The Checkup with Doctor Mike - How "Food Noise" Nearly Ruined Her Life | Dr. Christle Guevarra

Episode Date: November 16, 2025

From Thanksgiving Day through Cyber Monday, get 40% off at cozyearth.com with code DOCTORMIKE. It’s the best deal of the year!I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Huge thanks to Dr. Christle Guevarra for this open and honest interview. Follow her on IG here: https://www.instagram.com/dr.christle/?hl=en00:00 Intro2:08 Her Journey with GLP-1's12:45 Medical School x Willpower20:02 Mental Health28:20 Food Addiction31:58 Family Medicine x Comparing GLP-1's40:53 Sports Medicine Fellowship51:40 Private Practice1:01:15 Marriage1:07:48 Body Building Community1:14:21 Correct Use x Pill Mills1:22:57 Future1:24:18 Fatphobia1:27:32 Health InsuranceHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

This is the thing that I had struggled with for so long and pretended like I didn't have the willpower. I wasn't good enough. What's wrong with me? In middle school, really started to look at like how I looked and because of the bullying, you know, went on all sorts of weird diets, cabbage soup diet, fat-free cottage cheese and saltines at one point. I was dieting on such low calories that trying to do homework just seemed really tough. I just remember staring at the same paragraph over and over, and things weren't happening. The amount of appetite drive from my brain has just been so strong for so long. When I finally decided to give Wagovi a shot, it was a life-changing experience for me.

Now I can show up and I can be my best self at work. I can be my best self as a spouse and as a friend because now this hunger thing has been removed. Welcome back to the checkup podcast. These days, so many are quick to over-emphasize the side effects of taking GLP1 medications. You hear all sorts of derogatory terms thrown around, ozempic butt, ozempic face. But like with any medical treatment, we need to discuss the benefits. as well as the harms, and sometimes those benefits can absolutely be dramatic. Today I'll be speaking with Dr. Crystal Guevara, a board-certified family and sports medicine

physician who actually serves as the traveling team physician for U.S. figure skating. She opens up about how uncontrollable food noise absolutely wrecked her health, her relationships, and even her ability to perform well in school. I very much appreciate her honesty about the difficulties along the way, including making the decision to start a GLP1 medication. I think it's more important than ever to share stories highlighting how for some these medications can absolutely be a life changer. Huge thanks to Cozy Earth for sponsoring this video. You've become very passionate in advocacy and discussion covering GLP1 medications, OZempic, Wagovi, Tresepetide, all of these ones that potentially patients can

take. Tell us more about that. Yeah, not sure where you want to begin. I. You're guiding the horse or the carriage, I guess. I guess I've just struggled for so long. I've failed so many medications and I've worked with that I've worked, you know, I have a doctor that, you know, has recommended all sorts of weight management medications in the past. And, you know, when I finally decided to give, you know, Wagovi a shot, no pun, intended in January of 2022. It was a life-changing experience for me. And it, um, it, it, it really just, I just found myself thinking, one, why did I say no two years ago when my doctor first recommended it to me? And why, why now? Like, why couldn't this have come sooner? Um, because this

is the thing that I had struggled with for so long, for so many years and pretended like I didn't have the willpower, I wasn't good enough, what's wrong with me, why am I broken, you know, if I could trade my, you know, intellect and my, you know, scholastic achievements for this type of peace, you know, I would 100%, you know, I don't know, I would 100% probably do it just because the amount of appetite drive from my brain has just been so strong for so long and so, you know, yes, I am completely biased because I have struggled with this my entire life. But man, these medications for a lot of people can be very life changing. And I just want people to understand that we're not broken. It's not a willpower problem. There is something

going on in the brain that is just incredibly powerful. And some of us just need a little bit of help. What was your journey like before the medication came on board? Because you mentioned you've had all these struggles. Yeah. I grew up. I always knew I had a much higher appetite than my peers. I had a girl who lived next door to me. I moved to the neighborhood when I was two. And I noticed she was, you know, maybe about 20 pounds lighter than me. We were about the same height. And her mom noticed that like I had a much higher appetite. So the clean plate club of the 80s. So she would always invite me over and just comment on how, you know, Crystal, you know, look at Crystal. She's such a, you know, perfect.

person because she, you know, eats all, everything on there. The fruit, the vegetable, the dessert, the main course. Well, that's how they shared life. Right. And they did. I love it. But I also just knew that, you know, I could definitely scarf down that plate. And I probably could have eaten a little bit more on top of that. I remember getting, you know, kind of bullied in school. You know, got teased. You know, I fought back and got in trouble. for saying not so nice things and but I always played what were they bullying you about yeah one one kid called me fat was making fun of me for being fat and then I fired back and started making fun of his learning disability and the teacher pulled me out of class and I got in trouble

because it was not a nice thing to say but you know very you know very early on people would tease me. But I was still active. I still played sports. I was very, did volleyball, basketball, you know, whatever my, you know, elementary school could offer. But just always found myself, always digging for, you know, snacks in the kitchen, rummaging in there. My mom, you know, she did her best. She, you know, would say stuff to me to, you know, make sure you don't overeat, you know, junk food. But it's clearly tasty and it tastes really good. And, you know, in middle school really started to look at, like, how I looked and because of the bullying, you know, went on all sorts of weird diets, cabbage soup diet, ate fat-free cottage cheese and saltines at one point. And I would do a lot of cardio, a lot of VHS tapes that my mom had just to kind of get in shape.

And it worked briefly and then puberty sort of hit and I just put on a whole bunch of weight. What was driving you to attempt all this weight loss? Were you health conscious that early or was the bullying having impact? The bullying was having a lot of impact. But also I also wanted to, I also wanted to not be chubby. I didn't want to look like that. And I know that's, you know, it's taken me a lot of really things. thinking about things like is it society or is it somebody else kind of pressuring me to

to make these changes but i didn't want to to uh look that way i remember i vividly remember at one point because i went to a catholic elementary school praying that like if we could just you know hello dear god are you there it's me margaret like if i could just trade this to be a little bit thinner, I would just, you know, trade all my straight A's because I was, I had that in the back pocket. Like, yes, I can't look this way, but I do well in school. I get straight A's. My grandmother loves me. I, you know, she pays me, you know, pays me for my report card every every time I show up. So, like, that's where I got my attention from as being the smart, kind of chunky kid in school.

And so lost a little bit with a bit of weight here and there, but it was always a struggle, always felt hungry all the time. And then high school kind of rolled around. And, you know, I think it was less people weren't really making fun of me for my weight, but I was still very self-conscious about it. Remember just kind of taking whatever over-the-counter, like supplement I could take that didn't require, you know, an ID or an age restriction, none of which worked.

The cabbage soup diet, you know, at one point, I remember buying Viverin, the caffeine tablets to kind of help stave off hunger, didn't quite work. Did you notice any negative impact of any of those interventions? Not at the time. Okay. Not at the time. So, I mean, you know, right now I feel pretty okay. So the yeah, it didn't do anything. I didn't feel anything. It was probably just a waste of my, you know, allowance money at best, knock on wood.

Yeah, classic supplements. Yeah. Right. And I just also remember really feeling struggling in school now with the dieting because I was dieting on such low calories that like trying to do homework just seemed really tough, you know, trying to do chemistry homework. And I just remember staring at the same paragraph over and over and just not really thinking like just things weren't happening. So if I could go back and tell myself maybe not a huge calorie deficit, but where were you getting your nutrition knowledge at the time from? Like where was your awareness of what a calorie was, where was that coming from? Man, I don't even know if I was aware of true calories back then. I remember a lot of it

came from magazines that, you know, before the internet existed. That's where I got sort of my work out, you know, shape magazine was a huge one that I would always buy because there was always these inspiring stories of women who lost weight. Here's how I did it. And there was a book, and I was trying to actually buy it at some point, like the Clinic 30 program that was written by a physician and his, like, I think his wife, who is an RD, that gave me a concept of like portion control, but not necessarily calories. And so, you know, I would try to, you know, eat less snack foods and try and cook more. So there was a time where I tried to, you know, do a little bit of that. And I don't know why I just decided to forget about put that away and do these

other things. So there wasn't like, it's not like the landscape that it is now where you have, you know, TikTok, Instagram, you know, YouTube to... Well, now you probably have more information than you know what to do with, especially because there's so many tribalistic camps of you only have to follow this or you have to follow that. And I think that becomes equally as confusing where back then you had one source of misinformation from Shape Magazine. Right.

Exactly. Exactly. I remember reading some like cigarette and champagne diet of like early days of Vogue. I don't know if you're familiar with that kind of stuff. But there's just the ridiculousness that we found in those magazines. I mean, I too read the men's health, men's fitness, where I would try and get a chest routine from. And at least that was a bit more benign because it's a chest routine at the end of the day. If you're moving around, you're exercising, it almost doesn't matter what you're doing as long as you're safe.

But I can't imagine how hard that must have been for you in hearing how difficult it was to read questions, to be focused in school. and then you went so far in your academic journey. How were you able to manage going to medical school, learning science, while struggling so much with what the outside world was saying about your weight, but also how you felt internally about the weight? Oh, yeah. That's because I did a complete 180 in undergrad and decided I did not want to be, you know, I did not want to be a C student anymore because my grades had tanked in high school, barely skated by in high school and I made, you know, made my way to college and I got my first

C plus in general chemistry and I said, that's it. I'm done. I'm going to do whatever it takes to, you know, be at the top academically. And so with that, given what happened in high school, I kind of went all in, made some not so great choices and just, you know, whatever I wanted to eat. I ate. I ate pretty much an entire day's worth of like very processed, high calorie dense foods, ate when I was hungry, when I was not hungry, when I was just bored studying. And so I ended up putting on, gosh, like one, so I think I entered undergrad at like 130 and I'm 411, and I think I graduated from undergrad at about 200, untrained with a pack a day smoking habit. So not exactly great, but the education was free, ended up building my CV. I thought I wanted

to be an organic chemistry professor. And so ended up getting into a bunch of different awesome graduate programs that offer that. And so on paper, it looked amazing. And when they find, when my, you know, alma mater, San Francisco State did an article on me about this, you know, new fellowship program that they are starting up and they did a piece about me. All I could see, the first thing I saw was the picture and I didn't recognize myself. And all I could think about was, how awful I thought I looked and how embarrassed I was to be featured on that article when they're saying all these really nice things and talking about the research that I'm doing and all I can think about is gosh, I just want to go into, crawl into a hole and like hide.

So I took a little bit of a detour, you know, in grad school. And I knew that, you know, this was not sustainable. By the time I got to grad school, I knew that like, yeah, what I did in undergrad, probably not the best thing for my health. So I quit smoking, cold turkey, which I know is not easy for a lot of people. This is really myth-busting the idea that weight gain is solely due to a lack of willpower. because you're doing enormous acts of showing how much willpower you have. You're quitting smoking cold turkey, which is notoriously hard.

You're succeeding academically in very complex fields. So you're putting in willpower, but clearly this wasn't what the issue was for you. It was something outside of willpower. Yeah. And I just didn't realize it at the time. So it took me a number of years in grad school, and then I ended up leaving. to go to med school because I decided I wanted to be a physician and not an organic chemistry professor. And so it took me a number of years to just get back on track, learn how to cook again,

learn how to cook and appreciate what a vegetable is, because the taste buds are much different when you're a smoker. And then when you quit, things become a lot more palatable in a different sort of way. and so I had actually lost kind of you know losing the first I'd say at 200 losing the first 30 to 35 pounds was always easy it's always sort of you know kind of move around clean your clean up your diet you know whatever that looks like it was never really a hard thing it's once I moved down to you know 165 or so that things become like progressively more different like exponentially more difficult And so I remember a really big transformation. I went down from, I'd say, down to 130 pounds right before entering med school. And looking back, I wasn't particularly lean. I wasn't like bodybuilding show type of physique or even a, you know, shape, cover model physique. It was pretty soft.

It didn't have a lot of muscle mass on me. but I the going into the summer of medical you know into medical school there was an accelerated anatomy program for all the overachievers who wanted to spend their summer doing anatomy so in the fall you could teach anatomy to all of the regular people who took the summer off and I just remember after dieting for a whole year and just remembering what the hunger pangs were like, just tossing and turning up until four in the morning, just this insatiable, like, food-focused hunger drive, you know, where I couldn't sleep. I couldn't eat anything because I'm trying to, you know, this is what I got to do, right? This is the willpower. Like, if this is what I

got to do to be, like, some semblance of, like, not thin, but kind of thin, then here we go. like, you know, and I ended up failing anatomy, you know, by a couple percentage points just because I couldn't, again, couldn't focus. I would just show up a zombie during anatomy lab. And then forget it, trying to do flashcards, like through one ear and out the other. And so were you working with physicians at the time, like not necessarily as part of the medical school journey, but maybe even in the post-grad time. Were you seeing a doctor to discuss your health? Were you getting labs drawn?

Were you getting advice? So I did have some labs drawn. And I did see a doctor every now and again. And I didn't really talk to them about weight management. They had brought it up every now and again, like, oh, you're overweight. I think at one point my triglycerides were a little bit elevated, 150, 155, but nothing. too terrible that you know really got to intervene with it so um yeah so they brushed over it kind of a little bit but also I wasn't super proactive about like hey I have this hunger problem because you know

um so it wasn't until um and just so we don't gloss over this because I think it's important yeah but feel free to pass on the question if you're uncomfortable answering it was mental health ever discussed in these doctors visits was it something that was at the top of your mind that perhaps you needed counseling, you needed therapy to discuss any of these issues? No, that's a really great point. And the answer is no, because I was pretty focused on, you know, med school. That was the only thing at the time that I cared about other than, you know, this other thing here. Probably would have helped a lot sooner if I would have done that. But no. Why do you think it would have helped? I think it would also give me a

place to talk about the emotional aspect of what I was going through because now I've just failed anatomy. I feel like a failure. The first two years of medical school were pretty, I don't want to say traumatic, but I always had that chip on my shoulder of I'm hungry all the time and now my weight is spiking back up because of that insatiable hunger drive that is now back. But at least my sleep is better. And then also I feel like a failure. I feel like a complete failure going into med school. And I just never want to fail another class again. So I'm kind of stuck between like, I want to be healthy, but I don't know how. But then I've tried asking people about, you know, my most pressing thing right now is to not fail out of med school. I'm slowly racking up

debt. So I want to, I want this. And so I put a lot of those kind of, you know, kind of weight loss stuff aside and just kind of, you know, kind of put my blinders on and, you know, just did the best that I could with what I had. And that was just passing. I just wanted to pass. Yeah, that's such an emotionally turbulent time without seeking help. Did you have any strategies that worked well for you at the time? Or was it just not going well and you were pushing along as best you could. So I had kind of sought the advice of, you know, after the whole, you know, failure, I did seek the advice of an online nutrition coach because it was actually a bodybuilding coach that kind of helped to get me to that failure point. And I realized that that wasn't going to

work. So I just stopped communicating with that person. And I had reached out to somebody a female kind of coach that I had kind of gotten to know a little bit on the internet. You know, I really wasn't on Instagram quite yet. She seemed very compassionate, seemed, you know, like she knew her stuff. And so I had a long conversation with her. I actually told her my story of what happened. And she was the first person to tell me, like, hey, I don't think trying to chase fat loss is a really good goal for you right now. It sounds, like there's a lot going on. You have a lot on your plate right now. Let's get you to a place where you don't feel hungry, but you feel satiated and you're filling yourself up with very

nutritious foods. So let's get to that place where, and let's see how, you know, your weight stabilizing because I think that's more important than chasing this like previous goal that you had, which I, you know, and she said, you know, I understand that if this, is still your goal, then I don't think I can be very helpful for you. But if you are, you know, willing to shift your goals, then we can work together. And I think that was the first time that, you know, I was a little miffed by it at first, but I ended up taking on her offer because I was like, yeah, that actually sounds like it makes sense. Why were you mithed? You know, because I was so emotional about this, you know, thing that I had just failed. I really wanted to get back down to

this size. And then she kind of just snapped me out of it. And I really thought about the pros and cons. You know, I thought about everything that it had just happened, failing anatomy, feeling out of control, the sleepless nights, you know, that I was like, you know what, for my own sanity, I think this does seem like a better deal to me. And so what do you think worked so well about her approach that it got you to make this change, not just from a practical standpoint, but mentally, you seemed kind of perhaps offended or MIF, as you put it. Why did it still work? Why was she effective in getting you to change that? I think she just laid it out there very plainly and she was very honest about what she could provide as a nutrition coach and what she

couldn't provide. And so for me, that's really important. I think being very honest and up front about, you know, things like side effects, things like potential pros and cons, I think are super helpful. And I definitely tend to, when I talk to patients, I definitely err more on the side of like under-promising and over-delivering, making sure we're really good on knowing what the side effects are versus saying, like, this is going to be the most amazing thing ever, like, that's going to be life-changing. I don't know that because I don't know, you know, everybody's different. So that makes sense. And you started working with this individual. what happened then how did it transform um you know i i got to a place where i you know i was back at

150 pounds but i was stable um and i just had a routine a nice stable routine um it was boring but effective like four meals a day um here's what i'm going to eat and i think it just took some of that um kind of mental fatigue out to be the decision fatigue out so i could just focus on studying and you know because I had other things to worry about like step one and so if it's the same boring for meals then yeah I can just batch cook them and just kind of you know put it in tapperware leave it alone I don't have to think about it medical school is notoriously a competitive place there's the term gunner that's often used where someone's actively trying to set up others for failure or outperform everyone else did you ever hold any resentment to your classmates

because they didn't have to think about food this much because they perhaps could eat whenever they wanted. How did you feel in those times? Oh, man, I actually felt really supported by my colleagues. And I remember when choosing medical schools, I just remember everybody at this particular interview just seemed real and awesome and didn't have that gunner mentality. and that's actually why probably one of the biggest reasons why I ended up going there because I'm going to have to spend the next four years with this cohort and I don't want it to be competitive like we're all going to do well and somebody has to be at the top I understand but if you have to sabotage somebody

to you know that zero some kind of game it's just not going to work and so there I do remember some people some guys talking about lean gains like like how hard it is to gain weight while eating chicken breast, broccoli, and rice, like, plain foods. And I just remember at one point, really just trying to stuff myself, like, with these whole foods that are lowering calories. And I just ended up with a very bloated stomach. And my brain is still telling me, like, you can still eat.

Like, I can still eat, like, a whole ton of stuff. But my stomach is just out to here. And so I remember getting a little, like, I would roll my eyes a little bit. it, but never resentful towards them, if that makes sense. Because they also never really said anything to me about it. We used to do push-ups after, you know, every lecture together. Really? Like, there's a little crew of us.

What was that? Push-ups. I've heard of people going out for drinks after a test with push-ups. There was a couple of us that did that. People did get drinks after. They would actually drive to Las Vegas and go out for a weekend after every exam. But a couple of us did some push-ups to try and see. stay active. Okay. That's fun. The way you talk about how you felt in your mind, the word addiction comes to mind. And there's been some controversy in the nutrition space

about whether food addiction is an accurate term. Is it fair to be used? How do you feel about the term and how do you feel it specifically in your scenario when it tied to your scenario? you know i'll be honest it doesn't feel great to kind of um i can see why people might associate that especially now that they are starting to do studies on um you know uh substance use disorders and glp1 agonists um you know i don't particularly like using the word addiction i'm And I'm not sure why, to be honest. Maybe just, you know, that's just my own bias and my own kind of, you know, doesn't seem fair. But if there is, there is that reward pathway that, you know, kind of is involved with kind of hedonic eating.

So I can see why people would use addiction as that term. But from, you know, and I wouldn't be particularly offended if people started using that. to describe this type of hunger signaling because there's a lot of overlapping pathways. But personally, I just, yeah, for whatever reason, I'm not really interested. There are other ways that I can, I guess I would like to describe it. How would you describe it? It's not, the hunger I experienced throughout my life is not just a psychological, you know, kind of feeling, but also there are these physical dry hunger cues that I can't

ignore. So it's both, you know, a physical and psychological thing that is happening. And it's this, you know, drive to eat. Because I think the other part to addiction is, you know, I can stop to, you know, using cigarettes. I don't need cigarettes, but I still need to find a way to, I can't live I can't avoid food forever. And so that's the part that becomes super difficult. Yeah, it's why some individuals will struggle with alcoholism where they say, well, I'll try and get back to social drinking, but they may struggle with the ability to self-regulate once they have one or two drinks to not continue moving forward. But with food, that's mandatory. You need to always have those one or two drinks in the food world. So it's always tempting to want to continue to go back

to that space. And it makes it very difficult. The physical manifestations are largely not talked about by how it impacts hormonal shifts, how it impacts things like sleep, as you mentioned, moods, ability to form and retain memory. That is what is important in our everyday lives when we talk about quality of life. And people will write those off as, oh, just because you're being lazy. And people like to take shortcuts in reasoning. So I understand why they're doing it. But we just have to remind them that's not accurate in every scenario.

And it's worthwhile that you're sharing your story. So obviously, I want to be grateful for that. Oh, thank you. So you're in, you're finishing. medical school, the medical training is so long. You're now having to choose which residency you want to go into. Why family medicine for you? Oh, for me, it was, I just, I couldn't say no to like one particular group. I really liked the balance, like the, you never know what you're going to get, you know, the, you know, pregnant patient with her kids or, you know, some elderly person. Like,

I loved all of that. So I love the variety. You just and it keeps you on your toes and you know, you build this net. You know just a little bit and, you know, just enough to figure out like there are things that you can manage, but also there's a team of specialists who just do cardiology, who just do neurology and it's really important to have that network. So that way, you know, if you do need to send somebody to a specialist, you know, being able to communicate with them, you know, to get the most out of it, you know, the best treatment for your patient, I think is also super important. So I liked that kind of, you know, being kind of the quarterback or being like the manager person. And so I find myself, you know, in non-clinical positions, like really enjoying

that aspect. Like if I don't know the answer to this, I'm going to find a specialist who does and I'm going to ask them that specific question. And I'm not going to stop until, until we come to an answer and a good action plan. Is that what you expect to go? going to medical school that you would choose family medicine? No, not necessarily. At one point, I was thinking about physical medicine and rehab, I think, is a choice. And I think those were the only two that I was looking at. I definitely wanted to do something sports related.

And so I knew that whatever I wanted to do, I wanted to take care of athletes. So, you know, I knew that family medicine, internal, there's a lot of different pathways to a sports medicine fellowship. And why athletes? You know, I, you know, at one point, uh, wanted to be an athlete, uh, you know, I wanted, I loved volleyball, but, um, my genetics, uh, you know, did not allow me to kind of pursue that. So, um, at various points of my undergraduate career, I thought about ways in which I could still work with athletes. Um, I had thought about going to PT school and decided I

loved math and chemistry way more at the time. So I decided to put it aside. And, you know, I just really love working with that, you know, motivated. They're, you know, doing all sorts of amazing things. And so it's, you know, but it's not just though that subset of population that I enjoy, you know, taking care of. It's also people who love being active and trying to get more of the general population sort of in that recreational athlete space. That would be the dream but um tough for everybody yeah yeah yeah i kind of left medical school maybe even residency with the notion of i want to treat my one-year-old and a hundred one-year-old patient as an athlete so when we had patients who were diagnosed with parkinson's i realized how important it was to keep them active

in order to decrease the effects of the condition decrease perhaps side effects of the medications they were taking and treat it like a rehabilitation process because the human body what makes it special is that unlike a car when it breaks out it doesn't heal the human body can actually heal and part of our osteopathic education is we need to give the body whatever it needs to heal and not overdo it yeah which is sometimes lost in health care because we love to overdo it oh we do um so you're going into your family medicine education how are you dealing with food noise at the time with nutrition as a whole? Yeah. I knew that the extreme dieting was definitely out of the question because now I'm responsible for this panel of patients and there was nothing that I was

going to do to jeopardize that. Like I did not want to be on call like starving and then miss something because I was doing something super, you know, selfish like trying to get like some sort of like, you know, fat loss diet for whatever reason. And so I knew that training, I loved to exercise. I loved to train, resistance train. And so that was always going to be a, you know, a stable thing for me. So I was still lifting heavy, you know, X amount of days a week, pretty consistently throughout residency, which was really awesome and helpful in a lot of situations. Which is a time where people usually get really unhealthy. Because they stop caring about themselves. They're working such long hours, notoriously eating some garbage in the

hospital cafeteria, which I don't know why. In a place where we're preaching health and wellness, the food options are like bread, bread, bread, bread, bread, bread in 10 different forms and breaded chicken. Yes. Yes. Fried breaded chicken. Yes. The cafeteria that I was at was not all that great. And so the, I knew, and so despite that, I was working with a physician at the time for weight management stuff. And so at various points of my residency, you know, I had tried, you know, I've been put on different medications that were used off-label for weight management.

One was Contrave, which is bupropion and naltrexone. Topamax, a topiramate, and I think that's about it. Yeah, and then the last one was Wagovi, which I said no to for various reasons, but that was a little bit further on down the line. Contrave, I broke out into the worst hives ever, so that was not, you know, an ideal choice. And didn't do anything for my hunger to begin with. And then Topamax didn't do anything. for my hunger and I had the worst brain fog slash word forgetfulness, which was pretty obvious and during rounds. Just very simple scent, like had all of my stuff right here in front of me and still couldn't figure out very simple words. And so, yeah, apparently they call it dopamax. So,

so both of those I said no too after the side effects. I'm curious if it ever, raised a flag in your mind, because I know in medical school, I've seen some of the students that I've been with use Adderall to help them study. But it's also notoriously an appetite suppressant. Did that ever go into your mind as a potential thing with other classmates using it, perhaps? Or did that not happen in your mind or in your school? So not necessarily Adderall for me, but I definitely had a higher, I have a higher tolerance for caffeine. And so, Um, yeah, uh, you know, um, white monster ultra was kind of my, uh, I don't know how many milligrams of caffeine are in that. Um, it's got to be high, 300, 400, 400. So, um, the, I want to say it's

160. Oh. And then the bang energy is about 300, I think. Yeah. And so it didn't really is bang the sound that your heart makes when it goes into it. Exactly. Exactly. Exactly. And so it didn't really do a whole lot, like maybe temporarily, but just wasn't there. And then your tolerance goes up with caffeine. And so, yeah, it was just there to keep me awake on those 24-hour shifts. Yeah, it was a brutal shift. Do you have any patients that stick out to from residency that were an interesting patient? Oh, gosh. Interesting in the sense of, that you would tell at a party. Hey, I had this patient. there was an older gentleman who would call every time I was on was on night shift just to make sure like his multivitamin he was a bit older and he wasn't sure if he took his multivitamin so should he take his multivitamin now or if he takes two is it going to be terrible and so every evening I would have to call you know because you would get paged and have to

call back and, you know, have to have a discussion, have a discussion about a multivitamin while I'm at the hospital handling stuff. Wow. Well, that's cute. In deciding your future after family medicine, how did you land on doing the fellowship? That was right around the pandemic, you know, so the ended up moving to Las Vegas for a sports med fellowship and then COVID hit wasn't sure where we were going to end up wasn't sure what was happening I decided to volunteer in the ICU because they needed help at the time

but yeah how did it impact your education I'm sure you had less face time right it was a good it was definitely interesting in the sense of when I got we actually went on vacation to Thailand It was like the one vacation you get to take, like the week off you get to take a year. Returned back and nobody was in the airport. And it was like, oh, this is serious. Like no, nobody's playing. Because, you know, you kind of heard that this thing was coming and like, yeah, whatever. You get there.

And so it impacted us in a way that I think, you know, it makes a whole lot of sense. So I spent a lot of time during my residency, calling my patient. on the phone and having conversations with them about, you know, their labs or checking in on them if they couldn't get into the office. And so for me, it was actually just a fine transition to do everything via telemedicine or a phone call because I had spent a lot of time just chatting with them on the phone, you know, after clinic is done. Because for, you know, whatever reason, I wanted to call my patients and let them know regardless of if their labs were normal, if there were labs were abnormal.

I told them I was going to call them either way. And so it seemed like a natural transition to do everything via the phone. But hard for sports medicine, though. Yes. Because if someone says they have knee pain. They have to come in. Yeah, yeah. It definitely impacted college sports.

And so everything was sort of put on hold. But a lot of college sports, yes, there's like knee pain. Yes, there's the musculoskeletal part of that. There's also still a lot of, you know, colds, you know, stomach flu or and all this other stuff that you have to manage. So despite the fact that, you know, I entered the Sports Medicine Fellowship in 2020 and then finished in 2021, still managed to like be a busy bee still see a lot they kind of had a kind of shortened football season but then they took all of the sports from the fall and put it into the spring and so that's where I got the the full experience of got it so you were busy then yes is that when you were initially

offered the wagovi prescription yeah and um back to the interview and just the second, but first, I want to tell you about cozy earth, a bedding and loungeware brand made with viscos. That's a natural cellulose found in bamboo, which makes super soft sheets and stretchy pajamas that wick away moisture and create air circulation to prevent heat trapping. Essentially, letting you sleep cooler. Lowering your body temperature in bed is one of the best evidence-based ways to improve your sleep. The holidays are here, and that means we'll be spending a lot more time indoors cozying up on the couch. It also means you'll be spending time buying presents for your friends and family. Cozy Earth pajamas make for the perfect gift for anyone because I believe

the evidence backs this up. Everyone sleeps. They offer a risk-free purchase too. Sleep on the sheets or in the PJs for 100 nights. And if you don't like it, you could send them back. They also come with a 10-year warranty. I love that piece of mind. From Thanksgiving Day through Cyber Monday, get 40% off at cozyEarth.com with the code, Dr. Mike. Remember, doctor is spelled out. It's the best deal of the year. And if you get a post-purched survey, make sure to let them know where you heard about Cozy Earth right here. Wrap the ones you love in luxury with Cozy Earth. All right, let's get back to the interview. At the time, I just, the insurance wasn't going to cover it. How come? You know, a school insurance. And I didn't really, and to be honest, I didn't really push that

hard for it. And then two, I wasn't actually had to take a pay cut in fellowship. because academia pays a lot less than some community programs. So I didn't want to pay out of pocket for it. And then, you know, three, the needle aspect of it, you know, because it's subcutaneous. The pen just didn't seem like I had reservations about taking a weekly injection myself. And so, and then I was just so busy with fellowship and doing well, doing research, to kind of pass the time since I wasn't seeing as many, you know, musculoskeletal cases as I would have liked to. And then kind of doing my own kind of ultrasound, you know, self-learning course

in the meantime that I just was like, nah, this isn't, I won't push for it. I'll think about it some other time and kind of move on from there. And then I heard in another conversation you said at that point you burned out on medicine and after fellowship you said no must yeah i did uh i did and it took a long time to kind of get a move on from that uh it was trying to do everything all at once um by the time we moved from to michigan from las vegas i told my husband um i i i I don't want to do anything related to medicine for a while. I don't know what I want. At the time I had, you know, the last, like I said, the last half of my fellowship year was pretty busy.

And I had gained a fair amount of weight back. I was back at like 185 pounds. I had some chronic nagging injuries. My elbow was given me some problems. And so I was pretty broken at the end of fellowship. I was not in a healthy place. I was also, you know, going out and having a couple of drinks and then having, you know, some high, high fat, tasty foods. So I was not in a healthy spot physically. And so I think that definitely wore on me emotionally. Um, and I think that's definitely part of what contributed to it. And the, the pandemic, you know, sure. Uh, it was, I wasn't sure where I was going to go with the state of medicine at the time.

And so, what was the emotional state at the time? Um, a lot of, there was a lot of, you know, um, people just seemed really upset and overworked. And I definitely took a lot of that in and internalized it and kind of, you know, people seemed really tired of working long hours. The amount of testing that we had, the amount of, you know, testing that we had to do to keep the athletes healthy. And then the amount of even more testing we had to do to make sure, you know, if they do have COVID, to get them back on the track. Like we didn't have the support during at my fellowship to kind of keep things sustainable. And so, yeah, I was working really crappy hours, getting up even earlier to manage all of this. And I just, again, everybody was just so awful to one another that I was like, I don't know if I want to stay.

Like, why would I want to stay in an environment? Like, not only am I working long hours. I'm working with people who, you know, some, a lot of them are great. A lot of them are awesome and I still have a lot of, have a lot of colleagues that I still chat with, but a fair number of people also were pretty miserable and just sort of passed that along to everybody else. Were you regretting the choice to pivot off of organic chemistry and going into health care? No, no, no.

So what was the thought process then? Back then, that I actually wanted to be a part of. patient care and not necessarily not back then meaning back then in you're finishing fellowship what's in your mind that you were having a bad time at this specific program but to say like I no longer want to practice medicine is different than saying I don't want to practice medicine in this specific area so what shifted there because that's a big shift I mean you were really worried in your med school days of how much money you're spending on the education that you were saying gain the weight. I don't mind because I don't want this money to go to waste. But now that you're

much further along the journey, you became comfortable saying, I'm not going to do this. So what changed there? I think it's also knowing that if I, there are other avenues that I can explore that can provide me the financial security that I don't have to feel like I'm, I'm in debt and therefore I need to, you know, pay off this loan. I was very lucky in that. Part of that was actually paid off. I actually spent an extra year in medical school doing the fellowship, doing a teaching fellowship. And so part of that, you know, helped with that debt. And then the other part was, you know, what are some different avenues I can explore that not really tied to medicine right now? And we'll, you know, we'll see where it goes.

So I gave myself like a six month kind of runway of, all right, let's do something different and then revisit this in, you know, say, yeah, about six months. And yeah, I took a marketing internship doing marketing research for a couple of months with Renaissance periodization before I decided to start looking into how do I open up, of a very small private practice. And how did that journey go? It went well. I really enjoyed talking to people. And it was just a nice change of pace and made me realize how much I miss talking to patients and I miss having that relationship and that interaction, which is what led me to kind of start looking at, what are my options to open up a private practice? Does it have to be brick and mortar?

can it be telehealth only? What kinds of things can I provide service-wise? And you clearly at that time, you said no to Wagovi. When did Wagovi enter your life? January of 2022. So we graduated from fellowship in July of 2021, started looking at private practice stuff like November of 2021. and then 2022 was when I decided, like, I think I'm ready.

I think it's time. What drove that decision? Combination of different things. You know, I had some long conversations with my husband about, you know, what is it, what have I been avoiding? What do I not like? Like, why are you all of a sudden, you know, you've taken these other drugs, you know, what makes this so different?

I think a lot of my hesitation was, again, my sort of ego thinking that, you know, maybe it is just willpower. I can just do it again, right? Like I'm out of residency. I'm out of fellowship now. I can just focus on sort of myself, maybe, and, you know, do it the old fashion way like everybody else has done. But, you know, Mike and my husband has seen me.

struggle for so long for so many years that and watching him kind of go through his bodybuilding journey. And you realize towards the end of a kind of a really extreme diet, how food focused and how insatiable their hunger drive becomes. And so I really started to think about my genetics and really started to think about maybe my food drive just is just genetically predisposed to this sort of situation that I'm in, you know, because I'm neither lean nor trying to get down to shredded levels of, you know, of body composition. Why, you know, we use air conditioning, we, you know, have self-driving cars. now, why am I making this thing so hard on myself? I've made it so hard on myself for the last

how many decades, what, you know, this drug has been around, this class of drugs has been around for a very long time. I've prescribed this class of drugs to people with type two diabetes, like it's no big thing. Why am I now having such hesitation with it? And so I just was like, all right, let's just, fine, let's just see what happens. I've talked about this enough, and I just remember going to San Diego with him and just going out to eat and I ordered a steak with some, you know, steamed broccoli on the side. And I had a glass of wine. And I just remember looking at him and just being able to have a conversation with him without without thinking about how starving I am and I starving would be probably just the most appropriate use of

that word and just being able to just enjoy the meal and not feel like I have to clean that plate up and I could just have a couple sips of wine and just put it down and we can just have a nice dinner together where I'm just not overly worried about how hungry I am, but like I don't want him to think that like I'm this ravenous, you know, like psychotic being who would just like shovel the food into her face. And I have to think about drinking water with every sip and chewing my food for 30 times before I swallow. It was just this sense of inner peace that I just didn't know existed. And I just remember looking at him like, this is just, wow, why didn't I take this medication sooner? And I cannot tell you how amazing it is to be on the other side. So when I think of people

who in the past have always been like, yeah, losing weight's just so easy, you just sort of eat less and like, yeah, it's kind of hard, but it's no big deal. My hunger drive has been an 11 right now. And now it's like at a two. Like food is awesome. It's great. It's actually just great. But it's not this awesome drive that like I've had in the past where it's like, yes, it's amazing. It's just sort of like, ah, yes, this is a lovely meal. This is lovely. it sounds like similarly how I discuss with my patients about starting perhaps SSRI antidepressants that the goal is not to make you a less subdued version of yourself it's just to give you more control so you could make choices about when you want to be sad when you want to be angry

if you're feeling sad how to cheer yourself up in a situation like that you were giving yourself back the control as opposed to something internally guiding all of your decisions and it sounded like it wasn't just guiding your decisions around food. It was more so guiding your decisions around joy and life. More broad topics. Did you feel that? Oh, yeah. I feel like these last what three years, three and a half years

has been a period of tremendous growth that I didn't realize was possible because now I can show up and I can be my best self at work. I can be my best self as a spouse. and as a friend and start to go to therapy and really start to do this inner work that I didn't, you know, how to communicate and how to regulate my emotions because now this hunger thing has been removed. And so I, and, you know, ironically now I'm, what, 145 pounds now, you know, my BMI is overweight and I feel I'm living my best life. Like I'm not super shredded.

I just, but I've done all these amazing other things outside of just the diet and exercise that I didn't realize was possible because I've been thinking about this hunger drive for so long that it's just eaten away at every other aspect of my life that I didn't realize was doing it at the time. Is it fair to say that weight for you wasn't the number? It was the hunger. that way because right now it seems like your focus is not even about the weight not even really about the fitness it's about how your life has come together that's what i'm hearing from you as opposed to

i'm at a healthy weight i'm happier at this weight you're talking about things that are completely unrelated to weight and yet you're talking about a weight related medication yeah the but i i guess the the weight is still part of it but i didn't realize how less of it becomes less about the weight and it just becomes this yes now I have the freedom to just show up and like do all sorts of other amazing things because I'm not spending all of this cognitive bandwidth thinking about food and about how hungry I am and so yeah I remember thinking that people who kind of talk about like it's more than you know just your weight and you know you would have asked me 10 years ago I mean like that's total BS but here I am now you know is that what

what you would have told your patients? No, I wouldn't have said that no, that's BS. No, not necessarily in that way, but did you believe that and that's what you were educating your patients with? I think there was a certain point where I had said, it's not just about the weight. I think that was a very brief period where I was feeling pretty emotional about me not being able to control my hunger. Very early on in med school, I remember kind of thinking that, you know, it's not about the weight. It's not about the weight. But at a certain point, it is. Because at 185, 190, joints start to hurt. I can't walk a block without feeling winded and having, you know, incredible back cramps. And so, you know, it becomes a huge. And I was snoring. I didn't have diagnosed sleep apnea,

but the snoring was pretty, pretty awful, according to my husband. I'm sure he made a joke of too about that. You know, speaking of Mike, what's it like, a, being married to Mike during a time like this? Yeah. And B, does it help or hurt in the journey being married to someone who's a bodybuilder? It's a great question. Mike has been the most amazing partner, husband, boyfriend throughout this whole journey. It was actually one of the very first things that I remember having a conversation with him when we first started talking was

kind of my stance on fitness and because didn't you meet on like a Facebook forum or something like he had some joke real about this I saw the other day yeah he was in he had there was a picture of him at the Arnold with a couple of other bodybuilder slash powerlifter people that I sort of knew from the Facebook powerlifting scene because I had power lifted competitively in med school and then in residency I love how you totally left that out. casually. You're like, oh, my weight was 10 pounds over. I didn't like it, but you were also powerlifting competitive.

And so he reached out and we just started chatting on Facebook briefly right before I had to go into hiding to take step one. And as soon as I was done with step one, I called him and we talked nonstop the entire night. I like got out of Prometric and called him. And then by the time we stopped talking, it was like 6 a.m. We just, you know, he has, oh, and so yeah, when we were talking, I said my philosophy on fitness is this. I really enjoy exercising regularly.

And I enjoy eating nutritious foods regularly. But I am not a bodybuilder. I'm not going to be a bodybuilder. I don't think ever. And so if you are looking for somebody who wants to be some sort of, like, fitness, like, lean. person, I don't think I'm the girl for you. And also, if you are not physically attracted to me, then we, you know, should probably part ways. Because I've also had, you know, interactions where people have told me, like, you have an awesome personality, but, you know, the, I'm not attracted

to you looks wise. Outright? Oh, yeah. Wow. Oh, yeah. Was that a partner that said that? Or just, like, someone on the street casually coming up to you? Um, so people, no, these were, um, These were people off of a forum. Well, you know, those were the intelligent people. Right, exactly. So, you know, I just wanted to make it, no, I take that back. One ex-boyfriend did start teasing me quite a bit about my weight when I was a grad student. And so it took a while for me to dump him because it was very subtle at first.

and then he slowly progressed the amount of insults. It was very innocent at first. And so I remembered that from that relationship. And so that's what led me to be like, okay, if... I'm setting my boundaries. This is my boundary. And he was like, no, I, you know, he found me attractive at all different sizes. I never once, you know, doubted him or he never once made a joke about my weight.

So in that realm, he's always been like super amazing and supportive. At one point, he tried setting up these diet templates to help me kind of, because he realized, you know, my hunger signals were kind of, you know, up there. And he had never seen that before. So the diet was sort of a lot of low, you know, less tasty, like high, fiber, high, you know, filling foods. So chicken breast, broccoli, um, oatmeal. And I would make it soggy, watery. So I could, you know, it would be more filling than regular oatmeal. And so that's where I had the like extended, distended belly, but the hunger drive was insane. So he, you know,

always, you know, wanted to, wanted me to be happy. And he knew that this part of me was just, like, this was all me. This was never about him. Like, nobody on the internet, even though they have made comments every now and again, you know, being, you know, married to him. Made comments in what regard? Um, like, why can't she lose the weight? Uh, you know, you're married to like one of the, you know, leaders in the fitness and nutrition space. Like, can't you just put her on a diet, um, you know, um, but at the end of the day, this was my decision and how I felt about it and not necessarily what some, you know, internet, you know, anonymous person on the internet had said, because I'm just, I'm beyond that.

Just. You're like, I've struggled enough. Right. I've gotten pimped in medical school. This is nothing. Exactly. Exactly. So the, you know, Mike has always been there for me.

But it, yeah, you just ended up realizing that this is beyond anything that he could have helped me with because, you know, there's just this, you know, drive that, you know, in my brain that's telling me like, you're hungry, like, you really want food and no amount of, you know, advice that he could have given me, except for talking me into starting, you know, trying the GLP1 that, you know, he could provide. And he, on the show even, has said how he was using either GLP1 medications or perhaps anabolic steroids. Does watching him do these things impact how you feel about yourself or perhaps about his actions? No. It's, you know, what he decides to do is his choice. And yeah, I don't, you know, if

anything, I would say the, my own journey has actually made it such that like I can actually like interact with a lot more bodybuilders and a lot more people in the fitness space because I'm at a place of mental peace where now I have this hunger thing controlled and so yeah whatever he wants to do I'm not affected by it yeah no not at all is given that monitoring body size body mass is so important the bodybuilding community do you feel like there's a lot of disordered eating food noise individuals, perhaps overuse of performance enhancing medications. Is there a lot of disorder in that community from that regard? Or is that just something that the general public believes but doesn't actually bear out once you study the population? You know, really it would be interesting

to see what that, you know, what if anybody has done studies on that to see if there's a higher, you know, eating disorder prevalence. I want to say that. there is, but I haven't taken a good look at it. And I don't know necessarily if it's the bodybuilding lifestyle itself that self-selects these people or if it's, you know, they're already coming in with sort of disordered eating and then they just find bodybuilding as like a way. A home where perhaps it's acceptable. Yeah. Yeah, like you've worked with the figure skating community before. And historically there have been issues with people going on crash diets, trying to overly controlled their weight. Is that something you saw when you worked in that community?

Thankfully, no. I have not. And, you know, the, and I think there's a really big emphasis on making sure that you fuel your performance. Making sure that you are strong and healthy is also a huge thing, which I'm starting, which I have been seeing, which I think is a really great message, you know, because you run into all sorts of things when you, you know, under-eathe. and under fuel those those skaters really take their joints take a beating especially with those jumps yeah um so um thankfully no um have you seen glp1 medications used as performance enhancing drugs in the sporting world not in the sporting world thankfully uh right now it's on the monitored list uh for wata um so i'll be very interested to see where it ends up going where we end up

in 2026. I don't make the rules, but, you know, particularly for weight class sports, I would think it makes sense that the drug might not be, you know, might not be applicable for, you know, either in competition or even off season, because, you know, it would theoretically help you get into a lower weight class by removing that hunger noise. And then what happens if you have diabetes or one of these conditions that would benefit from one of these months. Yeah, that becomes a very complicated issue. The lines are all blurring in these, in the medical performance space. It is.

Because there's also new medications on the horizon about perhaps limiting the negative muscle loss effects of GLP1 medications. Have you heard much about that? Briefly, I know Mike is very excited about these medications. Um, I, you know, we'll see where it goes. It doesn't see like, I think some of them are on phase two trials, but, um, still too early. Still too early. I'm much, you know, once it starts hit in phase three trials and beyond, then I'll start to kind of look at it. But I mean, right now, you know, the most important things with, uh, you know, preserving muscle is resistance

training and protein intake, you know, it's a, which a lot of people aren't doing. Yes. That's what I'm finding not necessarily in my patient population, but more so personal life of when I hear people are taking these medications. They're using them for the benefit of losing some weight, sometimes vanity weight, and they're not doing those things. Do you believe that to be harmful? I don't think that's necessarily the best route to go, you know, when it comes to using these drugs. And I think it gives it, particularly if you are making, you know, social media, reels talking about the experience, I can see why, you know, the medical community and also the fitness community would feel some type of way. So, you know, thankfully, and the reason why I wanted

to come here and speak is because there's always that pendulum shifting with, you know, now you do have a lot of, you know, kind of the TikTok crowd, kind of doing this vanity weight loss. And then you have the fitness community really kind of lashing out on GLP1 medications as a whole. Yeah, why is the fitness community so mad about GLP1 medications? You know, really great question. I think there's also something to be explored within themselves as a coach. Is it really like your own ego that's, you know, because why is it so awful for somebody to, you know, are they not doing it the right way?

You know, I feel like at times I may have gotten a pass for being, okay, Crystal, you know, Dr. Crystal is this spokesperson for GLP-1s because I've done the resistance training since 2009, you know, she's done this, you know, she's always had a high protein intake despite the fact that she has, you know, increased her calories or has a sensational hunger drive. At least she gets her protein in, at least she resistance trained. So she's like doing all the right things. for it. I think there was also a huge scare in the very beginning, at least from what the feedback that I had seen when I first started talking about this, that their jobs would be kind of done with. And I almost want to say that that's actually couldn't be further from the truth is, you know, we actually need people in the fitness community now more than ever because they're the ones who are going to be talking about protein intake or how, you know, here are some recipes to, you know, that you can use or let's put, you know, put together a program for you that involves resistance training and have those multiple points of check-in, you know, weekly.

So you can stay on top of it. So I would say, you know, coaches are way more needed now, now that we have this hunger problem solved, you know, we'll see what happens when the, you know, myostatin inhibitors kind of come. But I would still say even then, I would say that building a community is probably going to be the most, you know, is going to be super valuable. Having human face-to-face interactions are still very valuable. Do you think that perhaps there's a correct way to think about GLP1 medications as someone who's prescribed them, as someone who's found tremendous benefit from them, but at the same time as aware of people who misuse them? what is the correct way that we should be thinking about them so that we're not marginalizing one of those communities that's a really great question the you know the

in or i feel like the biggest uh the most popular question that i always get asked is you know you have somebody who wants to lose the last 10 to 15 pounds and you know is this medication appropriate for this person, and I would argue that, you know, it's hard for me to figure out what that last 10 to 15 pounds looks like unless I have a person who's standing right in front of me, you know, first off, I guess unless your BMI is like 18 or something, you know, obviously low, even somebody whose BMI is still 23, 24, 25, like right underneath the overweight category, I would still take it on a case-by-case basis. because they could have, you know, they could have type 2 diabetes hiding under the hood

that might actually make them applicable for, or a good candidate for these medications. You know, really thinking about digging into their past diet history, what have they tried in the past, what have they failed, what is their schedule, you know, what is their day-to-day look like now, and then also taking a look at their comorbidities, you know, not just the weight portion, but also the struggle, because if diet and exercise didn't work the first time, what makes you think that it's going to work this time and why? I mean, I know that there's a lot of people who, you know, are able to have success losing weight without these medications. But I would also argue that the benefit of trying, putting them on

this medication and trying it may just be the catalyst for them to start eating better, start lifting, you know, start actually getting into the gym and resistance training. And that doesn't necessarily mean that they have to be on the medication forever. I know the research says that most of the people who end up taking, you know, discontinuing these medications end up gaining a lot of the weight back. But I also think there have been, there have been patients who have stopped. and are still doing great. So I don't know if that necessarily answered your question.

No, no, no. It does. It's like trying to find that balance of when we use it versus when we don't and not just demonizing it or hyper-celebrating it across the board because it's a medication. There are times where it's applicable, times it's not. And that's why sometimes when I get invited on podcast, I remember I went on Howie Mandel's show and he said,

what do you think of Ozempic? And it's like, I don't think anything of it. I think it's a medication that I use it sometimes where it's appropriate and we don't when it's not. Yeah. And that's going to be different for each patient. I'm curious if you have any thoughts on pill mills or perhaps maybe not pill mills in this case, shot mills of companies that are popping up left and right online that are giving

these medications to people that they're not adequately following, that are not adequately doing the resistance training and the nutritional protein changes that you are. recommended. What's your take on that? Yeah, I can't, ideally wouldn't, you know, don't really, I'm not a huge fan of them, but I think if I spent my time being angry at the pill mills, I find that I'm just going to end up in a really angry, like just the amount of energy it would take to either try and shut them down or, you know, rat on them on Instagram so their accounts get blocked is just not my way of going about things. So ideally it would not be great and you should go talk to a doctor. My big thing is, well, if you are going to do that, I would hope that there's

somebody out there, somebody that you can, you know, trust and get some sort of good information about protein intake and resistance training and kind of navigate your way around there because that is the biggest, the scariest thing about some of these places is that there's no real oversight. It's just sort of, here you go. And then, you know, so either side effects happen and there's no communication on their end or they'll just keep losing and they'll, you know, not lose the muscle too and then feel like, oh, these people didn't real, like this medication didn't work. I just ended up with like, ozempic butt or something. Yeah. There's a concern that I have in the back of my head that perhaps is unwarranted but may play out where we've had this explosion

of opioids because people ended up getting addicted to them. We had an explosion of over-prescription of Adderall for teenagers that are in college that perhaps don't have a true diagnosis of ADHD. There's some instances where people routinely prescribe SSRIs without doing a full mental health evaluation just reflexively, oh, you're not feeling great, here you go. I don't want to want it to become where these GLP-1 medications end up playing that role, where it's just reflexive, oh, your BMI is in this category, like a robot, you get a prescription for it, without all the other additive features that need to be discussed, without the holistic viewpoint of what's going on in their life, what is the last 10 to 20 pounds for them?

When someone tells me that they have tried dieting, what does that mean? because they could have followed the Dr. Gundry diet or the cabbage and soup diet. Cabbage soup diet. So like, dieting means something different for everyone. And without truly spending the time to figure out who that individual is, we can hyper-celebrate the medication, then get into another problem. Yeah. So, like, I love that the medicine worked for you.

I love that it made such an impact. I mean, it's visible that it impacted your life in ways that go so much further than your cholesterol score, the number on the scale, your relationships in life, your joy with your work, just things that you can't even quantitatively measure. But they're very important in your life. So how do we celebrate your case, but also not bring too much promise where people are like, I can't be positive. I can't be successful without the medication. So where's that fine line? Yeah. I think it's, well, it's always a nuanced conversation. It's always a conversation and I always encourage people to talk to their doctor and have that, you know,

start that back and forth because there's no, you know, I don't think that's ever going to be misconstrued as terrible advice. Unfortunately, when you do go to a pill mill, it's not necessarily a doctor who knows you and does a thorough intake of who you are, what you value, what your life has been like. And so it is hard because then those don't get the clicks. Those don't get the attention. that like a 30-second, you know, real might get on Instagram. And so the, yeah, I guess I always, you know, I never want to come off as somebody like, this drug is amazing and everybody should be on it

because not everybody should be on it. But for people who are struggling, and I find that the people who are struggling aren't the people who are talking about, you know, these drugs. So I have quite a few people in my, you know, DMs who have, you know, come to me and say, you know, I'm really, you know, I don't know what to do. You know, I feel like I'm struggling with this, but like I don't, you know, really, like, is this for me? And so I always just encourage people to, like, go to their doctor and have a

conversation about it because only then can they figure out, like, you know, figure out, like, what are the pros and cons of this drug? Is this drug even appropriate? And so I just wanted to make sure that like that doesn't get lost in translation sure what uh what's on the horizon for you what are you most excited about um gosh uh just um you know i do a lot of stuff on the back end of the our youtube channel and so uh was part of my non clinical um duties and so the same Right. And so I think, you know, just kind of we've got a couple of, you know, cool projects sort of wrapping up and just writing more content, writing more educational content about exercise, nutrition, seeing if I can kind of pair that down for the general population because I know that, you know, our YouTube channel and our fitness space is, a very small subset of the population recreational athletes. I want to try and find other ways in which I can draw the general population and get them excited about fitness. That's not

judgmental. It doesn't seem like overly taxing. There are ways in which you can incorporate fitness into your life without having it take on your entire life. You don't have to be a fitness influencer to be fit. Sure. I feel like I should have asked you this question earlier, but do you think going through your life as someone who struggled with their weight and had weight as a primary concern, did you ever feel the medical community was fatphobic directly to you? Or do you feel like the medical community in your education taught you to be fatphobic to patients?

I don't know if it was necessarily fatphobic. I just the medical community, the things that I had learned about nutrition just seemed to be so kind of not taking the long-term approach. There were a lot of times where it was just very much just the weight loss. I didn't really feel like I experienced it directly. Everybody seemed, you know, can't really think of an instance where, I felt targeted personally for my weight, but there was never a situation where you came in to see your doctor for a symptom and they brushed it off as a weight related issue where in

reality you had something more serious going on? No, not not particularly. The yeah, the biggest thing I had in as a resident was I had sort of a knee issue. And they didn't brush, like, it was not weight related. It was, you know, just sometimes stuff happens when you're lifting heavy weights in power lifting. And so, you know, they were always, yeah, they were always pretty supportive about it. But like the kind of when we talked about nutrition, again, it was very much lean animal sources of protein were not really, like they were kind of pooed upon. It was very much the Whole Foods plant-based, which, you know, I like the idea of eating more plants. I think it's really important for fiber.

But if you, you know, not all animal sources are terrible, you can eat eggs. You can eat, you know. It's a pendulum, right? Everyone's swinging. And it also depends what you're talking about. Like, yeah, in the American standard diet, yeah, please let's get more plants in there. We're eating almost zero, except maybe the little fake slice of, lettuce that's in our burgers, if it's even there. I feel like there's a book here.

Oh. No, you disagree? Like some kind of food noise titled book, talking about your journey because it's a pretty unique journey you've been on in the sense of what you've experienced with both your mental and physical health, but also the fact that you're on the other end, also taking care of other people's mental and physical health. And now you're also married to an individual who's hyper-focused on physical and mental health. So I feel like this is a very unique vantage point you have. Oh, I guess I was just so busy thinking about other projects going on that I hadn't quite stopped to think about it until now.

Well, perhaps maybe we could plant the seed in this non-plant-focused day. All right, I'm giving you a magic wand. Final question. Okay. You could fix one thing in health care. only one thing and it instantly gets fixed but it has to be specific not just make everyone healthy

because that would be beautiful but not realistic even in my magical experiment so I give you the magic wand what are you fixing price transparency and insurance get rid of insurance get rid of insurance like single payer yeah all of it

wow okay so government funds it actually no I take that back. Get the government out of insurance. Okay. Yeah, sorry. So then who's covering who's banked insurance? You know, so here's my, and this is the reason why I'm like, yeah, just do if I had a wand. A lot of times, yeah, I find myself, you know, having to go to bat for my patients and still the co-pays are terrible to the point where a lot of times I've advised my patients, like, just pretend you don't have insurance because the self-pay price is so much cheaper. In certain instances. Yeah, pharmaceuticals, that happens quite often. Not often,

but happens. And enough times that I'm like, gosh, why are we here? I understand that there's probably a purpose in there somewhere, but that's kind of where I'm at right now. Yeah, I wouldn't say that's a government issue. I know. I know. It's a little more complex than that. It's probably more pharma issue and lack of government regulation in the pharma space because i just had the head of uh or the former head of CMS on and hearing the fact that they have such an inability to negotiate certain parts of drug prices uh condition prices i'm like oh my god so these people are just getting away with charging whatever they want and it shows that without oversight the capitalistic nature can really take advantage of health care, because I'm not anti-capitalist by any means, but

the capitalist model within health care technically breaks health care. Because if you're someone who needs insulin, as a capitalist, you say, well, charge as much as the market will allow. Well, if I need the insulin to stay alive, I'll pay every dollar I have because otherwise I die. You can really get away with robbing people. So that's where the government interventions need to step in and say, okay, it's capitalist, but it needs to be government regulated to some degree. Whatever causes the self-pay price to be cheaper than or different than some of the other, like if you're covered by insurance and they can't give you a clear answer. I think that's the PBM world. Yeah. Yeah. Whatever that is, I would like to. I would fix

that as well. Let's ban PBMs. All right. Well, thank you so much for your time and your transparency on everything. I think it's a powerful story that people will. will resonate with. I think you'll make an impact in their lives because there are people who are judgmental against them taking certain medications. There are folks who are embarrassed to take certain medications. Whereas there's all sorts of things that break in our bodies. One in three males will have incontinence after the age of 40. And that's okay to talk about. Right. So I'm glad we're airing all these conversations out. So thank you for that. Thank you so much for having me on. Oh, and before we wrap, where do you want people to go to follow along your journey?

Oh, I'm on Instagram only. I try and stay away from TikTok. It's a little too new for me. So, Dr.D. Crystal, C-H-R-I-S-T-L-E. Cool. All right, we'll be following along and tracking the progress to see what that book is going to look like. I really want to thank Dr. Guevara for coming on the show today.

She really opened up for us about a super sensitive subject, which I know is really hard to do. If you found this conversation interesting, you might like my interview with Dr. Christine Renfielding, a bariatric surgeon right here in New York City. We talked about the future of bariatric surgery in light of so many patients having success with GLP-1s. Scroll on back to find that, it's definitely well worth it. And if you'd like to help out the show, the best thing you could do is leave us a five-star review. Drop a comment down below.

I'd really appreciate it as it helps us find new listeners and viewers. As always, stay happy and healthy. Thank you.