January 31, 2024 • 36 mins
Text with your questions & comments for future episodes!
GLP-1's like Ozempic and Monjauro are everywhere these days and being used frequently for PCOS- both for insulin related concerns and weight loss. My opinions and concerns about these medications have been met with real life experience helping many clients use them effectively over the last couple of years and today I'm sharing insights gleaned from this.
Basically, this episode will cover what GLP-1 meds are, how they can help PCOS, if they are worth taking, the biggest concerns, pitfalls, and cautions, and how to lose weight safely, efficiently, and effectively while on them.
If you are currently on a GLP-1 medication like Ozempic for your PCOS or considering taking one, this is my nuanced take on them and I hope it helps!!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome back to an Amber a Day.
I'm your host, amber Fisher.
This is season four.
I'm so excited.
I can't believe that I havebeen doing this since 2018 and
that so many of you have beenalong for the journey.
So thanks for being here.
We're gonna talk today a littlebit about some of my thoughts
on GLP-1 medications, so thingslike Ozympic Majaro I think it's
(00:25):
pronounced with Wagovi WajovI'm not actually sure how it's
pronounced, but these kinds ofmedications that people are
using these days for insulinresistance, pcos and
particularly for weight loss.
So we're gonna talk about someof those today, but before we do
, I want to do a little bit ofhousekeeping.
First, welcoming you to seasonfour.
That's what's on my notes.
(00:45):
So welcome to season four.
This year, I've got some stuffplanned out for us that I'm
really excited about.
I've got a podcast that'salready in the editing works
with my good friend, dr KaliaWaddles, who runs the functional
fertility account on Instagramand TikTok, and her and I are
going to be discussingmitochondrial health in PCOS,
(01:06):
and I know that maybe sounds alittle bit boring or overly
sciencey, but, trust me, we makeit very interesting and the
mitochondria actually make areally big difference in PCOS.
So if you're interested inmanaging your PCOS from a
cellular perspective, you'regonna want to listen to that
podcast with Kalia.
I've also got some other greatguests coming up with topics all
(01:26):
around eating, disorderedeating, behaviors in PCOS, and
new research that's come outabout PCOS and pregnancy, and
you know just lots of otherthings that I have in the works
for you guys, topics that willcome up as the year goes on.
So I'm excited to share all ofthis with you.
(01:48):
I want to mention because it isthe beginning of a new year and
it's typical this time of yearfor people to want to start
doing something about theirhealth, and when you have PCOS,
you know it often times in newyears when you're like, okay,
I'm gonna actually buckle downthis year and start taking care
of some of these symptoms thatI'm having.
So if that's you, if that's thecase for you, then I just want
(02:10):
to recommend to you a coursethat I've created called PCOS
Foundations.
It's a four-week course,itself-paced, so you can do it
at whatever pace you'd like.
You don't have to complete itin four weeks.
You have lifetime access to it,but it's a series of lectures
that I created with likePowerPoint presentations for you
(02:30):
guys all about the foundationsof PCOS nutrition, so what I
think you need to know and to doin order to really address your
PCOS symptoms from the rootcause.
So it's all based on principlesof functional nutrition and
it's all based on the work thatI have done with clients for the
last nine years.
We're going on a decade ofprivate practice working with
(02:50):
PCOS.
So I have a lot of experienceunder my belt and I've seen a
lot of success stories and Ikind of distill everything that
I've noticed, learned,researched, all that into this
course in a way that is notgoing to be super overwhelming.
So I have another course calledFunctional PCOS and you know
some other stuff going on, andone of the things that I have
heard consistently aboutfunctional PCOS is it's very
(03:13):
interesting, there's a lot ofinformation and it's a real deep
dive, but it can be a bitoverwhelming when you are first
just trying to make changes.
You know, not all of us want tobe like me and think about PCOS
all the time.
Right, you just want someone totell you this is what you, how
you need to eat.
These are the things that youneed to do.
Let's implement them and get onwith our lives.
So that's what PCOS Foundationis all about.
(03:33):
It comes with a meal plan,recipes, grocery lists with
those recipes, so it's organizedfor you.
All you have to do is, you know, buy the food, watch the
lectures, learn, look at my faceand yeah, and you'll come away
with that knowing a lot moreabout PCOS.
So if you are, you know,starting off your new year
(03:53):
thinking about that, then thatmay be a good resource for you
and I will link it in the shownotes below.
So, today's episode what are wetalking about?
Well, I just got off of a callwith a client Interestingly
enough, I plan to record thispodcast already and then her and
I met and one of my clients Iwon't mention her name, but she
(04:13):
is on the GLP1 medications.
She's taken ozympic and thenrecently was switched by her
doctor to manjaro, and her and Ihave had a lot of good
discussions about these GLP1sbecause her observation in her
community has been that a lot ofher girlfriends have kind of
gotten on these medications, andwith some success.
(04:34):
Right, they've lost some weightand everything, but aren't
changing their dietary habits atall.
They're basically, you know,they're still going and mostly
eating, you know, fast food andnot really watching the makeup
of their diets at all, and a lotof them are kind of stalling
out in their weight loss or someof them are continuing to lose
weight, and her frustration waswhy are they losing weight while
(04:56):
they're not paying attention atall to the quality of the food
that they eat?
And yet I'm paying attention somuch to the quality of what I
eat and to you know the ratiosand the macronutrients and all
of that stuff, and I'm losingweight, but it's slower.
And so I had some thoughts onthat that I thought I would
share with you, because from theoutside, it might look like she
(05:16):
is not as successful as herfriends, and a lot of people
will say things like well, thisis just clearly fact that
calories are the only thing thatmatters, and you know these
women are clearly they're justnot eating very much.
They're appetite suppressed andso they can eat whatever they
want, but they're not hungry forthat much, and so that's why
(05:37):
they are losing so much weight,and that's the success right.
So often in our culture and thisis the case not just for the
culture at large, but even inour medical culture, like when
you go to your doctor.
What is the one symbol ofsuccess that they hyper focus on
?
It's the number on the scaleand how much you weigh.
It's not how inflamed you areor aren't.
(05:59):
It's not how flared up yourautoimmune condition is or isn't
, you know.
It's not how balanced yourhormones are.
It's all about how much do youweigh, how much weight have you
lost, and if you starve yourselfto get there, well, good for
you.
You've done it, you know you.
You conquered the, the weightbeast, and that's all that
(06:19):
matters.
So I have a lot of like reallycomplicated feelings about these
drugs, and that's why I kind ofthought I'd do the podcast
today.
So I wrote down some notes.
My talking style, as you guysknow if you've listened to the
podcast before sometimes I goall over the place.
I think this topic inparticular is going to send me
(06:39):
in a lot of different places,but I just want to get these
things out there because I get alot of questions from followers
on social media and fromclients.
They're being offered thesemedications and they want to
know what my advice is or what Ithink that they should do.
I think my answer tends tosurprise them, because I'm not
(07:00):
anti-GLP ones.
I actually think, in the rightcontext, that they can be very,
very helpful.
Let's talk about some of thethings that I think are helpful
about GLP ones.
The most helpful thing is thatthey balance your blood sugar
and insulin levels quite a bit.
If you are very insulinresistant, and particularly if
you're insulin resistant andleptin resistant, which means
(07:20):
that you have the insulinresistant stuff going on but
also you have trouble with yourhunger cues and signals, you
tend to be hungrier than yourbody necessarily is.
You feel hungrier than younecessarily are.
Glp ones are great because whenyou're on them this is what I
hear, what I've observed,because I've never taken them
myself what you experience is ahuge reduction in food noise.
(07:46):
Food noise is like the mentalchatter in your brain around
food when you have insulinresistance and when you have
leptin resistance, when you havePCOS, you know that oftentimes
running in the back of your mind, as if it's a computer tab
that's open all the time, isyour thoughts about food.
You think about what you'regoing to eat next.
(08:07):
When you're going to eat, itcan't wait until you can have
this or that, or go out to thisrestaurant or whatever.
I think it's human nature tothink about food because food is
survival right.
We're programmed to think aboutfood.
With these sorts of medicalconditions, we tend to think
about food like we're thinkingabout it a lot.
In a lot of cases it can bedebilitating when you're so
(08:31):
hungry all the time that all youcan think about is food and you
can't focus on other things.
You struggle really hard withdieting or restriction of any
kind because of those thoughtsaround food.
It can make things like aweight loss journey very
difficult, because a weight lossjourney kind of includes a
(08:51):
little bit of restriction incertain areas, right?
One reason why people tend tonot be super successful with
long-term weight maintenancewhen they have these sorts of
conditions is that food noise.
It's always there in thebackground.
The GLP ones do a pretty goodjob of cutting back on that food
noise, at least insofar as weknow, because they haven't been
(09:16):
around that long.
Right, people haven't beenusing them for weight loss and
PCOS for that long.
I don't know what things aregoing to look like in 10 years
on a GLP one, but at leastcurrently that seems to be the
feedback that I'm getting from alot of people.
That's a gift.
That's a real gift and a realplus in the corner of GLP ones.
(09:36):
There are also a lot oflong-term risks and implications
of having insulin resistancethings like heart disease and
just all kinds of other chronichealth conditions diabetes,
things like that that can causea range of issues.
You're at increased risk whenyou have insulin resistance and
(09:57):
a lot of that is that underlyingsort of insulin blood sugar
volatility, all that stuff.
It's not great for your body,right.
It's damaging for your cellularhealth and kind of ages your
cells maybe faster than whatthey normally would.
That's one reason why people Idon't know if you've ever seen
this before, but I've seen a lotof talk about using metformin
(10:19):
another kind of drug thatmanages insulin responses as an
anti-aging drug, because thatblood sugar volatility and the
ups and downs with it is one ofthe things that ages the cells.
Aging is not just how we look,but also how our organs and
cells and everything function.
There are some real long-termrisks with unmanaged insulin
(10:43):
resistance for sure.
I think the GLP ones have thepotential to be a really big
gift for that.
I should mention here in thispodcast that I'm not a medical
doctor, I'm a nutritionprofessional.
You need to definitely.
What I'm doing here is dippingmy toe into a realm that's like
(11:07):
it overlaps with my scope butit's a little bit out of my
scope because these areprescription medications that
you couldn't come to me to workwith me one-on-one and I could
prescribe you a simpic.
It doesn't work that way.
I take everything I say with agrain of salt and make sure that
you discuss all this with yourhealthcare provider.
I think there are some reallybig positives to them.
The negatives, however, areconcerning to me, and mostly
(11:36):
from the standpoint of a personwho doesn't want to or doesn't
have the energy or the desire tosort of manage the other side
of their health.
What I mean by that is let'stake my client, for example.
So she's kind of the best casescenario of being on a GLP one.
She came to work with me soonafter she was prescribed it so
(11:59):
that she could use theopportunity of having reduced
food noise and, you know, havingthe weight loss sort of happen
in the background.
So she could use thatopportunity to manage her food
habits, to kind of get onto aroutine, to make better choices
and to come up with sort of asolution to a lot of these
(12:23):
overeating, you know, bingingand restricting behaviors that
she'd done in the past.
And so, while she is in thissweet spot of like she's not
having to really worry about theweight loss, because it's kind
of taking care of itself, she'salso learning how to eat enough
protein, she's learning how tomanage her macronutrients, she's
learning how to get herexercise in order, she's
(12:45):
learning how to eat inmoderation the things that she
really wants to eat.
So there's a lot of positivesto her journey with that, and
the Monjaro or the Ozympic orwhatever is just a tool that
she's using as part of thatjourney, whereas some of her
friends, for example, they'reusing these medications as, like
, weight loss easy ways out.
(13:07):
And don't get me wrong, I wouldlove, I would love nothing more
than for there to be a weightloss easy way out, like I would
take it if it was like safe andeasy.
Sign me up, okay, because Ihave PCOS too, I have insulin
resistance too, and I've beenopen recently with some people
about how I'm currently on alittle bit of a weight loss
(13:28):
journey myself.
Over the last few years sinceI've become a mom, particularly
once my son started walking mylife got a lot more hectic and
complicated and stressed and alot of my healthy habits sort of
didn't go out the windowcompletely, but I had trouble
sticking with them, especiallyduring those kind of stressful
times, and so I've gained someweight back.
(13:50):
So I'm in the process of tryingto lose about 20 pounds that
I've kind of regained, and it'stough.
I haven't had to do this in along time, and so I'm being
re-confronted with all theuncomfortableness about weight
loss, not just, you know,emotionally.
Of course there's a lot ofdiscomfort emotionally with,
like having to take stock of mybehaviors and and my thoughts
(14:12):
and all these things around food, but also physically.
It's not fun to be hungry, andin order to lose weight you do
sort of have to be a little bithungry sometimes.
So all of that is tough.
So I understand the desire for aweight loss miracle and I'm
kind of hopeful that one daythey may find something right,
because it does seem to me thata lot of weight issues there's a
(14:36):
genetic component to them thatis part of the evolutionary
process of like humanity sort ofgetting to where we are now.
We've gone through ourhistorically humanity has gone
through a lot of like thingslike feasts and famines and all
these other things that are outof sync with the modern context
where we tend to have a lot oflow quality but cheaply
(14:58):
available food at our fingertips.
So we're not set up to handlethat, particularly if we have
PCOS, and so I'm hopeful aboutthat and I'm like totally on
board with you know, keeplooking for it, right.
But what makes me nervous aboutthese is that I don't think
they're quite good enough to beused as just complete miracle
drugs, the reason being that oneof the main ways that they work
(15:23):
is not just by managing theinsulin responses, but also by
suppressing appetite, and sowhat I'm seeing with with
certain people is very similarto what I see, what I've seen
before, when clients have beenprescribed something like
Adderall, like maybe they werediagnosed with ADHD and they got
an Adderall, and at first it'slike this wonderful feeling
(15:43):
because it's like, oh, myappetite suppressed.
Less food noise like that'samazing.
But with time it becomes thisthing where the appetite
suppression actually is, causesproblems around the relationship
to food, because you starthaving what we call food
aversions.
So, particularly healthy foodsthat would be good for you to
(16:05):
continue eating because they'renutrient dense and because they
contain a lot of the things thatyour cells need to function.
Vitamins, minerals, all thatkind of stuff become disgusting
to you or you don't really wantto eat them, and so you end up
doing this thing where, likewell, your appetite suppressed
so you could just not eat, right, or you could just have a
protein shake and call it a day,and you don't have to think
(16:26):
about it and you're losingweight and that's great and you
feel good because you're kind ofin that fasting mode and you're
, you know the weight's comingoff without you having to try,
and so it's exciting and you'regetting positive reinforcement
for those behaviors.
But long term, what happens whenthe appetite suppressant effect
wears off?
I don't know.
(16:48):
I have had some clients who'vetold me that with time, these
medications stop being aseffective for them and so they
have to go and get more or theyhave to switch to a different
one, right, and so I've seenthat happening and I'm wondering
, like, okay, what happens ayear from now?
Right, when we need to switchagain, but there's nothing else
(17:08):
to switch to, or we've kind ofhit our max with how helpful
it's going to be.
Or, like in the case of, like,true appetite stimulants or
whatever, like Adderall, whathappens when your body pendulum
swings into this mode where it'slike I've been starving and I
need to eat and so it reallykicks up your appetite and
(17:28):
everything.
The long-term risks associatedwith that are what kind of
concern me from a nutritionperspective?
I'm not talking about from, like, a medical perspective or a
health perspective, becausethat's outside of my scope, but
I'm talking purely from anutrition standpoint, like what
happens when a person has beenessentially in starvation mode
(17:49):
for a couple of years, hasn'tbeen eating their veggies,
hasn't been getting theirnutrients and they've depleted a
lot of their resources and thenthey either the appetite
suppression wears off, they runout of you know things to switch
to if they need to switch, orthey get off of it completely
(18:09):
and all of that pent up energycomes back.
You know the body's like we'vebeen starving, and this is very
similar to the concept of like.
If you've ever done yourtypical diet before, right, the
whole yo-yo effect.
You tend to be excited at thebeginning.
You lose a lot of weight.
A lot of people push themselvestoo hard to lose too fast.
(18:30):
They lose all the weight andthen, as soon as they get to the
point where they're, you know,maybe five pounds from their
goal, or they've reached theirgoal or whatever, and they're
happy.
All of a sudden, the hungersignals kick back up and now
they're twice as hungry as theywere before, because their body
is trying to reach a certainequilibrium.
I think that's just humannature, that the body likes to
(18:51):
have an equilibrium.
It doesn't like to feel likeit's starving.
People often forget that bodyfat is a survival mechanism.
So maintaining that body fat isdeeply primal for the body.
It wants to hold on to it right?
So what I have heard through thegrapevine I will not reveal my
(19:13):
sources, but I have spoken withsome people who run a popular
weight loss DLP1 program and Iknow somebody who's associated
with them.
Anyway, what I heard throughthe grapevine from them is that
a lot of doctors are thinkingnow that the most effective way
(19:35):
to kind of use these medicationsor utilize these medications
would be to keep the person onit permanently.
So essentially, the idea isthere's something fundamentally
wrong with the way that yourinsulin responds and so, because
of that, this medication isgoing to even you out and you're
(19:57):
going to need to be on it forlife so that it can continue to
do its job, because there'ssomething fundamentally wrong
with you and with the way thatyou process carbs.
And while I do think that theremay be some truth to that,
right, like those of us withPCOS always, kind of say, with
diet changes, one of the hardthings about having PCOS is that
we do have to try harder thanother people right, to get the
(20:17):
same results, to maintain thoseresults, because there are all
those genetic influences.
So I think there's some truthin that.
But my concern is if you, if themedication is necessary to kind
of maintain its effect, youneed to stay on it for life,
what happens when theseinsurance companies don't want
to pay for it or this or that?
(20:39):
I mean the whole like theinsurance company stuff that's
going on with getting thesemedications covered.
The pharmacy is not being ableto stock them, people who really
, really need them, like typetwo diabetics, not being able to
get them because so many peopleare using them for weight loss.
I mean these are a lot of likesystemic issues with this drug
(20:59):
that may over time, you know,fix themselves.
I mean there's, since there's arun on them now, right, but the
interest will die down or therewill reach some sort of
equilibrium.
But I guess my concern is likewhat if they stop being covered
or they're not covered to beginwith?
These aren't cheap drugs, right?
They're very expensive, atleast currently.
So until that changes, I'm not100% sure that it would be worth
(21:23):
it for most people.
Maybe somebody who hasunlimited financial resources
could pay, you know, five to$900 a month for their Zimpik,
until the prices go down.
But you know what I mean.
It's just like that kind ofconcerns me from a financial
perspective, like throwing allof this money into something
that eventually, I may not beable to afford anymore.
I may have to go off of itanyway.
So that's why, then.
(21:48):
That's not to say that youshouldn't do it, but that is to
say that you need to have aclear vision of what the whole
process looks like.
So, instead of focusing on thebeginning part of like I'm going
to get on this, I can affordthis now.
It's going to make me loseweight.
Think, while you are in thosephases of losing weight, think
(22:11):
about the future.
Think about what happens incase you're not on it.
What happens in case you can'tafford it anymore?
What are you going to do andwhat habits do you need to build
now so that there's secondnature for you when you go off
of it.
What things do you need to doto be cautious with your body so
that you don't send your bodyinto this like major starvation
pendulum swing thing.
(22:34):
There really are no easy waysout with weight loss,
unfortunately, and so what Ithink the most effective way to
use these medications is to usethem as a tool to implement
positive lifestyle changes,without a lot of mental noise
and while actually havingsuccess with, like, those
changes, getting the weight off.
Because, yes, it's absolutelythe case that there are some
(22:55):
people with insulin resistancewho I've worked with before who
their insulin resistance was sosevere that, even when they were
doing everything right, stilltheir body kind of wanted to
maintain status quo and it waslike almost a snowball that had
to get rolling.
They had to lose some weightbefore the weight would really
start to come off, which is kindof frustrating.
(23:16):
Well, isn't kind of frustrating, it's very frustrating.
Here's what I think as far ashow they should be used.
When you get on a DLP one, youshould be also on a nutrition
plan, if possible, working withsomebody, one-on-one or in
(23:40):
person, or taking a doing.
You know, shout out to selfpromotion here, but like being
in, like my PCOS EssentialsAcademy group program, right,
which I'm currently in themiddle of one of my cohorts
right now, but we'll probablyrun another one in the summer or
something like that so that canbe a good resource that cuts
(24:01):
down budget wise on what itwould cost to see a dietitian
one-to-one or yeah, like seeinga dietitian one-to-one, working
one-on-one with a nutritionprofessional, somebody who's
acquainted with your uniquehealth circumstances, so
somebody who has specialty inPCOS.
And if not, that then takingsome having some sort of course
that you go through to get thebasics, so that you kind of know
(24:22):
what you need to be doing ifyou're very self motivated,
right.
So there are a lot of differentways to do it, but the mistake
that people tend to make is theyget on the medication and
they're just kind of like let merelax for a while and not think
about anything else.
But this is really when youhave this profound opportunity.
(24:42):
Top on your priority list needsto be reducing muscle loss when
we don't eat enough whether wedon't eat enough because we're
not hungry, or whether we don'teat enough because we're
starving or fasting or what haveyou.
When we don't eat enough, wetend to lose muscle mass.
We need to eat a certain amountof protein every day to
maintain our muscle mass, andideally we would even try to
(25:08):
maybe increase our muscle mass,which, fair enough, is very
difficult while you are losingweight, but we could at least
try to maintain what we have.
This is key because muscle massis kind of the major factor in
what burns calories at rest.
So if you have more muscle,just lay it on the couch, you're
going to burn more caloriesthan somebody who has less
(25:29):
muscle who's doing the samething.
And this becomes really, reallykey in the maintenance phases,
because more muscle could meanas much as a couple hundred
extra calories a day, whichmeans an extra snack, which
means eating a slightly biggermeal.
There's a lot of different waysthat it helps, and that's
important because when you're inthe maintenance phase you're
not going to want to track allthe time, right, you're going to
(25:51):
be tired, fatigued from theprocess and so and I don't
recommend that you track foreverbut if you have a little bit
more of a cushion or a wiggleroom, then it's easier to
maintain.
So top priority is maintainingyour muscle loss and maintaining
your muscle mass, and the wayyou do that is by eating enough,
particularly enough protein,and continuing to do strength
(26:13):
training.
So that's like priority one.
Priority two is maintainingyour nutrient status and
remembering that weight is notthe only indicator of health.
Oftentimes, weight is a symptomof underlying issues that need
to be corrected, and so this iswhere food quality comes in.
(26:36):
Yes, if you eat less foodquantity, you will probably lose
weight, at least at thebeginning, and many people can
get all the way to their goalwithout really focusing on
nutrient quality At all.
There's truth in that, butthat's not the best way to do
things, because your body needsvitamins, minerals, nutrients,
(26:58):
your gut needs fiber.
You need all of these things,and so making sure that you are
managing for your protein andthat you're managing for your
vegetables, fruits and otherlike plant based foods, legumes,
particularly like things thatare going to give you a lot of
fiber, eating as many wholefoods as possible If you can do
(27:20):
those things while still beingon these medications and losing
the weight, then you're goldenright, and so the question that
my client had was why is herweight loss lower than her
friends?
Well, likely it's because herfriends, while they are still
going to McDonald's and whatever, they're eating a lot of fast
food.
They're probably also just noteating very much at all compared
(27:43):
to her, because maybe they'rehaving one meal a day and
they're getting whatever theywant, but they're probably just
eating a few bites of it becausetheir appetites are really
suppressed, whereas with her,I'm almost forcing her to eat
more than what she wants to.
She's not hungry for a lot ofit, but she's having to eat more
to meet her macronutrient goals, because what I'm trying to do
with her is have her lose weightat a rate that's sustainable
(28:05):
and healthy for her body.
Just because we can lose weightfast doesn't mean we should.
Several reasons for that.
I talked already about the kindof the pendulum swing effect,
but another thing that'simportant to understand is that,
especially if you've hadhormonal issues, quick weight
loss can be a trigger forgallbladder dysfunction.
A lot of people, after a bigweight loss journey, they often
(28:28):
need to get their gallbladderstaken out because it was so hard
on their body.
There are other things going onbesides just losing weight
Muscle mass, pendulum swinging,gallbladder health, hormone
health in general can get alittle jacked up during major
stressors, and starvation is astressor.
(28:48):
What I'm doing with her isfeeding her more than what she
feels she needs on these GLPones because her medication is
suppressing her appetite, butI'm still feeding her
significantly less than would bea maintenance amount of food
for her.
(29:09):
She's on a calorie deficit, butit's not just a calorie deficit,
it's a structured caloriedeficit, so it's not too much of
a calorie deficit.
She's not eating thousands ofcalories less than what she
should.
She's not eating to lose likethree pounds a week.
She's on a calorie deficit, butit's also a calorie deficit
(29:33):
that's managed around hermacronutrient needs.
So how much protein she needs,how much fiber she needs.
It's also managed around howmany micronutrients she needs
vitamins, minerals, all thatkind of stuff.
This doesn't have to becomplicated.
I know it sounds complicatedbut at the end of the day,
eating more whole foods andmaking sure that you're eating
about a palm-sized amount ofprotein with each of your meals
(29:55):
it's kind of all you have to dofor most people, especially if
you're on one of these meds,right?
So it's not like this thingwhere she has to calculate out
have I eaten this many grams ofthis or that?
No, she just eyeballs like okay, I need to make sure that I'm
eating like this much protein.
And then, on top of that, I'llmake sure that I'm eating
veggies at each of my meals.
(30:17):
I make sure that when I havesnacks, that my snacks are whole
food snacks, so they're likefruit with like some sort of
protein source, maybe peanutbutter or nuts or something like
that.
You know these kinds of thingsthat can really become second
nature over time.
And so her weight loss is goingslower than her friends, but
it's at the rate that I did themath so that we would expect and
(30:38):
that's the key right Like it'sgoing according to the plan.
The plan was to lose weightslow and steady.
Slow and steady really does winthe race when it comes to
weight loss.
Now the research does show thatwhether you lose weight quickly
or slowly, you're just aslikely to regain it, which is
(30:59):
kind of a bummer.
But what I think that researchdoesn't take into account is
things like muscle mass and whatthe long, long, long term
implications of losing that kindof weight at a slower pace
versus a faster pace might looklike.
I'd be very interested to seelike a 30-year study on this or
(31:19):
something like that.
But regardless, if you want tohave the most chance of success
at maintaining strength training, making sure you're eating
enough protein, making sureyou're still eating quality food
most of the time.
The other thing that's reallypowerful that I'm having her
work on is moderation.
So often we have insulinresistance.
(31:40):
We tend to eat go all out.
So we go get fast food andwe're gonna get the whole thing,
we're gonna get the basket offries right.
What she's learning, with thehelp of these GLP ones as a tool
, is to eat a small portion andthis is good for her muscle
(32:02):
memory because, yes, later on,if she gets off these
medications, she may be hungrierfor more.
But if she has built that habitof like I'm gonna be okay, I
don't physically need to eatthis entire thing, like I can
stop, and that's fine.
And if she's learned that likethat's possible, not just with
whole foods and like thehealthiest healthiest foods, but
(32:23):
also with things like fast foodand restaurants and things that
we're all gonna do right, it'snot realistic to say you're
never gonna do that stuffanymore.
We build it in.
So the majority of the week iswhole foods.
The majority of the week is youknow, everything's managed, but
a couple times a week, you know, maybe we're getting some
Chick-fil-A and we're learninghow to not order the 12-count
(32:48):
with the extra large fries.
Right, we're getting a smallermeal and we're just letting that
be enough, or we're getting thesalad or whatever you know.
So just learning to makedifferent choices, the muscle
memory of that is good.
From a neurological perspective,like from your brain's
perspective, food is not allabout hunger and what you're
putting in your mouth anddiscipline and willpower.
(33:09):
It's also about just buildingsecond nature habits, muscle
memory.
I, for the last six months I'vebeen salsa dancing and the
difference between when Istarted to now is that I can do
arm styling and all kinds ofdifferent things.
Now, because my footwork ismuscle memory, I don't have to
(33:30):
think about my footwork anymore,it just comes to me.
And so now I can play with themoves more, I can start adding
more, and it's the same thingwith nutrition.
At first it's gonna feel like alot just learning those first
basic steps, but once those aredown pat, once you've got a good
grasp on them, then you canstart to add more, to start
(33:52):
thinking about things likeyou're you know meeting a fiber
goal or you know what have youLike you can add to it and it's
not so draining or stressful.
So I think those are all mythoughts on the GLP One, so I
hope this was helpful.
Let me know if it was.
Leave a comment, leave a reviewon Apple Podcasts particularly
(34:16):
the reviews really help and letme know if this was helpful for
you on your GLP One journey oron your thoughts about GLP Ones
and if I missed anything that Ishould have covered.
Also, let me know that too.
I again I'm grateful for youguys for sticking with me on the
podcast here and hope I'mexcited about the year to come
(34:37):
and all the things that I've gotin store for you guys.
So I will see you next week.
Bye.
Welcome back to an Amber a Day.
I'm your host, amber Fisher.
This is season four.
I'm so excited.
I can't believe that I havebeen doing this since 2018 and
that so many of you have beenalong for the journey.
So thanks for being here.
We're gonna talk today a littlebit about some of my thoughts
on GLP-1 medications, so thingslike Ozympic Majaro I think it's
(00:25):
pronounced with Wagovi WajovI'm not actually sure how it's
pronounced, but these kinds ofmedications that people are
using these days for insulinresistance, pcos and
particularly for weight loss.
So we're gonna talk about someof those today, but before we do
, I want to do a little bit ofhousekeeping.
First, welcoming you to seasonfour.
That's what's on my notes.
(00:45):
So welcome to season four.
This year, I've got some stuffplanned out for us that I'm
really excited about.
I've got a podcast that'salready in the editing works
with my good friend, dr KaliaWaddles, who runs the functional
fertility account on Instagramand TikTok, and her and I are
going to be discussingmitochondrial health in PCOS,
(01:06):
and I know that maybe sounds alittle bit boring or overly
sciencey, but, trust me, we makeit very interesting and the
mitochondria actually make areally big difference in PCOS.
So if you're interested inmanaging your PCOS from a
cellular perspective, you'regonna want to listen to that
podcast with Kalia.
I've also got some other greatguests coming up with topics all
(01:26):
around eating, disorderedeating, behaviors in PCOS, and
new research that's come outabout PCOS and pregnancy, and
you know just lots of otherthings that I have in the works
for you guys, topics that willcome up as the year goes on.
So I'm excited to share all ofthis with you.
(01:48):
I want to mention because it isthe beginning of a new year and
it's typical this time of yearfor people to want to start
doing something about theirhealth, and when you have PCOS,
you know it often times in newyears when you're like, okay,
I'm gonna actually buckle downthis year and start taking care
of some of these symptoms thatI'm having.
So if that's you, if that's thecase for you, then I just want
(02:10):
to recommend to you a coursethat I've created called PCOS
Foundations.
It's a four-week course,itself-paced, so you can do it
at whatever pace you'd like.
You don't have to complete itin four weeks.
You have lifetime access to it,but it's a series of lectures
that I created with likePowerPoint presentations for you
(02:30):
guys all about the foundationsof PCOS nutrition, so what I
think you need to know and to doin order to really address your
PCOS symptoms from the rootcause.
So it's all based on principlesof functional nutrition and
it's all based on the work thatI have done with clients for the
last nine years.
We're going on a decade ofprivate practice working with
(02:50):
PCOS.
So I have a lot of experienceunder my belt and I've seen a
lot of success stories and Ikind of distill everything that
I've noticed, learned,researched, all that into this
course in a way that is notgoing to be super overwhelming.
So I have another course calledFunctional PCOS and you know
some other stuff going on, andone of the things that I have
heard consistently aboutfunctional PCOS is it's very
(03:13):
interesting, there's a lot ofinformation and it's a real deep
dive, but it can be a bitoverwhelming when you are first
just trying to make changes.
You know, not all of us want tobe like me and think about PCOS
all the time.
Right, you just want someone totell you this is what you, how
you need to eat.
These are the things that youneed to do.
Let's implement them and get onwith our lives.
So that's what PCOS Foundationis all about.
(03:33):
It comes with a meal plan,recipes, grocery lists with
those recipes, so it's organizedfor you.
All you have to do is, you know, buy the food, watch the
lectures, learn, look at my faceand yeah, and you'll come away
with that knowing a lot moreabout PCOS.
So if you are, you know,starting off your new year
(03:53):
thinking about that, then thatmay be a good resource for you
and I will link it in the shownotes below.
So, today's episode what are wetalking about?
Well, I just got off of a callwith a client Interestingly
enough, I plan to record thispodcast already and then her and
I met and one of my clients Iwon't mention her name, but she
(04:13):
is on the GLP1 medications.
She's taken ozympic and thenrecently was switched by her
doctor to manjaro, and her and Ihave had a lot of good
discussions about these GLP1sbecause her observation in her
community has been that a lot ofher girlfriends have kind of
gotten on these medications, andwith some success.
(04:34):
Right, they've lost some weightand everything, but aren't
changing their dietary habits atall.
They're basically, you know,they're still going and mostly
eating, you know, fast food andnot really watching the makeup
of their diets at all, and a lotof them are kind of stalling
out in their weight loss or someof them are continuing to lose
weight, and her frustration waswhy are they losing weight while
(04:56):
they're not paying attention atall to the quality of the food
that they eat?
And yet I'm paying attention somuch to the quality of what I
eat and to you know the ratiosand the macronutrients and all
of that stuff, and I'm losingweight, but it's slower.
And so I had some thoughts onthat that I thought I would
share with you, because from theoutside, it might look like she
(05:16):
is not as successful as herfriends, and a lot of people
will say things like well, thisis just clearly fact that
calories are the only thing thatmatters, and you know these
women are clearly they're justnot eating very much.
They're appetite suppressed andso they can eat whatever they
want, but they're not hungry forthat much, and so that's why
(05:37):
they are losing so much weight,and that's the success right.
So often in our culture and thisis the case not just for the
culture at large, but even inour medical culture, like when
you go to your doctor.
What is the one symbol ofsuccess that they hyper focus on
?
It's the number on the scaleand how much you weigh.
It's not how inflamed you areor aren't.
(05:59):
It's not how flared up yourautoimmune condition is or isn't
, you know.
It's not how balanced yourhormones are.
It's all about how much do youweigh, how much weight have you
lost, and if you starve yourselfto get there, well, good for
you.
You've done it, you know you.
You conquered the, the weightbeast, and that's all that
(06:19):
matters.
So I have a lot of like reallycomplicated feelings about these
drugs, and that's why I kind ofthought I'd do the podcast
today.
So I wrote down some notes.
My talking style, as you guysknow if you've listened to the
podcast before sometimes I goall over the place.
I think this topic inparticular is going to send me
(06:39):
in a lot of different places,but I just want to get these
things out there because I get alot of questions from followers
on social media and fromclients.
They're being offered thesemedications and they want to
know what my advice is or what Ithink that they should do.
I think my answer tends tosurprise them, because I'm not
(07:00):
anti-GLP ones.
I actually think, in the rightcontext, that they can be very,
very helpful.
Let's talk about some of thethings that I think are helpful
about GLP ones.
The most helpful thing is thatthey balance your blood sugar
and insulin levels quite a bit.
If you are very insulinresistant, and particularly if
you're insulin resistant andleptin resistant, which means
(07:20):
that you have the insulinresistant stuff going on but
also you have trouble with yourhunger cues and signals, you
tend to be hungrier than yourbody necessarily is.
You feel hungrier than younecessarily are.
Glp ones are great because whenyou're on them this is what I
hear, what I've observed,because I've never taken them
myself what you experience is ahuge reduction in food noise.
(07:46):
Food noise is like the mentalchatter in your brain around
food when you have insulinresistance and when you have
leptin resistance, when you havePCOS, you know that oftentimes
running in the back of your mind, as if it's a computer tab
that's open all the time, isyour thoughts about food.
You think about what you'regoing to eat next.
(08:07):
When you're going to eat, itcan't wait until you can have
this or that, or go out to thisrestaurant or whatever.
I think it's human nature tothink about food because food is
survival right.
We're programmed to think aboutfood.
With these sorts of medicalconditions, we tend to think
about food like we're thinkingabout it a lot.
In a lot of cases it can bedebilitating when you're so
(08:31):
hungry all the time that all youcan think about is food and you
can't focus on other things.
You struggle really hard withdieting or restriction of any
kind because of those thoughtsaround food.
It can make things like aweight loss journey very
difficult, because a weight lossjourney kind of includes a
(08:51):
little bit of restriction incertain areas, right?
One reason why people tend tonot be super successful with
long-term weight maintenancewhen they have these sorts of
conditions is that food noise.
It's always there in thebackground.
The GLP ones do a pretty goodjob of cutting back on that food
noise, at least insofar as weknow, because they haven't been
(09:16):
around that long.
Right, people haven't beenusing them for weight loss and
PCOS for that long.
I don't know what things aregoing to look like in 10 years
on a GLP one, but at leastcurrently that seems to be the
feedback that I'm getting from alot of people.
That's a gift.
That's a real gift and a realplus in the corner of GLP ones.
(09:36):
There are also a lot oflong-term risks and implications
of having insulin resistancethings like heart disease and
just all kinds of other chronichealth conditions diabetes,
things like that that can causea range of issues.
You're at increased risk whenyou have insulin resistance and
(09:57):
a lot of that is that underlyingsort of insulin blood sugar
volatility, all that stuff.
It's not great for your body,right.
It's damaging for your cellularhealth and kind of ages your
cells maybe faster than whatthey normally would.
That's one reason why people Idon't know if you've ever seen
this before, but I've seen a lotof talk about using metformin
(10:19):
another kind of drug thatmanages insulin responses as an
anti-aging drug, because thatblood sugar volatility and the
ups and downs with it is one ofthe things that ages the cells.
Aging is not just how we look,but also how our organs and
cells and everything function.
There are some real long-termrisks with unmanaged insulin
(10:43):
resistance for sure.
I think the GLP ones have thepotential to be a really big
gift for that.
I should mention here in thispodcast that I'm not a medical
doctor, I'm a nutritionprofessional.
You need to definitely.
What I'm doing here is dippingmy toe into a realm that's like
(11:07):
it overlaps with my scope butit's a little bit out of my
scope because these areprescription medications that
you couldn't come to me to workwith me one-on-one and I could
prescribe you a simpic.
It doesn't work that way.
I take everything I say with agrain of salt and make sure that
you discuss all this with yourhealthcare provider.
I think there are some reallybig positives to them.
The negatives, however, areconcerning to me, and mostly
(11:36):
from the standpoint of a personwho doesn't want to or doesn't
have the energy or the desire tosort of manage the other side
of their health.
What I mean by that is let'stake my client, for example.
So she's kind of the best casescenario of being on a GLP one.
She came to work with me soonafter she was prescribed it so
(11:59):
that she could use theopportunity of having reduced
food noise and, you know, havingthe weight loss sort of happen
in the background.
So she could use thatopportunity to manage her food
habits, to kind of get onto aroutine, to make better choices
and to come up with sort of asolution to a lot of these
(12:23):
overeating, you know, bingingand restricting behaviors that
she'd done in the past.
And so, while she is in thissweet spot of like she's not
having to really worry about theweight loss, because it's kind
of taking care of itself, she'salso learning how to eat enough
protein, she's learning how tomanage her macronutrients, she's
learning how to get herexercise in order, she's
(12:45):
learning how to eat inmoderation the things that she
really wants to eat.
So there's a lot of positivesto her journey with that, and
the Monjaro or the Ozympic orwhatever is just a tool that
she's using as part of thatjourney, whereas some of her
friends, for example, they'reusing these medications as, like
, weight loss easy ways out.
(13:07):
And don't get me wrong, I wouldlove, I would love nothing more
than for there to be a weightloss easy way out, like I would
take it if it was like safe andeasy.
Sign me up, okay, because Ihave PCOS too, I have insulin
resistance too, and I've beenopen recently with some people
about how I'm currently on alittle bit of a weight loss
(13:28):
journey myself.
Over the last few years sinceI've become a mom, particularly
once my son started walking mylife got a lot more hectic and
complicated and stressed and alot of my healthy habits sort of
didn't go out the windowcompletely, but I had trouble
sticking with them, especiallyduring those kind of stressful
times, and so I've gained someweight back.
(13:50):
So I'm in the process of tryingto lose about 20 pounds that
I've kind of regained, and it'stough.
I haven't had to do this in along time, and so I'm being
re-confronted with all theuncomfortableness about weight
loss, not just, you know,emotionally.
Of course there's a lot ofdiscomfort emotionally with,
like having to take stock of mybehaviors and and my thoughts
(14:12):
and all these things around food, but also physically.
It's not fun to be hungry, andin order to lose weight you do
sort of have to be a little bithungry sometimes.
So all of that is tough.
So I understand the desire for aweight loss miracle and I'm
kind of hopeful that one daythey may find something right,
because it does seem to me thata lot of weight issues there's a
(14:36):
genetic component to them thatis part of the evolutionary
process of like humanity sort ofgetting to where we are now.
We've gone through ourhistorically humanity has gone
through a lot of like thingslike feasts and famines and all
these other things that are outof sync with the modern context
where we tend to have a lot oflow quality but cheaply
(14:58):
available food at our fingertips.
So we're not set up to handlethat, particularly if we have
PCOS, and so I'm hopeful aboutthat and I'm like totally on
board with you know, keeplooking for it, right.
But what makes me nervous aboutthese is that I don't think
they're quite good enough to beused as just complete miracle
drugs, the reason being that oneof the main ways that they work
(15:23):
is not just by managing theinsulin responses, but also by
suppressing appetite, and sowhat I'm seeing with with
certain people is very similarto what I see, what I've seen
before, when clients have beenprescribed something like
Adderall, like maybe they werediagnosed with ADHD and they got
an Adderall, and at first it'slike this wonderful feeling
(15:43):
because it's like, oh, myappetite suppressed.
Less food noise like that'samazing.
But with time it becomes thisthing where the appetite
suppression actually is, causesproblems around the relationship
to food, because you starthaving what we call food
aversions.
So, particularly healthy foodsthat would be good for you to
(16:05):
continue eating because they'renutrient dense and because they
contain a lot of the things thatyour cells need to function.
Vitamins, minerals, all thatkind of stuff become disgusting
to you or you don't really wantto eat them, and so you end up
doing this thing where, likewell, your appetite suppressed
so you could just not eat, right, or you could just have a
protein shake and call it a day,and you don't have to think
(16:26):
about it and you're losingweight and that's great and you
feel good because you're kind ofin that fasting mode and you're
, you know the weight's comingoff without you having to try,
and so it's exciting and you'regetting positive reinforcement
for those behaviors.
But long term, what happens whenthe appetite suppressant effect
wears off?
I don't know.
(16:48):
I have had some clients who'vetold me that with time, these
medications stop being aseffective for them and so they
have to go and get more or theyhave to switch to a different
one, right, and so I've seenthat happening and I'm wondering
, like, okay, what happens ayear from now?
Right, when we need to switchagain, but there's nothing else
(17:08):
to switch to, or we've kind ofhit our max with how helpful
it's going to be.
Or, like in the case of, like,true appetite stimulants or
whatever, like Adderall, whathappens when your body pendulum
swings into this mode where it'slike I've been starving and I
need to eat and so it reallykicks up your appetite and
(17:28):
everything.
The long-term risks associatedwith that are what kind of
concern me from a nutritionperspective?
I'm not talking about from, like, a medical perspective or a
health perspective, becausethat's outside of my scope, but
I'm talking purely from anutrition standpoint, like what
happens when a person has beenessentially in starvation mode
(17:49):
for a couple of years, hasn'tbeen eating their veggies,
hasn't been getting theirnutrients and they've depleted a
lot of their resources and thenthey either the appetite
suppression wears off, they runout of you know things to switch
to if they need to switch, orthey get off of it completely
(18:09):
and all of that pent up energycomes back.
You know the body's like we'vebeen starving, and this is very
similar to the concept of like.
If you've ever done yourtypical diet before, right, the
whole yo-yo effect.
You tend to be excited at thebeginning.
You lose a lot of weight.
A lot of people push themselvestoo hard to lose too fast.
(18:30):
They lose all the weight andthen, as soon as they get to the
point where they're, you know,maybe five pounds from their
goal, or they've reached theirgoal or whatever, and they're
happy.
All of a sudden, the hungersignals kick back up and now
they're twice as hungry as theywere before, because their body
is trying to reach a certainequilibrium.
I think that's just humannature, that the body likes to
(18:51):
have an equilibrium.
It doesn't like to feel likeit's starving.
People often forget that bodyfat is a survival mechanism.
So maintaining that body fat isdeeply primal for the body.
It wants to hold on to it right?
So what I have heard through thegrapevine I will not reveal my
(19:13):
sources, but I have spoken withsome people who run a popular
weight loss DLP1 program and Iknow somebody who's associated
with them.
Anyway, what I heard throughthe grapevine from them is that
a lot of doctors are thinkingnow that the most effective way
(19:35):
to kind of use these medicationsor utilize these medications
would be to keep the person onit permanently.
So essentially, the idea isthere's something fundamentally
wrong with the way that yourinsulin responds and so, because
of that, this medication isgoing to even you out and you're
(19:57):
going to need to be on it forlife so that it can continue to
do its job, because there'ssomething fundamentally wrong
with you and with the way thatyou process carbs.
And while I do think that theremay be some truth to that,
right, like those of us withPCOS always, kind of say, with
diet changes, one of the hardthings about having PCOS is that
we do have to try harder thanother people right, to get the
(20:17):
same results, to maintain thoseresults, because there are all
those genetic influences.
So I think there's some truthin that.
But my concern is if you, if themedication is necessary to kind
of maintain its effect, youneed to stay on it for life,
what happens when theseinsurance companies don't want
to pay for it or this or that?
(20:39):
I mean the whole like theinsurance company stuff that's
going on with getting thesemedications covered.
The pharmacy is not being ableto stock them, people who really
, really need them, like typetwo diabetics, not being able to
get them because so many peopleare using them for weight loss.
I mean these are a lot of likesystemic issues with this drug
(20:59):
that may over time, you know,fix themselves.
I mean there's, since there's arun on them now, right, but the
interest will die down or therewill reach some sort of
equilibrium.
But I guess my concern is likewhat if they stop being covered
or they're not covered to beginwith?
These aren't cheap drugs, right?
They're very expensive, atleast currently.
So until that changes, I'm not100% sure that it would be worth
(21:23):
it for most people.
Maybe somebody who hasunlimited financial resources
could pay, you know, five to$900 a month for their Zimpik,
until the prices go down.
But you know what I mean.
It's just like that kind ofconcerns me from a financial
perspective, like throwing allof this money into something
that eventually, I may not beable to afford anymore.
I may have to go off of itanyway.
So that's why, then.
(21:48):
That's not to say that youshouldn't do it, but that is to
say that you need to have aclear vision of what the whole
process looks like.
So, instead of focusing on thebeginning part of like I'm going
to get on this, I can affordthis now.
It's going to make me loseweight.
Think, while you are in thosephases of losing weight, think
(22:11):
about the future.
Think about what happens incase you're not on it.
What happens in case you can'tafford it anymore?
What are you going to do andwhat habits do you need to build
now so that there's secondnature for you when you go off
of it.
What things do you need to doto be cautious with your body so
that you don't send your bodyinto this like major starvation
pendulum swing thing.
(22:34):
There really are no easy waysout with weight loss,
unfortunately, and so what Ithink the most effective way to
use these medications is to usethem as a tool to implement
positive lifestyle changes,without a lot of mental noise
and while actually havingsuccess with, like, those
changes, getting the weight off.
Because, yes, it's absolutelythe case that there are some
(22:55):
people with insulin resistancewho I've worked with before who
their insulin resistance was sosevere that, even when they were
doing everything right, stilltheir body kind of wanted to
maintain status quo and it waslike almost a snowball that had
to get rolling.
They had to lose some weightbefore the weight would really
start to come off, which is kindof frustrating.
(23:16):
Well, isn't kind of frustrating, it's very frustrating.
Here's what I think as far ashow they should be used.
When you get on a DLP one, youshould be also on a nutrition
plan, if possible, working withsomebody, one-on-one or in
(23:40):
person, or taking a doing.
You know, shout out to selfpromotion here, but like being
in, like my PCOS EssentialsAcademy group program, right,
which I'm currently in themiddle of one of my cohorts
right now, but we'll probablyrun another one in the summer or
something like that so that canbe a good resource that cuts
(24:01):
down budget wise on what itwould cost to see a dietitian
one-to-one or yeah, like seeinga dietitian one-to-one, working
one-on-one with a nutritionprofessional, somebody who's
acquainted with your uniquehealth circumstances, so
somebody who has specialty inPCOS.
And if not, that then takingsome having some sort of course
that you go through to get thebasics, so that you kind of know
(24:22):
what you need to be doing ifyou're very self motivated,
right.
So there are a lot of differentways to do it, but the mistake
that people tend to make is theyget on the medication and
they're just kind of like let merelax for a while and not think
about anything else.
But this is really when youhave this profound opportunity.
(24:42):
Top on your priority list needsto be reducing muscle loss when
we don't eat enough whether wedon't eat enough because we're
not hungry, or whether we don'teat enough because we're
starving or fasting or what haveyou.
When we don't eat enough, wetend to lose muscle mass.
We need to eat a certain amountof protein every day to
maintain our muscle mass, andideally we would even try to
(25:08):
maybe increase our muscle mass,which, fair enough, is very
difficult while you are losingweight, but we could at least
try to maintain what we have.
This is key because muscle massis kind of the major factor in
what burns calories at rest.
So if you have more muscle,just lay it on the couch, you're
going to burn more caloriesthan somebody who has less
(25:29):
muscle who's doing the samething.
And this becomes really, reallykey in the maintenance phases,
because more muscle could meanas much as a couple hundred
extra calories a day, whichmeans an extra snack, which
means eating a slightly biggermeal.
There's a lot of different waysthat it helps, and that's
important because when you're inthe maintenance phase you're
not going to want to track allthe time, right, you're going to
(25:51):
be tired, fatigued from theprocess and so and I don't
recommend that you track foreverbut if you have a little bit
more of a cushion or a wiggleroom, then it's easier to
maintain.
So top priority is maintainingyour muscle loss and maintaining
your muscle mass, and the wayyou do that is by eating enough,
particularly enough protein,and continuing to do strength
(26:13):
training.
So that's like priority one.
Priority two is maintainingyour nutrient status and
remembering that weight is notthe only indicator of health.
Oftentimes, weight is a symptomof underlying issues that need
to be corrected, and so this iswhere food quality comes in.
(26:36):
Yes, if you eat less foodquantity, you will probably lose
weight, at least at thebeginning, and many people can
get all the way to their goalwithout really focusing on
nutrient quality At all.
There's truth in that, butthat's not the best way to do
things, because your body needsvitamins, minerals, nutrients,
(26:58):
your gut needs fiber.
You need all of these things,and so making sure that you are
managing for your protein andthat you're managing for your
vegetables, fruits and otherlike plant based foods, legumes,
particularly like things thatare going to give you a lot of
fiber, eating as many wholefoods as possible If you can do
(27:20):
those things while still beingon these medications and losing
the weight, then you're goldenright, and so the question that
my client had was why is herweight loss lower than her
friends?
Well, likely it's because herfriends, while they are still
going to McDonald's and whatever, they're eating a lot of fast
food.
They're probably also just noteating very much at all compared
(27:43):
to her, because maybe they'rehaving one meal a day and
they're getting whatever theywant, but they're probably just
eating a few bites of it becausetheir appetites are really
suppressed, whereas with her,I'm almost forcing her to eat
more than what she wants to.
She's not hungry for a lot ofit, but she's having to eat more
to meet her macronutrient goals, because what I'm trying to do
with her is have her lose weightat a rate that's sustainable
(28:05):
and healthy for her body.
Just because we can lose weightfast doesn't mean we should.
Several reasons for that.
I talked already about the kindof the pendulum swing effect,
but another thing that'simportant to understand is that,
especially if you've hadhormonal issues, quick weight
loss can be a trigger forgallbladder dysfunction.
A lot of people, after a bigweight loss journey, they often
(28:28):
need to get their gallbladderstaken out because it was so hard
on their body.
There are other things going onbesides just losing weight
Muscle mass, pendulum swinging,gallbladder health, hormone
health in general can get alittle jacked up during major
stressors, and starvation is astressor.
(28:48):
What I'm doing with her isfeeding her more than what she
feels she needs on these GLPones because her medication is
suppressing her appetite, butI'm still feeding her
significantly less than would bea maintenance amount of food
for her.
(29:09):
She's on a calorie deficit, butit's not just a calorie deficit,
it's a structured caloriedeficit, so it's not too much of
a calorie deficit.
She's not eating thousands ofcalories less than what she
should.
She's not eating to lose likethree pounds a week.
She's on a calorie deficit, butit's also a calorie deficit
(29:33):
that's managed around hermacronutrient needs.
So how much protein she needs,how much fiber she needs.
It's also managed around howmany micronutrients she needs
vitamins, minerals, all thatkind of stuff.
This doesn't have to becomplicated.
I know it sounds complicatedbut at the end of the day,
eating more whole foods andmaking sure that you're eating
about a palm-sized amount ofprotein with each of your meals
(29:55):
it's kind of all you have to dofor most people, especially if
you're on one of these meds,right?
So it's not like this thingwhere she has to calculate out
have I eaten this many grams ofthis or that?
No, she just eyeballs like okay, I need to make sure that I'm
eating like this much protein.
And then, on top of that, I'llmake sure that I'm eating
veggies at each of my meals.
(30:17):
I make sure that when I havesnacks, that my snacks are whole
food snacks, so they're likefruit with like some sort of
protein source, maybe peanutbutter or nuts or something like
that.
You know these kinds of thingsthat can really become second
nature over time.
And so her weight loss is goingslower than her friends, but
it's at the rate that I did themath so that we would expect and
(30:38):
that's the key right Like it'sgoing according to the plan.
The plan was to lose weightslow and steady.
Slow and steady really does winthe race when it comes to
weight loss.
Now the research does show thatwhether you lose weight quickly
or slowly, you're just aslikely to regain it, which is
(30:59):
kind of a bummer.
But what I think that researchdoesn't take into account is
things like muscle mass and whatthe long, long, long term
implications of losing that kindof weight at a slower pace
versus a faster pace might looklike.
I'd be very interested to seelike a 30-year study on this or
(31:19):
something like that.
But regardless, if you want tohave the most chance of success
at maintaining strength training, making sure you're eating
enough protein, making sureyou're still eating quality food
most of the time.
The other thing that's reallypowerful that I'm having her
work on is moderation.
So often we have insulinresistance.
(31:40):
We tend to eat go all out.
So we go get fast food andwe're gonna get the whole thing,
we're gonna get the basket offries right.
What she's learning, with thehelp of these GLP ones as a tool
, is to eat a small portion andthis is good for her muscle
(32:02):
memory because, yes, later on,if she gets off these
medications, she may be hungrierfor more.
But if she has built that habitof like I'm gonna be okay, I
don't physically need to eatthis entire thing, like I can
stop, and that's fine.
And if she's learned that likethat's possible, not just with
whole foods and like thehealthiest healthiest foods, but
(32:23):
also with things like fast foodand restaurants and things that
we're all gonna do right, it'snot realistic to say you're
never gonna do that stuffanymore.
We build it in.
So the majority of the week iswhole foods.
The majority of the week is youknow, everything's managed, but
a couple times a week, you know, maybe we're getting some
Chick-fil-A and we're learninghow to not order the 12-count
(32:48):
with the extra large fries.
Right, we're getting a smallermeal and we're just letting that
be enough, or we're getting thesalad or whatever you know.
So just learning to makedifferent choices, the muscle
memory of that is good.
From a neurological perspective,like from your brain's
perspective, food is not allabout hunger and what you're
putting in your mouth anddiscipline and willpower.
(33:09):
It's also about just buildingsecond nature habits, muscle
memory.
I, for the last six months I'vebeen salsa dancing and the
difference between when Istarted to now is that I can do
arm styling and all kinds ofdifferent things.
Now, because my footwork ismuscle memory, I don't have to
(33:30):
think about my footwork anymore,it just comes to me.
And so now I can play with themoves more, I can start adding
more, and it's the same thingwith nutrition.
At first it's gonna feel like alot just learning those first
basic steps, but once those aredown pat, once you've got a good
grasp on them, then you canstart to add more, to start
(33:52):
thinking about things likeyou're you know meeting a fiber
goal or you know what have youLike you can add to it and it's
not so draining or stressful.
So I think those are all mythoughts on the GLP One, so I
hope this was helpful.
Let me know if it was.
Leave a comment, leave a reviewon Apple Podcasts particularly
(34:16):
the reviews really help and letme know if this was helpful for
you on your GLP One journey oron your thoughts about GLP Ones
and if I missed anything that Ishould have covered.
Also, let me know that too.
I again I'm grateful for youguys for sticking with me on the
podcast here and hope I'mexcited about the year to come
(34:37):
and all the things that I've gotin store for you guys.
So I will see you next week.
Bye.
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