Does YOUR Doctor Lift Weights? (Dr. Spencer Nadolsky) | Ep 256 - Wits & Weights | Fat Loss, Nutrition, & Strength Training for Lifters

Episode Transcript
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Philip Pape (00:01):
Do you feel surrounded by doctors who don't
understand your fitness goals orwho dismiss your lifting and
nutrition approach?
Imagine walking into your nextdoctor appointment and having an
intelligent conversation aboutprotein intake, lifting heavy
and body composition goals,instead of just being told to
eat less and exercise more.
Today, we're sitting down witha doctor who lifts weights and

(00:23):
wants to transform healthcare bycombining medicine with
real-world fitness experience.
You'll learn how to finddoctors who actually get it,
what to do when they don't and,most importantly, how to take
control of your health whileworking within the medical
system.
If you're frustrated with thetypical medical advice or simply
want to optimize your healthbeyond what typical healthcare
offers, this episode will giveyou the blueprint to bridge the

(00:45):
gap between your fitness goalsand your medical care.
Welcome to Wits and Weights,the podcast that blends evidence
and engineering to help youbuild smart, efficient systems
to achieve your dream physique.
I'm your host, philip Pape, andtoday I'm excited to have Dr
Spencer Nadalsky on the show toreveal why healthcare

(01:08):
desperately needs more doctorswho themselves practice a
fitness lifestyle.
Now, dr Spencer isn't yourtypical physician.
He's an obesity and lipidspecialist who's competed as a
heavyweight wrestler andfootball player before becoming
a doctor.
He's working hard to connecttraditional medicine with
accessible lifestyle changes andis a self-proclaimed meme

(01:29):
specialist who calls out thecharlatans on social media,
whether they're doctors or not.
He's also the co-host of theDocs who Lift podcast.
Today, you'll learn why evenwell-meaning doctors often don't
understand fitness andnutrition, how having physicians
who lift weights couldtransform healthcare, and what

(01:49):
it really takes to combineevidence-based medicine with
practical training and nutrition.
Plus, we might discuss somesimple, uncontroversial topics
like the root cause of obesityand the future of healthcare.
Dr Spencer, welcome to the show.

Dr. Spencer Nadolsky (01:58):
Thanks for having me, buddy.

All right, man.
So I've been following yourstuff for a while and I
definitely encourage folks tocheck you out, both on Instagram
and on threads.
Your feed is full of memesabout what people say about
doctors and what doctors say andthings like GLP-1 and all the
fun stuff Diet Coke, you name itand you've defended physicians
who have good intentions, sowe're definitely not here to
bash doctors, which you are.

(02:21):
So let's start with the crazystuff to set the stage.
I'm curious what's a ridiculousbut typical advice that you
hear doctors give, related to,say, exercise or lifting weights
?

Yeah, I mean, the most common thing that
I see is when patients arelifting weights themselves and
they go and they're kind ofproud about it and the doctor
will say, well, you shouldn't dothat, that's not good for you,
you need to go run instead.
And it's like will say, well,you shouldn't do that, that's
not good for you, you need to gorun instead.
And it's like you know to bereally patient centric, you
should applaud their efforts ofwhatever they're doing for

(02:52):
lifestyle change and the doctorshould know that lifting weights
is good for them.
Unfortunately, I'd say it'sactually probably some of the
older doctors that are probablyon their way out.
Kind of the newer line ofthinking is like, hey, probably
any physical activity at thispoint is good and lifting
weights is is a very healthfulthing to do, obviously, as you
know.
But it's it's so anti-patientand this is kind of what causes

(03:16):
some of that distrust in themedical profession is when they
kind of wag their finger and say, no, no, you should be doing
this, and especially when it'scompletely wrong.
So one of them is the wholelike no cardio is better than
weights and like, obviously Ipromote a combination of the two
.
But more importantly, what willthe patient actually do?

(03:39):
Go with that?
If, like if, a patient told melike I don't want to lift
weights at all, it's miserable,I just want to run and be
physically active, I'd say, okay, great, you know, maybe you
just haven't done some sort ofweight lifting or resistance
training that was at allenjoyable.
And then we go from there.
But sometimes they refuse and Iwouldn't be like you shouldn't

(03:59):
run, you should only liftweights.
So when people do that, theopposite, the other thing that I
see is, of course, really it'sa lot related to nutrition.
Some doctors have a plant-basedbias, some doctors have a keto
uh kind of bias, and so they'llkind of push patients in one way
or the other.

(04:19):
You know, I I had a more lowcarb bias.
Uh, a lot of my mentors werelooking back, they were low carb
zealots.
When I was going through medschool, I mean, like I was
hanging out with some of thefamous low carb doctors that I
now kind of make fun of.
It's really funny.
I was a student at the timejust learning, and now I'm like,
okay, but you know, but thengoing through and actually

(04:41):
taking care of patients, and I'dbe like, okay, going through
and actually taking care ofpatients and I'd be like, okay,
you gotta kind of go low carband be like, well, no, I
actually lost 100 pounds doingthis kind of high carb, uh, low
fat, plant based type of diet.
I'd be like, all right, am Igonna tell this patient that
that was stupid and wrong?
No, I'm not gonna tell themthat, but you'll see it all the
time online.
So patient will do, let's say,a carnivore diet.

(05:02):
They'll feel good aboutthemselves and they'll go in to
the doctor and tell them aboutit and the doctor will wag the
finger, hear this patient like Ilike making fun of keto and
carnivore and stuff like that.
But I'm not going to tell apatient that they're an idiot
for having just probably changedtheir life around from
following it.

(05:22):
I'm going to make sure thatsome of the blood markers are
okay because of it can altersome of those unfavorably, but
it can improve a lot of markersin their health very favorably
and it would be reallyanti-patient to kind of wag your
finger at them.
So kind of that dietary dogmathat some of these doctors bring

(05:42):
in.
It's just, it's really too bad.
And also I don't even know if Iblame the doctors as much as
they blame the system.
Basically, right now, whatwe're seeing and this is the
threads is kind of hilarious.
It's it's.
You see it on x as well too.
But there's different crowds, uh, at each of these places.
And if I say something like hey, seed oils probably aren't as

(06:03):
bad as what people are saying,like you can take them or leave
them, I don't really care, andwhat these people are, like you
just big pharma shill, likeyou're clearly getting paid by
the government to make a meme.
I'm like, if the government'spaying me to make memes on
threads and what I like, then wegot bigger problems because,
like they shouldn't be paying meanything to be posting any of

(06:25):
this stuff.
But there's a lot of this kindof anti-doctor sentiment where I
think a lot of it's just thesystem and I think hopefully in
the future we see this takenback by the doctors to kind of
overhaul the system.
It's a long ways away.
We can get into that a littlebit, but I think a lot of it's a
system.

Yeah, no, I mean everything you say I resonate so
hard with.
I'm in my forties and just inthe time I've been seeing
physicians and specialists overthe last 20 years and then when
I got into lifting like fiveyears ago, I seen that kind of
bifurcation between differentgenerations.
But but not only that cause,I've had doctors who are like in
their 60s, who are super opento learning and being, you know,

(07:04):
like you said, patient centric,which that's the root cause of
a lot of it.
People feel like they're beinggaslit and all of that and
whatever it is.
And then the idea thatadherence, sustainability, is
probably the most importantthing, because if you're just
not doing it, going to do it,forget it doesn't matter what
you're doing.
But there's a big anti-doctorsentiment.
What I like about what you callout is people, you know, fear

(07:24):
monger over silly things andstuff.
They forget the fundamentalswhether it's seed oils or diet
soda, whatever, yeah Right.
And it gets a lot of views andlikes.
So I know you you like takeadvantage of that, which is fine
you know, cause it gets themessage out.

It's a lot of hate.
A lot of hate too, although Iguess the hate can bring
engagement, which then bringsthe people that are that enjoy
it too.
The reason I say it is also isbecause it's it's like just a
sarcastic, like, very like thesepeople are idiots, but I'm
going to say this sarcastically,and so that makes the, it makes

(07:57):
other people laugh and then itpisses off the, the people that
want to piss off.
But those people get.
They get really mad.
I'm like this is just theinternet, like you guys are like
why are you so mad about this?

I know, and if they met you in person.
You know that I always think,like if you met another person
who posts something online inperson, would you respond that
way, because people hide behindthis insanity.

It's bizarre behavior.
I've not seen anything like it.

How does that make you feel like in terms of do you
get stressed out or do you losesleep over some of the
negativity?
I don't lose sleep.

There were .
There was a time, probably 10or so years ago, where once in a
while I could lose sleep overit, because it was kind of newer
back then and it would reallymake me mad.
My skin's gotten a lot thickerand so, like I'm used to it.
Some people it's just like,okay, this person's being very

(08:47):
aggressive, I have to block them.
Other people I'll restrict them.
Other like a lot of some peoplecome in and you can tell
they're coming in good faith,like, and they'll even say like
you know, I'm not trying totroll you, I really have this
genuine question.
I will engage in those peopleand the other people that come
in shooting like really hard,sometimes I will, I'll even and

(09:10):
some people think this is thewrong thing to do, but I'll
respond, quote, respond, so notrespond in the thread.
I will quote it and make a verysarcastic, passive-aggressive
comment and then that one willgo gangbusters viral.
Some people like you're engagingin the with the trolls, don't

(09:30):
feed them.
But I think sometimes fightingback and showing like hey,
you're not going to, like youcan't just try to bully me Like
I'm not, I'm not even bullyinganybody, I'm just making funny
comments.
And then people try to come inand harass and bully.
I'm like, all right, you wantto go, let's go.
You have like 30 followers anda private account.

(09:51):
But my favorite is looking likethere was one the other day
where someone's like you justshut up, you're such an idiot,
you're a shill, indoctrinateddoctor in their thing.
It's that their profile.
They had like 50 followers.
They sell vintage t-shirts.
So I said, well, this isinteresting, you sell vintage
t-shirts.
I'm a triple board certifiedphysician and I even said I

(10:13):
don't want to appeal toauthority, but I'm going to
address these concerns so thatit makes a sarcastic comment and
then I'm able to give aneducational lesson during it.
But some people are like that'sfeeding the trolls.
I'm like I don't know.
I don't know what the rightanswer is, but I I mean those
sometimes make the best topics.

honestly, like I know, if I do an episode and
it's coming out maybe for thisone called about carbs, like
even just with carbs in thetitle, I think this one's called
the number one reason to eatmore carbs and it's about how
it's anti-catabolic or whatever.
I know I'm going to get tons oftrolls from that just because
people are dead set in theirmindset.
So I like what you're doing.
So, getting back to thespecific topic, then I mean, how
did you get to this point?

(10:52):
If you look at your medicaltraining and practice, where
you're like either I've hadenough with this and I need to
start speaking out, or was therea moment in your training where
you thought either something'smissing or maybe things are
moving in the right direction,but people need to hear about it
when it comes to what we thinkof as traditional medical care.

Yeah.
So you go through four years ofmedical school, which honestly
I think is probably too long.
I think we could actually makeit three years.
That's a whole nother topic foranother day.
But I felt like my fourth yearof like you could do a lot of
electives and I'm, and like I'mready to go start seeing
patients and because that's theway you really learn fair um is
actually seeing patients, seeingwhat happens.

(11:33):
You learn all this stuff frommed school, in the classroom,
but then actually likepracticing is.
It's so much different ifpeople, you have all this
medical knowledge but you don'tactually know how to use it.
Anyway, that's another, totallyanother topic.
But you go through four yearsof medical school for the time
being and then you go to your,your specialty training.
I did family medicine, which isthe broadest of all the

(11:55):
medicine, and that's three years.
Some other specialties arethree years.
They go up to like eight yearsif you're doing like
neurosurgery, and then afterthat you can actually do
fellowships and then specializefurther and then some people are
in training forever.
But I remember my first year ofresidency, which is called your
internship year.
First of all, I knew right away.

(12:17):
I was like wow, the practice ofmedicine.
This where we bring people andthey take a half day off work to
come sit in a waiting room fullof the waiting room.
Full of not a weight room but awaiting room full of It'd be
nice if it was a weight room.
Yeah that would be nice.
If these people are sick they'recoming in for just their
physical or whatever, butthey're around other sick people

(12:38):
coughing and wheezing and thenyou get like 20 minutes with
them.
You don't get enough time toactually spend teaching
lifestyle to the patient.
I knew right away when Istarted seeing valves like this
is an archaic, inefficient, justridiculous way of practicing
medicine.
And one of the my firstquarterly evaluation from what

(13:00):
we call the attending doctorswas my advisor.
There are multiple advisors atthe residency.
The comment was that theythought I was a little bit of a
zealot in terms of lifestyle andI was like, huh, that's
interesting.
Like you know not to brag, butmy board scores show that I know

(13:21):
the pharmacology pretty wellhere and I know all the
pathophysiology.
I'm just trying to embracelifestyles because that that is
the right way to do it teachingpage like it.
In fact, when you look at allthe major chronic disease
guidelines, people like, oh,they're all big doctors want to
do and all these organizationsare in cahoots to sell more

(13:42):
drugs.
And when you look at all thenumber one recommendations
lifestyle it always is, doesn'tmatter if it's osteoarthritis,
doesn't matter if it's sleepapnea, doesn't matter.
Obviously cardiovasculardisease, hyperlipidemia,
hypertension, obesity, all thedifferent things related to
lifestyle.
The number one thing is likelifestyle changes and then it

(14:04):
goes into the pharmacotherapy.
But I was told that I was azealot.
My first quarterly evaluation.
I called my brother rightafterwards.
I was pretty upset and he waslike, well, you just do what you
think is is right and you'll befine.
By my third year, my last likeevaluation, they were like you
know what?
We were wrong.
Uh, you're actually a championfor what is the right way to do

(14:29):
this.
And in fact the they, a lot ofthose attendings, started
getting into lifestylethemselves because I just kept
promoting and promoting it.
It felt good, felt vindicated.
But um, it's a systemic andsystem issue.
So obviously, the people that gointo medicine, that matters,

(14:50):
because if someone goes intomedicine because they're
interested in surgery only theymight not be into helping people
with lifestyle.
So they just want to go in andmake a lot of money cut.
People drive a Porsche.
I don't know, that's not themajority of people, but there
are people like that.
But other people they just, youknow, they're smart and they
were like what should I do?

(15:11):
I should go be a doctor, Iguess, I don't know, that's
probably a bad reason, but youshould see a lot of people that
think that way and they're like,oh, this is kind of miserable
and not that fun.
So first of all it from the verybeginning of med school there
should be this emphasis of andnow people will say doctors need
to learn a lot more aboutnutrition.
I don't think doctors need tobe the ones knowing the ins and

(15:34):
outs all about nutrition and howto deliver it.
I think they need to understandthat nutrition and exercise
just have major impacts onpatients and should know
behavior change and understandways of improving the barriers
to what patients go through thatstop them, prevent them or
hinder them from doing thosebehavior changes.

(15:54):
Here's this pathology, it's XYZdisease and here's how to fix
it.
And just pepper in every bitthat they can about lifestyle.
It has to start early and ithas to be constant.

(16:14):
It's just like anything else.
And then from there, same thingthrough residency.
It has to be pushed.
There has to be ways Now.
But on another, system-widelevel, even if the doctor wants
to do it, we need to find waysto make it easier to implement
and this is where some of thenew admin maybe I don't know,
maybe they'll they'll make thisbetter, but there's there's been

(16:36):
some talks about reimbursing,uh, primary care doctors to
actually do this.
So right now, you're not reallyincentivized.
People are like all doctorswant it.
They're incentivized to pushdrugs.
Well, we don't get kickbacks.
People listening to this I seeit all the time and I actually
make a post about it every weekon threads.

Yeah, you talk about it a lot.

And every time the post gets like 500 to
1,000 likes, but there's alwayscomments like yes, you do you
hundred to a thousand likes, butthere's always comments like,
yes, you do, you make money fromprescribing drugs.

I go, we don't conferences and yeah, I'm like I
personally don't I actually uh,decline all the money.

I've been offered a lot.
I don't do it just because it'spublic.
I don't want people to thinkthat I'm um, being swayed by big
pharma, so I don't.
But like doctors in general,you know most doctors aren't
speaking for pharmaceuticalcompanies but there's this
thought that doctors are gettingkickbacks for prescribing meds
and that that's why they do it.
It's not that.

(17:32):
It's that the systemincentivizes just doing that and
not even talking aboutlifestyle, cause imagine you
have to keep the lights on andthe reimbursement keeps going
down, down, down.
You reimbursements higher fordoing a procedure, so like
having somebody into the cathlab where they stick the thing
up their legs, the catheter uptheir legs and then inserting a

(17:55):
stent what's called a stent,like a little spring thing to
open up their arteries.
They get a lot of money forthat.
Ideally we should have preventedthat in the first place.
But the primary care doctorsthey need to see a bunch of
patients per day to make endsmeet, in order to pay for the
bills, and that's part of that'salso big corporations, big
hospital systems owning anddoing it so like they force the

(18:18):
doctors to do it, whereas if thedoctors just owned it
themselves and had betterreimbursement, they wouldn't
have to see a million patientsper day.
So you're incentivized to justlike hey, I die in exercise,
fine, but here's this medicine.
The other thing is.
So let's say they try to do it,they try to do the lifestyle,
like me, and during residency.
A lot of patients unfortunatelydon't want to change, they just

(18:42):
want the pill, and that'ssomething we have to accept.
So what then happens is thatdoctors who do want to do it get
burnt out.
But imagine if there is anincentive to continue to push it
and it wouldn't burn thedoctors out Again.
This is like a large systemicchange that would need to happen
.
It's a big undertaking.

Which then raises the question what can we, as in
the listeners and people who areactively in control of their
own healthcare, do about some ofthis in the meantime, Because
you mentioned some reallyenlightening things for folks,
like one being that the systemincentivizes this or that we get
it, another being thatlifestyle itself has shown to be
probably the first and bestgo-to solution for many, many

(19:27):
things, and again, I've seenthat personally, I have some
little conditions here and there.
One of them is an esophagealcondition, eoe, and I remember
the doctor constantly sayinglook, there's an elimination
diet you can try and that'sprobably what you want to do.
When I saw that I had toeliminate 80% of what I liked, I
said no, give me the drug,right, I had to eliminate 80% of
what I liked.
I said, no, give me the, give methe drug, right, Like?
I mean, the patient will dothat, You're right.
But the other thing that comesto mind is what about?

(19:48):
I have a GP and I'm not goingto name him who he's just not in
good health, Like I could tellhe's not in good health, like
physically or otherwise.
What do we do about that interms of, I mean, we're not
going to make doctors themselveslift weights and everything and
everything, but is theresomething at the medical school
level that can change that?
Or what are your thoughts onthat, when a doctor itself
doesn't seem to be healthy?

Yeah, you know it's an interesting thing.
So like it's a logical fallacyto say this doctor is not
healthy, so they're not a gooddoctor.
Now, having said that, though,if the doctor is not healthy,
some of the studies show thatthey're not as likely to maybe
recommend the lifestyle changesthere's.

(20:30):
Also, potentially patients maynot respond as well if they were
.
Now there's some of that data'smix.
I've seen some kind ofcontradictory information there.
So like, let's say, thedoctor's struggling with their
weight themselves, but they'retrying and they try to help

(20:51):
their patient, the patient willrespond to that.
But if, let's say, they justkind of give this lackadaisical
and it's clear that they're notputting in a lot of effort, the
patient may not respond asfavorably to, and or the doctor
won't even give thatrecommendation.
So how to change that?
I mean, you know I I promotehow.

(21:12):
Obesity is a disease and we canget into that.
That's not a communicabledisease where you catch it,
although some people think thatis possible, but it's.
It's not one of those things.
It's physiopathophysiologicallevel.
It's just more it kind of fitsthat chronic disease model, kind
of like type 2 diabetes.
So a lot of people strugglewith it.
Doctors can struggle with it.

(21:33):
But I think if we try to again,starting in medical school,
really promote this idea of,like, healthy living and some of
these medical schools are, it'skind of this more forward
thinking way they're teachingthem how to cook, they're
teaching them which we allshould have cooking skills by
the time we're in med schoolit's after college, but some

(21:54):
people just don't know how to.
Some people have never toucheda weight before.
Some people have never donephysical activity.
So then I do think it'simportant to doctors should be
at least trying to practice whatthey preach.
I don't think they need to looklike bodybuilders or anything

(22:14):
like that, but they ideallywould be trying their best to
have their own lifestyle be good.
It doesn't mean that if theydon't have that, they don't have
the brain or the smarts and theright recommendations.
Like, for example, there wasjust a post the other day that
said if your doctor can't do acouple pull-ups, you need to
find another doctor.

(22:34):
And someone was like well, god,I don't care if my oncologist
or my whoever can do a couplepull-ups, I want to make sure, I
want to know that they're, thatthey're a good doctor.
So, like you know, that's alittle bit extreme, it's more so
.
This like, hopefully thatthey're trying to live their own
healthy lifestyle, and thenthey're.
But we're all kind of human,you know.

(22:56):
Yeah, trying to think of someunhealthy things that I do.
I sometimes, at night, I'llsnack on some like potato chips,
because it's like kettle ifthey're in the house.
If they're not in the house, Idon't need them.
Lime, actually lime, uh,tortilla, hint of lime, tortilla
chips.
It cannot be in the house.
I will, I'll put the kids down,I'll grab a handful with some
salsa and it's just, it's so.

(23:17):
It's the salty crunchy flavorthat's just great.

Yeah, yeah, so anyway I have some beds.

I I can't say that I'm perfect by any
means, but but, like you know,obviously I live a mostly
healthful lifestyle.
So, again, ideally, again.
But people are behavior, changeis tough and most I was just
looking at how many peoplefollow the current healthcare
guidelines so I posted this onthreads about how like people
are, like the government doesn'tpromote exercise, the

(23:46):
government doesn't care ifyou're healthy and I'm like.
Well, the cdc has theirrecommendations for physical
activity.
It talks about 150 minutesphysical activity and that's in
addition to two days a week ofstrength training.
Those are pretty like and it'svery few people actually get
that.
I mean it's.
I was looking it up.
It was around maybe a 25% ofpeople hit those numbers, but I

(24:09):
can't even imagine 25% of peopleactually hit those numbers,
cause like like that's two daysa week of strength.
How many people are actuallydoing that part?
Let alone the 150 minutes of,uh, moderate intensity aerobic
training.
I just I don't anyway.
So, um, but getting people todo it, it's tough, it's just
tough.

Yeah, it is tough.
I mean, I know sometimes youmake fun of nutrition coaches,
which I am, and that's cool,cause I get where you're coming
from, especially when they saythings like you know, doctors
don't get any nutrition trainingand stuff like that.
But a lot of us got into this,seeing the behavior change side
of it as being the obstacle fora lot of folks.
Right, and now you got methinking.

(24:47):
When it comes to GPs, andprimary care is potentially
being incentivized, I could seethat being its own specialty
almost, of preventive care, likeyou get in you have a GP and or
a behavior physician, I don'tknow what you'd call it, but
like that, that's an interestingconcept because you're right,
that would, that would and thatwould save healthcare a lot of
money.
That would save insurancecompanies a lot of money too.

(25:07):
I think it's not that theydon't get it right, but it's a
huge system with a lot offriction in it.
So I mean, what about thelifting part of it?
So you're a doc who liftsweights.
You talk about it with yourbrother on the show all the time
.
I guess the younger doctors aregetting more into it.
I know one of my surgeons.
I had back surgery.
He was definitely catering toathletes and you can see it in

(25:29):
his language and understandingof it.
He knew.
So one of the biggest things,Spencer, is when you get injured
or you have surgery or you'reolder, there's all these fears
about getting hurt and youshouldn't lift anymore or you
shouldn't get back to liftingRight and like.
First thing I wanted to doafter back surgery was get my
deadlift back up and then hit apr.
You know like and some people belike you're crazy, you can't do
that.

(25:49):
So, like, what are your thoughtson that?
Again, I don't know how we canchange the whole system, but
just for the listener who lifts?

this is where it has to start med school
and and then obviously, ifthey're doing, if they're a
surgeon, they went throughtraining the old guard and this
is going to sound ageist, it'slike I'm not woke or anything
like that, but of course I make.
I'm like people online are likeyou're a woke, elitist, liberal
, democrat, doctor and I'm likeman, if you knew me, I'm, you

(26:19):
know I'm not like that, but likeso I'll post and then I'll, you
know, get it from the, theright and I'll get it.
I'll get heat from the left.
So if I post something likeyou're an ageist, ableist, I'm
like no, no, I swear to God, I'mjust trying to be reasonable
here.
But there's an old guard andthey're going to retire at some

(26:42):
point here and that's going tobe a good thing.
Like you said, there's some ofthem have an open mind and some
of them are lifting weights andhave that forward way of
thinking and not stuck in theirold ways.
But there are a lot that justthey're going to need to retire
and I hate saying this, but someof them are kind of these old
dinosaur folks not sayingyounger folks are better.
It's just that we are able tohave gotten more of a bigger

(27:06):
array of of understanding of howexercise works, like.
So I tore my biceps.
I was doing juju.
I'm a wrestler, but I was doingjujitsu and someone put me in
an arm bar and I curled them upbecause I didn't know what the
heck it was.
I didn't know what was going on.
I was like what is it?
My arm feels stuck.
I curled them up, my my felt mybiceps just pop and I was like

(27:26):
what the hell is that?
Anyway, head surgery prettyquickly.
And my guy was I've read allthese things where they put your
arm in this like, basicallylike a cast type of thing, and
you can only use the range ofmotion.
Uh, they, they adjusted therange of motion every however
many weeks by like a centimeter.
They adjusted the range ofmotion every however many weeks
by like a centimeter.
All these different things.

(27:48):
My guy was into lifting.
He treated a lot of the seals,navy seals, and he was like no
man.
Like you know, don't be anidiot with it, but like you
should be aggressive here I'veseen very good things.
I went to the physical therapytwo times and I was already
progressed way past what they'dever seen, because and I wasn't

(28:13):
an idiot about it.
I wasn't like doing curls aftermy surgery but, like I was, I
was moving it a lot and, youknow, started to do very light
back rows and things like that,things that like normally they
wouldn't have allowed, andbecause of that it got strong
very quickly.
You know.
It again, it takes this.

(28:34):
People are a little tooconservative.
You know you don't want to betoo aggressive, but I see this
all the time where it's likewhatever, like a hernia surgery,
other types of surgery, like no, you should never lift again
more than five pounds.
I'm like what, what is that?

didn't even make any sense your body is five
pounds, right, yeah, you gottathink, yeah, you gotta think.

You gotta think, okay, biomechanically, I
think, anatomically, I think,like, from a pathophysiology
standpoint, like, why would thatmake sense?
And honestly, if you just thinkof it logically, you know, yeah
, sure, do we need studies tolook at what happens over time?
Yeah, sure we do.
But like, at the same time,it's like you just have some

(29:14):
common sense about that.
Why would, why would you not beable to do x?
You know lifting xyz, or youknow if, if it's a some sort,
hey, yeah, maybe you shouldn'tbe doing like the world's power
lifting competitions anymore,although, like you know, even at
that point some people aregoing to.
You know, that's their passion,it's what gives them purpose.

(29:36):
You know, you still want to bekind of that patient centric,
but again, I think that I thinkit would start in in training,
uh, especially for the surgeonswho are I've seen that so many
times and it's like, okay, let's, let's back up and think about
this from a very logicalstandpoint.
Let's use science to do it, notbe idiots about it.

(29:57):
And, yes, we should.
You know run trials, but theycan be expensive.
But I agree with you, it's it's.
We see that a lot.
Nope, no more XYZ exercise.
It's like huh, it doesn't makeany sense.

Yeah, I mean, I personally even though this is
anecdotal I've never heard ofdozens of hundreds of people
doing this.
That made it worse.
I mean, I'm sure somebody wenttoo aggressive, but it's
definitely the norm being theopposite, not doing it enough.
And then you get the scar tissueand limited mobility.
And then now, a year later,you're trying to do something
with this, you know tight tendonor scar tissue, whatever.
It's a lot harder to do.

(30:30):
It's funny I have a physicaltherapist.
He's remote, he's in New York,I'm in Connecticut, he's a
barbell trainer who's also aphysical therapist.
It's got like a combinedpractice, like man, if you're a
patient, and they kind of canhandle both sides, they can walk
both sides of it really nicelyfor you and be aggressive.

It's hard to find those types of folks,
but yeah, when you do it's likeoh God, yeah, yeah.

Yeah, that's what we need More, more, more guys
like that, more guys like youout there to do that.
So let's talk about the obesitystuff, cause there's definitely
a lot of mean material there,but it's also a very serious
thing.
So I've got some of the quotesfrom your recent posts, like
telling someone with obesity toeat less and move more, similar
to telling someone with anxietyjust to calm down.

Yeah.

Right, or calories matter, but appetite drives the
bus.
Let's just talk about like okay, what are the myths about
obesity?
People keep spreading, thatdoesn't help, and what are the
top couple things that we needto understand to be empathetic
and also to help ourselves andothers with obesity.
You know, move forward.

Yeah.
So whenever I talk about like,let's say, obesity is is the
disease?
Obesity is more than willpowerand discipline People will say,
no, you're taking out thepersonal responsibility.
It's just an energy balanceproblem.
They just need to eat fewercalories.
I'm like these aren't mutuallyexclusive.
Like energy balance problem,they just need to eat fewer

(31:48):
calories.
I'm like these aren't mutuallyexclusive.
Like energy balance absolutelyis the underlying factor here.
That doesn't.
The energy balance principlesdon't tell us what drives the
obesity, and that's kind of somestraw man type of arguments you
see out.
There is that like just becauseenergy balance doesn't tell us
the why things happen doesn'tmean it's still not true type of
thing.
It's.
Energy balance doesn't tell usthe why things happen doesn't
mean it's still not true type ofthing.

(32:08):
Energy balance is absolutelytrue.
What goes on with obesity?
And a lot of these patients mostof these patients have tried to
eat fewer calories in some sortof form of fashion whether it's
counting calories, a ketogenicdiet, vegan,
plant-basediterranean, paleo,grapefruit diets unfortunately

(32:29):
lots of the different fads andthat type of thing and what
happens is that over time, asthey try to do this, their brain
kind of fights back and, in aform of like appetite
dysregulation, it increases.
They've done thismathematically.
There's a really brilliantresearcher out there named Kevin
Hall who has shown thismathematically and kind of

(32:52):
looked at appetite changes andhow, when people lose weight,
their appetite gets ramped up,up and up and up the more and
more you lose weight.
Now I'd say this is moreindividual, because you do see
some people like who've lost 100or 200 pounds and have kept it
off for, you know, a few yearseven sometimes, and they're

(33:12):
doing okay.

Oh so, like you know, it's not it's not, like,
guaranteed that you're going tohave this strong, what I'd call
biologically, uh appetite drivewhich hold on that spencer,
because that's important forpeople to know that right there
there are massive differencesbetween people and so many
people will put their ownperspective on others in that

(33:35):
department and I've seen it withclients too, where they have
zero appetite at any level ofdieting, and others that like
just start a calorie deficit andit's like holy crap, what are
we gonna do about this?

yeah, yeah , individual difference.
And this is where becauseyou'll see online in fact you
know a lot of the people thathave the strongest like obesity
bias are those who used tostruggle with obesity themselves
and have overcome it withlifestyle.
Only They'll say, basically,since I did it, everybody can do
it.
And if you can't do it, itmeans you're not trying hard

(34:06):
enough, you're just lackdiscipline.
And I think you know, if we putourselves in other people's
shoes, it's hard to putourselves in their shoes.
I'm like you know, I think someof some of us listening when
you're in elementary school youcould probably do things better
or worse than other kids in yourclass.
And it's like none of thosekids in your class were working

(34:28):
hard at whatever they're good at.
It's just they were naturallybetter at something, whether
it's math or running or whatever.
You can obviously improve withpractice.
We're not set, you know,genetically determined exactly,
but there's genetic differencesthat in upbringing that change
our trajectory.

(34:48):
So you can imagine genetic andbiological differences of why.
I mean, we see it as it's,about 15 or so percent of people
will lose a substantial amountof weight and keep it off over
the course of a year with justlifestyle alone.
And when I say that it's around15 or so percent total body
weight loss or more, you can getup to, you know, maybe 20%, but
around 15%.

(35:09):
So let's say you're 200 pounds,10% would be 20 pounds, 15%
would be 30 pounds, you get downto 170.
So around 15% of people.
And so when you look atlifestyle changes, about 15% of
people will lose about 15% oftheir weight.
More people lose around 5% oftheir weight.
More people lose around fivepercent of their weight, which
is considered clinicallysignificant.

(35:30):
But, like when we're looking atthese newer drugs like
semaglutide, which is theozempic Wegovi or manjaro Zepbon
, which is terzapatide, thosedrugs get around 15 percent
average body weight loss.
We're talking about semaglutide, 20 percent for teriseptide or
even a little bit more.
And when you look at how manypeople achieve those results,

(35:53):
you're starting to get into likehalf or three-fourths of those
people are starting to lose anaverage of 15 or more percent
total body weight loss Whereas,like, only 15%, a very minority
of people lose that amount ofweight with lifestyle alone.
So what's different about thosepeople that are able to do it
biologically?

(36:13):
They probably don't have thatstrong, as as much of a strong
driver.
Maybe they found some otherways to cope with that, uh,
appetite change, but I thinkit's important for people to
know those biological yeah uhdifferences.
I don't even know what startedthis conversation.

No, no, no, that's perfect because because
ultimately I'm going to tie thisback to kind of the behavior
change and the medical industryand all that but I definitely
want people to understand andalso not feel totally defeated
when they find that theirexperience is different,
especially I mean, we had drStephan Guine.
You know he talks about, yeah,the brain and you mentioned it
as well.
A recent study came out tooabout again confirming, like

(36:52):
epigenetics and the importanceof during your lifetime, even
when you've dieted many times.
That seems tends to exacerbatethat for a variety of reasons,
which is amazing to think aboutthat.
When you mentioned, like thedrugs versus not the drugs, we
try to have a nuanced discussionabout that.
Even though people get lividabout the GLP-1s and all that,

(37:14):
there's a gradient.
There's people who desperatelyneed it because nothing else has
worked and they have a lot ofweight to lose for their health.
There's people who maybe havebeen using it and then were able
to sort of clean up theirlifestyle because now this
massive signal is not there andthen they can gradually titrate
off of it.
And then there's maybe folksthat don't need it and fine,
there's a fair criticism thereand the behavior change piece of

(37:35):
it like you talk about dietsoda.
Let's go there.
You talk about how, like youhad a patient who swapped all
her regular soda for diet soda,lost a bunch of fat and then her
type 2 diabetes went intoremission, right.

Yeah.

Like.
I think that's a great exampleof an accessible change that is
not too far right.
And then now was that patienton these drugs?
No, right?

No, no yeah.

So you know, tying that back to the system, the
broken system.
What do you want listeners tocome out of this thinking?
If they feel like they're notable to lose the fat, not able
to lose the weight, theirappetite's always super strong
and maybe they aren't willing togo on the drugs.
Whatever, what's step one?

Yeah, you bring up some good points.
What's step one?
Okay, so I would say normalize,or understand that you're not a
failure if you're unable to doa lifestyle.
I think that's people will saythey failed lifestyle and it's
it's a somewhat of stigmatizing.

(38:37):
I've used it in the past becausewe, you know, you like for you,
for example, for youresophagitis, eosinophilic
esophagitis let's say you, youtook a certain, you did the
elimination diet.
Uh, what they would write inthe note patient failed
conservative therapy.
Moving on to the steroid orwhatever they're using.
So with diet and exercise, whentrying to lose weight, we'd say

(38:58):
patient, uh, failed diet andexercise.
And now we've, we've changed itbecause the patient didn't
necessarily fail, they didn't,just didn't respond.
So now we say we've changed itbecause the patient didn't
necessarily fail, they didn't,just didn't respond.
So now we say they didn'trespond to it.
So some people don't respond it.
And people will say, well,they're not working hard enough,
they're not whatever.
Instead of shifting the blameto the patient because that's

(39:19):
what we do, we're like theyclearly not doing it why don't
we shift it towards hey, hey,maybe it's.
This biological drive is justtoo hard to overcome.
And that doesn't mean take awayall person.
People are like you.
Just want to take away personalresponsibility and sell drugs.
I'm like I swear.
I swear I'm not.
I'm just thinking of thisdifferently here.

(39:39):
Shift it to more ofunderstanding this biology.
So for people out there there,don't think of yourself as a
failure if you're unable to do alifestyle.
You try, try your hardest, tryyour best.
There are, you know, people dorespond.
Don't not think you can, don'tthink you cannot try, you, try,
uh.

(40:00):
And then if you aren'tresponding to it and you do need
to lose weight for clinicalreasons, you have type two
diabetes, sleep apnea, thosetypes of things, and it's like I
really need to lose 20% of myweight or 15 or so percent of my
weight.
There are medicines out thereNow the big thing right now is
that they're not covered veryreadily, like 40% of commercial

(40:21):
insurances that pay for it, thatsome of those places are
dropping it because it's soexpensive.
I think we're going to see alot different in 10 years
because the drug costs are goingto come lower.
More competition is going todrive these drugs lower and
lower in terms of cost.
So, um, but I would just knowthat.
Just hold out hope that thereare therapies out there.

(40:42):
Now you don't again.
You don't have to take thesemedicines uh, no one's forcing
you to.
But that's what I would tellpeople.
Step one, just like don't thinkof yourself as a failure.
Do know that it is possible forsome people to use lifestyle
only.
Do know that there are othertherapies out there.
If you don't respond to that,that's what I would say.

(41:03):
If you don't respond to that.

Heather (41:04):
That's what I would say .
Hello, my name is Heather and Iam a client of Philip Pace.
Just six days after I startedthis cut, my family and I were
in a 7.9 magnitude earthquakehere in Adana, turkey.
As I tried to process thestress and trauma, my first
instinct was to say, oh, you'vebeen through something hard,
this is not a good time.
But instead I reached out to mycoach and he got me under the

(41:27):
bar that day and he helped mekeep my macros that day.
And not only did I realize thatI was doing something fantastic
for my body, but I realized thatI was doing something fantastic
for my mind and that it wasgoing to help me keep the mental
clarity that I was going toneed to get my family through
what really has been a verydifficult two months.
Here I am on the other side ofeight weeks, got my kids through

(41:48):
all the things that we havebeen through, and I weigh 12
pounds less than I did, and Igot a new PR on my bench press.
I have a long way to go andthere are still things that I
really want to accomplish, butnow I know that I can and I'm
really grateful.
Thank you, philip.

And when we talk about lifestyle, what?
What is the?
So I'll tell you my opinion onon lifestyle, just just from
again, anecdotally, it seemsthat being more active and
strength training tends to be acatalyst for a lot of people, if
they can get into it for otherthings, even nutrition, like if
I have someone say, should I donutrition?
Like if it's, if it's a thoughtexperiment, fix my nutrition or

(42:25):
fix my exercise and start.
I'm like, just start liftingweights because you're going to
find the nutrition follows it,you're going to want to feel
your body.
That's just my opinion.
How many folks do you think whoare being, say, encouraged to
take these drugs, are seriouslytrying or being given the
information for lifting andtraining?
You know, building muscle,building straight, that, that

(42:46):
piece of it, cause I thinkthat's, I think that's missing
in a lot of this.

Yeah, so the let's see.
So there's two parts to thishow many people are being given
the information and then howmany people are actually
following through if they'regiven that information.
So if I had to guess, I wouldsay the minority of people are
being given that information.
Just based off of my, I don'teven know how this would be
studied.

(43:14):
That you'd have to look at.
You'd have to go back and lookat large EMR databases and then
look at the note of what theysaid.
But even still, even if theyput it in their note, did they
actually tell them how to do it?
Hard to study it.
But okay, let's let me give mymy guess.
Though, if I had to guess, 10are being told to do it, maybe
20 at the most.

(43:35):
I I just can't imagine.
I can't imagine it's more thanthat, because you go to it's
it's.

We've already talked about the beginning we
talked about it, doctors, justdon't all get it.

Yeah, so they might say, like you know,
make sure you're, I don't know,make sure you're exercising.
That might be the the extent ofit, specifically weight
training.
Oh, the, it's got to be small,it's got to be small.
And then, and then like, arethey giving recommendations
beyond, just hey, you should goweight train.
I, there's just no way.
There's just no way.
So it's got to be the minoritypeople.

(44:07):
Now let's say that they're abig proponent.
Let's say they come to me.
I have a program I mean I have Icall it lift rx and I I'm like
pushing it hard and I, you know,of course I don't force people
to do it.
I can't force people to do it,but even still, that percentage
of actually people when I'm itit's.
If I had to guess again, thiswill be.

(44:29):
I have a study that I'll bestarting here soon, looking at
body composition, because that'swhat everybody wants to see is
like, okay, what's going on here?
We're going to look at strengthand body compositions after
they start these medicines, andthe reason it's going to be cool
is because I will be pushing,lifting hard.
So then, what we're going to doit's not a trial where we do

(44:50):
one group gets a placebo, theother one.
It's an observational thing.
So if in my clinic I'm pushingit hard, regardless, it'll be
interesting to see thepercentage of people that
actually do it and we'll makesure we follow them along.
Again, we'll see who doesn't doit versus who does it.
But everybody will get veryaggressive, like counseling, to
do it and we'll we'll make surewe follow them along.
It's again, if we'll see whodoesn't do it versus who does it
, but everybody will get veryaggressive, like counseling, to

(45:11):
do it.
So if I had to guess, I wouldsay 30 to 40, 30 probably
actually follow through andstart doing it.
But I don't know.
You know we'll see.
We'll see when I publish.
Yeah, so like that's small,that's that's not.

Yeah, not enough people are doing it yeah, yeah,
no, I bring it up cause it's,it's always on my mind.
I wish more people would, andthat's I know, all of our
mission to do that, andspecifically with the, the
weight loss drugs.
You know, you hear I'll call itmisinformation due to a lack of
understanding.
Like, oh, you lose weight soquickly and you lose all this
muscle mass when you look at it,it's, it's probably because

(45:44):
your rate of loss tends to befaster on these.
Yeah, thus you're hitting intothat severe calorie deficit that
causes muscle loss.
It just like if you did itnaturally at that rate, and
that's why I bring it up.
But anyway, yeah, yeah.
So that's why I want people toknow about it and know that
there's a lot of nuance there.
Do you have time for like threereal quick?
rapid fire social mediaquestions.

(46:06):
Okay, I rarely do this, but Ithink it'd be fun.
So the first one is what's themost controversial fitness
influencer?

that's getting it right, at least one
that you can think of, so acontroversial influencer that's
getting it right?
Besides you, besides you Idon't know if they're well, if
they're getting it right.
I don't know if they'recontroversial, but I, I would
say I, I really like um uh, bencarpenter.
He's my buddy, but he, he's,he's just on point, every single

(46:35):
video that he does like he'sjust on point.

I like him okay yeah, I mean controversy could
be like you're controversial insome ways.
Youknow what I mean yeah, yeah, you
cause.
You cause a lot of uh discussion.
Yeah, yeah, that's true.
Um, all right.
The second one is name the onefood labeled as unhealthy all
the time by influencers, but itactually can be quite helpful oh

(46:59):
yeah, I mean there's so manyright the one the one that I'm
seeing right now.

It's seed oils in general.
And I say that there's a lot ofnuance there.
But, like, when people say thatthey give a blanket, that seed
oils are bad for you, it's likewhoa, whoa, whoa, whoa, whoa.
What do you mean by that?
Well, they cause inflammation.
Well, no, the trials show theyactually don't.

(47:24):
So, like, what are you comingup with?
So that's probably the one, andI'm not going to sit here and
say they're amazing for you andthey're going to help you do X,
y, z, but you know, you gotta,you always gotta, compare it to
something else.
So, um, you know, seed oils Idon't, I think it's to me, just
for anybody listening I thinkit's the foods that come
packaged with seed oils are theculprit.

(47:45):
They're easily overeaten, hyperpalatable, ultra processed,
increasing excess calories,causing adiposity, excess fat
deposition.
That's the issue.
I'd say the seed oils are.
What a red herring is is theterm.
Yeah, it's like we're, you'refocused on this, you're, you're

(48:05):
hyper focused on one little's,it's, it's everything else that
comes in.
Anyway, that's what I would say.

No, that's good, I could have guessed that.
I could have guessed that, um,yeah, cause one of my friends,
his name is Dustin Lambert.
He's a nutrition coach thatloves to look at the research
and, um, we, you know, or likeyou said, they're found in
processed foods.
Same thing with red meat andothers, where you have to take
away the confounders and thecorrelations going on, exactly.

(48:32):
Um, all right, Last rapid fire.
What's more dangerous?
Uh, steroid using nattyinfluencers or doctors pushing
fad diets?

That's great, uh, okay.
So the doctors pushing faddiets or natty uh steroid users,
and what are they promoting?

steroid using natty influencers.
Yeah, this is this kind of asilly one, to be honest um, yeah
, I, you know it.

It yeah so silly.
So I'm just I'm thinking ofexamples, because there are I
don't even I don't, you knowsome of these people.
You don't, I don't know ifthey're using steroids and they
claim they're natty, but some ofthem might be giving out good
information despite not beingnatty, whereas some of these
doctors are are extremelydangerous.

Dangerous Okay.

So I'm going to go.
What was?
What was better or worse?
I'm going to say the doctorsI'm going to say that the doctor
doing the fad diets that's whatI would say they're the
dangerous ones.

Cool, cool, cool.
All right, All right.
Last question this is not arapid fire.
It's just what I ask all guests.
Is there a question that youwish I'd asked and, if so,
what's your answer?

No, this has been a great discussion.
I just, you know, I think if weall step back, you know, we, we
want everybody to be healthier.
We want people to lift weights.
We want people to eat healthier.
There are different ways toskin a cat on and to get there.
Uh, I think doctors are, overall, good and want patients to be

(50:02):
healthy.
You know, we talked about notenough doctors lift and I think
that they're wrong, but I stillthink that they have your best
interest.
So, uh, I don't want peoplecoming around.
Oh, this guy is trash anddoctor.
I, I like doctor.
Doctors are good in general.
There's some bad apples, thethe fad diet doctors, as

(50:23):
mentioned, and some of them,some of these people, I, I swear
they're just doing it for fameand and clout on the internet.
It's really, really weird andtoo bad.
Um, but for the most part, mostdoctors out there, just they
want people to be good, uh, so Iwouldn't fault them for not
promoting lifting weights, um,but I would hope that the new
crowd, the new wave, the newgeneration of doctors,

(50:47):
understands it.
I think so.
I think we're seeing that andpart of that social media.

So, yeah, there you go.
Yeah, I'm seeing it too.
That's good.
It's a positive message, and ifyou're listening and you're,
you know, taking control of yourown health, maybe you're going
to inspire doctors to do that.
And I've heard stories of that,where the doctors themselves
get more educated by patientswho are very much into this
stuff, from includingchiropractors and non-doctors as
well Just like, oh, what areyou doing A lot more yoga?
No, I'm actually liftingweights.
Ah, interesting.

(51:11):
Yeah, that's cool.
Good stuff, good stuff.
All right, where do you wantfolks to find you, dr Spencer?

I mean, uh , instagram and threads.
I I hate saying X cause, like Idon't know, I don't even.
I call it Twitter still, butInstagram at Dr, dr Nadolsky, dr
N-A-D-O-L-S-K-Y, you can.
You can listen to Docs who Liftpodcast.
I have a podcast with mybrother who's an endocrinologist
, who's lifts a lot of weightsas well.

Yeah, that's all right, All right man, I'll throw
those in the show notes.
I really appreciate you doingthis.
For me and the listener it wasfun thanks for having me on.

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Does YOUR Doctor Lift Weights? (Dr. Spencer Nadolsky) | Ep 256

Episode Transcript

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Does YOUR Doctor Lift Weights? (Dr. Spencer Nadolsky) | Ep 256