225.The Best Nutrition to Maximize Weight Loss on GLP-1s with Gretchen Zimmermann

In a world where the conversation around obesity and weight management is evolving, understanding the role of nutrition and medication becomes crucial for achieving lasting health.

In this episode of Health Bite, Dr. Adrienne Youdim welcomes Gretchen Zimmermann, a registered dietitian specializing in obesity and diabetes management, to discuss the impact of GLP-1 medications on nutrition and overall health.

Gretchen shares her insights on the importance of proper nutrition while using GLP-1s, the challenges patients face with appetite changes, and how to mitigate potential side effects through dietary choices.

Who is Gretchen Zimmermann?

• Registered dietitian with over 15 years of experience in obesity and diabetes management
• VP of Clinical Strategy at Vida Health
• Advocate for integrating nutrition into obesity treatment

What You'll Discover in This Episode:

• The rise of GLP-1 medications and their impact on obesity treatment
• The critical role of nutrition in managing weight loss and muscle preservation
• Strategies for patients experiencing appetite loss and aversions to protein
• The importance of fiber and its effects on gut health and GLP-1 release
• How to navigate side effects and enhance medication adherence through dietary choices

Why This Episode Matters:

If you or someone you know is using GLP-1 medications or struggling with weight management, this episode provides essential insights into how nutrition can support health goals. Gretchen's expertise highlights the importance of a holistic approach to weight loss that goes beyond medication alone.

This episode will help you:

• Understand the relationship between GLP-1 medications and nutrition
• Explore effective dietary strategies to enhance weight loss and health
• Recognize the importance of maintaining muscle mass during weight loss

“Nutrition is the key to controlling what’s built and what’s lost.” – Gretchen Zimmerman

Connect with Gretchen Zimmermann:

• LinkedIn: https://www.linkedin.com/in/gretchen-zimmermann-17736117/
• Instagram: @gretchenzimmermann.rd

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Connect with Dr. Adrienne Youdim

• Website :https://www.dradriennespeaks.com/
• Instagram: https://www.instagram.com/dradrienneyoudim/

Transcript

Adrienne Youdim

Welcome back, friends. Welcome to the Health Byte podcast, the podcast where I offer small essential nutrients to greater physical, mental, emotional, and professional health and well-being. I'm your host, Dr. Adrienne Youdim. I'm a triple board certified internist, obesity medicine, and physician nutrition specialist, and I've learned in working with patients and clients for nearly 20 years that good nutrition is not just about the food that you eat, but all the ways in which we can nourish ourselves, mind, body, and soul. This week, I am really excited to have a special guest. I have with me Gretchen Zimmerman. She is a registered dietitian that specializes in obesity and diabetes management. She has been working in this area and in the healthcare space for over 15 years. She currently serves as the VP of Clinical Strategy at Vita Health. Gretchen, it's so great to have you. Great. Thank you, Adrienne. I'm happy to be here. Well, I think this is the absolute perfect time to have you and someone with your expertise because GLP-1s have exploded through the roof. So many people are using these medications right now. Often people are getting these medications not by obesity medicine specialists like myself, their dermatologist is prescribing it, their rheumatologist is prescribing it, and they're not working with people like you who are savvy in the nutritional requirements and considerations for these drugs, and it's causing problems in our patients.

Gretchen Zimmermann

Yeah, absolutely. I don't know about you. You'd probably agree. But working in this field for so long, I have never seen anything as exciting and impactful as GLP-1s and how they've come to market and really have just changed the entire face of obesity. And how we think about obesity is more so now it being acknowledged as a disease, a chronic condition, versus just a choice. Over the last year and a half, we've seen that. As a health care provider, as a registered dietitian with nutrition, of course, being one of the key components, it's something I'm really excited about. But yes, to your point, there is such demand like we've never seen before. And people are kind of doing anything and everything to get access to these medications. And they are getting access. And yes, there are a lot of concerns around that.

Adrienne Youdim

Right. I mean, I echo your sentiments completely as a physician who's been working in this space for almost 20 years. The ability to have drugs that actually help patients and are doing so in such a great way. I mean, these drugs, while I think the lay press and maybe our influencers have kind of spotlighted downsides or maybe even created problems that don't even exist with these drugs. So there's a lot of like press. that's not well informed. But we know that these drugs really are impactful, that they're doing great things, but they need to be used in the right way. And to me, the critical piece of using it in the right way, in addition to the right candidate and dosing it properly, is proper nutrition. there is a right and wrong way of eating on these drugs. So I want to start by asking you what you think, well, what do you think is the most critical downfall in terms of how people are eating on these drugs and how it can impact their long-term health?

Gretchen Zimmermann

Yeah, so there are certainly a few that I'd love to highlight. I think the first one that comes to mind and probably the one that we hear about most is this loss of lean body mass that happens when patients are on these medications. And we see rapid weight loss. And they're losing not only weight, but, of course, muscle mass as well. And while that is normal to a certain extent, I've worked in bariatrics as well. And we certainly do see patients are not just losing fat. Of course, they're losing muscle mass. But as much as we can, if we can mitigate some of that loss with nutrition and physical activity, that's what we should be doing. And so yes, there are certain things that we should be focusing on. Protein has kind of become the superstar nutrient and the one with all of the buzz now. And I can't say I'm not entirely relieved after this over-fixation on carbohydrates over the last few years. But protein is important. And I think you've probably seen this as well. And we've talked about this before. But things tend to swing, right, kind of thinking about a pendulum from one end to the other. And so now there's really this focus on protein, but there is, and there's a good reason to focus on protein because it does help to sustain some of that muscle mass as we are losing weight. It also has other impacts on the gut and hormone signaling and kind of triggering the release of some of that endogenous insulin as well. I'm sorry, GLP-1 as well. So there's lots of important pieces to the protein puzzle. Speaking of the pendulum swinging in the other direction, I do think that people are consuming more than they probably need to. Your body can only absorb a certain amount, say 20 to 40 grams a meal. The rest of it we're going to pee out. We call it very expensive urine, right? Because protein is expensive. And so I think that's really where the role of a registered dietitian comes into play is really working with patients to make the right choices when they are dealing with things like side effects and reduce appetite, especially as they are starting these medications.

Adrienne Youdim

Yeah, there's so much there. So I want to really like unpack all of this because I think we could spend over an hour talking about just your point number one. First thing I want to just clarify is The point that you make that when people lose weight, they lose fat and they lose muscle. This is a function of weight loss as both of us have experienced with bariatric surgery. People lose muscle after bariatric surgery, not because of the surgery per se, but because it's an effective modality for weight loss. and any effective modality for weight loss, be it bariatric surgery, be it medications or anti-obesity medication, it will cause a loss of muscle mass as well as fat. What you're saying is though that we can kind of direct that loss to more fat, less muscle loss, which is what we want to do. We don't want to lose muscle and we can't completely prevent that, but we can to a certain degree with the way that we eat and protein is very important to that. Now, two things you brought up that I want you to give us some more information on. Number one is Um, what do people, what do you tell people who have such a loss in appetite that they just can't get adequate protein in? Or I'm sure you've also heard this. Some people just have like an aversion. They're like, I just can't eat, uh, meat or I just can't eat protein. It's not what my body wants anymore. So I have very limited appetite and the appetite I do have is not for protein. How do we manage that?

Gretchen Zimmermann

Yeah, and that is tricky. And I think it does get better over time as people start to adjust, and we're titrating them up, and they're getting to that optimal dose of the medication. But certainly, initially, this is an issue. And for patients who are really, they don't have an appetite, under eating, right, that's a major concern. So what I would encourage them to do is focus on protein first, if that's the first macronutrient that we can focus on, we think about protein and fat and carbohydrate is, is let's focus on protein first. And you're right, it is harder for some people to eat protein, especially when they're just feeling full. Protein does make us feel full, right, in and of itself. And so there are some strategies and things that people can do. Certainly spacing out meals throughout the day is one way to do it. So maybe instead of three big meals, maybe it's six smaller meals where we're just taking in maybe 10 grams of protein or 15 grams of protein at a time. There are also other ways to kind of sneak in protein. And while I'm not a huge fan of the protein shakes, like the pre-made protein shakes that you can get on the shelves, I think they do serve a purpose, especially during this phase. And if someone tolerates that, great. Maybe they can just make a smoothie. It's like with our bariatric patients, sometimes it's easier just to drink something initially rather than have to kind of sit down and eat a full meal. And while I don't recommend that as a long-term strategy, I think that that can be really effective upfront as people are kind of going through this stage where they're losing appetite.

Adrienne Youdim

Yeah, and you make a good point that know that things are going to change. So just because you didn't like it or couldn't tolerate it when you first started the medication or when you first dosed up or titrated the dose. doesn't mean that you won't change. So being mindful of it, making it top of mind and a priority and testing yourself down the line is helpful. I also agree with you that while I don't love the pre-made protein shakes, that using a high quality protein powder, the ones that we have in the office are heavy metal tested and they're concentrate and purified. Because there is also a lot of junk that you can get over the counter. So you do have to be a educated consumer. But that's a great way of getting in some of that additional protein. So I agree with you there. I want to also dig in a little bit into the side effect issue, right? Because there's so much has been made about the side effects and yes, the side effects can happen, but I don't know about you Gretchen, I am using these drugs like I'm prescribing it like bonkers. And I can count on one hand how many patients I've had where the side effects made us discontinue the drug. I mean, if anything, I'm very conservative. So if I have a patient who's throwing up all the time, it's like game over. I will not prescribe the drug. So this is not even me being tolerant of side effects. What I can say is that I really, and I don't think I'm special because it's my office, but there are ways that you can manage the drug so that people tolerate it. So it's not what you're hearing on like the Yahoo, you know, on Yahoo every day. So talk to me a little bit about how you use protein and how you found it to manage side effects in patients on GLP-1s.

Gretchen Zimmermann

Yeah, I mean, it's a great point. I completely agree. I do think we, as a society, tend to kind of focus on the negative aspects of things like side effects. They are concerning, yes, and in some cases can be very concerning. But I read recently, and maybe even in clinical practice, have seen really only about 30% of the time will patients experience a side effect like nausea or vomiting or constipation or diarrhea. And then, of course, we have people who just don't respond at all, right? We have our non-responders, so GLP-1s, we have to watch out for that. So I think that's the first piece. And I mean, you're the physician, so really the titration, kind of that slow titration and the close monitoring over time is certainly one way to mitigate some of that. And then the other is, And what we found, I'll just kind of say, because I'm most familiar with this model, is that VITA, for our patients who actually do end up on GLP-1s, which is a pretty small percentage of the patients who come through, there's a very high adherence rate. So it's greater than 90% of the time, the patients that are going on these medications are staying on these medications. And a lot of that has to do with how we are managing these side effects. the interventions that we're providing as it relates to medical nutrition therapy, prescribing the right amount of protein, making sure people are eating enough calories. And it's even beyond protein, right? Like it's all about fiber and it's about fat as well. Fat can certainly make us feel even more nauseous if we're experiencing some nausea. So usually there's some guidance to kind of steer away from that for a little while. Same thing with fiber also slows digestion, may not be as well tolerated as people are kind of titrating. So it is it's really this holistic approach to nutrition where, yes, protein is a key factor there. But then we also have to look at how some of these other macronutrients and nutrients have that same kind of metabolic effect.

Adrienne Youdim

Right. So so higher fat meals tend to cause more side effects, especially at the beginning. I've certainly seen that. Um, I'm curious and I don't know the data about this myself. What have you heard about, uh, or what has you been your experience in terms of sugar? I've almost experienced certain patients having, we talk about like dumping syndrome with bariatric surgery. So this experience of like sugar, usually it's the process kind, but sometimes it can be fruits causing this, like. really sudden, excessive amount of diarrhea. And I'm seeing that with GLP-1s. Has that been your experience as well?

Gretchen Zimmermann

Yeah, I haven't seen it as much, but I definitely think it occurs and it makes complete sense, right? And I think that's also another reason that when people are eating carbohydrates and some of those simple sugars like you might find in fruit, that you also want to pair it with something like a protein or maybe a small amount of fiber to slow the digestion so it doesn't all rush into the small intestine and create that kind of diarrhea and the dumping syndrome effect. Right. Certainly possible, though. But then I wonder if you've heard this as well. I've kind of seen it in the literature, too, that these medications are not only reducing the food noise, but also reducing cravings for sugary foods.

Adrienne Youdim

Absolutely. Absolutely. but you know there are people who um it's not complete people respond differently the studies show maybe up to 30 percent are non-responders even to these drugs so using um using some of these these skills and tricks to help not only compliance with the medication if you don't have this kind of obliteration of the food noise that some people have, but also to manage the side effects like you've discussed, as well as to potentiate the effect of the drug. So I do want to go back to what you were saying earlier, that the protein that we consume also enhances the release, our body's own release of GLP-1. So if you are one of those frustrated people, And I laugh because you shouldn't really be, a lot of my patients are frustrated that they have any appetite whatsoever. And it's like, look, this was not the deal, right? The deal was to suppress the noise enough to kind of take out that background chatter so that we can make the right decisions. But it is true that some people are just not getting the results. We titrate, titrate, titrate, and they're not seeing the results that they would like. Consuming more protein also helps GLP-1.

Gretchen Zimmermann

It does. Consuming more protein and then also fiber. So I think we talk so much about protein that we forget to talk about fiber. And fiber has the same effect, especially certain types of fiber, like the fiber that is easily fermentable that you might find in foods like garlic and onions and leeks. What's important about those foods is they travel through our intestine and they're not fully digested. However, they're fermented in our distal small intestine or our colon. And why that's important is because they change into short-chain fatty acids, which essentially trigger the release of GLP-1, so our body's own GLP-1, as well as PYY, right? It has these hormonal effects, both protein and fiber. And I think that's why we also think and theorize and have seen in practice that fiber can help with weight loss, right? Now, granted, this isn't enough, right? Obviously, this isn't enough to cure obesity or or induce drastic weight loss. But when I think about long-term sustainability and if people are going to come off of these medications at some point, I think when you're thinking about the type of nutrition you need to be consuming while on these medications, this is it. because I think that this is going to really support metabolic health long-term. To what extent, we don't know, right? But when you think about the standard American diet, which is devoid in fiber, typically, average American gets about 15 grams. Recommendation is 25 to 35 grams a day, kind of depending on age and gender. We're not getting that, right?

Adrienne Youdim

And so I think- Which is already still so low, if you think about it. I mean, it's such a low amount. And I really appreciate you shifting the conversation because we do talk about protein a lot. I talk about it a lot in the office, but I am by no means this like keto, you know, fan. So it is about balance. It's about recognizing that, you know, maybe protein first, especially in those early days. But you want a balanced diet and not all carbs are bad. We don't need to lump, you know, carbohydrate is such a, you know, mishmash of stuff because like Twinkies are carbohydrates, right? Yes. As is, you know, these, um, high fiber foods that you talk about and the fiber is important to release the GLP-1. I'm glad you brought that up because I had forgotten about that point. But it's also really important in people supporting their digestive health with these medications. So we see with GLP-1s, some people get diarrhea, some people get constipation, and the fiber actually manages both of those things.

Gretchen Zimmermann

Right, right. And that's the healthy microbiome, right, which we essentially destroy by eating all these ultra processed foods and sugary foods and it's we do a lot of damage in that way. And so, yes, the fiber is really critical, I think, to establishing and kind of maintaining that. that healthy microbiome.

Adrienne Youdim

That was actually one of the points you brought up in the initial protein conversation that I wanted to circle back to. It was kind of in the corner of my brain, so I'm glad that you brought it up. Can you just, can we zone out for a minute and can you talk a little bit about the gut microbiome how our nutrition impacts that and how changes in our gut microbiome changes overall metabolic health. Can you give us a little bit of background?

Gretchen Zimmermann

Yeah, so it's exactly that, right? When I think about the types of foods that we consume in the standard American diet, we're typically coming in short when it comes to fiber. And fiber comes from a whole bunch of different types of foods. But think plants. Plant-based foods is where we're going to get our fiber from. So of course, you have leafy greens, and you have vegetables, non-starchy vegetables, starchy vegetables as well. And then we have fruit, which unfortunately has been demonized, I think, a bit by the low-carb keto movement over the last few years.

Adrienne Youdim

Of all the bones to pick in life, the blueberry, really, is that what you're going to go after? The banana. I mean, that's the one that gets me. Leave the banana alone.

None:

100%.

Adrienne Youdim

And actually, I put a banana. I don't have protein shakes every morning, but I do periodically, and I always put a banana in there. I'm a fan.

Gretchen Zimmermann

And I will go eat a sugary banana. Doesn't matter. Thank you.

Adrienne Youdim

But we digress.

Gretchen Zimmermann

Let's have a different effect. But that's a whole other. But yeah, kind of going back. Right. I like I really like to center around the standard American diet and just what we're typically consuming. And so yeah, it's those plant-based foods and I think that's what does have the most impact on our microbiome. So what is our microbiome? We have bacteria, millions and billions of different types of bacteria in our GI tract, our small intestine, our stomach, right? And so it's important to keep those in balance and that's when we start to think about probiotics and prebiotics and prebiotics are like the food for the good bacteria and the good bacteria are the probiotics. A lot of times it's not just plant, right? It's also dairy, right? Yogurt is probably the biggest example I can think about, kefir, things like that. naturally fermented foods that provide these really good sources of bacteria. Kimchi, right? Sauerkraut, those types of foods. And so those are probiotics, right? That's the healthy bacteria. When we don't consume enough of those and we consume more of the ultra-processed, and just be careful to say ultra-processed, not necessarily processed correct to process foods. That's where we start to experiencing shifts the experience shifts in our bacteria and our bacterial imbalance. And then of course that leads to or can trigger some uncomfortable side effects like the constipation and the nausea potentially and diarrhea, right, like just different imbalances. And so yeah, so I think kind of going back to your original question, I think it's like fiber is fibers really where it's at and fermented foods. When I think about the microbiome, just kind of in its simplest sense, that's where I would focus.

Adrienne Youdim

And this is where I think, you know, the conversation around nutrition shifts from food is fuel to like food is nutrition. um for a long while i was guilty of this i was in the food is fuel camp because i was exclusively seeing patients for weight loss and you know 20 years ago or 15 years ago it was all about you know, fast nutrition, you know, dense protein and so shakes and bars. And I'm still a fan of these tools, right? It's like we don't have to vilify it. It doesn't have to be all or nothing. These are still it's still great. Like we just said, to use these shakes, et cetera, to augment. Yes. But if we can shift our thought process a little bit away from just weight loss and food is nutrition, the relationship between the food that we eat and our gut microbiome, which is that good stuff, bacteria and fungi and all these little buggers that live down there, which can get kind of gross if you think about it too much, but they're actually there to help you. So don't go down that rabbit hole. But if we can really think about that, right? Like this is an opportunity where what you eat can really either kill and annihilate that ecosystem down there or can really support it in a way that we now know is helpful to cognitive health, cardiovascular health, mental health and well-being. So like, guys, we really need to take time and nourish ourselves. Again, I get the whole fast food and I don't mean McDonald's, but just, you know, like I don't have time. I'm just going to eat what I can, you know, to get by. But this is such an opportunity.

Gretchen Zimmermann

Right, yeah. And sometimes that's OK, right? Sometimes we do the best that we can with what we have. But yes, overall, it is an opportunity. And I think really the other piece to this puzzle that we haven't talked about yet, but it's also how we eat and how we think about food. And this really gets us into the mindful eating and when we sit down. And one thing you said earlier that reminded me about mindful eating, one thing I always used to teach is, When you sit down to eat, just insert a pause and ask yourself, am I hungry? What am I feeling right now? Am I physically hungry? Am I just feeling something emotionally? And I think GLP-1s are a really good tool for that. Like you said earlier, right? They kind of, they give us that ability when they take away the food noise to just pause and put a little bit more thought into what we're eating. And so that's the first step. Certainly how quickly we eat impacts our digestion as well. So generally we want to spend 15, 20 minutes at a meal and make sure we're giving our body enough time for our brain to receive the signal that we're eating and we're reaching satiety or starting to feel fullness. And then kind of the third piece of that is back to the protein shakes and those really serving a role. But I think overall, the more we can chew and choose cruciferous fruits and foods and vegetables and nuts and seeds. That's a really good rule of thumb when you think about how to choose foods that are going to be good for your digestive health and your microbiome. Drinking a protein shake is going to digest so much faster than a meal that you have to sit down and chew and process. and digest. And overall, that really helps not only just with overall digestive health, but satiety and feeling, you know, full overall.

Adrienne Youdim

Right. So there's there's this link between the act of chewing and the signals that are being released to the brain. Tell your brain that food has been received and we can shut off that hunger valve or at least dial it back. That's right. Yeah. What other nutritional considerations do you think about when it comes to GLP-1s or the significant calorie restriction that may occur with or without medications? I'll tell you, I don't typically recommend a multivitamin. I am with you on not wanting to create expensive urine, that's usually what happens. But with my patients with the GLP-1s, I think there's a gap in nutrition, and that's where I recommend it. So I'm curious about your thoughts on that, and then maybe you can tell us if there's anything else that you consider with your patients who are on these drugs.

Gretchen Zimmermann

Yeah, I'm glad you brought this up because this is one of the other big ones for me. And I think there is definitely a risk of malnutrition and certainly under eating on these medications. And yes, that's partly what we're trying to reduce, a reduction in food intake. However, beyond a certain level, it's not healthy. I read somewhere, I don't know how true this is, but it's not unusual for patients who are on GLP-1s to just eat less than 1,000 calories a day. That is not, that is not enough. We usually say for females, it should be at least 1200 calories a day. Don't go below that. 1500 for males. And the reason is it's because it's really hard to meet your macro and your micronutrient needs if you're not at least meeting those minimum calorie requirements. More acutely, if this is happening over a shorter period of time, I'm not as concerned. But over time, as we're seeing rapid weight loss, we know people are not eating enough. And that's when you start to get into those nutrient deficiencies and the micronutrient deficiencies and things like iron deficiency and magnesium. The B vitamins are another one, which, speaking of protein and animal foods, that's an important source of B12. And so when you have those deficiencies, then we can see things like hair loss. Hair loss is another big one. People who are losing rapid weight, even bariatric surgery, again, any type of rapid weight loss. You know, there could be some nutrient deficiency there. Maybe it's related to iron. Also, protein is another one. And so you get the idea, right? Like it's just I'm trying to think about this as a long game. I acknowledge that when people are going on these medications, there is an expected period of time where they're going to eat less. They're going to potentially struggle with some side effects and their nutrition will be altered. But if we really want to help people succeed long term, then this is the stuff we need to be focusing on. Biased or not, I don't know. I'm a registered dietitian, but this is where I think dietitians really have the opportunity to come in and play a very important role as a very critical part of the care team, the multidisciplinary care team with physicians like yourself and nurse practitioners and therapists. We didn't even get into mental health yet. You know, that's kind of, I forget where I was going with this, but this is, that's kind of.

Adrienne Youdim

I know it's important. It's important that the nutritional piece be incorporated. It's important that a registered dietitian who is knowledgeable to be involved Um, if your physician is not savvy or not giving you the time or doesn't have the background to advise you, because I think a lot of times weight loss gets conflated with nutrition just because. where one is losing weight doesn't mean that they're consuming adequate nutrition and maintaining adequate nutritional status.

Gretchen Zimmermann

That's right. So the focus exactly that should be on sustainable metabolic health rather than the number on the scale. And this is, I think, what's going to set our patients up for success in the long term. Right now, the literature suggests that obesity being a disease, some patients might need to be on these medications for life. We do know some patients will want to come off. And so if they're not eating enough while they're on these medications and they're losing that lean body mass, you and I both know that as soon as someone comes off these medications, they're going to gain the weight back. It's likely they'll gain that weight back. They're probably not getting muscle mass back. They're probably going to gain fat back, right? And then, you know, we just know metabolically that's not going to be as supportive for long term health as that muscle mass. So it's like the muscle mass is gold. We want to do whatever we can to hang on to it throughout these weight loss journeys and as we get older and, you know, really kind of throughout this whole process.

Adrienne Youdim

Yeah. And I just want to sidebar for a moment because I think, and I know that this is not absolutely where your head is at because you have worked with these patients for so many years, but I just want to make the point that, um, when people come off these drugs, they, the clinical studies are showing that they are regaining the weight. And this is not because. they're lazy or they don't have enough willpower or things of that sort. You've mentioned a few times that obesity is a disease. And I think even that notion rubs people wrong. But I think it's worth saying that when people gain excess weight, that the hormones change when we try and lose weight in whatever manner, hormones will change to get people to regain that weight so that the hormones shift to promote more hunger so that people are more hungry. Now, Could you ignore the fact that you're starving when hormones are bombarding your brain? Sure, I guess, but it's not a moral character flaw if you genuinely feel hungry because your hunger hormones are going bonkers. The point and where this becomes important with the drugs is that Now you have a drug that's helping by offering an offset to that hormonal imbalance. This drug is actually a hormone that helps satiety or helps the sense of fullness. If you've gone on the medications and you have lost 30 pounds and now you take away the GLP-1 that is supporting that satiety and the 30-pound weight loss is resulting in a hormonal shift that's bombarding your brain, we're setting ourselves up for failure. So like you, I have a lot of patients who don't want to be on a drug forever. I understand that sentiment, but I would say that if we're going to try that we have this realistic mindset and that should weight regain occur like it is in the studies, you come back to your dietician, you come back to the physician without shame, without judgment, recognizing that this is something that we would have expected and that we help people get back, you know, the tools that they need in order to make this a sustainable situation.

Gretchen Zimmermann

Yeah, I completely agree. I also think that shifting the conversation to more about overall health reduction in cardiovascular disease factors and improvement in cardiovascular and cardiometabolic health overall is really important. Because then it kind of, you know, we know with some of these drugs like terzapatide that you can get 20, 25% weight loss. And that doesn't always need to be the goal for every patient. And you can achieve clinically significant weight loss of 7 to 10% with a good percentage of patients and see improvements in other biomarkers like hypertension and hyperlipidemia and A1C. and improvements in quality of life. And so I just think that there's obviously, right, like there's such a fixation on weight right now. But I think it's also important to like reground, right? And like, what are the real clinical goals here? Because if someone does come off of a medication, a GLP-1, and they do gain some of that weight back, you know, maybe that's expected, but maybe there can still be enough lifestyle support or whatever type of intervention that we're still able to sustain some of those other biomarkers. You know, I don't know. The literature seems to suggest that they go back to baseline, but I don't think that necessarily losing the maximum amount of weight loss always needs to be the clinical goal.

Adrienne Youdim

Yeah, I agree. And I think this is a perfect kind of reframe of the entire conversation, which is as weight loss is going to drive many of these improvements in cardiometabolic health, the way that you have advised our nutrition and the consumption is also supporting cardiometabolic health. So, I always tell my patients that these drugs, you know, we were earlier, we were talking about how certain foods cause more side effects. It's kind of like these drugs are, um, are slapping you on the hand when you don't, when we don't eat, eat, when you don't eat the way like you should eat, right. It's almost like making people eat in the way that is really the most healthful. And if we can lean into that part of what the drug does, the fact that it is really trying to engineer us to eat the way that we think is healthy or that we know is healthy, that is when we're getting the most out of this medication. It is driving the weight loss, but it is also driving a nutritional profile that is supporting cardiometabolic health should you continue it throughout your lifespan.

Gretchen Zimmermann

I agree. Yeah, I love that. I think, you know, GLP ones are controlling how much we're eating to a certain extent, but nutrition is really there to control kind of what's built and what's lost and what's sustained over time. And so the two definitely, they go hand in hand. Yeah.

Adrienne Youdim

Well, Gretchen, this was a great conversation. You gave us so much information, so many important nuggets. that I think are relevant for people who are on the medications or not. So I really appreciate you being here. And I agree that registered dieticians as well as mental health professionals and so many other ancillary health professionals are so critical to this work. How do people connect with you? How do people find out more about what you do? Where can we direct them?

Gretchen Zimmermann

Yeah, thank you. I've really enjoyed this conversation as well. So I, you know, a lot of the work that I do is with VEDA, so VEDA Health, but I also am pretty active on LinkedIn. So I do like to share a lot of information and kind of thought leadership around GLP-1 and the obesity space as a whole. And then I do have an Instagram profile, it's Gretchen Zimmerman with two N's dot RD. So those are kind of the three different places that you can find me. And yeah, I really appreciate the opportunity to talk with you today about one of my favorite topics.

Adrienne Youdim

Yeah, perfect. We follow each other on LinkedIn, but I don't know that we follow each other on Instagram. So I'm going to head over there and find you. And again, thank you for your time. This was really lovely. And to all of our listeners, if you are on a GLP-1, maybe listen to this again and take notes. If you have a friend or family member who's on a GLP-1, send them this episode and head back over to wherever you listen to rate and review. Thanks again, Gretchen, and we'll see you all again next week. Great. Thank you so much.