Mocktail Minutes

Who Should Not Be On A GLP-1

• Mocktail Minutes • Episode 163

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Last week we talked about people who are potential candidates to be on a GLP1. This week we are talking about those who are not. Some of this may sound like tough love, but this is our advice from our combined experience working with our clients! Our goal is to give you help you make informed decisions. 

If you have questions, or topics that you want to hear about, head over to our Instagrams https://www.instagram.com/bayleethedietitian/ or https://www.instagram.com/brianna.dietitian/ and send us a DM! You can also follow the podcast https://www.instagram.com/mocktailminutes/


Featured Mocktails: 

BUBS naturals

Leisure Hydration 


**Disclaimer** We are not your dietitian. This info is for education only. If you would like to receive personalized nutrition guidance please speak with a dietitian personally. 

Click play, sip back, and be empowered.

Baylee

Hello, everyone. Welcome back to this week's episode of Mocktail Minutes. This is Bailey.

Brianna

And this is

Baylee

And this is Brianna. And if you're watching the video, we also have Gannon today. Can you say hi? No? Okay. It is a morning recording this week, and he just woke up, so he's not too happy about it. This week I am drinking, it's called a Leisure Hydration. I found them at Fresh Thyme. It's like an electrolyte drink. But it's only, like, 25 milligrams of sodium, 60 milligrams of potassium. It's got some vitamin C, 120, magnesium 140. It's not crazy high in a lot, but it's a good one. It also has the L-theanine in it

Brianna

I love Althena.

Baylee

Yeah

Brianna

I'm doing... I have a coffee, but I'm doing the Bubs Naturals collagen and then their MCT oil. It makes it super creamy.

Baylee

Oh, yeah

Brianna

do the MCT oil if I have coffee before food, which you shouldn't do, but

Baylee

I do like some good old MCT oil in it This week, so last week we talked about who could be a good canicate, canicate candidate for a GLP-1. This week we're talking about who does not probably need a GLP-1 at this time. And again, these are just as, just educational purposes, general recommendations. Please do not take this as, like, medical advice or anything. But we're just kinda giving you our thoughts or what we have seen with people who don't necessarily need a GLP-1. Because yeah, one of the biggest misconceptions, I would say, is that everyone who wants to lose weight should, like, be on a GLP-1, or many people are like, "Oh, I, I just wanna lose some weight," like, "I should just do a GLP-1." Where it's like, eh, it's a little bit more complicated than that. It's not that... It's not to the poor point where, like, everyone just needs a GLP-1 to lose weight. We can lose weight naturally. But as we talked about on the last episode, there are some instances where, yes, people do need a GLP-1, and there's no shame in that

Brianna

Yeah. I would say, and again, this is no judgment if you have been that person, 'cause I just feel like they're everywhere, but someone who only wants to lose a few pounds. So you're already a healthy weight,

Baylee

No book

Brianna

wanna lose maybe five to 10 pounds, like you're going on vacation, or you have a wedding, or you just have an aesthetic goal, and you don't have any weight-related issues, like no other diabetes, That's what we're calling it now, right?

Baylee

Yes, PMOS. P- I think it's like POMS, yeah

Brianna

yeah. You're just like, "Oh, I kinda wanna lose a little bit of weight." A GLP-1 is not the appropriate tool, just because these can They work very well, and they're doing a lot, and if you just have a tiny little bit you wanna lose, I don't think it's worth it to bring it on, to be completely honest

Baylee

yeah. And something like that, when I see it, if you're some- like, if you're someone who has a tiny bit, a lot of times you're usually not strength training yet, so then it's like, okay, let's just start strength training. Or you're undereating. I would say those are the two most common where it's like I just want to like... Most of the time these people are wanting to kind of like tone. They're like, "I just wanna kinda see my muscle. I wanna get rid of some puffy feelings." So then it's checking are you undereating or are you under-muscled, fixing that problem, and then, yeah, you may not need a GLP-1

Brianna

if you're not strength training, you're probably not gonna look toned.

Baylee

The whole part of, like, looking toned is you have to reduce fat. Like, that's what toning is, is just reducing fat. It's not necessarily... I don't, I wouldn't say it necessarily has to do with the muscle. It's more, yeah, you gotta reduce fat. And part of strength training is you're building muscle, which helps increase your metabolism, which helps you burn fat

Brianna

Yes.

Baylee

Kind of brings us to our next point. If you are not someone who has it established, the basic lifestyle habits, GLP-1s are gonna work best when combined with enough protein or resistance training just like movement all throughout the day, adequate sleep, the stress management. So you need to have those components in place still. If someone is already eating very little protein, not getting a lot of movement in or strategic movement, like sleeping five hours a night, drinking every weekend, then the medication may help with appetite, but it won't solve the underlying lifestyle factors that are truly affecting health there.

Brianna

Yeah.

Baylee

Just like like we talked about with supplements, like you can't GL- out GLP-1 your life.

Brianna

100%. And the issue for many people is we just have a hard time sticking to those lifestyle changes as it is. So it's like, what would happen if you just established those and stuck with them? You'd probably be a lot farther than you thought. The other, or the next one is a temporary quick fix, and I actually get this a lot. So people thinking "I'm gonna start a GLP-1, I'll lose the weight, and then I'll stop the

Baylee

Then I'll, yeah

Brianna

I'm gonna... i'll start from a good place." That is... I could see where that would be, like, a good thinking of just "Let me get to a healthy weight, and then I'll figure it out," but you're not just gonna then figure it out. So obesity is often chronic. It's a chronic disease similar to high blood pressure, diabetes, stuff like that. It took a while to get there for a lot of people, and if you significant metabolic dysfunction and you just stop taking the medication without addressing things like, how to control your appetite, what that increased food noise feels like, what's gonna happen when you have the weight regain. Because for a lot of people, they'll get on it, they will just stop feeling all those things, they'll lose a ton of weight really quickly. weight lo- or fast weight loss is not sustainable. It will come back. You will regain the weight, and everything's gonna come back with a ven- vengeance, and then you're gonna be in a worse position to establish these lifestyle changes but feeling worse about yourself because you lost the weight and then regained it. And then now you're metabolically less flexible

Baylee

Yeah, and you're not as efficient. And you start to have these, like, metabolic adaptations. And because of that appetite reduction, and you've just been eating less and less and less, your metabolism, like you said, it's almost in, like, a worse spot than what you started with. So now it's kind of like you're working overtime to help your metabolism a little bit.

Brianna

Yeah

Baylee

The next one I would say, like, someone with not a ton of food noise, and they have, like, good hunger regulation. This one's kinda tricky, but we have an episode on food noise, so if you're like, "Okay, this might be me," really... If you feel like, "Oh, this might be me," reevaluate, do I actually have food noise, or are these just normal thoughts? And so, like, if you're truly thinking about food all day, you have those constant cravings, you're always hungry, you just have that out of control feeling, that could probably lean towards food noise. If you're like, "Okay, what's gonna be for dinner 'cause I need to plan out my groceries," that I wouldn't consider, like, obsessive food noise. So understanding, like, if you truly have food noise and identifying that. And then the other part of hunger regulation I think is tricky because a lot of adults don't have great hunger regulation is what I've realized. Hunger or satiety regulation. Because, as we've always talked about, a lot of people we see now are undereating. So then you're not having those hunger hormones fire up as well. So that can be a tricky one. But in general, like, if you're like, "Oh, I need a GLP-1 because I have food noise," really consider is it actual food noise, or is it just normal thoughts to plan your day out?

Brianna

Yeah, being like, "Oh, cookies sound good," doesn't really need... you don't really need a medication for that. Duh, the cookies sound good,

Baylee

yeah

Brianna

someone with an active eating disorder. So these I don't think ever really have a place for these de- I guess, depending on the eating disorder, and depending where you're at with the eating disorder, what your care team looks like. But for sure, someone who has an eating disorder where you're actively restricting is a bad idea because you are going to restrict even more. So if you have restrictive eating patterns, the binge and purge, severe food related anxiety, we don't wanna do this 'cause they suppress appetite, and they can sometimes complicate recovery or mask unhealthy behaviors. Also, I have had someone... She wasn't working with me, but she worked with me after and then I referred her out 'cause I don't really do eating disorders, but

Baylee

Mm-hmm.

Brianna

she had the problem of still wanted to binge and emotionally eat even though I wasn't feeling hungry. That was

Baylee

Yes. Yeah

Brianna

she got very ill because she binged, and then on a GLP-1 it takes way longer to digest, and she just... she had to

Baylee

We are

Brianna

She just felt like crap. Crap 'cause So again, if you have an eating disorder, like a lot of people are like, "These are gonna be a game changer," a lot of times when we're binging and emotionally eating, it's the actual eating disorder. You don't need to feel hungry to do that.

Baylee

Mm-hmm.

Brianna

that's not how that works. So

Baylee

Yeah. That's kind of like those underlying things that we have to take care of, that GLP-1's not gonna fix an eating disorder necessarily. That has other things to do with not your GLP-1 hormones. The next thing I would say is someone who is not going to prioritize muscle preservation. The- one of the biggest concerns with using a GLP-1 is, is that rapid weight loss lose- which leads to losing muscle mass. So if someone is unwilling to eat enough protein or strength train consistently or maintain adequate nutrition even when they don't feel like it, a significant portion of that weight they lose is coming from muscle. So the goal should be fat loss, not just simply weight loss. And that can definitely just... I think that's a big thing that I tell a lot of people. I'm like, "I, honestly, if you..." Because again, people are asking this all the time, like, if you are not going to be diligent with your meals, this is where I say it can sometimes be harder when on GLP-1, but

Brianna

Yep

Baylee

have to make sure you're eating enough, and you have to make sure you're strength training to not get all these side effects that people talk about

Brianna

Yeah. hard because they're everywhere, and I think they're tempting, and people really want the, "Let me just figure it out right now, and then everything else will work out later." But I feel like it needs to be, like, mandatory. I am strength training, and I am trying to preserve muscle mass because the shortsightedness of it is gonna get you in trouble. you need your muscles and you need your bones. That, that's it. And the medications don't inherently make you lose muscle mass, that there's nothing in the GLP-1 that's just making your muscle go away. It's the not eating enough and not strength training. But

Baylee

That's not talked about a lot. It's not the GLP-1's fault, it's the under-eating, not taking care of your muscle p- p- faults

Brianna

Yeah, it's not like there's nothing in the GLP-1 that's "Oh, automatically my muscle's wasting

Baylee

Mm-hmm.

Brianna

It's the not doing the things you need to do to preserve it, which is already inherently an issue already. And again, like Bailey said, it's hard to establish those things once you start a GLP-1 because you're just like, "Oh, I don't need it." Whatever. Don't do that. the next one will be someone without excess body fat or metabolic disease. So again, someone that's already like a healthy body composition, has normal blood sugar regulation, functions well physically, maybe doesn't have a lot of inflammation.

Baylee

And this, I feel like it seems obvious, but I think with a lot of things, when you hear about how good people are feeling on a GLP-1, you're like, "Oh, do I need this?"

Brianna

Yeah. Yeah

Baylee

But maybe you don't. Maybe it's, again, like, okay, we're at a healthy weight, we're at a healthy body composition, all these things. We just feel a little low energy. Maybe that's just because you're doing the undereating side of things. So there can be other reasons. So I think that that's a big thing with this, quote-unquote, person, is if you don't have these, you don't need a GLP-1, which seems obvious, but a lot of times we just want the thing that everyone's talking about that makes you feel good

Brianna

Yeah. And I think that is a lot of what's going around is like, "I just feel great. It managed my inflammation." Inflammation is a buzzword still. A lot of people do feel really good with inflammation, and I think that's how a lot of this started out was there was like a not a like a lot of functional doctors and naturopathic practitioners that were using it for kinda like pain management, like the microdosing pain management, 'cause it does help with inflammation. When I see people that are using it and it's just to lose the one or two pounds or feel good or look more cut, my first thought is, you probably could have done that. You probably could have decreased alcohol a little bit or cut something out of your diet or done something else to look and feel that way. And also, it's kinda putting people in this like perpetual "I just look super cut all the time," which that's not how that works either.

Baylee

Yeah. And then,

Brianna

It's just not. You're

Baylee

mm-hmm

Brianna

Look like that all the time.

Baylee

Yep. And I have a few people that are at, like, a pretty... Like, they're not considered obese. They're at a generally healthy body weight, but showing shi- so- showing signs of some inflammation and insulin resistance. So they microdosed. We didn't change anything. It was someone who had already established, like, the four-strength training. She was doing tracking her macros. Like, all the things were adding up. We added the GLP-1, and she did see that inflammation come down, and her blood sugars looked a lot better. And so that was someone who just needed a little help while doing the thing. So there's definitely some caveats to that. But I think, again, it's that specific person and really making sure, and you're being honest, that you're doing the things

Brianna

Cause I feel like it's one of those things right now where it's like everyone could benefit,

Baylee

Yeah.

Brianna

It'll just make you feel good. Everyone's "Should I be on it? Wait, I wanna feel good." Like

Baylee

Yeah. No, and that's definitely something, like, I've even, like, thought about. I'm like, oh, 'cause like when microdosing came out, I was like, "Oh, this is kind of cool," like inflammation. But then I'm like, I don't have a lot of inflammation. Like, I'm just, like, gaslighting myself that I need a GLP-1 microdose because, like, people talk about how great they feel. I'm like, okay, I also could just, like, make sure I'm eating enough carbs, which I wasn't, so problem solved there

Brianna

Also too, a lot of these people do get money from this, and I'm not saying they're not doing them, they probably are, but like a lot of people are partnering up with companies where they do get a cut from getting other people to be on. So it's like you always kinda have to also look at are these people benefiting at all financially from me? 'Cause if they are, of course they're gonna be online being like, "I feel so good. This is night and day difference."

Baylee

Yeah

Brianna

Is it night and day different? Okay. Be careful.

Baylee

So yeah, I would say those are kind of like the main things we think about of, like, who does not need to be on a GLP-1 and why. The other things you can do is just getting a little bit of an evaluation with some labs to see, okay, deeper picture, like would I benefit from a lower dose? Like, you're kind of on the edge, like, okay, I do have 30-plus pounds to lose. I am feeling inflamed. I'm feeling puffy. I might have some insulin resistance. You could also do some labs to just create your picture in a little bit better way. So like like looking at your glucose metabolism, getting a fasting glucose to show your current blood sugar levels in the morning. This can also be normal even when insulin resistanc- insulin resistance is present, so also testing your fasting insulin. This is one of the most useful markers of identifying early insulin resistance, and this is often elevated, like, years before that glucose becomes abnormal. So this is one I really like to get, is that insulin. So there is a difference between the insulin and the glucose. And then A1C, this is gonna reflect your average blood sugar over the past two to three months. So this often helps identify prediabetes and diabetes as well. So having all three of these can provide just a much better picture than just getting a fasting glucose. A lot of times we get that, and it's like, okay, glucose is normal, everything might be fine, but then I've seen glucose A1C be good and then insulin be very elevated.

Brianna

There's also the HOMA-IR, which we can order these tests for a lot of people, especially through Nourish. When we work through

Baylee

Yeah

Brianna

they cover labs 'cause they're trying to get, insurance companies to see hey, the more labs that you cover,

Baylee

Mm-hmm.

Brianna

people are, like, the more they know. But this is gonna take your fasting glucose, your insulin, and your A1C, and it's basically complicated, equation to see, like, how are they working together? Yes, like, how well is your body listening to that insulin that it has? So it's another really good one to kinda test for insulin resistance despite normal glucose. So I like to get the HOMA-IR and the fasting insulin just because every- and the f- glucose and the A1C. Everything is just... 'Cause remember, labs are like a snapshot,

Baylee

Yeah

Brianna

Some of them give us a deeper picture than others, but it's kinda... No, because then you can kinda sit there and, you may be one of those people that are like, "I feel like I'm doing the things that they're saying. I feel like I'm really good with my sleep and my strength training and my steps, and I'm, like, balancing my plate." Maybe you do have something that's making it harder to lose weight, and I feel like that's being talked about more. But the biggest argument is always you're not in a calorie deficit. But my whole thing is what the heck does a calorie deficit mean for someone? Because it's not always as simple as I calculated it and I'm in a deficit, but I'm not losing weight. Sure, it is about a calorie deficit, but not everybody can apply that to themselves. And see if you do have some sort of metabolic dys- dysfunction, we don't have a way of looking inside and being like, "This is how well your body is utilizing calories," clearly.

Baylee

That'd be nice.

Brianna

It's, 'cause I've known plenty of women who I know are, like, tracking every single thing they eat, and I'm, like, just as dumbfounded with them. I don't know. It looks like you're in a calorie deficit.

Baylee

Yeah

Brianna

Metabolic dysfunction, you are gonna have a harder time. You're utilizing nutrients different. So labs can be helpful to see am I one of those people?

Baylee

Mm-hmm. Yeah, I would say getting those, just having all three, well, I guess four of those, that can be helpful just to get that better picture of your glucose metabolism. Inflammation markers like HSCRP, so your high sensitivity C-reactive protein. This can also provide some insight to chronic, just, like, low-grade inflammation, which is... But it's also usually elevated with obesity, insulin resistance, and cardiovascular disease. So is it great? I would say no. But it does tell us, like, oh, okay, how bad is the inflama- inflammation? How high are the numbers? It can just give us a little bit more insight. And then of course, I think a thyroid panel. Like, a full thyroid panel, not just a TSH. Weight gain is rarely caused entirely by thyroid dysfunction, but thyroid health should still be assessed because it is part of the, part of the equation And so having, yeah, like the TSH plus T3, T4, TPO antibodies, all of the above. Maybe we should do an episode on like a thyroid panel.

Brianna

I think that would be a good

Baylee

Sure.

Brianna

especially because I feel like that's kinda changing a little bit, too. So again, just like the range for an- fasting insulin is really big, so is it for your certain thyroid markers, where now we're seeing, oh, we start treating underactive thyroid a lot sooner than we would have. And the reality is, it's we've had a chronic thyroid markers being less than optimal.

Baylee

Mm-hmm.

Brianna

is much harder to lose weight. And I feel like a lot of people are now feeling like, "Oh, I don't feel so gaslit." Wow, cool.

Baylee

Yes.

Brianna

Yeah. Clearly, there is an issue as to why so many people are overweight and have such a hard time losing weight. Of course, it's always gonna be lifestyle factors and the fact that we're not taught how to eat or how to move or how to sleep, then we don't really have a world that helps to support that. But then also, we let a lot of these metabolic markers go, tell us give us little warning signs for a long time until we're just messed up. And then of course, it's like now you're really working uphill, and you don't have the tools to help yourself

Baylee

Yeah, I would say s- so, like, labs, insulin, glucose, A1C, homoir, lipid panel, liver enzymes, full thyroid panel. Those would be good ones to get to help reveal if there's insulin resistance, pre-diabetes, fatty liver, inflammation, thyroid dysfunction to all which can make fat loss more difficult. But they're also... That's just still one piece of the puzzle. There are-- We still wanna assess, like, the level of food noise, the hunger and satiety cues, weight and dieting history, sleep quality, stress, activity, body composition. These are all things that we would consider as well. So overall, kind of thinking, like, when you're asking this question of who does, who does not need a GLP-1, rather even just thinking in the simplicity of, like, can this person lose weight? Thinking more is excess body fat causing health problems and is their biology making weight management diffi- more difficult despite their efforts? If the answer is yes, then yeah, GLP-1 may be appropriate. If it's no, then lifestyle interventions are often gonna be a better first choice

Brianna

And I always tell people, too, you're only gonna benefit from lifestyle changes. That's it. Even if you do end up having to bring a GLP-1 on later, you are only gonna benefit from doing the lifestyle changes, and I would argue that if you don't have the lifestyle changes, you are not gonna get the most benefit out of this tool. You're just not. It's gonna be a waste of time. could be a waste of money, and eventually, the weight will likely come back, and you could be in a worse place than you started, depending. But

Baylee

Mm-hmm.

Brianna

yes. But generally, you do not need a GLP-1 if you only have a very small amount of weight you wanna lose, you're getting ready for some sort of vacation or something coming up, you have healthy hunger and satiety cues, you don't have any weight-related conditions, you have not attempted sustainable lifestyle changes, and you're just looking to put the cart before the horse

Baylee

Yes. We hope this episode was helpful just to give you better insight as to if you... I hope everyone can hear my son sneeze.

Brianna

It's a pretty low screen, though. a pretty chill screen

Baylee

But yes, we hope this episode just helps give you better insight to who does, who does not need a GLP-1. We're truly just trying to share these things to help you make decisions or have these conversations with your providers, with just some things that we've noticed with working s- with so many weight loss patients. So yeah, let us know if you have any other questions pop up about GLP-1s, and we'll be back next week with a brand new episode.

Brianna

Bye

Baylee

Bye. No

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