Lynda Steele: Hey, welcome to the podcast, Change My Mind. I'm your host, Lynda Steele. And today I kind of want to talk about the gold rush of 2026. And it actually has nothing to do with gold, but it also has nothing to do with tech or real estate. And it has everything to do with what might actually be in your medicine cabinet right now. We're talking about weight loss drugs because they have exploded into the public consciousness. And I don't know about you, but... Dr. Zentner thank you so much for spending some time with us. We really appreciate it. All right, that was fascinating. And we bring back in producer Mel. Wow, ⁓ I learned so much in that conversation that I have pretty completely changed my idea ⁓ and my thought around these weight loss drugs.
Ali Zentner: It's a pleasure, absolutely, Lynda thanks.
Lynda Steele: Now I come from a family that has struggled with weight. My mom, bless her soul, she's not with us anymore, but she really spent an entire lifetime dieting. And it was a struggle. And the family used to make fun of her like, oh, Thelma's the fat one in the family. Even though I look back now at these family reunion photos and I think every single one of us could have lost a minimum of five, 10, 15, up to 50 pounds.
Melanie Nagy: I'm curious, because I did hear you say that during your conversation right near the end. And like you too, I was on the edge of my seat listening to everything. Flesh that out a bit for me. What do you mean by that, that you changed your mind? How did you change it?
Lynda Steele: Okay, well, first of all, I think I felt a little bit judgy, because I thought I'm, you know, I'm watching what I eat and I'm working out hard. And then I've got friends who are just, boop, you know, taking a little injection and then suddenly they look fabulous. And I kind of thought, you're cheating. But after listening to her, she's saying, no, I mean, if you compare it to any other drug, when she said, you know, do you take a cardiovascular drug or statins or whatever, it's the same premise that obesity is If you're watching a hockey game, for example, during the NHL playoffs, notice it in the intermission when you're watching the hosts, ⁓ whole set is virtually wrapped in the words, Ozempic, Ozempic, Ozempic, Ozempic, Ozempic everywhere. ⁓ now it's actually, Wegovy Wegovy, Wegovy. And these are two of the most popular brand names for these weight loss drugs. ⁓ it just struck me as odd. I thought I'm watching professional athletes, really fit guys. So I think that we get this weird sort of idea that it's someone else's got a problem and we're all fine. And I just wonder if we could just talk about the stigma off the top here. What do you see and how difficult is it for people who are really struggling with their weight? Because there seems to be this idea that it's a lack of personal responsibility or something. and the program is flogging weight loss drugs. That's interesting to me. But what's more startling is the fact that there are some really major professional athletes that are now shilling for companies that are selling weight loss drugs, like Serena Williams. disease and this is treating a disease and we're just lucky that we have this medication now. So I also thought well you know maybe maybe it is something that I would look at or a microdosing and she's saying no hand up would not work for you. You don't fit the criteria for it. So I do still have a little bit of concern that maybe there are young people or teenage girls or people who have eating disorders who are attracted to this who maybe shouldn't be.
Ali Zentner: I think almost summarized it beautifully in that comment. Like ⁓ Thelma was the one with the problem. ⁓ if we look back, everybody else had the, ⁓ you see what I mean? Like I think in and of itself, and it's not to call you out at all, Lynda, but as a society, this seems to be the last ⁓ ⁓
Lynda Steele: These drugs are really popular and they're actually called semiglutides or GLP-1s. They work really well for a lot of people and that's why so many Canadians are taking them. There's something like a million Canadians taking these drugs, which isn't surprising because it's estimated that one in four British Columbians is considered to be obese. One in four, like that's astonishing.
Ali Zentner: that it's just okay to pick and poke. And I think if we break it down, first and foremost, when we talk about so-and-so should lose X amount of weight, there is no such thing as a goal weight. The quote standard that we adhere to about ideal weight is a complete emperor has no clothes kind of moment. that comes from, you know,
Lynda Steele: but then the doctor should be the gatekeeper.
Melanie Nagy: Yeah, I thought there was so many things, because she took us really from this, the place of understanding obesity and the stigma attached to the place of what these drugs are, the science of it. I thought the body mass index, mean, honestly, tracing that back and the BMI becomes such a foundational thing that you hear. You go to a gym, they measure your BMI. So that was a big takeaway for me. But really, I she made this conversation accessible.
Lynda Steele: These drugs work in kind of simple, mysterious ways, but what they do is they control your blood sugar, they slow your digestion, and they make you feel fuller longer. And the best part, I think, is they sort of turn off that little voice in your head that is thinking, ⁓ I wanna eat a bag of chips, or ⁓ what am I gonna eat next? That's the thing that sabotages most diets. So these drugs are really quite incredible when you think about it.
Ali Zentner: If we want to even talk about where, quote, the concept of ideal weight comes from, that's back in the when an astrologer named Adolf Quiddily ⁓ to find out what the average man looked like at the time. So he took the and weights of the Scottish and Flemish army, ⁓ and came up with the body mass index. And that's the standard that your beloved mother, Thelma, fabulous name the way, would have absolutely been adhering
Melanie Nagy: The risks, a lot of people talk about that as a ⁓ but I've never heard anybody frame it and make it as accessible when she commented on the risk. But for me, really, there was one thing she said, she said, it all comes down to choice and agency. ⁓ And really, we just need to accept that, right? It comes down to our own choice and our agency ⁓ in consultation a medical professional. But ⁓ great conversation.
Lynda Steele: And the only problem is that they're really expensive. So it costs about $450 a month. A lot of people don't have coverage. So that's a lot of money to lose weight, right? Unless you're really, really serious about it or you have a real serious health condition. But there is some good news on two fronts. One of them is that Canada is poised to become one of the first countries in the world to approve generic versions of these drugs. Thank you.
Ali Zentner: to in terms of numbers and growing up probably in a Weight Watchers Society and so we see there's that piece to it and we'll come back to that in a minute but that's the vestiges of dieting culture running through, running rampant through our society and talking about issues around sort of personal responsibility and personal fault etc. which we're seeing emerge in conversations around health now in a
Lynda Steele: Right. I loved it. And for anybody who was even potentially a little bit judgy like me, I hope that we all have expanded our thinking around this because the reality is I've learned that your genes, you are just born that way, you know, as Lady Gaga says, and there's not really a lot you can do about it. It isn't, it wasn't like my mom, Thelma, eating too much. It was the way her body was designed and she just didn't have a drug to help. And that's gonna cut the cost by hundreds of dollars a month, which will make these drugs really accessible to way more people. The other good thing is that there is a doctor right here in Metro Vancouver who started a petition to try to get the province and PharmaCare frankly, to cover these drugs for anybody who needs them. We're gonna talk to her in a little bit, so stay tuned for that. But first of all, I was thinking to myself in doing research for this podcast,
Ali Zentner: detrimental way. So there's that one piece. When we talk about stigma and know weight bias in society
Lynda Steele: and now people do, so amen. She may not call it a miracle, but it's certainly a game changer for a whole lot of people. All right, thanks so much, Mel. That was an awesome conversation.
Melanie Nagy: sure.
Ali Zentner: it's the one area where everywhere it permeates, know, and part of it, I would argue, is a bit of a feminist issue. know, women were told for decades, if not centuries, that our physicality determined our value and our acceptance and our worth in this world, and unfortunately medicine co-opted that and said, ⁓ yes, and your health as well. And so now conversations that used to happen around
Lynda Steele: Okay, so how do I feel about this? ⁓ Well, like I said to Mel, I really have changed my mind. I think that it is about learning more, about having a deep understanding of how obesity works, that it is based in your genes and all the different hormones that come into play. So I do see the potential for it to change lives. And I do see the potential for it to also save the healthcare system a bunch of money, which maybe it does make a ton of sense to have governments say, that I really wish these drugs were available when my mom was alive because she dieted and struggled with her weight every goddamn day of her adult life. I mean, it was really sad. She was someone who had a sweet tooth and she would hide chocolate bars in the back of the freezer. And if one of us kids found them and ate them, ⁓ my God, there was hell to pay. But she had a tough time. And as a kid, especially a girl watching a mom,
Ali Zentner: vanity and appearance have now been quote almost in a weird way reframed around health. But still equate size with health with which is completely wrong. ⁓ ⁓
Lynda Steele: you start to develop some kind of weird thoughts around food and dieting in your own head. And I remember the exact moment that my lifelong obsession with weight began as well. I was 18 years old, which is sad. I was 18 years old and I was in the woman's washroom at the Athabasca Pub in Hinton, Alberta. And I was wearing my favorite jeans and my girlfriend said, not very kindly, I might add, This is a drug for a disease that can ultimately save us all as society a bunch of money. I do also think that, yeah, I guess this is not a drug for me and maybe I should be happy about that, that I am able to control my weight, keep it healthy through diet and exercise. So at the end of the day, I do feel like I've learned a lot and I certainly have moved the yardstick significantly.
Ali Zentner: How do you break that stigma and how do you break that discussion or how do you start that discussion?
Lynda Steele: Well, and I'm curious about that too, because I fall into the trap of thinking, ⁓ you know, wow, that is five foot 11 and she weighs 120 pounds. And I think, ⁓ my God, I must be obese then because she's way taller than me and I weigh ⁓ more than that. ⁓ there's so much wrong about the way we think about how much people weigh. So as for you, you do not have to agree with me. You do not have to change your mind. Just keep it open and stay curious. And thanks for joining us. ⁓ Lynda you look like you're putting on some weight, ⁓ And I remember just being thunderstruck, like ⁓ some reason, I had not noticed that I was putting on weight. And she was maybe unkind, but she was also accurate. ⁓ had been putting on weight and I don't know why I didn't notice that my pants were too tight.
Ali Zentner: Yeah, I think it's important to break that down even further. So understand that I don't think we would have the same discussion if we were talking how tall people were, would we?
Lynda Steele: So I went off on a lifelong journey myself of alternately being, I wish I could get rid of that last 10 pounds. Oh, now we're at 20 pounds I need to get rid of. I think at my heaviest, it was maybe 25. Okay, I'm be honest, maybe 30 even pounds that I had to lose. And I have struggled with it. I have not eaten what I wanted to eat. I have worked out when I didn't feel like it. So am I interested in these drugs? Yeah.
Ali Zentner: Right. So remember that weight is as genetic as height and eye color and well, hair color is not genetic. It's what colorist tells me. ⁓ know, hand size, foot size, etc. So There are 5,500 genes at play here, period, that determine everything from whether or not you have a sweet tooth to where you put your weight, how much weight we'll all lose and gain in our lifetimes, how we respond to treatment, all of that's genetics. And that's even beyond the genetics of the genes you got from Thelma and your dad, but it's also the genes that we as a species evolved to select for by just
Lynda Steele: Do I have questions? ⁓ hell yeah, I do. So let's bring in producer Melanie Nagy for a discussion and a setup of our guest. Hi, Mel, ⁓ you must know some people in life who are taking these drugs or you suspect they're taking them.
Mel: Yes on both accounts. Yes to taking them. Yes to suspecting them. These drugs are unavoidable in conversation, on social media, advertisements, whether it's your advertisements online or in magazines. They're everywhere. I really do feel that you can't escape them.
Ali Zentner: The idea that think about it as a species we would have selected for genes that prevented famine. We would have selected for genes that prevented us from dying of starvation or what we call thrifty genes. And what we see is an expression of those thrifty genes in times of stressors. when physiologically your body's exposed to stressors, you know, we think of genes as they turn on when we're a baby and that's it. But our genes turn on and off throughout our lifetime.
Mel: ⁓ And I think it's really interesting because everybody has a different... People have different personal approaches to weight and stories and trauma with weight. But then there's a flip side too where there is also the movement of celebrating body and accepting body. So I find it a really interesting topic in how we balance it, whether it's the access issue that you talked about, whether it's how do you avoid body shaming and connection with these? what's wrong someone's body that they might feel they have to take these? so many questions to explore and navigate.
Ali Zentner: times in response to certain stressors. Absolutely. We're also dealing with what's called a neuro hormonal feedback mechanism. So every organ in your body talks to every other organ in your body through a series of hormones. And in this case, you're dealing with the most important hormonal conversation in the world because if you think about it for a minute, if there's no gas in the tank, then the engine doesn't run. So your body's energy regulatory system
Mel: That's why think we have the perfect guest today. I know you mentioned Dr. Allie Zentner. She is a Vancouver-based physician. She has spent over two decades specializing in metabolic medicine and obesity. She's the founder of Revolution Medical Clinic. That's one of Canada's largest public obesity clinics.
Ali Zentner: is more important than how often you breathe or how many times your heart beats in a minute because...
Mel: she's an advocate for treating obesity from the lens as a chronic disease rather than a failure, like a personal failure or a personal failure of willpower. ⁓ And through she's also written a book ⁓ about the It's called The Loss Prescription. She's also started a movement called No Fat Shame. And that's all about... ⁓
Ali Zentner: None of those things are gonna happen if there's no gas, so to speak. So we, as a species, have 37 different hormones that regulate this. Your brain talks to your gut, your gut talks back, and that's from out the anus. are hormones throughout. We know that fat and muscle tissue also produce about half a dozen different hormones each, ⁓ hormones, usage hormones, ⁓ cetera. ⁓ your brain, you even have
Mel: Ending weight bias in medicine and changing the way doctors ⁓ Treat and talk about obesity because it's a really interesting thing you mentioned some of the people that I know that are exploring those drugs They've actually even faced stigma and judgment from their doctors So there's so much to explore dr. Ali's that I think she's gonna be the perfect person for you to connect with
Ali Zentner: of the brain called the hypothalamus which is subconscious and it controls things like body temperature, sleep-wake cycles, blood pressure, respiratory system, etc. But it also has a part of the brain called the arcuate nucleus which literally has hunger neurons and fullness neurons. Not even I feel hungry and I feel full but full gas tank empty. for example there's even conditions where if for example there's a part of the brain if you have a stroke in the arcuate nucleus you can actually
Mel: and explore all your questions
Lynda Steele: I have so many questions. So Mel, you're gonna ⁓ back and you're gonna come back in after the conversation and we're gonna have a little bit of a debrief ⁓ see whether or not I've changed my mind about these drugs. ⁓ I'm looking forward to talking to you in about a half an hour or so.
Ali Zentner: eat yourself to death.
Lynda Steele: Wow.
Ali Zentner: ⁓ so just as an so this is highly regulated, ⁓ so who's to say And it's interesting because 50 years ago we used to think depression was just you wanted to be sad and you chose to do that. Now we understand depression is an inflammatory brain disease that is highly regulated by a bunch of different neurotransmitters and it's chemical. So why is it that we still think that why we gain weight is because you know my patients are sitting on a couch eating chocolate and watching television and not exercising enough. ridiculous. Like it's not just mean, it's stupid. Like, fine, I say to people, you know what, you want to be mean, be mean, but don't be dumb. and you know, I get that a lot from like patients who are not patients from people who are like, ⁓ you know, you're just, you know, you're just giving people a free ride. I'm like, no, no, you're just being dumb. Like, if you want to think that go for it, but the earth is round. You can think it's flat, but dude, it's round. Sorry. So that's what the hypothetical dude who's giving me crap feedback but I just say idea here like like I have this ⁓ pod your listeners can't hear but I have a very ⁓ fabulously thick head of hair and I it's not because I drink or eat protein it's just my dad Okay, he had a really great head and that like, there's so many things in this world that are genetic that we accept, right? Intelligence is a huge one, you know, or, or quote, talent, like, I am going to take singing lessons till the day I die, but I'm never going to be Beyonce. She's just got innate talent. And so you're telling me and you're not, but this is a highly sophisticated regulatory system that the brain that we have evolved over thousands of years and I'll take it one step further and say this to you, think about it for a second, if you don't want to die of a famine you better do two things really well, you better hunt food and you better store fat and anyone who's ever been on a diet has experienced this firsthand. You go into what's called starvation response, so you lose weight and then you stop and that's an activation of the storage system of starvation response and then all of sudden you have cravings through the roof, you dream about food, food tastes better etc. and that's the activation of the brain, a part of the brain that's known as our craving center that makes us good hunters. So we have these two systems in our body that are activated at all times that some of us have just, shall we say, an over activation of. Right? So just like some people, have an activation of an excess heart rate and patients go into atrial fibrillation or like it's, you know, there's sometimes organs don't do their part and the body just goes left when it shouldn't. And that's what we're seeing here. Now, Why are we seeing an overwhelming population around this? Well, I think twofold. One, there are an enormous amount of environmental stressors that make it very easy for the brain to go into starvation response, number one. And number two, our diagnostic tool for what classifies as, quote, obesity is based on an 1870s astrologer's chart. So remember that yes, in some patients, obesity is very much a disease, meaning a biological dysregulation that affects how you move through the world. In some of us, it's just a risk factor, but in everybody it's a social construct.
Lynda Steele: Good grief. mean, I've learned so much in just the last few minutes there, ⁓ but mean,
Ali Zentner: Don't you want to gather your family together and just contact your mom and say, we're really sorry. We were total jerks.
Lynda Steele: Yes. Exactly. And let me ask you this then, because I really think that I wish these GLP ones were available when my mom was alive, because she had such a struggle her whole life. And I've got some friends who have tried these drugs, and they've really worked for them, who have described them as being like game changers, or miracle drugs. I mean, what are you hearing? What are you seeing in your practice?
Ali Zentner: Right. Right. So remember, let's go back to starvation response and let's explain how these medications work. So if the brain thinks it's starving, it stores and it hunts. And your friends who tell you they're game changers say, I don't get it. I eat what I want and I lose weight. So ⁓ what are these medications? ⁓ goal of treatment should be to trick a starving brain into thinking it's not starving. Well, what better way to trick a starving brain than to give it a hormone it only gets in the presence of food? Anyone who's ever taken the birth control pill knows you can't get pregnant when you're pregnant, thank goodness. ⁓ And so take a pill that tells your brain pregnant. Right? It's a hormonal trick. Well, if your brain thinks there's a famine and it's going to store and hunt, then you give it a hormone that you normally get when you eat. Well, so semaglutide, which is called Ozempic or Wegovy depending on what you take it for. Same drug. Fun fact. It's a copy of a single gut hormone called GLP-1. most people have heard the expression, takes 20 minutes for your stomach to tell your brain you're full. ⁓ not your stomach talking, it's 20 minutes for food to go from your mouth to your small intestine. ⁓ when food hits the small intestine, again with the hormones, ⁓ a dozen hormones are released from the small intestine to tell the brain a meal's arrived. ⁓ of those hormones is GLP-1, another one's called GIP, ⁓ one is released from the liver. called glucagon. one's released from the small intestine called amylin. I'll you why I'm naming those hormones because they all become very important. ⁓ So is a GLP-1 analog. You may heard of another drug called tersepitide, which is Mounjaro or Zep-bound, depending on what you use it for. ⁓ Well, it's and GIP, which are ⁓ both released the small intestine. Fun fact, GIP was first ⁓ sort of in Canada. So it's a BC based hormone actually. ⁓ ⁓ there's a new medication called servodotide that will probably be released in Canada in the next year and a half. It's in of Health Canada and it's GLP glucagon agonist. ⁓ There's cragrinolide with semaglutide which is a GLP. Lp-amalin agonist, which is coming probably in the next year or so. You're gonna hear about all of these. There's another one called retatratide, which is a triple gut hormone of three. So the idea here is, remember when Prozac launched and we said it was like a copy of a, it was like a, helped serotonin stay in the brain, right? And then all of a sudden you saw five different antidepressants and now you have serotonin reuptake inhibitors, dopamine reuptake inhibitors, have norepinephrine, you have all these different ones. So in other words, what I'm saying is there's a similarity here. We've cracked a code and we've realized that these drugs don't work by making people eat less because the problem never has been math. Your mother, bless her, didn't eat too much and not exercise enough. That's not what was causing the issue. She might have at times had more cravings than ate, but that was a symptom of a starving brain and not the cause of the weight ⁓ gain. ⁓
Lynda Steele: Okay, well now that's really interesting because so many people then are, you know, we see influencers and we see former athletes like Serena Williams and actors and all these people suddenly, you know, on ozempic or a drug like that. So my question is, who are these drugs really for? Can they be for everyone or are they really meant for people who are dealing with the disease of obesity?
Ali Zentner: Lynda, do we only do abortions for women who are raped?
Lynda Steele: Okay, that's very interesting because we're also talking about ⁓ microdosing and things like that too. So as for me even I've thought, maybe this is something I could look into myself.
Ali Zentner: choice. I think it's more of a philosophical question and remember that the genie has officially left the bottle, right? ⁓ And the genie left the bottle not of these medications, but the genie left the bottle with dieting. ⁓ So I'll give you an example. ⁓ one has a problem with a of ⁓ any size going on a diet and what she's eating. but people all of a sudden are deciding who takes what medication. Now, I should tell you, I am a physician. I am a specialist in obesity medicine. I believe there should be guidelines around, you know. like there should be parameters around who gets what treatment period. it's not like a pizza for everybody, right? Like we don't do chemo prophylactically for cancer. Absolutely, right? So there are criteria that we need to adhere to around medical safety, right? Safety and efficacy period. However, with that said, it comes down like on a broader topic, it comes down to choice and agency. And I would argue, I am never, and I hear this all the time, but I am never a fan of someone practicing medicine without a license. So I don't think that, and I mean, I realize there's some irony here that we're having a podcast discussion for mainstream, but I don't believe that we, my patients should get the bulk of their medical information from TikTok. I don't even have an account, full disclosure. don't, first of all, I think that we've gone so, the pendulum has swung so far. in one direction. used to be that they're like medicine used its own language and there was such, you know, don't ask, don't tell, and there was a huge secrecy, but it's almost too much access and too much freedom of information and less sort of gatekeeping around what's what. And I mean, a perfect example is every one of my patients can go online and look at their labs and then they Google and wait for the word cancer to appear, you know, and they've already self-diagnosed. themselves based on their laboratory situation. So I think we've swung so far, microdosing is a perfect example. One of the reasons people microdose, probably the biggest one is cost. So I would argue I have a bigger issue with the fact that these medications have become a niche product for people of... means ⁓ not like we're not having real conversations around who should really take this because right now in Canada in particular ⁓ mind the US they've got other ⁓ I mean, don't get me started, but ⁓ in Canadian system, which is a socialized health care system, ⁓ which a system that in theory, God bless Tommy Douglas, ⁓ this be based on need. And for those of you who don't know who Tommy Douglas is, he is the father of socialized health care and worth knowing about. And here's the tick tocky fun fact, is Kiefer Sutherland's grandfather. ⁓ However, ⁓
Lynda Steele: Wow, yeah.
Ali Zentner: yes. ⁓
Lynda Steele: Can I just stop you for a second because I just want to ask one thing. Are you saying ⁓ that ⁓ anyone should be able to access these drugs? ⁓ No? Okay.
Ali Zentner: ⁓ I am saying that this is a conversation that everyone should be able to have with their physician or healthcare provider to learn if this is an appropriate treatment for them. So let's take you. You said, I've even thought about this for myself. and you're not someone who would meet criteria to take these medications meaning your body mass index is not above a certain number which it's hysterical because we just spent a few minutes you know can I swear on this podcast or no?
Lynda Steele: Sure, go ahead.
Ali Zentner: We've just spent a few minutes shit talking the BMI, absolutely. And now we're like, we still use it as criteria for medication. Absolutely. ⁓ However, ⁓ I will say, let's say you're someone at risk cardiovascular disease, ⁓ or you've even had cardiac disease. And let's say you're someone with a metabolic liver disease or a fatty liver is ⁓ the term use. Well, these drugs are indicated for that. So. ⁓ isn't that a conversation that you would like to have with a professional? Right? Like, so do you see what I mean? Like, this is a conversation that you should have with your doctor and that we should discuss risk and benefit and what you can anticipate, etc. Just like you would with any other drug.
Lynda Steele: I hear you, but I also watch CNN and cable shows where they're coming up at 10 o'clock at night and saying, would you like some generic Viagra? Just punch in 42, 42, 42. I mean, are we gonna get to the point where people can get it online or through a black market and they shouldn't really be taking it? Okay.
Ali Zentner: ⁓ they already can 100%. But that doesn't mean they should be. ⁓ again, it's ⁓ why you and I are having a conversation, And we're a long one, ⁓ for sure, or like more than five minutes, absolutely. But the around this is... ⁓ Do I think that drugs should be advertised on TV to the extent that they are being advertised? Absolutely not. But I'm not, I'm a realist and I understand that, you know, I'm a Canadian physician, which is a whole different ball game, but I understand that healthcare in most parts of the world is still a business. ⁓ I don't think I like that aspect of it. I don't agree with it. But I think I'd like to think that the people that I see every single day still have a degree of respect for my authority and for, you know, my ⁓ not even authority is probably not the right word for my expertise and for my experience and all of that. so, you know, so I think and I say this to patients all the time, like, validity doesn't come from personal experience. It comes from years of practice, right? You know, it's fascinating to me that the 10,000 hours rule applies everywhere but in medicine, which I think is hysterical, right?
Lynda Steele: expertise. You
Ali Zentner: like, well you know I have patients who come in and go well you know I've talked to whole bunch of people about this and I'd like to try this and the joke I all the comment I always say is all right you're in trouble with the law do you go down to a prison and ask the inmates what worked and didn't work for them or do you call the lawyer?
Lynda Steele: I mean, you're making a lot of great points and I want to back this up to cost because that is it's almost like a two tiered system for people. These are expensive.
Ali Zentner: It is a two-tiered not almost like a two-tiered system. It's a two-tiered system that ironically, you know, the house always wins kinds of things. This saves the healthcare system. You know, it's like, we know these drugs pay for themselves within a year in terms of treatment. But I also think, you know, to your point, you said...
Lynda Steele: Can you explain that first before you go on? How do they pay for themselves?
Ali Zentner: Well, prevention, right? So we know, for example, there's data to show that, let's say, tersepiditis or ZEP bound, 50 % reduction in sleep apnea. So if you have sleep apnea, and let's say you stop breathing 60 times an hour, you literally... have a 50 % reduction in the amount of times you stop breathing. So many patients who let's say have moderate sleep apnea go from moderate to mild on these medications. Let's also talk about percentages. So I know we said numbers don't matter, No one believes that, let's be honest. Chief among them, patients. Absolutely not. And this is where you have science butting up dieting culture, which is what we're seeing here, right? ⁓ And so the reality is, and you talk about this, you know, TikTok and influencers and everything, that's dieting culture. So it's, it's ⁓ same game, different rules, if you will, to speak, or, you know, it's, it's, or sorry, same rules, different games, so to speak. But it's that idea of the diet and culture still talking about it because, you know, and it's interesting to me about all of it and about sort of the discussions that we have about... the death of dieting culture. But let's be honest, my patients and my colleagues learned everything they need to know, and I put that in huge air quotes, about weight and diet from dieting culture, which is all garbage. So there's that. So just to your point, the idea around cost and that, the drugs themselves, you have a 90 % reduction in development of type 2 diabetes, you have a 10 to 20 % body weight loss in the vast majority of patients. Some lose more, some lose less. The newer agents like the dual agonists or the triple agonists, you're talking about 20 to 25%. In fact, nowadays, you when I started practice 25 years ago, 5 % body weight loss in the old drugs was considered a gift. Now, if it's not 15 % or more, it's a crap drug, so to speak. So it's quite impressive. But these drugs,
Lynda Steele: Ha
Ali Zentner: you know, also 20 % reduction in heart attack and stroke, treatment of metabolic liver disease, which is the leading cause of liver cirrhosis in North America. So you're talking prevention, prevention, prevention, prevention. I I run a program in BC called Get to Surgery, where we look at, help patients who've been told by their orthopedic surgeons, lose weight, and then I'll take care of your knee. We work with them with a medical approach, not a dietary approach, but just medical approach. And
Lynda Steele: Right.
Ali Zentner: We get them to joint replacement surgery, but in one year we took 10 patients off a joint replacement list. Well, at $10,000 a joint, that's a lot of money saved, right? ⁓
Lynda Steele: Which is great, and I do know that there's two things that are happening that I think are, you know, make people feel optimistic. One of them being that Canada is kind of looking at approving some generic versions, which should bring the cost down. But also you're behind a petition to try to get government to cover the costs for people who really need these drugs.
Ali Zentner: Yeah, I think I've been knocking on government's door for a while now. It's interesting what's happening in, ⁓ it's, it's unfortunately, it's two step forward, three steps back a lot of times. you know, petition is one thing, but absolutely ⁓ the issue will be Right now, these medications, they started at being far more ⁓ expensive than they even are now. So for example, semaglutide in the form of the trade name Wegovy which is a 2.4 milligram dosing, used to be about $450 a month. It's now $288. Okay, so the drugs are coming down. Part of it is that in Canada, in particular, semaglutide has lost its patent. So that means that it invites generic companies to basically copy the drug. And there are nine sitting in front of Health Canada waiting for approval including well actually not because the generic that's produced by Novo Nordisk which is the company that produces Wegovy and Ozempic already has approval by Health Canada. Why? Because it's essentially the non-generic, like they don't need approval, right? So they just cross out the name and put in whatever their new name will be. Absolutely. But lost their patent in January. And again, it takes time for Health Canada to approve generics. ⁓ governmental, and I'm like dissing Health Canada, but it's fascinating to me the sort of time it takes around these sort of approval experiences. I'm not asking them to fast track, but we have had... years of experience with GLP-1s. Like for example, when people say these drugs are new, I'm like 2019. so, semaglutide was approved in Canada for use in 2019. That's seven years ago. Like that's a long time. Absolutely.
Lynda Steele: Well, you know, that is a long time, but I do wonder about the long term safety. Like, what do we know if someone's been on these drugs for 20 years, 25 years? we...
Ali Zentner: Yes. Lynda, you want a drug, you're not going to get that. So that's not how science works. So the good news about that is, I'll give you an example, how long you've been using a cell phone for.
Lynda Steele: Yeah, a long time, decades.
Ali Zentner: You've got earbuds in your ears, by the way. Yeah. What's the long-term data on the use of earbuds for radiation? I'm just curious,
Lynda Steele: Yes. You're nailing me to, okay, I get it, right? That we don't know about a lot of things.
Ali Zentner: We don't, but that doesn't mean we need to. I don't know about you, I don't want a drug from 1940. Right? I don't. Do you want to drive a 1940s car? I mean, it's cute, but it's not safe, is it?
Lynda Steele: Yeah, yeah, yeah. No. No.
Ali Zentner: Right? Yes. I want a drug that has gone through rigorous testing, that has had double-blind randomized placebo-controlled trials with thousands of patients, that has been tested on women, not just on men, like most drugs were up until now, that has at least 50 % of, you know, of... the patient population that has been tested to be somebody who might look like me, absolutely, in a modern day. And I want rigorous accountability ⁓ and et cetera. ⁓ None that existed 30 years ago. ⁓ So science moves forward is I get that people want
Lynda Steele: Fair enough.
Ali Zentner: you know, they worry about the, it's leftover from the thalidomide world. We told what, right, but that's not happening anymore.
Lynda Steele: Yes.
Ali Zentner: Right? And so for example, I'll give you the opposite. You know how many drugs we said we weren't sure were safe in pregnancy that now we use in pregnancy because we have that kind of data? So there is the opposite effect that's happening. I'm not saying, but I'll give you an example. Metformin was a classic drug. was talking about it with one of my students today. And when I graduated medical school, we didn't use metformin in pregnancy. And now it's mainstream because the safety data is there. So I get that people are worried about, ⁓
Lynda Steele: Yeah.
Ali Zentner: 20, 30 years from now, what's this going to look like? I totally understand that. But what they don't also consider is 20, 30 years of untreatment. What does that look like? And I've been around long enough to know ⁓ that medicine in particular, ⁓ know, physicians are divided into what we call early adopters ⁓ or wait and seeers. ⁓ And, you know, and my patients... ⁓ have done the wait and see for a long enough time now. And all of it's one thing if it was one or two studies, but the mounting amount of evidence towards the safety and the efficacy of these medications over and remember a drug that launches seven years ago was actually studied for at least four or five beforehand. So you have, and let's understand when we're talking about semaglutide, there was liraglutide before it, which launched five years before that. So this class of medications has at least 15 years of data. And so when you say to me you want long-term data, what I say to you is how long? Like is 15 years good enough? Is it 20? I don't mean to sound like
Lynda Steele: Yeah, no, you're making a good point. My question now is, no, no, when you talk about length of time too, because I do know some friends who are on it, ⁓ have lost weight and then actually went off it because they lost too much weight and are now back on it. So my question is, do you have to be on it forever? And what happens when you come off it? Does that mess up your metabolism?
Ali Zentner: So let's go back to your brain as starving, right? So we trick your brain into thinking it's not and it doesn't store and it doesn't hunt. ⁓ What happens when we wake your brain up again and psych! Can you take your glasses off? ⁓ You're wearing glasses for those of us. Right, how well can you see them?
Lynda Steele: Yes. I can see okay, I can get by.
Ali Zentner: Yes, so your eyes really aren't learning from those glasses, are they? Right. Medications for chronic disease apart from antibiotics and pain relief, which is what we what the vast majority of Canadians take medications for chronic disease. In fact, most diseases nowadays, apart from infections and acute pain are chronic, right?
Lynda Steele: Right, no.
Ali Zentner: They are not an education for the body. They're a compensation for what the body's not doing in the first place. And it's funny to me because that argument is never made. Let's take out the word obesity and say, I take medications for my blood pressure. No one ever says, once my blood pressure gets to target, I'm stopping my meds. No one ever, that is not right. But it's right.
Lynda Steele: Got it. ⁓ God, that makes so much sense, you know, when you put it that way.
Ali Zentner: So it's bias. it's the fact that, you got, and again, a lot of these arguments that are being made are the dieting worlds dying literally. And so it's fighting back. You know, another example that we hear a lot about is what's called sarcopenia or muscle loss. No one ever complained about muscle loss from diet and exercise or starvation diets, which happens absolutely. Like, let's be clear. Can I tell you a fun fact? Fact. Any time you lose weight, doesn't matter how you do it, whether starvation program, whether it's a liquid diet, whether it's keto, whether it's medication, whether it's bariatric surgery, any way you lose weight. 25 % of that weight loss will be muscle, ⁓ and there's specific amount of minimum exercise that you have to do ⁓ and even that 25 % muscle loss goes down to 10%. So you can expect a minimum of 10 % muscle loss ⁓ no matter Why? Because that's just the way of all flesh. Now no one cared about that when you know when Oprah did her liquid diet remember in the day and she pulled the like no one ⁓ or Oprah her jeans and everything
Lynda Steele: when she pulled the cart out with the fat on it.
Ali Zentner: Oh my god, she's lost 25 % muscle mass. But now that she's on this medication, the world's in an uproar. I'm like, really people? That's amusing. That is really impressively amusing.
Lynda Steele: Can I just ask you one more question? Because I know I can't keep you here forever, but.
Ali Zentner: You're gonna go back to your friends and really set them straight. I love it. It's all good. Yes. I will say that I don't believe that they lost too much weight. I'd love to see how that was because your body won't let you do that. Like realistically, your body has a bottom and it doesn't do it. In fact, there is no if you are losing too much weight, there's something else going on.
Lynda Steele: I'm curious, like many drugs. Okay. Okay. Okay, good to know. Let me ask you this one last question. Often we find when a drug is introduced for one thing, it ends up having this astonishingly positive benefit in something else. And I think I read somewhere that GLP-1s may help with blood cancers. There may be an association with dementia. There may be an application for people who have addictions that it sort of dulls that. Can you talk a little bit?
Ali Zentner: Agra.
Lynda Steele: about what we may see in the future.
Ali Zentner: Yeah. So Viagra was a blood pressure pill. Yes. Not anymore. It wasn't a very good blood pressure pill, by the way. Now they use it actually for pulmonary hypertension ⁓ and for ⁓ altitude sickness. ⁓ I climbed Kilimanjaro on Viagra. quite funny, but we use it to prevent altitude. ⁓ Yeah. Yeah. Because it treats altitude.
Lynda Steele: ⁓ yeah. You did? Wow, that's interesting.
Ali Zentner: So you're right. ⁓ We know that these drugs, so we've already seen this. So there's a 20 % reduction in heart attack and stroke, cardiovascular risk reduction. There's a treatment for fatty liver. fact, Health Canada has now given some aglutide, ⁓ Health Canada approval for treatment of fatty liver, or metabolic liver disease. It's called metabolic non-alcoholic steatohepatitis or MASH, or we just call it liver disease. The dementia data has not panned out. So that was a trial that recently was actually announced at the Dementia Conference in December. They looking at the use of this drug. And again, was a randomized placebo control trial, whether or not it would help ⁓ slow dementia And the answer was no. ⁓ There's a couple of small trials and one or two larger scale trials ⁓ looking at both semaglutide and tersicol. so Ozempic slash Mounjaro ⁓ in the use of substance misuse. ⁓ And the studies are actually incredibly promising, showing a decrease in kind of, ⁓ in particular, it's looked at in an alcohol use, but decrease in alcohol and alcohol consumption. ⁓ And part of that has to do with how the drug itself works. So you have part of your brain, we talked about the Hunter system, the part of our brain, it's part of our brain called the Mesolymphic system. ⁓ And it's literally ⁓ sort of a, cluster it's like a highway of dopamine receptor sort of dopamine cells dopamine ⁓ neurons that snake through the brain and it goes from your compulsion center to your reward center to pleasure and planning. It forms in all of us at age 10 and comes fully online at age 21 when our sort of goal prefrontal cortex or goal oriented behavior officially comes on board. And it's a dopamine pathway with opioid receptors and nicotine receptors and cocaine receptors and cannabinoid receptors on it. And it also has GLP-1 receptors and GIP receptors and amylin receptors and glucagon. So it's got got hormone receptors because its actual purpose was to make us a hunter. So think about it 50,000 years ago we're sitting in a cave and one of us has to go run a buffalo down in our underwear in 90 below zero. Well you have to be very like a little bit, you know, crazy. Yeah, like to go do that, like me at a, you know, sample sale, kind of crazy, right? so what this what that is, is literally, it's our hunter system and it's been linked to everything including cravings, it's been linked to addiction and substance misuse, it's been linked to ADD, it's been linked to binge eating, it's that's where that part, those diseases live in that part of the brain and so if you think about it, if you... you can, you know, and one of the ways we treat substance misuse disorders, we give patients, you've heard of Narcan or ⁓ give patients sort of a longer acting version of an opioid blocker so that their brain's receptors don't click on, right? Well, this would be a similar kind of action, right? You literally blunt craving response by shutting the, you know, I call it the little, you know, the dragon falls asleep in the back of the cave, the hunter. and doesn't think, ⁓ my god, give me this now, because it's literally gotten what it was looking for. And so I think what we're seeing here. ⁓ is a huge shift in culture around blame and shame and dieting and this kind of idea of, you know, a personal ⁓ sort of ⁓ ⁓ and around and I hope what we're ⁓ embracing more is of all ⁓ of diversity of body size and body shape, number one, that there is no longer this standardized, quote, ideal, number one. And more importantly, that we embrace the fact that this isn't a simple math equation of just eat less, move more. And if you're not getting the body we want you to get, it's because you're not working hard enough.
Lynda Steele: Well, amen to that. ⁓ Dr. Zentner, this was fascinating and it has really changed my mind about these drugs. So thank you so much for joining us. I really, really appreciate this conversation.
Ali Zentner: Thanks for having me.
Ali Zentner: It's a pleasure, absolutely, Lynda thanks.
Lynda Steele: Now I come from a family that has struggled with weight. My mom, bless her soul, she's not with us anymore, but she really spent an entire lifetime dieting. And it was a struggle. And the family used to make fun of her like, oh, Thelma's the fat one in the family. Even though I look back now at these family reunion photos and I think every single one of us could have lost a minimum of five, 10, 15, up to 50 pounds.
Melanie Nagy: I'm curious, because I did hear you say that during your conversation right near the end. And like you too, I was on the edge of my seat listening to everything. Flesh that out a bit for me. What do you mean by that, that you changed your mind? How did you change it?
Lynda Steele: Okay, well, first of all, I think I felt a little bit judgy, because I thought I'm, you know, I'm watching what I eat and I'm working out hard. And then I've got friends who are just, boop, you know, taking a little injection and then suddenly they look fabulous. And I kind of thought, you're cheating. But after listening to her, she's saying, no, I mean, if you compare it to any other drug, when she said, you know, do you take a cardiovascular drug or statins or whatever, it's the same premise that obesity is If you're watching a hockey game, for example, during the NHL playoffs, notice it in the intermission when you're watching the hosts, ⁓ whole set is virtually wrapped in the words, Ozempic, Ozempic, Ozempic, Ozempic, Ozempic everywhere. ⁓ now it's actually, Wegovy Wegovy, Wegovy. And these are two of the most popular brand names for these weight loss drugs. ⁓ it just struck me as odd. I thought I'm watching professional athletes, really fit guys. So I think that we get this weird sort of idea that it's someone else's got a problem and we're all fine. And I just wonder if we could just talk about the stigma off the top here. What do you see and how difficult is it for people who are really struggling with their weight? Because there seems to be this idea that it's a lack of personal responsibility or something. and the program is flogging weight loss drugs. That's interesting to me. But what's more startling is the fact that there are some really major professional athletes that are now shilling for companies that are selling weight loss drugs, like Serena Williams. disease and this is treating a disease and we're just lucky that we have this medication now. So I also thought well you know maybe maybe it is something that I would look at or a microdosing and she's saying no hand up would not work for you. You don't fit the criteria for it. So I do still have a little bit of concern that maybe there are young people or teenage girls or people who have eating disorders who are attracted to this who maybe shouldn't be.
Ali Zentner: I think almost summarized it beautifully in that comment. Like ⁓ Thelma was the one with the problem. ⁓ if we look back, everybody else had the, ⁓ you see what I mean? Like I think in and of itself, and it's not to call you out at all, Lynda, but as a society, this seems to be the last ⁓ ⁓
Lynda Steele: These drugs are really popular and they're actually called semiglutides or GLP-1s. They work really well for a lot of people and that's why so many Canadians are taking them. There's something like a million Canadians taking these drugs, which isn't surprising because it's estimated that one in four British Columbians is considered to be obese. One in four, like that's astonishing.
Ali Zentner: that it's just okay to pick and poke. And I think if we break it down, first and foremost, when we talk about so-and-so should lose X amount of weight, there is no such thing as a goal weight. The quote standard that we adhere to about ideal weight is a complete emperor has no clothes kind of moment. that comes from, you know,
Lynda Steele: but then the doctor should be the gatekeeper.
Melanie Nagy: Yeah, I thought there was so many things, because she took us really from this, the place of understanding obesity and the stigma attached to the place of what these drugs are, the science of it. I thought the body mass index, mean, honestly, tracing that back and the BMI becomes such a foundational thing that you hear. You go to a gym, they measure your BMI. So that was a big takeaway for me. But really, I she made this conversation accessible.
Lynda Steele: These drugs work in kind of simple, mysterious ways, but what they do is they control your blood sugar, they slow your digestion, and they make you feel fuller longer. And the best part, I think, is they sort of turn off that little voice in your head that is thinking, ⁓ I wanna eat a bag of chips, or ⁓ what am I gonna eat next? That's the thing that sabotages most diets. So these drugs are really quite incredible when you think about it.
Ali Zentner: If we want to even talk about where, quote, the concept of ideal weight comes from, that's back in the when an astrologer named Adolf Quiddily ⁓ to find out what the average man looked like at the time. So he took the and weights of the Scottish and Flemish army, ⁓ and came up with the body mass index. And that's the standard that your beloved mother, Thelma, fabulous name the way, would have absolutely been adhering
Melanie Nagy: The risks, a lot of people talk about that as a ⁓ but I've never heard anybody frame it and make it as accessible when she commented on the risk. But for me, really, there was one thing she said, she said, it all comes down to choice and agency. ⁓ And really, we just need to accept that, right? It comes down to our own choice and our agency ⁓ in consultation a medical professional. But ⁓ great conversation.
Lynda Steele: And the only problem is that they're really expensive. So it costs about $450 a month. A lot of people don't have coverage. So that's a lot of money to lose weight, right? Unless you're really, really serious about it or you have a real serious health condition. But there is some good news on two fronts. One of them is that Canada is poised to become one of the first countries in the world to approve generic versions of these drugs. Thank you.
Ali Zentner: to in terms of numbers and growing up probably in a Weight Watchers Society and so we see there's that piece to it and we'll come back to that in a minute but that's the vestiges of dieting culture running through, running rampant through our society and talking about issues around sort of personal responsibility and personal fault etc. which we're seeing emerge in conversations around health now in a
Lynda Steele: Right. I loved it. And for anybody who was even potentially a little bit judgy like me, I hope that we all have expanded our thinking around this because the reality is I've learned that your genes, you are just born that way, you know, as Lady Gaga says, and there's not really a lot you can do about it. It isn't, it wasn't like my mom, Thelma, eating too much. It was the way her body was designed and she just didn't have a drug to help. And that's gonna cut the cost by hundreds of dollars a month, which will make these drugs really accessible to way more people. The other good thing is that there is a doctor right here in Metro Vancouver who started a petition to try to get the province and PharmaCare frankly, to cover these drugs for anybody who needs them. We're gonna talk to her in a little bit, so stay tuned for that. But first of all, I was thinking to myself in doing research for this podcast,
Ali Zentner: detrimental way. So there's that one piece. When we talk about stigma and know weight bias in society
Lynda Steele: and now people do, so amen. She may not call it a miracle, but it's certainly a game changer for a whole lot of people. All right, thanks so much, Mel. That was an awesome conversation.
Melanie Nagy: sure.
Ali Zentner: it's the one area where everywhere it permeates, know, and part of it, I would argue, is a bit of a feminist issue. know, women were told for decades, if not centuries, that our physicality determined our value and our acceptance and our worth in this world, and unfortunately medicine co-opted that and said, ⁓ yes, and your health as well. And so now conversations that used to happen around
Lynda Steele: Okay, so how do I feel about this? ⁓ Well, like I said to Mel, I really have changed my mind. I think that it is about learning more, about having a deep understanding of how obesity works, that it is based in your genes and all the different hormones that come into play. So I do see the potential for it to change lives. And I do see the potential for it to also save the healthcare system a bunch of money, which maybe it does make a ton of sense to have governments say, that I really wish these drugs were available when my mom was alive because she dieted and struggled with her weight every goddamn day of her adult life. I mean, it was really sad. She was someone who had a sweet tooth and she would hide chocolate bars in the back of the freezer. And if one of us kids found them and ate them, ⁓ my God, there was hell to pay. But she had a tough time. And as a kid, especially a girl watching a mom,
Ali Zentner: vanity and appearance have now been quote almost in a weird way reframed around health. But still equate size with health with which is completely wrong. ⁓ ⁓
Lynda Steele: you start to develop some kind of weird thoughts around food and dieting in your own head. And I remember the exact moment that my lifelong obsession with weight began as well. I was 18 years old, which is sad. I was 18 years old and I was in the woman's washroom at the Athabasca Pub in Hinton, Alberta. And I was wearing my favorite jeans and my girlfriend said, not very kindly, I might add, This is a drug for a disease that can ultimately save us all as society a bunch of money. I do also think that, yeah, I guess this is not a drug for me and maybe I should be happy about that, that I am able to control my weight, keep it healthy through diet and exercise. So at the end of the day, I do feel like I've learned a lot and I certainly have moved the yardstick significantly.
Ali Zentner: How do you break that stigma and how do you break that discussion or how do you start that discussion?
Lynda Steele: Well, and I'm curious about that too, because I fall into the trap of thinking, ⁓ you know, wow, that is five foot 11 and she weighs 120 pounds. And I think, ⁓ my God, I must be obese then because she's way taller than me and I weigh ⁓ more than that. ⁓ there's so much wrong about the way we think about how much people weigh. So as for you, you do not have to agree with me. You do not have to change your mind. Just keep it open and stay curious. And thanks for joining us. ⁓ Lynda you look like you're putting on some weight, ⁓ And I remember just being thunderstruck, like ⁓ some reason, I had not noticed that I was putting on weight. And she was maybe unkind, but she was also accurate. ⁓ had been putting on weight and I don't know why I didn't notice that my pants were too tight.
Ali Zentner: Yeah, I think it's important to break that down even further. So understand that I don't think we would have the same discussion if we were talking how tall people were, would we?
Lynda Steele: So I went off on a lifelong journey myself of alternately being, I wish I could get rid of that last 10 pounds. Oh, now we're at 20 pounds I need to get rid of. I think at my heaviest, it was maybe 25. Okay, I'm be honest, maybe 30 even pounds that I had to lose. And I have struggled with it. I have not eaten what I wanted to eat. I have worked out when I didn't feel like it. So am I interested in these drugs? Yeah.
Ali Zentner: Right. So remember that weight is as genetic as height and eye color and well, hair color is not genetic. It's what colorist tells me. ⁓ know, hand size, foot size, etc. So There are 5,500 genes at play here, period, that determine everything from whether or not you have a sweet tooth to where you put your weight, how much weight we'll all lose and gain in our lifetimes, how we respond to treatment, all of that's genetics. And that's even beyond the genetics of the genes you got from Thelma and your dad, but it's also the genes that we as a species evolved to select for by just
Lynda Steele: Do I have questions? ⁓ hell yeah, I do. So let's bring in producer Melanie Nagy for a discussion and a setup of our guest. Hi, Mel, ⁓ you must know some people in life who are taking these drugs or you suspect they're taking them.
Mel: Yes on both accounts. Yes to taking them. Yes to suspecting them. These drugs are unavoidable in conversation, on social media, advertisements, whether it's your advertisements online or in magazines. They're everywhere. I really do feel that you can't escape them.
Ali Zentner: The idea that think about it as a species we would have selected for genes that prevented famine. We would have selected for genes that prevented us from dying of starvation or what we call thrifty genes. And what we see is an expression of those thrifty genes in times of stressors. when physiologically your body's exposed to stressors, you know, we think of genes as they turn on when we're a baby and that's it. But our genes turn on and off throughout our lifetime.
Mel: ⁓ And I think it's really interesting because everybody has a different... People have different personal approaches to weight and stories and trauma with weight. But then there's a flip side too where there is also the movement of celebrating body and accepting body. So I find it a really interesting topic in how we balance it, whether it's the access issue that you talked about, whether it's how do you avoid body shaming and connection with these? what's wrong someone's body that they might feel they have to take these? so many questions to explore and navigate.
Ali Zentner: times in response to certain stressors. Absolutely. We're also dealing with what's called a neuro hormonal feedback mechanism. So every organ in your body talks to every other organ in your body through a series of hormones. And in this case, you're dealing with the most important hormonal conversation in the world because if you think about it for a minute, if there's no gas in the tank, then the engine doesn't run. So your body's energy regulatory system
Mel: That's why think we have the perfect guest today. I know you mentioned Dr. Allie Zentner. She is a Vancouver-based physician. She has spent over two decades specializing in metabolic medicine and obesity. She's the founder of Revolution Medical Clinic. That's one of Canada's largest public obesity clinics.
Ali Zentner: is more important than how often you breathe or how many times your heart beats in a minute because...
Mel: she's an advocate for treating obesity from the lens as a chronic disease rather than a failure, like a personal failure or a personal failure of willpower. ⁓ And through she's also written a book ⁓ about the It's called The Loss Prescription. She's also started a movement called No Fat Shame. And that's all about... ⁓
Ali Zentner: None of those things are gonna happen if there's no gas, so to speak. So we, as a species, have 37 different hormones that regulate this. Your brain talks to your gut, your gut talks back, and that's from out the anus. are hormones throughout. We know that fat and muscle tissue also produce about half a dozen different hormones each, ⁓ hormones, usage hormones, ⁓ cetera. ⁓ your brain, you even have
Mel: Ending weight bias in medicine and changing the way doctors ⁓ Treat and talk about obesity because it's a really interesting thing you mentioned some of the people that I know that are exploring those drugs They've actually even faced stigma and judgment from their doctors So there's so much to explore dr. Ali's that I think she's gonna be the perfect person for you to connect with
Ali Zentner: of the brain called the hypothalamus which is subconscious and it controls things like body temperature, sleep-wake cycles, blood pressure, respiratory system, etc. But it also has a part of the brain called the arcuate nucleus which literally has hunger neurons and fullness neurons. Not even I feel hungry and I feel full but full gas tank empty. for example there's even conditions where if for example there's a part of the brain if you have a stroke in the arcuate nucleus you can actually
Mel: and explore all your questions
Lynda Steele: I have so many questions. So Mel, you're gonna ⁓ back and you're gonna come back in after the conversation and we're gonna have a little bit of a debrief ⁓ see whether or not I've changed my mind about these drugs. ⁓ I'm looking forward to talking to you in about a half an hour or so.
Ali Zentner: eat yourself to death.
Lynda Steele: Wow.
Ali Zentner: ⁓ so just as an so this is highly regulated, ⁓ so who's to say And it's interesting because 50 years ago we used to think depression was just you wanted to be sad and you chose to do that. Now we understand depression is an inflammatory brain disease that is highly regulated by a bunch of different neurotransmitters and it's chemical. So why is it that we still think that why we gain weight is because you know my patients are sitting on a couch eating chocolate and watching television and not exercising enough. ridiculous. Like it's not just mean, it's stupid. Like, fine, I say to people, you know what, you want to be mean, be mean, but don't be dumb. and you know, I get that a lot from like patients who are not patients from people who are like, ⁓ you know, you're just, you know, you're just giving people a free ride. I'm like, no, no, you're just being dumb. Like, if you want to think that go for it, but the earth is round. You can think it's flat, but dude, it's round. Sorry. So that's what the hypothetical dude who's giving me crap feedback but I just say idea here like like I have this ⁓ pod your listeners can't hear but I have a very ⁓ fabulously thick head of hair and I it's not because I drink or eat protein it's just my dad Okay, he had a really great head and that like, there's so many things in this world that are genetic that we accept, right? Intelligence is a huge one, you know, or, or quote, talent, like, I am going to take singing lessons till the day I die, but I'm never going to be Beyonce. She's just got innate talent. And so you're telling me and you're not, but this is a highly sophisticated regulatory system that the brain that we have evolved over thousands of years and I'll take it one step further and say this to you, think about it for a second, if you don't want to die of a famine you better do two things really well, you better hunt food and you better store fat and anyone who's ever been on a diet has experienced this firsthand. You go into what's called starvation response, so you lose weight and then you stop and that's an activation of the storage system of starvation response and then all of sudden you have cravings through the roof, you dream about food, food tastes better etc. and that's the activation of the brain, a part of the brain that's known as our craving center that makes us good hunters. So we have these two systems in our body that are activated at all times that some of us have just, shall we say, an over activation of. Right? So just like some people, have an activation of an excess heart rate and patients go into atrial fibrillation or like it's, you know, there's sometimes organs don't do their part and the body just goes left when it shouldn't. And that's what we're seeing here. Now, Why are we seeing an overwhelming population around this? Well, I think twofold. One, there are an enormous amount of environmental stressors that make it very easy for the brain to go into starvation response, number one. And number two, our diagnostic tool for what classifies as, quote, obesity is based on an 1870s astrologer's chart. So remember that yes, in some patients, obesity is very much a disease, meaning a biological dysregulation that affects how you move through the world. In some of us, it's just a risk factor, but in everybody it's a social construct.
Lynda Steele: Good grief. mean, I've learned so much in just the last few minutes there, ⁓ but mean,
Ali Zentner: Don't you want to gather your family together and just contact your mom and say, we're really sorry. We were total jerks.
Lynda Steele: Yes. Exactly. And let me ask you this then, because I really think that I wish these GLP ones were available when my mom was alive, because she had such a struggle her whole life. And I've got some friends who have tried these drugs, and they've really worked for them, who have described them as being like game changers, or miracle drugs. I mean, what are you hearing? What are you seeing in your practice?
Ali Zentner: Right. Right. So remember, let's go back to starvation response and let's explain how these medications work. So if the brain thinks it's starving, it stores and it hunts. And your friends who tell you they're game changers say, I don't get it. I eat what I want and I lose weight. So ⁓ what are these medications? ⁓ goal of treatment should be to trick a starving brain into thinking it's not starving. Well, what better way to trick a starving brain than to give it a hormone it only gets in the presence of food? Anyone who's ever taken the birth control pill knows you can't get pregnant when you're pregnant, thank goodness. ⁓ And so take a pill that tells your brain pregnant. Right? It's a hormonal trick. Well, if your brain thinks there's a famine and it's going to store and hunt, then you give it a hormone that you normally get when you eat. Well, so semaglutide, which is called Ozempic or Wegovy depending on what you take it for. Same drug. Fun fact. It's a copy of a single gut hormone called GLP-1. most people have heard the expression, takes 20 minutes for your stomach to tell your brain you're full. ⁓ not your stomach talking, it's 20 minutes for food to go from your mouth to your small intestine. ⁓ when food hits the small intestine, again with the hormones, ⁓ a dozen hormones are released from the small intestine to tell the brain a meal's arrived. ⁓ of those hormones is GLP-1, another one's called GIP, ⁓ one is released from the liver. called glucagon. one's released from the small intestine called amylin. I'll you why I'm naming those hormones because they all become very important. ⁓ So is a GLP-1 analog. You may heard of another drug called tersepitide, which is Mounjaro or Zep-bound, depending on what you use it for. ⁓ Well, it's and GIP, which are ⁓ both released the small intestine. Fun fact, GIP was first ⁓ sort of in Canada. So it's a BC based hormone actually. ⁓ ⁓ there's a new medication called servodotide that will probably be released in Canada in the next year and a half. It's in of Health Canada and it's GLP glucagon agonist. ⁓ There's cragrinolide with semaglutide which is a GLP. Lp-amalin agonist, which is coming probably in the next year or so. You're gonna hear about all of these. There's another one called retatratide, which is a triple gut hormone of three. So the idea here is, remember when Prozac launched and we said it was like a copy of a, it was like a, helped serotonin stay in the brain, right? And then all of a sudden you saw five different antidepressants and now you have serotonin reuptake inhibitors, dopamine reuptake inhibitors, have norepinephrine, you have all these different ones. So in other words, what I'm saying is there's a similarity here. We've cracked a code and we've realized that these drugs don't work by making people eat less because the problem never has been math. Your mother, bless her, didn't eat too much and not exercise enough. That's not what was causing the issue. She might have at times had more cravings than ate, but that was a symptom of a starving brain and not the cause of the weight ⁓ gain. ⁓
Lynda Steele: Okay, well now that's really interesting because so many people then are, you know, we see influencers and we see former athletes like Serena Williams and actors and all these people suddenly, you know, on ozempic or a drug like that. So my question is, who are these drugs really for? Can they be for everyone or are they really meant for people who are dealing with the disease of obesity?
Ali Zentner: Lynda, do we only do abortions for women who are raped?
Lynda Steele: Okay, that's very interesting because we're also talking about ⁓ microdosing and things like that too. So as for me even I've thought, maybe this is something I could look into myself.
Ali Zentner: choice. I think it's more of a philosophical question and remember that the genie has officially left the bottle, right? ⁓ And the genie left the bottle not of these medications, but the genie left the bottle with dieting. ⁓ So I'll give you an example. ⁓ one has a problem with a of ⁓ any size going on a diet and what she's eating. but people all of a sudden are deciding who takes what medication. Now, I should tell you, I am a physician. I am a specialist in obesity medicine. I believe there should be guidelines around, you know. like there should be parameters around who gets what treatment period. it's not like a pizza for everybody, right? Like we don't do chemo prophylactically for cancer. Absolutely, right? So there are criteria that we need to adhere to around medical safety, right? Safety and efficacy period. However, with that said, it comes down like on a broader topic, it comes down to choice and agency. And I would argue, I am never, and I hear this all the time, but I am never a fan of someone practicing medicine without a license. So I don't think that, and I mean, I realize there's some irony here that we're having a podcast discussion for mainstream, but I don't believe that we, my patients should get the bulk of their medical information from TikTok. I don't even have an account, full disclosure. don't, first of all, I think that we've gone so, the pendulum has swung so far. in one direction. used to be that they're like medicine used its own language and there was such, you know, don't ask, don't tell, and there was a huge secrecy, but it's almost too much access and too much freedom of information and less sort of gatekeeping around what's what. And I mean, a perfect example is every one of my patients can go online and look at their labs and then they Google and wait for the word cancer to appear, you know, and they've already self-diagnosed. themselves based on their laboratory situation. So I think we've swung so far, microdosing is a perfect example. One of the reasons people microdose, probably the biggest one is cost. So I would argue I have a bigger issue with the fact that these medications have become a niche product for people of... means ⁓ not like we're not having real conversations around who should really take this because right now in Canada in particular ⁓ mind the US they've got other ⁓ I mean, don't get me started, but ⁓ in Canadian system, which is a socialized health care system, ⁓ which a system that in theory, God bless Tommy Douglas, ⁓ this be based on need. And for those of you who don't know who Tommy Douglas is, he is the father of socialized health care and worth knowing about. And here's the tick tocky fun fact, is Kiefer Sutherland's grandfather. ⁓ However, ⁓
Lynda Steele: Wow, yeah.
Ali Zentner: yes. ⁓
Lynda Steele: Can I just stop you for a second because I just want to ask one thing. Are you saying ⁓ that ⁓ anyone should be able to access these drugs? ⁓ No? Okay.
Ali Zentner: ⁓ I am saying that this is a conversation that everyone should be able to have with their physician or healthcare provider to learn if this is an appropriate treatment for them. So let's take you. You said, I've even thought about this for myself. and you're not someone who would meet criteria to take these medications meaning your body mass index is not above a certain number which it's hysterical because we just spent a few minutes you know can I swear on this podcast or no?
Lynda Steele: Sure, go ahead.
Ali Zentner: We've just spent a few minutes shit talking the BMI, absolutely. And now we're like, we still use it as criteria for medication. Absolutely. ⁓ However, ⁓ I will say, let's say you're someone at risk cardiovascular disease, ⁓ or you've even had cardiac disease. And let's say you're someone with a metabolic liver disease or a fatty liver is ⁓ the term use. Well, these drugs are indicated for that. So. ⁓ isn't that a conversation that you would like to have with a professional? Right? Like, so do you see what I mean? Like, this is a conversation that you should have with your doctor and that we should discuss risk and benefit and what you can anticipate, etc. Just like you would with any other drug.
Lynda Steele: I hear you, but I also watch CNN and cable shows where they're coming up at 10 o'clock at night and saying, would you like some generic Viagra? Just punch in 42, 42, 42. I mean, are we gonna get to the point where people can get it online or through a black market and they shouldn't really be taking it? Okay.
Ali Zentner: ⁓ they already can 100%. But that doesn't mean they should be. ⁓ again, it's ⁓ why you and I are having a conversation, And we're a long one, ⁓ for sure, or like more than five minutes, absolutely. But the around this is... ⁓ Do I think that drugs should be advertised on TV to the extent that they are being advertised? Absolutely not. But I'm not, I'm a realist and I understand that, you know, I'm a Canadian physician, which is a whole different ball game, but I understand that healthcare in most parts of the world is still a business. ⁓ I don't think I like that aspect of it. I don't agree with it. But I think I'd like to think that the people that I see every single day still have a degree of respect for my authority and for, you know, my ⁓ not even authority is probably not the right word for my expertise and for my experience and all of that. so, you know, so I think and I say this to patients all the time, like, validity doesn't come from personal experience. It comes from years of practice, right? You know, it's fascinating to me that the 10,000 hours rule applies everywhere but in medicine, which I think is hysterical, right?
Lynda Steele: expertise. You
Ali Zentner: like, well you know I have patients who come in and go well you know I've talked to whole bunch of people about this and I'd like to try this and the joke I all the comment I always say is all right you're in trouble with the law do you go down to a prison and ask the inmates what worked and didn't work for them or do you call the lawyer?
Lynda Steele: I mean, you're making a lot of great points and I want to back this up to cost because that is it's almost like a two tiered system for people. These are expensive.
Ali Zentner: It is a two-tiered not almost like a two-tiered system. It's a two-tiered system that ironically, you know, the house always wins kinds of things. This saves the healthcare system. You know, it's like, we know these drugs pay for themselves within a year in terms of treatment. But I also think, you know, to your point, you said...
Lynda Steele: Can you explain that first before you go on? How do they pay for themselves?
Ali Zentner: Well, prevention, right? So we know, for example, there's data to show that, let's say, tersepiditis or ZEP bound, 50 % reduction in sleep apnea. So if you have sleep apnea, and let's say you stop breathing 60 times an hour, you literally... have a 50 % reduction in the amount of times you stop breathing. So many patients who let's say have moderate sleep apnea go from moderate to mild on these medications. Let's also talk about percentages. So I know we said numbers don't matter, No one believes that, let's be honest. Chief among them, patients. Absolutely not. And this is where you have science butting up dieting culture, which is what we're seeing here, right? ⁓ And so the reality is, and you talk about this, you know, TikTok and influencers and everything, that's dieting culture. So it's, it's ⁓ same game, different rules, if you will, to speak, or, you know, it's, it's, or sorry, same rules, different games, so to speak. But it's that idea of the diet and culture still talking about it because, you know, and it's interesting to me about all of it and about sort of the discussions that we have about... the death of dieting culture. But let's be honest, my patients and my colleagues learned everything they need to know, and I put that in huge air quotes, about weight and diet from dieting culture, which is all garbage. So there's that. So just to your point, the idea around cost and that, the drugs themselves, you have a 90 % reduction in development of type 2 diabetes, you have a 10 to 20 % body weight loss in the vast majority of patients. Some lose more, some lose less. The newer agents like the dual agonists or the triple agonists, you're talking about 20 to 25%. In fact, nowadays, you when I started practice 25 years ago, 5 % body weight loss in the old drugs was considered a gift. Now, if it's not 15 % or more, it's a crap drug, so to speak. So it's quite impressive. But these drugs,
Lynda Steele: Ha
Ali Zentner: you know, also 20 % reduction in heart attack and stroke, treatment of metabolic liver disease, which is the leading cause of liver cirrhosis in North America. So you're talking prevention, prevention, prevention, prevention. I I run a program in BC called Get to Surgery, where we look at, help patients who've been told by their orthopedic surgeons, lose weight, and then I'll take care of your knee. We work with them with a medical approach, not a dietary approach, but just medical approach. And
Lynda Steele: Right.
Ali Zentner: We get them to joint replacement surgery, but in one year we took 10 patients off a joint replacement list. Well, at $10,000 a joint, that's a lot of money saved, right? ⁓
Lynda Steele: Which is great, and I do know that there's two things that are happening that I think are, you know, make people feel optimistic. One of them being that Canada is kind of looking at approving some generic versions, which should bring the cost down. But also you're behind a petition to try to get government to cover the costs for people who really need these drugs.
Ali Zentner: Yeah, I think I've been knocking on government's door for a while now. It's interesting what's happening in, ⁓ it's, it's unfortunately, it's two step forward, three steps back a lot of times. you know, petition is one thing, but absolutely ⁓ the issue will be Right now, these medications, they started at being far more ⁓ expensive than they even are now. So for example, semaglutide in the form of the trade name Wegovy which is a 2.4 milligram dosing, used to be about $450 a month. It's now $288. Okay, so the drugs are coming down. Part of it is that in Canada, in particular, semaglutide has lost its patent. So that means that it invites generic companies to basically copy the drug. And there are nine sitting in front of Health Canada waiting for approval including well actually not because the generic that's produced by Novo Nordisk which is the company that produces Wegovy and Ozempic already has approval by Health Canada. Why? Because it's essentially the non-generic, like they don't need approval, right? So they just cross out the name and put in whatever their new name will be. Absolutely. But lost their patent in January. And again, it takes time for Health Canada to approve generics. ⁓ governmental, and I'm like dissing Health Canada, but it's fascinating to me the sort of time it takes around these sort of approval experiences. I'm not asking them to fast track, but we have had... years of experience with GLP-1s. Like for example, when people say these drugs are new, I'm like 2019. so, semaglutide was approved in Canada for use in 2019. That's seven years ago. Like that's a long time. Absolutely.
Lynda Steele: Well, you know, that is a long time, but I do wonder about the long term safety. Like, what do we know if someone's been on these drugs for 20 years, 25 years? we...
Ali Zentner: Yes. Lynda, you want a drug, you're not going to get that. So that's not how science works. So the good news about that is, I'll give you an example, how long you've been using a cell phone for.
Lynda Steele: Yeah, a long time, decades.
Ali Zentner: You've got earbuds in your ears, by the way. Yeah. What's the long-term data on the use of earbuds for radiation? I'm just curious,
Lynda Steele: Yes. You're nailing me to, okay, I get it, right? That we don't know about a lot of things.
Ali Zentner: We don't, but that doesn't mean we need to. I don't know about you, I don't want a drug from 1940. Right? I don't. Do you want to drive a 1940s car? I mean, it's cute, but it's not safe, is it?
Lynda Steele: Yeah, yeah, yeah. No. No.
Ali Zentner: Right? Yes. I want a drug that has gone through rigorous testing, that has had double-blind randomized placebo-controlled trials with thousands of patients, that has been tested on women, not just on men, like most drugs were up until now, that has at least 50 % of, you know, of... the patient population that has been tested to be somebody who might look like me, absolutely, in a modern day. And I want rigorous accountability ⁓ and et cetera. ⁓ None that existed 30 years ago. ⁓ So science moves forward is I get that people want
Lynda Steele: Fair enough.
Ali Zentner: you know, they worry about the, it's leftover from the thalidomide world. We told what, right, but that's not happening anymore.
Lynda Steele: Yes.
Ali Zentner: Right? And so for example, I'll give you the opposite. You know how many drugs we said we weren't sure were safe in pregnancy that now we use in pregnancy because we have that kind of data? So there is the opposite effect that's happening. I'm not saying, but I'll give you an example. Metformin was a classic drug. was talking about it with one of my students today. And when I graduated medical school, we didn't use metformin in pregnancy. And now it's mainstream because the safety data is there. So I get that people are worried about, ⁓
Lynda Steele: Yeah.
Ali Zentner: 20, 30 years from now, what's this going to look like? I totally understand that. But what they don't also consider is 20, 30 years of untreatment. What does that look like? And I've been around long enough to know ⁓ that medicine in particular, ⁓ know, physicians are divided into what we call early adopters ⁓ or wait and seeers. ⁓ And, you know, and my patients... ⁓ have done the wait and see for a long enough time now. And all of it's one thing if it was one or two studies, but the mounting amount of evidence towards the safety and the efficacy of these medications over and remember a drug that launches seven years ago was actually studied for at least four or five beforehand. So you have, and let's understand when we're talking about semaglutide, there was liraglutide before it, which launched five years before that. So this class of medications has at least 15 years of data. And so when you say to me you want long-term data, what I say to you is how long? Like is 15 years good enough? Is it 20? I don't mean to sound like
Lynda Steele: Yeah, no, you're making a good point. My question now is, no, no, when you talk about length of time too, because I do know some friends who are on it, ⁓ have lost weight and then actually went off it because they lost too much weight and are now back on it. So my question is, do you have to be on it forever? And what happens when you come off it? Does that mess up your metabolism?
Ali Zentner: So let's go back to your brain as starving, right? So we trick your brain into thinking it's not and it doesn't store and it doesn't hunt. ⁓ What happens when we wake your brain up again and psych! Can you take your glasses off? ⁓ You're wearing glasses for those of us. Right, how well can you see them?
Lynda Steele: Yes. I can see okay, I can get by.
Ali Zentner: Yes, so your eyes really aren't learning from those glasses, are they? Right. Medications for chronic disease apart from antibiotics and pain relief, which is what we what the vast majority of Canadians take medications for chronic disease. In fact, most diseases nowadays, apart from infections and acute pain are chronic, right?
Lynda Steele: Right, no.
Ali Zentner: They are not an education for the body. They're a compensation for what the body's not doing in the first place. And it's funny to me because that argument is never made. Let's take out the word obesity and say, I take medications for my blood pressure. No one ever says, once my blood pressure gets to target, I'm stopping my meds. No one ever, that is not right. But it's right.
Lynda Steele: Got it. ⁓ God, that makes so much sense, you know, when you put it that way.
Ali Zentner: So it's bias. it's the fact that, you got, and again, a lot of these arguments that are being made are the dieting worlds dying literally. And so it's fighting back. You know, another example that we hear a lot about is what's called sarcopenia or muscle loss. No one ever complained about muscle loss from diet and exercise or starvation diets, which happens absolutely. Like, let's be clear. Can I tell you a fun fact? Fact. Any time you lose weight, doesn't matter how you do it, whether starvation program, whether it's a liquid diet, whether it's keto, whether it's medication, whether it's bariatric surgery, any way you lose weight. 25 % of that weight loss will be muscle, ⁓ and there's specific amount of minimum exercise that you have to do ⁓ and even that 25 % muscle loss goes down to 10%. So you can expect a minimum of 10 % muscle loss ⁓ no matter Why? Because that's just the way of all flesh. Now no one cared about that when you know when Oprah did her liquid diet remember in the day and she pulled the like no one ⁓ or Oprah her jeans and everything
Lynda Steele: when she pulled the cart out with the fat on it.
Ali Zentner: Oh my god, she's lost 25 % muscle mass. But now that she's on this medication, the world's in an uproar. I'm like, really people? That's amusing. That is really impressively amusing.
Lynda Steele: Can I just ask you one more question? Because I know I can't keep you here forever, but.
Ali Zentner: You're gonna go back to your friends and really set them straight. I love it. It's all good. Yes. I will say that I don't believe that they lost too much weight. I'd love to see how that was because your body won't let you do that. Like realistically, your body has a bottom and it doesn't do it. In fact, there is no if you are losing too much weight, there's something else going on.
Lynda Steele: I'm curious, like many drugs. Okay. Okay. Okay, good to know. Let me ask you this one last question. Often we find when a drug is introduced for one thing, it ends up having this astonishingly positive benefit in something else. And I think I read somewhere that GLP-1s may help with blood cancers. There may be an association with dementia. There may be an application for people who have addictions that it sort of dulls that. Can you talk a little bit?
Ali Zentner: Agra.
Lynda Steele: about what we may see in the future.
Ali Zentner: Yeah. So Viagra was a blood pressure pill. Yes. Not anymore. It wasn't a very good blood pressure pill, by the way. Now they use it actually for pulmonary hypertension ⁓ and for ⁓ altitude sickness. ⁓ I climbed Kilimanjaro on Viagra. quite funny, but we use it to prevent altitude. ⁓ Yeah. Yeah. Because it treats altitude.
Lynda Steele: ⁓ yeah. You did? Wow, that's interesting.
Ali Zentner: So you're right. ⁓ We know that these drugs, so we've already seen this. So there's a 20 % reduction in heart attack and stroke, cardiovascular risk reduction. There's a treatment for fatty liver. fact, Health Canada has now given some aglutide, ⁓ Health Canada approval for treatment of fatty liver, or metabolic liver disease. It's called metabolic non-alcoholic steatohepatitis or MASH, or we just call it liver disease. The dementia data has not panned out. So that was a trial that recently was actually announced at the Dementia Conference in December. They looking at the use of this drug. And again, was a randomized placebo control trial, whether or not it would help ⁓ slow dementia And the answer was no. ⁓ There's a couple of small trials and one or two larger scale trials ⁓ looking at both semaglutide and tersicol. so Ozempic slash Mounjaro ⁓ in the use of substance misuse. ⁓ And the studies are actually incredibly promising, showing a decrease in kind of, ⁓ in particular, it's looked at in an alcohol use, but decrease in alcohol and alcohol consumption. ⁓ And part of that has to do with how the drug itself works. So you have part of your brain, we talked about the Hunter system, the part of our brain, it's part of our brain called the Mesolymphic system. ⁓ And it's literally ⁓ sort of a, cluster it's like a highway of dopamine receptor sort of dopamine cells dopamine ⁓ neurons that snake through the brain and it goes from your compulsion center to your reward center to pleasure and planning. It forms in all of us at age 10 and comes fully online at age 21 when our sort of goal prefrontal cortex or goal oriented behavior officially comes on board. And it's a dopamine pathway with opioid receptors and nicotine receptors and cocaine receptors and cannabinoid receptors on it. And it also has GLP-1 receptors and GIP receptors and amylin receptors and glucagon. So it's got got hormone receptors because its actual purpose was to make us a hunter. So think about it 50,000 years ago we're sitting in a cave and one of us has to go run a buffalo down in our underwear in 90 below zero. Well you have to be very like a little bit, you know, crazy. Yeah, like to go do that, like me at a, you know, sample sale, kind of crazy, right? so what this what that is, is literally, it's our hunter system and it's been linked to everything including cravings, it's been linked to addiction and substance misuse, it's been linked to ADD, it's been linked to binge eating, it's that's where that part, those diseases live in that part of the brain and so if you think about it, if you... you can, you know, and one of the ways we treat substance misuse disorders, we give patients, you've heard of Narcan or ⁓ give patients sort of a longer acting version of an opioid blocker so that their brain's receptors don't click on, right? Well, this would be a similar kind of action, right? You literally blunt craving response by shutting the, you know, I call it the little, you know, the dragon falls asleep in the back of the cave, the hunter. and doesn't think, ⁓ my god, give me this now, because it's literally gotten what it was looking for. And so I think what we're seeing here. ⁓ is a huge shift in culture around blame and shame and dieting and this kind of idea of, you know, a personal ⁓ sort of ⁓ ⁓ and around and I hope what we're ⁓ embracing more is of all ⁓ of diversity of body size and body shape, number one, that there is no longer this standardized, quote, ideal, number one. And more importantly, that we embrace the fact that this isn't a simple math equation of just eat less, move more. And if you're not getting the body we want you to get, it's because you're not working hard enough.
Lynda Steele: Well, amen to that. ⁓ Dr. Zentner, this was fascinating and it has really changed my mind about these drugs. So thank you so much for joining us. I really, really appreciate this conversation.
Ali Zentner: Thanks for having me.
