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The Future of Addiction Treatment Starts Here: GLP-1s Explained With Dr. Ken Spielvogel
00:44:59
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- [00:00]
Dr. Kenneth Spielvogel
You know, using these drugs without a. To me, a supervised medical professional that's guiding you in terms of what you should be taking on top, how you should be exercising, how you should be, you know, looking at metrics of fitness and longevity, then you're doing yourself a disservice, and so is the person that's just giving it to you.
- [00:40]
Addiction Support Representative
If someone has a problem with substance use disorder, please call one call placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. One call placement is affiliated with Carrera Treatment Wellness and spa and one method treatment centers.
- [00:58]
Richard
Today I'm with Dr. Kenneth Spielvogel, senior medical officer at Carrera Treatment Wellness and Spa, to talk about something a lot of people in addiction and mental health are watching closely. GLP1 medications. These drugs were created for diabetes and weight loss, but early research shows they may also reduce cravings and relapse risk. With major new deals dramatically lowering their cost and expanding access, this could become one of the most interesting developments in addiction treatment. Dr. Spielvogel is here to help break down what's real, what's emerging, and what still needs to be proven. Dr. Spiel Vogel.
- [01:46]
Dr. Kenneth Spielvogel
How are you? Richard?
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Richard
How you doing, buddy?
- [01:47]
Dr. Kenneth Spielvogel
I'm really happy to be here.
- [01:49]
Richard
So the first thing I want to say is two years ago.
- [01:53]
Dr. Kenneth Spielvogel
Right.
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Richard
Okay. When Carrera started, you told me about the GLP1s and how it worked for addiction and limited cravings, and I laughed in your face.
- [02:09]
Dr. Kenneth Spielvogel
Yes, you did. You weren't the only one.
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Richard
Right. And today I want to say that I was wrong. You were right, and I was wrong, and I apologize.
- [02:18]
Dr. Kenneth Spielvogel
This is recorded, right?
- [02:19]
Richard
It is.
- [02:20]
Dr. Kenneth Spielvogel
Sweet. I mean, look, people looked at me with a third eye, you know, when.
- [02:25]
Richard
I.
- [02:27]
Dr. Kenneth Spielvogel
Said there's a medication that we can use that absolutely reduces craving. There's not great data to support it right now, but there's plenty of things that we do in medicine.
- [02:38]
Richard
But it doesn't matter what the data is, because I was smoking 15 Cuban cigars a day, and now I gotta struggle to smoke two.
- [02:47]
Dr. Kenneth Spielvogel
Poor booby.
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Richard
I know. I just can't. I mean, you took the last thing I had. That and food. And you took that, too. You took everything.
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Dr. Kenneth Spielvogel
Thank God it's only those two. It could be worse, actually.
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Richard
You're dating the mother of my children, so. You took her, too.
- [03:04]
Dr. Kenneth Spielvogel
There we go.
- [03:05]
Richard
Well, you brought.
- [03:06]
Dr. Kenneth Spielvogel
What was that? Was that 48 seconds in?
- [03:08]
Richard
Hey, dude, it's. You're a Better man than me, clearly.
- [03:11]
Dr. Kenneth Spielvogel
Stop.
- [03:12]
Richard
All right, so go on.
- [03:15]
Dr. Kenneth Spielvogel
Go on. Where, where would we like to go?
- [03:16]
Richard
I mean, look, this is the, the, the GLP ones are right now. I'm using it, right? You, you had me using it for my cholesterol and my blood pressure. Right?
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Dr. Kenneth Spielvogel
Okay, because you want to look sexy. You wanted to lose weight and.
- [03:34]
Richard
Okay, but. And I do. And I look very sexy. Here's the problem. It works so good that I'm on an ice cream diet. Literally, I've got a six pack and all I've been doing for the last week is eating ice cream.
- [03:50]
Dr. Kenneth Spielvogel
That craving for sugar.
- [03:51]
Richard
Yeah, well, I mean, does it. So it clearly doesn't. But I'm looking great and I'm happy as a clam. But I know it's hurting me. I know it's gonna end up harming me long term.
- [04:04]
Dr. Kenneth Spielvogel
So that, I mean, look, that's one of the biggest concerns. I, I liken this revolution to Botox a little bit in that Botox came out, you know, wrinkle reduction, all the facial rejuvenation stuff. And all of a sudden it went from MDs to nurse practitioners to guys with their baseball hats backwards injecting people. So the same thing right now is going on with these medications and people getting them over the Internet and just getting a drug and injecting it. It's literally, it's piecemeal medicine and I'm totally not cool with it.
- [04:41]
Richard
How did GLP1 medications even end up in the addiction conversation in the first place?
- [04:47]
Dr. Kenneth Spielvogel
It's a good question. So you know, Ozempic, which was really the first, first, let's answer this question. You know, why are we injecting a drug once a week versus just taking a pill? Right.
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Richard
Okay.
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Dr. Kenneth Spielvogel
I mean, why wouldn't we just take a pill? The problem was with the early versions, the oral versions is that the absorption in the intestine was really variable. So if you ate anything, you had to be fasting. You couldn't eat for at least 30 minutes afterwards. You had to take it at the same time every day. How many people can do that? Plus, if you're going to think about the idea of using it in addiction and recovery, people being on a regimented schedule of taking medications when they're really just starting to piece their life together. Unless they have an assistant that's giving them the medication on time, it's never happened. It's not happening. And most people are super non compliant when it comes to oral medications. So the idea with compliance, with getting people to take A medication to have it be reliable. The less frequent you have to use it, the better. Got it. Okay. So an injection once a week. A good start. And what they saw was with people using Ozempic was they reported that they just had not only, like, feeling fuller, all metabolic numbers looking better, improved insulin resistance, lowering their hemoglobin A1c, improving their cholesterol panel, maybe even a secondary effect of lowering blood pressure is that they had less craving for food. And then when you looked at obese alcoholics, opioid addicts in particular, you saw that they reported less desire to use, less desire to drink, less desire to smoke.
- [06:38]
Richard
So that just what's happening to me? But on the zepbound, because the Ozempic made me nauseous. What's the difference between. Between Ozempic and Zepbound, and why was I having such a hard time with the Ozempic, but the zepbound is not a problem at all.
- [06:58]
Dr. Kenneth Spielvogel
That's a great question. I mean, I think that it's a. It's a complex answer. First of all, the Zepbound, which is Tirzepatide, is a GLPGIP receptor agonist, where Ozempic, which is semaglutide, is just a GLP agonist.
- [07:16]
Richard
Man, can you dumb that down for my comments? How about dumbing it down for me?
- [07:20]
Dr. Kenneth Spielvogel
So it works in two different places with Tirzepatide and semaglutide works in one place. Okay, so two is better than one, if we really want to say it. You're probably going to lose more weight. You're probably going to have more appetite suppression on the Zepbound. On Zepbound, and you're going to have an increased sensation of being full sooner.
- [07:42]
Richard
Right?
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Dr. Kenneth Spielvogel
And then probably the crave addiction type behavior is, you know, is squashed.
- [07:51]
Richard
Let's talk about it wasn't. It wasn't squashed with the Ozempic, I could smoke all I wanted with Ozempic, Right. On Zepbound, I'm literally about one tenth of my smoking consumption because there's receptors. And I'm not enjoying it, doing it. I'm doing it as habit and holding on. I am not enjoying it.
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Addiction Support Representative
Mm.
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Dr. Kenneth Spielvogel
And the reason for that is that what happens when we do pleasurable things? Well, we have a dopamine reward center in the brain. Okay. You have the. It's called the vta. I'm not going to even get into the scientific name for you. VTA produces dopamine. You smoke a cigar. Richard's brain says, God damn, that's good. Dopamine surge goes to the nucleus accumbens. Nucleus accumbens says, wow, that really feels good. Let me tell the frontal cortex, tell us to smoke another cigar. That feels good. Now let's take another drug that we're both familiar with, meth. So meth will take that dopamine amplification and crank it up 10 times that of even cocaine.
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Richard
Right.
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Dr. Kenneth Spielvogel
So you get this massive surge of dopamine. That's why people that use methamphetamine are hooked almost immediately, because there's nowhere else. There's no other substance that is going to give that of dopamine. So now along comes the dopamine traffic cop, which is semaglutide, tirzepatide. They come along and they squash. I'm not going to get scientific here. They kind of squash and temper that dopamine response.
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Richard
Okay.
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Dr. Kenneth Spielvogel
So you don't get that surge. And they also do a reset in the brain. So where once you're if a meth addict, their brain is flooded, rewired, and to get to a place where they're if we looked at brain imaging to say that their signal signaling was the same as a non user, that is going to take an awful long time. And for these drugs, tirzepatide in particular, we see a resetting of the dopamine system in a much more timely fashion. So that's why when you're doing these behaviors that normally gave you, boom, a surge of dopamine, you're not getting that nearly as much.
- [10:17]
Richard
And by nearly as much, you mean not at all. No.
- [10:21]
Dr. Kenneth Spielvogel
You're still getting it for sure.
- [10:22]
Richard
I'm not getting it.
- [10:24]
Dr. Kenneth Spielvogel
So you're. You're a sensitive, good responder.
- [10:26]
Richard
I don't smoke cigarettes. I only smoke cigars.
- [10:29]
Dr. Kenneth Spielvogel
Okay.
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Richard
But that's only because, you know, I don't live in a trailer.
- [10:32]
Dr. Kenneth Spielvogel
Let me ask you a question I'm interested. I don't really know the answer to this is when you wear a nic, you wear a nicotine patch or use nicotine gum?
- [10:41]
Richard
Absolutely.
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Dr. Kenneth Spielvogel
Okay. When you use that, do you find when you're on that medication that it doesn't have as much of an effect?
- [10:49]
Richard
No. The patch clears up my head first thing in the morning because I'm foggy. And the nicotine is actually good for you if the delivery system is appropriate. Smoking is the worst, but a patch is good, gum is fine, and it helps me wake up in the morning with my coffee.
- [11:13]
Dr. Kenneth Spielvogel
I mean, the nicotine gets a bad rap from the delivery system.
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Richard
And my fish Oil, I do fish oil, the patch and my coffee with a little lion's mane in it and I'm perfect.
- [11:27]
Dr. Kenneth Spielvogel
But you don't find that when you use the nicotine patch or nicotine gum that you get less of a like calming sensation or like a reward feeling from using that once you've been on that occasion.
- [11:38]
Richard
I've never gotten a reward feeling other than my head clears up so I can think of, think, you know, first thing when I wake up in the morning, my head is very foggy.
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Addiction Support Representative
Right.
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Richard
And it's always been that way. So if I need to do something important at 8 o', clock, I'm waking up at 4.
- [11:56]
Dr. Kenneth Spielvogel
Right.
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Richard
Just so I can be completely clear and ready to go. Yeah, yeah, makes sense. From early research and clinical observations, where does this look most promising so far?
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Dr. Kenneth Spielvogel
I mean, I think number one, let's just talk about obesity, right? So to me, obesity is still looking at addiction because people overeaters. Eaters Anonymous is not losing members anytime soon. So America has an obesity problem. We have over 50% of Americans. Despite these drugs being out there on the market, available prices coming down is. Obesity isn't going away. So, you know, these drugs, beyond just people not being able to go to the all you can eat buffet and Caesars and sit there for four hours stacking four plates is. It also is decreasing that compulsion and food noise, which to me is the torture, because people that truly cannot control whether it's food, whether it's nicotine, whether it's, whether it's alcohol, whether it's, you know, cocaine, methamphetamine, it's the noise in their head and the compulsion to use. And look, you're way more familiar with the other external factors, your lower companions, environmental, everything else that's going to trigger you to use. But decreasing that noise in the brain is huge.
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Richard
Have you seen any findings in studies or patient feedback that genuinely surprised you 100%?
- [13:37]
Dr. Kenneth Spielvogel
Like, I'll give you, I'll give you a story of just one person. Okay, so this was a guy, a very wealthy client, was, you know, in treatment. Alcoholic, cocaine, sex addiction. And, you know, he was overweight, had prediabetes. I started digging down into his health history, which is what we do at Carrera. You know, we, we try to tune people up medically, diving deep into their medical history, surgical histories, looking at their habits in terms of exercise, diet, everything. And this guy was a total wreck. And to be able to. I put him on the medication essentially because his hemoglobin A1C, which is a measure of your blood sugar control was diabetic. In diabetic range. And I knew he wasn't going to take medications every day. I said, I'll inject you once a week. He was one of the first. He was like, almost patient zero at career.
- [14:35]
Richard
Really? Yeah. And I know who that is. Go on.
- [14:39]
Dr. Kenneth Spielvogel
Maybe you do.
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Richard
Oh, I do.
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Dr. Kenneth Spielvogel
And.
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Richard
And he's doing fantastic.
- [14:43]
Dr. Kenneth Spielvogel
Fantastic.
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Richard
Okay.
- [14:45]
Dr. Kenneth Spielvogel
After the first, I would say two injections. And again, one thing to keep in mind is when you look at starting doses of these medications and you look at Tirzepatide and they tell you 5 milligrams is a starting dose. You put somebody on 5 milligrams, they are going to be miserable.
- [15:01]
Richard
Oh, miserable. Would you have me on 2.5?
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Dr. Kenneth Spielvogel
2.5.
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Richard
And you were miserable right at the beginning.
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Dr. Kenneth Spielvogel
Right.
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Richard
I've had clients, in all fairness, I was miserable because I couldn't eat at the beginning. And at the beginning, for me, what felt like depriving was I liked the chewing. I want to eat something. And when I didn't eat all day, I was like, I wasn't hungry, but I was like, I want to eat something.
- [15:31]
Dr. Kenneth Spielvogel
Right.
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Richard
And remember when I called you and I started eating too much and I. I literally hurt myself.
- [15:38]
Dr. Kenneth Spielvogel
Yeah.
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Richard
Right. And you told me it was because.
- [15:41]
Dr. Kenneth Spielvogel
Why Stomach gets full, you know, you can't process food as quickly and easily. On top of all the receptors in your brain that are telling you, like, slow down, eat less.
- [15:53]
Richard
And. And after that.
- [15:55]
Dr. Kenneth Spielvogel
Okay.
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Richard
I've been really good, you know, and now I'm on the 3.5 because I got used to the 2.5.
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Dr. Kenneth Spielvogel
Right? Yeah. And that's still a baby dose. You're still well below what was considered the starting dose.
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Richard
I don't need to be on anything over 3.5.
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Dr. Kenneth Spielvogel
Right.
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Richard
It's just, you know, it's just. It's perfect.
- [16:17]
Dr. Kenneth Spielvogel
Right. So that, you know, I think, again, like, dosing and working with patients, it's really important that you have somebody that's clued into you that doses you in a way where you're not going to walk away completely. Because I've seen clients that have done 5 milligrams out of the gate and are sick for two weeks. Yeah, you can, you know, so. So this particular client started him at 2.5. We did that for a couple weeks, increased him to five. And the first thing he said was like, I'm not. Like, all of a sudden the noise around alcohol is gone. I'm not even thinking about it, you know, and we'll use, you know, we have drugs for addiction that try to naltrexone that.
- [17:04]
Richard
You know, we're the only ones doing the GLP1s. I mean, we've been doing it now two years. Okay, but there's not another treatment center that's been using these GLP ones. Not one.
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Dr. Kenneth Spielvogel
I'm surprised by that.
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Richard
Why?
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Dr. Kenneth Spielvogel
Because I would think that at this point, especially with the day, I'm sure after this week, where? Washington Post, Women's Health, cnn, msnbc.
- [17:29]
Richard
You don't know these people the way I do. Let me tell you something. The science is always 15 years ahead of the practice. These guys won't even be using these for another two years. I'm not kidding. That's how far back we innovate here. Which is why we did it two years ago.
- [17:49]
Dr. Kenneth Spielvogel
It'll be interesting to see. I think the one thing I heard all the time was it's off label. It's off label. It's off label. I'm like, we use drugs off label all the time. And let's talk about what we're doing here.
- [18:00]
Richard
No, no, before you do that, I want you to give examples. Because. Because we use off label all the time.
- [18:05]
Dr. Kenneth Spielvogel
Sure. I mean, baby aspirin. I mean, we use baby aspirin for the prevention of cardiovascular disease and stroke and clot formation. And that's not at all what it was made for. No, not at all. Okay, so there's excellent. That's probably. That's the one that always comes to mind for me, you know, indicin, which is a drug that is an anti inflammatory drug. We use it in the field of obstetrics for preterm labor. Preterm contractions. Because it works on the uterus and reduces them. There's not an indication for it, but we still do it and it works.
- [18:41]
Richard
What was it used for? What was it made for?
- [18:43]
Dr. Kenneth Spielvogel
It's used as an anti inflammatory like Advil, ibuprofen. Okay.
- [18:46]
Richard
And you use it for the uterus.
- [18:48]
Dr. Kenneth Spielvogel
Yep, we use it for relaxation of uterine contractions.
- [18:52]
Richard
Really?
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Dr. Kenneth Spielvogel
Yeah. There's tons of examples of this. Those. Okay, all right, good. But what was I talking about? Completely gapped.
- [19:02]
Richard
We're okay.
- [19:03]
Dr. Kenneth Spielvogel
All right. Yeah. But in, in using those medications, you know, and we're using them off label. What is the downside here? Okay, so we have somebody who's obese, who's going to eat themselves to death, drink themselves to death, use cocaine or meth or whatever other substance you're going to tell me you're going to Convince me they've been in treatment 12, 15 times doing the same route. You're going to tell me that it's not worth trying something different? Oh, no, it's off label.
- [19:35]
Richard
No, no, this is.
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Dr. Kenneth Spielvogel
Right.
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Richard
This is. This is as good as it get. This is the one other than Narcan. Okay. Which actually saves your life. Okay. This is the best drug I've seen for the treatment of drug addiction and alcohol.
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Dr. Kenneth Spielvogel
I'm saying a lot coming from you ever.
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Richard
Ever. Wow. More than an abuse, more than Vivitrol, more than anything. This is the one. This is the one.
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Dr. Kenneth Spielvogel
That's pretty awesome. I mean, I don't disagree. Our patients, our clients are staying sober.
- [20:16]
Richard
I just. And much more than they used to be. I know you're gonna be out of business. It's okay. I'll find something else to do. We'll solve the homeless crisis next, I promise.
- [20:27]
Dr. Kenneth Spielvogel
I mean, yeah, it's true. I mean, beyond the. Just like. Okay, so you stop them, you know, snake oil salesman that sold, like an oil that'll do something that'll cure everything in your body.
- [20:39]
Richard
Right.
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Dr. Kenneth Spielvogel
Okay, let's talk about it. You look at in medicine, people with stacks of medications across the board, you have four things, really, that are going to kill you besides not wearing your seatbelt and guns and accidents and not wearing a helmet when you ride a bike, which are the most common ones. One of the most common ones. But cardiovascular disease, stroke, major adverse cardiac event. It's called mace.
- [21:05]
Richard
And your wife.
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Dr. Kenneth Spielvogel
Okay, that's number one. That's number one.
- [21:10]
Richard
Number one killer of men is.
- [21:13]
Dr. Kenneth Spielvogel
And women is cardiovascular disease and stroke. Okay. Number two, cancer. Lung cancer being number one. Colorectal, breast and prostate cancer. Moving down the list. Number three, if really you want to look at it, Alzheimer's disease, dementia, and the complications thereof of that. And number four, metabolic diseases. Which are what? Which are diabetes, you know, is the big one. Then we get into women. More women die. A hip fracture, osteoporosis, than they do of breast cancer in this country. And that's a whole other podcast to talk about why that is and the epidemic of that. And I would love to go through that. So now we have a drug that you take once a week. Okay. That has been shown to go. I'm going to say it in really simple terms that people understand. It goes to your arteries and that lining of the arteries which is so delicate that you want to keep nice and smooth. And the effects of smoking, environmental exposures that create these little dents and cracks in it that allow Cholesterol to hang on to there and form a clot, a plug that then causes a heart attack. So you have a medication out there that's going to keep them smooth, that's going to keep them from spasming, that's going to lower your blood pressure.
- [22:33]
Richard
That's what the GLP1s do.
- [22:35]
Dr. Kenneth Spielvogel
On top of it's going to lower weight so that your heart isn't pumping and working as hard. So there goes number one, and your blood pressure isn't right and your blood pressure is going to come down. Number two, we're going to go to cancer. For women, obesity lends itself to fat cells that produce estrogen that increase your risk of potentially, you know, maybe a promoter of. Of breast cancer. I'm really hesitant to say that, but it's. There's probably a role in there. Uterine cancer. Absolutely. And for men, prostate cancer, gastrointestinal cancer. So now you have a drug that's going to control weight, that's going to reduce that down, that's going to increase your insulin sensitivity, which in turn is going to lower inflammation. Lower inflammation in the body is going to equal less of a chance of cancer for sure. Okay. Alzheimer's disease, dementia. New data coming out, ongoing trials that say that probably you have a reduced risk of plaque formation in the brain. Plaque formation is what we find in radiographic studies showing Alzheimer's disease and dementia.
- [23:46]
Richard
You're kidding.
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Dr. Kenneth Spielvogel
No. So if you get a diagnosis of dementia, of Alzheimer's disease and you're 60 years old, it's like getting a stage four cancer diagnosis. There ain't shit you can do about it. You can try to slow the progress of it, but you got that diagnosis. What you do now is what's going to prevent that from occurring. A GLP1 potentially for, you know, I could sit here and say probably everyone would benefit from it, even in a microdose. I think that's where we're going to land in some way. But reduces that risk of plaque formation. Then we move to the fourth one, metabolic disease. Well, diabetes isn't. It's a layup. Right. Increasing insulin sensitivity, less obesity reverts right back to, number one, cardiovascular disease and stroke. So that's why diabetes is such a kick killer, because it not only has its own havoc on blood vessels, amputated feet, you know, obesity, all the other things, but then it goes back to cardiovascular disease and is one of the major risk factors.
- [24:52]
Richard
Nothing is all good.
- [24:53]
Dr. Kenneth Spielvogel
Right.
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Richard
Okay. I've never. There's nothing that's all good. No drug okay, what's the side effect of this?
- [25:01]
Dr. Kenneth Spielvogel
Right. So I mean, the biggest side effects are going to be gastrointestinal. So, you know.
- [25:07]
Richard
Gas. Yeah.
- [25:09]
Dr. Kenneth Spielvogel
I mean, bloating, gas, nausea. Obviously, I'm none of those. Right. But when you're, when you're beginning, those are the ones that people are going to mainly experience. Some people experience constipation, some people experience insomnia. These are the ones that I see on a fairly regular basis. That's not cardia.
- [25:31]
Richard
That's not fair. I don't think. I don't think that's fair because we're seeing, you're seeing people right now in treatment, and when they get here, they're completely destroyed. And a lot of them don't have good sleep hygiene in the first place. So to say that, you know, you're getting the feedback from these guys doesn't mean anything to me. It didn't affect my sleep. It didn't make me nauseous. It did take a couple days to get used to it. Right. But I look forward to it every week and I really take it now every five days because I feel like.
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Dr. Kenneth Spielvogel
Starts to wear out. That's right, yeah. And you could go to twice a week. There's a lot of different.
- [26:16]
Richard
I don't like shooting myself with the needle. I don't like it. So I just do it every five days.
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Dr. Kenneth Spielvogel
Right. And that's fine. You know, some people headache, another, you know, then we're going to go down the line like you're watching a drop drug commercial, and they're going to list every side effect known to man. Thyroid tumors was one that they saw in mice, hasn't been replicated in humans, in human studies thus far. So, you know, that's kind of where we land in terms of side effect.
- [26:43]
Richard
The thyroid term, or the thyroid tumor.
- [26:47]
Dr. Kenneth Spielvogel
Is concerning, but it hasn't been shown in humans. They've seen it in mice, but hasn't been shown in humans. And these drugs have been out a.
- [26:55]
Richard
While now with the Trump administration's new pricing deals dropping costs from well over 1,000 bucks a month to roughly 150 to 250 for many people, including some Medicare users. How much does that change access and the overall landscape?
- [27:13]
Dr. Kenneth Spielvogel
I mean, you make it more affordable than more people are going to have access to it. That being said, I still think the cost is definitely prohibitive. When we first started this, I would say if you didn't have an injury.
- [27:26]
Richard
For a drug addict, it's not.
- [27:28]
Dr. Kenneth Spielvogel
Yeah.
- [27:28]
Richard
Because if you can spend hundreds of dollars a day Getting loaded. You can spend 150 to $250 a month.
- [27:37]
Dr. Kenneth Spielvogel
Right.
- [27:37]
Richard
Okay. To make you healthy, keep you off drugs. Right. And I, I don't, I don't share that. Yeah, yeah.
- [27:49]
Dr. Kenneth Spielvogel
I mean it. Accessibility from the standpoint of people being able to see a provider, get a prescription, start the medication, stick themselves, like you said, you're apprehensive about it. Stick themselves with a needle once a week. I still think accessibility is an issue. Certainly cost reduction is great. We have strategies to lower the cost. Using Lilly Direct, which is an excellent program. You sign up, you send the patient's information in. Lily handles all the communication directly with the patient, mails them the medication. You know, we've moved away now from these auto injector syringes that you can't be flexible with the dose. So now it's just a vial. You drop a dose, you like 3.5, you can draw that up and they send you the syringes. They send it in a cold pack. So it's really great. It's very, it's very cost effective and, and they do a really nice job with that. Now the compounding area of it, which are you know, essentially non FDA approved sources for getting these medications. Compounding pharmacies are manufacturing their own versions of tirzepatide and semaglutide. That.
- [28:59]
Richard
Why would people want to do that instead of just going out and getting Zepound cheap? Yeah, but it's not as good, is it?
- [29:07]
Dr. Kenneth Spielvogel
You know, I think there's reputable, there's repro reputable, pardon my French, compounding pharmacies where it is effective and it is good and you know, it's an extra step of having to constitute it.
- [29:20]
Richard
Okay, but if it's 150 to 250.
- [29:23]
Dr. Kenneth Spielvogel
Yeah. That's going to be a game changer.
- [29:25]
Richard
Okay. For the real stuff.
- [29:27]
Dr. Kenneth Spielvogel
Right.
- [29:27]
Richard
How much is it for?
- [29:29]
Dr. Kenneth Spielvogel
It's about the same. It might be a little bit cheaper than that.
- [29:33]
Richard
Okay. So why would anybody want.
- [29:34]
Dr. Kenneth Spielvogel
I think it's going to put them out of business. I think that was the, their goal. I don't know if it'll put them out of business. They have other things they can sell. They also do some interesting combinations. They'll do combinations with other peptides that potentially, you know, work. Work somewhat synergistically with these GLP1s. Because one of the biggest side effects, let's talk about this, is people that lose weight is they'll lose muscle in a larger proportion than they will fat. And if you're not being Counseled and taking the proper protein intake, complementing it with the proper supplements and not doing weight bearing exercise, you are going to lose muscle mass. Muscle is the largest endocrine organ in your body. It deals with sugar, it increases sensitivity to, to insulin, and it protects the bone from fracture falls which are really big killers of the elderly as we get older. So you know, using these drugs without a, to me, a supervised medical professional that's guiding you in terms of what you should be taking on top of how you should be exercising, how you should be, you know, looking at metrics of fitness and longevity, then you're doing yourself a disservice and so is the person that's just giving it to you.
- [31:08]
Richard
This is why I hate the online pharmacies.
- [31:11]
Dr. Kenneth Spielvogel
Okay.
- [31:12]
Richard
You get these doctors that just rubber stamp everything, don't teach you anything. Okay. Aside from the fact that it's a brief breeding ground for cartels.
- [31:23]
Dr. Kenneth Spielvogel
Right. With the.
- [31:24]
Richard
And everything else.
- [31:26]
Dr. Kenneth Spielvogel
Right. And let's go to what we're talking about, addiction. This is your area expertise. So you can take an addict and you can reduce the noise, but if they're not doing the work to heal.
- [31:38]
Richard
That's right. Then they're just going to be dry and miserable and they're not going to have their best life to look forward to because they didn't do the work.
- [31:46]
Dr. Kenneth Spielvogel
And guess what, they're probably going to stop sticking them if they really want to use. They're going to be non compliant with the medication and they're going to start using because the noise is going to return people. I do see some people that are fixated on getting. I want to get off it, I got to get off it. Which is how we feel about drugs. I personally, I don't get it. You have a substance, I don't even want to call it a medication. It's actually a peptide that does all the things that I gave you that long winded explanation of preventing you from dying from, from. Why are you fixated with coming off of it because you think medications are bad? I mean we have medications out there.
- [32:24]
Richard
I don't really think drug addicts think medication is bad.
- [32:28]
Dr. Kenneth Spielvogel
I love it though when drug addicts say to me, I'm really careful about what I put in my body.
- [32:32]
Richard
That's my favorite. That's my favorite.
- [32:35]
Dr. Kenneth Spielvogel
I don't mean to make fun of people that say that.
- [32:37]
Richard
I do. I mean I made fun of myself for it. I'm making fun of you, you for it.
- [32:42]
Dr. Kenneth Spielvogel
I mean they'll have track marks up and down their Arm. And I'm like, this is an injection you do once a week. I'm really careful about what I put. I'll do my own research, doctor, and I'll get back to you. Hey, Chatgpt. I mean, it's, it's pretty wild, so. Yeah, but if you come off, the worst thing someone can do is yo yo. So when you lose a ton of weight, you don't exercise, you, you don't eat enough protein, you don't take creatine, aminos, other supplements, you're going to lose more muscle than you are fat. So now you've yo yoed down, now you start eating again. Guess what? More fat, less muscle. Then let's say you go back on the medication. Then you're going to lose a higher. So see where I'm getting at? You're constantly losing a greater ratio of muscle to fat.
- [33:34]
Richard
Okay, so this is really simple because this has been a lot to unpack. Okay, but it's simple. If you're using this, you got to work out every day and you got to eat healthy. So basically what it is, is if you use it as a head start to get healthy and then you stay on it for maintenance. You're. What you're telling me is not only are you going to look better, but you're going to live longer.
- [34:02]
Dr. Kenneth Spielvogel
Yeah, for sure. I mean, look, if you're eating well and exercising and in an ideal body weight range, I mean, it's not that hard. Exercise is the.
- [34:13]
Richard
It is hard because last week I was on an all ice cream diet, Kenny.
- [34:19]
Dr. Kenneth Spielvogel
Okay, so I'm just telling you.
- [34:21]
Richard
But I'm. I. Dude, I was so happy last week. Okay? And then it was like I woke up this morning and I felt shitty. And I'm like, you know what? This is done. You know, I threw out all the ice cream in the house. I know I'm not perfect. This is horrible.
- [34:39]
Dr. Kenneth Spielvogel
Cold Stone Creameries.
- [34:41]
Richard
Tell them what they're. In the morning. Tell them about the.
- [34:43]
Dr. Kenneth Spielvogel
How many. How many people out there can say, I got a Christmas card from Cold Stone Creamery. Dear Richard, thank you so much for. For your business sign Felicia.
- [34:57]
Richard
So nuts.
- [34:58]
Dr. Kenneth Spielvogel
Richard calls. He calls Colt. So gravy. And he gets a. Hi, Richard. You want the usual today?
- [35:07]
Richard
I'm not kidding.
- [35:08]
Dr. Kenneth Spielvogel
That's not a joke.
- [35:09]
Richard
It's not a joke. And you beat me up for it for about six months.
- [35:13]
Dr. Kenneth Spielvogel
I think it was a year.
- [35:14]
Richard
It was a year.
- [35:15]
Dr. Kenneth Spielvogel
I want to say this. I don't want to lose this point. There is no greater intervention than to Save your life than exercise, period. I've been trying for 30 years as a medical doctor, an MD to get my clients to exercise. It has been, for the most part, fairly futile.
- [35:39]
Richard
Do you know what the. My favorite thing is? When you go to the facility and you work out with them and you went and you golfed with somebody else and then you took somebody. What do you call it? Kite sailing. Yeah, right. That was bitching.
- [35:56]
Dr. Kenneth Spielvogel
Yeah.
- [35:57]
Richard
It's like I've never met another doctor ever that not only tells you what to do, but says, all right, come on, I'll show you how to do it. Let's go, you and me, walk the walk, man. So cool.
- [36:09]
Dr. Kenneth Spielvogel
What an awesome job. How lucky am I I don't have to friggin wear a white coat and sit behind a desk and push prescriptions all day, you know, and tell people what to do. Look, if you're a doctor out there and you're a fat ass and you smoke and drink and don't exercise, don't. Don't expect one patient to listen to a word you're saying because you have to be the, we have to be the models of health and wellness.
- [36:39]
Richard
You know what else drives me nuts? When I don't have enough time to.
- [36:44]
Dr. Kenneth Spielvogel
Tell you all the things that drive me nuts.
- [36:46]
Richard
Okay, well, this drives me nuts when you walk in and you do a deep dive on all their medications and you go, okay, this is no good with this. This is no good with that. That's why you're nauseous. And it's like the first thing, not just me, but all my clients are thinking is, why didn't my doctor tell me this? Why didn't my doctor look at all my medication to see why I was nauseous or why I wasn't feeling well? Because these two medications didn't work well together, right? Why don't doctors do that? Especially now when it's all in the portal and all they have to do is look right?
- [37:28]
Dr. Kenneth Spielvogel
Or like, let's go a step further. Why did my doctor give me all this crap to begin with versus just telling me I need to eat like this? I need to take these supplements in the morning and the evening because people don't.
- [37:42]
Richard
Don't eat like that, man. That's why.
- [37:45]
Dr. Kenneth Spielvogel
Well, I mean, I think it's important as medical leaders that we are in a preventative mode. We've learned how to treat disease. It's boring. Treating disease and cutting people open and taking out tumors and putting them on medications. It's. That's all, you know Reactive medicine. We've been preventative medicine has never been more available and simpler than it is now.
- [38:14]
Richard
This has been really good. The GLP1s for addiction. And people are just starting to figure this out. Okay, what's next?
- [38:23]
Dr. Kenneth Spielvogel
Right? So what's next is you don't like taking a injection every, whatever. If I tell you do it twice a week. So every three and a half days I'm gonna tell you a little bit, a little story. So when HIV came out, I told you the story like in our own personal space. So when HIV came out, a lot of reason why people died was because they couldn't stick to a six time a day, tens of medications to take. Each time compliance was low. That's how we started this talk. Talking about the oral medication.
- [38:55]
Richard
That's right.
- [38:56]
Dr. Kenneth Spielvogel
Right now we have prep, which is a single injection. It's pre exposure prophylaxis. They take an injection. I want to say I'm having a brain fart. Six months is what I'm thinking. It's not my field, but I believe it's every six months. So twice a year you get an injection that prevents you from getting HIV and dying of aids. What we're going to see with these drugs eventually, you know, oral. Are we going to go oral? I'm less concerned, concerned about that versus you're going to get an injection. It's going to last you once a month. You're going to have a little meter that you wear that's going to monitor your blood sugar, probably adjust there. And we already have those for insulin. But for a preventative type medication, maybe that's what's going to come down the line. Maybe it's a patch, who knows? But that the delivery system to me. And then we'll get more targeted and saying, richard, you want to quit smoking? This particular drug works really well on whatever the dopamine smoking center is in the brain. This one's for coke, this one's for alcohol.
- [39:58]
Richard
Let me ask you a question. With the GLP1s, if you don't exercise right? We've already discussed the dangers of that. Okay, but what happens, we're using sometimes testosterone therapy too, aren't we? How are you?
- [40:20]
Dr. Kenneth Spielvogel
That's such a good question.
- [40:21]
Richard
Yeah, how are you? How are you doing that with the clients?
- [40:24]
Dr. Kenneth Spielvogel
And that's all about going back to the muscle thing, right? Because we get older and we get declines in hormone. Men do as well as women. Women have been deprived of HRT for the last two plus decades because of one crappy trial. The WHI trial that came out and looked at risk of breast cancer and saw 10 more cases in 100,000 women. The study was flawed, it was skewed, but it freaked people out and it changed the face of what I do. And women were denied hormone replacement therapy for two plus decades. Those women are going to have fractures, osteoporosis, cardiovascular disease, stroke, Alzheimer's disease, dementia. So when we're taking these drugs, we just said the muscle is the largest endocrine organ in the body. I'm getting excited now. So for men, I want them on creatine. I want them on doses of creatine that are not like a single scoop. We're looking at, you know, 10 grams, maybe 15 grams a day. Not only for athletic performance, 10 to 15% boost, but also there is creatine in the brain. Creatine creates ATP, which is energy, cellular energy. And we know that creatine in the brain gets depleted, especially when you're sleep deprived. So creatine, amino acids, protein powders, and then for men, when appropriate, testosterone therapy.
- [41:48]
Richard
How do you give it to them?
- [41:50]
Dr. Kenneth Spielvogel
I mean testosterone therapy as an injection is painful. For some people it is somewhat of a hurdle. So I can do, I have a compound one compounding pharmacy I use and trust that will do a high dose cream. And then I'll do injectable as well too. I'll do injectable as either.
- [42:06]
Richard
I, I think the cream doesn't work. Does the cream work at all?
- [42:10]
Dr. Kenneth Spielvogel
I think, you know, I would say I'll get some younger guys that definitely have evidence of testosterone insufficiency that whether it's placebo or not, I don't think so. I think they definitely get a tiny boost which maybe in those people. I want, I don't want my patients, I don't want a 60 year old guy to look jacked and like overly. I just want him to be lean. I want him to be strong. I want him to preserve muscle mass. No old person ever said, gosh, I wish I had more, you know, I wish I didn't have as much muscle as I did. Women also need testosterone, let's be clear. They need estrogen, they need progesterone and they need testosterone. Women on testosterone supplementation have an up to 30% reduction in breast cancer. People are saying, oh, but you're going to get tumors, you're going to get, you know. Now granted, over replacement would lead to oily skin, acne, unwanted hair growth, but that's not what we're looking at.
- [43:13]
Richard
So you're giving them Basically a microdose.
- [43:15]
Dr. Kenneth Spielvogel
Yeah, well, they're getting about a tenth of the dose that men get.
- [43:18]
Richard
Okay.
- [43:19]
Dr. Kenneth Spielvogel
You know, I think one thing that, you know, you've prompted me to explain today is that, you know, addiction is a multifaceted disease, whether it's food, gambling, sex and love, cocaine, meth, alcohol, opiates. And now we. We have tools that under proper medical guidance, we have a way. On top of all the therapeutic tools that accrera are the best in the world, that we have a way. And we didn't even get into, like, the lifestyle modifications that we make on people there, but we have a way of truly, truly keeping people sober and leading happy, healthy lives they're proud of. There is no I'm gonna cry. There's no better way to make a living.
- [44:12]
Richard
Now you're gonna make me cry.
- [44:15]
Dr. Kenneth Spielvogel
It's true.
- [44:16]
Richard
All right. Do it.
- [44:18]
Dr. Kenneth Spielvogel
So lucky to get to do this, and I'm so happy to have the opportunity to be here today.
- [44:26]
Richard
What? What was that?
- [44:28]
Dr. Kenneth Spielvogel
What? Do it. Do what?
- [44:31]
Richard
Look in the camera.
- [44:32]
Dr. Kenneth Spielvogel
What do you want? I'm not gonna say. What you want me to say.
- [44:34]
Richard
Why?
- [44:35]
Dr. Kenneth Spielvogel
Because I won't do that. Why? You want me to say see you next Tuesday?
- [44:39]
Richard
I sure do.
- [44:40]
Dr. Kenneth Spielvogel
I'm not doing it.
- [44:42]
Richard
We'll leave it there. See you next Tuesday.
- [44:46]
Podcast Host
We're out of time. Please subscribe on YouTube. Click the thumbs up and leave a comment. Please subscribe on Apple podcast and Spotify and leave a rating and a review and share the we're out of time podcast with others you know who will get value out of it. See you next Tuesday.