The Real Truth About GLP-1 Medications with Dr. Alexandra Sowa
Why is it so hard for women to lose weight? Did you know it is harder today than ever before? There is a biological and a hormonal reason for this. Dr. Alexandra Sowa tells patients the real facts and knows how to help them lose weight and keep it off. She specializes in internal medicine and obesity medicine with a holistic, evidence-based approach for success. She teaches at the NYC School of Medicine. Central to this episode is an exploration of why weight loss remains a formidable challenge for women, especially in contemporary society. Dr. Alexandra Sowa, an esteemed authority in the fields of obesity and internal medicine, emphasizes the intricate biological and hormonal dynamics that complicate weight management for women. She is passionate about combating the stigma and blame game often given to patients who can’t lose weight. She views obesity as a medical condition and stresses that GLP-1s like Ozempic can help. These drugs have gotten a bad rap lately with misinformation. Dr. Sowa says they also provide multiple health benefits for our heart, kidneys, and can even help with addiction. She dispels the misconceptions about these drugs. Her new book THE OZEMPIC REVOLUTION is a Guide for people on GLP-1s and tells you what your doctor isn't. Tune into this episode of Women Road Warriors with Shelley Johnson and Kathy Tuccaro as Dr. Sowa clears up the myths, along with powerful facts and tips you need to combat and lose weight, and if products like Ozempic are right for you.
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Transcript
This is Women Road warriors with Shelly Johnson and Kathy Tucaro.
Speaker A:From the corporate office to the cab of a truck, they're here to inspire and empower women in all professions.
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Speaker B:Welcome.
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Speaker B:I'm Shelley.
Speaker D:And I'm Kathy.
Speaker B:When it comes to weight loss, doctors have quite often played the blame game with their patients.
Speaker B:They've regarded obesity as a lack of willpower.
Speaker B:Too many have even regarded patients as victims of their own sloth or ignorance.
Speaker B:Shocking, isn't it?
Speaker B:These are terrible perspectives that marginalize patients.
Speaker B:Dr.
Speaker B:Alexandra Soa is an obesity specialist whose patients have had great and successful outcomes.
Speaker B:She doesn't buy into these perspectives.
Speaker B:She says obesity is a fact of biology and is a disease state.
Speaker B:There's no blame to be assigned.
Speaker B:Dr.
Speaker B:Soa is up on the latest weight loss breakthroughs and techniques.
Speaker B:Through over 10 years of practice and as a clinical instructor at NYU School of Medicine, Dr.
Speaker B:Soa has developed a profound understanding of the biology of obesity and how to treat it with tools like GLP1 agonist medications.
Speaker B:She says products like GLP1 meds like Ozempic are game changers and can also have health benefits.
Speaker B:Her new book, the Ozempic Revolution offers answers and clears up any confusion people may have about GLP1s, which many people don't totally understand.
Speaker B:Dr.
Speaker B:So has been interviewed by major media outlets, most recently on Good Morning America.
Speaker B:Dr.
Speaker B:Soa is with us today to educate us.
Speaker B:Welcome Dr.
Speaker B:Soa.
Speaker B:Thank you so much for being on the show with us.
Speaker E:Thank you so much for having me.
Speaker E:Absolutely.
Speaker D:It's great to have you.
Speaker E:Are you kidding me?
Speaker C:Awesome.
Speaker C:This is going to be so enlightening.
Speaker C:Before we cover your tips on how to successfully lose weight and keep it off, as well as educate us on GLP1 medications, I wanted listeners to know more about you, what's your background and what exactly do you do?
Speaker E:So, as you so nicely described, I am a dual board certified doctor of internal medicine and of obesity medicine.
Speaker E:So I am a pretty niche doctor and for the past 10 years, I've been helping people to achieve health through weight loss.
Speaker E:And I take a very scientific approach to this.
Speaker E:And this all started from my undergraduate degree at Johns Hopkins and then through my medical training at nyu.
Speaker E:I always wanted to be an evidence based doctor, but what I wanted to do was to prevent disease, not just treat end stage disease, which is often so much of our medical care in the United States is really focused on end stage disease management.
Speaker E:And I was like, there has to be a better way.
Speaker E:So as I was really coming to find what specialty I was going to pursue, I found this very nascent early stage field called obesity medicine.
Speaker E:And I was so fortunate to become an early adopter in this field.
Speaker E:And that has led me to be using GLP1 medications and all of the most modern techniques for weight management over the past 10 years and has really allowed me to kind of emerge as someone who says, hey, these meds aren't new.
Speaker E:I've been using them for a long time and here is my framework.
Speaker E:And that's how this book came to be.
Speaker C:It's super informative and I think it's going to be a game changer for a lot of people who finally can lose weight and keep it off.
Speaker C:Your first chapter says try harder is terrible medical advice.
Speaker C:Is this the typical banter of doctors?
Speaker C:I mean, that could be super discouraging to patients who really are trying?
Speaker E:Oh, yes.
Speaker E:I mean, I think every single person who is listening right now who has ever had any weight to lose knows that they had weight to lose.
Speaker E:And to go into the doctor's office and to say, hey, I've put on £15 and I don't know why, and I'm trying and to be met with just, you know, eat less, exercise more, it is so disheartening.
Speaker E:And unfortunately, that's really what we were taught in medical school Even up to 15, 20 years ago, you know, that was just what we learned.
Speaker E:It was the patient wasn't doing the right things, they must be overeating calories, they're not moving their body enough.
Speaker E:So just give them this advice to try harder and hopefully it works.
Speaker E:And we just know that that's not true.
Speaker E:Because when you look around and doctors are struggling with their weight and everybody is struggling with their weight, it can't be that we're just a bunch of, you know, slovenly people if that's just not it.
Speaker E:Weight loss is very, very complicated.
Speaker E:And it's taken quite a few decades for us to translate the research of obesity and understanding that it is disease to the wider public and in turn, even to medicine.
Speaker E:Medicine is very slow to adopt.
Speaker E:Actually, what we know to be true, there is a widely cited study that says it takes about 17 years for medicine and doctors to give the most updated advice.
Speaker E:So we've known for a while that Obesity is a disease and we actually had effective medications to help manage the disease.
Speaker E:But instead, so many of us have heard and continue to hear, just, you know, try harder.
Speaker E:And it really doesn't work.
Speaker E:No.
Speaker C:And people get caught up in this vicious cycle.
Speaker C:They go to every kind of weight loss program they can think of, they spend thousands and thousands of dollars and they lose it, and then they gain it back.
Speaker C:And of course, then you're hearing on the news the obesity percentages in North America.
Speaker C:Is it true that there are more people who have an obesity issue today than say, 50 years ago?
Speaker E:Absolutely.
Speaker E: years ago, about: Speaker E:And steadily every year they would climb.
Speaker E:Only recently have, just this year, probably in thanks to these new medications, have we started to see a decline, subtly and not across all groups, but in some.
Speaker E: But since: Speaker B:Wow.
Speaker E:Yes.
Speaker E:Yes.
Speaker C:So why is that?
Speaker E:Well, I talk about this in the book.
Speaker E:It is complex and there is no one answer.
Speaker E:What did happen around that time is we started to have big changes in our environment and what we were eating.
Speaker E:So we started having a lot more packaged food.
Speaker E:The government came in and started subsidizing corn, and that corn byproduct made its way into a lot of our packaged food.
Speaker E:We were trying to solve for a problem of how do we feed everybody, like, how do we feed people?
Speaker E:And processed foods and packaged foods became some of that solution.
Speaker E:So that was one part of it.
Speaker E:Our environment started to change.
Speaker E:Instead of walking two miles to the bus stop, you started driving more widely.
Speaker E:Our jobs shifted from jobs in which we were more active to ones in which we were more sedentary.
Speaker E:And then this problem has only gotten worse and worse and worse as we all sit on our computers and we have telehealth.
Speaker E:And, you know, that's what I do now instead of working in a clinic and our screens and our devices and we started to move out to the burbs and we were less urban centric.
Speaker E:So a lot going on, a lot.
Speaker E:And we really can't pinpoint it on one thing.
Speaker E:Something that has also happened, and I talk about this in the book, is our genetics can't change over one to two generations, but the genes that sit on top of our genes do, the epigenetics.
Speaker E:And so as we get heavier, our next generations also get heavier by what we pass down to them.
Speaker E:So even in utero, what we're exposed to.
Speaker E:If our mothers are carrying more weight than they did in previous generations and we're set to carry more weight, it's.
Speaker E:It's pretty remarkable.
Speaker E:So it's kind of been this snowball effect.
Speaker C:That's interesting.
Speaker C:I'd not heard of that.
Speaker C:Epigenetics.
Speaker E:Epigenetics.
Speaker E:Epigenetics.
Speaker B:Interesting.
Speaker C:You know, I think a lot of people trying to lose weight feel like they're, they're so much alone with that many people who are struggling.
Speaker C:It is not a minority.
Speaker C:People everywhere are fighting weight loss and trying to keep it off.
Speaker C:Why is it so many people can't lose weight and keep it off?
Speaker B:What are the biggest reasons?
Speaker E:Well, I think kind of coming back to this idea that it's biology and even this concept, I just told you about this, it's fascinating.
Speaker E:Epigenetics or genetics or the environment and all of these reasons of what, why this has happened, they're big systemic problems and they're not something that's easily solvable on an individual level.
Speaker E:And I said this, I think it's really important for people to understand why weight loss is so complicated.
Speaker E:And if you're considering going on a GLP1 medication to really understand the whole process.
Speaker E:And so in the book the OIC Revolution, I really discuss this and I move people through the science of obesity, the science of these drugs, before we get to how do you make yourself successful?
Speaker E:Because it's so complicated.
Speaker E:And I want people to know that this is not a failure of you as an individual.
Speaker E:This is a much bigger problem.
Speaker E:The, the answer to your question of why is it so hard?
Speaker E:Is that our body is working against us to constantly get back up to its highest set point weight.
Speaker E:So even if we start in a nice lean style state, if every year we're putting on five pounds and then in between we take off seven and then put on ten and then take off two, we constantly, our body wants to put more weight on and this comes down to hormones.
Speaker E:And we discuss this in the book.
Speaker E:But really, obesity, yes, it has something to do with what we've done in our lifetime, you know, what we've eaten and if we've moved or not, but much bigger than that, it's a balance of hormones.
Speaker E:And as weight comes on and the environment around us encourages the weight to come on through, the foods we eat and the things we do, our hormones in our body that talk to our brain and our gut and our fat cells, they become very dysregulated and it becomes almost nearly impossible to Lose significant excess weight on your own.
Speaker E:Of course, we do know, we might know somebody who's lost significant weight and kept it off, or you see the social media picture.
Speaker E:But on average, very, very few people, less than 5% of people, are successful at losing significant weight and keeping it off.
Speaker C:When you're talking about hormones, women have constant hormone fluctuations.
Speaker C:They have, after having babies, they have the pregnancy weight that they have a hard time losing.
Speaker C:Would you say that hormones create more of a problem for women and maybe that they have a harder time losing weight?
Speaker E:Oh, that's such a good question.
Speaker E:As a whole population, studies show that men and women will have similar rates of obesity.
Speaker E:Women will have more fluctuations over the course of their lifetime.
Speaker E:And it does get harder.
Speaker E:I, I shared with you both right before the call that I, I just had my first fourth child.
Speaker E:So I intimately know this dance of weight gain through pregnancy, trying to get the weight, the weight off after.
Speaker E:And our body does change.
Speaker E:And every time that we have these big changes and every time we put on more fat, it does become harder for our body to let go of that.
Speaker E:One of the other things that happens with women specifically is through all of these life changes, specifically in the midlife, changes in the perimenopause and the menopause changes, our estrogen decline will make it so that our body composition changes.
Speaker E:And when body composition changes and we put on more fat, mass over muscle, which also happens in with every year that we age, that makes it harder to lose weight because muscle is much more metabolically active and will help our hormones stay in balance.
Speaker E:And so it can be a really significant struggle.
Speaker E:The other thing that happens with women is through our hormonal states, such as pcos, polycystic ovary syndrome, or pregnancy, with the fluctuations in estrogen and progesterone, it can be very easy to put on significant weight.
Speaker E:And that is a scenario I've often found.
Speaker E:My patients will tell me that every other doctor under the sun has just said, you're doing something wrong.
Speaker E:They're like, I'm literally not doing anything wrong.
Speaker E:I've changed nothing, zero, zilch.
Speaker E:And I'm doing all the right things and my body is just working against me.
Speaker E:So, yes, I think that women in the, on the individual level just have a much harder time in their lifetime because of all of the changes we're constantly experiencing.
Speaker B:Lucky us, huh?
Speaker D:I'm going through that currently myself, I'm going through menopause.
Speaker D:I sit in equipment for 14 days straight, 13 hours a day.
Speaker D:My thyroid quit working about 10 years ago.
Speaker D:And so it's very difficult, I find, or I should say it's very easy to gain weight.
Speaker D:It's almost like I look at food and it just jumps on my body.
Speaker D:And there's a lot of women who I work with who are in the same predicament.
Speaker D:And I haven't changed anything.
Speaker D:Like, I feel, you know, I don't eat gluten.
Speaker D:I'm, I'm gluten, I'm a severe allergy to gluten.
Speaker D:I don't have dairy.
Speaker E:I don't eat meat.
Speaker D:I'm, you know, I go to the gym and it's still, it's like, oh.
Speaker E:My God, like, the battle is unreal.
Speaker E:Yes, yes.
Speaker E:And I hear that a lot.
Speaker E:And, and it does happen in these transitions of life.
Speaker E:One of the other things that often I'll identify regardless of where you are in life, is if someone says to me, the weight's just coming on and nothing has changed.
Speaker E:I really like to do a holistic, deep dive into their metabolic health.
Speaker E:And I, I, I lay out this framework in the book.
Speaker E:But I think it's really important just to go back to basics with labs and really look at what defines metabolic health.
Speaker E:Because one of the things that develops is often insulin resistance.
Speaker E:And very subtly, it will develop before you start seeing pre diabetes or before you see real blood sugar imbalances.
Speaker E:And that's something that occurs in peri and menopause.
Speaker E:And it's one of the things that really makes it hard for people to lose weight even though they've shifted nothing else in their lives.
Speaker E:And I make a case for really testing for fasting insulin and comparing it to your fasting blood sugar.
Speaker E:And it's not something that most traditional primary care doctors do.
Speaker E:And it really gives insight.
Speaker E:You also mentioned that you have hypothyroidism.
Speaker E:We'll see this a lot, too, because when we start to see autoimmune or other endocrine diseases come on, really does interfere with metabolism.
Speaker E:And it can make it very hard to move the needle on the scale.
Speaker E:And that's where when we say, okay, we'll treat your hypothyroidism, well, we also might need to treat weight in the same way we might need to use a medication.
Speaker E:And that's where these GLP1 medications really have become a game changer, because it's not just you going into your doctor's office and us saying, okay, well, work out harder.
Speaker E:I'll see you next year.
Speaker C:Yeah, what a frustrating thing.
Speaker C:It's like here we keep raising the bar for you.
Speaker C:Keep, keep trying.
Speaker C:Keep trying.
Speaker C:See ya.
Speaker C:Nobody wants to hear that.
Speaker A:Stay tuned for more of Women Road warriors coming up.
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Speaker A:Welcome back to Women Road warriors with Shelly Johnson and Kathy Tak.
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Speaker C:We want to help as many women as possible.
Speaker B:For way too long, the medical world has kind of failed folks who are dealing with problems losing weight.
Speaker B:Many doctors have blamed their patients treating obesity like it's just about laziness or a lack of willpower.
Speaker B:That mindset totally outdated and honestly, pretty harmful and outrageous.
Speaker B:Enter Dr.
Speaker B:Alexandra Soa.
Speaker B:She's an internal medicine and obesity medicine specialist who's flipping that narrative on its head.
Speaker B:Dr.
Speaker B:Soa views obesity as a medical condition, a disease, not a character flaw.
Speaker B:She's been in the game for over a decade, teaches at NYU School of Medicine, and stays sharp on the latest science and Treatment options.
Speaker B:One of the biggest breakthroughs.
Speaker B:She talks.
Speaker B:GLP1 medications like Ozempic, these aren't just buzzwords.
Speaker B:They're real tools that are changing the way people approach weight loss and even improving other health markers.
Speaker B:If you're curious or confused about these meds, Dr.
Speaker B:Soa's new book, the Ozempic Revolution, breaks it all down.
Speaker B:It's an honest, science backed guide to understand how these treatments work and why the old blame game is finally being shown the door.
Speaker C:Dr.
Speaker C:Soa, we are hearing a lot about GLP1 meds like Ozempic and people have different opinions.
Speaker C:Some are just giving it a bad rap and some are saying, hey, it's a game changer.
Speaker C:What are the misconceptions or urban myths about GLP1 medications?
Speaker E:Well, the first one is, is that it is just a magic shot and people are taking the easy way out or you, if you take it, that you don't have to do anything else.
Speaker E:And it couldn't be farther from the truth.
Speaker E:And that is why I wrote the book, because I laid out the holistic framework that I have my patients follow, which is how to change habits, how to eat, how to think, how to exercise.
Speaker E:It's really not just here's a shot and then nothing else changes.
Speaker E:In fact, the medication really does help trans people's behaviors.
Speaker E:They want to eat differently, they need to eat differently, they want to start moving and exercising for the first time in 20 years.
Speaker E:And so there's a lot of work that does still need to go into thriving on these medications.
Speaker E:So that's really, I think, the biggest misconception I see.
Speaker E:It is not the easy way out.
Speaker E:I think anyone who is struggling with their weight would so have preferred to have either the genetic genetics or the fortune in life or the circumstances in life that they never had to deal with, deal with their weight.
Speaker E:So I really, really wish that that narrative would go away.
Speaker E:I think the other big misconception I see is that these medications are new and we don't know what the long term side effects are.
Speaker E:And that is actually very false.
Speaker E:These medications have been around in use, FDA approved for almost no at this point, 20 years.
Speaker E:They were released.
Speaker E: medication was released in: Speaker E:The evidence and the now backlog of 20 years of being able to study patients on these medications for this long is so robust and the safety profile of these medications is incredibly robust.
Speaker E:And so when people say we just don't know what will happen when you're on these meds, we do and you're, you'll do well.
Speaker E:And in fact what we now know is that for people who are on these medications, their risk of 16 types of cancer is down.
Speaker E:They're all cause mortality is decreased by 20%.
Speaker E:So is risk of stroke and heart attack and kidney disease and type 2 diabetes and sleep apnea complications and osteoarthritis.
Speaker E:And honestly the list goes on and on.
Speaker C:Wow.
Speaker E:Yes.
Speaker E:So, so that's the big one I hear.
Speaker E:And I can just kind of come right back and say that you're absolutely wrong.
Speaker C:This is good because you hear a lot of fear mongering and I think that there's a lack of understanding and people are skeptical if they don't understand something.
Speaker C:What exactly do GLP1 medications do with the body?
Speaker E:That's a great question.
Speaker E:So they have.
Speaker E:So just to take it back a step further.
Speaker E:So our body makes GLP1 hormone, that's one of the hormones that I was referencing that become dysregulated over time.
Speaker E:So a few of the big ones that I talk about in the book, Insulin becomes dysregulated, we develop insulin resistance, we develop something called leptin resistance that becomes dysregulated and GLP1 also becomes dysregulated.
Speaker E:So we make this naturally in our body and we have GLP1 receptors all over our body.
Speaker E:The medication is a synthetic version of the protein of the hormone.
Speaker E:What makes it different than the version that we produce in our bodies is that the version that we get through an injection lasts much, much, much, much longer.
Speaker E:So instead of having an effect in the order of minutes on our body, it has an effect for weeks.
Speaker E:And that's what has made it such an effective tool for us.
Speaker E:And how it works is it works at the level of our brain and it talks to our brain to quiet food noise, to not be hungry when it's not necessary to be full.
Speaker E:What is food noise?
Speaker E:Oh, that's a great question.
Speaker E:So that's like I ever heard that one.
Speaker E:So you know that little creeping feeling where you really shouldn't be hungry but you're thinking about your next snack or you sit down to watch TV and you can't, you know, you see the ad for chips and your brain just keeps telling you to go to the kitchen and get chips?
Speaker E:Uh huh, yes.
Speaker E:So it's not a scientific term, but I think.
Speaker E:But it's a term that's been coined by the Internet and I think it so appropriately describes what this medication does, which is just to stop that ever present noise.
Speaker E:That tells you to snack and eat and constantly think about food.
Speaker D:Ah, yeah, okay.
Speaker E:Yeah.
Speaker C:It stops food cravings, essentially.
Speaker E:It does it very, very dramatically.
Speaker E:And it's not like previous anti appetite medications that we've had.
Speaker E:It's even more profound than that.
Speaker E:It doesn't just curb your appetite.
Speaker E:It actually stops from a high level of thought of constantly thinking about it.
Speaker E:And so this has been very effective.
Speaker E:Also, outside of weight and blood sugar management, these medications are being studied for treatment of alcohol use and opioid and drug abuse disorder too, because it's the same part of the brain that keeps telling you to think about alcohol or drugs or food.
Speaker E:It's all connected.
Speaker E:So super interesting.
Speaker E:So that's the first place that it works.
Speaker E:And the second place it works is in the gut, and it slows down our stomach emptying time.
Speaker E:So food sits in our stomach longer.
Speaker E:So in effect, it's almost as if you've had a bariatric surgery where your stomach is smaller and the food feels more, you're fuller, longer.
Speaker E:It really does sit there longer.
Speaker E:And so you just don't want your next meal as soon.
Speaker E:So that's the next way.
Speaker E:And then the final big way that it works is at the level of the pancreas.
Speaker E:And pancreas secretes insulin, whose job it is to scoop up blood sugar and to take it where it needs to go in the body.
Speaker E:And it really makes this process very seamless.
Speaker E:And we had briefly mentioned something called insulin resistance.
Speaker E:And that's where your body isn't very good at regulating blood sugar and responding quickly with the right levels of insulin.
Speaker B:And.
Speaker E:And this medication helps regulate that.
Speaker E:And when our blood sugars remain stable, not only does that become an effective treatment for things like type 2 diabetes, but it actually becomes an effective treatment for weight loss because a stable blood sugar will allow our body to burn its own fat stores.
Speaker E:So Those are the three big superpowers.
Speaker E:We have GLP1 receptors all over our body.
Speaker E:So we are seeing even bigger benefits.
Speaker E:Cardiac benefits, kidney benefits that are independent of weight or blood sugar regulation.
Speaker E:But that's really kind of the short.
Speaker E:It's not so short, but that's the shortest I can make an answer about what these drugs do.
Speaker C:You've really helped us understand this.
Speaker C:And I think that it's going to quell some of the fears out there, because I think there's some people that are like, ooh, I've never heard of this.
Speaker C:This doesn't sound right.
Speaker C:And anytime people have acronyms that they hear, they think it's really scary, you know, tlp.
Speaker C:What does that mean?
Speaker C:You know?
Speaker E:Yes.
Speaker E:So it shouldn't be scary.
Speaker E:I talk through this in the book.
Speaker E:I think that there's an appropriate level of fear around medications.
Speaker E:You know, anyone who's probably old enough to be losing weight does remember things like fen phenomen.
Speaker E:Right.
Speaker E:I call that the fen phen fiasco.
Speaker E:We had a drug released in the 90s that did cause actual heart damage.
Speaker E:That changed the game for how well controlled the studies needed to be and how long and big the studies needed to be for weight management drugs.
Speaker E:And it became actually a lot harder to create and distribute and to get these drugs out to market.
Speaker E:So I think.
Speaker E:I think it's appropriate to come with a little level of skepticism.
Speaker E:I will say.
Speaker E:What makes drugs for the management of obesity probably different than other diseases is that the thing we have to be honest about is that there's a lot of weight bias in the world.
Speaker E:And so a lot of people, whether they want to admit it or not, think that a medication or weight is.
Speaker E:Is cheating and it's taking an easy way out, and it inherently must be wrong.
Speaker E:And I think we've been sold a whole society that's built on selling us programs and gym membership and try harder and January starts that it's really hard to unravel the way that our brain has been trained over the past.
Speaker E:Our past lifetime.
Speaker B:Sure.
Speaker C:Who's a good candidate for GLP1 meds?
Speaker E:So it's pretty broad right now.
Speaker E:The FDA says for weight management specifically, there are two things to qualify for, and we go by body mass index, bmi, and that just takes into account your height and your weight.
Speaker E:And so anyone with a BMI greater than 30, which puts people into an obesity category, qualify for this medication or a BMI of 27 with one health condition that would be improved by weight loss.
Speaker E:And generally, if you're carrying excess weight, I can generally find one other health condition, whether it's this slightly high blood pressure or back pain, sleep apnea.
Speaker E:And people think that obesity looks a certain way.
Speaker E:But I will say that BMI of 27 looks pretty normal, and so does a BMI of 30.
Speaker E:And it really doesn't.
Speaker E:It doesn't matter how someone looks.
Speaker E:It's really about their metabolic health.
Speaker C:Haven't they changed BMI parameters over the years too?
Speaker E:Well, I think that there's been an appropriate amount of skepticism about bmi.
Speaker E:They really haven't changed parameters.
Speaker E:They're constantly kind of renaming what we call things.
Speaker C:Yeah, that makes it confusing, too.
Speaker E:It does make it confusing.
Speaker E:Body mass index does not tell us anything about someone's health.
Speaker E:It really just tells us the relationship between height and weight.
Speaker E:And it's a good screening tool, but it doesn't get to the root of it.
Speaker E:So like a bodybuilder could have a BMI of 27 and have truly no body fat on them and there's nothing to lose and there are just a hunk of muscle.
Speaker E:And then someone could have a normal BMI and have no muscle tone.
Speaker E:And that's not healthy either.
Speaker E:So really, while the FDA kind of sets these clear guidelines there, there, we really need to look at the person as an individual and a better predictor.
Speaker E:And this is where we'll move toward over the next, I don't know, probably take medicine a while.
Speaker E:But the way that we're going to move is about body composition.
Speaker E:So instead of looking at bmi, we should be looking really more at body fat composition and, and your metabolic health as a predictor.
Speaker B:So those would be different tests that.
Speaker C:The doctors would have to do then.
Speaker E:Yeah, yeah.
Speaker E:And it's, I don't know, there are, there are special scales.
Speaker E:They're expensive and I think we need to bring the costs down and just kind of make it more accessible.
Speaker E:But there are actually, there are cheaper ways to do this too.
Speaker E:We can use a simple old fashioned soft measuring tape to look at the ratio between your belly and your hip.
Speaker E:And that can tell us a lot, actually, about where we're carrying our fat.
Speaker E:When people hear that, though, I'll tell you, even I say it out loud and I'm kind of like, oh, I got a pit in my stomach.
Speaker E:People are listening to it and they're like, you want me to measure myself?
Speaker E: Is this like the: Speaker E:Are you trying to give me an eating disorder?
Speaker E:But it can tell us a little bit about kind of where we're carrying our weight, because we do know that the belly fat is the type of fat that we want to work against and it's not well distributed body fat.
Speaker E:So BMI gives us a cutoff, but really we need to look at the individual.
Speaker E:And the other part of the conversation here is that these medications are approved for, for a few uses.
Speaker E:Now, one of them is weight management, but the other, the first FDA approval they garnered was for the management of type 2 diabetes.
Speaker E:So anyone who has type 2 diabetes, regardless of weight, is a good candidate for these medications.
Speaker C:Okay, so what are some of the good habits and behaviors for patients who want to lose weight and keep it off?
Speaker C:You've had great success with your patients.
Speaker C:So I have.
Speaker C:What do you recommend to them?
Speaker C:I would imagine it differs with every patient, but it does.
Speaker E:But I found after treating thousands of patients truly on these medications, that the framework to kind of guarantee success has remained the same.
Speaker E:And I never felt great ever, ever.
Speaker E:Even when I had to do.
Speaker E:When I was started off my career and kind of more general internal medicine, I never felt great about just handing someone a prescription for any disease and saying, see you six months.
Speaker E:It just never felt right in my soul.
Speaker E:And especially when I went exclusively into the field of weight management, I knew my patients needed a lot more.
Speaker E:So what do they need to do?
Speaker E:I put the framework and everything that I teach my patients into this book, the Ozempic Revolution.
Speaker E:And fundamentally, the framework is habit foundations.
Speaker E:It's a food foundations.
Speaker E:It's knowing how to eat, not going on a diet, but knowing how to eat to fuel yourself.
Speaker E:And then the third category of foundations is actually your thought and mental foundations.
Speaker E:This is the part that I think is most overlooked in our society.
Speaker E:Weight is complicated, and the weight that we carry with us brings emotions and trauma and history and a whole lifetime.
Speaker E:And if you aren't prepared to do some of the mental work along this journey, I find that it can be very difficult and unsuccessful for some.
Speaker E:So in the book I lay out these foundations.
Speaker E:I think if I were to say the number one thing to ask yourself, if you're listening to this, this conversation, is, is this right for me?
Speaker E:I want everyone to ask yourself, why would you want to do this?
Speaker E:Like, why do you want to go on a weight loss journey?
Speaker E:Why would you want to consider this medication?
Speaker E:And I really want you to think about health and life improvements, not vanity.
Speaker E:And if you can only come up with one reason, that's vanity related, this probably isn't right for you because this will.
Speaker E:This is a lifetime that we want to look at changing our behaviors, not just for a singular event or getting back into an article of clothing.
Speaker E:And I've found that my patients who do amazingly and are so thrive and are so happy, their motivations were always rooted in something that made their life better.
Speaker E:I want to be able to get on the ground and play with my kids.
Speaker E:I want to avoid the disease that my grandparents had.
Speaker E:I want to be able to hike up a mountain, you know, things that made their life better.
Speaker E:Not I want to be skinny.
Speaker B:Makes sense.
Speaker D:Yeah, I got.
Speaker D:I have a really weird question.
Speaker D:Why do you call fat an organ?
Speaker E:Oh, because it is.
Speaker E:It's so powerful.
Speaker E:It's not Just a nuisance.
Speaker E:It's.
Speaker E:It talks to every part of your body, and that's actually why it's so.
Speaker E:It causes so much disease and why it's so hard to get rid of and stay off.
Speaker E:Because fat is a very dynamic organ that controls hundreds of hormones and.
Speaker E:Yeah, so we.
Speaker D:I don't think people really have ever.
Speaker D:I've never heard it like that, and I've never really thought about it like that.
Speaker D:And I think.
Speaker E:You know what?
Speaker D:You're right.
Speaker C:Well, Dr.
Speaker C:Soa, isn't fat also an insulator?
Speaker E:Yes, we need it.
Speaker E:So.
Speaker E:And like, let's say a heart as an organ, like we.
Speaker E:We need a heart, but you can't just.
Speaker E:We're not trying to get rid of our heart.
Speaker E:Right.
Speaker E:So that's where I think people get a little confused about fat is.
Speaker E:Yes, we need fat.
Speaker E:And fat nourishes us, keeps us warm, it protects us.
Speaker E:There are very healthy fats in our body, but in excess, it becomes this dysregulated, powerful organ that talks to all of our other organs, and we do want to get rid of some of it.
Speaker C:What does cholesterol.
Speaker C:How does that interact with fat?
Speaker C:For those that don't know?
Speaker E:Well, that's a good question.
Speaker E:So our cholesterol is in our bloodstream and dietary.
Speaker E:This is all very confusing.
Speaker E:It's a good question because dietary cholesterol is different than the cholesterol that our body makes and breaks down.
Speaker E:And we need it.
Speaker E:We need cholesterol for really, for.
Speaker E:To keep functioning.
Speaker E:It becomes a problem when we make cholesterol and package cholesterol in excess and it starts to build up in parts of our body.
Speaker E:One of my favorite components of cholesterol to look at that gets so overlooked is something called triglycerides.
Speaker E:And triglycerides, no one ever really talks about them in the doctor's office, but they are a part of a fat that floats around in our bloodstream that is actually representative of the amount of fat and excess calories we have, specifically from carbohydrates that's floating around.
Speaker E:So it can be a marker kind of, of our whole metabolic health.
Speaker E:And there is a relationship between our fat, really, because it's an organ and it's talking to the rest of our body of how to process and package things and our blood cholesterol.
Speaker E:So as we lose weight, we actually see dynamic changes in our cholesterol.
Speaker E:Some that you might.
Speaker E:That might surprise you.
Speaker E:In fact, as we're losing weight, our.
Speaker E:Our blood cholesterol can sometimes go up.
Speaker E:Not because we're doing anything wrong, but because we're actually releasing fat stores and we can see a translation of higher ldl temporarily.
Speaker E:It's not harmful, but we'll we'll see it.
Speaker E:And so there is a relationship.
Speaker B:Interesting.
Speaker A:Stay tuned for more of Women Road warriors coming up.
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Speaker A:Welcome back to Women Road warriors with Shelly Johnson and Kathy Tucaro.
Speaker B:Try harder is not what a patient who has trouble losing weight needs to hear.
Speaker B:The medical community has blamed patients for way too long.
Speaker B:Dr.
Speaker B:Alexandra Soa knows this treatment modality is not the way to help people.
Speaker B:She says weight loss is very complicated and it's taken many decades to adopt effective treatment regimens.
Speaker B:Dr.
Speaker B:Soa views obesity as a medical condition, a disease, not a character flaw.
Speaker B:Part of the problem, she says, is how people have been eating and processed and packaged foods, along with driving, more walking, less and more sedentary jobs have created part of the problem.
Speaker B:We're a product of all of that and obesity is a disease, not a lifestyle or a choice.
Speaker B:As Dr.
Speaker B:Soa says, Our epigenetics have changed and this means future generations are carrying more weight.
Speaker B:The reason we can't lose weight is systemic and it's biology and dysregulated hormones.
Speaker B:Women have more fluctuations of that over their lifetimes.
Speaker B:The newest medications like Ozempic have helped with weight loss significantly.
Speaker B:Dr.
Speaker B:Soa says they have many health benefits like improving longevity and even helping with addictions.
Speaker B:There are too many misconceptions about these drugs, which have been around for 20 years.
Speaker B:Dr.
Speaker B:Soa knows the benefits of GLP1s, which are what our bodies produce naturally and have GLP receptors.
Speaker B:She teaches at NYU School of Medicine and stays on top of the latest science that helps her patients lose weight and improve their health.
Speaker B:One of the biggest breakthroughs she talks about are GLP1 medications like ozempic and dispels the myths and misconceptions about them.
Speaker B:Dr.
Speaker B:Soa's new book, the Ozempic Revolution, is super educational.
Speaker B:She's been educating Kathy and I with some amazing facts.
Speaker B:Dr.
Speaker B:Soa, I was watching one of.
Speaker C:Your interviews and you had some recommendations for people when they're taking GLP1 meds.
Speaker C:And I don't know if it also applies to people who may not be taking that.
Speaker C:But as you talked about habits, food and thought, prioritizing protein, minimizing muscle loss, focusing on hydration and don't skipping meals.
Speaker C:Are these some fundamentals or are there some others that you could add for people who are trying to really get a handle on their weight gain?
Speaker E:Yes.
Speaker E:Well, even if without these medications, I think following the framework that I set out in the book is very helpful.
Speaker E:I've used this framework for patients on other medications.
Speaker E:I've now perfected this for patients on GLP1 medications.
Speaker E:But also the, the truths of it remain true even without the medications.
Speaker E:So things like logging your food and making sure you're actually hungry and making sure you're honoring your hunger and we're not just eating for emotion.
Speaker E:That's a habit I'll go through in the book that can be helpful on or off these meds.
Speaker E:Same for my food foundations.
Speaker E:Protein is a very overlooked macronutrient and we really need to prioritize that specifically when you're on these medications because your appetite is down.
Speaker E:And we need to make sure you get the right nutrients to really sustain, sustain you to minimize muscle loss.
Speaker E:But protein will help in any weight loss plan.
Speaker E:I talk about a, a really interesting study that came out of Cornell a few years ago that looked at the order in which we eat our food.
Speaker E:And if you just change the order of food, you'll have big blood sugar benefits.
Speaker E:And in turn, if you remember, if you keep your blood sugar more normal and stabilized, you will lose, you will lose weight.
Speaker E:So if you eat your protein first and then your vegetable and then your carb, you'll have a much lower blood sugar than if you ate the traditional meal of the carb first and then the vegetable and then the protein.
Speaker E:So simple things of like reordering our food can really help and yes, I think checking in with your mental health is a big part of it, too.
Speaker E:I teach a cognitive behavioral therapy framework model in the book which allows us to just stay honest and true to how we're feeling and making sure our brain isn't talking us out of our habit changes.
Speaker E:And whether you're on a GLP1 or not, you'll.
Speaker E:You guys will.
Speaker E:Will appreciate this, but our brain can often tell us, well, you know, I thought today was going to be a day I ate well, but then I had a bad lunch, so I might as well throw it out the window and have a bad dinner, and then I'm going to have three drinks and a dessert, and then I'll start tomorrow.
Speaker E:Right?
Speaker E:Because our brain just gets ahead of us and says nothing was worth it.
Speaker E:And now you might all just throw in the towel.
Speaker E:Right?
Speaker C:Yeah, our.
Speaker C:Our brain has that.
Speaker C:You get that nasty little voice saying, ah, what the heck, just do it.
Speaker C:Too late now.
Speaker C:Right.
Speaker E:So I think that, you know, a lot of the things, and I say this honestly in the book, a lot of the recommendations I give might feel familiar.
Speaker E:The thing about being on a GLP1 medication is, is it gives people a new lens in which to.
Speaker E:To execute on some of these behaviors, and so we can all learn something from it.
Speaker E:Even if you're just curious about the medications, the book will still be a helpful tool, but it really is crafted to help people thrive on these medications.
Speaker E:Because so often the story you hear is one of, I didn't feel well on them, or they didn't work for me, or my sister went on them and lost too much weight, and now she's not eating anything.
Speaker E:You know, and we want to do this in a very healthy and controlled manner.
Speaker C:Why do people have those kind of outcomes where they didn't feel good?
Speaker C:What's going on there?
Speaker C:Are they not doing what they need to do in.
Speaker C:In concert with the meds?
Speaker E:I think that there's.
Speaker E:I think that there are a lot of prescriptions being written in the country either with good intentions or not so great intentions.
Speaker E:You know, I think we've all probably seen our Facebook ads pop up with all these companies that are like, just log in and we'll send you the meds.
Speaker C:Oh, yeah, take this simple pill.
Speaker E:Yeah, yeah.
Speaker E:And you have to be really careful about those because those aren't nest, those aren't FDA approved.
Speaker E:But, but even if you are getting the medication, I just think traditional doctor's offices aren't set up to give you any knowledge and information.
Speaker E:And also I will be honest, most doctors just don't know.
Speaker E:We don't learn this in medical school.
Speaker E:And even as an expert in this field, it's taken me 10 years to really perfect exactly how I patient, I help patients.
Speaker E:And that's one of the reasons I wrote this book.
Speaker E:Because doctors just don't have the time, knowledge, bandwidth to educate.
Speaker E:And so when it comes to side effects, we can really help people get ahead of side effects, manage them, and understand how to minimize them.
Speaker E:The side effects are a byproduct of how the medication works.
Speaker E:It is not the way that the drug should work.
Speaker E:And if you're not feeling well, something is off with your dose, how you're eating and how you're responding to the medication.
Speaker E:Aside from the book, I actually created a whole product line called so well for GLP1 users because I realized that my patients all needed product.
Speaker E:They needed an electrolyte, they needed a protein, they needed a fiber, and they needed about 15 other individual ingredients that were based in evidence.
Speaker E:But I couldn't find anywhere else there.
Speaker E:So I created it for them.
Speaker E:And, and just having the routine of waking up and making sure you're getting in your electrolyte and then even if you're not hungry, you're getting in your protein shake.
Speaker E:And then, gosh, I really can't eat my vegetables yet because they don't have a very big appetite.
Speaker E:But I'm going to make sure to get in my fiber.
Speaker E:So I keep the nausea and the constipation and the diarrhea at bay.
Speaker E:Because if you don't know that those things are coming and you don't know that you have to stay on top of them, they can take over and make the experience really complicated.
Speaker E:So, you know, I've even had patients come to me who say, I don't think I can do this again.
Speaker E:Like, I tried it once with another doctor.
Speaker E:You know, I've heard you're great, so I'm going to listen to you, but I don't think so.
Speaker E:And just with the right planning of what to eat and how to stop before you're full and how to think about this process and understanding how the medications work, they do great.
Speaker E:So it's very, very, very rare.
Speaker E:Someone really can't tolerate these meds.
Speaker D:Does the water intake stay the same?
Speaker D:About two liters a day?
Speaker E:That's a great question.
Speaker E:So you should keep up your water intake.
Speaker E:But here's the problem is that not only does GLP1 tell your brain to not be hungry, it also quiets your Thirst mechanism, which are very much related.
Speaker E:And so that is one of my food rules, is that not only do you have to make sure you're getting in protein throughout the day, even if you're not really hungry, you must also drink success.
Speaker E:64 ounces of water.
Speaker E:And electrolytes become a key part of this because we get a lot of our salt through processed food and just food.
Speaker E:And we need salts to actually get water into the right parts of our body.
Speaker E:So even if you're not eating a lot, you can still continue to feel well if you get enough hydration with a solute or a salt.
Speaker E:And that's why I'm a big proponent of electrolytes on this journey.
Speaker C:It's a complicated process, but when you think about it, we're nothing but a petri dish.
Speaker C:We're nothing but chemistry in a petri dish.
Speaker E:It's true.
Speaker E:And we just have to kind of biohack it in the right way in order to feel well.
Speaker C:Absolutely.
Speaker C:So how much weight can patients actually lose on a gld?
Speaker E:That was gonna be my next question.
Speaker E:Yep, that's a good one.
Speaker E:And people really wanna know that.
Speaker E:So, 1.
Speaker E:It depends on the individual, but on population averages.
Speaker E:Medications like Ozempic and Wegovy, which are the same drug, just have two different names.
Speaker E:One's for type 2 diabetes management, and one is for weight loss management.
Speaker E:People, on average, will lose about 15% of their total body weight with the newest class of drugs, called Tirzepatide, which is Manjaro or Zepbound.
Speaker E:Patients will lose up to 23 to 25% of their total body weight.
Speaker C:Okay.
Speaker E:It really depends on the individual.
Speaker E:In my practice, people get a lot higher percentages because they are doing the holistic work.
Speaker E:And then it's sometimes impossible for me to know who will respond to which medication better.
Speaker E:But really, on average, with the newer versions, we're seeing even more weight loss.
Speaker E:I do want to say one caveat to this, is that people sometimes think that if they go on these medications, that they'll achieve truly, like, a.
Speaker E:Just a different body.
Speaker E:Like.
Speaker E:Like they'll be so thin or they'll get back to high school, even if high school is 50 years ago.
Speaker E:And that's one thing that I'm always talking to my patients about.
Speaker E:That again, this isn't even if we have these big percentage of numbers.
Speaker E:We're doing this for health, not for thinness.
Speaker E:And we have to be realistic in our expectations of what they can do.
Speaker C:Yeah, that's where people are.
Speaker C:They're seeing Stuff on social media, it's like, hey, I want to look like her.
Speaker C:You know, it's like, if you didn't have an hourglass figure to begin with.
Speaker B:You probably won't now.
Speaker C:Right, Right.
Speaker E:And every year that we age, our body changes.
Speaker E:Even if we were to stay at the same weight where our breasts are and our fat distribution and we age, we age.
Speaker E:And so people need to, to be realistic, I talk about this in the book, but sometimes, sometimes people need to actually work with a therapist toward the end of their weight loss journey, because even though they've achieved everything that they could possibly achieve through health and weight loss, they're still.
Speaker E:They still need to work through some of that kind of what, disappointment, and making sure that we're not fostering any sort of body dysmorphia, which is where we're not enjoying our body because it doesn't look a particular way.
Speaker E:And we have a lot of work on a society to still do there.
Speaker B:Oh, yeah.
Speaker C:Unrealistic expectations, for sure.
Speaker C:Now, is this covered by insurance?
Speaker C:And how do patients get their insurance company to cover it?
Speaker B:Because that's always a problem, too.
Speaker E:Yes.
Speaker E:So this is a great and excellent question.
Speaker E:And right now, there is a bill sitting in Congress, actually, not a bill.
Speaker E:It's a proposed rule that will allow Medicare and Medicaid to cover these medications, which is a very big deal.
Speaker E:And if that passes, we're going to see a pretty profound decrease in the cost of these medications for everyone.
Speaker E:And so I'm really pulling for that.
Speaker E:And you have an opportunity as a listener to let your Congress people know that you are in support of this and your senators and anyone who will listen that you're in support of it.
Speaker E:Really?
Speaker E:That's, in my opinion, where it needs to start.
Speaker E:Insurance companies, unfortunately, have a little bit too much power right now in the fact that, that they both set the prices for the medications and dictate coverage for them.
Speaker C:I am surprised they're allowed to do that, and they really should be.
Speaker E:And it's a really big problem that needs reform.
Speaker E:And unfortunately, this is the biggest problem right now I have with these medications is that they are for the.
Speaker E:Approved for the use of chronic disease management, meaning once you start them, we know that you, you will likely need to cover them.
Speaker E:We didn't, we didn't talk about that on this podcast, but that is the truth.
Speaker E:And right now, unfortunately, insurance companies, they're.
Speaker E:They're really playing God here where they're giving coverage and then they're taking it away.
Speaker E:Oh, yeah.
Speaker E:And that's just true malpractice.
Speaker E:And if I did that as a doctor and just willy nilly took it away, that's just.
Speaker E:We know that that leads to worse outcomes.
Speaker E:And so I.
Speaker E:That's the biggest problem I have.
Speaker E:So these meds are expensive.
Speaker E:In Europe, they are about a fifth to a sixth of the price per month than what we establish here.
Speaker E:So we know costs can come down and we all need to continue to put pressure on the government, the pharma companies, but really the insurance companies, in my opinion right now are playing with us.
Speaker E:Many commercial plans will have coverage of these and some state and federal plans will.
Speaker E:But unfortunately, there's just a big gap right now.
Speaker E:And I can't.
Speaker E:I can't tell you which ones.
Speaker E:People come to me all the time.
Speaker E:They're like, I have Blue Cross.
Speaker E:Will it cover it?
Speaker E:And I'm like, I don't know.
Speaker E:It's so complicated.
Speaker C:Oh, it really is.
Speaker C:You have to take a college course to understand the coverages.
Speaker C:And they can change all the time.
Speaker C:It's really a nightmare.
Speaker E:It is, it is.
Speaker C:And that discourages good healthcare.
Speaker C:And it's wrong.
Speaker C:So, I mean, that's another subject.
Speaker C:You don't want me getting on that soapbox, trust me.
Speaker C:I was like, I totally agree with you, Dr.
Speaker C:Soa.
Speaker C:Where do people find your book?
Speaker C:I mean, you cover everything.
Speaker C:You even have some recipe recommendations, which is simple, easy meals when you don't feel like eating, that kind of thing, as well as a guide to dining out.
Speaker C:That's a godsend, too.
Speaker E:Well, I really, I put everything in here that I've given to my patients.
Speaker E:Again, this framework that I knew people needed.
Speaker E:It just wasn't out in the world yet.
Speaker E:So I wrote this book with HarperCollins.
Speaker E:You can buy it wherever books are sold, always.
Speaker E:I encourage you to support your independent bookseller, but you can also get it on Amazon.
Speaker E:I love hearing from people when they get it.
Speaker E:So you can find me on social media too, @AlexandroSoamd.
Speaker E:And I love seeing pictures of the book out in the wild.
Speaker B:I love this.
Speaker C:You have been so educational.
Speaker C:You've changed my opinion on some things, too.
Speaker C:I mean, I didn't have the knowledge.
Speaker C:Now I'm convinced.
Speaker C:Okay.
Speaker C:This makes sense, you know, it really is.
Speaker C:Yeah.
Speaker E:Thank you.
Speaker E:That's.
Speaker E:So, that's, that's the best thing I can do is just to provide education and support to a very complicated issue that a lot of people grapple with.
Speaker E:So thank you for that.
Speaker E:This is.
Speaker D:This is great.
Speaker D:This is absolutely great.
Speaker C:Yes.
Speaker C:People need to go out and get your book the Ozempic Revolution.
Speaker C:Can they also get it on Amazon, places like that?
Speaker E:Yes, go go to Amazon and you can get Kindle or or Audible.
Speaker E:I narrated.
Speaker E:So if my voice on this podcast was enjoyable to you, you can go find my.
Speaker E:You can go listen to me in my book.
Speaker E:And I really enjoyed that process too, because again, I think that this is just a complex emotional journey and if I could be the doctor in your ear helping you along, I'm very happy to do so.
Speaker B:That's excellent.
Speaker B:You have been a wealth of knowledge.
Speaker C:Thank you so much.
Speaker D:What a great guest.
Speaker D:Thank you so much.
Speaker C:Yes, thank you Dr.
Speaker C:Soa.
Speaker B:We hope you've enjoyed this latest episode.
Speaker B:And if you want to hear more episodes of Women Road warriors or learn.
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Speaker B:We also have a selection of podcasts Just for Women.
Speaker B:They're a series of podcasts from different podcasters, so if you're in the mood.
Speaker C:For women's podcasts, just click the Power network tab on womenroadwarriors.com youm'll have a variety of shows to listen to anytime you want to.
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Speaker B:Thanks for listening.
Speaker A:You've been listening Listening to Women Road warriors with Shelly Johnson and Kathy Tucaro.
Speaker A:If you want to be a guest on the show or have a topic or feedback, email us@sjohnsonomenroadwarriors.com.
