The Future of Addiction Treatment Starts Here: GLP-1s Explained With Dr. Ken Spielvogel

You know, using these drugs without a, to me, a supervised medical professional that's guiding you in terms of what you should be taking on top, how you should be exercising, how you should be looking at metrics of fitness and longevity, then you're doing yourself a disservice and so is a person that's just giving it to you. If someone has a problem with substance use disorder, please call One Call Placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. One Call Placement is affiliated with Carrera Treatment Wellness and Spa and One Method Treatment Centers. Today I'm with Dr. Kenneth Spielvogel, Senior Medical Officer at Carrera Treatment Wellness and Spa, to talk about something a lot of people in addiction and mental health are watching closely, GLP-1 medications. These drugs were created for diabetes and weight loss, but early research shows they may also reduce cravings and relapse risk. With major new deals dramatically lowering their cost and expanding access this could become one of the most interesting developments in addiction treatment dr spiel vogel is here to help break down what's real what's emerging and what still needs to be proven dr spiel vogel how are you richard how you doing buddy i'm really happy to be here so the first thing i want to say is two years ago right okay when carrera started you told me about the glp ones and how it uh worked for addiction and limited cravings and i laughed in your face yes you did you weren't the only one right and today i want to say that i was wrong you were right and i was wrong and i apologize this is recorded right it is sweet i mean look people looked at me with a third eye you know when i said there's a medication that we can use that absolutely reduces craving there's not great data to support it right now but there's plenty of things that we do in medicine but it doesn't matter what the data is because i was smoking 15 cuban cigars a day and now i got a struggle to smoke too poor booby i know i just can't i mean you took the last thing i had that and food and you took that too you took everything thank god it's only those two it could be worse actually you're dating the mother of my children so you took her too oh there we go well you brought what was that was that 48 seconds in hey dude it's you're a better man than me clearly stop all right so go on uh go on where where would we like to go i mean look this is the the the glp ones are right now i'm using it right uh you you had me using it for my cholesterol and my blood pressure right okay and because you want to look sexy you wanted to lose weight and okay but and i do and i look very sexy. Here's the problem. It works so good that I'm on an ice cream diet. Literally, I've got a six pack and all I've been doing for the last week is eating ice cream. That craving for sugar. Yeah. Well, I mean, does it, so it clearly doesn't, but I'm, I'm looking great and I'm happy as a clam, but I know it's hurting me. I know it's going to end up harming me long term. So that, I mean, look, that's one of the biggest concerns. I, I liken this revolution to Botox a little bit in that Botox came out, you know, uh, wrinkle reduction, all the facial rejuvenation stuff. And all of a sudden it went from MDs to nurse practitioners to guys with their baseball hats backwards, injecting people. So the same thing right now is going on with these medications and people getting them over the internet and just getting a drug and injecting it. It's literally, it's, it's piecemeal medicine and I'm totally not cool with it. How did GLP one medications even end up in the addiction conversation in the first place? It's a good question. So there, you know, Ozempic, which was really the first, first let's answer this question. You know, why are we injecting a drug once a week versus just taking a pill, right? Okay. I mean, why wouldn't we just take a pill? The problem was with the early versions, the oral versions is that the absorption in the intestine was really variable. So if you ate anything, you had to be fasting. Um, you couldn't eat for at least 30 minutes afterwards. You had to take it at the same time every day. How many people can do that? Plus, if you're going to think about the idea of using it in addiction and recovery, people being on a regimented schedule of taking medications when they're really just starting to piece their life together unless they have an assistant that's giving them the medication on time it's never happened it's not happening and most people are super non-compliant when it comes to oral medications so the idea with compliance with getting people to take a medication to have it be reliable the less frequent you have to use it the better got it okay so an injection once a week, a good start. And what they saw was with people using Ozempic was they reported that they just had not only like feeling fuller, all metabolic numbers looking better, improved insulin resistance, lowering their hemoglobin A1C, improving their cholesterol panel, maybe even a secondary effect of lowering blood pressure is that they had less craving for food. And then when you looked at obese alcoholics opioid addicts in particular you saw that they reported less desire to use less desire to drink less desire to smoke so that just what's happening to me but on the zep bound because the ozempic made me nauseous what's the difference between ozempic and zep bound and why was I having such a hard time with the Ozempic, but the Zep bound is not a problem at all. That's a great question. I mean, I think that it's a complex answer. First of all, the Zep bound, which is terzepatide, is a GLP-GIP receptor agonist, where Ozempic, which is semaglutide, is just a GLP agonist. Man, can you dumb that down for my audience? Or how about dumbing it down for me? So it works in two different places with terzepatide and semaglutide works in one place. Okay. So two is better than one. If we really want to say it, you're probably going to lose more weight. You're probably going to have more appetite suppression. On the Zep bound. On Zep bound. And you're going to have, you know, an increased sensation of being full sooner. Right. And then probably the crave addiction type behavior is, you know, is squashed. Let's talk about. It wasn't, it wasn't squashed with the Ozempic. I could smoke all I wanted with Ozempic. Right. On Zepbound, I'm literally about one 10th of my smoking consumption. Because there's receptors. And I'm not enjoying it. I'm doing it. I'm doing it as habit and holding on. I am not enjoying it. And the reason for that is that what happens when we do pleasurable things? Well, we have a dopamine reward center in the brain. Okay. You have the, it's called the VTA. I'm not going to even get into the scientific name for you. VTA produces dopamine. You smoke a cigar, Richard's brain says, God damn, that's good. dopamine surge goes to the nucleus accumbens nucleus accumbens says wow that really feels good let me tell the frontal cortex tell us to smoke another cigar that feels good now let's take another drug that we're both familiar with meth so meth will take that dopamine amplification and crank it up 10 times that of even cocaine. Right. So you get this massive surge of dopamine. That's why people that use methamphetamine are hooked almost immediately because there's nowhere else. There's no other substance that is going to give that of dopamine. So now along comes the dopamine traffic cop, which is semaglutide, terzepatide. They come along and they squash. I'm not going to get scientific here. They kind of squash and temper that dopamine response. Okay. So you don't get that surge. And they also do a reset in the brain. So where once you're a meth addict, their brain is flooded, rewired. And to get to a place where they're, if we looked at brain imaging to say that their signal signaling was the same as a non-user, that is going to take an awful long time. And for these drugs, terzepatide in particular, we see a resetting of the dopamine system in a much more timely fashion. So that's why when you're doing these behaviors that normally gave you, boom, a surge of dopamine, you're not getting that nearly as much. And by nearly as much, you mean not at all? No, you're still getting it for sure. I'm not getting it. So you're, you're a sensitive, good responder. I don't smoke figure out. I only smoke cigars. Okay. But that's only because, you know, I don't live in a trail. Let me ask you a question. I'm interested. I don't really know the answer to this is when you wear a Nicky, you wear a nicotine patch or use nicotine gum. Absolutely. Okay. When you use that, do you find when you're on that medication that it doesn't have as much of an effect no i the patch um clears up my head first thing in the morning because i'm foggy and the nicotine is actually good for you if if the the delivery system is is appropriate smoking is the worst right okay but a patch is good gum is fine okay and it helps me wake up in the morning with my coffee yeah i mean the nicotine gets a bad rap from the delivery system And my fish oil I do fish oil the patch and my coffee with a little lion mane in it and I perfect But you don't find that when you use the nicotine patch or nicotine gum that you get less of a calming sensation or a reward feeling from using that once you've been on that medication? I've never gotten a reward feeling other than my head clears up so I can think. First thing when I wake up in the morning, my head is very foggy. And it's always been that way. So if I need to do something important at 8 o'clock, I'm waking up at 4. Just so I can be completely clear and ready to go. Yeah, makes sense. From early research and clinical observations, where does this look most promising so far? I mean, I think number one, let's just talk about obesity, right? So to me, obesity is still looking at addiction because people, Overeaters Anonymous is not losing members anytime soon. So America has an obesity problem. We have a 50 over a 50% of Americans, despite these drugs being out there on the market available prices coming down is obesity isn't going away. So, you know, these drugs beyond just people not being able to go to the all you can eat buffet and Caesars and sit there for four hours stacking four plates is it also is decreasing that compulsion and food noise. which to me is the torture because people that truly cannot control whether it's food, whether it's nicotine, whether it's alcohol, whether it's, um, you know, cocaine, methamphetamine, it's the noise in their head and the compulsion to use and tie. And look, you're way more familiar with the other external factors or lower companions, environmental, everything else that's going to trigger you to use, but decreasing that noise in the brain is huge. Have you seen any findings in studies or patient feedback that genuinely surprised you? A hundred percent. I'll give you, I'll give you a story of just one person. Okay. So this was a guy, a very wealthy client, uh, was, you know, in treatment, um, alcoholic, cocaine, sex addiction. and you know he was overweight had pre-diabetes I started digging down into his health history which is what we do at Carrera you know we we try to tune people up medically diving deep into their medical history surgical histories looking at their habits in terms of exercise diet everything and this guy was a total wreck and to be able to I put him on the medication essentially because his hemoglobin a1c which is a measure of your blood sugar control was dive in diabetic range and i knew he wasn't going to take medications every day i said i'll inject you once a week he was one of the first he was like almost patient zero at career really yeah okay and i know who that is go on maybe you do oh i do um and and he's doing fantastic fantastic okay after the first I would say two injections and again one thing to keep in mind is when you look at starting doses of these medications and you look at terzepatide and they tell you five milligrams is a starting dose you put somebody on five milligrams they are going to be miserable oh miserable would you have me on 2.5 2.5 and you're miserable right at the beginning right I've had clients well I was in all fairness I was miserable because I couldn't eat at the beginning and at the beginning for me what felt like depriving was I liked the chewing I want to eat something and when I didn't eat all day I was like I wasn't hungry but I was like I want to eat something right and remember when I called you and I started eating too much and I, I literally hurt myself. Yeah. Right. And you told me it was because why stomach gets full, you know, you can't process food as quickly and easily on top of all the receptors in your brain that are telling you like, slow down, eat less. And, and after that, okay, I've been really good, you know, and now, uh, I'm on the 3.5 because I got used to the 2.5. Right. Yeah. And that's still a baby dose. You're still well below what was considered the starting dose. I don't need to be on anything over 3.5. Right. It's just, you know, it's just, it's perfect. Right. So that, you know, I think again, like dosing and working with patients, it's really important that you have somebody that's clued into you, that doses you in a way where you're not going to walk away completely. Cause I've seen clients that have done five milligrams out of the gate and are sick for two weeks yeah you can't you know so so this particular client started him at 2.5 we did that for a couple weeks increased him to five and the first thing he said was like i'm not like all of a sudden the noise around alcohol is gone i'm not even thinking about it Right. And we'll use, we have drugs for addiction that try to naltrexone. Do you know we're the only ones doing the GLP-1s? I mean, we've been doing it now two years. Okay. But there's not another treatment center that's been using these GLP-1s. I'm surprised by that. Why? Because I would think that at this point, especially with the day, I'm sure after this week, where Washington Post, Women's Health, CNN, MSNBC. No, no, no, no. You don't know these people the way I do. Let me tell you something. The science is always 15 years ahead of the practice. These guys won't even be using these for another two years. I'm not kidding. That's how far back. We innovate here, which is why we did it two years ago. Yeah, it'll be interesting to see. You know, I think like the one thing I heard all the time was it's off label. It's off label. It's off label. I'm like, we use drugs off label all the time. And let's talk about what we're doing here. No, no. Before you do that, I want you to give examples because we use off label all the time. Sure. I mean, baby aspirin. I mean, we use baby aspirin for the prevention of cardiovascular disease and stroke and clot formation. And that's not at all what it was made for. No, not at all. Okay. So there's, that's probably, that's the one that always comes to mind for me. You know, Indosin, which is a drug that is an anti-inflammatory drug. We use it in the field of obstetrics for preterm labor, preterm contractions, because it works on the uterus and reduces them. There's not an indication for it, but we still do it. And it works. What was it used for? What was it made for? It's used as an anti-inflammatory, like Advil, ibuprofen. Okay. And you use it for the uterus. Yep. We use it for relaxation of uterine contractions. Really? Yeah. there's tons of examples of those okay all right good but um what was i talking about i have completely gapped we're okay all right um yeah but in in using those medications you know and we're using them off label what is the downside here okay so we have somebody who's obese is going to eat themselves to death drink themselves to death use cocaine or meth or whatever other substance you're gonna tell me you're gonna convince me they've been in treatment 12 15 times doing the same route you're gonna tell me that it's not worth trying something different oh no it's off label no no this is right this is this is as good as it can this is the one other than Narcan, okay, which actually saves your life, okay, this is the best drug I've seen for the treatment of drug addiction and alcoholism. That's saying a lot coming from you. Ever, ever. Wow. More than an abuse, more than Vivitrol, more than anything. This is the one. This is the one. That's pretty awesome. I mean, I don't disagree. Our patients, our clients are staying sober. I just, and much more than they used to be. I know you're going to be out of business. It's okay. I'll find something else to do. We'll solve the homeless crisis next. I promise. I mean, yeah, it's true. I mean, beyond the just like, okay, so you stop them, you know, snake oil salesman that sold like an oil that'll do something that'll cure everything in your body right okay let's talk about it you look at in medicine people with stacks of medications across the board you have four things really that are going to kill you besides not wearing your seat belt and guns and accidents and not wearing a helmet when you ride a bike which are the most common ones uh-huh one of the most common ones but cardiovascular disease stroke major adverse cardiac event it's called mace and you're okay that's number one that's number one number one killer of men is and women is cardiovascular disease and stroke okay number two cancer lung cancer being number one colorectal breast and prostate cancer moving down the list number three if really you want to look at it alzheimer's disease dementia and the complications thereof of that and number four metabolic diseases which are what which are diabetes you know is the big one then we get into women more women die a hip fracture osteoporosis than they do a breast cancer in this country and that's a whole other podcast to talk about why that is and the epidemic of that and I would love to go through that. So now we have a drug that you take once a week okay that has been shown to go I'm going to say it in really simple terms that people understand. It goes to your arteries and that lining of the arteries which is so delicate that you want to keep nice and smooth and the effects of smoking environmental exposures that create these little dents and cracks in it that allow cholesterol to hang on to there and form a clot, a plug that then causes a heart attack. So you have a medication out there that going to keep them smooth That going to keep them from spasming that going to lower your blood pressure That what the GLP do On top of, it's going to lower weight so that your heart isn't pumping and working as hard. So there goes number one. And your blood pressure isn't. Right, and your blood pressure is going to come down. Number two, we're going to go to cancer. For women, obesity lends itself to fat cells that produce estrogen that increase your risk of potentially, you know, maybe a promoter of breast cancer. I'm really hesitant to say that, but there's probably a role in there. Uterine cancer, absolutely. And for men, prostate cancer, gastrointestinal cancer. So now you have a drug that's going to control weight. It's going to reduce that down. that's going to increase your insulin sensitivity, which in turn is going to lower inflammation. Lower inflammation in the body is going to equal less of a chance of cancer. For sure. Okay. Alzheimer's disease, dementia, new data coming out, ongoing trials that say that probably you have a reduced risk of plaque formation in the brain. Plaque formation is what we find in radiographic studies showing Alzheimer's disease and dementia. You're kidding. No. So if you get a diagnosis of dementia, of Alzheimer's disease, and you're 60 years old, it's like getting a stage four cancer diagnosis. There ain't shit you can do about it. You can try to slow the progress of it, but you got that diagnosis. What you do now is what's going to prevent that from occurring. A GLP-1 potentially for, you know, I could sit here and say probably everyone would benefit from it, even in a microdose. I think that's where we're going to land in some way, but reduces that risk of plaque formation. Then we move to the fourth one, metabolic disease. Well, diabetes isn't, it's a layup, right? Increasing insulin sensitivity, less obesity reverts right back to number one, cardiovascular disease and stroke. So that's why diabetes is such a killer because it not only has its own havoc on blood vessels, amputated feet you know obesity all the other things but then it goes back to cardiovascular disease and is one of the major risk factors nothing is all good right okay i've never there's nothing that's all good no drug okay what's the side effect of this right so i mean the biggest side effects are going to be gastrointestinal so you know gas um yeah i mean bloating gas nausea obviously i'm none of those right but when you're when you're beginning those are the ones that people are going to mainly experience some people experience constipation some people experience uh insomnia these are the ones that i see on a fairly regular basis that's not fair i don't think i don't think that's fair because we're seeing you're seeing people right now uh in treatment and when they get here they're completely destroyed and a lot of them don't have good sleep hygiene right in the first place so to say that you know you're getting the feedback from these guys doesn't mean anything right um i didn't affect my sleep it didn't make me nauseous it did take a couple days to get used to it right but i look forward to it every week and i really take it now every five days because i feel like it it starts to wear out that's right yeah and you could go to twice a week there's a lot of different i don't like shooting myself with the needle i don't like it so i just do it every five days right and that's fine um you know some people headache another you know then we're going to go down the line like you're watching a drug commercial and they're going to list every side effect known to man, thyroid tumors was one that they saw in mice. Hasn't been replicated in human studies thus far. So, you know, that's kind of where we land in terms of side effect. The thyroid tumor is concerning. But it hasn't been shown in humans. They've seen it in mice, but hasn't been shown in humans. And these drugs have been out a while now. With the Trump administration's new pricing deals dropping costs from well over a thousand bucks a month to roughly 150 to 250 for many people, including some Medicare users. How much does that change access and the overall landscape? I mean, you make it more affordable, then more people are going to have access to it. That being said, I still think the cost is definitely prohibitive. When we first started this, I would say if you didn't have an end for a drug addict, it's not. Yeah. Because if you can spend hundreds of dollars a day getting loaded, you can spend 150 to $250 a month. Right. Okay. Uh, to, uh, make you healthy, keep you off drugs. Right. And, uh, uh, I, I don't, I don't share that. Yeah. Yeah. I mean, accessibility from the standpoint of people being able to see a provider, get a prescription, start the medication, stick themselves, like you said, you're apprehensive about it, stick themselves with a needle once a week. I still think accessibility is an issue. Certainly cost reduction is great. We have strategies to lower the cost using Lilly Direct, which is an excellent program. You sign up, you send the patient's information in. Lily handles all the communication directly with the patient, mails them the medication. You know, we've moved away now from these auto injector syringes that you can't be flexible with the dose. So now it's just a vial. You drop a dose, you like 3.5, you can draw that up and they send you the syringes. They send it in a cold pack. So it's really great. It's very, it's very cost effective and they do a really nice job with that. Now the compounding area, of it, which are, you know, essentially non FDA approved sources for getting these medications, compounding pharmacies are manufacturing their own versions of terzepatide and semaglutide that, you know, Why would people want to do that instead of just going out and getting zepound? Cheap. Yeah. But it's not as good, is it? Um, you know, I think there's reputable, there's reputable, reputable, pardon my French, compounding pharmacies where it is effective and it is good and you know it's an extra step having to constitute it okay but if it's 150 to 250 bucks yeah that's gonna be a game changer okay for the real stuff right how much is it for it's about the same it might be a little bit cheaper than that okay so why would anybody want i think it's going to put them out of business i think that was their goal i don't know if it'll put them out of business they have other things they can sell. They also do some interesting combinations. They'll do combinations with other peptides that potentially, you know, work, work somewhat synergistically with these GLP ones. Because one of the biggest side effects, let's talk about this, is people that lose weight is they'll lose muscle in a larger proportion than they will fat. And if you're not being counseled and taking the proper protein intake, complementing it with the proper supplements and not doing weight bearing exercise, you are going to lose muscle mass. Muscle is the largest endocrine organ in your body. It deals with sugar. It increases sensitivity to, uh, to insulin. and it protects the bone from fracture, falls, which are really big killers of the elderly as we get older. So, you know, using these drugs without a, to me, a supervised medical professional that's guiding you in terms of what you should be taking on top, how you should be exercising, how you should be you know looking at metrics of fitness and longevity then you're doing yourself a disservice and so is a person that's just giving it to you this is why i hate the online pharmacies uh-huh okay you get these doctors that just rubber stamp everything don't teach you anything okay aside from the fact that it's a breeding ground for cartels right with the and everything else. Right. And let's go to what we're talking about in addiction. This is your area expertise. So you can take an addict and you can reduce the noise, but if they're not doing the work to heal. That's right. Then they're just going to be dry and miserable and they're not going to have their best life to look forward to because they didn't do the work. And guess what? They're probably going to stop sticking them. If they really want to use, they're going to be non-compliant with the medication and they're going to start using because the noise is going to return. I do see some people that are fixated on getting, I want to get off it. I got to get off it, which is how we feel about drugs. I personally, I don't get it. You have a substance. I don't even want to call it a medication. It's actually a peptide that does all the things that I gave you that long-winded explanation of preventing you from dying from. Why are you fixated with coming off of it because you think medications are bad i mean we have medications out there i don't really think drug addicts think medication is bad i love it though when drug addicts say to me i'm really careful about what i put in my body that's my favorite that's my favorite i don't mean to make fun of people that say that i do i mean i made fun of myself for it i'm making fun of you for it i mean they'll have track marks up and down their arm and i'm like this is an injection you do once a week. I'm really careful about what I put. I'll do my own research doctor and I'll get back to you. Hey, chat GPT. I mean, it's, it's pretty wild. So yeah, but if you come off the worst thing someone can do is yo-yo. So when you lose a ton of weight, you don't exercise, you don't eat enough protein, you don't take creatine, aminos, other supplements, you're going to lose more muscle than you are fat. So now you've yo-yoed down. Now you start eating again. Guess what? More fat, less muscle. Then let's say you go back on the medication. Then you're going to lose a higher. So see where I'm getting at? You're constantly losing a greater ratio of muscle to fat. Okay, so this is really simple because this has been a lot to unpack. Okay, but it's simple. If you using this you got to work out every day and you gotta eat healthy so basically what it is is if you use it as a head start to get healthy and then you stay on it for maintenance you're what you're telling me is not only are you going to look better but you're going to live longer yeah for sure i mean look if you're eating well and exercising and in an ideal body weight range i mean it's not that hard exercise is the well it is hard because last week i was on an all ice cream diet kenny okay so i'm just telling you no but i'm i dude i was so happy last week okay and then it was like i woke up this morning and i felt shitty and i'm like you know what this is done you know i threw out all the ice cream in the house i know i'm not perfect this is horrible cold stone creamery is tell them what they're in the morning tell them about how many how many people out there can say i got a christmas card from cold stone creamery dear richard thank you so much for your business sign felicia so nuts richard calls he calls cold stone creamy and he gets a hi Richard you want the usual today I'm not kidding it's that's not a joke it's not a joke and you beat me up for it for about six months I think it was a year it was a year I want to say this I don't want to lose this point there is no greater intervention to save your life than exercise period i've been trying for 30 years as a medical doctor an md to get my clients to exercise it has been for the most part fairly futile do you know what the my favorite thing is when you go to the facility and you work out with them and that and you went and you golfed with somebody else and then you took somebody uh what do you call it kite sailing yeah right that was bitching yeah it's like i've never met another doctor ever that not only tells you what to do but says all right come on i'll show you how to do it let's go you and me walk the walk man so cool what an awesome job how lucky am i i don't have to freaking wear a white coat and sit behind a desk and push prescriptions all day, you know, and tell people what to do. Look, if you're a doctor out there and you're a fat ass and you smoke and drink and don't exercise, don't, don't expect one patient to listen to a word you're saying. Because you have to be the, we have to be the models of health and wellness. You know what else drives me nuts? When I don't have enough time to tell you all the things that drive me nuts. Okay, well, this drives me nuts. When you walk in and you do a deep dive on all their medications and you go, okay, this is no good with this. This is no good with that. That's why you're nauseous. And it's like the first thing, not just me, but all my clients are thinking is, why didn't my doctor tell me this? Why didn't my doctor look at all my medication to see why I was nauseous or why I wasn't feeling well because these two medications didn't work well together. Why don't doctors do that, especially now when it's all in the portal and all they have to do is look? Right. Or like, let's go a step further. Why did my doctor give me all this crap to begin with versus just telling me I need to eat like this. I need to take these supplements in the morning and the evening. because people don't eat like that, man. That's why. Well, I mean, I think it's important as medical leaders that we are in a preventative mode. We've learned how to treat disease. It's boring. Treating disease and cutting people open and taking out tumors and putting them on medications. That's all reactive medicine. we've been to preventative medicine has never been more available and simpler than it is now this has been really good the glp ones for addiction and people are just starting to figure this out okay what's next right so what's next is you don't like taking a a injection every whatever if i tell you do it twice a week so every three and a half days i'm gonna tell you a little bit a little story so when hiv came out i told you the story like in our own personal space so when hiv came out a lot of reason why people died was because they couldn't stick to a six time a day tens of medications to take each time compliance was low that's how we started this talk talking about the oral medication that's right right now we have prep, which is a single injection. It's pre-exposure prophylaxis. They take an injection. I want to say I'm having a brain fart. Six months is what I'm thinking. It's not my field, but I believe it's every six months. So twice a year, you get an injection that prevents you from getting HIV and dying of AIDS. What we're going to see with these drugs eventually, you know, oral, are we going to go oral? I'm less concerned about that versus you're going to get an injection and it's going to last you once a month. You're going to have a little meter that you wear that's going to monitor your blood sugar, probably adjust there. And we already have those for insulin, but for a preventative type medication, maybe that's what's going to come down the line. Maybe it's a patch. Who knows? But that the delivery system to me, and then we'll get more targeted and saying, Richard, you want to quit smoking? This particular drug works really well on whatever the dopamine smoking center is in the brain. this one's for coke this one's for alcohol let me ask you a question um with the glp ones if you don't exercise right we've already uh discussed the dangers of that okay but what happens we're using sometimes testosterone therapy too aren't we how are you uh that's such a good question. Yeah. How are you, how are you doing that with the clients? And that's all about going back to the muscle thing, right? Because we get older and we get to clients in hormone men do as well as women. Women have been deprived of HRT for the last two plus decades because of one crappy trial, the WHI trial that came out and looked at risk of breast cancer and saw 10 more cases in a hundred thousand women. The study was flawed. It was skewed, but it freaked people out and it changed the face of what I do. And women were denied hormone replacement therapy for two plus decades. Those women are going to have fractures, osteoporosis, cardiovascular disease, stroke, Alzheimer's disease, dementia. So when we're taking these drugs, we just said the muscle is the largest endocrine organ in the body. I'm getting excited now. So for men, I want them on creatine. I want them on doses of creatine that are not like a single scoop. We're looking at, you know, 10 grams, maybe 15 grams a day, not only for athletic performance, 10 to 15% boost, but also there is creatine in the brain. Creatine creates ATP, which is energy, cellular energy. And we know that creatine in the brain gets depleted, especially when you're sleep deprived. So creatine, amino acids, protein powders, and then for men, when appropriate, testosterone therapy. How do you give it to them? I mean, testosterone therapy as an injection is painful for some people. It is somewhat of a hurdle. So I can do, I have a compound, one compounding pharmacy I use and trust that will do a high dose cream. And then I'll do injectable as well too i'll do injectable is either i i think the cream doesn't work does the cream work at all i think you know i would say i'll get some younger guys that definitely have evidence of uh testosterone insufficiency that whether it's placebo or not i don't think so i think they definitely get a tiny boost which maybe in those people i want i don't want my patients i don't want a 60 year old guy to look jacked and like overly no supplementing about i just want him to be lean i want him to be strong i want him to preserve muscle mass no old person ever said gosh i wish i had more you know i wish i didn't have as much muscle as i did women also need testosterone let's be clear they need estrogen they need progesterone and they need testosterone women on testosterone supplementation have an up to 30% reduction in breast cancer. People are saying, Oh, but you're going to get tumors. You're going to get, you know, now granted over replacement would lead to oily skin, acne, unwanted hair growth, but that's not what we're looking at. So you're giving them basically a microdose. Yeah. Well, they're getting about a 10th of the dose that men get. Okay. You know, I think one thing that, you know, you prompted me to explain today is that, you know, addiction, is a multifaceted disease, whether it's food, gambling, sex and love, cocaine, meth, alcohol, opiates. And now we, we have tools that under proper medical guidance, we have a way on top of all the therapeutic tools that at Carrera are the best in the world that we have a way. and we didn't even get into like the lifestyle modifications that we make on people there but we have a way of truly truly keeping people sober and leading happy healthy lives they're proud of there is no i'm gonna cry there's no better way to make a living now you're gonna make me cry it's true all right do it so lucky to get to do this and i'm so happy to have the opportunity to be here today what what was that what do it do what look in the camera what do you want i'm not gonna say what you want me to say why because i won't do that why you want me to say see you next tuesday I sure do. I'm not doing it. We'll leave it there. See you next Tuesday. We're out of time. Please subscribe on YouTube. Click the thumbs up and leave a comment. Please subscribe on Apple Podcasts and Spotify and leave a rating and a review. And share the We're Out of Time podcast with others you know who will get value out of it. See you next Tuesday.