Can AI Be Your Nutritionist? GLP-1s and Weight Health with Ashley Koff

Your best shot at life fulfilling your life purpose is optimizing your weight health. We can be so unhealthy if we're looking at weight loss as an umbrella. Ashley Kauf, registered dietician and author of your best shot. Today we discuss whether GLP ones are right for you and the health metrics that we need to retire. Despite having more health information than at any point in human history, we explore why we're still sick. Do we have infobesity? Everything bad that is said about a GLP one is completely accurate with the exception of it's not the GLP ones fault. It wasn't like I'd slowly lost my appetite. It was like the next morning I just didn't eat. Yeah, yeah. If you don't feel hungry at all, I don't think we're on the right dose. I'm not willing to trade an obesity going down for a bone health crisis or a muscle health crisis or a cognitive function crisis. I joke that the reason I trained my own AI was because it told one of my patients I was a Lakers fan and not a Cavalier's fan. If we want to turn AI into a practitioner for us, if it loses that curiosity, you are going to lose the value and you're going to get a practitioner who gives them right answers as opposed to gives them the answers they need personally. Ashley, welcome to the Community Podcast. Thanks for having me. I want to set us up with a little scaffolding and I want to talk a little bit about AI because for decades, we've been anchored in what I often think of as kind of population-based health, right? So there's a wonderful clinical trial that's beautifully done, right? And 10,000 people participate and out of that study comes some sort of fabulous conclusion that low-duster's appetite results in weight loss of 15 to 20 percent for the average person, or reduce saturated fat consumption, reduces APOB and LDL markers. Or whatever it happens to be, right? And then we apply that homogeneous information onto a heterogeneous population. And we never find out as an individual of, is this actually right for me? We're never mapped onto the distribution curve of that study. Okay, so enter artificial intelligence, right? That has this incredible ability to, for computation and for crunching tremendous amount of data. And as a bio individual, that these large language models can learn your genomics, they can learn all aspects of your environment, your sleep patterns, your HRV, they can ingest your wearables, your medical history, all of this stuff to get a portrait of Ashley, of Jeff, not just as a snapshot in time, but longitudinally, right? And that's pretty amazing. And then compare that against this enormous corpus of data. So all that to ask you, is AI the key to move us from health 2.0 to personalized bio individual medicine? And where does it fall short? So I'm going to start this conversation off where I now have learned to start everyone off. I am always and it depends, or here's the nuance, right? And that we have to be in that space. I've learned over in my deep dive on AI, which has really been the last three or four years, that AI can stand for a couple of things. It could stand for artificial, it could stand for augmented, and what I want to share is it could also stand for Ashley. So in Ashley's intelligence, we'll talk a little bit about that. But I think the, you raised several incredible points in one. The first for us to understand is that the double blind placebo controlled study, the RCT, et cetera, that has been hailed and driven so much of medical care, especially in the place of nutrition, has led us to a place of not giving people what they need to optimize their health. Now, I'll use the term optimize there in terms of saying like, you know, it does your body have what it needs and is it able to then use what it gets and run better. But I would even argue that a lot of the population data has kept people from even achieving a baseline satisfactory health. And we have that data, that evidence, you know, roughly 9 and 10 Americans or 8 and 10 Americans, adult Americans don't meet the criteria for metabolic health. And I actually think that's a two that the criteria isn't strict enough. So I'm just going to like kind of throw us all in there. So when we look at that and we say things as an example, if you look at the dietary guidelines right now, they say that men need more fiber than women. So it's based off of your sex. That's also based off the idea that men eat more calories than women. Just blank eat more calories. And as a result, the amount of fiber you need is a percentage of the calories. And then it suggests that after 50, we need less fiber. Why? Because we should be consuming less calories after age 50. So all of that I could debunk with a thousand other studies, but also most of the patients that are in my office. Well, what we have with AI then is if you go out there and the AI, the public AI, scrapes that data, it can give you right answers based off of that existing data and be totally as far away from what you need. It could also hit a bull's eye. You know, if somebody is consuming 10 grams of fiber and they increase to 20 grams of fiber because they've been told that 28 grams is really what's optimal for them. And their digestion is okay, and they're not flying. And it's a time where they're not getting their period and they get in enough water and the type of fiber that they consume is actually one that aligns with what their body needs. We could see a reduction in their LDL. We could see their APOB get better. We could see their weight health improve more often than not. We won't see that. And what ends up happening, and this is just the tricky space of a diet in health industry that's trillions and trillions or billions of dollars is then we feel like failures. So then we internalize that wasn't, you know, what was better for me. So now if we have the opportunity with AI to come over and say we could collect all of that data about you, but what you really need is somebody to be curious with you to figure out what you actually need. I always thought that was the delineation. I thought that was where we couldn't where AI couldn't go. Turns out AI can go there. In the private realm, which is where I've put my IP for 25 years of, you know, practice. If we instruct an AI or create an AI that only allows for it to use that content and it doesn't scrape what's out in the public, then it can come in and say, you know, Jeff, before I figure out how much fiber you need or we're not even going to answer that question, we're going to look at does your body have an optimal amount of fiber with an S at the end for your health goals. But let me start off with what are those health goals? Then let me ask where are you currently getting in fiber. Then let me also ask about your digestive system and let's now map out a plan for an experiment to see what happens over 90 days when we increase fibers at your nutrition or whatever based on this. Well now we can lead a 90 day experiment that can actually see it will be better, it will be worse. Not that I want to judge your whole health based on that, but we can it start to do things. So it's interesting to me as I think it really comes down to how you're using AI and also what type of AI you use. It's a long answer to your very direct question. Yeah, no, this is great. And my sense is, though correct me if I'm wrong, that your relationship with your patients is probably more holistic than the average primary care position, right? So we're in this system where even me who has fairly decent healthcare. But when I go see my doctor, she's got 12 minutes, 15 minutes, right? So to get the whole holistic story of Jeff, like, am I getting enough sleep? You know, what does my nutrition look like? What else is going on in my life? Am I going through a period of deep stress? Like my dad passed away. How's that impacting my life? I've got three teenage daughters. That's crazy. All the time. And what else might I might I be going through? Where I can sit, you know, in my cloud project, and I can scaffold this thing out. I can, you know, connect it to my Cedar Sinai medical history. I can it'll intake me as it'll never let me believe, basically, because it's it's trained to continue to engage with you and give you more recommendations, right? So it'll keep asking me questions until it builds up a really very multi-layered repository of Jeff. And as I in a way that I've never had a primary care physician know as much about me. And so as I then begin to like hook up my various wearable data, I am consistently impressed by what it spits back out at me. And, okay, I have also fallen into the trap of chasing a metric over chasing the subjective feeling of what it is to be the most vibrant Jeff. And, does that concern you? Do you think that, you know, with all of this data, I know you have a term called Infobesity 2, which is related to this idea, but with all this information, can we often fall into the trap of chasing the metric instead of actually chasing the feeling? Yeah, so we absolutely can. You're humans. We can chase metrics in a lot of different places and not experience, you know, the person who makes the, they decide they need five million dollars, they make the five million dollars, but their life suffers for it, you know, or so I think that's in a lot of places. There's the, so you raise a great point, which is our current structure of health care, where the DR or the equivalent, the DO or the ND or the person that you're seeing for your primary care, may not have the opportunity to know about you. So I get a lot of people that kind of fall into the, what I think is a little bit of a victim mantra of, well, my doctor doesn't know anything about nutrition. Totally fine. We'll get into that in a second, but if they don't know about your nutrition, that's your responsibility. So if you haven't said to your doctor, this is what I have. This is why I have it. This is, and then if your doctor can't handle that, we'll talk about that in a second, but again, don't just judge their, their knowledge base, but the DR who has 15 or 20 minutes. So wouldn't it be incredible if an AI can now bring that doctor up to speed because you've been able to, at a different point in time, have a whole conversation, share these things. The other thing is we come in and depending on the traffic or depending on the mood, how the doctor is that day, or you know, like I love my doctor. Sometimes we come in and we end up talking about like the Lakers Cavs game, you know, and then it's like, oh wait, hold on, you know, like did I need to do, you know, so it just depends on, on that space. So I think that's a great way to use AI. Here's the concern that I have with Claude, with chat, with Gemini, with any of these that are, again, what I'll call public AI on that part, is it will continue to ask you questions. Unless it's, has the expertise that I Ashley cough RD have, it's not going to ask you, it's not necessarily going to be as curious in the way that I'm curious. So the reason I had to train, I joke that the reason I trained my own AI was because it told one of my patients, I was a Lakers fan and not a Cavalier's fan and like that was traumatic for me. But the real reason was I actually saw that there were multiple, my patients were coming in and they said, oh, I've got so-and-so's book and I took your protocol and I put it in here and I was like, you know what? That's a totally interesting protocol for you to go towards. I'm not going to say 100% it won't work, but I'm pretty sure this, this, and this aren't right, because it didn't go over here, right? It didn't ask you, are you not sleeping at night because you're afraid that somebody's going to break into your window because there have been robberies around, you know, whatever it is, you know, the example. So I think one of the things that we have to recognize about AI is that if the source of your AI knowledge is not expert knowledge and it is research-based knowledge, the same research, guidelines, and available practitioner information, which my information is all over, you know, that like all of those recommendations are out there, but they're out there primarily through the lens of the way the media has captured them or the way I showed up on a TV show, which was pretty scripted, you know, these other things. If that's the guidance that you get, we already know the outcome, 9 and 10 Americans, not metabolically healthy. So instead, if I have an opportunity to work with you as an expert in a private AI, then I can turn around and I can say, hey, Jeff, I'm just curious about this. I'm curious about, you know, we've mentioned your teenage daughters and, you know, this piece and I'm curious where you're letting your eating is maybe coming up against how you want a role model eating and experiences with them and how can we find the win in there, right? That's going to be different than Claude saying, I've noticed that your A1C is trending up and an idea for you would be to change banana to cauliflower. Again, maybe the banana cauliflower is a good exchange, but in both of them you get good potassium and maybe actually the carbohydrate in the banana was fueling your ability to hang out with your daughters at eight o'clock at night, you know, whatever it is on that piece. So I think the key piece for us to look at again is not, I'm very big on not blaming the instrument for user error. So I see this all the time in GLP1 medication. So medication causes muscle loss. The medication is making people not like food or not hungry or any of these things. No, the misuse of the medication, the impersonalize, the dosage being wrong. The same thing for AI, I think it's going to be, I mean, it's here. We can't avoid it. The question mark is if we want to use it. So now you are responsible. If you, Jeff, want to go in and create a scaffold, create a scaffold with expert intel that, you know, that's some, I suppose the way that many of us talk about as practitioners, like my greatest asset as a practitioner is curiosity. I come to you and I'm just like, oh, so tell me more about that. I might have all these answers that were right on tests that I learned in medical school or, you know, whatever, but they're not right for Jeff. And there might not be, they might have been right for Jeff three years ago, but now you've got the teenage daughter. So they weren't, you know, preteen to teen, they're not right. So how do I come in and be curious with you? Well, if that's the greatest asset of a practitioner, if we want to turn AI into a practitioner for us, if it loses that curiosity, you are going to lose the value and you're going to get what I think, unfortunately, most people experience, which is a practitioner who gives them right answers, as opposed to gives them the answers they need personally. Yeah. So well, one place where I found AI to be very useful. So my dad did pass away in March. And as he was moving into hospice, it was very clear that there was no quarterback for his, his care. And he had collected infirmities like spare cables. Like you have one of those drawers, he was like, he had, you know, chronic UTIs that were going septic, he had a demon, he had cancer, which was really the, really the, the emperor of the situation. But then, you know, he'd also fallen and broken his hip. And so he had an oncologist, he had a radiologist, he had an orthopedic, he had a urologist, nobody was talking to the other person, right? And what I found was I could upload all of that various information into a project and kind of be able to keep it organized and straight and then be able to share it with the, the, the healthcare practitioner that needed so they could get a more holistic picture. So I don't know if you, if you, I so, oh my gosh, I so value that. So let's also be clear, my conversation about the AI thus far up until you just asked this question, has been about can AI be a practitioner that can really take the place of where there's suboptimal practitioner experience, not because the practitioner doesn't isn't well intended or even knowledgeable, but just the way our healthcare system is set up. You raise such an important point. And I think that the, there's so much value in AI as you also to help the healthcare practitioner become better, like run their businesses better or run their great efficiencies in their time. I just came from a conference where we were looking at like how can it help you avoid burnout? The fact of the matter is a lot of practitioners have to compete against influencers and brands and even marketing their services. There's all these great value places. And in the example that you gave absolutely, here's the opportunity, what it can do is it could, you could say, Hey, if I'm trying to quarterback my dad's care, this is what everybody is telling us. Are there things, first of all, that fly in the face of each other? Like where, you know, where's that happening? Are there things that, is there something that I would be better suited to ask the radiologist than the oncologist? Or do you think that before I go and get my labs done, have my dad get his labs done, it would be beneficial that we wait and implement what the nutritionist is working on with us, you know, for a month or whatever. It's interesting. I've evolved my career a bit probably. Maybe I was like this from the beginning. Part of it is I come from the background. My dad's a doctor, my brother, doctor, my sister-in-law's a doctor. I love doctors. I remember my dad saying to me, you know, you're not going to be respected, though, as an RD. We like, it's just not the space. He's like, you really should become a doctor. If you want to do, you know, what you want to do. And I said, but the thing is, my toolkit is nutrition. And I also really look at you. And I want to diagnose, I don't want to diagnose your symptoms and your disease. I want to decode what your body is telling me. And then I want to look at total nutrition and lifestyle and see if I can help address some of those signals and optimize. And two years ago when my type one divot, my nephew was six now, and he was four, and he was diagnosed as a type one. And I was explaining to him the difference between myself and my sister-in-law, who's a pediatrician. And he turns around and goes, oh, well, you're a backwards doctor. And it was like you resolved my whole like professional like I just didn't understand it so I've like run with that right so the RD being the backwards doctor And the reason for that is I've always had to play the quarterback because what happens when you are come to me is I need to understand that your Chiropractor Recommended this for you for your back But then when you went to see your cardiologist they took your blood pressure and Nobody was asking the question in there hated that fiber supplement have licorice root in it and it turned out the cardiologist was going to put my patient on not one but two blood pressure medications now The cardiologist wasn't wrong. I did a full audit of their nutrition their lifestyle. I was like I don't see anything else in here and your blood pressure is kind of scary right now So maybe what we do is we put you on the medication and then we you know start to like look at how we can mitigate any side effects from the medication But because I always ask hey, how's your digestion while she told me it's fine now Because after seeing the the chiropractor he gave me a fiber supplement and I immediately looked at the fiber supplement It was like wait a second. She goes oh, I wasn't taking one dose. You know what you're doing? You're really constipated shake like four doses. You're like I just want to poop right you know so she comes in and she was like I was taking that I said was that when you you're and she's like that's exactly when my blood pressure went up That's the curiosity and again, there could AI potentially have said what's your supplement and then also why is your doctor recommending blood? Absolutely, but the chance of the mist is also there too so you can use it Absolutely just make sure that you're either able to ask all the questions around it or It might be that what you figure out in that moment is you know what for my dad I actually need to hire someone who can quarterback his care with me And that's the value hopefully of a backwards RD or somebody who's going to really takes that holistic look at him. Yeah. Yeah Hey, it's Jeff so we often think of wellness as something external what we eat how we move But inside our bodies is an amazing repair system driven by stem cells They're constantly working to renew and restore, but as we age that repair system doesn't work as well as it used to But what if there was a way to support it? Well enter stem region Founded by stem cell scientist and health pioneer Christian Drapo Stem regen offers unique supplements designed to naturally support your body's ability to release more stem cells into circulation More stem cells means more repair more recovery and more vitality It's like giving your body the boost it needs to stay resilient Rejuvenated and ready to take on whatever life throws your way so right now Commune podcast listeners can get 20% off their first order at stem regen.co Forward slash commune with the code commune pod that's commune pod for 20% off at stem regen.co Forward slash commune unlock more of your body's innate repair system with stem regen It's interesting because so I was diagnosed type 2 diabetic like six years ago and In some ways I began to I began to see Metabolic dysfunction or diabetes more as a phenotype than It's sort of a disease category that we lump a lot of people into But it doesn't really reveal what the underlying cause is And that could be one or a combination of many different things It could be stress or sleep or obviously nutrition and food consumption. How did they diagnose here at your diabetes? It was it was just a one C that's it. Yeah, it was just chronically elevated glucose levels period. That was it So what's going on like what are we missing here? Yeah, so let's talk forever I mean it's it's in so in my book I have a chapter called shit to unlearn apologies if that offends anyone But I just got to the place. I mean that literally could have be its own book like we have just been you know the Magnesium RDAs which I call really dumb amounts are you know, they're now called DRIs but the acronym worked better But it's from 1997 for 135 pound woman and 160 pound man And it's based again off of gender like this is we're in such a dismal state of recommendations I love all the work like now being done to figure out how we can you know make The peptide world cleaner and safer and everything I was like but you know that most people wouldn't need a lot of what we have right now If the dietary guidelines like magnesium were approved right, you know, I mean, it's like there's low hanging fruit for us to get at One of those is an a1c So I was practicing when we didn't have an a1c or when we started to use a1c and a1c is a 90 day average Let's talk about how we get it averages. You know, you could be in a you could be peaks and valleys You could be rolling hills at a very high level you could be and there's so many ways for us to get there right so when we look at 90 days It was so much better than just finger pricking all the time and being like what's our blood sugar at this moment or what's our blood sugar at this moment But it misses all the why in there the other part is for some reason We've been taught that our blood sugar is based on the for the most part what we're eating and very specifically Carbohydrate so I just did an exercise at one point I listed out in my head all the things that reasons that somebody's blood sugar could go up or down and it was 40 plus Yeah, right so when we're in that space we have to look at if there's 40 plus reasons and we're now looking at an average Um, if you take most of my professional athletes They are almost always going to be in the pre diabetic range or the diabetic range during their especially during their season You know or that piece and a large part of that we have to work on because we have to make sure they're recovering Effectively that their bowels, you know, what are you eating all these other pieces? But we look at really good things like great that you're stressing your body out great That it's you know efficiently using this so we're missing so much when we use these markers We are missing it when we look at cholesterol even cholesterol like the best cholesterol You know that's looking at all the apolipoproteins and everything else in that part But when we're looking at that and saying heart health heart health is so much It's your endothelial tissue. It's your blood flow It's your you know the minerals that you have like all these different things in the big one that of course I get to is when you look at the scale And so if we look at a scale and we say your total weight is at all reflective It's not even an average it like if we just look at that number really it is literally telling me nothing about your your health at all on that part So for you the moment and part of it that bothers me is you got to a place where you saw ascending a one C and then it was like Oh, aha, we have to work on this Years before that years before right we were seeing things that Hey the stress of this or the maybe I had suboptimal magnesium levels because you know and these sorts of things Yeah, well this was my springboard into getting curious about my health which was all of a sudden I got a diagnosis Yeah, it wasn't like and for me at that juncture I was like this just came out of nowhere But of course, yes, like every perimenopausal woman says like oh my god and you're like no, no, no This was progressive over decades, but I was that guy mm-hmm, and I do say guy because we often like Go to our PCP once a year and if you don't get a call back you're good, right? That's exactly a physical event. Yeah, and oftentimes we even cancel that appointment because we're just too busy And so you know and especially if you're thin right and you say right on that part. Yeah, well, yeah, and I wasn't okay Yeah, but um, so this was then, you know my like well how I got curious Mm-hmm into this into just my own human physical was under the hood here and what's going on? Yeah And and then subsequently I made the mistake of trying to be my my daughter's like health advisor Which is something you should never do but It was it was interesting as I as I you know read your book and it's very entertaining and like I teased out the go nothing earlier, but just to summarize that piece You were going through some issues and you were diagnosed by a healer That you had a worm right and that the key to this situation was going to be this goat nut quest right and That didn't work out so well worked out for like maybe a week, right and then then it didn't and then you ended up in a bar I know the bar that you were in actually yeah, which is not a liquor store as we know it It's it's actually a bar a wonderful bar actually. Um, I miss spent plenty of nights. Yeah And you you cycled up to someone and got a piece of advice that you wouldn't not necessarily get in a bar Right, right that that got to more of the core of what you were dealing with and I can overlay this very directly on our middle dog daughter, so She also had a lot of ear nose and throat issues. She had turned out that she had a Macadamia nut or what we think was a macadamia nut stuck in her nasal cavity So we went to take out her Townsels yeah Because of chronic infections and because of the chronic infections despite my wife's kicking and screaming we put her on multi, on multiple rounds of broad spectrum antibiotics. And finally, we're like, okay, I guess we should go in and get her tonsils removed. And we brought her in and I went into her as she got to see this little tiny girl gets sedated. It's like, well, and under general anesthesia, and we were kind of went into the waiting room getting ready to be there for two or three hours or whatever it would be. And then 10 minutes later, the doc, the ENT comes out with this kind of little specimen cup. And she's like, you know, I'm not sure we're going to go ahead because look what we found. And it was, it was hard to recognize which particular nut family belonged to it, but all of a sudden the provenance of her chronic infections became clear, um, poor kid, but the really negative downstream impacts didn't really present until a few years later, where she was suffering from digestive issues. And then she started to put on weight. And that was like in your book, you talk about that's all fine and good when you're seven or eight or nine, and you can kind of be the ham and be the funny person. And you know, she really was kind of got that took stepped into that character. But as she began to enter her early teenagers, it was really, really hard, especially under the unblinking eye of Instagram and everything else. And we had to kind of get to the bottom of what was happening to her body and why. And that was, it was a real journey for our family filled with all sorts of anxiety and eating disorders and all sorts of other things that we had to grapple with and lots of parental failings along the way. But if we had early on had a partner, a medical practitioner partner that could have helped us to understand some of these core origin issues, um, we would have spared our family a lot of grief. Isn't it so, um, it's so, so the data exists today that several different types of antibiotics eight years of implication in the microbiome. We know certainly even one and that's one dose. We know one dose of others, you know, and, um, and that is not to say that they're not an incredible tool, but we have to understand how we use any tool and the, um, I get in few things, get my mama bear up, I mean, aunt, I don't have my own kids. Um, but for all of our kids, uh, the way that this issue gets me going on that part. And I'm so grateful. I have a colleague, Dr. Lisa Song, who's one of the best pediatricians in this space and she's been groundbreaking in talking and bringing forward gut health and gut health testing and helping us, you know, look at that and, uh, it comes to mind because we were just together and, uh, I was saying I was like, I'm, I may get in a lot of trouble and I'm totally here for it. I'm all the good trouble. But the downstream upstream side stream consequence of all of these individuals weighing in pun intended with that choice word on the use of GLP one agonist in teens and in kids because they're now available for eight, from a, a jade up, uh, depending on, uh, diagnosis, I shouldn't say they're available to anyone access is, is challenging. The judgment of, I, you know, people, I can't believe you would do that and here's diet, what about diet and exercise and this parent is such an awful person without coming back and saying, Hey, let's look at all of the consequences of, and I'm, we're not talking about obesity here. I don't know about your daughter. Her obese, not clinically based on BMI, um, but I, um, uh, I tried on eating disorders. I had definitely had disordered eating. I had disordered body image, I drank alcohol way too early, way too much, way too often, which further exacerbated my issues, which also put me in really scary situations and contributed to some of my trauma. I judged myself as unsuccessful as being a failure because I wasn't successful at eating disorder when my friends in college were, I mean, like, you go down the path, you hear shakiness in my voice because I keep thinking at 53 on beyond all of this and I'm like, and it's still there, you know, it's still there. Anyway, um, we, uh, we really have to come back and say that as we're course correcting as a society, the risk is injudging anyone tool, AI, a GLP one in antibiotic, any of these things without evaluating the pros and considerations, right? We have to say, even if I look at your dad, you know, saying like, and I think we do a better job, maybe in some of these spaces of saying, you know, even the concept of hospice, like, hey, how do we have you end your life in a way, uh, hopefully if you're choosing or with some dignity or protecting certain, you know, trying, we do it really well with dogs, I think. But, you know, we're, we need to like embrace and, and do, you know, more in this space. But we are really like being very judgmental about our perceptions of what the outcomes and the consequence and all these things can be without realizing that you all, I'm going to, I don't know this, but I, I know you and your wife, like a little bit and got to know the community and know your work, but you all brought a lot of resources to the table. Like you were, you had a place where even in feeling like a failure as a parent, you were able to still find ways for your daughter to be supported or for your other daughters to support her or like any of these other things. And as we go down the spectrum of available resources and then judge people for the tools that they use, we, we really are missing, we're missing, like, like, this is a, this is a big issue. So I'm not really sure where I'm going with that one, but I hear you and it's, um, I'm really grateful you shared that. And I think her trajectory is so much more empowered. That's what I want to say is that we have the opportunity with personalized healthcare truly personalized, not partially personalized, which gets served up a lot or sometimes accomplished through AI, uh, to empower people in their, in their health and in their bodies. And so much of what we currently have is really disempowering. Yeah. Let's talk about young people just for a moment. I recently read this article about GLP ones and sororities, whoa, um, I mean, just the mass usage and it's a really double edged sword because I think this year was the first year that obesity rates maybe went down in the United States. And I don't, I mean, my guess would be that that would be directly attributable to the adoption of GLP ones. I don't really see what else it would be. It's not eliminating red dye or some of the other things. So I mean, they're all of their role, but like, yeah, I think we can look at that. Exactly. Yeah. Obviously, a lot of the data that we are, that we've had for decades, but even new data that we're having, uh, we're collecting on GLP ones is pretty encouraging. I mean, the use of HRT and GLP ones together. I mean, there's just a lot, you know, uh, GLPs and cognitive health, um, GLP, I mean, I went on a low dose Terzapatide because I had very elevated, um, lipid markers. And it wasn't really, and obviously I had some, obviously historical blood glucose issues, but it wasn't primarily for that. Right. So I looked at some of the data on lipid markers on APOB and LDL. And I was like, okay, I'm going to, I'm going to do a little bit of me search, as you say, and, you know, jump into my own Petri dish. And I'm going to do this for three months, and I'm going to test on either side. And I'll, I'll see, you know, um, and granted, I, I have a little bit of luxury just to be able to do that right in my own life, but I did drop. My markers did get better, um, so there's a lot of reasons to be excited about pharmacology as it relates to, to, to, to GLPs and GIPs. And now I can't ever pronounce it properly. I don't have to help me retratitude, retrutite, which appears to be promising to, so there's a lot of reasons to be excited about it. Um, on the other hand, there's a plenty of reasons to be cautious about it. So how do you weigh that? I mean, again, you say it's a tool. So what falls into the, the pros and considerations? It's lost. Um, we should be looking at fat loss, the type of fat, um, fat changes in locations. So if we lose liver fat, great, you know, those sorts of things. Um, but, you know, anything, um, I'm never going to be excited about the, uh, obesity rate going down. I'm going to be excited about the metabolic health rate or the weight health rate or whatever changing on that part. So I'm not willing to trade an obesity going down for a bone health crisis or a muscle health crisis or a cognitive function crisis, and I am not blaming the medication on that. I'm blaming the misuse on that, right? Okay. Um, we also have another reason. big issue in the absence of access being appropriate through or even available. I don't know if appropriate is the right word through insurance because again insurance is not just using BMI but has also still like come in and said we're actually not going to use BMI where diet and exercise can still work over there but for diabetics we'll give it to you. But now what's happening is the and these companies and I understand opportunistic capitalist like there's real value in that okay we're going to bring this forward as a tool but they're bringing it forward as a tool with very limited guardrail so I've had a couple of emergency extremely emergency situations happen interestingly not with sorority girls but with fraternity boys so this should be equally scary to us where they were through one of their coaches getting access to peptides which included GLP1 and GIP with fake IDs like I used a fake ID to get into a bar to like drink more and not good you know more alcohol and and put myself in risky behavior but I was not injecting myself with things you know like in that space and so the injection here you know and have access to that well you know medication peptides that were interfering with their SSRI or other medications and so I had somebody who was hospitalized for suicidal tendencies that they wanted to blame on the GLP1 and I was like that's totally inappropriate we found out that he was taking a higher dose of testosterone also and had also it was also playing around with a muscle building peptide had access to all of that and was injecting himself along with his other you know in the fraternity so I feel um hmm especially talking to a dad of teenage girls the list of like at this point it's like do we even send them off to college like is the new home schooling that we all get together in a community and just do college together I mean it's so scary on so many levels right so I think the the the way that I would love to have the the sorority girl experience occur or a young woman experience occur is to help someone understand that if you lose fat here so first of all if you are uncomfortable in your body I am here for you if that is three pounds if that is five pounds now look if you want to be in someone else's body that's a psychological conversation that we should be having and we in your nutrition is going to be part of that but you know I was um I wasn't short um I was probably five four five five but you know I wanted to be five eight and I wanted to be tall skinny and blonde and I like that's just not me like I'm not that's not my my avatar so finding peace with myself is something that we have to recognize you know it's going to take some some time to do but we have to help somebody understand the pros and considerations so on the pro side if someone's hormones these are hormones GLP1 GIP PYY CCK Amalyn oxymodulin if these hormones are dysregulated are suboptimal in the same way we deal with thyroid we deal with estrogen we deal with testosterone any other hormone you know that that is suboptimal for an individual if they're suboptimal then that is something for us to address the issue that we have the consideration on that part is if you then take and you replace that hormone in the case of a GLP1 you're replacing from a two to five minute um signaled operation several times a day to now a sustained operation for 24 hours all the way up to seven days in doing that you actually are then throwing off other things so you're telling hormones like your insulin and glucagon to go to work or you're leptin and grail and to go to work or even in the case of ture's appetite it's one of the reasons I I do like it for men and for women but you're helping with blood flow you're helping with the endothelial tissue you're also helping with bone building because GIP impacts osteoblasts are bone building cells so we're giving all that hormone well that sounds like a great idea when those are metabolic builder hormones what's not happening when you're building building building is you're not relaxing you're not recovering you're not turning off and in digestion the opposite is happening we're further and further and further delaying gastric emptying when that happens we're impairing how your body receives nutrients when it gets those nutrients and how it's able to use those so now we could be sub optimally resourcing a body at the same time that we're telling the body to build build build and build more so the sweet spot is you work with someone to figure out what's the right place for you so I um come at me if you will in the comments I work with patients of all ages who are on GLP1 medications and I truly believe that the work that myself and my team do in collaboration is the backwards you know a doctor in collaboration with their doctor and in collaboration with their therapist when needed or anyone else who's prescribing anything else for them is able to dimensionalize and help somebody understand when is this a good tool for you and how are we seeing what and beforehand how are we seeing what what's going to come up right you know where am I up against oh wow like this could be something where um if we're under resourcing your body and you're about to go into your lacrosse season and your lacrosse athlete this may be a time period where we need to shift either your nutrition plan or we need to shift your medication plan without that we're using a tool that has long-term consequences has short-term consequences everything bad that is said about a GLP1 is completely accurate with the exception of it's not the GLP1's fault right it's the user and I don't want to blame the patient I want the plate the patient to have equal blame and in the case of someone who was under 18 I want the unit to around them to have equal blame with the practitioner and the practitioner team and if you are a parent I highly advise my poor parents because I was definitely the one that took the um my gas card and bought everybody like beer and food and toilet paper you know everything at the gas station you know these days I think it's actually just if you can open the door to the conversation and say if you are ever curious about a medication a peptide something for your hair something it makes your butt look bigger something it makes you have more abs um I want you to bring that to me that's got to be what happens from a parent standpoint when I play tennis element is my go-to electrolyte mix now I'm 55 years old but I'm still running down drop shots like I'm half my age when I don't replace my electrolytes I basically turn into a raisin with a limp opinion and even worse slice back in it's true electrolyte imbalance can cause headaches cramps fatigue brain fog and weakness element is a zero sugar electrolyte drink mix and sparkling electrolyte water born from the growing body of research that optimum health outcomes occur at sodium levels two to three times government recommendations each stick pack delivers a meaningful dose of electrolytes free of the sugar artificial colors and doggie ingredients found in other popular sports drinks element is formulated for anyone on a mission to restore health through hydration and is perfectly suited for athletes folks who are fasting and those following keto low carb whole foods or paleo diets you can get a free sample pack of elements most popular drink mix flavors with any purchase at drink element dot com forward slash commute that's drink LMNT dot com forward slash comment yeah I think it's tough as a teenage girl when all you want to do is get into tridelt right and you know that tridelt only takes size two and below and I'm not fucking with you this is what this article to say and they'll take one size four like just for the funny girl I mean that's literally what the article says I was the size 10 or 12 funny girl let me be clear yes yes and so and that is that priority that's your priority as a young woman and I get it over like lean muscle muscle mass or you know a healthy metabolism overall so you know the rampant usage or misusage in this case I think on college campuses of gelpie wins and certainly for for boys too that seem to be taking it in a cocktail with with testosterone or Tesla morale and our hyper morale and our this other kind of growth hormone promoting peptides alike and then drinking a ton of alcohol I don't think a sorority should be able to exist if they are still operating under that criteria that is you as businesses today we hold people to certain standards you know etc I also think that the and again like I obviously know that we're not the Greek culture is not changing overnight but wouldn't that be delightful if we saw you know different values the the other part of it is we have to look at athletes so you know for me I was really lucky I think I probably joined the I'm gonna embarrass myself I probably joined the college it was a club team we were very good club team but a club lacrosse team because of how hot our coach was like he was and because we got to hang out with the lacrosse players also I liked my friend you know it was a good way to meet friends but I was running down the field I was such a moderate like being nice to myself moderate athlete but people loved having me on the team I was fun I you know got things done I'm bossy whatever anyway I was running on the field in face planted I mean I'm really lucky that I didn't break my nose like fully tripped face planted and was out and I'm coming to and he says to me like oh my gosh and like what did you eat and I go Nothing, I was so proud of myself. I thought he was gonna be like, "Oh, did you fall because you're a fat kid?" And I was like, "I didn't eat anything, like I'm good." And I had, I didn't, wasn't allowed to come to practice for a couple of weeks until I had monitored meals, right on that part. We, where we can intervene, hopefully, is to open these conversations up. If you're a sorority, open invitation. I would love to talk to your, you know, to your group and talk about how we can have these conversations and recognize. And I hope when we look outward at the women leaders, we have such great, incredible women here. And we're demonstrating, like, and role modeling, we can be all sizes, we can, we look all different, we have different approaches to healthcare. But at the end of the day, we are really all trying to make a space for empowering women of all ages and having them have the resources that they need. I hope that younger girls can see that. And one of the things I value is being an aunt and also, you know, being out there as a healthcare practitioner and, you know, why I think, like, school nurses and coaches and, like, bus drivers, there are women that are going to help your daughters. If you're not, if, as a parent, you feel that's not in your toolkit or it's just not your opportunity. Yeah, yeah. I mean, they often are not looking to me to be their nutritionist or gastroenterologist. Sometimes we can't help ourselves, though, right? Yeah, completely. You know how many podcasts I text my kids? They're like, "No thanks, Dad." That's right, yeah, that's right, yeah. And don't you dare say the fucking word meditation. Yeah, that's right, that's right, yes. Yeah. But I do think that there is a kind of fluency among young people that certainly didn't exist when I was a kid. I didn't know anything about lean mass or whatever. My daughter's all know this stuff. So that's the silver lining, right? We're doing a little bit, we're doing some of it. Yeah, and they're into like weight health and not just the number on the scale. So if you were to define that, help us understand what that means, what weight healthiness is. Yeah, for those of you that are my age or in and around, we had the electric company as a TV show. So there was one word and the other word and then the two came together. And so for years in my practice and my life, I was always like, I'm gonna be the person that just brings health forward and ditches the term weight. Even at Cedar Sinai, I wanted to rename bariatric surgery and I was like, okay, it's no longer weight loss surgery. It's health gain, right? I was like, that's so sexy and they're like, nobody wants it, like that was before SEO, but they're like, no, Ashley, we're not doing it, right? So I ended up figuring out weight health in an electric company moment and saying to myself, I'm gonna bring these two together, but there had to be a logic to it. There had to be a reason, like, yeah, we cannot, but there's two things that are unignorable. The first one is that your weight actually is a health signal. Your bone, muscle, fat and water, which is what you're made up of. There's a little ash in there also. But we have that. The type location and amount of those are health signals. So just like your blood pressure, just like your blood sugar, those are all health signals, right? So that's our weight health. So if we assess weight health along with all of these other things, then we are going to understand what isn't isn't working. So I, to me, I mean, especially having practice for 15 years in Los Angeles, bone health was as big of an issue or finding the woman who was what, I don't love the term skinny fat, but finding the person who had visceral fat and saying, like, hey, I don't like what I'm seeing with your liver and with your fat here. When the scale was saying, like, oh, you're good, like, you know, on that part, we have to look at weight health. So we can't, you know, come away from that. The second that should nail it in the coffin for everyone, now that they're out there is GLP1GIPYYCCK Amelene, they, we, our body is made with hormones that regulate bone, muscle, fat, satiety, blood sugar. Like, they're the starder hormones until all these other hormones to go to work. So if we have weight health hormones, then we need to be weight healthy. And the only way we can be weight healthy is when we have optimal weight health hormones. So one of the things that actually got buried in my book title, 'cause everybody want it, like, you know, they think that I wrote, like, your best shot is about, like, a marketing play on the shot and this kind of thing, no. I want to turn around and be like, your best shot at you, you, your best shot at life fulfilling your life purpose is optimizing your weight health. Whether you use a GLP1 medication ever, it's up to you, it's up to access, it's up to, you know, whatever we can identify. But that was so significant in there. To be able to day, I don't think we can, like, to me, there's no reason that anyone should be saying, like, we should use weight loss. I'm a weight loss doctor. I believe in weight loss. I want to see your weight loss. These medications have weight loss. Weight loss is an umbrella term under which you have bone, muscle, hair, erections, or orgasms. You have, you know, nutrient losses, we have energy, we have mood, like, all of these things can be lost under weight, right? We can be so unhealthy if we're looking at weight losses in umbrella. Weight health is absolutely essential to optimal health, health, span, longevity, whatever, you know, destination we're pursuing. - Wait, so we're gonna just press on this for a second. What does weight loss have to do with erectile dysfunction? - Yeah, so when we are pursuing weight loss and we sub-optimally resource our body or we inappropriately use a medication, you will see erections, you will see that negatively. You will also see it if somebody's taking a statin and we don't address the testosterone loss, right? But testosterone can be, as we are losing weight, we can be losing our ability to make, to produce, to have sufficient testosterone. Similarly with orgasm, we can be contributing to dryness, we can be, we can get into the whole ecosystem of the body. You did say something before that I wanna double click on there because one of the pros right now of use a GLP1 with HRT is that one of the positives could be, hey, you'll lose that, some of that excess fat that's been a problem for you. On the one hand, maybe in that fat loss, but you could also lose muscle and bone if it's not used correctly. But remember, when we use estrogen, when we use testosterone, if you use any type of hormone replacement therapy, those hormones are actually need to be detoxified because they're fat soluble. Our peptide hormones are not fat soluble, but those hormones need to be broken down and eliminated. So if you're delaying digestion and you don't have optimized detoxification from a nutrient resource standpoint, you actually could be increasing risk of disease, like a cancer or anything else because you're going to have the circulating estrogen or the circulating testosterone not being broken down and eliminated correctly. You also could be shrinking fat cells, which is the desired goal. You're like HRT and GLP1, yay, we brought them together. I'm shrinking fat cells. I love the way I look in my clothes. I love the way that I feel, but I've liberated both physical and emotional toxins and my body wasn't ready to deal with it or it happened too quickly and I'm not eliminating those toxins. So considerations in all of it, again, why I wrote my book is that when we take a medication, we have got to optimized digestion, we have to optimize detoxification, we have to look at all of these other pieces. Otherwise, we will solve one problem and potentially create others. - Great another, yeah. So let me ask you then, just to pull on that thread, because diet culture has often been centered around crash diets that where you're losing a lot of weight precipitously. And it sounds like from what you just said, that that could have very negative downstream impacts. Aside from like, you're restating metabolic rate plummets and then you go off the diet and you gain it all back and mostly in fat. But it sounds like there's other things where lipophilic toxins get released and things like that. So would you recommend sort of moderate calorie deficit? I mean, I'm almost nervous to use that terminology because I don't wanna get into the kikko debate, but I'll just tread into it lightly. Would you say like, it is better to lose weight gradually than, and how do you do that on a GLP? Because I will not be honest, my experience with a GLP, and I was low dose chest appetite, so 2.5. I was like, it wasn't like, I'd slowly lost my appetite, it was like the next morning, I just didn't eat. - Yeah, yeah. - And it could have been, it's still very hard for me to get enough calories and certainly to get enough adequate protein to maintain muscle mass. So like, how does it like- - Yeah, so let's go back into the shit to unlearn, right? So we're gonna hit the calories one. The thing about the medication is that, remember that low dose, I love that you're using and thank you for the intentional use of low dose versus microdose. You've been well, you're well-researched, trained, et cetera. That low dose has been set though, based on a medication that was prescribed for people who fit one of two criteria, so obesity or diabetes. We don't have for your today or whenever you were taking the medication, we don't have a dose associated with your body composition at minimum, right? So it might be that 1.0 is the right dose for you. It might be that if we do do 2.5 that we work on, not force feeding, but we're very intentional about not relying on your own cues for the first couple of days and then we extend you out over two weeks and still see the benefit for the cardiovascular side. So as we move into, we need all these different protocols and that's something I've been involved with, which is how do we look at using a medication that has exciting opportunity because it is also is an agonist. It's working with your body. You know, statins and PPI's and these others are antagonists. They're working against our body. So there's all this opportunity, but we really need to look at the dosage. Okay, so the other part is I am going to have everyone break up with calories and calories out. Here's where I stand on the debate. There is no debate. Calories are only potential energy. We have this whole myth that they are actual energy, but they are not. They're unrealized energy until your digestive system gets a hold of them, and then is able to break down, break them down, convert them, make them usable, and then deliver them, and they get where they're supposed to be used. Right? So when we look at a caloric amount, or even a grams of protein, we'll get into that one next, and we say like this caloric amount might be right for you. Well, the caloric amount is going to have fluctuations. Anybody that's measuring even RMR, RER, any of these other things, you cannot come over to me and give me a caloric decision. You can give me caloric information, which it could be one component, but then I have to look at digestion and then I have to look at the content of those calories and look at how it's resourcing your body. Because remember, your body is really just like a car. It's about optimal resource. So yes, we need the right amount of gas, air in the gas in the engine, in the tank, oil in the engine, air in the tires, I'm not a good gas person, right? But then we have to make sure everything's operational under the hood, right? And that the car runs when those two things merge. We do not do, if your car doesn't start, we don't go out and drain all of the gas out of the tank and go, now does it start? You know, we look at what's going on under the hood. So when we come over to protein or any of these things, and you're saying, I have difficulty getting it in, then we, whenever we have times in our life where there could be difficulty, that difficulty could be stressed, that difficulty could be a woman in her cycle, that difficulty could be a treatment, that could be a performance. I mean, there's all sorts of different things. Then we look at how do we efficiently bring in those nutrients. So the one way that we bring them in is we might say food, we may say supplements, I might sometimes say liquid nutrition is going to, you know, we could look at Chinese medicine there and look at congees and you know, all these beautiful ways of when you warm up food, it's more readily, you know, or if I have to chew less, if I'm not able to chew, whatever. And then we come over and we say, and how is the digestive system going to receive it? So one way the digestive system is going to receive it better is if it doesn't get too much at one time, right? So the caloric exchange and one of the reasons I go into a lot of of this in my work is that really often I have better success with people by splitting things up in the day. So the amount of protein you're currently taking in may work beautifully for you, but maybe it's just too much at one time, maybe 50 grams at dinner after a day of all of this other stuff, your digestive system is like, I ain't getting in there. And so as a result, some of it's just going to get stored as fat and some of it might get used. Or maybe we need different diversity in your protein choices, different amino acids. I love to lean into creatine HCl, but also on the side of touring and losing and not just saying like creatine, creatine, creatine, like let's look at, you know, these other pieces, these other amino acids. So too often we get into this space of you need, you know, half your body weight in water or 100 grams of protein or X amount of grams per kilogram of body weight. When that isn't the case, it's how am I resourcing my body at each of these, you know, what I call pit stop. So I think of your body like a race car, you know, how do I pit stop for that? When you ask about the GLP one, then all it is like any other situation is it's brought to me and it's like, okay, now that you're on a GLP one, let's now personalize your nutrition for this week. Do you know that most people on an injectable or something that's going to last for seven days have more restriction those first two days. So those first two days, I don't want you hitting your highest amount of fiber because your digest your delay of gastric emptying, it's going to be tough on your system. I might move your fiber to later in the week and still spread out. But in those first two days, I do really need you to get nutrients in and you might not feel hungry at all. But if you feel if you're struggling to consume, we're going to look at maybe this is where I lean into your supplements more often, which might be egregious for some dietitians listening. But oh, yes, I do believe that. Or it might be that, you know, hey, days one and day two, we lean into a smoothie or a soup. And then you really chew on somethings, you know, days five, six, and seven, right? This is personalization. It is so different than what our guidelines teach us, recommendations, et cetera, what's served up. Yeah. Do you ever get into bed tired? And then you're bringing the sides. This is the perfect time to revisit that awkward conversation. Well, that was me. I'd lie there exhausted worrying about things that did not need to be solved at two, seventeen in the morning. When your sleep goes cockeyed sideways, everything gets won't get your focus, your mood, your patience, your digestion, that's one reason. I started adding magnesium breakthrough by by optimizers to my nighttime routine. It combines seven different forms designed to support relaxation, recovery, and sleep quality in a comprehensive way. And now they've gone a little cuckoo for magnesium. They've launched magnesium breakthrough advanced 10, which contains 10 bioavailable forms of magnesium, plus active vitamin B6 and ionic trace minerals designed to support sleep recovery stress and metabolic health. Head to www.bioptimizers.com/onecommun and use code one commune, for fifteen percent off your order. You can also get free shipping and every order is backed by their 365-day money back guarantee. Go to bioptimizers.com/onecommun and use code one commune. So you've mentioned a couple times that when we take a GLP-1, a pharmacological dose of GLP-1, that that signal lasts for five to seven days, right? So I'm curious because now I have seen an efflorescence of GLP-1 promoting supplements and foods. Are there foods and supplements that actually promote the endogenous production of GLP-1 and how can they actually compare against GLP-1 as an injectable when the duration is so different? So the answer is absolutely yes. If your body is designed with something, then resources that your body needs are going to be applied to that design. So these are peptide hormones. So when you hear peptide, you want to think protein amino acids. So if you don't have the amino acids to build these or said differently, if you don't have enough for your whole body, this is this optimal amount, the body might decide that it is going to use those amino acids to build and repair your heart muscle and it's not going to build and repair your GLP-1 or your GIP amino acid supply. Your body also has to be able to enzymatically bring them together. We have something called peptide bonds. Well, genetics could be at play there, digestion could be at play there, what impacts build, other things that help with the building of that vitamins, minerals, antioxidants. And then we have to signal for these to be turned on. So that signaling occurs in your mouth, it occurs by the vagus nerve, it occurs. So there are all sorts of things that calm the knock on the door of the L cells, the K cells, and they tell it to go to work and be deployed. Now it's deployed and it has to go and get where it's supposed to go by way of your bloodstream, where your vagus nerve. I'm out of breath. That is all nutrient-resourced. So for everything that's nutrient-resourced, there's a supplement associated, right? And that supplement could be have a tremendous value. So I can argue for glutamine because it's in the lining of the digestive tract, I can argue for omega-3s, I can argue for burberine having an impact, I can argue for all of these things, none of them. And I'm willing to almost say ever in my lifetime, I don't know that we will ever have a supplement that can go directly to your, the way like an injectable, it goes right there and it circumvents everything else and it does that. They all are going to impact how our body produces, deploys, signals like all of that stuff, some of them more directly than others. I call those activators where I think they're going to activate because they're exceeding what our normal optimization would be, right? If we ever optimize our own hormones, that might be enough for some people to have their weight health and like all of these other advantages. Some of us need more of that activation and I think that's as we evaluate the research and see what these additional compounds can be doing. But I also call them toppings, like kind of toppings on a pizza because at the end of the day, you still have to have your foundational digestion, hydration, detoxification optimized. Yeah. I wonder if in practice you've seen much anhydonia related to GLP1. I read an article I believe it was in the Atlantic that talked about dopamine circuitry essentially and that it's either a reduction in dopamine production or reception that is associated with GLP1 that mutes or blunts not just desire for food, but just desire more broadly. In many cases it has been applied adaptively to alcohol, right? So I think people who are taking GLP1s generally have relayed that their desire for alcohol must end. For me it was also coffee and I live for my morning coffee and I'm like and I still get up and want to make it and then I sort of just nurse it for a very long time. But I wonder just in practice, have you seen much of that? And do you have a sense for what mechanism is a play there? There's a gathering on this, and one of the things that's being presented is a dual agonist that has Amalyn in there. Amalyn is a weight health hormone that is distinct from all the other ones I've mentioned because it's actually in the pancreas. So it partners in the beta cell and it's with insulin. It directly targets dopamine. So the initial research on this, actually, the initial, this is where our weight bias society, the initial unenthusiastic response to this medication was, "Well, people didn't lose weight as fast." But you know what else didn't happen? They had almost none of the side effects, digestively, and other things. So, but it wasn't as fast and it wasn't as significant in the time period of the weight loss. Still had great weight loss. Exactly. But it's, it has a direct impact on dopamine. And this medication may be a much better suited medication for people who wear the dopamine components, which we know we can look at genetically and we can also look at in behavior and addiction, but we can also look at the implications of other medications, you know, interactions, that that, we know there's a direct effect. And so I don't think anyone is measuring or maybe they are, and I just, I'm not aware of their research, but in humans, how that amelin then is working with their dopamine, but we know that's a play, right? What I've seen in practice is a variety of different offerings. I've seen people who genuinely love food, love to cook, and are like, I don't, I'm not really interested, like I'm kind of throwing back some protein drinks or whatever. And immediately that's a sign for me that we're not on the right dose or we're, we don't have the right whole picture put together. So that lack of a hedonic experience, like that there, there's that side of it. And we also have to remember so much of what is creating that experience is also environmental. So it's also people who, you know, we, we might have that experience if in the same way, if we walk into a restaurant and we love the way we look and we see people and whatever and we sit down and we're certain, you know, like there's all sorts of STEM things that can stimulate us, right? In that part. So I think it's important to pay attention to that. I have seen people who are, many people mentioned the coffee and it's like very begrudging, you know, like that. But I was like, hey, what it's actually doing is it's inviting us to look at our rituals and the impact of our rituals because what it's saying is, Jeff, every morning, I want you to maybe smell something, experience something, do something and then also slow down in your experience of it. The flip side that I also want to mention is that I'm working with, oh, here come the emails, but several boys in their teenage years who have really battled depression, obsessive behavior and are on a variety of different medications, their sleep has been an issue, they know their gut health has impacted and we've introduced GLP one and we are reducing or removing some of those medications, they're experiencing empowerment with things where maybe binge eating at night was an issue or binge behavior that translated into other things, you know, etc. A lot of gaming is binging where it's I literally can't stop myself. So the opposite side is it play and that's why I think we have to be very, I mean, I guess my walkthrough life is to learn how to be non-judgmental, but we have to be non-judgment, we can't be in a space of yay or nay on these, we really have to say like, let's marry the tools and the protocol with the person, you know, with where they are today to help us really, you know, optimize them for the future. Yeah, obviously there's been a new movement, particularly for women around muscle-centric medicine, I'd be remiss if I didn't ask you about resistance training, do you advise resistance training to counteract muscle loss with basically just about everyone who goes on a GLP one? No, I recommend that all humans are challenging our muscles, remember our digestive tract is a muscle, we have a lot of muscles in a lot of places in our body, our muscles work based on being challenged and relaxing, that's the way that the tissues work. So this is nothing, we just have to pull away from weight biases, this is nothing to do with your honor, if you're off a GLP one. All of us need to be focusing on challenging our muscles, but before we do that, we need to understand that the resources that our muscles need, it gets from our digestion. So if you have suboptimal digestion and you keep increasing your protein intake, you are just making yourself more inflamed, more digestively overwhelmed and you are not going to see those muscles being built because the body will more than likely put it as fat, which it doesn't you know, in a stressed out state, unless your caloric intake is so low, so that's where the calories you know can come in, but it's certainly not going to build muscle there. So the first thing I always recommend, crust of the pizza, digestion, digestion and hydration is a part of digestion on that part to make sure that the body gets the resources that it needs. The second part is going to be your total nutrition so that the body now has the resources to build muscle. So I would not be telling everyone that lifting heavy is what we need to be doing. We very well may need to lift heavy or then we currently are if we're doing it safely and if our body can manage that. But when we lift heavy or even or and it's heavy for us on that part and heavy for our body, if we are out of alignment, we can throw our digestion off, we can create all sorts of other, you know, physical problems, but we also cannot have we can have the body experience stress that doesn't go towards building muscle. So resistance training needs to be more than the conversation of just your own body weight, some for some people that will be appropriate, but it's really about what is right for your muscles and what we're all saying is you need your muscles. So this is like going back to our GLP one sorority girl conversation. Can we help them just understand that you need your muscles? So if you are going to be a sorority girl who is on a GLP one, please at least then just evaluate lean body mass not only for your muscles, but also because you're building your bone in this time period. And if you have, if you don't build enough bone, then years later when it's breaking down, you're also in a worse, you know, bone place, but it's not that you, everybody needs to be doing strength training or, you know, all of the same kinds of things. It's that we need to evaluate and then personalize your, your, what helps your muscles grow and stay healthy. Yeah. It's a longer answer. I always in the one with the long answer. I love that. I love that. You've met a very happy audience with me. And I think this was a good book end to our conversation because it, it brings me back to AI on some level because what AI is really good at and what we are awash in is information. But what we really should be caring about is transformation. I mean, insights that get us there, we don't need info, we need the insights about our body. Yeah. Right. And so that is the big challenge I see right now. We're awash in information. I mean, Andrew Huberman was lightning in a bottle. I'm, I don't know, I'm having mixed feelings about him, but I kind of feel like that information is now everywhere, right? You can type in anything that you want into chat or clot or something and there's a lot of information. But how do we move from there to actually impacting and changing lives? And I mean, obviously you're doing that day to day in practice. But this is the hope that I hold for AI is that, that it is a tool that helps us move from information to transformation and I mean, it's what I spent, I've spent it to date over a year training my AI. She's called the Weight Health Nutritionist because I will not let it be called Ashley Koff. I don't want somebody being like, okay, I'm talking to you on AI. But I decided to create that not just because it will be very clear, I'm a Cavalier's fan, but because I was like, okay, there's so many people that I can't reach. And even like when I tell people about my book, as I'm telling your audience here, it's at the library. Like if you do not have a resource, if you're listening, this podcast or free, if you're anywhere else, like it has a QR code in there, you can go to our community for free. If we really want to transform, we have, we have so much that has to happen and we have to be able to bring that forward. But every one of us has a personal responsibility. If we do something illogical, so it is illogical to listen to an Andrew Huberman on a podcast, a day that he uses two electrolyte supplements a day, and then go take the same electrolyte supplements twice a day, which my friend from LA, a doctor here called me and was like, I don't know what to do. All my patients and they're coming and their sodium is so high and I was like, wait, he's also like ginormous. He's ginormous. He talks about how much he sweats. He knows what how much sodium he eats. He's done this end of one experiment and he knows this works for him. If you're not taking that away from your AI, if you bought his protocol book, if you're buying any of this other stuff, good ideas there. You have to start with the insights of your body and it's our job and thank you for the work that you do. It's our job to get this out there and figure out how we can help people access those insights. I'm very excited about AI in the larger space of being able to do this and also all the other stuff we talked about where it could maybe make it easier or more accessible for somebody at home to be able to do all of those things. But I also sat on the stage at the first digital health summit at the Consumer Electronics shows was 2011 and everybody thought it was going to be this raw raw yay, look at what we can do in AI and the person before me. And then Dr. Oz went and they're like, yeah, and this is what's great about it and you know what you guys are doing in digital health And I go I'm really worried. I was like I'm worried because the information that we have right now is so bad about calories and like all these other dietary Guidelines and if you guys use that to like you know put your like fit bit together and like all these other Recommendations were just going to double down. What are we done 15 years later? That's exactly what we've done in digital health So not always there's been some you know great movements forward. So A.I. has a great opportunity, but We're going to have to use it in such a better way for it to be truly transformative. Yeah, yeah, actually it's been great very very broad-ranging and I really enjoy you and I love the way that you that you walk through life Thank you and you too and this community. Thank you just for for all aspects of it. I'm really grateful Thank you for listening to today's episode for more of my weekly musings along with add free episodes and live stream Conversations head over to my sub-stack at Jeff Krasno dot substack dot com I also want to let you know about our course platform over on commune which contains over 3000 lessons and practices from the world's leading integrative medicine doctors health experts and Yoga fitness and mindfulness teachers. It's a living library For holistic well-being and you can try it for free for 14 days at one commune dot com forward slash try commune as a reminder the audio version of my new book Good Stress is Available on audible and you can listen to it for free as part of your premium Spotify membership and If you prefer the old school analog option Well, you can pick up a dusty old scroll at Good Stress dot com and get over $900 worth of bonus courses From some of my biggest influences including Dr. Mark Hyman, Dr. Zach Bush and Dr. Gabor Motte as always feel free to reach out to me with comments questions or criticism of the constructive variety at Jeff K at one commune dot com Okay, that's all from the commune for today. My name is Jeff Krasno and I am here for you Now you've probably heard a lot about GLP one on the show and other places But did you know that your body naturally produces its own GLP one as part of the system that regulates hunger and satiety? 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