Primary Care Voice

FDA Approves First Oral PCSK9 Inhibitor: Lipfendra Explained (Who It’s For, Cost, Benefits, Myths) Dr. Kulmeet Kundlas discusses the FDA approval of the first oral PCSK9 inhibitor, Lipfendra, as a potential game changer for patients with high cholesterol who can’t reach LDL targets with current therapy. He explains how cholesterol and lipoproteins (LDL and HDL) work, why lowering LDL reduces heart attack, stroke, PAD, and death risk, and how statins and PCSK9-targeting therapy lower LDL through different mechanisms. Lipfendra is a 20 mg once-daily pill taken on an empty stomach, priced at about $310/month, and can lower LDL by roughly 56–59% with minimal side effects (e.g., diarrhea, dizziness). FDA-approved use is as add-on therapy for patients on statins not at goal, familial hypercholesterolemia, and established ASCVD; it is not a statin replacement. He addresses common myths, emphasizes lifestyle changes, and outlines likely insurance and prescribing steps. 00:00 The FDA Just Approved This — Why It Matters 01:00 From $1,400 Injection to a $310 Pill 02:04 How Cholesterol Actually Works in Your Body 03:46 Statins vs. PCSK9: Two Different Targets 04:23 Why Lowering LDL Saves Lives (The Numbers) 05:42 Why I'm Excited — and Why It's Add-On, Not Replacement 06:44 Who's a Candidate — the Three Approved Groups 08:41 How to Take It: 20mg, Empty Stomach, Wait 30 Minutes 08:59 The Molecular Redesign That Made a Pill Possible 09:32 How Much It Lowers LDL — Cost and Side Effects 10:04 5 Myths I Need to Clear Up 12:07 Your Next Steps: The 4 Hoops

Medicare GLP-1 Bridge: 7 Facts They Did not Tell You Overview Start date: July 1, 2026 End date: December 31, 2027 (18-month CMS Innovation Fund demonstration) Purpose: Expand access to anti-obesity GLP-1 medications for Medicare beneficiaries Processing: Outside Part D, centrally administered via Humana Copay: Flat $50/month per medication Covered Medications Semaglutide (Wegovy) Tirzepatide (Zepbound) Liraglutide (Saxenda)

Medicare GLP-1 Bridge Program Explained: $50 Wegovy/Zepbound, Eligibility, PA Rules, and What Happens in 2027 A board-certified primary care physician explains Medicare’s new GLP-1 “Bridge” pilot program covering weight-loss medications (Wegovy and Zepbound) with a $50 monthly copay. The program is separate from Medicare Part D coverage and will be administered by Humana.

How to Reverse Diabetes With Diet — Why Fiber Is the Secret Fiber for Type 2 Diabetes Reversal: Lower A1C, Cholesterol & Heart Risk (Soluble vs Insoluble) Dr. Kulmeet Kundlas explains how increasing dietary fiber can help reverse type 2 diabetes, reduce post-meal glucose spikes, and protect blood vessels by preventing high-sugar damage to the glycocalyx that contributes to plaque, heart attack, and stroke. He contrasts a low-fiber Western diet (about 15 g/day) with recommended intake (~30–35 g/day) and describes soluble, viscous fibers (e.g., oats, barley) that slow gastric emptying, reduce spikes, and lower cholesterol by binding bile, and insoluble/fermentable fibers (e.g., beans, lentils, greens) that feed the microbiome to produce short-chain fatty acids linked to satiety, improved insulin resistance, colon health, and increased GLP-1 signaling. He offers practical targets and food examples, advises adding fiber gradually with hydration, notes medication timing concerns, and highlights fiber’s role in preventing constipation, including with GLP-1 drugs,

Carb Counting for Diabetes: Labels, Net Carbs, Plate Method, and the Rule of 500 In this live diabetes-series session, the host explains carbohydrate counting as a key survival skill for diabetes management, focusing on how carbs affect blood sugar, how to read nutrition labels (total carbs, fiber, and net carbs), and how glycemic index influences sugar spikes. The script reviews what food is made of, why carbohydrates are the body’s preferred fuel, and how insulin works in type 1 versus insulin resistance in type 2 diabetes. Practical guidance includes estimating daily calories (10/15/20 calories per pound based on activity), aiming for a balanced diet (about 50% carbs, 25% protein, 25% fat), typical carb targets per meal (women 45–60g, men 60–75g), and using the 9-inch plate/hand-portion method. It also covers common mistakes, using CGMs, and insulin dosing with the “rule of 500.”

Type 2 diabetes reversal is no longer a hope — in 2026 it is evidence-based medicine. The latest ADA guidelines confirm that diabetes remission is achievable through diet, weight loss, exercise, sleep, and stress management. In this video, Dr. Kundlas walks you through the exact pillars that put insulin resistance into reverse, why simple carbohydrates (not all carbs) drive disease, and how losing 10–30% of body weight unlocks 34–86% remission rates. This is not about a fad low carb diet or a quick fix. It is a complete diabetes management framework rooted in physiology — the kind your doctor wishes they had time to explain.

Best Diet for Diabetes (and Metabolic Disease): Calories, Macros, Mediterranean, Low-Carb, and 5:2 Fasting Explained In this live masterclass, Dr. Kulmeet Kundlas explains how diet and daily micro-habits drive metabolic disease (diabetes, hypertension, high cholesterol, sleep apnea, coronary disease, stroke, peripheral artery disease) through visceral fat, insulin resistance, and beta-cell failure, emphasizing obesity as hormone-mediated rather than willpower. He provides calorie targets by activity level (10/15/20 calories per pound) and a weight-loss rule of 500–1000 calorie daily deficits, noting diet can reduce A1C as much as or more than medications. He breaks diets into macronutrient “levers” (fat/protein/carbs), contrasts low-carb (keto/Atkins/carnivore) vs high-carb (vegan/Ornish) patterns, highlights Mediterranean as sustainable, and describes 5:2 fasting (500–800 calories on two nonconsecutive days) as highly effective for weight loss and insulin resistance. He reviews diabetes remission data with greater weight loss, offers a hybrid early low-calorie/low-carb approach (especially within 10 years of diagnosis), outlines meal-order and timing strategies, ADA plate guidance, fiber and micronutrient needs (magnesium, zinc, B12 with metformin), and key medication safety cautions (avoid SGLT2 inhibitors with keto; manage insulin/sulfonylureas with fasting; prioritize protein and resistance training on GLP-1/GIP-1 drugs).

7 Early Warning Signs of Throat Cancer (Don’t Ignore These Symptoms for 2–3 Weeks) The script challenges common stereotypes about throat cancer and explains seven early warning signs that should not be ignored: persistent sore throat, hoarseness, trouble swallowing, unexplained weight loss, one-sided ear pain without other illness symptoms, a neck lump, and coughing up blood. It outlines key risk factors including smoking and alcohol, HPV-16 (described as causing about 70% of throat cancers), chronic acid reflux, occupational dust exposure, poor diet/malnutrition, and a weakened immune system, noting that symptoms lasting beyond 2–3 weeks require medical evaluation. It describes how throat cancer can arise across the nasopharynx, oropharynx, and larynx, creating a diagnostic trap, and explains the care pathway from primary care to ENT endoscopy and biopsy. The script emphasizes prevention through HPV vaccination, stopping smoking and drinking, treating reflux, and addressing exposures and immune deficiency. 00:00 Early Warning Signs of Throat Cancer in Men (Doctor Explains) 00:02 Introduction 00:51 Early Warning Signs 01:36 Risk Factors 02:35 Throat Anatomy 04:07 HPV Virus & Throat Cancer 06:09 Why Men Are at Higher Risk 09:08 Diagnosis & Detection 10:20 Prevention & Treatment 12:22 Conclusion