GLP-1s: Miracle, Menace, or Misunderstood?

Joining us today for his second time on the Synergy podcast is the Jim Laval, a globally recognized clinical pharmacist, board certified nutritionist, and a pioneer in integrative and precision health. With over 35 years of experience, Jim has helped everyone from elite athletes to everyday individuals optimize their health through personalized metabolic solutions. He's an acclaimed author, editor, and the mastermind behind the Metabolic Code, a system that transforms how we understand and manage our health. Get ready for a fascinating conversation on unlocking your body's full potential. So grab a pen, lean in and enjoy today's episode.

Welcome back, Synergy listeners. We are so excited to be back in studio with one of our favorites, Jim Laval. We had Jim on in earlier this year, earlier 2024. We aired that episode March 20, 2020. If you have not listened to it, even if you have listened to it, I'm going to challenge you to go back and listen to it again because that discussion was so deep and rich and wide. I've listened to it again and I've learned from it. He also shares his story on that episode. And I think it's really important when you're listening to information that you know where that information comes from. And we just love this guy. We have been following him since 2009. He's been an educator and a mentor to us. We read his work, we anchor a lot of our practices based on the philosophies that he's taught us. So we, we feel like we're standing on the shoulders of a giant here. And we're just so excited that he's generous with his time and he's back with us today.

It's great. I'm glad we're just doing this audio because people see how gray my hair is.

Actually this one's going to be video. Dr.

This is going to be video. So they're going to see it.

Oh, I guess I'm glad I combed my hair.

I love it. It actually looks really good today. I was going to tell you. You must have just had it cut.

Yeah, yeah. Well, you know, my wife is, was an esthetician and stylist before she became a dietitian. So I've got an in home stylist. So it ends up working out pretty good for me.

Well, that explains everything. You're always looking so sharp.

Well, you know, that's, I think that's her requirement, so.

True. Well, we just want to dig in today and kind of do a follow up to where we were before. And I think just starting out with, you know, talking about GLP1s, because that is such a hot topic right now, Semaglutide and all of those that are out there and kind of really digging into the question I just want to poke around at, is it really a miracle, a menace? Is it neither one of the two, like where what has evolved and what have you seen in your practice since we last talked?

Well, I think it's both. I think it is a miracle and I think it can be a menace. So, you know, it's a menace when all you do is you inject the GLP one and you don't change your lifestyle. You're absolutely going to be dependent on it forever. If you're not. If you're a type 2 diabetic, that's a whole different story. If we're talking about it for weight loss, that's a different story. People should be able to utilize that as a tool and then change the way they're living in order to really overcome their insulin resistance. Right. Because a lot of things happen when you're insulin resistant. So, you know, you do want to exercise, you do want to eat better, you have to dramatically increase. If you looked at the recent article that just published on retention of lean mass, I'm just going to post something on that on Instagram here today or tomorrow, and it basically showed you got to eat protein at 1.3 to 1.6 grams per kilogram in order to maintain lean mass. And that's just where you start. So, you know, I think they're an incredible innovation. And I always go back and talk about the fact that when insulin was invented, it saved lives. I think GLP1s are saving lives for a different reason, that it supports the pancreas. Right? Because, you know, you've got insulin core to, you know, the beta cells releasing that, then you've got these incretin hormones that if they're not working and people that have gained weight have become insulin resistant and they just keep pumping out glucagon and storing fat. They can't get to that fat and they can't burn that fat. So instead of insulin being an acute life saving agent, now we've got peptide, the GLP1s and the GLP1 mixed, you know, agonists, you know, that are what I say, saving a chronic life. Meaning that, you know, we're reducing the problems related to, to kidney issues, cardiac remodeling, all the other, you know, potentially Alzheimer's. Right. All the things that we're seeing, the benefits may be so I do think that they're another great tool that's been invented, but at the same time, I think they're being misused.

Yeah, 100%.

We couldn't agree with you more.

So I want to frame for our audience because the scope of the problem that you just mentioned with inflammation driving all of those chronic disease states, you know, that starts somewhere. And I think that people don't. They know they're overweight, they know they have low energy, but they don't really respect what got them there in the first place. And then even if we use a GLP1 to correct the weight, if we don't correct that tsunami effect of chronic stress, then what have we really done? One of the things that you said last time that we met, that really shook me because we were talking about all of the things that contribute to that meta inflammation, and I expected you to say the biggest was lack of movement. Movement because we're such a sedentary lifestyle now. And lack of movement is now the smoking of, you know, the past. And you said, no, you said it's upregulation of the autonomic nervous system and being stuck in fight or flight. So I kind of want to frame that out too, as part of this discussion. Like, how does that start? And then what is the cascade of things that happen physiologically that leads us to being overweight and insulin resistant and. And eventually diabetic cancer, type 3 diabetes and autoimmunity. Yes, and autoimmune.

Yeah, and more.

And more. Yes, and more.

Yeah. So, you know, obviously you want to look at root causes, because I don't believe there's a root cause.

Right.

Environmental burden's a big deal. You got to realize that I do agree with you. People need to move more, but they need to move more in a way that it's conducive to their health. A lot of people now are actually, I think, either over training or what we like to term it, you know, lifetime being their chief science officer. Now they're under recovered.

Yes.

You know, they don't, you know, they're not sleeping right. And I'm going to go back stress for me, when I look at most people, they're, they're just stuck in fight or flight. They're not getting enough sleep, their heart rate's too high, their blood pressure's trending high. And what that sets up, it's very simple. As you get under chronic stress and you start to flatten out your cortisol curve. And what that means is you're staying in Fight or flight. You're releasing too much cortisol throughout the day, and you lose the diurnal pattern of cortisol, where you're supposed to release cortisol in the morning at a fair amount, and it's supposed to drop at noon and drop again in the evening, and then drop the nothing at bedtime to signal melatonin release and to activate the master slave clock known as the super chiasmatic nucleus in your brain that then regulates every other organ in your body, including the beta cells of the pancreas, for how you're going to use insulin the next day. So the very first thing that happens, it's a simple lever mechanism, cortisol goes up. Insulin will go up because cortisol's telling your body, keep glucose in the bloodstream because a tiger is coming to fight you. So your glucose goes up and your insulin goes up. Now, at the same time that's going on as it's carrying through. Over time, you start to lose thyroid function. So you're not. You're not making energy as efficiently. You're not burning fat as efficiently, you're not detoxing as efficiently. There are a lot of processes that go on with thyroid, but the net net of it is, is as the cortisol goes up and the insulin goes up, glucagon inhibition goes down so that you don't have incretin hormone release. And the incretin hormones are helping you to access your fat and utilize glucose appropriately. So when your brain gets stimulated, I'm under all this stress, what I'm setting my body up for storing fat and not burning it. And then there's downstream effects, right? Because as your insulin goes up, you make more adrenaline and more noradrenaline. That starts to create, you know, a tightening of your blood vessels. So now you're getting reduced blood flow to the kidneys. You start to gain visceral fat. When you gain visceral fat, you make this compound called angiotensinogen in your visceral fat, and that makes your. What's called your intimal medial thickness increase. So the vessels get stiffer. And then your muscle starts to thicken as well, which then compresses the blood vessels as well. And so it really sets up a tremendous cascading effect where you gain weight really well. Because when you store visceral fat, it's releasing so many, what's called adipokines or basically cytokines and other compounds that are moving against your homeostasis in your health and all of that. Cascading effect is why we've got 50% of the population that's either insulin resistant or a diabetic. And well over 70% of the population is overweight. And I also think it's why we created the tsunami effect of people desperately reaching out to get GLP1s any way they could, because they tried diet, they tried exercise and they didn't lose a pound.

Right.

I'm glad you laid it out that way, because I think the point in everything that you said is a lot of these metabolic functions are going on underneath the current. We're not paying attention to what's going on with the body, and it shows up as weight gain. And we're so focused on the weight gain that we can't see the forest for the trees. We can't see what all has happened in a very systematic way within the body as the body's trying to keep you alive.

Right.

It's trying to be more efficient.

Right.

But it's leading us down that pathway of chronic disease states. And weight gain is just a side effect or it's actually just a symptom of a bigger problem.

Absolutely. And look, I have people that are fairly lean that have trouble with their, their blood sugars. Right. I mean, there's some really cool studies coming out showing people that have trained a lot in their life actually have increased risk of type 2 diabetes in their later years. And that makes a lot of sense to me because when you train a lot, you release a lot of cortisol. That's why it's so important to understand if you're going to engage in exercise. Well, what kind of exercise? How much do I exercise? What type of exercise is right for me, for where my metabolism is right now? Right. Because, you know, I think what happens is, like, I got to lose weight. I'm going to join a boot camp.

Yeah.

I got to get up at 5:00am that means I got to get up at 4:00am for the 5:00am class. And now, you know, the wheels are just coming off the cart. Right. So I think what I've come to the last year, what I've really come to the conclusion of is it's every bit as important for me to counsel people on lifestyle.

Yes.

How do you really get a lifestyle that's going to promote health and longevity? You know, we're not living in Sardinia, we're not living in Icarus, Greece, we're not living in Okinawa, Japan. You know, the blue zones are fantastic. Unfortunately, we're swimming upstream here in the U.S. i mean, right. We've got, you know, texts and emails and all kinds of bright signs everywhere, you know, and then, you know, our food quality is not what it should be. And you know, we got all these things that we have to work against and unpack before we even get to thinking about how folks live a centurion life. Right. We want to get them into their 80s right now feeling great.

Yep.

I mean, and in some respects, I think about many of the people that I know that have started GLP1s and they've had really favorable effects on body fat, right? Favorable, sure. On other things as well. But my concern is again, is if we don't target these other underlying things, if we don't help them understand that they are not necessarily better off long term.

Yeah, no, I totally agree with you on that. And that's been my passion. We're developing a massive program for GLP1s that we're releasing. Lifetime's got two and a half million lives that we can touch. Right. And I'm sure we're not going to get that many of them, but if we can get 100,000 lives and show the impact of diet and lifestyle and mindfulness, in addition to other things you take with the GLP1 in order to enhance the retention of lean mass. Because muscle's the currency of aging. Right. We heard that over and over again you want to retain that lean mass. And the big thing they found out in the human studies is that when you, when you do a GLP1, you're going to lose about 30%, up to 40% of your of your weight and lean mass. Pretty equivalent to a medical induced diet. Right. That's the baseline if you're not doing anything other than injecting that GLP1. And I do think there's also room for titration of GLP1s, you know, using less. So therefore you're, you know, these incretin hormones that are affecting the, you know, pancreas. You don't have such a dramatic effect with high dosing in terms of when you try to titrate somebody off. Because that's one of the big things we hear. Right. I get off of it. My weight came back. I'm not so happy there. And the reality is they can take control of all of that.

Yes. And that's actually what we found as well, and I'm glad you brought that up, is not only titrating, but even splitting doses and microdosing, you know, splitting into two doses a week or three doses a week versus one Dose a week. Like are you using some of those strategies? Have you seen benefit to any of that yet or.

No, I haven't done the split dosing because the kinetics of it are such that it was six day, you know, a six day, you know, life, you know, you just have to have really close, you know, I would say, you know, really looking at that patient and really seeing what's going on with them, I can understand how it may be favorable. I haven't done that. What we've been doing currently is a couple of different strategies. One is using, you know, a titration, stopping at the dose where you're losing weight. Don't lose more than two to four pounds a week, don't put the pressure on your gallbladder, right in your liver and reduce the side effects. So titration and then as you're achieving your goal weight, reverse titration. Because you started at such a lower dose, you have that opportunity with changing lifestyle, managing stress, looking at intoxication, like look at hormones, right? You know, sex hormones and every other hormone and make sure you got all that moving right direction. And then I also combine using callocurb with it, which is of course the GLP one, that's from hops out of New Zealand. That's a natural incretin compound that releases, allows release of the, the incretin hormones for like four to six hours instead of doing it for days. So I've been combining more, trying to use that as I'm moving people off. But you know, I know practitioners have been out there doing, you know, either the micro dose or doing twice a week dosing at a lower rate, you know, lower dosage. I'm sure that it's effective. You guys are doing it. I'm sure that you're seeing some nice results.

Well, I think, you know, one of the things that we've been working on is monitoring other biomarkers besides lean body mass. I mean, I think that we all know that we've had to really look at lean body mass, but we're seeing changes like elevated in heart rate elevations and heart rates rate, heart rate variability dropping. And so looking at those and kind of trying some of these things to see if it benefits in that way.

Yeah, I do think it's like one of the side effects that you see with it. Right. And you see changes in hrv. And the one thing I'd encourage people to do is get something really good to measure your hrv. I currently am wearing three different devices to measure my HRV to Figure it out. And it's kind of funny, you know, and so that's what happens when you're in that chief science officer position. I got to look at all this stuff. And so when I look at it, I go, oh, you know what? You probably. If you want a really accurate heart rate, you probably need to wear a strap. If you want an hrv, that's really good. I'm wearing this right now. This is ultra human. This isn't an aura. It's ultra human. And it's kind of in between this, which I think does a terrible job on hrv and this, which does a decent job on hrv. And then, hold on, guys, this. The Morpheus, which does a tremendous job on hrv. But, you know, so I think that looking for those issues, I think are important and managing that. And I think also looking at things like, what's your lipid particle number? What's your APOB doing? What, you know, where are these advanced markers which we know the GLP1s help.

Right.

You know, what's happening with that as well. So I haven't had. I've had more issues on people taking something like Tessa Fentany for their weight loss, which I think is a great compounded drug that tends to really, in general, raise heart rate pretty consistently. A little more inconsistent on it, doing it in, you know, with the GLP1s. But that's why at lifetime, we're collecting all this data. You know, we're going to collect data, you know, we'll quickly have a thousand lives that we're going to be able to process data on and go, okay, what's really happening, you know, when you change exercise, change diet, you're checking in with a dietitian, you're checking in with a trainer, you're on a GLP1, maybe you're using sermorelin with it in order to maintain lean mass, or maybe you're just using creatine for that aspect of it. What are the real variables that create the optimal approach to using a GLP one for all the benefits and none of the risk.

Yeah. That combination approach, it's not just about the injection. It's about.

Yeah. I think your point about it not just being about the lean mass is super important. I mean, where's the nervous system going? Where is the blood pressure going? Do we see changes? Is that, you know, all these. The changes that are, you know, reported in the studies. Great. But studies are always shorter term. We want to look at over the long term. Right. So that I. It. It's really. We're in such an infancy with this.

So one of the things that you mentioned last time is a possibility when you start seeing someone's heart rate go up and heart rate variability drop beyond stress with the GLP1s is low magnesium. And, you know, I checked red blood cell magnesium on patients, and I thought I was doing a really good job of getting them repleted. But after that topic came up, it caused me to kind of dig in a little bit more and make sure we're repeating those tests and make sure that what we have them on is actually adequate. And I have to say, repleting magnesium has been a big deal for several of those patients that we were seeing that trend emerge with elevated heart rate, low heart rate variability, that we just couldn't get to come up in any other way. So never underestimate the power of those minerals, too, especially magnesium.

100%. Absolutely. Key importance. I rarely see someone with a good RBC mag. Now nobody's up at 5, 6 to 6. 2. Everybody's down in the fours or the low fives. And, you know, magnesium's critical, and it's critical in a lot of ways. One, yeah. And parasympathetic tone and managing that HRV along with phospholipids. Right. I mean, the. The whole thing of using phosphatidylcholine, or complexes of the. Of the phospholipids are important for that, you know, but magnesium is even involved in insulin regulation and glucose. Right. So, you know, all. All of that. It's so important. And, you know, one of the issues that I think we deal with is that, you know, we've got this problem of people malabsorbing. Right. So a lot of times you're giving them magnesium and you're still not seeing the numbers come up. And that's a core problem for people that are insulin resistant and or diabetic because their lipopolysaccharide levels are elevated. And that's going to, by default, trigger inflammation and start to create a sloppy, you know, tight junction between your epithelial cells of your gut. And now you're not absorbing things the way you should.

Yeah. When I find when patients first come in for a program at our clinics, nine times out of 10, they need a gut protocol, regardless of what their point of entry, whether it's hormonal, whether it's fatigue, whether it's weight gain. Most of the time, working on that gut integrity is so important. Like, that's one of the steps that we'll go through with patients is making sure that we correct that gut microbiome as much as we can, that we get those lipopolysaccharides down. And that can be measured in blood that's easily measurable. But to your point, because of chronic stress, that permeability in the gut lining is there, and it's allowing those lipopolysaccharides to wreak havoc on the immune system and create inflammation.

And it very well can be also why you get the brain issues. Right. Because LPS crosses the blood brain barrier, and as that goes up, your glial cells start firing off in the immune system and kind of that thought process moving through, like, why do people with diabetes have more dementia?

Right, right.

It's because as that lipopolysaccharides going up, you've got to make a compound called galectin 3, which is another marker that I. I look at. And that Galectin 3 is what's wreaking havoc across those neurons. Right. And causing all the damage.

Yeah. I'm glad you mentioned Galactin 3, because we're measuring that. So what's your goal for Galactin 3? What. What's the target?

Love it. In the teens.

Okay.

Yeah, if I can get it in the teens, I'm good. I mean, 22 is kind of the marker at the high end of normal. There's another Galectin three, you know, that's used in research as a, as a marker, which is a little more accurate, but it's just not commercially available. But, you know, when you got somebody in the 20s with their collectin 3, you know, they're just, they're a hot mess. Right. They're just triggering inflammation, and they're. They're going to be melting their brain down. They're going to start creating problems with those neurons, and, you know it. Once again, you know, if people listen to my first talk with you guys, you know, I got a rich family history of diabetes, and it's a real important, you know, topic for me. And, and, you know, people don't realize, look, these damages are just occurring over time, and they're slow to, to kind of hit, but when they hit, it's like falling off the end of the Grand Canyon. Right? I mean, you're not, you know, it's like, oh, my gosh, now I'm really struggling with my memory and, man, my weight and my kidneys. And, you know, look at all these folks with this insulin resistance issue. Their kidney filtration is terrible.

But Ultimately, we're dealing with a population that in many cases don't even know that they have it because the wrong tests have been done for so long.

Right.

Typical traditional medicines, looking at just a standard fasting, you know, glucose, or they're doing an A1C and they're like, oh, I'm good. Not realizing that variability has a lot to do with it too. We're talking about complicated situations and economically, I kind of want to go back to the economics of all of this is because economically the GLP1s are not inexpensive. They're not. And most people are not getting them covered. And then on top of it now we're asking them to do foundational work, gut protocol, you know, getting testing done. And you know, they're just like, I mean, I hate to say it, but you know, quick fix, you know, I just want, can't you just give me the GLP1? And they're migrating to those clinics out there that are just doing that, not realizing they're killing themselves in that. It's so hard for me, someone that genuinely cares for people, to get them to understand, yes, it's expensive, but being sick is expensive too.

Well, and it's expensive, but what's the long term benefit? Right? So when you're not managing this correctly, I mean, you can look forward to 12 less years of life. I mean, and it's going to be chronic illness all along the way. I mean, you're going to be managing, going to dialysis, eventually you're going to be managing that memory loss, peripheral vascular disease. That's just if we're talking about the light stuff, right? And then, you know, so, you know, it's interesting what I've, I think I found I've had to do is ease people in and give them the things that are essential to the success of the GLP1. So they use a GLP1 and they titrate. Maybe we're giving them something to help their lean mass and help. Something to help the liver gallbladder so that we're not worrying about the gallstone effect. And then is it stress? Like give them something that helps with stress and maybe it's a probiotic because they're all, it's a mess in terms of their microbiome. And then as they start to lose weight and feel better, they're way more, I think they're way more open to spending money on their health. When I find, when I give them too much to do, you know, it's that old story. There's two kinds of people, you know what I call Spartans. And then there's the everyday folk, right? And you know, Spartans are people like me where if I come to your guys clinic and I go, hey, Laurie, you know, what's your plan for me? And you give me 10 things to do, the first question out of my mouth is going to be, why 12? I can do 12. I want 12. I mean, because I can do 10 in my sleep, okay? And. But for a lot of people just asking them to eat because the very first thing that happens is they don't eat enough. And getting them to eat responsibly while they're doing a GLP one is core. I mean, you don't get enough protein and you're in trouble. And you know what, looking at a 12 ounce New York strip isn't going to be the answer because they're just going, oh, so you know, how do we create efficacy and adherence on that? And then the next thing is, is how do we get you to move? You know, because you're. If you're really not active, how are we getting you to move? And then, you know, those don't cost anything. You got to eat and movement's free. You know, don't take your golf cart to the end of the driveway to get your mail anymore. Try, try walking. It might be 100ft, you know, but you can do it, right? And I know I sound sarcastic and I guess I kind of am, but I, I'm passionate about people being willing to move. You know, park your car at the end of the parking lot and walk into the store if it's not bad weather, right? I mean, there's those things and then, you know, there's so much work. You guys know this. By the time somebody's insulin resistant, you got a hot mess on your hands metabolically, you're literally having to fix everything. So I find I've been trying to walk them through that journey and get them to kind of graduate into the next phase of being willing to commit. And it seems to work fairly well. I mean, I'm with you, you know, when all you do is you go in. I'll give you a good example, real life example, family member in law, very successful with titrated tirzepatide. She finds out she can get it covered by her insurance. She gets her insurance to pay for branded manjaro. But the dosing is no longer titrated. She does the bigger dose and now she's hypo. She was hypoglycemic and it was a problem for her, right? And so I, I think there's a lot of layers to this and I think people that end up failing with GLP1s, they go, Man, I stayed on it. I can't afford it anymore. I got off of it, I gave my weight back. They're probably more prone to listen to how maybe it can work with a more comprehensive plan, you know, But I'm totally with you on that. It, that's why at the beginning of our talk, we said, you know, is it, is it a blessing or is it a monster? Right? I mean, which is it? And it's really both based on the application of it.

Right.

And I think we, it's going to take doing shows like this, us getting that word out about, hey, there are ways to do this so you can actually recapture your life and recapture vitality and create a path to where you feel great and you're empowered with your health and you're not just sitting there saying, well, time for my weekly injection. It's the only way I can keep my weight down, which is important, important to get the weight off. Right, but how do you empower people? That's the, that's the key.

And I think empowering other clinicians too, that are out there fighting the fight, right? Looking at the long game instead of the short game and holding each other to that. Because the economics on a practice are hard too, right? To put together a team of people that can help these individuals get to where they need to go. I mean, that's been a real struggle too. So we do have to collaboratively come together as clinicians too, to hold each other to that level of expert of doing what we need to do, really gonna make a difference and not hurt, right? Not hinder, but help.

Well, I mean, you know, the, I commend you for that because a lot of people don't end up doing that. And what I always did in my practices is looked around and said, all right, who's the trainers that I can rely on that aren't going to take a 50 year old who has an exercise and try to, you know, rip their body apart, right? You know, it's like, who's got experience, who understands the population that they're going to be working with? So, you know, finding that person and finding that, that dietitian, when somebody needs to learn how to eat and, you know, and maybe it's emotional, you know, who's the, the practitioner from that side, you know, maybe they need emdr, maybe they just need counseling or whatever. But I, but I do think, you know, it's one of the reasons, you know, when I decided to go on and because I'm busy enough, I didn't need to do it, but the opportunity to go to lifetime and be able to have diet, mindfulness, exercise, medical practitioners. So we got, you know, MD medical director, NPs with a concierge person there to really try to see what, you know, can we raise that bar of adherence and can we raise that bar of really surrounding the person with the tools that they need? Because you know, the issue, you know, they come to us and I don't know how you're doing your program, but if they're coming in once a month, you know, and they're not doing a check in, I mean they, they can get, they can stray really quick.

Right.

And so accountability is so important to help them. Right. And so I'm, you know, once again, I mean, I, I always love coming on your guys show because, you know, you, you take such a thoughtful approach to what am I doing with this person?

Yes, this person.

Right, this person. And I think that's key. I mean, when we, we taught our weight loss certification at a 4M for GLP1s, this is, this is a lot what we teach. It's, it's. Look, if, if all you want to do is, you know, and inject a GLP1, guess what? You and a million other clinics, every clinic in the world can do that. But is that, is that best for the person?

Right, right.

And you know, a lot of success stories, you know, we've all had them now. Right. But you know, I think it's so important that you understand you, you know, baseline magnesium status, super important. You know, looking at what other markers of inflammation are present, you know, you know, where are they at? I have a lot of people that, that they want to start with a GLP one. And it's, you know what, there's some other things here you need to clean up that's going to really help that, you know, so that's kind of one of the reasons that I, you know, I really try to get people to understand weight loss is a comprehensive metabolic issue. It's not a GLP1 deficiency.

Right.

Part of the problem.

Yeah.

Well, typically have them do a 16 week program before even initiating the GLP one because we really want that foundation solid.

Right.

And to me, that's where it works the best. The patients that I've taken on from other clinics that started GLP1 without that foundation, the majority of them did not do well. And some of them were actually regaining their weight on maximum dose.

Right.

That's a metabolic issue. And so it's been really fun to rehab some of those patients and really fun also for our team to see that this is why we do it the way we do it.

Right.

This is the reason why we go through the process that we go through is because we want long term success, we want sustainability, and we want them to actually be better in every way possible.

Right.

Life is going to throw us curve balls. But as much as we can control and as much as we can teach those foundational learning principles and have them embrace that, I think it's just life changing.

But taking that stand has not been easy.

No, no.

No.

But listen, that's been our stance from day one. It was our stance before GLP1s. We had a really good, solid program before we have it had access to GLP1s.

Right.

And so GLP1s became the cherry on the top, not the main course.

Right?

Yeah. And don't you think that you get less attrition because you're doing it that way? I mean, you might, it might be harder to find your people that are willing to commit, but the ones that, that see it, do it, understand it, they start to go through the process with you, they get the level of care that you're at with them and how much you're really trying to work on them. You don't lose people. That's always been kind of. I think my success and maybe secret is just when people come in, it's 100% about what's going on with them and making sure that we're addressing their needs. And our team, my docs, my dietitians, we're going to really work to do what's best for you. And yeah, your friend may have lost £40 in a month and a half. But you know what? That might not be the best way to do it if you want to be in this for the long game. Right. And the one thing I think, the one thing we didn't touch on that I think is really important, because it goes back to the stress response piece, is that cutting the food noise down is incredibly, incredibly important, you know, because when people get under stress, they're either going to go for, they're going for the hedonic urges, man. They're going for alcohol, they're going for food. Maybe if you take alcohol and food away, they go for gambling or shopping or, you know, whatever hedonic urge that's there. Right. But the reality is We've got a lot of people who have gotten themselves in this dopamine deficiency because of chronic stress.

Yes.

I think it's another thing that has to be worked on. I try to talk to people about that when they're going on a GLP1. It's like, hey, this is great that your food noise is cut down, you're not craving as much, you're not reaching for extra food. But one day when this GLP1 goes away, if you're not modifying that stress. And you know, one of the things I try to teach is just, hey, look, you might not be able to do meditation for a half hour. You may not be able to, you know, you know, do a, you know, lengthy stress program during the course of your day, but you can box, breathe for three or four minutes two, three times a day.

Yes.

You know, just unload that stress, be mindful that you've taken it on and that now you're going to let that go. And if we start to, you know, I think that part is the other reason that people are seeing some failure, because they haven't figured out that, you know, what some of your eating pattern is. Probably just the fact that you're stuck. And, you know, I need comfort food and I need a lot of it.

Right, right.

And that's where I think the GLP1s have been a miracle is just shutting that fight off that people have. Because how many times, remember pre GLP1 and for people that didn't before, first time they came into you. Right. Because we always advantage it using Laura. We're dampening their stress response. Right. We know what to do to do it. But how many times have you heard, I'm great, I was great until 4 o'. Clock.

Yes.

And then, yes. I gotta hug that lays. I gotta hug that lay's potato chip bag or, you know, I gotta see that empty row of cookies. You know, I can't have one. I'm gonna, I gotta eat that row. And, and I, I honestly, I, you know, I think it's one of the most important things that it's done for people is when you can start to get out of the food noise fight, then you can start to become more responsible. And the thing is, is, you know, the people that are on GLP1s are two times more likely to go to a gym than before they use their GLP1.

Yeah.

So there's this piece of self esteem that gets into it as well where you think of somebody who's been 40, 50, 60 pounds overweight, or more like, I got a guy, a perfect example. He's lost 122 pounds with us.

Wow.

All right. And he sold alcohol for a living. I mean, he's going into bars all day long. Right. And he wasn't an alcoholic or anything like that, but you know, basically bar food and you know, hey, try this new whiskey or whatever. And when the food noise stopped and he, you know, he got past that first 30 pounds of weight loss, for him, he's transformed over the course of 18 months where he loves going to the gym, he loves eating responsibly, he loves making the right choice now. And I think that's what it takes is when people, because look, people, they do their GLP when they lose weight, it still might not feel great. It still could be achy, they still could be foggy headed, they still could have blood pressure potentially. Usually it'll help lower it some. But the point being is, is once we can get them to that place of appreciating the absence of feeling bad, that's to me, we've won.

Yeah.

And that's why your program that you put together, even though it's an uphill battle and it's the same battle I do, I mean, you guys have heard me now for almost 20 years and I've done this work this way for 40 years.

Right.

You know, it's, it's so important that we stay strong and how we approach that, because you already know it's the only way they're going to get success.

Absolutely. And that's one of the commitments that Kelly and I have had for years is we came together with our business called Synergy. And Synergy has developed not only a place where we can mind share, collaborate with other practitioners to hold them to a standard and case share, but also developed content that they can use in their practices that we have used for years to bridge that gap. Because economically, sometimes you can't afford to have that rd. You can't afford it, maybe in your community have that, you don't have that health coach. And so giving them just a little snidbit of, you know, 10 or 15 minutes of a video or of an educational piece or a questionnaire that they can fill out. Because you're exactly right, if you're only seeing them once a month, they're not going to make the progress. It's just not going to happen.

You know, I learned early on and I, and I, I actually brought in an adherence coach when I had my big institute in Ohio. So, you know, we're processing 300, 400 people in a week.

Wow.

Right? All personalized. Right. Wasn't no cookie cutter stuff. Yeah. Three rooms go on full time. You know, three rooms, five days a week, eight to ten hours a day full.

That would be stress.

That was fun. I, I loved it because I got to go between the rooms so I could just go in and do decisions. Go here, go here. And the docs were in the rooms and the nurse. It was, it was, it was fun. And, and by the way, I learned a lot because I saw so many people.

Right.

You always see patterns.

You just start seeing patterns and it really helps. That's how I developed a metabolic code, was through pattern recognition.

Yes.

And, and you know, so it's really interesting that you have to touch people. Typically what was, what we were told was touch people at least three times in the first six weeks. If you're not doing that in some kind of communication, it's meaningful. Not an email, like, hey, here's my, here's my blanket email I'm sending everyone, which they delete. You know, touching them in a meaningful way literally decreases that drop off. I mean, I mean three, 400 people a week you get, people come in and they just go, hey, I don't want to do all this. Right. Like what you guys saw, right. I just, can't you just give me testosterone? Can't you just give me estrogen? You know? Yeah, right. You know, we don't do it that way. But it, but it was, it's interesting because you see you get that drop off rate, you know, 25%. We cut that in half just by that fact of what you said of communicating any little bit that a practitioner can give in between visits. A food list is important.

Yes.

Understanding stress, you know, how is the program going to work? Right. All those things are critical because we like to think that the consumer that's walking in, they're 100% passionate and bought in and even though they're there, they're not sure yet.

Well, I find it takes a lot to get them there. They want to be there. They're there for a reason. But to your point, they've got to really have confidence that they're going to see some type of result pretty quickly and that we're committed to their process and it is their process.

And that is right on it. You know, you guys know, it's the big thing that I've taught for years is you better get some kind of result in the first four weeks.

Yeah.

Something you can hang your hat on. Even if it's something not super important, but kind of important. And let's face it, you get people on their magnesium, their bowel movements are regular, and then they're super happy with you.

Right.

It's the number one thing people love. Right. Oh my God, I can't believe it. My bowel movements are normal. You know, it's like, yeah, but guess what? Look what I did to all these other things. Yeah, whatever. I don't understand that, but man, right? I'm regular now.

Little things can mean a lot.

It's the little things.

It's the little things.

Yeah, it's.

So I wanted to. And this is kind of backing up a little bit, but I think there would be some value in talking about GLP1 in the way that we make GLP1 in our digestive tract.

Right.

It's not a foreign substance. So what are the things that we could be doing on a daily basis, weekly basis, to help support natural GLP1 inhibition for a person?

Yeah, I mean, I think there's, there's several things you can do. I mean, first of all, you know, we don't have to eat all day long. You know, you eat all day long and you're going to upregulate glucagon and it's just, you know, you're just going to keep it going. So one is get on a pattern of eating. And you know, I'm a big believer in 1212. It's kind of like what's happened forever. You know, when I was a little kid, you ate breakfast, then you ate lunch and you sat down at dinner with your family and you talked about your day and you ate your dinner and kitchen closes at 7. Don't go in and mess my kitchen up. That's mom, right? Don't mess the kitchen up. And so if you get your treat, you're getting your treat before seven when you're a little kid and then, you know, you're seven to seven, you're kind of fasting naturally. And I think that's really a good habit to think about. Set my meal day. You know, when you travel, like for me, and I've been traveling like crazy, I have to work really hard not to have a late dinner. And I try some days I'm going to fail. There's no way to get around it. I get off stage at 6:30 and people are coming up to me and I'm not getting to a restaurant until 8 o' clock and that's tough. But on a regular basis people should try to do that. I think the second One is zone two exercise. So zone two cardio exercise. And if you want to know zone two and you're not getting your VO2 max measured to get exactly where zone two's at. And looking at, you know, that aspect, getting tested for it. You know, an easy rule of thumb is, you know, you can. You could talk two or three sentences, but you can't have a conversation while you're exercising. So that's kind of a safe one. You can do it by age too. Right? But, you know, I think why that's important is that you're not triggering as much inflammatory chemistry when you're training really hard. Now once you get. Get more conditioned and you understand how to recover, well, then certainly you can train harder. I'm a big. I love training hard. I had to learn. You know what? I lied. I have four. I have four things on. I've got. I'm trying to deck.

I have mine.

I'm trying the Dexcom right now. I did freestyle libre about four weeks ago. Now I'm on Dexcom. You know, it's. It's before you know it, guys, next time I'm gonna have something stuck on my forehead, you know, but, but, you know, I think that, that it's so important that you understand that the goal of exercise for the average person is to enhance the rest of their life. And then, and then you have Spartans like me. I want to get like, I've got a gym in my garage, and it's a commercial gym in my garage. And I, I love the train, and I had to learn that. And I did that through that Morpheus strap. It kind of gives me my recoverability score and my hrv. And I can tell how hard I need to work out the next day or how light I should work out the next day. And I think those. That aspect of exercise that really important. And you got to do some weight bearing exercise if you want to maintain lean mass doesn't mean you got to be, you know, trying to heave heavy weights, but you need some weight bearing. So those are two big things. And then the third one is sleep. Because as soon as you disrupt sleep and you disrupt the master slave clock, you are disrupting glucose and insulin regulation.

Say it loud. Including myself.

Once again, it gets hard, you know, you know, let's go. Let's go back to fight or flight. Let's go back to stress response. And why I say that's number one is 60% of adults in the U.S. will report that they're Having trouble sleeping at least a portion of their year. And most people are underserved on their sleep time. That's why I do love these things. All these gadgets that tell us how much we're sleeping.

For sure.

I'm not real, I'm not real happy with the results I'm getting with this one right now. Just because I don't like the numbers that I'm putting out. Come on, can't you change if I put it on a different finger? You know, change the numbers. That doesn't. Dang it. I'm just looking for that better result. But, but, but honestly, if you started there and then of course the type of food you're eating, you're looking for reducing glucose oscillation.

Right?

Right. So glucose oscillation being that big change between fasted and meal state.

Right.

And triggering inflammatory chemistry. So am I eating a lot of, you know, too much carb? Yeah. You can go to using one of these guys if you want. I mean, I think it's great insights for people. You got to realize these are probably about 7 to 10% off on accuracy. So you have to realize that the g, the continuous glucose monitors are good. Not as good as a finger stick. Finger sticks will be between 1 and 3% off versus 7 to 10% off. But they're still showing you, hey, what happened after I ate.

Right.

It's still showing us a trend. And that's really what we're looking at is velocity of change and trends. And so we still get that information. Yeah.

And I think getting fiber in is important in terms of slowing transit time on your, on your glucose. And then the big one. Everybody's moving to the carnivore diet now. Oh my God, it's a miracle. Carnivore diet. The issue I've got with that is that, you know, we know that high saturated fat diets that are low in fiber are going to increase more lipopolysaccharide release. It's been published over and over again. People argue with me over it all the time. I'm like, I don't know what to tell you. Let me show you 20 studies. I mean, it's not me, it's not the Jim Laval ethos. I like to look at the literature and say, what do we find out? What do we know? And so I think if you started there, fiber, transit time, more responsible eating, not to spike your glucose, creating a 12 hour eating window. Don't graze all day long. Give your body a chance to reset, try to induce some autophagy where you can renew some, you know, some cellular function and metabolism, things like Prolon. I think doing a Prolon kit three times a year is not a big deal. And they keep publishing more and more and more evidence. I'm not. Look, do I enjoy doing a Prolon kit? No, I'm not like, oh my God, here we go. Like it's a mushroom soup mix. You know, it's not like it's a big source of joy. But I know one thing people in general feel, feel like when they come out of it. I feel cleaner, I feel more efficient. I feel like I'm not eating as much. And we're knocking down a lot of the markers related to aging. That's been published with that. Those are just some key things. I see. What else do you want to add to that?

I want to speak to the prolon. Okay. So my strategy for the past three years, based on some of your recommendations, what I've heard in lecture is I'll do a. I'll do a prolonged kit. October, November, December, and then in January, I do a detox. And let me. That has been transformative for me and a lot of my patients following that strategy. I just finished a prolonged kit and what I noticed was my resting heart rate dropped five points, my heart rate variability went up, and now I'm to the point where I don't want to eat at night because I don't want to change that pattern. I'm like, I'm going to eat all my food in the daytime and not eat after 5 o' clock and see how long that resting heart rate stays down. Because I've done everything trying to correct for that. And it's been one of the things that it's just been like, wow, what can I do? I wasn't paying that much attention to it last year when I did my Prolon, but this is the first time I've noticed that big of a drop. So kudos to Prolon. I think it's good for structure. Do I enjoy the soups? I do not. But it is something that I feel like it's five days. I can do anything for five days.

Right.

You're not being asked to water fast.

And for the results that I'm seeing and the results I've seen for my patients, it just makes sense.

Yeah, it's one of those tools that when you really think about it, if you said to the average person 15 days out of 365, actually, let's add 18 because on day six, you should eat pretty clean and light. Right. So let's make it 18 days out of 365 days. Could you reduce your food intake and just do these, you know, the powders and the glycerin water in the bar just for 18 days to create the equivalent of you eating a Mediterranean diet all year long.

Wow.

And not messing up.

That's awesome.

Right? I mean, so. And I do think that it's got value just from that general meta inflammation reset point. You know, I keep going back to, you know, that, you know, I just dig. I mean, one of the other pieces I'm really big in right now is the glymphatic system. Right. Just really understanding the glial lymphatic flush that's supposed to go at night. So when you don't sleep, you don't get that glymphatic release of clearing your brain of the byproducts of metabolism and the inflammatory cytokines that your brain has made for that day. And of course, exercise is the other thing that does it as well. And so I just think that when you are. You do something like Prolon, you got people eating them regularly. A healthier diet. Yeah. You know what? People are going to have a birthday and look, if they're not, they don't have gluten sensitivity that makes them miserable. And if they don't have, you know, celiac, you know what? Just have a piece of birthday cake. It's okay. Just don't eat three.

Right.

You know, I mean, and it's. It's a birthday, not a birth week. It's a holiday, not a hollow month. You know, it's like getting those concepts across to people so that it really, you know, becomes special when you do want to celebrate something.

Right?

Right. And, and by the way, eating healthy doesn't have to mean you're not eating foods that are incredibly tasty.

Right.

I mean, we, at our home, we cook a lot. I mean, my wife being a dietitian, my father was one of the top hundred chefs in the world. I mean, we. I grew up in great food, and I had a transition to great healthy food. And I think that's the other important thing people miss because they almost think, like, oh, my gosh, I'm gonna go on this GLP1 now. I'm gonna have to, you know, I'm gonna be eating, you know, blah food. Put some effort in it. Put as much effort into your weight loss program if you're going to take on a GLP1. Anybody listening? You're going to take on a GLP1. Put as much effort into that program as you would put into looking for your next house or your next car or even your next refrigerator.

That's awesome, right? That is awesome.

Just put the same amount of effort in.

Yeah.

Because you know what, how many people were perseverate over what is the right refrigerator? I know I do. So, you know, but I perseverate on everything. Yeah. You know, I'm going to think about everything all the way through. I want to know every angle. Right. But. Well, I think it's important and you need to think about your sleep and what you're doing to maintain sleep. I know. I have no problem sharing personal stories. A lot of stress over this last six months for me. Good stress. Books and business and we're buying a new house. I had a lemon law car. You know about this. You know, nice. What I thought was a nice car. Had to go through all this lemon law stuff to get another car. I mean, all of a sudden I'm going, I'm only. My. My ring. I'm only sleeping six hours now. I'm getting four cycles of sleep. And that. I'm still. I'm still getting my cycles, but I'm not getting enough sleep.

Right.

Because I'm waking up thinking about all those things. And. And so I've had to take action on that. You know, I've taken action on it to try to, you know, work back up to my seven hours. And I think people need to attack their health. It's that simple. And you know, that's what's great about what you've developed is you guys are passionate about helping people attack their health.

Yes.

And I've come.

That's what it takes.

Yeah, absolutely. And I've come to the conclusion is we are either actively pursuing living well or we are actively pursuing dying. Like it's that there is no such thing as just being static. You have to be in active pursuit of it. And that means seeking out opportunities to learn and grow and try new things and all of those things that you said. So listen, we could probably talk for hours.

We could talk for days. Are you kidding me? Days.

We could.

We're gonna have to have round three, I'm sure.

Yes.

So we want to hear about the books. We want to hear about the books. We want to hear how can people connect with you. I know you've got jimlavel.com but tell us about the books.

Yeah. And the real Jim Laval on Instagram, apparently that's. I never look at that stuff. And My son's like, you know, you have over150,000 and get, you know, whatever downloads. It's like, okay, what's that mean? I had to ask him, is that good? I didn't know. I don't get any of this stuff. And so the real Jim Lavelle and so the books, new metabolic code book coming out and it's going to be relabeled, ought to be about meta flammation and the march towards aging gracefully and, you know, using the metabolic code method and you know, which we're really happy about. We're using it with armed forces, obviously. We've, you know, really have validated that now with George Washington's curriculum department going through our coursework and stating it. And then so I've got that and I've got a human performance book coming out. You know, how to optimize your athletic performance through blood labs and lifestyle changes. So those are the two. Then of course, the second edition of your blood Never lies is coming out. So awesome in my handbook, peptide handbook version two, that's coming out too. So those. That's all hitting in the next 90 to 120 days.

Well, I hope it's planning a really nice vacation for yourself to decompress and regroup after all of that output.

You know, it's funny you said that, actually. I want to talk to Laura, my wife, this morning. I said we got to take a week in January. We just gotta like, use our, My frequent flyer miles and let's just go somewhere.

Yeah.

So important. Well, we're gonna have to write you a script for that.

There you go. I'll take it. I'll need that.

That's right. Well, thank you once again just for being so generous with your time and again for just, you know, be having such a strong influence on our lives and therefore the lives of, you know, the patients that we get the privilege of being able to treat. Opportunities like this, they're golden for us because we do feel like, you know, you said this coming on in the very beginning. I don't think any one of us are super comfortable with, you know, videoing ourselves and, you know, doing things like this. We don't do it for that. We do it because we have a passion to change lives. And so thank you for being part of that.

Oh, my pleasure. Anytime.

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