Can Ozempic Fix Our Obesity Crisis?

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman: Coming up on this week's episode of the Doctor's Pharmacy, these drugs can cause permanent damage as I mentioned, bowel obstruction, gastroparesis, pancreatitis, loss of appetite. The side effects are not trivial. They occur in half of all the people in these studies, and severe side effects occur in 10%. Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman, that's pharmacist with Alpha Place for conversations that matter. And today we're going to talk about what are our biggest crises, obesity and how to handle it, and it's part of our new health series called Health Bites. Little Bites of Information Improve Your Health that will help you take small steps over time to improve the quality of your life. Now, let's get into it. 93% of Americans have some type of metabolic dysfunction, meaning they're on the spectrum somewhere from pre-diabetes to type two diabetes or even a little bit of pre pre-diabetes. Six in 10 Americans have a chronic disease, four in 10 have more than one. Over a billion people worldwide are considered obese and 2 billion are overweight. Type two diabetes, cancer and heart disease are arising and few people know how to handle this, and people are desperate for solutions, which is why we're seeing an explosion is something we're going to talk about today, which I'm going to get to in a minute. So what is a solution to this obesity crisis? Is it bariatric surgery? Should we do gastric bypass on everybody and we're doing this now on teenagers. Is it the new crazy explosion of the weight loss drugs like ozempic, the GLP one agonists, or is it maybe instead getting to the root cause? Today we're going to do a deep dive on the science of the GLP one agonist or ozempic, wegovy, manura, all those drugs and the one getting most headlines, obviously ozempic, but it includes the other ones like Wegovy and Manura. Now Ozempic also known as Semaglutide, it's a peptide. It's a once weekly anti C injection that's formulated by the pharmaceutical company called No Nordisk. Now Ozempic has become the biggest contributor to the GDP of Denmark where this company is, and it's a peptide just like insulin. It was approved as a diabetes drug, not in a weight loss drug, but it's exploded as a miracle weight loss drug garnering excitement from the public with the help of celebrities like Elon Musk and Kim Kardashian. It's all over the social media platforms like TikTok, which is singing its praises as the answer to our obesity problems. But as the research unfolds, we're quickly discovering that it is not risk-free and it comes with a very concerning side effects, which we're going to get into today, and that's why for this week's health bite, we're diving deep into the complexities of ozempic. We're going to go deep in the science and we're going to talk about why this drug that's making waves not only for being an obesity cure, but also for its ozempic related risks and the risks to your health. We're going to get into that. We're seeing nationwide shortages for people who actually need the drug and for which it was designed for diabetes patients because everybody's using it for weight loss. We're seeing extraordinarily high costs, lack of insurance coverage and severe, severe and very common side effects. Today we explore the hurdles of ozempic, the problems with this and the question of whether or not it's truly a sustainable solution to our growing obesity crisis. You'll know my answer by the end of this podcast. We'll also shed light on the functional medicine approach that focuses on addressing the root causes and the power of nutrition, diet and sleep for combating metabolic dysfunction. And we got to get to the root cause. This was not a problem years and years ago, there were no obesity crises in the 18 hundreds or 17 hundreds or 16 hundreds. This is a modern phenomena that's mostly a late 20th and early 21st century problem. So let's get started. This deep thought provoking I hope episode on Ozempic as we start to answer important questions about its role in our current healthcare landscape and explore maybe some other pathways to a healthier, more sustainable future where we can really treat the root cause of obesity. So let's get into it. Ozempic or semaglutide is something called a GLP one agonist binds to a particular receptor GPO one receptor, and it does a lot of things. We're going to get into what it does and it was originally formulated by pharmaceutical companies as a way to treat and manage type two diabetes, and lately it's been in the news and the media and medicine for being this anti-obesity miracle drug for weight loss. Now, there's a high demand for this drug. There's a lack of coverage as I mentioned. There's nationwide shortages and it's hard to get for those who need it the most. We know it works for type two diabetes, but it's also being looked at as a treatment for reducing cardiovascular risk, cancer risk, Alzheimer's, and even as a treatment for longevity. Now, Novo Nordisk approved another version of the drug called wegovy, which is the weight loss version and it's even approved it for obese teenagers. Now that is concerning to me and some are now proposing it be used in children as young as six years old and there are studies for this. I mean this is just staggering to me that we're thinking of using a lifelong drug with serious side effects on kids as young as six years old instead of a stressing the root causes, which is our toxic food system. Now, the research on improving cardiovascular risk factors with ozempic is strong, but it's not straightforward. Maybe it's because of the weight loss, not necessarily the drug. And many believe that improvement could be just from the weight loss. And so it reminds me of a study that was done around bariatric surgery where they basically took very obese patients, half of them got bariatric surgery, half of them didn't. Both groups had diabetes and severe metabolic dysfunction. The group that had bariatric surgery had the bariatric surgery diet and then the control group got the same diet as the people who had surgery but without the surgery, you know what? There was no difference in the outcome. Was it the surgery that worked or the diet that worked? Well, it's pretty obvious from my point of view. These drugs have become a craze and there is a lot of money flowing into research. Unfortunately most of it's funded by the industry and by pharma, but we're going to get some more answers. But what we're seeing now is an increase of very serious side effects for people who have been on it long-term. There's also a common short-term side effects, but there's common side effects that affect the gastrointestinal system. It basically makes you noxious mom and have diarrhea and that happens in 50% of people who take it. But there's more very serious side effects that I'm concerned about, including gastroparesis, which is paralysis of the stomach, meaning you can't move food through your stomach and that creates a huge problem. Bowel obstruction, which often requires surgery and pancreatitis and even death. And we're going to talk about all these side effects in a little more detail in a minute. Now this really makes me question the long-term use of these and the widespread use of these, and we're going to go deep into the side effects, but the real question is this that no one asks is how did obesity triple in the last 60 years from about 13% of the population to 43% of the population? I can guarantee you it's not. And ozempic deficiency, functional medicine provides a better framework for understanding root causes, particularly around obesity, metabolic dysfunction, and type two diabetes and provides a way more sustainable and affordable treatment that works. I've seen this over and over again. We're going to talk about that in a minute. So let's get deeper into what's going on here in America. Why is this drug important and why are we seeing such increased use of it? Well, we have a problem. There's no denying that. As I said, 93% of Americans have some type of metabolic dysfunction because of poor diet and lifestyle. That means only 6.8% of Americans are metabolically healthy, meaning they're not somewhere on the continuum of type two diabetes, meaning they don't have high blood pressure, high cholesterol, high blood sugar or overweight or have had a heart attack or stroke. So only 6.8% of the population meet that criteria. The rest of us are metabolically unhealthy and somewhere in that continuum, six in 10 have a chronic disease, four in 10 have two. There's over 400 million people around the world who are diabetic. 90% obviously are type two diabetes or more. 40 million Americans or one out of every 10 Americans has type two diabetes, which is terrifying to me. As I mentioned, over a billion people worldwide or obese and over 2 billion are overweight. 43% of US adults are obese, 75% are overweight, 40% of kids are overweight. It is really a problem. We saw increase in obesity during covid because of the stresses and the challenges people faced and we're seeing now Wegovy or semaglutide, another version of ozempic is now approved for 12 to 19-year-old obese teens. Now one in four teenage males has either pre-diabetes or type two diabetes. That's frightening to me. 25% and the obesity rates are staggering. Teenage obesity is at over 22% from between 12 and 19 year olds, and as I mentioned, 40% of kids are overweight. This is not a problem. That's because of genetics. It's a problem because of our toxic food environment and the cure isn't a drug and especially a drug that has serious side effects and needs to be taken for a long time or lifelong. Now, this is a great business model for pharma. You have a very expensive drug that needs to be taken forever. It's a gold mine and it creates customers for life. But teens have a problem. They're targeted by the food industry. They have all sorts of issues around eating disorders. There's lots of unlawful advertising and targeting your kids videos going viral on TikTok and it's really concerning to me. I think people don't realize that there's literally $10 billion or more spent just directly targeting junk food and processed food ads to children. And now there's currently trials going on in kids as young as six years old for the gov ozempic, I mean six years old. What are we talking about here? This is nuts. And it's not addressing the root cause, it's not addressing our food system. It's not addressing our toxic nutritional landscape. It's not addressing the fact that ultra processed foods make up 66, make up 60% of our diet and 67% of kids' diet. That ultra processed foods account for about 90% of the added sugar in our diet, which is about 150 pounds of sugar per person per year. About 34 teaspoons a day for kids and 22 for adults. That's nuts. It used to be maybe 22 teaspoons a year when we were hunter gatherers. This was causing all sorts of metabolic dysfunction. And this metabolic dysfunction is not just about weight, it's obviously about obesity, but it's also about type two diabetes, Alzheimer's, dementia, fatty liver disease, chronic kidney disease, and premature death. Now, this is a huge problem. Chronic disease is bankrupting our system and our nation. There's now $4.3 trillion spent on chronic disease and healthcare in this country. In 2000 it was 1.6 trillion and that's only 23 years ago. So we are in a crisis of accelerating disease, accelerating costs, and it's not solved by a new drug that has serious side effects and may actually cause a bankruptcy of our nation if we follow through on this, if you look at the cost here, diabetes alone is 413 billion in 2022. Ozempic is exploding in its revenue and one study in the New England Journal of Medicine found that if just obese Medicare patients were prescribed ozempic, the cost annually to the government would be 267 billion a year. Now to put that in perspective, the entire Medicare part D, which is the drug benefit program, is 145 billion. So it's another a hundred plus billion dollars a year over what we're spending for the entire drug benefit for all drugs, for all seniors, this is an insane amount of money. So if we were to do that, we'll bankrupt our country and if all the overweight people and obese people in America took ozempic or a similar drug, it probably will cost over $5 trillion, which is more than our entire healthcare expenditures. Now let's talk about the risks because I think this is where it gets sticky. Everybody's looking for the miracle cure, the miracle shot, instant weight loss, and it can work. I'm not saying it doesn't work, I'm just saying that it's not a free ride. Now, part of the problem is that many drugs don't have long enough studies when they're initially approved, and the longest study is about 68 weeks in these drugs. Now often these side effects don't occur till more chronic use of two years or longer, and there's some of that data coming out now, which is called post-market surveillance, meaning after the drug comes out, let's look at what's happening and it's a bit concerning now we're seeing a lot of side effects, not just the nausea, vomiting, diarrhea that's in 50% of users, but we're seeing side effects that are life-threatening, things like gastroparesis or paralysis of the stomach, bowel obstruction and pancreatitis and deaths rising now. Now to put things in perspective as I share some of the statistics around the findings of people who've been on this drug longer and what it's doing to 'em in medicine, when we see a 20 to 30% increase in a response to a drug or a side effect, it's considered highly significant. For example, statins which are a blockbuster drug to reduce heart attacks, they only reduced the risk of heart attacks by 20 to 30%, and that's a blockbuster drug. Now listen carefully as I explained this next study in the study of over 4,000 patients published in jama, five out of every thousand patients had stomach paralysis, which was an increased risk of not 20% or 30%, but 367%. The risk of pancreatitis, which is an incredibly dangerous illness, which causes your pancreas to be inflamed and leads to type one diabetes, maldigestion and really very serious problems went up by 900% and bowel obstruction, which is very serious and often requires surgery went up by 422%, not 20 or 30%. So this is not insignificant. It's not an artifact and in fact, when you see these kinds of studies, these data, you have to pay attention. This is the kind of almost the risk we see with smoking and cancer. These are really concerning, concerning numbers for me, and they're not trivial and they can cause permanent damage and require surgery. The other thing that people don't realize is when you lose weight, 40% of the weight loss with ozempic or these drugs is muscle and muscle is where your metabolism is. When you lose muscle, you lose your metabolism, it slows down and you end up needing less food to maintain your weight even when you gain the weight back. The other problem is that 65% of the weight that you lose is regained when people stop the medications. So I think it's really quite concerning how we get off the drug. What happens? What happens with these drugs with kids we don't know. How does it affect development? How does it affect puberty? Menstruation is a lot of open questions. Now I want to get into this whole issue of obesity being a disease or being genetic. I think there's a lot of conversation out there that's a little bit disturbing to me, and I just think just if when I was born 5% of the population was obese and now it's 43%, did we somehow magically have a genetic mutation in the global population or in America to account for this? No, this is an environmental problem. Same thing with the Pima Indians. A hundred years ago they were thin fit, healthy. They had no obesity, no diabetes, they ate their traditional diet, they lived in Arizona. Now they're the second most obese population in the world and 80% get diabetes by the time they're 30 and their life expectancy is 46. And kids as young as two years old get type two diabetes because their genetically predisposed, they're not predestined and when they're in the wrong food environment, which they are, which is the white poisons, white flour, white sugar and white fat, otherwise known as Crisco or shortening, which was their government commodity surplus foods, they were given even a word for it. They call it commod bod. We need the commodity foods. You get big and diabetic. Now, this is not a genetic problem, and what's disturbing is that Dr. Fatima Sanford, who's an obesity medicine doctor at Harvard and Massachusetts General, who was also in the dietary guidelines committee in 2025, very disturbing to me. She said, obesity is genetics. You said it on 16 minutes. Now it's true that if your parents are overweight, you're more likely upper weight, but this is epigenetics, not necessarily genetics. This means it's changeable. Now, where were all of the obese people 60 or a hundred years ago is this whole nonsense. It's our toxic food environment. It's impacting our gene expression and our predispositions. Now, the idea that it's genetic is very disempowering. It removes our autonomy, our agency, it essentially says this is a disease that must be treated with medication. There's nothing you can do about it. It's just genetic. So it's hard. Now, the costs of this are staggering. As I mentioned for the drug, it's over a thousand dollars a month, $1,700 a month. You depend on where you get it, but it's a lot of money and you're supposed to take it for life and really it's hard to come off of and it's going to be completely bankrupting our nation if we continue to do this. And there's again, as I mentioned, nationwide shortages for people who have diabetes because everybody who wants to lose five or 10 pounds or 20 pounds is taking this drug and getting it from their doctor because any doctor can prescribe a drug for any reason once it's been approved by the FDA, it's called off-label use and this whole pill, every Ill quick fix is really not the solution here. We have not been addressing the root causes. The other thing I want to address here is this whole body positive movement and healthy at any size. I think what's happening is that there's a confusion about this. We do not want to blame the person who's got this problem for the problem. If you're overweight, it's not your fault. You're living in a toxic environment. If you take somebody and you put them in an environment where all you can get is ultra processed food and sugar and starch, and you're told by the government to eat six to 11 servings of bread, rice serum pasta day, it's no wonder that we have become obese. It's not your fault. And by the way, I'm getting into this in a minute, but there's a lot of data on the addiction properties of these foods. So what's happening is that is this whole movement that doctors aren't talking to their patients about obesity. They can't say the word. It's considered fat shaming. If a diagnosis, someone who is medically obese or overweight, people don't want to be weighed in the doctor's office. They don't want to talk about diet and lifestyle. They feel like it's shaming or somehow belittling. I think this is a problem, and I think there's a lot of celebrity endorsements and news media magazines normalizing obesity as healthy, but it's just not no data that it's healthy. The only I think data was if you look at people who are older, sometimes the data on when you're older shows that you die if you're thin, but because you have cancer or some kidney disease or something else that's wasting your body away. It's not because being thin is a risk factor for disease. It's the diseases and unfortunately a lot of people are getting canceled for talking about this. I saw a report about an email that went out to all the students at Columbia University talking about this in medical school saying, you can't talk about this. It's fat shaming. And it sort of made it not okay to talk about, imagine it saying, well, we can't talk about diabetes. That is a disease that they don't have any control over and it's fine and diabetes healthy in any way. It's kind of nuts. Now, I've been practicing this medicine for decades and I've been doing deep dives on their people's biology with all these problems, and I see real issues when people have metabolic issues. Now, this whole being overweight thing, being normalized is not scientifically true. I understand the goal, which is not to victimize or blame the person who's overweight, but the truth is it's our toxic food environment and it's the addictive ultra processed foods that are driving the obesity epidemic, not our genes. Now, there was a review of 281 studies in 36 countries, and it found that 14% of adults and 12% of kids meet the scientific definition for food addiction. I put in perspective, the prevalence of alcohol addiction in the population is 14%. Now 12% of kids are food addicts based on strict criteria and scientifically validated metrics. This is not an accident, by the way, by the way, the reason for this is that the food companies have designed these foods to be hyper palatable and hyper addictive and stimulate dopamine. They even do such things as put children in an MRI machine so they can see on a functional MRI, which part of their brain lights up when it's triggered by different images of different junk foods. So it's not trivial. It's not an accident and it's not your fault. So if you struggle with weight issues, it's really a complex issue that your metabolism, your hormones, your neurochemistry has all been hijacked by the food industry and so is our kitchen center restaurants and our grocery stores, and we're just unable to often find our way through. Now, there's certain concerns about ozempic too because people are using counterfeit ozempic. They can get it online, they can buy it from different places and people can get very sick from it. So I think I would watch out for that. There's a large part of the way traditional medicine is that misses the mark, no pun intended, because it doesn't address root causes. And functional medicine is about root causes. It treats symptoms, not mechanisms. It treats symptoms, not causes, and it doesn't focus on prevention or lifestyle. There's no early intervention for pre-diabetes or weight gain. There's no lifestyle or exercise prescriptions that really are integrated into our healthcare system. There's no payment system for it. I say if people and doctors got paid to do this, it would work, right? I remember working on health policy in 2008 and I was met with the Secretary of Health Human Services and we proposed a lifestyle change program where we would basically guarantee that people would become healthier and reduce healthcare costs, and if they didn't, we would pay back the money that Medicare paid us or paid the doctor. And she said, well, this is great, but who's going to learn how to do it? Well, I said, if you pay for it, it's like if you pay for angioplasties, people will figure out how to do it. There was nobody who said, oh, well, how do we reimburse angioplasties? No doctors know how to do it because it's a brand new procedure. Well, guess what? As soon as they pay for it, people figure out how to do programs at work and we often, we don't do things until it's too late. We wait and see. I had a patient who had a blood sugar 110, and I said, you see your doctor about this? And she said, well, yeah, but they said, well come back later when I get higher in my blood sugar and then we can treat it with diabetes drugs rather than dealing with the fact that he was already on his way. So rather than dealing with the root causes, which is our food system, we're trying to get a quick fix with these GLP one agonists like ozempic, which do help suppress appetite, which do reduce calorie intake, but it really is important to deal with the causes, not just the problem that is quickly fixed by a drug because there's downsides to it. And the real issue is our excess intake of refined starches and carbohydrates and sugar, ultra processed foods and a lack of ability or access to follow a really whole food nutrient dense diet that's full of satisfying foods, amounts of fiber, foods and vegetables, protein, good fats, and the fact that we don't live an active lifestyle. The fact that we don't use our bodies, the fact that we're under muscle, then our metabolism is slower. All these things drive obesity. I think one study by Kevin Hall at the NIH showed that people who were freely allowed to eat as much food as they want, whether it's ultra processed food or whole food, they ate 500 calories, more of the ultra processed food. There was no rate limiting thing in the brain or the body. It was like the body didn't recognize it as something that was food. And so it just kept getting more and more hungry in order to satisfy some nutrient needs. But it was like looking for the love in all the wrong places. So it's important that we also focus on nutrition quality and our diet quality. People are eating all this ultra processed food, but they may be eating same stuff but just less of it because they're noxious. But if you focus on a lower calorie intake, which is what happened with ozempic, without focusing quality, you're going to become nutritionally deficient. You're going to get worse metabolic dysfunction, you're going to have copper, selenium, mineral deficiencies, zinc deficiencies, you're not going to get protein, potentially have muscle loss, which definitely happens. And when you look at these studies, they don't look at body composition, they look at weight. Now, weight is not exactly the most effective way to look at your metabolic health. It's really looking at how much muscle you have, how much fat you have, where it is, is it in your belly, on your arms or legs and the percentage. And so body composition is something that's critically important to do, and yet most of the studies don't look at it because they don't want to see it. The drug companies don't want you to tell you. So they just measure weight loss. They don't measure the percent fast fat loss versus the percent muscle loss. They don't look at the ratio of body fat, percent of body fat. They don't see how all this works. So if you lose lean muscle, it's serious. If you lose lean muscle, that's what your metabolism is. That's what your energy factories is, that's where your glucose sink is. So basically what happens is if especially in the elderly, if you lose more muscle, you, you're going to become more frail and weak. But even if you don't, when you lose the weight, you lose 40% as muscle, which you do with these drugs. Then let's say you gain the weight back after you stop. You may be the same weight as when you started, but your metabolism will be slower because usually you gain all the weight back is fat so you don't gain back the muscle. So you basically end up worse off and needing to eat less and having a slower metabolism after the fact. So it's really quite concerning. Also, we don't really focus on the right strategies around weight loss that we could help people reduce starch and sugar. We could help them get off ultra processed foods. We can increase protein, we can increase good fats, we can increase fiber, we can increase activity. We can do this in ways that work that are effective for behavior change. That's the other issue, and that involves group models and things like I've done with the church at Daniel Plan in Saddleback Church and at the Cleveland Clinic where we have group model therapy for and treatment for chronic disease. And it works incredibly well. It works three times better than regular interventions. Now, part of the thing I want to emphasize too is that it's not a free ride. Once you get on these drugs, you end up gaining the weight back in this one study called the step one trial, semaglutide treatment effect in people with obesity, it was a randomized controlled trial where they found that two thirds of people regained the weight they lost two years after discontinuing the drug, and also any benefits to their cardiovascular biomarkers like cholesterol also went back to where they were. The other thing is that these drugs can cause permanent damage. As I mentioned, bowel obstruction, gastroparesis, pancreatitis could change your taste for food, loss of appetite. Now, the side effects are not trivial. They occur in half of all the people in these studies, and severe side effects occur in 10%. So one out of every 10 people has a severe side effect from these drugs. There's reports of stomach pumping being needed because of bowel obstruction, even death, and taking this drug that costs a lot of money, even if it was lower price for the rest of your life with all these consequences, I think is highly concerning. And the longer you take it, the more concerning one of the things it does. It affects the GI tract, and that's why you have these symptoms of nausea, vomiting, diarrhea. What it does is it thickens the bowel wall, so it makes the bowel wall thicker and that ends up leading to bowel obstruction. This may be a permanent thing. We're still not sure, and we're still not clear on what's going on in the long-term with these drugs. So they haven't been studied long enough. There was a good study that came out in the New England Journal and article I read years ago. It said, be sure to use new drugs as soon as they come out before the side effects develop. So I think that's true in this case. Now these drugs do work, right? People lose 10 to 20% of their body weight and it's not insignificant. So it can be a helpful drug in certain patients. I don't think categorically like nobody should take it ever. I'm not against it, but it has to be for the right reason. And I've only prescribed it once in someone who was an older patient with severe obesity who had a neuro den disease and we need to get as metabolic health dramatically improved. And he was almost diabetic. So I think he was one of the few people I've used it for and I would not use it, and I make sure he's having high amounts of protein and doing resistance training at the same time. So we see big weight loss, but we see also improvements in cholesterol and A1C and triglycerides and liver function and all those are good things, but I don't think it's the emic, it's just the weight loss. Like I said, with the bariatric surgery example, I have all the same results, even better by the way. We see, for example, a reduction in A1C, the measurement of your average blood sugar, which is important. And if we see this with ozempic, but it's like one point I did a dietary intervention with a patient at Cleveland Clinic and hers went from 11 to five and a half, which is almost a six point reduction. This is an algorithmic scale, so I mean, sorry, a logarithmic scale. So it's really significant amount. It's not just a trivial amount. And so diet and lifestyle work far better than these drugs. Now, it does help with improving insulin insensitivity and improves a lot of these things, but you'll see basically only 1.3%, 1.6% reduction in the A1C. It's not that dramatic. And it's really important to realize we have a chance to do something quite different by having a more focused targeted intervention, which I'll talk about in a minute. Now, the cardiovascular benefits are being touted in addition to weight loss, but there was a large double line randomized placebo controlled trial that looked at the risk of heart attack strokes and so forth, and they found it was a reduction by about 20% over 33 months versus placebo. And that's good, but maybe there's cardiovascular benefit, but I don't think it's independent of the weight loss. In other words, if you kept people at their weight and you gave 'em this drug, I don't think you'd see the same benefit. So I don't think it's a drug per se. And the GI side effects, as I mentioned, were really concerning and I think we need to take those very seriously. The other thing you have to recognize, when these drugs are being looked at from the research, the studies show benefits, they all look like it's a golden drug, but they're all paid for by Novo Nordisk and they're all paid for by basically by the company that makes the drug. So if you're Coca-Cola and you're studying soda, you're going to find that it's not harmful. You're studying these drugs, you're going to introduce bias, which is really a problem. And it's the study design, it's the writeup of the study. It's what's included, what's included, and those things all can be kind of manipulated in a way that actually makes the drug look better. And this happens over and over in medicine is not a new problem. And we know that drugs that are funded, studies that are funded by the pharmaceutical manufacturer often done with contract research organizations or with large conflicts of interest. So I think we have be really kind of skeptical in some ways also of these studies. And the thing also I'm concerned about is the long-term studies on these just have not been done. And then the more these drugs are out there, the more they're being used, the more we see these dangerous side effects come up. So what is the right approach if it's not ozempic or maybe if it's ozempic in certain select patients or rego V or majuro. Again, I'm not opposed to these categorically and they can be helpful, but I think we need to kind of sift out the risk versus the benefits and look at actually dealing with the root cause rather than just trying to put a bandaid on this, which is a very, very expensive bandaid with very, very serious side effects. Now, what we do in functional medicine is quite different is we look at the root cause, at the root cause of obesity and type two diabetes. The problem really is the flood of incredibly toxic food-like substances into our food supply that are everywhere ubiquitous and that are marketed to us aggressively and that are on every corner and every grocery store and every restaurant. It's a problem. And these foods, these ultra processed foods, these high star sugar foods are driving massive metabolic dysfunction. As I said at the beginning of the show, including 93% of us being metabolically and healthy. They're driving high hyper insulin levels, they're increasing our blood sugar lipids, fatty liver triglycerides, lowering our HT L, and always convenience foods are not so convenient when it makes you sick. We have high amounts of refined sugar in our diet, lots of added sugar, lots of soda, sugary drinks, all sweetened with high fructose corn syrup, which is a whole nother podcast on its own. So what is the solution? We have to really remove these ultra processed foods from our diet 100%. There's really no room for them at all. You can eat whole foods. It doesn't mean you can't have foods that are delicious or fun or have some comfort foods. If you want to have pasta occasionally that as a minimally processed food, if you want to have occasional whole grain breads, that's fine. It's really about these weird foods that come from factories that are deconstructed from their original source, soy, wheat and corn into the different molecular constructs that our body sees as foreign. And that doesn't process as food and disregulates our hormones, our brain chemistry and our appetite and our metabolism. And so these are hijacking our biology and we need to get rid of them. And of course, we need to exercise. We need to do resistance training and build muscle. We need to learn how to manage stress, get adequate sleep and all the things we know help our health. What happens when you do this, and I've seen this over and over again. I mean people, I just had a patient who lost 60 pounds. I didn't put him on zabi. He was a big guy. He just diet, got him off the things he was eating, and we saw dramatic drops in his insulin. We saw basically the insulin come down, which is the key factor here. And this is part of what these GLP one agonists do is they help reduce this insulin resistance and prove insulin sensitivity, and you need less insulin. Insulin is the fat storage hormone. The more insulin you have, the more fat you'll store and you'll store it on your belly and it gets locked in there and it doesn't come out unless the insulin goes down. And as long as you're eating a high starch and sugar diet, your insulin's going to be high and the fat's going to be locked in there. And weight loss is very difficult. Also, it causes these fat cells in your belly to become very inflamed, produce all kinds of cytokines, which leads to more obesity, more inflammation, more insulin resistance leads to fatty liver, messes up your triglycerides. HDL causes more cholesterol problems, small particles, things we've talked about on the show before. It also leads to fatty liver, dysregulated appetite control, hunger, and it's a big, big problem. So getting the insulin down by cutting down the Sargent sugar, having more fat protein fiber is really the key. And that helps weight loss happen almost effortlessly and automatically. And when you eat whole food, you'll restore your metabolic health, you'll reduce inflammation, your mitochondrial work better, you'll reduce oxidative stress, you'll have more metabolic flexibility. And so basically when you get to a more normal metabolic state, you can have more flexibility. So if I eat a bowl of ice cream, it's not going to really affect me, but if I was diabetic, it would affect me. And by exercise an hour a day or whatever, or eat healthy or have a huge amount of fiber and protein and fat, it's really important to understand that it really is about tuning up your biology so you can have more metabolic flexibility. So what should we be eating? We should be eating whole foods, real food, unprocessed food or minimally processed food. I means sardines in the can is processed, but that's very minimal. You know what it's, I learned how to cook if you don't how to cook, this is really important. It's a life skill. You don't how to drive, you don't how. Use your iPhone, how to brush your teeth. This is a basic life skill. And people who eat at home and cook at home have a better diet quality and they have fewer calories. They have fewer carbs and processed foods and added sugar and more fiber and more good fats. So focus on nutrient dense foods, focus on high satiety foods like fiber, protein and fat. And we think about the calories in the food, but we really need to think about the nutrient in the food. What's the nutrient to calorie ratio? It's for example, if the nutrient to calorie ratio is low, you're in trouble. So Coca-Cola has almost no nutrients and a lot of calories. That's bad. If you have a lot of nutrients and fewer calories like broccoli, that's good. So it's not a hard concept to understand. I wrote that about that. My first book, ultra Prevent about the nutrient to calorie ratio as a simple concept about nutrient density and how to think about your food. It's really about food quality. We talk about getting fiber. Fiber is really important. I was in Africa and I saw the Hadza tribe, which is once the last hunter gathers, and one of the things they do is they eat a lot of honey, but they don't have any metabolic issues because they eat 150 grams of fiber a day. Now the average American eats about eight grams. We should be eating 30 to 50 grams of fiber. So that helps your metabolic health and improves your cholesterol. Blood pressure, lipids improves weight loss, slows the gastric emptying, prevents the sugar spikes, improves something called short chain fatty acids in your gut, which is anti-inflammatory have been shown to reduce insulin resistance. Happy will lose weight. It actually boosts GLP one, so fibers in natural GLP one agonists, which is a good thing. Right? And what are the sources? Well, lots of veggies, nuts and seeds. You should eat three to five cups of veggies a day. You should eat lots of nuts and seeds. You can have low glycemic fruit. Berries are great and any kind of non-starchy veggie. Also, protein is a key thing to regulate your appetite. We basically need a gram per pound of ideal body weight. So let's say you're 180 pounds, I need about 180 grams of protein, not if you were 400 pounds. You don't need 400 grams of protein, but you need to have enough to build muscle when you need about 30 to 50 grams per meal, depending on your size, it helps. Appetite control is a thermic effective protein, meaning it takes more calories to burn protein. It reduces your appetite, so you lower your overall energy intake, leads to weight loss and helps body composition because it helps you build muscle. So protein is really key. And animal protein has much higher bioavailability than plant proteins and grass fed beef and lamb and eggs, chicken, Turkey, fish protein powders, like things like goat weight I like or bone broth, all help. Now, you can get a couple hundred calories in four ounces of chicken or meat, but you're going to get about a thousand calories if you get the same amount of protein from grains or beans, which is a lot of calories. And you'll feel a lot of that food, like six cups of rice or two cups of beans for a four ounce piece of chicken or fish. So it's much easier to get your protein that way. High quality fats also important. Fats also help reduce appetite, make you feel full. Avocados, nuts, seeds, nut butters, animal foods with fat in them are all great. Also, you can do time restricted eating 12 hours minimum 14. I don't think you need much longer than that, but that helps. And don't eat before bed, just really key, just overnight, fast. Don't eat before bed. Three hours you're going to do much better. And then sleep. Also really important, getting the root cause of some of our problems has to do with our sleep deficits. And if you don't sleep, you're more likely to be overweight, you're more likely to be obese. It reduces the leptin, which is the hormone that makes you feel full. It increases ghrelin, which is the hormone that makes you hungry. It increases cortisol. The stress hormone also makes you crave sugar. It lowers blood sugar regulation and stimulates your appetite. And the nurse's health study, which was about 68,000 women, we were followed for 16 years. Women who slept five hours or less a night had a 32% higher risk of a 15 kilogram weight gain. That's like 35 pounds or more. That's a lot. And for those sleeping six hours, there was a 12% high risk of obesity. So get your sleep sorted. I have a sleep masterclass. You can look at that. You can go to sleep at the same time every night. You want to get six or seven, eight hours minimum six is usually not enough for people. Then you want to move. I mean, there's no way around it. Our bodies were designed to move. You got to move about 150 minutes a week of exercise. So it's not that much. It's like 20, 30 minutes a day. And it could be just a walk or it could be could do walking in the morning or in the evening after meals, particularly after meals, great after dinner. Even a 20 minute walk makes a huge difference. Resistance training three times a week to build muscle. It really is key. And muscle is really a sink for glucose, so you have to build muscle. There's just no way around today to say you can lift weights, you can do resistance bands, you can do body weight exercises, all of it. Also, it's important to mindfully eat. You don't want to be in front of the tv, scrolling on your phone, eat with family and friends. Make it a social thing. Enjoy the food, take your time. Really important. And supplements also can help because often we're nutrition deficient. If you're more obese, you're more likely to be nutritionally deficient in vitamin D and many of the B vitamins, magnesium omega threes. And so taking a good multi vitamin D, magnesium and omega threes is really helpful. And if you're concerned, I would also look at some testing, which we can do. You can do through function health. Go to function health.com. You can use the code Young forever and jump the wait list, but you can see what's going on with your metabolic health. We help you measure insulin. We help you measure your lipid particle number and size, uric acid and many, many things A1C that look at your metabolic health in a very deep way so you can know what's going on. Also, you can look at your metabolic health by looking at your body composition, and you can use in body or those little machines, you can use in some gyms or even a body composition test called the DEXA Scan. Really, really helpful to know what's going on. So you've got to kind of get a sense of where you're at and be personalized in your treatment. But in conclusion, I just want to share that I think this whole craze for these weight loss drugs is misguided. It's highly risky. It's highly expensive. It's untested in long-term. And I think we're going to see more and more problems and complications come online as these drugs are being used long-term. It's not stopping the gold rush, it's not stopping the frenzy. But I had to put in my 2 cents here, and it's not something I would never use. If you have a type two diabetic who's not responding, or you have some very obese patient, you need to get'em to drop weight and you need to do it for some medical reasons, I think that's okay. But often you really don't need that. I just had a patient email the other day, lost 200 pounds, no drugs, no bariatric surgery. It's possible to do just by following simple approaches that work with your body rather than against it. So I think I'm really concerned about the long-term consequence of this drug. It doesn't address the root causes, as we say. It doesn't really work in conjunction with lifestyle, and the side effects are very, very, very concerning and it's hard to come off it. And we need to help people think about an exus strategy for these drugs. Rather, I'd prefer you take a functional medicine approach that looks at your entire system at the root causes and gets to the bottom of it, which is our metabolic poor health, which is mostly caused by Sergeant sugar and ultra processed foods. And it leads to high levels of insulin, insulin resistance, inflammation, and all those things can be addressed through a high nutrient dense diet, exercise, sleep hygiene, stress reduction, and understand that if you're overweight, it's not your fault. We live in a toxic food environment and it's really tough to do the right thing in this culture, but it's not impossible. It just takes a little bit of a learning and a focus, an approach that I think can be helpful. And I've written many, many books about how to address this. The 10 day detox diet is probably one of the most important in terms of getting your metabolic health sorted out. And it does it very quickly. We put a diabetic patient on this who was very severely diabetic, and in three days she was offered insulin. In three months she was off all her meds and her A1C went from 11 to five and a half. So it's possible to do so. That's my rant on Ozempic. I hope you liked it. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Dr. Mark Hyman and we'll see you next time on The Doctor's Pharmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guest opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. It's not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for helping your journey, seek out a qualified medical practitioner. Now, if you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.