Episode 171:

Show Notes 

In this episode of the Real Health and Weight Loss podcast, Dr. Lucy Burns and Dr. Mary Barson delve into the challenges faced by individuals relying on weight loss injections, specifically focusing on the supply issues related to medications like Ozempic. They express concern about the erratic and unpredictable supply of these medications worldwide, which causes distress among people who depend on them for weight loss and managing conditions like type 2 diabetes.

The episode emphasises on the concept of the "lowest effective dose" as a crucial strategy during medication shortages. Dr. Burns and Dr. Barson explain that finding the minimum effective dosage is essential not only to reduce side effects but also to save money and maintain a consistent dosing schedule. They stress the importance of empowering individuals to make informed decisions about their health and weight loss journey, particularly in the face of supply challenges.

The short-term and long-term side effects associated with weight loss injections like Ozempic. Short-term effects include nausea, vomiting, diarrhea, and constipation, while long-term concerns involve a decrease in muscle mass and potential issues related to bone health. They highlight the significance of addressing these side effects through lifestyle changes, particularly focusing on nutrition choices. Prioritising unprocessed foods, rich in protein and low in sugar and starch, can naturally improve insulin sensitivity and support metabolic health.

Dr. Burns and Dr. Barson introduce their four-week program, the Four Week Body Rebalance, designed to provide listeners with comprehensive knowledge and actionable steps for sustainable weight loss. This program aims to empower individuals with practical strategies to improve their metabolic health, reduce side effects, and make the most out of their weight loss medications, especially during supply shortages.

Throughout the episode, the emphasis is on the importance of individualised approaches, informed decision-making, and lifestyle changes that align with the goal of achieving and maintaining a healthy weight. They encourage listeners to prioritize their well-being and seek guidance from healthcare professionals for personalised advice and support.

Elevate your health journey with our 4-week course! Join The Companion Guide to Ozempic now: 


Episode 171: 


Dr Mary Barson (0:11) Hello, my lovely listeners. I'm Dr Mary Barson.

Dr Lucy Burns (0:15) And I'm Dr Lucy Burns. Welcome to this episode of

Both: (0:20) Real Health and Weight Loss!

Dr Lucy Burns (0:23) Good morning, lovely listeners. I'm joined this morning by the gorgeous, effervescent, bubbly, excitable, lovely, gorgeous human, Dr Mary, not to build you up or anything.

Dr Mary Barson  (0:35)  No, that's alright. I feel pressure to perform now I feel like this podcast has to be extra effervescent.

Dr Lucy Burns (0:43)  Well, interesting that we're talking about it. I don't know, maybe a topic that doesn't cause effervescence for some people. But it's very topical for the moment. So I think this is great and again, the reason we're talking about this is because we've been asked a lot about it. And so we thought we'll why don't we just do a podcast on it? And it is talking about weight loss injections. So I mean, weight loss injections are around, they're here to stay, they're. You know, they're a great tool for some people, they're potentially a tool that some people are using who probably don't need that tool. That's not the discussion for today. One of the things I wanted to talk about today was the fact that particularly in Australia, but also around the world from my readings is that there is trouble with the supply of this particular medication. So we're talking about the injectable medications, in particular, one that is marketed as Ozempic in Australia. It's also marketed as Wegovy. But we don't actually have that here yet, it'll come. And just the fact that the supply for people is really irregular and erratic.

Dr Mary Barson  (1:58)  And it's used as a treatment for type two diabetes and also used as a standalone in Australia still off label use for weight loss. And it's hard to get hold of at the moment, which is creating angst and difficulty for a lot of people. And as we live and we work to empower people to lose weight in a healthy way, like you said, Lucy, we do get asked a lot about weight loss injections.

Dr Lucy Burns (2:26)  Yeah, absolutely. I think there's a couple of things that we're learning about these medications in particular, you know, even things around protocols for people having surgery, for example, that protocols are still being developed as we learn about the side effect profile or the response profile for people as a whole. So, you know, like any medication, you'll have what we call hyper responders, so people that respond extremely well to low doses of medications, you'll have people that that need a higher dose, and then you'll have people that barely respond at all. And, you know, maybe some of our listeners out there have said, I've tried that it didn't work for me. And it's the same with the side effect profile, you'll have people who barely have any side effects, and other people who feel like you've just opened up the packet, and you've already got the side effects. So we know that there is a huge variation in that. And that for some people, the side effects immensely impact their quality of life.

Dr Mary Barson  (3:35)  Absolutely. And I've seen and treated people who have come into the emergency department with really significant side effects of these weight loss tablets. But equally, I know that there are lots of people out there who are tolerating it really well. I think it'd be important for us to say here that we're neither dissing nor promoting this as a tool. So you know, people can choose to be on these medications. And that's a discussion for you and your doctor. And, you know, if you want to make that informed choice, absolutely go for it. However, it's an action in itself, taking a weight loss medication, or weight loss injection is an action that can be helpful, but it's usually it's not enough on its own. And that there are some really important powerful steps that you can take to improve your health and wellness and your weight loss that can work really well with these weight loss medications and or work instead of these weight loss medications. This is a particularly important thing to discuss when there are supply issues for people who want to know what they can do to lose weight without them or to lose weight on a lower dose.

Dr Lucy Burns (4:47)  Yeah, absolutely. And look as lifestyle medicine doctors, we, you know, love lifestyle interventions. For some people, they're enough for other people they need medication as well but the beauty of a lifestyle-first approach is that what it can enable you to do is then use the lowest effective dose of a medication. And I don't think there's a doctor in the world that wouldn't agree that the lowest effective dose is always a goal, because it vastly reduces the side effects. The lower the dose, the least side effects. The lower the dose, the lower the interactions with other medications can be, and the lower the dose, the cheaper for the patient. I mean, you know, why would you want to pay double the price when you can get the same effect by only using half the dose? So for us, it's like, yeah, lowest effective dose. Now, for some people, the lowest effective dose is nothing, which is great. It's even cheaper. And for other people, the lowest effective dose literally is that they go, you know, you and I both have a look in various Facebook groups, support groups for people utilising these medications they are, they're incredibly busy, incredibly active, not always well moderated. And quite often the advice given in there is not by health professionals. So you know, people are going—- Oh, should I go up a dose, I don't have any side effects. I'm losing weight. And you know, 50,000 people are putting in their opinion on whether somebody should go up a dose or not. So our firm belief is that everybody should be on the lowest effective dose. So there are a couple of ways in which we can do that. And we'll talk about that in a moment. But also I guess, just wanted to talk about some of the side effects, both short-term and long term that happen. And again, how do we minimise that? — lowest effective dose. So short-term side effects, I mean, you know Miss, as you've seen it, we've seen it. And again, not everybody gets this, but lots of people do. The medication is designed to work on a number of levels, but one of its levels is to delay gastric emptying. It's very effective at that. And the consequence of delaying gastric emptying is that you're fuller, with less food and for longer, which is yeah, that's reasonably helpful. But Miss, what are the side effects of delayed gastric emptying?

Dr Mary Barson  (7:31)  So people can feel quite nauseated and unwell, which is unpleasant, it is quite an unpleasant side effect. Often people cope with nausea, less well than we cope with pain. Being nauseated, it's not much fun at all. Some people can also cause vomiting, diarrhea, and constipation as well.

Dr Lucy Burns (7:49)  Yeah. And reflux is another problem, because again, if you've already got reflux, and then you've got a stomach that doesn't empty, then your reflux will get worse. And you know, this is part of the issue with surgery is the delay in people's gastric emptying is very variable. So some people don't get much of a delay. And other people, it can be days they can have their stomach contents remain in there for days. And that's not how our gastrointestinal system is designed to work. So we know we now know that people having surgery, who are also using these injectable medications, often need to be off the medication for one or two weeks before their surgery to account for the fact that there are outliers in this gastric delay, and nobody knows who they are. So they're the sort of gastrointestinal side effects and the diarrhea can be intense, let's just call it that. And it can be for some people, but they can't leave the house. So it's not just –oh, well a touch of diarrhea, it can be really, I mean, people can't go to work, they can't do anything. So it's really, really not just a, you know, an inconvenience necessarily. And so, you know, there's some of the short-term side effects. And then the long-term ones that people really do need to be told about is that we do know that there is a decrease in muscle mass that comes with prolonged use of this medication. And that itself can be problematic. You know, for those of you who have listened to our podcasts, we know that muscle, the bigger your muscles, the better your health. Let's just take steroid use out of that. But in general, the better your muscle mass, the better your health, better your metabolic health, the less frail you are, the less likely you are to have falls. The more food you can eat so much so many wonderful benefits from having added muscle mass. And yet this medication does cause a decrease in it, you have to take active steps to reduce that.

Dr Mary Barson  (10:09)  Same with your bone health, like your bone mass.

Dr Lucy Burns (10:13)  Yeah, absolutely. And then, you know, the manufacturers suggest, again, it's very tricky because these haven't been around very long. But the suggestion is, and it would make sense to me that if you're using this for weight loss, it's a long-term proposition. As you all know, we firmly believe that the thing you do to lose weight is the thing you do to maintain it. And I think for a lot of people, they are perhaps, told or believe the story that I'll use it until I get to my goal weight, and then I won't worry about it anymore. And the evidence suggests that if you do that, it will come back on. In fact, the problem is that you'll then be in a worse metabolic state because your number goes back to being the same. And let's just pull out 100 kilos for ease. So maybe you are on it, you've lost 20 kilos, you've put back on 20 kilos. In the meantime, though, your muscle mass is decreased. So in fact, you've gained more fat than you had in the first place, unless you've done active steps.

Dr Mary Barson  (11:26)  So you've got that unless you're doing, you've got the right advice and the right sort of lifestyle changes to ensure that you can mitigate these long-term side effects that you can stay well, that actually taking these weight loss medications may move you further away from your long term goals rather than close towards them, which is not what we want for anybody.

Dr Lucy Burns (11:46)  No, and no, everybody knows this, nobody wants to lose 20 kilos only to put it back on again, like nobody, no one has ever said that – Yeah, I'm happy, so long as I'm thin for the wedding, I don't care then afterwards. Nobody, nobody ever says that. In fact, we see it a lot, people are panicking because they're their medications not available, they've spent a lot of time going through the whole side effect profile and lost some weight. And now it's like – Aah! So, Miss, I guess in this shortages, and I'm gonna be, you know, maybe a little controversial and say that the people are being promised that the short shortage will end soon. And we've all seen it. And I don't think it's ever going to end. And I'm going to be even more controversial to tell you that I actually think this is, again, based on nothing other than my own opinion. But you know, there are some benefits to the pharmaceutical company by having a product that is in demand. So the supply and the demand, you know, drives up the price for which they can charge governments, insurance companies, and all of those sorts of things for their product. So I suspect we'll find that for a long time, this supply issue will come and go. And it's never going to be just a constant — Yep, here it is, here there's plenty everyone can have all of that stuff. So with that in mind, let's assume that we, everyone's in agreement that we should be doing the lowest effective dose. How do we do that, Miss?

Dr Mary Barson  (13:22)  Yes, well, I think it's useful to think about how, like semaglutide works, how it improves our internal metabolic hormones in a way that is conducive to weight loss. That's one of the things that it does, it improves insulin sensitivity and improves the effect of insulin in our body. So there is something that you can do with the way that you nourish your body by making delicious food choices that work for you, that will do that as well and actually will also increase your natural production of the type of hormones that semaglutide improves. And that's eating food that is as unprocessed as possible. Eating food that is rich in protein and eating food that is naturally lower in sugar and starch. You do those things, and then your body will also sort of make more of its own, essentially make more of its own semaglutide, if you will, but you also lower insulin and you can heal that the metabolic cause of being overweight in the first place. So it's a really safe way. It does not cause pancreatitis doing this, it does not increase your risk of reflux. In fact, for most people, it dramatically reduces reflux if you've got it has a myriad of health benefits, and also works really synergistically with weight loss medications. So if you still need them, or you still want them or you still choose to take them for whatever reason, it's going to work much better for you.

Dr Lucy Burns (14:52)  Yes, absolutely. So the the name of these little hormones if you like there's a couple of them and they're lumped in together to be called the incretin hormones. In our programs, we teach people about this knowledge around you, a medication that you may need to take forever, it's really important. So that you can use the lowest effective dose so that by doing so, you will save money, you will be able to ride through shortages, and it will make your life better using the lowest effective dose. So we just want people to know that there is knowledge available in easy-to-digest forms that teach you about the incretin response for which Ozempic Wegovy, Manjaro, they're all part of that. So gorgeous ones, I think the key is we want to prioritise protein, we really want you to be able to use your medications at the lowest effective dose. We want you to have the knowledge so that you can make decisions that help you decide what is going to be the lowest effective dose. And because of this, this is why we've created a short program that teaches you all about this. It's really, I mean, it's not called the companions guide to his Ozempic, although maybe we should call it that. But it's really like that it's like a companion guide, what can I do that's in my power to use the lowest effective dose? And that my friends, is really the key to being able to then navigate the world of shortages, reduce the long-term and short-term side effect profiles, and have yourself feeling the best you possibly can.

Dr Mary Barson  (16:55)  We want everybody to be empowered to live their best possible life. And that includes if you're on these weight loss medications to be on the lowest effective dose. And for that reason, we have created a wonderful four-week program, we could kind of call it you know, like your Ozempic companion guide. But that's not what we've called it. We've called it the Four Week Body Rebalance. And it's this powerful four-week course you will learn everything you need to know for those simple doable lifestyle changes, to heal your metabolism to be able to lose weight without being hungry, to make it easy and fit into your life in a way that will help you be on that lowest effective dose or for people who aren't on weight loss medications, it is relevant for you too. And we've got little episodes in there for people who are on weight loss medications to know how they can apply it and make it work for them. 

Dr Lucy Burns (17:53)  If you'd like to learn how to get the most out of your Ozempic so that you can actually take the lowest effective dose, head over to the information page at www.rlmedicine.com/oz, which is just a little O and little Z. It's a four-week program giving you every single thing you need to know to make your ongoing health and weight loss journey easy with the minimum effective dose. I think our mantra is most definitely the lowest effective dose, the least amount of side effects, the least amount of money outlaid, the best possible outcome is what we want for everybody. Absolutely, yeah. Alright, gorgeous ones, have a beautiful week and we will catch you next time!

Dr Mary Barson (18:39) See yeah!

Dr Lucy Burns (18:46) So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr Lucy Burns…

Dr Mary Barson (18:53)  and I'm Dr Mary Barson. We’re from Real Life Medicine. To contact us, please visit rlmedicine.com

Dr Lucy Burns (19:04)  And until next time…

Both (19:05) Thanks for listening!

Dr Lucy Burns (19:08) The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide, individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.

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