 Right now in December 2023, why are GIP and GLP1 agonists in the news? Again, it's because a brand new study just came out. The weight loss drug worked for the majority of patients, but if you stop taking it, you regain some of the weight that you lost while taking the drug. Hey guys, my name is Boris. I'm a physician assistant. I'm currently working in urgent care medicine, but for my first year of clinical practice, I actually worked at a medical weight loss facility where I prescribed weight loss medications like fentramine, wagovi, and also diabetes medications that are used off-label to aid in weight loss, such as tralicity and manjaro. And the reason I'm making this video is because I saw a Zep bound, which is made by Eli Lilly, in the news and how people are concerned about it. And I thought that I would just share some of my thoughts and my experience and my opinions about the situation as a professional medical provider who used to prescribe medications just like Zep bound regularly and saw the pros and cons and saw the practical aspects of prescribing these things and using them for medical weight loss. First things first, what is Zep bound? Terzepotide. Zep bound is the brand name. Terzepotide is the name of the compounds. So if there ever is a generic version, which will hopefully be way cheaper because it's expensive, it will be called Terzepotide and it'll be made by multiple different drug makers as opposed to Zep bound, which is only made by Eli Lilly and is branded and is thereby very expensive at the moment. So what is Zep bound? So Zep bound is a combined GIP and GLP-1 agonist. And I'm not going to give you like a detailed pharmacology lecture about how exactly this thing works, but very briefly, the medication is an agonist. An agonist means that the medication mimics or acts exactly like a substance that our bodies already make naturally and in order to have a desired certain effect on the body. In this case, to lower blood sugar, curb the appetite and also help with losing body fat, which eventually the downstream effects of which are lowering risks of heart attack and stroke and also high blood pressure, obesity, etc. All right. So the TLDR, the too long didn't read version of all of this, how these medications work is they act like two hormones that the body already produces naturally, which eventually decreases appetite, decreases blood sugar, and hopefully causes weight loss, which is the desired effect. Now all of that sounds pretty great. However, what are some of the downsides? Well, like any other medication, there are side effects, most commonly nausea, vomiting, abdominal pain, diarrhea. In my experience prescribing these drugs, however, if you start at the lowest possible dose and very slowly and gradually titrate upwards, increasing the dose until you have the desired effect, or there are some mild side effects. So generally patients don't really have intolerable side effects. And the mild side effects that they may have will go away in a few weeks once their body adjusts to the drug. And also those mild side effects can usually be controlled with things like Zofran for nausea and other certain medications for the side effects. If you also use this is my clinical experience. If you also use different versions of these medications, such as the oral version, Rebelsis versus the injectable versions, which are multiple different injectable versions, some patients are able to tolerate some better than others. So some patients tolerate the injectables better than the oral version and vice versa. Also Rebelsis, the oral version, and I think there might even be other ones at this point, they allow you a lot more control as opposed to the injectable ones, which usually last all week. So it's a pretty good dose that kind of goes out throughout the whole week, as opposed to the oral ones, which you have to take every single day. The ones that you have to take every day is more annoying. However, you have much more control, much more ability to micro adjust so that you can kind of take a little bit less at certain times and a little bit more at others, you know, based on my clinical experience. And that also helps to mitigate some of the side effects. However, nothing I'm saying here is medical advice. Talk to your medical provider if you're interested in these medications. This is not medical advice for you personally. This is just what I did my sharing my personal experience as a prescriber of these medications. And it actually did work out very well for the majority of my patients that I use them on. Unfortunately, another side effect of these medications is missing a mortgage payment because would go be runs about $1,300 a month. Manjaro runs about $1,000 a month. Trilicity about $800 a month. And it's pretty difficult, unfortunately, to get them covered by insurance for the purposes of weight loss, especially if you don't have diabetes. Even for diabetes, it's kind of tough to get them covered by insurance, especially completely. But for weight loss, it's even harder. So the cost is definitely because these medications are so new, most of the patents are still in effect. So it's very, very difficult to afford these medications and to get insurance to cover them. But anyway, all of that is also actually old news, the cost, the side effects, the effectiveness, all of that is old news. They've been around for over a year at this point and people know what they are. So right now in December 2023, why are GIP and GLP1 agonists in the news again? Well, it's because a brand new study just came out, a randomized clinical trial, clinical trial, just came out, which concluded that, and I'm reading a quote here from the conclusions, in participants with obesity or overweight with drawings or terzepotide, the drug I mentioned earlier, withdrawing this medication led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction. So basically what that is all saying in science speak is the weight loss drug worked for the majority of patients, but if you stop taking it, you regain some of the weight that you lost while taking the drug, no way. Wait, so the drug works and if you take it, it'll work and you'll lose weight, but then if you stop taking it, you'll stop losing weight and you'll even regain some of the weight back. Okay, I don't understand why that's surprising. Why is that surprising? You stop taking your heartburn medication, you're probably going to have heartburn again, you stop taking your cholesterol medication, your cholesterol is going to go back up, you stop taking your diabetes medication, your sugar is going to go back up, you stop taking a medication that controls your headaches, you're going to have headaches again, you know, usually. So why is this surprising? What did people expect? That taking the medication for a few weeks would simply fix obesity and overweight forever? That it's impossible for you to now regain weight because you took Wagovie or terzepotide for a certain number of time? That's literally impossible. It's literally impossible. There's no treatment in the world that can do that, not even a gastric bypass. You know, the surgery where they staple part of your stomach or, you know, in layman's terms, they basically make your stomach smaller and also reducing the area that it has to absorb things so you're not absorbing as many calories or just kind of pooping them out causes tremendous, tremendous side effects, so many problems after these gastric bypass surgeries. And unfortunately, a lot of people even regain the weight, some or all of it. So I know that sounds crazy. You take your stomach and you make it a lot smaller. How could you possibly regain weight? People find a way. The body always finds a way. So not always a lot of people do lose a lot of weight and they keep the weight off, but I can't tell you in my clinical practice as a weight loss professional, a medical weight loss professional, how many people came to our medical weight loss practice because they already had a gastric bypass and they regained all or some of the weight and now they want help losing it because obviously you can't get another gastric bypass. It's, you can only get one, you know, per lifetime. And if you already screw it up, well, you're kind of shut out a lock and now you need help. So yeah, even a gastric bypass is not permanently going to fix your weight problem for all patients. For a lot of patients, people gain, you know, most or all of it back. So there is simply no way around bad behavior. Take this as an example. Okay, let's say you wake up at 730 every morning. Let's say maybe you wake up at 8am every morning, more realistic, right? Let's say you wake up at 8am every single morning, your alarm goes off, you hit the alarm, you don't hit snooze, you get out of bed, and then you wake up and the first thing you do every single morning is you grab a hammer and you hit yourself in the foot. Okay, if you do that every morning, probably right away, but eventually your foot's going to hurt. It's the same exact concept with waking up every day and having a muffin or a bagel or a donut or breakfast and then going to work and snacking throughout the day and maybe even going to HR and, you know, just taking a piece of candy from the candy dish once or twice a day and saying just a little piece of candy, you know, one's not going to hurt and then rarely or never doing anything physically active. Literally, it's the exact same concept. You do bad behavior, you get bad results. It's the way of the world. I'm sorry. I didn't make the world. That was God. That's not me. I'm just reporting the facts that if you do something, it's going to have an effect. If you have a poor diet, if you eat processed foods, if you don't exercise, you're going to be obese and simply taking a medication, especially for a limited amount of time, is not going to permanently fix that. The fact of the matter is it's a daily thing. Daily habits do add up. Daily habits matter. That's what causes either weight loss, weight gain, health or poor health. All right. So I'm not really sure what people expected and why this is so surprising to people that you stop taking the weight loss medication, you gain weight back up, but apparently it's surprising to people. But anyway, so these weight loss medications, like most medications are a crutch. Now, don't get me wrong. My job as a medical provider, as a licensed physician assistant, is literally to practice medicine, which means I occasionally do prescribed medications. I'm not opposed to medications. I think they're magic. I legitimately think medicine is magic. That's why I love it. And that's why I practice it. That's why I committed so many years of my life to it is because medicine is magic. I still am baffled every single day. It never ceases to amaze me that a tiny little pill can eliminate or at least drastically reduce terrible suffering that without that pill would have been impossible or at least difficult to tolerate. Medicine really is magic. And surgery, also part of medicine, also just fixes things that people would have just had to live with or die from. So medicine is magic. However, even though it's magic, it cannot simply solve every one of your problems. In the case of weight loss, medication can help. It's been proven. And sometimes it can even help quite a bit. But as this study shows, it's not a silver bullet. It won't permanently fix your problem. Okay, guys, hope you enjoyed that. Let me know what you think in the comments. I'll see you in the next video.