Episode 112: How Genetics and GLP-1 Shape Your Metabolism with Ashley Koff, RD

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Dr. Rob Whitfield, the board certified plastic surgeon specializing in explant surgery Breast implant illness is a topic that is not often talked enough about, especially in medical community, but is something that affects many women. In this podcast I'll be discussing the latest research, treatment options and personal stories of women who have undergone explant surgery in an effort to heal breast implant illness. In this podcast, we'll explore the symptoms of breast implant illness and delve into the latest surgical techniques for explantation and the recovery process. Whether you are currently experiencing breast implant illness or are considering explant surgery, this podcast is a valuable resource for anyone looking to take control of their health and wellness. So let's dive in. Welcome to the show. Ashley Kauf R. He leads the national conversation on truly personalized nutrition. She's translated her 25 years as a practitioner and her experience into system BNP better not perfect to help you identify and make your better nutrition choices more often. She's the founder of the Veteran Nutrition Program and the founding Nutrition Director for the University of California at Irvine's Susan Samueli Institute's Integrative and Functional Medicine Fellowship cough has a new book available January 2026 on GLP1 optimization from HarperCollins and offers certification for IT and coaches and practitioners. She's also the author of two consumable publications, Recipes for IBS and Mom Energy, and a contributor to three practitioner publications, was also the on air dietitian for three reality TV shows and regular contributing expert for national and local media outlets. Awarded by InStyle magazine as Hollywood's leading nutritionist, as among CNN's top 100 healthmakers, recognized in the top 10 social health makers in Nutrition and Nutrition and among the top 50 natural influencers in health and Nutrition to follow on Twitter Now X Cough was selected for the first list of top 10 registered dietitians in USA in the US by Today's Dietitian. All right everyone, I have Ashley Kauf with us and she is got a book coming out in the 2026 about GL1P agonists and optimizing them. And we were kind of before we hopped on, we were discussing the advent peptides and you know, gosh, I'll probably get, you know, censored here for peptides. Talking about peptides again. Peptides are just amino acids and a sequence of amino acids. Ashley was just telling me, you know, her positioning really on what this is helping us understand. So I'll just let her carry on from there because I'm very interested to.

Hear what she has to say, thanks so much, Rob. So, you know, I think the question that I get asked a lot or we're hearing asked is like, to shot or not? And that really is the wrong question. Right. You know, so first of all, if we understand what the shot is, and the shot is a synthetic version, so I'm talking about the shot. You know, maybe It's Ozempic or WeGovy, or maybe you're using a compounded version of the ones that are probably most known today. Tirzepatide or which is a dual agonist, or semi glutide, which is a single agonist. But there are a lot coming up on the market. Probably even by the time that this podcast comes out there, you know, there'll be more. So when we think about that, that is a synthetic version of hormones that are made in your body. And there is a difference in the design of those. When they make them synthetically, what they were able to fig figure out is a way to override what happens in the body. In the body, when these peptide hormones are produced or when they're deployed, an enzyme is deployed concurrently, so simultaneously, and it degrades them, so it deactivates them in about two to three minutes. So these hormones work a lot like a motion detector, if you will. Right. Like something passes by and they respond and they start a cascade of events. The synthetic version stays on. They don't have that. They override. They're not broken down by that enzyme. So they stay on for the duration. Right now is about 24 hours for seven days. So I like to think of them as like an artificial sweetener as opposed to what you would get from eating an apple. Like, the difference is that the sugar that's in them has been chemically, you know, just an artificial sweetener. The sugar has been chemically modified to be thousands of times sweeter. And as a result, it's going to do things at a higher intensity. And we need to understand that in the body. So we come back to the question to shot or not. It really isn't the question. The shot is a tool. And the tool may be used in somewhere in somebody's lifetime, you know, for my patients to help us when we need that higher amount or when we need something that will stay on for a longer period of time. But we do have to understand what that will do in the body. And we can come back to that for all of us, for every single one of us, and especially for the some somewhere in the neighborhood of 93% of Americans that are deemed metabolically unhealthy. When we look at, you know, metabolic health definitions, it also is helping us understand that there's something called GLP1 and it's really GLP1p, y y cck a lot of these peptide hormones dysfunction. So there's suboptimal function of these hormones and so there's an entire continuum. And my book really goes over how do we actually assess what your hormone production looks like right now and how your body is able to respond to it. And then we figure out how do we optimize your hormone production. And that optimization is going to take us through something I call our weight health ecosystem. But like all the different systems in our body that are involved in metabolic health. So we really have this huge opportunity, thanks to the shot and to what everybody is seeing happening as a result of the people who are taking it, to understand what all of us can benefit from, which is how do we actually figure out is there suboptimal function of our own hormones and how do we then what tools do we use, what processes are involved in optimizing our own? So I'll pause there. Does that track for you, like kind of in a different way?

Yeah, when I think of it globally, you know, we all talk about enzymatic function. So, you know, basically when you're trying to, you know, have homeostasis in a system, the ability of, or how I think of it is you can't pick your parents and you can't outrun a bad diet. So if genetically you inherit, whether it's a gene that has incomplete penetrance like brca, or if you have a gene inherited that is more of variable expressivity, like Marfan's FNAB1 or something like that. Basically, you know, from my understanding, you know, basically what you're saying is, because we have that, and I don't know if you're saying it's, you know, a gene specifically because there's probably a number of them involved, one that's got incomplete penetrance or variable expressivity. You know, our capacity is the problem. So if you're eating so many, whatever, so much sugar that you can't handle it, then enzymatically it's, it's incapable of maintaining homeostasis and then we get what we get out of that. So I always think of it like that in terms of genetics. Certainly peptides to me have had some. I mean, for me personally, I can't think of another product from big Pharma that's had such an impact on modifying behavior? Because I don't, I don't really. Not that I was sitting there as part of a trial, but man. So if you look at what it's going to do downstream, you're going to change. Because I'm a surgeon and dealt with all of the indoor damage from different diseases, you're going to really change how I think of like chronic renal disease. I mean, are you going to have. It's me, when I think of it like dialysis is not going to, it's not going to ever go away, but it's going to diminish.

Absolutely. And I love where you're taking that. You know, the surgeon is, is one who really understands, you know, the, the old adage like the hip bones connected to the thigh bone, you know, this just like kind of how is this all operating? And one of the really important things about these peptide hormones. So first of all, they're made in the lining of our digestive tract throughout. So and I really look at GLP1 not in isolation. I look at it with PYY and CCK because. And then there's amylin and there's GIP. I mean, there's a lot of these hormones. That's why the protein quality and the amount of protein, you know, and our body's ability to break down and use these amino acids is so important. But it's made in the lining of the digestive tract. So if we just think myopically there, not even globally at how many things injure the lining of the digestive tract. Right. So we have like, you know, I was a kid that was given like antibiotics prophylactically, you know, by the time I was probably 10 and just tons of them. And it really wreaked havoc on my gut. We have, you know, we know that there are toxins in the environment today. Pesticides, herbicides, residues, metals, things like that, that, that are challenging to the body. We know that there are, you know, things as simple as drinking alcohol that, that is going to impact the, you know, or taking a Tylenol and ibuprofen. Like these are going to be impacting the lining of the digestive tract. And so that's going to impact your body's ability to produce and deploy these, these hormones. But additionally, the hormones are deployed through the vagus ne. And so when we look at vagus nerve dysfunction, another huge area. And as a surgeon, you're super understand this part. Just when we look at the nervous system and we look at the body's ability to transport these hormones to the receptor sites throughout the body. You bring up the kidneys. We now know that there are GLP1 receptor sites on the kidneys, that they're on the heart muscle that they're on. We're not just talking about the pancreas and diabetes on that part. And we certainly know that they're in the brain. So the body's ability to get these to where they're supposed to go is going to be impacted when anyone experiences, oh, I don't know, stress or trauma or if you have nutrient insufficiencies that make the vagus nerve feel, as my, Our mutual colleague, Dr. Nawaz Habib talks a lot about unsafe in some way. You know, when we don't have enough acetylcholine or when we don't have enough omega 3s, that's going to impact our vagus nerve nerve health. And so what we're basically seeing, and the reason I use the term weight health ecosystem, is we can no longer look at metabolic health as, you know, what's going on in your digestive system, what's going on in your, what is your cholesterol, what's your bmi, what's your blood pressure? We really need to do a more thorough assessment of the body and understand the interdependence of all of these nutrients. So your body's ability. So, yes, we need to think about, am I able to make enough of these hormones? Am I able to. Are they able to be deployed in their active state and get where they're supposed to go? Are the receptor sites actually healthy enough to receive them, you know, in that part. And then when that happens, are the cascading reactions, you know, that, that are signaled, are those going to occur? There's a lot of places in modern day where all of those things are then challenged, you know, whether it's too much messaging coming in and overwhelming the vagus nerve or what we're doing to the digestive system, you know, where it's insuffic, et cetera, you're gonna have upstream and downstream interactions when you. Or challenges when you don't have optimal levels of these hormones. But you're also, when you add in the synthetic version, the one that stays on now for 24 hours, seven days a week, you're really going to see significant issues. And I'm pretty disturbed by the fact that they're calling them side effects because that would be like if you, if you, you know, decided to, to as a surgeon, attach an arm to a hip instead of a leg to A hip like these aren't side effect. This is completely intended when you understand how this works. So what we need to be doing is a better assessment of people and then using the medication as intended, but understanding how the medication works to help optimize people's health while they're on the medication.

Isn't that a function then? Many times what I see is a lack of understanding about personal genomics. So if someone doesn't really, I see this bantered about by the quote unquote, health gurus all the time. Methylation can cure every single problem. A person was quoted recently that I had to go on and they said 60% of the population had a MTHFR mutation and really the highest percentage of MTHFR mutations is in Hispanics, not Caucasians. And when you look at the, the ethnicity breakdown. Anyway, my point was if, if this is yet another example of that problem where if you don't really understand someone's personal genomics and how that like you said, GLP1 basically predominantly is made in the gut, there's a tiny bit made in the brain and you know, it's the goal of it is to stimulate enough or more insulin release and block, you know, glucagon. So, you know, side effects, like you said to me are like, it delays gastric empty. A huge problem in surgery because if you get somebody who has delayed gastric empty and the chance that they could aspirate goes up.

Right.

Surgeries are going to get canceled because of a.

Already happening.

Yeah, because of a full stomach. And you know, personally, you know, in, in my practice we have a very strict situation with GLP1 agonists is you have to be off of them at least three to six months prior to anything that I'm doing. Because for those reasons I'm not going to have a problem with, you know, whether it's delayed gastric emptying or being in my business for recovery. My whole program is about eating enough protein and getting enough calories in to actually recover. So like it goes against basically what.

I'm doing, like how you can, how you can optimize it. Well, let's chunk it into three things. I'm hearing a couple of questions from you. So first of all, I think genomics is a fascinating space for us to really look at this and I've dived into, you know, as you're talking about the looking at because I, for many of my patients I'm lucky enough to have a nutrigenomics profile and you know, more, there are a variety of different Things that we can look at, you know, we can look at your likely likelihood for leptin resistance. But if I see that you're, for example, if you have a GSTM1 deletion and you aren't going to detoxify, well, I have to be very careful. Like, I need to optimize your detoxification system as I go through this because we're going, we intentionally are shrinking fat cells and we're going to be releasing a lot of toxins. We're also adding a synthetic hormone to the body. So I need to make sure that those things are going to be broken down and, you know, converted and conjugated and eliminated. So there are a lot of different ways to look at you, to use genomics to both help us understand how, optimize somebody's experience and also to understand when this might be a good, you know, a useful tool. When I look at certain, you know, genes, there's, I call it the snack gene. And you know, I mean, there, there are a variety of them that help us see that somebody is really going to be in a space where their body is going to consistently challenge them to utilize energy that it takes in in a successful manner. It doesn't mean that they can't though. It's. That's 30%. But if their epigenetics have proven out and their environmental situation and maybe they'. Who. I don't. I mean, all of us have traumas, but, you know, how you've addressed your traumas and how you're dealing with your stress and, you know, vagus nerve dysfunction and some of these other pieces, there can be a whole recipe there that says it's going to be really difficult for this person to be successful without this medication. And why not come in and use this hormone replacement in the same way we use other hormone replacements and, you know, come in and be able to optimize that. But having the genetic understanding of how to do that better is going to be very, very helpful for someone. So that's, I think, you know, on that side of when we look at, though, understanding that it delays gastric emptying. And I love that you point out not many people know that things that hormones like GLP1 are made in the brain. There is some that's made in the brain, it's made locally and it acts locally there. And we tend to talk about that one a little bit more like a neurotransmitter. So because of what it's doing there, as opposed to it's not doing the same Things as what the GLP one from the gut is doing. But you're right, it has to get there. And then it's impacting leptin, it's impacting, you know, insulin. So many different factors. But it also, we've seen that GLP1 and even semi glutide, so the synthetic version, they actually help to repair the lining of the digestive tract. So it's like we understand that this is a necessary agent. Just the question is, do you take the, you know, do you take it at a dose where it's going to be on 24 hours a day for seven days? And some of the ones that are coming up, they want to keep it on for longer. And we've learned in the world of oral contraceptives, for example, with women, just some of the pros and cons or pros and considerations of having things that are, you know, there are some women are on oral contraceptives where they don't get a period for forever or where they don't get it for six months or where they think they're getting a period but the body isn't doing, you know, what it's doing through that. We also learned with COX2 inhibitors, you know what happens when we decide to fully shut something off and we downstream, we saw that, oh, like this is bad for the heart, we might shut off the pain, but this is a problem. And so what you're picking up on is how many people already have gastric emptying issues. And then we go in and we delay the gastric emptying. So I can't think of a better example than the fact that something like 60 to 70% of adults are using some version of an acid suppressing medication. They're using the medication or an over the counter. That's a crazy number when you then think about those people. At bare minimum, the practitioners or if they're buying a GLP1 Agonist online, they're not even asking that question. So what we're. And then we're telling them on top of it. And so I wanted to go with your particular expertise to eat more protein. What happens when you eat more protein in a system where gastric emptying is delayed or where you're suppressing stomach acid and we now have inappropriate or insufficient breakdown of the protein and now we have more inflammation and we have more smelly gas and we have more, I mean, disruption to the small intestine and the microbiome. You see how this is a recipe for disaster. My point in all of this is if you and I can have an informed conversation that we understand all of this. We should be able to. And what I'm seeing in my patients who are choosing to use the medication where that's the better decision, you know, collaboratively with their health care team, we can address these. These aren't things that, like, this medication doesn't make you lose muscle. This medication doesn't make you have constipation. This medication doesn't make you X, Y or Z. It exacerbates underlying dysfunction, and it also comes around and will reveal things that you maybe don't know. And then we need to be able, you know, to address and hopefully, you know, to be able to prevent those where, where we have good information.

Yeah, I've monitored several discussions about this lately, and from our perspective, surgically, programmatically, I've gotten, I guess, more and more aligned with. Everybody's got to work on multiple things prior to surgery so that your preparation, if you will, whether it's a surgical procedure or just like this, undertaking a, an intervention where you're going to inject something if you do it quickly without enough thought. I don't want to say hastily, because I don't. I hope nobody's just doing this hastily. But thinking about what's going to happen if in fact you already have constipation or if you already have a lot of problems with your nutrient absorption is very complicated. I spend a fair amount of time through either video or interviews discussing, you know, our take on it, because in order to heal anything, you have to, you know, take in enough amino acids, enough protein, that's going to create more problems with fermentation in the gut if you don't up. Upgrade the patient's enzymatic activity. So we always are talking about that and giving an option of something that has more proteases in it, which is the digestive enzyme. So there's lots of those options as well, but like, for the standard discussions may not be happening in general, if I'm going to be probably pretty candid about that. I don't know how many providers really can go into that amount of detail. And if they have access to someone like you or another, you know, nutritionist or dietitian who can help them, that would be great. That's probably pretty complicated in most settings, given the constraints on providers with time. It's just, that's a. I mean, if you can't at a. I guess we can all agree that's you. You have to have that conversation before you get down the. Think down the path of this.

Yeah. Well, in 2005, I started. And kicking and screaming. Well, not kicking and screaming, but it wasn't. I did not think that it was a career choice. I didn't even think it was something that we should be doing. But I started working. I was at Cedar Sinai as a stand in for somebody who was on maternity leave. Outpatient, minimally invasive surgery. And so I. I was taking on bariatric patients, you know, and here I was, a young dietitian, and I was like, I can get anyone to lose weight. And this is so dumb. I don't know why we have bariatric surgery. And I was. And then I came to learn I can help many people lose weight. I also see them regain it. And, you know, as I started to step into working with bariatric patients, number one, from an insurance standpoint, it was required that they at least meet with me. So there are a variety of caliber and, you know, approaches in nutrition and dietetics, and there's so many more today. So I can appreciate that, you know, not everyone is going to meet with somebody who has maybe the experience or, you know, looks at this in a similar manner. But. And that's what my company today is trying to address. So, you know, and why I'm writing a book. When we look at this, I remember at the time just being like, okay, if we at least a month out, start working with people on their how to meet your protein needs and how to optimize your digestion. And this was just a month out. I wish that we had three or six months, you know, on that part. And it would, lo and behold, that, you know, the surgeons are like, this is incredible. The outcomes are so much better. And that. And it was that recognition that if you. That, of course, if you're coming in for bariatric surgery, there's underlying gut dysfunction like this, you know, that we understand what happens in the body when there is, you know, is. Is, you know, the dysfunction is the tell. And that's why I think it really begets a bigger question or a point, which is, you know, our weight and in particular, our weight composition. So our fat, the types of fat masses, you know, where it's allocated. Our bone health, our muscle, our lean body mass, our weight composition is a key performance indicator for our health. It is not a number or a judgment or something that we treat people on. It actually is revealing this really great information for us. And for me, what it has always revealed is, okay, there's gut dysfunction, and that is the case if you have. If your body fat is quote unquote perfect and you are not making lean body mass or you have bone health issues, there's still gut stuff that we have to look at on that part, you know what I mean? So I think it's just so important that we look at and we have this conversation. And that's where GLP1 optimization has been so groundbreaking. Whether it's in the practitioners that I'm teaching and supporting or whether it's in the individuals that we're working with, where this is not for. This is not to say like somebody is obese and as a result they should do this, this instead of using a medication. This is also for someone who is noticing the 3, 5, 7 pounds that's inching up or the just maybe it's not even that much, but it's the belly weight that is coming on at a particular life stage. Or as I mentioned before, I'm trying to do, I'm trying to eat protein and I'm not able to put on lean body mass. And that doesn't mean that you need semorelin, like maybe, but, you know, it doesn't mean I need a new peptide or I need a new thing over here. It means, hey, the whole system, the ecosystem is not working better. And so now we need to pull it apart and look at where in the ecosystem are there imbalances, insufficiencies, challenges, dysfunction. And then we address those. And you know, to me, this is one of the reasons I'm just so happy about the shot. I'm thrilled, you know, this shot heard around the world. You know, semi glutide. Thank you for discovering the Gila monster. You know, the venom in the Gila monster is. We can now have these conversations in a much more informed way and help people understand that you actually have a system that is regulated. It's started by these motion detectors, these peptide hormones. And so if those aren't working optimally, then all of these other things, as you said, like there's going to be, you know, upstream, downstream, there are going to be all sorts of issues on that part.

Feeling low on energy or stressed out. You might be missing essential, essential B vitamins. Introducing liposomal B complex from Dr. Rob Solutions. The blend designed for maximal absorption to fuel your body's energy production and support mental clarity. Everybody's heard of the MTHFR gene. You need a methylated B complex in order to support this. If you have this problem, which about 40% of Americans do, B vitamins play a critical role in Reducing stress, boosting mood, and maintaining overall vitality. With liposomal technology, you get the nutrients where they are needed most right into your cells. Discover the benefits today by visiting the link below or visit DrRobSolutions.com and revitalize your health. I'm glad you brought up so specifically. You know, the gut, and we hear about the gut brain axis and there's many things talked about as it relates to the gut microbiome. There's prebiotics, there's probiotics, there's all these things. And there, unfortunately, there's very little quality in terms of scientific literature about the gut microbiome. And I know the National Institutes of Health are doing more work now, which is great. I just did a literature search the other day and there was very little about randomized controlled trials as it relates to the gut microbiome, as you would expect one, because it's not been something that's been probably a point of funding in terms of research during our careers, but there was a randomized controlled trial looking at mild cognitive impairment with Provotella and Probatella. For everybody listening, that's typically. It's a mouth bacteria. So everything starts with your mouth and your oral hygiene and then your, obviously it affects your gut. And I, I found, you know, that interesting. And then using things like Lactobacillus as, as a, a way to combat that. I mean that. But it's very sparse, right? It's, it's such a, you know, quote unquote topical thing. Prebiotics, probiotics. Yeah, Kombucha, all, all these things to take and versus just, I don't know, some fermented foods, maybe something.

And the fermented foods are probably, you know, one of the greatest, in my opinion, inventions that we've had in the last couple of years is the recognition. And now like we're seeing in just the application for pro resolving mediators. So these specialized, you know, they're Omega 3s and Omega 6s that have been in the lipid category, have been acted on by enzymes and they are. Now they go in and they do that. They are phase two of inflammation. They resolve inflammation. And you know, this is what aspirin does. So it's, you know, it's just really amazing to see. And we know that that's in fish, but when you extract a fish oil to just an EPA and a dha, you often lose that, right? And so. Or you do lose that. And so, you know, when we look at this is this concept of an ecosystem, when you Talk about a fermented food. We're not eating a fermented food for a particular strain of Lactobacilli. We're eating it because there's antioxidants, there's trace minerals, there's, you know, I mean there are all these different things that we're getting in there. And I think the ecosystem concept is fascinating. Premise of my book is to really understand how you nurture your weight health ecosystem. Years ago I was in Alaska, did some work to help to prevent pebble mine. Which is the one of the main reasons that I was so concerned about this mine was that when you change to a microscopic amount of a trace mineral that was available, when you start to see just a little bit of copper, like we know we only need tiny, tiny amounts. Well, when it changes in the water, wild salmon, their sensory ability that brings them home to spawn, they don't come home anymore. Just a microscopic amount of copper that changes in the water. And so we were going to, you know, the waste product from the mine was going, because it was a copper mine, was going to, you know, prevent that to have tons of copper in the water. Why is that a factor? When wild salmon don't come home and spawn, what happens? Bears don't eat, birds don't eat. I mean the whole ecosystem is disrupted. Right. And so what you're talking about of a microbe when, when the, or when our oral hygiene is not where it, it where we need it to be and something is able to grow that and it's able to grow in too great of an amount, you throw your entire weight health ecosystem off. So I just think it's, it's, you know, it's fascinating to look at that. And then as to your point, if we're eating fermented foods, but not the manufactured fermented foods that have now been, you know, you know the kind of the concept of oh, you can drink your sugar and get, get some like the probiotic sodas or things like that, you're just like, this isn't a win on that part. So we do really have to look at nutrition as a foundational way of really optimizing so your body is an operating system and we're meant to have optimal amount of resources. And what is perceived as optimal is going to depend on what's going on with your body in that moment. I just had a woman who, who has been doing great with her digestive health, who has RSV right now. And she said, you know, she's like, I just feel like the impact of the glutamine is actually waning now that I have rsv. And I said, no, your needs have changed. You know, when you have rsv, your body is turning around and it is saying, like, I need so much vitamin C, I need more glutamine, I need more magnet. Like I have much more needs because I'm at war. I'm not in a. I'm not in a place where I'm trying to do the repair work and the healing after. So, you know, our job as practitioners is to come in and to help us under help, like identify and understand what needs does your body have right now. And then what are the choices for meeting those needs. And if a choice is going to be a quote unquote processed food, which I'm not against, I can appreciate, hopefully it's a better quality processed foods, but I can appreciate reality, then we need to make sure that we're at least giving the body what it can use. And we're not giving it at the same time. We're not washing our floor with dirty shoes. We're not giving it something and then having it be irritating or frustrating or overwhelming at the same time.

Yeah, I mean the access is always. The hassle and the costs. Obviously we've actually gotten to the point where we don't go to the store for very much. We go to local farmers markets. But that's not everybody's reality. That's very challenging. And there is obviously the concept of food deserts in this country. It's a reality in a lot of communities. So you did speak about the fermented food. So let's. I mean, you know, the basic ones are things that, you know, people are like, I don't like sauerkraut or, you know, I don't want to eat kimchi. And then we just said like, the basic things like that are, I guess if you want to call them processed kefir or kombucha or whatever those can in reality have. I don't know your take on it, but there's so many like varieties of these things now.

Yeah. And I think you can do things. So you might not like sauerkraut because your experience with sauerkraut was putting sauerkraut on a hot dog and you were like, wait, I liked the hot dog or whatever. Or maybe now you're not eating hot dogs. So there also, there are things that we can do with it. So I'll take. I have a dressing that I like. It's got some ginger and some apple cider. Vinegar and some olive oil and some other stuff. And I'll mix that with the sauerkraut and I put some seeds on it because I personally, the texture of the sauerkraut alone might feel a little bit like, you know, off. So. And that's appealing to me. And you know, it just, it kind of depends or like what you have it with, you know, so I also think that there's, there's tremendous variety in fermented vegetables that you can, you know, maybe like carrots or pickles, you know, like, I mean, there are ways for us to at least like start, you know, into that. Now what I do have to claim clarify is we know a lot of strains of, so all of all bacteria come in strains. And so when you're looking at the strains, there's strain specificity that's in there. So Lactobacilli reuteri might function differently in the body than Lactobacilli acidophilus, but they're all part of this ecosystem. So we don't necessarily just need one, but there may be times where we're looking for one or where there's benefit of one in a greater quantity. And that is where I think supplementation can be really effective. And there are also some strains that we call today, like novel strains as opposed to the commensals in the body where, you know, they aren't your. There isn't a food source of Akkermansia as an example or of Clostridium. There are things that we can do to nurture those in the body. But if modern living and choices, you know, sometimes we don't feel like taking an antibiotic was a choice. But the choices that, that have either been made for us or the choices that we've made, if they've reduced our amount of these things, then we may need to take them in supplementally. And I'm a pretty strong proponent of food first. But when you get into the place of, when you look at your total nutrition, there are some times where the supplements are just going to be able to do something that the food actually can't do for us in the initial phase or at 8.5 point in time. And then there's a big distinction between food and fortified food. So, you know, a lot of people will say to me, oh, you know, instead of taking a B vitamin complex, you should eat nutritional yeast, you know, and it's big in the plant based or plant monogamous community. Well, it's been mistakenly represented that it naturally has B12 and folate in there, it has B6 and it's a really good source of B6. But the folic acid or the folate and the B12 are, are fortified in there. So back to your methylation. You know, since all of us have quote unquote, have this MTHFR issue. But if we're, you know, I, we go through a folic acid finding exercise and if we find that you're, you know, if you're using nutritional yeast on a regular basis, we look at your nutritional yeast. I would rather you had one that is not fortified. And as a result you don't get the folic acid and the fortified B12 there. And then you get better forms of those maybe in a supplement. So this, the world of food and supplementation, you know, can, can come together. Somebody said to me the other day that they're getting their probiotics because they eat sourdough bread, you know, that their choice is, is sourdough. And I said, well, so there's a fermentation process there. Absolutely. But that can't count for. And, and by the way, I love that you're having the sourdough and their stomach was tolerating it and you know, and the whole process of making it. And I was like, okay, but we can't have you have sourdough or even kefir if say dairy is a problem for you or you know, something else if like, you know, on, on these pieces. So we're in this. We are in this. I will say we're in a fortunate space in the fact that we can put together these total nutrition plans with supplements and with foods. We're in a challenged place because fortification often makes us feel that the easier or the more food based route. And you probably don't know this about me, but I started my career in advertising selling sugared cereals. So I did Raisin Bran Crunch and Smart Start and you know, mea culpa. But you know, one of our big things was to tell people, you remember the Total Cereal commercial? Like, oh, get all your vitamins and minerals here. Yeah. If you do that, you're also, you're getting forms and amounts that are not better for your particular body today. So I like to move away from fortification wherever possible. You know, enrichment flour is the worst term ever. I love school enrichment. But enriched flour really means we destroyed the flour, took everything out of it and then we came back in and added what we wanted to in there. Like it's, it's not better for you. So teach, I feel like kind of teach people a different lexicon or a different way to look at food and make those choices. Coming back to fermented on that part, fermented in name doesn't even sound good. So now we use cultured, you know, so cultured, you know, when it comes to sauerkraut or you know, to other, or to cottage cheese, you know, other things on that part. So there are ways, you know, there are cheeses that some people do really well with raw goat and sheep's milk cheeses. And these are ways that we can get in more of the stuff that we're supposed to get in. But at the same time it may not be enough to turn the corner if your other, if other choices or environmental issues are factors. When they are factors on that part.

Yeah, that's the, I mean that's a great take home because programmatically we have a methodology that really, you know, I want people to control what goes in as much as possible. So you know, they're a really underappreciated thing is air quality. You know, obviously not everybody's going to change their, you know, liquid intake. They may have developed through the media or through reading or through, you know, the death scrol scroll on Instagram that they need to have, you know, a ton of electrolytes or alkalization or, or what have you. Like your body is very clever. You know as well as I do that if you keep giving it salt, you're just gonna pee the salt out or you're going to become hypernatremic, which is you have too much salt or if you drink too much free water, you're going to become hyponatremic because that's what happens. And so, you know, I try to give these small lessons like if you're going to drink water, try to drink it out of something that's glass or stainless so that we avoid phthalates which are in the plastic water bottles and things that we've from single use has just dominated the marketplace. We try to really get people to concentrate on elevating their protein intake. Like you said, my most difficult client is somebody who's plant based because they don't get enough protein in their diet and it doesn't really matter. You know, if you just take a basic 110 pound woman and say you need a gram per pound of body weight. I mean in a plant based diet that's almost impossible, if not impossible without supplementation. And then talking about supplementation. If people show up eating and drinking these, these quote Unquote, you know, shakes or whatever. I will tell you, I get extremely concerned now because of the fillers that are put in those things that magically, you know what that means? Like anything with like plus three or four ingredients. I get super skeptical about that. You know, in a, in a, a protein for sure. Because like, what, what are you doing? What are you putting in there? It's just filler to make up for volume of which you're. You're talking about. They don't really have the nutrient value that, that you want. So I mean, this is. I try to keep it really basic.

I wrestle with this. I hear you so loud and clear. And this is where like, this is why also I became the RD instead of the doctor, right? Because I was like, we need to have better information. And by the way, we're not going to have this. But like this waiting for this information to come through dietary guidelines and recommendations and all of that stuff is I'm working on it. And, and I've been working on it for 20 years. And you know, part of the reason that we do what we do in a public and in a business form is because we need to just make sure that people have access to this information. I think that the. There are two different things. One is. Well, three. One is that we are infobeast. So the epidemic of infobesity is profound and problematic. We have too much information. And we also have this assumption that knowledge is power. Power when it comes to nutrition. I honestly don't care what you know about nutrition. I care do you know what your body needs and are your choices delivering those needs? So I want insights about your body that like there's kind of like, other than me and, and some of my colleagues who have to take a test every couple of years, like there's. And it's the worst test. There's no reason to know all of this stuff about nutrition. I understand it's really exciting, but part of the reason that it's exciting is we're trying to figure out what's better for us. And the interesting thing about what's better for us is it's personal. So great example is protein needs are not 1 gram per pound of body weight like we, we. They are also not 0.8 grams per kilogram. Like we, when we come in, we look at a person and we say, you know, so for me, there's four pillars of better nutrition. Quality, quantity, balance and frequency. And we're looking at, you know, when you get it in, how often what the balance, what the type of it is and you know, what's the, what's the quality and how much. And when we look at somebody's protein needs, I also distinguish between plant based and plant monogamous because it's so confusing. People tell me they're plant based and then they're like having eggs or they're eating chicken. They're like, yeah, I'm plant based. And I was like, all right. So if you're plant monogamous and you're not taking in any animal products, on that part, it is doable. It just needs to be very intentional. And you need to understand that if your protein, your protein needs, there's no food in nature. It literally in nature that is just a protein. They are going to bring in carbohydrates, they're going to bring in fats. And so you need to make sure that your balance of nutrients isn't throwing things off. And we also need to look at how much protein are you getting in at one time so that it's spaced throughout the day rather than somebody saying, I'm going to eat 100 grams of. I had somebody who was eating 100 grams of bison at night and he thought he was, was meeting his protein needs because he was having a little in the morning and then he was having basically carbs all day, you know, on, on that part. So it's like, okay, we've got to space it. Your body's more like a race car. You know, we need to look at that amount. But when I look at plants, I need to understand there's a very big difference than getting my, from getting my protein in and hemp seeds, than getting it in from, say, lentils. And then there's another difference from getting it in, in rice protein or pea protein powder, which is, you know, what you're talking about. And so we want to look at, on that part. And if anyone is saying, well, what are my protein needs? A good rule of thumb, I love that you brought up the one gram per pound. One gram per pound is a really good starting place. I use it for your desirable body weight. So say you're weighing 300 pounds now, but your desirable body weight is 150, then we'll start with, we'll look at 150 pounds. But if you're only, if you're getting in 60 grams of protein right now, I'm not going to take you from 60 to 150 in the same way. I'm not going to. If you're doing 2,000 steps, I'm not going to tell you to get to 10 steps. We're going 10,000 steps. We're going to work incrementally and make sure that we're spacing it throughout the day. After about 150, you know, even with my, like, I have a couple of football players who are, you know, 360, 370, super muscular, etc. I still don't go much higher than 150, maybe 200 grams of protein. Protein in that individual spread throughout the day. And then we're obsessed with their digestive health. And we're also making sure that we're looking at the distribution of the amino acids to make sure that their body can make everything that we're needing because360 or say the person's supposed to weigh 300 or 350 pounds, 350 pounds of protein on kidneys. And when we look at what you're consuming in modern day, even if you're consuming the absolute quote, unquote, best, best quality that exists out there is so hard on the body. So one of the things that you were saying that I so appreciate is like, I think that there's this side of it where we've tried to make things basic and simple, and it actually isn't basic and simple, it's personalized. It has to be about you and your choices. And then the final thing that I'll say is I don't think anyone likes a lesson like none of us like to go to school. None of us like to, to be told, even though we're trying to learn all this stuff. And so, so what we've done, and one of my favorite things to do, you'll notice that I mentioned earlier something called a folic acid finding. We create experiments. So we do experiments whether wearing a continuous glucose monitor, we might use that for experimentation. We have our. Are you a hose versus a sponge? Your hydration. To do a hydration experiment. So that instead of saying to somebody, don't drink too much water or are you taking in too much sodium? They're like, I don't know. Or they try to read or they try to track it with chronometer. But if you have to, if you drink 8 ounces of water and you have to pee sooner than two hours, you're probably not absorbing your water. Similarly, if you drink 8 to 10 ounces of water and you don't have to pee for like four hours, then something's going on and we're not eliminating properly. And so, you know, that also helps us to look at what else am I having when I drink water? Am I drinking water via coffee or tea? Or am I having, you know, too much sugar at water one time or different things that are also impacting my hydration status. So when we look at the personalization, I know for people listening, this can sound really complicated. The, the, the most important thing for you to get your ROI on any of your health investments, including your time, including your hope. And this is really key when we bring it back to the glp, one conversation is for you to have someone who can work with you to get those insights and for you to personalize. And it's why we make so much of our content available. I personally do. I get, you know, conversations like this and, you know, I'm writing a book, you know, at the Better Nutrition Program. This is why we work with people all over the country and make it. Try to make it affordable. And if you're working with a practitioner that is not helping you personalize, demand more of that relationship or find a new relationship, because you're going to end up in this space of if somebody sends you out the door with a eat this, not that, and you don't like half the foods on the eat this list, or you don't know how to make them, or they're not delicious, or you don't think you tolerate them, or they tell you just, you know, have this amount of this or don't do this. That's not personalization. It might be a starting point, but, you know, that's where a dietitian or a nutritionist can really be helpful.

The kind of, I mean, that's what's lacking. Right. Like, everybody.

Yeah.

Is they're searching for those answers. And, you know, as much as we're trying to, you know, help explain, I, I find a lot of disconnect with the, you know, the messaging.

Right.

There's so much information that is. I mean, I could spend all day dispelling rumor, myth, and other crazy things that are said about, you know, whether it's surgery or like, someone asked a specific genetic question. And because I've made that such an emphasis in our practice to personalize how we, you know, address patients.

Yeah.

By default, you know, I'm getting asked other genetics questions. And, you know, I'm not a genetic counselor. Obviously, all of the, the things that we learn help, you know, personalize how, how we take care of patients. To your point, like, what are those triggers? Are they somebody who's got the snacky gene? Are they going to binge? Are they going to be someone who has difficulties with detoxification, like you mentioned, either from the GST COMT or FUT2 issues. I mean, there's a whole host of things that go into, you know, why people behave, you know, the way they behave. Certainly trying to wrap it up. I like the fact that you have a book coming out about GL1P1S. I'm sorry, GLP1S. The thing is, by the time it's out, I mean, my gosh, how much further down the road are we going to be with those, you know, medications? Obviously that's to be determined, but certainly it's another tool in the toolbox to help patients. I don't think any one thing is ever going to resolve all of the things that we encounter in daily practice. If people want to work with you or with your team or learn more about you, where can they go to find that information?

Yeah, I love this. I mean, I've been doing this for 25 years. And so all of the materials and the way of being able to get all of this, this is available now. I'm not saying like, hey, wait until January 2026. So head to the Better Nutrition Program. You know, we, this is an opportunity for you to get a truly personalized plan. Whether you work with us to implement the plan or not is totally, you know, your choice on, on that piece. And@thebetternutritionprogram.com you can see the different resources that we also have available that, you know, are, we have free resources, we have access to different tools. If you're a practitioner, you know, we have certification in GLP1 optimization for practitioners and coaches. So a lot of opportunity on that part. And the other thing is, wherever this is posted, if you, you know, however you follow Dr. Rob, we are happy to interact with you. I'm happy I answer questions on my newsletter three a month, ask Ashley's and we go through how would I personalize this? So you also don't have to choose to, to invest at this point in time if that's not an option for you. I do need you to choose to demand more and demand better. That is your, that's your responsibility. I will never say somebody is non compliant if they're trying, but if you are just following what somebody is telling you and it's not, it doesn't feel like it's working or it doesn't feel like it's doable. Please demand more or find a better. I call it a better not perfect. As my sweatshirt says, a better not perfect. Solution for yourself.

Thank you so much.

Thank you.

Thanks for joining me today. I hope you found the information and stories shared on this podcast helpful and informative. Remember, taking control of your health and wellness is key to recovery from breast implant illness. If you're looking for additional resources and support, be sure to visit our online store, Dr. Rob's Solutions at drrobsolutions.myshopify.com you'll find a wide range of wellness products and supplements to support your journey to recovery. From specially formulated detox supplements to personalized skincare products, we have everything you need to aid your recovery. Visit Dr. Rob's Solutions today at drrobssolutions.myshopify.com thank you for listening and we'll be back with another episode soon. Remember, remember, you're not alone in this journey and together we can overcome breast implant illness. Take care.