Speaker 1: 0:01

Dr Crystal Guevara, how are you?

Speaker 2: 0:04

I'm doing amazing, especially now that this head cold situation has resolved itself. How are you doing?

Speaker 1: 0:10

I'm doing great. I am so excited that you're here. I'm an avid follower because you're so smart and your kindness also. Kind of not everybody can actually shine through social media, but you do, and I'm so happy that you're here. So thank you.

Speaker 2: 0:28

I appreciate it. It's taken a lot of work to get to this part of my life and I think if you would have said I don't think you would have said the same thing about me even a couple years ago, but I'm glad I feel I really actually, when you say that, I actually truly believe that too. So thank you for you know, it's taken a long time to get to this part, so thank you. Oh my God, I'm going to already start crying, geez.

Speaker 1: 0:55

Wait, no, but like now, I have to pause for a minute and ask if you don't mind explaining a little bit on getting to this point. Welcome to Bodyholic with Dee. No fads, just facts. I'm Dee and I'm here to help you ditch the noise and build a life you love. Let's go. Oh, but wait. I'm not a doctor, so use your common sense. Now let's dive in. Who is Dr Crystal Guevara?

Speaker 2: 1:24

Because I have struggled with hunger and this, you know, hunger, signaling noise, food noise for so long that I've tried to compensate for it by doing all of these academic you know things like I just sort of resigned myself to, like the this is the genetics I've been dealt with.

Speaker 2: 1:47

I don't have you know what it takes to be like or even lean.

Speaker 2: 1:53

I you know I feel out of control, despite the fact that, like you know, my CV says that, like I have willpower, I can do things. Like I've done some really amazing things on paper, but I just always felt like this diet part has been this, like stain or this you know chip on my shoulder for a very long time. And now that I have actually found a solution like it was the one thing in the toolbox that, like I couldn't, I didn't know the secret to I have failed multiple times that it has now allowed me to become like not just you know, yes, I have lost weight and kept it off and like all these amazing physical things, but I haven't been able to progress emotionally, mentally, showing up at work, I haven't been able to be my best self because I've always had this you know thing that I've struggled with for so long and it's it clouded my mindset completely. Just, you know, no matter what I, you know, tried to do, hired a coach, worked with different coaches, work different apps, you know, etc.

Speaker 1: 2:59

So Wow, it's a lot. Wow, it's a lot. How is it possible that this woman was was anything, was even knocking her down. That's kind of it's almost like really, but it's one of those things that I guess you don't wear on your sleeve and it's just yeah.

Speaker 2: 3:37

Yeah, so, but I, yeah, and now that, like, we have data and studies that actually look into this concept of hunger and food signaling and food noise, you know, I guess. Now I just I would hate to not share my story because for every you know person who's like you have no willpower, you're cheating or whatever you know bot, you know person hurls some insult at me. I can't tell you how many people have been in my DMS saying thank you so much for your story. I'm on a GLP-1, you know medication and I'm really embarrassed to talk about it. Or I'm thinking about it and I'm really embarrassed to talk about it and like not having, not having anybody to go to, to actually like say that and ask for it and have an honest discussion about it.

Speaker 2: 4:30

That's guilt-free, just, uh, it would be, you know. Uh, it makes me sad, you know, and I would just hope that, um, we could just be a little bit more compassionate, both the people who are struggling with it and coaches out there who do work on behavior change, and we'll, you know, ultimately, if they haven't already come across a client who is either thinking about these medications or is on a medication, and you know, we want to just make sure that, like we're all on the same team, I promise you nobody's trying to cheat their way through anything or whatnot. You know we all really want the same thing, so it would be very beneficial for us to kind of, you know, come from a place of compassion and figure out a way to move forward with it.

Speaker 1: 5:15

Was GLP-1 the game changer for you?

Speaker 2: 5:19

Yes, I have failed. Multiple weight management medications in the past prescribed by my physician came with a whole host of side effects and did nothing for my hunger, so I started taking this medication in January 2022.

Speaker 1: 5:40

January 2022. So this has been. It's been a while.

Speaker 2: 5:44

Yeah, and what you know and what is it like a daily dose.

Speaker 2: 5:48

No, it's, it's a once a week. All of the the GLP-1 agonist drugs currently are, the half-life is about a week. So there is an oral pill that you could take daily, but it's you have like meal timing. It has to be first thing in the morning, like I think I want to say that there you have to like drink X amount of fluids after it sort of it's a little bit more like and it's also a little less effective than if you just bypass all of that and you know, inject yeah.

Speaker 1: 6:23

So can you do you want to, maybe as a physician, kind of talk about GLP-1 and what it is? I actually went on a whole rant, I think we talked about this about GLP-1 and Ozempic and the fact that, uh, the research is really um, very impressive, like it's, just as I. I really I tried not to be impressed by it, but I was like this is so impressive. So um maybe like a few words about it from a physician, and that was amazing man, that was amazing.

Speaker 2: 7:11

Yeah, the GLP-1 is a glucagon-like peptide one. It is a hormone that we naturally produce in our body and the way it works is essentially, you ingest food, food goes down through your stomach, churns and gets spit out into your small intestine and the cells that are lining the small intestine detect that food is coming down the hatch. So we need to like, do stuff right, like we need to shuttle these nutrients to, like, you know, do awesome things, and so the intestinal cells will release this hormone, glp-1, and it does a whole host of things. It, you know, tells the pancreas to secrete some insulin so we can utilize and shuttle the glucose that's going to get, you know, made, you know, from the food it also gosh. It also kind of sends up signals to, you know, the brain to let you know hey, I'm full. The problem with our hormone, like the native GLP-1 hormone that we make, is we also make an enzyme called DPP-4, which is neither here nor there, will come and cleave off, you know, manipulate the hormone and then, once it's manipulated, it's completely inactive. So these GLP-1 hormones, the typical half-life for these hormones that we produce is somewhere on the order of three to five minutes. Like that's not a lot of, it's not a very long time, right, like to do like it can only affect so much, you know, do so much in the body with like that much release and that long of a half life.

Speaker 2: 8:50

So they discovered and isolated GLP-1, like back in the late 70s, early 80s, and so they, because of the fact that it signals, and you know, the insulin release, they started working on this for decades to, you know, like, thinking about, like a pathway to kind of for diabetes medications. And it wasn't until 2005 that the first GLP-1 agonist so let me back it up An agonist, basically, is something that will attach to the receptor very similarly, but this is able to dodge that DPP-4 that like would come in and cleave. So the drug that we, you know, that people would inject, it'll go through the bloodstream and actually attach to the GLP-1 receptor, which are on places such as the brain and also the pancreas, to do the thing right. Give me some insulin, give me, you know, turn off this, you know pathway, telling me that, like you know, let me know that I'm full, but it lasts a whole, much longer than you know what our bodies can naturally do. It'll last a full week. So right.

Speaker 2: 10:05

So agonist essentially will allow the signal, you know, allows the signal to happen. You know, and actually, yeah. So the first drug was discovered and FDA approved in the United States for type two diabetes in 2005. So we took a while right, it took a while, but also we've been using GLP-1 agonist drugs since you know, it's what? 2025?.

Speaker 2: 10:33

Yeah, it's been 20 years, and so it wasn't until, like the 2014s. You know that liraglutide it was a next generation of the you know drug.

Speaker 1: 10:46

The diabetes drug.

Speaker 2: 10:48

The diabetes drug that they also noticed that there was this like side effect of like weight loss. That was happening because very early on, with the very first drugs in the early 2000s, the weight loss component was really not that impressive. The studies it was like somewhere on the order of like five to six pounds, so it was just like meh. And so as they kept improving on the you know so 2014 is when they first start the FDA in the United States approved it for chronic weight management, so not too many people were on it. It was still a daily injection because the half-life wasn't as long, and then it wasn't until like 2017 that semaglutide had come out. It was lasted a week and the weight loss effects were very, very dramatic. And so I think a combination of you have that dramatic weight loss effect and you have, you know, that satiety part was really dialed down. But then you also had social media. We didn't have social media like social media in the early 2000s is not like the social media of like 2017, 2018. With TikTok, you know Twitter, Instagram, you know Absolutely, and so you've got a lot of people barking about it and having you know, expressing their feelings about it.

Speaker 2: 12:10

So, as a physician, I have been very familiar with both the chronic weight management side and also, very early on, with dealing with, you know, treatment for type two diabetes. So I'm very comfortable with it. It does a great job of lowering the A1C. And then, you know, nowadays it's more along the lines of, you know, incorporating it into an overall game plan for weight management, because this is a lifestyle. You know, there is a very huge lifestyle component to you know, managing weight. So, and it's not just taking the drug and then like, see you later in three months, Right, Exactly, and those who take the drug and see you later in three months.

Speaker 1: 12:59

I think that's kind of where the noise comes from. Yeah, am I right? Yeah, can you say a little bit about that and why it has to be really the two, the Ozempic or whatever drug right, because it's not only Ozempic, if I'm not mistaken now?

Speaker 2: 13:15

Yeah, yeah, there's now a dual agonist, terzepatide, which not only is a GLP-1 agonist, it's a GIP agonist, so it's-1 agonist, it's a GIP agonist, so it's a dual agonist. It has the data for terzepatide for not just the weight loss component but also reduced cardiovascular risk. Improvement in fatty liver disease and then also with kidney disease like that are aside from that, are independent of weight loss, so it does make it a lot more attractive as far as, like you had to pick one versus the other. You know, and also anecdotally, I do see a lot of people who have problems with the most common side effects with semaglutide seemingly faring a lot better side effect profile wise to that, you know, when they switch to terzepatide.

Speaker 1: 14:16

Speaking of, you know what you're seeing and in the field, yeah, yeah, yeah, I'd love to know, um, especially, like, if you're looking at colleagues and seeing what's going on over there. I'm interested also if you think that there are people who are too quick to prescribe medications. Um, like, what if? How do you approach the lifestyle? What if the lifestyle interventions aren't really fully explored? So what, what's going on over there?

Speaker 2: 14:50

Yeah, and I think it's, you know, I, I think it's, I guess, trying to understand from I don't do a traditional brick and mortar practice. I don't work for a major healthcare company. I am not paid by the pharmaceutical industry to speak upon this, so I, you know, so I do realize that I have the freedom to kind of practice how I want to, that not every provider is able to, because it really is. You know, I got to give the physicians a lot of credit who are working in major healthcare corporations. It's a grind.

Speaker 2: 15:28

You got 15, you know you got 15 minutes and like it really pained me to try and figure out how to like I used to try and incorporate some lifestyle stuff, like I remember doing like some wall pushups together with one of my patients to like and I'm trying to do this in 15 minutes, right, like you know, and then I've got this line of people, you know, in the waiting room just like pissed because I'm, you know cause then you know you don't want to kick people out, but then they're like I have this one more thing.

Speaker 2: 15:56

So so, yeah, it is, it's difficult. So and I think the lifestyle part definitely gets missed. What I would really love to see and I'm starting to see this more with now that everybody's really taken notice of you know how powerful these meds are for weight management where they are doing a lot more collaborative process with you know having a dietician, having a health behavior, you know wellness coach, having a strength and conditioning coach to kind of come in and like be able to outsource that you know, but like if you are in your again a regular family medicine or internal medicine where you're not just dealing with weight management, you're also seeing you know all sorts of other medical you know issues. It's really hard to coordinate all that If, especially if that's not the bulk of your practice is like just this right.

Speaker 1: 16:59

The. It's important that the person who's going for it has to be. You know, what can we do? We can't educate the people who don't want to be educated, but, uh, maybe the doctors, you know, maybe they can be educated. And the first thing should really be what you're saying, like let's go for the holistic, uh route for the dietician, for the wellbeing coach, for a personal trainer. You know, that would be ideal, right? I almost want to say like, maybe that's what the pharmaceutical companies have to start providing, like you know to, to just like here's how we do it really safely and right.

Speaker 2: 17:44

Right, yeah, so it. I, I 100% agree, uh, and the thing is, is that, um, you've got, uh, you've, and I think it would also be a little bit easier for people to be monitored um, kind of a lot more closer? Um, because there are people sometimes it's like come back in a couple of weeks. So much has happened in a couple of weeks that you can't you know, and I understand it's not realistic every day checking in, but I think once a week checking in. I think the mode and delivery in which healthcare is being delivered is also has rapidly evolved, especially after the COVID pandemic. People realize that, like I don't want to have to like, get in my car, drive to the doctor's office, sit in a waiting room while they're running late. It's a waste of people's time.

Speaker 2: 18:33

Um you know from from and I say this as a physician and a patient, right Like I hate having my time wasted. So, um, the, and I know that sometimes with the reimbursement uh, reimbursement for a telemedicine visit has its own like, like special kind of requirements from the billing side of things, which also further complicates things and it makes it harder to provide great care when the insurance companies, you know, don't always want to pay full price for a over the phone visit or a Zoom call, versus like having them dragging them into the office to talk about stuff.

Speaker 1: 19:14

I just have to pause you for a second, because I lived in the States for some time. Um, and I am in Tel Aviv right now. Yeah, one of the driving forces to me returning home was the insurance. The health insurance, like what you're describing to me right now, is a non-issue. Where I live, it's a non-issue. I the other okay, let me.

Speaker 1: 19:43

I mean, I'm going to to my American friends. I'm going to blow your mind right nowissue I the other. Okay, let me. I mean, I'm going to to my American friends, I'm going to blow your mind right now. The other day I had like a red dot near my nose and it was kind of itchy and uncomfortable. It's just because it's so bloody hot here, like it all of a sudden became so hot. Um, but I started I was worried. It was like I was like, oh my God, what is this? Like a herpes fungus kind of. I was exaggerating, it was really just a red dot, yeah. But I got on my insurance that everybody has here and I called a skin doctor and got him to look really close at, got into the, into the camera, and I was like what is this? And he was like it's really nothing and I was like, okay, thanks.

Speaker 2: 20:34

And that was it.

Speaker 1: 20:36

Yeah, so like, what you're describing to me right now is just unbelievable. There's going to have to be some kind of revolution.

Speaker 2: 20:47

Yeah, I don't know what this. I wish I had an easy solution for you, but right now, uh, I just yeah, uh, I know that there are some providers who are just going all in on weight management and like, and I think that's actually great. I think you know you need to like be able to focus on it, because it's so intensive having to do, having to work with patients or clients on, you know, the lifestyle portion. It's so important and you can't do that in a 15 minute visit once every you know what month, once every three months.

Speaker 1: 21:23

Right, and actually it really is. You know, smart insurance wise like to take care of these people while they're actually healthy. Right Then, before they get to the metabolic syndrome.

Speaker 2: 21:36

Exactly, exactly. And then we're trying to play catch up here. But the way it works is it's really easy to get these drugs approved if you have type 2 diabetes or even pre-diabetes, and then get the drug that way versus trying to. You know, I got a prior auth approval for a patient's you know weight drug weight management drug and the copay was still like hundreds of dollars and it's like why are we paying insurance if she still has to basically pay almost full price for this drug? Yeah, yeah, I'm with you I yeah.

Speaker 1: 22:16

Yeah, it's a pain. It's. It's a painful issue. Speaking of painful issues, what do you think and I'm also asking you, crystal the person what do you think are some of the biggest psychological or behavioral barriers that you see in patients that are trying to make lasting health changes?

Speaker 2: 22:42

So, like we're talking about lifestyle now, yeah, yeah, and I think it really depends, like I know that we're kind of in the fitness space, so when I'm looking at, like the general population, I think just even desire to even start like they don't see that they have a problem. There's no, you know, especially if you don't already have diabetes, high blood pressure, you know, high cholesterol, um, if all those markers are normal, there's a lot of people who are just like, yeah, this isn't important to me, like this, I don't see what the problem is because there are no problems right now. Um, and so it's hard for me, to me to, you know, I can have a conversation and I can try and broach that you know topic very gingerly, depending on you know how they react to things, because that is a very sensitive topic, right, and you have to get that trust and buy-in and I don't always get that. That's one Like I. Just, you know we're in pre-contemplation mode where, like nothing is a problem. The other things are, you know things that I've seen with other patients that not necessarily to my practice that taught me what I needed to do up is, um, I think having a discussion about body composition um is important. Um, having a honest discussion that the scale is just one tool in the toolbox and doesn't tell you the full picture. Um, I think those are.

Speaker 2: 24:16

And then also, you know, making sure that you, when you're checking in, not just focusing solely on, like the, did you? You know, what does your weight look like? Did you get your steps in? Did you, like hit all your meals? But you know what are some new things, like what's a non-physical way that like this journey has like had? Like, what kind of an impact has that had on you? Have you noticed that you interact with the world differently? Have you noticed the world interacts with you differently? So, getting a, you know, kind of a sense of like, it's more than just that. It's like changing the mindset of uh, you know of, of like now I'm a fitness person, because these people don't.

Speaker 2: 24:58

I usually, when they start, they don't identify as a fitness person. They see, you know, normal body to lean bodies and they're like, I don't look like that. I don't know if this is. You know, it's very overwhelming to me. I don't know if I'm ever going to get there. And, and those are all very valid, I've felt those, you know, as a you know myself, and, um, so, trying to coach people and making sure we have that talk about body composition, especially early on, because I've seen a lot of patients diet themselves down to a number and then they're like, oh, I'm, you know, super like skinny, with no muscle, and then I got to build muscle, which, is it happens, it's totally fine. And depending on where you start, is it happens, it's totally fine. And depending on where you start, where you like, I would rather, you know, have that than have somebody not start at all.

Speaker 1: 25:51

But I mean, you know, if you can, do it in a slow man, slow, sustained manner, like I'm all for that journey. I really no. No, I agree with you. I'm a Manning Everything you're saying because body composition, as far as I'm concerned, is so much more interesting to me than the number on the scale, and I don't think everybody can afford a DEXA scan, but you could even just use the mirror to just like are you standing?

Speaker 1: 26:19

Yeah, that's actually what I do in my studio. I take like a really bright, unflattering picture you know, with lots of light and um, and then we come back in 12 weeks and we do it again and I don't have a scale in my studio. Actually, okay, you just like I, I really don't, I don't mess with it. I'm not a dietitian Um, I train people and, uh, my most, like my biggest thing, is just lift really heavy lift weights lift weights.

Speaker 1: 26:50

lift weights with perfect form and it's all going to be okay. Yeah, like also. Like, if you're angry and stuff, lift weights and it'll be okay, you know I mean it's just the solution to everything.

Speaker 2: 27:03

It is, and there are other coaches who do like, who do once a month check-in or like not over indexing on the scale every week which I think is also great as well, right as long as there's like some sort of you know check-in. That's a little bit more like you know. Obviously you're not going to just be like let them go for a month and be like have fun.

Speaker 1: 27:24

See ya Right.

Speaker 2: 27:27

So I encourage to take the pictures because it's sometimes when you're seeing yourself day to day you don't realize how far you've come. And I think, also as a physician and as a coach, also as a physician and as a coach, reminding your patient or your client about how far they've come or reminding them, you know, like of the little wins. Like I have a patient who went to the gym but also invited her. You know she invites her daughters to go train with her because they want to build muscle. And then she invited her friend and I was. I told her that's really awesome. You are becoming a fitness person, you are incorporating this and you're bringing your social network into it. Like that is super awesome and I love to see that right. Like you are changing as a person, not just the body part.

Speaker 1: 28:16

The identity thing is really really important, like, you once you start identifying as, whatever it is that you want to be, right You're that's, then that's what you are Right, like it. It becomes like the future, becomes the now. Yeah, um, I, I have to just stick with this, with the um BM, with this. Um, yeah, I've got to stick with this for a second because I have to talk about skinny fat issues, because you're talking you just mentioned the body composition and it really I have to say that the high body fat percentage, low muscle mass and the the low or normal BMI is really an issue. Like I want to just you mentioned it I kind of want to surface this.

Speaker 1: 29:12

This is really an issue. This is a lifestyle issue and even though you you walk around thinking that you're really skinny and like great, so you're at risk for low bone density, you're at risk for having excess visceral fat, which means fat around your organs, so you could have all kinds of metabolic issues. Um, so I'm interested in now, like how do you address a situation like that? Cause that's actually that's really hard, like in terms of mindset, trying to get someone to like understand that it's not ideal and it's not optimal for their health and longevity.

Speaker 2: 30:06

Yeah, how do you go about that? Yeah, that's a great question. I'm glad you touched on the BMI because I think one of the most common questions I get on a podcast is say you have somebody with like a normal BMI and they just want to lose the last five pounds, like what would you do? And I'm like you know it really depends. It's not a, you know, automatic, no, because of the BMI, like you, like you said, all those other things do matter.

Speaker 1: 30:34

And.

Speaker 2: 30:35

I think it really starts with what is actually important to them and then kind of building the case like you know the potential risks down the line, and kind of going from there you know, and if yeah, if the no-transcript what their life goals are and kind of tying it to that, because it's not always about the you know I want to look this way and sometimes it is. And then you have to have a conversation about you know, muscle is what is actually going to.

Speaker 2: 31:42

You know, give you the shape that you are probably looking for route, kind of showing them like what you know. What are you looking for in terms of you know physique and then having to explain how important muscle is in the equation?

Speaker 1: 32:07

Right, Like I want my jeans to fit nicely. But there you go, You've got a. You've got right, you've got a.

Speaker 2: 32:14

Yeah, it's not you know not everybody bought their. You know had got a BVL and called it a day, so you know, and those aren't long. Like you know, not everybody bought their. You know had got a BVL and called it a day, so you know, and those aren't long. Like you know, you can still like. You know, if you're not weight training, you know those results might not be as lasting as you would expect especially as the muscle starts to shrink over time, right, right.

Speaker 1: 32:39

The what would you say is the number one and not working out, specifically not working out the number one daily habit that maybe you see with yourself or you even recommend that really is a game changer. So not GLP-1 and not working out.

Speaker 2: 33:02

Oh, between the two, or do you want me?

Speaker 1: 33:03

to pick a third one. I want you to pick a third one.

Speaker 2: 33:06

Oh, I mean definitely meal prep, learning how to cook and you know, preparing ahead of time is like that is it?

Speaker 2: 33:14

You know? Yes, I think training I would go insane if I and I have gone insane, taking a couple month hiatus off of training. But definitely because I feel like a lot of people out there in this world kind of just react. They like whatever, you know I'm, you know I'll go and grab, go to Starbucks, grab you know a frappuccino, and like this page a pastry, and like, call that a meal, and then I'll just, you know for whatever, for lunch I will go to some fast food and pick up something, and then you know cause I don't have time or I don't want to make time.

Speaker 2: 33:53

But see, that's also a really good point of um. You know, when people do bring that up, I will pull up the menu and we will go through some healthier options as well, because I do think it's important to like, you know, nobody not everybody's trying to be a bodybuilder, so you don't need to eat dried chicken breast and broccoli. You know steamed broccoli and white rice, like that's also just. I mean, if you want to, you can give it a shot, but most people are going to be like, oh, gross.

Speaker 2: 34:19

So I think, you can eat on the run. It's not the ideal thing, but the alternate. What's the alternative? You eat crappier food with no protein and just carbs and fat.

Speaker 1: 34:31

Right, I have to say that, like even prepping, like looking at the menu, prep, just you know, you know what you're going into the restaurant with. I think that's so powerful and I think it bypasses the willpower thing. So, of course, when you actually prep and you have the containers and it's all like laid out and planned out and you really don't have to think, yeah, that's amazing in bypassing the willpower, yeah, but then you know that's also really understanding the menu, going through it with your patients or whoever you're working with. I think that's amazing, yeah, and I think more and more fast foods are offering, you know, the, the healthier option.

Speaker 2: 35:14

Oh, yeah, yeah, oh yes. There's two sides of that spectrum, because I did just see. I think it was either Domino's pizza or Little Caesar's pizza, offering a mac and cheese pizza with, like a sausage roll embedded into the crust.

Speaker 1: 35:32

No, okay Folks, this is only in America.

Speaker 2: 35:37

We are undefeated with, you know, the fast so. But the other thing is, the fast food companies will continue to provide what we buy, right? So clearly they think there is a target demographic out there that really will find this appealing and they will cater to it.

Speaker 1: 35:51

So I just kind of lost my lunch a little bit. But yeah, yeah, I, and I'm not judging, hey, if that's your thing cool.

Speaker 2: 36:15

I just can't. You know for and enjoy. And so here you go. If nobody buys it, it's going to 100% going to get off the shelves like ASAP, because it's not in a company's best interest to continue offering a crappy product that no one wants to buy.

Speaker 1: 36:30

Yep, I would even. You know, I I've actually lectured on the topic of there is, you know, the companies, there's the consumers. I'm actually I want to talk to the government Like I actually let's. I'm actually I want to talk to the government Like I actually let's put those two aside, and I want to talk to the government about how they regulate and how they educate and et cetera, et cetera. But that's a topic for another day.

Speaker 2: 36:56

That's a topic for another day.

Speaker 1: 36:57

Yes, that's a topic for another day. Yes, is there anything I have before I actually give you the freedom? I have one thing that's just kind of sitting in my head, for sure, and you'll soon see why. I'm saying no pun intended. But the deal with leptin, okay, I'm like wondering why nobody's talking about leptin with the GLP-1. Does GLP-1 basically cancel out the whole leptin situation? I'm just going to explain that leptin is the hormone that signals satiety.

Speaker 2: 37:31

Yeah, so that's a really great question. Um, the um and I. My hypothesis, uh, is that, um, the leptin is completely removed from the equation. I know I have read the studies where they had been working on the leptin pathway as like a way to, you know, kind of tackle those drugs. But it also leptin correct me if I'm wrong I completely like lost my, had a brain fart.

Speaker 2: 38:03

Um, leptin also deals with, like, um, thermogenesis, like how you know, your um, neat, uh, how, um and so the, if they solve the leptin problem, um, I would say that, like, all of this part is solved and the last thing that they need to work on is building muscle, which I know that the myostatin inhibitors are kind of coming down the pipeline, at least in research. This entire problem altogether of, like this lack of muscle mass, the, you know whether it's you want to generate that signal on your own or take some medication to solve that problem, which definitely rubs people. You know some type of way. But I think we're, you know the people who are able to adapt. You know, because we're going to, I think we are going more than ever, despite the fact that we have these drugs down the pipeline, we're still going to need people to talk to like human connection. That's still going to be important to a lot of people, you know.

Speaker 2: 39:14

Having that sense of support outside of just like inject and, like you know, by themselves of just like inject and like you know, by themselves, so I don't think that you know coaches, personal trainers I don't think that they're going away, like you know we, you guys, like people, should not be scared of this. They should just view it as another thing. You know tool in the toolbox, and if you're, you know, if you can't offer, you know community or support or something else other than macro counting and like sending programs, then then maybe you know it's time to pivot your career entirely.

Speaker 1: 39:48

Yes, yes, absolutely Like that. You know what I feel like. That's actually. That's a great way to actually wrap up Like I could. I could also. I could go on about. I could really expand on almost everything we touched on.

Speaker 1: 40:06

The leptin, by the way, is something that I find so fascinating and, uh, I I really got into the whole uh period of time between ghrelin and leptin. I'm just going to also explain that ghrelin is a very interesting survival hormone that, basically, if you haven't eaten for about four hours plus, it'll start telling you that you right now have to eat a refrigerator. Now, that's what it's basically telling you yes, gr, right, so so then, um, and then the leptin is like the other guy who says okay, you know, I'm full. Once your body fat percentage goes up, also the leptin, um, if I'm, if I'm not mistaken, uh, goes, goes up. Um, I was always wondering, like, how is there not? How is leptin not the big thing? And then you know, all of a sudden, I'm understanding that there's this whole GLP-1 thing, which the GLP-1, they don't even nobody mentions even leptin.

Speaker 1: 41:14

So, but what you're saying actually is something super interesting that I didn't understand that you're saying the GLP-1 bypasses it, but really leptin is the issue.

Speaker 2: 41:29

Leptin is a problem. Leptin is part of the problem and it's. You know. I don't necessarily know if like the connection of how leptin off the top of my head, how leptin deals with satiety and hunger. I do know that the GLP-1, we do have receptors in the hypothalamus that are able to shut off that satiety signaling. I don't know what the connection is. I do know that, like independent, they're independent pathways. I don't know how they necessarily work together, so that's definitely something I should definitely look up and figure out, because, no, it's interesting.

Speaker 2: 42:08

It really is. I just you know. The other thing is yeah, I don't know where the I want to say that they have done studies where they tried to make drugs addressing the leptin pathway. Yes, they have, they have, but it hasn't just make drugs addressing the leptin pathway yes, they have, they have. But it hasn't. Just I don't know where the like it didn't work on humans Like it was really interesting, like there there were.

Speaker 1: 42:33

there's a study and I can't, you know, pull it out right now, but there's a study on mice.

Speaker 2: 42:38

Yeah.

Speaker 1: 42:39

Um, where the the they could see the difference between the mice who were receiving leptin as opposed to mice who weren't, and the mice who received leptin were losing weight, yeah. And then they tried to move it to humans. Didn't work, yeah, just did not work. It was completely irrelevant, yeah. So, yeah, it's a really interesting topic. Um, I would totally dive into it, uh, try to figure it out myself.

Speaker 1: 43:17

But, um, what you said about the support, the emotional connection, I think that my feeling is that, no matter how many generations of GLP-1 are going to show up and they're going to show up, there it's happening and no matter how how clear the meal prep is and you know all the stuff that we should be doing prep is, and you know all the stuff that we should be doing If you don't have a strong support system in place, if you're not going home to a strong support system, if, if you don't reach out, maybe maybe really what? Maybe you're not going home to, maybe you know you've got your cat, but also like reaching out and really not being ashamed. That goes back to what you said in the beginning. Your DMs are full of people saying like yes, thank you, and that there's a reason because people really need that support.

Speaker 2: 44:16

Yeah, agreed, agreed on all counts. You know we are connected, now more than ever through social media, but also seemingly disconnected, now more than ever. Just, you know, with the way we interact. You know online, which is all good and dandy, there's something to be said about actual face to face, having face to face time that for a very long time I just either didn't compartmentalize to try and get through medical training as fast as possible, and that was my number one thing. And looking back, you know it came with some sacrifices, like I definitely, you know my relationships suffered at that cost. I don't regret it, but looking back and being able to tackle this hunger situation has allowed me to really start thinking about how can I do better to show up in other parts of my life. But, yeah, I think probably having a little bit more social support, I could have, you know, done a lot better with you know so but it is what it is.

Speaker 1: 45:21

Yeah, yeah, of course, but you also said something so beautiful on the whole, like not dealing with this hunger thing.

Speaker 2: 45:31

Yeah.

Speaker 1: 45:32

Is allowing for life to happen. That's what I'm hearing. Oh yeah, oh my.

Speaker 2: 45:39

God, the amount of cognitive bandwidth that it would take for me to sustain at 150 pounds I'm like 145 right now, comfortably post-op and the amount of cognitive bandwidth it would take for me to even get down to 150 pounds naturally was just unnerving.

Speaker 2: 46:02

I would bite my nails and kind of chew on my cuticles to try and pretend like the kitchen wasn't there, pretend like I didn't feel hungry, and then I'd feel guilty because you just have to have willpower right, you just have to grind through it. And I've dieted in the past to 130 pounds and I would be up till four in the morning with my stomach growling, like I could audibly hear my stomach growling and just tossing and turning because the hunger was so bad and I was like, well, maybe I just this is the way, that this is just something I have to deal with. And I yeah, I was such a zombie in medical school that like I failed anatomy and so that was like a wake up call that like okay, maybe this isn't going to work or I'm just not going to be a doctor if I continue to try and you know I'm 4'11".

Speaker 1: 46:54

So like at 130 and 4'11".

Speaker 2: 46:58

You know not really anything. You know spectacular in terms of getting lean, but holy crap man, the signal, you know, the food noise was so incredibly yeah it was insane.

Speaker 1: 47:13

Wow, I am so happy that your life and you are showing up for each other.

Speaker 2: 47:21

Yeah, and I would love for that for other people. Right, if I'm, you know, was able to sort of grind through this, you know, by the skin of like white knuckling through life, you know, for the last 40 years trying to take care of patients, trying to, you know, be a great spouse, trying to be a good friend man, I'm sure there are other people who are white knuckling themselves through life and have found a lot of freedom with this medication. So I would hope that you know, if you were even thinking about it, to like go to your doctor and talk about it and just have that conversation of whether or not this is, you know, something that you know might be right for you. You know I always encourage people like getting going and talking to your doctor about it is never the wrong answer.

Speaker 1: 48:09

Right, in my opinion. Going and getting educated about things that can serve you and help you is that really is, I think, what you and I are saying here. The message is you know, go get educated. It doesn't have to be a certain way.

Speaker 2: 48:24

Yeah.

Speaker 1: 48:24

There, we live in a world with so many, so many, so many options that, um, you know, go and reach out, find out, get support. You know it's, yeah, what a great message, Thank you. Thank you so much, Dr Crystal. Ah, thank you so much for inviting me on here, hey, thanks so much for tuning in, and if this hit home, please share it with your crew. Likes, comments, shares. Show your loved ones you care.