Ketogenic therapy is a powerful tool for weight loss. But not everyone who cuts carbs is able to achieve their goal weight and metabolic health goals. Could GLP-1s offer the missing piece when low-carb and clean eating aren’t quite enough?
In this episode of the Metabolic Mind Podcast, Dr. Bret Scher sits down with Dr. Shannon Robinson, a board-certified psychiatrist and addiction medicine specialist, to explore this overlooked population who could benefit most from GLP-1s. Drawing from both her personal journey and clinical practice, Dr. Robinson highlights why lifestyle alone isn’t always enough, and how medications can sometimes be life-changing.
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Context & Participants
Discussion on GLP-1 medications (e.g., Wegovy/Ozempic [semaglutide], Zepbound/Tirzepatide) and how we may be “talking about GLP-1s all wrong.”
Guest: Dr. Robinson — board-certified in psychiatry and addiction medicine — sharing her personal and clinical perspective.
Personal Background
Long history of weight fluctuation; previously tried WeightWatchers, Jenny Craig, MetaFast.
On low-carb for ~11 years with strict avoidance of sugar and starch.
During a major life stressor (mother in hospice and passing), gained ~20 lbs, then another ~20 lbs despite unchanged intake.
Began a GLP-1; has been on it for ~1 year and 3 months at the time of the conversation.
Why GLP-1s (for some low-carb patients)
Even with consistent low-carb, some people need additional assistance to control appetite/cravings and “food chatter.”
GLP-1s can help adherence to dietary changes rather than replace them.
Addiction-Medicine Analogy
In opioid use disorder, psychotherapy alone leads to ~85% returning to use within a year; combining with medications (e.g., methadone, buprenorphine) dramatically improves outcomes.
By analogy, GLP-1s can be a medication “bridge” that enables behavior change (e.g., CBT skills, low-carb adherence) for those who need it.
Emphasis on avoiding stigma or shaming toward people who benefit from medication support.
Effects & Day-to-Day Experience
Marked appetite reduction, especially after dose increases.
Easier time entering and maintaining ketosis on GLP-1s; could lower protein somewhat and still achieve ketosis compared with pre-GLP-1.
Continues resistance training (lifting twice weekly). Notes some **
