Personalized System for Optimal Weight Health in Menopause—GLP-1 Shot Or Not

If you have questions about your optimal weight, how you get there in menopause, or you have questions about GLP-1, you have the shot or not, or avoiding it, whatever your questions, this is it. So I have the GOAT here, what I would call greatest of all time, in the house to interview. She's also the author of a book that you're gonna wanna pick up, and not because it's about GLP-1 and not because it's about not doing GLP-1, but because it is a wealth of knowledge and we'll dive into that so much that you too will be convinced by the end. You've been warned. You're in perimenopause, menopause, or postmenopause, and you're not slowing down. You're just getting started. But the old rules don't apply anymore. The workouts that worked before, they're working against you now. The advice you've been given, incomplete at best. I'm Debra Atkinson, and I'm the founder of Flipping 50, the pioneer in fitness for women in midlife. For more than 40 years, I've been in the trenches with women just like you, and for the last 12, right here on this podcast, and, and the founder of Flipping 50: The Stronger Way app and membership. Welcome to Flipping 50: The Stronger Way, where science meets strength, where you'll find the tools, research, and real talk to build the body and the life you want in your second half. Each week you'll get evidence-based exercise and nutrition strategies, conversations with leading experts, and honest answers to the questions your doctor didn't get answers to in medical school and doesn't have time to answer in an appointment. This is your show. Let's get stronger. Hey, thanks for joining us at Flipping 50: The Stronger Way. I have a great guest for you today on a great topic. And a little while ago, not long actually, I did a solo episode on GLP-1. It's kind of an update update because a couple years ago we began talking about it, talked about concerns, talked about where I stood. So I kind of gave the State of the Union for me. But this episode I am bringing in the big guns. And so I'm here with Ashley Koff, who is an RD. She is the USA Today bestselling author of Your Best Shot by HarperOne and founder of the Better Nutrition Program. We're talking all about things, not only if you are on the shot, you're thinking about the shot, you want to come off the shot, but also if you just want optimal weight management. What does that mean to you? What does it look like? And I'm talking nutrition in a way you've never heard it before. So if you're thinking tuning out, stay with me, stay with me, and then come back. And I'd be willing to say after this one, I could say, "I told you so." So Ashley Koff is an acclaimed weight health expert and practitioner for more than 25 years. Koff has a leading transformative movement in personalized nutrition, turning better, not perfect choices into practical, sustainable strategies that deliver real outcomes. Your Best Shot introduces weight health hormones GLP-1, GIP, CCK and PYY as the regulators of weight health, offering the first-ever assessment of their function and a personalized optimization system, shot or not. A trusted expert featured across major media and sought-after educator for health professionals, Ashley's been recognized as one of the CNN's top 100 health makers and featured In Style as Hollywood's leading dietitian. You're gonna love this. The way she says things sticks, and that is the most important thing if you're asking questions about your health and nutrition. Ashley Kopp, thanks so much for being here.

Thank you for having me.

This is so amazing. So number one, it's always very selfish because there are certain people that I've wanted to meet and talk to for a long time. A good mutual friend of ours, JJ Virgin, is like, you should be talking to her Why aren't you talking to her? And I'm like, okay, I'm doing it. So here we are. Thank you so much. And you're also on my nightstand. I've shared with everybody your book. They should go get it. Number one, I don't care if they're on it, they're doing the shot, they don't want to do the shot, they need the options. That is a wealth of information in that book. And it, I'm sure, makes me feel like it's— I've just tapped the surface of the knowledge that you have.

So first of all, thank you for all of us for writing the book.

Yeah, thank you so much. You know, I've written other books and this one is the book. Like, this is the space where, you know, the GLP-1 conversation is an enabler for me to come in and have this. But this is the book on personalized nutrition and understanding weight health that I have. Like, you know, as I share, it's my story, but it also is so many of our stories. And it's the one that I've wanted to do for so long. So thank you, it means a lot to share that space with you right there next to your pillow.

Yeah, yeah. And I want to call out this— the attention to something in the way that you very distinctly make a nuance that in 42 years I haven't had anybody else do. So I've either been sleeping under a rock or you're doing this uniquely. You very distinctly don't call it body composition. You call it weight composition. Talk about that.

Yeah, you know, there's a part of me, and as somebody who dieted and has had like just such a like hate exponential relationship with my body and dieting for so many years, um, in my early life and, and totally at perimenopause, um, that wanted to just remove the word weight from the conversation. And we see that, we see in the Health at Every Size movement, and we see that like you know, just we shouldn't be on a diet and ditch the scale. But the problem is, is that our weight is actually, and our weight composition is actually a really important key performance indicator. So our fat mass, our muscle mass, our bone mass, our water mass, the location, the type, the amount, any changes in it, good, good data. So when I got like, I'm very intentional with words. I started my career selling sugared cereals and telling people, you know, very well, like this gives you more energy, right? It was because calories are energy and sugar gives you energy. And so it's like, words matter, right? And they market a lot. And so for me, body— your body composition is like all these things, but your weight composition, if we actually understand and we, we dive in and we say like, okay, what is my weight comprised of? What are the components? Then we can actually shift the conversation. The other thing that's beautiful about that is it helps us break up with BMI, with body mass index, or with a total number on a scale. Because your weight for your height is not a helpful indicator of anything as it relates to your health. Um, potentially changes in your weight for height could maybe help us. We know that the height's not typically changing that much, you know, once we're adults. So, um, but I don't think it really does that much. So weight composition, super intentional, important term.

Love it. I love it. And I, I want to ask you too, am I just noticing this? And again, I'm behind, but you know your industry, you know others who are, you know, RDs in nutrition. I think you're way ahead of things. I think you're talking about things in a way that they're not yet, or at least I'm not hearing others talk about. Have you gotten pushback because you've, you've been different and we're swimming upstream?

Yeah, so I've been different since the day I became the backwards doctor. So like since the day I was like RD instead of DR, I was different from my family. Physicians who— and primarily like my dad, a surgeon, was like, why are you becoming a dietitian? No one's going to listen to you. And I was like, oh, I'm going to make them listen to me, including I'm going to make doctors listen to me. Because even in my training, other dietitians told me, doctors don't listen to you. They don't read your soap notes. So just don't plan on that. I'm like, I don't do things if somebody is not going to pay attention to me. Like, I'm like, it's not happening. So I'm like, oh, they're going to, you know? So I think that, um, and it's interesting you say that I have had so many from group gatherings of colleagues, and I also train a lot of I'm part of, um, you know, entities that I'm faculty for, entities that train dietitians, have come up to me and have said, thank you so much. They're like, you're confident, you're willing to take this on. Um, so I believe so many dietitians believe this. Um, I also believe many don't. So you're right. I think there are people, you know, that are, and then the other part about it is we exist in a society in every level where it's impossible to be like gray or purple. Like you can't be black or white, or they want you to be red or blue, or, um, on one of the podcasts, somebody was like, you have to take a stance on if you're for or against an agonist. And I was like, I actually don't have to do anything. Like, but let me tell you why I'm agnostic. Right. And so I came in on that part. So I think a lot of my colleagues have really struggled with how to find a place to be in the middle and to say what it is that I'm saying. And I wrote this book for them too. Um, but I think the biggest problem that dietitians have faced is the not being respected for being the experts in— potentially being the experts in total nutrition. And I think that's one of the pieces that— and notice I caught myself there. You don't give respect unless it's earned. So that is part of training. So there, if a dietitian doesn't believe in supplements or doesn't believe that I'm going to assess what someone's total nutrition is, food and supplements, or if a dietitian feels that everybody should still focus on calories in, calories out, or some of the things that we've just like completely debunked as like, this doesn't work, right? Then, then they wouldn't be worth your respect. Same. And I say the same conversation with a doctor, you know, on that part. But as nutrition over the course of 20 years, as nutrition has gotten more popular, I've moved from really trying to kick and scream, get doctors' attention about the role of nutrition and total nutrition in their patients' lives to now doctors feeling that they can just do the nutrition, that I can share with you, eat this, not that, that I can tell you what is better for you from a nutrition standpoint. And doctors will talk about food in one place and supplements in another, because most of the time they're not, they're not able to, or taking the time to evaluate your nutrition in totality there. So backing up to answer your question, I've always been ahead of it. Like, and that can sound like super ego. Um, I actually think it's one of my challenges. Like I often miss like, popularity, you know, because I'm talking about something way before somebody is comfortable. And that's certainly happening now. But I think the majority of dietitians would like to be in this conversation. Yeah.

Yeah. Oh my gosh. Okay. So I feel like we have parallel lives and that I could say the same about exercise, fitness, physical activity, and, and all of the professionals that I work with or have taught, you know, at a university also feel like they can't get heard and they're wondering, but they coined this term exercise as medicine 2 decades ago. Why didn't they come? Why didn't they refer to me? And like, they thought they were going to land in their lap. I'm like, it's a relationship. Did you think about that? You know, but yes, it's, it's such a challenge. And I, I feel this somewhat the same way as well. 2013, nobody was talking about menopause fitness, and now like everybody is. And I'm like, well, wait a minute, I've been talking about that. Wait, wait, wait. And it's— this is so interesting. So thank you for sharing that. And I want to jump in here to everybody who's landing here because you wrote the book. Let's get back to the book. But I think this backstory about who you are, what you're doing is— I mean, you are really penetrating deep and bridging this gap, I think, because we know doctors haven't had, you know, either exercise or nutrition education. And so how do we get them to be able to do it? Because they still are the respected authority. And I don't know if they're falling off those pillars these days, maybe a little bit more, but I still think they have a captive audience. Everybody's got a doctor. Not everybody has an RD or a trainer.

And that's going to be so— and I think you and I exist in that space because it's like, if I hear one more person say more protein and if you hear one more person say more strength training, we're just going to be like, my head already exploded. And I'm not here, neither of us are here. We'll just double-click on this to have you not have confidence in your doctor or to have you break up with that relationship. The issue— and I'm forced into a place of being very public about this right now, or chosen to accept a place being very public. As one, as an administration pursues changing education for physicians. Look, I think that's great for nutritionists to learn about nutrition if they learn better nutrition. We don't need anyone else learning poor or suboptimal nutrition. That's not great. The second piece about it, though, is that— and I want everyone listening to take this away, and this would be because I see doctors as patients. So let me— like, they're my patients, right? So let me go through this. I don't care how much you know about nutrition. And quite frankly, the more that you know about nutrition, the less you are often likely to actually make better choices for your body. So one of the things that we do have to break up with, and I talk about this quite extensively in my book, is the concept of acquisition of knowledge making us healthier. And in fact, we are infobees. We are fat on information. I'm using the term fat there very intentionally because when we consume too much of anything, the body produces fat. It doesn't matter if it's the healthiest food or not. When we consume too much information, our body becomes overwhelmed and accumulates that in the same way. I'm just using an analogy with fat there. And one of the things I want anyone to understand is it's not that I don't want you to know about nutrition. We— there are some core components to know about, but then it becomes about what are the insights that your body is telling us. And that is how we actually figure out your better nutrition. So to any doctor listening or any doctor you are working with, If they want to spend the hour beforehand or the 30 minutes beforehand or whatever evaluating your entire total nutrition and your labs and your why and your preferences, you know, get that out of the session with you and then personalize a total nutrition plan, then have you implement it and come back and explain what was doable, what wasn't, and what insights you got, then they are practicing nutrition and they have my full respect for that part. Anyone else is just going to be giving you do this, don't do this, and we are done with that. That's not getting us better. And I think that's what the key— and 1,000%, I mean, I right now have 3 fitness trainers because I am doing an endurance, um, event, but also because of where my body is at, you know? And it's like, and by the way, I totally accept that that is like, I'm, uh, it is a privilege. I'm not somebody with a lot of resources, but I'm choosing to allocate my resources for that. But I also brought them all together and was like, okay, like at the end of the day, you guys all have a ton of knowledge. That's great. This is my body right now. I'm going to tell you, here's this, this, and this. So that— oh, it always— like we have to be the center of our universe. We get to be very self-focused in that way, which sometimes I think we think would be narcissistic, but it's actually very beneficial in healthcare.

Yeah, absolutely. And I think right now, again, just to draw the parallel, this week ACSM just released new guidelines, you know, and, and yet I think the risk still is, uh, okay, let's just not go off a checklist, you know, for every individual, because you've got an individual in front of you. You don't have a collective of the 30,000 subjects that were in all these studies. You have one, you have one in front of you. What's going on? What's— what are the effects? What data is the body telling us? Yeah. Absolutely love. Okay, let's do some ABCs, back, back, back, and define. So let's talk about the GLPs and let's assume that a listener is still, you know, I'm hearing about it every day, but I couldn't turn to my best friend and tell her this is what it is. Let's just give her some ammunition for the next coffee break or walk they're going on. Yeah, so let's talk about the body's ability and weight health hormones like GLP-1, GIP, CCK, and PYY. And we just gave a lot of alphabet soup to somebody who's like, wait, what, what?

Yeah, totally. Break that down. I've, um, I just recently gave my TED Talk, um, to, uh, University of Cincinnati students. It was graduate and undergraduate students, and nothing has prepared me for this answer better because that one of them was like, I'm a doctor. And so they wanted to dive down into like something super specific, or one of them was, you know, in med school. And then like 5 of them were like, I'm in like, I'm in dance. One was like, I'm in criminal justice. They're like, I don't— I literally didn't even follow you with GLP-1. So let's start here. I love that you started with our human body. So the body in the lining of the digestive tract and throughout the digestive tract has cells that release hormones. So hormones, as we know, they can be— they are messengers. They tell other things to go to work. So, they have a receptor site, like, they leave a cell and they go to a receptor site. And, when they hit that receptor site, it's like, "For wonder twin powers, form of," and it's activated, like, whatever happens. And oftentimes, it's telling another hormone to go to work or it's telling another activity to go to work. So, in our body, in the digestive tract, there are these cells and they release— and some of them are L cells, K cells, they all have letters. And, those cells release hormones. Now, there are two types of hormones. There are steroid hormones made from fats, protein hormones made from, um, peptide hormones made from proteins. One key thing in this world of hearing a lot about peptides: not all peptides are peptide hormones. Peptides could just be a chain of amino acids. Some peptides are peptide hormones. So we are talking about a couple of peptide hormones. You know one very well. Insulin is a peptide hormone. So good to know that it's made from protein. Why is that helpful? Because if you're, if you weren't taking in enough protein or your body wasn't able to break down from the food you're consuming and actually liberate those amino acids and have them become that peptide hormone in the body that can affect the formation and also like the type of hormone you make and, you know, all of that stuff. So the quality of your protein matters, the body's ability to use it, like all of that stuff. So these hormones, GLP-1, GIP, PYY, CCK, and there's actually a lot more of them. There's amylin, oxymodulin, GLP-2. So just think about this, there are a bunch of hormones that do things in the body. Go back, if you will, 20 years ago when we didn't really even know that we had a microbiome and we definitely didn't know that there were like a gazillion different types of probiotics, right? So, we're in that discovery phase now. We're like, oh, there are all of these different hormones. And these hormones are, in most cases, the initiator of telling other hormones that we already know about to go to work. So that's super important because in healthcare and medicine for a long time, one of the reasons we have 9 in 10 Americans that are not metabolically healthy is that we've been trying to fix problems by looking at some hormones and saying, oh, those hormones aren't working. Like maybe eat differently or maybe take some of them, or maybe, you know, you need to do like whatever. But what we haven't looked at is under the hood. Maybe the ones that tell those hormones to go to work aren't doing their job, right? So it would just be like if every day you got up and you went downstairs to your car and your car doesn't start and there's oil in the engine, gas in the tires, air in the tires, gas in the tank. You don't go and you don't like drain the gas out of the car and go, why isn't it starting? Or you don't like play with the windshield wiper fluid and go like, hey, why isn't the car starting? There's a series of things. Or if you're like me, you take it to someone or get towed. But there's a series of things that we look at. I think it's called spark plugs and other stuff. I don't know. But you look at what isn't working and you look at what order it does that need to happen. Because it doesn't help me if something's working, but it doesn't work because what was supposed to tell it to go to work doesn't work. Right. So, you know, first you're like, okay, did you put the key in the car? Did you turn the key on? Right. Did the key— did that spark something to go? And you go down the line. So what we've been doing with insulin or with leptin, which is a hormone related to your— that tells you to feel full, um, or with other things in the body, is that we have been working on those, and we've been trying to help you figure out ways to optimize those. GLP-1 and GIP tell those hormones to go to work. It turns out that those GLP-1, GIP, PYY, CCK tell hormones related to appetite blood sugar, bone formation, and stopping bone breakdown, fat allocation, the type of fat we think, and also the location of the fat, inflammation. And they also are in the— their receptor sites, meaning there's activity that's happening. We still don't even understand fully what that activity is in the lining of your arteries, in the endothelial tissue. Holy cow! When I discovered it, it was like discovering that there was an entire underweb of like all, like all the stuff that I was trying to work on on top. And it gave me this light bulb moment where I said, okay, I've never known why I have focused on helping people fix their digestion. And I've seen all of these improvements come about. So I knew digestion was key, but now that I know what's real, that it's because part of digestion's job is that in the lining of the digestive tract, these hormones need to be released and get where they're supposed to go. So long answer, but the most important thing to understand is these are your own hormones. Now, people are taking a GLP-1 medication. So around about 2005, Janet Jackson has her wardrobe malfunction. The Facebook first comes available, literally the first year. That was the first year that Byetta, a twice-daily injection of our own hormones, modified, our own. So I call it biosimilar, not bioidentical. Our own hormones were modified. So instead of staying on for only 2 to 5 minutes, they now could stay on for half a day. Then medication liraglutide came on the market, could stay on for a day. Then semaglutide more recently came on the market and it could stay on for 7 days of diminishing impact. So it starts with the full amount and then, and then it goes away by that 7th day. So now we're in a space where we have the ability to provide these hormones for people whose hormones are not in the system around them that tells them to go to work or that allows them to get to their receptor sites where that isn't working effectively. That is why people are using the medication with benefit, because it's replacing their own and it's not relying on the system of the hormones to work effectively. It's allowing the first domino, you know, the GLP-1 to tell insulin to go to work or, you know, whatever on that part. So maybe not so easy for you to explain on a walk with someone, but I think it's going to be helpful to think about like, "Oh, I now understand that just like I could take progesterone or estrogen, or I could take insulin or, you know, etc., if I needed additional hormone, I could do the exact same thing with my own GLP-1 or GIP." But just like if I go on insulin or I go on thyroid hormone, I don't just like get fully better, I still— we still have to work on the system around it, you know? And I think that's what we're talking about here with, with, you know, at least that's my intention with weight, health, hormone optimization.

Yeah, so much so. Okay, so what about the fear, concern? Is this valid? We start taking a GLP-1, will the body stop producing GLP-1 on its own? And does that ever come back online?

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So great question. So first of all, if you go on and you have any benefit, you experience legitimately anything, right? Like you're like, I feel X, like, you know, my brain quieter, I feel this, whatever, or that my labs show this, it proves that some part of your own hormone levels or the system around it were suboptimal for your body right now, right? So we already know if it was suboptimal and you go on it that your levels weren't optimal. So if you go off of it, your levels are going to go back to suboptimal unless you have figured out while you're on it a way to nurture your system so that it, it becomes at a place where it could go to optimal when you, when you come off of it. The second thing to your point is there was, there was research done, only one, and I don't think anyone's racing to do this research from a pharmaceutical company standpoint. That is said with total cynicism. So just that, that's me being sarcastic. But there was one study that I've seen done on liraglutide that one that where it was the medication was used for one and stayed on for 24 hours that showed a suppression of our own GLP-1 on it for a couple of weeks. If you had taken a dose of the liraglutide. So now imagine— so it's a couple weeks— so now imagine that you're on it for 7 days, um, with semaglutide, tirzepatide, retatrutide. I think we can infer there's a degree of suppression. I do not use the term that it turns off your own because I don't have evidence that it completely turns yours off. But if yours was suboptimal, is it going to be further suboptimal? Absolutely. And then the final piece of that is if you go on it, and we know that the way that the medication works, it delays gastric emptying. It also tells these other hormones to go to work, which are metabolically activating hormones, right? They, they're in your, um, your, they're in your metabolism, your activity phase. So as a result, we could be downregulating the amount of time you have in rest and digest. So your recovery may be less effective. And we see that with things like heart rate variability. So if because of delayed gastric emptying, because of not being hungry, because of heart rate variability, um, going down, if you then further, if you then don't get in and give your body what it needs and you further reduce the resources that it has, then absolutely your own hormones are going to be, um, are going to be problematic. And so, um, this should not be, uh, any surprise anywhere. And I'm I'm still stunned, again, said with sarcasm, that people are getting paid to do research on this because I just explained how it works. I mean, I never mind if research wants to clarify and be like, mechanistically, this is exactly how, but like, I like, can we remove our surprise face on all of social media when like these statements that come out like, oh my God, aha, like here's what it does. Yeah, no kidding. That's exactly how the medication is designed, right?

Oh my gosh. Okay. I love you so much.

Totally. I'm like, I mean, what do we not have time for? Like, any of this, you know? It's like, unless you're like a researcher who's like super excited about— but I'm a practitioner who's trying to help every patient live optimally. Like, I, like, I'm like, I'm on the clock with y'all, like, for— and, you know, and you are like— it's like, we don't have time for this. Like, it just, you know, you know what I mean? It's like, oh, let's move.

Yeah, yeah, yeah. So much so. Okay, for this audience, I, I have 3 things I actually want to cover. So my goal Goal here is to put these in order. But I mean, always with this conversation with GLP, it's always a conversation of, oh, you'll lose muscle. And, you know, we predicted we were going to see that. I don't know that we are. You know, it depends on whether the lifestyle changes have occurred or not. But if we lose muscle, there also has to be a conversation about bone. But should we talk about the thing that might come before both of those? This audience is hypersensitive to the word cortisol, and they're hypersensitive, frankly, to cortisol. It's, it's amplified for everything that caused them stress in the first place. And now here we are. You punched your ticket as a woman for this train on menopause. You didn't know you got in that line, but here you are. I mean, cortisol quietly influences weight health, but how, you know, and how can they address this cortisol, GLP-1, and weight connection?

Yeah, so it all comes down to pizza, my friends. So when we think about pizza, which, you know, I was trying to think of an analogy that lands for everyone. I think everyone, anywhere, any age gets it. Pizza crust, sauce, cheese, toppings optional. So your digestion is actually the most foundational, and I'm going to share that for cortisol, bone, muscle. I also want to acknowledge that I have over the last like 5 to 10 years absorbed, pun intended, hydration into the digestion conversation because hydration's job is to deliver nutrients where they're supposed to go. So that's absorption, right? So when I—

Sponger hose.

I respect that.

Yes, exactly.

Perfect. And so when I look at your digestion, I'm looking at the ability to break things down, move them where they're supposed to go, absorb them properly, and eliminate. And so when we look at those components, hydration falls under absorption. Okay. Okay. Why am I coming back to digestion? Because cortisol, muscle, and bone are all going to be a factor there. Now, let me start off with a generalized statement about a GLP-1 agonist, very much similar to perimenopause. A lot of women will say to me, all of a sudden perimenopause hit and, you know, I had never had a problem with my eating. I'd never had a problem with my exercise, but all of a sudden I'm gaining belly weight. All of a sudden my bone is, you know, I'm losing muscle. All of a sudden I'm not sleeping well. Okay. No. What happened was your body was like letting you do those things and was not sharing the receipts, but it was keeping them. So, the things you did in your teens, in your 20s, in your 30s, whenever you start to go through perimenopause, whatever decades, it's now shining a light on that. Now, do hormonal fluctuations, how your hormones decide to show up and what's available, exacerbate all of that? Absolutely. But this is not all of a sudden it started to happen. What was happening was you were laying the groundwork and really laying the groundwork good for a lot of this. So when we look at all of that, the underpinning of what affects the body is really going to be digestion. And so one of the things that I get frustrated with, with GLP-1 agonists being blamed for worsening cortisol, worsening muscle, worsening bone, worsening hair, worsening like any of this stuff. Is it could, but most of the time it is exacerbating what was already going on. In some instances, it is just creating it for the first time. Um, but as somebody who's seen thousands of patients with these medications, I see that in the teens. Like, I don't— that is not— so I'm gonna call that like the 1 to 3% of the, the cases. So what we have to understand there is that when you, as soon as you go on the medication, even at a low dose, which is not a microdose, but a low dose, Even at a low dose, which many people are calling microdose, um, you are going to further delay your gastric emptying. You are going to alter what is happening, everything that's happening in that digestive phase, and you're altering hydration in that part. So because your own hormones only stay on for 2 to 5 minutes, these are staying on for 7 days or 1 day, depending on what you're taking. So if we understand that, then what we understand is that the— whether or not we choose to use a GLP-1 agonist, If we come back to, if our own hormones, our own weight health hormones are suboptimally functioning, the place we have to look at first is digestion and hydration. So cortisol is a total wake-up call that— ooh, that rhymed. Cortisol is a total wake-up call. All right, that's a new TikTok or something that I don't do. But anyway, that is a total wake-up call for us to say your body is literally trying to send an alarm bell. Like it is just trying to tell you to pay attention. Attention. And the place we pay attention to is your digestion, because your stress response is— when your stress response is activated, it shuts— it diminishes digestive efforts. So it really lowers. So that means you're not getting credit for the nutrients you're taking in. That means you're not getting credit for your workout. That means you're not getting credit for your sleep. Like, all of that stuff. So bone, muscle, fat, cholesterol, any of it sorry, cortisol, I would definitely say that the place to focus on there would be your digestion.

Okay. So I want to ask you this. So it's— I feel like this theme is coming up. I mean, would you agree with this? Chinese New Year aside, 2026 is the year of the gut.

Yeah. Yeah. I wrote Recipes for IBS in 2006. I thought 2007 was going to be the year of the gut. I thought 2008. Right. 2026 is here. You know, our good friend Cynthia Thurlow has a great book. Like, you know, there are so many perimenopause books out there, but she's coming in, she's like, you guys, it's the gut. So can we please acknowledge— and, and we see this at every phase of our lives, it's just like we need, we need to give it much more attention, um, especially at perimenopause and menopause. But you're the— when your hormones go off course, they throw digestion off course. So when they fluctuate, and like, think about even when you're like 25 5 or 30, the couple of days around your period, your digestion's usually like a little, eh, or a lot, like, whoa, like it's horrible, you know, whatever. You're— the changes in your hormones there, right? And so a lot of times, like, even people who try to cycle their exercise and, and will say like, hey, I would cycle your exercise, or I would cycle your eating, or I would do any of that stuff around your hormone cycle, what they're really saying, what the reason these things work is you're leaning into the changes in your digestion. So I'm always— I, I'm assessing somebody's digestion throughout the month, or in the case of perimenopause, I invite women to assess their digestion on a daily basis and just be like, how is it showing up? Because if your digestion is showing up as blocked or bloated or slowed, um, and you throw a lot at it, it's just going to give you the middle finger. It's going to be like, this is just not time. Like, it's not— I'm not going to do what you're asking of for me. Um, and one of its big jobs is to have your weight health hormones go to action, you know, on that part. So yeah, Absolutely. So whether it becomes the year of the gut or not, we are saying gut, yes.

And that is so related to— I think it comes back to bone density. I know I started talking about my own, you know, here's what I did to reverse osteopenia, and the questions didn't come out of curiosity. They were like, wait a minute, how come you had bone loss if you exercise all the time? And I'm like, well, guess what? You can't outrun your past, you know. And the cumulative the cumulative effect of any habits that you got away with catch up with you and me too. Yeah.

Yeah. So, think about it. There was just research that came out. I liked it. I haven't dove into it more extensively than just to share it, but one course of antibiotics, 8 years, sticks around for 8 years. Now, depending on the type of antibiotic, whatever, some were 4, whatever, but 8 years, right? For me, that's very profound because my 8-year-old self was the year that a bully punched me in my belly, called me fat, and I was like, "Oh my God, I got to get rid of this belly." And from then on, and copious amounts of antibiotics later, you know, it would take before I would kind of put all that together. And, you know, I'm someone who even like, like in my forties, I'd have a dose of antibiotics or, you know, whatever, like that, that kind of thing. So, um, I think that's important. Um, I loved alcohol for a long time, or said differently, I love that alcohol really helped me escape from a body that I was not loving, like, so, you know, or a person I wasn't loving. So I, I probably abused or used alcohol like as a friend, you know, in, in, in instances. And there were times also too where I just loved alcohol, alcohol. Challenger to your gut. Stress, challenger to your gut. I have friends who have done and have beautiful children because of IVF, challenger to your gut. I have people who are on autoimmune, have autoimmune situations where they find out years later they were allergic, truly allergic to gluten, celiac. Guess what? Challenger to your gut. Like, we can just keep going on here, right? And so when we look at that, what's very interesting though is we now know that through the process of GLP-1 and GIP, I want to be very clear when I say this, GLP-1 and GIP, your own, the hormones in your body. There is research, and when we understand the body's physiology, those hormones turn on bone formation, which means they turn off. So, we're talking about the osteoblasts, not the osteoclasts. So, they are a positive for building bone. I want to double-click on that. So, if your own are suboptimal for all the reasons I was just talking about, like either trauma, like any of these things, like the signal sterling didn't work, your own hormones weren't working. If your own hormones, those ones that stay on for 2 to 5 minutes, aren't optimal, your bone will suffer. Now, additionally, we need a lot of nutrients from a bone standpoint. So if you ever dieted or if you ever drank alcohol and had it interfere with it or, you know, whatever on that part, and you reduced the nutrients, you— or your diet didn't include the key nutrients that actually help build bone— spoiler alert— much more than calcium, um, you know, then we want to be building bone successfully, right? So what makes me crazy is the, the commentary and the poorly done research now that says that GLP-1 agonists are creating osteoporosis, that they are ruining our bones. Because if you think about it, they're actually giving you an exponentially high dosage of the ingredient that actually tells bone to go to work. Now, here's where the rubber meets the road. If you were osteoporotic or had osteopenia before that, and you had underlying gut issues before that, then it's very likely that your bone could worsen while you're on a GLP-1 agonist if you don't, on an agonist, optimize your digestion, optimize your total nutrition to get the nutrients in, and then do the kind of exercise, which is not just strength training, do the kind of exercise that's better for bone building on that part. So I think, like, you know, a lot of this, Debra, I don't know how you feel, but what I often come at is I've been told for decades to make nutrition simpler. Like, somebody listening right now might be like, "Ashley, this is like super complicated. There's all this." I get that. However, when we make things more simple or oversimplified, like our dietary guidelines, you know, eat at the top of the pyramid and don't eat the bottom or whatever it is on that part, we turn around and we actually tell people that these things are going to work for everyone and we miss the nuance and we miss what's going to work for you. What I can tell you is if you're interested in healthy bone, muscle, fat, hydration, brain health today or tomorrow, cardiovascular health, your skin looking the way that you want it to look, or just in general feeling like a good person most of the time, your gut is the place to focus on that part. Yeah, totally.

Yeah, that was totally—

there we go.

Totally simple.

I love that. Yeah.

Okay, I have a question for you. You've seen so many people you. Even my dog thinks you're great.

So mine's not— I've got Heather, so mine unfortunately won't be talking to yours, so that's good. Yeah, yeah, you sleep.

I want to ask you this on behalf of every listener here. When somebody hits a plateau despite consistency, and let's, let's fingers crossed consistently doing the right things, how often is it that you would say— and I know I'm asking you to to use a crystal ball here, how often is that a cortisol adaptation rather than a calorie or a macro issue?

Yeah, so first of all, I don't believe that there are right things, um, and consistency. Like, so like, it— I think that like just, you know, that what do we call it, and we say like the lexicon or the words matter on that part. And that's not for me to disagree with you. When I talk to a patient, this is what I'm going to say. What I'm going to say is, you have— the great news is you've been consistent with this stuff And so now I can see that what you're doing, while it was working for us over here, and we have evidence, we saw fat loss, we saw better sleep, or we saw your skin, but you're doing the same thing over here and now it's not working. So that's— and let's understand what that means, it's not working. There's a difference between I have stopped losing fat versus I'm now gaining fat, or I was sleeping beautifully before and now I'm not sleeping. You know, so we have to understand the what. So what that is, is that's just experimental data right now that then turns around and says to me, okay, so now I want to understand what is different today. So that's what it is. It's a signal. Sometimes what's different today is we end up having a conversation and it comes out. This happened with one of my patients just recently. She's like, oh my gosh, I'm ready to kill my mother. She's like, my mom's in her 80s. I— this— she's like, I'm this and this. And she just like— and I literally watched her in front of me on on the screen morph into her younger self who was so mad at her mom. And I was like, okay, we're gonna take a deep breath. We're gonna move in some movement. I was like, can you just tell me if 2 weeks ago, a month ago, she goes, oh no, everything was fine. But my mom like had to just start a fight with someone. Now they don't want her living there. You know, like all this other stuff. And I was like, okay. So when you talk about cortisol, is it cortisol adaptation or is it like, hey, situation changed and my daily on a scale of 1 to 10, when I measure out like, how annoyed am I with my mom? It went from, uh, maybe a daily is a 3 to 4 to a 7 to 8. Guess what? That is affecting your vagus nerve. That is bringing up childhood trauma. That is you being pissed at this age, you're still dealing with it in the same way. Like, you might be mad at yourself. Like, I get mad at myself when I fall for things that I, like, fell for when I was, like, 15, you know, whatever. The whole space of it, I'm like, okay, there's that whole piece. That might be one them. Somebody else might come in and be like, well, I actually was like doing so well at the gym that I started going 4 times a week or 5 times a week, or I'm lifting heavier, or I added this on. And I was like, oh, well, you know, when you exercise more intensely— I'm pretending to be Debra now— but when you exercise more intensely, that's going to actually— that's a stressor on your body. We have to recover more intensely then. And what we may be seeing is that you've got You might have hormones that are in stress or presenting as stress because your body isn't feeling as recovered. So, maybe we're gonna add some magnesium to your bath or whatever. Anyway, could it be cortisol adapti? Absolutely. But what I really wanna get into is, and again, this is less about like, I don't actually care if you know the why on that part. I really care that we have the insights. And so, what may come up for me is, you know, we gotta pivot. I gotta pivot to where if you are gonna exercise like that 4 or 5 times a week, we've gotta do this or this, right? Or I'm gonna pivot to, all right, what are we gonna do every time you get off the phone with your mom? And it's not gonna be half a bottle of alcohol. So like, what's, what are we gonna do? You know, or when you're on a call with your mom, can you do like, can we breathe like this? Or can you, um, pet your dog? Or can you remind her, read the thing that we had her write and And she sits it right next to her phone right now and it says like, my 15-year-old self felt this way, my 30-year-old self felt this way, my 6-year-old self feels this way. Okay, mom. All right, mom. You know, like that kind of thing. So I think one of the pieces is, again, coming back to great if you understand it. I am not trying to dumb things down or saying like, don't be informed about physiology and that part. What people come to us for is how do I fix it? And the way that we fix it is this. And the final piece about a plateau, it infers that when you— that you like— it's like, it's a little bit of like an ego in our brain to call something a plateau. Your body is never in a plateau. Like, that is an absolutely inappropriate— that is a diet industry term for— because I know, because I got it a lot, showing up at Weight Watchers and getting on the scale and it hasn't moved, and they're like, well, you are not a winner. You are also not quite a loser because God forbid you gain weight, but you are definitely not okay. So we're going to come up with a name for you, and that's going to be that you're on a plateau, and it's just about your total weight. And that's like dumb because your body is always moving. It's like there's always something going on. So what we're doing is now decoding— we're decoding it differently rather than thinking about a plateau.

Yeah, so beautifully said. Okay, so let's say we've got somebody listening here who's like, She's talking to me. I've known this, but she's really calling me out on it. Thank God she's not walking with me. But, you know, what, what would be— and I know if we're talking personalized, that's a little hard to answer for everybody— but are there some habits that women may think are helping them but might actually be hurting their gut? Or if you'd rather approach it from this way, what would be some low-hanging fruit that women could do right away to help improve their gut with— without lifting much fingers-wise.

Well, one of the reasons I wrote this book, because I've written other books and chapters and have all sorts of stuff on digestive health, since I realized that the problem is today we have so many things we can do for our gut. Well, the first thing you don't want to do is do a ton of stuff, and the second thing you don't want to do is depend— is to assume that if my gut is not better, I should do X, like I should take a probiotic, I should take magnesium, I should increase my fiber. No, you should determine what isn't working. And then there's an opportunity to experiment with different things, but always doing an experiment that is typically one thing, maybe two things, you know, um, but that would like be max on that part. So as an example, in my book, I talk about upfront, this is what I, right when I get into the motility section, if you are somebody with slowed or not happening motility, do not do this first. And I actually lean in like, Do not increase fiber. And I'm like, off the table. I do not like— so all of these people who are on a GLP-1 that people are saying to them, you need to get in 30 grams of fiber. Oh my God. Like, don't do that the day that you take your shot or you take your pill. Like, and if you take your pill on a daily basis, maybe we don't do fiber in the morning. Maybe we lean into fiber more throughout the day or we adjust the type of fiber. Like, we have to make sure that we're not doing the wrong thing. So that's the key thing that I want to share with you. And I do provide that as an assessment and a way to, you know, help you to personalize it. So there is a piece of personalizing. So the key things to think about: don't do something in the name of this is good for digestion. No, the question mark is, is this going to be better for your digestion? And that's just an experiment, you know, we try that. The second thing is it is not always food. So one of the places that I'm really comfortable with people leaning into And before I speak out of turn, I want to acknowledge that I am not a personal trainer or at all trained in fitness. I have my own— I use coaches, train people, and I learn from people like Debra. So, I want to be very clear about that. One of the things that is very key for us is to make sure that we're moving our midsection. So, we often suck in our breath. We often wear tight clothing. We, like, we, you know, hold it in like a Spanx, you know, that kind of thing. Or we exercise and we exercise in a way that doesn't move our midsection, or we sit and we're then definitely not moving. So we need to move our midsection. So sometimes I have people rolling on a foam roller, on a ball, or, you know, doing things and rolling it around. Sometimes it's simple, you're laying down, you're doing chair twists, you know, or knee, you know, anything that like moves your, your belly area on that part, um, preferably while breathing. And so the other part would be we could be breathing better. And then I think one of the other pieces for digestion is to directly connect connect elevated stress with digestion. So, for me, for every centimeter that my shoulders go up in any given moment or that my breath goes higher, you know, closer, like out of my belly and into my diaphragm or up into my neck because I'm experiencing elevated stress, good or bad, like I could be training or anything else, every time that happens, that's a signal for me that my digestion is not being— it doesn't have attention, it's not working better. So that is really good for us to know that in that moment, as an example, if you are super like in a crazy hurry or you're trying to deal with something and you're like, okay, let me just get in some food real quickly. That is the worst time for you to eat. Now I'm a total realist. I know that's gonna happen, but what could you do in that moment? Could you take 10, 4, 7, 8 breaths? Could you let, could you intentionally watch something on social media that makes you laugh? Like really laugh, you know, on that part. Could you turn around and say, you know what, Ashley, none of that's gonna work for me. Okay, I'm gonna grab liquid nutrition as opposed to something complicated from a nutrition standpoint. Notice I'm not saying juice or that kind of thing, but something that's balanced from a nutrient standpoint because liquid is at least going to go into my system a little bit better, you know, et cetera. So there are a lot of different options to lean into on that part. The other one is to be very clear about any over-the-counter remedies that you're using, including cigarettes and caffeine, or medications that could be having an impact on your digestion. And those would be ones that I ask questions about too in my book. Yeah.

Wow. Excellent. And yes, I mean, so back in the end, the resources and the experiments are so awesome. So get the book if you're listening and you haven't already gotten the book. You're going to want to do it whether you're thinking GLP or you're not thinking GLP. It's just a wealth of information. Ashley, thank you so much for being here, for the work you're putting out in the world, and the education you're giving everybody.

Thank you. I love this. And thank you to this community. It's so fun to be a part of it.

All information shared on Flipping 50 the Stronger Way is for educational and informational purposes only and not intended as a substitute for medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider before beginning any exercise program, making changes to your diet, or adjusting any medications or supplements. Individual results may vary. Debra Atkinson and Flipping 50 are not responsible for any injury or adverse outcomes resulting from information presented on this Hey guys, real quick, I want to pipe in earlier in this episode I shared something about Aquatru, which is my countertop water filter, and I've been using it since November 21st.

I'll say that because I moved in on the 20th and it certainly was not organized enough to do that on the first day. But it's been on my radar to be extremely conscious of the water I drink and the air I breathe since about 2013 when I first began on my research about the toxins, the hormone disruptors that for me as a personal trainer, health coach, medical exercise specialist, strength and conditioning coach, anything that I would do with women, I realized, or for myself, was not going to work as well if my body was dealing with all kinds of hormone disruptors. Hormones influence exercise, exercise influences hormones. We have to look at this in an integrative way. We can't isolate and say the exercise is good, it should should give me X results, because that wouldn't happen anymore for my ladies in midlife. And many of you listening are nodding your head saying, yes, this is true, it's not the same. But when I moved from the Midwest, where I was a tap water drinking girl, to Boulder, Colorado— I lived in the mountains at about 8,000 8,800 feet, and very quickly realized that the quality of the water, number one, it tasted very different. So that, you know, always gives you pause for— doesn't feel like home if you don't like the drinking water. And when we're very consciously trying to drink more water to become or be more hydrated, especially a Midwestern girl moving to altitude, I knew I needed more water and it was trying and, and actually doing, but it didn't taste good. So I first began using BPA-free large bottles of water, filling it up down in town, hauling them up two flights of stairs—

not an easy task, but well worth it.

And I tested my tap water in the mountains because what passes as safe enough by, say, a city may not be what you would deem safe. And I found that to be true. There were detectable amounts of heavy metals, lead and others in the water. That was not cool. So I didn't cook with it. I didn't drink it. And the only thing that I did do was bathe in it, shower in it, brush my teeth in it. And still those things If you're really being careful, you want to think about— so on a repeated basis, it's what we do frequently and repeatedly, even if in small amounts, that will matter to us. When I moved suddenly from Boulder to Scottsdale, then Phoenix, so in the area, um, the water was terrible down there. So high levels of lime in the water there, and everybody knew it. I mean, you You could see it in the showers, you could see it in the shower head, and then the whole change in my skin, my body. So, you know, every move that I'd made changed literally my skin. A breakout became drier, became oily, or something. Your skin tries to figure it out, but that too is somewhat related to the quality of water that you are putting on your skin and using. As well as what you're drinking. But I realized then that obviously if I was bathing in that, I didn't want to be drinking it. So I continued to get a dispenser for the kitchen and drink bottled water. When I finally invested in a home, I decided installation of home and throughout. So I was bathing, showering in clean water. Filtered and got one for the kitchen as well. Now, ideally you wanna do anything that you're, you're cooking in. So you're, you know, boiling water to make something or you're steaming vegetables, you're using water for soup. You wanna use clean water to do all of that. You wanna put that clean water in the dog bowl and do all of those things. But anything that is going on your skin on a regular basis, really important to consider. The skin is the largest organ of our body. We're drinking tons of water to stay hydrated, but we want to make sure that it's clean and safe water. That became extremely important to me. Many of you know I'm a new grandma, moved back to the Midwest in November and realized within the last few months that we have the highest cancer rate of all states. Not an award we wanted to win, but a lot of that is due— we're in the middle of farmland, pesticides, fertilizers, and that runoff goes into water. And although I live in a city that has one of the cleanest water in the nation, supposedly. My son on the other side of town in a smaller suburb lives and has some of the worst. So it's very interesting how this all happened. But the taste of the water is one thing, but the quality of it is another. It's really important to me that the water I'm drinking tastes really good and that I have tested it and it makes sense. So I started testing my water and in 2013, '14. Definitely did so in Boulder when I lived in that house. Did it in Phoenix and Scottsdale area. And, and then just didn't do it when I invested in a house. I knew it, and so I invested in the filter. So here I am, and I just knew I'm buying a house, an old house that's been redone But the pipes are old, and that really kept me up at night. Who knew? And so I decided right away I needed to get a water test. I wanted to know what were the heavy metals in the water. And so I— the filter system was just a no-brainer for me. I absolutely needed it. And when I discovered that, you know, doing it throughout the house in an older house was going to be a little bit more complicated. So I did the countertop and have loved it. Taste test twice with my family. So I entertained for Thanksgiving. That was my goal, green bean casserole in my new house for Thanksgiving. And I did. And then instead of Trivial Pursuit and Pictionary, we played blind taste test. So we handpicked people in each group of relatives and we did this blind taste test with out of the tap. Remember, I have some of the cleanest water in the nation. Then out of the filter for chlorine, that is really the faucet for drinking water here in this house. And then the AquaTru from the counter. Didn't tell anybody. Hands down, every taste tester said, yes, the AquaTru is the one that tasted the best. So in terms of taste testing, yes, but what's even more important to me is the void of all heavy metals. It's clean water. I feel good about drinking it, and so I'm drinking more. The other thing that has really helped me, and I'm not somebody who likes to have a lot of things sitting on the counter, the only thing I thought I would at one point was a KitchenAid stand mixer. I thought it would be fun and colorful, and yet it collected dust, and so I gave it away. And I don't believe it got used probably more than 5 times. But the Aquatru sitting on the counter actually encourages me to drink more because I think, "Did I drink all of that today? How many times did I fill it up?" up. And, um, it's just been game-changing. Even though I'm consciously drinking water and always have, I just always— I can't think of a time that I didn't. But this has really upped my game. I see it, I think, gosh, when was the last time I had some?

And I drink it.

So if you need reminders of how very important These two basic things, the quality of the air you breathe and the quality of the water that you're drinking in on a regular basis, are to avoid microplastics. Use a container. What upgrade could you do even today? What kind of actions can you take? I highly encourage you to look at how you can take care of these two really important things. And thanks for listening all the way through. But the biggest point and anchor here is no matter what you're doing with your fitness, with your supplements, with your trying to get sleep, the air you breathe, the water you drink are extremely important. Make sure that you're taking in the highest quality possible.