Ep 260 – Do GLP-1s Really Cause Muscle Loss? ft. Dr. Angie Sadeghi

In this episode of Muscles by Brussels Radio, Ben sits down with Dr. Angie Sadeghi for an in-depth conversation on GLP-1 medications, gut health, digestion, fiber, and the growing confusion surrounding modern nutrition advice.

Dr. Sadeghi explains how medications like Ozempic and Mounjaro actually work, why they’ve been so effective for appetite regulation and metabolic health, and what the research really says about concerns like muscle loss and long-term safety. The discussion also dives into insulin resistance, intramuscular fat, and why she believes many people have been misled about carbohydrates and fiber for years.

Ben and Dr. Sadeghi explore why most Americans are severely lacking in fiber intake, the differences between soluble and insoluble fiber, and how gut health is often oversimplified online. They also discuss probiotics, fermented foods, microbiome testing, digestive discomfort during transitions to plant-based eating, and why Dr. Sadeghi no longer recommends the FODMAP diet for most patients.

Throughout the conversation, Dr. Sadeghi shares practical insights from years of clinical experience helping patients improve their digestion, body composition, metabolic health, and long-term quality of life.

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TRANSCRIPT

Ben (00:00)
Hello everyone and welcome back to another episode of Vegan Proteins Muscles by Brussels Radio. I’m Ben and today I’m joined by Dr. Angie Sadeghi. She’s a board certified gastroenterologist whose mission is to improve the quality of life for her patients through an integrative framework combining evidence-based medicine, digestive expertise, and a passion for nutrition and fitness. She has developed a comprehensive approach to helping patients recover from illness.

Dr. Sadeghi has been featured in several documentaries, is a book author, and has been published in Vegan Health and Fitness Magazine. Thank you so much for being on the podcast today, Dr. Sadeghi.

Dr. Angie Sadeghi (00:32)
Thank you so much for having me, Ben.

Ben (00:34)
I’m really glad to be talking to you today. I had a really lovely conversation with you probably about two or three years ago with Sawyer back when we were running our own podcast. And that was one of my favorite guest interviews that we did. And since then, there’ve been some developments in the medical field that I’d love to talk to you about today that we get a lot of questions from our members and a lot of our clients on.

⁓ and that is relating to GLP-1s. But before we get into that, I like to start usually these podcasts with just a little bit of chit chat and just to let the listeners know a little bit more about you. So I’d love to know what inspired you to go into this field in the first place and what does a typical day look like for you these days?

Dr. Angie Sadeghi (01:17)
What inspired me to go into gastroenterology and obesity medicine is, you know, one of the most important things when you’re searching for your future career in medicine is to engage your talents, like whatever you’re good at. And when I was doing my internal medicine residency and applying to fellowship, I was doing a stem cell research fellowship, postdoctoral fellowship that involved reversing liver disease.

decided

to go into subspecialty training and fellowship, I decided to go into a field that engages my prior research experience and that would be the GI tract liver disease and things like that. And, you know, little did I know that I’m going to fall in love with the whole field of nutrition and digestion and gut microbiome and all of that stuff that ended up being all encompassing. And of course, I love, I’ve always enjoyed obesity medicine because I actually struggled with

weight loss myself throughout childhood and my teenage years. And even into well into my 20s and 30s I always struggled with my weight even though was an athlete I always worked out swimming and figure skating and weightlifting. I’ve been weightlifting since 15 and I used to think that you could just manage your weight when you exercising and you can eat whatever you want as long as you’re exercising then you should be okay and it took me a long time.

to realize that nutrition is very important in weight management. But anyway, I think that my own struggles led me to become a weight loss doctor.

Ben (02:52)
Well, that’s really, I think a lot of people could probably relate to that and feeling like there’s this maybe misalignment of, feel like I’m doing all this work. I feel like I’m exercising a lot, but I’m just not necessarily seeing kind of the changes that I want. And then kind of coming to this understanding of, okay, exercise and working out and lifting weights, these are amazing things for our health, but for weight management, it’s really nutrition that’s going to move the needle more.

and really allow us to see those changes that we want. And it ends up being a really transformative experience for people, just kind of unlocking that and then figuring out, okay, now that I understand that this is important, what’s the practical? What am I actually going to do? And that’s something that I’m assuming you get to practice on a daily basis with the folks that you work with.

Dr. Angie Sadeghi (03:38)
yes, it’s like one of those things that you really have to teach people because if you ask, when I ask people questions, basic nutrition questions, you would be surprised how many people actually don’t know. And there’s nothing wrong with that. I’m just saying though, people are lacking basic nutrition knowledge. And so you really have to go from the very beginning and teaching them the alphabet of nutrition. Like how many macronutrients are there? What are macronutrients? What are macronutrients?

because invariably every time you bring up the topic of weight loss they’re like okay if I just cut out the carbs that’s all I need to do I could lose weight right? No. And so it’s almost like 99 %

percent of people have it wrong and they don’t understand the whole calorie balance they don’t understand the importance of carbohydrates in diets in as far as gut health and body health muscle gain and all of that stuff and somehow they the carbs have been demonized and people have just learned incorrectly so we have to just undo this damage and then teach them from the get-go okay let’s let’s start from the beginning

Ben (04:44)
Absolutely, I mean even people not understanding what a carbohydrate is because people will say, ⁓ know, Oreos or pizza and donuts and then, you know, probably more of the calories are coming from fat and those things than carbohydrates. So there’s, you know, there’s a misconception there. And then there’s also like, okay, is, you know, a piece of candy the same thing as a piece of fruit? No, we can understand that, you know, like pretty logically there. And I’m curious just continuing this conversation on this topic.

Dr. Angie Sadeghi (04:54)
and

Ben (05:09)
⁓ Once somebody feels like they’re understanding the actual X’s and O’s and they have the knowledge, what do you find are some of biggest barriers to actually implementing that and then being successful with that?

Dr. Angie Sadeghi (05:21)
Look, the biggest barrier to weight loss and weight management is our natural appetite, right? So we all have an appetite set point. Whether that’s derived by your genetics or your lifestyle or your gut microbiome balance or whatever it is, your hormonal balance doesn’t matter. Your appetite dictates how many calories you consume per day. And the biggest barrier is that exact thing. I mean, it doesn’t matter that

most people look at ice cream and donuts as sugar. I mean, of course, you and I know that it’s more fat than sugar. so, but keep that aside. Yes, I know that most people don’t understand nutrition and they have very little understanding, but they actually know that’s junk food, right? So theoretically, if people understand junk food versus healthy food, even if they ate a little bit badly, if they could keep their calories smaller, they would lose weight, right? So why is it that people

are not losing weight because time after time it has been proven that willpower doesn’t work. People are busy, stressed out, they stress, they eat a lot, they eat more than they should and they basically they’re in a calorie surplus every day and that is the biggest problem of why people can’t lose weight and that’s where I know we wanted to talk about these GLP-1 so I’m just gonna segue into talking

about it right now, that’s why the GLP ones have been very successful. The same people who’d come to me and say, I can’t lose weight because of my hormones, I can’t lose weight because of this and that, and they give me a thousand excuses, and then you put them on GLP ones, they lose weight every time. know? I mean, like, look, I’ve heard it all. I’ve heard people say, when I go to Europe, I don’t lose weight because they have less hormones. No, they don’t really have less hormones. Food is food, calories are

calories

right so whether you’re here eating a pasta or in Europe eating the pasta the calories are the same it’s just that you know over there you’re walking more maybe you’re not consuming as much so you know I will always have people come into me and say like you know it’s it’s it’s my hormones check my hormones and like 99.9 percent times when you check the hormones everything’s normal so it goes to tell you that it’s a calorie surplus problem it’s not a hormone problem it’s not a metabolism problem

is a calorie surplus problem. Now what gets people to eat a calorie surplus diet, that’s just whatever. It could be stress, could be lifestyle, could be misinformation, doesn’t matter what happens. It’s like people can’t lose weight on their own because well power doesn’t work for the majority of people. And so that’s why these weight loss medicines are playing a very important role in helping people lose weight. And in many instances, keep it off on a maintenance dose, and you might be

population.

Ben (08:13)
I’m wondering if you could talk a little bit about what these medications actually are because I think people have heard of them. They’ve heard of maybe some of the brand names like they’ve heard of Ozempic, they’ve heard of Monjaro, but they don’t necessarily maybe understand, okay, what actually are these medications? How are they developed? What is the actual physiology behind what are they doing? Why are they so successful in helping control people’s appetite? Could you speak a little bit on that?

Dr. Angie Sadeghi (08:37)
Yeah, so there are different types on the market. There’s the GLP ones, and then there’s the GLP-GIP, and then there’s the new one, GLP-GIP-Glucogon. These are natural hormones that are released by the gut naturally on a daily basis. So when you eat fiber, fiber stimulates the production of these, through the gut microbiome, produces these natural hormones on a daily basis. But if you inject them,

in a concentrated form, they have these mechanisms that help you to help suppress your appetite. So the GLP slows down the gastric emptying and gives you a feeling of satiety for a long time, longer period of time. So this low, it puts the brakes on the stomach and the intestines. so your stomach is not emptying as fast. So you feel full longer. The GIP similar kind of a mechanism of

action but also perhaps it has some kind of a

some kind of a mechanism of action on the brain and gives you satiety. then, you know, so, so basically it’s somehow they make you feel fuller for a longer period of time. And so you’re not overeating. That’s all it is. It just basically cuts down your calorie intake is what it does. The nice thing about these medicines compared to the old versions of weight loss medicines we had, we used to have like stimulants,

amphetamines and they used to cause anxiety, insomnia. So this whole weight loss industry has been around for a long time, but this is the first time we have medications that don’t have these major side effects like anxiety and insomnia and high blood pressure and things like that, palpitations and things like that. These medicines are actually very healthy for you. They control your, they improve your metabolism. They bring down your hemoglobin A1c. They perhaps release a little bit

of insulin, they stimulate the pancreas to release a little bit of insulin. And so they also help you not eat as much. So basically, overall, they bring down your insulin, they bring down your hemoglobin A1c levels. And I don’t know if your listeners know what the hemoglobin A1c is, but that’s a measurement of how your blood sugar has been in the last three months, right? So

The lower the hemoglobin A1C, it’s a better indicator that your blood sugar has been controlled in the last three months of your life. So when the red blood cells live for three months in your blood, So each red blood cell has a lifespan of three months. And as it’s zooming around in your blood vessels, it gets saturated with that sugar. And so when it does, it’s called glycosylation.

So after three months, this red blood cell dies out and new ones come out. But if you take a snapshot of the blood and look at the glycosylation of the red blood cells, that’s the measurement of the hemoglobin A1C So it shows how well has your sugar been managed in the last three months of your life.

And every three months, you can measure it and you’ll see that with these GLP-1s, it goes down, keeps going down and lower and lower. Whether the patient has diabetes or pre-diabetes, the hemoglobin A1c slowly declines and normally they can achieve a normal hemoglobin A1c, which is an amazing opportunity for metabolic health. You will see people’s triglycerides go down, LDL goes down. You will see that patients

fatty liver disease, is the accumulation of fat inside the liver. People lose a lot of weight, their blood pressure goes down. It’s kidney protective, it’s heart protective, it’s liver protective, it’s brain protective. These are miraculous medicines that we are now using to help our patients improve their health.

Ben (12:25)
Thank you for that. I have a couple of follow up questions that I’m curious about if it’s known. So you mentioned all these positive benefits that come with taking these medications. Is it known if those are a consequence of the weight loss or if those are kind of independent mechanisms that will occur regardless through the mechanisms through which the medication acts?

Dr. Angie Sadeghi (12:45)
Most of it comes from the weight loss. Most of it. Because, you know, obviously if you are not losing weight, you could make a little bit of a difference in your blood pressure. You can make a little bit of a difference in your hemoglobin A1c by changing your lifestyle. But most of it comes from that weight loss. So…

Ben (12:47)
Mmm.

Dr. Angie Sadeghi (13:04)
If you think about it, let’s think about this scenario. If you didn’t use the medication and you lost weight, you will achieve improvement of the hemoglobin A1c, improvement of triglycerides, improvement of fatty liver disease. So if you just did it naturally and lost the same amount of weight, you’ll get a lot of the same benefits. But with the medication, because it does stimulate the pancreas to produce a little bit more insulin and at the same time simultaneously because a weight

loss, you’re getting insulin sensitivity, I think that the medicine is a little more powerful in achieving that goal than if you did it without the medicine or with just natural weight loss.

Ben (13:44)
Not to mention the fact that I think for some folks, you know, they’ve tried for so long and I think there’s probably a lot of guilt and shame around that and just like the fact that they could take a medication I’ve talked I’ve heard of people talking about their food noise decreasing dramatically and just you know being able to actually now implement a lot of the healthier lifestyle habits and choices that they’ve been trying they they’ve tried to implement in the past they kind of almost

brings down that barrier to entry for them. Where now they can focus on the healthy eating, they can focus on these other things because the medication is acting them as like, it’s almost a bridge between them and those habits. Is that something that you’ve observed with your patients?

Dr. Angie Sadeghi (14:23)
Well, yes and no. There’s a lot of misinformation about nutrition. So even though they’re eating a lot less of the bad stuff, you still have to really teach them on what’s actually important. What’s very important is to actually teach them what to eat and what not to eat. And I tell you about 99.9 % of my patients are not consuming enough fiber. So it’s very important to teach them about the basics of nutrition and help them

transform their diet because a lot of them got into that So I mean you and I know okay look at for how long we’ve been lied to about nutrition Look at for how many years we’ve been told eat a high protein diet low carb diet high protein low carb that has been so ingrained in people’s brains and people don’t understand fiber is a carbohydrate. So what happens is they go low carb and ⁓

they don’t understand the difference between a pure added sugar

versus carbohydrate meaning fiber. So it is very important that people who understand nutrition actually teach people what a healthy diet is, especially the fitness industry, because I feel like most of the misinformation came from the fitness industry in the first place. And so the fitness industry needs to step up the plate and really teach people the difference between fiber and sugar and added sugar versus fruit sugar and all of

that stuff right so like anyway we have a lot of work on our hands because even if people use these medicines to lose weight we still have a really big problem people are gonna go back back back to their unfortunate really terrible diets which is bad for their health and bad for their recidivism as far as weight gain after using GLP ones right it’s a big problem

Ben (16:12)
I think that’s so important to say like the you know even if we have these medications that are amazing and fantastic and you know they help us with a lot of these these things we still have to learn we still have to understand you know what it means to put you know good nutrition into our bodies to fuel ourselves properly to be able to live long healthy lives which is ultimately you know what pretty much all of us want so you talked about there being

The side effect profile of lot of these new medications is ⁓ way better compared to a lot. And you know, obviously the medications are way more effective as well. I’m curious, I feel like there’s been a little bit of a narrative and I remember when I first heard this, my immediate thought was to question kind of the claim, which is that these medications will cause muscle loss in people. And my immediate thought is, well, are they doing any resistance training? Because I think most

Dr. Angie Sadeghi (16:59)
Yeah.

Ben (17:04)
of us who work in the fitness industry understand that that is going to be way more, that is the main driver of retaining and building muscle mass. And so when I was hearing about these studies, I was like, well, are they having them do resistance training alongside the protocol? So I’d love to hear your take about people talking about GLP-1s causing muscle loss or we don’t know the of the long-term.

side effect profile, which I have my own thoughts about, you know, about that, but I’d love to hear yours first.

Dr. Angie Sadeghi (17:32)
Yes, sure. mean, so the studies show that patients lost a lot of muscles, but unfortunately they ⁓ used hocus pocus methods of measuring the weight of the muscle loss. So I don’t even agree with it. So you can’t use these impedance studies to prove muscle loss because it was just the wrong method. So as far as I’m concerned, they don’t help you lose muscle. They help you lose fat. So let’s go over this. You know, if you look at the muscle, right, what’s

What’s inside of a muscle cell? What is this one thing that’s sitting inside of a muscle cell of an obese patient? Guess.

Ben (18:11)
inside the muscle cell of an obese patient, I’m guessing there’s fat in there.

Dr. Angie Sadeghi (18:14)
Exactly. There’s a whole ton of fat sitting inside their muscles. So what happens when they lose weight?

Ben (18:22)
the fat will come out of the muscle.

Dr. Angie Sadeghi (18:24)
the fat is through the process of when they’re losing weight, that fat, intramyoicite fat, which is the fat inside of the muscle is getting burned for energy, ATP production, right? So what happens to the muscle cell when the fat is shrink, once the fat shrinks, the intramyoicite fat shrinks, what happens to the muscle cell?

Ben (18:45)
Yeah, the muscle gets smaller and so it registers, I’m guessing, as muscle loss.

Dr. Angie Sadeghi (18:48)
cleaner.

it becomes

leaner, right? People lean out. So, you know, if you put them on that impedance test, it’s going to look like they lost muscle. Okay. It’s not really muscle loss. They’re just leaner. That intramisites fat, by the way, I’m not, don’t need to like a segue to talking about something else. That’s the enemy right there. That intramisite fat is what causes insulin resistance. It’s not sugar that causes insulin resistance.

Ben (19:09)
No, go on, go on.

Dr. Angie Sadeghi (19:18)
it’s that intramuscite fat inside of the muscle cell that dictates how much sugar and insulin can get inside of the cell. So if you have a ton of fat inside of the cell, that’s what gives you insulin resistance. So that’s where people, instead of losing weight and bringing down body fat to become more insulin sensitive, what do they do? They cut out sugar, which is the wrong thing to do. Does that make sense? So that’s where when you lose

your hemoglobin A1c goes down and you become more insulin sensitive because you’re losing that intramisoside fat. Now, going back to what we were talking about.

That fat also contributes to when it goes away, that’s what happens when you stand on those impedance studies. It looks like you’ve lost muscle, but that’s just fat going away. So I always tell people, the studies did not go biopsy your muscle cell as count the actual cells. It’s not like when you lose weight, your muscles go through apoptosis and just explode and die. That’s not what’s happening. So they used

inappropriate measure measures to prove that people lost muscle but in my opinion it was a mistake to even report it why even report like a faulty finding inside your reports and scare the hell out of people because that you know I I love these medicines because they’re doing such great things for people they’re improving metabolic health and helping people live long

healthier, like if you’re gonna scare people, like actually scare them about something that’s actually real, rather than just make something up and I mean the researchers must have known better than use these methods, you know? So anyway, what I would say to people is what I would do if I were…

losing that much weight and worried about muscle loss, would just measure strength at the gym. So I tell my patients when you’re going to the gym, first of all, do participate in weight resistance exercises, right? Because it’s very easy to lose muscle if you’re not working out. And especially in a calorie deficit diet for a long time. So do work out and do lift weight. But like here’s my bicep curl.

just say as a woman, as a 60 year old woman, you’re using 10 pounders to do bicep curl. All right, just keep doing that and measure your strength as you’re losing weight. Most of my patients are getting stronger. So is that really muscle loss or is it just fat loss that looks bad on the impedance studies? Does that make sense?

Ben (21:58)
It does,

it does. And speaking of scaring people, coming back to this idea of, and I think this is kind of a general attitude that I’ve seen from people in general. You see it with vaccines as well, where people are kind of late adopters. They’ll say, well, we don’t know kind of the long-term side effects or consequences of these things. And I’ve heard that same argument discussed with GLP-1. So what would you say to somebody who maybe has weight to lose? They’ve struggled in the past, but

⁓ Maybe they’ve heard, well, we don’t know kind of the long-term, you know, risks if there are any. What would you, what would that conversation look like with that person?

Dr. Angie Sadeghi (22:33)
Well, the GLP ones were not the…

created yesterday. We’ve had these things for 25 years. We’ve used GLP-1s in the world of diabetes for the past 25 years. And there have been multiple randomized controlled trials on the GLP-1s. And there was a recent meta-analysis of all the RTCs in the last 25 years. And there is really no known risk of cancer. There is this theoretical risk because one of the rats in the study got medullary thyroid cancer. But if you look at the

analysis of all of these studies, there’s really no risk of cancer and these medicines can’t be safer. of today, science evolves, right? That’s what science is. Evidence-based medicine evolves. But thus far, I am yet to find a really bad side effect. I mean, some people have anaphylaxis, like an allergic reaction, but the same thing, like you would get a penicillin shot and have an anaphylaxis reaction.

patient who had that. I’ve had some patients who

can’t tolerate them because they just get nauseous and have vomiting or severe constipation. have one patient who develops severe constipation and you can take them. All right, great. But like these aren’t killer. You know, you just stop. If it doesn’t agree with your body and you don’t like the side effects, you just stop. But I haven’t seen any detrimental side effects that would deter me personally from using them if I had diabetes and hypertension and metabolic syndrome.

obstructive sleep apnea, heart disease, coronary disease, any of that stuff.

Ben (24:07)
Yeah, that’s exactly what kind of my line of thinking was is, okay, well, even if you maybe had some concerns of, you know, what’s the alternative, right? Especially if you’ve been living with, you know, obesity for, you know, quite some time. You mentioned fiber. Fiber is something that people don’t put enough emphasis on. And most Americans are not meeting the recommendations for fiber.

What are the actual, like, is there a fixed amount that we should be aiming for? Does it scale based on energy intake? What kind of, recommendations? Do you even have people track their fiber intakes or is it kind of just eat more of these foods?

Dr. Angie Sadeghi (24:41)
I don’t know what-

Most people, first of all, I’m gonna have to define fiber because to you and I, this sounds very simple, but when I say to people, you need to eat more fiber, you go, is there a brand you like? Because people think automatically that I’m talking about a supplement, like Metamucil. So let’s go back to the basics and trust me, I dare you to ask like 10 people and like most people don’t get that. I mean, my patient population, I’ve realized I really have to go back to the basics. So there are five macronutrients, I’m not trying to teach you,

talking about the general like public.

Ben (25:12)
No, this is great. This is great. Yeah.

Dr. Angie Sadeghi (25:13)
There are five macronutrients. Carbohydrates, which includes sugar and fiber, protein, fats, water, and alcohol. And ironically, a lot of people think alcohol is carbs. Alcohol is not a sugar. Alcohol is its own macronutrient. So carbs and ⁓ protein have four calories per gram.

Alcohol has seven.

Fats have nine and water has zero. So like when I say fiber, mean the carbohydrate that is, that basically carbs include sugars and soluble and insoluble fiber. So when we are right now talking about fiber, I mean carbohydrate fiber, not the supplement that you can buy on the, on the shelf. So fiber is something that is not digested by the digestible

digestive system but by our bodies. It’s something that is digested by the gut microbiome. And it leads, and it’s called, the process is called fermentation, and it leads to the production of short chain fatty acids which are very important for gut health, for muscle health, muscle growth, for brain health, cardiovascular health, and everything else to bring down your hemoglobin A1c, to bring down your cholesterol. It’s very important. So in all of the randomized control studies,

that

are worth looking at, the higher the fiber intake, the lower your blood sugar and your glycemic index. Alternatively, the higher the meat intake, and so if you’re eating a high meat diet, the higher risk of diabetes, the higher risk of heart disease. This is very important. Fiber is a carbohydrate that is very healthy for you. When you hear eat high

protein low carb, that is a mistake because at a molecular level we know that fiber decreases your hemoglobin A1c, decreases your cholesterol, but at a macro level in all of the randomized controlled studies, nutritional studies, we know that fiber also is protective. So carbohydrates are good, carbs are good for you. That’s what I really want to drive, okay, into when people are listening.

I would say that in my patient population, 99 % of people are carbohydrate and fiber deficient and they are eating excess amounts of fat and excess amount of protein. And they’re eating too much saturated fat.

And I literally have to go teach them food labels to read a food label. When it says 42 grams of carbs, that’s not bad for you. Look at how much of it is fiber. OK. And when it says protein, high protein, that’s great. But look at the saturated fat.

So you want the food label to have less than 5 % saturated fat and you want it to have less than 5 % added sugar. You want like low added sugar, but you want high carb. So don’t look at the carb and make a decision as to if something’s good or bad for you. And I think that’s what happens. That’s why people eat a low fiber diet because they look at food labels and they’re like, they freak out. my God, this guy’s so much carbs. Calm down. It’s okay. It’s fiber.

So anyway, what do I say to people? I teach them this basic thing that I just talked about. And what I do is I also teach them what fiber is. Fiber comes from plants. Fruits, vegetables, right? Vegetables have a lot of fiber. And fruits have a lot of fiber. And they say, but I’m not supposed to eat sugar. And then I say, OK, but listen, most of the population studies have

shown that when you eat a lot of fruits, your diabetes gets better. And that’s because diabetes is caused by the intra-myocyte fats and also saturated fat that ruins the glucose transporter systems. Fruits don’t cause that. It’s the saturated fat that causes diabetes. So you can eat all the fruits that you want. That’s been proven by population studies. That’s been proven by molecular structure studies. All of that needs to be driven in. But then also going

back to the fiber discussion and I tell them beans and legumes and lentils have a lot of fiber you need to eat more of that and grains like quinoa and oatmeal all that stuff has a lot of fiber and then it like well goes off they’re like ⁓ wow okay I get it now like they you really have to spell it out and teach people where fiber comes from and most people really don’t know that and you know sometimes maybe maybe your followers do because they’ve been in the vegan world or they’ve been in

the athletic world and naturally they’ve studied nutrition but 90 % of Americans, average Americans who walk into my weight loss clinic have no idea what fiber is. think it’s Metamucil.

Ben (30:01)
Question about about supplements like Metamucil or like psyllium husk. these are these ever something that you would consider supplementing somebody’s diet with in addition to what they’re usually doing?

Dr. Angie Sadeghi (30:13)
yeah, of course. When people have hemorrhoids and constipation, it’s a really good idea to help them with the psyllium. Psyllium is a great supplement, but it shouldn’t replace your fiber intake. It shouldn’t replace the fruits and vegetables, nuts, seeds, grains, and legumes that you would eat every day because the population studies have shown, the random control of nutritional studies have shown that these fiber rich foods are helping your health. You’ve got microbiome, your health, your diabetes,

cholesterol, these people were eating fiber, like they were eating actual fruits and vegetables, they weren’t eating Metamucil. So you have to remember that it should be in addition to, not in replacement of.

Ben (30:54)
Right,

right. So I know oftentimes when we’re coming up with recommendations for the amount of things that people should eat per day, it’s based on, this is the standard 2000 calorie diet. This is how much you should be eating. And I think I’ve seen numbers like recommendations of 30 grams of fiber per day is kind of like a broad recommendation. Would you say that’s about right? Or does it kind of depend on the person and how much they’re eating per day?

Dr. Angie Sadeghi (31:18)
nutrition is very difficult to teach people.

So it just depends on how many calories you’re consuming. So the way I teach it is I don’t teach it like that. say drop, you know that my plate that the government has put out, I think that’s a really good way of teaching people, like simplifying it. I go split your plate in half, 50 % of it should be fruits and vegetables, 25 % of it should be protein, 25 % should be a grain. And I think that’s

easier to help people understand now if you eat three times a day three times do that if you eat two times a day two times do that if you eat one time a day just do it that once doesn’t matter and everybody has a different calorie intake for for weight loss like my calorie intake for weight loss is 1200 calories a day you’re much taller than me so if you wanted to lose weight your calorie intake for weight loss could be 2000 so then the protein has to match the calories the fiber has to

the calories the fat intake has to match the calories

It’s all estimates. The food labels are all estimates. It’s just really hard. So it’s not easy, but the nice thing is when you give them GLP-1s, they literally have no appetite to eat and they usually drop down their, the calories go down to like 800 to 1,000 calories a day and people respond very well. They lose weight.

That’s what’s nice about it.

Ben (32:40)
Yeah,

I hear what you’re saying. A lot of the positive outcomes that we’re looking for can be accomplished through just these habits and we don’t have to always get so ⁓ granular with the exact amounts. You mentioned soluble and insoluble fiber. Could you just talk a little bit about the difference between those two so people have an awareness of that?

Dr. Angie Sadeghi (32:58)
Yeah, so under the macronutrient carbohydrate, you have soluble fiber and you have insoluble fiber. Soluble fiber is what forms into a jelly form. It’s soluble. just forms like jelly in your ⁓ stomach or in your small intestine. And these are fermentable fiber. Usually they escape digestion and they go on to the ends of your small intestine and your colon, and they get fermented by the gut microbiome. And that’s how they’re broken.

down. Insoluble fiber is just what’s bulking the stool. don’t, excrete digestion and they go into the colon and they’re, they usually ⁓ can drop some water into the stool and it’s good for constipation and they just, they’re just basically, they’re not getting digested, they just bulk the stool.

Ben (33:47)
Okay, that’s helpful for people to know kind of the difference. And I don’t think people need to be too concerned about tracking, are you getting insoluble versus soluble? I think it’s just helpful for people to know, hey, these are the differences and these are the, you know, there’s these two that exist.

Dr. Angie Sadeghi (34:01)
I would not track soluble versus insoluble. When you eat food…

Almost every single fiber-rich food, like fruit, vegetable, nuts, seed, grains, lean legumes, whatever it is that you’re eating as your source of fiber has both. It really doesn’t matter. You don’t really sit there and track it.

Ben (34:20)
Yes, I’ve certainly seen that with people that I’ve worked with where I think getting too far into the weeds or the details ends up being a stressor that’s unnecessary and isn’t actually moving the needle. And again, kind of bringing it back to what are the vast majority of people out there in the United States doing? This doesn’t even need to enter the realm of conversation because it’s so far away from the realm of practicality and what are we actually going to be doing on a daily basis? I think it creates.

for a lot of people probably more barriers than anything else and just more things to worry about. So another question that I had for you is it’s been my, I guess, experience talking to people that sometimes when someone starts transitioning from a standard American diet towards more of a plant-forward or plant-based diet, especially if that’s a very sudden change where they’re switching over everything they’re eating very quickly, sometimes people tend to have

some digestive discomfort with that and I’m wondering if you have any just like tips or little like tricks that you’ve picked up that can help people with that transition.

Dr. Angie Sadeghi (35:18)
Yeah, well, most people don’t understand this and I haven’t really talked about this a lot. So this is the first time I’m talking about it on any podcast or any platform. So here we go. It’s not about like what, you know, the fight. So a lot of people think, ⁓ fiber produces a lot of gas. First of all, when you have maldigestion or something’s not digesting very well, it’s not because you ate too much fiber. It’s because you have a, a, dys, like a dysbiosis picture going on and your, your gut micro

biome is imbalanced. If you eat extra calories, whether it came from fat, whether it came from carbs, or it came from protein, you’re gonna have a lot of gas bloating and flatulence. Have you guys on, I don’t know if I can say this word, but have you heard of protein farts? Like,

Ben (36:00)
Yes, yes, I would say that most people probably who are listening to this podcast or a lot of our listeners are familiar with with this idea of having protein farts

Dr. Angie Sadeghi (36:09)
So what is that? So when you eat a ton of protein, it’s not all getting absorbed as amino acids. So protein goes into the small bowel. It gets broken down into amino acids and then it gets absorbed and goes into the muscle. But let’s just say you decided your trainer said, you need 300 grams of protein a day and you go eat that. Well, what’s going to happen is just going to go into your colon and it’s going to get petrified. What that means is remember when the carbs go into the colon, they get fermented. The word for protein

by the gut microbiome is called putrification. So all that excess protein goes into your ⁓ colon and it gets putrified by the gut microbiome and it turns into short-chain fatty acids and toxic gases like methane and it also turns into ammonia which can cause acidification of the environment which is toxic to the cells. So even if you ate too much protein you’re gonna have a lot of bloating and gas. It’s not just exclusively reserved for the fiber.

But if you eat a lot of fiber, if you’re going over your calories, you’re gonna have the same thing. The fiber is gonna go into your colon and it’s gonna get fermented by the gut microbiome and you’re gonna produce a lot of gas. Sugars are not so much that way because sugars don’t need digestion and fermentation. So if you eat sugar, it just kinda goes into the system from the small bowel so you don’t get a lot of gas protection. But almost all the other macronutrients, they go into the

and if you ate too much, you will have gas formation, whether it’s protein, fats, or ⁓ carbs. And the reason is this. So, you know, in nature, what’s the most important thing for our survival of the human species is that we don’t starve to death, right? That’s what everyone does. You wake up every day, you go, do I have enough money to go eat? Do I have enough money to feed my kids? I mean, that’s like the whole world from day one has been around, what do I eat? And I don’t want to starve to death, right?

So the body has evolved mechanisms so there’s no calorie wasting. If you wasted your calories in the poop, wouldn’t that be tragic? Like you’re finding food and you’re eating and you just poop it out. So no calories can be wasted. So the body has evolved mechanisms. So if you overload your digestion, what happens is those calories go into your colon and the gut microbiome ferments them and absorbs them in the

Ben (38:14)
you

Dr. Angie Sadeghi (38:31)
of short-chain fatty acids whether it’s meat or whether it’s carbs doesn’t matter it’s the same thing same thing happens so it turns into short-chain fatty acids and gets absorbed and then your body puts it away as calories in the form of fat everything turns into fat at the end of the day so you don’t die in a times of famine so yeah it doesn’t matter like a lot of things fiber that causes gas but like it could be anything excess calories

So they’re either eating too much calories, they’re constipated, they have acid indigestion, they have pancreatic problems and they’re not digesting their food well,

Ben (39:12)
Hmm. One question that I wanted to ask you as a follow up to that is sometimes you’ll hear people talking about FODMAPs and these are like type of, well, I’ll let you kind of explain them, but you know, are these something that people should be concerned about or paying attention to, or is it really something that people are kind of just like focusing on kind of the minutiae?

Dr. Angie Sadeghi (39:31)
Yeah, you know, the FODMAP diet came out. I was very excited. Most GIs were very excited. And now we know that it’s just like, it’s a very useless, it’s really a useless diet. And it actually deters people from eating the right things. And I would say like, don’t ever follow the FODMAP diet. First of all, it’s a band-aid therapy. You’re supposed to do it for six weeks. So the premise was that if you’re eating fermentable fibers, you’re going to have more bloating and gas, right? So let’s cut them out because they’re fermentable.

fibers but you know overeating causes fermentation doesn’t matter if it’s from fiber or something else you’re gonna have the same reaction so I don’t think that the FODMAP diet is at all useful I’ve the last time I used a FODMAP diet was many many years ago when it first came out I was a little excited about but I realized that it’s just a band-aid therapy and it doesn’t work very well so I’m just using other methods I think it’s just literally useless

Ben (40:25)
I think, you I’ve had experienced people talking to me about trying to go on. I think one, it’s very impractical. Like you said, like cutting out all these different foods, trying to figure out which ones are giving you, you know, more, and like you said, it’s probably bigger picture issues and not necessarily always these kind of smaller specific foods. And I think that it, again, kind of just takes away the focus probably from areas that we should be focusing on. I, yes.

Dr. Angie Sadeghi (40:51)
It does. I think it’s important thing. It

takes the focus away from areas where we should be focusing. The only thing on the FODMAP diet that I like is it asks you to eliminate dairy. Because 61-65 % of the population is lactose intolerant. And so most people feel well on the FODMAP diet because it avoids dairy.

Ben (41:12)
Hmm,

that’s okay. That’s a good clarifier then. Probiotics, what are your opinion on them? What does the research say about if they’re ⁓ effective or not? And should we be looking to get, if so, should we be looking to get them from supplements or from foods? What kind of impact do they have, if any?

Dr. Angie Sadeghi (41:27)
So good question. My opinion doesn’t matter, so let me start the research. So there was a research study where they did, they eradicated people’s gut microbiome and they put them on the probiotics and one group got probiotics, one group didn’t. And one group got a fecal microbial transplant. So when they tested to see what came back faster, the people who got a gut microbiome transplant, the microbiome came back faster than the people, than the other two groups. And then guess who’s microbiome?

recovered faster the ones who got nothing or the ones who got probiotics? Guess.

Ben (42:01)
I’m gonna, based on the way you’re phrasing, I’m gonna say the group that got nothing came back faster.

Dr. Angie Sadeghi (42:04)
Yeah, exactly.

The group that got nothing after taking antibiotics did better than the group that got probiotics. So that right there tells me that we don’t know everything about these probiotics and that we shouldn’t just randomly use them for no good reason. There’s really no convincing research out there right now that has led me to believe that probiotics are useful. Therefore, I never, ever, ever put any of my patients on probiotics at the moment until some research breakthrough

research study comes out that says for this this this reason you should be using I just find them to be quite useless and very expensive and ⁓ you know right now this whole like microbiome testing they’re all hocus pocus too like there are these companies that are making billions of dollars going here let’s get you this snapshot of your microbiome tests and tell you what probiotic to take they’re all useless like literally like there’s no clinical

validity to any of them and so people should just stay away from don’t waste your money on probiotics that’s the thing that I want you to take away from this then you brought up something else probiotic foods right that’s that’s that was a whole different story because one is in a pill form one is in a food form so I’ve been on this crazy search of like everyone is saying eat probiotic rich foods like like what is up with that like where’s the research coming from

I still have not yet found a single study that shows that these fermented foods bring down inflammation or do anything really good for you. Meaning that if you were to give the patient that food, right? If you were to give that food without the probiotics and give one group the food with the probiotics, let’s say you’re giving someone kimchi, okay?

that’s a fermented food and you take one group take all the microbiome out of that and give them the kimchi without the bacteria and then give the next group kimchi with the bacteria and see who does better there’s no such thing like there’s no such study and some studies show fermented foods are good for you but then of course they are good for you because there’s fiber in there is it the probiotics that are doing the good or is it the fiber that’s doing the good I think it’s the fiber

doing the good because when you give people probiotics it doesn’t work so anyway so again you know we just don’t have enough studies to go you better eat your fermented foods you know like we just don’t have that and until but it’s what I tell my patients if you like kimchi eat it if you like tempeh eat it if you don’t like it don’t eat it I think I think it’s silly to recommend it because of its probiotic content

Ben (44:22)
Mmm. Mmm.

Last question for you today. I’m sure this is one that people get, maybe that you get a lot and that I’ve heard from people. And generally my answer to this is no, are there any, assuming someone is following a balanced diet, they’re eating all the foods that they should probably include on a regular basis, are there any supplements that you would say are evidence-based to support digestive health?

Dr. Angie Sadeghi (45:11)
well, fiber is good for hemorrhoids. There’s some studies, like if you give someone fiber, like food fiber plus supplement fiber, it’s really important to give them that. That supplement, the fiber supplement for hemorrhoid health. Yeah, that is important. As far as vitamin D deficiency is real, so you want to do vitamin D supplementation for patients who are not going out in the sun and not getting it naturally,

low levels and b12 deficiency is real so I would say those are the three supplements that I recommend I don’t recommend anything other than vitamin D vitamin b12 and the fiber supplement for hemorrhoids and fissures and

in a rectal disease and sometimes people with severe constipation.

Ben (45:55)
Thank you so much. You’ve answered pretty much all of the questions that I had. I’d love to know if there are any ⁓ exciting projects that you’re working on or any kind of messages that you want to leave our audience with before we wrap things up.

Dr. Angie Sadeghi (46:07)
I’m just really working hard at teaching people how to eat healthy and

you know, help them lose weight to be of normal weight, not to be skinny, but to be a healthy weight. I encourage people to improve their health, improve their diet, improve their lifestyle. And that’s something I strive to do. also like helping people with hormone therapy because a lot of women suffer with lack of hormones and menopause and things like that. So my focus is women’s health, nutrition, fitness, and

improving people’s lifestyle for health and longevity.

Ben (46:42)
I love that. And if people want to keep up to date with what you’re working on and what you’re sharing, where can they find you?

Dr. Angie Sadeghi (46:48)
Yeah, so my clinic, and my clinic phone number is 949-404-4444. We’re in Newport Beach, California, beautiful place, come see me.

Ben (47:06)
Excellent and we’ll have all your links to your social media and website and everything down in the description. Thank you so much again, Dr. Sadeghi and maybe we’ll look forward to having you back on the podcast someday, I hope.

Dr. Angie Sadeghi (47:17)
Thank you, Ben. I really enjoyed talking to you. Thank you for the wonderful questions and helping people around the world improve better health.

Ben (47:24)
thank you so much. Okay, bye everyone and thank you for listening.