DR SOWA: EPISODE LINK

THE OZEMPIC REVOLUTION: BOOK LINK

TRANSCRIPT:

Colleen: – Welcome back to “How Flashes and Cool Topics.” Today we are talking to Dr.

Alexandra Sowa. Welcome to the show.

Dr. Sowa- Thank you so much for having me.

Colleen: – Well, thanks for joining us. I think this conversation is really

needed because your book,”The Ozempic Revolution,” breaks down and

answers a lot of the questions that women have.

We are being inundated. every other commercial is take a GLP one,

semiglutide, Ozempic, we’ll go, women don’t need, don’t know what they are, who to

trust, should they go on them? There’s so many questions. So I thought we could

start with the basics. What exactly is a GLP one?

And how did it go from being something for diabetic patients to something for weight

loss.

Dr. Sowa: Yeah. Okay. So this is a big topic. I’ll try to make it as easy to

understand as possible.

Colleen:

Dr. Sowa: Thank you. Yeah. GLP one is a glucagon like peptide.

And that is a naturally occurring hormone that happens in the body. We have native

GLP-1. It’s secreted in our gut. In the book, I go through the biology of weight

gain and metabolic health, and I talk about the key hormonal players, and GLP -1 is

one of them. Now, what happens over time is that our body doesn’t respond to the

native hormones, and as we put on more and more weight, when people say, “I’m doing

everything I can,” and the weight just keeps coming on, it’s because our hormones

become dysregulated, and GLP -1 plays into that. And we found,

through science and investigation, a hormone that we could give ourselves that is a

copy of native GLP -1, but is thousands of times more effective than what our body

makes and lasts in the terms of weeks rather than seconds, and our body really

responds to it. So that is what semaglutide or Ozempic or Wegovy,

it’s an artificial analog, a copy of what we naturally make in our body.

So GLP-1s, why they have gotten so much attention is because they’re incredibly

powerful. We have GLP-1 receptors all over our body. It’s not just something that

affects weight. We actually have GLP-1 receptors in our brain, in our heart, in our

kidneys. And this is one of the reasons that we see added benefits beyond what are

the two known benefits, which are management of type two diabetes and weight

management, because we have these receptors everywhere. But the three superpowers, as

I call them, are they affect our brain, our stomach and our GI tract,

and at the level of our pancreas, they make our blood sugar more controlled. And

these three things together make it so that we have very big and revolutionary

outcomes in terms of this drug’s ability to control both blood sugar and also in

terms of weight loss.

Bridgett: – And you know, your book also addresses the fact that in the

past, you go to your doctor, so many people have had such a negative experience

with their weight and they truly have tried things.

Dr. Sowa: – Yes.

Bridgett: – Can When you talk about

how this plays such an important factor and how you address it in the book,

that people that are considered obese or larger, they really have tried.

They’re not cheating. Can you address that?

Dr. Sowa:  I think, unfortunately, in traditional

medicine, we have not been encouraged to trust our patients. I talk in the book,

I open and close the book with the story of my grandmothers. My grandmothers both

struggled with their weight and their whole lives they tried to lose weight and I

was constantly surrounded by talk of the new diet, recommitting to Weight Watchers,

going to the gym, having a Fitbit on, what else could they do and it was always a

constantly losing battle. But I knew that they were trying and I knew that they

were very very bright and gifted women and it wasn’t a willpower thing. And so From

a young age, I realized this was biology and in my case, genetics. And I was

handed these genetics and I had to figure out, “Okay, what is going to lead me

down the healthiest path?” I could already see before I even found this specialty

that it was not going to be constant dieting. That could not be it because it

wasn’t working. And I know so many women who are listening to this are like, “Yeah,

that was me.” And my doctor just said, eat less, exercise more, or good luck. And

it’s biology. I mean, a lot of why we carry weight is both genetics,

but what’s happened since about 1980 is that the whole country has become heavier

and heavier and heavier, and it has to do with the epigenetic changes that we’re

experiencing on a population level because of the way that our food is now made and

the toxins in the air and the chemicals that we just consume by a product of our

fast world. And there are so many factors that are going into why it is hard to

lose weight beyond what we are or are not doing. And it’s just,

I start the book off by saying why your doctor has failed you,

right? That’s chapter one. And I apologize to everyone who’s ever heard from their

doctor. “Just there’s no way you could be eating that little. “ “I don’t believe that

you’re going to SoulCycle five times a week. “ “How could that be? Or trying this or

trying that, you have to try harder. “ We just now know. Science now is starting to

realize that Obesity is a disease, waking is multifactorial,

and it’s not just about willpower, it’s biology. So for anyone who’s heard that

before, please keep listening ’cause we’ll get into it when you can do about it.

Colleen: – And you talk about that in the book that it’s neural hormonal dysregulation and

genetics. That genetics plays such a big part. And that,

you know, women have been, and men too, we just hear all the time, well, if you

just eat less and exercise, but your genetics are your genetics.

Dr Sowa:  – Right.

And your genetics set you up too, to be either more susceptible to what’s around us

or not. And so it’s not, it doesn’t all just come down to a gene level, because

truthfully, For 1980, we had about 15 % of the population who would meet criteria

for obesity. And that was genetics. And that was probably my family’s story, right,

just genetics. But then what’s happened is some genes have kind of set us up to be

more susceptible to this hormonal dysregulation that happens.

So we talk about, in the book, I lay out all of these hormones and why weight

gain is so complicated. We talk about how GLP1 is becomes dysregulated but so does

insulin. You probably have heard the term insulin resistance. That’s something that

really rears its head in peri and menopause and it becomes very hard for women to

lose weight. We have something called leptin resistance and it’s our genetics that

set us up to be more adaptable to these things. And then,

so it’s beyond just the obesity genetics, it becomes how well does your body built,

so live in the modern world where everything around us is fake. Right.

Bridgett: Yeah. And

you also address what happens in society, how society is looking at so many things

involved with this. Society looks at women or men, both people that are overweight

or obese and they connect it to their self -worth and value.

And that reflects back on people. And then now they have these GLP ones that are

going to help them. And then they’re being insulted for taking the GLP ones. So

there’s so many factors there that are involved. Can you address who would qualify

for a GLP -1, what the BMI is, you know, there’s so much involved with that.

And then other issues that also make people qualify for GLP -1s.

Dr. Sowa:  – You’re so right

about that. It’s like such a double -edged sword. Now you’re not doing well enough.

Oh, now you’re taking the easy way out, right? – Yes. – I see that a lot on

social. Okay, so then these medications have made it so that we actually for the

first time have an effective treatment for this disease that helps people realize

that, oh, if I actually can treat the hormone, then look at that. I have the

ability to control what I’m eating. I am motivated to do the habits and go to the

gym and do all of these things that I was doing before, but weren’t working or

they weren’t working. So I got frustrated and I stopped. So these medications have

actually been around since 2005, if you can believe it. But we were first using

them for the management of type 2 diabetes and through clinical trials, we realized

that contrary to most type 2 diabetes treatment, which previously would actually lead

to weight gain in people, these medications were not only really good at treating

the blood sugar, but they were helping people lose weight. And since 2005, there

have been new iterations of the drugs that have been released that have become

closer and closer to that native GLP -1 that we make and more effective for that

reason. Now what makes these drugs so different than what we had said was like that

native one that they make is that they last for a very long time. And so the

newer versions of this drug are weekly injectables. And since these, this version has

come out first Ozempic and then Wegovy for weight management. And now we have a

newer class of drugs even that combines GLP1 with gLP hormones, and that’s called

Tirzepatide. This is where we started to hear a lot about these drugs because the

weight loss potential jumped from like 8%, maybe 10%,

now to 15%, upwards of 20 % total body weight loss. And so people were like,

okay, now this is really something to talk about. So Now, it is becoming more and

more part of medical management, and so that’s great because we’re kind of blowing

open the doors of saying that we shouldn’t be scared to manage the disease of

obesity and get ahead of diseases. But with that is what you were talking about at

the start, which is like, oh, now we’re inundated by all these ads, like, where do

I get this med from? Is it right for me? And this is now we’re kind of getting

into a little bit of a murky territory. So I appreciate you asking me, like, what

are the indications and who’s right for it? Okay. So FDA says that on the weight

management side, we use BMI criteria. And the BMI criteria is a BMI of 27 or

greater, which truthfully, people think that people should be on these drugs when

they are very, very overweight, but BMI of 27, you honestly wouldn’t like pick that

person out of a crowd at all. And with that, you should also have something called

a comorbidity. So some other thing, disease that would be positively affected by

weight loss. So high blood pressure, high cholesterol, insulin resistance, joint pain,

back pain, sleep apnea. Usually I can find one of those things because with waking

comes these other issues and that’s why we care about weight. It’s not just about

being thin, it’s about preventing other disease or you have a BMI greater than 30.

What’s really interesting is that these definitions are shifting. So while these kind

of still sit with the FDA, some of these drugs are removing their BMI criteria and

they’re getting FDA approval for other diseases. So if you have known coronary artery

disease or peripheral vascular disease and you have some excess weight, okay,

now you’re going to get these covered. Maybe you don’t even need to have as high

of a weight or sleep apnea treatment is getting approval. So we’re kind of expanding

who is appropriate for these. It’s very fast evolving kind of changing definition and

we are starting to look instead of BMI because that’s not like a really good marker

of health that just takes into your account, your height and your weight. We’re

looking at body fat composition which to me is a much more important driver of

metabolic health than the number on the scale and it’s really what women should be

looking at because sometimes people are so obsessed. We’ve been trained to think

about being thin on the scale but really you want to be strong on the scale. You

want to be strong on the scale and that’s more important than thin. So if you have

higher body fat percentages that kind of fall into the obesity criteria and you have

some health issues but your BMI is lower then you might qualify for these drugs

too. And I think for a lot of women in our demographic, especially, we are more

concerned with being strong, having muscle mass. Because as we get older, we want to

protect our bones. And it’s important to be strong and healthy.

Colleen: I like in your book

that you talk about what it feels like to be on the drug, like what you can

expect, side effects and things like that. But before we get to that actual

experience, A lot of people are concerned because, you know, I knew someone who a

year and a half ago was spending like $800 a month for the medication. I was like,

are you insane? You know, because they weren’t that heavy. They weren’t, but it

just, it was the new thing.

Dr. Sowa:  – Yeah.

Colleen:  – How can people go about confirming that?

Number one, they’re getting the right one for them. And two, that it can be covered

by insurance.

Dr. Sowa: – That’s a great question. First, on the cost,

we need to be doing a better job in this country from a government level through

kind of how drugs are distributed, through pharmaceutical responsibility. We need to

be bringing down the cost of these medications. In Europe, the same drugs that are

$1 ,200 here are $200 a month there. So there’s something wrong, right?

To that point, Some people see this actually as an investment in their health and

what my patients have found, if they even have to pay out of pocket, they are

spending a heck of a lot less money eating out, uber -eat -ing, snacking,

drinking. And so when they actually look at the balance,

they’re like, okay, this is something that I’m investing in because I see it as

preventive, but most people don’t aren’t afforded that luxury.

In the book I lay out the exact script that my office uses on how to talk to

your insurance company because my goodness is it complicated and sometimes you get

the wrong answer but you really should be your own advocate with your insurance

company and you call and you ask do I have coverage if it’s for weight management

it’s not just GLP1 coverage, do I have coverage of Wegovy or Zepbound for the

treatment of obesity? And if so, what are the qualifications and what is my out of

network cost for this? Or, you know, do I have to meet a deductible? Insurance is

so tough. I have four kids and I’m constantly like, I get my all the like the,

the papers upon papers from insurance. And I’m like, What is going on here? Why is

this so complicated if I can’t figure out what any of this means? I don’t know how

patients do it, but if you call your insurance, you can generally understand what

the cost is. I will say with Medicare and Medicaid, it’s becoming a very interesting

time. So previously, in the early 90s,

Medicare passed a bill that said we will never cover weight loss drugs.

And this has been something that my society’s, my obesity medicine society has been

fighting against for years and years. Well, we got somewhere this year. WeGovy was

the first weight loss drug to be approved by Medicare. And it’s a little bit

tricky. It’s not just for obesity. It’s for obesity with preexisting coronary artery

disease. And now it’s being used for stroke prevention that could cause death and

from heart disease. We are also seeing sleep apnea being covered by Medicare and

Medicaid and currently right now in Congress is a proposed bill that was pushed

through by Biden and has a really good shot of making its way where all anti

-obesity medications would be covered by Medicare and Medicaid. This would be a huge

turning point for us. So if this is something that sounds good to you, call your

representatives and just voice your support that this is something that you would

like because how, like, these medications are such an amazing revolution and

advancement in medicine, but if only a small fraction of people can afford them,

what does that mean for us. And, you know, not to mention what it’s going to do

if you are able with all the things that obesity leads to.

Bridgett: Exactly. Yes.

Yeah, just the metabolic syndrome, right.

Dr. Sowa: Metabolic syndrome, 16 types of cancers,

heart disease, heart attack, stroke, dementia.

potential use of GLP ones for dementia prevention and treatment, which is,

which is insane. Now, people are kind of like jumping ahead with those studies

saying, oh, everyone should be on it, but no, but we’re using it for actual

treatment progression. And it really does appear to be very promising. So yes,

it’s kind of like, hey, if we could get our meta, we know that the root of, the

root cause of the majority of chronic disease in this country is metabolic

dysfunction. Just like you said, I love that you referenced metabolic syndrome, right?

When our blood sugar is out of control, or even just slightly elevated truthfully,

not out of control, but just not normal. When our triglycerides are not normal, when

our belly fat is higher than we want it to be, when our ratio between our hips

and our waist is off, that sets us up for a lot of chronic disease.

And so if we, ideally, we get to avoid it entirely without treatment of medication,

but that’s not how it’s appearing for us as a country and as a world right now.

So if we have a treatment for it, the potential of decreased spending, of just

better years of our life, which we all deserve, the potential is extraordinary.

It’s amazing.

Colleen: So can we talk about what it’s like to be on one of these medications, you know, side effects and, you

know, we hear, I’ve heard several people who have gone on it talk about the food

noise is gone. So can you talk a little bit about what you can expect when you go

on it?

Dr. Sowa: Yeah. So it’s a little different from everybody and I always tell people

that your journey is unique. So if you don’t feel a decreased food noise

immediately, it’s not that it’s not working for you. It’s just how you’re responding.

Or if the second you take it, you’re like, “I feel no appetite.” That’s just normal

for you and it will get better. Your appetite will come back. And I talk people

through all of that in the book, The Ozempic Revolution. But the side effects

component, I think, is the thing that’s gotten the most amount of negative attention

and necessarily so. So when we talked about how this drug works, it works at the

level of your stomach and it decreases your stomach and GI tract emptying time.

So food sits in your stomach longer, which actually in turn signals those hormones

that have been a little bit dysfunctional to say, “I’m full. I’m full. I’m full.

Please don’t tell me to eat again.” And it works. And part of that process is

decreasing this food noise where people are constantly thinking about their next meal

and their snack and just constantly thinking about food and it just writes it. And

that impact on the stomach where the stomach slows, well, so does your digestion get

a little bit altered. So we have those things we hear about constipation or some

diarrhea or some nausea. It’s impact on blood sugar can sometimes leave us feeling a

little fatigued. But if you know that these side effects are coming, you can get

ahead of them. I have a whole protocol. I have a shopping list in the book of the

things that I want people to get. I got so good at treating people in my practice

where in the average population up to two -thirds of people were stopping these meds

because of side effects, but nobody was stopping them in my practice. And I thought,

well, what am I doing so differently? And it’s because I put people on this this

regimen of about, I don’t know, like 10 to even like 13 supplements, everything from

fiber, electrolytes, magnesium, probiotics, things like this. And I actually created a

whole supplement line out of this because I felt like there was nothing out on the

market for people. So if people are interested in kind of helping get ahead of

their side effects, I have a product line called So Well. We have a GLP OneSport

system and we’re getting a retail all over the country. I don’t know if we’re in

Tennessee yet. What do you guys have there? What’s your grocery store there?

Bridgett & Colleen: – Kroger’s. – Kroger’s. – Kroger’s and Publix<

Dr. Sowa:  in Kroger. – So later this year, you

should see us there too, because people need additional products to help minimize

what people are calling side effects, but it’s really just byproducts of how these

drugs are working. You’re not drinking as much, you’re not eating as much, You’re

feeling a little dehydrated, you’re a little volume depleted. It’s hard to get in

your fiber, so you need to supplement at the beginning. You know, you don’t have

big appetite, so we wanna make sure that you’re supplementing with protein and things

like that. So it’s just knowing what is kind of ahead of you. Now, in very,

very, very rare cases, there are some bigger things, side effects that will happen.

Generally, they’re related to a preexisting disease. So we’ll often hear about this

term paralyzed stomach. It means gastroparesis. That’s not a byproduct of this

medication, but likely have already nerve damage that’s happened

through elevated blood sugars. And then something about being on this drug and the

management just didn’t mix. I’ve never seen it, but that’s the one thing you kind

of hear about out in the world. Right. And there’s people that shouldn’t take it.

Bridgett: You address that in the book, like pancreatitis, pancreatitis, different things.

Can you address some of the things that…

Dr. Sowa:  Sure. So one of those other side effects

that I want people to know about is gallstones. So when you lose a lot of weight,

you can form gallstones. And some people have them already and ignore the pain of

them or know that they’re there. And sometimes that needs to be addressed before

starting this medication, the medication doesn’t cause gallstones, but it caused a lot

of weight loss. So if you already had gallstones, they might grow, or if you’re

having some pain, I want people to know what it is because we need to address it.

And if you have them, it’s not a contraindication to going on the medication, we

just need to kind of make sure they’re watching out for any gallstone pain.

Pancreatitis is generally caused by gallstone issues. So if a gallstone gets stuck in

the biliary tree, it can cause inflammation that leads up to the pancreas. Again,

it’s not the medication that causes it, it’s just a byproduct of how much weight

you lose. If you have a history of unclear pancreatitis, we might have to be a

little careful with you, but usually there’s a reason for why it happened. And if

we can identify the reason, then you can still use this med. The only people that

we really do avoid this medication in for now is people with a family history of a

very specific type of endocrine tumor called MEN type 2 endocrine tumor or someone

with a history of Medullary Thyroid Cancer. We have not actually seen an increased

risk of any cancer activity in humans but there was a theoretical risk in animal

models at much higher doses and so for now we’re careful about that but those

cancers are incredibly rare. And so, generally,

the benefit of these medications far outweighs any small risk.

Colleen: You also talk about

in the book, because we do hear a lot about protein and how you need to have a

higher intake of protein. And in your book, you say you shouldn’t wait more than

six months to start strength training as well. So, you know, I think some people

have the image of I’m just going to take this drug and I don’t have to do

anything else, but there are lifestyle changes you have to consider as well.

Dr. Sowa: 100%. And that’s why I wrote this book. It’s not just the science of the drugs and

obesity. It’s like, what do you need to do to be successful? Because there’s a

misconception. And I think it’s a lot of times from naysayers who are like, you’re

taking the easy way out. It’s a magic wand. It’s not a magic wand. If you want to

achieve health, you really have to do the work. So we move through three foundations

in the book. We go through habit foundations, food foundations, which protein is king

when you’re on this medication, and then the mental thought foundations. And all of

those you need to work on so that you can do the important work, like get to the

gym and strength train. And that is often the biggest hurdle that people are like,

but I’m not someone who likes to work out. And I’m like, you don’t have to like

it, but this is now a gift that you’ve been given with this medication and you

have to stay strong and you’re going to look at it as something you need to do

for your health. And if you’re taking this drug for your health, you’re also going

to work out for your health. And what I think many people have not enjoyed about

working out is that they were on a treadmill for 60 minutes in a class sweating

sweating, never seeing results and they’re like this is just not for me and

I want people instead to be focused on muscle fatigue so whether that’s heavy heavy

weights or just repetitions that we are building muscle it’s really really important

because these drugs they cause you to lose a lot of weight and although there are

some drugs in development that may target fat loss alone or more so than muscle

generally when you lose weight you lose weight both fat and muscle and we need to

do our best to both eat for muscle building and loss of prevention of loss and

then also build up those muscles with strength training otherwise you end up in a

really tricky situation especially as we age, where you end up dealing with something

called sarcopenic, sarcopenic obesity. And that is where you might be thinner on the

scale, but all of a sudden we just have a lot more fat mass and that doesn’t help

us live a better life.

Bridgett – And the thing about these drugs is,

another great thing about them is the long lasting effects of the drugs. That the

people, I’m I’m a yo -yoer. I am one of those people that,  I’m my first diet,

I was 15. I joined Weight Watchers when I was 15. And it’s a here and there and

here and there. And it’s kind of been that way since I was 15. And this is

something that lasts, but you have to take it forever. So can you address that?

Dr. Sowa: – Right, I think a lot of people think, do I take it for a year and then I’m

off. So that’s the tricky part, especially when it comes to cost, and it’s something

that I think a lot of people aren’t aware of when they start this drug. And I

care so much about stopping yo -yo dieting that I literally put it in the title,

the subtitle of this book, that this drug is a way to end yo -yo dieting forever.

Because yo -yo dieting makes it harder to lose weight. You know this. It makes it

harder to lose weight every single time, and it causes stress on the body. And this

medication, once you lose the weight, although it might have a maximum weight loss

and you might want to lose more, but this drug allows you to get to a place you

have metabolic health, you will need to continue on the drug to continue the

benefits. Maybe about five, and if you can really push it in some trials,

10 % of people will be able to come off. They tend to be a very specific

demographic. Maybe one, they put on their weight very quickly and for a specific

reason. Another medication they were on, something dramatic happened in their life or

it had to do with treatment and /or pregnancy. And those same people are really able

to focus on strength training and food. But I’ll caveat that because not everyone

who focuses on strength training and food and is perfect can come off these meds.

So that’s not a failure of you. That’s just a byproduct of the fact that this

synthetic hormone is curing something that was deficient and dysregulated.

And just like we would need to treat your hormone, hypothyroidism with a hormone,

I think I mis -said that, but just like we would need to treat your thyroid with a

medication, we might need to treat obesity with a hormone medication indefinitely,

too, to continue to see the effect.

Colleen: You talk about in the book that some people

five months to a year feel less of the, they start hearing that food noise again,

but that doesn’t necessarily mean they’re going to gain the weight back. Can you

talk about that?

Dr. Sowa:  Yeah, I’m really glad you brought this up. And thank you for

really reading the book. That was like a little bit of a very detail. So people

really panic when this medication stops having the dramatic effect.

And I see this on social media all the time. And my patients come to me, even

though I warn them about it, people forget because your brain sometimes is your own

worst enemy in this process. But the  fact that the medication has will start to

quiet at about five to 12 months of any given dose. This is very clearly elucidated

in research and then what I’ve seen in clinical practice and people panic because

they say I’ve become immune to this medication and it’s not working anymore but I’ll

ask the same patient that tells me that I’ll say have you gained weight and they’ll

say no. Do you feel like you’re out of control? No. Well,

why do you think that it’s not working? Well, I just now have hunger.

Having hunger is normal. And eventually, most people were returned having a more

normalized sense of hunger. But you need to be aware of it. And that’s also why

some of the habits are very important. In the research,

all hunger and cravings and affinity for different foods, it will return, but what

stays is your ability to control what you eat and your weight maintenance.

And so people just need to know not to panic because what happens is because we’re

so primed to have failed so many diets before, you’ll say, “I knew this was too

good to be true.” And then they might stop taking their medication or just cancel

their next appointment. And they’ll get way ahead of themselves. And so it’s really

important to know that this will happen and it’s normal and it’s good. Hunger is

good. The pleasure of eating is good. We just need to make sure that we continue

to stay connected to it.

Bridgett:  – I have a question too about you address compounding.

And I know a lot of online because I follow an online

app. And they are coming out. I have not done this, but they have come out with a

compounded form. And I’m really kind of suspicious of this.

So I have not partaken of this. Can you address the issue with compounding? Yeah.

Is the FDA approved?

Dr. Sowa:  Yeah, it’s really tricky. And I know why people are turning

toward compounding. It’s because of cost. I will say though that compounding is not

affordable. I mean it’s not by any means as affordable as the FDA approved version

in Europe. So we have some problems over here and one way we could kind of solve

this is if pharma would just bring down costs and I truly believe and if our

government would kind of set mandates. Okay, but they haven’t yet so what do we do

about that? So compounding, I really have always used compounding pharmacies as a

doctor because I think that they provide a super unique service.

Compounding of these drugs is much trickier than traditional compounding pharmacies.

These peptides are complicated and they’re actually, they’re under patent. So whatever

you’re getting at a compound is not, is not the real drug and it’s very hard to

make these medications. And I have just seen too many patients who come to my

practice, having been on compounding medications who, one, didn’t see efficacy, two

had some very weird side effects, and then we put them on the real medication, and

then it’s smooth sailing, and then they see success. So I am concerned about what a

lot of these medications are. I think even bigger than that, a lot of the places

that are giving compounding pharmacies, I do not think it’s holistic medical care.

You should, and I write in the books, you can advocate for yourself, like what labs

you should be getting. We should not just be starting this without knowing what our

baseline is, so that we need to know to see the improvement. We need to know what

got you here in the first place. You know, I just spent 30, 40 minutes talking

about how it’s not your fault, but also like we need to know if you have

underlying insulin resistance. We need to know if you have Sleep Apneia or binge

eating disorder. We need to know if you’re using this for wrong reasons.

And I think I’m starting to see that all over social media, people who never ever

should have been able to get access to these medications and the system failed them

because they were trying to treat an eating disorder, a significant severe eating

disorder with this medication, and the system failed them by prescribing the

medication, right? And so working with someone who really understands these medications

and you and is looking at all of you and not just you with a number of a BMI is

really important. So compounding is tricky and I think if you’re not seeing the

results you want or getting support you want then look outward. Finding an obesity

medicine specialist will often help you figure out how to use the real medications

at a much lower cost. I can’t tell you the amount of people who come to me who’s

other doctors or other compounding pharmacies, they don’t touch insurance or prior

authorization. So for years they’re paying out of pocket, it actually turns out they

had coverage and no one just no one did the prior authorization. You know

compounding pharmacies don’t want to work with your insurance and insurance won’t

cover them so you may actually have coverage. So it’s tricky. It’s tricky. And I

understand it, but I also just be careful. Be careful and treat yourself holistically

as your body deserves.

Colleen: Do telehealth companies, are they able to get prescriptions to people for the GLP

ones versus the compound?

Dr. Sowa: I think it depends. Most large telehealth companies, like

ones that just ran an ad on the Super Bowl, they are funny.

They’re vilifying pharma, but then they are their own pharma. I don’t understand it.

They aren’t using the FDA approved and they’re not. It’s a lot of work to get

prior authorizations. And so be kind to your primary care doctors too, because it’s

a lot of back administrative work and time. But try to advocate for yourself. If

you know you have coverage and you can kind of like help with some of the

paperwork and go on and make an appointment and you know, be nice.

Bridgett:

You address that

in the book too.

Yes. I mean, it’s so thorough and the list in there and the

recipes are great. The go bag, you know, to have ready in it.

But I really do like to how you addressed that if you’re, you’re doing this for

just to be skinny, that’s not the thing. I think you had, was it three things that

you need to say? Yeah. Only one of them can be about your appearance.

Dr. Sowa: Yeah. I mean,

that’s the most important thing. Actually, the thing I start off with in the book

is why are you doing this? And I ask everyone to identify their why’s. And yeah,

you come up with three things, but only one of them is allowed to be rooted in

something vanity or appearance -related. And if you can’t think beyond that, this

isn’t right for you because you’re not going to be motivated. Skinny is not

motivating. And you’re not gonna be happy because being skinny doesn’t fix anything.

So unless it’s health -related, that’s motivating. Like seeing your hemoglobin A1C

blood sugar numbers come down, being able to get off the floor ’cause your joints

don’t hurt as much, being able to play with your grandkids, that’s motivating, then

isn’t.

Colleen: – So, and I think that is something that women of our demographic understand

much more clearly than women in their 20s and 30s that skinny doesn’t mean health.

So it’s not the same thing. What do you see in the future? I guess my last

question is, what do you see this going in the next five years as far as weight

loss and management?

Dr. Sowa:  One, I see costs coming down. They have to, they must. It’s

important for us as a country. I do think we’re going to see exciting,

expanded FDA approved reasons for going on the medication like potentially dementia

prevention. And then I think we may see alternate dosings. I’m actually, I talk out

a lot about how I don’t of this term micro dosing because the clinical trials for

the FDA approved reasons right now have been set because we’ve studied the doses and

this is what works but we may start seeing smaller dosages and we’re going to see

different versions of the drug come out, maybe a pill and like we’ll start to get

a little bit more specific on who needs which one and I think we’ll get a little

even deeper into the genetics. So I think it’s a very exciting time. I will also

say what needs to happen in the next 10 years is that we need to continue to push

forward on preventing obesity in the first place as a country. You know, I love

these medications because they treat the disease that’s in front of us right now,

but I hope for my children and my grandchildren that we can fix our food supply

and we can fix the quality of our air and the amount of microplastics that are

everywhere around us. I just don’t think that can treat obesity currently and we

need to do both at once.

Bridgett: – Right, if someone wanted to get in touch with you,

you have So Well Health. With So Well Health, can people, I know Colleen addressed

the question about telehealth, but can people that don’t live near you, can they

contact you that way?

Dr. Sowa: – Yes. So,  SoWell Health is a company that helps people

wherever they are on their GLP one journey. So we have our products that I talked

about. We have a lot of information. I have the book now for anyone who’s

contemplating it or just needs support without me. And then yes, we do have a

telehealth arm. It’s pretty small because it is just me providing care. And I’m in

13 states and I actually am about to run a new opening to the practice in March.

People come and work with me in, they have to come in and work with me through

like a group at first. It’s a course, not really a group. It’s like a course. It’s

the SoWell method that I write about in the book. I teach live and then you get

to work with me one -on -one. So we’re doing that in March and you can find me on

our website, getsowell.com or on social media. I’m at Alexandra Sowa MD and I try

really hard to answer questions in DMs. You’re one person. Give yourself a little

grace on that one.

Bridgett: Guys, the book is very thorough and it’s a fast read. I’m not

saying it’s, it’s not like the thick thing.

Dr. Sowa:  No, no. So I don’t want to scare

people like that, but it is a great resource. If you have any questions about GLP

One, this is a great book. It’s a great resource, The Ozempic Revolution. Thank you,

Dr. Swa, we appreciate you coming on today. Thank you.