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>> And good evening.

Thanks so much for watching HealthLine here on PBS Fort Wayne I'm your host Mark Evans talking about a very topical relatively topical anyway subject tonight because it is the holiday season we're going to talk about how to maintain your weight and maybe even lose a few pounds during the holiday season.

But the main thing is is not to gain and we're also going to start the show talking about the GOP one medications better known as those little shots that you can give yourself and so forth.

You've seen the commercials on commercial television.

>> You know, I have type two diabetes and a little presentation like that, some Broadway stuff going on.

>> So we're going to be talking about those and how effective they are.

And we have Dr.

Ryan Singleman who is our special guest tonight and he's been here a few times before.

>> It's great to see you.

Thank you.

It's good to be back.

Absolutely.

And you are a doctor of osteopath.

That's correct.

And you also have I don't think it's on your title bar when that comes up at FAA RFP.

>> What does that stand for ?

It is a fellow of the American Academy of Family Physicians.

So that just means that not only my board certified in being a family physician but I've also spent a number of extra hours and time giving back to the community teaching and doing things like that.

That makes me at a fellow level for that academy.

>> OK, very good.

I was really curious about that.

I saw that last time I forgot to ask this year so the GLP one medications we're going to be talking about at first I do want to open the phone lines because I have a feeling this is going to be a hot topic this evening 866- (969) to seven to zero is the telephone number to call and we'll be here for you for the next half an hour.

We are not commercial TV so therefore we won't be stopping down for commercials.

>> It's a thirty minute program so get your calls in as soon as you can.

>> So Dr.

Syngman GLP one medications how long have they been around?

>> Well that's a really great question.

So they've been around almost pushing into eight and a half to ten years now they've only recently became very much in vogue because the PEN devices have gotten easier to use.

>> They have had a lot better utility behind them so that they work better and there are a lot more accessible in that they're being prescribed for different things not just for diabetes but people use them for losing excess body weight.

You sometimes see them being used for unhealthy livers and things like that.

So they've become much more in vogue though because some of the newer ones have had such a tremendous impact on excess body weight.

>> So they are in turn effective then they are effective at doing that and helping to regulate that GLP one hormone that cannot be working as well in the body and in the human with the GOP ones and they're working properly that can actually reduce some of the hunger signaling they can make your pancreas work a little bit better.

So you actually put out more of your own insulin and also helps to regenerate some of your insulin cells that start to die off over time with diabetes also helps to slow down your stomachs.

You feel full longer and can actually be very effective at protecting your heart from heart disease while also helping your muscles to burn more sugar and burn more energy so they can be effective in many different ways at helping to prompt up or prop up your human body if it's failing for some of those other causes and I've seen them being promoted to help with the AC one right away one right.

>> Sorry.

Oh that's all good one see factors so well I'm glad to hear that they are effective now it is not a magic pill however it's not a magic shot.

>> Correct and you're right there are actually some that are in pill form but it's not a magic shot and I think that's one of the things that is most frustrating is people on TV, on the Internet just Ann Colter all about hey, I really want this shot that's going to fix everything for me and they feel like there's there's no chance that are causing a side effect or there's no chance there ever being a problem with it.

>> And unfortunately there are and and especially when it comes to the desire to lose access bodyweight what I don't hear said enough is that any medication that is being used to lose excess body weight has got to be done alongside of intentional lifestyle changes too often people are being given these medications or they're buying these medications online and just taking it and hoping to see magic happen and magic doesn't always happen.

>> No, you have to and we're going to talk about this later in the show about how you need to have the mindset right and also change your lifestyle.

>> Now I don't think we'll get in any trouble with the FCC or anything like that enlisting some of these so that our audience certainly be they can make the connection.

But what are some of these medications?

I don't think they have a whole lot of competition among themselves, no.

>> So you asked how long they've been around one the earliest ones was a medication called By Derian which is going on for quite a while.

They had a much bigger pen and that's been out for many, many years.

Didn't quite capture the market share I think because of how hard the device was to use then you had some of the newer ones.

>> There was a Telecity that was out for a while.

People may have heard of that one there of course the OTS Inpex and we Gobi and the Zep found and then the Manja are some of the bigger ones out there.

There are some oral versions that are available.

So there's there's so many different types of brands and they all work a little bit differently and the the method of action does tend to play mostly around the GOP one hormone although there are some that have more than just that one hormone in terms of appetite which is is that pound or the Munjal has both the GOP one and gyppy hormone put together and there they do a little bit different stuff.

>> So that's kind of why I want to make sure I make this disclaimer we're not here to promote any of those.

We are simply here to provide information about them because it seems to be something that's very, very popular.

>> Right.

And they work really well, especially when it comes to helping control Type two diabetes because of how they affect the pancreas to help lower that blood sugar.

One of the net effects of it though is how much it can help reduce excess body weight and some individuals we're looking at possibly reducing fifteen twenty to twenty five percent of excess body weight and quite frankly starting to get into the amount of weight loss you would see if someone had had bariatric surgery.

>> OK, we do have a first call coming in.

It's from Max Mac Max is actually wanting to stay off the air and that is perfectly fine as long as we get your questions you can ask them yourself or we can transcribe them.

>> I can read them for you.

Max is asking I'm currently on his IMPAC and I am experiencing constipation as a side effect.

What do you recommend to help to get back to the regular schedule?

>> That's a really great I love this show because we can be so candid about things like that.

Well I'll still try not to be too vulgar.

>> Oh OK.

He won't be vulgar.

No not at all.

Maybe overly cat.

Yeah don't do that.

>> So Max great question.

So when it comes to these medications part of the effect that they can have is slowing down some of your GI tract, slowing down your stomach emptying slowing down your bowels emptying as well.

The other reason why constipation can occur because of these medications is because you're not likely to be eating as much as you were eating so you can have less fiber coming in.

You could be drinking less and your colon's main job is to keep you from dehydrating, keeping fluid from excessively leaving your body.

And so if you're not drinking enough fluid when you go to have a bowel movement, it can be like trying to push a bunch of dry clay through a desert.

It's just not going to go very quickly.

So some of the things you can do to work on is one make sure you're getting more dietary fiber and if you haven't been and if that is not coming in the realm of actual fruits and vegetables, you can use something over the counter that might have insoluble fiber usually called psyllium husk, often found under the brands of like Mirrorless or beina fiber or similar to be able to work with that and then the other thing is making sure you're drinking plenty of water and I'm often asked how much water should I be drinking and you might hear six cups a day, eight cups a day.

>> Reality is you should be drinking enough water that at least once a day when you go to urinate your urine is completely colorless.

>> You'll know you've hit the full saturation if every time you go to use the restroom and you urinate and urine is dark yellow or even a little bit yellow you're probably not fully hydrated.

You should keep working on that.

So there's some simple steps that he could do to try to help push off the constipation back to regular schedule.

But if it is continuing and not getting better, you definitely need to talk to your doctor about that because long term constipation can absolutely have bad side effects and bad outcomes.

>> What are the what would you call it the qualifications for a patient to be on a GOP one medication?

>> I mean do you have to be a certain weight, a certain health situation, maybe a little bit of both what's going on?

>> That's a great question.

So we can actually fall into a whole host of different areas.

>> The first one it could be is simply if you're looking at for type two diabetes then it's anybody with an agency of six point five or greater could technically qualify now because the expense these medications insurance programs usually have you jump through multiple hoops before you could get there.

>> But an agency of six and a half or greater is usually so they would qualify.

>> There have been some new indications for some of these for those who are dealing with we call nonalcoholic fatty liver disease where your liver may have fat cells invading into it causing destruction, causing your liver enzymes to go up and there has been some indications to use it for that then the other reason is of course those using excess body weight.

So if somebody has a BMI of 30 or greater then that would be potentially depending on the insurance, not always on the science but least for the insurance would be a reason to consider using these medications.

Now if you are somebody who has struggled for a long time to lose excess body weight and you have to be make maintain a BMI of twenty seven or greater and having multiple comorbidities let's say you have sleep apnea or type two diabetes or some other kind of thing along side high blood pressure, high cholesterol that may be appropriate but it's not what I would ever consider to be a first line medication.

>> All right.

So is it more classified as a last resort or somewhere in that realm?

>> Not necessarily a last resort but more of an issue where sometimes we always we sometimes always never get a statement.

>> Sometimes we reach for a nuclear bomb when a fly swatter would have been OK.

Right.

So how many times is this being used in place of that intentional lifestyle change making sure people's calorie intake is appropriate, making sure that they're working on their mental health which is so important how many times would a medication like in the cases GLP one solution cost eight hundred to fifteen hundred dollars a month and that's you know with insurance you know covering a lot of that that's still a big expense when maybe a two or three dollars a month medication would do just as well.

Right.

So I think people see the big flashing lights and these great advertisements and the good paid actors and all this and they want to go for that and it's everywhere.

>> I mean the marketing for this medication you can't get over what people are saying on the different online social media platforms and everyone's talking about it and I think see if people want to be on this big train but they can have a lot of side effects that are potentially very problematic.

>> And we mentioned that there is one that you can use via pill but most of them are injection.

Correct.

And I think I've seen those look like actually writing pins with the needle about this long.

>> Where do you inject yourself usually when people are injecting themselves with these they would do it either on their abdomen or they can potentially do the upper thighs and point to my thighs but I'm under the table.

But yes, pointing to your upper thighs depending on your sensitivity you might find one side is better or easier than the other one.

But these medications work pretty well provided that you don't always use the same spot you do want to rotate it around on your abdomen because if you keep doing the same place you're more likely to get not only little pockets of the medication but to cause irritation to areas you definitely want to rotate the location around.

>> So when you do that is it like a little click on the end?

>> It just you put it up against your abdomen and you click it or is it absolutely depends on the device so it depends on which one you have various everyone is a little bit different.

>> All right.

I would have issues to be honest with you because it's a needle.

So but you know and I do know diabetic patients who hated needles but if they didn't have a needle and taking insulin they wouldn't be on the earth right now.

>> That's fair.

One thing that has made a huge difference we used to think of these insulin needles and pins, you know, like it's a three inch long needle and it's a huge bore actually the needles we use now are almost as thin if not a little bit thinner than an average human hair and they're only about a quarter of an inch long because these are not going down to the muscle.

They're just going underneath the skin just to get into the under line fat tissue that's underneath there.

Right and getting absorbed that way.

So they're actually it hurts significantly less than if you were pinching yourself.

It's pretty impressive how comfortable at least the needle part of that is.

>> Well, and you said they've been around eight , ten years or so but are you satisfied personally as a physician who probably prescribes this from time to time the safety, the efficacy and also the legality of this medication?

>> Are you happy with the track record it has so far?

So would most physicians say that I I would think so broadly, yes.

>> But then there's a caveat.

No so broadly yes, these medications are great but they're far from perfect and they don't work for all people.

>> There are certain individuals who wouldn't qualify for it if you've had certain kinds of thyroid cancer previously, if you have a history of pancreatitis it might make you more likely have pancreatitis again.

You've got to be careful with that if you already are somebody struggles with your stomach emptying regularly something called gastroparesis you may need to be really cautious about using these medications if you're going to be have any kind of surgical procedure.

These things slow things down so most surgeons and most anesthesiologists want you to be off that medication for at least a week ahead of having a surgical procedure.

>> So in that instance they can have side effects, other things less like GI upset, vomiting.

There are some concerns about how you can feel a lack of energy with it or even have mood changes which yes, could be some of the medicine.

But most of the data right now is pointing to it's more about just lack of total calories coming and because you tend to be reducing your appetite quite a bit.

OK, so the lack of energy and maybe having some anhedonia not feeling like doing stuff might be more related to the lack of calories and change in that lifestyle there.

>> But when you talk about the safety they really are very safe.

It's very hard to cause any kind of permanent damage or harm.

I'm not saying it couldn't happen and saying it can be a little bit hard.

However, there is a challenge there because they are so expensive and they have been hard to find.

They've been manufacturing delays that you can get to a point with them where people are desperate for them.

Insurance may not cover it and they may very soon to pay out of pocket.

So there's a lot of these compounding pharmacies that are taking these medications and making them available at a reduced price.

And I said, you know, the average one of these paying cash for you might pay eight hundred to thirteen to fifteen hundred dollars a month for these.

Will you see these online pharmacies and other compounding ones who will say hey we'll sell to four hundred and fifty a month?

I mean who's not jump at that somethin's and they've been struggling for as long as bodyweight they want to go right to it.

>> Well where's the harm in that they're offering these these medications as they're generic compound but there is no generic formula available.

>> It's not been released.

It's not out of patent.

So where they're getting these the compound to salt is usually from third parties that are not even in the United States.

And so there's purity concerns.

There's efficacy concerns.

They're often being combined with other things like A B twelve or even sometimes I've seen it advertised on some of these websites where actually combined with other weight loss medications to give people even more and more robust response and then they're sending you a vial that they've labeled themselves with some syringes to inject yourself with.

>> You're taking an awful risk that what they say in it is really in it.

>> And I understand that the desire for people to get healthy is something I work with all the time with people.

But there is a lot of concerns about the efficacy, the safety of these online compounding pharmacies and they're also working in a legal gray area.

>> The FDA does have a statement that if a medication is on a shortage list then you could compound it to get around that and sell it.

Well, they've had some manufacturing delays for a while now.

They've been on these shortage lists but they've been coming off and then that's been causing issues and some of these manufacture errors have actually been taken legal action against the the compounding pharmacy.

>> So the individual patient's not going to be at risk but it does make me concerned.

So you don't know honestly what you're getting you don't know if the safety standards are these medications have not necessarily been studied in the way they're being used and compounding pharmacies.

>> So it has to be taken with a large grain of salt and it goes back to the old statement of buyer beware.

Yeah, I thought it'd be very important to bring that up so it's probably best just to go with what's prescribed.

>> It's definitely the recommendation and this is coming from the FDA but also comes from one of the places I'm bored to by which is the Obesity Medical Society.

They also recommend you know, we should be really careful about using compounding pharmacies.

>> OK, we still have about ten minutes left in the program.

The number is 866- (969) 27 two zero.

Talking to Dr.

Ryan Singleman who is a specialist in weight management and also a specialist in just family doctor it's all around great guy.

>> So let's Segway here a little bit because it is the holiday season.

Oh, wait a minute.

Rosano is online too.

>> He has a call Rosano.

I do beg your pardon.

Go ahead with your question Dr.

Singleman.

>> Yes.

I would like to know if like I no longer have a gallbladder but going on a spinach diet, could it help you lose weight?

>> That's a really great question.

So if you no longer have a gall bladder you're trying to lose access bodyweight with spinach help and generally speaking, yes, spinach would be very helpful because you can get not only some great nutrients from it but that is a large leafy vegetables.

It takes up a lot of bulk and space in your belly and helps you feel full.

So anything that is space occupied and high in fiber is going to help you feel more full and hopefully help you reduce your total hunger and eating less.

The real key when it comes to any kind of lifestyle and dietetic approach though is even if you're eating healthy foods, are you eating the right amounts of them?

I have found it sometimes surprising to me when my patients are shocked when I say look, even though eating healthy food you're still gaining weight because the amount that you're eating is not appropriate for your height ,your weight and your age and so we have to work through that.

So yes, eating a spinach salad might be just fine but if you're covering it and three gallons of ranch dressing and you're throwing in a handful of cheese and putting a side of beef on it, it may not be such a healthy salad.

>> So you've got to really make sure you're looking at all the different components there.

>> Yeah, that's a great question.

Rosarno, thank you very much and happy holidays to you.

>> We want to talk about some weight management during the holidays and to be honest with you, I mean obviously I'm no skinny many have been heavier much heavier in my life but holidays were always a struggle mainly because I seem to graze.

>> Oh, somebody brought cookies into the office.

>> Oh, somebody brought some candy and all those calories add up.

You don't know it but you have that issue and you also have a tendency to overeat because you're sitting down with family and so forth and you sometimes gorge yourself like around Thanksgiving.

Luckily I did not this year but I'm very conscious of it because I hate to gain the weight because it's so hard to lose it and it takes time to lose it.

>> So let's talk about how we can at least maintain our weight and not gain through the holiday season.

>> That's a really, really great question and very pressing for right now.

Bottom line when you're going to lose access by the way and you're trying to maintain it even at that and you're going to be faced with the different holidays and the gatherings and the meetings and the parties and the foods that are out there.

>> What I would strongly recommend doing is if you know you're going to go out to eat and you know you're going to go to a friend's house for a party, maybe conserve your energy, conserve your calories for that time period so if you're going to go there, maybe don't have your full breakfast or your full lunch, do something very, very small instead of having a full breakfast, maybe a small yogurt, maybe just do a protein shake if you're going to have a large meal and then go out for dinner later, maybe you just only have a small side salad so that you can keep your calorie content at a lower level during the day.

So if you're going to go out you've got a little bit more room to spare.

The other thing you can do if you're going to go to these large dinners and gatherings instead of taking a full serving spoon full of every dish that's out there, maybe just get a teaspoon or just like a tablespoon and just take a taste of everything that way you're not denying yourself the chance to try it but you're also not putting so much food on the plate that we all have our mother in the back of our head saying you've got to clean your plate, which is not necessarily a great place to be but we tend to do it so take a small taste of things instead of all of it.

>> And the last thing is don't say no to yourself on everything but don't say yes to everything either.

If you have someone bring in all the cookies and all the cakes and all the ice cream, whatever it is reserved yourself one suite a day doesn't have to be all of them but just do one a day and not do like five cookies at the same time but maybe just one cookie or one small piece of pie and just make sure that you're moderating yourself over things holiday season what is that the old saying moderation is the key.

Yeah, even moderation sometimes.

>> You know I did some research before the shows I always try to do for these HealthLine programs but some information I retrieved from the Mayo Clinic.

But one of the things that really impressed me and it was really highlighted on here was make sure especially if you're going to start on a weight loss program, make sure you're ready and you don't do it just because the doctor told you to try to find some inner motivation.

>> Don't you have to find a reason to do it?

>> You know, it's one of the challenging times of the year where everybody in the next few weeks is going to finally be ready to go make that lifestyle change and to push through for that New Year, the New Year kind of thing.

Reality is when you're trying to help you've got to be at that mindset.

If you're trying to get healthy, you may need to be making a 180 degree change in every area of your life , not just what you're eating but how you're sleeping, how your mental health is, what your diet is like, who your friends are, where you're going out of all those different aspects play a role and you've got to be ready to make it.

>> And if you're just looking for a quick fix, I'm just going to go to the gym.

I'm just going to change your lifestyle.

It doesn't happen on time.

So making small achievable goals and having somebody help hold you accountable is going to be really important.

>> Absolutely.

We have time for one more phone call and we'll have to do this kind quick.

>> And Diane is on line one, our line five oh she's off the line.

She wants us to ask verbally she has type two diabetes and the keto diet.

>> She's wanting to know if that's safe for that and she's also currently as and what is Atlantis will this affect her have any type of side effects?

>> So great question, Diana and generally speaking the keto diet is a decent way to help control blood sugar and lose excess body weight.

But you have to be careful because the significant reduction in calories that can occur alongside of Akito diet and when you're cutting a lot of carbohydrates at the diet can significantly decrease the amount of insulin you're taking in that Lantis and you need to make sure that you're talking to your doctor about that to make sure that you have a plan in place that you do not over dose yourself with insulin and end up having a low blood sugar effect.

But otherwise yes, it can be safe even while you're taking those IMPAC and it's something that can be explored.

Keto diets are effective ways to help them lose body weight.

Statistically they're hard to maintain but it's not a bad place to start.

>> I will tell you that it's been about twenty years ago I was on a diet and I did it during the holiday season.

>> I lost forty pounds in ten weeks.

I'm not that good job.

>> OK, Dr.

Ryan Cinnamon, thank you so much for being on the show tonight and some very, very important topics for the especially for the holiday season and the new craze the GLP one medications.

>> All right.

Pleasure being here.

Thank you.

Hope to see you again very, very soon.

Thank you.

And we thank you very much for watching tonight.

>> We sure hope you have a happy and healthy holiday season until next week.

Good night and good