# GLP-1s: The Hype, the Fear, and What the Science Actually Says

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 10 Feb 2026, 58 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/m97cgmi5b8r4rlhaq2sj4mlb.mp3

GLP-1 medications are everywhere, but the science is often misunderstood. Dermatologist Dr Ryan De Cruz explains how GLP-1s influence appetite and metabolism, why responses vary, what side effects are commonly overlooked, and what’s known about muscle, skin, and long-term use. He also unpacks popular myths and online fears, focusing on evidence over hype. This episode is for general education only and does not replace personalised medical advice. Find us on Instagram: @vainishpodcast and thanks to our guest Dr Ryan De Cruz Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at www.listnr.com See omnystudio.com/listener for privacy information.

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hi everyone, it's Bec Judd.
[0:51] And Jess Roberts.
[0:53] Bec Judd.
[0:54] Why do I sing it like that?
[0:55] I don't know, because it sounds pretty.
[0:57] Oh, thanks.
[0:58] Welcome to Vanish.
[1:00] And we have an awesome one for you today.
[1:03] I'm really excited about this one.
[1:05] It's going to go off.
[1:07] Yeah, I'm really excited to talk about this.
[1:08] But I'll tell you what was not going off.
[1:10] Oh, ass on Thursday.
[1:11] You and I last week.
[1:14] We had a weeknight wedding.
[1:17] A Thursday night wedding.
[1:18] I know.
[1:18] I was like, who does that?
[1:20] Now I know why.
[1:21] Because then you become tame.
[1:24] But we didn't.
[1:24] Yeah.
[1:25] Do you know what?
[1:26] I think Thursday night is almost now like the new Friday night.
[1:29] Yeah.
[1:29] Do you know how your weekends get so full of kids stuff and social things sometimes?
[1:33] And like Friday's a bit of a cheat day at work sometimes.
[1:36] Yeah, but also if you've got children, they're at school.
[1:39] Yeah.
[1:39] So you can just die in bed.
[1:41] Yes.
[1:41] Yes.
[1:42] So Thursday's the new Friday.
[1:43] Oh my God, they're so smart.
[1:45] They are so good.
[1:46] But what happened the next day?
[1:48] What did you have to do?
[1:49] Well, I didn't have to do anything, but I put lots of plans in so I could get out of bed.
[1:53] I got my first hangover.
[1:54] What?
[1:55] Yeah, it was horrendous.
[1:56] It was so bad.
[1:58] Now I know why people were like, don't drink a lot.
[2:00] That was heavy.
[2:01] Yeah.
[2:02] Yeah.
[2:02] Because you're lucky you can drink and drink and not really ever get affected by it.
[2:06] You've got some kind of machine gene.
[2:08] Yeah.
[2:08] And I'm very jealous.
[2:10] But I loved it.
[2:11] Producer Liza the next day is sending us all of these production questions and...
[2:16] Jess and I were like, we can't even open that audio and listen.
[2:19] We are just so hungover.
[2:21] And then Jess sends us a photo of her current situation, which was?
[2:25] Oh, yeah.
[2:26] So I thought, you know what?
[2:28] I've got the kids at school.
[2:29] I can just relax and die in bed.
[2:31] No, all my kids forgot everything.
[2:33] So then I get the text messages.
[2:34] Can you drop this off and that off and this off?
[2:36] So then I actually don't even remember what they actually left at home because I think I was still in all sorts.
[2:41] You were still drunk, babe.
[2:42] I was still drunk.
[2:42] Yeah.
[2:43] So anyway, I literally was like, I've got to get it by a certain time to the kids.
[2:47] I was like, I can't even think about what to put on.
[2:51] My brain's not there.
[2:52] So I'm just going to jump in the car with a robe on and everything and just like go to school.
[2:56] So I went to school, full robe, dropped everything off.
[2:58] Ugg boots.
[2:59] Ugg boots, everything.
[3:01] Robe.
[3:01] Like your bed robe, like your pajama robe.
[3:03] Yeah.
[3:04] Straight to your fancy private school in Bright.
[3:07] In Bratton.
[3:08] I wonder what they say about us when we're not there.
[3:11] Because I've done similar.
[3:12] I just go in in Ugg boots looking like crazy.
[3:16] I think we're like, I think they've adapted to us now.
[3:19] They've adapted.
[3:20] I think they're like, oh, this is just a normal look for Beck and Jess.
[3:23] So yeah, rocked in, did that.
[3:24] And then, yeah, those Uggs boots stayed on all day.
[3:27] I went to my child's assembly at 2.30.
[3:30] Still in your robe.
[3:31] Oh, no, I did have my robe, but I had my Ugg boots on still.
[3:32] Wow.
[3:32] Yes, you did.
[3:33] You posted it.
[3:35] Yeah.
[3:35] Okay, so I've got a funny story, which I hope you don't mind me sharing, but I think the reason our kids' school knows about and is comfortable with you especially wearing robes is because of a little incident that happened when we were homeschool learning.
[3:49] Oh, my gosh.
[3:51] Are we allowed to tell this?
[3:52] Yeah, yeah, yeah.
[3:53] You can make it more G-rated than R-rated.
[3:55] Actually, maybe make it M, but not R. All right.
[3:59] Okay.
[3:59] All right.
[4:00] Okay.
[4:00] So in lockdown, our children had to do online learning, but it wasn't like- For two years.
[4:05] For two years.
[4:06] And it wasn't like just a couple of hours.
[4:08] It was from like 8.30 in the morning to like 3.30 in the afternoon.
[4:11] Yeah.
[4:12] Which was actually awesome because a lot of schools didn't provide this for their students.
[4:16] And we, because we're stuck at home.
[4:18] This is in Victoria.
[4:19] Yeah.
[4:19] our school actually provided full learning from 8.30 to 3.30.
[4:22] So it meant when we were at home working, we didn't have to entertain the kids.
[4:25] We didn't have to school the kids.
[4:26] We didn't have to mark anything.
[4:27] We didn't have to do anything Monday to Friday.
[4:29] These classes ran as per normal.
[4:32] Yeah.
[4:32] Yeah.
[4:32] No discounting school fees.
[4:33] No discount.
[4:34] Actually, maybe they gave us a tiny bit.
[4:35] No, they didn't.
[4:36] Didn't they?
[4:36] No, I was all over that.
[4:38] I was like, where's our discount?
[4:39] Every other school got discounted.
[4:40] We did it.
[4:41] Yeah.
[4:41] Because we're providing a full curriculum.
[4:42] They did.
[4:43] They did.
[4:43] A lot of PE, a lot of HIIT workouts in their bedrooms.
[4:46] Yes, there was.
[4:46] Lots of squat jumps up and down, bouncing
[4:48] Yeah, and then all my child was under the table the whole time not doing it.
[4:51] So anyway.
[4:52] You had a front row seat inside your house while your kids were learning.
[4:56] The kids were online learning.
[4:58] I reckon it was like nine o'clock in the morning.
[5:00] I think one of my kids was trying to spell the, like T-H-E. And I was like at my wits end going, you're like in this year level and you can't spell the.
[5:09] I was like this.
[5:09] And we're all at breaking point at this point.
[5:11] Yeah, where this is like a year and a half in lockdown learning.
[5:14] And then she's like, what is my T-H-E?
[5:17] H-E. And then she's like, what?
[5:19] And I'm like, I kept repeating myself.
[5:21] And I was like, that's...
[5:22] F-ing it.
[5:23] Like I lost it.
[5:25] I was in a robe with no clothes underneath and I started swearing and I kicked the wall, but I didn't kick the wall.
[5:34] I kicked the skirting board, broke my toe.
[5:36] She literally broke her toe.
[5:38] I saw it afterwards.
[5:40] It was horrendous.
[5:41] I mean, no, I didn't.
[5:43] I didn't see you in real life.
[5:46] I mean, I saw you on a FaceTime.
[5:48] I saw her little toe.
[5:49] It was bloody purple.
[5:50] The whole thing was broken.
[5:51] My foot, and it all went up to my ankle as well.
[5:54] Like it was so badly broken.
[5:56] But with that, I was jumping up and down and then my robe was- In the back of the Zoom.
[6:01] So the whole class and the teacher could see.
[6:05] Yep.
[6:05] And I also wasn't muted either.
[6:07] So you could hear every swear word I threw.
[6:09] And then I'm jumping up and down and my whole robe opens open.
[6:13] Boobs and all was displayed for the whole classroom.
[6:16] Ha ha!
[6:18] It was trauma.
[6:19] And then I remember like, and then, I remember you calling me like, are you okay?
[6:23] I'm like, no.
[6:24] Who else called you?
[6:25] The school principal.
[6:26] I'm the teachers.
[6:28] I'm the teachers.
[6:29] They're like, your child can go offline for the rest of the day and you can just regroup and calm your farm.
[6:36] I was like, oh, my God, trauma.
[6:39] We love our school.
[6:40] They're so good to us.
[6:41] They're so good to us.
[6:42] And thank you for educating our children for two years nonstop.
[6:45] Yeah.
[6:46] Because it actually, I don't think I could have educated them during that time because it was such a hectic time.
[6:52] It was so hectic.
[6:52] And, babe, thanks for providing all the entertainment.
[6:54] Oh, my God, there was so much entertainment in lockdown with me.
[6:56] I was a tremendous.
[6:57] rain rain.
[6:57] I was like not croaking.
[6:59] You, Jess Roberts robe, it's like an iconic kind of phrase amongst the school teacher community.
[7:06] Yeah, yeah, literally in my contest pajamas.
[7:09] Love it.
[7:17] We have a really interesting episode today.
[7:21] We do.
[7:21] With an incredible doctor who is so experienced in the topic we're going to talk about.
[7:27] What are we talking about today, Jess?
[7:28] So we've both heard, you know, in Celebrity World, just amongst our friends about a medication called GLP-1.
[7:37] Yeah.
[7:37] And I literally was like, I don't even know what that is because there's so many terminologies for this one word.
[7:44] We are seeing GLP1s spoken about by celebrities.
[7:48] We're seeing it on reality TV.
[7:50] We're seeing it on TikTok.
[7:51] We're seeing it on Instagram.
[7:52] People have so many questions.
[7:53] Yeah.
[7:54] Our listeners come to us and they have asked for us to cover this topic.
[7:58] So even though we're two skinny bitches, we're going to talk about it today.
[8:01] Yeah.
[8:02] So we're not here to lecture anyone.
[8:05] We're not here to push a GLP-1.
[8:07] We're not here to poo-poo a GLP-1.
[8:10] We are here neutral in our lane.
[8:12] We are staying in our lane of, like I said, two women who've had the privilege of never having to have a lived experience of...
[8:21] body issues when it comes to their weight.
[8:23] So we are here just being completely neutral, guys.
[8:27] We want to give you the information.
[8:29] There's so much stigma around it as well.
[8:32] We have friends, people we know who won't even talk to their friends and family about what they're doing and why because they feel so much shame around using these medications.
[8:44] So we just wanted to kind of chat to someone that was professional in that area to kind of
[8:49] debunk the medication that's, you know, that's around.
[8:53] Yeah.
[8:53] And we're here saying no one has to look a certain way.
[8:57] We're not here saying that no one should take this.
[9:00] We are, like I said, completely neutral.
[9:03] We, what's that say?
[9:05] We look and we do not judge.
[9:07] Is that the same?
[9:08] We are the messenger.
[9:09] Don't shoot the messenger, guys.
[9:11] We are here and I hope
[9:13] anyone who is considering this, who has friends and family who are doing this, pass this podcast, send this podcast on to them because we have Dr. Ryan DeCruz coming on.
[9:25] He is a medical professional to give us all the expert information and to cut through all the misinformation that we're seeing on social media.
[9:34] I think this is going to be a really interesting topic.
[9:37] Welcome, Dr. Ryan DeCruz.
[9:38] Thanks so much for having me, guys.
[9:40] I'm really excited and I'm really passionate about this area of medicine because it's something that, as you said, we can't pretend that it's not existent.
[9:48] Yeah.
[9:49] And I think we really need to understand it, understand the science behind it, the psychology behind it, the social implications behind it.
[9:54] So I'm really pleased to be here.
[9:56] Thanks for having us.
[9:56] So remind us, for everyone listening, what are your qualifications?
[10:01] Sure.
[10:01] So I am a fellow of the Australasian College of Dermatologists, which means a board certified dermatologist here in Australia.
[10:07] As part of what I do, I'm very big on lifestyle medicine.
[10:10] So I believe that food, exercise, mental health, all of these things play really strongly into our skin health.
[10:17] So we can do all the things, the creams, the lotions and potions, the injectables, the lasers and what have you.
[10:23] But if we're not looking after ourselves internally, then really we're fighting an uphill battle.
[10:28] And that's why I'm here.
[10:30] Okay, fantastic.
[10:31] Do you know what's really interesting?
[10:33] I didn't even realize that the whole peptide things and then this medication was kind of tied in.
[10:39] Yeah.
[10:40] Yeah, that was a big shock to me.
[10:41] You and I both, right?
[10:43] So we're talking about peptides for skincare and all the different types.
[10:46] Yeah.
[10:46] And I remember you saying they're like messengers, right?
[10:49] And then at the end when you were saying these weight loss drugs are of peptide as well.
[10:55] Yeah, yeah.
[10:55] I was like, okay, we need an education.
[10:57] Yes.
[10:58] So what exactly are GLP-1 medications and how do they work in the body?
[11:02] First thing to say is these aren't a new class of medication.
[11:05] We've had GLP-1 agonists for well over 10 years.
[11:08] The thing that's happened more recently is that they've actually improved in their quality and their efficacy.
[11:13] So what is it?
[11:15] Every time we eat food, our body naturally releases a whole range of hormones.
[11:20] But glucagon-like peptide 1 is one of the key ones that's produced by our intestine.
[11:25] And what this does is it tells our stomach and our brains to slow things down because we've just eaten.
[11:31] So it actually slows the movement of food through our stomach and through our intestine and it helps us produce insulin.
[11:37] So our pancreas produces insulin and it produces insulin to keep our blood sugar levels normal or within a narrow limit.
[11:45] Right?
[11:46] So it is a naturally occurring hormone, but what these clever scientists have done is worked out if we actually give it to people in an injection form, we can help them listen to their body a bit more carefully, help them feel more full.
[12:00] It tells their brain that they've got food in their system that they don't need as much, and it slows that transit time.
[12:07] So the class of medication was really invented mainly for diabetics and pre-diabetics.
[12:11] And that's where it sort of came from.
[12:13] Because in that group of people, particularly patients who have type 2 diabetes, they produce insulin, but their body is resistant against it.
[12:21] They essentially need to produce so much insulin to get a response that their blood sugar levels are allowed to climb up very high.
[12:29] Right.
[12:30] So that's where the medication came from.
[12:32] Type 1 is the one that you inject.
[12:34] Insulin 4.
[12:35] Insulin 4.
[12:36] That's right.
[12:36] That's different.
[12:38] Correct.
[12:38] Exactly right.
[12:39] So type 1 diabetics, for genetic reasons, do not produce insulin.
[12:43] Their pancreas is just not producing it from a young age.
[12:46] So most type 1 diabetics will be diagnosed within the first 10, 15 years of their life.
[12:50] There are these late cases, what we call later cases, which are a little bit different.
[12:54] Mm-hmm.
[12:54] Type 2 diabetics produce insulin the majority of their life, but over time start to produce less and less of it because as their pancreas gives out.
[13:02] Right.
[13:02] So it's type 2 diabetes.
[13:04] That's the one that you get from diet.
[13:08] Yeah, so it's more lifestyle related in that we have a slight degree of more control over it.
[13:13] Yeah.
[13:13] You're right, because what we know is that if our diet and our exercise isn't fantastic for years, and as we gain more and more weight, our body has to work harder and harder to control glucose levels, and they're producing more and more insulin, and the brain and the body becomes actually resistant to that insulin, so it's not listening to it anymore.
[13:33] It's not eliciting the same response as it was, and so blood sugar levels increase.
[13:38] And are there certain ethnicities or genetics that also make you more prone to diabetes as well?
[13:43] Definitely.
[13:44] And you're looking at one right here.
[13:45] Yeah.
[13:45] Is Polynesia, like Maldi, I feel like my family are more prone to it.
[13:51] Yeah.
[13:51] So Islander populations, Asian populations, Indian populations, they are all at much higher risk of insulin resistance and type 2 diabetes because of our genetics.
[14:01] Okay.
[14:01] Yeah.
[14:01] So for us...
[14:03] we are allowed or we can afford to carry less weight than a white Anglo-Saxon or Anglo-Celtic person if we want to prevent against getting diabetes.
[14:11] So we actually have to be working even harder just genetically.
[14:15] Wow.
[14:16] Which is really frustrating and really unfair.
[14:19] So it's actually affecting your appetite and metabolism at a hormonal level.
[14:23] Absolutely.
[14:24] Yeah.
[14:24] So there's a whole lot of hormones involved here and I'm not going to get too technical, but we have one group of hormones called the leptin hormones.
[14:32] These are produced by our fat cells.
[14:33] That's one that I don't have.
[14:35] You don't have leptin?
[14:35] You don't have any leptin?
[14:36] Yeah.
[14:36] Is this the genetic testing you did in Korea?
[14:38] Yes.
[14:39] Yes, you sent it to me.
[14:40] I don't have leptin and then it doesn't do this other thing.
[14:43] Tell you that you're full.
[14:43] Yes, I can just eat and eat and eat.
[14:46] But you don't.
[14:46] That's really interesting.
[14:47] Oh, no, I do.
[14:48] When I eat, I eat.
[14:49] Oh, you saw me in Korea.
[14:51] I came back nine kilos heavier.
[14:53] And I saw you in Ibiza.
[14:54] Yes.
[14:55] And in Greece.
[14:55] And we did a pregnancy test because you weren't pregnant.
[14:59] I wasn't pregnant.
[14:59] I just ate.
[15:00] I just ate.
[15:01] The thing about leptin is it's produced by our fat cells and it tells our body that we're full.
[15:05] Exactly as you were talking about.
[15:07] But what happens is if we, again, carry too much fat, particularly what we call truncal fat or visceral fat,
[15:14] our brain becomes resistant to leptin.
[15:16] So it sort of doesn't make sense.
[15:17] So if you saw some person who's a larger individual, is overweight, you'd think, oh, that person should be producing a lot of leptin, right?
[15:24] Because they've got more fat on them.
[15:25] They should be telling their brain that they're less hungry.
[15:28] But what happens is the brain gets resistant to it.
[15:30] Okay, so it's like the opposite.
[15:31] Yeah, exactly.
[15:33] Exactly.
[15:33] I do have an 87% chance of having diabetes.
[15:36] That was in my genetic testing.
[15:37] Yeah, interesting.
[15:38] Yeah.
[15:38] Interesting.
[15:39] So this group of drugs that are now commercially available all around the world have really changed the way that we look at obesity, type 2 diabetes, insulin resistance.
[15:49] Right.
[15:49] Because all of these conditions are what we now see are going to be the thing that kill the majority of people in the Western world through heart disease, stroke, diabetes and kidney disease, right?
[16:00] So they actually are game changers for a huge percentage of people who are at risk.
[16:05] Right, okay.
[16:06] Yeah, you kind of think like what are the flow-on effects for something like this?
[16:09] Seeing what's happening in society, I know people on GLP-1s and even in the older community, males as well, very, very unhealthy, very, very overweight, at risk for the things you mentioned, now have like lost 50 kilos.
[16:26] Yeah.
[16:27] What does this mean in the future for...
[16:31] obesity and people being overweight, is this going to exist in 10 years, 20 years?
[16:37] Will governments...
[16:38] I mean, these are all just opinions and we don't know, but I'm kind of thinking ahead going, is this something governments could prescribe to people to help with their health outcomes, live longer lives, take stress off healthcare systems?
[16:54] Yeah.
[16:55] We're at a really interesting time.
[16:56] We are.
[16:57] We are.
[16:57] And it's hard to predict what the future holds because these drugs are only getting better.
[17:00] So we had GLP-1 agonists initially.
[17:04] So one was called liraglutide.
[17:05] Now that's been surpassed by semaglutide, which is sold commercially and available as WAGOVI when you are prescribed for weight loss indication, or it's called Ozempic if you're prescribed for a diabetic indication.
[17:15] Mm-hmm.
[17:16] Is there one called Monjaro?
[17:17] Monjaro, absolutely.
[17:18] So Monjaro is actually a combination of two different hormones in one medication.
[17:22] So it's got the GLP-1, but it's also got a GIP agonist as well.
[17:26] And it has been proven in the clinical studies to work even more effectively.
[17:29] So it can achieve up to 25% weight loss.
[17:33] 15 to 25% weight loss is the average.
[17:35] So are these medications, are they...
[17:38] Some injected and some are taken orally.
[17:40] At the moment, these are just injected.
[17:42] Yeah.
[17:42] Right?
[17:43] So that's where we'll probably see the majority of these playing out.
[17:46] But in the future, who knows?
[17:47] Yeah.
[17:48] It always comes around that, you know, people would prefer to take a tablet than take an injection and we'll see.
[17:52] So time will tell.
[17:53] At the moment, they're injectable.
[17:55] Coming up, there's yet another medication which is not commercially available yet.
[17:58] That's called retitrutide.
[18:00] And that's got three different hormones that it agonizes.
[18:03] So it's going to be even more effective again.
[18:05] So the point here is that we're seeing every couple of years evolution of these medications that are getting better and better.
[18:11] Mm-hmm.
[18:12] To answer your question, well, what is the future for weight loss and obesity?
[18:16] And it's very hard to predict because is this something that a healthcare system should necessarily fund and pay for?
[18:22] Well, that's an ethical question and a taxpayer kind of question and a health economics question.
[18:29] At the moment in Australia, if you would like to go on one of these medications and if you qualify by the TGA, and I'll come back to that in a moment...
[18:36] you have to fund it privately.
[18:38] So you are paying out of pocket yourself to elect to go on a medication such as semaglutide or Wegovi or tezapatide, which is Munjaro.
[18:45] So you're paying for it.
[18:46] The government will not assist you except if you have type 2 diabetes.
[18:50] Okay.
[18:50] Already proven.
[18:51] How did they come to be used clinically for weight-related conditions?
[18:54] Yes.
[18:55] Great question.
[18:56] So it was really in the clinical trials when they were using it for patients with insulin resistance and type 2 diabetes that they found patients losing substantial amounts of weight.
[19:06] So they were using it really to control blood sugars.
[19:09] That was the primary purpose of these studies.
[19:11] But of course, they were looking at a whole lot of other metrics as well.
[19:14] And they found that on average, patients were losing somewhere between 10 to 20% of their body weight.
[19:20] Right.
[19:21] I want to be really clear here though, because body weight includes fat, right?
[19:26] And there we have some form of fat that's important.
[19:29] So females have to sit at a slightly higher body fat percentage than males for a whole lot of reasons.
[19:35] Fertility being one of the most important ones, their longevity as well, right?
[19:39] So you can't compare males and females.
[19:41] That's the first thing to say is that females biologically need to sit a little bit higher.
[19:46] The second thing to say is that with these medications, you not only lose fat, but you lose muscle as well.
[19:50] And this is a huge risk of the medications that perhaps isn't spoken about anywhere as much as it should be.
[19:56] Is that only happens to someone that hasn't got diabetes and is on the medication that they lose the weight and the muscle?
[20:03] No, anyone who goes on this medication.
[20:05] Okay.
[20:06] So regardless of the indication for the medication, so that is the reason you're on it, you will lose some fat but you will lose muscle and muscle is what is biologically active.
[20:16] It is what fuels our metabolism.
[20:18] So think about it.
[20:19] If you go on one of these medications going, yeah, great, I'm going to lose 10 kilos, 15 kilos, 20 kilograms, okay?
[20:25] And then you think, oh, great, I'll go on it for maybe a year, two years, and I'll come off it.
[20:30] You're absolutely kidding yourself.
[20:31] Because what will happen is unless you are super careful with weight training and resistance training.
[20:36] And protein.
[20:37] And protein intake.
[20:37] Eating protein.
[20:38] And fiber.
[20:38] Yeah.
[20:40] you will lose not only fat but you'll lose muscle as well so that when you come off drug, you've now got very little metabolism left.
[20:47] Yeah, you've literally wiped out your metabolism.
[20:50] I know people who have come off the drug and put on weight worse than before.
[20:54] Rebound.
[20:55] Right.
[20:55] So if you are on this medication...
[20:59] Do you have to be on it for life?
[21:00] Like this is a big risk.
[21:02] And this is the thing.
[21:03] This is this sparkly new thing that everyone's talking about.
[21:06] I know diabetics have been having it for a long time, but used in this weight loss way, how do we know long term that we're not doing more damage?
[21:14] That's a really good question.
[21:15] And the true answer is we do not because they have not been around for long enough.
[21:19] That's frightening.
[21:20] Yeah.
[21:21] So how long does it have to be around to kind of have a gauge and idea?
[21:24] A minimum of 10 years.
[21:26] And these newer drugs haven't been around for that long.
[21:28] Yeah.
[21:28] So I guess as a doctor, I would say if you have a 10-year safety profile and you've got follow-up of patients, you have a really good gauge of what the medication is doing and not doing the risks, the long-term risks.
[21:38] Yeah.
[21:38] What the studies have shown is that a decent proportion of patients who come off drug will regain weight, right, because they haven't necessarily done all those things that we've just talked about, the high-protein diet, the resistance training, and the mindset training.
[21:52] Because so much of eating and weight control and weight management, it's multifactorial.
[21:58] It has to do with our self-esteem, our mental health, our depression and anxiety.
[22:02] It has to do with our physical activity and the way that we approach food and eating.
[22:07] Mm.
[22:08] You have people like me who are absolutely emotional eaters.
[22:11] I love food when I'm tired, when I'm stressed, when I'm feeling stressed or anxious.
[22:16] You know, the hedonic eaters, those who really love it.
[22:18] It sort of makes you feel good.
[22:20] Yeah, yeah.
[22:21] Then you have patients who will just have what we call habitual eaters.
[22:24] They're just kind of eating, not even thinking about it.
[22:26] They're just kind of...
[22:27] going for it.
[22:27] Yeah.
[22:28] Then you have patients who have probably mental health disorders, right?
[22:31] So body dysmorphic disorder, they'll have, you know, bulimia, anorexia, nervosa, all of those other conditions.
[22:36] There are so much that goes into it and it's a very complex area.
[22:39] So it's kind of like you need to find out your mental health, how you eat, your diet and everything.
[22:45] Yep.
[22:46] When you're on the medication, it's not just about just taking the medications.
[22:48] It's a whole factor of how to support it after you finish it.
[22:52] That's right.
[22:52] Yeah.
[22:52] And how do we adopt healthy approaches to food, a healthy relationship with food, a healthy relationship with our bodies, knowing that not everyone is going to have the same body shape, even at, say, 20% body fat percentage.
[23:06] patient A or female A might look quite different from female B.
[23:10] And then if they're seeing this person on social media going, well, we're the same body fat percentage, but we look really different.
[23:17] Well, that's genetics and that's okay.
[23:19] And bone structure and everything.
[23:20] Absolutely, bone structure, all these things.
[23:22] So have we seen in the literature people who come off it successfully and do not have to go back on it?
[23:30] Yes.
[23:31] So there are people who will not regain the weight, absolutely.
[23:34] And what are the rules around that?
[23:36] Like how much resistance training is and how much protein?
[23:39] Like is there a recipe for it?
[23:41] There is.
[23:42] There is in general terms.
[23:43] And again, it depends on your metabolism.
[23:46] It depends on your genetics.
[23:47] But in general terms, resistance training three times a week is recommended.
[23:52] So weights training, right?
[23:53] Yeah, weight training.
[23:54] And, you know, good Pilates, clinical Pilates is also resistance training, but weight training definitely.
[23:58] So this is stimulating your muscles.
[24:00] Correct.
[24:00] Because use it or lose it, right?
[24:01] Yeah.
[24:02] Correct.
[24:02] Yeah.
[24:02] So you want to stimulate your muscles to then be biologically active and burning calories while you're sitting there and while you're at rest, right?
[24:10] So that's your metabolism is really a huge part of that is from your muscle bulk, your lean muscle bulk.
[24:16] Mm-hmm.
[24:17] In terms of protein intake, you mentioned earlier, a good rule of thumb would be 1.5 grams of protein per kilogram per day.
[24:25] So that's quite a lot.
[24:26] You work out your body weight.
[24:27] Your current weight or where you want to be?
[24:29] Well, your current weight.
[24:30] To make it simple, your current weight, right?
[24:32] To make it a little bit simpler.
[24:33] Yeah, you're right in that it could be, some people will argue that it's lean muscle mass.
[24:37] But at a minimum, if you just work out, you really have to prioritize protein.
[24:42] Why?
[24:42] Because protein fuels muscles.
[24:43] That's what muscle's made out of.
[24:45] You want to prioritize fiber.
[24:48] Okay, so fiber is what will go through your body.
[24:50] We don't actually digest it very fully.
[24:52] It sort of moves through our body.
[24:54] It helps us feel fuller for longer.
[24:56] It's like psyllium husk and all of those, metamucil and all those things.
[24:59] But it's also primarily from vegetables.
[25:01] Yeah, so good quality, your broccolis, your carrots, all of those sort of good quality, celery, all those sorts of things.
[25:07] loads of water, loads of water because there's a lot of water shifts in the body, and electrolytes.
[25:14] It's the other thing that is really important when you're on one of these medications.
[25:17] So there's a lot that goes into it.
[25:18] It's not as simple as, yeah, jab yourself and off you go.
[25:21] You have to adopt all of those other lifestyle factors, dietary factors, and the mindset factors for it to be successful.
[25:28] And that's hard.
[25:30] Really hard.
[25:30] Jess, we know people who are so frightened of coming off it
[25:37] to the gym training, the diet, the mindset, but they can commit to administering the medication on themselves.
[25:46] And conversations with them, they don't want to come off it because they're scared of relapsing.
[25:52] And it can be dangerous because we don't know what the long-term effects of this.
[25:57] They're expecting to be on it for life.
[25:59] Yeah.
[25:59] And I think a lot of, you know, back in the day when people were being put on this medication, I don't think there was a lot of knowledge of the doctors giving this is what you need to do to, you know, support this and get off it.
[26:12] I think they just, oh, yeah, you're at this weight.
[26:14] Let's just give you this medication.
[26:15] But then there's no... No education.
[26:17] People we know got zero education on the protein and the weight training.
[26:22] They've just been given the medication and that's it.
[26:24] And off you go.
[26:25] I couldn't agree with you more.
[26:26] And they found the information on...
[26:28] Instagram reels and their algorithm telling them what they need to do.
[26:32] So this is what I call unethical prescribing.
[26:34] There's a lot of unethical prescribing out there because it's unethical because as a doctor, we are obliged to do no harm.
[26:42] It is our job to educate you on the benefits, but also the risks of any medication, of any choice.
[26:48] And then it is the patient's choice to make those decisions based on evidence, right?
[26:52] The information that we're giving them.
[26:54] How can you make an educated choice if you don't have that knowledge, if you have no idea?
[26:58] And we said, yeah, just go on this medication, you'll be on it for six months and then you'll come off and you've lost 10 kilograms.
[27:03] But it's completely false or, you know, really misleading.
[27:06] Yeah, and they're not saying you could come off it and then put it all back on and some more because we've completely stuffed your metabolism.
[27:13] Yeah.
[27:13] The other thing is that if we look at the dosing schedule that's invented by these companies, now at the end of the day, pharmaceutical companies, they are a business, right?
[27:22] They are a business and one of their primary things will be profit, of course, right?
[27:26] Of course, they're looking to help patients.
[27:27] They want to invent drugs that will change the world and change people's lives.
[27:31] But of course, profit has to be part of that.
[27:33] So dosing schedules, so what's been sort of prescribed or recommended based on clinical trials, are often going to be pretty high, right?
[27:41] So they can sell more drugs, right?
[27:43] Yeah, of course.
[27:44] There's commercial...
[27:47] Element to it.
[27:47] Element, yeah.
[27:48] You can't ignore it.
[27:49] You cannot ignore it.
[27:50] So we also have to recognise that not everyone needs those high doses.
[27:54] Some people may only require smaller doses, but they don't know because they haven't been told or educated properly about actually just listening to their body using lower doses, using what we call off-label prescribing, which is where you take a medication but you don't necessarily follow the prescription guidelines
[28:11] The manual.
[28:12] The manual, exactly.
[28:13] But it's still equally acceptable and probably beneficial.
[28:17] Can any doctor prescribe GLP-1s?
[28:19] Yes.
[28:19] In Australia, anyone who has a medical licence can prescribe it.
[28:23] The Therapeutic Goods Administration says very clearly the people for whom these medications are indicated are those who have a BMI of over 30, so a body mass index over 30, or a BMI of over 27 and one risk factor factor,
[28:37] such as cardiovascular disease risk factors, so high blood pressure, hypercholesterolemia, type 2 diabetes or insulin resistance.
[28:45] Now, the problem with BMI as a tool, as a blunt tool, if you know the way it's calculated, is it takes someone's height and their weight and it does a sum to work out whether they sort of sit in the overweight category or obese category.
[28:57] So if you're over 40, you're categorically obese, according to BMI.
[29:02] If you're over 30, you're overweight.
[29:04] It's so flawed, that.
[29:05] It's really flawed.
[29:06] So Chris, my husband, when he was at his peak football superpower, best player in the league, his BMI put him in the overweight, almost obese range, which is like he was a lean professional athlete at the top of his game.
[29:23] Yeah.
[29:24] And we would look at the BMI and just go, what?
[29:26] Because his muscle was just.
[29:27] Correct.
[29:27] Yeah.
[29:27] He's full of muscle.
[29:29] So the muscle makes you heavy.
[29:30] Yeah.
[29:30] Yeah.
[29:31] Yeah.
[29:31] So.
[29:32] What we know now is the way that we really should define obesity is what's called your abdominal circumference compared to your height.
[29:39] Oh.
[29:39] Yeah, so this is the newer sort of definitions.
[29:42] They're still not what the TGA says.
[29:45] Yeah.
[29:45] Right?
[29:45] As to, yeah, but this is...
[29:46] I need an update.
[29:47] It is.
[29:47] It's an update, right?
[29:48] Yeah, yeah.
[29:49] It is an update.
[29:50] And you'll find this, there's all sorts of examples of this throughout medicine.
[29:53] But essentially now we look at your abdominal circumference to height ratio.
[29:58] And if that is over 0.5, you are defined as being overweight or obese.
[30:02] Okay.
[30:03] Why?
[30:04] Because it's really important to understand that that abdominal circumference reflects what we call visceral fat, which is the fat that's tied in around our organs.
[30:12] So not the sort of fat that you can pinch, that's actually internal.
[30:15] It covers our intestines, it's around our liver, it's around our pancreas.
[30:19] That sort of fat is harmful to us, right?
[30:22] So it increases our risk of diabetes, it's very pro-inflammatory, high blood pressure, high cholesterol and heart attacks and strokes and all of these sorts of things.
[30:32] So we know that when someone, particularly for a female, if you have an abdominal circumference over 88 centimetres, you're at significant risk of cardiovascular disease, heart attack, stroke.
[30:42] If you're a male, if you have it over 102 centimetres, you're particularly at risk as well.
[30:47] So it's either 102 or 104.
[30:50] Maybe I've made a slight mistake there, but either way, it's over that.
[30:53] You're significantly at increased risk.
[30:55] Right.
[30:55] Okay.
[30:56] So what are the most common side effects that people don't really talk about?
[31:00] Yeah, so actually the most common side effect is significant fatigue.
[31:04] You feel tired.
[31:05] You are... Loss of energy is huge.
[31:08] Why?
[31:09] Because you're in quite a significant calorie deficit.
[31:12] Yeah, you're not eating properly.
[31:13] You're not yet.
[31:13] You're really... You're going from, let's say...
[31:16] You need to be consuming, let's call it roughly 1,800 calories.
[31:19] Some people are going as low as 600, 700, 800 calories a day, maybe even less, right?
[31:24] So they just think, great, I'm not hungry, so I'm not going to eat.
[31:27] You feel really tired because your brain needs food.
[31:30] Your brain needs protein.
[31:31] Your brain needs glucose.
[31:32] It needs carbohydrates to function as well.
[31:35] vitamins and minerals and nutrients.
[31:38] But it's also like if you're losing weight by a drug, I guess you should go, oh, I don't have to exercise now.
[31:44] And you need exercise to get that dopamine, serotonin, all those levels up.
[31:47] And to keep your muscles big and your metabolism firing.
[31:50] Yeah, and your blood flowing and all that, but you're stopping.
[31:53] So it's another way of feeling quite fatigued.
[31:55] You could see how people would fall into that habit very easily.
[31:59] Yeah.
[31:59] Absolutely.
[32:00] I know.
[32:00] If you go into this with the incorrect mindset, which is I need a quick fix, I want an injection that will just solve all my problems, dare I say you're doomed to fail.
[32:12] You're doomed to fail, yeah.
[32:13] I really, I believe it.
[32:14] Do you recommend if you were to put someone on that medication, you'd say, let's get you exercising, get into a really healthy routine of diet and exercise.
[32:27] That next part is that medication that would just kind of take off those extra calories.
[32:31] I feel like if you just give them medication...
[32:34] They don't have the foundations and the structure to kind of get... You almost like set up the lifestyle changes first.
[32:39] First and then give the medication.
[32:41] I think that's an excellent point.
[32:43] You should go into health counselling, Jess.
[32:45] Look, absolutely.
[32:46] And we sort of have for many years tried to do that with our pre-diabetics and diabetics, so type 2 diabetics.
[32:53] We'll say...
[32:54] I'm diagnosing you with type 2 diabetes, but at this point in time, we're going to control it with diet and exercise.
[33:00] So we used to call it, say that, yep.
[33:02] And patients say, oh, okay.
[33:04] And they'll go home and they'll go, oh, I'll start thinking of my diet and my exercise.
[33:07] And what would happen is you'd have two groups of people.
[33:10] You'd have, sadly, the minority who would go and take that really seriously and work really hard because it is hard work.
[33:16] It is mentally, emotionally, physically hard work to be super strict with your diet and to be exercising that regularly, particularly based on your genetics and your lifestyle.
[33:27] You know, if you are a busy mum, single mum, busy dad, carer for your parents, carer for your children, it can be incredibly hard to do all of those things that you know that you need to do.
[33:38] Yeah, I'm definitely one of those patients that like someone's like, go do that for your back, Jess, it will work and I won't do it.
[33:43] I won't do the exercises.
[33:44] It's really hard for a lot of people.
[33:45] It's really, we know that there's so much that goes into it, right?
[33:50] But then there are the majority of people who sort of, who just, yeah, who can't do it, who don't do it.
[33:54] And then what happens is the longer we leave them saying, you know, can you just make these life child changes?
[33:59] Can you?
[34:00] be careful with your diet and do all the exercise for whatever reason, for the whole host of reasons that they'll come up with or that are true, they still can't achieve it.
[34:07] So I agree with you.
[34:08] I think we do need to have all of those principles in place, those pillars of good health.
[34:13] Yeah.
[34:13] The pillars of love yourself and be kind to yourself because you actually may have genetic slash metabolic slash medical reasons to be carrying extra weight that are not your fault.
[34:24] And I think the
[34:25] Greatest example of this is menopause and perimenopause or females.
[34:28] Yeah.
[34:28] Where, you know, I think there are a huge proportion of the population who may need medical assistance.
[34:34] Yeah.
[34:35] I think having the mindset of, well, we know the benefits of exercise and the importance of resistance training as well as cardiovascular training.
[34:45] diet and having an understanding of portion size, having an understanding of good quality foods that are high protein, high fibre versus the processed stuff that you can buy very simply and very easily that aren't helping.
[34:57] Yeah.
[34:59] Knowing, you know, your water intake, putting it all together and giving people that plan or that encouragement to consider all of those things first, absolutely.
[35:06] We have to do.
[35:07] I think it's critical.
[35:08] And then a close relationship to say, well, how is it all going?
[35:11] Depending on how they're responding, they may need that benefit of medication to assist them.
[35:16] Yeah.
[35:24] Back to the side effects we spoke about.
[35:27] Fatigue.
[35:27] Yep.
[35:28] What else?
[35:29] Yeah, so nausea.
[35:30] So a lot of people just feel sick.
[35:32] They feel sick in the stomach.
[35:33] They feel like they may vomit.
[35:34] Sometimes they do vomit.
[35:36] Any gastrointestinal upsets are either diarrhea or constipation, and it can be different for different people.
[35:41] It can just really make you feel pretty uneasy.
[35:43] You'll either be running to the toilet or blocked up, which is why you need heaps of water and the electrolytes, and fibre and the electrolytes are all really common.
[35:51] And it may also just affect your mood and the way that you would normally respond to alcohol.
[35:56] So some people who will drink alcohol suddenly go, I'm not enjoying it anymore.
[36:00] It takes off some of those positive feel-good hormones if you have alcohol as well.
[36:05] So all of those things are important.
[36:07] Very rarely will you have the serious side effects that have been perhaps overemphasized in media and they include things like pancreatitis.
[36:16] Osteoporosis.
[36:17] Yes.
[36:18] Now, the osteoporosis is very much related to the lack of weight training, the sarcopenia.
[36:22] And the lack of nutrition.
[36:24] And nutrition, yeah.
[36:25] Vitamin D and all the minerals, absolutely.
[36:27] Something that definitely can happen is you can get gallstones, right?
[36:31] So with any rapid weight loss or weight gain, you can develop gallstones, which can be incredibly painful and then you need surgery for and that can lead to pancreatitis.
[36:40] So there's a whole lot of potential risks.
[36:42] And that's why any weight loss with these medications should be done carefully and slowly.
[36:48] It shouldn't be a quick fix or a rapid thing because we know that that's bound for failure as well.
[36:53] Okay.
[36:53] So with these weight loss things and talking about pancreas, that's like one of my biggest fears, like getting pancreas cancer.
[37:01] Because when you usually find out you've got pancreas cancer, it's too late.
[37:05] Yes.
[37:05] Does this cause... No.
[37:07] So we're very clear.
[37:08] It does not increase your risk of pancreatic cancer.
[37:11] Mm-hmm.
[37:12] That we know of yet.
[37:13] That we know of yet.
[37:14] Right.
[37:14] There have been certain cases of pancreatitis, so inflammation of the pancreas because of the stress that's put on it, but probably because of gallstones, which is one of the most common cause of pancreatitis, but not pancreatic cancer.
[37:26] Okay.
[37:27] Let's talk about body dysmorphia.
[37:29] We're seeing it globally.
[37:30] We're seeing it on Instagram.
[37:33] We're seeing it in high-profile Australians where, you know, there's whispers about people.
[37:41] They're on this GLP-1 and they've taken it too far.
[37:44] And we've seen it.
[37:45] We've seen it on these people.
[37:47] how damaging can this be and who and how are they getting prescribed this medication and when do people step in and say stop?
[37:58] And I know it sounds...
[38:00] odd coming from me.
[38:02] The irony of Jess and I, two very naturally thin people talking about GLP-1s, Eurozempics and New Manjaro, like that's not lost on us, right?
[38:12] I'm someone who's grown up my whole life from when I was in primary school.
[38:18] I think like year one was probably the first time I was bullied for being too skinny.
[38:21] My whole life from kids at school to media to trolls, I've
[38:27] always been told that I look too skinny.
[38:29] I've never been on a diet.
[38:31] I've never taken any medication to look the way I do.
[38:34] It's just genetics for me.
[38:36] My mum looks the same.
[38:37] My sister looks the same.
[38:39] So it's not lost on me that we're discussing this.
[38:42] I'm an anomaly, right?
[38:45] And most people to look like the way I naturally do as a healthy, fertile, 42-year-old
[38:57] I understand that for most people to look like me, and you Jess as well, that there needs to be some kind of dieting, overexercising, medication or whatnot.
[39:08] So it feels kind of weird me here talking about GLP-1s.
[39:12] I'm genuinely curious and interested as someone who...
[39:16] has never delved into this world, but a lot of my friends have.
[39:20] Some of my friends were, you know, a part of diet culture from very young in high school years.
[39:25] I'm talking like year eight.
[39:27] But there does become a point where we're looking around at people and- They've taken it too far.
[39:32] Yeah.
[39:34] And I don't know, like-
[39:35] I don't know if they need help, but then I know people will DM me saying, you need help.
[39:40] I'm like, no, I'm actually really healthy and really fertile and ticking all the boxes in life.
[39:45] I just look different to you because of my genetics.
[39:47] We're seeing people now who are different to me, but like they look as thin as me, but it's not natural for their body.
[39:54] Body, yeah.
[39:55] So I wanted to ask Dr. Ryan, what's the relevance of body dysmorphia and these medications?
[40:01] It's a really good question and I think you guys are definitely going to get a lot of DMs after this episode, right?
[40:07] Why?
[40:07] Because everyone ultimately...
[40:10] thinks that they need to conform to a certain body size, dress size, body shape, right?
[40:17] This is what I think, you know, media, social media is saying.
[40:22] Mm-hmm.
[40:22] And at a young age when we're exposing young children who are clearly vulnerable but also very impressionable to all sorts of images and to filtering.
[40:31] Mm-hmm.
[40:32] It's kind of saying to people, well, we all need to look skinny to be happy.
[40:36] We all need to be a certain dress size to fit in and to be popular.
[40:41] And this is what I'm really keen that we make sure that isn't the message here.
[40:46] Yeah.
[40:46] And I feel like we're on shaky ground because we are seeing these images of these dramatic weight loss peppered all over TV, movies, social media.
[40:54] And we're almost back into that, you know, that 90s era.
[40:58] You're in naffies, babe.
[41:00] Do you remember that era?
[41:01] No.
[41:01] You know, like that Kate Moss, the supermodel era where bones were in.
[41:05] Yep.
[41:06] I feel like... We're going back there.
[41:07] Are we back there?
[41:09] Well...
[41:09] But then I feel like an idiot talking about it because I am a naturally really bony person.
[41:14] You know, I Photoshop out my bones.
[41:16] Yeah.
[41:17] in my images.
[41:18] I will soften my bones because I get called out on how they look, even though that's just my frame.
[41:25] And all my kids have these knobbly bits as well.
[41:27] But I'll soften them because they look really fucking bony.
[41:29] Yeah, yeah, yeah.
[41:30] But I was just like that.
[41:32] Now, other people are looking like that
[41:34] And it's a result of us.
[41:36] It's just weird.
[41:37] We're in a weird space.
[41:39] We are in a weird space.
[41:40] And this is where I think as a society, as medical professionals, as people with influence, our job is to really ensure we promote health and well-being above all else.
[41:51] And that includes mental health as well as physical health.
[41:54] These medications can assist people to achieve health and wellbeing if they require it, right?
[42:01] Mm-hmm.
[42:01] So this is where who is prescribed these medications for what indication, what sort of, what are they, comorbidities, are they at risk of heart disease, are they at risk of stroke, do they need medical assistance?
[42:12] These are the sorts of questions that need to be asked.
[42:14] Mm-hmm.
[42:15] It shouldn't be the sort of thing that we should be promoting to everyone who is just struggling to lose weight or to be healthy.
[42:21] Mm-hmm.
[42:22] And let's remember the definition of health isn't being a size zero or it isn't being a 10% body, that percentage, right?
[42:29] Which is really unachievable for most people.
[42:32] Yeah.
[42:32] For most people.
[42:33] Yeah.
[42:34] It's about saying if you are overweight or obese, if you are at risk of type 2 diabetes, high blood pressure, cholesterol, all of these things which contribute to liver disease, kidney disease, stroke...
[42:48] heart disease, well, you may benefit from medication if it's appropriate for you.
[42:53] It's not about trying to put everyone on Ozempic or on Munjaro and saying, yeah, go ahead and jump on one of these medications because that is not what this should be about.
[43:03] As a doctor, when you're prescribing one of these medications to a patient, do you only have a certain amount of scripts they can possibly have?
[43:11] Is there a stop to it?
[43:13] At any one time, that's a really good question.
[43:15] No.
[43:15] So it's possible for people to doctor shop and I'm sure they do.
[43:18] Right.
[43:18] So it is possible from, yeah, you go get a script from person A and doctor B.
[43:23] That's possible.
[43:24] Is that flagged in the system?
[43:26] Like can the pharmacist, when they log it in, go, oh, it's come from all these different doctors.
[43:29] That's a really good question.
[43:30] Because they do that with... My medication.
[43:31] My medication.
[43:32] Your ADHD medication.
[43:33] Yeah.
[43:34] They do sleep in tablets.
[43:35] I think they do sleep in tablets.
[43:36] Yeah, that's called Schedule 8 medications.
[43:38] There are certain medications that you can track.
[43:41] Yeah.
[43:41] Drugs of dependence, so sleeping tablets, morphine, oxycodone, those sorts of things, oxycontin.
[43:48] From a weight loss medication or type 2 diabetic medication point of view, I don't think they can because it's a private script.
[43:56] So it doesn't go through the government.
[43:58] Well, unless you're on it for type 2 diabetes.
[44:00] Yeah, yeah.
[44:00] From the PBS.
[44:01] But otherwise, no, I suspect you probably could.
[44:03] And this is, you know, where the whole black market comes into it.
[44:06] This is where the...
[44:08] compounded medications, so they're a rip-off of these drugs being made.
[44:11] It's a bit challenging.
[44:12] I've literally heard about people picking up JLP1s from backyards.
[44:16] No, I've heard about that, but I haven't heard that.
[44:18] And getting on the internet on like, you know, what are those?
[44:21] The Black Market.
[44:21] Silk Road or whatever, whatever, yeah.
[44:23] I didn't know that people were making... Compounding their own.
[44:26] Yeah, and just making different variants of it.
[44:29] That's dangerous.
[44:29] They're very dangerous.
[44:30] They've been... You don't know what's in it.
[44:32] You don't know what's in it.
[44:32] There have been examples of them being completely fake and just like literally buying saline and everything that.
[44:37] So there's a whole lot of rubbish out there.
[44:39] But look, coming back to the body dysmorphic disorder... Are there red flags?
[44:43] Yeah, for sure.
[44:45] So talk to me about... You've got someone who comes in and you're worried that it's more a body dysmorphia issue.
[44:50] What are you looking for and what do you say to that patient?
[44:53] Yeah.
[44:53] Well, I always go back to the definitions of what obesity is.
[44:56] I'll take their abdominal circumference.
[44:57] I'll take their height.
[44:58] I'll do all of those objective metrics to say, well, this is for whom this medication is intended.
[45:04] There are good quality questionnaires out there now where you can pick patients who have BDD and actually it's now incumbent whenever you do a cosmetic procedure on someone
[45:13] The Australian government has now stipulated that we should be screening patients and it doesn't matter what they're coming in for, whether it's a certain type of laser, if it's a facelift or, you know, whatever it is, you should be screening patients for this sort of thing.
[45:25] So now it's very much part and parcel of what most good cosmetic practitioners should be doing.
[45:31] Is there a cooling off period for a GLP-1 medication?
[45:35] Not in the same way as cosmetic procedures, no.
[45:37] Because there is diabetics who need it.
[45:39] Absolutely.
[45:40] And so I can prescribe it for a patient or recommend it to a patient.
[45:43] That patient will then go home and think about whether or not they actually want to do it.
[45:46] Yeah.
[45:47] But I think certainly what these medications aren't intended for and shouldn't be prescribed for is getting everyone to look at exactly the same shape, body's shape and body's size.
[45:57] It's about achieving health.
[45:59] And this is where BDD can come into it because you can see other people losing weight.
[46:04] We know that they're on these medications, but unless you have your mental health, your self-esteem and all of those other pieces of the puzzle intact, these medications can do a lot of harm.
[46:14] A lot of harm.
[46:16] Yeah.
[46:17] I really hope so many people are listening to this podcast because there are so many people talking about it, doing it the wrong way, getting it from the wrong source, not getting educated, and they're going to end up with the opposite result to what they are intending to.
[46:34] Literally.
[46:35] As doctors now getting more information on how they should prescribe it to their patients,
[46:41] Look, I should hope so.
[46:42] Certainly, there is a lot of information online.
[46:45] I have gone off and done a whole lot of education on this specific topic.
[46:48] I'm a dermatologist at the end of the day, right?
[46:50] So this is not what I'd call my bread and butter.
[46:53] I'm so passionate about it.
[46:54] But you're obviously seeing a lot of Ozempic faces as well.
[46:56] Well, I do see Ozempic faces.
[46:58] That's true.
[46:58] That's true.
[46:59] We don't call it that.
[46:59] Yeah, what are they called?
[47:02] I think you can.
[47:02] Yeah.
[47:02] I think, okay.
[47:03] Everybody's talking.
[47:04] That's what they call it, right?
[47:05] Yeah, that's what they call it, yeah.
[47:07] But I think this is really critical because what we're seeing now in society is that a whole lot of medical problems and skin problems and hair problems are directly related to insulin resistance, pre-diabetes, being overweight.
[47:20] That's the new wave of diseases that we're seeing.
[47:23] Yeah.
[47:24] skin problems related to being overweight or obese and having insulin resistance.
[47:29] So that's why I know about it and that's why I care about it.
[47:32] So that's how it came into your sphere, I guess.
[47:34] Sphere, yeah.
[47:35] Okay.
[47:35] So my gastroenterology colleagues, my brother, one of my best friends, they will be prescribing these medications because of the liver disease.
[47:43] That's the result of having fatty liver, now called metabolic associated liver disease.
[47:47] So there are so many different things.
[47:49] We're going to find out about these medications and their role of dementia, of polycystic ovarian syndrome.
[47:53] There are so many different diseases that are all related.
[47:56] Right.
[47:57] So what are you seeing in skin?
[47:58] Yeah.
[47:59] In skin.
[47:59] When patients are on GLP-1s, in terms of benefits, what are you noticing?
[48:04] So let's talk about the benefits of, I'm not going to say of GLP-1s, but I'm going to say the benefits of good insulin control, of having good blood sugar control.
[48:13] The benefits are that people have less acne.
[48:15] Mm-hmm.
[48:16] There's a specific condition called hydradinitis separativa HS, which is, think of it like acne boils and cysts under the armpits, under the breasts, in the groin, or the worst places you can imagine getting a big cystic pimple.
[48:29] Ow.
[48:29] Yep, that I manage a lot of.
[48:31] Yeah.
[48:31] This is a condition that I think will be a particular group of individuals who benefit from GLP-1 agonists and GLP agonists.
[48:38] We have hair loss, so female pattern hair loss.
[48:40] There's growing evidence that this is insulin resistance at that level.
[48:43] Mm-hmm.
[48:44] oily skin.
[48:45] You have really good hair, by the way.
[48:47] Thank you.
[48:47] Just noticed.
[48:48] Thank you.
[48:51] And excess skin appearing in darker skin on our faces and on our necks.
[48:55] That's a condition called acanthosis nigricans.
[48:57] So there's heaps.
[48:58] There are so many different skin conditions that are related to insulin resistance, type 2 diabetes and having high blood sugars.
[49:06] And then, yeah, in answer to your question.
[49:08] The negative side effect.
[49:08] The negative side effect.
[49:09] Well, we're seeing people who are losing weight far too quickly and lose all their hair.
[49:14] So you're going to see so many people who have these massive episodes of what's called a tillage and effluvium, hair shedding, which happens postpartum.
[49:22] I heard that.
[49:23] And it happens when with dramatic weight loss, does it?
[49:25] Exactly.
[49:25] Okay.
[49:26] So dramatic weight loss.
[49:27] That's scary.
[49:28] How do you treat that?
[49:29] Well...
[49:30] The truth is you can't.
[49:31] So telogen effluvium, TE, has to correct itself.
[49:34] So the body needs to then get to its normal, well, re-equilibrate to its new baseline.
[49:39] The problem with TE is that if you've got the genes for female pattern hair loss or male pattern hair loss and you have a big TE, you're then unmasking your genes.
[49:48] Like 5, 10, 15 years too early.
[49:50] Yeah.
[49:51] So yes, there are a couple of medications we can use, minoxidil, et cetera.
[49:53] They're not perfect.
[49:54] So there's no, so that's really significant.
[49:56] The hair loss is very significant.
[49:58] very common.
[49:59] Is it common?
[50:00] Yep.
[50:01] And it's through excessive rapid weight loss.
[50:03] Yeah?
[50:04] So it has to be done slowly and smartly.
[50:06] As you said earlier, you lose a whole lot of fat, you lose facial fat, which actually is important.
[50:11] Yeah, it makes you look young.
[50:12] Correct.
[50:13] It actually helps keep our faces looking fuller.
[50:15] It irons out, the deep wrinkles.
[50:17] We need some degree of facial fat.
[50:19] You want fat in your face.
[50:21] Absolutely.
[50:22] I got some from my leg and stuck it under my eyes.
[50:26] No, she looks great.
[50:27] But that's...
[50:29] I know some people who have had some dramatic weight loss and now they are considering getting plastic surgery because their skin is so saggy.
[50:39] They're considering upper eyelid surgery.
[50:42] They're considering facelift and they're considering fat transfer around their cheeks and in their eye hollows because they've lost so much.
[50:50] They actually...
[50:51] look 10 years older in their face.
[50:54] It was like, remember watching The Biggest Loser and all these people would go on this weight loss journey and then at the end their skin was really sagging.
[51:01] They looked a lot older in their face.
[51:03] We're seeing a lot of that.
[51:04] Absolutely.
[51:05] Yeah.
[51:05] Really aging.
[51:06] It's fast-forwarding aging for a lot of people.
[51:08] Which as a dermatologist, it's kind of like...
[51:11] That's why you got into it, like learning about it.
[51:14] Well, that's why, no, absolutely.
[51:15] So then how do you treat that?
[51:17] Well, it's very difficult.
[51:17] All those things you just mentioned.
[51:18] It's all surgical procedures.
[51:20] It's putting in filler.
[51:21] It's putting in fat.
[51:23] It's like tightening skin.
[51:25] It's biostimulants.
[51:27] It's everything.
[51:27] It actually costs more.
[51:29] Way more.
[51:30] Way more.
[51:31] I think the learning here is that everything you do, there are marked side effects.
[51:36] Yeah.
[51:36] Yeah, there's potential benefits, but there are potential risks and complications and side effects.
[51:42] Yeah.
[51:42] So when you're making a decision, it needs to be an educated one.
[51:46] You need to have all the facts in front of you and you need to understand why you're going on a certain medication and whether it's actually indicated for you.
[51:54] Yeah.
[51:55] And when to stop.
[51:55] Because it may not be.
[51:56] And when to stop.
[51:58] And how to stop.
[51:58] And if you can stop.
[51:59] Yeah.
[52:00] So it's quite complex.
[52:01] And the biggest thing here is that I'm not confident that most people are adequately informed when they get that prescription.
[52:08] We know that they're definitely not.
[52:10] We've spoken to so many people.
[52:11] Yeah, they're frightened.
[52:11] They're so frightened.
[52:12] And they have no idea, you know, how to stop it or...
[52:16] Well, can you actually get off it slowly?
[52:17] If done properly, yes.
[52:20] Yeah.
[52:20] Knowing that you still have a risk of regain, absolutely.
[52:23] But in order to come off it slowly and then be able to stay off it, it's all those things we mentioned earlier.
[52:28] It's the high-protein diet, it's the building of your muscle, and it's having the mindset that actually you'll start all that, what they call the food noise.
[52:36] So, you know, there are these people, I think I'm in this group,
[52:40] who just genuinely feel hungry more than another person.
[52:44] Yeah.
[52:44] Yeah, just, they're always just feeling it.
[52:46] You don't have that leptin.
[52:48] Exactly.
[52:49] Now, these people, that food noise is suppressed by these medications.
[52:54] So when you come off drug,
[52:56] you're going to hear that food noise again, right?
[52:58] So you will then have to work out, well, what have I learned over the last 12 months, 18 months, two years as to how to drown out food noise?
[53:06] Yeah, what is that trigger?
[53:07] Yeah.
[53:07] I'm going to learn the trigger.
[53:09] Triggers?
[53:09] What am I going to do?
[53:10] I'm feeling hungry, but I probably don't need excess calories right now.
[53:14] Am I going to drink more water?
[53:16] Am I going to go and do some exercise?
[53:17] Whatever it is, you have to have some mindset training for all of this.
[53:22] Otherwise, you won't be able to come off track.
[53:24] Yeah, there you go.
[53:25] Are there myths about GLP-1 medications that really bother you as a doctor?
[53:31] Yeah, I think the myth really is that it's a quick fix and that anyone and everyone who's got a few kilograms to lose should jump on one of these.
[53:40] Because it is becoming so commonplace.
[53:42] Everyone is thinking about and talking about it and then it's being prescribed inappropriately and that really does bother me.
[53:48] I think...
[53:49] With anything to do with your health, that has to be, you know, a long-term achievable goal.
[53:56] You have to have all of those pillars in place first before considering a medication and understand the risks and the benefits that there are so many of them.
[54:05] Equally, I think there's a lot of scaremongering about the medications as well.
[54:09] And if you jump online and you look at social media, they'll often highlight all of the worst possible side effects, right?
[54:15] And that's not good either.
[54:17] There are many patients who benefit from this and this is being proven every day, who genuinely need them.
[54:23] I also heard that it's been prescribed for people with all different types of addiction.
[54:29] Yep.
[54:30] So what's the evidence behind this?
[54:35] Great question.
[54:36] So again, this is what we call an off-label usage and the evidence is still growing.
[54:40] So we don't have the big randomized controlled trials like we do for weight loss and we do for type 2 diabetes yet.
[54:48] But because of the blunting that happens at the level of the brain,
[54:52] When you eat food, there's the less you basically don't derive that same level of enjoyment.
[54:56] So is it like dopamine or serotonin?
[54:58] Both of them.
[54:59] What's been starved?
[55:00] Okay.
[55:01] Both of them.
[55:01] Okay.
[55:02] The same sort of theory is now being applied to alcohol and potentially other drugs of addiction.
[55:06] I have most knowledge about the influence of alcohol compared to other drugs of addiction.
[55:11] I know about it because someone who's a gambling addict...
[55:14] Yeah.
[55:14] On a GLP-1 for gambling.
[55:16] Yeah.
[55:17] So this will be completely off-label.
[55:18] Wow.
[55:19] So, of course, in Australia, the TGA would be saying, well, no, that's not what we should be using these medications for.
[55:26] But we are going to learn more about it.
[55:28] The approved indications in Australia are also for sleep apnea, so obstructive sleep apnea, people who have thicker necks, who snore very loudly, who wake up multiple times overnight.
[55:38] It's a potential indication.
[55:39] No, it's not.
[55:40] It's just so I sleep with you a lot.
[55:41] Yeah, yeah.
[55:42] I don't know.
[55:42] We share a bit.
[55:43] We share a bit all the time.
[55:44] But you don't talk.
[55:45] I don't know.
[55:46] I'm just thinking of somebody else.
[55:47] I'm just like.
[55:47] Yeah.
[55:48] Oh.
[55:48] Anyway.
[55:49] So that's an approved indication.
[55:50] Okay.
[55:51] And we'll see more what we call more approved indications over the next few years.
[55:54] Okay.
[55:55] Wow.
[55:55] So interesting.
[55:56] So interesting.
[55:57] And it's just constantly evolving.
[55:58] It's just like educating and seeing if you are a candidate, speaking to your doctor.
[56:04] Yeah.
[56:04] So knowledge is power here, right?
[56:06] You have to, we really, I'm in the job of trying to educate people appropriately.
[56:12] It's not required for everyone, right?
[56:14] So if you were just, you know, perhaps a few kilos heavier than you were five years ago and you know that you've let your diet lapse, you know that you're not doing enough exercise and you know that you've got a few reasons for it, well, I'm not just going to prescribe one of these drugs.
[56:26] Yes.
[56:27] Yeah, yeah, yeah.
[56:27] But these people are going to go and get it online.
[56:30] Yeah.
[56:30] That's true.
[56:31] It's a tricky one, isn't it?
[56:32] I feel like if you are listening to this and you have a friend or a family member who is considering it, please share this episode with them and they can listen to Dr. Ryan and especially with some of the side effects and knowing if they're appropriate for it, go and see a doctor who's well-trained in this to make sure that it's right
[56:52] Yeah, for you.
[56:53] And also it's not just having this medication.
[56:56] There's a whole lot of pillars that you have to have to support having this medication.
[57:01] It's not just taking it.
[57:02] Knowledge is power.
[57:02] Yeah, definitely.
[57:04] Thank you so much.
[57:05] Thanks for having me.
[57:06] Let's see what the reaction is from our audience.
[57:08] We would love to hear from you guys.
[57:10] What do you want to know more of?
[57:13] And if there's enough in it, we'll get Dr. Ryan back for sure to discuss some more.
[57:19] Because I feel like this is just the beginning for these types of medications.
[57:22] In another five, ten years, we'll be talking about them in different ways again.
[57:26] Absolutely.
[57:27] And I know when it's coming from two skinny bitches who've never had to worry about their weight.
[57:31] I know there's eye rolls happening, but we're here to help.
[57:34] While we haven't lived it personally, we lived this through our friends.
[57:38] And, yeah, it's not lost on us.
[57:39] Two skinny bitches.
[57:40] Maybe we should have caught our podcast.
[57:44] Two skinny bitches talk about GLP ones.
[57:48] Oh, for fuck's sake.
[57:49] How did we get here?
[57:51] Oh, my God.
[57:52] Anyway.
[57:53] The two skinny bitches will be back next week.
[57:56] Not talking about weight loss because that's weird.
[57:58] We'll talk about something else.
[58:00] Bye for now.
[58:01] Bye for now.
[58:04] Bye for now.

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