Life after Ozempic?

Hey there Voice Finder,

Three things before we get started:

1️⃣ Join the Find Your Food Voice book discussion! Order the book and be ready to discuss (please join even if you haven’t completed) the first chapter by Friday. That’s when I will send you the first book club discussion question here via email.

2️⃣ Have PCOS and need more ways to promote health without dieting? We need to be friends. Here’s my latest PCOS essay.

3️⃣ Anytime you click that heart on this email and especially when you share it—you are helping me and my team. TIA!

Let’s get to this week’s podcast episode!

Photo by Nick Perez on Unsplash

I recently received a Dear Food letter that moved me. It was from someone who lived with binge eating for years yet found respite while on a GLP-1. They just learned they need to come off of the medication and they are frightened. Here’s the letter:

Dear Food,

I can’t believe I am at this place again. You and I have been through hell and back. Our relationship got fucked up starting at age 10. I was made fun of at school because of my size and I started stealing my mom’s herbalife. I also started copying her food choices–if she skipped breakfast I did too. If she cut out carbs, I did too. Unfortunately, I got diagnosed with PCOS just like she did when I was in college. I struggled throughout college with binge eating, going on and off diets, and felt miserable around you food.

Last year I got my first job and great health insurance that covers a big portion of my GLP-1. Starting it felt like magic–cravings were gone, I stopped thinking about food, and I had energy. I have never craved exercise before yet now I go to one most days. I don’t feel guilty about eating food either. My doctor was thrilled to see my A1c go into the normal range again.I thought I would never have a problem with you after the last year on Ozempic.

What went wrong? My job changed health insurance companies and in January it switched over. I realized this would happen in November so I stock piled and spoke with my doctor about weaning off slowly. It looks like I will be completely off of it by June or July.

Food, I am so scared. HOw the fuck will I do this? I am scared I will go back to having constant food noise and bingeing. I know i am not supposed to care about this but I did lose weight on this drug too. NOt as much as I thought I would but enough that people noticed and chairs felt less uncomfortable.

I wish I could stay on the Ozempic forever yet I can’t. I am so mad at my body and myself for not being normal and being obsessed with food.

How do I keep the benefits from Ozempic without using it? Is there any way?

Sincerely,

Desperate for another way

Are you too looking for an off ramp to help transition off Ozempic, Wegovy or another GLP-1? I provide practical advice on preparing for life after GLP-1s, including the implementation of CHIPs (check-in props) to foster a softer place to land amidst the chaos. In this episode, I explore what to expect along with the unknowns.

Some markers for your listening:

00:00 Introduction to GLP-1 and Food Relationships

02:22 Understanding the Letter: A Personal Struggle with Food

05:03 Navigating Life After GLP-1: Strategies and Insights

05:10 Understanding GLP-1 Medications and Their Impact

11:01 Navigating the Transition Off GLP-1s

17:36 The Role of Inositol and Other Supplements

24:10 Managing Changes in Appetite and Food Relationship

30:22 Navigating Dietary Challenges and Embracing Recovery

31:34 Closing Thoughts and Community Support

Important Episode Links:

• Inositol info post: https://julieduffydillon.com/inositol/

• Omega 3 info post: https://julieduffydillon.com/omega3/

Want to watch the show instead? Here’s the episode via YouTube:

That’s all for now. Thank you for supporting the show and contributing to the Find Your Food Voice movement 💜 I will be back in your inbox on Friday with the first Find Your Food Voice book discussion question!

Warmly,

Julie

Looking for transcripts?

Here they are. Please know they are primarily created by AI so I hope you are patient with any errors. Listen along above!

Julie Duffy Dillon (00:00)

Welcome to episode 414 of the Find Your Food Voice podcast. Today, this episode is for those of you who are having to come off your GLP-1, like Ozempic or Wegovy What do you do? I have it all mapped out for you. Let's get to it.

Hey there, voice finder. I am Julie Duffy Dillon, registered dietitian and your host. Today is a very special episode because for a long time, I haven't featured a letter, but I have a letter episode for you today. So if you're new to the podcast or have never heard a letter episode, a Dear Food letter is a letter that a listener just like you writes in and describes their current

complicated issue with food and I sift through it, give you some insight and at the end of the episode, food writes back. So this letter I am handling with care because I know many of you are experiencing the same thing or you fear this happening. So I have a letter from someone who has been on a GLP-1 there on Ozembic, but I think it could be for any GLP-1.

and they're having to come off of it for their particular reason after being on it for about a year. And they have this past kind of complicated relationship with food that includes binging and lots of food noise and they are fucking scared. Of course they are. This was a medicine that was supposed to be the solution.

So I'm gonna read this letter for you and then we're just gonna go step by step. Did you all read Anne Lamont's book, Bird by Bird? That's what we're gonna do. Bird by Bird, just go through it all. And throughout, I want you to know that you can do this. If you are like this letter writer going through the same thing, you can do this and I wanna help.

Before we get to this episode's letter, I wanna go through just a few announcements. One, the Find Your Food Voice book is out and I am just feel so grateful whenever you have reached out to me to let me know how you are experiencing the book, what it's like for you to go through each exercise. So keep the feedback coming, I love getting it.

If you are wanting more, if you're wanting to know what is next after the Find Your Food Voice book, join me over on Substack. That's where we're continuing the conversation. I am starting a book club discussion very soon and I'm doing weekly lives. So you can join me over there and continue on the process to finding your food voice.

Alright, are you ready for this episode's letter? Here it goes. Dear food, I can't believe I'm at this place again. You and I have been through hell and back. Our relationship got fucked up starting at age 10. I was made fun of at school because of my size and I started stealing my mom's herballife. I also started copying her food choices. If she skipped breakfast, I did too. If she cut out carbs, I did too.

Unfortunately, I got diagnosed with PCOS just like she did when I was in college. I struggled throughout college with binge eating, going on and off diets and felt miserable around you food. Last year, I got my first job and great health insurance that covers a big portion of my GLP-1. Starting it felt like magic. Cravings were gone. I stopped thinking about food and I had energy for once.

I have never craved exercise before, yet now I go to an exercise class most days. I don't feel guilty about eating food either. My doctor was thrilled to see my A1c go down into the normal range again. My cycles are regular, even though I have no desire to ever be pregnant. I thought I would never have a problem with you food after this last year on Ozempic. What went wrong?

Well, my job changed health insurance companies and in January it switched over. I realized this would happen in November, so I stockpiled and spoke with my doctor about weaning off slowly. It looks like I'll be completely off it by June or July. Food, I am so scared. How the fuck will I do this? I am scared I'll go back to having constant food noise and binging. I know I am not supposed to care about this, but I did lose weight on this drug too.

Not as much as I thought I would, but enough that people noticed and chairs felt less uncomfortable. I wish I could stay on the Ozempic forever, yet I can't. I am so mad at my body and myself for not being normal and being obsessed with food. How do I keep the benefits from Ozempic without using it? Is there any way? Sincerely, desperate for another way.

All right, voice finder, we are going to unpack this letter after a very quick sponsor break.

Julie Duffy Dillon (05:11)

Welcome back. All right, let's get to this episode's food letter. ⁓ letter writer, I wanna give you a very big virtual consensual hug. I just know you've got to be exhausted and also terrified. I want to tell you a few things. One thing I've gathered over the last few years is most people do get just about a year on GLP-1s.

for many different reasons. Some of it is like yours. It sounds like it's financially just not feasible for you anymore since your insurance isn't going to cover it in the same way. But I know for other people it's side effects or because of some interaction with another medication. But I have seen online the statistic of 75 % of people need to stop within a year. So, you you mentioned a few things in the letter about feeling abnormal and listener.

If you can relate to that, just know everything that this person is saying in this letter is not abnormal. Like there's so many things about your relationship with food and how you describe it. That's very like the rule, not the exception. There's nothing abnormal at all. And as you are like, you have this kind of unique experience where you know when this pivot is going to happen. And I don't know about you, but

I had experienced a lot of anxiety and most of my anxiety is this intense anticipatory anxiety. And what my therapist, I think my very first therapist ever taught me to do was to really like do a brain dump. Like, what are you fearing? Like lay it all out. Because one thing I know is even if you name it or even if you try to block it and to avoid the feeling,

The feeling's still there. You're already doing the hard work. So ignoring it is not necessarily doing anything to protect you from how hard these feelings are and how uncomfortable the fear is. So one of the best things is just to dump all that fear out. And this is what my first therapist taught me to do whenever I was experiencing that hardcore anticipatory anxiety is to name the worst and the best and in the middle. So...

Number one, what's the worst thing that can happen? Just lay it all out there. You name some really significant important things in your letter and let yourself just go and name it all. But then as you go through all the things you can think of, that would be the worst case scenario.

I want you to do the polar opposite. And what if the best thing happened? It sounds like you're wanting some of the side effects of the medication to continue. So what if nothing changes a year from now that you're experiencing the same thing? Maybe that's the best thing. And then as you go through all the best case scenarios and you exhaust that list, go in the middle. What's in the middle? And here's the key to all this, you know, to

Julie's late 20s, early 30s therapist, what she was trying to help me with is like, usually it ends up in the middle. There's the worst case scenario and the best case scenario, but usually we land in the middle.

So that's one of my first things that I encourage you to do. Just let yourself all, let it all hang out. But I also want to say a few things about PCOS, insulin, and GLP-1s like Ozempic. And even if you're not on Ozempic, this goes for Wegovy Monjaro, any of the ones in this category. We don't have a lot of long-term research, know, greater than five years with...

people taking this medication who do not have type 2 diabetes. It's unclear from your letter, letter writer, whether or not you have type 2 diabetes. Certainly your A1C has been high, but I don't know if it's in the pre-diabetes range or just kind of creeping up or if you have type 2 diabetes. But with PCOS in particular, the GLP-1s are not FDA approved for PCOS. There's actually no medications that are FDA approved for PCOS, which is...

infuriating. We've known about this condition for over 100 years. One in seven women and people with uteruses have PCOS. So why don't we have medication? I mean, that is totally another podcast episode, but I digress. I know a lot of people with PCOS are experimenting with GLP-1s. And what I've been gathering in my membership and just talking to people with PCOS is that as people are coming off of this medication, many are still experiencing the benefit from their GLP-1.

months or years later. ⁓ Certainly months later, many people are still experiencing some of the benefits.

And what you'll notice with PCOS is these energy increases, sleep improvements, craving changes, cycles, if you still have a cycle, those becoming more regular. So,

You may experience this too with letter writer. There's no way for me to know for sure. mean, one of the reasons is because while I am a dietitian, I'm not your like individual in-person dietitian. I'm just this random dietitian on the internet. So I don't know for sure. But also I don't have a crystal ball. I don't know exactly what's going to happen. And we don't know long-term yet when you're doing that worst case, best case scenario or somewhere in the middle, you may find that there's some lag time.

where your insulin levels still stay improved and it may for a very long time. So keep that in mind. You you may notice that you still have some of the benefit from taking it. So as you are looking at the calendar, whenever the last day is going to be, I encourage you to do three things. Let me make sure it's the right number. Yes, three things. As you're preparing, as you're looking at the calendar,

and you're preparing for that day when you're no longer on a GLP-1, there are three things that I encourage you to do. And number one is to get ready. You know, the thing that you've noticed that this GLP-1 has helped with is your insulin and your blood sugar, which impacts cravings, sleep and cycles. So...

I would encourage you to check in with your medical provider about some of these recommendations I'm providing to you because, you know, again, I'm just this random dietitian on the internet, but doing some of these things I recommend if your doctor okays it are things that can help you to make the off-ramp just a little bit more gradual and less of an all or nothing. And at the same time, remember you may actually have some long-term benefits from this medication. So it may not be that all black and white anyway.

but making the off-ramp more gradual, I think is something just you can use as a way to help. So tactically speaking, if you're not taking an inositol and you have insulin resistance or PCOS, talk to your doctor to see if you can take an inositol supplement, but I would start that now before you come off of this GLP-1. If you already are on an inositol supplement, talk to one of your healthcare providers in person.

and find out if you're taking the right amount, the right ratio, and that's been in your system for a good few months. And the reason why I suggest doing this now is it basically takes a few months for inositol, which is, you're wondering what the hell is inositol, you may have heard of it, especially if you have PCOS, but you're not really sure what it is. It is a B vitamin that is a secondary messenger, and it repairs insulin receptors.

people with PCOS and insulin resistance have a defect or a deficiency of inositols. And it's behind those intense cravings, irregular cycles, if you still have a cycle, the really painful fatigue. And again, it can take about 90 days for the body to have enough repleted inositol to get the full benefit of it. So start it now. That's what I would suggest to anyone. And the other one I would also encourage exploring and talk to your doctor about

is adding the omega-3 supplement. I have two blog posts on inositol and omega-3 that goes into some particulars and some information you can just bring right to your doctor. I also have some discount codes in there as well. Something I'll just put in here that is like in the works. I have my blog on my website, but I continue to blog more on Substack. That's why I always encourage you to follow me there.

And my sub stack is the same in name as the podcast and as my book, it's Find Your Food Voice. But I am doing a deep dive and a Nassatol research update deep dive that I hope to have ready and maybe the end of May, early June. We'll see how the stars align for that. But ⁓ if you follow me there, you'll you'll get to it as soon as it posts. But I do still have information on my website that has ⁓ blog posts on those for you so you can get to some handy information.

Then the other thing to ask your doctor about are other medications. Certainly this may sound so old school, but metformin is still an option. It's an accessible option too. And if you benefit from a GLP-1, then you probably would also benefit from metformin. And again, it just would be more accessible. In the United States for a lot of people, it's only about $5 a month. So metformin is something that

⁓ you could also explore and you could possibly start that as you're weaning off the GLP one. All right, so that was number one, get ready. Number two is CHIPs what are CHIPs? Well, CHIPs are these wonderful, salty, crunchy snack foods. No, but CHIPs that I'm talking about come from chapter five of the Find Your Food Voice book.

Chapter five is actually called pivot, which letter writer, that's what you're doing right now. You're preparing for a pivot. And CHIPs are these particular interventions that I encourage people to do who are in a place where they feel really scared or anxious about their relationship with food. Sometimes people tell me they feel out of control or maybe they can't stop binging or their food noise is just constant. Chips is where I encourage you to go.

I started this like chip intervention after working with people who would come to my office wanting to do intuitive eating work. And intuitive eating work, especially 10, 15 years ago, it became really popular. And I had been doing this work with clients for probably 10 or 15 years at that point. And so I was already ready for it. And people were coming in who were newly moving away from diets and

were really in a chaotic space and felt really, they just kept saying they felt out of control with food. And so attempting to do intuitive eating work, know, listening to hunger and fullness and satisfaction and practicing that unconditional permission to eat, it felt ⁓ terrifying. And so CHIPs were the things that we did before a lot of intuitive eating work and CHIPs. What that stands for is check in props.

Check in props. If you do any yoga class, have you ever seen the blocks or the straps or any of the interventions that your yoga instructor will sometimes insert to help you to start to build a pose? Props are something that I know sometimes in yoga classes, they talk about like doing the full expression of a pose and the props are just if you need them. But Laura Burns is a

yoga teacher who is kick ass and I love her so much. used to do a lot of work in the PCOS space with her and she taught me as in her yoga approach that everyone starts with props, everybody uses them and that doesn't mean you're not getting the full expression of the pose. Like that's the full expression. And I think of the same for you, letter writer and anyone else who has this kind of fear around their relationship with food as they're moving off a GLP-1 is

I want you to also experience non-diet ways of eating. if doing kind of a black and white, all or nothing, intuitive eating kind of approach feels terrifying, we can like build you a slower off ramp, like I was referencing earlier. So what CHIPs look like? And again, it's chapter five of my book. It goes really deep, of course, into all of it, but it basically helps you make a clock-based check-in arrangement.

and you're checking in every two to three hours and going through a series of grounding exercises and then a series of questions. And the questions are very specific and I have reasons behind them, but they basically help you to repair that mind-body connection that honestly letter writer probably was already ⁓ blocked, severed because of the diet industry, the...

diet culture that you were living in and all the pushes to diet because you have PCOS, but have also further been blocked from the GLP-1. Part of how GLP-1's work is still a mystery. And I know for a lot of people, they've talked about how it has quieted their food noise. And something that I just wanna gently say is that GLP-1's work by how they basically send a fire hose amount of this

this thing called incretins through your GI tract when our body really is only supposed to have a trickle. And again, if you have insulin resistance, it helps with helping your body be able to like have insulin that actually works. So it's amazing.

Another side of GLP-1s that we don't quite understand yet is how they impact the mind. But you've told me, letter writer, and many of you listening too have told me that it impacts that food noise. It makes it so it's not loud. And I know so many of you have said that you have felt so free for the first time. So what I know to be true is we don't know what's happening, but I do know that malnutrition is still happening.

happening. Even though you're not experiencing the food noise, like there's still talking going on. Like your food voice and the chatter and the intensity, it is ramping up and loud. But for some reason, there's just a dial that turns it off when you're on a GLP-1. ⁓

So when you're coming off of a GLP-1, it's gonna be loud, right? That's a really easy kind of prediction. These series of questions, these CHIPs that I'm directing you towards, they are gonna help you and your mind-body connection, reacquaint yourself, especially if you can start to do them before you actually come off the medication. It just gets you reacquainted so you can start to notice the subtleties and start to practice.

the these techniques and part of the pivot and the Find Your Food Voice book, what I talk about is not only are you asking these questions, but you're asking them in a very compassionate way that leads to this repair work. So you can actually reconnect with your food voice and learn like how you and your body are best suited to experience food and how to eat and take care of this part of your self care.

All right, let's get to the last one. Let's get to number three. So as you're coming off this medication letter writer, anyone who's listening who can relate to, I encourage you to continue to practice the CHIPs. And part of that is monitoring your appetite. Monitor hunger, fullness. I talk a lot in the book about different types of hunger and fullness, meal hungry, snack hungry.

Are you emotionally hungry, physically hungry? There's lots of different vocabulary you can start to practice in this stage. There's of course, an intuitive eating. That book has a scale of one to 10 that you can use for hunger and fullness. Use whatever works for you. And I'm not sure exactly when the hunger will start to increase. Again, some people notice it takes a few months. Some people it's been even longer and they haven't really noticed a drastic change.

And there have been a few people I talked to that said within just a couple of weeks, they're like, yep, I could tell my appetite increased really quickly. And so as you notice the, the appetite increasing, I can appreciate, I almost can feel the energy of that. Like, I hope you can say hello to it.

remember how GLP-1s impact body size and how insulin is working is through malnutrition. I mean, it's important to name it, right? And so as the malnutrition experiences come back online, you will probably notice a few things. One, increase in food thoughts, like the food noise, like a lot of people are saying right now, yes, you're gonna experience that.

I would also expect things like waking up in the middle of the night. These are behaviors and cognitive experiences many of my clients in the throes of an eating disorder would describe. So as people have been coming off GLP-1s, I feel really prepared because I worked with people who were in the throes of eating disorders for a really long time. And while you may not identify as having an eating disorder while being on a GLP-1, your body's going to think that you have been

going through a famine. And just like you need to breathe every single day, you need to eat every single day. And there's something about this medication that turned off that need. And so your body's going to tell you, we've been freaking the fuck out and it's time to eat. I hope you can practice two things here, compassion and permission. I appreciate their hard cells.

I know that those are really hard cells because that's not the way that I think a lot of this world is reacting to body change. But be kind to yourself as you notice these changes happening. Lean onto those CHIPs. Those check-in times, they seem really simple, but they can be really powerful. And there's something about them that when I would...

work with clients who were in the throes of some really intense chaotic eating. And we'd insert these CHIPs into their day. Two to four weeks later, many times people would come in saying, holy shit, I can't believe how much calmer I feel with food. Now, I can't promise anything, but lean on those CHIPs. And so when your food noise is hell aloud, just...

Let yourself know, hey, this is my body's way of responding to malnutrition because it is a successfully evolved human and this is not my fault. And then give yourself what you need. And something I talk about in the pivot chapter, are there are times that you're gonna wanna eat outside of one of these check-in times? And that's okay. It's more about getting used to doing these check-ins and checking in with your mind-body connection.

that is really behind the recovery and the repair process.

So there's another side to GLP-1s that I don't think enough people are talking about. I think more people will, but what we know is, think it's the last time I read about it, it was like about 40 % of the weight lost on GLP-1s is muscle, our lean body mass. And the downfall of this, and this is what I've been dreading as I've been preparing for GLP-1s to not work as the people have been hoping.

is your body is going to require less food to stay at a certain weight. Now, this is not like new metabolic information. We have known about this for decades that when a person goes through some kind of calorie restriction, their body metabolism decreases how many calories it needs to maintain the weight that they've always been at.

So what that means basically is if you started out at XYZ weight, lost 50 pounds, gained it back to maintain XYZ weight, you need less calories than you did before you started the diet. So that's what I would expect with this too. And I hope you can appreciate, I'm just gonna name this, but I hope it's obvious. Like I don't want necessarily anyone counting calories or counting anything. I'm just saying like as kind of a, hey, this may be ahead

you may notice that you're not eating that much and the weight is coming back on. That's not because you're doing anything wrong that your body's broken. Your body's reacting to malnutrition. And when the body goes through famine and then starts to get food again, it basically has now figured out a way to maintain homeostasis on less. there's no like potion, there's no solution that's going to make any different.

are experiencing a...

This is a hard one to say. You're experiencing, you're a victim of the diet industry again. I mean, that's the thing with the downfall of GLP-1s is metabolically your body's going to be different. Metabolically, your body's going to need less and your hunger and fullness are not going to match that. Now there's ways to promote health in this space.

lots, I probably have at least 400 episodes that cover this at this point. But there's no way to control your body size in response to that. Again, we have over 100 years of research that we don't have an intervention that helps most people to maintain weight loss long term. And I am afraid that GLP-1s are also going to be a part of that. Now I know for you letter writer, you had to come off the medication because

It just was no longer accessible. But there's lots of reasons why people can't go on it anymore. And maybe for a few people, they can stay on it for the rest of their lives. And maybe GLP-1s will be like gastric bypass surgery. I've read 20 % of people after gastric bypass surgery are able to maintain the weight loss. That's higher than any diet. And maybe GLP-1s will be the same. But what about the 80%, like the rest of us, the majority of the people who are using this intervention?

letter writer, I think you're gonna be more the norm than the exception, but you may just be ahead of the curve. And as you are picking up the pieces, you're repairing, and you're tending to this complicated relationship, remember to give yourself a soft place to land, make this off-ramp as gentle as possible. as you're, again, as you're repairing, I hope you can look behind you for others who haven't quite gotten there yet.

and will need your support too when they go through the same thing. We're gonna know more in the next few years. And again, you're gonna be ahead of the curve and I have a feeling you're gonna be really helpful for those who are coming up behind you. All right, so I see that food is written back. But before we get to food's letter, I wanna sign off and say thank you so much for joining me on this episode. Thank you for listening to the whole thing. And if you wanna continue to...

Tend to your food voice. I encourage you to buy the Find Your Food Voice book. Join me on Substack. We have links to all of those in the show notes right there below. And until next time, take care.

Julie Duffy Dillon (30:23)

Dear Desperate for Another Way, I am so sorry this medication is no longer an option. We see how relieved you've been even though not really eating much. We wish the solution was simple, yet know it will be messy. Even though it may get complicated, remember this, you are not broken. In fact, you are a successfully evolved human. We hope you consider what you can add to your health regimen

while also repairing your mind and body connection. Then as their cravings come back, we hope you respond with love, patience, and compassion. You are worth this recovery. We are sorry you have been a victim again to the diet industry and know that you are never alone. You deserve to eat enough food no matter how your body responds to it. Just like oxygen,

You need food to survive. Not because you're weak, but because you are human. Love food.

Thank you for joining us in this Find Your Food Voice episode. It was written, produced, and edited by me, Julie Duffy Dillon. Podcast assistance by Rachel Popik and Find Your Food Voice admin help by Colleen Brebner. Stay up to date with everything we have going on at julieduffydillon.com. Subscribe here or on our sub stack. Leaving a review here or a book review helps a ton. We look forward to being back in two weeks for another episode.

Until next time, take care.