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 long-term. 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 to 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 of the Conquer Your Weight podcast. I am so excited to bring on a guest, Dr. Pooja Saigal. She is a family medicine physician and an integrative medicine physician, and Pooja and I know each other super, super well. She was one of my attendings in residency at the University of Chicago. She is still on faculty there and recently has opened her own private practice, the Life Transformation Integrative Medicine. So I I'm excited to hear about what that looks like. And I am bringing on Pooja today because we are going to be talking about supplements. This is a question that I get all of the time, people asking, you know, I saw this advertisement or that advertisement, which of these ones is actually legit? What are the ones that have data? So I did not feel qualified to answer that. And integrative medicine does so, so much more beyond supplements, but I thought Pooja would be a perfect resource. So I am so excited. Dr. Pooja Saigal, thank you so much for joining us today. Dr. Pooja Saigal: Sarah, it's a pleasure. Thank you so much for inviting me and having me in. It's a loaded topic, that's for sure. Yes. It's my pleasure to be here to discuss this with you and anybody out there who is a patient, a provider, anyone at all could benefit from some knowledge on this. There's a lot of hype out there on the media. Dr. Sarah Stombaugh: Yeah. Yes, absolutely. Well, Pooja, tell us a little bit more about yourself. And honestly, we have not had an integrative medicine physician on the podcast before. So also for the listeners, tell us a little bit about both yourself, but then what is integrative medicine and how do you use an integrative medicine approach when you're supporting a patient with their weight goals? Dr. Pooja Saigal: Well, I think, first of all, you kind of introduced me perfectly. I've been an integrative medicine physician trained with University of Arizona's fellowship with Dr. Andrew Weil a long time ago. So I've been practicing integrative for maybe 14 years or so now. And alongside that was a broad spectrum family physician and worked with the University of Chicago and still work with the residents of faculty there. specifically talking about integrative medicine. So integrative medicine physicians both apply Western medicine and apply complementary techniques. And those techniques may include anything from supplements, lifestyle, various techniques where we may involve other providers related to manual therapies, like massage or chiropractic or osteopathic manipulation. We may involve acupuncture. Modalities from around the world, really. And our goal is to bring in the best of both worlds in a way that's supported by studies and individualized to the patient to kind of optimize mental, physical, spiritual wellness, community wellness as well. And so certainly focusing on weight is a really, really important part of integrative medicine. Just to touch on why weight is so important, why you might see many integrative medicine physicians focusing on this. So I think we all know and the common public knows that when weight is increased, certainly that affects body image, which is a really important part of our wellness and our confidence and how we communicate. Also, we know, of course, it affects cardiovascular and metabolic health. We know, the common public knows that weight causes mechanical effects, pushes here and causes snoring and disrupts sleep quality, causes more wear and tear in our joints, et cetera. I think... a big concept for integrative medicine physicians that I want to really emphasize and bring in where weight plays a big role as a concept of immune dysregulation. So immune dysregulation is a concept of, I think the general public thinks of it as a word of inflammation, but it's a little bit more than that. Our body makes good inflammation. And so our immune fighting cells and chemicals are fighting off invaders like viruses and bacteria and tumor cells. When the immune system is dysregulated, the immune system shifts and fights internally against our own organs and tissues, fights in areas of wear and tear, like where we have arthritis, but also fights in areas where we're genetically vulnerable. So if we've got genetics for allergic disease, it fights our sinuses and lungs. If we have genetics for autoimmune disease, it fights our joints and skin and gut. If we have genetics for cardiovascular disease, it might fight in the lining of our arteries and cause plaques to form, neurologic disease, psychiatric disease, you name it. Many factors cause the immune system to get dysregulated. That may include certain infections, certain environmental toxins, but many lifestyle factors, including how we manage stress, we're not getting adequate sleep, we're not exercising adequately, creating inflammatory foods, and finally, the weight part. So we didn't know this maybe 30 years ago, but we now know that if we fill up our fat cells, the more we fill them, the more they turn into active glands, and they spew out all sorts of hormones, and they also spew out inflammatory chemicals that dysregulate the immune system, so it's doing the wrong thing and fighting our own body. and not as available to do the right thing to fight off infections and cancer cells and such. So these are all kind of reasons why weight management is such an important part for us as integrative doctors who are kind of holistically managing the patient and trying to fix the underlying causes of disease. Dr. Sarah Stombaugh: Okay, that was so, so good. And I feel like you and I could just talk for 10 hours about all of this approach to integrative medicine in weight. And there's a couple of things that you said that I really want to highlight. One is that fat is not this inactive blob. Sometimes we think of fat tissues as just a sort of blob on our body, but the reality is it's very active and hormonally active and creates other issues down the road. And it's just a piece of It's a piece of the broader health scope picture, as well as we think about then treating weight, as well as honestly any health condition, there may be all of these different tools. And so, especially in weight, there's so much conversation around medications or surgeries or supplements as we're going to talk about today. But then also it's our lifestyle, it's our sleep, it's our stress, it's our movement, it's the food choices we make. And so today we're going to be talking about supplements. And I think it's just really- Dr. Pooja Saigal: Yeah, absolutely. One of my favorite things about you as a very unique obesity physician is that you're very holistic in your approach. So I love that this topic makes both of us kind of glow and light up because we're both so holistic. So I know you're certainly well-versed and covering so many of these other topics. So I get to address the difficult one. Yeah, yes. Dr. Sarah Stombaugh: Yes. Well, so let's, let's dive into this because there are countless supplements and that are regulated or not regulated rather, but they're marketed for weight reduction. So you see things from appetite suppressants and metabolism boosters and fat burners. When you see these things on the market, tell me a little bit about where are there any legitimate clinical benefit and what are the ones that actually have some data behind them? So I will turn it over to you to tell us a bit about that. Dr. Pooja Saigal: Yeah, great, great question. And I'll just kind of say as a disclaimer, kind of the data that I share, first of all, as physicians, we like to look at not like the hot new individual study. We love to look at studies that put together data from many, many, many other studies. And so that's really... where the money's at. And a lot of the hot new supplements that come out, they're looking at like one or two small recent study and kind of using that as leverage. And that sometimes is true and sometimes it's not true as far as the benefits that are touted. But I will be referring to supplements only for adults and not pregnant persons and not children as I'm talking through this today. And I think we have to think of supplements kind of like medications, right? They generally are more subtle in their benefits and they're more subtle in their side effects, but they can certainly have side effects and they certainly can have real benefits. And they certainly can have interactions with our diseases and with medications that we're on. So kind of getting good information about supplements is really important. knowing about supplement quality is also really important. The FDA regulates supplements similar to food, and so they kind of have manufacturing standards out there, and they make sure supplements are not specifically touted for certain indications, and that's kind of how they regulate it. But it's kind of the job of your integrative doctor to really look at the quality of specific individual supplements for what it's each type of supplement or each type of condition and decide what's good quality, what's the right dose, etc. So they're not to be taken lightly, that's for sure, even though they are available over the counter. So diving right into your real question here about what's effective, what's not. So I like to think of it as kind of a few different categories of supplements that can support weight. First, there's kind of what's the really hot category right now is supplements that help us to metabolize carbs better. Obviously, one of the big goals is to reduce intake of refined and starchy carbs, yes. But when we do take those in, how can we metabolize those better so we're making insulin when we should, not making unnecessary insulin when we shouldn't, which can promote more weight gain. And a lot of it's genetic, as you know, right? you know, kind of thinking about who will benefit most from these types of supplements that help us to metabolize carbs is your classic person who maybe has a family history of diabetes. Maybe that person has prediabetes or they have PCOS where they eat more carbs and their periods start to spread out or they start to have a little bit of hair growth and such. So looking at this category of supplements first, I say these are kind of the hotter supplements because GLP-1s and incretin mimetics, these injections are the hotter drugs right now for weight management. They work through a variety of pathways, but one major pathway is to help us with carb metabolism. So I would say actually, to tell you the truth, my favorite supplement is one that has been used for a long time for diabetes and is not really currently being promoted by the media. So it's a good hot secret for you. Probably one of my top supplements is Berberine. And Berberine has quite an extensive amount of data and studies. And studies showed that people can lose up to even 11 pounds on Berberine, which is a decent amount actually in the supplement world. Remember the supplement world is not gonna be like losing 15 or 20% of your body weight, like being on an actual GLP injection drug, right? And it does, though, stimulate GLPs in the body and works through a variety of other mechanisms. Also good for cholesterol, also antioxidant. And so I like to use berberine in, say, patients who are already working on lifestyle. They feel stuck. But maybe they're just stuck at being five or 10 pounds heavier than where they want to be and where they would feel better health-wise, better about their body image and how they fit into clothes. And Berberine also helps reduce waist circumference. So that central weight, which we know is particularly inflammatory and also particularly affects how our clothes fit us. And it has GI side effects. It can cause upset stomach, but much less than the GLP injections, of course. And I do tell people that I'm very careful about combining it with medications for diabetes, or usually I won't combine it with GLP drugs. I know people might think, can I get that extra oomph? But there's too many overlapping mechanisms of action, actually. And people run the risk of having hypoglycemia or too low blood sugar, which can be serious. But at the right doses and, you know, the right product, people can lose a decent amount of weight. And that may be all they need. Even many people don't actually even qualify for weight loss medications. So for those people that are needing that little bit of edge, I think another one that I am a fan of. And again, it's kind of like an older tried tested one is apple cider vinegar. Now, you can have this in the form of the liquid or you can have this in the form of supplements. Actually, while this is a discussion about supplements, the supplements don't have as much evidence as actually having like a shot of apple cider vinegar a day, like a tablespoon diluted in water once a day. And so studies show even up to 15 pounds of weight loss with this, which is pretty cool. Yeah. And it works again. many metabolism or many carbohydrate metabolism types of pathways. Um, so it can help certainly help diabetes as well. And so again, this, the data is not really as robust when it comes to supplements. I have patients who ask like, what about if I put it in my like vinaigrette with my salad instead of taking it as a separate shot? Well, the studies are about taking it as a separate, like diluted shot. I couldn't really answer the question. But we do know that incorporating vinegar into food is a healthy thing for carb metabolism. We've been doing that across cultures, you know, since, you know, through history. So I just caution people, if you're going to add the vinaigrette that you weren't having before, be careful because usually that also has the olive oil, which is really healthy for you, but has like 120 calories per tablespoon as well. So be careful if you're adding the two things in, if you're adding it in as a vinaigrette versus... having it as a shot. And up and coming one is alpha lipoic acid. You might be hearing more and more about. You may lose up to six pounds of weight. I don't use it that much because it can have some effects on thyroid. You hear about chromium. Chromium is in some of like the hottest, most advertised supplements that are out there right now. And I won't mention names, but you see this kind of on TV and social media all the time. Chromium does work through supporting carbohydrate metabolism, and it actually has good data for diabetes. Honestly, the weight loss data is kind of so-so, not really significant as far as how much weight people lose on this. So if you're wondering what I'm looking, what I'm talking about, just, you know, ask Google or AI what are the hot new supplements that contain chromium in them. And really, chromium is a heavy metal. High doses that can cause liver and kidney damage, but not really the doses and supplements that are sold for like weight loss and blood sugar. But even low doses of chromium can also cause people to feel like agitated and anxious and insomnia. So I'm kind of careful about that because a lot of my patients are already feeling that way. And we're already those kinds of symptoms and nervousness and such. So I am careful about that. Questions so far? And then I'll get into a couple of different categories that are, are separate from carbohydrate metabolism. Dr. Sarah Stombaugh: Okay. I think this is great because we see, you see all the time, like, oh, nature's GLP, for example, I feel like that's something we've seen really capitalized on over the last couple of years as the GLP medications have become popular and all these supplements may be sort of touting the same benefit. And so I've seen Berberine actually advertised as nature's GLP, but you see that across a lot of different supplements. And so looking at what are the new and trendy ones. And then as you said, the risk of side effects of these medications is not zero. And for some of it can be really significant. And so especially for something like chromium, I think just to emphasize, as you said, that is a heavy metal. So we want to make sure that we're not taking it inappropriately or taking it too high of doses. And so this is where having the support of, especially an integrative medicine physician can be really valuable to, you know, what are the risks and benefits of some of these, some of these certain things, but no, this is great. Let's, let's keep going. Tell me about some of the other, you know, do you think about, you know, I see things advertised either as like as appetite suppressants or like fat burners, but tell me a little bit about some of those categories. Dr. Pooja Saigal: And I'll just go back and say that the word nature's GLP is probably not wrong because a lot of these supplements I just talked about, they do increase our body's GLP system. It's true. But they work through a variety of other mechanisms as well. And you're right, because GLPs are so hot and popular, everybody's advertising by using that word. So it's not completely wrong. It's not completely right. Certainly these things are still not equivalent to 15, 20% weight loss if you're going to get on a GLP injection. So talking about, let's talk about kind of fat burners and that kind of category. So first of all, I'll mention ketones. Okay, so this is kind of a hot thing that's come up, especially everybody talks about keto diets and such. And so, you know, just kind of going, stepping backwards, what is this process of ketosis? Ketosis is a process by which we're low on carbs in our diet. Also, we're low on calories in our diet. Both of those are deficits. And I always tell people our bodies really have not evolved very much since our cave person days. We still kind of have and live in those like primitive bodies just in a modern society. So if we deprive our body of carbs and of calories in general, our body goes back to this cave person phase. almost starvation state, but that was almost a normal state in primitive days where we would frequently run into famine, times where we wouldn't have access to food. Maybe it's winter time and we're not gonna have access to food for a long time. So the body goes into this kind of hibernation conservation state. And it runs out of carb stores. So it starts burning off our fat stores for energy. And those get turned eventually into ketones. And then ketones provide energy and calories to many of our organs. So ketones are kind of like somewhat of a byproduct and an energy source. Now, this process of being in this hibernation conservation state, what happens? It's pretty cool. The body uses kind of like hormones. all the old like garbage materials from cells and like reuse, recycles that. And it's a very rejuvenating process because our body is able to use all of its own stores to basically stay alive and use our own resources. And so that includes our own calories. So it's rejuvenating. It's like an anti-inflammatory time. It's an anti-aging time. Super cool. It's a time when we have downregulation of hunger hormones, but that makes a lot of sense. If you're supposed to be hibernating and conserving, you shouldn't be hungry at that time, right? The body's just using internal resources. So while ketones can feed into this kind of a cycle and signal the body that we're in this kind of state, we need to downregulate hunger hormones and such and use up all our resources and our fat stores, Really, ketones are not in the end what truly triggers this process. It's reducing carbs and it's reducing calories in general that triggers this process of burning fat stores and reducing hunger. So there's ketones out there like BHB, MCT, and people are thinking that should reduce hunger, reduce fat stores, cause weight loss. Really the data hasn't panned out that just adding that end product of ketones will actually cause this process of ketosis and cause all of those benefits. Another kind of fat burning, you could say, supplements category out there are stimulants, of course. We also use legitimate weight loss medications like phentermine that are stimulants as well that rev up the metabolism but also reduce appetite. And so I would say that in the supplement world, kind of the biggest ones would be caffeine, green tea, ephedra are kind of ones that are out there. Caffeine, we do know that, yes, you do lose weight. And the higher the doses you go, the more weight you lose. Up to like 2% of body weight, that's different from when we're thinking of medications like topiramate, which is, as you know, 8% to 10% of body weight, right? And so the problem is with caffeine is that as we up the dose and try to get to more weight loss, we're also upping the side effects, right? And so it overtly has side effects separate from the fact that you can develop a tolerance or get addicted to caffeine, certain people with certain genetics can, but it causes people to be revved up, anxious, lose sleep, palpitations and arrhythmias, headaches, even serious things like seizures, right? So high blood pressure. So it's a little bit different than these kind of long-term FDA approved medications like phentermine, topiramate, where phentermine is a stimulant, but topiramate is a calming drug in there that reduces appetite, but also reduces some of those hyper side effects, right? So it's a good like combination, whereas caffeine is just like all stimulants. And with phentermine, topiramate, we might have enough weight loss where that actually lowers our blood pressure just from weight loss. So we're countering the blood pressure increasing effects of the stimulant. Whereas with caffeine, again, we're not losing that much weight. And so we're not necessarily countering some of the risks of the stimulant. When we look into green tea, the caffeine in green tea directly can cause weight loss. But that, again, is kind of what I just talked about. It also has a component called catechins, which is ECGC. At high doses, unfortunately, though, the doses that are used in weight loss supplements, not only is the weight loss not that great, but ECGC can be toxic to the liver at those kinds of doses. So not a super idea. You'll see many supplements will include green tea, but in teeny tiny amounts in combination with other stuff, that's probably okay, but probably doesn't really benefit you for weight loss either. But like pure green tea, ECGC supplements, that can be concerning. Ephedra is known to cause weight loss, but it's known to have just a host of side effects. It's otherwise called Mahuang. That's kind of the plant where it comes from. And Ephedra has been banned in supplements by the FDA since like 2004, I think. So if you see that in a supplement, don't take that supplement. It's just... written with side effects, quite a health concern. So those are kind of some of our like fat burners, you could say. Dr. Sarah Stombaugh: Okay. And so I'm hearing that the fat burner category, when we're talking about, especially from supplements, maybe not the best, not a lot of data and huge risk of side effects. Dr. Pooja Saigal: That's right. That's absolutely right. Yeah. So those are not my go-to. Dr. Sarah Stombaugh: Okay. Okay, excellent. And then tell me, as we're thinking about, are there other big ones that I'm missing in terms of things that have support with weight loss? Dr. Pooja Saigal: Yeah. So I think what you're going to hear big time in this day and age is probiotics, right? And that's really heavily pushed and marketed right now. I think everybody's hearing about Akkermansia right now. And so You'll see that all over media, all over your feed, on your social media, et cetera. So very heavily marketed. So what's the data behind this? So I think probiotics are an extremely promising world. This whole idea of the gut bacteria and the composition of the gut bacteria, I mean, we even have studies where there's this world of fecal transplant, which basically means we take somebody's poop and put it into another person. This is a known treatment for severe infections like C. diff, which is a severe bacterial infection of the gut that many people have heard about. But we've done mice studies with fecal transplants where we're actually able to take mice and turn them into mice that become skinny or turn them into mice that gain weight. by doing a fecal transplant from a thinner mouse versus from a mouse that struggles with obesity. And these are mice that are eating the same amount of calories and yet transforming their gut bacteria completely transforms how they're metabolizing what they eat, how they're absorbing what they eat. There are... Bacteria make certain chemicals called short chain fatty acids that affects GLP-1 systems and carbohydrate metabolism. So there's a lot to this. When we do similar studies in humans, we have actually done some studies where we have humans eat pills that have feces, yes, of other humans, or we will take the feces and instill them in the gut of these other humans. It has some data, but maybe like six pounds of weight loss. We have extensive data on actual probiotics. What we've found is that the winning species of probiotics are Lactobacillus, Bifidobacterium, and Akkermansia. Getting down to the species within the species of what's actually effective, what doses are actually effective, taking a pill is a very different load and amount of bacteria and it's certainly not replacing our own stool. It's very different from completely removing what's in the gut of a mouse and completely replacing it with different bacteria, right? I think this is an extremely promising area. So far, we're really seeing a few pounds of weight loss. Some of the better studies may be six, seven pounds of weight loss, but it's really not consistent. Most studies are showing like two pounds of weight loss. So it's, you know, I think every year we're gaining more and more research. And so it's extremely promising. But if you are hearing that this is like the magic bullet, so far it's not. But I think this will contribute to finding somewhat of a magic bullet. And what we eat, our stress, our lifestyle, our medications, our antibiotics, all of that affects the gut bacteria as well. So changing the gut bacteria and maintaining the gut bacteria are all important parts of this. I would say the other thing that I hear about, but it's gotten less popular, we used to hear about it more before, was fiber supplements for weight. And there's kind of two kinds of fiber out there. There's Insoluble fiber, that does not soak up water. So it's not water soluble. That's like the roughage in plants. It makes us have bowel movements, right? Makes fruits and vegetables kind of crunchy. And there's soluble fiber. When we put that in water, it's water soluble. So it soaks up water and expands kind of like oatmeal and chia seeds that you see. So it's that second kind, that soluble fiber that has all sorts of metabolic benefits, also promotes GLP activity and also just anti-inflammatory, really good for the system. So this is actually an area, and I will say that that soluble fiber is a prebiotic, so it feeds the good bacteria, right? So that's really, really important, whether we get it from food or we get it from supplements, ideally from food. We can find it in beans and lentils and oranges and apples and pears and berries and various seeds. In a supplement form though, we can see up to nine, 10 pounds of weight loss with adding soluble fiber. But we're talking about adding like 15 grams of soluble fiber a day. The common kind of soluble fiber sold out there is like psyllium husk, for example. And so that's a powder that you mix into a beverage What's really important here is every three, four grams of soluble fibers, like what's serving on the back of the package, you have to mix that into whole eight ounces of water. If you're having soluble fiber and you're not having the appropriate amounts of water with it and increasing water appropriately, it all can kind of like congeal in the gut and make you like super constipated even to the point of like really serious constipation. So we're talking about, you know, kind of four times one of those servings or five times one of those servings, that means four or five times adding eight ounces of water. So you can't just put 15 grams of powder into like just eight ounces of water. So follow the back of the package. It'll tell you that every three, four grams or a scoop goes into like eight ounces of water. But that's actually particularly promising. And actually, there's particularly promising data when we're combining that plus a probiotic. So prebiotic plus a probiotic, we get more weight loss. And that makes sense again, because the prebiotic feeds the probiotic bacteria. So I would say those are probably the other commonly talked about hot supplements that are on my list. Dr. Sarah Stombaugh: Okay. Well, which is so good. I mean, we hear a lot about these different ones and when we think about probiotics, we think about prebiotics especially. I mean, in a lot of ways, prebiotics is just the way that we eat, right? Are we eating the type of foods that are going to fuel the desirable gut bacteria, for example? And are there supplements like the psyllium husk or other fiber sources that can continue to support that? We very commonly recommend that even in supporting sometimes certain side effects from GLP medications, but even the appetite reduction of that, you know, have patients start low because you also, if you're not used to getting that much fiber in your diet, it can be really bad. You can have a lot of side effects, whether it's bloating, gassiness, those can be really, really common. But excellent, you know, the risk of those medications or those supplements rather is really pretty low. And the benefit is potentially huge. And so there's not a lot of downside to doing that. So excellent. Lots of good stuff out there, learning about how we're supporting supplements for weight loss. I'd love to take a few minutes and talk about medications, maybe for people who are in their weight loss journey, whether that is some of the GLPs like Wegovy and Zepbound, or honestly, if they're just losing weight in general, and we want to be thinking about reducing risk of nutrient deficiencies, maybe if they're having side effects from medications, can you speak to that piece a little bit? Dr. Pooja Saigal: Yeah absolutely so kind of as the integrative doctor I’m pretty used to uh watching for nutrient um and vitamin deficiencies and I’m checking vitamin levels pretty regularly across like any of my patients but specifically for patients on a weight loss journey so there's a few aspects to this um one aspect is that people that are on their weight loss journey so uh the idea of GLPs that slow down the gut i think it used to be thought a lot more that slowing down the gut reduces nutrient absorption, we've now figured out that's not really so much the case. However, that said, people that are on GLPs or any weight loss medication, or they're just on a weight loss journey without medication, what we do know is those people are generally eating less, right? So if you're eating less of everything, you're also going to get less nutrients. So there is that aspect. And hopefully people are eating produce because produce is where you're getting a lot of vitamins, you're getting a lot of antioxidants, you're getting a lot of fiber. But produce is also hard to eat because fiber and roughage is difficult when your belly feels so full. Now, that said, even people who are cutting out or reducing certain categories of foods, they can have nutrient deficiencies. Some people from eating overall less or because they decided on certain ways of life might be eating less animal protein, for example. So they might be at risk for deficiencies in B vitamins and in iron and in omega-3. Some people are going lower on carbs, appropriate, but actually our flour and our grains are purposely fortified with B vitamins and zinc. So we might start to get deficiencies in those areas. The other aspect I will say is that many people on weight loss medications have nausea and acidity and acid reflux, and so many of them are concomitantly on acid-reducing medicines. With acid-reducing medicines, people are absorbing less of their B vitamins, their iron, their magnesium, calcium. It can also affect their gut bacteria. the question is kind of like how to approach this does everybody have to monitor vitamin levels or what should we do so some people will decide to preemptively just be on a multivitamin I think that is actually a very reasonable approach to help prevent vitamin deficiencies um and that would be a multivitamin that doesn't have like extravagant doses of individual vitamins but like Just like 100% of the recommended daily intake. So when you're looking at the back on the label, it should say 100%, 100%, not like 1,000%, 500%. And the multivitamin should be specific to somebody's genetic sex. And as far as male, female, it should be specific to... to age, and that's usually just like 50 plus, or it doesn't say anything, which means for like people under 50, and there are certain reasons for that. I, as the integrative doctor, will usually monitor vitamin levels, frankly, and I don't necessarily just put everybody on a multivitamin, but if they're on one, I say that's fine. So I'm usually checking vitamin D, B12 and folate, and iron levels at least once a year, if not every six months, while they're on their weight loss journey, and until like Everything's plateaued as far as what's the final plan for nutrition, what's the final weight, and so on and so forth. What's the final plan as far as medications they're going to stay on. And so I might supplement things individually, or if I'm seeing many B vitamins, B12 and folate are low, I might start to want to be complex. But again, nothing that's got really extravagant doses. And really, a primary care doctor or a weight loss physician many times will be well-versed in these labs that I just mentioned, ordering them, interpreting them and supplementing to treat deficiencies in these. So they're not necessarily reasons that you have to see an integrative doctor. Caveat with vitamin D is gonna be that vitamin D is sequestered in our fat cells. So the more we wait, the more doses of vitamin D we need, the less we wait, the lower doses of vitamin D we need. But that's actually something unique where the amount you need, the dose you need to maintain a good level will actually decrease with the weight loss journey usually instead of increase with the weight loss journey. Dr. Sarah Stombaugh: That's a great point because we do know that vitamin D deficiency, while it's common honestly, in many people, especially in the amount of sun exposure we get. And then when we are getting sun exposure, we're so sunscreened, which is great from a skin cancer protection standpoint, but it's created a lot of vitamin D deficiency with then having excess fat stores being an additional reason that a lot of people may have deficiency. And so the supplementing of that may need to be higher. And the labs that you mentioned, it's very common that you know, we actually in our practice have everybody start a multivitamin just because it's really nice. We call it like a fail, you know, fail safe of let's just make sure we, you know, cover all of our bases just generally, especially early in the journey when your appetite is so suppressed, the idea of eating large volumes of vegetables or a big salad, like it's just like, oh, like that can be really challenging. And so the micronutrient deficiencies that can come with that, or as you said, you know, decreasing carbohydrates really significantly. So we're like, hey, let's just get, let's get that multivitamin on board, whatever your favorite one is, it's totally fine. But I agree. It's definitely something then we're starting from the get-go and then we're monitoring because those deficiencies then can create really significant side effects that people don't always think about. Dr. Pooja Saigal: Absolutely. Totally agree. People don't think about, even in the medical world, many physicians end up not thinking about how many side effects people can get from B vitamins affecting mood and energy and nerve function and blood cells and you know so on and so forth and and there are some vitamins where they're less commonly tested like zinc magnesium or when we test them we're testing red blood cell levels or we're doing tests that may or may not be covered by insurance And so for a lot of those, like having a multivitamin on board helps with kind of a fail safe, like you're getting some zinc every day. Magnesium, I more so look at kind of clinical signs of deficiency. If people are constipated or headachy or have a lot of muscle spasms or are like more, they worry too much or have sleep issues. Those are all kinds of signs to me that somebody has a magnesium deficiency, which a lot of people without their weight loss journey have magnesium deficiency, even their basic blood test doesn't show that. So I'll be supplementing a lot of people along those lines, as well as to address side effects from weight loss medications. I'll be using magnesium often. Dr. Sarah Stombaugh: I love magnesium. I think if I had to rank all of the things that I would just put in the water, magnesium would be up there, maybe number one. Dr. Pooja Saigal: Yeah, agreed. Dr. Sarah Stombaugh: And there's, there's a lot of different forms out there of magnesium. Talk to me about that a little bit, both in terms of, we'll start talking about maybe some of how it can mitigate some of the side effects that come up with GLPs, but then also when you're looking for a magnesium supplement, you know, there's ones that are going to create, you know, like citrate is going to create massive loose stool, for example, where others like we use a lot of glycinate in the practice, for example. So talk to me a little bit about magnesium. Yeah. Dr. Pooja Saigal: Okay, so it's true there's kind of a spectrum of types of magnesium, depending on the second word, like you said, magnesium glycinate or magnesium citrate. And this basically determines how much magnesium is absorbed versus how much magnesium stays in the gut. The more the magnesium is absorbed, the more it'll calm down things like headaches and anxiety and muscle spasms, etc. asthma and so on and so forth, the less magnesium is absorbed, it'll probably still help all of those things, but it will stay in the gut more and cause more loose stools. So the magnesiums that are more absorbed and cause less loose stools are gonna be like magnesium glycinate. Magnesium threonate is getting to be a popular one in this day and age because that is thought to cross more from the blood into the brain. And so many more benefits for like headaches and sleep and anxiety and such. Then magnesium oxide, I kind of think of like in the middle. And magnesium citrate is kind of more on the far end of like more of it stays in the stool and more of it then causes like the looser, softer stools. So it's true that the magnesium can help any of these people, but I picked the formulation according to how hard or soft is your stool. Like how much help does your stool need versus some people that have loose stool tendencies, then I'm really going to give them more like a glycinate, 3 and 8 type of a thing that gets well absorbed and doesn't cause a loose stool. But the people that are constipated or they get constipated from the medications, I will give them magnesium citrate or in the middle, magnesium oxide. And I'm usually using doses regularly. Kind of my sweet spot is 400 milligrams, and I always give it at nighttime because it has many mechanisms to help with sleep and calming the brain. So yes. Dr. Sarah Stombaugh: Okay, excellent. And then talk to me about other supplements that you might use from a side effect standpoint. Dr. Pooja Saigal: Yeah, good question. So I think when it comes to the lower gut constipation, diarrhea, honestly, probiotics work a wonder, whether you have constipation or diarrhea. So good quality probiotic is going to be good. Good quality matters. Unfortunately, I'm not going to talk about brands today, even though I am very specific with my patients. Doses run around like 20 billion colony forming units for a dose is like probably a pretty adequate dose. to heal a gut that needs some kind of repair and you need to move away from constipation or loose stools. And probiotics are just anti-inflammatory and they're good for brain health and they're good for so many things that they're an easy one to add on. The soluble fiber that I mentioned earlier, that psyllium husk or there's wheat dextrin as a common one, that is actually interesting because when it's in your stool like i said it soaks up water and expands so it makes the stool kind of like bulkier and softer so for the constipated people it can with enough water help them to like um have soft bulky stool that the gut can like grasp and push out and meanwhile for the people that are having loose stools it helps to soak up all that extra water, right? And so it can kind of help on both ends. So that's a very reasonable one, I think, to try for the constipation or the diarrhea. For the upper gut stuff, the nausea, the vomiting, the acid reflux, and even a lot of people have the gassy burps from above. Interestingly, I found probiotics work for the gassy, burpiness. So it kind of works from both ends. And, you know, I think probiotics, we know not just regulate gut bacteria, those bacteria that also regulate like the pH, like the acid-base balance in the gut. So it might, you know, help us to understand why they can help with the gassiness above and below as well and the better digestion. So one of my favorites, which is so simple and fascinating, it could be a supplement, but more so dietary wise is chamomile. Chamomile has really calming effects for the upper gut and it reduces gut spasms. It reduces gut acid production, but without actually having the like downsides that we have in the acid reducing medications. And so tea of like, they sell like organic chamomile flowers in tea bags and steeping that for eight to 10 minutes and having that tea like before eating a meal, for example, that can be really nice and soothing. Other good ones for the upper gut would be licorice specifically. There's formulation commonly sold in DGL where they've removed glycerin in the licorice. That's really important to pick DGL type of licorice because glycerin has stereotypes of properties. We don't want that in the mix. And often those supplements can be combined with other supplements like slippery elm or marshmallow root. All of these are very soothing for the gut, very healing. And so all of these can really protect and heal the gut from the upset stomach that may happen with the GLP types of drugs in particular can cause these. And stimulant drugs can certainly cause acid types of issues. But honestly, to tell you the real truth, I find that when my patients are on a really anti-inflammatory diet going into the medication, those are the patients that have the least and often no side effects, even ramping up the GLP, see the highest dose. So I really get people with that type of diet on board. And at least for a month, really clean before we even get started on those kinds of medications when I do give them those medications. And then they know when they kind of cheat and have that unhealthy cheat meal of the week, which I tell everybody that's good and that's natural. You should enjoy life too. Then they're like, yeah, I felt that. Now I felt the gut side effects from the drug. And so that's a reminder. I need to go back to my anti-inflammatory food for the rest of the week. Yeah. Dr. Sarah Stombaugh: That's really powerful. I love that. And thank you. I didn't know about the chamomile in that context. You know, I was certainly everyone speaks of it from a sleep medicine context and supporting mood and stress and, you know, supporting sleepfulness. But really cool. I didn't realize it had that effect from an acid standpoint. I will start utilizing that with my patients. Yeah. Amazing. Well, Pooja, I honestly think you and I could talk all day long about this. And so I'm going to wrap this up so that we don't bore our listeners. But thank you so much for coming on to talk about all of these supplements to address some of this data. If people are interested in learning more about you, in also just having a conversation maybe with their physician, I guess first tell us where can people go to learn more about you, the work that you do? If people in Illinois, I know you see patients in Illinois, tell us a bit about your practice. Dr. Pooja Saigal: Yeah, sure. And actually, I'm going to throw in one plug about something, a really important concept before I go into that. Just want to mention that the people who are out there that have carb cravings, they very often, that's a sign of a serotonin imbalance. The people that are out there with comfort food cravings, carbs, fatty foods, variety of foods, salty, crunchy, sweet, that's very often a sign of a dopamine imbalance. And so I just want to empower you to not feel stigma of these kinds of imbalances, which also are concomitant with mood disorders and sleep issues. And there's medications and supplements that can help with all of that and can help with cravings. So even when we're on our weight loss journey and we're changing our food, and even if we feel less hungry, so we don't continue to feel cravings or feel deprived or feel so much kind of in a long-term grief or loss over, you know, some of these less healthy foods. So I just kind of want to throw that in there. I thought a really good point. Dr. Sarah Stombaugh: Absolutely. Yeah. Dr. Pooja Saigal: Thank you for asking me about my practice. So Life Transformation Integrative Medicine, very long name, but that's, my aim is within a few visits to help people to transform their entire life. So kind of do like two to four hour visits with patients. We get to spend a half a day together when we do new patient visits and often an hour and a half, two hours, even during follow-up visits, We get to move people along very rapidly and healing sometimes 50, 60 years worth of, you know, ailments, which is really nice. And like I said, that includes weight loss. So I have a fully virtual practice and I take patients throughout Illinois. And if people reach out and say, I'm not in Illinois, but I need help finding an integrative provider, certainly I would do that as well. I just want people to get the right care they need. to, you know, kind of address and healing their diseases and their symptoms and their conditions. Dr. Sarah Stombaugh: Oh, that's amazing. I'm trying to imagine spending four hours with a physician. My new patient visits are 60 minutes. And I usually have a little bit of, you know, buffer after that. So we sometimes spend longer. And typically in those visits, you know, patients, it's the most time that they've ever spent with a physician. But if you see Pooja, you can have four hours of visits. That's amazing. Dr. Pooja Saigal: Surprisingly, time passes quick and I get to meet their pets and so it's lovely just to be home with them and it's a wonderful experience. Dr. Sarah Stombaugh: Yeah, I absolutely love that. And we will make sure to link everything for your practice in the show notes. Before we wrap up, anything else you want to make sure that we address, Pooja? Dr. Pooja Saigal: No, I think we've kind of been thorough and covered it. And again, I hope it's been informative for our listeners to kind of navigate the world of weight loss supplements and hopefully not boring. And everybody's kind of picked up one or two things that might kind of help them in their weight loss and health and healing journey. Dr. Sarah Stombaugh: Oh, absolutely. I know I've even learned from this conversation. So thank you so much for coming on today. This has really been a pleasure. Dr. Pooja Saigal: Thank you. Thanks for having me. Dr. Sarah Stombaugh: Yes, absolutely. Well, everyone, thanks so much for joining us for this week's episode. We will see you all next time.