Dr. Sarah Stombaugh:
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:
In today’s episode, we are talking about what should you eat on a GLP medication because I am sure you have heard so much different advice out there and I want to simplify it so you know what you actually need to do to be successful on the GLP journey. I’m Dr. Sarah Stombaugh obesity medicine physician, and it’s my goal to support you on your GLP journey so that you can have the tools that you need to be successful with the medications so that your body feels good, you feel energized, and eating well is absolutely a part of that. I think one of the biggest challenges that comes up for me is that patients are reaching out with so many questions about nutrition. They are getting fed all sorts of different information online. A lot of times information that is conflicting, they see recipes that look really appealing and they’ll have a hundred different high protein, low carbohydrate recipes saved.

And it can be really difficult then to actually implement that in your day-to-day routine. And not that there aren’t so many wonderful different recipes out there, but my goal is to keep it simple, keep it easy so that you can make goals, you can stick to your goals, and absolutely they can and should evolve over time. I think a lot of times we decide to just overhaul everything and the experience becomes miserable. We are buying totally different foods. Maybe we’re eating differently than other members of our family, and we don’t know how to do this in a day-to-day routine. And it just is like, “You know what? This is too much, so forget it.” So today, let’s talk about what are the things that are going to best support you in your weight wash journey. So what I want to reassure you is that there’s no single GLP diet that will be the most successful, but here are some general tools that I want you to think about.

Now, again, these are tools, not rules. So I want you to use these as guidelines of things that can be supportive. But if you’re like, “Hey, I’m vegetarian and you are talking about meat.” Well, obviously don’t eat that. I want you to choose things that align with you. Use these tools to support you. And if you find them too constraining, then they’re just tools. They’re just tools and they are not rules. So one, you’re going to hear it here, you’ve heard it everywhere is protein first. We are absolutely living in a society right now that is very protein focused. You’ve probably heard me talk in other places too. I think sometimes we’re actually a little bit too protein focused, and I think it’s really easy to feel like we’re just undercutting it on protein across the board. And so let’s talk about what does that actually mean to emphasize protein?

What is the point of eating protein? So protein does a lot of really important things to our body, predominantly is helpful in supporting our muscle mass. Whether we’re talking about our current muscle mass or whether we’re talking about growing muscle mass, protein is one of the most effective tools for doing that. And when we are on a weight wash journey, if our body is looking for energy, we want to make sure that we get adequate protein from the diet so our body is not trying to break down muscle in order to meet its protein needs. So getting adequate protein in the diet will be important. Now, what is adequate protein, you’ll say. You will hear all sorts of different recommendations. When we think about someone who is sedentary, someone who’s not active at all, they should aim for about 0.8 grams per kilogram of body weight of protein.

So grams of protein per kilogram of body weight. And this is going to be based on their ideal body weight, not based on their current body weight. So we want to look at based on their height, based on are they male or female, what would put them into a normal and ideal weight range? What would be that number? Convert it two kilograms and then look at about 0.8 grams per kilogram. For the average activity person, one gram per kilogram will be sufficient. And this is a really sweet spot for a lot of people. Now, in today’s episode, we’re not going to go into too many calculations. I do do that in other episodes, so feel free to check out those. We’re talking about, okay, don’t get too much protein. Are we protein obsessed as a culture? But for most people, the range of 60 to 100 grams of protein per day is going to be perfectly adequate.

And for a lot of women, especially numbers on the lower side of that, particularly if you’re short, if you are petite, you are not going to have the same body structure as someone who is much taller. And so aiming on the lower side of that, if you are a very active person, will be fine. So that means 20 grams of protein three times per day is going to adequately bring you there. I’ll also check with people, what are you doing right now? Because if your protein goals or your protein sort of day-to-day, what you’ve been eating right now is pretty low, we’re just working on nudging that up over time. And then beyond protein being important for our muscles, protein is actually really important for satiety as well. So when we think about fullness, what are the things in the body that make us feel full, that keep us full for longer periods of time?

Protein is really important at this. Protein and fat are going to be the best things to support satiety, but protein being a lower calorie option compared to fat, which is an important thing during the weight loss journey as well. While calories in versus calories out is absolutely oversimplified and there are so many other modifiers that we need to put into that calculation, we do know that being in a caloric deficit, so eating less calories than your body is burning every day will be important during the weight loss journey. So as you’re eating, you want to make sure that your calories really count. You want to choose ones that are very nutrient dense and eating calories from fat can be important, but we want to make sure that we’re mindful of our quantity of fat as well because it is very calorically dense. So therefore, when we think about, okay, what are the things that really create satiety that are less calorically dense?

Protein is going to be the best thing there. Now, when you pair protein with fiber, that is an amazing tool for lasting satiety or lasting fullness. We’ve got fiber that slows down the digestion of everything so that our body’s able to digest and use that protein for a longer period of time. And that can be really helpful in terms of feeling energized, feeling nourished between meals and not feeling like you’re getting hungry frequently. So that protein piece not only supports your muscles, but really helps you to feel good. So I want you to think about, okay, how can I get in lean protein getting two or three servings ideally of lean protein throughout the day, whether that’s animal sources, whether that’s non-animal sources, lots of great ways that you can do that. Now, as you’re thinking about some of these different goals of eating, I really want you to be thinking about how are you supporting your body.

So often in the weight loss world, we have these conversations that feel very restrictive. Certainly if you’re going on a GLP journey, typically the goal is weight loss, and so it’s easy for those feelings of restriction to come up. So I want you to think about, okay, how am I fueling my body? We talked about this satiety piece, but how is my body feeling throughout the day? Do I feel energized? Do I feel comfortable? Am I noticing that I’m hungry all the time? If I’m getting hungry all the time, is that a problem? Is that because of food choices that I’m making or is that because of underlying metabolic disease? Now, if it is because of underlying metabolic disease, that’s exactly why we’re starting you on a GLP medication and we want to make sure that we’re partnering that with fuel choices or food choices that help your body to feel good, feel energized and feel lasting in between meals.

So we talked about that fiber piece, we talked about that protein piece. We also want to think about eating in order to manage side effects. Now, certainly at the beginning of your journey too, you will notice that side effects are coming up and that is normal. Not everybody has them, but most people will have some sort of side effect, most of which are gastrointestinal. So things like nausea, maybe vomiting, diarrhea, or constipation. You can also have things like indigestion, feeling like you have reflux, maybe burping or bulging that can come up. And so with those, you want to make sure that you’re making food choices that feel really good in your body. We do know that there are certain foods that will help with side effects, as well as certain foods that will drive worsening side effects. So let’s talk about some of those foods that can be helpful with side effects.

Now, one of the things I do like to point out is, especially if you’re having some of those GI side effects like nausea, for example. A lot of times if we’ve had GI illnesses in the past, you’ve been experiencing nausea and vomiting and you’re like, “Okay, I’m just going to eat simple foods. I’m going to have saltines. I’m going to have maybe some Sprite or ginger ale.” And it’s not uncommon that I talk to people in a GLP journey and they’re doing that exact same thing. They’re like, “Okay, I’m feeling a little bit nauseated. I’m feeling sick. Let me just eat some really simple crackers, some sodas, that type of thing.” What I want to caution you on is that this is not a GI illness. You are likely going to feel this way for a while. And if there’s a day or two that you need to do that, that’s one thing.

But I want you to think about if you’re needing to do that day in, day out for a longer period of time, is having salting crackers and soda really supporting you in your weight loss goals? And the answer to that question is likely not. A lot of times, are you on too high of a dose of medication? You want to make sure that you’re on a dose of medication or you’re able to manage and work through your side effects before moving up to the next dose of medication. So at your current dose of medication, let’s make sure we’re optimizing your nutrition there, thinking, “Okay, am I fueling my body throughout the day?” At the very beginning of your journey, it may not look like complex meals. You may feel nauseated. You may be thinking about, “Okay, let me have a protein shake. Let me sip on some really simple soup or bone broth or something like that.”

You might be looking at yogurts or eggs, just really easy to digest nutrition foods, and that is absolutely okay. Those foods, again, you’ll hear protein as one of the underlying pieces of those foods. Very simple, easy to digest proteins. A lot of ways, ones that aren’t going to create this very heavy feeling in the body. Sometimes that very heavy feeling can come up because of fat content in foods, and so you want to be mindful of that, but some really simple proteins can be helpful from that nausea standpoint as well, and to be supportive of your weight loss goals. You might notice other side effects like constipation is one of the most common side effects that comes up, and fiber can be a really important tool for this. Now, at the very beginning, when we think of fiber, we’re thinking about fruits, we’re thinking about vegetables, we’re thinking about grains in their whole form.

Traditionally, these are foods that are going to be much more volumous. So these are foods that are going to take up a lot of space in the stomach, for example. And at the beginning of your GLP journey, the idea of eating an entree salad may sound like, ugh, that is just simply too much food to put into my body. So if that sounds okay, great, good for you, and absolutely lean into that. But if you are like, “Ugh, you know what? Having a large volume of vegetables right now feels like it would just be too much food sitting my stomach.” Do not worry that this is a time that we might be thinking about things like fiber supplements. So checking in, am I getting my fiber? Am I able to get that from whole foods? If so, awesome. But if that feels like too much, leaning into things like a fiber supplement like metamucil, psyllium husk, bellywelly, lots of good fiber products that are out there, Benafiber, one that you can do as well that could be helpful in supplementing your fiber as you are starting your journey, and then eventually you can transition that to whole food type products.

So thinking about how does my body feel? How is my body feeling fueled? Am I feeling good or are there challenges that are coming up? We talked about that saltine and Sprite or ginger ale, for example. If you are fueling your body with simple carbohydrates, you’re likely to actually drive worsening of side effects. A lot of times we feel this up in our blood sugar, but we feel the down as well. So the blood sugar might come up with some saltines and ginger ale, but then it’ll come back down, which sometimes just worsens the nausea that’s coming up. So you feel this all day rollercoaster of wave of nausea, wave of nausea, wave of nausea. And so you find yourself just all day long eating a few saltine crackers, sipping on some ginger ale. And that overall, because those are very simple and processed carbohydrates is not going to be supportive of your weight loss journey that is going to put you in a situation where your body is still processing carbohydrates for energy.

You’re not adequately fueling or supporting that protein piece. So you may be at risk for muscle breakdown in that situation and your body’s not going to feel good. You’re going to sort of perpetuate this blur feeling. So like I said, if you need to do that for a day or two, totally fine. But if you’re finding you need to do that more often, make sure you reach out to a doctor to ask about what sort of, or a registered dietician, what sort of nutrition changes can you make in order to help overcome nausea? Because sometimes we can make some really simple swabs that both feel good in your body as well as supporting your weight loss goals. Now, another thing we sort of alluded to here is thinking about the way fat feels in your diet. So fat is not necessarily a bad thing. I think a lot of times we think about fat as, okay, if you eat fat, then maybe you’ll put fat onto your body.

The thing is that fat is very calorically dense. It’s easy to see why in the 80s and early 90s, we were really obsessed with a low fat diet because we know that fat is calorically dense and eating a lot of fat, particularly added fats to foods, can be a driver of excess caloric intake, which can lead to weight gain. However, fat is actually a very important thing in our body and it also drives satiety or that fullness that we were talking about earlier with protein. So fat is really important. It’s also the basis of all of our hormones. And so getting adequate fat is important for our body feeling fueled, feeling nourished, feeling energized. We just want to be mindful that we are not overdoing it with fat. So what do I mean when I say that? So foods that are naturally containing fat, so foods, for example, like a cut of meat, like a chicken thigh, for example, versus a chicken breast.

Most people will find that a chicken thigh is still a appropriate amount of fat. So any of the dark cuts of meat, for example, where they can get lots of protein, they can get a little bit of extra fat, they feel nourished, and it doesn’t bother their system. A lot of people, particularly on GLP and GIP medications will notice that fat, particularly heavy quantities of fat can really be bothersome for them. So this can be fats that are added. So fats in greasy or fried foods, for example. So things like hamburgers, french fries, chicken tenders, pizzas, that type of stuff, donuts, anything that is fried or has extra fat in it because it was fried and therefore soaked up fat during the cooking process. Those foods are often very bothersome in the GLP journey. And so eating those type of foods, that fat just sits really heavy in the stomach.

People might notice worse things like indigestion, reflux, lower GI symptoms. So loose stool or diarrhea can be very common after having a high load of fat in the meal. And those particularly added fats can be bothersome. But I want you to also be mindful of fats that naturally occur in foods. A lot of times we’ll think about fats in dairy products, fats in animal products like meat products, as well as fats that are naturally occurring in nuts, seeds, fishes, and some even fruits and vegetables, things like avocados and olives, for example. So I want you to be mindful of all of the different sources of fat and knowing that fat is very calorically dense. So we do want to be mindful when we’re consuming it. A lot of times something like mindfully snacking on trail mix or cashews may be really bothersome from a GI side effect standpoint.

So it may really trigger some of those lower GI side effects or upper GI side effects like we were both talking about. And it’s also very calorically dense. And so it can be very easy to overeat these foods, even if you’re thinking about nuts. We’re talking about cashews or trail mix and just snacking on these things. A lot of times if you look at the serving size of nuts, it’s like the size of the palm of your hand. It’s a very small amount of nuts that we’re talking about. And so that might not feel like a huge volume of food. So you want to make sure, okay, what is a serving size of this? Am I having a serving size or am I having two, three, four, five serving sizes? Which sometimes comes up, especially when we are not mindfully eating it, when we’re kind of working while snacking on something and not really paying attention to it.

So I really want you to be mindful both of the unhealthy fats, so those greasy or fried foods, but even those healthy fats when they’re consumed in larger portions may also be bothersome. I’ve had patient situations where they’ve had salmon, for example, with a rich in cream sauce on it. They had a salad with a vinegarette. They went out to dinner out for dessert and had ice cream afterwards. And so even though we’re talking about salmon, we’re talking about a cream sauce that was maybe some dairy, we’re talking about a vinegarette, so maybe some olive oil, for example, and then ice cream, that person is still consuming a lot of fat at one meal and that even may be bothersome. So just be mindful if you are having salmon that you would have vegetables that are roasted, for example. So it might be lower in fat, that you are skipping dessert perhaps that day because you might know that it will be more bothersome compared to if you were eating a different meal.

So just being mindful of how you’re partnering these things together. And sometimes the best experience is having an experience that you’re like, “Oh, I did sort of overdo it here. Even if I didn’t realize that would be the situation, it felt miserable in my body when I consumed fats in this way.” And so if a chicken thigh was creating problems for you, you might choose a lean cut of meat like a chicken breast, for example. So there absolutely is some trial and error here, and I want you to be playing around with that and feel comfortable with both A, you will have to figure out what this feels like in your own body, as well as B, it’s likely to evolve over time. So I want you to think about those fats. I want you to think about those proteins. Let’s also talk about carbohydrates.

We talked about it in the context of you want to be getting good fiber, you want to be about avoiding some of those just simple added sugars like saltine crackers, like ginger ale and Sprite, for example. But carbohydrates are important. I think a lot of times we think about carbohydrates like they’re really bad for you, but the reality is carbohydrates our primary fuel source for the human body. Our body loves carbohydrates for energy. We just want to be mindful of how we’re partnering those with other foods. So in our practice, one of the things we talk about a lot is no naked carbohydrates. So if you are consuming carbohydrate, make sure that you partner it with protein and/or fat so that you get that lasting effect from it. So you don’t want to be eat carbohydrates by themselves. So if you’re eating a slice of bread, for example, eating it as part of a sandwich where you’ve got some cheese, you’ve got some meat, you’ve got some vegetables, that is going to create a lasting satiety compared to having bread on its own.

Or let’s say you’re like, “Dr. Stombaugh, I don’t want a sandwich. I do want to have bread on its own.” Having bread on its own with an avocado, with an egg alongside some soup, something else where you’re going to be partnering it with something else so that your body is not feeling this up and down impact on blood sugar that can happen when we have carbohydrates by themselves. So I want you to think about partnering carbohydrates with things, as well as how can we use carbohydrates to really fuel our body. So if you are someone who’s very physically active, you’re getting back into exercise, carbohydrates are burned incredibly well for fuel. And so having carbohydrates immediately during or after exercise can be helpful as well to help build and recover your muscles. And so we want to think about, okay, when we are having these things, how do we partner them in a way that is going to feel good and help support you in your goals?

So carbohydrates in the form of fuel for our body used alongside exercise is one of the best ways to do it. So these are how we’re thinking about some of the different rules. Now you might be like, “Dr. Samba, you promised me you weren’t going to make that complicated and you just went and made it complicated.” So if you were very first starting out, you’re thinking about how do I make this thing as simple as possible? I want you to think about what am I already doing? What are my day-to-day routines and what does that look like? If I had to estimate, and this can be a great time to go into Google or ChatGPT or something like that, and estimate how much protein are you getting in a typical day? You might be surprised to find that on an average day right now, you’re getting 50 or 60 grams of protein already, in which case, great.

How do I optimize that even further? Or how do I just keep doing exactly that? You might realize that, okay, I’m actually doing pretty well here. And so let me just feel, let me start the GLP medication, see how my body’s feeling, make sure I am getting the different protein sources throughout the day, and then see where is it challenging. A lot of times people might notice that it’s challenging in the morning. They’re waking up and not feeling particularly hungry, but they know that eating early in the day may be really helpful for them based on a busy work or a personal schedule, for example. And so eating in the morning might really make sense, but the idea of eating a large volume of food or eating any real volume of food might feel like too much. So that might be the person for whom a protein shake as the first thing in the morning option may be exactly what they need.

So that can be something that really makes sense for that person. There may be other people who recognize, okay, I’m really struggling to eat consistently throughout my day or to even just carve out time during my workday to eat. And so what does that look like in terms of having some quick grab and go snacks in my desk drawer at work, in a mini refrigerator at work, something like that. We’re coming out of the cold winter months, at least at the time of this recording. So I don’t recommend storing many things in your car, but are there things that you can store in your purse, in your briefcase, in your office, in your home so that you do have those grab and go snacks? And that can look like things like whole pieces of fruit, for example, that maybe you partner with a protein shake or partner with a cheese stick or a meat stick or something like that.

That can be individual serving yogurts or some of the yogurt drinks that are very popular right now that can be things like nuts. I really like the single serving packets of nuts or trail mix for that grab and go situation can be also helpful in signs in terms of portion size so that you don’t find that you’re eating too much, but just look for these little tweaks that you can start making over time with what am I already doing and how can I align this more with my goals? I think that is the number one mistake that I see people making like we talked about at the beginning where they just want to overhaul everything. They’re just like, “You know what? I’m going to totally do everything differently.” And while that sounds really good on the surface, it’s very overwhelming for our psychology to do that.

And we are so much more likely to give up because we’re like, “You know what? This is just too complex.” So a lot of times I’m saying, “Hey, just start your GLP medication, I want you to make sure you’re getting protein a couple times throughout the day, you’re getting fiber a couple times throughout the day, and then we’re making some adjustments from that. ” If you find that you are someone who is on social media and saving 20, 50, 100 different TikTok recipes for high protein meals, for example, I want to challenge you to choose just one of those. Choose one thing that is new, write down an ingredient list, go to the grocery store, buy the ingredients for just one thing and make it, see how you like it. And if you like it, great, you might add it into your repertoire. And if you do not like it, no big deal, move on to the next one.

But at any given time, I find that most people do really well with 10 recipes that they eat on repeat. And then depending on whether you’re cooking for a family or you’re cooking for one, you may ramp this up or ramp this down. But for the average family even, having 10 sort of go- to recipes that you eat on a, let’s say, two week rotation, and you make enough of it that there might be some days where there’s leftovers or maybe you know you eat out once or twice a week, for example, and all of a sudden those 10 recipes rather become enough food to last two weeks. And so you just repeat that. Every two weeks you eat those same 10 recipes and it makes life really simple. You choose recipes that your family is already doing, recipes that you already like. Maybe you’re making slight tweaks here or there to further align with your goals, but there’s no reason to overly complicate it, no reason to exclude the rest of your family from what you’re doing either.

I want you to feel like, “Hey, this is simple, this is doable, and I’m slowly moving things in the direction of my goals.” So if you are overcomplicating it, I just want you to know you are not alone. I think we all have that temptation of let me just overhaul it, start over, but I want to encourage you to keep it simple. And I want to encourage you to really feel, okay, what is feeling good in my body? Really paying attention to, for one, there might be side effects for medication that are coming up. We’ve talked about some of those that can come up and how you might combat that, but what things feel good in my body? You might notice that it feels really good in your body to have protein dispersed throughout the day. You might notice that it keeps you full for longer, that you feel energized for longer periods of time.

You might notice that there are certain things that really help with managing certain side effects that are coming up, for example. So you might realize, you know what? Having a really ice cold beverage, for example, can really help to decrease some of my nausea or just sipping on a protein shake is an important thing for me to do in the mornings where I know that I have these busy days, so I’m going to grab and go because this type of food feels really good. So focusing on those type of things, as well as focusing, okay, what are the foods that make you feel bad? And I don’t mean morally bad that you’ve made some sort of bad decision, but that physically you feel unwell after you eat them. We’ve talked about those fats, so foods that are greasy, foods that sit really heavy in the stomach.

A lot of times overeating will drive these type of side effects as well. You’re listening to the audio only version, major air quotes there on the overeating in that I don’t necessarily mean it’s a huge volume of food, but one of the things that comes up sometimes, especially at the beginning of the GLP journey is that it may not take a huge amount of food to create that feeling of, “Ugh, I ate too much.” So being really mindful of, okay, what is the amount of food that creates that feeling of sort of perfect satiety, that adequate, like I’ve had just enough food in my body. And if you reach that point after a very small amount of food, go ahead and stop eating. I think this is one of the biggest challenges that come up is like, “Well, I only had three bites of that sandwich that really wasn’t that much.

I probably should eat some more food.” And then we eat more and we actually then end up overeating or eating more than our body felt like it really needed. So if your body is feeling full, go ahead and end that meal. That is going to be one of the most important things for helping to reduce the risk of side effects early on is to limit that overeating. But pay attention, these heavy or greasy foods that sit really heavy in my stomach or drive some of those side effects overeating, especially early in the journey, just eating more than my body feels like it can tolerate these things feel really miserable. You might notice there’s other things like alcohol, carbonated beverages, including sodas, sometimes even sparkling waters can be really bothersome. So just paying attention to how do these foods feel in my body? Does it make me feel better?

Does it make me feel worse? Does it help me stay full for longer periods of time? These are the tools that I want you to use. And with these tools, I believe that people can be successful in a wide variety of diets, whether they have preferences for meats or preferences for vegetables or preferences for any different cultural cuisine, there are many different ways to be successful on a GLP journey. And if you are engaged in a program that’s giving you very strict and regimented things that feel really difficult to stick to, I just want you to know that there are other options out there. Working with someone who could help to personalize this is one of the best things you can do. If you are based in Illinois, Tennessee, or Virginia, I would love to see you as a patient in my clinic. I see patients throughout those states by telemedicine or in person in my Charlottesville, Virginia office.

If you are looking for an obesity medicine physician who is located near you, you can go to the American Board of Obesity Medicine and find a provider in your area who is certified in this way to help provide you that comprehensive support you need in your weight wash journey. Thank you so much for joining me for today’s episode. We’ll see you all next week