The Exchanges

Q So talk a little bit about how Ozempic counters this insatiable hunger that we end up being left with from processed foods, and what's your experience, like, been like in the year and five months that you've used Ozempic?

A Well, so if you ate something now, it doesn't matter what it is. After a little while, your pancreas will produce a hormone called GLP one, along with some other hormones. And GLP one is basically your body's natural signals going, Hey buddy, you had enough, stop eating, right? It's the brakes. But natural GLP-ONE only stays around in your system for a couple of minutes and then it's washed away. What these drugs do is they inject you with an artificial copy of GLP-ONE that instead of sticking around for a few minutes, sticks around in your system for a whole week, which has this incredible effect. I'll never forget. Second day I took Ozempic, I was lying in bed just behind where my laptop is now. If I turn my laptop around, you'd see it. Um, and I woke up. And I thought, huh, I feel something strange. What is it? And I couldn't locate what it was, what I was feeling. And it took me about five minutes to realize I had woken up and I wasn't hungry. It had never happened to me before. And I went to this diner just up the street that I used to go to every morning. I'm slightly embarrassed to say I ordered the thing I used to get every day, which was a huge chicken mayo sandwich with loads of chicken and mayonnaise in it. And normally I would eat that really quickly and I would still want some potato chips. And I had like three, maybe four mouthfuls of this sandwich and I, and I wa…

AI assessment note: “What these drugs do is they inject you with an artificial copy of GLP-ONE”

Q And if that happens, I mean, you could abruptly, you could abruptly have people thrown off the medicine, whereas like they can afford the compounded drug, they cannot afford 1300 a month. So what happens if you get abruptly tossed off the drug?

A Well, it's a really important question. So, uh, I want to explain what the drug companies say, and I want to explain why they're probably right, but we need to take it with a small pinch of salt. What the drugs say, what the drug companies say is these drugs are like statins or blood pressure meds. They work for as long as you take them. And when you stop taking them, they stop working. So you regain the weight pretty rapidly. And they have funded studies that, a study that seems to demonstrate the vast majority of people regain the vast majority of their weight within a year. Um, there's a small pinch of salt in that, in that, of course, they have a vested interest in telling us that we have to take them forever because they make money forever. They do seem anecdotally to be some people who take them for a shorter period, use them to radically change their habits, and then seem to stay at a lower weight, although I suspect they're a minority. There'll be more research on this soon, but yeah, if you're thrown off, you'll almost certainly regain the weight.

AI assessment note: “if you're thrown off, you'll almost certainly regain the weight.”

Q there. But the thing that really struck me as the risk was, um, You talk about how it could potentially dull people's, uh, emotionally a little bit to pleasure and reward, and like physical rewards. Uh, for instance, like people start to drink less, um, but there's concern that it might just make everything in life less pleasurable. Uh, can you talk a little bit about why that might be?

A So I want to stress this is all the scientists who've expressed this concern, expressed that it's speculative and we can't be sure. So some scientists have argued that these drugs seem to be causing depression or even suicidal thoughts in a minority of people who use them. That in itself is contested. It did not persuade the European Medicines Agency, although the FDA in the United States does have a warning about potential suicidal ideation from these drugs. And there's a huge debate about why that might be. Some of it relates to the question about the brain effects. So a different theory about how these drugs may work in the brain and on the brain is that in your brain you have something called your reward systems. The reward systems are what Motivate you to do anything that propagates life, right? We eat because we get rewards from it. We have sex because we get rewards from it. We engage in social behaviors because we get rewards from them. They all make the reward centers of the brain hum. One theory about how these drugs work is they may be dampening your reward systems. So it may be that I no longer Feel the urge to eat a Big Mac over a salad because I get less reward from the Big Mac than I did before. There does seem to be some evidence that there's lots of people report losing their pleasure in eating after taking these drugs. Now, although not everyone, and I actuall…

AI assessment note: “One theory about how these drugs work is they may be dampening your reward systems.”

Q they've been able to engineer the food to, I mean, obviously we're going to talk about Ozempic as an answer to this, but before we get into that, how have they been able to engineer the food to make, make us never feel full? Um, is it intentional or is it just a byproduct of the type of food that exists when it's manufactured, as you mentioned, versus whole foods?

A I think the honest answer to your question is a bit complicated. What's definitely not happening is they're not like James Bond villains going, Bwahaha, how can we make everyone as obese as possible? That's, that's not happening, right? That would be a stupid way of thinking about it. It's in some ways much more simple. If you're the head of a KFC, Kraft, any of the food companies, you have a fiduciary responsibility to your shareholders to maximize profit. So how do you maximize profit as a food company? You sell as much food as possible, right? So they are constantly figuring out ways to maximize the amount we eat, right? So if there's two foodstuffs, one that makes us feel full and we stop eating after having half of it and one that makes us want to eat five packs of it. They're going to go for the one that has five packs. And I don't blame those individual companies. I mean, they do things that are unethical, like employ lobbyists to rig the rules or advertise to children. There are certainly lots of things I would condemn about them, but actually it's the job of the rest of the society to regulate those companies, right? Those companies are doing what those companies are meant to do. The democracy needs to do what it's meant to do and regulate them to prevent them from harming our children and screwing up our bodies and harming our health. There's lots of ways in which pro…

AI assessment note: “There's lots of ways in which processed food undermines our sense of fullness”

Q But some people find worse ways, right? Like they, they, when they stop having that food addiction, they go to alcohol or other things that harm them even more.

A Yeah. Exactly. So. I think, and we know this with other forms of, um, I often think the best way of understanding the effects of these drugs is actually to compare them to bariatric surgery. People have only been taking these drugs for obesity for a couple of years now, but, uh, when it comes to, um, it's radical weight loss, the most reliable method up to now has been bariatric surgery. Um, things like stomach stapling, gastric sleeves, gastric bands, and so on. So when we look at bariatric surgery, what do we see? I mean, first thing we know is that it's a fucking horrible operation, right? One in a thousand people die in the operation. It's no joke. It's grim. But why do people go through that? Well, they go through it because they get extraordinary benefits. So bear in mind that they obviously had to be really quite obese to get the surgery in the first place. But if you have bariatric surgery in the seven years that follow, you are 56% less likely to die of a heart attack. You are 60% less likely to die of cancer. You are 92% less likely to die of diabetes related causes. In fact, it's so good for your health. In those seven years, you're 40% less likely to die of at all of any cause. So we know it has extraordinary benefits, but also we know, interestingly, after bariatric surgery, your suicide risk almost quadruples.

AI assessment note: “after bariatric surgery, your suicide risk almost quadruples.”