How 'boosting' your immune system increases inflammation and 4 ways to support balance instead | Dr Giulia Enders

24:54So we've had this obesity epidemic. We've now got this drug, which is magical. But I think a lot of people feel like, well, I ought to be able to sort of take this thing and be cured. And you're saying that's not really the case. This is like an ongoing treatment.

25:08Dr. Ania Jastreboff:But is it depressing that if somebody has high blood pressure that they would have help from a blood pressure medicine? Or is it wonderful that we have treatments for people, that we have options for people, whether they have high blood pressure, whether they have diabetes, or whether they have obesity. And the added difference with obesity is that obesity is related to over 200 obesity-related diseases. And so if we treat obesity effectively and safely, then in essence, aren't we preventing, mitigating or treating over 200 other diseases. And that has an incredible impact on the health of our world.

25:53So I totally agree with that. I think that what probably quite a lot of people listening will say is, yes, but why are we in that situation in the first place?

26:03Dr. Ania Jastreboff:Our obesogenic environment. We have to work on our obesogenic environment. There's no debate. So as we are hopefully changing and reshaping that obesogenic environment to be a default healthy one, that will help prevent obesity in those who don't yet have it. But for the people who have obesity, if they are seeking treatment, we would like options for them. I love that. And I love the passion comes through really, really strongly. So I would love now to talk about like our latest understanding, you know, we're here in 2026 and this is obviously, you know, I think you paint a picture of how fast this has been moving and you've been at the center a lot of this research.

26:45Before we do that, I think there's an important topic that I'd like to touch on briefly. Most drug studies are funded by the drug manufacturers. And I know that this has been true for like all four of those studies in New England Journal of Medicine. And I think the question that a number of listeners are going to have is, well, does that mean that I can't trust the results? And does it mean that I can't trust you?

27:12Dr. Ania Jastreboff:Yeah. I mean, it's a really great question. And I think that for any disease, this is how we develop new therapies. It's working together. A company may not be seeing patients in clinic. They may not know what the patient is asking for, what the patient is experiencing, in the same way that I'm not in the lab making the medicines, nor are my colleagues. So I think it's really working together, just as we would for any other disease, any other complex chronic disease. Will you just talk me through for a minute how science makes sure that these results are in fact true? Because clearly there's an enormous amount of financial interest from a pharmaceutical company to prove that this drug is safe, there's no side effects, and it works really well because then they make billions of dollars of revenue.

28:10How, as science and scientists, do we make sure that we don't just get fake results?

28:16Dr. Ania Jastreboff:Yeah, absolutely. It's incredibly important. So there are multiple steps that these studies have to go through. There is constant communication with the FDA, the EMA, to ensure that the steps are taken and that the trials are conducted in such a way that they demonstrate, are these medicines safe? Are there toxicities that we would be worried about? Are they effective? And there has to be a balance. So this actually brings me to one thing that you asked about in the very beginning, which is this micro dosing. All it means is little dose. Now we use little doses for our patients all the time. Maybe the patient only needs a little dose, right?

28:58Dr. Ania Jastreboff:Maybe they don't need the larger dose, which is very common for any disease, including obesity. But the medicines haven't been studied in people who don't have obesity, right? Maybe overweight with an obesity-related disease, but not without that, right? And so the FDA doesn't have the data needs to know whether the risk to benefit ratio is a good one for someone who doesn't have obesity, who doesn't have overweight with an obesity related disease. That is exactly why we do the trials. People listening may be wondering, are you employed by one of these pharma companies and do they get to just write the paper and then it gets published?

29:39What's the actual situation?

29:41Dr. Ania Jastreboff:Yeah, no, I'm not employed by any of the companies. I do serve as a scientific advisor to many companies, as many of my colleagues do in every field of medicine. In terms of the papers, I write every word. You have authors that are academic and you have authors that are from the companies and we work together. But for the papers that I lead as a first author, everyone knows I'm going to write that first draft. I'm going to integrate all of the different feedback from all the authors, the academic authors, the authors who are sites for the trials and from the companies themselves. So integrating all the comments and then working with the journal and getting feedback.

30:25Dr. Ania Jastreboff:We get peer reviews, right? So external experts who are reviewing our papers. And I love that rigor. Can we talk a bit about what the latest, I guess, facts are about these drugs. And maybe we could start with what the latest trials reveal about how much weight can be lost from these newer versions of these drugs. Yeah. I don't even want to say long ago because it wasn't that long ago, but the threshold that the FDA set for these medicines was losing at least 5 % of your body weight, right? So if somebody weighed, let's say 200 pounds, that would be 10 pounds, or let's say somebody weighed 100 kg, it would be 5 kg.

31:10Dr. Ania Jastreboff:That was the threshold that was set. Now that seems like a pretty low bar. Why was that threshold set? It was set because with diet and exercise, if somebody lost between 3 and 7 percent of their body weight, there would already be metabolic benefit. For example, if they had diabetes, it may improve their blood sugars. If they had prediabetes, it may help prevent it. So with that degree of weight reduction, there was already health benefits, right? And the FDA wants to know what are the health benefits of what we're doing, right? So that's why that was set. Now with the newer medications, we started seeing weight reduction of more than 15%, more than 20%.

31:51Dr. Ania Jastreboff:And now the medicines that are to come, we're looking at weight reduction that's 25%. 25%. Maybe 30%. 30 % of your body weight. And then you're approaching what you would see with bariatric surgery, with weight loss surgery. And not only that, if the medicines are targeting different mechanisms, you can use them in combination. So if a medicine has a GLP-1 receptor component, you don't want to pair it with a medicine that also has that component. But if you have a medicine that, for example, targets GLP-1 receptor, GLP-1 GIP receptor, and then you have an amylin analog or targeting some other receptor, you can pair them for additional weight benefit.

32:37Dr. Ania Jastreboff:And we did this, and we still do this with older medicines. There were medicines, and there still are medicines for obesity treatment that are not GLP-1-based or not nutrient-stimulated hormone-based medications. And we use them in combination. But I'm going to just come back to one very important point, which is that it's not just about the weight reduction. Yes, weight reduction is important for health. Treating obesity is about improving health. It's about optimizing health. So it's weight as well as some of the direct peripheral effects of these medicines. So, Anja, can you tell us what the latest data tells us about the impact of these drugs on actual health conditions?

33:18Dr. Ania Jastreboff:So, one, we of course see that these medicines result in weight reduction in treating obesity and reducing adipose, right? Reducing fat mass. We also see improvements in heart health, kidney health, improvements in lipids, improvements in blood pressure. I'll give some examples. So with semaglutide, we already know that it can improve heart health in terms of preventing a second heart attack or stroke in somebody who's had a heart attack or stroke. And now semaglutide is approved for people with cardiovascular disease. Obstructive sleep apnea is another common obesity-related disease. And now, trisepatide, there's a trial that was conducted with trisepatide, Surmount OSA, or Surmount Obstructive Sleep Apnea, that demonstrated improvements in those who have obstructive sleep apnea.

34:06Dr. Ania Jastreboff:And now trisepatide is FDA-approved for the treatment of obstructive sleep apnea, a medicine. The medicines are being looked at for kidney outcomes, for blood pressure. Another aspect of health is liver health. So basically, these medicines are helping to remove fat from the liver. That can have a lot of detrimental effects on our health. Are these likely to end up being drugs that we start to think of as being valuable, not just in order to either lose weight, as many people listening to this will think about, or to deal with health conditions that are a direct result of obesity? The short answer is yes.

34:47Dr. Ania Jastreboff:As an example, trisepatide is FDA-proof for obesity treatment. The FDA calls it chronic weight management. It is also FDA-proof for obstructive sleep apnea. Semaglutide is FDA-proof for obesity treatment. It is also FDA-proof for cardiovascular disease, as well as MASH, a form of liver disease. So I guess to your question about will they be used for people who don't necessarily have obesity, I think the one caveat would be that if they don't have obesity and they're taking a medicine that causes weight reduction, we'd have to balance that, right? Because then you'd want a medicine that maybe targets those things but doesn't lead to that significant amount of weight reduction.

35:37Dr. Ania Jastreboff:And the older medications that were GLP and receptor agonists, they didn't result in as much weight reduction. What actually happened was that the scientists wanted to extend their half-life, meaning help them to last longer in the body. So instead of taking them multiple times a day or once a day, those were the original ones, how do we make them last longer? A week or maybe a month, right? And as they were trying to make them last for longer, they found that they led to more weight reduction. And part of the thought is, by them acting longer, do they have more opportunity to do whatever it is that they're doing in the brain to act on those receptors in the brain?

36:21Dr. Ania Jastreboff:But by making them last longer, they also happen to have more impact on weight. We are in our infancy of understanding. Can we talk about side effects now? Anything that's new, I think there's always this question, how safe is this in the long term? What do we know about the potential long-term side effects of GLP-1s? And what level of concern should somebody have as they're thinking about that? Yeah. So the most common side effects are gastrointestinal, nausea, diarrhea, constipation, and in some instances, vomiting. These are quite short-term effects, right? Like I'm going to get that side effect quite rapidly after I start to take the drug?

37:04Dr. Ania Jastreboff:Yes. Usually if people have side effects, it's at that start and when the dose is increased. Are there any known long-term effects that maybe you don't feel at the beginning, but are risks that will build up if I keep taking these drugs for years? Well, there are rare side effects that we talk about with our patients so that they know and they can look out for them. One is increased incidence of gallbladder disease. So with any form of weight reduction, whether it's bariatric surgery or diet and exercise and these medicines, there can be gallbladder disease. And so we counsel patients, if they have abdominal pain, that they shouldn't ignore it, right, that they should get treatment for it.

37:47Dr. Ania Jastreboff:Most often, patients can resume taking the medicines, right, once their gallbladder is removed. We also continue to monitor for pancreatitis. So pancreatitis is increased in people who have type 2 diabetes versus people who don't have type 2 diabetes. So we don't use these medicines in people who have pancreatitis or, you know, acutely are having pancreatitis. Or if they develop pancreatitis, then we stop using the medicine. Again, we cancel our patients on abdominal symptoms so that they know. There are other things that patients come to us after they've lost a significant amount of weight. So hair loss is one.

38:25Dr. Ania Jastreboff:And we saw this with bariatric surgery. When patients were losing a significant amount of weight very rapidly, they would experience hair loss. And we can see this with these medicines as well. Other things that have come up and questions are muscle loss or bone loss. Again, these are things that we see with any form of weight reduction. And now they're coming up with these medicines because people are losing a significant amount of weight. And this brings me to a very important point, which is that when these medications are taken or prescribed, they need to be paired with healthy diet and physical activity.

39:00Dr. Ania Jastreboff:Because the goal of obesity treatment is improving health. And there's no medicine out there that can help us eat more healthfully or move more. And so really for optimizing health, it's pairing both. It's pairing the medicines that help recalibrate the amount of fat that your body wants to store with the healthy diet and physical activity. One thing I'm struck as I'm listening to that is the risk of taking the drugs for a short period of time, losing a lot of weight, then coming off the drug for whatever reason. And you're saying you should stay there and then getting back. Zach, and I think about this because we've talked a lot about the problems of doing this through yo-yo dieting, right?

39:42That's come up often on other podcasts. But here you can do something really extreme, right? You're saying you could lose 30 % of your weight and then come off it. Are you potentially in a worse place if you do that because you sort of lost the muscle through this, then you go back on? And so you really, really want to make sure that if you're going into this, you're describing, you know, you need to be aware you're going to have to stick with it.

40:04Dr. Ania Jastreboff:There's one study with loraglutide and exercise. It was published in 2021. And the people who paired loraglutide with exercise did better in terms of maintaining their lean mass. And obviously the medicine was helping in terms of the fat loss. Do you know someone who's on a GLP-1 like Monjaro or a Zempik? Or perhaps someone who's thinking of starting one? Maybe like me, you know, people who've tried a GLP-1 and then given it up. If so, why not share this episode with them right now and replace social media noise with the very latest scientific information about GLP-1s in 2026. In a world where we're surrounded by conflicting messages and influencers making bold claims, why not share clear science-backed insights?

40:51I'm sure they'll thank you. So I'd love to pull all this together now and say, OK, we've talked about all the science. What does this mean for like a real person who's considering starting out on one of these new therapies? We talked a lot about living with obesity. How do I translate that to me saying, well, I weigh this amount. Like, is this relevant for me?

41:16Dr. Ania Jastreboff:The studies have included participants who have BMI, a body mass index of greater than or equal to 30, or a body mass index of greater than or equal to 27 with an obesity-related disease, like high blood pressure, like high cholesterol. The studies have also looked at people who have type 2 diabetes, irrespective of BMI. And could you just paint me a picture? So if I have, for example, a BMI of 27 or 30, what does that mean? Greater than 25 is greater than or equal to 25 is overweight. Greater than 27 was a midway point that was chosen within that overweight range. But if you look at the labels, so the FDA labels for semaglutide, trisepidide, if you look at the labels for these medicines, what they actually state now is overweight or obesity.

42:11Dr. Ania Jastreboff:They don't state the BMI criteria for the indication, right? So it's looking at the whole individual and seeing where is the data in the trials and then what is the risk to benefit ratio for that person. And so are these just sort of slightly arbitrary cutoffs that, you know, you and others used in trials to decide who's in here? and we don't know that it won't work great if your BMI is 26 or 25? Or do we know like this really only makes sense as you're starting to get into those levels? So it's not arbitrary. It's based on morbidity and mortality. So it's based on older studies. But again, BMI is not a great measure.

43:02Dr. Ania Jastreboff:It was designed as a screening tool, not a diagnostic tool. And so we really need to, if we're going to continue, which I think we're going to continue using BMI, we need to revamp it by age, sex, and race, ethnicity. That's what we need to do. Yeah. Yeah. So let's say you go and see your doctor. They say, yes, this makes sense for you. We want to start. What should you think about as you're about to begin treatment? And I'm particularly thinking that a lot of people drop off these drugs quite quickly. So what do you need to do to maximize your chances of this succeeding? Because after all, you told me I need to be on this forever, right?

43:42So I need to make this work.

43:44Dr. Ania Jastreboff:Yeah. So, I mean, my approach with patients is I I like to see where they are, what their expectations are, what their goals are for their life, not just for this, but in general. And I always start with the biology. So there's a shared understanding of what the disease is and what we're trying to accomplish and do. And then I invite them to ask questions, right? So I invite them to ask me questions about side effects, about potential other things that may happen beyond weight reduction, right? When somebody loses a significant amount of weight, there's a lot of things that change in their life.

44:19Dr. Ania Jastreboff:So we start to have that conversation. And a lot of that first visit is focused on what are the side effects and what are ways to mitigate those side effects. We learned very quickly not to go up on the dose quickly. And most of my patients do not go up once a month. Also, even if they're not having side effects, if a patient is losing weight on a certain dose, we don't increase. That dose is working for that patient. There's no need at that moment in time to quickly dose escalate. The weight did not come on overnight. Why would we want it to come off overnight? Now, what are ways that you can help mitigate side effects besides start low and go slow?

44:59Dr. Ania Jastreboff:There are several things that I talk about with my patients. One is not eating past the point of fullness. So you're going to feel full earlier. Tracking which foods may exacerbate your symptom. That's the second thing. Our patients tell us that fatty foods tend to exacerbate their symptoms. For some people, it's spicy foods or carbonated beverages, but fatty foods seem to be a common theme. So eating less fried foods, less French fries or chips, right? Eating less of those foods while your dose escalating. You can always come back to those once you're at a stable dose and you plateau. And sometimes I have people just keep a diary, right?

45:37Dr. Ania Jastreboff:It's hard to keep track of what foods you may have eaten. Then the third thing is eating more frequently but smaller amounts. And then the final thing is staying well hydrated. So being dehydrated can actually exacerbate people's nausea. And when people are less hungry, they also tend to be less thirsty. And food has water. So if somebody's eating less food, they are also taking in less water. So that's the final thing. Can we talk about the quality of the food now? And of course, on this podcast is bound to be something that we think quite a lot about. There's been a lot of discussion around the fact that you're suddenly eating much less than before and that many people on these drugs probably haven't been on the best diet anyway, because part of the challenge of, you know, the obesogenic environment, as you're talking about, it's like all this ultra processed food and all the rest of it.

46:27But certainly if you suddenly reduce the amount you're eating, then what if any other challenges around getting the nutrients that you need? And I guess on the more positive side, what do you see about the opportunity in this moment to actually change what you're eating and improving the quality of what you're eating?

46:48Dr. Ania Jastreboff:It's almost like putting yourselves in the shoes of someone who has obesity. someone who has experienced food noise or just they finish their day and they have followed this plan that they laid out of this perfectly healthy breakfast, lunch, dinner, and then after dinner they are hungry. They are pulled towards the ice cream in the freezer or the cookies or the biscuits in the pantry because their body wants them to get more energy. Their body wants to get them to that higher set point. And now they take the medicine and all of a sudden their brain says, you have enough. You don't need to eat more.

47:37Dr. Ania Jastreboff:Now, we have not gotten to the state yet where we can have medicines that change food preference, although there's a caveat there. Maybe some of these will, we don't know yet. We have to do that research. but the freedom that patients now have. And so that freedom could be, okay, well, they also impact, for example, alcohol intake, right? Some of these medicines. So somebody doesn't want another glass of wine, right? And instead they'll have the water, right? Or they don't want another bite of the chips. Is there anything that you would be saying, look, I think it's really important you focus on these couple of things in your first six months, say, on these drugs?

48:19Absolutely.

48:20Dr. Ania Jastreboff:Number one, hydration. Very important. Prioritize protein, vegetables, fruits, all the things that we talk about, whole foods, to the extent that is possible within that person's sphere, within what that person has available to them. In terms of your question about protein and other things, because people are full earlier, what I advise is try and eat those foods first. because you're going to get full earlier and we want your body to get all the nutrients that it needs in order to be as healthy as possible. If the dose is escalated too quickly, what we don't want is somebody to be eating very little and not to be able to get in all of those healthy, nutritious foods.

49:04Dr. Ania Jastreboff:That is rare, but this can happen in some patients if we're going up too quickly on the dose. So it's super important to not go up on the dose too quickly. If I'm going up on this dosage a lot faster than you're describing you do in your patients. I would not advise that. And, you know, I think there's a lot of people who get these drugs, you know, online in some way with quite limited amount of physician support. I think that is the reality for a lot of people around the world. Are there any particular risks that they should be aware of to watch out for in that situation? Yeah. These are not weight loss drugs.

49:42Dr. Ania Jastreboff:These are not weight loss aids. They are medicines, just like a blood pressure medicine or a medicine to treat your heart disease. These are medicines. Would someone take a medicine for their blood pressure or for their diabetes without the compassionate care of a provider? There are absolute detrimental effects. There are negative things that can happen if the dose is escalated too quickly, if it's escalated inappropriately if a higher dose is taken than is needed or a higher dose is taken at the outset, right? Somebody doesn't dose escalate, maybe because they don't know or because the person who's providing them with the medicine didn't know.

50:22Dr. Ania Jastreboff:So it's incredibly important to make sure that the medicines are treated as medicines and they're provided in a safe way as we would any other medicine for any other disease. It's really interesting to hear you talk about that because I think there's so much noise about this. People find ways to get this without ever physically seeing a doctor. And I think it is treated almost like taking a vitamin supplement that you might be able to take. It's not treated with the sort of seriousness that you're describing. What is your message to someone who is thinking about it like that? Talk to your health care provider.

51:00Dr. Ania Jastreboff:Talk to your primary care doctor. Ask the questions. This is new. The healthcare field is catching up, but find healthcare providers that can help you along this journey. I feel like that naturally pulls me onto a question I asked right at the beginning about people so-called microdosing on these drugs because as they're getting older, they want to stay as thin as they were when they were 25. What would you say to people who are doing that or thinking about doing that? We don't have the evidence yet. We need to know what the risk to benefit ratio is. And in the same way that anytime somebody comes to us who has obesity, there's a choice to be made.

51:41Dr. Ania Jastreboff:You asked me very early on about, should everyone take these? Well, if somebody is seeking treatment, we should give them options, but we need to present them with the risk to benefit for those treatments as we would for any other disease. Are there any natural ways to increase your levels of these GLP-1s to sort of manage your hunger, you know, long before you end up in the situation where you're with this, you know, this disease of obesity? We don't have a way to do that at this point. There are ways to help prevent obesity from developing. And those start early on before the onset of obesity, right?

52:21Dr. Ania Jastreboff:So being physically active, moving, eating a healthful diet, all those things help prevent. But just let's not forget that there is a strong genetic component to obesity. And it's not just your parents. At this point, it's your parents' parents. We don't know when those changes, those recalibrations of the set point occur. Do they occur in utero? Are they generational? And I would argue that they are. There is one other topic that I really wanted to make sure that I got your answers on, which is around exercise while you're on this drug. That's another area where there's been a great deal of discussion.

52:58What is your view?

52:59Dr. Ania Jastreboff:It's very important. It's very important. So at that first visit, we talk about side effects and we talk about healthful diet and movement, whether that's to maintain muscle mass, muscle function, which is even more important than muscle mass, any incorporation of physical activity or movement into the day. And let's not forget about resistance exercise, right? So it's cardiovascular and resistance, but meeting the patient or the person where they are, right? Wherever they are, adding a little bit, and then along the way, as they lose weight, adding in more and more and more. We're at time, but I'd like to ask one final question.

53:41Imagine that you're sitting here again with us in, let's say, five years time. What do you think might be the most exciting next new thing that you might be talking about, which is like a dream of a study in front of us, but you could be sitting here talking about the results today?

53:59Dr. Ania Jastreboff:In the next five years, I'm hopeful that we'll have more than one class of medicines to treat obesity. There's more than one type of obesity. Not everybody responds to these medicines. So I'm hoping we have different choices, different classes. We will have, we already have, oral, so daily oral, weekly and monthly options, maybe even less frequent options. And most importantly, I think we will be five years farther in our understanding of how these medicines impact health, of how treating obesity impacts health. And I think that's the most exciting thing is how can we help our patients lead healthier lives.

54:48Amazing. And I'd like to do a summary of just maybe a few of the things that we've covered because we've covered a lot of things today. I mean, the first thing that's obviously striking is you said, when you went to medical school, you didn't even study obesity. None of these drugs existed. and now you're saying that, you know, the latest version of these drugs that are just going to come through can potentially deliver 30 % weight loss and then this extraordinary set of health benefits that follow. So this is really a sort of transformation in terms of this whole new class of drugs and the impact they have.

55:24The second thing I'm struck by is, you know, I thought of these as being GLP-1 drugs and you've corrected me and said, well, actually, that's not even right. You know, GLP-1 is almost like one lock in my brain, in my body that a drug can unlock to have benefits. But we've already found at least three of these different sort of locks as I was thinking about them. I think you described these as nutrient-stimulated hormones. And basically, there's probably loads more that we don't even know about. So potentially, we're going to continue to have impact. And that interestingly, although the weight loss is driven by the fact that these drugs change something in our brain that mean that basically we stop being hungry, we stop being surrounded by this food noise, we actually have these receptors, these lots all around our body.

56:15And that as we're expanding these drugs, they're having a lot of impact on other areas. It, in fact, started originally in terms of managing blood sugar. There's all of these new sets of drugs that are doing things around the liver, which seems really exciting. And there are already a set of studies, a number of which you've been involved with, that show that, for example, I think it was semaglutide. You said if you've already had some sort of heart attack or stroke and you take this drug, it dramatically reduces the chance of a second one, which is pretty magical. And that another drug, I think it was trisepetide.

56:48Trisepetide. These are tricky names. He said a 94 % risk reduction in getting diabetes. So these are like really big impacts outside of weight loss. You've also emphasized that all of these trials are about people living with obesity or who are overweight. And this impact can be life-changing. that because of what's happened in their brain, like this isn't something that, you know, traditional approaches were able to solve because, you know, we haven't talked a lot about it, but this whole like, you know, just count your calories, like none of this works. Well, it doesn't recalibrate. Because it doesn't change the set point that is in your body.

57:26But you're very cautious about what that might mean for people who are using these drugs who aren't in those categories with that level of weight. And I think really emphasize that this is, you know, it's a serious medicine. You want to make sure you have a physician looking after you and you're quite cautious about this. In terms of like what does it mean to actually be taking these drugs? The first is the main side effects are sort of gastrointestinal. So this is like nausea, diarrhea, constipation. And the key approach that you take in your clinic and your colleagues is start low and go slow, which means you know the amount that you're taking is not very high to start with and you don't ratchet it up really fast and you're saying if people are losing weight actually don't need to increase that whereas for a lot of people if you're ratcheting up the levels very fast and getting this very high weight loss you're also increasing the chances of the symptoms and that's a problem because what you're also saying is you've got to be on this for life so if you do it for a bit and then you have bad symptoms you give up actually you're just going to go back to where you were at the start so you need to get past all of these initial symptoms and you need to think about this, like taking your blood pressure medication, you're just going to take it for life.

58:38But you did have a bunch of other tips. The one you kept talking about was being hydrated, which is really interesting. Like you really need to drink with this. You need to rethink how you eat because suddenly you're going to eat much less. So you need to prioritize like the good stuff first. So all the things I think that we talk about on this show, you mentioned, you know, whole foods and vegetables and protein, like get that first because suddenly you're going to be full up much faster than before. And then finally, you know, I think on exercise, it was like a very positive message rather than being very anxious about this because you're losing weight.

59:08And what will this mean for muscle mass? Actually, many people feel able to do a lot more exercise on these drugs. And so almost as you're making progress on them, then suddenly you can do more. But of course, it's really good for your health. And that is something that you want to encourage all of your patients to do as they're on this journey. Yeah. As you can imagine, hosting this podcast, running Zoe, juggling family life, it all keeps me pretty busy. So I try as best I can to stay energized and show up well in all those parts of my life by fueling my body with the right food, by exercising, and by adding a scoop of Daily 30 to my meals every day.

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1:00:28By the way, whenever we talk about Daily 30 as a good source of fiber, we're required to say that it contains four grams of total fat per serving. Obviously, that's all amazing healthy fats from plants. So order yours today at zoe.com slash daily 30. Thanks for listening and see you next time.

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