Dynamic Dialogue with Danny Matranga - 394: Weight Loss Medications, Muscle Loss + More w. Dr. Christle Guevarra

Episode Date: November 20, 2024

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Hey everybody, welcome into another episode of the Dynamic Dialogue Podcast. As always, I'm your host Danny Matrenga and today I'm joined by Dr. Crystal Guevara. You might know her from Instagram. She is a beast in the gym. She trains with resistance through the fullest range of motion you've ever freaking seen. She does jiu jitsu and she's a practicing physician. And on this discussion, we're going to cover a lot of different topics. I should say in this discussion, we're going to cover a lot of different topics, specifically

things like weight management, medication for weight management, strategies for preserving muscle, the utilization of different medications, whether or not compounds like GLP-1s such as Wegovia ozempic ribelsis are safe, how one may or may not off-ramp from those, amongst many other really cool things. So I want you to enjoy the discussion today with Dr. Crystal Kevara. This podcast has some awesome partners and one of my favorite of course is Legion Athletics. Legion is my go-to supplement manufacturer for what I like to call my big rock supplements. This would be my protein powder, my pre-training formula,

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with creatine utilization. And of course, my favorite supplements for my ancillary micronutrient health are Legion's multivitamin and Legion's greens powder. Not only do these two products contain a ton of high quality vitamins and minerals, they also contain unique adaptogens like KSM 66, ashwagandha and reishi mushroom, which I like to take each and every day to promote my health.

If you want to cover all your bases with a high quality protein, creatine, post-workout or the ancillary micronutrient health stuff like greens, powders and multivitamin, I encourage you to go over to LegionAthletics.com and check out using the promo code Danny. That'll save you 20% on your first order and you'll rack up points that you can use the same way as cash every time you use the code and you'll also be supporting the show. Dr. Crystal, how are you today? Oh, I'm doing good. How are you? I'm doing really well. I'm glad we're talking. For those of you who are listening, who aren't

familiar with Dr. Crystal, she's one of my favorite followers on Instagram. She trains really hard with resistance in a progressive fashion. She's a practicing physician, which is incredible. She works with the United States figure skating team, amongst many other cool accolades and accomplishments. She's just very fun to talk to, likes a lot of my posts, which makes me very happy and fluffs my ego. Um, and today we're going to talk about a lot of things specific to weight loss, body composition, et cetera. But Dr. Crystal, why don't you tell the listeners what got you into health, fitness and helping

other people with it too? Oh man. Uh, lots of things. So it really got me started in health and fitness. Like I was always an overweight child. I was always 20 pounds heavier than most of my peers, but I was always active. Like I played sports, like sports, so to speak,

or at least I tried every year. I did some type of sporting activity. And it really wasn't until I got to college that for a whole variety of reasons, I decided that the most important thing to me at the time was being number one in academics, at least in my university. And unfortunately, that came at a sacrifice of

my own health and fitness. So I sort of hit rock bottom in 2006 when I graduated with honors, all these bells and whistles, I was 411, I was 198 pounds, probably hit the over 200 mark, but like on at the Weight Watchers, like I had sort of, you know, kind of finagled like my water weight such that it was one 98 officially. I was a pack a day smoker at the time. I stopped exercising and doing anything active and everything just hurt. And so I went to grad school just feeling like I was a hundred years old, even though I was like, what, early twenties? So that sort of set me up for this, the next 20 years of like my health and fitness journey,

just trying to get back to these behavior, like unlearning the behaviors that I had done for a three to four year period. And it took, you know, at least a decade, you know, if not more to kind of get to myself to where, you know, and then another decade to kind of get to where I am right now. So. Well, I mean, I think I work with a lot of general population adults who tend to find fitness later in life than I did. I got I've always been thin. I got lucky.

I kind of stumbled into fitness in high school and I was like, sweet, this will give me some muscles and maybe a sliver of female attention. I'm sold like. But when I got into fitness, I realized so many of the people I'm working with have 10 to 15 years of poor health making decisions, maybe because they have pursued something academically that's really challenging or they have a family that takes a lot of time. But just what made it kind of flip for you?

I'm sure some of it was the education itself where you were like, I'm, I'm going to quit smoking, which I did read your post about the other day. I thought that was fantastic. I'm going to get a routine going, take care of my body so it doesn't hurt anymore. And now I know you as somebody who trains through like the fullest range of motion, potentially imaginable, does Brazilian jiu-jitsu and is in great shape. So that, that is a, that's a transformation. What clicked internally? Was there, was there the, you know, moment of like, this is it, I have to make a change? I think part of it, part of what kind of set me off was,

I remember there, somebody, the SF State like news people decided that they wanted to do this online article, and this was in the early 2000s, so online article, like they wanted to interview me because I had gotten this very prestigious academic research fellowship. It was like the best that you could have gotten, you know, as a science major at the university. And they wanted to do interview me on like the research I was going to do with it and all this other stuff. And they took my picture. And so when that article came out and I saw what I looked like, I wasn't happy. Like,

you know, full stop. Like I didn't, I didn't recognize who I was because I had gained so much, like I had gained about 40 to 50 pounds in the span of a couple of years. And so that sort of hit. And then I had graduated and sort of felt like, okay, like if I can't make it in graduate school, like doing something else because right now, like I can barely walk, uh, you know, up the stairs without being winded. Um, I can't live like, I, I just, I can't live like this. So, um, so when I got to, like, I quit smoking that summer, like as soon as I had gotten off stage for graduation, I was like, that's it. Like, cause it was like a crutch to study.

And I was like, if I fail out of grad school because I can't like smoke cigarettes, then I deserved fail. I was so to speak. So cold turkey and then, um, really just, um, trying to not eat takeout was like the goal. Like for the for the first year or so, which sounds like, oh, wow, that sounds really boring. You didn't do like some, you know, like program or whatever. I had done some commercial programs. I did Weight Watchers on and off for some time, but I just didn't really feel like the weekly meetings were doing it for me.

So I kind of steered off of that. But yeah, that article, I remember that article because it was like, this should have been something so meaningful. And all I keep thinking is like what I look like in this, un know unrecognizable in this picture Yeah, that's that's powerful Something that you said that I actually want to kind of circle back to when it came to like quitting smoking cold turkey and I See that as being like one of the most challenging Conceivable things like most people who quit smoking will tell you like oh, yeah, that was fucking hard as shit. Uh-huh Mm-hmm. I have a question

Where would you rank? the dieting process To get to where you got Comparatively speaking to smoking because I am somebody for whom maintaining a thin weight feels relatively easy I've always been thin Yeah, but I know for some people, quitting smoking is way easier than dieting. And I think it might be a good segue to our next topic. I'm curious where you would rank those two. Oh yeah. No. And I know at least for me, I know that cold turkey is not for everybody

because I have seen a wide variety of responses to that. But on my own scale, cold turkey was just as equating smoking cold turkey is just as easy as getting into training consistently. The diet was always the hardest thing possible. And it wasn't until Medicaid, like medication, like I found a medication that was okay for me that it has always been the biggest challenge. Yeah. we'll talk about that too. But what do you think it is about the environment that we live in? Because I would say that the perceived, the perception is that quitting smoking should be harder than losing weight. And I would say it's definitely not because 70% of people are struggling with their weight.

And I know for a fact 70% of people are struggling with their weight. And I know for a fact, 70% of people are not smoking. So I think there are a ton of societal and environmental factors, but what do you think it is specifically about the West that it makes weight management, weight loss so difficult for so many adults? I mean, it makes it just so easy if somebody has food like that food drive to consume calories. Like, it smoking is like you don't actually need to you can like put it you could do it to cold turkey, you could we could ban it and people will be fine. You still have to interact with food at some point like all the time

stuff all the time. So the you know, trying to that drive to obtain food, if we really wanted it, it's so easy. We have Uber Eats at our fingertips. We have, you know, apps that just sort of, you know, help us to grocery shop. And so you can pick and choose, you know, whatever it is that you want. And food is tastier than ever. Let's be real. Nobody is getting fat on olive oil and chicken breast and you know, steamed fish, which I know a lot of people, you know, come in and like, I don't know, I just, I eat a chicken breast salad and like, girl. And then you ask them what they had like the meal before, like what'd you have for breakfast? And they're like, I stopped off at the gas station and had a breakfast sandwich.

And I'm like, okay, let's start there. So I definitely think that we don't make it any easier for people to lose weight with all of these things that, the technology that we have in our hands today. So yeah, the technology that increases access to food paired with the landscape of high amounts of, you know, hyper palatable foods everywhere you go. I often tell people like I go to the hardware store a lot. I can't even check out of the hardware store without walking past like chips and candy. And it's like you're, you're on the way out the door.

You're going to be tempted by something that's between 200 and 600 calories. And those things really add up. And there is a certain noise that I think exists, uh, in most people's heads. You know, it's an evolved response for 200,000 year old species. And if you could get some quick calories, you should grab them. Um, if anything, we're our survival instincts and our environment are clearly misaligned and the technology is accelerating things. I believe it might be the best pathway out of the problem, which leads me to something I want to spend some time on.

You have had a lot of success in your training career. You've had a lot of success losing weight training career. You've had a lot of success losing weight, but recently you've had some success with the introduction of a GLP-1 into your weight loss. So you have played with some of these compounds and you've had some success. That's not the only reason you have the physique you have. You are well-trained.

But I think it's interesting, there's such a stigma here. We just talked about how fucked up the food landscape is and how challenging it can be for an obviously intelligent person with willpower to manage this. So bless the rest of us. What was your experience like with these compounds? For those of you who don't know, GLP-1s are the category of drug that

like Ozempic would fall into. How did they help? How did they make the dieting experience different? We'll talk all about the stigma, but I kind of just want to let you talk about your experience first. Yeah. I think I also would like to, you know, kind of take a step back really quick and talk about what dieting is like without. Ah, yes. Yeah. Yeah. Very good. So I was coming, I was entering med school. It was 2012. I had successfully successfully dieted my way from 150 to about, oh, 135, 130. I was still early on in my lifting journey. So I was a little under, like a lot less muscle back then. But I, and I continued to diet through like the first three months of medical school.

And I remember the hunger, like feeling, actually feeling physical hunger. I was on a low amount of calories. So I just, but for whatever reason, I thought like, this is what it's gonna take to stay at this 130 body weight, which was, you know, more on moment number one, looking back is just a little hilarious,

but I couldn't sleep. Like I would toss and turn until four or five in the morning because like my sympathetic overdrive was just out of control and my stomach was physically growling. So I wouldn't get any sleep. And then I would walk into anatomy lab like a zombie. I couldn't study and I was hungry, food focused all the time.

So even after I got home from lectures, I would just be thinking about food and I failed anatomy. So like even after I got home from lectures, I would just be thinking about food and I failed anatomy. I failed anatomy in med school. And that was sort of like the wake up call that I was like, you know, I kind of messed something up. I feel like I have some pretty good willpower here. Like I, you know, took my hunger to like its limits and now I have to, you know, I'm in debt and I have to figure out if I'm gonna pass. I'm gonna pass. So that's what dining is like, was like without medication.

Like that was the extreme version, but like there were always iterations of like, I'm not even lean and like my food focus and my food drive and my hunger is so out of whack. Yeah. Like this seems unfair. The life is unfair right now. Yeah.

And it's, I think it speaks that story in particular speaks so well to this notion that people who struggle with weight loss, they just lack willpower. I'm like, okay, this person is in medical school because of their willpower and their capability. And you know, this is still a challenge for somebody. You have more willpower than I do. I barely got a bachelor's degree. I'm so undisciplined.

But I think this, it really, it gives me more empathy as a mo as a lifetime thin guy for people who have that food noise because I think most people are battling a lot of other stressors. And when you pair that with the challenge of, you know, struggling to lose weight, they're overwhelmed even if they have tremendous willpower. Right? Yeah, no, I just, yeah, the whole, the next like eight to 10 years after that was sort of some iteration of that, but like because I had failed at school

because of this like seemingly vain pursuit of a body comp, you know, a type of physique that I was changing for or yearning for, I never let it get to the point where it ever affected my, you know, never again. I, you know, did fine in med school, but like I never dieted to the point, like as soon as it hit like, oh, I've got like brain fog or food focus,

like I just kinda, you know, quit, you know, the fat loss diet, you know, at that point. to quit the fat loss diet at that point. Trying to lose weight after starting the GLP-1 medication was like a light bulb. Like this thin body, like thin guy kind of thing growing up with not having a weight problem. It was like, yeah, a light bulb went off in my head and it was like, oh, a light bulb went off in my head and it was like,

oh, I don't have to shovel this food down my gullet like a starving person, you know, in a third world country. Like, I can also leave a couple bites on the plate and it'll be OK. Like, I can still get nutrients but not feel like I'm still hungry after a meal. still get nutrients, but not feel like I'm still hungry after a meal. Those are things that like just doesn't like never really crossed my, you know, things that I did not experience growing up as a child, teenager or even an adult. So it was life changing. And knowing what you know, would you say that those sensations to eat more,

to maybe keep going that some people don't have, that some people do, is that driven by genetics? Do you think there's a component there? Yeah, I think there's a component to that. I also think if potentially, like if you are coming from, I think it is a little bit harder when you have put on weight in the past, or if you are coming from, I think it is a little bit harder when you have put on weight in the past, or if you're starting from, you know, having a little less

muscle and a little bit more fat, I think it does make it harder because you'll still have your fat cells don't disappear. They just sort of shrink in size. And so you have all those hunger signals, your body's still yearning to still be that same weight you were before. So I have heard up a lot of misinformation on the internet around these drugs. I think the primary perpetrators are actually people in my field of work, specifically people who work as personal trainers slash online fitness trainers,

whatever you want to call that. They used to call them trainers. Now they call them coaches, but fitness professionals for whom people losing weight successfully should normally be an awesome thing. Right. And a lot of it is not particularly based in science or even practice, but one of them is this huge fear of losing lean mass. And I have actually heard this, um, parroted by doctors who I think probably know that this isn't exactly the case, but I heard somebody the other day say, when you get on Ozempic, which isn't even the weight loss iteration of smeglotype, you're going to lose three quarters of your weight from muscle. And so what is the actual reasonable thing?

Should people actually worry about muscle loss? How can we fight it? And is this sensationalized? Well, yes, for TLDR. Yes, it is sensationalized. The other thing is that as coaches, fitness professionals, personal trainers, you play a very important role in all of this. And with these drugs, we need your help now more than ever. Like you are still valuable. You're actually even more valuable now that these drugs are around because I think what taking away that food drive is like have most of the equation. I think that's the hardest part is getting people the whole equation. Like the whole thing. So another thing, I actually am really happy that I have been

peripherally involved in the fit professional fitness, professional space online, because I'm a throw shade at my own colleagues. Like I'm not really excited about the advice they give when it comes to nutrition and training either. Like there's a small fraction of them on Instagram that I do follow that, you know, you know, protein, you know, either your protein fiber, get your fiber in, do your resistance training. So you preserve that muscle mass, which is the biggest thing. You be the amount of like misinformation that I even hear from my own colleagues,

like makes me just wanna like, oh God, dude. It really is, you know, get your protein in and also make sure that the rate of weight loss is accounted for. People don't talk about that in the medical space. They just like, it's not ever a thing. Like, and I can't tell if it's just so convoluted with, and I've taken, I actually was just finished up a course

on obesity, you know, how to manage obesity in the medical space. And the information was so convoluted and just so overwhelming that there was actually no practical information. So when I see your posts, I hit the reshare. I'm like, this is practical stuff. Like this makes sense.

So the, yeah, the muscle mass thing. And I hopefully there was, I think it was Dr. Grant Tinsley. I don't know if I'm butchering his name, Texas in Texas, who just came out, just published, uh, should be coming out soon. That I'm really excited about like body composition. Um, and you know, making sure that like, if you lift your weights, you get your protein in and you're not like, you know, doing some crazy 500 calorie a day diet, like you'll be fine. It'll be fine.

I agree. It's can you think of any medical reason why somebody would lose a ton of muscle when taking one of these compounds other than just the calorie restriction? What's going on guys, taking a break from this episode to tell you a little bit about my coaching company core coaching method More specifically our app-based training We partnered with train heroic to bring app-based training to you using the best technology and best user interface possible You can join either my home heroes team or you can train from home with bands and dumbbells or elite physique

Which is a female bodybuilding focused program where you can train at the gym with equipment designed specifically to help you develop strength as well as the glutes, hamstrings, quads, and back. I have more teams coming planned for a variety of different fitness levels, but what's cool about this is when you join these programs, you get programming that's updated every single week, the sets to do, the reps to do, exercise tutorials filmed by me with me and my team. So you'll get my exact coaching expertise as to how to perform the movement, whether you're training at home or you're training in the gym. And again, these teams are somewhat specific, so you'll find other members of those

communities looking to pursue similar goals at similar fitness levels. You can chat, ask questions, upload form for form review, ask for substitutions. It's a really cool training community and you can try it completely free for seven days. Just click the link in the podcast description below. Can't wait to see you in the Core Coaching Collective, my app-based training community, back to the show. Yeah, so there really is no mechanism other than

if you lose weight rapidly, more of it than you would like would probably be muscle. Yeah. But if you lose weight at a reasonable pace with weights and protein being featured in the equation, you'll hold on to as much of it as you can. Oh, yes. Okay. Hypothetical question. Yeah. If a sedentary person, you would probably can't give this advice because I don't know if a sedentary person, you would probably can't give this advice because it, I don't know if a sedentary person were to pair their GLP one with say a low level anabolic agent, we'll leave the legality of that agent up to the listener. Yeah. Do you think that would essentially assuage any reasons to be concerned? And maybe we should just give all these fucking weenies who are afraid of it a little low

dose anovar or something. I feel like that actually that is a question that I do get often. I figured. Yeah, no, somebody was actually just kind of beating around the bush with the question. I just kind of like did this one eye thing like, are we talking about steroids here? It's okay. We can say stuff. Yeah, but most people like most the general public. So I would say somebody throughout that hypothetical question, my only concern if you're thinking about the general population, legality aside, that if you're already coming

at an unfavorable body composition, I'm worried about other things like particularly high blood pressure. If they've also got, obesity is also associated with fatty liver disease. So putting in Anovar, which is an oral, could be hepatotoxic, so. Interesting on the note of fatty livers.

I recently did a discussion at an event you're gonna be speaking at in five months in Vegas. I spoke last year. I learned quite a bit about fatty liver when I was investigating how alcohol affects the body. And I was shocked at how many adults live with fatty liver. And it kind of just completely and totally blew my mind how many people have a liver

that is just overloaded with adipose tissue and probably overwhelmed by alcohol, which brings me to a nice segue here still on the topic of these GLP ones. At not your body composition focused person, you strength train. I think that most people when they use GLP ones, they use them for weight loss. I have seen some fascinating research on how these drugs affect alcohol consumption and other compulsive behaviors. Oh yes.

What's that about? Yeah, the research is fascinating on that. Thinking about, you know, where those receptors are, because part of that, the GLP-1 receptors are definitely in the brain. And that also helps with satiety. I don't know what parts of the brain off the top of my head are involved in the like sort of hedonistic pathway where it's like, whatever, you know, parts of the brain, you know, some of the research, not just alcohol, but also cigarettes.

I've seen gambling. I've seen gambling. Yeah. So the research is still very early on. I'm excited to see where that goes because the since we're already using it for diabetes, we're already using it for chronic weight management. It actually becomes a lot easier to do research for these other pathways like addiction, compulsive behaviors.

Anecdotally, I've also seen that in people too, who also take it, who some people have reported not wanting to have alcohol. I myself was never a big alcohol drinker, but even more so now, I'm like was never a big alcohol drinker, but even more so now I'm like, eh, like one drink and I'm like, all right, we're good. Or even a half a drink. And, um, some people with cigarette smoking report that like, yeah, not really, not really interested.

These drugs clearly play some type of interference with these parts of the brain that seek compulsive eating or gambling or whatever. And, and that's a big reason they work. I think a lot of people think they work exclusively by just making you lose body fat. Like you just take the GLP one and lose body fat. And I have had a couple of clients personally who have used to GLP one and they have still struggled to implement the lifestyle changes associated with lowering body weight, like moving more and eating foods higher in protein and fiber. And they saw good initial results, but they are struggling to see continued results.

And I think that kind of brings me to a good point about these drugs. What lifestyle changes need to be made in connection with these drugs to make them the most effective? We already talked about weights and protein, but you still have to make good decisions, right? Yeah, and I think another component that I'm starting to kind of realize

is everybody's maintenance calories are different. Like there's a huge spectrum of, you know, where people, you know, body weight, where they settle at. And so I think one misconception that I've always had is because I've gotten a bit more muscle mass, because I'm super active, that like I'm going to get maintenance. My maintenance calories doing, you know, all this activity is going to be like really high. Like all these CrossFit people that I see on Instagram and it's like, no, you're at 1600 calories, which is even harder when you pair it with a high food drive. So I do jujitsu seven sessions a week and I lift three days a week and I get eight to

10,000 steps a day. I believe wholeheartedly that there is no demographic for whom weight loss is more horrifying than short women. No offense. Well, like if, for those of you listening, if you can, we're talking about a high activity, high amount of skeletal muscle mass, but just being completely knee capped by the fact that you're not that tall.

You are, you mentioned this off air. How tall are you? So I'm 411. I'm 140 pounds, but I'm 140 pounds though, compared to like other people who are of that weight. And I'm about like the last time I did a dexa, it was, you know, somewhere on the lower 20, you know, 20% body fat, like, you know, lower end. So I'm not, you know,

are you categorically considered obese because of your height and weight? Ooh, I think I'm like right on the cusp of like overweight and obese. Like my BMI is like somewhere like 29 and some change. So it's like not quite there. But this is audio. But Dr. Crystal's ripped, guys. This is like she's ripped.

She's just short. But that's actually a good question for a medical professional. You know, BMI gets just trashed a lot. Do you do you think it's a useful tool? Do you think it's a useful tool? Do you think it's a defeating tool? I think it can have its use. I think I'm trying to change that narrative when talking to patients, thinking more in terms of body composition and really sort of, you know, versus a BMI.

Like, you know, I don't find that tool to be super helpful. In that sense, like the patient already knows they're obese, they already know they're not happy with their weight, what's the BMI gonna tell me? Like, it's not really gonna tell me anything and it's gonna just sort of like leave them in, you know, feeling more bad about themselves than like when we started. So I really try to like sell it in

terms of like, we really need to get your muscle mass up and then, you know, or we really, yeah, like one, we need to get your muscle mass up period, regardless of the, you know, fat, you know, body fat issue, we can always deal with that down the line. And then, you know, thinking about a fat loss diet, you know, down the line, or let's get some other behaviors in first before we really, you know, dive in with a diet. Cause I think jumping into like a fat loss diet

sometimes just gets to nowhere and, you know, leads to rebound effects and like is not a long, you know, a decent, like I've seen at least personally for myself. Um, if you don't tackle the behaviors first, it just like, it'll just, you'll just, when you're done with your 12 week program, you're just going to go back to eating or doing whatever the fuck you did before. Totally. And that's that's a great follow up point going circling back to these GLP ones. Again, from people who are probably not entirely educated on the topic, I see a lot of sensationalism around you're never going to be able to get off.

You're just going to like you'll be on them for the rest of your life. going to be able to get off. You're just going to like, you'll be on them for the rest of your life. And like what, you know, that then you're going to die from that. And it's like, hold on, hold on. And I'll be completely honest, I am not in, I am not the most educated person on this topic. And I, for one, really never thought too much about, yeah, you know, I guess I don't know what the protocol is for somebody who used a GLP one for weight management. Is this something people can use continuously or is there an off ramp if there's even a reason to off ramp for someone who's maybe GLP one curious, but they've heard that this is a life sentence from some Insta bro?

Like is what do they what do they need to know? Well, think about it. I mean, your food drive has probably been with you your entire life. And now we are going to take this medication and remove that food drives so you can live your best life. So people have been this drug has been this class of drugs has been on the market in the United States since 2005. This is true.

I learned that surprisingly like two weeks ago. Yeah. So the this, you know, um, some aglutide came out in 2017. So I get that there's some sort of like, oh my God, this, you know, it just came out. Um, the first GLP one agonist drug that was FDA approved for weight management was in 2014. So we have this has been this isn't like an action this isn't anything new this yeah yeah so these people who are like oh my god like we're gonna you know why should you be like this is too soon like have no sense of timeline and have no idea how research in tech work, you know,

pharmaceutical tech work. So, you know, people can stay on this medication, it's okay. This, you know, if this is going to you still have to eat healthy for the rest of your life, you're still going to have to lift some weights for the rest of your life, you're still going to have to do these all these other things for the rest of your life. So what, you know, if you want this kind of life, or you want these sorts of outcomes, like, yeah, you probably will be on this for the rest of your life. And that's okay. That's all right. Would you say in general that a dosage someone might use to get out of a state of chronic obesity would be different from a dosage someone might use to get out of a state of chronic obesity would be different from a dosage they would use after the fact when they've maybe achieved a more normal weight? Or is it the case that the waste, the dosage that's best for managing

obesity is usually where you end up for maintenance? That's a really good question. That almost seems very similar to like what I used to think about calories and that whatever calories you ended with on a fat loss diet, that was going to be your calories for you. You're still my God. Oh my God. That's it. And then you like crash and burn and you're like, why do I feel like shit all the time? It varies. It varies from person to person. That makes sense. So no rhyme or reason. I know some people who have gone down in medication

and have maintained just fine. I know some people who've stayed and been able to do just fine on their own. Follow-up question about these these compounds having recently returned from Mexico and frequenting many a La Farmacia. I noticed there are oral forms of this compound and I thought to myself, well, that's interesting. I guess I shouldn't be surprised.

I'm at La Farmacia. So this isn't exactly the most cutting edge. But I thought to myself, wow, a tablet. Do we don't typically prescribe those here, do we? We tend to go more for the injectable form of these compounds. Yeah. Ribelsis, which is... I haven't heard of this. Yeah, that's so it can be less effective. It's it's one of those medications where you have to take it 6030 to 60 minutes before your first meal of the day.

You have to take it with like X amount of milliliters of water. You know, it's a lot. It's annoying. You know, um, it's a lot. It's, it's annoying. Uh, you know, it can be. Um, so, you know, if you're not averse to a little needle, uh, you know, once a week, and then also you have to take it every day. You also have to take it every day. So, so an oral is probably less effective and has a way lower rate of compliance than the injectable.

Yeah. If you were going to take it properly, I'm sure, you know, like you wake up late and you're like, oh shit, I gotta go to work. Like, let me pop in my my ribelsis and go there. But yeah, once a week seems a lot more doable. I would imagine so. And I, of the people that I know who use these compounds,

they are on an injectable form. Okay, when it comes to use these compounds, they are on a, on an injectable form. Uh, okay. When it comes to sourcing compounds in the name of vanity, many in aesthetic focus person has probably pursued a compound that might make them look better from a less than, you know, scrupulous place. People have been known to go to crazy lengths to get their hands on things that will help them lose weight. Yeah. What is it?

Is there a safety issue here with some of these compounds? Should people be very aware of where they're getting them? For example, La Farmacia versus from the doctor. I'm not quite sure about Mexico, just in the sense of like, I actually don't know because like some of the stuff could be. Yeah, I actually just who knows. Some of the pills work. I can tell you that. I, you know, and they, it seems seemed and you're buying it from a pharmacist

behind, you know, they have to anyways. The you know, there is always a case of, you know, people get stuff from compounding pharmacies, compounding pharmacies, which I see you quoted that. There's some skepticism. Well, yeah, because there is for if you're getting the drug, you know, paying the full price for, you know, the Eli Lilly brand, there is a level of good manufacturing practices that happen with that,

that sometimes, you know, that are highly regulated for better or for worse. But like there are very stringent guidelines on like how, you know, how everything's made, how it's packaged, you know, what temperature versus some of the pharmacies that, you know, are associated with, you know, medical spas and whatnot, might not have those. They don't necessarily have that strict of a regulation of like, how did they make it? Who made it? Like, you just don't know where stuff comes from. And I think it is very important to be mindful of that you may be getting, you know, bunk compound or stuff that's, you know, laced with something else, you know, depending on where you are, you

know, whether it's a compounding pharmacy, whether you're trying to troll the internet for, you know, whether it's a compounding pharmacy, whether you're trying to troll the internet for these things. So I think it's just, always be very careful. So I never, I don't feel comfortable recommending those to people, but I do know that people will find if there's a will, there is a way. No, I totally agree. I've just noticed like, wow, Bro know, Bro Zempix Labs is also the owner of Bro Zempix compounding pharmacy LLC. What could possibly go wrong in that supply

chain? You know, like totally legit compounds for sure. For the most part, I think people are safe. But I do think in general, if you can get the, the non-generic name brand compound, that's probably best. Off air, we talked a little bit about a Senate hearing that was taking place. Fairly performative. That's actually not the one I want to talk about. Oh. On the same day, there was another Senate hearing around lowering the cost of GLP-1 drugs. Similar to how the federal government has worked to cap the cost of insulin. I want to ask you a philosophical question here.

Okay. Because I have talked to Mike in the past on this podcast and I know how he feels about certain things and I would love to hear your opinion. Do you think the government should work to lower the cost of GLP one drugs for the general public? I think in the sense I had read somewhere not too long ago that because of Ozempic's sales, they have actually recovered all of the R&D costs of the drug. So let me preface that by saying, like, I get why they're very expensive in the beginning, because I have been a part of the R&D process and the timeline it takes to get there.

So in the beginning, I completely understand why drugs cost the way that they do. Now that they have recovered all of those costs. I'm not quite sure if it's necessarily lowering the, the forcing them, the forcing them, but I also think doing something about the patent laws surrounding that, I am for government, the government stepping in and either, you know, kind of putting a much shorter timeline or removing that patent on some agglutides

so other manufacturers can come in and start producing the drug and allowing for competition to occur. If that makes sense. It does make sense. This is what insulin famously was, of course, never patented for this exact reason. And Lord knows how long it took to get to a place where it was affordable, but I would argue that there are so many people in America

who are struggling with obesity. And I think you probably know better than anyone actually working in medicine, how that affects people internally, beyond the vanity that we have around how we look, that it probably would make sense to get these drugs out to more people. Despite all the negativity that people are seeing online, I, I actually, I think this might be the most disruptive technology outside of AI in the last 10 years.

That's my honest opinion. Yeah. I just don't know how like by forcing them. Like I, so my answer is yes. I just was trying to figure out like a way to actually make that happen in reality because yeah. So let's let the senators do that. Remove the patent, remove the patent and let the market decide because once you have that competition down and there already is enough competitors coming into the space, remove the patent and let the market decide. Because once you have that competition and there already is enough competitors coming into the space, I have so many ads coming at me with, you know,

his, you know, all these like medical spas and like all these manufacturers coming in, which, you know, on one hand, I've seen a lot of physicians who are like disgruntled about all of it. And on the other hand, I'm like, you know what? Like, that's what happens when the cost of this medication is way too high and a lot of insurance companies aren't covering it. So totally.

And I got that for one, I got into this industry to help people lose weight and live healthier. And I have seen so many clients who've really struggled find success with these things. So I'm kind of over the moon because nothing's, nothing's more exhausting than, you know, trying to rationalize with somebody who's they're taking in everything you're saying, but there's something running in the background that is really hard to get under control.

So I think this is just, uh, fantastic that we have these drugs. I think that I am probably in the minority in my field and having that opinion, but I actually expect things to change. And I hope that this leads to a better discussion overall about weight, weight stigma, how we look, body composition, body shape, body image. Like maybe this is our pathway to having a little more empathy for each other and how we look and how we feel because there is so much we are learning about the variations person to person from these drugs, from these trials. I think it's, it's awesome.

One more question about pharmacology. Yeah. GLP ones, I think hugely net positive in a society that we live in. But we're going through a little bit of like a reformation around medication. People are like anti meds. They're anti. They're anti. I think they are reasonably skeptical of the financial motivations of our largest pharmaceutical corporations, but very much throwing their products out with the bath water.

They're anti all drugs. Oh boy. Working with the average American in the general population outside of these GLP ones, what are the most life saving prescription medications with a high safety profile that people should not reasonably run away from because of the internet that they should, you know, gosh, I mean, you know, uh, the highest safety profiles, like basically all of the high blood pressure medications. So these are most things like, um, like a calcium channel, channel blockerer like amlodipine. OK, in angiotensin receptor blocker like low sartan.

I forgot telomassartan, which is the popular one amongst bodybuilders like center ace inhibitor like lysine, a pro. You know, what about statins? You know, statins have a relatively fine safety profile. I do see where I think where I don't always agree with some of my other providers in the sense of like, unless your risk profile is that high, there are certain criteria that I go by

that like calculating it overall 10 year risk, based on whether you have diabetes, what your blood pressure's like, if you're a smoker, it'll spit out what your likelihood of getting an adverse cardiovascular event like a stroke is or heart attack. So yeah, I guess overall statins are fine. I've seen some people say everybody should take them no matter what.

I've seen some say nobody should take them ever. And oh, no, no, no, some people should. Some people definitely should. If you're you know, blood pressure is unchecked and uncontrolled. That's something we have to figure out. If your diabetes is out of control as well, you're a smoker and you're somewhere between the ages of 40 and 75. The likelihood that you, you're, you know, and you have, uh, you know, messed up lipids, the, the likelihood that you're going to have something happen to you in the next 10 years

is going to be high. And then I typically recommend you should probably get on a statin. Makes sense. Okay. When it comes to hormone replacement therapy, this seems to be very popular. I want to talk about women's hormone replacement therapy, not men's. TTRT is like everywhere now. And I get why. But HRT for women for a really long time had a really bad rap, especially around estrogen replacement and the proclivity for that to cause breast cancer. As a woman who is very active and has a handle on this stuff, and I'm sure knows almost all there is to know about hormones. Do you think hormone replacement therapy for women as they age is something that women should consider talk to their doctor about?

Or do you think that this kind of wave of HRT for everyone is maybe a little bit too much? Great question. Uh, the pendulum did swing in the direction of like nobody should be on HRT and now I feel like we are sort of coming back to the other side. I honestly think it is a conversation that people

should be having, um, with their physicians about it and you know, if their doctor gives them a lecture about how this is like the way life should be, I honestly think that they should get a second opinion. The yeah, with men, it's sort of like, oh, low testosterone, you should replace it like, yes. You know, the so I'm.

Yeah, I'm now that I'm in my 40s. I now also have a personal vested interest in like, huh Do I like, you know, should I need to I've been thinking about that a lot lately is more of a patient than a physician but Overall, yeah, I think people should women really need do need to start having that conversation I'm glad that conversations now really starting to come swing, you know the other way Yeah, men don't need any excuse. They find a way. But like with women, I think I work with mostly women and I have, you know, long

thought, Jesus, it's kind of brutal how you just go from like feeling great to like five years of slowly feeling like shit and then you're out of hormones and then you're just fucked. And I think that this makes to me a lot more sense than a lot of the ways, uh, people are using men's hormone replacement therapy. I think there's so many women who would be a great candidate for this if they could at least talk to somebody about it. So thank you for adding some context there. And that's really all I have today. I'd love to let my audience know where they can find you.

Keep up with you. Follow your training. All of that. Yeah. On Instagram, I am doctor.crystal. C-H-R-I-S-T-L-E. Hopefully in 2025, we'll have some educational content project that I've been working on.

So hopefully more of that will be coming in the near future. But once, you know, 2025, I'll be hopefully yapping about it. Awesome. I'll link all of Dr. Crystal's information down in the show notes for you guys. Be sure to follow her on Instagram. We keep up with her training and a lot of her great tips and advice.