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Microdosing GLP-1s: Can Less Actually Work Better? | Dr. Karen Mann
Microdosing GLP-1s is quickly becoming one of the most talked-about topics in obesity medicine, but can taking less actually produce better long-term results for some people?
In this episode, Dr. Karen Mann shares how personalized GLP-1 dosing, food noise, behavior change, and identity-based habits may be the missing pieces to sustainable weight management. We also discuss preserving muscle, optimizing protein intake, resistance training, menopause, hormone replacement therapy, and why lasting health depends on changing who you become—not just what you weigh.
#GLP1 #Microdosing #FoodNoise #WeightLoss
TIMESTAMPS
[00:00] Why discomfort is the key to lasting behavior change
[00:43] Welcome to The Optimized Woman
[01:15] Dr. Karen Mann's personal journey into obesity medicine
[02:51] Why weight management requires a personalized approach
[04:18] Why standard GLP-1 dosing isn't right for everyone
[08:08] Why behavior change matters more than motivation
[10:45] Finding your "why" and building identity-based habits
[14:56] Becoming the person you want to become
[16:32] Coaching, accountability and habit formation
[18:46] What microdosing GLP-1s actually means
[22:09] New oral GLP-1 medications explained
[26:15] Food noise, emotional eating and impulse control
[29:43] Ultra-processed foods and why we're still hungry
[34:16] Can you lose weight eating unhealthy foods?
[36:10] Protein, muscle loss and resistance training
[39:42] Why strength training becomes essential with age
[42:21] Hormone replacement therapy and healthy aging
[47:49] Self-talk, self-compassion and changing your mindset
[50:56] Redefining discomfort as an act of self-love
LET'S CONNECT
Guest: Dr. Karen Mann, MD
Instagram: https://www.instagram.com/drkarenmann/
Host: Orshi McNaughton
Podcast: https://optimized-women.captivate.fm/listen
Website: https://www.optimizedwomen.com/
YouTube: https://www.youtube.com/@optimizedwomen
Instagram: https://www.instagram.com/orshimcnaughton
Substack: https://substack.com/@orshimcnaughton
Transcript
For me, that moment was when I understood that it was my relationship with discomfort that was holding me back.
Speaker A:When I say discomfort, I mean with habit changes.
Speaker A:Going to the gym isn't super fun.
Speaker A:Sometimes eating a meal that looks different than other people isn't fun.
Speaker A:It feels uncomfortable.
Speaker A:How do I relate to that discomfort?
Speaker A:What does that discomfort mean?
Speaker A:It used to mean punishment, now it means self love.
Speaker A:Now it is curiosity around what that change in behavior is going to do for me.
Speaker A:So it's all about not making discomfort the enemy, but something you can sit with and be with and actually turn into something self loving rather than self denying.
Speaker B:Welcome to the Optimized Woman where we explore the future of longevity.
Speaker B:I'm Your host Orshi McNaughton and I bring you conversations with the pioneers advancing human performance and health optimization and I share what I discover as I explore this rapidly evolving field myself.
Speaker B:Let's get into it.
Speaker A:I have personally had a journey with my weight since I was a little girl.
Speaker A:My first best friend was a bag of M&Ms.
Speaker A:And I'm not kidding, that is where I got my emotional sustenance from an early age.
Speaker A:So I understand very deeply what that relationship with food looks like and how it impacts us and how it shapes us and how it becomes a way that we learn how to not deal with our lives and how beautiful it is to acknowledge that and step out of that and try to look for something different and being a doctor and wanting to understand weight, how the body physiologically manages weight.
Speaker A:So I went and did the obesity medicine training as well so that I could incorporate it all in what I do.
Speaker A:And then because I'm a midlife woman and a gynecologist, I knew there was a big gap in my knowledge base around menopause care.
Speaker A:So I also do menopause care as well.
Speaker A:So that's also really helpful in the way loss journey because that that tends to be one of the main places in our life where we do put on weight.
Speaker A:So when it comes to why I'm with noom, if it's not already obvious, NOOM is a digital health tech platform that initially started as one of the first psychology based weight management systems.
Speaker A:And I did Noom myself around the time of the pandemic, maybe a little bit after that, had success with it and was blown away with how they were incorporating the basics of weight management with this heart centered emotional piece that is missing in a lot of other programs.
Speaker B:I think most of us, when you go in to see a Regular Dr. Or OB GYN specialties are so siloed into just a single specific area that most physicians unfortunately know very little about weight management.
Speaker B:You may get lucky and somebody knows hormone replacement therapy or somebody knows about obesity medicine, but then they don't have the coaching or all those extra pieces that have to fit in place for people to unlock success.
Speaker B:Because what I notice, especially in midlife with women, that it's not just one thing, it's usually 10 different things and 10 different boxes you have to check.
Speaker B:And, and they all have to come together in a different puzzle for every woman, depending on their own makeup of what their weak links are in their physiology.
Speaker B:And this is why it's so challenging to manage weight.
Speaker B:And especially in midlife, everything gets twice as hard.
Speaker B:Just regular allopathic care is now prepared to handle this complexity and, and be able to connect the dots and support people holistically through this journey.
Speaker B:Why is sort of the standard allopathic way of using GLP1s is not a good fit for a lot of people?
Speaker B:Why don't we talk about that first?
Speaker A:With the Trials with the GLP1s, they were all done in a very cookie cutter kind of way.
Speaker A:They excluded a lot of patients, included certain patients.
Speaker A:So what the studies show us is that the results are good, but they don't speak to everybody person that's out there, and I think that is one of my biggest missions is to help people understand the diversity that we all bring to the table and that we cannot be treated as just one person.
Speaker A:And this goes for everything.
Speaker A:This is for allopathic medicine.
Speaker A:When you see your doctor and it's for that influencer that you love, it's for the person that's telling you try this or try that.
Speaker A:This is off the beaten path.
Speaker A:Sometimes even that isn't the right thing.
Speaker A:So what is the best practice is to really get curious about you.
Speaker A:And I was thinking about this, so I just was at the Obesity Medicine association annual meeting in beautiful San Diego, California, where I happen to live.
Speaker A:I went to this meeting and so that, you know, obviously just to keep up to date with everything.
Speaker A:But what, what I feel like they're starting to shift towards is this idea that we can personalize things.
Speaker A:And medicine doesn't do this because the studies, we use evidence as allopathic doctors to really guide what we do.
Speaker A:So as we start to learn things that work that the studies didn't study, we call it off label.
Speaker A:But a lot of times that's where the magic is.
Speaker A:So we are starting to use these medications in new and different ways.
Speaker A:We're starting to use the lowest effective dose rather than just titrating to the highest dose, we're starting to use them at intervals spaced out.
Speaker A:I heard this from the experts as I was listening to these lectures over the weekend.
Speaker A:Starting to try to cater to the individual so that we can accommodate the needs of more people.
Speaker A:And what's interesting is the study of obesity is really the story that our bodies tell that go back to before when we were born that include what our mother did when she was pregnant with us, us.
Speaker A:Like there is so much complexity, there is no way to account for everybody to continue that story.
Speaker A:So we call that fetal programming.
Speaker A:As an obstetrician, this is all the things we do when we're pregnant that influence the outcome of that baby.
Speaker A:Then when we're children, food insecurity.
Speaker A:How polluted was our environment?
Speaker A:Did we have dinners with our family?
Speaker A:What was our stress level like when we were, when we were kids?
Speaker A:Was our best friend a bag of M&Ms?
Speaker A:That all goes into our body story.
Speaker A:And then as we're especially women, we get the messaging that we need to look different than we do.
Speaker A:I don't know about you, but I don't know a lot of women who feel completely at peace in their body their whole life.
Speaker A:That messaging comes from the outside.
Speaker A:So then we start dieting and then we start exercising and restricting and doing all the things that we do to fit a certain template that influences us, that changes our brain chemistry and our neurotransmitters, that changes our hypothalamus.
Speaker A:So then that goes on into, as we go more into adult life, we have our own pregnancies, we have medical problems, we take medications.
Speaker A:All of this figures in to what our bodies do in the world and how we show up.
Speaker A:And then in the midlife, I'm, sure we'll, we'll get to that as well.
Speaker A:And how the hormone change shifts everything.
Speaker A:But to your original point, when it comes to treating patients, allopathic doctors are going to do one thing.
Speaker A:It's not their fault, it's not your doctor's fault that they're trying to treat you the way that they learned how to treat you.
Speaker A:But what we're learning is that curiosity around other ways to be in the world, other ways to treat our body are starting to get more accepted.
Speaker A:And I think that's really interesting and really cool.
Speaker B:I love all the things you mentioned, especially everything from your childhood trauma and experiences and how you grew up.
Speaker B:And we all looking at our own struggles through our own lens and think that's the only thing that exists.
Speaker B:But somebody like you who, who've worked with a lot of people know that everybody's situation is so unique and different and everybody's sort of makeup is so complex and, and I think this is why there's no sort of cookie cutter solution.
Speaker B:And even GLP1s that are an amazing medication cannot be applied just the same way for everybody.
Speaker B:What I like to zoom in is behavior change and how do we accomplish that in a way that creates lasting results for people?
Speaker B:Because just going back to the original question earlier, with the traditional allopathic care, there's a lot of people that have great results, they lose a lot of weight, but then the question is, can that be maintained and how do you maintain that?
Speaker B:And now are you going to be on these drugs forever?
Speaker B:And maybe that is okay to be on the drugs forever, but are there also a lot of side effects with those drugs then that you have to live with?
Speaker B:And is there really a Goldilocks way of doing this where you can at some point phase off of the drugs and manage your own weight and figure out how to do that yourself?
Speaker B:How do you accomplish that?
Speaker B:So I guess what I'd like you to talk about a little bit is how do we create lasting results?
Speaker B:And the behavior change piece, how does that come into the picture and what does that look like within doom?
Speaker A:So there's no yes, no answer.
Speaker A:There's no black, white, it's gray, it's many, many shades of gray.
Speaker A:So when we talk about can I come off the medication or am I on this for my.
Speaker A:Who are you, what are what all the things I just talked about in terms of what has created the body that you're in, the story of your body, we need to tell that story from the perspective of your voice.
Speaker A:So for some it does mean coming off the medication.
Speaker A:And there are some ways that you can go on to other maybe oral medications to help you maintain.
Speaker A:It's going to really depend.
Speaker A:So maybe a patient who has only lost weight once in their life, who's younger, who only needed to lose maybe 20 pounds, who used a GLP1 to do that, who also implemented lifestyle support, that person may be able to come off the medication.
Speaker A:People do in the trials.
Speaker A:Generally people do regain, but not all of the weight and not everybody.
Speaker A:So let's not treat everybody like they're the same person.
Speaker A:As a physician, as an obesity medicine trained physician, I also have to understand that these are life saving medications.
Speaker A:So your patient whose BMI was higher.
Speaker A:And we all know BMI is a terrible proxy for our health and our weight, but it's what we use today.
Speaker A:We also use other things like weight, circumference and other measurements, body composition.
Speaker A:So it's not the only.
Speaker A:But for now it's the easiest and it's what we use.
Speaker A:So if your patient, my patient has a BMI that's over a certain point, has cardiac risk factors, has sleep apnea, has all of these things that often accompany obesity, that person I might want to keep on the medication because I know long term I'm going to help them live a longer, healthier life.
Speaker A:You have to look at everybody as their own person and cater manage them as they are.
Speaker A:When it comes to behavior change, that's Noom's thing.
Speaker A:And you mentioned coaching.
Speaker A:That's a big component of behavior change, is the support system that goes with it.
Speaker A:I'll just say that with the GLP1 therapy, the labeling actually says that you're supposed to use the medication with a lifestyle.
Speaker A:So a lot of physicians, and I'm not blaming any physicians who are just writing prescriptions, I get it.
Speaker A:You've got 40 patients to see in a day.
Speaker A:I get it.
Speaker A:But if you do have something like Noom that fills that space between the doctor visits, that provides that component that is on the label, the lifestyle component, it can be a game changer for a patient in terms of how they manage their weight.
Speaker A:And when we look at all of the different voices and behavior change, there are many books out there.
Speaker A:I don't know if you've read any of these authors like James Clear, Atomic Habits or BJ Fogg, who did Tiny Habits.
Speaker A:And what they want you to know is that motivation is unreliable.
Speaker A:It will tire out over time.
Speaker A:So you really need to design your habit changes in a way that fits your environment.
Speaker A:And one of the biggest things is the ease.
Speaker A:So don't pick the hardest thing that you can possibly think of doing.
Speaker A:Pick something small.
Speaker A:Nothing is too small.
Speaker A:No change is too small.
Speaker A:So find something small that you can do, have it associated with a cue, and then have a moment of acknowledging what you've done.
Speaker A:So this is BJ Fogg's thing.
Speaker A:He's all about celebration.
Speaker A:His book is funny.
Speaker A:He wants you to do a fist bump or something to yourself to acknowledge that you did the behavior so that you can continue to feel good in the moment, because that is so important.
Speaker A:That little bit of dopamine hit that you get from accomplishment, from achievement, from self efficacy means a lot when it comes to being able to sustain.
Speaker A:Then the other thing that we talk about in noom, it's one of the first lessons with noom, you get content and the content I really felt like when I did the program was kind of where it was at.
Speaker A:Like these are the lessons in psychology and mindset shifts and how to think differently.
Speaker A:The core thing is coming up with your why.
Speaker A:And when I do coaching, I have people figure out their why by asking the question why until they can't ask the question anymore.
Speaker A:So they've gotten underneath to the very core part of you that motivates your behavior.
Speaker A:That is your ultimate why.
Speaker A:And you hold on to that, and that is your identity.
Speaker A:So you are acting from the place of who you are, not from what you want to be, what you wish to be, what you want to achieve.
Speaker A:You are not going to the gym to lose weight.
Speaker A:You are a person who goes to the gym.
Speaker A:You're a person that pays attention to what you eat.
Speaker A:You're not trying to lose weight.
Speaker A:You're not trying to restrict calories.
Speaker A:No, you're a person that eats vegetables.
Speaker A:So I think these are some of the kind of key components to behavior change that we try to incorporate in our content.
Speaker B:You have to assume the identity of that person that you trying to become.
Speaker B:If you want to become an athlete or just call yourself that even if you're not going to be an Olympic athlete, but even if you want to eventually have an athletic body and say I'm an athlete, then I have to start showing up like an athlete.
Speaker B:I have to to wake up early in the morning, hit the gym, put in the time and effort under the bar or whatever lane you pick in fitness.
Speaker B:And you have to assumed identity that I'm a runner, so I'm going to go for a run every morning, or I am somebody who lifts weights and I'm going to have a calluses on my hand and that I'm comfortable with that.
Speaker B:And you have to assume that identity of that person.
Speaker B:And once you do, then it's way less effort and it becomes just who you are.
Speaker B:Right.
Speaker A:You talk as somebody who's done this and seen this work in your life.
Speaker B:Yes, I have the calluses on my hand, which I'm proud of, because it takes work to maintain that.
Speaker B:Right.
Speaker B:But you're right, it's very hard to force things, even with nutrition, too.
Speaker B:You have to become the person who eats a certain way or become a person who goes to certain types of restaurants only or meal prep on the weekend, or have certain habits, structures that you build into your life.
Speaker B:Is that something you guys teach through the app of how to develop these habits?
Speaker A:We do, like I was mentioning, we have content that sort of speaks to how to create and curate these habits for yourself, how to initiate a new habit.
Speaker A:The coaching is also a big part of it because then you have some accountability around that.
Speaker A:And those coaches are very well trained and a lot of them have a lot of nutrition backgrounds, so they're wonderful to bounce ideas off of and check in once a week and make sure you're staying on track with them.
Speaker A:There's also communities, so it's also very nourishing to speak to other people who are on the same path as you.
Speaker A:And you can talk about your pain points and you can talk about what's worked for you.
Speaker A:And it's.
Speaker A:A lot of it is around the mindset.
Speaker A:And again, that's something that I loved about Noom.
Speaker A:It's what I use in coaching, is changing the thinking around the behavior.
Speaker A:Because if you think that something is a punishment, if you think that something is hard, you're not going to stick with it.
Speaker A:Motivation is going to break down.
Speaker A:So you need to create a new mantra, you need to create a new way of addressing the habit that you want to change.
Speaker A:And so, yeah, Noom does speak to all of those things.
Speaker A:And then we, you know, the basics are always going to be there.
Speaker A:Weighing yourself.
Speaker A:So that can be a real point of very triggering for people.
Speaker A:But we know that when you do keep track of your weight, you have a better chance of maintaining your losses and of losing.
Speaker A:So that's part of the program.
Speaker A:Weighing in.
Speaker A:Food logging is very important, which can get tedious, but, you know, it's getting easier and easier.
Speaker A:You snap a picture of your meal and it's going to tell you what's in there.
Speaker A:And so that gets quite quicker and quicker.
Speaker A:We try to, like gamify, so make things kind of fun.
Speaker A:You can collect seeds and coins, you can compete with other people so that you can hold each other accountable that way.
Speaker A:And then we just have some other tools as well.
Speaker A:Like we have a body scan that helps with body composition.
Speaker A:We have, we have a face scan that tells you, like, your biological age based on blood flow underneath your skin.
Speaker A:So a lot of things that are engaging and fun and help you be consistent and keep those habits going for yourself long term.
Speaker A:One of our biggest features is our recipes, so anything you can think of, we've got tons of them.
Speaker A:And we also have exercise videos as well for all levels of fitness.
Speaker A:So Those are big, big pieces of the weight loss journey as well.
Speaker B:It's good to be inspired with food because just speaking for myself, that I always end up eating the same things over and over and gets really boring.
Speaker B:So it's nice to get inspiration from others and see how other people are managing the healthy eating journey, which can look different for every everybody.
Speaker B:I would love to talk a little bit about this whole idea of microdosing.
Speaker B:What do you consider a microdosing amount?
Speaker B:I think you currently offer semiglutide and tirzepatite through your program, right.
Speaker B:And then there's also a new oral version that came out and I'm assuming that semi glutide, the oral version, maybe you could break down for us what is microdosing and then also for the oral medication, how is that different as far as results compared to the injectables?
Speaker A:So with microdosing, the truth is we do not have a standard definition for it.
Speaker A:And this actually came up at the conference that I was at over this weekend.
Speaker A:And one of the pain points with microdosing is that it's hard to study because we don't have a full, clear definition of what it is.
Speaker A:So there will be variability based on where you get your product from and what that is.
Speaker A:For us, it is around the dose itself and having it come in at a smaller dose than what the max therapeutic dose would be.
Speaker A:So 2.4 being.
Speaker A:Well, now we have 7.2 of semaglutide, but less than that, you know, maybe in the, in the 0.2 to 0.4, 0.6 range, milligrams.
Speaker A:That is what we would consider microdose.
Speaker A:At the conference, I heard people talking about spacing out the medication, doing every 10 days, every two weeks, whatever it is that helps you to maintain and get your results.
Speaker A:That can also be considered microdosing.
Speaker A:I would urge people to get established on a weekly pattern before you start doing that, because you want your body to get into that steady state where the medication is not up and down all the time, but you can experiment with it.
Speaker A:And this is how medication practices are changing around GLP1s as physicians are out there starting to try to make these changes.
Speaker A:Not necessarily calling it microdosing, but basically anything that sort of deviates from the standard pattern of prescription could be considered a microdose when it comes to the oral medication.
Speaker A:The truth is we just got it in our hands.
Speaker A:It just was approved a couple months ago.
Speaker A:So we don't have really long term experience with it with we don't have post marketing data around it yet, but it's a little bit more difficult to take because you have to take it on an empty stomach with a small amount of water.
Speaker A:You have to wait to eat.
Speaker A:So it can be inconvenient.
Speaker A:As much as it's nice to take a pill rather than have to do an injection that sometimes can be limiting for certain patients.
Speaker A:In terms of results, they were very similar to what we saw with the injectables.
Speaker A:So still very, very effective.
Speaker A:And also the side effect profile, very similar what we see with the injectables.
Speaker A:So time will tell.
Speaker A:Well, we're still learning.
Speaker A:And then we just had orforglipron or Foundio.
Speaker A:Foundeo.
Speaker A:I don't know how, how they're pronouncing it, but that just got approved.
Speaker A:So we'll start prescribing that as well.
Speaker A:And that's easier to take.
Speaker A:You have a little more flexibility around that.
Speaker B:And what is that exactly?
Speaker A:That is a non.
Speaker A:That is a GLP one, but it's a small molecule rather than a peptide.
Speaker A:But it does the same kind of contraindications and same indications.
Speaker A:The labeling for it is basically the same.
Speaker A:And again, I am still learning about it.
Speaker A:I haven't started prescribing it yet because it's so new.
Speaker A:So let's talk again after I have some experience and I'll tell you what I learned.
Speaker B:Yes, a lot of people are worried about injecting themselves.
Speaker B:But if anybody who has been on this journey realize that, I think a once a week injection is much easier than taking pills every day, especially before eating.
Speaker B:We spoke about this briefly before we started recording that anything you have to take, whether it's a supplement or medication prior to eating, gets missed.
Speaker B:Because usually when you're hungry, you want to eat then and not want to wait 20 minutes to an hour to eat afterwards, then you have to carry things around with you.
Speaker B:So compliance could be harder.
Speaker B:So I'm really curious to see how people do with that.
Speaker B:But I think the nice thing could be with the oral medication is that you could potentially, if you have any side effects or anything, you can stop it.
Speaker B:You're not stuck with that for a week.
Speaker B:Although the titration might be a little bit more difficult since it's in a pill form.
Speaker B:I'm not sure if you're able to cut things in half or if it's a capsule.
Speaker B:Can the dosing easily be modified or is that.
Speaker A:Yeah, I think time will tell.
Speaker A:I have not seen it be prescribed in any way.
Speaker A:Other than what the standard titration is.
Speaker A:But like the injectables, I have a feeling people will start to experiment with it and see if taking it less can be as effective or more so and reduce side effects.
Speaker A:But again you want to make sure that it's getting into your system in a steady state so that you're not having these wild fluctuations of the drug because that's really how it's most effective.
Speaker A:And we do know that the worst side effects tend to happen when you are up titrating or starting for the first time.
Speaker A:So that's something just to keep in mind when you wanting, when you're wanting to try to deviate from what, what the plan is.
Speaker A:For now, I think sticking with the plan, taking it as prescribed is where we're going to be.
Speaker A:But, but again I think with time we will start to see some creativity around its use.
Speaker B:So just to recap a little bit about what you said on microdosing.
Speaker B:So from what I understand your non definition is that anything below the standard titration dose, that is the step up that would normally be in the allopathic standard of care, anything below that you would consider microdosing.
Speaker A:It tends to want to be on the smaller side.
Speaker A:So perhaps less than 1 milligram of the semaglutide, you know, maybe less than the 10 of tirzepatide.
Speaker A:So yeah, it'll vary and would you.
Speaker B:Say, and I don't want to put words in your mouth, I understand there's no clear definitions around this but the standard dosing will be more for like an aggressively loss versus the microdosing, more like maintaining or titrating off or, or even for non weight loss benefits of the drugs.
Speaker A:Yeah, and I'm so glad that you brought that up because I again want to reiterate that obesity is a disease.
Speaker A:It's a chronic disease associated with other things that cut our life span and our health span short.
Speaker A:So the data we have support the high doses and those are what are studied for patients that have the cardiac history that have higher bmi, that are going to need those higher doses.
Speaker A:So I wouldn't recommend microdosing for somebody that has other reasons to be taking the medication other than interest in anti inflammatory benefits, perhaps a little bit of weight loss.
Speaker A:So I just want to reiterate to, to use the medication as it's intended for the reasons it's intended, if that's why you're taking it, does that and.
Speaker B:I think maybe some of the other benefits, I don't know if you want to expand on that, a little bit of just impulse control.
Speaker B:And there's a lot of psychological benefits beyond weight loss that people are not realizing.
Speaker A:Yeah.
Speaker A:So this is all very true.
Speaker A:The medication works in the brain in a powerful way.
Speaker A:And I think for somebody who has had a lifetime of reaching for food when food wasn't the needed thing, these medications are as freeing as anything anyone has ever known.
Speaker A:Like, it is incredibly liberating to have that disconnect between I need to eat because I'm hungry and I need to eat because something's not right in my body.
Speaker A:I'm trying to get away from it, I'm trying to cope.
Speaker A:There's an emotion, there's something I'm resisting.
Speaker A:And so this medication kind of takes that piece away.
Speaker A:And I think it's very.
Speaker A:It's powerful.
Speaker A:When we look at.
Speaker A:You mentioned addiction, they're studying at small studies around alcohol use.
Speaker A:They do see a reduction in alcohol use that's not approved for that indication.
Speaker A:The studies are a little mixed.
Speaker A:It's not like a.
Speaker A:It's not like a total game changer.
Speaker A:But we do see a reduction in alcohol use in patients that are on these medications.
Speaker A:So it does hit sort of that dopamine, dopamine pathway that takes some of that hedonic pleasure out of these substances, food, whatever, and it gives you some space mentally so that you're not constantly having that battle with yourself around trying to resist doing a habit that you know is not going to serve you.
Speaker A:When I see patients, I really invite them to explore how that feels.
Speaker A:I invite them to journal what it feels like to not be in your head about what you're eating all the time.
Speaker A:What has opened up for you, what space has been made, what are you thinking about now?
Speaker A:How does that feel?
Speaker A:So that when you do go off the medication, you can reflect back and maybe even use some of those cognitive tools that you developed while you were on the medication and take them into.
Speaker A:If you're one of these people that wants to come off the medication to try to continue to maintain.
Speaker B:The reduction of food noise is probably one of the biggest feature of GLP1s, why they work, whether you're using them in a microdosing or standard dosing format.
Speaker B:And I think that's where it can have a huge benefit of staying on a micro dosing level even after you lost the weight, because there's a huge difference having or not having the food nose and somebody who have dieted down before for competitions and even just cutting 100 or 200 calories out of your normal amount of food that you eat creates so much food noise that you, you're always hungry and you always think about food just trying to lose weight without any type of drugs or medication, at least for most people.
Speaker B:And I remember I've also done a lot of fasting and things like that.
Speaker B:Anybody who've done multiple day fast, you, you know that one of the feature of fasting is that by day three, your senses are so dialed and you can smell food from a mile away and you can't think of anything else.
Speaker B:You're just zeroed in on when is the next meal coming from?
Speaker B:Because we biologically wired to survive and to think about maintaining our caloric intakes.
Speaker A:Yes, yes.
Speaker A:Everything you're saying resonates so powerfully.
Speaker A:And what you're hitting on, the fact that, yeah, calorie restriction is almost a form of torture to the body.
Speaker A:It's your body is going to fight against it because it doesn't know you can go to Starbucks or McDonald's or wherever it thinks something's wrong with your environment and it's a danger signal to your body.
Speaker A:So that is why we upregulate our eating, our appetite, all of these things when we've been calorie restricting because it's our body's way of trying to get it back into homeostasis.
Speaker A:And I also want to add, I could talk about this forever.
Speaker A:Like one of my biggest fascinations is what happened in the 70s when the obesity and overweight rates started to go up.
Speaker A:I always show this graph that shows this inflection point around like 77 where all of the sudden we just started to get bigger.
Speaker A:And it's beyond the scope of this talk.
Speaker A:I understand it's very complex, but a big part of it is the food that is available to us today that we were never meant to eat.
Speaker A:We were never meant to have these experiences with these foods.
Speaker A:They hijack our brains.
Speaker A:There's a lot of literature around what we call ultra processed foods.
Speaker A:I'm sure you are very familiar with your background what these foods do in our brains, to our brains, to our psychology.
Speaker A:And they're unavoidable.
Speaker A:And I want to say that, that we're treating obesity and overweight at the level of the individual.
Speaker A:But the problem is systemic.
Speaker A:And I know that it is very challenging to change food systems, but I'm hopeful that that will be part of where we move forward from here, is to start to understand ultra processing is not the best thing for our bodies as organisms and to start to encourage more of a whole foods based diet, which is what I always try to advocate for because that gives your body what it's looking for.
Speaker A:When you're giving your body ultra processed food, it says, no, I'm still hungry, you didn't give me what I needed.
Speaker A:When you do the whole foods based diet, your brain is able to say, ah, there's that micronutrient I was looking for.
Speaker A:And it shuts down your system's drive to seek.
Speaker A:So again with the weight loss journey, with the complexity of weight management, one of the foundational things I always advocate for is to try to include as many whole foods in your diet as possible.
Speaker A:And that can be fun to do.
Speaker A:You know, that can be what you can get creative, try new things, try new recipes.
Speaker A:Cooking at home is so, so, so beneficial for your health versus eating out.
Speaker A:But I do understand what certain types of foods can do for my brain and how it doesn't always benefit my biology.
Speaker B:And the beauty of this is that once you start eating whole foods, you crave whole foods too.
Speaker B:So people that have a clean diet, it's very hard to imagine walking into McDonald's and eating there or eating some processed junk food.
Speaker B:It's, it does not taste good, it does not have the same effect.
Speaker B:It's kind of like what you eat is what you crave in many ways.
Speaker B:So if you eating healthy foods, you craving healthy foods.
Speaker B:And I love what you said about this inflection points in the 70s and what we have a lot in the grocery stores is calories without nutrient density.
Speaker B:So there's no nutrition density in the food anymore, but there's a lot of calories, easily accessible, delicious calories.
Speaker B:So it really, you have to reset your palate.
Speaker B:And that's one of the things that really the GLP wants help with is when you turn off the food noise, resetting the system becomes easier.
Speaker A:Yeah.
Speaker A:Then you can start to implement all the changes around starting to have more whole foods in your diet.
Speaker B:This is why it's so important that people not just take the medication, but also make lifestyle changes at the same time.
Speaker B:Because that is the recipe for success.
Speaker B:If you're just taking the medication and continue to eat foods that don't have a lot of nutrition in them, maybe less calories that you're taking in because you're not as hungry or not able to eat as much, but you still eating foods that are lacking nutrition, that is not a good recipe for success long term.
Speaker A:Yeah.
Speaker B:What happens to people that keep eating like that and taking GLP1s, they still.
Speaker A:Can lose weight, they still will see benefits.
Speaker A:And I think what happens to their health?
Speaker A:Well, I think we are still learning that long term.
Speaker A:I think that the answer is obvious, that if you continue to eat the foods that don't serve your body, that you're going to see results of that whether you're on this medication or not.
Speaker A:But it is true.
Speaker A:The medication does cover up a lot of that, even if you continue to not eat as well.
Speaker A:But I encourage people to try to be on a journey, a health journey, and not just make it about reducing your weight.
Speaker A:And this was something that I started to hear them talk about at this conference, is that we are not treating obesity to get the scale to change.
Speaker A:We are treating obesity to optimize your health, to make you healthier, to make your function better.
Speaker A:So decoupling weight, body image, the way you feel about how you look from your practices and why you're doing them, and making them about the long term change in your body versus just what I look like right now and not being happy with that, I think is what's more sustainable.
Speaker B:Yeah, 101 point.
Speaker B:So we don't gloss over that.
Speaker B:Is this idea of that, yes, you can lose weight on a Twinkie diet too, just by eating less Twinkies, but.
Speaker B:But then you're also going to lose muscle mass and you're not going to look so good once you lose the weight because your body will lack a lot of nutrition.
Speaker B:You may feel better just because you lost a whole bunch of weight, but the overall outcome is not going to be great.
Speaker B:So one of the biggest thing that people need to focus on is maintaining the protein consumption, which is actually very hard to do when you're not hungry.
Speaker B:It's hard to eat enough protein to preserve your muscle mass.
Speaker A:Yeah.
Speaker A:And I'm really glad that we're not glossing over that when it comes to reducing our calories.
Speaker A:And we're doing it easily and naturally because these medications are helping us to do it.
Speaker A:Understanding that your body still needs a certain rda, a certain requirement of micronutrients, macronutrients, and you still need to focus on getting those into your system because you will see nutrient deficiency.
Speaker A:Otherwise you will see what we call sarcopenia, which is loss of muscle mass.
Speaker A:So to your point, you know it's not.
Speaker A:Less Twinkies is not going to be the best thing for you when you're looking to make sure that you have the nutrition in your body that it needs.
Speaker A:One thing about protein this is like the never ending debate and I'm sure you have a lot of thoughts about what is adequate protein.
Speaker A:We do know that as we get older, our body absorbs protein less effectively.
Speaker A:So higher requirements as we get older is important.
Speaker A:I generally hear 0.8 grams per kilogram is sort of what's recommended is like just a population based basket for everybody.
Speaker A:What I was hearing at this conference was try to get 30 grams in per meal.
Speaker A:So try to aim for at least 60 to 90 grams per day.
Speaker A:Because what I hear from patients is how am I going to eat this much protein?
Speaker A:So we end up supplementing with shakes and bars and doing all these things to get the protein in the body.
Speaker A:And I totally get that and I'm fine with it.
Speaker A:And I'm not against a shake if it's how you have to get your protein.
Speaker A:But I also understand, and this might not be a popular opinion, I do have shakes.
Speaker A:Chewing is part of the eating experience and part of good digestion.
Speaker A:So when we're drinking our calories as the predominant way of getting them in, sometimes that can work against our metabolism.
Speaker A:But that being said, if you are one who is struggling to get your protein in, I'm all for a protein shake.
Speaker A:I definitely will have those myself.
Speaker A:But again, just emphasizing yes, get your protein in 30 grams at least per meal is kind of a good rule of thumb.
Speaker A:That's what I found and that's what they're teaching us as obesity medicine physicians.
Speaker A:And I don't know, you probably have a lot to say about that.
Speaker A:That and tell me.
Speaker B:Yeah, I completely agree with that.
Speaker B:It's actually really hard to eat 30 grams of protein when you are on GLP1s.
Speaker B:In my opinion, of course, on a micro dose you it's easier.
Speaker B:So this is why I think I'm a fan of a microdosing strategy.
Speaker B:Because I think if you're in a regular dosing, it's almost impossible.
Speaker B:I usually try to target for women at least 100 grams of protein, which is very close to what you said.
Speaker B:Very hard to get that in for everybody, especially when you're in GLP1.
Speaker B:So that's why I think your dose should be the dose where you can still eat 100 grams of protein a day.
Speaker B:And that's like your dose in my opinion, because once you just cannot eat enough protein, you're gonna start losing muscle mass.
Speaker B:And especially for midlife women or women that are a little bit older, once you lose it, it's very hard to put it back on.
Speaker B:Even if you work out, even if you strength strain, which needs to be like a prerequisite in my opinion, to maintain muscle mass.
Speaker B:Even with that, it's hard to maintain.
Speaker B:It's hard to even maintain, but it's very hard to build it back up once you lost it.
Speaker B:And I completely agree with the protein shakes.
Speaker B:Everything you should do everything.
Speaker B:Protein shakes, amino acids, supplements, creatine, all those things going to be the minimum supplement stack if you want to support yourself.
Speaker B:Not losing muscle mass.
Speaker B:Yeah.
Speaker A:I have to be honest that the muscle building, the resistance training is one of the hardest habits that I struggle to keep in my life.
Speaker A:So I think that is one of the ways that I resist and one of the ways that I don't show up for myself and one of the habits that I need to really practice what I preach, and that is putting more resistance training.
Speaker A:Because I completely agree with everything you're saying around muscle mass.
Speaker A:It starts to drop in the late 30s and the 40s.
Speaker A:It continues to drop as we age.
Speaker A:Regardless of what we do, it's just going to be reduced.
Speaker A:I think one of the, one of the misunderstandings around the medication and around weight loss in general is that you will always lose lean mass.
Speaker A:There is no way to lose weight without losing some muscle.
Speaker A:It goes with weight loss.
Speaker A:And that makes sense because if you have a bigger body, you need more weight in your muscles to support that body.
Speaker A:And as the body gets smaller, so does the muscle mass.
Speaker A:So that, that being said, the only reason I say that is just to take some of the fear out of people's minds when they're wanting to start these medications thinking that they're, they're just gonna, they're gonna lose all of their muscle mass.
Speaker A:That's not necessarily true.
Speaker A:That's true.
Speaker A:No matter.
Speaker A:Muscle mass is lost no matter how you lose weight.
Speaker A:So it's no different with these medications.
Speaker A:But I do think that resistance training is incredibly important because that protein doesn't go anywhere if you don't use your body to get it into your muscles.
Speaker A:And so you can have all the protein you want.
Speaker A:It's not going to automatically magically build muscle unless you're using it.
Speaker A:The other thing that we're learning about these medications is that function, muscle function tends to be preserved, which is kind of a good thing because even as we're losing the muscle, it's working better, it's healthier, it's metabolically healthier.
Speaker A:So that's actually kind of a good thing around these medications that we're starting to figure out as we use them more and study them more for those reasons.
Speaker B:The key thing is where you are in your perimenopausal menopausal journey before you hit menopause.
Speaker B:You are probably okay not being too fearful about muscle loss once you had menopause either.
Speaker B:You need to have a very comprehensive HRT supplementation along with everything else you're doing.
Speaker B:Because then if you're in GLP1s and you're in menopause and you're not replacing your hormones, you're almost guaranteed to lose your muscle, even if you strengthen.
Speaker B:Unfortunately, it's just what happens.
Speaker B:And maybe this is a good place to talk about hormone replacement therapy and the importance of having a comprehensive approach for midlife women.
Speaker A:Yeah, I, I just learned about this recently.
Speaker A:All the ways that estrogen supports muscle and how we.
Speaker A:They have the satellite cells that are responsible for like regenerating muscle that are directly influenced by estrogen.
Speaker A:Our joint health, so influenced by estrogen, obviously bone health, that's a given.
Speaker A:So, yes, as estrogen declines, all of these systems in our body suffer.
Speaker A:And estrogen replacement, I think, is incredibly beneficial for so many reasons.
Speaker A:And I think we just don't have enough data.
Speaker A:And I know there are a lot of people out there in the menopause space that will tell you every single person needs to be on estrogen therapy.
Speaker A:I'm not against that message.
Speaker A:It's fine.
Speaker A:Everyone can be on, on estrogen therapy.
Speaker A:If they don't have contraindications, that's fine.
Speaker A:But again, I think it requires more information.
Speaker A:We need to understand these hormones more because we need the study that says we should all be on it.
Speaker A:I'm waiting for that study that says if you have no contraindications for your heart health, for your bone health, go ahead and take this medication.
Speaker A:We just don't have those data yet.
Speaker A:That being said, I am somebody who would advocate for hormone therapy with really any symptom profile that was suspicious for estrogen deficiency.
Speaker A:Again, without contraindications.
Speaker A:I do think that it's an incredibly beneficial longevity hormone that we need more information on, need to accept more, needs to be more accessible, we need more education around it.
Speaker A:I had to go back and do like special training in order to even learn this stuff.
Speaker A:And in my residency, I don't know, we had like, you know, a day of it, learning how to prescribe this stuff.
Speaker A:But again, when I trained, we were coming off of the end of the backlash from the whi.
Speaker A:I don't know if I'm sure you've probably looked into all of this stuff, but so everyone is coming off of it.
Speaker A:So we're just finally getting to a place where we're allowing people to go back on it.
Speaker A:I think the removal of the black box warning is a great step in that direction.
Speaker A:But I think widening the indications because the indications today still are just for osteoporosis prevention, hot flashes, hypoestrogenic states, that's what the FDA says they're approved for.
Speaker A:We're starting to see them used more off label for other indications.
Speaker A:And I just want more.
Speaker A:I want more reason to stand behind them and say, yes, they are good for so many more people than who is getting them.
Speaker B:Hormone replacement is a very nuanced topic.
Speaker B:We could probably spend a whole hour talking about that.
Speaker B:But just briefly touching on in the context of GLP1, I think especially important to mention for midlife women, I don't necessarily think everybody needs it because there are women that age really well, going to menopause, have no symptoms, fit, lean, maintain a very active lifestyle, and they feel good.
Speaker B:So if that's the situation, you don't necessarily need to be on on hrt.
Speaker B:Unfortunately, vast majority of women are not.
Speaker B:Not in this shoes.
Speaker A:Yeah.
Speaker A:Yeah.
Speaker A:And I think what kills me is the woman who's like, I'm having hot flashes, I'm miserable.
Speaker A:And they're not getting access and they have no contraindications and they're not getting access.
Speaker A:I'm like, can we at least get those people treated?
Speaker B:And.
Speaker B:And the reason I'm also just bringing this up in the constant context of GLP1 is because if you're in midlife and you're in GLP1s and you're already struggling with eating protein, maybe you're not strength training, then your likelihood of muscle loss is so high that in this scenario, you mentioned longevity.
Speaker B:When you're looking at a longevity of a woman, somebody that when you're 80 or 90, you don't want to break your hip and you want to have mobility, you want to be able to have some vitality as you're aging.
Speaker B:So it's not even when you're 50.
Speaker B:It's what's going to happen when you're 70 and 80.
Speaker B:And I think women don't realize what you do in your 50s will affect your health and longevity as your aging, your cognitive function, if you can take care of yourself as you're getting older or you're going to need help and what kind of lifestyle you can have as you're getting older Well, I think.
Speaker A:Everybody would do well to just educate themselves on the changes that happen in the midlife.
Speaker A:We need to stop and look at what's going on in our heart, because midlife is a transition like no other transition.
Speaker A:Maybe parenthood is as abrupt and draining of a transition as the menopause transition can be, but it is a redefinition of who you are.
Speaker A:Your body is going to start doing things that you don't understand and are scary.
Speaker A:And if all of the people out there that are intending to support midlife women would really start to come at a point at it from a place of compassion and standing in the shoe, in the shoes of a midlife woman going through these changes, we would be all so much better off for it.
Speaker A:Because our midlife women are the pillars of our community.
Speaker A:They are the ones that have the wisdom.
Speaker A:They're taking care of our parents and our children.
Speaker A:So their role cannot be overstated as to its importance.
Speaker A:And understanding the psychology and just being there and saying, I understand this is hard, and I'm here, I've got you.
Speaker A:Let me hold your hand through it.
Speaker B:I love that.
Speaker B:Thank you for bringing that full circle because we started talking about the psychology and maybe can you give us a couple of tools?
Speaker B:You mentioned journaling before.
Speaker B:Besides journaling, which is an amazing tool, what are some of the other ways that we could see what's in our heart?
Speaker A:So for me, it's.
Speaker A:Much of it has to do with listening to your thoughts, listening to what you're telling yourself and asking, is that true?
Speaker A:So that's step number one.
Speaker A:Really get a baseline on where you're at.
Speaker A:Are you constantly berating yourself?
Speaker A:Are you beating yourself up?
Speaker A:We all do it.
Speaker A:So ask what that's about.
Speaker A:Ask what those thought processes are, and then turn it around and say, what if this weren't true?
Speaker A:So it's a little bit like of a reverse psychology tactic.
Speaker A:Just it doesn't change the fact that your body hurts.
Speaker A:But one of the treatments for vasomotor symptoms is cognitive behavioral therapy.
Speaker A:Nothing to do with any medication that we can give.
Speaker A:Everything to do with the power of your brain and your heart.
Speaker A:There is a psychologist, his name is Carl Rogers.
Speaker A:I have his quote.
Speaker A:The curious paradox is that when I accept myself as I am, then I can change.
Speaker A:So I would invite everybody to be in the space that they're in and be okay with it, and not push, but allow.
Speaker A:And then when you are trying to change from that place of being where you are, make that change about moving towards love, rather than pushing away from fear.
Speaker A:Every single change you want to make can be framed as, I'm afraid of this happening.
Speaker A:So I'm going to do this or I invite this experience into my life.
Speaker A:So I'm going to do this.
Speaker A:Which one is more empowering and is going to stick?
Speaker A:So those are just like some mindset tricks that I share with patients and then the other thing that redefined my journey.
Speaker A:So have you ever had a moment in your life where like something changed, something flipped?
Speaker A:You were like, this is information I've been looking for my whole life.
Speaker A:I go to these conferences and I'm constantly looking for the moment where I'm like, oh, I have it all figured out.
Speaker A:I need nothing else in my life.
Speaker A:For me, that moment was when I understood that it was my relationship with discomfort that was holding me back when I stopped making discomfort.
Speaker A:When I say discomfort, I mean with habit changes.
Speaker A:Going to the gym isn't super fun.
Speaker A:Sometimes eating a meal that looks different than other people isn't fun.
Speaker A:It feels uncomfortable.
Speaker A:How do I relate to that discomfort?
Speaker A:What does that discomfort mean?
Speaker A:It used to mean punishment.
Speaker A:Now it means self love.
Speaker A:Now it is curiosity around what that change in behavior is going to do for me.
Speaker A:So it's all about not making discomfort the enemy, but something you can sit with and be with and actually turn into something self loving rather than self denying.
Speaker B:Oh my God, I love that so much.
Speaker B:What a beautiful way to round up this conversation.
Speaker B:What is a good way people can connect with you?
Speaker B:You connect with NOOM.
Speaker A:Yeah.
Speaker A:So Noomis Noom.com easy enough.
Speaker A:Go on there.
Speaker A:We have a free program so you can try it out.
Speaker A:Just get a sense for the app.
Speaker A:See if it's something that it's if it's your jam or not.
Speaker A:Personally, I'm at Dr. Karen Mann on Instagram.
Speaker B:You'll find this episode's show notes, my writing and links to everything I'm creating@optimizewin.com Thanks for being here.
Speaker B:I. I appreciate you more than you know.
Speaker B:This podcast is for informational and educational purposes only and it is not intended as medical advice.
Speaker B:Always consult a qualified healthcare provider.
