Weight Health, GLP-1s, and the Gut Connection - Ashley Koff RD on Metabolic Health, Food Noise & Hormones

What if weight loss has never been the right goal in the first place? In this episode, Dr. Taz sits down with registered dietitian Ashley Koff, RD, author of Your Best Shot, to unpack why the conversation around GLP-1 medications is much bigger than Ozempic, Wegovy, or tirzepatide alone.

This episode reframes the entire GLP-1 conversation by shifting away from weight loss as the goal and toward what Ashley Koff calls “weight health.” Instead of treating Ozempic, Wegovy, tirzepatide, and related medications as magic fixes or villains, the conversation explores the deeper hormonal ecosystem behind appetite, blood sugar, digestion, inflammation, body composition, and metabolic health.

Ashley explains that GLP-1 and GIP are part of a larger family of peptide hormones made in the gut lining, and that when this system is disrupted by poor digestion, stress, gut lining damage, nutrient insufficiency, dehydration, medications, or microbiome imbalance, the body’s weight regulation becomes suboptimal. She argues that many people are not failing at weight loss. Their body simply does not have what it needs to function optimally.

If you’re dealing with weight changes, food noise, metabolic dysfunction, or feeling like your body is not responding the way it should, and want deeper, root-cause support, join the Circle here:
 👉 https://holplus.co/circle

Weight is not just about calories in and calories out. It is deeply tied to gut health, digestion, blood sugar, inflammation, hydration, stress, hormones, and how well your body is actually functioning beneath the surface.

Learn more about support related to this conversation:
Metabolic Health & Weight Support: https://holplus.co/glp1-and-peptides
Digestive Health: https://holplus.co/conditions/digestive-health

Dr. Taz and Ashley also discuss when GLP-1 medications may be useful, why low dose use is often misunderstood as “microdosing,” the importance of preserving muscle and digestion while using these medications, and why a truly personalized, holistic plan matters far more than chasing a number on the scale. 

If you’ve ever felt frustrated by belly fat, food noise, weight regain, or confusing lab results that say everything is “fine” when you know it’s not, this episode will help you understand what may actually be going on.

In this episode, we cover:

•  Weight loss is not the same as weight health, and focusing only on the scale can be misleading 
•  GLP-1 and GIP are gut-derived peptide hormones that act like signaling switches in a broader metabolic ecosystem 
•  Poor digestion, gut lining damage, stress, dehydration, and nutrient deficiencies can all impair natural GLP-1 function 
•  Many “normal” labs miss early signs of suboptimal metabolic health 
•  GLP-1 medications can be helpful, but they need to be part of a personalized, holistic strategy 
•  Low dose GLP-1 use is often mislabeled as microdosing, even though true microdosing is something different 
•  Preserving muscle, digestion, sleep, and hormone balance matters just as much as reducing appetite 

This is not just about losing weight. It is about understanding your body, improving metabolic function, and building a healthier, more personalized foundation for long-term well-being.\

About The Guest:
Ashley Koff, RD is a registered dietitian with more than 25 years of clinical experience and the author of Your Best Shot. She is known for her work in metabolic health, nutrition, and personalized wellness, with a focus on helping people understand the deeper root causes behind weight, digestion, and hormone-related challenges.

About Dr. Taz:
Dr. Tasneem Bhatia (Dr. Taz) is a triple board-certified integrative medicine physician,
bestselling author, and founder of hol+ a multi-location integrative medicine practice.
Learn more: https://doctortaz.com/about

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Host & Production Team

Host: Dr. Taz; Produced by ClipGrowth.com (Producer: Pat Gostek)

Chapters
00:00 Why weight loss may be the wrong goal
02:00 Introducing Ashley Koff and the idea of weight health
03:00 How Ashley got into the GLP-1 space
04:20 What the incretin effect really means
05:15 How gut hormones regulate the body
08:30 Where GLP-1 hormones are made and how they work
09:45 What happens when the signaling system breaks down
13:30 Why natural GLP-1 function becomes suboptimal
15:00 Gut lining damage, digestion, and modern life
16:40 The vagus nerve, stress, and metabolic signaling
19:00 Stress, cortisol, and early warning signs
22:00 Digestive clues your body may be struggling
25:25 Why GLP-1 medications are everywhere right now
30:00 Weight health vs. weight loss
34:35 What to track instead of total body weight
40:30 The truth about metabolic health markers
46:40 Where GLP-1 medications can help
49:00 Side effects, digestion, and appetite suppression
50:40 Low dose vs. true microdosing
53:30 Why GLP-1s need a holistic plan
55:30 Insurance, responsibility, and the broken system
59:30 Ashley’s message from Your Best Shot
01:01:00 The future of GLP-1 and new medications
01:03:10 Creating generational weight health

Creators and Guests

Host

Dr. Taz Bhatia MD

Dr. Taz Bhatia is a triple-board-certified integrative medicine physician and founder of hol+, where she brings together science, spirit and the human experience to deliver holistic, whole-person care.

Producer

Pat Gostek

Founder of ClipGrowth.com - End-to-End YouTube, Podcast & Clips Management (you just record).

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