00:00
Ashley Koff
My first job was working at an ad agency. Kellogg’s was our client and then we had two new cereals. One was called Smart Start and one was Raisin Bran Crunch.

00:08
[miscellaneous speaker]
Kellogg’s Raisin Bran Crunch.

00:10
Ashley Koff
The legal team and the agency all had to get together and figure out what we could say. Turned out we could say that Raisin Bran Crunch gave more morning energy. And why? Because we had more sugar. When the ultra processing of food happened and we came up with marketing terms like enriched flour.

00:29
[miscellaneous speaker]
The meal enriches its white flour with vitamins and minerals.

00:32
Ashley Koff
Insist on enriched flour, which is actually the opposite. It’s the poorest flour, you know. But enrichment sounds, you know, like it’s something people, you know, want in their lives. We are under fueling our bodies.

00:42
JJ Virgin
How much of a role have ultra processed foods played in the fact that we now need GLP1?

00:48
Ashley Koff
Everybody can get all wrapped up in what is in those ultra processed foods. What I get wrapped up in is what is not in there. The day that I first injected myself with that medication, I turned around and I go, you know what? I actually think this is what a normal person’s brain is with food. It was an overnight difference.

01:10
JJ Virgin
Hey, I’m JJ Virgin, PhD, dropout, sorry mom. Turned four time New York Times bestselling author. As a certified nutrition specialist, fitness hall of famer and globally recognized leader in health, I’m driven to keep asking the tough questions and use my podcast to simplify the science of health into actionable strategies that help you thrive. I’d also love to hear your thoughts on the show. And here’s the fun part. When you send me your review, I’ll reply to you using my on demand virtual me. That’s right, my team and I created a virtual JJ packed with my books, speeches and wisdom so I can personally connect with you. Here’s how you do it. Subscribe and leave an honest review of the podcast. Take a screenshot of your review. Text it to 813-565-2627. That’s 813-565-2627.

02:08
JJ Virgin
My virtual JJ will reply directly and trust me, this will make your day. So subscribe now@subscribetojay.com and text me your review. Let’s keep thriving together. JJ here. And I am with my like new friend, but really should be my longtime friend. We met a year ago and I’m like how have we not known each other forever? I still don’t understand it. Anyway, Ashley Koff is a registered dietitian and the Founder of the Better Nutrition Program. And she has a new book out that we are gonna be talking about today. I’m super excited about it. Your best shot, we are gonna be unpacking GLP1s. And she has such a unique perspective because she is a dietitian who’s worked a lot in behavior change, emotional eating, and for the last couple years, you’ve been working with people using GLP once.

03:01
JJ Virgin
So we are gonna talk about this. You’re gonna hear some straight talk, some amazing wisdom with my buddy Ashley.

03:07
Ashley Koff
So welcome. Thank you. Yeah. And we both have reality TV shows and like, other things to our. To this space. It’s so great to have this conversation with you because, you know, from the moment that this came out and people had this awakening about GLPs, maybe like, as a medication, maybe four or five years ago, I’ve. 2004 was when I first understood our GLP1 hormone as it relates to a bariatric patient. But my first patient on liraglutide was in, I think around 2010. So this is like, this is a long time. You know, in that part, I remember you said, and I even did a podcast on that.

03:39
Ashley Koff
We’re like, can we just cut through the BS of who’s what People are saying that blaming the medication for and then what they’re also blaming people for and really look at what is just bad practice with a tool, you know, on that part. So I really appreciated that part of you.

03:55
JJ Virgin
So I’d love to back up because I think that where you come from is so fun.

04:01
Ashley Koff
Earth. We’ll start there. Yes, I am.

04:04
JJ Virgin
You are not an alien. Although sometimes someone wonders, but you came from marketing sugar cereals and processed foods. Yeah. Like, that was your world.

04:17
Ashley Koff
Totally. Yes. Okay, so here’s a story. I wanted to be you. I wanted to be tall, skinny, and have long, straight blonde hair. Like, that was my. I grew up in Columbus, Ohio, and I think I was pretty good with who I was until I was about age 8. I kind of talk about being. If you look back at photos, I was a cross between Shirley Temple and Spanky from the Little Rascals. Like, I was bossy, bold, super empowered young girl and had these big brown curls. Nothing’s changed and nothing’s changed except for unfortunately at age 8, I started to be bullied about my belly. And I had a belly and I was cute, but then it suddenly didn’t become cute. And I had a boy in school who was a bully, take me out back and like, punch me in my stomach.

04:57
JJ Virgin
I wish we’d been friends then, because I was the protector of all of my. I was.

05:02
Ashley Koff
I needed you. Yeah, I needed you. And by the way, like, people did, you know, they would want to protect you. My parents were amazing. Like, they never made me feel like my size was anything other than, like, you’re just strong, powerful, and beautiful. But society told me different. And so it ushered in such an era of dieting. And at first, I tried dieting, like, all the right ways on that part, and. And then I started getting into really unhealthy behaviors, like, kind of going down that whole space. And so in wanting to be you, what I never gave up on my version of you at that time was Angela Bauer from who’s the Boss? She worked in advertising, and I just thought, like, it was the coolest thing. And so.

05:38
Ashley Koff
And I love to sell things, and I was this young entrepreneur, and I’m like, I’m gonna go out and do that. Well, my first job out of college was working in an ad agency. Kellogg’s was our client. Our first were tasked with things like, you know, sugar smacks and so selling sugar cereals to kids. So, you know, that was Cartoo and, you know, make it delicious. And then we had two new cereals. One was called Smart Start, and one was Raisin Bran. But we wanted to make it now accessible for a younger audience. So Raisin Bran Crunch. And that was actually the first time I remember meeting dietitians, because the legal team and the agency all had to get together and figure out what we could say.

06:12
Ashley Koff
Well, it turned out we could say that Raisin Bran Crunch gave more morning energy, which is what we’d learned from the research people wanted than any other cereal. And why? Because we had more sugar. We had sugar on the flakes, we had sugar in the flakes, we had the raisins, you know, et cetera. So here I am, like, hawking those, but also dealing with a body that was really, by that point, breaking down. I was a macrobiotic vegan who did yoga and didn’t drink alcohol in New York city at age 20. Wow. I was, like, not fun at all. No fun at all. I tried being real fun. You know, drinking was a college sport for me, and I tried that part. I tried so many different things.

06:51
Ashley Koff
But what it didn’t end up happening for me was a rock bottom moment where doing all of that wasn’t working. And I had met a healer at yoga, and she pricked my finger and looked at my blood. I think through a Fisher Price microscope. She told Me, I had a worm. And that to kill the worm, I had to drink goat’s milk for seven days. And I drank goat’s milk. 40 ounces. This is 1996. Do you know how hard it is to find goat’s milk? So I’m like, schlepping to find goat’s milk, and I did it. And I actually had a flat belly during it. And she also told me that if I looked at my poop, I would see that I was passing the worm. Well, spoiler alert. If you’re only drinking goat’s milk, your poop looks like a white worm that passing.

07:24
Ashley Koff
But the problem, like anything, is when a cleanse ends. When the master cleanse ends, like any of this.

07:29
JJ Virgin
Oh, God, the master cleanse.

07:30
Ashley Koff
I remember the master cleanse. I mean, literally, I’ve done it all. So when it ended, I found myself having gained weight back. Like, the ten pounds I’d lost, I’d gained. And I gained one more pound. So I did what everybody does when we, like, absolutely rock bottom. I went to a bar and did shots of tequila and was chanting with people telling my story, kill the worm. Kill the worm. And a gastroenterologist, I did not know this at the time, comes up to me. He was eating a burger. He was not up at the bar. And he goes, by any chance, did you take antibiotics as a kid? And I looked at him, I’m like, that was the weirdest pickup line I’ve ever heard. Right? And then he says, no, Like, I’m actually. And I said, yeah, I freebased them.

08:06
Ashley Koff
Anyway, he gives me his card. I go to see him, and he said the most important thing. And this is, I think if anyone takes anything away from this conversation, it’s not what you’re eating or what you’re not eating. It’s that your body doesn’t have what it needs to run better. And that changed my life. It changed my life because I had been in this place where it was all about my weight, and it was never about my health. But yet I’d been on antibiotics. Antibiotics and all these medications, and now somebody put it together for me and said, your belly, the body, inappropriately making fat mass or putting it where it doesn’t belong, that’s a key performance indicator. You not making muscle means that’s a key performance indicator of your weight health. And suddenly it was like the world was open.

08:46
Ashley Koff
And I learned how to, you know, you heal your digestion. You work on these other pieces. So it was a long way round of starting off In a real dark hole of selling cereals.

08:55
JJ Virgin
And then you went back and became a dietitian.

08:57
Ashley Koff
And I became a dietitian. Kicking and screaming. I quit all the time because I felt like what I was learning in school.

09:03
JJ Virgin
That’s true.

09:03
Ashley Koff
Dietitian didn’t actually help me. But I got some great advice. At one point somebody said to me, just become the dietitian. Get the letters after your name and then go out there and change things. So that little eight year old girl is out there trying to change things on the cart.

09:15
JJ Virgin
Thank you for doing that too. Because it’s like that’s always driven me crazy. I remember I was in one class and we had two of our professors and they were like, you can get all the nutrition you need from a potato.

09:26
Ashley Koff
Yeah.

09:26
JJ Virgin
And I’m looking at them and they looked like potatoes.

09:28
Ashley Koff
That’s right. That’s right.

09:30
JJ Virgin
Like, I don’t think so.

09:32
Ashley Koff
I don’t think so. Yeah. And that’s when you actually see someone visually and you’re like, you look like a potato. Well, you know, then I was working in Hollywood and it’s like I have all these people that look the part, you know, and some people would call them lollipops. They were like so thin and had bigger, you know, heads on that part. So they were even on the thinner side. But inside they were not a potato. It was like all things were going wrong. And so I think, you know, we have this society today where we are still judging people based on their appearance, were judging their health. And you’re in my book. This is such an important point. I’m in your book. You are in my book. Yes. You are in my book.

10:05
Ashley Koff
And you know, that conversation around we need to break up with the idea of weight loss. We need to break up with telling somebody that you’re a certain way because of your appearance. We have to be able to lift, we have to be able to move our bodies, all of these other things. And so the fact how you’ve talked about muscle and how you’ve said to women well beyond 40 that it’s a about what you’re able to do. We have to build strong bodies, you know, that’s just such a powerful message.

10:31
JJ Virgin
I don’t know if you know this story, but back when I was in high school, because I was so tall, I kept. Everyone goes, you should be a model now. I’m not photogenic.

10:42
Ashley Koff
You are photogenic.

10:42
JJ Virgin
No, I’m not. If you see a great picture of me, it was like a thousand pictures to get there.

10:47
Ashley Koff
I love that.

10:48
JJ Virgin
It was Photoshopped.

10:49
Ashley Koff
I gotcha.

10:50
JJ Virgin
There was makeup artist involved. There was a lot of.

10:51
Ashley Koff
I see the beauty in you, but okay.

10:53
JJ Virgin
Yes.

10:53
Ashley Koff
All right.

10:54
JJ Virgin
So I’m always like, oh, my gosh. So basketball, volleyball, and be a model, so. Which, by the way, you cannot do both of those. That’s right. Unless you’re gabby rich. So I go off to San Francisco to the modeling agency, and they go, how much do you weigh? And I said, 140 pounds. And they go, you need to lose 20 to 30 pounds.

11:15
Ashley Koff
Stop, stop.

11:16
JJ Virgin
Like, I’m the same now as then, except I have a little more muscle.

11:21
Ashley Koff
Yeah.

11:21
JJ Virgin
And I was like, okay. I go home.

11:24
Ashley Koff
Oh, my God.

11:24
JJ Virgin
I go to the library. I get a diet book. I get a calendar. I mark down my calories every day. And a couple weeks into this, I now can’t do basketball, I can’t do track, and I am dying over here. And one of my coaches was like, are you anorexic? What’s going on here? And thank God. And I realized I’m like, wow, I can either. And I’d always been strong. Like, I’d always been this muscular strong, and that was my identity. And I’m like, I chose that.

11:52
Ashley Koff
Yeah. I love that. It’s such a profound point, because one of the things that I talk about in the book. Yes. And certainly publicly. Not that, like, I felt like it kind of surprises me at 52 that I’m needing to share my whole personal life. But one of the failures was I tried every eating disorder that exists out there.

12:08
JJ Virgin
You weren’t good at any of them. Yeah.

12:10
Ashley Koff
And to carry a badge is a failure. Like, I’m a failure on the eating disorder side. I didn’t have your athletic intention or that skill where I was like, oh. I have my other people that are saying, like, hey, you’re strong on this. But I did have a lacrosse coach who I was very modest, but I loved playing. And I went and I face planted on the field, and he’s like, what did you eat? And I was like, so proud. I go, nothing. And he goes, okay, you can’t play. And I was like, what do you mean? And I had to sit. I had three chaperoned meals a day for a week before I was able to get back out on the lacrosse. And I. To this day, I think of him, he was a young guy.

12:45
Ashley Koff
I think he was even a grad student. And I’m like, you like, thank you for adulting in that moment. So I’m so glad that you had that pivotal change. Cause otherwise we would all be in this, where we see so many women having what they’ve carried Forward into their 40s and their 50s. Is this, like. I have figured out a way, whether it’s willpower or whatever, to control my eating to such a degree that my appearance looks the way that I believe society wants it to look, or even the way I want it. But unfortunately, then what happens for them at 40. Right. Is then they’re falling apart inside and suddenly they get it out.

13:17
JJ Virgin
Then perimenopause.

13:18
Ashley Koff
Exactly.

13:19
JJ Virgin
Everything goes sideways for them.

13:21
Ashley Koff
Yeah.

13:22
JJ Virgin
Yeah. It’s interesting because one of the things that I love, that I heard from a mentor early on, is you don’t lose weight to get healthy. You have to get healthy to lose weight. And what I’ve taken that to is you have to get healthy so that your body can hold onto muscle or better yet, build it while you’re losing fat. The first time I’d heard about weight health, now I see it everywhere, was you’d written something. What the heck is weight health?

13:43
Ashley Koff
Yes. Yeah.

13:43
JJ Virgin
What is this term?

13:44
Ashley Koff
Yeah. So I’ve decided marketing, actually selling sugared cereals has paid off. Right. I have taken marketing to trying to market better nutrition, including creating a definition for better nutrition, because one didn’t exist. And then what I realized was society had been talking to me, always about my weight and telling me that my health was fine and my weight was an issue. And we have perpetuated that myth down to when I was seeing patients for weight loss surgery. I wanted to call it health gain surgery. They’re like, nope, that’s not the case. When somebody goes to a cardiologist because of a heart issue, the cardiologist is like, let me work on your heart. And they might say, like, if you lost some weight, if you could just go over there, if you could lose some weight, it would help you on that part.

14:23
Ashley Koff
But they’re not looking at it as a weight health thing. And so what I realized is if I teach people that your body is a weight health ecosystem, if you understand that every choice that you make, what time you go to sleep, what food you eat, what food you don’t like, all of these things, they’re going to have impact, and then they’re going to also have other impacts in the ecosystem. If we realized we’re a weight health ecosystem, then something really incredible happens. In 2004, when I saw my first bariatric patient, I saw overnight their diabetes went away. Then I saw over the course of one week that their Entire relationship with food, with appetite, with cravings, with hunger, all of that changed. And the doctor kind of flippantly said to me, well, yeah, that’s their incretin hormones.

15:04
Ashley Koff
And I was like, what is an incretin hormone? I was a total geek in school, like in grad school. I’m like, I’ve never heard of this. And at the time were only looking at it as glucagon and insulin. But what we learned was there are these hormones and that tell those hormones to work. There are these hormones that tell leptin and ghrelin, which are our hunger and satiety hormones, to go to work. Well, those incretin hormones, incretin is like a tough word if you flip it and you actually call them. They are GLP1 and GIP and PYY and CCK and Amylin and GLP2. And we can keep going on if we call them weight health hormones. We now understand our body is actually designed with hormones that based on the signals that it gets, it goes and tells the body what to do.

15:45
Ashley Koff
Those hormones, GLP1 does not just tell you not to eat GIP. They tell the bone mass, they’re involved in bone formation, they’re involved in your fat mass, the type of fat mass where the fat mass gets allocated. PYY scans your poop and then checks with the body to see how hydrated you are. And it affects your hydration, which affects your blood sugar, which affects your metabolism. So the body is so much smarter than we ever gave it credit for. So we can’t have a weight or health approach. We actually are failing. And to the tune of 9 in 10Americans Don’t Meet the criteria for metabolic health. I think probably 9.7.

16:23
JJ Virgin
I was gonna say it’s higher now.

16:25
Ashley Koff
It’S higher, but 9.7 don’t meet the criteria for weight health. Weight health hormones. The GLP1 conversation is not for fat people. It is also not a diet and exercise conversation. It is a physiologic conversation to understand how do we optimize our body and then to also take into account that modern serves up a lot more challenges to our weight health hormones than say, pre industrialization.

16:48
JJ Virgin
Well, that’s exactly. I mean, thinking about that, how much of a role have ultra processed foods played in the fact that we now need GLP1s? Yes, like, so you’ve just taken a diet that is now 70%, the average person, 70% of their diets, ultra processed foods, which the key thing that these things have been engineered to do is decrease satiety.

17:12
Ashley Koff
Yes. Override our satiety mechanism. Right. Salt, sugar, fat. Thank you, Michael. In terms of that, I think the other piece about it, and everybody can get all wrapped up in what is in those ultra processed foods. What I get wrapped up in is what is not in there. We come back and we say, the body is an operating system. So most of us know a car or maybe an iPhone or something. It’s an operating system. And we have for the longest time set the standards for suboptimally resourcing an operating system. If that happens and you go in and you say, okay, I’m going to make sure there’s gas, there’s air in the tires, gas in the tank, air in the tires, and oil in the engine.

17:51
Ashley Koff
But if the engine actually doesn’t work, then you have this whole issue there where you’re like, okay, it doesn’t matter that your car is full of this stuff if it literally doesn’t work. So number one, if digestion does not work and our weight health hormones are in our digestive tract, if it doesn’t work, I don’t really care what you’re taking in. So number one, we’ve gone through this space of. Of healthy food versus not healthy food. We high five. When you eat kale or when you eat wild salmon, the body doesn’t. That’s like, basically, if I eat wild salmon and I’m like, I’m so great. That’s like me presenting a paper to my teacher and saying, thanks, here’s the paper. I got an A. And the teacher comes back, they’re like, no, you got a D. I’d like you to rewrite three paragraphs.

18:28
Ashley Koff
You know, so for a lot of us, the salmon isn’t getting to the muscle or the salmon. Or maybe the salmon gets to make the muscle, but we don’t have enough leftover for it to make hair, for it to make skin, you know, for it to do these things because we’re suboptimally resourcing it. And the dietary amounts. I know we have dri’s today. I like to call them. I like to use the term of the RDAs from the old days. So the recommended daily allowances, because I like to call them really dumb amounts. Like they were so dumb. And they still are. And when we look at that, we’ll come in and we’ll say, all right, for magnesium, it’s suggesting 400 milligrams is enough for the body. Well, for most of our bodies, we need maybe 6, 800 milligrams. Right.

19:05
Ashley Koff
So instead of having 10 units of magnesium, if we have needs for 10 units, instead of having 10 met, let’s say that we only have four. We don’t get to say to the body, I would rather poop than have my heart muscle pump. The body’s like, sorry, one of those four is going to be, we’re going to have the heart muscle pump. Right. So it doesn’t really care if it takes you longer to poop or longer for the stress to turn off. So when the ultra processing of food happened and we came up with marketing terms like enriched flour, which is actually the opposite, it’s the poorest flour, you know. But they came up with the term enriched. I know because it was during my marketing time. It’s like, we’ll make you feel rich.

19:39
Ashley Koff
And enrichment sounds, you know, like it’s something people, you know, want in their lives. It’s so devoid of the ingredients that we need. So enriched flour has 70% less magnesium than the shaft of the wheat. Right. So that food product now comes in and is contributing to us being suboptimally resourced in that part. I think at the end of the day, we’ve, we have created the problem. There’s two reasons why we need the agonist, but one of the reasons we have is because we are under fueling our bodies, which goes back. This is why you’re in my book. This goes back 100% to what you will say is it’s not about what you lose, it’s about what you’re building with. You know, I think that’s so important.

20:17
JJ Virgin
I want to really get into GLP1s because I feel like there’s so much misinformation out there. First of all, it’s just one of the weirdest things about this is that it’s such an emotional issue and there’s all this shaming and hype and I’m like going, why is that? Like you don’t hear that about thyroid hormone or insulin and you’re still.

20:36
Ashley Koff
Or statins or proton pump inhibitors or any other medication.

20:39
JJ Virgin
But this one’s like, it’s like this weird shaming thing. Let’s start with. Cause you mentioned it earlier, but I’d like to unpack it further. What are they really doing? What are they not doing? What’s the role of GLP1? And then if you’re using it as a medication as opposed to your body naturally producing it.

20:56
Ashley Koff
Yeah, and you went right there because you mentioned insulin and Thyroid. So we have been in the business of hormone replacement therapy for diabetics for thyroid and for sex hormones for a long time on that part. Those are bioidentical hormone replacement therapies. So yes, they’re made in a lab, but they are meant to work the exact same way. And you know, like my five year old nephew is type one diabetic. It means for him that we keep him alive. Cause he can get that insulin, right? Or somebody needs estrogen. And it might not be that they have no estrogen, it might be that we need to boost up a little estrogen or a little testosterone. And so we use some of it. But being bioidentical means that it actually comes in and it works exactly the way that the body’s own works.

21:36
Ashley Koff
The difference with these weight health hormone replacements, which is what semaglutide and tirzepatide are, is that they are biosimilar. So let’s use that. Biosimilar means when the body receives them. So we take an injection or we take a pill and the body receives it goes right to the receptor sites, which we now know, thanks to these medications are all throughout our body, not just dealing with blood sugar and in the brain for satiety. So it goes to the receptor sites. It circumvents all of your own work. Like it doesn’t need to be digested, it doesn’t need to be deployed, it doesn’t need to wait for a signal. It just goes there, right? So it’s going to go there and then it is going to work exactly like your body’s. So the dissimilarity is it goes right there.

22:16
Ashley Koff
It doesn’t require signaling to be secreted and you know, all of that stuff. The other dissimilarity is the ones in our body stay on for about two to five minutes. Two to five minutes. These stay on for. The first ones were 24 hours for a day, and now these are 24, seven. And they’re even looking at ones to extend longer than that. So think about if you had a motion detector outside in front of your door in case somebody walked by, right? And it sets off a bell on that part. So think about your electrical bill. If that just happened, two to five minutes, maybe like a couple times in the day, the light was on for what, like a total of 30 minutes. So you pay for electricity.

22:50
Ashley Koff
These, the light is on for like you went on vacation and you left a light on in your house. That’s gonna be like, you know, a lot of hours on that part and a higher electrical bill. What we’re seeing when you’re on the medication is the body is paying the cost of a higher electrical bill. It’s getting. There are a ton of pros, but one of the considerations is this is going to stay on much longer. The pro is for many of us, two to five minutes isn’t enough because unlike in a pre industrialized society, we are actually dealing with motion detector issues almost 24 7. We have things coming up on our social media or, you know, we’re driving by potential food choices or our, you know, our memories of things or smells of things or, you know, just all of this messaging.

23:33
Ashley Koff
So that’s happening all during the day. So we probably need something more than two to five minutes. So that’s where that is advantageous. On the flip side, if you stay metabolically active, you’re not in rest and digest. Your body isn’t relaxing. So I have patients who have fatigue. I have patients who their heart rate variability a marker of how are they in that rest and digest or not, that’s going lower. I have people where they don’t even have the energy to exercise. And that means wrong dose. And also their total nutrition is not being optimized to address how this medication actually works.

24:05
JJ Virgin
Is the energy, is the low energy because they’re not eating enough.

24:09
Ashley Koff
Those people probably aren’t eating enough. So first of all, it could be some people are so suppressing their appetite that they literally aren’t eating all.

24:16
JJ Virgin
Day, which just says this is the wrong dose.

24:19
Ashley Koff
It’s the wrong dose, definitely. Or they also haven’t gone over a plan where it’s like, even at a low, like even at the right dose, we might have to not rely on your hunger cues. We might actually have to be a little bit like for the first time in your life, you might not be hungry, but I need you to eat every three hours. So I have some people where they have an alarm that goes off and it’s like, okay. Or they know those set timings for a while. It’s kind of like retraining the body on that part, you know, So I think in that way that’s key. But we have to recognize that fatigue happens for two other reasons. The body is on all the time. It’s pushing insulin, it’s pushing leptin and ghrelin. It’s telling the body to go do this.

24:55
Ashley Koff
We need to help it, you know, be turned off a little bit. The other part is it’s delaying gastric Emptying. So gastric emptying, you know, when you have these hormones go on, might be activated, delayed for like an hour. When you delay it for a much longer period of time, you’re affecting your entire microbiome. It might mean that the salmon that you ate is not getting where your body needs it for like three or four hours. So your fatigue is not that you’re not eating, it’s that it’s not getting there in time. Or it might be that suddenly, like, you’re not breaking it down. So maybe we need to add digestive enzymes, or maybe we need the first two days of medication for you to get it in a liquid form. Like maybe, you know, your protein drink. I love.

25:33
Ashley Koff
Cause we get all the amino acids in there. Or we can, you know, get things from bone broth, you know, and do different things. And so, like, those are the considerations in there. It’s also not what a doctor is going to recommend. Like, I am sitting here as a dietitian who’s been practicing this way for 25 years. Like, when we think about the medications, another pro and consideration is who’s the right user of the medication and a dietician who has the right training or a nutritionist, I should say, like a qualified nutritionist is going to come in and help somebody personalize how to use the medication and then say to the doctor, you know, based on what we’re seeing, let’s change the dose or let’s adjust some of this. So I think there’s a systemic issue there too.

26:13
JJ Virgin
This really lends itself when you look at GLP1s. To me, I think before you get on a GLP1, you should be working with a dietician or nutritionist and working with a trainer. You’ve gotta get those pieces in place and then you start dosing it lowest dose. Just get to the point where you’re getting the like, if that would be my perfect world, I worry. And I just pinged our buddy Dr. Tina about this. Cause I was like, would it be that GLP1s would create SIBO?

26:46
Ashley Koff
We all wish in that, like, perfect world that we could actually, like, see the patient beforehand, right? That never happens to. To me, if you’re listening to this and you’re one, you absolutely have to step into the space where you’re like, hold on a second. Even if the place I think that I’m like, so stoked because the place that I’m buying it from makes the dietitian optional, it cannot be optional for you. I also recognize not everybody’s trained the way that I am. I also wrote a book so that, like, hopefully, you know, there’s a playbook on that part. So that’s number one on that piece. The thing to understand about the medication is it will exacerbate any underlying weight health dysfunction. Any underlying weight health dysfunction. So if you had underlying digestive issues, it is going to exacerbate it. Absolutely.

27:26
Ashley Koff
If you will, it create them. Very likely. Like, very likely. And especially as we go up on those higher doses. So when we talk about sibo, we talk about ibs and we talk about a variety of different things. Let’s think about three things. If I already have some digestive issues, it is going to make those worse. Now I can work on those issues while I am on the GLP1 agonist and especially on that lower dose. I thought where you were gonna go is Tina and I were text one day because I was like, I think we’ve lost the battle. We’ve absolutely lost the battle. I was like, you use the term microdose. I learned about microdosing from her. You had us on a panel. I was like, this is your brilliance on that piece. And suddenly it was published.

28:03
Ashley Koff
And I said, you know, from a marketing standpoint, now, microdose is being the term for low dose. So when somebody says microdosing, they mean low dose. A microdose is not actually going, per tina and I 100% agree with her. That’s not what you use for weight composition. Like, that’s where you’re, you know, using something very targeted. But the interesting thing about the SIBO piece that I also don’t think is getting enough attention is of course we’re going to have microbiome alterations, because I just told you that the medication circumvents your own body’s system for turning these weight health hormones on. So the process exists there, but it’s kind of like the gut is frozen. Like, it doesn’t need to do it. The receptor sites are satisfied. So your brain might send a message down there. But what’s Akkermansia doing?

28:48
Ashley Koff
Do we need butyrate like all these other things? We know you absolutely do. And we especially know if you ever want to be able to come off of or if you want to, you know, be at a lower dose, et cetera. When you’re on these medications, they are suppressing. At best, they’re suppressing your own body’s weight health hormones. At worst, they’re fully turning them off. So it would be kind of like if I Said to somebody who is on a proton inhibitor that’s totally suppressing acid or someone who’s on a statin medication that’s interfering with the formation of cholesterol, nothing else is going to happen in your body. Are you kidding? We know that like if you’re on a statin, your testosterone is going to go lower. We know your CoQ10 is going to be an issue.

29:25
Ashley Koff
The plaque formation and the endothelial glycocalis in your blood vessels, that’s not going to improve just because you’re on the statin. Right. And so this is the exact same for this medication. But because this is a weight related medication, the bias isn’t having that conversation. The blame goes either to the medication or it goes on the person who’s using it. Using it.

29:44
JJ Virgin
So you mentioned something and I’m assuming in the book.

29:48
Ashley Koff
Yeah.

29:48
JJ Virgin
Do you talk about how if someone wants to come off of these, even if it’s just now, instead of shutting off your body’s production, you’re overproducing these and you get used to the overproduction and not having to worry about food cravings, or do you believe that people can come off of these successfully? Because I know that’s one of the other arguments which I’ve always found a little ridiculous, to be honest. Because they’ll say you might need to be on these for life. I go, well, if you were on this and you got off your blood pressure medication, your statin medication, all these other, your diabetic medication, you lost the weight, but you had to be on this for life. You’re one thing versus five things. I don’t know, I call it a win.

30:25
Ashley Koff
Oh my gosh, so many of my patients are going off so many other medications. So I love that you said, and let’s be clear, if you have any physiologic or psychologic benefit on this medication, you’ve actually proven my thesis. You had suboptimal functioning of your own in that part. And it is not a question of suppress. So there’s actually research on liraglutide. Nobody has done it on semaglutide or tirzepatide to say that it turns off or that it suppresses your own. But we have that from liraglutide. So I know that it suppresses your own because when a receptor site is satisfied, your body doesn’t call up on it. So it may mean that they’re just sitting there like, and they’re hanging out and they’re like anytime you call us action, it’s totally cool. But nobody’s calling us on that part.

31:04
Ashley Koff
So when we look at that, then the question is, do we need to come off of it? There’s tremendous weight bias that’s suggesting that the finish line for any of those fat people, and I say that with fat in quotes and with a lot of sarcasm for that fat or obese person or that diabetic, like, you’ll be a success when you come off this medication. You need to go on this medication to learn how to do all those things you don’t know how to do. Let us tell you all about that.

31:28
JJ Virgin
Which I can tell you. Anyone who struggles with weight knows more.

31:30
Ashley Koff
About anyone compliant patient. I mean, literally, like I challenge somebody to tell me that they have gone as. I mean, unless you’ve done a seven day goat’s milk cleanse, I don’t know if anyone’s done as many different things. But we are not non compliant. And I think, you know, when you look at that and you come over to that side and you say, is the destination you coming off the medication? It does not need to be. Especially if to your point, it’s helping you do all these other things on that part, right? It’s enabling you to come off other medications. It’s enabling. So number one, I don’t want to set the goal post there. Now there’s a very real issue that’s a budgeting issue, that’s an access issue. Maybe my insurance takes it away from.

32:10
Ashley Koff
Maybe I don’t have the money to stay on it for however long. And I have those conversations. It’s another reason why places that are just offering a prescription to these or doctors that are just scripting it and not having the bigger budgeting conversation is a problem. You need a coach or a dietitian to have this. Because if I know that somebody only thinks they have a budget for a year of my services and of the medication, we’re going to work on their dosing in a very different way and we’re also going to work on their timeframe in a different way. So can you come off of. Absolutely no, never. If you don’t change anything underlying. And that is the same for every single medication that’s out there. Or like that would be like me being like jj, I rocked it.

32:50
Ashley Koff
I finally figured out how I can do like three pull ups, which that’s my goal. Right now I’m working on the three pull ups and then it’s like, okay. And then if I get to those three pull ups. And then I stop strength training. And 10 years from now, I’m wondering why I can’t do three pull ups. Like, no, you gotta do the work right. Like, we’ve gotta keep doing. So you have to stay on it. If we don’t fix what’s underneath, the question mark is, can we optimize what’s underneath? Yes. And no practitioner ever should say to you, because we don’t have a crystal ball, that you will be able to come off of it and you will be able to stay off of it in your life. If they’re doing that, they’re selling something other than you and having healthy outcomes.

33:25
Ashley Koff
What I will say to someone is, I have worked with patients on it. I have worked with patients having them come off of it. I had a woman, I share her story in the book where she came to me, having been on the medication, lost 60 pounds and said, My doctor recommended you. I’m ready to come off of it. I did my weight health hormone assessment, which is in the book and online, and I went through it with her and I said, you are not. I was like, you’ve lost muscle, you’ve lost bone. We also don’t have this and this in place, but I think we can get that in place over the course of the next six months. So we worked on that and during that time period, weaned her. So we kept her on the same dose and we extended the dose.

33:58
Ashley Koff
I then brought in Amerisate callocurb because when she started to have some of the food noise and the cravings come back, we used that to extend it. And she did beautifully. Then she goes. And then I didn’t hear from her. And what happened, what was great in that part is I was working with her and I was working with her therapist and her doctor. And we signed something and it’s like, if you want to ghost me or you don’t want to work with me because maybe you don’t like me anymore and you want to go work whatever happens, you don’t have money, any of that stuff. And that’s what had happened. She felt bad reaching out to me.

34:24
Ashley Koff
She was going through a custody battle that had, you know, the divorce had been where she had put the weight on, and now the custody battle was. And it was a real financial issue and she didn’t feel like she could afford me. She went to her therapist and therapist came back to me and said, she’s gained eight pounds and she feels like a failure. She feels like she had finally gotten to the place where she was off this. I said, first of all, you are not a failure. Eight pounds. We’re in good shape. If you had come back to me at 60 pounds of regain, I would have been really upset. But I said, don’t pay me what I want your therapist and your doctor to do. We have all the tools that are there. I’ve given you the plan.

34:54
Ashley Koff
Let’s go back on the medication. Let’s go back to the weaning schedule. She went back on it another six months. She actually was at half the dose because she continued using the calocerve and we had tuned up her digestion and these. She leaned into it. And after that, she came off of it. But she does something really funny right now, which is she keeps the medication in the refrigerator. And she said, my identity is not about me being on or off a medication. And what I want you to hear in that and for any of us, and what I take away from it was that at the moment in my life when that little boy hit me, I suddenly saw my belly as a weakness, and I wanted to be strong. And when I became weak, I felt disempowered.

35:32
Ashley Koff
And that disempowerment just became this snowball that really visibly was belly. Every time I tried a diet and it didn’t last. On that part, we feel so disempowered, and our patients feel so disempowered. And if you use a medication wrong, you’re going to contribute to that disempowerment. In this case, this woman is now so empowered through her entire weight health journey, you know, on that part, and she feels like, okay, if I ever need this again, no issue. On the flip side, I have a patient that came to me and was adamant. I don’t want to use a GLP1 Agony. 42 years old. We worked with her. We helped her. 90 days. She had pretty much lost the fat that she needed to. And then another 120 days, and she was doing beautifully. And she said to me now, like, I’m great.

36:15
Ashley Koff
Like, I’m all good. And I said, so I kind of thought I was all good from 30 to about 48. And then my belly showed up. My belly showed up. I was traumatized. I had read Mindy Peltz’s book. I was doing fasting like a girl. Shorter and shorter periods of eating. I was drinking coffee and not eating. All my intake was down. I was training for an endurance event, doing zone two and no strength, creating jd. I was a mess I blew up.

36:38
JJ Virgin
I did not know you yet.

36:39
Ashley Koff
I had £20 on myself and, you know, on that part. And it turned out I also had a massive fibroid. My uterus was like five times the size. And I am so grateful, you know, for that intervention. And people always ask me, like, what’s your journey? You know, and all of this other stuff. I had somebody very bluntly be like, are you on a GLP1 agonist? As if, like, I’m going to be snotty about you or whatever. And I was like, first of all, like, nobody ever has to say, you know, on that piece. But. But because I wrote a book and I’m very open about my public story in there, I do think I have to say, at 48, I didn’t decide.

37:08
Ashley Koff
But when I had done the endurance event, I then came round and I had gained 20 pounds of fat and had climbed, had basically done an Everesting event because I had not, you know, all this other stuff. My cortisol was a mess, my labs were a mess, all of that. And I met our friend, Dr. Tammy, and I was like, tammy, like, I’m so. I’m writing this book, I’m doing all this other stuff. She’s like, well, why don’t you try an agonist? And lo and behold, I looked at myself and I was like, I have weight health bias. I was like, I think that would be like, me failing. Like, I shouldn’t need to go on it or whatever. I went on semiglutide. I used the low dose at the lowest dose. I was constipated. And I will never allow myself to be constipated.

37:48
Ashley Koff
I tried everything under the sun. I was on it for about three months. I lost about 15 pounds of fat. I was back in the gym. I was doing my strength training. I finally got healthcare again. And I went to someone and she’s like, you need a hysterectomy. And so I ended up coming off the medication and not the agonist and having my hysterectomy and doing all of this stuff. I’m 52. My hormones are still, like, you know, going around. Cause now I’ve had a hysterectomy and I’ve been off the medication since. So I used it maybe for about, like, four months. It’s sitting in my fridge because as estrogen and everything else goes away, like, and, you know, I’m out on book tour and everything else if I need that tool ever again.

38:23
Ashley Koff
And I will say, the day that I first injected myself with that Medication. I turned around and I go, you know what? I don’t believe in the word normal, but I actually think this is what a normal person’s brain is with food. It was an overnight difference for what it calmed in my brain, which is my eight year old brain. And when I look at my genetics, my predisposition for obesity, my predisposition for leptin resistance, you know, for some of these other pieces. So what I will say on that part is like, I am a walking example, but I’m not gonna tell anyone that I’m never gonna use this again.

38:54
Ashley Koff
But I feel like, you know what, for me to use it in that time period and to feel empowered and to say, like, I mean, I think I have access to like every tool under the sun. This is a game changer in that space. But it also has to be used properly because I was not gonna be somebody who was going to fit into a pair of clothes and have either sibo come on or have be constipated, you know, all the time. So I think it’s really important to recognize that this is a tool like anything else is a tool and how do we use it?

39:24
JJ Virgin
Yeah, I love that it is a tool.

39:25
Ashley Koff
I don’t know if I’ve talked about that with anyone. It’s even better for the book on that part. I’m like, all right. Yeah, there we go. Yeah. It was a very short question of, hey, do you think people can come off of it? I think we have to change that. That’s not the destination. I think that people can achieve their weight health and it is an ongoing optimization effort. When you optimize weight, health, hormones, how you do that. GLP one shot or not.

39:45
JJ Virgin
And there’s calocurb.

39:46
Ashley Koff
Yes.

39:46
JJ Virgin
And you know so many things and.

39:48
Ashley Koff
Your book to help them.

39:49
JJ Virgin
Yes, yes. Your best shot.

39:51
Ashley Koff
Thank you.

39:52
JJ Virgin
Out now, Amazon, everywhere else, everywhere. So grab it. Thank you for writing that. Thank you for being vulnerable. I appreciate it and I’m just glad you’re a mother.

40:01
Ashley Koff
Thank you. Same.

40:02
JJ Virgin
That was an amazing interview and I just want to make sure that, you know, we have some great resources for you. I’m going to put them all@jjvirgin.com YourBest shot for Ashley’s book. And we will put in there Ashley’s book, some of her bonus materials and also some information on our buddy’s Calicurb product that has been found to boost GLP1 as well. So lots of great resources there. Make sure you check it out and grab the book at the so Definite for your Success library. Be sure to join me next time for more tools, tips and techniques you can use to look and feel your best and be built to last. Also, I’d love to connect with you and hear your thoughts on the podcast. Here’s how. First, subscribe to the podcast and leave an honest review.

40:50
JJ Virgin
Second, take a screenshot of your review and third, text it to 813-565-2627. That’s 813-565-2627. When you do, I’ll reply using my brand new Virtual jj. It’s my on demand virtual self built from my books, talks and years of experience so I can interact with you directly. You’ll make my day and I can’t wait to hear from you. Thanks for tuning in and I’ll catch you on the next episode. Hey JJ here. And just a reminder that the well Beyond 40 podcast offers health, wellness, fitness and nutritional information that’s designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis or treatment. Treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.

41:51
JJ Virgin
Make sure that you do not disregard, avoid or delay obtaining medical or health related advice from your healthcare professional because of something you may have heard on the show or read in our show Notes. The use of any information provided on the show is solely at your own risk.

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