Is Your Biological Switch Broken? w/ Ashley Koff, RD | Ep 20

Welcome back to the Health 3.0 podcast where the innovators shaping the future of healthcare share insights that you need to take control of your health today. Today I've got a great interview for you. I interview Ashley cough our dean Ashley and I talk about all kinds of interesting things in the realm of personalized nutrition. What's wrong with weight loss today. We talk about GLP one agonists we go into potentially who should be using one of these drugs who may want to not consider using one of these drugs. We talk about a lot of the language that she uses in her new book. Some of it's very groundbreaking and it's very different and she has found a way to move forward in the weight loss space, which is unique because it is such a noisy, noisy space. So if you are someone who is looking to improve their weight as she would say find the right weight health. Let go of that. Let go of weight. Maintain healthy weight. Then this is for you because she has a unique approach that you're probably going to want to hear welcome back to the health 3.0 podcast brought to you by life and I'm your host Dr. Doug Lucas or 3d surgeon head of longevity medicine at life and Each episode I sit down with the innovators disruptors and clinicians redefining what's possible and modern medicine and what that means for your health. Let's get started. Actually welcome to the health 3.0 podcast. I'm really excited to have you here and we have a lot to talk about. Thank you. I'm looking forward to it. Yeah, so I was just mentioning before we hit record you are our first dietician on the show and don't take this the wrong way, but I look at an RD almost as like a gateway credential because I work with a lot of dieticians and I have Ditiations that have been a part of the programs that I built over the last several years, but I know that I would never hire just any dietician because once you go through that program everybody that I've worked with has had to seek additional training additional education because what you come out of the dietics training with is in my opinion, probably going to leave you falling short of where I want you to be as a dietician. So you have done a lot because you are a dietician and a speaker and an author and you have your own interesting story that I love in the beginning of your book. So give us a little bit about sort of where you've gone from maybe you're a little bit about your own story, but then also what you've done since your dietic internship to get to where you are now. Yeah, so I'm the daughter of a surgeon, a pediatric urologist and family member, my brothers, a physician, my sister, a mom's a physician, most of my friends at college, etc, went on to pre-med and became physicians and the one decision that I made was I will never be an MD. I will never be a dr. So my niece and nephew five and eight now coined when I was explaining to them when I do and they said, but an Ashley aren't you a doctor and I said no I'm an RD and one of them goes, oh, you're a backwards doctor. And I said, why yes, I am. So I think it's really interesting. I think your critique of dieticians to me is one that I hear so often from physicians. I would critique physicians the exact same way. I think that, you know, there are I understand the training, but I also really appreciate the limitations of the training. I wanted to work in weight health. That is that's where my story comes from. That's the work that I wanted to do. I wanted a different toolkit and I felt very fundamentally that doctors cannot do weight health. So I see doctors as maybe a a nice to have in the space of weight health and I see dieticians trained properly as the must have. So it's good for us to be here in this doctor dietician conversation on that piece. I think one of the reasons is is that as somebody who battled my weight as a child and I talk about that. I think that's not unique and certainly wasn't unique in the 70s, 80s, 90s, you know, on that part, there was different diets and programs and you know, you name it it was there and I literally tried it. So the myth of the noncompliant patients, you know, I think that there were a lot of doctors who. I was never obese and so I never sort of fell into that space of how a doctor might have treated me, but there were certainly doctors that would just say, hey, nothing going on health wise, but you have this this weight issue, you know, you need to diet, you need to exercise, you need to lose weight. And kind of like I'd never thought of that or never tried it, you know, in that way. So I think the piece for me was I absolutely had health issues. I was on antibiotics from pretty much like the time that I was born, ear infections, throat infections. We know a lot more about that today and we know what that does to digestion. That would have certainly helped exacerbate a belly issue or even create one and then kind of coming out of that I had issues with, you know, heavy periods and so then it was why not use birth control. So it was on that at a young age later on in my early 20s, I had skin issues. So it was like why not try acutane why not try these others. And even when my ear infections and throat infections became deemed a health issue, the it was, let's just get rid of your thyme of your tonsils. So I got my tonsils and my add noise out. So I felt like doctors, you don't get it. Like it was literally just I never want to see another one of them, which is what led me to meeting a healer. I was a macrobiotic vegan who did yoga pretty much twice a day and didn't drink alcohol at age 20 and you know, you're like what. And I was trying everything. I was trying all the non doctor route, you know, sort of after seeing that that didn't work and that healer that I met in yoga said to me, you know, I think you like basically like prick my finger, look at my blood. I tell this whole story. But her she was like, you need to do a goat's milk cleanse like you have a worm. You have to kill it. I'm like, okay, like it doesn't want to do anything. You know what I mean. And I think that those rock bottom moments or those really challenging moments when a diet fails you just feel like Come on like, you know, and so when somebody bring something else up, you're like, all right, I'll go ahead and try spoiler alert for anyone listening. It did not work. But it led me actually to a different kind of doctor. I met him belly up at a bar. I was drunk because I'd gone back to drinking after yoga because I was just annoyed that my cleanse didn't work. But he actually was not drinking and came up to me and said, by any chance did you take antibiotics. And I was like, what? And he gave me his card and I must have still had some hope and probably because he took my insurance and I was a poor 20 year old. I went and saw him. And what's so interesting about that conversation was he never put me on a scale. It was a gastroenterologist, a different kind never asked me about my weight. But boy did he get curious. He was curious about why the antibiotics. He was curious about the different types of birth control. He was even curious about my parents health, you know, and asking questions. So that curiosity at the like kind of as he waived his magic wand and said, you know, he's like, it's not what you're eating or what you're not. I was like, what? Hold on a second, you know, and he's like, no, he's like, it's your body doesn't have what it needs to run better. And that completely threw me. I was like, what are you talking about? And he explained my digestive system as an operating system. And from there, I was like, a Mr. Fix it like I'm like, I'm going to go out and be able to do that. So that's that shift there was really what birthed me as a dietician and why I, you know, didn't become a doctor. I wanted to have different tools, but it was interesting because many dieticians often will lean into what you eat and what you don't eat. And if we play that game and we don't come behind that and say, what is your body actually able to use and is it showing me that it has what it needs and can use it. Then we're not you're we're not going to help you get better, right, especially today when nine and 10 Americans don't meet the criteria for metabolic health. So it became a dietician and After a handful of years in about 2004 working with bariatric patients, I first learned that our bodies make GLP one. And that was just this light bulb moment where I'm like, wait a second. Not only do we make hormones that regulate our weight, not just our fat and not just our satiety, but our bone, our muscle, our hydration, inflammation and blood sugar, all these different things. They're made in the lining of the digestive tract and they're deployed from the lining of the digestive tract. As soon as I learned that, I understood my own. I really understood myself, even better. And that was 2005 was really when I was like, I've got this playbook for optimizing weight health and I've been doing that ever since, you know, reality TV shows, books like all these different things. And I'd been working with patients who are on agonist, but it wasn't until I'd say kind of for everyone coming out of COVID, the like maybe around 2020 2021 or your take is, but there was just this explosion of GLP one agonist. And that had for me was, hey, we're going to be in a world of hurt. If we think that we use a medication for weight loss and the solution is diet and exercise. And we don't actually understand that they're weight, health hormone replacement and what that means. Yeah. So you've obviously been watching the the weight loss space. I want to hear your thoughts on what we have wrong. Even I mean, I know gosh, go back 20 years, 30 years. I know what we have wrong. I mean, the exact same things that you said, but today and today's world for people who are struggling with weight loss, maintaining a good a healthy weight. Yeah. What do we get? What are we getting wrong? Yeah. What are the biggest things? Sure. So weight loss is the problem. Total weight as any marker of your health is the problem. You know, you can have people that might appear as patients that might they get on the scale and they we like the number, they like the number. But when you look underneath the hood, you're like your bones aren't good or your muscles aren't good or your blood sugar isn't good. You know, so there's, there's issues there. Right. Total weight doesn't tell us anything total weight for height also doesn't tell us anything. We may have population data, then it may help us, you know, there in a way. Total weight BMI is an access point for who gets a GLP when agonist BMI is used for who is allowed to be in our army. Guess where BMI is not used. The NFL, the NBA, the WMBA. So like we're our highest performance athletes are not just on their weight for height. And in fact, none of them would be, you know, we wouldn't have a field of athletes if that was the case. So for me, weight as the marker is actually the issue. When we look at weight health, we actually look at your weight composition. So your bone, your muscle, your fat, and your water content, the type, the amount, and the location as I would say together, as a key performance indicator for your health. Now, I factor that in with things such as your lived experience, do I have cravings, do I feel full after I eat, I factor in digestive health, I look at hydration, I look at things like inflammation and other stuff. So I'm not just myopically looking at weight composition, but when I look at it and I understand weight composition is going to tell me that what your body is trying to tell me. 'Cause at the end of the day, that's how we optimize health. We do not look at a chart and say, you are here and you should be here. We look at how are you feeling today and what is your body telling me about your health? When we look at weight composition, we can actually understand that weight loss as an approach, typically worsens and almost always disempowers the individual because it doesn't work long-term. So the issue would be is if you are already under-resourced or your body is not able to use what it's getting in, and then you decide to eat less or eat in a shorter window or get rid of a food group or something like that, and you don't optimize where there is suboptimal function. You haven't fixed anything. So the way that I would say it is, you go to start your car, your car doesn't work. Maybe you're like, oh my gosh, am I out of gas? And you're like, nope, I've got plenty of gas. I've got air in the tires. I look maybe under the hood and I see I've oil in the engine. You don't then go and say, well, maybe I should just try to put more gas in the tank or maybe I should let a little gas go or I should let out a little bit of air in the tires and see if the car can start. You usually get the car toad or maybe you know how to do this, but you look under the hood and you say, and I don't know anything about cars, but maybe it's like a spark plug or maybe it's something else, but it's something else that's going on, right? And we are not looking under the hood. And instead we're coming in and we're saying to people, well, it must be something that you're eating or that you're not eating. And while those can be factors, they are not the strategy going forward. So I use the analogy of a pizza and the pizza is your crust is your, where we're looking at your digestion and your hydration, your sauce is gonna be the better nutrition and your cheese is going to be those lifestyle choices. They're all going to need to be important, but if you don't work on, if your crust is suboptimal, you don't have a pizza, right? You know, or you don't have a good pizza. And then what everybody gets excited about, which I think is where you dug and I end up, you know, getting the questions is the toppings. Like, do I take an agonist? Do I cold plunge? Do I, you know, what do I do? And so those are toppings. They can absolutely make your pizza delicious to your body today, but they aren't going to be able to override if you don't have a crust or you don't have a good crust or you don't have the sauce, you don't have the cheese. - Yeah, that's awesome. You went from a car metaphor to a pizza metaphor. - I did, just like that. - Yeah. Only a dietician, I don't know, can do that. In your book, you talk about this switch and you kind of bring it up early and you, it becomes a foundation of what you end up recommending and the end. Can you tell us a little bit more about like, what is this switch that we're talking about? Because you talk about the switch hormones too. So can you kind of dig into all that form? - Yeah, I think it's so interesting too. I always try to come up with analogies and I remember, and I actually talk about him, one of my brothers is a fly fishing guide and one of the things about being somebody who's a practitioner or a guide is that we respect that not everybody is going to be able to learn what they need to do based on the same story or the same analogies. So I remember one time having a fly fishing guide who basically just started to talk in a normal voice and then get louder and louder and louder as I was not doing the like 10 to 2, as I was trying to cast. And I was just getting more and more pissed. So I'm like whacking it. Like obviously it's not doing well. And I remember telling my brother that and he's like, oh man, he's like, so you know, sometimes I use this and he obviously knowing me, he knew that I played the cross and he's like, okay, you know when you shoot a score this way, it's like, you know that. And he had me do that and I was like, oh, done. You know, and it was so easy. And he's like, you know, if you, you know, go faster, it's not going to work, but if you kind of, right. So and in that way, I think we can lean into analogies. So when I started understanding how our body has these weight health hormones. So GLP1, we've almost all heard of, I think at this point, many people think it's a medication, but it is a hormone that's made in the lining of our digestive tract, GIP or GIP, depending on how people pronounce it. PYY, CCK, we now know about Amelin, Oxymodulin, we know GLP2. So there are a lot of these and they're all in the lining of our digestive tract and they're different than other hormones because they're peptide hormones. So they're made from amino acids, whereas like say testosterone or estrogen, they're made from fats, they're steroid hormones. So that's relevant in only that when we talk about protein and we talk about digestion, we have to understand that we have to have that available to make them. To your question, why then would you talk about a switch in that space? Well, I want to be able to understand that, and this is before the agonist, but now I think it's really important. Our own hormones only stay on about two to five minutes. So they're designed like a motion detector. When they get a signal, they switch on, and they're supposed to run and get where they're supposed to go in about two to five minutes, one or two of them, maybe even for an hour, but a short amount of time. And then they're deactivated. Something comes in and turns them off, right? There's an enzyme there. So if the body, which I think is brilliant in design, a lot of times we try to unpack how the body is designed and a lot of advice might be like things like stop stressing or don't have inflammation. You're like, hold on a second. We have an inflammatory response. It's important. Or stress, actually the stress response is important, but how we optimize those is going to be key. And so when we started to think about these weight-out hormones, I'm like, I'm not going to say it's wrong for them to be designed like a switch. But what we have to understand is if your switch is not working, if it either does not get switched on or it gets switched on after you've eaten one or two slices of pizza, and it doesn't get-- the hormones don't get where they're supposed to go until you've finished the pizza and had all of the slices of pizza. That suboptimal functioning of the switch is going to be what we need to look at. How do we optimize it? What does it need for repair? Well, when the agonist came on the market-- so GLP1 agonist-- so an agonist by definition is a medication that works the way your body is supposed to, whereas an antagonist is one that tries to stop a function. So an agonist comes on the market, and these medications, these hormones are hormone replacement therapy. They look exactly like ours. With the exception, they are not a switch. They're more like one would argue a force field. So the ones that we know of semi-glutide, temperatures, epitides, red or true tide, they stay on for seven days. Now they started a higher amount and go down, but they stay on for that time period. So you're 24 hours a day. You're having your switch turned on. So imagine if you had-- we'll keep the math simple-- if we had two to five minutes six times a day-- let's call that 30 minutes-- let's say your electrical bill was correlated to that 30 minutes. Now let's say you switch on your motion detector. You leave town for a week. And you go, oh, I forgot that I left that on. So that's now seven days times 24. I can't do this math on cue. And then time 60, because 60 minutes on that part. And we look at that and we go, OK, that's a much bigger electrical bill. So when we're on the medications, we have a much bigger electrical bill. And that'll obviously also be dependent on the dose of the medication. So we have to understand that while they're similar in that they hit the receptor site and they work the way that our own bodies, hormones, work, moving forward, they have a higher burden on the body from that like we'll call it the electrical bill. So for me, it feels really important for us to understand that a switch, depending on-- number one, your switch needs to be working. It needs to be able to tell all this other stuff to happen. If it can't do all of that in two to five minutes, then we need to figure out how to optimize it. We can do all of that. And I've done that for-- your wife has done that. We've other people. For 20 years working with patients on that part. The question mark is, is there some people where the switch, because it's not working, the body is now so suboptimally functioning that we actually could benefit from using a force field for a period of time, absolutely. But we have to acknowledge the considerations of what else we have to do while you're on that to make sure that we don't go into debt based on your electrical bill. So it's a switch, an electrical bill. I don't know, it's a whole conversation. And I think it's really important for us to come back to that, because it also helps us understand why you can't come off of the medication and just expect your switch to work. If it was not working before, and the medication gave you a force field, and you go off of it, and you don't even have a working switch, like you're in this place where you've got now a bigger problem and you're going to see all the other things come back. It still doesn't work. So when we talk about the switch not working or like a dysfunctional switch, this is really interesting to me, because I go back, my wife, for those who've never heard me talk about my wife on this podcast, we were talking earlier because her name is also Ashley, and she also registered a dietician. - He's kind of brilliant. - Okay, yep. - She's a great combination. - That's right. - And so she is in the weight loss base, and I was her beta patient. And so we go back, I look at myself, and I look at my genetics, I look at my nurture versus nature, I have a dysfunctional switch. So I talk about myself openly. - Yeah. - When it comes to the dysfunctional switch, though, how much of this is, is this genetic, is this what we're exposed to, like what makes it dysfunctional in the first place? - Yeah, so it's yes to all. And you'll hear me, like every time I hear weight loss, I say weight health on that part, only because I want us to frame that the actual outcome is we want to optimize your health, right? We don't want you to just lose weight and not actually fix your switch. So when we look at that, So what we want to think about is the way that a switch gets turned on is actually, you can go over and you can flip a switch, but in the wall behind if that electrical isn't working, then it's not going to get turned on. So we have to go all the way back to your genetics, absolutely. There's some data that shows that genetics are anywhere from 30 to 50% of their impact. And I really unpack this because I had somebody who told me I have no wonder this has always been a struggle for me. I have genes that would before being obese and like kind of like congratulations, you're not obese. I had somebody else who looked at my same genetics, but who framed it completely different and said, Oh, wow, like you have such survivor genes. So your body, yes, it's going to hold on to food, but you're meant to be out there, like all the rest of us will be gone and you're going to be out there. And she's also helped me see that I really had an endurance athlete in me. And it was like you can actually really like hit it hard, you know, climb up mountains and do some of the endurance stuff that I do. And that was like such a great reframe, you know, instead of being like, Oh, these are obesity genes. One of the things I want us to caution about just looking at the genetic component is saying that the genetics are not the outcome on that part, right? So there could be a genetic component in there. And the way that I like to look at genetics is when we understand where you're efficient and where you're inefficient, we want to try to create an overall efficiency and optimize from that, right? We want to balance out, you know, and we can do that. So genetics are going to be key. And then we understand that from the way that your body is thinking about food is it's going to get signals from all of your senses. So it might be thoughts. It could be your smell. It could be your taste. We have GLP1 receptors on our tongue. It could be, I can't remember what else, you know, thoughts and any of these. And then that's going to send these messages from the brain via the vagus nerve down to the gut. And then the gut, the vagus nerve is going to drop them and kind of knock on the doors of the L cells, the K cells and be like, Okay, now you need to send those hormones out because I'm going to let you know you're about to be in receipt or you are already in receipt of things. And they send those hormones and those hormones travel via the vagus nerve or via the blood stream to what we now know to be a lot of different places that there are receptor sites, right? So when I explain all of that without almost even taking a breath, and then I say that you have two to five minutes, like that's a problem. So the issue is that even if today I could test that moment from when the signal knocks on the door of the L cell and your hormone gets deployed and the amount and then the transit time, even if theoretically I could test that, like say we had a continuous GLP1 monitor and I could see I'm not I'm missing half of the system. And for many of us, half of that system is not working well. And then for the rest of us, nine in 10 Americans, not meeting the criteria for metabolic health, the rest of us, we know that digestion is impaired. So we've in the signal getting and on, you know, and knocking on the door of the L cell in the case, I'll maybe a factor, then those cells opening up and sending out those hormones and then blood flow, blood stream, like it could be a crowded highway. We could have blood sugar issues there. We could have endothelial issues. We could have dehydration issues. And then you have your vagus nerve again. So when I look at all of that, that's all of what I'm unpacking to look at sub optimal function. Now, what you acknowledged about yourself and what I was sharing about myself is when we are not taking care of our systems, we probably, because of many of those things, are more likely to have actual dysfunctional, you know, of our weight health hormones. I have a lot of people where they're sub optimal, but they're just it's suppressed or it's maybe delayed. Like they're technically working. They're just not getting there on time or, you know, at the pacing we would like. And suppressed might be, hey, everything about how the whole system is working should be working great, but you're not sleeping or you're drinking alcohol or your stress, you know, things and you're, or you're eating, even though all the other things are working. So in that space, depending on where you are on that sub optimal spectrum, it's going to dictate a little bit of how we treat it. And it sounds like maybe the majority of those things are something that we could actually do something about. Like is this switch fixable? Is the dysfunction correctable without the agonist? Yeah. So I wrote a book which I think, you know, I always think like I started my career in marketing. I sold sugar cereals, I sold like hair color, I sold diamonds, you know, this kind of thing. And I'm like, okay, Ashley, like your best shot, great name. Like it's like, ooh, double on tundra, you know, like that kind of thing. But then I put like the, uh, personalized system for optimal weight health. Like almost nobody knows that they want a need optimal weight health. So like, you know, they're not, it's not the weight loss. And then I put these term on there, GLP1 shot or not. And you know, what everybody wants today is, and literally I've had people be very aggressive with me on podcasts. Like are you for or against them? And I'm like, that's like asking me like, am I for or against cholesterol, like or a cholesterol. Or, you know, I'm like, this, the body has them. Like I'm not for against what I would say on this part is they are a hormone replacement therapy. So here's a situation. Can we repair thyroid without thyroid medication? What would you say? Yes, we can. Yes, we can. However, what if you don't have enough thyroid hormone? Then you might need a replacement. You might need a replacement. Now you might need a replacement forever. You might need a replacement for a period of time. You might need a different dose than someone else. What about testosterone? Are we going to wait until you have no testosterone? That's not fun for a woman or a man on that part, right? And we know testosterone is about muscle building. It's not just about sexual performance, you know, et cetera. And we also know it is your iron levels are a factor with testosterone and vice versa. They have this relationship. So when we look at hormone replacement therapy and we look at GLP1 agonist in that place, and I want to put a very significant footnote. This is being recorded in February of 2026. There are medications coming on the market that like Orphal Glyparon and others that are called small molecule non-peptide. They are not hormone replacement therapy. When those come on the market, we have to look at this conversation differently. So I just want to acknowledge that because everybody is going to be listening to this for a hundred years. So I just want to make sure. So the thing for us to understand in that space is if we are trying to take a position on whether or not we need hormone replacement therapy, we are really trying to wave a crystal, like use a crystal ball and say like what's going to happen in your life. So what I would say is this, if you are on if a patient is unable to do the things, and that could be access, that could be other things that go on in their lives, that could be we have trauma to work on, that could be that we want to actually use this hormone replacement therapy and I can get you off and there's a true story, five other medications that are antagonist. And we can do all of that then why not on that part. But as I talked about in my book, I have several patients, Mr. Pizza Pop early on and then I have patients more recently where they said to me, I do not want an agonist and I said, okay, so let's go through and here's how we do this, right? But I also have said to each one of them that I can't wave a crystal ball for, or I don't think that's right, it's a double expression. I can't look into a crystal ball and know that you aren't going to be a paramedical a woman or a man who was losing testosterone 20 years from now and we're not going to need to use this or this wouldn't be the better choice for us in that place. So the part of what is driving, I think these questions is fear and the fear is being borne out of a society that is bringing these medications out and talking about them as weight loss drugs in a society that has so much weight bias because they judge us based on our weight for our height or just our total weight. And if instead we actually talk them about them as hormone replacement therapy, we actually erode most of that bias. All right, that's interesting and that's the, those are the conversations that I've been having in our own clinical environment because we have, we have a weight management vertical. Yeah. But yet I am the VP of health and hormone optimization. And so we end up crossing over. Yes. And in my space, I'm really talking about what's the lowest dose of these things that we can accommodate and utilize because we're optimizing as much as we can all the other pieces. Whereas in the conventional model, we're using, you know, the phase three trial dose recommendations, you know, starting at X and moving up toward Y and which judge no health outcomes other than total weight. Now a couple of them, like Retotrutite have looked at AST and ALT and that kind of thing. But I think the issue and I, I would hope and this is just I'm going to throw this out there. I would love to see a removal of something called weight management because it also, it tells somebody like me that I'm a bad manager, right? Like that I should be able to, or that this is just something to manage. I'm here to optimize, like I want to optimize my weight composition at every stage, you know, and make sure that I'm not losing fat mass and losing bone or I'm not losing fat mass and losing muscle. But the problem that we have right now is we, these have been brought to the market for diabetes. So blood sugar that still uses hemoglobin A1C, a 90 day average that we, you could have rolling hills or you could have an EKG machine under that 90 day average and it's still going to give you the same average. And it uses weight and total weight loss and how fast you can lose that weight as the marker of success in those clinical studies. And then it also is a model that suggests that we are going to only look at those medications and and look at keep going up on dose with the idea that more and more and more of this is what would actually improve outcomes. And we have an influence or population and a researcher population and quite frankly, some practitioner, more doctors and the dietitians population that says that emphasizes that more you just need more protein, you need more fiber and you need more strength training. When we actually look at that, that is all of those things are problematic for an operating system that is actually an ecosystem that's saying, I want to have the right amount in the right form where I need it and when I need it and I want to be able to use it. And so you should just take over the other department, get rid of weight management and make it all about hormone optimization. So there you go. Every org here company. - I'll be sure to let the manager know that. - Great, perfect. - But I couldn't agree more from an optimization perspective. In fact, when I left orthopedics, the company I started was optimal human health. By design, we're talking about the same thing. It gets really challenging when you are trying to bridge, what is what you and I are talking about, which is this new health model, right? What is actually optimal for each person individually versus the conventional model where we are, which is what is right for an insurance system and what is right for the pharmaceutical industry and how do we play with all of these bridging that gap is actually what we're here to do. And so we are, I mean, actually I think my water bottle says it nicely, what does it say? It says optimal bone health in D, right? It's the same thing. But how do we work with this system as it is while we're trying to get what we hope our patients are looking for, which is the least amount of something that is going to overload our ecosystem that's such a great word to ecosystem. Because there are so many other variables at play. So I'd love to get into a little bit of tactics. So if the strategy is, let's optimize this. - Optimize, yeah. - Then tactically, where do we even start? - Yeah, you cannot have any switch optimization if digestion is suboptimal. And digestion is not, I'm not telling somebody, please do not run out and get a large test to see what you're allergic to or what you're not and don't get a direct to consumer one that's going to say like, oh, it was all almonds, the almonds that you were eating. No, we have to actually see like your digestion is broken into different parts. It's about breaking down things. So your body digestion is an active process whereby your body breaks down what you take in and it breaks it down into usable components. Sometimes it structures it and builds it into other things. In the case of peptide hormones or pro-resolving mediators or any of these things. And we have that, but then it has to move things where they're supposed to go. Then it has to be able to be absorbed so that it can get absorbed in and go either via the bloodstream or however it's supposed to get where it's supposed to go. And then it should eliminate and get rid of. So that's going to be the first place for us to assess. And we have to do better digestive assessment. The great part is that that doesn't really require much more than tuning into your body. So it does require looking at your poop, maybe even smelling yourself. I've got your assessment for your poop test in my book and I've got the sniff test. And if you're not going to be honest about your smells, like you can also just say, am I covering up my smells? What do I smell like before I put deodorant? What do I smell like before I brush my teeth? These kinds of things. And especially any changes. Have we seen changes there? Skin health will give us some insights. Belly, things going the wrong way and I bloated and are things not going at all. Those kinds of things. When we unpack digestion, we can actually see where we need to focus in terms of optimization. And that's really important because it brings me over to things like the dietary guidelines. And in terms of whether an upside down or a right side up pyramid, I think the pyramids are one of the seventh wonders and they belong in Egypt. This is just not better for us or a plate or a plate with a glass of milk also not helpful. Because the body is more like a race car than a street car. It really cares about how you fuel it in any one moment. It's just it's very needy like a child. Just do I have what I need in this moment? And then it's like on to the next thing, right? In that way. And needy children are wonderful. We should pay attention to their needs. But we want to make sure that we're focused in that space. And so when we look at that part, we have to come back and say instead of is chicken healthier than meat or is kale versus spinach or the big one. Like can I have plant-based protein versus animal protein? Your body is going to tell you if something is healthy by when it actually arrives as the nutrients that it needed and is able to use it. So the way you and I see that is what does your muscle look like? What does your bone look like? Is water intracellular? Is water extracellular? You know, on that part. We don't give credit to food outside of the body unless you are trying to market something. And our dietary guidelines and in particular, the ones that are related to the food pyramid or whatever, they're deciding that some foods are healthier than the other. The body is just like I need nutrients. And it also, one of the reasons that we can't look at dietary guidelines is no one today is just eating food for their nutrients. We have fortified foods. So we have things that have supplements built into them. And then we also have dietary supplements. And we have some nutrients that are coming in by way of medications in terms of like a fish oil medication or that kind of thing. So we have to look at our total nutrition in that space. So if you look at two things and you look at digestion, which would include hydration in there and you look at your total nutrition, we now know what is not working better for your body and we also know what is working for your better for your body. So the way that a dietitian, CNS, you know, someone who is trained in practicing nutrition, not somebody who has learned or studied on tests what nutrition is or you know, better nutrition is or isn't, the way that somebody's gonna work with that is they're gonna say, hey, these are all the things that are working for your body. Here's what's not working. Now we're going to optimize. But if we look at nutrition before we look at digestion, we're never gonna get your switch to work better. - I wanna double click a little bit on the functional testing piece. - Yeah. - So you didn't actually say those words. - Correct. - I'm gonna use the word functional testing, which I think the word functional is kind of a dirty word currently because-- - Confusing word, right? - Yeah. - It's just a space where a lot of the different types of providers live in summer, well trained in summer, less trained. And there's just a lot of, I think there's a lot of hope in the space, there's a lot of confusion in the space. And unfortunately, I think there's a lot of taking advantage of people in the space. But functional testing is, I would describe it as testing that is outside of the conventional system that are looking at different markers and then summer helpful and summer probably not. You mentioned specifically looking at food sensitivity testing and I wanna name these things 'cause I know that people are going out there or you mentioned direct to consumer, they're out there, right? - Genetic testing, like a lot of these. - Yeah, yeah. - So where does this fit in? And where should people run away from when it comes to functional testing? So maybe if you could get specific-- - Absolutely. - Name the task like helpful, not helpful. - Great, okay. So I'm gonna change the take on functional a little bit in the concept of functional or of integrative or of any of this is the idea that can we get to the root understanding of what is causing your disease? So one of the reasons I don't love the term functional testing is that a test never gets to the root cause of your disease. The test in interpretation with all these other insights and really through the interpretation of a practitioner brain not an AI at this point, 'cause AI is going to be how the AI is trained, maybe in the future, but I don't feel right now. So I don't think that we should actually call a test functional, you know, in that way. And then the flip side is we have all these biomarkers out there and they-- Some of the markers used in through, like the way that I interpret a marker as an example, Faratin. I was taught that Faratin was maybe necessary, maybe not, but was totally related to iron status. I now know that Faratin can tell me a lot about inflammation. It can also help me give me a gauge on where I wanna look at testosterone. So, you know, I think that we have to recognize it's also-- So much of this is in who's interpreting the information. So that means I'm gonna answer your question but kind of not, so that was just a scapegoat on that part. So in that way, what I want us to think about is first and foremost, you noticed in what I was actually asking us to do was all insights about your body. It was not a test. They're all free. You can drink eight ounces of water and you can let me know how long it is before you have to pee. And that's gonna give me some insight about how your body is folding onto water versus how it's letting you go. I call that the hose versus the sponge. You can bite into an apple and you can tell me how sweet it is. Now it's on your testing of one-- on a scale of one to 10, you know, your sweetness, where one is a yak and 10 is a yam, like a full yam. And so if it's about a seven, then I know that your sweet taste buds are picking up on sweet. So there are a lot of these things that like, you don't have to pay a dollar for. Okay, once you decide to pay a dollar for, the question mark that I have is how useful is a test to you personally? And this is where I'm really anti- the majority of tests in a direct to consumer space. Now, I'm not anti us having direct to consumer tests because as a clinician, I know oftentimes my patients struggle to get a test through a physician or through insurance or something else like that. So the fact that they can go to a lab and now get, like I literally-- I was doing a story on LIPA protein A. I remember this was when Bob Harper had his scare. So those years ago, and I was doing it with someone from the New York Times. And I just wanted to know my LIPA protein A. And I was in an executive health program at a very well-known university. And the doctor was so mean to me. And he's like, I'm just not-- now he's like, insurance not going to pay for it. And I go, cool, I have the $60. Like this isn't an issue. And just what can you do? He goes, you have no heart history, no heart disease in your family. I said, right, I still just want to know what this-- we went back and forth. And he literally wouldn't-- and I just finally yelled at him. And I said, look, like, are you going to do this? Or do I need to like get another doctor on that part? And you wrote, you know, probably for the 87th time, non-compliant. Here we go. Like, go get your LIPA protein A. So I don't want people to have to go through that and not get the data that we need. So I like that. You just shouldn't be interpreting your data. I should be interpreting your data. Your doctor should be interpreting your data. Maybe we as a team should be interpreting your data. Because when a doctor looks at data, they're going to look at it differently than when I look at it. And so collaboratively, we can do that. So I think-- and let's talk about a machine. So the ones that are-- if you get a test done, and they are then selling you something. So you're. you get the test and then they're selling you a supplement from there. You get the test and they're then selling you a food program. You get the test and then they're selling you another test or any of that stuff. Run from that. And I tell my patients, like they'll go to some of these companies that now will do like 100 biomarkers and then you get an AI report. I say, great, do that. Just don't read the report. Come to me like that and I'll look at that. So I think that's kind of where we are in that space. The issue that I have specifically with, we talked about genetics. So I don't need to like do much more on that part. But the genetic testing that then tells you that this is what's going on in your body or this is what you will have is happening for you is completely wrong on that part. And any genetic test that looks at one gene and tells you what your outcome is, that's a flaw. So the second part, when you look at digestive tests in particular, you want to understand that they are going to tell you what is going on in your system. So if you look at food sensitivity, if you tell me I have these gut issues, like I feel like after I eat, I'm bloated, I feel like after I eat, I get hot after I eat, I get, you know, my mouth gets irritated. And then you go and you eat stuff and you take a poop test and it comes back and it tells you everything that you eat or drink as bothering your system. You've just proved out what you knew before you did the test. You've got an irritated system. So in that instance, I almost always will have my patients instead of doing that test first, I will work on tuning up their digestion and then we might do the test. If I'm like, I'm just curious about this, right? Sometimes we can do an elimination without that and just a very focused elimination and get, you know, similar data. Now we've moved to the place where we have genetic assessment of the microbiome. So we can do this, what they call a shotgun and they can get a whole snapshot of that. And that can actually give us some good data, but I don't go in there and I don't look at what bacteria are there versus what bacteria aren't there. And if something's not there or it's in a lower amount or something's in too high of a amount, I don't just then make a decision based on that. I look at it as part of your story. And that's where I think all testing should be used. So we have to in that space not actually ask the question, do I have the money for the test? Do I have the money for me to interpret the test? And here's the issue. Today doesn't pay me to interpret those tests for you. So that's really where the rubber meets the road. One of the reasons I love what you're doing and I love the concept of health 3.0 is we have as somebody who has worked within the system and you've worked within the system. For me, I even went to DC and tried to disrupt the system and then I ran and was like, that's not going to work. And then we came back to the spaces of, well, what if there's like kind of, we can look at business and we can look at the private sector and say, can we create these businesses that maybe address access, but addressing access to a medication to a supplement to a test without addressing access to the qualified practitioner team that you need to put all that together. That's not making things better. And I think what the final piece that's happening with testing, I think is so problematic, is because our system is so broken, right? Like I think everyone would agree. Like healthcare costs are, you know, the only people who seem to be making money are people who are very high up at insurance companies or maybe at pharmaceutical companies on that part. And maybe that's an oversimplification and just presents my bias, but there I said it. But if that's the case and we know it's so broken, so what ends up happening is all of these companies are coming on the market and there's a group, there's a world of investment money that's coming in and saying, you know what, I don't care if you're an actual solution. I'm actually not even going to judge you based on patient outcomes. I am going to judge you based on what you sell. And I think like even if you are just fixing a little, you could actually like why not worry about that? Like maybe you're just a little bit better, right? Where's the issue with that? Who loses me again? And I become further disempowered because I tried to stool test. I got rid of the almonds. I felt a little bit better for a period of time and it's no different than my goat's milk cleanse and I end up back at a bar drinking and I'm like, and hopefully, you know, some practitioners like me walks in the door and says like, hey, did you ever take antibiotics? Right? So we're in a way no different than where we were in 1995 with so much more access to so many more testing and things like that. And we're still nine and 10. We're so much more unhealthy than we were even in 1995. I look at this slightly differently. Okay. The same idea where when I go back and look at the system that I was in, my practicing orthopedia dex and the conventional system, mopping up metabolic disaster left and right because that's what surgeons do. I put an ankle was my subspecialties. That's really what we did, right? Learned a lot about metabolic health by cutting off the extremities. And I look at what happened as I transitioned into an integrative model and then I go in functional pathways, hormone, like all these things and I sort of looked at all of this amazing data, all these amazing tests that I could expose people to. And then I started doing that and I realized I'm really not making most of my patients better. Because it's not an information deficit and actually use the great word, infobesity. I love that word. It's not an information deficit. But at the same time, as you experienced, there are people who have enough of a background to be able to utilize some of this information. That's right. So then where do we find that middle ground? Because there aren't enough of you that there can't be enough of me to be able to service the entire country, let alone the world. The entire globe has the same problem. So I'm trying to figure out, because now I'm at a company where we are doing things at scale, we have some fantastic AI initiatives. But I agree. Right now, I have a community where we, I teach people how to interpret things in not in a medical way, but like, hey, like this is what this data means and they're using AI and I love it because they're mostly older and like this is also new to them and it's amazing. But what I'm finding is that what they're coming back with is pretty wrong. Yes. And this is frustrating. The more I learn about AI, I don't think we're as close to AI being this really amazing, helpful tool as many of us think that we are. I think there is a way to do it. I had an amazing conversation with somebody who was in an AI startup talking about how to protect AI's from the outside world. And like this idea, like a closed loop AI where we're only training it on our information. But the reality is to do that with the amount of information that would be needed and not have it be conflicting. Nobody's working on that I'm aware of. So I think there is a future where we can hopefully have some of these things where we do have a DIY approach that isn't just exposing people to the infobesity reality that is the internet right now when it comes to healthcare. Yeah, I've trained in AI because I, it was kind of like, I'm either going to train in AI or somebody is going to make an AI and I'm somehow going to be absorbed in it and I'm going to be like unhappy on that part. And the process of training in AI was really interesting. It came about because I had a lot of patients who had shared with me that they were taking my information and a couple of other people's books or a podcast and feeding it all in. And I'd be like, well, we almost got there. You know, like I wonder if I had just said it this way, you know, whatever. So anyway, going through the process of training the AI has been really interesting for me. But what has been also great is to help somebody get to the point where, because there's a part of being a practitioner that I always say the difference between a researcher and an influencer and a practitioner is, first of all, our patients teach us so much humility. Like, there is no right answer. I am never going to know right answer until it is demonstrated as a right answer. And that might even be that we all thought that this was going to be, and then my patients like, yeah, I went to the store and this wasn't available, you know, or whatever. So we all, there are all these different factors that are in there. And so they, they humble us. And then at the same time, because I practice for so long, and, you know, I have these ways of saying, like, I don't know if this is in the research anywhere, but I know this from my practice so I can share with you. So what I've done in training the AI is I've actually trained the AI to encourage my patients to be curious. And I'm inviting everybody to be curious. I think that that is the cornerstone of an incredible practitioner. And I also think it's what we have as responsibility for ourselves is to be curious. Now when we're curious, we could go info seeking. And if we go info seeking instead of insight seeking, right, we go info seeking, we're going to get information that's not necessary, that's not based on our body. We're not going under the hood. We're not looking if we go insight seeking, we're going to actually get information on that part. So that's what I've trained the AI to do. And then you hit a place where it's like, and Ashley the AI, I call it the better and not perfect nutritionist, is now telling you that we can't go any further. So you have options of would you like to work with me? Are you, if you're already working with someone, here's what I suggest you share with them. Because part of it is is maybe the gap between somebody who practices like you or I, maybe I can help a patient have a better experience with somebody who maybe doesn't have as much experience or practice the way that I do by empowering them to take in those insights to the practitioner and say, hey, you know why I want to like a protein A because of X, Y and Z. And if you are not going to give it to me, then I'm actually going to see a different practitioner. That will wake somebody up, you know, on that part. So I think the secondary side of it is what I didn't listen in my bio and my credentials is that I train practitioner. So I train physicians, I train dietitians, I train CNS, I train health coaches. We need an army like this and we need to get out there. But I also think that that is, there is a responsibility to the person listening. And I say that if you're a practitioner, then listen about this for you as the patient, right? So just think of or of your patient. You have a responsibility and that responsibility is to not take information from somebody who does not know you at all. So you know, yes, there have been times I remember like Jenny from the block. Like I looked at something. I think she was in a magazine and there was something and I was like, oh, I'm sorry. Oh my gosh, I used to do Cindy Crawford's workout, you know, whatever. And I'm like, why don't I look like Cindy Crawford? Or, you know, with Jenny, and I'm like, you know, why don't I, like, why don't I have great dance moves? 'Cause like, I have nothing like them. And also, they don't know anything about me. So why am I trying to follow what they're doing, you know, like point by point by point on that part, stop that. Don't listen to this podcast here. And, you know, if I said to you, I take an electrolyte supplement at 10 a.m. after I work out, don't go and do that. But maybe hear this, why am I taking that? Because I did this test and I saw after drinking water that while I was drinking water during my workout, I was peeing it all out right afterwards. So when I added an electrolyte after some of these workouts, I actually noticed that I didn't pee for two hours and that helped me blah, blah, blah, right? So when you gather your own evidence, do, you know, do those pieces. But I think what has ended up happening, and it's whether it's the functional space, as we're talking about the functional testing, whether it's, you know, you're trying to do this, at scale, I'm trying to do this at scale. I think, you know, so many of these different companies are trying to do this at scale. And where we cannot do, where we cannot go is to create protocols that are more than are mass. And I think that that's the, you have to have truly clinician led, and you have to have practitioners, not just clinicians who no longer see patients, but you have to have practitioners in these key roles in these companies at scale who are saying, I might give somebody information about what a roadmap could look like, but here's where you need to get curious, 'cause we have to maintain that with the patient. And again, that's why I like what you're doing, 'cause you're actually bringing, you're connecting people, you're not behind the scenes saying, come in, fill out a form, and we're gonna give you a medication and now go off and do that. You have the ability for people to interact, and I think that, you know, that will play out differently. - Yeah. Well, I think that the arms dealer, quote unquote arms dealer approach to medicine is going by the wayside. I mean, there is something to be said about access. - You're hopeful, okay, yeah. - Yeah, because I think consumers are getting smarter. And I've put a lot of thought into this, 'cause I think about our healthcare system, I did this recording a couple months ago, and I went back and kind of looked at like, how do we get here? You know, like go back to the early 1900s and the Flexner report and like, how did we get here? And I realized like, well, this, I don't think the system actually is broken. I think we're just asking something of it that it's not built for. - It's overwhelmed. - Maybe? - Yeah. - It's built to manage infections, trauma, and at that time, not very well, but infections, trauma, and urgent problems, right? Like it's there to manage acute problems. We are now asking it to help us to optimize and to manage chronic disease. It's not the system for that. - Do you think it's working in trauma and acute though? - Well, I think now, I mean, the fact that like, we're in Manhattan. - Yeah. - If you were I were to have a heart attack, we would be probably in a cath lab in 25 minutes. - If we had the insurance. - Well, they would get you there either way. - They might not even pick us up in the ambulance. - Yeah, well, I don't know how this works in New York. - Yeah, yeah, well, to be fair, we'd get a taxi because we're in New York. But I think that's like the, I don't think trauma and acute and especially outside of a place like New York where most Americans are living, but carry on. But I agree with you, there's no chance it's working in optimization. - In my world as a surgeon who would see people in the ER, we didn't, I didn't see the issue with insurance because everybody just came in. And we, maybe it's because I was at a high level - Or that they were bankrupt after they're in home in their fix and then they're bankrupt. - Yeah, that might be true. - Yeah. - But the fact that, I mean, same thing with trauma. You know, if you have orthopedic trauma, the surgeries that can be done, the limb saving, life saving, things that we can do, are amazing. - Yes, we have incredible medicine. My concern with the break is the impact, the role in particular of insurance companies in the medicine. When you have a doctor stepping out of the OR to be on the phone with the insurance company to find out about which stitches approved or whatever on that part. Like that to me is, we're not in our best place. - It's interesting, I never dealt with that. 'Cause we had, I mean, we did have pre-approved contracts. So there were things I didn't have access to. But anything that I was doing, I would be able to use. Now I did have complaints from patients to say, well, if you had used a different plate, - Yes, yes. - They would have caught, and I say, look, that's not my job. - Right. - And I, you know, I'm sorry that this experience, I mean, this plate is costing you more money than that plate. But I put the device in you that thought was right for you. - Yes. - But now that we are in this space, where we realize, okay, it can't be, I mean, even cookie cutter, right? It can't even be algorithmic for the most part, right? It truly has to be customized. - Yes. - An individual based off of all of these factors. And I love that you, you actually threw so many companies under the bus that we didn't talk about. We didn't name 'cause I don't want this to be pulled off of the air. But there are so many approaches right now, which are just in the marketplace of like, let's test this one specific group of genes. - Yeah. - And we're gonna call this a product. And we're gonna sell you supplement. - Yeah. - That to me is making things worse, not better. - Yeah. - They probably help some people along the way. - Yeah. - But so much bigger than that. - Yeah. - And the challenge I'm having right now is building both women's health from a hormone perspective, which is a big thing. But bone health is more interesting to me right now because it is all of the things, right? It is nutrition. It is exercise. It is customized. If we're going to improve bond density or reverse osteoporosis potentially, it can't be algorithmic. - Yes. It's genetics. - It's all of it. - Yes, yes. - All of it. - And so to do that at scale, is such a fun puzzle. - Right. - But it's also a really frustrating one. But it is actually, I think the perfect beta for anything. Because if we can do this with bone health, you can do it with anything. You can do it with dementia. You can do it with heart health. You can do it with anything. And so it is fun to have all of these resources to try to figure out how to train a group of providers so that we can actually train them quickly. - Yes. - Because what I built originally, I couldn't hire anybody to come in and see patients. It had to be me. - Yeah. - I could not train that. So now with additional tools, with videos, with AI, with all of the tools that we have. - You and I are in the exact same situation. - It's amazing, right? And what I love about the fact that like, I don't see you as competition. And I don't think you see me as competition. Because I was like, no. It's such shit again. - Yeah. - Thank you. - No, I'll just get it. Yeah. - There's just so much need. - Right. - Right. - And I look at some of my other quote unquote competitors. And I'm asking them questions. And some of them will talk to me and some of them won't. And the ones that won't, I'm like, what are, like are we really competing for the same thing? - Well, let me back up from that. The reason that I don't see you as competition is that I think that, and we were talking about this. So at the Better Nutrition Program, my company, I run that to provide truly personalized nutrition at scale. And we white label our services under any of these longevity optimization centers. But we also white label them to the most insurance and places where people are getting free service. Like, I mean, just so many different places and for practitioners. But there's no one out there that is doing personalized nutrition in these systems in the way that we're doing them. And so that's why I say, like, you know, within there, where I think, if I ran a company that was saying, like, oh, and we provide GLP ones, or we provide, like, or we provide physicians, or we provide, I also agree with the statement that we wouldn't see each other as competition. And I actually think that all of these different models that are trying to figure it out were all the better for a variety of different models. And that part, our patients, not our patients. Individuals may not be the better for, like, as we're in this figuring it out phase, you know, I think in that space. And also figuring out how to help somebody work with, if the bodies in ecosystem, and they're working with you on bone health, how do we, how do we factor in their general practitioner? How do we factor in when they go to their dentist? How do we factor in like, you know, so what, how do we bring that ecosystem? So a lot of what we do at the better nutrition program is we quarterback the care for you. Because what I have realized is that people go to all these different programs. And in almost no situation, does everyone have all the information in one place? So if I, minimum, have all your information in one place, like I had an 80 year old woman who's shooting great health, and her doctor put her on a, on a blood sugar medication, 'cause there was just, you know, something, go and she was, she asked me and I said, look, I'm like, we can try this, it's fine. But I saw her and she said, you know, I'm getting real dizzy. And I was like, so has anyone like, have you talked to your doctor about the amount of this? And I was like, hold on a sec. And do they know what's going on? What your history with your blood pressure is? And do they know that you go, you know, that you eat very well and tend to eat lower carbohydrate? And do they know? And none of that was, you know, in the space. So I think what we have to do is, I do think in this time period where all of this is getting figured out, I'm going to share that I think that the pressure point really lies with the individual. I think that it, and it's not about this, like, you have to be your own advocate. Yes, you have to be your own advocate. It's so much worse than that. You have to have all of your information and you have to, anytime you need a gut check, you have to be very comfortable with that. And you really have to make sure that anyone in your, your system, you know, is, is, is combined in that way. Bone health to me is one of the, I love that you're focused on this. Bone health is one of the most amazing ways to be able to show someone how the body's ecosystem works, including how weight health hormones are involved. So I love that piece. And I think that one of the issues is somebody whose entire career has been based around gut health, the fact that gut health and bone health have not been looked at together until very recently is just like, I mean, insane to me, you know, on that part, it's like it's insanely exciting, right? Of how much we can do. So I, yeah, I love that. Yeah. Well, I appreciate that. And, you know, those are all the pieces. And like I said, and this is, this is the beta for any chronic disease, you know, which is amazing. So we didn't get to talk about tactics much at all. And I know that you, we're at a conference from New York and you have to go get on stage. Yes, part two. Yes, part two. Well, I would love to do tactics as part two. Yes. But to leave us off with part one, I guess maybe talk about your book a little bit. And maybe through the lens of like, if somebody's struggling, yeah, I know personal advocacy, yes, we need to do it. But like where the heck do they even, where do they start? Yeah, so I actually do think we nail tactics assess your digestion. Like there's nothing else that you should move forward with. That's it. Yeah, okay. Because or said differently, don't play with your food, the quantity, the quality, the macro balance, the timing, until you are sure that your digestion is optimized. So let's, you know, look at that piece. Okay. I wrote a playbook for how to personalize nutrition because it is whether you're using a shot or not, whether you're in the weight loss space, whether you're thinking about fat loss, whether you're thinking about muscle bone, whether you're thinking about your cognitive function, and whether you're thinking about all of those, they all, it all comes back to this playbook. We have to optimize the ecosystem on that part. So in here, all of those different tests that I was like the insights that I was talking about, that's all in here and how to do it. And really how to navigate things like this type of magnesium or what about magnesium and vitamin C, or do I start with fiber like answering all of those? So it's extremely tactical. And then when I finished my book, I panicked and I was like, it's not tactical enough. So on page I X instead of and throughout the book, but definitely on page I X before we get into page number one and forward, there's a QR code. So even if you get this book from the library, that's what I want to share with you. If you have no dollars to your name and you are struggling, or if you happen to, thank you, have the 30 or the $25 and can buy the book, this then brings you over into a HIPAA compliant portal where you have more, we've got some more of those quizzes and some more of the online stuff, but you also have access to our health coaches. And the reason I did that is I did, it's not you get to go in free and we're going to coach you, and you're, you know, here's all that part. But for free, anyone in the community can ask questions about what, this is what I'm struggling with. I don't know how to move forward. So to me, empowerment is the name of the game. So we can turn around and we can say, hey, do you know about this life, MD, or hey, if you're looking at bone health, here's this thing, you know, and we have all these resources and the ability of what my coach can do is come in and actually help somebody create the smirkle. And sometimes that smirkle is, I would think you would benefit from talking to your practitioner about this question, and you know, really coming in on that piece. So when you have that, I think you have something. So I was, you know, I'm 52 now. I started the process. I started, became a practitioner in 2001. And I'm like, I want to be off the clock. Like, I'm just like, this is not, you know, but I also recognize, I don't know in my lifetime if we'll be down to two in 10 Americans, or, you know, suboptimal weight health. But there is no reason we should be nine in 10 Americans. Like, so five in 10, that's my goal. The way we do this with this book, with being able to find people that, you know, that can help you on that part. The second thing is, it's not an if you are struggling. We are all struggling. So one of the things for us to acknowledge is in, in the struggle, in the suck, we are in the yuck, like, whatever it is, how are you feeling? That's where you're going to make a bad investment decision. So if you thought about, should I buy crypto or buy a lot of lottery ticket, because I don't know how, and I'm not making fun. Like, I've been here. I sometimes, I am here. Like, I don't know how I'm going to pay this bill. Or do I re not pay this one, or do I for like, whatever it is, like wherever you are in that moment. If you've had that, what I would recommend is not investing, not spending money on anything, but rather coming to a place and saying, so I need help. And what, where am I going to get that help? And if I'm not getting that help with my doctor, and this is not to disrespect doctors, but weight health doesn't belong with you as that place to help you figure out what would be that better choice for you, then if you have insurance, if you don't have insurance, if you have cash like, look at maybe my best next investment is to find somebody who can help me put this together as a plan, like rather than going and buying the tests that we find online, or buying the supplement that my friend talked about at the dinner party, you know, or that kind of thing. Yeah, it's usually, I wrap up by asking a question that I think you just answered. I'm going to ask it anyway. Okay. And let me know if you would change anything. So as we move into what you and I are calling health three-pointed. Yeah. If you were given the key to the kingdom, unlimited budget, unlimited resources, what's one thing that you would change? Or create another way to say? Well, I've created it. I would just make sure that everybody could have it, I think on that per. Yeah. And, you know, and I think there are so many dietitians. I mean, I train, you know, we have a certification. I train practitioners to do this. I just want you guys to be able to do it, you know, and that's not just, I don't train anyone to be Ashley Cofford, nobody wants that, but I train you to be able to be curious and do it in this way in the same for physicians. So I think that it's a, I think we have what we need. One of the issues is that every all of the direct to consumer stuff and even, and I include that in the in places like life, I'm doing, et cetera. But they have bigger marketing budgets. And so I think one of the harder things is for something like this to break through, which is why I'm really grateful for this opportunity. Well, thank you for showing up. I really appreciate it. Where can our audience find more about you? Yeah, if they can't from anything in the show notes, we have a problem. So look in the show notes, your best shot, Ashley Coff, or they, if they find your wife, great. But look for that, you know, Ashley name and we'll go from there. Yes. That's great. Good. Thank you.