Ep 187: Weight Health with Ashley Koff

 Welcome to another episode of Fertility Forward! Today, we are joined by registered dietitian and bestselling author Ashley Koff to discuss weight health and fertility. Tuning in, you’ll hear all about Ashley’s new book, Your Best Shot, and what inspired her to write it. We talk about what agonists are, the pros and considerations of weight health therapy, and how we can understand weight loss hormones using a pizza analogy! Ashley delves into why nutrient reduction to lose weight when trying to get pregnant is dangerous, before discussing the use of GLP-1 agonists in fertility treatment, pregnancy, and postpartum. We even touch on the psychological piece of weight health, how trauma affects the function of the vagus nerve, and weight health, why you cannot bully yourself about your weight, and so much more. Finally, Ashley reminds us of the importance of including joy in weight health treatment programs. This is a conversation you don’t want to miss, so be sure to press play now!  

Transcript

SPEAKER_01 0:14

Everyone, we are Rena and Dara, and welcome to Fertility Ford. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.

SPEAKER_02 0:36

Today I am super duper excited to have registered dietitian Ashley Kough, who is USA Today's best-selling author of Your Best Shot and founder of the Better Nutrition Program, an acclaimed weight health expert and practitioner for more than 25 years. Ashley is leading a transformative movement in personalized nutrition, turning better, not perfect choices into practical, sustainable strategies that deliver real outcomes. Your best shot introduces weight health hormones as the regulators of weight health, offering the first ever assessment of their function and a personalized optimization system, shot or not. A trusted expert featured across major media and sought-after educator for health professionals, Ashley has been recognized as one of CNN's top 100 health makers and featured in InStyle as Hollywood's leading dietitian. Not to mention, just have to say, she was the main attraction this past week at my favorite conference, the integrative health symposium here in New York. And I'm just so happy to finally have you on, Ashley. It's been a long time coming.

SPEAKER_00 1:47

Thank you so much. I love it. I love how worlds have orbited. I'm so excited about this conversation. And I feel like coming out of the weekend's energy, like, let's do it. Yes.

SPEAKER_02 1:58

I know, finally. So I'm just super interested. I know you've been you've been present in the health and wellness space for so long, but I'm really curious as to your inspiration for writing this book and how it all came to be.

SPEAKER_00 2:11

Yeah. I sharing the book my personal story, but definitely my personal story is a key motivating factor for how I became a practitioner that really looked at first, I thought it was digestion as the sort of key to everything health. And I, and you won't have me change that. You know, I think it's so important for us to optimize our digestion to have anything, you know, work better in our body. But about 2004, when I was working with bariatric patients or people having weight loss surgery, I learned about the incretin effect and I learned about these hormones, GLP1 and GIP. And when I started to learn what they do, I was like, wait a second. Like it makes so much sense because they actually are directing what I call weight health. And at that time, it really helped me switch my practice from being digestion focused to really in an personalization optimization, but to focus on this concept of weight health. So my youth was, I was plagued by weight loss and weight really as its own thing, like separate from health. When we look at that and understand the body's design is actually to be a weight health system, to have where our weight, bone, muscle, fat, water, the type, the amount, the location of them is a key performance indicator. When I saw that, I was like, oh, now I can actually just explain to people that the way that you get it all, yes, you can have it all, not just have your body be the size that you want it to be, the body, the size that your body is better suited to be, but also you can have all of the health, right? Like that you, and even when maybe health challenges occur, you can recover better because we're optimizing this weight health. So weight health, you know, really kicked off at that point. And why this book? I was hiding out in a mountain in Maine. I was like, I was done with media. I, you know, I had this company, I was helping, you know, behind the scenes person with personalizing nutrition for patients and for companies. And I started to see, I'd been seeing patients for years who were on an agonist, um, a GLP1 medication, but I started to see that these were being called GLP1, they were being called weight loss medications or diabetes medications. And I'm like, oh, no, no, no, no. Not on my watch. Like they're weight health hormone replacement therapy. So that's why I was like, all right, people need to understand that number one, the body has weight health hormones. We all need them functioning optimally. But if we are going to use an agonist, we need to make sure that we don't just use the agonist and think it solves weight health hormone issues. It's a tool for optimizing them like any other hormone, you know, that we were that we use hormone replacement therapy for. But if you have any wins on a weight health hormone replacement, if semi-glutide, ozempic, wigovi, if any of that works for you, you've proven to me your own were suboptimally functioning. So to ever get off of them, or you still have to optimize that dysfunction below. So I'm like, all right, and it's gonna take an RD, not a doctor, to do this because doctors are typically prescribing the medication, or when they talk about food or nutrition and lifestyle choices, it's like, do this, not that. And I'm like, hold on a second, let's go under the hood and see what's actually going on. Maybe do this, maybe do a little this. This is how you can do it. This is what's better for you. You know, how do we do this in a personalized way? So that's the whole this of your best shot, and certainly where we are in the weight health conversation right now.

SPEAKER_01 5:35

That is fascinating. And I mean, the the one thing that came to my mind first is the word agonist, because that's often used in fertility treatment as well, with the protocol, right? You have an agonist or so, how is that the same or different with the GLP?

SPEAKER_00 5:51

Yeah, exact same thing. So in the body, we either have things that we want to agonist. So an agonist means that we support the body in the way the body is designed to function, or an antagonist means that it comes in and it challenges the body's function so that we can change something that's happening. So, say you have too much pain going happening. We might use an antagonist to come in and turn off that pain. Maybe we have too much cholesterol being formed. We might have an antagonist that stops the formation of that cholesterol and so on. But an agonist is when we look at hormones, is that we actually want those hormones to work the way they're supposed to. So estrogen, testosterone, insulin, thyroid, these are agonists. They're basically saying, I want us to do this in the way that the body is designed. Now, the difference between weight health hormone replacement therapy and say sex hormone or thyroid or blood sugar hormone replacement therapy is that our own hormones from a weight health standpoint stay on for about two to five minutes. They're a motion detector. They are a blip. They're literally just to let you know something has happened and trigger other reactions to occur. When we replace them, the ones that we replace them with, say lyriglutide was one of the first ones, that stays on for a day, or the pill version of semiglutide works for a day. But most of what we know about the GLP1 agonist shots is they stay on for seven days, right? That's their half-life. So that's their, they're gonna stay on for a much longer period of time. So if you, I use this analogy a lot, if you have a motion detector and let's say that it goes on and off for two to five minutes, let's call it six times in the day. So that's gonna be anywhere from 12 to 30 minutes. Your weekly bill would just be for, let's call it 12 to 30 minutes, right? If we were paying an electricity bill. Now, if I leave town and my motion detector stays on, it stays on for seven days, then you're gonna be paying an electrical bill for seven days, 24 hours, and six times 60. I don't know what that number is, but it's a lot bigger, right? Like that's gonna be in the hundreds, thousands on that part. So when we look at a GLP1 agonist, a weight health hormone replacement, how it's different than say fertility hormones or looking at the use of hormone therapy in in that space, is that it's biosimilar, it's not bioidentical. It is going to stay on so much longer, which when it has like really impressive results, but it also has things that we have to be very concerned about because it's not working exactly the same as your old.

SPEAKER_02 8:20

I'm happy you pointed that out because that's not the exact same that we have to recognize that it that it works differently. And there's I love your book because you you do share the pros and the potential cons. You do share also if we do not use the shot, if someone does not use the shot, what are some other tools? And I would love for you to talk about your, I love your pizza analogy. You're great at really making some complex information really usable for the for the listener.

SPEAKER_00 8:52

Yeah, thank you. So I think, and I always use the phrase pros and considerations. The con somebody's con is when somebody sells you something and says it's the only thing you need. Like there you go. And and if you let yourself be con, you know, we all have a little bit of a gut instinct. Is this too good to be true? Yeah, like you know, okay, it is. Now, that said, sometimes a tool, if you're doing all the other stuff or if you're doing enough of the other stuff, like sometimes that tool, like I had been like kind of white knuckling migraines. I'm 52 now, and about six months ago, I started to have like I was like, oh, I'm having a monthly migraine. And you know, I knew my estrogen was leaving. And the other day I finally just said, all right, I'm gonna put the patch on. And literally, like the migraine was gone. And I had been trying, like I was sitting in a magnesium bath taking magnesium with like something over my eye, you know, and and I'd been trying to sleep, but I don't drink, and I like all of these other things. So it's not to say that sometimes a tool like a GLP1 agonist isn't that thing. When Oprah talks about how she, when she took the shot the first time at eight o'clock in the morning by 2 p.m. that day, she's like, I felt like an indifferent person. My hormones were activated. Okay, so we've got that part. But here's the thing when we look at that, at the end of the day, that's still a tool. It's not, it's what I call a topping on a pizza. Like it can be the absolute thing that makes your pizza totally delicious to your body today. So, you know, if it is the pepperoni or it is the begrudgingly, I say pineapple because I don't know why people put fruit on pizza, but some people really love it and they're like, that's the thing. Okay. But for a pizza to be delicious, it still has to be a pizza. And so all of us, and I I have my character, Mr. Pizza Pop, in the book. He was a client of mine that really showed how my weight health playbook can work in the era before the GLP1 agonist. But I, when he when we started, we literally he only ate pizza and we changed the order and the amount of his pizza, and we got him to lose the weight that he needed to lose, and we got his diabetes reversed, and we got like all this other stuff just with this concept of literally he was eating pizza. So now I use it as an analogy. So pizza is the crust of your pizza, it is always going to be digestion, which includes hydration. So it's going to be the process of your body breaking down, first of all, evaluating, then breaking down, moving and absorbing and using, sending where it's supposed to go, what it is we're taking in. And that could be foods or supplements. If we do not have optimal digestion, if our crust is not working, if it's not delicious to our body, no matter what food you take in, or whatever, no matter what supplement you take in, you're not going to get the optimal benefit from that. So I layer on top of the crust the sauce, which is your better nutrition. And I have four pillars of that quantity, quality, timing, and balance. And I talk about Mr. Pizza Pop's a perfect example. He actually was having great quality pizza and it was nutrient balance. It had cheese, it had sauce, it had crusty. We had some protein, some carbohydrates, some vegetable, there was some fiber in there, you know, like there's a little bit of everything, right? But the issue for him was he was having a pizza every day at about five o'clock. And what was happening was the timing for him meant and the amount at one time. When you have a large pizza all at one time, it was too much for his system. His system was like, I'm overwhelmed. I can't break this down and I'll use it. But he had actually been told that he had to meet a certain level of calories because when he'd been on a low calorie diet, he had actually gained weight. So he said to me, I'm so confused. I'm not gaining weight anymore, but I'm getting worse in terms of diabetes. And my sleep is awful, my reflux is awful, my digestion is awful. So we pivoted him and we had him eat two to three slices of pizza. This was just my idea because he he could have cared less what he was eating. He was like, I failed every diet under the sun. I hate food, no, no worries. And I'm like, all right, just have two to three slices of pizza from the time that you wake up every three hours. And within about six weeks, he had lost the weight that we needed him to lose. But more importantly, after two weeks, we were already adjusting blood sugar medication. And then before he had his surgery, he actually was off of, he was not diabetic anymore, like before he had the weight loss diabetes surgery, you know, on that part. So, what that showed was when you optimize crust sauce and then your cheese being your lifestyle choices, your sleep, your breathing, your stress, even the joy. Like he was feeling so hopeless and disempowered because he's like, I don't know what the problem is with my body. You know, I've tried everything, right? So when he started to see his body was working better, he felt better on that. So the concept there is that that's your pizza. And that's the same for all of us. That helps all of us optimize our weight health hormones. It helps us give our body what it needs, when it needs it, and it helps it get where it's supposed to go. And then the digestive part is, and so the body can actually use it. So in that space, whether we ever have a relationship with a GLP1 agonist medication or not, we all need to know what part of our pizza is not working. And this is where I use another analogy, which is really a car. If you go down to start your car in the morning and it doesn't turn on, and you look at your the, you're like, okay, there's gas, right? Or there's electricity, whatever your car is riding at. There's oil in the engine, there's air in the tires. If the car's not starting, you don't go around all those and like drain them and be like, well, let me just take gas out, or let me like get, you know, get rid of the air in the tires. You maybe if you can get it, see anything on the dashboard, you're like, okay, maybe it's telling me where to look. Or if not, you or someone who's qualified looks under the hood and says, What's going on here? Is it a spark plug issue? Is it a, you know, whatever? And that to me is how we take the pizza and we turn around, we say, okay, what we really need to do when somebody is not, you know, it's it's why the crust is so important, but we really need to look under the hood and ask that question of what's not better, not just start changing our macros and being like, let's eat less in the day, you know, on that part. So weight loss versus weight loss there.

SPEAKER_02 14:40

I love your philosophy, is being curious. I think that's great. Or part of your philosophy is really looking at things from all different angles. And I love that the the crust, the base is digestion and hydration, which so you had it way back when. Yeah. Yeah. You know, that foundation that was still there. But building the pizza with that foundation is really critical.

SPEAKER_00 15:03

Yeah, I've tried so often to work on the sauce. I think, I mean, so first of all, that in case it didn't land for anyone, in the car analogy, weight loss is the approach where we just say diet and exercise. It's like, let's just change gas, oil, and air in the tires and let's not look under the hood. And it disempowers, it doesn't work. Maybe in moments it works. Like if you didn't have enough gas and you add a little more gas, or maybe if there was too much gas, you know, whatever on that part. But it's not going to actually fix the problem. Like, you know, when we identify that weight health is a key, you know, when we're looking at our weight, it's a key performance indicator. But so is cholesterol, so is blood sugar, so is our sleep, so is our joy, so is our so many other things, you know, on that part. But I think that the the reason that I get curious is like I've been taught, and and we as practitioners, we're gonna come over and help you look under the hood. And so sometimes even other things that are out there, the these toppings that are sold, are hey, instead of looking under the hood, just take this probiotic. You'll be great then. Then your gas, oil, and air in the tires will work fine. And then it doesn't. And you're like, it's because it wasn't a probiotic issue. Maybe it was an inflammation issue, or maybe it was a, you know, whatever. So, you know, one of the reasons I think there's a point for practitioners, and there will always be a point for practitioners, regardless of AI, is that our curiosity is going to be so experiential with you. Like, we don't just want to know what you are doing, we want to know why you're doing. Now, could we train an AI to maybe do all of that perhaps? And we'll chat further in the future. And sometimes maybe an AI is like nicer on a day that, like, I'm not having a nice day and you feel super like, you know, supported. But truly, when we're looking at how to help you with your weight health, it is so multifactorial that what has happened for a lot of people is they have tried something that actually would help their body, but they didn't try it in the right order or in the right amount, or it overrode something else that needed to work better. So it's so interesting to me, you know, that we've been in this weight loss. And I'm worried that we could actually stay in this weight loss place. You know, when every study comes out comparing any of these medications, you know, so retitrutide compared to terzepitide or semiglutide compared to or oral semiglutide versus injectable semiglutide, they're all being compared to percentage of weight loss or body mass index, which is just weight for height. And they're not really looking at, you know, in a few cases, they're looking at things like liver enzymes or inflammation or changes in the presentation of autoimmune symptoms, you know, pain and plaque and other stuff. But when they're not looking at the whole body and they just look at who can, what medication helps somebody lose more weight or lose more weight faster, and then they're surprised that people have lost muscle or they're surprised that there is hair loss, or they act surprised that, you know, somebody like all these things. You're like, hold on a second. You know, this is exactly how you've been teeing up this medication. Like we have to change how we think about those for sure.

SPEAKER_02 18:04

Yeah, I see that in my practice quite a bit. Working in the fertility clinic, I see a lot of patients coming to me, say my doctor suggested that I go on a GLP1 agonist and prior to treatment to get my BMI down. And it's so great that you are also changing the conversation around weight loss, weight management versus weight health. I don't think this was really spoken about, I don't know, five, 10 years ago.

SPEAKER_00 18:32

Right. I love that. And I am so glad you brought up fertility and just this whole space of the Agnes as Medicaid. So if we can pivot over there, I would love to chat about it because I think we're in a space there where there's so much problematic messaging and you all are the experts. So I love that. First of all, we can all, I you know, we just saw Ayla, a farmer, who we love is just an incredible fertility and looks so much at what nutrients does a person, a woman need. And one of the things we want to recognize is that if you do any form of weight loss and you reduce the amount of nutrients you're taking in, uh that's not a pathway towards fertility. And it's not a pathway towards usually the baby will be healthy and then mom is just going to be challenged because she's gonna end up with, you know, an insufficient amount of nutrients. And so we want to make sure that we are not doing that weight loss approach where it's just taken less as a way to get yourself pregnant. We also want to understand that there is truth too when there's excess fat, when there's visceral fat, and really when weight health hormones are suboptimally functioning, they direct bone formation, they look at hydration, the impact hydration, inflammation, blood sugar, satiety and fullness, and really a lot of like obsessive thought in the brain, like so much of this that any of those factors could be a challenge too if the intention of fertility is getting pregnant and sustaining a healthy pregnancy, then that could absolutely be a factor. So I think where the rubber meets the road is you don't use a GLP1 agonist to lose weight to get pregnant. Let's just break up with that concept. But what we do do from a fertility standpoint, and feel free to comment on and dementialize what I'm about to say, but is, you know, my like my simplistic version of how we get pregnant is we help the body say you are safe and okay, and you have enough resources to sustain a healthy pregnancy. And what we do as the experts, what you all do as the experts, is you look under the hood, not at the gas, oil, and air. I mean, you'll look at them, but not exclusively. You look under the hood and you say, where is their suboptimal function or where is there a challenge? And that's what we optimize. So can we use a GLP one agonist? Absolutely. Because oftentimes we can use a GLP1 agonist and we can actually take people off of medications that were challenging their, not just in terms of losing fat mass or optimizing weight composition, we can reduce inflammation or we can optimize blood sugar or we can help somebody not have obsessive thoughts about their eating and restricting their eating, or we can help the thyroid work out. We can do all of these things. So a GLP1 agonist may be a great medication. Here's the issue: we don't have any clinical data that would support being on a GLP1 agonist during pregnancy. So one of the things that I want us to understand, and this is in the idealized world, which I know as practitioners, we never find and patients, we never find ourselves in this perfect scenario. If we had our perfect scenario, we would use the playbook, your best shot, for optimizing weight health and potentially a GLP 1 agonist. And we would help somebody optimize their weight health. And in doing so, we would look under the hood and we would fix and we would repair what's going on under there. They would get pregnant and we would wean them off their GLP 1 agonist. They get pregnant, they're not on the medication. What's happening is people are on the medication and they're getting pregnant there. Totally fine. If we then immediately take you off the medication, which I think is the appropriate protocol, unless your physician has different data or you're deciding. On something else. But if we take you off of it, we now have no support for your weight health hormones. And we have also suppressed them while you were your own internal ones while you were on a medication because the medication was satisfying the receptor sites. So that may be totally okay. You may gain weight during pregnancy. We may see shifts in blood sugar. So that's why hopefully you're working with your dietitian to optimize that as best you can. And it may be like a little bit suboptimal because we're dealing with the fact that, again, your own weight health hormones aren't necessarily starting as quickly as we want them to. And some of our tools are a little bit more limited during pregnancy with what's safe and what we're comfortable with. Here's the issue. After you have your baby, we're then going to, and you're healthy, baby's healthy. We then are going to look at when it would even be appropriate for us to consider and do we need to consider at that point resuming the medication. So what has happened in the research that's being done is nobody's doing this and nobody is talking about this. And they're looking at data solely about does using a GLP1 agonist help women get pregnant? And they're saying yes, because they're seeing people who were not getting pregnant get pregnant. So they're saying yes, it's a fertility tool. Then they're also, though, have studies, and they're just a couple that are coming out that have said people, women who were on these agonists are going to have, they're going to have heavier babies, and they also are going to have a harder time with weight gain after their pregnancy, and they might be at a higher risk for gestational diabetes. Yes, absolutely, to all of those things because those women did not get the playbook. They didn't get the pizza help. They just got the topping, right? On that part. So we need to, and you all need to, I mean, you guys are the type of practitioners that you are, the way you're handling this is in the sub-optimal way, wherever you're meeting a woman, is to just explain that to her and not make not have anyone feel based on the research or any of this other stuff that she's some statistic or should feel shamed about or any of this other stuff. We're just going to work with you where you are. But we have a lot of tools that we could use to optimize your weight health throughout your pregnancy and after your pregnancy. And we really have to be thinking about it as your weight health. That the exclamation mark is that we know that it's also your child's weight health because that's how early we're imprinting not just the genetics, but also the epigenetics around what their weight health story is going to be.

SPEAKER_02 24:26

I think we still have a lot to learn. I think I'm super curious to see where the research goes, but you made a great point right from the beginning, and it still applies now. It is these medications are a tool, but not the only tool in the toolbox. It shouldn't be the only topping. You shouldn't be limited to one topic.

SPEAKER_00 24:46

That's right. That's right. And not everybody's topping. I mean, how many of us order pizzas and we split it down the middle, right? And it's like somebody wants pepperoni and somebody wants peppers. Great. And in our lives, we're going to have different toppings, you know, in those ways as well. I just, I'm so nervous, even in this time period where we're not accumulating the best research for women, especially at such an important time period. And we're seeing it on the other end. We're seeing HRT and GLP1, what I call WHRT, weight health hormone replacement, on that part therapy. We're seeing them being used together and it's the same conversation. You cannot just use the hormone replacement therapy and expect the outcome to be optimal weight health.

SPEAKER_01 25:25

I think this is so interesting. And I'm coming in not in the same field as the two of you, Dara, and actually. So it's it's really interesting to hear this deep dive into it since my expertise is in is in mental health. And so, Dara, I don't know if you see in your practice or actually in yours, patients, though, you know, they started GLP and then they they really struggle with conceiving or not because of can I stay in the GLP or not? And I know that's sort of been the burning question in our meaning the fertility industry since GLPs really became sort of more mainstream, which is are they safe before, during, after, any long-term ramifications? And that's sort of been the real top questions on people's minds, I think.

SPEAKER_00 26:17

Yeah. Well, I first want to acknowledge as we look at this, we're all talking at the end of February in 2026. So just want to timestamp that because what's not going to survive is within the next month or two, we are going to see medications come on the market under the naming of GLP1 agonists that are small molecule non-peptide. So they are not hormone replacement therapy. They're a medication that is going to do the GLP1 agonist thing, but it's going to function in the receptor site in a different way. It may have significant benefits that these medications don't, but it has different pros and considerations. So I just want to acknowledge that so that this conversation lives. And I think what you were just bringing up is really so important. Number one, if a medication stays on, if our own hormones are two to five minutes and a medication stay the hormone replacement therapy stays on for a day, that's already such a significant difference in terms of how something is working. Because when it stays on, it's not just like it's lighting up and it's staying on. It is signaling other hormones to work very specifically, which means their counterbalance hormones are not working specifically. And when I when we think about for when we think about not just the act of getting pregnancy, but of getting pregnant, but of sustaining a healthy pregnancy with the dual outcome of mom being healthy, not just today, but throughout her lifespan, but also the baby on that part and what inputs are occurring for the baby, that's really something for somebody to unpack. And I don't think they're going to unpack that anytime soon, you know, in terms of because it's real hard to do that in the research. You know, it's not like we experiment, you know, in that way. Now, on the flip side, if we understand that at low doses, we may be able to help someone optimize scenarios that allow for their bodies to respond in a certain way, that then maybe we can comfortably reduce them or extend the time period. So I have some patients that after using the medication for a period of time or you know, longer, they're on it every once a quarter, you know, or they're on it once a month and we're on a really low dose. So, really, depending on what's going on for someone, where I thought you were actually going to go, which is an interesting part, and I want to lean into your expertise, is actually trauma and understanding that the trauma of our fertility stories of infertility, the trauma of our lived experience with our weight, the trauma of our lived experience with our parents and becoming a parent and like so many, and just the trauma of the world. Trauma actually impacts the vagus nerve function. Well, the vagus nerve is the transport system for the signals that tell these hormones to go to work and also for the hormones then to get where they're supposed to go, most of them. Some also travel by the bloodstream. So if that's the case, then using an agonist where it goes directly to the receptor site and it doesn't have to engage the vagus nerve can also be a reason why women are actually able to change their fertility story and become pregnant. But what will end up happening is when you remove that hormone replacement that goes directly to the receptor site and circumvents the whole vagus nerve both ways, both there and back, you know, on its uh rules, then you suddenly have a woman functioning during her pregnancy to try to have these hormones work with her trauma impacting her vagus nerve. And with the added trauma now of I don't feel the same way that I felt about food or about my weight, you know, about anything else. And so it really, in my opinion, means that the role of the psychotherapist, the psychologist, the whole team around the woman really, and around her partner, but her, you know, in the whole space, it really needs to be explored because that trauma really impacts how healthy, how the weight health hormones work. So I think there, you know, what you're bringing up in your area of expertise is so important to this, whether it's a woman navigating her pregnancy or whether it's just a woman or a man in general on that part. Some of the worst challenges to weight health hormone optimization that I've seen and experienced with patients has been either somebody helping them, like bariatric surgery as an example, helping somebody be in a position where they lose weight and they lose weight really quickly. And they are not ready to be to have people see them in a different way. And they're not ready to be experiencing society through the lens of someone who has less, less fat or less weight on them. Um, and similarly, other people where the people around them, because they're eating differently, are engaging with them differently, or don't want to be their friends because they don't want to go to the bar or they're not, you know, any of these pieces. So the psychology around weight health is an absolutely essential piece of this. And it's why I wrote a book on shot or not, because we really have to make sure that somebody is going to be in an okay place to both use a shot or to not use a shot based on what's going on. And then also maybe to come back on a shot because something happens in their life and it's a trauma that they, you know, an experience that they don't, they're not able to do what they were doing before, you know, that optimize their health.

SPEAKER_01 31:34

Well, okay, so now now you're totally speaking. And a lot of questions from that. I mean, the first I would say is I totally agree. And I'm going to not only read this book and recommend, or I've read it, but reread, but really read your other book because I will say in in my work with clients, that has come up a lot, this identity around the before and after with clients that have used a GLP to lose a significant amount of weight and how to navigate that in the world, because as you as you said so eloquently, it really is a whole new identity, both for yourself and then the people around you. And so to think that you can have this shift and and have nothing else change is a fallacy. And so it's like meeting yourself, reintroducing yourself, all the things. But then my other question, going back to the vagus nerve and the trauma, does the way that this works though, could you potentially, if you have a trauma, whether it's a big T trauma, small T trauma, whatever, potentially almost block it from working?

SPEAKER_00 32:39

Yeah, great question. So, first of all, I think we all have trauma. So I, you know, and especially childhood trauma. And you know better than I in terms of, you know, the body wasn't kind of stored it, or I love the book The Body Keeps Us Born.

SPEAKER_01 32:52

Yeah, we talk about there and I talk about the we talk a lot in here, right? Yeah, and the the mind-body connection, all of that totally.

SPEAKER_00 32:59

And the mind-body connection in this instance is literally the delivery system. So what's interesting about it is one of our colleagues, Dr. Navazib, he wrote a book called Upgrade Your Vagus Nerve. And he talks about five types of safety that the vagus nerve needs to be experiencing in order for it to function optimally. So one of those is biological, it has nutrient needs. And so if we're, if we reduce our intake or we skew our intake in such a way that we're not getting in the nutrients that the body needs. The second one is the trauma of our lived experiences. So there could be a psychological trauma. There could also be a physical trauma where, like when we all sit or I'm kind of hunched over right now, not better. I need to, you know, we're all working at our posture and we're we don't move or we can't move. You know, maybe we've had surgery. And for me, there's no time that I've battled my mental health as significantly as when I've had surgery. And, you know, so I think in in those spaces, it's really important to understand. So you are overriding the function of your weight health hormones. Yes, 100%. Your own GLP1, GIP, PYY, and CCK will be suboptimally functioning solely because of one aspect of that can be because of, no, it's not the fact that you have the trauma, it's whether or not you are the presence of the trauma means that your body, that your vagus nerve doesn't feel safe and it's challenging function. So what I mean by that is I am very outspoken about my story, like, but I didn't even put in the book. And it was when I started doing podcasts and talking about, like at eight years old, this kid took me out back and punched me in my belly and was like, you're fat, you suck, like, here's all of this. And I'm like, okay, I remembered that trauma going to my eight-year-old niece's birthday, like as I was, you know, doing a podcast about my book. Well, that trauma has been in me. I don't think that at this stage of my life as a 52-year-old woman with where I am now, that that is interfering with my vagus nerve function, in large part, quite honestly, in terms of writing this book, because I have talked about how I was so wrong to think my belly was this weakness. My belly was a check engine light. It was a somebody should have been looking under the hood, right? It was not on it for me as an eight-year-old to go down this path to try to play around with what version of air in the tire, oil in the engine, gas in the tank, what what's the right amount in there? So that trauma is not interfering right now. So I want to make sure that people we can make peace with our traumas and we can also, and again, I think I'm like, this is your work, you know, like we can learn to dance with our traumas and you know, and understand they are who who made us who we are. The flip side of that is what I do experience currently, like going and speaking on this and that kind of thing. I had somebody walk up to me and she said, and I was at a conference and I'm, you know, in a bright colored dress and I made myself look good. And she's like, wow, she's like, you look amazing. She's like, and whispers, comes up in like kind of whispers close to me. You know, when people get in too close and she's like, You just you've lost so much weight. I knew you years ago. And I'm thinking in my head, like, no, years ago, I actually hadn't gained a bunch of weight. Two years ago, yes, but like years and years ago, you know, like so I'm unpacking this. And she goes, you know, if you're on one of those, I think you're on too much because you're looking a little too thin. And like to my face. And the eight-year-old in me was outside being punched in the belly. I was so upset by this woman, right? The person that I am today was able to just kind of pivot and take her aside. And I said, How dare you? I said, first of all, I don't know what virus I have right now. I haven't kept food or anything in for five days. I was like, I'm happy I'm standing here and thank you for telling me I look great. I was like, I don't know if you're coming to my talk or not, but like what you just did is such a violation. And I was like, I have worked my whole life to think that like somebody is not looking at my appearance and judging who I am or how I do good, like my value, you know, any of that. So in the empowered way, I was able to talk about it, but did like it's still there with me. It's a little bit of a sting. It's like, I just don't, I don't know why, you know, at the conference, like I know we love to say to each other, you look great. And we truly want to celebrate when somebody says, You look great, like, you know, like you look awesome, you know. And I've learned to say, oh, that's because life is really awesome right now. Like I look good, I feel good, here's what's going on. Trauma is so interesting in that way because when we have the psychological trauma, it often then also plays over, it spills over into the other traumas, right? We eat differently, we may exercise differently, we may have all these other stuff. So bringing that into fertility or just into this larger conversation of weight health, it's one of the reasons that I think we have to break up also. One of the reasons I think weight loss is so problematic, or managing your weight is so problematic, is it almost seems linear. Like you're here, and then every week I just expect you to lose weight and you get closer and closer and closer to goal in a time period where you're normal based on BMI where or the scale, you're normal and you're great, right? Like that's what society is set up. And instead, if we basically say you're awesome where you are right now, your body is more challenged, like, and it is harder for things to work or whatever. We've got some signals, let's work on them. We're going to see things like we're going to work on this a little, and then maybe we're going to see something shift. And then we might, we're going to reassess and we're going to work on something else a little bit in that part. And for some of my patients, year, two years on a GLP one agonist before they can even like start to unpack any of the their diet, weight, nutrition, like any of that stuff. You know what I mean? So my job is just to have them have a good, healthy experience on the GLP one until we get to that place where we can move. And it's not this linear and like suddenly aha, you're great. You could long before be at a goal body composition and health and still have a lot of work to do on the other side of it as well.

SPEAKER_01 39:01

Yeah. Well, I love what you brought up, and something I I feel like we've talked about on this podcast and want to continue is just sort of the idea of stigmas. And right, that lovely close talker who really told it like it was to you. It's an assumption. She made an assumption, right, that, oh, you want to be thin or thin is good. And I mean, I just hate it's just such a stigma, right? And so I love how you said it's not about like there's something wrong with you, quote unquote, or it's okay, you're coming to me, your body is not functioning optimally right now. Is it because maybe you're carrying extra weight? Okay. So if we're looking at how to get you at a place where you can be functioning optimally, right, the answer may be you need to lose weight for that. It does not mean that you don't look good, you don't, whatever. Maybe you don't feel good. Right.

SPEAKER_00 39:54

But and so to take away why is your body carrying that weight, right? Like we can answer, like the question we're really going to ask in there is why. But I love you that you use the word stigma. The thing I'll also share, and I don't know if you say this to your patients, but I say every single day in this weight health conversation. Whenever somebody comments on your weight, they're thinking about themselves. Just know that. If it was your mom, she's thinking about herself. It's a mirror. Like it is always and they're in their head. So I just was like, look, you obviously have your own stuff to deal with in that part. Like, but like as my little uh five-year-old nephew says, like, don't yuck my yum. Like, I don't want that, you know, on that part. So I think that stigma part is one of the empowering things for women in this space is to recognize that the person who is judging you for your weight health, you have no control, like judging you about your weight, you have no control over them, but they are really just focused on themselves. It is a narcissistic moment, you know, in that space. Now, the flip side of that, no one has ever been as much of a bully to me as I have been to myself. That's the work that we do have to do. Because when we adopt a stigma, when we assign value to ourselves, when I accepted at age eight that I had a weakness and my belly was a problem and I was not going to be productive and awesome and do all the things. And like now I had a limitation for what I could be in society, that's my issue to deal with. And so I think that's the you know, sort of the duality of it.

SPEAKER_02 41:22

I'm happy you mentioned that because it's true. We create these belief systems during these these moments of of bullying, so to speak. And usually the bully themselves forgets that they what they said, but we carry it with us oftentimes until adulthood. And when you recognize, okay, I don't need to believe that anymore. I could tell a different story. And you know, it's it's one area of nurturing our our health ecosystem. So I I know it's it's not the only answer, but I love that in your in the book you spoke about how can we bring joy? Joy is a huge component. We have moments every day where we can really be struggling, but how can we bring joy? That was that was for me like the the the star that I I really highlighted in in this book because I don't see many people in this space really speaking about about that component. I know Rena, you do.

SPEAKER_00 42:17

Yeah.

SPEAKER_02 42:17

Um but it's not something we see.

SPEAKER_00 42:20

And I think Rena, like, I mean, that's the beauty of having also for on our end a collaborative ecosystem of I'm so grateful when my patients are working with Arena, you know, and I and I invite that in. And I think that's like, you know, one of the in the same way I'm unhappy with a medical system that is allowing doctors to prescribe these medications and not mandate a dietitian and not mandate a therapist, you know, and certainly a psychiatrist if if medications are involved, noting a psychiatrist as a physician. So I think on that part, not only am I the joy piece, if you actually go into the research, which I very rarely do, because I like to like just kind of meet with people and like figure out, but I was like, so I found this so incredible. You know, a lot of times people would say to me, the reason I want to lose weight is I want to experience more joy in my life, or the reason I want to lose weight is I enjoy doing this and I can't do it while I have this. And then I went back and I was like, oh, actually, joy, experiencing joy is actually part of the treatment protocol. It's part of your recipe. It's it's your cheese. So when I realized that, I pivoted to actually I created a joy assessment so that, you know, and I always am like gonna want to know, like, so if somebody says more joy, I need more joy, then I need to know, well, what is your current level of joy? Or when are we disrupting your joy? And you have these moments where you actually learn in that space that joy becomes like you have the ability. And joy is not happiness. Happiness is a you can't be sad and be happy. You can be sad and experience joy. So you can be in the worst moments of your life and have gratitude and experience joy. So when I really started to unpack that, I was like, this is incredible, you know, and I think there's a Woman that's just a physician that just wrote a whole book on this. But it was um to me, it's one of those, it's also something that, you know, it's just not always about carbs and fiber and protein. Like as a dietitian, can we please find, you know, but can I also ask you, do you enjoy the food or do you enjoy your meals? You know, like that kind of thing. So anyway, I think it's nice to I appreciate that that that stood out as a star for you because I think that it's it's where we are as a society too. Yeah.

SPEAKER_02 44:26

It's refreshing to not just see fiber protein, very important, but it's not the only component that we should that we should be looking at. Um, there's so much to unpack in this book. I really do recommend that everyone gets a copy. It's really, there's so much, there's a lot of meat. I literally I finished the book today. I read it from front to back.

SPEAKER_00 44:47

Thank you.

SPEAKER_02 44:48

And there's just so many good nuggets in there. I think it's really well-rounded, really digestible too. I love that you bring your humor into it. It's it's really a great addition.

SPEAKER_00 44:58

Yeah, I appreciate that. You know, Darren, it was gonna take a lot for me to get back out here. We all we, I think those of us that have done it or have observed it, what it takes to market a book these days, like because I didn't write it to just be like, oh, look at me, I wrote a book. I'm like, I literally want this in the hands of everyone because I want to change. I believe in generational weight health. I believe we can help parents become weight healthy. And as a result, they can we can have kids that are weight healthy. Maybe we don't need GLP1 agonists 20 and 30 years from now, the way that we need it, we need them now, because we've or even 60 years from now because of shifts that we've made. But it's a lot on that part. And so, you know, there's hopefully there's a lot of love and there's also additional online support so that people can talk to live humans in case you get stuck with something that I'm saying that doesn't land for you. I want to make sure that we don't yuck someone's yum so badly that they're like, what does this mean? You know, so we made access to our online coaches on there available. Amazing.

SPEAKER_01 45:54

Well, what a fabulous resource and tool. And thank you so much for coming on and sharing a bit about you, your story, your insight, your knowledge, and I think definitely more to come. We could certainly have a part two at the very least about this. I think this is really just the beginning. I hope so.

SPEAKER_02 46:17

Thank you. So, how we end, Ashley, is with words of gratitude. So I'm putting you on the spot. What are you grateful for today or at this moment?

SPEAKER_00 46:26

You know, I think that I think it's really leaving the the conference. So I am just so grateful for my family and my chosen family. This I am the luckiest person for the people who show up and support me in a variety of different ways right now. That's a bit big G gratitude on that part.

SPEAKER_02 46:45

So nice. Well, I'll piggyback on that. I'm not sure I mentioned yet on this podcast, but uh, I know you also recently lost a dear friend. I lost one of my greatest mentors. And, you know, I'm so grateful that she's that she was in my life. And I'm also very grateful. I want to give a shout out to a friend of mine who saw that I was struggling and recommended this book. And it's called Broken Open by Elizabeth Lesser. I highly recommend it. It has changed my life and it's really helped me in the in the grieving process. So I'm grateful for that. What about you, Rena?

SPEAKER_01 47:22

I'll kind of piggyback on both of you and just say, you know, really grateful for my village. And it it takes, it definitely takes the village. And so super grateful for mine. So love that. Thanks so much again, Ashley.

SPEAKER_00 47:37

Thank you for having me, and I love I'm loving it. I've just dove into your podcast, and so this has been really fun. Yeah. Thank you so much for coming on.

SPEAKER_02 47:46

Thank you so much for listening today. And always remember, practice gratitude, give a little love to someone else and yourself, and remember, you are not alone. Find us on Instagram at fertility underscore forward. And if you're looking for more support, visit us at www.rma ny.com and tune in next week for more fertility forward.