Nelms Nutrition

09/25/2026

You’re losing weight. But what are you actually losing?

When someone tells me they’ve lost 30, 40 or 50 pounds on a GLP-1 medication, that can represent a tremendous improvement in health.

But I also want to know:

How much of that weight was fat—and how much was lean tissue?

Studies using body-composition measurements have found that approximately 25–40% of weight lost during GLP-1-based treatment may come from lean mass, depending on the medication, population and study.

That number gets my attention—but it needs context.

Lean mass and muscle are not exactly the same thing. Lean mass includes skeletal muscle, but also water, organs and other non-fat tissues. And losing some lean tissue occurs with substantial weight loss in general—it isn't unique to GLP-1 medications.

The question is: How much can we preserve?

Muscle isn't just about looking toned. It plays an important role in glucose disposal and insulin sensitivity, strength, balance, mobility, bone health and our ability to remain independent as we age.

That makes preserving muscle particularly important in midlife and older adults.

And here's where nutrition comes back into the picture.

GLP-1 medications can dramatically suppress appetite. When someone is eating substantially less, protein and overall nutrient intake can drop right along with it.

Combine rapid weight loss, inadequate protein and little or no resistance training, and preserving muscle becomes even more important.

The good news is that resistance training can substantially improve lean-mass preservation during weight loss.

So I'm not only asking:

How much weight are you losing?

I'm also asking:

Are you getting enough protein?
Are you resistance training?
Are you maintaining your strength?
What is happening to your body composition?

Because I don't just want you to become lighter.

I want you to lose the tissue we want to lose while protecting as much of the tissue we want to keep as possible.

Part 3 of my GLP-1s & Nutrition series.

Next: Why do some people experience nausea, reflux, constipation or diarrhea on GLP-1 medications—and what’s actually happening in the digestive tract?

09/24/2026

It’s Not Just How Many LDL Particles You Have. It’s What Can Happen to Them.

A few weeks ago, I started looking at what lies beyond the standard cholesterol panel.

In Part 1, we talked about why total cholesterol, LDL, HDL and triglycerides don't always give us the whole cardiovascular picture. In Part 2, we looked at why the amount of LDL cholesterol and the number of LDL particles aren't necessarily the same thing.

Now let's go one layer deeper:

What can actually happen to those LDL particles while they're circulating?

You may have heard of oxidized LDL (oxLDL).

“Oxidized” sounds complicated, but think about what happens when you cut an apple and leave it sitting on the counter. It gradually turns brown.

That's oxidation.

Oxidative stress can also modify LDL particles, changing how they behave in the body.

Why does that matter?

Oxidized LDL can irritate the lining of our blood vessels, trigger an immune response, and contribute to the process that eventually builds plaque.

So it's not only how much LDL cholesterol we have or how many LDL particles are circulating. What happens to those particles matters, too.

We can also look for clues about the environment those particles are traveling through.

One example is myeloperoxidase (MPO), a lab marker that can give us another window into oxidative and inflammatory activity involving the blood vessels.

This is why different cardiovascular markers can tell us different parts of the story:

How much cholesterol is being carried?
How many particles are carrying it?
Are those particles being oxidatively modified?
What's happening in the blood vessels themselves?

And sometimes those answers don't all move in the same direction.

In Part 4, I’ll show you a real example from my practice where different cardiovascular markers told very different stories—and why looking at the whole picture changed what we focused on next.

Beyond the Cholesterol Panel | Part 3

09/22/2026

I've been working with a client recently who came to me with an HbA1c of 5.8% and a note from his physician that read:

“Excellent labs overall — mild stable prediabetes.”

I kept coming back to that word: "stable."

An HbA1c of 5.8% may represent mild prediabetes by diagnostic criteria, but 5.8% is not a healthy blood sugar state. And “stable” doesn't tell me what's happening underneath that number.

So I looked deeper.

We measured fasting insulin and C-peptide. Both were higher than I'd ideally want to see in the fasting state.

Why run both?

Fasting insulin tells me how much insulin is circulating in the bloodstream. C-peptide gives me another window into how much insulin his pancreas is actually producing. When the pancreas makes insulin, it releases C-peptide along with it.

And in this case, both were telling a similar story:

His pancreas was working harder than it should have to in order to manage his blood sugar.

That's the piece HbA1c alone doesn't show us.

As insulin resistance develops, the pancreas compensates by producing more insulin. That can keep glucose relatively controlled for quite some time—even while metabolic dysfunction is progressing underneath.

So when I see “stable prediabetes,” my question is:

What's keeping it "stable?"

Because prediabetes doesn't suddenly begin when HbA1c reaches 5.7%.

The diagnosis has a starting point. The physiology doesn't.

Case details limited to protect client privacy.

Up next — Part 3: Why too much glucose becomes damaging.

09/21/2026

Why are some people losing their hair?

Hair loss is increasingly being reported by people using GLP-1 medications. But is the medication itself causing the hair loss?

Maybe not—or at least, that may not be the whole story.

One of the patterns researchers are seeing is telogen effluvium, a temporary type of diffuse hair shedding that can occur after the body experiences significant physiological stress.

And rapid weight loss can absolutely be one of those stressors.

Think about what can be happening when someone loses a significant amount of weight quickly:

They're eating substantially fewer calories. Sometimes very few calories.

Protein intake can drop. When the amount of food you're eating gets much smaller, it becomes harder to get enough protein unless you're intentional about it.

Micronutrient intake can drop too. Iron, zinc, vitamin D, B vitamins and other nutrients all play roles in normal hair growth—and deficiencies or inadequate intake can become more likely when overall food intake falls.

But there's another piece that I think is really important:

Rapid weight loss and significant energy restriction change the body's metabolic environment. Insulin, leptin, thyroid signaling and reproductive-hormone signaling can all adapt as body weight and energy availability change.

In other words, the body doesn't necessarily experience rapid weight loss simply as “Great! We're losing weight!”

It is also receiving signals that energy availability and stored energy are changing—sometimes very quickly.

And hair growth isn't essential for survival.

When the body is under physiological stress and resources are limited, maintaining hair growth may not be very high on its priority list. More follicles can shift out of the active growth phase and into a resting phase—and the noticeable shedding may not show up until a couple of months after the triggering event.

That's one reason someone may not immediately connect their hair loss with the rapid weight loss that came before it.

So when a client using a GLP-1 tells me, “My hair is falling out,” I don't automatically assume the medication is directly damaging their hair follicles.

I want to know:

How fast are they losing weight?
How much are they actually eating?
Are they getting enough protein?
What do their iron stores look like?
Are there other micronutrient concerns?
What does thyroid function look like?
Are there other potential causes of hair loss that need to be investigated?

GLP-1 medications can be incredibly useful tools. But losing weight successfully and keeping the body well nourished during that process are two different things.

The goal isn't simply to make the number on the scale go down.

It's to lose weight while protecting the health of the person who's losing it.

GLP-1s & Nutrition — Part 2

09/21/2026

I’m so excited to share that the massage therapist I work with has added a new service - intraoral, buccal massage. She tells me it’s going to make me look younger. 💃

09/15/2026

Her doctors were looking for Alzheimer’s. I was looking at her nutrition.

A 64-year-old client came to me very worried about new changes in her memory. She was forgetting events, struggling to retain new information, and knew her brain wasn’t working like it used to.

Her doctors appropriately investigated serious causes—including HIV, syphilis, and phosphorylated tau, a newer blood marker associated with Alzheimer’s disease. Those investigations were reassuring.

But her standard blood work was telling another story.

She had been using GLP-1 medications for the past year, which had dramatically reduced her appetite and how much she was eating. Her labs showed very low iron stores, profoundly low vitamin D, low-end vitamin B12, and changes in her red and white blood cells that made me suspicious that multiple nutrients needed attention.

She was also having a bowel movement only once every 7–10 days.

Sometimes I don’t need an exotic nutrient panel to know where to start looking. Standard blood work can contain nutritional clues when the markers are interpreted together.

We went to work making sure she was getting enough protein, vitamins, minerals, and overall nutrition from the smaller amount of food she was eating—and addressed the severe constipation.

Her energy improved.

And her brain started working better.

Her memory improved, and over time, so did some of her fear that she might be experiencing irreversible cognitive decline.

GLP-1 medications can be very beneficial when used appropriately, and many of my clients use them successfully. This isn’t an anti-GLP-1 message.

It’s a nutrition message:

Weight loss and nutritional health are not the same thing.

When appetite drops dramatically, nutrient intake can drop with it. If we’re helping someone eat substantially less, we also need to make sure the food they are eating is giving their body—and their brain—what it needs.

GLP-1s & Nutrition, Part 1.

Next: What can happen when appetite suppression leads to nutrient deficiency—and the rare but serious neurological complication researchers are now reporting.

09/13/2026

This store is right down the street from my office…I’m already using their Meyer Lemon infused olive oil - I obviously need to pick up the raspberry flavored oil, too.

🍓 Raspberry Brie Grilled Cheese using our raspberry flavored olive oil.

Makes 2 sandwiches

Ingredients

* 4 thick slices sourdough bread
* 5–6 oz Brie, sliced
* ½ cup fresh blackberries or raspberries
* 2 tablespoons Raspberry Infused Olive Oil, divided
* 1 tablespoon honey
* 1 teaspoon balsamic vinegar, preferably a traditional dark balsamic
* Small handful fresh spinach or arugula
* Pinch of salt
* Fresh cracked black pepper

Make the berry mixture

In a small bowl, lightly mash the berries with 2 tablespoon Raspberry Olive Oil, honey, balsamic vinegar, and a tiny pinch of salt. You want the berries broken up but still chunky.

Build the sandwiches

Layer Brie generously over two slices of sourdough. Spoon the berry mixture over the Brie, then add a small amount of spinach or arugula. Season with a little black pepper and top with the remaining bread.

Grill

Brush the outside of the bread with the remaining Raspberry Olive Oil instead of butter.

Cook in a skillet over medium-low heat for about 3–4 minutes per side, pressing gently, until the bread is golden and crisp and the Brie is completely melted.

Tree of Life twist

Sourdough + Brie + Blackberry + Raspberry Olive Oil + a touch of honey + Aged Dark Balsamic.

The raspberry olive oil gets used both inside the berry mixture and on the bread, so you can actually taste what the oil contributes rather than wondering where it went.

09/12/2026

She was 32 and trying to conceive.

She had been diagnosed with PCOS at 22. Her periods were irregular, she wasn't consistently ovulating, and her labs showed low progesterone—a finding we often see when ovulation isn't occurring normally.

She had already gone through two unsuccessful rounds of IUI.

When she came to see me, she told me she had a hunch that nutrition might be affecting more than her weight.

She was right.

She was overweight, but interestingly, she was also underfueling much of the time. She fasted frequently, went long periods without eating, and then often made food choices that weren't giving her body what it needed. Add a very high-stress job to the mix, and there were several things we could work on.

One thing I explained to her was that reproduction doesn't begin in the ovaries.

It begins in the brain.

The hypothalamus sends signals to the pituitary gland, which releases FSH and LH. Those hormones communicate with the ovaries and help regulate follicle development, ovulation, estrogen and, after ovulation, progesterone.

In PCOS, that communication can become disrupted. Insulin and androgen signaling can further influence the system, making normal follicle development and ovulation more difficult.

Nutrition can't simply “balance your hormones.”

But adequate nutrition, improved food quality, better insulin sensitivity, appropriate weight reduction, movement, sleep and stress management can change the metabolic and hormonal environment in which that entire system is operating.

That's what we worked on.

And this client was incredibly committed.

She stopped approaching food as something she needed to avoid and started learning how to actually fuel her body well. She improved the quality and consistency of what she ate. She worked on the lifestyle factors we could influence. Her weight came down.

And her reproductive health changed along with it.

About one year after we started working together, she delivered a baby girl.

Can I say nutrition caused that pregnancy?

Absolutely not. Fertility is far too complex for that.

But this case remains one of my favorite examples of something I tell clients all the time:

Food doesn't just provide calories. It provides signals and raw materials that influence systems throughout the body—including the systems involved in reproduction.

Sometimes the goal isn't to “fix a hormone.”

It's to improve the environment in which the body is trying to regulate those hormones in the first place.

09/06/2026

I’ve been thinking a lot about purpose lately.

Not necessarily the big, intimidating question of “What is my purpose in life?” I’m not sure I believe most of us have one single purpose anyway.

Maybe it’s quieter than that.

What makes you feel useful? Connected? Who needs you? What do you still want to experience? What makes your life feel meaningful—not to the whole world, but to your little corner of it?

There’s actually fascinating research around this.

People with a stronger sense of purpose tend to have less depression and anxiety, lower perceived stress, better sleep and healthier behaviors. Research has even found associations with inflammation, cardiovascular and cognitive health, and longevity.

Not because purpose cures disease. It doesn’t.

And certainly not because illness means someone has the wrong attitude.

I find it fascinating because we sometimes talk about the mind and body as though they live in separate rooms.

They don’t.

A thought can change your heart rate.
Fear can change your digestion.
Anticipation can keep you awake.
Grief can leave you physically exhausted.
Feeling safe can change the way you breathe.

And having something meaningful to get out of bed for can change the choices you make once you do.

That’s where mindset becomes much more interesting to me.

Not positive thinking. Not pretending everything is fine.

Mindset is how we make sense of what is happening to us—and what we believe is possible from here.

And purpose gives us a why.

Eating well feels different when it’s about having energy to live your life.

Movement feels different when it’s about staying strong enough to do what you love.

Taking care of yourself feels different when you recognize that your life is something worth taking care of.

I spend a lot of my professional life thinking about what makes a body healthier—nutrition, movement, sleep, metabolism, inflammation, blood sugar, digestion.

All of those things matter enormously.

But lately I keep coming back to a different question:

What are we trying to be healthy for?

Maybe one part of taking care of the body is giving the person living inside of it something meaningful to move toward.

09/03/2026

CONSTIPATION IS A SYMPTOM. THE QUESTION IS: WHY?

Constipation may be the GI complaint I hear about most often in practice.

Recently, I worked with a 32-year-old woman who was having only 1–2 bowel movements per week. She was also living with bloating, cramping, intestinal spasms and abdominal pain.

Once we looked more closely at what was contributing to the problem, we made a few targeted changes designed specifically to support her bowel function.

She is now having a comfortable, well-formed bowel movement every day.

But here's the important part:

Not everyone with constipation needs the same intervention.

When someone isn't having regular bowel movements, there are a lot of questions I want to ask.

Is there enough fluid and movement?

Is the person getting the right amount and types of fiber?

Is food moving too slowly somewhere along the GI tract—through the stomach, small intestine or colon?

Are the nerves and muscles of the GI tract communicating and contracting appropriately?

Is the pelvic floor relaxing and coordinating the way it should?

Could the anatomy itself be contributing—for example, an unusually long or tortuous colon?

Could connective-tissue differences be affecting the structure or function of the GI tract?

Could medications, thyroid function, metabolic factors or neurologic conditions be slowing things down?

Could changes in the gut microbiome be contributing?

And often, more than one of these things is happening at the same time.

That's why I don't think of constipation as simply a problem of “how do we make you go?”

The better question is:

Why aren't you going in the first place?

Sometimes the answer is relatively simple. Sometimes it takes more detective work.

But the goal isn't simply to find something that makes you p**p.

It's to understand what's interfering with normal bowel function—and address that.