Dr. Spencer and Karl Nadolsky sit down with David W, a nurse practitioner and one of the actual patients enrolled in the Triumph 1 retatrutide phase 3 trial, to break down the data that was just presented at the American Diabetes Association conference and explain why everyone in obesity medicine is paying very close attention.

In this episode they cover what retatrutide actually is and why adding glucagon agonism to the GLP-1 and GIP dual agonism of tirzepatide creates a meaningfully different drug with direct effects on liver lipid metabolism, insulin sensitivity, blood pressure, and fat catabolism that you do not see with semaglutide or tirzepatide alone, what David's personal experience in the 12 milligram arm looked like from dose escalation through steady state including the GI side effects that faded by month seven and the heartburn that a low dose PPI fixed quickly, how David went from 240 pounds and a BMI of 35 down to 167 pounds by the end of the trial representing roughly 30 percent weight loss which is right at the trial average, what the Triumph 1 obesity trial found at 80 weeks with the nine and 12 milligram doses delivering nearly 26 and 28 percent average weight loss respectively and almost half of patients on the highest dose losing 30 percent or more, why the 104 week extension data showing patients who stayed on 12 milligrams reaching 30.3 percent average weight loss is being compared to bariatric surgery outcomes, what the Transcend type 2 diabetes trial showed with average A1C dropping to 5.9 percent on the 12 milligram dose in patients who were on no other diabetes medication, why the 41 percent triglyceride reduction and 20 percent LDL reduction are particularly interesting given that the mechanism appears to involve multiple pathways in the liver that tirzepatide and semaglutide do not touch, what the 70 percent reduction in WOMAC knee arthritis pain scores and 60 percent reduction in sleep apnea events mean for patients who have been told their only option is surgery, how Spencer plans to use retatrutide clinically once it is approved and which patients he thinks are the right candidates, why the gray market research peptide version currently circulating is something both doctors strongly advise against, and what Triumph 2 and Triumph 3 are measuring and when that data is expected.

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