The Healthy Use of GLP-1 Drugs with Dr. Michael Koehler

Dr Michael Kohler is the medical director at Affinity Whole Health. They’re an organization helping people through personalized care, live better and healthier lives. Welcome to the show, Michael,

Dr, Michael Koehler 0:12
George, thank you so much. I appreciate it. Thanks for having me. Excited to

george grombacher 0:16
have you on. Tell us a little bit about your personal lives, more about your work and why you do what you do,

Dr, Michael Koehler 0:21
absolutely. I’m the medical director of affinity Whole Health, and we provide hormone therapy and weight loss therapy to patients, and as you mentioned, to live better and healthier lives. We currently operate four clinics George. We have two in Ohio, one is in Cleveland, and one is in Columbus. We have a clinic in Indianapolis and also one in Chicago. And you know, when I refer to hormone therapy, I’m specifically talking about testosterone therapy for both men and women. We provide hormone replacement therapy for women who are suffering from menopausal symptoms, which are very common, unfortunately. And we also offer weight loss therapies, mainly in the form of the GLP one or glucagon like peptide one medications that are all the rave right now for weight loss. So we’ve been doing this for quite a long time. We’ve actually been doing hormone therapy since 2012 and then once the weight loss, GLP one medications were approved several years ago, we’ve been doing that space as well, and we just patients get really fantastic results. It’s very rewarding. Nice. Appreciate

george grombacher 1:20
that. And it’s a, certainly a needed thing, because, very because we are a little overweight as a culture.

Dr, Michael Koehler 1:29
Unfortunately, yes, and you know, the problem is, is, yeah, you know, it’s not just about looks, either, right? I mean, we know that carrying around excess body fat, it has, it sets you up for so many deleterious things in the future. You know, elevated blood pressure levels, cholesterol levels that are not ideal, diabetes, which is huge too, and those things end up leading to the number one killer in the United States, which is cardiovascular disease, right, heart attacks and strokes. So this is a really important medications.

george grombacher 1:58
Have we finally found a panacea you just, just take it and and everything is fine. You

Dr, Michael Koehler 2:05
know, in terms of any medication, there are always potential side effects with any medication you have, right? Luckily, for the GLP one medications, they’re quite manageable usually. I mean, there’s always going to be a patient who just can’t take it for whatever reason. But in terms of me being a physician, there’s never been a class of medications that I can prescribe to patients who are overweight and need these medications that have these results. I mean, they’re they’re really incredible. And more and more data keeps coming out. Really all of that, almost all of it, is positive. It’s pretty amazing.

george grombacher 2:39
It it is pretty amazing. So it strikes me that it makes sense to work with an organization such as yours, where where you can take a look at everything that they have going on, because I’m sure that there is more that goes into it that just taking this new medication that’s going to help me to lose weight, at least optimally,

Dr, Michael Koehler 3:02
absolutely. And you know, when you know our process, our process is, you know, the patient reaches out to us, and they’re connected with a patient care coordinator, which is a real person. I mean, these are people that are actually working in the clinics. They work side by side with the providers, such as myself, and you’re with that patient care coordinator throughout your whole journey, you know. So it’s not like it’s kind of, you know, I’ve seen some online places where it’s very impersonal and you’re just texting someone. You never actually talk with anyone who knows where these people are. But I think that that’s an important part of the way that we treat patients, is that we actually have a kind of an actual person that you’re with the whole time. But also we just have a lot of experience with these medications, you know. So we have the patients come in, we have an in body Analysis Machine, which is a machine that we have, that we have one of these machines in each one of our four clinics, and it uses biometrical impedance to really give you more information about your body composition, because you know when, when you read the headlines, and when you when, just human nature. Everyone’s talking about weight loss, weight loss, weight loss, right? And everything’s about the weight and stepping on a scale that, yes, that is important for someone who doesn’t work out at all. Right, but what’s really important is your actual body composition. What is your body fat percentage? What is your lean muscle mass percentage? Because ideally, with these medications, George, you want to just lose fat. You don’t want to lose muscle mass that you have. You don’t want to lose the bone mass that you have. And so you really can’t measure that just by the scale, right? And so that’s why these in body machines are really important, because we offer that as a free service to every patient we have. You come in, you step on the step on the machine, and it sends vibrations to your body. And it can measure these outputs, you know, your actual percentages of these different of your fat and your muscle, and it keeps a log of that, so throughout your journey, you can see what’s happening. And hopefully what you want is just for your fat to go down, everything else to remain the same or even increase.

george grombacher 4:50
And that’s, that’s the needle the thread, right?

Dr, Michael Koehler 4:54
Yeah, absolutely, you know. And we see a lot, you know, when you that’s why I think it’s important for a special. Clinics like us who just focus on these core things. If you go to a primary care doctor, it’s difficult. I mean, you have 15 minutes to discuss everything, and then at the same time, they look at your chart and they say, Well, you have these medical problems, or your body mass index is 30, and you’re obese, etc. And they say, well, here’s this medication. A lot of them don’t have time to really explain. Oh, how should the dosing be? What are the potential side effects? What should I expect? What should I be measuring? Right? So that’s why I think it’s important for clinics like ours who provide these kind of medications, because we can sit down as 30 minutes with the provider after meeting with their patient care coordinator, and we talk about, hey, you know what these medications, everyone is different. Not everyone requires the same dose. Sometimes your dose will be too high and need to reach out to us. We can adjust it. Sometimes it’s too low because you’re not feeling results, and we need to adjust it that way. But I think really focusing on just the fat loss and how to really focus in on that instead of just losing weight is very important. You know, some tips that we provide are really counseling the patients on the how important protein intake is. I mean, protein, if you’re not taking in enough protein from whatever source, you’re going to lose muscle, because that’s the only building block for muscle. And so if you’re if you’re in a caloric deficit, which these, these medications help patients achieve, that’s the only way to lose weight, right? You’re spending more calories and you’re taking in consistently. That’s how you lose weight. If you’re in a caloric deficit, it’s very difficult to not lose that lean muscle mass, so keeping protein intake high, slow and steady wins the race. I mean, you know, every we’re human, we want quick results. That’s never good. Because if you’re losing more than you know, we tell patients a good goal, if you’re just using the scale at home, is to lose no more than two pounds of body weight per week. You know, one to two pound half a pound to two pounds is ideal. We know from very good data that it’s basically impossible for a person to lose more than two pounds of pure body fat per week. So if someone’s losing consistently three or four pounds per week, we tell them, you know, you know, and they don’t have time to come in for a repeat. In by analysis, we tell them you’re probably losing muscle too, and you don’t want to lose that muscle. So also, strength training is also very important. If you’re not using your muscles, no matter how much protein intake you’re taking in, there’s no stimulus for those muscles to stick around, so they’re going to atrophy as well. So incorporating some type of strength training very important protein intake and losing weight in a slow, consistent fashion. Those are kind of the tricks that a lot of patients who I’ve seen on these medications that they’re not aware of.

george grombacher 7:31
And that’s just it strikes me that that’s obviously really, really, really important. Because I don’t I, I wouldn’t, certainly want to. I want to feel good. I want to be healthy. I want to look good. I want to feel good about myself, and I want to do that when I’m 70 and 80 years old. I want to be healthy, and I don’t want to kind of rob Peter, to pay Paul, and just from what I’ve heard, and please correct me where I’m wrong is if I’m losing bone density and muscle mass and connective tissue, some of that stuff, it’s hard to get back, if possible, to get back. It’s very

Dr, Michael Koehler 8:09
hard to get back, especially as you get older. And you know that that kind of brings us into testosterone therapy too, you know? So again, you know, we talked about the methods that we counsel our patients on to try to maintain lean muscle mass. You know, testosterone therapy, which we haven’t talked about, that is something that is probably, gosh, one of the most misconceived medications ever available. You know, you but, but testosterone, yes, it has effects on muscle, which is what most people associate that medication with, but it has profound effects throughout the whole body. But yeah, so if we have a patient who comes in just for weight loss therapy, and if they qualify for hormone therapy, such as testosterone therapy, and this goes for both men and women, by the way, George, that’s a that’s a medication that can help prevent that muscle loss, for sure, because that’s the actual hormone that signal that says, hey, you know what? George has taken in enough protein intake. He’s worked out his muscles. He’s exercised today. Let’s use that protein to stimulate muscle protein synthesis, or at least maintain it. So those medications, testosterone and these GLP one medications actually go together very well for that purpose. And

george grombacher 9:16
so my understanding that testosterone levels in men and women has has reduced dramatically from even a generation or two ago. Yeah, is you’re looking at that? Do you I mean, there’s lots of reasons why Americans are overweight. Is it chicken in the egg? Is it because my testosterone is low, or is the environmental factors reducing my testosterone?

Dr, Michael Koehler 9:42
It’s a great question, and honestly, it’s a mystery. So when they’ve actually studied this, the drop in testosterone levels over the past few decades, even using age, even even using adjusted variables, right? So adjusting for all these people, OBS versus those people, they There’s no rhyme or reason to it. And, you know, yeah. General, a person who is obese, their testosterone levels can be suppressed at some point. They’re not going to be suppressed by like, 50% or anything, but they are being suppressed. But when they’ve adjusted for that George, they still don’t know why this has happened. And there’s a, obviously, there’s, there’s a lot of hypotheses out there. And you know why this is happening? Maybe it’s the stuff that we’re that we’re eating, you know, that’s probably one of the leading theories, but we just don’t know. But it is a problem. You know, because testosterone deficiency can it again, it’s a hormone that interacts through the entire body, your brain, your muscles, your bones, everything. And so that’s why, when we when we talk about testosterone deficiency, you know, patients aren’t just losing muscle mass, right? It’s not just losing muscle mass and gaining fat, it’s having low energy levels, having fatigue, having libido issues. That’s a huge one too. Sex drive goes, goes into the toilet. Men, you know, exhibit erectile dysfunction. Women, they can have painful intercourse and really just no desire to have intercourse. I mean, these, this, this hormone really affects the entire body. And so that’s why, when patients are suffering from any of those symptoms, we encourage them to just get their levels checked, because you never know. I mean, you might get your level checks and it’ll be very low for you, and if you get on a testosterone program, it might make a world of a difference. I hear these stories every day. That’s why this is very rewarding position for me. Yeah,

george grombacher 11:19
yeah, I can definitely see that I have a tendency to be too reductive. So again, just kind of rein me in here. Let’s assume that I am. Let’s just use use me maybe a couple years ago, let’s say I’m 45 years old and I’m 20 pounds overweight, and I hear about these new therapies, if I just start taking it well, what? What is the right way to kind of say this is if I take it and I’m working with you, and you say, George, we need to be doing strength training. We need to be increasing protein intake. And based on your testosterone levels, they’re lower than I believe that they ought to be. If I combine all of these, then I’m essentially positioning my body to handle the GLP one effectively, and it will focus more on burning fat or reducing my body compositions, fat levels, versus leaching the bone density and the muscle tissue and stuff like that.

Dr, Michael Koehler 12:26
That’s, that’s, that’s, that’s very correct, right? It gives you the best chance on your weight loss journey, which is what you came to us for, to do it the right way, to do it the healthy way, and to, again, retain that muscle mass. Remember, in general, the more lean muscle mass you have, the higher metabolism your metabolism is going to be. So the more calories you burn at baseline. That’s why patients, mainly, you know when testosterone, in particular, testosterone has no direct effects on fat at all. It does not work on fat itself. It works on lean muscle mass and on your muscle tissue. But so why do patients who have low testosterone levels typically have higher fat levels. It’s because they don’t have enough lean muscle mass, so they’re not burning any calories at baseline, right? It takes a lot of calories to maintain that muscle mass. That’s why it makes sense. You know when, again, when you’re a caloric deficit, especially on these GLP one medications where, you know, and we’re talking about semaglutide and trapetite, right? With semaglutide, the average amount of weight loss over a year in the original clinical trials, George was 15% of their body weight. That’s a lot with triceptide, it was 21 22% it’s even more powerful. But when you take that into account, remember, they’re just measuring the patient’s weight, right? They’re just measuring that body mass index level, which the body mass index, or BMI. It only takes into account your height and your weight. That’s it. It’s not giving much information. So again, we know that you just wasting away and being cachectic to nothing is not a good thing overall. It’s actually probably better than being obese. There’s almost anything is better than being truly obese, right? Having a body mass index over 30 and someone who doesn’t work out at all, which is usually is it’s better to be thin than to be obese, but we’re all about optimizing your health and longevity. And you kind of mentioned this before. There’s this difference between health span and lifespan, right? So, lifespan is the amount of years that you actually live. Health span is the amount of years that you live where you’re actually healthy and able to do things, you know? I mean, who you give people a choice, Hey, would you rather have, you know, diet age 80 or live into a or die at age 85 but have your health span be you’re only healthy until age 75 and most people will say, Oh, I would die at 80 anytime, right? Because, who wants to be bedridden for the last five or 10 years of their life because they haven’t taken these precautions to be healthy when they’re younger, you know. So that’s why I think, again, I think the medications go very well together, but they’re also not a magic bullet either. You know, you have to put in some work. Yes, they’re going to help you get more results than someone who’s not on these medications, for sure, but you still have to do work, right?

george grombacher 14:58
Yeah, for sure. Do? So I am. I want everybody to get what they want. Somebody wants to be NFL player. I hope that they’re able to do that. Somebody just wants to lose 20 pounds so they can chase their kids around better, that that that’s awesome, and for adults, and they go into this eyes wide open, and they say, Yeah, great, I’m going to lose this weight. And then they decide not to, you know, do the exercise. They decide not to increase protein. That’s their choice. I am more reticent and concerned about like younger children who are obese, say, teenagers who get into this and they’re not exercising, they’re not changing their lifestyle. That really bothers me. I don’t know if you have thoughts on that. Well,

Dr, Michael Koehler 15:44
you know, we don’t, and we don’t treat any, any, really, patients under the age of 21 in our clinic for that purpose. You know, we only take adults. And you know, interestingly, again, the obesity epidemic has spilled over to kids too. For whatever reason, maybe it’s the food that we’re eating that’s probably my guess. Because again, you know, the cheapest food is the unhealthiest food for you, right? Um, but you know, recently, the American Academy of Pediatrics, I mean, these medications are approved in kids now, yeah, and I don’t know, you know me, it’s a personal decision. Obviously, I don’t know if I’d feel comfortable putting my child on a medication like that for these ends, right? I feel like, as a parent, and again, everyone has has different opinions on this, but focusing on hey, you know, tell your child you have to exercise this. It’s so important, man, you know, you have to eat, right? You can’t eat junk all day long as a child, that’s what. That’s a lot more important, you know. But I understand the scenarios where, you know what, this child is truly obese. And, you know, we have these kids who are diabetics, that’s terrible. And so in those situations, these are these medications warranted, probably, I mean, you know, because, again, you want to make sure that these, that these kids, when they grow up, that they’re as healthy as they can be, and if they’re already on that trajectory at a young age, how difficult Do you think that is to change them when they’re older. George, I mean, they’re almost like genetically, you know, predisposition from that point to have these bad habits. It’s very unfortunate. So I see the reasoning why these, these, the GLP one medications have been approved for kids, but again, you know, going back to the root cause, we wouldn’t have these issues in the first place, right?

george grombacher 17:19
Yeah, yeah, that, that, that is a super tricky thing, right there? So, super tricky thing, yeah, I also it, I mean, you can, obviously, there’s so many layers to this stuff. It’s like, if somebody has not been in the habit of exercising, and it’s, it’s intimidating to start walking into a gym, or, How do I even hire a trainer and do all these things? But it’s such an important thing to be able to start, you know, doing some strength training, even if it’s just, just at home. I don’t know if that’s how does your clinic handle that? So,

Dr, Michael Koehler 17:56
you know, again, going back to, I think, slow and steady wins a race, you know. And we have the patients that come to us are from all types of different activity levels and fitness levels. We have, we have people who are ex pro sports players, so they’re already in great shape. We have people who have, like, never exercised and don’t exercise at all. So that we have this very wide variety of patients that we get. But I think from my personal experience as a physician, if you sit down with a patient and you start telling them you need to get two grams of protein per pound of body weight, and you need to exercise, and you tell them to do all these things, that is a setup for failure. You know what I recommend is, as a general rule with the with in terms of the protein intake, which I believe that most patients are, this makes it a lot easier for them to digest. I say whenever you have and when you’re in, you’re on this medication, and you’re attempting to lose weight and you’re trying to get healthier. As a general rule, you don’t need to sit there and calculate the grams of protein you’re getting per day. I don’t do that. I’m not expecting any of my patients to do that. And so I tell them, as a general rule, whenever you have a meal or a snack, make sure that the majority of that meal or snack is comprised of protein. It’s super easy. That’s the easiest way to do it. Focus on that. When you sit down to have a meal, eat the protein portion first and then eat the rest. Okay, if you want to have a snack, don’t grab a bag of chips or something that has no nutritional value. Get a protein bar or something that has put Yog, whatever that has protein insects. So that’s really the advice that I give initially, for patients who are just completely new to nutrition. I think that’s easy, and I think those are good rules, right? I think anyone can follow those. In general. In terms of exercise, a lot of patients don’t understand what exercise is, and there’s different there’s different intensities of exercise. So right now, if you look at the World Health Organization, they recommend, and this is the bare minimum that patients should get, around 150 minutes of moderate intensity exercise per week, right? That means 30 minutes a day for five days a week. That’s the bare minimum you should get. What’s moderate exercise? It’s, it’s, it’s broad. I mean, gardening is moderate exercise. Walking out. Side is moderate exercise. You don’t have to tell and I never do this. I never tell patients, okay, you need to get a trainer, and you need to go the gym, and you need to go there three or four times a week, and you need to be there for an hour. It’s too much stuff, and most people are not going to do it. I feel like if you tell patients initially, if you take these steps with the nutrition, focusing just on protein intake, without specific variables to follow, focusing on just getting more active. I mean, like, that’s the bottom line. If you’re walking around, you know, you know, take the steps when you go to work. It’s all these little things that really add up if you do them on a consistent basis. I think telling them that is much more effective than giving them some regimen that you put people on, because the the reality is, the medications are going to handle a lot of the shoulder work to begin with, and it’s going to help them and our bodies work on feedback, right? So negative feedback, very, very strong, right? So people get obese, that makes you not want to do anything, right? Who wants to go to the who wants to go to a gym where they feel, where they’re, they’re, they don’t feel well about themselves, right? They don’t want to do that. But, well, I tell patients, when we see this all the time, positive, positive feedback is also very strong, and that’s what people forget about. So let’s take someone who doesn’t exercise in their obese and they come to us because they want to be on a weight loss medication. They want to improve their selves, their looks, their health, etc, right? There’s a strong psychiatric component to this, because even if they don’t start exercising a lot, the 150 minutes per week or whatever, and they get on these medications, their caloric intake comes down, right? Because, remember, these medications, they help suppress the appetite. George, so that cuts down on overall hunger and cravings, right? Even alcohol cravings. I mean, it cuts down on that as well, but they also delay the process that your stomach can empty its contents, so when you eat a meal, you feel fuller, more quickly and for a longer period of time. So that’s how they work. Just doing that in and of itself, without increasing your activity, you’re going to lose weight. And so what we find is these patients who aren’t used to exercising, they start losing weight, they start psychologically feeling so much better that gives them the the confidence to get more active, because they’re like, Well, you know what, I look pretty good. Now I can go outside and walk around, and people are going to probably be say, Hey, you look pretty good. Or I can go to the gym now, because I feel like I look you know? So that that positive feedback is super important, and it keeps rolling. You know, I

george grombacher 22:20
love everything about that. It’s such a it’s such a great point. It’s just, it’s human nature, for sure. You know, Dave Ramsey talks about getting out of debt using baby steps and the snowball method and small bites, and that’s kind of what we’re talking about here. It’s just incremental progress, and you do get more confident, and confidence is a beautiful thing, and hopefully that’ll lead you to to healthier lifestyle choices. So makes a ton of sense. Well, Michael, thank you so much for coming on. Where can people learn more? How can they engage?

Dr, Michael Koehler 22:49
The easiest way is to go to our website. We just revamped it several months ago. It’s www dot affinity, whole health.com. Has all of our contact information on there. We have a pretty robust, frequently asked questions that we put a lot of work in. You know, just for general questions that patients have before they actually want to contact us. We have information on there. It has more information about us, about me, about our team. That’s that’s definitely the best way to get in contact with us.

george grombacher 23:15
Excellent. Well, if you enjoy this much, as I did, show Michael your appreciation, share today’s show with a friend who also appreciates good ideas. Go to affinity, whole health.com, and check out all the great resources and those FAQs. And just educate yourself on this process and reach out and find out if it’s a good fit for you and what it is you’re trying to accomplish. Thanks again. Michael,

Dr, Michael Koehler 23:37
thank you so much. George. I appreciate it. Thank you Till

george grombacher 23:41
next time, remember do your part by doing your best. You.

george grombacher 16:00
So if I want my iPhone, and my Tesla and my Bitcoin to work, we need to get the metal out of the ground.

Pierre Leveille 16:07
Absolutely. Without it, we cannot do it.

george grombacher 16:13
Why? Why is there a Why has production been going down.

Pierre Leveille 16:21
Because the large mines that are producing most of the copper in the world, the grades are going down slowly they’re going there, they’re arriving near the end of life. So and of life of mines in general means less production. And in the past, at least 15 years, the exploration expenditure for copper were pretty low, because the price of copper was low. And when the price is low, companies are tending to not invest more so much in exploration, which is what we see today. It’s it’s, it’s not the way to look at it. Because nobody 15 years ago was able to predict that there would be a so massive shortage, or it’s so massive demand coming. But in the past five years, or let’s say since the since 10 years, we have seen that more and more coming. And then the by the time you react start exploring and there’s more money than then ever that is putting in put it in expression at the moment for copper at least. And what we see is that the it takes time, it could take up to 2025 years between the time you find a deposit that it gets in production. So but but the year the time is counted. So it’s it’s very important to so you will see company reopening old mines, what it will push also, which is not bad, it will force to two, it will force to find a it will force to find ways of recalibrating customer, you know the metals, that will be more and more important.

george grombacher 18:07
So finding, okay, so for lack of a better term recycling metals that are just sitting around somewhere extremely important. Yeah. And then going and going back to historic minds that maybe for lack of technology, or just lack of will or reasons, but maybe now because there’s such a demand, there’s an appetite to go back to those.

Pierre Leveille 18:33
Yes, but there will be a lot of failures into that for many reasons. But the ones that will be in that will resume mining it’s just going to be a short term temporary solution. No it’s it’s not going to be you need to find deposit that will that will operate 50 years you know at least it’s 25 to 50 years at least and an old mind that you do in production in general it’s less than 10 years.

george grombacher 19:03
Got it. Oh there we go. Up here. People are ready for your difference making tip What do you have for them

Pierre Leveille 19:14
You mean an investment or

george grombacher 19:17
whatever you’re into, you’ve got so much life experience with raising a family and doing business all over the world and having your kids go to school in Africa so a tip on copper or whatever you’re into.

Pierre Leveille 19:34
But there’s two things I like to see and I was telling my children many times and I always said you know don’t focus on what will bring you specifically money don’t think of Getting Rich. Think of doing what you what you like, what you feel your your your your your, you know you have been born to do so use your most you skills, do what you like, do what you wet well, and good things will happen to you. And I can see them grow in their life. And I can tell you that this is what happens. And sometimes you have setback like I had recently. But if we do things properly, if we do things that we like, and we liked that project, we were very passionate about that project, not only me, all my team, and if we do things properly, if we do things correctly, good things will happen. And we will probably get the project back had to go forward or we will find another big project that will be the launch of a new era. So that’s my most important tip in life. Do what you like, do it with your best scale and do it well and good things will happen.

george grombacher 20:49
Pierre Leveille 21:03
Thank you. I was happy to be with you to today.

george grombacher 21:06
Damn, tell us the websites and where where people can connect and find you.

Pierre Leveille 21:13
The it’s Deep South resources.com. So pretty simple.

george grombacher 21:18
Perfect. Well, if you enjoyed this as much as I did show up here your appreciation and share today’s show with a friend who also appreciate good ideas, go to deep south resources, calm and learn all about what they’re working on and track their progress.

Pierre Leveille 21:32
Thanks. Thanks, have a nice day.

george grombacher 21:36
And until next time, keep fighting the good fight. We’re all in this together.