Episode 255: Ask the Obesity Doctor Part 2: GLP-1 Safety, Counterfeit Medications, Side Effects & Ozempic Face

[00:00:00] Welcome back to the Back on Track: Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:27] Hello, and welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. And we are now back for part two of our Ask the Obesity Doctor, where I'm actual questions that you left for me on

[00:00:43] one of my YouTube videos or social media. I want to sometimes I'm not able to answer everybody back. So I just wanted to use this as a way of answering questions that have been left. And so today we're going to be talking a little bit about safety. We're going to be talking about compounded GLP-1 medications, counterfeit and black market products, medication interaction, side effects, and then something that I see a lot, the Ozempic Face and a lot of patients bring it up in our visits.

[00:01:11] So we'll talk a little bit about that as well. So question number one, are compounded GLP-1 medications as safe and effective as brand name medications? This came from one viewer of my What Happens When Food Becomes Your Comfort Zone video. She reports that she was paying about $4.49 a month for ZepBound through Lily Direct and was asked about weight loss clinics selling compounded medications because she heard they were much cheaper.

[00:01:39] And she was concerned. She was like, are compounded medications as effective and safe as brand name medications? So that's a great question. So number one, I think we need to look at what is the difference between brand name medications and compounded medications. So brand name medications come from the manufacturer. So these individuals spend billions of dollars actually researching the molecule.

[00:02:05] They have to go through four different phases of medication development. And usually after that third phase, they will send the information to the FDA and they will either approve the medication or they'll send it back and say, hey, you need to work on this, this, and this. So they'll send them back notes of stuff they want to see that is effective before they approve it. Usually this process can take up to 10 years.

[00:02:30] So from when they first started actually even thinking about the molecule to testing out to see if it works, to actually getting a small subset of human subjects to see what side effects they have, and then expanding it in phase three where they're now giving it to, you know, multiple, like thousands of people to see how it works and is it effective. So they go through this for 10 years to get to phase three where the FDA will approve it or not approve it.

[00:02:59] And so, of course, billions of dollars have been spent on this product. So you know the brand name that is effective and safe because they've done the testing. Now, compounded medications basically take the same ingredients because, you know, you have to put a patent on. So they know the ingredients of the medication and they are creating it in their lab. And the compounding pharmacist is creating this.

[00:03:23] And so usually there are compounding pharmacies that are regulated by the FDA as far as for sanity, make sure that they're, you know, having the proper technique. But the FDA does not look at what they're creating and it does not regulate compounded medications. So even though they say it's the medication, is it the same as the brand name?

[00:03:46] You know, that's to be debatable because let's say I had the same ingredients for a cake and you have the same ingredients for the cake, but your cake tastes better than my cake, but I had the same ingredients. And the reason being is that how you put that together, how you bake that cake, that makes it better. My cake may be burnt. Your cake may be soft and moist. So it definitely makes a difference.

[00:04:10] And so whether safe and effective, I can't necessarily answer that because the compounded medications haven't gone through the same rigor as brand name medications because they haven't gone 10 years of doing testing and seeing if it works and actually comparing it from people who are taking the medication to people who aren't taking the medication and seeing if it works that way.

[00:04:32] So, you know, definitely any questions, I'd recommend seeing your physicians, your physician team, whether that's the best thing for you. But no, we can't say that because we don't know who's making the medication. And just to put an asterisk here, you know, this is for education only. That is my goal. But most importantly, it's important that you see your own doctor because they know who you are

[00:04:57] and they're able to give you recommendations specifically for you based on, you know, your medical history and things like that. So, all right. Question number two. How can I tell if a GLP-1 or a peptide product is fake? This is coming from one viewer who watched fake retitutide in the black market. Is it just sugar water? And the question was, how can patients tell if GLP-1 peptide product is authentic or counterfeit in the black market?

[00:05:27] So, the answer to that is that you can't tell. There's no way to know unless you take that medication, bring it to a researcher and say, hey, can you check the contents if this is truly what it says it is? Unfortunately, with these GLP-1 peptide websites, they're not regulated by the FDA. So, no one's checking to see if it's the actual medication that you're buying. And so, you're giving yourself something that you don't know where it came from.

[00:05:56] Even though you know the company, they have a website, they may have a little, you know, thing that says that they're accredited or whatnot, but you don't truly know what's in it. At least you know from the brand name or the manufacturer, yes, this is manufactured in their factories, but it's going through the same rigor in testing to make sure that what they say is in that needle or in that vial or in that pen is what it says that you're getting. So, to be honest with you, you can't know.

[00:06:24] Now, if it's retitrutide, I just want to mention that retitrutide is not FDA approved in the U.S. at all. In fact, they finished the testing phase three trial, but they haven't released the results for obesity. They've released results for type 2 diabetes, but not for obesity yet. So, this is not FDA approved and people are taking this medication thinking that I'm getting the same retitrutide as what Lily is making,

[00:06:53] but who knows because it's not even out. So, you know, I would say it's important if you want to be safe, it's important that you avoid these compounded retitrutide and black market because it's just not safe and you can't tell if it's authentic or counterfeit. But I will tell you, retitrutide is not out in the market, so it is counterfeit. All right, let's talk about question number three.

[00:07:20] What medication combinations require extra caution when using a GLP-1 drug? This comes from a viewer who was watching Discover the Latest Medical Breakthroughs. Now, the one thing I want to just state is that with GOP-1 medications, they work by slowing down the stomach emptying, meaning that digestion is a lot slower. So, that means sometimes with medications, they can be absorbed differently and maybe not as quickly as they normally were.

[00:07:50] So, some medications that require more caution are going to be birth control or oral birth control, oral contraceptive, just because with that medication, it can reduce the levels of how much of that birth control is circulating in the body and it can make it less effective. So, if you were using it to not get pregnant, there is a chance that that could occur. Also, if you're using it for other reasons, just kind of regulating your cycles, you may notice that it may be not as effective.

[00:08:19] So, what they recommend, especially for GLP-1 medications, is that when you start the medication for the first 30 days, for weeks, you at least have a barrier method if you're trying not to get pregnant or another non-oral method to make sure that you are protected. Also, when you go up on the dose, there is an increase of less absorption of the birth control.

[00:08:44] And so, you should have that barrier method as well or a non-oral birth control for that. Other medications that you should kind of just make sure you get your levels is with like warfarin or that blood thinner where it needs to be between a certain threshold, meaning a certain range. And so, just make sure that your warfarin is in the correct range and you're getting your monitoring that. That's the only caution that you need to have. But as far as other medication combinations, they do pretty well.

[00:09:14] Not necessarily any type of contraindications with certain medication, but just to be mindful of it. So, all right, let's go on to our next question. Our next question is, how do you know if a side effect is normal or something I should worry about? One viewer on the video, Wagovi Highest Dose Explained, Is It Safe and Effective?,

[00:09:37] reported that after her taking the 7.2 dose, she noticed some skin sensitivity and pain on top of her hands and feet, along with some substantial fatigue. The one thing I would say is that it's important that if you are having symptoms, that you go to your doctor and get it checked out. Well, sometimes with the 7.2 dose, they have noticed, and I'm not going to say it right, but some skin sensitivity or numbness and tingling there.

[00:10:04] And so, you know, it is important if that occurs, that you get checked out, because there may be other reasons why this is occurring. Also, with the substantial fatigue, we want to make sure you're getting enough protein, enough water and things of that nature. And so, it's important that you see your doctor so that they can be able to, you know, check you out and make sure there's not something else contributing to this sensitivity that you are experiencing.

[00:10:30] So, you know, I would say it's important to not assume that every symptom you have is the medication, because there are other reasons why certain causes can happen. And it's important to see your doctor so that they can be able to check you out, do blood work, make sure that you're okay. All right. Last but not least, question number five. Does Ozempic Face happen to everyone? Now, it's very interesting. I have a lot of my patients where they'll come in and I had this happen.

[00:11:00] They're like, well, I can't take a GLP-1 because I don't like how people look on the GLP-1. And I say to myself, I'm like, there may be people that you know that are taking this that have lost weight, but don't have the ozempic face. So, it's not something that happens to everyone. Do you want to just kind of maybe just describe what's happening? So, they call it ozempic face. That's been the terminology.

[00:11:25] But basically, what's happening is that people are losing body fat under their skin. So, as you lose weight, you lose body fat. And so, under the skin, there is this layer of what we describe as subcutaneous fat that's decreasing. And so, sometimes people may look a little bit jagged with their features or you may notice their face is a little bit smaller than usual. But that just happens as people lose weight.

[00:11:51] If they did bariatric surgery and lost a significant amount of weight, you would notice a difference in their face. And so, it does not happen to everyone. One, I find as people, especially if you're younger and you're losing weight consistently, you know, slowly and consistently, you're not going to necessarily have this. Sometimes it's more apparent in some of us who are older because, you know, we don't have as much elasticity in our skin. And so, you can see more wrinkles and things of that nature. But, you know, that's just with the process of losing weight.

[00:12:21] You're going to lose body fat. And that body fat may be lost from the face itself. But it's not something to really worry about. I think zempic face has been kind of blown out of proportion. And I find for a majority of my patients who have lost weight, yes, you can see that they've lost weight in their face. But it's not to the point where they're looking sick and things of that nature. So, I would not worry about that. And I wouldn't look at somebody else to dictate how you're going to respond.

[00:12:49] Because I tell my patients, you are a complete unicorn. I cannot look at you and tell you what symptoms you're going to have or how your body is going to respond. All I can tell you is that we start at a low dose and we taper up slowly. And if you are having side effects, we will go back down that dose or we'll treat you for that and try to make sure that you are feeling well on the medication. So, no, it doesn't happen to everyone. But know that there's multiple things happening at this time.

[00:13:17] I mean, you really can't look at somebody else's progress and think that's how your body's going to respond. Because people don't tell you everything. They don't tell you what medical conditions they have. They don't tell you all the other stuff. You learn that over time. I mean, you may not learn that at all. So, you know, I wouldn't look at somebody else's progress and say, okay, this is how it's going to go. Because it probably will not.

[00:13:44] So, I thank you today for just your time and for listening to this episode on Ask the Obesity Doc Part 2. If you have questions that you want me to answer, feel free to send that through social media, on the message, on the podcast. And we'll be able to, you know, create an episode just for you. All right. And thank you again. Please share with somebody who needs to hear this.

[00:14:09] And just until next time, just remember to stay strong, stay committed, stay consistent. And remember, we are stronger together. See you next time.