Taking a Balanced Approach to GLP-1s

< Full Episode

Transcript: Taking a Balanced Approach to GLP-1s

Season 10, Episode 10  | April 8, 2025

[MUSIC]

Welcome to another episode of Life Time Talks. I’m Jamie Martin. And today we’re talking about taking a balanced approach to GLP-1s. We all know that weight loss drugs have been front and center in recent years, making lots of headlines for both their healthful benefits and, sometimes, their harrowing side effects.

In this episode, we’re talking about how short-term use of GLP-1s, when used in combination with intentional lifestyle changes, may be the healthiest path forward towards long-term weight management and overall health and well-being. Back with me for this conversation today is Jim LaValle. He is a clinical pharmacist, the co-chair of the American Academy of Anti-aging Medicine, the chair of the International Peptide Society, and the chief science officer for Life Time.

Hi, Jim, how are you?

I’m doing great. How are you doing?

I’m doing great, too. And I’m so glad to have you back for this important conversation. We know that these weight loss drugs have been, like I said, front and center for a while now. And we really want to talk about, it’s been a few years since we started hearing so much about them, the GLP-1 agonist, that type of thing, both positively and negatively in the news.

So let’s start first by having you talk about, what are the pros and cons about them potentially? And why are we hearing both — so much of both?

It’s a great question. I think it’s a complex question. I think the pros are that GLP-1s have given people hope that they could actually lose some of the weight that they have tried everything in the normal realm. I dieted, I exercised, I tried to count my calories. And nothing moved the needle on that scale.

And so I think the pros are that it’s another tool in the tool kit that when used responsibly, it can help people achieve a better body composition, which, we all know, better body composition means reduced health care risks. The cons are that people look at it as, first of all, as another magic bullet where I just do a GLP-1 injection or tablet, and that’s going to take care of my weight loss. And I don’t have to really try to improve the lifestyle that I have.

That’s one. And the second issue, of course, the other con is when people do too big a dose too quickly, that starts to create problems in terms of side effects. And there are side effects to these medications. So the pros are clear. I think the cons are reliance on them instead of really relying on the fact that, you know what? Taking care of yourself is a little bit of work, but it’s really worth it.

Yes.

And then if we can create a balance between those two, I think it’s a win.

Awesome. Yeah. I mean, it’s one of those things where it’s not just an either/or situation, it really is both and. It’s like when we talk about this in finding a balance, it’s probably a combination. It’s one tool in the toolkit of many things that we can do. Right?

That’s exactly right. I think if you rely on it too heavily, and think that — which a lot of people are doing. I mean, you can just go online and see hundreds places where you can get semaglutide and tirzepatide now. But the issue is, are they getting the right counseling? Are they learning how to eat appropriately? Are they getting enough protein? Are they exercising enough? So it absolutely is a great tool, but one that shouldn’t be solely relied on.

Exactly. Well, I want to just take a moment and go back. We had a conversation a few months back around GLP-1s. And we did talk about this. But I do think it’s important to talk about what GLP-1s are and how agonist came about as a result of this hormone.

Sure. So, I mean, a GLP-1 is a glucagon-like peptide 1 agonist. So all this is doing is it’s mimicking a hormone that your body should be making. But for some reason, when you gained weight — whether it was due to stress or the eating inappropriately, or maybe it was a lack of exercise, or any number of reasons why — it became very hard to lose weight.

Glucagon is a peptide that your body makes. Your pancreas pumps out glucagon. When you take a GLP-1, what you’re doing is blocking glucagon. And you’re blocking glucagon so that your body doesn’t think that it can continue to store fat all the time. Because that’s kind of — that ends up being what happens.
So you’re improving insulin release so that your blood glucose improves the way that it’s functioning. And you’re blocking the continued release of glucagon, which doesn’t allow you to access fat when you’re making glucagon all the time.

Got it.

So the magic is in when you block glucagon, you can access your fat stores and you can regulate your blood glucose better.

Yeah. That makes sense. Talk a little bit about the food noise element, too, when that’s something we hear a lot about for people when they take the GLP-1s. Like, the reduction in food noise. Why is that so important?

Well, it’s important because it keeps people from destroying their cabinet that’s got all the snacks in it, right?

The pantry.

That pantry just gets wiped out. So food noise, there’s four things that happen when you utilize a GLP-1. One is glucose regulation is better. You regulate glucagon. You slow your gastric emptying, so you feel full longer. And then because it’s changing the hormone signals from your gut to your brain, the food noise goes down because you get the signal, I’m not hungry.

Resetting that.

It’s resetting that signal. Now the big issue with that is, well, if you’re still under stress — say you want to go off of a GLP-1. But you’re still under chronic stress and you haven’t learned how to manage that — whether that’s through lifestyle, mindfulness, exercise, proper food choices — that food noise creeps back in.

And then all of a sudden, people find themselves back in that conundrum of, gee, I wanted to get off this, but the food noise is making me crazy. Maybe I really need to stay on it. Whereas if you can apply other processes to try to correct that, well, then all of a sudden, well, hey, I can wean myself down. And I don’t have the food noise anymore.

So it’s important. And look, these drugs are important. And people with type 2 diabetes, for example, it improves their lipid profile. It reduces their risks associated with heart disease, reduces their risk associated with kidney disease. And even there’s some literature that would support that it reduces the risk of Alzheimer’s and dementia.

So, I mean, these are important medications, but it’s different when you’re using it for weight loss and just reclaiming your metabolism than it is when you’re in a chronic illness, like if you have type 2 diabetes. So I think that distinction doesn’t get made enough.

Right. And actually, you just said the word metabolism. I mean, one of the things that it’s helping to address is metabolic dysfunction, right? And so again, getting to the root of that, talk a little bit about that.
Sure. I mean when you have — so one of the biggest things that creates metaflammation, or metabolic inflammation, is when your glucose and insulin get disrupted. Now that can happen for a lot of reasons. It could be diet. It could be stress. It could be overtraining. It could be any number of things that could lead you to that path of having insulin resistance.

But once you become insulin resistant, you’re making a lot of inflammatory compounds in your body. And what inflammatory compounds end up doing is they start to alter the way your hormones are signaling each other, the way your neurotransmitters are signaling in your brain. And that is what starts to disrupt your metabolism. So now you become very efficient at gaining fat.

Right.

And really inefficient at accessing that fat to burn it. Even though you’re going in the gym and you’re working out an hour or an hour and a half, and you think you’re doing all the right things, you have — what I like to basically compare it to is it’s like a circuit breaker box that’s in your garage, that’s controlling everything in your house. And you can go to that light in your living room and turn that switch on all you want. But if that circuit breaker is blown out in the garage, that light’s not coming on.

And that’s kind of how your metabolism works. So we have to fix the circuit breaker box. And the GLP-1s help one of the major circuit breakers that relate to your metabolism that cause you to store fat.
Yep. So that really gets to it. If listeners are interested, we just did an episode on metabolic health that just went live a few weeks ago on Life Time Talks with you and Cliff, which we want to make sure to point — that’s like, a really good fundamental episode on metabolic health and what that does.

Right.

So the next thing I want to address is in a recent article we published in Experience Life, we noted that the US health care providers wrote more than 9 million prescriptions for these drugs in the last three months of 2022 alone. And it’s estimated that by 2030, there will be some 30 million US users of these drugs, driven equally by both weight loss management and by those dealing with diabetes or blood sugar management. Why are we seeing such an increase in the use of them, do you think? Or do you know?

No, I know.

I figured you might.

No, I mean, I’ve studied insulin resistance and diabetes now for almost 40 years. I’ve written multiple publications. So the first thing to realize is 50% of the US population is either insulin-resistant or people with diabetes. That’s one in two adults.

Crazy.

And once you’re insulin-resistant, you’re going to be prone to weight gain. And once you’re insulin-resistant or have diabetes, that leads you down a path of a lot of other illnesses and conditions. So one, there’s the growing awareness that GLP-1s may be able to help cut off that future risk towards other what they call comorbidities, other illnesses that occur due to insulin resistance.

And that’s hypertension, atherosclerosis, kidney disease dementia, Alzheimer’s, all the things I had mentioned previously.

Yeah.

So I think, one, the reason that the numbers have gone up is awareness of the utility of GLP-1s. Like, how can they help people? And I think the other one is consumer demand.

Yeah.

Quite honestly. So many people got fed up. If you read a lot of posts in social media, especially consumers that are posting, they’ll say, I tried everything. And I got on this GLP-1 and I started losing weight. Well, the problem was they didn’t understand the back side of that. Meaning that it’s not just the drug or the GLP-1 that you’re utilizing. If you want to really overcome your weight issue, it’s creating a healthy way of life.

Yes. Which we talk about all the time.

Well, it’s our core belief, right?

100%.

And so I think awareness and the fact that we just had so many people — over 70% of the US population is overweight. You’ve got an obesity epidemic that is literally approaching by the year 2030, 50% of the US population.

1 and 2 again.

Right. And I think that’s what’s driving this.

Yeah.

People are desperate.

Yep. I totally hear you on that. I mean, I think what’s so interesting — and again, this was another stat that we had — is, like, people were desperate. They’re doing these things. But often it’s hard to stay on them. There’s some statistics around — there was an examination from medical and pharmacy claims data from 2021 that found that over 50% of the non-diabetic GLP-1 users with obesity discontinued use within the first 180 days.

Nearly 70% stopped within a year, which, for many of those people, they’re possibly then regaining the weight if they don’t have these other things in place. So, I mean, with that in mind, what’s behind that? Like, the starting and the stopping and all of those pieces, I mean, is it the side effects?

Yeah, I think it’s the side effects, mainly. Because a lot of times what happens in the conventional approach to using GLP-1s is people get started on pretty aggressive doses quickly.

Yep.

And that’s going to lead to problems like constipation and nausea. And people aren’t going to tolerate that for a long time.

No, you want to feel better than that.

You want to feel better. You don’t want to be nauseous. And I think those are the main things. There’s lesser side effects that occur less frequently. You have to worry about kidney function. But in general, when you do too much, you don’t feel good.

Yep.

And I think once again, it’s that thought of well, how much do you need in order to accomplish the reset of your metabolism versus treating someone who is insulin-resistant with clinical obesity and they’re type 2 diabetics? I think there’s a difference that we have to appreciate and manage. And I think that’s what really did not happen.

And look, I’ve seen all kinds of things on social media. I mean, I have people that are somehow getting the medication and they show a picture of their needle that they’re using for the injection. And they’re asking the question, is this the right amount?

You’re like, uh.

And that’s — ah, yeah, I don’t think you should be trying to self-medicate with this. This is a real medication that should be supervised. And it should be ongoing owing supervision.

Yes. So talk — I mean, you mentioned the word in the conventional usage of these. I think one thing that with the MIORA program and with a lot of other integrative programs that are out there dealing with GLP-1s or using them, it’s taking this more individualized and personalized approach for people. So really it goes back to the fundamentals of, you need to understand each individual. What’s at the root of their issues, right? And how can — and start from there. So talk about that a little bit.

Well, with the American Academy of Anti-aging Medicine, I think now for the last three years, we’ve been training health care providers on a more precision health approach, is the way I would put it. Where you’re evaluating all the aspects of an individual. Where is their magnesium status at? Are there stress hormones playing a role in — or their weight issues?

Getting a full thought around who that person is. And in the end, they probably are going to need a GLP-1. But it’s appropriate dosing. You know, I’ve got a whole group of physicians in my faculty that we go through each aspect of this and teach this to health care providers, that starting with a dose and titrating the dose — so a small dose and just titrating to the dose where a person starts to see that metabolic reset.

Right.

Where they start to lose weight, notice that their appetite is — that food noise is down, the appetite is less, but not just continuing to increase the dose because you can. But to stop it at that dose, where, hey, I’m losing weight, I feel good. I feel like going to the gym. I still have some appetite. I’m able to eat. Because one of the biggest issues is people will do larger doses and they just don’t feel like eating.
And that is going to lead to 30% to 40% of their weight loss being lean mass. And, of course —

Don’t want that.

— at Life Time, we believe in people losing lean mass. We want to hold on to lean mass because that’s our currency of aging, of course. And so titrating the dose to get to that effective amount. And the reason that’s so important, when you go to get off of that medication, now it’s going to be easier for you because you weren’t so dependent on a big dose.

You’re able to, through lifestyle changes, through diet and exercise, you start to titrate back off. And then the lifestyle changes kick in. And maybe looking at your cortisol and, do I have enough magnesium on board? And, what’s the status of my gut health? You can start to rely on those things to manage your metabolism.

Yep. I love that. And you’re really referring to — it’s like we’re seeing this increase in providers who are looking at this kind of as a deprescribing model. Like, you’re starting them with the goal of this not becoming an ongoing dependency, right? We know that this is the process. So I mean, is there anything with that? I mean, that is definitely being seen as a more sustainable approach for people, right? Are they seeing longer term results with that? What have you seen in that?

Well, I can only go on to maybe 800 providers that I’ve trained over the last few years. And the feedback has been this is amazing. It really works. Now I’m going to say there are some times where a person may need a once a month dose, and that’s what they need. But that’s the provider working with the individual to decide, where do you need to be in order to maintain healthy, lean mass?

You’re not losing your fat pads, so you’re not looking drawn. You’re not looking as if you lost too much weight. But at the same time, it’s meeting people where they’re at with their metabolic needs. And so I love the model of deprescribing. Because I think for most people, if they’re willing to change to a healthy way of life, this is a temporary bridge to getting them back on track.

Yeah, it’s kind of that jump start, in some cases, that we need. Like, we’ve hit this — they’ve plateaued at this space where nothing is working. How do we jump start it? But always with the intention of it being a temporary option.

Exactly. So I think it’s key for people to try to work on their health and adopt a lifestyle that’s going to allow them to maintain their ideal weight that they’re happy with, where they feel good about themselves. Right? Because in the end, that’s what we’re trying to accomplish, is get your labs to where you have reduced risk of any kind of problems.

That’s what leads to true longevity, is when you take all the inflammation out of your body. You’re going to have a better chance at living a longer life, right? And feeling better in the process.

Yeah. We want to feel good for as long as possible, feel good and function as well as we can for as long as possible.

That’s exactly it.

That health span that we want to increase, along with the lifespan. You’ve talked about lifestyle habits. And I know we talk a lot about, particularly, strength training and why that’s so important, as well as getting enough to eat. I mean, that’s one of the things that’s like, we have to be eating. And we have to ideally be eating enough nutrients so we don’t become nutrient deficient.

That’s right.

Talk a little bit about some of those lifestyle habits that we really do need to focus on if a GLP-1 is part of your toolkit that you’re using.

Well, strength training is important. You need some resistance training. And I would encourage if someone doesn’t have a trainer, that they get with someone in DPT and they really develop a plan, something that they’re formally working with so they know they’re getting the resistance training that they should do.

And so that’s step one. And it’s really important. And honestly, it’d be great if they could do that three times a week.

Right.

That would be ideal. Diet-wise, I mean, we’re fortunate at Life Time because we have lots of dieticians that are very well-schooled on how to help people learn how to eat. And the most important part when you’re on a GLP-1 is getting enough protein. And that sometimes is hard. When people’s appetites are reduced, they’re not looking at a grass-fed New York strip steak going, oh, yeah, I really want to eat that.
The whole thing.

That whole thing. So it’s important that they get a diet — what I call a program. And I always watch on diet. I like to try to get people to understand. Eating, it’s more a way of life.

Yes.

You want to learn how to eat to hit your goals, right? What are my goals? Live longer. Live healthier.

Right.

Help maintain my ideal weight. Help me perform better, whether I’m in the gym or I’m out on a bike or whatever it is. But you do have to get enough protein in. And that minimum amount, probably 1.2 to 1.6 grams per kilogram. So what that means is you’re hitting about 80% of your body weight.

Now obviously that shifts a little bit the heavier someone is. But honestly, that’s probably the most important aspect of maintaining lean mass. There is no reason — these categories of drugs, when you look — once again, look out in social media. You only lose lean mass. You don’t lose fat. The reality is you lose the same amount of lean mass if you’re on a GLP-1 and you reduce your calories and you’re not eating enough as what happens when you’re on a medical diet.

Right.

30% to 40% lean mass loss. We can dramatically reduce that by improving protein intake. So at least twice a day, you’re getting a nice serving of protein. And then in addition to that, maybe you’re adding in some protein powder as a support. Like I always tell people to make it maybe even into a pudding if you don’t want to drink a big drink, because that volume sometimes can be a little intimidating.

You can just mix it with a little bit of water, make a pudding out of it, and then that can be another source. Another 30 grams once or twice a day. But that’s really important that they get that in. And then the other piece is, what are the habits that you were doing before you decided to do a GLP-1 because you’re desperate?

Were you eating more starches? Were you kind of getting in that cookie jar a little bit too much? What are the habits that you know you need to change? And then work on that as well.

Right. What about fiber? Because I know that’s — I mean, there’s a risk of, you said, there’s some constipation and things like that if you get too much too quickly. But is that something, making sure we’re getting enough produce fiber to keep our digestive system in good working order?

Well, I think a couple of things. One is magnesium is really important for folks. Because most people are at least functionally deficient in magnesium. And magnesium really helps your bowels to move regularly. So that’s important.

And then the other piece that is important, I think people should take fiber when they’re on a GLP-1. It’s a great addition to make sure that they’re getting regular bowel movements, they’re not getting constipation.
Because some people could even get loose stools from being on GLP-1. So I think fiber is the great equalizer. And of course, whenever you start fiber, you start at a smaller amount. And then you can move to the goals that maybe the dieticians have set for you if you’re going through utilizing Life Time.

Got it.

Yeah.

So ultimately what we’re hearing — what we’re hearing, we’re talking about today — the balanced approach we’re talking about is really where GLP-1s are part of a toolkit that are part of a broader lifestyle and healthy way of life transition. Embracing those habits, so that we’re not creating that ongoing dependency over time. Right?

Yeah, absolutely. Yeah. And I think the other big thing is I think people have to eliminate the fear of going off of the GLP-1s.

Yes.

Because I’ve talked to a fair amount of patients. And that’s one of their big questions right away, is, am I going to gain my weight back right away?

Right, yeah.

And honestly, the better that we help them shape that new lifestyle, the less fear there should be.
Got it. Yeah, I think that’s super important because I do — you do hear about that all the time. It’s like, if I go off this, I’m going to just fall back into old habits? But again, what is that like from a — when you’re lowering the dosing in that, how are you working with people? Or how are your — the doctors you’ve worked with? How are they working with people to help them transition in a really meaningful way and really sustainable way?

Well, hopefully what’s happened is during the time they were on the GLP-1, they learned, hey, here are the foods I should be picking from. It’s not so much telling people what they can’t do. It’s helping people understand what they can do.

Yeah. Can we take an additive approach in this versus another? Yeah.

Yeah. So you do that. And so during that time, they’re reshaping their exercise habits. They’re reshaping their dietary selections. So that when you start to titrate down — and basically it’s over a 4 to a 6-week period — that you’re taking a little bit less each week.

And then when you go to maintenance, there are other options of nutrients or compounds that if you do get into a little bit of a craving pattern, you could utilize something that’s a little gentler that will still be effective that can help people to maintain that. Because the biggest issue on craving for a lot of folks is that it’s stress-induced. You know, it’s called comfort food.

Oh, yeah.

We’re under stress.

I think we all experience that in different ways.

And unfortunately, broccoli is not at the top of the comfort food list.

Not the first thing I grab.

Exactly! So, I mean, I think that part’s important is that as you’re titrating down, you’re just able to talk to the person and be able to say, hey, are you experiencing any cravings? Do you notice any of the food noise coming back? How are you feeling? As long as we do that, we continue the communication and we stay tethered to the individual, well then, I mean, success is going to be right there for that person.
Well, again, it goes back to having that support in place for people. And I think that’s one of the differentiating factors. What you’re offering, what MIORA is offering at lifetime is this ability to have somebody who you can reach out to at any time and say, here’s what’s going on, here’s what I’m feeling. I mean, it’s a personal experience.

And I’m not on a GLP-1, I’m doing other things with MIORA. And having that resource to be able to go back and forth with is so huge. And to know that there’s somebody trusted there who understands this, that can help me. And I think no matter what our health issue is that we’re working through, always having a support system is going to make a difference.

It’s the most important piece to really helping people reshape their lifestyle is having that support network. One of the biggest challenges when people want to try something, they need to understand what they’re doing and why they’re doing it. And when you have that support team around you, that network that can answer those questions so you’re not wondering, well, why am I taking this nutrient? Or gee, is it normal for me to feel this way?

Yes.

Being able to have that support network that can help guide you and give you comfort that you’re on the right path, or change things if something has changed and you need to change a little bit of direction, that’s key to lasting success. And I think that part’s underappreciated, having that support network that’s right there for you so that you’re not just going at it blind.

So I’m not posting on TikTok, my, is this the right dosage for me maybe?

Exactly! Though I have to tell you, that one really got me.

I’m sure. I’m like, that kind of freaks me out, even just thinking about it.

Yeah.

Before we shift to our final surprise question, Jim, is there anything else you want to make sure we covered? Did we miss anything when it comes to this kind of balanced approach of, it’s kind of more of a short-term thing ideally, and that short term is going to mean different things for different people. But anything we missed?

I don’t think there was anything that we missed. I do think that I hope what people come out of listening to this is that there is an approach where you can use GLP 1 responsibly. What that will entail is understanding your metabolism.

Yeah.

And that means get a lab test. Go over that lab test with one of our providers so that you can get an understanding of where you are at. And then, in addition to that, take an inventory of how you’re feeling.
Because that matters.

Am I craving?

Right.

Am I anxious? Am I having trouble sleeping? So it’s that balance of get your lab values, get a good, thorough symptom picture. And then with a thorough plan that you have a great support network with, you can achieve the results you need. And that’s whether you’re on a GLP-1 or you have other issues that you’re coming into MIORA for.

Right, right. Well, I love that. So thank you. That’s awesome. OK. David usually does the surprise question, but he’s not here with us today. This is not a hard one for you, I’m sure. But I was just thinking about you’ve been involved in so many different — with different academies, associations. You’ve seen a lot of change over the last 40 years in your career.

Yes.

So of all the developments and advancements that you’ve seen in — maybe in the last five years, what are you finding to be the most inspiring and promising?

Oh. Boy, that’s a tough one. You know what the most inspiring thing is, really, to me? Is that people are actually starting to take a serious approach to their health. That they’re not waiting until they feel sick or something problematic happens. That they’re actually engaged, interested, and wanting to explore their health. And they’re understanding the concept of health span.

I have the right and the opportunity to participate in my health and live as long as I can, as healthy as I can. That’s actually the most inspiring. That’s why I’ve done all the work that I’ve done over the last 40 years, and written all the books and all the databases, and go lecture all over the world. It’s to help motivate and inspire not just the providers, but inspire people.

Because you know what? It feels pretty good when you feel healthy.

Yeah. Taking that proactive approach to our health versus waiting for that —

Right.

— to happen. That now we’re reacting to something. How do we get ahead of it if we can, to the best we can?

Yeah, exactly. And if I had to think of the most significant innovation, it actually is the GLP-1s. Because we had a lot of desperate people that weren’t losing weight. They were trying really hard. I think the GLP-1s are a significant advancement, along with other peptides that are coming into the market and have been there. They can really help people bridge that gap to get them back on track and adopt a healthier way of life.

Yep. Which is what we are trying to do every single day. So, well, Jim, thank you so much for joining me again. I want our listeners to know that if they want to learn more about MIORA performance and longevity, they can visit MIORA.lifetime.life.

And if you want to follow Jim, he is on Instagram at @therealjimlavalle. And you’re always putting great content out there of you out there presenting and sharing awesome information, so be sure to follow him there. So Jim, thanks again for being on. We love having you.

Well, I love being here.

Good. Come back again.

Alright.

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