The one I wanted to do is that new macro study on GLP-1s, which I think is super interesting. Oh, tell us. Do you guys remember I talked a while ago about how they were able to mine VA data? So the VA, right, they take care of veterans and they have all the medical records, and on an anonymized basis they can make that data available to researchers. And so if you guys remember this, this is how they identified that the Epstein-Barr virus, or the virus that causes mono, as being statistically certain to be the trigger for multiple sclerosis in the cohort of hundreds of thousands of patients that were in this data set. No one got MS that didn't get Epstein-Barr virus. If you did not get Epstein-Barr virus, you did not get MS. I don't know if you guys remember, I did the Science Corner a while ago. Anyway, so the data set that you can mine at the VA is incredible. So they pulled all the data from everyone that's been on the GLP-1 agonists and they identified all of the health effects across multiple indications, the statistical difference between the cohorts. Okay, so this research team out of St. Louis pulled all the data from the VA database and basically they looked at, you know, 1.2 million people with diabetes that didn't take anything compared to 215,000 that took the GLP-1 receptor agonists and another 600,000 people that took other drugs for diabetes. So basically this cohort segmentation allows them to isolate the effect of the GLP-1 drugs. And as you can see here, this shows across hundreds of thousands of patients the effect of the GLP-1 on a hazard ratio, which means like how likely are you to have the following health condition versus the population that's not taking the GLP-1s. And then on the right, if you scroll to the right, Nick, are the increase in risk, and on the left are the things that go down. So the increase, the only thing that increased is like, you know, an 8% or 10% increase in nausea and vomiting, musculoskeletal complications, GERD, which is, you know, gastric reflux, and sleep disturbance, indigestion. So it's all abdominal stuff. Now if you go over here to the benefit side, so the benefit side is what conditions did you see a decrease in. So you have a decrease in shock, a decrease in hepatic failure, so liver failure, respiratory failure, cardiac arrest. In fact, on cardiac arrest you see a 30% decrease in the probability of having cardiac arrest from the cohort that's on the GLP-1 versus... wow, schizophrenia. So this goes to the point, if you guys remember the interview I did a couple months ago with the CEO of Eli Lilly, that they have all these clinical trials going on right now for different indications for the GLP-1 receptor agonists, that they're seeing that there's health benefits beyond just the weight loss in reducing things like kidney disease, obviously liver problems, mental problems, and so on.
Do we know why? And if we don't know why, do you think it's because this is suppressing the food and it's the lack of food or the change in the food consumption that's creating this? Do you know what I'm asking? Like, do you think the drug is actually...
Yeah, yeah. So you should watch the interview I did with Dave Ricks. In fact, this is a good moment to call it out if you haven't seen it. Yeah, I think he highlights that this class of drugs, there are, you know, genes get turned on and off. So there's a, you know, what's called a gene expression cascade that occurs with certain compounds. So we know that the GLP-1 receptor agonist means that it binds to these GLP-1 sites and there's a cascading effect of genes that then get expressed. And what that seems to do is turn off things like inflammatory markers, it turns on things like sirtuin genes, which can actually increase cellular repair. So there seem to be other benefits from these drugs beyond just the appetite control, and it's not the appetite control itself, but there seems to be other effects.
Let me ask you a question. From these receptors being activated, would you put your kids on this? No. Okay. Would you put your wife on this?
I would consider it, and I would consider it for myself too, just for the anti-inflammatory effects.
How will you make that decision?
Well, for me personally, and the thing that I weigh against is the muscle loss and the bone density loss. So I think that if you look at the biggest kind of effect on these on the downside basis is you should increase your protein in your diet, you have to do weightlifting, there's things that you would do. And frankly, if you do those things anyway, if you increase protein in your diet and do more weightlifting, you're actually going to see very good health benefits from just doing those things that may actually outweigh the benefits you get from the GLP-1.
I have a question, D, which is, and this is the question, is when you look at that data and you talk to the CEOs, how much do you think really long-term, when the long-term data is out, is going to be that it was the drug, or just that being obese is very bad for you, and so when you take your body fat down dramatically, all these other gene expressions happen anyway, right? So which one will it be?
Well, this is what they're starting to isolate. And I will say, Antonio, they are starting to see that there are other expressions that are not related to the obesity in people that don't have obesity that are using these drugs. So they're seeing that cohort data now. Clinical studies, phase two were published, and I think we're going to see phase three in some of these indications soon. But it is looking very positive that it's not just the loss of obesity. Now, to your point, being obese, not exercising, eating poorly destroys your health. You stop that, everything gets better.
If you lift weights, Freeberg, can you tell us when you decide to do this?
I will. Yeah, if I do do a GLP-1 receptor agonist, I will let you guys know. Right now, I actually feel like I want to go through a process of increasing my weightlifting routine more. I've been trying to create a more kind of rigorous... my schedule just sucks, so that's been the hardest thing for me. But I actually want to go through that first before making that decision.
I was just curious, why that order? I don't understand.
I want to measure the effects because I do think that if you actually get into a regular weightlifting routine and you increase protein in your diet, which is another thing I've been making a concerted, measured effort to do, which is hard as a vegetarian, by the way, you see pretty significant health effects. And so I'm trying to get through the process of increasing muscle composition before I make the decision on whether or not to add GLP-1. I don't want to kind of confound the two factors.
