Here's a number that actually shocked me

when I learned it. This from a Kaiser

Family Foundation poll. One out of eight

Americans is now taking a GLP1. One out

of eight.

Maybe I shouldn't have been so shocked

because the number is higher in my

social circles. I have tried these uh

for reasons I'll explain, but they're a

strange medication, right? They don't

make you lose weight. They make you not

want to eat food. that like that's what

they do, right? But then they do all

these other things. They seem to protect

people's heart health independent of

losing weight. They're protective of

kidneys, of livers. There is ongoing

research about dementia, Alzheimer's.

They have all these strange effects on

addiction [music] and desire. But should

everyone be on these? Like, what does it

mean for society to have access to drugs

that regulate desire in this way? What

do they mean for the sick? What do they

mean for the well? I've wanted to do an

episode on this for for a while, but

haven't known quite how to approach it.

And then Julia Beloo, who's a

contributing writer at New York Times

Opinion [music] and co-author of the

book Food Intelligence and also was a

health and science reporter with me back

at Vox, she started doing a lot of

reporting on JLP1s [music] and she's

written a lot of great pieces on them.

She is one of the best health and

science reporters I have ever known.

incredibly deep on the science, but

really compassionate [music] and

detailed and relentless about talking to

actual people about their experiences

inside the health system. And I wanted

to have her on to hear what she's been

learning. [music]

As always, my email is for client showy

times.com.

[music]

Julie Blues, welcome to the show.

>> Thank you so much. It's a pleasure to be

here.

>> So, I was shocked by this number.

According to the Kaiser Family

Foundation's poll, one in eight

Americans are currently taking a GLP1.

Why?

>> Yes, it was surprising to me, too. So, I

think um one of the ways we can

understand this is there's this very

long history of people seeking out

basically the magical elixir for weight

loss, right? So, I think that's one

piece of it. And now we finally have

something that rivals the only other

effective medical intervention we've had

to help people lose weight, which is

beriatric surgery. On the other hand,

there's a lot of people who are living

with diabetes. And I think that's

another reason that that we see so many

people who are on these drugs. In

addition, I think these drugs have

really met a particular moment, which is

this algorithmic social media age.

They're everywhere. Um, in the US, we

already had this relatively unrestricted

approach to marketing pharmaceuticals.

Um, we see them advertised everywhere.

we've seen this tele medicine kind of

industry flourish since co but also

around these drugs [snorts] and um I

think that's why we're seeing these kind

of shocking numbers.

>> So I want to start on the part of this

that people actually don't talk about

that much which is diabetes which is

what these drugs are originally approved

for as you say a huge number of

Americans have diabetes and and have

terrible health consequences often from

it including limb amputation and and and

blindness.

What do these drugs do for diabetics?

>> So, our bodies produce GLP-1 naturally.

So, we have this hormone that's produced

in our gut, in our brains, and to a

lesser extent in the pancreas. So,

basically, they're this synthetic

version of a hormone we produce

naturally. And the big breakthrough for

diabetes was that they're stimulating

the pancreas to release insulin only in

the context of high blood sugar. So,

it's not like when when you take insulin

and you need to be careful about what

you're eating and you're at risk of

really low blood sugar levels and the

dangers that come with that. These are

only stimulating insulin secretion when

your blood sugar is running high. So, as

the re as researchers who are working on

this are trying higher and higher doses

to help people with diabetes get more

and more benefit, they start to discover

these weight loss um results in the

trial. So people start to spontaneously

lose weight and then later we're finding

all these slew of other benefits that no

one would have predicted. No pharma

company would have bet on this. We're

only at the beginning of what what's

been called this ompic era. I think

we're we're really just at the beginning

of discovering the benefits and the

harms of these drugs.

>> Okay. So you have the recognition which

is just something people begin observing

that diabetics on these drugs begin to

lose weight and they don't feel hungry

and as researchers begin testing you

know the first generation of this ompic

what we now in that context calli

how big is the effect size what do we

actually know about what wgoi does for

weight loss there's another one which is

slightly more advanced it has more

mechanisms of action to his epatide

which is also goes by zbound. How much

weight do people lose on these?

>> So it depends on the drug but we're

talking like 15%. [snorts] It's the

first time we have a drug that really

rivals the more effective types of

beriatric surgery. The key point there

is that it's turning down appetite. So

it's not ramping up metabolism or energy

burn. GLP1 is a hormone. And the idea

was that this is a gut hormone. um or

that that's the the thing that a lot of

people focused on and we're just and it

it's released after eating and it helps

people signal satiety. It helps them

feel full and know that they've eaten

and we're just giving a really souped up

version of this um this gut hormone.

[snorts] And it turns out that actually

you need to stimulate the brain GLP-1

system to get the weight loss effects.

So you only interfere with appetite once

you reach this brain GLP-1 system. Well,

you've written [snorts] or co-written a

whole book about the metabolism. And one

of the arguments of that book, one of

the arguments of of books in this space

that I think people don't appreciate is

that hunger is a function of the brain.

And it's a function of the brain's

reaction and predictions about the world

around it. And we we always have this

idea that, you know, people just feel

hungry. And then, you know, you should

use your brain to decide if you want to

eat, but your brain is deciding if you

feel hungry. and and and you're sort of

fighting its own instincts. So, I'd like

you to spend a minute on this like idea

that hunger is a function of the stomach

versus hunger as a function of the brain

and sort of how researchers moved from

one to the other.

>> Yeah. The way we describe it in the

book, we use this analogy of breathing.

So if I tell you like take control of

your breath right now, like breathe more

slowly or breathe more quickly or hold

your breath, you can take control for

short periods of time, but eventually

physiology takes over. Um, and the same

thing is true of what we eat. So we have

this illusion of control over our

individual meals and snacks, but there's

this symphony of internal signals that's

going on inside of us all the time. And

the brain is sort of leading this

symphony. And um the decisions we make

are much less a product of conscious

control that I think many people

appreciate. So when you're taking a

GLP1, you're getting a much higher

longerlasting version of what your body

produces and it has to reach the brain.

And the the theory is that it's reaching

into the part of the brain that usually

signals that there's a toxin in

circulation. And so that shuts down your

appetite and increases your nausea.

>> Like what you would get during food

poisoning or something.

>> Exactly. or what you would have on a

these are the most common side effects

of these drugs, right? Um so so it

reaches into that.

>> So the wonder drug we've invented is

we've made your brain slightly think

it's being poisoned all the time.

>> Um I I think that's one way to put it.

Absolutely. [laughter]

And so this so

>> modernity baby.

>> I know. And in the context of our

completely toxic food environment,

right? It's just turning down your

appetite by reaching into this GLP-1

brain system. So it acts as a

neurotransmitter in the brain and from

there reaches other parts of the brain.

Um yeah this is something this is a very

active area of research but that's the

sort of bottom line and and this dialing

down of appetite is the key key feature

of these drugs. One of the things that I

find interesting about the GLP1s

is we basically created this food

environment that does not exist in

nature of hypers sugary, hyper fatty,

hyper salty, hyperc calorie dense foods.

Our brains are evolved over very very

long periods of time to treat those as

getting you know three cherries on the

slot machine and to really really want

them. So, we've put people into this

hyper stimulating environment,

but we didn't change everybody's brain

to turn down the level of hunger when

you come into something that is very

calorie dense or very sugar dense. And

so we've been asking people with these

like caveman all of us myself um with

these caveman brains now surrounded by

the fruits of modern industrialized food

production where the Mars company is

spending god knows how much on R&D to

make my kids want M&M's

and it doesn't work for people and then

we blame them and tell them they've not

done a good job exercising their

willpower and self-control.

>> I think you were also someone who

struggled with weight earlier in your

life. Uh, I was very very heavy until I

was almost an adult. Um, like I lost

like 60-ish pounds, 50-ish pounds when I

was uh, 16. And then ever since like I

fight my food desires. Like if we had a

bowl of Oreos on this table, 30% of my

mental energy the whole time we were

talking did not eat the Oreos.

>> Right. Yeah. Ex. Absolutely. I remember

we had lunch in Washington when I was

doing lots of obesity reporting and you

said why am I a person who if the

chocolate cake is there like 50% of my

brain is focused on the chocolate cake

and I didn't have a good answer for you

then. Um

>> do you have one now?

>> I do. Yeah. I think it's that you know

so when when we think about something

like common obesity so there's many

different types of obesity. Um, but what

most people have is called common

obesity and it arises from these tiny

[snorts] like over a thousand genetic

variants that all act almost all act in

the brain. And so you have a

neurobiology probably that's different

from someone who doesn't have to fight

the chocolate cake. Um, and I actually

did genetic testing for the book and I'm

also someone who struggled with my

weight and I I turns out I have a higher

genetic risk than like 90% of the

population. But this risk in a

particular environment won't be

expressed. But as you said, when you put

people like us in environments where

there's lots of M&M's and lots of

chocolate cake, it becomes much harder.

Um, and I think most people don't have

this um privilege, let's say, of being

able to finally curate their environment

to control their weight in maybe the way

we might have had. I have a family

member who uh I'm not related to by

blood and one thing that always amazes

me is she will order dessert and she

loves dessert and she loves chocolate

cake and she'll like eat half the cake

and then take the rest home.

And I always look at that and I think

whatever is happening in you is not

happening or me or or possibly vice

versa whatever is happening in me is not

happening in you. And then I feel in

other ways elsewhere in my life. Uh I

can have a cigarette or a puff on a

vape. I have no interest in another. It

does not exite any desire in me. I can

have a whiskey and leave half of it or a

glass of wine and I don't particularly

want to keep going. And I've had people

in my life who struggle with alcoholism

and I don't have willpower. They don't.

>> Yes. something is happening in their

bodies or in their minds absolutely that

is not happening in mine.

>> And I've always thought the way we blame

people for this is so cruel because it

is so often people who don't have the

propulsive desire, blaming people who do

for not exercising willpower. But those

people aren't exercising willpower. I'm

not exercising willpower to not have

more cigarettes. I don't want them.

>> No, absolutely. I have this conversation

all the time with my husband. For some

people, the cards are just stacked

against them. Um, one person that really

helped my thinking on this was Robert

Seapolski. He talks about how we have

these um potentials or vulnerabilities

that are created by our genetics and

then in different environments, they're

either expressed or activated or not not

expressed, right? Like it's extremely

hard to, you know, do the right thing to

buy the foods that you know you should

be eating or to exercise every day when

you're working the night shift and

you're raising kids and you're um maybe

the single mom or dad or whatever it is

like um how how are you going to do all

like all the things that you know you

need to be doing to protect your health

and to fight against um this

neurobiology that you might have. So you

have this you have this interplay of

biology neurobiology as you're as you're

saying it this thing we call willpower

which is a very a very poorly specified

concept and then environment to me this

question of environment is really

important I'll I'll use myself as the

example you know when I lost a lot of

weight I mean when I was younger a lot

younger

a high school student with nothing to do

>> and I was able to really really hold

that when I was a young adult. Um, and I

have not been able to diet successfully

since I had kids because I can't control

the food environment.

>> And there's a lot of other things I can

control. I have money. I can, you know,

go to the gym. I have a certain amount

of autonomy over my schedule. So, as you

say, when you add in things like the

night shift, when you add in not having

the money to to to get healthy foods or

or go to the gym, when you add in having

more kids or less time, that we will

power works very very differently when

you're able to have the autonomy or the

money to create a certain kind of

environment around you that is conducive

to living in a certain way, right?

you're a Hollywood celebrity with a

personal chef versus you're a single

mother of four, you know, who works two

jobs. And this idea that like willpower

is some unchanging like muscle inside

the mind as opposed to some reserved

discipline that gets depleted like if I

don't sleep enough, I eat more.

>> Right. Absolutely. And you're designed

to eat more when you don't sleep enough.

And you're absolutely right that this

symphony of internal signals that I was

referring to earlier, it's interplaying

with our environments. So, one thing

I've really appreciated about your work

on the GLP1s as a reporter and as

somebody who's very deep in the science

is you've done a tremendous amount of

interviewing people on them and you've

interviewed many of the kinds of people

and again to me this has always been the

cruelty of this conversation who were

exercising a tremendous amount of

constant willpower going on and off like

very restrictive diets you know losing

30 lbs gaining it back.

What is it like for them? Um, for the

people who've seen huge amounts of of of

weight loss, how do they describe the

experience of being on a GLP1 versus

what it's like off of one?

>> I think the big common thread for people

in whom the drugs are effective for

weight loss is this idea that suddenly

this willpower that they were always

searching for that they feel they didn't

have enough of, suddenly they have it.

Um, suddenly it's not that hard to say

no to the extra piece of cake or the

cake altogether. um they're eating

smaller portions, their cravings change.

Like they have this complete there's a

lot of discussion about food noise. When

the cake is there, 30 to 50% of your

brain is on the cake or you have

cravings that distract you. A lot of

people say that this just disappears.

>> You said a second ago, for whom the

drugs are effective.

For whom are they effective and for whom

aren't they effective and why? So this

is another area we don't fully

understand but it seems like there are

some people who are quite sensitive to

the drugs and others who are insensitive

to the drugs and there might be a

genetic component to this too. um that

that's sort of a frontier um area of

science. And so I think the the quest

that a lot of the companies are on is to

understand like how how do we

differentiate the people who might need

higher doses initially or much lower

doses because they're having um so much

sensitivity to the drugs and side

effects um and whatnot. They're having

such a strong response or losing weight

too fast. Um so there there absolutely

is this variation in how people are

responding. Tell me about the side

effects of these GLP1 drugs. In studies,

people often don't stay on them that

long. People do cycle off of them

sometimes for cost, but sometimes for

for other reasons. Like what what is

unpleasant on them? What what can go

wrong?

>> So, the most common are that we know of

right now are the gastrointestinal side

effects. So, the nausea, the vomiting,

the diarrhea. Um those those are the

most common, but it seems like there's

other emerging potential problems. So

there are lawsuits around um severe

stomach problems um damage to the ocular

nerve um so so eye damage um and those I

don't think we have clear answers on how

common that is um and but but the basis

of of those lawsuits is that people

weren't properly warned that this could

happen. One thing that a lot of people

don't seem to be warned about is the

fact that you have to stay on them to

keep reaping the weight loss benefits.

Um, so I think there's an idea that a

lot of people have. I'll lose the

weight, I'll learn how to eat properly,

and then I'll go off the drugs. I'm I'm

always surprised that even people who

got the drugs from their doctors don't

seem to

>> What happens when people go off the

drugs?

>> You tend to regain the weight and

>> you just feel hungrier again. The the

sort of resets exactly this this

appetite that was suppressed through the

brain um through through acting on on

the brain GLP1 brain system, that effect

is gone and you're back to the food

noise. you're back to um yeah the hunger

that you had before.

>> Isn't that pretty? I I've heard this and

it's definitely true in the the data.

But I guess like people in my life have

chronic conditions and the drugs are on

like they just have to stay on them. You

know, you stop taking statins and the

effect goes away. Um if you're diabetic,

you have to keep taking your insulin.

That like I feel like that's like a like

people who are used to drugs to treat

acute conditions not being used to drugs

to treat chronic conditions. But I think

that this is the thing like that goes

back to the beginning of the

conversation that a lot of people still

have this idea that they should just be

able to will their way out of it, right?

I think these drugs helped reveal how

much we are products of our physiology

and um that with this, you know, you

take take this drug and suddenly again

you have the willpower you you didn't

have for your whole life. Um but there's

still this expectation. It's like any

other diet. And um that feels like a

place where people haven't been warned.

But as you as we've been saying, there

are now so many people on the drugs. And

I think these more rare side effects

we're going to start to learn more

about.

>> I want to talk about a possible social

side effect, which is

the our cultures expectations for what

people's bodies should look like have

been punishing for a long time. Um

particularly punishing for women and

girls. I think we we've interestingly

been entering an era where they're

increasingly punishing on boys and men

and there's this whole thing of like

male looks maxing and uh you know the

guys in the Marvel movies are completely

jacked now and on all kinds of things

you probably shouldn't be taking. And

you know, if you're obese or overweight

and you're taking a GLP1 to lose weight,

you know, great. Um, or to, you know,

protect your cardiovascular system. But

I think a lot of the cultural effect of

them has come from celebrities and

influencers

who all of a sudden show up and are much

thinner at times skeletal now in ways

that you know when you have the body's

natural hunger signals coming back at

you is is harder to do. [gasps]

You know there was like this big body

positivity movement and that was always

going to be a very uphill climb in this

country. But how do you think about

GLP1s as possibly a like a like a

pharmaceutical accelerator

of, you know, fairly dangerous body

expectations because now it's like,

well, if you want to look thinner, why

not just go on to GLP1?

[snorts]

>> I think that's that's absolutely a

strange um in this conversation and in

this in this moment that we're living

in. Um the place that it freaks me out

the most is um I talked to pediatricians

who are prescribing the drugs in

children. There's no screening yet for

for these drugs and eating disorders in

young people and and they've they

anecdotally have seen people use these

as aids for essentially eating disorders

and and kind of exacerbating eating

disordered behavior. One of the

underlying assumptions of the health at

every size or fat activism or body

positivity movements um was that you

can't control your body size. Therefore,

you must accept it. We had surgery

before. It wasn't as accessible or

scalable. But now we do have this

medication where people do have the

option, right?

>> Or at least the ones who are sensitive

to it

>> and the ones who can afford it and

access it and all all of that, right?

We've seen influential people in these

the body positivity fat activism

movement come forward and really grapple

with starting on these drugs and um and

losing weight on them. And one thing

that those movements did that was really

important was highlight how much shame

and stigma people who are living with

obesity face every day, especially

women. So, like there was this great

economist article a few years ago where

they parsed the data on the pay penalty

and they they did such a great job of

highlighting the discrimination and

stigma that people with obesity face.

But I think there was really a dangerous

glossing over of the health effects of

carrying extra weight that even if there

is this variation in individuals at the

population level, it's very clear that

the higher you go up the BMI ladder, the

more um health risks you're you're

carrying. I I've spoken to people who

were part of these movements. They had

issues with movement. Um they had

problems with their blood sugar. They

had um they were concerned about

fertility and they were so grateful to

be able to now have a medication that

could help with those issues. That

debate became very polarized. It was

either you're fat accepting or fat

phobic. And I think we're kind of moving

to something maybe in between.

>> But but you but I take your point on

that. But put put that side of the

debate over here, right? That was always

a like an like an effort that was

running up against the mainstream of

American culture, which believes very

strongly in thinness as a synonym for

virtue. And you know, one thing that the

people I know are worried about and

frankly that I'm worried about, I mean,

I feel like I would not have had this

concern for like young boys, which is

what I have a while ago. And now I look

at the rise of male looks maxers and it

looks a lot like toxic diet culture you

know that girls were exposed to before

and you know and obviously you know

clavvicular who's the uh avatar of that

has talked a lot about being on you know

GLP1s or some some form of these drugs

and I wonder what it's going to do when

it is just that much easier for people

at the top of society to exert like

hair24 unknown levels of control over

their bodies and when they're doing it

with these like wild stacks of GLP1s and

peptides and you know uh pills to

prevent hair loss and everything else

you know constant Botox

like that filters down.

>> Oh, absolutely.

>> And it makes the the the ideal both like

ever more unreachable

and ever more punishing to try to reach.

>> No, I think about this a lot with kids,

right? there's this basically this

market that hasn't been tapped to the

extent that the adults have which is

children with obesity and diet-caused

diseases and I think it's something like

1% of um children who are eligible are

taking these drugs now but I think that

number is expected to rise

stratospherically um pretty quickly

especially with the expanded access and

going to pill form and there's so much

there's if we if there's like a lot we

don't know in adults there's so much we

don't know about what it means to

suppress appetite during these critical

phases of growth and development. At at

the same time, um diet caused diseases

like obesity and diabetes, they hit

young people particularly hard. Um and

there's some question with diabetes for

example about interactions with growth

hormone and insulin signaling because

the disease comes on so ferociously and

it's so hard to treat in young people.

So now we have this treatment or or

thing that can actually help young

people in a way we couldn't accept with

beriatric surgery before. But what is it

going to mean for them when we're yes

blunting appetite um not only with the

pressures on body image at that age but

also on yeah your muscles, bones, um

puberty, all these things, right? We're

we're about to put all these young

people on these drugs. Like I think

about my kids and the pressures that

they're going to face. Um, I think about

I don't know if you've done this thought

experiment, but imagine being like

chubby 16-year-old Ezra now. Would you

have gone on one of these drugs at 16?

Like I I I've thought I would I have,

you know, I I also I think my weight

fluctuated a lot, but I think around 17

or 18 I would have had obesity. And

would I would I have pushed like my

parents to say, you know, I really

wanted GLP-1. And where would I be now?

Would I have had a happier childhood and

like or teens and early 20s? Um, if I

had one of these drugs, would I have

learned to eat in the way that I've

learned to eat by changing my food

environment? I I don't know. Like I I've

But the pressures I think young people

are going to face now growing up in the

culture that we have, it's it's scary.

It's punishing. I'm terrified for my

kids when I hope that there's some sort

of correction, but I don't know if the

correction is coming or how, you know.

>> So, the conversation we've been having

here sort of tracks what I would call

like the first cycle of ompic coverage

excitement.

And then a new thing begins happening.

And it's sort of when I began paying

closer attention. There was a study that

came out that particularly caught my eye

as a former healthcare reporter, which

was that we were seeing huge drops in

mortality from any form of cardiac

event, but the drops didn't seem to be

connected or didn't need to be connected

to losing weight.

>> That's right. Yeah.

>> So, can you explain what we saw then and

then how that begins to shift the story

here?

>> Sure. Yes. So we have this drug that

comes on the market for diabetes in the

diabetes trials as as we start ramping

up the doses people start to lose weight

and then for any diabetes drug now that

comes onto the market there's a

requirement that companies must look

into what these drugs do to

cardiovascular events to look for harms.

So so they were so the companies were

looking for harms. Does this increase

the risk of a cardiovascular event?

>> Past past weight loss drugs like fenfen,

you know, which were not diabetes drugs

like did increase the risk of

cardiovascular events. Right. We've had

wonder weight loss drugs before and they

gave people

>> heart issues.

>> Exactly. So, so, so they're looking for

harms and instead they find this 20%

risk reduction.

And

>> put that in context for me. How big is

that?

>> It's big. Um, statins are a drug that

are targeting these conditions and the

risk reduction is something like 29%.

What's really significant about it is it

seems that more and more of the benefits

that researchers are discovering from

these drugs seem to be weight

independent. So in other words, what

everyone expected is you make people

lose weight, inflammation in the body

goes down, um your metabolism of fat and

sugar um improves. So maybe um you see

improvements in fatty liver disease or

your diabetes or whatever it is. But

what no one predicted was that you would

start to see these weight independent

benefits and that that goes for the

heart, it goes for the liver, I think

the kidney, there's a slew of benefits

that seem to be weight independent.

>> There's possible benefits on dementia.

Um I mean my understanding of this is

that observationally people on these

seem to have much lower risk of

dementia. They did a study seeing if it

uh a randomized control trial seeing if

it improves people who have Alzheimer's

and it didn't. But we're not sure about

whether or not it can prevent

Alzheimer's and some people seem to

believe Alzheimer's or dementia are

metabolically activated.

And so now there's this whole question

of does it is it cognitively protective.

So the Alzheimer's trials, so these were

really much anticipated um randomized

control trials to see what would happen

with um these drugs in Alzheimer's and

they had negative results. And so it was

a big disappointment um to the community

and to the companies, but there is this

question of in a different population or

with a different dose or a different

drug, will we see the benefits? And

that's an active um question, right?

>> Yeah. If you're intervening earlier,

it's an active um question and area of

study. So I don't think that case is

closed. And sleep apnea is a big one.

Sleep apnea is weight dependent. So you

need to lose the weight to see the

benefit. That's another indication that

these drugs are approved for now.

>> So these weight independent results,

they break our theory of the mechanism

of health improvement here a little bit.

So as doctors and scientists try to

grapple with this, how does our sense of

what the drug is doing and why it is

helping the body change? So there's a

researcher in Toronto, Dan Ducker, who

helped discover this whole class of

drugs and he described to me like let

let basically there's these three

buckets. So one is the weight loss

bucket that's clear it's going to help

you lose weight and you'll get the

benefits from the weight loss. Um the

second bucket is reducing inflammation.

So inflammation is when you're exposed

to a pathogen um an infection and

injury, your body mounts this immune

response and it can signal healing. But

when it goes into kind of overdrive at

low levels, you have this chronic

inflammation and that's a hallmark of

many of these diseases we've been

talking about. Obesity, diabetes,

cardiovascular disease. And these drugs

seem to lower work on inflammation. They

seem to lower inflammation. And this to

me is the most exciting area because

we've had drugs in the past that kind of

shut down inflammation like steroids um

let's say but but you put people at risk

because you're essentially shutting down

the immune system. You're putting people

at higher risk for cancer or other

infections. But the way this is

described to me is that GLP1 seem to act

as these finetuners of inflammation. So

they have this more subtle approach and

um it's not something we've really had

in medicine before. So we're using these

drugs. So GLP-1 and there's other drugs

that are coming on the market with like

the dual and triple agonist um that use

more than GLP-1. And the question is

like are we going to discover these

other hormones that we can subtly

manipulate the immune system and

inflammation with? And so we might just

be at the beginning of this. And I think

the other exciting facet of it is we

might really get amazing insights into

the immune system through these drugs

that we haven't had before because we

haven't been able to do these more

subtle manipulations.

But the third bucket that the the third

way these drugs seem to help people is

by directly targeting the organs that

are involved in particular diseases. So,

um sending signals to the liver to heal

scarring involved in fatty liver disease

or to clear the fat from the liver um or

whatever it is to promote healing in the

liver or the kidneys. That that's a

third way these drugs seem to be helping

people.

>> Why would it do any of that?

>> Your guess is as good as but um there's

models in mice of what's going on. Um

[snorts] but how this is working inside

of us, we don't know. My family has a

lot of cardiovascular disease in it that

um has hit members of my family young.

And as everybody sort of around me began

going on GLP1s, I began reading these

things about cardiac events. Um I was

like, well, am I an idiot for not being

on one? Are we all going to be on one of

these in a few years? And so I've tried

them. I want to talk about that

experience in a minute, but I want to

ask that underlying question of you

given these three buckets you just

described and how many things they seem

to be helping to treat. It increasingly

seemed to me like shouldn't everybody be

on lowd dose ompic or toeptide if you're

seeing reduction possible reductions in

dementia that we don't really know but

reductions in weight reductions in

cardiovascular events reductions in

liver and kidney disease reductions in

sleep apnea improved blood sugar we'll

talk about the addiction um and

compulsivity findings later but it began

to seem like a thing we should be

putting in the water

>> you know I had the same question is you

and the the deeper I've gotten into the

the deeper I dive into the science, the

more I've wondered the same. We did this

poll with the Times um for a piece on of

GLP-1 [clears throat]

users and asked them like what's your

experience been like? And I went into

that poll thinking we would get these

kind of negative results. I I had a

feeling that a lot of the headlines in

the media had been quite triumphalist

about these wonder drugs, but we weren't

reporting what the lived experiences of

people on these drugs was really like

with the side effects and cycling in and

out of insurance. And what we got back

was people kind of generally feeling

great and having benefits that they

didn't expect and that they wanted to

stay on the drug for benefits for for

reasons other than which the drugs were

prescribed. This was amazing to me that

63% of people in your survey said even

if the drug didn't work for weight loss,

they would want to stay on it.

>> No, this was it shocked me. I did not

expect this. Um, one of the most amazing

stories to me is the woman who had um

postconussion syndrome for almost a

decade whose life was essentially I

don't want to say shut down but it was

she was suffering suffering deeply um

with symptoms and she started to find

mice and cell research suggesting these

drugs could benefit postconussion

syndrome. So, she talked to her doctor,

she got the prescription, and she tries

it. And within days, she starts to

experience benefit, and now she's back

to her normal life. Um, but the big key

is we haven't done a randomized control

trial on this. We don't have the high

quality evidence to say, is this going

to be everyone with postconussion

syndrome, 80% of people or like 2%, we

don't know. In addition, we don't

understand the how these drugs interact.

For example, if you were on, god forbid,

but some other type of like a cancer

therapeutic or something like this, we

don't know how how does this fine-tuning

of the immune system I talked about work

when you're taking an imunotherapy, for

example. There are so many unknowns and

and researchers are always going to be

cautious. But I ask almost all the

researchers I talk to this question and

they all say we're not at that stage

where we should just all be on this. I

understand why the researchers have to

say well look we don't know

but we don't know actually isn't an

answer to that question right you have

to make a decision like as a person with

one life and a life where you have a

chance of getting heart disease a chance

of developing dementia a chance of

developing kidney disease a chance of

developing all these different things

and you have to look at these studies or

the coverage of these studies is more to

the point and say or say with your

doctor,

do I think I should be on this thing

that seems to modulate inflammation

which appears to be a source cause of

all kinds of major chronic and acute

illnesses people develop or not. And you

know, one reason I think you're seeing

like really really aggressive

experimentation

particularly around this class of drugs

is because something that has all these

effects for the well or for the you know

for chronic conditions saying well I

don't know in 12 years maybe we'll know

more. You actually kind of have to make

a yes or no decision as a person because

if you miss out on protecting your body

from the chronic effects of ongoing

inflammation for five years, you've

missed out on 5 years of protection and

you have accumulated 5 years of damage.

I don't know. It sure seems like maybe,

but I know different doctors feel

differently about this. And I feel like

we're in this place. It's actually like

really

tender and tricky.

>> Absolutely. But I think the question I

was answering earlier was this. Should

it be in the drinking water? Yes. I

didn't mean to actually make it

mandatory.

>> No, no, no. But yeah, no, but this

question of should you, Ezra, as an

individual with your particular family

history and your underlying disease risk

profile or whatever you've struggled

with um already. Should you be on the

drug? That's a conversation people and

you should certainly have with your

doctor and um get the prescription and

have someone monitor you. What scares me

about this GLP1 era is how many people

are circumventing the medical system.

They're getting these very low barrier

um prescriptions through tele medicine.

Um they're going to like elicit research

chemicals through people like

influencers on Tik Tok. Um there's so

much enthusiasm and I've seen this

happen with other drugs. It's like it

seems to do everything and then we dial

it back. We're not quite there yet that

we can just say put it in the drinking

water. So I went on the lowest dose of

toeptide and like two and a half um

milligrams and I did not have the

experience that people in your survey

had. Uh so on the one hand it's like the

most interesting drug or one of them

that I've ever tried uh you know legal

or non-legal because I seem to be

sensitive to it and all of a sudden I

just didn't want to eat which is never

an experience I've had before. It was

like living in somebody else's brain.

The way I've described it to people, I

used a slot machine analogy earlier.

It's like being a gambler who loves

slots and going up to a slot machine and

pulling the thing and getting the three

cherries and then nothing lights up.

>> It made me feel like that there was this

level of experience that I hadn't even

recognized I had, which was around

desire. Like I would taste something and

it would be good or I'd smell something

and I hadn't noticed that the thing it

would then trigger another feeling which

was desire because like the feelings

were so connected for me. But all of a

sudden I would have that same I would

have that same experience and then the

desire wouldn't trigger

and I would walk by the candy bowl and

not stop or I would leave half the

burrito on my plate

and it was in a it was in a way

revelatory.

Um,

the problem is it made me quite

depressed.

>> Interesting.

>> And andhonic. And whether that was

because I wasn't eating enough or or

what what was going on. But the thing

where people report more energy and and

and more focus and feeling cheerier for

me, it really doled experience.

>> Almost sounds like an anti-depressant

experience. Well, and that's why I think

it's like interesting to bring in my own

experience because there is this whole

thing where it's working on some kind of

reward mechanism too on maybe dopamine,

but people are reporting not just a

desire to eat less, but a desire to do

all kinds of things less. Drink alcohol,

take drugs, online shop, and then this

anhidonia thing is also being reported

by people. And so, what have you seen

about the whole reward system dynamic of

it in your reporting?

>> Yeah. So, this has been a very exciting

area and one that we've paid a lot of

attention to, I think, in particular in

the media because the anecdotes are so

startling and I think they're real. I've

talked to people who have reported like

reversals of um alcoholism, um the

desire to smoke, um sex addiction, like

any kind of addictive behavior you can

imagine seem to be dialed down with

these drugs. The trials to date have

been mixed and the researchers who study

reward are quite cynical that these

results are going to endure. And the way

it's been described to me is so for a

long time we know that if you make

rodents hungry, they're more likely to

have addictive behaviors like they're

more likely to get hooked on cocaine or

push the lever.

So hunger has this overlapping pathway

with these other motivated behaviors and

it [snorts] can increase the risk of

addictive behavior. Um it seems and so

it's it so one explanation is that once

you've been on these drugs for a while

and your appetite starts to normalize,

you've lost the weight and your hunger

starts to normalize again whether the

results for addiction are going to

actually endure after that. I think a

lot of people think about these as like

clear treatments for these addictive

behaviors and that's where I think we

don't have the the high quality research

we want to have.

>> Well, that my assumption of why some

people were getting uh anhidonia, some

people were seeing, you know, lower

desire for drinking that that was

actually not necessarily that it would

end up proving to be a clear treatment,

but that it is messing with a system we

don't really understand. And I mean I I

sort of think what's interesting about

this whole conversation is we're

basically saying we don't understand any

of the systems very well. We don't

understand the appetite system. It's

working a different way than we

hypothesized. The cardiac system is not

doing what we thought it would be doing.

We don't know why the inflammation

system is responding. The reward system

is changing. I mean the human body is a

very very very

complex set of systems

and this seems to be a complex change to

them that like at the population level

is positive probably but not in a way

where we can precisely define

the mechanisms by which it is positive

or tell you for whom it will be positive

for whom it will be negative and who

will actually lose weight and who won't

and how

It it's a very weird

space actually.

>> Absolutely. And and that's where Yeah. I

feel I really feel this like there were

just at the beginning of this um after

we ran this piece where we did the poll

and and talked about all these other

surprising benefits people have

experienced. I got lots of emails about

weird like people who were on SSRI. So

they were on anti-depressants and they

start on a GLP1 and they completely

spiral. Um, and that's not something

that I've seen show up in the randomized

control trials or or in in um the

research, but it's an experience that

people have. So, I think we're going to

have lots more of this at the scale that

people are taking um these drugs. Um,

we're [snorts] seeing these these new

drugs are coming down the pipeline. Um,

we're seeing that there's now oral forms

of these drugs available. The drugs are

going generic. We're going to see more

and more people on these drugs and learn

much more about them. There's so much we

don't know. What about all the drugs

that are coming now? So I know people

who are getting reatitride from some

compounding pharmacy in China or

something and reitatride maybe you can

explain it but it's another Eli Liy drug

eli also makes the makes zeppound the

tepatide um variant and this is in

trials now and it's expected that it

will be approved in the next some amount

of time and it'll probably be a big deal

but it works even better than the other

two but I don't really understand why

all these people I know are getting a

compounded thing fromies they can't like

oversee when there are perfectly good

GLP ones on the market now that you

could get and have full confidence in

the way they're being manufactured. Like

what's going on with Reddit Tutread? Why

is it like both like around my community

and all over my social media feeds?

>> Oh, interesting. Um, this says something

about are you in bodybuilding algorithms

or

>> No, this is just straight up X for me.

>> Oh, interesting. Okay, that's

interesting. Um so so it's still it's a

research compound that's still under

study. It's targeting three hormone

receptors. So simaglletide um ompicovi

is targeting one. Um and this is where

at the beginning of the conversation we

talked about how we had this a lot of

research on these diabetes drugs over

many years and we could be fairly

confident in their safety profile. these

drugs um that have come on since um like

Mangaro, like so trespide and like

reatride, they're they're targeting more

than just the GLP1. So they're they're

targeting other hormone receptors and we

don't have long-term data on these drugs

>> and I think that's a really important um

thing that a lot of people overlook,

right? Um, so, so this one is still

under study, but in the research we have

so far, it looks like it's causing

faster and more dramatic weight loss and

it's taken off in I think longevity and

bodybuilding,

social media.

>> The the argument I keep seeing about it

is it it increases energy use that it

seems to have some independent effect on

how much how on the calories you're

burning. Yeah, I'm not sure what the

mechanism um but that could make sense

that it's not just reducing appetite,

it's also increasing metabolism and

maybe that's why people lose even more

weight more quickly. Um but but the

point is we have this emerging evidence

that it might be even more effective

than what's already available. And I

think it just speaks to the frenzy

around these drugs that people don't

want to wait for the FDA to get the

randomized control trials to approve the

drug. they're going directly to illicit

sources um and trying to buy the drug

which is still a research compound.

>> People I knew who used to order drugs on

the internet, they they were ordering

fun drugs. Now it's like [laughter]

these weird

>> Yes.

>> eat less and focus more. One thing I

think is interesting about the GLP1s, I

mean for everything we've talked about

here is for instance, you know, the

categories of who might want to lose a

little bit of weight or even more so who

might want to protect themselves from

inflammation. They speak to this reality

that the difference between well and

sick is not this like clear binary

thing. We now have these categories like

pre-diabetic and prehypertensive and

premenopausal and we didn't used to have

them. I mean we keep expanding the space

in which you should worry and I think

that there is an interesting dimension

as people start looking for like

chemical answers to wellness because the

truth is for a lot of people get enough

sleep and go to the gym regularly and

eat whole foods is hard. If you could

just like give yourself a shot or take a

pill, people want it. How do you think

about the broader shift, which is not

new, but it's happening with more force

right now towards medicine as not a way

of treating illness, but as a way of

optimizing wellness?

Do you see it as something new? Is that

something old?

>> I think it's more pervasive maybe, but I

think we have to be careful. So like in

if you think about the American public

like most people aren't eating the

minimum daily requirements of fruits and

vegetables let alone like personalizing

or optimizing their diet beyond that.

Most people aren't getting enough sleep.

Most people aren't getting enough

physical activity. And I think that's

the majority. Right.

>> Right. That's I'm agreeing with that.

>> Yeah. But but then there is I think

there is this minority that we pay a lot

of attention to in the media um that

that is interested in the longevity and

the optimization. I don't think there's

anything that new about wanting to use

medicine to be more well as opposed to

heal from illness. And we've been doing

that forever and we've had health and

wellness influencers forever. But I

think if you look around the mediacape

at this exact moment and you think about

how big like Rogan and Huberman and Aia

and then you have like Brian Johnson is

one of the breakout

media figures of the era. This sort of

former entrepreneur who's trying to

never die and is like the you know has

like ended up in this incredibly

incredibly

intense regimen of optimization. Like

I'm very skeptical this is ultimately

going to be good for him but you know

it's his life I guess. Clevicular this

like look maxer streamer who like hits

his head with a hammer and is on these

like crazy stacks and you know oded the

other day uh on a live stream but you

know has become like is getting billions

of views on his clips

and I think there's something about the

way like how dominant this has become in

the media sphere and it doesn't have

checks it used to have on it. I mean,

you were talking I remember the coverage

you would do at Vox of of Dr. Oz, but

one of the things happening on Dr. Oz

was like there was a network behind

that. I mean, there were gatekeepers.

There were people who didn't want to see

their stock price go down if something

went wrong. And now it's a complete wild

west boosted by algorithmic interest.

And I think it's going to push us into a

real period of like a longevity and

optimization focused

system because like there's going to be

money for it. there's going to be

attention for it and so yeah I mean a

lot of people in this country are very

very sick and what they need is

treatment for chronic illness but I

think there's going to be a real push in

the system towards treating these people

who what they are is not very sick what

they are is they are well and they want

to be weller

>> right we we so we always had the worried

well and like we've always people have

always done really wild things to

optimize their health as you're saying

but the megaphone is so much bigger and

more fragmented and it's so much more

effective at creating this confirmation

bias. Like I think about my mom who was

diagnosed with osteoporosis and she was

trying to decide whether to go on one of

these um medicines it's available for

the condition and she ended up in a

complete YouTube rabbit hole of doctors

who were really skeptical of

osteoporosis drugs and she became quite

frightened and and it took her like a

couple of years to go on the medication.

Um and this is happening at a scale that

we've never seen before, right? But this

desire to optimize like like in our book

we found this wild example of after the

first world war there was an ingredient

in explosives manufacturing that sped up

the metabolism and caused people to lose

weight and doctors at Stanford pivoted

and turned it into a drug that was taken

by like hundreds of thousands of people

and became one of the first targets of

the FDA. Um and it had terrible side

effects and c like killed people and

caused eye problems and um so so I think

we've we've always done these wild

things in search of yeah looking for the

magic cure um the quick fix or bettering

our health but the the in-your-facess of

the messages and the the way they're

targeted um with the algorithms this

we've never seen. So, I think you're

touching on something really important,

which is how this media landscape has

changed, not only around the blockbuster

FDA approved drugs like the GLP1s, but

around this broader ecosystem of um

yeah, wellness hacks and optimizers.

>> I mean, this goes to something that you

wrote about in your in in a piece you

did for the times, which is that these

are the first blockbuster drugs to

collide with our wellness obsessed

algorithmic age. And yeah, I mean I must

have clicked and at some point on Reddit

who tried content on X and now every

time I turn on the system, the platform,

I get these videos from people like

telling me how great Reddit tried and

there's a huge boom in people just

getting random peptides from China. I

shouldn't say random, but ordering

peptides from places where they can't

really tell what's in them. Um, the New

Yorker tested some of these and found uh

a lot of them have lead or impurities or

things you don't want or they're not at

the right dose. Like there there's

something wrong. We got these

blockbuster drugs and you might expect

everybody to be really excited and be on

them, but it seems to have exploded

into this biohacking moment in which

it's like if something like Mgoi could

exist, well then who knows what is out

there and you should order it from China

and inject it into yourself and find

out, right?

>> Like what do you make of it? I think it

it was it's sort of the perfect drug for

this social media algorith al

algorithmic age that we're in. Um

because it's visual, right? It's not

like like you have the before and after

photos. You have I spend way more time

than I'd like to admit on different

social like Tik Tok and um Reddit

accounts where you see the videos and

the before and after photos and how

people's bodies are transforming. Um,

and we we're kind of living in this very

appearance obsessed culture. And now for

the first time again, we have this drug

that does something that humans have

quested after for like a century or

more. Um, and and so it's meeting that

moment. Um, I think like I was doing a

thought experiment when I was working on

that piece you mentioned about, you

know, what would it have been like?

Okay. So when Prozac came on the market

um what what that was another

blockbuster drug that was another drug

where we had a cultural moment around it

but we didn't have tele medicine so you

still had to go to your doctor to get a

prescription the internet wasn't in

widespread use so you couldn't order a

research compound from China there was

no social media to compare you know do

do your um person like compare your

personal experiences and share them with

the world so yeah we have all those

things now when we have this this elixir

that we've wanted for so long, right?

The weight loss elixir. So many people

have wanted this. We have it at the same

time as we have all these other things

that have just helped create, I think,

the moment that we're in.

>> I guess this does reflect what I've told

my algorithm to to tell me, although not

intentionally.

I see so many people just posting about

like random studies that are not full

randomized control trials are often not

even in human beings and being like see

look at this amazing mechanism and look

at these early results and at least

according to them they're getting them

compounded and and and ordering them and

I'm fascinated by this because there is

some weird overlap between the community

of people who are incredibly skeptical

of vaccines of the FDA.

And at one point that was understood as

a preference for naturalism

that there was a primitivist impulse

here. And yet some of these same people

who were so skeptical about was what was

a very wellstudied

class of drugs

are now ordering completely unknown

forms of peptides. some which are about

weight loss, but some of which are just

to increase energy use or to cure your

tennis elbow or to, you know, try to

improve like, you know, cell

regeneration. And they're stacking them

in different formulations.

Like it's like a mistrust of the

authorities, but a belief in unproven

technologies in a way that like that I

find culturally very interesting. And

I'm curious as somebody who's been

around the space for a long time, what

you've made of it. Well, I think it kind

it kind of goes together. So maybe even

it was brewing before the pandemic, but

we've had this uptick in an

appreciation, an interest in um health

and health optimization.

Um and then we have these technologies

now to spread information about um

health optimization, podcasts in

particular, that are often sponsored by

supplement makers. They're mistrustful

of authority and a lot of people I think

were left quite cynical after the

pandemic of um public health and the

medical establishment and now we have

this vehicle actually that was helped

also in the pandemic with tele medicine

um where people can take their health in

their own hands in a way that they

haven't been able to before and then

this this idea that you can just do it

yourself but it it feels like that's

almost the currency today of social

media like you know you say there's this

new study and this

I found this new use for something and

now I'm going to promote it on my feeds.

Um,

>> well, I think it reflects this way in

which you have to trust something. The

world is simply too complex for anybody

to have firstirhand knowledge of very

much of it at all. So you can trust

established authorities like the FDA and

the CDC,

but if you lose trust in them, you have

to still find some way of deciding what

to believe and what not to believe. And

a lot of people choose individual

voices, you know, Andrew Huberman or Joe

Rogan or Peter Aia, uh, or people

further into the the Maha world. And I'm

not even saying they're necessarily

corrupt, but if you're in media, for

instance, and you run a podcast on

health and wellness week after week, you

have to find new things to say. Just

getting on the mic every week and

saying, "Here's another week when you

should eat whole foods and try to reduce

your stress and sleep well, it doesn't

last." Even putting aside the fact that

some of them are getting a cut of either

supplement companies or advertising for

it, they have this huge bias towards the

next new thing

>> and it was always there, right? I spent

a lot of time earlier in my reporting

career with you at Vox like looking at

Dr. Oz and I remember once interviewing

him years ago and he said, you know,

that I I think I said like why do you

have the magic and miracles on your

show? Like you're you're a

cardiothoracic surgeon. You know, this

isn't um research base. It was a

question like that and he said you know

if I didn't have the magic in miracles I

wouldn't have a show. Um I think there's

also something that like the you know

that the very sound advice the very

sound scientific foundation we have for

how to optimize your health. [snorts]

It's so boring. Right. It's what you

said. It's like sleep more have social

relationships. Eat more vegetables. The

stuff your mom has been saying to you

since you were in your high chair. And

yeah, but to to have the podcast or to

have the social media feed, you need to

have this new advice. I totally agree

with you.

>> I I will say before I make this next

point that I think injecting yourself or

taking poorly studied peptides, it's a

stupid idea and people shouldn't do it.

So, I really want to say this very

clearly, but in preparing this episode

and reading what some of the peptide

booster types are saying, their argument

is, look, people have a right to do

this. It is their body. They are doing

it and it would be better if we let them

buy them from domestic compounders whose

processes we could regulate and oversee

rather than these fly by night Chinese

companies

that we can't trust. But how do you

think about balancing this this argument

like look people are doing this it's

their right. um we should allow them to

get things that are safely made against

this like the government doesn't want

you doing this and we're going to try to

make it hard to get them and increase

the you know the risk so more people

>> you know don't try. So that argument is

how we got the supplement market. We

have you know do you know that the

history of how supplements became kind

of this thing that FDA

>> um it's that there there was a big

campaign push in particular helped by

supplement makers. It was like a massive

letterw writing campaign on the part of

the public um TV ads with famous actors

and the thing was like don't touch my

supplements. I have the right to use

these supplements. representatives who

were from states with um large

supplement manufacturers really pushed

to to have this kind of lacks regulatory

environment. Um but it was this this

argument that Americans have the right

to use the supplements they want to use.

That's why we have this regulatory

regime around supplements that we have

today.

>> Which way does a supplement argument

actually point? You know, you walk into

Whole Foods or you walk into CVS and

there's a lot of supplements and I don't

think we see it as like a national

tragedy and a lot of those supplements

have names I don't even know. So, is

that a bad thing or a good thing? Right.

Am I upset people can create these

supplement stacks? I mean, not really.

If you want to take aine or whatever, go

for it.

I think I think when people are being

misled and using like scarce resources

on things that aren't going to help

them, I think actually it is a problem.

Um I I personally think like you know

the government has a role in protecting

public health and protecting consumers.

Um, but it's a very sensitive topic and

a lot of people, especially in the

American context, it's this idea that,

you know, you have the right to do what

you want with your body and to access

the the um products that you want to

access. And like I I guess I have a more

conservative view on that, but a lot of

people definitely disagree with me.

>> I mean, my gut is that this is going to

become a disaster. My my personal view

is actually fairly conservative. I'm

trying to be the devil's advocate here,

but it seems like people are taking a

lot of things right now to increase cell

growth, which maybe is good in the short

term, but has really frightening

cancerous properties in some of these

cases. In the long term, I mean, I think

we might end up realizing that a couple

of the things that people are starting

to get excited about, you know, are

really not good for folks, which has

happened before. I mean, we were talking

about Fenfen and things like that

earlier. We have had periods where

people got really into something and it

wasn't good for you. We used to put

cocaine in Coca-Cola.

>> Absolutely. Yeah. If you know anything

about the history of medicine, it's

littered with examples like this. And

that's also why I always come at this um

much more conservatively. Um but I I

think yeah, we're we're we're definitely

in this big experiment now where yeah,

these these different things are

colliding, right? this interest in

wellness and longevity and health

optimization, the availability of these

drugs that seem to do everything and

then these um these over-the-counter

variants that people are accessing and

buying online or in the pharmacy. It's a

it's a potential disaster waiting to

happen. One thing that I think is just a

deep appeal of these drugs of of broader

peptides and other things that are you

know becoming culturally uh influential

is you know what on some level we all

want is control.

Control over our bodies, control over

our health, control over never getting

the diseases that scare all of us.

And on the one hand, if you are able to

be given a real possibility for control,

if it's true that the GLP1s at low doses

protect you against heart disease,

amazing. Uh, statins have been amazing.

If it's true, I have a friend, somebody

who I I I care about tremendously, whose

parent died young of dementia, and I've

been following all this Alzheimer's

research on them, you know, very closely

because if they're prophylactic against

dementia, like I want my friend to take

them. So, I'm not saying that wanting to

protect yourself is a bad impulse. It

isn't.

On the other hand, a desire for endless

control over your own body and future

can be mentally poisonous too because

you can't control it. Right? The the

great insight of Buddhism is that you

know desire and craving are the root of

suffering and you know the more we trick

ourselves into believing we can control

what will happen to us then when things

do happen to us we feel like we failed.

>> Absolutely. We live I think we live in

this in particular around controlling

food and the body. We live in food

environments that are so gamed against

making the right choices for most

people. Right? So even if you are on the

GLP1 and I've talked to many of these

people, they're not losing the amount of

weight they want to lose um because they

have other barriers to eating the way or

exercising the way they'd like to. We've

created these systems and um food

environments that make it literally

impossible for most regular people to do

the things that they know they need to

be doing for their health. [snorts] And

that's something that I would love more

attention paid to um by whoever's in

power, like pulling more levers to help

prevent these diseases from the first

place so that we don't have to do things

like um inject young people with drugs

that we don't understand the long-term

effects of. And I'm not anti-GLP1 at

all. Like I think they've been absolute

like game changers for so many people

I've talked about for friends and

family. But we're doing this big

experiment on the population because of

diseases that really are preventable. If

we do the things that we've long known

we need to do like restricting junk food

marketing to kids, um figuring out ways

to make healthy food more accessible. It

actually it enrages me as a person who

struggled with my weight before like

this realization that this was

preventable. I didn't have to suffer

like that. And kids like the kids who

are now going through this now, they

don't have to suffer like this.

>> I feel like I've heard this argument as

long as I've been touching this issue

which like as you know the beginning of

my career as a healthcare reporter and

I, you know, we debate food deserts and

what would happen if we put you know

good grocery stores in food deserts and

we did this in a bunch of places and it

didn't really work. I I've become very

cynical about this. I mean, yes, it

would be much better if everybody had

was like wrapped around with, you know,

more walkable places to live and and

better and healthy foods. And I don't

think you should be able to advertise

junk food at all to children. I think it

should be illegal to have Paw Patrol on

kids cereals. I think this whole thing

where we allow endless advertising

children is completely insane. And it

makes every parent's life in the grocery

store a nightmare, myself included.

And for the society at large, I think

the problem is people want things that

aren't good for them.

>> But we've never done enough.

>> But people don't want you to do enough.

>> But which people? I feel like

>> the people who vote like this happened

in in New York. Bloomberg wanted to tax

sodas.

>> They almost ran them out of town on a

rail.

>> Okay. Okay. No, but I think things are

the politics of this are changing. I

think like more and more people are

raising kids with diseases like diabetes

and fatty liver and they're aware that

this is caused by the food environment

and I feel like that that the politics

there is shifting but we've never done

the inversion of our food environment

that we need to do. It's going to take

many many levers to really see an impact

and that really hasn't been done. I've

just become I I think you would need a

level of paternalism for that that I

guess what I would say about it is that

there is not a single jurisdiction in

this entire country where the politics

of that have worked. Like we cannot

point at one thing, one place, one

state, one city where we've been able to

do that much. If it were there to do, I

would be the first one to say we should

do it.

>> But I don't think it's there to do. like

the public health community like we

tried to get people to take vaccines in

the like aftermath or the the the math

during a deadly pandemic

>> and it led to like the largest public

health backlash

um in my lifetime such an RFK Junior is

now the secretary of health and human

services people's sensitivity to

paternalism is very very very high it's

a very potent political force

>> but I think one thing that I'm talking

about and that that we write about in

the book it's not about taking people's

fried chicken or their M&M's away. It's

about making a food environment where

the healthy options are as accessible as

the unhealthy stuff. And and so so I'm

living now in France and obviously the

politics are completely different.

There's no shortage of chocoliers of

places where I can buy croissant bos

like all these things that I know I

shouldn't be eating every day. But as

accessible are the healthy options. So

they they've done things like fresh um

food markets in every district. Um they

minimize the size of grocery stores um

through land use planning since the late

1800s like using school lunches as a

lever to feed children healthfully. And

over time they've become more and more

avancgard about what that actually

means. They pull all these different

levers. But what we're what we're

talking about I think is creating this

regulatory environment around chronic

disease. like how do you protect the

public from developing these diseases

like obesity, diabetes, cardiovascular

disease? And it seems like impossible

now because it does involve these

radical changes to the food environment.

But America did this over 100 years ago,

right? When we started to protect people

against acute food poisoning, it was

just it was wild west. They were putting

calf brains in milk at this time and

putting like brick dust to dye food in a

certain way and lead. That's where the

FDA came from. And that's where the meat

inspection program of the USDA came from

after um like the the publication of

Upton Sinclair's book. And but I hear

you. It's going to be very difficult. I

do think the politics are changing. So

we're in a moment where like places like

California and West Virginia are both

looking at, you know, doing things like

reducing ultrarocessed foods in school

lunches and um banning certain

additives. Um, so, so really politically

distinct places and people like Robert

F. Kennedy Jr. and Trump and the former

FDA commissioner David Kesler. Um, what

they're saying about diet caused

diseases, you can't tell who's saying it

anymore.

>> That's true. But I've been extremely

disappointed by the abil by Kennedy.

I've been extremely disappointed to see

that even the parts of Maha that I

thought made sense like have made it

nowhere. right? You will watch Kennedy

now at like like eating his call fried

French fries and you know go into um

like these fast food restaurants that

you know if they really wanted to make

America the um American food environment

better like they could. Meanwhile, the

president of the United States is like

forcing RFK Jr. to eat McDonald's and

photo ops,

>> right? Like their actual willingness

when it came down to it to take on

industry was extremely low.

>> No, absolutely.

>> Like Yeah. Like if you listen to what

they're saying, it's fine. Have they

done anything that will in a sustained

way change the food environment for

people? I would love to have seen Maha

ban, you know, advertising to kids. They

didn't.

>> No. The way I think about it is we, you

know, you had the the new nutrition

guidelines come out which had this great

message, eat real food, right? But no

one is doing anything to make it easier

for the people who actually really

struggle to afford and access real food

to to to eat that food. Right. It's like

there's something like 3 million fewer

people on SNAP and that's something that

the administr the administration has

made it more and more difficult for

people

>> huge cuts are are continuing to go into

effect there.

>> And um and there there were programs to

make um local and fresh produce

available for school lunches and those

have been cut. And then there's a lot of

like um tweaking at the edges of you

know swap out high fructose corn syrup

with cane sugar or focusing on certain

food additives and there's such marginal

problems in in the greater system if you

really want to help more Americans eat

real food. You're going to have to do a

lot more than that and you're going to

have to focus on the segments of society

that were on food stamps for example. Um

so so I completely agree. I think a lot

of the rhetoric has been in the right

place. Like this is the first time I've

seen at that political level people

talking about the food environment and

saying, you know, these diseases are

preventable and they are caused by these

environmental factors um taking the