Sumeet: One of the questions that we heard recently was, are these medications only for Diabetics or can a Non-Diabetic person take these for weight loss? 

Edward: Yes, well the problem with and a funny thing you mentioned is not long ago I had a patient asking me if she would be able to get this medication when she is not diabetic. And I explained to her that when these medications were developed, they were not developed to substitute insulin which is like the mainstay for dealing with Diabetes and glucose levels in your blood. These were designed to lower blood sugar levels to an extent where you can actually handle the measurement that I mentioned before called the A1C. So, the amount of glucose or sugar in your blood that they are supposed to modify is just 1%, 2% maybe 3% and maybe less actually of the quantity of sugar in your blood. So by saying this, I would say people who are not diabetic may be able to use this product like it is right now with Wegovy but only in the event that their blood sugar levels do not drop dramatically when they're using it. 

Sumeet: Makes sense, makes sense. So basically you can use it but you need to track your health, you need to track where your sugar level is, where your A1C levels are. 

Edward:  Right, right and one other important thing to consider if you are already obese, if you are experiencing problems with body weight and you are overweight and technically when you have a BMI of over two meters per meters squared, you are a person who may be a good candidate for these drugs. I don't think it's necessary for a person who does not meet the criteria of being overweight using these medications just because I want to lose another 10-15 pounds just to look skinnier than what I am already. 

So yes, there is always a risk of people misusing it like you know with many other things. But yes, there will be a legit use for these medications if you are actually overweight. 

Sumeet: Good point, very very valid point. Now one additional question on this topic is are there side effects of this? Are there you know immediate side effects, potential side effects? Could there be long-term side effects because one of the things is yes, now I lost weight will it negatively impact my body in the long run? 

Edward:  Yeah, that's a good question and with medications with pharmaceuticals there is always a chance for side effects that were not noticed, were not discovered during the other trials. So for that same reason, during the research of new medications they have stage one, two or one, two and three, three being the one that is the aftermarket reporting meaning that there were certain side effects, certain situations that were not noticed during the first two stages of researching. Once it goes out in the market, there is always open a channel for us as pharmacists to report new side effects that may be arising with long-term use. Typically the research papers are performed, a good model for research is about two years. During two years of research you can kind of pinpoint more or less where the side effects land. 

However, there is always the opportunity for certain side effects not to show and that's where the aftermarket research which is if I say is the one that allows them to find out whether there will be additional side effects and additional health issues or additional benefits as well. 

And yes, it is important to note that Semaglutide, GLP-1s and Mounjaro, especially Semaglutide (Wegovy) which is the one that is approved for body weight loss, they do carry a black box warning. The black box warning is something serious, something that may be a contraindication. It is life-threatening and this black box, when they were experimenting with a certain kind of rodents, they realized that these rodents that had the tendency of developing Thyroid Cancers, Medullary type cancer, they actually suffered cancer and died within the time of the experiment.  So even though in this model it was with rodents and maybe not correlation to humans, there is always an opportunity that if you have a familial history of Thyroid Cancer in your family, it is advisable that you talk to your doctor and reconsider the possibility that it may be a cross reaction to humans as well. 

Right now, nothing has come through as a valid point in terms like, oh yes, it does cause Thyroid Cancer in humans. No cases have a reason that I know, but it is always a consideration. So I think it was a good point by the FDA to mention this in case so you can be aware if you know that there are problems in your family with thyroid issues, you may just want to take a double look and be very extremely careful while using these medications in your particular case. 

Sumeet: Wow, okay. No, but it is good to know, right? I mean, that you need to be self-aware of things that you pointed out. Firstly is if you do not have Diabetes, and if you there is a potential that your sugar level might drop, you need to talk to your doctor carefully about it. Secondly, you also pointed out if you have a history in family of cancer or thyroid cancer, you need to talk to your doctor about it. You just need to be open to your doctor about it. 

Last question, so I know that you guys fill out a lot of these prescriptions. Have you had customers come back to you or patients come back to you with success stories that, hey, look, I lost X pounds or have you seen patients lose weight with this? 

Edward:  Oh, definitely, definitely. 

Sumeet: Okay, good, good. Yeah, so basically, it's not a myth. It's true, it's tested, you have seen it live and it does help. 

Edward:  Well, I guess I can give you a couple of examples of people with extremely bad side effects and also tremendous accounts of people really losing weight. Like, it's really hard to believe, but I have seen it myself. 

So, yeah, the side effects that you would expect by using these medications, I need to start with that. They all have to do with the gastrointestinal tract because that's where the particle works. So, you can experience the main three ones and that doesn't mean that you will actually feel and experience them, but those are the three more reported side effects are nausea, constipation, and diarrhea, more or less in that order. 

And I always kind of ease my patients' fears about side effects by telling them these side effects were reported, but they tend to be low. That means that during the studies, a small segment of the population, the research population reported them. However, you never know if you're going to be that unfortunate, 1% that gets it. So, you got to be aware of that. 

And I have discovered as well, I don't know if maybe some research has already done it, but the correlation of things that once you know how this medication works, you can actually use some of the side effects as a teacher in a way. So, I talked to you about the way this medication works. So, when you normally are not taking this medication and you've eaten to your satisfaction, intestines release that information to the brain that tells it, “hey, you need to tell this person to stop eating because you're already satisfied.” And my question to them is, okay, how do you feel once you ate to your satisfaction if you decide to take an extra bite, a little bit of that thing that was so extra delicious? And the answer is always like, oh, I feel nauseous or I experienced some discomfort. 

But that's exactly why you need to pay attention to this. That means that the medication is working. Whatever you have in your system is signaling your brain, don't eat, you're good, you're not hungry. So, having that information given to them, they now know that they need to create a new lifestyle, create an awareness of how much to eat. And they normally do, you know, of course, after we talked to them, they do create like a calendar or like a log of activities they do throughout the day. And once they pinpoint like, oh, maybe I'm eating, you know, a high-calorie breakfast or a large amount of this or that, so I'm going to cut it in half. And some of them have reported that once they do that, the side effects disappear at all. 

Now, to note, the side effects are always mild or they tend to be mild and not lasting more than two days in duration when you do have them. So, that kind of pinpoints or it gives me a hint that it has to do with the fact just how the body actually works. 

One other side effect that hasn't been noticed is that when you do have constipation, that means that your intestinal tract has slowed down a little bit. And this is also the way this medication works. So, by slowing down the transit, you feel full most of the time. Therefore, you don't eat. The problem is that if you normally have problems with constipation, you may be experiencing a condition called Gastrointestinal Paresthesia. And that means that normally your intestines are per se lazy to move stuff around. So, by adding an agent that slows you down, you may have a problem with constipation and maybe just a blockage. So, you got to be very careful with that. 

And the way you overcome that is by taking sips of water, increasing your physical activity, walking around. So, you can use gravity as a way to help out getting rid of waste. 

Sumeet: Awesome. Yes, go ahead, Edward. I know you want to add something else. 

Edward: Yes, because I think I left out part of the question about success stories. Yes, I have seen people and this is hard to believe, but it did happen. I had one patient that started the treatment when this man was a 350 pound man. And six months into it, when he walked into the pharmacy, he had lost, and here it is, 150 pounds. So, there is a chance for success. Yes. 

Sumeet: Oh, wow. Awesome. Awesome. Good to know that.

If you missed Samantha and Edward's discussion on Ozempic and Eat The Rainbow (Part 3 - Green), you can still watch the full episode here  -->  https://www.facebook.com/cobionic/videos/the-cobionic-talk-show/801701211600377