Beyond the Prescription: A Doctor's Playbook for Eating Well & Building Habits on a GLP-1 (Part II)

0:00 The topics and opinions express and the following show are solely those of the hosts and their guests, and not those of W FOURCY Radio. It's employees are affiliates. We make no recommendations or endorsements for radio show programs, services, or products mentioned on air or on our web. No liability explicitor implies shall be extended to W FOURCY Radio or it's employees are affiliates. Any questions or comments should be directed to those show hosts. Thank you for choosing W FOURCY Radio. Welcome to to Ask Good Questions Podcasts, broadcasting live every Wednesday, six pm Eastern Time on W four CY Radio at W fourcy dot com. This week and every week, we will reach for a higher purpose in money and life, as well as a focus on health and wellness. Now, let's join your host, Anita bell Anderson, as together we start with Asking Good Questions.

1:01 Hello, and welcome to the Ask Good Questions Podcast. I am your host, Benita bell Anderson, and I know that today's episode is going to be something that a lot of people are interested in, because everywhere everywhere I go, it seems like people are talking about GLP, and you're seeing all kinds of ads. So I have back doctor William Summers, who was here previously we kind of got started talking about it ran out of time, so I want to welcome back to the podcast stage. We're going to continue the conversation today. Hey, Benita, Hey, so.

1:41 Let me just say just a little bit before we get into what we're going to discuss. We last time we talked a lot about the science and what it was, but now today we're going to talk with Dr Summers about what really means to you know, what looks like to live well with do doing a GLP. He is a physician that deals with this all the time. He's done a lot of YouTube videos that you can go check out, and so we're going to get into the daily reality of what to eat, how to protect your muscle and energy, how to build habits that make these medications work with your body instead of having some kind of crazy things happen. So in part one we really kind of started cutting through the noise. We're gonna hopefully give you today a conversation that centers around the playbook of how to do this well. So for anyone who missed Part one, Doctor Summers give us the quick version where did we leave Well, you know, we left off kind of you know, the summons and everything, and why is that day to day management just as important as the medication itself?

2:59 Okay, well, I think in summary where we left off before. And a good place to start would be that anyone who's overweight, we can now measure at least four neuro integrine hormonal signals in our bodies that are disrupted. I like to say, there are four buttons, and our body messed up. When we're overweight and we eat and we have to eat, and these things are messed up, we gain weight unfairly, and as we gain more weight, these same chemicals get more disrupted, and here we are on sort of developing what we now know is the chronic disease of obesity. So the medicines that we talked about target specifically one, two, or three or four of these buttons that kind of put us back into a sort of more normal physiologic state, so that we can do the behaviors and break the old habits into better habits to maintain weight loss. And of course, anything we do for weight loss we must continue and sustain. And then I think a really big principle to understand is that our bodies are designed for weight gain and resist weight loss, which why one of the reasons we see variations the way our bodies adapt and respond to anything that we do for weight loss. So We've got lots to talk about or to cover, and I'll answer questions the best of my ability. But uh, and I think that if I spoke to anybody ever, I always say we should have and I know we did talk about this is obesity as a chronic disease and is so undeserving of any stigma or discrimination. We're all beautiful and deserving and loving people that should be treated fairly across all boards,

4:29 and that we want to lose weight not to be a better person, but to have a higher quality of life. And discrimination and ignorance need to go. I was listening to. I was listening to somebody who was talking not about GLP ones, but who was just talking about the fuel. We need to get into the habit of only putting into our bodies those things that are gonna support us right. So well that that ideally that would be great, but we all have that thing that probably doesn't support us. But we can manage in the context of an overall life or health style change that maybe can work on a moderate level and still be a part of our life in some cases.

5:11 Awesome. Well, now you have a clinic that you see people in. What tends to separate people who thrive on a GLP one regimen as opposed to those that struggle? What is it that separates those groups? That is a great question, And I think the first thing to understand that obesity is multifactorial and that there are many genetic factors, environmental behavioral factors, and they're with certain patients and you hear about them, OHI I lost so much weight so quickly, and others are struggling, as you say, But any individual patient should be evaluated. Certain patients around medications that influence these medicines or weight altogether.

5:57 Some have a different sort of a microbiome and their which is influencing their success as well, genetic variations and the way that we respond on the receptor level to each one. Of these products as well. Stress levels are different among different people, and stress, of course with cortisol, which we need when we have stress, is sort of like contra for what our goals are as far as making us hungrier and gaining weight. So there's so many individual factors. And then there are also some medical indications where people that have familiar OBC childhood obesity, and there's new and exciting development and tests for certain medicines that target things that are rare, but they do exist. So individually, I think the thing that I would ask people to be is be patient and then report to your provider if there is a non responsivity that could be looked at from the history and physical into even your family patterns.

6:50 And other options that might be considered. Well, some people respond, go ahead. Well, I was just going to say, some people when you start now, each one of the medicines, the peptides, the GLP one or the GIP medicines, they have titrition levels and you do level one and if there's no side effect, you go to level two. And these are designed to move up the board. Some people just readily respond right off the bat. Some people need to be more patient because you have to get used to it to go up the ladder, so to speak. But when you look at the measurements of efficacy of these medicines, they're all measured from the top doses. I don't think everybody needs to go up, but some people do. And if you start out and it seems slower, not to be frustrated, but be patient. And I think as you move up and then again other considerations as we just mentioned for any individual with medications and lifestyle changes or life circumstances and stressors and things like that.

7:47 So for somebody who might be just getting started, is there any kind of is there a mistake that people make when they're just getting going in the first few weeks. Maybe they're excited, but they really haven't work on this. You know, I've been asked that question, and I think one mistake people make is they're going to just say, well, I've heard about these medicines. I'm just going to start them and just see what happens. And I mean and and really even in that context there's probably some success because but when you really get serious and you're going to say, I'm going to do this in conjunction with maybe breaking habits and try to be real about like in my emphasis is a lot on the type.

8:28 Of sugars that we eat. So so I think the mistake will be one to just say, well, it didn't work for me, but did you work with it, and two would be that you have to be patient if you start it and you don't see it just as abundantly right away. You've got to realize these like one level one medicine has five dose titrations, one has six, one has seven titrations. So it takes a little bit of time. And this is for the long haul safe medicines to treat the disease in our body that we now recognize just as it is a disease in our body. Well, you hear all over the place about how these drugs curb appetite, you know, traumatically. So if somebody is barely eating, if they're just not hungry, how do you make sure that they're getting the nutrients that they want to have.

9:19 That they should Well, you know, these were never designed to be anorexic. You need to eat. Our body needs nutrients, and people that there are medicines in the past that would just make people not eat all day long, and there's such massive muscle loss with that. That's so like contraindicated and contradictory to everything on board. But how do you make someone eat? I think that if somebody's at the point where they just like I can't eat anything. They may back the dose down a bit because we want to get rid of feed noise, but not rid of our appetite all together. And then recognizing the quality of what we eat. And I'll just say in a broad context, farm the table is just healthy and eat what you like, change it, but like it so it can be sustained with boundaries that I always say keeping the carbs under one hundred grams a day. I think it's good advice for people, and massive amounts of protein. So if you were asking me somebody I'm not going to be very hungry, what should I eat, I would say we'll get some protein drinks and mix some protein powdered with some fresh berries and put some kale and spinach or fiber in it and drink those. But they will be the necessary ingredients, and there are essential fatty acids. I will get three and six. So I think when people get on something and they see momentum, everyone becomes smarter. But if you're getting on that and not eat at all, I'd say maybe dose it down, because this is to help us regulate our blood sugars in ways that we are necessary, and to control food noise, which is all sort of there because we're overweight in the first place, and our body allows more food noise.

10:50 Well, I see arguments and all kinds of stuff about protein. There is you know, oh my gosh, the champs of different for the four protein animal protein versus plant protein. It's us all over place. So why is the whole idea of protein so important? And how much are we really talking about? What? What do you need to be looking at? I think that it is scary when I'll tell you women as a rule need one hundred and twenty grams of protein to day and men one hundred and sixty grams of protein. Now, why do we need the protein? First of all, if you think of our body's metabolic rate as a motor speed, and the motor speed, obviously, if our motors rank faster, we need more fuel. As we lose weight, naturally, our motor is going to slow down.

11:42 And the thing that slows our motor down most significantly is the loss of muscle mass. Now, when we eat a sugar and we store it as fat, okay, it's called lipogenesis that we got store fat, that store fat, we want to get rid of it. So we're gonna take fat and turn it back into sugar, which is called gluconeogenesis. We go fat to sugar, we must include amino acids to make that even happen. So if fat is. Leaving your body, which we all hope will happen, so are amino acids and they live in our muscle. And if muscle is the predominant affect of how fast our motor is, will basically, when you lose fat, you lose muscle, you lose you lose your motor speed. If we will have enough protein, which supplies amino acids in our bloodstream which will last a long time. For protein the one macro that stays in our bloodstream, then we'll use those amino acids instead of our muscle amino acids. And we don't need to break down muscle as we convert fat to sugar. So it's sort of muscle protective in that way.

12:37 And in person that already may be getting some increasing food noise, amino acids really turn off that turn off that food noise. It's the one macro that makes our body feel satisfied and less hungry for longer. So, but why do we need more protein? And it's a lot I mean it's a lot of protein, which is why I would say most people probably ought to just get their favorite protein powder at their favorite store and take little juice drinks through the day to maintain that amount, which is really I call the superhero for weight loss. And so let's say you're asking me to eat mortallyse weight, I definitely am when it comes to protein. And again, why to spare the muscle so that our metal box rate is going to stay up and not go lower and we burn more fuel obviously that way.

13:21 So walk me through a typical day. What is uh, what's a good day of eating look like? Okay, I always you know, I have gone through with a career of managing people with weight for weight issues, and I tried this diet and that diet, and you know what, this is what I've come to just recommend eat what you like, change it, but you have to like it with boundaries, and that gives us pretty much a broad set of circumstances because everybody has their own individual taste, likes, dislikes. I use the boundaries I mentioned earlier, one hundred grams of carbs a day, and this like Superhero one hundred twenty or one hundre sixty grams of protein.

14:01 So if somebody asked me particularly, and I'm gonna be big, big on the sugars and the type of sugars. And we talked about processed foods, it's really involving sugars that go into our bloodstream too fast. So if I was going to ask anybody to design, would like change it and like it to become sugar smart, and God, sugar is complex. Sugars that go into bloodstream controlled and slowly are so much more powerful for maintaining a healthy weight than the ones that we process and go into the blood way too fast. So I would tell somebody like, I mean, I think a good protein smoothie in the morning is easy and and and great for anybody that's on the run. But eggs are fine. I mean, you can make the But if I was to advise anybody to give up the things, specifically sodas and even diet sodas, sugary drinks of any kind at all, because we're kind of addicted to those.

14:48 And I still drink diet cokes, but I drink way less than I used to, and I'm trying to get off of it all together. Well, I think everybody has that thing. Mine is cheese dep ca soap, and I'll just say, well, you know what, I'm just gonna have to have a little weight, but I'm going to have my CASEO. Sorry, that's off limits that it's not going to be. So what I've learned to do though, is and not every time, but most of the time I will peel some like red peppers and bell peppers and dip that into the cheese depth and it makes it less harmful. So it's a compromise, and you do everything in moderation. Ice cream is my thing, and that would not be something in doctor is going to say put on your meal plan. But I'll just keep that in the freezer and take one spoon and get one bite and that's it. But you know, everything, it just I think that we can equally like change it and like it and make it work. And so I don't want to tell no. I do like to recommend a book, The South Beach Diet, popular in the nineties because it deals a lot with how fast the sugars that go called the glycemic index, and you'll see that basically again, anything that God created with sugar in it is going to be so much more healthy than anything that man created with sugar in it. To avoid corn, corn syrups, I did see fruit tresse, corn syrups. Those products are in there and they make us buy that product again, but they are so unhealthy in terms of our weight management, so I never say eat this now.

16:05 People want sometimes instructions, I'll also refer them to the Mediterranean Diet, the book that's probably the most studied and approved for high pertension, type two diabetes, qurdivascular disease, And it's really a low fat diet with a lot of olive oil, but the sugars in there are going to be sort of the complex sugars. So if they needed a meal plan, I'd go South Beach Diet Mediterranean Diet. But people will do that until they won't. So starting out from the baseline eat what you like? What can I change? Would what's really bad on my plate? Well, if it came out of a packager, it can it's probably bad. Can you substitute it? And if you cannot, can you have less of it? Less often of it? And allow us to not feel like we're in some sort of like food prison. But just trying to have a goal of being healthier for again, a healthier quality of life.

16:51 I think what you're saying is a life. I mean, it's basically a lifestyle choice to choose to eat more healthfully but better quality. Right. Yes, Yes, And a lot of people deal with food insecurities, and that's that's an issue we have to deal with that don't have access to organic, whole food types of you know, the groceries I'm talking about. But even in any individual could probably sit down with somebody, with your provider or someone in the office to help you try to help yourself better. And there's no judgment because I can know, I can tell you ten things to do and I might miss all ten of those tomorrow when I'm eating, So don't don't judge me. But we're all human and and breaking the habits. Breaking habits you mentioned is probably the biggest biggest challenge in all of us because any habit we have, any habit, you have to take a twenty one day of really maintaining strict focus on developing a change in that and the attention to it.

17:45 And you know, we're all busy in life and we prefer and you get stressed and you go back to but but you know, a daily failure is not a lifetime failure. We are going to make mistakes, but that doesn't mean it's over when we're you know, just stay on course, walk slowly, you still get there. Well, talking a little bit about maybe you know the mistakes you might make. Is there any foods that you've seen make a side effect worse? Well, okay, you know that these medicines that we're talking about, any of the injections that are out there, they do not come with a do it before after meals. And some patients find just individually they might do it before they eat, others do better after they eat. There's not a certain food that I know, there's not, like there's certain medicines, not the ones we're talking about in this context.

18:33 That would be where the fat. Would be a problem with the side of factor or certain But no, there's not really a food that's going to make you have more side effects or less side effects based on what you put in your mouth. In other words, if you had a higher fat meal, don't expect higher side effects on that. But I'm not saying to do that, but just saying there's not going to be a list of foods to try to avoid if you're doing these injections other than the context of what you're trying to eat would be into sort of healthy boundaries, and I leave that as a context. So no specific foods. That that will help you or hurt you other than as far as the side effect of the medicine and that question. I think the healthy thing to do is to focus on the foods that you know are going to be good for your body, right right.

19:19 Right, and and and again I want everybody to recognize that there is there is definitely Okay, let me start here. I've been a doctor for a lot of years and I do a lot of blood tests on people, and they'll just on their thyroid test. It's very commonly just like the thyroids running low, and I'll say, oh, your thyroid's low. Here's some thyroid medicine. And no one's ever questioned that. I mean, like, oh, give that to me, because I'll feel better, my body will work better when that thyroid low, thyroids fixed to normal. Well, in this context, we have four buttons that are are low, and people are like, oh, I don't know if I can do that. That kind of scares me. So it's just like we're understanding this all in one big conglomerate. But I see it no differently than any other indocrine system like a low thyroid, And not saying that everybody needs some medicine for anything and everything, not at all, but to do understand it, Like if your THOERROI is low and I give you medicine, you would not ask many questions or any I don't think anyboy's ever challenged me on that. Yes, please, I will feel better and function better. And I feel for the people that have had difficulty with their weight management that I would look at this as saying, well, your GLP one is messed up, and your GIP is messed up, and your gluedcon is messed up, and we now know your amulan and your pyy is messed up, and these are all going to be targeted to put us back into a state where at least now now put us back normal so we can do behaviors that matter. Because the frustration is when things are messed up in our body and we lose a little bit and stop and it all comes back. I mean, it's just a why people kind of give up because what they're doing great efforts don't seem to really produce many results when we

20:51 have things in our body fighting against us. Well, let's ask another good question, and that would be the whole water again, a topic I've seen a lot of a lot of you know, all kinds of places where people go with how much water do you feel? Because I know I spend hard. I said an alarm now on my cell phone to remind me to drink water through the day. That's very diligent. That's great, you know, I used to just I used to generically say eight bottles of water or sixty four ounces, but now that's probably low by today's recommendations. I think for women it's recommended to do ninety and for men one hundred and twenty ounces. And this is all going to be varied with also how much outdoor activity and heat levels and probably anything going the more the greater side of that instead of the lesser side. And when I say water and people say I don't like water, flavor water coffee, tea without the additives I mean other than maybe some lemon. It doesn't have to just be water, but fluids, and our body is designed to work. Just think of a river stream that's so low in water nothing's moving, or if it's too much, it's flooded. But there's just a right amount where there's an ideal flow. And I think our body operates on the higher end, probably with women probably between ninety to one hundred and men between one hundred and twenty one hundred and sixty ounces a day. That just to keep the river flowing so that the nutrients go through and we excrete what we're supposed to excrete, and all the organs are getting good perfusion and good oxygen

22:23 at that level and not sort of like scrambling to figure out how to move the water with when it's low, I. Think it probably about sixty. So you're making me go, oh, I need to be drinking more than. I always tell people if you're if you're paying, you're losing weight. Okay, okay. Also the color I. Know that, Okay, right, you can use that sort of like that sort of like almost just minimally yellow. It's pretty ideal. But you know, if you think about we waste in our body, it was either going to be excreted through our bowels or it's going to be excluded through our our kidneys and go up. So if we're urinating, we're getting rid of waste in our body that if we don't get rid of it, we store it as spat if that's sort of an oversimplified analogy. So, but but hydration, I think that when I just say generically eight ounces eight bottles of water, that's probably low by today's standards of recommendations.

23:25 Okay, of course, go ahead. Oh well, let's move on. I thought you were taking a long stare at that. Yeah, let's move on to side effects. I know that, like nausea, stomach issues are probably the things that people really worry about. So what what. Actually helps calm the nausea and the stomach issues down? Okay, let's break it down. What causes the nausea. Well, one of the ways that these medicines work. One of the ways of medicine work, it slows our stomach emptying and we feel full longer. But that slowness can create nausea and some indigestion as well, and that's just sort of physiologic and a side effect. Now, there's also a part of our brain. It's called the CTZ. It stands for chemo receptor trigger zone, and that's a little area in the brain that things in our bloodstream that are there will hit a button and causes to me nauseous.

24:26 So there's a direct effect from slow emptying. And some people are just sensitive at the brain level. So is there anything that I don't know if anything to eat or not I eat. Now, a lot of people require a little something for nausea, and I would just always say the nausea means we got to move up the ladder more slowly. It's almost always a dose dependent issue. So they'll start saying level one at any of the medicines, and they're just different dose and bilogrounds. But level one you do an injection once a week. If there's a little nausea, don't move up the ladder. If you do an injection of level one and you get nausea, let's break it down into a small what they say the microdosing. Let's get you used to it. And one of the things that people do get frustrated with they may have that sensitivity of I get so nauseous with any medicine at the brain level, but you're not really up high enough the ladder to get the weight loss effect at the receptor levels within the with the brain to control the food noise and to regulate your blood sugar. So there's what I'm saying is probably anybody, we can get this broken down to a smaller dose and get used to it, and walk up the ladder and get used to it slower to get you to the level that will be effective for weight management. So do I know of a food or no food, or activity or no activity? Not necessarily, I've heard anecdotally I recommended people to use the subkey fat in the belly just like a clock to go around and do these weakly injections. Some people tell me, oh, I'd use my thigh, which is acceptable with less nausea. More So, individually, I think it's a good discussion with your provider to say, now,

25:57 when is the nausea. Typically, if it's just a typical physiologic side effect of the medicine, I see that if you inject on Monday, you kind of get this effect on Wednesday, and so some people more immediate, I think that sort of hits the brain, like, shoot, okay, here's some zofran or finnergen or undiensitrona or promethazine the generic terms, and we can give you antimetics when do you worry about it? And when do you worry about the nausea? If you have abdominal pain, pain shooting to your back, that needs to stop the medicine and let's do some blood tests and maybe come in for an in office clinical evaluation. So nausea okay, but pain with a nausea are really protracted the word the nausea and vomiting because nausea is common, but vomiting is not that common. So if you're having novegy vomiting, my red flag goes up a little bit more. Let's pay attention to you and whenever you think about it, you can always do and the test always do to make sure bankers are okay, we'ld be an amylase and a light pace. A simple blood test done on a routine lab could be done stab, but a routine draw it on Monday afternoon, you get it back Tuesday morning. It's a quick turnover and then you'll see if these medicines are going to be continue to be safe for you.

27:02 Well, it sounds like, you know, that's just being smart. Is like sometimes the side effects might be just part of the adjustment, but if it's extreme, like what you're talking about then you need to go see your provider, right, Yeah. I always sell you know, I do phase two clinical trials with other some pharmaceuquals in the development of these medicines and the way the trials run, and like I said, there's different levels of titration and the clinical trials, they'll have a patient do level one and they must go up to level two the next month, they must go to level three the next month, and there's a force titration, so they report forty percent nausea. Because most people in the real world do not need to do that, so we can tailor it an individually. So I always think nausea it's just so common. I say it about ten to fifteen percent of my patients, you know. And it's sort of paradoxically or ironic that as we get more and more developed with more ingredients, more button fixers, a one button fixer or a two button fixer or three button fixer, there tends to be less nausea with the as we get sort of more sophisticated with more ingredients in the medicine. But expect about ten to fifteen percent.

28:11 If I was talking to providers in your patients and if you explain to them in the beginning this may happen, there's a lot less anxiety about it, and emphasize if there's nausea and pain, then then we need to have anxiety about it, and that if you do have that, let's treat it and to make it safer. Lit'sten. We have to these injection pins. We can repackage those and the way that they are all the volumes ato point five secs sterile vials. Inject it and draw up less of it and make each so it's called repackaging, which is legal but means to be done when somebody knows what they're doing, not to contaminate it. To fix maybe a one injection into three injections. But people can get you know, you get a message, you're sick, you don't want to do it again, you back off. So but they're package for standard commercial release at certain levels because of population studies. But every individual has the right to respond and be super sensitive or a little bit insensitive, and that's okay.

29:06 Well, you know a lot of times you can you know, if somebody has just given a prescription for something that's that's pretty easy to just start taking something. But forming good habits. That's harder. So where do you tell them? Yeah, I mean where do you tell people to start? So you encourage them to, you know, get into the new habits that are better and not be overwhelmed. It is the toughest thing. It's easier for me to talk about it than to do it. And I know that for sure. I do want everybody to realize that obesity was ten percent at World War two and it's forty percent today. And the biggest change and the biggest change, and that's like for disease increase, that's like astronomical rise ten to forty percent. I mean, our disease will go from six to six point two percent, and you get upset. Ten to forty percent is outrageous. And what is the big culprit?

29:57 It's going to be refined or processed fees And the shure is basically what I'm talking about here, and the sugars that are added to everything we eat so and yet we our brain loves those. It rewards our brain every time we have a bite of those simple processed sugars, which why are the doing there? So we buy that again. But it's hard to break that habit and you do. And it's not a misogynistic statement, but men tend to be able to drop the sugar a little bit more easily on their body. Then women get fatigue. And fatigue is a big side effect that's really undiscussed in the sort of the common side effects. But you might experience fatigue. But let me just say, if you can just push through that or slow the dose down, give yourself two to three weeks, you will feel more so much better than you have ever felt because we have now getten customed to let's get that little bite of something sweet for that little pickup, which in thirty minutes is followed by a rise in insulin that makes a sleepy. So we have to have that sugar byte for a pickup. And that's just where our bodies are.

30:54 So I think when I say, how do I want to talk to patients initially, what do I want them to do? I ask them to all just become sugar smart. Just read about the sugar they're eating and the sugars that they that how they're just it's not just calories. They're all four calories in a gram. But we do any good sugar or bad sugar, same calories. But the response in our body is so different and so ten percent to forty percent, and I'm going to blame the sugars on the greatest part of that, right, So becoming sugar smart and then really identifying. Okay, I like a lot of people like I like my coffee in the morning. Well, I don't put sugar in it. But if people have a soda in the morning for their caffeine, you know they're used to that, and it's They're not gonna tell me stop my coffee tomorrow, but I'm not. So if you have less of it and get used to it, I promise you the reward is out there. And it's not that men are stronger by any means. Our body is just metabochically a little bit different. Like an acin's diet of thirty carbs a day. Man go, yeah, I'd lose weight fast and feel great. Women don't. They don't like that. But we're all built uniquely different in the way God made us. So I think I have to kind of caution women to expect a little fatigue along with me. They be no nausea or some nausea, and if they can just kind of get through that, it's going to be greater for them, they'll get a bigger reward, so breaking habits, learning sugars and trying to help them figure out. And I have struggles with myself how do I get that much protein? I mean, I just can't eat that much tuna in a day and chicken, and so I have to rely on the supplements. And I don't endorse anything commercially. Just find some protein powder that let's say has no sugar in it and make it something good to eat that you can put in the

32:25 blender and it's an easy meal. Smoothies. Well, you know, habits are something that I think is just going to be an ongoing thing, but kind of along with forming better habits. Do you think that you're going to have to do that? I've seen that where you know, some say you're going to have to do this for the rest of your life. What do eat? Wellddy? Yeah, that's why I say, this is why I start out with this, the whole premise, eat what you like, change you, but like it because you are going to need to do it for the rest of your life. Because anything that we do for weight loss any way, that for improving. Remember we're designed to gain weight our body says, gaining weight so easy and good. Losing weight, our body doesn't like it, and it's got this whole system of the hunger hormone garylan is going to increase and make you start getting so much hungrier than even before.

33:14 It just says, a compensatory so that we can put that weight back on, and the things that regulate our sugar, the j w ones and the pyys and these other sort of gips and stuff all sort of respond adaptively. So which is another reason back to the first question, This is an adaptive It's like if somebody loses weight and puts it back on like super fast, they blame themselves. And I think you got a really smart body because that's the way we're genetically designed. It's doing what it's designed to do. So if we do something and sustain it over a period of time, I would like to say, our body gets used to it, then you us because the brain has the imprint like, oh, you're supposed to have a BMI forty five and you get down to a normal BMI. You're bringing up. We got to put you back at forty five. So we got to.

33:54 Sit there long enough, which is another thing in the duration of Madison use. But I think it's a good thing to say. That's why I say my case. I mean it's on the table. I'm not going to give it up completely. I'll do it less often and maybe not have the corn chips to go with it. But so what you like, change it and like it, and you create a pattern of success, then you're able to say I can do that the rest of my life instead of just being excited about coming in as a new patient. And I'll give you a meal plan and you'll weigh these vegetables out and eat this meal and I don't like salmon, but I'm gonna do it. But you're not gonna do that for a while. So I kind of find more success in helping people navigate their own taste buds, right, because there's lots of great things. Well I for me, it just comes down to how am I going to live for the rest of my life?

34:38 How am I going to eat? How can I just continue to go down that better road on what I put in my mouth? And along with that, let's turn to movement. Okay, exercise, Okay. The exercise should help you maintain your muscle mass. Right, Yeah, Well, there's there's there's I kind of say, there's two exercises, the cardio and there you know, moving getting your heart beat up, and that's great, and that's I bet everybody should be aware of cardio activity. That's great for your heart. And we need to have movement and heart disease and stroke is the number one killer in this country. Also associated with b City by the way, But resistance and building muscle is critical for weight management, more muscle member.

35:24 If we lose weight, we lose muscle, and we getting a plateau or getting a hole, so maintaining muscle loss and that would be doing like anything resistance. And you know it's not just lifting weights. There are yoga classes, and there are home exercises and even with limited mobility, things that you can do for muscle toning and just little things really make a difference on the long haul. But it's intimidating to think, Okay, I got going to the gym to more impress is a big old thing I can't leave. You know, it's not any of that. And and in terms of anything movement, cardio or what we say resistant training for muscle building, you know, how do you get people started. I'm a big believer in the if you're not having fun, you're not doing it right. And if you're not having fun, you won't do it very long. So I so, you know, to say, what exercises.

36:08 Would you do? I can open a book up and show you all these body you know, fitness guys and stuff that, but but that maybe not that would intimidate me I have to do. So I think getting with a group, a couple of friends, even a friend, walking every day with a friend. It's probably therapeutic for aerobics. And mental health, just to kind of have somebody hash it out, getting people together, and it's something that you can make it a fun something that you enjoy then you look forward to doing instead of you have to do it and you and it's more longer to sustain. And so I think to find the activity individually that would be like the taste buds that that that has the taste budds of Yeah, I think I can enjoy that and continue doing it.

36:49 There's lots of things that do. He could be pickleball is a big thing right now with people, and yeah, it's great, and I mean, but you can just get you know, you get your friends out and do these crazy you know, h kinetics of exercises and just have fun doing it. You play a twister game if you want to, you know. Yeah, Well so for those that are like some of our listeners are sixty and beyond. Right, right, yes, Is there. Anything different about starting a GLP one when you're a little bit older? Well, I think, you know. I want to emphasize the safety of these medicines that there as the studies are coming through and they've already been branded and continue to show evidence that again the number one killer in all of us and especially as we age, will be heart disease and stroke, and these medicines have shown benefit to lower the risk of that.

37:37 That's just huge, huge, all right. As we age, growth hormone in our body is made from the anti pituitary land and through our adult or especially our after puberty and growing, we have lots of growth hormone to maintain muscle density and we just feel better, and we naturally lose growth hormone as we age, so our muscle all of us have a muscle cline in our body as we age and we lose growth hormone. And I won't get into the discussions of the test moral ins and the things that improve that. I mean, that's a side, but just recognize as we age, we lose muscle, our metal block rate slows down, our weight loss tends to be more. It's called sarcopinic like for the muscle wasting that makes you look almost like you're sick when you lose weight. You look unhealthy when you lose weight. So it's i think the biggest thing to balance.

38:24 And I'll say I'm a senior saying to say this for the seniors would be to really emphasize the protein and resistance training. Are the medicines dosed definitely not at all. No, And as we age more likely on other medications. And it's comfortable to know that these medications that we're talking about, the ones out now in the future development, are having no drug drug interaction with any medicines in our bloodstream. They don't affect the liver in any way or the kidney in any way. They're just fixing buttons in our body that need to be fixed to give us a chance. I think when you get to this point, so for the seniors, must loss is already on the table at a little bit more escalated place and just knowing that's sort of where are A little bit more focus will go to gradually, not not tomorrow, but over the next months to build a plan for a consistent muscle protecting and building, and they'll get more benefit from the medicine like anybody would with more muscle development. So the medicines are safe, but we are fighting a little bit more.

39:23 We're going to We're already on the steeper hill to get started. Well, one more question. In the seniors group, a lot of people are already juggling other medications and conditions. Correct, right, correct? And how does that change the day to day picture? I mean, should you be talking to your provider more closely if you're also doing a GLP one and you've also and maybe if you lose some weight you might be able to get off of the other medications. Well, that's that's that is the the biggest point. First of all, everybody needs to recognize that abdominal obesity and just obesity in general is associated with two hundred diseases.

40:11 Two hundred diseases. I mean, I could, I could, we could do a bunch of podcasts on this. This is why I get fired up. Two hundred diseases and rise of cancer, aut immune diseases, and inflammatory diseases because of the fat and our belly. And if you want to really measure success, measure your abdominal girth. Women get it under thirty five inches, men under forty for your optimal ideal health. But two hundred diseases are associated with that. So when you start using a lifestyle change, health style change, and or medicines with that for success, more than likely many of the medicines will either be eliminated or lower doses of the ones you're on. And that's my biggest reward. When people come to me and I don't see them every visit, and they'll knock on my door and they'll say to me, every day I hear this, I no longer take this and this and this medicine after I've took these things.

40:56 So there's a lot of noise about some avers advancing things and anecdotal stories, but these are safe medicines that and I always say, the branded medicines, they can go get them at the pharmacy and use them, and they can be individually catered to anyone using them. If you use them, not say anybody needs them, but if you get them I think that you can go with confidence, just like if your thought were low, you're getting a mess and to fix a hormonal signal that we're not as commonly aware of, like as the thyroid itself, the j W one, JEFP, gligigon amlin pyy. So so, doctor Summers, we are almost out of time. I cannot believe it every time it happens. So I want to talk about the long game. Okay, Well, you know we talked a little bit about maybe taking this maybe you're gonna end up if you build some good habits and maybe you have some kind of maintenance stoves that you just continue on.

41:52 Right, Well, let's talk about that. I tell people anything you do to lose weight, you're going to have to do for a while. I'll usually point to a box. If you chew on that box and it makes you lose weight and you get your go way, you better keep chilling that box for a while. So in the world of how long do I take these medicines, let's eliminate one myth. Right here, A lot of people think, well, if I'll do these medicines and I stop them, I might have diabetes. If I'll take these medicine my body is not going to work right, not at all. It's just if anything we do for weight loss we need to continue. When I was in the early training days of getting boarded in obesity medicine, they would say, someone did these medicines, how long do they need to say on them? And there was like an answer for a test question two years. That's very much outdated. Now there are some academicians which would really just go on and on and preach about would take these things forever.

42:41 I do not agree with that. I think that there's a Harvard rule the last I check that if you take a jumpy one for a year, and you know, we're talking like you know, fifteen to twenty percent weight loss over that time, maybe ten to fifteen percent, even five to ten percent is pretty modest, but pretty much going to happen. You're your whole system of quality of health is improved, even at a modest level. But if you take that for a year and you get your goal weight, I think you ought to just put in your head you want to stay on it another year and if you can, as if you're on level five of those, maybe do that and go to level four and do that and go to level three. I try to get everybody off the medicine, and if after a period of time they see some of their body going aha, we're gonna put that weight on pass, then we could reinitiate the medicine. So do you need so some say forever? I'd say, and probably balance as long as you did to really get productivity, and then to continue for the sustainability. But then I think most people will come off of people feel so much better, they're kind of scared to get off of them.

43:36 I don't want to quit them. But less is always better when it comes to medicines. Right right, Well, it basically sounds like you just monitor, you monitor. You should be monitoring your health regardless, right, You should be eating well, doing those things that are going to support your body. And it sounds like the sense of whole thing to do is just to monitor this and see what you need to do going forward. That's correct. Correct. Everybody's different and unique, and you know, we we practice from the position standpoint based on population studies, but every individual is not a population study and needs their own little sort of tweaking, so to speak. And that's what you know, we should be prepared to do.

44:21 As well. I think that maybe we've talked about one of the biggest questions I've seen is how long do I have to take it? So we are just about out of time, and so I want to just you know, maybe it'll I'll have you come back in when we have some some updates. Who knows that we go in months or so. But what would be one piece of encouragement if somebody is like considering this or or or you know, what would what would you encourage people to do if they're really thinking about it? Oh, if I could, if okay, if if I had once shout out for humanity and encouragement, I would say, love yourself, love yourself, and love yourself, and then love your family and friends, and even in your enemies, find something common denominator to love about them. And I think that's a great starting place for everybody to be encouraged.

45:10 And we help each other because we all can help each other. We want to live our best life, and we all have different experiences and cultural sort of influences and a broad special makes it very interesting. So to encourage someone, let them know they're already beautiful and we're doing whatever we're doing here just a little bit longer in a happier way, to see our kids, grandkids, great grandkids are great grandpuppies and all the other great things in life has for us. I love your family, love your enemies. I was telling him before we started that in a couple of weeks I'll be going to the wedding of my first first grandchild to get married. And it's like, you want to be healthy enough to be able to experience.

45:53 Those kinds of things. I think that is so wonderful. I always tell my patience, the only reason to have kids is to have grandks kids. So you will, that's gotta joke. But but that's a beautiful to be able to see your grandkids getting married, that's that's a blessing. So that's that's amazing. And you're already beautiful, se don't outside the bride, just show up and you know, all right. Show up, no chance outshine and try, that's for sure. So thank you so much for joining me today. This has been so helpful. I think we've asked a lot of good questions that hopefully will give people a little bit more clarity on how to deal with this.

46:36 And thank you so much, thank you for having me Thank you so much. You bet so, and thank you so much for everyone for joining us on the Ask Good Questions podcast. We will see you next time. Okay, thanks, today's episode is over, but we need Ask Good Questions again, didn't. We don't miss out as we broadcast live every one say six pm Eastern Time on W FOURCY Radio at. W fourcy dot com. Joined Benina Bellanderson next week for more conversations with experts on finances, retirement, behavioral finance issues, health and wellness. And more.

47:16 Until then, remember to ask good Questions.