Blog Post by Coach Julie
NCI Certified Nutrition Coach L1 & Certified Mindset Coach
Wegovy and Ozempic are both GLP-1 (glucagon like peptide).
With GLP-1 drugs, you will lose muscle mass if you are not doing some sort of resistance training. “Much of the "weight loss" resulting from GLP-1 agonists is the loss of muscle, bone mass, and other lean tissue rather than body fat (Ida, et al.).”
When taking GLP-1 drugs it’s important to focus on getting adequate protein to at least maintain muscle mass. (Usually .75g of protein per pound of lean body mass is adequate. If your goal weight is 150 pounds that means 113g of protein per day.)
A significant loss of bone mass, for example, predisposes serious bone diseases such as osteopenia and osteoporosis. And a significant loss of muscle mass lowers metabolic rate (increasing the risk of weight regain), raises the risk of falls, and impairs function and quality of life.
Research has found that when people stop taking Wegovy/Ozempic, they rapidly regain weight. (Diabetes, Obesity and Metabolism: Journal, June 2022) Experts say this is because the drug is not a cure and it does not prevent the metabolic adaptation that occurs during weight loss.
A study published in April 2022 which sought to examine changes in body weight and cardiometabolic risk factors upon the termination of the drug, found that after a year people had regained two-thirds of the weight they had lost. The positive changes they had seen in cardiometabolic risk factors like blood pressure, blood lipids, HbA1c, and C-reactive protein had similarly reversed.According to the study authors, these findings reinforce the need to continue treatment in order to maintain the benefits of the medication. (Diabetes, Obesity and Metabolism: Journal, April 2022)
The fact that people may need to stay on Wegovy indefinitely in order to maintain the weight loss has raised concerns about long-term use. (NPR, 2023)
As a nutrition coach, I have been asked several times about these two drugs. I always suggest talking with your doctor about this and making sure that this is the right answer for you. My opinion though is to always work on lifestyle, diet and fitness interventions first. I would invest in a coach before I spent the money on this very expensive drug. If you have further questions, shoot me a DM, we’ll talk.
EVERYBODY IS TALKING ABOUT IT.
Unless you follow Dr. Oz, the #ketowarriors, or the descendants of Vegan Gains — you’ve heard that a “calorie deficit” is the key to losing fat.
We’ll get into details later, but to refresh: a “calorie deficit” simply means your body is burning more calories than you’re consuming (i.e., calories out > calories in = weight loss (few exceptions)).
A “calorie surplus” means you’re burning fewer calories than you’re consuming (i.e., calories out < calories in = weight gain).
And if you’re eating at your “maintenance calories,” you’re burning around the same number of calories as you’re consuming (i.e., calories out = calories in = maintain stable weight).
Now, I could get deep into the minutia of calories in calories out and how your body “burns” calories, but you probably don’t care about the science.
What you do care about: me knowing the science and giving you the actionable steps to put into practice.
And that’s exactly what I’m gonna do, so take a quick glance at this pretty picture and let’s keep it movin’.
That’s the why. Now, I’ll share the how.
For the record, I’ve never seen another fitness coach put this information out for free. This is exactly how I set up a calorie deficit for my online coaching clients, so listen up.
STEP 1: BUY SCALES. Buy a bodyweight scale and a food scale. These are reasonably cheap and some of the best investments you can make for managing your body. Plus, there are two things humans suck at: estimating and remembering data. In fact, one study on daily food reporting showed even dietitians to be off by up to 800 calories. Some non-dietitians were off by over 1,000 calories! So, yeah. Buy the scales so you don’t do this.
STEP 2: DOWNLOAD A FOOD TRACKING APP. I recommend FatSecret or My Fittness Pal to my clients. Don’t use the macro calculator for any of them as that’s the point of this post ⏤ this way is more accurate. MFP might just be more accessible in terms of how to use the app for some people. However, another downside of MFP is their calories can be off with some of their foods due to user inputted data. Just make sure your total daily macros match up to your total daily calories and you’ll be good to go. Any tracking app or using a pad and pen (if you’re a neanderthal) will work just fine. We’ll cover your macros (proteins, carbs, and fats in a bit).
STEP 3: EAT NORMALLY AND TRACK EVERYTHING. Without drastically changing how you currently eat, track every single thing (very important this is accurate!) you put in your mouth for at least four days (preferably three weekdays and one weekend day). I say to eat normal because you want to find your current baseline. If you go changing everything you eat, you’ll skew your results. And when I say track everything, I mean EVERYTHING — alcohol, condiments, oils, drinks, supplements, butter, sauces, dessert, etc.
STEP 4: AVERAGE OUT YOUR BASELINE. After tracking at least four days, find the average number of calories you ate during that time period.
STEP 5: REMAIN CONSISTENT WITH TRACKING WEIGHT AND FOOD FOR 14 DAYS.Try to hit within +/- 50 of that average calorie amount (2,150 – 2,250) every single day for the next 2 weeks (including weekends!) AND weigh yourself every day in the morning – before you eat and after you take your morning dump. It’s important you try to mimic each day so you can get a realistic idea of what your “typical” intake and weight would look like, i.e., don’t do this during vacation.
STEP 6: ANALYZE WEIGHT TRENDS. Given that you followed step 5 correctly, we should now see a trend in what your weight does based off how much food you’re eating. If you’re eating ~2,200 calories per day and your weight is trending downward (not down every single day because weight fluctuates) over the course of two weeks — you’re likely in a calorie deficit. If your weight is staying about the same (within a pound or so), subtract 250 calories from your daily calorie goal and keep consistent. This means you are eating around your maintenance calories. If your weight is trending upward, take away 350-500 calories per day (you’re in a calorie surplus).
What is PCOS - Polycystic Ovary Syndrome is a hormonal disorder that affects millions of women.
Polycystic ovary syndrome (PCOS) is a condition affecting between 1 in 10 and 1 in 20 women of childbearing age. This condition causes the body’s hormones to become unbalanced, leading to issues like ovarian cysts, increased hair growth on the face and body (hirsutism), acne, weight gain or obesity, thinning hair, irregular menstrual periods, and even infertility.
It’s very likely you or someone you are close to suffers from PCOS.
You must have two of the three following criteria to be diagnosed with PCOS :
Hyperandrogenism (Higher Testosterone)
About 50% of people who have PCOS also suffer from obesity.
Being diagnosed with PCOS is not a “death” sentence when it comes to being able to lose weight.
Thankfully, more and more doctors are beginning to recognize the importance diet plays in preventing and controlling PCOS.
Insulin is thought to play a major role in PCOS. This powerful hormone, released by the pancreas, exists to transport sugar out of the blood and into the cells.
However, many women with PCOS are insulin resistant, meaning this process doesn’t work correctly within their bodies. As a result, high levels of insulin contribute to many of the symptoms of PCOS, such as weight gain, high cholesterol, diabetes, and ovarian cysts.
Ladies, you’ll be glad to hear that controlling your diet can play a huge part in helping reverse insulin resistance. Firstly, stick to a balanced diet consisting of whole grains, fruit and vegetables, healthy fats, and protein.
Losing just 5% to 10% of body weight can improve symptoms of PCOS and reduce insulin resistance.
Physical activity has been shown to play an important, if not essential, role in the treatment and prevention of insulin insensitivity, meaning it’s central to the management of PCOS.
At least 30 minutes of aerobic activity is recommended a week. Aim for strength training twice a week, as in order to improve insulin levels and aid weight loss, lifting weights is thought to be an important aspect of exercise for those with PCOS.
Let’s have a look at the best dietary choices to decrease insulin resistance and therefore manage PCOS symptoms.
While standard guidelines recommend that we get 45% to 65% of our daily calories from carbohydrates, women with PCOS should strive for the lower end of this range.
If you’re already insulin resistant, a lower carb diet is typically a better option.
I promise you won’t have to starve yourself to get the benefits of a lower carbohydrate intake.
Even switching to a diet consisting of 43% carbohydrates has been shown to reduce fasting insulin levels, and therefore improve insulin sensitivity, in women with PCOS.
Choose high fiber, whole grain carbohydrates like brown rice, oatmeal, whole rye, and whole wheat pasta in small amounts. Not only do whole grains have a lower GI rating, which improves insulin sensitivity, but they also help improve cholesterol levels – another PCOS-related complication.
And don’t forget the vegetables. These are always your best source of carbohydrates, so eat plenty of them.
This has to be one of my favorite topics – the importance of fats.
Dietary fat is vital in a PCOS diet as it slows the release of glucose, ensuring your blood sugar levels remain relatively stable. Fat can also be important in weight management as it helps you feel full and stops overeating.
One fat you can safely cut out is trans fats, which are unhealthy and now banned in the US. Trans fat raises LDL cholesterol (the bad kind), while reducing HDL cholesterol (the good kind). Since you’re already at risk of diabetes, heart disease, and high cholesterol from PCOS, you don’t need to add to the risk by eating these fats.
Then you can turn to other healthy fats, namely monounsaturated and polyunsaturated fats from nuts, seeds, and avocados.
No discussion on fats can leave out the importance of omega 3 fatty acids. These essential fatty acids prevent or reduce symptoms of multiple conditions, and PCOS is no exception.
They don’t just decrease cholesterol and lower blood pressure, but they have also been shown to be effective in improving hirsutism and insulin resistance in patients with PCOS.
The Role of Exercise
Physical activity has been shown to play an important role in the treatment and prevention of insulin insensitivity, meaning it’s key to the management of PCOS.
At least 30 minutes of aerobic activity is recommended a week. Aim for strength training twice a week, as in order to improve insulin levels and aid weight loss, lifting weights is thought to be an important aspect of exercise for those with PCOS.
In addition to regular exercise, eating whole grain carbohydrates, healthy fats, limiting sugar, and supplementing with vitamins in order to manage your PCOS, there are a few other things to consider.
Here’s an idea of what a typical day looks like on a PCOS friendly diet – pretty good wouldn’t you say?
Just make sure to adjust your portion size based on your calorie needs.
Need help on finally losing that weight for good?
If you would like help on figuring out your portion sizes for your specific goals, reach out to me and apply for a free, no pressure, 15 minute coaching call. During this call we will discuss your fitness and nutrition goals and see if I can help you see that success faster.
Done correctly, deliberate cold exposure can positively affect brain and body health. Below, I detail some of those benefits and how best to access them.
Never get into a dangerous body of water. Also, never do deliberate hyperventilation before or during cold water (or any water!) immersion. Start slow (warmer than colder)—as cold shock is possible; just as with lifting weights or other forms of exercise, you’ll need to find the right temperature for you, yet prioritize safety.
How cold? This is the most common question I hear, and it makes sense to ask that. However, it is truly impossible to answer, as some people tolerate cold better than others. The key is to aim for a temperature that evokes the thought, “This is really cold (!), and I want to get out, BUT I can safely stay in.” For some people, that temperature might be 60°F, whereas for others, 45°F.
Here is the key: the colder the stimulus (water immersion, shower, etc.), the shorter amount of time you need to expose yourself to the cold. One study showed significant and prolonged increases in dopamine when people were in cool (60°F) water for about an hour up to their neck, with their head above water. Other studies describe significant increases in epinephrine from just 20 seconds in very cold water (~40°F). The good news is that as you do deliberate cold exposure more often, you will be more comfortable in the cold at all times and can start to use colder temperatures with more confidence, just like exercise.
Ice bath, cold shower, or cryo?Most of the studies use ice baths or cold water immersion to the neck. Those are best, but cold showers can work too (and are more accessible to most). Cryo is very expensive and harder to access and not subject to much variation in protocols, so it is not considered here.
To Increase Energy and Focus
Deliberate cold exposure causes a significant release of epinephrine (aka adrenaline) and norepinephrine (aka noradrenaline) in the brain and body. These neurochemicals make us feel alert and can make us feel agitated and as if we need to move or vocalize during the cold exposure. Cold causes their levels to stay elevated for some time and their ongoing effect after the exposure is to increase your level of energy and focus, which can be applied to other mental and/or physical activities.
Building Resilience & Grit
By forcing yourself to embrace the stress of cold exposure as a meaningful self-directed challenge (i.e., stressor), you exert what is called ‘top-down control’ over deeper brain centers that regulate reflexive states. This top-down control process involves your prefrontal cortex – an area of your brain involved in planning and suppressing impulsivity. That ‘top-down’ control is the basis of what people refer to when they talk about “resilience and grit.” Importantly, it is a skill that carries over to situations outside of the deliberate cold environment, allowing you to cope better and maintain a calm, clear mind when confronted with real-world stressors.
In other words, deliberate cold exposure is great training for the mind.
Enhancing Your Mood
While not true of every stress, cold exposure causes the prolonged release of dopamine. Dopamine is a powerful molecule capable of elevating mood, enhancing focus, attention, goal-directed behavior, etc. Even short bouts of cold exposure can cause a lasting increase in dopamine and sustained elevation of mood, energy, and focus.
In the short-term, cold exposure increases metabolism as the body has to burn calories to increase core body temperature. The total calories burned from the cold exposure are not that significant. However, the conversion of white fat (energy storage) to beige or brown fat (which are highly metabolically active) can be beneficial for:
Of course, calories on (consumed) versus calories out (metabolized) or “CICO” governs whether you gain, lose, or maintain weight. There is no escaping the laws of thermodynamics.
A Solid Basic, Science-Supported Protocol
Consider doing deliberate cold exposure for 11 minutes per week TOTAL. NOT per session, but rather, 2-4 sessions lasting 1-5 mins each distributed across the week. Again, the water temperature should be uncomfortably cold yet safe to stay in for a few minutes. You can do more, but this should be the minimum to achieve the benefits of cold exposure. You can do very cold, very brief exposures for adrenaline release too, but the 11 minutes is based on a recent study that explored a range of effects and is a good solid, basic protocol for ongoing use.
The “Counting Walls” Approach
Undoubtedly, during (or before) cold exposure, you will find your mind pushing back against the challenge. Your mind will say, “I really don’t want to do this,” even before getting in, or “Get me out of here.” You can imagine those mental barriers as ‘walls.’ Those walls are, in fact, the effects of adrenaline pulses in your brain and body, which in this case is what triggers the eventual adaptive response. After all, if it were easy, then there is no stimulus for your body to change (adapt). By maintaining top-down control of your reflexive urge to exit the cold environment, you will have successfully traversed that wall. Challenge yourself by counting walls and setting a goal of “walls” to traverse (e.g., 3-5 walls) during the round of cold exposure. You can also go for time. Up to you. The advantage of the walls approach is that it carries over to other scenarios more seamlessly, as most of life’s stressors don’t lend themselves so well to merely timing the duration until it passes. It also enhances your sense of mind-body connection to do it this way.
Shivering and The Søeberg PrincipleThe Søeberg Principle based on deliberate cold researcher Dr. Susanna Søeberg is: To enhance the metabolic effects of cold, force your body to reheat on its own. Or “End With Cold.”
Also, allowing your body to shiver may enhance metabolic increases from cold. Shivering causes the release of succinate from muscles and further activates brown fat thermogenesis.
Try this protocol to increase shivering, either during or immediately after cold exposure:
Don’t huddle or cross your arms while in the cold or after getting out. Also, don’t towel off. Let your body reheat and dry off naturally. Admittedly, this is tough. Unless doing deliberate cold exposure on a hot sunny day, admittedly, I prefer to take a hot shower and towel dry after cold exposure, but I am no doubt limiting the metabolic effect by doing that.
Physical Recovery A meta-analysis of cold-water immersion effects on recovery found that cold exposure can be a highly effective recovery tool after high-intensity exercise or endurance training. Short interval (< 5 mins), cold water immersion demonstrated positive outcomes for muscle power, perceived recovery, and decreased muscle soreness (in part due to a reduction in circulating creatine kinases).
The problem is that cold water immersion (but not cold showers) can limit some of the gains in hypertrophy, strength or endurance if done in the 4 hours or so after training. It’s better to wait 6 to 8 or more hours until after training, or do it before training UNLESS your goal is simply to recover without adaptation (for instance, when in a competition mode and not trying to get better, stronger, etc.)
Day or night?
After cold exposure, your body heats up. Yes, HEATS up. Body temperature increases tend to wake us up, whereas body temperature decreases tend to shift us toward sleepy states. Thus, I suggest using deliberate cold early in the day and not too close to bedtime. Sometimes it’s better to do it late than never, but not if it perturbs your sleep. If deliberate cold affects your sleep, try doing it earlier in the day, or not at all.
Increasing the Resilience-Enhancing Effects of Deliberate Cold Exposure
Staying completely still while in cold water allows a thermal layer to surround your body, ‘insulating’ you from the cold. To be most effective as a resilience training tool, move your limbs while keeping your hands and feet in the water. That will break up the thermal layer and you will experience the water as (much) colder than if you stayed still. This is also a good way to increase the potency of a cold stimulus without having to make the water colder. This is akin to slowing down the movement of a weight lift to reduce momentum and provide more tension on the working muscles.
Thank you for your interest!
I will answer all questions! Please feel free to drop them in the comments or email me directly @ firstname.lastname@example.org
Disclaimer: KM Fitness is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast, blog and website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
Stress and Weight Loss: The Link
You have probably heard me talk fat loss killers in social media posts and videos, but there are so many moving parts that have to work in harmony to achieve fat loss that it’s important to really highlight the major sources of problems. We have talked about how water, diet, sleep and movement all affect fat loss, the one that most people tend to forget is STRESS.
Stress can affect your fat loss in several different ways. As a matter of fact, it can be the major wrecking ball that takes out the other pillars necessary to keep your weight trending down toward your goals.
First, let’s address what constitutes stress. People use the word stress interchangeably with anxiety, feeling anxious, fearful, nervous, overwhelmed, panicked or stressed out. Usually stress manifests in people’s lives without them noticing, but usually shows it’s ugly face through anger, irritability, depression, tension, headaches, joint and muscle aches, gastrointestinal distress, frequent illness and lack of sleep. Your body cannot tell the difference between stressors or negative emotions. All of these things to your body are simply stress. A fight with your spouse, rough day at the job, lost $20 at the slot machine, feeling under the weather . . . the situations are numerous, but the point is, your body doesn’t know the difference between these situations or if you’re being chased by a lion or starving. All stressors cause your body to automatically go into flight or fight mode to help you survive that famine or fight that lion. To do this, your body releases adrenaline and cortisol, the stress hormone. When cortisol is released, glucose is also released into your bloodstream. Glucose is your body’s primary source of energy. Great, your body is now suited up for battle.
The problem is when the threat is gone (great job, you killed the lion), your adrenaline wears off and your glucose wears off, but your cortisol goes into high gear to replenish your energy supply. So what does this mean for you? Let’s break it down
When your glucose level drops, your body craves sugar because your body knows that sugar will give it the quick energy boost it thinks it needs. The problem with this is, when you consume so much sugar after stressful situations your body tends to store as abdominal fat, which is usually one of the hardest areas to lose it. This creates the infinite loop of stress, cortisol, gain weight, crave sugar, eat sugar, gain more weight and round and round the mulberry bush we go.
So maybe you think you’re stronger and smarter than your body so you don’t end up in the sugar cycle mentioned above. Ok, let’s cuss and discuss what that pesky cortisol does to your metabolism. Even if you aren’t eating high fat or high sugar, cortisol slows your metabolism and as an added perk, also raises your insulin, a hormone that contributes to fat storage. Researchers have found that stress could cause as much as an 11 pound weight gain in one year.
So there’s other perks of high stress, anxiety, cortisol (whatever word, be it 4 letter or otherwise, you’re using for it) on your body. (I really hope you’re picking up on my snarky sarcasm toward stress, because it can be a pesky bugger.)
Are you an emotional eater . . . STRESS. Cortisol not only causes unhealthy cravings but can also make you eat more than normal.
Do you struggle to plan meals or prepare meals when you’re stressed? That probably makes you want to hit up that Chik-Fil-A down the street or just grab something easy rather than taking the time to make a healthy choice.
Stress can often mean you’re overworked, have a busy schedule or spend too much time commuting can really cut into your time at the gym or other activities you would usually do. This also makes people cut out meals from their diet.
And last but not least . . . DRUMROLL PUH-LEASE . . .
Remember SLEEP and how not getting enough sleep can cause you to hold on to extra body weight?? Let’s recap, not getting enough sleep can cause ghrelin, your body’s hunger hormone, to increase and also make your leptin levels decrease. Leptin is the hormone that makes you feel full. So basically when you don’t get adequate sleep, you eat more because you’re hungrier and feel less full.
Ok back to stress. Stress comes in clutch to really round out this terrible cycle by making it difficult for you to fall asleep, stay asleep and get good sleep. So that cycle ends up looking like this>stress=little sleep/poor sleep=increased appetite. It is a nasty cycle, and when you pair that with the research showing that lack of sleep also leads to a decrease in metabolism, you then aren’t sleeping, you’re eating more and your body isn’t burning as much of what you put in.
I’m not sure how you’re feeling about that little cocktail of weight loss disasters, but if you’re 100% not ok with it, continue reading and let’s talk strategies to fix it.
First, we need to say that you will never be fully free of cortisol. Your body does need some, but it produces its own normal amount without you jump starting it like a dead car battery. You have to practice stress management. You can do this through self care, meditation, mindfulness, breathing exercises, getting adequate sleep, exercising, journaling, reading, listening to music, and eating a diet of health foods. These things are very important to your mental health, physical health and overall well being. There’s nothing frou frou about taking care of yourself. You have one body and one life, treat them well. Other simple things you can do are drinking water and eating more whole foods. These things help fight cravings but you have to put in the work to keep your mind right in order to hit your goals.
If you have questions or want to discuss your situation in more detail, click the link and apply for a coaching call.
Kayli is a certified personal trainer and online coach that specializes in fitness, wellness, nutrition, mindset, mobility and everything in between.