GLP-1类药物与中年新陈代谢：Rocio Salas-Whalen博士解析减肥与更年期的科学：第二部分

正是如此。

Exactly.

这对他们来说是个问题。

And it's a problem for them.

这并非小事。

It's not something banal.

这是个实实在在的问题。

It is a true problem.

那么，这些是生理层面的变化。

So, those are the physical.

接下来我们谈谈情绪或心理层面的变化。

Then we go to the emotional or psychological changes.

许多患者直到现在才首次达到理想体重，这时会产生一种新的焦虑感，对吧？

Many patients that were never on their ideal body weight until now, a new type of anxiety comes in, right?

现在他们患上了体重反弹焦虑症。

Now they have an anxiety of weight regain.

既然他们知道了保持体重的感受，就特别害怕体重反弹。

Now that they know what it is to be in their weight, they're terrified of regaining the weight.

这可能会对他们的心理造成影响，对吗？

It can affect them mentally, right?

因此需要安抚他们，在达到目标后继续随访，确保他们不会对体重反弹产生焦虑。

So, it's reassuring them, it's seeing them after they reach their goal to maintain also that they don't become anxious about weight regain.

有些患者的生理适应比心理适应更快。

Some patients, the physical adaptation is quicker than the psychological adaptation.

所以很多患者即使减掉了100磅，他们仍然无法用新的眼光看待自己，对吧？

So, many patients, even though they've lost a 100 pounds, they don't see themselves still in that way, right?

我在患者身上观察到的另一个现象是，特别是大幅减重（比如50磅）后，周围人对他们的看法和态度都不同了。

Another thing that I see with our patients, especially if it was a large amount, you know, 50, is the world is looking at them differently and treating them differently.

而他们缺乏应对这种新关注度的社交技巧。

And they don't have the social skills to deal with all of this new attention.

他们曾经是隐形人——特别是女性在中年及之后更容易被社会忽视。

They were invisible Especially before women become more invisible in midlife and beyond.

我们总是看重青春、虚荣和苗条。

We always value youth and vanity and being thin.

然后突然间他们拥有了这个新身体。

And then all of a sudden they have this new body.

你如何就‘我’这个问题给他们提供咨询？

How are you counseling them about I

我接诊了一位二十七八岁、三十出头的女患者。

had a new patient that I saw in her late twenties, early thirties.

她告诉我一年前去看医生，医生开了GLP-1类药物，但她决定先不用。

And she told me one year ago, I went to a doctor and he gave me a GLP-one, but I decided not to use it.

我决定在服用GLP-1类药物前先接受心理治疗。

I decided to go to therapy first before going on a GLP-one.

她说，我想做好准备，当人们因我体重下降而对我态度不同时。

And she said, I wanted to be prepared when people would act differently to me when I lose the weight.

她说，我需要对自己有安全感，当人们仅仅因为我瘦了就对我更好时，我不会质疑——这对我来说简直像精神高潮，对吧？

She said, I needed to feel secure about myself and not question when people start being nicer to me just because I lost weight, which I like, it was, for me, it was like a mental orgasm almost, right?

就像你渴望的事情突然实现时那种‘天啊，太棒了’的感觉。

Like the thing that you want is like, oh my God, yes.

你看，这就是我们现在看到的情况。

You know, this is what we're seeing now.

我赞赏她，并为她感到无比骄傲。

I applaud her and I was so proud of her.

你认为那些经历大幅减重的患者需要心理治疗吗？

Do you think that massive weight loss, those patients deserve therapy?

百分之百。

A 100%.

百分之百。

A 100%.

而现在我们全靠自己。

And right now we are doing everything ourselves.

这就是我正在学习的内容。

And this is what I'm learning.

这也是我写书的原因，因为我每天看到的比任何人都多。

And this is what I wrote my book because I'm seeing more day by day than anybody else can see.

我看到它们在一起。

I see them together.

这就是你全部要做的事。

That's all you do.

这就是我每天、每周五天都在做的事。

That's all I do every day, five days a week.

所以这就是为什么我的书很重要，要让那些无法接触到我这样的医生或心理健康资源的人看到它，对吧？

So that's why it's important for my book to get it out there for those that don't have access to doctors like me or mental health, right?

它并不能替代任何那些资源。

It doesn't replace any of that.

但与此同时，我们都需要接受教育，我们需要更多专门研究肥胖和减肥的心理健康专家，我认为这将成为下一个专业领域。

But in the meantime, we all get educated and we have more mental health professionals specialized in obesity and weight loss, I think is the next specialty that is gonna come out to it.

那些同时从事医疗保健和心理健康工作，并专攻减肥领域的专家将会非常重要，因为我们需要通过治疗为患者提供心理工具，帮助他们迎接新生活。

Somebody who's in healthcare and mental health, subspecializing in weight loss, it's going to be very important because we need to give therapy to give them the mental tools for patients to approach our new life.

让我停下来强调一下，对大多数患者来说，这些都是令人欣喜的变化。

And let me stop and say, for the majority of patients, it's happy changes.

是的。

Yeah.

即便有了这些变化，患者们也不愿回到过去的状态。

Even with those changes, patients would not choose to go back to where they were.

所以对大多数人而言，这始终是积极正向的。

So, for the majority, it's always something positive.

在我的诊所里，我只接诊女性患者。

So, in my clinic, I only treat females.

你则是男女都接诊。

You're treating both.

而且我确信你也会接诊夫妻档。

And I'm sure you treat couples.

这恐怕在所难免。

It's probably inevitable.

我不接诊。

I don't.

我们只看女性患者。

We only see women.

偶尔在复诊时我们会聊到近况，我注意到如果夫妻中只有一方使用GLP-1类药物而另一方没有，他们的关系会出现许多微妙变化——外出用餐、参加聚会、饮酒习惯等等，这些他们建立感情基础的生活乐趣和社交互动都发生了改变，导致一方进步而另一方停滞不前。

So occasionally, you know, in follow ups and we're talking about how's it going, what I'm seeing is if there's a mismatch, if one part of the couple is on a GLP-one and the other is not, there are so many micro changes in their relationship, going out to dinner, staying at parties, drinking alcohol, you know, that things that they built their relationship on, their fun time, their social interactions have changed where one person is left behind and the other person is changing.

问题并不在于某一方患有肥胖症。

And it's not that one part is obese.

她爱这个人已经二十五年、三十年，不管多久，你知道，尽管他的身体没有改变，但她已经变了。

She's loved this person for twenty five years, thirty, whatever it is, you know, even though his body hasn't changed, but she's changed.

你在实践中见过这种情况吗？是的，我也见过。

Do you see that in your practice Yes, as I do.

实际上我见过离婚案例。

And I've actually seen divorces.

是的，我正想问，你听说过'奥泽匹克离婚'吗？

Yeah, was gonna ask, have you heard of the Ozempic divorce?

听说过。

Yes.

我有好几个病人，我分别以夫妻身份见过他们，但妻子来了，丈夫来了，然后他们就离婚了，对吧？

And I've had several patients that actually I saw them as couple individually, but that the wife came, the husband came and that they got divorced, right?

所以，这里会有很多——生物心理社会因素。

So, again, there's gonna be a lot of- Biopsychosocial.

生物心理社会环境的变化。

Biopsychosocial environmental changes.

这甚至在GLP-1药物出现前就有，当我与病人讨论糖尿病、营养护理时，我总是告诉他们，如果家里其他人也这样吃或开始锻炼、健康饮食，效果会更好，对吧？

This is even before GLP-one medication, when I used to talk to my patients about diabetes, nutrition, care, I always used to tell them, it will work better if the other people in the house will also eat this way or start exercising or eat healthy, right?

这样更容易坚持。

It's easier to maintain.

所以我经常看到的是，如果配偶先来就诊，最终另一个配偶也会来，对吧？

So, what I see many times is if the spouse comes first, eventually the other spouse would come, right?

如果他们也在与体重作斗争，或者把食物当作享受的话。

If they were also struggling with weight or food was an enjoyment.

因为如果你的配偶正在进行重量训练，那就不成问题，对吧？

Because if you have a spouse that is working out weight training, then that's not an issue, right?

他们很高兴自己的配偶现在正参与其中——

They're happy that their spouse is now in that-

和他们一起进行。

Doing that with them.

正是如此。

Exactly.

但如果有一对夫妻双方都在与体重作斗争，饮食不健康或酗酒，那么最终另一方也会受到影响。

But if you have a couple that both of them struggle with their weight, struggle with eating poorly or alcohol, then eventually the other spouse comes too.

我觉得这种情况很常见。

And I think I see that a lot.

跟我谈谈成瘾性以及我们观察到的行为变化，那些无意识的、你知道的，GLP-1带来的可能是积极的变化。

Talk to me about addiction and changes in behavior we're seeing with unintentional, you know, GLP-one changes we're seeing that might be positive.

就拿酒精来说吧？

So with alcohol, right?

也有关于烟草的研究，因为对一些有成瘾问题的人来说，以酒精为例，它可能是一种奖励，是一种期待，因为GLP-1会阻断这种奖励机制。

There are studies with tobacco also, because for some who have addictions, let's talk about alcohol, it may be a reward, it's an anticipation because GLP-1s block that reward system.

如果酒精曾是一种奖励，那么这种驱动力就会减弱，行为也会改变。

If alcohol was a sort of a reward, the drive will be less, the behavioral changes.

此外，它还会让你更有饱腹感。

Also, it makes you fuller.

所以你可能喝一两杯就满足了。

So, you may have one, two drinks that's you're done.

我所观察到的是，要达到那些效果，必须使用更高剂量的药物。

What I do see is for those effects to happen, it has to be on higher doses of the medication.

在最低剂量下，我很少看到对酒精或吸烟产生影响。

I rarely see an effect on alcohol or smoking at the lowest doses.

我们实际上必须达到更高的剂量。

We have to actually have to reach higher doses.

作为一名更年期专家，我当时非常兴奋。

As a menopause specialist, I was really excited.

我知道去年你也很期待看到研究证实我们在实践中观察到的现象——与单独使用相比，司美格鲁肽（semaglutide）的效果。

I know you were too last year to see what research had really confirmed that we were seeing in our own practices that versus, and it was semaglutide, semaglutide.

因此，使用GLP-1的患者与同时使用GLP-1和更年期激素治疗的患者相比。

So, patients on the GLP-one versus patients on GLP-one and menopause hormone therapy.

接受更年期激素治疗的GLP-1组比单独使用司美格鲁肽减重更多。

The menopause hormone therapy GLP-one group lost more weight than semaglutide alone.

你认为这是什么原因？

Why do you think that is?

嗯，这可能既涉及生理层面也涉及社会层面，对吧？

Well, it can go from the physiological to the socially part too, right?

举个例子，如果一位中年女性正经历失眠、睡眠障碍、凌晨3点醒来，而另一位接受激素替代疗法的患者睡眠良好、精力充沛、更有运动动力，这时给她们使用GLP-1，后者显然会取得更好效果，对吧？

So, if you have a woman in midlife who's having insomnia, not sleeping, waking up at 3AM in the morning, versus you have somebody who's on hormone replacement therapy, they're sleeping, they're feeling energized, they have more drive to exercise, and you give them a GLP-one, well, they're gonna have better results, right?

如果我们讨论外部因素，那么激素水平也同样重要，对吧？

If we talk about the external things, but then hormonally also, right?

就像最初讨论的，雌激素下降会改变你的身体成分，对吧？

So, as we talk initially, the drop of estrogen can change your body composition, right?

通过给予他人他们无法自行生成的东西，你就是在提供帮助。

By giving somebody what they're not making, then you're helping.

我们从不把它们宣传为减肥产品，对吧？

We never promote them as weight loss, right?

对。

Right.

激素不是用来减肥的。

Hormones are not weight loss.

针对减肥，我们有GLP-1类药物，但它主要是帮助身体重组。

For that, we have GLP-one medications, but it's going to help your body recomposition.

协同作用。

Synergistically.

没错。

Exactly.

共同作用。

That work together.

毫无疑问，这些药物目前非常昂贵，可能超过一半甚至更多美国人负担不起。

So, there's no question that these medications are very expensive and out of the ability right now for probably half of Americans or, you know, more than half to afford.

我女儿们给我看了一些模因，内容基本上是名人整容前后的对比。

My daughters were showing me these memes that were basically celebrities before and after plastic surgery.

标题写着'你不是丑，只是穷'。

And title was you're not ugly, comma, you're just poor.

现在变成了'你不是胖，只是穷'。

And now it's you're not fat, comma, you're just poor.

这太令人难过了。

That's so sad.

作为一名医疗提供者，我对此深感困扰，因为我能给那些没有明显糖尿病症状的患者开这些药物并让保险报销，或者某些政策会覆盖糖尿病前期患者。

It is something that I struggle with as a provider because the only patients I can offer these medications to who don't have overt diabetes and get insurance to cover, or some policies will cover prediabetes.

但如果她因内脏脂肪偏高就诊，却未达到病态肥胖标准，或不符合保险公司设定的门槛，这些患者中有部分人负担不起这种药物。

But if she's coming in with elevated visceral fat, but she's not morbidly obese, or she doesn't meet whatever the gatekeeping of the insurance companies is deciding, some of these patients cannot afford this medication.

你觉得成本会下降吗？

Do you see the costs coming down?

我确实认为目前这种药物处于垄断状态。

I do think right now there's a monopoly of this medication.

我们来谈谈这个问题。

Let's talk about that.

诺和诺德和礼来公司。

Novo Nordisk and Eli Lilly.

他们是这种药物的唯一生产商。

They they're the only sole producers of this medication.

所以，他们可以随心所欲地定价。

So, they can charge whatever they want because they can.

此外，单个注射笔的生产成本非常高。

Also, the production of the individual single pens is very expensive.

你看在欧洲，Mounjaro注射笔提供四剂药量。

So, you see in Europe, the Mounjaro pen gives you four doses.

所以那是个月用注射笔。

So, it's a monthly pen.

相比之下，这里的情况是每周都要使用新笔，说实话，大量开具这些笔对环境的影响让我很痛心，因为我研究过这些笔的处理方式。

Versus here, we have every week you use a new pen, which believe me, that hurts me to prescribe so many in what's doing to our environment, because I investigated what to do with the pens.

它们无法回收。

You cannot recycle them.

也不能焚烧处理。

They cannot be burned.

最终只能填埋。

They go to landfill.

所以从这点来说，我们虽然解决了一个问题，但会不会在环境方面制造另一个问题呢？

So, to start with that, it's already, we are fixing one problem, but are we creating another problem environmentally, right?

这就是成本居高不下的原因。

So, that's what's driving the cost.

现在礼来公司把他们的替尔泽肽药品装在玻璃瓶里。

So, Eli Lilly, now they have their drug tirzepatide in vials.

是的。

Yes.

对吧？

Right?

现在我们的患者大多直接从礼来公司获取药物，价格比我们去年告知他们的便宜了近一半。

That is now where most of our patients are getting the medication is direct from Eli Lilly and the cost is roughly half of what we had to tell them last year.

如果患者自费购买2.5毫克剂量，每瓶可能要1100美元，而每月费用是300美元。

So, if they're paying out of pocket for the two point five milligram dose, it could be $1,100 For vial itself, it's $300 a month.

所以几乎是原价的四分之一，对吧？

So, it's almost one fourth of what they cost, right?

如果我们使用更高剂量，成本就能减半。

If we go to higher doses, it becomes half of what it costs.

还有更多选择，对吧？

There's more options, right?

有生产商的优惠券可用。

There's a manufacturing coupon.

诺和诺德和礼来都有直营药店。

There's the direct pharmacies from both Novo Nordisk and Eli Lilly.

所以这是好事。

So that is good.

希望未来能有更多小瓶装供应。

Hopefully more, they will become more available in a vial.

是的。

Yeah.

取消笔式注射器的制造流程，或者改用可重复使用的笔。

Removing the manufacturing process of the pens, or they can become multiple use pens.

我认为成本也会随之下降。

I think that's also going to decrease.

但一旦有更多制药公司加入竞争，推出更多药物和选择，价格就必须下降。

But also once there's more competition that is coming from different pharmaceuticals and more drugs and more options, then the cost needs to come down.

我想回到目前最常用的两种处方药——司美格鲁肽和替尔泽肽，以及它们的复配问题。

I wanna go back to, you know, semaglutide and tirzepatide, which are the two most commonly prescribed medications now, and compounding.

有些远程医疗平台只开具复配药物的处方。

So, some of these telemedicine platforms are only prescribing the compounded options.

其中一些平台本质上就是药房，他们向患者分发大量复合药物。

Some of these platforms are basically pharmacies and they're distributing a lot of compounded medications to the patients.

你对复合药物有什么看法？

How do you feel about compounding?

它确实往往更便宜。

It does tend to be cheaper.

你知道，对很多患者来说，费用是个大问题。

You know, a lot of patients, it's cost prohibitive.

就他们的预算而言，要么选择复合药物，要么就什么都用不起。

It's compounding or nothing as far as their budget.

是的。

Yep.

所以，安全不应该有价格标签，对吧？

So, the safety should not have a price, right?

你不应该因为更便宜就拿自己的健康冒险。

You should not put your health at risk because it's cheaper.

你认为这些药物正在让人们处于危险之中吗？

You feel these drugs are putting people at risk?

没错。

Yeah.

所以，实际上已经有相关研究了。

So, actually there's studies.

这特指复合药物

This is specifically the compound

转换。

conversion.

有研究表明，大多数关于GLP-1药物过量的毒理学咨询都与复方药物有关，因为存在自我用药过量的风险。

There are studies that have shown that most of the calls for toxicology for overdose of GLP-one is with compounded medication, because you run the risk of overdosing yourself.

复方药物存在多个问题。

The problem with compounded medication, there's several.

其一是它不受FDA监管。

One is that it's not FDA regulated.

FDA审批药物需通过更高质量和安全标准，对吧？

The standards of higher quality and safety that FDA drugs go through, right?

所以一种药物要获得批准，可能需要十年研究并提交安全性研究报告。

So, for a drug to get approved, you know, it can take ten years of studies and showing the studies of safety.

但复方药物不需要经过这些程序，对吧？

But that doesn't happen with compounded medication, right?

其次，在药物短缺时期，配制复方药物是合法的。

Second, right now, when there was a shortage of the drugs, it was legal to compound the medication.

好的。

Okay.

但现在已不存在短缺情况。

But now there's no shortages.

实际上礼来和诺和诺德公司正在积极起诉复方药房，因为它们无法再仿制原研药。

And actually both Eli Lilly and Novo Nordisk have active lawsuits to compound their pharmacies because they cannot reproduce the drug anymore.

所以现在很多复方药房通过混入其他成分来规避这项法律，对吧？

So what's happening is a lot of the compounding pharmacies are mixing them with other things so they can get around that law, right?

所以并不完全是同一种药物。

So not exactly the same drug.

所以他们添加了维生素B12、叶酸和其他成分。

So they're adding vitamin B12, they're adding folate, they're adding other things.

所以这已经是对药物、对化合物的改造，增加了另一种副作用的风险，对吧？

So, it's already manipulation of the drug, of the compound, another risk of side effects, right?

或者是在FDA批准的药物监督研究中未预见到的副作用。

Or side effects that are not expected that were not seen in the supervised studies with the FDA approved drug.

我在书中确实谈到了复方药物，因为这是一个现实问题

I do talk in my book about compounded medications because it's a reality

是啊，这确实是个现实。

as Yeah, you it's a reality.

我看到有些患者在使用复方药物，他们原本绝不会用这类药物，绝对会去沃尔格林买他们需要的任何药品。

I see patients who come in on a compounded medication who would never have used anything compounded, absolutely would go to Walgreens and pick up whatever they needed.

他们根本不会想到走这条路，除非是为了这个。

It would never occur to them to go that route, except for this.

所以我非常不建议这样做。

They're I so don't recommend it.

我不会开这种处方。

I don't prescribe it.

但我理解有些人仍然会选择使用复方药物。

But I understand some people will still go on a compounded medication.

因此在我的书中，我提供了一个指南，列出了那些符合最高标准或更高质量的复方药房。

So in my book, I give a guide of which are the compounding pharmacies that are at the highest standards or at a higher quality.

还有，关于给你配制药物的人，有哪些危险信号和积极信号，对吧？

Also, what red flags and green flags from who's giving you the compounded medication, right?

因为如果有人给你配制药物，我几乎可以确定他们不是内分泌专家，也不会是经过认证的肥胖医学专家。

Because if somebody's giving you compounded medication, I can almost know that they're not endocrinologists, they're not gonna be board certified obesity medicine.

所以，不仅仅是他们在给你配制药物，更重要的是你从这些配制药物中获得了什么指导？

So, it's not just that they're giving you the compounded, it's what guidance are you getting with the compounded medication?

让我们回到未来，谈谈激动人心的部分。

Let's go back to the future, the exciting part.

药物研发管线现在是什么情况？

What does the drug pipeline look like?

目前我们有GLP-1类药物，然后是替尔泽肽。

So right now we have GLP-1s and then we have the tirzepatide.

替尔泽肽和司美格鲁肽有什么区别？

What is tirzepatide versus semaglutide?

我喜欢这样描述这些药物：就像iPhone，我们有iPhone X，iPhone XII。

So, I like to describe the medications like So, the iPhone, we have the iPhone X, the iPhone XII.

每次改进后，它们性能更好，漏洞更少。

Every time they improve it, they work better, they have less bugs.

GLP-1类药物也是如此，对吧？

Same thing with the GLP-one medication, right?

现在我们有iPhone 16，也就是替尔泽肽Mounjaro套装，但iPhone 17今年或明年就要来了，对吧？

So right now we have the iPhone 16, which is tirzepatide Mounjaro set bound, but the iPhone 17 is coming this year, next year, right?

所以每次新药问世，药物都变得更精密、更安全，副作用也更少。

So the drugs are becoming more sophisticated, safer with less side effects every time that a new one comes out.

所以，我们从单GLP-1开始，对吧？

So, we went from mono GLP-one, right?

这是什么意思？

What does that mean?

就是它只有一种激素，即GLP-1。

That it only has one hormone, that is GLP-one.

好的。

All right.

那就是司美格鲁肽。

And that's semaglutide.

司美格鲁肽，现在还有利拉鲁肽，明白。

Semaglutide, now And liraglutide, okay.

没错，就是司美格鲁肽和利拉鲁肽。

Now, exactly, semaglutide, liraglutide.

现在我们有了双重肠促胰岛素。

Now we have twincretins.

所以它含有两种肠促胰岛素，因为这类——什么是

So, it has two incretins because this class of- What's

我们还没讨论过的肠促胰岛素

an incretin we haven't talked Inkretin about

是帮助胰腺产生更多胰岛素以控制血糖的药物。

are drugs that help the pancreas produce more insulin for glucose control.

这些就是这类激素。

Those are the type of hormone.

这是它们的主要功能。

This is their main function.

所以，GLP-1是一种墨水吗？

So, GLP-one is an ink?

它是一种肠促胰岛素。

It's an incretin.

好的。

Okay.

我们有GLP-1类药物，如利拉鲁肽和司美格鲁肽，但现在我们有了双促胰岛素药物，即一种药物包含两种肠促胰岛素——GLP-1和GIP。

So, we have the GLP-one, which is liraglutide semaglutide, but now we have twinkretins, which is two incretins in one drug, which is GLP-one and GIP.

这种组合就是替尔泽肽。

Now that's a combination that has That's tirzepatide.

所以它有两种不同的作用途径。

So it has two different pathways.

因此我们看到更显著的减重效果。

So we're seeing more weight loss.

而且现在——副作用也更少。

But now- And less side effects.

恶心反应越来越轻微。

Less And less nausea.

这正是我们

That's what our

患者所观察到的。

patients see.

我们几乎不开索马鲁肽，除非患者已经在使用且效果良好。

We almost don't prescribe semaglutide unless they've been on it and they're happy with it and it's going well.

我们更倾向于使用替尔泽肽，因其副作用更少。

We tend to lean towards tirzepatide because of the lower side effect profile.

现在，瑞他鲁肽是另一种即将问世的药物

Now, retatrutide is another coming retraxeter

它含有

that's had

三种肠促胰岛素合而为一。

three incretins in one.

包括GLP-1、

So GLP-one,

GIP和胰高血糖素——这是另一种由胰高血糖素细胞分泌的激素。

GIP, and glucagon, which is another hormone that is made in the Glucagon.

这些机制通过不同途径协同作用，实现更显著的减重效果。

So all of this are working different pathways to provide us greater weight loss.

关于这种新药的研究数据如何？

And what are the studies on this newer medication showing?

减重效果前所未见。

Weight loss that we've never seen before.

最高可达惊人的40%体重下降。

Significant up to even 40% of body weight loss.

他们有监测体成分变化吗？

Are they monitoring body composition?

他们现在只是在测量体重吗？

Are they just Now doing weight in

他们开始做体成分分析了吧？

they're starting to do body composition, right?

因为所有研究都是用BMI指数完成的。

Because all of the studies were done with using BMI.

然后还有其他制药公司带着他们自己的肠促胰岛素类药物，对吧？

Then we have other pharmaceuticals coming with their own type of incretin, right?

未来几年内我们会有一款每月用药一次的新药上市。

We have a monthly one coming in the next few years.

口服药有什么选择？

What about oral options?

口服药方面，我们从2019年就有了司美格鲁肽口服剂，商品名诺和泰。

So oral options, we have semaglutide orals since 2019, it's called Rybelsus.

当时人们对此寄予厚望。

And it was like a huge expectation.

哦，现在我们有了第一款口服GLP-1类药物。

Oh, now we have the first oral GLP-one.

我们在临床上发现——这款药获批时是针对二型糖尿病的。

And what we found clinically, and it was approved and came out for type two diabetes.

它从未针对减肥进行过测试，对吧？

It was never tested for weight loss, right?

但我们推测这是同一种药物。

But we assume it's the same drug.

我们会说这和Ozempic针对糖尿病的情况一样。

We're gonna say same as Ozempic came for diabetes.

然后我们看到了结果，人们开始减重。

And then we saw the results, people were losing weight.

现在它获得了减重适应症，但口服司美格鲁肽自2019年上市以来并未出现这种情况。

Now it has the indication for weight loss, but that didn't happen with the oral semaglutide, again, since 2019 is available.

为什么？

Why?

因为当时我们确实看到了与Ozempic相似的血糖控制效果，但没有减重效果。

Because we did see glucose control similar to Ozempic at that time, but not weight loss.

没有减重效果。

Not the weight loss.

简单说明一下，现有剂量分为三毫克、七毫克和十四毫克（当可用时）。

So just to give you an idea, the doses there is three milligrams, seven milligrams, fourteen milligrams when it's available.

目前拥有该药物的诺和诺德公司正在研究五十毫克的剂量。

Right now Novo Nordisk, who has this drug, they're studying at fifty milligram.

哇。

Wow.

用于减重。

For weight loss.

口服。

Oral.

口服。

Oral.

好的。

Okay.

效果显著，高出很多。

So significant, much higher.

现在，口服药物会产生更多副作用，所以观察患者实际耐受情况会很有趣。

Now, oral gives more side effects So it's going to be interesting to see if patients actually tolerate it.

现在，礼来公司有Orfogliparone，这是另一种口服GLP-1药物。

Now, Eli Lilly has Orfogliparone, which is another oral GLP-one.

它不是口服替尔泽肽，只是单纯的GLP-1单激素制剂。

It's not tirzepatide oral, it's just GLP-one, one single hormone.

但减重效果无法与注射剂相提并论。

But the weight loss is not comparable the injectables.

它们的用途可能在于维持阶段，对吧？

What they can have a use is for maintenance, right?

我认为口服药物在维持减重效果方面会很有用。

I think oral medications will have great use for maintaining the weight loss.

当需要较低剂量时，患者或许只需服用口服药片——理论上应该更便宜，但口服司美格鲁肽和注射剂价格相当。

When you need a lower dose and maybe patients just can take a oral pill, which in theory should be less expensive, But oral semaglutide is equally expensive as the injection.

所以，仅因为是口服形式并不意味着更容易普及。

So, just because it's oral doesn't mean that it's gonna be more accessible to everybody.

关注心理健康可能会让人感到孤独。

Taking care of your mental health can feel isolating.

有些日子，在网上浏览建议就是无法满足你的需求。

There are days when scrolling through advice online just doesn't give you what you need.

坦白说：寻求心理支持可能会让人感到不知所措。

And let's be honest: Reaching out for support can be overwhelming.

有时很难知道从何开始。

It can be hard to know where to start.

而这正是Alma的用武之地。

But that's where Alma comes in.

Alma拥有覆盖全美20,000多名多元化的持证治疗师网络，其中99%接受保险，让寻找合适的治疗变得简单且经济实惠。

With a nationwide network of over 20,000 diverse, licensed therapists, 99% of whom accept insurance, Alma makes finding the right care simple and affordable.

您无需注册即可搜索，然后根据性别、种族或治疗方式等关键条件筛选，甚至可以通过免费保险估算器预先查看咨询费用。

You can search without creating an account, then filter by what matters most, like gender, race, or therapeutic approach, and even see the session costs upfront with their free insurance estimator.

使用Alma的用户平均能节省80%的咨询费用。

On average, people using Alma save 80% on their sessions.

Alma最突出的特点是它不提供速效方案或泛泛建议。

What stands out most about Alma is that this isn't about quick fixes or generic advice.

它专注于建立真实的人际连接，您可以安排与多位治疗师进行15分钟免费咨询，直到找到真正符合您需求的人选。

It's about real human connection, which means you can schedule free fifteen minute consultations with as many therapists as needed to find one who truly fits your goals.

随着时间的推移建立有意义的治疗关系能带来更好的心理健康结果，而Alma让这个过程比以往更容易。

Building a meaningful relationship over time leads to better mental health outcomes, and Alma makes that easier than ever.

与人相伴更美好，与Alma同行更美好。

Better with people, better with Alma.

立即访问helloalma.com/unpaused开始您的旅程，预约免费咨询。

Visit helloalma.com/unpaused to get started and schedule a free consultation today.

网址是helloalma.com/unpaused。

That's helloalma.com/unpaused.

荷尔蒙影响的不仅是你的情绪。

Hormones affect more than how you feel.

它们也会影响你的皮肤。

They affect your skin too.

随着中年雌激素水平下降，你的皮肤会流失胶原蛋白、水分和弹性。

As estrogen drops in midlife, your skin can lose collagen, hydration, and elasticity.

这就是Alloy Health的用武之地。

That's where Alloy Health comes in.

Alloy提供基于实证的更年期护理服务，为女性对接受过更年期专业培训的医生。

Alloy makes evidence based menopause care accessible, connecting women with menopause trained doctors.

现在他们正用M4系列重新定义护肤——这是含有雌三醇（一种仅作用于皮肤的雌激素）的处方产品线。

And now they're redefining skincare with M4, their prescription line made with estriol, a form of estrogen that only works on the skin.

最初推出的是M4面霜Rx，现在Alloy又新增了两款颠覆性产品：M4面部精华Rx和M4眼霜Rx。

It started with the M4 Face Cream Rx, and now Alloys added two game changers, the M4 Face Serum Rx and the M4 Eye Cream Rx.

开始使用非常简单。

Getting started is easy.

访问myalloy.com。

Head to myalloy.com.

网址是myall0y.com。

That's myall0y.com.

回答几个快速问题后，持证医师会审核你的信息。

Answer a few quick questions and a licensed physician will review your info.

使用优惠码MCH20。

Use code MCH20.

输入优惠码M C H二零，首单立减20美元。

That's M C H two zero for $20 off your first order.

您的个性化护肤产品直送到家。

Your personalized skincare ships right to your door.

无需预约，不用排队。

No appointments, no pharmacy lines.

因为肌肤在变化，您的护肤流程也该与时俱进。

Because your skin's changing and your routine should too.

访问myalloy.com并使用优惠码MCH20。

Visit myalloy.com and use code MCH20.

优惠码是MCH20。

That's MCH20.

在这个节日季，送礼不应意味着在品质或纯净成分上妥协。

This holiday season, gift giving shouldn't mean compromising on quality or clean ingredients.

Primal Pure让一切变得简单，提供无毒小批量套装，即拆即用且真正有效。

Primal Pure makes it easy with toxin free small batch bundles that are ready to wrap and designed to actually work.

在寻找一款无毒除臭剂和既奢华又纯净的身体乳霜吗？

Looking for a non toxic deodorant and a body butter that feels both luxurious and clean?

他们的竹炭天然除臭剂富含生物活性维生素成分，不仅能有效中和体味，还能帮助减少毒素堆积。

Their charcoal natural deodorant is made with vitamin rich bioavailable ingredients that work with the body not only to effectively neutralize odor, but to help minimize toxic buildup.

您也可以试试他们畅销的杏仁香草身体乳霜，不仅保湿滋润，而且完全无毒，是沐浴后的完美选择。

You may also want to try their best selling almond and vanilla body butter, which is not only moisturizing, but free of toxins and perfect after a shower or bath.

需要准备节日女主人礼物吗？

Need a Hostess gift for the holidays?

试试他们的限量新品，比如我最爱的温暖香草薄荷身体护理系列或蔓越莓红润唇膏。

Try their new limited edition picks, like the Cozy Vanilla Mint Body Care or Cranberry Red Lip Balm that are at the top of my list.

好消息是Primally Pure不仅仅是一份礼物。

The good news is that Primally Pure isn't just a gift.

它是对纯净生活和用心自我护理的邀约。

It's an invitation to clean living and mindful self care.

他们的畅销品是人人都会喜爱的奢华无毒必备品。

Their best sellers are luxurious, non toxic staples that everyone will appreciate.

使用优惠码UNPAUSED可享Primarily Pure购物85折。

Use code UNPAUSED to get 15% off your Primarily Pure purchase.

官网是www.primarypure.com。

That's www.primarypure.com.

结账时别忘了使用优惠码UNPAUSED享受85折。

And don't forget to use code UNPAUSED at checkout for 15% off your order.

我的听众能做什么呢？

What can my listeners do?

他们已经听完了这些信息。

They've heard all this information.

他们可能会想：好的，我要找人聊聊这种药物及其对我的可能效果。

They're like, okay, I want to go and talk to someone about this medication and what it might do for me.

我知道要预约到你可能非常困难。

I know that to get in to see you is probably very difficult.

他们该找谁咨询呢？

Who do they talk to?

这是他们的家庭医生吗？

Is this their family medicine doctors?

这是他们的妇产科医生吗？

Is this their OBGYN?

这是他们的，你知道，你会去找谁？

Is this their, you know, who do you go to?

你怎么知道的？

How do you know?

某处有名单吗？

Is there a list somewhere?

是的。

Yes.

而我的书就是为所有这些人群写的。

And for all of them is who I wrote my book for.

因为我的书是我个人的指导手册，内容涵盖开始GLP-1治疗前该做什么、该注意什么，治疗过程中如何引导他们安全用药。

Because my book is my own personal guidance, is that before you go on a GLP-one, what to do, what to look for, and then during a GLP-one, how to guide them to a safe journey.

以及在GLP-1治疗结束后该怎么做，对吧？

And then after a GLP-one, right?

所以我的书就是我的诊疗方案，就像把专家请到家里一样。

So, my book is my protocol is like having me at their home.

说到这里，理想情况下由肥胖医学委员会认证的医生会更熟悉这类药物，对吧？

Moving to that, ideally an obesity board certified physician will be more expert on these drugs, right?

美国肥胖医学委员会的官网是abum.org。

And there is the American Board of Obesity Medicine website, which is abum.org.

有一份肥胖专科认证的名单，你输入邮编就能查到。

There is a list of obesity board certified that you put your zip code.

我们会把这个放进节目备注里。

And we'll put this in the show notes.

它能告诉你附近有哪些获得肥胖专科认证的医生。

And it can tell you who is close to you that is obesity board certified.

我们怎么知道自己得到的是最佳诊疗呢？

How do we know we're getting the best care?

如果他们关注的不只是体重秤上的数字。

If they're looking beyond the scale.

好的。

Okay.

如果他们讨论肌肉问题，如果从第一次就诊就开始和你强调蛋白质摄入。

If they're talking about muscle, if they're talking to you about protein from the get go, from your first visit.

你离开诊室时必须了解肌肉相关知识——肌肉流失的可能性、如何避免流失、以及为什么保持肌肉量很重要，明白吗？

You cannot leave the office without having knowledge about muscle, about the possibility of muscle loss, on how to avoid the muscle loss and why it's important not to lose muscle, right?

这就是个积极信号。

That's a green flag.

好的。

Okay.

那危险信号呢？

What about the red flags?

我常告诉患者，即使是激素治疗，也别因为对方是内分泌科或妇科医生就认为一定会给你开激素处方。

I always tell my patients, even for hormones, don't assume that just because it's an endocrinologist or gynecologist, you're gonna leave with a prescription of hormones.

你必须做好尽职调查，打电话询问医生是否开具激素替代疗法处方？

You have to do your due diligence, call and ask, does the doctor prescribe hormone replacement therapy?

GLP-1类药物同理。

Same with GLP-one.

这位医生有相关经验吗？

Does the doctor have experience?

这位医生开具GLP-1类药物处方多久了？

How long has this doctor been prescribing a GLP-one?

这位医生的患者是否出现过严重并发症或副作用？

Have the doctor has severe complications or side effects in patients?

对吧？

Right?

你可以做出这个选择。

You can make that choice.

你可以打电话咨询。

You can call and ask.

如果他们不做身体成分分析，那就是个危险信号。

If they're not doing body composition, that's a red flag.

那么，如果你能让世界变得完美并重写肥胖护理的标准，那会是什么样子？

So, if you could make the world perfect and rewrite the standard of care for obesity care, what would that look like?

身体成分分析，力量训练。

Body composition, strength training.

没错。

Yep.

营养，更侧重于瘦肉蛋白和GLP-1。

Nutrition, more focused in lean protein and a GLP-one.

作为亲人，我们该如何支持？要知道我们是医生，我们明白该怎么做，感谢你成为我获取这方面信息的主要来源，至少让我入门了。

How can we as loved ones, so, you know, we're physicians, we know how to do this and thank you for being the main source of my information on this subject or at least getting me started.

但对于那些没有体重问题的听众——不过可能73%的美国人有这个问题——他们该如何更好地支持正在经历这段旅程、或许刚开始使用GLP-1的人呢？

But for our listeners out there who don't have a weight problem, but probably because seventy three percent of Americans do, how can they be more supportive of someone going through this journey and perhaps starting a GLP-one?

我认为家人非常重要的一点是，要理解你的朋友、儿子、丈夫或任何正在使用GLP-1药物的人，他们的饮食习惯会和以前不一样。

I think it's really important from family members, right, to understand that your friend, your son, your husband, whoever's on this GLP-one medication will not eat as they used to eat.

不要质问：'你怎么不舒服了？'

Not to question, why are you sick?

'为什么不吃东西？'

Why are you not eating?

如果他们不吃东西，不要觉得是针对你个人。

Don't take it personally if they're not eating.

他们正在服用抑制食欲的药物，而这正是药物该起的作用。

They're on a medication that is suppressing their appetite and that's what we want the drug to do.

要尊重他们的饮食方式，明白有专业人士在监督用药，对吧？

It's to respect the way that they're eating, understand that there is supervision whoever's giving them that medication, right?

说明这个人能使用这种药物是经过一定程序的。

That there were some steps taken for that person to be on this medication.

让患者自己决定愿意分享多少信息，好吗？

And to let the patient guide them in how much they wanna share, right?

我认为分享用药经历是非常私人的事，人们会在觉得合适的时候才分享。

I think it's something very personal that people share when they feel it's time for them to share.

我总说分享是第一步，对吧？

I always say share an entry, right?

分享开胃菜，然后学习。

Share the appetizer and then learning.

我总是和患者沟通，特别是当他们处于不匹配状态时——比如恋爱中一方在使用GLP-1药物而另一方没有，你知道的，他们的饥饿信号会发生变化。

I always talk to patients, especially if they're in a mismatch, meaning one person in the relationship is on a GLP-one and one is not, that, you know, their hunger cues are gonna change.

而且你不必整天反复提起这事，因为可能会惹恼你的伴侣。

And you don't have to mention constantly all day because you might irritate your partner, you know.

哦，我不饿。

Oh, I'm not hungry.

哦，我只是...你知道的，就像你的饥饿信号或状态会变得不同。

Oh, I just, oh, you know, like your hunger cues or things are gonna be different.

要记住，你的伴侣感受和你并不相同。

And remember, your partner is not feeling the same way.

所以你的生活改变了，而他们的还没有。

So your life has changed, theirs hasn't yet.

所以要保持沟通开放坦诚，但不断强调自己不饿、吃得很饱，可能不是与爱人分享这类信息的最佳方式。

So like, you know, keep the conversation open and honest, but constantly mentioning that you're not hungry and you're so full may not be the best way to share that information, you know, with your loved ones.

什么样的人适合使用GLP-1类药物？

Who's a good candidate for GLP-1s?

我们医学上称之为禁忌症。

And we in medicine, we call it contraindications.

哪些人不应该服用？

Who should not be taking it?

能接受的人比不能接受的人多。

There's more who can take it that not.

所以，我会选择那些不能接受的人。

So, I'm gonna go with the who cannot.

任何有髓样甲状腺癌个人史甚至家族史的患者，都不建议使用。

Anybody who has personal history of medullary thyroid carcinoma, even family history, it's not recommended.

因为在老鼠实验中，它被证明会促进髓样甲状腺癌的发展，这是一种非常严重且侵袭性强的甲状腺癌。

Because in mice, it was shown to promote medullary thyroid carcinoma, which is a very severe, aggressive type of thyroid cancer.

因此，不幸的是，对于有髓样甲状腺癌个人史或一级家族史的患者，这是禁忌的。

So, unfortunately for patients with personal or first degree family history of medullary thyroid carcinoma, it's contraindicated.

其他类型的甲状腺癌，如乳头状、滤泡状或甲状腺结节，并非禁忌症。

Any other type of thyroid cancer, papillary follicular hurdle, thyroid nodules, is not a contraindication.

好的。

Okay.

因药物引发胰腺炎的患者。

Somebody who has developed pancreatitis from the medication.

好的。

Okay.

这一点也需要根据具体情况灵活判断。

And that is also a little bit open to per case basis.

如果有人开始用药后剂量增加过快而引发胰腺炎，那么或许存在风险的可能性，对吧？

If somebody was started on the medication and moved the doses too quick and developed pancreatitis, then maybe there's the possibility with always the risk, right?

所以，这些患者是绝对禁忌使用该药物的。

So, those are the patients that it's absolute contraindication on the medication.

从这一点来看，我认为谁能从这种药物中获益还是个非常开放的问题。

From there, I think it's a very open book on who can benefit from this medication.

我想说的是，对任何人而言，减肥和保持体重感觉就像一份全职工作。

I would say for anybody to lose weight, maintaining weight feels like a full time job.

他们都可以成为候选人。

They can be candidates.

他们可能是这种药物的适用对象。

They may be candidates for this medication.

这次对话非常精彩，我相信我们的听众一定收获颇丰。

This has been an amazing conversation and I'm sure our listeners have learned so much.

在完全结束之前，我想像往常一样问您几个问题。

Before we finish completely, I wanna ask what I ask all my guests a few questions on unpaused.

那么，现阶段你生活中最美好的部分是什么？

So what's the best part of this stage of your life?

所以，过去几年你经历了相当大的转变。

So, you've had a pretty big transformation in the last few years.

是的。

Yeah.

离婚后成为单亲妈妈，开创了自己的诊所，

Divorced, single mom, started your own practice,

还在纽约市买了公寓。

bought an apartment in New York City.

我认为目前生活中最美好的部分，是作为先行者亲眼见证人们的健康将如何改变。

I think the best part of my life right now is being an early adopter and seeing firsthand how health is going to change for people.

这是减少2型糖尿病的开端。

This is the beginning of less type two diabetes.

这是一个开始。

This is the beginning.

2型糖尿病可能在未来某一天变得过时。

It may become obsolete at one point, type two diabetes.

就像，你能想象这有多不可思议。

Like, you imagine that It's that's a crazy.

与肥胖相关的癌症将会减少，包括乳腺癌、结肠癌、前列腺癌、胃癌、甲状腺癌等与肥胖相关的癌症。

There are gonna be less type of cancer that are related with obesity, breast, colon cancer, prostate cancer, stomach cancer, thyroid cancer that related with obesity.

因此，当下这个时刻正决定着未来几代人的健康状况。

So, this moment in time is truly defining what our health is going to be in the next generations.

我认为这很棒。

And I think that is great.

在个人层面上，我想到了我的母亲，还有其他经历过我所经历或正在经历一切的女性，她们没有我们现在拥有的这些工具。

In a personal moment is I think of my mom and I think of other women that went through everything that I went or other women go and didn't have the tools that we have now.

是的。

Yeah.

她们不得不经历这些，经历了离婚，经历了单亲妈妈的艰辛，感觉糟糕，失眠，健忘，潮热，夜间盗汗，抑郁，阴道干涩，尿路感染，却依然设法应对一切。

That they had to go through it, that they went through a divorce, that they went through single motherhood, feeling terrible, not sleeping, forgetting things, hot flashes, night sweats, depressed, vaginal dryness, UTIs, and they still manage to do things.

我很感激在我人生的这个阶段，我拥有知识和资源来帮助我更好地度过难关，因为这本该如此。

Like I'm grateful that at this period of my life, I have the knowledge and the access to things that can help me get through things better because that's how it should be.

这些关于将女性健康放在首位的讨论，真正让我们明白可以改变余生健康轨迹的对话。

These conversations of putting women's health first, of really understanding that we can change the trajectory of our health span for the rest of our lives.

是啊。

Yeah.

正是这些对话会让它成真。

And it's these conversations that are gonna make it happen.

你曾经历过哪些本以为会击垮你、却最终让你更强大的挑战？

What is a challenge you thought once that might break you but actually made you stronger?

离开家乡，离开祖国。

Leaving my home, leaving my country.

嗯。

Yeah.

你想念那里吗？

Do you miss it?

我想念。

I do.

你会回去吗？

You go back?

每隔三四个月，我就觉得必须回墨西哥一趟。

Every three to four months, I'm like, I have to go to Mexico.

必须踏上墨西哥的土地。

Have to touch Mexican ground.

必须吃墨西哥菜，这样才能安心回来。

Have to eat Mexican food just like to feel like, okay, then I can go back.

但你知道，作为医生——我确信你也有同感——你会开始习惯错过生日，习惯错过节日。

But you know, as a doctor, and I'm sure this is, you experience the same, you start getting used to missing birthdays, you start getting used to missing holidays.

但还有我的离婚，选择离婚而不是另一个选项——维持不幸福的婚姻，对吧？

But also my divorce, choosing a divorce instead of the other option, which is staying in an unhappy marriage, right?

我曾以为不能每天见到孩子会非常艰难，现在我仍在挣扎，但我依然坚持着，而且过得很好，孩子们也很开心。

I thought I was gonna be very hard not seeing my kids every day, which I still struggle, but I'm still here and I'm thriving and my kids are happy.

感谢你今天与我们在一起。

Thank you for being with us today.

你还有什么想对我们的听众说的吗？

And anything else you wanna say to our listeners?

我很高兴能来到这里进行这次对话，一定要关注我的书。

I'm very happy to be here and to have this conversation and definitely look for my book.

我写这本书是为了所有不理解肥胖症的人，为那些考虑使用GLP-1类药物或正在使用的人。

I wrote it for everybody who doesn't understand obesity, for anybody who's thinking of being on a GLP-one or they are on a GLP-one.

我希望每个人都能接触到经验丰富的医生，但遗憾的是受过专业培训的医生数量不足。

I wish everybody had access to experienced doctors, but unfortunately there's not enough doctors trained.

因此通过我的书，我希望能让足够多的人了解这个领域。

So with my book, I want enough people educated in the subject.

在哪里可以找到医生。

Where to Find Doctor.

罗西洛·萨利斯瓦伦。

Rosillo Salaswalen.

提醒我们的听众，你的书《等候名单》将于12月出版，现在已开放预订。

As a reminder to our audience, your book Waitlist is out in December and available for preorder right now.

听众们也可以在Instagram上找到你：DrSalisWhelan。

Listeners can also find you on Instagram DrSalisWhelan.

我很想听听你对这个话题或其他任何你想分享的想法。

I'd love to hear from you about this topic and anything else that's on your mind.

你可以在Instagram上找到我@DrMaryClair，并在thepawslife.com获取关于健康、健身和中年生活的真实准确信息。

You can find me on Instagram DrMaryClair and get the honest, accurate information on health, fitness, and navigating midlife at thepawslife.com.

如果你喜欢这个播客，请务必在你常用的播客应用中点击关注，这样你就不会错过任何一集。

If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode.

同时，请给我们留下评价，并记得把这个节目分享给你关心的女性朋友们。

While you're there, leave us a review and be sure to share the show with the women you love.

我们将不胜感激。

We would be so grateful.

你也可以在YouTube上观看完整剧集。

You can also find full episodes on YouTube.

《Unpaused》由Odyssey与Pod People联合呈现。

Unpaused is presented by Odyssey in collaboration with Pod People.

我是主持人，医生

I'm your host, Doctor.

玛丽·克莱尔·哈弗。

Mary Claire Haver.

《Unpaused》表达的观点和意见仅代表主持人和嘉宾的个人立场。

The views and opinions expressed on Unpause are those of the talent and guests alone.

这些内容仅供信息参考和娱乐目的。

They are provided for informational and entertainment purposes only.

本播客及其相关材料的任何部分都不应被视为专业医疗建议、诊断或治疗的替代品。

No part of this podcast or any related materials are intended to be substitute for professional medical advice, diagnosis, or treatment.