Gina Kaye (Host): Welcome to Jamaica Hospital Med Talk. I'm your host, Gina Kaye. And joining me today is Dr. Alliya Shafi from MediSys Health Network, Jamaica Hospital Medical Center. Together, we're diving into the topic of GLP-1s, Diabetes, and Weight: A Simple Guide to Today's Treatments. Welcome to the show.

Dr. Alliya Shafi: Thank you so much for having me, Gina.

Host: Absolutely. You know, you can hardly tune into social media these days without hearing about GLP-1s. And for those listeners who want or need more information, let's begin by having you tell us what exactly are GLP-1 medications and why are we hearing so much about them lately?

Dr. Alliya Shafi: So, I hold GLP-1s very close to my heart. GLP-1s are essentially a once weekly non-insulin injectable drug. So, how it works, it usually mimics the gut hormone called glucagon-like polypeptide, which is released after eating. It works through several mechanisms, including insulin secretion, suppressing glucagon-like activities, and essentially slows gastric emptying down. And it ultimately reduces appetite and increases satiety.

Clinically, they were, first developed for controlling type 2 diabetes, but why we're hearing about them so much on social media is its substantial weight loss effects, about 15-20% of body weight reduction.

Host: That's crazy. So, how do the GLP-1 medications help people with type 2 diabetes manage their blood sugar? Because I believe that was their original intent.

Dr. Alliya Shafi: No, definitely correct. So, how it works or how it essentially works on your blood sugars, they help enhance insulin release from the pancreas. So, more insulin in the body, less of a glucose spike after those meals that you eat. It suppresses release of sugar from the pancreas, so it also reduces blood sugar spikes. Most importantly, it slows gastric emptying down so you're essentially fuller for a longer period of time, so you're not consuming as many meals. And also, they indirectly cause weight loss. It increases your insulin sensitivity and decreases your insulin resistance, which ultimately leads to better glucose optimization.

Host: Okay, good. So for someone who's been diagnosed with type 2 diabetes, when might a doctor step in and consider starting someone on that GLP-1 medication?

Dr. Alliya Shafi: So usually, patients with uncontrolled type 2 diabetes or A1Cs are 9, 9s or even 7s, and also if a patients classified as overweight or obese. They're also used in conjunction with other medications, most importantly metformin or Jardiance as well.

Host: So for people who are already using GLP-1s for diabetes, what improvements can they typically expect to see first?

Dr. Alliya Shafi: Yeah. So, a lot of my patients report early satiety So, it helps decrease that food noise that you have in your head. It helps you decrease constantly thinking about that food. So you're not consuming, as much calories or that food during the day. A lot of people notice improvements in their weights. Usually, you have to find the optimal dose for that patient where you find that sweet spot for that weight loss. And then, also, you know, at the end of the day, it does really reduce your A1c about 6-8%. So, that's a really great benefit of the medication.

Host: So many listeners have also heard about GLP-1s as "weight loss injections." How do they help people actually lose the weight?

Dr. Alliya Shafi: So, kind of emphasizing reducing that food noise that a lot of people have. Because ultimately, obesity being overweight, you have that struggle with that food noise. You're constantly thinking about food, wanting to consume food. So, it helps suppress that appetite and increases your satiety so you're fuller for a longer period of time. And also, it slows down that gastric emptying. So, you're fuller for that longer period of time as well.

Host: You know, it's kind of funny when you've mentioned food noise a couple different times, and I think there was a time when we all just thought we were always hungry. And now, there's a label to it. This food noise actually comes up quite a bit in conversation when you're talking about GLP-1s.

Dr. Alliya Shafi: So food, in general, or just weight loss or obesity, that's an epidemic in America right now. It's an addiction. And to break that pathway, for craving that food, always wanting that food, coping, some people, you know, eat because they need to cope with stressful situations, this medication really, really, really does help calm down that food noise.

Host: That's really great. So speaking of lifestyle changes, are these medications then meant to replace healthy eating and exercise? Or do they work best with certain lifestyle changes?

Dr. Alliya Shafi: So, they're supposed to be used in conjunction with diet and exercise. I always tell my patients it's not a magic injection or a magic pill. In some cases, where they use oral GLPs, you have to help the medication. You have to incorporate those healthier lifestyle, modifications, those diet changes. That's when you see the most optimal weight loss and the most optimal glucose lowering.

Host: One other thing I would like to address—and I think this is something that's also found a lot on social media and there's a lot of differing opinions—but if somebody starts a GLP-1 either for diabetes care or maybe the weight loss management, what can they expect to see for side effects?

Dr. Alliya Shafi: A lot of patients, I would say maybe like 60% reporting side effects, including GI side effects. Those are nausea, vomiting, sometimes diarrhea. Newer studies have shown that people have been reporting visual disturbances. And people with thyroid disorders, it is contraindicated in thyroid cancer. Some people have reported loss of muscle mass as well. And in years of using the medication, you can see hair loss as well.

Couple of tips that I usually tell my patients, ways to combat these side effects, followup with your primary care doctor about every six to eight weeks or your endocrinologist, whoever's prescribing this medication for you. Make sure you know you are up-to-date with your vision exam, seeing an ophthalmologist. Increasing your protein to help combat that muscle mass loss and increasing your weight resistance in the gym. And, of course, staying on a multivitamin for that hair loss.

Host: There's a lot of options out there now to seek treatment for GLP-1s. If someone is interested in a GLP-1 treatment, what's the first step? I'm assuming social media is probably not the best, but maybe talking to their primary care doctor, endocrinologist or weight management clinic.

Dr. Alliya Shafi: Usually, PCP, your endocrinologist. I'm glad you brought that up, social media. A lot of social media kind of promotes these wellness clinics or wellness influencers. But they usually promote the compounded version of GLPs, which is very unregulated by the FDA. They're combined with a whole bunch of vitamins, and it causes more harm than good, essentially. So, starting with your PCP, I think, is the best first step. And, if your PCP is unable to manage that A1c or they're not comfortable with prescribing the GLPs, definitely endocrinology is the next best step for that.

Host: As we wrap up, what's the one key message you want our community to take away about GLP-1 medications, their role in diabetes care, their impact on weight, and what they could mean for someone's long-term health?

Dr. Alliya Shafi: Yeah. So I mean, GLPs are changing the game. And it's changing how we treat diabetes and obesity. I'm a diabetic myself since I was 19, and this is a total game-changer, especially in the community, I work with a lot of uncontrolled diabetics. And people who just need a little bit of a boost, they're not just lowering the blood sugars in people with type 2 diabetes, they're actually addressing the biology of weight and obesity and metabolism. For the right type of patients, drugs like Ozempic, Mounjaro, just GLPs in general, can be very meaningful for weight loss and, in the future, help reduce our all-cause mortality risk for cardiovascular disease. So definitely, if it's an option for you and your doctor, you know, brings it up, think about it, read about it, of course. But it's truly a game-changer.

Host: We very much appreciate your wisdom and exceptional advice, Dr. Shafi. Thank you very much for all the information you shared today.

Dr. Alliya Shafi: Thank you so much. I appreciate it. Thank you for having me.

Host: That was Dr. Alli Shafi. For more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for more topics of interest. I'm Gina Kaye. And this is Jamaica Hospital Med Talk. Thanks for listening.

Disclaimer: All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast episode.