Sharon Bergquist, MD: Hello, and welcome to the Whole Health Cure, a space for trustworthy science-based information on how you can live healthier, longer, and happier naturally. I'm your host, Dr. Sharon Quist, a Yale and Harvard trained physician with three decades of experience in chronic disease prevention, longevity and human performance, And the author of The Stress Paradox, why You Need Stress to live longer, healthier, and happier.

Today's conversation is about weight health, what that means, and how to achieve it, especially in the age of GLP one medication. No matter where you stand on these drugs, I think you'll find this conversation truly valuable. I'm joined by Ashley Cough. She's the USA today bestselling author of Your Best Shot And the founder of the Better Nutrition Program and acclaimed weight health expert and practitioner for more than 25 years.

Ashley is a leading a transformative movement in personalized nutrition. Turning better not perfect choices into practical, sustainable strategies that deliver real outcomes. Your best shot introduces weight health hormones as the regulators of weight health offering the first ever assessment of their function and a personalized optimization system. Shot or not, a trusted expert featured across major media and a sought after educator for health professionals.

Ashley has been recognized as one of CNN's. Top 100 health makers and featured in InStyle as Hollywood's leading dietician. Ashley, welcome.

Ashley Koff, RD: You so much. It's a pleasure to be here.

Sharon Bergquist, MD: Oh, Ashley, I'm so glad we were able to coordinate this and huge, huge congratulations to you. So this wonderful outstanding book is now a USA Today bestseller. So congratulations.

Ashley Koff, RD: Thank you so much. You know, it's, I think whenever we write a book don't think for us as healthcare practitioners, that's the goal, but then somewhere along the line you realize, wow, I really want everybody to have this. And then, then you turn in and you're like, okay. That, you know, becomes, it's just such an important marker.

So I'm really grateful and, grateful to everyone who's been supporting it.

Sharon Bergquist, MD: Yeah, it's, it's really just a recognition of how valuable the work that you do is and how much it resonates because I think it's so needed, you being in primary care and internal medicine, we have so many conversations around weight. and I'm really excited to get your perspective from all of your experience.

Let me start by asking you to give. Background about your story, how you became a registered dietician, and to ultimately writing the book.

Ashley Koff, RD: Yeah, I think the story of the book, which actually includes my story and it is probably. best place to start is to recognize that while there are certainly aspects of my story that are so unique and I hope unique, 'cause I'll, I'll go through those in a moment. but, my story is one of so many individuals, especially as I've gone around the country having these conversations now I, so many people are saying, yeah, me too.

And this part of it is that, we were taught if you ever had any type of a weight issue, for me, it was a belly. And, really from age eight that belly Society told me it was an issue. Kids bullied me. I bullied myself. I was, very motivated to get rid of that belly.

I was simultaneously told that I was healthy. So like every sort of turn, great news, you know, it was like there's nothing wrong with you, but you need to manage your weight. And to do that, you need to lose weight. And to do that, you need to eat differently.

You need to diet, you need to, maybe exercise more as a pretty active kid. So that one didn't come up that much, but. It was really about, Hey, you're just not doing these things right, and it was really about consumption of food. What happened to me over the course of about 15 years was that my pursuit of weight loss made me so unhealthy, both physically and mentally, and it also really disempowered me and.

When you put all of that together, it leads to at 20 no joke, me doing a goat's milk cleanse. 'cause somebody pricked my finger and was like, you have a worm. And it is just crazy, You know? So you do crazy things or you invest money you don't have.

Or even more important, you invest time in hope, in places. But when things weren't working, it really was keeping me personally, from actually pursuing what I was meant to do. I wouldn't have found this path. And what's crazy was that moment after the failed goats milk cleanse, I met a gastroenterologist and he said to me, he actually asked me no questions about my weight, but he was really interested in had I taken antibiotics as a kid.

he had heard my story And starting to talk and, And we got into it. And he said to me, Ashley, it's not what you're eating or what you're not eating, but your body doesn't have what it needs to run better. And that statement was literally life-changing for me. but I also think so transformative when we think about healthcare because what it did was it said it's not a weight issue.

It is not something to manage. It is not something to lose, but rather it's an operational system. Our body is. I need to decode the messages in there. I need to understand what it doesn't have, what's suboptimal and why isn't it working the way that it's supposed to? And then that's gonna allow me to optimize it.

And so I went into this, build it better mode, you know, I was like, okay, like it's a problem I can now actually solve because I took a different approach that led me to being personally very empowered, and it led me to changing my career, to becoming a dietician.

And in about 2004, so I became a dietician kind of over the end of the nineties and, And the early two thousands. And, And in 2004 I was working with bariatric patient's and one of the physicians said to me, you know, 'cause I said like, how is this working so quickly?

How is diabetes overnight turning away? You and people are feeling differently about food consumption. He said, ah, incretin hormones. And I remember going home, we didn't have Google, but I searched and I was like, what are incretin hormones? And when I learned about a body part that I didn't know about before, I thought I had, searched for a long time for that willpower muscle, And we don't actually make it.

but I found that we have incretin hormones, which interestingly is GLP one. So we'll talk about that. That actually helped me understand that my early work for myself as patient number one and and my patient's of optimizing digestion was actually optimizing these hormones. And as I've gotten to know these hormones, and as we all get to know them now through medications.

We actually are learning that they regulate weight health in the body. So, it wasn't even that weight loss was a bad goal or weight management, a bad approach, a bad idea. It was not biologically accurate. Weight health is biologically accurate. Our weight composition, our bone, our muscle, our fat water content is a signal.

Of how our body is working, but it's one of many signals. And so that's what we decode and that's what we optimize. If there's suboptimal function. And that's really what empowers us as individuals to have agency over our bodies, which is, you to me the really amazing outcome of the work we get to do.

Sharon Bergquist, MD: As I'm listening to you, I'm. Really thinking back of the decades of how the culture, as well as the advice that we've given people around weight, and weight management has really evolved. And I remember when gastric bypass surgery was introduced and, helping patient's through that and, over the, decades, how, our approach has just changed our very understanding really of weight, of obesity of.

The role of hormones, the role of our bodies, in regulating appetite has really just, I think, unfolded dramatically in the last couple decades. And I love your framework and approach because truly I think That is the case with not just weight, but every chronic disease you. Have to think of it more as not something is broken, but really what is not in balance in my body and how can I support my body better?

Because our bodies are really just talking to us and they're trying to tell us something is wrong And we then call it disease or a problem. I really love that framework. I wanna double down on the term that you've used. Weight health. Can you explain that a little bit better?

Ashley Koff, RD: Yeah, so if instead of thinking of weight and health in silos, if we bring the two together, we realize that our weight, that composition, not the total number, the total number is really unhelpful, like it is. Definitely doesn't give us any health insights. But if we look at where is my body putting fat?

What kind of fat, how much fat? Same with bone and muscle as well as do I have water inside the cells? Do I have water outside of the cells? That weight composition, or what's often called body composition is actually going to tell us something about our health. So whatever body size, if you're in a larger body or in a smaller body.

If you have fat in places that you're not supposed to, then that's a signal And we wanna decode that. similarly if we have insulin and we're not producing insulin at all in the case of type one diabetes, or we have insulin, but it's not covering off and getting to our sugar on time and removing it and taking it into the cells.

Then we turn around And we say, okay. Why isn't that happening? Right? And so when we start to ask those questions And we decode those, that's where weight health comes into play. Because really, ultimately, the goal of all of us is optimal health. We wanna be healthy for as long as possible, and when we're unhealthy, we wanna be able to restore our body to optimal health as quickly as possible.

Weight health is foundational to that. So you can't be healthy, you can't have optimal health if your weight health is suboptimal. And you know, I went through this whole thing and I'm like, wait, this makes so much sense, Ashley. You're totally on it. And then GLP one and GI, P and PY.

Y and C. CK. it turns out that we have hormones in our body, in our digestive system that, in particular in the lining of the digestive tract. They switch on and off like for about two to five minutes. You know, maybe like a few more minutes. I think one of 'em can stay on for a couple of hours, but.

They go on and off very quickly, but they direct so many things in the body. So they tell insulin to go to work or glucagon instead, you know, or they tell leptin or they tell ghrelin. and it turns out they even are in on our heart muscle in the lining of our arteries, like in that endothelial tissue.

So they're telling a lot of stuff to go to work. So what I started to realize was. These are actually weight health hormones. if the body makes weight health hormones, just like your stress paradox, like we can't say stress is bad for us. If the body actually makes it like there's an intention behind or it doesn't produce it, but it uses it, right?

We have a stress response. So if we have these weight health hormones. Then Aha. They're regulating weight health. And it gave me a way to have a conversation about the body as an ecosystem and not kind of looking at digestion in one place. Nervous system function in one place, endocrine function in one place, cardiovascular function in one place, but rather to look at it into totality and to give someone a framework for how to think about their weight.

Sharon Bergquist, MD: there are so many things in there that you said that I wanna circle back to. The first is that it's so important to not just look at weight. I have so many patient's that ask me, what's a healthy weight for me, and I think the way you've just reframed it is instead of looking at the number to really look at how your body's functioning is, really such an important point.

And you also mentioned another really important point. You know, in this era of GLP one, we're so focused on that as the singular. Appetite hormone. And yet there are other's that are key, that you mentioned And how they have a role in how, weight and, muscle, et cetera, are just distributed throughout our body.

for people that are struggling, and trying to find, what is not working in their body. 'cause they feel that they're struggling, they're trying different things. They're listening to people's advice here and there, trying all kinds of things, but are just so frustrated because they don't feel good and they're not getting the results that they want.

What's a good starting point?

Ashley Koff, RD: Thank you. So I think the first one is to not listen to other people. That's a great starting point. Now, if you're doing this in collaboration with your practitioner, have a conversation and do this together. But every single thing. That your body is doing is a signal. So just think about your body as unable to speak to you.

So like a crying baby or a baby that then you know is crying and you're like, okay, I'm gonna run through the list. Like, do they need to poop? Do they need to eat? Are they uncomfortable? Is something in their nose And we just literally go through it functionally, right?

That's what we wanna do here. And I'm so glad that you in, asking the question, you gave a diversity of different, because there's so much variety there. You know, I ask people like, do you feel joy in your day? Or do you notice when you feel joy and when you don't feel joy?

are you feeling less joy? Like that might be an indicator. people on agonist, on a GLP one agonist. I ask a lot of questions about your mood and your energy, right? I don't just ask about. Do you feel hungry or not feel hungry? we can ask questions about, and I actually created an assessment, And the assessment is in my book.

It's also free online, and it is about understanding what are the questions to ask or the clinical ways that we can investigate weight health assessment or weight health hormone function that might be your digestion. And That is not just, am I pooping or not pooping? It's what does my poop look like?

What does my poop feel like? How often am I pooping? it might be, are things going in the right direction? Are they going in the wrong direction? So are things coming up, are things just stuck? Like, are they not moving? Do I feel bloated? Do I have gas? Do I notice changes in my breath?

Do I notice changes in my body odor? So we can go through those. I ask, And have you investigate through some experiments a little bit about your breathing. So, am I breathing just, from sort of my shoulders on up, like how does it feel when I take a belly breath?

or is it the kind of thing that I'm noticing that if I am tracking at my heart rate variability, you know, which tells me about how much time my body is in rest and digest versus the timing that it's active. We will look at labs. I don't discount them.

I. Personally and And so curious from a doctor perspective, we're like the DRRD here. But, I find lab trends very valuable. I find just one set of labs oftentimes not as insightful, but I do ask about those labs and maybe wearable data if we have access to them. And then of course, I am going to look at weight composition.

So I wanna understand, I think it's so important that we give people. Permission to feel, because sometimes when someone, we perceive that somebody's body size isn't quote unquote abnormal or problematic or sub ideal. We may discount, And this happens, I practiced in LA for 15 years And we may discount that somebody is having the experience of my body is changing in front of me And we could wait too long and miss that code.

So I don't consider five pounds of weight on a somebody who's in a smaller body to be a desire for vanity, weight loss. What I don't want them to do is try to stop eating or eat less or do that kind of thing to lose that weight. I want to instead understand why is the body allocating fat now where it is?

So, it's assessment and I highly encourage that we do the assessment And that we don't do it in a way that just looks at, there's a lot of testing that's out there today, And we don't just say like. You need thousands and thousands of dollars of testing, but rather we need insights.

A lot of insights about your body And also about what choices you're making.

Sharon Bergquist, MD: Yeah, I, a hundred percent agree with simplicity. You know, we do a lot of assessments, but you really just need a handful of markers to get a general sense of health. Body composition, I think is just the key. so to me That is such a critical part of setting goals.

Really for people other than weight, because ultimately their weight is not the best predictor in itself, for longevity, for health outcomes. It's just, it correlates with the better predictor. So I think That is really important. so a person can go through some assessments and determine, what their, signs, symptoms that can suggest that their body is, just needing some support and help and.

if a person finds that they do need that help and support, there are a lot of things a person can do to support their weight health. So let's talk a that, because as you've already mentioned, it's not so simple as what. To eat. there's so many facets even around food, which you know, can be an entire episode or two by itself, but there's so many facets around getting the body back to a place where we can switch on and off these hormones appropriately.

Ashley Koff, RD: Yeah, I'm gonna start, I'm gonna do like I did last time. I'm gonna tell you what we don't do. We don't just take a medication. Now, we could use a medication, but in my book, I actually. Use an analogy of a pizza. So a pizza is crust, sauce and cheese toppings are optional.

And I would put a medication like a GLP one agonist or any medication, I would say, okay, that's gonna be a topping, a topping can make a pizza. Like it is gonna make it delicious. It's gonna make it be exactly what's right for you today. But it can't correct if there isn't or is suboptimal crust, sauce and cheese.

And I think that's really important for us to understand. Said differently. If you use a GLP one agonist, we'll just use that. 'cause we're talking about weight and it's very of the moment. And you have any benefit whatsoever. You have proven my theory that your weight health hormones were suboptimally functioning because if that's what gives you the correction, they are a weight health hormone replacement therapy.

So if we back up, the most important thing we can do is do that digestive assessment. And I include hydration in there because we give a lot of credit inappropriately in society today, whether it's. An upside down or a right side up pyramid of which foods are healthy and which ones are less healthy.

or it's just what we teach, like, oh, these are healthy foods. This is not healthy. but really our body doesn't give us credit until the food becomes nutrients that the body has and can use. Where it needs it, when it needs it. So. That's the process of digestion. my story illuminates that, You know, 100%.

I mean, I didn't share this, but while I was in pursuit of losing my belly, I was a macrobiotic vegan who didn't drink alcohol, who was doing yoga twice a day like there was a lot on my no list, you know, and like a lot of really great stuff I was doing.

It didn't matter. My digestion didn't take that stuff and wasn't able to use it successfully. So I would say I would lean in there and when we talk about optimizing digestion, and my book literally provides a playbook for this. It's not about just like take a probiotic or, Hey, you need fiber, or This is good for digestion.

It's a. Which phase of your digestion isn't working better, and how do we wanna experiment with, you know, if it's motility, maybe it's, we need midsection movement throughout the day. or maybe we need more magnesium, or maybe we need a combination of both of those, you know, or that kind of thing.

So we have to get really into it a bit. personalize that. And then we move into your nutrition and, that's the sauce. And I have these four pillars in there. And talk a little bit about how to optimize. But our cheese is our lifestyle choices. And I think that's also really important because if your sleep, as an example, is poor, if you're having poor sleep, that's going to suboptimally, going to be part of either you have poor sleep because your digestion isn't better, or your digestion becomes worse because you have poor sleep.

So then it's going to affect your nutrition. So we may actually start with sleep, you know? So it's kind of like how we build the pizza is gonna depend. It is really important for us to start off with that crust on that part.

Sharon Bergquist, MD: So. Ashley I think is so important and just doesn't get said enough and I'm, so glad you said it. And it's really about the bioavailability. so much of the focus is on how much protein is in the food I'm getting, as opposed to how does my body utilize that protein?

Rears it going, how's my body using it? Can you explain that better? Because it is so important.

Ashley Koff, RD: Yeah, thank you. We could use protein. I'm gonna use magnesium 'cause it's one of the ones that changed my life. And I think a really great one for us to think about and I'm sure it's a big star, in your book on that part too. we in this country are still operating.

We've moved from the recommended daily amounts or allowances, which were the RDAs. I call them really dumb amounts by the way. But we moved to DRIs, which are the dietary reference, like index, like this amount that's intake that we're supposed to take in. We're still using the one for magnesium from 1997 for a 135 pound woman and 166 pound man.

just based on weight and gender, we're saying that women need 20% less magnesium than men, And the overarching number at 400 milligrams is far from optimal. So when the body doesn't have. All of what it needs, it will prioritize what it needs to stay alive. It actually doesn't care about looking good.

It doesn't care about your energy levels. It doesn't care about like any of these longer term things. It's in the moment. Decision is I'm gonna prioritize what I see as needed to stay alive. So of the over 400 reactions that the body needs for magnesium, maybe it's works on 200 if you've got 200, you know, or maybe it works on two 50.

So it's consistently deprioritizing certain things, which could be bone, right? Or it could be your bowels not having the relaxation. So you move, things through. So that motility's impacted. when we think about what we need to take in, and This is where total nutrition as a concept is so much more important, your food and your supplements together, what are you getting in?

We really wanna look at the fact and use the term bioavailability is how is when we take something in, is it available to my body? Well, that's the process that digestion will liberate. Now, we could of course, inject ourselves with magnesium, or we could take an IV that has magnesium, but.

Let's just say for ease sake here, we're talking the majority of the time about consumption. So if I choose my favorite source of magnesium, dark chocolate, I'm gonna be like, okay, I'm gonna consume that dark chocolate. I, hopefully I'm gonna chew it. maybe I do, maybe I don't. Or maybe I'm putting powder into something.

it's not until that magnesium gets separated out of that chocolate and is goes to where it's supposed to go and can be used. Now, I might take, And this was happening to a patient of mine yesterday. She was like, I don't even know why I'm paying you money, because I know my problem is, she's like, I am taking so much magnesium And so.

If we're gonna talk about magnesium, I said, I know, but the form you're taking So, it could be the form as in it could be a tablet and she needs a powder, or she needs to sit in a bath. Or it could be that in this case she was taking magnesium oxide, which is just more difficult for the body to break down.

And when you shift a magnesium citrate. there should be a significant win there. Or when you shift to magnesium glycinate, there would be improvement there. So when we look at everything, we have to look at again, we only check the box of what is better for my body when we actually have that evidence.

Which leads me to, I think, a key point of what you were saying too about bioavailability. You can get a recommendation from anyone, from your practitioner online, all these other things they'll tell you, and especially if they're selling the product, they'll tell you that This is what works for this.

But you personally should not reinvest in anything. You can experiment with it if you want. You shouldn't reinvest in anything until your body actually demonstrates that that was successful. And what I find when I decode it and, And the decoding is the work that I share with everyone in the book.

Sometimes it's that you were taking your magnesium at the same time as calcium or as the same time as iron. They were competing and magnesium lost out. Sometimes it's the form you know what I mean? There are all these different factors, right? The wrong time of day for it to be useful for your body.

So this process of how we nourish our body and how we get it to being optimally resourced is actually more complex. Um. But it is based on insights about our body. It's not actually based on somebody telling you what to do And then going and doing it.

Sharon Bergquist, MD: I'm so glad you explained that. if a person has been working towards weight loss and they come to you and they say, okay, should I take a GLP one? What is the process you go through to see if, some of these foundational things are in place? or what's a good starting point?

Ashley Koff, RD: Yeah, That would be the most amazing scenario. And so, by the way, if anyone's listening and that's what you're considering, come to me now and ask that question, or come to Sharon now and ask that question. We get the patient's who come in, they've bought it online, or they saw a different practitioner, or they're taking something.

And by the way, This is true of every medication. Every diet approach, like, you know, all these different things. And then they're like, Hey, this isn't working. Or Hey, I might have lost weight, but I also, I feel horrible. My digestion, You know, some of these other things. So in this scenario you described, which I have to say is like 5% of what happens for me, I would start through the assessment And we would say, I wanna think about a couple of things.

And I actually did this recently with a patient and I, shared a bit about it in my book. She came to me saying she does not wanna be on a GLP one. I had another person say to me, my doctor recommended it, but I'm not sure on that part.

So what we went through, as I said, if we just take that off the list And we just try to get you to your goal, what is your goal? And at first it was 20 pounds, And then it was like, well, You know what, I'm on these pain medications 'cause my back hurts all the time.

Or I'm, feeling like I'm, you aging right before my eyes and I'm slowing down, or, I really don't like this belly. 'cause also I feel so uncomfortable when I exercise. So we started to go through those. So that was how we shifted to a weight health conversation. 'cause I said, all right, let's have a little bit of a discussion about.

What your goal really is, And also that you won't actually be happy if you just immediately were a different size if you felt really poorly. And also, if I told you five years from now you're going to have poor cognitive function, or 10 years from now, you're not gonna be able to lift your grandchild.

we walk through all of that And we have those conversations, And then we talk about what it is. We would need for you to be able to do like the digestive work. Maybe we're gonna work on digestive repair, the nutrition side, the lifestyle choices, And then what I usually lean into is if some or all of this doesn't feel doable because you're struggling with cravings or because you feel like.

Even if I'm not struggling with cravings, I'm thinking about food all the time. Or if we turn around And we say, well, your blood sugar is still, despite your trying to eat this way, your blood sugar is still higher than we would like it to be, which means that's impacting your hydration, that's impacting your metabolism, that's impacting your body fat.

We'll have those conversations and I'll say, You know. especially at a low-dose. I'm a big low-dose fan using a lower dose of this medication as a starting point. We could experiment with it if we're still gonna do these other things. It's not an either or on that part. And we come in And we have that conversation.

And then if we decide to use a GLP one agonist as a starting point. We then have a budgeting conversation, budgeting for my services. Unfortunately, they're not through insurance for this because, unless somebody has certain diagnoses, maybe I can get one or two sessions, through insurance, but very rarely.

usually what we'll do is we'll turn around and say, here's what my cost or our charge is going to be. I might need you to have a different scale than the one that you currently have. Maybe you buy it or you go somewhere to use it. I may need you to take some supplements And we may change what you're eating or how you're exercising.

What does this budget look like in terms of money, in terms of your time And also in terms of your emotional bandwidth? And that's before I'm recommending to someone, Hey, let's move forward with a GLP one agonist. Those are gonna be all the things that we're talking through. So I try, you know, whenever I can to actually have it be more of an informed conversation.

I'm not faulting the patient's or like really anyone in this space. That's not typically where people are coming to. And that's okay. Like you can come to me in the throes of what you feel like is a hot mess. And then we turn around And we say, okay, let's still go through that process at this point.

'cause that's gonna help us decide what our better next step is.

Sharon Bergquist, MD: In that process, I'm just gonna raise a question I frequently get, which is, what are the side effects and most people are concerned with long-term, and I ask this of you because I know you have such a profound understanding. Of how the body works. And that question is really much bigger than what is published as a long-term side effects.

it's really a question of what happens to our body when we exogenously take a hormone? how does our body adapt And what can we expect as a result of that?

Ashley Koff, RD: Yeah. First of all, when we ask that question about this medication, we darn well better be asking that question about every medication, probably every supplement, And also every dietary approach. That we're taking. So the weight bias that we have in this society when we're like, Ooh, but the long-term side effects, like we gotta talk about that.

Proton pump inhibitors have horrible long-term side effects, and yet they can be a very strategic tool that we use if we use them correctly, or they may be the thing that we use for a moment, And we try to get you off of them. And, I could say that about every medication.

Look at, you know, we don't keep someone on chemotherapy for like, the long-term on that part, we wanna look at what are, there are really long-term side effects And what we do is we say, great, it saved your life and now we're going to optimize your body, to get you back to optimal health.

when we think about being on these, we also have had GLP one agonists since 2004, in the original ones, and now also with the oral. Those would stay on for about a day. The original one was a twice daily injection, and now we have ones that stay on for seven days.

So remember your own hormones only. Stay on for two to five minutes. That's what we have to look at the consideration for long-term. So you could stay on this medication long-term and if we're consistently optimizing your body and your body is responding and staying optimally healthy, we can do that and use this medication and there won't be what we call long-term side effects.

Most of the things that are called side effects are actually a hundred percent the intended effect of the medication. It's how the medication works. When you stimulate metabolic hormones to stay on, you don't turn off those metabolic hormones. You don't go into rest and digest. So could you burn out on something?

Potentially. But we should see those signals And we should be adjusting. And that's also why I like to adjust dosage or how often someone's using it, You know, over time. And then we also have to look at what else is happening in your body. I don't have a crystal ball, so I don't know how your body, what other hormones are gonna leave or how they're going to leave, or with what pace or.

You what your activity is gonna be like or these other things. And so we really just always want to be assessing your body maybe on a quarterly basis or more frequently, or, depending to see how your body is performing on the medication. And then if we did have information that you would need to be coming off of it, even if we find that out from like an emergency standpoint, then we need to recognize.

That, okay, your body had something turned on for so much longer. So This is gonna be the downstream consequence of coming off of it very quickly. So how can we handle that in the moment? how can we deal with that? And I'm seeing that in some people who, in a lot of the research And then also anecdotally working with my patient's around pregnancy, some women who were using this to become pregnant, then stopping it.

Or women who are using it after birth to kind of get their bodies back to, hopefully it's not just a weight loss after birth, but like, might be using it, to help them in that space. And we wanna make sure we're using that strategically. So I think that really is the question.

I take so much issue with the way research on these medications are being presented, And the enthusiasm for the one that delivers the greatest percentage of weight loss. Or the, highest, fastest pace of weight loss. I love when the research findings show us that liver fat came down or that liver enzymes were optimized, or that inflammation shifted, or that blood sugar changed, you know, and those kinds of things.

So I also think that we really have to, challenge researchers. you know, it's hard with who's funding the research and all these other pieces. It's a complex system, but to actually say like, are you going to give me information about this from the way the, medication actually works, which is as a weight health hormone replacement?

Or are you still leaning into a weight loss obesity model, which is actually one that disempowers and doesn't provide optimal health for the patient. And I think that's key.

Sharon Bergquist, MD: And I think the other key that you've mentioned is really also, questioning the guidelines put forth by the companies that are making the drugs, the dose escalation. Protocols every two weeks you increase the dose. 'cause I practice very similar to what you're describing. It's so different with every individual and working with each person to meet their needs.

hopefully keeping people on low doses. And I have tremendous success for the majority of my patient's on the low doses.

Ashley Koff, RD: Yeah.

Sharon Bergquist, MD: Can you also talk a little bit about giving people the best chance at deescalating the medication? You know, I have patient's who reach their goals and are really trying to do their best to use the least of the medication as they possibly can. How can they increase their chances?

Ashley Koff, RD: well, everything we talked about with your pizza is going to be both your best chance for optimal results on the medication, as well as if you're weaning or deescalating, et cetera. I also sometimes look at the benefits of. Staying on the medication and de-prescribing deescalating other medications. I mentioned the proton pump inhibitor.

and I also mentioned, you know, things like what we're seeing is tremendous improvements in autoimmune disease, plaque psoriasis, rheumatoid arthritis, And we understand the mechanism, like it's very clear to me how This is helpful there. So if I can help somebody come off of other medications and maintain their time off of those medications and use this medication more strategically, that may be the win.

And then I think the other one That is really helpful is to take this approach of, we've really. Not done ourselves a favor by having this idea of like a once annual checkup, right? Or I only see the doctor when I have to, or I do something annually. I'm very big on quarterly.

In the book, I go through what used to look at daily, what you look at weekly, what you look at monthly, but quarterly is a big one because it's very likely that different quarters, like kind of different seasons. Of our lives are going to throw different things at us or said differently, it's gonna shift.

Like, as an example, for me, I'm such an outdoor Like I work out a lot outdoors. Like I love to go hiking and everything else. So in the winter months, when it gets dark, I used to live in Maine, it got dark at three o'clock, like. That would be such a, I had to shift so much, You know, and I ultimately found, I was like shifting to have dinner at like four o'clock.

I would, you know, going to bed. I mean, There are ways I could make it healthier, but I had to make that shift And in order for me to maintain my weight health, as a part of that. So I think that that's really important for us to look at And for you to maintain your plan and your support system around you.

the overarching goal of all of This is to never look at the medication as the solution. It is a tool, and you may use it in different ways as a tool, but the solution is really gonna be your personalized plan for optimal weight health. Okay.

Sharon Bergquist, MD: With the time you have left, Ashley, what is the one thing that you. Wish everybody knew that as you're traveling and, and talking about this book that you find is just gravely misunderstood.

Ashley Koff, RD: You know, there were so many, like what's the one thing right on that part? to me, I think it's this, if we could break up with the total weight, think intuitively, most of us know it. It's just so hard. Like here I am this weight health expert and at 51 I was standing on the scale and I had.

been, working on rebuilding my body. I'd had surgery, so I'd lost muscle, and I'm like trying to gain muscle back. And I get on the scale And the scale stayed the same. And I had really been busting it for two weeks. And I, as a matter of principle, I don't get on the scale more than once a week.

And the number stayed the same. And I was like, really, like I was mad at myself, And so I sat there, I'm looking at the number And then like it. Beep beep beep. And I'm looking at the spreadsheet of the information that it's telling me and I'm looking at it and I wanna say it took me a good two to three minutes to be like, oh, you lost two pounds of fat, but you gained two pounds of muscle.

This weight here is a good number. It's just what it was. And I like walking myself through it. Like I had to replace a tape, and This is totally true, a tape deep inside of me that whenever things like kind of don't work well enough, like I still go back there.

I'm human. And come back to this one and say, This is the better tape. So I would say in that space, I think that it's, that if we can start to work towards embracing this concept of weight health and my job, your job is for us to try to get the country, our recommendations at the national, at the government level and certainly how practitioners are trained to meet you where you are.

But if you can break up with weight loss and move to weight health. Think you're going to be, it's not, I think I know you're gonna be so much more empowered and as a result, really have the potential And the agency to optimize your health.

Sharon Bergquist, MD: And that speaks to my heart because if you can approach weight that way, you're gonna approach your entire health. You're gonna approach your longevity, quality of life. So I love that framework. Ashley, for people who want to learn more about your book, about you, about the assessments that you mentioned, where can they find you?

Ashley Koff, RD: Sure. So my book should be everywhere. If your best shot is not where you need it, let me know so I can help you take your best shot. in the book there's a QR code. It takes you, so even if you get the book from the library or if you get it on audio, you wanna make sure you use the QR code.

It takes you over into, you have to opt in and it takes you into our, HIPAA compliant. Portal for the intention of it also gives you access to our coaches. I want that so that we can answer the questions and help direct you to what's gonna be better for you and, where you can find those resources.

And then I tend to like just exist on that social media world everywhere with my name. I hope it's me. if it seems weird, then it. Probably is not me. But, you'll have in the show notes my name and I would say, You know, whether it's Substack or Instagram or LinkedIn and those sorts of things.

I'm there. And, I would just love to get to know you and understand, you know, kind of where you are on your journey. I always like to close is if you're feeling disempowered today in this. Space, even if everything we just said it is like, I overwhelmed you too much.

Take a deep breath. And the key takeaway is like, the way you're feeling today is not anything about you doing it badly. It's that society has disempowered us. So, And the empowered space is to lean into, best shot being like, what can I actually do? And I think that's what we, we all need more help with.

Sharon Bergquist, MD: So well said. Well, thank you so much,

Ashley Koff, RD: Thank you.

Outro (Sharon): Thank you for listening. I hope you enjoyed this episode and share it with a friend. Until next time, do something to help improve your whole health naturally.

disclaimer: The

views and opinions expressed in this podcast are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.