Well with Arielle Lorre - 376: How to Lose Weight, Lower Inflammation and Disrupt Your Brain’s Dopamine Loop with Dr. Sara Siavoshi

Episode Date: February 26, 2025

Dr. Sara Shiavosi is a triple board-certified neurologist, headache and obesity specialist located in San Diego, California. Her focus is on tackling obesity as a leading risk factor for brain diseases like stroke and headache syndromes causing blindness. She joins the show to discuss the dopamine loop in our brains especially as it pertains to food and addictive behavior around eating. WE talk how to really practice moderation and lose weight without the help of medication, as well as how medications are useful when it comes to weight management and metabolic and hormonal disorders like PCOS. She explains what our body’s weight set point is, common contributors to weight gain, why calorie deficits matter, where supplements can be useful and so much more.This episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct, or indirect financial interest in products, or services referred to in this episode.Visit Puori.com/BLONDE for 20% off. Visit oneskin.co/well and use code WELL at checkout for 15% off your first purchase.Go to www.YNAB.com/well for an exclusive three-month free trial with no credit card required.Go to mollyssuds.com/BLONDE and enter code BLONDE for 20% off!Visit openphone.com/BLONDE for 20% off 6 months. Visit nutrafol.com and use code BLONDE to get $10 off your first month’s subscription & free shipping.Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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Sonders Sonderger Go to your Reisadviseur or SunnyCars. The following podcast is A Dear Media Production In a world of ever-changing wellness trends and information, what does it mean to truly be well? I'm Ariel Lorry and I'm going

to explore this with you. I am bringing you candid conversations that will equip you with everything you need to live your best life and look good doing it. Think of well as your go-to resource for all of the latest in wellness and me as your internet bestie. Well, let's get into it. Hi, everybody. Welcome to the show. I have such a great episode. for you today. I'm talking to Dr. Sarah Chiavasi. She is a triple board certified obesity neurologist and headache specialist. Her focus is on tackling obesity as a leading risk factor for brain diseases. She's also the founder of Dr. Brain RX, which is a telehealth company operating across 20 states where they offer GLP1 weight loss solutions. We are talking about GLP1s as they relate to not only

weight loss, but also brain health and neurology. She serves as the CEO of Dr. Brain Rx, but she also practices as a neurologist and headache specialist at UC San Diego, where she's also a clinical professor of neurosciences. She's also an expert witness, where she provides valuable insights into traumatic brain injury and headache cases. And she has had the privilege of chairing the UC San Diego Neurosciences Society. So she is, incredibly smart. And she's also just kind of a girl's girl. I had so much fun talking to her about everything from the dopamine loop in our brains, especially as it pertains to food and addictive behavior around eating, binge eating, things like that. We talk about how to practice moderation

and lose weight without the help of medication, as well as how medications can be useful when it comes to weight management and metabolic and hormonal disorders like PCOS. She also talks about our body's weight set point, common contributors to weight gain, why calorie deficits matter, where supplements can be useful and so much more, and she's just really, really fun. So you guys are going to love this episode. Please enjoy Dr. Sarah Shiavasi. Welcome. Thank you. Thank you for having me. Very excited to talk to you. I feel like we've been kind of in the DMs for a little bit now. Yeah. So it's always good to. You're always traveling. Yeah. Very, very hard to reach. Yes, I know.

I've been definitely in my travel era right now. It's been amazing. I love that. Oh, so fun. Yeah. So when I was preparing for this episode, I thought that something really interesting is what you talk about with like the dopamine loop as it pertains to eating and food and disordered eating and all of that.

So I think that would be a great entry point into this conversation because I know that my audience, it's very relevant for them. It's been relevant for me at times in my life. And whenever I do Q&A's, people always ask about binge eating. And I'm like, I don't really know what to tell you because A, I'm not a professional. And B, for me, I had to hit rock bottom with it in order to change. So let's start there. But you can introduce yourself to the audience first and tell them who you are and what you do. Sure. So my name is Dr. Sarah Civoshi. I am a board certified neurologist and headache specialist and weight loss specialist. So many different specials. And I, you know, I love that you want to start with the dopamine loop because I think that so many people out there are talking about g-lp-1s, ozempic this, ozempic this. There's like a million ozempic experts, right? I'm like, at this point, we've heard it.

It works. It's great. And then there's the other side that villainizes it. Whatever. There's these arguments. But I think the question that I get asked most is, how did you as a neurologist, you're a brain doctor, why are you, why are you an ozempic doc all of a sudden? So a couple reasons. Number one is that I don't know if I was like meant to be a doctor. And when I started practicing medicine,

one of the things that I was most interested in was just like the existential crisis of humanity. I feel like we all live and struggle and work. And our day to day is so rough, especially in this country. And we're all constantly chasing happiness. Like we all want to be happy. And that's that dopamine loop, right? Like chase, chase, chase, run, run. Try to achieve some level of euphoria and satisfaction that I don't know if that truly exists.

At least not in this life. I don't know. I feel like it's a constant. I was just reading this article today and they were calling it hedonic treadmill of us just constantly chasing fulfillment. But when I was when I would sit there in my office as a neurologist and I still practice as a neurologist, looking at people, especially in their older age, I would see them with their regrets and it would make me so sad. And one of the biggest regrets that a lot of people had was just not focusing on their health, not preventing illnesses that they could have prevented. And so also as a headache specialist, I saw a lot of people who were overweight and struggling. And so when I heard about the GLP ones that came out, I saw how much they were increasing people's satisfaction in life. Like, okay, yes, as a neurologist, they increase your brain health, right? Like, they will make your brain fuller and more healthy with increased neuroplasticity for a lot longer and decrease your risk of dementia, decrease your risk of various cancers.

They're incredible. The research shows that the science is there. But also, when people lost weight and they would come into my office, they would come in so happy. They were different people. And they would tell me that they felt more confidence. They could now pursue relationships that they couldn't pursue before just because of a lack of self-confidence, right?

Like confidence is everything. Us as humans, there's this inherent desire to feel recognized and loved. And so we want to feel like we can achieve our goals. Like we can talk to people and feel like we're connecting. Right. And a lot of times when you don't have self-confidence and you feel badly about the way that you look, it just sucks. And so a lot of the doctors out there are saying, well, don't focus on the aesthetics.

But to me, the aesthetic part is also really. important. And I loved that I was helping their brains, helping people live longer, reducing their risk of cancers, but making them increase their self-confidence. And for me, that was so, so, so important. Sorry, I know I talk a lot. But along that dopamine loop conversation, there is an article that recently came out, and it was O-Zempic's effect on the brain. And there were two really big takeaways. There was actually three, but two of the big takeaways that I loved. And I was so interested and you'll love this as well because it has to do with addiction. One of them was that, well, first of all, the GLP-1s, the GLP-1s, the GLP-1s, the GLP-B is this like class of drugs, right?

Ozampic, Monjaro, Zep bound, some of them are GL-1 agonists. They increase GLP-1. Some of them also increase a different receptor, GIP. But in general, they all also increase GLP-1. GLP-1 is neuroprotective, and I think people forget that it has this big role in the brain. It's anti-inflammatory for the brain. It's neuroprotective. And so this big study that just came out actually showed that GLP1, OZempic itself, increased cognition, decreasing the risk of dementia. That's amazing. So it's anti-inflammatory for your brain, increasing your memory scores, decreasing your risk of dementia. As a neurologist, I'm all about it. I love that. Number two, OZempic, as we know, also works on the Mesolympic pathway. What is that? That's this dopamine pathway in the brain where it dampens dopamine.

Okay, so what's this whole dopamine? Dopamine is like the Kim Kardashian of neurotransmitters. It's like the superstar. Everyone always talks about dopamine. And honestly, it's a little played out, but it is still important. Like dopamine, what happens is it's a desire hormone. It's not necessarily all the biggest player in addiction. So like let's take a person, let's just take a person who's addicted to coke. Okay, like a cocaine addict. Me. Was that you? Yeah. I've heard you talk about alcohol. Alcohol was my first love, but I was a blackout drinker from the beginning and I was like, I got to figure something out to manage this. And then I found Coke. And I was like, hello. Okay. Now I'm not blacking out. So then it was alcohol and coke. And then it was benzos to

help come down and then manage the anxiety the next day. But then the benzos were dampening a little bit too much. And so then I needed Adderall to pick me up during the day. So it was those four. Yeah. Yep. Yep. Yep. No, I have. heard that story. That's so common. But it was all to support the drinking. That's like the first love. Okay. Well, in any of these, right? So when you drink alcohol, when you do coke, or even when you're like addicted, when you have like a highly addicted personality to food, you've got a food addiction, the dopamine is what's driving the addiction. It's driving the motivation to get to that place where you feel euphoric, right? So you do coke and you do a line or two. or whatever, or you're drunk, you're belligerent. And the first couple times, especially, there's these opioid receptors that are on fire.

And it's releasing this euphoric feeling of like, wow, I feel great. But what happens when you start doing this over and over and over and you habituate? The opioid receptors aren't as active, right? You're not feeling as euphoric anymore. So why is it so addictive if you're still, if you're not feeling as great anymore doing it the hundredth time?

Because dopamine is still dry. you to want to achieve that euphoria, that opioid trophy, right? Like you want to feel that, but you're not feeling it anymore. So you have to go, go, go, go, go. Let's get more. Let's do more. Let's get there. That's dopamine. Chasing the high. Chasing the high. I always said, like, there was nothing like that first time that I did it. But every time that I would do it, I would think, maybe we'll get back there. Like that, and that was the chase for 10 years. Exactly. Exactly. So what we think about of Zempic and these GLP-1s is that they dampen the chase, not necessarily the high. They don't dampen the opioid.

They dampen the chase. They dampen that mesolimbic pathway. They dampen the dopamine so that you're not chase, chase, chasing. So I'll tell you something. And this is like a little controversial because I'm a skinny little thing. Right now I'm pregnant. Whatever. It's different.

But I have when I wasn't pregnant, I was like, you know what? I have prescribed Ozempic to a gazillion of my patients now. I need to know what the hell this thing feels like. So I tried it. I tried it once. I actually tried Monjaro, which is sort of like the star, right? It's like the version 2.0. It's amazing. Tried it once. Felt sick for a few days. It's like I just felt nauseated. It wasn't fun. The first time some people take it, you can feel a little nauseated. And then you get used to it and it's great. After a few days, though, it was so interesting. I remember going to a really good restaurant and I had this great meal and I was eating. And I wasn't, so I have an addictive personality in general. Okay. And I have also, I'm like a binge eater,

especially when I'm social. I just want to eat. And it's this compulsive, like I can't stop, which is annoying. But I remember when I was at this restaurant, I didn't have that compulsion to eat. I wasn't eating in a manic way. I was eating really slowly and I enjoyed every bite. Why? Because the GLP one wasn't necessarily working on my opioids. I still felt that really great high from food, but I wasn't chasing it. So I was eating much less, much slower. And that food noise was gone, which was amazing. Now, I didn't need to lose weight. That's not my problem. I didn't continue it. But I experienced it. And it was really great. I now understand what that.

food noise dampening feels like and it was wonderful. There are so many skincare products out there. It's really hard to know what is legit and what is not. And most skincare products focus on surface level results. But one skin, which was founded and led by an all-woman team of skin longevity scientists, goes way deeper working at the cellular level for lasting results. So after testing more than 900 peptides, they developed OS1, which is the first ingredient. scientifically proven to interrupt a core aging process called cellular senescence. So with age and

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moments when it comes to women's health. And I'm going to ask some of the questions that we're a little too afraid to ask. I'm your host, Kat Schneider. I'm a mom of three girls and the founder and CEO of Ritual. Ritual is a women's health company. that's working to set a totally new standard in the supplement industry with traceable science and traceable sourcing. In this series, I'll be sitting down with leading experts and friends, and we'll be diving into topics that affect us all, from periods to fertility to postpartum and even perimenopause.

So let's be a little provocative, a little TMI, and have exactly the kind of conversation we all need right now. Let's get into it. I know a lot of people that have done it as well and something that they have said is like they don't want their wine at night or they don't want their coffee. And I don't know if that's a side effect of the nausea maybe or if it's because of that that drive is like dampened, that desire. So that's exactly what that article just showed. Yeah. Is that it's dampening the desire for addictive behaviors. People were not just being seen to have.

this neuroprotective effect and have a decreased risk of dementia. But they had a decreased risk of nicotine use, smoking. And so now the GLP-1s, Zemphic-type drugs are being studied for alcoholism. And I'm seeing tons of my patients come back and say, I don't really want to drink. And these aren't like alcoholics, actually. These are people who just drink socially, but maybe too much sometimes. Like, it's an unnecessary form of calories, alcohol. It's a lot of calories. But they're like, I don't want to drink. It's great. I've cut those calories out of my life, but also it's just healthier. I feel great the next day when I go out. It's an interesting conversation and I think it'll be a debate because I know for myself,

like I'm in recovery and I have been since I got sober not to get too much into it because I don't talk about it on a public level. But, you know, they said decades ago, maybe someday science will achieve something where you can take a pill and your desire to drink will be gone. But until then, there's got to be another way. So for me, it was like the spiritual path that, has brought me so much fulfillment and it just eradicated the need for me to drink or do drugs, not replacing one with the other, but it was like the obsession was lifted. I haven't thought about drinking or doing drugs. I haven't had a desire since the day that I got sober. And I wouldn't trade that for anything. I wouldn't trade that for a shot or a pill or something that could take away

the desire to drink or use. But obviously there are people who don't want to go down that path. And there are people who aren't technically alcoholics, but they are problem drinkers where, you know, it's like a harm reduction thing, where I think it could be, you know, incredibly valuable or people who just cannot get sober and they try and they try the recovery thing and they can't stay in and they're in and out. And potentially, I believe it's a chronic terminal disease. It's going to lead you down that path. And it usually gets worse, never better. So in those cases, like, it could be life saving. Yeah. Let me ask you something.

a lot of the people that I know who have recovered from addiction, they replace one addiction with another. Do you have like another addiction that you've replaced it with that's a healthy addiction? Macha. No, just kidding. No, I have one Macha a day. No, it's weird. Like, I mean, I just became a very moderate person. I mean, I definitely recognize certain behaviors where it's like, if I'm dealing with something kind of emotionally triggering, I'll go shopping. You know what I mean? But I'm like, oh, I'm acting out right now. Like, I am trying to numb out. that thing and I am aware of it. Yeah. But you're like describing an aesthetic lifestyle, like a monk's lifestyle. I'm definitely not. Which is like not you. No. I mean. I've seen what you wear. Yeah. You are not a monk.

No, no. Not that. But I just don't have anything that I consider to be an addiction. I think when I was newly sober, like when I was around two years sober, when I started my Instagram account, at the time I started it as a fitness accountability thing. I was doing BBG. Kayla had seen as bikini body program, counting macros, working out seven days a week, never miss a Monday, doing all the challenges, posting the selfies. She used to be obsessed. Remember you used to do Kayla every day? And at that time, I was like, I didn't know what health and wellness looked like. I thought that it meant having abs. And at that time, it was like the days of Arctic Zero and Quest bars, like microwave quest bars. halo top and I was restricting during the day and I was counting macros. I was at like 1800 and I'm like,

well, I can still eat so much. Then I'll do 1,200. This is like a year, a two year sober, ish. And lots of control and lots of binge eating and things like that. So I think that is kind of the closest thing where I was using these things to kind of modulate how I felt and there was a lot of control and there was a lot of addictive and disordered behavior, but I didn't know it at the time. Like, I thought that I was getting healthy, you know, and then I had to hit a rock bottom with that where like I had no energy, you know, I was eating so few calories. I was working out like crazy. That was the sole focus of my life. You know, I couldn't go out to lunch because I would bring my boiled chicken and Tupperware with my food scale. Like, that's no way to live. That's crazy. So that was like, that was a big turning point

for me when I acknowledge that. And then that's when I like learned how to meditate and like tune into my body and stuff like that. I don't think I've ever been addicted to anything. Certainly not in the way that I was addicted to like alcohol where it's consuming. There's consequences. It's all I think about. Every decision is revolving around that thing, whatever it is, except for those early days when it was like the food and the exercise. Yeah. Peace. I mean, I think it just speaks to the human problem of like it's really hard to be happy and content. It's so hard to be happy and satisfied and fulfilled. And then when you think there's these things that are going to make you satisfied and fulfilled, you get them. And then you're like, I'm happy for a second, but now I need more. It is a constant problem.

And you know, you read all these articles like, this is one problem that I truly, I know that I have this issue. Every single place I get to in my life, I'm like, I need this and I need this and I need this. And so I get there. I achieve it and I'm happy for literally two minutes. And then I'm like, well, what's the next thing? What's the next thing? You build a house. It's beautiful. You have kids. They're great. They don't really truly bring on that fulfillment. They really don't. Like this life is just devoid of fulfillment. So I actually don't know what the answer to that is. Yeah, remember I had a psychologist on the show who talked about slow dripping happiness throughout your day. And she's like, whatever that is, if it's like,

your coffee in the morning, like sit there and really enjoy it. Don't be like scrolling on Instagram while you're drinking it. I mean, it's like, yeah. But I think about my own experience, at least in the last 10 years, because everything prior to that kind of a shit show. But I think back to when I first got sober and I was in sober living for six months with a bunch of other women after being in rehab for six months. And then I moved into this, like, tiny apartment. I got this, like, older used car. I was working at a boutique in Santa Monica, like, making $800 every two weeks. Like, and I was so happy. It was the happiest time of my life probably because life was so simple. And, I mean, also, I was, like, newly sober and I could do things that I couldn't do. Like,

I could not go to the DMV to get, like, my freaking registration. That was something. that I just could not do when I was in my addiction. And I was like, all I want is registration and valid insurance and a valid license. And I couldn't do it. You know, like I would make the appointment at the DMV in two weeks. And then two weeks later, I was still drunk, you know, and I would have to make it for another two weeks. Two weeks later, I'm still drunk in bed. So being able to do those little things and be like a normal functioning member of society was so, like, amazing to me. But also the life was just so simple and sweet. And my focus was my little job showing up and then like my recovery and like finding ways to be of service. And that's like the only way that I know to like really

touch that thing inside me because to your point earlier, the shoes, no, the bags, the flying private, like done all that, the houses, the cars. Like I did all that, you know. And nothing brought me any kind of sustainable returns. And I had somebody on last week. week, Dr. Elisa Hallerman. And she was like, all those things have expiration dates. You know, the shoes, what that last two days, maybe, if that, like the relationship, like all of these things have expiration dates. So you have to find something that that sustainably delivers that feeling of fulfillment. And it's hard to your point today. It's really hard. And, you know, I think so many people listening and so much of the feedback that I get from people who listen to the show are like,

I don't even know where to start. This year especially has been like, I would compare this year to those early days when I was newly sober. Because this year, like, after I got divorced, I was kind of like, all right, I need to like figure out who I am again, like, not in this relationship. And it's been fun. And I am finding things that like that I love and things outside of work and exploring my identity. That's what I'm working on in therapy right now. Like, what is my identity outside of like my job and a relationship and all of that? but it's hard. It's really hard. I know. I mean, is it going to stop you, though, from still buying

nice things? No. You know, the best part is, I feel like if I'm doing both, if I'm like working, if I'm doing my ways of being of service and getting that like fulfillment, maybe helping other women who are like wanting to get sober, whatever, like that really lights me up. If I have balance, if I am, you know, pouring myself into my relationships, doing things. that I love and buying the stuff, then I can enjoy it. And I also don't have expectations. Like, I fully know, even if I'm in one of those weird spots where I'm like, I just need to go to Neiman's and like spend some fucking money. Like, I don't even care what I buy. Like, I know it's not going to really move the needle at all, you know? And then I think when there's no expectation attached to it,

then I can enjoy it. Like, I bought a new house. Like, I am enjoying that. I'm enjoying the process, you know? And that was like a goal of mine. So, In that way, like, it's not to say that you can't get any enjoyment out of anything, but I just think that, like, to expect that it's really going to move the needle and, like, how you feel or how you feel about yourself or any of that, that's where we get into trouble. Yeah, I agree. But it, and it goes back to my point earlier of, like, those pleasurable activities will still release. They'll still work on your opioid receptors. They will still be working on that opioid pathway where you're not.

you feel that euphoria, but you're just not constantly chasing it anymore. It's the dopamine has dampened. The chase run, run, run, run, run. I have to get to that euphoria. I have to get to that opioid release is not as prominent and it's not driving every little damn thing that you do. And it's not creating that vicious cycle of addiction. So yeah, it makes complete sense. I always start my day with protein. I have spoken so much about how big of a game changer it's been in terms of my health because it really has a downstream effect when I'm starting my day, just going straight to the macha, suddenly my cortisol is spiked, my blood sugar is spiked, and that sets me on a roller coaster all day.

My other hormones are all over the place. So eating protein first thing in the morning has been amazing for me. That said, I recently found out that the majority of protein powders out there which is what I have in the morning in my oats or my yogurt, have a lot of contaminants in them, which is why I made the switch to Puri. So in the recent 2024, 2025 protein category study by the Clean Label Project, where over 160 products from over 70 brands representing 83% of the market were tested, Puri was the only brand that was Clean Label Project certified and had the Clean Label Project Transparency Certificate. So it is free from things like heavy metals and pesticides and other contaminants. In fact, every batch is tested by the Clean Label Project for more than 200 different contaminants. What is in the protein powder is 21 grams of minimally processed clean, high quality weigh protein from pasture raised cows milk. There's no hormones, no GMOs, and no pesticides. It also has 5.8 grams of branched chain amino acids and 2.4 grams.

of lucine. I personally love the PW1 bourbon vanilla. So it has real vanilla seeds from bourbon vanilla from Madagascar, which is known for its high quality and amazing taste. They also have PW1 dark chocolate, which has dark chocolate from raw organic cacao powder. So both are absolutely delicious and also really, really good for you. So add periods PW1 to your routine now. I have an amazing deal for you right now. You can get 20% off or if you choose the already discounted subscription, you get almost a third off the price. This is only available when you visit my exclusive URL, which is puri.com slash blonde and use my promo code blonde. Or you can save 20% off when you make a one-time purchase still such a great savings. That's P-U-O-R-I-com

slash blonde and use the promo code blonde. Again, puri.com. slash blonde. I truly believe that financial wellness is a huge part of overall wellness, but it's really hard to achieve financial wellness if we don't know where our money is going, which is why I have started using YNAB this year, and it has been a total game changer for me and for so many others. So YNAB spelled YNAB is a life-changing app that helps you do what you want with the money that you have. All you have to do is create a flexible plan for your money through the simple practice of giving every dollar a job, keeping you focused on the life that you want. So you can cover your rent, you can build an emergency fund, you can decide where you're allocating your money without

sacrificing dinners with friends, that long-awaited trip, or that pair of shoes. With Wynab, you stop wondering where your money goes and start deciding where it will take you. I have to tell you, When I started using Wynab, it was incredibly illuminating to me to see where all of my money is actually going. And now it's something that I really enjoy. I check my app daily to see where I can allocate and really have a clear visual and a clear idea of what I'm spending, where it's going, what I'm making, all of that. So I love that Wynab is not a budget. It's a spendfulness plan. so it will really help improve your relationship with money.

92% of users report feeling less money stress since using Wynab and the average user saves nearly $600 in their first month and $6,000 in their first year. Life is short, spend it well with Wynab. Listeners of Well can claim an exclusive three-month free trial with no credit card required at www.w.w.w.wynab.com slash well. That's y'nab.com slash well. I have been sharing a lot about my current health challenges and sensitivities in the last few months. And I have been really surprised at how many people are experiencing the same thing on some level or another. And I really think that a lot of it has to do with our exposure to harmful chemicals in our environments,

things that are really overwhelming our systems. Our bodies aren't designed to be living in these types of environments with the, types of ingredients day in, day out. And we all have different thresholds, but I think that a lot of people have kind of reached their max. So I'm really trying to clean up every area of my life that I can, including things like cleaning products, laundry products. These are things that we expose ourselves to so much, and oftentimes we overlook them. So I have recently switched to Molly's Suds, and I absolutely love it. They offer powerful laundry detergents and household cleaners made with simple, safer, earth and planet-derived active cleaning ingredients. They're also

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How are some sustainable ways that people can approach weight loss or moderation without using GLP ones? Yeah. There are still many people out there that have huge success stories that lose weight without needing medication. At the end of the day, and this is the way that GLP, one's work is it's calories in versus calories out. They reduce the amount of calories that you take in. So if you are one of those people who I don't know what impetus it was, like for some overweight

or obese person that actually set off a fire under them that created this newfound motivation to do the work, which is extremely hard to do. And there is so much gas lighting. that goes into losing weight because you'll have someone who doesn't believe in GLP once, you will say, listen, you just have to get off your ass, exercise, and start eating less. That's a lot easier said than done. That is the hardest thing to do when your genetics are driving obesity, when you've been obese all your life, or when you just are depressed because of the way that you look, it's very, very difficult to get out of that.

But if you can, and there's some fire that you've got, start small. One small thing. I don't think people realize that it's like some really small steps you can take to start losing weight. And then that encourages you. That makes you feel good about the process. And then you keep on going with the weight loss, right? And that small amount of weight loss, even five to 10 pounds can make someone feel so much better so that they start exercising. Right.

So it's like one thing. Stop putting five teaspoons of sugar in your coffee every morning. And people, when I tell them that, I'm shocked that some people are still doing that. like, wait, you really do that? And they're like, yeah, I have a full on, like, I dump the sugar in my coffee in the morning. And I'm like, oh my God, I haven't done that in like years. That's such a treat for me. Or stop buying soda. You don't need to drink Pepsi. You don't need to drink juice. Right? These are like extra calories that you just don't need. So it's calories and verse calories out. If you can find some small steps to do that and you can actually achieve it that way, kudos,

wonderful, good for you. I bow down. That is the hardest thing. in the world to do, especially if you've been overweight all your life. But if you cannot, and you're struggling and you're being gaslit by people telling you to do these things, and you just can't do it, then start a medication. It helps you. These GLP ones are here to save lives. They don't increase the risk of cancers. There's a huge Scandinavian study that just studied 145,000 people and did not show an increased risk of thyroid cancer like we once thought. That was only seen in rats, actually, obesity increases the risk of various cancers, including thyroid cancer, breast cancer, colon cancer, liver cancer, kidney cancer, and many others. So these medications and

weight loss will increase your health, increase your longevity, increase your brain health, as I talked about now. We know it's neuroprotective, anti-inflammatory for your brain, the GLP ones, and sustain you and potentially help you to have increased self-confidence. The other thing that I didn't mention as part of that one study, Ozempic in the brain, Zempic actually also was shown to not have an increased risk of suicidality and not have any negative psych outcomes like we've been thinking like maybe cause depression and anxiety. So it's great. Are there some negative side effects? Yeah. As I told you, I tried it one week and I felt like, oh my God, I was super nauseated that first time. Like I didn't need it. I did it as an experiment.

Okay. Don't judge me, people. I wanted to know what my patients feel like. I did it for one week. I felt really nauseated the first two days. And then after each injection, yeah, there's some weird noises. After each injection, your body gets used to it. You feel better and better. And people do really, really well. The risk of side effects are incredibly low. What is your body's weight set point? Mine? No, like in general. That's a very personal question. Hard pivot. The body's weight set point. So there is this idea that the brain, that the brain, and body want our bodies to be in this one set point. Like I have many, many patients who have struggled at some point in their life. So most of the time they'll actually tell me, hey, I've been skinny on my life.

And then when you really dig, you'll look back and like at some point in childhood, they struggled a little bit. They were a little bit on the higher end of that growth curve, right? But at some point, especially classic case, I have a patient that's like in perimenopause, their hormones are changing, and now their weight set point for some reason has changed. And they just cannot get that extra 10 to 15 pounds off no matter what they do. And their weight set point has changed from like 130 to 150. And it makes them miserable.

They're like, what can I do? So this weight set point phenomenon sucks. It's really, really frustrating for people because they exercise, exercise, they try to eat less. And the weight just doesn't come off because of that. we think that maybe it's the hypothalamus a part of the brain that's involved we think it could be just your hormones we're not sure exactly what it is but it's a brain body connection that's causing your weight to stay at one place and i will say that the patients will always tell me doc i cannot eat any less i cannot eat any less it cannot be a calorie deficit thing i put them on the medication and they

go into a calorie deficit and they lose the weight and their weight set point changes so the weight set point thing is real, but calorie deficit is always going to win. It's always going to help to lose that extra weight that people are just really struggling with and can't get off. And oftentimes people think that they're in a calorie deficit, but they're not. So what are some common contributors to maybe not being in a deficit that people don't necessarily think of? I know one obviously is like scooping from the almond butter jar and like the handful of nuts. Like, is it really the handful or is it, are you, are you eating 2,000 calories of nuts? So I'll tell you one thing that I really hate is like people who are extreme about diets.

You've got, and this is so frustrating to me, it's so frustrating to everyone. There are crazy people on the internet that say that you have to not eat this like one category of food. I think the lectin theory of food is total bullshit. Don't think it's founded. And actually we have evidence to suggest that it's not. then you've got people saying don't ever eat fruit because it's going to make you gain weight. Don't ever eat nuts because it has too many calories. It's going to make you gain weight.

So I hate the villainizing of food because whole foods, if they're truly whole foods, are healthy for you. Fruits, vegetables, nuts, these are all good for you. And honestly, like, even bad foods, okay, once in a while in moderation are fine. But what it comes down to is any food that you eat in excess of calories is just going to make you gain weight. If you have too much fruit, you may gain weight. If you have too many nuts, you may gain weight. If you have too many vegetables, too much broccoli can make you gain weight, right? Like anything can make you gain weight if it's eaten in excess.

So don't villainize food, but calorie deficits are real. So too much of anything will cause weight gain. So some of the most common foods that people just will shovel into their mouth. And they're healthy foods in moderation, right? But they're just a really dense source of calories. fruit is a huge one. Okay. Like, fruit is good for you. It's healthy. Eat your fruit, but don't eat too much. Five apples in one setting or five bananas are they're going to make you gain weight. I remember so, oh my God, I hope they don't listen to this. But my husband's family, they are just like,

they have this unhealthy relationship with food. Okay. And I remember one time, oh my God, I'm going to get in so much trouble. But one time I went over to my brother-in-law's house and he had all of these foods from Costco that he had bought and put on his counter and he was like, I'm on a diet now. I'm eating all these really healthy foods. And it was like, okay, fine. Sure, they're great if you eat them in moderation, but it was like bags of dried fruit, especially and like other sorts of dried snacks. I love dried fruit. I love them too. They're so yummy and I have them all the time. But like they bought these Costco sizes and I highly doubt that in that house, that bag lasted more three days. Like there's no way. So they were eating, they're eating healthy things that should be

eating sparingly in excess. And that's going to make you gain weights, too many calories. So it's just like anything that you even think could be healthy if eaten in excess is going to make you gain weight. Calorie deficits work. I mean, there have to be people who are like, I'm in my fitness pal. I'm weighing my food. I know exactly what I'm putting in my body. And yet I cannot lose weight. Does that factor into something like PCOS? Oh, yeah. Like insulin resistance. 100%.

There are some, absolutely, they're rare, right? But even PCOS patients do incredibly well on GLP ones. They lose weight. Hormonally too, right? Hormonally, their fertility increases. And the PCOS symptoms decrease their heirsutism, the facial hair, that truncle obesity really responds well to GLP ones. But absolutely there are hormonal contributions.

And so I do have some patients where they are just not responding. And I tell them, listen, it's time to get you into see an endocrinologist. We need to do a full hormone panel. We need to check. Obviously, thyroid is like the biggest one. We need to make sure that your thyroid levels are balanced and that you're not having especially hypothyroidism. Excess cortisol states. Sometimes some rare tumors can be hormone secreting and cause problems with excess weight.

And then there are some rare causes of obesity that actually don't respond to GLP ones. They're super, super, super rare. But sometimes they do exist and there are things that should be looked into for sure. What about things like berberine, quote unquote, nature's ozempic? Yeah. What is the validity? Yeah. I mean, I've never seen like a double blinded placebo controlled study.

And in all fairness, we're not going to, right? Like supplements kind of, it sucks. Like, first of all, I think that they're over promoted. Okay. But also, some supplements do work, but we're never going to get. get good studies from them because there's not a pharmaceutical company backing the study. Okay? Like we have these huge companies backing these studies from Ferozempic and Monjaro.

So they get the good studies. We see the safety data behind them because they have pharma money behind them. That's the honest truth. Burberene, I've seen people try and I actually haven't seen much success, to be quite honest. Like I'll tell my patients, listen, if you use it as an adjunct and you think it's helping, you may be it's placebo. I don't know what it is. Great. But I also think people take too many supplements. I actually promote a supplement myself. It's magnesium L3 and 8, but I tell everyone, if you're not sleeping well, eating well, and exercising, don't waste time on anything that I promote that's a supplement or that

anyone else does because it's a waste of money and they're expensive. Right? Like I love magnesium L3 and8. It's the only form of mag that crosses the blood brain barrier and actually helps with cognition and it gets into the brain. right? It's patented for that for that permeability, which is amazing. But truly, don't waste your time if you're not living healthy. Don't buy it. It's expensive. And unless you're a huge, huge, huge supplement company, you're not even making that much money on it, which I'm not. So I believe in it. It's great. But don't buy it if you're not doing the foundational things. Yeah, it should be like a cherry on top, not the entire Sunday. That's exactly right. I love three and eight, by the way. Right. Love it. Yes. I know. So I feel justified now. Yes. Oh, I take three capsules every night, even through pregnancy.

Really? It's so great. And ever since I started taking it, I have my husband on it too. It helps sleep, cognition, focus. It's helped me so much. Which brand do you use? I use symbiotica. Yeah.

It's like my bedtime dessert. That's partially why I love it. Yeah. Because it has that, I don't even know what it is. They use coconut nectar or something. So it's like a little bit sweet almond oil. Yeah. Right.

And it's just like, I don't know. I don't know. I used to have such a crazy sweet tooth where like I had to have something sweet after dinner and I had to have it right before bed. I would eat at like 10.30 like a yogurt bowl with all this stuff in it. And then some reason, beginning of last year, like that just kind of went away. But I still like just a little something. And for whatever reason, that. And then I also like the symbiotica sleep. It's like a cacao liposomal thing. It's like I don't even know what's in it. But I have those too. And I'm like, no one's going to buy mine. I'm sorry.

Damn. No, no, no. As I said, like, I truly don't make that much money. It's the profit margin is so small. I really just branded mine because I believe in it. And I don't want to brand anything else because there's nothing else that I found that, like, I really believe in. I do like this myatica one, too. The only reason I didn't continue using that one is because it was breaking my fast.

And I was fasting. Okay. Yeah. And I was like on this card for fast thing. But whatever. Their stuff is great. I actually, the owner's amazing. She lives in San Diego, Durana. Yeah, I love her. You met her? Yeah, she came on. She's awesome. She's they're so smart. Yeah. They're doing incredibly well. No, I know. Yeah, they're doing incredibly well. Yeah. They don't need my

endorsement. Yeah. They're great. Mine either. I don't think. What about vitamin D? I know that you've talked about this before. Yeah, vitamin D is so important. We're all low. Everyone's low in vitamin D. And you've got all these crazy people saying go walk in the sun for an hour and get your vitamin D. But the problem is that like it, your skin. I don't know. I'm really, really paranoid about my skin. I wear tons of sunblock, because I believe in sunblock. It works. But I also like, I wear a visor because I usually use retinol out of the, when I'm not pregnant. I use retinol and vitamin C. And then if I'm in the sun, even with sunblock, I can hyperpigment. Right. So like, I don't want to get my vitamin D from the sun. It is good to be in the sun. It's good for you. But I choose to get my vitamin D from a

supplement and I take 4,000 to 5,000 I use every day to keep my level just within the normal range. And this is a problem. It's like as a neurologist, I've seen a lot of multiple sclerosis patients. Vitamin D3 is neuroprotective to our myelin sheath. And we actually check our vitamin D3 levels in most of our MS patients and want their levels to be between 60 and 100, 60 to 90, 60 to 100. And the normal range in a lab is like 30 to 60 or 30 to 80. but it's above 30. So we want our levels to be higher. So we know it's neuroprotective, immunoprotective, helpful in hormone health. Vitamin D3 is an amazing and underrated supplement. Yeah, firm believer in vitamin D3. It's incredible. With K2 or on its own? I take mine without K2.

Okay. Do you do yours with K2? No, no. But I have some, like, because I am given so many supplements. Yeah. And I know the D3 K2 combo is a big thing. But the one that I, I take is, I want to say designs for health and it's just regular vitamin D. I just take the regular, regular old vitamin D3. Anything that we should all be doing when it comes to our weight, if we're not on GLP ones. Yeah, exercise and whole food. Like, it's simple, right? If you're not on a GLP one, we should be moving.

Weight, resistance training is big. But so is cardio. Like, I feel like we're all talking about resistance, resistance, resistance. cardio is still really, really good for our brains and our hearts. So a combination of both is awesome. And whole foods, just stick to whole foods, eliminate alcohol as much as you can, live a balanced life. You know, I know you're in a different category. You don't drink at all. But like if you are out right and it's like once a month, twice a month and you want to have a cocktail or two, have a cocktail or two. Don't deprive yourself of something. If you're not in that special category, like have a cocktail. Enjoy it. Fine. move on. If you're out and you want to enjoy that meal and have that dessert after, enjoy it. Don't feel guilty about it. Live a balanced life. Be normal. But in your day to day, have a routine, try to restrict your calories and focus on whole foods. It's easy. You don't have to be extreme. You don't have to be weird. Like you don't have to follow some crazy diet. It's just restricted calories. If you're trying to lose weight or

maintain your weight, keep it in that, in that calorie range that you're supposed to be at for your height and goal weight, and move. That's it. Simple. Amazing. Everything in moderation, including moderation. That's what I'm thinking. It's like this quote that I heard, and I feel like that kind of aligns with everything that you're saying. I love it too. Don't be weird. Don't be weird. Medical advice. Don't be weird. Seriously. There's so many weird people out there. They're extremists. I hate it. Well, we're in this era of extremism, too, where it's like, that's what gets engagement. Engagement.

How weird can you get? Yeah. Nobody wants someone saying, just be normal. Do you think you're supposed to do to be balanced? But it's the truth. That's, it's the honest truth. It's science. It's the science.

We believe in science. I love it. Tell everybody where they can find you. On my handles, Dr. Brain S.D is my personal slash business. And then I've got my weight loss only GLP1 account, which is Dr. Brain. RX. But if you're looking to sign up for a GLP1, Dr.BrainRX.com, is where you can find a sign up for a quick consult, talk to our team, and we'll get you set up if you're an appropriate candidate. Thank you. Thank you. I hope you enjoyed that episode. If you liked the episode,

and if you liked the show in general, please take a second to rate, review, and subscribe. It goes such a long way in supporting the show. Follow the show over on Instagram at well.com. You can also follow my personal Instagram at Ariel Laurie. I'm always sharing great clips from the episodes. And we also have full episodes on YouTube as well if you want to watch in entirety. Thanks for listening. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.