The GLP-1 and addiction connection no one’s talking about with Dr. Jason Giles

Eva (00:00):
Hey friends. Today I'm bringing you an interview that I did with a doctor named Jason Giles, who is an addictionologist in the Los Angeles area. I had such an interesting conversation with him about food addiction that I wanted to share it over here with you all too. Kami and I will be back next week. And in the meantime, I hope you enjoy meeting Dr. Giles. I want to share a pro tip before we get to it. If you follow us on Spotify, you can hit the little bell to be notified when new episodes are live. My guest today is Dr. Jason Giles. He is board certified in both anesthesiology and addiction medicine, and he holds the great honor of being the very first addiction or addictionologist to be on Meet the Doctor. So welcome to the podcast. Thank you for joining us.

Dr. Giles (00:51):
Thanks, Eva. It's great to be here. Thanks for having me.

Eva (00:53):
Okay, so tell us what an addictionologist does.

Dr. Giles (00:58):
Well, an addictionologist studies addiction. And addiction is one of those things that everyone knows what it is, but it's difficult to say exactly what it is. Addiction comes from the Latin word adicere, which is awesome when you hear what it means, unless you already know, do you already know that word adicere? Here's what it means, to sell oneself into bondage, to sell yourself into bondage. So it's not to be put into bondage or captured as a slave, it's to voluntarily and willingly enslave yourself. And where that comes from is in old times before there were lending institutions and banks and rules, if you wanted to buy something and you didn't have the money for it, you would go to a person with money and you would pledge whatever the item was, tools for making chariots or string to make bows or whatever business you were going to go into or materials to build a house.

(02:00):
And of course there was security interest in the property, but the real security interest was you, because if you didn't pay back the note, they took you, because you had value as a slave in the salt mines down south or something. And so to voluntarily enter into that agreement is you're getting benefit now, which in this case would've been money or resources, but in exchange for selling your very self into bondage. So they let people do this and sometimes they couldn't pay the notes, of course, and they wound up in the salt mines. And that is a really good way to think about what addiction is. So you get pleasure out of something upfront and then eventually the cost of that or the note comes due after time. So an addictionologist studies those things, studies the effect of substances and behaviors on what people do and how to break those cycles and get them free.

Eva (03:00):
Are you focused on a specific kind of addiction within that field?

Dr. Giles (03:06):
Yes. So my interest is substance use disorder. The substance habits, we used to call them habits in olden times. We call it a drug habit or a drinking habit, or he has a smoking habit. Now we call it a medical illness, but it's the same thing. It's the thing you do repetitively that kind of takes on a mind of its own sometimes it's called second nature. So it's a piece of you that you don't seem to be in control of any more than you control your balance when you walk. And it's because you've learned how to do it. For me, I've been doing this job for about 20 years. I was in anesthesia and high intensity trauma and cardiac and transplant anesthesia at a university hospital, and I did a fellowship in pain medicine. That's where I got interested in the patients. And then I had my own recovery experience.

(03:59):
I got exposed to this world getting sober myself 25 years ago. And for lack of a less cheesy way to say, it fell in love with the field, with the patients, with just the whole world of this spirituality mixed with science. Because there's some piece of this that we just, I'm a scientist, but we can't explain some of why with the same history people go on to get, well. I can't explain why I got well, I still don't know, but I do know that it's possible and likely if you do certain things. And since I fell in love with it and had my own experience, I've been an exponent of that. I've been a proselytizer of this sober life and encourage as many people as I can, not just to get well, but to pass it on to others. So I get to take all the science and care and medical care and apply this other dimension.

(04:58):
And that's how the company runs. That's the company's full of people with the same disposition, most of whom who've been through some similar experience. And believe me, when the patients figure that out, you have to be careful with disclosure and so forth. But when they figure out that it is a weird thing, I mean, it's a weird thing, most people don't require that their endocrinologist have diabetes in order to be a good endocrinologist treating diabetes. But there is something about this problem that, shoulders go down and the patients are more candid and they relax. I think it has to do with the fact that they know they're not being judged. Even if you're a great doc and you aren't judging someone, they sometimes feel judged or in their minds, they imagine they are. And the story they sometimes tell themselves is, well, this person understands, so at least somewhat understands. And when it's your doctor prescribing your detox meds or listening to the story, I think that helps. I think it's not a hundred percent essential, but it sure helps.

Eva (06:06):
There's lots of parallels you could draw to that. It's like having a trainer who was never fat when you need to lose weight or, maybe lower stakes there, but we could talk about how food is also an addiction

Dr. Giles (06:21):
For sure.

Eva (06:22):
If we had five hours.

Dr. Giles (06:23):
Or like a boxing trainer that never boxed, or a football coach that never played or any of that stuff. And there are some, I mean there some who are just brilliant at whatever the thing is, and they really can explain things. But for a shortcut, if you want a shortcut to connect it with patients, have this experience yourself. And that's really a big part of the message, which is so many people think that they have, it's been too long or they waited too long, or their lives are ruined or their best way. I've heard it said their yesterdays have ruined their tomorrows, but that's not true. And once they get on the other side of it, no one's excited usually to tell you about their drinking problem. But once it's behind them, they won't shut up about it. Oh, I used to really have a drinking, and they'll tell you all about it. And so what happens is their relationship to their prior behavior changed. That's what it is. They feel different about their past and imagine that, right? Imagine if you could feel different about your past and let that not only not drag you down, but be a source of connection with other people. So that's why I fell in love with it, because it's magic. It's magic to go from before and after with this experience

Eva (07:51):
Is before a story that you tell. Will you tell it to us?

Dr. Giles (07:56):
Sure. My before is I grew up in an alcoholic home. So I grew up with a father who managed his feelings that way and all of the chaos that came along with that. I remember that I wanted to live a different life, that I wanted to somehow transcend that. And I had the gift of being good at school, so that was a natural fit, and I focused on that. And so as I got better at school, I saw that as a way out. And so I went from my local school, I went to community college, and then I transferred to Berkeley. So I was on my way there. I studied biochemistry, and then I got into medical school. I loved medical school, focused on surgery. And then each time I reached a new peak, I got a sense of accomplishment, but also this gnawing abyss of a gulf between, well, there's not many more accomplishments left to get, and we're less than halfway to feeling okay.

(09:09):
I felt like there was something not right or wrong or missing or something defective about me, which is normal. I learned later that that's normal. That feeling is quite normal. But what's abnormal is thinking I can fix this on my own. That's where the problem came in. So thinking if I studied enough and if I got enough paper on the wall or if I achieved these credentials, then I would feel okay. I would be regarded okay and I would feel okay. In reality, no one was regarding me badly. I was regarding myself that way. And the process of believing that I could fix it, was good on the one hand because it propelled me through all this academics. But it was bad on the other hand, because it propelled me into drugs. Because when I got to the accomplishment, when I was on, you know, the toes on the diving board of beginning a career in anesthesia as a cardiac anesthesiologist, I felt worse than ever. I felt like I was a fraud. I felt like I didn't fit, I didn't belong, and I thought I need just a little break from those feelings. And so the curiosity and the seeking of relief, I took one ampule, when I used to tell this story 25 years ago, I would have to repeat the substance because people were like, what's that, I've never heard of that before? But now everyone knows fentanyl, and so back then fentanyl. So I was a pioneer in that sense long before it became popular.

Eva (10:46):
An early adopter.

Dr. Giles (10:46):
Early adopter. Exactly. Exactly. And so I thought I was really clever. I thought because of how much I knew, this is a very short acting drug. I only wanted a little bit of sense of relief. I probably didn't even want the relief. I wanted to feel like I could if I needed to break glass in case of emergency, of feeling this fraudulent way now being responsible for life and death. And so I tried it one afternoon at home and a very small amount, and I felt like I now had a secret. But the weird thing with that, the terrible thing is that if you feel like you're separate or weird or different before giving yourself an injection of fentanyl afterwards, you're sure of it. And so now I had a secret I couldn't share. I couldn't be honest with anybody about that. I didn't feel like I could. Now, the stakes were way too high. And I wrestled with that first some weeks and then did it again, and then wrestled with it for another couple of weeks after that, and then did it again, and then wrestled with it for another few days and did it again. And each time the interval got shorter until I couldn't wait for my shift to end.

(11:57):
And then one day feeling terrible, several months into this madness, I got a phone call from the department chair, which you don't usually get at my level, this trainee level. And he said that a bunch of fentanyl's missing from the hospital pharmacy. I never took anything from the patients. I always took it out of the pharmacy thinking that somehow was okay. It was okay because I was still doing my job, but I was only hurting myself. He said a lot of fentanyl's missing from the pharmacy. If it's all backed by five o'clock, then we're okay. And the only way for it to be back by five o'clock at that time would've been if I were standing in the pharmacy because I had used it all. And so I said, can I talk to you? He said, I was hoping you would say that. And he said, we've been through this before.

(12:57):
It's an occupational hazard in the specialty anesthesia. Sometimes the guys get wrapped up in this. We've had residents who died. I'm glad you're not dead. You're one of the best residents we've ever had. You're going to get through this. These are all the things he said to me, to Dr. Moore, you're going to get through this. We're going to be here when you do, and you're going to come back and work here, and we'd love to have you on the staff. And that didn't sound like I just said, it sounded like we got you. We're going to slam the door. You're going to hear the bolt slide shut. You're never coming back here again. That's what I thought was really going to happen, but he was saying things that sounded pretty good, and I was out of options. And so I called the number that he gave me, and I got involved in a program which is monitored through the medical board, and I stayed there for more than five years.

(13:43):
And I learned about this problem that I've been talking about, and I learned about myself. And then I watched other guys come in, other docs and ladies come in and get well, and I saw the patterns and I could see that the nature of this illness is one we'd never discussed in school. We didn't learn anything about this. Fortunately, I went through that program and then everything came true. Everything he said came true. I went back to the hospital, I went back to the OR, I went back to taking care of patients. I went up giving the lectures for many years on the addicted physician, so as Exhibit A, and it was an amazing experience to go from riches to rags to riches emotionally in the place where I went to medical school where I grew up. So it was a real return story, and I remain so grateful to the whole process for how that came together.

(14:44):
And it serves for me as the ideal, the experience I had, I think is the ideal for how to help somebody and marked at least by longevity. So these programs where you go for 30 days or less and just get dried out, they don't work because this is the heart of addiction. The substances, you could hear in my story, the substances where the solution. They were the solution to how I felt. Okay, so you get rid of the solution, but you still are left with how you feel about yourself. That's what you really actually have to work on. And that takes more than 30 days. If you look at the number of millions of people with a substance use disorder, in some form it's at least 50 million. It may as many as 70 million people.

Eva (15:31):
It's all around us. It's everywhere.

Dr. Giles (15:33):
It's all around us. And I'm not counting food. I'm just talking about misuse of substances. If you add food, it's probably three quarters of the country has some kind of problem with this. And so what I learned is the only thing actually wrong with me is that I thought there was something wrong with me. I was just mistaken. That's all. And what unraveled that sweater is I was mistaken about drinking. So I was mistaken about substances. Actually, maybe I don't need anything to be okay. Maybe I was wrong. I used to think if I don't have something I can't go on, how am I going to make it in this world with all these people and all this scary stuff? And if I don't have something, well, I don't need that. I do need something, but not that.

Eva (16:18):
What is it that you need?

Dr. Giles (16:20):
Purpose.

Eva (16:23):
Purpose. Yeah.

Dr. Giles (16:24):
So you study yourself. You study your life in context with the challenges and the ups and downs, and you figure out, oh, I'm actually a source of my own pain. When you get that, and then you don't have to keep doing that anymore. It's like Viktor Frankl says, ultimately you have a choice. Even if you're in a concentration camp and they've killed your family, you have a choice how you react to that. You have a choice about what your response is. And so yeah, I'm different. I've got some strengths, and that's interesting a little bit, but what's way more interesting is the way I'm just like everybody else, which is in the weaknesses, which is in the self-doubt, which is in the not good enough, which is in the trying to gain validation and acceptance from other people. Everyone's doing that. I mean, look at the explosion of social media.

(17:22):
That's like a Petri dish of, please like me, please, like me. And everyone is susceptible to the same things until you start to notice, wait a minute, do I need this? Do I need to feel accepted by strangers? Why do I need, was I made alcohol deficient? Right? Was I born into the world missing a few hits of meth? And that's the only way I can get by is if this substance comes into me?You might be mistaken in your outlook. You might not be looking at it exactly right. That's where community helps. So you talk to somebody else and that maybe why it's, it's easier to talk to a provider or somebody who's been through it, or even a priest, alcoholic clergy or pastor or rabbi who's been through it. There's this human level connection. That's what matters. It's the way you see yourself that matters. And if you wonder how people are seeing themselves, think about how you see yourself. That's how they're seeing themselves. They're seeing themselves as the center of their universe, as the star in their movie. What we all do, we think it's happening to us, right? It's happening to us, but it's not just happening to us. It's happening to everybody.

Eva (18:44):
We explore a lot of food issues on another one of my podcasts, and one of the recurring themes is these horrible, really, truly horrible things that we said to ourselves in our own minds for decades.

Dr. Giles (18:56):
Like what?

Eva (19:04):
I used to walk past the mirror and say, well, you're looking rather hulking today.

Dr. Giles (19:12):
No, that's not good.

Eva (19:12):
And I never, never admitted that I said that to myself until I didn't say it anymore.

Dr. Giles (19:19):
Yeah.

Eva (19:19):
So we, I'll transition to my next very big question with this is, food addiction and substance addiction, they are really similar thought patterns, I think. And the GLP-1s are the thing that saved my life. And I will probably have added, I don't know, you can't count how many, you can't predict, I could die tomorrow, but how many years of my life did I get back? And how much happiness did I get back? Because the GLP-1s changed the way that I thought about food, and then I lost weight. It was the mental change that for me was the thing that brought the joy back to my life and stopped me from saying things like, well, you're looking really hulking today.

Dr. Giles (20:11):
Yes.

Eva (20:12):
How are the GLP-1s helping on your side of the fence with substance abuse? Are you seeing that?

Dr. Giles (20:19):
Yes, we're starting to get this from a trickle to a flow of papers about the GLP-1s as psychiatric medicines. And this concept you're talking about, which is in the substance field, it's about cravings that that's the marker that they focus on. And craving is just a thought, just a thought. It's a thought. A thought for wanting something that you think is going to fix the way you feel or make you feel better. And you can crave the end of the song that you heard a piece of it and it's stuck in your mind, and you crave to hear the rest of the song. And you can crave Sara Lee pound cake, and you can crave roast chicken or you can crave fentanyl or actions. So you can crave going to the racetrack because that's where the

Eva (21:14):
Shopping.

Dr. Giles (21:14):
Shopping, that's where the, where some people play slot machines, and it's the sounds and it's the smells, and it's the other people, and it's the feel, and it's the rumble of the wheels as they turn. And all those little visceral reinforcers, which make us feel like we're safe and novel. So something we're not in danger, and there's something new. Those sentiments are literally the reason our species is so successful. We're the best at tuning into those things. So that's why we form societies, because we're safe in groups, and that's why we explore, because we're looking for something novel. So if you have the same thing over and over and over and over and over, that's depression. If you have only novel, that's anxiety because it's all scary and terrifying and overwhelming. So it's the balance of safe exploration that is the stickiest thing. That's why we're all over the planet. That's why we're so successful.

(22:20):
So food is chemistry. Food is molecules that get into your thoughts, and your thoughts are just molecules, also. Now, spiritual dimension and all that stuff. But when the nerves send a message across the synapse, it's a chemical. It might be serotonin, it might be norepinephrine, it might be gamaminobutyric acid or gaba, it might be glutamate. But they send messengers across electrical signals, carry down the wire, and then there's a little packet that's sent across the synapse. And food works on those levers also. It makes different molecules come out. It gets in between its molecules itself. The substances are the molecules that get in between, opiates activate those pathways, amphetamines, activate those pathways. All of our drugs, like SSRIs and so forth, they're all tinkering with those pathways and GLP-1s, those peptides, a whole family of peptides. We use peptides as one of the most ancient forms of communication between distant spots in our body and steroids and other hormones.

(23:25):
So some of them are, I mean, melatonin is a peptide, and that's the time to wake up peptide. You slept long enough. So I don't think it should come as any surprise that when we take in a peptide, it changes the way we think. Now, fortunately, we found some peptides that changed the way you think about safety and novelty, and that's what the GLPs are doing. Now they have other effects. Most people don't know this, but when you're hungry, when you have the feeling of hunger, where do you think hunger is? Where you said, Hey, when you're hungry, where are you hungry? Where in your body is hungry? Stomach.

Eva (24:03):
Stomach, yeah,

Dr. Giles (24:05):
My stomach is empty. I'm hungry. That's not where it is at all. The stomach doesn't sense hunger. The brainstem senses hunger, and it has to do with the combination of factors. It has to do with some of the hormones that are released in the stomach, ghrelin and so forth, and leptin. But also it has to do with the vagal tone between the stomach and how long it's been active. It has empty sensors or full sensors, but where hunger, the concept of I'm hungry is in the brainstem, which means it's very old. And that makes sense because you want organisms to be able to eat. You have to wait till you're evolved as a human being to get some food. It has to be an old ancient signal, but your mind maps the sense of hunger back to your stomach, because we see ourselves as these three dimensional entities where embodied consciousness. So GLP-1s, they affect the way you feel because they affect your thoughts.

(25:00):
And so that makes perfect sense what you said. And we see this in substance use disorder also. So there's some big trials, the results of which are starting to come in that show that people drink less when they're on Wegovy or Ozempic, and then the newer ones, tirzepatide and so forth. The newer ones, are probably even better at that, because they work at multiple targets. So yes, you are doing that. The bigger question is, is that okay for the long term? Now, any of these things has side effects, and so some of them are figuring out. But yeah, if you lose, and we know if you're obese, which is a pretty low definition, so over BMI 25, for the average size person, you're going to live six to 10 years shorter than somebody who isn't. And if you're morbidly obese, 40% over IBW, your life expectancy is probably 25 to 35 years shorter because it's really bad to be really heavy.

(26:06):
The people who passed away in Covid, most of them were obese or morbidly obese, almost 90%. So you don't have the reserves, it has its own problems. It causes cancer, it causes all sorts of things from being overweight. And my pitch to people about being sober is not about the living longer, it's living better. So it doesn't make my, I guess I die six years earlier or later. I don't know, whatever. That seems like something that's so it's almost meaningless, right? I mean, in an abstract sense, we all want to live longer, but more important is the quality of life. Now, let me ask you a question. Got on the GLP -1 inhibitor changed the way, if I heard you right, changed the way you felt about food, and then because you felt differently about it, your eating habits changed, and then weight came off, I presume, right?

Eva (27:01):
92 pounds.

Dr. Giles (27:04):
That's huge. That's like most of you. You lost a whole other person.

Eva (27:07):
Both of my children less, I mean, they weigh less than combined than I lost.

Dr. Giles (27:13):
Yes. So how do you feel about food now?

Eva (27:18):
Indifferent.

Dr. Giles (27:19):
Could you imagine going back to it being the focus of your life?

Eva (27:24):
I am terrified of it.

Dr. Giles (27:26):
You're terrified of that happening?

Eva (27:28):
Yeah.

Dr. Giles (27:30):
Why?

Eva (27:31):
Because, well, the medications on very hard to get.

Dr. Giles (27:36):
Getting hard to find. Yeah.

Eva (27:39):
Or cost prohibitive. So it's really a scarcity issue that's scaring me.

Dr. Giles (27:45):
Gotcha. Because it's expensive and hard to find and/or hard to find.

Eva (27:49):
Right now it's affordable. But if they remove compounding, which they have, it's been going on and off shortage for a couple months now. If it goes away, then what am I going to do?

Dr. Giles (28:00):
So deeper question. Tell me to buzz off. You don't want to answer this question.

Eva (28:03):
No, it's fine.

Dr. Giles (28:04):
Deeper question is let's say it's gone. This is a Flowers for Algernon kind of a situation, so you get this, magic medicine changes the way you feel about the food, eat differently, lose a ton of weight, or 5% of a ton of weight. And then let's say in this novel we're writing, for some reason compounding forces it be, who knows, whatever the medicine is in a parallel, universe, no longer available. But you have had this experience of feeling differently about food. You don't walk by the mirror and tell yourself those things anymore. You're changed is my point. You're different. You've had this life. Do you think that your feeling about food, I know you're afraid that this isn't true, but do you think your feeling about food might persist? Indifference or a source of nutrition?

Eva (29:06):
No. I actually don't think that it's in my control without the medication.

Dr. Giles (29:10):
Gotcha, gotcha. Well, that's okay. I mean that concept, back to substance use disorder is, I just talking with one of our providers, is what we call medication assisted treatment. So you didn't just use a GLP-1 inhibitor, you didn't just do that. You did a bunch of other things, changed your diet, you changed your self concept, you're talking about it. You're saying things that you never said before, maybe today for the first time on your show. And so, I submit to you that you have momentum to be a different person. Now, do you need to stay on this stuff the rest of your life? Maybe, maybe not. It becomes a risk reward thing. Is it worth the risk of going off of it to go back to what that was? Is there a way to safely do that and see if the change is stuck? These are all questions we don't know. In my field, it comes up with a drug called Suboxone. So people are on opiates, we use Suboxone to detox them, but then also it keeps the cravings away. It's magic medicine if there ever was one in terms of that stuff. And then the question is, how long should you stay on Suboxone? So let me ask you this, were you heavy your whole life?

Eva (30:26):
Oh yeah.

Dr. Giles (30:27):
From when you were a little girl?

Eva (30:29):
Yeah. I mean, we talk about this stuff on my other podcast every week. I started dieting at 10, which means my mom started worrying about it before that.

Dr. Giles (30:43):
Gotcha, gotcha. So there's some biology. And so I have patients who have been on, or know people also, who've been on suboxone for decades, for 20 years. And the ones that I know who are like that, are the highest function people you'd want to meet, you would never guess. You would never guess. And they've tried many times to taper off and just to stop it. And they feel bad and they get worse. And many times relapse, unfortunately not relapse fatally. And so for that group, it's a no brainer. You just would stop messing with it and say, look, just take this and this is fine, and it's not expensive. And your life before and after it is a very dramatic start contrast. There are other people who won't take it at all, have to go through it natural, and they've got to tough it out. And they have a mindset about that.

Eva (31:35):
Oh yeah. They're the same ones who have babies without epidurals.

Dr. Giles (31:37):
They have babies without epidurals. They have, I guess, dental work without lidocaine. I'm not sure what they do. Yeah, they walk on the coals, these people. But they won't do it. And that's fine. And that's part of their journey. It's a smaller percentage, but they'll do it. And then most of the people in the middle use it like a cast for a broken ankle. So they'll have it for some months or even years, usually on a tapering dose until their life is together. And so that's one of the deep questions is now for some of these people, an opiate use disorder or history of it, the way they feel on whatever it is, Percocet or heroin or fentanyl is so, they feel like they're finally okay. It's a missing piece. Those people probably are opiate deficient. They probably are. And so it's possible, or they have become opiate deficient through whatever their process was or their use. Being heavy resets your GLP-1 set point. That's why it becomes futile to try and lose weight. It gets harder and harder the heavier you get because it's like I'm not eating anything. The body gets really efficient at conserving calories.

Eva (32:48):
Eating nothing and starving all day.

Dr. Giles (32:50):
And starving all day.

Eva (32:51):
It becomes all consuming.

Dr. Giles (32:52):
And all you're thinking about is food. Yes.

Eva (32:53):
Yes.

Dr. Giles (32:55):
So we have a lot to learn. And so this is a new frontier and there's new peptides coming out. There's all kinds of new stuff coming out. Will they come up with one for addiction? Maybe your next question? Maybe. I hope that happens.

Eva (33:09):
I hope so.

Dr. Giles (33:10):
I hope that happens. I don't think so because of the nature of how the mind organizes information and why we become addicted in the first place. I think it's part of the system. Same way depression is, right? Depression causes us to slow down, rethink, retrace our steps, ruminate, go over it again. Now that can be taken to a catatonic extreme if you're paralyzed with your thoughts and you can't get out. Most depression is self-limiting. And we learn something about the mistakes we made. It's usually precipitated by some mistakes. And it's not like I'm doing great and then all of a sudden I feel bad. That's usually, I mean that's bipolar, but not usually. So I think it's a fascinating world.

(33:57):
Last year I went to several different talks, even by different people, one by an endocrinologist, obviously GLP-1's really hot topic there, one given by a psychiatrist and they're using it for psychiatric illness. For other things, it might be helpful with schizophrenia, it might be helpful with bipolar, it might be helpful with depression. So how does that work? And then an anesthesia talk, because it paralyzes the stomach, and so if this is a public safety warning, if you're going to have elective surgery, you should be off of this stuff for a month beforehand, because it takes that long for it to get out of your system and for your stomach to wake back up. And so the reason that's important is you don't want a full stomach when you go to sleep. You can throw up and get sick in your lungs. So it's a frontier. It's very super cool. I've talked to a lot of people who, for whom it has been life-changing, but I have also talking to people who, spoken to people who went too far with it, and had changed their physical appearance. I know a guy who had plastic surgery as a result of the excess skin that was left over and there were major complications from plastic surgery. Not saying that that's worse than the weight, but there are trade-offs for sure.

Eva (35:16):
Yeah, it opens up all kinds of other things.

Dr. Giles (35:20):
Great question.

Eva (35:22):
Sharon Osborne was in the news a lot for staying on it too long and getting too thin. She didn't even look like herself. I mean, we sort of follow all the celebrity weight loss news, and I just pay attention because it's interesting.

Dr. Giles (35:41):
I think it's fascinating, and I think people do copy what they see on, if you look at the Ozempic use, it was sort of smoldering along for four or five years and then it just skyrocketed because once it's going up and then everybody's on it, and then it becomes a thing. And then the compounding. And I think the Covid times facilitated that also because of demand and because it was listed as a unavailable medicine, it was taken off patent control. And government of Denmark and there's just so many interesting implications. The 10 Ks from last year from the sin companies, so Krispy Kreme and Doritos and PepsiCo, the guilty pleasures, those things, Ozempic and the peptide drugs have affected their revenues.

Eva (36:35):
Yeah, I think Walmart spotted it in their sales first and reported on it.

Dr. Giles (36:39):
Did they?

Eva (36:39):
Yeah.

Dr. Giles (36:39):
Yeah, yeah. They have the best data. Walmart has the best sales data,

Eva (36:42):
Sure. They do

Dr. Giles (36:43):
Better than Amazon even. They're the kings of data.

(36:47):
But yeah, no, I think it's an interesting time. But there are many other medicines in that arena that might be helpful for other things too. We just saw a new pain medicine come out. A new non-narcotic acute pain drug was released last week. And so there's huge changes in pharma. I think we're about to get a new HHS secretary. There's been a lot of, I'm one of the people who thinks, and it's not that much of out on the line that there's been regulatory capture of FDA and a bunch of the other agencies. So weirdly, it's stymied drug development because it just makes sense. If you're the big gorilla, if you're the big drug manufacturing company, you don't want anybody else coming up with new products because that's more competition. So there's a lot of promising things that are killed in their cribs, so to speak, and we never hear about them. Or they pick the other study that shows maybe this is iffy instead of the one that shows it's great.

Eva (37:54):
Because they're trying to get a winner. They're trying to get something to be both on the schedule and a worldwide sensation that literally everyone on earth has to take. Sort of like what's happened to movies. They won't make a movie if they're not a hundred percent sure that everyone's going to go watch it. And that there's nothing left. There's no creativity, there's nothing left.

Dr. Giles (38:17):
And yet here we are on what's basically new media. This is long form journalism unedited straight from the source. I think this guy is full of nonsense and I don't want to listen to him or Wow, this totally, I've thought this. This is great. Or anything in between. And you don't need 75 million ticket buyers to make something a hit. You can have a few hundred people or a few thousand people or a few million people, if you've got really a message that resonates and make a huge difference and connect and change things with a microphone and a video connection. You don't

Eva (38:57):
In my laundry room.

Dr. Giles (38:58):
In your laundry room, in my office. You don't need to make a giant production out of it to tell the truth and to connect with people. And sometimes the truth is, we don't know. A lot of my field is we don't, we don't know. We don't know the precise moment to intervene and say, Hey, Eva, how's it going? Because if I knew and I could reach out to you and text you at that moment when you're thinking you're looking kind of hunky today or hunlky going, going by the mirror, if we knew that, right, if we knew that right before then, that would be the most efficient way to intervene Right? I'm going felelin hulking today. How did you know? And we probably give it off. We probably give it off with our facial expressions. We give it off with our activities, with our behaviors, with stuff. This gets into privacy, which you could probably, if your little angel followed you around all day, it would probably, Hey, why don't you text Eva and check in on her? But that would be the most efficient way to help people stay sober is that at just the right time, you got contact or something or something came into your consciousness to remind you of the real stakes.

Eva (40:15):
This is why we used to wear a rubber band.

Dr. Giles (40:17):
Rubber band.

Eva (40:17):
That was the Weight Watchers trick.

Dr. Giles (40:18):
Rubber band don't smoke.

Eva (40:19):
Yes, they taught me that at Weight Watchers.

Dr. Giles (40:21):
Yes.

Eva (40:22):
I don't remember what the thing was that I was supposed to snap the rubber band for.

Dr. Giles (40:26):
Yeah, that's what I remember.

Eva (40:27):
Go to the fridge, open the fridge. Oh no, snap the rubber band like this is my Skinner box.

Dr. Giles (40:33):
There's a guy, Alan Carr wrote a book called Easy Way about quitting smoking. And one of the tricks in there if you want to quit smoking is when you really feel like having cigarette, he suggested taking five deep breaths all the way to the top of your lungs and all the way out.

Eva (40:50):
The whole book? That's what they?

Dr. Giles (40:51):
No, no, no. There's a whole lot more to it. But one of the techniques when you're feeling like I'm going to give in, I have to have a cigarette, is take five breaths. And if you take five breaths, it actually changes your pH a little bit. You get a little alkalotic, you'll feel a little lightheaded. You'll get a little extra oxygen to your brain. It takes 30 seconds or so to take five deep breaths, and it interrupts your thoughts. And most of the time you snap out of it because we get into these trances of, I've got to eat the thing, or I've got to do some drugs, or I need a drink. And we keep telling ourselves these things over and over, which are not true. They're just how you feel at the moment. So we need a little reminders. We need reminders. I need reminders.

Eva (41:41):
I quit smoking too, and I kind of grew up when smoking, everyone still did it in college and stuff.

Dr. Giles (41:48):
Me too.

Eva (41:49):
You could still smoke in the mall when I was growing up, in the airport. It wasn't like it is now where nobody smokes.

Dr. Giles (41:56):
Yes.

Eva (41:57):
And the thing that ultimately got me to stay quit, I tried many times, but when I finally did it, it was because someone told me, after one week, it's all in your head.

Dr. Giles (42:08):
That's it.

Eva (42:09):
And so when I got to one week, then I went back to that idea over and over and I was like, oh, you're just fooling me brain. That's not a real craving. That's a fake one. That was the trick for me.

Dr. Giles (42:23):
I agree with you completely. I think that tobacco companies put this idea out that it's the harder to quit than heroin.

Eva (42:31):
Of course they did.

Dr. Giles (42:32):
It's not true at all, it's not. Nicotine, by the way, first of all, not bad for you. Nicotine, the chemicals not bad for you. The tobacco on fire or it dissolved. Nicotine dissolved in the vape solution, those things are bad for you. Tobacco in the oral form is bad for you. But nicotine is not, and nicotine, it's easier to quit nicotine, from an addiction standpoint, than coffee. It bothers you less to quit it than coffee. You quit coffee.

Eva (43:02):
That's the only thing I'm addicted to now is coffee. There is no world where you're taking my coffee away.

Dr. Giles (43:08):
And coffee's not bad for you either. So long as you're drinking gallons of it and it's disturbing your sleep. Coffee's not bad.

Eva (43:14):
We're starting to see people using nicotine in public again, not smoking

Dr. Giles (43:18):
The zins, right?

Eva (43:19):
Yeah.

Dr. Giles (43:20):
Yeah. I think that's great. I don't have a problem with that at all. I think nicotine lozenges or nicotine pouches, so long as they don't have anything else in them that's bad for you. I mean, you can have some mint leaves or something in there.

Eva (43:35):
Well, I think they're going to have to be a conversation for another day. And we've gone through a lot of really interesting things today. I don't want to keep you any longer.

Dr. Giles (43:46):
We covered territory. Yeah. Well, obviously this mountain has no top because

Eva (43:52):
No, it doesn't.

Dr. Giles (43:53):
You're dealing with human nature and we are looking at it through this particular lens of addiction or eating disorders or whatever, but we're dealing with human beings. Part of why it's so fascinating is there's always a new story. There's always a new wrinkle. There's always something you haven't thought of that that could be a possibility. And so it's endlessly interesting, and I feel new and like I'm learning all the time from my patients, from the field, from developments. This is not stale. So if there's anyone in medical school thinking about it, addiction medicine is an awesome specialty. You can go all over the place and what you leave behind in terms of if you're able to connect with somebody and help them is a changed person who then goes on to change other people.

Eva (44:42):
That's purpose. And if we're interested in following you anywhere online or reaching out, I don't know if you do that.

Dr. Giles (44:51):
I'm just starting to. So be gentle, be gentle with me as you reach out. But I'm Dr. Jason Giles everywhere, so DR Jason Giles on X or Instagram or any of that stuff. You can find me.

Eva (45:07):
I will make sure we put it all in the show notes so it's easy to locate. And I'm so grateful for your time today and for hearing your story. Thank you so much.

Dr. Giles (45:14):
Back at you. Thanks for your candid sharing. That was awesome. Thank you for doing this.

Eva (45:20):
Follow us on Instagram @LessofYoupodcast. Are you confronting the same challenges and have a story to tell? I'd love to hear your story on our Skinny Shot Stories podcast. Contact me for more details at skinnyshotstories.com. If you're a doctor and would like to learn more about sponsoring this or any of our cosmetic surgery and weight loss podcasts, go to lessofyou.com. Less of You is a production of The Axis, theaxis.io.