Fasting Space

Ten years ago, I thought that GLP-1s
were the closest thing

to a miracle weight loss tool
we would ever see, and I wrote

prescription after prescription,
starting with diabetes.

But then the weight impacts
were not hard to notice.

There's clearly benefit,
but the longer I worked with my patients

and with these products, the harder
certain realities became for me to ignore.

A fair number of patients
would be having some decent success,

minimal side effects,

but then another would end up
in the hospital with pancreatitis.

And when I started to balance out
in my own personal practice,

the wins against the failures
started asking

deep questions like how many goods
cancel out the bad anyway?

And that something, as a I'd say,

true believer in the principle of first
do no harm.

I found that very difficult,
and I found myself sitting in a space

in this growing middle of mediocrity
and an enormous price tag.

Today, I'm going to share with you
why in 2024, as an internal medicine

physician, as someone for over 12 years
prescribing these medicines

with great enthusiasm,
I finally put the prescription pad down

and I switched to 100% lifestyle approach
for weight loss.

Really nice to have you with me here.

Hello, I'm Doctor Z, internist,

primary care doctor
for many years here in Wisconsin.

Now consulting specifically weight
management and type two diabetes.

So if you are interested in weight loss
for any reason,

I think you're going to find this session
very interesting.

Whether you are trying to lose weight
or whether you are

a health care practitioner.

Also, on the other side of the
prescription pad, like I was for so long.

Hey, we are here together
both in this session and also,

you know, in this very interesting moment
in time, I say GLP one.

I mean, it's fascinating, isn't it?

This is like a medical phenomenon,
I would say.

And it's even a societal phenomenon
because it's so big now.

It's been a big part of my life
for a long time, you know, prescribed

so many of them and interacted with

so many people
navigating the experience of using them,

walking along a
weight loss and health path with it.

So I'm going to do my best today,
share my honest human experience

of this process with you
in the most transparent way I can.

I hope you find it valuable.

I would love to have a big discussion
about it.

If you're here with me

live, share your thoughts and reflections
in the chats as we go.

If you are here on the replay,
so glad to have you here.

Share your reflections and thoughts in
the comments and glad to have you here.

At any point, let's have an ongoing
conversation about it.

Topic like this.

So big, so many different perspectives,
every perspective.

Welcome.
I say as long as everyone is kind.

Just be kind and every perspective

I welcome and we have a discussion about.

Grab a coffee or tea, settle in,
let's do some reflecting together on it.

So here's some disclaimer
thoughts from me.

So just so you know, people that I know
and care about deeply, yes,

are taking these medicines
and I wish them the very best I do.

I want them to have fantastic success
with it.

And I've prescribed
thousands of these medicines

and I'll tell you more about that.

And I never would have done it personally
if I did not think that

benefit could come from it,
and it wasn't a reasonable thing to do.

So if anyone is taking them

and you coming into the session, you say,
I say, I'm not prescribing it anymore.

I'm not saying it's the wrong thing to do
or that no one should do it.

Just sharing my perspective of why
I am not doing it.

So anyone who is taking these products
and having benefit from it.

I just want you to know
I am truly happy for you and

this is what we want in medicine.

You know, moving toward health,
having progress.

And I say no matter what perspective
we come from, we're all on the same team.

This is how I feel.

We are definitely all on the same team,
moving in the direction

of health through any path.

So I am not telling anyone to take or not
take any medicine.

See my full disclaimer down here
in the video description.

Okay. All right.

So here is starting out
about my experience.

So I have been personally dedicated
to helping people achieve

a healthy way
to find a health in every type

of way that they can.

Since 2009, which is

when I actually became a doctor.

So it was like at the very beginning,
this has been a big part

of what I have been doing,
and I've tried to build that process

from the very beginning
and just learning as I go.

So I started my medical career
as a resident physician at the VA

hospital here in Madison.

Wonderful experience, wonderful place,
interesting experience.

And when I started, there was no GLP one

on the formulary at the VA at that time,
so couldn't prescribe it.

So, you know, my initial medical training
I had many different.

Weight loss meds that I could prescribe.

Started getting experience
with that as a prescriber of medicines,

but no GOP one
until I joined the university in 2012.

So at that point wrote my first GLP

one prescription
Beda for type two diabetes.

And then as time went on,
we got longer acting version by durian.

And so I started building some experience
as a prescriber

of these medicines for diabetes.

And so in a glucose space,
you know, we're monitoring blood sugar.

You start someone on a GOP
one easy to see the blood sugar effect.

And, you know, people weren't thinking
of it at the time as weight loss drugs.

But I'll say within three months
of writing

my first prescription,
I was already aware.

I was like, you could see

that there are weight effects
that are readily apparent taking it.

And as someone who is a young doctor

very interested in helping people

get their weight in the best place,
you know, this really piqued my interest.

And I became a major prescriber of GLP
one 2012.

As you know, really through 2022,
I was prescribing tons of them,

but waning enthusiasm toward the end.

And then I wrote my last GOP
one script in 2024.

And now I have floated through
two solid years

here of not prescribing them
and continuing to help people,

hopefully in an increasingly powerful way,
is what I am working on.

So I've prescribed
pretty much every weight loss drug

in my attempt to find, you know,
what is the thing,

you know, always looking
what is the thing?

And of course, you hope as a prescriber,
someone you know,

you have an ability
to write a prescription for someone

you hope this is a thing
that is so helpful to someone you're

always looking for,
maybe this combination, maybe this.

And I've gone
to pharmaceutical conferences

back when, you know, when I was searching,
you know, before I really learned

about lifestyle medicine

and the power of it and the ability
to get into root levels of our metabolism.

I say, what is the thing
I prescribe so much Fenton mean?

I had a very bad many bad experiences
with Fenton seen in its variations,

like Fenton Topiramate can trade
this combination be propia.

Now, I never saw anyone harmed by it,
and some people really do find it helpful.

So I'm not, you know,
negative on that orlistat you know.

Oh boy oh boy.

So in the big picture I have never been

extremely enthused about any other type
of weight loss medicine.

Like I got enthused about GLP ones.

You know, as far as weight
loss medicine, GLP one, you know, it.

Even still, in my perspective,
if I had to prescribe

a medication for it, I probably, you
know, would still look in that direction.

Okay.

Especially for this scenario, type

two diabetes, diabetic medications,
especially insulin okay.

Huge overlap.

And then here I'm going to focus in
though on weight specifically.

So even with the enthusiasm
okay I want you to see my history.

Thousands of scripts written seeing the
real benefit of people who have had it.

But I'm going to try
to give you the total vision of how

I came to the position that I am.

So we see the benefit,
but then I say, but even then, okay,

so here is a randomized controlled trial.

It was published in
the journal Diabetes Care last year,

and it looked at a very large collection
of patients, both with and without type

two diabetes, who are taking GLP ones
and looking at the effect on weight.

And so that the two sections
that I highlighted down here to see

47 randomized controlled
trials, 23,000 patients

taking GLP ones from a range of time
1 to 2 years in the study

and the results of this study,

out of this enormous volume of patients,

is that the average patient lost 10 pounds
over the course of 47 different studies.

And when they did a subgroup

analysis of these patients
and these stripped out all of the studies

that were less than a year
or so between 1 and 2 years,

then that went out to 16
pounds average weight loss at two years.

And so of course, an average implies
half are better and half are worse.

And this is as we'll start
to build out the experience.

Some people have significantly
better results than other people.

And and so there is definitely
a distribution.

And this is what I want to focus on
is we're painted

the picture in the commercials

that everybody who takes these products
has extremely beneficial results

with no side effects
when the reality you know is different.

Some people having incredible results
without readily

apparent side effects, but some people
not having that experience.

And so as someone who ran
a weight management clinic for many years

and sit there
is especially difficult this scenario,

someone working with medicines,
taking them at great expense,

needing to lose weight
for medical reasons, wanting to do it.

You imagine being two years out,
you want to lose 100 pounds

and you're minus eight
after two years of this therapy.

This is, you know, it's not exactly
as inspiring as you wish it would be.

This is the scenario.

So this has been my contrarian experience.

You know, it's very interesting.

I started out in 2012,
extremely high enthusiasm.

And I worked for many years to transition
many people,

especially with diabetes
from other medicines on to GOP ones,

something that I still think
is reasonable in many circumstances.

And then as things became available
for weight loss,

I prescribed so many of them.

But it's just so interesting
as the societal experience

has blown out into this very,

you know, interesting phenomenon
that we have now.

My personal experience has
has really gone in the other direction.

I've become more and more middle
about it, more and more middle.

Yeah.

The more experience I've gained,
the more mediocre I've tended to feel.

And this is the reason.

So here is just a standard distribution.

It's not a distribution of any effect
specifically for a GOP one.

But just conceptually
we can think about it because

most things in life
follow some sort of distribution.

I don't know exactly

know what the slope of these lines
would look like for a GOP one,

but this gives us the concept way
out on the tail on the side,

some people having extreme benefit
with no side effects.

And then as we start coming
in, people having pretty good results

and feeling good about it and can be
sustained over some period of time.

And then as we come
into the middle results a little more,

but it's like still seems worthwhile
and people are happy about it.

And then as we flow over
into the other side, there's like a lot of

people in the middle,
as I say, mediocre middle.

And then this other side is the type
of thing that we don't like to talk about.

Certainly it doesn't go on a commercial,
it doesn't sell a lot of tickets

to conferences, and people aren't excited.

But there's all kinds of people
who are having experiences

where they say, well, it is not quite
so positive.

You know, something like this, people
developing side effects.

And as we head down the slope here,
we say, oh, some gastroparesis

and other processes that,

you know, are unpleasant but not severe.

But as we head out the tail,

you know, people that I have prescribed
these medicines to have almost died

and ended up in the hospital for weeks
with severe pancreatitis.

And so that's the other side
of the distribution.

And the more times, say,
if we were to draw this,

you know, the slope is probably shifted
left more people

having a positive experience
than having the negatives.

But, you know, it
take a very, very, very large number

of very positive occurrences, in my view,
to cancel out almost killing someone.

And I don't even know if it could be done,
you know.

And so that is the experience there.

So I say the other thing
that I want to bring into it, when I was

reflecting so deeply about whether I was
going to continue to do this, you know,

I look at this graph
and I see the the tails on the sides.

If I can frame myself here
and we say the very,

very goods and the very, very bads, to me
that's like matter and antimatter.

They kind of blow up.

We're left with this mediocre middle
where like the results

of the meta analysis are showing, say,
okay,

you know, 10 pounds out
now, I'd love if we're having a debate.

I've got some other doctor here
who who just loves it and say,

are you saying that
that's not significant?

I'm not saying it's not,

you know, significant or relevant
for someone to lose 10 pounds.

Of course, happy people
sustainably lose any amount of weight.

But I'm sitting in my weight management
clinic with a person who needs to lose

100 pounds

in order to be able to get there,
you know, abdominal surgery

or have the knee replacement
that they want, you know, 8 pounds,

you know, isn't going to move the needle
over two years, you know what I mean?

And so now we're in this mediocre middle
where we're kind of struggling.

Many people, everybody who's having
the great results go

perfect, beautiful, you know,
don't need any other, you know, help.

You know, perhaps.

But now we're in here and now
we're sitting in this space where we have

great cost and mediocre results
or not good results.

And that's a slice where I think
we really need to think deeply about.

We do a cost benefit analysis,
and I'm going to show you

a little bit of that list.

Price of wiggly over $16,000 a year.

You know, and this is radical
now as I dug into this in detail.

Very few people actually pay that.

Some people do get really stiffed
with the full bill, people

with high deductible health
plans and insurance loopholes, things,

you know, who don't have giant programs

advocating for them,
sometimes can get stuck with a full price.

Many insurance contracts negotiating down
this is like a sales tactic of pharma

companies set the bar high,
and then it gets negotiated down

through all kinds of processes.

But the cost is still extreme.

Even after all the financial
finagling data that I found.

See all the points I'm making here?

I have listed in references down
below the papers and the things.

If you want to dig into any of it.

$132 billion total expenditure on

GLP one in the US in 2025.

And then that is not split out
between weight management and diabetes.

But I'll show you some graphs
from JPMorgan

in a little financial analysis
saying that that slice of diabetes

getting smaller and smaller as the weight,
you know, part explodes higher.

And then of course, there's also overlap
between diabetes and weight.

And so, you know, this is giving us a
a perspective on the impact

of the cost of these medicines to society.

And then I just put, you know,
this interesting little point I found

for reference,
total US expenditure on food

at home in 2025 1.1 trillion.

So we're sitting here, 11% of food

spent at home cost on the medicines
to help us eat a little bit less.

It's just a very, very fascinating
situation to me that we have, you know,

both financially, economically,
philosophically, medically fascinating.

So more than a feeling, my feeling

which I put here is like a vibe, right?

Cost benefit vibe from me
is that when we add

in the financial cost of this mediocre
middle, this is my curve.

It just turns into a flat line,
the whole curve.

It's like the the ends of the tail fold
in the middle, folds in with the cost,

and we end up with a flat line
that, you know,

I was describing a couple years ago
is a long, expensive trip to nowhere

on average, recognizing that people within
that space having benefit and bless you

if you're having the benefit,
that is the whole point.

But in a big picture,
I don't know that we're going anywhere.

You know,

I think we're spending an enormous
amount of money for a lot of mediocrity

and also harm that is canceling out
a lot of the benefit.

And you see, that is not a scientific
perspective, doctor Z.

And so if you want

a scientific perspective,
people do actual cost benefit analysis.

And I linked one in the.

You know, a video description. Okay.

So if you read cost benefit analysis

calculates out $135,000

per quality for some glue tied.

Okay.

What is a quality that stands for quality
adjusted life years.

So that means one extra year

of optimal healthy life for one person.

Okay, so for some gluten,

spend $135,000
to add one year of quality of life.

That's the assessment from the academics.

Now what does that mean?

Okay, people in the space say
if something is under 100,000,

that could be cost effective

and other people say under 150.

So it's kind of a range.

So some people, you know,
in the academic community that studies

this say this is maybe a potentially cost
effective. And.

You could go with that.

I'd just say my feeling
on it. Unscientific.

I'm not so sure. You know.

And whether it is or isn't,

if it doesn't completely flatten out
the line, like I'm saying,

it at least brings it down right
at at least brings it down a little bit.

So you say, okay,
is there a silver lining to it all?

You know, I don't know, I hope so.

If there is a silver lining
it would be this.

Here's epidemiological data
on charting incidence

of obesity in the United States
over the last couple of decades.

And look there, 2022 a peak in this data

and so much commentary spent on this.

And here's the big ramp up of GLP
one for weight loss.

Is it actually having a societal impact?

Is that what we're seeing?

This is basically survey data could be
many different interpretations of it.

But I'm open to that explanation
certainly could be possible.

And. That would be a silver lining right.

It's like is it working now
people going to say we're going to ramp up

GLP ones,
we're going to get them to everybody

and we're going to see this continue
to go down.

Now, I would love to be
an eternal optimist, and I would love to

to say
that a big part of my doing this talk is,

you know, a personal reflection
to see if I think that is true.

I changed my perspective.

I say I took two years off,
maybe I changed my mind.

Should I jump back in?

You know, I would do it
if I thought it was the the thing to do.

Here's the other side of it.

At the same time that we are seeing this,
we are also seeing this.

Here's
an update this year from the CDC about it.

CDC finds record high obesity
rates for children

and teens as adults have a slight decline.

And so if we are going
to really think about what is happening,

I would say in the big picture,
right, societal health,

everything that is happening,
things are not improving, right.

If the next generation of people is like
we're raising, like the society is not

health healthy, all the money that we are
spending is not helping kids.

It's not helping to raise
healthy generations of people.

No root problems being solved,
as far as I can see.

I mean, this is this was cynical.

I had to write this feels cynical.

We're just awaiting the next generation
of profits, right?

The next GOP one customers.

We're just, like,

coming on like I, I just say that
does not sound like a silver lining.

What it sounds like to me
is a golden lining.

Okay. And here's data from JPMorgan.

This is their extrapolation,
their financial analysis.

I linked it in the show notes.

They only see this process continuing
radical expansion

of GOP ones
and radical expansion of profits.

Right. There is a lot of money to be made.

And, you know, more patients,

more product flow, more profits.

You start reading the financial analysis.

You know, nobody thinks that
this is solving the problem, right?

We have only growing demand.

No root problems being solved.

Here is Chris, senior analyst at JPMorgan.

Launch of Oral GLP.

Once coupled with lower prices, broader
access, we're adding Medicare

and Medicaid coverage going to drive
higher utilization and market penetration,

more affordable, more convenience,
increasing scale.

The money just going to keep flowing.

This is like this is the priority,
you know, of the system.

And here was from in the article
that he wrote investors taking note.

I summarize a bit after having
to discontinue their internal GOP

one program for causing liver issues,
Pfizer bought out this company, Metra,

developing many other assets, $10 billion

they spent on it, up to 30 million people
in the US

going to be on these drugs
by 2030, making the growth of GOP ones

one of the key storylines
to watch for investing.

Right. For making money. Right?

I say in the health space to is
I think it's fascinating.

It is all fascinating.

They say less clear how GOP
once will influence other industries.

This analyst says GOP once projected
to lead to an annual revenue

reduction of 30 to 55 billion by 2034
for the food and beverage industry.

Well, I say I hope so.

I mean, that would be a silver lining.

I'd say it'd be a silver lining.

But now I got to tell you what, I'm
going to take the under.

Like, you know,
I'm not going to bet the farm on it, okay?

But I maybe bet the tractor

on the under that
that it's not going to have that impact.

But we'll see.

I would be happy to be wrong on that
I would.

Rabbi Marcus Senior analyst JP Morgan
noted that disruption in the medtech

sector has so far been minimal,
while GOP ones are reshaping obesity

and diabetes care, the medtech sector
continues to benefit from broader health

care trends, meaning people still getting
sick were still on the pipeline.

Need plenty of medtech?

Okay. We're not.

Don't worry. Keep investing.

No indication GOP ones have negatively
impacted medtech volumes or pricing.

Instead, the sector remains resilient.

This is my bet
for global agribusiness, too.

You know it's going to be a resilient
demand for food is

going to be resilient in my guess.

Okay, so here's the big perspective.

We try to bring this down
into some practical spaces for us.

Here's further data.

Usage of GOP medications for weight
loss continues to gain in popularity.

Here's 2024 on the left
when I stopped prescribing them in 2026.

At present time, where we are now
and the two lines are current

users
versus ever users on the top in blue.

And so to me,
this is the most fascinating thing.

The gap.

All right.

The gap is what I really want
to talk about.

The idea of these medicines
is that you take them forever.

And if that were the case,
then the lines would overlap.

People would never stop taking them.

If if people get on them,
they have miraculous results.

They have no side effects.

It's accomplishing every stated purpose.

So we have
these two lines would not diverge.

But if we look over the years,
this is a small set of data.

It is subtly diverging,
the gap is widening.

And my prediction is that this gap,
the gap between the current GLP one users

and the ever users,
is going to continue to grow.

Because of what I have described
the many times the mediocre results

and the side effects and the cost

and the access, all these things,
it is going to continue to diverge,

I predict, and the system,
as far as I can see,

as someone intimately involved in it,
does not really recognize this gap.

And you think about what that gap means.

What does it mean for people
who are in that increasing blue line?

People took it but stopped.

And just think what that means
as a personal level,

people took these medicines
because they had hopes

that were not fulfilled,
you know what I mean?

It's like they took the medicine
and they had a side effect.

They took the medicine, they didn't
get the results, they took the medicine.

And then they had to stop for some reason

because they couldn't afford it
or because of some process. And.

The gap.

Yeah.

This is why I decided to stop prescribing,
because I was just sitting in the gap.

So much of what was happening in my weight
clinic was actually sitting in the gap

with people and recognizing that we,
that we really need as a thoughtful health

care system, powerful practices
to help people in this space.

Anybody who stays on the Green Line,
who is served in the current process,

and who is someone who the GLP one is
just really resonating

with their physiology,
and they have no side effects

and they're accomplishing anything
they want.

They are being served
by this current process.

That's beautiful.

Okay.

I want to specifically focus on the gap.

That's what I've been doing two years.

People who are not served by it,
who are left behind.

Yeah, this is the point.

People told by the system.

You need to stay on these forever.

But what if people can't do it right?

So we just hang people out to dry.

Basically,
there is a non insignificant probability

that someone won't be able to do it right.

And so I want to help make systems
that help people

in that situation
specifically don't right off the gap.

Yep. Don't lose hope.

That's what
I want to say. Don't lose hope.

If you are on the blue line
and you couldn't take it.

Say research can.

Come on, I tell you,
you read the medical literature,

the journals,
the journals are nothing but positive.

Okay. And it's fine.
And there is a real benefit.

I hope I have given you an unbiased,
you know, perspective, real benefit.

Also,
let's look at the bigger perspective.

Every paper can continue
to show incredible results.

And as long as this gap exists,
I think at least part of the system right

should be focusing really as possible
to to do that.

I say, you know,

almost every day it can feel like now
it GLP one is indicated for heart disease,

GOP one is indicated for sleep
apnea is just going to go on and on.

And the
the hype cycle can just go on and on.

And I say this is fine for my point.

My perspective is I've reviewed for it.

I see for primary reasons why this gap
is going to continue to grow and why it's

important and shouldn't be overlooked,
which is the medical contraindications.

The more I prescribe this medicine,
the more I collect groups of people

who have to stop taking it
because of side effects,

and I run into people
who are trying to lose weight

but can't take them because of the huge
list of contraindications,

including personal
and family history of thyroid cancer,

history of pancreatitis, and the myriad
reasons that people can't tolerate it.

You know, including, you know, things
that people currently wrestling with,

like muscle loss and all kinds of
sort of things, and the subtle, you know,

lingering concern that we haven't yet
identified all of the problems, which is,

you know, the longer this goes on
and the deeper I study these processes,

the more I really do,
you know, worry about it, I do.

And then the financial limitations of it,

you know, certain

people have full coverage of these things,
barely have to pay anything.

Yet the whole system is still paying
extreme amounts of money.

Obviously, the health care system itself
is under significant financial burden.

The idea that we're going to triple out
the expense of this

from $130 billion, and we're going
to spend half $1 trillion on it.

And this is why the investment case
is being made,

that the money is going to flow.

I don't personally, I'm not an economist,
certainly not a health care economist.

I don't know, you know,
can the system handle that?

I doubt it, but what do I know? Okay.

I just know that on a personal level,
there are people

who are taking it
and then they cannot take it any longer.

People's insurance situation changes.

People
get kicked on to a high deductible plan

and they get kicked off their medicine.

And so there are financial limitations.

Do you think that
that is just going to disappear?

I don't, so
I think that this gap is going to persist.

I've described the limited efficacy
for some people.

Everybody who has great efficacy
presumably are the ones on the green line.

They're going to keep taking it.

The people who don't have
that experience are on the blue line.

This is like like the
the idea of continuing to take a medicine

that is very expensive for years,
that you're

getting mediocre results from those people
not going to keep taking it.

Right.

So then there's the gap between
the current process and where we are.

And I don't see any sign
that that is changing.

Right.

So and then there is just the personal
preference of people right now.

Did I show it on that slide. Yeah.

We're about 11% of the US adult population
is taking these drugs right now.

And of course
these are the people on average

who are most wanting to take them.

And there are many people, of course,
on the other end of the curve who,

just out of a personal preference,
do not want to take a pharmaceutical

substance.

And I'm not optimistic
that that is going to change.

We're not I don't think we're ever going
to reach 100% penetration

on the market, you know, of these drugs.

And so therefore
the gap will always persist between

the potential total addressable market
and then the actual market penetration.

So I want to be helping anyone
in that situation.

And so what I've been doing for two years,
to the best of my ability,

is to provide an alternative.

And I don't want to hype anything.

I'm not even going to say
it's a better alternative.

It's just an alternative.

In the current framework,
if there's no alternative, you know,

having anything you say,
well would be better if if I can't take

because increasingly the weight management
space is just

this is like a you know, if we're cynical,
we call it a black hole.

If we're optimistic, we'll call it a star,
okay?

It's just a star.

And the whole space
is just orbiting around like

one pharmaceutical class
when, in my view, in light of everything

that I have explained, it's like there's

there's just that gap simultaneously,
while I've experienced everything

that I have shared with you
my whole experience over 12 years

of being very enthusiastic,
prescribing these things, coming

to see the broader reality as best I can,
thinking deeply about it simultaneously.

Through that, I became aware of the deep
power of lifestyle processes.

Everything that I talk about
on this channel,

a thoughtful and gentle fasting
based practice combined

with a diet of stripping out
all of the processed foods if possible.

Literally all of it. Just get it out.

Pairing that with thoughtful movement
in the body does not have to be marathon.

Running can be gentle
things like taking a walk,

and then the mindfulness strategies, which
might be the very most important thing

helping our mindset. We are a mind body.

We take all these four practices, put them
together into a lifestyle process.

I've seen such powerful transformations
of people free from a medical standpoint.

Okay,
there's cost to consult with someone.

Okay, you go to the doctor,
there are co-pays to do that.

Right.

And but no medication cost for a lifestyle
intervention.

And I did a talk like this.

Go back on my science deep dives.

You know, the research that I did,
I got grants at the university to fund

a fascinating study
of my lifestyle process, help people

spending over a decade using insulin
start bringing in fasting based processes

of seen people completely reverse type
two diabetes and normalize

blood sugar from the very worst place
to completely normal.

And that is such an incredible experience.

And to go from an experience

of prescribing script after script
and having mediocrity

to start, you know, and people harmed,
which I never want to happen.

I say, how do I have a practice personally
where I am able to deliver incredibly

powerful results to people sustainably

over time that do not just disappear,

while also never harming anyone
with pharmaceutical side effects

and try to give people
the most incredible value,

meaning you deliver the right lifestyle
intervention.

Once you pay for it once and you help
someone learn something

could serve them for a lifetime.

The cost benefit analysis on
this is so immense.

The distinction between 100 and $35,000
per quality.

Okay, which I explained if you're new,
just coming in okay, one year

for semaglutide versus an intervention

that costs a few hundred dollars,
you know, to deliver a professional time

with someone, it's
just it's just so immense.

So this is why, okay,
to answer the question after all of this,

why did I stop prescribing it?

What changed the situation?

This is the thing you can picture two arcs
the enthusiasm coming down for GOP

ones coming, I think, to a grounded space
like I've tried to show.

I'm not opposed to them.

In principle, I think they can be
appropriately used finding other people

who are able to tolerate them
and have the exceptional results.

I'm all for it. Okay. And at the.

But at the same time, recognizing
that that is not the majority of people.

And then the other curve,
as I'm really dialing in on the power

of these situations,
lifestyle interventions

is just night and day between a process
of helping people to do.

The core foundational,
transformational work of health

is so much more effective.

It's just actually effective, like
the number of people having actual benefit

that I work with in this process versus
even when I would do

both, I'd be like, here's the script
and can you try to do this, please?

Like, it's just it's hard

the way I used to do it

when I was prescribing
GLP one is I'd be like,

look, here is a tool to help
you do the things that I am describing.

And if people can use it that way,
I think that's a real benefit.

I did that for,
I don't know, 4 or 5 years.

I say, here's something that will help you

with that appetite
and can it help you to practice fasting?

And some people do find that,
and I think that is a benefit.

I have found more success, actually,

as I have just 100% dialed in on it.

And so that brings us here, right?

This this whole thing was a review for me.

Like I said, I would change my mind.

I would go back to prescribing a thing
if I was really convinced.

But I'm pretty convinced, pretty convinced
that I'm just very happy.

I'm personally very happy
to be doing what I am doing.

Simple fasting is this channel where
I'm sharing my best thinking

with people and is my clinic
in Fitchburg, Wisconsin, where I'm

one on one working with people,
trying to help people actually do

the process
in a powerful, sustainable way.

That to me
feels like after this whole experience

I've had in medicine, you know, is
just like been, you know, my life, right?

Medical school and residency training,
an entire decade

plus of like practicing and learning it.

And I feel like to distill it
all down into this point.

I feel like it is
what is needed in this modern moment,

and not that it has to replace in any way
an entire pharmaceutical complex.

But even if that sliver,
we're just 1% right.

If the gap of 1%,
okay, 1% out of 100 million,

like we got plenty,
okay in the gap is plenty bigger than 1%.

Okay.

The gap is like 2,030% okay.

So there's just a huge space.

I feel like this is the space
that we really that I at least okay.

There's no shortage of people
prescribing these medicines.

So one little doctor Z stops prescribing.

Say let's just have a couple people
just looking in this other space.

And so I'm feeling personally very happy
about it.

I'm going to keep doing it.

That's where it is.

I came with an open mind.

I'm reading the data, I'm thinking
through it, and I'm like, you know what?

We're going to stick with this, stick
with it.

Simple fasting in the clinic and simple
fasting on the channel.

So beautiful to have you here.

We're going to keep going.

In the next talk. Probably the next talk.

Maybe it'll be tomorrow.
I have a mind to do it. Tomorrow.

I'm going to share with you my best ideas
that I have, especially for my clinic.

I have during this.

As you know, if you've been following

along, had a little illness
that I am bouncing back from.

And as I was sitting on the couch
thinking about

how I'm really looking forward
to having some more energy

so that I can dial back in on this fasting
lifestyle process, help more people

build powerful, incredible systems
that are delivering

sustainable, effective results
to as many people

as possible
for as little money as possible.

I just think the potential is so huge.

This is this was helping me feel better
as I was sitting on the couch

feeling badly.

I just was having so many beautiful
thoughts.

I'm like, no, we are going to crack
the code on this, on this gap,

you know, and we are going to help people
in a bigger and more powerful way.

I'm just really building up
my mindset on it.

So I'm going to write it into a talk.

Maybe I'm going to try my best
to get it out this week, maybe tomorrow.

Thank you for the comments.

Let me dive into some comments, share
more comments reflections on these topics.

Questions.

I'd love to have a broader discussion
about it.

Maria. Hey,
I hope you're doing well these days.

Are you bouncing back,
still needing to take these medicines

for the rest of your life?

Can be frustrating,
can help you to lose the weight,

but still needing them once
the weight is off.

Counterintuitive.

Yeah, I
this is a difficult space to navigate.

You know, if you read in the obesity
medical literature, you know,

I read an article journal article
the other day,

I lost the weight I wanted,
should I stop my medicines?

And, you know, they're just

and they're telling the doctors,
you got to tell everyone.

Keep people on it.

Keep people on it. Don't help.

Don't let them stop,
because then the weight will come

back and people can be really stuck
in a space with it.

If people are not having side effects,
will the medicine help you

to keep the weight from coming back?
Probably will.

Like if you are in the scenario

where the medicine helped
you lose the weight, absolutely.

The data would suggest people stop it.

Weight going to come back on.

This is the really the box
that we can get stuck in.

And I want to help people get out of that
box if they want to be in it.

The standard medical advice
is that people stay on the medicines

indefinitely,
and I'm not telling anybody what to you.

Do you talk to your doctor?

You want to talk to me as a doctor?

Come to my clinic.

I'll give you actual medical advice.

I'm just sharing,

you know, knowledge and perspective here,
but that is a very tough.

I agree with you.

That is a very tough situation
for so many people.

And that's why the gap in that graph
that I showed is going to persist in widen

as the years go on, years and years

after years,
there's going to be attrition.

Absolutely from it.

A lot of people
not going to be able to do this.

It took 30 years, but

I fully believe lifestyle changes
and habit changes are the way to go.

Hey, that's an incredible perspective.

Hey, to be an incredible perspective.

Thank you for sharing that.

I had.

I had some great fortune in my life,
some truly,

truly great fortune in that
when I went through

periods of tremendous stress
and I gained a lot of weight and I had no

effective coping skills
other than ice cream and mac and cheese,

that that I came to a fasting process
early, you know,

and I found it and I, I used it
to great effect in my body before.

You know,
I had a long standing problem with it.

You know, that started to really change
my perspective.

And so, you know, as a physician,
as a prescriber of medicines,

you know, maybe it took me seven years
to really start seeing the idea of.

Really the power of lifestyle.

I certainly didn't get it in
medical school,

you know, and it took a while
through practicing medicine to see

the other side of the curve, you know,
and to say, no, we really need it.

And, you know, we want something.
I mean, I do.

That's why I go to pharma conferences
historically,

I use my CME money,
I go listen to the speakers.

I read all the studies.

That's why I wrote so many scripts. Right.

But then after letting that process run
its course, like it took me a while,

you know, nearly a decade to see,

oh, look, here is this person
I've been prescribing pill after pill.

And like I said in the talk, it's
been a long, expensive

path to nowhere by the end of it.

And eventually I couldn't,

you know, do that
as I was really seeing the power of it.

And so, you know,
but the whole course for me.

Until I really caught the idea,
the full power of a lifestyle process,

you know, it's 15 years,
so took 15 years to really let it sink in.

Is there a push for doctors
to prescribe GOP ones over?

Matt Foreman curious.

Well, there there are pushes for sure.

And let me just tell you
about the most powerful one.

From my perspective, I've gone to a number
of conferences over the last six months

and, you know, medical conference place
to listen to people

hear what they are talking,
talking about, network with people.

I tell people what I'm doing.

You know, people some people interested,
some people saying, and,

you know, mainly people are interested

because they want to know
how much money I'm making.

They're like, oh, you left.
You started your own thing.

Like, oh, how much money are you making
is what people ask me.

And I'll be like, I'll be honest and not
really making very much money, you know?

But I'm having an interesting experience.

Okay. Interesting.

And I got to tell you,
every time I encounter

somebody like this, they asked me,
why don't you start prescribing GLP ones?

Like, do you know how like my friend,
he left, he started a GLP one practice.

He's making you and believe
how much money he's making.

And so that's like a drive.

You know, the drive to prescribe

is that if you're out on your own, man,
you can make a lot of money doing it.

It's huge demand and people understand it.

You know, this is the easy path.

People talk, oh, I talk to my friend.

My friend
said they'd just started taking this.

Like it helps. Okay. It's like, okay.

I was like, so people make a lot of money.

That's one of them.

Just the whole like I said, it's a star.

Everything in the medical system
is orbiting around it.

It's a spiral.

The amount of money that is being spent.

I mean, I don't watch TV anymore, okay?

I've just tried
to cut this out of my life.

I try not to ever look at any commercials
that come up on any streaming thing,

but how many times
do you have some sort of media?

How many times does a commercial of happy
dancing people,

you know, have to come up for a GLP one?

I mean, it's every time I see media, it's
just everywhere,

ads all over the internet of the thing.

And so then the demand is so incredible.

Like talk to any primary care doctor.

You know, I would just say and ask them,
you know, what is it

like of people
coming in with demand for these medicines.

And they'll tell you I'm
sure that it's significant, you know,

and so it's very hard to exist
as a physician prescriber

in this space
without being a part of it.

And I'll just tell you, it's it's
one of the reasons that I had to leave

the university, like,

in order to create enough space where
I could just get some perspective on it.

You know,
that's what I wanted as much as anything.

Because after being having
this huge experience,

being so connected to it
and for so much prescribing

and the whole thing, like I needed
some space to just to be able

to reflect on it and just think deeply,
you know, is this really the right thing?

At least for me, you know, and that's why
I think I'm doing this talk now,

because now that we're two years out,
and now that I've gained some experience

on my own outside of the standard
medical system, where it's just really in

this pure state, I'm just pure lifestyle
and everything, you know,

I feel like I've taken a big, deep breath,
you know,

and all of a sudden, and I can like,
be a little more objective on it.

And like I said, I had some thoughts
when I started reading these articles.

I was like, should I go back?

Like, maybe I was wrong, you know, I would
feel like I'm an open minded person.

I go back, I say I'm refreshed, I'm back.

Round two of doctor Z and GOP ones.

I started up again.

I just, you know, I spent the last week
really thinking deeply on this

and I just I can't do it, you know,
I couldn't do it. So.

This is where we are at now.

This is where I am, the whole history.

However long we've gone here,
you know everything that has led us here.

Now we are here in this moment.

From my perspective.

I'm very happy to be here.

And my my energy level

is like is really building up.

I will tell you,
I the more I have thought about it,

you know, the last two years
it's been very interesting

doing the channel kind
of percolating along my little clinic.

I'll be like, I know a lot about medicine.

You know,
I practice medicine for a long time.

It's hard to do something different.

I certainly don't know much about business
or YouTube or running a thing,

but I'm like this process.

It's just sinking in.

I love we were talking the other day
on the session about a plateau phase,

going through a space
transformation of some kind.

It's like we want this thing.

We just want the results.
We want it to blow out.

I've had this sort of thing,
and I really do believe that

a lot of things happening under a surface
that we don't always appreciate.

And I think
that's my biggest encouragement

to people that going through any process,
whether it's a medication process

or it's a lifestyle process
or you're doing both things right,

the story that is coming to my mind,

I think I told before,
is like I was some piece of advice.

Someone was like, oh, 30 years old.

They had some sort of career.

They decided, oh, they really had
wanted to go to medical school.

But now I say, it's all, it's too late.

And they're talking to this career
counselor and they're like,

oh, it's so long. And they're like,
how old are you going to be?

You know, if you go back to med school
now, by the time you get out, it's like,

well, I'm well then I'm going to be like
37, you know,

by the time I finally get my residency,
you know, it's like, well,

how long, how old are you going to be
if you don't do that?

It's like it's
just the same, you know, it's the same.

So they're like, you know,
we go through a process, whatever it is,

medication, lifestyle, time is passing
no matter what we are doing,

and we're going to end up at a space
one way or the other.

And so that's why doing the deep work,

diving in on a lifestyle process
is the most sustainable in the long term.

I never give people guarantees,
say like some salesman

like, oh, you're going to get like this
weight loss by this time.

Okay. No no no no.

I shared somewhere in the past
I got to bring the image back.

It shows like a compass
and then a speedometer,

and it says, focus on this and not this.

Right.

Focus on the direction and not the speed.

Right. Got to get our direction.

Got to get our direction right.

Yeah. Awesome.

Contrive was my biggest
go to when I was prescribing things.

Absolutely.

I try to tell people
this is something, you know,

it can really tone down a little bit.

Some of those craving sort of pathways.

Subtle.

But you can notice that that is exactly
my experience with contrade.

Right.

And people experience
that in a number of different domains.

Of course, low dose.

Now, treks don't help people

with chronic pain and other situations
because it's a neuromodulation.

And so in, you know, the weight
loss space specifically.

That's what I tell people,
especially in the last few years

of my prescribing, I would tell people,
look, we got this wave going on, GOP ones.

Here's pros and cons, all these things.

Here's
natural perspectives that I have on it.

You can dial in this.

You want something in the middle. Subtle.

You know, just help.

You know,
that was I prescribed a lot of that.

And like I said, to my knowledge,
nobody harmed by it

and be appropriate
and of course, a little bit anti-anxiety.

And for most people that take
it can help calm that down.

A hunger craving itself is a type,
I say, of an anxiety experience.

So it makes sense a little bit

in their help to just bring that down.

And then to me that is kind of a bridge
the gap sort of thing.

I also don't like leaving people
on something like that

forever,
if not necessary for some other purpose.

But I tell people,
look what most people's experiences.

Let's do every natural thing
possible, get all the processed foods out

and all the carb level,
especially simple carbs way down,

so that our hormonal state with insulin
and blood sugar is stable, right?

So we're not experiencing
these wild energy swings.

As we start to stabilize that, then

it is easier to practice a fasting space.

Yesterday or on Friday,
I was describing that in the ideal state,

as we switch over from that sugar
burning state into the reserve energy,

that if we practice
that the body gets better at it

and that transition state becomes
smoother, make fasting easier over time.

And like I say, fasting,
I never say, oh, it's easy.

You just do it now.

It can be intense and difficult.

That's why
we approach it in a very calm, centered,

thoughtful and patient way
so that we can ease into it.

Even if that took multiple years
to really lean into.

No problem, because we got plenty of space
and time here.

Never a rush, nothing forest and.

Absolutely.

So people can experience then
okay, craving intensity,

going down, understanding it more.

Maybe take some probiotics.

Help get that natural digestive things in.

Probiotics help to balance

the hormonal state in the GI
system to can be so helpful.

Look into the series we did this summer.

Summer Weight Loss Challenge
dove into the fascinating

topic of exercise
induced appetite suppression.

There is some major win wins that can come
as we start to realize,

okay, in a fasting space and
an exercise space, these are like a match

made in weight loss heaven, in my view,
because as you gently lean into it

and you realize how synergistic they are
that as we,

you know, sit before you can walk, walk
before you can run, okay.

But as we open up the space training,
the metabolic strength of the body

to be able to utilize the energy
that is within it.

The big analogies
I use here, picking the lock, right.

Does it feel like the energy is trapped
inside of the body?

How do we get it out?

This is the point of it, right?
Say I want to lose weight.

Energy is here. Body fat is energy.

How do we release it?

All right, look, we're
building the actual pathways that use it,

not a synthetic peptide hormone
that is artificially altering things,

but the deep physiology of the body
of how it actually works.

So we say, how do we release the energy?

Body fat is there to
power the body in the absence of food.

And so we gently train the body
to open up in a calm, gentle, low

stress environment
where we're not prevented from eating,

but we're voluntarily opening it up
and the body says, hey,

we've got energy for this.

It's like we start to build the pathways
to do it.

It's getting hopefully
a little easier over the time.

Now we start moving in that space,
all the sugar is out of the way.

The body is releasing body fat, energy,
energy levels stable.

We're not feeling energy
crashing, feeling energy increasing.

And all of a sudden
then the exercise can start.

To compound that,
we say the fasting space is like

opening up the door where
everything is cleared out of the way.

Now the energy can flow,

and now we've got the gentle movement
going, so synergistic.

And then we see exercised
induced appetite suppression.

Go watch that one and see that.

Then it can feed back around that people
afraid of fasting in the first place.

You say without food I'm going to be low
energy.

Can't do anything.

Maybe true in the beginning when we've
never done it and we haven't had it.

That's why I say sit before you can walk.

You got to let the body take a deep
breath.

I always picture some cell in the back.

It's like, what do we what do we do?

Like, we haven't done this in a long time.

And then somebody in the back,
it's like, no, we got plans.

Or in this crate back
here, like dusted off.

It's going to it's going to be okay.
All right.

They're like scurrying around
trying to get out the plans.

Right. That's like the DNA, right?

We're looking for the coding segments
so we can build

all the pathways to access these energies.

But then we do it and then it gets easier.

Now you can say, oh, I used to feel like

so low energy,
but now look, now I'm not eating.

And actually the energy is increasing.

Have you ever experienced that?

I'd want people to be able
to find that space.

If you haven't done it
and you're looking to do it, stick with me

on the channel every day.

Weekdays where diving into this

space ask questions, share experiences.

But then as it's flowing out

and then you can start to be more active
in that space very gently.

And now all these muscles, right,
that we use and gently every time

we're using it, they're like sponges
just soaking up the energy.

And that is how we feed forward.

And then as we start doing that and we
get that fact, then the appetite is less.

There is not a medicine that you can
prescribe or take that can do that.

There just isn't.

You know, and that's what I've seen

as a physician,
that medicine can't get that effect going.

And it's free.

It is free and I love it.

I am sure your medical pact is centered
around lifestyle

medicine will gather steam.

I think more people are starting to
realize quick fixes aren't the best path.

100% agree. I have total confidence.

Total confidence in it 100%
it is happening and it is going to happen.

And even if it didn't happen,
it's all okay.

That's how I feel.

Everything is okay.

It really is all my gosh.

I am so happy about it.

Grab a coffee and let the energy flow.

This is like how simple it can be.

You know, the whole idea of the talk here.

I'm looking at the timer.

First time since I clicked the go button.

One hour and three minutes.

You know, it just goes by.

And to me that's fasting space.

You know, this has been a fasting space.

Grab a coffee, share some thinking,
do some talking, you know, and we fasted

for an hour together, you know,
and I'm personally so happy about it.

Feeling good.

I personally
am happy to keep this fasting space going.

I've done no fasting for the last
almost month because I was on this

antibiotic, which I hate taking
and but it was terrible.

You know, if you don't eat.

So today, a fasting day for me,

which I'm so happy about and already
I know my stomach just feeling better.

Just like a little open space,
a little rest.

Stomach has done so much
processing nasty antibiotics

and all the food and all this stuff,
and it's just going to get a break.

So taking a deep breath for the body.

Really appreciate the conversation.

The thoughts, if you have ongoing
thoughts, come back to the session.

Share them in the comments.

Let's have an ongoing talk about it
and I will be back tomorrow.

Look forward to more thinking,
more discussion.

Share some more ideas with you.

I hope you have a beautiful day.

I'll see you back here soon.