Brandon VanderWel, MD
109 posts
Brandon VanderWel, MD
@BWVanderWelMD
Surgeon. Tinkerer. Family Bran. Mariner Fan. Bariatric Surgery. Endosleeve. GLP-1.
Greater Seattle Area Katılım Ekim 2024
107 Takip Edilen14 Takipçiler
@BWVanderWelMD My wife and I first did reta 2 years ago. And she got it.
It drove her crazy. But it went away after a month or two.
I have had it a couple times, but only for like a day or two
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Reta bros are you seeing much dysthesia? Pain, numbness, or tingling of the skin?
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@BWVanderWelMD I like that way you said "these drugs don’t change your hardware. They are saas"
This is a great analogy
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One of the biggest arguments against GLP-1s is:
‘If you stop taking them, you gain all the weight back.’
But this real-world chart tracking over 25,000 people after stopping tirzepatide tells a VERY different story.
2 years later:
46% were actually EVEN LOWER weight than when they stopped.
9% maintained their loss.
Only about 21% regained it all or more.
Interesting…
For decades obesity rates exploded while everyone screamed:
‘Just diet and exercise.’
Now something is finally moving the needle at scale…
and people are angry about it.
The conversation around obesity is changing fast.
Fruitville, FL 🇺🇸 English
@TheWarEnglish 30% is the average of all comers for bariatric surgery. The “almost 30%” in Reta is a curated group that could tolerate the med long term.
If you want to help the most amount of people do awesome procedure + a little glp1
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Eli Lilly just dropped Retatrutide phase 3 obesity data.
Up to 30% bodyweight loss. 85 lbs in some patients.
That's bariatric surgery territory in a syringe.
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@juryverdicts @PatrickByrne @archer_rs @grok Having poor hvac probably helps their obesity rate though
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@PatrickByrne @archer_rs @grok We have massive cities in the desert.
We have air conditioning.
Europe doesn’t have air conditioning because their energy grid can’t support air conditioning.
Pretty embarrassing for a country that nearly conquered the globe.
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@rodrig39386 @DoctorTro Indeed.
Life is a series of calculated risks.
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@BWVanderWelMD @DoctorTro All surgical procedures of course carry risk
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Doctors aren’t even medical experts
Ask one how to get off diabetes medications 💊
They won’t known
Dutch Rojas@DutchRojas
@ruthefordml Doctors are not experts in healthcare. They are medical experts.
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@darealmoka Obesity is hard and not everyone’s biology is the same
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the hidden ozempic side effects conversation was inevitable
a smaller glp1 dose already helps with cravings and overeating, so i never understood why full dose became the standard for nearly everyone
Rivenna Vale@rivennavale
A good general rule of thumb is: You want to approach weight loss as organic as possible while getting the highest desired effect AND - and this is very important - you want to minimise the side effects. I’ve been hitting the gym for almost 2 years now. A good body composition with a low body fat percentage and a decent amount of lean muscle mass is super important for my fitness and longevity goals. Most studies on full dose ozempic indicate a 25 - 40% loss of lean muscle mass, not fat. That’s unacceptable for most people, almost nothing is as important for overall health and sustainable weight loss as having muscles. Even if you lose weight on a full dose of ozempic, once you get off it, you are missing the necessary muscles to sustainable burn more fat and you will gain the fat back. Microdosing GLP1s is the solution. Much less muscle loss and also less of the other side effects while simultaneously suppressing hunger and especially binge eating behavior enough to reduce body fat.
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@Emeka3345 Neurosurgery residency is absolutely brutal. The lifestyle afterwards is also challenging. Everything is so high stakes.
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I've always wondered why. There are a lot of medical students that when asked,they will tell you they want to be a neurosurgeon. Now looking at the number of neurosurgeons we have now, they are quite few compared to these number of medical students .Is it that spaces are limited?
morale◾@moraleDmaestro
neurosurgeons are so rare to see
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@skiiskiim @DoctorTro Metabolic surgery can work amazing and be your only chance of a cure with type 2 diabetes.
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@DoctorTro No one is an expert in all of medicine. Doctors don’t really know how things work at the cellular level, they know how to treat disease. Scientists understand how things work at the cellular level but don’t know how to treat disease.
Diabetes can’t be cured in most cases
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@rodrig39386 @DoctorTro Metabolic/bariatric surgery is your next best tool. Can work incredible. Best tool for diabetes treatment and weight loss too
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@DoctorTro Type 1 DM destruction of islet cells little chance of getting off insulin without pancreatic transplant / implantation of inlet cells
T2D disease of obesity insulin resistance weight loss , low carb high protein diet may bring about remission but in some cases
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@DoctorTro Healthy food. Small portions. Avoid junk food and sugary drinks. If that doesn’t work metabolic surgery is your next best tool. As long as you have enough natural insulin it can work amazing. I’ve put lots of people into diabetes remission.
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@m_aadil Glp1 still doesn’t work that great when patients are on abilify
Do you have a couple med alternatives or combos that you try out if someone is on abilify?
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I am a strong advocate for the use of GLP-1 medications, and I hope that psychiatry will embrace them to prevent the metabolic harms and risks that continue to pose the biggest challenge for many medications.
Crémieux@cremieuxrecueil
We're going to win
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@grok can you link the full study?
Without access to the full study. I can say that if they are using epic data it may show a patient going off GLP-1, but over the last 2 years a lot of patients have lost insurance coverage or co pays went way up so lots of patients switched to a compound GLP-1 out of the epic system. The med rec in a patients chart is really hit or miss for meds not prescribed by that system.
Good chance that a good portion of those “off GLP-1” just switched from name brand to compound not through epic. But maybe I’m wrong and they specifically asked patients, but most of those big data scrape studies aren’t really able to do that realistically.
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@BWVanderWelMD Not a study just health data. @cremieuxrecueil posted this two days ago. Could be confounding variables as to who these patients were, did they switch to another, why did they stop…it’s so early to say
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@CyberHealthProf @kalos21million Agree. Your relationship with food needs to be intentional, not based on your feelings. Because when you come off the feelings toward food go back to being a huge challenge
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@kalos21million I did a podcast recently and touched on it. The key is your nutritional habits. You must have a good healthy foundation that fits you specifically. Start food tracking now and after. It would be beneficial to also run labs now and down the road.
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@ctc8910 @kalos21million Cost, side effects, not effective enough. Even with minimum effective dose, multi week dosing, etc some people’s biology can’t find a sweet spot to make it worth it. My experience is only with smg and tz.
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@kalos21million I think the more interesting question is, why ever stop? The benefits don’t stop, it’s useful for more than weight loss alone.
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Great take from @NeilFlochMD
Obesity is a terrible, serious disease. That negatively affects every area of the patients life. We need serious treatment algorithms because once you are obese it is so challenging to treat. We need serious prevention recommendations to prevent patients from getting there.
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Best take of a surgeon arguing against their own revenue stream to make a systems point.
This is the kind of honesty the healthcare conversation desperately needs more of.
Prevention doesn't pay. Treatment does.
Until that changes, every clinical innovation is just a more sophisticated way of treating a problem we chose not to prevent.
Neil Floch MD@NeilFlochMD
As a surgeon who makes their living by prescribing GLP-1 and doing bariatric surgery… what we ultimately need is to reexamine and research our food and living environments and pass laws and incentives to help prevent obesity. This will best control obesity for future generations.
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From a numbers standpoint if @novonordisk wants to have a cost effective differentiator from tirz, it would make way more sense to have a study showing benefit of adjuvant semaglutide + MBS. All MBS, not just sub optimal response.
Number of MBS has never been that high compared to GLP-1 users. And number of poor responders to MBS is a low percentage.
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Good news. We also need RCT’s assessing MBS after suboptimal GLP1 treatment. But who would fund such a study?
Daniel J Drucker@DanielJDrucker
In people with a suboptimal clinical response after MBS, semaglutide results in substantial and clinically significant body weight reduction along with improvement in metabolic parameters and quality of life, compared to placebo @NatureMedicine nature.com/articles/s4159…
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@PSchauerMD @NeilFlochMD Indeed. The multimodal era is upon us
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Agree! Given that only 10-15% of people with clinical obesity get any evidence based treatment, it’s great we now have effective medical and surgical options. The next challenge is to figure out who should begin with surgery or medical treatment. Many may need both.
Neil Floch MD@NeilFlochMD
Accurate and succinct: the role of bariatric surgery is explained and must be included in the comprehensive treatment of obesity - additionally - surgery and medications do not overlap in effectiveness they are additive!
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Some of my “Star” patients who placed their diabetes in remission with keto 5 to 8 yrs ago are coming back to see me due to diabetes rearing its ugly head again. These are among the most motivated of the motivated. The stubborn shadow of type 2 diabetes follows and it needs to be respected and not judged.
Dr Terry Simpson@drterrysimpson
This is not true. Diabetes is a disease that can be made worse with a bad diet, but cannot be "cured." You cannot regrow islet cells that produce insulin. Some can go into remission, but cannot be "reversed."
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