129. Ashley Koff: The GLP-1 Conversation Most People Are Missing

Extend Podcast with Darshan Shah, MD

Jan 13, 2026•1 hr 2 min

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Episode description

Most people think weight loss is about discipline, calories, or finding the right medication. But what if the real issue is that we've misunderstood how hormones, digestion, and recovery actually regulate metabolism in the first place?

In this episode of Extend, we sit down with registered dietitian Ashley Koff to unpack what GLP-1 medications are really doing in the body and why bariatric surgery revealed metabolic changes long before significant weight loss ever occurred. We explore incretin hormones, vagus nerve signaling, and why appetite, blood sugar, and inflammation are part of a much larger hormonal ecosystem.

We also dive into the often-missed pieces of the GLP-1 conversation, including digestion, detoxification during fat loss, protein quality, and why offboarding plans matter as much as starting doses if you want long-term success without burnout or regain.

Ashley Koff is a registered dietitian nutritionist and founder of The Better Nutrition Program. She has over two decades of experience supporting patients in bariatric care, metabolic health, and digestive optimization. She is the author of Your Best Shot, a practical guide to understanding weight health through a systems-based approach.

What We Discuss:

(00:00) Why Weight Loss Fails When Hormones Are Ignored

(05:42) What Bariatric Surgery Revealed About Metabolism

(11:18) Incretin Hormones and Why GLP-1 Is Only One Piece

(18:06) The Cost of Keeping Metabolic Signals Turned On

(26:14) Fatigue on GLP-1s Is Not Just About Calories

(34:22) What Happens When Fat Loss Releases Toxins

(44:10) Why Coming Off GLP-1s Too Fast Leads to Regain

(55:03) The Biggest Nutrition Mistakes During GLP-1 Therapy

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