Hey plus 5 squeeze. Before we jump into the podcast, do me a favor, like, subscribe, and share if you haven't already. This helps us to refer to an algorithm so we can find more people that need our help and guidance from our doctors. Thanks so much for supporting the show. Let's jump in. Are you interested in understanding what you want to keep on like the subject of coffee or Montaro? Then join us on the Plus5 Cracking Wheel PC Code, the groundbreaking podcast helping people change their lives one episode at a time.
SPEAKER_00The Plus 5 Podcast is disruptor.
SPEAKER_06We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that will help you filling your force off of hours. Join us every time to learn from doctors or specialists around GLP1 medications like those types of Google Manjaro. We'll provide you with science and facts and values of incredible stories. But that's not all. We'll also bring you the voices of the GLP1jaro types of community. Real people who face the challenges of obesity related diseases and disorders have discovered incredible plus fives of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovering empowerment? Tune in to the plus five cracking the obesity code, and together we'll change the narrative around obesity and the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus size of life together because every story deserves to be heard. Every life deserves to find, and everyone deserves access to expert knowledge on my podcast. The plus size podcast. You're not alone. It's not your fault. Today's episode is brought to you by the Roe Body Program. If you've been following along on my GLP1 journey, you know that managing weight and metabolic health is a huge part of what I advocate for. Roe's approach combines GLP1 medications and then personalized support, giving you a tailored solution to help you take control of your health. And it's more than just weight loss. It's about finding the balance and the support that you need for long-term sustainable change. If you're ready to take the step, you can go over to row.co slash plus sides with a Z and see how Roe can support your journey. That's row.co slash plus sides. I'll link it here in the show notes. You're not alone. It's not your fault. Welcome, welcome to the plus sides. Oh, welcome. Hi. How you doing, Kat? Come on in. Come on in. Yeah. Hi, everybody. Um, we're super glad to have you here. Um, we want to talk a little bit about what we're gonna talk about today. Uh so Kat and I are gonna kind of explain our guest and the goal of our show. So, you know, Kat and I talk a lot about diet culture and sort of how that's changed society, but because of diet culture, many of us grew up believing that metabolic health was really all about weight loss, right? I mean, you hear metabolism, that's what you think, right, guys. Um, so what though, and if you watch the show a lot, you probably already know this, but what if it was really about more than that? What if that's wrong?
SPEAKER_04What if it's not about what do you mean, Kim? Like if you have not been following Kim, where are where have you been? But yeah. Listen, new people, like hundreds of people virus every week. Like, exactly. So where have you been? That's what we talk about. Um so well, speaking of, um, today we're gonna learn what metabolic health really means, how it affects our bodies. Uh, far beyond the numbers on the scale. I know. Shocker. Um, and why understanding it may help us uh better protect our health before, you know, serious disease develops. And, you know, we talk about that a lot on the show.
SPEAKER_06We do. Yeah. Um, so we'll start with one of the country's leading experts in obesity and preventative cardiology, um, who will also help us um break down the science in a really patient-friendly way, like we try to do, right? And then we're also going to hear from a patient to learn about heart health and what her journey has been like, understanding metabolic health even further, and then recognizing what those early risk factors could be so that we can get in front of it, right? So we hope that you will enjoy this uh show. But after now that we've kind of explained a little bit about what it's going to be about. If you're new here, run the quick intro so you know me and Kat, okay? Uh if you're a loyal listener that listens every single week, this is your cue to fast forward. Okay. My name is Kim Carlos. Uh, I'm an obesity care advocate. I run this podcast with my friend Kat and my husband. It's an education advocacy podcast, and it is all about metabolic disease, the different treatments, and it's for people that suffer from it so that they can better understand their bodies, their diseases, and be able to advocate for the car that they need and deserve. Okay. And so it's, I promise it's not one, though. We have Kat who who helps everything right. Okay. Um light and fluffy. That's right, light and fluffy. And um, I struggled with obesity the majority of my life and even in childhood and diet culture and all the things that come with that. And so I talk about it quite a bit here. And I on GLP once was able to experience something um that really helped me realize that it wasn't my fault, right? That it was a disease and there's certain things in my control and certain things that aren't. Um, I dropped uh 110 pounds. I've regained some. Um, but guess what? You have to change your treatment. Why? Because it's chronic disease. So these are just things that happen, and we talk about that a lot here, okay? Um, and uh just not about wheels, guys. Okay. So Kat, who are you? What are you doing? Why are you here? What's up?
SPEAKER_04I'm Kat. Um uh you call you can follow me, Kat Carter7 on the Tiki Talk or Mrs. Cat Carter, M R S Cat Carter on the IG. Um, I too have lost, I lost 100 pounds. Um, so Kim talks a lot about it now, regain and stalls, but my life has been a stall on a GLP one. So um, but um I'm extremely thankful. It it took a long, it took a long time, three years, three and a half years to lose 100 pounds. Um, but uh like I always like I've been saying a lot lately. Um I've always told myself I'm not going to go without a glass of wine, nor am I going to go without a slice of cake if I'd like one. Um but I do like to, like we always say, like to get um, I like to get 20 from that one. All right. Like a good square. Um I think it's the coffee that I spilled. And um, but um so uh I I do enjoy enjoy fitness. I like I've always said that um it was the most frustrating part about being in an obese body, um having obesity, is that talking to doctors till I was blue in the face. Like, do you not see? I wish you could see how hard I put in the work. Um, and I'm still 280 pounds. So can you stop talking at me about this? But here we are. Here we are. Here we are three years later with um with the Monjero with the turbulent power. So yeah, I wanted to make it short and end up being long. I apologize.
SPEAKER_06Why did you want to make oh you mean your intro? I was gonna think I thought your journey was gonna be short. No, well no, it's never short.
SPEAKER_04So Kim is like in the middle, Kim is in the middle of like my life that was like two years ago, and I was a whiny baby about it. I'm not saying you're a whiny baby, but I was a whiny a little bit of a whiny baby because um everybody else around me was having had had food aversion, everybody else was dropping it like you know, hotcakes. But I'm telling you, the slow journey is where it's at.
SPEAKER_06Um it's a good one. That's okay. Let's talk about it. What do you think? Yes, we're gonna. Oh, have you remembered to comment, like, subscribe, share, click the reminder bell wherever you're watching or listening to this podcast? If not, please do it now so that you can help us grow and help more people. We love you. Hope you're enjoying the show. All right, so we're gonna invite in our uh patient guest today and understand her story, and then we're gonna have in our doctor guest, and we'll go from there. Okay. All right. Welcome, Amy. How you doing?
SPEAKER_03Hello, good family. It's good to see you too.
SPEAKER_06Um, so what we usually do here, uh, if you of course watch the show before, is we allow our patient to tell us their story, right? Um, and uh as it pertains to, you know, whatever it may be. So feel free to just let us know about, you know, really your health and it could be personal, you know, when things started and all the things. Um, and then we'll go from there. Does that sound good?
SPEAKER_03That sounds great. Thank you so much for having me. I, you know, I could talk for hours and hours about this. Um my story is 20 years in 2027, it'll be 20 years uh in the making with um what we now know as CKM syndrome. Um but uh a little bit about me is um I live in California and I have a big, beautiful, blended family. Together we have six kids and eight grandkids. So we keep super busy with uh seeing everybody and doing all the things. Um my story really, if I look back at it, start as an adolescent and I always had issues with food. Um as a teenager, I made decisions to not eat. And um then as an adult, it turned into binge eating and uh you know gained weight and lost confidence in myself, which made me not exercise and you know, just all the things that goes with obesity, and I always just I just didn't have enough willpower. And then in 2007, I was in a car accident and I had a non-traditional heart attack. I uh the impact of the seatbelt tore an artery. And three days later I went in and had a non-traditional heart attack. And even though at the time I was told, oh, you have uh high cholesterol, I was just like, Oh, well, the heart attack was from the car accident, so really we're okay. And I told my doctor, I don't need any medication, um I can do this on my own. This was kind of a wake-up call, I thought, and then it wasn't, and then a couple years later, I went in for a physical and was told I was borderline type two diabetic, still high cholesterol, and again I said, I just need stronger willpower. I I've got this. You're scaring me, I've got this. And I didn't and then um in 2013 I had a widow maker heart attack. I had three stents uh placed in my LED, and at that time I was told I had congestive heart failure, and my injection fraction was at that time 15%, and that's how much your heart squeezes out. So most people is at 75% on a good heart, mine was at 15. And my cardiologist said, I don't even know how you're getting up and walking. I'm like, I don't have a choice. So that's where things kind of kicked in for me, and I was like, I need to change some stuff up, and how do I do that? I had no idea how to um navigate my new journey. You know, not only did this all affect my physical health, but it affected my mental health. Um, I had PTSD because of the heart attack, I struggled with depression because I was trying to navigate something that I did not understand. And my doctors at the time were just treating my cardiologist, was just treating my heart symptoms, my endocrinologist was just treating my diabetes. And um I didn't know at the time that my food addiction and my mental health and my cholesterol and my heart disease was all intertwined. And we weren't talking about it at that time. So that's that's kind of my background. It's a lot to take in, I know.
SPEAKER_06So how did you end up getting to where you were like a level of treatment? Like what did you do?
SPEAKER_03So once I had the widowmaker heart attack, um I really went in with my cardiologist and started new medications. Uh the biggest point was to get my ejection fraction up. So that was my main focus at that time. Did you tell your audience what an injection fraction is? Your ejection fraction is how much your heart squeezes. So this is my heart, and most people's heart squeezes 75%, and minors at a 15%, but wasn't able to get the fluid. So I would have like fluid built up on my lung, um, was hard to breathe at the time, easily fatigued, uh, was barely making it through a day without taking a nap because I needing to be in bed by 7 p.m. So um my main focus was on getting just my heart better. I was like, well, if I get my heart better, everything else will fall into play. And so that was my main focus at the time. And I just kind of let everything else fall to the wayside because I had this traumatic event. You know, with the first heart attack, I was like, oh, it was a car accident, it's nothing that I'm doing. Um the second one rocked my world. And uh I struggled emotionally. Um sorry, it still brings up emotions for me.
SPEAKER_06Uh no, don't be sorry. That's what the show's about. We talk about all things, okay?
SPEAKER_03I've come such a long way, and I'm so proud.
SPEAKER_04Uh you should be proud.
SPEAKER_03Difficult as this journey was, um looking at it from this side, I'm like, wow, girl, we did this. We did this with a great team of people and huge support for my um my health care team and for my family. So it wasn't just me. Um, but I did do a lot of the work dang it.
SPEAKER_06So uh how do you go still work, Amy? What did you do? Um, so you were trying to you had like small goals, it sounds like like well, not even small goals, it's a big goal, right? Is to try to improve the 75-15 like ratio, right? How did you go about improving that? Like medicine, movement, like what did you do? Because you were so tired. I can't help it either. Like, how could you do anything?
SPEAKER_03Yeah, I didn't for a while. Like for several months, I just cried a lot and just kind of did whatever my doctor told me to do, and that was take your medications, watch what you eat. And when you get that scared, it's kind of easy to be like, you're not having that French friend. Uh you know. Um it changed it changed my way of thinking for a while. Um and then as you get back into the routine of it, yeah, your old thought processes kind of start going back in. So at the beginning, you know, I would take small walks. And at the time I would just beat myself up and be like, oh, I only walked half a block today. Not realizing that my heart was trying to heal from a very traumatic event. Um, it was easy to say no to the fried food because of what I'd gone through. And so I just really kind of focused on the whole big picture, and that was taking the medications that I was told to take, doing small exercises in the beginning, and watching what I ate. Um, so it's kind of the whole trifecta of doing what your doctors are always telling us to do. And then as I got back to my regular, sort of regular activities, I was like, I'll go ahead and have that, Dr. Pepper, and I'll go ahead and have those fresh fries. And I started going back into my old weight and um just kind of went back to what I had always done. And I didn't, I mean, I would beat myself up because I'm like, Bing, you've had this traumatic life event. Why are you going back to what took you there? And then I felt like a failure. Like, what is the matter with me that I can't get this under control for longer than six months at a time?
SPEAKER_04Sure. I can't nod my head hard enough, like I know, right?
SPEAKER_03Like we're like, yes, we totally know all those feelings. And you feel like an absolute failure, you know. You're my doctor, my primary care physician was like, you have this health care, what is it gonna take? And I'm like, I don't know. I don't know why I'm back to where I want. Help me figure it out. Because I it's not that I don't want to figure it out. I want to work anything. I wanted to be able to watch my kids graduate high school. I wanted to be able to see my grandkids be born. I don't know why I am going to help me. And they couldn't agree.
SPEAKER_06So what did you do?
SPEAKER_03So um part of it that we don't talk about is and that nobody told me after my heart attack was I went into cardiac counseling. Um we have it, I I go to Stanford, we're here in California, I go to Stanford, and they uh recommended cardiac counseling to me. And then I went into a private practitioner as well and started talking about why do I have a food addiction? Why is it easier for me to sit on a couch and watch my favorite show than it is to go for a walk and finding that there's emotional triggers for me as to why I am the way that I am. It's not a lack of willpower. It's things that have happened to me and my thought processes and the comforts that I needed in a weird way foods made me feel like home. And um you know, I always tease my family, food is my love language. Like you come over and we're having a big old dinner and we're having all the things. And yeah, so I I needed to start a cardiac camping. So that's what I did. And I um I had drastic measures done. I had asterisk leave done and um for the CKM part of it, uh the biggest thing that I did was I started advocating for myself. I was so intimidated to talk to my healthcare providers about what wasn't working for me because I was like, they're the doctors, they are educated, they see this day in and day out, they know what to do. So I just took the med that I was told. And the biggest thing that happened for me was um I went in for just a yearly physical and I was talking to my primary care physician, and she's like, Okay, well, let's just go over your medications. And I started bawling. And she's like, What is going on? I have a really good relationship with my primary care. Um, but she's like, Are you okay? And I'm like, I'm not taking my medications like I'm supposed to. And she's like, Why? And I'm like, Because they make me sick. I survived cholesterol, diabetes, two heart attacks, and my medications are making me so sick that I don't want to get out of bed at night. Or yeah. Anyway, yeah, I was I was literally looking into going on disability because I could not make it through my day at work without going to the bathroom to throw up because I was so sick. And um I work in public education, so I didn't have the luxury of being able to just go to and be sick. And um you know, people were counting on me. And when I did go to work, then I would come home and I had nothing left to give to my family. Um I just broke down in her office and just I'm not telling these people, you know, these other doctors that I'm getting sick from this medication and nobody's looking to me. She's like, So then stop it. I'm like, wait, I can do that. I can quit taking medication that my endocrinologist and my cardiologist, and she's like, I'm not saying stop medication, I'm saying stop what you're taking and let's find something that works for you. And I was like, I can do that. And I it just wasn't even a thought in my mind. Um, so we got together and found things that worked for me. Um, I had originally banned for my diabetes on metformin, and that was one of the ones that made me so nauseous. We all agree.
SPEAKER_04Yeah, I agree.
SPEAKER_03Uh so I started a GLP1. I'm on 2.5 milligrams of Manjaro, and um I take it once a week, and my A1Cs are at a 5.7. Uh, the food noise is completely gone for me. The at 53 when I started it, it was literally the first time in my life that I didn't have my mind telling me what was in my pantry and what was in my refrigerator.
SPEAKER_05It's crazy, right?
SPEAKER_03Um I was on a statin that made me so weak and my muscles so sore that I felt like I had been punched in all of my muscles. Um, so my cardiologist put me on repatha, and that had been a game changer for me as well. So advocating for myself had been the biggest game changer in my in my health journey.
SPEAKER_04Yeah. I think we're just gonna sit on that for a second. Advocating for yourself. That's what we talk about all the time.
SPEAKER_06But it's very hard to do. Well, I think that I think it's for a lot of reasons. For one of the biggest ones that you said is we do, because we know the doctors are very educated, right? We do look to them and go, they must know. I think that what I've learned through this is when it came to weight management, nutrition, unless they were experts, even they didn't know very much. You know, that's why they always told us to eat less and move more. And that's that's all they knew. I mean, they got like an hour of nutrition training, and you know, it must be us, and you know, and all those different things. And I think that, you know, even now it's really difficult because it's a there, it's a very complicated disease, you know, and I think the path to treatment and all of that is is difficult. I don't know if you know this, but we interviewed when we first had the podcast, um, Rosie O'Donnell, and she had a widowmaker heart attack as well. And she also had sleeve, and she's also on 2.5 Montaro, um, because she doesn't need as much, right? Because she has the sleeve. But um, I didn't know if you if you knew if you had seen that or knew that, but it was very similar. And she would say the same kind of thing like, how could I have a heart attack like this and still not have this under control, right? Right when I'm accomplished in all of these other different areas, many of us, you know, have have been like that. And I don't really know what the answer is. Like the doctor's never said, Oh, this is what equals the answer. But what it seems to be, right, or my experience, like my opinion, is that when we go through this, I'm super curious what you think, um, is that I think when we have this dysfunction, right, that's within our body and it affects our brain, right? And we have this, and our body's always trying to keep us there, it does everything it can to keep us there, right? And it doesn't care that we had a heart attack. It doesn't care, right? The noise is there, the noise is pushing, and it's it's it's weird the things that I feel like it even talks you out of doing, right? Like I mean, I've had people tell me before they've gone to the gym, got all the way there, and been outside and gone, I don't want to go. You know what I mean? And fill my brain every day. You know what I'm saying? Like, our brain really does try to do everything, you know, to keep us where it thinks that we need to be, you know, and that's just what like my experience has been. I was curious if you feel like that too, now that you've gone through several different things. Yeah, yeah, yeah.
SPEAKER_03You know, and I always I always just thought I just didn't have enough willpower. I'm like, I have willpower in all these other aspects of my life. Why don't I have it for this? And you know, you would read these things like, oh, it takes 21 days to create a habit. I'm like, girl, I have been doing it right for years. So, you know, and in my experience, um when a doctor would say, you just need to exercise and lose weight, and I would be like, Great, how do I do that? You just put easy, or you would see you know, you would see a comment um on social media of oh they've gained weight, they would just quit eating, or if they just made a healthier choice, this would want to be a problem. It's not that easy. And until you've been through an addiction, you're never gonna understand it. Like I've tried to explain it to my husband. We can be sitting on a couch watching our favorite show, and my brain goes to you have Cheeto Cusp in your in your pantry, you have mint chocolate chip ice cream in your freezer, and I'm lit, it's looping in my mind the whole time we're watching our show.
SPEAKER_06Oh, yeah, the whole time, yeah, and that's really the difference, I think, between like what feels like food noise, right? And then what feels like hunger. Hunger's different. Yeah, yeah, yeah. But it's like it's very different.
SPEAKER_04Yeah, but something like, but you know, have you noticed like how the medication helped you? Like you you get to like it's stop, you can stop yourself and say, Hey, maybe I'm just tired.
SPEAKER_03Yeah, maybe I'm just thirsty. Yeah, yeah, right.
SPEAKER_06Like it's I it's okay too. And I'm like, it's weird. It's like you can kind of like do mental gymnastics in your brain. And even if you go, maybe I just this, it's weird how you can sort of accept that. Like, I don't know if everybody's like this, but like you can go, oh yeah, that is what it is. I just want some water. Like, and I'm you know, yeah, that is insanely different for me. I I remember like when I was first learning in the first year, I was like, God, I was looking over and I saw like little Debbies and stuff, right? That my son and my husband and all the things, and I was like, I kept looking at it, and I'm like, I want to eat that, but I don't want to eat that. And I went, and then I stopped and I went, I think I might just be hungry. And then I like legitimately, and then I went to the refrigerator and I picked out like one of those little like quick plug for Sargentos, Sargento's like cheese and nuts, little berries things, and I was completely satisfied, and I was like, right?
SPEAKER_03Yeah, yeah, I actually crave healthy food now, and that's it's weird, right? Why is that? So but it's so good, like yeah, had I have known sooner what it would be like, I would have started sooner. Oh yeah, you know, just even you know, looking back having CKM before I even knew I had CKM before my heart, before my widowmaker heart attack. Knowing, okay, well, you got this cholesterol piece. Okay, well, we're gonna take care of this cholesterol piece. You need to quit eating a lot of red meat, you need to quit eating cheese. Okay, well, you have diabetes, so you need to quit eating sweets, so you need to start taking the protein. And then, you know, just one doctor telling me this is your nutrition, and another doctor telling me this is your nutrition, and then another doctor telling me no, this is your and it doesn't align up. So what health issue am I going to focus on today to make sure that I'm healthy? And it was all these, and I wouldn't say it was misinformation. My doctors are very knowledgeable, it was what was good for what they are experts at. And um, so I just had to start taking bits and pieces of what each doctor was telling me and do what I feel is best for me and what makes me feel the healthiest.
SPEAKER_05Yeah. Yeah.
SPEAKER_03Again, that's just being an advocate for myself.
SPEAKER_04Yeah. Bottom line. Yes, indeed. It is weird, like we really do have to yeah, go ahead, Kat. What'd you say? Oh, so bottom line, that's what it is. It's it's about advocating. Yeah, you know your body, you know.
SPEAKER_06Yeah, yeah. And I know how I feel. It's hard. Yeah, especially I think too, if you've lived in like a bigger body, right, for like a long time. I think a lot of times we want to be pleasing and we want to not be seen, or we know, like I think for lots of reasons, you know. Um, and I think sometimes it's difficult when you're in there. I I've had that problem, and I most doctors will tell you, like, I know probably about this, right? A lot more patient-centric, right stuff than maybe some PCPs because it's a complicated thing and I've been studying it for three years, right? But but it's not like I could treat anybody, but you know what I'm saying, like this not coming out right. Um, my point being really is that even though I know what I know, if I'm in there talking to a PCP and I know my body and I know all of these things, right? I'm still like I've I've still been in a place where I don't say, uh-uh, or I need this, or that doesn't work for me. Because I just end up like feeling like going right back to where I was before, like you know better than me. And then and they don't, you know, they don't like you do know your body, and you do have to kind of figure out how to connect those dots and stuff.
SPEAKER_03They're they're I don't want to take anything away from the doctors, they're very knowledgeable in what they know. Sure. And I know my body, so let's work together. It's about being a team and having a health care team, and I am part of my health care team.
SPEAKER_02Absolutely.
SPEAKER_03And um I didn't believe that in the beginning. I was like, well, clearly I don't know anything because I am where I am, but over 20 years I've learned some things and I've gotten great advice from many physicians, and they have helped guide me to be a healthier version of myself. I still have the I still have high cholesterol, I still have even type one or type two diabetes, even though it's manageable, but we've all had to work together to become manageable.
SPEAKER_04Yes, indeed. That's true. You know, if you think about it too, not to take any away anything away from doctors, because that's that's that's right. Um, if you feel like with your PCPs, they have they have to like know kind of like everything. There's not really a specialty. So you are teaching them something.
SPEAKER_0615 minutes to spend with me.
SPEAKER_04Right, right. If you're speaking with specialists, they know that one, that one area, right? So you're right. When you start opening up and having that conversation with with your doctors, then things, you know, they they get bigger. The the the spectrum, the the understanding gets gets better. Um, I didn't know there were obesity doctors until about you know 15 years ago. That um that's another element that you can go to now.
unknownRight.
SPEAKER_06I didn't know that 15 years ago. Absolutely not. I I had um I had lap band surgery in 2007, and I and I and I did not know there was obesity specialist. You know what I mean? Like it was nothing like that. I didn't know any of this until honestly, Kat and I started the medicine, you know, four years ago, you know, and I was like, oh my god, this is really a big deal. Like, we have got a lot of people. Open your mouth, right?
SPEAKER_04It's a big deal, it's a big deal. Open your mouth, share it.
SPEAKER_03Yeah, well, um, so cool about um excuse me, being on the CKM panel. So I've been on it um since 2020. Tell us what that is. We haven't talked about what that is yet. Yeah, so CKM is cardiovascular kidney metabolic syndrome, and that is um that all these issues are interconnected with the cholesterol and the diabetes, with the heart disease, to kidney disease, to liver disease, it's all to mental health issues, it's all interconnected. And um, working with the American Heart Association as a um patient, I've been able to learn how to communicate with my doctors as as far as what's going on, and even to open their eyes to some things. When it first came, when I first started working with them, I went into my cardiologist and um if you know anything about cardiologists, you know that they're very very science-oriented. Sure. Doctor, look what I'm look what I'm doing, look what I just done. I was so excited to show him all this, and it like nobody had even heard of it yet. Like it was just in the the beginning stages of it. And to be able to tell him what I'm learning and to have science back it up, and he's like, Oh, let me look into this, and then to watch the video that I was in and to see um papers that scientists and doctors have been writing about to be able to show my doctors, hey, look into this. And you know, I'm sure if it's affecting me, it's probably affecting other um patients that you have. And um that it is all interconnected. You start out with one thing for me, it was my cholesterol, and then my cholesterol turned into type 2 diabetes, and then my type 2 diabetes turned into a widowmaker heart attack, and then my widowmaker heart attack gave me severe emotional issues, so just having all of this stemming from one thing and it's moving forward to other things, and we're just now talking about it. I'm just so brave.
SPEAKER_06Has anybody ever and and while you've been learning through this, has anybody ever told you that maybe the beginning piece of that was the obesity?
SPEAKER_03Just recently. Just even after doing this for four or five years now, we're just now really talking about it. And and I was like I said, I um I was anorexic in high school, and then it turned into binge eating as an adult. And at my highest weight, I was 237 pounds. And um, you know, you you know, at that time it was the early 90s, and it was just she's fat and she doesn't try, and she doesn't move enough, and sure. People still say that, yeah, and and you know, and it was a different time back then, you know. I have literally been on every single diet that I can think of, yeah, and um restricted calories, and I would do super good for the day, and then like seven o'clock a day, and I would eat three times as much food into 10 man, it was um it was downhill, and um I would sit there at night and just be disgusted with myself and do you made it all day long, and now you know you you get the kids to bed and you're sitting there and you're watching TV, and it's like let's go have this, let's go have that, and I I couldn't control it.
SPEAKER_06Yeah, you get it. I mean, I think um the only thing I wanted to like I it's such a wonderful story, and like hearing about what you've learned and how these are all things connected, you know, and um how you've learned about it and been able to advocate for uni. It sounds like also meet others and help others kind of understand too, which is wonderful, you know. Yeah, it's um very, very fulfilling to be able to do that, isn't it?
SPEAKER_03It's a huge blessing to be on this side of it, and you know, the biggest takeaway I want people from my story is um to advocate for yourself, to know that you're not alone in this, and there are people that are willing to help you and um to listen to what your need not not it's not even a want, it's a need. I needed to get healthy, and that they would help me do that, and um to just to know that there's a whole other side of it, you know. 20 years ago, I was in the depths of depression, and um I remember my cardiologist at that time I was like, So what does what does this all mean for me? Where where where am I gonna be at? And he told me if you're lucky you have 10 years, and that was in 2007. And um here I am at the month 2027.
SPEAKER_05There is hope for you.
SPEAKER_03And it it your story may not look like my story, and that's okay. Find what works for you, find the people that can help you and don't take no for an answer. If you know something's not working out for you, or you feel that there might be something else going on, do your own research and take it to your healthcare team.
SPEAKER_06I love it. And build a good one, I think as much as you can. I so it's wonderful. I think what might be good is um to have on a doctor that knows kind of those pieces, those underlying pieces, what was going on with you and you know how they affect the brain and how they affect the body so that people I think we hear these things, right? Um, and uh we hear things like um, you know, metabolic disease, and we hear these things about, you know, diabetes and obesity and all this different stuff, but understanding what's actually going on in the body, at least from from what we know, I think it's really important. And it's we do have specialists that study this and have been learning this, and they've been learning so much, so much about obesity and these related diseases and disorders, you know what I mean, and how complex it is and how it's multifactorial and all these things. And um, so I think it's good for us to understand how that works. Um, and it I don't know about you, but it just makes sense to me. And it also allowed me to be like in a place where I could forgive myself for talking to myself exactly how you said you did, right? Yeah, I love that myself. Yeah, I think just understanding the piece of of understanding why it's happening, and it's not just you and your brain and your willpower is very freeing, you know, because then you can be like, it wasn't my fault, right? It was biological. What pieces can I control? What am I accountable for? You know, which is exactly what you did, you know? Yeah. So I just love that. And uh congratulations. I'm so glad that you're doing well and on the other side of it and helping people. Yes. Oh, have you remembered to comment, like, subscribe, share, click the reminder bell wherever you're watching or listening to this podcast? If not, please do it now so that you can help us grow and help more people. We love you. Hope you're enjoying the show. All right, all right, let's invite it. Uh Doctor in Doomlight. Is there anyone?
SPEAKER_04Dr. And you're welcome in.
SPEAKER_01I'm great. Thank you so much. And what a what a what a uh deeply affecting and and really helpful conversation. Uh really wonderful to hear. Thank you, Amy, for sharing.
SPEAKER_06Thank you. Thank you. Um, so what we usually do in the beginning with all of our guests is ask you to tell us a little bit about who you are and how you help with that.
SPEAKER_01Sounds good. Uh well, thank you so much for having me. Uh uh so I am a preventive cardiologist. Uh, I care for people. Um, well, I care for people with existing heart disease, but I also spend a good amount of time trying to help people not develop heart disease in the first place. Uh, in the when they have what we call risk factors, things that make heart disease a little bit more likely. Um, so I got drawn to the idea of prevention from a really early age, doing kind of health fairs that my mom dragged me to when I was a high school student. Uh, so I was really always interested in trying to, you know, help people optimize prevention. And um early on, um, prevention was very much about um high blood pressure, high cholesterol, not smoking. And those things were obviously super key, super important, super uh relevant today. But uh I also over the years noticed that there was a lot of what we call residual risk, kind of remaining risk that was laying on the table, and things that we just weren't really paying attention to, things that we weren't addressing, we weren't helping people with, and also things that were increasingly becoming the causes of cardiovascular disease. Uh, and um, that's the stuff that we're talking about right now, things like uh the metabolic health and things like the uh um you know chronic kidney disease and kind of the relationship with adiposity, as we'll talk about with obesity. And these challenges were things that we just weren't addressing, and their interconnectedness were things we weren't addressing. So I think that that really is the origins of this broader concept that we're starting to talk more and more about today, which is this CKM health that Amy brought up.
SPEAKER_06Yeah, absolutely. We'll talk all about that today. Great.
SPEAKER_04Weird out really, really, really, really, really big. Um, I know I have a question set up, but can we go over again uh and define what CKM is?
SPEAKER_01Yeah, so uh CKM or cardiovascular kidney metabolic health really uh just reflects exactly what Amy said, uh, which is that there is a close connection uh between metabolic conditions, so things like obesity, but really excessive and dysfunctional adiposity, so fat tissue, um, and with uh other factors like diabetes and like high blood pressure and abnormal cholesterol with chronic kidney disease and with the cardiovascular system. And it occurs along a very predictable spectrum. So basically it starts from early stages where silently uh fat tissue is causing some early challenges within the body and it progresses to the overt or the earlier development of metabolic factors like diabetes and high blood pressure, or also the development of chronic kidney disease. And then eventually you start seeing subtle changes in the heart, subclinical, what we call that, so not yet clinical, like a doctor would necessarily pay attention to it, but early changes in the heart. And then that's the precursor, the predecessor to actual cardiovascular disease. This process, that spectrum takes many, many years to occur, but it is often very unrecognized and it often goes unaddressed, and it's increasingly the cause of not just heart disease and kidney disease, but early mortality. And um, as a result, it's something that we are needing to pay attention to. And because all these things are interrelated, it tends to happen not just one condition over time, it tends to be clusters of conditions that become more and more complicated to manage.
SPEAKER_07Yeah.
SPEAKER_04Wow. That's like that's like that kind of tees up to the question. The original question that I had was like how um, you know, diet culture and the bias in medicine is sort of progressive. Us to kind of go back and look at what you're you're speaking of with the with the foundation of the adiposity and the fat tissue. Um so basically, like metabolic diseases really starts here. So basically, my question was to the audience can you help us understand what metabolic disease really is and how it affects all the organs, pancreas, kidneys, muscles, all that good stuff?
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SPEAKER_01Yeah, this is a whole body issue, and it's a very um, it's a very um, yeah, it's just very widespread. So what tends to happen is metabolic diseases reflects all of these multi-system consequences that result because of this um adipose tissue in the wrong places with the wrong kind of function, secreting things that are harmful for the body. And then it can cause widespread challenges, can cause it across these other metabolic organs, like your pancreas and and other tissues, but can also cause it in your cardiovascular system and it causes it in your kidney system. And over time, you just get this progressive damage that leads to more and more uh eventually clear diagnoses of bad clinical things um and and and a lot more challenges. But that's the concept metabolic or are these consequences of excess and dysfunctional adipose tissue, fat tissue.
SPEAKER_04Storm has been a brewing. Yeah. Storm has been a brewing.
SPEAKER_01And actually, the so so the the spectrum I described um is actually one that uh unfortunately increasingly starts among youth. So this is not, we tend to talk about the kind of adult diagnoses for things most of the time like diabetes and high blood pressure, but underpinnings of this actually start quite early. So, and it's increasingly the case that we're seeing that. Um, but to your point, the storm's been brewing, it's often a very silent storm for a long time and unrecognized. So this is kind of calling recognition to challenges that we just have not been addressing for a long time.
SPEAKER_06Yeah, yeah, absolutely. I think that's true. I think you've already answered the question I had before that, which is sort of the um the idea of this being progressive, right? Which I think is what we were saying in the beginning, like how do we get ahead of this or reduce it or slow it when these things start to happen? Because I think when and and and correct me if I'm wrong, but if you're have a kid, oh, that's you know seems perfectly healthy, um, you're not gonna be checking heart indicators, right?
SPEAKER_01Yes. Uh that is is very much the case. Now, um I think uh it goes to a lot of uh what you all were saying just to start with. This is really complex. Uh and one of the biggest failings that we've had in the medical world is that we um treat all these issues, particularly with relation to obesity, as personal responsibility and individual failings and you know just cosmetic, whatever we want to call it. And as a result, we do so much disservice to every aspect of uh the health issues that we're describing and the complexity of these challenges. Uh, I I, as a preventive cardiologist, I I don't think I've met a patient with uh who is it who has you know any excess weight who hasn't tried different diets. I haven't I don't know that I've met somebody. Um, but it's not about that. And it's not about saying, you know, shaming people or saying you need to eat less and move more. It's about recognizing that there's a lot of complexity that contributes to this. And in fact, it's not just the biological complexity of all the metabolic consequences I was talking about. Once you uh once you develop, and I'm sure you guys talk about this all the time, but once you once obesity comes into place, that set point that you described, your body does a thousand things to keep you there. Like a thousand things. Like it's your metabolism, it's your appetite, it's your hunger, it's the food noise, it's all kinds of things to keep you there. So this is uh uh as chronic of a challenge and as not a personal individual failing as anything out there, but we're not equipped. As you said, we have very, very little training in this regard, and this is uh something that we don't think about. But I will say, in terms of the chronic progressive component, um two things are really important. First of all, uh these challenges can develop really at all levels of weight. So we can see this from some individuals who just have a little bit of excess fat and then we or you know, and not see it in some other individuals, and in some other individuals we see rip-roaring consequences. So it's like it's very, very variable. Um, and that really makes it important to focus a little bit more on health, not just the numbers on the scale, but actually what's going on for that individual in their body and how can we best support you? So I think that's the piece. And when we start to have these challenges, they do accumulate over time, they do become more complex over time. So if we identify things earlier and provide support earlier, it's less likely that we get to the very, very multi-system complex stages. And some of the things that Amy was describing, um, you know, we potentially can avoid or at the very least really delay substantially those challenges.
SPEAKER_06Yeah. Something that Amy was talking about that I feel like resonated with me is um sort of talking about food as an addiction. But as I've learned, and the one thing I will say is in all fairness, when I speak, sometimes I'm speaking about myself, sometimes I'm thinking about what the doctors have told me about most people, right? You know, um, but while I think that I'm not that I'm it's not that I'm saying that food addiction doesn't exist, right? I I'm not saying that. Um, I think that there's just like you said, like it's complicated. There's like lots of reasons. But for me, it was easier when I was young, you know, when I struggled with this, because like I remember being eight years old and my mom making spaghetti and bargaining with myself at the table at eight years old to not go back for seconds and thirds. And so when I was addicted to food at eight, do you know what I mean? And I was big, you know what I mean? And so, and my family, my my dad's side of family, tall big people, you know, and I think there's just so much to this that it's it's so interesting when it comes to like weight and weight loss and metabolism, how much we have oversimplified, right? What's going on in the body to blame you for one of the most complicated things there is at their treatment, you know?
SPEAKER_01We it's it's it's remarkable. I I I I mean, and as a physician, I will say it's remarkable what a bad job we do in this regard. And and and the simplification that we do uh really makes it so much easier to stigmatize. It makes it so much more likely that we discuss things in really judgmental ways. And all that does, number one, is make people just not want to engage. Uh and and it actually is associated with worse health outcomes. So the people who have a better appreciation of the complexity, number one, are able to describe and think about things in much, much less none judgmental fashion, and then are much, much more effective in engaging. Um, and it doesn't mean, hey, that means you're gonna attribute everything to weight and ignore concerns. It doesn't mean that every day we're gonna be talking about weight loss. It just means that you have an appreciation of the complexity of everything that's occurring and that you want to think about this as a whole person with a lot of things going on, and you want to provide appropriate support. So I hope we can start moving the conversation forward in a way that is less of what we've been doing historically.
SPEAKER_06Me too. That is what we were working on, side, right? And I think Amy even as well, right? They discuss that there are complexities at these because people are worthy and and and deserving care, you know.
SPEAKER_03I may fake him um when you're talking about wanting to go for seconds and thirds at eight years old. Um I always from years and years ago, I was always like, why can my friend be a half of a hamburger and be so full that she feels like she's gonna bust out of her genes, and I could damn two hamburgers, and it took me that long to feel like that. Like, what is going on with our brain connection to our stomach connection that we're not getting that um that signal that we're gonna do? Yeah, I I never in my earliest years could never understand why my brain did not signal that I was full when my girlfriend could do that.
SPEAKER_06Yep, crazy.
SPEAKER_03Why aren't we talking about that more?
SPEAKER_06I'm talking about it a lot.
SPEAKER_04Yeah. Speaking of like it being like as complicated and complex, and that was, you know what, Amy, you just teed it up for me. Um teed up this question perfectly. Um, speaking of complexities, can you explain insulin resistance, leptin resistance, visceral fat, adipose tissue, all that good stuff. Um, maybe in a patient-friendly language, if we can. Well, I'm sure we can.
SPEAKER_05We're trying. Yeah, I think we should be able to do that.
SPEAKER_04You can do this. Okay, so concepts and uh helping patients better understand um treatment.
SPEAKER_01Yeah, so this, so, so uh and I think this is actually really important because uh this uh just like Amy described, this is something we're helping doctors get more comfortable with, but also the more patients are empowered with this as well, I think that has a synergistic effect. So I think this is really important. So these things that we're talking about are kind of some of the core elements of CKM syndrome. So I think first uh adipose tissue, we'll start with that. So adipose tissue is really just about fat cells, so fat tissue basically. Now, fat tissue can occur in different places. Um, the main two places that we think about for fat are in the subcutaneous space. That's like in the surface. So that's kind of almost on the outer part of the body, so under the skin, but on the surface. And then the visceral fat, which is more inner, so like kind of under the muscle and like within. And that visceral fat is actually where we see the most metabolic consequences. All these things we've been saying about metabolic health, it usually comes from visceral fat. Now, what's interesting is that some people at the same level of adiposity or same level of weight, let's say, some people have more in the way of subcutaneous fat, and their metabolic profile is gonna be less concerning. And then some people at the same level, and it's probably genetically mediated, have more in the visceral cavity, and then they're gonna have a more abnormal profile. But you won't know that unless you start understanding and examining and looking for these things. That's the first thing. So visceral fat is about fat being within the most of the time in the abdominal space, like within, but then all not just on the surface, and then also built up in organs where it's not supposed to be, which we call ectopic fat. So basically, it can build up in the liver uh and then lead to more inflammation and some of the other things you're gonna ask me about insulin resistance, uh, but it could also build up around the heart, around the kidneys, around the blood vessels, and these different places it builds up can either cause local inflammatory effects that impact the function of that organ, like the blood vessel or like the heart or like the kidney, or it can also cause systemic effects because those fat cells start secreting bad humors or bad factors that cause challenges throughout multiple systems. So that's how you can think about visceral fat. Insulin resistance is a very important challenge and a marker, it actually goes very closely in hand with inflammation, which is your body getting all like so inflammation can be acute, like if you have an infection, you're you know, get a fever and white blood cells get all red done. But here we're talking about a more chronic inflammation. It's like a low-grade reva, but a low grade like irritation and heat in the body that occurs because of these visceral uh and excess adiposity we're talking about. That the consequence of that is often insulin resistance. And insulin resistance is how your body is insulin, is a hormone that impacts how your body uses sugar. Am I doing okay in terms of explaining that? Okay, I want to make sure I'm not getting too much. Yeah, no, it's fine, yeah. So insulin resistance, insulin, sorry, is a hormone that impacts how your body uses sugar, how it handles sugar, glucose. So basically, uh when you over time, when you get more and more of this inflammation and insulin resistance, sorry, inflammation and adiposity, and especially ectopic fat, even in the pancreas, for example, as well, over time you start getting more and more insulin resistance. Your body becomes resistant to the effects of insulin. And when the body becomes resistant to that, then your blood sugar starts going up and up and up. And eventually, as your uh pancreas starts working harder and harder to overcome that insulin resistance, at some point the cells in the pancreas start tiring out and you can get full-blown diabetes. But before that, we see what we call insulin resistance, and then it can kind of get worse over time. Uh, leptin resistance is a similar concept of being resistant, but leptin is a very, very important and interesting hormone that impacts how you're um, it has a direct impact on metabolism, it has a direct impact on fat storage, but it also impacts how you process hunger, how you actually when you feel hungry or not hungry, and when you feel satiated or uh satisfied, and when you're not satisfied, and that's very biological in that regard. And actually, leptin and some other adipokitins are actually predictors of are you more likely or less likely to progress along that CKM syndrome spectrum. So it's actually very kind of biologically all interrelated, all these factors here. But those are all those different pieces. And what happens is when you have more visceral fat, it tends to lead to more inflammation and insulin resistance. Leptin resistance is more likely to make you spread along this spectrum, and then you're more likely to be needing more urgent support uh for some of these challenges that we're talking about.
SPEAKER_06Yeah, yeah. That's so I know. I've been learning so much about that over the past few years, it just blows my mind. Like, um, I had a doctor on the show and a VC specialist a few weeks ago that said that like one of the like treatments or cures or whatever for leptin resistance was to lose fat, but that a lot of people can't lose fat because they have insulin resistance. Oh, yeah. You know what I mean?
SPEAKER_01And I'm just like this is so freaking complicated. And that's why, by the way, it's so challenging to tell somebody, oh yeah, just just go do something about that. When there's the most complex challenge going on, it's super biological. And then yeah, you are absolutely gonna go and you're gonna do things that you don't want to be doing because your body's gonna tell you to do those things constantly because of all this complexity. So absolutely. This is why we need to do a better job of supporting these.
SPEAKER_06Absolutely. And I will tell you, I mean, I'm we're recording this July 2nd. And while I am thrilled that our seniors are gonna have access to this, I'm highly concerned because this is incredibly complex. And um, I'm I'm I'm worried like that we don't have the infrastructure to support them and like to understand these things. And it's way more than just side effects and people think that like these GOP ones are just set it and forget it. They're not, and this is why. Anytime anybody ever thinks I just need my medicine, I want you to play back the last 20 minutes of this conversation because what happens is as you start to treat these things, other things change in your body and your body adapts. So you have to like always this is not a set it and forget it thing, it is a chronic disease and you deserve care. So make sure you get good care. Okay, I'm gonna go off my pedestal.
SPEAKER_04I probably say because your bodies are flipping smart. Yes, millions of years of evolution, right, doc.
SPEAKER_06Like, I mean, it's like you know, it's they're smarter than we are.
SPEAKER_01They are uh yes, and they really do they they govern these things. It's a remarkable. I, you know, it's uh personal willpower is often the mantra that so many people think about. And the reality is your body tells you when there's a bigger story, and and the big it's this is a bigger story. This is not about individual willpower or personal failings, right?
SPEAKER_06Like it's epic, right? Yeah, I think um sorry, I mean product. Um, yeah, and I think that um, yeah, I think that's so true. And like um, I wonder too, I've had some doctors on recently that have said things like genetics plays a big role in this, right? Um, you know, and I'm curious, like in terms of aligning with you know the new guidelines, right? Yeah, like how do you how does that align? Like um, I've had some doctors say, you know, 40% of your weight, of the weight that you're gonna be, right, is is genetically predetermined. Like you can't even touch that, you know, and then if you have all these other things that are complicated on top of that, it makes things even more complicated, you know. What do you think about that?
SPEAKER_01It is it is complicated, but again, it's honestly not gonna be that simple, unfortunately. I wish I could make it more simple. I wish it was, right? So so so what happens. So what happens is for obesity, there's a good amount of heritability. So is you know, if it and does tend to be, I don't remember the exact numbers, I want to say like 40 to 70 percent, but you know, between from one generation to the next, you know, that the weight patterns are gonna be similar. Now the question is to what extent is that all biologic, to what extent is that all social, to what extent is that all environmental, like what exactly is going on there? So if you look at um genetic studies and do uh like uh look at single genes, those single genes, and there's been a lot of studies, like those whole genome-wide association studies, we look at all the genes in the whole body, um they explain these individual genes a really small amount, like a really small amount of how much of the uh of uh weight is explained to those genes. Now, uh that being said, uh something I do find very, very interesting is that if you take the genes and don't just take individual genes, but put them into a collection, like a polygenic store, then you get start getting a little bit more information, but still not enough. But then if you take those genes and you put them together with your environmental situation or your kind of exposures or health behaviors together, now you start seeing a synergistic effect. So for example, let's say you um look at the impact of drinking sugar sweetened beverages like sodas and stuff like that. So if you look at the impact of that, and generally that's gonna be associated with some weight gain. However, there's a synergy between your genetic risk and that activity with regards to how much weight you gain. So the person who has less genetic risk is gonna be less genet consequences, but it's actually amplified in the person with more of that polygenic risk that you're gonna get a lot more of that. So there is, I think, some of the most interesting is the polygenic piece combined with the environmental piece over time that we see more of that synergy. That being said, we still don't fully understand.
SPEAKER_06They had to tell you I wish I could tell you we did, but we no, I I that's what I that's why we kept this podcast going for as long as we have, because every time we talk to somebody, we learn something new. And like I had this guy on the uh this this um researcher and doctor and like founder in this field on before, and he said there are things that GLP1s are touching in the body that regulate weight that we don't even know about yet. And I think the reason we can say at this point that it's not your fault is because it's a freaking crapshoot. Like you like, all you could do is what you could do. Yeah, you know, yeah, but I think like a lot of us um who have obesity would love for our children and our children's children and children's children to be able to find a way to either prevent it or slow it or manage it, or God's sake's cure would be amazing. But doesn't sound we're close to that part yet.
SPEAKER_01We're not there yet, but I will say that we so first of all, I do think we can do some things better than we have been doing, and we're starting to. There's the opportunity to do so. Uh, and I think you're getting into uh a few of those. So, first, I think I think even just starting without the the non judgmental discussions and the better understanding of the complexity of obesity will be. Changing the conversation around uh obesity and adiposity will be a huge starting point for the medical community because then hopefully that can translate more effectively to how we're discussing things more broadly and stop thinking about this as a shaming issue or a stigmatizing issue or a cosmetic issue. So I think that's the first thing, and focusing on the health piece of this overall. The second piece then is that we do know that when you have uh um this, the first line really needs to be not just saying, oh, eat less and uh and and and exercise more. It's actually about a full support for behavioral change. So basically, I work very closely with a uh a clinic in uh where I am, I'm a Johns Hopkins. And basically, our clinic is a clinic that supports kind of a whole person behavior change. And it's about you know a lot of different elements that people are doing and changing their overall triggers and structure and how they're responding to various stresses. It's a broader behavior change framework, and then using that to support healthier lifestyle activities, including better sleep, better exercise, understanding how to address and deal with stress, and then how to make both a dietary milieu and dietary choices that are healthier for you. So that's all first line. Now that is not a one-time thing, that is not a doctor saying you gotta go do this. Is a long-term chronic thing, and we will see some weight regain with that because your body will do some things that bring it back, and that's what it happens. But there's an importance to that for a couple of reasons. Number one, it's gonna have a synergistic benefit along, well, at least an additive at least benefit along with the other therapies we're talking about. But number two, there's these other things that go on in the body that we don't measure that happen as a part of this poor metabolic health. So basically, your body, the inflammation we've already talked about, but then your platelets get more sticky that make heart attacks and strokes more likely. That's pro-thrombotic. Um, your blood vessels, there's something called endothelial dysfunction, where they basically don't kind of function the way they're supposed to and make some of these other consequences more likely. Um, and there's actually even the size of the cholesterol particles, they get smaller, and there's more of them that are more likely to stick within the artery walls in this setting. And a lot of those things are just harder to you can't just medicalize. So you have to do the lifestyle pieces to kind of mitigate some of that in addition to the other things we're thinking about in terms of GLP1s or surgery or everything else. So those things are going to be really helpful, but you still have to, we need to better support the lifestyle behavior modification piece as well.
SPEAKER_04Absolutely. So all that lifestyle stuff. How do they work alongside the medical therapies?
SPEAKER_01But you kind of just there's it's it's super important. And I talk to my the people who I see all the time. You know, uh, we are we see tremendous uh results when we pair those two things together and actually continue to chronically support them. And it's this isn't about health, this is about people feeling a lot better, and it's about people having better health indices, but also just feeling like, you know, they're just feel better and and they're happier. Um, and uh, and also I will say um Amy made a really, really good point with regard to the mental health piece. Um, that is something that we are also not very good at and we often ignore. We describe it in the CKM health framework as a risk enhancer. It's just like you know, having a family history of diabetes or kidney failure, or having, you know, a chronic inflammatory condition, things like psoriasis or rheumatoid arthritis, those amplify this risk that we're talking about. Mental health conditions are just like that as well, and are likely to just basically make it that much more that you've progressed along this. So we need to better support that, and that also can get better with these approaches we're talking about too.
SPEAKER_06It's funny, I've told Kat several times. I'm like, I swear that when people talk about the work on GLPs, in my opinion, the hardest work is the mental piece. Like I talk, I Amy, I think you'll understand this. Like before I was on GLPs, and keep in mind, I do not, I think everybody is evident. I don't think they're the end, I'll be all. I just think they're great tools, like not even a tool. I think they're a treatment. Yeah, I don't even call it a tool. Like, because to me, a tool is diet and exercise. Like to me, this is a treatment. It's taking medicine, it's a treatment for disease, but I see it different, you know. But the the the movement and the nutrition piece, it blew my mind how autumn it's it's sort of the medicine kind of got me in a place to receive the therapy. Does that make sense? Like, so like I automatically, within once I got to like whatever therapy was for me, didn't even think that any of the things that I ate before that maybe cause all these different things with car, you know, that we're just talking about the stickiness and all that. I didn't even want those things anymore. And if I did feel like I wanted them, I just did a few bites. And just like Amy said, I would crave salmon and Brussels sprouts and things like that. Rice I still like, ain't gonna lie. But you know, that's the kind of stuff that I would want. And then I found I automatically had was was just lighter in my brain. And then I wanted to move and I wanted to go do things, and I was interested in other things, like for example, sitting on the TV. I mean, I used to be a big binge watcher, bench podcast, binge television. I don't binge anything anymore. Yeah, and it's been four years, you know? So it's like there's lots of things like that. But do I have slide backs? Yeah, my sister just passed away. I'm going through perimenopause. I've had some ups and downs and the weights since that's happened. And I think if anything, it's just like made me realize again that it is complicated, that it does change, that our bodies do adapt, and then we have to constantly revisit, right? Where are we now? Right. And I think that piece of it people don't necessarily realize or talk about because even though GLPs have been right in market, if you will, a long time. Actually, matter of fact, the cardiologists that I've had on our shows have told me they've been prescribing them forever. They're like, they're great. We know we've known about it for a long time before any of these other people were prescribing it. We were, you know, cool kids first. Yeah, that's what the cardiologists always say when they come on. Yeah, yeah.
SPEAKER_03But I think um it's interesting that you say that because um I didn't talk to my cardiologist about a GLP one until I worked with the CKM panel. And it was several people in our panel that were like, I am on this for my diabetes, it's been a game changer, it's good for your heart disease. And I was like, why has anybody talked to me about this? Why am I still taking that gym and it makes me more information? You know, so like the doctor was like, hey, what do you think about this? Is this is this an option for me? Let's let's go into it. So yeah. Yeah, that's awesome.
SPEAKER_01I've heard what you've said a lot, Kim, that people uh find that the uh it's often the case that they are more ready to receive and engage with the healthier choices with the GLP ones. It's actually quite remarkable how uh, and you don't think of it then as like exercise prescription, but people are like, I'm more likely to engage in my exercise. Like it's it's it very much as receiving that.
SPEAKER_06So yeah, it's very yeah, it it it's utterly and it's interesting because I've asked doctors before, why does that happen? Why do we not think that stuff tastes good anymore? Like, why and the road? It's like we're we're we're team that let's do that, you know. But like, but we we don't know, but let me know if you learn. And I'm like, sure, and you let me know if you learn. But I think that's back to what you're saying, that the piece is that this has all been uh we're cats at the storm has been brewing a long time, right? And so it's like you know, it's it's it's complicated. There we go.
SPEAKER_04Like it's it's so orange cones.
SPEAKER_01Yeah, but do you want do you want to I'm happy to say a little bit more about GLP ones because you know, I think there's a couple things that are really important to know, recognize about GLP1s. Um uh so obviously we'll we'll start with the weight because that's what we are talking about right now. And they, you know, so you know, the one thing that I would say that's you know, beyond the fact that, you know, you know, the clinical trials of semaglutide and trusepatide show about a 15 to 20 percent, you know, weight loss. I actually tend to see even greater weight loss in the context of kind of the aggressive lifestyle changes that occur, but still at least around that range for many people. It's all across the spectrum. Some people respond less, some people respond more, but we tend to see that. Um the interesting thing about it is that um, you know, when we do a lifestyle change by itself, those compensatory mechanisms that the body does, we tend to see this curve where we go down and then we tend to go back up. We don't always go back up all the way to where we started, but we almost always go back up. And it's just a natural trend that happens because of all the compensatory mechanisms. For some reason, the GLP1s seem to combat a lot of those compensatory mechanisms. So the curve just looks different. You just have this, and then at some point there's a plateau. Things can go up and down, as you said, with life changes and other things, but generally we see more of a stability at a certain point. And that's just a very big difference that lack of that compensatory rebound that we've seen before. So that's number one. The number two is that we see uh uh it has a direct effect on glycemia. It affects how we uh our bodies use glucose, glucagon, and glucose and all these hormonal changes, and basically will lower the blood sugar, sometimes pretty dramatically, actually. And for many people, let them get off of insulin because it's that good from that standpoint, or at least lower the insulin dose. So that's helpful. We tend to also see all these kind of metabolic factors, we see those also get better as well. So blood pressure and cholesterol and inflammation, all of those we see kind of going in positive directions. Most recently, what was most surprising to me actually came out right after the CKM initial initiative. We rose recently had guidelines, but but the um kidney factors get better with GOP1s in diabetic kidney disease. They actually we see those get better as well, and uh we see uh in that setting mortality be improved as well. So that's remarkable. And then we also see very substantial cardiovascular benefits. So we first started seeing a lot in terms of less heart attacks and less strokes and less death from heart disease. More recently, we've also seen for the newer agents improvements in heart failure as well, um, rates, and all of those things are occurring. And interestingly, the last kind of outcome piece I'll say is that we see that those benefits of cardiovascular benefits seem to be largely independent of how much weight you lose. So it's not really related to the weight by itself. The weight is certainly beneficial in terms of that, but there's something more a direct cardiac benefit that goes above and beyond that. And that actually is real, there was actually an older GLP one that we don't use anymore called albigutide. That one didn't really have a big impact on the other.
SPEAKER_06That was for the Adam's fat.
SPEAKER_01Yeah, I believe so. Yeah, I think so. I think so. I don't use, I don't, I I uh the older one. Yes, the older one, but it's not on our market here anymore. Yeah, but but uh but but albiglutide, even though it didn't really have a big impact on weight, it still reduced cardiovascular events by more than like 20 something percent. So so so it's actually kind of uh it really speaks to the fact that there's multiple benefits of agents. How yeah, just like you said, how they impact uh weight, we know that they change, they slow gastric emptying, we know that they change something about the signals in your brain and satiety and also appetite. We know that they probably are impacting, lowering some of these bodies' compensatory mechanisms, but as everybody else has said, we don't fully understand all of the benefits of these, we just know that they're super freaking beneficial.
SPEAKER_06Yeah, right. I mean, it's funny. I had this it was the first season. We had this doctor on the show that is a bariatric surgeon, and he saw this shift right away. Like as soon as it was like, Oh no, I see where this is going, you know, and he came on the show and he goes, Listen, because I you know I asked him to explain to us how we can understand. He said, Well, years ago, we were doing bariatric surgery on people that have type 2 diabetes, and GLP1 exists at the bottom of the intestine, and we were taking the bottom of the intestine and moving up to the stomach, and it was bursting GLP1, and people were walking out of the hospital in remission from their diabetes, but they hadn't lost before before losing weight, before losing weight.
SPEAKER_01That's where I first learned about that's where I first learned about GLP1 was in this context of the changes hormonally that happened in biological surgery before uh weight loss. And that's of course where everybody got super excited, and now here we are today.
SPEAKER_06Now here we are today, and the other ones coming down, and it's funny because a lot in the community, it's a lot, a lot of the conversation right now is I've had some regain, it stopped working, I've plateaued no matter how much I reduce my caloric intake and exercise, I can't lose anymore. And then people barking at each other, like that's a bunch of crap, just keep reducing your denominators, you know what I mean? And I'm just like, and I just must be real, it's far more complicated.
SPEAKER_01Yeah, it is, and everybody has their spot that they can they get to, and then it seems to be the case that we'll plateau. Then in that setting, then the question is okay, do we do a different agent? Do we do something else? But to say just try harder, that misses the point. The point is that everybody's body is different and how they respond is different, and there's often a plateau.
SPEAKER_06Yes, absolutely. Yeah, that's what we try to talk about too a lot on here with the doctors, because everybody thinks like it is it is a common misconception that if you continue your lifestyle changes, do all the right things, stay on GLP one and stay in your deficit, that you will hit your goal weight and you'll hit it fast. And that you may not need another agent or you may not need additional therapies. It is a very common misconception, and it's because of the way things work with the algorithm on the internet, right?
SPEAKER_01Well, can I could I say one more thing about GLP1? Absolutely.
SPEAKER_05Say whatever you want.
SPEAKER_01So, um, and this actually is more emblematic of this broader concept of CKML. So it's interesting because GLP1s are directly impacting visceral adiposity and inflammation and insulin resistance and metabolic risk factors and chronic kidney disease and cardiovascular disease, they're actually kind of pretty perfect medications right now in terms of impacting all these parts of the CKM pathophysiology or disease processes. But the broader piece is that these things are so interconnected that it actually can't be the case that I, as a cardiologist, like, oh, I'm just gonna pay attention to the cardiovascular issue, or the endocrinologist will be like, well, I'm just gonna talk about the hormonal issue, or the kidney doctors say, I'm just gonna talk about the kidney issue because everybody we're seeing has the same stuff and all these interrelated things, and it crosses our silos and the medications we use, the GLP1s, but there's other therapies these days as well, like these SGLD2 inhibitors, they cross silos, they actually have multi-system effects. So basically, one of the real goals is for us to stop focusing on our specific silo, but to talk about the whole person and to be thinking about for more clinicians to be thinking about the whole person. So the good thing about this guideline that we just put out for it's not just an American Heart Association guideline, it's American Heart Association, American College of Cardiologists, two heart associations, but it's also the American Diabetes Association, and it's also the American Society of Nephrology, and it's all of these different groups together so that you can stop going to different doctors and hearing different messages, and you can stop going to different places and be like, who's gonna take in charge of this? We should all be engaging in this whole person approach. So that's part of the hopeful goal for this.
SPEAKER_06God, I love that so much. I was could that happen right now? I that would be wonderful because so just like Amy said, she would go and talk to these people on their silos or their specialties. Let's face it, a lot of this is because of our insurance system and healthcare system, but our system and trying to find a way, okay, well, what does this work for me? And then you're like your own mad scientist trying to figure out what works for you and your body. But if there was a way for us all to talk together, like I mean, it would just be amazing outcomes for our society and for our health. You gotta get approved for that, Kim.
SPEAKER_04Remember, you guys.
SPEAKER_06I know, right?
SPEAKER_03For me, um, three of my doctors are all within the same hospital, the same network, and all that. So I made the assumption that they could see the note that the other doctor was saying, and they're they could be like, hey, well, this doctor is saying this to her, and this doctor's and I would go the amount of doctor appointments that I have are ridiculous. Don't don't give me reading that. Sometimes two doctors in a day and tell your story and you're over again. Especially if you're having to um to reconnect to to connect with a good doctor because I during all of this I moved from I moved to A. So I just started all over again. But to not be able to communicate with each other and to tell your story constantly and to get different opinions. I don't want to say opinions, but opinions is so confusing as a patient because you don't want to be considered a non-compliant patient. That's the last thing I want to be is a non-compliant patient. But I have this doctor telling me this, and I have this doctor telling me this, then they kind of intertwine, but then they're also opposite, and so it's very confusing as a patient. So that's why I'm so grateful for this CKM um initiative that we're finally getting to the point where we can talk about all the things and do what's best for the patient as a whole.
SPEAKER_06Absolutely. I love that. And that you know it's probably a really great way to end things. Like, I just I think that's fantastic. Um, let's make sure everybody knows where to find you both. So go ahead and tell us um where they can find you, where they can find more information, um, so that they have uh somewhere to follow up, or they can, you know. I think I like to I like to always end with something like uplifting because like sometimes this can be really sad. You know what I'm saying?
SPEAKER_01Like, like well, actually, I could say a quick uplifting thing, actually. Um, so two things. One is what you asked. So uh in terms of where to find, so there is a really great website. If you go online and you look for just Google CKM or say CKM Health, you'll basically find a website with a ton of resources for patients that will give you kind of know-how, education. There's videos. You can see Amy's lovely face on there for some of the videos as well, uh, and resources and show you just like what are we talking about and how can you empower yourself and better understand where you are along the spectrum and what keep kind of support you need. So that's one thing. The other thing that I should say is that you know, there's two major imperatives for this kind of construct, this thinking about this whole body uh CKM construct. Number one is that if we start actually addressing this earlier in the process, it's much like and we don't progress either at all or as likely to those later stages. There's so much better survival, better quality of life. We see that, and that's a huge thing. So that's that preventing that progression is amazing from that standpoint. And you can see that. But then the other thing that is important, this is my this is my uplifting attempt here. My last thing is that there's actually a very important concept. So preventing progression is great. But the other thing is that if we recognize things earlier enough in the process, we can actually promote regression, we could actually go backwards and we can lose the criteria for a lot of the things we're talking about. And actually, the study shows that we can go back from that stage two or early stage three back to stage one and back to stage zero, which is not having any of this at all. And we actually can see that. Uh and it's really important, and it's associated also with better outcomes. So knowledge and empowerment is a key part of this, and there's a lot of potential to improve health.
SPEAKER_00Hallelujah.
SPEAKER_06Sorry, spirit.
SPEAKER_01I I deserve that one. It is good.
SPEAKER_06Everybody's dad now. But I think it's great. I mean, like it's so cool to hear that because like my like I'll just tell you exactly what you said about what happened to my dad. So my dad was uh type two diabetic, heart issues. Um, he has uh kidney, he's basically in kidney failure. Um, and then he started uh GLP1. He started on um what's the one that was before all the ones? Started the T trillicity and did that for a while and it kind of helped, but then he went to um, I think Ozympic. And then when he was on Ozympic, he got off insulin. And then his kidney function has all gotten like it's not completely better, but it's significantly better in terms of stages. Um he has a heart valve issue better, you know. I mean, it's like, and and now he's much better. He also here's what's other crazy he has chronic leukemia, and he just recently. Got to a point where it was in chronic leukemia, right? Where it was in such like uh low numbers, like barely detectable, that they were like, To give your kidneys a break, we're gonna take you off your medicine for a while. And this all happened when we started taking GOP1s and thinking about things as a whole, not just you have a diabetes. I just have this, right?
SPEAKER_01So so so to the point you just made, uh we talk about this as CKM because those are all causes related to cardiovascular disease, all these and cardiovascular mortality. But this is not isolated to those. So you see improvements in the cognitive stuff, you see the liver. Cancer is actually strongly related to all the things that we're talking about as well. And the quite, I mean, I we don't have enough data like here, Dan, where we see that for remission, but we do know that addressing this makes that stuff less likely as well. So there are whole body consequences for what we're talking about, but also whole body benefits for some of these changes we're talking about as well. So, yes, this is not isolated to a couple of organisms within our acronym, but it's really about the whole person. Absolutely.
SPEAKER_06Yeah, absolutely. I love that so much. Um, do you have any socials that you're on that people could follow, or should they just go to this website?
SPEAKER_01I uh so I am on, I am not the most active social person, but I my name, Chiadi and Dublin, is my is my is my so is my social media handle on Twitter, and I will occasionally try to uh provide some medical insights around these topics.
SPEAKER_06Wonderful, wonderful. What about you, Amy? Can people find you on social?
SPEAKER_03Um, yes, I am set to five it, so you gotta prove to me that you're a good person. I like it. Um I am on um on Instagram at Ninth Amy uh3. And I just wanted to para off of Dr. Nimba. Sorry, Dr. Chiadi. Right.
SPEAKER_04Um I'm a word nerd and Doomalay is just anyway.
SPEAKER_03I just wanted to para off of him that the American Heart Associates Association has a great website. If you go to AHA.org and you type in the search engine CKM syndrome, all this information is coming up. And you know, they've worked really hard. Um, I'm very proud to be part of the work that they did. A little part, they've they've just done amazing, and I'm so proud of it of the work that we've done to get any questions answered um in there and to talk to your your healthcare team about you know what you you're feeling, what you're learning. Um and my kind of takeaway is that there is health. You know, I was literally at the moment in my life, there was other things going on in my life that I really think I would be where I am and to have the hate that I have, the endurance that I have to keep up with my grandchildren and to um go in little like little hate the little things that I don't take for granted. I have so much gratitude for and um to be able to share my story. I've I've been able to share it at a local level and at a national level, and I'm just so grateful to be on the other side of it. There's hope in numbers, there's hope in therapy, um and the people got this. It's just a matter of you know, finding the right people to support you physically, health-wise, emotionally, and to believe in yourself that you can get through the hard days. And there's always that there's always hope in that.
SPEAKER_06I love that, Amy. Thank you so much because we're just gonna go through them a lot because that's how life is, you know. So I love that. And it I really appreciate, I don't mean to say your testimony, but your testimony because it's just you know, so we appreciate you so much, everybody. Um I will put the links that everybody suggested in the show notes because AI will tell me what to put there. Yay! And then everybody can be able to have access to this. Obviously, if you have any questions, you guys know that you can comment and all the things, and I'll I'll get whatever thing we need answered, answered if we can. And I think this has just been a lovely conversation.
SPEAKER_07One more plug.
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SPEAKER_06Cats, cats are she she's always gonna do our shameless plug. Hit all the buttons, do it now. Gotta do what you gotta do, you know. Thank you guys so much. And um, everybody, we love you, and we will see you next week. Asta La Pasta.
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SPEAKER_06We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that'll leave you feeling informed and empowered. Join us every week to learn from doctors who are specialists around GLP1 medications like Ocinfit, Bogovia Manjaro. We'll provide you with science and facts to validate these incredible stories. But that's not all. We'll also bring you the voices of the GLP1 Manjaro TikTok community, real people who face the challenges of obesity-related diseases and disorders, and discovered the incredible plus sides of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovery and empowerment? Tune in to the plus sides, cracking the obesity code, and together we'll change the narrative around obesity and in the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus sides of life together because every story deserves to be heard. Every life deserves to shine, and everyone deserves access to expert knowledge and medication. The plus sides podcast. You're not alone. It's not your fault.