Extend Podcast with Dr. Darshan Shah, MD

Episode 129: Ashley Koff – The GLP-1 Conversation Most People Are Missing
Date: January 13, 2026

Episode Overview

This episode features a deep and nuanced discussion between Dr. Darshan Shah and registered dietitian Ashley Koff, founder of the Better Nutrition Program and author of "You, Best Shot." The conversation unpacks the biological, nutritional, and emotional complexities surrounding GLP-1 medications (like semaglutide and liraglutide), emphasizing that the real missed conversation isn't about the drugs themselves—but about the systems, education, and support (or lack thereof) that surround their use. The episode further delves into detoxification, vagus nerve regulation, trauma, hormone therapy, and the persistent dangers of oversimplified nutritional advice.

Key Discussion Points & Insights

The GLP-1 "Ecosystem": Beyond Weight Loss

• Ashley’s background — Her journey with weight and health, growing up as a doctor’s daughter:

  "My whole upbringing... was weight was over here and health was over here... It’s weight health, it’s not weight over here and health over here." (Ashley, 03:50)

• GLP-1s as part of a larger hormone ecosystem — Discussion of incretin hormones (GLP-1, GIP, PYY, CCK, amylin) and their broader effects:
  • Affect blood sugar, inflammation, cardiovascular health, appetite, and liver
  • These are natural signals the body makes—not just pharmaceuticals
• Key point: GLP-1 medications are biosimilar hormone replacements and act as powerful tools, not magic bullets

The Science Behind GLP-1 Medications

[05:04–10:45]

• Rapid improvements post-bariatric surgery — Diabetes and hunger often resolve almost immediately, pointing to hormone effects, not just weight loss (Darshan & Ashley)
• How long GLP-1s act — Endogenous GLP-1 acts for 2–5 minutes; medications stay active for hours or days

  "Imagine your electric bill... if they only go on when somebody comes in front of your door. Now imagine your electric bill when they stay on 24 hours, seven days a week. It's a big difference." (Ashley, 06:45)

• Semaglutide origins — Modeled after a peptide in the Gila monster’s venom that has a much longer effect
• Implications: Longer-acting GLP-1s keep the body metabolically “on,” requiring specific nutritional and medical management

The Risks of Oversimplifying GLP-1 Use

[13:03–15:27]

• GLP-1s as a trigger response: “I'm overweight. I'm gonna do a GLP-1.”
• Many complications—fatigue, digestive issues, muscle loss, hair loss—often occur due to lack of personalized support, not from the drugs themselves

  "If you're losing muscle, we have not optimized either your digestive system or your protein or amino acid profile... so it says to me that it’s a broken system, not a broken tool." (Ashley, 14:12)

Shifting to “Weight Health” — Systems, Not Just Numbers

• Doctors focused only on weight loss miss the broader health picture—need to build healthy bodies, not just shrink the scale ([13:32–15:10])
• The failure of “one and done” GLP-1 prescribing
  • Need for systems: contracts, regular check-ins, long-term plans
  • GLP-1 offboarding: vital to do gradually, over a year if possible

The Vagus Nerve, Trauma, and the Emotional Side of Weight Health

[17:32–30:21]

• Rehabilitating multiple systems during GLP-1 use:
  • Food habits, metabolic health, vagus nerve, gut health, trauma
• Contract or collaborative care models (including therapists, dietitians, physical health practitioners)
• Trauma and life transitions: Profound changes (marriage, divorce, weight loss) often resurface deep-seated issues. GLP-1 therapy must address the whole person.
• Anecdote: Patient who kept her GLP-1 in the fridge “as a reminder that a medication doesn’t define success or failure... it’s just a tool.” (Ashley, 21:30)

Shame, Social Media, and Weight Bias

[23:50–26:24]

• Weight- and GLP-1-shaming:

  "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..." (Ashley, 25:19)

• Social media myths — "Just eat better and exercise" is dangerously dismissive
• Everyone’s journey is different: Thin people can have metabolic disease; GLP-1 is an individualized tool, not a universal fix

Nuance in Nutrition—Protein, Fiber, and Supplements

[38:42–54:12]

• Supplements: Fill real micronutrient gaps; sometimes essential on GLP-1s; can’t "eat your way" to optimal status when on medications that alter absorption ([38:42–40:08])
  • Example: Urolithin A for mitochondria, Akkermansia for gut
• Hormone therapy (HRT) and GLP-1s: Synergy for some women; but must monitor and detoxify hormone metabolites

  "Hormones, the sex hormones, are steroid hormones. They require elimination once they've been used up... If that happens, they recirculate and it increases our risk for cancer and other things." (Ashley, 41:41)

• Detoxification: Rapid weight loss liberates toxins from shrinking fat cells. Detox pathways must be supported to prevent complications ([12:20–13:03], [41:41–44:49])
• Personalizing protein and fiber intake: "More" isn’t always better; type, timing, and individual needs matter; motility and digestive function must be considered
  • Example: A patient who nearly went to the ER after eating 30g fiber in one meal while on GLP-1s ([47:17–48:57])
• Myth busting: Refuting mass recommendations like “just more protein” or “just fast” for everyone; critiques genetic tests and supplement recommendations not tailored by actual clinicians

Reassessment, Personalization, and the Dangers of One-Size-Fits-All

[55:25–57:55]

• Importance of ongoing reassessment:

  "If we don’t reassess it, then... 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..." (Ashley, 56:09)

• Tools like body composition scans (DEXA, InBody), Dutch testing for hormone metabolism, continuous glucose monitors, and multivariate data aggregation (even via AI) are only useful with professional interpretation

Notable Quotes & Memorable Moments

• "It’s a broken system, not a broken tool." (Ashley, 14:12)
• "If you're losing muscle, you're not... we have not optimized either your digestive system or your protein or maybe your amino acid profile..." (Ashley, 14:12)
• "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." (Ashley, 25:04)
• "If somebody tells you 'just do this and you will be weight healthy,' they're selling you something." (Ashley, 48:47)
• "There’s so much shit we have to unlearn." (Ashley, 47:36)

Timestamps for Key Segments

• 03:50 — Ashley’s personal journey: Weight and health are not separate
• 05:04–10:45 — What are incretin hormones & how GLP-1 meds were developed
• 13:03–15:27 — Why most GLP-1 complications are systemic failures, not drug failures
• 17:32–22:54 — The need for contracts, collaboration, and integrating emotional/psychological support
• 23:50–26:24 — The harm of shaming around GLP-1 and why weight stigma persists
• 30:21–39:37 — Vagus nerve regulation, stress, trauma, and why supplement type and dose matter
• 41:41–44:49 — HRT, GLP-1s, and why detoxification is essential
• 47:16–50:16 — Personalizing nutrition: Quality, timing, and delivery over “more”
• 53:13–54:12 — Why nuance and N=1 personalization matters for success
• 55:25–57:55 — The necessity of reassessment and rejecting "one and done" protocols

Conclusion and Actionable Takeaways

1. GLP-1s require holistic, personalized management—Medical, nutritional, emotional, and detoxification support are essential for best results and safety.
2. Rapid weight loss releases toxins—Support detox pathways to avoid secondary health problems.
3. Regaining weight post-GLP-1 is usually about lack of preparation and support, not patient failure.
4. Shame and oversimplified advice are harmful—GLP-1 is a tool, not a symbol of character; weight health is multifactorial and deeply individual.
5. Personalize everything: Nutrition, supplements, dosage, and emotional support must be tailored to the individual, with ongoing reassessment and adjustment.

Where to Find More

• Ashley Koff: The Better Nutrition Program
• Book: “You, Best Shot” – Available January 6th
• Social: @ashleykoff on Instagram and other platforms

This episode challenges conventional thinking around GLP-1s, weight loss, and metabolic health, showing listeners that the true magic comes from individualized, multidisciplinary care—not from medications alone. For those considering GLP-1 therapy or supporting others who are, this conversation is essential listening.