EP048: An Interview with Dr. Marshall Runge
An Interview with Dr. Marshall Runge: Real Talk on GLP-1s, Heart Health, and Hope
“It’s never too late. Even after decades with diabetes, the steps you take now still help.”
In this episode of The Diabetes Podcast, we sit down with Dr. Marshall Runge, CEO of Michigan Medicine, Dean of the University of Michigan Medical School, and author of The Great Healthcare Disruption and Coded to Kill. Dr. Marshall Runge shares his own weight journey, two hip replacements, and how GLP-1 therapy helped him find steady progress. We unpack how GLP-1 and GIP medications work, what the evidence says for A1C and heart risk, why compounded versions are not the same as FDA‑approved drugs, and how policy, food environments, and pharmacy benefit managers shape our health. This conversation is honest, practical, and full of hope.
Who is Dr. Marshall Runge?
CEO, Michigan Medicine
Cardiologist, scientist, and health leader
Author of The Great Healthcare Disruption and Coded to Kill
Dr. Runge’s Personal Story: Struggle, Science, and Steady Wins
He battled weight swings starting in his late 20s as activity dropped and metabolism slowed.
Tried Weight Watchers and Optifast. They helped short term, but weight returned.
Had both hips replaced in the last few years. He believes higher weight and weight swings made hips worse and slowed recovery.
With a University of Michigan weight management specialist, he started a GLP‑1 and lost over 40 pounds in about eight months.
The biggest change: stability. He kept the weight off for nearly a year with far fewer swings.
He’s aiming for a BMI of 25 and feels renewed motivation.
How GLP‑1 and GIP Medicines Work
They lower appetite and slow stomach emptying (delayed gastric emptying).
They also act on brain reward and self‑control pathways linked to addiction.
People on these medicines often report less interest in alcohol, smoking, and other reward‑seeking behaviors.
The class started as diabetes drugs. Weight loss was first noticed during trials.
Examples: Wegovy (semaglutide), Zepbound (tirzepatide, a GLP‑1 + GIP).
Why Compounded GLP‑1s Are Not the Same
Compounding pharmacies operate outside FDA approval and routine FDA oversight.
Original purpose: adjust approved medicines to special doses (for kids, sensitive adults).
With GLP‑1s, they cannot copy patented drugs. They make “similar” versions.
Quality, purity, and dose are not FDA‑verified. Side effects and safety are unknown.
Lower price is tempting, but risk is real. FDA‑approved options have tested dosing, safety, and outcomes. Compounded versions do not.
GLP‑1s, A1C, and Heart Health
GLP‑1s reduce A1C strongly—more than most other single agents, and they add benefit on top of metformin and even insulin.
In people on good standard care (statins for LDL, blood pressure medications), adding a GLP‑1 further lowers:
Heart attacks and strokes
Heart‑related hospital stays
Cardiovascular death
Tirzepatide (GLP‑1 + GIP) may be a bit more GI‑tolerable for some people.
New options coming:
Oral semaglutide for weight (pill form), expanding beyond injectors.
Additional oral incretins under FDA review.
Research into combos that may reduce muscle loss during weight loss.
Muscle Matters: Protect Your Lean Mass
Weight loss can reduce muscle as well as fat.
Counter it with resistance or weight‑bearing exercise at least 2 days per week.
Aim to meet protein needs to support muscle.
Physical therapy helped Dr. Runge regain strength after hip replacements. He now jogs again thanks to building quads and hamstrings.
What High A1C Really Does Over Time
A1C is a long-term marker tied to risk.
High A1C increases risk of:
Eye disease and blindness (retinopathy)
Kidney failure and dialysis
Heart attack and stroke
Fatty liver disease that can progress to cirrhosis
Lowering A1C improves outcomes across organs: eyes, heart, brain, liver, kidneys.
Prevention Works at Every Age
It is never too late to improve. Even after decades with diabetes, steps you take now help.
Find a primary care provider you trust. A strong, honest relationship changes care.
Small, steady actions add up: more movement, better sleep, stress support, and medication adherence.
Bigger Picture: Policy, Food, and Costs
The U.S. ranks poorly in life expectancy and healthy life expectancy compared to peers, despite the highest per‑person healthcare spend.
Drivers include:
Food environment engineered for overconsumption (bliss point of salt + sugar)
Highly processed, low‑nutrition foods priced cheaper than healthier options
Complex, non‑transparent drug pricing and PBMs (pharmacy benefit managers)
Ideas discussed:
Start prevention early in schools—kids influence parents.
Make healthy food easier and cheaper; consider taxing ultra‑processed foods and using revenue to discount healthier foods (like Singapore).
Increase transparency and reduce waste in the drug supply chain; explore cost‑plus models and government purchasing power.
Ensure a baseline “medical home” so everyone has access to primary care.
Simple Steps You Can Start This Week
Move a little more:
Add five extra minutes of activity a day. Build toward 150 minutes per week.
You don’t need 10,000 steps. Just get your heart rate up in a safe, steady way.
Strength matters:
Do resistance training two days a week if you’re on or considering a GLP‑1.
Prioritize protein to support muscle.
Book care:
If you don’t have a primary care provider, schedule an appointment and bring your real questions.
Plan ahead:
Complete a living will/advance directive so your wishes are known.
Common Questions We Covered
Are compounded GLP‑1s safe? They are not FDA‑approved, not identical to branded drugs, and may carry unknown risks. Talk with your clinician about approved options.
Is insulin “best” for A1C? Insulin is powerful and essential for many people. GLP‑1s reduce A1C strongly on their own and add further benefit on top of insulin and metformin, plus they reduce heart events.
Do GLP‑1s cause reflux or nausea? GI side effects are common early. Slow dose titration can help. Eating smaller meals and avoiding late overeating helps too.
What about muscle loss? Pair medication with resistance training and adequate protein.
Why We’re Hopeful
Today’s care is better than it was even 10–20 years ago.
GLP‑1 and GIP therapies improve both diabetes control and heart outcomes.
Prevention helps at every age. You can feel better, move better, and reduce risk starting now.
The U.S. excels at complex, coordinated care. More innovation is coming.
Resources and Where to Find Dr. Runge
Books by Dr. Marshall Runge:
Available wherever books are sold, including Kindle versions.
He speaks to community groups at no cost. Check his website for details.
Episode Takeaways (Quick Recap)
Obesity is a chronic, recurrent disease. Treat it with compassion and science.
GLP‑1/GIP meds work on appetite and reward pathways, lower A1C, and reduce heart events.
Compounded GLP‑1s are not the same as FDA‑approved drugs—quality and safety are unknown.
Protect muscle: add resistance training and protein.
Prevention works at any age. Find a primary care provider you trust.
Start small this week: move more, lift a little, ask for help, and make a living will.
If you enjoyed this conversation with Dr. Marshall Runge, please like and leave a review. It helps others find the show. For questions or support, reach us at [email protected].
You can do this. We can help.
Disclaimer
The information in this blog post and podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.
Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.
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