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Beyond the Injection: Supporting Patients on GLP-1 Therapy with Wendy Burke · Wellness by Designs - Practitioner Podcast

• 0:11
  SPEAKER_00: This is Wellness by Designs and I'm your host Amy Skilton.
• 0:15
  SPEAKER_00: And joining us today is Wendy Burke, a naturopath who's worked in the space of healthy hormones for quite some time, but is joining us today to talk about a really interesting niche in the wellness space.
• 0:31
  SPEAKER_00: So, Wendy, thank you so much for joining us on the Designs for Health podcast.
• 0:36
  SPEAKER_03: Thanks, Amy.
• 0:37
  SPEAKER_03: Absolute pleasure to be here.
• 0:39
  SPEAKER_03: You have been one of my favorites for so many years.
• 0:42
  SPEAKER_00: Ah, thank you so much.
• 0:44
  SPEAKER_00: It's such an honor to be chatting with you today, especially about such a an important topic.
• 0:50
  SPEAKER_00: And that is how we can support our patients who are considering or might already be on GLP1 therapy.
• 0:58
  SPEAKER_00: And I know this is a very hot button topic.
• 1:01
  SPEAKER_00: A lot of people have a lot of opinions about this medication, whether it should or shouldn't be prescribed for this purpose, how it should be used.
• 1:09
  SPEAKER_00: But I think the reality is that it is being used for weight loss and are being handed out, you know, willy-nilly, if you like, from doctors to patients who are asking for it.
• 1:22
  SPEAKER_00: And along with that, there is a lot of unintended consequences in addition to the intended weight loss that that happens along with that.
• 1:32
  SPEAKER_00: So I from our pre-chat, we just should have hit record on our pre-chat because it was such a good conversation.
• 1:37
  SPEAKER_00: I know I could have talked with you all day.
• 1:39
  SPEAKER_00: Oh, it was so great.
• 1:40
  SPEAKER_00: And you're such a wealth of knowledge in this space, and I'm so yeah, I can't wait for you to share everything that you've learned.
• 1:48
  SPEAKER_00: But before we dive in, I know some practitioners who might be new in the profession or who might not yet have come across patients and therefore not looked at GLP1 agonists too closely yet.
• 2:02
  SPEAKER_00: Can you just give us a little summary of what these medications are actually doing in the body?
• 2:09
  SPEAKER_00: Because I think everyone knows they're being prescribed for weight loss, but that might be the extent of some people's understanding.
• 2:15
  SPEAKER_03: Yeah, sure.
• 2:16
  SPEAKER_03: Um so I think what we should probably do is just go back even to a little bit of really early ANP 101, which just um is about the gut in itself.
• 2:25
  SPEAKER_03: So GLP1 is a substance that is naturally produced in the gut.
• 2:29
  SPEAKER_03: It's produced in the um L cells, usually in the uh farer end of the intestine, and it has a lot of different um roles to play.
• 2:38
  SPEAKER_03: But the one that was has has gained the most attention is its impact on insulin and blood sugar control.
• 2:44
  SPEAKER_03: So um GLP1 is released in response to food that we um intake and some foods more than other foods, which we'll have a chat about later.
• 2:54
  SPEAKER_03: Um, but basically, what it does in the body is it slightly slows down gastric emptying.
• 2:59
  SPEAKER_03: Um, it does help with the hormones in your brain to go, oh, hang on, we're full now.
• 3:04
  SPEAKER_03: But most importantly, what it does is stimulates the pancreas to release insulin.
• 3:09
  SPEAKER_03: Um, and this is really where the research was with GLP1.
• 3:13
  SPEAKER_03: And it's got a couple of mates also that hang out with it in the um interopancreatic space.
• 3:18
  SPEAKER_03: And they become important because I think they're also, we're going to see a lot of those coming forward in the future of weight loss and you know, diabetic medication.
• 3:26
  SPEAKER_03: So GIP is another interopancreatic hormone, similar-ish sort of actions as GLP1, but also does a little bit more work with lipids.
• 3:37
  SPEAKER_03: Uh, PYY, which also helps our brain go, hey, you're full now.
• 3:41
  SPEAKER_03: You could stop eating.
• 3:42
  SPEAKER_03: Um, and amylene is another um uh hormone that's released.
• 3:47
  SPEAKER_03: It also has some kind of impact on blood sugar regulation.
• 3:50
  SPEAKER_03: So scientists have known what GLP1 and GIP in particular have done in the body since probably the early 80s.
• 3:57
  SPEAKER_03: They recognized that it was potentially a tool that could help um uh type 2 diabetics in particular because of its action on insulin.
• 4:05
  SPEAKER_03: And so those hormones, GLP1 and GIP, are called incretin hormones because of the impact on insulin.
• 4:13
  SPEAKER_03: So if we fast forward how it naturally works in the body, that this is a substance that is naturally made in the body to where we are now, the difference is one little enzyme called DPP4, because it naturally degrades GLP1 in the body quite quickly within minutes.
• 4:29
  SPEAKER_03: So it's a hormone, and like all hormones, it's attaching to a receptor, which is then what's the signaling mechanism to every other beautiful thing that happens with hormones.
• 4:39
  SPEAKER_03: So what the trouble, trouble, wrong word, challenge with researchers who are very specifically looking at these pathways in relation to uh type 2 diabetes was that there's this enzyme called DPP4 that degrades it so quickly.
• 4:54
  SPEAKER_03: So, in around the 80s, a little bit later than the 80s, they came across um something called a gilla monster, which is basically a big ugly lizard, really.
• 5:03
  SPEAKER_03: Um, and they found that this lizard could eat half its body weight and it would not change its blood sugar regulation at all.
• 5:11
  SPEAKER_03: And so they found a molecular structure inside its saliva that was molecularly similar to humans' GLP1.
• 5:17
  SPEAKER_03: Um, and so what they did from there was they started to work out what would happen if we use this.
• 5:22
  SPEAKER_03: It antagonized or agonized rather, sorry, the receptor.
• 5:26
  SPEAKER_03: And it meant that the GLP1 basically hung around longer in the body.
• 5:31
  SPEAKER_03: And so it did more of the actions than it naturally does.
• 5:35
  SPEAKER_03: Over time and over with science, of course, because technology has just rapidly increased, the structure of that molecule that they created has become more synthesized.
• 5:48
  SPEAKER_03: So once upon a time, way back in 2005, I think the first GLP1 receptor agonized was registered for type 2 diabetics.
• 5:55
  SPEAKER_03: So, I mean, this that's 20 years ago.
• 5:57
  SPEAKER_03: Like this is this concept is actually not new when we think about it.
• 6:01
  SPEAKER_03: I guess it's new in terms of hundreds of years, but not new from a science point of view.
• 6:06
  SPEAKER_03: So once that was registered, then the race was on, obviously, to find out something that lasted longer than four hours.
• 6:13
  SPEAKER_03: And so we then had the next evolution, uh, which was the Lyra glutides, and they lasted a day.
• 6:20
  SPEAKER_03: So some people might remember them, that's sexenda.
• 6:22
  SPEAKER_03: Um, and then the next evolution from that was the semaglutides, of course, which the most famous is Ozempic and Wagovi as well.
• 6:30
  SPEAKER_03: And then the evolution next from that is tazeptide, and that's GLP1 and GIP.
• 6:35
  SPEAKER_03: But basically, what I say to people, the very short version, is that it it agonizes the receptor so that GLP1 hangs around longer in the body and it influences an incredible, incredible amount of functions all over the body.
• 6:49
  SPEAKER_03: We have GLP receptors almost everywhere in the brain, in the muscles.
• 6:54
  SPEAKER_03: We think they're in our reproductive systems as well, obviously in the pancreas because, you know, insulin.
• 7:00
  SPEAKER_03: So it kind of accounts for this broad range of actions that we're seeing this plethora of research come now of, you know, a GLP one can do this, the GLP one agonist can do this, it can do this, it can do this.
• 7:12
  SPEAKER_03: And it's because we have them everywhere in our body.
• 7:15
  SPEAKER_03: And and that was a little bit lengthy, but I'm always, I love to go back to where did this start?
• 7:21
  SPEAKER_03: And it actually starts in the body.
• 7:23
  SPEAKER_03: We have this.
• 7:24
  SPEAKER_03: And the reason why I always start there is because naturopathically, of course, it starts in the gut, right?
• 7:30
  SPEAKER_03: Everything starts in the gut.
• 7:33
  SPEAKER_03: All health starts in the gut.
• 7:34
  SPEAKER_03: And to me, when I first came across these, that was a clue in how naturopaths can be a part, if they want to be a part, can be a really big part in supporting this cohort of people that choose to take GLP1s, you know, for weight management or for there's a plethora of research that's coming through for other inflammatory diseases as well.
• 7:56
  SPEAKER_00: Wow, my gosh, that is just a mind-blowing introduction to the subject.
• 8:01
  SPEAKER_00: And I feel like I want to take a pause there for a moment.
• 8:03
  SPEAKER_00: For anyone listening, Wendy works at a beautiful clinic called Soul Spectrum Wellness in North Lakes, and you've really worked in women's hormones and that, you know, whole hormone space.
• 8:14
  SPEAKER_00: Of course, it's not elite to go from hormones to GLP1, but I have to ask, you're the resident expert on GLP1 now.
• 8:22
  SPEAKER_00: How did you get here?
• 8:24
  SPEAKER_03: How did it all start?
• 8:25
  SPEAKER_03: Yes.
• 8:25
  SPEAKER_03: Yeah.
• 8:26
  SPEAKER_03: It is, look, and I I love women's hormones.
• 8:28
  SPEAKER_03: Women like female hormones, the most interesting thing in the whole world, in my humble opinion.
• 8:34
  SPEAKER_03: Um, where I started with GL pun GLP1 receptor agonist is probably partly my own journey, Amy.
• 8:40
  SPEAKER_03: Um I lived in a large body for a significantly large part of my life, I would say almost all of my life.
• 8:45
  SPEAKER_03: Um, and it was when my son was four months old, um, and I had quite a decent case of postnatal depression.
• 8:53
  SPEAKER_03: Um, lived in a, you know, put on a lot of weight, was very uncomfortable in my body, was very unhappy, disliked almost everything about me.
• 9:01
  SPEAKER_03: Um, and what our action plan, you know, my husband and I got together and worked out an action plan.
• 9:06
  SPEAKER_03: And part of that action plan was to um start moving again, to change my diet.
• 9:11
  SPEAKER_03: And that's actually what brought me into the health space.
• 9:14
  SPEAKER_03: So I lost um, you know, a considerable amount of weight, I think it was about 40 kilos all up.
• 9:19
  SPEAKER_03: Um, so I went, wow, nutrition, everybody should know, everybody should do this.
• 9:24
  SPEAKER_03: This is like magic.
• 9:24
  SPEAKER_03: So I went to study it.
• 9:26
  SPEAKER_03: And in nutrition, like I met naturopaths.
• 9:29
  SPEAKER_03: Oh my god, herbs, aren't they the best thing ever?
• 9:32
  SPEAKER_03: So went and studied naturopathy.
• 9:34
  SPEAKER_03: I got my um set three and four in personal training um somewhere along the way as well.
• 9:39
  SPEAKER_03: But my interest with GLP1 very specifically happened because I I lived in a larger body.
• 9:46
  SPEAKER_03: I know what that feels like.
• 9:49
  SPEAKER_03: And I know what weight bias feels like, and I know what weight stigma feels like.
• 9:55
  SPEAKER_03: And I was starting to hear, I guess I was starting to hear just a little bit of judgment from my beautiful naturopathic um community about, you know, people who are choosing to take these.
• 10:06
  SPEAKER_03: And I really felt that this was actually an opportunity for us rather than it being a negative, um, a negative thing.
• 10:14
  SPEAKER_03: I just thought, oh my God, this is an opportunity for a cohort of people that have tried to, you know, they've almost ignored the health for so long because often they have been, you know, weight-shamed by health professionals in the past, um, or society in general.
• 10:31
  SPEAKER_03: Like what a beautiful opportunity to be like a cornerstone of help to a cohort of people that really felt quite ignored by health professionals, actively, actively ran away from them because of experiences that they may have had in the past.
• 10:47
  SPEAKER_03: And I mean, it's actually showing out in the numbers now too.
• 10:50
  SPEAKER_03: You know, Rudas ran a story, Rudis Health ran a story last year about people who are returning to, you know, GPs as a start, um, to have conversations about their health because that they're willing to again, whereas they were, they didn't want to in the past.
• 11:05
  SPEAKER_03: So I'm really passionate about being able to help a cohort of people.
• 11:11
  SPEAKER_03: And I also think there's so many things.
• 11:13
  SPEAKER_03: Like this, our beautiful profession is in the best place to help this cohort of people.
• 11:21
  SPEAKER_03: There is no other modality that does mind, body, spirit like we do.
• 11:25
  SPEAKER_03: And that's exactly what these people need.
• 11:28
  SPEAKER_03: Like the GLP ones, they're just a vehicle.
• 11:31
  SPEAKER_03: They're not the destination.
• 11:32
  SPEAKER_03: The destination is, you know, how do you, what's your relationship like with food?
• 11:36
  SPEAKER_03: What's your movement?
• 11:37
  SPEAKER_03: What's your sleep?
• 11:38
  SPEAKER_03: What's your relationship like with self?
• 11:39
  SPEAKER_03: Where's your joy in your life?
• 11:41
  SPEAKER_03: Everything we do every single day.
• 11:44
  SPEAKER_03: So I just went, I just have to find out everything I can about these, these um medications, help as many people as I possibly can, and along the way, maybe, maybe influence some naturopaths to embrace this tidal wave because it's coming.
• 12:00
  SPEAKER_03: Like we can stick our heads in the sand and pretend it doesn't exist, but that's not going to work because there is a tidal weight of men coming our way.
• 12:08
  SPEAKER_03: And I really think that we can help this cohort.
• 12:11
  SPEAKER_03: Do I accept that the food system is broken and it probably contributed to where we are now?
• 12:17
  SPEAKER_03: Yep, but I can't fix that right now.
• 12:19
  SPEAKER_03: But what I can do is help someone be healthy when they take this medication and be healthy when they come off this medication so that they can live their best, best life in the most happiest way they possibly can.
• 12:35
  SPEAKER_00: I love that.
• 12:36
  SPEAKER_00: I think I understand, you know, as holistic practitioners, the mindset of wanting and hoping to keep people off medication altogether or achieving results in a more natural way.
• 12:48
  SPEAKER_00: And also the truth is people uh have been grown, you know, grown up in a society of the silver bullet and they're just going to do what they want.
• 12:56
  SPEAKER_00: And sometimes that can actually be a really powerful step in them claiming back their health.
• 13:00
  SPEAKER_00: I mean, I I'm thinking of one client right now who was seeing me for something entirely different, um, did find that she had leptin resistance and, you know, worked out a strategy to address that.
• 13:11
  SPEAKER_00: And then in between, you know, appointments where she was on a maintenance plan, she went away, got on to GLP1s, came back, and had lost a significant amount of weight, but didn't receive any support from her doctor because partly they're not qualified to provide nutritional support.
• 13:30
  SPEAKER_00: They don't have the time, they don't have the resources, they don't have the training.
• 13:34
  SPEAKER_00: And so these medications are just simply being prescribed and people having to just wing it, really, and hope for the best.
• 13:42
  SPEAKER_00: And typically there isn't any support to optimize it, reduce the chance of side effects, correct any underlying, you know, metabolic or habitual issues that set someone up to be where they are, or even, as you said, help them come off it and having an exit strategy.
• 13:59
  SPEAKER_00: So there's so much we can talk about and really offer as naturopaths here.
• 14:04
  SPEAKER_00: And as you said, you're either going to get educated on this to support your patients, or you can allow them to see somebody else who is, because uh it isn't going to take long if you haven't already seen someone who's on them, that's just around the corner.
• 14:18
  SPEAKER_00: Um, that's for sure.
• 14:20
  SPEAKER_00: Look, I think the other thing that um concerns probably all health professionals, not just naturopaths, but is the side effects of GLP ones.
• 14:30
  SPEAKER_00: And we're going to talk shortly about how you can support someone before going on them, while they're on them, how they come off them.
• 14:37
  SPEAKER_00: But there also, I want to acknowledge there's a lot of conflicting information around side effects.
• 14:43
  SPEAKER_00: And I would love to hear what you're seeing as the most current information and and why you think there's so much conflicting information out there too.
• 14:52
  SPEAKER_03: Such a juicy topic, and I do have many opinions on this.
• 14:56
  SPEAKER_03: Um I'll we'll share the not exploitable ones.
• 15:01
  SPEAKER_03: So um absolutely, are there side effects?
• 15:04
  SPEAKER_03: Yes, yes, there are side effects.
• 15:06
  SPEAKER_03: Um, I do think that there are many side effects that have been um, I'm just trying to think of the right word.
• 15:14
  SPEAKER_03: Probably, I don't want to say blown out of proportion because I feel that's a really under underrated word, but I do think that there have been components of marketing strategies of perhaps other competing companies, pharmaceutical, natural medicine, or otherwise, that have taken pieces of information out of studies and really not taking everything else in it.
• 15:38
  SPEAKER_03: So, you know, I think I I'm fairly pragmatic about most things and I do like to research.
• 15:45
  SPEAKER_03: So, you know, I've sat down and I've looked at the research, especially about the serious side effects, and I've looked at the marketing from people who are absolutely emphasizing the serious side effects.
• 15:56
  SPEAKER_03: And I can't help but go, I wonder where the money trail is.
• 15:59
  SPEAKER_03: Like, you know, I think let's be honest, right?
• 16:01
  SPEAKER_03: We are in a capitalist society.
• 16:03
  SPEAKER_03: We also know that this is drug companies that are pushing the GLP1 receptor Agnes through GPs.
• 16:09
  SPEAKER_03: I accept that.
• 16:09
  SPEAKER_03: I I absolutely do.
• 16:11
  SPEAKER_03: But let's not forget that there is a slew of other companies that are pushing their own barrow in relation to weight loss and pharmaceuticals.
• 16:18
  SPEAKER_03: And I think we have to be really savvy about, you know, making sure that the information that we're actually providing hasn't just been relayed from some influencer who also has something to sell.
• 16:29
  SPEAKER_03: And I think that's the thing that really I get really angry about companies that are taking advantage of people, like the general public who understand GLP one somehow is associated with weight loss.
• 16:41
  SPEAKER_03: Um, and I think we really we kind of have a responsibility to even educate our patients what to look for as well, so that they know, you know, what is marketing bullshit and what is actually real.
• 16:54
  SPEAKER_03: So that was the first thing I would say about that.
• 16:56
  SPEAKER_03: Be very careful when you're reposting information from sources that you really don't know whether there is actually science based on that and whether there's current research.
• 17:04
  SPEAKER_03: What are they trying to sell?
• 17:06
  SPEAKER_03: What I would say is that I've strolled through every piece of research I can possibly find in terms of side effects.
• 17:12
  SPEAKER_03: And what we'll do is we'll go through like the most common and then the more serious, because there are some.
• 17:18
  SPEAKER_03: Um most common is gastrointestinal.
• 17:20
  SPEAKER_03: You know, I think that we're all sort of fairly aware of that.
• 17:23
  SPEAKER_03: Um, can happen absolutely.
• 17:25
  SPEAKER_03: Does it happen to most people to some extent?
• 17:27
  SPEAKER_03: Um, that can range from very mild through to quite strong, and they are usually sort of nausea, constipation, diarrhea, um, uh sometimes headaches.
• 17:38
  SPEAKER_03: Um, and I personally think a lot of that can be mitigated by decent pre-planning.
• 17:45
  SPEAKER_03: And this is where I think naturopaths can come into it.
• 17:48
  SPEAKER_03: But we also see it's most prevalent in that titration upwards as well.
• 17:52
  SPEAKER_03: So, in both medications that are available in Australia, both semaglutide and tazepatide, they are 16 weeks for semaglutide, 20 weeks for um tasepatide to go up to full dose, which by the way, not everybody needs to get to, but most of the side effects are in that early titration stage.
• 18:13
  SPEAKER_03: And I said to you, I really truly believe that if there's a bit of pre-planning in relation to this, we can mitigate some of those.
• 18:20
  SPEAKER_03: Um, I also think, you know, having a conversation, there should absolutely be a conversation about what someone's bowel motions are before they start these.
• 18:27
  SPEAKER_03: Oh my God, someone who's constipation should not be having one of these until we sort out that constipation, because, you know, hello, gastroparesis, right?
• 18:35
  SPEAKER_03: So I think first of all, that can be a way that we can mitigate some of the side effects, but that's what's the most common.
• 18:41
  SPEAKER_03: We see incredible changes to appetite, which theoretically sounds like a great idea, but that's how we then get nutritional deficiencies.
• 18:48
  SPEAKER_03: And I think here's the time to separate what are the side effects of the drug and the consequences of the drug.
• 18:53
  SPEAKER_03: So a consequence of the drug is that they lose appetite, which means they're not intaking food, which means then they can have nutrient deficiencies, A, D, E, C, all the B's, calcium, iron, all that sort of stuff.
• 19:06
  SPEAKER_03: But that's not a side effect, it's a consequence of losing your appetite.
• 19:11
  SPEAKER_03: Again, good planning and good support can assist with that.
• 19:16
  SPEAKER_03: Um, and we do see sometimes skin changes, fatigue, and hair loss.
• 19:21
  SPEAKER_03: But again, I would say that is a consequence of um the fact that our like nobody feels like eating.
• 19:28
  SPEAKER_03: GLP1 does naturally do actually impact the hedionic eating center of the brain anyway.
• 19:33
  SPEAKER_03: So the receptor agonists have a really strong impact on that.
• 19:36
  SPEAKER_03: Um, it really dials down any of that hedionic eating that people might have engaged in.
• 19:42
  SPEAKER_03: And I don't know, you you mentioned you've got a client on GLP1.
• 19:46
  SPEAKER_03: Almost everybody, all of my patients will um report that they've lost a craving for, you know, coffee, alcohol, something.
• 19:53
  SPEAKER_03: Like it just doesn't, they don't have that craving anymore.
• 19:57
  SPEAKER_03: And that's partly with what GLP does in the brain.
• 20:01
  SPEAKER_03: Loss of muscle mass is is is another consequence.
• 20:05
  SPEAKER_03: And this is where I get, I get, you know, cranky again.
• 20:08
  SPEAKER_03: All weight loss, all weight loss will result in loss of muscle mass.
• 20:13
  SPEAKER_03: So between 15 and 25% in a normal, you know, normal diet and exercise program, around sort of 31% with gastric surgery and with the GLP1 RAs, between 25 and 40% muscle mass might get lost.
• 20:29
  SPEAKER_03: Again, planning, right?
• 20:31
  SPEAKER_03: We do the nutrition right.
• 20:33
  SPEAKER_03: We get them strength training and moving, then the muscle mass loss isn't to the extent.
• 20:40
  SPEAKER_03: And this most of this comes down to good planning and good support.
• 20:48
  SPEAKER_03: In terms of more seriousness, yeah, there is an increase in um non-arteritic anterior ischemic opic neuropathy, which was really hard to say.
• 20:59
  SPEAKER_03: Also in diabetic neuropathy.
• 21:01
  SPEAKER_03: So there is an increase in that and there has been quite a number of studies that have shown and that is a serious consequence because that does appear to be irreversible.
• 21:10
  SPEAKER_03: I might add that it's 14.5 per 100,000 person years.
• 21:17
  SPEAKER_03: But it is still a risk and it absolutely needs to be considered as anything should be considered when we're speaking about ingesting pharmaceuticals, herbs, nutritionals, we should always be looking at the risk-reward ratio.
• 21:31
  SPEAKER_03: Thyroid cancers there have been multiple meta-analysis now and analysis and so far, even though they appeared to increase in my studies, there has not been an increase in human studies, but absolutely all researchers accept that there's only three years of data.
• 21:46
  SPEAKER_03: So we don't know long term, absolutely don't know.
• 21:50
  SPEAKER_03: Early on there were some issues in terms of potential for pulmonary aspiration when there's endoscopy procedures.
• 21:57
  SPEAKER_03: But if anyone looks at the gastroenterologist and the anesthesiologist sites in Australia, you can see now they actually have procedures in place.
• 22:05
  SPEAKER_03: So that comes down to making sure that people are aware that to be taking GLP1 RAs if they're going in for any kind of procedure because there may be slightly different anesthetic requirements for that as well.
• 22:19
  SPEAKER_03: There was the discussion about whether there's acute pancreatitis but the literature doesn't seem to play that out as well pancreas enzymes can be raised.
• 22:29
  SPEAKER_03: And there was a whole lot early on about the neuropsychiatric side effects but so far in the literature that hasn't played out.
• 22:39
  SPEAKER_03: In fact often the opposite seems to be the case.
• 22:44
  SPEAKER_03: So you know really from from a hardcore what are the studies saying there is some that I think need to be taken very seriously and there are some that we just need to be let's just be sensible like and and and again it comes down to can we prep?
• 23:01
  SPEAKER_03: Can we plan?
• 23:02
  SPEAKER_03: This is about trying to make sure that that people are aware and this is I guess part of my part of my mission as well Amy is not just naturopaths, but I really, really want to try and get out and say to people look I think that the medications have merit um I think they well placed are a wonderful tool in the toolbox but I really want to make sure that there's some prep done and if GPs are in not in a position to do it, some will, some won't.
• 23:28
  SPEAKER_03: We all know that their GPs act in different ways we different philosophies, different times that they like to work with if if a GP can't do that then look here's some information you know get basic bloods done you know get make sure you're not nutrient deficient make sure your bowel motions are working properly do you have a plan do you know what you're supposed to eat nutritionally you know do you have a plan from an exercise point of view?
• 23:54
  SPEAKER_03: You know do you know what the the side effects might be?
• 23:58
  SPEAKER_03: What's your plan in relation to that?
• 24:00
  SPEAKER_03: So I really think a lot of this can be mitigated.
• 24:04
  SPEAKER_03: Some of the more common side effects can be mitigated with really good planning and you know because research right so there is actually research that indicates that too so those candidates that have been well placed in terms of planning ended up with a you know that less um traumatic outcome I can't think of the right word but that's the only way that comes to mind because they were aware of what the gastrointestinal side effects might be.
• 24:28
  SPEAKER_03: They had a plan they knew what they had to do some of it is look I think I come back to my original point be very careful about the information that you're reposting from somebody else because the information is coming thick and fast about these medications, right?
• 24:49
  SPEAKER_03: So there is probably a very current research piece on that particular side effect that may not be that's more current than what you're hearing.
• 24:58
  SPEAKER_03: And also like I said understand that there are other people trying to sell stuff as well.
• 25:02
  SPEAKER_03: This is a massive market.
• 25:03
  SPEAKER_03: The diet industry is dying or is on its way down and the diet industry is billions and billions and billions of dollars.
• 25:11
  SPEAKER_03: So I I think we have we would be naive to think that there's not financial interests from other areas not just the pharmaceutical companies that have developed these medications but there's there's interests money interests everywhere.
• 25:24
  SPEAKER_03: So just being really savvy about where you get information I think is a really good idea.
• 25:29
  SPEAKER_03: But overall I think you know I really think these these peptides have merit you know they are giving people their lives back for some people you know it allows them to move live life out of the pain.
• 25:41
  SPEAKER_03: It's it's a it it it can be a long haul when you've done a lot from a weight management point of view.
• 25:51
  SPEAKER_03: And I think the one thing that we forget not always forget but we don't we do tend to in the politically heated debate about whether these things you know should be on the market or not on the market we're losing sight also of the fact that you know living with excess adipose tissue significantly more adipose tissue comes with its own health problems in its own right.
• 26:14
  SPEAKER_03: You know, there is uncontrolled inflammation to the point I personally believe there is a point that the body gets to that is almost unrecoverable with you know diet and exercise.
• 26:24
  SPEAKER_03: And I think that's where it's stuck in this endocrine dysfunctional circle that goes round and round and round.
• 26:31
  SPEAKER_03: And I really feel there's a lot of people in the world that are like that at the moment.
• 26:34
  SPEAKER_03: So I think that these um these peptides can be quite valuable in trying to cut that circuit of inflammation that's just driving this endocrine dysfunction around and around and around.
• 26:46
  SPEAKER_00: I think that's a really good point for practitioners to sit with especially any practitioner who's never experienced being in a bigger body or someone who maybe has put on weight but found it easy enough to lose doing you know the usual strategies that we all learn.
• 27:03
  SPEAKER_00: I think it's very easy to sit there and consider that it's the easy way out or the lazy way out for instance.
• 27:15
  SPEAKER_00: And I know for me personally I developed extreme leptin resistance after toxic mold exposure and having had you know a a perfect body weight if if there is such a thing as a perfect body weight but an ideal body composition up until the age of 37 and then stacked on you know over 20 kilos in the space of a few months I know that my entire endocrine system and metabolic responsiveness was completely different with the leptin resistance.
• 27:46
  SPEAKER_00: And although I've never used a GLP1 I ended up because nothing else was working used the pharmaceutical medication HCG injections.
• 27:56
  SPEAKER_00: And that was the thing that broke the dam for me and allowed my inflammation to come down my mitochondrial function to return my leptin levels to start to fall instead of continuing to rise and at that point I was in so much pain I could barely function but I certainly couldn't exercise I for other reasons related to mould couldn't breathe properly so was quite immobilized in addition to the fatigue and the pain that I was experiencing.
• 28:25
  SPEAKER_00: And there was just and I also had very little appetite and was eating very little it had nothing to do with caloric intake it was entirely metabolic and HCG was the gift that allowed me to turn the ship around and actually recover my body composition to the point where I was actually able to return to some normal activity and then I got my appetite back and was able to eat more protein and then I actually my fatigue dropped and I was able to actually start you know doing resistance exercise again.
• 28:54
  SPEAKER_00: And I think that's a really important consideration for practitioners who may view things like HCG is a great example but GLP ones is another good example as cheating.
• 29:07
  SPEAKER_00: And I would say you know gastric sleeve surgery or liposuction or appetite suppressance you can certainly look at all of these interventions and think oh that's lazy or it's you know it's it's a it's a bad way of doing things.
• 29:23
  SPEAKER_00: Now all of these things have consequences intended or unintended of course and as practitioners we're always looking for what's underneath but as you pointed out this can sometimes be the thing that allows someone to course correct and make it easier to change their choices um as especially because I think that quick win if you like can really be very motivating for people.
• 29:50
  SPEAKER_03: Well I think a win at all can be really can be really really motivating and I think that's one of the things as well I I don't view these as a quick um a quick fix and and that the research is is super clear like all the trials were a year long.
• 30:04
  SPEAKER_03: So you know we're not talking about putting people on these things for you know six weeks or eight weeks although I know that there are fertility specialists that do that and that's an entirely different kind of entirely different sort of reasoning but you know these these were not intended to be quick fixes they were intended to be you know slower um slower long term and they were always supposed to be with adjunct diet and lifestyle every single trial every single one of the trials with semaglutide and taze when they were done for weight loss were done in conjunction with diet counselling and lifestyle counselling in fact again coming back to the reason why I'm so passionate about trying to get people before they get on them the most successful arm in the tazepitide trial had a 12-week lead-in program where they did diet um and they did diet counseling and did exercise for 12 weeks before they started the taceptide and they got the best results out of any single other trial.
• 31:07
  SPEAKER_03: And I think the thing that is not always um you know when we talk about weight loss with the the GRP1s um they're incredibly anti-inflammatory as well.
• 31:18
  SPEAKER_03: So they reduce a heck of a lot of inflammation of every kind and it's part of the reason that you know they're starting to be looked at for use of so many other things.
• 31:29
  SPEAKER_03: You know there's a few cases of lipoema I've sort of I've seen one study now of lipoema being treated and I know anecdotally it's used where it can be in lipoemia because that's such an inflammatory disease.
• 31:42
  SPEAKER_03: And again something very female oriented often you know comes with um excess adipose tissue but not always um you know cardiovascular disease the research is so clear on that um and and very soon I'm sure we're gonna see them independently being um prescribed for that.
• 32:01
  SPEAKER_03: And I think it's really important that people recognize too that the the reduction inflammation wasn't just because they lost weight.
• 32:07
  SPEAKER_03: Like I know that like I've when I've talked to people they go yeah of course if they lose weight inflammation's gonna reduce like these these results are independent of weight loss as well.
• 32:16
  SPEAKER_03: So we're looking at a multifaceted approach and and again I come back to these are naturopathic principles in terms of working on the gut and reducing inflammation.
• 32:25
  SPEAKER_03: I mean these are things that I think can help people but yeah um they're not supposed to be they're not supposed to be short term.
• 32:32
  SPEAKER_03: They shouldn't be short term and they should absolutely not be rapid weight loss we should again counsel people against rapid weight loss as well and that's probably where one of the consequences you know sometimes we see uh gallbladder issues and that's you know any rapid weight loss we see that sometimes with gastric surgery um as well so you know making sure that people are cancelled well at the start and they're not viewed as quick fixes and this is a hull and this is about a process and this is about changing you know relationship with food this is about you know relearning diet if that was that's what needs to be but I think we have to recognize there is a body type like I I work out as a minimum five to six days a week I love my time in the gym I do strength training I do you know anaerobic anaerobic fitness I have a really good diet I would still be considered overweight you know I I I sleep well I mean I've probably got a tiny bit more stress than I need to have because hello life and family um but I do all the things and still would be considered in an overweight category.
• 33:36
  SPEAKER_03: So I think recognizing that there are also body types that are not really struggle with the world that we have now like it is a different world.
• 33:46
  SPEAKER_03: When you think about how we live now versus how we lived gee 50 years ago totally different world.
• 33:55
  SPEAKER_00: It sure is a real mismatch isn't it those of us that were programmed to survive famines are now living in the time of very little activity and you know endless availability and access to food.
• 34:09
  SPEAKER_00: And I say that sometimes in clinic totally and then you know blue light not enough sunlight during the day like there's just so much going on that we're up against and yeah I think it it's definitely as you say it's got a it's got a real place to support people to factory reset themselves to a better body composition.
• 34:28
  SPEAKER_00: And as you said for practitioners whose patients are considering going on a GLP one given their doctor is almost certainly not going to be providing this part of the support looking at the exercise plan.
• 34:45
  SPEAKER_00: Now perhaps that might require a referral to a personal trainer, exercise physiologist, something of that nature but making a plan around how are you going to preserve active tissue mass?
• 34:55
  SPEAKER_00: How are you going to attempt to build it?
• 34:57
  SPEAKER_00: How are you going to nourish it given that your appetite is going to be much smaller than it has been in a way that doesn't sort of sit in your tummy and feel uncomfortable.
• 35:06
  SPEAKER_00: Nutrition guidelines, how are you covering the bases on their macros given their appetite's going to be down?
• 35:12
  SPEAKER_00: How are you additionally supporting the micronutrients they won't be ingesting and of course you know the there's probably more than this but including looking at the gut, ensuring their gut health is optimal they're having at least one bowel motion a day and pre-treating the gut so that you can avoid any kind of sluggishness, you know, a knock-on effect from the medication is such a beautiful place to start an intervention.
• 35:39
  SPEAKER_00: And if you're lucky enough as a practitioner to get a patient saying to you I'm thinking about it or I'm going to do it soon or I'm flirting with the idea this is such a lovely opportunity to set someone up for success.
• 35:52
  SPEAKER_00: And it's very interesting that the trials all of the trials were done in conjunction with nutrition and exercise and that the ones that got the best results had basically set those people to up to succeed in a way that you know perhaps they haven't been otherwise.
• 36:09
  SPEAKER_00: So I think that's a great thing to keep in mind.
• 36:12
  SPEAKER_00: Although I imagine what's happening more often is in my case I'm thinking of a particular client who you know was six months was in between her appointments and she came back and was like surprise I'm Happy once I'm like oh dear okay now we have to you know try and recover the muscle mass you've lost or you might just have a client presenting for the first time and you see on the list of medications that they're on that they're on one of these for however long that they've been on.
• 36:42
  SPEAKER_00: So if we dive now into like some of those key areas around how we can best support people who are on them I would love to start with nutrition.
• 36:55
  SPEAKER_00: And although this might be a little obvious I'd love to hear it from you like what are the key micronutrients you're like right we've got to make sure these are covered.
• 37:04
  SPEAKER_03: Absolutely and I think you know almost certainly we'll need to supplement in some shape or description although it does really depend on how much food drive is dialed back for each person.
• 37:15
  SPEAKER_03: Some people it's dialed almost completely back and it's non-existent and some people it's just dialed back a little bit.
• 37:21
  SPEAKER_03: In terms of protein you know protein really becomes king no surprise there you know we're looking at sort of 1.5 grams per kilogram of body weight but sometimes in ease of trying to just get people to eat I'm I'm sort of like you know we're really looking at like 30 grams kind of three times a day.
• 37:40
  SPEAKER_03: If you're not feeling very hungry I I talk to them actually about scheduling food in the same they would schedule any meeting because we just have to recognize that the food drive is down and whilst I'm a massive fan a lot of my background is working with a weight management psychologist for my own for my own health my background is working through intuitive eating and listening to your body I think we have to be really just this it just doesn't work in this case because if they listen to their body some of them will never eat.
• 38:08
  SPEAKER_03: So looking at liquid options so we're looking at collagen here we're looking at other kinds of proteins to make sure that they're our people are ingesting protein because we really need to reserve it like reserve that muscle mass it's it's it's also just you know from a hair point of view from a skin point of view because nobody wants their hair to fall out and have terrible skin.
• 38:29
  SPEAKER_03: So so that becomes really very important and you have to work with the person with where they're at.
• 38:34
  SPEAKER_03: So often it's very simple meals monounsaturated fats tend to be um nicer on their guts.
• 38:41
  SPEAKER_03: They tend to not enjoy high saturated fat foods and most of them will tell you that they've sort of they try to like they had a fatty food and it made them want to vomit so they realize that they can't really eat that.
• 38:54
  SPEAKER_03: But even long term this is a great way of getting people to sort of work with the kind of diet style we're after.
• 39:00
  SPEAKER_03: So love to get trying to get some fibre in there.
• 39:02
  SPEAKER_03: If it's not possible then absolutely supplementing with a mixed style of fiber needs to be for bowel motion but also if we're long term thinking about gut microbiome we really want to make sure we're still we're still fed those butyrate producers so that we can get the short chain fatty acids.
• 39:18
  SPEAKER_03: Like I I think that's super key for long term making sure that we're feeding the gut so uh I do that I do omega threes usually as well because you know food drive is down fish sometimes it's not as palatable you know to people and look some people don't like fish anyway like let alone if they're on a TLP one.
• 39:39
  SPEAKER_03: So often we'll use um omega three and then I kind of look from there depending upon where they're at um we we have an in depth conversation about what their food drive is and that sort of really determines my course of action from there.
• 39:53
  SPEAKER_03: But my big focuses really are on you know omega three good fats, um monounsaturated fats Fiber and protein, because I'm thinking also of preserving as many other functions as possible.
• 40:05
  SPEAKER_03: And then we add in as required.
• 40:07
  SPEAKER_03: Sometimes fatigue is a player, so we'll need a B vitamin, you know, sometimes even a multi, although I very rarely do multis, I just find that mostly we get better results if we're looking at something of a slightly higher dose, more therapeutic, if that makes sense.
• 40:23
  SPEAKER_00: Sure.
• 40:23
  SPEAKER_03: Um, and then we work from, you know, what else, herbs-wise, you know, are you getting nausea?
• 40:28
  SPEAKER_03: Where are you at?
• 40:29
  SPEAKER_03: Of course, you know, all of our beautiful herbs, ginger, as many ginger chewables as you probably can.
• 40:34
  SPEAKER_03: And they're readily available and not hard to get, preferably not the ones with sugar.
• 40:39
  SPEAKER_03: Um herbs, I think we just need to be careful as well.
• 40:42
  SPEAKER_03: If there is, you know, slower gastric um motility.
• 40:47
  SPEAKER_03: We just need to be a little bit mindful of half-lives as well.
• 40:50
  SPEAKER_03: And there's a little bit of sort of research.
• 40:53
  SPEAKER_03: There's certainly some um concerns from a pharmaceutical point of view, and there's a little bit of deep diving in how this might impact the half-lives of other um drugs that they might be taking.
• 41:03
  SPEAKER_03: So I think that we should just be cautious with herbs as well.
• 41:06
  SPEAKER_03: Uh in terms of dosage, let's just be don't, I would never and have never high dosed someone on a herb with DLP one.
• 41:15
  SPEAKER_03: Um, and where I can be really mindful of their stomach space, right?
• 41:18
  SPEAKER_03: So if we're putting something in there, then something else might not give.
• 41:21
  SPEAKER_03: I actually treat them a little bit like the way I sometimes treat my gastric surgery people, in that there's limited, usually limited amount of space, and we've got to max everything out.
• 41:33
  SPEAKER_03: The difference here is that, you know, in gastric surgery, there is not that impact, sort of from a brain point of view, but there's a really strong impact with GLP1 RAs on the food drive and the kinds of food.
• 41:46
  SPEAKER_03: So it can be helpful in some ways, but because there's no food drive in some people, we really have to focus on that.
• 41:52
  SPEAKER_03: Um, muscle mass, you know, through movement.
• 41:55
  SPEAKER_03: I like I did personal training, you know, I work out, I love weight training.
• 42:00
  SPEAKER_03: I'm biased.
• 42:00
  SPEAKER_03: I I absolutely admit that I'm biased.
• 42:03
  SPEAKER_03: But I think, you know, it it's really important that we move people into either referral or, you know, there is a bazillion online programs now.
• 42:12
  SPEAKER_03: I fully accept, like, I lived in a larger body and I can tell you, does it make sense to go into a pool for my joints?
• 42:17
  SPEAKER_03: Yeah.
• 42:17
  SPEAKER_03: Would I do it?
• 42:18
  SPEAKER_03: No, because then everybody's going to see me in a swimsuit in a public area.
• 42:23
  SPEAKER_03: So, you know, being really mindful about um people's body size and pain and the potential of what exercise can and cannot bring them.
• 42:31
  SPEAKER_03: I was very fortunate in my journey.
• 42:33
  SPEAKER_03: I had a personal trainer who was, you know, wise beyond her years.
• 42:36
  SPEAKER_03: She never put me in an uncomfortable position.
• 42:38
  SPEAKER_03: So I think being really mindful of the human that's in front of you and what's their capacity is important.
• 42:45
  SPEAKER_03: And hydration, oh my God, hydration is paramount, because the drive to hydrate will drop.
• 42:52
  SPEAKER_03: And our first cues are not always there because that sits in the part of the brain that can be impacted by the GLP1 receptor agonist.
• 42:59
  SPEAKER_03: So it does become a little bit like a job.
• 43:01
  SPEAKER_03: Um, so I do, I just I'm up front with my clients.
• 43:04
  SPEAKER_03: I'm like, this is we have to look at this a bit like a job.
• 43:08
  SPEAKER_03: Your signals are a little bit mixed up at the moment.
• 43:11
  SPEAKER_03: So we really have to get you in the habit.
• 43:12
  SPEAKER_03: Again, though, if we get them in the habit, that will bode well for when they want to come off the medications um as well.
• 43:20
  SPEAKER_03: And then doing the things that we do amazingly, like leaning into while there's space and time, because you'll find that food noise drops a bit.
• 43:29
  SPEAKER_03: While there's space and time, it's a beautiful time to lead into, you know, what was your relationship like with food?
• 43:35
  SPEAKER_03: How did you use food?
• 43:38
  SPEAKER_03: You know, was it was it a comfort thing for you?
• 43:41
  SPEAKER_03: Was it a way that you connected with other people?
• 43:43
  SPEAKER_03: I think I was telling you in my pre-chat, there was, you know, someone who, you know, she had a wine every night, and when we delved, it was because that was the way she spoke to her, like her husband.
• 43:52
  SPEAKER_03: That's how they communicated.
• 43:53
  SPEAKER_03: They had a wine every night together and they talked about their day.
• 43:56
  SPEAKER_03: That becomes a different treatment strategy than just don't have wine.
• 43:59
  SPEAKER_03: That becomes, okay, well, you know, maybe you guys need to work out a way to have a conversation without wine.
• 44:06
  SPEAKER_03: So I think really leaning into don't be afraid to ask questions about how what is people's relationship like with food and then, you know, sleep, stress, all the beautiful things because we can set people up for a much easier ride when they finish.
• 44:24
  SPEAKER_03: And I know I've gone, you know, on a little bit, especially about the gut, because I'm just such a firm, I honestly think it's going to make a difference.
• 44:32
  SPEAKER_03: I think that we will figure out that what people have in their gut, and there's early research to suggest this, what people have in their gut will determine the outcome and the efficacy of the GLP1 receptor agonist.
• 44:45
  SPEAKER_03: So I it's why I sincerely and passionately want to support gut health.
• 44:51
  SPEAKER_03: GLP1 is produced in the gut.
• 44:54
  SPEAKER_03: We look after our gut and then we have a much better ride after that.
• 45:01
  SPEAKER_00: Yes, this is really powerful strategies for practitioners to consider for sure.
• 45:08
  SPEAKER_00: And I love that you touched on exploring the person in front of you's relationship with food too, because there could be emotional attachments, they could be using it for boredom reasons, or you know, there's a lack of sweetness or joy or stimulation in their life.
• 45:25
  SPEAKER_00: And so they're trying to get that from their food.
• 45:27
  SPEAKER_00: And unless those elements are being supported, as soon as the GLP ones are withdrawn, they're going to go right back to using food as a cheap form of medicine, I suppose, to simplify, oversimplify it.
• 45:42
  SPEAKER_00: And they'll end up just returning to their original baseline.
• 45:47
  SPEAKER_00: Um I do I do want to touch on though, because you uh brought this to my attention, food noise, especially in neurodivergent populations, is like another kettle of fish, so to speak.
• 46:01
  SPEAKER_00: And you've got some tools in your toolkit around that.
• 46:04
  SPEAKER_00: Can you walk us through like what's going on there and how you overcome it?
• 46:09
  SPEAKER_03: Yeah, and it look, it's a it's a multifaceted approach.
• 46:12
  SPEAKER_03: But I when I when I was going through my journey, I was very fortunate to meet um, you know, a weight management psychologist who essentially changed um my life.
• 46:21
  SPEAKER_03: And I ended up working for him as well.
• 46:23
  SPEAKER_03: I trained some of his clients.
• 46:24
  SPEAKER_03: And so he really was wonderful in terms of tools that he gave me.
• 46:28
  SPEAKER_03: And he's more than happy for me to share them.
• 46:30
  SPEAKER_03: I I checked um today.
• 46:32
  SPEAKER_03: So some of the things that that we do, he he also works with the neurodivergent population as well.
• 46:37
  SPEAKER_03: And where where where it sort of becomes a food noise for our neurodivergent population, um self-included, there's an afternoon, especially an afternoon, it's a very dopamine y kind of picture.
• 46:52
  SPEAKER_03: So there's not hunger, there's not um, there's not a need to eat in terms of signaling, but the signaling, there's there's a signaling that's happening.
• 47:00
  SPEAKER_03: And sometimes that sensory component is not being read to whatever it is, right?
• 47:05
  SPEAKER_03: So in in the effort of trying to figure out what it is that they need, um, eating can be one of those things because chewing, first of all, is a very sensory stimulating exercise.
• 47:15
  SPEAKER_03: Anybody who's got um, you know, autistic people in their life will know that I have an autistic son, and um, one of the things that we really struggled with is, and still do we have to have two toys and and make sure that he's got access to that because it's quite, it's quite um sensory stim uh sensory soothing.
• 47:31
  SPEAKER_03: Um, but also just that act of eating releases chemicals, right?
• 47:35
  SPEAKER_03: That's why we can have emotional eating um dysregulation, because just we would we're drawn to food.
• 47:43
  SPEAKER_03: If we weren't, if we didn't get a buzz from food, we would have been extinct millions of years ago because there would have been no drive to actually eat.
• 47:50
  SPEAKER_03: So when we are, you know, when there's a bit of sensory dysregulation and our neurochemistry is not as balanced as we would like, for want a better expression, food is one of the things that we'll get driven to because all your brain wants to do is make you feel good.
• 48:04
  SPEAKER_03: Its whole purpose in life is to make you feel good and keep you alive.
• 48:07
  SPEAKER_03: And so food is one of the things that'll search to the memory bank and it'll go ding, oh, this thing that made us feel good in the moment.
• 48:14
  SPEAKER_03: So we're gonna go do that.
• 48:15
  SPEAKER_03: So the way that I approach is that we do like a check-in, a mind-body check-in, right?
• 48:20
  SPEAKER_03: And this is the things that you know Glenn taught me.
• 48:22
  SPEAKER_03: Um are you are you hungry?
• 48:25
  SPEAKER_03: Are you do you actually need to move instead?
• 48:27
  SPEAKER_03: Are you thirsty?
• 48:28
  SPEAKER_03: And it's taking the the 10 seconds before we eat to do our full body check-in.
• 48:34
  SPEAKER_03: Am I tired?
• 48:35
  SPEAKER_03: You know, do I am I do I actually need to move, especially for our neurodivergent population?
• 48:40
  SPEAKER_03: Do I need to move?
• 48:42
  SPEAKER_03: Checking in, is this really hunger or is this some other drive?
• 48:46
  SPEAKER_03: And it doesn't work all the time, Amy, but it does work.
• 48:50
  SPEAKER_03: And sometimes I say to people, if it works 50% of the time, that's 50% of the time.
• 48:55
  SPEAKER_03: You know, we're changing neural pathways because once that pathway is built, in regards to I ate that, I get that brain chemistry, brain remembers, reward pathway, it goes around and around and around and around.
• 49:07
  SPEAKER_03: So anything that we can do to stop that reward pathway going around and around gives us an opportunity to rewire ourselves.
• 49:15
  SPEAKER_03: And that was that's that's the work that I did, you know, with with Glenn was was to try and rewire where my brain was at because I was that person I I ate, I ate in a car in secret because it made me feel better.
• 49:27
  SPEAKER_03: You know, I I I was the person that would, you know, go to the bakery and get the family a loaf of bread and buy a cookie and like eat it by the time I got home.
• 49:36
  SPEAKER_03: So I I I resonated with a lot of um that emotional eating capacity.
• 49:42
  SPEAKER_03: So we'll all lit emotionally.
• 49:44
  SPEAKER_03: It only really becomes more of an issue if it is a way that we manage uncomfortable feelings.
• 49:50
  SPEAKER_03: That is that is then um how we need to address that because that just builds pathways that go round and around and around.
• 49:56
  SPEAKER_03: It's very difficult then.
• 49:58
  SPEAKER_03: And that's you know, we see it all the time.
• 49:59
  SPEAKER_03: That's the glass of wine while I'm getting dinner because that's my signal to relax.
• 50:05
  SPEAKER_03: You know, that's the muffin that I have because that makes me feel good.
• 50:10
  SPEAKER_03: You know, that's the procrastinating before I'm just about to study, right?
• 50:13
  SPEAKER_03: I did I finished uni last year, and I can tell you there was a bit of procrastinate eating in that.
• 50:18
  SPEAKER_03: Um, boredom and a reward.
• 50:21
  SPEAKER_03: My gosh, the amount of people I've had a hard day.
• 50:23
  SPEAKER_03: Absolutely it is a reward, you bet.
• 50:25
  SPEAKER_03: Is it food?
• 50:26
  SPEAKER_03: I don't know, right?
• 50:27
  SPEAKER_03: I don't think so.
• 50:28
  SPEAKER_03: So that was a long answer, and it wasn't just specific to our neurodivergent population, but I also, you know, let's look at let's look at what what's the neurochemistry, you know, what are the what's that saying?
• 50:38
  SPEAKER_03: Is there something that we can do in terms of even supplements for that?
• 50:41
  SPEAKER_03: You know, I I love L-thenine, I love Passion Flower, I love, you know, uh mag3 and eight.
• 50:47
  SPEAKER_03: Um, some of those can be really beautiful in com in combination with some skills to go, like it's I call it a stop check-in.
• 50:54
  SPEAKER_03: And again, that's something that, you know, Glenn has shown me.
• 50:56
  SPEAKER_03: It's the stop, think about it, just put the three seconds of that prefrontal cortex thought strategy reasoning to kind of prevent that circuit of that amygdala response.
• 51:08
  SPEAKER_03: I use some tapping here as well.
• 51:11
  SPEAKER_03: Uh, and look, I think there's other people that have got some extra skills as well.
• 51:15
  SPEAKER_03: You know, I know a couple of hypnotherapists.
• 51:17
  SPEAKER_03: If you've got another, you know, modality, great, but you don't have to.
• 51:22
  SPEAKER_03: I think it's very much about again leaning into what's the relationship?
• 51:27
  SPEAKER_03: What is it, what is it giving that person?
• 51:30
  SPEAKER_03: If you can get them to stop, and sometimes that's visual reminders, sometimes that's reminders on phones.
• 51:35
  SPEAKER_03: Visual reminders can be really helpful because they're like, they're almost like exactly like stop.
• 51:41
  SPEAKER_03: Circuit breaks, the amygdala, prefrontal cortex kicks in.
• 51:45
  SPEAKER_03: Oh, okay, actually, no, is this this is not furthering my goals and I'm actually thirsty, or I'm bored, or I'm I'm, you know, something else.
• 51:59
  SPEAKER_03: It was kind of a long answer, wasn't it?
• 52:00
  SPEAKER_00: No, I think it was really thorough because this is an area, certainly, first of all, great idea to refer to a psychologist, uh, you know, uh someone who specializes in sort of weight loss and food psychology, because it is really complex and it is really nuanced, as you've clearly illustrated for us.
• 52:20
  SPEAKER_00: But also it is helpful from a practitioner point of view to at least start that conversation, find out if people have any awareness around their triggers and what it is they reach for and what might be behind it.
• 52:33
  SPEAKER_00: I mean, just speaking from personal experience, whenever I'm really stressed and adrenally fatigued, I'll crave salt and vinegar chips.
• 52:41
  SPEAKER_00: And it's the salt that my adrenals are looking for.
• 52:44
  SPEAKER_00: And so when I started leaning on electrolytes more, and actually, well, first of all, not burning myself out to the point where my adrenals were like, give me the sunfall.
• 52:53
  SPEAKER_00: Yes, yes, step number one.
• 52:55
  SPEAKER_00: But also if I'm gonna flog myself, like extra magnesium, extra electrolytes, you know, scheduling rest.
• 53:02
  SPEAKER_00: You know, if I'm having a heavy day like today, have a lot a lighter day tomorrow instead of just trying to uh continue to operate on top of just uh, you know, feeling a little worn out and really identifying those triggers if someone's yeah, anxious and it's a way of avoiding tackling what's bothering them or feeling overwhelmed and you know, all of that kind of stuff.
• 53:25
  SPEAKER_00: And even just starting that conversation, even if you don't necessarily peg it down to an exact answer or have an exact strategy, it allows your patient to begin to actually observe themselves and come out of the experience and gives them another opportunity for a way to leverage um themselves.
• 53:44
  SPEAKER_00: And this actually happened to me somewhat recently.
• 53:47
  SPEAKER_00: I've never had a tricky relationship with food.
• 53:51
  SPEAKER_00: I feel very blessed to have avoided developing a really unhealthy relationship with food, but I have also always really liked to entertain.
• 54:00
  SPEAKER_00: And I remember a colleague of mine said to me, you know, she's very pragmatic and very dry.
• 54:06
  SPEAKER_00: I'm not saying this is right or wrong or me, but she was like, food is just fuel.
• 54:10
  SPEAKER_00: You should be just thinking about it from a like just literally what does your body need, and everything else is superfluous.
• 54:15
  SPEAKER_00: And I was like, clutched my pearls.
• 54:17
  SPEAKER_00: I'm like, I beg your pardon.
• 54:19
  SPEAKER_00: Like I want my food to be delicious and stimulating and you know, all the rest of it, as well as nutritious and good for me.
• 54:28
  SPEAKER_00: And um, that sort of led me down the rabbit hole of, you know, making healthier versions of recipes of things that are not necessarily that great for us.
• 54:34
  SPEAKER_00: Um, however, I had a really interesting experience in the last few months.
• 54:39
  SPEAKER_00: I have become really engaged in a project and it's feeding me creatively and it's lighting me up, and it must be giving me dopamine and other great neurochemicals.
• 54:53
  SPEAKER_00: And for the first time, I felt a shift in actually how I related to food.
• 54:58
  SPEAKER_00: It was not even an emotional shift, but I was being nourished by something outside of myself, and my interest in my food being, you know, beautifully aesthetically pleasing and an amazing, delicious culinary thing, as well as being nutritionally complete, became less important.
• 55:16
  SPEAKER_00: And I was able to kind of eat a plainer meal and not feel like, oh, I'm missing out.
• 55:22
  SPEAKER_00: And it was just really curious to even for me who's not had an issue with food like that, to notice the shift when I'm being nourished and stimulated elsewhere.
• 55:30
  SPEAKER_00: And I think there's something in that for everybody, really.
• 55:33
  SPEAKER_00: Um, you know, a lack of sweetness in our life will lead us to craving it in our food.
• 55:37
  SPEAKER_00: And absolutely.
• 55:39
  SPEAKER_03: And you know, there's so much background to food as well.
• 55:41
  SPEAKER_03: You know, for me personally, what I recognize is actually when I feel joy, which is, you know, quite contrary to what Hollywood tell would tell you.
• 55:48
  SPEAKER_03: Um, because that was what my background and family was when people got together.
• 55:52
  SPEAKER_03: We ate and drank too much.
• 55:54
  SPEAKER_03: And so when I was happy, I immediately associated with, well, I I eat and drink too much, until it was actually quite blunt that someone said to me, Well, why do you like you're happy and you're rewarding yourself like you're not a dog.
• 56:07
  SPEAKER_03: So why would you reform reward yourself with food?
• 56:09
  SPEAKER_03: And it really took me back.
• 56:10
  SPEAKER_03: I'm like, oh my god, they're true.
• 56:12
  SPEAKER_00: Yes, exactly right.
• 56:13
  SPEAKER_00: Well, it doesn't have to be a food-based reward, but I think it's the easy, it's like the lowest hanging fruit, if you like.
• 56:20
  SPEAKER_00: Um, it's accessible.
• 56:22
  SPEAKER_00: And I think in some ways, you know, as small children, our parents probably also placated us and rewarded us with little treats.
• 56:30
  SPEAKER_00: And so the habit gets established very early on and can be very much a subconscious thing.
• 56:35
  SPEAKER_03: Absolutely.
• 56:36
  SPEAKER_03: And it brings us out out to, you know, it's not just we we need to move past that, you know, it's food and movement is the only solution to this.
• 56:45
  SPEAKER_03: We absolutely have to move past that.
• 56:46
  SPEAKER_03: And we have to move past the moral judgment of someone who lives in a larger body because when we look at what the you know determining factors are to someone's body size, like in 2007, the um British government did a foresight program that put health professionals together to map, like to do like a system map of obesity.
• 57:04
  SPEAKER_03: So 2007, right?
• 57:06
  SPEAKER_03: So a fair while ago.
• 57:07
  SPEAKER_03: And they came up with seven subheadings of only two were personally associated to that individual, which was, you know, that individual um diet and individual movement.
• 57:18
  SPEAKER_03: The rest was the environment in which they're in, food-wise, the psychology environment that they're in, the exercise environment that they're in, you know, our food production as well, um, in addition to their physiology.
• 57:29
  SPEAKER_03: So I think, you know, we do need to think.
• 57:31
  SPEAKER_03: I actually use that as a bit of a guide in my, you know, holistic um uh treatment of people as like, what is the environment that they're in, both movement, you know, and social.
• 57:43
  SPEAKER_03: Um, you know, what's the physiology of the person I'm looking at?
• 57:46
  SPEAKER_03: There is a body type that will gain weight super quick.
• 57:49
  SPEAKER_03: I am that body type, you know, and I've got mates who are the absolute opposite and can shove stuff down their face like they would not believe.
• 57:56
  SPEAKER_03: And they look at what I eat and they're like, man, you should be like that.
• 58:00
  SPEAKER_03: And I'm like, right, well, I'm not.
• 58:02
  SPEAKER_03: So that's fine too.
• 58:04
  SPEAKER_03: Um, so we we can use that framework as the way that we can help our clients if we're looking, zoom out and look at everything around their life as well, which is again something that I'm you know super passionate about.
• 58:16
  SPEAKER_03: And and I think, you know, recognizing that the difference between male and female physiology becomes very important too, because ease region has a really big impact in this game as well.
• 58:28
  SPEAKER_03: And we know that it actually impacts the um the efficacy of GLP1 receptor agonists too.
• 58:32
  SPEAKER_03: So pre-menopausal women um will have a better response than post-menopausal women.
• 58:37
  SPEAKER_00: Wow, this is just such an in-depth conversation.
• 58:40
  SPEAKER_00: And I think one of the big takeaways I'm getting from this is when you take that holistic approach, especially if you can apply it prior to going onto GLP1s, but especially also during, you can really set someone up for success, not only while they're on it, but I think post-GLP1.
• 59:00
  SPEAKER_00: And this is another conversation that, you know, as we're getting to the end of the podcast, we should probably have.
• 59:06
  SPEAKER_00: And that is, you know, what is the exit runway for someone wanting to come off them?
• 59:11
  SPEAKER_00: I think people, like many other medications, are so excited to go on something, feel better, get a result.
• 59:17
  SPEAKER_00: They don't actually look at the next step beyond that as like, how do I come off this?
• 59:21
  SPEAKER_00: And how do I maintain my results?
• 59:23
  SPEAKER_00: Um, how do I feel good?
• 59:25
  SPEAKER_00: So, can you run us through like what you would consider to be the best practice according to the evidence we have and your clinical experience?
• 59:33
  SPEAKER_03: Yeah, there's actually um not much evidence, actually, in regards to people coming off them, unsurprisingly, because I think there's a push to not come off them from a medical point of view.
• 59:42
  SPEAKER_03: So, what I've done is collected bits and pieces of studies that I found, arms of studies that I found as well, and then equated it with things that we know.
• 59:51
  SPEAKER_03: Um, so there was an arm in one of the uh Tasepatide trials, and they had people come off them, they Revisited them 12 months after.
• 1:00:01
  SPEAKER_03: So the arm that maintained diet and lifestyle regained weight far less.
• 1:00:08
  SPEAKER_03: Like it was quite a small regain of weight.
• 1:00:10
  SPEAKER_03: The arm that did, you know, nothing went back to the way that they were, regained, you know, at least a third of their body weight, if not more.
• 1:00:17
  SPEAKER_03: Oh my God, what a surprise.
• 1:00:18
  SPEAKER_03: Um, so what I've read also is there's a couple of European um clinics that have done this really well.
• 1:00:26
  SPEAKER_03: So they have this taper-off program.
• 1:00:28
  SPEAKER_03: And so they never just stop people.
• 1:00:30
  SPEAKER_03: So as they were stepping up with dosages with both the semaglutides and the tzeptides, this European clinic starts to step people down.
• 1:00:39
  SPEAKER_03: So they actually do it as like a nine to 10 week process.
• 1:00:42
  SPEAKER_03: And I personally think that's a really intelligent idea because you can start to see when things are coming back, right?
• 1:00:48
  SPEAKER_03: Like, so is hunger coming back then?
• 1:00:50
  SPEAKER_03: All right, let's spend some time at this particular level.
• 1:00:52
  SPEAKER_03: Because is it actually hunger or is it food noise?
• 1:00:55
  SPEAKER_03: So let's let's explore where our hunger and fullness signals again as well.
• 1:00:59
  SPEAKER_03: Because you know, there are some people that are interpreting food noise as hunger, and there are some people that are interpreting hunger as food noise as well.
• 1:01:06
  SPEAKER_03: Like it's okay to be hungry.
• 1:01:08
  SPEAKER_03: Like that's a normal physiological response.
• 1:01:11
  SPEAKER_03: So if you do a step down, then you can address each thing as it arises, um, and you can prep people in a far better way.
• 1:01:18
  SPEAKER_03: So obviously, you know, protein, fiber, saturated, unsaturated fats, limiting saturated fats from a gut perspective, because we can get our own GLP one working better if we have that kind of diet, very Mediterranean style, really, is what we're looking at there.
• 1:01:35
  SPEAKER_03: Um, but outside that, when things pop up, right?
• 1:01:39
  SPEAKER_03: So has the food dice come back?
• 1:01:40
  SPEAKER_03: Okay, what's at the bottom of that?
• 1:01:42
  SPEAKER_03: Have we addressed emotional eating?
• 1:01:44
  SPEAKER_03: Um, but that does seem to be the best evidence, but there is not much, let me tell you.
• 1:01:50
  SPEAKER_03: Um, the other thing that I always look at is our sports nutrition mates, right?
• 1:01:55
  SPEAKER_03: Like they've actually been doing this for a bit.
• 1:01:57
  SPEAKER_03: They've been doing, you know, the whole let's lose weight, let's lose, you know, fat mass while we're maintaining muscle mass for a long time.
• 1:02:04
  SPEAKER_03: That's what bodybuilders do.
• 1:02:06
  SPEAKER_03: So if we're able to, you know, do a much more graduated approach where we're looking at food, looking at sleep, looking at inflammation, really repairing the gut, simple things like chewing 30 times before you actually swallow will increase your own GLP1, which still has great impacts in your body, even it is degraded by you know DPP4.
• 1:02:28
  SPEAKER_03: Um, you know, make sure you've got good protein.
• 1:02:31
  SPEAKER_03: It's actually the things that we know.
• 1:02:33
  SPEAKER_03: But the runway can definitely be there, especially if you've done the prep work, you've done the work before like during the work after becomes becomes easier.
• 1:02:42
  SPEAKER_03: The work after becomes much, much harder if there has been rapid weight loss, if there's been no nutritional support, because almost inevitably there has been enormous muscle mass loss, and we've probably put that person in a poorer metabolic position.
• 1:02:54
  SPEAKER_03: So that is, you know, again, the passion that drives me is to try and get people well before this time because I you know there is good evidence if this is done, you know, consistently.
• 1:03:06
  SPEAKER_03: And I this might be quite controversial, but I liken it a little bit like and this is gonna be very controversial, and I apologize.
• 1:03:17
  SPEAKER_03: So, in in Alcoholics Anonymous, one of the things that they do is that you need to go to a meeting regular and you need to stay accountable regularly.
• 1:03:25
  SPEAKER_03: And I do think that when you have lived in a significantly larger body with an aberrant metabolic system, when you come off these things, there has to be regular check-ins for an ex an extended period of time.
• 1:03:37
  SPEAKER_03: If we transfer what we know about people who have lost um big amounts of weight, whether it be through GLP ones or bariatric surgery, we know that the successful people that maintain weight loss are those that have some kind of regular check-ins, whether it be a health professional or a group or something that they do, but it is one prioritized in their life, because there have been studies on this, prioritized in their life, and they um they are engaging on a regular basis with someone who keeps this upper mind of their mind.
• 1:04:07
  SPEAKER_03: And the reason I the reason I bring in the association, like as again, as I appreciate it's it's quite controversial.
• 1:04:14
  SPEAKER_03: So I uh I live with a recovering alcoholic, and we've talked many times about isn't it interesting the philosophy of um being able to maintain weight loss without being crazy and living with the diet culture, but just making sure that food movement is uppermost in mind, you know, and he talks about the things that they do in terms of you know, making sure that they are accountable for their actions every day and you know, that they are aware of what their triggers are and they're actively working towards them.
• 1:04:46
  SPEAKER_03: So I think we can take that sort of approach, but without without the the bigness associated with it and work through helping our clients, you know, put themselves in an environment for six hours like you, if you don't put any pride into this, hell yes, it's going to go back to where it was.
• 1:05:06
  SPEAKER_00: Absolutely.
• 1:05:07
  SPEAKER_00: And I think not that you can compare addictions or coping mechanisms to one another.
• 1:05:14
  SPEAKER_00: However, alcohol is not essential for life, you know, heroin is not essential for life.
• 1:05:21
  SPEAKER_00: You can live without those things for the rest of your life.
• 1:05:24
  SPEAKER_00: Food you have to keep eating if you want to stay alive.
• 1:05:27
  SPEAKER_00: And I think being forced, you know, face to face with something that if you have had challenges with your relationship with food or your appetite in the past can be really tricky.
• 1:05:38
  SPEAKER_00: Uh, but that makes perfect sense that regular support, regular check-ins, regular pep talks make all the difference.
• 1:05:46
  SPEAKER_00: And it's like anything in life who you surround yourself with can be really make or break like how your life ends up turning out.
• 1:05:53
  SPEAKER_00: And with health, it's no different.
• 1:05:55
  SPEAKER_00: And and certainly in the case of this, it's just like any other health challenge.
• 1:06:01
  SPEAKER_00: You deserve that support and and to really prioritize that focus for yourself too.
• 1:06:05
  SPEAKER_00: And and you know, GLP ones aren't the easy way out at all.
• 1:06:09
  SPEAKER_00: It comes with many different challenges, which means if you really want to hang on to the results that you've got, like preparing well for it makes all the difference.
• 1:06:18
  SPEAKER_00: You know, holistic support during it also makes all the difference, and then preparing the exit and and navigating that gently and kindly also.
• 1:06:28
  SPEAKER_03: Gently and kindly is a beautiful, beautiful way of putting this because I think let's go back to there's a cohort here that have felt very stigmatized in the past, and this is an opportunity.
• 1:06:43
  SPEAKER_03: This is an opportunity where you know we can really help a bunch of people that have not wanted to be helped before.
• 1:06:51
  SPEAKER_00: Oh my gosh.
• 1:06:52
  SPEAKER_00: Well, this has just been the most amazing conversation, Wendy.
• 1:06:56
  SPEAKER_00: Thank you.
• 1:06:57
  SPEAKER_00: And I want to just point out a couple of things for anyone who's interested in connecting with Wendy.
• 1:07:03
  SPEAKER_00: She, you can find her on Instagram at GLP1Support Naturopath.
• 1:07:08
  SPEAKER_00: And she's building a lovely community over there.
• 1:07:11
  SPEAKER_00: So whether you're a practitioner who wants to learn more or you are someone who's using GLP1s, whether you're a practitioner or not, that is a wonderful place for you to go.
• 1:07:21
  SPEAKER_00: And I will just briefly mention and please DM Wendy for more information about this.
• 1:07:26
  SPEAKER_00: But she is putting together a pilot program looking at gut bacteria or the difference between gut bacteria between those who respond well to GLP ones versus those that don't, and actually correcting the issues that she's noticed and supporting people to respond better to that medication.
• 1:07:44
  SPEAKER_00: So I will absolutely link your Instagram account when people can find you and learn more from you and of course connect over that pilot program if that's of interest to them.
• 1:07:54
  SPEAKER_00: But I want to just say thank you for sharing your wisdom and experience and also such an incredibly empowering structure for practitioners to consider when it comes to supporting patients.
• 1:08:07
  SPEAKER_00: It was an honor to chat with you today.
• 1:08:09
  SPEAKER_03: I have loved chatting with you, and I just really hope it helps.
• 1:08:12
  SPEAKER_03: That's all I want to do.
• 1:08:13
  SPEAKER_03: I just want to help people, help people, help practitioners, and then if practitioners know, then they can help more people.
• 1:08:19
  SPEAKER_00: Yeah, absolutely.
• 1:08:20
  SPEAKER_00: And you're right.
• 1:08:21
  SPEAKER_00: This is the era of GLP1.
• 1:08:22
  SPEAKER_00: So we either need to learn properly what to do or be left behind, really.
• 1:08:29
  SPEAKER_00: 260 are currently um in some sort of trial.
• 1:08:35
  SPEAKER_00: So there's more coming.
• 1:08:37
  SPEAKER_00: There's more coming.
• 1:08:39
  SPEAKER_00: Well, I I think I speak for everybody who's heard this podcast today, and that we thank you for getting us across these really important aspects of that.
• 1:08:47
  SPEAKER_00: And to everyone who tuned in today, thank you so much for listening.
• 1:08:52
  SPEAKER_00: Also, remember you can find all of the show notes and our other podcasts at the Designs for Health Australia website.
• 1:08:58
  SPEAKER_00: I'm Amy Skilton, and this is Wellness by Designs.