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Zepbound Dosing: Your Doctor Probably Didn't Tell You About This Issue — Transcript

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0:01What if I told you that most people that
0:03use GLP-1s are never actually on the
0:06same dose twice
0:08despite the number that's on the pen?
0:10And what if I told you that that might
0:12be why so many people struggle with
0:14these medications and eventually give
0:16them up? If you've ever felt amazing on
0:19a GLP-1 and then terrible the next week
0:22even though your dose didn't change,
0:24you're not crazy. You are actually just
0:26experiencing something that likely your
0:28doctor never discussed with you.
0:31Today's conversation completely changed
0:34the way that I look at GLP-1s and
0:36dosing. Because what if the problem that
0:39we're running into isn't the drug that
0:41we're on, but the way that we are dosing
0:44and titrating that medication? On
0:46today's episode, Dr. Ian Ellis talks
0:48about his own journey. A journey of
0:51having obsessive control to losing
0:54control. And ultimately discovering
0:57something along the way that could
0:58reshape the way that we view GLP-1
1:01dosing. And it all comes down to one
1:04core idea.
1:05What if it's not about the dose that
1:07you're on, but the level that you're at?
1:10If that has you curious, you're going to
1:12want to stick around for this entire
1:14video because this conversation is an
1:15absolute game-changer and reshaping my
1:18own approach to GLP-1 medications. Now,
1:21it's important to understand that Dr.
1:22Ian is a doctor, but he is not your
1:25doctor and this video is not medical
1:27advice. It's simply something, like
1:29everything we bring you here at On the
1:31Pen, that is designed to empower you to
1:33have a more competent and confident
1:35conversation with your doctor. So,
1:37before we get started, hit the like, hit
1:39the bell, but make sure you're
1:40subscribed for updates because we bring
1:42you all the GLP-1 news and updates that
1:44matter for you on your journey. Thanks
1:47for
1:55What if you've been on a GLP-1, but
1:57you've never actually maintained the
2:00appropriate dose? What do I mean by
2:02that? Well, what if despite following
2:04the protocols to a T, your body has
2:07experienced something entirely different
2:09than what was expected? Well, that's
2:11what our guest today, Dr. Ian Ellis, set
2:14out to explore based upon his own
2:16journey. And in doing so, it developed
2:18this idea that really what we should be
2:20paying attention to is not the dose that
2:22we're on. It's the level that we're at.
2:25And I thought that this was a super
2:28apropos conversation for the things that
2:29we've been talking about it on The Pen.
2:31So, I want to welcome in today's guest,
2:33Dr. Ian Ellis. Dr. Ian, welcome.
2:36>> Yeah, thank you so much for having me.
2:37It's a true privilege.
2:38>> Yeah, I really appreciate you A reaching
2:41out, and I'm so excited about what you
2:45are working on uh there at Voofit, and I
2:48think that what you have discovered here
2:51could be an absolute game-changer uh for
2:54people who are on The Pen and people who
2:56in the future will be on The Pen.
2:57Something that this space has long
3:00needed. So, when we talk about your
3:02level and not your dose, can you tell us
3:06sort of
3:07how this all came about in your mind,
3:08Dr. Ian?
3:09>> Yeah, absolutely.
3:11So, this really starts, you know, from a
3:14position not being a
3:16you know, coming at this from the
3:17perspective of a physician as much as a
3:20patient myself. So,
3:22you know, I long time ago, before I ever
3:25got into medicine, uh I was a certified
3:27personal trainer, worked as a
3:28nutritionist. I've always had a very
3:30intense interest in maintaining a
3:32healthy body composition and helping to
3:33solve this,
3:35you know, global problem of obesity and
3:38overweight. And noting in in the people
3:41in my own life, including my own family,
3:42just how difficult a problem that was to
3:45solve. Okay, you know, I grew up in the
3:46'80s and '90s
3:48when thin was really in. Everyone was on
3:50a diet all the time. And at least in my
3:53personal experience of the people around
3:55me, no one was really achieving any
3:57success in that, right?
4:00And I have a a very distinct memory when
4:02I was 14 years old. I was standing in
4:04front of a mirror, just a young teen,
4:06and saying, looking at myself in the
4:09mirror and saying, "I'm going to solve
4:11this problem. I'm not going to lose this
4:13battle that I see everyone else in my
4:15life fighting and losing."
4:17And so,
4:18really from that moment forward, started
4:19dedicating my own life to that. Uh
4:22coming from a This is pre-internet,
4:24right? This is coming from not a
4:26significant position of special
4:27knowledge, just saying, "I'm going to
4:29try really hard, and I'm going to have
4:31enough willpower to succeed. I'm going
4:33to eat the right foods, I'm going to
4:34exercise the right way, and I'm going to
4:36win this battle myself, and I'm going to
4:38teach a lot of other people how to do
4:39that, too."
4:40Okay?
4:41So, that's where I started. Uh became an
4:43athletic training major in college, and
4:45was kind of moving towards that as my
4:47career. Kind of fell into medicine late.
4:50I didn't, you know, start pre-med until
4:52midway through college. Um
4:54And eventually became a board-certified
4:57ER physician. And that's kind of what I
4:59was doing full-time for my career, but
5:01still at the same time really having a
5:02focus on my own physique and the
5:04physique of, you know, people around me.
5:07Okay?
5:08Well,
5:09here was the challenge. Uh before
5:12medical school, I would say that
5:14externally,
5:15I achieved a great deal of success in
5:18that arena. You looked at me, I was, you
5:19know, maintaining a body fat percentage
5:21somewhere between 8 and 12. I looked the
5:24part of a finely tuned athlete. I was,
5:26you know, training athletes myself and
5:28training people in in the gym.
5:30And, you know, preaching the same mantra
5:32we've all been preached to, which is
5:35just eat right. Eat the right things,
5:37eat the right amount, calories in,
5:39calories out, exercise, and everything
5:41will take care of itself.
5:42Okay?
5:43Well, externally, I looked fine.
5:46Internally, absolutely not fine at all.
5:50Like really toxic obsession with food,
5:53with calorie counting, with obsessive
5:55restriction, over exercising to
5:58compensate for my appetite when I would
5:59lose control, running marathons the day
6:02after Thanksgiving, literally I did that
6:05to burn the 2600 calories I had
6:07meticulously counted in the MyFitnessPal
6:09app
6:11that I would have to deal with somehow,
6:13someway.
6:14And just generally living that
6:17very
6:18difficult obsessive place of trying to
6:21win that battle when the deck is really
6:23stacked against all of us in the western
6:26world with the western food supply, with
6:28our lack of daily physical activity,
6:30with the you know, nutritional
6:32deficiencies we have in the processed
6:34foods that we eat.
6:35Uh the environment we are in is simply
6:38not conducive to achieving health.
6:42Okay? So, what do people do?
6:45This is just statistically true.
6:47They either try to keep some balance in
6:50their life, maintain the relationships,
6:52enjoy their food, enjoy their travel,
6:54try to keep some perspective, and
6:56generally end up overweight or obese.
6:59Okay? 75% of the of people that's the
7:01case.
7:02The other 20 to 25%
7:05this is where I would count myself in
7:07before.
7:09You know, you sacrifice all of these
7:10things. You sacrifice you know, good
7:13food, family time, relationships,
7:15balancing your life and pursuits, you
7:17know, going on vacations, doing those
7:19kind of things that give life its flavor
7:21in exchange for dedicating your life to
7:22the pursuit of fitness.
7:24Okay?
7:25Well, I'm here to tell you neither of
7:27those are acceptable.
7:30Right? We should we have to find a way
7:32as individuals and in our society to
7:35have both. How can we have balance,
7:38enjoyment of life, and also be healthy
7:41and fit? Because I shouldn't have to
7:43choose and I don't want to choose. Okay?
7:46Well, here's where I'm I'm going with
7:47this.
7:48I chose option B for most of my young
7:51adult and adult life until I went to
7:55medical school.
7:57Because in medical school and residency
7:58as a medical professional, I didn't have
8:00the choice anymore of making that choice
8:03because I was working 120-hour weeks.
8:06I was not able to over exercise to
8:08compensate for my excessive appetite. I
8:10wasn't able to cook and prepare my
8:12natural whole foods at will because I'm
8:14eating, you know, cupcakes at the nurses
8:16station, whatever you can grab when
8:18you're in the middle of a 36-hour call.
8:20Okay?
8:21And I lost the ability to compensate for
8:25the difficulties of our environment
8:27uh through excessive exercise activity
8:30and overly
8:31uh over restriction. Well, what was the
8:33outcome of that?
8:35I became what I most feared.
8:38I went from 6 to 8% body fat to 40 lb
8:41overweight, 35% body fat, snoring like a
8:44freight train, and couldn't walk
8:46upstairs without getting out of breath.
8:47That's the state I was in when I
8:49graduated residency as someone with a
8:51career and background in fitness and
8:54nutrition.
8:56Okay?
8:56>> give us a just a rough idea of like what
8:58year this is?
8:59>> Oh, yeah. So, that was I graduated
9:01residency in 2016 and kind of started my
9:04process of trying to get back to a state
9:07of health in 2017. Uh kind of when I
9:09finished up fellowship. Okay? Well, the
9:12only thing I knew how to do at that time
9:14was jump right back in after I had
9:16graduated into the same environment I
9:18was before. So, I got back on the
9:19treadmill 3 hours a day. I start I hired
9:22a trainer and was working out twice a
9:23day, 6 days a week with a trainer that
9:25would drive an hour from Dallas each way
9:28you know, to whip my butt into shape in
9:29the driveway. Okay?
9:31And, you know, jumped right back into
9:33that same obsessive uh focus to try to
9:36get back to this place of health, okay?
9:39But, it wasn't okay because now I'm
9:41married. Now I had a kid,
9:44actually several kids, and [snorts] I
9:45had a career that required my attention.
9:47And I also had friends and other things
9:49that were really important parts of my
9:52life, and I started to feel that tension
9:53acutely. Like this
9:56way, this method of getting to that
9:58place of health is no longer viable. I
10:01can't do that because there's too much
10:02sacrifice, okay? But, I don't want to
10:05end up in the 75% that are overweight or
10:08obese. So, what could be the solution?
10:11Okay? Well, that brings us to 2022,
10:15or actually I think it was the end of
10:162021,
10:18when a colleague in the ER, who, you
10:20know, was probably sick of me just
10:21complaining every day on shift about how
10:23hard it was to not eat, okay,
10:27mentioned, "Hey, I've heard of this new
10:28drug.
10:29It's called Ozempic."
10:32And I I, you know, coming from the place
10:33of working in the ER, this is right at
10:35the beginning before this kind of got
10:36mainstream, never heard of it before,
10:38and I said, you know, "What what is it?
10:39Tell me about it. You know, what's the
10:40big deal?"
10:42And they said, "Well, I mean, I hear you
10:43like you just take it and it takes away
10:45your appetite and you can just lose
10:47weight."
10:48And I said, "Well, what do I need to
10:49know about it?" They said, "Nothing.
10:51It's it's magic."
10:54To which I said, "Sign me the frick up,
10:57okay? Because I'm tired. I can't fight
10:59this battle anymore. I'm hurting myself,
11:01I'm hurting people around me, and I'm I
11:03I I can't whip so between these two
11:05extremes any longer. So, it was really
11:08like, if this tool exists, please let me
11:11try because I I do I want to find that
11:13place of balance in the middle where I'm
11:15not fighting my appetite tooth and nail
11:17every second of every day to maintain a
11:19healthy weight.
11:20Well,
11:22that provider prescribed it to me. I got
11:24the standard dosing schedule. I got my
11:27meds in the mail, and I started. 0.25 mg
11:30of semaglutide.
11:32A day later,
11:34I don't want to overstate this.
11:38It was like the doors of heaven opened
11:40up
11:41because all of a sudden, and I didn't
11:43even perceive it at the time. You know,
11:45I I just got up, I went through my daily
11:47activities, I started to make lunch, and
11:50I remember it so distinctly. There was a
11:51ribeye sandwich
11:53that I made.
11:54Like just the most tasty, delicious,
11:57succulent, perfectly cooked, you know,
11:59meat and a sandwich that I honestly
12:01would have in the past eaten one of,
12:03probably eaten two of, maybe eaten
12:05another half, and then gotten on the
12:06treadmill for 3 hours to burn off the
12:08calories. Okay?
12:10And I took my first three bites,
12:12and I got halfway through the sandwich,
12:14and I just
12:16didn't want to eat it anymore.
12:19>> Wow.
12:19>> And I wasn't feeling sick, I wasn't
12:21feeling overstuffed, I just didn't have
12:24the desire to keep eating. And almost
12:26without thinking about it,
12:28well, actually that's not true. I did I
12:29recognized as it was happening. I
12:30wrapped it up, and I put it in the
12:31fridge, and I went,
12:34"What the hell was that?
12:36Is this what it's like to feel satiated?
12:39Is this what it's like to feel like my
12:41appetite is satisfied
12:43when I haven't overeaten and stuffed
12:45myself to the point where I can just
12:47can't eat anymore? And
12:49you know, that continued for that week.
12:52And you know, the scale started to move.
12:54I still had good energy. I was feeling
12:56really great, still eating high-quality
12:58food, and just kind of moving through
12:59the week.
13:00Well, I took my second dose.
13:03The day after that, I didn't feel quite
13:06so good anymore.
13:07Okay? I really I was developing a slight
13:10food aversion. It's like you all we all
13:12know what that looks like. You look at
13:13food and you go, "I I really don't think
13:15I can eat that." And I certainly don't
13:17want to. And when I would, because I
13:19knew I had to eat something, I would
13:20start to feel that, you know, little
13:22tinge of nausea, a little bit of reflux,
13:25stomach's a little overfull, just not
13:27having that blissful experience, but
13:29still good, right? I'm still losing
13:31weight, still in a calorie deficit, no
13:32big deal.
13:34Week three.
13:36I started to feel really sick.
13:38I had quite a bit of nausea. I started
13:39having some diarrhea.
13:41I started to have some low energy
13:42because I really wasn't eating much at
13:44all. Okay, I was really restricting my
13:46calories. I'm still trying to go to the
13:47gym like I normally would, and my
13:48performance is starting to suffer. Okay?
13:51Well, that continues until I hit week
13:53five.
13:54Okay? Week five, the wheels of my
13:57semaglutide journey fell off completely
13:59because I got really sick. Uh just
14:01intractable nausea, vomiting, diarrhea,
14:03couldn't eat, couldn't function.
14:05>> And you never you never dosed up during
14:08this time.
14:09>> Well, well, I increased I put 2.25,
14:110.25, 0.25, 0.25, and of course,
14:15following the directions I was given, I
14:17increased to 0.5 in week five.
14:20>> So, you did increase. Okay.
14:22>> Yeah. But, you know, progressively
14:24having a worse and worse experience even
14:25on the same dose, and this is critical.
14:27We'll come back to that. Even on the
14:29same dose, my experience was changing
14:31from day to day.
14:32Okay?
14:33Well, here's the bottom line. I
14:35continued to escalate because that's
14:36just the way it was prescribed. I stayed
14:39off and on sick for quite a long time
14:41after that. But, the scale was moving,
14:45the weight was falling off, I certainly
14:46wasn't fighting my appetite, I was
14:48fighting different battles.
14:50>> Right.
14:50>> But, making progress.
14:52Well, I got to the end 3 months later.
14:55And I'd lost about 30 lbs, which was the
14:5630 lbs that I had been, you know, really
14:58fighting with tooth and nail for quite
14:59some time.
15:00Feeling pretty good
15:02in terms of the outcome. Then I got on
15:05an in-body scanner, which is a body
15:07composition scanner, similar to a DEXA
15:09scan, and really does have, when you do
15:10it right and consistently, uh it's a
15:12really accurate measure of your body
15:13composition.
15:14Well, I have one of those in my house,
15:16in my office here.
15:17And so, I have years of data going back
15:19what my average body composition is,
15:21when I lose weight, where does it stay,
15:23what is the ratio of fat and fat loss to
15:25muscle loss, and just knowing what that
15:27was like without medicine.
15:29Okay?
15:30I get on the scale, 30 lbs down.
15:33Absolutely horrified by what I saw.
15:36Because I had lost 30 lbs, 2 lbs of lean
15:40mass for every 1 lb of fat
15:43I had lost, and my body fat percentage,
15:46that oh so important metric, had barely
15:49changed.
15:51I was smaller,
15:52but I wasn't, by that metric, much
15:54healthier. I certainly was weaker, and I
15:57had nowhere near the physique I had had
15:59in the past when I reached that weight
16:01during a cut.
16:03And this is coming from a a bodybuilding
16:04background where I had done bulks and
16:05cuts, you know, many many times over the
16:07years. Okay?
16:09Well,
16:10you know,
16:11I looked at that, I took a step back,
16:13and I went,
16:14"Oh my gosh.
16:16Like,
16:17I I see the dichotomy here. These
16:20medicines
16:21have the potential to be world-changing,
16:24to solve this appetite problem that is
16:26so intractable.
16:27But, this
16:30can't be the outcome.
16:32We We can't accept a population, and I
16:34couldn't accept it within myself,
16:36a population that's just smaller and
16:38weaker, but has the same body fat
16:40percentage, right? Yeah. And of course,
16:42then I put my, you know, I put my
16:44personal trainer nutrition's brain back
16:46in my head, and I went, "Well, it's
16:48obvious why this happened. I haven't
16:50eaten in 3 months.
16:52And when I have eaten, I was too sick to
16:53get protein in, so I'd eat simple
16:56carbohydrates cuz they made my stomach
16:57feel good.
16:58And then when I went to the gym, I
17:00wasn't exercising with the same
17:01intensity to remind my muscles to hang
17:02around. And I was really getting overall
17:05really poor nutrition. So, it's not like
17:07it was like, "Oh my goodness, what
17:09happened?" It's like,
17:11"Well, it's obvious why this happened.
17:13But, can these medicines be used in a
17:15way where that isn't the outcome. And I
17:18became really obsessed with that answer
17:20because I was not willing to go back
17:24to not being on the medicine and
17:26fighting that battle every day. That was
17:27not an option.
17:28>> Yeah, that makes sense. And and I I'm so
17:31glad that you've you've highlighted this
17:34especially with the with the fact that
17:37the medication did
17:38it did it was doing what it was supposed
17:40to be doing in the sense that you were
17:42taking in less energy, right?
17:44Um
17:45And and this is where I get really
17:46concerned for the fact that these drugs
17:49are opening up to the Medicare
17:51population over the next few months is
17:53because without
17:55without doing this the right way
17:58if we get a bunch of older patients uh
18:01to lose weight, but the bulk
18:04[clears throat] of that weight comes
18:05from lean mass
18:07>> Mhm.
18:08>> then arguably the health outcomes could
18:11be worse.
18:12>> Uh it's it would be a catastrophe.
18:14And that's not overstating it at all.
18:16The elderly population, particularly
18:17those that don't exercise, don't have
18:19lean mass to spare.
18:21>> Right.
18:21>> But they do have fat tissue to lose. So,
18:24it's a it's a medical imperative to
18:26treat this population, but it's equally
18:29as imperative to find a a better way to
18:31do it, right? Because they can't take
18:34the risk. You know, I'll give an
18:35example.
18:37Like a real example, and I can say her
18:38name cuz she's given me me permission uh
18:39many times. Her name is Pat May. She's
18:41one of my favorite patients.
18:43She came to me in true desperation.
18:46Okay, she's mid-60s. She had severe
18:49osteoarthritis in both knees, immobile.
18:52310 lb at 5 ft 0.
18:55Okay, so BMI way north of 50.
18:58And, you know, multiple medical
19:00comorbidities, heart issues, kidney
19:01issues. She's just been She's just been
19:03in the hospital for kidney failure and
19:05sepsis.
19:06Okay? Well, that is a person who is
19:08excluded from the trials. A typical
19:11doctor on the standard protocol would
19:13recognize this person can't tolerate any
19:16side effects.
19:18And yet,
19:20she we have to treat her. It's like if
19:22we don't get that weight off, she's
19:24she's at the end. Okay? Unless you can
19:27get that person to a healthy weight, get
19:28you know, cuz she she needed bilateral
19:30knee replacement surgery, which she was
19:31disqualified for because of her BMI.
19:34Okay? She's also not qualified for
19:36bariatric surgery because of her
19:37comorbidities.
19:39Okay? So, what is the option for her?
19:41The option based on the standard dosing
19:42protocol is, "Sorry.
19:44Good luck.
19:45Hope you do okay." All right? Well,
19:48I'll get into how we treated her
19:49successfully.
19:51But I'll jump ahead to the, you know,
19:53the punchline. A year later, we did
19:56treat her.
19:57We treated her precisely based on level,
19:59not based on dose. We'll get into that
20:00in just a moment. Uh she's lost over 100
20:02lb. She's nearing 200. She already got
20:06one of her knee replacement surgeries,
20:08and she's on track for her second this
20:10next month. So, this is a real person
20:11who's being treated actively now. Well,
20:14we have to figure out a way
20:16to treat that population safely.
20:19Okay? And the standard dosing ladder
20:21doesn't let us do that. Okay? So,
20:24you know, that brings me back to the
20:25beginning. Well, I you know, I I was
20:27thinking
20:28and and evaluating my own experience,
20:30and I went back to that first week,
20:32and I went, "Man, that felt great. If I
20:35could feel like that every day,
20:37that would be perfect. Okay? That would
20:39give me that balance that I was looking
20:41for." Week two, I wasn't feeling quite
20:42as good. You know, progressively felt
20:44worse and worse.
20:46And then week five, I got really sick.
20:47Okay? So, I dove into the
20:49pharmacokinetics because I wanted to
20:50understand. Like I had to solve this
20:53problem, and I had to figure out a way
20:55to have that week one experience every
20:56time. Okay? Because I was confused. I
20:59took the same dose each week,
21:02but I had a different experience. And
21:03why is that?
21:04Well, if you look at the
21:05pharmacokinetics,
21:07and you just understand what's happening
21:09in your body, it makes perfect sense.
21:13Okay?
21:14These medicines, I know your I know your
21:16your listeners are familiar, at least to
21:18some degree, with the concept of
21:19half-life.
21:21These medicines last a long time. If I
21:23were to sneak up behind you, and you're
21:25a GLP-1 naive patient, and I inject you
21:27in, you know, your shoulder with
21:28semaglutide, okay? That medicine would
21:32reach a peak within 24 to 48 hours,
21:35but it would still be in you a month
21:37later.
21:38Okay? In a week after that injection,
21:41half of it would still be there. Another
21:43week after that, another half is still
21:45there. So, it's rapidly absorbed, and
21:47it's slowly metabolized. Okay? But,
21:51follow this. It's Yeah, and you can
21:52scroll down there. That's great.
21:54So, go up to that first that first one,
21:56actually.
21:58There we go. So, that's a typical uh
22:00curve for semaglutide. It's rapidly
22:02absorbed, and then has a long tail.
22:05Okay? A week in, okay? And you can see
22:08there I think you can see on the screen
22:097 days in, there's a lot left. Half of
22:12it, on average, is left in your body.
22:14So, when you take that second dose, go
22:16ahead and go down the next slide.
22:19When you take that second dose, you're
22:21not starting from zero. There's still
22:23half left. I'm going to use round
22:25numbers, you know, semaglutide is dosed
22:26in fractions of a milligram, so I'll
22:28just use round numbers for ease of
22:29conversation. Let's say you take a
22:31milligram on day zero,
22:33and day seven, there's half of it left.
22:36So, you take another milligram, same
22:38dose. Thanks, doc. I felt great that
22:40first week. Well, jokes on you, because
22:43now you've increased your level of
22:45medicine by 50%. There's 1 and 1/2 mg in
22:49you now.
22:50Well, that becomes metabolized slowly.
22:53That reaches its peak within 24 to 48
22:55hours, and now it's time to take your
22:57third dose.
22:58Same dose. Now, you're like, man, I
23:00don't feel that good. I'm glad I'm not
23:02increasing my dose.
23:04But you are.
23:05Unbeknownst to you, your third dose
23:07stacks, and your fourth dose stacks. So,
23:10you have four different therapeutic
23:12levels of that medicine even at fixed
23:15dosing
23:16>> Mhm.
23:16>> for that first month.
23:17>> Yeah, I hope I hope that people catch
23:20what what you're saying here because
23:23when you start
23:25the medication, you have zero in your
23:26system. But the half-life of semaglutide
23:29is 7 days, and semaglutide has how many
23:31half-lives?
23:33Many, right?
23:34>> Yeah. Yeah, it takes five half-lives, at
23:36least, for it to be completely
23:37metabolized.
23:38>> So, so we're talking 4 weeks into
23:42dosing, you still have some of your
23:44first dose in your system, so to speak.
23:46So, you are you are layering these doses
23:49as you go up. So, this the chart that
23:51we're looking at here, Dr. Ian, is going
23:54from zero
23:56medicine over on the left to taking the
23:58first dose, to that second spike is the
24:00second dose, and that third spike spike
24:03is the third dose. And you see, the
24:05levels are rising in your bloodstream,
24:07but the dose is staying the same.
24:10>> Precisely. And that explains beautifully
24:13my own experience. First week, felt
24:15great. Well, that peak, that first peak,
24:18that was the level of medicine, the
24:20level of medical medicine effect on my
24:23body that I needed.
24:25Okay? It would be crazy
24:28to go to your doctor and say, "You know,
24:29I feel great on this dose. It's perfect.
24:31Can I have more?"
24:33You should say, "That feels great. Let's
24:35hold there until I need more."
24:37>> Pause, right where we're at.
24:39>> But the standard dosing protocol,
24:40because of the pharmacokinetics, does
24:42not allow for that. The second dose will
24:45increase your level, and the third dose
24:47will increase your level. And right as
24:49it's about to stabilize around dose five
24:52is when you reach steady state. What
24:54does the standard dosing protocol say to
24:55do?
24:56Double your dose.
24:59Okay? So, now you take that same dosing
25:01ladder where you have had accumulation
25:03over time and you say, "I'm actually
25:04going to do twice that."
25:07Well, [snorts] where does that put you?
25:08By week five, you're at three times
25:11the medication level as you were in week
25:14one.
25:15Okay?
25:16Here's what I want you to see since you
25:17brought up this graphic here. That green
25:19line is is a theoretical
25:22therapeutic window. Okay, a therapeutic
25:24window is a constant in medicine where
25:26there's a top range of medicine effect
25:28where you if you go beyond that, you
25:29don't get more benefit, you get more
25:31side effects.
25:32And below that, it doesn't work.
25:35So, you want for any medical
25:36intervention, you want to stay in that
25:38that band where you're getting maximal
25:41effects and minimal side effects. An
25:43easy example we can all understand is
25:45ibuprofen.
25:46Okay? You have a fever. You need to take
25:48enough to get your fever down.
25:51Okay? But not so much that if your
25:53fever's already down and you take more,
25:56you're just going to tear up your
25:57stomach.
25:58Okay? But you also have to take enough.
26:01If I take, you know, if if the typical
26:04therapeutic dose of ibuprofen is 200 mg,
26:05if I take 20 mg, it's probably not going
26:08to do much.
26:09So, everyone has an individual
26:12therapeutic window for a GLP-1 where
26:15they feel their best. What do I mean by
26:17that? Their appetite is controlled. They
26:19still get hungry, but when they eat,
26:21they feel full fast. They have good
26:24energy. They don't have GI side effects.
26:27And they can move forward. Okay? The
26:29problem is the standard dosing ladder
26:33inexorably, inevitably,
26:36steps people up progressively and never
26:39gives them the chance to hold.
26:41Okay? Now, this is why and I want to
26:44give credit to the ladder. It wasn't
26:45done maliciously.
26:47It's a brilliant design for a study to
26:50gradually move people up to defined
26:52levels to assess efficacy.
26:54Okay? That's what the trial was designed
26:56for.
26:57And it did that really well. It
26:59escalated people gradually to a steady
27:01state at
27:02.25, at .5, at 1, at 1.7, at 2.4.
27:08So, it gave us a great snapshot. Does it
27:10work on a population level at this fixed
27:13dosing? Okay? There's nothing wrong with
27:15that in a trial. In fact, I don't know
27:16that I would do it any other way.
27:18But, for an individual,
27:20it never asks, the trials never ask the
27:23question, "What is the right level for
27:26an individual person?
27:28What is the level that makes you feel
27:30your best? And if you can find it, how
27:33do you stay there?"
27:35Okay? The studies didn't ask.
27:38And because they didn't ask, they didn't
27:39provide a question.
27:41Well,
27:42in a a perverse, you know, turn of
27:44events, we applied a a study designed
27:47beautifully for the New England Journal
27:49of Medicine to individual patients, no
27:51matter how tall they are, no matter how
27:53big they are, no matter how old they
27:54are, no matter their starting point, and
27:56we say, "Everyone gets on the same
27:59escalator
28:00and try to make it to the top."
28:02Right? That's what you were told.
28:05Okay, let's get you to 15 mg cuz that's
28:07the greatest efficacy on a population
28:09level. Okay?
28:11Here's the tragedy of that.
28:13A lot of people don't need 15 mg. A lot
28:15of people don't need 5 mg. Some of my
28:18patients, and this is real, real
28:20patient, real data.
28:22Her name is Mary Alice. She came to me,
28:23she's 30 years old. She'd been trying to
28:25lose, you know, 20 lb
28:27uh without success for quite a long
28:29time.
28:30>> [snorts]
28:31>> And she warned me. She said, "Doc, I'm
28:33really sensitive to medicine.
28:35Okay? I'm really scared of side effects.
28:37I I've heard a lot of bad things about
28:38GLP-1s." And I said, "Well, let's take
28:40the the standard dose, which was 2 and
28:421/2 mg, which is a peptide.
28:44Let's cut it in thirds. Let's start you
28:46on literally a third, less than a
28:48milligram.
28:49Okay? Well, wouldn't you know,
28:51she was she wasn't tell she wasn't
28:53lying. She was really sensitive. She got
28:55super sick.
28:56Okay? She didn't leave the bathroom for
28:58a week.
28:59>> Wow.
29:00>> Well, what would the standard dosing
29:01ladder say to do? Well, first of all, he
29:03would have started her on 2.5. Can you
29:05imagine
29:06what her experience would have been?
29:08But what they would say is, well, let's
29:09hold it there. Well, guess what? If we
29:11had held it there,
29:13the next week she'd have been higher.
29:15The next week she would have been
29:16higher. The pharmacokinetics don't
29:17change just because your dose decreases.
29:20Okay? So, here's what we did for her.
29:23Here's what we did for Pat May, and
29:25here's what we did for myself.
29:27Go back
29:28uh uh
29:296 months from that period of time. When
29:32I realized that the pharmacokinetics
29:34result in inevitable progressive
29:36escalation of levels,
29:38the the question
29:39was just burning into my mind. Can I
29:42figure out where
29:45I am right now, based on all my previous
29:47doses, based on when I took them. Can I
29:50figure out a number, this is my level
29:53right now. This is how much medicine is
29:55in my body
29:56right now, at this moment. Okay?
29:59If you can figure that out,
30:02what is the dose? This is so critical. I
30:04hope everyone is listening right now.
30:06What is the dose
30:09if I'm down here, because my body has
30:11metabolized some of that medicine, and
30:13I've established this is the level at
30:16which I feel the best?
30:18What is the dose to get me back to here?
30:22Okay? I'm so glad you brought this up.
30:25Uh you know, we've established that
30:26green band is the therapeutic window.
30:28That's where I feel my best. What would
30:30this patient's experience be in this
30:32scenario, which is hypothetical? The
30:34first dose,
30:35their level wasn't high enough.
30:37They didn't have adequate hunger
30:38suppression, and of course they didn't
30:40experience side effects, because they
30:41never reached a therapeutic
30:43level. The second dose, that's that
30:46magical day, right? You're in your green
30:48zone, your appetite is suppressed,
30:50you're not above it though.
30:52So, you're not experiencing a lot of
30:53side effects, but you get hungry
30:56on day five.
30:58How many of us have had that had that
30:59experience, right? You have a day or so
31:01where you can't eat that much, three or
31:03four days where you feel great, and
31:04towards the end the medicine wears off
31:06and you go, "Man, I really hope Monday
31:08comes quick so I can take my next dose,
31:09right?"
31:11Well, what if you could say,
31:13"I I need to take a dose right now.
31:16I'm hungry.
31:17But how much do I need to take to get
31:19right back to where I was?"
31:22You know, because the week before I felt
31:23great. Why would I take the same dose
31:26and escalate above that?
31:28Because there's nothing but badness
31:30that's going to happen. You You already
31:31have adequate hunger suppression.
31:34So, what's going to happen is you're
31:34going to experience side effects for no
31:36reason or you're going to force your
31:38body to adapt to a higher dose
31:41when it doesn't have to.
31:43And that is so important because if you
31:46force your body to adapt to higher and
31:47higher levels, your body starts to need
31:49that level of medicine to maintain
31:52adequate control, okay? So,
31:55that's the question. Can you find your
31:58own ideal level of medicine? If you can
32:00find that, can you calculate how much do
32:02I need to take at any moment in time
32:06to get me right back there?
32:09Okay?
32:09And when I found that level,
32:12over time, you can see in the graphic
32:13here, they have that consistent dose
32:16over time where they stay in their
32:17therapeutic range, they're feeling good
32:19every dose, and they're having that
32:21first day experience that I wanted back
32:24every day.
32:25Okay? Well, what happens next? Your body
32:28will adapt. You're losing weight. Your
32:30body changes. Your insulin sensitivity
32:31is improving.
32:33You know, you're not a static creature.
32:36Okay? So, you probably will need more
32:38medicine over time, which is why they
32:41designed the escalation to happen.
32:44Well, here's what you could do
32:46in a perfect world.
32:48What if you found your therapeutic level
32:50and you find a way to know what your
32:53dose is to stay in that green band at
32:55all time. But then you have a week where
32:57you're like, man, I I didn't have side
32:59effects, but I got pretty hungry early
33:02on, maybe even a a day or two after your
33:04dose.
33:05Okay?
33:06The standard protocol would say, well,
33:08then double it.
33:10>> Mhm.
33:11>> Okay?
33:12It stands to reason that would put you
33:14above your green zone, throw you into
33:16side effects, which many people, in
33:18fact, probably most people experience
33:20when they escalate their dose.
33:23Right? And put you on that treadmill of
33:25increasing escalating levels.
33:27Well, this is what the standard level of
33:30the standard dosing protocol does. This
33:31is the actual standard protocol. You
33:35have 20 weeks
33:37of four at a time fixed doses and then
33:40an increase and then four fixed doses
33:42and an increase. Would you believe that
33:44in that entire 20 weeks, you do not have
33:47the same medication experience on any
33:50week?
33:52>> Every week.
33:53>> That to me is the mic drop.
33:57You have So, what you're saying here is
33:59that if you're following the standard
34:01dosing protocol, which is what I just
34:02had thrown up on the screen, right?
34:04You're you're 4 weeks on the dose and
34:07then the fifth week you're on a next
34:09higher dose. During the entire process,
34:13you never have the same amount of drug
34:16in your system. So, if you're feeling
34:17good on a day or a couple days stretch,
34:21well, hold on, cuz it's all changing
34:24within a matter of a couple days.
34:26>> Correct. And so, that is the tragedy of
34:29this is
34:30everyone has their own level where they
34:33feel their best at one moment in time,
34:35and even though that target may change
34:37over time, the standard dosing protocol
34:39does not ask the question
34:41and provides no way of answering it or
34:46holding, even if you could figure out
34:49the answer.
34:50Okay? Well,
34:52I I realized this. I basically, you
34:55know, took a week, cracked open some
34:58pharmacology textbooks, and, you know,
35:00had some conversations with ChatGPT,
35:01talked to some pharmacists, and figured
35:03out, okay, what are the equations? Could
35:05I calculate my level based on if I knew
35:08all my previous doses and I put them in
35:09accurately, can I calculate that level?
35:12Well, turns out you could.
35:13So, I figured that piece out. Then I set
35:16out to answer the next question is, at
35:18any given time, can I calculate how much
35:20to take to get back to that level
35:23that I felt good at?
35:25And turns out the answer to that is yes,
35:26too.
35:28So, when I've And And this is before you
35:29Trust me, I hadn't built an app yet.
35:31This was me in Google Sheets.
35:33>> Yeah.
35:33>> Okay? One dose at a time. Okay, for me,
35:36for my regimen.
35:38Well, it turns out you can do it, and
35:41it's world-changing.
35:43Because you can figure out where you
35:44feel your best, and you can actually
35:46calculate on a rolling dynamic basis
35:48where you want to be.
35:49Well, I retired from the ER, I opened my
35:52own clinic, and I started basically,
35:55you know, finding patients to see if
35:59this worked not just for me, but for
36:01others as well.
36:02Okay? And for a whole year,
36:05you know, not thinking long-term,
36:06really, just thinking for my individual
36:08patients in front of me,
36:10if we can do this, if we can calculate
36:12your level, figure out the right dose to
36:13get you to your therapeutic range, and
36:15increase by a smaller increment every
36:17time you plateau, not doubling the dose,
36:20but just nudging it up, and the average
36:22nudge in our practice is 2%.
36:24>> Mhm.
36:24>> Okay? 2% increase.
36:26>> What are the What are the so tirzepatide
36:30uh the standard dose
36:32uh escalation
36:34I mean, you go from
36:362.5 to 5, you're increasing your dose
36:39100
36:40>> right?
36:41>> And you're doing 2%.
36:43>> Correct. So, a a 10, you know, 10 10x at
36:46least, you know, increase in resolution.
36:50Okay?
36:51Well, it turns [snorts] out a 2%
36:52increase for most people is enough
36:54to break a plateau. Okay? And these are
36:57>> just to pause right there,
36:59when you say the this patient patient
37:02population that's responding to this
37:03therapy and that are following the
37:05protocol are not diabetic, correct?
37:07>> Uh some of them were. Some of them were
37:08not.
37:09>> Did you notice a difference in terms of
37:11how much you had to crank the dose up
37:13with a diabetic versus a non-diabetic to
37:15respond?
37:16>> Uh to be honest, not really.
37:17>> Really?
37:18>> Okay, the primary differentiator is the
37:19starting weight. People that are at at a
37:22much greater body weight overall
37:24typically require high doses of medicine
37:25to find that therapeutic effect. People
37:27that are relatively lower in weight, so
37:29BMIs of, you know, 30 or around there,
37:31typically respond to doses that are like
37:34literally a fraction of the standard
37:37dose. That's Mary Alice, okay? Because
37:39we found her level and dropped it. Her
37:42next dose after that 1 mg dose
37:46which was three units in an insulin
37:48syringe, her next dose was one unit.
37:51>> Wow.
37:52>> Okay? A tenth of the starting dose. And
37:55wouldn't you know, this is again, try
37:57not to bury the lead, three months later
37:59she had lost her 30 lb
38:02and guess what? She never even reached
38:04the starting dose.
38:06>> Wow.
38:07>> She never took 2.5 mg at one time of
38:10tirzepatide ever in her entire course of
38:12treatment. And guess what? She we we we
38:15tapered her down, we transitioned to
38:17maintenance, and her maintenance dose
38:18was about a third of the starting dose
38:20of tirzepatide.
38:22Had she gone to a typical doctor with
38:24the recipe in front of them,
38:26they would have started her on 2.5, she
38:28would have been sick as a dog and either
38:30quit or had a miserable experience for
38:33the next 3 months, lost that 30 lb, two
38:36to one lean mass to fat mass,
38:39and looked and felt terrible in the end.
38:42Right? That is the
38:44outcome for so many with standard
38:46dosing, and we have to find a way to
38:48individualize that because
38:51you know, if there if there are people
38:53that only need a tenth of the starting
38:56dose,
38:57we have to find a way to identify them
39:00and to adjust their dosing to match
39:02their needs.
39:03Okay?
39:04>> Yeah, and I I obviously this is this is
39:06a big problem because I I think, you
39:09know, if I were to to find a reason to
39:11push back
39:12on on what you're saying here and and
39:16look at the clinical trials and say,
39:17well, why didn't they investigate this
39:20in the clinical trials? You know, if
39:22there's if there's any pushback, you
39:24know, you can look at the post-marketing
39:25data. Whether our community likes this
39:28or not, people don't stay on these drugs
39:31long-term. Like a lot of times they'll
39:32go back to them over time, but the the
39:36discontinuation rate of these drugs is
39:38something that the industry is really
39:40wrestling with.
39:41>> Yeah, it's it's the the major headline
39:43this year, okay? 40 to 70% attrition,
39:46okay? Because of about equally split
39:49side effects and cost.
39:51>> Sure.
39:52>> Okay? Here's the, you know, mic drop for
39:55that. Those two are related.
39:57>> Yeah.
39:57>> If you jack up your dose and you're
39:58taking more medicine, you're spending a
40:00lot more money and you're probably
40:02experiencing a higher degree of side
40:04effects. And potentially, and this is
40:06the key to understand, potentially
40:07without any actual increase in the rate
40:09of weight loss for that spend, okay?
40:13In our clinic, we did a retrospective on
40:16our, you know, first 112 patients that
40:18we dosed with precision dosing, finding
40:19their level, finding their minimum
40:21effective level for the medicine, and
40:23dosing them to that over time.
40:25They lost weight faster
40:27than the trials.
40:29>> Mhm.
40:29>> Okay? [clears throat] They lost weight
40:31at a at a rate of 1.1 to 1.3 times at an
40:34time-matched interval from what the
40:36landmark trials showed. But, guess what?
40:39They used 50% of the medicine.
40:42>> Wow.
40:42>> So, they took less medicine, and they
40:44lost more weight. Well, how is that
40:46possible?
40:47Well, the standard dosing ladder, if you
40:49overdose,
40:50is
40:51malignant to muscle mass, and really
40:53dangerous to your metabolism.
40:56Okay? So, you'll reach a plateau earlier
40:59if you are losing muscle mass, and
41:01losing metabolism, and not getting
41:03enough nutrition. And you'll hit an
41:05early plateau that you wouldn't have
41:06otherwise. Well, what's the only
41:07solution that the standard dosing ladder
41:09has for that? Double your dose.
41:12Well, that's going to make the problem
41:13worse.
41:14Okay? To make the problem better, you
41:16find the minimum effective level, and
41:18you don't go above that unless you have
41:19to. Okay? Allow your body to lose weight
41:22at that 1 to 2 lb per week that is
41:25sustainable.
41:26Avoid side effects. And if you have side
41:28effects, realize
41:29those have a cost. If you can't eat for
41:32a week, that has a cost. It has a
41:34metabolic cost. It has a muscle mass
41:36loss. It has a nutrition cost. Okay? So,
41:38don't stay there. Go down a little bit.
41:42Okay? Well, that isn't possible in the
41:45current prescriptive pathway. Okay?
41:48So,
41:50suffice to say, that was our experience
41:52in that first year. I I began to realize
41:55that this is a solution. I'm not saying
41:58it's the solution. There are other ways
42:00to solve this problem of overdosing.
42:01Many clinics are doing experimenting on
42:03their own with microdosing, and
42:05splitting dosing, and finding ways to
42:07match this
42:08experience to the dose better.
42:11But, I'm not aware of anyone that's
42:13doing it with a degree of visibility and
42:15precision that our method utilizes.
42:19Because if a if a doctor says, "Well,
42:20let's just not go up as much."
42:23Well, that's better than doubling your
42:25dose, but you're still going to stack.
42:28You're still going to have a little bit
42:29of a different increase, you know, with
42:31each dose of that, and it's very
42:33difficult
42:34to find a stable, reproducible
42:37experience on a dose-to-dose basis
42:39without actually being able to see your
42:41level. And, you know, thank you for
42:43bringing up this graphic. This is in our
42:45current application that we built to
42:47actually make this possible. Because,
42:50you know, providers
42:51are not going to calculate every
42:53patient's levels and every dose every
42:55week like I had to do for a year. Okay?
42:58That is not scalable.
43:00>> Wow.
43:00>> Okay?
43:01So, you need technology to make this
43:03visible.
43:04Well, what does our application do?
43:06It calculates in real time how much
43:08medicine is in you right now.
43:11Okay? That's that green line.
43:13The purple line,
43:14that's your target. We call it my level
43:16just as a way to communicate the
43:18information to lay people. But, you say,
43:20"What is your ideal level?"
43:22Well, that's what that number is. We
43:24split the total dosing range, you know,
43:27zero being off, no medicine, 50 being
43:30the level you would reach if you took 15
43:32mg once a week, or 2.4 mg once a week.
43:37Whatever that calculated level is from
43:39the standard dosing, the max. That's
43:40what we set as the ceiling. We don't
43:42want to go above that because that's not
43:43been really studied.
43:45But, in between that,
43:47we split that therapeutic level into 50
43:49steps.
43:50Okay? 50 steps. So, when you increase,
43:53you're going 2% up the ladder. Now, this
43:55is critical.
43:56Not 2% increase in your dose.
43:592% increase in your experience.
44:03>> Mhm.
44:03>> Okay? I want it to be a a stronger.
44:05Well, how much stronger?
44:07You go up one, it's 2%. You go up two,
44:10it's 4%. We actually put up a warning
44:13label if you go up more than three
44:15because most people don't need an
44:17increase bigger than that and they may
44:19experience side effects.
44:21Okay? So,
44:22with this,
44:24you know, within the first few weeks
44:25with supervision, with a provider who
44:28cares and understands this method, you
44:30can find your ideal level. You can find
44:31that sweet spot. It usually only takes a
44:33couple doses.
44:34From there, you put a pin in it. This is
44:37you my personal my level. This is where
44:39I feel my best. Every dose I take, no
44:42matter whether it's early, whether it's
44:43late, whether it's on time, whether
44:45it's, you know, 2 days before a trip cuz
44:48you don't want to take your medicine
44:49with you or 2 days after a trip cuz you
44:51back got back and forgot to take your
44:52medicine with you, it always calculates
44:54and tells you, "How much do I take to
44:57get right back to where I felt?" What is
45:00What happens right now in those
45:01scenarios?
45:03Well, doc, I'm traveling. Can I take it
45:04early?
45:05Uh
45:07sure.
45:08Well, what happens?
45:10You just overdosed because it stacked up
45:12more than you predicted before. If you
45:14took the standard fixed dose early, your
45:17level got too high.
45:18Now you're sick on your cruise.
45:20Strong work. Or you say, "I'm not going
45:23to take it. I want to take it later and
45:25catch up." Well, how much do you take to
45:27catch up? If you take your standard dose
45:29later,
45:30more has been used up and now you never
45:32get back to where you wanted to be.
45:34>> Right.
45:34>> So, it's it's chasing a ghost. It's
45:36like, "Where is this perfect level where
45:38I feel so good, where my appetite is
45:40controlled, that kind of heavenly place
45:41that we're all looking for?" Well, if
45:43you can visualize it and know what it
45:46is, you can actually calculate how much
45:48to take to get there. That's what we've
45:50innovated.
45:51That's we've rolled out to our patients
45:53in my clinic and we're, you know, moving
45:55as quickly as we can to make this
45:57available to any provider who wants to
45:59dose their patients with precision and
46:02to any patient that wants to have a
46:03consistent day-to-day control over their
46:06GLP-1 experience. And and this is what
46:08I'll say just in summary of this
46:10component.
46:12GLP-1s
46:13when dosed with precision
46:16and when you have control and visibility
46:19they can be
46:21and you know, remember my provider that
46:22said they're magic.
46:24>> Mhm.
46:25>> Well, it turns out they are.
46:27If you can turn them and adjust them
46:30like a dial where you say, "I want a
46:32little more control.
46:34I want a little more room.
46:36I'm having an event
46:38coming up that I'd like to enjoy. Let
46:40your levels drop a little bit further
46:41and then catch up with precision later."
46:44It becomes like a thermostat dial for
46:47your appetite that can be utilized to
46:49actually do what?
46:51To find that place of balance where I'm
46:53not having to obsess over my appetite,
46:55but I also can live life.
46:58I'm not controlled by the medicine. Like
47:00we've all had that experience, right? I
47:01go to barbecue. I really want to eat
47:03that today.
47:04But I can't.
47:06If I do, I'll get sick. That's the
47:08medicine driving the ship instead of you
47:11saying, "You know what? This moment in
47:13my life is important.
47:15I want a little more room. I want to
47:16enjoy that. Can I do that with precision
47:18and then catch up
47:20in a way that is visible and
47:22reproducible next time?"
47:23Well, nobody's doing this. Why?
47:26Cuz it takes a lot of math.
47:28And it's really hard. And you have to
47:30find a way to make it easy and simple
47:32both for providers and for patients. And
47:34I believe that we have come up with a
47:36solution that makes it possible for
47:38almost day one.
47:38>> Yeah, and not only that, but even some
47:41of the most seasoned folks who have been
47:42in the community for a long time don't
47:44understand, you know, just the basic
47:46elements of the pharmacokinetics of the
47:48drug and the way that it built one one
47:50dose builds on another. And I think, you
47:54know, I had never even considered the
47:56fact that during the titration process,
47:58you're never going to experience the
47:59same amount of drug in your system.
48:01>> That one time is insane.
48:03>> But what's uh and I want to
48:05give a shout back out to industry. It
48:07was a brilliant design for a study
48:11because [snorts] if they had thrown
48:12everyone on the max dose right away,
48:14no one could have tolerated
48:16>> Nobody stayed on the trial, right?
48:18>> They did a fabulous job for assessing
48:20efficacy, for proving that it does work
48:23at these defined population levels. The
48:25study just wasn't designed to answer the
48:27question for the individual. And here's
48:29why they haven't done it, because big
48:31studies cost a lot of money and this,
48:35you know, precision process that I've
48:37described to you is not possible without
48:39technology.
48:40>> Mhm.
48:41>> And so, that's a pretty far bridge to
48:44cross when you have a medicine that on a
48:46population-wide basis is working pretty
48:47well. But here's the challenge.
48:51It actually isn't working well. That's
48:53what we've discovered the past year.
48:55People can't stay on them. They're
48:57having unnecessary side effects. They're
48:58having outcomes that are inconsistent
49:00with the goals of the drug.
49:02And so, therefore, we need to find out a
49:05new paradigm,
49:07run the studies, get the data,
49:10okay, figure out a way to use these
49:12tools of precision. I use this example
49:14all the time. A sledgehammer.
49:17Incredibly important tool in
49:18construction. You can drive in a
49:20railroad spike, basically into steel
49:22with it. Well, that's pretty cool. But
49:24if you miss and hit your ankle, you'll
49:27break every bone in your leg.
49:29>> [snorts]
49:30>> Okay? That is the best description I can
49:33think of of a GLP-1. When dosed with
49:35precision, it makes the impossible
49:37possible.
49:38But when dosed with imprecision, it
49:40makes the impossible inevitable
49:43and comes with it a host of undesirable
49:45side effects and outcomes. And so, we
49:47have to figure out a way to use these
49:49tools in a way that is
49:51effective, but also safe. And And
49:55unfortunately,
49:56it's different from person-to-person.
49:58There's no single answer. We have to
50:00find a way to make it uh precise for
50:03every individual.
50:05>> Yeah. I love I've always loved the idea
50:07of of incremental dosing and and the the
50:13sort of
50:15variety or variety is not the right
50:17word, but the the utility of of a
50:21multi-use vial uh that you're able to
50:23get through compound pharmacies.
50:25>> Mhm.
50:25>> And I know that Lilly has
50:27uh has gotten approval for both Zepbound
50:30and Mounjaro in multi-use vials, uh but
50:33have yet to to release them.
50:35Uh you know, I think
50:38how do you kind of see this in in the
50:40real world playing out? Like let's say
50:42compounds became a little bit more
50:43difficult to uh obtain when so many of
50:47these drugs are in fixed-dose pens.
50:50>> Yeah. It's It's a fabulous question. So,
50:53let's get into the
50:55the compounding question just a little
50:57bit. Okay? Compounding serves an
50:59essential function within the
51:00pharmaceutical industry, and it serves a
51:02function that that by definition has to
51:05pass two tests.
51:07Okay?
51:08Uh well, actually, there's three
51:09options. One is shortage. There's not
51:12enough medicine to go around.
51:14Well, the FDA has said, you know, if
51:15there's not enough medicine to go
51:16around, then yeah, we're going to let
51:17pharmacies make their own. Okay? It
51:18fills a a critical need. Okay, we all
51:20experienced that, you know, a couple
51:21years ago when semaglutide was in
51:22shortage where diabetics couldn't get
51:24it.
51:25Okay? Well, that's not acceptable.
51:26Compounding fills that role.
51:29But, the What is the other bucket that
51:31compounders can fill?
51:33It is patients with a medical need
51:36for something different from the
51:37commercial formulation.
51:38And require a dose that is different
51:40from the commercial formulation. Okay?
51:43Well,
51:44this is my
51:46banner to wave about that.
51:48Real patients, Mary Alice,
51:50she didn't need 2.5 mg of tirzepatide.
51:53In fact, that would have been a horrific
51:55experience for her. In fact, she didn't
51:57even need a milligram.
52:00She needed a fraction of that to have
52:02the drug's intended outcome.
52:05Okay? That need
52:07can't be met by the commercial
52:09formulation currently.
52:10If we tried to stuff her into that box,
52:13she would have been deathly ill and had
52:14a really negative experience and
52:17probably quit the drug.
52:18Okay? Which is I know is not the
52:20intention of the pharmaceutical
52:21uh manufacturers either, right? So, it
52:24just she had a documented medical need.
52:27Okay? Cuz you couldn't tolerate the
52:28standard dose.
52:29And the dose [snorts] we gave her was
52:30certainly, you know, greater than 10%
52:32different than the commercial
52:33formulation. That's just one example of
52:35many. Okay? The question is how do
52:37identify those people?
52:39Right? How do you figure out who the
52:41commercial formulation will work for and
52:43who they won't? Okay? My answer to that,
52:46in naked self-interest here, is I think
52:48using a tool like mine to find their
52:51precise level
52:53and assess, is this a person who the
52:55form commercial formulation will work
52:56for? If so, fantastic.
52:59I don't have a beef with commercial
53:00drugs. In fact, they're amazing. You
53:03know, thank you, Eli Lilly and Novo
53:05Nordisk for making these tools possible.
53:07Okay? For patients that your
53:08formulations work for, I want them to go
53:11to you.
53:12Okay? But for patients that your
53:14formulations don't work for, they need
53:17an option.
53:19And my ask of the pharmaceutical
53:21industry is, "Please provide us that
53:23option. Don't make us choose between
53:26compounded meds and a commercial
53:28formulation." Really?
53:30>> Okay, release the vials.
53:32>> You know, that would solve a huge
53:34component of the problem. Okay? Uh in
53:36the current environment,
53:38it's not met by that and I believe there
53:40is a huge subset where it is not
53:42medically appropriate to do the standard
53:45dosing ladder. They have a documented
53:46medical need for something different and
53:48compounders legally should be able to
53:51fill that gap.
53:53>> [snorts]
53:53>> The challenge is you actually have to
53:55take care of the patient. You have to
53:57know the patient. You have to look into
53:59their experience and understand it and
54:00that is the gap that a lot of telehealth
54:02companies are not filling.
54:05Okay? If you just write a script for
54:07someone you never seen or talked to and
54:08don't have any visibility into their
54:09experience,
54:11you know, it's hard to meet that
54:12two-part test.
54:14But if you have some technology that can
54:16give you a window into that experience,
54:17then you can justify it and not just to
54:19justify it because it's real, because
54:22they need it, because they need it to
54:24succeed.
54:25>> Right.
54:26>> Um
54:27you know, if someone from the industry
54:29out there is listening or watching,
54:31okay? Give me a call. Let's figure out
54:33how to make this type of precision
54:35dosing, whether it's via my tool or
54:37somebody else's tool, we have to find a
54:39way to solve this problem for everyone
54:42to make precision dosing available to
54:45individuals, not just a population.
54:48And if we can, oh my gosh, the benefits.
54:51A population that's losing body fat and
54:54holding on to muscle mass, that's not
54:55suffering from unnecessary side effects,
54:57that don't end up sarcopenic and
54:59breaking hips from osteoporosis in the
55:01elderly population, and also keeping
55:03costs down.
55:05Because if you take less medicine, you
55:07have to buy less of it. In industry,
55:09maybe that's not such a great thing. I
55:11know they want to make money,
55:13but guess what?
55:14If you can go from 50% attrition to
55:17people staying on the drug,
55:19it's it could be revenue neutral
55:22to have a much better outcome.
55:25>> Yeah.
55:25>> So, that's what I want to encourage, you
55:27know, industry to think about is it's
55:29not
55:31it's not the end of the world if people
55:33take less medicine. In fact, it may make
55:36everything better for everyone.
55:39>> Amazing.
55:40I think that this is a a brilliant
55:42strategy and plan that you've come up
55:44with here. I think it's a real solve for
55:46some really serious issues facing facing
55:49patients who are who are getting on
55:51GLP-1 medications or even patients who
55:53have been on them for a long time and
55:54asked a lot of questions about, you
55:56know, just is this is it worth staying
55:57on this for the trade-offs, right? And
56:00so if you can find that ideal number and
56:02I think the most compelling statement
56:03that you've made in this whole
56:05interview is that you you're just you're
56:07never on the same dose twice during the
56:10the escalation period. Certainly, if you
56:12camp out on a dose for a an extended
56:14period of time, then then you'll level
56:16off eventually, but for most people,
56:18you're never on the same dose twice. But
56:20what if you could pinpoint that moment
56:22in time where you felt your best, you
56:24were getting the results that you wanted
56:26and you needed, and then you had the
56:28versatility to, like you said, go on and
56:30live your life. If if it's giving you a
56:32good level of appetite suppression, but
56:34you're going on a cruise and and you
56:36want to be able to enjoy food in the way
56:39that the medication doesn't allow you to
56:41do, go ahead and go off of it because
56:43you have the confidence that you're
56:44going to be able to get back to that
56:45level.
56:46>> Yes.
56:47>> Strategically using the tools that you
56:48have. I think it's a brilliant tool.
56:51Where we at in the commercialization
56:54of this
56:55>> right now?
56:56>> Yeah, so you know, we've we built it for
56:58our for my clinic. Okay, this was never
57:00intended to be, you know, or never
57:02envisioned, let's say, to be something
57:05for widespread use. We just built it
57:06because we wanted to see if it worked.
57:09And to prove the model because I thought
57:11it might be a better way to do those
57:12things.
57:13You know, once we kind of ran our own
57:15internal study and saw the outcomes and
57:17saw over time over that first year just
57:19how much of an a better experience
57:21patients were having,
57:22you know, of course, how could I then
57:25say, "We'll just keep this to
57:26ourselves."
57:27You know, I want that my goal, my dream
57:31is for this to become the standard of
57:32care. Probably not just for GLP-1s, but
57:35for any long-acting medicine. Okay, we
57:37don't have time probably in this podcast
57:38to get into it, but you know,
57:39testosterone could be dosed the same
57:40way.
57:41Let's see we fight the same battles with
57:43peaks and troughs and inconsistencies
57:45and you know, trying to find that ideal
57:47level and dose.
57:48Um
57:48>> [snorts]
57:48>> it's really just an inversion and and an
57:51opening your mind to a different way of
57:53thinking. It's not the dose. It's the
57:56therapeutic level. How do we find it?
57:58How can we dose it? How can we dose it
58:00and how can we adjust to that and how
58:01can we adjust it?
58:02Well, we are to the point where we have
58:03a platform that can be utilized by other
58:06clinics.
58:07If you're a clinic or clinician who's
58:08interested in this, please reach out to
58:10me directly. We'll talk about it. Um we
58:12are working very hard and by we I mean
58:14myself and my very small humble clinic
58:16team uh to get this to the point where
58:18it's something scalable where you know,
58:20anyone who wants to use it can use it.
58:23Uh we're also of course investigating
58:26what does it take to have this be
58:28compliant uh and safe at scale.
58:32Right? We're you know, getting together
58:34an IRB trial to validate this method as
58:36prospectively, not just retrospectively
58:38looking back
58:39uh
58:40>> [snorts]
58:40>> to make sure that it's A, does what we
58:42think it does, but B, uh to be so that
58:45other clinicians and providers can feel
58:47confident that this is the way to go.
58:49Um so it is available for use right now
58:51under with certain limitations. Um my
58:54goal is in the next 6 months to have a
58:56large-scale IRB trial uh to validate
58:59this method that other clinics can then
59:01join.
59:02Uh because that gives us the ability to
59:04do this and use this tool in a way that
59:05kind of passes muster with the FDA
59:08because we don't want apps practicing
59:09medicine. This is not what this app
59:11does. All of these things are uh
59:14effected and supervised by the
59:16supervising physician.
59:18That is critical to mention here. This
59:20is not hey patients, you know, you can
59:24you know, do whatever you want
59:26>> Dose yourself.
59:26>> with this medicine. That is not what
59:28this technology does. It gives
59:30visibility to the patient and to the
59:32provider.
59:33So we can see what that next dose should
59:36be. When a patient requests an increase
59:38or desires an increase, the provider can
59:39approve that and it automatically does
59:42all the math. That's what this
59:44technology does is it takes the hard
59:46work
59:47out of precision dosing and leaves the
59:49patient with a very simple you know, yes
59:51or no. Do I feel good? Do I want to go
59:54up? Do I want to go down? Do I want to
59:56take doses a little more frequently? And
59:58the provider has, you know, perfect
59:59visibility into that same information.
1:00:02It collects side effect info. It
1:00:04collects, you know, patient experience
1:00:06and allows us to actually take care of
1:00:09the individual patient.
1:00:11>> That's amazing.
1:00:13If people want to give you a follow and
1:00:15kind of keep tabs on on what you're
1:00:17doing in the progression of all this,
1:00:18what's the best place for people to find
1:00:20you, Dr. Ian?
1:00:21>> Yeah, so uh that uh
1:00:23handle right there at voafitmd, that's
1:00:25my handle on almost every social media
1:00:27platform. Um I have a a private social
1:00:30media page that maybe we can post in the
1:00:31comments here as well. Uh that's where I
1:00:33post most of my own personal thoughts on
1:00:34this. And then our website, voafit.com,
1:00:38v o a f i t.com. Uh that's where I have
1:00:41a full description of the My Level
1:00:42Method. We have our white paper posted
1:00:44there. Uh all the data sets that we've
1:00:46used to validate this method, as well as
1:00:47going through the reasons and rationale
1:00:50in detail for people that want to learn
1:00:51more about this method. So voafit.com is
1:00:53a great place for that. And you can
1:00:55email me directly, md medical doctor, at
1:00:59voafit.com.
1:01:01That's certainly the most direct line to
1:01:03me. Uh I believe my office phone number
1:01:05is posted on the website as well. Uh I
1:01:07welcome conversations both from patients
1:01:10that are interested, providers who are
1:01:12interested in utilizing or learning more
1:01:13about this tool, or just discussing and
1:01:15brainstorming how do we make precision
1:01:16medicine possible at scale.
1:01:18And then certainly people in the
1:01:20research industry, I would love to have
1:01:22those connections. Uh I am not a
1:01:25researcher by training or trade. I'm a
1:01:28clinical physician who had an idea that
1:01:31I think might be something important.
1:01:33But if there are people in the industry
1:01:35that are willing to join forces and
1:01:37really validate this method, I welcome
1:01:38those phone calls.
1:01:40And then people in industry as well,
1:01:42you know, from the pharmaceutical
1:01:43companies.
1:01:44You know, my goal is to help,
1:01:47you know,
1:01:48everyone to be able to succeed on these
1:01:51medicines and to help them reach their
1:01:53amazing potential that I think is being
1:01:56squandered by a dosing protocol that
1:01:58doesn't individualize the treatment. So,
1:02:00>> Yeah.
1:02:00>> And and pharma companies, I would
1:02:02challenge pharma companies
1:02:04to consider, you know, consider this
1:02:07method in their clinical trials in the
1:02:09future.
1:02:10You know, I think this would be a great
1:02:12way to
1:02:13personalize medicine,
1:02:16to leverage technology to personalize
1:02:18medicine when it comes to these drugs in
1:02:19a real big solve as you said uh to the
1:02:21attrition, you know, the the drop-off
1:02:24rates on on GLP-1 medications because
1:02:27that is something that the industry
1:02:28badly and surely wants to address and
1:02:30this this accomplishes that and it it
1:02:32delivers a personalized experience to
1:02:34patients that I think would make their
1:02:36experience
1:02:37much more efficient with these
1:02:39medications and I think that that's
1:02:40great for everyone.
1:02:42>> So, let me
1:02:43at the risk of getting too personal, let
1:02:44me take this back to your experience.
1:02:46>> Yeah.
1:02:46>> Right?
1:02:48Your experience from what I understand
1:02:49and correct me if I'm wrong,
1:02:50is you were escalated very quickly
1:02:53to the max allowable dose
1:02:56in order to, in theory,
1:02:58okay, from a good place of mind, effect
1:03:00the most possible weight loss in your
1:03:02situation.
1:03:03>> Yeah.
1:03:03>> Okay?
1:03:04The outcome, unfortunately,
1:03:07is you
1:03:08forced your body to adapt to a very high
1:03:12dose very quickly
1:03:15and made it very difficult for you to
1:03:16sustain weight loss over time and to
1:03:19quit the drug.
1:03:20Okay?
1:03:22If you can bring up the the document one
1:03:23more time and scroll down, I just want
1:03:25to bring up that slide where it's the
1:03:26difference between the standard dosing
1:03:28protocol and how escalation can happen
1:03:31in the My Level method. So, go
1:03:34down. Right. Keep going. All the way
1:03:36down.
1:03:37Keep going.
1:03:38>> Going Going back to the beginning or
1:03:39>> No, no, all the way down to the bottom.
1:03:41>> Oh, to the end. Okay. Yep.
1:03:44>> Right. Keep going. Keep going. Keep
1:03:46going. Right there.
1:03:47Up. There we go. Okay. Now, this is This
1:03:50is not a real patient's data. This is
1:03:52This is a representation
1:03:54of what it's like to find an ideal level
1:03:57early, which you can see if you can zoom
1:03:58in with your eyes, is lower than the
1:04:00first peak.
1:04:01Okay? This is representative of someone
1:04:03like Mary Alice. Okay? Where we found
1:04:05that perfect level, and there was
1:04:07adaptation over time. You did need more
1:04:09medicine over time, but you only needed
1:04:112% more, not 100% more, 50% more, 25%
1:04:16more. Well, over time, that delta or
1:04:20difference between those peaks in the
1:04:22standard protocol and the peaks in the
1:04:24My Level protocol,
1:04:26that represents savings in cost,
1:04:30uh savings in metabolic adaptation where
1:04:33you're not forcing your body to adapt to
1:04:35a higher level of drug,
1:04:37and it also results, of course, in lower
1:04:39side effects because that's primarily
1:04:40determined by your medication load.
1:04:42Well, here's the key. How How How many
1:04:45weeks did it take you to get to 15 mg?
1:04:48Do you remember?
1:04:49>> Uh 16, maybe?
1:04:51>> Okay. That is so fast. Okay? So, you got
1:04:55to the top
1:04:56of that escalation protocol early.
1:04:59>> Yeah.
1:05:00>> Within 16 weeks. Well, once you're
1:05:02there,
1:05:03you have nowhere to go.
1:05:04>> Right.
1:05:05>> no option. Okay? Your body's adapted to
1:05:07that high level. If you start to quit
1:05:09after you try to quit, your body screams
1:05:11at you. It says, "No. Like, I need this
1:05:14much medicine to maintain appetite
1:05:15control. You get ravenous. You have a
1:05:18very high risk of regain." Okay? Well,
1:05:20what if you got to that same 16 weeks
1:05:23dosed with precision?
1:05:25If you can see on that scale, the
1:05:27difference between the peak at 15 and
1:05:30the peak where you could be,
1:05:31potentially,
1:05:33on precision dosing. Well, now, let's
1:05:36say you do adapt and you need more. You
1:05:39have years of runway
1:05:41>> Right.
1:05:42>> to utilize the incredible benefits of
1:05:44these medicines. I have patients that
1:05:45have been on this medicine with this
1:05:47with this method for 2 years and they're
1:05:49still at 7 and 1/2.
1:05:51>> Mhm.
1:05:52>> Okay? Because they didn't need any more.
1:05:54Okay? But, this is the key and I wanted
1:05:56to to tie this up here at the end in a
1:05:58bow.
1:05:59When it's time to get off,
1:06:02it makes it possible because you haven't
1:06:05forced your body to adapt to such a high
1:06:07dose, it makes it easier to gradually
1:06:10titrate and step down and allow your
1:06:12body to rewire, to stay for 6 to 8
1:06:16months at a maintenance dose,
1:06:18and then gradually taper down to where
1:06:19your body can maintain that new set
1:06:22point. Okay? It is possible. And the
1:06:24best example I can give you of that is
1:06:27me.
1:06:28>> Mhm.
1:06:29>> I used to wake up in the morning, every
1:06:31morning, and eat 2,500 calories before
1:06:3310:00.
1:06:35I just my appetite was absolutely
1:06:38ravenous. It was like the battle of my
1:06:40life to just keep that calorie number
1:06:42down to maintenance or below.
1:06:45Well, and that's where I would, you
1:06:47know, you overeat and then you over eat
1:06:49restrict and that's why I would end up
1:06:50running marathons after Thanksgiving is
1:06:52trying to manage this appetite.
1:06:54Well, after a few years of precision
1:06:56dosing
1:06:57and titrating down carefully and
1:06:59precisely, guess what?
1:07:02I don't need to take a GLP-1 anymore.
1:07:04And I also, you know how many calories I
1:07:06have on an average breakfast?
1:07:08About 4 or 500.
1:07:10And do you know that I can maintain my
1:07:11weight without that?
1:07:14I'm not saying [clears throat] that's
1:07:15that will happen for everyone, but it is
1:07:17possible.
1:07:19It It's possible if you don't
1:07:21relentlessly escalate someone to a high
1:07:22dose and make it impossible for them to
1:07:24come off. The beauty of these drugs is
1:07:26if you can dose them precisely, titrate
1:07:28off intelligently, and not overdo it in
1:07:30the middle,
1:07:31people have a chance of actually not
1:07:34needing them in the future. And if they
1:07:36do need them in the future, this is so
1:07:38key.
1:07:39They may not need 15 mg a week, which is
1:07:42really expensive.
1:07:44Okay? People are quitting due to cost.
1:07:46If you can reach your goal weight and
1:07:48find maintenance on a fraction
1:07:51of the ending dose of the trials, you
1:07:52can stay on that longer. You don't have
1:07:54to quit due to cost.
1:07:56So, that's what precision dosing makes
1:07:58possible. Um my dream is to make that
1:08:01possible at scale.
1:08:02>> Yeah, I would love to see how the how
1:08:05the data ultimately shakes out um in
1:08:08some larger
1:08:09studies here. I think that this I think
1:08:11that you're onto something and I think
1:08:13that it will be successful. Uh and so
1:08:15I'll be eager to see how that all pans
1:08:17out and hopefully we'll be able to to
1:08:19connect you with some folks that can
1:08:22um catch the vision, too. I would I
1:08:24would hope that some folks within
1:08:26earshot are are listening.
1:08:28>> So, I'll I'll name-drop a few groups
1:08:30that I'm working with right now uh
1:08:32really because they have been an
1:08:33incredible help in moving this forward.
1:08:36So, Aurora Health and Aesthetics is one
1:08:38group. They've been incredibly
1:08:39instrumental in helping us move this
1:08:41forward. NextGen MD 360, uh they're an
1:08:44amazing clinic that has helped us as
1:08:46well. Uh scripts.co
1:08:48uh is one as well. And then there's some
1:08:50smaller clinics like Crux Point Health
1:08:52Solutions in uh Denver, Colorado and
1:08:55some other groups as well.
1:08:57Um
1:08:57Uh Striker Pharmacy, I need to to
1:08:59mention them as well. They've been
1:09:00incredibly receptive to the concept and
1:09:03idea of precision dosing. Um but it's
1:09:05just the beginning. You know, my goal is
1:09:07to have this be a universal tool that
1:09:09anyone can access to take better care of
1:09:11their their patients. And uh that's
1:09:13where we're heading and I hope, you
1:09:14know, it's met with a receptiveness in
1:09:16the industry for sure.
1:09:17>> Amazing. Dr. Ian Ellis, I really
1:09:20appreciate you coming on and sharing
1:09:21with us today. This is I think this is
1:09:23an exciting thing to to think about and
1:09:26I I I think a a natural sort of
1:09:29evolution of the space towards genuinely
1:09:31personalized medicine when it comes to
1:09:33this stuff. I just don't think that uh I
1:09:36just don't think by and large everybody
1:09:37fits into that
1:09:39um clinical trial box and this is a out
1:09:42of the box way of of looking at it. So,
1:09:45kudos to you and what you're creating
1:09:46there and I can't wait to watch how it
1:09:47all unfolds.
1:09:49>> Well, thank you. And I'll just say this,
1:09:50uh you know, this is a solution.
1:09:53I'm not saying it's the solution. There
1:09:55may be other ways, other minds, other
1:09:57creative ways to personalize these
1:09:58medicines. That is the goal here. It's
1:10:01not to use a particular tool, a
1:10:02particular app, particular technology,
1:10:04but as an industry,
1:10:05that is my passion. It was my passion
1:10:07when I was 14 years old. We have to
1:10:09solve this obesity crisis, which is
1:10:11absolutely killing
1:10:13our country, literally.
1:10:15GLP-1s are the best tool that has ever
1:10:18been invented to make a dent in that
1:10:21gargantuan task, but they are being
1:10:24squandered by the way people are being
1:10:27dosed. We have to find a solution. I
1:10:30would love to be a part of that
1:10:30solution, but I would also welcome
1:10:32conversation with other thinkers who can
1:10:35be creative
1:10:36because the status quo is not working
1:10:39well enough for enough people.
1:10:41>> It's definitely not working as well as
1:10:42it could be. Um I know that uh folks
1:10:45will watch this in our community, the
1:10:47these, you know, hardcore GLP-1, you
1:10:50know, from my cold dead hands will you
1:10:52ever pry it. Um but but the reality is
1:10:56there's an even greater number of people
1:10:58out there who have yet to try these
1:10:59drugs and a equal number of people who
1:11:02are quitting them. And um
1:11:05quitting them before they they reach
1:11:06their goals that the drug ultimately
1:11:08could help them reach if if it was done
1:11:11appropriately. I think this is a great
1:11:14uh potential solution and I'll look
1:11:15forward to see how this
1:11:16>> Well, and that's the beauty is if you
1:11:17can gain control of the tool.
1:11:19If the medicine is not controlling you,
1:11:21you can gain control of the tool. You
1:11:23don't have to stay on it all the time,
1:11:25but you can get back on it intelligently
1:11:27when you need to. I mean, speaking
1:11:29personally, when my schedule is
1:11:31controlled, when I'm getting enough
1:11:32sleep, when you know, I'm at home, when
1:11:34I'm exercising regularly, I do not need
1:11:37tirzepatide to maintain my weight.
1:11:39But guess what?
1:11:40Come November, I'm at grandma's house
1:11:42for a month. I'm super stressed at work.
1:11:44I'm not getting enough sleep. I don't
1:11:45have access to my regular exercise
1:11:47routine. I need help.
1:11:49And so it's okay to cycle on and cycle
1:11:52off intelligently and precisely
1:11:56to get your get you through your actual
1:11:59life.
1:12:00And that's my dream for these medicines
1:12:01is for them to be a tool that is
1:12:03flexible, that puts you in control of
1:12:06your experience and your appetite and
1:12:07allows you to again in the very
1:12:09beginning we talked about, okay, you
1:12:10have two choices.
1:12:12Neither of them are good. Either allow
1:12:14yourself to become unhealthy and enjoy
1:12:15your life
1:12:17or dedicate your life in a in an
1:12:18obsessive way to fitness and miss out on
1:12:21so many beautiful things that are
1:12:22related to human flourishing. Okay? If
1:12:25you can use this tool precision, that to
1:12:27me is the way where you can have both.
1:12:31And I'm living proof of that that it is
1:12:32possible. My wife can tell you my my
1:12:34kids can tell you. They are so happy
1:12:36that I am not on the treadmill 3 hours a
1:12:38day. I'm not, you know, pulling out a
1:12:40food scale every night at dinner and
1:12:43eating something different than they
1:12:44are. I'm not saying, "No, I'd rather not
1:12:46go on a vacation to Italy cuz I'm afraid
1:12:48of focaccia."
1:12:50Okay? That's a real anecdote. I'm not
1:12:52making that up. Okay? [laughter]
1:12:54That is possible. I'm living proof of it
1:12:57and I'm not dependent on 15 mg of
1:13:00tirzepatide every week for the rest of
1:13:02my life to have that experience. And
1:13:04that's, you know, the best summary
1:13:06statement I can come up with. It's what
1:13:09precision dosing makes possible if we
1:13:11can just find a way for enough people to
1:13:12do it.
1:13:13>> Excellent. I really appreciate you
1:13:15sharing today. Thank you for giving some
1:13:17of your time to the channel and keep us
1:13:18posted on how this evolves.
1:13:20>> Absolutely. Thank you, Dave. It's a true
1:13:21privilege. Thank you.
1:13:22>> Yeah, thank you, doctor. I appreciate
1:13:24it.
1:13:30>> [music]

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