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- [00:02]
Brandon
Hey Brandon, I wanted to ask you, you know, with your vast background in nutrition and being a dietitian and being in fitness, I know that you are very familiar with people and their desires to lose weight. And so right now there's a lot of folks that are using some drugs that are intended for other health issues but have shown that they, you know, can help with weight loss. Things like Ozempic and wegovy I think is another one. And you know, what are your thoughts on that? Is something that people should be doing or is there some risks that they might not be aware of, speak to that.
- [00:38]
Alex
So it's a great question and it all kind of ties back into what we were alluding to previously about, you know, the services that we can offer to help, you know, our members or the community as a whole. But I think it's one of those things that it's, you know, yes, it was designed like say was for folks with diabetes to help with getting their A1C and their blood glucose levels down. And then it's turned into to where the side effects of it was weight loss. And we've seen some cardiovascular side effects as well, beneficial cardiovascular. So, and then it's kind of started getting used off label, which is what we see today with this increased in popularity. The Semaglutide, the compounded versions, the Ozempic, the prescribed just in the pin version that you can't adjust the dosage yourself. And so it's, it's one of those things where I think you look at it like a tool to help in weight loss because it's simple, you know, like weight loss. Same thing with weight gain is difficult a lot of times because yes, it's easy to look at it. Calories in versus calories out. That is the simple, right? So if you eat less then you, or if you burn and, or eat fewer calories than you take in, you're likely going to lose weight. The problem is it's that everything in the middle of that little equation, right, there's so much that goes into it. There's other factors that go into it. So are there risks 100%. Are there unknown risk? Yes. To me I look at it as no different than someone that has to have gastric bypass or a lap band or a gastric sleeve or something like that. It's a tool. Now if you implement the tools but you don't change some of the things that kind of got you there, that is your lifestyle habits, your food, your nutrition or your food intake, your activity level, etcetera it could have some detrimental effects to your health. Weight loss is hard. It takes time. And today's day and age, most people just don't have the patience or the time. So someone might have taken 10, 15 years to gain 10, 20 pounds, whatever it is, but they want that poundage going in a month or two, you know what I'm saying?
- [02:55]
Brandon
Oh, I know what you're saying. I felt that exact same way. Yeah.
- [02:59]
Alex
You know, it's like I said, when, when someone asks someone else about their, their weight loss journey, well, if that individual is talking about, you know, food portions and counting calories and macros and all that fun stuff and you know, they had to tighten up here. They, they had to let some of the fun stuff, maybe the, the extra alcohol, some of the sweet treats or breads, whatever. When you hear that and you hear that someone worked out for, you know, an hour a day or whatever for six days a week, well then they're like, okay, yeah, good for you. I don't think I'm going to be doing that, you know what I'm saying? So.
- [03:31]
Brandon
Right, right.
- [03:32]
Alex
So it's kind of like that. It is a lot of hard work and I don't make any if, ands or buts about it. When I'm talking especially to our members or a client or prospective client, I tell them this is going to be work. And so these things have made it simpler and easier for that weight loss. One big problem is we don't know the long term effects of these drugs. Short term they look like they could be helpful for some 100% but we don't know the long term. And I was about to start a workout with a few friends. One of those friends, he's a good friend of mine, he's a pharmacist, a pharmd. So I was like, I get that we don't know if there's any long term effects for folks that don't have diabetes that has taken this medication for the weight loss benefits of it. I was like, but what about, you know, the diabetic population? He was telling me that there aren't any long term studies on it yet. And I was like, oh. And that kind of changed my think because I was thinking, okay, well you know, surely the diabetic population has some longer term studies.
- [04:26]
Brandon
Right?
- [04:26]
Alex
You know, and even after we talked I may go, you know, get on PubMed and do some research and see if I can find any because as of now I'm just taking his word for it. But so that kind of Was like, I was like, oh, okay. So, I mean, you know, because off the bat we do know by the actions that these drugs do inside the body, yes, you do have some slowing down of digestion, so you could get some gastroparesis, you could get diarrhea, your constipation, but you can have some things, you can have pancreatitis from it. There is some tachycardia or increased heart rate from it, even though it does have some beneficial cardiovascular side effects to it as far as decreasing your blood lipids or cholesterol levels and stuff like that. But it's just, it's a gamble. And then even from my perspective, not looking at it, just from the medical side, I see what it, what it's doing to some of these folks that have lost a lot of weight. So on the scale it looks great. Their clothes sizes are smaller. Yes. But there was a term that was popular several years ago, probably five, 10 years ago, skinny fat. And because of the mechanisms of these drugs, it does decrease your appetite. That is the weight loss is helped because you were eating significantly less.
- [05:48]
Brandon
Right? The calories in calorie out theory.
- [05:51]
Alex
So now we're looking at an individual that might have been consuming 2 to 3 to 4 to 5000 calories, are now probably getting by on 800 to 1200 calories a day. And they're getting full really quick. So then you look at the quality of their diet. What if somebody's just eating a certain couple of things a day, a sandwich, I don't know, a turkey sandwich, and that's it, and they're getting full. Well, okay, well what does their protein intake look like? What about fruits and vegetables and how can they tolerate them? Because the thing about these medications is everybody is going to respond differently to them, at least to this point. From what I've gathered in the literature that I've looked at in the past, we don't really know how it's going to be. And I look at it like, okay, so now if they're on the medication and they're losing weight, but are they doing any strength training, what is their protein intake like? Because now I'm looking at muscle mass loss. So, you know, it goes back to what, what I was saying previously. Like, yes, if I, working with an athlete, if I take this athlete and he, he or she loses a bunch of, let's say he. Because I'm thinking of like a lineman, right? Offensive defensive lineman, and they lose the weight, but they lost a lot of muscle in the process. Well, now they're a less effective, more inefficient athlete, but yay, great they made weight for coach, but they're not going to be as good in their position because they're not as strong as they were. It's the same thing with just lifestyle active adults is it's in the short term, we don't think anything about it. In the long term, it could cause some serious issues with activities of daily living. It could cause some other medical side effects as far as, like I said, with the pancreatitis or constipation or the gastroparesis, where the gut just kind of shuts down completely, which can be tough. And so that's kind of where I can see how, you know, a facility like ours and the professionals we have in the building, the trainers, dietitian, etc. Can help these individuals with this because we can help offset some of those side effects that you're going to experience. There's just no if, ands, buts about it. Plus there's so much data out there that shows when you're in a calorie deficit, there's several important factors. But two important factors from my lens is an elevated intake of protein and you need to be strength training. Those two things have shown to preserve muscle mass when you're in a caloric deficit that is weight loss. Does that make sense?
- [08:18]
Brandon
Yeah. Yeah.
- [08:20]
Alex
And there's a lot of people that don't have that. And if you go back and you look at your gastric bypass patients because of their nutritional quality of their diet was so poor because they were eating so little after those surgeries, well, then their hair starts falling out, their nails are brittle, their skin is kind of dry and stuff, and they have a bunch of other issues, you know, just with their gastrointestinal system as a whole. And this could potentially have similar type side effects. So yes, like I said, you might be losing the weight, but if you're doing it in an unhealthy fashion, you could pay for it down the road.
- [08:53]
Brandon
So let's just say you weren't taking any of them and you put yourself on an 800 calorie diet, it would still be just as bad.
- [09:03]
Alex
Very, very much so.
- [09:04]
Brandon
So aside from the side effects that we don't know, you know what they are just the lack of calories. And I would imagine probably I've learned a lot over the years from consistently working out and I read things and I, you know, have intentionally learned. And I'll bet if I showed you my diet, you could improve it significantly. And so an 800 calorie diet for someone who's not really studied, like what's essential, you know, in those 800 calories, there's probably no way they're getting a quality diet. So that's going to create the problems.
- [09:41]
Alex
It could very well, yes. That's outside of the potential side effects of the medication or medications in and of themselves. Yes. Your nutrition can make or break your health 100%, as we all know. I mean, that's why from a lifestyle perspective, some of us get put on blood pressure medication and cholesterol medication and stuff. There's a reason for that. It usually goes back to our dietary habits.
- [10:07]
Brandon
Right, right.
- [10:08]
Alex
Other lifestyle factors, but yes.
- [10:11]
Brandon
So is there a. Now you mentioned it as a tool. So is there a way to do this in a healthy way or would that be. They would really need some supervision on this and somebody to, okay, if you're going to do this and you know you're going to subsist on 800 calories, they're going to need to know exactly what that needs to be or how can you use it as a tool and get it as healthy as possible.
- [10:36]
Alex
So that's kind of where like probably a sports dietitian, you know, trainer, certified nutrition, et cetera would come into play because you would have those professionals that would be able to help you construct a diet that would meet what your goals are and your body requirement needs are relative to the medication you're taking. So that's where someone like me would come in and say, okay, let's look at the overall quality of the diet and see what areas that you're lacking that we can improve on while minimizing the side effects, you know, so like if there was someone like this and they were at the higher dose range and they hadn't been taking a lot of fiber, but they've been having maybe some constipation or something like that. Well then if they start eating a whole bunch of Good Foods, I.e. high Fiber Foods, the fruits, the vegetables, stuff like that. Well, if they've got a slow GI tract, they're increasing their fiber intake, their hydration, say their water intake is normal or low because again, your hunger and your thirst mechanisms are kind of similar in that regard. So this medication could decrease both of those. Well then when you start, if you were to implement those kind of quote unquote, healthier foods now, you could have actually caused worsening problems with your GI tract because too much fiber with not enough fluid can be counterproductive.
- [11:58]
Brandon
Oh, wow, wow.
- [11:59]
Alex
It kind of can, can get a little stuck in there, for lack of a better word.
- [12:03]
Brandon
Yeah.
- [12:04]
Alex
And so that's again where someone like me would come in in my role. And you know, we'd start with the protein, then we'd probably start and look at the fruit, vegetables, the hydration and see kind of where those things are and then add in any additional fuel or nutrients or food that we would need relative to their activity levels or medical issues or whatever it may be.
- [12:26]
Brandon
So someone is, you know, because I realized, like you said, losing weight is hard. Like when you think of, okay, you're going to have to stay on a diet, you're going to have to get a certain amount of exercise, you're going to have to change some things in your lifestyle, give up some things. It is a hard road to think you're going to have to do this for a while to lose 20 pounds or you can take this pill, you know, and so it's offering a very attractive alternative. So if I was going to say the most important thing that somebody could do if they're going to take, go the route of taking a pill to do this, the most important thing that they could do in addition to that is if it's not you, then to call someone, call a nutritionist and, and get a solid diet, I would definitely.
- [13:14]
Alex
Look at, I mean, and there are some amazing quote unquote, just nutritionists like who have a nutrition certificate degree. But excuse me with you also got to keep in mind, some of these individuals taking these medications are in a category of a population that have other medical issues going on. So that's why I would recommend probably going to see a dietitian first and foremost because they'll also have the medical background. The beauty with me is I also have a sports and physical activity background as well. So I can really help the individuals that are, say, in the gym setting or active individuals or whatever it may be. But yeah, I think finding a dietitian in your area googling to see one that's near you or whatever it may be would be a great complement to you using that medication.
- [14:07]
Brandon
So a dietitian has a medical background, a nutritionist doesn't.
- [14:12]
Alex
Correct.
- [14:12]
Brandon
So if you're a dietician, you're a nutritionist, but if you're a nutritionist, you're not a diet.
- [14:16]
Alex
I was about to say that that's a standard kind of saying in our industry, but I don't want to take anything away. It's just that, yes, the education background in that has a clinical foundation to it.
- [14:29]
Brandon
Okay.
- [14:30]
Alex
And the bulk of dietitians are probably or have been in years past in a clinical setting, in a hospital setting.
- [14:36]
Brandon
Okay, okay. So that, that can really help now ultimately, if you're not taking these for other medical issues and it's just a weight loss thing, the ultimate thing would be to try to see if you can do make a lifestyle change first, to develop some fitness habits and some diet habits and, you know, go that route first if you can, you know, break through and get some of this to be a part of, you know, the way you live your life.
- [15:03]
Alex
Or 100% Ozempic, I believe is the semaglutide compound that I think it's prescribed dose is 2.4 milligrams per injection. So even if you could keep yourself at a lower dose, you know, decreasing the risk of the side effects that come with the higher dosages. And while making those lifestyle changes or dietary changes, whatever may be, might serve you better in the long term. Because I have seen countless, and again, this is just my own personal observation, no, no scientific literature to back this. I have seen countless of individuals that have gotten on these have really great results. But as soon as they got off, their hunger levels were significantly higher than when before they started the medication. And I've talked to several people inside of our facility at the Helena Health Club and outside just in my private practice. So even as you titrate down, you know, maybe you get to a certain dosage that is maybe a little too, or it's high and then you're like, okay, I'm starting to have side effects with that dosage. Let me back this down a little bit. Then again, with each level or each step down, there tends to be, and not everybody, but there's going to tend to be an increase in hunger cues. And that's when those decisions are made. And like I said, it's similar to the sleeves and stuff where I've seen people overeat or eat past that level of comfort, even though they do have a gastric sleeve or bypass or whatever, you can still overdo it and make yourself sick and miserable. Is same thing, you know, as you're weaning off this, unless you plan on being on this medication the rest of your life, you're going to have to face those lifestyle factors that we are trying to work around. You know, it's not, it's, it's. It's hard. I don't want to. But it's doable. That's just it. It's doable. It's you finding that, you know, that the nutrition plan, the fitness routine, that works for you, and it doesn't have to be the same as everybody else. It can be different. There's plenty of ways to approach this.
- [17:07]
Brandon
You know, maybe the hunger coming back stronger is. Maybe you don't want that to go away because maybe that's your body saying, hey, you've been starving me for nutrition, and it's looking for it for you. It's almost forcing you to do it. So maybe you don't want that to go away, but you certainly don't want this thing that you were avoiding now be 10 times stronger either.
- [17:29]
Alex
Well, and that's the kicker is those cues could be your body signaling, hey, feed me, please. Come over here. I'm eating myself from the inside out, quote, unquote, I. E. That's the loss of muscle, Right? Because we're eating our muscle tissue. Because we got to get energy from somewhere. And if we're not doing it from food, then we got to do it from inside the body, which can lead to muscle wasting. But it also could be the mechanisms of those compounds or of that medication that are blocking some of the hormonal signals in the body that increase our hunger cues and. And just our wants, you know, like, do we need cookies? No, but we sometimes have a won't or, you know, that euphoric effect of having a higher sugar food or whatever, it makes you feel good short term.
- [18:13]
Brandon
Right.
- [18:13]
Alex
But so it might not just be your body saying, hey, we got some things going on in here that ain't working for me, but it's also just the makeup of the medication, what the medication is doing inside the body. Yeah, but say the same thing with alcohol. A lot of folks, they'll turn over, you know, a beer and like, oh, this only has so many carbs in it. I was like, okay, that is fair. And that, that is what's on the label. But what happens when we drink the alcohol inside the body? And that's what we don't understand, because it. The alcohol doesn't digest like a carb, it digests like a fat. And it can cause a signal in your body, like switch your liver hormones up to where it promotes fat storage. So even though it says carbs, it doesn't. When it enters the body, the body doesn't treat it like a normal carb would be treated. Alcohol is different in that regard. So that's what a lot of people don't understand.
- [19:07]
Brandon
You know, my app, I think I use myfitnesspal Changed recently used to give you the macros in fat, protein, and carbs. They now have a separate category for.
- [19:18]
Alex
Alcohol because it's higher.
- [19:19]
Brandon
Yeah.
- [19:20]
Alex
Calorie content is higher. Like it's. What is it? 7. 7 calories per gram of carbohydrate?
- [19:26]
Brandon
I think so.
- [19:27]
Alex
Whereas most. Most carbohydrates are 4 grams.
- [19:30]
Brandon
Yeah.
- [19:30]
Alex
4 calories per gram.
- [19:32]
Brandon
Yeah. Yeah.
- [19:33]
Alex
Carbs and fat or carbs and protein are similar. And then fat is the.9. Nine calories per gram. So some of those. The apps will have a alcohol category because it is different.
- [19:44]
Brandon
Yeah.
- [19:44]
Alex
We just assume that it. That it's not. It says carbs, so we think carbs. Well, it doesn't happen like that. It's not treated. The body doesn't treat like that once you ingest it.
- [19:52]
Brandon
Yeah, I know. I saw that on the app and I said, I don't want to deal with you right now. I'm just gonna go with carbs right now and pretend I didn't see you.
- [20:02]
Alex
Yes. 100%.
- [20:04]
Brandon
After the super bowl, maybe I'll, you.
- [20:06]
Alex
Know, I've got many a client. They'll log everything except for that. That whole bottle of wine that they drank. They just want to tell me about that one. They don't want to like, because it is. It's like in your face kind of a self check. It's like, okay, no, I did drink.
- [20:21]
Brandon
Yeah.
- [20:25]
Alex
And. And a lot of times that's. That's where I'll get people. Like, I just don't know why I'm not making progress. My. My diet's doubt in blah, blah. It's like, okay, well, let's look at those liquid calories real quick. You know, whether it's alcohol or sweet tea or sodas, whatever.
- [20:38]
Brandon
Yeah.
- [20:38]
Alex
I was like, yeah, let's look at that and. And see what that looks like.
- [20:42]
Brandon
Yeah.
- [20:43]
Alex
No, but alcohol is a big one and it's. And that's a hard one for people to. To decrease, in my experience. Yeah, that's a tough one. And that's usually one that I try to save for last.
- [20:55]
Brandon
Yeah.
- [20:56]
Alex
Just so I was like, okay, we've. We've made all the other changes that we can make. It's time.
- [21:03]
Brandon
Give me that beer.
- [21:03]
Alex
Yeah, it's. It's. It's time. It's up to you to make that decision. But it's. It's gonna hinder you more than you realize.
- [21:09]
Brandon
Yeah. Yeah, I know. Well, been there.
- [21:14]
Alex
Yes.
- [21:15]
Brandon
So. Well, hey, I appreciate you sharing your thoughts on that. I think that that's some really important Stuff for people to understand in a weight loss journey. That just the effect that some of that has because I don't think they're thinking about those things. And this is what you do for a living. So you know, you know these things.
- [21:35]
Alex
And they're not thinking about it. And none of us would because we know that, hey, this thing is giving me results. And okay, good or bad results. Let's, let's, you know, I had a friend, he did a case study and they did a, it was either a in body scan or bod pod, I can't remember, with some of his clients that had just started taking it. And then they did a follow up without making any other changes in their nutrition or exercise. And I believe it showed a loss of muscle mass in six to eight weeks. And then he, they stayed on the medication, but they changed their diet and they changed their workout routine and it showed that they still lost weight, but they maintain their muscle mass, which is good. I mean, you're going to lose some. Yeah, but if you can prevent that, that is, that is. Yeah, because that's what your goal is, you know, for. If we're taking these things outside of the medical reasons, like for vanity and there's nothing wrong with that. Everybody wants to look good naked. You know, subjectively, I'll set up for.
- [22:37]
Brandon
Looking good with clothes on.
- [22:38]
Alex
Yeah, yeah. You know what I'm saying? But same thing. But, but subjectively you'll, the spouse say, like, yeah, it's great that I'll use a guy, for example. It's great that she lost all the weight, but she also lost her butt, you know. Yeah, you'll hear. And those are, those are common things. And it works in reverse too. I've heard women say something about their husbands as well, like, yeah, great, but he's, you know, he's not as he used to be, you know, and so it's. And even if we do take it for vanity, if we're still not careful or just weight loss, you know, if we're not careful with the other pieces to this, then it may end up not quite the result you want. You know, the skin may be a little saggy when it's all said and done or a little loose and things like that. So there, there are other things that can happen. Even though the number on the scale looks good and the clothes are fitting differently and better, there's some other repercussions you may see down the line and that's not including the medical ones.
- [23:34]
Brandon
And then you got to get surgery. There is that maybe we need to take a pill for vanity, get rid of our vanity.
- [23:40]
Alex
And that's going to be hard to do.
- [23:43]
Brandon
Yeah.
- [23:45]
Alex
100%.
- [23:46]
Brandon
Yeah. Well, well, thank you so much for.
- [23:49]
Alex
And I appreciate you having me.
- [23:51]
Brandon
Yeah. I appreciate you being here, man.
- [23:52]
Alex
Thank you.
- [23:53]
Brandon
Great. All.