Johann: [00:00:00] These drugs are rocket fuel for eating disorders. I am really worried. In addition to extraordinary benefits for people like me, if we don’t tighten the regulation around these drugs, we’re going to have an opioid like wave of death toll of deaths of young girls and eating disorders do just overwhelming the young girls.
Obviously you get some boys, some older women, but it’s overwhelming the young girls who are able to starve themselves to death who would not have been able to do that had they not had access to these drugs.
Mike: Hello, and welcome to a new episode of muscle for life. I am your host, Mike Matthews.
Thank you for joining me today for an interview with best selling author and journalist, Johan Hari about Ozempic, about GLP 1 drugs and specifically about some of the side effects and some of the risks that are not being openly discussed by [00:01:00] everyone who is advocating And of course there are significant benefits as well, which Johan has experienced personally as a part of the research that he did for his latest book which is called Magic Pill.
And in this book, Johan offers a unique perspective on how drugs like ozempic could reshape the obesity epidemic. And he’s going to talk about that in today’s interview. But, as the title of the book implies, the biggest question, of course, Is Ozempic truly a magic pill? Is it a modern miracle? Or might it lead us into a future where hundreds of millions of people have to choose between being overweight and overdrugged?
But first, If you like what I’m doing here on the podcast and elsewhere, then you will probably like my award winning fitness books for men and women of all ages and abilities, [00:02:00] which have sold over 2 million copies, have received over 15, 000 4 and 5 star reviews on Amazon, and which have helped tens of thousands of people build their best body ever.
Now, A caveat, my books and programs cannot give you a lean and toned Hollywood body in 30 days, and they are not full of dubious diet and exercise hacks and shortcuts for gaining lean muscle and melting belly fat faster than a sneeze in a cyclone. But, They will show you exactly how to eat and exercise to lose up to 35 pounds of fat or more if you need to lose more or want to lose more and gain eye catching amounts of muscle definition and strength.
And even better, you will learn how to do those things without having to live in the gym, give up all of the foods or drinks that you love, or do long, grueling workouts. workouts that you hate. And with my books and programs, you will do that. You will [00:03:00] transform your physique faster than you probably think is possible, or I will give you your money back.
If you are unsatisfied with any of my books or programs, the results, anything, for whatever reason, just let me know and you will get a full refund immediately. on the spot. Now I do have several books and programs including Bigger Leaner Stronger, Thinner Leaner Stronger, and Muscle for Life. And to help you understand which one is right for you, it’s pretty simple.
If you are a guy aged 18 to let’s say 40 to 45, Bigger Leaner Stronger is the book and program for you. If you are a gal, same age range, Thinner Leaner Stronger is going to be for you. And if you are a guy or gal, 40 to maybe 45. Plus muscle for life is for you. Hello, Johannes. Nice to meet you. Thanks for taking the time to do this.
Johann: Hey, Mike. I was warning you off camera that I’ve had an insane amount of caffeine today. I’ve basically been [00:04:00] freebasing caffeine. So there is a not insignificant chance that I will die during this interview. So I’m glad my last words are going to be recorded for posterity.
Mike: I will have to cut that clip and make that the one you would understand.
You would understand.
Johann: It’s true. It’s what I would have wanted. I once saw Joan Rivers on stage. She said that, she’d be like, when she was really old, she’d be like, I could die at any moment. And you’ll be like, I was there. I was there. The bitch was walking around and she was just dead.
Mike: And now with social media and cell phones, you can live forever.
It’s a very 2024 way to go. How much caffeine are you up to, by the way?
Johann: I suspect that my blood, if you did gave me a blood test, I’m more caffeine at this point, but it’s all fine. I’ve had a bit of a mad day.
Mike: One of the, one of the guys who works with me when we were all in the office together before COVID, we went remote at that point, but he would regularly consume probably a gram to a gram and a half per day.
That was just a, [00:05:00] that was just a normal cruising altitude for his caffeine intake.
Johann: In the last year of his life, Elvis had a doctor who would come and inject caffeine directly into his veins every morning. And I was like, I need that doctor. And my friend was like, yeah, what happened to Elvis next? I was like, yeah, good point.
Didn’t work out that well.
Mike: Oh yeah. I didn’t think of that. You might as well skip that. Just go to the Hitler phase. You want meth? You want, skip the caffeine. If you’re going to go intravenous, come on. Speaking of injecting drugs we’re. That’s a very good pivot. I like it.
That’s what we’re here to talk about. Is is injecting drugs. We’re here to talk about some glutide or ozempic as many people know it. And this is something that I’ve spoken a bit about it. I’ve written a bit about it, but I wanted to have a bit of a different discussion and more, as they like to say, nuanced discussion with you about, about where the.
Research is at with this drug. And looking to the future [00:06:00] of where this might go and how it how it might impact society. Also looking at some of the safety concerns that have been brought up. But I think where I wanted to start was a quote with of yours where you said the idea that obesity is just about willpower is scientifically absurd.
Can you explain what you mean by that?
Johann: I don’t think I did say that. I do think that, but I’m not sure that’s anyway. Willpower is real and willpower plays a significant role in this, but willpower is one part of a much bigger picture. And if you want to think about that, I would just say everyone listening, pause this podcast and do something for me.
Just take the name of the nearest beach to where you live. So I’m guessing for you, Mike, it’s Tampa and just Google photographs of that beach. In the year that I was born, 1979, and just look at them for a minute and then come back to us, right? If you’ve done that, you will notice something really weird.
Those people don’t look [00:07:00] like us. If you look at photographs of beaches in the year I was born, pretty much everyone, pretty much everywhere in the world, looks what we would call either skinny or pretty jacked, actually. You look at it and go where was everyone else on Tampa Beach that day? Where was everyone else?
Was it like a skinny person convention? What was going on? And then you look at the figures. That’s what people look like in the year that I was born. So between the year I was born and the year I turned 21, obesity doubled in the United States. And then in the next 20 years, severe obesity doubled again, right?
This is bizarre. You have 300, 000 years where human beings exist and there’s some obesity. But it’s exceptionally rare. And then literally in my lifetime, obesity blows up. Why? Why would that happen? Now, you could say everyone just had a mass failure of willpower. There’s just a breakdown in willpower.
That doesn’t seem very [00:08:00] plausible. And we have very good research on this. And we have research on willpower. and both its reality and its limits. In fact, we know why this happened, because it happens, we know why this physical transformation in people’s bodies happen. It happens everywhere where one change takes place.
It’s where people move from mostly eating a diet based on fresh whole foods they prepared on the day, to mostly eating a diet of processed and ultra processed foods, which means foods that are constructed in factories out of chemicals in a process that isn’t even called cooking, it’s called manufacturing food.
And it turns out these processed and ultra processed foods affect our bodies in a really different way to the old kind of food, right? And there’s lots of evidence for this, and we can go through a lot of it in detail if you want, and I go through a lot of it in the book, but if you want to understand the heart of it, I think you’ve got to understand an experiment that to me just nails it.
It was carried out by a scientist I interviewed called Dr. Paul Kenny, and I’ve [00:09:00] nicknamed this experiment Cheesecake Park. That’s not the official title, right? It’s a very simple experiment. He’s the head of neuroscience at Mount Sinai in New York, and he got a load of rats and he raised them in a cage.
And all they had to eat was the kind of natural, whole foods that rats evolved to eat over thousands of years. And when that’s all they had to eat, the rats would eat when they were hungry. And they would stop when they were full. So they had some kind of natural signal that just said, Hey guys, you’ve had enough, stop now.
So they never became fat or overweight when that was the only food source they had. Then Dr. Kenny introduced them to the modern American diet, get ready to salivate. He fried up some bacon. He bought some Snickers bars. Crucially, he bought a lot of cheesecake and the rats went crazy. for the American diet.
They would literally dive into the cheesecake and eat their way out and just emerge just completely slicked with cheesecake and they ate and ate and ate and all this natural nutritional wisdom that they’d had when they ate the old kind [00:10:00] of food just disappeared and they all became severely obese.
Then Dr. Kenny tweaked the experiment again in a way that feels to me a bit cruel as a former KFC addict. He took away all this American diet And left them with nothing but the healthy food and he was sure he knew what would happen. He thought they would eat more of the healthy food than they had at the start and this would prove that exposure to the American diet increases the number of calories you eat in a day.
That is not what happened, Mike. What happened is much weirder. Once they had the American diet and it was taken away, they refused to eat anything at all. It was like they no longer recognized the healthy food as food. They only went back to eating it when they were literally starving to death. Now, I would argue we are all living in a version of that Cheesecake Park experiment.
The food we’re eating is undermining our ability to ever feel full and get the signal from our body saying, hey, stop eating now, right? Now, we didn’t choose that, right? More three year old American children know what the McDonald’s M means than know their own last name. They didn’t choose that. I didn’t choose that.
You didn’t choose that. [00:11:00] 65 percent of the calories the average American child eats in a day are from ultra processed foods. That’s not by choice. That’s undermining our ability to feel full from the moment we’re born. And you can now willpower can play a role in correcting that. Like I say, it is real.
Everyone listening will have had the experience of exercising willpower over something, right? I nearly had another glass of coffee before I did this podcast. I get it. I will actually, I will just, I’ll sound like a coke addict. I’ll be like Al Pacino at the end of Scarface if I start doing that. That was willpower, right?
Willpower is real. But you exercise willpower in a wider context and we’re existing in a wider food environment that is systematically undermining our willpower.
Mike: And in the book, Magic Pill, you decided to try Ozempic. And how did that experience go? And particularly, were there any surprising side effects that you didn’t expect?
How did that experience compare to what you were expecting?
Johann: [00:12:00] Going in, I felt really conflicted. I remember so vividly the moment I learned about the existence of these drugs. It was the winter of 2022. And it was that moment at the end of the pandemic when the world was opening up again. And I got invited to a party and I was like, Oh, I remember them.
Okay, let’s go. And I was in an Uber going to the party. This party was thrown by an Oscar winning actor. I’m not saying that just to name drop. It’s relevant to what happened next. I was sitting there and I suddenly felt this kind of wave of dread is too strong a word, but like self consciousness.
Because I thought, I was quite fat at the start of the pandemic and I gained quite a lot of weight during it. And I thought, oh, this is a bit embarrassing. But then I suddenly thought, wait a minute, most of the people I know gained weight during the pandemic. This party is going to be really interesting.
We’re just going to all pretend
Mike: like it didn’t happen.
Johann: I’m just like Hollywood stars with a bit of like flat on them. This is going to be fascinating. And I arrived and I walked around and it was the weirdest thing. [00:13:00] Not only had none of them gained weight, they were gone. Everyone was like much thinner than they’d been at the start of the pandemic.
And not just the actors, like the agents, the screenwriters as partners, like I was like. Whoa. And I bumped into a friend of mine on the dance floor and I said to her. Wow, it looks like everyone really did take up Pilates during lockdown and she laughed in my face and I was like, why are you laughing at?
And she pulled up on her phone and an image of an Ozempic pen. And that was when I learned, obviously I read a lot more about it later, but that we, there’s been a staggering medical breakthrough. Some of these people have described this as like a fad or a craze. It’s really important people understand this is, there’s plenty of things we’re worried about, but this is not a fad.
We now have a new drug. That gives people a staggering amount of weight loss. The average person who uses Ozempic Wigobi loses 15 percent of their body weight. The average person who uses Menjaro, which is the next in this new class of revolutionary weight loss drugs, loses [00:14:00] 21 percent of their body weight.
And the next one that will come online probably early next year, Triple G, the average person loses 25 percent of their body weight, only a little bit below bariatric surgery, staggering. And as soon as I learned this. I had two very strong contradictory thoughts. The first thing I thought was this could save my life.
Because, I was about to turn 45, which is the age my grandfather was when he died of a heart attack. Loads of the men in my family get heart disease. My dad had terrible heart problems, though he survived them. My uncle died of a heart attack. As I say, my granddad died of them. And I knew then that obesity makes heart disease much more likely.
Actually, makes worse or causes over 200 known medical conditions. So I thought, whoa, there’s a drug that reverses or massively reduces obesity. That’s a big deal, but I also thought, wait a minute, this sounds way too good to be true. This just can’t be [00:15:00] right. So I ended up going on a really big journey all over the world from Iceland to Minneapolis to Japan to interview the leading experts on these drugs, the biggest defenders of the drugs, the biggest critics of the drugs, and really do a deep dive into what are the benefits and risks here.
And what is this extraordinary. Revolution. This medical breakthrough going to mean for all of us. And of course, as you said, I took the drug myself, but I can’t really research this without taking it myself. So I took it as well.
Mike: And how was that experience when you took it and how did it compare to expectations?
And what did you conclude or what did you learn through that phase of doing it? It’s 1 thing to read about research and to listen to experts and even to understand the mechanisms of action and so forth. And it’s another thing to really experience it. And I’ve not experienced it. Many of the people listening have not many people possibly have, but for the many who have not, there probably are many who have considered or are considering.
Using it and [00:16:00] I’ve in, in my experience and what I’ve seen, there are a lot of people who I would not recommend it to who are using it and some people I would recommend it to, but
Johann: yeah, it’s a really important question. 47 percent of Americans now want to take these drugs partly because everyone who takes them then becomes a kind of walking as advertisement for the drugs.
People are like, whoa, what happened to Bob? It’s half. It’s half of Bob. Where did he go? He stole the other half. It’s, how does it feel? There were lots of ups and downs. The initial effect is. It was bizarre. So I remember the second day after I’d taken Ozempe, I woke up and when I’m, I live half the year here in London and I went to this diner up the street from where I live and I ordered what I used to order every morning for breakfast, which I’m embarrassed to say to someone who’s as glowingly healthy as you, but I, it was a huge chicken sandwich with loads of chicken and mayo in it.
And normally I would like inhale that and still want some chips. And that [00:17:00] morning I had three mouthfuls. And I just felt full. I didn’t want any more. I thought this is weird. And that’s really how it was from then on. These drugs make you feel very full, very fast. So it’s not, think about conventional dieting where you’re hungry but you learn how to deny yourself this longing.
It’s not like that. It changes what you want. Now, we know some of what’s going on there. One of the weird things about these drugs is we don’t entirely know how they work, but there’s some things we do know. So if you ate something now, Mike, doesn’t matter what it is. After a little while, your pancreas will produce a hormone called GLP 1.
GLP 1 is just part of your body’s natural signals going, Hey, Mike, you had enough. Stop eating. It’s the breaks, basically. But natural GLP 1 only stays around in your system for a few minutes and then it’s washed away. What these drugs do is they inject you, or in the pill form they give you, an artificial form of GLP 1 that instead of sticking around in your system for a few minutes, stays around in your system For a whole week, which means when I start to eat that chicken sandwich, [00:18:00] I’m already pretty close to full.
So quite quickly, the signal of, Hey, Johan, stop, you’ve had enough kicks in. So it produces, as I said, dramatic amount of weight loss for me. I lost just a staggering amount of slight, nearly 20 percent of my body weight. I went from a BMI of, I think it was 31 to BMI. 24, 23, something like that now. So a really dramatic shift.
So that’s the first and immediate effect. You asked before about side effects. I go through in the book 12 significant risks associated with these drugs, as long as huge, alongside huge benefits. I’m sure we’re going to unpick both, but the, in terms of the risks that I’m describing are different to the side effects, right?
So the most common side effect by far is nausea. That most people. Almost everyone, when they start taking these drugs, feels nauseous. For most people, it goes away pretty quickly. For me the very first day I was nauseous, it was like a mild nausea, if I had randomly felt nauseous like that one day, I wouldn’t have gone home and gone to bed.
I would have just carried on about my [00:19:00] day, but I would have felt a little bit rough. From then on, every week when I injected myself, I felt mildly nauseous the next day and gradually that went away. And here I am, more than a year and a half later and I don’t, I’m still taking it for reasons I can talk about, but I never get nauseous.
The nausea now. So that’s most common side effects along with a burping constipation. But I was separate that from the benefits of risks.
Mike: Yeah. So minor side effects in terms of short term. What you experienced then obviously. Greatly offset by the production appetite that then made it a lot easier to maintain a calorie deficit, which most people listening are going to understand that’s what drives weight loss.
And that’s really the benefit of it. And coming back to the willpower point that you spoke about just to add a comment to that, For people listening who have never really struggled to lose weight, because in my experience interacting with those people, they don’t quite understand what it is [00:20:00] like to, for example, we can start with just being hungry all the time.
And that is a common experience for people who have struggled with their weight for a long time. Many of those people are just hungry all the time. And for somebody who has not experienced that, or doesn’t generally experience that, They don’t understand just how difficult that can be to deal with. And for people listening who don’t generally experience that, if you’ve ever dieted to get very lean, if you think to that period, especially toward the end of that diet, you probably were hungry.
A lot, and you were experiencing cravings a lot. So now imagine that was just your default appetite all the time, regardless of body composition. And so the factor of willpower, even you’ll hear people, even professional bodybuilders talk about this, that once you get deep enough into a diet and your appetite reaches a certain, it crosses a certain threshold, it’s only a [00:21:00] matter of time.
Until you lose the battle that you can only apply willpower no matter who you are for so long until your appetite wins. And so again, people who play with their body composition for a living, they know that and they plan for that in their dieting and so forth. Have you ever wondered what strength training split you should follow?
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Johann: Now, that is such an important point. There were lots of things I learned in the research of the book that shocked me.
There’s a brilliant professor you should have on the podcast called Professor Tracy Mann. I interviewed her in Minneapolis. Who’s been researching, she’s done the best research on the, when do diets work and when do they not work? And it’s interesting, When she started researching this around the year 2000, the evidence was absolutely unambiguous on diets, diets work.
Huge, many thousands of studies demonstrating that diets work for the obvious reason that if you, like you said, if you burn more calories than you consume, you lose weight, that you’d have to deny the laws of physics to deny that, right? When she looked at this in more detail, she noticed almost all the research on the efficacy of diets looked at it.
People who diet for three months, some of them looked at six months. So basically you lose a lot of weight and then the people doing the study just assume and then you remain happily ever after at that lower [00:23:00] weight until you die, right? Everyone listening will know people who dieted and will notice that’s not the reality of it.
Certainly that’s what Professor Mann noticed. I know lots of people who You know, this is a weird time frame to look at. So she then gathered all the evidence that had only been about, I think it was 24 studies at the time that looked at dieters over two years, rather than three months to six months.
And over the two year timeframe, what you find is very different. The vast majority of people regain the weight they’ve lost. Not everyone, and it’s important to note, it’s not everyone. There’s a significant minority, it’s about 15 to 20 percent who don’t, but most people do. It’s interesting, what’s, why would that be?
What’s going on there? And this relates to a really interesting debate about the new, revolutionary new weight loss drugs. We’ve talked about how they have this effect, GLP 1, that has this effect in your pancreas and your gut. So it was initially thought, what these drugs do is they simulate GLP 1 is a gut hormone, so the effect of these drugs must be primarily on the gut.
They must slow down gut motility, things like that must be how they work. [00:24:00] And they do have that effect. But it’s increasingly clear, and I interviewed the cutting edge neuroscientists on this, it’s increasingly clear actually these drugs don’t work primarily on the gut, they work primarily on the brain.
They change what you want. There’s a huge debate about how they change the brain, and it’s frankly disconcerting to go and interview lots of really good neuroscientists and go, what’s it doing to my brain? And they go, yeah, we’re not really sure. But one key theory, which I found quite persuasive, although it is contested, and there are other theories.
Compelling theories. One theory relates to this question about diet failure. There’s some stuff we know about dieting that’s really interesting. If you go back to the 60s, there was a theory that was developed about dieting and just body weight more generally, which was, it was known as set point theory.
So it comes from your body temperature. So if you think about body temperature, it’s by an analogy with your body temperature, think about your body temperature. From when you’re born as a human being, you have a set point for your body temperature, right? [00:25:00] If you go above your body wants to keep you within a very narrow range around the body temperature that’s healthy for your body.
And we will have all had the experience if you get above that body temperature, your body works really hard to bring you down. You start sweating, you desperately want shade. And equally, if your body goes ends up below that body temperature, your body works very hard to bring you back up, you shiver, you desperately want warmth.
So your body has a natural set point, it keeps your temperature at a particular level, and you can’t really go outside that range for very long without your body fighting back really hard. So in the 60s, they thought, by analogy, when you’re born, You’ve got a certain set point for your body weight that’s just fixed from when you’re, from birth, right?
And, it or a little bit below it, but basically you’re fixed. Then the obesity crisis happened beginning in the late 1970s. And at first they thought, oh, we just need to throw out set point theory when it applies to weight, [00:26:00] right? It just doesn’t work because if your body weight was set, how could it increase so much?
But then a really interesting adjustment to the science happened for people like Professor Michael Lowe at Drexel University, who I interviewed. What they, from looking at the evidence, what they began to realize is your body does have a set point for your weight, but as your weight rises, your body takes that higher set point as its new set point.
So let’s imagine two identical twins, right? You don’t have to imagine, a British writer called Chris Von Tullochan, who’s a scientist who is one of identical twins in the second tip. Picture two identical twins, one of them gains, 40 pounds. and then loses it. So again, they look the same, right?
But as you gain weight, your body fights to hold that higher weight. It slows down your metabolism. It makes you crave more fatty foods. If you were able through force of willpower through a hardcore diet and exercise program to come down, you would actually, because your body [00:27:00] is trying to drive you back up, you’d have to eat significantly fewer calories than your identical twin to remain in even the same weight, right?
And I remember when I first learned this about set point theory. Thinking I just don’t see how that can be true, because given that obesity is so bad for your health, why would nature endow us with something that was so dysfunctional, right? Why would it make us want to be obese? But if you think about the circumstances where human beings evolved, it makes sense.
In the circumstances where human beings evolved, the situation we live in now, where you have surplus calories for your whole life, more calories than you can ever consume all around you forever That never happened, right? Our evolution did not prepare us for that scenario. What did happen quite a lot in the circumstances where human beings evolved was a very different threat, which is famine.
It was quite likely in the circumstances where humans evolved that you were sooner or later going to run out of food. And if you think about obesity in relation to that, it begins to make sense, right? If you picture, if a famine comes along tomorrow, [00:28:00] me at my fattest would survive and timothy chalamet would die in week one right and kate moss and i would cry over their bodies bury them probably eat them to be honest and you know i would still be standing right so actually in the circumstances where we evolved it made sense If you find surplus calories, consume them because they ain’t going to last for long.
And building up stores of fat will protect you for the famine that’s coming along. But our evolution is now preparing us to protect us against a famine that is not going to happen, right? So we’ve ended up maladapted to our environment. And the reason this relates to the drugs, apart from obviously explaining why diets fail in most cases, is one theory about what these drugs do to your brain is that they reset your set point.
They lower your set point. So if you now gained a load of weight please don’t, it would be a tragedy for gays and women everywhere. But if you did you would find it hard to go back, right? Because of that adjustment in your set point and that change in [00:29:00] your metabolism, But one argument is what these drugs may be doing is actually lowering your set point.
This is a more crude analogy than any of the scientists would use. But the way I began to think of it, it’s almost like taking your iPhone back to the factory settings, right? It’s like lowering your set point. So that’s one theory about what’s going on here. That’s certainly true about why diets fail.
And it’s a plausible theory, but I wouldn’t take it further than that for why the drugs may have some of that dramatic
Mike: effect. And just to comment on the point of diets that fail versus diets that don’t based on not just my understanding of relevant literature, but also what I’ve seen now, and a lot of people over the years is there.
There are some commonalities among the people who do successfully get there through. I guess you could say willpower, but they also, they create their regimen so that it requires as little willpower as possible with being specific about the type of foods that you’re eating and the macronutrient breakdown net macronutrient [00:30:00] composition of your diet, for example, fully dropping highly processed foods out of the diet, eating a high protein diet being Conscientious about vegetable intake and fruit intake and in eating even more servings, like getting up to 68 servings of fruits and vegetables per day, even so far as, creating zucchini soup is a tip that I’ve shared that.
For some reason, zucchini, just in my experience with people, seems to be particularly filling. There’s just a lot of volume to it, low calorie, turning that into a soup. And and then on the exercise side of things, understanding how your body responds to high intensity versus low intensity exercise.
And we could talk about research in terms of how high intensity versus low intensity tends to affect appetite, but it can vary individual by individual. And so finding out what type of exercise for you tends to turn your appetite off, but a lot of these strategies again, come back to the heart of the matter, which is appetite.
A lot of these strategies [00:31:00] are geared toward. Minimizing appetite and what I’ve seen in people who have successfully lost a lot of weight and kept it off is they used a lot of these tactics to create again, a regimen that not only allows them to consistently lose weight, but allows them to just keep appetite.
Low and keep cravings low. So for some people that means having small amounts of things that they like just giving themselves enough on a regular basis for other people. It’s having, maybe there are certain treats that are allowed and other treats that are not allowed because for whatever reason, it just triggers something if they go to get the ice cream, they can’t just eat.
A hundred and fifty calories of ice cream because it’s four spoons or whatever. So the, so ice cream is out, but dark chocolate, for whatever reason, they can have a hundred calories of dark chocolate and they feel satiated. Again, the point that just for people listening is if you have been struggling with Losing weight and keeping it off simply through diet and [00:32:00] exercise, and if it’s been particularly a matter of appetite and cravings, it may be that you need to get more particular about the details, and you might have to micromanage the process a little bit more than someone else who maybe it’s for purely just physiological reasons.
There could be some genetic factors in play, whatever. They don’t need to pay attention too much to the details. They’re just more high level and they eat enough protein. They don’t really pay attention to the rest and they just maintain their calorie deficit and move on again, bringing it back to these drugs from what I’ve gathered is they’re helping many people experience.
It’s a bit more than you could achieve through just diet and exercise, but experience a bit more of the process. That it might be a minority of people, but the people who would say, how hard is it? It’s just willpower. Just stop eating. It doesn’t matter because again, for them to achieve the desired outcome that is all it required.
Johann: Yeah, I [00:33:00] think that’s a really important point. And I would definitely say if you’re overweight and obese or overweight or obese, and you’re listening to this, try to lose weight through diet and exercise first. I doubt that there’s a single overweight or obese person listening. I’ve not tried that, but like you should definitely.
Mike: Sure. However, how you go about it matters though that’s just all I want people to know is that there are a lot of bad diets out there, unfortunately, that try with the sledgehammer and that’s all they have,
Johann: no, that’s a really important point. I would also say if you’ve tried diet and exercise and they haven’t worked, what you now have to do.
A, there’s good news, which is there’s a staggering new tool, which works really well at certain things in these drugs. But also I would say what you now have to do. is way too competing sets of risks if diets haven’t worked for you. The first risk is the risk of continuing to be overweight or obese.
And by the way, you don’t have to be hugely fat for health risk to kick in. Even just at being slightly overweight, the health risks start to kick in. I’m [00:34:00] embarrassed to say this because this will be won’t be news to you, Mike, at all, but of all the things I learned for the book, the thing that most shocked me was really looking with a clear eye at how unbelievably bad for your obesity actually is.
Obesity makes basically everything we fear medically. significantly more likely. It makes you significantly more likely to get dementia, makes you significantly more likely to get cancer, makes you significantly more likely to have a stroke, which is the thing doctors most fear getting, makes you significantly more likely to have a heart attack, makes you significantly more likely you’ll have a horrible old age where you can’t walk, where you’re in agony with your knees, with your hips just across the board, it’s disastrous.
And we know that when you reverse obesity, you massively improve health outcomes. If you have bariatric surgery in the seven years that follow, you are 56 percent less likely to die of a heart attack. You are 60 percent less likely to die of cancer. [00:35:00] You’re 92 percent less likely to die of diabetes related causes.
In fact, it’s so good for your health. You’re 40 percent less likely to die at all in those seven years, right? So there’s that set of risks. You’ve got to weigh them against the risks of these drugs. which are significant. And I go through in the book 12 significant risks, which I want to make clear are different from the side effects, significant risks that are associated with these drugs.
And Different people will make different calculations. Like I say, I have a long history of heart disease in my family. The men die young. So for me, the fact that these drugs reduce your risk of heart attack or stroke by 20%, if you take them and you started with a BMI higher than 27 was absolutely decisive for me, right?
I was just like, okay, I’m in. For other people. That will not be the right calculation. I don’t think there’s a one size fits all guidance on this. I think people, I hope, what I hope my book Magic Pill helps people to do, as well as, helping to understand how these drugs make you feel and all sorts of [00:36:00] things, is, and how they’re going to affect the economy, how they’re going to affect the society, how we got here, how we can get out of this dilemma of tourism being fat or being drugged.
I hope people, gives me a chance to go down the list of, okay, what are the benefits, What are the risks? What applies to me? Should I make this decision for myself or not?
Mike: Can you speak to some of the more significant of the 12 risks? Because, this is, as the fact that there are risks, there’s a bit of controversy over, some people more or less dismiss any such concerns and try to sell the drugs as, Basically all upside, no downside.
Johann: I think that’s very irresponsible. As Professor Karel Le Roux, who’s one of the scientists who worked on these drugs said to me, there are two kinds of drugs. There are drugs with side effects and there are drugs that don’t work. You don’t get the benefits of drugs without risks, right?
There’s no such thing. It’s, it would be a childish way of thinking. So in terms of the risks, it’s important to stress. If you ask scientists who’ve studied this in detail about the risks, [00:37:00] generally what they say is actually we know quite a lot about these drugs because diabetics have now been taking them for nearly 20 years, right?
For people who don’t know, in addition to having this effect on appetite, these drugs also treat type 2 diabetes because they stimulate the creation of insulin. So they say, look, diabetics have been taking them for 20 years. We’ve got quite a lot of data on diabetics. It’s a really important point and it should give us some level of comfort that.
But some other scientists said, okay, if we’re going to base our confidence largely on the diabetics, let’s do a bit of digging on the diabetics. So for example, there’s a leading French scientist called Professor Jean Luc Fayy at the University Hospital in Montpellier in France, who was commissioned by the French Medicines Agency to look into the safety of these drugs.
So he went away, he looked at the evidence, and he started to look at the evidence from type 2 diabetics. It’s very basic. They have very good medical databases in France because you can’t opt out of them. They don’t really have the equivalent of HIPAA. He was really [00:38:00] alarmed by something. So he compared using these databases, groups of diabetics who take in these drugs.
with groups of diabetics who were similar in every other way, but had not taken these semaglutides. And what his research seemed to indicate is that if you took these drugs, you were significantly more likely to develop thyroid cancer. In fact you were, the increase in the risk was really, it was 50%, which when I heard that, I was like, whoa.
And he said no, you’ve got to understand that doesn’t mean if you take the drug, you have a 50 percent chance of getting thyroid cancer. If that was the case, there’d be bonfires of ozempic all over the world. What it means is what, If he’s right, and this is highly contested, whatever your thyroid cancer risk was at the start, it goes up by 50%.
Right now, thyroid cancer is a rare form of cancer. 1. 2 percent of people get it in their lifetime. 80 percent of people survive it. Nonetheless, If he’s right, again, stress is contested, that’s a significant increase in a relatively small risk. And there’s a [00:39:00] broader range of risks that are emerging like this.
The biggest thing that worries me is, relates to eating disorders, and that doesn’t worry for me, worry me for myself, because I’m not going to develop an eating disorder, I’m highly confident with that, but that worries me for a lot of young girls, I can come back to that. But for me personally, the one that worries me most.
It’s that we just don’t know the long term side effects, right? We don’t know, no one’s been taking them for more than 20 years. And there’s an analogy that I want to stress. I’m not suggesting these drugs will have this effect, but the analogy should help us to think about some of the risks here. So if you go back to when anti psychotic drugs were first being given to people in the late 1950s, the early 1960s, scientists at the time judged that the benefits of these drugs outweighed the risks.
And that was the best judgment call they had based on the evidence they had at the time. It was only, what, 40, 45 years down the line that it was discovered If you take these drugs for a really long time, you are way more likely to get [00:40:00] dementia. Now, it’s not that the scientists in the 50s and 60s were being negligent.
There was just no way you could know that, right? You had to have people take it for a really long period of time. It’s possible, now I’m not suggesting drugs will cause dementia, there’s no reason to believe that, but it’s just possible that there’ll be something that these drugs do, especially when you consider they primarily work by activating core aspects of the brain, it’s possible that further down the line these drugs will have some disastrous side effects and someone will find this podcast to go what for he was to take these drugs.
Now, against that, I would say, I think a lot about something that Dr. Shauna Levy, who’s an obesity specialist at Tulane University School of Medicine in New Orleans said to me, we don’t know the long term risks of these drugs, but we do know the long term risks of obesity. And effectively, the long term effects of drugs would have to be horrific to outweigh the long term risks of obesity.
Now, that might be the case, right? But so that for me was the, that’s the thing that most gives me pause. There’s been some other stuff as well, but that’s, yeah, and there’s other things I’m worried about for other people that I’m not as worried about for myself.
Mike: You mentioned [00:41:00] eating disorders and particularly, I think you said in younger women.
Johann: This is a huge problem. So everyone, I’m guessing pretty much everyone listening has known someone with, to name one of the bigger eating disorders, anorexia, one of the more common eating disorders.
Mike: Or some degree of orthorexia, pretty common in the fitness world in particular.
Johann: If you look at someone with anorexia, for example, there’s a struggle going on inside them.
The biological part of them that wants to live and wants to eat. And then there’s the psychological part of them that for complicated reasons wants to starve themselves. And what these drugs do if you take them at a high enough dose is they can just amputate that biological part of yourself. They can just cut off the part of you that wants to eat.
And this is why Dr. Kimberly Dennis is one of the leading eating disorders experts in the United States. You should have her on as well. Great person. It says, these drugs are rocket fuel for eating disorders. I am really worried in addition to extraordinary benefits for people like me, if we don’t tighten the regulation around these drugs.
We’re going to [00:42:00] have an opioid like wave of death toll, of deaths, of young girls, and eating disorders do just, are overwhelming the young girls. Obviously you get some boys, some older women, but it’s overwhelming the young girls, who are able to starve themselves to death, who would not have been able to do that had they not, had access to these drugs.
And the access issue is a really big deal at the moment because look, I can see you, Mike, right? You do not qualify for these drugs. You should, unless you’re diabetic, type 2 diabetes. If you went to a doctor for these drugs, you should not be given them according to the medical guidelines. I guarantee you, you could hang up on me now.
And within an hour, have a zoom call where you would get given these drugs.
Mike: No, you’re not obviously not a risk manager. Similar to TRT now exploding, you can just say, I think I have low testosterone up. Here’s your script. Exactly.
Johann: Exactly. And that brings with it a whole other set of potential risks.
So along with potential benefits. So you think about that, right? So what Eating disorders experts like Dr. Dennis say, and I strongly agree with them, [00:43:00] is we need to urgently tighten the regulation. Firstly, you should not be able to get these drugs on Zoom, because how are you measuring people’s BMI on Zoom, right?
It’s meaningless. A, you should get on Zoom. You should have to go in person to see a doctor. That doctor should weigh you and check you. If you do not meet the criteria, you should not be given them. So if you’re not diabetic or overweight or obese, you should not be given them. And they should be trained in spotting people with eating disorders and they should refer you.
Now, that’s not perfect. You could get a friend to go and get it for you. There are leaky, there are holes in that, but that would save a lot of people. So the way I think about these drugs, this is a slightly over the top way of putting it, but only slightly. These drugs are such a powerful tool.
They’re like the discovery of fire, right? Fire is a great tool. If I use it to heat up my house, it’s a really lousy tool. If I use it to burn down your house in the same way, this breakthrough is so staggering. It can be used for great good and great harm, and it can and will be used for both. So [00:44:00] we need to.
One of the things I hope my book is a kind of chance for us to, we’re literally living through a staggering scientific revolution. We’ve cracked the code of what controls human appetite as one of the scientists who developed these drugs. Put it to me, we really need to pause and think about what that’s going to mean for our economy, our society, our bodies, ourselves, how we feel about ourselves.
The book is called Magic Pill because there’s three ways these drugs could be magic, right? The first way is the most obvious. It could just solve the problem of obesity. I got to tell you, Mike, there are days it feels like that. My whole life I’ve overeaten. Now, once a week I do a tiny little scratch in my leg.
I barely feel it. I don’t overeat. I lost a shit load of weight. It’s mind blowing, right? The second way it could be magic is much more disturbing. It could be like a magic trick. It could be like the magician who shows you a card trick while he picks your pocket. It could be that over time, 12 risks associated with these drugs outweigh the benefits.
I don’t think that’s the most likely scenario for most people, but you certainly can’t rule it out. The third way it [00:45:00] could be magic is actually what I think is the most likely. Think about the stories of magic that you and me grew up with. Think about Aladdin, right? You find the lamp, you rub it, the genie appears, Robin Williams grants your wishes, and they come true, but never quite in the way you expected.
There’s always cascading, unpredictable effects to the magic, right? Think about Fantasia, think about all these stories. We’re already seeing that. I think about the effects on the economy, right? Krispy Kreme stocks are tanking. All the fast food companies are already freaking out. Restaurants trade is really worrying.
In LA, there’s been a huge run on jewelers because so many people’s fingers have shrunk that their wedding rings don’t fit them anymore. There’s gonna be all sorts of huge, Jeffrey’s Financial just did a report for the American airlines. about a year and a half ago showing, saying to them, you’re going to have to spend a lot less money on jet fuel pretty soon because the population is about to get a lot thinner and it takes, the heavier you are, the more money costs to more jet fuel you need.
So there’s going to be huge implications to this that we need to really deeply think [00:46:00] through. There’s a lot of people need to be warned about and prepared for. So yeah, I think we really need To think about this is a great moment. This is a frightening moment. This is all of those things. And we need to honor the complexity of this.
Anyone who’s coming into this, just going, yay, Ozempik or boo Ozempik is, I think, missing the much more interesting story that’s unfolding all around us.
Mike: You mentioned earlier that something else you discussed in the book. And I wanted to follow up with a question on is let’s assume that there may be trade offs, but it’s mostly.
The magic is mostly positive and we have a lot of people who have lost a lot of weight and to some degree we’ve solved obesity, at least enough to, let’s say reverse the alarming trend that the trajectory actually it actually starts to downtrend just of just BMI. And where though, do you see.
Where things could go [00:47:00] from there, where we have a lot of people now who are using these drugs and my understanding of based on a couple of previous interviews that I did is the best way for people to succeed long term with these drugs is to while using them, use that as an opportunity to start to ingrain the habits that help with natural weight maintenance and that would, that Include some of the stuff I mentioned previously, the same types of successful little techniques and tactics that people use to diet successfully without the use of any drugs, or maybe the worst, they’re the, they use caffeine or something, or maybe it’s a Fedrin, right?
And so while they’re using. Was that Baker or Govey or some of these other two others that you mentioned, they use that to now start to just get in the habit of. Eating in a certain way exercising in a certain way on a certain schedule. So then once they reach their target body [00:48:00] composition, they’re able to wean off the drug and maintain a healthy body weight, a healthy body composition.
And that’s a range. And so that’s the ideal scenario as far as I understand it. However, there are many people and you mentioned that you’re still taking the drug and I wanted to ask about that as well. And this is relevant to the previous question. Many people who lose a lot of weight and then they continue taking the drug and are planning on taking it.
More or less indefinitely or they’re they don’t they haven’t really formalized a plan yet of how they’re gonna get off the drug and maintain a healthy body weight or a healthy body composition. And so looking forward to the future. Let’s say we do have a lot of people who. Have used it or using the drug, have lost a lot of weight, great benefits, like you mentioned, but now we have, how many people are even being projected?
I don’t even know what the numbers are we talking? I’m guessing it’s projections into the [00:49:00] 9 figures of people who are going to either have used or are currently using the drug and is there any conceivable way that we can get it? To pass that phase and to where now we don’t have 50 to, who knows, 70 percent of our population having used or using the drug and also have at least able to maintain a large degree of the health benefits that we’ve experienced through that heavily drugged face, but.
Johann: So partly the answer to your question is unknown because there’s a big debate about do these drugs work after you stop taking them. So what the drug companies say is absolutely not. They’re like statins or blood pressure meds, while you take them they work, and when you stop, your cholesterol or your blood pressure go back to what they were before.
So they say these drugs mean you lose weight while you take them, and then when you stop, your weight will go back to what it was before. And the drug [00:50:00] companies have so far one study which does demonstrate this. The vast majority of people who stop taking, I was then picked. WorkOV regained the vast majority of their weight within a year.
Now, you want to be a little bit skeptical of that because the drug companies obviously have a vested interest in us buying it from them forever. Nonetheless, these were serious scientists who produced this study and it does seem quite reputable. That’s the only evidence we have at the moment. We’ll have a lot more evidence in the next few years because there’ll just be lots of people who take it and then stop either because they get thrown off their insurance or because they can’t get it or because they just stop for the reasons you give.
Anecdotally, I know some people who took it. Lost a load of weight, changed their habits, and now seem to be maintaining a lower weight, but they do seem to be a minority of the people involved. So we need to know more about that. But I think there’s a deeper layer at which we need to answer your question, because you’re absolutely right.
To me, it comes right back to where we started with Cheesecake Park. We absolutely should not tolerate that our children and grandchildren face a choice between a risky medical condition and taking a [00:51:00] risky set of drugs. That is not the choice that we have to live with. And if you want to understand why it’s not the choice we have to live with, I went to Japan for the book.
Japan is the third richest country in the world, and it has almost no obesity at all. There are, more than 40 percent of Americans are obese, less than 4 percent of people in Japan are obese. It has. literally almost no childhood obesity. It’s a weird thing. I went to Japanese schools, you walk around a school of a thousand children and there’s not one single fat child in that school.
It’s weird. And you hear that and you think it must be that the Japanese people won the genetic lottery, right? They must just genetically be less likely to become fat. But we know that’s not true because in the late 19th century, loads of Japanese people moved to Hawaii where I was recently. And Japanese Hawaiians.
having been there now for five generations, are almost as fat as everyone else in Hawaii, right? So you move, Japanese people move to America and stay long enough, they get as fat as other Americans, right? So that’s not what’s happening. It’s not, their genes cannot possibly have evolved that rapidly in such a [00:52:00] short period of time.
So there’s something in the way Japanese people live. And I went to see what it is. They have concerted policies in their schools to teach children to only eat and love healthy food. They don’t allow shitty processed foods to hijack their kids. They do all sorts of things to do some things that we absolutely would not do.
They’re unthinkable in our societies, but once you’re over the age of 40 in Japan, everyone gets weighed by their boss once a year. And if you’re overweight, you have to come up with a plan with your boss to bring your weight down. And as a company, if you have. fattening workforce. You get fined by the government.
So I went to see this. It was like, Whoa, it’s wild. And I was like so I was with all these Japanese people who were like, Oh, we love this policy of this company. And I’m like, so if you did this in the U S we would burn the office down. And they’re going, but why being fat’s really bad. I’m just like, it was like such a cultural gap.
It was fascinating. But yeah, so there’s some aspects of Japanese culture that we can’t assimilate, but many that we can, and [00:53:00] we absolutely should. Cause this change. Your grandparents were not obese. My grandparents were not obese, right? Actually, two of mine were, but they were outliers in their generation.
And, this is a very recent change. We eat in a way that would have been unrecognizable to our great grandparents. Impossible, actually.
Mike: Yeah,
Johann: literally impossible. You’re exactly right. We don’t have to just bank that. That we’ve been screwed over by the food industry as if that’s just a given, right?
Japan is a real place. It can feel a bit sci fi sometimes, but it is a real place. They didn’t allow it to be done to them and their kids, right? We can make that choice, too. And I talk very clearly in the book about how we can do it and how we get there. In the meantime, for someone like me, Look, I am where I am.
I’m gonna make the choice I’ve gotta make. But we should change the culture in the society and the food supply system such that not everyone is trapped into making this somewhat risky choice that I’ve had to make.
Mike: Absolutely. And I totally agree and I would recommend that [00:54:00] people get the book and read it and particularly this part of it, because anybody, I have two kids and so this discussion.
Personally, it’s a bit more personal for me. I’m not concerned about myself but exactly. So the point that you’re making is I’ve been pretty conscientious about exposing my kids to what it means to eat relatively unprocessed. What, how should we actually be eating and limiting their exposure to these other foods and so forth for all the reasons that you’ve talked about.
Johann: It’s funny you say that because I grew up in so the opposite environment. My mother is Scottish and it’s the country that invented the deep fried Mars bar. If anyone has never had one, don’t do it. And it’s not a health obsessed culture. There’s a photograph of me and my mother when I’m six months old, where she’s breastfeeding me, smoking and resting the ashtray on my stomach.
And when I found this photo a few years ago, I thought I should feel guilty. I show it to her. She said, You were a difficult baby. I needed that cigarette. So completely [00:55:00] unrepentant. So yeah, she was not thinking about how do we get into zucchini soup? I think if I gave zucchini soup to my mother, I think she would punch me in the face.
Yeah,
Mike: that’s a, that’s actually a great picture. That one should be in a frame.
Johann: I wanted to put it in the book. And she said you’re not putting my tits in a book. She said, I’m very angry about that as well.
Mike: That’s great. That’s a great story. We’re coming up on time. And and of course the book is magic pill.
People can get it to wherever they like to get books. And is there anything else that you would like to tell them about anywhere, social media or any, anywhere where you’re active?
Johann: If you go to magic pill book. com, you can see where to get the audio book, the ebook or the physical book. You can see where to follow me on social media.
I got in trouble at the end of a podcast a while back because it was a few years ago. I was interviewed by a guy who was about 50. And at the end, he said to me, what’s your Instagram? And I said, he said, what’s your Facebook? And I said, it, he said and they said, what’s your Snapchat? And I said, I’m a 45 [00:56:00] year old man.
The only 45 year old men on Snapchat are definitely pedophiles. Why else are they there? And he didn’t laugh. And I have this very bad habit. If. If I tell a joke and someone doesn’t laugh, I double down on the joke. And I said, that show to catch a predator where they catfish pedophiles. I said, the next season of to catch a predator should just be, they go up to adult men in the street and say, what is your Snapchat profile?
And if they’ve got one, just immediately arrest them, throw them in the van. And he didn’t laugh. I later looked him up and he’s he’s a 50 year old man with an active presence on Snapchat. And I was like, okay, so I’m really glad I got through this interview without accidentally accusing you of being a pedophile.
That’s my new bar for all interviews. I’m glad I passed it this time.
Mike: I’m a 40 year old man and I do not have a Snapchat. So you can’t just arrest me on the spot. You’re going to have to dig deeper than that.
Johann: Get rid of habeas corpus. I don’t believe in it. No, no due process here. I’m going to go full Dirty Harry on the Snapchat.
I don’t want men on Snapchat for sure.
Mike: Again, thanks for your time. Johan, it was a great interview.
Johann: Oh, you asked great questions. [00:57:00] Thanks so much. Cheers.
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