[SPEAKER_01]: Hey, it's Elizabeth McGand, the holistic GLP1 podcast.
[SPEAKER_01]: Look, we do it.
[SPEAKER_01]: Today we're going to talk about one of the most misunderstood parts of the GLP1 conversation, especially for women over 40.
[SPEAKER_01]: GLP1 medications can be powerful tools for healing and weight loss when they're used holistically.
[SPEAKER_01]: When they're not, they're being used the wrong way.
[SPEAKER_01]: And every week, I speak with women who are curious about using JLP1s holistically, but are also feeling confused by all the mixed messages out there.
[SPEAKER_01]: When women come into our holistic gelpine coaching programs, it becomes very clear how much guidance is needed on how to use these peptides in a way that protects muscle and supports metabolism.
[SPEAKER_01]: And before we get into this conversation with the brilliant, Dr. Zenchi Liu, one of the world's leading experts on how gelpine medications affect muscle and metabolism.
[SPEAKER_01]: I want to sound the alarm and walk you through a pattern.
[SPEAKER_01]: I'm seeing play out again and again.
[SPEAKER_01]: I call it the seven-step GLP-1 muscle loss cycle.
[SPEAKER_01]: And once you understand it, you'll understand exactly why so many women lose weight, only to gain it back and often end up in a worse place metabolically than where they started.
[SPEAKER_01]: So here it is.
[SPEAKER_01]: Step one, a woman starts a GLP-1 weight loss journey focused only on losing weight fast, and most likely on a dose that's too high.
[SPEAKER_01]: Step two, her appetite disappears.
[SPEAKER_01]: She eats too little, nutrition drops, and she's not strength training.
[SPEAKER_01]: Step 3.
[SPEAKER_01]: The scale goes down, but a significant portion of that weight loss is muscle.
[SPEAKER_01]: Step 4.
[SPEAKER_01]: With less muscle, her metabolism slows.
[SPEAKER_01]: Step 5.
[SPEAKER_01]: She stops the JLP1 medication.
[SPEAKER_01]: Step 6.
[SPEAKER_01]: She now has less muscle and a slower metabolism, which means she has to eat even less, just to maintain her weight, so the weight comes back easily.
[SPEAKER_01]: She's back to the same weight or higher, but with more fat and less muscle than when she started.
[SPEAKER_01]: Step 7.
[SPEAKER_01]: She blames herself in the cycle repeats.
[SPEAKER_01]: And that's what we're talking about today.
[SPEAKER_01]: And we're incredibly fortunate to have Dr. Zenchi Lue with us.
[SPEAKER_01]: Dr. Lue is a physician, anthropologist, and professor of medicine at the University of Virginia.
[SPEAKER_01]: And one of the world's leading researchers studying how GLP-1 medications affect metabolism and muscle.
[SPEAKER_01]: He has spent more than two decades studying GLP-1 long before these medications became part of the mainstream weight loss conversation.
[SPEAKER_01]: Today is going to help us understand how to use GLP1 medications the right way so you can lose weight without losing muscle or slowing your metabolism.
[SPEAKER_01]: Let's dive in.
[SPEAKER_01]: Hello.
[SPEAKER_01]: It's so fun to have you here and I've really been enjoying your work.
[SPEAKER_01]: You're such a brilliant position.
[SPEAKER_01]: We're really lucky to have you share your wisdom with us.
[SPEAKER_01]: Let's just dive right in right now.
[SPEAKER_01]: A lot of people are using GLP ones just to eat less and lose weight quickly.
[SPEAKER_01]: From what you see, what can go wrong when that's the only focus.
[SPEAKER_04]: Right, so it's, let's put that away.
[SPEAKER_04]: Wade has been, has been an issue for a lot of people and in other, in other words, saying there's a lot of people are dealing with the way to issue.
[SPEAKER_04]: And people are trying to use different modalities, including different diets.
[SPEAKER_04]: And, you know, people tend to lose some weight but they're frequent again those way to back.
[SPEAKER_04]: So you have those like a you're wearing weight loss and eventually people get frustrated and you know, you know, well.
[SPEAKER_04]: And so development of the W1 related drugs has come to the market, giving a lot of people hope, which is good, but unfortunately, a lot of people try to use it as a quick way to lose weight.
[SPEAKER_04]: Yes.
[SPEAKER_04]: and we saw the, you know, realizing that it's a medication.
[SPEAKER_04]: So when you talk about the medication, it always has a positive side on our health and also potentially negative side on our health as well.
[SPEAKER_04]: So what could the potential go wrong?
[SPEAKER_04]: Then let me just decide the warning from the American Diabetes Association.
[SPEAKER_04]: And your nutritionists, you know this quite a way is that when we don't eat, we are facing two major issues.
[SPEAKER_04]: One is, we may have issues with the administration, right?
[SPEAKER_04]: If we don't eat enough nutrients, and when we suppress our appetite, don't eat enough nutrients, so we're going to have issues with the potential of the administration.
[SPEAKER_01]: I'm so glad you brought that up just real quick.
[SPEAKER_01]: Is that, you know, they talk about ozempic face?
[SPEAKER_04]: That's a little bit different.
[SPEAKER_04]: There is a little bit different, it's because when we lose weight, right, pederate, and then we have it redundant schemes.
[SPEAKER_04]: And that's more like, you know, sort of a cosmetic appearance, but when we talk about the nutrition is more or less is, well, normally we need to eat a balanced diet with adequate ingestion of different type of nutrients.
[SPEAKER_04]: And when we drop our appetite, so not only we don't eat carbs, proteins, fat, but also other micro nutrients as well.
[SPEAKER_04]: So there's a possibility
[SPEAKER_04]: And so this is one of the major issues and another major potentially major issue that can continue to run is excessive muscle loss.
[SPEAKER_04]: Yes, I think our body and again this may have something, you know, what again this has something to do with the medication as well and the but the not that is a specific so overall if we decrease our appetite, so not taking enough nutrients, including most of the proteins, carbohydrates and the fat and we're going to lose weight.
[SPEAKER_04]: So, when we lose weight, there is one potential negative impact, is our body needs certain nutrients, particularly when you talk about our particular amino acids in order to renew our cell metabolism, to keep our cells.
[SPEAKER_04]: So the healthy and the functional.
[SPEAKER_04]: So where do we get the new, I mean, assets?
[SPEAKER_04]: If we are not eating enough, body takes from somewhere else, from our body.
[SPEAKER_04]: And then the muscle.
[SPEAKER_04]: Well, naturally, from the muscle.
[SPEAKER_04]: And most of these, the easy target, because Mosa has the most, not only, so Mosa, not only function, as a sort of, maintain our body posture, posture, and, you know, but also function as a
[SPEAKER_04]: amino acids are from our body reserve and the nature comes from the muscle so that could the potential to go wrong particularly in people who have who have reduced amino acid reserve or muscle reserve.
[SPEAKER_04]: So in people with overweight or obesity, we tend to have a lower muscle mass, right either relative muscle mass, or absolute muscle mass, or sort of reduction.
[SPEAKER_01]: We can ask a question now because with you, if you've got 50 extra pounds on you or more, don't you have extra muscle to hold that all up, though?
[SPEAKER_04]: Yes.
[SPEAKER_04]: Yes, you are absolutely right.
[SPEAKER_04]: So when you have a whole body sort of size goes up, and most of them are sort of fathomasts, but they're also also increases.
[SPEAKER_04]: But it is the one problem with that, the modern model is the number one is the relative amount is not enough to solve the actual body weight.
[SPEAKER_01]: So if what you're saying is if people are eating too little, they're gonna pull that protein, those amino acids from their muscle, and they don't have enough muscle to do that.
[SPEAKER_04]: Yes.
[SPEAKER_01]: Okay, so and and also in people who's overweight or obese and also the muscle quality is not as good so tell me more what does that mean muscle what's the muscle quality mean Isn't muscle muscle like isn't skeletal muscle skeletal muscle or is there different types of skeletal muscle
[SPEAKER_04]: Well, there were the same types.
[SPEAKER_04]: So we have one type of muscle, so mixed muscles.
[SPEAKER_04]: So the types are the same.
[SPEAKER_04]: But when we talk about quality, it's more or less we talk about a functional difference.
[SPEAKER_01]: How strong that person is?
[SPEAKER_01]: Is there any exactity if they're using their body?
[SPEAKER_01]: Well,
[SPEAKER_04]: Ray, Ray, Ray.
[SPEAKER_04]: So when we have no more muscle function, our body tend to be more, we tend to have more strength, right?
[SPEAKER_04]: We tend to have more strength.
[SPEAKER_04]: But when people with increased sort of anti-positioning of body, what happens is our body tend to store some fat in the muscle,
[SPEAKER_04]: in the muscle.
[SPEAKER_04]: In the muscle, yes, in the water, not just in the, you know, in something we call the artificial, but also in the muscle.
[SPEAKER_04]: And when you have increased the muscle, a fatty in the muscle, your muscle strength actually decreases.
[SPEAKER_04]: And the muscle tend to not respond to insulin.
[SPEAKER_04]: as well as a normal sort of non-obvious people do.
[SPEAKER_04]: And also, you know, there's some strong evidence that you're sitting in the mitochondria, which is the energy powerhouse within their cells, is functioning not up to the power of those who are trained who's healthy with our obesity.
[SPEAKER_04]: So you're talking about both quality and quantity issue.
[SPEAKER_01]: Oh gosh, that's so helpful to know.
[SPEAKER_01]: So people that are carrying extra weight, the quality of their muscle itself is poorer and the way the insulin works, it makes it worse when they're losing weight.
[SPEAKER_01]: It doesn't respond.
[SPEAKER_04]: Well, when they lose weight, well, that's further different issues.
[SPEAKER_04]: So when they lose weight, what before they lose weight?
[SPEAKER_04]: So their response to the insulin is decreased.
[SPEAKER_04]: And the function is decreased.
[SPEAKER_04]: When they lose weight, you want to sort of over-short a bit of time, they may respond better, do you in-selling, and the demonstrators may improve over-short a bit of time, but over the long run, if we have absolute muscle loss.
[SPEAKER_04]: then you kind of negate, potentially negated, those are positively effect.
[SPEAKER_04]: So that's why it's important to pay attention when you're losing weight, you're really needed to make effort to rebuild your muscle.
[SPEAKER_01]: Oh, yes, 100%.
[SPEAKER_01]: So I just want to know, our listeners, they're listening.
[SPEAKER_01]: They really want to do GLP ones the right way.
[SPEAKER_01]: And they've heard that it's important to strength train.
[SPEAKER_01]: It's important to use the muscles.
[SPEAKER_01]: So you don't lose muscle mass and you lose more fat.
[SPEAKER_01]: I'm curious, just your background with patients.
[SPEAKER_01]: Are you in more of a researching mode?
[SPEAKER_01]: Do you work one-on-one with patients as a prescribing doctor for GLP ones?
[SPEAKER_01]: way.
[SPEAKER_04]: Yes, I do.
[SPEAKER_04]: Yes.
[SPEAKER_04]: So actually I do and in the clinic when I talk to patients, I actually spend more time with patients talking about the potential of what the critical run and what what should we do about it instead of just purely tell people that you know you're going to lose weight with the medication and
[SPEAKER_04]: keep the medication for so long, but I just spend a lot of time talking about what could the potential go wrong in the particularly particularly for those people who have for the risk of alone lower body mass index and who's at risk for low muscle and particularly for those you know, elderly people and when people get in the 60s, 70s, I get a really nervous about those
[SPEAKER_04]: Yeah, I could just spend a fair amount of time talking to them on those aspects.
[SPEAKER_01]: Oh, that's so good.
[SPEAKER_01]: I'm so glad you talked to them about it.
[SPEAKER_01]: Do you?
[SPEAKER_01]: So when you talk to them, what do you emphasize?
[SPEAKER_01]: Do you emphasize strength training and resistance training?
[SPEAKER_01]: Do you make sure that they're doing it?
[SPEAKER_01]: What do you tell them to do?
[SPEAKER_01]: If someone's listening, how much exercise do they need to do?
[SPEAKER_04]: So what I usually tell people is, since suddenly I tell people how to use those medications first and to make sure people, you know, stick it to the prescription.
[SPEAKER_04]: And once that is all said, I study talking about what the people should do.
[SPEAKER_04]: First of all, when that's the lack of patience, I don't put everybody on gel period, except the agonist, you know,
[SPEAKER_04]: and for manufacturing, look at their risk for potential aggravated muscle loss and if they are at this risk, I would rather hold those medications or at least delayed treatment until things improve.
[SPEAKER_04]: Yeah.
[SPEAKER_04]: After screening, if I don't have those concerns and I would tell people to immediately start.
[SPEAKER_04]: Cup of things.
[SPEAKER_04]: Number one is make sure they're beginning a routine access program and talk about routine access program.
[SPEAKER_04]: It includes two components.
[SPEAKER_04]: Why is it a resistance training and you probably should do at least two to three times a week.
[SPEAKER_04]: Okay, at least.
[SPEAKER_04]: And the resistant training helps build muscle, make muscle stronger.
[SPEAKER_04]: But also also emphasize the utility of aerobic exercise.
[SPEAKER_04]: So we typically recommend that at least 150 minutes per week of either moderate or high intensity aerobic access
[SPEAKER_04]: aerobic access is not as effective as the resistant training in building muscle, but it actually improves our access capacity, which is really important.
[SPEAKER_04]: So this is another concept called the cardiovascular fitness, and which is independent of BMI, independent of predictor of cardiovascular
[SPEAKER_04]: whether we're old weight or we're new, if we have low cardiovascular fitness, mortality rate is much higher, you know, if you could read for the higher.
[SPEAKER_01]: So the cardiovascular fitness is very important.
[SPEAKER_01]: While it won't build muscle per se, it helps with the overall result.
[SPEAKER_01]: Yes.
[SPEAKER_04]: What part of the thing is, are people with obesity?
[SPEAKER_04]: Do you tend to have lower cardiovascular fitness from different reasons?
[SPEAKER_04]: And, you know, sort of aerobic exercise helps to improve that.
[SPEAKER_04]: So, this is an exercise I tell people to do.
[SPEAKER_04]: And also, I also want to make sure nutritionally, they are well-rounded.
[SPEAKER_01]: Well, let's talk about that.
[SPEAKER_01]: I love hearing.
[SPEAKER_01]: I love hearing about doctors talking about well-rounded nutrition.
[SPEAKER_01]: What are some?
[SPEAKER_01]: What are some of your best tips for nutrition?
[SPEAKER_01]: And how important is protein?
[SPEAKER_04]: So, so the best tip about nutrition is number one, eat a bonus of the diet.
[SPEAKER_04]: Yes.
[SPEAKER_04]: So that would include all nutrients, try not to pick one and, you know, you connect with the other and our body needs needs also of, you know, nutrients.
[SPEAKER_04]: So we eat a bonus diet.
[SPEAKER_04]: This is very important.
[SPEAKER_04]: And the number two, before we get into the specific and I always when people even if we don't have, you don't feel like you need to eat,
[SPEAKER_04]: Particularly when you're on the medication, particularly hard those super-tool-arm, and many times their appetite do tank.
[SPEAKER_04]: So people don't eat.
[SPEAKER_04]: And that could be problematic because you're not going to get a sufficient nutrients.
[SPEAKER_04]: So what's terrible?
[SPEAKER_04]: Yeah, so what I usually tell people is, even if you don't have an appetite, market-economy that eat as a specific type.
[SPEAKER_04]: You know, though you may not eat much, but at least you can take in some nutrients.
[SPEAKER_04]: So this is a kind of two types, but a specific duty nutrients, and I do emphasize sufficient amount of protein intake, and which is really important in building the muscle.
[SPEAKER_04]: Yeah.
[SPEAKER_04]: So, I mean, there are a lot of different recommendations, but on average, it's roughly between 1 to 1.5 kilogram per kilo per day.
[SPEAKER_04]: So, you're talking about maybe a roughly, I think
[SPEAKER_04]: Yes, we do today.
[SPEAKER_01]: Yes.
[SPEAKER_04]: That really helps in preventing the muscle loss because protein provides amino acids.
[SPEAKER_04]: Yes, body.
[SPEAKER_04]: And amino acids has a two very distinctive function.
[SPEAKER_04]: Why is a subuting block?
[SPEAKER_04]: you build the proteins.
[SPEAKER_04]: And the number one is number two is it actually it exterminates the amount of assets were protein building signaling cascade.
[SPEAKER_04]: So it's a building block, it initiates the whole process and when you cover the protein
[SPEAKER_04]: Yes, thank either alone question.
[SPEAKER_01]: Yes, I've heard some people say that eating protein alone can build muscle is that true.
[SPEAKER_04]: Um, it is true for shorter period of time.
[SPEAKER_04]: Okay.
[SPEAKER_04]: So you eat a muscle as I just said, it provides a building block and it stimulates the protein synthesis that cascade of process.
[SPEAKER_04]: Mm-hmm.
[SPEAKER_04]: So over short time, you can improve sort of building a build muscle mass, but over the non-run, the effect is not where studied.
[SPEAKER_01]: Okay, and I'm glad we're talking about proteins because our audience is rather sophisticated when it comes to the protein conversation and I want to just actually even grab this supplement that I have on my counter just to ask you a specific question.
[SPEAKER_01]: So the protein conversation, a lot of people know that they're supposed to eat protein and a well-balanced diet and I love that you emphasize that because we need all the nutrients, all the micronutrients, we need a healthy, balanced diet and with, with, with protein, though, how to get it people a lot of times people, especially on these GLP ones, they're not hungry.
[SPEAKER_01]: So they're under eating, so a lot of times people are taking their protein and protein powders or like protein drinks and they want to supplement proteins.
[SPEAKER_01]: So are there, let's just talk about this, what's the best protein sources?
[SPEAKER_01]: There's animal protein better than plant-based protein, let's start there.
[SPEAKER_04]: Well, I think a really depends on your perspective.
[SPEAKER_04]: Do you have some evidence suggesting planned a podium might it be better?
[SPEAKER_04]: Might.
[SPEAKER_04]: Really, might.
[SPEAKER_04]: Yeah.
[SPEAKER_04]: Might.
[SPEAKER_04]: OK.
[SPEAKER_04]: But I would personally, I would say the evidence is not as strong as it has been uttered highest.
[SPEAKER_04]: And so I usually don't recommend a specific so the protein source, but I do emphasize however the best source is a meat meat meat a meat x fish, you know, not those those type of things they have a lot of a variety of proteins and it's certainly coupled with, you know, plant proteins
[SPEAKER_04]: So I personally like to recommend that people eat every variety of different foods that include both animal and, uh, uh, uh, and applying the proteins.
[SPEAKER_04]: Uh, for people who have really really a little appetite, don't don't want to eat at all.
[SPEAKER_04]: And, uh, so those are protein supplementation, uh,
[SPEAKER_04]: I mean, it helps.
[SPEAKER_04]: So protein powder just makes sure that they either, you know, sit in the amount every day.
[SPEAKER_04]: It does help.
[SPEAKER_01]: Is it better if you, is it better to get it from real food versus a protein powder?
[SPEAKER_01]: Is it the body handle, real food proteins more than a powder?
[SPEAKER_04]: Well, not necessarily, our body should have the capability to digest the proteins, because digestive system is functioning normally.
[SPEAKER_04]: So compared to the powder, whatever protein we eat is going to digest it into small peptides or amino acids, getting absorbed, and our body uses a beauty block.
[SPEAKER_04]: But I would rather emphasize sort of the whole food, simply because of, you know, they put a make of a bonus diet.
[SPEAKER_04]: And we talk about meat or egg, other than protein, it has other nutrients as well.
[SPEAKER_01]: Yes, very much so.
[SPEAKER_01]: And so sometimes when I'm working with a client who's a vegan or vegetarian, that doesn't eat meat, they have a harder time figuring out how to get the right amount of protein.
[SPEAKER_01]: And there's there's some products out there, supplements where they're, um,
[SPEAKER_01]: There are amino acids, and like there's a brand called Perfect Aminos, and when you look at it, it shows that there's really only about two grams in the serving, but it's they say that it's because it's all the amino acids, essential amino acids that it's as if you're taking 20 grams,
[SPEAKER_04]: Great.
[SPEAKER_01]: Is that, is that true?
[SPEAKER_01]: Isn't it essential amino acid like when you're just taking looseine, lysine, trip to fan, et cetera, would, would essential amino acids translate as if you had 20 grams of protein and a meal.
[SPEAKER_04]: It's kind of yes or no question and the reason why I've said it with ambiguity here is the reason why we call it, I mean, you say to you, I mean, I say it's that our body does not have the capability.
[SPEAKER_04]: to produce those amino acids.
[SPEAKER_04]: For the long essential amino acids, the upper, the upper can synthesize them from other sources.
[SPEAKER_04]: So that's the one called essential one is called a non-essential.
[SPEAKER_04]: And when you have enough essential, I mean, as it's intake and our body can couple with other, I mean, as it's resource to make proteins.
[SPEAKER_04]: So that's the major difference.
[SPEAKER_04]: So if we don't want our body to synthesize from other sources,
[SPEAKER_04]: then take some non-essential amino acids, it's also important as well.
[SPEAKER_04]: I think the key issue actually, you know, to me, is the more or less how much do these things cost.
[SPEAKER_04]: Okay.
[SPEAKER_04]: And, you know, I, there are a lot of protein supplements over there and some, some of them may cause the people on the lake, depends on how long they take.
[SPEAKER_01]: I see.
[SPEAKER_04]: Right.
[SPEAKER_04]: And, you know, in reality, probably not, probably, you know, the effect,
[SPEAKER_04]: exaggerated to some degree.
[SPEAKER_04]: But, you know, to me personally, I would think, again, the most important thing is taking enough and abonanced.
[SPEAKER_01]: Mm-hmm.
[SPEAKER_01]: Yes.
[SPEAKER_01]: So would you, if someone's a vegan or a vegetarian, what would you recommend?
[SPEAKER_01]: Would you tell them to supplement with with essential amino acids?
[SPEAKER_04]: I would recommend the supper with a protein diet, a protein powder rather than with the essential amino acids.
[SPEAKER_01]: Okay, so you don't think it's central amino acids or that important.
[SPEAKER_01]: Well, it is important because we have to have them, right, but to supplement with them.
[SPEAKER_04]: Well, to supplement it with excessive.
[SPEAKER_04]: Oh, have.
[SPEAKER_04]: Harvard praise is not as important as eating a balanced diet with a sufficient amount of or amino acids.
[SPEAKER_01]: Right.
[SPEAKER_01]: But if they're not, if they're a vegan, like they're just eating plants all the time, it's hard to get 20 grams of protein a meal.
[SPEAKER_04]: Well, then they can just add suffix in the amount of protein from the protein powder, the plant protein.
[SPEAKER_04]: Yeah, plant or, you know what, yeah, plant protein should be fine.
[SPEAKER_01]: Yeah, and it's interesting that you said, because that's news to me that I always heard that animal-based protein was more
[SPEAKER_01]: The body worked with it better to build muscles that plant-based protein was harder to metabolize and maybe not as efficient in building muscle, and you're saying the opposite.
[SPEAKER_04]: Well, I'm not saying the opposite.
[SPEAKER_04]: What I'm saying is that evidence over the non-run, the benefit is not public base, not obvious.
[SPEAKER_04]: They're different.
[SPEAKER_04]: Okay.
[SPEAKER_04]: Yeah.
[SPEAKER_04]: So our body has, you know what?
[SPEAKER_04]: Humans kind of, they're just a system, kind of like an animal's right.
[SPEAKER_04]: And so probably it's easier to digest animal protein.
[SPEAKER_04]: And for the plant proteins,
[SPEAKER_04]: our body can also digest it, and the mind not to be as efficient as animal proteins or meat, but sometimes we take enough.
[SPEAKER_04]: So again, my point is probably, you know, sometimes you take enough that the body needs.
[SPEAKER_01]: Yes, very good.
[SPEAKER_04]: I personally, you know,
[SPEAKER_01]: Yes.
[SPEAKER_01]: A balanced diet.
[SPEAKER_01]: I agree.
[SPEAKER_01]: I'm curious, Dr. Lou.
[SPEAKER_01]: What do you think of GLP ones?
[SPEAKER_01]: Are you?
[SPEAKER_01]: Do you feel like they're good for people?
[SPEAKER_01]: I know it's not just one size fits all, but in general, are you a fan of this medication?
[SPEAKER_04]: Even from weight loss perspective, I may think of a lifestyle modification, and because it doesn't more natural way, I produce weight, and the Sydney area requires a lot of wepower to engage someone for extended period of time for exercise and diet control, but it works.
[SPEAKER_01]: Mm-hmm.
[SPEAKER_04]: Yeah.
[SPEAKER_04]: It does work and and and also the negative impact on our bodies, not as, you know, sort of potentially big as you have you weren't really the medications.
[SPEAKER_04]: And certainly, weight loss is one of the major benefits on the medication, but on the sort of above the weight loss, it's also very effective for people with diabetes.
[SPEAKER_04]: You mean, you're talking about topology diabetes in controlling their blood glucose?
[SPEAKER_04]: And you include cardiovascular outcomes in people with diabetes and potential also in people with obesity as well.
[SPEAKER_04]: So for those reasons, you know, combination of cardiovascular risk reduction, weight loss, glucose control, so I am big fan of it.
[SPEAKER_04]: And that's why I dedicated my career
[SPEAKER_04]: to understand the job you want, uh, and the job program with several to activists.
[SPEAKER_04]: That's yes, Drugs.
[SPEAKER_01]: Yes, we're grateful to you for all the research that you do.
[SPEAKER_01]: And I love that you said that.
[SPEAKER_01]: behavioral change is really important.
[SPEAKER_01]: It's an important driver in long-term weight loss.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: Do you feel like there is, in the work that I do with clients, when they're working with their doctors, I like to help them think about how to do behavioral change with the GLP-1.
[SPEAKER_01]: And often, low doses of GLP-1s were finding out here in California where people tend to be
[SPEAKER_01]: that they're even micro dosing GLP ones or taking really sometimes staying at just the first starting dose and not really going much higher letting the behavioral change and the lifestyle do most of the heavy lifting instead of just dosing up higher and higher and having all the side effects.
[SPEAKER_01]: Are you what are you seeing with that?
[SPEAKER_01]: Do you feel like a GLP one could be an
[SPEAKER_04]: I would say yes, and particularly in those people who are motivated to lose weight and, you know, if there are motivated in making behavior change, they may need
[SPEAKER_04]: So the last help from medication.
[SPEAKER_04]: So typical of what I do is I, you know, after I set people's motivation, I put people on, so they're studying those of the opioid receptor diagnosed, and I would observe for a couple of months.
[SPEAKER_04]: and depends on how they respond.
[SPEAKER_04]: If they tend to lose significant amount of weight, I keep it in the lower dose.
[SPEAKER_04]: Because the higher dose, I mean, you have high chance of potential negative impact that we just talked about, right?
[SPEAKER_04]: So keep it in the lower dose, until you know, what suddenly in people who
[SPEAKER_04]: If we need to hide those, I go up with the details, but if they don't need that, I mean, I adopted a principle as a little as a possible.
[SPEAKER_04]: I mean, you're talking about medication.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: Yes.
[SPEAKER_01]: Well, it sounds like common sense to have like the least amount, you know, the minimum effective dose.
[SPEAKER_01]: It seems like common sense.
[SPEAKER_01]: That said, it often looks like for some people that are on them, they just are advised to go higher and higher.
[SPEAKER_04]: Well, I kind of understand that part.
[SPEAKER_04]: And that's based on the clinical trial data.
[SPEAKER_04]: And so we only have certain dosages getting tested in clinical trial, right?
[SPEAKER_04]: So if like a four, four, are we going?
[SPEAKER_04]: Yeah, if we did those that tested two point of four,
[SPEAKER_04]: and getting, you know, sort of the effect than, you know, people tend to go up.
[SPEAKER_04]: And also, I think the one of the care at is we are all under the impression that including patients who are taking it and also physicians, in terms of weight loss, they're fast, they're better, you move, they're better.
[SPEAKER_01]: No, but right, do you think that?
[SPEAKER_01]: Do you think, don't you?
[SPEAKER_04]: Yeah.
[SPEAKER_04]: No, you can't do that.
[SPEAKER_04]: That was, oh, I lost the 30 puns.
[SPEAKER_04]: And that might have been too much for a person over a short period of time.
[SPEAKER_04]: Right.
[SPEAKER_04]: So it's a really, when we, when we lose weight, we need to adopt a approach that, you know, graduate approach works the best.
[SPEAKER_04]: And that's a particularly, and also, you know, sort of adequate amount, and each individual is different, and, you know, two skinny probably is not good for, for anyway, and also another problem with two fast and two, um,
[SPEAKER_04]: too much weight loss, not only is it increases the risk for muscle loss and the magnification, and once you stop the program, people tend to regain most of the weight of the back.
[SPEAKER_01]: especially if they don't change their behavior.
[SPEAKER_04]: Exactly.
[SPEAKER_04]: So that's what I always emphasize, behavior change.
[SPEAKER_01]: Yeah.
[SPEAKER_04]: We don't change your behavior.
[SPEAKER_04]: You just put people on those medications.
[SPEAKER_04]: They're happy, you know?
[SPEAKER_04]: They call you a good doctor and you're the best because a lot of 20 pounds in three months.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: And yeah.
[UNKNOWN]: Yeah.
[SPEAKER_04]: Yeah, and once you stop it, and without concurrent behavior, modification, you still not work exercise, and the iPad started coming back, and there was some study show to if that happens, without access, people actually tend to gain more fat back,
[SPEAKER_04]: then the combination of fatter and the muscle.
[SPEAKER_04]: And that's actually a part of problematic.
[SPEAKER_04]: It's a mention that that people with obesity tend to have a rather difficult muscle loss and the tend to have lower cardiovascular fitness, right?
[SPEAKER_04]: And if you gain more weight, fat back, you don't gain sufficient muscle back to support this fat.
[SPEAKER_04]: And what happened to your exercise capacity?
[SPEAKER_04]: It drops for the
[SPEAKER_04]: So that could have been problematic.
[SPEAKER_01]: Oh, yes, because then they gain the way back.
[SPEAKER_01]: And now they have less muscle and more fat.
[SPEAKER_01]: And their metabolism actually works less efficiently.
[SPEAKER_04]: It's getting worse.
[SPEAKER_01]: Yeah.
[SPEAKER_04]: You didn't want to get it worse.
[SPEAKER_01]: So that's a problem.
[SPEAKER_01]: And
[SPEAKER_01]: Do you, how do you measure muscle loss?
[SPEAKER_01]: Do you at your, in your practice?
[SPEAKER_01]: Do you do a body composition analysis?
[SPEAKER_01]: Do you do a dexa or a in body?
[SPEAKER_04]: Well, you, you, you, you, my research I do.
[SPEAKER_01]: Mm-hmm.
[SPEAKER_04]: In research program, I do a major people's body mass conversation using Dax's gang and look at their access capacity.
[SPEAKER_04]: But those are too complicated for clinical practice.
[SPEAKER_04]: There's no way you can do it in the clinical setting and we don't have it equipment and we don't have it at time to do all those things.
[SPEAKER_04]: So what are our usually emphasized to people?
[SPEAKER_04]: way the last thing important, but the strengths assessment is even more important.
[SPEAKER_04]: Okay.
[SPEAKER_04]: So I do assess people's strengths in the chronic.
[SPEAKER_04]: How much do they can walk?
[SPEAKER_04]: You're talking about a second minute of walking test, how fast can you walk their gate or the gate city.
[SPEAKER_04]: And if we're also able to sit down and stand up we're seeing 15, 30 seconds, how many sit-ups can they do?
[SPEAKER_04]: So all those can be used to assess the muscle strength for different muscle groups.
[SPEAKER_01]: I see.
[SPEAKER_01]: So you do it more without clinically when you're working one-on-one with a patient, you'll do it more as an assessment, like you just said, versus a densa.
[SPEAKER_01]: Okay.
[SPEAKER_01]: And if someone tells you that they're not working out, they're strength training and resistance training, will you stop the medication or
[SPEAKER_04]: Well, if there are other medication, our power would not stop the medication for fear of weight-reagan, and I would emphasize again the importance of exercising, and I would also emphasize even more the importance of nutrient supplement.
[SPEAKER_04]: Yes, you can turn the protein supplements.
[SPEAKER_01]: Yes.
[SPEAKER_01]: And so what I'm hearing you say is that strength training for muscle is critical and you have to be doing at least three times a week.
[SPEAKER_04]: Absolutely.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: And what ideally if someone wants to do it 100% the right way, they don't want to mess around, would you say they should be doing something every day or is there too much exercise?
[SPEAKER_01]: What would be if you could wave a magic wand and make someone do what you say?
[SPEAKER_04]: Uh, well, I would say particularly for people who get into certain age.
[SPEAKER_04]: Mm-hmm.
[SPEAKER_04]: Don't know.
[SPEAKER_04]: Don't not always say to your body.
[SPEAKER_04]: Okay.
[SPEAKER_04]: Do as much as you can because every little bit helps.
[SPEAKER_04]: Okay.
[SPEAKER_04]: And the certain people who are able and I do ask a people to do, um, uh, uh, resistant training to the three times.
[SPEAKER_04]: uh... per week and aerobic access minimum fifty five hundred fifty minutes uh... per uh... week and it's out you know too much interruption you know if you can do it every day that's even better but uh... you know we know everybody is a busy and then you know
[SPEAKER_04]: it's gonna be hard to do it every day.
[SPEAKER_04]: So it's possible, but don't overze it and it does as much as your body can tolerate.
[SPEAKER_04]: And this is a critically important for people who get it in a certain age, who are not as strong, because you don't want people to fall, you don't want the people to break their bones.
[SPEAKER_04]: And so it's kind of, you have to have a balanced assessment.
[SPEAKER_01]: Yeah, start slow, start slow and low and build.
[SPEAKER_01]: Don't jump right into something.
[SPEAKER_04]: Yeah, bit a bit bit by bit.
[SPEAKER_04]: Yeah, yeah.
[SPEAKER_01]: Yeah, okay.
[SPEAKER_01]: So, what would you say for people that are, there's a lot of people and that are relying only on the medication?
[SPEAKER_01]: What's, what's the one mistake that you see people
[SPEAKER_01]: doing with that.
[SPEAKER_01]: When they're relying only on the medication.
[SPEAKER_04]: So if people are only relying on the medication, I frequently see a two actually come and mistaken.
[SPEAKER_04]: Why is it not to make enough
[SPEAKER_04]: and encoding exercise and the nutritional sort of supplementation.
[SPEAKER_04]: And another one is people tend to use medication and stop and use and stop.
[SPEAKER_04]: And it depends, I mean, suddenly, sometimes it's harder to control because of the insurance, the issue, finance, the issue, and all different things about the act where I see a lot of people would take the medication and a stop, take the medication and a stop.
[SPEAKER_04]: And it's actually a common phenomenon
[SPEAKER_04]: particularly in elderly population, you can take it, stop it, take it, stop it.
[SPEAKER_04]: So as I just mentioned, that type of union could present with major issues with
[SPEAKER_04]: You lose weight, including muscle, and you don't do exercise or you're trying to supplement your stomach medication, you regain weight, and you're actually getting potentially more fat, the muscle, and you start your journey.
[SPEAKER_04]: So the possibility is, you know, your muscle must be continued to decrease with the other
[SPEAKER_04]: Oh, your body weight.
[SPEAKER_04]: So you actually make your body conversation even worse.
[SPEAKER_01]: Yeah, it is not what we want to do.
[SPEAKER_04]: So no, no, no, no, that's just yeah, many people are happy.
[SPEAKER_04]: It's like, oh, I lost the 30 puns that didn't stop, and then, you know, after a couple of months or a year, it's like, oh, again, that all the way to back, and then the start started medicating again.
[SPEAKER_04]: So is this type of unioning?
[SPEAKER_04]: Um, I mean, this is another really specific.
[SPEAKER_04]: to do a few more related drugs and even with other way to loss of modalities.
[SPEAKER_04]: And it happens to that as well, including purely diet induced weight loss or sometimes even with the, well, that's not much union with the bariatric surgery, but also those approach also produce a significant amount of weight loss and including muscle loss.
[SPEAKER_01]: Mm, yes.
[SPEAKER_01]: And so to end on a positive note, if someone wants to use GLP ones in the healthiest way possible, what's the one thing you'd want them to understand?
[SPEAKER_04]: If you want to use it,
[SPEAKER_04]: I would say, no, I would say, JRP1 is a related drugs.
[SPEAKER_04]: They are very effective in losing weight and that it has potential downside.
[SPEAKER_04]: And you cannot use the medication in place of lifestyle modification.
[SPEAKER_04]: I think you have to have both.
[SPEAKER_01]: your words to God.
[SPEAKER_01]: You have to have both.
[SPEAKER_01]: It's so important.
[SPEAKER_01]: And I think they could even use the opportunity to be on a jail, who wanted to change their whole life, to change their eating, their exercise, their stress.
[SPEAKER_01]: And it seems like you really are helping people with that.
[SPEAKER_04]: Yes, that's really important.
[SPEAKER_04]: That's why in the Kmanak, actually, we'll give people the prescription.
[SPEAKER_04]: I could just spend more time talking about other aspects.
[SPEAKER_01]: So important, so important.
[SPEAKER_01]: I really hope people are really taking notes and listening, this is, it's holistic.
[SPEAKER_01]: It's a behavior of change.
[SPEAKER_01]: And those are the people that get the best results.
[SPEAKER_01]: And the people that don't do that, it's pretty scary.
[SPEAKER_04]: No, it is.
[SPEAKER_04]: It is.
[SPEAKER_04]: So you have to use the, you know, sort of addiquetry.
[SPEAKER_01]: Yes.
[SPEAKER_04]: That's what we call the medications.
[SPEAKER_04]: Another term is a drugs, right?
[SPEAKER_04]: If you have positive side and also negative side, we have to weigh the benefits, what's this risk?
[SPEAKER_01]: Oh, absolutely.
[SPEAKER_01]: And Dr. Liu, I know you do so much with your research and your physician working with patients and endocrinologists.
[SPEAKER_01]: Right.
[SPEAKER_01]: You're studying so much.
[SPEAKER_01]: What are you excited about?
[SPEAKER_01]: I know this, you said this is your life's work.
[SPEAKER_01]: Tell me what's coming up for you in the next 18 months.
[SPEAKER_04]: So we actually trying to,
[SPEAKER_04]: 18 months, probably 18 months to the next five years.
[SPEAKER_04]: Yes.
[SPEAKER_04]: So, so one thing get me really excited is what I've been studying, uh, GPU one, and uh, GPU related drugs, uh, for the past 20 years, and uh, I'm so excited, the progress we have made over the past two decades.
[SPEAKER_04]: particularly in terms of the diabetes control, weight reduction, and I see the change particularly in people with the type of diabetes and the good old days that we most emphasize on glucose reduction, controlling people's glucose and everybody gets happy, but you're more and more real, real nice, how important they're on the lying
[SPEAKER_04]: in diabetes, proteogenesis, and it's complications.
[SPEAKER_04]: So by understanding those process, we might be able to, you know, do several things.
[SPEAKER_04]: Number one, maybe we can prevent the occurrence of a type of diabetes.
[SPEAKER_04]: But in terms of diabetes and management, we have really shifted
[SPEAKER_04]: shifted from purely glucose control to addressing their underlying issues, including obesity, and for the reduction in cardiovascular risk in that group of people.
[SPEAKER_04]: So those are really, really sort of exciting.
[SPEAKER_04]: And what we have been doing in our laboratory
[SPEAKER_04]: in the people who's going to develop diabetes or obesity diabetes and the hard year of year one, regulated data process, particularly in the investigator.
[SPEAKER_04]: And we actually
[SPEAKER_04]: Insan actually in the rescue nature is reduced.
[SPEAKER_04]: And that happens really, really early and that could contribute to the development of diabetes.
[SPEAKER_04]: And on the other hand, that the European one, the European one, the European one, the drugs, can slow down that a process or even reverse that process.
[SPEAKER_04]: So potentially down the road, if we understand more and no exactly wouldn't, to use it, how much do you use it?
[SPEAKER_04]: And we might even be able to use this type of medications to prevent the development of diabetes and the complications associated with diabetes.
[SPEAKER_04]: Not just simply by reducing weight.
[SPEAKER_01]: So would you be taking it that's fascinating?
[SPEAKER_01]: And I didn't realize that you've been studying JLP1s for 20 years.
[SPEAKER_01]: I knew you had been researching for a long time.
[SPEAKER_04]: Yes.
[SPEAKER_04]: That's that.
[SPEAKER_04]: You haven't done love it.
[SPEAKER_01]: I love it.
[SPEAKER_01]: I mean, you want to spend it so much fun.
[SPEAKER_01]: Well, I mean, it's wonderful.
[SPEAKER_01]: And so you've been studying these for 20 years before they became so popular.
[SPEAKER_03]: Yes.
[SPEAKER_01]: So what was that like for you having studied this your whole life and then all of a sudden Oprah's talking about it and and everybody's talking about it.
[SPEAKER_01]: I'm talking about like people like me regular people.
[SPEAKER_01]: What what was that like for you?
[SPEAKER_04]: What excited and the gratifying?
[SPEAKER_04]: Yeah, tell me more, how's it?
[SPEAKER_04]: Yeah, I think you know, excited is because we, we, we understand much better, the underlying physiology behind obesity and diabetes, behind the heart of you, one works and how this type of drug works.
[SPEAKER_04]: And this understanding actually may open the door for endless possibilities done the road.
[SPEAKER_03]: Yes.
[SPEAKER_04]: And it's certainly gratifying that's probably easy to understand whatever you did, contribute it to current and suicide.
[SPEAKER_04]: And in this course of drugs and many people are benefiting from that.
[SPEAKER_04]: You know, again, a lot of people understand the importance and the emphasize the positive side and also because I do so much in this research and this cross of drugs.
[SPEAKER_04]: So I also have a good understanding of potentially, you know, the potential negative impact.
[SPEAKER_04]: So sometimes I feel like, you know, I need to caution people.
[SPEAKER_04]: on the use of those medications.
[SPEAKER_04]: So, so, yeah, excited and gratifying.
[SPEAKER_04]: And that also also fears on response speed it is this way.
[SPEAKER_01]: Oh, sure, I appreciate their responsibility because I like to say, I think a lot of people, if not most people are doing them wrong.
[SPEAKER_01]: I mean, they're not emphasizing behavioral change.
[SPEAKER_01]: They're not doing strength training.
[SPEAKER_01]: The doctors don't have enough time to educate patients.
[SPEAKER_04]: Oh, I see a fair amount of physicians.
[SPEAKER_04]: even with the detailed examination of the patient just write a prescription salt.
[SPEAKER_04]: And you can actually get it online, your fear in a couple of questions.
[SPEAKER_04]: Online, you can have somebody to write you the prescription, which,
[SPEAKER_01]: You're made for scary it is really scary so I really is closer to the end of the podcast but I feel like we're just there's some a few more juicy things can you talk for a little bit longer?
[SPEAKER_01]: Ah absolutely okay great and I may have to grab my power cord in just a moment but I still have a little bit of juice so
[SPEAKER_01]: You're familiar with Oprah Winfrey, right?
[SPEAKER_01]: She's kind of a force of nature.
[SPEAKER_01]: She's the talk show host, Oprah, the show Oprah Winfrey.
[SPEAKER_04]: I know her, not a familiar.
[SPEAKER_01]: Okay.
[SPEAKER_01]: All right.
[SPEAKER_01]: Well, Oprah is a powerhouse and she was she, uh,
[SPEAKER_01]: is a big advocate for GLP ones.
[SPEAKER_01]: She had a lifelong battle with obesity and it played out over the media for 20 years.
[SPEAKER_01]: She was like a TV personality, a lot of people in my audience are familiar with.
[SPEAKER_01]: And she's been going on TV lately and really talking openly about how GLP ones have changed her life and how, and how, and how,
[SPEAKER_01]: obesity is a disease.
[SPEAKER_01]: And using that language, which, you know, maybe it's obesity has always been classified as a disease, that said it being spoken about today as a disease obesity is a disease.
[SPEAKER_01]: is becoming the new narrative in the zeitgeist, you're hearing that a lot and me growing up, I didn't used to hear it that way.
[SPEAKER_01]: I didn't used to hear, oh, you've got to disease.
[SPEAKER_01]: It was more like, oh, it's a willpower issue, you're lazy.
[SPEAKER_01]: There's that sort of thing.
[SPEAKER_01]: Just work harder, eat less, move more.
[SPEAKER_01]: Now they're talking about it as a disease.
[SPEAKER_01]: What do you think about that?
[SPEAKER_04]: Well, I actually believe strongly that obesity is a disease.
[SPEAKER_04]: It's a chronic recurrent disease.
[SPEAKER_04]: And I believe strongly for several reasons number one is people with obesity they tend to develop a lot of different other chronic diseases
[SPEAKER_04]: particularly in my field, you know, diabetes and the people tend to have a habitation.
[SPEAKER_04]: And so, and the certainly some, you know, join the issues and because I'm from the wait and those are, you know, sort of complications from obesity.
[SPEAKER_04]: And this is number one, number two is that you tend to, if you don't control it, you will come back.
[SPEAKER_04]: So if it's not a disease and typically you get your way down, you should stay where it is, but it's not.
[SPEAKER_04]: You don't work back.
[SPEAKER_04]: So, you know, for this, most of the for this two reasons, I personally believe it's, well, I believe strongly.
[SPEAKER_04]: that is a chronic disease.
[SPEAKER_04]: In that regard, I do agree.
[SPEAKER_04]: And once the people lose certain sort of weight, and if they can maintain other general health, improve their strengths, and people are more productive, their life is more productive and more happier.
[SPEAKER_04]: So yeah, I think it's a disease.
[SPEAKER_01]: Yes, I agree.
[SPEAKER_01]: It takes the sum of the shame out of me.
[SPEAKER_01]: So many people struggle with it.
[SPEAKER_04]: Yes, exactly.
[SPEAKER_04]: And social stigma has been a huge issue.
[SPEAKER_04]: Not only in the past, even now, it's a still issue.
[SPEAKER_04]: And this is particularly true for 14 years and for women.
[SPEAKER_04]: And it has been a lot of social problems.
[SPEAKER_01]: Yes, and that if it's a disease which it is and people are understanding that more and thanks to researchers like you have been studying this for 20 years, what it makes sense that similar to like a blood pressure medication that someone goes on and it treats their blood pressure, wouldn't it make sense that someone who has the disease of obesity is treated with a GLP1, would it make sense that they would need to be on it for the rest of their life?
[SPEAKER_01]: It's spoken that way, because it's a disease.
[SPEAKER_04]: Well, it is.
[SPEAKER_04]: It is so sort of an interest in you.
[SPEAKER_04]: You mentioned a part of the pressure, people need to be on, and they need to be on medication for the rest of the life, and for people with diabetes.
[SPEAKER_04]: and most of the new medications for the rest of their life, but however, if you can address the underlying sort of pathology or physiology, for example, for diabetes or type of diabetes, if you reduce people's weight, improve their insulin sensitivity, and many people actually can stop their medications.
[SPEAKER_04]: And they keep their glucose in a normal range.
[SPEAKER_04]: So this is what we call something diabetes remissue, which is pretty popular.
[SPEAKER_04]: And if you want, ready the drug act here.
[SPEAKER_04]: has the potential to induce that.
[SPEAKER_04]: So back to your question, whether we should keep people on DRV1, except the acronym for the rest of our life or not, and I cannot really give you a definitive answer now.
[SPEAKER_04]: I would say for people who
[SPEAKER_04]: who don't have it, we are powerful, so for example, or if they are limited, physically, they can't really access it, they have terrible joints and people just can't move around and shoot you, put them on for the rest of their life.
[SPEAKER_04]: I would say,
[SPEAKER_04]: to put it on for as long as possible, but in the mid-high, you probably should continuously to evaluate the potential negative impact on those patients.
[SPEAKER_04]: Part of the rhythm I say that is,
[SPEAKER_04]: The criminal trial, that's the fault.
[SPEAKER_04]: Their longest one is only a couple years.
[SPEAKER_04]: I forgot exactly how many years.
[SPEAKER_04]: And the less of our years, and it's put that way.
[SPEAKER_04]: And anything beyond that,
[SPEAKER_04]: What's the, you know, sort of positive was his negative balance, the benefit of risk ratio and just need to be continuously assessed, but if they do need it and the can't really exercise, I think, nutrition monitoring is extremely important.
[SPEAKER_01]: Yes, I love that you answered that so carefully and even surprisingly, I mean, I'll be candid as a nutritionist, I believe that lifestyle and behavior of change is probably the most important thing and a drug while I think they can be quite helpful for people.
[SPEAKER_01]: It makes me nervous to see people over rely on them.
[SPEAKER_01]: And as a nutritionist, I've seen people reverse or put diabetes type 2 in remission through just diet and lifestyle alone.
[SPEAKER_01]: So in my mind, it would make sense that if you could get your blood glucose and your health markers in balance, you could come off the medication.
[SPEAKER_04]: Yes, I do that.
[SPEAKER_04]: I do that.
[SPEAKER_04]: Yes, I do that.
[SPEAKER_04]: I do that in the clinic and for people with other diabetes, let's move one step forward.
[SPEAKER_04]: For people with other diabetes, simple for weight loss, right?
[SPEAKER_04]: They try to some other means other drugs and they will work.
[SPEAKER_04]: And then I put it in an idea of the one of the separate arguments, and it mean time at a while sitting in a lifestyle modification.
[SPEAKER_04]: And the science for some people, they are very motivated.
[SPEAKER_04]: And once they are, once I know they are motivated, and then I stopped, you know, as well.
[SPEAKER_04]: I kind of graduated down, when I graduated down the medication, once the rich, you know, sort of, and you go to the way to go, and then, and for, and sort of emphasize the importance of continued.
[SPEAKER_04]: lifetime modification meaning continued exercise continued watching you know what you're eating and observe the weight change you can see the weight are holding you know i don't want to stop it and you know great and continue to watch
[SPEAKER_01]: And do you see for people that like the patients you're describing the ones that are motivated, the ones that are doing the behavioral change that are eating well, that are exercising, they're now at their ideal weight, do you keep observing them?
[SPEAKER_01]: Are they able to maintain, you know, within five, ten pounds for a longer period of time?
[SPEAKER_04]: It's really in those of people who are motivated, yes.
[SPEAKER_01]: Yes, yes, it's possible.
[SPEAKER_04]: Yes, absolutely possible.
[SPEAKER_04]: Yeah.
[SPEAKER_01]: Yeah, I love that.
[SPEAKER_01]: Good.
[SPEAKER_01]: That makes me so happy.
[SPEAKER_01]: That's I'm seeing that too.
[SPEAKER_01]: And it's it's hopeful to hear researchers and physicians, you know, also talking about that because the standard of care, you'll often hear physicians just talk about that it's they're going to need to be on it for life period full stop.
[SPEAKER_04]: Yeah, I'm always
[SPEAKER_04]: Never say about taking those things for the rest of your life.
[SPEAKER_04]: Or it's a never say about that.
[SPEAKER_01]: Yeah, good, yes, behavioral change, so important, thank you.
[SPEAKER_01]: I really appreciate our conversation today, Dr. Lou.
[SPEAKER_01]: Thank you so much for sharing your wisdom with us.
[SPEAKER_01]: This is so good.
[SPEAKER_01]: Where can people find you if they wanna learn more about your work or follow where you are University of Virginia?
[SPEAKER_01]: Where do people find you?
[SPEAKER_04]: Ah, well, I think my information is everywhere.
[SPEAKER_04]: Okay, good.
[SPEAKER_04]: because I have a lot of publications, and I have my email, and also I go to, I don't use Facebook that much.
[SPEAKER_04]: I used to use Trader, and not as much as anymore, but the email, and Dick
[SPEAKER_01]: Okay, wonderful.
[SPEAKER_01]: Well, we're gonna post this podcast and we'll share your information in the show notes.
[SPEAKER_01]: Thank you so much for being here.
[SPEAKER_01]: I really appreciate you.
[SPEAKER_00]: And we'll say bye for now.
[SPEAKER_00]: Yeah, we do it.