Kim Vopni (00:01.617)
Hi Ashley, welcome. Nice to have you here. I am excited about our conversation today about weight, weight health, weight loss, GLPs, all the stuff that's kind of blowing up on the internet right now. So I would love to start with you introducing yourself in terms of your background and what led you down the path of nutrition, registered dietitian, and now being in this space dealing with the infobesity as you term it.
Ashley Koff RD (00:30.346)
Yeah, thank you. Thanks so much.
You know, I think there are, so number one, I don't know what it, at 52, made me decide to dive in and share my personal story in a book, but anyway, it's in the book. So I won't have, I won't go through all the different pieces if people are really curious, but I think there are some really pivotal moments. I was a child that was born and always deemed for the first 20 years of my life as healthy, but I was, and I was super cute. I was this cross between Shirley Temple and, you know, I like to say Spanky from,
You know, we think about the little rascals and like just a lot of personality, a lot of energy. And something happened to me around age eight. I had a belly and I never really saw that as an issue, but society shifted, you know, at that point and it became a, hey, you're not cute. And I had a boy in school who was a bully and he punched me in the stomach after school a couple of times and said not nice things. And suddenly I was this really like strong,
young woman and like this, you I had a lot of like enjoyment in life and I suddenly saw my belly as this weakness and this liability. And so my mission was how do I get rid of my belly? That led me down a really unhealthy path. And again, society just kept saying like, you have a weight issue, you know, eat differently. I was told to stop eating when I was full. I never felt full. So that was great. I was like, okay, I must be eating the right amounts or, you know, I go in for my weigh in at Weight Watchers and you'd either get like high fived and hugged by a
or you just like were asked to sit down and maybe next week, know, or, you know, hopefully you didn't gain weight. Like that would be, it would have been the worst thing. And so this whole, was really disassociated in my body from weight and health. It led to really unhealthy behaviors and.
Ashley Koff RD (02:19.15)
That I think is something that I've really been driven to focus on later in life is understanding that those early years and how we identify with our body is so important. know, we can unpack that. And it was really after kind of trying all the things that were one might de-medically sound to address my body, I got into the really like unhealthy things that I think so many of us have, you know, gone down that path, not eating, over-exercising, definitely not taking care of my body. And a really important point for me was even when I was de-enthusiastic,
to have a health issue. had had one more ear infection, throat infection, and the doctors just decided to take out my tonsils. Like that was the answer. You know, again, surgery was the answer. It wasn't a health issue. So when all that failed me, somewhere around age 20 in Manhattan, I was selling sugared cereals, working in advertising. I was making raisin bran crunch and Smart Start and Sugar Smacks ads for them. I wasn't making the cereals and I wasn't eating any of that. I was a macrobiotic vegan who was doing yoga twice a day.
wasn't drinking alcohol. It was like a real odd, but you know, at that point, because I was so just trying to find my way, you know, it's like, please help me, Michio Kushi, you know, I dig you. And this healer said to me that she could help me. She's like, I think I know what's wrong with you. She diagnosed me.
pricking my finger and looking at my blood. I'm pretty sure it was a Fisher Price microscope. You know, she's like no business doing this and said you have a worm and the worm has been with you since you're, you know, between years and this worm is, know, making you fat and is going to keep making you fat. And you know, it sounds like absolutely like full on crazy, but like at that point I was like, well, all the things that don't sound crazy haven't worked. this is so one of the big things we can unpack today.
There's such a myth of a non-compliant individual when they're battling their weight. Like, you just tried eating less. If you just exercise, like I tried everything. I challenged somebody, you know, to figure that out. So anyway, I did what she said and I drank goat's milk for seven days. And I actually got a flat belly during that time period and felt pretty good. But the consequence of the end of a cleanse, as we all know, is like, where do you go next? And unfortunately, you know, a couple of days or a week post cleanse, the 10 pounds that I
Ashley Koff RD (04:34.896)
I lost, I had gained the 10 pounds back and I gained one more. And I always remember that moment for anyone who's ever tried anything. That was the moment where I just lost hope. I just completely was like, I'm done. I put myself into a bar. I was like, I'm gonna start drinking again. I drank tequila. I sat at the bar with the guys. We're like chanting, kill the worm. You know, they're laughing at me. Like maybe laughing with me, who knows?
And in that moment, I decided I was going to be a standup comedian. like that sounds like, all right, go there. was like, I was funny. I was like, maybe this is what I was due. I actually thought that that was a career where I could also be fat. Like that's what I decided. Like I could be fat and I could, and that's like so, like there's so much to unpack in that, that we don't need to in that space.
What I want to acknowledge for people is I was so far from fulfilling my life purpose at that point because of everything that I was involved with with my body not, you know, working the way that it was meant to. in that bar eating a burger was a gastroenterologist who came up to me and said, have you ever taken an antibiotic? It sounds like a crazy joke or a weird moment. I was drunk. I said to him, like, that's the weirdest pickup line I've ever heard. And then later said, you know, like, of course I have, you know, I was a child of the seventies. I basically
free base them and he's like yeah so
It's not that your body, that what you're eating or what you're not eating, it's that your body doesn't have what it needs to run better. And that was the moment my life completely changed. I left doing the work that I was doing. I shifted over to becoming a dietitian. And I realized that we don't have that message out there, that at that time, circa 1996, 1997, Y2K, like all these other things, like we didn't have any of the resources that we have today, but the message
Ashley Koff RD (06:21.884)
the problem with the messaging is still there today. We are telling people to do things and giving treatments and offering tools up as solutions, including GLP-1 medications, and we're not actually helping people decode the signals of their body and figure out what their body needs to actually run better. And it's also why I'm obsessed with your work, because I think, you know, whether we're talking about the vagina, whether we're talking about the mouth, whether we're talking about our bellies, our bodies send us all these signals. And if we don't have
a whole plan for addressing it, we're going to go down a path of potentially making things worse, which I definitely did, or just missing and feeling like failures. You know, and I just, I didn't want to feel like a failure. So that's why I am where I am today on that part.
Kim Vopni (07:08.305)
Cool story. As you're talking near the end there, over the last probably, I mean over the last few years, but in the span of the last six months, I've had several of my friends reach out to me. We're all approaching or beyond 50 now, and many of us are now on the post-menopause side of things. And they'll say, you know,
I turned 50 and I just had a coughing fit and oops, I leaked. Now I need your services. And I said, well, you've known me for over 15 years. You've always needed my services, but you waited until you had something. So then it prompted me to go into to message my girlfriends to say, why? Like, why do you wait?
Ashley Koff RD (07:33.708)
Yes!
Ashley Koff RD (07:43.384)
Yeah.
Ashley Koff RD (07:49.933)
Yeah.
Kim Vopni (07:51.896)
why do you think you have to have a problem in order to pay attention to your pelvic floor? And one of my friends is on GLPs and she said, well, I know that I could eat differently. I know that I could get some gut health support. I know that I could exercise. I know all the things that I could do, but it was easier to take the GLP. And so kind of to your...
Ashley Koff RD (08:12.462)
Mmm.
Yeah.
Kim Vopni (08:15.471)
I think we're kind of the path you're going down is, is there's a lot of, we just simply don't have the information. It has not been part of our growing up. was a child of the seventies as well. Like you just, you went to the doctor, whatever the doctor said was wrong. You had a pill for it and that's what you did. We've never had this education about our bodies. And so now we're in this overwhelming.
Ashley Koff RD (08:25.133)
Yeah.
Ashley Koff RD (08:30.787)
Yeah.
Ashley Koff RD (08:35.681)
Yeah.
Kim Vopni (08:39.057)
amount of information and we don't know where to turn and what's true and what's not true. And then it just, it's, think another reason why, well, I might as well just take the GLP. And I don't want to, like, this isn't about bashing GLPs, but it's just sort of the, the bigger messaging here of we simply don't have the information. Then when we try to get it, we're overwhelmed with the information and how do we unpack it, as you've been saying, to find the truth or find what's going to work for us. Um, so
Ashley Koff RD (08:47.372)
Yeah.
Yeah.
Kim Vopni (09:05.935)
you become a dietician, that was kind of a turning point for you. What happened, I guess, personally with your own health, and then now what do you do to help others?
Ashley Koff RD (09:07.427)
Yeah.
Ashley Koff RD (09:13.528)
Yeah.
Yeah, the goal and really why I'm writing this book and I'm sort of back out here in this space and having this conversation, because I also like kind of at 40 something ran to the mountains of Maine and was like, I don't know if I need to do like all the public education stuff. you know, I'm helping. I run a company that provides personalized nutrition nationwide. I was like, that's great. But I realized that we, what is holding us all back and this totally aligns with what you were saying is that we have been in this weight or health
We have been in a society that has divorced weight from a conversation about the body and the body is an ecosystem. Your weight and in particular your weight composition and I will I will share for your friend who's on a GLP one agonist, including the muscles of your and your pelvic floor. It is an ecosystem, so any choice. So her GLP one use right now has the opportunity to improve her pelvic floor or to worsen her pelvic floor. As we get into a conversation around muscle and
and we get into a conversation around optimally resourcing the body. And I felt like there was no weight health conversation that was going on. So in 2004, when I saw my first bariatric patient, so somebody who was having weight loss surgery that I tried to change the name to health gain and nobody fell for it. But at that time I learned about an incretin hormone. I never in my career had learned that we have hormones. I call them weight health hormones today, but GLP1, GIP, PYY, CYP1,
like a whole range of these, but those four I call the switch. Those hormones are actually the first dominoes in a series of reactions in the body. So we have weight health hormones. We are a weight health ecosystem. And if we don't approach it in all aspects of medicine like that, we're missing the forest for the trees. And that's what we see in people who have treatments, medications, other things that may help one area, but actually negatively.
Ashley Koff RD (11:16.016)
impact the other or even may help an area, but they exacerbate an underlying issue, you know, or that piece. So one of the key things to understand about GLP-1 and GIP is not only that we make them in the lining of our digestive tract. That was the biggest aha for me because when I learned that, I learned that everything that I had been doing, all my issues, starting from my youth with antibiotics, later being on, you know, put on birth control for bad periods, et cetera, et cetera, all of those issues were ones
that were negatively impacting my own weight health hormones. So there may have been genetics there, but there were certainly epigenetics. There were choices that were impacting it. So we look at those hormones and we understand, yes, they affect our fat. They also affect the type of fat that we are making, not just the location of the fat. Yes, they affect our food noise, our appetite and our hunger. Yes, they affect blood sugar, but they affect bone. They affect muscle. In the lining of the endothelial,
in our blood vessels, which is the endothelial lining and on the heart muscle, we have receptor sites for GLP-1, which means that we're meant for that hormone that only stays on for two to five minutes. We're meant for it to go there. I believe ultimately, I don't think we've like checked the urethra for, you know, receptor sites and all the rest of the body, but because of the medications, I think we're going to see there are receptor sites for these. And we know PYY affects hydration, which is going to have a direct impact. So when we look at all
of this, it's like, hold on a second, like we can't just go on a GLP-1 agonist. And if we are on an agonist and it's working for us, you've actually proven to me that your own hormones were suboptimally functioning. So we need to fix the ecosystem, right? I'll stop there because you're like full head nods. this is like the, like this is so important for us to have this bigger ecosystem conversation, which, you know, again, is one of the reasons I'm loving having discovered your work as well. Yeah.
Kim Vopni (13:09.596)
Mm-hmm.
Kim Vopni (13:13.54)
Mm-hmm. Yeah, this is something that I've I so I kind of bring this
longevity lens into the pelvic floor from all the things we do for longevity could also help support the pelvic floor but all the things that we're not doing because of our pelvic floor can impair our longevity and it's not looked at that way often it's usually the pelvic floor is this little silo here but you know I wrote down muscle wasting because that is something where my mind always goes to I talk about a lot we lose muscle in our body as we age so the pelvic floor is not immune to that we lose more type 2 muscle fibers we're not in
Ashley Koff RD (13:30.87)
Right.
Ashley Koff RD (13:41.272)
Yes. Yes.
Yeah. Right.
Kim Vopni (13:50.597)
immune to that. And then when I started to see the GLPs and what was happening in the muscle wasting and the bone, I'm just like, this is just another thing fueling pelvic floor dysfunction and challenges that plague so many people and still not getting to the root side of things.
Ashley Koff RD (13:58.168)
Yeah.
Yes.
Kim Vopni (14:12.53)
You ended on a great place there where the fact that GLPs were working tells me that things were dysregulated. So I guess let's go there. when you see that maybe somebody comes to you, they are or they have been on GLPs or somebody's thinking about going on GLPs, where do you start with that person and how do you understand, how do you, I guess, determine if there's a dysregulation there and how do you then work to get it back?
Ashley Koff RD (14:20.418)
That's right.
Mm-hmm.
Kim Vopni (14:42.192)
to being regulated.
Ashley Koff RD (14:42.348)
Yeah, and you the interesting thing about clinicians, your friends are like my friends. mean, these are the conversations we have with all of our friends, right? Where they come to me and they're like, now, like Ashley, I've been on the agonist and you know, I'm really losing my hair. And I was like, well, why didn't we have the conversation before you were going on the agonist? And you know, and I would have looked at these pieces. So as a clinician, I'm often seeing people where we're already into a decision, right? If I had my way and I could see everyone at like the start of their weight health challenges, you
which might be in utero for some and for others might be in the first 20 years of their lives or later on, I would start as far back as I could. And I think that's really important for us as we make access to these medications available to teenagers, ages 12 on up on that point. But I think one of the key things for me as I, so I've been practicing this way since 2004. So I've been optimizing weight health hormones for 20 years prior to the mainstream introduction.
of GLP-1 agonists. also have been using, working with patients who have been on Lyraglutide since about 2007, 2008, and that was the first one of these. So this isn't new for me on that part. What is new is a society that's now talking about a GLP-1 and also a society that has a dosing schedule and like sort of is seeing it as a solution or selling it as a solution instead of a tool. So what I do for everyone is I try to have them do the weight health hormone assessment. I created an
assessment because there is no blood test to say like, your, how's your own GLP-1 working? We need to ask questions about your choices. Remember I said like, I didn't feel full or after eating I might still, you know, I might have low energy or, know, I just ask some questions there. I do look at some blood work. I ask questions about breathing. I ask questions about weight composition. I have you look at your poop. I evaluate your digestion. I ask you questions about hydration. So it's a clinical tool. When you, when you do this in the book or you do it, it's free online. Anyone can do it.
If you do this assessment, know that it's a lot, like it's work. It's not like a fun quiz where you find out you're a lion or a tiger on that part, et cetera. But from that information, we actually get direction to what may be suboptimally functioning. And what I find from that is there may be true dysfunction where your hormones are not getting where they are supposed to go. And as a result, we see that impact. And so then we are going to unpack, is it because maybe you don't have, your body isn't producing them?
Ashley Koff RD (17:11.824)
producing them, the deployment where they travel via the vagus nerve or the bloodstream, that's not working effectively. Or maybe it's a combination of they're overwhelmed. We talk about that infobesity. Maybe you have so much thought process in your brain all day long going on about what should I eat? What supplements should I take? All these other things. Maybe you're too stressed out. Maybe everything's tight. You know, we're not relaxing. And so as a result, that's so there are a lot of factors. So we we unpack that part and then we come over and we say, so what's
are the best tools in the toolkit for you? If there is any underlying digestive challenge, which includes hydration, we have to address that. We are not what we eat. One of the pieces, I have a chapter called Shit to Unlearn. One of the pieces in that chapter is this idea of we are what we eat. You we high five from a society standpoint. The media says like, yeah, you eat salmon or go you for eating kale. And it's like your body doesn't high five you until it gets where it's supposed to go and it can use it. Right. And that's what digestion is doing.
then also that we're eliminating properly. So we come over to that part and we'll look at that. And then, and I call that the crust of your pizza. So I use an analogy for pizza. The second part would be we do need to have what I call better nutrition. That's giving your body what it needs to run better and reducing or avoiding what's irritating and disrupting to it. Excuse me. And so in that part, it is really important that we look at the quality, the quantity, the timing of when we're eating.
the balance and then I add your cheese which are your lifestyle choices. We can get into quite a few of those and then I get into the toppings. Then I get into the medications, the supplements, know, all the different treatment protocols that exist out there as well. Yeah, so that's the approach on that part.
Kim Vopni (19:00.806)
Yeah, I love that. That's a good place to start. A couple of things that I want to touch on there. First, I'm to go to the constipation one where we need to be eliminating. there's many reasons why people aren't pooping well every single day. And there are some people who are, you know, I always...
Ashley Koff RD (19:09.955)
Yeah.
Kim Vopni (19:16.912)
I always make sure that I say, you pooping well? Like Bristol stool chart for not just pooping daily because people could be pooping rabbit pellets daily and think that that's normal. But constipation is super common in my community and I.
Ashley Koff RD (19:21.485)
Yeah.
Ashley Koff RD (19:26.936)
So sorry.
Hey Kim, can we, can we pop, I don't know, there's something stuck in my throat. Give me one sec. So sorry.
Kim Vopni (19:34.282)
yeah, yeah, yeah.
Yeah, no problem.
Ashley Koff RD (20:34.435)
Goodness.
Ashley Koff RD (20:38.676)
I have no idea where that came from. I'm so sorry. Are you, you're okay to, you're okay to edit on that part. Yeah. Perfect. Thank you. It's a talking, but you know, I actually think I was cleaning my dog's, big thing in the car. And I think like, I actually, there's like hair and dust. I'm like, my gosh, like all in that part. Okay. Pause back, coming back to you. Thank you. Yeah.
Kim Vopni (20:41.543)
You're talking a lot, it's all right.
yeah, yeah, yeah, no problem.
Kim Vopni (20:59.537)
Yeah, all good, all good. Okay, so I'm just going to get back to my thought. I was asking about constipation and you had said something about elimination and
Ashley Koff RD (21:07.68)
Yes.
Ashley Koff RD (21:12.14)
You said we can be constipated for so many reasons and you were about to go talk about what that indicates and that's brilliant. Yeah.
Kim Vopni (21:18.291)
Yeah and then was going to tie it into oh yes I know what I was going to say okay all right
Ashley Koff RD (21:21.891)
Thanks.
Thank you.
Kim Vopni (21:28.295)
So something I want to come, you said a few things and I want to start with constipation and many people in my community are constipated for multiple different reasons. It could be pelvic floor related, it could be hydration related, it could be diet related, but it could also be GLP related or fasting related. think a lot of people have, are lured into different ways to lose weight, if that's a goal that they have.
Ashley Koff RD (21:53.71)
you
Kim Vopni (21:55.987)
And the fasting part has always been a bit of a challenge for me, especially people who do struggle with constipation or potentially that is going to contribute to constipation. When you don't have food going through, you're not going to poop well and you don't really have a lot of stuff to poop. And then also when I think of the GLP thing is just a different form of fasting in a way because you're still not going to be eating the same volume of food, potentially nutrient deficiencies. And then I also come back to the pelvic floor and I say, okay, well, yes, we need the exercise, but we also need the nutrients. need the building blocks. And if you're not
Ashley Koff RD (22:07.768)
Mm-hmm.
Kim Vopni (22:25.92)
consuming them plus you're on a medication that's also going to be depleting them even more than what problems is this going to lead to down the road.
Ashley Koff RD (22:36.59)
Yeah, love, know, so one of the things to understand about the medication. So these are biosimilar hormone replacement therapy. Let's unpack that for a second. They are like our own hormones. So we have these and our own stay on for two to five minutes. These stay on for 24 hours, either for one day or for seven days, right? Look at that exponential difference because one of their effects is they delay gastric emptying. So yes, you might be eating less, but they are functionally delaying emptying, which
means they're functionally challenging motility. So if you have any underlying issue with motility, that is something we absolutely need to know because that is going to be exacerbated. The other part of it is your weight health hormones and one of them, PYY in the colon regulates hydration. From that standpoint, when we're suppressing, when we're on a medication that replaces our own, then our own don't have to be produced and aren't working. So in that way, they're not
needed because the receptor sites are satisfied. In that way, we see a down regulation of our own hormones, including PYY. So we see an increase in dehydration. In somebody who's already dehydrated, so people are taught when they're on the medication will often say, have, God, have the like hardest time pooping and I also have really hard, dry poop. That's why I have us looking at the poop and assessing that as part of this. So all of those pieces, we may have people who are, they have fatigue because when the
medication stays on.
It keeps you in this metabolically active time. And as a result, we don't see as much of the rest and digest that's occurring. We understand, you'll take that to the pelvic floor and understand what that's doing. So all of these factors on an agonist. And look, I love the tool. Like it is such a good tool. I am such a good user of it. I do think most physicians are not actually good users of it. I want to be clear about that. think as a dietician, as somebody who looks at total nutrition,
Ashley Koff RD (24:38.832)
and total lifestyle like you, where you're asking kind of all of these connect the dots about the body's ecosystem. I think we are asking questions and interacting with somebody's body in a different way. And as a result, we're connecting all of these dots instead of diagnosing an issue. So one key thing is you can't say that constipation, that everybody should just have more fiber and maybe drink more water. We have to look at mutility as a factor. How are you moving? So in my book, one of the key things under movement
movement under that cheese is looking at midsection movement. How do we move the body? How do we make sure that the system, you know, that is designed to be active? How's that moving? But I also look very deeply at magnesium and vitamin C because of their role in making sure that we're encouraging that motility, etc. So one of the things to consider in this whole space is remember your weight, your weight composition is a factor. It's a key performance indicator of your overall operating
system. So if you're allocating fat in a place you haven't before, whether it's, I'm putting on belly weight or I'm making visceral fat, we need to decode that and come in and understand what's going on. And one of the things that happens for women around the perimetapausal time period and then extends into menopause is the like EKG machine looking of our hormones for, five or 10 years, you know, where they're going crazy. Every time our sex hormones shift, they actually throw the digestive system off course.
So that interaction there means they naturally are impacting our weight health hormones. That's why we see belly weight. That's why we see visceral fat. That's why we see blood sugar issues, you know, and other things. So in all of that, I think you're so smart to come over and say, like, don't look at a symptom and treat the symptom. Come in and say, that's a signal and we need to decode that signal and really look at it that way. Yeah.
Kim Vopni (26:33.082)
Yeah. Something else you said kind of the not this past little segment, but just before you talked about the vagus nerve as being, is that part of the messaging system for the weight health hormones? And if so, how does that work? I haven't, I think of the vagus nerve as, know, it's the wandering nerve. It's the, it's like this so, so full of information and so
Ashley Koff RD (26:41.101)
Mm.
Kim Vopni (27:00.25)
key for so many things and usually vegas means down regulating and you know if you if you want to kind of get into a sympathetic parasympathetic state you want to stimulate the vegas nerve right and so if i think about that being the messenger for the weight health hormones as you say i'm curious about how that mechanism works
Ashley Koff RD (27:11.756)
right.
Ashley Koff RD (27:21.324)
Yeah, it's fascinating. I think this is one of the most important things to unpack in this space is that your messages that send signals to the gut for weight health hormones to be deployed, to be secreted, come via the vagus nerve. Now they come also from our mouth, from taste receptors and other things, but the vagus nerve significantly. So we'll talk about that in a second. And then when they're secreted, they go either by the bloodstream, but to get to the brain and to
to get to receptor sites, they also go back by the vagus nerve. So it is the transport system for weight health. And one of the things for these weight health hormones, one of the things for us to now unpack is, okay, so if the vagus nerve is under-resourced, and it means it doesn't have an optimal amount of things like choline or, you know, other omega-3s or other things in the body, and as a result, the vagus nerve isn't getting the nutrients it needs, that's gonna be a factor. But what about our stored trauma, right? What about the trauma
that we've accumulated throughout our life? And then also, what about the traumas associated to just a society where we have so much messaging around food and food choices? I can look out my window literally, and if I kind of lean around, can see a Starbucks, I can be on my Instagram seeing what I should have. can be in all these different things, and it's like message, message, message. So the vagus nerve gets overwhelmed, right? It's overwhelmed, it may be under-resourced, it may be, frankly, challenged from poor
sleep, it may be challenged from lack of movement or poor like body structure. You know, I have to one of the things I learned early on and our mutual colleague has helped me a lot with is my posture. You know, I used to be cousin my belly. I used to like stand a lot with my belly sticking out and kind of in these things. And you're like, OK, that wasn't better, not just for your pelvic pelvis, but also for your vagus nerve. You know, so, you know, look at this. So you nailed it there. And if that's the cornerstone for rest and digest for this parasympathetic for the
body's ability to relax, then we have an issue there. And what happens when you're on a GLP-1 agonist is...
Ashley Koff RD (29:27.842)
the body, the medication goes into you and then goes directly to receptor sites. So it totally circumvents the vagus. Like it just doesn't that whole system doesn't need to work. That's amazing because for those where it's not working well, that's going to be like, OK, I don't like I don't have to rely on it. Right. It's like you don't have to take a freeway that's got a ton of traffic. And instead, you just like, you know, jets in yourself to the location, you know, or whatever on that part. Here's the issue. It means we don't address the underlying
dysfunction that's there, right? And that dysfunction shows up in a variety of places for us, for sure. Yeah.
Kim Vopni (30:04.294)
That's super interesting. And I think, you know, exactly as you just said, we bypass that system, which sounds glorious. And yes, you're going to get your results that you want, but you're now, I think of all the other things that the vagus nerve is going to be helpful for. And it's just going to be taken out of, of all the other things as well. It that that whole rest and digest and yeah, that's crazy.
Ashley Koff RD (30:26.978)
Yeah, somebody asked me, they were like, why do you have us doing our BOLT score and looking at our breathing or looking at heart rate variability? And I was like, okay, first of all, like, because I wanna know how your whole operating system is working, but as it relates to your weight health hormones, because it's gonna tell me like, if the pathways are the problem, like maybe you beautifully make and, you know, could deploy these, but you know, they aren't the pathways, the problem for you. So I think, you know, it would kind of be like, I think the analogy is very similar to when somebody goes on
a statin medication and says like, I'm not making more cholesterol. Yay. Okay. But like if you haven't fixed the, if you haven't optimized the lining of your, your blood vessels, if you have plaque in there, if things are building plaque, if there's tension, you know, all these other things, you are leading towards a heart health crisis, cholesterol, low or high doesn't matter on that part. You know, so I think like that's really important for us to understand, you know, sort of the conceptually how key it is to, pay attention to the vagus nerve as well as the blood.
stream. Yeah.
Kim Vopni (31:27.474)
A lot you've mentioned, know, this perimenopause kind of postmenopause, that's where usually we have some changes in our body composition and belly fat seems to be one of the things that is a big struggle for a lot of women. In my experience, when I was going through perimenopause, not knowing it was perimenopause at the time, knowing something fundamentally was off, but being told normal, symptom after symptom. Anyway, I go through this
Ashley Koff RD (31:40.813)
Yes!
Kim Vopni (31:56.652)
navigation, trying to research everything, one book leads to another book, that type of thing. Anyway, I start learning about the thyroid and I start learning how similar hypothyroidism and Hashimoto's and perimenopause, it's like the identical symptom list and that most people being diagnosed with Hashimoto's are women or hypothyroid are women but that
Ashley Koff RD (31:59.245)
Yeah.
Ashley Koff RD (32:03.778)
Yeah.
Ashley Koff RD (32:10.476)
Yeah.
Yes.
Ashley Koff RD (32:20.301)
Yeah.
Kim Vopni (32:20.73)
A lot of people are diagnosed with hypothyroidism that are typically autoimmune. So there's a whole piece there. And I want to know from your perspective with this GLP, if we're adding that now into the mix, is that going to complicate things from a perimenopause hypothyroid? I like thyroid all the autoimmune side of things or could it potentially be beneficial?
Ashley Koff RD (32:32.824)
Mm-hmm.
Ashley Koff RD (32:40.172)
Yeah.
Ashley Koff RD (32:47.98)
Yeah, I love thinking about the thyroid and the whole ecosystem, right? Cause it's this metabolic engine and it, it's so small, but so nutrient needy, like it's like our brains, it's like, I need the nutrients. And it also dictates so much that happens in the body. So it's a key part of our, weight health system, know, ecosystem in that space. And, know, one of the things that I think often happens is we just, first of all, we don't diagnose it effectively. we have been taught to look at TSA.
H levels, you know, I think we've got to look at T3, T4, reverse. We also need to look at inflammation. We need to look at things that, you know, factors that are, you know, nutrient things like vitamin D, you know, and others in that space. And so understanding how the thyroid is functioning is really important and not just coming in and trying to, you know, make the thyroid run better, right? But I feel like that's what everybody Googles as soon as that belly shows up. Is my thyroid low? You know,
Cause it's like, you just kind of want to sit there and be like, I feel like I'm trying the other things. I'm strength training. I'm eating protein. I'm, you know, for me, it was the fat that I love. can have a whole fasting conversation, but I, you know, I just kept shortening my window and shortening my window and being like, I'm just going to have coffee for longer in the morning. I'd read fasting like a girl. like, I'm doing it like a girl, you know, like all of that stuff. And I was like, I mean, I was blowing up inside and externally, you know, and having that belly issue. And then I had one or two, thyroid.
antibodies be elevated. And I was like, stop. Like this is never, I'm like, I'm not an autoimmune. Like what's going on here? So there are several things to unpack. Number one, nutrient resourcing. We need to give our body optimal amounts of nutrients. Yes, digestion needs to make sure we can use them, but we do need to get in optimal amounts. The amounts that we've been given as markers for what are the levels we should think of are what I call really dumb amounts. I borrowed that from the RDA, like historically they are so suboptimal.
and they also don't acknowledge lifestyle, like time, life stage changes, you know, and things like that. So, you know, vitamin D is not just about our immune system or is not just about our bone or is not just about, there's a lot of roles for vitamin D in the body. And so when it's suboptimal, that means that the thyroid might not be what the body is choosing to prioritize for delivering that. We also need to look at things like iodine and iodine is something that,
Ashley Koff RD (35:15.246)
you know, we've because of salt being eliminated and changing to sea salt and iodized salt. And, you know, it's just not as much iodine that we're getting in. And so we can see that where there's an insufficiency, there might even be a frank deficiency, you know, on that part. So resourcing becomes really important on that part. And, you know, something like magnesium, our current dietary recommended intake is from 1997. It's a last century. It also is for a 135 pound woman.
That will never be me again. Like that I passed out the years ago and like I'm very comfortable in my body my weight not me and then the other part is a 165 pound man and it infers that men need 20 % more magnesium than women and when you think about that magnesium does this relaxation of our muscles encourages parasympathetic turns off our stress response Helps our muscles relax. You know, if you've ever had one uterine contraction I think you can say I least need as much magnesium as a man like that's just you know
on that part and my weight has nothing to do with it. So suboptimal resourcing is really gonna impact your thyroid function on that part. And then the autoimmune P's, one of the things we also need to understand is that inflammation has been this idea that we are either pro or anti inflammation, right? Eat foods that are anti-inflammatory and it doesn't work that way in the body. The inflammatory response is very important. It's important for inflammation to occur so that the body gets the signals that it needs to help itself and it needs to recover.
But what happens is we don't often resolve inflammation and there are specific resolvins. Aspirin is actually one of them that in our body and that's what differentiates say like aspirin from other non-steroidal anti-inflammatories. resolvins are made from omega-3s and omega-6s. So anybody that tells us that we don't need omega-6s or that omega-6s are inflammatory doesn't understand how the body works. They're a core part of our body's ability to resolve inflammation.
including the often, you know, arachidonic acid, is, you know, blamed for every, you know, bad thing in the world. Right. And so when I come into this, one of the key things is to look at, you nourishing your thyroid? And one of the biggest reasons that I think this time period is key for us to understand is that so many of us, just like when I was my young, you know, 10, 12, 18 year old self, I was so suboptimally nourishing myself because I saw belly fat as something that
Ashley Koff RD (37:44.848)
if I reduced my intake and if I exercised more, I could actually lose belly fat. And what the body is actually saying in perimenopause is you need to triple down on nourishing me. You need to focus on building me. Any place where I have building deficits that throughout your life, you if you had disordered eating when you were younger, your bones are not, you know, weren't built as strong, it's going to show up now. If you are now leaning into
to not eating for longer. If your mood, your energy, your cortisol, like it's going to show up now. So long way around to your very specific question, that thyroid is essential in here as it relates to weight health hormones. So then what happens is, if we go on a GLP-1 agonist as a solution and not a tool, we don't put it into a system that is able to optimally nourish the body and we cut back on our nutrition. That's a form of suboptimally nourishing our thyroid. And so we will exacerbate that
dysfunction. And what's really interesting is more women are being recommended GLP-1 agonists right now because it's being seen as, and it does have very potent inflammatory response enabling effects. So people are saying, well, if it helps with inflammation, it's going to help with my autoimmune thyroid, or it's going to help with, you know, overall thyroid function or any of these other things. And it's like, it can, but it can absolutely exacerbate that dysfunction. So it's a really, I love the way your mind works. Like where you're going,
Kim Vopni (39:14.214)
Mm-hmm.
Ashley Koff RD (39:14.512)
because it's like, nailed it. Like that's so important for us to pay attention to. Yeah.
Kim Vopni (39:18.514)
Mm Yeah. And that I had written down inflammation because that's what you hear a lot is like this is so great for and you micro dose it and your inflammation goes away. And so so I guess I want to kind of come back now to what are the what would you say? When would you say GLP is are good?
Ashley Koff RD (39:22.253)
Yes.
Kim Vopni (39:38.643)
What would you want to have in place first? Because some people make the argument, well, the GLPs help with that initial weight loss, reducing inflammation can help with a motivation maybe to then go and put the fundamentals in place. And then there's others that say, no, no, no, we have to have the fundamentals in place first. And then maybe you don't even need the GLP. So how do you approach it to ensure that it's being used responsibly, effectively, and not having the detrimental effects?
Ashley Koff RD (39:51.905)
Yeah.
Ashley Koff RD (39:57.408)
Yeah, I love it. Yeah.
Ashley Koff RD (40:05.623)
Yeah.
And I have 20 years of this, right? So like in that space, I want to double click. You did an incredible episode with a colleague and friend of mine, Dr. Tina Moore. And one day we're texting and I just was like, yeah, we lost. Like we lost the battle of the conversation, you know, for her work, which was to expose the benefits of microdosing. Low dose semi-glutide interzepatide is being called microdosing. So I want to acknowledge that because when I, try to just always say low dose, but since it's being the marketing term,
that's out there is microdosing and all of those people. Here's the thing, a lower dose is one of the pros and considerations. The only con with the medication is using it without any of this other stuff or somebody who is selling it to you as a solid solution itself. Like take this, measure your body composition, eat more protein, take more fiber and do more exercise and you'll do great in life. No, that's not it. That's a con. But considerations are very important.
considerations is what is the better dose for you. So like I had a woman in this life stage come in two days ago and has a history of eating disorders, has family cognitive decline, has heart health, very severe heart health, family history and her own, you etc. And I was like, she's like, you know, I'm kind of I don't know if I should stay on this. What are the long term? I'm like, I actually think this is a great medication for you. I actually think we're going to be able to keep you off other medications, but we have to use it differently.
You're on too high of a dose. is making you so fatigued. It is, you know, you're feeling like your digestive system is shut down. You're not getting that recovery. So let's optimize. So let's reduce dosing. Right. And I am a dietitian. I'm not a doctor. And so I will have that conversation, you know, but she also wasn't working with a doctor on this. So I'm like, all right, let's, you know, have this conversation. So I also wanted to engage her practitioner, you know, to engage her physician in it. So I think some of the considerations are what's the better dose. And that might be how frequently you use.
Ashley Koff RD (42:06.968)
and it might be what level you're using it at. The second thing in that space of thinking about application that I think never gets asked about is we have to budget. So we have to look at, and I don't care if you have like every resource under the sun, many of my patients do, like finances, I mean, they still care about their finances, but finances are not a limitation and they have choice in their food and their supplements and flying to all these places or whatever, but they're also traveling a
and flying to all these places. So I'm like, you need me. And my services are not myself or my colleagues. Yes, I make them accessible. I try to make them affordable. But we are not, you can't just go on the medication. So you need to be able to afford that. I may need you to afford its supplementation and maybe some specific, like actually some expensive, maybe it is 10 or 12 supplements in the beginning because I need to make sure that your system is optimized and
I don't know that you're going to be able to get what I need you to get from food right now So I'm just kind of doing a total nutrition thing, right? Like can we get this in and then let's see if that's what's working and then let's lean into trying to have you get to a place where you can get more of it in from food so the budgeting of For and I like to budget out for a year because if you say to me I think I might be able to budget for the medication for the year, but I can't budget for you We're gonna have a whole other conversation and that conversation is gonna be like maybe we need to shift the amount you're
or these other pieces, or here's how I'm going to bring forward my services, or I'm so glad I wrote this book, because at least we can do some of this together, and that kind of thing. So we've got that side. And then the third one that I think is really interesting of the when is, there is a really great question of chicken and egg here. There's a great question of, I have tried all these things. So I, Ashley Kaufardee, 48 years old, am like, okay, I've tried all these things.
and I feel like this isn't working for me. And I'm so like, I'm just kind of at the end of my rope. You know, I feel like I'm feeling not hopeful. I'm feeling, you know, in that space. So at that point I could say, well,
Ashley Koff RD (44:18.292)
I'm going to do this and be able to see. I could also say, you know, I might lean into, there's a couple of different supplements that are called GLP-1 activators. There's one that I use that's a hops from New Zealand and it gives me about four hours of appetite and
Kim Vopni (44:37.33)
Is that callocurb?
Ashley Koff RD (44:38.35)
that callocurb, yeah, about four hours of, you know, of appetite and craving and like food noise coverage. And so in a day, like I might be able to add that up, you know, four and eight hours, right? And be able to do that and not negatively impact my sleep. And that might be what works for me, right? For someone else, their trauma, their lifestyle, their access, the other pieces, they may benefit from the medication. So I think the question mark is, to me,
there's one key takeaway from this conversation is it is never an either or. It is never about I went on the medication, let's go back to your friend in the beginning. It is never, well, I just decided I don't want to do those other things. I'm going to go on a GLP-1 agonist. An agonist is not a solution and it is absolutely going to be a problem for you if you don't do weight health hormone, weight health optimization in collaboration with it. But for anyone who
does not need, does not have access to, does not want, whatever the story is, a medication, you can do what we need to do for your body with weight health hormone optimization. And if you hit a place where you are stuck and you then feel, I now actually feel like I want to try the medication, then I can go that route. And I guess the closing point on that is people ask me all the time, well, do you have to stay on this forever if you go on it? And yes,
Absolutely. If you don't do any of the optimization, if you don't fix anything underlying, is overriding your own. It is coming in and satisfying receptors at an exponential level. and it is driving functional change in your body. If you just go off of it, you're going to go right back to where you were before and very quickly. And that's not better for your body. The other side of it is, can you come off of it? That like doesn't need to feel like this goal. Like you're not a successful person. If you've used this medication and come off of it, your success,
if you figured out how to optimize your own weight health, right? And what tools you need. But you may decide or we may collaborate and say, we're going to bring you off the medication. And then we track and we see. And then if life happens and suddenly, know, menopause hits you and you're like, my gosh, I need this thing again. Great. Then we use it again. Or if suddenly you're like, you're on it and you're like, I'm pregnant now and we're not on it. Great. We're not going to be on it. And here's what we do. So I think we have to shift a lot of the conversation.
Ashley Koff RD (47:07.96)
around the usage, but pros and considerations are how I tee up when it's appropriate.
Kim Vopni (47:11.507)
Amazing. You've mentioned your book a couple times. We don't know the title. So where can people, what's the title of book? Where can people find it and where can they learn more about you?
Ashley Koff RD (47:17.358)
Yeah, that's right.
Ashley Koff RD (47:22.722)
Thank you. Hopefully you can find your best shot anywhere. It's your best shot, the personalized system for optimizing weight health, GLP one shot or not. So it's really my point of view from a weight health standpoint. And I chose your best shot a little bit, very, not a little bit, a lot as a double entendre. I want this to, this is your best shot at longevity, at optimal health. And I believe like myself, when you are battling your weight health and your
body feels like it's not showing up for you or you really you have health issues and you can't show up in your life. You don't have your best shot of fulfilling your life purpose. So I wanted to write this book so that the people who are the person who's going to find a cure for uterine cancer is going to be on their path and able to find that as opposed to battling their own weight health, et cetera. So I wrote it for that reason. So anywhere you find your best shot, I think on All Social, I met Ashley Koff
for Ashley Koff approved. And then my company is the Better Nutrition Program. And we have in, when you open up the book, there's a QR code. We've created bonuses for you that are a little bit different. You actually get to come into our HIPAA compliant practice management tool and you can interact with our coaches so that if you have questions about what it is you're learning or what you're trying to decode as you go through this, you have a human that you can interact with and we can share great resources like
Kim's, know, and Vagina Coach Resources, etc. to direct you where you can find that better help. We're all working in this together. Yeah.
Kim Vopni (49:02.897)
Yeah, yeah, I love it. I love what you're doing. Thank you.
Ashley Koff RD (49:06.178)
Thank you.
Kim Vopni (49:06.704)
Thank you for heading down the path that you're on and for sharing your knowledge with us today. It was super interesting and yeah, I think I loved the episode with Tina as well and glad that you guys are collaborating on that. It's a big, big topic and we've only barely touched the surface. I loved how you brought in as I think about it. I was back to the pelvis, but yeah, so many little considerations in there. So thank you so much for your time.
Ashley Koff RD (49:16.045)
Yeah.
Ashley Koff RD (49:21.398)
It does.
Ashley Koff RD (49:29.08)
Yes, yeah.
Ashley Koff RD (49:33.58)
Thank you.
