Why Everyone’s on GLP-1s (But No One Admits It)
Off The Charts Podcast
Hosted by Dr. Paul Maximus and Dr. Bobby Parmar
[Bobby Parmar]
Hi everybody, welcome to Off the Charts, where we're talking about all kinds of crazy shit, including today, Ozempic, Mounjaro, GLP-1, all the medications that everybody talks about, but nobody says they're on. So let's get into it. GLP-1, Ozempic, Mounjaro, all the names, all the rage.
Everyone is on them, but clamoring. Nobody's actually saying that they're on them, which I find so interesting. There's like a secrecy around it.
And I want to talk about what you think that is from and the why. Why do you think, I have my own opinion, but why do you think people are so secretive about being on this medication as a provider who gives almost every day, anybody who walks in the door has the access to it, but they don't want to tell anybody about it, and they want to hide and cloak themselves into a Traitor cloak all the way out the door and be like, how could it really be?
[Paul Maximus]
How many layers? Part of it, I think, is the shame of being on a drug, any drug, needing something. It's like a failure.
Same reason why people don't want to advertise, I'm on an antidepressant, because you need an antidepressant? What's wrong with you? There's sort of this flawed, I don't know, this kind of feeling of being flawed if you need something like that.
Or it's a moral failing. It's a moralistic like, oh, what, you couldn't do it with diet and exercise? What do you think about that, though?
You're from the bodybuilding world. I mean, a long time ago.
[Bobby Parmar]
45 pounds, pre-doctoring. Enjoy the cutout that you're about to see. But like, you're a bodybuilder.
Was. Was. Just bring him the trophy.
Be like, look. The one that leg is broken off?
[Paul Maximus]
Yeah, I got two of them. I got a heavyweight natural bodybuilding trophy and an overall, because I won the whole thing. And then the overall guy, I was like cleaning and hit him and he fell and broke.
So I threw him out. So now I only have the one guy.
[Bobby Parmar]
But I won two things. Being a trophy snatching bodybuilder winner, natural, national, all that competition stuff that I don't I don't really know. Right.
Yeah. Does that have any role to play in why people are so afraid of talking about being on a weight loss medication? My perspective is it is because everybody's personal trainer, personal trainers, nutritionists, everybody in the world is like, you should have done it yourself the whole time.
Doctors for the longest time have been like, what's wrong with you? There isn't anything else that I can magically give you or test to make you feel better or lose weight. It's you.
You're the problem. I think that society created this secrecy and that's where a lot of that comes from. And there's like a shame component of it that we've been told for so long.
It should have been you doing it the whole time.
[Paul Maximus]
I was I was talking to a friend of mine who is a bodybuilder. He still competes nowadays. And when I told him, oh, yeah, here's what I'm up to.
We're going 15 city tour next year. We're talking about GLP ones. I'm obviously prescribing a lot of them.
I was working on this presentation last night kind of thing is he immediately was kind of like, that's huh? Why don't people just do what I do? Diet and exercise.
I do it. You know, I cut my calories and I go to the gym and I work really hard. And why are people lazy?
He said, what a wonderful example of something literally in your life that is still not with it. Like a lot of people. Bright guy, too.
Good guy, bright guy, not close minded, but just he's a bodybuilder. So his view is, you know, I remember the days where people liked hard work. Yeah.
And that's his perspective. But like I had to bring up, hey, do you know how we treated obesity? One hundred and fifty years ago, we put people in a circus cage, basically pointing at them and shaming them overtly.
Then a hundred years ago, it was a moral failure. Right. Of like we need to starve and still to this day that that pervades.
But 50 years ago, it started to be acknowledged as a as a pathophysiologic process, like a disease, a biologically underpinned disease. And then 25 years ago, the drugs got better and better and better. And they're the ones we're talking about today, obviously, that have kind of turned the tide where you shouldn't be forced to fail diet and exercise in order to be offered.
But so many people are still looking at this whole physiology as if it were eighteen hundreds, like you should be diet and exercising. And only then, only when you fail. And this changed 20 years ago in the guidelines and the early guidelines were already saying, hey, maybe there's more complex things going on here than we appreciate.
But still, to this day, you talk to people and they are in 1999. They're still shaming and blaming and telling people that they're cheaters or there's there.
[Bobby Parmar]
I think that comes from like I've said this so many times. We're like in a fat phobic society. Everybody is like the Jenny Craigs and the Weight Watchers, like everybody made fun of people being like, you're probably on Jenny Craig or like you at a Weight Watchers, like it's pervasive.
And like the whole Oprah thing and weight has been such a stigmatized issue and that you are just a lazy fat slob and that this fat phobic society in medicine, it's also pervaded there. And so nobody's been allowed to think of it in that way, that even though we had the data and the evidence and all this, yes, obesity and being overweight is a physiologic thing. It is very much outside of a lot of people's, if not most people's control when they're having this yo-yo situation.
And it's because we live in a world that doesn't like to do anything other than shame people for being overweight. And when you and you know, Ozempic and all these medications for the last five or six years that have been used for weight loss specifically, when you tell doctors like, okay, like start thinking of prescribing this, just they're like, no, why would I? Pharmacists even when a person comes to them to fill one of our prescriptions, pharmacists will still be like, you don't need this.
Yeah. You're on this. You're on this.
Yeah. I don't know. I've had patients cry in line at pharmacies for being shamed.
I've had patients tell me after they went to the pharmacist, not to beg on pharmacists, but everybody, you can't escape the fat phobia, no matter where you are in this world, because you come from that society, you're part of the fabric. And pharmacists are telling our patients, just spending an hour educating them on diet and exercise, so that they might say no at the checkout. Because they're just like, you're not big enough to warrant this.
You're not fat enough to warrant this. They're educated people, and yet they still are at the mercy of this. Shame, that's a part of it.
Like, I need to shame you into not doing this. Because why didn't you just go to the, you know about this drug? How much, like, you're gonna be constipated.
You're gonna be nauseous. Do you really want to put up with all of that? It's like, bitch, I've been putting up with this shit as a person who has disease as a result of my body weight for so long, and I can't get out of cycle.
So just give me the pen. Jesus, fuck. That's where I think it comes from.
It's like, even the medical providers have just revealed how violent this idea is that you're not allowed to have medicine treat your weight. You should just do it on your own, because you got there yourself. If you got there yourself, try to get out of it yourself.
And it's just like, oh my god, how did we get here? And it's clear. And I think a lot of us have played a role in this to make it be like this.
And we're trying to unravel that now. We're trying to really unweave this fabric so that people are more okay with thinking, this had actually nothing to do with me. Maybe it's generational.
Maybe it came from my granny. Maybe it came from something that happened when I was in the womb that changed the way the genes that I was inheriting actually showed up in this body. Maybe it has to do with my ethnicity, all kinds of things.
I always like talking to people who come from, like you're ripped, like you're this ripped doc.
[Paul Maximus]
Genetics. Yeah. And upbringing and socioeconomic status.
And there's a lot of variables that can work for and against somebody. I have a lot of the variables that are working for me. At the same time, we made a, because we're doing this presentation on this thing, we made a slide comparing the two of us.
And it has, you know, a couple of bullet points about Bobby, how he could eat and drink and kiki all day long. Just dopamine, ride the wave all day long. I had a hard time riding that wave.
And for me, it's like, I couldn't be bothered to eat. I forget to eat. This is why I'm not a bodybuilder anymore.
Because unless it's a full time focused, like job for me, put it in my schedule, I'll skip meals, I'll forget to eat. I'll be halfway through a meal. And then I'll get a, there'll be a fax or an email or something where like, that's more interesting to me than eating.
I'm just not wired to care about eating that much. Right. I'd rather be doing other things for dopamine.
[Bobby Parmar]
And all I want to do, I'm one of those epic people, or was, now I'm on Mounjaro. All I want to do is stand in front of the fridge. All I want to do when something happens in the day, if I'm if I'm excited, if I'm just like, oh, there's like a space between things or literally doing something, I just wish there was a bucket of ice cream.
And I can't help feeling that I can't help it. Like, there's nothing I could do to cognitively change the voice in my brain that has that. And people have it in different levels.
They have it a different degree. Some people like, oh, yeah, I get some food noise, as we call it food noise. Yeah.
[Paul Maximus]
And other people hear it screaming. And there's differences in how much we want to move. I'm constantly moving, constantly fidgeting.
We go for a drive for an hour somewhere to Abbotsford or something. I mean, you won't let that happen. And I want to stop every 30 minutes to get out and go for a walk and stretch my legs.
Bobby famously has taken an 18 hour plane ride once, realizing when he, I don't know if you realize or if you knew the whole time, but when he got there, he hadn't stood up to go take a pee, to walk down the aisle. He could just power through a flight to the other side of the planet. And so like, how much of this is Bobby consciously being like, I should get up versus like, I can't help it.
[Bobby Parmar]
Yeah, no, there's no itch. There's no fidget. There's nothing in my muscles that says, oh, you should be getting up.
Obviously, I need to be getting up to pee. I just don't need to pee. Obviously, I need to be preventing clots from forming.
It's just my body is just not telling me that. My boyfriend has to nudge me to be like, I need to go pee because he also has a small daughter and has to go every 30 minutes. I'm just like, oh, my God, I got to get up to let you go.
But then I don't follow him to go to the bathroom. I mean, I don't follow him so that I pee as well. I just don't feel that.
We're wired so differently. And I feel like the point is, people still don't get that. They don't get that we're literally, they're like, it's willpower.
No, it isn't. You'd like for it to be willpower. You'd like for it to be that we just choose differently in the day.
And then that's the answer for it all. It's like, that's not the way this works. And we're trying to dismantle that from doctors to pharmacists to personal trainers to nutritionists being like, get off people's backs.
Let them do. And the reason I get so uppity about it is because it's so annoying to have to answer so many. It's been 60 years that we've been prescribing these medications.
And we still every single day have women usually that come into our office and say, so-and-so told me I shouldn't go on it because I should just get my ass to the gym. But I've been trying. How unfair.
So-and-so said that I'm going to go blind. Did you read the news? I'm going to have a brain tumor as a result of this.
I'm going to die earlier. Actually, you're going to live three to five years longer. Who's telling you these kinds of things?
And I think it's all, and this is what I've said to you before. And I've said to other people before. So these drugs, people, these drugs have been around since 2007.
Like the iterations of this drug, they've gotten better and better and better. They've been around since 2007. Did you hear about these medications from 2007 to about 2020?
No. Did you hear about their side effects from 2007 to 2020? No.
Why? Because they were only offered to people with diabetes before. Nobody cared about diabetics.
Nobody cared that diabetics were going blind from these medications. Nobody shamed them for going on these medications. Nobody said they're going to die from cancer.
Nobody said that they are going to suffer from constipation to the point they're going to be hospitalized and get gastroparesis and pancreatitis and they're just going to die. Nobody even brought it up. And why didn't they bring it up?
Because it wasn't about weight at that point. As soon as it became about weight, as soon as it became about something to do with a judgment society has, diabetics are just like, oh yeah, they're diabetics. Who cares?
Like we don't talk about diabetics in that way in normal part of society, but do we talk about fat? Yes. And as soon as it became about fat and as soon as it became a weight loss tool, it's like, get them.
Don't let them get block every access point to this medication that you possibly can and make them feel bad about it. Even insurance companies, insurance companies are cock blocking the shit of this thing. They're like, you have to be qualified to get to this point.
And it's based on studies and things like that. Like they'll stand in your way from getting their own medication that's meant for those people only because it still has to obey very strict rules to get it. And people say, I'm not qualified for this.
It's like, yeah, you are just because an insurance company doesn't cover you. It doesn't mean you're not qualified for it. That's a money game.
[Paul Maximus]
Yeah. There's this whole concept I think that people have of cheating too. Like if I'm going to the gym and working really hard and I'm laying at night chewing ice cubes and laying in bed, ignoring my cravings and white knuckling it, then it's not fair that somebody else uses an injectable.
It's not fair. Fair for who, according to what standard. And the other thing is the naturalistic fallacy.
We get personal trainers and nutritionists and people, naturopathic doctors or naturopaths who are all in on the natural is better than prescriptive. And that's another layer of this. The naturalistic fallacy, this kind of misunderstanding.
If you really believe that natural is all better than pharmaceutical, throw away your phone. Don't use your dishwasher. Don't take a car, a bus, a train, like a boat.
Don't use any technology and just use your legs. Just walk. Just like write a letter.
Use a pigeon. Can you talk about the fact that this hormone is natural? Modern advancements.
Yeah. Modern advancements happen. We use them to make our lives better, easier, to be more efficient, to have a job be done more effectively.
This is not a new pathway in human physiology. The GLP-1 pathway is some studies say it goes back 400,000 years that all vertebrates except one, some random like zebra mussel or something doesn't have.
[Bobby Parmar]
That's why I asked Paul this question because he learns about zebra mussels and he's about to tell you about a Gila monster.
[Paul Maximus]
Strap it. So 400,000 years, we all have these nutrient sensing pathways. It's one of the fundamental jobs of a cell is A, to have an identity, DNA, and then B, to be able to manage energy in, manage energy out.
And then maybe C, to be able to move away from harm or towards opportunity. Like it's one of the basic fundamental parts of the cell. So we have so many mechanisms within and between cells for energy sensing.
This is one of those. So GLP-1, various vertebrates make more of it, less of it, slightly different. There's different receptor expression and all kinds of stuff, but fundamentally its role is to potentiate insulin so that you eat food and then this is made in your gut and it's a communication pathway between your gut, your pancreas, your liver, your brain.
There's receptors like everywhere and it's effectively supposed to be this feast, famine, metabolism, modulating, anti-inflammatory protection mechanism for when you go from feasting a long time to suddenly a big meal. You have to be able to process that big meal and not die from it and not become inflamed as a result of it. It's a stressor, eating as a physiologic stressor.
So GLP-1 is one of those things that's evolved to be able to help you metabolize a meal, spike insulin so that it can get into muscle cells and get into the liver and then to be able to drop potentially for a long time of famine again. And so researchers came across this Gila River monster that lives in the Sonoran Desert. Did I call it a Gila monster?
I mean, yeah, it's spelled G-I-L-A. So we did that for like three months before we looked up the YouTube pronunciation. So it's the Gila River monster.
It's this little like foot, foot and a half long lizard that's like orange and black and it has 150 proteins in its venom and saliva. And of those, there's something like 10 or 15 of them that are toxic, in some way toxin. Calocrine, I don't know, substance P, there's a number of them in there.
One of them, I think, is called Exendin-4, something like that. And it's effectively GLP-1, the human version of GLP-1. Again, it goes back 400,000 years.
We don't all have literally the same one. It evolved for different species and different environmental pressures. So this Gila River monster eats five to 10 times per year.
It sits under a rock. It has to lower its metabolism to conserve energy. And then when a mouse comes in front of it, under its rock, it has to be able to grab it, neutralize it, and then digest this entire thing, which can be 50% of its body weight that it digests in the span of a couple of hours.
And that's a really, I don't know if you've ever eaten 50% of your body weight in one sitting.
[Bobby Parmar]
I have eaten.
[Paul Maximus]
What was I doing on Thursday night?
[Bobby Parmar]
I forgot who I was talking to.
[Paul Maximus]
It wasn't my birthday. Yeah. But that's a stressful, that's a physiologically stressful event.
And so it's one of the compounds that it evolved to be able to not die from the meal, and then to be able to drop its metabolism back down again for another month, let's say, before its next meal. And so in the human body, we make this thing, and we have these big brains. We lose heat.
We're constantly moving. We're really energy inefficient as a species. And we need to be constantly eating.
We need to be constantly hunting and eating and making up for this inefficient energy use. I know that very well. That half of the equation.
So human evolution made it such that our GLP-1, each molecule, I think only lasts one to two minutes. It's got a half-life of one to two minutes. And when we eat, we get this wave of like 30 to 30 minutes to like two hours of GLP-1 satiation, like feeling full from GLP-1.
And then it wears off. And then you're hungry again, doesn't matter how much you eat, doesn't matter how big of a salad you have, and how full your guts are, your brain stops getting that signal. And then you're hungry again two hours later.
And so like, this is not conducive for a lot of people's, like the environment that we live in now, where we have pressures, we have McDonald's on every corner, we have low socioeconomic status, we have night shifts, we have on-demand meals, we have hyper-palatable foods.
[Bobby Parmar]
Living under a rock, just waiting for a rat to go by. We are constantly stressed all day long. Women particularly that have all of this shit to do.
And then they're also expected to go to the gym two and a half hours because that's what it's going to take for them to heavy lift their way out of having the extra 15 pounds that they feel is hurting their knees.
[Paul Maximus]
And you're supposed to white knuckle it. You're supposed to ignore all of the billions of advertising that was meant to get your dopamine spiking for a mocha latte, whatever it is, and for a McDonald's happy meal. And you're supposed to somehow ignore all of that.
You're supposed to be up until midnight with your kids and getting the job done and whatever else it is and go to bed hungry, stressed, cravings. And so a medication comes along, EExendin-4, turns into Exenatide in 2004. From there, there's like 12 other molecules, GLP-1, maybe not 12, 10 or so that have been 5, 10 that have been approved since then that just got like an iPhone upgrade that just got better, better, better, better.
And then a few years ago, realizing, hey, these things work really well with diabetics, not just for normalizing their blood sugar, but helping them drop weight. Let's get let's give these to people with obesity and let's see how they work. And lo and behold, they worked really well.
Approval came for obesity. And now, because of celebrities and this catching on, they're trillion dollar companies. And the cat's out of the bag that like these things are here.
They work. The latest iPhone version of the GLP ones, Semaglutide, Tirzepatide, Retatrutide is coming in another year and a half. They're unbelievable.
Why would you not use these to augment your biology, to get done the job you're trying to get ineffectively, inefficiently by white knuckling your biology?
[Bobby Parmar]
That's the other thing. Obesity, like the word obese makes most people think, you know who you're thinking of. You have an image in your head of who that is.
Biggest loser, 400 pounds, my 600 pound life. That is not who these medications, because they're hormones that are in your own body. That's not who they're only meant for.
You can take them. You can have access to them. You don't have to hum and ha about them because like you've heard all this.
They're only meant to be for obese people. And that's not me. And no, you need to be able to have access to medications like this because obese just means that you have enough fat in your body that it's causing complications, or it's more likely to cause complications.
You could already be there. You could be an Indian person who is not technically obese by the standards that we have as a threshold for what constitutes obese, but still have like your liver enzymes elevated. You could have your sugars a little bit elevated.
You could feel like, how come I, I'm not able to lose weight. Why am I struggling through this? You could have PCOS.
You could have all of these other things going on that have nothing to do with what you imagine obese to be. But we have to like tear down some of the way that we think about all of this in order to make it so that it's more accessible to more people because it like, it deserves to be. And people just don't think it's right for them.
And that, that enforces the whole like cheating thing. It's like, I'm not obese. I only have 25 pounds to lose.
That's like, if you want to lose that 25 pounds, because it's affecting you negatively, maybe you're depressed because of it. That is a very valid reason for you to take a medication to help you resolve the depression around the way you feel about yourself, because you live in a society that happens to make you feel terrible about it. That's the kind of shit that I want to like really like tear down.
I want more people to feel like comfortable and accessing it, talking about it, not being scared to be like, you know how many people you have together? There are people that come into the chair, and I know that they kind of like, why are you here? Um, um, my girlfriend told me to come see you.
And she's doing really well. So I wanted to talk to you about like me doing really well. And then before I would give that person 30 minutes to be like, okay, when are we going to get to the point that you're asking for was epic?
Like, when are we going to get to the point that I know who your girlfriend is? And they'll now I'm just like, what are you here for? And then it's like, Oh, I just want to feel well, in what way?
And I really want them to get to the point fast. So we can have this full conversation, because everybody's kind of sheepish about it.
[Paul Maximus]
Where do you think that comes from? Like, you go to a doctor? Is it because in our healthcare system, a lot of people have this experience of going to their MD and they ask for something and they have to justify it, they have to embellish it almost and make it worse than it is in order to get taxpayer dollars to pay for testing X, Y, or Z lab?
Do people come to us in the same way sort of feeling like they have to justify or they have to, they almost have to like grovel or they have to they're ashamed of it?
[Bobby Parmar]
I don't know.
[Paul Maximus]
Why is there this hesitation in the private pay sector and not just in public pay medicine?
[Bobby Parmar]
Let me tell you, when I found out about Ozempic, and we keep saying Ozempic, like GLP-1, basically, it could be any of them, it's just what I've, everybody's most familiar with, you know, like, we think Ozempic is the Kleenex, right? It's like the Kleenex. So when I first found out about it, I asked my doctor at the time, I was like, you're putting me on this.
And she was like, okay, like, no, like, you're gonna put me on this. It looks amazing. You're putting me on this.
And she was friendly enough and open enough to explore it with me right away, after some blood tests to reveal how desperate of a situation I was in, unbeknownst. So we were like, that's part of it. And then the second, the second part of it that just got me Ozem-pissed.
Ozem-pissed, because the thing that we're talking about is like, we're constantly asking patients to be their own advocates. Constantly. You need to advocate for yourself.
You want to go on menopause hormone therapy, you need to advocate for yourself. You want to go on a medication that's going to help you with your weight or inflammation or whatever. And it happens to be Ozempic, you need to advocate for yourself.
You're somehow supposed to have gone to law school and medicine school for 15 years to be able to speak in a kind of way that makes you able to win that courtroom drama scene with your doctor to help get them to a point where they're like, I understand. It's their job to be doing that. It's not your job.
It just happens to need to be your job nowadays, because so many healthcare providers are so closed, this kind of thing. So you're forced to somehow to like a lawyer up, put your fucking wig on and get ready to fight. But like, that's not the way it's meant to be, which is why we're trying to change that.
We're trying to get other healthcare, nurse practitioners, pharmacists, like, stop, like read a book. Like you used to read books really nicely. What happened to you?
[Paul Maximus]
You put the book away. There's also the like standard algorithm, standard practice, where I forget if you were telling me this or an MD that I was talking to was telling me this, I think you were saying this, that in a lot of MD circles, you know that another MD is going to read your chart, especially if you're in practicing in the same clinic. And you don't want to be seen as rogue.
You don't want to be seen as doing anything questionable. So you just do your job exactly by the book, according to the most conservative algorithm. Can you speak to that?
[Bobby Parmar]
Yeah. So this is some medical doctor friends of mine who, who don't want to break the standard of care box, because if they do, then they get essentially ostracized by the other. Stigmatized by the other doctor.
Yeah. And be like, what are you doing? Oh my God, you're such a renegade.
That's crazy. And then you end up, if you're still in the public system where somebody is like taking over for you or you're in a group practice, and then you end up looking like this kind of like wild, wild Westie, like unhinged provider, who's just all over the place. I feel like those doctors end up leaving the profession and going private because they're like, Oh, this, like the shackles off me.
I want to be able to do right by my patients. And I can't do it in this context. I've been told that, I mean, we can have doctors on here to speak to this.
That would be so fascinating, but that's what I've been told as one of the reasons. And then two, they feel like they have to justify what they're doing to both like their college. And they feel like they might get audited and that they feel like they're, there's this like 1984 vibe overlooking their shoulder, constantly having over what they're doing in their charts.
And that must feel also uncomfortable. And yet at the same time, they off-label prescribe 50 to 70% of the time. So when you bring that up, you're just like, why won't you off-label this?
How can we off-labeling everything else? The majority of medicines are off-label medications. Pain medications are antidepressants.
Like we're, you got some pain, here's an antidepressant. That's off-label use. Why are we so okay with off-label use for everything until it comes to something off-label because you're fat?
That's crazy to me. That is wild to me that we still have that kind of barrier. And I think it's psychological.
Like how many times, I always wonder this about too, healthcare providers, do they not feel this? Like they're, they get that like middle spread. They get the spare tire.
Are they all hitting the gym and doing high rocks all day long? I don't think so. I don't know.
How are they not? And they're just getting it from their service sources. Usually their friends who are other providers who give it to them or they access us.
So we need to have a better conversation with medical providers about this too, because they're not practicing the way they would like to have practice be served to them at the same time. And it's so gross that it's like this because there's billions of people who are in this boat. We talk about people who are overweight, people who are obese, people who are just 20 pounds heavier.
And if you just lost that 20 pounds, maybe we'd be able to prevent that knee replacement you might need in 10 years, because you're on a trajectory to get surgery. Put them on Ozempic, put them on Mounjaro, put them on some kind of GLP to make a difference for them. So they get there faster and then they'll be fine.
Then they won't need that $15,000 of public health funds. Their insurance might've paid for it, or maybe they were okay with paying for it. And that's the other thing.
People think it's so expensive. People come in here thinking that they're going to pay two grand a month. And they're just so busy watching CNN, hearing about the conflict between insurers and the government and the whole American pay system, which I do not understand.
I'm not able to pretend that I do. It's not like that here. There's access, there's ways of getting discounts, and it's also not that unaffordable and it's about to get way cheaper.
[Paul Maximus]
And there's the concept of click counting, which we've done a ton of in the last two years. If you're not familiar with that, that's where the doctor prescribes a larger size, a large size pen, and then has you take a small size dose of that pen. And so you're counting the number of clicks instead of doing the standard, every pen lasts one month for the same price approach.
So there's click counting, there's program pricing for Canadians.
[Bobby Parmar]
And then you get like clapbacks from pharmacists who are just like, why are you counting clicks? This is not in the monograph. Three, four years ago, that's all we got, right?
Now they've kind of melted. They've all kind of just been like, okay, I guess we're doing click counting. Now they're just like, okay, so you mentioned the number of clicks.
Please also write the number of milligrams so that we have that on file. And they're like, oh, you're like, you're with it now. Thank God you finally got there.
It's such a wave of change that's happened in the last, and it's so reassuring that they're seeing that nobody's ending up in the hospital. Nobody's ending up needing medical surgical intervention because they can't take a shit for 10 weeks on this medication. Nobody's getting the Babadook thyroid cancer from, nobody is getting these kinds of things in the kinds of numbers that are being presented.
Somebody like, um, came for me on Instagram last week when I spoke about this and their comment was just like, oh Jesus, just get to the gym fatty. And you're just like, let's talk about that.
[Paul Maximus]
The, the misperception of blindness and pancreatitis and gastroparesis and his comment was dangerous side effects.
[Bobby Parmar]
Why would you offer a person medication when they could just do exercise? No, no, fast and eat a clean diet. And that will solve everything.
That's what, that was the comment. And a lot of people feel that way. He was just brave enough to comment on my post, which go for it if you dare.
Um, and your thumbs will get a lot of already do. So like the comments like that are representative of this like feeling in society, right? There's definitely this, like he's representing a big population in the world who believes this and who would like to, I think they're dying out a little bit in this way, but they still represent a big group who are part of the shaming and the dangerous side effect comment.
It's not, these are not dangerous things. There's not going to be the, the side effect potential is fractional at worst. And it is manageable with fiber and water, maybe some magnesium for like slower bowel movements because it works on making your intestines go a little slower.
So you don't dump sugar into your blood and have it run amok. And the other ones that are spoken about, it's always headlines that are just like pancreatitis study on Ozempic. And then it makes a headline personal trainers online, or they're like, see, and then they're share, share, share, share, share, take the headline.
[Paul Maximus]
And then what happens when you read it, go and read the actual, next time you see one of his articles, go find the actual study that they were referencing. I dare you. I'll read the actual study.
We've read all of them. We've read all of them. You'd be like, Oh, two in a hundred thousand.
Guess what they say? It's all people who had raging comorbidities, polypharmacy. They were on a lot of different drugs and they were way too aggressively managed.
In other words, too much of a good thing, too much, too high of a dose of too quickly causing changes to their A1C changes to the osmolarity changes to the pressure in their eyes. It was, it literally, they say too fast, too much of a good thing for these fractional cases. These, these cases on the margin that are not you, they are not you reading this.
[Bobby Parmar]
And we got to talk to the influencers out there. Come on. Do better.
[Paul Maximus]
Yeah.
[Bobby Parmar]
You guys, you guys are just click baiting the shit out of this. You're coming for Serena Williams for like literally putting years onto her life. You are like trying to like, gotcha.
We know you lost weight because you were on those epic. Why do you think all these celebrities are so afraid to say that they were on to take it? And they're literally lying saying, yeah, I adopted a new, uh, eating regimen and I just got less stress from yoga.
Come on. Like the 20 years it didn't work. It just started during COVID was during global wars.
Yeah. I somehow had the peace of mind to be able to like, do this on my own as if. So congratulations to the one who have, but like, they're just afraid they're still suffering the, the, the, like the insecurities of having people like you come for them for this kind of stuff, leave them alone, leave me alone and leave the others alone.
Let them, let them do what they want to do with their life, their literal body, their literal choice. And like the whole other part of this is like, a lot of these influencers are personal trainers and nutritionists were like, you could have done this. You could have done this without taking this risky, dangerous, expensive, horrible medication, big pharma, big pharma, big pharma.
No, that is not what, what is happening here.
[Paul Maximus]
I used to work for precision nutrition. I was one of the early coaches on precision nutrition, massive, amazing. Like you've probably even heard of them.
If you're listening to this precision nutrition.com 15 years ago, they were, they were, and still are like the leader in terms of body transformation coaching. And we would have people where we would every single day, give them a habit and a, and a workout and a psychological, like an article, a lesson to read. And they would have to check the box every day for, did they do those habits?
And did they do that workout? We monitored them. We had them go through a program for an entire year, monitoring their compliance.
Even with a gold standard program like that, or biggest loser or something where you're like, you have the full support encouragement, maybe even somebody cracking a whip on you and you make a dramatic transformation. How many of those people do you think maintain that transformation? Five, 10 years later, we have the data.
The majority don't hold on to the changes that they made. It's just, these are chronic obesity as a, as a disease is a chronic illness. And it's not that all of a sudden, it's not that there's a black or white about obesity and non-obesity, it's a spectrum.
And so all of this is a chronic challenge.
[Bobby Parmar]
That brings up a great question and an answer. So if this is a chronic issue and we're all stressed and we're all trying to deal and try to cope and the strug is real and like all of that, right? The people who then ask, I only want to be on this for three months.
I only want to be like, like, this is going to get me into my wedding dress. And then I'm going to be fine. Right?
No, you're going to be on this for life. If you've had this problem that you're coming to me complaining about being like, I've been trying, or actually I haven't been trying because I don't have the ability to try. Then you probably are the kind of body that is going to need this for life because you have all of these inputs swooping around everywhere, making it so that as soon as you come off, you're going to go right back to where you were.
And it's going to be hard for you again. We really try to put it into people's minds. Why would you want to come off of this?
Like this is really life. If we're talking about longevity medications, this is one of them. Yeah.
This is going to be necessary for you to maintain the benefits you got for the rest of your life because you have to stop thinking about it like a weight loss drug. It's not. The longevity.
It's an anti-inflammatory. It is making sure all the different systems in your body are working at their peak in the way that the versions of the drugs that we have can now. It's going to lengthen your life.
It's going to prevent inflammation in a way that might have a snowball effect on all kinds of other diseases in the future. My God, why would you not want this in the water? Like it's, it's so impressive.
I mean, let's not put it in the water. I would suffer.
[Paul Maximus]
I would suffer greatly, but to your point, to your, to your point, it actually hasn't been made into liquid. The older we get, bodies break. We're all going to get older.
We're all going to need medications to make up for failing organs, to make up for processes that are not, we don't have 20 year old bodies anymore at age 60, 70, 80. Why is this any different? Again, it comes back to the fat shame.
[Bobby Parmar]
Listen, bodybuilder, do you think that if a drug comes out that is the GLP, that has the ability to also make a person gain muscle? Oh, that's a, we're going to talk about that for sure. Go ahead.
What do you think would happen? So let's say it's not just about losing fat and losing body weight. What if they unlock, they crisper the shit out of this and they're like, now it can make you gain muscle.
What are all the personal trainers and the nutritionists and the world?
[Paul Maximus]
What's going to happen? It'll be the same, but different. It'll be stigmatized the same way.
People pretend that they were never on it. Even creatine, God sakes, for God sakes, creatine took a hit for like a decade or two because people believed it was a steroid because the baseball, the like baseball players who were on anabolic were also using creatine and it got lumped in as, Ooh, that's one of those dangerous, scary muscle building, bad for your kidneys. Where did creatine just disappeared off like the public radar.
And now it's making it now it's bodybuilders have been using it for forever. Weightlifters have been using it for forever still, but now it's coming around to, Oh, look, it's got some brain benefits. Oh, look, paramenopausal women should use it for their bone strengthening.
People with Alzheimer's should be using it. But it took a hit because people associated it, lumped it in with this cheating steroid scandal. And so we have the same thing when it comes to muscle building as we do with fat, not as, not as, uh, rampant, not as stark, but it's going to be the same thing that like, there's a stigma around anti-kachexic or anabolic drugs because they're seen as, Oh, roid ragey cheating.
You're going to have some big gorilla who's going to like punch people in the face walking down the street. It's dangerous. We in a futuristic way as well, because we're all going to get older and fatter and we're all going to get old and sarcopenic, meaning that we're losing muscle.
So that's coming next. Besides after we manage this, like weight, like social stigma, we're going to have to talk about anabolics or anti-sarcopenic agents.
[Bobby Parmar]
I think what's going to happen is the moment a muscle Ozempic comes along, everybody's going to put their weights down and be like, give it to me. And it's going to, well, one, because it's going to be like a male specific thing. Like men are going to be like, get it, give it to me.
You see it all the time. People wanting peptides. It was like, give me the peptide.
Like all these like muscle, everything is just like, nobody's hiding it at all. There's like boys, let's go. The same thing will happen.
And mostly because that's what happens in our world. Like women's specific things and like perimenopause and obesity and being overweight, those are all just like, oh, you weak. It's just so weak.
Like get a fad, fad yourself. I think it'll immediately, it'll be like, everybody's kind of waiting for it. Like, when is the Ozempic for muscle going to come?
Like just itching, like, where is it? And as soon as it drops, the pharmacies will have to put bars up.
[Paul Maximus]
Yeah. There will still be the whole cheating stigma. And there'll be overuse.
[Bobby Parmar]
I don't think so.
[Paul Maximus]
There'll be maybe more abuse or maybe more overuse. I don't know if more of the same, because certainly there are probably people out there who are trying to seek out Ozempic, even though they're already underweight, objectively underweight. And so it's not without its harms given prescribed to the wrong person in the wrong context.
I think that same thing is going to happen with anabolics. They're going to be abused as they, as they can be, or already are, but they're going to have far more benefit utilized properly, the right dose, the right person, the right length of time for the right purpose. That's why aren't we already going full steam ahead faster in that direction as a corollary or in conjunction with GLP-1s and not even GLP-1s, because even that category to your point of, will a person be on this for the rest of their lives?
I often joke with patients that even if you love Ozempic or Mounjaro, and it's so great, it changed your life. You're going to put a tattoo of Ozempic on your chest or on your arm. Don't because you're not going to be on it the rest of your life.
There's a newer, better version of it already around the corner. There's 60 copycats of that already around the corner. You think you're still going to be on the same medication in 10, 20 years at the rate of change?
They're better, better, better. They're getting more effective, longer lasting, less side effects.
[Bobby Parmar]
I'm going to have to laser off the OZ that I have that you have on your lower back. The muscle part of this is also important to talk about, because that's the other thing. A lot of people are just like, well, I'm going to wither away and turn into the wicked witch of the West.
[Paul Maximus]
What do you have to say about the muscle loss that happens with this? Going back to bodybuilding culture. We take a lot of lessons from bodybuilding.
If you've ever lived with or known anybody or tried to dramatically change your body composition, like bodybuilding style, you know that there's a bulking phase and there's a cutting phase. You're really good at the bulking phase. I'm really good at the cutting phase.
I will cut a bitch. Cut the tape. On a bulking phase, you indiscriminately just try to put on as much mass as you can.
You hope that there's more lean mass than fat mass. Then when you're in the cutting phase, you try to take off as much fat mass while preserving the lean mass. It makes sense.
You're kind of zigzagging your way. A good ratio is 75% fat lost, 25% muscle lost. That's tremendous.
If you're a bodybuilder who repeatedly does a bulk and a cut and a bulk and a cut, and every time you have 75% loss of fat and 25% loss of muscle, you're going to keep building muscle over time proportionately while bringing the fat down. It's all about ratios. If you're 50-50, that's not great because you're just kind of going up, coming back down, going up, coming back down.
Every time you go through this cycle, if you're batting those averages, you're doing incredible. Ozempic has the same rates. It's 25% to 40% muscle lost.
You can make that better by doing some of the right things, but still, that's in the range. Even then, people picture, oh, 25% muscle lost or 40% muscle lost.
[Bobby Parmar]
That's devastating.
[Paul Maximus]
That's terrible. Imagine somebody who's 300 pounds. They're 300 pounds.
Every time they stand up and sit down, how big are their calves? Why'd you look at me when you said, imagine somebody 300 pounds? I mean, look at the ghost of you.
Those calves are built to squat 300 pounds up and down. When you no longer have 300 pounds to squat up and down, what do you think is going to happen to your calves? They're going to shrink.
Some of that is not useful tissue. Some of that, of course, is going to go down. A lot of that is even non-contractile tissue.
Even the connective tissue between your organs, there's so much muscle lost. That's not muscle you care about, especially if you're still just as strong, just as good endurance. In fact, you have less body fat, so you're probably stronger.
You have better endurance. It's not always the muscle you care about. If it's muscle you care about and you're getting weaker, then you're sorely hypocaloric.
You're doing it too aggressively. You're doing it too fast. That's mitigatable with enough protein intake, a positive nitrogen balance, and with stimulating muscle, stimulating growth, stimulating muscles themselves.
[Bobby Parmar]
You know what we're going to do the next time we talk about this? There'll be plenty. We'll be about specific examples, me included, my journey, and then specific examples of people that we've been able to keep as healthy as possible in all of these ways that we're talking about while being on these kind of medications.
I think that'll be very fruitful for the audience.
[Paul Maximus]
Yeah, there's ways of doing it more efficiently and less efficiently. I painted this to my friend this morning that imagine somebody who's all they eat is McDonald's and you give them a GLP-1. Then guess what?
They're going to eat less McDonald's. They're going to lose weight because they can't finish the 20-pack of nuggets. If you tell them, hey, I'm not going to give you Ozempic.
You have to go and fail diet and exercise, there's no guarantee of it even working. There's no guarantee of it staying, but if you have them take Ozempic plus, hey, I really need you to keep up your protein, eat the rainbow, get unprocessed foods, prepare your meals in advance, wash your blueberries and celery and spinach and have your hummus and your cucumber ready to go. That's going to multiply your efforts, but it's not an either or.
If it is an either or, if it is going to be diet and exercise or prescriptions, the data shows prescriptions win. You do not have a leg to stand on if you're black and white about diet and exercise over prescription if you had to choose one. Both, yes, for sure, but which one's more important to start people on right away?
The prescription.
[Bobby Parmar]
That's the end of today's episode because there's clearly so much more to talk about, so wait for it. Come back to Off the Charts podcast. Thank you for joining us so much.
If you have any questions, please send them to us in all the ways that you can.
[Paul Maximus]
In fact, give us your questions, give us your controversies, give us the hot buttons that you want us to get into about this topic or any other. We'll get around to it. We're here to make your life better.
Off the charts.
Disclaimer: This transcript may contain errors, omissions, or inaccuracies. It should not be considered a verbatim record of the conversation. For context or clarification, please refer to the original audio or video recording.
