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Uh, we are joined by Doctor Christy Cradeville now in studio here with us to talk about these GLP1 medications. This is a distinctly modern phenomenon. We're excited to dig into it, but you're taking a little bit of time out of your Friday to be with us here, Doctor Cradeville. How's everything going? How are you doing? -- I'm doing -- great, thank you for asking. How are you? I'm doing really well.
We are, we've got about 53 minutes left of streaming, and things have been smooth so far. So we're about to, you know, we're, we're kind of already looking ahead at a clean show, which is great. We're really excited, but we're more excited to have you here because this is something that we've reported on as a station a lot. And while we were just talking here in studio, something interesting came up. Something unique about this medication is you say GLP-1, and we can't be entirely sure that translates to the general public because there are much more common vernaculars that people have been using.
Can you describe what these are and maybe what brands some people might be thinking of as the common terms? Sure, sure. So GLP-1s is the kind of general term for these medications, um. But the, the brands that are out there are, um, that are for treating the disease of obesity would be, uh, Wigovi, Sexenda, Zebound. Um, the newest, uh, the newest kit on the block is, uh, Foundeo, um, and that's, uh, orthogliperon. Um, so you would know Wagovi and its counterpart for type 2 diabetes is Ozempic, um, and so that's saglatide, and then Zebound and its counterpart Manjaro.
Uh, that's, uh, for type 2 diabetes. Um, that's repetide, and then you have, uh, Saxenda and its counterpart Victoza, which is loraglatide. So, those are, those are the guys that are out there. And from what you've seen, what has kind of the growth been like of the use of these medications and maybe people who are asking you and your colleagues about these medications? I mean, the growth has been, uh, I guess over the last probably 6 to 7 years has been pretty, uh, substantial and really over the last probably 5 years. Um, so when, uh, Ozempic kind of blew up. Um, so I will say, um, in the late 2000s is when I was first introduced to Byetta.
I was, uh, just telling, uh, Jen about that. Um, that's when I got into the treating the disease of obesity when I was still active duty military. And, um, and, uh, and, uh, I had a, a mentor who said, you know, you put your diabetics on these medications, they're going to lose weight, and it's going to be incredible, and it really was. Um, and so, so that exanetide or Byetta has been out for a long time and, and changing lives. So these medications have been around for, for a while, um, and, and doing this. So, um, but really it's been in the last, um, probably 7 years now, Saxenda. Uh, was actually FDA approved, uh, in the, I can't remember exactly when, but it, it was the first to be, uh, FDA approved more than 10 years ago, um, for, for this, uh,
for this indication of obesity, and Victoza was before that. So it brings up an interesting point. Well, first, let me say bad anchoring on my part. Uh, Doctor Cradeville, clinical lead for obesity medicine at Centera Health, and I make sure I, I put that in there. I was so excited to get into this that I kind of skipped over that part. Now you. You talk about how um in sort of public perception is that these are very new but they've maybe been around a little longer than people realize um I'm wondering, do people have concerns about how new it is and how that might impact
the amount of knowledge we have about long term effects on health. Is that something that you have found is a major concern for people who are considering using the medication? Yeah, it is, um, and I, I appreciate people's concerns, especially since, um, I think that these medications can sometimes be prescribed potentially, um, uh, inappropriately in some situations, um, uh, because of, uh, some of the. Uh, ways that they are marketed out there. Um, uh, and so, um, but they're just such, um, life-changing medications for the right people.
Um, and, you know, more than, um, 70% of our country, um, struggles with the disease of obesity or, or overweight, um, that, these, uh, medications certainly could be, uh, you know, life-changing for such a substantial portion of our population that I think we really need to consider that. So, um, so considering the risks, uh, versus the benefit before you, uh, go into any medication you're about to take, um, is important. So when patients bring that to me, I make sure that we, you know, have a frank, candid discussion about, well, what is the risk of the disease that you currently carry, the disease of obesity, versus the risk of taking this medication. And, you know, what are the long term side effects of taking a medication long term, um,
and. There, there are, um, risks, obviously, of both, so. Can we talk a little bit about some of the risks, short term and long term, that come with taking medication? So, uh, side effects. Short term, uh, for these medications are mostly gastrointestinal. Um, so, meaning nausea, uh, constipation, diarrhea, those are really the main ones we hear. Um, that truly can for the most part, be mitigated with, uh, dietary change. You know, we can't just prescribe these medications in a bubble, I like to say.
Um, I, I have patients as much as possible, uh, if insurance allows meet with, uh, a dietitian to talk about, um, uh, behavioral, uh, change with your, uh, your nutritional approaches. So I call it optimizing your nutrition. So, Um, making sure that we are starting to look at what types of proteins are we consuming, um, how much fiber are we getting in our diet, not just from our fruits and vegetables, but from our grains, you know, carbs aren't the enemy, it's, it's the types of carbohydrate that we're consuming. And, um, and looking at these ultra-processed foods, and are we, uh, how are we trying to start to kind of weed them out?
Um, how much sugar are we getting in? Because what we find is that the more of these higher fat. Um, higher, uh, sugar foods that we're consuming, the more side effects people tend to have. Um, so we can mitigate some of these short-term side effects, um, that people have on these medications with, uh, our dietary choices, but not always. So if patients are having nausea, I want to hear about it. So, um, I don't knee jerk, give someone an anti-nausea medication when they start one of these, because I want to know if you're having nausea. I want to know if you're having some constipation.
Um, I want to know if you're having any other, um, side effect, um, because, uh, maybe that's an intolerance and not a side effect, and we need to consider either another GLP1, um, or taking a break and trying some another approach. Is that part of figuring out does this work for your body? Is it observing those side effects, understanding them, why are they happening as opposed to just trying to. Kind of shoo them away with more. Right. Medication. OK, sounds good. And it sounds like a lot of the dietary things that you're speaking about are helpful just in general for people to try to.
Right. Adopt for, for better health. So, kind of, you know, a bit of a double bonus there. Yeah, whenever you're treating this chronic, the chronic disease of obesity, you know, the, the behavioral approach, it's, it's a, You have to have the behavioral approach as well. It's not just about, you know, medication. There's certainly biological underpinnings that are, are driving this, which is why it's not just, uh, what we as a society and, uh, as, and, and unfortunately, also as a healthcare community have, uh. Some, sometimes, uh, treated this disease as a disease of willpower. It's not. Um, there's a genetic and biological metabolic reasons for, for this disease, um,
hence why these medications have been so much more effective than the traditional, uh, eat less and, and move more. Um, that, that has not worked. It has not worked for. Decades, um, and now we are seeing these medications showing a true impact, um, so. Why do you think that is, that this disease in particular is one that people think can be cured with willpower and that people seem to ignore the other factors involved in this? Why is it that has not been able to break through that real factual information?
Yeah, I think, um, because there is a, uh, there is a neurobehavioral component to it. Um, there are, uh, because some, uh. People are able to overcome some of their, uh, genetics and meta metabolic disease with changes to behavior more so than others. And that's an area called epigenetics. And it's how we, uh, express our, uh, our genes that we are provided with. Um, and so, and everyone, uh, as an individual expresses that differently. It's why in some families you'll see some people who are struggling maybe more with the disease than others, um,
and it's how we're expressing those individual characteristics that we're given. About short term in terms of long term potential side effects, what do we know? -- How much information do we have and what might exist -- there? Yeah, um, I hate to be such an optimist, but we're looking, I mean, what we're seeing is a lot of, of good that's coming out of it. I think what people have, uh, more concerns about, um, is, uh, some of these, uh, there are some black box warning, um, things that are on these.
Uh, one of them is, and I, I'll point out because it's the one I get the most questions about. Um, is the, this, uh, thyroid cancer, uh, risk that's on these black box warning. And that I, I just want to let, uh, people know is only if you have a family history, um, or a personal history of something called medullary thyroid carcinoma is, uh, what it was seen in the rodent. Studies that were done, um, on it was, uh, in rodents on, uh, that were, uh, given these medications. So it has, there have not been any human cases of this. So overall long term, uh, we haven't seen, uh, much, much long term, um, uh, any long term issues.
There are populations of people though that we are avoiding giving the medications to, such as people who have severe gastroparesis, which is a condition where you're, uh, uh. Intestine doesn't move, uh, move as much. Um, we, we don't want to give it to you because these medications do slow down your stomach emptying and, uh, your, uh, intestine moving as much. So we want to, uh, avoid giving it to people who have that because we don't want to slow down or cause something like a bowel obstruction. Um, so there are, you know, considerations that you have for people.
Um, if people have, um, Start to experience side effects, like, um, one of them being maybe an elevated heart rate from one of these medications. We do see elevations in heart rate in some people. Um, we stop the medication and you may not be able to continue that medication any longer. Uh, we do see, uh, An increased rate of, of cholecystitis and cholelithiasis, which is gallbladder stones and gallbladder disease, and that's independent just of weight loss, um, in patients who take these medications. So, if you develop that,
you may not be able to continue these medications. Um, and then also something like pancreatitis, that's another one that we consider. So those are some long term and more severe side effects that we consider, um, in patients before starting during treatment and then if it's developed during the treatment, uh, -- when patients -- are taking it, right? So which speaks to why it's so important to continue consulting with your doctor with a medical professional. Throughout this process or really any time you think about taking any medication, um, you, we love a good paradox on this show, and you said you hate to be an optimist, which I think is distinctly paradoxical, so we, we do greatly appreciate that, uh,
you know, I wanna ask, we talked so much focus on the physical manifestation of this medi uh medication, right, the weight loss mentally and emotionally are their impacts. So it's interesting you say that. I know that just, uh, there was just an article that was published in, I forget what, uh, psychiatry journal this month about the mood, uh, changes and, uh, if this needs to be looked at more closely. I haven't read the article yet. One of my friends is sending it to me, um, that, um, uh, do, uh, does the, does the behavioral health community as a whole need to be looking at, um, patients that their patients who are taking GLP ones, um,
a little bit differently. Um, so I will say that the, um, there was a prior risk, um, that was placed, um, was there an increased risk of things like suicidal ideation and whatnot on these medications that's since been removed, um, that there's not been found to be an increased risk of that on these medications, um. But, um, one of the, I think what came out of that, um, article, uh, was something about, um, maybe a flattened affect, meaning, um, not feeling as much emotion on these medications. Um, in my, what I have found, um, I have not seen a lot of, of mood changes with patients.
I, I will say there have been some patients who have reported that, OK, here and there, um. And, uh, and so I, I think that there is something that needs to be looked at. Um, however, uh, there are a lot of reports of things like fatigue, um, that, that have been noted, um, so, uh, so I'm interested to read that article and I, I think that there's, uh, there's probably, uh, the behavioral health community, you know, and, uh, and, we need to come together as we, as we do when we're treating our patients with the disease anyway. About other things, so yeah, and, and patients being honest about what they're feeling, what they're going through again, another key to this, uh, you know,
I, I'm wondering what the next frontier is, where does this industry head from here because it has, like you said, it's really kind of exploded on the scene here and had an exponential rise in popularity. What is next? So, there are the, um, the next phase, um, of medications are going to be what we call, what are being called the triple Gs. So the ones that are hitting multiple receptors. So right now we have the GLP-1, and then we're, we're calling them as a whole, the GLP1s, but, um, they're actually, um, uh, GLP-1, and then you have GLP-1 slash GIP, which is, um, which is, uh, ZP bound in Manjaro.
Trietide that hit two receptors, um, and so, uh, the triple Gs are going to hit one of them, um, is, uh, retarutide, um, and that one is going to hit, uh, GLP-1, GIP, and glucagon. So now that's, and I think showing even more, uh, weight loss, um, I think approaching that of bariatric surgery. Um, so you have, um, not quite to that level yet. Um, so you have, um, You have, uh, that's the next wave that's coming, um, and there's, there's even more beyond that, um, and then you have another class that's coming, that's hitting, not that's outside of these, uh, these, uh, these receptors that I've just mentioned. So, um, there's, there's a lot in what we call the pipeline right now.
It's just talking to you, I, I obviously, you know, it's clear how much thought, um, that the medical community puts into. This medication, how it's used, what the impacts are, um, and the who it works for and who needs it to, like you said, weighing the risk factors of a disease that you may have right now versus what this could, um, what this could help with. I'm wondering, are, what is the. Are there instances of people who are abusing this medication who do not need it but want to be thinner or achieve a certain image, is that something that we're seeing and that there are solutions, uh, you know, being pursued
if you are seeing it? So I don't see it as much where I'm at my, you know, where I'm at, um, uh, so I know that it's out there, um, it's, it's unfortunate, um, that it's not better regulated, um, I don't like to, I don't like to fault people for wanting to feel better about themselves, to, to lose some weight, um, to, to get to a goal and feel better, uh, about yourself as a human. Um, but using these medications is to do, to do so is, is not the way. They're, they're not a quick fix. They have, they have consequences.
They have side effects. They are affecting multiple organ systems. They are used to treat diabetes. They are used to treat liver disease. They are used to treat cardiovascular, uh, disease in patients who have established cardiovascular disease. Um, they're used to treat obstructive sleep apnea. They are not meant to, to lose 5 pounds before we go on our vacation, you know, um, and yes, there, there are instances of that.
Um, I, I think, I don't know how to, I don't know what the answer is to how to regulate that, um. And uh and I think it can be very harmful what we're doing and I think it's harmful in multiple ways. I think it's harmful to the patient, um, and I think it's harmful to the people who really need these medications and what we're trying to do to reverse the stigma of the disease of obesity. Um, because again this is a chronic progressive relapsing disease, um, and untangling the difference between the business of weight loss and treating the disease of obesity is, is very difficult, and, and as a health care provider.
Um, you almost have to choose what you're doing and, um, and that, that's something you have to kind of contend with. Absolutely, just very insightful answer, you know, we really appreciate you spending some time with us today. Is there anything else that you want to add, anything I didn't ask about that you think is important? You, um, had mentioned before we were talking about like microdosing, um, and I, uh, wanted to just Make sure that I, I wanted to let you know there is a position statement that the Obesity Medicine Association put out a prospective statement, I should say that, um, is for providers and for patients, um, that I could provide you the link with for your viewers.
Um, and just that, you know, microdosing is a marketing statement. It is not a medical term, and that patients should be very cautious of anything that's directed toward them about microdosing. Um, it's not been validated through any FDA approved clinical trial, um, and it, it could be, you know, harmful to their goals, um, so, uh, and, um, I, I can provide you with that link so people could educate themselves. I know I said last question, but you giving that answer kind of, do you find it frustrating at times when you and your colleagues are attempting to, um.
Use these medications to help people and make sure that they become available and popularized for anyone who truly needs them who will it will improve their lives and then you have to contend with, especially in a new industry like this, people who are going to, like you said, abuse this or use it in ways that are not medically approved but maybe still present it as such, uh, do you find that frustrating? Is it something that's difficult to contend with? Yes, but I try to remind myself that, um. I'm, I'm here to help patients understand the scientific basis, um, and to objectively present them with that and, um, and to help them understand that, um, and as,
as long as I can do that to them, do that for them rather in a nonjudgmental and, um. And, uh, objective way, um, that then I've done my job for them, um, that's, that's what I have to just kind of keep in mind and, and try not to get too frustrated with, you know, what's out there. So, yeah, very good. Well, thanks so much for stopping by Live Impact News. -- This has -- been thank you for having me. -- This has -- been wonderful, yeah, and we've been wanting to talk about this topic for some time. And we report on it so much.
It's so rapidly developing, so maybe we'll see you again down the line as, as things continue to progress and grow and evolve. Yeah, I hope so. -- Thank you -- again. Absolutely, Doctor Christy Cradeville from Centera spending some time with us today to talk about GLP ones and a lot of great information there. We do really appreciate it, Christy, and any links that you send us, we'll try to make available as well.
