The OZEMPIC Episode: GLP-1 Nutrition Tips, Food Noise & Coming Off without Regain with Dr. Eric Williamson

CONTEST INFORMATION! Reminder- there is a special keyword embedded in today’s episode where you can win a $500 gift card to Shoppers Drug Mart. Simply text the keyword plus you’re full name to 925-555. Standard message rates apply. Go to https://www.seekyoursounds.com/contests for contest rules. Also, if you're a PC optimum member, the Super Redemption Event at Shoppers Drug Mart runs from June 27th until July 2 so you can get even more points when you shop in store and online. SUPPLEMENTS FOR OZEMPIC SIDE EFFECTS: For a reliable source of protein to prevent muscle loss that is easy on your gut, check out Neue Theory’s 2-in-1 Plant Based Probiotic Protein Powder. https://neuetheory.com/products/plant-based-probiotic-protein-powder If dealing with constipation and bloating, check out our digestive supplement Digest + Debloat @neuetheory IMPORTANT MOMENTS: Here’s a run down of what we discussed in today’s episode on Ozempic and weight loss medication GLP1s. 00:41 - Introduction 02:02 - GIVEAWAY Reminder! 03:00 - Weight loss rates on GLP-1s 04:54 - Food Noise 11:24 - Nutrition Tips on Ozempic 21:05 - Supplement Recommendations 22:03 - Dealing with Nausea 23:40 - Managing Bloating & Constipation 25:35 - How to Come off Ozempic (Without Regaining Back All the Weight) 31:55 - Quality of Life on Ozempic 36:00 - The Stigma of Weight Loss Drugs Check in with today’s amazing guest: Dr. Eric Williamson, PhD Instagram: @eric.williamson.phd TikTok: @eric.williamson.phd Website: unlockedfitnessandnutrition.com REFERENCES: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905697/ https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 https://pubmed.ncbi.nlm.nih.gov/34170647/ https://www.frontiersin.org/articles/10.3389/fendo.2021.721135/full https://pubmed.ncbi.nlm.nih.gov/34170647/ [https://pubmed.ncbi.nlm.nih.gov/33269530/] https://onlinelibrary.wiley.com/doi/full/10.1002/2327-6924.12504 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898914/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797148/ https://www.nature.com/articles/s41576-021-00414-z https://pubmed.ncbi.nlm.nih.gov/33899337/ https://www.cmaj.ca/content/192/31/E875 https://www.ajmc.com/view/review-of-current-guidelines-for-the-treatment-of-obesity Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. Don’t forget to Please subscribe on Apple, Spotify or wherever you get your podcasts and leave us a review! It really helps us out. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Many people are worried that they're going to lose all their pleasures in life, that because they're not going to experience the dopamine boost from food, and they're not going to have this reward in our brain from eating, that everything is going to suck, that they're no longer going to be able to have fun.

• 0:28Abbey Sharp?

  Welcome to another episode of Bite Back with Abbey Sharp, where I dismantle die culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. Today, we're going to be delving into learning about the most powerful weight loss drugs we have ever seen, and how they may be changing a lot more than just waistlines.

• 0:53Abbey Sharp?

  Ozempic, Wegovy, and Monjaro are not just headlines anymore. Their rapid uptake has been reshaping bodies, rewiring hunger, and igniting a cultural firestorm about medicine, morality, and who "deserves" to lose weight. But what is the full story behind these so-called miracle drugs? Who do they help? Who do they leave behind? And what are we not talking about in this new road to thinness? Today, I'm joined by one of my closest colleagues, Dr. Eric Williamson, to talk all things GLP-1 agonists. Eric is a fellow registered dietitian specializing in fitness, performance, and longevity,

• 1:36Abbey Sharp?

  with a PhD that focused on the intersection of exercise nutrition and metabolic health. He's also the director of nutrition at Canyon Ranch Wellness Resorts, and has been a key scientific advisor for my supplement brand, New Theory. In today's episode, Eric and I will be peeling back the hype to reveal the science, the stigma, and the uncomfortable truths that we need to confront in this post-Ozempic era. Okay, but before we get too far into things, I have a very exciting giveaway to tell you about midway through the show, so you've got to be listening super carefully. Also, as usual, this episode is not a replacement for one-on-one healthcare advice, so please speak to a healthcare provider if you're considering a weight loss drug like Ozempic.

• 2:22Abbey Sharp?

  All right, let's get into it.

• 2:30Abbey Sharp?

  Well, Eric, thank you so much for joining me.

• 2:33Speaker 00

  Thanks for having me back, Abbey.

• 2:34Abbey Sharp?

  Okay, Eric, so just to kind of briefly set the stage for folks. These drugs are broadly known as GLP-1 receptor agonists. And GLP-1 is a hormone that your body naturally produces every time that you eat. It boosts satiety, it slows digestion, and it releases insulin to help lower blood sugar. So GLP-1 receptor agonists essentially mimic these hormones to kind of make some aspects of weight loss easier. So Eric, in terms of efficacy, what kind of like weight loss percentages can we expect if we were to compare like good old fashioned lifestyle, diet and exercise versus semaglutide, which is Ozempic, Wegovy, and ribelsis, and then terazepatide, which is mongero and Zepbound?

• 3:19Abbey Sharp?

  How do these things stack up?

• 3:20Speaker 00

  Yeah, great question. First, starting with lifestyle, I still look at the look ahead trial as our framework for that. It's using an interprofessional team. So this is different from somebody attempting weight loss on their own, but working with dietitians and people helping with exercise and a physician and people helping with mental health. We're seeing that 50% of people are losing and keeping off at least 5% of weight. Take that a bit further, 25% of people will keep off 10% of their weight and about 10% of people will keep off 15% or more of their weight. And then the other 50% are either not losing weight or regaining back all of it.

• 4:04Speaker 00

  Compared to other medications that we've had in the past, that those would result in weight loss of 5 to 10%, mostly on the lower end towards 5. And they've had a lot of poor side effects and some of them can only be prescribed for a very short period of time. That we've been really struggling with finding a pharmacological intervention that's as effective as these new medications that you just outlined.

• 4:30Abbey Sharp?

  Right.

• 4:31Speaker 00

  Semaglutide, for example, being Wegovy and Ozempic, that on average results in weight loss. Of 15 to 20% and the tirzepatide being Zepbound and Monjaro resulting as much as 20 to 25% on average weight loss. So much, much greater effects than we've ever had in history.

• 4:51Abbey Sharp?

  Wow. Yeah, yeah. And, and one of the reasons why these drugs are so much more successful than previous weight loss drugs is that they don't just act on like hormones like GLP-1 and insulin. They actually kind of affect the reward signaling pathways in the brain, basically to quiet something be colloquially called food noise. So food noise is often described as these like constant intrusive thoughts about food, like what are you going to eat? When are you going to eat? Planning meals, intense guilt, you know, cravings. And, you know, pre Ozempic, I feel like for professionals, we were mostly talking about food noise in the context of restrictive dieting and eating disorders. Because when we are physically or emotionally starved of food, you know, food noise kind of

• 5:34Abbey Sharp?

  access that adaptive mechanism to try to get us to eat, to restore our kind of body homeostasis. But there's been so many folks who, who will say to me, and I'm sure to you too, Eric, okay, I'm not restricting. I'm eating everything that I want to eat and I'm still thinking about food nonstop. What is going on here?

• 5:55Speaker 00

  Well, first, as a dietitian and somebody who is looking at the nutrition component of this with my, my guests and my clients I work with, first I want to make sure that's actually true. I'm going to dig a little bit deeper because just because someone is eating a lot or eating what they want, doesn't necessarily mean that that's going to be a solution for food noise.

• 6:17Abbey Sharp?

  For sure.

• 6:17Speaker 00

  So I'm going to be looking back at the earlier part of their day. Most of the time, these intrusive thoughts and the preoccupation with food tends to come up later in the day.

• 6:26Abbey Sharp?

  Right.

• 6:26Speaker 00

  I'm going to be looking back at the very early part of their day, making sure their meals are balanced, that there isn't some opportunity there and that they're eating in a very structured way throughout their day. Now, of course, there are other components to this outside of nutrition. There are genetic components. We're aware of certain genetics and genes that can increase somebody's risk. Of obesity because not only do they impact satiety levels or the level of satiety that people experience from food, but in large part, it's related to what you're talking about. People have these biological drives to eat more. They are more susceptible to marketing materials as in seeing photos of food or smelling food.

• 7:09Speaker 00

  They tend to be more motivated to consume that food than others. And in certain contexts, they are going to have a much greater susceptibility to over consuming those foods. They tend to be driven for these types of foods, which is very much so related to what we colloquially call food noise or these intrusive thoughts. So one gene, for example, FTO gene, the gene that most people are going to be aware of, they've probably heard of that one before. It's been around for a while, highly penetrative as much as 50% of people with those genes with just one allele will have obesity or will be living with obesity. And when they have two alleles, we're seeing as much as, you know, close to 70%.

• 7:54Speaker 00

  And part of it is because we know that they have this greater preoccupation with food. Their brain lights up more when they see these photos of food. And there's also genes like the MC4R gene, also highly correlated with with obesity. Very small percentage of the population has this, but as much as 4% of people with obesity have it, have a variant of this gene, very much so associated with that that weight gain, which is driving this preoccupation of food. But what they want to point out here is that I don't think we should just stop at genes either. I think we need to look at somebody's entire life situation and consider that as well.

• 8:37Speaker 00

  Because if somebody's a single mother or father and they're lacking sleep all the time and they're working and they don't have any time for themselves.

• 8:48Speaker 00

  Our bodies are dopamine-seeking machines and they don't have time to gain this reward through dopamine through means that may be more supportive of their weight and their health.

• 9:02Abbey Sharp?

  Of course.

• 9:02Speaker 00

  And they're going to be far more likely to be choosing food on a regular basis because it's something that's easy, it's quick, it's convenient, and it allows them to continue to have to engage in this lifestyle that they may actually have to do.

• 9:16Abbey Sharp?

  Yeah.

• 9:17Speaker 00

  People who've been through severe trauma, maybe have depression, struggle to maintain good social relationships.

• 9:23Abbey Sharp?

  Yeah.

• 9:23Speaker 00

  We have to look at what options they have for pleasure and dopamine reward in their life because that's going to factor in to how likely they are going to be driven for food as a way to gain that reward aside from just genes.

• 9:41Abbey Sharp?

  Right. Really interesting. I think this really speaks to the importance of having access to these medications without this stigma because, you know, as you and I spoke about in our last episode together, weight loss is hard enough and there's always going to be like some level of food noise peeping in when you're dieting no matter what, even if you're not predisposed to obesity with these, some of these genes that we've been speaking about. But, you know, evidently it is so complex and there may be some inborn reasons or maybe so many environmental reasons to explain why some folks do suffer with this kind of food noise, with this food cue reactivity that a little bit more than just your average person. And it can make sustainable weight loss seemingly, you know, a real uphill battle.

• 10:23Abbey Sharp?

  So I think it really takes a skilled practitioner to really be able to kind of look at all the pieces to determine who's a good fit for this. And it's interesting that you bring up the fact that a lot of the time, you know, socioeconomic status does come into play and time and access and skills that people are bringing into their ability to make these kind of, you know, more nutritious, healthier lifestyle choices. And it's just, it's too bad because when we look at these medications, of course, this is an expense. And so, you know, in some ways, it's a question of, you know, are the people who need these things most, are they going to be the ones that can access?

• 10:58Abbey Sharp?

  So I mean, that's a big topic for another day, but you know, I think a related thing that I that's I see come up often is this toxic narrative perpetuated by diet culture and like, you know, people like Jillian Michaels that taking Ozempic is the quote unquote easy way out. Because you don't need to think about what you eat or exercise or anything. So you just kind of like take this shot and poof, you're thin. But that could not be further from the truth. I'm hoping you can help us understand some of the most important nutrition considerations when it comes to, you know, being on a GLP one array.

• 11:31Speaker 00

  Well, I think number one, which is a good segue from the last question that you asked me is that we should be attempting nutrition first. We should be attempting lifestyle modification as a whole first. And nutrition makes up a large component of that.

• 11:45Abbey Sharp?

  Of course.

• 11:46Speaker 00

  And when possible, that should be with a professional, not just going out and trying whatever the new fad diet is, or what you saw on social media, or having chat GPT write you up a nutrition plan. That's not what we mean when we say that lifestyle is our first line of defense.

• 12:03Abbey Sharp?

  Right.

• 12:03Speaker 00

  And then these medications are an adjunct if required. And that's a decision to be made between the individual and their physician often has to include a discussion around what is their risk level at their current body weight? How much is their current body weight playing into their health risk? And that's going to help somebody and their physician decide if these are right for them. But it's always meant to be an adjunct to lifestyle, something that we add on.

• 12:29Abbey Sharp?

  Right.

• 12:30Speaker 00

  So that's first and foremost, but I know that we're also referring to what are some considerations when somebody is on these GLP one medications?

• 12:37Abbey Sharp?

  So important.

• 12:37Speaker 00

  Well, number one, there is the risk that somebody may not lose weight.

• 12:42Abbey Sharp?

  Yep.

• 12:43Speaker 00

  We do see that just under 10%, around 7% or so, people do not lose weight on these medications. And we don't have the data on this yet, but I can tell you from my experience working with people that I still see people coming in who are having such a high calorically dense diet, which is something we got into in our last episode, where they may be drinking a lot of their calories that they may be. Consuming foods that do not have much satiety value to them, which can completely override the effect of these drugs, and they're not going to be able to exhibit their effect.

• 13:18Abbey Sharp?

  For sure.

• 13:18Speaker 00

  So we need to be considerate of that. And that risk, along with the risk of full-blown nutrient deficiencies.

• 13:26Abbey Sharp?

  Right, kind of goes both ways.

• 13:28Speaker 00

  Or the very least, subclinical nutrient deficiencies. We need to consider the nutrient density of somebody's diet. It's it's not a replacement for that. It's meant to actually, in some ways, make it easier to consume a more nutrient-dense diet. And for these reasons, it is, at the very least, just as important so that we're not lacking or we're not under-consuming nutrients.

• 13:52Abbey Sharp?

  Right.

• 13:52Speaker 00

  And that the drugs can still exhibit their effect. Somebody is able to lose weight and preferably at the lowest dose that's required. Because nutrition is going to play into that as well. The better somebody is able to manage their lifestyle, on average, their lifestyle and their nutrition, and engage in behaviors that we already know help with weight loss for people who take that lifestyle approach. That's going to be synergistic with the medication as well.

• 14:18Abbey Sharp?

  Right.

• 14:19Speaker 00

  They're likely going to require a lower dose. The third thing, which people have probably heard before. In some ways, I think it's very important that it's stressed. In other ways, I think it's overblown. But we need to make sure that we're considering our muscle mass. With that, first and foremost, aside from nutrition, greatest magnitude of effect you're going to have is resistance exercise. It's strongly encouraged to resistance exercise on these medications. I highlight that to every single person that I meet who's considering these or on them. And then number two, from a nutrition perspective, is ensuring they're consuming adequate protein.

• 14:51Abbey Sharp?

  Right.

• 14:52Speaker 00

  Making sure that the protein choices they're making are very protein-dense. Because in many cases, they're not going to be able to eat as much food. So we want to make sure that they're they're choosing the most efficient options they can.

• 15:04Abbey Sharp?

  Yes.

• 15:04Speaker 00

  They're getting the most bang for their buck. Each bite, having the most amount of protein in it so that they're meeting their protein needs and they're preserving lean mass while losing fat mass.

• 15:13Abbey Sharp?

  And how much protein, like as a percentage of calories? Like, what are we recommending typically? For when you're on a GLP-1 receptor agonist.

• 15:21Speaker 00

  Yeah, that's actually the part that can be a little bit overblown is people actually thinking that these medications directly cause lean mass loss and thus muscle loss. That's not the case. Even people who take a lifestyle approach are at risk of losing lean mass and muscle mass.

• 15:39Abbey Sharp?

  Right.

• 15:39Speaker 00

  It's the weight loss that puts somebody at higher risk of muscle loss. So protein needs aren't different from somebody who's taking a lifestyle approach to weight loss than they are from somebody using these medications. They're the same. About 1.8 grams per kilogram is what somebody should be aiming for, or in pounds, or relative to pounds, that's 0.8 grams per pound. And as a percentage of calories, it's about 30%. Now, there is a lot of nuance there. I'm giving you what's going to apply to the majority of people.

• 16:13Abbey Sharp?

  Sure.

• 16:14Speaker 00

  Especially when they're losing about half a percentage to a percentage of weight loss each week. But there is some nuance and I encourage somebody to meet with their dietitian to discuss exactly what they need for them.

• 16:25Abbey Sharp?

  Of course.

• 16:26Speaker 00

  But most people, it's going to be around 1.8 grams per kilogram, 0.8 grams per pound, or 30% of their total caloric intake.

• 16:33Abbey Sharp?

  Okay, as promised, huge giveaway here. Bite Back is giving away $500 gift cards to Shopper's Drug Mart. Each week I give you a different keyword, and this week's keyword is apple. So text apple and your name to 925555 to enter for your chance to win. Again, text apple, that's A-P-P-L-E, plus your name, to 925555 for your chance to win a $500 gift card to Shopper's Drug Mart. Standard data and message rates apply, so see contest rules linked in the description of this episode for details. All right, back to weight loss.

• 17:17Abbey Sharp?

  And I've seen, you know, I've seen a lot of folks post their Ozempic food diaries online and there sometimes I'm like, whoa, there is just no way you are meeting like any of your nutrient needs because of the volume and total calories are just so low. So, you know, how low is too low for calories when it comes to like meeting these base nutrient needs, including protein, but of course, you know, just including everything else as well?

• 17:43Speaker 00

  I can't really put a number on that because there is such a vast array of nutrient density to different foods.

• 17:55Abbey Sharp?

  Sure.

• 17:56Speaker 00

  We want to make sure that they're actually consuming as much food as they can and particularly of these nutrient density, high nutrient density foods to reduce their risk. But certainly lots of vegetables, for example, non-starchy vegetables are where a good chunk of our vitamins and minerals come from. And we can choose certain non-starchy vegetables that are high in certain vitamins and minerals. And all of those tend to have very low chlor content to them. So we can be strategic and, and we need to consider the overall nutrient density. That's what we want to focus on.

• 18:36Speaker 00

  For any individual, it's best to undergo a full assessment to look at what their intake is. If they want, they could track it themselves and have like chronometer for a period of time and check their, their intake of certain vitamins and minerals. But we need to take that on a case by case basis.

• 18:54Abbey Sharp?

  For sure.

• 19:09Abbey Sharp?

  And when it comes to calorie deficit, I mean, I know everybody's different, but we hear, you know, most people, when they just kind of quote unquote, go on a diet, they're looking to like cuts like 500 calories a day. Is that the range we're still kind of working with, with a GLP-1? Receptor Agnes, are we looking to make a much bigger dent, smaller dent? Like just to to kind of reduce the risk of some of these unwanted side effects like muscle loss, like just general, you know, nutrient deficiencies, et cetera.

• 19:39Speaker 00

  Hmm. The best indicator of that is how quickly somebody is losing weight. Because we could perhaps look at a theoretical caloric intake that somebody requires to lose a particular amount of weight. And that does actually work very well in research labs. It's incredible how well they're able to predict how much weight someone will lose if they know somebody's caloric intake and expenditure. But in the real world, we can't do that.

• 20:03Abbey Sharp?

  Right.

• 20:03Speaker 00

  It's way too difficult. Expenditure especially, and most people can relate to that, but intake as well. We can use apps like MyFitnessPal, and that's still not a good indicator. That's still inaccurate. So we need to use these metrics on on a relative basis to induce about 0.5 to 1% weight loss each week. That is what we should be aiming for. Yes, that's going to end up about being around 400 to 600 calories in deficit per day. But we really need to consider it on a relative basis and what allows somebody to meet about that rate of weight loss on average.

• 20:48Abbey Sharp?

  I think that's helpful because I think, you know, in some cases, what I'm seeing is people going from eating like five meals a day, now only eating one meal a day. And it's like, hmm, that that's going to be a pretty significant calorie deficit that that may result in a lot of these side effects. We've just kind of discussed. And are there specific supplements or vitamins that are most likely indicated for folks who are on these medications?

• 21:11Speaker 00

  The only one I can really think of is protein that somebody may want to consider a protein supplement. Nausea can be a common side effect.

• 21:20Abbey Sharp?

  Yeah.

• 21:20Speaker 00

  Sometimes it's just easier to drink our nutrients than it is to eat them when we're experiencing nausea. If somebody would like to have a little bit extra insurance that doesn't pose a great amount of risk, a multivitamin is is generally safe for the vast majority of people. And big reason for that is because you can only fit so much of those vitamins and minerals in one single pill.

• 21:45Abbey Sharp?

  Mm hmm.

• 21:45Speaker 00

  They're not going to have astronomical levels of vitamins and minerals like you see in the single vitamin mineral supplements out there. So it's highly, it's much more unlikely that somebody's going to overconsume any vitamin or mineral by taking a single multivitamin.

• 22:01Abbey Sharp?

  Yeah, that's really helpful. I know, of course, we have to consider the side effects because they also have this like bidirectional relationship with our nutrition in that what we eat can make our experience, you know, more or less tolerable on these medications. And nausea is one of the big complaints, usually at the start, when you've just kind of started these medications or you're changing dose. But, you know, a lot of people still do kind of experience this general ick, yeah, maybe that they didn't have before. What are like your, you know, quick and dirty diet recommendations you're for experiencing this kind of nausea?

• 22:35Speaker 00

  Hmm. As an approach for the nausea, we need to consider it in the same way that we would any other form of nausea for any other reason. And in many cases, smaller, more frequent meals can help. And that actually comes back to what you were talking about before, too, where some people may not have the appetite to eat multiple times throughout the day and now they're just having one meal. Well, perhaps they're not hungry, they don't have an empty stomach, but we need to actually think of it as nourishing ourselves as well. And getting ahead of experiencing nausea is if we were, if we were to have a very large meal. So smaller, more frequent meals works for the majority of people to help, to help reduce nausea.

• 23:21Speaker 00

  Other than that, it's on a case by case basis when it comes to food. And then we can look at certain herbs or in some cases supplementing with these herbs like ginger or peppermint or using these more in our cooking because we know that they have evidence behind them to help reduce nausea as well.

• 23:39Abbey Sharp?

  Yeah, that's great. And, and then, like you mentioned, constipation and bloating, that it can be a bit more of an ongoing issue for some people because these medications do slow the movement of food in the gut. So what are your kind of go to suggestions, you know, for folks who are experiencing this kind of occasional constipation, bloating symptoms?

• 23:58Speaker 00

  The number one nutrient that I'm going to be looking at is fiber.

• 24:01Abbey Sharp?

  Yes.

• 24:02Speaker 00

  Just like it being important for somebody taking a lifestyle approach to weight loss and all of us, we should be aiming for increasing our fiber, making sure we're meeting minimal recommendations. And sometimes there's benefits, even bumping it up from there. It's one of those unique nutrients that in general, the, the more you have that you can tolerate, the better it is for you.

• 24:24Abbey Sharp?

  Yep.

• 24:25Speaker 00

  And to be more specific, in the case of constipation, we're going to be looking at insoluble fiber. So certain foods like berries, nuts and seeds, whole grains, beans, a lot of these are going to be coming with soluble fiber as well, which is okay. It's not that we're trying to avoid soluble fiber. We're really trying to make sure that we get a high amount of insoluble fiber because you know that is what we call prokinetic. It helps speed up motility through the gut or increase the transit time through the gut to allow someone to have more regular bowel movements.

• 25:02Abbey Sharp?

  Yeah, I have IBSC, so I, I know all the tricks and I actually, we did a great interview with Andrea Hardy all about constipation and bloating. So I'm going to leave links to that below if you're suffering because there's lots of ideas there. But I, we bran on everything. Chef's kiss. Just throw it in anything and everything. And also a little plug here for New Theory's Digestive Bloat because it has that pro motility agent ginger, which is great for regularity and it's great for the nausea. So that lots of other ideas too in that other episode. So, okay, I, I want to talk about coming off because you know, the statistics aren't exactly kind for folks. You know, most people are going to gain back

• 25:43Abbey Sharp?

  two thirds of the weight they lost within a year. If people do want to scale back their dose or just come off altogether for whatever reason, what are the most important steps for helping ensure that they can stay within their goal weight range when they've lost weight?

• 26:00Speaker 00

  The first thing we have to recognize is how these medications work.

• 26:05Abbey Sharp?

  Yes.

• 26:05Speaker 00

  There's multiple mechanisms, but at the very bottom line, they reduce appetite and they allow somebody to stick to that caloric deficit through lowering their intake in particular. If we're going to be removing that benefit, then we need to make sure that we are replacing.

• 26:29Speaker 00

  That effect with lifestyle modification.

• 26:34Speaker 00

  Just as if somebody loses fifteen percent of their body weight. With a lifestyle approach, we see that their baseline hunger levels are higher compared to people who have never lost weight. We see that they can eat more in a single sitting. They have a greater capacity to eat at meals compared to someone who's never lost weight. Somebody on these medications, that challenge has been completely wiped away. As soon as they go off of those medications, they are going to have those challenges, just like someone who lost that weight with lifestyle.

• 27:13Speaker 00

  We need to make sure that we are using lifestyle and nutrition in particular to offset that increase in appetite. Need to make sure that we're having these highly filling foods, ones that are high in protein and fiber content. And even water content, believe it or not, water content is actually the number one predictor of how satiating a food will be. And I don't mean water on the side of a meal, I mean water in the food. So we need to make sure that we're having these foods that are highly satiating, allowing us to stay full.

• 27:54Speaker 00

  I do like to point that out, it is important to stay full. Fullness is a good thing, especially in this case. So that we can maintain that level of satiety and feel full, reduce our risk of food noise, reduce our risk of overconsumption to the point of regain. Right now, somewhere around ten to twenty percent of people are keeping off a significant amount of weight. And like you said, the majority are regaining. But especially in my practice, anecdotally, I can tell you it's those people who use the medication

• 28:35Speaker 00

  to reinforce lifestyle habits, develop a very strong routine, incorporate these foods that are highly filling, that are far more likely to be successful with keeping it off if they want to come off of these drugs, or at the very least, really lower their dose.

• 28:53Abbey Sharp?

  Yeah, yeah. So like you mentioned, lots of protein, lean protein, getting in that the high fiber, high volume fruits, vegetables.

• 29:03Abbey Sharp?

  Those are really going to be super important to keeping you satiated because those are the those are the hunger crushing compounds, folks, and and they're gonna definitely help as you go through that transition. But I think, you know, there are obviously loads of valid reasons to to to want to come off once you've come on. But I do think it's important that, you know, people who are considering starting a GLP-1 receptor agonist know that these drugs weren't designed to be like a quick fix, right? So, you know, going back to what we were talking about earlier with regards to, you know, seeing these as, oh, you just take a shot and then you're thin. No, these are an adjunct. They're a very, they're a tool, but it's not meant to be kind of a quick one and done situation.

• 29:48Abbey Sharp?

  And unfortunately, I am seeing that narrative flow around, and I think it does mislead people. Like, I literally saw a doctor on Instagram the other week saying that she gives patients micro doses of Ozempic for just like the week they're on some sunny vacation so that they don't overeat while they're there. And I'm thinking, well, that's that's off off off label. And kind of a really good way to ruin your vacation if you're having like nausea and all these like, you know, bloating and constipation symptoms right at the gate. And also, these drugs haven't necessarily been tested or studied for sporadic use like that, but.

• 30:21Speaker 00

  Exactly. As you mentioned before, every clinical trial today, all the research has been focused on. Improving health and medical risks and complications as a result of higher body fat levels. And that's what we've been focused on. We don't know what the outcome will be for somebody who's microdosing this to fit into a dress for their wedding or to, to control themselves, air quotes there, when they're on vacation. Eli Lilly actually released a statement, which is one of the manufacturers of this, these drugs, saying that there's no research on this. It is ill-advised to do that at this time. Maybe

• 31:03Speaker 00

  one day we'll have that and people will be able to make that, that choice for themselves with a physician. But at, at this time, we do have to recognize if somebody's doing that, there is a risk associated with it.

• 31:17Abbey Sharp?

  Right. And, and, and another kind of just quick mention of another risk is that a lot of these microdosing protocols rely on compounded semaglutide, which there have, there has been risk associated with that because they're not well regulated. It's kind of the Wild West. Everyone's just making up their own, you know, protocol and cocktail. So, um, you know, just something to keep in mind and in conversation with your doctor.

• 31:53Abbey Sharp?

  But I did want to end on a positive note, uh, because I do often feel like a lot of these conversations around weight loss drugs and weight loss in general, you know, are about the side effects, the risks, the stigma, the weight regain. And, and for a lot of folks who have hope, like maybe this is what's right for them, it can feel a bit discouraging at times. Um, so when you speak to some of your patients who are currently on a GLPO and receptor agonist, what are some of the like unexpected benefits that they report?

• 32:25Speaker 00

  Many people are worried that they're going to lose all their pleasures in life.

• 32:30Abbey Sharp?

  Hmm.

• 32:30Speaker 00

  That because they're not going to experience the dopamine boost from food and they're not going to have this reward.

• 32:44Speaker 00

  In our brain from eating that everything is going to suck.

• 32:49Abbey Sharp?

  Right.

• 32:49Speaker 00

  That they're they're no longer going to be able to have fun. But it's actually the opposite that people experience when they're actually on these drugs. They're using it as prescribed. People report that they can go to events and parties and social occasions and still enjoy themselves without having to think about how they're going to navigate the food. And they're not sleep, not constantly preoccupied with how not to overconsume and how they're going to control themselves or how guilty they feel after eating the meal when they're hanging out with their friends. Now they find that they can enjoy the food at a level that they're comfortable with and

• 33:34Speaker 00

  they know is still supporting their health. And they still gain pleasure from all of these other activities. And that's very important. One thing that's that's unique about these medications compared to other medications that have that we've had in the past is that they are very specific to brain regions that are associated with food intake and food reward. So they can still gain pleasure from other from other activities and those that are very supportive of our health, like social relationships. And that's going to be very important so that people can still have dopamine, can still gain reward and and pleasure in their their life.

• 34:19Speaker 00

  And I think that that's one thing that's been very positive that I've heard from people.

• 34:23Abbey Sharp?

  That's wonderful. Yeah, I I'm so I'm so I'm all about knowledge is power, choice is liberating. I'm so happy for folks who have found success on these drugs and and, you know, that that benefit that you just mentioned, I can imagine can feel like, wow, the world has opened up for me because I can I can I can engage in these activities, in these interactions, these these relationships without the constant food chatter of like, you know, the only thing, it's just basically blinded. It's like it's like wearing glasses and all you can see is food, food, food, food. That's the only thought that you can have. So I can imagine this this experience can be incredibly freeing for folks. And I'm very excited to see where the science takes us on all this. Because I really think we're just scratching the surface of what's possible.

• 35:05Abbey Sharp?

  So as always, Eric, thank you so much. Such a pleasure to chat.

• 35:09Speaker 00

  Thanks so much, Abbey. I think this is such an important conversation to have. Glad we're getting these messages out there.

• 35:15Abbey Sharp?

  Absolutely. And if you, friends who are listening, if you're not already, please, I highly recommend following Eric at eric.bliamson.phd. So much valuable information there. And you can visit him at Canyon Ranch, too. I think I'm due for a visit anytime. I need a holiday.

• 35:31Speaker 00

  Definitely. Yes, please come visit. Abbey will be having here soon.

• 35:34Abbey Sharp?

  Perfect.

• 35:35Speaker 00

  Thanks, everyone.

• 35:40Abbey Sharp?

  I loved this conversation so much for so many reasons. But most significantly, I really do think it's important to have voices like Eric and my own advocating for folks to have access to the best evidence-based healthcare for them without judgment or shame. You know, we are living in this uniquely body-hostile era, where despite the concurrent advances that we've seen in both body acceptance and also in weight loss, fat people are placed in a really cruel and impossible bind. On one hand, they're relentlessly shamed for simply existing in larger bodies,

• 36:23Abbey Sharp?

  constantly told that they're not doing quote-unquote "enough" to lose weight. And this message is louder than ever, where they're basically being told, "Hey, we now have this foolproof solution, so like, what exactly is your excuse?" But when someone in a larger body does choose to use a tool like Ozempic, the narrative often flips. Suddenly, they're cheating, they're taking the easy way out, or they're conforming to toxic beauty standards. It's really a no-win situation where autonomy is punished and outcomes are judged not only by their perceived level of individual health.

• 37:03Abbey Sharp?

  But now also on how palatable their health journey seems to others. This double standard doesn't just reflect social stigma, but it actively reinforces health inequalities. It deters people from seeking out legitimate medical support out of fear of judgment, while promoting a system where only certain bodies are seen as worthy of compassion, flexibility, or evidence-based care. In a post-Ozempic era, our focus should not be on outing people for having health or body goals or achieving them in certain ways, but on ensuring that the solutions we are offering are evidence-based

• 37:46Abbey Sharp?

  and tailored to the true desires and needs of the individual. So we do need to shift towards a model of care that is empathetic, nuanced, and rooted in body autonomy, where we advocate not for a specific body shape or size, but for access, support, and choice. So whether you are pro-Ozempic for all or staunchly against it for anyone, I invite you to get curious about your beliefs, about other people's health choices, and ask yourself, why does someone else's weight or choice for their body affect me? I know it's very hard to set aside our own personal bias or judgment,

• 38:30Abbey Sharp?

  but I encourage you to try to lead with curiosity, compassion, and the understanding that every body's story will look different. And on that note, I am going to wrap it up here. Again, a big thank you to Eric Williamson for helping a bite back against misinformation. If you liked this episode, I would really, really love if you would give us a five-star review. Also, subscribe wherever you get your podcasts and leave me a comment, because it really, really does help me out. And remember that the Shopper's Drug Mart contest is three weeks long for up to three entries to win $500 in gift cards. So there will be another keyword in next week's episode for you to listen for.

• 39:13Abbey Sharp?

  Signing off with Science and SaaS, I'm Abbey Sharp. Thanks for listening.