Episode 74: Dr. Weiner’s Take on The Real Fix for Our Broken Healthcare System

 In this episode, Dr. Matthew Weiner takes a bold look at the future of healthcare — predicting that by 2030, the current U.S. healthcare payment system could collapse under its own weight.

But instead of doom and gloom, he explores why this shift might actually improve patient care, reduce costs, and finally force the system to prioritize quality over profit.

You’ll learn:

• Why hospitals can profit more from complications than success
• How the current model discourages innovation and improvement
• What a better, more effective system might look like
• And how this could impact patients using GLP-1s, bariatric surgery, and other obesity treatments

If you’ve ever wondered why healthcare feels broken — and what it might take to fix it — this episode is for you.

Learn more about our Platinum Program here.

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Transcript

Zoë (00:21)
Welcome back to the Pound of Cure Weight Loss podcast. How are you doing, Dr. Weiner?

Dr W (00:26)
doing great. How are you doing, Zoe?

Zoë (00:28)
⁓

I'm doing great too. Body's feeling good after kind of lot of injuries that I've been recovering from. So I'm finally feeling kind of good.

Dr W (00:37)
I'll tell you, it's interesting. I get together with some really good friends once a year and we kind of have a lot of athletic competitions in this. And it used to be whoever was in the best shape would kind of win the event. Now it's whoever's the least injured. ⁓ And I'm quite a bit older than you. So I think you're starting to get a little bit of a taste of what us folks in our 50s kind of struggle ⁓ with.

I've been saying this for over a decade, that the secret to exercise is not getting hurt. As long as you can avoid injury, that really is the secret.

Zoë (01:14)
Mm-hmm, absolutely.

Yeah, and it's so funny because I used to, you know, just jump right into the workout or go running or whatever. And now it's like I need to spend 15 minutes warming up, do my dynamics, stretching and really like make sure that we're safe going forward. So yeah, I'm excited. My half marathon is next Saturday. So we're getting there.

Dr W (01:26)
Yeah.

Yeah. Yeah.

my gosh.

⁓ you know, I've run three marathons, three.

Zoë (01:47)
Really? I didn't know that.

Dr W (01:48)
Yes,

back in medical school. I went for a very brief moment in time where I was super into running and I ran three marathons and I think running a mile right now would be very hard on my body. So it's fleeting. I did it, got the medal, moved on. So I had the most delicious thing.

Zoë (01:55)
Mm-hmm.

You're like, don't, been there, done that, I'm done.

Yeah.

Dr W (02:11)
wife and I made it and it was so easy and fast. I gotta tell you about it. We ate it. like, oh my God, we gotta talk to Zoe about this. chicken, we went to Trader Joe's. The whole thing was like 20 bucks for our grocery list, right? So we got chicken breast and just, you know, we splurged and got the pre-cut broccoli.

Zoë (02:16)
Can't wait.

Nice.

Dr W (02:32)
one less thing to do and love it, love it. And so with a little bit of olive oil, we sauteed the chicken breast and kind of sauteed the broccoli. We cooked them all together and then we added soy sauce. ⁓

Zoë (02:33)
Getting fancy out here.

Dr W (02:46)
salt, a little bit of nutritional yeast. Have you ever used nutritional yeast? Yeah, just a little bit. It's like Parmesan, basically. ⁓ And then here's the magic ingredient, peanut butter.

Zoë (02:50)
Mm-hmm. I like it on popcorn. Yeah.

⁓ you made like kind of Thai flavor. Mm.

Dr W (03:02)
So it was like a peanut butter, Thai, chicken,

broccoli. It literally took 20 minutes to make, 100 % Palme de Cure approved, and it was freaking delicious.

Zoë (03:14)
Yup.

I love that. I will have to try that. That sounds really good. Love that.

Dr W (03:18)
Yeah, give that a shot. Yes. All

right, so what are we going to talk about today? We got some big news articles.

Zoë (03:26)
Yeah, we've got some articles to talk about and we've got some questions. So I think it's gonna be a good show a little bit of everything. So you want to kind of get us started on our big news.

Dr W (03:37)
So mean, the big news is that Trump Rx is going to now offer obesity medications. ⁓ And the details are a little flimsy. Like some of them basically said, they're going to offer WeGoVee and ZepBound at like 350 bucks per month starting, which is what you can get on Lilly Direct right now. ⁓ they're essentially

The details are not, there's not a lot of details and I don't think a lot has been agreed on, but in essence, here's what I'm seeing from this. Traditionally, Medicare, Medicaid would go through pharmacy benefit managers to purchase these drugs and it looks like some of those barriers are being broken down and so.

It's allowing and essentially what we're seeing is the government negotiating directly with pharma, which has been something that has essentially been forbidden, which is one of the main reasons why our drugs are so much more expensive. Every other country uses their buying power to negotiate with pharma companies and we haven't done that and we're starting to. But in all honesty, it's gotten to the point where it's crazy.

And nobody likes the fact that this is they're selling drugs for $1,100 that they make for $5 and these are Medications that we need for our health. That's just you know, that's crazy It's like if all of a sudden you drove out on your main road and they're like that's gonna be $20 to drive down the street today You'd be like, well, that's crazy. I need to drive down the street because I need to go to work But you'd be pretty pissed off about it

And that's essentially what's happening with medications. I need these medications. My doctor said I should get them, but I'm being charged in a ridiculous amount. all of sudden what we're seeing, and this is also in the midst of this government shutdown, which is primarily about healthcare, we're seeing a huge amount of political attention being directed at healthcare. And I think this is just the very beginning. My personal opinion, and you heard it here first,

is that our financial payment system for healthcare, Cigna, United, Blue Cross, Aetna, Medicare Advantage plans, will not make it through the rest of this decade. We're going into 2026, and I think that we won't, by 2030, we will not have a functioning financial payment system. That your typical insurance, and in my mind, this is probably a good thing, because how much worse could it ever be?

Zoë (06:00)
you

Dr W (06:18)
⁓ And perhaps, perhaps it would actually put financial pressures on hospitals, pharma companies, doctors' offices, nursing facilities, all of the healthcare facilities out there to provide higher quality at a lower cost. Right now, there's zero pressure to do that in our payment system, none. In fact, and I always talk about this, if I doubled my complication rate, I'd make more money.

Zoë (06:36)
Mm-hmm.

crazy. I was going to use a different word but...

Dr W (06:48)
Isn't that crazy? Because those complicated, yeah,

take backs and complications, you get paid a ton for those. You do a perfect surgery and have somebody out the door, you don't get paid anything. And so the financial pressures actually support poor, low quality care. And that shouldn't be any surprise because anybody who's been using the doctor lately, that's what you're generally getting. It is not user friendly.

It is not a good experience for patients. And that's we've we got what we created. lot of corporate profits, very little high quality, low cost care. So I think the details of this whole thing are they're flimsy. We don't we don't know what's going to happen with this whole Trump Rx thing. But we do know that all of a sudden we're looking directly at costs. What was also really interesting is they're looking at Medicare and even Medicaid.

being able to purchase through this program, which is going to extend access to these meds. And that's really cool. They're gonna have to pass a law though, because it is a federal law that Medicare can't cover obesity treatment, obesity medications. They made that after fen-fen. ⁓ And so you're gonna need a law to be passed, which is gonna require a majority vote, which is.

Zoë (07:53)
Mmm.

Dr W (08:15)
seems quite difficult these days in the political system. Yeah. So I think you might look at this and be like, problem's problem's not solved. But it is a move in the right direction. do really, I'm glad that we're doing this. I'm glad we're paying attention. Anytime you're talking about price in medicine, I think that's a good conversation to have. Because it's out of control, it's hidden, there's no transparency.

Zoë (08:17)
This doesn't seem like a good track record.

Dr W (08:44)
That's something we're really working toward in our practice is we wanna make sure every single patient who sees us knows exactly what they're gonna have to pay to meet with us. That's our platinum program is that, hey, we created a good program. This is what it costs. We're gonna give you good care. We're gonna help you lose weight. We're gonna help you save money on the meds. And this is our price. And we're working on that with surgery too. Yeah, know, patients are like, how much is this gonna cost me? And I feel terrible. like, I have no freaking idea.

Zoë (09:06)
And don't even deal with the...

Dr W (09:13)
and I have no way of finding out. We're sorting through that and we're actually coming up with some ways where we can do that. ⁓ I think that's just so important. If you don't even talk about the price, well, how are you gonna lower it? The first step is at least saying, here's the price. So we're talking about price in medicine, which is great. Any conversation around that, I'm in support of.

Zoë (09:15)
Mm-hmm.

Right.

Be very interesting to see what happens. Like you said, you know, we're coming into 2026 I've been feeling like for a while and we've talked about this on the podcast before that it feels like something's coming to a head and there has to be some change that happens So I'll be interested to see what happens over the next couple years of going along with what you

Dr W (09:59)
You know, we buy, we're small business our practice, right? And so we buy ⁓ health insurance for our employees. And it went up 25 % this year. And so, you know, I look at this, I gave my employees a raise because we didn't pass that on to them. And so we gave them a raise. ⁓ so like that's, know, my employees don't look at it that way.

And I understand why but that's you know, we when I see this 25 % in one year, I think we've passed the tipping point You know and and I think we have gone and there's a couple of things that are happening. I'm seeing them happen In terms of how you know and what you're seeing is doctors are leaving networks. So now that you're paying, you

between you and your employer, you're paying $1,000, $1,200 for a family and no doctors accept that insurance. And so that just tells you, where's that money going? Clearly not to the people who you want them to go, you want your doctor to see you. So I think we've hit the tipping point. I think, like I said, by the end of the decade, it's gonna come to a head. ⁓

Zoë (11:17)
Yes.

Mm-hmm. Well, so guess we'll stay tuned.

Dr W (11:29)
Yeah, for sure.

Zoë (11:31)
So our next article actually is showing that there is change in the data around obesity. So it comes to us from Vox. I know it's so exciting, right? Finally, we're starting to see those scales tip a little bit. The title of the article is The Ozempic Effect is Finally Showing Up in Obesity Data. And this article basically shows us that from 2022, obesity, this was self-reported obesity rate of 39.9%.

Dr W (11:39)
I love this.

Yeah.

Zoë (12:01)
Basically 40 % in 2022, down to 37 % in this year, 2025. So that is a meaningful decline, the first one in years.

Dr W (12:12)
one ever. I think since we've been recording it. ⁓ That I mean, we're getting thinner. Our country is getting thinner.

Zoë (12:13)
Yeah, because it's always been going up. Yeah, yeah.

Mm-hmm. And that's

what also it was saying is that, you know, back in 2024, 6 % of Americans were using this medication. And now, only one year later, it doubled to 12 % of U.S. adults.

Dr W (12:38)
When the cost comes down, it's going to double again. We've been talking about this for a while now. Obesity is 100 % treatable. Patients come in, they're 500 pounds, and I'm like, we're going to get this fixed. You can live your life at half that weight. It really is the interplay of meds and surgery. It's the two together that are the...

Zoë (12:40)
Mm-hmm. Mm-hmm.

Mm-hmm.

Dr W (13:06)
that allow me to say that because 15 % of people don't respond to the meds. And I think that's, you know, that's really, and we see this all the time in our practice and it's really, it's kind of devastating. ⁓ That's a problem I don't think we've solved yet. It's gonna be interesting as we see new meds come out. And we do see some people who respond well to one, but not the other, but it's not a lot, you know, often if you don't respond to WeGoVee, you also don't respond to ZepBound. ⁓

100 % true, but we certainly see that. If there's five drugs, does that increase your chances of responding by five times or not? That's an answer we don't know. ⁓ And so this to me though is great because we've been gaining weight for 40 years, 50 years, and now we're finally not. And this is really something to be celebrated.

Zoë (14:00)
Mm-hmm.

Yeah, something that I'm interested to see what will have a ripple down effect on is childhood obesity. If obesity among US adults is going down and maybe that's changing the household environment and maybe that she's changing some food environments or eating patterns or how families interact with their relationship with movement and physical activity. I just wonder if we're going to see a ripple down to childhood obesity without necessarily

having children on the medication.

Dr W (14:38)
Yeah, well, here's something. GLP-1s are contraindicated in pregnancy and nursing. ⁓ How's that gonna play out, right? The big concern is neural tube defects. It's very, very flimsy data. ⁓ These meds stay in your system for a long time. The current recommendation is stop taking them before you try to become pregnant. ⁓

Zoë (14:57)
Mm.

Usually they stop

taking them because they've become pregnant because they've lost the weight.

Dr W (15:10)
We've

seen that many, many times, as fertility increases, and I don't know that there's that awareness, but I think we're gonna be able to study these people who were taking GLP-1s right up to pregnancy, and what's the rate of childhood obesity there versus, it's gonna take five or 10 years to figure this out, but it's gonna be fascinating.

Zoë (15:13)
Hmm.

very fascinating going back to the concept of these different DNA, different genes in the DNA get turned on versus turned off in the environment. And if the obesity is changing in the maternal and paternal DNA, how is that impacting the fetus? I think that's a really cool thing to think about.

Dr W (15:48)
Yeah, I mean the epigenetics of this all, Are

the GLP-1s preventing the genes from being turned on in the children and how's that all gonna play together? That's gonna be really, really fascinating. What do you think from a dietician perspective? mean, because you were practicing before GLP-1s, how does that change your conversations with patients, the way you counsel people? Like what's changed in your

Zoë (16:09)
Mm-hmm.

Dr W (16:18)
space. What are the other registered dietitians saying about these meds? Give us the dietitian's perspective on the meds.

Zoë (16:29)
You know, I think that at first there was a lot of, because of the unknown, a lot of hesitation, right? And you know, before working with Pound of Cure, I kind of had that same, I didn't know, so I had hesitation around bariatric surgery. Now of course, being in the space and working with patients and knowing how much of a life-changing experience it can be, you know, obviously the more we learn, the more we grow within that, you know, kind of.

mindset, I see that a lot with dieticians and maybe even not just registered dieticians, but you know, this is a little bit flimsier of, you know, online health coaches or fitness influences or whatever. I think that space maybe still has some extra stigma around that using GLP ones, unless it's glamorized as peptides, right? And then...

Dr W (17:14)
Right.

Exactly. And they can

make money on it. Yeah.

Zoë (17:27)
and they can make money on it, exactly. But

I think in terms of how this has been a trajectory and a learning experience, not just within the field of dietetics, but with the patients, more, we've seen it double in the last year, people on these medications, it would be...

it would be out of touch to just be having like such a rigid mentality around whether or not they are helpful or you shouldn't use them or whatever personal biases other dieticians might have. But just seeing how we can help these patients use the tool, just what we talk about all the time, use the tool to change the lifestyle habits and really view it as this.

amazing opportunity that we didn't have before because you know we talk about funtamine and it's like ah kind of scary and not something that as dieticians we necessarily would love to see people on but now with this new class of drug it's it's really changing the game and I think it definitely opens up a conversation for how do we you know obviously this is what

Dr W (18:16)
Yes.

you

Zoë (18:39)
I do every day, but other dieticians that I've either mentored or they'd asked these questions about how do we help these people on GLP-1s. And it's exciting for me to be able to kind of lead the discussion in those areas of other dieticians to help them help their patients more.

Dr W (18:59)
Yeah, I think another thing is just, you because just straight up lifestyle changes have such a low success rate.

that I gotta imagine just being a strict lifestyle only dietician would get very frustrating because so many people are just, lose, and you're like, my God, amazing, you're doing so great, and they lose 10 % of their body weight by trying with every fiber of strength that they can muster up, and then you bump into them six months later and they've gained the weight back and that traditional kind of yo-yo dieting, ⁓ and really.

Zoë (19:14)
Mm-hmm.

Mm-hmm.

Dr W (19:35)
very low success rate for long-term durable weight loss from lifestyle alone. Now all of sudden you get to be part of this solution that actually does result in long-term sustainable weight loss. And I think that's when you talk to other dietitians who work in the bariatric space, that's something they really love about it is their patients are losing weight. That's what they wanted to be a part of and now it's very reliable and they get to celebrate as opposed to kind of

Zoë (19:57)
Mm-hmm.

Dr W (20:04)
counsel, almost be a grief counselor, right? You know? Yeah.

Zoë (20:08)
every single session. And

it's frustrating for the patient, it's frustrating for the provider, and it's just like, you feel so drained. They feel drained because they've been working their butt off, you know, as the provider. It's draining to continue trying to, you know, encourage and come up with new ideas when they're doing like everything right, truly. So yeah, it's a game changer for sure.

Dr W (20:14)
Yeah.

Right.

Yeah.

Yeah, I think another thing that's really interesting and I think most of the dieticians have kind of figured this out is with bariatric surgery, it actually dramatically increased the need for dieticians, right? And I think GLP-1s have really done that. There is a right and a wrong way to eat on GLP-1s and there's a lot of people who just, well, I'm just gonna portion control it.

⁓ I think what we're gonna find is the same thing we found with bariatric surgery, that portion control trap that we've talked about with bariatric surgery. I think that exists with GLP-1s. yeah, and so taking a GLP-1 in my mind increases your need for a dietician. It doesn't decrease your need for a dietician. It doesn't replace it. It actually makes it more of a challenge to figure out what you should be eating.

and what you can do to leverage maximally the effects of these drugs and the sustainability of the weight loss ⁓ that we see from the meds.

Zoë (21:30)
Absolutely. Yeah, and if you're spending

that much money on these drugs, wouldn't you want to get the most out of it? And that's, you know, definitely where a dietitian can come in handy and really working with like the individual, right? Because everybody's so different.

Dr W (21:37)
Yeah.

Yeah.

And I think that's something we're really working toward in 2026 with this app is to kind of take, know, if you're on GLP-1s, what should you be doing to really get the most out of them? And we're looking to kind of use both AI and human-guided, registered dietician-guided support to help patients really maximize the results of these drugs. I think our app is good. It's not great.

I think we're going to get it to great next year. And I think that that's a really important thing we have to bring into the GLP-1 space is what's nutrition look like on a GLP-1? There's been tens, hundreds of thousands of nutrition books, including mine, written over the years. And in my mind, anything written before, 2024, is probably irrelevant.

Zoë (22:25)
.

Mmm.

Dr W (22:43)
⁓

And so, you know, what does it look like with GLP-1s? What is the GLP-1 diet, right? You know, I don't know that that's been defined. It's a wide open space. It's something I think our nutritional program is really well-suited for. My program was designed for bariatric surgery. It's hormonal changes, GLP-1s, bariatric surgery, they both work through the same mechanism. And so,

we're looking at that type of program. I still stand by that program as being the best diet for GLP-1s.

Zoë (23:17)
There's so much overlap in the metabolism and how your body responds. that's what a lot of people say who maybe had bariatric surgery and then go on a GLP-1 and it's like, it reminds me of when I was in my honeymoon period again. And it's like, we want to use it in the same way.

Dr W (23:22)
Duh.

Yeah. Yeah.

got my sleeve back. Right? All the time. All right, we got a couple of questions, right? Maybe we'll go through two questions.

Zoë (23:37)
Yeah, absolutely.

Okay, yes, so we actually do have some questions that we got from Facebook, some from YouTube, so we'll read one from Facebook right now. This person says that they are not wanting to take a GLP-1, but they want to lose another 20 pounds. I had gastric bypass three years ago and lost 80 pounds. I've been at this weight for at least a year, not feeling the way I thought I would.

I thought I would love living in my new body after a while and very grateful for the procedure and the health has improved immensely and they're just looking to lose an extra 20 pounds right now. Their weight is 173 and 5'3". Really could use some advice.

Dr W (24:25)
Yeah. So this person started out, it sounds like around 250, lost 80 pounds down to 173. You know, what I hear,

Zoë (24:31)
Mm-hmm.

Dr W (24:36)
is that this is someone transitioning from the honeymoon period to the end of the honeymoon period. Right? Would you agree with that, Zoe?

Zoë (24:40)
Mm-hmm.

Yes, and having that expectation management, I think, is huge too.

Dr W (24:46)
Yeah.

So I think the first thing that I, you if this person comes to my office and we're having this conversation, the first thing I'm gonna do is pull out our calculator. We have calculators on our website. I think we're gonna start putting them out on Instagram too so that patients, so the people out there can use them. ⁓ But we have a calculator that allows you to calculate, to predict how much weight you're gonna lose. This weight loss sounds to me to be kind of right in line with what I would expect.

⁓ And so, depending on your age and gender and whether you had diabetes and whether you take psych meds, ⁓ those numbers can be different from person to person. But ⁓ this to me sounds reasonable. And the first thing I would do is look and say, hey, did you lose what we would have expected? My suspicion is the answer is yes. ⁓ And then, so then they wanna lose another 20 pounds. ⁓

Zoë (25:38)
Mm-hmm.

Dr W (25:43)
I'll let you kind of handle the ⁓ nutrition part of this. ⁓ My general thought on this is that, and I used to say, whatever that lowest weight you hit is after your surgery, that's the lowest weight you're ever gonna be for the rest of your life. And I don't say that anymore because of GLP-1s. ⁓ But I would say that if you don't wanna use GLP-1s. And so I think this

you know, this person is really going through the natural changes that we see after surgery. How are you gonna handle this from a nutrition perspective? Because I think that's what this person really is looking for.

Zoë (26:22)
Yeah, so I'm gathering that a lot of this body dissatisfaction, let's call it, is not necessarily about maybe what they weigh, but maybe body composition. My question for this person would be, okay, if you were to stay at 173, but maybe you had a little bit more of a toned physique or you lost some more body fat, but we gained some muscle and really kind of

focusing the change on is there a way that you do feel really great in your body but not necessarily focusing on that scale weight, then we would definitely talk about, is there the opportunity of adding in strength training? Can we focus on this body recomposition piece, especially being out of the honeymoon period? We know that in the honeymoon period, that's when there is that rapid weight loss, but coming out of the honeymoon period,

Dr W (27:12)
Yeah.

Zoë (27:20)
that's a really good opportunity because now you're maybe you're eating a little bit more to build muscle, right? You're no longer losing weight as fast. So I would definitely kind of explore that further. But if we break it down to just, want to lose another 20 pounds, obviously we would definitely take an audit of what are you eating? What are your lifestyle, you know, ⁓ factors? Is there an area of opportunity for increasing your activity? Maybe we want to do the metabolic reset diet. Was there any?

weight regain? there some of those old habits slipping back in? There's a lot of different directions that we would dig into, but my main thing would be those smaller baby step changes. for example, if it's, yes, I work a desk job and I lost a lot of weight because I was in my honeymoon period and I don't really exercise that much. Could we add in those movement sprinkles during the day, not only to help with increased activity, but you know,

mentally, getting a little bit of mental reprieve from that screen, getting some stress reduction, maybe that will help you sleep better at night, which will

Dr W (28:23)
Okay.

Zoë (28:24)
overall improve health and ideally help your weight drop a little bit more too. So kind of finding these little tweaks within your daily routine or maybe there are some swaps that we can make in what you're eating or maybe we find that you're really focusing on hydration in those first couple years because...

That's what was hammered into you as part of the honeymoon period, but maybe now that has slipped back down a little bit, maybe you're drinking coffee all morning instead of prioritizing your water. So there are just a lot of these little questions that I would ask, having that expectation also of is this actually where we wanna be weight wise based on what's predicted? And then also thinking about it from the perspective of body composition versus weight on the scale.

Dr W (28:45)
Right.

Yeah, think gratitude journaling would probably also be really helpful for this person because what I'm hearing, and this is a very human thing, this is why social media is so popular, is because

Zoë (29:13)
Mm.

Dr W (29:20)
we focus on the things we don't have, not the things we have. And so, you you've lost 80 pounds and they did certainly acknowledge that they were grateful for that. But it sounds to me like most of that energy, most of the thought is going into the 20 they didn't lose as opposed to the 80 they did lose. And I think reframing that can, you know, that's something that you could control and could.

because you may not, without GLP-1s, be able to control whether or not you're lose those last 20 pounds. I think if this person is like, okay, great, but I wanna lose 20 pounds, the answer is GLP-1s. It's probably low-dose GLP-1s, and that's not necessarily such a bad thing. I think we look at GLP-1s as this binary decision, and I would never ramp this person up to the highest doses upbound, like never, but would.

a touch 2.5 milligrams, the starting dose of ZepBound, plus working with Zoey to really ⁓ get the lifestyle as dialed in as possible, build muscle, all those things, we might see 20 pounds of weight loss there. And so that's just the decision you might actually be faced with. And recognizing the parameters of that decision and deciding one way or the other, whichever you feel is best for you.

I would encourage that this person, even though they're saying, I don't want GLP-1s, nobody does, do you not want GLP-1s or do you want to lose 20 more pounds? That's the decision you probably, the realistic decision you have to make. ⁓ if you, whichever way you choose, it's totally your decision, your body, your choice. But that's kind of the way I would look at this.

Zoë (30:52)
Which one is more important? Yeah.

Yeah.

just have to call out the fact that I love you mentioning the reframe and where you're putting your energy and your focus and that gratitude because we know, and this is actually something that I work with patients on a lot, and even though maybe it's not necessarily nutrition coaching, it's like to me so powerful and such an important part of the journey on that mindset side of things and how you're speaking about things and thinking about them and.

Dr W (31:26)
Mm-hmm.

Zoë (31:35)
When you're putting all of your energy and focus into the lack, then that's what you're gonna get more of. So good job calling that out. I love that.

Dr W (31:40)
Yeah.

Thank you. All right. What's our last question?

Zoë (31:45)
Okay, last question comes to us from YouTube. Hey guys, I recently diagnosed Celiac. It's so restrictive. I was hoping y'all might have some insight. And it looks like this person got a bypass three years ago, lost 89 kilograms. amazing work there. Huge, that's a lot. So just wanting some advice for specifically Celiac patients. So I'll kinda get started on this.

Dr W (32:01)
like 200 pounds, yeah.

Sure.

Zoë (32:15)
The metabolic reset diet is great for people who are gluten-free, right? If we're thinking about eliminating grains and focusing on whole foods, not necessarily low carbohydrate, but still having those high quality, complex fiber-rich carbohydrate sources, as well as all of our other great metabolic reset diet aligned foods, that's a really good place to start. But taking it a step further and being able to individualize this is a...

beautiful place to start on the app because you can really, the Pound of Cure app, if you don't have it downloaded, it's free. We have Sage where you can actually ask, I'm on the metabolic reset diet, but I'm also celiac, help me with a meal plan. Or you can update your food preferences within the app and say gluten free so that all of those recipes, all of those meal plans, all of those recommendations that get fed to you will be.

very individualized and tailored to your nutrition needs.

Dr W (33:15)
Yeah. You know, I think also with gluten-free, there's kind of variable levels of how gluten-free you need to be.

Zoë (33:25)
Mm-hmm.

Dr W (33:25)
Because

there's, know, think Keto's is gluten-free vodka. Which I guess means that other vodka has gluten in it, which I don't kind of understand. Not that vodka is a good thing for anybody to be consuming on regular basis, but I think it really makes the point that there's trace amounts of gluten in everything. And I certainly know people who are just so paranoid, like, my God.

Zoë (33:49)
Yeah.

Dr W (33:54)
There's the tiniest amount of gluten. And I think this is something you'd have to work with whoever diagnosed you with celiac is, know, is there a tolerance for a small amount of gluten? Because avoiding anything with even the microscopic doses of gluten becomes very, restrictive. But if we just don't eat bread and things with wheat as a primary ingredient, we can cut that gluten level down to say, you know, from 95 percent.

Zoë (34:11)
Mm-hmm.

Dr W (34:23)
⁓ Is this adequate? And for some people the answer is yes and for others no, but that's also something to kind of think through is that bread and something with trace amounts of gluten will impact someone with celiac disease very differently.

Zoë (34:39)
Right, because it's the autoimmune disorder versus a sensitivity or an intolerance to the protein.

Dr W (34:42)
Mm-hmm.

Right,

right. Where the true biopsied autoimmune disorder is relatively uncommon. The insensitivity to gluten is extremely common. And so where you lie on that spectrum is something I think every patient who is struggling with ⁓ eliminating gluten from their diet, they have to figure out exactly where they are at that. Yeah, exactly.

Zoë (35:06)
what that kind of upper threshold is. Yeah, great direction

on that for sure. All right, great questions, good conversation. I like that we were able to address some questions that we got over on the socials and also talk about what's going on in the news and media right now. So lots of good stuff going on and excited to see what might happen over the next couple of years.

Dr W (35:29)
For sure, it's gonna be interesting, no questions there.

Zoë (35:33)
Yeah, absolutely. Well, thank you so much for joining us. We will see you in the next episode and have a good one.

Dr W (35:40)
Absolutely. See you next time.