human cases showing causative. I will just say for the FDA, which is 75% funded by pharma, which is basically a subsidiary of pharma, for.

Them to put a take the step of putting a black box warning means there's pretty scary data in my opinion on the thyroid cancer. Well, I was gonna finish. They took the rat and they gave him a 100 times the human dose. And they got a very rare form of medullary thyroid cancer that rats develop spontaneously. And the control group also got a high rate of medullary thyroid cancer. But you're not downplaying anything. I'm not downplaying anything. No, I'm talking about what the Cleveland.

Clinic is showing for the actual data. Just for listeners, should they be concerned.

About thyroid issues, hormonal issues leading up to thyroid cancer? They should talk to their doctor. And if they have a history of medullary thyroid cancer in their family, they should absolutely that's a doctor-patient relationship discussion. I'm not defending Ozempic and I'm not defending it at high doses for weight loss. I'm talking about nuance. We're not throwing out the baby with the bathwater.

I think that's an important point, you know. I think we have to do it in the right way, in the right context for the right patient. I always say, you know, there's a Buddhist concept called the right medicine. What is the right medicine for this person? Is it a motherectomy if they're 50 years old living with their mother that's driving them crazy or, you know, or that they need exercise or what, then they need the nutrient they're deficient in or do they need to have some support for their metabolism? And I think, you know, it's conversation is hard because we're threading a very tight needle here, which is at scale in the population, the way it's being done now, I think is problematic. But is there another alternative to think about this that we can basically encourage people to think about that includes an aggressive lifestyle intervention with some peptide support? for it, which I use across many, many other peptides. I use many peptides in my practice for just general therapeutic treatments that support the body's own endogenous functioning, which is what I love about peptides. I love things that nature made, not that or God made, not man-made because they tend to be more problematic. That doesn't mean that these don't have side effects when you use them in huge doses. It looks like vitamin D, right? So one of the things that also is a problem is muscle loss. And there's a lot of the data is very clear on this. in DEXA scans and some of the studies showing significant weight loss. But the truth is, if you just lose weight without exercising and eating protein.

You'Re gonna have the same result.

It's the same percentage on a low-calorie diet. So, it's the same percentage on a low-calorie diet. So, if you calorie restrict and you don't eat protein and you don't strength train, you are going to lose muscle and you'll lose muscle and fat at about 50% each. And when you gain the weight back, you gain back all fat. And so, you screw up your metabolism if you do the weight cycling, which is a real problem. So, how do you address address some of the concerns. Because aside from the protein increased needs, when people are on these drugs, they tend to have suppressed appetite. So they don't want to eat as much protein and they don't want to eat as much food. And then they may be at risk for nutrient deficiencies. So how do you deal with those kinds of issues?

Well, first off, I think that's a dosing issue. If you pull back the dosage low enough, people have an appetite. and they continue to eat regularly. And interestingly, I've got people eating, claiming to eat the same amount of calories and still having visceral fat loss, and they're tracking themselves. So there's something changing there. We have data to show that it decreases visceral fat while maintaining and actually inducing muscle protein synthesis. GLP-1s induce muscle protein synthesis through various signaling pathways and through perfusion, blood perfusion and delivery of amino acids. It's folks going on a severely calorically restricted diet that is causing the muscle loss. The doctors are cranking the dose too high too fast. They're being ramped up way too fast. It's crushing their appetite. They're going into an anorexic state and they are indeed losing everything. And just like you said, they're gonna end up way worse off at the end of this terrible journey. And so I don't disagree with that. I always say that strength training is non-negotiable. And I've said that for decades. Strength training is non-negotiable, period. If you wanna live a long healthy life and be metabolically optimized and survive the zombie apocalypse, you have to strength train.

The game is tough, right?

It really is. And so we can blame the doctors, we can blame the pharmaceutical industry, but I'm talking to the patients because you and I both know that compliance is an issue with patients, and they don't always do what we want them to do, and they don't always do what we need them to do. So my patients understand the prescription ends if you don't strength train. I will pull this out.

We will no longer be dispensing this. So strength training, optimization. They need to have their Fitbit or.

Their Apple Watch or their Oura Ring. Yeah, they need to pump directly to you so you can see. Well, I can tell by touching them. I'm a chiropractor, I can tell by their muscle integrity just by putting my hands on them, whether they're, you know.

Good musculature or fatty, flabby muscles. That's a bad idea, right? It's not a bad idea to support.

People and have them track and be accountable as they're doing this. That's helpful. It sounds like we're all in agreement. And I just want to like tailor, like the person I have in my head is the median American who is on the fence about Ozempic, who's hearing the PR that this should be the, you know, standard of care for somebody that's overweight or obese. And, I want to be clear kind of what we're all agreeing on here, which is that Ozempic at the recommended dose, at the dose you would get from your doctor if you go get it, is essentially an injectable crash diet.

Dr. That's not all it is. There's a ton of regeneration and healing.

Happening from the peptide. Dr. So, I think it's important to talk about what we call pleiotropic effects in medicine, which is the multiple kinds of effects on the body from one compound. that's in the body.

Well, if we're going to talk about the interconnectedness of the body, you know, I think we should look at the 80% of people, you know, having serious side effects. And the, you mentioned the mental health, but the data is pronounced impact in mental health issues.

Not correct.

Well, there's a EU investigation into suicidal ideation.

And they came back and said it was not an issue.

They have not. They have not. There's a serious investigation going on in EU that is not it impacts the drug. Tell me if this is the drug is basically gut dysfunction. It messes with our gut where 95% of our serotonin is made. If we're gonna talk about the gut. It actually shifts your microbiome into a.

Favorable microbiome and out of a pathologic microbiome.

When I talk about the interconnectivity of the body and the interconnectivity of this drug, I think we would all agree there's much more we don't understand about about how this drug impacts the myriad of metabolic dynamics going on in the body.

I think there's mixed data, right? I think there's some data that show that there was a study looking at antidepressant effects of GLP-1 receptor agonists. That was a meta-analysis with 2,000 people, five randomized trials, one prospective cohort study, and it was about 24 to 60 weeks. And they found that actually it reduced depression in adults in both adults and adults with type 2 diabetes.

So there's also studies that show that maybe it's not. I've got a question. So this drug, we're saying it's a miracle drug that makes you not want to eat, that makes you not want to gamble, that makes you not want to have sex in some cases, there's reports of. It basically decreases, it seems like, desires. So are you worried that there's an impact that this drug has on our dopamine or serotonin levels?

It actually improves dopamine signaling.

By making us not want to engage.

In the activities that bring us joy? No, it impacts the HPA axis and It's a dopamine-ergic effect.

So you're saying flatly that a drug-.

It's not a drug, it's a peptide and they're overdosing people on it and that's why they're having terrible side effects.

And also when people lose a tremendous amount of weight too fast, they get depressed and suicidal. So you're not concerned about unknown impacts.

To our dopamine or serotonin from a.

Drug that by all reports makes us.

Want to do less of the things that bring us joy.

Well, just eating.

I don't know if- no, no, there's studies coming out of- I'm not seeing any appetite suppression. It's being used as a gambling cessation.

And an alcohol cessation.

That's awesome. That's good though. Yeah, that's awesome.

I don't want to do almost everything. That's what the drugs are for. Maybe it's maybe I'm just saying that doesn't indicate.

I'm not hearing that from people. There's an interesting conversation here about dopamine because I think we have dysregulated dopamine and there's, and I do genetic testing with my patients and we see polymorphisms or variations in the dopamine receptors, the DRD2 receptors, which affect pleasure. So, some people may need a lot of a substance, whether it's alcohol or sugar or gambling to actually feel pleasure. And so there are people who are at risk for increased obesity. It's based on this sort of low hedonic drive to pleasure. And I think the question is, do these drugs modify that in some way? Do they actually not do it in a bad way, but maybe they do it in a good way? Because I think if there's something that can actually help people reduce their addiction and reduce that drive and actually have pleasure from things that are just things that we all get pleasure from, that would be better.

I'm just trying to use common sense here, right? I'm not saying it's a bad thing that people are eating a little bit less, that gambling less, engaging in alcohol less, engaging in drug use less. But if this drug is basically across the board making people want to do less of things, that to me demonstrates potential concerns, unknown concerns with impact on our dopamine levels. There's a lot of concern. There's a serious concern.

My joke always is that there's a study in the New England Journal years ago that said we should start to use these new drugs as soon as they come out before the side effects develop. So we don't know what's gonna happen in five, 10, 15 years.

We really don't. Well, we have 20 years of data on GLP-1s, just not semaglutide and tirzepatide. And we weren't hearing all of this, these huge mainstream media headlines before that, with exenatide that's been around for 20 years and liraglutide.

Yeah, I mean, there's mixed data on the suicide thing. And some of its population data, the clinical trials don't show that. There's big horror studies of 240,000 people, 1.6 million patients with diabetes prescribed Ozempic, 240,000 on Wegovy, and there's a lower incidence of suicidal thoughts in patients. And so I think, you know, I don't think we know. We just have to keep tracking it. I think you're right, it's good to be concerned, and we do need to do post-market surveillance of what's going on with these drugs and how they impact people's health. sort of, you know, like, I'm sitting here honestly, like, kind of in the middle and also confused because part of me is like, God, wouldn't it be great to have a leg up? Because I've been treating people with obesity and overweight issues for 30 years, and it's tough. It's really tough for them. They really struggle. They want to do the right thing, and they're highly motivated patients, and it's still tough. And so I wonder, you know, this is not a miracle drug. I don't think Tina would say it's a miracle drug. I think, you know, like any compound has and so is there a role? How do we use it? Does it make sense to actually think about this differently from how the traditional pharmacological medical approaches is doing something and doing just not dismiss it wholesale as a part of an overall solution. So I think in the perfect world, we totally fix our food system. We would get rid of all the junk. I mean, I had this crazy idea that if we actually gave Ozempic, everybody's overweight, all of a sudden people stop eating junk and the industry would collapse and everything would be great. In fact, the CEO of Novo Nordisk who makes Ozempic was getting calls from people in the fast food and junk food industry really concerned about this. McDonald's is concerned about this because it's cutting into their stomach share, we call it stomach share, which I think is a good thing.

Yeah, the CEO of Cheez-Its, the fact that there is a CEO of Cheez-Its cracks me up, but the CEO of Cheez-Its said we will keep an eye on this and they're actually doing a detour and coming up with potentially supplements to offset their snack sales because they're down. The joint replacement companies are concerned. Dialysis clinic companies are concerned. You know, there's a lot of big companies that are concerned about this as well. So I feel like, and here's just a total, you know, out in left field. I actually think big pharma is concerned. I think the big pharma companies who don't hold a patent on a GLP-1 agonist are very concerned because they happen to be the ones who hold the patents on the population regular statin drugs and blood pressure drugs that every American ends up on for life. So I really wonder if Big Pharma isn't actually, you know, depends, you know, War are the big Pharma companies. I don't know.

I'm speculating, but I've been. They're, they're thrilled because Colmar videos are going to go up.

Colmar videos are going to go up. Are they, though? Yeah.

Because, because we do it right. If we do it how we're doing it now, but if we do it right. This is why it's zero sum and why it's so important. Colmar videos are going to go up because that happens literally with every chronic disease drug in the history of modern America. They would be literally the first to not be correlated with increased chronic disease. Here's why. Because if you are, and I want to understand where you're, because you're saying it's a good thing, it seems like that the standard of care, that the high dose is actually going to lead to a lot of reduction in comorbidities, that's the track we're on. We're on the track with a very high dose being open season for the majority of the American people. And if the standard of care when a child is overweight is to prescribe them this drug and not talk to them about your books.

Right.

Can I interject? We're saying that HCG is gonna go down at scale as this drug is widely prescribed. That's what we're on the verge of doing.

I think we're giving doctors a little less credit than they deserve.

Well, we might disagree on that.

I'm not a fan. Well, I purposely did not become an MD because I wouldn't do it. I purposely became an naturopathic doctor because I didn't actually have- I wanted to go to naturopathic school. I didn't go, I wasn't gonna go work for the evil empire. So from the get-go. So I have been watching every single webinar piece of information that every single medical platform has put out. Medscape, every single one. On this topic. On this topic. I have been doing nothing but consuming information about this. And in every case, the doctors, the obesity obesity specialists mean well. They all talk, especially I watched a whole one on childhood obesity and they were like, we don't want to be injecting children. We can talk about children exercising more and children eating better and children doing all the things. Really the issue is their parents. Getting the parents.

The whole environment.

Parents aren't trying to poison their children.

Actually most children who suffer from obesity have obesity parents.

Parents.

Okay, so we have a situation where I wasn't 80%. Sorry, go ahead.

In all of these webinars, they specifically double down on lifestyle. Yeah, they specifically double down on lifestyle. And I'm not bought out by Big Pharma. I'm not a fan of the allopathic medical community, but I have been watching all everything from all sides that I can get my hands on to see where this nuanced conversation is. And in every case, they are talking that we have to be implementing lifestyle strategies for adults and children. And the other part of the conversation.

That- Tina, but that's true Tina, but there is no incentives to do that.

I understand.

If there were, I agree with you, it would be amazing if we all start with that.

But the doctors are saying, at least that's they're trying.

Don't look at what they say, look at what they do.

They don't, they're not a system that allows them to do it. Every doctor I know would want their patient to exercise and eat more and do better.

Oh yeah, I've talked to Harvard obesity doctors off the record where they said they didn't get into this to see kids be obese, but also that they would be laid off and their entire department would be laid off if they don't have more obese children. And they do understand those incentives. Every obesity doctor- I think they'd be.

Happy to be out of a job for that. They do find something else to do.

But a person at an obesity clinic who has payroll, who has loans underwritten on their new center that requires more children to be obese, let me back up a little bit.

Sure, there are perverse incentives, but I would push back a little bit on doctors being evil. that way.

I think they're stuck. I don't think they got into this for kids to be obese, but it is just a statement of economic fact that they need more obese children in order to have a job.

Yeah, maybe. But I think if you talk to most physicians who are dealing with this, they would love to sort of magically snap their fingers and have some place to send their patients to an intensive, immersive lifestyle change program. I know that's true. And when I was in Washington in 2008 and '09 during the Obama care development of the legislation, I was really working hard to insert in the legislation something called the Take Back youk Health Act, where we basically got the government to pay for intensive lifestyle change with a multidisciplinary team over a long period of time to create sustained behavioral change. Because we know how to change behavior and what you're talking about is behavior change, but we don't have any mechanism in our healthcare system to support behavior change. And that's really the problem. We don't pay for it. We don't incentivize it. We don't have it. No one has how to do it. I mean, I met with Kathleen Sebelius, who was the head of Health and Human Services at the time. And I proposed this idea to her during this time. She said, this is a great idea, but who's going to know how to do it? Because doctors aren't trained to do it. They don't know how to do it. They know anything about nutrition. I'm like, you're right. But let me tell you something. When somebody invented angioplasty, you didn't and you reimbursed it. You didn't have to worry if they.

Were going to figure out how to do it. If you paid them $10,000 to do that, they'd freaking learn how to do that. And I think we're in the same situation. It's all about perverse financial incentives. sentiment.

Yeah, let me just double click on.

That because I think obviously doctors get in this for the right reason. I really do think they're stuck. But the raw economic fact is that there's been no more profitable invention in the history of modern American capitalism than a sick child. A sick child is the most profitable entity in the world because that child is not learning metabolically healthy habits and they're continuing to rack up comorbidities.

So imagine a high school, right?

Long term, they'll be the ones... Imagine a high school. Well, but they're not going to die right away. They're going to so profitable. So imagine a high school right now. You've had a doubling of prescriptions for SSRI, statins and metformin among high schoolers, a doubling in less than the past decade. So those drugs are being prescribed like candy. You have diabetes and pre-diabetes epidemic, you have a high cholesterol epidemic, you have a depression epidemic, you have a high blood pressure epidemic, and you have an obesity epidemic in high schools. And those kids are the most profitable patients in America, because if you can get to them and say that the high cholesterol is a statin deficiency and the high blood sugar is a metformin deficiency and the obesity is an obesity deficiency. They're not learning metabolic healthy habits. It's about the money. Okay, so are doctors evil people? No. Are they complicit in this dynamic knowingly? Absolutely. That is a profitable... If you take that kid, if you take a 12 year old, and I want to talk to every parent listening right now, it is open season very soon on your 12 year old to give them Olympic, you're gonna be pushed, you're gonna be shoved studies down your face, you're gonna be saying you're anti-science if you don't give this, you're gonna.

Be, you're gonna have to sign, you're.

Gonna have to sign, you're gonna actually have to, they're gonna pressure you to say you're going against the American Academy.

Of Pediatrics, they're gonna pressure you to jab your 12 year old. That is going to be open season. The reality is because doctors are stuck in a system, it's like a black box, and what they don't realize that most of their education is pharmaceutical driven. I was sitting on a chairlift once skiing at a resort and this woman was next to me, she's like, so what do you do? I'm in, you know, pharmaceutical education. I'm like, what do you do? She's like, oh, we put on continuing medical education conferences for doctors. So, you know, there really is a corruption of our medical education system. My daughter's in medical school now, I see it. There's a corruption in the research infrastructure and how it's done. and we don't fund the right types of research to support lifestyle intervention. So we have a very screwed up system and doctors don't necessarily know they're in it.

It's like the Matrix. What do you think is going to happen for a 12-year-old if they're prescribed Ozempic and not given lifestyle intervention? Are they going to watch their weight? Are they going to stop eating? So that marginal 12-year-old who's on the borderline of obesity, do you think are they going to embark on a path of metabolic health and curiosity? Are they going to continue to ultra-processed food, continue to poison their cells even if it's 80% less.

Well, that's the problem.

That's the problem with those industries.

I think what Tina was saying before is really key. If you link the prescription of these drugs to certain behaviors and track them.

But that's a cultural, that's a monumental cultural change that would have violent opposition because the second as a standard of care for medicine, you start talking to a kid, remember, that kid is the most profitable entity in America being sick. So there's gonna be huge violent opposition to instead of prescribing them a statin and ozempic to give them the blood sugar solution or one of your books and talk to them about exercise and incentivize them to eat a healthy diet. That would immediately take millions of children off the chronic disease treadmill that's fueling the largest and the fastest growing industry in the country.

I don't know. I'm not sure. I'm not sure I agree with you. Cause I said to the Cleveland Clinic once, I said, well, we were at the World Economic Forum, Toby Cosgrove, and I said, listen, Toby, and I was kind of joking. I said, how would you like me to empty out half your hospitals and cut your bypasses and angioplasties in half? And he said, that would be a great idea. I said, but what you're making $8 billion a year, what if you're making $4 billion? He says, we'll figure it out. We'll figure out what the right thing to do is. So not everybody obviously is like that in medicine, but I do think that people in medicine generally want to do the right thing. And if they could get rid of.

All of these kids, I think they would do it.

Are businesses and private equity and medicine now. I mean, it's like, it is a-.

Then why isn't the American Academy of.

Pediatrics talking about diet? Why?

Because they're funded by pharma and the food industry, that's why.

Why isn't, why is the, you know, why isn't the American Diabetes Association talking about diet?

Same reason, same reason.

But those are the doctors. No, they're not.

They're the professional associations.

Who set the standard of care that-.

Who set the standard of care?

True.

But doctors aren't necessarily- why are doctors speaking up?

Some are. Some are.

You are. I mean, there's a few.

I've been in this a long time and it's really challenging. It's easier said than done because you could put all of these perfect world scenarios in front of a 12-year-old and if their parents are not going to comply with it, that kid's stuck. That kid's stuck in that household having to deal with what's made for dinner for them by their mom and dad. And most cases of childhood obesity are stemming from obese parents. There's a whole overhaul that we have to do that is so much more nuanced than just changing public policy.

I'm gonna work with Tina for a minute on this because I think what you're doing is so unique and I think we can learn from it because you're not practicing metabolic medicine in the same way that most endocrinologists are or doctors are who prescribing Ozempic or similar drugs. And, you're including a very different set of things that you look at, that you treat and that you manage and you don't, you're not finding the same complications, side effects, a weight regain, muscle loss, stomach issues, gastroparesis, nausea, vomiting. You found a way through to do this in a way, in a very different way that I think is worth talking about because, you know, we all agree that the traditional pharmacological approach is a bad idea. And I agree getting a 12 year old in Ozempic and just sitting on their way for the rest of their life is a bad idea. what is the right idea? If we can create a blue ocean and say, okay, what would be the perfect use of these peptides in the world to deal with a really serious crisis that we all agree is happening, which is a metabolic crisis? So, in a real-world scenario, in a perfect world with a blue ocean, how would we create a 360 treatment approach, which you've done, to help people regain their metabolic health when they're metabolically busted? which is anywhere arguably between 42 and 93% of Americans.

I always start by giving them something to add and not something to take away. I don't take away the ultra refined carbohydrates right off the bat.

People will fight- Damn, you're nice.

I'm gonna give them a vote. They will fight for their addictions. People will argue for their addictions. You go, shit.

I know.

They tried to tax soda in New York and people flipped out and rioted. People will not let go of their addictions, but if you can get them to acclimate mate to a new normal and you can get them to stack some wins and get some little dopamine hits on their own, you start to see change. So I get people walking, I get people increasing their protein. When you increase your protein, you become less hungry, you stop eating as much garbage. It's a slow incremental step up. When they start to feel stronger and their joints feel more stable, we start to get them strength training. I do start to educate them about the evils of ultra refined carbohydrates. I educate, it's tattooed on my wrist, doserri. I educate my patients so that they understand why they're making these changes. I have them read good books. I have them own the information because when they own it, they're empowered. Even with best efforts, sometimes we need a little hormone depending on their age. We might need some probiotic support for a short time. I'm not a big fan of doing that long term. We might need to obviously address nutritional deficiencies. It's a comprehensive, holistic stupid way of getting the body back to homeostasis. And when the body comes back to homeostasis, weight starts to fall off. Yeah.

Right?

And so that's part one. Part two, something that no one's talking about that obesity experts know well is that getting weight off is actually the easy part. Keeping weight off is incredibly difficult. So what do we do there?

And I think that's important because what we were saying before was that these are perceived as lifelong drugs, but maybe if we use them properly.

We got to get leptin signaling corrected. We got to get ghrelin signaling. There's leptin resistance in the brain, there's cortisol, there's all kinds of issues. And so I look at a person comprehensively. I don't look at them as a condition. They come in and they say, I have this, this and this. I'm like, okay, whoop-de-doo, I'm interested in you. Mark, let's see what's going on with Mark. How do we get Mark back to homeostasis? And things start to fall into place that way. It's a slow, steady process. I realize not everybody has access to doctors like you and I, and I realize that not everybody knows how to practice the way we do or even wants to practice because it takes time. time, and it's arduous, and it's complicated, and it's like trying to hit a moving Target. Right. But I'm trying to pull people back to Center so when they know better, they do better. They can educate their families. They can. That trickles down. You know, I catch my daughter schooling her friends on things. I catch my husband teaching the work crew about nutrition in his own, like, you know, blue collared way. So we teach and we educate, and that's all I'm really trying to do about these peptides is like, yes, I understand that mono therapy high. the way it's being handled, jabbing 12-year-olds with it, not the solution. Not long-term, not sustainable, not a good idea, but there's nuance here and I do think they have a place. And so I will use them as needed per the individual. I don't know if that person's going to need it forever. I don't know how metabolically busted they are. I don't know how quickly they're going to respond. And I don't mind if they feel fine taking a tiny little dose of this and cycling it for a long period of time. I am there to treat them and serve them. I'm not there to impart my policy changes on them for a worldview. and say, well, Ozempic's bad, therefore you can't have it. That's not my job.

In a sense, what you're talking about is taking someone who's metabolically busted, as you call it, to what I call metabolically resilient. So when I take a patient who's type 2 diabetic, who's on 100 units of insulin, I'm like, no, you can't have any sugar. Of course. You probably can't have any fruit for now. You can't have any flour. This is just a hard no, okay? If you want to get reversing your diabetes, you just like Benjamin Franklin said, you need a pound of cure, not an ounce of prevention. And then when we get them metabolically resilient, then yeah, you can add that stuff back and you can try to have a little, see how it affects you, have some more fruit, you want to have sugar or dessert once in a while, okay, if it's the end of a meal, become more metabolically resilient. And what you're talking about is shifting people from metabolically busted to metabolically resilient.

And using a holistic approach that may include peptides.

Right?

Correct. But didn't you say your patients weren't metabolically busted?

Not all of them. They work better in people who are using them to optimize. If we're just using peptides to optimize or we're using a little TRT or a little bioidentical hormone replacement in someone who's generally optimized, it's a much lower easier process.

Like your dad, for example. My dad's a mess. He's got diabetic, he's a mess.

100 pounds overweight. What would you do for him? Dad, doesn't matter what I teach him, he's not gonna change his eating habits. He's got a serious addiction. And so I told him, I was like, Hey dad, you've got one foot in the grave, you're in your early 80s, you're on your way out, his toes are purple. I mean, he's looking at toe amputation here in a hot second. He won't walk anywhere, he won't do anything. I said, I am gonna crank the dose up on you. I'm gonna get this weight off. But you know what? Cranking the dose up in my world does not match what the allopathic system is doing. We're still going very slow and low. And my dad's actually talking. now, and he's got hope. And it's the first time at Christmas, this Christmas was the first past one that we actually had a conversation. My dad was involved instead of just being checked out and glazed over. So he, and he has hope. I bought him a vest, like a puffy vest. I said, see, you can wear them on your walks because he can't get a jacket on because he's so heavy. He doesn't want to go outside and be seen. He's embarrassed. And so I bought him a puffy vest, and it didn't quite fit. And he looked at me and he goes, I have, I'm hopeful this is going to fit me soon. And, like, Yeah. I have my dad back. Yeah. And he's still on a baby dose.

Yeah.

You know, it's a little bit higher than the starting dose, but it's still a baby dose and so be it. And if he has to take it forever, so be it.

It's working.

It's working great and it's slow and low and the weight, he's so heavy he can't get on a traditional scale. So we don't even know what his weight is. But his doctor was so impressed, his doctor said, let her manage that, let her keep going. And you know what I do when I go over, I drop little dietary tidbits and I'm like, Hey, maybe you shouldn't be sucking this down all day, Dad. It's not so good for you. But he's actually, his lights are on and he's listening. So I had to do something because for three decades I watched him decline and I couldn't do anything. And I'm shocked he's still alive. So I was like, you know what?

We're throwing in the Ozempic, we're gonna see what happens. And, I mean, I'm really excited. It's been a game changer. We call these, these sort of non like weight loss effects. And, and, and I've been reading some papers around Ozempic or not Ozempic, but GLP-1 agonist and longevity. and obviously I'm really interested in longevity. I'm like, wow, this is really interesting. It reduces inflammation, it reduces oxidative stress, improves mitochondrial function, it helps neuroinflammation, all the things that we know cause aging. Now, I do have a thought, well, what if you just lost weight? Would that be enough? I don't know. But it's interesting and I think there's really interesting mechanisms that we're kind of just learning about. And I think, like you're right, we can't throw the baby out with the bathwater. and I think one of the challenges is that people can't get therapy in the way that we're talking about easily. And I just want to dive into that for a minute. And this is this whole world of compounded peptides. So for those who are not listening, there's prescription drugs you can get at the drugstore that are FDA approved and.

That.

Are brand name usually or generic versions of those. There's all kinds of compounds, whether it's B vitamins or whether it's glutathione or other things that we use in medicine that have to be made by by non-traditional pharmacists called compounding pharmacies. And they produce things like peptides or intravenous nutrition or different formulations of hormones that you might like that you might not get a prescription like a cream or a gel. So compounding is tricky because compounded drugs are not well regulated. And so you have to know what you're doing. You have to find the right pharmacy. You have to make sure they have proper testing for the dosage, the purity, the potency. And, the FDA has come out really hard against these. Now, maybe because they're just includes with pharma, I don't know. But, basically, I've been using these compounded peptides for a long time and I find them extremely effective for myself personally, for my patients for all sorts of different reasons. And, semaglutide is just a peptide. And, what's really striking is you can get it or like literally pennies a day. And instead of costing you $20,000 a year, it might cost you a few hundred dollars a year. In fact, a study came out just last week in JAMA talking about the price of these GLP-1 drugs, maybe going between 75 cents a month to $72 a month. Even in Canada, it's $300 $1,700 a month. And here it's like 17, $1,800 a month. So these compounded things are not easy to get. They're not easy to use. You have to mix them up yourself. You have to draw them up like a doctor with putting water in the bottle and sterile and then drawing it up and then injecting it yourself with a needle. It's like a diabetic. Diabetics do. They take an insulin bottle and they pull up the insulin, but now they have insulin pumps and different things. They don't have to do that anymore. But it's kind of a little bit tricky to use it, right? and then you have to find a doctor who knows what they're doing. So can you speak to this sort of this version of peptides you're using, the compounded peptides, and why you use those, why they're different, and how you kind of navigate this tricky world?

Well, I've always used compounding pharmacies since I graduated and got a license, and I didn't realize that most doctors didn't, to be honest with you at first. That was my bubble of privilege, but I have found that some acetyl-L-carnitine enters epinephrine when compounded. are always coming pre-mixed, so you don't have to reconstitute them like some of the other peptides. They're coming mixed up with clear instructions on the label, and then patients are to draw them up. I have heard that we're seeing problems, people presenting to the ER because they're taking too much.

These peptides- There's not a pre-filled syringe, like the Ozempic is a pre-filled syringe. You can't screw it up.

Right, you can't screw it up.

Hit the button, it goes in. Can't change the dose. It is what it is. If you drop too much and you don't know what doing. Right. I think it's supposed to be 100 units, but it should be 10 units.

You're kind of screwed.

Right.

So that comes down to doctor education with the patient in the office and being careful of that. And I realize, like you said, there's, you know, internet telemed doctors. You can just get it sent to you. But even in those cases, the patients I know who are using those, some, some are going that route and they're finding it to be just fine. No one's run into any problems. When people want the fast route, I think they might start piggybacking. We heard about that woman who died in Australia. She actually was using two separate types of peptides, neither were prescribed or maybe one was prescribed and once she got off the internet and she piggybacked them and she ended up dead. So there are problems and you can get in trouble fast for sure, just even the slightest little bit too much and you might have start seeing some nausea, you might start seeing some stomach aches, so we don't want that. But I don't think that compounding pharmacies are the danger the FDA is making them out to be. I've been watching the smear campaign lately and it's incredible. They really are on the bender. They don't want these peptides getting released without them being, and I'm sure that is something to do with big pharma. We can speculate, but I don't see any problem with it. And you can play with a dose. That's why I like compounding. We can play with the hormone dose, we can play with all the doses, and we can in, the whole point of compounding to me is that you individualize the medication for the patient in front of you.

We're in total alignment here. We were just talking before we came on, that a report said OZEMBIC cost about $5 to make. They're charging Americans and American taxpayers in many cases and more soon around $1,800 a month. And then Germany's paying like $60 a month. So the margins on this product are astounding. That's a scandal. And there's definitely a war. Just to be clear, I'm not anti-drug. I'm kind of a libertarian. I think people should have access to biohacks, and take whatever drugs they want. There's definitely a pronounced thing here. The reason this is getting so much attention is because there's so much profit that can be made from basically taking advantage of the American taxpayer, which is where the opportunity cost really comes in because there's hundreds of billions of dollars could go to actually fixing our food supply.

So it's kind of at a high level, just to kind of summarize, we kind of agree that we have a toxic food environment that's driving this, that we have have a world in which our microbiome has been completely destroyed that affects our metabolism weight, that there is a flood of obesities in the environment that are contributing to our metabolic dysfunction, that 93% of Americans are somehow screwed up in their metabolic health, and that our current solutions don't work. We're also in agreement that we should be fixing our food system so that kids are eating healthy stuff in schools and that people aren't exposed to a food carnival everywhere they go of junk food. that people are actually in a medical system that can support nutrition education, that supports intensive lifestyle therapies, that funds all those things. And you and I are working on that in Washington Cali and we're working hard. But again, it's like ending slavery or civil rights or women's rights, it's going to take a minute. In the meantime, we're seeing a crisis of poor metabolic health and our current solutions aren't working. Now, Is the Ozempic revolution the solution? I don't think so. Is the smart use of peptides in the right patients a potential solution done in a different way with a 360 view of lifestyle change and lower doses that mitigate the side effects that can be done in a way that don't lead to rebound weight gain, that don't lead to the muscle loss that increase protein at a gram per pound that make you hit the gym and pump iron four times a week, included with aggressive lifestyle behavioral change, support and coaching. I think there's a role for it, but I don't think it's how it's being done now and I think we all kind of agree with that. Did I miss anything?

A couple quick reactions is, and this is just my perspective from digging into this issue a lot, I think that if you're extremely obese and diabetic, in your case with your father, that seems to make sense. It's like no complaints there if you really have lost your way, which is the edge case of folks.

If you want 10 pounds off for the summer, no.

Well, the one, I will say the one case I think is promising is PCOS. I mean, people don't realize PCOS is insulin resistance, essentially in a metabolic dysfunction. If you do a crash diet, you're actually going to increase your fertility most likely and reduce the symptoms of PCOS. So for a targeted, basically crash diet to improve your insulin resistance quickly, I don't think it's a long-term solve, but I do actually get that. Again, if if you do a big calorie deficit diet and get your insulin resistance under control or fasting, you will improve PCOS. So I do get that. I think the key thing is the average American. The average American, we're facing a toxic environment and we have to, as a matter of public policy, get the average American practicing habits that are combating all of these threats to our metabolic health. And I think we are being lied to that this is a long-term solve for that, which is the most pronounced use case. If you are a patient in the kind of middle class- In the mantra.

Of the medical establishment is that this is a lifetime drug.

Yeah, for the majority of the American people, which is why this is the most valuable company in Europe.

Although it's interesting that about 50 to 75% of people quit after a couple of years.

Yeah, so that speaks- and that speaks to that. I actually believe the drug is going to be recalled because of the side effects. It's actually extremely pronounced side effects that we talked about. And I actually think the drug's a disaster and going to be recalled. But even in the absence of that, it's not the long-term solution for the median American. If you are a patient, and particularly if you're a parent, I would be very skeptical when your doctor inevitably tells you that this is a long-term solution, the lifetime solution for dealing with metabolic and my big point is, if not now, when? This is zero sum. Are we going to spend $1,800 per person per month on an ejection? Or are we finally going to ask in the midst of a situation where we're mass poisoning children in utero for metabolic dysfunction, are we going to actually change way and follow what you have been putting the stake on?

I mean, I don't know.

That point is right now, we should.

Not, we should be very very impatient. And that's why Ozempic is important, Mark.

I'm in a curious, open-minded but skeptical kind of moment around these GLP-1 agonists. And I'm doing a lot of work and researching what they do, how they work, the complications, the side effects, but also the beneficial effects. And I think the thing about peptides is so fascinating is, and Tina, you hit on this, is they're regenerative. They help to regenerate and hair. So it's a miracle to me. I could take an Advil and sure, my whatever won't hurt for that night, but the next day it's gonna frickin hurt. If I take a shot of a peptide, I'm like, damn, that bicep tendinitis went away and now I can lift weights again. And I'm like, that was pretty cool. And so I'm like, these are really different in their biological actions. And so they become drugs not because they're patentable, but because the delivery system is patentable.

Yes.

So patentable is a little auto injector, not the actual compound. That's why you can get it in a compounding pharmacy for pennies.

I just want to say that since I released these podcasts on my podcast, I've gotten hundreds of messages. Well, I've gotten hundreds of messages from people. What have you heard? And I have a, I don't have the size of audience you do, but I have a sizable audience. And I have so many people writing me saying, I'm writing you through tears. Like that exact quote. I'm writing you through tears. Thank you. so much for shedding light on this. I have been on these peptides. I do all the things. I follow you. I mean, I know the average American doesn't have access to doctors like us, but they do have, there's so much free education on the internet now.

There is, yeah.

And they are combing through it. They're implementing, they're doing all the things, and they just couldn't get over that hump. And they started GLP-1 Agonist, and it got them over that hump. And they are crying in gratitude. Hundreds of people messaging me constantly. They're also telling me that they don't tell their husbands they're on it because they're getting shamed. The pharmacist is giving them side die. Their family comes down on them at every holiday meal because these peptides are being so vilified. So I'm team patient and I'm team whoever's sitting in front of me, like you said, and I'm going to do whatever I need to do to get that person what they need to get that leg up. Because what I'm finding and what my followers are reporting and what my patients are reporting is that once they start on these peptides and they start to take effect and they start to get that decrease in neuroinflammation and they start to lose a few pounds, they want move.

Yeah.

And they want to eat right and they suddenly have energy because it is impacting the HPA axis and they're suddenly wanting to actually cook the meals instead of going out for fast food or order in. They're starting to implement the strategies that they need to be doing that they just didn't have the energy or the gumption to do before. I don't know what it is that gets people to implement. That has been the one crux of my practice. I cannot figure out why some people implement and some people don't, but some people just need a leg up.

So I want to be clear, too. I, I thought it was, it's very important for me to put some, frankly, doubt in the listener's head and put some of these macro concerns and, and frankly, systemic concerns as, as folks determine whether to use the standard Pharma prescribed Ozempic for themselves or their children. But we're in total agreement with Dr. Tina. I, I think we need to get to a world. I, I, I really believe the American people will make the right decision if they're not corrupted by bad incentives and bad information. I think it is a scandal that these drugs cost so much. It's a scandal for the medical industrial complex. Yeah, it's a scandal that they're being pushed down our throats.

Yeah, I think that's- Agricultural food industry complex. Yeah, but, you know, I'm with you on that.

I think it's very important. Yeah, it's very important. And, you know, I think I don't know much about the regenerative aspects of it. I think that's very promising. It's not blanket either or. I think obviously the systemic, I think ramming these drugs into our bodies is a problem. But I really do think we need to get to where back to, this was a bio, as you mentioned, this is a biohacking kind of, this has been around for decades, these peptides where people have been experimenting. I think that's great and I think people should be able to experiment. And I just think the societal solution for obesity is a really problematic with this drug.

Well, Callie, I agree and I thank you for working on this issue so diligently. you're going all over the country, you're everywhere now. I'm really inspired by your voice and your mission to get people to wake up to what's going on. I've tried to do it for a long time. You're a bit more passionate and vocal and compelling than I am, so maybe you're gonna help push it over the line. I've been like Sisyphus pushing the rock uphill for 30 years or 40 years. I think you're like Superman, you're gonna push it over the edge and it's gonna fly down. So, your book is amazing, good energy, the surprising connection between metabolism and limitless health. People should definitely get that. You wrote it with your sister Casey Means. And it lays out a lot of these issues around metabolic health and our social and political issues. It's a must-get book. It's out now, so make sure you get it. And, Tina, your work is so important. I think both of you are some of the most thoughtful committed people I've ever met who are thinking about these deeply and not just sort of at the surface and trying to find real solutions both on the macro and micro level. And, I'm so grateful to both of you and your work, Tina. You have a wonderful free GLP-1 video training series, Ozempic Uncovered. If you want to get deeper with Tina, for sure, go there. It's drtina.com/ozempicuncovered. That's drtina.com/ozempicuncovered. www.nutritionfacts.org/osemeticuncovered. Be sure to look at it. We'll put it all in the show notes. We're gonna put all the studies in the show notes we talked about. We're gonna put more studies in there. We did probably 20 hours of research that I did. I probably, my team did 20 hours on top of that. You guys have done so much. All that's going in the show notes, you can click through and read the studies yourself. You can make a decision for yourself. But I think what we're talking about is a very different and nuanced view of how to approach this problem of both poor metabolic health and I love this concept of metabolic busted and also the macro issue of, you know, how do we deal with this at a social level? So we don't have to give people a zempic or anything else. We just, you know, somebody sent me a video of like somebody walking around this everybody on the beach in the seventies. And there was like not a single person overweight in the seventies. So now it's like we're all, we're all in this together. So thank you both.

Any last thoughts or words from either of you? Well, there was one study I didn't share, and I don't know if we're allowed to talk about it here, but they did it in 2022. They had type two diabetics admitted to hospital with COVID They administered once a week Semaglutide for a few weeks, 80% reduction in death and ICU admission. Interesting.

That makes sense. That makes sense, because if you're improving metabolic health, you're lowering your risk.

I'm just wondering, aside from the good points that Callie makes, there aren't potentially some smear campaigns on these going forward.

Too from-- well, listen, it's true.

And I would just say, I know we're all in agreement that our body is also a GLP-1 agonist, and we can create with food and with supplementation, GLP-1. And my company, which we're proud to have you as a supporter of TrueMed, we have doctors right interventions to actually combat obesity with food as medicine. Pendulum, I know a company we're fans of, has a new product that's specifically formulated. So we actually help, if appropriate, unlock tax-free spending to these items. And that's where I think the rubber really hits the road. We need to be steering money to food and pendulum, not necessarily drugs. And that's what we're doing right now at TrueMed.

Well, we didn't get to talk about it enough. And we'll put it in the show notes, Anthony, you talk about a lot. But there are ways to naturally increase our GLP-1. For example, if you are testosterone deficient, if you hit the gym and you pump iron, your testosterone will go up. If you stop eating sugar and starch, your testosterone will go up. There's the same thing with GLP-1. If you're low in GLP-1, there are natural ways to do it by eating more protein, by exercising, by taking certain herbs like berberine and cinnamon. There are other things that actually work to help. and I want you to just for a second talk about Truvada because it's a way for people to get access to these kinds of treatments with tax-free dollars. So tell us about Truvada for a sec because I think it's important if people are wanting to make lifestyle change but they can't afford it or they think they have money, there's a way to get access to these things with.

Dollars that are pre-tax dollars. I go to my mom, the standard American patient, when she had high cholesterol, she got a quick prescription for a statin. That doctor could have written a letter of medical for probiotics, for healthy food, for exercise, and with that letter of medical necessity, it unlocks tax-free spending. There's $150 billion in these HSA FSA accounts. Right now, those are generally just waiting for you to get sick or go to drugs. Yeah, health savings accounts. And those often are just you get sick and you buy your drugs, you buy your interventions. Those can go right now to root cause items, to items that you talk about, to pendulum, to athletic greens, to daily Harvest to CrossFit, to companies we're proud to partner with.

Yeah, that's great. I use my HSA card to buy supplements with Truvada. 100% of the time, I use my HSA card to buy things when I go to get an acupuncture or get.

A massage or do things that actually help my body. We've been so proud in the past five months, we've done 130,000 patients. So much that some of the arms of the healthcare industrial complex are saying, hey, it's moving a little fast, but this is fully within the law right now that medicine can be food, can be supplements, can be exercise. If a doctor outlines those interventions for the prevention or reversal of disease, we can do that. And what our message is, whether you use TrueMed or not, if you're about to get your Ozempic or a statin or metformin, if you're about to get on that chronic disease treadmill or your child, you can ask your doctor, Hey, can we do a letter of medical necessity instead? Can we actually outline some dietary exercise lifestyle interventions. And with that letter, you can actually use tax-free money on those items. We've got to steer money, medical dollars to these items. That's what our mission is.

Thank you, Callie, for doing that and making it available. It's such a great thing. And I think you both are probably the education training, doing such good things in the world. I'm really honored to have you on the Doctors Farmacy podcast. Maybe we'll have you back, go deeper. It was a great conversation. I think people hopefully got this. sense of what we're talking about and have a little bit more thinking about when it comes to this and get out of the binary black or white conversations and talk about more of the nuance and be able to actually get deep into a topic that matters for all of us, which is getting America healthy, getting us as individuals healthy, and creating a solution that works and includes all the potential levers we have to pull because sometimes we need a pound of cure. So thank you both and we'll see you again soon. you love that last video, you're gonna love the next one. Check it out here.