Best Tools for Gut Health & Weight Loss | Dr. Chris Thompson

“GLP drugs that help people lose immense amounts of weight and stop feeling this food noise thing. And on and on. But can we start by just having a conversation about this tube that is the digestive”

“And we weren't doing much with it, unfortunately, until the GLP-1s came around. So GLP-1s are fantastic from that standpoint. They're not perfect, you know, there's limitations, but they're, it's much better to have them than not have GLP-1s for sure.”

“There's issues with, with certainly adherence, unfortunately, right? So there's a, there's a number over a million people a month are coming off GLP-1s, right? Right. For a variety of reasons, about 30% come off GLP-1s in the first month and then 50% or so by, by the end of the year, right?”

“That does weigh heavy on some people's minds. And that might be why they stop as well. So in my practice, where we do endoscopic therapies, over 85% of people have already been on a GLP-1 and either they're struggling on it or they've come off. 80%. 85%.”

“Like people love their drugs. Like I, you know, I've heard about the nausea. I don't, there are a number of people now who are quote unquote micro dosing the GLPs and finding that they're getting some benefits without taking the prescribed amount. I'm not recommending people do that.”

“you get to that dose, you're losing weight, you're losing weight. And then for maintenance, rather than just stopping it, because if you stop the GLP ones, there's problems, right? This is not meant to be stopped. These are kind of lifelong medicines instead of stopping it, just go to microdosing and you'll find a spot. Hopefully, you know, not everyone does,”

“okay? You're putting the fat back on. So now you've shifted your body composition to be less favorable than before you were on the GLP-1. And then you go on and again and you lose weight again and you lose a little more muscle. And then you go off and you put more fat on, not more muscle.”

“So there has to be a game plan. If you're coming off the GLP-1, you need either to micro-dose it or have a bridging plan to a procedure or something else, which will keep the weight off for you. Are there any good studies showing that resistance training can offset the muscle loss from a standard or micro-dose of one of these GLP drugs?”

“But you can actually see that that does play a major role in maintaining muscle. And that's with anything. It's not just GLP-1 medications. It's with the first generation medications. It's with any surgical procedure or endoscopic weight loss procedure. You know, if you're doing resistance training, you tend to maintain your muscle because the body realizes, oh, I need this muscle.”

“So you want to get screened for this structural thing in the eye. But it's not true that like GLPs are making people go blind all over the place. So what I'd like to ask is when patients come to you and they say, like, I didn't like the GLP or it wasn't working for me. Are they telling you why? Are they saying, like, it made me feel nauseous?”

“Make sure you have adequate muscle mass. And if you don't, you really have to think twice about if you want to do the GLP-1, right? Or if you want another avenue to try to lose the weight. And you definitely have to start hitting the gym. I think that's the most common thing is muscle loss in obvious places or sarcopenia.”

“big players. We're talking about the GLPs, which obviously play a role in satiety and other things, hence the side effects. So what are some of the big ones that we don't hear about so much anymore because of the GLPs?”

“It does help. I think it helps with nausea. So it allows you to have higher doses potentially of GLP-1 with less nausea. So GCP, I think, plays that role. It has a role in insulin sensitivity as well. It does some of the same stuff GLP-1 does, and it's synergistic, I think.”

“And so the drugs just didn't pan out. I think that with the GLP-1s, it's another story, right? I think, you know, incretins in general, we've talked about incretins. We've been talking about these hormones that are produced in the gut. They go into the blood and they do something.”

“So you do surgeries of various kinds. The people are coming to you, have they all tried GLPs and they don't like them or they're not working for whatever reason? Or they'll microdose it, but it's not solving the problem. And what sorts of surgeries were you trained to do?”

“do a targeted approach. So you're not just doing that with drugs where GLP-1 is actually GLP-1 isn't really targeting a deficit necessarily. There's different ways you can treat things. You can either find a pathology and treat the pathology, right?”

“But your A1C corrects and it's a potential treatment for diabetes. They've also done some studies. I don't believe these are published yet, but I think that is showing that when someone comes off of GLP-1, if you use this treatment, it keeps them from regaining their weight. So you can take a GLP-1 and then have your duodenum kind of reset, if you will.”

“So, that's why it's so important. GLP-1s help fight part of that, right? You're replacing the GLP-1 that's you're not addressing the ghrelin or other things. So, time will tell if we can have long-term weight loss, but it does, it does. So, ghrelin isn't the whole story, right?”

“But that doesn't mean it's irrelevant, right? So when you do a procedure, like say a gastric bypass surgery, right? Or you go on a GLP-1, you still got to fix the fundamentals that got you in the problem to begin with, right? You need to start getting more fiber. You need to, you know, have a better diet. You know, try to avoid the insulin spikes.”

“Well, I think one thing that's very exciting is gene therapy, right? So we talked about GLP-1s and how it's mega dosing, super physiologic. It's not nutrient responsive.”

“And I was involved in the very early work for this. And basically what they're doing is they've developed a viral vector that has the gene for GLP-1 in it. And they're using the promoter for a beta cell insulin gene, right?”

“So it's very exciting. So we'll see how that goes. But it looks like it'd be very promising, right? So one-time GLP-1 injection, that could be nice. Additionally, you could use it to augment other therapies. You can use it to augment the gastric procedure or the small bowel procedures. It might be another tool in your armamentarium.”

“You could have too much saturated fat too, but too much glucose. And then too much glucose, you could catch that by doing a CGM, right? So that's one way you could do it, a continuous glucose monitor. You could then see if you have particularly glucose spikes to certain foods. And if your glucose is shooting up to 200 with certain meals, you know you're sensitive to that.”

“Okay. We have to look at other things getting back to metabolic syndrome ideas. So first you could check for glucose. So glucose spikes. A CGM can do that. I wouldn't say wear it all the time. Get one for a month or two. Learn what spikes your glucose. See if something spikes your glucose and adjust it. Next, you have fasting insulin.”

“Again, that's functionhealth.com/slash Huberman. It's gratifying to hear that you put the CGM pretty early on that list, very early, in fact. I mean, I don't, I want to be clear, I'm neither complaining about nor am I trying to turn you against your colleagues.”

“So I get it on the one hand why a lot of physicians are worried about people walking around with a lot of data. I heard the same about CGMs. Okay, I'm going to try not to rant here. It was like, oh, gosh, who needs to know that glucose goes up, glucose comes down. In the absence of diabetes or pre-diabetes, like you can have a glucose spike.”

“But now that CGMs have been out for a couple of years, I don't hear much pushback. Yeah, if somebody wants to use CGM for a couple of weeks and see how they react to different foods, post-exercise, post-poor sleep, et cetera, cool. So it's kind of wild to me that physicians don't want patients to have data.”

“We had access to fasting insulin, right? But think about this. So say you don't get the CGM and you have fasting insulin, right? And the fasting insulin is normal. You don't know if a step before that is a problem and they're going to have problems with fasting insulin. Or if it's abnormal, you need the CGM to learn how to eat, right?”

“You're spiking your insulin, or you got to figure out why you're spiking it, right? So then you go back to the CGM and you learn, and I don't have any stock in a CGM company either. You got to learn how to eat to not spike your insulin in that case. Now, if you're taking a bunch of saturated fat, that's not great either.”

“for them. I'm going to, you know, put their Apo B through the roof. And they'll think it's okay because it's not showing up on their CGM. I think it's not giving the patients enough credit because generally, if you're getting a CGM, you probably are trying to do the right thing. So I think it's how are they using information?”

“things rather than a biopsy and something that would increase risk. Okay, well, thank you. I was asking you to take my side in the argument, but since you threw out CGMs first, I just kind of took that as an opportunity. I think my, I won't name names, but let me put it this way: whenever I get that sort of pushback, I'll”

“And almost inevitably, they say the same thing. Give it 20 months. This will be standard. And that happened with CGMs. No one bulks at the idea of a CGM. Yeah, you want to put that thing on? You can afford it. You want to get some data. Like most people, most physicians I know now are comfy, but at the beginning, it was like all the pushback in the world.”

“It's just I don't want to blame it for everything. Right, right. I get it. I think that the, you know, earlier we were talking about CGMs and there's sort of a kind of a common theme here, which is the general public now, because of online health information, good and bad, is starting to create their own nomenclature.”

“I think doing it's better than not doing it. I still skip the breakfast. The topic of fermented foods, low-sugar fermented foods as a possible benefit for gut health has come up since Justin Sonnenberg and colleagues have published that study. There's a small number of people in that study, admittedly, but that taking in some low sugar fermented foods really helped lower the inflammatone.”

“And I think there's the study you referred to, actually, I think they compared it to fiber, right? It was fermented foods to fiber. And with the fermented foods, you had reclaimed some diversity in the microbiome, which was great, as well as the reduced inflammatory markers where the fiber didn't seem to do that.”

“So it stands to reason that we probably see that as well as we do more research in the fermented foods. They're beneficial for a variety of reasons. You know, one, they're prebiotic, right?”

“So it's sort of like when you're trying to grow something, you want to plant the seeds, but also have the fertilizer and whatnot. And this is what fermented foods do for you. So I think, you know, that's very helpful. And it's all about maintaining this kind of healthy microbiome that can produce things like butyrate, which have a lot of benefits we can talk about.”

“What else do you recommend to your patients as they start to move away from obesity? So obviously, fiber, some fermented foods. It sounds like resistance training might be in the list, given that they're at risk of becoming thin, but more jelly tissue than lean mass.”

“I think you need a certain minimal amount of omega-3s, right? You know, if you eat fish once in a while, you're getting all you need. Do you strive to get like some fatty fish in your diet? I do. I love fatty fish. It's good for you. I try to do it a couple times a week. I take Lovaza, the high-dose omega-3 pharmaceutical, because I don't want the mercury.”

“You want to get your daily allowance, if you will. I mean, again, if you're a vegetarian, you can do it from algae, the original source. The fish are just consolidating, right? So, you know, you don't have to eat the fish, but that or get that in some kind of supplement form. You heard it here from Chris Thompson. Fish are just consolidated algae.”

“I mean, I think you put it beautifully. I don't like eating fish, so I take the Lovaza. Yeah. I don't like the fruit. But I'm on the East Coast. You guys tend to have better seafood. It's delicious. Yeah, I know. I got to get up, but it's too cold out there. Then you got to take vitamin D out here.”

“as many as 20% of people 18 and older have taken or are currently taking a GLP or either, you know, Ozempic, Mounjaro, soon Retatrutude will be out to market. What's your thought on these compounds?”

Also filed under GLP-1 Agonists

“There are. I think that muscle loss honestly is one of the bigger ones, right? And it might just be subtle, like Ozempic face, ozempic bot, right? You're losing some muscle in places where it's noticeable. Other people actually truly develop sarcopenia, I think, right? Where you have significant loss of muscle.”

“I'm kind of sensing a theme here, right? Like we have these drugs like Ozempic, Mounjaro, et cetera, that blasted GLPs through the roof, helped a lot of people that need help, but there were a lot of side effect issues.”

Also filed under GLP-1 Agonists

“It's not quite as potent. People think of it as Batman and Robin with GLP-1 and GIP, right? People might be curious to know that this drug, Retatrutide, that the more cavalier peptide curious folks are already getting off from compounding pharmacies and gray market, black market.”

Also filed under GLP-1 Agonists

“need help, but there were a lot of side effect issues. Then along comes this other drug, retatrutide, which is like, okay, well, let's increase GLP, but let's also kind of bump up the GIP system a nudge or two. Let's also bump up the glucagon system. And lo and behold, we get a much better effect, muscle sparing, and actually better weight loss.”

Also filed under GLP-1 Agonists

“But what are your thoughts on low-sugar fermented foods? So we're not talking beer. We're talking kimchi, sauerkraut, brine. I think they're important and they're missing in the Western diet, which is an issue. And I think there's the study you referred to, actually, I think they compared it to fiber, right?”

Also filed under Fermented Vegetables, Fermented Foods

“I like that. I think it's tasty. Yeah, it's good. Kimchi is good. You know, sauerkraut. There's all different types, yogurt. You know, there are different types I think that everyone should be able to find is kombucha, you know. And it's certainly missing in our diet.”

“Now, the problem with coming off of them is, especially with the original drugs, like Semaglutide, an example, right? Where when you lose weight, about a third of the weight you lose would be lean mass, right?”

“This would be amazing. And I mean, in rodent models, it's phenomenal because we did these trials where you randomize mice to get semaglutide, high-dose semaglutide, much higher than you get for a human, and then the transgene, right? And both groups lose weight.”

Also filed under GLP-1 Agonists

“I've seen those data. But this is not an incentive for people to start drinking diet sodas. It sounds like, you know, saccharin and splenda are probably worse for you than stevia and aspartame. Like, where are you at with these things in terms of their potential negative effects? And if you know of any positive effects, I'd be curious.”

“So it's similar. It's just minimally processed stuff is better. I think the problem with sweeteners, artificial sweeteners, is they come in foods that are that are highly processed as it is, right? And you can't separate the two.”

“And, you know, like parents who get a great effect of an Adderall or a Vivance for their kid that couldn't focus. I have friends with a kid like this. And they're just like, it's remarkable, but they're worried about the reduced growth effects.”

“But yeah, it's hard to, well, I don't know. Do you see this recent avocado oil thing out of UC Davis? This is wild. UC Davis went and analyzed like all these avocado oil containing products. They're supposed to be like healthier.”

“I feel like it's all kind of made up for entertainment, but both sides are really adamant. It's just kind of stupid. Olive oil, butter, right? Or you're the physician. Tell me, am I thinking about this wrong? I do the same. No, olive oil is the best, obviously, then small amounts of butter. I don't think large is bad in small amounts.”

“You can do it different ways. There are genetic tests you can do like cologuard. And if you do that, you have to do it every few years, but you can do that. You can do screening colonoscopy every 10 years if it's normal. And there's other things you can do as well.”

“that like would lead people to say these are bad. There's no reason to run out and use them if you don't want to, but the weight loss data say people who drink diet sodas instead of water actually lose more weight. I've seen those data. But this is not an incentive for people to start drinking diet sodas.”

“And what was there was mainly stimulant-based, like the fenfluramine and like other valve issues. But you had fentramine, right? Which was a sympathomimetic, really.”

“And, you know, it gets trapped in the liver very quickly. And that's the only place I can really process it. So I think that fructose is something to watch. Again, not if it's in fruit, even in juices, it can be kind of, juices are processed fruit, right? So it's similar. It's just minimally processed stuff is better.”

“Do you make it a point to consume them? I do. Yeah. Yeah. I like kefir or kefir, I never really know how to say that, right? I like that. I think it's tasty. Yeah, it's good. Kimchi is good. You know, sauerkraut. There's all different types, yogurt.”

“Yeah, it's good. Kimchi is good. You know, sauerkraut. There's all different types, yogurt. You know, there are different types I think that everyone should be able to find is kombucha, you know. And it's certainly missing in our diet. So I think it's important to recommend it to folks do.”

“like the fenfluramine and like other valve issues. But you had fentramine, right? Which was a sympathomimetic, really. And speed. Yeah, basically. Mother's little helper kind of thing, right? Right. I mean, and nicotine.”

“fiber. Yeah. I make it a point to eat fruits and vegetables because I like them. But recently I started supplementing with a powdered Psyllium husk and some of them actually taste pretty good. And my expectation is I was going to feel really bloated. It was quite the opposite. Not that I had gut issues before.”

“I've seen those data. But this is not an incentive for people to start drinking diet sodas. It sounds like, you know, saccharin and splenda are probably worse for you than stevia and aspartame. Like, where are you at with these things in terms of their potential negative effects? And if you know of any positive effects, I'd be curious.”

“You want to find a deficit and then supplement, right? So, even with vitamin D, you know, most people probably are deficient, so they benefit from it, but there's no point in really doing it unless you're deficient for most things. And I think with omega-3s, it's similar. You want to get your daily allowance, if you will.”

“Lower dose, right? Yeah. This was years ago on this podcast, we looked at the whole ADHD thing and the effects of these drugs on ADHD. And like parents who get a great effect of an Adderall or a Vyvanse for their kid that couldn't focus. I have friends with a kid like this, and they're just like, it's remarkable, but they're worried about the reduced growth effects.”

“I like that. I think it's tasty. Yeah, it's good. Kimchi is good. You know, sauerkraut. There's all different types, yogurt. You know, there are different types I think that everyone should be able to find is kombucha, you know. And it's certainly missing in our diet. So I think it's important to recommend it to folks do.”