Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now, here are Ron Aaron and Dr. Tamika Perry.


RON AARON
Thank you for joining us today on the award winning Docs in a Pod. I'm Ron Aaron. We come to you on the radio in several cities in Texas and Florida and on podcasts. The award winning Docs in a Pod is available wherever you get your podcasts. And with us today, our co-host, Dr. Tamika Perry, who is also our special guest. She's an associate regional medical director of quality for North Texas and Houston for those markets for WellMed. In that role, Dr. Perry tries to ensure that patients are getting the kind of care that they not only expect, but deserve. Dr. Perry earned her undergraduate degree from Prairie View A&M. She then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was National Health Service Corps Scholar. She completed her family medicine residency at Methodist Charlton Medical Center, where she served as chief resident. She's board certified by the American Osteopathic Board, and Dr. Perry is a diplomat of the American Board of Obesity Medicine. So, if you are chunky, she knows what to do. Tamika, thanks for being with us on Docs in a Pod as both guest and co-host.


DR. TAMIKA PERRY
Love it. Absolutely love it. And one of my favorite topics today. Medications that not only affect your metabolic process, but also your image, your weight.


RON AARON
We see ads 24/7 for some of these drugs. Originally intended for diabetes treatment but have now slipped over to weight loss treatment. We're talking about the so-called GLP-1 agonist. Drugs like ozempic and Wegovy. You name it, right?


DR. TAMIKA PERRY
Right. Exactly. If we say people know these buzz terms like GLP, GLP-1 agonist, I mean, what does that really mean though? It literally stands for glucagon-like peptide, and agonist means similar to. As opposed to antagonist means opposite. So, these are glucagon-like peptides that stimulate these receptors in your body. And your body already makes a substance called glucagon, but we give you a large dose of it and this is what happens. It increases a substance called amylin in your body. It does a couple of things. It tells the beta cells, and the beta cells are the particular cells in your pancreas that produce insulin, hey, don't quit working. Keep working on us. Because one of the mechanisms in type two diabetes are those beta cells kind of die off, and they don't make as much insulin as they did before. And that insulin isn't recognized as appropriately as it used to be by your cells. So, it tells us that glucagon-like peptides beef up those beta cells to work better. Secondly, that amylin slows down the motility regarding your gut. Your gut being from your mouth to your derriere, right? So, a few minutes ago, Ron caught me eating a breakfast sandwich. When I eat that breakfast sandwich, it goes down into my food pipe, into my stomach and my stomach breaks it down, and then it goes out. And that's how it goes. What slows down that process?


RON AARON
By slowing it down, you feel full for a longer period of time?


DR. TAMIKA PERRY
Right. You feel fuller longer, and when it's slowed down, the peptides that go to your brain that says, hey Ron, you're hungry, those are turned off. So, not only are you so full, you don't have the desire to eat. So, now your extraneous fuel source, i.e. that tire around your belly, is used for energy and you lose weight.


RON AARON
Well, when you talk about a tire around your belly, I see all kinds of articles that talk about that's the worst fat of all. Belly fat.


DR. TAMIKA PERRY
It is.


RON AARON
Why?


DR. TAMIKA PERRY
It's part of something called metabolic syndrome. It's a sign that you have insulin resistance, glucose intolerance, which means that if you don't already have what my grandma calls a sugar, it's coming. And it's a sign that you're at an increased risk for stroke and heart attack. So, when we eat a food like a carbohydrate, what happens is that our body processes it, breaks it down into basic substances. Part of it's turned into an energy source by the cell nucleus called adenosine triphosphate, ATP. And that's kind of like the gasoline that our bodies use so we can run. The rest of it is a fat, waxy substance called glucagon, right around our liver and midsection for later usage. And when I said that, I put quotes in air because most of us don't use it later.


RON AARON
Because we keep eating.


DR. TAMIKA PERRY
Because we keep eating. So, a marathon runner who has like a big carb load before he runs, but who eats pasta and then runs 26 miles? I don't. I eat pasta, watch a movie and go to sleep. So, you get this continual buildup around this area and it leads to other things like fatty liver in the cascade and it just gets worse and worse and worse.


RON AARON
Those who are asking their doctors to prescribe ozempic like drugs, GLP-1 drugs, because they want to lose weight, the drugs appear to be very effective.


DR. TAMIKA PERRY
They are effective in losing weight, and some of the newer agents called GLP and GIP, and I say newer agents. There's only one of them, Tirzepatide. It's the same thing as Mounjaro. It actually has what's called GIP and GLP receptors. Big words for it does this job even better. Some of the weight loss long-term is somewhat comparable to surgery. Now surgery, you’re going to get a big bang up front of weight loss, and then you may gain a little bit, but then you kind of plateau out. Well, if you look at that plateau out on both drugs, the two lines in the graph are coming real close together. So, they are very, very effective, but not every drug is for every person.


RON AARON
Let's follow that up in a moment. I want to let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. I'm Ron Aaron along with our co-host and guest today, Dr. Tamika Perry. We're talking about some of the newer drugs that are on the market and more are coming. The GLP-1 and related drugs are often used for weight loss as well as the treatment of diabetes. Dr. Perry, it’s interesting to me that there are many drugs that turn out to have a secondary usage that becomes very popular. I'm thinking of Rogaine, a drug now used for hair growth that began as a drug to treat kidney problems.


DR. TAMIKA PERRY
Yeah, blood pressure in particular. Minoxidil is the generic name for it. But yeah, it's very effective for hair loss, particularly in inorganic alopecia. The same thing is happening with the GLP-1s and the GLP-1s and the GIP/GLP agonists. The secondary effect is a decrease in cardiovascular events.


RON AARON
Which means you don't die of a heart attack as quickly?


DR. TAMIKA PERRY
You're less likely to get that event, which is an excellent thing. It’s an excellent side effect to have.


RON AARON
Exactly.


DR. TAMIKA PERRY
Because you have to think about how these drugs were initially used to treat diabetes. They make that pancreas work better to make you put out more of your own insulin more efficiently, you lose weight, your sugar gets better. What is one of the biggest risk factors? One of the biggest sequels from diabetes is heart disease. A heart attack.


RON AARON
Wow.


DR. TAMIKA PERRY
Not only is this medicine making my sugar better, causing me to lose weight. On the back end is also helping me to not have a stroke or heart attack or cardiovascular.


RON AARON
Can everybody take those drugs?


DR. TAMIKA PERRY
That's the million-dollar question. No, everyone cannot take them. So, let's just start with the side effects for the general population. The side effects of the drugs can be constipation and or diarrhea. Remember, it slows down the motility of your gut and your gut being from your mouth to your bottom. So, if it's slowing down that gut and that large intestines, then that stool just sits there, water will be reabsorbed into the system, it becomes compacted and hard. Then if that gut gets a little bit angry or perturbed because the stool is sitting there, the liquid stool behind it will come out and then you can have constipation and or diarrhea. More commonly constipation. So, I always recommend that if patients are on this class of medicine, high fiber foods, lots of water, over the counter gentle agents like Colace if you really have an issue. If it's too bad, we just stop. But you have to look at it once again the risk benefit ratio. What are the benefits versus the side effects of the medicine?


RON AARON
Now, when you stop those medications, what the research I've seen shows is people gain weight.


DR. TAMIKA PERRY
A lot of weight loss is about not only metabolism genetics but habit. So, if you've done something to purposely make you feel full and make you basically forget about eating because you've turned off those peptides, during that period of time when you're on the medicine, we need to learn how to develop good habits. Eating what is good, eating the appropriate amounts, etc. But it is also important to know that Liraglutide in particular, and there may be others now, but I know Liraglutide in particular has been approved by the FDA for the chronicity of obesity.


RON AARON
What does that mean?


DR. TAMIKA PERRY
Obesity is a chronic disease just like hypertension or hyperlipidemia. At some point in our lives, if our blood pressure gets better with medicine, diet, exercise, we may come down on the medicine, but we may not come off of it because our body ages on the inside just like it ages on the outside. I dye my hair on a regular basis. I have these fancy progressive lenses on because my body is aging. So, the FDA has said we recognize obesity as a chronic disease, and some of these medicines, if appropriate for you, can be taken on a regular basis to help maintain your weight. Now go back to the question you asked about is it appropriate for everybody? No. If you have a history of something called a thyroid medullary carcinoma, a very particular type of thyroid cancer, it's not for you. If you have something called multiple endocrine neoplasia one in your family, which is an endocrine disorder, which is very distinct. You would know what you have, and you would know the people look different, they behave differently metabolically. It's not something like, hey, do I have this? You would know if you have it, but it's not for you. Multiple repeated episodes of pancreatitis. It's not for you. If you get pancreatitis on the drug, it's not for you.


RON AARON
Pancreatitis can be life threatening.


DR. TAMIKA PERRY
Very much so. So, the people who are at the greatest risk for pancreatitis are males, smokers, most certainly females can get it, most certainly nonsmokers can get it. These are the greatest risks. Heavy drinkers, uncontrolled blood sugar. So, those patients who fit that category, I'm always hesitant to give them the medicine or I say listen, this is what can definitely happen, so let's you and I make a decision together.


RON AARON
You are a diplomat of the American Board of Obesity Medicine. Talk to me a bit about changing on a permanent basis the way we eat, and whether these drugs can be a gateway to do that. I'm Ron Aaron, along with Dr. Tamika Perry, you're listening to the award winning Docs in a Pod.


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RON AARON
We are so pleased you are sticking with us right here on the award winning Docs in a Pod. I'm Ron Aaron along with our co-host and guest today, Dr. Tamika Perry. The award winning Docs in a Pod podcast is available wherever you get your podcasts. We also are on the radio in several markets in Texas and Florida as well. Dr. Perry, as a diplomat of the American Board of Obesity, you have a real in-depth understanding of what makes us fat and ways in which we can deal with it. You mentioned earlier that you have to change the way you eat, your interaction with food and these GLP-1 drugs like Ozempic can help you do that. How do you stay with it?


DR. TAMIKA PERRY
One, Ron, I prefer the term pleasantly plump.


RON AARON
Versus fat?


DR. TAMIKA PERRY
Yes. It just sounds so aggressive. I prefer pleasantly plump. So, nonetheless, I digress. You need to take a structured approach, and really sit down with a clinician and the clinician should be able to advise you of a few things. One, they're going to advise you of what your total daily energy expenditure is. That's the amount of calories that you burn every day for you to be Ron at his current weight. That's the amount of calories that you need for you to blink, to talk back and forth, for you to sleep, for you to have a conversation with Gina, for your food digest. So, that's called your TDEE. For example, if Ron burns 2,000 calories every day for Ron to be Ron and his current weight, but Ron really eats 2,500 calories a day, that extra 500 calories goes in the reserve tank. The reserve tank, it's anywhere but particularly in your midsection. So, if you eat an extra 500 calories on Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, and Sunday, you've consumed an extra 3,500 calories that week. Guess how many calories are in a pound? 3,500. Anybody listening out there, you can just Google TDEE calculator. Look at how many calories your body consumes at its current state. Then what you should do is take about, I don't know, anywhere from a fourth or a third of that away. So, in your case, if you burnt 2,000 calories a day, I would say, Ron, we're going to put you on a 1,500 or 1,600 calorie diet and we will break down your macronutrients. How much is carbs, fats, proteins? And by that equation alone you're losing 500 calories a day just from diet. Now, if we throw in exercise, we can calculate how much you're going to lose from the exercise because weight loss is either you put in less or put out more or a combination of the two. So, what the medicine does to help us stay on that diet is that we don't have that urge to eat like we used to, and in some individuals it decreases our cravings for certain types of food. My mom said she would not mind me telling you this, and I love my mother to death, but I put her in the class of medicine for diabetes. When I put her in the class, she's only 5’3” or 5’4”, a little over 200 pounds, and I put her on the medicine, she was just devastated by that one, I gave her a diagnosis of diabetes, two, that she had to do a shot because she was associating every shot with insulin. So, I went through it, explained that everything in a shot is not insulin, mom, and I promise this is going to have a great outcome for you. I put her on that with the combination of metformin and over a course of seven or eight months, she went from 222 to 156.


RON AARON
So, 75 pounds.


DR. TAMIKA PERRY
Yes. That was in 2012. 13 years later, we've maintained that. Now, she's been on the medicine consistently, but at a much lower dose. It's easier for her to exercise and she will on occasion ask me inappropriate things like, can she wear my jeans? No, grandma. They are inappropriate for me, they're definitely inappropriate for you, grandma.


RON AARON
That’s funny.


DR. TAMIKA PERRY
But she looks fabulous in her health. Her A1-C will not get any higher than 5.7.


RON AARON
Now, for those who don't know, A1-C measures your risk for diabetes.


DR. TAMIKA PERRY
It measures your degree of diabetes if you have it. How well it's controlled or not controlled. So, for a diabetic to have a A1-C of 5.7 is excellent.


RON AARON
What should it be for normal?


DR. TAMIKA PERRY
If you're not diabetic, A1-C should be between 4 and 5.6. 5.7 to 6.4 is prediabetes and 6.5 on two or more occasions is diabetes. The A1-C is a three-month average. For example, that 6.5 says your three month average is 140. So, when we get into the double digits of A1-C, we're talking neuropathy, amputation and heart attack. We don't want to touch that like the plague. We don't even want to get there. So, we want to emphasize lifestyle changes, diet, exercise and medication if applicable.


RON AARON
Back to those medications. At the moment, most insurance doesn't pay for the Ozempic type medications, and they are very expensive.


DR. TAMIKA PERRY
They're very pricey. Sometimes we have to jump through their hoops to prove that it is for diabetes. They won't pay for it for weight management. Zep Bound, which is the same as Tirzepatide and the same as Mounjaro is also indicated for obstructive sleep apnea because the mainstay of treatment for sleep apnea besides a CPAP is weight loss. So, that's another indication for it. But we can also get these medicines compounded, which is a complex situation. The government says, yes, we can compound those medicines because there's a shortage and they're a little bit pricey, but you're a clinician has to have a relationship with a compounding pharmacy that they really trust and that they're really compounding that substance and not something else.


RON AARON
So, a pharmacy that compounds is making that medication comparable to what the manufacturer would be making.


DR. TAMIKA PERRY
Yes. Think about it like this. Do I want Coca-Cola or Walmart brand cola? They're both cola.


RON AARON
Yeah, but they don't taste the same.


DR. TAMIKA PERRY
Yeah, there's a little difference in the taste, but they're both cola. They're both carbonated water with caramel and syrup, and they both can give you diabetes, right?


RON AARON
Yeah. There you are.


DR. TAMIKA PERRY
Don’t sue me, Coca-Cola people or Walmart cola people, but on the other end of the spectrum, Liraglutide is the same as Victosis. If you get Liraglutide compounded at a compounding pharmacy, you're in essence going to get the same effect, except the cost is much lower. We're talking a difference of $200 to $300 a month versus $1,000 a month.


RON AARON
Which is real money.


DR. TAMIKA PERRY
Which is real money. These are things to talk about with your clinician to say if this class of medicine is indicated for me, am I appropriate for a compounding agent and do we know the integrity of that compounded pharmacy.


RON AARON
I see ads all the time, especially on the internet. We can get you that GLP-1 that you've been paying a ton of money for dirt cheap. How do you know if it's the real stuff?


DR. TAMIKA PERRY
You don't. Usually it's a clinician or a clinician group who has a relationship with a compounding pharmacy, and that clinician group will counsel you and give you medical advice. Is it appropriate for you? Is it not appropriate for you? Then it's ordered through the compounded pharmacy and sent to your house. You know if your blood work gets better, if your A1C goes down and your cholesterol goes down because you lost weight, well, it's probably working, but we don't. That's the only downside to it. We don't.


RON AARON
When patients come to you, Dr. Perry, one of your patients who may be pleasantly plump, who's tired of being pleasantly plump and they say, put me on that Ozempic now.


DR. TAMIKA PERRY
First of all, I say watch your tone. I doubt I'll say that.


RON AARON
You probably hear that, though, right?


DR. TAMIKA PERRY
Oh, I hear it a lot. And I say watch your tone in my head, but I say, let's discuss it. Let's discuss the pros and cons of this, and if it's indicated for you. Let's discuss your alternative if it's not indicated for you. That's exactly how that conversation starts. When I go to my car dealership and I say, I think you should use this type of oil, I let the guy tell me, am I right or not? Because that's an area of expertise, right?


RON AARON
Right.


DR. TAMIKA PERRY
That's what I'm paying him for because he went to school for that. Me and my patients have a very candid approach. So, if I tell them it's not in your best interest, then they genuinely say, thank you, Dr. Perry. I appreciate that. If it is in your best interest, let's see what we can do to make this medicine obtainable for you.


RON AARON
Then are you on that for life?


DR. TAMIKA PERRY
Not necessarily. Being a diplomat of the American Board of Obesity Medicine is not just giving medicines. It's like, what are we doing in your lifestyle to change it? We recommend cardiovascular exercise 150 minutes a week, intertwined with weight training. If you can't start off like that, working your way up to that. We work our way up to that. We talk about what macronutrients, and macronutrients are carbs, fats and proteins. What proportion should you eat? It's a whole totality that you should look at when you're saying this is my weight management journey. Once we come up, what is our plan to come off of the medicines? And once we come off of them, we always follow to see how you're doing. Do we need to revisit it or do we not need to revisit it? Once again, Ron, some of these medicines are indicated for chronic use.


RON AARON
Often when people do come off of those medications, they start putting the weight back on as we discussed earlier. Can you go back on the medicine or can you break that cycle now of weight gain with lifestyle changes?


DR. TAMIKA PERRY
A combination of both. I'll look at, well, what happened? If you go back to that number, your total daily energy expenditure, every time you lose a significant amount of weight, 5% to 8% of your body weight, that number changes. Remember, that's based on what you weigh right now. So, we may have to reset your caloric goals based on your new TDEE. We may have to increase your exercise output. We may have to restart a low dose or restart the medication, but we can get you back on track.


RON AARON
For those who are wondering, before we run out of time here, Dr. Perry, what's the best way to bring up that conversation with your PCP?


DR. TAMIKA PERRY
Doc, I'm having some issues with my weight. If your BMI is high, your doctor should have already asked you that question. What would you like to do about your weight? How should we partner to make sure you are the healthiest you?


RON AARON
BMI is body mass index.


DR. TAMIKA PERRY
That is correct.


RON AARON
What does it show you?


DR. TAMIKA PERRY
It shows me, based on my height, weight and sex, where do I fall on this bell curve per se? Where am I at to see if I'm healthy, overweight, obese, or morbidly obese?


RON AARON
This has been great. For folks who want to learn more, Dr. Perry, what do you recommend?


DR. TAMIKA PERRY
You can go to the American Board of Obesity website, you can go to the Centers for Disease Control's website, and you can go to FamilyDoctor.org. These are good resources for you. Most certainly the best place to start is a conversation with your primary care physician.


RON AARON
Perfecto. Dr. Tamika Perry, thank you. Fascinating stuff. GLP-1 agonists and more. We appreciate you sharing that with us today on the award winning Docs in a Pod.


OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.


DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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