0:00

At Radiolab, we love

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also like to get into other

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or politics, country music, hockey, sex,

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looking at science or not science, we

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the world anew. Radiolab, adventures on the edge

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of what we think we know. Wherever

0:29

you get your podcasts. Hello

0:32

and welcome to Raising Health, where we

0:34

explore the real challenges and enormous opportunities

0:36

facing entrepreneurs who are building the future

0:38

of health. I'm

0:45

Olivia. And I'm Chris. As

0:48

Ozempic, Wogowi, Monjaro, and Zepbond capture

0:50

the healthcare spotlight, we've decided to

0:52

develop a series of episodes that

0:54

go beyond the headlines and take

0:56

you into conversations with the specialists.

0:59

So for the next few episodes, we bring you

1:01

the science and supply of GLP1s. Our

1:04

first guest is Carolyn Jassik, Chief

1:06

Medical Officer at Omada Health. She

1:08

gives us an overview of the

1:10

science of satiety, the perspective from

1:12

obesity-focused physicians, and the sometimes

1:15

surprising lifestyle implications for patients on

1:17

these medications. Next week,

1:19

we'll hear from Brooke Boyarsky Pratt,

1:21

founder and CEO at Knownwell, on

1:23

the necessity of creating a patient-centered,

1:26

evidence-based, holistic experience when tackling obesity.

1:29

In the following week, we talked

1:31

to Cronus Manolis of UPMC Health

1:33

Plan on how payers and providers

1:35

are thinking about these drugs, as

1:37

well as pricing and prior authorization

1:39

considerations. Together, the trio provide insight

1:41

into what anti-obesity medicines are, where

1:43

they're going, and the challenges that

1:45

have to be overcome along the way. Today,

1:47

Carolyn talked with Vijay Pandey, founding

1:49

partner of A16C Bioin Health, about

1:52

the excitement around GLP1s, how

1:54

these medications might be approved for more conditions

1:56

over time, and even how society might

1:58

change as a result of... widespread use of

2:00

GLP-1s. You're listening to Raising

2:03

Health from A16Z, Bio-in Health.

2:09

It's my pleasure to welcome Karlin Jasek,

2:11

Chief Medical Officer of Amada Health to

2:13

Raising Health. Karlin, thank you so much

2:16

for joining us. Thank you for having

2:18

me. You have a particularly interesting background

2:20

across academia, clinical medicine,

2:22

and startups. I'd love to

2:24

hear you walk us through your career to date.

2:27

I think a lot of people think that

2:29

you've got a medical degree and it's a

2:31

pretty predictable career, but I think these days,

2:33

especially with medicine changing so rapidly, many of

2:35

us have careers that range a long

2:38

period of time with lots of different choices.

2:40

I think for me, it's always been about

2:42

preventing disease through engaging

2:44

patients in behavior change. The

2:46

particular age range and the

2:49

subject area has changed over

2:51

time, but that's really been the main piece. When

2:53

I was an undergraduate, I majored in public policy

2:56

with a focus on health policy and quickly

2:58

realized that behavior was the underpinning of

3:00

a lot of the challenges that we

3:02

have in health care and chronic disease.

3:05

And initially, I focused on reproductive health. I

3:07

actually thought I would go to graduate school

3:10

in population studies. I've always been a mask

3:12

geek, love statistics, but that

3:14

isn't quite what my path took. I

3:16

ended up at medical school. And

3:19

while I was there, I really thought I was

3:21

going to focus on women's health, but I was

3:23

blown away by the obesity crisis. I've always been

3:25

the kind of person that is asked, what's

3:27

the biggest problem in policy that's impacting

3:29

our country at any given time? And

3:32

at the time I went into medical

3:34

school, it was definitely obesity. Then

3:36

when I got to residency, I did

3:38

pediatrics because of the behavior change

3:41

piece. And for me,

3:43

that experience in pediatrics and

3:45

fellowship was learning the science

3:47

behind behavior change and what

3:49

works and really

3:51

becoming impressed by the limits of what

3:53

we can do while we're in the

3:55

clinic. We only have maybe 15, 30

3:58

minutes for the patient. And. Kobe

4:00

completed my training and to fellow Sab

4:02

I thought I was playing to do

4:04

what we're all told to do it

4:07

is the an academic clinician. I was

4:09

ready to write as one of the

4:11

classic an age grants that people do

4:13

and as I was getting ready to

4:15

submit that you Csf wrote as a

4:18

large tax to attack somewhere the as

4:20

a guitar and asked if there were

4:22

any and sessile t. Or the aren't

4:24

or necessity, my case, That wanted

4:26

to help with that and so at

4:29

the time I was planning to write

4:31

some grants i'm using technology in primary

4:33

care for obesity and so I decided

4:35

to work on the attack install a

4:38

easier south and I worked on that

4:40

for five years and what was interesting

4:42

about that experienced was service. Just the

4:44

historic moment it was to get all

4:47

the hospitals on each hours than all

4:49

the fun and challenge of that. Son.

4:52

A. Society as a one time I

4:54

mean some my best memories actually he

4:56

says as far as from the go

4:59

lives are big bang alive day. However,

5:01

I just I just felt like I

5:03

didn't wanna spend the rest of my

5:05

career kind of considering someone elses software

5:08

that I hadn't designed myself and that's

5:10

when I need probably the. For.

5:12

This decision really of my life because as

5:14

kind of a careful planner up until then

5:16

a Melbourne a new and they said does

5:19

anyone know anyone in industry had never worked

5:21

in industry. I was born and bred academic

5:23

and my brother. Had a friend

5:25

that worked with a woman named Lend

5:27

Sale at Kleiner and I had lunch

5:29

with Land and we hit it off

5:32

right away and see gave me my

5:34

first consulting gig at a small set

5:36

of she had just investors and and

5:38

one thing led to another I left

5:40

Ccs ass and ended up in industry

5:42

which is not lab or thought that

5:44

I would do by. It's been great

5:46

at the end of the day it's

5:48

come full circle of Donnelly. Can I

5:50

be entrepreneurial but I can also do

5:52

research? Harrys appeared on a. Mother.

5:55

Or is hot topics in the space. Is

5:58

guilty ones. In. a surface

6:00

stage that you could see very early

6:02

on that obesity was a real crisis.

6:04

How have GLPs evolved over time? Like

6:06

how are the sort of

6:08

newer ones different from the original ones?

6:11

Yeah. So the original ones, uh, did not

6:13

have as much weight loss. In some cases

6:15

were dosed daily, then we went to weekly.

6:17

Uh, now there's some in development that are

6:20

monthly. So the frequency of

6:22

dosing change and also the side effects.

6:24

So the side effects have gotten better

6:26

with each medication that's come on. And,

6:29

um, most recently, I think we won't

6:31

even be calling them GLPs anymore. Uh,

6:33

I think I just came back from

6:35

the obesity medicine meeting and they're really

6:37

just using anti obesity medication or ALM

6:39

as a category. Some people call them

6:42

in Griton type medications, uh, because

6:44

now we're in dual agonist and

6:46

soon triple agonist, uh, therapy. So

6:49

what's your broad clinical take for the benefits

6:51

and risks of GLP one? So, uh, as

6:53

you mentioned, they came out originally for a

6:55

type two diabetes, not for obesity. How do

6:57

you think about them for the obesity space?

7:00

Oh my gosh. I mean, I did, like I said,

7:02

I just came back from the obesity medicine meeting and

7:04

I just don't even know if he could describe it

7:06

anything more than a fan fest, to be honest. Um,

7:10

that's what it felt like. Uh, this

7:12

it's thrilling for our industry and for

7:14

our field. Honestly, uh, we have not

7:16

had a medication that's this helpful for

7:18

weight loss. I mean, the last thing

7:20

we really had was bariatric surgery and

7:22

to every few medications have been almost

7:25

uniformly at this disappointment, at least

7:27

in the 20 years that I've

7:29

been practicing, they'll come out. There'll

7:32

be some major side effects, whether

7:34

it's cardiac or gastrointestinal. They'll be

7:36

poorly tolerated by patients and even

7:38

with all that, not very effective.

7:40

So this is really exciting. And,

7:42

um, I mean, game changers and

7:44

understatement, but a lot of

7:46

discussion about, uh, just how it's all going

7:49

to work because these are not simple medications

7:51

and I think you have some questions coming

7:53

about the Side effects

7:55

and some of the other pieces, but I would

7:57

say just. We

8:00

excitement and positivity about that having such

8:02

a great saw an article box. Well.

8:05

I'm curious how you balance that with.

8:08

Also, as I said, there's been a

8:10

lot of consumer excitement and all

8:12

these different mechanisms for getting shield

8:14

the ones that maybe differ from it

8:16

your typical primary care doctor prescribing

8:18

it. I. Think that

8:20

the consumer isn't around Glp.

8:23

Is is. Not. Unexpected.

8:25

These are weight loss medications I

8:27

they are as indicated by very

8:29

specific weight range. There a lot

8:31

of people especially in you know

8:33

the public eye people talk about

8:36

that wanna lose weight that may

8:38

not be currently old, the of

8:40

overweight or obese and sell. I

8:42

think that kind of the consumers

8:44

and is a distraction and it's

8:46

really a shame because their supply

8:49

chain certain farmers for diabetes patients

8:51

is. Impacted by. People

8:53

taking these medications his and beyond them

8:55

and secondly within the obesity space. Ah

8:57

we need to tell are these medications

9:00

to the people are target the medication

9:02

to the people that need them the

9:04

most at least in the short term

9:06

where we a significant pressing challenges and

9:09

also supply chains. I think this to

9:11

be very careful about who is getting

9:13

the medication and to as and I

9:16

am a die hard fan of medical

9:18

home Many people have tried to convince

9:20

you otherwise Ah by for so many

9:22

different reasons. I think important medications

9:25

like this one said be prescribed

9:27

within some and medical whole night.

9:29

Deep concerns about going to a

9:32

letter to tell a health provider

9:34

or a outpost in as pharmacy,

9:37

or whether someone might find medication

9:39

that isn't their medical home. I

9:41

worry that safety, I worry about

9:44

salad care. I worry about cost

9:46

containment. Where from from too soon

9:48

as he starts as serve expand missile

9:50

that we're beyond obesity would you figure

9:52

some your presents or for two sons

9:55

of these drugs Were hearing about all

9:57

these are new possible invitations Gov I

9:59

think there. two groups, there

10:01

are indications that are very closely tied

10:03

to obesity. So we have to look

10:06

carefully at the data and understand whether

10:08

the positive impact, and there will be

10:10

a positive impact on some of these

10:12

conditions is due to the primary mechanism

10:14

of weight loss or whether it's a

10:17

unique mechanism of action of the

10:19

GLP for that disease. So I'm

10:21

thinking about heart disease, renal disease,

10:24

liver disease. These are

10:26

all sleep. These are all very important

10:29

chronic conditions that can result from obesity.

10:31

So as we look at the literature and

10:33

we understand more about these medications, it's important

10:35

to understand whether the mechanism is the weight

10:38

loss or whether there is a primary effect

10:40

directly on the condition itself. Then

10:42

there's a second category, which are things like

10:44

addiction, which aren't really related to obesity

10:46

at all, which is really exciting and interesting.

10:50

And I think we'll all have to watch that area very

10:52

carefully. Yeah, the addiction part

10:54

was particularly stunning. You can always

10:56

think about comorbidities of obesity, and

10:58

there's tons of them. I guess

11:00

people are not thinking about obesity

11:03

as related to addiction in

11:05

any way, or is there

11:08

some connection that one can draw? I think

11:10

at this point it's conjecture. I mean, I

11:12

think the research needs to be done. Clearly

11:15

there's an association with the use of GLPs

11:17

and a reduction in some types of addiction.

11:19

There's many types of addiction one could look

11:21

at. Some people wonder

11:23

about whether part of the mechanism

11:25

for obesity around food and being

11:28

able to have restraint in eating

11:30

might be linked to what's happening with addiction.

11:32

I think it's really exciting. The

11:36

neurochemistry of obesity and eating,

11:38

it's probably beyond the scope of this

11:40

podcast, but as we talk about the

11:42

side effects of GLPs and why people regain

11:44

the weight, there is so much happening in

11:46

the brain with GLPs. I think it's not

11:48

surprising at all that it could be having an

11:50

effect beyond just kind of the hunger,

11:52

satiety effects that we've already kind

11:55

of looked at with the medication.

11:57

One of the interesting aspects of GLP1s is that...

12:00

in principle, and you should

12:02

correct me on this one, is

12:04

that it's, in a

12:06

sense, helping do something which endogessingly we

12:08

may have done on our own

12:10

before and replacing that. Certainly

12:12

when I was younger, I could eat a lot more

12:14

and have different metabolic reactions

12:17

to it and so on. I

12:19

have to tell you, if there's

12:21

a part of this TLP business

12:23

that has been just the most

12:25

fascinating for me, it's really the

12:27

neuroendocrinology of this. So my answer

12:29

to your point, your question, is

12:31

that a person, the signaling pathway

12:33

is leptin, insulin, and ghrelin. Those

12:35

are the main three. There's other

12:37

ones as well, glucathones in there. Those

12:40

hormones and how they impact your

12:43

body change dramatically by age.

12:46

So your hunger increases during puberty. Those hormones

12:48

are involved in that. And then your

12:50

hunger and satiety go down and your metabolic rate

12:52

go down as you get older for women after

12:54

menopause for men a little bit later. And

12:57

so those natural things happen.

13:00

But then if you add on top

13:03

of that our toxic environment, whether it's

13:05

a low level of physical activity or

13:08

over nutrition, you start to get resistance

13:10

of a lot of those hormones. And

13:13

so speaking to your point, a person may

13:15

have a normal signaling pathway when they were

13:17

younger, but then they've kind of attenuated

13:20

that over time with their own

13:22

behavior and that will alter their

13:24

signaling pathway, in some cases permanently.

13:27

And then there's the other part of

13:29

genetics, right? Some people are just born

13:31

to have either more resistance

13:34

or more sensitivity of some of

13:36

those hormones. And I have to say

13:39

that to me is one of the

13:41

best things that's come out of this

13:43

whole discussion about GLPs. I

13:45

think Oprah had a special last week about shame

13:47

and obesity. And there's some quotes

13:50

from her about how guilty

13:52

she feels for perpetuating a culture of

13:54

shame. And I think learning about

13:56

the science of GLPs and how they work has

13:58

allowed us to really understand

14:01

that, you know, this

14:03

isn't people's fault, a lot of it has to do

14:05

with genetics and how they're just set up. Just

14:08

one other thing that I think is just

14:10

so fascinating and it was actually Biggest Loser

14:13

where we learned some of the science is

14:15

how hard it is for people to maintain

14:17

weight loss once they lose it. And we're

14:19

seeing this with GLPs where you

14:21

if you go off the medication, that

14:23

when you lose a whole bunch of

14:26

weight, your body's metabolism slows down. And

14:28

those changes, getting to the point

14:30

in Biggest Loser, they found that those

14:33

changes of the metabolism come off for

14:35

years actually, like four, five

14:37

years after the metabolic slowing.

14:39

So one person who weighs, I don't

14:41

know, let's say 160 pounds and never

14:43

was obese and another person who weighs

14:45

160 pounds but was

14:48

400, they're going to have a

14:50

slower metabolism potentially. And

14:52

so their ability to maintain

14:55

that weight is going to be harder

14:57

than for the person who is never

14:59

obese or overweight in the first place.

15:01

We've talked about prescribing GLP1s about the

15:04

various pros and cons of it. But

15:06

what can we do beyond just prescribing

15:08

GLP1s? Given potential

15:11

side effects or given the potential

15:13

high cost of it and

15:15

even just supply issues, are there

15:17

things we can do in terms of care

15:19

delivery that can go beyond just prescribing GLP1s

15:22

and having people take them? Yeah.

15:25

So this is something we've thought about a lot,

15:27

especially at OMATA. In many ways,

15:29

these medications are specialty medications. So if

15:31

you're familiar with how

15:33

rheumatoid arthritis is treated or

15:36

lupus or Crohn's disease,

15:38

they also have injectable medications available for

15:40

those patients. And by and large, you

15:43

don't just get the medication, you get

15:45

a specialty service set either from your

15:47

PBM or through your provider to help

15:49

you take those medications, learn how to

15:52

do injections, learn how to store

15:54

them, proper disposal of the

15:56

needles initially. And then there's

15:59

the side effects. that might be on those

16:01

medications, making sure you have the support

16:03

and education you need around that. If

16:05

you have insurance disruption or cost barriers,

16:07

making sure that you're able to navigate

16:09

those so you don't have a disruption

16:11

in treatment. And those kinds of companion

16:13

programs have been shown to reduce costs

16:15

and increase outcomes time and time again

16:17

for complicated medications with either a complicated

16:21

or intricate titration protocol or

16:25

injectable storage, any of those

16:27

things. The challenge is those

16:29

types of medications typically are available to

16:31

a very small population.

16:33

So those programs can be high test

16:36

and high cost. Here we have what

16:38

is essentially a specialty medication that I

16:40

don't know what's the latest statistic you've

16:42

read. I think about maybe half of

16:44

people on earth could

16:47

potentially maybe take this medication. So

16:49

being able to offer, at least

16:51

in the spirit, some of those

16:53

services that I believe are very

16:56

important for those medications, but at

16:58

a cost that is doable for

17:00

whoever's sponsoring the medication, I

17:03

think virtual care companies

17:05

have a really big role to play here in

17:07

terms of educating people on medication, helping them once

17:10

they're on it, navigate all the things that we've

17:12

been discussing in the call and then when they

17:14

make the decision with their provider to go off,

17:16

having the support to maintain the weight loss, which

17:18

we haven't had a chance to talk about. We

17:20

can talk more about what maintaining the weight loss

17:23

after the medication might look like. Because these

17:26

medications are pretty well tolerated, but there's a

17:28

lot of side effects. You can have

17:30

reflux, you can have nausea, constipation,

17:32

some people have vomiting. So these

17:34

kinds of companion programs, I don't

17:37

think need to be staffed necessarily

17:39

by clinicians, but a health coach

17:41

with a clinician at arms

17:43

reach can be really helpful. And

17:45

Omada were in particular interested

17:47

about the exercise component

17:50

and the lean muscle mass and

17:52

looking at is there an opportunity

17:54

for companion programs to both educate

17:57

and supervise an exercise regimen that

17:59

will. attempt to preserve lean

18:01

muscle mass because it is so important

18:03

for so many reasons. Yeah,

18:05

maybe you could walk us through what you think a

18:07

companion program could look like while they're

18:10

on the GLPs and then what happens after you

18:12

go off the GLPs? I think

18:14

a well-designed, scientifically-based companion program

18:17

would first partner with the

18:19

sponsor to make sure the

18:22

right patients are getting on the medication by

18:24

weight. I have a lot of concerns about

18:26

fraud and abuse with people

18:28

especially getting telehealth prescriptions without having to

18:30

confirm weight, so making sure the weight's

18:32

confirmed and the health history is confirmed.

18:34

So I think a companion program can

18:36

help with that. And then

18:39

once folks are on the medication, just all the

18:41

logistics. I mean, think about the last time you

18:43

got a simple prescription and all the steps involved

18:45

just to go get those pills at the pharmacy

18:48

and go home. So working

18:50

with people about what is an injection,

18:52

how do injections work, where do I go to

18:54

get it? Oh my gosh, my co-pays $400,

18:56

what do I do? Savings

18:59

card information, maybe look at the

19:01

formulary, all that kind of support. And

19:03

then educating folks and supporting them on the side

19:06

effects. Most of the side effects get better after

19:08

the first month of youth. So

19:11

really supporting people about that, encouraging them

19:13

to go back to their provider to

19:15

maybe slow the titration. And

19:17

then while they're on the medication, nutrition.

19:20

So depending on the GLP

19:23

and especially with the amount of weight loss

19:25

that we're seeing most recently, people are eating

19:27

very little. And so in

19:29

many cases, these are individuals at the

19:31

prime of their life that need to

19:33

maintain their muscle mass and their bone

19:35

density. So educating people about

19:38

what their diet should look like and

19:40

to make sure that they don't miss key

19:42

nutrients like calcium and others, iron

19:45

and things so that you don't get other

19:47

health problems. That's another piece. And

19:49

then off the medication, if

19:51

that's somebody's choice, I think

19:53

very, very close monitoring with

19:56

weight and exercise

19:59

support and nutrition. to make

20:01

sure that that weight doesn't go back on because

20:03

there's just nothing more devastating

20:05

for the patient in particular and the

20:07

individual that sponsored the medication to have

20:09

that weight come back rapidly as we've

20:11

seen in the research. Yeah, I

20:13

would think when one is eating so few

20:15

calories, basically every calorie matters,

20:18

right? Because that is all

20:20

your soul amount of nutrition. How much effort do

20:22

you think people put into the diet part of

20:24

it while they're on the GLP ones? Very

20:27

little because I think most primary

20:29

care providers, I'm a big fan

20:31

of primary care, but they are

20:33

not staffed to really provide that level

20:35

of detailed help and dietician visits

20:37

are available, but they're difficult to access. People have

20:39

to get into their car and they have to

20:42

go. So I think having

20:44

somebody who can look at your food record

20:46

and say, hey, you know, I really

20:49

don't see a good range here.

20:51

Have you considered a multivitamin? The

20:54

average patient is to be blunt,

20:56

just thrilled that their appetite is

20:58

down and they're not really watching what they're

21:00

eating and losing weight really

21:02

quickly and missing

21:05

out on a lot of key nutrients.

21:07

I think we will learn a lot

21:09

as time goes on about bone density

21:11

in particular in women on this medication

21:13

if we're not carefully monitoring. No,

21:15

that makes sense. So let's say we're sitting

21:17

here, we're having a conversation again, we're going to

21:19

talk sooner than this, but let's say we're chatting

21:22

in 2034. What

21:24

do you think has happened? What has all this led

21:26

to? In 10 years, what do you

21:28

think these medicines will look like? Oh,

21:30

crystal ball, I love it. I love those

21:32

questions. I hope at five years that the

21:34

price has gone down. I

21:37

say I hope because I think we've seen

21:39

cases where that has been achieved and I

21:41

think we've seen cases where it isn't. My

21:43

hope is that by five years, we will

21:46

see the price go down so the access

21:48

is more broad. So that's the first thing

21:50

I would love to see broad and available

21:53

access to these medications. I

21:55

think that we will learn that people do

21:57

not want to take these medications for life.

22:00

Life on a GLP is hard. You

22:02

can't go to Thanksgiving dinner and you

22:04

know have a really big meal You

22:06

won't feel well, you're gonna feel really

22:08

uncomfortable You know, you

22:10

can't you can't dance at your daughter's wedding

22:12

and a big piece of cake and a

22:14

nice steak, you know So people want these

22:16

life experiences. They don't want to live in

22:19

such a restricted way So again, not to

22:21

persevere it on Oprah, but she was talking

22:23

about intermittent use I think we'll see intermittent

22:25

use of this medication I think people will

22:27

use it initially for the weight loss and

22:29

then we will see touch-ups Where

22:31

they will go off and then if

22:33

life touches them by surprise and some

22:35

weight has gone back on Well,

22:38

it's the intermittent use to go back

22:40

on naively. This sounds like just a

22:42

modern yo-yo diet How

22:44

would that be different? Yeah, it's interesting. No

22:46

one's put it to me that way I think that's

22:48

kind of accurate to be honest Maybe we'll get to

22:51

a point where very low dose version for this medication

22:53

people can have The side

22:55

effect profile and the appetite that they want

22:57

but so far that we just don't know

22:59

enough to know if that's the case But

23:02

I think you're right and I think Interestingly

23:06

what I hear in your question, but I don't think you meant this

23:08

but let us hear in there your question is Okay.

23:10

So let's say we have someone who has lost a

23:12

significant amount of weight Now they're in a normal weight

23:14

range and they gained 10 pounds or 20

23:17

pounds and they want to go back on

23:19

the GLP They're technically not eligible Right because

23:21

10 to 15 pounds won't put

23:23

them back in the overweight and obese range So

23:25

that so the bad effects of yo-yo dieting that

23:27

we know of is when people go up and

23:29

down by 30 40 pounds Gain

23:32

it lose it that kind of thing. There's really

23:34

bad metabolic effects of that so

23:36

what I hope to see in five to ten years to go back

23:38

to your question is a little

23:41

bit more Acknowledgment that obesity is

23:43

a chronic disease regardless of what

23:45

your current weight is So

23:47

I would love to see people be able to

23:49

access this medication if they have a history of

23:51

obesity Even if their current weight

23:54

does not put them in the obese range

23:56

because I Would hate for someone

23:58

to have to regain 50 pounds in order. The get

24:00

to be able to get the medication again and again.

24:02

He went on Sat. Never know how do

24:04

you think society itself would change or

24:06

and over kind of pushing the limits

24:08

your rights? Maybe the cake size just

24:10

gets really small with fear factor has

24:12

are highly are still. Saying and think

24:14

about it will we have less heart

24:17

disease, will be had less diabetes I

24:19

think. Need Yes, I hope

24:21

we don't sign some long term effect of

24:24

these medications. That's we don't know that. I

24:26

don't think we'll all cause we've had them

24:28

for fifteen twenty years for diabetes and we

24:30

haven't seen that. So we're going to have.

24:33

Potentially. Less heart attacks, less diabetes.

24:35

and I think you're right, it is

24:37

a quarter of the letting his on

24:40

A T L P. Noises about

24:42

that before. So and maybe it's yeah, had

24:44

me, maybe more than half. You know. the.

24:46

Night take that had a far as as was. Just

24:48

as as much as. Less

24:50

evil because I think it's gonna be

24:53

fascinating. Cells were do just basically

24:55

made takes. A generation. But

24:57

in their generation we would have fundamental

24:59

change in the world. Yeah.

25:02

Because the in a few important

25:04

to do the first, a surprise

25:06

fight needs to be accessible. The

25:08

second is just learning as much

25:10

as we can about the medication.

25:12

And who's Cbrn? Who said and

25:14

you know there's some feel that

25:16

are signed on and can't tolerate

25:18

it by the Obesity Medicine meeting.

25:20

Like I said just sell nights

25:22

hope and optimism about what's possible.

25:25

And I think from her behavior

25:27

seen stand Plankton this is what

25:29

I think about most day to

25:31

day release. That behaviors haynes

25:33

can hold the important. Part.

25:35

Role that it dies and it still

25:37

has a very, very essential an important

25:39

role in nests. but it's not burdened

25:41

with the whole place in any more

25:43

than legal system is overwhelming and difficult

25:45

because it's behavior change alone, wealth and

25:47

in it just wasn't enough. Less it

25:50

because we see. what our it's of easier

25:52

for some it may be banal for everyone

25:54

that site or if you domo of does

25:56

your question was asked everybody but for usually

25:58

pretty clear interesting So if you

26:00

wouldn't mind sharing, what do you do for your

26:03

own health? So right out

26:05

of COVID, I went to my

26:08

first employment doctor's appointment or whatever.

26:12

And my PCP said,

26:14

well, your blood pressure size. So here's your blood

26:16

pressure medicine. And I looked at her and I

26:18

said, no. That

26:21

is not happening to me. I

26:24

have a thousand people per week going

26:27

through this hypertension program that I designed.

26:29

That is not happening. And so I

26:31

told her, I said, give me six

26:33

months and I'm going to like fix

26:35

this. So for my own health,

26:37

I've gotten pretty regimented about

26:40

diet and exercise. I hate to

26:42

share that I was not able to get out

26:44

the blood pressure medicine. It's looking like that was

26:46

genetic, thanks to my mom. But I have made

26:48

a ton of changes. Something that

26:50

I'm particularly passionate about right now is

26:55

staying healthy while traveling because I

26:57

travel a lot for work. So

26:59

I'm getting really interested in finding

27:01

places to exercise when I'm on

27:03

the road. And I'm

27:05

not any big athlete. So finding opportunities

27:07

that make sense for me, super into

27:09

that. And I've always been interested in

27:12

trying to figure out how to eat

27:14

healthy on the road or at home.

27:16

So I'm totally obsessed with those two

27:18

things I would say. So

27:20

this is like one of the most important

27:22

questions. I was like, so how do you eat healthy

27:25

on the road? That sounds very hard. You

27:27

have to be very planful and I would

27:29

say a little bit obsessive. So I just

27:32

came back from seven days of travel that

27:34

included three different states. And I

27:36

have a couple of things that I do. So

27:38

the first thing is I have a bag of

27:41

like between 100 and 200 calorie

27:44

high protein something in my

27:46

bag. So bars, nuts, like

27:48

little things. And in

27:51

the airport, it is very challenging.

27:53

So there are a few really

27:56

great choices that a lot of people don't know about.

27:58

So like Hudson News and or and

28:00

companies like that, they have the little

28:02

sad refrigerator in the basket. So

28:05

in that sad refrigerator, you can

28:07

actually find very healthy, appropriately portioned

28:09

food that isn't gonna come with

28:12

a pile of fries. So like

28:14

a turkey sandwich or a cheese

28:16

and cracker with salami, little tray,

28:19

you can find these things in

28:21

there. And that

28:23

is a great option. And

28:26

then the other thing is when I get to the

28:28

place, I mark every day that has a really

28:30

nice meal because I want to enjoy myself.

28:32

And then the rest of the time I

28:35

only eat my snacks. Because if you're not

28:37

careful, it can be breakfast with the team,

28:39

lunch with the client or the partner, dinner

28:42

with the client or partner, snacks in the

28:44

conference room. I mean, it's endless. It

28:46

sounds small, but every little

28:49

thing adds up. Every avoided

28:51

sugar, added protein, avoided carbs.

28:54

And it just either becomes this virtuous

28:56

cycle where you feel good and you eat

28:58

healthy and all this stuff or this vicious

29:01

cycle. And having

29:03

the nudge and the push of GLP ones

29:05

is super helpful, but it's more than just

29:07

that. So I think all this matters. Thank

29:10

you so much for joining us on Raising Health.

29:12

Oh, thank you for having me. Thank

29:23

you for listening to Raising Health. Raising Health

29:25

is hosted and produced by me, Chris Tatyosian

29:27

and me, Olivia Webb, with the help

29:29

of the Bio and Health team at A16Z. The

29:32

show is edited by Phil Hegcess. If you

29:34

want to suggest topics for future shows, you

29:36

can reach us at raisinghealthata16z.com. Finally,

29:39

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29:43

content here is for informational purposes only,

29:45

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29:48

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29:50

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29:52

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29:54

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29:57

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