Jono (00:00.92)

Welcome back to the Bite Me Nutrition podcast. Today we don't have intro music and it's probably the first time I think ever, or unless my first ones didn't, I can't remember. But I got some, quite a lot of feedback saying that it was too loud and I'm not prepared to do the audio mixing that I'll need to do to make it balance. So it's gone, but that's okay. RIP, intro music. It does mean though that we're gonna get into the good stuff a bit quicker. So that's great. And today's good stuff is, look, I call the podcast a Ozempic because I think that's the word.

certainly in the media and on social media that people are seeing the most. And it's probably the default when we're talking about weight loss medications as a whole. But today is going to be more talking about, yes, Ozempic and Wegovy but also kind of another class of medications as well around Monjaro and ZetBound. basically, so to set the scene, Ozempic slash Wegovy are brand names for a drug.

called semaglutide, right? And just the same way that Panadol is a brand name of a drug called paracetamol, right? Same thing. So semaglutide is really the thing and Ozempic and Wegovy are the names that you might instead hear them called. Now the other class of medications we're gonna be talking about is tizepatides. Apologies in advance for the butchering of those names that I'm probably gonna do. But that is your Monjaro and your Zepbond.

Okay, so slightly different mechanisms of action between your semaglutide and your tzatzepotide. And we'll go through what those look like. Just at the current time of recording, August, 2024, Ozempic and Monjaro are approved for the management of type two diabetes symptoms in Australia only. They're not actually approved for weight loss or the management of obesity. So technically you can get them prescribed for

in a way that's called off label. I've definitely had lots of clients that GPs are doing that to help them with body fat loss. You have to tick a few boxes to be approved for that, know, have a few conditions that you're managing to become eligible. But if that is the case, yes, technically, these have been approved only for type two diabetes symptom management. Again, at the time of recording, so August 2024, literally this month, we go V, which is a semaglutide

Jono (02:24.494)

has been approved in Australia specifically for weight loss. So technically, would expect that moving forwards, I'm going to get more clients who, if they have become eligible for these medications and want to use them, if it's just for the management of obesity, we'll see them being prescribed with Wegovy and Ozempic slash Monjaro will be more about the management of symptoms and type two diabetes. But that leads me to a very, very, very important point. I'm not a doctor. This is

medical advice. This is not me telling you whether you should or shouldn't take these medications. I don't know you. I don't know if you're eligible. Even if I did know you. I'm not going to say yes, you should. I might say, Hey, have you had this discussion with your GP? Because that is exactly who you should be discussing this with. If you have questions about it, or if you feel like you might be eligible, you should not be listening to a podcast, or reading blogs or watching YouTube videos on this stuff until you have, unless you have first

talk to your GP. So if they have flagged that, yes, you are eligible, and they've had that conversation with you, this podcast is hopefully just to help you understand a little bit more about what's going on and help you make a bit more of an informed decision as to whether that's something you want to do. But again, I'm not saying you should or shouldn't, but you should talk to your doctor. That's it. Cool. So basically, the way that both semaglutide and tizepatide work, so remember, that's all of the ones we've just chatted about.

they, they share a mechanism of action and then they've, your tizepatide has an extra kind of layer on top of it. So some megalotide, ozempic and we go V, they work. Sorry. And all of them, they work because they are what's called GLP agonists, ie they can have the same effect that our GLP one, which is a hormone that we naturally produce called glucagon like peptide one. they can have the same effect that that hormone.

They can mimic its action and so we can cause more of that action to occur. And that's really, really good when it comes to the management of type 2 diabetes because those actions are things like increasing your insulin secretion. So making your body release more insulin, which is helpful for managing blood sugar. It decreases the amount of glucagon released. So glucagon is just kind of the opposite hormone of insulin. So reducing it is helpful as well.

Jono (04:45.054)

and it can also help reduce something called hepatic, a glucose, neo Genesis, which basically means it can stop your liver from making new glucose, right? Hepatic means liver, glucose, neo new Genesis make right liver make new glucose. it's nice to know that some of my anatomy stuff from uni still rattling around in here, but, all three of those things can be really, really beneficial in improving your management of blood sugars, right? it can reduce.

Yeah, your area under the curve and so improve something called HbA1c. It's just really good improvements in blood sugar control, right? Which for type 2 diabetes is phenomenal, you know, because those complications are, you know, in terms of like blindness, kidneys, all of these things can be impacted down the line if we have poor blood sugar control. So that's really, really good. Now we also know that GLP -1 can decrease gastric emptying, i .e. it can slow the amount of time that food

that it takes for food to get through your gut, which makes you feel fuller, right? Makes sense. If food is hanging out there a little bit longer, you're probably less likely to go and eat. And so we know that GLP -1 can definitely reduce your appetite. And I'm sure you can appreciate that if your appetite is reduced, you're probably going to eat a bit less. And if you're going to eat a bit less, you're probably going to lose weight. So that's one of the other reasons as to why these medications have been prescribed for the management of obesity off label,

Now, when it comes to Monjaro and Zepound, these are the two Zepatides, they also are GLP -1 agonists. So all that stuff I just talked about, the insulin, the glucose on the hepatic gluconeogenesis, there's way too many big words in this podcast, sorry. But, you know, all of those things, it still does that. But it also is a GIP agonist. Sorry, forgot. And so it can also mimic the action of GIP. Now, I forgot to look up what GIP was before I recorded this podcast.

It's probably like gastro something peptide. Anyway, it's kind of a, it's a similar, what's called an incretin hormone, but basically it's, it can have similar impacts to GLP -1, but one of the other things it can do is it can increase the insulin sensitivity of your fat cells, which makes them easier to break down. Okay. So that's why what we see in the trials to zepatides typically have greater impacts on fat loss than semaglutides because

Jono (07:13.588)

Zepatides have that extra mechanism. They've got that GIP one, sorry, they've got that GIP agonist impact as well. Okay. So, that's what we're seeing now. Now, like I said, though, right now in Australia, the only one that has been approved specifically for the management of obesity is, we go V. but I wouldn't be surprised if we saw Monjaro or Zephbound potentially get approved for the management of obesity in Australia at some point, but like, just spit ball on here. Don't please.

I'm just a dietician. So a big question I get, because there's a weird ethical conversation around this. There shouldn't be, but there is. And I'm not going to go too deeply into it, but the answer I always give is when someone says, should I take Ozempic for weight loss? Because I don't think what they're asking is does it work, right? We're pretty confident that it works. Like I said, there's this weird kind of ethical, am I cheating? I don't know, all these weird things.

The analogy or the similarity I always draw is between these medications and using medications for say depression. So taking antidepressants. Hopefully no one feels guilty about taking antidepressants to manage their depression. Okay. If you do that's please go talk to someone about that because you shouldn't. And it's very similar to weight loss medication, right? So just like with antidepressants, no one is telling everybody who's a little bit sad.

to go on antidepressants, right? And even some people who are struggling with clinical depression may not need antidepressants. But for lots of people who are struggling with depression, antidepressants are phenomenally helpful. They might need to be on antidepressants for a short time. They may need to be on antidepressants for a very, very long time. The dosage of those antidepressants may change over time. Nobody who is prescribing antidepressants is just saying, hey, just take some antidepressants, good

They're also saying, hey, take these also, hopefully these help you focus on the lifestyle interventions as well. You know, the psychological strategies, know, taking care of yourself, hopefully improving your nutrition, like all of those amazing things that we also know also help with the management of depression. But sometimes, oftentimes, you need the antidepressants to give you the support to be able to do those other activities, which are also really helpful, right?

Jono (09:38.872)

So hopefully you can see all of the reasons why that is the same as these weight loss medications. No one is prescribing these medications, sorry, that's not true. People shouldn't be prescribing these medications for someone who just wants to lose a couple of pounds, right? They are for the management of more serious cases, right? Secondly, no one is suggesting that you just take these medications and don't make any lifestyle changes.

Like I've seen with all of my clients who've opted, who were eligible and have opted to start the medication, it has supported them in making the changes that they were already trying to make, right? It is improved their ability to continue to make those positive changes. That's really what it's about. It's not about, is it right or wrong or any of, again, the weird ethical things. It's just down to, is it right for you? Are you eligible? And will it facilitate you doing those things that you, the other things that you could do to support?

your health and body composition. that's hopefully that has summed up how I feel about them. I just wanted to finish by touching on kind of two of the main symptoms I think that come up all of the time. Now there are quite a few reports of GI distress. That's, you know, we're seeing in the studies that's very real. Things like nausea, reflux, vomiting and definitely less frequent

those sorts of feelings are definitely a potential side effect. Now, like with most notifications, everyone's individual response is different. We've definitely also seen with clients that there's certain dietary strategies you can use to reduce the risk of getting those symptoms. broadly, it's things like still eating a good quality diet, you know, overall, doesn't mean never eating a donut, but it does mean that, you know, we're not just talking about

yeah, just eat whatever you want and take these medications. We still want to strive for an overall healthy dietary pattern. We find that that helps with the side effects and also definitely listening very closely to your hunger and fullness cues, even if they seem a bit different, because they're going to be different on this medication. Listening to those is also really, really helpful. If you do want more help and you're on these medications, like shameless plug, actually it's not shameless, come and talk to us, we can help you. And if you don't want to talk to us, that's totally fine.

Jono (12:00.506)

go talk to other dietitians that I'm happy to connect you up with and we can help build a good diet that will help. The last side effect I've heard people fear mongering about is the loss of lean mass, so I eat bone and muscle, particularly muscle, and obviously that's not great, know, we definitely want that to maintain, but the reality is this is something that we know occurs in weight loss all the

This is not unique to the weight loss that's occurring on these medications. Anyone who loses a significant amount of weight is at a higher risk of losing lean body mass. Now, technically, it's often still worth it in the long run in terms of improvements in health. But it also means that we still absolutely strongly suggest that you do all of the other things that you can do to protect your lean mass. So whether you are

you're in a calorie deficit without these medications or you're in a calorie deficit with these medications, we would still strongly recommend getting adequate amounts of protein, trying to space that throughout the day. And then most importantly, lifting weights, doing some form of resistance training. If it's not weights, it's bands. If it's not bands, it's like aqua aerobic, some kind of resistance. And just again, like any kind of fat loss journey that you're on, whether it's with medication or without medication.

these things protein and resistance training are invaluable for protecting your lean body mass. So I haven't seen anything to suggest that to suggest that these medications amplify or cause more than expected loss of lean body mass. is pretty much probably the biggest thing is like, yes, it might cause slightly larger lean body mass than if you're dieting without the medications, but that's largely just because the medication typically allows you to eat

and in more of a deficit. So it of just tracks with the size of the deficit. And again, eat protein, lift weights. I mean, sort of everyone should do that. I'm sure there's a bumper sticker or shirt out there that says that as well. yeah. Anyway, I hope that's helped. I think that's everything. If it's not, let me know. Comment below. Send me a most. I was going to say send me a post and a message. So send me a most. But most importantly, if you found this really helpful, I'd love a review or a like or a share.

Jono (14:18.78)

So I can continue to validate myself with. All right. Thanks