← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
129. Ashley Koff: The GLP-1 Conversation Most People Are Missing
01:01:48
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- [00:03]
A
Welcome to xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Today's episode is a deep dive into one of the most misunderstood topics in modern health. GLP1 medications, metabolic healing and what it really takes to to build a healthy body, not just weight loss. We're joined by Ashley Koff, who's a registered dietitian. She's a founder of the Better Nutrition Program and a leading voice in personalized sustainable nutrition. She's been recognized as one of CNN's top 100 healthmakers, named Hollywood's leading dietitian and her upcoming book, you, Best Shot is already generating major buzz around GLP1s. Ashley's gonna break down what GLP1s actually are, why they work, how to use them safely, and why the real problem is in the medication. It's the lack of support, education and long term systems around it. We also talk about detoxification, vagus nerve regulation, the dangers of oversimplified nutritional advice, and how to personalize protein, fiber and supplements for real metabolic change. If you want clarity, compassion and science backed truth around GLP1s and weight health, this episode is a must. Listen. Ashley, thanks so much for joining me today to talk about your book and everything that you've learned over the past few decades. It's incredible to have you.
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B
Thank you so much for having me. This is really fun. Yes.
- [02:13]
A
So you've been a huge friend of Next Health and you've supported so many of our patients in their weight loss journey. And what I love about how you speak about weight loss is you really take a zoomed out approach because weight has so many different factors that affect it from stress to, you know, the hormones we're going to talk about to activity. There's so much to it and I think that we're living in an age right now where GLP1S is like 99% of the conversation.
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B
Right.
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A
And rightfully so. They have a major effect. But there's a lot about them that if you're not doing them right, if you don't have the full picture, you're really not gonna benefit or you might even have problems. Right?
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B
Yeah. You know, for me, I think it really goes back to my roots, and that's even before my roots as a practitioner. So as a kid, probably, you know, about age 8, I started to be keenly aware of my belly as an issue. And having a belly, I was always talked about as healthy. So I'd go into the doctor, and the doctor's like, you're healthy. With the exception of the fact that literally every month I was on antibiotics. But, you know, they didn't see that as an unhealthy. It was just, oh, ear infection, throat infection. But I had this belly, and it was always a weight issue. So my whole upbringing and through to my early 20s was weight was over here and health was over here. You know, I grew up the daughter of a physician, of a surgeon, and, you know, it was always like, doctors handle health, and then your weight is this thing that, like, you have to manage. Right. So I think when I see our patients and when we look at, you know, the approach for me was really about understanding that it's weight health. It's not weight over here and health over here. And all of those. If we use your, you know, we look at all those different pillars and we look at the circle, you know, and on that, you know, all of those different things are going to affect your weight health. And what's really interesting, and it was 2004 for me when I saw a bariatric patient, because prior to that, I'd been working with people on their digestion. And then I started helping bariatric patients with their digestion. And all of a sudden, I saw right after surgery, like, immediately, and you saw this, that their diabetes was gone. The way that they thought about food, their hunger, their appetite was better regulated. And the doctor kind of said to me in passing, oh, yes, it alters their incretin hormones. And I was like, incretin hormones? And I was a total geek in school, and I'm like, I've never heard of those. So GLP1 GIP are incretin hormones. And we know today that they are so much more than just blood sugar regulators. And there's PYY and there's CCK and there's amylin, and there's so much more than Even appetite regulators, they're regulators of inflammation. They, you know, their receptor sites in the lining of the, in the endothelial tissue and the lining of the blood vessels on the heart muscle. They're affecting liver health. So they're really like regulators of what I call a weight health ecosystem that's in our body. And I love that you said if you're not doing this the right way, they're a bad tool. Or that's what I'm going to summarize. You know, they're a bad tool, but if you're doing it the right way, these can be an amazing tool to correct where so many things haven't worked for so many of us.
- [05:04]
A
And so. True. Let's go back to that bariatric surgery because I think it's super important. So I'm a surgeon, I did bariatric surgery for a long time. And the thing that was very surprising that you mentioned is we thought that the effect of the bariatric surgery would happen in a few months after they lost the weight. But the reality was the effect happened immediately. And the effect on the metabolism happened immediately. The effect on their hunger happened immediately. Right. And that didn't make sense. There was a disconnect there. Like it wasn't the weight causing the metabolic problem. It was, wasn't the weight causing all the things that we are trying to, we call comorbidities of being overweight. It was something else and it's the incretin hormones. Now incretin is a category of hormones, right. Of which GLP1 is one of them. You mentioned CCK P Y Y and these are all the ones that we have names for.
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B
Right.
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A
There's many others. Right. Some of them, we don't even know what they are yet. Right. So there's an ecosystem of these hormones. Right. And, and just to emphasize another fact that you said and stated another way is that these are hormones, these are not drugs, these are not chemicals that we put into our body. These are signals that our body's naturally making.
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B
I love that you're bringing that up. So let's bring everybody up to a physiology conversation. So one of the things I'm the most excited about with these medications is and they'll win all sorts of prizes out there, you know, Nobel, all of this other. And they should win the prize for modernizing our understanding of how the body works. So the fact that we now have all this research on something that is a bio similar hormone replacement. So what you brought up is like spot on. And I wanna be Clear. That's not necessarily, you know, this'll be 2000 and we're in 2026. But some of the medications that are coming out are going to be small molecule non peptide. So I do wanna say that that's not gonna be the case for every medication. But for the ones that we're talking about right now, they are ones that are the medications are replacing. They're the same as our own hormones with a big difference. So our own hormones stay on for about two to five minutes. They're a motion detector. Right. These stay on for 24 hours, seven days a week. You know, liraglutide, the first one, stayed on for 24 hours. So what you have there is you have an exponential impact, but you also, it helps us understand the pros and the considerations of the medication. Because when something stays on for that long, like imagine if you have lights on outside of your home. Imagine your electric bill if they only go on like when somebody comes in front of your door. Now imagine your electric bill when they stay on 24 hours for seven days. It's a big difference. And that doesn't mean a negative thing. It just means that it has to be medically managed and in my opinion, nutritionally managed. Cause that's really where the rubber meets the road is how do we help someone optimize in a body where they may be metabolically turned on for a longer period of time. So a biosimilar hormone replacement is different than say estrogen, testosterone, insulin, thyroid, which are bioidentical, but they're similar in the sense that your body is going to. And the reason they're called an agonist is your body recognizes them and they're designed to go in and help your body do what it already to go with the way that the body is meant to work. So a cholesterol lowering medication or a proton pump inhibitor, you know, for lowering stomach acid, those are called antagonists.
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A
Right.
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B
So those are going to go against how the body is working. So you know, all of these like comments about like the side effects of the medication, everything are from people who just don't understand the physiology of the body.
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A
Exactly.
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B
Or they don't understand how the medication is intended to work.
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A
Right.
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B
Yeah.
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A
So let's take semaglutide as an example. GLP1s are only supposed to work for maybe a few hours. Right. And these semaglutide works for a week. How is the GLP one changed from something that only works for a few hours to something that works for a week?
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B
Yeah. And keep in mind, GLP1 actually works for two to five minutes in the body.
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A
That's right.
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B
Not even an hour. PYY and CCK. So when we group it all, we like to say about an hour. But some of these are really working for a short period of time. And so when we look at that, scientists actually found. So in 2004 when I was seeing a bariatric patient and I learned about these hormones, I was then like, I like, you know, self. I'm young, so I'm very ego. And I was like, I'm a genius. Like I've been helping people's digestive tracts and the lining of their digestive tract. But I'm like, no wonder people who are coming to me who are getting digestive optimization are actually getting weight health optimization. So when I knew that, I knew where I could lean into. At the same time, scientists were discovering that a Gila monster, which is a prehistoric animal, I think it's kind of funny that a prehistoric animal is our modern day solution, right? To Wade El but anyway, a prehistoric Gila monster, actually I describe it like every perimenopausal woman we really liked, like hang out in a cold, dark place and not have to go out anywhere or talk to anyone. And if we could eat the fat in our tush, we'd probably be pretty happy, you know, like. So it's like fine on that part. I joke about myself, but in that way there in the venom of that Gila monster was a peptide hormone. So that means it's made up of amino acids. That's different than other hormones that are made up of fatty acids that are steroid hormones. And in that, when we have that peptide, what they found was that one stayed on for 30 days. So they were able to come in and look at. Could we then manipulate. Or the idea came up, could we manipulate our own peptide chain, the one that's in the human body, and make it closer to the Gila monster. And so, you know, we do those manipulations all the time. Like that's, you know, we see that in peptides. You could look at the difference between sugar and Splenda. And that is also a manipulation of a chain, right? So this isn't, you know, inconsequential, but it's not, it's not new in that way. So when they did that, they realized that it goes into the body and it's going to stay on for that longer period of time. What you and I then know, you know, in coming in and where I look At a nutritionist is, okay, number one, if I keep somebody metabolic, metabolically active, if I'm stimulating insulin, if I'm stimulating hormones like leptin and ghrelin, if I'm telling the body, go to work. You had to basically understand and deal with any nutrition that you have. You're in a metabolic, you're not in a rest and digest phase. So one of the key things that is a consideration, and we see this in our patients, especially with Nexhalt. Cause we're, you know, we've got them wearing oura rings. We're looking at their CGM like, you know, we're tracking all of their labs. And if we're seeing that go down, then that's gonna tell us, hey, this person isn't recovering enough. And fatigue, as a side effect is often discussed as people. Oh, those people. I love when people are like, oh, those people. Oh, those people aren't eating enough. You know, and that could be a factor. They could be eating in the incorrect way for their body. But most of the time that fatigue is because we're seeing that they're not in that, you know, they're not in rest and digest. And then the second big dissimilarity when you keep something on for that long is when we delay gastric emptying, which is the way that this is working. We're going to see any. It's going to exacerbate any underlying digestive issues. If you were constipated before, if you have reflux, if you have any of that stuff. And then on the other side of it, you also are going to see where it could create those issues for someone. So we have to be very careful. And, you know, what I do in personalizing the recommendations is to look at. Maybe somebody's going to have a different nutrition plan for day one and day two of the medication, and then different as it kind of subsides in their body. Or maybe for a woman when she's on her cycle, we're going to alter the dosage or, you know, different things. And so it really comes back to this whole. I mean, it's the end of one. It's the personalization. You know, we have to look at their sleep. We have to look at another one that I think NextHealth focuses on so significantly is also. And I focus on. I think I'm probably the only one who wrote a book with anything to do with GLP1s that is talking so much about detoxification. When you shrink fat cells, you're liberating toxins. If the body is not able to eliminate those because the digestive system has slowed down or the detox detoxification system isn't working, well, you are setting up yourself for a lot of problems. So, you know, we look at things like, you know, whether we're replacing plasma, whether we're having people sweat it out, whether we're just nutrient wise supporting the detoxification system. Those are really effective tools.
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A
Wow. So, see, this is all considerations that people need to think about when they're going on GLP1s that most people have never even thought about because, you know, it's been such a trigger response like, I'm overweight. I'm gonna do a GLP one. And they take it and they start losing weight. But then they have complications and problems because of all these issues. And it's given, you know, unfortunately, a lot of people are now fearful of GLP1s because it was done incorrectly many times. And a lot of news stories around that.
- [13:32]
B
Well, and one of the things I want to say, and such respect. I've always partnered with doctors, and I am very clear that I partner with doctors in that part. I think a lot of doctors don't understand this. And we have a whole in, like a whole part of medicine called obesity medicine. And their goalpost has been just weight loss. Like, how do I help my patients lose weight? And even back in the day, I totally lost the battle. Instead of calling it weight loss surgery, I wanted to call it health gain surgery. You know, Cedars was like, nope. You know, like, okay. But, you know, we have a society that focuses on weight loss instead of building healthy bodies. And some very smart and big audience physicians have been talking about how, you know, when their patients have gone on the medications, they've lost muscle. When their patients go on the medications, they've lost hair. And when their patients. And my answer to that, again, I've said it to their face, but also with total respect, is you shouldn't be scripting if that's what's happening to your patients.
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A
Exactly.
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B
Nobody should have a patient that regains. If they lost 60 pounds. Nobody should have a patient that regains 60 pounds. You should have a system in place. Like, you have your contract. You should have a system in place that says, hey, at five pounds, like you were check. We're going to. You're going to check in with Ashley each week. And at five pounds, flag on the field, if you've come off the medication, we need to look at what isn't working right now. Because we don't want you to go from 5 to 15 in a regain, you know, those pieces. And if you're not, if you're losing muscle, you're not, we, we have not optimized either your digestive system or your protein or maybe your amino acid profile within there or maybe your inflammation or maybe your detoxification. So, you know, it says to me that it's a broken system, it's not a broken tool. On that part, I love that.
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A
If you're having these problems with your GLP1, your doctor should not be prescribing your GLP1. Number one, they're not doing it correctly. They're not giving you the right advice. But also they probably don't even know that it is not the GLP one causing the problem. It's the ignorance of all the other factors around the GLP1.
- [15:28]
B
That's suboptimal function. Yes, exactly. And then that comment too, of like, once you're at your BMI or once you're close to your bmi, like, let's just take you off of it. So I want to be very clear. When you're on the medication, I should have said this under the dissimilarities when you're on the medication because it goes into your body either orally or via injection, it goes right to the receptor sites. That's what's brilliant, right? It goes right there. It means nothing in the body has to work. So it means that the vagus nerve doesn't have to work, the digestion doesn't have to work, and the vagus nerve bloodstream to take it back doesn't have to work. Why does that matter? It's basically turned off or at least significantly suppressed while you're on the medication. So if you don't fix any of these underlying things and you go off of it, or if suddenly your insurance doesn't cover it, or suddenly you have to have a treatment or a surgery or, you know, whatever reason you decide to come off of it, your body doesn't know like it is. There is nothing that is going to have it working at all. Like it was suboptimally functioning. It's still suboptimally functioning. So the work that I do is I work on how do we restart your system, you know, so we use different tools that might be a lower dose. It might be weaning somebody out for a longer period of time. Most of my helping people come down or off the medication happens over a year. It does not happen, you know, in three months or in six months, if we can control for that. When I've had somebody who's gotten pregnant or had a new cancer diagnosis, we pivot, but we understand what's going on in their body, you know, and work with that. And that's so important for us to understand because again, we still are this society that just blames people. If we blame people, we blame a medication and we turn around and we say, oh my gosh, look at that person who came off the medication. They regained all of their weight. Well, of course they did. Your body, you didn't fix your body. Like you didn't optimize. And I will say your body is never going to naturally work the way that it is when you're on the medication. And so that's an argument for maybe a low dose moving, you know, ongoing or, you know, figuring out different pieces. But I think we have to have a much better conversation that also acknowledges there's just so much weight bias. And unfortunately, I think it plays out and it comes over into the medical side of this on that part.
- [17:33]
A
Yeah. You invited me a couple years ago to join you on stage Talking about the GLP1 journey because you saw the contract I put people on and I really look at the. I have them sign the contract as more of a just a contract, not like there's going to have any problems if they don't follow it, but basically just so they understand how serious of a time it is. Because when you're on GLP1s, it's the beginning of a journey to rehabilitate many different systems in your body. I look at it as changing a good time to change your relationship with food, just in general. Right. To learn how to eat healthy, but also to fix your metabolic health. We use a continuous glucose monitor while you're on a GLP1. To your point, also is the time to rehabilitate your vagus nerve. Right. Fix your gut. Yeah, yeah, all of it. This will all be happening while you're on the GLP1. So when you do get to your goal weight, it's the off boarding makes more sense because your body's rehabilitated during that time.
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B
I think it's so interesting and I love the contract. I have always, when I've worked with somebody, especially when I've worked with their therapist or I've worked with other practitioners, I've set up a version of a contract in agreement that if you decide not to work with one of us, you're still okay that we're in conversation about this so that somebody doesn't feel just kind of left out and doesn't understand what's happened. And I really think that's the way collaborative care, integrative care, you know, should work on that part. One of the main reasons is we're actually also unpacking trauma. And it is. It blows up relationships. And the changes. When you make changes with your food, many people make changes with alcohol. Many people make changes with what they decide, what activities they like to do, because maybe now they actually enjoy going to the gym instead of going, you know, to the bar, like, as an example, you know, on that part. And I think what ends up. What I saw in bariatrics very early on was when we didn't have the social worker or the therapist as a partner, I had people who were trading food addiction for maybe even sex addiction, or I saw divorce happen, and I saw, you know, some of these other pieces. So it was very early on for me in this journey. And I've been working with patients in this space for about, you know, 20 years, you know, on that part. It was pretty early on that I realized I had to have that collaborative relationship with those other practitioners. Recently, I saw a woman who came to me, and she had gained. It's not that recent. It was a year ago, but she gained about 60 pounds that she said because of a divorce. Well, what's leading up to a divorce? You know, a lot of stuff. Right. So it wasn't just the moment that you decided to get a divorce, you gained 60 pounds. It was several years and maybe even longer, you know, of. Of trauma. And she actually started to unpack that with her therapist. That's important because when she came to me to come off the medication, which she really saw herself as kind of being a failure, being on the medication. She was so excited to come off the medication. So that was a little bit of a clue and something I invited her and her therapist to work on. But when I. What I. I said to her initially is, first we've got to get your body in better shape. Like her, she'd lost muscle, she'd lost bone. You know, she'd like all these different things. So we were working on that. She started. And then we started weaning her, and she was doing great. And she actually came to a place where we were going to have her off. And then she ghosted me. I just didn't hear from her. I was like, nobody ghosts Ashley. And I'm like, what's going on? I'm so used to being ghosted you know, on that part. And like I get it, like I don't have a starring role in somebody else's life. Like, you know, I gotta, gotta come in, right? So that's me at 50 being more evolved than earlier. But you know, I think what happened was I found out from her therapist and her therapist reached out and she said she's mortified. She's gained eight pounds, she's going through a horrible custody and a financial situation. And I said, look, don't pay me. I was like, she has everything that she needs. I said, I also am fully available. I am cash pay. Unfortunately, just cause they don't, insurance doesn't cover me. Unless you are diabetic and are deemed, I guess with obesity on that part. But what ended up happening there was. She was too embarrassed to come back. And I was like this. We really, at that point and one of the key things was we really actually had to. Not only did she. She went back on the medication at half the dose. We were. We had been using Kalocurb Amerisate to like kind of wean her off. And because she was already doing pretty well in there, we just were able to bring that back and kept her on it for about six months. And then she's been off the medication, but she now keeps the medication in the refrigerator as a reminder to herself that a medication doesn't define if she's a success or a failure. It's just. It's a tool. You know, she's got greens juice in her refrigerator, she's got coffee, she's got. It's like just one of her tools, you know, on that part. And I think that was really key. But one of the things that she really started to unpack was that her thoughts about her own body when she was a teenager was really at the root of what got her into a very unhealthy relationship. And that was what her marriage was at everything. So I'm like, I mean, it sounds like nothing that we would talk about on, you know, when we were talking about the medical side of this. But we, we have to remember in weight health, we aren't unpacking. We're unpacking being teased as a kid. We're unpacking diets, we're unpacking not being invited to things or from a blood sugar standpoint, feeling like we're a failure because we've been trying to not eat carbs to optimize our blood sugar, all of these different things. And so I think that if I bring it Round to the medication. This emphasis on the medication that works best is the one that works fastest is just so wrong. Right. I mean, we really have so much of a, of a societal shift that we have the potential to usher in, you know, this amazing opportunity at generational weight health. But we also have a lot to change on that part.
- [22:54]
A
Yeah, it's so true. About probably 20 years ago now, I was on Dr. Phil, the show on TV, because I had done a bariatric surgery on a woman that completely changed her life. And her name is Lori. And Lori was invited to be on Dr. Phil to talk about how this changed her relationship with her husband. You know, and they're a very strong couple, thank goodness. But it's a massive change. Right. And so to your point, it brings up a lot of deep seated traumas because, you know, you can ask 100 people, where do their traumas come from? Probably about 30 of them might say from their weight. Right. It's that big of a problem. And the prevalence of it starts from like, you know, like you were saying for you, even childhood. So it follows you through life. And so this can be a big part of the overall story and changing relationships, changing how you feel about yourself. I mean, I even had people that want to gain the weight back because they don't know how to live in this new body, right?
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B
Oh, my gosh. Yeah, I love that. And you and I both work, you know, I started my practice in Hollywood. I've been here for 20 years. You're there. You know, I'm so bothered by everyone's critique on, you know, I understand that seeing people who are in a smaller body and maybe even seeing people that you perceive of that they're too thin or even, you know, you, if like, maybe you are a practitioner and you're diagnosing them and looking at them on Instagram and deciding that they're too thin. Number one, unless they are actually your patient, please don't assume they're on a GLP1. I have a very public, a very visible public client right now who has cancer and has been trying to keep it quiet and has lost a lot of weight and has lost hair and has changed and every, like, people are showing her picture everywhere as somebody who's on a GLP1 and is losing it too quickly and it's gutting her, you know, and I'm just like, like, you're strong, you're strong, you know, and she is strong, but like this, she doesn't need to be dealing with that too. So first of all don't make an assumption about what somebody is doing. But also, you know, we point at Hollywood and we tend to just say like, oh, they like everybody in Hollywood needs to be so thin. So first of all, if it's working for someone, if they found a weight health tool and they've had excess fat and maybe also we know this, there are people who look totally thin, you know, thin or just look, I don't like the word normal, but look a normal, you know, weight and they have visceral fat and you know, or that they have, you know, fatty liver. They have, you know, cardiovascular needs and this is like a total benefit to them. And so, you know, you are actually, it's the reverse of fat shaming when you're GLP1 shaming someone right now. And a lot of people are doing this publicly and a lot of celebrities are doing it publicly about other celebrities and it's just stop, like, you know, I mean, it's not, you know, and I understand how it can feel so triggering if suddenly people around you are changing their body shape. Like we actually have a tool now that is working and can work very successfully for people. And again, misused, it can be a total disaster. But I do think that what we're seeing is we have to recognize that this is a societal thing. And you know, if you're, if you're doing it out of a positive intention or if you're bothered and you're on social media and you're shaming people about their GLP1 use, I think that's also really problematic and something for us to, you know, kind of call out on that part too.
- [26:07]
A
Yeah. You know, the comments that say just go to the gym and exercise and eat better. It's like this person has been eating extremely well, probably goes to the gym more than you do. Commenter.
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B
Yes.
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A
And they're still having issues, you know, and so there's so many, there's. Social media is terrible.
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B
It's so bad. I have a, I used to give this talk for practitioners and now I found I need to give it for social media. But it's the myth of the non compliant patient.
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A
Right.
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B
And when you are in weight health, you have to understand, I mean, my own journey myself. If anyone says I literally don't know that there's something that I didn't try and that's embarrassing and I'm very open about it. In my book From Laxatives, from Over Exercising, I even tried to have eating disorders and thank goodness they didn't. I can say as an adult now, thank goodness I didn't have an eating disorder, but I tried. And what's absolutely crazy about it is I saw myself as a failure because I couldn't be a binge and perjurer and my friends could, you know, that kind of thing. That's so messed up. And one of the things about compliance, I mean, I even did a seven day goat's milk cleanse. So if anybody thinks we haven't tried things, we have tried on that part. And I think another space for men and for women, and we deal a lot with this in our patient community right now, is also perimenopause. And for men, the changes with testosterone, you know, I think they call it andropause. But looking at that, you know, when you, what ends up happening is I think weight. Because we've had this focus on weight versus health. We've felt anyone who's battled their weight side of it has felt so disempowered because we've been trying and then we're trying all these things. And I see that with my patients as they're going through perimenopause. We have a patient, we share a patient who, you know, she's like, she, many people would think of her as thin. Somebody would think of her as like, definitely an acceptable weight, you know, and she's felt good about her body her whole life and now she's put on about five pounds of fat around her belly. And she's miserable, absolutely miserable. She has been dismissed by everyone in her community, by other practitioners. It's why she found us, because they're like, whatever, like five pounds, come on. And they're kind of making fun of her on that part. And the first thing I said to her is, I am so proud of you because that is a signal that your body is trying to send. And you are like, I am going to listen to this signal. And, and we would not tell somebody who has a small mole on their back to just wait a couple of years and see if it becomes a big mole. We would look at it, but we're not that mole. If it's your belly, like, because it's weight, we still have this, you know, so it's just, it's so much to unpack on that part. There's a lot.
- [28:42]
A
Yeah. You know, weight is not just a number. There's so much that goes beyond that number emotionally, how much you feel, you know, as a failure or success because of it. And there's a lot of considerations there, for sure. So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances, I travel across many time zones to support my work, and I just want to live my life to the fullest. Staying active as I age isn't just about willpower. It's about supporting my mitochondria, the powerhouses of my cells with the energy that they need to recharge my muscles and recharge my brain. Mitopure is a supplement that I take. It's backed by solid research showing that it can boost cellular energy, increase muscle strength and support overall healthy aging. Personally, I take Mitopur every single day. It's helped me continue my active lifestyle, whether it's a high intensity workout or keeping up with my kids. So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.comdrshaw to get started. That's timeline.comd rshah your future self will thank you. I want to go back to like a few things that we don't normally get to talk about in this podcast that you've written about in the book. Can we talk about rehabilitating your vagus nerve and kind of what happens with your vagus nerve and your HRV and just all of the sympathetic parasympathetic when you're on a GLP1?
- [30:22]
B
Yeah. And I can also just direct everyone to your podcast with Nawaz Habib because you know, our friend, I call him out in here, upgrade your vagus nerve. And then it was actually really fun for me. I went to a high school about each of our classes, about 20 or 30 people. Karen Onderko, who is a sister of Patty Onderko that I went to high school with, is actually worked with Stephen Porges on the polyvagal theory. And I was like in our like little high school, like there's, you know, the two sides of this. I'm fascinated with it because one of the things I think for me the understanding first came about when I started to explore magnesium. When I started to look at why is our body, why might we be staying in a stressed out state longer? And I understood that stress was just a problem for the body. But what I was really focusing on, cause remember I was focusing on digestion, was that stress was diverting attention away from digestion, that it was challenging motility that was slowing things down. Right? And we are not what we eat, we are what we digest and absorb. And so, you know, we don't like, we give. A lot of people say like, what are healthy foods? And I was like, you know, like kale, salmon. I'm like, actually the body doesn't tell you anything is healthy until it actually, the cells get what it needs where it needs it, right? So it's kind of like turning in your paper to the teacher and be like, I got an A and the teacher's like actually got a D. And I'd like you to rewrite four of those, you know, like that kind of thing. So one of the things I was focusing on in my book and when I started to talk to Nawaz about it was, you know, and really Gabor Mate or Amy Agaben and like starting to unpack trauma and understanding that we have this vagus nerve. And the vagus nerve running from our brain to into our gut and then also from our gut back up to the brain. It is on both sides of this messaging with the weight health hormones delivering it to certain receptor sites. And so if you are, if you're, if you have vagus nerve suboptimal function, then you're likely to not get this signals to your weight health hormones for them to be deployed or secreted. So what can happen is you can have your L cells, could be perfectly equipped to work and you could have the GLP1, the GIP, it's ready and it's there, but you're not getting the signals. And remember, the vagus nerve, that's a motion detector, right? It's set up to turn it on for two to five minutes. Well, what we have today is we have like a stampede running in front of our vagus nerve, right, Instead of like a little something. So what's happening is our vagus nerves are so overwhelmed, they're being asked to deal with what I refer to in the book as infobesity. So in about 2011, I had heard that term related to data and I was like, oh my gosh, that's what my patients are dealing with. And it is not better. You know, we have too much data, too much information. We have too much data. We're collecting too much information about what we should and shouldn't eat. And our brains are, you know, thinking about all of this and we're stimulating it with social media and we have a lot of cues. You know, we're getting cues visually, we're getting cues from our, from all of our senses. And so, so that's all supposed to go along our vagus nerve. So Our vagus nerve, as Dr. Habib talks about it, really has five different ways it needs to be optimally resourced. And so when we look at things, and he calls them safety and so biological safety, so we need to move our bodies for our vagus nerve to work, right? We can't sit all the time. We certainly can't sit hunched over and sit like this. So we need to sit. I'm not good with posture. We have to sit and do that. And we need to move our midsection. And I talk about that in the book. But we also need to recognize that we have nutrient resources. The goal for the body as an operating system is to never have to prioritize what it has. It wants to have an optimal amount of nutrients. So if it has an optimal amount of nutrients, say you have 10 units worth of choline that you need, right? For all the different places for it to go. Well, if you only give it four, it's going to choose six things that it's just going to say, sorry, I don't have enough choline. And it's going toyou. Don't get to choose which one. You don't get to be like, could you make my hair look good today? Or could you make my energy good? It's going to go like, no, I'm going to do whatever keeps us alive here on that part. So what happens is we may have an insufficient amount of choline, and so our vagus nerve doesn't have enough choline. Phosphatidylserine, acetylcholine, looking at it that way, magnesium. I've already talked about omega 3s, which we think about for heart health, but you're like, that's vagus nerve function. So, you know, some of. There are all of these different ways to think about the safety of the vagus nerve. But if the vagus nerve is not feeling okay, then you're not going to have an optimal system in terms of it working. So part of our work while you're on an agonist is to work on optimizing and upgrading your vagus nerve. Here's the challenge. And he and I, this is actually what we're talking about at A4M and teaching practitioners on. But he and I have teamed up to really look at. There's a problem when you're on an agonist because, remember I said instead of two to five minutes, you're on it for 24 hours for seven days. There's a bigger problem. Of all of the places and the practitioners and the pharmaceutical recommendations to Just keep increasing your dose. When you increase your dose, you're further suppressing and further keeping you metabolically active and further suppressing your heart rate variability. So one of the techniques might be using a lower dose. You know, some people call that microdosing. I like to call it low dose, but using a lower dose. Another technique might be working on your sleep. Another technique might be a PEMF mat. Another technique might be a hyperbaric chamber. Another. I mean, there are all of these different techniques that we can use on that part. I'm pretty partial to the ye olde breathing one. You know, learning to breathe better, you know, laughing. So, you know, I like to use humor, but when we laugh, we actually engage our vagus nerve and move out of you actually physiologically can't be stressed and laughing at the same time. So it's like a cool dynamic in the body. And so all of those are going to be the things that we need to lean into. And very often, and this is where I come down really, really hard to their faces on stage. So nobody's gonna think this is the first time that they haven't heard it. Anyone who tells me that I, as a dietitian or anyone that feels that supplements don't belong in this space do not understand what we are dealing with. We cannot eat our way, especially. Especially if you're on a GLP1 agonist to optimally resourcing our body. But supplements can also be used at times when we don't want to be eating. And so I'll use Ben Greenfield as a great example. You introduced me to him, and through Vitaboom, I was helping him with building his stack for sleep. And one of the things I so admire, here's this guy who is like, when I want my body on, I want it on. He's like, it's firing. He's doing all these things. But he so understands the importance of recovery, of turning it off. Right. And so when we looked at that and we were looking at nutrients for sleep, at first, I was like, well, you know, yeah, and of course, like, we're leaning into magnesium and some, you know, glycine and some others. But we got in there and really looked at some very key nutrients that, especially for a guy or a woman who is really like a high performer and really like sort of in their activity mode, really turning it on. How do you turn it off? And we have to do that with supplementation. I'm not telling you to eat 50 things before bed. Otherwise I've now given your body digestive work to do, which means that the work it's supposed to be doing while it's recovering, you know, isn't happening. So I think that the role of supplementation, it is not that. And somebody asked me this. On the flip side, they. I had somebody in a recent. At a book event, somebody said, you know, I'm embarrassed. She was embarrassed to tell everyone publicly she was on a GLP1. And I said, so first of all, like, we give a hug, you know. And then I said, you know, what's your question? She said, well, I've been told, I've been. I've heard that people like me should be on certain supplements because I'm on a GLP1. I said, first of all, there's no person like you, so that's number one. And I said, second of all, you may need supplements, but my job as a nutrition specialist is to look at your total nutrition and to see what your food is not bringing forward. And then we match that. You know, supplements can fill gaps. They can prevent gaps for us from a nutritional standpoint. And so they belong in the total nutrition conversation. Then there's a third area, which is they can be used therapeutically. And so we use a lot of them therapeutically. You know, we might say to somebody, you know, hey, let's try plant sterols or something, instead of using a statin as a first intervention. But that's why you work with a practitioner on that part and you personalize it. So I think supplements get maligned for very, like, a lot of bias that's there, again, by people that don't understand how to use them properly in that space and using them. And one of the places they can be really effective is as we try to optimize the health of our vagus nerve on that part.
- [38:42]
A
So, yeah, supplements. The problem with saying just supplements, you know, is that there's so many different categories of supplements, to your point. And, you know, some are for micronutrient replacement, others have an effect, a biological effect that we're trying to achieve. Some are there for optimization that we've scientifically found that they work to. You know, I love urolithin A for increasing mitochondria, which is. I love using that for. Also vagus nerve problem.
- [39:06]
B
And a new study on muscle with urolithin A. So I'm so excited. Yeah, there's a lot of wins there. And Akkermansia, we use. And Akermansia, we use a lot of. Right.
- [39:15]
A
Especially for, you know, for reforming the critical bacteria, keystone bacteria in our gut that help us make GLP1 as well. So there's so many nuanced conversations to have about supplements and just telling people like, oh, you're just. No supplement is going to help you because it just creates expensive pee is like so dismissive of the science there, for sure.
- [39:37]
B
Yeah, yeah. And I think another area I'd love to talk about that's the dismissive and like just so wrong is the whole space of hrt. And I think it's such a great opportunity for us to talk about because I have termed using a AGOP1 agonist as a weight health hormone replacement therapy on that part. And I feel like, have you seen, somebody was asking me about research and I'm just curious what you've seen in terms of research and patients on the combination of HRT and GLP1.
- [40:09]
A
Yeah, I was just talking about this in my last podcast, which was, yes, there's, there's research in women now that's been done showing much better efficacy of both of them if they're used together.
- [40:20]
B
Yeah. And it's like, duh, like, I wish I could have done that research study. Here's how the human body works. And now let me, you know, just like go ahead and assign that. So when we have our. Like for men and for women, when we have our hormones shifting before they frankly leave us, when we have our hormones shifting, those throw digestion off course. And so that's going to alter the production, the deployment and even the reception of triggers for our weight health hormones. So they are interdependent. It is an ecosystem relationship. I think that's so important because when we are trying to address what are some of the symptoms of hormones going away, like, oh, that belly fat or, oh, that brain fog or other things, a GLP1 agonist could be our best tool in that space. I like to take everything. I like the idea of building stacks. You know, I was talking to Dr. Maritza about that and I asked her this question and she said, but she was saying that she felt comfortable using say estrogen and a GLP one together and kind of getting in there. And my experience with women, my experience myself has been when we're trying to figure out, especially before our hormones have just gone away, when they're shifting all the time, it can be our sex hormones can be very hard to manipulate with hormone therapy. And so it can be like six or eight months before we figure out what's actually going on. And when you use a low dose of a semi glutin in there, it can be a very stable or a terse appetite. It can be a very stabilizing force in that way. The downside that I think we have to be clear about, and I don't think this gets talked about enough in hormone replacement therapy for men or women, and now in weight health hormone replacement therapy, and that is that hormones, the sex hormones, are steroid hormones. They require elimination once they have been used up. So we use up hormones in the body. When we use them up, they go through our detoxification process. There's a phase one and a phase two. And phase two exists because those are in a fat form and they need to be made into a water, water form so that they can be eliminated properly, whether they're being eliminated through urine or through stool. And when we have inefficiencies, which we find, we use 3x4. When we find inefficiencies in people's detoxification systems, from a genetic standpoint, or when it's under resourced, or it's not optimally working, or when they have fat in the liver, or when other medications are interfering, or all the different things, and we drink alcohol, all the different pieces, we may be suboptimally detoxifying. And if that happens, they recirculate and it increases our risk for cancer and other things. So I wish that in the Women Health Initiative, among all of our wish list, that those that did get cancer that we could have actually looked at, was their detoxification suboptimal? Because I think that's really important. Why do I bring that up? If you decide to use hrt, man or woman, and so you're replacing your sex hormones there, and then you're coming over and you're adding a GLP1 agonist, and if you shrink any fat cells, any of them, you're putting toxins into the space that, that also need to be detoxified and be eliminated. You have to do the work to optimize detoxification. So again, I think I'm like probably the only book out there that has spent as much time on detoxification as in the GLP1 space. Because what I don't wanna see is, I don't wanna see people achieving weight goals or blood sugar goals or inflammation goals, or hormone, you know, sex hormone, balancing goals and then developing cancer as a result. Like, that's not a win for us on that part. So I think we need to just be smarter. All of this says at the end of the day that we should be working with practitioners when you're putting together any of these plans, which is why I love a collaboration like that.
- [43:53]
A
Absolutely. Absolutely. And so to your point on the hormone replacement therapy, I think this whole missing piece that you talked about is detoxifying the hormones after they've been used. No one really checks for that. And the way we do now is we have incorporated Dutch testing, where you can test for metabolites of the hormones and see if you're adequately detoxifying hormones, because not only can it lead to, you know, more toxins accumulating in your bloodstream, but it can also cause other negative physiological effects besides, even cancer is one of them, A terrible one. But. So you're absolutely right.
- [44:26]
B
Autoimmune, like, autoimmune disease. And you guys also test. I know because I'm always looking at the labs. But you. You also test, you know, right out the door. You're testing for toxins across the board in both, like, vitrect, when we're looking at, from a gut standpoint, vibrant, when you're actually looking at heavy metals and other pieces. So I think it's really important to understand and then to adjust the pacing of your hormone replacement based on that piece.
- [44:49]
A
Yeah, it's so true. And another point that's really important is that all these things work together in your body. That's why we had the wellness wheel. There's many different considerations, 12 different considerations that you can have in any therapy. And it's not a one size fits all. There's so many ways you can use this for the good or also for evil, I hate to say. And so. So it's definitely having a practitioner that understands all of these nuances is critical. That's why your book is perfect for practitioners. Actually, I think all practitioners should also read this book.
- [45:21]
B
Thank you.
- [45:21]
A
So they understand all of these different nuances of GLP.1 therapy. It's not just about weight loss, and it's not just about maintaining skeletal muscle. Obviously, those are two big pieces of the story. There's many other considerations.
- [45:34]
B
Yeah. You know, years ago, I thought I would create another company, and it was just gonna be a. Called, like, what she said. And so basically, I had a lot of women who would come in or husbands who would come in and say, well, oh, my wife is always telling me that, and I don't do it. Or then I would have the wife say, and this very stereotypical, like, I tell my husband or I tell my child that, and they don't do it, but when you tell them it. And I was like, I know, I was like, isn't that special? I'm like, number one, I'm the professional, but number two, I'm not in your relationship, right? Yes. And what's really interesting is I've played that role with so many, between so many patients and their physician. And it's not that the physician doesn't know or doesn't understand nutrition or like, like, it's that it just for whatever reason didn't come up in the conversation. And if we're not connecting those dots, then there's a relationship issue there where, you know, something isn't happening, like in a better way. And, you know, and having that. And so I think that that becomes so important. So I've actually said to patients, this is a great book to read to know how to talk to your doctor and then to doctors is a great book you can read, you know, on that part to come in and have that conversation. I want to also just like a little bit on the nutrition part, bring up another thing that I think we could break up with is just the idea that, like, everybody's talking more, right? Like more protein, more fiber, more strength training. One of the things that, you know, when we were working on our nutrition recommendations and talking to the providers across, like, you have a gazillion next health franchises now in the place we were saying, like, you know, can we be the place that actually meets someone where they are and doesn't just say like, hey, you should have more protein? It's like, we care about the quality of your protein. And then we also want to look at. If you just, if you put more protein into a system that isn't working better, especially digestively, you're gonna have a disaster. Like, that's not going to do better. If you put more poor quality protein in, that's gonna be a problem.
- [47:17]
A
That's a problem too.
- [47:18]
B
And so I think that notion of helping people understand. In the book, I use like 15 to 30 grams as a pit stop about every three hours. And that's like a very. That's a starting point. And then I teach you how to personalize from there. But the idea isn't about how much do we have in the day, you know, So I have this whole chapter, is it okay to curse? Maybe not.
- [47:36]
A
Yeah, okay, go for it.
- [47:37]
B
The chapter's called Shit to Unlearn. I did put an asterisk in there just because I didn't want to offend anyone, but whatever. Anyway, we have so much shit we have to unlearn. And I feel like what's great about it coming at the start of the book is that like, can we break up with total weight as an indicator of anything? Can we break up with total cholesterol or total, even total blood sugar in terms of a 1C, not a helpful number. Can we break up with really dumb amounts? The RDAs that do not optimally resource our body. I know they're called DRI's now, but marketing wise, really dumb amounts who have worked for you. And there are so many things to break up with. And I think what is again happening, I feel like everyone who is talking about GLP1s or is out there is also now selling a protein powder and just telling people more protein. And then maybe now they put fiber in there and are like, more fiber. And if you take more fiber, especially for that patient who's on a GLP1 agonist, I had somebody the other day who thought she was supposed to get 30 grams of fiber at one meal. And she did it on the day that she took her shot and she was on her way to the emergency room. She felt so badly and she's like, well, and I had had the gummies. I thought they were the good ones. And I was, first of all, I was like, what gummies? You know, and then I'm like, okay, fiber gummies. But we were going through that and one of the things I realized, I was like, so can we just quiet the noise? I want you to be able to ask these questions in a safe space. But one of the things I talk about in my book is that more fiber may actually be a problem. It is not my go to for somebody until we know that their motility is working. And your motility is going to take hits when you travel, when your hormones shift, when you strength train, when you go on a GLP1 agonist, when you go on other medications. So. So we have to make sure that we're optimizing motility and effectively hydrating you when we're also looking at your fiber intake. So I think any of these that are sort of like the catchphrases that make it on TikTok, just do this. If somebody tells you just do this and you will be weight healthy, they're selling you something. We sell outcomes. If somebody is. If you're coming to us, it's because we really want to be able to personalize that. And I will say also, it's just a small plug for my book. I don't know why I did it, but I do know why I did it. There's A QR code in there. So even if you're borrowing my book from a friend or you're getting it at the library, the QR code, you can access. And you can access our live human coaches. And so if you have a question and you want help with that and you're looking for a resource, maybe you want to know, where could I get an agonist that I can get the kind of care, then that's great, because, like, we don't script them, but we can say, like, hey, come over to nexthalt. And they have a whole program around this, and you can see a dietitian, you can work with, a practitioner, you know, those kinds of things. So that was important to me because I don't even think that in a book with all of those ideas that I can keep up with, like, how many new isms there are that are problematic on that part. You know what I mean? Yeah.
- [50:17]
A
Your advice about just more is not the right answer. It reminds me of I was recently doing a talk somewhere, and they had a buffet in the morning after the talk, the day after. And this person's in line who had asked me a GLP question during my talk, and she was in line at the buffet, and she had a plate just piled up with sausage.
- [50:38]
B
Oh, yes.
- [50:40]
A
And I was like, what are you doing? She's like, well, my doctor told me that while I'm on this GLP1, I have to get more protein. So she's eating all this highly processed, fried, horrible sausage from a buffet line, and she thinks she's doing something good. And it's just like, no, that's not.
- [50:57]
B
Can we also just be clear? There's no food in nature that is a protein.
- [51:00]
A
Right?
- [51:01]
B
There's no food that exists. Like, that is just a protein. So messages like, eat protein first. Like, okay, which proteins? Like, you're either gonna get carbs and protein, fat and protein, or you're gonna get carbs, fat and protein. Unless you're like, free basing whey protein, like, you know, as an isolate, you know, on that part. Right. And I don't recommend that. I mean, you might use it as a tool at times, but I don't recommend that as subsisting on it. So, you know, again, like, one of the things we want people to understand there is like, you know, maybe it was a better. I don't. I don't think so if you're at a conference, but. But maybe it was a better source of protein and fats. But you are getting so much fat along with that. Protein there. And your poor body is like, wait a second. I'm actually slowed down. And part of that slowing down my gastric emptying, which means the acids in the stomach to actually that are being called upon to break down that protein are moving slower. It's kind of like everybody's real groggy in there. They woke up with a little bit of a hangover. They're groggy. So maybe the better thing is for you to, yes, meet your protein needs, but to do it with better choices throughout the day on that part, you know, and to do that at a better pace. Yeah, that's a big one on that piece. Yeah. I mean, it's just. I think one of the things I was able to come to a talk. I think Ben's making it into our podcast quite a few times. But you, Colleen. Our friend Colleen Cutliffe from Pendulum and Ben had a talk when Ben's book was coming out, and I loved one of the things I think doesn't get talked about enough. You know, so many people will make me will come onto a podcast and be like, all right, pro or con? Like, are you for or against an agonist? And I'm like, I'm agnostic. I was like, I love them as a tool, if they're used correctly. But, you know, but we as a society don't. We're this black or white, this blue or red. Like, I'm purple, I'm gray, and I. You know, I think in that space, you know, it feels a lot of times that one of the main issues with where you get your information from, it's why I love this podcast setting is, you know, in short bites, they're asking you to, like, take a. For something to break through. It has to be this, like, staunch opinion. Like, JJ was just saying to me, she's like. Like, we were getting on stage, and she's like, ashley, we're screwed. And I was like, what? Like. And I'm like, wait, what? What's going on? She's like, you know, you. And I just see so much nuance. And you guys had been talking about that. You were like, there's so much nuance in here. And I think we really have to come back to the nuance of really understanding how a body works, you know, in that space, right?
- [53:14]
A
And I think once you understand that there's nuance and you learn about it, you make so much more progress, because then you can really use therapies like GLP1 hormone replacement therapy on a real N of 1 basis to see what's working for you?
- [53:27]
B
Yeah. What do you think is one of the worst? I'm turning around and interviewing you, but I'm curious in the nutrition space because I always think this is fun. What do you think is one of the worst mass recommendations that gets perpetuated on that part? Does one come to mind for you on that?
- [53:42]
A
I think the protein one is definitely way up there. I think there's so much talk about just more and more protein, and it's a real problem. I think also fasting is a problem. The way it's purported as being the. Everyone should be doing it. You know, that's another one up there. I think a lot of nutritional advice doesn't take into account gut health and individual gut bacteria flora as well. So I think there's a lot there as well. There's quite a few things.
- [54:13]
B
Yeah, there's a lot. You know, calories in, calories out, and, I mean, drink half your body weight in water. You know, I'm like, okay, cool. If you're a hose, you're just peeing it out. You know, it's like it's going in, it's going out. On that part, you know, I think that's. That ends up being so, like, just, you know, ridiculous in that way and perpetuates. And I think the other piece of it for me, that. And one of the reasons I really leaned into writing this book now is we have so many tools that are out there selling personalization, but they're selling it without the practitioner, or they're selling either a supplement or a lab test, that singular test or supplement as a solution itself. And, you know, we really, like, you can't. Somebody just said to me, they sent me over somebody who does a genetic test on methylation and was like, oh, I'm supposed to. I was told that if I do this test, then I'll know what supplements to take for my metabolism. And I was like, your genetics are like 30% maybe. You know, I think, like, you know, I think Kara Fitzgerald's work has really shown us that, like, epigenetic. I mean, so many people's work. But I, you know, I think of her and certainly Yael's in terms of, you know, epigenetics and genetics on that part. But, you know, that we can't use one tool and think of it as a solution in and of itself or as, you know, that guidepost post by itself on that basis.
- [55:26]
A
Yeah. I think that's where people really get tricked, actually. A lot of times is they get these Genetic recommendations back. And it's like, take these supplements. And to your point, like, that's not the whole story and you can actually cause some harm by taking the wrong supplements.
- [55:38]
B
Yeah, yeah.
- [55:39]
A
To really take someone that understands the full picture. And, you know, I think a lot of people too can get a lot of good information using AI now, like uploading all their blood work and everything to AI and asking questions. But still, you still need to talk to a practitioner before you take any AI recommendations. For sure.
- [55:54]
B
Yeah.
- [55:55]
A
But at least now you're considering multivariates in your biology and not just going from a genetic test to a supplement.
- [56:01]
B
Yeah. I had somebody the other day, I don't think I even told you this. They told me they put you, Peter Attia and me into. They fed it into their AI and then fed their results in. And we're like, what would you recommend? And they like it spewed out a plan. And I was like, I have to say I'm impressed. But it missed two really big things. And that was interesting on that part, you know, so interesting, I think, in that way, you know, and by the way, it can spew out a plan for you to do. I think this is another big one that people can really learn. At the end of my book, I think I do something that almost no other book does out there in nutrition, for sure, and in healthcare, and that's. I focus on reassessment, on how important it is to come back. I do not care if you do one lab test ever. If I don't have an understanding from another lab test or whatever we decide to use to judge. Do we look at how your hair is doing? Are we looking at how you feel after a meal? Whatever it is, is. If we don't reassess it, then to me, it's just a really dumb marker. It was like, oh, you found something. Resolutions to me are so dumb. I'm like, let's make this the year of smart goals on that part and look at that time bound within 30 days. I never let people stay on. I try not to have them on supplements for more than 90 days without reviewing and then updating their supplement stack and looking at that. And I think what we miss with reassessment, and that's a part of AI on that part, which is AI or a practitioner or anyone could give you recommendations, but if they don't act, if you don't have set in there, okay, now go experiment with my recommendation. And then I want to hear back like, this is what we're tracking. And I want to hear back. You know, it's one of the reasons that I love using, you know, we use inbody or, you know, Dexa or these others to come back to and see what has actually changed with your whole weight composition on that part. When we look at that, we can come back and say, okay, is the protein amount that you're eating or the exercise, like we can tweak things instead of just assuming or not assuming based on that part. So important.
- [57:56]
A
So true. It's so important. Wow. So much incredible advice and we've only scratched the surface of what you've written about. Your book is available now at your.
- [58:05]
B
Best shot on January 6th. It's out to the world. Yes. On that part. Yes.
- [58:10]
A
And we'll provide a pre order link and a link in our show notes. Absolutely. And I think if you're gonna go on a GLP1, you have to read this book first. And if you're a practitioner prescribing them, please update your knowledge with reading Ashley's book. I think it's gonna be a game changer for your practice. And where can people learn more from you?
- [58:29]
B
Yeah, I mean, I think that's it. My book hopefully is everywhere. My name gets you, you know, finds me on social media. My company's the better nutrition program. If people are looking for more information there. And I would say too, if you're not on a GLP1 and you're just trying to understand how your body works from a weight health standpoint, the or not part of my subtitle there is really important to me. We don't have a crystal ball. We don't know what your life is going to be like into the future. And I think this is really your best shot at being able to figure out how to path your weight health journey from here on forward. So thank you.
- [59:01]
A
Thank you so much, Ashley. Can't wait to have you on again. Yay. Another fantastic conversation with Ashley. She's helped so many of our patients at Next Health with their metabolic health. Here are the top five takeaways I had with this episode on GLP1s with Ashley Cough. Number one, GLP1s are not a quick fix. They're a biosimilar hormone replacement. They mimic hormones your body naturally makes. So problems arise not from the medication itself, but from using them without proper medical, nutritional and detoxification support. Number two, weight loss releases stored toxins and your body has to be equipped to clear them. Your detoxification pathways, nutrient status and metabolic support are essential when you're shrinking your fat cells to eliminate the toxins that have been stored in them for a while. Number three, most people regain weight because they were never properly supported in the first place. Going on to and coming off a GLP one should be a guided long term process that addresses factors like your vagus nerve, your metabolic stress, your nutrition and your lifestyle. Number 4 shame around GLP1 use just needs to stop. Weight loss is complex. Not everyone responds to diet and exercise alone. Using a medically sound tool is not something that anyone should have to hide. Number 5 Personalized nutrition is far more than eat more protein or eat more fiber. Protein sources always come packaged with other nutrients. Fiber isn't universally beneficial to everybody and supplements should fill specific gaps, not just following the latest trend out there. So that concludes this episode on GLP1S. I hope you found it extremely useful and gave you another perspective on how to think about this incredibly powerful medication. And if you know someone that's about to go on a GLP1 or is currently on one, please forward them this episode. They should be able to learn something new that can make this a much more successful journey for the them. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.