Weight Loss and Willpower: The Science of Metabolic Health and GLP-1s with Dr. Alexandra Sowa
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What's really outdated is this concept of energy in, energy out. It really doesn't work for the majority of people thinking about health or weight loss. This is Smart People Podcast. A podcast for smart people, where we talk to smart people, but not necessarily done by smart people. Hello and welcome to Smart People Podcast, conversations that satisfy your curious mind. Chris Tempier, thank you for tuning in.

Happy 2025. Hope your new year's off to a good start. I will say here at the podcast, ours is not off to the best start because we kind of entirely kind of skipped an episode. I mean, look, the holidays are fun, but busy and life is getting crazy. But if you go back and look in our history, I don't think we've missed an episode launch day in like, I don't know, seven years might've made that up, but

Anyways, apologies. Hope you still have us. Hope you still find us because we have a good one for you. Especially as many of us think about the year ahead and goals for ourselves, one of the most common is to get healthy, get in shape. Often it's lose weight. And many people today are choosing the magic pill or shot, if you will. That is Ozempic or really it's GLP-1's

in general. And so I wanted to talk to an expert on these. In addition, I myself, although not interested in GLP-1s, am interested in metabolic health slash metabolic dysfunction. And that is where we spend a lot of time, the first half of the show, actually.

which is really the nuts and bolts of how do we metabolize food and turn it into energy? What are some of the common misconceptions that we're all living by? What are some tips on how to make sure we are metabolically healthy? Because as you're going to hear, less than 20% of people actually qualify as metabolically fit or healthy.

I know it's crazy. And you'll hear our guests as we talk about that. That means that most of us listening fall into that camp, despite if you're not overweight or if you do exercise, there's different panels, different tests, different things that really help us understand how our bodies process food and the likelihood that we maintain that

that health into the future. So in this episode, you will understand not only some key components to GLP-1's ozempic, what it is, should you take it, but you'll also learn about metabolic health and how to lose weight if you so choose.

Our guest this week is Dr. Alexandra Soa. She's a trailblazer in obesity medicine. She has two certifications in internal medicine and obesity medicine, along with her role as a clinical instructor at NYU School of Medicine. For over a decade, she has been an obesity specialist. And so she really has this nuanced view of it all. You know, this isn't just a

a doctor who decided to jump on the GLP-1 bandwagon. In fact, this is somebody who for years has been searching for different ways to help her patients get to and maintain a healthy weight, healthy lifestyle, healthy body.

She's the author of the brand new book, literally came out a week ago as of today, The Ozempic Revolution, A Doctor's Proven Plan for Success to Help You Reverse Obesity, End Yo-Yo Dieting, and Protect Yourself from Disease. Can't wait to get into it. Listen, with the new year, as always, we are continuing to do things. So you've probably noticed my supplemental episodes, which I think I'm going to continue. We are also doing newsletter takeaways.

So it's a really important sign up. So you get those. That is all we're sending out is kind of those key takeaways and thoughts from the episode in newsletter form. Go to smart people, podcast.com, scroll down to the bottom, sign up for the newsletter. We don't sell it. I wouldn't even know how to sell your email address. Okay. I wouldn't know how to give it away to somebody or spam it out. All right. That's not the point. Make sure you follow the pod everywhere you listen.

Feel free to reach out to smartpeoplepodcast at gmail.com. Let's get into it. Our interview with Dr. Alexandra Soa about her brand new book, The Ozempic Revolution. Enjoy.

Your book titled The Ozempic Revolution, and obviously it is predominantly focused on GLP-1s. For those who are not overweight or obese, should they even listen to this episode or potentially read the book? I mean, yes to both. And here's why. So yes, I wrote the book.

Generally, for the person who is contemplating going on these medications is on these medications. But really, it is for anybody who knows somebody. And everybody out there knows somebody on these drugs, struggling with the concept of being on the drugs, thinking about their weight in terms of their health.

And what I do in this book is we walk through the science of weight gain in a way that I think is very digestible. And we talk about the life tools and, uh,

the elements of healthy long-term weight loss in a way that's very adaptable for anyone even thinking like, Hmm, I want to better understand my sister, my mom, my friend's journey. And actually I would really like to stay in the place of prevention of the disease of obesity, which seems to be all consuming in the world around us. And this book offers a lot of very actionable, uh,

that you can employ. So while this is for people, like on the surface, it's for people on these medications or considering them, I really think it's for anyone who lives in the modern world. Yeah.

And if you have not heard about Ozempic, maybe you just want to move on because I'm not sure what rock you're living under. But if you've heard about it, have questions, then the episode's for you and the book is for you. From my stance and why I was interested in it, the topic of metabolic health versus metabolic dysfunction is something I've become increasingly interested in because I

you know, I heard this definition about metabolism or metabolic health is basically how we turn food into energy and then like live. And I thought, okay, that's,

Different from the way we talk about food all the time, which is just like, don't eat this, do eat that. I think it's this idea of how do we internally process what goes in our body and turn it into energy to function? Totally. So what's really outdated is this concept of energy in, energy out.

It really doesn't work for the majority of people thinking about health or weight loss. It has some foundation for maintenance and for prevention. But the problem is, is that a lot of the calories in our modern society are ultra processed foods, and they've corrupted the way that we process food for energy. And herein lies kind of this question of metabolic health. And

The majority of people who come to me as an obesity and metabolic health doctor are doing most things right by the book. And they're like, I'm not eating very much and I just keep gaining weight. I'm going to the gym and I just keep gaining weight. Well, so what's happened and what's,

In the majority of time, I can find something on labs that shows me that they are not in optimal metabolic health. And so when you lose your metabolic health, you become metabolically dysfunctional. That is where weight starts piling on. And this like five pounds a year concept, we used to think it was just kind of like laziness. But really, those five pounds a year that start coming on, it might be a sign that your body is not functioning.

operating at the highest form of metabolic health and we need to do something about it before five pounds turns into 50. You emphatically talk about obesity or gaining weight is really not an issue of willpower. And I believe that, but I don't know how much of it is lifestyle choices versus let's call it genetics.

As an example, I am almost the exact same weight as when I graduated college. Almost. Maybe like five pounds more.

But the majority of people that I went to college with have put on probably 20 percent, 30 percent. So I'm curious, like what choices were happening or is that just aging process? It's all of the above. So in medicine and in life, multiple truths can be true. Right.

And so weight is something that has a genetic component. It most definitely has a lifestyle component and a behavior component. We, I am not discounting that. Um, but what's tended to

And what tended to happen is something very dramatic happened since 1980 in this country and around the world where we had people of different bodies throughout history, right? Some people carried more weight, some people carried less. But as a population whole, we were generally pretty lean.

And then something happened around 1980, right? You can see it on the pictures on a beach. Yeah, we all know that picture. It's very dramatic. So what happened in 1980 that led them about 50% of our population is approaching obesity. 88% of our population is metabolically unwell. Only 12% of American adults meet all the criteria for metabolic health.

That's insane. So what happened around that time? And I talk about this in the book, actually. There are elements of your life that have allowed you to stay leaner potentially than your counterparts, right? You already told me that you were an athlete growing up, like really building up muscle mass, right?

healthy habits of eating. And then I would ask you if you're willing to share your parents, anyone around you, did they maintain leanness into adulthood? They did. And that's what the genetic component I got to understand. I mean, my dad has eight siblings and I'm about to go spend time with 40 something cousins. We just got lucky. I know that for a fact. Right. But there are probably

probably some things that you've done and also your parents did them and then they taught you to do them too, right? So behavior and maybe how you ate growing up in your house, that was important and less ultra processed foods. And now you've adapted that into adulthood, right? But I really appreciate you actually saying we got lucky because I do think that there is a genetic component that is a little bit like winning the lottery sometimes.

sometimes here. And what I do see on social media is often people are like, well, I work hard at it. Well, it might be actually easy for you to work hard at it because your baseline is here and you're maintaining your health. And when you maintain leanness, it is easier to kind of do all of the things that you know you need to do, like go

Go to the gym, eat three square meals, sleep well, right? It's what happens when this is like domino effect of weight starts coming on, you feel fatigued. And then actually by processes of biologic hormonal imbalance, neurohormonal dysregulation, you start to become hungrier even as you're gaining weight.

And then you become even more sluggish. And then your sleep starts to become impacted and your stress. And it just becomes this place where you can't like even get over the hump to do the things that you knew you should be doing, if that makes any sense. And that's where this revolution of GLP-1 medications has been so incredibly effective. The most effective medical tool that we've had to help people manage their weight is

stop the cascade of health problems that come with weight in their tracks, reverse disease. And it gives people back the ability to say, okay, I now have time and space in my life to get back to the basics and to start to change my environment, my behaviors, and kind of tip the balance more in the things that I can do. But when the weight's coming on, it becomes very, very, very hard. As anyone who's listening knows, it's like,

Of course, you know when you're gaining weight. Of course, you know when you need to lose weight and you try. But then the next day you revert back to old habits because it's this insurmountable feat. Head to Whole Foods Market to jumpstart your January during our New Year boosting event with savings on feel-good favorites storewide. Save on organic picks, wellness staples, and more all month long.

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Yeah. And if you're listening, cause you want to know the ins and outs of JLP ones, I promise we'll get there in the table with some, some other things actually. And that, that reminds me of a question I've had for a long time, which is, is there any truth to the fact, like if you gain, let's say you gain 10, 15 pounds over time, nothing extreme.

Does that now become like a new body baseline? Because one thing I have found is that if I put on, let's say five, like getting back to that previous one, I now feel more hungry constantly. You know what I'm saying? So like, do you reset a hunger level or a calorie necessity level that you then have to break internally? Yes. It's a little, it's complex, but yeah.

As we gain weight, as we age, our calorie needs technically go down generally, especially as we put on fat and not muscle in terms of that five pounds, 10 pounds. And the symptom of putting on the weight might actually indicate that there is some neuro hormonal dysregulation. So the main one that I talk about is insulin resistance. So insulin resistance is when our body is,

stops receiving a signal of insulin from the pancreas in an effective way and it needs your body to make more insulin, which in theory sounds good. But the problem with that is then you get this slightly elevated blood sugar while you wait for your insulin to be pumped out of your pancreas to grab the glucose to then go off to your body.

And that slightly elevated blood sugar and that slightly elevated rising insulin, it's just going to keep rising. And that makes you hungry and it makes you fat. Insulin is a fat storage hormone and it's a hunger hormone. So it's not in your head when you're putting on weight and you're like, oh my gosh, I can't stop eating. Sometimes...

And actually, in the majority of cases that I find, I'll find something like early insulin resistance. And this is before we find type 2 diabetes or even pre-diabetes. But there is an imbalance in the way that your body is taking in food, how it's receiving it, and how your body is processing it. Instead of taking in energy that your body is able to burn efficiently, you know,

and you're wanting to get out and burn this food and your body knows what to do with it, it's just taking it and storing it over as fat because that's what your body is being signaled. We, in essence, are animals and we really weren't built to live in a society that has ultra processed food and constant food signals. And it's just doing its best to try to keep up. But once that metabolic health

tips over and you're no longer fully metabolically healthy, it adds to the problem of excess weight and a whole host of other diseases that come with it. But that hunger piece you were asking me, it's rooted in hormones. And I can often find it. I'll test people for fasting insulin in the morning.

We'll calculate something called a HOMA-IR score. And I can find HOMA-IR is a great tool. It's an early predictor of insulin resistance that is not widespread. It's not used in medicine often. We tend to wait for the disease state in medicine before we do anything. So people will just screen for hemoglobin A1C, which is an average blood sugar marker over three months. And people will say, well, you're fine.

this is how I was taught. Not that long ago. Wonderful, wonderful medical institution. And like, well, your patient doesn't have diabetes yet. And I'd be like,

Wait, no, wait, I can see it coming. Right. And so the earlier that we can find that your body is not processing, we can change the quality of foods we're eating, the type of foods, the macronutrients, and we can get ahead of it. And so there's just a lot more education that needs to be done at the level of the medical field and then at the level of the patient so that when they they're kind of like,

Let's let's be precise about these labs. Let's understand my family history, my needs, what's going into it. I think for so long when when someone would come to the doctor's office and they step on the scale and they say, you've gained five pounds since last year. Just just work harder. You know, yeah. Stop eating that cookie. And that person will walk away being like, I'm not eating cookies. I don't need cookies. What are you talking about? Right. You know, and but there are probably other things that we can target and kind of, you

to reverse that. So I think early prevention and understanding of what's going on is key. That brings me to another thing. You've mentioned a couple of times the idea of the labs you would run. I think you said something like 11% of people considered metabolically fit. Could you tell us what those labs are, what you would recommend if people want to know,

And how that helps us define metabolic health. Yes. So the things that go into metabolic health are, and I'll run through them right now. So

Five elements. So we have a healthy level of HDL, which is good cholesterol, which is cardioprotective cholesterol. Low triglycerides, which is in the cholesterol panel, but often goes kind of ignored because people are like, I don't really know how to interpret that. Well, it represents kind of excess free energy from food. So it's very important. Waist circumference, which waist circumference depends

depends on your goals based on your ethnicity or, uh, and whether you're a man or woman, um, we have healthy levels of blood sugar. So a fasting blood sugar needs to be ideal. And then blood

blood pressure. And it's not just the systolic number that people pay attention to, generally, the top number, it's the bottom number that goes into metabolic health. And I feel very strongly about testing the right labs. I actually feel so strongly about this that in my practice, we launched a company during COVID for at-home metabolic health lab testing.

So my company is called SoWell, and we have an at-home weight biology kit that tests for the markers that look at metabolic health.

One of the things that I do unique in my treatment and management of metabolic health is looking at fasting insulin, which if you go to the majority of doctors in this country and say, please test my fasting insulin, they'll be like, huh, what? We didn't learn about that. But again, that's how in tandem with fasting blood sugar, you can test your fasting insulin, put it into this –

this validated tool called the HOMA IR tool, HOMA insulin resistance score. And you can really understand where you fall kind of in metabolic health. Can I ask you about that real quick? I just, not to cut you off, because this stuff is fascinating, but fasting insulin, that's

That means, is that how much insulin, which is a hormone, is floating around in your bloodstream while fasting? Yes. Okay, okay. So insulin is, just to back up, insulin is produced by the pancreas. It is a necessary hormone.

What happens in the majority of Americans is that over time we become insulin resistant, meaning our body does not receive the signal of insulin. Insulin's job is to scoop up glucose. So if you eat a carbohydrate, it gets broken down into glucose, scoop that up, and then to take it off to your brain, your muscles, all parts of your body to be used. And as we age, genetics

the food we eat, the weight we put on, insulin resistance settles in and your body won't receive the signal of the insulin and glucose unless your body starts making more and more insulin.

So if you go to bed at night and you fast past midnight and you wake up in the morning and your insulin is still at levels that look like you just ate a meal, that's a problem. So all night long, your insulin levels were high. They never had a chance to go down. And that can tell me that your body is just making way too much insulin and that your

It is hanging out and doing problems all throughout the day. So at night when you should be in a fasted state in repair, your body is still like, I got high levels of insulin. I'm not going to let you burn any fat. We're going to store that fat and you're going to wake up. You're going to be so hungry. So it can give us a lot of insights into the things that we are feeling. And I think it's often it helps people like.

unlock and understand and take the burden of responsibility off of them. They just thought they were doing it all wrong. And I'll be like, oh, no, no, no, it's your insulin. Now we have to like

change how we eat, change how we work out and change how we're thinking about this, but it can be a real aha moment for people. Okay. That's really cool. Thank you for that. Sorry, I cut you off. We were, we talked about the five things we're testing for the lab so well and insulin. So, so I just think that there are certain things that when people go to their primary care doctor or their doctor, they'll be like, Oh, I'll

check some labs. There isn't really anything that we can test why you're putting on weight. Well, there are. And we can check for all of these metabolic health factors. So a lipid panel, fasting insulin, fasting glucose, the average blood sugar marker, hemoglobin E1C. I like to check a thyroid. I also really like to look at elements that might be making you feel unwell. So vitamins. So

Um, I will look at vitamin D. I will look at iron levels. I will also look at levels of inflammation. So HSCRP is a cardiac marker, which can tell us how your body's operating. And if it's high, we've got some things going on and it's not a very, um, specific marker, meaning it doesn't really tell us exactly what's happening, but it will tell us that something's off and we need to dig a little bit more. Um,

I also like looking at, that's a great place to, all of those are great places to start. I like looking, especially if we find any element of lipid panels that are off. So the cholesterol markers, I like advanced cholesterol panel testing. So apolipoprotein A and B, they'll tell us much more about what's actually going on with your cholesterol and your heart health than our traditional panel. Although it's a good place to start.

So, you know, there are a lot of things that we can do. One of the other tests that I, and I have not talked about this anywhere in talking about this book, but one of the other things that I do in my clinical practice, especially if history, whatever,

Family history kind of supports it. And then also if we find any element of cholesterol dysfunction, I like ordering a coronary calcium artery CT. So this is a test. I just heard about those. Oh, tell us, tell us, tell us. Yeah, yeah. So it's a test. It's like a little snapshot of your heart and your vessels in your heart.

It's never covered by insurance. Nobody's insurance covers it. But it's not that expensive, I don't think, right? It's really not. In the majority of places in the country, I can get it between $99 and $149. And it can tell us a lot. Now, it can't tell us everything, but what it looks for is calcium buildup, plaque buildup in your arteries. And if we have any present, well, then we have to talk about...

secondary prevention treatment. Like we might have to talk about starting a statin. And if you don't have any buildup and yet your cholesterol markers are on the higher side and, you know, when I dig deeper into your cholesterol markers, it still shows kind of healthy levels. Well, then we really take the path of prevention through nutrition and exercise and weight loss to kind of keep everything healthy and there. But it's a good, it's a good investigation

Gator. Like it's, it's a good thing to be like, okay, I'm thinking deeper. I'm not just on the surface here waiting for the disease to start. Um, so I really like that tool too. Yeah. I heard about that one. I got excited and I actually, I'm glad you brought it up because I forgot the name, but I want to do it just because I love this stuff, but it's, I forget it was a podcast or something. It was like 140 bucks, get to see how the pipes look. And I was like,

Yeah. Sometimes they call it CAC for short. Okay. There you go. Score. Yeah. So that's awesome. One other thing you mentioned cholesterol a couple of times, and I don't know where you stand on this because I cannot get it straight. I cannot get cholesterol straight. Like I,

We have chickens. We really like eggs in this household. So jealous. Right? Mom won't let me have them. Yes. One of the reasons we moved here, by the way. But five months in a row, I'll read things. Oh, yeah. Eggs are great. I know cholesterol is in them, but blah, blah, blah. And then I'll see something that's like, just kidding. It's going to kill you. Dietary cholesterol is the worst. Do we actually know? Like, what is the truth here? The truth is...

eat your eggs. Okay. So dietary cholesterol is not the kind of cholesterol we're talking about when we talk, when we test your labs for cholesterol. Now,

The caveat to that is that there is a subsection of people that are dietary cholesterol responders. It's very, very low in the majority of people. The benefits of eating whole foods like eggs and chickens and eating protein far, far, far outweigh any sort of risk. If you have a strong family history of familial hyperlipidemia, which is a disease, that your doctor might...

Have you watched some of your cholesterol intake, but please eat all the eggs. They are healthy. And even the cardiology associations are on board with this now. Oh, wow. I will tell you, there was some shady, shady studies that went on, and it was called the Heart Health Hypothesis, where it's been debunked, where

industry was supporting studies that said, oh, you should really you should really avoid all the whole the like the meat and the eggs and you should eat our processed food. Yeah. Processed grains. Wow. Is that where a lot of the misinformation I think came from? Because there's this revolution happening to an extent about meat and about eggs and avocados where people are like you

saying literally the healthiest meal is steak, eggs, and avocado. And that's just, now I'm all confused, but it sounds like, and it makes sense. Of course, everything within moderation, but for the most part, those are all whole foods there. Whole foods. Really, the best thing you can ever do is to walk around and shop at the periphery of the grocery store and to really minimize anything that's processed.

The way we have a problem in the United States of how we've allowed processed foods to exist, it's very different. Just yesterday, my husband went to the grocery store and we ate pork chops for dinner. So pork chops, right? People were like, I can't believe you as an obesity medicine doctor ate pork chops. Well, we did. You know, that's a rare treat, but we did it.

And he wanted to get applesauce for the kids. And I was so proud because he said there were two applesauces on the shelf. One was from Germany and one was American made. I won't mention the name, but he's like, I turned it over. And the American one had high fructose corn syrup in it.

Now, applesauce, if anyone's ever made homemade applesauce, you do not. I know. It's sweet enough. I know. You don't need anything. So the German jar that he brought back had just apples. It was just pureed apples. And it was delicious and sweet. And I'm thinking, why would they have ever put high fructose corn syrup? And it's the one we all know, by the way. It's the applesauce we all know. Oh, I'm sure. So we just have a problem here. So listen, I am a mom of four kids. There is only so much fruit.

that you can do at home. And I understand that convenience foods can be helpful, but still like flip it over because you can choose convenience foods that are better for you. So yeah, whole foods,

If you read the book, my program is really centered around protein. So in order to thrive well on GLP-1 medications and really to build muscle and to maintain weight loss, protein is king. And it is whether you're on these medications or not. And I take care of patients who are vegetarian, but it is the most helpful if you're able to eat some animal sources, protein.

like eggs, or if you'll be pescatarian and eat fish. But I am a fan of meat, but we also need to balance it out. So I don't really want to hear that you're just pure carnivore. That's tough. Your gut really does benefit from fiber. You as a person will feel better with fiber generally, right? And grains are not the enemy, but...

But seeing how you respond to specific grains and really favoring grains that need a little bit more cooking time, they tend to do a lot better for glycemic control. And in terms of weight and metabolic health, they're better for you. What's an example of like a grain or two that you're referring to? So like a quinoa or I'll use legumes and beans, but like they need a longer cooking time, um,

You know, rice is okay too. Rice is not the enemy. We, you know, but you kind of need to see how you respond to specific things. I think pastas in this country get really processed. People will always say, I went to Europe and I ate all the pasta and I came back losing weight. Well, there are a few reasons for that. One, European cities are made for walking, right? Not like ours. And the majority of us just drive in our cars.

And the food, the pastas are generally fresher and made with no preservatives. And so, you know, be discerning.

And that's just kind of like, look at the labels, man. I'm looking at the time. I'm like, I have so many questions. Okay. Kind of some rapid fire. Cause I want to get into LP ones. I just can't help it. You mentioned you have four kids. I have three. A lot of people listening, have kids, me and my wife, like we're, we're pretty insane about food, but not in a weird way. Like we all the foods. Yeah.

But we're just aware. And it's a struggle because my kids, it's all boys. Two of them are super active, young. They just are getting in that stage where all they want to do is eat. And I can't give them like salmon and steak and avocados all the time. What can we, what do you do when you're like, I need to cheat a little? That's a good question. How do I feed my family? Yeah, we eat everything in my family too. Um,

I think the cheat things on the go are great. Like cheese sticks for the kids trail mix, right? There's nothing wrong with nuts, dried fruit. They love that. And like gives them a boost before all their games. Yeah. And, but I will tell you that my philosophy, even in treating adults and then raising my kids is that we really need to eat meals. And I think so often as a society, we're like hyper-focused on snacking and

And I saw this, you know, raising my boys in New York City, you would just walk around and all the kids were sitting in the stroller with these like, like applesauce pouches. Yeah. Well, if I did that all day with my kid in the stroller, then they would not eat their meals. And so I've always just kind of had this philosophy that let's eat and

And sometimes some of the plates get finished and sometimes some of them don't. And that's okay. And I'm not going to ever, if a kid is hungry, I'm going to feed them. But if you can kind of get into that good routine, I think it's really wonderful. And my kids know what I do. My older boys are older, 10 and 8, and then I have two babies. But they know that mom is a doctor who helps people with their health and everything.

We talk about they know the word weight loss and we don't really talk about weight in our family. But what is one of the things that they know that mom does is that we really make sure that people eat real food. And so they have a concept of what a protein is and what a vegetable is and what a green is. And I'm just like really like here, you know, we don't really teach the food pyramid because it's.

Just like the heart health hypothesis, which is off. We have a problem with our food pyramid in this country. But, you know, what's going to grow their muscles and what is going to make them healthy. And I let them pick their favorite meals. So like they have a rotation of meals that they really like. So, yes, they're not getting salmon every night, but they have food that is complete and whole foods that they really like. But I mean, do we do a frozen pizza from Costco? No.

Yeah, we do. And you just have to. And I think it's all about balance. We definitely...

I make them work a little bit more for their sweets. I'll tell you, not like that sounds terrible. Please don't put that clip in isolation, but I'm teaching them how to cook. So we have an ice cream maker and we're using an ice cream maker with like Greek yogurt or we'll do cream too, but they're like, they love it. They're like finding recipes and we're not doing it every day, but we're

I have them cook with me and I'm really teaching them to cook. Actually, I think that we, one of the factors that's gone into the obesity epidemic from 1980 onward is we took home ec out of schools. Yeah. And a lot of my patients were like,

I didn't, no one taught me how to cook. So then like, I just had to eat all my meals out. Well, you're going to get yourself in a real pickle if that's the case. So I have my boys starting to cook with me. That wasn't really quite the question, but like moderation. Yeah. Just like pull them into it. And we don't talk about weight. We just talk about being strong and fast and feeling fueled. And, you know, we have a lot of fruits and vegetables and,

We still pack their lunches. And actually, it was like the greatest honor of my life this year when we were doing a kitchen reno and I had them buy their school lunches for a while. And they were like, no more, mom, please, please. There you go. See, they appreciate it. Yeah. One of the things that we do is we do thermoses for their lunch. And so they'll get like

They like a lentil stew that we make. Wow. No, that's impressive. I don't even like lentils. I'll give you my recipe. It's spicy pudding Greek yogurt. It's delicious. And there's one in the book too. Our book has recipes, but all,

Like the things that they like. And then we put them in the thermoses. But then they also get sandwiches. But for their snack at school, they have a mid-morning snack, which we never had growing up. I don't know. I know. They take out a mid-morning snack. And they get vegetables. They get like the carrot sliced up or the cucumbers or the peppers. And they're cool with it. And the school is good because they support it. They're like, please don't send in like super sweet stuff. We don't want that. And I think it just is kind of like they know that they have to fuel their bodies. But I mean –

please, they went through so much Halloween candy this year. I was like,

But the reason I ask is because one, the cornerstone of the show is like there are people like yourself who spend their lives doing a specialty. And I don't think we ask those people like, what does it mean for how we should live? Right. We get the clips and we get to do this and that gets confusing. But how should we do it? And and that's what's helpful. So with the remaining time. All right. Let's get into it. GLP wants. I'll tell you the first thing I I'm curious about.

They are a peptide, correct? Okay. I love this idea of peptides. I first learned about it a couple of years ago, listening to these like biohackers or whatever. And I actually take some peptides, different ones, like BPC-157 and some cool ones.

but I don't know enough about them. What is a peptide and like, how did that lead to the discovery of GLP ones? So, okay. So that's a big conversation. So peptides are proteins and, um, this protein is a hormone that, so GLP one medications are an analog. They're a synthetic hormone that mimics a hormone that we have in our body. And we make, uh,

hormones in our guts and throughout our body that are involved in weight regulation. So satiety, fat storage, relates metabolism. And we have gotten good at identifying these hormones. We have

We have so many hormones. We have so many genes that are involved in this, but a few that I hone in on and I write about in the book, we have GLP-1, we have GIP, we have insulin, we have leptin, we have glucagon, we have ghrelin. We know that these are the main players and there are a few others, but these are the main players in GIP.

hunger, satiation, and how your body processes and stores and utilizes fat. So when we discovered GLP-1 hormone, it was very interesting. And I don't think we realized how to utilize it first. Now, these medications have been around since 2005. It was the first FDA-approved medication. What's gotten better is creating...

Versions that have longer half-lives. So how long does the medication stick around in your body? And that's what makes GLP-1 medications so, so effective versus endogenous native medications.

So the GLP-1 that your body makes in response to a food, once you become metabolically deranged, that homeostasis process of your own hormones doesn't work anymore. And we get insulin resistance and leptin resistance. And GLP-1 isn't that effective in the gut anymore because it degrades within a matter of seconds to minutes versus this synthetic hormone that we inject or take orally that

It lasts for days and weeks. So in the first versions of this drug, we had daily injections, actually even like BID, twice a day injections, because it really faded very quickly. But we've gotten better at creating these drugs. And now you take a once weekly injection. I didn't know that. Oh, yeah. And in development, we have a once monthly injection. Yeah.

where it just sticks around and it is so much more... Because it sticks around, it does that job of what GLP-1 would do when it would be released in response to food and it just sticks around. So it's very, very, very effective in the brain. And there's evidence that it crosses the blood-brain barrier. So...

That's where this sets it apart from other drugs that just kind of made you so jittery or it worked like it just decreased appetite. This drug is actually getting to the root cause of when you want to do things that don't serve you like overeat, drink too much, shop too much. We see like lots of indications for this drug. Wait, wait, wait, wait. Okay. Okay. So...

So peptides are proteins. Right. Hormones are not proteins, right? Well, yeah. I mean, how do you make up a hormone? Yes. I have no idea. I don't have a PhD. No, I mean, I'm not a neuroscientist, so I'm not going to give maybe the best explanation. But they are essential. They're made up of proteins. So that's how the drugs are made up and how hormones are made up. It's proteins bonded. So we make them in the gut. Like these things are made up. Mm-hmm.

You would then think its primary purpose is metabolism or food processing, but they also have a direct impact on the brain and then the way we behave. Yes. So, okay. So I keep, I've used this word a few times, but neurohormonal dysregulation is what is at the root of a lot of weight gain.

So neuro, neuro is the brain. And we used to think it was the stomach. We used to think it was the gut, right? The bariatric surgery works. Bariatric surgery targets the stomach and we bypass the stomach or make it smaller and

I have a lot of patients in my practice who've actually had bariatric surgery and the GLP-1 drugs are the thing that works for them. So they had surgery, they've regained, and then the drug is the thing that has made them lose and keep it off. Why? Because it has a profound impact on the brain. Let's back up even further. So what do GLP-1 medications do?

GLP-1 medications help you lose weight or regulate blood sugar. Those are the two primary FDA-approved indications by talking to the brain, telling it to be less hungry, telling it to be satiated, telling it to be calm, and to stop firing at all cylinders just thinking about food.

And I alluded to the fact that we also have this drug in development for alcohol cessation and drug cessation because it almost seems as if whatever your vice is, it tells your brain to stop firing for that thing you're obsessed with, food, alcohol, shopping.

Okay. And it quiets it. So people say it just, I have no more food noise. And you'll say, well, what does food noise mean to you? And it's like, I was constantly thinking about food constantly. I would see it on TV. I would feel hungry. I would think about what I was going to eat next. I was just couldn't wait for my next break. And then it just goes away.

Then it talks to the level of the stomach and it is powerful. It decreases your stomach emptying time. And so this is where some of the side effects of these drugs come from. And we have to be very careful and work with the fact that your, your stomach decreases its emptying time. Food sits there longer. When it sits there longer, you're full longer. Those hormones that signal your pancreas and your gut and your brain fire at higher levels. So it's not just the GLP-1 drug at that point. The GLP-1 drug is,

then influences a cascade of other hormones that tell you to be full and you're just not as hungry. And then finally, it works on the level of the pancreas. We've talked a lot about insulin in this chat. It makes insulin more effective and your body right away takes in a carbohydrate. Your pancreas is just like ready to fire off insulin. The effective kind, it grabs the glucose. That's how it works on the level of blood sugar regulation and everything just becomes a lot more stable.

Um, so it's a very powerful hormone. GLP-1 receptors, the thing that the GLP-1 medication talks to you are all over the body, all over. And so we have to see them in the heart. We see them in the reproductive system. Uh, we, we see them generally everywhere. And so the impact, we're even learning more and more about the potential impact and how it talks to these receptors, um,

And, you know, some of them are a little annoying. They're actually GLP-1 receptors in the heart. So you can get a slightly elevated heart rate on these drugs, about 5 to 10 points, which for some people that's

that's not great. And for some people they can notice it. And for many others, it's not a problem because they started at a lower heart rate or as they lose weight, their heart rate comes down because there's not as much body to support. But, you know, so, so they are complex drugs and they have great outcomes, but it's good to know how they work. And I talk about this in the book. I really, my mission for this book is everything we've talked about here is

making it very, very clear. So you have this little Bible, this go-to Bible of understanding this new class of drugs. So we talk through the science of obesity and weight gain. We talk through how these drugs work. And then we walk people through how to be successful on them so that you know how to combat the things like the side effects in the stomach and the nausea and the constipation and the things that come as a byproduct of how this drug works.

drugs and that you need to get through and know how to manage in order to feel well. Because the whole point of being on these drugs is to improve your health, not to make you miserable. Right, right. Well, I love that. And like you said, I mean, the book is specified. It's so much more info on GLP-1s, which do sound fascinating, even though I don't have any plans on going on them. But it's just the future and the science seems so...

bright and possible. And I know there's downsides to every drug. And I know the idea of just taking a drug and all of a sudden be skinny. I mean, let's all be honest here, but it does seem like the evolution of the science of feeling good, essentially. Yeah.

that this medication is unique. I think that in one hand, it is the treatment for diseases that have become very prevalent because of Western society, right? And they allow us to help manage and reverse the trend of obesity in one or two populations. That's incredible. These drugs, they change the way that you eat. They change your taste buds on a genetic level, right? We know that people who go on these meds, they don't want the foods that they were

addicted to really. And their brain chemistry just said, I need this ultra processed foods. They don't want that anymore. So amazingly, they're starting to change behaviors. They change those behaviors in the home. Like we were talking about, like how your parents cooked for you. So you're starting to pass on different, it breaks a chain, a cycle that is very unhealthy and potentially we're allowed, we're going to change the epigenetics for the future generations. And

And so we have a lot of benefits. There are emerging benefits of this drug. And I do want to say that I am not a believer that everyone should be on this drug. I'm a proponent of them. But what I hope is that they can help us get to a place where more and more of us don't need these drugs and we get to kind of revert back to normalcy.

Just naturally raising our longevity and then targeting using some elements of the science of these targeting in our specific use case scenarios. This is not like I don't want to be putting this in the drinking water. Sure. Yeah. Well, that and Flora. Well, I appreciate it. You know, those listening who want to know more about.

GLP-1s and the specifics of it. The book is The Ozempic Revolution, A Doctor's Proven Plan for Success to Help You Reverse Obesity and Yo-Yo Dieting and Protect Yourself from Disease. Dr. Soa, aside from the book, where else would you like people to go? You mentioned you have a company, SoWell. You want to talk about that? Yeah. So, okay, you can find me lots of places. I'm on social everywhere at AlexandraSoaMD.com.

And I launched a company called SoWell Health out of my brick and mortar practice. And it's where my, I've been practicing in this field for over 10 years. So I was using these drugs and looking at metabolic health well before it became popular.

And out of my practice spun products that I thought people could use at home. And during COVID, it was tough to get into the doctor's office. So we started with an at-home lab testing kit. And then from there, we created products for people who were like, you know,

I just would like a little bit added support. And in August, we launched the GLP-1 support system. So we were the first product to market that helps people minimize side effects and maximize their success on these medications. So at its core, we have a protein, a fiber, and an electrolyte, but they're made just for the GLP-1 user. And it's been an exciting journey as an entrepreneur to launch a product that was

I created out of my practice because I didn't see it out there and I knew my patients needed it. And we were cobbling together all of these resources. And so my goal is if someone starts these drugs, I want them feeling the absolute best. And in the book, I have my food nutrition plan. I have my foundational habits. I know exactly what you need to do to feel well, to avoid side effects and to keep going so that you can get the success on these medications and not

experience these clickbaity headlines that we see, right? And supplementation, unique supplementation is needed on these products. So I like to do a lot of things and I decided I can do this. Like let's get to R&D and it took about 18 months and we created a really phenomenal product that's popping up in retailers all over the country and is online. So you can find us at getsowell.com. You can get our testing kits there and our GLP-1 support products there.

And yeah, it's just actually a small family run business with a mission to just make people feel better and to achieve metabolic health. So come check us out and go buy the book. We're out January 7th and yeah,

You'll be seeing me on some big outlets the week of March. Probably all over the place. I know. Yeah, we're excited about it. But also just come find me over on Instagram and ask me questions because I try my best to respond. That's awesome. Well, I appreciate it. Thanks for kind of making the complicated uncomplicated and supporting, you know, people who are, a lot of people who are struggling with this. So it was a fantastic conversation. Thanks for doing it. Thank you. Bye.

Welcome to Smart People. All right, we're kicking off 2025 right. A huge thank you to our guest, Dr. Alexandra Soa. The episode was hosted, as always, by Chris Stemp and produced by yours truly, John Rojas. And for the quick housekeeping items, if you'd ever like to reach out to the show, you can email us at smartpeoplepodcast at gmail.com.

or message us on Twitter at Smart People Pod. And of course, if you want to stay up to date with all things Smart People Podcast, head over to the website smartpeoplepodcast.com and sign up for the newsletter. All right, that's it for us this week. Make sure you stay tuned because we've got a lot of great interviews coming up and we'll see you all next episode.