#373 The GLP-1 Revolution: How to Support Natural Production Through Food and Supplements with Shefaly Ravula, PA-C

This week on The Less Stressed Life Podcast, we’re diving into the world of gut health, metabolism, and the hottest new trend in health: GLP-1 medications! 🎉 I had the pleasure of chatting with the amazing Shefaly Ravula, a PA-C and founder of Precision Gut Health, who’s on a mission to transform gut and metabolic health using a fusion of culinary medicine, advanced labs, and a whole lot of passion. 🌱✨

We’re tackling everything from the role of GLP-1 agonists (think Ozempic and Wegovy) to how gut health impacts metabolism and longevity. Curious about how these medications work and why they’ve become so popular lately? Shefaly breaks it all down, including why supporting your body’s natural GLP-1 production with fiber and polyphenols is just as important.

It’s a juicy episode filled with practical tips on managing gut health, exploring the science behind GLP-1, and why it’s essential to approach weight loss holistically. Plus, we’re dishing on healing spices and their magic in supporting gut health! 🌶️💪

KEY TAKEAWAYS:

• What GLP-1 agonists (Ozempic, Wegovy) are and how they work
• Why gut health is key to metabolism and longevity
• The difference between natural GLP-1 production and medication
• How to support your body’s own GLP-1 with fiber, polyphenols, and healing spices
• Should you be taking GLP-1 medications? Shefaly’s take on who benefits the most!
• The healing power of “Vitamin C”—community—and “Vitamin J,” joy

ABOUT GUEST:
Shefaly Ravula, PA-C, is the visionary founder of Precision Gut Health, a virtual telehealth practice on a mission to unlock the secrets of gut health, metabolic balance, and longevity. At the heart of her practice lies a powerful fusion of culinary medicine, advanced labs, and a profound commitment to digestive and metabolic health optimization. She is dedicated to guiding patients towards a future where gut health and longevity are intricately entwined—and where vibrant health is not just a destination but a lifelong journey.

FREEBIES FROM SHEFALY:
Download Your Free Gut Health Survival Guide at https://precisionguthealth.com/

Gut Healing Herb Guide: https://precisionguthealth.com/gut-healing-herbs-and-spices-guide/

WHERE TO FIND:
Website: https://precisionguthealth.com/
Instagram: https://www.instagram.com/precisionguthealth/

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: ****https://www.christabiegler.com/links

NUTRITION PHILOSOPHY:

• Over restriction is dead
• Whole food is soul food and fed is best
• Sustainable, synergistic nutrition is in (the opposite of whack-a-mole supplementation & supplement graveyards)
• You don’t have to figure it out alone
• Do your best and leave the rest

Transcript

[00:00:00] Shefaly Ravula, PA-C: I see people able to get people off slowly, not everybody and also it depends on the dose that you start off and how you start off.

[00:00:07] Shefaly Ravula, PA-C: Is your gut in shape? Are your detox pathways great? Did you do all of these things before you got on them? And then you're probably gonna be on a lower dose possibly in the first place or you can titrate off. 

[00:00:19] Christa Biegler, RD: I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common that we're both in pursuit of a less stressed life. On this show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high performing health savvy women in pursuit of abundance and a less stressed life.

[00:00:49] Christa Biegler, RD: One of my beliefs is that we always have options for getting the results we want. So let's see what's out there together.

[00:01:07] Christa Biegler, RD: all right, today on The Less Stressed Life, I have Shefali Rubula, which I just talked to her about pronunciation. So hopefully I am on the right track. Perfect. She is a visionary founder of Precision Gut Health, a virtual telehealth practice on a mission to unlock the secrets of gut health, metabolic balance, and longevity.

[00:01:25] Christa Biegler, RD: At the heart of her practice lies a Powerful fusion of culinary medicine, advanced labs, and a profound commitment to digestive and metabolic health optimization. She's dedicated to guiding patients toward a future where gut health and longevity are intricately entwined and where vibrant health is not just a destination, but a lifelong journey.

[00:01:41] Christa Biegler, RD: Oh, it's just so hot. It's like a bedtime story. So welcome to the show. 

[00:01:46] Shefaly Ravula, PA-C: Thank you. I know it sounded pretty long there, but, it could have gone longer. 

[00:01:50] Christa Biegler, RD: Yeah, it could have gone longer. Okay, so we're talking about something pretty exciting today, pretty trendy. We're talking about GLP 1 production, antagonists, all the things.

[00:01:57] Christa Biegler, RD: So before we jump into that, just give us a little snapshot of how you ended up where you are now. I know you're a PA, so how did you end up working in This field of let's call it functional medicine. Sometimes we assign different names to it, but tell us a little bit how you landed here first.

[00:02:14] Christa Biegler, RD: And then we'll talk about GLP once. 

[00:02:16] Shefaly Ravula, PA-C: Yeah, I always call it a circuitous path because, I'm straight out of grad school as a PA, get this job working, oddly and very niche bone marrow transplant of all, but I learned a lot of great critical care skills and, inpatient hospital medicine, etc.

[00:02:31] Shefaly Ravula, PA-C: But my dad, I got, I was paged. This is before cell phones. was, I got paged, he was having a heart attack and basically fast forward 20 years, I got into the field of nutrition on my own, self taught really for the most part over many years, which then led me to functional medicine and lifestyle medicine.

[00:02:53] Shefaly Ravula, PA-C: And then ultimately, taking aspects of all of it, like precision, how functional medicine, a little bit of longevity genomics. I love how you said we labeled these in different ways, but really all of it is about finding the root cause, and really working on Lifestyle measures, honestly.

[00:03:08] Shefaly Ravula, PA-C: So that's the, really the short version. There were different paths in there. I became a culinary instructor for a long time, had a catering thing, and then a food, did all of that. And then, worked in. GI for a long time, conventional allopathic GI, which is, I love that I have that as a background because it's just really eyeopening, obviously, because of nutrition and, functional medicine and gut health.

[00:03:32] Shefaly Ravula, PA-C: And then I did do a few years in metabolic health in urology. So lots of different pieces. 

[00:03:37] Christa Biegler, RD: I want to ask you. Before we jump in, because it will be connected to our overall conversation, you worked in conventional gastroenterology, and now you're working in essentially functional GI. And I bring this down to, I feel like in conventional GI, we're very good at structural diagnostics in evaluation, and in functional, we go, it's different.

[00:03:59] Christa Biegler, RD: How was that for you a little bit? Do you feel after you started learning things and applying them in functional medicine, how did you feel about your time in conventional GI? I'm just very curious just because we're almost not necessarily at odds, but there could be more synergy.

[00:04:15] Christa Biegler, RD: There could be more synergy. 

[00:04:16] Shefaly Ravula, PA-C: Yes. And 

[00:04:17] Shefaly Ravula, PA-C: I love that I have that background because I feel blessed that I do have that synergy with all the local, many of the local practitioners that are conventional medicine that are open minded to thinking about sending patients to me because they know, I suppose they are comfortable because they know that I have that allopathic background and I know when to refer.

[00:04:36] Shefaly Ravula, PA-C: Or when somebody needs imaged when somebody needs diagnostics that I can't do in a virtual practice. But I will say it was challenging so I became a culinary instructor for a while I was like a stay at home mom. So I did that for a while and I wasn't in allopathic GI at the time.

[00:04:50] Shefaly Ravula, PA-C: I had done that already and stayed home. And then I said, I've learned so much about nutrition and functional medicine. I want to bring, and my kids were older. I'm like, I want to, I miss, being a PA. I miss that clinical. Expert that using that part of my brain, and I wanted to bring food as medicine.

[00:05:06] Shefaly Ravula, PA-C: Really, it was food as medicine that I wanted to bring to the GI practice. So I went back same practice, different location. And I said, this is on my resume. I have all this training and this expertise and, Culinary medicine and nutrition. And I want to bring that especially to like IBS and GERD and IBD and fatty liver and all the things that we see every day in GI.

[00:05:26] Shefaly Ravula, PA-C: And it, it didn't work. I joined, I rejoined the practice, tried it for a few years. I had a lot of, a decent amount as a PA. Usually we have a little bit more extra time. We're still seeing 10, 15, 10, 10, 12 patients a day. Maybe not 30. So I had the time, but I could just stick in little blurbs here.

[00:05:44] Shefaly Ravula, PA-C: Oh, I want you to have five, it's not enough. It's not enough time. And it's certainly not still addressing the root cause. Anyway, that's a long winded way of saying it didn't work as well as I wanted it to. And I wanted to offer so much more. And so that's why 

[00:05:57] Christa Biegler, RD: I 

[00:05:57] Christa Biegler, RD: know, I love how you say tend to hold patients.

[00:06:00] Christa Biegler, RD: You had time to do more than that. 30 because you don't hear that. subjective opinion very often on the show. But to your point, I always say people like, don't be mad at your doctor. He's barely got time to see you. It's not the way he wants, he or she wants to see you. Yeah. 

[00:06:15] Shefaly Ravula, PA-C: Absolutely.

[00:06:16] Shefaly Ravula, PA-C: And they're run, also by the insurance model and it's such a complicated thing. Just even seeing you as a patient, but then directing your care and and how we're all parsed out now in medicine, you've got this specialist and this specialist, and no one's talking to each other.

[00:06:30] Shefaly Ravula, PA-C: And that's what we do, we bring it like we bring it so that we're like your tree trunk and ideally that would be like a really strong integrative or functional medicine primary care practice that can then help you figure out navigate where to go. But then at the end of the day, that person is still helping you solve the root cause. 

[00:06:49] Christa Biegler, RD: Yeah, I love this. Okay, cool. So we're going to talk about a pretty hot topic today, which is GLP 1. If someone has not been paying attention to what's on the news, draw out some flash words that they might be, that they might be familiar with the medical, the medications that are GLP 1 whatever.

[00:07:08] Christa Biegler, RD: Let's just talk about hot topic. Give us a little GLP 1 101 if people aren't sure that they've heard it before, but before we get into the nitty gritty. 

[00:07:15] Shefaly Ravula, PA-C: Yeah, absolutely. And to preface this, I'm not a board certified obesity medicine practitioner. That's a whole board certification, but I've had some training there.

[00:07:23] Shefaly Ravula, PA-C: I've done their whole, course where years ago before these meds were approved and these medications I'm talking about are GLP 1 agonists. And they are like brands like Ozempic, Wegavi, Monjaro, and non branded would be semaglutide, terzepatide. I learned about these some years ago, actually, when I was mentioning that I was working in the urology practice doing metabolic health, so lots of low testosterone patients, males.

[00:07:49] Shefaly Ravula, PA-C: Women to infertility, all those things, but I was doing their functional nutrition and really some functional medicine. And so I really realized that there was a role for these medications in some people, because if you have a BMI and, that's pretty high and people won't operate on your knee because of the risk of being that.

[00:08:11] Shefaly Ravula, PA-C: Yeah. That, significantly with morbid obesity and the orthopedic surgeon is saying I want you to walk. You need a surgery. You need knee surgery, but I'm not going to be safely able to do that on you. So it's just a catch 22, right? So these people were left very suffering. And so I wanted to really open my mind and educate myself about the physiology of obesity, which is a disease and also understanding the pharmacology behind it, not only bariatric surgery as a tool, but all the other things.

[00:08:41] Shefaly Ravula, PA-C: So that's how I got introduced to them. Those are the drugs. Now, fast forward, they're more than just for they were just indicated for diabetes because of what we saw with blood sugar reduction. And now, in the last year and a lot more than that, now they're approved certainly for obesity.

[00:08:57] Shefaly Ravula, PA-C: So that's the medication. Do you want to talk about like how it works? 

[00:09:02] Christa Biegler, RD: Let's talk about how it works 

[00:09:03] Christa Biegler, RD: And then also is there anything sticky going on in the current landscape with these medications? Like why did they just become hot? Is it because they were approved for obesity?

[00:09:12] Christa Biegler, RD: Is that why? 

[00:09:13] Shefaly Ravula, PA-C: Yes. 

[00:09:13] Shefaly Ravula, PA-C: Yeah. That's why. Yeah. So you, they're FDA approved, right? And so then you is depending on the indication, you could get insurance approval for them. And so then they're affordable. But the problem was short supply and this is not a, this has been an issue before for other brands too.

[00:09:29] Shefaly Ravula, PA-C: A short supply and demand concern with the various brands. And so we're here now having an issue with a short supply and all, I believe my understanding with the short supply is related to the actual pens. And not the medicine itself, but don't quote me that. That's what I've been recently hearing about from the various practitioners out there that are using these widely for various.

[00:09:51] Shefaly Ravula, PA-C: Other non obesity related things as well. and so compounding pharmacies are being used, utilized, to be able to deliver the medications because they're on short supply from the companies. So the sticky points to answer your question, there are so many, first of all, weight , it's a very tricky topic and it's, it has a lot of stigma and certainly in the dietetic community, I have a lot of peers and mentors in the dietetic space that I very much admire and respect.

[00:10:19] Shefaly Ravula, PA-C: And so many people are very much of the mindset that let's go back a little bit. think for a long time. Even in functional medicine, and certainly in nutrition, there was a stigma against using these medications. Oh my god, you're using these medications, you need to do the lifestyle stuff first.

[00:10:35] Shefaly Ravula, PA-C: Or, Why should you be using it for just 20 pounds of weight gain? Why aren't there's just a lot of shame and judgment just all around. And there always has been with weight, right? So these are sticky points with the GLP ones and the use of them. And, Dr. David Allison did an excellent job.

[00:10:54] Shefaly Ravula, PA-C: If anybody has a chance to listen to this podcast on Dr. Peter Attia's podcast, he was the guest. He's an epidemiologist. So he understands the lack. of nutrition science out there, but he also, understands public health. So I like the marrying of the two and understanding that we really, we just don't know a lot about the medicines in terms of safety after, we know safety data for 10 years.

[00:11:18] Shefaly Ravula, PA-C: But do we know 40 years? No, but we do have some safety data to make it so that, okay, what's the pro con list of using these medications? And that's really meant to be a discussion between provider and patient or practitioner and patient. Like it is very nuanced. There's so many things at play.

[00:11:34] Shefaly Ravula, PA-C: It's not, it's your gut health. It's your goals. It's aesthetics. Your metabolic health by far. So many things that come into play when we're trying to make a decision about using these. 

[00:11:44] Christa Biegler, RD: Yeah, so when people go on the GLP 1 medications like Ozempic, is there a time that people are usually coming off or is this sort of a ongoing thing at the moment?

[00:12:00] Shefaly Ravula, PA-C: If you look at how obesity. Is as a, is a disease and the physiology of it. The idea is that you get to a point where you've reached a metabolic set point. And so your body is fighting hard against weight loss. So this is probably why some people that do everything or try everything life's, exercise.

[00:12:23] Shefaly Ravula, PA-C: Diet, nutrition, et cetera, sleep, stress is some of those last two, not most people don't always do, but the top two, I feel like are things that people feel empowered to work on and they, try various things. Oh, I did the keto. Oh, I did prolon. Oh, I did some macro counting. Oh, I, exercise at orange cereal, five days a week or whatever it is.

[00:12:41] Shefaly Ravula, PA-C: They might lose some, but then they get to a stopping point, right? And, or they regain it if they go off of a particular pattern. So the way I'm digressing. Your question was what again, Krista? 

[00:12:54] Christa Biegler, RD: Oh, it was just once people go on, do they come off? Is there a plan? 

[00:12:58] Shefaly Ravula, PA-C: Yeah. Yeah. So Because it's a pharmacotherapy agent, it's a medication, I think the thinking is I know the thinking is obesity is a disease, so you treat the obesity with a medication, so how could you come off of it if you're treating your disease?

[00:13:13] Shefaly Ravula, PA-C: They equate it to, okay, I'm specifically talking about people that are in the field of obesity medicine. And I don't quite agree with this fully. Because of our functional medicine background. But the idea that like if you have high blood pressure and you're on a medication, you're not just going to go off of it.

[00:13:30] Shefaly Ravula, PA-C: But in our world of functional medicine, natural medicine and nutrition, we can sometimes get people off medications because we work on all the other things and it's a slow process. But it's possible weights a little tricky. And I think it's so complex. We're looking at hormones and perimenopause and andropause.

[00:13:48] Shefaly Ravula, PA-C: And Thyroid and, everything else. So it's not that simple. Like maybe high blood pressure is a little bit more simple, I think, or acid reflux is actually even more simple. Yeah. So I think that, yes, I see people able to get people off slowly, not everybody and also it depends on the dose that you start off and how you start off.

[00:14:08] Shefaly Ravula, PA-C: Is your gut in shape? Are your detox pathways great? Did you do all of these things before you got on them? And then you're probably gonna be on a lower dose possibly in the first place or you can titrate off. 

[00:14:20] Christa Biegler, RD: Yeah, I would say to answer those questions, is your gut health great and is your detox, are your detox pathways optimized?

[00:14:27] Christa Biegler, RD: The answer is usually no. Typically, right? The answer for the average human, it'd be hard for them to have those things optimized unless they fully, I'm just saying what I, maybe I have a pretty skewed view of that, but I think it's true. So GLP this is a hormone that's already occurring in the body that impacts carbohydrate metabolism.

[00:14:49] Christa Biegler, RD: So when we're taking the medication, it's just filling in, is it almost like hormone replacement therapy? Probably not so much like a synthetic hormone replacement. 

[00:14:57] Shefaly Ravula, PA-C: Yeah. It's 

[00:14:58] Shefaly Ravula, PA-C: a peptide. So GLP 1 is a peptide, right? But here's the big difference. And this is what I wanted to really talk about today with you is.

[00:15:06] Shefaly Ravula, PA-C: Like our innate glp one and what that really means compared to taking the medication and they're very different in the sense of the dose. So what we produce in our body. is fairly short acting and acts upon times that we eat. So we produce it in the intestines from the L cells. And there's a whole GLP one pathway that involves parts of the microbiome, like agarmancia and bifido and other prebiotics that help feed fast forward, feed forward that cycle plus many other parts of that pathway.

[00:15:38] Shefaly Ravula, PA-C: If we are making our own, and there's so much we don't know about this, right? So if we make our own, we know that we make probably small amounts that help us feel full. So that's one of the functions. And then certainly with that carbohydrate metabolism that you talked about, but the doses for medications are super dosed, right?

[00:15:57] Shefaly Ravula, PA-C: So standard FDA approved are super dosed. Mozambique and Manjaro. Manjaro has GIP1 in it also, not just GLP1, so it's a combo drug. You would, that is why they're working. That's why they work so well, because they're super dosed. And they do work well. They work fast. I have concerns about that.

[00:16:15] Shefaly Ravula, PA-C: I have concerns about rapid weight loss in from anything as you probably do, Krista we see some of the ramifications of that. And I certainly see that in the longevity space long term you would be concerned about rapid weight loss for various reasons. And we can go into that later if you want to. 

[00:16:32] Christa Biegler, RD: Okay. So with our innate GLP 1 production, let's just. very different because it's these small little pieces. And so we don't really know how we feel about that. We just know that when we're medicating, we're not really doing it like the body does. So that's the takeaway there. 

[00:16:45] Shefaly Ravula, PA-C: Yes. 

[00:16:46] Christa Biegler, RD: Let's talk about, should we be provoking, promoting more GLP 1 production? How can you do it? 

[00:16:56] Shefaly Ravula, PA-C: Yeah. And you could title that question or talk. any which way, because the answer is the same. Eat more fiber, eat more colorful fruits and vegetables, eat more natural whole foods that come in their most pure form that you can possibly get.

[00:17:16] Shefaly Ravula, PA-C: From the ground really that's, fiber is an answer for a lot of However, of course, if you have If you just have gut issues, so if you are somebody that goes to your doctor and has bloating and loose stools or not regular bowel movements or undigested food in the stool or fat in the stool or you name it, any GI issue that you feel like either you've been dealing your whole life and you think it's normal, which it's not, or somebody in the allopathic world is telling you, oh, it's just IBS, or it's just aging, trust your gut that's like my bottom message, like trust your gut and be your own advocate, but at the same time, you do need to lean on it.

[00:18:00] Shefaly Ravula, PA-C: your professionals you can't take everything in control, but you do want someone that's open minded, that has a bi directional relationship with you, that's listening to you. So I was going off on a tangent, but if you have those gut issues, , it's not so easy for you to do eating all the fiber and eating the probiotics and prebiotics and polyphenols, because you might not tolerate them.

[00:18:20] Shefaly Ravula, PA-C: So you have to get that. 

[00:18:21] Christa Biegler, RD: But you can later. And I will say about. fiber is a prebiotic, but not all prebiotics are fibers. And when you talk about these colorful vegetables, you're talking about polyphenols and polyphenols are prebiotics and they are very rich prebiotics. And also let's not discount amazing fresh spices as being such a useful piece of polyphenols.

[00:18:44] Christa Biegler, RD: So these are just like magical. And I was going to say, I'm going to reiterate in different words, just to make sure this lands for people. Yeah, it's our We think rebiotics, the definition, I believe is that you're supposed to selectively feed good bacteria. But when you sit down with microbiome professionals, we agree that they are not tolerated by people with massive gut imbalances or digestive issues, et cetera.

[00:19:06] Christa Biegler, RD: And so you just, again, to reiterate what you said, you have to figure out what is the problem before that, why you're not digesting that particular thing. It's the same reason why people are not digesting carbs or feel worse after sometimes eating carbs, et cetera. 

[00:19:17] Shefaly Ravula, PA-C: Absolutely. Yep. 

[00:19:18] Christa Biegler, RD: Which is funny because the GLP 1 improves carbohydrate metabolism, right?

[00:19:22] Christa Biegler, RD: And so this is literally, honestly, my entire life. It's this should work, but you need to do this other step first, this whole cycle can work just better, right? And I think about butyrate must be involved in this as well, which is fiber plus good bacteria in the gut, makes sure fatty acids. I don't know enough about GLP 1s 

[00:19:41] Shefaly Ravula, PA-C: So they were 

[00:19:42] Christa Biegler, RD: not like something 

[00:19:43] Christa Biegler, RD: popular we learned about before.

[00:19:44] Shefaly Ravula, PA-C: No, I 

[00:19:45] Shefaly Ravula, PA-C: know. I know. I'm now they're all popular. So it so butyrate as we know is fuel for the entire sites, the colon cells. And so the only cell in the body that uses most other cells use glucose for fuel and colon cells and pterocytes use butyrate. So that's how important butyrate is and butyrate triggers like the G protein coupled receptors to release GLP one from those intestinal L cells from them in the mucin layer.

[00:20:11] Shefaly Ravula, PA-C: So there's a direct correlation. So then people say why don't we give butyrate? Butyrate also, We have to look at that whole pathway. And I think this is what's like cutting edge and we don't know a lot about it, but acrobats, yeah, helps it's acting on the GLP one pathway, but it's also helping make the Buret and helping deliver it.

[00:20:30] Shefaly Ravula, PA-C: Pendulum, is

[00:20:31] Christa Biegler, RD: I was going to ask you about this. People ask 

[00:20:33] Christa Biegler, RD: about this all the time. They're like, should I be taking, they must listen to a podcast and learn about acrobantia being this keystone. Bacterial strain. That's important for everything. And I think this is what happens when we start to study an individual thing in the body.

[00:20:45] Christa Biegler, RD: It's wow, this thing is magic. I know. I think a lot of stuff in the body is just magic actually. It's how it feels. 

[00:20:51] Shefaly Ravula, PA-C: Yeah. And everybody, we all want that magic pill or that magic supplement and that magic one, but we don't know enough yet. You guys to. Single handedly put all our effort and money into an Ackermancia product.

[00:21:04] Shefaly Ravula, PA-C: Now that being said, their research is super awesome. I think they were able to actually grow the organism and they did a great trial. And people's A1C went down in their trial, but they're using a very specific formula. A lot of these companies, I wanted to talk about this because navigating the supplement space with GLP 1s is hard now because so many people, the Kardashian, somebody just came out with one and hers has, I looked this up in prep, cause it just came out in preparation for talking to you today.

[00:21:32] Shefaly Ravula, PA-C: It has blood orange extract from Sicily, and then it has saffron, the world's most expensive spice and it has lemon. So it may be a very, some specific brand, 

[00:21:43] Christa Biegler, RD: polyphenols 

[00:21:44] Shefaly Ravula, PA-C: species of lemon. Yes. So okay. Do you do that? Do you do the acromantia? Do you do the butyrate too?

[00:21:50] Shefaly Ravula, PA-C: And do I have to buy extra fiber powders too? Like you could spend so much money on this. There's nothing wrong with it, you guys. I'm not anti any of that. And I just think it can be supplement overwhelm, especially if you already have to work on other things in your body. Physiology. The other thing is try to do a food first approach, but it's not always feasible.

[00:22:14] Shefaly Ravula, PA-C: So yeah, I'm not going to blame you. If you want to take a few supplements here, you do what you need to do, but you need to work with somebody that's going to listen to you too, and meet you where you're at in your lifestyle too. Not everybody. I have stellar patients that do not fit what you were talking about.

[00:22:28] Shefaly Ravula, PA-C: with, them not having their, I have 50 percent of my practice is like that healthy, super healthy person that lives on a farm and grows everything and is in vitamin D all day long and doing all the things that then their labs aren't great. And then the other half is basically the vice versa of that.

[00:22:44] Shefaly Ravula, PA-C: We're all, everybody, we got to meet you where you're at. That's the bottom line. 

[00:22:47] Christa Biegler, RD: Totally. And this kind of, I'm going to talk about a little bit about how you support those things naturally for a moment, but this kind of goes back to why I think weight loss is secondary anyway, because it's okay, your body would make butyrate if it had good bacteria in the gut and you gave it fiber.

[00:23:02] Christa Biegler, RD: It'll make GLP 1 if you give it fiber. It'll make Acromancia, if you give it red polyphenols or red plant foods. So it's all the same message. We're just trying to make it sexier and we're trying to shortcut the process and jump straight to the result, which is very human. I totally understand. I also want to do that all the time because I'm also a human, but it's reminding us that those things are there.

[00:23:24] Christa Biegler, RD: And sometimes for me, when I am reminded of that sexy detail about polyphenols, I'm like, Oh yes, I must get back to microplaning some lemon. feel in my water or in my food or whatnot, right? like the magic is right here already. 

[00:23:40] Shefaly Ravula, PA-C: Yes it is, and it is 

[00:23:41] Shefaly Ravula, PA-C: hard to remember all the things, 

[00:23:42] Christa Biegler, RD: you gotta make it enjoyable and a ritual slowly, very slowly. 

[00:23:46] Shefaly Ravula, PA-C: Yes. 

[00:23:46] Shefaly Ravula, PA-C: And tasty. 

[00:23:47] Christa Biegler, RD: And 

[00:23:47] Christa Biegler, RD: reminded. Yes, I know. That's the most important thing. And on this point, I, once upon a time I went to a spice shop and they had all freeze dried spices and it was so delicious. I went home and got rid of all my other spices and replaced them and they're more expensive, but I know because they're so rich in poly, they're so much better for polyphenols.

[00:24:04] Christa Biegler, RD: I feel like I'm like making my food taste amazing and getting much better nutrition and it feels like a big easy button all the way around. 

[00:24:10] Shefaly Ravula, PA-C: Yeah, 

[00:24:11] Shefaly Ravula, PA-C: I'm glad you brought up the healing spices because People don't think that they need the fresh and the dried have very high ORAC scores, the ORAC score with the, I can't remember exactly what antioxidant level, I think it's a compounded antioxidant, we should look that up maybe in for later, maybe for your show notes.

[00:24:29] Shefaly Ravula, PA-C: But I covered that in one of my food is medicine academy classes, but it's even just a little bit of dried oregano. Throw it on there, dried rosemary. That's totally fine. It makes it taste good. So do it, 

[00:24:41] Christa Biegler, RD: get yourself a mother in law with a freeze dryer and life. She brought me some freeze dried herbs the other day.

[00:24:48] Christa Biegler, RD: And I was, I'm already ordering freeze dryers, but so good. So good. Yeah. Okay. So we're like cracking through our list on GLP 1, right? We talked about the medications, we've talked about foods. Do you think we've covered foods okay that support? 

[00:25:00] Shefaly Ravula, PA-C: Pretty 

[00:25:01] Shefaly Ravula, PA-C: much, yeah but I do want to mention bitters.

[00:25:02] Shefaly Ravula, PA-C: Bitters, we don't want to forget about bitters. I got my sandy tea right here, my dandelion root tea. It's bitter, and it might be an acquired taste for some, but I think we are, probably fail with our children and not. allowing them to taste bitter foods by covering up their medicines with, whatever it is.

[00:25:20] Shefaly Ravula, PA-C: So I think we outgrew our bitter receptors over time. So you have to bring them back. Make sure you have some bitters. It stimulates all kinds of great things in your GI tract, upper gut, lower gut, everything, but does help probably with the GLP one as well. 

[00:25:33] Christa Biegler, RD: I love fennel seeds, cardamom. Do you have favorite bitters as well?

[00:25:37] Christa Biegler, RD: I love arugula and lemon are also a 

[00:25:40] Shefaly Ravula, PA-C: food I love. I love arugula because I don't find it better, and I do love radicchio, but for a drinkable better, I like, I do like dandelion root tea. It's strong. I use the traditional medicinals brand and it's, steep it for a while and, but it's pretty strong. 

[00:25:57] Christa Biegler, RD: There's a brand of tea. I think it's good earth teas and they make like sweet and spicy and a chai tea. And there are some of the strongest teas I've ever had. I think those are wonderful.

[00:26:06] Shefaly Ravula, PA-C: I was going to say one thing I don't want our listeners to at least my perspective on using the medication is that I'm not against it,

[00:26:14] Shefaly Ravula, PA-C: I'm just not against using these medications right now. I think we have enough safety data, but I know it's limited. Not that many years, but we have to figure out like, what's your tipping point as a person? I think people mention that they get really annoyed by people using GLP ones for, modest weight loss, but it's tricky because are we going to judge the person for going to get a nose job?

[00:26:39] Shefaly Ravula, PA-C: I don't, I feel like that's getting less judgment and shame than somebody wanting to use a medication for weight loss when they are hitting metabolic set points. And they might also have biomarkers that are completely. Yeah. Off like an elevated HSCRP or blood sugar problems, etc. I don't want anyone to go take these medications without listening to people like you and me.

[00:27:03] Shefaly Ravula, PA-C: You've got to do all that foundational work before, hopefully, during and then, hopefully after. So that you can keep that up. But I think it's another tool. In the weight management kit, but I do think it can be that weight loss is a side effect of the whole process too. 

[00:27:18] Christa Biegler, RD: Yeah, for sure. Okay, you have in your list how are vitamin C and choline related to this topic? 

[00:27:27] Shefaly Ravula, PA-C: Oh, I meant vitamin C and vitamin J. I love talking about vitamin C and vitamin J but they're not the vitamins that I'm talking about. I think vitamin C for me is community. I think 

[00:27:36] Shefaly Ravula, PA-C: it's so valued in, the blue zones, which is, we're talking about longevity. We're talking about a purpose ikigai, which is the term for purpose, I think, in, in Buddhism. Parts of the Japanese culture and which is where one of the blue zones was in Okinawa. So I think vitamin C for community.

[00:27:54] Shefaly Ravula, PA-C: I just call it vitamin C. Like I, I don't know. It's fun. And vitamin J is joy. Joy is the purpose. C is the sense of belonging and something where you feel like you have a community. Doesn't have to be big or small. So I don't think it matters. In terms of introverts, extroverts, enneagrams, whatever you want a little bit of community in your life to feed your soul. 

[00:28:16] Christa Biegler, RD: Yeah, I love that. So we've covered how the medications work. We covered that the medications are basically super doses. We talked about how the body creates much lower amounts of GLP 1, but to stimulate it looks like polyphenols and fibers, etc. Supporting gut health in general will increase GLP 1.

[00:28:37] Christa Biegler, RD: Is this something you've put into, have you had this conversation with a lot of your clients and said, do you want to do a really intentional experiment around upping fibers and polyphenols and see what the outcomes are? 

[00:28:49] Shefaly Ravula, PA-C: We have some, gut health people that we're not ready for that yet.

[00:28:52] Shefaly Ravula, PA-C: So when we're past that absolutely, and that has worked well. So you prep and treat and get through the root cause and absolutely people are able to readjust their dosing of all these different types of foods slowly into their diet and do really well. Now. Weight not specifically necessarily for weight there.

[00:29:11] Shefaly Ravula, PA-C: Not everybody's coming to me for weight. Most people are not actually right. Sometimes, like I said it's like a tertiary or later goal. It's not their primary or secondary goal. Often, if it is their primary or secondary goal. We have a discussion about whether we need to do, is that something you're interested in going down this pathway with the medication or do we want to try to do everything else?

[00:29:31] Shefaly Ravula, PA-C: And everybody's different on what they want to do. 

[00:29:34] Christa Biegler, RD: Yeah. I don't usually look at it through this lens and I usually tell people like, wait, is very secondary. Like your body's got to feel safe to lose weight, aka your gut health's got to be in a good place. And many other things. Yes. Many other things, right?

[00:29:46] Christa Biegler, RD: And so usually I discharge people when they've gotten to the maintenance part of they're tolerating fibers and doing all of those other things. But before we start to wrap up, I don't think there are, but it just popped into my head, are there any other reasons people take these medications except for blood sugar originally and now for weight or specifically obesity, according to the FDA?

[00:30:03] Christa Biegler, RD: Is there any other benefits or reasons that people take them or prescribe them? 

[00:30:09] Shefaly Ravula, PA-C: Yes, absolutely. And there are definitely practitioners out there, physicians out there that are prescribing these. From a compounded pharmacies to be able to delicately titrate and adjust dosing to the person in front of them rather than necessarily going by what the FDA is dosing people at for their specific indication.

[00:30:29] Shefaly Ravula, PA-C: So it is used off label. But it's also used off label for other things because GLP 1 receptors are found everywhere in the body. So on the heart, the brain, we already know what the pancreas and the just everywhere, liver, et cetera. So I think there's just a lot more information coming out about that.

[00:30:48] Shefaly Ravula, PA-C: And. More and more studies looking at okay, specifically, like, how is this working for neuro inflammation or neuro degeneration or addictions or, heart failure. So these are coming out. We have great with the select trial that was published last year. We should totally link to that, , it is in a way it is a magical, beautiful.

[00:31:09] Shefaly Ravula, PA-C: drug. Again, we still have so much to learn about it, but it is moving the needle on metabolic disease and all kinds of metabolic disease, but then also the addiction piece addictions, which is perhaps why, we see that crushing of that hedonic urge when people take this medication, that food noise going away in those cravings.

[00:31:28] Shefaly Ravula, PA-C: And I'm not saying that's necessarily the only approach, but we can't knock it and we can't. We can't disregard that these drugs are working on the brain somehow, and so much to learn about how that is happening. Yeah. 

[00:31:42] Christa Biegler, RD: Yeah, when you mean its impact on addiction, do you mean mostly food addiction, or is it being used for other addictions as well? 

[00:31:48] Shefaly Ravula, PA-C: Other 

[00:31:48] Shefaly Ravula, PA-C: addictions, yeah. And then, food addictions I'm not comfortable with, that in my practice by any means, I'm not a eating disorder specialist or anything like that, and I screen for that and refer out but I have seen other practitioners using it for food addictions.

[00:32:01] Shefaly Ravula, PA-C: I've seen data also on addictions, but not just food addictions. No. 

[00:32:06] Christa Biegler, RD: Interesting. It's interesting, right? It's this natural compound in the body that we're somehow manufacturing. I'm curious how they are manufacturing that. I don't know anything about that. So if you know anything, cool.

[00:32:17] Christa Biegler, RD: I'm always like, how is, I wish this podcast is called, how is it made, which already exists. I just want to know everything about how something's made. No, 

[00:32:26] Shefaly Ravula, PA-C: I'm sure. I know how the, for example. Some things, I love sulforaphane as an upstream driver, Neutrogenomically for multiple pathways. This is how I'm connected with a lot of my, some of my peers and mentors are in the genomic space, Neutrogenomic space, and I know how that's made by a couple of companies, Where they literally are taking fields of broccoli sprouts, And putting them into these little capsules.

[00:32:51] Shefaly Ravula, PA-C: It's like pounds and pounds of broccoli sprouts, that's fascinating, but I don't know. I don't know about, 

[00:32:56] Christa Biegler, RD: how are we leveraging something that's already made in the body and then putting it in and superdosing? I have no idea. Maybe there's, that's why there's a shortage.

[00:33:04] Christa Biegler, RD: I'm not sure something to look into, but I'm intrigued. It's always nice to have more options for things like neuroinflammation, which can be very debilitating. Obviously, heart failure, obviously addiction, right? If we have things that can be supportive, the question will be, are there any negatives?

[00:33:18] Christa Biegler, RD: And the other question for us and for our client population is there anything, should I even care about this? And is there something to know about what should I know about this and can I do anything naturally and the answer is yes. Yeah. 

[00:33:31] Shefaly Ravula, PA-C: I think it's, this is the foundation of science like I think you know you must be asking questions like whether you're a patient or practitioner, medical, whatever.

[00:33:41] Shefaly Ravula, PA-C: You should be asking questions and you should be, in my opinion, very open minded to all of it as the science unfolds. And we're never going to have enough of the science. We certainly aren't going to have enough nutrition science. We can't do those studies easily. But, we have to Healthy skepticism is really important.

[00:33:59] Shefaly Ravula, PA-C: But that means that you're doing it in a healthy way, meaning you are thinking about all the options. I just invite your readers to just really ask the questions, be open minded and be thinking about you as a person, not the person on Instagram that's taking it or the person on Instagram that's not taking it.

[00:34:19] Shefaly Ravula, PA-C: They don't know your labs. They don't know your family history. They don't know your psychosocial factors. They don't know who you live with. They don't know your Enneagram. I love the Enneagram. I still haven't done mine, but my friends have told me what I am. And I have to do it because I think it's going to be a really good part Of bringing this into my practice.

[00:34:39] Christa Biegler, RD: Yeah, we'll talk about that as soon as I press pause. This is my favorite side topic. Good. On this note, where can people find you online and learn more about you? 

[00:34:48] Shefaly Ravula, PA-C: Yeah. We're on social media is Precision Gut Health. We have rebranded from Precision Metabolic Health because that's a lot of syllables you guys, and I was just tired of saying the whole thing.

[00:35:00] Shefaly Ravula, PA-C: And I think gut and metabolism go hand in hand together. So it's the same practice. New name, precision Gut Health. And that's our website too. Precision Gut health.com. Let's see, we have a cool freebie out. On our website that is just a little gut health, fun thing. And if you DM me on precision gut health, I will send you a really cool guide on this just reminds me that I have this.

[00:35:22] Shefaly Ravula, PA-C: So I, and I haven't given it to anybody, so I'm going to give it to your readers. Because you talked about spices, so gut healing spices. So I'm going to get that for you guys. 

[00:35:29] Christa Biegler, RD: Cool. Sounds good. Thanks so much for coming on today.