The Future of Weight Health: A Client-Centered Approach to Better Nutrition

On Wednesday, March 4th, FMCA hosted a special Ask the Expert webinar with Ashley Koff, RD, founder of The Better Nutrition Program (BNP) and a nationally recognized leader in personalized nutrition. With more than 25 years of clinical experience, Ashley is known for her practical “better, not perfect” philosophy that helps individuals achieve measurable, lasting health outcomes.

Hosted by FMCA Founder and CEO Dr. Sandra Scheinbaum, this session explores a more integrative and functional approach to weight health: one that moves beyond restrictive dieting and toward personalized, sustainable strategies. Designed for health coaches and anyone passionate about wellness and nutrition, this conversation offers practical insights you can apply immediately.

In this webinar replay, you will learn:

• The “Better, Not Perfect” approach to sustainable nutrition change
• An integrative perspective on weight health beyond restrictive dieting
• Key drivers of metabolic and weight resilience
• How health coaches can confidently support weight health conversations while staying within scope
• Practical coaching strategies to help clients implement personalized, sustainable nutrition shifts

Watch the Replay

The Future of Weight Health: A Client-Centered Approach to Better Nutrition, With Ashley Koff, RD:

Listen to Ashley Koff’s Episode of Health Coach Talk here: The Truth About Weight Health, With Ashley Koff.

Transcript

Dr. Sandi: We are all here together to learn from our wonderful presenter today. We met many years ago, actually on a short-lived, I don’t know if it’s still going on, it was called Clubhouse. It was audio-only, and it saved us during the pandemic. We connected and I was so impressed the first time I heard Ashley Koff. I just thought, “Wow, this woman is brilliant.” She is so knowledgeable.

She is here today to talk about the subject that I know you’re all interested in. It is weight, weight loss, GLP-1. So, she has a wonderful book out called “Your Best Shot.” And she has The Better Nutrition Program. And it has been wonderful to collaborate with Ashley. She is one of our star educators. So, I introduce you to Ashley Koff. And I know you will have some questions. If you do, you can use that Q&A that is on the bottom of the screen and post your question. And then after Ashley has her presentation, we will do our best to make sure that those questions are answered. So, take it away, Ashley. We’re grateful, honored to have you with us today.

Ashley: Thank you so much, Sandi. And I just echo back. I feel like the world of coaching really was sort of exploding around the same time, even a little bit before Clubhouse. But certainly that time and I think during the pandemic personally, I benefited so much from having a coach. I always loved coaches.

But the missing piece for me was this Functional Medicine Coaching Academy. When I discovered that, I was like, “Oh, now I can actually partner with coaches and my patients,” where before I felt like I, a lot of times, wasn’t fully comfortable leaving my patients with the coach. So, it was kind of, how do we do that? So, I’m just so grateful and love this and the opportunity to share.

What I’m going to do is open us up to a discussion of weight health today and what that is and why we want to think about it and what we’re calling the GLP-1 era. And then I think Sandi has some questions for me, and you all have questions, and we’ll dive into making this as practical as possible on that part. I won’t go into this. Y’all, pretty soon I’ll have my TED Talk, but this is where we are today. I’m 52. And when I was a young girl, I would say five, six, seven, what I just want to share today is this is such a personal experience, and it’s something that I wish there were coaches that knew this. I wish there were practitioners that knew this information.

And so now that we have this information today, it’s like since when we can’t unsee something, it is so important to me that we spread this as widely as possible. So, I hope that you will think about weight health in the GLP-1 era in a new way as we walk through this today. But if it seems like I’m asking you to unlearn or I’m going against things that you have learned before, great. That’s exactly why we’re here because what we’ve been doing has not been working for us.

Before I get into this where we want to start, I just want to all ground us in the fact that 9 in 10 Americans, as of the pandemics around the time that we were all club housing, 9 in 10 Americans didn’t meet the criteria for being metabolically healthy. That was waist circumference. That’s looking at a couple markers of cholesterol and a couple markers of blood sugar and blood pressure. So, we are not talking about just a population of people who either want to lose weight or who have excess fat. We’re not talking about obesity, which is really just a diagnosis based on somebody’s weight for their height. And we’re not talking about a subset of the population who haven’t been able to get where they want to go based on diet and exercise. And I think that’s really… I want to ground us in that as we start off today.

But before I do that, I’d love to ask you about your car. So, let’s say that you go outside and you go into your garage and your car doesn’t start. So, you go and your car doesn’t start. And you notice, after checking, that there is gas, oil, air in the tires. I’d love for you to put into the chat which better describes your approach, A, B or C. Would you go over and… If the car doesn’t start and you have gas in the tank, oil in the engine, air in the tires, would you go then deflate the tires to see if you could start the car or drain it of all of the gas and maybe try to put extra air in the tires or would you maybe change the type of oil to see if you could start the car? Okay. If that’s you, then you would enter A. B would be if you notice those things and you can kind of start it and you see some of those check engine lights and you’re like, “Oh, okay, now it’s telling me…” So, you go and you read the manual and you’re like, “Okay, why isn’t it starting?” and you read the manual. That would be B. What about if you’re somebody who says, “Okay, well, I could read the manual check or maybe I can’t even see the check engine lights. So, I’m going to get it towed and call an expert who’s going to look under the hood, identify the problem and then repair it as indicated.” And I always have to say the caveat. They’re going to repair it correctly because I know many of us have bad stories about taking our car in and being like, “I don’t know what they did and I just left with a really bad bill.” I would love to know, are you an A, B or a C? And if you want to just answer that in the chat, that’s great.

Why am I asking about that? Because our bodies are designed just like a car. And if I use the analogy and we think about gas as carbohydrates, protein is air in the tires, right? It makes our muscles big on that part. And then thinking about oil in the engine, the fats that help us, things like inflammation and hormones and help us with cognitive function, etc. So, when we tell people to diet and exercise and when they get in there and the car won’t start, we’re going to have the car not starting being like, “I don’t like where my weight is. I don’t feel good. My body doesn’t feel good. It doesn’t look the way that I want it to look.” And we go over and we say, like, “Let’s go on a diet. Let’s get rid of carbohydrates or let’s reduce them or let’s increase and have more protein or let’s do any of these varieties.” And we don’t look under the hood. We don’t read the check engine lights. We don’t work with an expert who can actually assess and figure out what’s going on. We end up with a lot of problems. We end up with a lot of stalled cars. We end up with a lot of cars that aren’t starting. We may spend money doing that. We may waste money,, and we definitely will often waste our emotions, our hope and certainly our time. And that’s not better. And that’s what we’ve been doing in a society that has been focused on weight loss and weight management.

What I want to share with you today is that your weight doesn’t tell me anything about your health. Legitimately, not anything. That total weight number doesn’t tell me anything. And it certainly doesn’t tell me about your worth or who you are and your value in society. And yet we have used that number for so many things—how we define ourselves, how we get access to healthcare, what kind of healthcare we get, whether we can be a candidate for our military. You know where we don’t use that? We don’t use our BMI, our body mass index, our weight. We don’t use it to determine can you be an NBA player, an NFL player. They’re at least smart enough to know that athletes are not just about the number of their weight, we’re about our performance and the body showing how it’s going to work.

So, what we have to understand is that, unlike our weight, what we need to look at is our weight composition because it does tell us a story. Your fat, your muscle, your bone, your water content, the type of those, the quantity of those, the location of those. And certainly if there’s any changes, those are check engine lights. Those are lights that come on that tell us, hey, something’s not going right. We got to look under the hood. We need to understand what’s going on under the hood. So, as a result, weight composition is a key performance indicator of our health but it’s one of them. It’s not the only one. We still need to look at labs. We still need to understand how you’re feeling. I like to understand, especially as it relates to weight health, how you feel about your eating. Am I thinking about what I’m eating? Do I feel good after I eat? Do I have good energy? Do I struggle to feel full? Do I feel full in a timely manner? All of these things, right? And then I even want to know about your digestion, and I want to know about your breathing, and I want to know about your hydration status. I want to know a lot of things because that’s going to be how I look under the hood to see what’s going on for you.

And it’s so important that we actually understand that what our check engine lights and asking those questions tell us is that it’s actually not what you eat or what you don’t eat. That’s a key thing in terms of the potential for what could be going into your body. But in order to understand whether or not your body is running better, whether your operating system is working better, we actually need to look under the hood because food, even though historically we’ve said wild salmon is healthy and luncheon meats are not healthy or we make all of these statements that could be factually true in a bubble but not in a body, because I don’t know if something is good for your body or not until your body lights up, until the car starts, until it runs well, until it gets you where you’re supposed to go in a temperature controlled environment with the music on and you’re like, “I like this.” and I can’t account for traffic. That’s an external factor. But until it’s feeling good, I can’t say, “Hey, your body did well with that food.” And what does that mean? It means that your body needs to be able to get from food or from supplements what it needs and it needs to be able to use it.

So, the body’s needs is actually, “Do I have what I need, where I need it, when I need it, and am I able to use it?” And that’s really what we actually want to answer in the world of weight health. So, weight health is actually a completely different approach than weight, than weight loss, than weight management. And we want to dive into understanding that it really is telling us that our body is an ecosystem, that it has all of these different integrally related parts and pieces, and that the optimization of those, having the body be optimally resourced is actually our goal. Our bigger goal is that we operate in the best way possible, right? Optimal operations on that part. The way that we get there is by being optimally resourced.

So, what I want to know is, is your total nutrition, your food and your supplements and your body’s ability to use it, your digestion and your hydration, are those optimal, right? And we include breathing and some other things in there because they’re part of how the body operates. So, that’s what we’re actually looking at in this weight health space. Weight health is going to have a different toolkit. Weight health means that we actually start from the standpoint of thinking about a patient or a client. I’ll just call it what it is. It’s a human being. And we want that person to be in the leadership. We want things to be led from you or from… When I’m going to my doctor, etc., I want to be led. I want my doctor to know how I’m feeling, what I’m curious about. I most importantly want my practitioner to understand why I’m making my choices. I don’t necessarily want them to just know what my choices are. I want them to know why. And that’s where practitioners and coaches become partners in helping us personalize because every car runs a little bit differently.

Even every Toyota Tercel, one of my first cars ever, they’re all designed the exact same. They go through… You know, they’re mass produced on that part. But once they come to you, how you operate them, where you operate them, like they all then become personal like us. They’re all beyond personal. So, all human beings are technically designed the same way. But once we come out, we’re unique and we need to have personalized solutions in that part. So, one of the foundations of weight health is actually understanding that assessment, evaluating where we are in any moment and reassessment, reevaluating once we’ve made choices is going to be so important for us on that part.

The second thing is, and this is really where coaching comes in, is that what we do not want, what is not helpful or completely unhelpful for us are mass recommendations. You know, we used to have these things called the RDAs, and I jokingly call them really dumb amounts, but they were the recommended dietary allowances. Today they’re called the DRIs, the dietary recommended intakes. And they’re these amounts that are based on gender or they’re based on age or they’re based on maybe a circumstance in life. But they are not based on you and your body and what it needs today. And they’re often so suboptimal because they were really designed to prevent disease but not really even understanding disease in the way that we understand them when we look from a functional perspective.

So, when we think about a SMART goal, we want to think about something specific, something that’s measurable, something that’s actionable or attainable in a specific timeframe, and it’s relevant to us specifically on that part. And then, as I mentioned, it’s timestamped. And that’s where I like to shift from instead of having a goal that maybe, you know, some of us… We’re in March and we’re already maybe done with our New Year’s resolutions.

I think New Year’s resolutions are so dumb, and we should be doing SMART goals instead anyway. But for any of us that resolved this was going to be the year that we lost 15 pounds or the 10 pounds or the 5 pounds that we gained over the holidays, that’s not a SMART goal. A SMART goal is, “Hey, I’m going to be very specific on what choices I’m going to make. Maybe hearing Ashley, I’m going to lean into, you know what, coming out of the holidays, I realized my digestion was giving me signals that it is not running better. And I’m going to lean into making some choices that are going to help my digestion work better. And I’m going to measure the impact of that. And one of those measurements might be whether or not I actually see fat loss and maintain muscle or even build muscle, etc., from there.” So, that’s how we want to lean into that.

I like to look at SMART goals on a 30, maybe even a 90-day time period and then revisit them. So, the timestamping is very important. We want to make sure that the time frame for our goal is actually attainable within that space.

One of the ones I think is so important in this weight health toolkit is really understanding total nutrition. We are not a product of our food over here, and our supplements over here, and our medications over here. They don’t work in silos. They all are resources that our body is getting as well as things like nature, sunlight, sleep, oxygen, as we’re breathing. So, those are all going to be inputs that are going to go into this ecosystem. And we need to understand how they’re working because often as I unpack and look under there—if you’re working with a coach, they’re looking at it—we may see that they’re working against each other. I call that washing your floor with dirty shoes.

We may see that you’re maybe deciding to take a supplement that has a methylcobalamin or methylfolate because you’ve learned that that’s better for your body, a methyl form than say cyanocobalamin or folic acid. But when I go over to your food, maybe you’ve decided to lean into nutritional yeast, or maybe you’re eating a bar on a daily basis, or you’re having a granola and it’s fortified and maybe there’s folic acid in there. Or maybe you’ve added a protein powder and it has a cyanocobalamin form, or maybe you’re having a GLP-1 agonist that you got from a compounding pharmacy that, as you’re injecting it, has B12 in there maybe in a form that isn’t better for your body. So, when we look at that, we have to look at these all in totality.

And this is where it can become overwhelming for the individual to do this alone, and maybe where there’s a benefit to being able to work with somebody who can, at minimum on a quarterly basis, kind of assess your choices and help you see where there may be things that are not better for us in terms of that. And then what we really want to do is we want to lean into what I call ecosystem protocols, understanding that when we do something, when we take something, it has its intended impact, but it can also have secondary impacts. So, I may intentionally add calcium so that I am getting that in because calcium is beneficial for my bone. But the unintended consequence could be that if I don’t have the right amount of vitamin D, vitamin K, magnesium, I could, number one, be causing more contraction and more constipation, which could lead to me not actually eliminating toxins and my body not relaxing enough to where it’s at a place where it can fat burn. And it could also lead to kidney stones or building arterial plaque. So, what we don’t want to do is we don’t want to add a nutrient and not optimize the body’s total nutrition on that part.

Okay. So, one of the things that I realized as I was building out a playbook built on all of weight health was that there was a missing piece. When I was working on it, like, okay, we want to make sure we’re looking at weight composition, we want to look at somebody’s digestion, we want to understand how their hormones are working. Wait, hold on. Hormones? Okay. Well, in about 2004, I’d been working on this for about five or six years. And as I was working through it, I knew about hormones like sex hormones—estrogen, testosterone, progesterone. I knew about hormones like insulin and glucagon for my blood sugar. I knew about hormones for thyroid, even had learned about vitamin D as really a hormone and not just, you know, vitamin D being something that was for us specifically to take for, say, bone health on that part.

What I didn’t know is that our body makes weight health hormones. And I learned from bariatric patients, from patients having weight loss surgery, where immediately following surgery, blood sugar and diabetes was reversed. They had changes in how quickly they felt full, changes in how often they were thinking about food, and changes in the quantity. And I first thought that that was just because we were shrinking the size of their stomach. And then I learned, no, there are two hormones called GLP-1 and GIP. They’re known as incretin hormones. Later, they would be called weight health hormones, as I named them that, because they’re part of our weight health playbook and weight health ecosystem. And these hormones like PYY, and CCK, and amylin, and oxyntomodulin, and GLP-2, and GLP-3 that we’re now learning about today, these hormones do a lot. They do things like regulating bone formation. They regulate fat, the type and the place that we put fat. They regulate the pacing of our digestion and specifically things like acids and enzymes that are breaking down and helping us use food. They impact hydration. They impact food noise and our ability to feel full in a timely manner. They impact blood flow and our ability for our blood to flow better so we have optimal blood pressure. They impact the lining of our arteries, our blood vessels on that part so that there’s better integrity there, so we’re not building arterial plaque, and they impact inflammation. They do a whole heck of a lot of stuff.

So, what’s really interesting about that is if I come back here, if I look at this in the center here, these weight health hormones, they are a check engine light. If they are not working better, our whole body is not going to work better. So, when we look at why is my body not working better, we have to assess those hormones. And if they’re not working better, we want to figure out how to optimize their function. Well, it turns out that we can do that both naturally with protocols, and I go through that in my book, and we can also do that by replacing them. So, today, one of the things that’s interesting is we have—and you know them by the names of semaglutide, tirzepatide, retatrutide, the original one liraglutide, brand names like Ozempic and Wegovy and other names out there, compounded versions, etc.—but we have hormone replacement therapy just like we have hormone replacement therapy for insulin, for thyroid function, for testosterone, for estrogen.

Now, what’s different than those other hormones is that these are not bioidentical, they’re biosimilar. So, similar to the other ones, they go and they do what the body needs them to do. So, when they go to the receptor sites, they tell other hormones to go to work, great, and that’s exactly the way other hormone replacement therapy works. But unlike those other ones, what we have to understand is that our own weight health hormones only stay on for 2 to 5 minutes. These hormone replacement therapies stay on for one day in the case of oral, or in the case of the original liraglutide, or in the case of semaglutide, tirzepatide, and retatrutide, they stay on for 7 days. Now they come on real strong and they wean in that time period, but they’re on for 7 days. So, that is going to mean that they are going to have pros. Yay, you have these hormones on all the time, that’s amazing. They’re going to create changes in how you feel and how your body experiences having satisfied amounts of hormones also, but they also have considerations. They stay on for a lot longer, a whole lot longer.

And that means they’re going to do things intended, where they work to delay gastric emptying. Instead of delaying it for 2 to 5 minutes, they’re going to delay it for 7 days that whole time. Instead of telling insulin to go to work, they’re going to tell it to go to work for 7 days that whole time, even while you’re sleeping, not when you’re eating, which means when you’re in recovery mode, you’re not really in recovery mode. You’re less likely to be in rest and digest as often. That is going to create challenges, and those are going to be challenges that we need to decode. Those are going to be check engine lights, and there may be challenges that they exacerbate because you already were having challenges with your sleep and your recovery, or you were already having challenges with your digestion, or they may be new ones that come on, or it could be a combination.

So, one of the things that I want us to understand is that when we use a GLP-1 agonist, if we choose to use that, we never need to. But if we choose to use that, we have to make sure that we decode the signals the entire time that we’re on. The other thing I want us to know is they are not a solution. They’re only working forward. They’re only working from the receptor site. They’re satisfying that receptor site, which means they’re turning on the hormones, and the hormones are going to work, and all these other things are happening. But behind the scenes, all the stuff that wasn’t working before, they’re not fixing it. When your check engine lights go on, they are not fixing all the things that were not working before. They are allowing the car to get started and for it to operate and for you to have benefits, and that might help improve some of the things that weren’t working before, but they’re not fixing it. So, the way that we fix it is that we optimize overall our weight health.

So, some of the things that we want to consider—I’ve gone through some of these but just double-clicking on it—is to make sure that we understand that they may challenge your sleep, your digestion, something called heart rate variability, and that amount of recovery that you get. They may challenge your already challenged nutrient levels. The body may not have been optimally resourced, and it may make it less optimally resourced. So, you may have things like hair loss, fatigue, skin, muscle hydration, bone challenges. Guess what? If you weren’t using the medication, you may have those as well. And so it doesn’t mean that the medication is causing those. It just means we have to pay attention to that in terms of that.

And they may also have financial considerations, just like any other weight health plan is going to have financial considerations, which means that we have to have budgeting conversations, just like any weight health optimization protocol. We want to have budgeting conversations, but there’s a special component here. If your budget means that you are going to need to come off of these, or not be able to use them ongoing, or you need to use maybe a lower dose or whatever for us to be able to have you have enough for the time period that we want to use that, we need to know that. Because we cannot have you, just like any other medication, just go off of the medication, because it is going to be doing something for your body. Just like if you were a diabetic and you were using insulin and one day you decided to not use insulin, we are not going to have good outcomes there. So, we need to understand that and be able to work to optimize that.

Okay. One of the other questions that I get asked a lot is what about things like GLP-1 supplements? Is berberine nature’s Ozempic? Or what about these different medications? And the answer that I would share with you is there’s no supplement ever that is going to work like a GLP-1 medication. There’s none today, and I don’t think that there will be in the future where it stays on for a day or greater, and certainly not 7 days. But there are supplements that help your whole ecosystem work better. There are also supplements that very specifically can help us, as part of your total nutrition, optimize those hormones and their function. And then there’s a couple that actually can give you a couple of hours of better activation of your hormones than even at baseline levels. So, when we want to use those, we want to do that and understand how they are working as well. But the best that we’ve seen is about four hours of work for some of those supplements. So, there is nothing out there that is nature’s Ozempic. So, if they’re marketing themselves as that, walk the other way on that part.

All right. I want to stop there as a way for us to… I know we probably have a ton of questions. And I want to just share that if anyone is interested in my book, or if you already have my book, I want to make sure that you know that online you have access to my FMCA coaches. So, that’s a great partnership for us, for free, included with the book, and also that there are more tools there in a community to ask these weight health questions, so you can opt in there for this. So, I’ll leave this up here for a minute on that part and then be able to have you dive in…have us be able to dive into the questions. I think, Sandi, I can’t see the questions. So, can I turn it over to you at this point to go into that?

Dr. Sandi: Sure. Yeah, I am looking here and yeah, I don’t see any questions that have come in. So, we encourage you to ask some questions. And while we are waiting for some to come in… Oh, here we go. You can’t see that Q&A, Ashley?

Ashley: No, but…

Dr. Sandi: I can read it.

Ashley: Yeah, if you can read it, I think…

Dr. Sandi: I can read it.

Ashley: There we go. Okay, perfect. Now I can. Yes. Okay. If utilizing supplements for all-around health, what is a good way to find ROI stats? Is organic acid test helpful? I love, Casey, where you’re going. So, here’s the thing. There’s a yes and a no to this. So, first part to the question, if you are using supplements, you have to be able to tell me why. Not me personally but if you’re working with me, you need to be able to tell the person you’re working with, or yourself if you’re the one who’s purchasing them, the evidence that they are working. Otherwise, you’re wasting your money, and here’s the kicker. They could actually be creating a problem for us on that part, right? In the case of the example that I gave with calcium.

So, first of all, the fact that we’re thinking about that and looking at ROI, bingo, awesome on that part. Now, how we assess ROI is going to be specific to the supplement. As an example, if I was thinking about that calcium conversation, it might be a question of, when I start the calcium supplement, am I having difficulty pooping? If I start a supplement to help me poop, are my poops better on that part? It might be a question of, if I’m looking to optimize a nutrient level that I’m able to see, as you mentioned, whether it’s an organic acid test or maybe it’s looking at a nutrient level test. However, if I’m not absorbing nutrients, then I might not see it show up there. So, I might actually, as a first step, decide to use a digestive assessment and be able to lean into that and to see if things like leaky gut or other issues are a factor on that part as well. So, I think which test I would use would be very much in the hands of the practitioner that you’re working with and figuring that out. I’m not a big fan of direct-to-consumer testing of an individual just using the test themselves.

And I think the other part to share with that too is sometimes from a financial standpoint, we can actually get the data that we need without you going and first using a test. But if we are using a test, I always like to have a budgeting conversation for two tests so that I can start off and see how it’s doing and then I can follow up and see how it’s doing. So, it’s just a good thing to think about as you’re thinking about how you practice in that part as well. So, yeah, really, really great question. Let me know if I answered it fully for you too on that piece.

Dr. Sandi: Yeah, thank you for that question. And I’d like to pose a question. I will hold my question because I want to make sure that our attendees have the opportunity to go first. So, we have somebody who is anonymous. You can just read that, Ashley.

Ashley: Great. Yeah. So, if a client… And you’ll note, I use the term “patient,” just practitioners tend to use the term “patients” and coaches wonderfully use the term “client,” so we’re talking about the same person in here on that part. So, if a client is on a GLP-1 agonist, on a medication, and it helped with the pros you listed and we’re trying to keep up with nutrition and exercise, which I’m helping with, he wants to wean off of it and his functional medicine doctor is not really helping. What resources can I point to him aside from your book?

Okay, great. So, a couple of different things. First of all, I think if somebody is wanting to wean off of a medication, you want to start with the conversation about why. And one of the reasons I want us to have that why conversation is there is a culture… And this really has to do with the weight loss and sort of the weight bias that exists in our culture. And there’s a cultural norm right now that you use the medication to get you to a place where you’re “fixed,” and now you’re “normal,” and now you can do all of this stuff without the medication.

And one of the reasons that I explained that this is a hormone replacement therapy is to help somebody understand that when they come off of this, they are no longer going to have the hormone at that…certainly not at that level. They do make their own hormones in their body, but we need to make sure that their own hormones are working effectively. And so, first, we want to have a conversation maybe about his why and kind of dive into, in that space, if you get any sense of, “I feel like I’m not successful if I have to stay on this.”

Now, the other reason for weaning off is I might not want to stay on it and I might not be able to afford, or want to afford, to stay on it. And that’s a good conversation, because then you can have… And I love that you’re using the term “weaning” here on that part. So, when we look at that, we want to think about… And there are a variety of different approaches. Some people will stay on the same dose and then space the time period out. That’s one of the protocols that I use.

And in that time period, when you’re helping him with nutrition and exercise, you really want to make sure that, number one, he is able to maintain the choices and the cadence and all of the different things that while he… When you go from after about 7 days—so you go to 14 days or 21 days in there—that from day 7 to 14 or day 7 to 21, he’s still able to maintain those same choices, because that’s going to be a time period where, especially in the beginning, his own hormones have been suppressed, and we need them to restart and kind of come on. If he starts to notice on day 8, 9, 10 that he’s not able to—you know, maybe he’s eating a little bit more, or he’s not as motivated to exercise, or whatever on that part—then that’s where you’re going to want to lean in and say maybe there are things that we want to do to support that in that time period.

And I think also that’s where you may lean into some supplemental support or working with his… And if he has a functional medicine doctor, you may want to find someone like me, like where it’s the dietitian to come in to then support you guys as you’re working on the nutrition and exercise in that. The key thing in here is to understand too that his digestion is going to be changing during this time period as he comes off of the medication, and we really want to nurture that.

So, some of the resources you can… Thank you for acknowledging my book on that part. You also can go through the content and the information from my book, and then it has resources in there that you could then use with him. So, I just want to acknowledge that piece. I would say the other piece from a resource standpoint would be, if you want to create some version of a symptom questionnaire with the individual to then say here are the things that we’re going to track. Number one, we’re going to look at your weight composition and we want to see that you’re maintaining your muscle and we’re maintaining your fat amount. We’re not seeing increases there. Then you also want to lean into some of the things that he may have been experiencing before he went on the medication that he’s not experiencing now.

And this is totally in a coach’s scope. Things like, do you notice more cravings? Are you noticing that you maybe don’t feel full as quickly? Are you noticing that you’re thinking about food more often? And instead of keeping those open-ended, I like to use a scale of like 1 to 5 or 1 to 10 and kind of say, “do you remember what it felt like before? Do you kind of remember what a number was before? And let’s gauge that.” And those are going to be the places where you would want to be able to then work on… If you start to see some changes in there, that would at minimum be a flag for him to then go back to his doctor.

Here’s something else I just want to acknowledge, and I say this boldly to any of our doctors. I love them, they’re so great. I am a backwards doctor. So, instead of a DR, I’m an RD. And our toolkit and our playbook is totally different. And I don’t think that a functional medicine doctor is the person to manage this patient. So, I would have a conversation with this patient about his longer-term weight health goals, and maybe there is a collaboration between you, the coach, and a functional medicine trained dietitian on that part. As an example, the coach runs the show and I usually check in with the patient quarterly unless something has come up. But behind the scenes, I’m available for the coach if they have questions on that part. So, that I think that could also just be a great partnership for you, even if it’s not something that your patient wants to invest in. So, I think there are just different ways we could look at those resources on that part.

Dr. Sandi: I love that, Ashley. And it is such a powerful collaboration between a health coach and a dietitian. And that’s what we encourage—seek people out. So, thank you for sharing that. So, yeah, we have a robust number of questions coming in.

Ashley: Totally. I’ll keep going through them and I just will acknowledge, Wada, that you had asked. Thank you. And at the Better Nutrition Program, we love collaborating with you. So, if you are an FMCA coach, absolutely come over to us. You get a better sort of deal on how we put it all together. And we love working with you, whether it’s working with your clients and then supporting, or whether it’s being able to work with you behind the scenes so that you feel more comfortable supporting your patients on this part.

Okay. Could increasing Akkermansia in the gut microbiome enhance endogenous GLP-1 signaling and support weight loss without medication? You nailed it, Milena. So, I love that. But here’s a bigger… Let’s have an ecosystem conversation. So, we can’t increase Akkermansia in the microbiome if the microbiome overall also isn’t going to be hospitable to it. Little bit of a chicken and an egg, because one of the great things about Akkermansia muciniphila is it chews up the mucin, so it helps to repair the lining of the digestive tract. But also, in order for it to thrive and survive, it does need that lining to be doing better. So, a lot of times I’ll lean into glutamine, and then I’m also leaning into feeding the… AAnd there are some other thing is that we can use, but feeding the Akkermansia, things like polyphenols and fibers and working on that part.

Now, endogenous signaling. So, for anyone that that statement doesn’t land for, what we’re talking about here is, can we help our own GLP-1 to turn on and support… And I’m going to say “weight health” instead of “weight loss.” I want to change the goal. But could we have that happen? Where the rubber meets the road is that we could improve… Akkermansia could help make sure, and it could be one of the reasons why the L-cells are not secreting GLP-1 sufficiently, and that could be a piece in the puzzle. But if somebody’s vagus nerve, if somebody’s oral microbiome, if somebody’s bloodstream, if somebody’s digestive system overall, if all of those other pieces aren’t working optimally, we’re not going to see the weight health optimization benefits result.

And then without the medication, one of the things for us to think about is we’re still only going to get 2 to 5 minutes of that hormone. And for many people, depending on where they are at, the degree of suboptimal weight health that they have and what’s causing it, they may need… Instead of two to five minutes, they might need four hours of help. They might need a day of help. So, it kind of depends, and so that’s where we make the decisions about what else we’re adding into the picture and what’s better for them in any one moment.

One of the reasons you’ll see at the bottom of my book, “GLP-1 Shot or Not,” I do share in there very clearly that I have plenty of case studies where we’re using this without using a medication. And sometimes it’s also one of those things that when we’re able to optimize this, we can take them off of other medications that were actually problematic for their weight health and causing issues with their own weight health hormones. So, really, really good on that part. Okay, so…

Dr. Sandi: Ashley, before we get to the next question, I just want to remind everybody that this is for educational purposes only. We are not diagnosing, or treating, or giving specific advice for any medical condition.

Ashley: Right, I am not your dietitian. I’m nobody’s doctor. I’m not your dietitian. And I’m also not the dietitian working with the coach’s patients. So, I appreciate that.

Okay. So, what if a client is complaining of muscle loss due to weight loss medications or GLP-1 agonists? So, first of all, I think it’s a great conversation to have, especially if they are aware of that. That’s such a great opportunity for you to lead in because we can create a SMART goal around that. Now, unfortunately, the medications… And there’s a lot of communication that you’re going to battle against this because a lot of the information about medications out there are these medications create muscle loss. That’s completely false. Muscle loss happens when we don’t have enough protein, when we don’t have enough nutrients that enable the body to be able to build muscle, when digestion isn’t working effectively to make sure the protein that we take in actually can become protein that can go into muscles and it can work, when inflammation or other factors are occurring inappropriately that keep the body from feeling like it can support muscle benefit and muscle growth, and also when we’re not able to do the right kinds of activity and recovery in order to promote muscle growth.

So, that is a lot. And that happens all the time. So, very often what happens is these medications are a great mirror for what wasn’t happening before. Their body probably wasn’t in a muscle-building place before, and now on the medication, it may actually be worsened because maybe they’ve decreased their intake, maybe digestion is worse, and maybe recovery isn’t better. Maybe they’re not able to, because of fatigue and do as much exercise and strength training, etc. So, what I would do is I would have the conversation about the things that are needed to optimize muscle growth. And what we want to do is acknowledge your circumstances right now while on the medication are absolutely going to be a factor, but it’s actually not the medication, which makes it great. You can stay on your medication and you can build muscle. That is absolutely factual. I do it all the time with my patients.

A doctor out there that says “my patients are on these medications and they are all losing muscle” reveals one thing—and I pick on doctors about this all the time—that their system is not successfully set up, usually they don’t have a coach and they don’t have a dietitian, is not set up to help a patient maintain and improve muscle mass. That’s what we’re talking about. So, the job would be to assess what isn’t working better. Most of the time it’s that we have to optimize aspects of digestion. A lot of the time it’s not the idea of total protein, but it’s actually spacing protein out throughout the day so that the digestion can actually use it more effectively and also maybe specific amino acids. So, we might look at things like leucine, or we might look at creatine, taurine, etc. on that part. There’s a lot for us to consider in that space, but what a great opportunity for you to be able to lean in with your client. And, again, this might also be where you want to be in collaboration with a dietitian.

The other thing for us to note is that all of our hormones work collaboratively, so there could also be a hormonal component that’s going on here, where somebody isn’t actually… Maybe their testosterone level looks good, male or female, but under the hood we actually see that their free testosterone is not good, and maybe that has even taken a hit while being on the medication. So, you can see it’s complex, but it is absolutely attainable. The one thing to note is the answer is not to say “more protein” or “more strength training.” We’ve got to do better than that. We need to personalize it.

And I am so excited to dive into Tim, or Timothy, here. You have lost 113 pounds on tirzepatide. Like all of us, we are just glowing for you. I’m so happy on that part. You noticed that you had plateaued when you were using vitamin gummies and your hair was thinning out. So, the GLP-1 medications, I think you’re asking about all of these other things. So, here’s what I would say is awesome, just absolutely awesome, and we just want to meet you where you are today. One of the most important things for us to understand is that when we shrink fat cells, we liberate a lot of toxins that were stored in there. So, 113 pounds of shrunk fat cells—or some of it might have also been muscle, but some of that, a good portion of that—we need to make sure that your body is eliminating, and that we’re able right now to make sure that all those toxins are coming out.

And why am I tying that into hair thinning on that piece? Because your body is like, all of a sudden it got all of this work to do. And so what happened is its nutrient needs actually increased at a time when actually you probably were maintaining or even reducing your nutrient intake because you were eating less, which was leading to some of the weight loss. So, I can’t really comment for you specifically because I have all these questions for you about whether I would use any of these other therapies. But what I can tell you, whether it’s sermorelin or even tesamorelin or growth hormone or anything else on that part, I would not look at those until I have evaluated you as a whole person, understand how your digestion is going, and understand about your total nutrition, because that I have to optimize whether or not we use any of those other protocols on that part.

Now, vitamin gummies, gummies can be a perfect source for you. A powder might be a good source too. One of the reasons I like those is they may be more easily absorbed for you than maybe a tablet or any of these other pieces. But what I wanted to share is we just get to meet who you are today, and we start and we do this assessment and we go and we lean into understanding and really pinpointing… Like, I want to check under the hood, right? Check the engine lights and pinpoint what’s going on on that part. So, love to. And my book and my system is going to be a great resource for you. And if you’re not working with a coach, we would also want to incorporate that part in.

Okay. So, don’t apologize if I spoke about it… I spoke quickly. So, if I went through it too quickly, don’t worry. But microdosing versus taking a full dose, long-term side effects. Okay. So, first of all, “microdosing” is a misused term with GLP all the time. A true microdose, a true microscopic amount, will not have weight health benefits. It might have specific ecosystem benefits like inflammation and other things, but it is not going to have weight health benefits in the space of being able to have things like helping your leptin and ghrelin and your insulin and some of the other things work better. Lower dosing is absolutely a win. And in my opinion, it is a better win because it allows us to really help your body level up to where it needs to work without giving it too much, which is often where we see the problems come in on that part. So, I really love that and think that there’s tremendous value.

Now, sometimes we do have to increase doses for different periods of time and for rationales, but the pharmaceutical approach, which was literally just we give people the medication and we keep giving people the medication, it was not a dietitian, it was not coaching, it was not leaning into how do we optimize your whole body, how do we optimize digestion. The only tool they had in the toolkit was to just increase doses, and that’s why you saw that protocol coming from pharmaceuticals. So, I don’t love that, and I don’t love when doctors practice that way. I like to see a more nuanced, whole-person approach on that part. Okay.

Dr. Sandi: The next question for Ashley, I would like to… First of all, welcome to FMCA, Verena. And you will… The wonderful presentation, all of the content that you have just heard, you will be able to offer to your clients, to educate them, to partner with dietitians, functional medicine doctors, so that this will be something you will utilize and your clients will be able to navigate these areas really successfully, and it will be life-changing.

Ashley: Yes, I love that.

Dr. Sandi: So, you will learn all about how to do this with the coach approach.

Ashley: And Sandi, can we share as kind of a spoiler that myself and one of my favorite colleagues on this actually have put together a specific training on this topic for FMCA-trained coaches and alumni? So, I’m so excited about that. So, you all know that.

Dr. Sandi: Yes, yes. Ashley is one of our educators, and you will learn so much from her.

Ashley: Yeah. Wonderful. Thank you. And so such an in-depth question, Antonio. I’m going to pull out on that part. I think that one of the things about weight management… I love that this approach is working very well for you, and I love that you’re… What I love is you’ve personalized and you’ve found what works for you on that part. I want us to expand the conversation around weight health and not just think about a total number on the scale. But one of the things that I love about Gundry’s work and “The Energy Paradox,” and really thinking about that, is that we can do so much by understanding the signals that our digestion is sending. And that’s why I started the conversation off with my car analogy—that hopefully landed—where we’ve got to get under the hood. We’ve got to see what’s going on in there. So, that is absolutely a part of the work. Whether it’s exclusively the work really depends on the individual on that part.

And Danielle, I’ll reference for you—and especially if you weren’t able to hear it—the muscle mass conversation we were just talking about. So, I think I went into pretty good detail on that part. And I think the only other thing that I would add on that part is, is it maintaining muscle? Yes, but we can even build muscle. And I think what I want to remind people of is the value of building muscle, because whether that person… I don’t have a crystal ball for any of my patients or for coaches for their clients. Whether comes off a medication or not, the more muscle that we have, the better our weight health is going to be throughout our lives. And Sandi is like the living evidence of that, decade on decade. When you focus on that, it helps our cognitive function, it helps protect our bodies when we fall, it helps us navigate so many different things. So, what we don’t want to do is have somebody in this window of time period where they’re using a GLP-1 and they lose muscle, which I know you’re not suggesting at all. But instead, what we want to do is really help them on their GLP-1. It’s why I’m a proponent of using lower doses to put a system together that optimizes muscle and really building muscle on that part.

In my book, the long-term use of GLP-1 agonists, is there any research over 20 years? No. So, I’m kind of at the forefront of this in the sense that in 2004…well, 200. And just to put in perspective, that was the year Facebook came on the market. It was called The Facebook, and YouTube was first available, Janet Jackson had her wardrobe malfunction at the Super Bowl. So, we think about that time period, that was a long time ago, right, that we’re thinking about that. So, that was when the first…when Byetta, which was a twice-daily, that’s when the first one came on the market. And then a couple of years later, liraglutide came on the market. And we’ve only in the last even 10-ish years had semaglutide and then more recently tirzepatide. So, we don’t have long-term data.

Why do I say that I’m at the forefront? Because one of the things that I did see was with bariatrics in that time period, how we were able to see how optimizing somebody’s weight health hormones, their own weight health hormones, how that was a benefit. The long term of the agonist, the only thing we don’t have an answer for is when you agonist something for that long of a period of time, right, instead of 2 to 5 minutes, it’s a day or it’s 7 days, once again why I’m a proponent of low dose and understanding that piece. So, in my book, I talk about how I approach this for patients who are using a medication or not using a medication, so that we can continue to optimize your health for the long term. And in my community, I also consistently go through how to be thinking about this based on what your long-term goals are, whether that’s to have children, or whether you’re dealing with a cancer treatment, or any of these different situations.

I love the question about food sensitivities as it relates to weight because we get to think about it in a totally different way. Food sensitivities are so often a key check engine light that helps us to understand that your digestion is not optimal. Yes, there are some food sensitivities that are going to be for someone based on their unique body and their circumstances ongoing, and certainly their food allergies. But food sensitivities usually tell us that we need to do work to repair digestion. When we repair digestion and optimize digestion, what are we doing? We’re optimizing our weight health hormones. So, it’s so part of the picture. And it’s also why I never recommend that somebody does a food sensitivity test, remove all of those foods, and then says, “Oh, great, I’m going to be healed on that part.” No, no, no. I don’t even usually start with that. I usually start with assessment and really optimizing digestive health even before I experiment with an elimination or reduction on that part.

I’ve already talked through microdosing. Oh, and you can tell I’m at Love Life. Yes, I’m giving a talk here tonight. So, if anyone happens to be in Los Angeles, I’m in El Segundo, 6:00, I’m over at Love Life. I’m so grateful. I was sharing that I have the most green, green drink and then a matcha here. So, it’s wonderful. So, thank you. Great to see that you’re aware of it. And so again, I’m talking about the dosing. So, when we’re referring to regular dosing… So, microdosing that you’re mentioning there, I would consider that low dosing and absolutely applicable in that capacity. Yeah.

And as a dietitian, have you been able to optimize patients who have gained weight back after going off of…? Yes. And unfortunately, I’m glad that I’m available and my clinicians with our coaches are available, because there are so many people who have used… I mean, the average amount of time is a year and people are then coming off of it. Even Oprah decided to try coming off of it and gained 20 pounds back. So, this is absolutely… And this is something that we do need to lean into and also recognize that there may be such a significant sense of failure. Look, no one should be gaining all their weight back. Every system should be set up that, if you gain 5 pounds back or you gain 10 pounds back, even if the situation in which you gained it back, we could fully expect, like even if it was, “I was injured and I couldn’t work out for six weeks” or whatever on that part, we want to be able to move things, but we want to be able to help somebody.

And a lot of that takes an emotional investment. And coaching is so critical because it’s not really diet and lifestyle here. It’s actually the personal connection to the individual to say, “I imagine that right now you must be feeling so sad, or frustrated, or even mad at yourself about that investment and how this has happened.” And maybe a lot of people have said to me that they feel like it’s never going to work out for them, that kind of like, “I can’t believe this has happened.” We have to dive into that, and that’s so valuable. And it’s a place too where coaches—and my coaches do this a lot—can really support mental health professionals that individuals are working with, or we suggest them to work with, where we can work on how do you see yourself as a success or failure and kind of navigate all of that together. So, my coaches liaise with those professionals as well.

Anyone can reach out to us at the Better Nutrition Program. We’ve got the website right there. Would love to connect with you. And Emily, the one that we just referenced for FMCA will be coming out very soon, so I’ll leave that to them to share with you on that part. Yeah. And let me just see if there was one other…

Dr. Sandi: Yeah. The question about what skills or experience…what we do is help you with that. So, our career accelerator track, career advancement initiative, we have a lot of training on that in my office hours. That would be an excellent question to bring up, how to connect and how to have an interview that goes well with dietitians.

Ashley: I love that. And Sandi, I also think your book does a really great job. So, I would just like to put a shout out for that. I think a lot of dietitians… So, nobody means to be territorial. I’m probably the least territorial because I know I was not trained as a coach and I also know it is not remotely in my zone of genius, superpower, etc. But what will happen a lot is that somebody might feel like what you have to offer is redundant to them. So, the only thing that I will share—and this is why I was suggesting Sandi’s book too—is to, in the same way we kind of have to illuminate with a patient and help them understand what it is like their missing piece or how this on that part, one of the things that I’ve experienced with bringing coaches and clinicians together is to really help both of them see their zones of genius as different. And then this is my favorite one. I always ask somebody, “What are you doing that you don’t want to be doing, that you don’t think is a good use of your time?” Right, Sandi? We’ve talked about that.

Dr. Sandi: Yes, I love that.

Ashley: The things that are not a good use of my time. And this is how I win over doctors all the time, because they’re like, “You know what, Ashley, even if I could do that, I don’t want to do that,” etc. on that part. And I’m like, okay, that’s how we win in that piece. So, I’m going to… Timothy, I would love to talk to you offline. It seems like there’s so much great opportunity on that part. So, I think I know that we’re also out of time and I want to make sure that I’m not overextending my welcome here, Sandi. So, I’ll turn it back over to you to close us out.

Dr. Sandi: Thank you. I cannot thank you enough. This has been just such a wonderful presentation. Your book, I highly recommend “Your Best Shot.” This is a great resource for you, for your clients. And I just want to acknowledge, Ashley, the support that you have for health coaches, hiring FMCA graduates, and in your book, offering coaching and continuing to share about the value of this collaboration with dietitians and coaches is just wonderful. So, thank you for being one of our educators. Thank you, everybody, for attending. And you will get a recording.

Ashley: Great. Thanks, everyone. I appreciate you. Take care.

Dr. Sandi: Bye now.

Ashley: Bye.