Unpacking GLP-1s: A New Approach to Weight Health with Ashley Koff

My first job was working at an ad agency. Kellogg's was our client, and then we had two new cereals. One was called Smart Start and one was Raisin Bran Crunch.

Kellogg's Raisin Bran Crunch.

The legal team and the agency all had to get together and figure out what we could say. Turned out we could say that Raisin Bran Crunch gave more morning energy. And why? Because we had more sugar. When the ultra-processing of food happened and we came up with marketing terms like enriched flour The mill enriches its white flour with vitamins and minerals. Insist on enriched flour. Which is actually the opposite. It's the poorest flour, you know, but enrichment sounds, you know, like it's something people, you know, want in their lives. We are under-fueling our bodies.

How much of a role have ultra-processed foods played in the fact that we now need GLP-1?

Everybody can get all wrapped up in what is in those ultra-processed foods. What I get wrapped up in is what is not in there. The day that I first injected myself with that medication, I turned around and I go, "You know what? I actually think this is what a normal person's brain is with food." It was an overnight difference.

JJ here, and I am with my, like, new friend, but really should be my longtime friend. We met a year ago and I'm like, "How have we not known each other forever?" I still don't understand it. Anyway, Ashley Koff is a registered dietitian and the founder of the Better Nutrition Program, and she has a new book out that we are gonna be talking about. Talking about today. I'm super excited about it. Your Best Shot. We are going to be unpacking GLP-1s, and she has such a unique perspective because she is a dietitian who's worked a lot in behavior change, emotional eating, and for the last, what, couple years you've been working with people using GLP-1s. So we are going to talk about this. You're going to hear some straight talk, some amazing wisdom with my buddy Ashley.

So welcome. Yeah, and we both have reality TV shows and like other things to our to this space, it's so great to have this conversation with you because, you know, from the moment that this came out and people had this awakening about GLPs, maybe like as a medication, maybe 4 or 5 years ago, I've been working— 2004 was when I first understood our GLP-1 hormone as it relates to a bariatric patient. But my first patient on liraglutide was in, I think, around 2010. So this is like, this is a long time, you know, in that part. I remember you said, and I even did a podcast on that, we're like, can we just cut through the BS of what people are saying, blaming the medication for, and then what they're also blaming people for, and really look at what is just bad practice with a tool, you know, on that part. So I really appreciated that part of you.

So I'd love to back up because I think that where you come from is so fun.

Earth, we'll start there. Yes, I am from Earth.

All right, well, you are not an alien.

Although sometimes— Yes, someone wonders. Yeah.

You came from marketing sugar cereals and processed foods. Yeah. Like, that was your world.

Totally. Yes. Okay, so here's a story. I wanted to be you. I wanted to be tall, skinny, and have long straight blonde hair. Like, that was my— I grew up in Columbus, Ohio, and I think I was pretty good with who I was until I was about age 8. I kind of talk about being, if you look back at photos, I was a cross between Shirley Temple and Spanky from The Little Rascals. Like, I was bossy, bold, super empowered young girl, and had these big brown curls. Nothing's changed. And nothing's changed except for, unfortunately, at age 8, I started to be bullied about my belly. And I had a belly and it was cute, but then it suddenly didn't become cute. And I had a boy in school who was a bully take me out back and like punch me in my stomach.

I wish we'd been friends then because I was the protector of all of my—

I needed you. Yeah, I needed you. And by the way, like people did, you know, they, they would want to protect you. My parents were amazing. Like they never made me feel like my size was anything other than like, you're just strong, powerful, and beautiful. I was beautiful, but society told me different. And so it ushered in such an era of dieting. And at first I tried dieting like all the right ways on that part, and then I started getting into really unhealthy behaviors. So, you know, like kind of going down that whole space. And so in wanting to be you, what I never gave up on, my version of you at that time was Angela Bauer from Who's the Boss. She worked in advertising, and I just thought like it was the coolest thing. And so, and I love to sell things, and I was this young entrepreneur, and I'm like, I'm gonna go out and do that. Well, my first job out of college was working at an ad agency. Kellogg's was our client. Our first were tasked with things like, you know, Sugar Smacks, and so selling sugar cereals to kids. So, you know, that was cartoons and, you know, make it delicious. And then we had two new cereals. One was called Smart Start and one was Raisin Bran, but we wanted to make it now accessible for a younger audience, so Raisin Bran Crunch. And that was actually the first time I remember meeting dietitians because the legal team and the agency all had to get together and figure out what we could say. Well, it turned out we could say that Raisin Bran Crunch gave more more morning energy, which is what we'd learned from the research people wanted, than any other cereal. And why? Because we had more sugar. We had sugar on the flakes, we had sugar in the flakes, we had the raisins, you know, etc. So here I am like hawking those, but also dealing with a body that was really by that point breaking down. I was a macrobiotic vegan who did yoga and didn't drink alcohol in New York City at age 20. I was like nothing— or no fun at all. I tried being real fun, you know, drinking was a college sport for me, and I tried that part. I tried so many different things. But what did end up happening for me was a rock bottom moment where doing all of that wasn't working. And I had met a healer at yoga, and she pricked my finger and looked at my blood, I think through a Fisher-Price microscope. She told me I had a worm, and that to kill the worm, I had to drink goat's milk for 7 days. And I drank goat's milk, 40 ounces. This is 1996. Do you know how hard it is to find goat's milk? So I'm like schlepping to find goat's milk, and I did it, and I actually had a flat belly during it. And she also told me, that if I looked at my poop, I would see that I was passing the worm. Well, spoiler alert, if you're only drinking goat's milk, your poop looks like a white worm that is passing. But the problem, like anything, is when a cleanse ends, when the Master Cleanse ends, like any of this—

Oh God, the Master Cleanse.

I remember the Master Cleanse. I mean, literally, I'd done it all. So when it ended, I found myself having gained weight back, like the 10 pounds I'd lost, I'd gained, and I gained 1 more pound. So I did what everybody does when we have like absolutely rock bottom. I went to a bar and did shots of tequila and was chanting with people, telling my story, kill the worm, kill the worm. And a gastroenterologist, I did not know this at the time, comes up to me. He was eating a burger. He was not up at the bar. And he goes, by any chance, did you take antibiotics as a kid? And I looked at him, I'm like, that was the weirdest pickup line I've ever heard. Right? And then he says, no, no, like I'm actually, and I said, yeah, I free-based them. Anyway, he gives me his card. I go to see him and he said the most important thing. And this, I think if anyone takes anything away from this conversation, It's not what you're eating or what you're not eating. It's that your body doesn't have what it needs to run better. And that changed my life. It changed my life because I had been in this place where it was all about my weight and it was never about my health, but yet I'd been on antibiotics and all these medications. And now somebody put it together for me and said, your belly, the body inappropriately making fat mass or putting it where it doesn't belong, that's a key performance indicator. You not making muscle means that's a key performance indicator of your weight health. And suddenly Suddenly it was like the world was open and I learned how to, you know, you heal your digestion, you work on these other pieces. So it was a long way round of, you know, starting off in a real dark hole of selling chocolate cereals.

Wow. And then you went back and became a dietitian?

And I became a dietitian kicking and screaming. I quit all the time because I felt like what I was learning in school—

Well, that's true.

Dietitians— Didn't actually help me. But I got some great advice at one point. Somebody said to me, just become the dietitian, get the letters after your name, and then go out there and change things. So that little 8-year-old girl is out there trying to change things on the heart.

Yeah, thank you for doing that too, because it's like, that's always driven me crazy. I remember I was in one class and we had two of our professors and they were like, "You can get all the nutrition you need from a potato." Yeah. And I'm looking at them and they looked like potatoes.

That's right, that's right.

Like, I don't think so.

I don't think so. Yeah, and that's when you actually see someone visually and you're like, "You look like a potato." You know, then I was working in Hollywood and it's like I have all these people that look the part, you know, and some people would call them lollipops. They were like so thin and had bigger, you know, heads on that part. So they were even on the thinner side, but inside they were not a potato. It was like all things were going wrong. And so I think, you know, we have this society today where we are still judging people based on their appearance. We're judging their health. And you're in my book there. This is such an important point.

I'm in your book?

You are in my book. Yes. No doubt. You are in my book. And you know, that conversation around we need to break up with the idea of weight loss. We need to break up with telling somebody that you're a certain way because of your appearance. We have to be able to lift. We have to be able to, you know, move our bodies, you know, all of these other things. And so the fact, like how you've talked about muscle and how you've said to women well beyond 40 that it's about what you're able to do. We have to build strong bodies. You know, that's just such a powerful message.

I don't know if you know this story, but back when I was in high school, mm-hmm, because I was so tall, I kept— everyone goes, you should be a model. Now, I'm not photogenic.

You are photogenic.

No, I'm not. If you see a great picture of me, it was like 1,000 pictures to get there.

I love that.

It was Photoshopped.

I gotcha.

There was makeup artists involved.

There was a lot involved. See, I see the beauty in you, but okay.

Yeah.

All right.

So I'm always like, oh my gosh. Yeah. So basketball, volleyball, and be a model. So, which by the way, you cannot do both of those full time unless you're Gabby Reese. Exactly.

Yeah.

I go off to San Francisco to the modeling agency and they go, "How much do you weigh?" And I said, "140 pounds." And they go, "You need to lose 20 to 30 pounds." Stop. Stop. Like, I am the same now as then, except I have a little more muscle. And I was like, okay. I go home.

Oh my God.

I go to the library. I get a diet book. I get a calendar. I mark down my calories every day. A couple weeks into this, I now can't do basketball. I can't do track. And like, I am dying over here. And one of my coaches is like, "Are you anorexic? What's going on here?" And thank God. And I realized, I'm like, "Wow, I can eat." And I'd always been strong. Like, I'd always been this muscular, strong, and that was my identity. And I'm like, "I chose that." Yeah, I love that.

It's such a profound point because one of the things that I talk about in the book, yes, and certainly publicly, not that like I felt like, It kind of surprises me at 52 that I'm needing to share my whole personal life, but you know, one of the failures was I tried every eating disorder that exists out there.

And you weren't good at any of them?

Yeah, and to carry a badge as a failure, like I'm a failure on the eating disorder side. I didn't have your athletic intention that, you know, or that skill where I was like, oh, I have my other people that are saying like, hey, you're strong on this. But I did have a lacrosse coach who I was very modest, but I loved playing, and I went and I face planted on the field, and he's like, what did you eat? And I was like so proud, I go, Nothing. And he goes, okay, you can't play. And I was like, what do you mean? And I had to sit, I had 3 chaperoned meals a day for a week before I was able to get back out on the lacrosse court. And I, to this day, I think of him, he was a young guy, I think he was even a grad student. And I'm like, you, like, thank you for adulting, you know, in that moment. So I'm so glad that you had that pivotal change, cuz otherwise we would all be in this space where we see so many women having what they've carried forward into their 40s and their 50s is this, like, I have figured out a way, whether it's willpower or whatever, to control my eating to such a degree that my appearance looks the way that I, I believe society wants it to look, or even the way I want it. But unfortunately, then what happens for them at 40, right, is then they're falling apart inside and suddenly they get a belly. Then they hit perimenopause. Exactly. Exactly.

Everything goes sideways for them. Yeah. Yeah. It's, it's interesting because one of the things that I love that I heard from a mentor early on is you don't, You don't lose weight to get healthy. You have to get healthy to lose weight. And what I've taken that to is you have to get healthy so that your body can hold on to muscle, or better yet, build it while you're losing fat. The first time I'd heard about weight health— now I see it everywhere— was you'd written something. What the heck is weight health?

Yes, yes, yes.

What is this term?

Yeah. So I've decided marketing— actually, selling sugared cereals has paid off, right? I have taken marketing to trying to market better nutrition, including creating a definition for better nutrition because one didn't exist. And then what I realized was society had been talking to me always about my weight and telling me that my health was fine and my weight was an issue. And we have perpetuated that myth down to when I was seeing patients for weight loss surgery, I wanted to call it health gain surgery. They're like, nope, that's not the case. When somebody goes to a cardiologist because of a heart issue, the cardiologist is like, let me work on your heart. And they might say like, if you lost some weight, if you could just go over there, if you could lose some weight, it would help you on that part. But they're not looking at it as a weight health thing. And so what I realized is If I teach people that your body is a weight health ecosystem, if you understand that every choice that you make, what time you go to sleep, what food you eat, what food you don't like, all of these things, they're going to have impact, and then they're going to also have other impacts in the ecosystem. If we realize we're a weight health ecosystem, then something really incredible happened. When I, in 2004, when I saw my first bariatric patient, I saw overnight their diabetes went away. Then I saw over the course of one week that their entire relationship with food, with appetite, with cravings, with hunger, all of that changed. And the doctor kind of flippantly said to me, "Well, yeah, that's their incretin hormones." And I was like, "What is an incretin hormone?" I was a total geek in school, like in grad school. I'm like, "I've never heard of this." And at the time we were only looking at it as glucagon and insulin, but what we learned was there are these hormones that tell those hormones to work. There are these hormones that tell leptin and ghrelin, which are our hunger and satiety hormones, to go to work.

Well, those incretin hormones, incretin hormones is like a tough word.

If you flip it and you actually call them, they are GLP-1 and GIP and PYY and CCK and amylin and GLP-2. And we can keep going on. If we call them weight health hormones, we now understand our body is actually designed with hormones that based on the signals that it gets, it goes and tells the body what to do. Those hormones— GLP-1 does not just tell you not to eat. GIP, they tell the bone mass, they're involved in bone formation. They're involved in your fat mass, the type of fat mass, where the fat mass gets allocated. PYY scans your poop and then checks with the body to see how hydrated you are, and it affects your hydration, which affects your blood sugar, which affects your metabolism. So the body is so much smarter than we ever gave it credit for. So we can't have a weight or health approach. We actually are failing. And then to the tune of 9 in 10 Americans don't meet the criteria for metabolic health. I think probably 9.7.

I was gonna say it's higher now.

It's higher, but 9.7 don't meet the criteria for weight health. Weight health hormones, the GLP-1 conversation, is not for fat people. It is also not a diet and exercise conversation. It is a physiologic conversation to understand how do we optimize our body, and then to also take into account that modern day serves up a lot more challenges to our weight health hormones than, say, pre-industrialization.

Well, that's exactly— I mean, thinking about that, how much of a role have ultra-processed foods played in the fact that we now need GLP-1s? Yes. Like, so you've just, you've just taken a diet that is now 70%, the average person's 70% of their diet's ultra-processed foods, which the key thing that these things have been engineered to do is decrease satiety.

Yes. Override our satiety mechanism, right? Salt, sugar, fat. Thank you, Michael. You know, like in, in terms of that, I think the other piece about it, and everybody can get all wrapped up in what is in those ultra-processed foods, what I get wrapped up in is what is not in there. We come back and we say like, the body is an operating system. So most of us know a car or maybe like an iPhone or something, it's an operating system. And we have for the longest time set the standards for suboptimally resourcing an operating system. If that happens and you go in and you say, okay, I'm gonna make sure there's gas, um, there's, air in the tires, gas in, in the tank, air in the tires, and oil in the engine. But if the engine actually doesn't work, then you have this whole issue there where you're like, okay, it doesn't matter that your car is full of this stuff if it literally doesn't work. So number one, if digestion does not work, and our weight health hormones are in our digestive tract, if it doesn't work, I don't really care what you're taking in. So number one, we've gone through the space of healthy food versus not healthy food. We high five when you eat kale or when you eat wild salmon. The body doesn't. That's like, basically, if I eat wild salmon and I'm like, "I'm so great," that's like me presenting a paper to my teacher and saying, "Thanks, here's the paper. I got an A." And the teacher comes back, they're like, "No, you got a D. I'd like you to rewrite 3 paragraphs." So for a lot of us, the salmon isn't getting to the muscle, or the salmon, or maybe the salmon gets to make the muscle, but we don't have enough left over for it to make hair, for it to make skin, for it to do these things, because we're suboptimally resourcing it. And the dietary amounts, I know we have DRIs today. I like to use the term of the RDAs from the old days. So the recommended daily allowances, 'cause I like to call them really dumb amounts. Like, they were so dumb and they still are. And when we look at that, we'll come in and we'll say, "All right, for magnesium, it's suggesting 400 milligrams is enough for the body." Well, for most of our bodies, we need maybe 600, 800 milligrams, right? So instead of having 10 units of magnesium, if we have needs for 10 units, instead of having 10 met, let's say that we only have 4. We don't get to say to the body, "I would rather poop than have my heart muscle pump." The body's like, sorry, one of those four is gonna be, we're gonna have the heart muscle pump, right? So it doesn't really care if it takes you longer to poop or longer for the stress to turn off. So when the ultra processing of food happened and we came up with marketing terms like enriched flour, which is actually the opposite, it's the poorest flour, you know, but when they came up with the term enriched, I know cuz it was during my marketing time, it's like, we'll make you feel rich. And enrichment sounds, you know, like it's something people, you know, want in their lives. It's so devoid of the ingredients that we need, so. Enriched flour has 70% less magnesium than the shaft of the wheat, right? So that food product now comes in and is contributing to us being suboptimally resourced in that part. I think at the end of the day, we have created the problem. There's two reasons why we need the agonist, but one of the reasons we have is because we are under-fueling our bodies, which goes back, this is why you're in my book, this goes back 100% to what you will say is, it's not about what you lose, it's about what you're building with. You know, I think that's so important.

I wanna really get into GLP-1s because I feel like there's so much misinformation out there. First of all, it's just one of the weirdest things about this is that it's such an emotional issue. It is. And there's all this shaming and hype and, and I'm like going, why is that? Like, you don't hear that about thyroid hormone. Yeah.

Or insulin and yet this one, or statins or proton pump inhibitors or any other medication.

It's like, but this one's like, yeah, it's like this weird shaming thing. Let's start with, cuz you mentioned it earlier, but I'd like to unpack it further. What are they really doing? What are they not doing?

Sure.

Like, what's the role of GLP-1? And then if you're using it as a medication as opposed to your body naturally producing it. Yeah.

And you went right there because you mentioned insulin and thyroid. So we have been in the business of, of hormone replacement therapy for diabetics, for thyroid, and for sex hormones for a long time on that part. Those are bioidentical hormone replacement therapies. So yes, they're made in a lab, but they are meant to work the exact same way. And you know, like my, 5-year-old nephew is type 1 diabetic. It means for him that we keep him alive, 'cause he can get that insulin, right? Or somebody needs estrogen, and it might not be that they have no estrogen. It might be that we need to boost up a little estrogen or a little testosterone, and so we use some of it. But being bioidentical means that it actually comes in and it works exactly the way that the body's own works. The difference with these hormone, with these weight health hormone replacements, which is what semaglutide and tirzepatide are, is that they are biosimilar. So let's use that. Biosimilar means when the body receives them, so we, we take an injection or we take a pill and the body receives it, it goes right to the receptor sites, which we now know, thanks to these medications, are all throughout our body, not just, um, dealing with blood sugar and in the brain for satiety. So it goes to the receptor sites, it circumvents all of your own work. Like it, it doesn't need to be digested, it doesn't need to be deployed, it doesn't need to wait for a signal. It just goes there, right? So it's going to go there and then it is going to work exactly like your body's. So the dissimilarity is it goes right there. It doesn't require signaling to be secreted and, you know, all of that stuff. The other dissimilarity is the ones in our body stay on for about 2 to 5 minutes. 2 to 5 minutes. These stay on for— the first ones were 24 hours for a day, and now these are 24/7, and they're even looking at ones to extend longer than that. So think about if you had a motion detector outside in front of your door in case somebody walked by, right? And it sets off a bell on that part. So think about your electrical bill. If that just happened 2 to 5 minutes, maybe like a couple times in the day, the light was on for what, like a total of 30 minutes. So you pay for electricity. These, the light is on for like you went on vacation and you left a light on in your house. That's gonna be like, you know, a lot of hours on that part and, and a higher electrical bill. What we're seeing when you're on the medication is the body is paying the cost of a higher electrical bill. It's getting— there are a ton of pros, but one of the considerations is this is going to stay on much longer. The pro is, for many of us, 2 to 5 minutes isn't enough because unlike in a pre-industrialized society, we are actually dealing with motion detector issues almost 24/7. We have things coming up on our social media, or, you know, we're driving by potential food choices, or our, you know, our memories of things, or smells of things, or, you know, just all of this messaging. So that's happening all during the day. So we probably need something more than 2 to 5 minutes. So that's where that is advantageous. On the flip side, if you stay metabolically active, you're not in rest and digest, your body isn't relaxing. So I have patients who are— have fatigue. I have patients who their heart rate variability, a marker of how are they in that rest and digest or not, that's going lower. I have people where they don't even have the energy to exercise, and that means wrong dose. And also their total nutrition is not being optimized to address to guess how this medication, you know, actually works.

Is the energy— is the low energy because they're not eating enough?

Those people probably aren't eating enough. So, first of all, it could be. Like, so some people are so suppressing their appetite that they literally aren't eating all day.

Which just says this is the wrong dose.

It's the wrong dose, definitely. Or they also haven't been— gone over a plan where it's like, even at a low— like, even at the right dose, we might have to not rely on your hunger cues. We might actually have to be a little bit like, for the first time in your life, you might not be hungry, but I need you to eat every 3 hours. So I have some people where they have an alarm that goes off and it's like, okay, or they know those set timings for a while. It's kind of like retraining the body on that part, you know? So I think in that way, that's key. But we have to recognize that fatigue happens for 2 other reasons. The body is on all the time. It's pushing insulin, it's pushing leptin and ghrelin. It's telling the body to go do this. We need to help it, you know, be turned off a little bit. The other part is it's delaying gastric emptying. So gastric emptying, you know, when you have these hormones go on, might be activate— delayed for like an hour. When you delay it for a much longer period of time, you're affecting your entire microbiome. It might mean that the salmon that you ate is not getting where your body needs it for like 3 or 4 hours. So your fatigue is not that you're not eating, it's that it's not getting there in time. Or it might be that suddenly like you're not breaking it down. So maybe we need to add digestive enzymes, or maybe we need the first 2 days of your medication for you to get it in a liquid form, like maybe, You know, your protein drink I love because we get all the amino acids in there. We can, you know, get things from bone broth, you know, and do different things. And so, like, those are the considerations in there. It's also not what a doctor is going to recommend. Like, I am sitting here as a dietitian who's been practicing this way for 25 years. Like, when we think about the medications, another pro and consideration is who's the right user of the medication. And a dietitian who has the right training, or a nutritionist, I should say, like a qualified nutritionist, is going to come in and help somebody personalize how to use the medication and then say to the doctor, you know, based on what we're seeing, let's change the dose, or let's, you know, adjust some of this. So I think there's a systemic issue there too.

This really lends itself when you look at GLP-1s. To me, I think before you get on a GLP-1, you should be working with a dietitian or nutritionist and working with a trainer. You've got to get those pieces in place. Yes. And then you start dosing it lowest dose. Just get to the point where you're getting these, like, if that That would be my perfect world. I worry, and I just pinged our buddy Dr. Tina about this, 'cause I was like, would it be that GLP-1s would create SIBO?

We all wish in that like perfect world that we could actually like see the patient beforehand, right? That never happens to me. If you're listening to this and you're on one, you absolutely have to step into the space where you're like, hold on a second. Even if the place, I think that I'm like so stoked because the place that I'm buying it from makes the dietitian optional. It cannot be optional for you. I also recognize that Everybody's trained the way that I am. I also wrote a book so that like hopefully, you know, there's a playbook on that part. So that's number one on that piece. The thing to understand about the medication is it will exacerbate any underlying weight health dysfunction, any underlying weight health dysfunction. So if you had underlying digestive issues, it is going to exacerbate it. Absolutely. If you— will it create them? Very likely. Like very likely. And especially as we go up on those higher doses. So when we talk about SIBO, we talk about IBS, when we talk about a variety of different things, let's think about about 3 things. If I already have some digestive issues, it is going to make those worse. Now, I can work on those issues while I am on the GLP-1 agonist, and especially on that lower dose. I thought where you were gonna go is, Tina and I were texting one day because I was like, I think we've lost the battle. We've absolutely lost the battle. I was like, you use the term microdose. I learned about microdosing from her. You had us on a panel. I was like, this is your brilliance on that piece. And suddenly it was published. And I said, you know, from a marketing standpoint, point now microdose is being the term for low dose. So when somebody says microdosing, they mean low dose. A microdose is not actually going— per Tina, and I 100% agree with her— that's not what you use for weight composition. Like, that's where you're, you know, using something very targeted. But the interesting thing about the SIBO piece that I also don't think is getting enough attention is, of course we're going to have microbiome alterations because I just told you that the medication circumvents your own body's system for turning these weight-health hormones on. So the process exists there, but it's kind of like the gut is frozen. Like, it, it doesn't need to do it. The receptor sites are satisfied. So your brain might send a message down there, but what's Akromancia doing? Do we need butyrate? Like, all these other things. We know you absolutely do. And we especially know if you ever wanna be able to come off of, or if you want to, you know, be at a lower dose, et cetera. When you're on these medications, they are suppressing at best, They're suppressing your own body's weight-health hormones. At worst, they're fully turning them off. So it would be kind of like if I said to somebody who is on a proton inhibitor that's totally suppressing acid, or someone who's on a statin medication that's interfering with the formation of cholesterol, nothing else is gonna happen in your body. Are you kidding? We know that, like, if you're on a statin, your testosterone's gonna go lower. We know your CoQ10's gonna be an issue. The plaque formation in the endothelial glycocalyx in your blood vessels that's not gonna improve just because you're on the statin, right? And so this is the exact same for this medication, but because this is a weight-related medication, the bias isn't having that conversation. The blame goes either to the medication or it goes on the person who's using it.

So you, you mentioned something, and I'm assuming in the book.

Yeah.

Do you talk about how if someone wants to come off of these? Yeah. Even if it's just now, instead of shutting off your body's production, you're overproducing these and you get used to the overproduction and not having to worry about food cravings. Do you believe that people can come off of these successfully? Because I know that's one of the other arguments, which I've always found a little ridiculous, to be honest, because they'll say, "You might need to be on these for life." I go, "Well, if you were on this and you got off your blood pressure medication, your statin medication, all these other, your diabetic medication, you lost the weight, but you had to be on this for life, you're on one thing versus five things." I don't know, I call it a win.

Oh my gosh, so many of my patients are going off so many other medications. So I love that you said, and let's be clear, if you have any, any physiologic or psychological benefit on this medication, you've actually proven my thesis. You had suboptimal functioning of your own in that part. And it is not a question of suppression. So there's actually research on liraglutide. Nobody has done it on semaglutide or tirzepatide to say that it turns off or that it suppresses your own, but we have that from liraglutide. So I know that it suppresses your own because when a receptor site is satisfied, your body doesn't call up on it. So it may mean that they're just sitting there like, and they're hanging out and they're like, Anytime you call us action, it's totally cool. But like, nobody's calling us, you know, on that part. So when we look at that, then the question is, do we need to come off of it? And there's tremendous weight bias that's suggesting that the finish line for any of those fat people, and I say that with fat in quotes and with a lot of sarcasm, for that fat or obese person or that diabetic, like, you'll be a success when you come off this medication. You need to go on this medication to learn how to do all those things you don't know how to do. Let us tell you all about that.

Which I can tell you anyone who struggles with weight knows more about dieting than anyone.

Compliant patient. I mean, literally, like, I challenge somebody to tell me that they have gone as— I mean, unless you've done a 7-day goat's milk cleanse, I don't know if anyone's done as many different things, but we are not non-compliant. And I think, you know, when you look at that and you come over to that side and you say, is the destination you coming off the medication? It does not need to be, especially if, to your point, it's helping you do all these other things on that part, right? It's enabling you to come off other medications. It's enabling So number one, I don't wanna set the goalpost there. Now, there's a very real issue. That's a budgeting issue. That's an access issue. Maybe my insurance takes it away from me. Maybe I don't have the money to stay on it for however long. And I have those conversations. It's another reason why places that are just offering a prescription to these, or doctors that are just scripting it and not having the bigger budgeting conversation, is a problem. You need a coach or a dietitian to have this, because if I know that somebody only thinks they have a budget for a year of my services and of the medication, we're going to work on their dosing in a very different way, and we're also gonna work on their timeframe in a different way. So can you come off of it? Absolutely no, never, if you don't change anything underlying. And that is the same for every single medication that's out there. Or like, that would be like me being like, JJ, I rocked it. I finally figured out how I can do like 3 pull-ups, which that's my goal right now. I'm working on the 3 pull-ups. And then it's like, okay, and then if I get to those 3 pull-ups and then I stop strength training and 10 years from now I'm wondering why I can't do 3 pull-ups, like, No, you gotta do the work, right? Like, we've gotta keep doing it. So you have to stay on it if we don't fix what's underneath. The question mark is, can we optimize what's underneath? Yes. And no practitioner ever should say to you, 'cause we don't have a crystal ball, that you will be able to come off of it and you will be able to stay off of it in your life. If they're doing that, they're selling something other than you and having healthy outcomes. What I will say to someone is, I have worked with patients on it, I have worked with patients having them come off of it. I had a woman, I share her story in the book, where she came to me having been on the medication lost 60 pounds and said, my doctor recommended you, I'm ready to come off of it. I did my weight health hormone assessment, which is in the book and online, and I went through it with her and I said, you are not. I was like, you've lost muscle, you've lost bone. We also don't have this, this, and this in place, but I think we can get that in place over the course of the next 6 months. So we worked on that, and during that time period, we weaned her. So we kept her on the same dose and we extended the dose. I then brought in Amerisade, Calocurb, because when, when she started to have some of the food noise and the cravings come back, we used that to extend it, and she did beautifully. Then And then she ghosted me and then I didn't hear from her. And what happened, what was great in that part is I was working with her and I was working with her therapist and her doctor and we signed something and it's like, if you wanna ghost me or you don't wanna work with me, cuz maybe you don't like me anymore and you wanna go work, whatever happens, you don't have money, any of that stuff. And that's what had happened. She felt bad reaching out to me. She was going through a custody battle, um, that had, you know, the divorce had been where she had put the weight on and now the custody battle was, uh, and, and it was a real financial issue and she didn't feel like she could afford me. She went to her therapist and the therapist came back to me and said she's gained 8 pounds and she feels like a failure. She feels like she had finally gotten to the place where she was off this. I said, first of all, you are not a failure. 8 pounds, we're in good shape. If you had come back to me at 60 pounds of regain, I would have been really upset. But I, I said, don't pay me. What I want your therapist and your doctor to do— we have all the tools that are there, I've given you the plan— let's go back on the medication, let's go back to the weaning schedule. She went back on it another 6 months. She actually was at half the dose because she continued using the Calocurb, and we had tuned up her digestion and these things. Things. She leaned into it, and after that she came off of it. But she does something really funny right now, which is she keeps the medication in the refrigerator. And she said, my identity is not about me being on or off a medication. And what I want you to hear in that, and for any of us, and what I take away from it, was that at the moment in my life when that little boy hit me, I suddenly saw my belly as a weakness, and I wanted to be strong. And when I became weak, I felt disempowered. And that disempowerment just became this snowball that really visibly was my belly every time I tried a diet and it didn't last on that part. We feel so disempowered, and our patients feel so disempowered. And if you use a medication wrong, you're going to contribute to that disempowerment. In this case, this woman is now so empowered through her entire weight health journey, you know, on that part, and she feels like, okay, if I ever need this again, no issue. On the flip side, I have a patient that came to me and was adamant, I don't want to use a GLP-1 Protagonist, 42 years old. We worked with her, we helped her. 90 days, she was— had pretty much lost the fat that she needed to, and then another 120 days, and she was doing beautifully. And she said to me now, like, I'm great, like, I'm all good. And I said, so I kind of thought I was all good from 30 to about 48, and then my belly showed up. Um, my belly showed up. I was traumatized. I had read Mindy Peltz's book. I was doing Fasting Like a Girl, shorter and shorter periods of eating. I was drinking coffee and not eating. All my intake was down. I was training for an endurance event doing zone 2 and no strength training. JJ, I was Yes, I blew up. I did not know you yet. I had 20 pounds on myself. And you know, on that part, and it turned out I also had a massive fibroid. My uterus was like 5 times the size. And I am so grateful, you know, for that intervention. And people always ask me like, what's your journey? You know, and all of this other stuff. I had somebody very bluntly be like, are you on a GLP-1 agonist? As if like I'm gonna be snotty about, you know, whatever. And I was like, first of all, like nobody ever has to say, you know, on, on that piece. But, um, because I wrote a book and I'm very open about my public story in there, I do think I have to say to say. At 48, I didn't decide. But when I had done the endurance event, I then came round and I had gained 20 pounds of fat and had climbed— had basically done an Everesting event because I had not eaten all this other stuff. My cortisol was a mess, my labs were a mess, all of that. And I met our friend Dr. Tammy, and I was like, Tammy, like, I'm so— I'm writing this book, I'm doing all this other stuff. She's like, well, why don't you try an agonist? And lo and behold, I looked at myself and I I have weight health bias. I was like, I think that that would be like me failing. That is so crazy. Like, I shouldn't need to like go on it or whatever. I went on Semaglutide. I used the low dose. Um, at the lowest dose I was constipated and I will never allow myself to be constipated. I tried everything under the sun. I was on it for about 3 months. I lost about 15 pounds of fat. I was back in the gym. I was doing my strength training. I finally got healthcare again and I went to someone and she's like, you need a hysterectomy. And so I ended up coming off the medication and not using the, the agonist and having my hysterectomy. Me and doing all of this stuff. I'm 52. My hormones are still like, you know, going around because now I've had a hysterectomy and I've been off the medication since. So I used it maybe for about like 4 months. It's sitting in my fridge because as estrogen and everything else goes away, like, and, you know, I'm out on book tour and everything else, if I need that tool ever again— and I will say, the day that I first injected myself with that medication, I turned around and I go, you know what, I don't believe in the word normal. Normal, but I actually think this is what a normal person's brain is with food. It was an overnight difference for what it calmed in my brain, which is my 8-year-old brain. And when I look at my genetics, my predisposition for obesity, my predisposition for leptin resistance, you know, for some of these other pieces. So what I will say on that part is like, I am a walking example, but I'm not going to tell anyone that I'm never going to use this again. Um, but I feel like, you know what, for me to use it in that time period and to feel empowered and to say like, I mean, I think I've accessed like every tool under the sun. Run, this is a game changer in that space. Um, but it also has to be used properly because I was not going to be somebody who was going to fit into a pair of clothes and have either SIBOs come on or have— be constipated, you know, all the time. So I think it's really important to recognize that this is a tool like anything else is a tool, and how do we use it?

Yeah, I love that. Yeah, it is a tool.

I don't know if I've talked about that with anyone. Even better with the book. It's like, on that part, I'm All right, yeah, there we go. Yeah, it was a very short question of, hey, do you think people can come off of it? I think we have to change that that's not the destination. I think that people can achieve their weight health, and it is an ongoing optimization effort when you optimize weight, health, hormones. How you do that, GLP-1 shot or not.

And there's Calocurb.

Yes.

And, you know, so many things.

And your book to help them.

Yes. Your Best Shot.

Thank you.

Out now. Amazon, everywhere else.

Everywhere.

So grab it. Thank you for writing that. Thank you for being vulnerable.

I appreciate it.

And I'm just glad you're in Thank you, same. That was an amazing interview, and I just wanna make sure that you know we have some great resources for you. I'm gonna put them all at jjvirgin.com/yourbestshot for Ashley's book, and we will put in there Ashley's book, some of her bonus materials, and also some information on our buddies' CalaCurb product that has been found to boost GLP-1 as well. So lots of great resources there. Make sure you check it out and grab the book. It's a definite for your success library.