Jason Giles, MD - Addictionologist in Los Angeles, California

Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest today is Dr. Jason Giles. He is board certified in both anesthesiology and addiction medicine, and he holds the great honor of being the very first addictionologist to be on Meet the Doctor. So welcome to the podcast. Thank you for joining us.

Dr. Giles (00:45):
Thanks, Eva. It's great to be here. Thanks for having me.

Eva Sheie (00:48):
Okay, so tell us what an addictionologist does.

Dr. Giles (00:51):
An addictionologist studies addiction. And addiction is one of those things that everyone knows what it is, but it's difficult to say exactly what it is. Addiction comes from the Latin word addicere, which is awesome when you hear what it means, unless you already know, do you already know that word addicere?

Eva Sheie (01:09):
No.

Dr. Giles (01:10):
Here's what it means to sell one self into bondage, to sell yourself into bondage. So it's not to be put into bondage or captured as a slave. It's to voluntarily and willingly enslave yourself. And where that comes from is in old times before there were lending institutions and banks and rules. if you wanted to buy something and you didn't have the money for it, you would go to a person with money and you would pledge whatever the item was, tools for making chariots, or string to make bows or whatever business you were going to go into or materials to build a house.

(01:45):
And of course there was security interest in the property, but the real security interest was you. Because if you didn't pay back the note, they took you because you had value as a slave in the salt mines down south or something. And so, to voluntarily enter into that agreement is you're getting benefit now, which in this case would've been money or resources, but in exchange for selling your very self into bondage. They let people do this and sometimes they couldn't pay the notes of course, and they wound up in the salt mines. That is a really good way to think about what addiction is. You get pleasure out of something upfront and then eventually the cost of that or the note comes due after time. So an addictionologist studies those things studies the effect of substances and behaviors on what people do and how to break those cycles and get them free.

Eva Sheie (02:42):
Are you focused on a specific kind of addiction within that field?

Dr. Giles (02:46):
Yes. So my interest is substance use disorder, the substance habits. We used to call them habits in olden times. We called it a drug habit or a drinking habit, or he has a smoking habit. Now we call it a medical illness. It's the same thing. It's the thing you do repetitively that kind of takes on a mind of its own. Sometimes it's called second nature. So it's a piece of you that you don't seem to be in control of, any more than you control your balance when you walk. And it's because you've learned how to do it. Substances, that's the thing. So most common is alcohol, and next would be opiates. And then probably in terms of damage and severity would be benzodiazepines, the sedatives, the downers. In terms of frequency or how common would be amphetamines next methamphetamine and the prescribed ones like Adderall. And then lastly, but a growing problem is marijuana.

Eva Sheie (03:39):
Do you think people understand that marijuana is a problem yet?

Dr. Giles (03:43):
Some do for sure. Yeah, some do. But most, I think the most important thing is that the marijuana that they maybe tried when they were young is not the same as the marijuana that's out there now. And that has to do with percent concentration of the active ingredient, tetrahydrocannabinol or THC. So in the seventies and eighties, if you found marijuana that had as much as 5% THC by weight, that was a really strong joints, it was Sinsemilla or Maui Wowie or these exotic strains got you really high. And that's 5% through science and chemistry, we now have distilled concentrated THC up to, in some cases crystalline form. So it's a hundred percent THC, but even the liquid vaporizers is 90 or 95% THC to the people who may have tried marijuana back when it was this, get it from a guy, before it came in these fancy dispensaries, which look like high-end luxury retail stores mixed with pharmacies. That stuff, if you smoke a joint of that, the rolled joints are commonly 70% or 80% THC. So you wouldn't have one, it'd be like smoking 15 or 20 joints, which of course nobody would've done back in 1985 when we were kids.

Eva Sheie (05:02):
No.

Dr. Giles (05:02):
So just on concentration, you're dealing with a different drug because of the amount. The same with alcohol. You may have had a couple of beers and got drunk, but you did not have a half a gallon of whiskey all at once. That would be an analogy between what the weed used to be like and what it's like now.

Eva Sheie (05:20):
You would be dead if you drank half a gallon of whiskey.

Dr. Giles (05:23):
You would be dead, you would be dead. And sometimes people do die from the tachycardia or from violence because THC in high concentrations in many people will make them violent. They get into fights that they wind up being killed in, or damaged in, or hurt in or hurt someone else in. So yes, there's a really good book by Darinson called Tell

Eva Sheie (05:43):
Wonderful book.

Dr. Giles (05:44):
Yeah. Do you know that book? Tell Your Children?

Eva Sheie (05:45):
I do.

Dr. Giles (05:46):
And if you want to learn more about how it's dangerous, that's an excellent place to start. But yeah, I think it's a time bomb because states are continuing to legalize marijuana, which is all fine. I mean in recreational amounts and small amounts and so forth. The trouble is, I think of it like a burglar getting into your house. The first thing the burglar would do is turn off the alarm. So the thing that the drugs do is they turn off your good decision not to do anymore. So you go from the plan before the weed, which is okay, I'm just going to have a little bit, to once you're intoxicated, oh, I want more of this feeling. That's how it starts and then it becomes obviously a big problem or can anyway.

Eva Sheie (06:33):
I have about 4,000 questions to ask you. What kind of people do you take care of today on any given workday, what do you do when you go to work?

Dr. Giles (06:43):
I have a telemedicine company and we provide medical care to many treatment centers, most of them in California, but we're in some other states also, and growing. What we do is assess and manage the acute stage of detox from all the substances we mentioned and a bunch of others. We manage the medical care of the patients because they have medical problems sometimes, sometimes directly related to the substance, sometimes related to the withdrawal, sometimes unrelated. Sometimes the diabetes is not caused by the substances, but you get people with diabetes coming in to get sober, also, just to pick one typical one malady. And then we manage them through their acute detox phase and then the early stages of recovery when there's still some lingering aftershocks and medical issues and irritability for the first month or so, month or two. And then we stay with them as long as they're engaged with these facilities that we help, where we provide the medical care, into several months for early stabilization, transition to ideally a lifestyle change, to a new sober life.

Eva Sheie (07:44):
You're like an expert resource for the treatment center to pull in for medical care, kind of at scale because you don't have to physically go there?

Dr. Giles (07:52):
Correct. Yes, exactly. And so we have a team of doctors and mid-level providers and nurses and administrative people that are in constant communication with the treatment centers and they ask us questions. We see the patients just like we're having this interview now, so by telemedicine. That was one of the, like the space program gave us Tang and Kevlar and a bunch of other stuff, the Covid lockdowns gave us telemedicine for behavioral health, and you can't do telemedicine for surgery. There's some split instruments, but you really, for most in-person medical visits, telemedicine doesn't substitute, but it does for follow-ups and it does for triage and screening. And so for behavioral health, something like 60% or more of behavioral health is now delivered by telemedicine. So we're part of that wave. It winds up being better in many ways, because of the intimacy and because of the candor and the privacy and also the cost. It's much less when you don't to be stuck in traffic between facilities going to see patients .

Eva Sheie (08:59):
Quality of life on both sides.

Dr. Giles (09:01):
On both sides, exactly. And also the talent pool. So we're able to recruit the best people in the country because we're not limited to, you've got to live within 50 miles of this treatment center. There are enormous advantages. And that's what we do. We have several hundred patients at any given time that are under our care and we're doing something that people like because we're growing. For me, I've been doing this job for about 20 years. I was in anesthesia and high intensity trauma and cardiac and transplant anesthesia at a university hospital. And I did a fellowship in pain medicine, that's where I got interested in the patients. And then I had my own recovery experience. I got exposed to this world, getting sober myself 25 years ago, for lack of a less cheesy way to say it, fell in love with the field, with the patients, with just the whole world of this spirituality mixed with science. Because there's some piece of this that we just, you know, I'm a scientist, but we can't explain some of why with the same history people go on to get, well. I can't explain why I got, well, I still don't know. But I do know that it's possible and likely if you do certain things, and since I fell in love with it and had my own experience, I've been an exponent of that.

(10:18):
I've been a proselytizer of this sober life and encourage as many people as I can, not just to get well, but to pass it on to others. So I get to take all the science and care and medical care and apply this other dimension. And that's how the company runs. That's the company's full of people with the same disposition, most of whom who've been through some similar experience. Believe me, when the patients figure that out, you have to be careful with disclosure and so forth. But when they figure out that, it's a weird thing, most people don't require that their endocrinologist have diabetes in order to be a good endocrinologist treating diabetes, but there is something about this problem that shoulders go down and the patients are more candid and they relax. I think it has to do with the fact that they know they're not being judged. Even if you're a great doc and you aren't judging someone, they sometimes feel judged or in their minds, they imagine they are. And the story they sometimes tell themselves is, well, this person understands so at least somewhat understands. And when it's your doctor prescribing your detox meds or listening to the story, I think that helps. I think it's, it's not a hundred percent essential, but it sure helps.

Eva Sheie (11:26):
There's lots of parallels you could draw to that. It's like having a trainer who was never fat when you need to lose weight or, maybe lower stakes there, but we could talk about how food is also an addiction.

Dr. Giles (11:41):
Football coach that never played or any of that stuff. Maybe there, and there are some, I mean, there are some who are just brilliant at whatever the thing is, and they really can explain things. But for a shortcut, if you want a shortcut to connecting with patients, have this experience yourself. And that's really a big part of the message, which is so many people think that it's been too long, or they've waited too long, or their lives are ruined or, the best way I've heard it said, their yesterdays have ruined their tomorrows. But that's not true. And once they get on the other side of it, no one's excited usually to tell you about their drinking problem, but once it's behind them, they won't shut up about it. Oh, I used to really have a drinking, and they'll tell you all about it. And so what happens is their relationship to their prior behavior changed. That's what it is. They feel different about their past and imagine that, right? Imagine if you could feel different about your past and let that not only not drag you down, but be a source of connection with other people. So that's why I fell in love with it, because it's magic. It's magic to go from before and after with this experience.

Eva Sheie (12:54):
Is before a story that you tell. Will you tell it to us?

Dr. Giles (13:01):
Sure. My before is, I grew up in an alcoholic home, so I grew up with a father who managed his feelings that way and all of the chaos that came along with that. I remember that I wanted to live a different life, but I wanted to somehow transcend that. And I had the gift of being good at school, so that was a natural fit, and I focused on that. And so as I got better at school, I saw that as a way out. I went from my local school, I went to community college, and then I transferred to Berkeley. So I was on my way there. I studied biochemistry, and then I got into medical school. I loved medical school. I focused on surgery. And then each time I reached a new peak, I got a sense of accomplishment, but also this gnawing abyss of a gulf between, well, there's not many more accomplishments left to get, and we're less than halfway to feeling okay.

(14:01):
I felt like there was something not right or wrong or missing or something defective about me. Which is normal, I learned later that that's normal, that feeling is quite normal. But what's abnormal is thinking I can fix this on my own. That's where the problem came in. So thinking if I studied enough and if I got enough paper on the wall or if I achieved these credentials, then I would feel okay. I would be regarded and I would feel okay. In reality, no one was regarding me badly. I was regarding myself that way. And the process of believing that I could fix it was good, on the one hand because it propelled me through all this academics. But it was bad on the other hand, because it propelled me into drugs. Because when I got to the accomplishment, when I was on the toes on the diving board of beginning a career in anesthesia as a cardiac anesthesiologist, I felt worse than ever. I felt like I was a fraud. I felt like I didn't fit, like I didn't belong, and I thought I need just a little break from those feelings. And so the curiosity and the seeking of relief, I took one ampule, when I used to tell this story 25 years ago, I would have to repeat the substance because people were like, what's that? Well, I've never heard of that before. But now everyone knows fentanyl, and so back then fentanyl. So I was a pioneer in that sense long before it became popular.

Eva Sheie (15:35):
Early adopter.

Dr. Giles (15:36):
Early adopter. Exactly, exactly. And so I thought I was a really clever. I thought because of how much I knew, this is a very short acting drug. I only wanted a little bit of sense of relief. I probably didn't even want the relief. I wanted to feel like I could, if I needed to, break glass in case of emergency, of feeling this fraudulent way, now being responsible for life and death. I tried it one afternoon at home and a very small amount, and I felt like I now had a secret. But the weird thing with that, the terrible thing, is that if you feel like you're separate or weird or different before giving yourself an injection of fentanyl, afterwards, you're sure of it. And so now I had a secret I couldn't share. I couldn't be honest with anybody about that. I didn't feel like I could.

(16:22):
Now, the stakes were way too high. And I wrestled with that for some weeks and then did it again, and then wrestled with it for another couple of weeks after that, and then did it again, and then wrestled with it for another few days and did it again. And each time the interval got shorter, until I couldn't wait for my shift to end. And then one day, feeling terrible, several months into this madness, I got a phone call from the department chair, which you don't usually get at my level, this trainee level. And he said that a bunch of fentanyl's missing from the hospital pharmacy. I never took anything from the patients, I always took it out of the pharmacy, thinking that somehow was okay. It was okay because I was still doing my job, but I was only hurting myself. And he said, a lot of fentanyl's missing from the pharmacy.

(17:12):
If it's all backed by five o'clock, then we're okay. And the only way for it to be backed by five o'clock at that time would've been if I were standing in the pharmacy because I had used it all. And so I said, can I talk to you? He said, I was hoping you would say that. He said, we've been through this before. It's an occupational hazard in the specialty anesthesia, sometimes the guys get wrapped up in this. We've had residents who died. I'm glad you're not dead. You're one of the best residents we've ever had. You're going to get through this. These are all the things he said to me, to Dr. Moore, you're going to get through this. We're going to be here when you do, and you're going to come back and work here, and we'd love to have you on the staff. And that didn't sound like I just said, it sounded like, we got you. We're going to slam the door. You're going to hear the bolt slide shut. You're never coming back here again. What I thought was really going to happen, but he was saying things that sounded pretty good, and I was out of options. And so I called the number that he gave me, and I got involved in a program, which is monitored through the medical board, and I stayed there for more than five years, and I learned about this problem that I've been talking about, and I learned about myself. And then I watched other guys come in, other docs and ladies come in and get well, and I saw the patterns. And I could see that the nature of this illness is one we'd never discussed in school. We didn't learn anything about this. We learned about

Eva Sheie (18:38):
It's still such a big problem that there was a whole program.

Dr. Giles (18:40):
Oh my God.

Eva Sheie (18:42):
An entire infrastructure set up already to help you?

Dr. Giles (18:45):
So in California, there's fascination, it has to do with the end of the Vietnam War, worrying about all the soldiers coming home and soldier wellness. And that was adopted into physician wellness. And so California was the first state to have a physician health program. So they were pioneers in this, hippies and everything's okay, and we'll help everybody, very generous point of view. And so I know the guys who started, it's called the diversion program. Many years later, because of how we feel, we feel both, America feels both ways about substance use, disorder, which is you pour thing, and you terrible bastard. How could you do this to yourself with your lack of willpower? But you're really a victim. And so we think both things at the same time. It's not one or the other, it's both. So in California we had the diversion program, which saved many physicians and their families.

(19:38):
But what you wind up arguing is doctors should go back to work even though they don't have a decade of recovery, because going back to work actually helps them stay sober. Having work, having purpose, being productive actually gives you an organizing framework for your life and reasons to stay sober. So it helps, but there's a public safety issue. So if you have an alcoholic surgeon, he says, he's sober. We're letting him go back to work, but do you want to be this patient of the surgeon? So it's one of these things where you've balancing public safety, in case the doctor relapses or isn't sober, against public benefit, which it's actually better for the state for the doctors to return to practice better economically, better in all senses, except if he drinks and hurt somebody. There are some lawyers who went after the board and they made it so it was impossible for the board to continue defending the program.

(20:35):
And so they sunsetted it in 2008. Tried to change it, it exists in a form now, but not back then. Back then, it was really something special. And I understand the public safety standpoint, but it's a shame because all those doctors are still drinking, but they've gone underground because there's now no safe place for them to do it. So I would love to see that I know how to fix it. I would love to see that get changed back where there was a real program. Fortunately, I went through that program and then everything came true. Everything he said came true. I went back to the hospital, I went back to the OR, I went back to taking care of patients. I went up giving the lectures for many years on the addicted physician, so as exhibit A, and it was a amazing experience to go from riches to rags to riches emotionally in the place where I went to medical school where I grew up.

(21:30):
So it was a real return story. And then I was, and remain, so grateful to the whole process for how that came together, and it serves for me as the ideal. The experience I had, I think is the ideal for how to help somebody and marked at least by longevity. So these programs where you go for 30 days or less and just get dried out, they don't work because this is the heart of addiction. The substances, you could hear in my story, the substances were the solution. They were the solution to how I felt. Okay? So you get rid of the solution, but you still are left with how you feel about yourself. That's what you really actually have to work on. And that takes more than 30 days. It takes a lifetime to get to the point where you're like, you know, fentanyl is a good solution here.

(22:24):
But to come to that way of thinking, you have to have been feeling really bad about yourself for a long time and managing with all these other ways that we discussed. So I think if you can get people involved in a program, get them sober so they begin to think clearly, but then keep them engaged in it, until you go through several cycles around the sun, you go through the birthdays, you go through life and you meet life without resorting to substances, then those people tend to stay sober for a very long time, which luckily has been me.

Eva Sheie (22:57):
You said 30 days is not the way, right?

Dr. Giles (23:01):
Better than nothing.

Eva Sheie (23:02):
Better than nothing.

Dr. Giles (23:03):
Better than nothing.

Eva Sheie (23:04):
A lot of people will do that and fail and go back over and over and over. An example from my own life is a friend who got court ordered to go to rehab and ended up meeting more addicts in rehab and went in the wrong direction because none of them wanted to be there.

Dr. Giles (23:22):
Learned advanced skills.

Eva Sheie (23:24):
Yes.

Dr. Giles (23:25):
Yes, exactly.

Eva Sheie (23:26):
Like going to prison and becoming a worse criminal probably. Without going too deep, explain to someone who doesn't know today what the best practice is for recovering when you're in a situation like this.

Dr. Giles (23:41):
So you can understand that fellow who, or the patients who come, I understand the patients who come, they want to get the least amount of treatment necessary, and then they can get back to their lives. There's two reasons for that. One is they don't understand the depth of the problem. They don't understand that problem is the roots are much, much deeper than just, okay, you should try to cut back, try not to drink so much. The days of just cutting back, by the time the patients get to, until they're in our care, the days of just cut back are long gone. So the fun, fun with problems, just problems stage, they're in the late fun with problems, if not just outright problems. So for most people, the idea of returning to the stage of controlled drinking is foolish. Now, you can try it and maybe it works, but my observation is it hardly ever does. So you're looking for a durable solution where you're not, you don't have to drink anymore. That's really maybe a good definition of addiction is where you have to do it. You're not in control of your own.

Eva Sheie (24:45):
I don't have to.

Dr. Giles (24:46):
Yeah. Yeah. So staying engaged in the process of self-discovery until the miracle happens, until you can see clearly the nature of yourself, the nature of your story, and I think a big piece of it is until your life looks at least somewhat like you want it to, so you have something to defend. Part of why it's so hard to get sober in your twenties for most people is they haven't accumulated something worth defending. They're bopping from job to job maybe, or still on parental support, or they don't have a sense of purpose yet. They don't have things bigger than them, more important than them that are more compelling than immediate temporary relief to achieve durable sobriety. I do think having a break from the routine, that's where residential treatment or substance abuse treatment helps. Because if you're still around hanging out with your homeboys and they're all into the same routine, there's a blob momentum of the people that you're hanging out with. They need to break that cycle. And that's where going to treatment can be very, very valuable. But for the most part, we try to sell treatment as the on-ramp into recovery, and by and large people reject it. If you look at the number of millions of people with a substance use disorder, in some form, it's at least 50 million. It may be as many as 70 million people.

Eva Sheie (26:17):
It's all around us.

Dr. Giles (26:18):
It's all around us. And I'm not counting food. I'm just talking about misuse of substances. If you add food, it's probably three quarters of the country has some kind of problem with this. The number of people who get treatment per year is just over 2 million. So you've got at least 50 million people with a, you should go get help now problem. And so 2 million out of 50 million, so 4% less than 5% of people with a, your hair is on fire, you are dying from substance use disorder. It's destroying your life. Only one in 20 says, yeah, okay, I'll go to treatment. So what that says is we don't have what they want. We're not selling something that people can fit into their lives, recognize the gravity of the problem, something that's easy for them to incorporate. It's like go away to rehab for 30 days. Most people can't do that. Most people can't drop out of their lives for 30 days. So you're like, okay, try and get through one more day with a little bit of whatever you're doing. Try to cut back, try to, man, I can stop for a little while, but that's most people versus go away for 30 days. No more drinking. Your friends know you can't drink anymore. You're going to have these scary feelings that you're not sure how to deal with them anymore.

Eva Sheie (27:35):
Oh, my life is going to be so boring.

Dr. Giles (27:37):
Bingo, I'm going to be bored. I'm not going to have any fun anymore. I'll tell you a funny story. When I was at this stage contemplating, it's not just fentanyl, you got to give up everything, right? You should. And I was thinking about it. I thought, well, okay, I'll go through this, t,his is when I was bargaining the bargaining stage like Kubler Ross talks about. So okay, I'll go through this process, then I'll go back to being a doctor, but someday at my daughter's wedding, I'm definitely going to toast. Right, it's the father's honor and responsibility to toast with a glass of champagne at his daughter's wedding. So this is what I carried in my mind. I thought, well, okay, I'm going to be sober, but when she gets married, then I'm going to walk her down the aisle. And then at the party afterwards, we're going

Eva Sheie (28:21):
Does she even have a boyfriend? And you're already imagining this glass?

Dr. Giles (28:24):
This is 1999. I had no wife, no daughter.

Eva Sheie (28:29):
You didn't even have a wife.

Dr. Giles (28:32):
So fantasy land on when someday it's going to be okay to have a drink. That's alcoholism, right?

Eva Sheie (28:39):
Yeah.

Dr. Giles (28:40):
Because, you're dealing with, well, what if the missiles are coming over the horizon with the nuclear warheads? What about then? And if you're going to stay sober, the answer has to be you don't drink even then because maybe it's a false alarm. And if it's not, why would you want to be drunk for the end? You want to be there fully present with your family, present with whoever's around you. So anyhow, it's, it's a different way of thinking. And this kind of getting by one more day, make it through way of thinking instead of planning for the future, building something solid that you can enjoy and live in for the rest of your life. There are different ways of thinking. And so what I learned is the only thing actually wrong with me is that I thought there was something wrong with me. I was just mistaken, that's all. And what unraveled that sweater is I was mistaken about drinking. So I was mistaken about substances. Actually, maybe I don't need anything to be okay. Maybe I was wrong. I used to think if I don't have something I can't go on, how am I going to make it in this world with all these people and all this scary stuff? And if I don't have something. Well, I don't need that. I do need something, but not that.

Eva Sheie (30:02):
What is it that you need?

Dr. Giles (30:04):
Purpose. Purpose, yeah.

Eva Sheie (30:07):
Yeah. Back to purpose, anecdote for you is when I was in my twenties, I had a boyfriend who he would drink as much as there was in the house. So I got to the point where I would either, I would buy a six pack and he'd drink the whole thing or buy a case, and he drank the whole thing. There was no, if I get a case, it'll last a week. It wouldn't. One day I asked him to just go one day without drinking. And you know what he did? He waited until midnight and then he opened a beer.

Dr. Giles (30:34):
12:01. Yeah,

Eva Sheie (30:35):
He sure did. I remember that moment being like, this is never going to work. I am done. And I also thought, I believed for many years he would never, ever get sober. He was a completely lost cause. And you know what got him sober? He had kids with somebody else, and they didn't stay together, but he's still sober.

Dr. Giles (30:59):
That's the educational variety of religious experience. So you, William James, so you study yourself, you study your life in context with the challenges and the ups and downs, and you figure out, oh, I'm actually the source of my own pain. When you get that, and then you don't have to keep doing that anymore, right? It's like Viktor Frankl says, ultimately you have a choice. Even if you're in a concentration camp and they've killed your family, you have a choice how you react to that. You have a choice about what your response is. And so yeah, I'm different, I've got some strengths, and that's interesting a little bit. But what's way more interesting is the way, I'm just like everybody else, which is in the weaknesses, which is in the self-doubt, which is in the not good enough, which is in trying to gain validation and acceptance from other people.

(31:59):
Everyone's doing that. I mean, look at the explosion of social media. That's like a Petri dish of, please like me, please like me. Everyone is susceptible to the same things until you start to notice, wait a minute, why do I need this? Why do I need to feel accepted by strangers? Was I made alcohol deficient, right? Was I born into the world missing a few hits of meth? And that's the only way I can get by is if this substance comes into me. You know, you might be mistaken in your outlook. You might not be looking at it exactly right. That's where community helps. So you talk to somebody else and that maybe why it's easier to talk to a provider or somebody who's been through it, or even a priest, alcoholic clergy or pastor or rabbi, who's been through it. There's this human level connection.

(32:50):
So where I invest has nothing to do, as I said with the paper on the wall. It's got nothing to do with the board certifications or any of that. It's the trying to connect with a person in the same place that you were connected to, right? It's the same feelings. That's what matters. It's the way you see yourself that matters. And if you wonder how people are seeing themselves, think about how you see yourself. That's how they're seeing themselves. They're seeing themselves as the center of their universe, as the star in their movie. That's what we all do, we think it's happening to us, right? It's happening to us, but it's not just happening to us. It's happening to everybody.

Eva Sheie (33:31):
We explore a lot of food issues on another one of my podcasts, and one of the recurring themes is these horrible, really, truly horrible things that we said to ourselves in our own minds for decades.

Dr. Giles (33:43):
Like what?

Eva Sheie (33:44):
I used to walk past the mirror and say, well, you're looking rather hulking today.

Dr. Giles (33:52):
Oh, that's not good.

Eva Sheie (33:53):
And I never admitted that I said that to myself until I didn't say it anymore. We all transition to my next very big question with this is, food addiction and substance addiction, they are really similar thought patterns, I think. The GLP ones are the thing that saved my life. And I probably have added, I don't know, you can't count how many, you can't predict, I could die tomorrow, but how many years of my life did I get back? And how much happiness did I get back because the GLP ones changed the way that I thought about food, and then I lost weight. It was the mental change that brought the joy back to my life and stopped me from saying things like, well, you're looking really hulking today. How are the GLP ones helping on your side of the fence with substance abuse? Are you seeing that?

Dr. Giles (34:47):
Yes, we're starting to get this from a trickle to a flow of papers about the GLP ones as psychiatric medicines. And this concept you're talking about, which is in the substance field, it's about cravings, that's the marker that they focus on. And craving is just a thought. Just a thought. It's a thought, a thought for wanting something that you think is going to fix the way you feel and make you feel better. And you can crave the end of the song that you heard a piece of it and it's stuck in your mind and you crave to hear the rest of the song. And you can crave Sara Lee Poundcake, and you can crave roast chicken or you can crave fentanyl or actions. So you can crave going to the racetrack because that's where the

Eva Sheie (35:38):
Shopping.

Dr. Giles (35:38):
Yeah, shopping, where some people play slot machines and it's the sounds and it's the smells, and it's the other people, and it's the feel, and it's the rumble of the wheels as they turn. And all those little visceral reinforcers, which make us feel like we're safe and novel. So something, we're not in danger, and there's something new. Those sentiments are literally the reason our species is so successful. We're the best at tuning into those things. So that's why we form societies, because we're safe in groups, and that's why we explore, because we're looking for something novel. So if you have the same thing over and over and over and over and over, that's depression. If you have only novel, that's anxiety because it's all scary and terrifying and overwhelming. So it, it's the balance of safe exploration that is the stickiest thing. That's why we're all over the planet. That's why we're so successful. So food is molecules that get into your thoughts, and your thoughts are just molecules also. Now, spiritual dimension and all that stuff. But when the nerves send a message across the synapse, it's a chemical.

(36:53):
It might be serotonin, it might be norepinephrine, it might be gam aminobutyric acid or gaba, it might be glutamate, but they send messengers across electrical signals, carry down the wire, and then there's a little packet that's sent across the synapse. And food works on those levers also. It makes different molecules come out. It gets in between its molecules itself. The substances are the molecules that get in between, opiates activate those pathways, amphetamines activate those pathways. All of our drugs, like SSRIs and so forth, they're all tinkering with those pathways and GLP ones, those peptides and whole family of peptides. We use peptides as one of the most ancient forms of communication between distant spots in our body and steroids and other hormones. So some of them are, I mean, melatonin is a peptide. That's the time to wake up peptide, right? You slept long enough. So I don't think it should come as any surprise that when we take in a peptide, it changes the way we think. Now, fortunately, we found some peptides that changed the way you think about safety and novelty. And that's what the GLPs are doing now. They have other effects. Most people don't know this, but when you're hungry, when you have the feeling of hunger, where do you think hunger is? She said, Hey, when you're hungry, where are you hungry? Where in your body is hunger? Stomach.

Eva Sheie (38:13):
Stomach, yeah.

Dr. Giles (38:14):
My stomach is empty, I'm hungry. That's not where it is at all. The stomach doesn't sense hunger. The brain stem senses hunger. And it has to do with the combination of factors. It has to do with some of the hormones that are released in the stomach, ghrelin and so forth, and leptin. But also it has to do with the vagal tone between the stomach and how long it's been active. It has empty sensors or full sensors, but where hunger, the concept of, I'm hungry, is in the brainstem, which means it's very old. And that makes sense because you want organisms to be able to eat. You have to wait till you're evolved as a human being to get some food. It has to be an old ancient signal. But your mind maps the sense of hunger back to your stomach. Because we see ourselves as these three dimensional entities where embodied consciousness, so GLP ones, they affect the way you feel because they affect your thoughts.

(39:08):
And so that makes perfect sense what you said. And we see this in substance use disorder also. So there's some big trials, the results of which are starting to come in that show that people drink less when they're on Wegovy or Ozempic. And then the newer ones that Tirzepatide and so forth, the newer ones are probably even better at that cuz they work at multiple targets. So yes, you are doing that. The bigger question is, is that okay for the long term? Now, any of these things have side effects. And so some of them are figuring out, if you're obese, which is a pretty low definition, so over BMI 25, for the average size person, you're going to live six to 10 years shorter than somebody who isn't. And if you're morbidly obese, 40% over IBW, your life expectancy is probably 25 to 35 years shorter, because it's really bad to be really heavy.

(40:04):
The people who passed away in Covid, most of them are obese or morbidly obese, almost 90%. You don't have the reserves. It has its own problems. It causes cancer. Cause all sorts of things from being overweight. And my pitch to people about being sober is not about the living longer. It's living better. So, okay, it doesn't make my own, I guess I die six years earlier or later. I don't know, whatever. That seems like something. So it's almost meaningless, right? I mean, in an abstract sense, we all want to live longer, but more important is the quality of life. Now, let me ask you a question.

Eva Sheie (40:40):
Okay.

Dr. Giles (40:40):
Got on the GLP one inhibitor changed the way, if I heard you right, changed the way you felt about food, and then because you felt differently about it, your eating habits changed, and then weight came off, I presume, right?

Eva Sheie (40:52):
92 pounds.

Dr. Giles (40:54):
That's huge. That's like most of you. You lost a whole other person.

Eva Sheie (40:58):
Both of my children less, I mean, they weigh less than

Dr. Giles (41:03):
Yes.

Eva Sheie (41:03):
Combined than I lost.

Dr. Giles (41:04):
Yes. So how do you feel about food now?

Eva Sheie (41:08):
Indifferent.

Dr. Giles (41:10):
Could you imagine going back to it being the focus of your life?

Eva Sheie (41:14):
I am terrified of it.

Dr. Giles (41:17):
You're terrified of that happening?

Eva Sheie (41:19):
Yeah.

Dr. Giles (41:20):
Why?

Eva Sheie (41:20):
Because, well, the medications on, it's very hard to get.

Dr. Giles (41:26):
Getting hard to find.

Eva Sheie (41:27):
Yeah. Or cause prohibitive. It's really a scarcity issue that's scaring me.

Dr. Giles (41:33):
Gotcha. Because it's expensive and hard to find and/or hard to find.

Eva Sheie (41:36):
Right now it's affordable. But if they remove compounding, which they have, it's been going on and off shortage for a couple months now. If it goes away, then what am I going to do?

Dr. Giles (41:48):
So deeper question. Tell me to buzz off. You don't want to answer this question.

Eva Sheie (41:51):
No, it's fine.

Dr. Giles (41:52):
But deeper question is let's say it's gone. This is a Flowers for Algeron kind of a situation. So you get this, magic medicine, changes the way you feel about the food, eat differently, lose a ton of weight. And then let's say in this novel, we're writing, for some reason compounding forces it be, who knows, whatever the medicine is in a parallel universe, no longer available. But you have had this experience of feeling differently about food. You don't walk by the mirror and tell yourself those things anymore, you're changed is my point. You're different. You've had this, you've had life. Do you think that your feeling about food, I know you're afraid that this isn't true, but do you think your feeling about food might persist? Indifference or a source of nutrition?

Eva Sheie (42:44):
No. I actually don't think that it's in my control without the medication.

Dr. Giles (42:48):
Gotcha, gotcha. Well, that's okay. I mean that concept, back to substance use disorder is, I was just talking with one of our providers, is what we call medication assisted treatment. So you didn't just use a GLP one inhibitor. You didn't just do that. You did a bunch of other things. You changed your diet, you changed your self concept. You're talking about it, you're saying things that you never said before, maybe today for the first time on your show. And so I submit to you that you have momentum to be a different person. Now, do you need to stay on the stuff the rest of your life? Maybe, maybe not. It becomes a risk reward thing. Is it worth the risk of going off of it? To go back to what that was? Is there a way to safely do that and see if the change is stuck? These are all questions we don't know. In my field, it comes up with a drug called Suboxone. So people are on opiates. We use suboxone to detox them, but then also it keeps the cravings away. It's a magic medicine as if there ever was one, in terms of that stuff. Then the question is how long should you stay on Suboxone? Let me ask you this, were you heavy your whole life?

Eva Sheie (44:00):
Oh yeah.

Dr. Giles (44:01):
From when you were a little girl?

Eva Sheie (44:02):
I mean, we talk about this stuff on my other podcast every week. I started dieting at 10, which means my mom started worrying about it before that.

Dr. Giles (44:17):
So there's some biology. And so I have patients who have been on or know people also who've been on suboxone for decades, for 20 years. And the ones that I know who are like that are the highest function people you'd want to meet, you would never guess. You would never guess. And they've tried many times to taper off and just to stop it, and they feel bad and they get worse, and many times relapse, unfortunately, not relapse fatally. And so for that group, it's a no-brainer. You just would stop messing with it and say, look, just take this and this is fine, and it's not expensive and it's going to, your life before and after, it's a very dramatic start contrast. There are other people who won't take it at all. They have to go through it natural, and they've got to tough it out. And they have mindset about.

Eva Sheie (45:01):
Oh yeah. They're the same ones who have babies without epidurals.

Dr. Giles (45:04):
They have babies without epidurals. They have, I guess, dental work without lidocaine. I'm not sure what they do. Yeah, they walk on the coals, these people. But that's fine. And that's part of their journey. It's a smaller percentage, but they'll do it. And then most of the people in the middle use it like a cast for a broken ankle. So they'll have it for some months or even years, usually on a tapering dose until their life is together. And so that's one of the deep questions is for some of these people, an opiate use disorder or history of it, the way they feel on whatever it is, Percocet or heroin or fentanyl, is so they feel like they're finally okay, like it's a missing piece. Those people probably are opiate deficient or they have become opiate deficient through whatever their process was or their use. Being heavy resets, your GLP one set point. That's why it becomes futile to try and lose weight. It gets harder and harder the heavier you get because it's like, I'm not eating anything. You're body gets really efficient at conserving calories.

Eva Sheie (46:05):
Eating nothing and starving all day.

Dr. Giles (46:07):
And starving all day.

Eva Sheie (46:08):
It becomes,

Dr. Giles (46:09):
All you're thinking about is food.

Eva Sheie (46:10):
All consuming. Yes.

Dr. Giles (46:11):
Yes.

(46:12):
So we have a lot to learn. So this is a new frontier and there's new peptides coming out. There's all kinds of new stuff coming out. Will they come up with one for addiction? Maybe your next question, maybe. I hope that happens.

Eva Sheie (46:27):
I hope so.

Dr. Giles (46:28):
I hope that happens. I don't think so because of the nature of how the mind organizes information and why we become addicted in the first place. I think it's part of the system. Same way depression is, right? Depression causes us to slow down, rethink, retrace our steps, ruminate, go over it again. Now that can be taken to a catatonic extreme if you're paralyzed with your thoughts and you can't get out. Most depression is self-limiting. And we learn something about the mistakes we made, it's usually precipitated by some mistakes. And it's not like I'm doing great and then all of a sudden I feel bad. That's usually, that's bipolar, but not usually. So I think it's a fascinating world. Last year I went to several different talks even by different people. One by an endocrinologist, obviously GLP ones, really hot topic there, one given by a psychiatrist and they're using it for psychiatric illness.

(47:26):
For other things, it might be helpful with schizophrenia, it be helpful with bipolar, might be helpful with depression. So how does that work? And then an anesthesia talk because it paralyzes the stomach. And so if, this is a public safety warning, if you're going to have elective surgery, you should be off of this stuff for a month beforehand because it takes that long to get out of your system and for your stomach to wake back up. And so the reason that's important is you don't want a full stomach when you go to sleep. You can throw up and get sick in your lungs. So it's a frontier. It's very super cool. I've talked to a lot of people who, for whom it has been life-changing, but I have also talking to people who spoken to people who went too far with it and had changed their physical appearance. I know a guy who had plastic surgery as a result of the excess skin that was left over and there were major complications from the plastic surgery. Not saying that that's worse than the weight, but there are trade-offs for sure.

Eva Sheie (48:25):
It opens up all kinds of other things.

Dr. Giles (48:28):
Great question.

Eva Sheie (48:29):
Sharon Osborne was in the news a lot for staying on it too long and getting too thin. She didn't even look like herself. I mean, we sort of follow all the celebrity weight loss news. I just pay attention because it's interesting.

Dr. Giles (48:45):
I think it's fascinating and I think people do copy what they see on, if you look at the Ozempic use, it was sort of smoldering along for four or five years and then it just skyrocketed because once it's going up and then everybody's on it and then it becomes a thing. And then the compounding. And I think the covid times facilitated that also because of demand and because it was listed as an unavailable medicine, it was taken off patent control. And the government of Denmark, and there's just so many interesting implications. The 10 Ks from last year from the sin companies, so Krispy Kreme and Doritos and PepsiCo, the guilty pleasures, those things, Ozempic and the peptide drugs have affected their revenues.

Eva Sheie (49:36):
Yeah, I think Walmart spotted it in their sales first and reported on it.

Dr. Giles (49:40):
Did they? Yeah,

Eva Sheie (49:40):
Yeah,

Dr. Giles (49:41):
Yeah. They have the best data. Walmart has the best sales data.

Eva Sheie (49:44):
I'm sure they do.

Dr. Giles (49:45):
Better than Amazon even. They're the kings of data. But yeah, no, I think it's an interesting time. But there are many other medicines in that arena that might be helpful for other things too. Just saw new pain medicine come out, a new non-narcotic acute pain drug was released last week. And so there's huge changes in pharma. I think we're about to get a new HHS secretary. There's been a lot of, I'm one of the people who thinks, and it's not that much out on a line that there's been regulatory capture of FDA and a bunch of other, the other agencies. And so weirdly, it's stymied drug development because it just makes sense if you're the big gorilla, if you're the big drug manufacturing company, you don't want anybody else coming up with new products because that's more competition. So there's a lot of promising things that are killed in their cribs, so to speak, and we never hear about them. Or they pick the other study that shows maybe this is iffy instead of the one that shows it's great.

Eva Sheie (50:43):
Because they're trying to get a winner. They're trying to get something to be both on the schedule and a worldwide sensation that literally everyone on earth has to take. Sort of like what's happened to movies. They won't make a movie if they're not a hundred percent sure that everyone's going to go watch it. And there's nothing left. There's no creativity, there's nothing.

Dr. Giles (51:07):
And yet here we are on what's basically new media, right? This is long form journalism, unedited straight from the source. I think this guy is full of nonsense and he isn't making, I don't want to listen to him or Wow, this totally, I've thought this, this is great, or anything in between. And you don't need 75 million ticket buyers to make something a hit. You can have a few hundred people or a few thousand people or a few million people, if you've got really a message that resonates and make a huge difference and connect and change things with a microphone and a video connection. You don't

Eva Sheie (51:43):
In my laundry room.

Dr. Giles (51:44):
In your laundry room, in my office. You don't need to make a giant production out of it to tell the truth and to connect with people.

Eva Sheie (51:52):
We've gone through a lot of really interesting things today. I don't want to keep you any longer.

Dr. Giles (51:56):
We covered territory. Yeah. Well obviously this mountain has no top because no, it doesn't. You're dealing with human nature and we are looking at it through this particular lens of addiction or eating disorders or whatever, but you're dealing with human beings. Part of why it's so fascinating is there's always a new story. There's always a new wrinkle. There's always something you haven't thought of that that could be a possibility. So it's endlessly interesting. And I feel new and I'm learning all the time from my patients, from the field, from developments. This is not stale. So if there's anyone in medical school thinking about it, addiction medicine is an awesome specialty. You can go all over the place. And what you leave behind in terms of if you're able to connect with somebody and help them is a changed person who then goes on to change other people.

Eva Sheie (52:49):
That's purpose.

Dr. Giles (52:50):
That's purpose.

Eva Sheie (52:51):
Yeah. What do you like to do for fun? Give us one more thing about you before we go.

Dr. Giles (52:56):
Well, I dunno if it's fun, it's not fun. One thing I like to do that's not fun, but I like how I feel, which is exercise. So that's satisfying. And one of my favorite ways to do that is to go hiking. So outside dealing with the elements in nature, ideally with a family member or friend, getting to the top of something or getting through some bouldering or getting through something like that. Just being out in the outside, that's the best.

Eva Sheie (53:23):
Best hike you've ever done.

Dr. Giles (53:25):
There's a piece of the Southern Sierra in California that is magnificent. It's mostly inaccessible except certain times of year. It's either too hot or frozen over. So you have to go in the fall and the best time to go is when there's a full moon and there's all kinds of everything out there. So fishing in mountain lakes, and wolves, and coyotes, and all kinds of stuff, and sequoias, and some technical climbs. There's some sandstone stuff to get over and some high peaks in the 12,000 foot range. So that's the best hike. I was out there with my pal Harry for most of a week, and that's the best hike.

Eva Sheie (54:07):
If we're interested in following you anywhere online or reaching out, I don't know if you do that, but.

Dr. Giles (54:13):
I'm just starting to. So be gentle, be gentle with me as you reach out. But I'm Dr. Jason Giles everywhere, so DR Jason Giles on X or Instagram or any of that stuff, you can find me.

Eva Sheie (54:28):
I will make sure we put it all in the show notes so it's easy to locate. And I'm so grateful for your time today and for hearing your story. Thank you so much.

Dr. Giles (54:36):
Back at you. Thanks for your candid sharing. That was awesome. Thank you for doing this.

Eva Sheie (54:44):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at MeettheDoctorPodcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, theaxis.io.