Michael Roizen, MD: You are listening to you The Owner's Manual Radio podcast on Radio MD iHeart Podcast Health, or wherever you download us from. Thank you for doing that. This is 1263 B. The bees are always wonderful guests. We have one today for you today. It is Nicolette Pace. Who's a metabolic nutritionist with a lot of experience, and I'm going to let her describe what.

Is coming in her life 'cause she's starting a new, facet of her life. But today we're gonna talk about the GLP one drugs, both the pill form that has just been approved by the FDA as well as. The, prior, injectables and both of those, both of the major ones concerning weight loss have just come down in price by 50%.

I am your host, Dr. Mike Rozen. We're sponsored by. As usual, the people who make true biotics and bovine colostrum, life's first naturals.com, as well as die rescue, go to their website to see the randomized double-blind studies for both true biotics and bovine colostrum. And you can see a lot of anecdotal evidence on D Rescue and how it helps, with the transition to higher doses actually of the GLP one drugs.

That's d Rescue, the other sponsors, of course. for youngevity.com, try their coaching program for free@foryoungevity.com. Nicolete, thank you for coming on. And how did you get in the field of, dietetics, or Diet counseling.

Nicolette M. Pace MS: Well, actually it's a long tenure. I've actually been in five and now going on six industries. So, I started in communications, worked all through all the networks, CBS and CNNI was a reporter, I was assignment editor, did all the technical work. I also was a financial services. I was a registered representative.

I had my own business. Also, I'm a chef, so I had a catering company. I also became a professor at CUNY and Touro Colleges. I've also, continued my studies. I am a lifelong learner and, went back into nutrition after a health scare and realized, I really did not have a good handle on a lot of medical stuff and, not that I'm a control freak, but, I felt very disenfranchised and disempowered.

And when I went into the field of having a culinary background, I embarked on it. I didn't realize I had quite the scientific mind. so I actually ended up advising within my ranks, became director at a facility and I tenured under six positions who gave me like an apprenticeship.

So I learned a, a lot, a lot of medicine, you know, pretty much equivalent to having gone to medical school 'cause I did hands-on to due to shortages and, other types of things at the facility. so I do have a really good handle on a lot of different things and I have always been a scientist.

through a great upbringing. I was raised by, uh, two teachers and a, financial wizard. So as an only child, I got all the education thrown at me and, I continue to grow with it. I had a practice nutrisource, incorporated, which still exists And we still do, telemedicine And that type of stuff.

But, media is my mogul and I, uh, enjoy doing it a tremendous amount. It has great impact. Patient's come in one at a time and they always say, I heard this. I heard this. Banana is bad and This is bad, and I'm really much against it, and there's only so much you can do.

I actually funded the practice because when they cut insurance reimbursement, it became just a, it was hemorrhaging,

Michael Roizen, MD: So tell us about the current interest in the GLP one Drugs.

Nicolette M. Pace MS: Well, I mean, it, it seems like the end all be all and, it is true. uh, it's great that it's finally approved for clinical obesity. I'm also glad that they finally termed it properly as clinical obesity. And thanks for that. And, now the FDA approval on like the ozempic, but it's not an injectable, so that it, it is less intimidating for folks and it's just a, pill.

And as you mentioned earlier, definitely lower cost. and people say it takes away my appetite And the mechanism, of course, as you know, it is made in the gut. it does slow gastric emptying So, It makes you feel full or sooner, but many people don't realize. It also does have the pancreas, release, or speeds up the first phase of the insulin response.

Which, generally is the reason why we say take 15 to 20 minutes before you to eat before you feel full, this can push it all the way up to five minutes or 10 minutes even. So, even the fastest of eaters can benefit from it, but you can still override it.

insulin response is pushed up to between five to 10 minutes in when you're eating instead of 15 to 20. And there's an un carle.org amount of food that can be eaten in 20 minutes. Having attended the hot dog eating contest, we know what that's like. it's a good thing.

But, there's some, other things to be had with it to make it work even better. I also like to know if there's a backend to this, or is it people supposed to be on this for the rest of their lives, as in like type one diabetes

Michael Roizen, MD: Well, we're on a lot of medicines for the rest of life. People are, such as blood pressure pills, to control blood pressure. So that doesn't seem to me if, if the cost is, low enough.

Nicolette M. Pace MS: Not doing anything right.

Michael Roizen, MD: and patient's are doing, resistance exercise, it seems to me that, if someone adapts to it, Those are the major, risks, right? Or the major, what you might call costs. Are they the actual cost as well as the, if you will, needs to, do, Resistance training or weight bearing exercise.

Nicolette M. Pace MS: Yes, absolutely. It's a, it is a very complicated obesity.

Michael Roizen, MD: as you have, shown in the, the brief I got, about 12% of the United States citizens have tried it at one time or another. Do we know how many, have quit because of cost versus how many have quit because of a side effect? They don't like.

Nicolette M. Pace MS: I don't know the actual percentage, but I'm going to really guesstimate that it is a substantial amount. This is why we are making it much more affordable. And making it easier, to administer, with eliminating the needle phobia and, so on And so forth. And also coupling it to, you know, we can control the internal factors, but these pills, do not control the external factors.

But there are programs and of course the guidance as you mentioned with resistance training and on the likelihood with telemedicine or counseling to help, control the environmental triggers. you know, GLP one friendly foods guidance on what's do at restaurants And the like, same thing we've been doing with bariatric surgery and these pills are like bariatric surgery without the surgery.

also for people who have regained weight after surgery, bariatric surgery, and, you know, they could be useful for help being to, put it back in gear

Michael Roizen, MD: we should say that Nicolette has a website, Nicolette, N-I-C-O-L-E-T-T-E, pace, PAC e.com, where you can find out more about her. what's different about the pill versus the injectables? has the pill been tested as long obviously? The injectables. Ozempic has been around since around 2012, I think it was, as a anti-diabetic medication.

So we've got a fair bit of years of experience from it. But, how long has the pill been tested and do we know, does it have the same effects? How, why is it taking so long to get a pill?

Nicolette M. Pace MS: I think it has a lot to do with the definition of, the rationale behind you know, whether it's diabetes or obesity. And I think a lot has to do with the redefinition of obesity and turning it a clinical obesity. prior to that it, it was, uh. BMI, which didn't really indicate anything.

sometimes people were muscular and their BMI was, substantial. But, you know, also from bariatric patient's, they got very offended being told they were super morbidly obese. I mean, they were crying in the office and it's very sad. So it's clinical obesity. It is true. It's an outcropping of the illnesses that occur as a result of, excess out of posts, and weight.

as far as the oral, I mean, there was rybelsus that's kind of faded into the background at this point, but I think it was a few years. It's definitely shorter than the ozempic, but This is all really, um, new and up and coming. There was speculation going back, about this up and coming thing about 10 years ago, which I was top of, but it wasn't anywhere yet.

There wasn't anything brought to market. And of course the future is, doubling it and tripling it. To other, ingredients so that, you know, we can really intensify the effect, increase metabolic rate. These are the other drugs, not the GLP one. it's a lot on the horizon.

Michael Roizen, MD: there's a pill being developed by Eli Lilly, but the pill that got approved was, Nova Nordisk's version of Ozempic. Is that correct?

Nicolette M. Pace MS: Yes. No go, no distance. Another player, yes.

Michael Roizen, MD: and one of the things that I've been impressed with, in the injectable form is that it decreases the cravings for not only food, but also for alcohol, cigarettes, and, drugs.

Nicolette M. Pace MS: I am glad you brought that up. Yes, And That is really fascinating because it is used in. tremendous potential in addictive behaviors, alcohol, nicotine, opioids. Absolutely. I'm glad you brought that up.

Michael Roizen, MD: And the other thing I've been impressed with is that it seems that people who have a. Reaction, a dysphoria to one of them. Meaning if they have a dysphoria to semaglutide, it doesn't cross react with tirzepatide, which is the Mounjaro and zep bound. is that true or is is my experience, unusual?

Nicolette M. Pace MS: the, Majaro is actually one of those, that's the one That is actually, it is a GIP,

Michael Roizen, MD: It is GLP and. GIP, right?

Nicolette M. Pace MS: Right. That's the dual, one of the dual, usually that's released after you eat, by the K cells, in the, in the gut again. it binds and it stimulates to the other receptors, the pancreas. So this actually starts attacking, insulin signals for release, but only in a glucose dependent way.

So. it doesn't send out too much insulin like we have done with diabetes patient's, who weren't properly managed and they were taking upwards of, I've had patient's with 300 units of Lantis a day, you know, And then just there was more and more weight gain, you know, they used to eat, but they're all the way through it and they end up with, a room wire or sleeve or something.

So, you were saying is that the dual action actually couples to that. it just gives it a double effect and has even tremendous, even greater amounts of weight loss.

Michael Roizen, MD: not only is more effective at. Weight loss, but seems to be, better tolerated. at least in, my patient's.

Nicolette M. Pace MS: And that would make sense because you know, it's not just targeting one mechanism where then you don't forget, the body's always trying to maintain homeostasis, so you got a corresponding system fighting it or getting nauseous or things like that. So yes.

Michael Roizen, MD: And do we know when is there a pill version of that underway too? I assume Eli Lilly is not, going to let Nova Nordisk have the, full reign of,

Nicolette M. Pace MS: They're staying one step ahead of them. And then actually it's the, retro tru Tide, and that's the Triple J, and That is now coupling it to glucagon. So that's the GCG. You got the GIP And the GLP one. So those three Gs together are attacking every facet of metabolic load, with the glucagon, usually accustomed to using it, You know, in type one diabetes patient's, You know, with hypoglycemia, it's assimilate, liver release, et cetera.

But, This is, um, you know, it's, acts in synergy, all three together, active synergy to try and, you know, manage this whole thing. And, the weight loss is enhanced. Um, by just then just doing the one GLP one. So, of course once this comes out, everybody's gonna want the best one.

You know, you want the best model And the price is down. I don't know what that's gonna be on it. It's going into phase three trial right now, the retro ide. just finished phase two.

Michael Roizen, MD: And so if it's starting the phase three trial now, is the FDA requiring a two year trial or a, six month trial? Do we know?

Nicolette M. Pace MS: don't, I'm not sure. I mean a speculation. They're probably are gonna bump it up. I thought I saw something like you said six. I'm not sure. It usually it is two. They're probably gonna rush it. I'm very, very happy with the movement to try and This is stuff I've been saying for decades, and I remember in the bariatric surgery class.

Group class, one of my patient's, she said, the country isn't ready for you. And I laughed and I did not know what that meant. But then I've heard before, and it's some I've been looking at for 10, 20, 30 years and it's all happening now. And I, I don't know what it is.

I guess it's because I'm a scientist, I have a real curious mind and I am also behaviorist most importantly. So I kind of look at things anthropologically and look and see trends. I, watch a lot. I see people where they shop, the way they eat, the way they socialize.

how they speak. I'm very well-versed in many cultures. I even taught my cat two languages. Would you believe he's trilingual? Who does that?

Michael Roizen, MD: One of the things that we've. Seen is that younger people are using this, not just us old people. what your feelings about that. 'cause they'll be on this for, you know, 60, 70 years.

Nicolette M. Pace MS: Well, yeah, that's why I brought up was the end point. And I agree with what you said. You know, you want something for, et cetera. like with bariatric patient's and they had diabetes and they had the surgery And then they say, I'm curative diabetes. And I would say, you not, you still have it, you just aren't treating it differently.

So, there is thought. I have a thought that if you are doing it right, I mean there's uh, many behavioral programs that aim to try and form the habits that go with it. Some of 'em are just winging it with the pill and eating everything they usually eat and just relying on the pill as a soul.

So motor operandi as you say. So that's a concern. The other thing is with the younger folks, you're having these like bootleg doses, mini doses. the injectables, splitting the dose, having whatever's left to get the most out of the vial. because it was costly. So you have those kind of things going on and You know, a lot of stuff on social media and it is very dangerous.

So Those are some other concerns outside of just how long to be honest. But, it could be dangerous,

Michael Roizen, MD: The other thing that it looks like is not only does this stop, obesity And it's outward appearance, but it decreases heart disease, stroke, memory loss, joint disease, progression of lung disease, progression of kidney disease. So these look like they're, um, major breakthrough I guess the one thing I don't know, that I'm really interested in is, do you think the pill will be, more effective than the, injectable, because of its, greater acceptance?

Or do you think it will be less acceptable because it isn't, doesn't get the medicine in as easily?

Nicolette M. Pace MS: the acceptance will be higher because of the cost And the lack of the, you know, needle phobia. However, due to the ease of use, it may not be taken as seriously, but I am very happy. and tremendously in favor of putting it in the hands of the professionals who really belong with treating clinical obesity.

And that was a big step in defining clinical obesity from all the chronic conditions that you've mentioned And the comorbidities that accompany it. That is a defining factor. And I hope that knocks out some of these ridiculous diets. And I know, uh, many, many, registered dieticians and nutritionists at the top of their fields who are eager to really work it properly.

But the public seems to think and some of them do actually. Talk about bananas And the simple things like cereals, et cetera, and they really don't get into the heart of the matter. But like, as I said, I'm, I have a long tenure in all this stuff and I'm, uh, I got a tremendous mind to look at the why And the mechanism of actions, et cetera.

So the acceptance, it will be there from the cost, but it may not be taken as seriously. but you know, if there's a renewal for the prescription and they have to mandatory go in and see a professional that'll kind of maybe bring it back home, I think that has to be coupled with it.

If you leave, people wander around themselves. Who knows, because even the fastest of eaters can eat through this thing. so it's gotta be a multidisciplinary approach and I think that would nail it. I feel it's a good thing.

Michael Roizen, MD: Well, thank you very much and I. Appreciate it. Just to remind everyone, our sponsors are life's first, naturals.com, the makers of Tru Biotics, bovine colostrum, as well as die rescue. And for youngevity.com. And thank you, our 50,000 people or so a week who download us. We couldn't do it without you, and you're the ones who motivate us.

And Nicolette, thank you. It's nicolette pace.com. We'll be back next week. This has been 1263 B. Do go to the A segments. The A segments are always the latest medical news of the week And what it means for you. Thanks again.