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Live Lead Last is a weekly podcast hosted by leadership coach, nonprofit director, and entrepreneur James Duvall. Designed for growth-minded leaders, this show helps you live by design, lead with purpose, and leave a legacy that lasts.
Through honest conversations, practical tools, and real-life stories, James equips leaders to develop strong roots, sustainable influence, and lasting impact — both personally and professionally. Whether you're leading a team, a business, a ministry, or a family, this podcast will help you become the kind of leader others want to follow.
Paul Kolodzik
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Paul: [00:00:00] But really what we see day in and day out, the bread and butter of emergency medicine. Is people with metabolic diseases, you know, obesity and the musculoskeletal issues that go along with that. And especially issues related to blood sugar physiology. Be because, you know, 30% of American adults are CRE diabetic and other 12% are actually diabetic. And of course that leads to all the problems that we see in the emergency departments from peripheral vascular disease to kidney failure. To true diabetic emergencies and then the blood vessel issues or the vascular issues associated with high blood sugar lead to, of course heart attacks and strokes.
James: Welcome to the [00:01:00] Lively last podcast, where we help you live with intention, lead with integrity, and leave a lasting impact. I'm your host, James Deval, and I'm so glad you're here today. Before we dive in, I wanna remind you again about the lively last five day leadership reset. It's a free, practical way to recenter your leadership identity, reignite your purpose, and get re anchored in what really matters You'll walk away with clarity, renewed energy, and a plan to lead from a deeper place of alignment. So head over to live lead last.com/reset and get started today. Today's conversation is one that matters for every leader because if you don't manage your energy, your body will eventually manage it for you.
We're talking about metabolic health, weight loss, and the overlooked connection between physical resilience and sustained leadership performance. With more than 30% of American adults now classified as pre-diabetic, many without knowing it, this isn't just a personal health issue, it's a leadership one.
The decisions you [00:02:00] make in your kitchen, your calendar, and your coping patterns impact your influence, your longevity, and your legacy. My guest today is Dr. Paul Kloza, a board certified physician in both preventative and emergency medicine. After decades in the ER treating crisis after crisis, many of them avoidable, he now helps leaders prevent disease before it starts in his private metabolic health practice.
Dr. Klok Uses continuous glucose monitoring CGM and strategic use of GLP one medications to help people lose weight, reverse chronic conditions, and regain control of their health without creating a lifetime dependency on drugs.
He's also the author of the Continuous Glucose Monitoring Revolution, where he lays out a clear Datadriven path to better health through lifestyle and smart tech. This is a conversation every leader should hear because your health is not a side hustle. It's the infrastructure for everything else.
so. Let's get into [00:03:00] it.
Paul, it's so great to have you on the Lively last podcast. Thank you so much for taking some time today to be with us.
Paul: The pleasure to be here, James.
James: Yeah, well just getting to know you a little bit before this conversation. Know we both have some Ohio roots. I won't hold it against you that you don't cheer for Ohio State, but That's okay.
I get it. So.
Paul: So, so just so everybody knows where we're coming from, we both grew up in Columbus, Ohio. So James expected me to be a Buckeye, but I went to school in South Bend and of course the Buckeyes hammered
James: Yeah, that is true.
Paul: know, earlier this year for the national championship, but, we're, we're we're, we're, we're coming back.
so I'll tell you, I've gone to every Ohio State Notre Dame game over the last 25 years, and we're like, oh and six against the Buckeyes, so,
James: That had to be hard though, like living outside of Columbus and you know, your teams playing and the place you live is winning, so that's.
Paul: Yeah. I mean, last year I'm proud of 'em. I'm just [00:04:00] happy where they got and, and you know, that's, that's actually, we could do a
James: I know we could, I I could go football and talk about Freeman and all that stuff. Right. Well, let's talk about you. So you started out in emergency medicine and now are in the metabolic health world. So talk to us a little bit about how you describe your work
Paul: well, I'm, I'm a career emergency physician. Actually, I, I'm still working five days a week at the Veteran's Hospital here in Dayton. Just 'cause I, it's hard to give it up. I enjoy doing it. If, if I'm only working a handful of days a month, it, it's really not that good. If I said a week, I'm in a month. But it's the metabolic health practice kind of grew out of that experience. Seeing people in the emergency department, you know, over the years that, that are having crises that could have been easily prevented. And what's get gets all depressed in the emergency department is the overdoses and, you know, the multiple traumas and the [00:05:00] assaults.
But really what we see day in and day out, the bread and butter of emergency medicine. Is people with metabolic diseases, you know, obesity and the musculoskeletal issues that go along with that. And especially issues related to blood sugar physiology. Be because, you know, 30% of American adults are CRE diabetic and other 12% are actually diabetic. And of course that leads to all the problems that we see in the emergency departments from peripheral vascular disease to kidney failure. To true diabetic emergencies and then the blood vessel issues or the vascular issues associated with high blood sugar lead to, of course heart attacks and strokes. So in terms of setting up my own private practice to help people address obesity and metabolic health issues grew out in that experience in the emergency department. You know, I've worked with a lot of people now over the course of the [00:06:00] last seven. Eight years in the metabolic health clinic and we've been able to reverse a lot of chronic conditions and, you know, have people move down a road so that they can avoid those problems.
James: That's awesome. Can you take a moment and just from your perspective, philosophy define metabolic health and. Why does it matter? In framing it in today's conversation?
Paul: So yeah, the word metabolic health, it can be a little bit confusing, There's a syndrome called metabolic syndrome, which is a combination of being overweight, problems with blood sugar, physiology, and then issues with cholesterol, hypertension, and then a variety of other problems go along with that, like fatty liver disease and sleep apnea. And so really when we focus on metabolic health, it's an effort. To reduce the, the risk associated with those issues and it really drills down. You know, I don't want to oversimplify, but quite honestly, I think it's helpful at times to simplify things to, to [00:07:00] making sure your blood sugar physiology is in order.
And that's why, you know, I think the continuous glucose monitors can be so valuable. I'm gonna give you a little bit of historical perspective. Some of this is opinion. I think most of it is fact. But, you know, in the 19 seventies when we were both back in the Columbus, Ohio area you know, the food pyramid came out and we were cold overnight to move our diet from a diet that was about 50% fat and 25% carbohydrates, the other 25% being protein.
And we were told overnight. Cholesterol was public enemy number one, and that we had to decrease our fat intake. So really in a short span, less than a decade our diets, we, we dropped that fat percentage in our diet to 25%, and the carbs the place of the 50% fat that was there before. So now an American diet is [00:08:00] primarily 25% fat, 50% carbs, and then the remainder protein. I think unmistakably. What happened when that happened is the obesity epidemic took off a few years after that and, and then the diabetic, epidemic took off just after that as well. So I personally believe it's unmistakable that there's a relationship between our increased carb intake what happened there?
I the, the cholesterol. most people, this is not everybody. I believe cholesterol could be an issue. It's not that I'm a non-believer in cholesterol, but from what I've seen, I believe that the majority of people should focus on blood glucose physiology and, and maybe not cholesterol as much.
And, and there's a natural tension there between the two because if you go lower carb to keep your blood sugar in order, your diet's gonna be higher in fat. That's [00:09:00] just. The, the way it works, and hopefully you're getting adequate protein and I talk with my patients about good fats and bad fats, but, but I think you, you know, the majority of this metabolic syndrome problem drills down to blood sugar physiology.
And that's why I've made education related to that and, and the management of that, a central tenant of my practice.
James: Yeah, because you can probably educate me on this, but. I think sometimes cholesterol gets a really bad name, but it's actually part of our physiology and it's actually important. So if you tamp it down or you know, if you don't have healthy levels of it, right, so it actually works for our health, right.
Paul: right. I mean, only 20% of cholesterol levels are controllable by die. And 80% is manufactured in your liver and you really can't do anything about that. Again, with 30% of Americans being pre-diabetic, half those people that are pre-diabetic don't know [00:10:00] they're pre-diabetic. I see 'em a new patient every week in my practice that doesn't know they're pre-diabetic as we've had this de-emphasis on blood sugar. you, you know, I think this is just a bigger threat for most people. terms of their long-term health. And you, you know, both cholesterol and blood sugar can contribute to vascular issues, which is really the, the ultimate damage that can be done when blood vessels in your heart and your brain and your liver and your kidneys are affected, by inflammation of the arteries.
But really, I think it's blood sugar that is the primary insulting event. And then cholesterol comes in and plays a role as well.
James: Okay, well, I've been looking for this conversation because if you turn on the tv, there's all sorts of commercials for, devices and GLP one, which we're gonna talk a little bit about later. But, let's start with continuous glucose monitor technology. So for someone who's completely unfamiliar with CGMs.
can you talk a little bit about how they work [00:11:00] and the breakthrough for weight loss and me metabolic health?
Paul: So CGMs are those devices you've probably seen on the back of the arms of diabetics, and they originally were utilized to help people manage insulin. So in other words, what's my blood sugar at the moment? How much insulin do I need to pay? Great, great tools to make people aware of what's going on with their blood sugar fi physiology.
And I'm, I'm gonna digress for a second because I think what's happened in American medicine is this gets deemphasized, you know, when I got outta my residency docs were still in their own little practices and, you know, have this relationship with their patients and, and now. I'm, you know, most physicians are health system employees and their schedule's vary regimented.
They get 20 minutes or whatever with a patient, they really don't have time at times to address the issues they want with their patients. I think the can gets kicked down the road at times related to blood glucose [00:12:00] physiology that is that, you know, you know, your blood sugars during your annual visit or semi-annual visit, oh, your blood sugar's a little bit high.
We should keep an eye on that. We'll check it next time. When, when really, in my mind, that's ba basically what the doc is saying. You are either pre-diabetic or you're close to being pre-diabetic, and, and that's the time where I think lights and sirens should be going off because that's the time to intervene. Because if you're pre-diabetic, you can avoid progressing to diabetes, never become diabetic if you do something about it. And that's where CGMs come in. We'll talk about technically how they work, but, but basically way I use them is I put 'em on the back of the arm of patients. Any patient, overweight patient, maybe a patient's told there's blood sugar's a little bit high. And just tell them to eat a normal diet for a couple weeks. And because you get then graphic readings of where your blood sugar is 24 7. You can see how everything your, you eat, [00:13:00] your activity, your sleep affects what's going on with your blood sugar physiology. And that's an eye-opener for some people.
So people that come to me primarily for. You know, I wanna lose 20 pounds and up realizing there are much, much bigger issues that need to be addressed. And the way more than one patient has put it in terms of seeing the grafts and there are 24 7 blood sugar readings because of the CGM is, once I've seen it, I can't unsee it. I ruin a lot of people for eating donuts and pizza be because, you know, once you have that experience. It's quite honestly hard to go back. I mean, it doesn't mean you're never gonna have a piece of pizza or you, you know, you aren't gonna have a donut or a pizza cake, but you're gonna have the knowledge in the back of your mind of really what's going on there.
And just briefly about the technology. So the CGMs put a little sensor under the skin. The sensor connects to your smartphone. for [00:14:00] two weeks, the sensors last two weeks. For two weeks you get 24 7 readings of what's going on with your blood sugar. So you can see exactly what, what is happening, what the issues may or may not be, and then how to address it.
And when I first started using CGMs, they required a prescription. Now they're available over the counter for anybody that wants one. They're about 50 bucks for a two week CGM. And I think just about anybody would benefit from. At least an initial use to see what's going on.
James: That's incredible. When you're talking about pre-diabetic, diabetic, you know, I'm an avid cyclist. I, you know, try to do 70 to a hundred. Miles every week and, and, you know, pretty good shape, you know. But you know, when I started getting a little bit older, I thought, you know, I'm gonna go see a functional doctor and actually get a full blood panel, which obvi doesn't happen in, you know, most primary care facilities.
And I was pre-diabetic, my blood sugar was high, insulin [00:15:00] resistant and so forth. And Obviously I could lose some weight, but I wasn't like obese, but really I was kind of a, a fat, skinny person so doing some protocols, I didn't do the glucose monitor, but doing some other protocols, starting to exercise and so forth, I was able to see, I my, you know, every time I did my blood work, those levels go down to where I was no longer pre-diabetic.
So You have to have the knowledge, right? You have to have the
know what's going on, and so many people don't. They're just eating what's there and not realizing that they're actually potentially killing themselves and what they're eating, right?
Paul: Right. I mean, and that's what a CGM is. It's
James: Mm-hmm.
Paul: Data is power. So you, you know, that's then get the information and they can decide what they want to do with it. And I have some people that put on CGMs and they've got relatively flat purrs. You, know, and they aren't that enthralled with it, but I have a lot of people that see these spikes and drops. That, you know, want to use them intermittently [00:16:00] going forward. And I actually have people that never want to be without a CGM on their arm again because they use it to guide their diet and, and to guide their lying. Can I give you a little bit of my perspective of the physiology
James: Yeah.
Paul: on here with the blood sugars and with, with that historical background of the food pyramid?
Just briefly. Okay. So the majority of patients that come to me most of them want to lose weight. all of them want to be in better health. There again is this gentle tension. With their diet regarding how much, how many carbohydrates, how much fat, and how much protein. But I think the original issues that have arose related to the food pyramid. Relates to the fact that, you know higher carb diet over the course of the last 50 years and now 60% of the food we eat is processed. And when you think processed food, you know, you don't have to get real complicated about if there are chemicals in there or dies and stuff that obviously can, [00:17:00] are getting a lot of press these days and an are an issue, but a processed food in my mind is basically a refined grain. And they're refined. That means, you know, it's basically ground flour. They're refined that way because they have a long health life. That's the whole reason for refining grains. 'cause you know, they can sit on a grocery store for months as opposed to, you know, a few days. They have seed oils in them, which are very inflammatory.
We were all told to avoid. We, we went toward margarine. Margarine is the seed oil, corn oil, safflower oil, sunflower oils, our inflammatory oils, and then of course sugar. And, and so 60% of the food we eat now is, is processed food. So a lot of what I like to do is just open people's eyes related to their diet. So the physiology then is, you know, you, you eat a carb. A carb instantly in your system be becomes blood sugar. People don't realize that, you know, [00:18:00] you know, with pasta, with potatoes, with bread, it becomes blood sugar. It's not sugar initially that gets absorbed directly, but it is broken down into the gut and absorbed the sugar. When you eat those carbohydrates, your blood sugar rises, the pancreas releases insulin. So far so good. That's what is supposed to happen. And insulin is the key in the lock to force that blood sugar into your organs. And when I say organs, think about your muscles. Okay? So, so far, so good. You know, our, our muscles need energy to contract on those long bike rides, you're gonna
James: Yeah.
Paul: and need energy.
What happens though is that if the blood sugar remains high for a long period of time, as I think it has in, in a majority of Americans higher than it would've been otherwise then, then those organs end up having all the energy they need. So they've already absorbed a lot of blood glucose.
There's a lot of blood glucose in the environment. They have [00:19:00] stored energy in the form of a complex blood glucose molecule called glycogen. Within the, the organ, the muscle organ itself. And so the organs then start resisting the signal from insulin. So you've heard the term insulin resistance. what insulin resistance is.
The organs are resisting that signal, basically saying, insulin, we aren't gonna listen to you anymore. We got all the energy we need. We don't need to take in this extra blood sugar. And then, because if the blood sugar would rise too much, it becomes toxic. That extra blood sugar goes to the liver and gets converted to fat. Then deposit around the middle. And that's why, that's the reason for the majority of American obesity. Some of that fat will stay in the liver. And that's what fatty liver disease is. So, which one in five Americans has now to fatty liver disease is a little bit of a misnomer because you think, well, fatty liver disease, that's gotta be from me eating too much fat. It's [00:20:00] not, it's from the blood. For the majority of people, it's from the blood sugar being up. For a period of time and those blood, that blood sugar getting converted to fat in the liver. So that's the basic physiology and for most of my patients, I recommend a low carb diet. You know, again, we watch the fats.
We, we, we talk about good fats and bad fats, but we lower the carbohydrate intake and that process reverses those organs, those muscles. Instead of saying, we have too much energy, they start looking around for another source of energy. The blood sugar has been relatively lowered. They aren't used to that, so where are they gonna get energy? And of course, it's all, it's around the middle. It's that fat that we all have, that visceral fat that we all have around the middle. They got build up with excess carbohydrates and now with lower carbohydrates, that path starts getting broken down and serving as a, serving as a source of energy. That's when blood sugar gets stabilized and, and people lose weight.
If you do that aggressively with the breakdown of pat, you get [00:21:00] ketones. That's where the term keto diet comes from. kind of in a nutshell that kind of
James: Yeah.
Paul: in terms of helping people reverse their metabolic syndrome.
James: Yeah, it's so fascinating. Going back to even the idea of processed food because business leaders, entrepreneurs, creators are going so fast paced, a lot of travel maybe, and it's easy to live on processed food. I was surprised a couple weeks ago I was at an event and they were handing out beef sticks, beef jerk jerky sticks package.
And you know, there's some I use like chomps and so forth, which is pretty clean. But this one, I was, I was looking at the ingredients 'cause I've been on this kind of seed oil, like trying to eliminate from my. And the thing was made out of three or four different seed oils, a beef stick, and it was just like, wait a minute.
This is, this is not even real food. And, and I think that's the hard thing is that because processed food is inexpensive and the seed oils are inexpensive, that you eat so much of it. That you don't [00:22:00] even know these, these processed things that you think you're doing something healthy and it's not right.
Even like some of the, the plant-based foods and so forth are a lot of seed oils in those. And so it, it is a difficult thing to, to keep up with. And I think that's where a lot of like leaders aren't really thinking about their health issues because they're running businesses and so forth, and then
they're busy.
Paul: understand all that. Yeah. But to be at the top of the, top of your game long term, which is where these people wanna be. And where they deserve to be. You gotta pay attention to these details. A general rule is the, the shorter the list of ingredients, the more healthy the food is gonna be.
James: Yeah.
Paul: you know, a steak, a steak doesn't have any ingredients in it. A baked potato, even though it's carbs, it doesn't have any ingredient broccoli. You, you know,
James: Yeah.
Paul: the, the shorter the list of ingredients, the better off you are.
James: That's great. So I, I wanna ask you like, how quickly can meaningful health changes [00:23:00] happen with the CGM? Like when people start seeing the results of it, like how do you coach people to use the data proactively, not just kind of respond to it? Like like once they see the data, it's like, what do they do with it?
Paul: Yeah, I mean, people self correct. Quite honestly, once you see the data, you can have. A doc in their office sitting across the, the office from you for years saying, oh, you know move more and eat lift, which is the standard. You know, little bit of advice. But, but people generally self-correct. In terms of, you know, I give them an outline.
I don't micromanage their diet. We set a carb target, which is often less than 50 grams of carbs a day. We ask them to get adequate protein. We talk about good fats and bad fats, you know, cooking avocado oil or walnut oil or olive oil, and avoiding the seed oils. But people generally that are motivated, generally self-correct. And then they can see [00:24:00] results within a matter of weeks really, because what they, you know what a lot of patients see is this irregularity this up and down. Of their blood glucose curves. 'cause the physiology is your blood glucose spikes, insulin gets released often. Insulin will overshoot the mark and drive your blood sugar down.
So you get these variables, which can lead to fatigue and, and brain fog as well. There's actually a whole group of physicians now, or looking at the mental health aspects of blood sugar physiology and how if you stabilize a blood sugar, that that actually can improve. And some other variables. so, so really people generally self-correct and I give them some general guidelines in terms of keep your carbs low, keep your protein high, other two legs of the stool of what I work with people on, which also helps reverse insulin resistance is a little bit of intermittent fasting. have to be crazy, you [00:25:00] know, 14 or 16 hours overnight, most days of the week. I don't ask people to do, you know, three day fast or even 24 hour fast. Some choose to do that, and I think that's okay if it's not excessive. And then the third component that we emphasize because it decreases insulin resistance as well, is strength training. So, you know, since the seventies there's been this big emphasis on cardiovascular fitness and that's great. People doing resistance training and whether that's weights or bands. Or some dumbbells or some people like to do Pilates or even just using your body weight with pushups and pull-ups. I think strength training is key 'cause the physiology is this is because if you can increase your muscle, mass muscles are the most malleable organs that we have. If you can increase that mass a little bit, you increase the quality and the receptivity, those insulin receptors on your muscles soaks up more insulin, soaks up more blood glucose and helps stabilize your [00:26:00] blood glucose.
James: Yeah, that was my issue. I talked, talked about going there as kind of skin, skinny, fat guy as I had no lean muscle. 'cause I, all I did was cardio. I mean, all I, I mean, I would do hours and hours and hours a week on a bike. I would still have a gut, you know, I'd still have like, you know, this tire around the, the waist.
And when I met with, you know, my doctor, he's like, yeah, you, you have no lean muscle. And so that was one of the first things that they did intervention for me too, was getting me to do strength training. And that's been a game changer for me, like adding three days a week, I just go in and do some, some weights and you know, over the last year I've.
Put on about eight pounds of muscle and you know, so my weight hasn't really went down, but like, it's, it's, I'm leaner and that's, it's been huge and, and in that process. So yeah, I think that's, I was always uh, reluctant to like, ah, I don't like lifting weights. But once you start seeing the results of it more than just being strong, like the health side of it, [00:27:00] it's pretty impressive.
Paul: I think it, it's, it's really critical, you know, after about age 30, 35, we lose 70% of our muscle per decade, excuse me, 7% of our muscle per decade. So, you know, you're into your sixties and seventies. That's a lot of muscle mass. I have my patients. It's, it's just like I do believe in cholesterol. It's just not an emphasis for most of my patient.
And actually, as an aside, if I have a patient that has a cholesterol problem, I recognize that I send them to a lipidologist, a lipid expert. We can go down that rabbit hole too, 'cause a lot of people with high cholesterol. Don't necessarily need to be on a statin because you can get subfractions of your cholesterol to sort that out.
That's probably another
topic. But in terms of cardiovascular fitness, I have my patients call follow the American Heart Association guidelines for cardiovascular fitness. Very straightforward. Get your heart rate to 80 to 85% of its max for 75 minutes a week, [00:28:00] or 65% of your max. For 150 minutes a week. So I like the 75 minute option. That's what I do myself. And the reason I like that is because it leaves me time for strength training. And I want to, so the ratio for me ends up being, you know, you working out, you know, four and a half fives, six hours a week. It ends up being a lot more time spent on strength training, but still getting the cardiovascular fitness in to meet the American Heart Association guidelines. You know, this is important for everybody especially important for women because of the risk of osteoporosis and the amount of muscle mass you have directly relates to ery osteoporosis as you get older. So very critical for women and I, I've had some women that have never picked up a weight in their life and then, and really gotten into it.
I had one patient that came in for a visit and she says, Hey Doc, you know what? I was brushing my hair this morning in the mirror, and I noticed for the first time in my life that I [00:29:00] have a bicep. that was pretty cool. And uh you know, you, you know, strength training as you get older is critical.
And you know, again, that's why one, it's why it is one of the primary components of the programs that I recommend for patients,
James: So I wanna talk about another hot topic. Every time I turn on the tv, I'm seeing another commercial from another company on a GLP one, I'd love to just get a little bit of your thoughts on GLP one, how you use it for someone hearing about for the first time, what is it and how is it used in weight loss?
Paul: So GLP ones they're a gastrointestinal hormone, and they have three mechanisms of action. One is they slow gastric empty. And that's a, that's a fancy way of saying they narrow the V between the stomach and the intestines. So food stays in your stomach for a longer period of time. The second thing they do is, is help stabilize blood sugar. We, we talked about [00:30:00] the importance of blood sugar stabilization, leveling out that blood sugar to, to you, know, lose weight. Via the mechanism that we, we really just discussed. And of course the primary use of these medications initially was for diabetics, but then the drug companies found that because GLP ones don't drop your blood sugar out. They stabilize it, but don't drop it low. And the diabetic patients on the medicines were losing weight. They went back and got approval by the FDA for weight loss. And then the third mechanism is a direct hypothalamic effect, an effect on the brain, and it just provides earlier satiety.
You know, you feel full earlier on, so you have a tendency not to eat as much. the, the, with these medicines you know the genie is outta the bottle on GLP ones and, and we are not going back. I think you have to consider them effective medicines and, and good medicines if they, if they aren't [00:31:00] abused. And people are, people are gonna want the, you know, more and more people want access to these medicines. There's huge cost issues related to that. As you're probably aware but I think these will become the most prescribed medicines in the history of the world, supplanting statins, which are, which have that role now, and it's just a matter of time.
So the, the key is using them, you know, initially I resisted this a little bit, but. But I don't think there's any resisting it anymore for people that want to use them. So the best approach, I believe, is to use low doses for limited periods of time. I use technique I call microdosing. So we go to the first couple levels of this medicine, not to the fifth or sixth level. We try and limit the use to a period of months, not years, and, and have it really compliment the lifestyle changes we talked about. You know, the dietary changes, the strength screening and the intermittent fasting. You know, there's this issue of [00:32:00] whether these should be, you know, medicines for a restart, you know, to get people headed in the right direction. But of course, the pharmaceutical companies would like this to be a treatment for chronic disease that, where people go on them and they're on down forever. my, my practice is conservative in that I don't use them in all my patients. But in those patients that I know. They, they want them and it's appropriate for them. And I don't want them going to somebody else that's not gonna provide the kind of guidance I do related to the other issues. Then we try to use lower doses for more limited periods of time.
James: Yeah.
Paul: then, you know, the muscle mass issue was huge with this because when you're losing weight on these, I on these medications, you aren't only losing fat, you're losing muscle mass.
So the strength training even need, needs to be in the protein intake, needs to be even more emphasized.
James: So I know that Zepi is like a big name, brand is that actually a GLP one?
Paul: Yeah. So the, here's kind of the, the scheme of these. So [00:33:00] Ozempic the, the, the scientific term, semaglutide, you may have heard that term as well. And Ozempic is for diabetics. Exact same medicine for weight loss is
wegovy.
James: Okay.
Paul: Which you've probably seen the
James: Yep.
Paul: the people marking down the streets
James: Yeah.
Paul: Right.
James: The song from greatest Showman.
Paul: yeah. And then the, so that medication is made by Novo Nordisk and then the analogous medicine made by Eli Lilly is Montero, which is for diabetics. And the weight loss medicate version of that, again, same medicine, different doses is zep bound, Z-E-P-B-O-U-N-D, and then the scientific name for that medicine is Tirzepatide.
James: Okay, so I'm. Meritide, and so that's why I was trying to figure out if there was a difference between that, which I, I'm familiar with and other GLP ones.
Paul: Yeah, there's basically on the market right now. In the States, there's only two, which is again, it's Ozempic. Wegovy, [00:34:00] which scientific name, semaglutide or Monro. Her diabetics, Zeba for weight loss and Tuti. So there's only those, those two medications. But there's many more coming, including I think, oral medications.
James: Yeah, and it is a very expensive. Medication. So do you, do you see as that continues to expand that the cost of those things will go down?
Paul: I think competition is gonna do that. The, the, the makers of those two medications are already offering discount programs. You probably heard early on that it's you know, $1,200 a month for these medications. Most of the discount programs from the manufacturer directly, which is the, the type of medicine that I prescribe. Generally in the $500 range. First few months might be 350 or something like that. Still very expensive, not obtainable for a lot of people but not as bad as the $1,200. And then there's been these compounded medications, which are kind of copycat [00:35:00] medications, which the, the FDA. As it said, are not appropriate any longer except in very specific situations.
So there's been that controversy as well.
James: Right. I don't wanna go down a, a, a long rabbit trail because I might wanna have you back on and have a conversation about this. But I'd love for you just to touch a little bit on. Alcohol and how GLP ones the work, there's, what you're seeing is re is all helping with alcoholism.
Paul: This is a very, very interesting topic and I think pertinent maybe you know, the people you wanna, you, the people that you are working with, operating at a very high level. And, and it has to do with alcohol intake. So and, and another former life of mine I got board certified in addiction medicine.
I had an addiction clinic in response, kind to the op, the opiate epidemic, and. Southwest Ohio. But as part of that practice, I, I treated alcohol patients as well. I started noticing with my patients on GLP one in the metabolic [00:36:00] practice that, they became less in, that their alcohol consumption went down. Most of them were not heavy drinkers, though I did have a handful of heavy drinkers and, and their consumption with these medications went way down. So, so now I'm branching into the arena understanding these are not FDA approved for alcohol use. I, I'm working with some patients specifically on alcohol use reduction. there's two philosophies related to alcohol. One is abstinence, which I'm all for 12 step program Alcoholics Anonymous, that that's, that's great for the people that can get there and avoid this roller coaster of abstinence, followed by relapse, followed by abstinence, followed by relapse. But most of the patients that come to me with a concern related to alcohol, they, they quite honestly just want to drink less than their drinking. that can be either their overall quantity and their pattern of drinking or the pack that they're binge drinking. [00:37:00] And so the technique there is called harm reduction, which is, you know, let's get your number of Brinks down, you know, and I them as we, we categorize this as per week that people are drinking, you know they're, you know, going home from work and drinking three or four drinks and then maybe a little bit on the weekend. Maybe they're drinking 30 drinks a week, and, you know, our goal is to let's, let's get you to less than 10. And, so then I. I'm happy to move people onto abstinence if that's their goals. A lot of people don't want to do that, so I use the GLP ones now. And then also, and the GLP ones when used are off-label, not approved by the FDA.
So we talk about all that. And then there's another medication I've been using for years that helps with alcohol use reduction, which is called Naltrexone. And we use that medication as well. And if you use those in combination. People really w [00:38:00] without lot of other work can decrease their alcohol use very significantly.
And, you know, I, I promote other approaches, individual counseling, journalizing, keeping what we call a drink log. You know, journalizing, the amount of drinking you're doing can be very helpful. So there are a variety of behavioral techniques as well. But in terms of medications, I think BLP ones are gonna be the first medication. Armament been added to our armamentarium in the last 30 years for alcohol use reduction, and again, not approved yet by the FDA, but I personally believe that
James: That's amazing. I feel like as I've talked to different younger leaders specifically. It feels like there is a, a move away from alcohol as a social part. I think with the health and wellness movement, I think people are like, ah, don't like the way it makes me feel. but there are people who struggle with that.
So when I started learning about what you're doing, it's like [00:39:00] that's probably an incredible opportunity for people who are trying to move away from that, part of their life. I think there's a whole social piece of that that has to be addressed too. But I was really intrigued when I started hearing about how GLP ones were used for that as well.
Is that something that, that you're doing, or do you feel like other functional doctors in the metabolic space are doing that as well?
Paul: No, I don't think that many people are doing it
James: Okay.
Paul: there is a group of clinicians that I'm involved with that, that, kind of networked related to this. There are a couple major centers I'll mention Steve Klein in Pennsylvania. He works at the Karen Center, C-A-R-O-N, kind of leading the charge on this. you know, this is always a risk benefit thing. We didn't talk about the risk associated with GLP ones, you know, because there are potentially serious risks, pancreatitis. You know, other serious risks. You know, if you keep the doses low, you can avoid. In [00:40:00] fact, I've had really no issues with any significant serious side effect.
I have people that get nausea and vomiting or abdominal cramping. But if you keep the doses low, you can avoid. The majority of that. So I think the philosophy amongst a, you know, a handful of addictionologists across the country that are using GLP ones in this manner is basically to keep your doses low, use it with naltrexone, the other FDA medic approved medication, and then integrate some behavioral So, but, but there's no question in my mind it has an effect on. Cravings, and I don't know if it's just because of that primary satiety effect in the brain, but the term I hear from people is they just become disinterested in alcohol. I mean, I've had patients you know, you know, four or five glasses of wine a night.
You, you know, problem in the addiction medicine practice, and again, there's some crossover here with my metabolic health [00:41:00] practice and, and they say they'll go home and they'll pour a glass of wine and. Before it's half gone, they become disinterested in drinking the rest of it. So that, you know, that has huge implications for not only mental health, but metabolic health as well.
James: That's amazing. Okay, I have a couple more questions I wanna ask you. This is really fascinating and I really would like to have you come back on, 'cause there's a lot of other health things that we kind of to on with statins and you know, those, that space. But so for someone who's listening that maybe can't work with you directly.
What would you suggest, and what are maybe three or four things that you would suggest that they do after listening to this? To start moving towards a place of better metabolic health.
Paul: Okay, so first of all, I am licensed in Ohio, Indiana, Arizona, and Florida.
James: Okay.
Paul: And I do all my work by telemedicine.
James: That's good to know.
Paul: but I would recommend to people to, to just start educating yourself. Start listening to the [00:42:00] metabolic health physicians that are out there. You know, there's a lot of good information. Out there on metabolic health. And again, once you start going down these rabbit holes, you're gonna feel you're, you're gonna find a lot of things. So I have a lot of colleagues doing what I'm doing in different states, but I would just start with a baseline educate yourself. I'll make a plug for my podcast where we talk about metabolic health and these techniques. Phil Oia O-V-A-D-I-A out of Florida is a great doc. He is a cardiothoracic surgeon, so a doc that opens people's chest up and does bypass surgery. And based on his own personal low-carb experience where he lost 120 pounds, he's now an advocate, which is, you know unusual. And a, a cardiothoracic surgeon who's an advocate for a low carb, high fat diet. He believes so much in the benefits of low carb and that you know, cholesterol is not the primary problem, but [00:43:00] there are all kinds of, of, metabolic health positions out there. And, know, just begin to educate yourself.
James: Okay, so I'm gonna put the link to your podcast and I think you've written a book as well on this, that.
Paul: Yeah, so I'll make a plug there. Actually, there's two other plugs I got one, one is the book, I think it is back there. It's the continuous glucose monitor revolution for non-diabetics and it's how diabetics can. Get an over the counter CGM and use it to educate themselves like we talked about. I have a separate non-practice website.
My practice website is metabolic MDs mds.com. But for states that I'm not licensed in, I have a site that that provides CGM education and there is also available on that site the opportunity to purchase an over the counter CGM at there, there's a. floor rate, the cheapest rate that we're allowed to sell them at.
So we, we do that and again, they're about 50 bucks for two weeks. And I also [00:44:00] have a team of health coaches that are not restricted by state licensure issues. And so my health coaches through the CGM dash doctor website can provide health coaching to people that put on A CGM and review their patterns with them and provide the kind of guidance I do in my practice without them directly providing medical care.
James: Oh, that's great. I was gonna ask you if you had a recommendation for a continuous glucose monitor. So I, I'll go to your website and I'm gonna start, I'm gonna check one out myself. So.
Paul: yeah. Do do it. Everybody should. I mean, you know you know, for at least a couple week period of time using A CGM, it can be eyeopening. So the last chapter in the book, you know, as we go through all these different things, how does CGMs work? What are. with the food pyramid, what are the best diet, strength training, fasting?
The last chapter in the book is CGMs changed lives because I've had people that just see that data and they see the spikes and, and [00:45:00] again, they're, they're ruined for, you know, processed food to some degree. I don't mean to take that enjoyment away from people. And a lot of PE times people realize, you know, you know, special occasion, you're going to a wedding, you're having a birthday party for your kids. That's great, but you know, in the back of your mind what you need to be doing in general.
James: That's so good. Well, Paul, thank you so much for being on the podcast. This has been really educational and really enlightening for me. I'm, it's actually very affirming of the things that I've been kind of doing for the last year on my own health journey and. And it, it doesn't take a lot of work.
It just takes work. I, I'm always reminded of one of my digital mentors, I never met him. He died a long time ago, but Jim Rowan always said that an ounce of discipline weighs far less than a ton of regret. And, you know, just a little bit of discipline, you know, now is gonna pay off huge dividends in the future if you start taking some of these tools that now are now available to us, right?
Paul: And, and I think if that [00:46:00] discipline is, is founded in knowledge, maybe founded in data, it doesn't become that
James: Yeah.
Paul: I mean, I have patients and they just, I, I mean there are certain foods, for example, that they just put out their mind. I mean, they don't even consider it as being quote on the table. such, and it's not like they feel deprived. I, I agree with you. a little bit of discipline can prevent a lot of regret, but with data and knowledge the lifestyle changes can be not that
James: Awesome. Well, thanks again for being here.
Paul: Alright. Thank you for having me, James.
James: What a valuable conversation with Dr. Paul kic. His approach bridges science strategy and simplicity in a way that makes metabolic health not only approachable, but at attractional for leaders who are wired for impact. This kind of clarity can be a game changer.
This episode is a strong reminder. The foundation of your leadership isn't just [00:47:00] mindset or vision, it's also physical resilience. And that begins with knowing your numbers, adjusting your inputs, and staying proactive about your energy. For those of you who wanna go deeper, make sure to check out all the resources that I've linked in the show notes.
And if you haven't yet started the Lively last five day leadership reset, now's the time. It's free, it's intentional, and it's designed to help you lead from alignment, not exhausted. So head over to live lead last.com/reset to get started today. You can also stay rooted and focused with my weekly email. Just text Grow to 6, 6, 8, 6, 6 to get signed up. If we haven't connected yet, I love to on social media.
You can find me on Instagram and LinkedIn at the James Deval. Finally, if this episode gave you something to think about or act on, consider rating, reviewing, or sharing it with someone who'd benefit. Every share helps this community of thoughtful, intentional leaders grow.
Keep leading with clarity, keep living with purpose, and keep building a life and leadership that [00:48:00] lasts.