Dietitian Advice on a GLP-1 with Steph Wagner, RD

Steph Wagner is a Registered Dietitian with 15 years of experience in bariatric surgery nutrition and now GLP-1 medications. She’s the owner and creator of Bariatric Food Coach, a comprehensive membership website for with resources, education and community for post-op surgical patients.

Website: BariatricFoodCoach.com
Instagram: @bariatricfoodcoach
Facebook: @bariatricfoodcoach
YouTube: @BariatricFoodCoach
Pinterest: bariatricfoodcoach

Steph Wagner joins us to explain what changes when nutrition stops being simple and starts affecting your symptoms, your labs, and your day-to-day life. We break down how dietitians support bariatric patients and people on GLP-1 medications while keeping care realistic, compassionate, and personalized. 
• knowing “healthy foods” versus building a plan that fits real life 
• using a dietitian when obesity and chronic disease make nutrition confusing 
• insurance coverage basics for dietitian visits and why Medicare rules frustrate patients 
• bariatric surgery nutrition goals compared with GLP-1 nutrition goals 
• managing GLP-1 side effects with protein timing meal texture and hydration 
• differences we see between semaglutide and tirzepatide tolerance 
• why a daily multivitamin often makes sense when intake drops 
• watching for deficiency clues and using symptoms to guide targeted labs 
• reducing triggers for people with disordered eating and screening for eating disorders 
• common barriers like time shame and finding a provider who feels safe 
• motivational interviewing as a way to set goals you actually own 
• navigating diabetes meds and when to ask about GLP-1s and SGLT2 inhibitors 
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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. I am so excited to have Steph Wagner here. She is a registered dietitian with 15 years experience in bariatric space. Um, started with patients who have undergone bariatric metabolic surgery and continues to do that as well, but also helps patients who are on GLP1 and other anti-obesity medications. She has a membership program on her website and a lot of amazing free tools available. So I highly recommend that you check that out and I'll include all the links below. But welcome, Seth. Thank you for being here.

Speaker 1 1:20

Thank you for having me. I love seeing you. And anytime we connect and talk, it's always such a pleasure.

Dr. Lindsay Ogle, MD 1:25

Yeah, absolutely. Well, let's get started.

When A Dietitian Truly Helps

Dr. Lindsay Ogle, MD 1:28

Um, I uh we'll just start with a kind of basic question, but how can patients benefit from working with a dietitian?

Speaker 1 1:35

Yeah, I love this question because, you know, I hear that I hear patients say all the time, which makes sense, like, well, I know what to eat, right? Like I know what to eat. And it's like, well, sure. I think any of us would pass that test, right? Like if it was like, here's a grilled chicken breast and roasted asparagus, and here's a meat lover's pizza, like we would pretty well know which one is healthier. I think my kids would know the answer to that. Um, and I think there's a lot of places to go, whether it's online or even like the local grocery store, to get helpful nutrition information, how to eat at home more often, how to eat more fruits and vegetables. But when does a dietitian come into play? I think it's when things are starting to get confusing and complicated. Um, so certainly when there's a chronic disease involved, obesity. Um, and then there's also a lot of obesity-related diseases. So if someone has obesity and the disease of diabetes, uh, high blood pressure, um, or if we're starting to add even food intolerances or allergies, like all of a sudden things start getting confusing. Um, not to mention the things that come into life, like I'm trying to also feed my kids, or I'm caring for an aging parent, or I'm on the road a lot. Or, and I think that is where a dietitian who specializes in both counseling and disease states in the body and how to make it all work for you, that's where I think it's worthwhile to work with someone that can really get in the weeds with you. That's my that's my go-to answer on dietitians. I have a lot of long answers about why dieticians are so great because I'm so biased. But anytime you feel you feel confused and overwhelmed, that's a good starting point.

Dr. Lindsay Ogle, MD 3:23

Yeah, absolutely. And I'm sure you've seen both, right? You've seen some people who are able to have maybe a few consultations and then some, you know, work longer term with dietitians. So there is that flexibility as well.

Speaker 1 3:37

Absolutely. I think that's a great point. And I think you could, you know, you could say the same is true with a mental health professional. You could probably say the same is true with like a financial professional. Sometimes, you know, someone needs an accountant and they just need help, you know, every once in a while with some basic tax things. Other times it's really complicated, right? Um, and I think the same is true. I might see, like I have uh patients that see me in the summertime because they're teachers and that's when they have time to really invest in that. And then they get into the school year and we just kind of touch base here and there, but mostly they're focused in on the school year. So it's totally dependent on the person in the place. Yeah.

Dr. Lindsay Ogle, MD 4:15

Yeah, that's awesome. I love anything that emphasizes an individualized approach. And like you were mentioning, like a lot of this information, you know, may be out there. You may be able to Google some stuff or chat GPT or you know, talk to friends, or you know, you've heard it before from other health professionals, but actually taking that information, you know, working all the way through it, finding what actually applies to you and then applying it to your your day-to-day life, that is a whole other beast. And working with somebody who this is what they have trained in and this is what they do all day, every day, can be so efficient and make the process so much easier.

Speaker 1 4:58

Yeah, absolutely.

Insurance Coverage And Advocacy Gaps

Speaker 1 4:59

And I think a word on like access to dietitians, um, because you know, you and I talk about advocacy a lot. Um, if someone has uh private insurance, Blue Cross, Cigna, Aetna, um, whom I forgetting, United, a lot of times under preventative care, you can get a dietitian visit covered at no cost out of pocket. So I have, I mean, pretty much my entire patient load is not paying for out of their pocket for these visits, especially with those insurance companies. Where it starts getting sticky and advocacy comes into play is if somebody is a Medicare recipient, then it's only with uh existing diagnosis of diabetes or end-stage renal disease or recent kidney transplant. So you think about all the diseases that are left out, you know, obesity, high blood pressure, um, cancer, um, eating disorders. So there is um there is a bill that we're advocating for, it hasn't been reintroduced yet, but to expand that because, you know, nutrition counseling to help, you know, get patients off of medications and improve these disease states is so important. So I mentioned that because it whoever may be watching this, it's possible you might have access to dietitians right now at no cost. Um, or if you're uh under Medicare, then you would have to have diabetes or in-stage renal disease, which can be frustrating.

Dr. Lindsay Ogle, MD 6:29

Super frustrating for you know those insurance um types, um, but also very important to know, you know, what to look out for if you have those types of insurance. And then if you do have private commercial insurance, um that you do have that access and might as well take advantage of it. Um, and like we said, it may just be that one initial consultation or you may start a you know long partnership with your dietitian. Yep.

Bariatric Surgery Vs GLP-1 Nutrition

Dr. Lindsay Ogle, MD 6:56

Um, I would love to hear what your approach is for patients who have undergone bariatric and metabolic surgery and then patients who may be on a GLP1. Is it similar? What are the differences? Um, tell me more.

Speaker 1 7:11

So such great questions. I think on a broad stroke, there's a lot of similarities because both of those uh are avenues to treat the disease, right? A surgical approach or a medical approach. And so nutritionally, we're going to be, you know, kind of moving in the same goals of meeting protein needs, getting in fiber, staying hydrated, um, paying attention to what symptoms might come up, whether it's nausea, um, lack of appetite, lack of thirst. Um so the overarching goals are pretty similar, but I think where it starts to get a little bit, you know, nuanced is um in a surgical patient, things are really uh maybe sensitive and fresh and new in that first three to six months, the first year post-op. And there's a lot of learning in that time, but the further out you get, maybe we're getting a little more comfortable with what's coming. Whereas in a medication, it's kind of it's just a different progress, right? If you start the medication, you may not have a lot of symptoms right away. If you increase the dose, then you may have a new set of symptoms, or uh your symptoms might be different from someone else. And that's true with surgical too. Um but we might like in a in a surgical patient, we probably would move them towards solid meals for breakfast, lunch, and dinner, um, focusing on hydration in between, and maybe protein supplementation, but the further out they get, they probably don't need to drink as many protein shakes. Whereas with medications, there may be situations where someone does do a protein shake in the evening if they're having a lot of nausea, belching, uh, discomfort because of that evening meal. So we might be moving more solid proteins and vegetables earlier in the day or kind of changing meal times or meal textures. So that's kind of unique to medication compared to surgery because they're similar and yet different. A protein shake in a surgical patient probably won't satiate them for very long because it's liquid-based, it's going to move through their surgical pouch faster. Uh, whereas there might be times where a protein shake, we don't want to rely on it with a medication patient, but there might be times to manage their symptoms that it's the better avenue. And that's where working one-on-one with a dietitian can be really helpful to identify your symptoms, your hunger control, uh, if you are having these other unpleasant side effects and how we can manage them through nutrition. Um, you know, how many, how many patients maybe started a medication and didn't have nutrition counseling on their side, and maybe they discontinue medication because of symptoms. And it's possible those symptoms could have been managed through nutrition. So those are some of the answers. But I think as a broad stroke, the goals are pretty similar, but maybe how we get there starts to be a little bit different. But all that to say, if somebody was looking for recipes, a GLP1 patient could look up bariatric recipes and find a lot of great recipes. Uh so maybe that's just a hack to find meal ideas that that would fit anybody. Yeah.

Dr. Lindsay Ogle, MD 10:30

Yeah, great. Thank you for going over that. And I really like that you highlighted the fact that, you know, a surgical patient, they have a lot of change post-op right away, whereas somebody who is on a medication, you know, we start at the lowest dose and then slowly titrate up as tolerated and as needed. And so it's a more gradual paced change compared to that surgical patient. Um, and then I also like that you highlighted if somebody maybe tried a medication in the past and didn't tolerate it for those, you know, side effects, then it it may be worth talking with your doctor and seeing if it's worth trying again alongside a dietitian to help with some of those side effects, which I think is is really important because when you're able to build that team around you, you may have a very different result.

Speaker 1 11:22

Absolutely. And have you let me turn that question on you? Have

Semaglutide Vs Tirzepatide Side Effects

Speaker 1 11:26

you noticed a difference if someone goes from a terzeptide, for example, to a synagogue? Do are their symptoms noticeably different?

Dr. Lindsay Ogle, MD 11:35

Yeah, sometimes. And I'll I'll highlight one time that it's almost always different, is if somebody tried a compounded version of a GLP1 in the past, and you know, compounded medications aren't regulated, so we don't know exactly what you were getting or exactly what dose, or you know, maybe you were you know titrated too quickly by that provider. And so if somebody has tried a compounded version, then I am much more encouraged to try and brand name version of the GLP ones, and you know, we may have better tolerance. Um specifically for semaglutide and trisepatide, um the semaglutide tends to have more constipation and nausea on average. And then trisepatide is more likely if you're gonna have a side effect, maybe like loose stools, um, maybe some queasiness. And so if somebody, you know, had one or the other, then it may be worth you know trying the opposite GLP1 and seeing if you tolerate that one better because they're very similar, um, but there are differences and people do, you know, some sometimes tolerate one better than the other.

Speaker 1 12:43

Yeah, that's great feedback. I've noticed that just anecdotally when patients mentioned they went from this medication to that medication and then are so surprised when the experience is so different.

Dr. Lindsay Ogle, MD 12:54

Yeah, yeah, absolutely.

Vitamins Labs And Deficiency Clues

Dr. Lindsay Ogle, MD 12:56

Um and then I I have another follow-up question with the difference between surgical and patients who are on anti-obesity medications. Uh, what is your approach to like vitamins and minerals and you know, those sorts of supplements?

Speaker 1 13:11

Oh, it's such a good question. I think in the world of weight management dietitians, um, you know, we love trying to keep up with this stuff, which is really exciting. Um, I'm a I'm a part, you know, I'm a member of all these different groups to stay on top of the research. So we have a lot of great information and data in the surgical patient. So we know um, you know, each surgery, a sleeve, a bypass, duodenal switch, uh, sips and sati, which I'm abbreviating those. Uh, but we can really get detailed if like this is exactly what they need for each of these vitamins and minerals. Um, we don't have quite as much of that data with um medical treatment with medications. Um and I don't, you know, you can't just completely apply the same things because there's not an anatomical change, there's not the same malabsorption that's happened with especially a DS, a duodenal switch, or a bypass. But certainly of supplementing with a multivitamin is a great idea. Um, and I don't um maybe you can speak to what labs you like to check, but I think even that can be a little bit of a moving target about what labs are being checked. So um dietitians, I think our field, our practice is growing a lot in the way of what we call nutrition-focused physical exams, which is a way of being able to identify um whether it's through sight or through touch, if someone is showing maybe some signs of a deficiency. Um, so there might be different questions a dietitian can go over, both with your food recall and what you're eating and kind of identify if maybe there's some gaps there, but also if there's any other symptoms you might be experiencing. So it is helpful to let a dietitian know if you're having dry mouth or tingling of the hands and feet. Um, and and same for any of your providers. If you're having any symptoms that feel new or unique that you weren't having before a medication, you should bring that up because those could be an opportunity to say, oh, we need to take a look at what this lab might be. And not all vitamins are checked every time. I mean, that that'd be incredibly expensive too, right? I would love to be able to do that, but uh it'd be it wouldn't be fun for the patient either. Um, B1 is a vitamin we watch quite a bit just because it's a really short half-life. So there might be situations where depending on the the patient and their intake, maybe we would add a B complex or we would just look at what your B, what your multivitamin is bringing in. Um a lot of providers like fish oil. Um so it gets a little bit more nuanced to sit down with a medical patient and and what they're eating and um you know what their labs were prior to starting a medication. Um, whereas the surgical, the surgical process is pretty buttoned up, right? We're seeing patients pretty consistently prior to surgery, checking a lot of labs prior to surgery, and then there's these routine follow-ups, and we've got really structured labs, um, structured vitamins to be taking. Um, whereas I think we have to get a lot more um, you know, clinically involved and identifying if there's anything going on with a medical patient that maybe could get missed. And and that's another situation where if you don't have a comprehensive team, something could get missed.

Dr. Lindsay Ogle, MD 16:37

Yeah, I agree. Um, it seems like we just we just don't know yet with the GLP1 medication specifically. Um, and I tend to recommend adding a multivitamin. You know, if somebody is reducing the amount of foods that they're eating, you know, we may not be getting all the vitamins and minerals that we need. And, you know, we may not have even been getting them before with you know our nutrition. Um, so it usually does not hurt at all to add that multivitamin. Um and then I absolutely want to repeat, yeah, if you're having any symptoms, especially that are new, definitely you know, tell your providers so we can look into that. Um, because yeah, we can't check everything. And so oftentimes it is um symptom-based. Um, so so definitely communicating that.

Nutrition Planning Without Eating Triggers

Speaker 1 17:24

Yeah.

Dr. Lindsay Ogle, MD 17:24

Um I'd love to hear what your thoughts are about um anybody who maybe has had a history of um disordered eating or over-restriction um and how to approach nutrition planning or working with a dietitian in a way that is not triggering.

Speaker 1 17:45

That is such a good question. I love that you asked that. I was I was texting with a personal friend last night whose specialty is eating disorder. She's a dietitian, and we talk often about our two worlds because you would think that they're not alike. And yet we talk often about how uh how similar they really are. Um, and I really appreciate having someone that I can talk to. Um, so I think some things to look for is when you're work, when you're looking for a provider like a dietitian, you probably do want to look for um pay attention to things that might feel triggering. Ideally, it's a a dietitian that isn't gonna pull out a a specific uh prescribed calorie count, um, especially if that's triggering, but that probably is a sign that this isn't gonna be as um focused on habits and lifestyle and disease management. This is a little bit too restricted and structured, which um, you know, there's just not a lot of uh great evidence that calorie-based eating is a great approach to treating obesity. Um you could look for if a dietitian has this is a newer credential, but a CSOWM is somebody that's more certified specifically in obesity management, and that's going to be someone that knows how to screen if there are eating disorders present. Um, you know, there's kind of different screening tools, just like most providers do. So while they're doing an intake, they might also be noticing. You know, you won't know that you're doing an intake form, but they might be kind of noticing if there is some um, you know, disordered eating patterns that they may want to refer you to a different specialty at that time. Um, because there's also a little bit of a difference between disordered eating and an eating disorder. So if someone has disordered eating, um, but we can, you know, that patient and I can keep working through their other habits. And maybe there's things that they can do earlier in the day that set them up better for that time of day. And through that counseling and through that process, um, we can work through maybe triggers towards some disordered eating and change their thinking or their approach, or just feel more safe that they've got somebody to work with and talk through all this with. But if somebody is now like, no, this seems more like we're moving into a diagnosis of an eating disorder, then they probably should not work with a dietitian that's specializing in weight reduction. They may need to go work with a dietitian that's more specialized in that disorder and feel get get true treatment before they can move kind of back into uh obesity treatment. It's it's it's a fine, delicate dance. I think we're all trying to figure it out. Um, but there's that I was texting a friend last night because there was a book that somebody shared on this topic, and I was like, let's read it as a book club.

unknown 20:44

Okay.

Speaker 1 20:44

And make sure that we're talking together as providers, how do we catch these patients, you know, because it it can lead to really detrimental things. Yeah.

Dr. Lindsay Ogle, MD 20:54

And it is such a fine line. And uh I'm sure you've seen on social media and just like working in this space that at times it seems like there we can be like budding heads with obesity medicine versus like health at every size or eating disorder providers. And when you really look at what our goals are for our patient, like you said, they really overlap and align. And I think a lot of it is just kind of the the maybe the terminology that we're using, or just uh I guess where we're starting from, I'm not quite sure. Um, but I do think that you know having somebody in that space that you can work with and can you guys can refer you know patients back and forth to each other, um, I think is so powerful because both both are really important and both deserve treatment. And the same if a patient does have, you know, disordered eating or even an eating disorder and they have obesity, they deserve treatment. For both, um, if that you know, you know, is what they want, and then um, and oftentimes it's usually you know that eating disorder gets treated first, and then we can treat um their obesity. So I've seen that in my practice, and it's gone very well um for patients who um had their eating disorder treated first and then come and see me.

Speaker 1 22:20

Yeah. That's so encouraging. I I love that you brought up the topic. I've even had personal friends go see a physician for uh obesity medication and it triggered their eating disorder. Based on a conversation with a provider, which we know is an issue, and that's you know, it can be upsetting. Um, so I think just kind of going back to your initial question, like if there are triggers present, um, you know, just like in any other situation, fight a different provider if it doesn't feel like a good fit. Because she ultimately took a year off and went to a different provider and it was a much better fit. So even as you're learning who your team's gonna be, if you feel like it is triggering you into a place that you know is not a good fit for you, listen to that inner voice.

Dr. Lindsay Ogle, MD 23:09

Yes, yes, you know, you know, you know what's best for yourself. You truly do. And you know, your physician and your dietitian and anyone else on your team were just helping provide information and help guide you. But yeah, you know what is best for you. So you know, we're always turning into yourself is important. Yeah.

Time Shame Telehealth And Motivation

Dr. Lindsay Ogle, MD 23:26

Um, so last question. Um, we talked about some barriers of insurance and maybe barriers of you know, disordered eating or eating disorders. Um, what are some other barriers that patients might face to working with a dietitian?

Speaker 1 23:43

That's a really good question. Um, I mean, I think probably like so many things. If I asked, if I went around, like, who is it that is it Jimmy Kimmel or whatever? One of those shows that had like on the streets. Um, and I asked people, I I have a feeling most people would just say time, you know, if it's one more appointment to get to, or I work eight to five and that's when their appointments are. So um I think that if that's a barrier, you know, trying it there are dietitians that will take evening or weekends. It's harder, of course, because most people don't want to work in those hours. Um, but there's it's possible someone in your area or somebody online that's licensed in your state could take an off hour. Um, or if it's a once a month check-in, maybe it's something you can uh start your day an hour later and take the first appointment of the day or take a lunch hour or whatever it needs to be. Thankfully, this is something that can be so easily done over telehealth. So you're not driving to a clinic to do it. Um and I think maybe the other one is just to if they if there is any concern of uh feeling ashamed of how you know, it's a very vulnerable moment to come into someone's office or a computer and uh tell them what you're eating. I mean, that's that's a really personal conversation. So um just like any other provider, mental health provider, you do want to make sure it's someone that you feel supported, you feel like there's empathy and compassion and you're being heard and listened. There is a style of counseling that dietitians are trained in, some more than others. Um, we have to get a lot of continual training in it, um, but it's called motivational interviewing. And the idea is that in the questions I ask you and my listening and reflecting back to you what I heard, you can find your own goals. I didn't give you the goals because if I came in here and was like, okay, Lindsay, I want you to do this, this, and this, you'd be like, okay, great, right? But I told you to do it. Yeah. So if someone is truly trained in how to do this dialogue where there's some education, but they're also helping you to find the words of what you're looking for and what your goals are, then there is research that says you're more likely to reach that goal because you made it. So I can say that's very true. Usually through the right conversations, patients kind of solve their own problems, meaning, oh yeah, if I, you know, put my keys next to my water bottle in the refrigerator, I won't forget my water tomorrow. And they came up with that. I didn't come up with it as an example.

Dr. Lindsay Ogle, MD 26:20

So that's awesome. Yeah, I knew you were gonna say time. That was the one that I was thinking and that I hear most often. Um, but you know, investing the time into our health is so important. And if it feels overwhelming and impossible right now, you know, finding people like stuff and following them on social media and getting bits of information along the way. There's so many, you know, great dietitians out there that you can start learning from. And then, you know, if you're needing that step further, then you know, scheduling an appointment can be so helpful or joining your membership. I'm sure that that's a great way to go about it as well. Um, and then thank you for bringing up the shame aspect because that is also so common in the fields that we are the fields that we work in. Um, and finding again, finding that um provider that is not going to shame you because it is not your fault. And it is okay to keep, you know, trying to find that person that is going to treat you with the respect and dignity that you deserve. Um, so thank you for for bringing that up as well. Um, and just thank you for the time here. Um, do you have any last um things to say, or definitely, you know, share how people can find you and connect with you?

Speaker 1 27:40

Yeah, I I will tell them how to share. I have one more question for you if we have time. Um Bariatric Food Coach is where you can find me on all the places, bariatricfoodcoach.com, hundreds of free recipes there, blogs, lots of stuff, and then all the social media channels. I'd love to see online there. Um,

Diabetes Med Options And Closing

Speaker 1 27:58

question to you is um like I had a patient as an example that newly diagnosed with diabetes, and they were seen with their primary care doctor, 21 years old, strong family history of diabetes, and they were given insulin and metformin, which in some ways I think that makes sense. Let's just get the blood sugars under control. But you know, they're that was that's all the information that they were kind of given to start with. So for that patient, is it appropriate for me to say, why don't you talk to your doctor about some newer medications? Because I'm thinking it's very difficult to lose weight if you're taking insulin. So we do want to manage diabetes, but we have other options available. Do I recommend an obesity medicine doctor or an endocrinologist? What would your take be on that?

Dr. Lindsay Ogle, MD 28:44

Yeah, that can be such a difficult situation to be in. And I found myself in situations like that because I have a contract position where I see patients for a specific condition, but I go over their history, and sometimes you know, some that scenario comes up. And I do feel strongly that our newer medications, our GLP1s and our SGLT2 inhibitors, and our old medicine, metaphorbin, are really the three best medicines that we have to treat type 2 diabetes. And patients should ideally be on those three. Um, and I do think it's appropriate, you know, to share to share that knowledge with patients. And I would start by ask having them ask their doctor about that, and maybe they did have a plan to just quickly or you know, more rapidly reduce their um blood sugar into a you know healthy range and then transition to those medicines. Um, and that, like you said, may be appropriate. Um, but I would just I would hate to, you know, them to continue on, you know, just insulin and metformin when we have those other options. And so if their doctor was not planning on that or does not feel comfortable with it, then that would be a time to maybe get that referral to endoprinology or obesity medicine or another primary care doctor. Um, but I I think it's worth having a conversation about that for sure.

Speaker 1 30:08

Yeah, thank you for your take on that. Like, what would Dr. Ogle do?

unknown 30:13

Yes.

Dr. Lindsay Ogle, MD 30:14

Um, all right. Well, yeah, thank you so much again for being here. Um I learned a lot and I know everyone else will too. And I will definitely ask you to come back on um in a future time to share even more. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast and they may also improve their metabolic health. I look forward to our conversation next week.