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- [00:03]
Anoush Zamorodi
You are listening to TED Talks Daily where we bring you new ideas and conversations to spark your curiosity every day. I'm Anoush Samaroti sitting in for Elise Hu this week with a special series of episodes all about how you can live a healthier life in our high tech era. You may know my voice from the TED Radio Hour podcast over at npr. I'm also an author, two time TED speaker, and this past April a guest curator for the TED 2026 conferen. My session was all about my obsession with technology, the human body, and what is keeping us human in this digital age. And that included the speaker you're going to get to know today. Dr. Dhruv Kullar Dhruv is a practicing physician and associate professor at Weill Cornell Medical College. He also writes for the New Yorker, where he investigates all kinds of topics at the intersection of medicine, policy and being human in this hyper accelerating world. I love reading his articles and I love his measured take on hot topics in health. He brings the perfect mix of science and just kindness and empathy. You'd want him to be your doctor, you know. Anyway, his talk is about a hot topic in medical innovation, GLP1s drugs like Ozempic and Wegovy that millions of people are taking to treat diabetes and more, more controversially, to jumpstart their weight loss journeys. And while these drugs have been around for a while, we are still learning a lot about how they work and the many ways that they can impact us beyond the number on a scale.
- [01:46]
Dr. Dhruv Kullar
Now. For a long time, GLP1 was thought to be mainly about digestion, but it's now clear that the medications affect much more than eating. They might have some of their most surprising effects not in the gut, but but in the brain.
- [01:59]
Anoush Zamorodi
As Dhruv explains, GLP1s are starting to show real signs of treating addictions, all kinds of addictions, from alcoholism to gambling. And the way that these drugs work is changing how physicians and researchers think about how they treat people with addictions. But also, as you'll hear, for some people it's more taking a GLP one can change the way that they think about themselves and how they actually live their life.
- [02:26]
Dr. Dhruv Kullar
There's still a lot of stigma that's preventing people from coming forward. They have an addiction. I don't want to say that, you know, our behavior, our will, has no role in these conditions. Of course we need to encourage and help people make decisions that are in line with their health. But I think that needs to be paired with an understanding that a lot of these processes are neurobiological and shaming people because they have these conditions is not going to be a productive way to go about it.
- [02:51]
Anoush Zamorodi
I called up Dhruv at his office at New York Presbyterian Hospital in New York City. You will hear all the action going on. You'll hear some of the emergency room sirens going off right outside his window. So coming up, Dhruv's talk and our conversation afterwards about living in a GLP one world.
- [03:11]
Sponsor/Advertisement Voice
This episode is brought to you by Walmart Business the best leaders might tell you the work that moves an organization forward doesn't happen in spreadsheets or supply chain emails. It happens when you have the space to think big. That's the idea behind Walmart Business. It's built to take the friction out of running an organization so your team isn't losing hours to procurement logistics when they could just be focused on the problems that actually matter. With an ever expanding business assortment, everyday low prices and fast, reliable shipping, Walmart Business keeps your operations running smoothly. Shop online, in store or through the Walmart Business app, however, works best for you. Simpler operations, smarter spending. It's Walmart built for your business. Sign up for a free Walmart business account@business.walmart.com this episode is brought to you by Dell Back to School starts now. Get long lasting battery life on the Dell XPS laptop powered by Series 3 Intel Core, so you can work from anywhere now starting at $699 with exclusive student pricing starting at 599. And it's lightweight, portable and packed with enough processing power to make multitasking a breeze. So say goodbye to distractions and hello to more free time because you finished your work faster. Complete your setup with savings on select monitors and more. Must have electronics and accessories, limited time deals and free shipping on PCs and more await you@dell.com deals that's Dell.com deals. This episode is brought to you by LinkedIn. Running a small business means every hire matters. A bad hire can cost you time, money and momentum. A good hire? They can help grow your business. But finding great talent isn't easy, especially when you don't have the time or resources to sift through piles of resumes to find the right fit. That's why LinkedIn built Hiring Pro, your new hiring partner that screens candidates for you. So instead of sorting through applications, you spend your time talking to candidates who are actually a good fit. With Hiring Pro, you can hire with confidence, knowing you're getting the best talent for your business. In fact, according to LinkedIn, those hiring with LinkedIn are 24% less likely to need to reopen a role within 12 months compared to the leading competitor. Join the 2.7 million small businesses using LinkedIn to hire. Get started by posting your job for free@LinkedIn.com TEDTalk terms and conditions apply.
- [05:46]
Anoush Zamorodi
And now our TED Talk and conversation of the day.
- [05:51]
Dr. Dhruv Kullar
Last year, I met a woman I'll call mary. Mary was 13 when she started drinking, and soon she could drink 18 beers in a sitting and barely seem buzzed. Her days became a blur of inebriation and hangover. Mary wanted to stop drinking. She tried alcohol rehab, Alcoholics Anonymous, a medication called Antabuse. None of them worked for her. One day, Mary was at a bar with a friend who also drank heavily. But that evening, Mary noticed that her friend had hardly sipped her drink. Her friend told her that she started taking Ozempic, and now she could barely drink two beers at a time. Mary was perplexed. She'd always thought of Ozempic as an obesity medicine. What did it have to do with drinking? But she decided to enroll in a nearby clinical trial that was studying whether GLP1 medications like Ozempic could help people with alcohol addiction. Every week, researchers blindfolded her and injected her with a either Ozempic or a placebo. Within weeks, Mary lost her taste for beer. She switched to white wine. And then she stopped drinking altogether. Many people talk about Ozempic as getting rid of the food noise inside their heads, those intrusive, unwanted, repetitive thoughts about eating. For Mary, it cleared out alcohol noise. It started to moderate her desire for drinking. It turned what was an overpowering emotional response into something that could be seen from a distance. Suddenly, she had the mental space to make changes in her life that she'd long wanted to. She started exercising. She improved her diet. She ended a difficult relationship. People know how much GLP1s affect your body, she told me. I don't think they realize how much they affect your mind. Now, as a doctor, I have long wished that we had more to offer people who are struggling with an addiction. And hearing Mary's story, it's hard to overstate just how striking it was. GLP1, or glucagon, like peptide 1, was first discovered way back in the 1980s. Scientists thought that it might be helpful to manage diabetes. But because the naturally occurring version of the molecule broke down within minutes, it was hard to turn into a drug. The big break didn't come until years later, when a scientist who was studying Gila monsters of all things, found that the lizard's Venom contained a similar peptide, and that peptide could hang around for hours. His discovery catalyzed what would become the GLP1 revolution. Now, for a long time, GLP1 was thought to be mainly about digestion. But it's now clear that the medications affect much more than eating. They might have some of their most surprising effects, not in the gut, but in the brain. Stories like Mary's have led scientists to consider whether these medications could be helpful for all sorts of addictions, from alcohol and cocaine to gambling and compulsive shopping. Research has found that GLP1s might help people stop smoking, reduce their cravings for opioids, lead them to consume fewer drinks. As one neuroscientist put it, GLP1s might be telling us that there is some type of universal pathology when it comes to addiction and that they are part of how we fix it. Now, that is a tantalizing prospect, that there's a general purpose key that unlocks the path to moderation. But that's what GLP1s seem like. They could be moderation molecules. They don't extinguish our desires, but they help us keep them in check, and no one knows exactly why. One possibility is that they modulate what's called the brain's mesolimbic pathway, sometimes referred to as the reward system. Alcohol, nicotine, cocaine, social media, they all increase dopamine release in that pathway. And GLP1s, they might be limiting the spikes of dopamine. So mice that are on the medications and given cocaine, they have smaller surges of dopamine, but they otherwise seem to maintain adequate amounts of the neurotransmitter. GLP1s could be calming the water without draining the pool. At the other end, GLP1s might make it easier to stop using a drug. Research that's currently under review has found that animals that are addicted to opioids and given a GLP one, they have less activity in a part of the brain that's involved with withdrawal. So again, these medications could lead to moderation, not just because they make a drug less pleasurable, but because they make abstinence less painful. Now, at this point, we should probably moderate our own enthusiasm about the moderating effects of these medications. Like any drug, GLP1s won't work for everyone. In fact, for some people, these so called moderation molecules, they could have an alter ego as a desire dampener. Maybe some people lose interest in drugs or alcohol or food because they lose interest in pretty much everything. A condition known as anhedonia it's also true that addiction is often a lifelong battle. But many people who start on a GLP1, they come off it within months, whether because of side effects or costs or access. And even people who do manage to stay on the medications might ultimately develop a tolerance to them, such that their cravings for a drug ultimately return. And yet, it is hard not to get excited about the potential for GLP1s to treat addiction when you consider how little progress we have made. Every year, tens of thousands of Americans die of an opioid overdose. Since the turn of the century, alcohol related deaths have more than doubled. And it has been 20 years since since the FDA last approved a medication for alcohol use disorder. The winding path of GLP1s from Gila Monster peptide to diabetes medication to obesity drug to potential addiction treatment. It is a story of hope. But it is also a story with a lesson. The hope is that more people will gain the power to bring their wants and their motivations and their behaviors into greater harmony. And they will live many more years in good health as a result. The lesson is about the unpredictability of medical progress. Discoveries like this one remind us why scientific curiosity, especially the kind that can seem obscure or impractical, why it matters so deeply, because we don't know where the next big innovation will come from. We might not even recognize it when we first see it. But now GLP1s are forcing us to reconsider not just the modern science of addiction, but ancient wisdom about restraint. For thousands of years, we have seen moderation as a moral achievement. Aristotle argued that the path to a life well lived runs through moderation. Courage rests somewhere between cowardice and recklessness, generosity between stinginess and extravagance. He's often quoted as saying it is best to rise from life as though from a banquet, neither drunken nor thirsty. Well, Aristotle never had a Dorito. He didn't have Krispy Kreme or McDonald's. He couldn't flip open TikTok and Instagram. There weren't algorithms that were fracking his attention. And ancient Greece was not beset by fentanyl and oxycodone. We have a society today in which the fundamental problem for many people has shifted from scarcity and boredom to excess and distraction. Our technology often seems purpose built to tap into our most basic vulnerabilities. And the question now is how to bring our minds and our bodies and our environments into a more natural balance. GLP1s. They suggest that Aristotle's moderation is not just a virtue. It is a physiological state. It isn't just about character, it is about biology. And none of this is to suggest that we should somehow give up on the struggle to bring about a more healthful society. That we shouldn't do the hard cultural and political work to bring about a better world in which we can address the drivers of addiction and other social problems, things like loneliness and trauma, pain, poverty, exploitation. But it does suggest that we should welcome a promising new tool into our toolkit now. Over the years I have cared for many patients in the moments when an addiction has taken almost everything from them. The young woman whose post surgery opioid use turned into a heroin addiction and then into the heart infection that took her life. The father whose liver failed after decades of alcohol use, who was slowly dying on a transplant list. Every morning I entered his room and was greeted by his children aged six
- [15:55]
and eight and they would ask me
- [15:58]
when their dad could go home. Those were some of the hardest conversations
- [16:04]
I have ever had.
- [16:08]
In recent months, I have returned again and again to something that Mary told me. She said that GLP once enabled her to act not just on her immediate desire to stop drinking, but on her deeper desire to reinvent the person she wanted to be, to change her habits, her relationships, even how she saw herself. She gained a kind of freedom to live alongside her desires instead of being ruled by them. Because alcohol was no longer an issue, she told me, I finally had the chance to think, what type of life do I want? And that is a question that every person deserves a chance to ask. Thank you.
- [16:54]
Anoush Zamorodi
That was New Yorker writer Dr. Dhruv Kullar. When we come back, Dhruv and I discuss why there's still a stigma around addiction, even though we have been talking about the genetic and biological reasons behind addiction for decades. Will GLP1s finally change that? And what about the people for whom GLP1s don't work? What are their options? Be back in a sec.
- [17:20]
Sponsor/Advertisement Voice
This message is brought to you by Apple Card. Apple Card members can earn unlimited daily cash back on everyday purchases wherever they shop. This means you could be earning daily cash on just about anything, like a slice of pizza from your local pizza place or a latte from the corner coffee shop. Apply for Apple Card in the Wallet app to see your credit limit offer in minutes, subject to credit approval. Apple Card issued by Goldman Sachs Bank USA, Salt Lake City branch terms and more@applecard.com this episode is brought to you by gusto. Great work rarely happens by accident. It happens when the right systems are in place and for small business owners that often starts with the basics. Payroll, benefits, onboarding, and hr. Gusto makes all of that simple. Gusto is an online payroll and benefits software built for small businesses. It's all in one remote, friendly, and incredibly easy to use. So you can pay, hire, onboard and support your team from anywhere. With built in tools that automate everything from offer letters to direct deposit, your team spends less time on paperwork and more time focused on growth. There's a reason Gusto is ranked number one on G2's highest satisfaction products list this year and trusted by over 400,000 small businesses. Try Gusto today at gusto.com TED Talks and get three months free when you run your first payroll. That's three months of free payroll at gusto.com TED Talks one more time gusto.com TEDTalks.
- [18:54]
Anoush Zamorodi
So did you meet Mary because you were doing research for your journalism or she wasn't your patient, right?
- [19:02]
Dr. Dhruv Kullar
No, she wasn't my patient. She was someone that I had met through a clinical trial researcher, and she was a patient who was enrolled in one of his trials.
- [19:08]
Anoush Zamorodi
Got it. So you got introduced to her and so she finds out about this clinical trial and she's like, huh, this could be interesting for me.
- [19:17]
Dr. Dhruv Kullar
That's right. You know, in Mary's case, she also experienced pretty significant reduction in her appetite. And so there were days where she was eating, you know, 3, 4, 500 calories a day, and she lost 55 pounds in just five months.
- [19:31]
Sponsor/Advertisement Voice
Oh my gosh.
- [19:32]
Dr. Dhruv Kullar
And she ended up having to come off the medication because she lost so much weight so quickly, but she was able to maintain her sobriety afterwards. So even after she came off the medication, really, she's had a much healthier relationship with alcohol and she's maintained her lower weight and she's maintained her healthier lifestyle. For her, it's been a really positive experience.
- [19:55]
Anoush Zamorodi
I mean, I think for normal people hearing that, get a shot of Ozempic and you can turn your life around. That seems amazing. But as a physician, what was it about these stories connecting GLP1 medication to addiction that struck you as so, I mean, I guess, strange and unprecedented?
- [20:17]
Dr. Dhruv Kullar
Well, I think you have to think back about the history of Ozempic. It was first discovered many years ago, and glucagon, like peptide one, which is a naturally occurring hormone, I mean, that was discovered nearly half a century ago now. And it was always thought to have effects for diabetes and then later weight loss. But the idea that it could modulate the way that people were experiencing the rewards of Drugs and other types of behaviors. That is a much more recent discovery. And so this kind of came about because there were just so many stories of people saying that they wanted to drink alcohol less, they didn't want to smoke as much. People who had been taking opioids weren't having the same types of cravings that they had in the past. And some of that you take as anecdotal evidence. You're not sure exactly what to make of it. But over the past year or two, there has been a good amount of trial work that has shown and is increasingly showing, that there are pretty substantial effects here, here GLP1s. They seem to be acting across these different types of addictions, which is quite novel and interesting. The prior thinking had been that they are modulating mostly our desire for food and creating a sense of satiety. And now the thinking is that maybe these effects are much broader than we previously thought. Things like alcohol or nicotine or cocaine, even social media, they seem to increase dopamine release in the pathway. And at least the theory is, and there's some animal work to support this, is that the spikes of dopamine are being blunted by GLP1s, but the kind of baseline levels of dopamine aren't being drained fully. And so it may be that this class of medications will be an important adjunct to people who are struggling with addiction.
- [22:03]
Anoush Zamorodi
So, I mean, we've been told in the last couple years, this is so interesting, like dopamine. Dopamine is the problem here that you're getting these squirts of dopamine, and that's what's making you behave irrationally, as you said, whether it's like Doritos or TikTok or whatever else it is. Is it that simple? Or tell us more about how this, like, mesolimbic pathway actually works and whether dopamine is the culprit.
- [22:27]
Dr. Dhruv Kullar
Well, dopamine is involved in all sorts of processes in the brain. So I think, you know, today in modern parlance, has become kind of synonymous with this idea of addiction, whether it's to social media or to a drug or other substance. But dopamine is involved in all sorts of things from motor function. You know, people with Parkinson's disease, for instance, have disrupted dopamine in some of the motor parts of the brain, as well as motivation. And so our desire or our motivation to seek out things, whether those are positive rewards or negative rewards, those are also being influenced by dopamine. So sometimes there is this kind of reductive sense that it's just a matter of dopamine spikes. And if we just blunt those spikes, we'll be able to overcome much of what's ailing us today. And I don't think it's as simple as that. And some of the ways in which these medications are actually operating are still mysterious. And so, you know, one of the interesting things I came across in my reporting is that it's still kind of, kind of a question mark how exactly these medications are even affecting the brain, you know, as they become these longer lasting, more powerful medications. And it's not even clear exactly how or if they get into the brain. And so, you know, there's a lot that we still have to learn about the exact ways in which GLP1s are affecting not only the brain, but the body more generally. But from what we're seeing, from trials that are being published not only on addiction but on other types of disorders, they seem to have a number of positive effects.
- [23:53]
Anoush Zamorodi
Yeah, I was just saying that there's research into like the relationship between the gut and the brain as well, that it's not just the brain that these drugs affect when it comes to eating and addiction, but the conversation that's going on between the intestines and the brain.
- [24:09]
Dr. Dhruv Kullar
Yeah, I mean, for a long time, GLP1s were thought to affect primarily the gut. They have their receptors all over the body. There are receptors in the pancreas and the gastrointestinal, intestinal tract. The brain, of course, GLP1s, they stimulate the release of insulin, they slow the passage of food through the stomach. They're signaling to the brain that we are full. So there's a lot of crosstalk between the gut and the brain. And there's some thought that maybe some of what we're seeing both in terms of addiction but also other types of conditions, is related to the ways in which the medications are affecting both the gut as well as the brain.
- [24:47]
Anoush Zamorodi
We're going to take a quick break and then we'll be right back.
- [24:50]
Sponsor/Advertisement Voice
This episode is brought to you by Walmart Business. The best leaders might tell you the work that moves an organization forward doesn't happen in spreadsheets or supply chain emails. It happens when you have the space to think big. That's the idea behind Walmart Business. It's built to take the friction out of running an organization so your team isn't losing hours to procurement logistics when they could just be focused on the problems that actually matter. With an ever expanding business assortment, everyday low prices and fast, reliable shipping. Walmart business keeps your operations running smoothly. Shop online, in store or through the Walmart business app, however, works best for you. Simpler operations, smarter spending. It's Walmart built for your business. Sign up for a free Walmart business account@business.walmart.com this episode is brought to you by NPR's Planet Money. You know, one thing I love about TED talks is how they take something huge, a scientific breakthrough, a global system, and make it feel deeply, personally relevant. NPR's Planet Money does that same thing, but for the economy. Every episode starts with a why are Pokemon cards outpacing your retirement account? How has Russia's economy held on through four years of war and sanctions? What does a 750 pound walk robot mean for the future of restaurants? These aren't abstract economics lectures, they're human stories. Funny, surprising and genuinely illuminating. The Planet Money team has published a book tracing the global supply chain, launched a satellite to explore the private space industry, and walked inside a live book auction. All in the name of helping you understand how money shapes the world. It's econ down to Earth. Follow NPR's Planet Money podcast and understand how money shapes the world. This message is brought to you by Apple Card Apple Card members can earn unlimited daily cash back on everyday purchases wherever they shop. This means you could be earning daily cash on just about anything, like a slice of pizza from your local pizza place or a latte from the corner coffee shop. Apply for Apple Card in the Wallet app to see your credit limit offer in minutes subject to credit approval. Apple Card issued by Goldman Sachs Bank USA, Salt Lake City branch terms and more@applecard.com.
- [27:15]
Anoush Zamorodi
I mean, with all of this, as you point out in your talk, it makes us rethink sort of assumptions we've made about people's morals or their personality for centuries. That someone is weak willed or has no, you know, has no discipline, that they can't stop themselves from whatever, drinking, smoking, etc. Etc. I remember this shift in thinking, like in the 90s, I guess it was, where people were like, you know, you're not a bad person if you're addicted. Addiction can run in your family. It's genetic. It's a chemical imbalance that's happening in your brain. It's not your fault. That was a flip that happened in terms of not blaming people who have addictions, but blaming sort of the way their brains work. Do you think that we're being set up for a new chapter, a new way of thinking about addiction and the way we talk about or treat people who struggle?
- [28:09]
Dr. Dhruv Kullar
I Think so. I mean, some of the estimates are that one of every eight people in the United States have been on a GLP1 medication at some point. So these are millions, tens of millions of people who are using these medications and are seeing the effects of them in their lives. I mean, I think because these medications are so widely used, there's going to be a different relationship both towards obesity as well as addiction.
- [28:33]
But I think there's still a lot
- [28:35]
of stigma that's preventing people from coming forward when they have an addiction. We have, as you said, made a lot of strides towards recognizing that a lot of this is biological, that it's happening even unconsciously, and that people really struggle in ways that, you know, they shouldn't be blamed for what's happening here. And so we've known that for many decades now. And for me, some of this really came home during my reporting for this piece. You know, I underwent an MRI scan and similar to what trial participants would have gone through. And, you know, I went into this mri, they were showing me photographs of all sorts of things, whether it's Big Macs or, you know, mountains or alcohol like beer, wine, whiskey. And they were basically seeing how my brain reacted to these various images. And afterwards, they showed me in response to photographs of alcohol, there was very little activity in kind of the relevant centers of my brain. And they compared them to people who are struggling with alcohol use disorder, and those areas just lit up in those people. And for me, it kind of drove home this point that so much of our behaviors, downstream of these processes that are happening inside of our brains before we even have an opportunity to make a kind of a reasoned decision about what we're going to do. And so I don't want to say that, you know, our behavior, our will, has no role in these conditions. Of course, we need to encourage and help people make decisions that are in line with their health. But I think that needs to be paired with an understanding that a lot of these processes are neurobiological. And shaming people because they have these conditions is not going to be a productive way to go about it.
- [30:13]
Anoush Zamorodi
I mean, I'm trying to picture as we go forward, you're saying one out of eight people is starting to take this drug and many of them are off label. Right. Like for all kinds of different things as well.
- [30:26]
Dr. Dhruv Kullar
That's right. So, you know, diabetes, obesity, addiction, these are just a few of the conditions for which this class of medications is being studied. I mean, people seem to have beneficial effects for cardiovascular health or stroke risk. There have been studies published that individuals with fatty liver disease or chronic kidney disease, those things either slow down or even reverse on GLP1 medications. Interestingly, even osteoarthritis seems to have some evidence. So things that we would not have anticipated seem to be amenable to treatment with GLP1 medications. And some of that is independent of the weight loss. One reason might be that GLP1s are having some type of anti inflammatory effect. So there's a change in the amount of inflammation in the body and that's what's contributing here. You know, I don't want to come off as a total booster of these medications. I think there are things that we should talk about in terms of cost and side effects that may limit the use of the medications in some people. But I have been struck by just how many conditions seem to be amenable to these drugs.
- [31:30]
Anoush Zamorodi
I mean, that's what's so like kind of bizarre to me is that I feel like everyone was like, well, let's wait and see, like a year ago, two years ago, and now largely the medical community has come around. But let's talk about like, you know, everything has downsides. What are the downsides for GLP1s? As far as we know now, anytime
- [31:55]
Dr. Dhruv Kullar
people start talking about a wonder drug, we should approach that with some skepticism. And I have approached that with skepticism and I've been surprised at how many times the evidence actually has supported their use for various conditions. But that being said, there are things that should still give us caution. So I think the first is that it can be hard for a lot of people to stay on these medications. Drugs only work if you take them. But at least in some studies, half or more of people come off these medications within a year of starting to take them. And so of course that is going to limit how effective they can be if people aren't able to stay on them. It's also possible that some people experience psychological side effects. There have been reports, not a lot of great research yet, but at least reports that people feel kind of a blunted mood or even anhedonia, they're not interested in doing the things that they used to do. And of course that is potentially quite concerning. If people aren't interested in kind of living the life that they want to be living. You know, that's something that needs to be followed very closely. You know, the cost is still a huge issue. The sticker price can still be a thousand or thirteen hundred dollars a month. And so as you can imagine, not a lot of people are going to be able to afford that. And finally, I would say GI side effects in clinical trials, they seem to be pretty well tolerated. So maybe 5 or 10% of people have significant enough GI side effects to come off them, but that is potentially higher in the real world. And one reason that people are coming off the medications, the thing that I
- [33:26]
Anoush Zamorodi
keep hearing about is, oh, they have the Ozempic look. It's the gauntness. And that is because, why, what happens to muscles when people are on GLP1s?
- [33:36]
Dr. Dhruv Kullar
Well, one of the things that happens when you're on a GLP1 is that often people are losing a lot of weight. And with that weight is going to be part loss of fat, but also loss of muscle. And losing a lot of muscle very quickly can be concerning for all sorts of reasons, but one of which is it can lead to frailty and people might be at higher risk for falls and other problems. And so the recommendation really is not just to take the GLP1 in isolation, but to do it along with the diet, an exercise regimen. The diet should be a high protein diet that allows you to preserve as much muscle as possible. And of course, the exercise regimen should involve high levels of strength training so that people, when they're losing the weight, can preserve as much muscle as possible.
- [34:18]
Anoush Zamorodi
And what about, like, long term, we just don't know, right? Like, some of the side effects may not show up for five years, a decade, 20 years.
- [34:28]
Dr. Dhruv Kullar
That's possible.
- [34:28]
I think one area that really gives me a little bit of confidence here is that these medications have kind of blown up on social media and elsewhere over the past few years. But versions of these medications have been around for two decades now. So the first GLP1 medication came out in 2005, 2006, axenatide, and that had to be taken twice a day. And it didn't have as powerful effects on weight loss. And so it wasn't kind of the phenomenon that these newer GLP1s have become. And we haven't seen those really concerning side effects that have sometimes cropped up with other medications over the course of five or 10 years. That's not to say that these specific formulations couldn't have other types of side effects, but it does give me some confidence that what we're seeing here is likely to be a more positive story.
- [35:15]
Anoush Zamorodi
I mean, that is reassuring in some ways. Part of me is like, put me on it now, coach. You know what I mean? Like what? Why not? If it's gonna prevent, you know, all the things that come with aging. Right. Those inflammation based chronic diseases. But two experiences have given me pause. One was that I was at an American Heart association meeting and some researchers were Talking about using GLP1s preventively in populations of kids where they don't get enough exercise or eat proper food. Or just this idea that obesity and diabetes are hitting younger people at younger and younger ages, school age children, that maybe if diabetes type 2 is rampant in a population, that this should be used preventively. And that kind of freaked me out. It sort of made me think like, oh man, are we once again going for the quick fix without trying to change and create better lives for people generally?
- [36:12]
Dr. Dhruv Kullar
I think that's a really important point, especially when it comes to children or adolescents. It's one thing to commit someone who is in their 50s or 60s to a medication that they're going to need to take for the rest of their life. It's quite different when someone is 10 or 15 or 20 years old. And so I do think it raises a really important set of questions about the treatment model here. You know, is it really the case that people are going to have to be on these medications for the long term, or is there a way to use these GLP1 medications as a bridge to other types of interventions? You know, I think the other thing that this raises for me is that of course, as you're saying, when a medication is so powerful, it becomes tempting to use it and not continue to push on the more societal factors that are creating the extremes epidemic that we're in. We're not addressing the root causes of obesity and diabetes and addiction. And that's the reason that we are using these medications in the way that we are. Of course, I'm the first to want to change the food system or the built environment or many of the other levers that we might wanna work on to create a more healthful society. But it's also the case that we have been trying to do that for decades and not made a lot of progress. And so in the short term, there are people who could really benefit from these medications today. And I think we should consider how to get it to as many people as possible who could really benefit from them.
- [37:40]
Anoush Zamorodi
Yeah, it reminds me of the other example or experience I had, which was I was invited to speak at a conference with a lot of very wealthy people, many of whom were on GLP1s. And it just felt like there was this other extreme at the other end of people who are all about taking whatever shortcuts necessary, whether it is to have 10x returns on a company, whether it is to look as skinny and think as sharply as possible that this is the 1% and they want to stay the 1%. Again, it was preventive, it was about optimization rather than like managing anything.
- [38:17]
Dr. Dhruv Kullar
You know, a lot of the health benefits that we've been talking about today, those have been shown in people who are either overweight or struggling with a chronic condition of some sort. I think what can be concerning is when we're seeing usage that is not supported by evidence and not supported by data. There's been a lot of growth in, let's say microdosing or people who just want to lose a couple pounds or are coming on and off the medications. Those are use cases that don't have data. We're not sure what the long term effects are. We're not sure whether there's any health benefits associated with them. This has really become kind of a cultural phenomenon where people are using these in all sorts of ways. As a doctor, I'm looking at the evidence, I'm seeing kind of where we have the data to support its use. But of course people are accessing these medications in all sorts of ways, whether it's direct to consumer companies or online or through social media, and we just don't have the evidence there to support their use.
- [39:14]
Anoush Zamorodi
Where do you think this is going then? Like in the next sort of year, would you say? Based on what you've been seeing?
- [39:20]
Dr. Dhruv Kullar
I think there's going to be more and more options for people on these medications. And so, you know, right now we have maybe two major types of GLP1s that people are taking. Semaglutide and tirzepatide. There's already another medication that hits not just one receptor or two receptors, but three receptors, Radatutride, that has completed phase three trials by Eli Lilly. I think there will be more versions that are oral versions as opposed to injectable versions. And so I just think there's going to be a lot more activity in this space, whether it's route of administration or trying to mitigate side effects or try to reduce some of the muscle loss that sometimes people experience. So I can see, you know, in the next five or 10 years that there are many versions of these medications and they're much more widely used.
- [40:08]
Anoush Zamorodi
I mean, one of the things, just stepping back, I've been thinking a lot about medicine as a technology in some ways, like MRNA vaccines are kind of a technology and genetic crispr, et cetera. Like, you know, you write about a lot of different ways that health trends intersect with medicine and technology. How do you think about it?
- [40:32]
Dr. Dhruv Kullar
Yeah, I mean, I think we are in an era where we are seeing enormous advances in technology and biomedicine. I think artificial intelligence is going to play a larger and larger role, not just in the delivery of healthcare, but also the development of new medications. This raises a couple thoughts for me. I mean, the first is that we should do our best to harness the positive aspects of these technologies. And that requires rigorous study of them. There will be any number of claims that are out in the public sphere, but without doing the controlled, careful study of these types of interventions, it's going to be very hard to say which claims are true and which are not. And I think we need that more than ever today when there are so many different sources of medical authority, so many different ways in which people access medicine, so many different channels through which they're getting information about their health. And so I think a really important part of this next phase is going to be not just how to develop these interventions, but how to study them in the real world.
- [41:34]
Anoush Zamorodi
Yeah, I mean, people seem to think, for better or worse, that like they can take a lot of their healthcare into their own hands. Whether it's because they can't afford healthcare health insurance, or because they think that medical research, technological research, moves too slowly and that by the time something gets approved, they could have been using it for several years and mitigated many of the symptoms that they had, whether that is muscle loss or cognitive abilities or just, you know, getting older.
- [42:02]
Dr. Dhruv Kullar
Yeah, I mean, I think people are
- [42:04]
excited about the potential to take advantage of new technologies or interventions. They want to lean more into health and longevity. And I think that in a way is a great thing. I think if we're going to have a market in which people are accessing medicines in the way that they are today, then there's going to be any number of claims that are made about these types of things. And I think it's incumbent on us to make sure that people have the information that they need to make those decisions about their health.
- [42:34]
Anoush Zamorodi
So how does it change the patient's physician relationship? All of these new technologies, like, I can see it both ways. Like on the one hand, great, we have AI to make more rapid diagnoses. This means that doctors can be more hands on and do the human part of the job, or I could also see that it goes the opposite way, is that everything gets outsourced to tech and the humans get extracted from the equation entirely. Where do you think things are going.
- [43:04]
Dr. Dhruv Kullar
I think both are going to happen. I mean, I think there's going to be a lot more insistence that people are able to access these things even outside of the traditional medical system. I think one thing that it drives home for me is that as doctors or other clinicians, it's no longer going to be effective simply to state the evidence or to state a recommendation that really has to come paired with a rationale, a perspective, demonstration of why it is that the recommendation that we are giving is what it is. Storytelling, I think, is going to be a really important part of the future. I mean, it sounds old fashioned, but really because there's so much information out there, there's so much disparate information, it's very hard for people to sift through it all. It's also possible to get abstract in your thinking and not tie it back to real people's lives. When I'm in the hospital, I am interacting with the challenges that people are facing in a very real way. And in a way, so many of the challenges that are in society, not just medical, but more general, they find their way into the emergency room, they find their way into the hospital, whether it's misinformation or homelessness, whatever it might be. But if you're able to tell a compelling story, if you're going to put together, synthesize things into a narrative, that can be really helpful in helping people put it all together. The other thing I'll mention, sometimes it's very helpful to just reach back to history and help people understand, you know, this new medication sounds like it's going to be amazing, or that intervention, that device is something I want to get my hands on today. And we don't want to wait for the studies to come out to prove them effective. There have been many, many, many claims that have been made in the past about similar things that turned out to be either not effective or harmful. I think it's important to point out that even something like 90% of drugs that make it to phase one clinical trials, let alone drugs that never even make it to phase one clinical trials, they end up failing before they become medications. And so just because something looks interesting or has some suggestive data, let's say, in animal studies, doesn't mean that it's going to be effective in people.
- [45:18]
Anoush Zamorodi
I want to just end by circling back to Aristotle, who you brought up in your talk.
- [45:23]
Dr. Dhruv Kullar
Aristotle, yes, of course,
- [45:26]
all talks should
- [45:27]
end with Aristotle, right?
- [45:28]
Anoush Zamorodi
Absolutely. But you talked a lot about moderation and Aristotle's calling for it. Do GLP1s and talking about societal structures that make them necessary, I guess, are we taking people's agency away? Where does the conversation for personal responsibility and modulation and finding your own sort of balance between extremes, where does that fit into this conversation?
- [46:01]
Dr. Dhruv Kullar
Moderation is so important. There are so many things in life that we want a little of, maybe quite a bit of, but not too much of. Aristotle obviously had this insight many centuries ago. And I think what I wanted to point out in the talk is that our world is kind of designed for too much these days. It's just inundated with content and food and desire and all sorts of things. And a lot of the challenges that we have, whether it's around our mental health or our physical health, is trying to bring ourselves into greater harmony with our environment. And for some people, that will require medications. For some people that'll require social supports. For some people that'll be therapy. For some people, they'll be able to do that all by themselves. But I think getting to this place where we recognize that moderation is important, but that the modern world is one that facilitates too much almost all the time is a really important kind of frame shift just to think about how we should be engaging with all the delights around us. And I think, you know, hopefully not everyone has to be on these medications forever. For some people, it can just be that break from the status quo that is needed to change your life. You know, I remember many years ago caring for a taxi driver who had a really severe heart condition that needed surgery. But he was really high risk for surgery because of his weight and other medical problems. And the recommendation from the surgeon was that he needs to lose some weight and come back and maybe they'll consider surgery at a later date. And everyone kind of knew that that would not be possible for him. And this was before GLP1s were widely available. And I still think back to that experience and wonder, if he had GLP1s available, would that have been something that could have kick started his journey to weight loss and then getting the surgery that he needed? Certainly I think it would have given him a much better shot than he had at the time.
- [48:05]
Anoush Zamorodi
I love that we're hearing the sirens in the background.
- [48:07]
Dr. Dhruv Kullar
I'm sorry.
- [48:08]
Anoush Zamorodi
No, it's all good. Okay, so the bottom line is proceed cautiously, make sure you have to manage the side effects, and don't think that maybe this is a forever plan.
- [48:19]
Dr. Dhruv Kullar
That's right.
- [48:20]
And I don't think it's a magic bullet. I think it's one part of a set of, you know, comprehensive changes that people should be undertaking to improve their health.
- [48:29]
Anoush Zamorodi
Thank you, Dr. Kullar.
- [48:31]
Dr. Dhruv Kullar
Thanks for having me.
- [48:37]
Anoush Zamorodi
I find this conversation fascinating. Thinking about how medical innovations could change the fundamental ways we think about people and their personalities. That's a big change that could happen in society. But I also appreciate that Dhruv is very cautious in his approach to writing and speaking about medical innovations. He doesn't write them off, he takes them very seriously. But he also is skeptical. And that is exactly what I want in my doctor Right. Because there are of course people who think that physicians are too cautious to the point that they are keeping people from trying treatments that could change their life. I keep thinking about the current peptide craze, for example, which Dhruv actually wrote about recently in the New Yorker. There are people on social media proselytizing about the effects of shooting unregulated synthetic proteins into their bodies, promising stronger muscles, more energy. And I mean, I get it. In the short term, it is enticing. But health? As we also discussed in the previous episode with geneticist Michael Snyder, it's about playing the long game, not just optimizing for quarterly results. And there is so much we don't know about the safety and side effects of these peptides. So high level, what do we take from all of this? I feel like the old adage remains that if it sounds too good to be true, it probably is. Nothing is ever perfect. But the right mix of treatment and care may improve your health. It may even make you happier. Moderation is generally not a terribly sexy concept, but it is a word to live by. That was Dhruv Kular at TED 2026 in conversation with me, Minouche Zamarodi. You can also see Dhruv Swift fulltalked.com thank you so much for being here on the next episode. The role of art in helping us understand the connection between our health tech and humanity. Yiyun Kang wants people to feel how AI is affecting their lives through massive interactive art that brings you inside the algorithms. That's what our conversation tomorrow is going to do too, so don't miss it. If you're curious about Ted's curation, visit ted.comCurationGuidelines Ted Talks Daily is a podcast from Ted. This episode was produced by Matthew Cloutier, Lucy Little and Katie Bonteleone. It was edited by Alejandra Salazar with editing support from Maggie Bishop, Sanaz Meshkinpour, and me. This episode was mixed by Matthew Polis. Dhruv's talk was fact checked by the TED Research team and our conversation was fact checked by Avery Keatley. The TED Talks Daily team includes Martha Estefanos, Oliver Friedman, Lucy Little, Emma Tobner and Tansika Sangmar Nivong, with support from Daniela Ballarezzo, Valentina Bohanini, Banban Chang and Lainey Lott. Special thanks to Sanaz Mesh Kinpour and my team at NPR's TED Radio Hour for all their help on this special takeover. And to my co curator ed 2226. A very special thank you to David Biello. You can hear more from these speakers on the TED Radio Hour with episodes coming out throughout the summer. I'm Anoush Zamorodi. I'll be back tomorrow with a fresh idea and conversation for your feed. Thank you so much for listening.
- [52:11]
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Dr. Dhruv Kullar
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Anoush Zamorodi
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