Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / Weight Health, GLP-1s, and the Gut Connection - Ashley Koff RD on Metabolic Health, Food Noise & Hormones
Transcript
- [00:00:00] Ashley Koff, RD: Weight loss is actually a bad goal. And diet and exercise doesn't [00:00:05] work because it doesn't optimize, it doesn't fix what's suboptimal. Yeah. In that part, and [00:00:10] knowing that we have weight health hormones, we, they are the ones that regulate weight health, [00:00:15] so they have to be working optimally. You never need to have a relationship with a, with a weight health [00:00:20] hormone replacement. [00:00:20] Ashley Koff, RD: You never need glide or tirzepatide if you don't need it. But we [00:00:25] all have to optimize these hormones if we wanna achieve weight health. So to me, we've had the [00:00:30] wrong goal. We've had the wrong approach. Uh, we have, you know, you know, the only [00:00:35] people who have been successful is anyone who sold anything in the realm of the diet. [00:00:38] Ashley Koff, RD: You know, trillion dollar diet [00:00:40] industry, and we have millions upon millions of people who feel like [00:00:45] failures. Whereas it was, is actually that their body isn't, you know, doesn't have what it needs to run better. It isn't [00:00:50] working better on that part. [00:00:51] Dr. Taz: Most people are trying to lose weight, but very few have [00:00:55] been taught how weight health actually works. [00:00:57] Dr. Taz: My next guest says this distinction [00:01:00] changes everything. Ashley Cough is a registered dietician with more than 25 [00:01:05] years of clinical experience and the author. Of your best shot where she explains why [00:01:10] we've been stuck in a weight loss mindset instead of understanding the system that [00:01:15] drives sustainable health. [00:01:16] Dr. Taz: She's recognized as CNN's top 100 health makers and [00:01:20] has been featured in style as Hollywood's leading dietician. [00:01:23] Ashley Koff, RD: There are 40 [00:01:25] factors that impact our blood sugar. 10 of them are nutrition. Oh my gosh. Only [00:01:30] one of those is carbohydrate. Right? You know, so your digestion, huge factor, you [00:01:35] know, is, is your body getting what it needs wherever it is? [00:01:37] Ashley Koff, RD: Hydration. If you are [00:01:40] dehydrated, that is going to in affect your blood sugar and vice versa, your blood sugar is going to [00:01:45] create dehydration. So there are a lot of things for us to, to unpack in that space. So [00:01:50] when we look at metabolic health, we want to look at it at the optimal [00:01:55] level, not at the functional level. [00:01:57] Ashley Koff, RD: Um, the most of the labs, the, [00:02:00] um, lab ranges that are out there and the, what we'll call the totals, like total [00:02:05] cholesterol, total, uh, blood pressure, blood sugar, they're not giving us the picture [00:02:10] underneath, you know, that we really need to pay attention to. [00:02:12] Dr. Taz: Please join me in welcoming my [00:02:15] friend Ashley. To the show. [00:02:16] Dr. Taz: This episode is sponsored by Hol+, a holistic health [00:02:20] platform built around education, personalization, and integrative care. [00:02:25] Hol+ blends holistic, integrative and functional medicine clinics with learning [00:02:30] resources like blogs, YouTube videos, and of course, this podcast. So you're not just [00:02:35] treated, you're informed. [00:02:36] Dr. Taz: The platform also includes holistic health quizzes and a curated [00:02:40] wellness shop, helping you make choices that support your body at the root level. [00:02:45] Hol+ is holistic healthcare designed for real life. Visit [00:02:50] us Holplus.co to learn more about the [00:02:53] Ashley Koff, RD: platform. Again, that's [00:02:55] HOL ps.co. [00:02:57] Dr. Taz: All right, Ashley, I am thrilled to have [00:03:00] you. [00:03:00] Dr. Taz: Here we go. Way back. Yeah, and it's been so fun to watch, you know, your journey through the [00:03:05] years. But I am super curious. How did you land in the GLP one [00:03:10] space? I know you're a registered rd. Like Yeah. What landed you here? You know, what are [00:03:15] your thoughts about the GLP one craze? Let's just get into it. [00:03:18] Ashley Koff, RD: Yeah. Thank you. Um, oh, this is [00:03:20] so fun. Okay, so. 2004, um, probably just a little bit [00:03:25] before I met you. [00:03:25] Dr. Taz: Yep. Oh my [00:03:26] Ashley Koff, RD: God, I remember, that's a long time ago. I, I know, I know, right. Um, [00:03:30] and I remember I was about, so I was about four years old as a dietician at that point. Yeah. [00:03:35] And I remember, you know, and I was a super geek. [00:03:37] Ashley Koff, RD: Um, in terms of the body's [00:03:40] physiology. We can unpack my own story, uh, later, and I do in my book, [00:03:45] but it was really interesting 'cause I had started working with bariatric patients. Mm-hmm. And first of all, my own ego [00:03:50] as a dietician was like, I think bariatrics is a bad idea. Like, I can help anyone lose a hundred pounds. [00:03:54] Ashley Koff, RD: I can [00:03:54] Dr. Taz: [00:03:55] understand that. [00:03:55] Ashley Koff, RD: And I was like, and I did help people lose a hundred pounds, but then I saw weight regain, or I saw [00:04:00] challenges, you know, and these sorts of things. And so when I saw bariatric patients, maybe after about [00:04:05] 10 of them, I recall saying to the surgeon. This is just insane. Like literally [00:04:10] overnight we're seeing diabetes change or we're seeing, you know, people's relationships with their [00:04:15] satiety change. [00:04:16] Ashley Koff, RD: And one of them kind of flippantly said to me, yeah, it's the incretin effect. And I was like, [00:04:20] what are you talking about Incretin effect. And all of a sudden I went back like there [00:04:25] was no Google, you know? So I had like go and I went back and I'm like, how? Wait, wait, was [00:04:28] Dr. Taz: anybody using that word back [00:04:29] Ashley Koff, RD: then?[00:04:30] [00:04:30] Ashley Koff, RD: Incretin. Incretin. Right? The incre effect. And so the only people that were using that [00:04:35] word were people that were so deep in understanding the physiology of what was [00:04:40] happening in the gut and understanding and, and really at that time it was just sort of, it's the incretin [00:04:45] effect. Well, for listeners that GLP one and GIP two, [00:04:50] hormones made in the lining of your digestive tract are called. [00:04:53] Ashley Koff, RD: Incretin hormones. Hmm. They [00:04:55] happen to be a part of many, what I call now weight health hormones. Because [00:05:00] when I looked at those hormones and I started in 2004 to get to know them [00:05:05] and then started to get to know the medications that came out that are really just [00:05:10] biosimilar hormone replacement therapy. [00:05:12] Dr. Taz: Hmm. [00:05:12] Ashley Koff, RD: So when I looked at that, I was like, wait a [00:05:15] second. These hormones are the first domino in a line of what [00:05:20] happens in our body. They tell insulin a hormone that we know to go to work. Right. They tell [00:05:25] leptin or ghrelin hormones that we know to go to work. Well, what we since found out [00:05:30] is that they actually regulate what I call a weight health ecosystem. [00:05:34] Ashley Koff, RD: So they help [00:05:35] regulate fat type amount, location, muscle, bone, blood [00:05:40] flow. 'cause they're in the lining mm-hmm. Of our, um, arterial wall. Yes. [00:05:45] Satiety, um, yes. Hydration. Uh, they're involved in inflammation. As a result, they're [00:05:50] involved in cognitive function. Oh my goodness. They like [00:05:55] everything. So to me, when you know something, you can't unknow it. [00:05:58] Ashley Koff, RD: And up until [00:06:00] then I really thought that everything was about digestion. Well, this kind of cemented [00:06:05] to me. Yes, it's about digestion. But it's really about the system of these [00:06:10] hormones and are they working well enough? [00:06:12] Dr. Taz: Oh my gosh. So you have nailed a concept that [00:06:15] even I have been talking about forever, that the gut is the foundation of your health, and whether we're talking about [00:06:20] weight or brain health or hormone health or all these different things, you know, that fundamental sort of [00:06:25] Chinese Ayurvedic idea that the gut is ground zero applies to the GLP one [00:06:30] conversation as well. [00:06:30] Dr. Taz: Mm-hmm. All right. You said a lot of words there and I wanna tease them out because many [00:06:35] people know GLP one. No Ozempic. No Wegovy. No Manjaro. Yeah. They know the names [00:06:40] of the medication, but they're not understanding the kind of the underneath story. Yeah. So when it [00:06:45] comes to the incretin effect, yeah, there are multiple hormones involved. [00:06:49] Dr. Taz: Right. So [00:06:50] how would you just. Define or describe incretin, if you just had to define that word. [00:06:54] Ashley Koff, RD: Yeah. [00:06:55] So the incretin hormones actually only apply to, I believe, GLP one and [00:07:00] GIP, and the effect was, hey, these actually regulate insulin and glucagon [00:07:05] what we now know. And let's back up and look at kind of like the big picture, the digestive [00:07:09] Dr. Taz: [00:07:10] tract and where leptin [00:07:10] Ashley Koff, RD: fits [00:07:11] Dr. Taz: into this, where [00:07:12] Ashley Koff, RD: growing. [00:07:12] Ashley Koff, RD: Absolutely. [00:07:13] Dr. Taz: You know, all of these hormones, by the way, [00:07:15] guys are playing together in the sandbox. So, you know, when we are trying to think about overall health and [00:07:20] metabolic health, we really want an understanding of all of it. Awesome. So I'll let you go. [00:07:23] Ashley Koff, RD: Awesome. Yeah. So we know [00:07:25] about a lot of hormones. We know about our sex hormones, um, which I think are, and other [00:07:30] practitioners have said this, are sort of diminished when we just call them sex hormones, right? [00:07:34] Ashley Koff, RD: But when we talk about [00:07:35] estrogen, testosterone, progesterone, we know about thyroid hormone, right? We know about [00:07:40] insulin for those, some people might be less familiar with leptin and ghrelin. Leptin is the [00:07:45] hormone in our brain that actually, when it's activated, helps the brain give the message of, you should [00:07:50] feel. [00:07:50] Ashley Koff, RD: Right. You should feel satisfied. Ghrelin, we always learned, we're like, so it's [00:07:55] the one that like stimulates hunger on that part. Right. So what's interesting about, uh, leptin, [00:08:00] what's interesting about insulin is these are actually peptide hormones. Well, it turns out we have a lot [00:08:05] more peptide hormones and they reside in our digestive tract. [00:08:08] Ashley Koff, RD: Why is the [00:08:10] peptide part important? Because they are made from protein, so they're made from amino [00:08:15] acids. So our other hormones are steroid hormones. They're made from fats. And then as you [00:08:20] mentioned. All of these hormones play together. So if you have a thyroid issue, you're going to have a [00:08:25] leptin, ghrelin, uh, sex hormone and what I'm about to call weight [00:08:30] health hormone issue. [00:08:31] Ashley Koff, RD: So these weight health hormones, GLP one, to [00:08:35] further confuse everyone listening, we actually do have GLP two and GLP three, but GLP one [00:08:40] G-I-P-P-Y, YCCK, amylin, [00:08:45] Oxy, Moulin. Oh my, I could go home. God. Okay. So the key thing for us to [00:08:50] know, and this is really important, is they reside in cells in the lining of our [00:08:55] digestive tract, in the lining, not inside the digestive tract, but in the lining. [00:08:59] Ashley Koff, RD: The [00:09:00] second thing is they only go on for about two to five minutes. Hmm. And then they're [00:09:05] deactivated, they're done by an enzyme in the body. So why in the world would the body make [00:09:10] something that goes on for two to five minutes That is so important and is in the lining of [00:09:15] the digestive tract because they are solely a switch. [00:09:18] Ashley Koff, RD: They're emotion detector. Mm-hmm. So [00:09:20] the idea is when you eat food, your body sends signals and it sends [00:09:25] signals from the brain to the gut, which is all the work you've been doing for years. And we, we know the gut brain [00:09:30] connection. So when we come in and we, and then it tells these hormones to go to work and their [00:09:35] entire job is to like jump hopefully into an HOV lane and get where they're supposed to [00:09:40] go, and they go and they tell these other hormones to go to work. [00:09:44] Ashley Koff, RD: Okay. That. [00:09:45] That's all they're supposed to do. But if they are not going there on [00:09:50] time, if there's not enough of them, if they get stuck in traffic or if they [00:09:55] just do not get deployed and sent out, then those other hormones don't [00:10:00] get switched on. [00:10:01] Dr. Taz: So it's almost like a traffic jam. [00:10:02] Ashley Koff, RD: It's like a traffic jam. [00:10:04] Ashley Koff, RD: So [00:10:05] imagine that you go to get into your car and let's pretend if cars of yesteryear, 'cause I don't understand how electric cars work, [00:10:10] right? But let's see that there's gas in the en, in the the tank. There's oil in the engine, there's [00:10:15] air in the tires, and you get in your car and you turn it on and it just doesn't go. [00:10:19] Ashley Koff, RD: It's a [00:10:20] spark plug issue. It is not an, is there sufficient nutrients, you know, or that [00:10:25] kind of thing. So one of the issues, and really why these medications were developed is [00:10:30] because for years we were trying to help people with diabetes address. Insulin challenges. [00:10:35] Mm-hmm. Either you don't have insulin. So then we were able to replace it and say, we'll give you insulin, [00:10:40] but what about an insulin resistance? [00:10:41] Ashley Koff, RD: Or what if insulin just, there wasn't, it was too [00:10:45] slow or it wasn't getting the message on time. And so they started to, you know, first deal with [00:10:50] just the insulin and what are, you know, things like burberine or what are medications, Metformin and other that [00:10:55] could help insulin, but they weren't seeing, and they even tried to, the, um, the [00:11:00] enzyme that deactivates, uh, GLP one and GIP, they even tried to create medications [00:11:05] to stop that from working. [00:11:06] Ashley Koff, RD: Those weren't as successful. So in about [00:11:10] 2005 [00:11:10] Dr. Taz: mm-hmm. [00:11:10] Ashley Koff, RD: Same year, Janet Jackson had a famous wardrobe malfunction. Yes. And [00:11:15] Facebook came, you're really dating all of this stuff. And Facebook ca it was the first year of Facebook. Right. Okay. So this is the [00:11:20] year I'm learning about this. [00:11:21] Dr. Taz: 2005 is the first year of Facebook. [00:11:22] Ashley Koff, RD: Yes. Okay. Okay. So this is the world that we're in. Right. [00:11:25] All of a sudden we're connecting with people on the Facebook. Right. Or on the YouTube. [00:11:28] Dr. Taz: Right. [00:11:29] Ashley Koff, RD: And at [00:11:30] that moment in time there was a medication mm-hmm. That was designed like our [00:11:35] own, but instead of staying on for two to five minutes, it actually stayed on for [00:11:40] half of a day. [00:11:40] Ashley Koff, RD: So it, that medication was byta twice daily injection. [00:11:45] Okay. Shortly after we had liraglutide. Yes. Once. Daily injection [00:11:50] solely for the purposes of helping diabetes work, and it worked on that part, or helping diabetics be [00:11:55] able to have their insulin work. Then somewhere in there, after studying the venom of a [00:12:00] Heal a Monster, they were able to, in scientific labs, create a synthetic [00:12:05] hormone that stays on for seven days. [00:12:07] Ashley Koff, RD: And that's your glide, that's [00:12:10] your tirzepatide. That's your ide. That was, [00:12:12] Dr. Taz: this is back in, [00:12:13] Ashley Koff, RD: this is about 2000. When [00:12:15] it came onto the market, this is more like 2012, 2015. So in that time period you had [00:12:20] liraglutide and then we were seeing the development. So that whole time I'm helping people [00:12:25] optimize their own hormone and I was like, oh, we can help you with your diabetes and your weight health, [00:12:30] just doing this without a medication. [00:12:32] Ashley Koff, RD: Right. But then I started to see patients on the [00:12:35] medication and I was like, oh, and they're solely on the medication for diabetes, but interesting things were [00:12:40] happening. Mm-hmm. They were saying like, you know, I'm able to make different choices. I see myself, um, [00:12:45] having a reduction of what we now call food noise. [00:12:46] Ashley Koff, RD: We were also seeing some shifts in, uh, [00:12:50] metabolic markers. And honestly, if my ego is in here, truthfully, I just thought it was the work I was [00:12:55] doing. Right. [00:12:55] Dr. Taz: Right. I was like, I got you on your omegas. I got you. You know, like [00:12:57] Ashley Koff, RD: all this other stuff. So it took [00:13:00] me understanding this whole system to say that, um, what ends up happening when [00:13:05] instead of having your own hormones on for two to five minutes. [00:13:08] Ashley Koff, RD: You have them on for a [00:13:10] week. So the, the receptor sites are satisfied and they're activated. You have [00:13:15] these, all these hormones fully activated all the time. That's a massive difference [00:13:20] when it comes to appetite, when it comes to blood sugar, when it comes to inflammation, right. When it comes blood flow. [00:13:24] Ashley Koff, RD: [00:13:25] And that's what we're seeing with these medications. Oh my [00:13:26] Dr. Taz: gosh. Okay. I've got much million questions. All right. [00:13:30] Let's start with something that I, you know, definitely when we think about overall health, I wanna [00:13:35] try to understand better. So if this sort of traffic jam is happening, [00:13:39] Ashley Koff, RD: yeah. [00:13:39] Dr. Taz: Right? Where [00:13:40] these GLP ones, GLP two, three and GIP are not able to do the work of [00:13:45] getting to where they need to get to to help us metabolize food and all that stuff better. [00:13:49] Dr. Taz: [00:13:50] Why is, why are we naturally not able to do that? Right? What's going on [00:13:55] there? Like, what is, what is happening where that lining of the gut that [00:14:00] contains these hormones is not doing the job it's supposed to do? [00:14:03] Ashley Koff, RD: Yeah. So I think it's [00:14:05] probably a handful of five. Okay. And for many people, it's all those things. [00:14:08] Ashley Koff, RD: And for some people it's one [00:14:10] or one or a couple of them. For some people, it's a suppression of your own. Some people [00:14:15] it's delayed. Some people it's dysfunctional. First of all, they're peptide hormones if you don't take in [00:14:20] enough protein. But also, and here's the kicker. [00:14:23] Dr. Taz: Mm. [00:14:23] Ashley Koff, RD: If your protein [00:14:25] isn't broken down and able to be broken into amino acids, and those amino [00:14:30] acids don't get where they're supposed to go, so they can be able to form these hormones. [00:14:34] Ashley Koff, RD: So if you [00:14:35] have challenges in your digestion. You're taking a proton pump inhibitor. You have acid [00:14:40] reflux. You are not chewing your food, your oral microbiome, your enzymes are lower. [00:14:45] They're not breaking things down. You have microbiome issues. You have sibo, you have, I [00:14:50] mean, there are so many issues, right? [00:14:51] Ashley Koff, RD: That could be happening. So it could be your protein intake, it could also [00:14:55] be your digestion. Now, the lining of the digest. Detract where the L cells and the [00:15:00] K cells are, which is where these are housed and where they're supposed to get the signals. There are so [00:15:05] many things about modern day that insults and injures the lining. [00:15:08] Ashley Koff, RD: It could be alcohol, it [00:15:10] could be stress, it could be things that your body specifically finds intolerant to. [00:15:15] So maybe it's gluten, maybe it's dairy, maybe it's exposure to toxins. Right. Maybe [00:15:20] glyphosate and other things like that. Yep. Um, and it might be that, uh, medications that you took [00:15:25] for all the right reasons. [00:15:26] Ashley Koff, RD: Maybe you went through cancer treatment, maybe you went through hormone treatment. We know [00:15:30] oral contraceptives. We know, um, maybe you are somebody who has had pain and you've been using [00:15:35] aspirin, acetaminophen, like other things like that. I think I mentioned alcohol in there. Yeah, you [00:15:40] did. Um, so there are a lot of things that can challenge the lining of the digestive tract. [00:15:44] Ashley Koff, RD: Now, [00:15:45] on top of that, in the lining of the digestive tract, which I kind of always just thought was a [00:15:50] tube that we just Yeah. We didn't want it damaged. Right. But I didn't realize like it has so much metabolic [00:15:55] activity in there. [00:15:55] Dr. Taz: Right. More leaky gut. Uh, metaphor, [00:15:57] Ashley Koff, RD: right? Yes, exactly. [00:15:58] Dr. Taz: That. Many of us are just like, oh, it's just this, [00:16:00] the cell, it's just a leakiness. [00:16:01] Dr. Taz: The spaces are separating and it's just leaking, [00:16:03] Ashley Koff, RD: right? [00:16:03] Dr. Taz: Triggering inflammation. [00:16:04] Ashley Koff, RD: And [00:16:05] we now know that there could be an absence of Keystone probiotic, so [00:16:10] Akkermansia. Mm-hmm. So Akkermansia eosinophilia job is to be in there. It's a, it's a [00:16:15] probiotic. It chews up mucin and it repairs your lining of your digestive tract. [00:16:19] Ashley Koff, RD: So the [00:16:20] mucin that's supposed to be there needs to be turned over. Well, it needs polyphenols. Mm-hmm. So it [00:16:25] wants pomegranate and, you know, other things to feed off of. It also needs certain [00:16:30] fibers being in there. Right. So maybe I'm insufficient in what I'm taking in, or I [00:16:35] don't have enough of these microbes. [00:16:36] Ashley Koff, RD: Um, bifidobacteria, clostridiums. So [00:16:40] then let's not talk about the digestive track for a second, but let's recognize the highways. The [00:16:45] highways are the vagus nerve and the bloodstream. So the easy one is the bloodstream. If the [00:16:50] bloodstream is high in sugar and there's a stickiness, or maybe you're dehydrated so that things [00:16:55] aren't flowing successfully, or maybe there's plaque or maybe the highway is in other [00:17:00] ways damaged. [00:17:00] Ashley Koff, RD: Right? Right. So if in that case, then if things aren't going to be getting where they're [00:17:05] supposed to go on time, but our vagus nerve I think is so interesting. So our vagus nerve [00:17:10] runs from the brain to the gut. Mm-hmm. And it basically delivers those messages and then it [00:17:15] also takes those messages and takes them where they're supposed to go. [00:17:18] Ashley Koff, RD: The vagus [00:17:20] nerve. Um, I think my friend, uh, Dr. Neva Habib has written one of the best books on this because he talks [00:17:25] about five aspects of safety that the vagus nerve needs to feel, could be [00:17:30] biologically. So it could be nutrients that aren't in there, could be that we're sitting too [00:17:35] much or that we are not moving. [00:17:36] Ashley Koff, RD: Our midsection. Could be things like trauma. So [00:17:40] it could be in the moment, trauma maybe I'm really disturbed by the news that's going on, right? [00:17:45] Even though I have no control over it. Right. Or it could be my lived experience. Yeah. And maybe you know [00:17:50] that, that, so there's a variety of different things. [00:17:52] Dr. Taz: Interesting. [00:17:52] Ashley Koff, RD: When we unpack all of this, I think it's [00:17:55] pretty easy to understand and I think there's an argument to say, I think the body is [00:18:00] brilliantly designed, but if we were designed with something that stays on for two to five [00:18:05] minutes, and I think that worked up until maybe pre-industrial until industrialization, I'm [00:18:10] not sure that two to five minutes is enough in, in modern day with the amount of, what I [00:18:15] would like to say is if we're designed with a motion detector and modern day brings a [00:18:20] stampede in front of a motion detector, maybe we actually need something that stays on for a little bit [00:18:25] longer. [00:18:26] Ashley Koff, RD: I'm not sure that most of us need something that stays on for seven days, [00:18:30] but maybe we need to, at minimum, make sure it works for two to five minutes. Some people [00:18:35] may need it where it stays on for, you know, three to four hours or even up to eight hours. And that's some [00:18:40] of the work that I've been doing with patients. [00:18:41] Dr. Taz: That's fascinating. I, I do have, I wanna spend one more [00:18:45] second Yeah. Just around this idea of why it's happening. Sure. You know, are we [00:18:50] noticing, for example, that stress is playing a role in it and you know that cortisol [00:18:55] is a part of this conversation as well? And then kind of to piggyback on that question, you know. [00:18:59] Dr. Taz: [00:19:00] What can someone, you know, we talk about leaky gut, we talk about the intestinal lining. [00:19:05] You know, what are some of the earliest warning signs? Mm-hmm. Right. Before we get [00:19:10] to medications and peptides and all these other things, what are one of the earliest warning signs [00:19:15] that this gut lining is damage? You need to sit up and pay attention. [00:19:19] Dr. Taz: Yeah. [00:19:20] Otherwise, you know, you might be on a track where. Two years from now, five [00:19:25] years from now, it's gonna be belly fat and weight gain, food noise, and it kind of catches you by [00:19:30] surprise. [00:19:30] Ashley Koff, RD: Yeah. I love that. Um, okay, I think there's three ways we can unpack it. The first one [00:19:35] is stress. Absolutely. So first of all, the body is designed with a stress response. [00:19:39] Ashley Koff, RD: So we [00:19:40] do not say that stress is bad or just you need to reduce your stress. We need to [00:19:45] recognize that elevated stress, the state of where stress is turned on at that elevated [00:19:50] level is awesome. Mm-hmm. Like if, I'm really excited for this interview right. You know, if I'm a [00:19:55] basketball player and I hone in on that part, you know, but I have to turn it off, right? [00:19:59] Ashley Koff, RD: I have [00:20:00] to make sure my body then goes into recovery and in elevated stress, the body is [00:20:05] burning through nutrients. It's also shifting attention away from digestion. Hmm. [00:20:10] So absolutely that is going to be a factor here. It could be burning through the amount of [00:20:15] magnesium that you have. 'cause magnesium belongs inside the cells to turn off the stress [00:20:20] response. [00:20:20] Ashley Koff, RD: It could also be slowing down, or frankly stopping motility. And so as a result, [00:20:25] things aren't getting where they're supposed to go. So turning off elevated stress and also learning to [00:20:30] recognize the. Signals for you of when your body is in elevated stress is going to be important. [00:20:35] The second one is, every hormone in the body plays together. [00:20:38] Ashley Koff, RD: We do not have a [00:20:40] cortisol or an adrenal conversation without having a sex hormone. Absolutely. Without having a thyroid, without having a [00:20:45] weight, health hormone conversation, without having a vitamin D, which is a hormone [00:20:50] conversation. So anyone that's just like, I, I think we have to say this because [00:20:55] perimenopausal women and men, uh, exploring testosterone therapy right now, um, and [00:21:00] women with HRT, it, it, I feel like we're in an environment right now where HRT is being served up as the [00:21:05] solution for everything they're saying [00:21:06] Dr. Taz: that [00:21:06] Ashley Koff, RD: is literally under my skin. [00:21:08] Ashley Koff, RD: It isn't the, the, it is [00:21:10] part of optimization, but if you optimize, if you increase [00:21:15] sex hormones and you only do that and you don't optimize gut or you don't [00:21:20] optimize detoxification, you can actually worsen problems and not, you know, [00:21:25] improve them on that part. And you're. Sex hormones and your weight health hormones are completely [00:21:30] interdependent. [00:21:30] Ashley Koff, RD: So our hormones are all in ecosystem. Mm-hmm. And I think that's really key. So the [00:21:35] what, um, the what for me? Because I wrote a book that is a playbook. Yes. I wanted people to understand the [00:21:40] why, but I was really tired of people feeling getting all of this information and then [00:21:45] not actually having a plan what they need to personalize. [00:21:47] Ashley Koff, RD: Right. So as a dietician, I'm a, people call me the, [00:21:50] um, my niece and nephew do, but now that other adults do. But uh, they call me the backwards doctor Uhhuh. So instead of [00:21:55] Dr, I'm an rd. And I was like, yeah. So I'm gonna focus on the how I love, you know what I mean? Like, so the how. Yeah. [00:22:00] So, um, in here I give you an assessment to go through your digestive signals. [00:22:04] Ashley Koff, RD: Um, I [00:22:05] think it is really important for us to understand that that is so much bigger [00:22:10] than Are you pooping or are you not pooping now? [00:22:12] Dr. Taz: Okay. So this is really important. This [00:22:13] Ashley Koff, RD: is, [00:22:13] Dr. Taz: we wanna, we wanna make sure we [00:22:15] get this. So there are digestive signals. Yes. That are warning signs, yes. That we [00:22:20] may be on the path to reducing or obliterating our own natural GLP [00:22:25] one. [00:22:25] Ashley Koff, RD: Yes, absolutely. And there are five components. Digestion is one of them. So that when we do [00:22:30] assessment of weight health hormones, there are five components. Let's focus on digestion because. It's the foundational [00:22:35] one. Alright. So if you're not pooping at all, that's a problem. Right? And this idea that like a [00:22:40] couple times in the week could be regular. [00:22:41] Ashley Koff, RD: Absolutely not. No. So we use a Bristol scale. So we look at [00:22:45] the type of your poop, we look at the smell of your poop, we look at the ease with which you poop. Um, [00:22:50] and there, you know, that certainly is going to be important. We also focus on your urine. We focus on [00:22:55] elimination that way. And that's why I actually tie hydration into digestion. [00:22:59] Ashley Koff, RD: Mm. So if [00:23:00] you are a hose and you're not a sponge, it means when you drink water, you're peeing it out. Or if you're peeing all day [00:23:05] long, or you're waking up in the middle of the night to pee, these are important signals for us on that part. [00:23:10] Um, it's not the color of your urine that tells us that it is actually when you [00:23:15] drink water, how long is it taking until you're peeing. [00:23:17] Ashley Koff, RD: Um, and so then the other parts of [00:23:20] digestive signals are things like how you smell. So I created the sniff test. Now sometimes we're [00:23:25] not, um. Honest enough with ourself to do the sniff test. So I always say like, get that really honest person, [00:23:30] like has your breath changed? Um, has your underarm odor changed? [00:23:33] Ashley Koff, RD: Has your vaginal odor [00:23:35] change? How does your gas smell? Not just are you passing gas? Um, are things [00:23:40] going in the wrong direction? If you have reflux, like that's an important thing for us to pay attention to. [00:23:45] How is your skin? So a lot of times we conflate skin issues with sex hormone [00:23:50] issues or thyroid issues, like maybe my scalp is itchy, or maybe I have dry skin, or [00:23:55] maybe I have, um, bags or maybe I notice changes or spots or things like this.[00:24:00] [00:24:00] Ashley Koff, RD: All of this is actually signs digestion on that part. Part Chinese medicine called it a hundred percent. [00:24:05] I like, I kind of go between Ayurveda and Chinese medicine and we have all of the tools that we need on that part. [00:24:10] So when we look in that and we do that assessment that is going to give us information [00:24:15] about where, what we want to see adjust. [00:24:17] Ashley Koff, RD: Here's where the rubber meets the road in [00:24:20] modern day, we have created solutions or what I will call band-aids, not true solutions. [00:24:25] Mm. For just. Covering up all of those. So I also wanna share with you, if you were someone [00:24:30] who's regularly using mint mouthwash, it's not that I don't want you to brush your teeth, your, your oral, [00:24:35] um, microbe, you know, your hygiene is very important, [00:24:38] Dr. Taz: right? [00:24:38] Ashley Koff, RD: But if you notice that you're [00:24:40] doing coverup a lot, that's gonna be really important. Yeah. I have a lot of people that tell me after coffee, they [00:24:45] have bad breath, [00:24:45] Dr. Taz: right? [00:24:46] Ashley Koff, RD: That's actually a sign. We need alkaline formers after we have something [00:24:50] that acidic, right? Mm-hmm. Um, so we go through all of those pieces and we can actually unpack what's [00:24:55] going on. [00:24:55] Ashley Koff, RD: And I will say this, I go through this in the book. For anyone who has any [00:25:00] suboptimal digestive function, it doesn't have to be dysfunction, it can be [00:25:05] suboptimal. You will not have optimal weight health hormone function. Point blank right [00:25:10] there. End of story. That's the end of story. So that's why to me, um, in my pizza analogy, it's [00:25:15] gonna be the crust for you. [00:25:16] Ashley Koff, RD: It's gonna be the one that we have to focus on first. [00:25:18] Dr. Taz: I love that, you know, [00:25:20] emphasis on really, that's where it begins. But let's move down the [00:25:25] timeline a little bit. Yeah. Uh, another question, you know, so many questions. One of the questions is, if [00:25:30] we knew about GLP one Medications back in 2012 or 20. 15 as you were saying. [00:25:34] Dr. Taz: Mm-hmm. [00:25:35] Why are they the rage right now? [00:25:36] Ashley Koff, RD: Yeah, totally. I think what happened is, um, [00:25:40] from diabetes to weight health, I think number one, uh, I think it was [00:25:45] 2019, they did a study, nine in 10 Americans didn't meet the criteria for metabolic [00:25:50] health. [00:25:50] Dr. Taz: Mm-hmm. [00:25:50] Ashley Koff, RD: Nine in 10 Americans. That's ridiculous. Okay. That was pre COVID. [00:25:53] Ashley Koff, RD: I don't think we've gotten [00:25:55] healthier metabolically that criteria also only looked at metabolic syndrome, and you and I both [00:26:00] know that that's probably subpar for assessing metabolic health. Right, right. And it actually doesn't ask any questions [00:26:05] about digestion on that part. So that's number one A, I think a whole series of things have [00:26:10] happened. [00:26:10] Ashley Koff, RD: Number one, I think we. Paid attention to metabolic health. We have continuous [00:26:15] glucose monitors and we have more evidence than ever that just trying to reduce your [00:26:20] carbohydrate intake doesn't optimize your blood sugar. Right. So as people got more and more [00:26:25] into how can I improve my blood sugar, I think there was a, there were more and more, quite frankly, [00:26:30] me, medication, you know, physicians and sort of, it went from becoming, um, [00:26:35] you know, sort of a, just for diabetes, um, out there to maybe I could try this in [00:26:40] pre-diabetes. [00:26:40] Ashley Koff, RD: And it was helping people. We also have the introduction of peptides. Mm-hmm. And [00:26:45] that's been really important. I was gonna [00:26:46] Dr. Taz: bring that up. [00:26:46] Ashley Koff, RD: Yeah. That's the, thats. The biohacking community. Right. Um, and that's [00:26:50] great. Um, it suddenly became okay to shoot yourself up. Right? Right. Like, we were like, instead of [00:26:55] drugs, we're gonna shoot ourselves up. [00:26:56] Ashley Koff, RD: Pick your poison. We have to understand that peptides from [00:27:00] an oral standpoint, until a new development recently happened, we actually could not take them [00:27:05] orally because the heat of the stomach broke down the peptide. So we have to inject them. [00:27:10] Mm-hmm. That's why they were, they came out as injectables. The other piece of that, um, I think [00:27:15] as we've moved along is people like, uh, our colleagues like Gabrielle Lyon, um, [00:27:20] JJ Virgin, uh, Stacy Sims, I think have really been out there on the front [00:27:25] talking about body composition mm-hmm. [00:27:26] Ashley Koff, RD: And moving us to this real, and this is really Gabrielle [00:27:30] muscle centric medicine. Yeah. That has been her husband and understanding. Yeah. That muscle is not [00:27:35] just like the tube of the, the digestive tract is not just like a nice to have, it's a [00:27:40] foundational thing in our metabolic health. Right. And it really dictates a lot of our metabolic health. [00:27:44] Ashley Koff, RD: I think all of [00:27:45] these things led to a place where people were really feeling disempowered. [00:27:50] Um, I'm gonna bring this back to a personal story. For me, I was a weight not health issue [00:27:55] for the first, uh, 20 years of my life. Mm-hmm. I had a belly and everybody in [00:28:00] society like. Triple stamped on it. And doctors told me, you don't have a health issue, you have a weight issue. [00:28:04] Ashley Koff, RD: You need to [00:28:05] learn to manage it, and you need to diet and exercise differently. [00:28:07] Dr. Taz: So we gotta dive into that too. [00:28:09] Ashley Koff, RD: Yeah. [00:28:09] Dr. Taz: I [00:28:10] wanna [00:28:10] Ashley Koff, RD: come back to [00:28:10] Dr. Taz: that. Lemme [00:28:10] Ashley Koff, RD: pause [00:28:10] Dr. Taz: because that's [00:28:11] Ashley Koff, RD: super [00:28:11] Dr. Taz: important. [00:28:11] Ashley Koff, RD: Yeah. [00:28:12] Dr. Taz: But, but finish your thought. [00:28:13] Ashley Koff, RD: Yeah. [00:28:13] Dr. Taz: Before we [00:28:13] Ashley Koff, RD: move into, so I think all [00:28:15] of those things really created a perfect storm. [00:28:17] Ashley Koff, RD: And then, you know, drug companies were figuring [00:28:20] out, um, quite honestly, they figured out how to, the patent on Glide and [00:28:25] Tirzepatide was not on the ingredient, it was on the injectable. So it was on this pen that you [00:28:30] could inject. And so when that came about, it wasn't, we're gonna sell vials of the medication, [00:28:35] we're gonna be able to patent this injection. [00:28:36] Ashley Koff, RD: You know, um, the difference is, I don't think they were counting on [00:28:40] compounding pharmacies being like, well, we can just sell somebody. Their needles are already out there and we can sell somebody a [00:28:45] vial. Right. So, you know, it, it's been a variety of different things and certainly [00:28:50] from 2015 to 2000, uh, to 2020, in [00:28:55] my own practice, the explosion of from diabetes to people [00:29:00] using this for weight health benefits was exponential. [00:29:03] Ashley Koff, RD: And then of course, obviously [00:29:05] Hollywood. Right. And influencers, you know, caught up with it. Caught on, caught on with it. [00:29:08] Dr. Taz: Yeah. If you're listening to this [00:29:10] and thinking, I know something is often my body, but I don't know where [00:29:15] to start. This is for you. That's why I created the circle. [00:29:20] The circle is my private community where I and my team focus on understanding your [00:29:25] body from hormones and stress to metabolic health and longevity with real life [00:29:30] guidance that you can actually use. [00:29:32] Dr. Taz: This is about clarity and consistency and [00:29:35] support beyond the exam room, and maybe outside of all the different [00:29:40] appointments and experts that you've been running around to. You can try the circle with a one month [00:29:45] trial using the promo code podcast@holplus.co back slash [00:29:50] circle. Again, that's Hol+ to HOL [00:29:55] ppls.co/circle. [00:29:56] Dr. Taz: All right, let's jump back into the [00:29:57] Ashley Koff, RD: episode. [00:29:58] Dr. Taz: Okay. Now, you've mentioned this a few [00:30:00] times. Yeah. Already you've talked about, and I've heard you say it subtly, and then [00:30:05] clearly you've talked a lot about weight health. Yeah. Versus weight loss. Part of it is your own [00:30:10] personal story. Yeah. You talked about having a belly. [00:30:11] Dr. Taz: I mean, I'll be a hundred percent honest. My belly comes and goes. I've noticed [00:30:15] it. You know, you guys might notice it too. Yeah. But it's very tied and connected to [00:30:20] cortisol and hydration more so than calories in, [00:30:25] calories out in my movement. So. Help us understand weight health versus weight [00:30:30] loss. What we need to be thinking about there. [00:30:32] Ashley Koff, RD: Yeah, I'm sure I'm not unique in, [00:30:35] uh, having had a weight issue and tried every diet under the sun. I think my uniqueness is, I don't know [00:30:40] anyone else who did a seven day goat smoke only cleanse. Oh my gosh. Um, that was my rock bottom. I was [00:30:45] here in Manhattan, seven days fortys of goats milk only. Oh my gosh. [00:30:48] Ashley Koff, RD: Um, and this was [00:30:50] pre Whole Foods. Uh, so that was rough. What [00:30:52] Dr. Taz: year is [00:30:52] Ashley Koff, RD: this? Do you remember? This was, yeah, it was 1990. Oh, [00:30:55] okay. Um, and when it fit, when it worked beautifully for me, um, for 10 days, uh, for [00:31:00] the seven days, and then for a couple days after I, uh, contemplated a life of [00:31:05] just goats milk. Wow. Like I was, because when you have battled your weight, your whole life [00:31:10] and when you have tried, so let's also, let's acknowledge the myth of the [00:31:15] noncompliant patient. [00:31:15] Ashley Koff, RD: Yeah. If one more physician out there says that these patients are looking [00:31:20] for a quick fix or they just need to understand diet or exercise, let's all exhale. I [00:31:25] just give them the middle finger. Like that is not it. Right. We have tried, we are so knowledgeable [00:31:30] on nutrition. We have tried everything. Um, and what has happened and [00:31:35] what thankfully happened to me was at my failed cleanse, um, I went back to, I [00:31:40] was actually not drinking. [00:31:41] Ashley Koff, RD: I was a macrobiotic vegan who did, um, [00:31:45] vinyasa yoga twice a day in Manhattan. I was as 21 years of age. Mm-hmm. Okay. And I didn't drink [00:31:50] alcohol. When that all failed for me and the goat's milk cleanse for me, I did what [00:31:55] every smart 22-year-old does. And I was belly up at a bar at three o'clock in the afternoon. [00:31:58] Ashley Koff, RD: Yeah. Um, [00:32:00] after hot yoga. Don't ever do it. Um, so I turned to a different worm. I was like, tequila. Yeah. I'm [00:32:05] here and I'm telling my story and these guys at the bar are laughing at me, you know, and we're his, it's [00:32:10] hysterical. Well, this is that like weird moment, life changing. A gastroenterologist [00:32:15] happened to be in the bar eating a burger and came over to me and he says to me, have you ever been on [00:32:20] antibiotics? [00:32:20] Ashley Koff, RD: And drunk off my tushie, I turned to him and I'm like, that is the weirdest pickup [00:32:25] line I've ever heard. And he was like, oh, I'm not trying to pick you up. [00:32:27] Dr. Taz: Yeah. [00:32:28] Ashley Koff, RD: And I was like, okay. Noted. And then he said, [00:32:30] but I really think I can help you. And I was done with help at that point. Yeah. I'm just like, it's not gonna happen.[00:32:35] [00:32:35] Ashley Koff, RD: Anyway, I did end up seeing him. My insurance paid for it. He said to me, he never [00:32:40] asked me about my weight. He said to me, just like, if I came to you today, um, you would be asking me [00:32:45] questions about my digestion. You would be asking me questions about my medication. So he was asking about that. He asked [00:32:50] about oral contraceptives. [00:32:51] Ashley Koff, RD: He asked about my drinking alcohol. Like he asked about all these other [00:32:55] things. And he said to me, it's not what you're eating or what you're drinking. Your body doesn't have what it needs to run [00:33:00] better. Yeah. And that moment forever cemented in my life that weight and health are [00:33:05] not separated. When I had my awakening with the, in 2005, [00:33:10] 2004, when I met GLP one, I learned we actually have hormones and that fully [00:33:15] cemented it. [00:33:15] Ashley Koff, RD: Mm-hmm. [00:33:15] Dr. Taz: But [00:33:16] Ashley Koff, RD: weight, our, our fat, our muscle, our bone, our water [00:33:20] status in our body is a key performance indicator of our health. Here's the [00:33:25] issue. It's not the only one. Our blood sugar, our poop, our, excuse me, our [00:33:30] sleep, um, our, you know, our energy, our joy, like, I mean, there's so, you know, our, our [00:33:35] related, it's all related. [00:33:36] Ashley Koff, RD: Right. So I came up with the term weight health [00:33:40] to help people understand that the goal is actually different. Weight [00:33:45] loss is actually a bad goal, and diet and exercise doesn't work because it [00:33:50] doesn't optimize, it doesn't fix what's suboptimal. Yeah. In that part, and knowing that we [00:33:55] have weight health hormones, we, they are the ones that regulate weight health. [00:33:58] Ashley Koff, RD: So they have to be [00:34:00] working optimally. You never need to have a relationship with a, with a weight health hormone replacement. You never [00:34:05] need glide or tirzepatide if you don't need it. But we all have to [00:34:10] optimize these hormones if we wanna achieve weight health. So to me, we've had the wrong goal, [00:34:15] we've had the wrong approach. [00:34:16] Ashley Koff, RD: Uh, we have, you know, you know, the only people who have been successful [00:34:20] is anyone who sold anything in the realm of the diet. You know, trillion dollar diet industry and we have [00:34:25] millions upon millions of people who feel like failures. Mm-hmm. Whereas it was, [00:34:30] is actually that their body isn't, you know, doesn't have what it needs to run better. [00:34:33] Ashley Koff, RD: It isn't working better on [00:34:35] that part. [00:34:35] Dr. Taz: So how would we measure, you know, if we are going, 'cause you know, as women, let's be honest. Yeah. [00:34:40] Like if that dress doesn't fit. Yep. We are in a bad mood. Right. So how do we [00:34:45] realistically. Change our perspective and what we track and measure. Yeah. When it [00:34:50] comes to weight health. [00:34:51] Ashley Koff, RD: Yeah. [00:34:51] Dr. Taz: Should we be getting on the scale? Yeah. Should we be getting on a body [00:34:55] composition type tool? You know, should we be measuring our waist circumference? Mm-hmm. You know, let's just [00:35:00] establish a standard. What is the best standard to understand where we are in the conversation around weight [00:35:05] health? [00:35:05] Ashley Koff, RD: So the most important thing is no to ever looking at total weight and [00:35:10] defining it, using it as any marker of health. [00:35:12] Ashley Koff, RD: It is not, it doesn't tell me anything about your physical health, [00:35:15] and it doesn't tell me anything about your value in the world. Um, so if you have a number that you love that [00:35:20] we have to break up with and look ladies, it's hard. I love that you said that your belly comes and goes. Right? Because as [00:35:25] somebody who personally has had that kind of trauma, the, the showing up of my belly [00:35:30] and the lack of control over it at 48, I'm now 52, was [00:35:35] mortifying. [00:35:35] Ashley Koff, RD: Yeah. It was so challenging. It was, I mean, I literally hidden the mountains of me and [00:35:38] Dr. Taz: I'm someone who never had a, [00:35:40] like I was always bigger in the hips ass. Our family story Yes. But flat stomach. [00:35:45] So now to deal with this accordion to deal with the belly, accordion, belly, it's like super frustrating. Yes. [00:35:49] Dr. Taz: But [00:35:49] Ashley Koff, RD: yeah, [00:35:49] Dr. Taz: you [00:35:50] know, I, I think I finally figured it out, but [00:35:51] Ashley Koff, RD: go ahead. So the number on the scale I remember even like after, [00:35:55] you know. Really following a plan and being like, this should work. I remember standing on this scale and I'm looking at the [00:36:00] number and I'm going, okay, like I'm actually pissed at this number because, and I was on a [00:36:05] body composition scale. [00:36:06] Ashley Koff, RD: Mm-hmm. And I, but I'm still looking at the total number. Mm-hmm. And I was like, I've been strength [00:36:10] training, I've been eating my protein. I got my cre. I got all of that. And I had to give [00:36:15] myself a good, I'm gonna call it three minutes. Yeah. To unpack that I had gained muscle [00:36:20] and lost fat, and the number had stayed the same, but the numbers staying the same reminded me of [00:36:25] going to Weight Watchers and being told to sit down without a high five or a hug. [00:36:28] Ashley Koff, RD: Mm-hmm. Because when the numbers [00:36:30] stayed the same and you don't lose, you don't win. Right. You're not a good person. Right. So we, we [00:36:35] have to work real hard on that one. Now here's the flip side. I want you to see. Every [00:36:40] aspect of your belly as a signal. So yes, we can measure weights to hip, yes, we [00:36:45] can look at our clothes. [00:36:46] Ashley Koff, RD: Yes, we can get on a, um, bioelectrical impedance analysis [00:36:50] scale that tells us muscle, fat bone. I prefer when we look at pounds and we don't look at percentages. Mm-hmm. 'cause the [00:36:55] percentages don't really tell me, uh, the information that I need. We could use a dexa, we can use, [00:37:00] um, these days you can scan with your phone. [00:37:01] Ashley Koff, RD: Right. Um, you can use a tape measure. I mean, there are so many things that [00:37:05] we can look at. Um, yes, I wanna understand if that belly, if it's actual [00:37:10] real gain, or also if it's gas or bloating. So if you notice times of day that that's occurring. [00:37:15] Mm-hmm. But we also wanna pay attention to our hair. We also wanna pay attention to our nails. [00:37:19] Ashley Koff, RD: We [00:37:20] also wanna pay attention to our sleep. We wanna pay attention to our body temperature. We wanna pay attention to, am I [00:37:25] interested in sex or not, you know, in these other signals. So when we start to put it in the [00:37:30] context of all signals, we can actually understand it a lot better. [00:37:34] Dr. Taz: [00:37:35] Fascinating. So it's really, so should women get on the scale then? [00:37:38] Ashley Koff, RD: Not for the, not the total number. [00:37:40] Do you want them to do I tend to use once a week. It really, and it also depends a little bit on your background, [00:37:45] um, in that part because for some people just even getting on a BIA scale is too [00:37:50] traumatic. Yeah. Based on their experience with scales. Yeah. Um, sometimes I have people just literally have. [00:37:54] Ashley Koff, RD: Phone [00:37:55] and the Bluetooth on, and they have that data, and that data comes over to me and they don't look at it, but I like [00:38:00] once a week on waking nude after you've gone the bathroom. Okay. Um, I actually [00:38:05] don't like you using a scale at the gym or at the, the longevity center that you're going to or at the [00:38:10] doctor's office because it's [00:38:11] Ashley Koff, RD: different. [00:38:11] Ashley Koff, RD: What happened in the day is going to dictate. I was just with this [00:38:15] beautiful, beautiful woman. I was giving a, a, a talk at a longevity clinic and she was like. [00:38:20] I cannot believe that my visceral fat is 12 and everybody's like looking at it. I mean, and she's tiny, right? Yeah, [00:38:25] yeah. We're like, no, it's not. Yeah. [00:38:26] Ashley Koff, RD: You know, and then I'm like, well, maybe it is. And this is a really important signal and I'm not sure [00:38:30] you know what this is. Um, and then like an hour, I think hour, an hour and a half, you know, now [00:38:35] at like seven 30 or eight o'clock at night, she got back on it and she's like, oh, now it's an eight. And I [00:38:40] was like, so what have is that happen happen, right? [00:38:41] Ashley Koff, RD: And so I was like, did you poop? Have you digested your food? Did [00:38:45] you happen to have had it before? And it turns out before she had had a sparkling water [00:38:50] she had eaten and all, she was really stressed 'cause she was trying to get everything done before the event got on [00:38:55] there. Um, and then the event happened. [00:38:56] Ashley Koff, RD: Maybe she moved her bowels. I mean, who knows on that part, right? I was like, I don't know if it was [00:39:00] how you were standing, whatever. I said, I'm just, I don't care. But you've proven my point. Let's not get on this [00:39:05] scale on repeat. Let's have the same time. Ideally it's one day a [00:39:10] week. And then the other part for women is to know that, um, wherever you are in your hormonal shifts, [00:39:15] so in perimenopause, our hormones show up differently [00:39:17] Dr. Taz: every minute of every [00:39:18] Ashley Koff, RD: day. [00:39:19] Ashley Koff, RD: Right, right. Um, [00:39:20] so just know that we may see fluctuations. My job as your practitioner is to [00:39:25] unpack that and to have your this information tell us a story of where we wanna look, [00:39:30] rather than judge you as a person or judge what, what it is that you're doing. [00:39:33] Dr. Taz: I mean, I think that's gonna be so [00:39:35] comforting to women. [00:39:35] Dr. Taz: And I would remind them too, just as. Somebody who's been through this and been through it with patients, like [00:39:40] on that estrogen uptick, we are heavier. [00:39:43] Ashley Koff, RD: Yes. [00:39:43] Dr. Taz: And there's more fluid [00:39:45] typically. Yes. So you need to pay attention to that. Yeah. And then on that estrogen downturn and kind of the [00:39:50] progesterone uptick, things are a little bit better. [00:39:52] Ashley Koff, RD: Yeah. [00:39:52] Dr. Taz: But if you're imbalanced, you experience it all [00:39:55] throughout the month and all throughout your cycle. That's right. And for those of you on HRT, it's the same thing. [00:40:00] Like if you get puffy with HRT that is hormonally based, you know, and you [00:40:05] need to look at your HRT regimen. Yes. And it's the gut and the liver and all these other things. [00:40:08] Dr. Taz: 'cause I love that you [00:40:10] say it's an ecosystem. I think that's so important. [00:40:11] Ashley Koff, RD: So we still measure it while we're onboarding [00:40:15] HRT or while we're adjusting it. But we have to factor in, we, we measure it [00:40:20] to under, to gather data, not to judge you as a person or judge your [00:40:25] compliance, if you will. Right. Yeah. [00:40:26] Dr. Taz: So you talked a lot. [00:40:27] Dr. Taz: So this idea of weight health. Yeah. Which I [00:40:30] love by the way. Thank. But you also like in conjunction with weight health is our metabolic health. Yeah. [00:40:35] Right. How, and you also talked about how we are not, you [00:40:40] know, latching onto metabolic health until you're pre-diabetic or diabetic or have like [00:40:45] super high cholesterol or high blood pressure. [00:40:47] Dr. Taz: So help us all understand, you know, [00:40:50] how can we latch onto what our metabolic health is doing. [00:40:53] Ashley Koff, RD: Mm-hmm. [00:40:54] Dr. Taz: As [00:40:55] we are contemplating the role of GLP one, and I know we're gonna get more into the GLP one medications in [00:41:00] just a minute, but, but like what is that differentiator between suboptimal metabolic [00:41:05] health and the signs and symptoms versus, you know, having actually a disease state when it [00:41:10] comes to metabolic health? [00:41:10] Ashley Koff, RD: And I incorporate in assessment of metabolic health as part of this overall [00:41:15] assessment of weight health, uh, and your weight health hormones. And I created, and it's in my book, it's free online. It [00:41:20] is a clinical tool, but I created it to assess our weight health hormone function because I [00:41:25] was like, we need to be able to. [00:41:26] Ashley Koff, RD: See what's going on right. In this whole space. So the metabolic health part of [00:41:30] it is understanding your breathing and your blood pressure, and maybe even looking at heart rate variability. Um, [00:41:35] and then when we look at our, the other aspects of metabolic health, blood sugar really [00:41:40] is an important one for us to look at in a different way. [00:41:43] Ashley Koff, RD: Look, you and I practiced when we [00:41:45] had finger pricks mm-hmm. And we understood in the moment Right. Blood glucose. Right. Right. And we're like, well, that's [00:41:50] helpful for, it's certainly super helpful for diabetes, especially in a type one diabetic. Right. Um, [00:41:55] but it's actually not helpful for us if we wanna see trends. [00:41:57] Ashley Koff, RD: And then we got very excited that A1C came [00:42:00] out and A1C was this 90 day average. The problem with an average is it [00:42:05] doesn't tell me like there are all these different ways. So you could have rolling hills at a higher level and that could [00:42:10] give me the same results as peaks and valleys at a lower level. [00:42:13] Ashley Koff, RD: And we come in [00:42:15] and what we're missing is what's the story of your blood sugar? So that's where continuous glucose monitoring [00:42:20] has been really helpful for us, if that's accessible. And I really like to use it, um, in that [00:42:25] way. And one of the things that we want, and we might use things also like looking at your triglycerides, we might [00:42:30] also look at fasting insulin. [00:42:31] Ashley Koff, RD: We might look at eptide. So it kind of depends on how we wanna [00:42:35] unpack, um, blood sugar on that piece. What we wanna recognize is that [00:42:40] even in regular non pre-diabetic, so I've had people where their A1C is [00:42:45] 5.44, normal 5.0, thank you. And I take a look at it and I'm like, oh my gosh, we've [00:42:50] got peaks and valleys. [00:42:50] Ashley Koff, RD: Yeah. And by the way. High blood sugar. This is the other one. 'cause I think that there are [00:42:55] a lot of people out there that are trying to have us, um, go for something that [00:43:00] is not sustainable but also isn't better for our overall health. We are not meant to have [00:43:05] low flat blood sugar. Right? Like we are not meant to exist at 80 or at 70 on that part.[00:43:10] [00:43:10] Ashley Koff, RD: Um, we want to have spikes in our blood sugar. When you really stress your body out, like with a [00:43:15] great high intensity workout, you're going to see your blood sugar rise. Mm-hmm. We then wanna see it come [00:43:20] down. Right? Right. So what we wanna do is actually have those rolling hills occur in [00:43:25] a way that we understand and we can drive, we can understand the impact of all your choices. [00:43:29] Ashley Koff, RD: [00:43:30] So one of the things that I share in my book and with my patients is there are 40 factors that impact our [00:43:35] blood sugar. 10 of them are nutrition. [00:43:37] Dr. Taz: Oh my gosh. [00:43:38] Ashley Koff, RD: Only one of those is [00:43:40] carbohydrate. Right. You know, so your digestion, huge factor, you know, is, is your [00:43:45] body getting what it needs wherever it is, hydration. [00:43:47] Ashley Koff, RD: Mm-hmm. If you are dehydrated, that [00:43:50] is going to inf affect your blood sugar and vice versa. Your blood sugar is going to create dehydration. [00:43:55] So there are a lot of things for us to, to unpack in that space. So when we look at [00:44:00] metabolic health, we want to look at it at the optimal level, not at the. [00:44:04] Ashley Koff, RD: [00:44:05] Functional level, um, the most of the labs, the, um, lab ranges that [00:44:10] are out there and the, what we'll call the totals, like total cholesterol, total, [00:44:15] uh, blood pressure, um, total, uh, blood sugar, all of these others, they're [00:44:20] not total weight. They're not giving us the picture underneath, you know, that we really need to pay attention to. [00:44:24] Ashley Koff, RD: [00:44:25] So better labs is going to be better. I look at things like a ST and a LT. Yes. Um, I [00:44:30] want us to look at A POB, not just at LDL, like all these sound like alphabet soup to people, but [00:44:35] it's also why I think clinical interpretation is so important in this, so [00:44:40] important, so important. [00:44:40] Dr. Taz: This is, I've argued this already, like we can't have AI doctors, you can't have, [00:44:45] like, you know. [00:44:46] Dr. Taz: Protocols that are spit out without knowing the whole picture. Because the under underneath Yes. [00:44:50] Fasting insulin low, HDL high L-D-L-A-B. [00:44:54] Ashley Koff, RD: Mm-hmm. [00:44:54] Dr. Taz: You [00:44:55] know, A1C is a reference point, but if it's normal, it doesn't mean you get a free pass. So [00:45:00] a lot of times people, a lot of times people are told their labs are normal. [00:45:04] Dr. Taz: Right. They're [00:45:05] not really normal. They're just not in depth. Yeah. And we need to go deeper. Yes. To understand the [00:45:09] Ashley Koff, RD: future [00:45:09] Dr. Taz: there. [00:45:09] Ashley Koff, RD: Or [00:45:10] the like, really, I call our RDAs really dumb amounts, right? Like, so, you know, somebody's turning around that and is [00:45:15] saying like, oh, you know, the RDA for magnesium is from 1997 based on an [00:45:20] 135 pound woman and 166 pound man. [00:45:23] Ashley Koff, RD: And it makes the assumption [00:45:25] based on gender and weight that men need 20% more magnesium than women. And we [00:45:30] just talk about like one uterine contraction, right? Yeah. Like one, like, like premenstrual time [00:45:35] period where your muscles are tight and you need magnesium to be able to relax it. We're not looking [00:45:40] for, um, more favor for women. [00:45:42] Ashley Koff, RD: We're just looking for equal, you know, on that part, we're looking for [00:45:45] equal and [00:45:46] Dr. Taz: suboptimal women, and men and children, [00:45:50] everyone, you know, if you've got a family, you're dealing with everyone. [00:45:52] Ashley Koff, RD: Yeah. [00:45:53] Dr. Taz: You know, you can no [00:45:55] longer subscribe to the theory that if you're eating healthy, you're getting all the nutrients right. [00:45:59] Dr. Taz: That you [00:46:00] need. I, I know so many doctors tell patients that it's simply not true anymore. Facts. Facts, yeah. Because the [00:46:05] RDAs are not where they're supposed to be for this modern time. Yes. Right. Bottom line. [00:46:09] Ashley Koff, RD: [00:46:10] And because if digestion is at all suboptimal, which let's just establish facts, right? Our [00:46:15] digestion is going to be suboptimal more than, it's going to be optimal in modern day with everything that impacts it. [00:46:19] Ashley Koff, RD: Right? And [00:46:20] with our choices of healthy living, as well as as challenges, that means that we can't give [00:46:25] credit to food for being healthy. The body gives credit to nutrients when they get where [00:46:30] they're needed and it can use them. [00:46:31] Dr. Taz: Right? [00:46:32] Ashley Koff, RD: So we have to stop saying like, oh, wild salmon is [00:46:35] a source of this, and as a result, it's a healthy food. [00:46:37] Ashley Koff, RD: When you eat this, this is what's going to happen in your body. Right? [00:46:40] Not if digestion is suboptimal, [00:46:41] Dr. Taz: right? Yeah, absolutely not. All right, let's wind our way back to these GLP [00:46:45] one medications, because of course, in the context of a holistic plan, there is a role for them. Mm-hmm. [00:46:50] There is a place for them. [00:46:51] Ashley Koff, RD: Yeah. [00:46:51] Dr. Taz: So, and give it your best shot. Yeah. Which is the book that is sitting [00:46:55] here, which is incredible and so timely, I think, you know, what has been your experience with these [00:47:00] GLP one medications? What is the right use of them? Mm-hmm. Where does Microdosing fit in? Sure. [00:47:05] Because we've been doing a lot of that. [00:47:06] Dr. Taz: Um. I would just love to hear your perspective on all of [00:47:09] Ashley Koff, RD: that. Sure. [00:47:10] So they are biosimilar weight, health hormone replacements. So we have our own [00:47:15] hormones and we can replace them. So just like estrogen or just like insulin, but those [00:47:20] hormones, estrogen and insulin are bioidentical. [00:47:22] Dr. Taz: Right. [00:47:22] Ashley Koff, RD: These are biosimilar. [00:47:24] Ashley Koff, RD: Okay. The [00:47:25] dissimilarity is they. Day on for one to seven days, whether you're taking the [00:47:30] oral or the injectable instead of two to five minutes. So I want us to think about [00:47:35] if I consume a teaspoon of sugar versus if I have a packet of [00:47:40] um, uh, Splenda as an example. So Splenda is a non-nutritive sweetener. [00:47:44] Ashley Koff, RD: It's thousands [00:47:45] of times sweeter than our own. So it may give us this opportunity to get a high level of. [00:47:50] Sweetness, but it also, and not get, and not take in calories. But it's gonna give us so much more [00:47:55] intensity and it may also alter the microbiome. Mm. That is exactly what's happening with these [00:48:00] medications. [00:48:00] Ashley Koff, RD: So what happens with these medications when they work exactly as they are [00:48:05] supposed to work? So this is not an aha, a surprise or a side effect. They stay on [00:48:10] for seven days. That means you're metabolically active more often than you're at [00:48:15] rest. That can create fatigue. It can create, uh, challenges with recovery in [00:48:20] the body and the body not turning off. [00:48:22] Ashley Koff, RD: Now on the positive side, it can also mean that we're [00:48:25] suppressing appetite, right? We're suppressing hunger. But if we suppress appetite and hunger too [00:48:30] much, you lower. You might also not eat during the day. You might not resource your body well [00:48:35] enough. Um, and you might also back load and that could also affect your sleep. [00:48:38] Ashley Koff, RD: So one of the things I'm seeing [00:48:40] as side effects from the medication is that, um, people who maybe already had. [00:48:45] Suboptimal sleep and suboptimal recovery are experiencing more of that. What happens when that happens? That [00:48:50] occurs, you're not as interested in working out, or your workouts aren't as effective. [00:48:53] Ashley Koff, RD: You lose muscle, you [00:48:55] lose hair. Your other hormones in your body are dysregulated. The other component [00:49:00] of these medications is the way that they work, this is not an aha or a surprise. Mm-hmm. Is they [00:49:05] delay gastric emptying. [00:49:06] Dr. Taz: Right. [00:49:07] Ashley Koff, RD: If digestion is already suboptimal, it's [00:49:10] going to exacerbate that. Yeah. If you're not pooping, it's going to be worse. [00:49:13] Ashley Koff, RD: Right. If you have reflux, [00:49:15] it's going to be worse. And if you are doing all of this and you're getting a hormone [00:49:20] that goes right to the receptor sites, instead of your body have to triggering it and releasing [00:49:25] it and deploying it and having it travel where it's supposed to go, your own hormones are getting [00:49:30] suppressed. [00:49:30] Ashley Koff, RD: Mm. So if you don't fix what's going on underneath or you just try to come [00:49:35] off the medication, you are not going to be able to. So we look at all of that. We [00:49:40] understand how it's working. [00:49:42] Dr. Taz: Screaming [00:49:42] Ashley Koff, RD: this, right? It's so you have to have a [00:49:45] holistic approach. Don't up for people to be saying this like, oh my gosh. [00:49:48] Ashley Koff, RD: And blaming the medication, [00:49:50] right? First of all, any blame of these medications is completely about weight loss, weight bias that [00:49:55] exists in this country. Because every medication, a statin, which interferes with cholesterol [00:50:00] formation, also interferes with testosterone, also interferes with erectile dysfunction or [00:50:05] testosterone in women, and a whole bunch of factors, and is also going to be a factor in [00:50:10] your iron and everything else. [00:50:11] Ashley Koff, RD: So if we look at every. Medication, it's going to have pros and [00:50:15] considerations. Alright? The dose is going to matter and the dose is going to be [00:50:20] important because at higher levels you're going to have this occurring at a greater [00:50:25] intensity, right? Instead of one packet of Splenda, if I use four packets of Splenda, I'm going to have [00:50:30] more microbiome disruption, or I'm going to have more high exacerbation of my sweet taste [00:50:35] buds and, and regular fruit isn't gonna taste sweet, et cetera on that part. [00:50:38] Ashley Koff, RD: So one of the [00:50:40] reasons microdosing has become popular. It's because it's actually not microdosing. It is [00:50:45] just a low dose of the medication. We like the term microdose because [00:50:50] low dose and microdose feel differently in a world that still hasn't [00:50:55] reconciled how we feel about weight loss. So what I, what I wanna be clear about there is that a [00:51:00] true microdose Yeah. [00:51:00] Ashley Koff, RD: Is actually going to be a microscopic amount of this [00:51:05] medication. [00:51:05] Dr. Taz: Okay. Where are [00:51:05] Ashley Koff, RD: you on this? In? Yeah. I'm gonna be real clear. Yeah. A microscopic amount of a [00:51:10] peptide doesn't actually create enough suppression in the appetite and hunger and in [00:51:15] the, the, um, yes. Doesn't stimulate the insulin. Thank you. So it's not gonna have that. [00:51:18] Ashley Koff, RD: And by the way, do not credit me [00:51:20] on this. This is Dr. Tina Moore's work and other people who very early on were saying. [00:51:25] We understand how microdosing of peptides work. [00:51:27] Dr. Taz: Yeah. [00:51:27] Ashley Koff, RD: Microdosing of peptides is like using a [00:51:30] homeopathic remedy. Yep. You use a small amount of something to tri to maybe potentially [00:51:35] trigger a reaction. [00:51:35] Ashley Koff, RD: That's not what's happening here. Now, a low dose super [00:51:40] effective. A low dose could be that you use a small amount on a weekly basis. It [00:51:45] could be that you use maybe even a little bit more, but you extend it over a period of time. [00:51:50] I'm using it in so many different ways with patients, you know exactly the same, and I have people that have [00:51:55] been off of the medication that come back on and needed. [00:51:57] Ashley Koff, RD: I have people that are staying on their same [00:52:00] dose at a low dose and have come off of other medications, and I have people that we have gone up on [00:52:05] higher doses as I'm optimizing their. Them along the way, and then we hit a [00:52:10] place. And if we ever hit a place where somebody doesn't feel hunger, [00:52:13] Dr. Taz: right? [00:52:13] Ashley Koff, RD: Where somebody is [00:52:15] losing a muscle with fat, right? [00:52:16] Ashley Koff, RD: Um, where somebody's digestion is too negatively [00:52:20] impaired, then I turn around and I'm like, we gotta pull back, you know, on that part. So it's interesting is [00:52:25] as a dietician, I am not meant to dose or prescribe or do any of this. Why am I [00:52:30] doing all of this? Um, it's because people are going online and buying their [00:52:35] medications. [00:52:35] Ashley Koff, RD: They're it themselves. Yeah. And they're getting it themselves. So what I am doing is I'm educating and I'm saying for [00:52:40] consideration, here are the adjustments that I would recommend. And I'm also training. I have a training program, a [00:52:45] certification. I'm also training, um, dieticians and physicians, nurses, like [00:52:50] everybody on how to do this better. [00:52:52] Ashley Koff, RD: The key takeaway in all of this is [00:52:55] whether you're on an agonist or not, you need a playbook for optimizing your weight health hormones, [00:53:00] because we don't get to choose that piece. If you are on an agonist and having any benefit, [00:53:05] if you lose a pound, if your blood sugar improves remotely, if for the first time in your life [00:53:10] like Oprah who did it at 8:00 AM and by 2:00 PM she's like, I feel like I have a different brain. [00:53:14] Ashley Koff, RD: Like [00:53:15] my, you know, my, uh, food noise is different. You have proven my thesis that your own [00:53:20] weight health hormones were suboptimal. Mm-hmm. So we know. You need to repair your own [00:53:25] function on that part. Whether you can repair it so that you can come off of it. I don't have a crystal ball in your life. [00:53:30] Right. [00:53:30] Ashley Koff, RD: And that's not really the point. The point is to figure out how we optimize your health, whatever medication we [00:53:35] use. [00:53:35] Dr. Taz: I mean, you and I are so on the same page with this one of Right, of course. Yeah. Course. Like, I mean, of course I've been talking about [00:53:40] like I don't wanna think about any medication or anything is all good or [00:53:45] all bad. [00:53:45] Ashley Koff, RD: Yeah. [00:53:45] Dr. Taz: But it has to be personalized. Right. And it has to be sort of titrated to you. Yes. [00:53:50] And the problem I think that I have with people going and ordering whatever they want and doing whatever they want is they [00:53:55] have nobody to like wind this stuff together for them into an [00:54:00] approach or into a plan. [00:54:01] Dr. Taz: Right. That is very linear, very strategic with like, okay, this is where [00:54:05] you are at this moment. This is the dose we're gonna do right now. But we gotta work on gut health. We've [00:54:10] gotta work on your steroid hormones. Yeah. Like your estrogen and progesterone and all those other things. Testosterone. We [00:54:15] have to work on your nutrients and your cellular health. [00:54:17] Dr. Taz: Yeah. We have to work on cortisol. We have to work on all of [00:54:20] it so that a pharmaceutical is not a pharmaceutical for life. [00:54:24] Ashley Koff, RD: [00:54:25] Right. [00:54:25] Dr. Taz: I think that's, well, [00:54:25] Ashley Koff, RD: it could be. So like, [00:54:26] Dr. Taz: it could [00:54:26] Ashley Koff, RD: be it. It could be. So let's talk about personal responsibility. Yeah. [00:54:30] 'cause I think that that's the other one that gets thrown around a lot in here. [00:54:33] Ashley Koff, RD: Again, 'cause we're in the land of weight [00:54:35] bias on this part. Right. If those people would just do X. Right. Um, you know, is, is kind of on that [00:54:40] part. So personal responsibility, here are the things that you as a human are responsible for. Um, number [00:54:45] one, if you buy anything and believe that one thing, whether it's a medication, a [00:54:50] food, a, a supplement, um, or even my book, like if you believe that something [00:54:55] alone is a solution and you don't invest in, in personalizing your own Right. [00:54:59] Ashley Koff, RD: And [00:55:00] recognizing that. Optimization is not just, I figured out a plan and I'm gonna stay with that plan [00:55:05] forever. Right? It's ongoing. You need a whole solution, right? So the reason I, and I say not even just my [00:55:10] book, because in my book on page nine, there is a QR code and that QR code brings you over to a [00:55:15] program for how to personalize it and gives you access to human coaches. [00:55:18] Ashley Koff, RD: Because I was like, [00:55:20] okay, you still are gonna have questions, right? For your personalization. A [00:55:22] Dr. Taz: hundred percent. [00:55:23] Ashley Koff, RD: Yeah. So we put all of that together as a [00:55:25] system, and that's why I claim, you know, on, on the book that part. So you cannot buy the, the, [00:55:30] the, the medication as a solution. Now here's the other part. [00:55:33] Ashley Koff, RD: Society and our [00:55:35] healthcare, uh, system, our government and our insurance, you are responsible. So insurance, [00:55:40] you are a huge part of the problem. You do not make my services in the preventative health [00:55:45] way available and reimbursable. You don't make your services reimbursable in the way that it needs. [00:55:50] To be, you don't mandate that for somebody to have access to this medication instead of [00:55:55] making the mandate being your BMI or your blood sugar, why isn't it actually [00:56:00] that you need to see a doctor and a dietician and they agree together and that's how you get your prescription. [00:56:04] Ashley Koff, RD: [00:56:05] That's what we did in bariatric surgery. You know, on that part. You [00:56:07] Dr. Taz: need a holistic [00:56:08] Ashley Koff, RD: approach. You need a holistic, which [00:56:09] Dr. Taz: is not [00:56:10] covered by insurance. [00:56:10] Ashley Koff, RD: Absolutely. [00:56:11] Dr. Taz: And then which Lee responsibility? Excessive [00:56:15] responsibility, I think on the part of a, of a, a consumer or a patient. [00:56:18] Ashley Koff, RD: Well let's talk about government blame, [00:56:20] right? [00:56:20] Ashley Koff, RD: Yeah. So the government's to blame with the wrong guidelines, right? Um, and the wrong, uh, and then [00:56:25] they're just saying, let's make access to this medication cheaper, right? So I am all for access [00:56:30] to medication being affordable and right accessible for everyone on that part. But if you [00:56:35] don't make AC them it accessible to us, then there there is going to be that piece. [00:56:39] Ashley Koff, RD: So I actually [00:56:40] am not arguing against the places. Like I don't love it, but I think, you know, the places [00:56:45] online that people are selling the, that. Companies are selling the product. Um, [00:56:50] but I do think that they're creating a problem because they're saying that they see a physician. [00:56:55] Mm. So if you, if you see a physician only for your prescription, that's the problem. [00:56:59] Ashley Koff, RD: That's [00:57:00] the problem. Thank you. You need to be seeing somebody for the management. And I also will, will say that I don't think [00:57:05] you should see a doctor for the management. I think you should see a qualified dietician and the doctor and the [00:57:10] dietician collaborate on that part, because you know me, I'm gonna get into the weeds on this, and [00:57:15] you're gonna be like, and you're gonna, you're gonna know all the questions to ask because you diagnose and you [00:57:20] prescribe. [00:57:20] Ashley Koff, RD: And you're, you do that as part of your investigation. You're not gonna spend an hour with somebody figuring out [00:57:25] like, how are we gonna meet your iron needs? Or how are we, you know, I mean, you might personally, but most practitioners, [00:57:30] you know, aren't going to, right. They don't do that. Right. So I think in that, and we also have to recognize that total nutrition [00:57:35] is your. [00:57:35] Ashley Koff, RD: Food and your supplements, um, understanding that whole piece. And we need [00:57:40] that to be optimal. So when we look at this, we're just in a messy, bad situation. Yeah. And when we [00:57:45] look at the fact that medications are now becoming accessible for individuals as young as age 10, [00:57:50] and we also look at highly problematic outcomes in those over 60 and [00:57:55] people coming off of the medication after three or six months because of the side effects.[00:58:00] [00:58:00] Ashley Koff, RD: What we're seeing is not that the medication should be blamed, but the system [00:58:05] around the medication should be blamed. [00:58:06] Dr. Taz: You are, you have an advocate right by your side on that. Yeah. We'll [00:58:10] preach together. Preach together. That's right. I mean, my mission and the mission of Hol+ has always been to change how [00:58:15] we think about medicine. [00:58:16] Dr. Taz: Yes. Deliver medicine. And we don't choose the easy way. Yeah. [00:58:20] Because personalization, if you're truly gonna be the advocate for the patient, [00:58:25] personalization is the doctor patient. Nutrition patient. You know, it's having that [00:58:30] person by your side to guide you. I think it's too much to tell people, you know? [00:58:34] Dr. Taz: Okay. [00:58:35] We want you to take care of your gut health, your liver health, your hormone health, and then understand where your medications [00:58:40] go in this equation, and then understand how to supplement. All by yourself. Yeah. Good luck with that. You [00:58:45] know, neither [00:58:45] Ashley Koff, RD: you or I do it on our own. [00:58:47] Dr. Taz: No. [00:58:47] Ashley Koff, RD: Like I see a you, you see a me like, I mean a hundred [00:58:49] Dr. Taz: [00:58:50] percent. [00:58:50] Ashley Koff, RD: Yeah. Just in all of these spaces. And so I just think that to your point, it's like this [00:58:55] idea of how we actually help our bodies become optimal and, and we maintain [00:59:00] that optimization or we, you know, anytime there's something suboptimally functioning, we work towards, uh, [00:59:05] optimization is an ongoing process and it needs to be a [00:59:10] part of our jobs, but it can't be our own day job. [00:59:12] Ashley Koff, RD: Absolutely. [00:59:13] Dr. Taz: Yeah. Well, you wrote a book. [00:59:15] Yeah. Giving It was what's the [00:59:16] Ashley Koff, RD: exactly your best shot, the first [00:59:18] Dr. Taz: last. I keep giving a best shot. That's right. [00:59:20] Yeah. I know, right? Yeah. So you wrote your [00:59:22] Ashley Koff, RD: best shot. There's a lot of patar. Yeah. [00:59:24] Dr. Taz: We've got a lot [00:59:25] going on out there with low dosing and microdosing and standard dosing. [00:59:28] Dr. Taz: What do you want [00:59:30] people to take away? [00:59:31] Ashley Koff, RD: Yeah. [00:59:31] Dr. Taz: Thank you. You know, with them in this book, [00:59:33] Ashley Koff, RD: I think the, the, the key piece about [00:59:35] this book is we need to meet our weight health hormones. You need to have the awakening that I had in [00:59:40] 2004. Um, we need to break up with weight loss and weight management. Um, as goals, as tools, [00:59:45] diet and exercise, absolutely they're important, but they have to be personalized in a context [00:59:50] of a system that is able to opt or. [00:59:52] Ashley Koff, RD: Optimally function, you know, to operate successfully. So [00:59:55] I put a playbook together for it. Um, this isn't the book to learn at everything under the [01:00:00] sun about these actual medications. This is the book to understand if I'm on the [01:00:05] medication, how do I optimize my health? Or if I'm not using the medication, how do I optimize my health?[01:00:10] [01:00:10] Ashley Koff, RD: Really by, through the lens of weight health on that part. That's incredible. And where can people find your [01:00:15] book? Well, hopefully they find it everywhere. I like to flip in and say, if you can't find my book, let me know. But [01:00:20] otherwise your best shot should be everywhere. Um, and uh, I read my own audio book. [01:00:24] Ashley Koff, RD: Yeah, I [01:00:25] do tell people to buy the hard copy just because I think you're gonna want something I love. You can mark up copy, you know, that kind of [01:00:30] thing. But don't forget to opt in for that QR code when you get on there so that you can get the access [01:00:35] to my coaches who are amazing and, uh, additional clinical tools. [01:00:38] Ashley Koff, RD: And also we're trying to [01:00:40] update, you know, like as an example, I wrote this with a nod to the oral [01:00:45] medications, but now there's a whole new type of medications that are coming out. Yeah. And I want people to understand [01:00:50] that they are actually not biosimilar weight health hormone. So I'll be back for a part two on this. [01:00:54] Ashley Koff, RD: Oh my gosh. [01:00:55] We really have to pay attention to where, [01:00:57] Dr. Taz: so you're talking about the Reddit ide? So [01:00:58] Ashley Koff, RD: I, not a Reddit ide. That one [01:01:00] still is and oral still is. I'm talking about Orrin and there's new, uh, medications called [01:01:05] Small Molecule Non Peptide. And they're coming out like right now and they are [01:01:10] non. [01:01:10] Ashley Koff, RD: Peptide so they're not biosimilar, um, they still go to the [01:01:15] receptor site in your body and unfortunately they're still being called GLP one agonist. This is gonna be really [01:01:20] confusing and I think that my work right now is as much with medical practitioners to [01:01:25] understand. Um, and my substack. I'm always unpacking it here, you know? [01:01:28] Ashley Koff, RD: Yeah, yeah. Here are the things, [01:01:30] and I always just am curious, you know, I'm not saying, again, I don't think that these are, are going to be bad for us [01:01:35] medications. I just think they're going to have very different considerations for us to [01:01:40] understand and probably different pros in terms of application. [01:01:43] Dr. Taz: Oh my gosh. [01:01:44] Dr. Taz: I was about to [01:01:45] ask you too, what is the future of, of these medications? [01:01:47] Ashley Koff, RD: Scary. Scary. It's really scary. Um, also [01:01:50] because it's kind of cool and it's scary. We are learning in real time about how [01:01:55] the body, um, is designed. So most people don't know about amylin or oxy, [01:02:00] I can't even pronounce it, but cin Modlin. [01:02:02] Ashley Koff, RD: Mm-hmm. Um, and these other, uh, peptide [01:02:05] hormones and yet we're now gonna be agonist them. So I think that's really important [01:02:10] because I don't know, like as a random example, and this is not true, but I'm just gonna hypothesize. [01:02:15] I don't know if when you take a statin, does it affect your [01:02:20] amylin? And if I don't know that and I now put you on a medication that is [01:02:25] agonist in your amylin mm-hmm. [01:02:26] Ashley Koff, RD: Which is encouraging it to work and work at a much, much higher intensity. [01:02:30] Right. In terms of. Staying on what that means for your thyroid medication or what it means for your [01:02:35] statin medication? Yeah, so I think one of the things that is has to happen for clinicians is [01:02:40] for us to move from the space of, I have a right answer, or I even know what the side effects might [01:02:45] be to, I am going to have to be curious and use every patient as an N of one and [01:02:50] understand that, and that's a really difficult place that's so hard. [01:02:52] Ashley Koff, RD: It's hard with like the kind of medicine that [01:02:55] you practice. It's hard, the kind of nutrition that I practice, it's hard for the [01:03:00] traditional medical system that allows for a 15 minute visit. It's impossible. Two years, it's impossible. [01:03:05] Yeah. Like every year it's impossible. Yeah. These annual visits are an absolute disaster in that space. [01:03:09] Ashley Koff, RD: [01:03:10] So that's a tough place for us all to be Right. I don't like to be, um, I'm [01:03:15] never gonna end on something negative. Right. That is concerning. Let's talk about the greatest potential and, [01:03:20] and where I'm really optimistic. With the tools and the awareness that we have, [01:03:25] I really believe we can understand how to optimize our weight health. [01:03:28] Ashley Koff, RD: And I [01:03:30] believe that as we help adults, children, young adults, um, everybody be able to, to [01:03:35] optimize our weight health GLP one agonist or not. I think we can create [01:03:40] generational weight health and we may see a greater need and use of these medications [01:03:45] today, but we may actually set up more successful, [01:03:50] um, uh, pregnancies and health in, and really be able to reverse what [01:03:55] I, which is what I see as like the most con concerning part, which is the [01:04:00] early onset of so much of this dysfunction. [01:04:02] Ashley Koff, RD: And if we can do that, we improve and [01:04:05] we create generational weight health. So I am super excited. I love the work that we all [01:04:10] are doing. Yes. You know, I'm like tripling down on it. Yeah. Um, but I, I think that, um, we [01:04:15] just have to do it in a very cautious and in a different kind of way. Well, that is definitely a more [01:04:20] promising, optimistic, we gotta land there. [01:04:22] Ashley Koff, RD: Optimistic. I was like, I feel like you and I, otherwise our [01:04:25] bellies will be back [01:04:25] Dr. Taz: there from stress. Exactly. You know what I mean? Gonna be right back out again. Totally. Well, I [01:04:30] love the work you've done over all the years. Thank you. I know we track and follow each other and [01:04:35] I'm just so proud of you and I'm, thank you. [01:04:36] Dr. Taz: Proud of this book. Thanks. And all the science that you've brought to this equation, because [01:04:40] I think we talk a lot about metabolism and weight and all this other stuff, but not really with [01:04:45] the understanding that these are, I mean this was learning for me today that these are [01:04:50] biosimilar hormones. Yes. [01:04:51] Dr. Taz: Essentially. Exactly. So they are part of the hormone conversation. Yes. And the hormone [01:04:55] ecosystem. So I think that's incredible. All right. Before I let you go, yeah. I ask this question to [01:05:00] everyone. What makes you hol? [01:05:03] Ashley Koff, RD: Ah, you know, moments like [01:05:05] this, I think that when I get to, um, fulfill my life [01:05:10] purpose, which I really do believe now, is helping people to understand how to optimize their weight health, [01:05:15] I feel more whole. [01:05:17] Ashley Koff, RD: Mm-hmm. And there's a, there's a selfish component to that. I am, [01:05:20] um, repairing some of the not wholeness that I felt in my [01:05:25] childhood and really being able to say, I'm sorry that you as a young girl, went through those experiences and felt so [01:05:30] disempowered. But now I'm not only empowered, I'm empowering others. [01:05:33] Ashley Koff, RD: So I think it's a big [01:05:34] Dr. Taz: one. I mean, that's [01:05:35] incredible. I think so many people do grow up with this feeling when they don't [01:05:40] fit a certain stereotype or certain ideal. That's right. And I think if, if you can help [01:05:45] repair some of that with the understanding of the chemistry behind it, that's powerful, powerful work. [01:05:49] Dr. Taz: Where can everyone [01:05:50] find you? [01:05:50] Ashley Koff, RD: Well, hopefully again, you, if you Google my name, hopefully it's me like that. You, I, I, [01:05:55] I, at some point I'll worry about that. Did that, I find a fake account about me too. I, every day I get somebody's trying to [01:06:00] log into a fake Instagram, but theoretically it's me. It's certainly me. [01:06:03] Ashley Koff, RD: If you find the curly hair on that [01:06:05] part. [01:06:05] Dr. Taz: I love it. Well, thank you so much, Ashley. Thanks for having me. This has been a joy. Thank you everyone else for [01:06:10] watching and listening to this episode of Hol+. We will see you guys next time before you go. [01:06:15] Take a second to reflect on what stood out for you today. [01:06:18] Dr. Taz: Then if you can [01:06:20] leave a quick review wherever you're listening, it really helps other people discover Hol+ [01:06:25] and start their own healing journey. And don't forget to follow me on Instagram at Dr. [01:06:30] Taz md. I love hearing how these episodes are supporting you.