Peptides & GLP-1s for Weight Loss — What You Need to Know About Longevity, Safety & Regulation

Hey everyone, Dr. Keshi here at the Noor Effect and I'm proud and privileged to be joined by the wonderful and amazing Dr. Rahul Singh, board certified hematology oncologist practicing here in Northern Virginia. Nice to nice to have you on.

Thank you for having me. Excited to be here.

Awesome. So, as you guys know, we're taking a deeper push into wellness and longevity, particularly longevity medicine. And there are certain topics that are quite hot right now. And I thought, you know what? It might be the time to bring a real a real smarty pants, a board-certified oncologist, uh, who's who's quite healthy himself and lives a good healthy life to help answer some of these questions for us. So, we'll start along the topics of peptides. The most I guess obvious question is uh what is a peptide and how is it different from a vitamin or a hormone? It's all the rage these days.

Yeah. So it's interesting. So peptides are basically like there's a thing called amino acids and they're basically short forms of amino acids that are targeted towards something whether it's like your muscle, your skin or something like that. Rejuvenation. Uh vitamins are more like the the minerals that feed what we need. Um and then uh hormones are like their actual uh mechanisms that drive functions in our body. Um and so those are the three different ways I I try to look at it more of a global perspective.

Why are peptides so talked about right now? Why are they all the rage? What what has happened that made them so cool?

Well, so I think the loss of regulation and now it's like the wild wild west and everybody's developing a peptide to target something to try to re enhance a part of the body um for positive effects obviously. Um, and so like I said, it's uh the FDA is not currently regulating it. And so that definitely has uh driven a lot of people.

Well, actually they they are they are they have this thing called a category 2 list and they put 20 of the most popular ones on that list, meaning don't give them to humans, right?

And they made the exception to allow for research use only. So they're kind of half regulating them, but they've become all the rage, I guess. Um a lot of celebrities and and and biohackers and you know gurus out there who are obviously not physicians are promoting peptide therapy as this newer alternative medicine that is more beneficial and superior to our boring western medicine right what what are the most popular peptides that people are using right now so uh any of them FDA approved

No. Well, there are some FDA approved drugs that are like peptides. These are our GLP-1s that we use, but um I don't think that's what you were focused on. So, there's a bunch. Um the top three there are I think it's like BPC or TB500. That's probably the most popular one. Uh and then there's a couple more on those on that time on that in that assortment, but none of them are actually FDA approved. So they I think the craze is to try to catch lightning in a bottle in a way, but not research proven. Meaning if you're trying to enhance something by developing a medication that's not regulated by the FDA, we don't really know what the true efficacy or how good that medication will actually perform.

If you look on Reddit, uh Reddit has a lot of these blogs where people are, you know, putting up statements like, "I went on peptide therapy and I no longer have pain. I no longer am fat. I'm no longer this." They're they're having chronic complaints and these peptides seem to be a cure. How much of that is actually true?

I don't know if I want to believe all that. You don't know the whole story.

Okay. Um, and honestly, if I took the same peptide as you, I don't know how my body's gonna metabolize it versus your body's gonna metabolize it. We don't really have any uh controls to prove that that's actually the case of the peptide being the reason why the person got the way they were or other factors. So, you have to take everything with a grain of salt. I think there's, like I said, we've talked about this before, there's a lot of misinformation out there. You have to be careful what you read.

But the peptides aren't new, though. I I've been reading that they the Soviets have been studying it since the 1950s even.

Right. Right. I mean they're just amino acids. I mean it's just depending on how you formulate it. Um we've had these for a long time. Cocktails of drugs with different types of amino acids. So you're right. Yeah. Just getting the craze now. Yeah.

I think the most popular peptide that everybody obviously knows about is are the GLP-1s that are FDA approved. Semaglutide um you know which is which is Wegovy and tirzepatide which is Mounjaro and and uh Zepbound um these are these are FDA approved for weight loss um do you think well most likely when these guys when these guys got approved and they worked I guess people then thought well if these peptides work all peptides must work right

No, not not true. I mean that could be a conception that people have, but I think it's a misconception that people would think that that's the same because these drugs went through scrutiny to get approved. They they had to be put through what we call phase three randomized placebo control trials.

Who pays for that?

Big pharma pays for that. Uh but I know as long as I know we all don't like big pharma in a way but sometimes it's necessary because when you synthesize a drug it's a compound that's patented and that same compound is replicated and when you're generating a peptide that could be compounded. Um you don't really know if it's the same formulation that's going into it every single time. So you don't know.

You're describing compounding as though like the the way the way it's manufactured, right?

So I think that plays a big role in understanding the differences between the two and you can't really draw a conclusion saying some of these peptides are the same as you know semaglutide for some for example.

So you know in the world of GLP-1s people want to lose weight. Um, you know, Novo Nordisk became the richest company in the world actually at one point, you know, outside of Norway when they got the FDA approval. They they got Wegovy and uh they were crushing it $1,300 to $1,400 in MSRP for for the drug. All those FDA approval was no insurance companies were paying for it because um you know they they viewed obesity as more of an aesthetic problem than a medical one. And also they don't they just want they just don't want to pay.

Right. Right. And there's so many Americans who have this problem. They're going to run out of money, I think.

So, so you know, you know, regardless, people wanting to lose weight. I mean, obesity affects people in multiple ways. It affects their self-image, uh, you know, their their chronic, they can get chronic pain, their their health, stroke, all this risk it can affect. So I guess um my my question to you is how how can we study the peptides better? You know, I think the two most prominent peptides that are on every vlog and blog right now are BPC 157 and TB500. Why? Because people claim that they're having regeneration, they're having pain relief, they're having damaged tissues better. I'm not I'm not going to say that it's not true because millions of people are obviously buying it and they're they're promoting it. So, you know, maybe it's true, but at the same time, there are a lot of things people say that may not may not be be totally true. We we don't have a way to check it. Now, you made an interesting point. You you said that um when it comes to to a drug, a lot of our research comes from big pharma. Well, you're right. Big pharma these are expensive. You're doing a randomly controlled trial with lots of people. It it costs almost hundreds of millions dollars to do the research and development of it. But why is it that way? Why why do we have to do it that way? Why can't we just do you know like why can't we rely on on the data that exists for peptides out of Soviet Union, these kind of places? They had their data too. But of course, they were not human. A lot of human data, right? They were they were on animal studies. Why isn't their data good enough?

In a world of society where we have regulations, I think you have to understand there's got to be a checks and balances. Um because if you're going off of old data, Soviet Union for example, I don't I don't think that's going to draw a parallel to our population. Um I think we already know that our population us and the world are everybody's different in how we metabolize things food drugs. Um I think it needs to be studied in our population. It has to be on a larger scale.

Who pays for it?

Who pays for it? Uh pharma uh or the government.

So pharma doesn't want to pay for it. Why?

That's a good question. It's probably because it costs a lot. I mean, I think uh for not knowing what the end result's going to be, no one wants to fork over that kind of money. And if insurances aren't going to pay for it, then why do it?

Insurances weren't paying for Wegovy and people spent millions if not billions of dollars buying it made over the richest company. You know, there was a there was a study several years back. Um there was a naturally occurring peptide in the body that the pharmaceutical wanted to patent and the judge ruled that nope any molecule that is naturally occurring you can't just take it and patent it because it wasn't yours it was already existing in the world. So what happened was you know in order for them to make a patent and protect their intellectual property uh it has to be something unique. So if these five fingers are floating in the world, I can't patent it because it's it's all over the world. It's naturally there. But if I take one of the fingers and bend it like this, now it's a completely new new thing, right? Uh now I can patent this for, you know, 15 or so years and charge whatever I want to charge and and and sell it in the public. So, you know, we we have a problem now. I I think where when it comes to research and studies, big pharma is the one that has the money and the the machinery to do it, but they're only going to do it if there's a financial incentive for them. So, they want to, you know, make recoup those losses on the R&D side, right? Now, I know that there's a there's NIH and they fund a lot of studies, but, you know, they've been having budget cuts.

Yeah. So it's harder for them to fund studies. So I mean I think you need to you they have to look at what I know it's sad. They have to look at what's going to generate them profit. And I think one thing that we're kind of alluding to is there's this thing called metabolic syndrome.

Yeah.

And there are many diseases that kind of run together that we see flow together like diabetes, like obesity, like sleep apnea, high blood pressure. And if they can get a drug that could be indicated for one of these conditions, then you're right. You know, that's a profitable thing for these companies.

So, on the subject of obesity, how did we get there? How do we get how do we we get to obesity? Um, I was watching uh recently uh Police Academy.

Yeah.

One of my favorite movies of the 80s and it's a great film. And uh you know, I was watching it and I noticed in the movie the so-called fat people, they would they just be normal guys now. We wouldn't call them fat anymore. They'd just be one of the guys, right? And uh but you know, in general, I you notice when you watch those movies, you know, that one and Caddyshack, all these prominent movies uh from the 80s, they're all pretty thin people.

Yeah.

Even I saw, you know, the on YouTube, you know, it was on for free. I don't know why, but it was White Men Can't Jump back early 90s. Woody Harrelson, Wesley Snipes, and everyone there is again, they're pretty fit, right? But when you start watching more modern movies, there's obviously more obesity in the film and yeah, you know, there's that. So, I'm just curious from from from your understanding or your opinion, how did we as Americans get to a point where this obesity thing began and it's gotten so bad? Um, a lot of people, if you ask the average American, he's going to blame McDonald's. It's easy answer. McDonald's, the diet, it sucks. That's why we're here. But I don't know, man. McDonald's been out since 1956. Yeah. Dennis the Menace didn't look like this.

No, he didn't know.

The Munsters didn't look like this. Lucy didn't look like this. The Police Academy. The whole all five of the sequels that look like this. Wesley Snipes didn't look like this. Never looked like that. No. So, so, so how how do we get here?

I think it's I think it's a it's a it's twofold. I believe that, you know, yes, diet probably does play a role. Um but genetics and how it's modified plays a big role. And I think like like we learn um that there's something called insulin resistance in people. Um so diabetes comes in different fashions. A small slender person could have diabetes and someone who's 300 pounds could not have diabetes. So, I think uh a lot of that is genetics, how it's modified, and then you add in what the current diet could be, and then you get like this perfect swirl of issues that can lead to accumulation and obesity developing.

How come Americans are obese, but I don't know, the French aren't? Yeah. Yeah. Why? Why is that?

Well, movement, right? I think we were kind of we kind of had a discussion about this that I think what do we do here? I mean we're a large country. You know what is our mode of transportation? We're here in Washington DC. I mean we have a metro but it's not really accessible to everywhere and if you get on 495 and you're driving you could be sitting your car for an hour and a half and go like a mile, right? So the car may have contributed.

I think the car we're not moving as a public but the car the first car came out early 1900s. Yeah. So, they've had a car for a while, right? So, how come they weren't like this in 1940?

Um, I think probably twofold, right? So, we're not moving. I think we're not moving like moving as in uh walking, engaged in physical activity. Our lifestyle spends more time on a nine-to-five job. They probably weren't working or if they were working, they're more physically involved. Um you'll see a lot now of people being stagnant laying on the couch watching television um occupying themselves in a non-movement way.

The 40s and the 30s had radio. People used to gather on the radio to the radio. Then 50s the television came out but 60s and 70s again they're not they're not looking like us today.

I would say it's not one driving factor right. I think also we're a blend of a lot of cultures. We're all bringing our genetics from different parts of the world. Like even if you study

But I've noticed obesity is actually not racist. Obesity is actually pretty open-minded. It's affecting every group here, whether they're from Asia or they're African-American. Um some more disproportionately than others, but but it's getting worse. Um you know, you and I, we're first generation Americans. We we we both uh you know, have parents from from other countries. I used to notice about myself whenever I I would go back to visit my my my family in Pakistan. We had this joke that we're like these chickens when you take them to a to the to to the certain village they lose this weight and I never understood what it was. I used to think okay maybe it's hot and we're just sweating a lot. I really believe that. Uh but uh it is true. If you if I was to show you my pictures when I when I first get there, when I'm leaving, I look like two different people. And you know, I I had learned in my travels along the world that, you know, as an American, I have this concept of Europe and the rest of the world that they're all like suddenly eating vegan and doing yoga.

That's not true. No, that's not true.

No. And uh when when I was, you know, in my travels, I went to France, you know, I saw people eating ice cream and chocolate. They were eating large loaves of bread. They were smoking a lot and they were they were they were drinking a lot of champagne. They have a siesta from 11 to 1 they have their champagne and they're passed out and I'm just like thinking man that's not healthy but then why do they look so good but then you are right in terms of movement there is more movement. Why? Because they're not sitting on 495 like we are for one hour each way they have to walk to the bus, walk to the tram, walk to the train. Uh when they have the groceries, they carry the bag over the shoulder while they're walking to catch this mass transit. Um you know, and I noticed similar other parts of the world. You know, Tokyo was the same way. Tokyo, Japan, there's 40 million people living in a very small quarter.

Yeah. So there is no room to even drive a car. For example, I was in the Amalfi coast and to get from where you live to maybe the beach, you're climbing a 100 steps.

Yeah.

And there's an 85-year-old person doing this. And here try to find an 85 year old person that might be able to climb a 100 steps. A 45 year old person may not be able to right.

So it's impressive. They've trained um themselves but not just in spurts, you know? It's not like I'm going to go to the gym for an hour. I'm going to crank out my workout and I'm good for the whole day. These people are constantly moving. It's probably good for their cardiovascular health for lean uh to basically lean out the fat in their body and generate muscle. I think it's a big big but I do think I do think this thing called um risk factor modification so it's all of it together it's how our body processes it so you're taking the person from France their body can handle there's something about their body that can handle it differently than the person here handles the food differently the way they're breaking it down probably and metabolizing it is probably different.

A lot of, you know, my patients who are very religious, you know, they they go on these, you know, uh trips to Honduras and these countries to to, you know, to help relief work. But I I noticed they all kind of have one similar story. Man, I I'm I lost all this weight in Honduras. I lost all this weight in this in this country. Why is it that we're losing weight there? And and on the flip side, when they those people come here, they start gaining weight. What is it about America? Is it the water? I mean, what what is it here that causes it?

I think it's the water. I think it's the diet. I think it's like I said, I think I think there are there needs to be a deeper dive in in what is in our diet and what we're eating. Uh I know I know McDonald's is everywhere, but I think our diet is I think I read that um just like in Italy, the pasta in Italy is very different than the pasta here. Uh, it's the way like when I went to Italy, like usually if I eat pasta like every day, my my gut's gonna be torn up, you know, but I could eat pasta every day in Italy and I felt fine the next day, you know? So, it kind of brings true to the it's something about how things are made there. Maybe it's fresh, maybe it's not. Uh, that plays a big role. Could be the water. Could definitely be the water.

But, you know, I've had I had a patient once, she came in and she had lost a lot of weight. I was surprised. She looked really good. She lost 30 lbs. Like, oh, what are you doing differently? You know, you always get curious. She goes, "Oh, I started, you know, appetite." Oh, good. Good for you. I'm happy for you. Um, and we started talking. And I was like, you know, did you try that exercise? She's like, you know, I did. She's like, I counted my macros. I uh I would do CrossFit three days a week. She used to do that. I'm like, yeah. And you didn't get results? She's like, no, I didn't. But she's like, "You know what's weird? Whenever I was deployed to like, you know, Europe, especially like Germany, she like I for some reason lost weight over there." I was like, "Did you drink less alcohol there or something?" She's like, "No, I actually drank more."

So, I began quizzing her like what was it difficult, you know, I've been fascinated by by by what what happens here versus other places. A lot of Americans are are joining these gyms and doing these very aggressive workouts, right? CrossFit's one of the those big ones. They're doing these high-intensity workouts. There has been data that has come out that shows that you know it is better to do mild to moderate cardiovascular activity more consistently throughout the day than be sedentary all day and then one hour do this intense activity. There's no major you know cardiac benefit. There's increased risk of injury from from that kind of a um diet or that that kind of a lifestyle. So, I guess, you know, my personal thinking is I'm going to make a very controversial statement that's probably going to get backlashed, but I think obesity is inevitable here.

I mean, there's that there's a picture of the map of America. I don't know if you've seen that where they like break it down by color coding BMI.

Yeah. Uh, and it's just red and darker red, you know, throughout the United States. So, and that probably wasn't that 40 years ago.

No. So, you're right. Um, something happened.

Something happened. Um, something needs to undo that.

Yeah. For us to get healthier in life.

So, you know, a common a common belief that that we hear is you're fat because it's your fault. It's your fault. You're lazy. And I take issue with that because America has one of the highest GDPs in the world. If I was to measure productivity, you know, GDP is what I like to point to.

Yeah.

Um they work very hard. They have the least vacation time in in in the developed world. Least vacation time, longest work hours. And nowadays in this gig economy, they have multiple jobs. I personally don't know anybody, even physicians, who have just one job. You know, even my physician friends have their one main job, whether it's the hospital or the clinic, but then they have other jobs. They're consulting, they're starting other companies, they're, you know, everyone has more more than one job, which may have potentially fueled inflation in and of itself. But, you know, I think it's beyond just diet. I mean, McDonald's was was there since the 50s. Now, is it more unhealthy now? Maybe. Sure.

But you know the government's be started started to be more aware too like okay we better look into this but nothing seems to be changing like we had to come out with these GLP-1s for weight loss which the data is showing is working.

Correct. It is it is changing behavior um when I go on Amazon now I'm seeing the rise of these mocktail brands like Del Sol and these kind of places and I started wondering man why did Americans suddenly want to drink mocktails why doesn't anyone want drink alcohol anymore. And the data suggests that the GLP-1s are the reason why. GLP-1s, you know, you know how they work. They basically slow down your your your gut. Um, they basically act as a speed bump in your digestive pathway. So instead of driving 60 miles an hour on I-95, you put a bunch of yellow speed bumps everywhere. You have to slow it down. A GLP-1 mimics glucagon-like peptide. So you you take it and your brain thinks, "Okay, you just had a nice big meal. Slow down and digest it," but you didn't. And what happens is you've you've created a traffic jam. And now what happens? What can you eat? You know, you can totally eat something easy to digest like a berry or or a salad. But if you try to eat something complicated, processed, heavily, oily, or fatty like a burrito or a taco, cheese pizza, you're going to get sick. Alcohol before it becomes alcohol is a sugar. It's a sugar. So what's happening is these guys, you know, I I joke with my friends, you know, when I when I go to a party now, I know which girls are on the GLP-1 and which ones are not. When they're hanging out with their friends and there's like six of them and they're doing shots, the ones who are doing four, five, six, seven shots and they're they're fine. They're not on it. But the ones who are on this, they're holding the same cup or the same drink and they're not getting more, it's like, why aren't you drinking more? I'm good. Like, okay.

Yeah, you're on that GLP-1 probably.

Which is fine, which is which is which is which is which is fine. Which is fine. But right, you know, um, a year ago, I was one of those doctors too who kind of looked down on it and and I thought, you know, oh my god, we're so lazy, you know, we why can't we lose weight? But this is this has been a crisis. This is going on for 40 years and it's been getting worse. And um you know it's just there's CrossFit which is one of the most popular high-intensity you know trainings. There's apps that make you work out and there are people who are working out there people who have I've seen patients my patients have shown me their Apple Watch monitor that they're getting their steps in but with why are they looking like this and you know I started looking at other risk factors whenever I traveled overseas. I get to know you know my other you know friends that I would make meet from Germany and Netherlands and you realize quickly there's more to our lives than just diet and exercise man there's also there's also like um you know your vacation even even the vacation different than us.

Yeah. I mean, I think I think like our lifestyle is very different, right, in the United States. And I think that is a hidden factor, right? You know, I think um stress is a big one. We know cortisol levels go up, it contributes to obesity, uh contributes to insulin resistance, which means your sugars don't get broken down as well. So, it kind of fuels it. There's extraneous factor that you can't study with a trial, right? I think these are the things that we have to understand.

Sperm count has dropped.

Yes, they studied sperm counts. They has dropped globally, but especially in the United States over the last 40, they were able to measure it by decade. 70s, 80s, 90s now.

Yeah.

So, I mean, a lot of physicians have this belief that we're just I guess over 40 million Americans are just lazy, but we have we still have the highest GDP in the world. They're working multiple jobs. I don't think they're lazy. You know, I don't think our patients need ridicule. I think they need to relax. I think I think they need roses. The average American worker is overworked. He has the least amount of vacation.

Yeah. Women give birth at the hospital. The nurses, they only get like Yeah. Yeah. They're not one month of maternity leave. Yeah.

In Europe, it's one year mandatory paid. Yeah. And I'm I'm just, you know, this stuff is is adding up. Um there's two types of fat in the body. There's subcutaneous fat and then there's visceral fat. Which one's the worst fat? Which one do people think is the worst fat?

Probably the subcutaneous fat.

Yeah, correct. They think it's the worst fat. It it's the one that that definitely you know you know it shows in the dress but but actually visceral fat is the one that is is really bad. Fat is not like a cushion. Fat is like like some contains fat kind of is like a cushion but visceral is like a gland. It's glandular. It's secreting you know hormones and other things that are that are contacting your insulin that are causing inflammation that are causing potentially cancer. I mean you're an oncologist. So we see that in breast cancer.

There you go. Yep. Yep. Yep. Yep. So breast tissue, big fatty tissue secretes estrogen. Um and so that's why we know I mean it's linked obesity with breast cancer, obesity with colon cancer.

And when and if they were to lose weight, their cancer just goes goes down to

Yeah, the risk and it's proven that's proven to be beneficial.

Um and so so yeah, that fat is bad in a way. But what's you know what's ironic though is visceral fat as evil as it is out of the two fats it actually is the most amenable to diet and exercise. So then the question goes back well why don't we just diet and exercise better. This is where I think lifestyle the rest of the lifestyle you know equation matters. You know the average patient of mine you know has some kind of job. They wake up around 6:00 7 a.m. to go to the first job, whether it's a teacher, an accountant, a loan officer, whatever they are. They do that job first. That's usually the morning up until maybe say between 3 to 5 he's done with that main job. Then when he or she is done, they then have starts a second job, whether it's Uber driving, DoorDash delivery, or some other side hustle. Then they're done with that. Then there's a vlog or a blog they're working on and or another business and some other venture that goes on from like 7 to like 10 or 11. Where's the time?

Where's the time? Yeah. I mean, they're they're having 30-minute lunches, which I think is completely insane. I grew up thinking it was normal to have a 30-minute lunch. I remember in school we were taught 30 minutes. Eat when you can.

Yeah. That that was not normal. You know, you're supposed to have a longer lunch. In fact, whenever people eat lunch and they they yawn, you remember they told us, "Oh, yeah. It's like because of carbs." We eat carbs in the morning. We have orange juice in the morning. How come I'm not exhausted in the morning? Right. Right.

So, so, so there's a lot of stuff we have done here in our drive for overproductivity. I think what what has what has harmed significantly has been our overproductive nature. We must produce the most money possible, which is why we have the highest GDP, right? That's not a lazy person. That's a hardworking person. But then at the flip side, convenience. We want our our citizens to be comfortable. We want comfort. I want to watch Netflix on the phone, right? I want to make it accessible. And with that comes more marketing to boost more consumerism and boost more capitalism. We have made a system that is very heavy on productivity and very limited on recovery. And now what has happened is it's like when you drive your car too fast, you can smell the fumes of your tires. Yeah, that's what's happened to to our bodies from the inside. You can smell the smoke of your endocrine system. It is burned out. Your adrenal levels, your adrenal glands are burned out. Your cortisol levels are high. Your sperm count is now lower. You now have insulin resistance. Your visceral fat, which technically is the easier fat to get rid of, but not for Americans. It's the worst fat which is causing all the cancer, right?

Um, which leads me to my question. What do we do about it? I had a very very long spirited debate yesterday or a few days ago with with another, you know, medical colleague of mine. He's a physician and uh he gave me the same lines that most Americans do. Americans are lazy. They need to get off their ass. They're just lazy and that's why they're fat. And I said, "Okay, so what's the solution?" Oh, walk for one hour a day. Okay. Well, besides the fact they're working two to four jobs now, let's suppose they just did, I don't know, CrossFit, which is very high intensity, high, you know, high intensity exercise for 1 hour. The studies have been done on that. They're not all losing weight. I mean, they might have better cardiovascular outcomes, but not not by that much either. They're still stuck in the same obesity problem, right? So, so what's what is the solution? Um, I ask how how does the American lose the weight now? I think the reason the European is okay and the French are okay despite them having high calorie diets, refined carbs, and alcohol, way more than us, by the way.

Yeah.

I think they're okay because those steps they needed, that activity, they got it continuously throughout the day. It wasn't bolused. You see us, we are sedentary all day, not by choice. That's right. That's the not in the factory anymore. We're not out in the field carrying the bale of hay.

Yep. That's not the nature of our work. We are a services sector. We are at the office. We're doing stuff through the computer and that's just the way it is.

Uh but you know, France also has computers. So does Germany and so do they have computers too. Right. Right. So why are they the way they are? We are the way that we are.

I think that's what we're trying to say is that like they are they have more movement in their day than we do. Sure. And I think that probably plays a big role. And I I really truly believe that, you know, what we're using GLP-1s for here, they might be able to achieve that through their own body.

So GLP-1s are found in the body. They they mimic your own body. Everyone has glucagon-like peptides in the body, right? I guess what what made theirs special was they modified the structure in a way so they can patent it and make make their their billions which is good for them. But, you know, I um I made a statement earlier. I'm going to reiterate it. I think the average American obesity is inevitable because there are structural problems in your society. I disagree with the notion that this is an individual failing or a moral failing. You're fat equals you're lazy, which is not true. Uh working three, four jobs a day is is pretty stressful. Making the country have the highest GDP in the world is is pretty takes a lot of hard work. Um, I don't think these guys are driving the Uber because they want to be lazy. If they want to be lazy, they can just watch Netflix for 4 hours. They're not. They're working. They're trying to work. Um, it's just the mode of work is kind of fueling the

Exactly.

Which goes back to productivity. We are measured first and foremost by how much money we make and how much we can buy. We watch, you know, these uh advertising uh the car manufacturer says, "Oh, you you earned it. Reward yourself. Get a Porsche." So, we are putting this consumerism message in every aspect of our life that you if you want to be the best, you have to buy the best. You have to earn the best to buy the best. Productivity this is it and this has murdered us. Um the European is very different than we are. I've traveled I've met them in you know Africa and you know my all my travels in Asia abroad. They're very much about their lifestyles, man.

Yeah. They're like, you know, they meet me. Oh, you're from America. How long are you on holiday for? Holiday. You mean vacation? Yeah. I'm just on vacation for like, you know, nine days. Yeah. Oh, how about you? I'm on holiday. What does that mean? Oh, well, I'm going to be visiting this country for 3 months. Yeah, right. Three months. Are you a millionaire? No. How do you pay for it? I'm not my my company is. Your company's paying for three months vacation because you know these guys wanted their lifestyle. They demanded and got their governments and the companies to take care of them right. Um there is a belief system out there that you know everyone ought to have you know uh a certain lifestyle and it matters because they don't look like and and they have bad habits too. They're they're they're smoking weed and they're doing all this stuff. They're smoking weed in Netherlands and eating munchies too. They're drinking lots of beer in Germany and they're eating high refined carbs with pizza and pasta in Italy and then drinking very calorie rich foods, right? And they're not doing yoga either, by the way. They're not I mean some of them are and that's great, but most of them are just normal. They're just going walking to work, coming back from work, right? When when when I was in France and I vacation, I saw people, you know, boys and girls when they're going on the date, it was at a park. They would walk in the park. That's the date. Not here.

No.

Date is I'm I'm working all day. I'm going to meet you at this bar so I can have a drink and I'm miserable. I have a drink with you and have this have this buffalo wing and I only have one hour on the so-called date and then I got to go back and wake up in the morning do it again. It's like an inconvenience. Um and I and that goes towards life.

Yeah. So I think Yeah. I think that's a big deal and that's why like I think you know as we shift it kind of more towards cancer. I mean this is this is driving things that actually really negatively impact our health and how do we change that I think is a big big deal.

So, you know, my my thinking is unless we get courage in the on the governmental level and agree to spend hundreds of trillions of dollars remaking our infrastructure so that we make it a less car based and a more walking based uh mass transit which is is not it'll never happen.

No, I will I I will I will die two generations over that happens.

We are entrenched. We have roads, we have highways, we have industries around the fuel and and auto industry and u you know large agro and and and the food sector are entrenched too. You'll never beat McDonald's or or those guys.

They will Yeah. They will outlive us.

So so so that's not going to happen. So what what can we do? I mean when the GLP-1s came out on the one hand I was happy that we're finally addressing it somehow. Yeah. But then you know the moral side of it is like oh how what a tragedy we had to make a drug for this. But then you you begin reading the data, you know, Medscape reported, you know, I read a Medscape article, they cited their study. Uh last year, Americans for the first time in 30 years collectively lost half a percentage of their body fat. Alcohol stocks are down, fast food stocks are down. I was like, "Wait a second. This is really good news. What happened?" And they're all tracing into the GLP-1s.

Yeah. You can't drink alcohol with a GLP-1. You can, but you won't drink much. You feel sick. You'll puke.

Yeah. You're not going to You can go to McDonald's. You can have maybe some of a burger, but you you can't have all of it. You're going to get sick. That's I I think one reason a lot of my patients fail on the GLP-1 has been because they refused to make lifestyle changes.

Yeah.

Um I chat with them and they're like, "Oh, yeah. Wegovy sucked. Didn't work for me." Did it? How'd you get it? First, they're getting this cheap compounded crap. Oh, that's a whole other thing. Yeah. Which doesn't even work. I mean, it works, but it's not that it's not the real thing, right? I mean, explain for the public what's the difference between a compounded uh medication versus a brand or generic medicine? Because I I've heard some people argue that, oh, yeah, it's the same argument as brand versus generic. They both work. But that's not true, is it?

No. No. And first of all, none of these are generic right now. So, yeah. So, you're not going to find them. Someone tells you.

So, so what's a brand and a generic and then what's a compound? There's three different things.

So, so brand is the pharmaceutical company that invented it. So, Novartis or somebody created this drug. They have a patent on that drug. That is the drug. It's the brand. Uh generic is when it when that patent is lifted and multiple companies can come in and take that same compound and make it.

But that also has to be tested FDA.

Correct. It has to.

And what about compounding?

Compounding is um depends on where you go, but it's like a mom and pop shop that's putting it together.

The pharmacist himself is the guy. He's the manufacturer now.

Exactly.

He's cooking in the kitchen and he's making he's making his own version.

Um but yeah, that's exactly what it is.

Yeah. Okay. So, so why did the FDA because FDA started cracking down on on the compounded one? They don't want them to do it anymore. They allowed them at one point to make these GLP-1s like like we're going but then they stopped. What is the reason now on Reddit the people say oh because FDA is corrupt and they're paid by big pharma and that's why. But what's your what's your take on

What I think? So I think uh there needs to be regulation in this area because without without regulation it's like I said earlier it's the wild wild west. You you need to know what's going into your body to if you're expecting results. If you're just going for a drug and expecting it to behave like a brand name drug, you might be very much short-handed because you don't know what you're doing.

The thing with the with the compounded product is compounded pharmacies don't have to follow the FDA and they don't have to prove efficacy either. Whereas FDA is very strict. If you're making a drug and you're making a claim, you have to prove it. If you say that this drug will make you run faster by this many seconds, like okay, show us your trial data. What's your control?

So, so I prove it. You have to have to prove it. So, I tell patients like there's something called complementary alternative medicine.

Correct.

They're not regulated by the FDA. So, when people go and take certain supplements, I'm like, you don't know if each supplement is dosed equivalently.

Correct. One could have a little more.

They're blends. They're hidden in blends.

Yeah. The moment you see the word blend, it means mystery.

Yeah. So, that's what I would say. That's my hesitancy.

So, you know, the thing is like the compounded, they they don't have to follow the rule. They're trying. It's like you're trying to make your pizza just like the one from Domino's. You're not obligated to follow to put in the same ingredients, make it the same way, and you may not have the same FDA, and you don't have to prove it either. You can just claim it.

You can just claim it.

So, there are lawsuits flying. FDA began cracking down on people making claims. And now, you know, you'll see these online, you know, retailers are admitting that, okay, um, we we have compounded like they used to make the claim, oh, it's just like it and they stopped doing that because the FDA made them stop doing it. You can't make a claim that's not true. But um because you can't prove the same effectiveness and the risk might be higher. I saw a study on PubMed. There was like over a 1,000% increase in calls of poison control.

Oh my gosh.

Mostly attributed to you know uh compounded products but you know because of dosing errors. I mean that's what I would scare me.

That's why I I think the public but why are we getting to a point? Do you feel like as a physician more and more patients, not only are they self diagnosing, which has been going on for millennia, but yeah, they don't trust us anymore. They want to go on Reddit or these places and get the drug directly and try it themselves, which I think is why peptides are so popular now. I mean, they think it's a secret that we we're hiding from them.

Yeah. No, no, no. I think uh that's that's the scariest part when you go to a social media post and you see a link through Instagram to go buy this peptide somewhere. It's it's it's accessible, but it's not necessarily the safest thing and the right thing for people. And I think uh you don't need a doctor necessarily to tell you that, but you have to be educated before you click on something like that. And I think uh understanding the background as to why why there are regulations, why we go through these processes to be able to get a drug, it has a there's a benefit there.

Um but why do you think we're in this world now where some wellness coach, 25-year-old wellness coach with a great haircut

Yeah.

and a nice smile on YouTube has more credibility than our doctors?

Like why I think it's misinformation. I think people are people are not uh taking the time to understand and validating the source.

Sure. I think that makes a big difference you know. Do you feel like since COVID there was like there's some kind of disconnect between the patient and the I feel like our relationship got harmed out of that

Very much so. We haven't we haven't recovered. Everybody went in right and everybody was reading what was there available and they weren't actually getting the human contact to talk to their doctors face to face or their providers and so I think a lot of misinformation just came out of COVID and how it was managed how we prevented it and that brought a lot of distrust to the medical system I think.

Yeah. Yeah. Unfortunately.

So how how do physicians rebuild trust?

I think it takes time. I think I think it takes this I think it's connecting in a different way with people through different mediums because that same old doctor who was 65 walking in with that white lab coat uh into the room and dictating how things were is not what medicine is now. I think medicine is a shared decision. Uh understanding the person that you're talking to, sharing your knowledge and what you've read and sharing what they know and what they've read. Um, and now in the day and age with ChatGPT and Claude and everything else, that patient across you, they might be on it while they're talking to you. So you want them record us. They record us and they'll trick you. No, no, I'm not recording. It's just by ChatGPT. I'm just making sure you're right. Like, yeah. Okay. So, I think I think it's uh you got to be able to level with them in a different way.