Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone, and welcome to this week's episode. We are talking about fueling your body and how we can think about food as fuel for our body. Now this does not mean that we don't also eat for other reasons, like for enjoyment and pleasure for special occasions and that type of thing, and we'll address that as part of this episode. But thinking about as I'm eating, what is the role that this food is playing in my body, that can be a really important thing. And understanding what types of foods, what types of eating patterns, timing of eating, for example, is going to impact our health and why. And then sort of tailoring that to what is going to make the most sense for you and your body and your needs. And what instigated. This episode was actually a recent post that I had on social media that was a bit controversial. And it's interesting because sometimes I know when posts are going to be controversial. And it's really funny because there is a whole group of people that are just ready to like, Hey, you're promoting eating disorders, or, Hey, you're not a good example for your children about how to eat. And so I want to tell you a little bit about the post that led to all of this, and then my thoughts about how we fuel our body with food. So I had a post on social media recently about going to Bodo Bagels, which if you are local to Charlottesville, Virginia, you will know that Bodo is an institution. It has the most delicious bagels, and I eat them from time to time. And on a recent trip to Bo's, I go there every single Monday with my daughter. We drop off the boys at school, they go to two different schools, we drop them off and then she and I do a mommy and me class at the park district. So we have this awkward hour gap between school dropoff and that class, and our home's a little bit too far away, but the Bodo Bagels is right around the corner from the place where my daughter does this gym class. And there's art in gym class. So every Monday morning we go to Bodo Bagels. And like I said, Bodo is delicious. If you've ever been there, you know that if you're traveling to Charlottesville, Virginia, I 10 out of 10 recommend it. But what I also know is that right now with my health goals, eating a bagel every Monday morning is not in line with my health goals. And I was recently there a couple of weeks before this happened and there were two older women who were eating a paper dish and they had eggs and avocado and tomato and stuff like that on them, but not on a bagel. So typically when you go to Bo's, everything is on a bagel. They have lots of different sandwiches and stuff like that. But I turned and asked these women who were sitting at the table right next to us, Hey, do you mind, I noticed neither of you is eating a bagel. Do you mind telling me about what you're eating and how you came to order that? I didn't even know that was in an option. So both these women were like, oh my gosh, we wish we could eat bagels all the time, but we're postmenopausal and trying to limit carbs. And so they have an option where you can order a sandwich on a plate instead of ordering it on a bagel. And so for example, you can order eggs and avocado, which is what I ordered most recently. You can order that and then instead of making that into a sandwich, they just put it on a plate, just sort of a scrambled egg and then avocado on top of it. So most recently on this trip, then I ordered that it was delicious. I put a little salt and pepper on top of it, and I enjoyed that while my daughter was eating her bagel and cream cheese. And everybody was happy until I posted it on social media. And there was a surprising amount of backlash, which sometimes happens with these things. So I'd like to talk a little bit more about that choice specifically, but then thinking about what are the things that we are choosing to eat? How are those fueling our bodies? And then how do we match up those different needs? Because the reality is it's really nobody else's business what one person is eating and while they're eating it. But it's a very common in our lives that we get external pressures either from things like social media or from our family or friends about the food choices that we're making. And so it's really important that as we're making those decisions, even if we're making those in alignment with our physician or a medical weight loss team, that we understand why we're making those and why it makes sense for our health. So I will tell you in the situation of the egg and avocado on a plate, I usually am not hungry early in the morning. You can ask my mom, when I was a kid, I was not hungry in the morning either. She used to force me to drink those Carnation instant breakfast chocolate milk drinks in the morning because I would've happily gone off to school without eating breakfast. But I would inevitably have gotten hungry at let's say 10 o'clock in the morning, which is what happens now generally, I'm not super hungry in the morning because of flexibility in my schedule. I'm able to eat and I build that in when it makes sense for me and my schedule. And I rarely eat early in the morning, but sometimes when I do eat, I want something that is going to be more protein forward, maybe a little bit of fat. My body feels fueled, but isn't like starving. I don't really like eating carbohydrates first thing in the morning, so I just don't, and that's aligned with my goals. And I was so excited to hear about this sandwich on a plate option that Bodo Bagels offers because the reality is I don't usually want to eat a bagel at eight o'clock in the morning. That just does not appeal to me. And I recognize to a lot of you that probably sounds crazy because as a society, we eat a lot of pastries and breads and that type of thing early in the morning. And if you love doing that and it's in line with your health goals, great, but I don't even really desire that, nor am I hungry for that. So I want to think a little bit about what are the roles of different foods and then how and why can we choose those, build those into our diet in a way that's going to be in line with our health goals. So you've heard me talk before about macronutrients, you've got carbohydrates, you've got protein, and you've got fat. Each of those things serves a very important role and you may be sort of bringing each a category of those up or down depending on what your goals are. So let's step back though and review what the roles of each of those things are. When we think about carbohydrates, carbohydrates are actually the human body's preferred energy source. Now, we can burn protein, we can burn fats energy, but carbohydrates are the most readily available source of energy. When our body is eating carbohydrates, we turn those into glucose that's in the bloodstream that can be used by every organ system in the body, including the brain. And when we have these sort of intermediate energy store is called glycogen, stored in our muscles, stored in our liver, and glycogen can be readily converted back into glucose during times where we need to bring those glucose levels back up because we've utilized the active glucose in our bloodstream. So carbohydrates play a very important role in fueling our body. They also can be stored as fat. So when we eat more carbohydrates than we need to, our body takes that extra energy and stores it away as fat for later. They're also really important in growth and muscle building. We talked about every cell of our body can utilize glucose and muscle building is actually, we think about protein and muscle building, which is true, but we also need carbohydrates. They can also play an important role in digestive health. So in the episode about fiber, we talked about the important role of fiber in keeping our bowels regular. And so fiber is a type of carbohydrate that is the most healthy carbohydrate, of course, the carbohydrate form this sort of plant product that is not broken down by the human body, and that is really important for our digestive health. So carbohydrates, even though they get a bad rap sometimes, at least in the last decade or so, people have been a little bit more anti carb than usual. Carbohydrates do play a very important role. Then we have proteins. Proteins also completely essential. They are broken down into amino acids. And these are the building blocks for growth, repair, maintenance of many of the tissues in our bodies like our muscles. They're the building blocks for hormones and enzymes. And in our immune system, when we think about the immune system regulation, all of that is mediated by proteins as building blocks for those. And then we think about the role of fat. Fat is really important for energy storage. It's a very dense energy source. We can use it readily for energy. It's important for nutrient absorption. So there are certain vitamins that are called fat-soluble vitamins, and those require certain amounts of fat in our diet in order to store those away as energy. So those are vitamins like A, D, E, and K. And then fats also play a really important role in the structure of our cell membranes and in building hormones. So each of those things is really important, but depending on your specific health and other dietary goals, you may be sort of ramping one of these categories up and down as it best serves you. So the biggest conversation people have been having recently is about protein in the weight loss space. I feel like all you hear is protein, protein, protein. Make sure that you get enough protein and that is absolutely important when you're on the weight loss journey. You want to make sure that you are emphasizing protein in the diet in order to support your muscle mass while you were losing weight. One of the things that can happen is that if we are not adequately getting dietary protein, our body will break down muscle in order to use those amino acids from our broken down muscle for things like building our cells and hormones and enzymes in the immune system and all of that. So there's an amount of protein that our body needs, and ideally we'll get it from dietary sources so that we don't have to break down our own muscle to do that, but our body can do that if it needs to. So getting adequate protein, we've talked about it in other episodes in terms of numbers, I'm not going to go into that too in depth in today's episode, but thinking especially when you're in a very rapid weight loss journey, like the weight loss journey that may happen with GLP medications or GLP/GIP medications, the Wegovy, Ozempic, Zepbound, Mounjaro, et cetera, semaglutide, tirzepatide, all of those medications, or if you have had bariatric surgery, making sure that you are getting adequate protein is really important in those rapid weight loss journeys. So typically people will talk about distributing it throughout the day, and so it may make sense to do it at least breakfast, lunch and dinner, but potentially having one or two more fuelings a lot of times, even with things like a protein bar or a protein drink for example, may be ways to support you in getting adequate amounts. I do recommend to my patients that they're getting it served to them typically about three times per day at a minimum. So that in a pretty significant weight loss journey, making sure that we're getting adequate protein is important. Now, we can balance that too with getting carbohydrates, with getting fats, and we can sort of time those to make sure that we're supporting our body in the way that it needs to burn energy. So carbohydrates, as we talked about, carbohydrates are very important. And when we're talking about carbohydrates that are in their whole form, like vegetables, like fruits, like grains in their whole form, like nuts and seeds, those are excellent ways to both get the carbohydrate, but in a very fiber rich variation such that it's supporting your digestive health, you're slowing down the movement of food through the GI system. So that can help your body feel satiated and stay satiated for longer, which is really important. And we can even time specific carbohydrates with how our body needs to use energy. So for example, when we have just had a pretty intense workout, whether we're talking about cardiovascular training or whether we're talking about more resistance training, our body is in a state where it is burning sugar more rapidly, that blood glucose, it's being burned more rapidly than it typically does. So during a long run, for example, I will sometimes encourage my patients to have a, it sounds crazy, a sugary beverage if they are talking about running a long distance in a pretty significant weight loss journey, we have oftentimes broken down a lot of our muscle glycogen stores. And so our body, you hear about marathon runners hitting a wall, for example, one of the things that causes that is inadequate glycogen stores. So all the conversation about carbo loading before big runs and that type of thing can support long distance running or other endurance type sports. And for patients who are in that situation, sometimes we talk about utilizing Gatorade or other similar sports beverages, and I'm talking about the real Gatorade, the sugar filled, real Gatorade, but only in the setting of while I am actively running, especially on a hot day or something, but times where I'm running harder, running longer, and I need a little bit more fuel in the terms of glucose in order to support my muscles. Similarly, in the time after a workout, and like I said, whether that's cardiovascular training or resistance training after a workout, as our body is recovering from that, particularly if we've done resistance training and we've now sort of damaged our muscles, which is what happens in resistance training in our building it back up, we need both protein and actually carbohydrates in order to do that. So one of the things I will often encourage my patients to do is if they are desiring to have, let's say a boose bagel, a plain white bagel that may not traditionally be in line with their health goals, that actually choosing to pair it after a workout where they've done a lot of resistance training, that may be the time where it makes the most sense because they are working to replete exactly what it is their body needs during that time. So they are choosing to fuel their body with a food that makes sense in that situation. So pairing those carbohydrates, for example, after an exercise is an excellent way to both enjoy the food and utilize it in a way that is in line with your goals. Now similarly, different diets may ramp things up and down. So intermittent fasting, for example, the idea of intermittent fasting is that we are going to eat in a more narrow window of time, and this is a tool that can be used in weight loss, can be used in reducing insulin resistance and improving metabolic health. So this is a technique that's often used, but you can, sometimes you need to decide, am I balancing the amount of time which I'm eating over protein goals? And depending on how rapidly you're losing weight, it may make sense to actually eat more frequently throughout the day and have protein distributed throughout the day rather than limiting the amount of time. So for people who are not post-bariatric surgery, for people who are not using weight loss medications, intermittent fasting is often a great tool in order to improve insulin sensitivity, reduce that insulin resistance, improve our metabolic health such that our body is getting used to burning fat for energy and such that our body is not being fueled as many times throughout the day. But this ends up being completely contradictory advice like, okay, so do I need to eat protein throughout the day or do I need to do intermittent fasting? And which of those make sense for me and why? I will encourage you to pay attention to what are your own goals right now and how do you best support them? And that may look different day to day. So let's say you're someone who three days a week you do a pretty intense workout early in the morning. On those days, you may find that it makes sense for you to eat breakfast afterwards, to have a breakfast that includes protein and carbohydrates versus on other days you might wake up and not be super hungry. And so you might not start eating until later in the day. So it also doesn't have to be this black or white, like every day I do this or every day I do that, it may be pairing. There are days when I'm more active and therefore I eat a certain way. Similarly, we look at other diets and the ketogenic diet, for example, as an extreme version of really trying to ramp up fats in the diet while limiting certainly carbohydrates, but even to some extent limiting protein. You don't want to overdo that in a ketogenic diet because we do require insulin also in order to process protein. But the role of the ketogenic diet is basically that we are putting fat into our mouth in order to train our body to more readily digest fat for energy. Whether that is fat that we're putting in our mouth or fat that is on our body, our bodies get used to burning fat for energy and in the place of glucose or glycogen or other short term or intermediate term energy sources. Once those have been utilized, then our body can start to dip into its fat stores and burn those for energy. Now this can be a fluctuating thing and the reason that if you know anyone or if you've personally done a ketogenic diet, they often talk about it takes a couple of, can be usually about two weeks on average. Some people are less, some people are more. It'll depend on what you're eating and how many glucose and glycogen stores you have, but usually about two weeks on average before your body transitions fully over to burning fat for energy, using those ketones for energy. And there are some people for whom they really like that. They like the way their body feels. When you look at dietary ways to lose weight more rapidly, the ketogenic diet tends to be the most rapid form of weight loss. That is dietary only not thinking about medications or surgery. And most people who do this find that they feel pretty, they feel like they have good energy levels. Sometimes their brain feels very clear. So a lot of people really describe liking the ketogenic diet. The problem with it is, is it tends to be an all or nothing diet. And so that can be really challenging because if you're going to eat carbohydrates on that diet, you're going to bring yourself out of ketosis. Now, I say this to say, you can use parts of it though to sort of train your body how to burn fat for energy, and you can start to teach yourself to burn fat for energy. So you may, for example, find ways to incorporate especially healthy fats into the diet. Like if you're eating, let's say a Greek yogurt, for example, to have a full fat Greek yogurt and find how having fat in the diet helps your body to feel more evenly fueled, to feel sea sheeted for longer. So maybe you don't need to eat as frequently, or if you're having a salad, for example, instead of having a low fat salad dressing to put something like olive oil and vinegar onto your salad, having especially unsaturated fats like olive oil are an excellent way to get the fats that we really do need in our diet. But then also to pair that in a way that's going to have, let's say you're putting on a salad, you have other vegetables, maybe you've got lean protein on there, and you're creating this more well-balanced meal. So we can use principles of that ketogenic diet to say, Hey, how can we incorporate fats in order to support us, to train our body to eat fats and utilize fats for energy without having to go all in and being in a ketosis diet? The other part is just leaning into what is it that my body's even asking for? So we talk about this in a sense of hunger, the sense of satiety. It's really fascinating to start to pay attention to what is the reason that I'm eating? Am I hungry right now? Does my body need to be fueled right now? And if so, great, I'm going to do it, but if not, does it make sense to eat at this time? So often we've trained our bodies to eat based on the clock, based on other people's schedules, based on all of these external circumstances, and that may make sense, right? It's not like you got to just quit your job and abandon your family and eat only according to your own hunger and satiety. We do need to think about these other things as well, but checking in and recognizing, sometimes there's days where you're hungry and there's days where you're not and you may need to pair your foods more based on that, like a day where you've been super active, you've been hiking, you've been all over the place, you will find that your body is more hungry on that day compared to let's say the morning after Thanksgiving when you've eaten so much food the day before, it's very common. The next morning you're kind of like, oh, I actually turns out I'm not super hungry. And so paying attention to, regardless of what the food choice is going to be, am I actually even hungry right now? And then deciding, does it make sense to fuel my body based on hunger, based on my schedule, based on other things? Does it make sense to pair food with my needs right now? So over time, then we get to develop and evolve. Okay, maybe I'm realizing when I have certain foods for breakfast, I feel ravenously hungry. Let's say I had a blueberry muffin for breakfast and two hours later I am just ravenously hungry. We can start to pay attention to on that day. Then when I had a blueberry muffin, that's a pretty processed carbohydrate made with lots of flour, lots of sugar, and it didn't provide the same sustenance for me. So I found that when I fuel my body that way versus on a day where I had, let's say eggs and avocado, I felt satiated for a longer period of time. Or maybe it means if I have that blueberry muffin and I know I'm going to get hungry later, I'm going to make it a more robust meal by pairing it with Greek yogurt or a sausage or an egg or something else that's got fat and or protein in order to support that more long-term satiety. So we start to choose foods and build them in a way that is in line with both our needs, our desires, and our goals. And then it really doesn't matter what other people think or other people's opinions you're just doing like you're eating because you're hungry or you're eating because this food makes sense for you or because you like it or because you're trying to build muscle or because you're trying to intermittent fast and whatever it is that you're doing, you just start to get to make choices based on your needs and really nobody else's. So I recognize that some of the advice that I gave here is a little bit vague because it's hard to know for you, my listener, what is exactly the thing that's going to make the most sense? And I would love to invite you to work with me in my medical weight loss practice. I see patients in person in Charlottesville, Virginia, and by telemedicine throughout the states of Virginia and Illinois. So if you are in either of those two states, I would love to help support you. If you're not, I've got a lot of great resources online, or I'd love to help connect you with an obesity medicine physician who is in your area, because if you have been struggling with your weight for a long time, struggling with the different recommendations out there, should I do this diet or that diet or what really makes sense for me? It makes a lot of sense to work with someone else to get this level of support so that you can make the best decisions for your health. I would love to be that person if you're in my area, but if not, you let me know and I'm happy to connect you to someone who can help. Thank you so much for joining me for this week's episode. We'll see you all next time. Bye-bye.