June 27, 2025 • 62 mins
Whatsup!! This week we are excited to sit down with Dr. Spencer Nadolsky; a board-certified obesity specialist, family physician, and meme legend known also as The Doctor Who Lifts to cut through the crap with us and get real about what actually drives fat loss.We talk about:
- Why "eat less, move more" is technically true but much more complex than that
- The truth about cortisol, hormones, and weight gain (spoiler: it’s not what wellness grifters say)
- How GLP-1 medications like Ozempic and Wegovy actually work
- Why most traditional doctors are unequipped to support long-term weight loss
- The broken healthcare model — and how direct care is changing the game
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're up at night doom, scrolling on whatever your
choice of social media, looking at politics and arguing with people,
and then you you're upset and then you don't sleep well.
The influencer person is going to try to sell you ashwaganda,
rodeola and phosphatil seering or some cortisol blocking thing. But
(00:21):
really the underlying issue is that you're not sleeping well.
And sure those things will disturb your your diurnal curves
of your cortisol and whatever, but that wasn't It wasn't
the cortisol. That was the issue is the sleep and
changes in lifestyle. Those are not sexy. People do not
want to hear that. They want to hear that it
was it's a supplement thing, but you don't have a
(00:44):
supplement deficient.
Speaker 2 (00:45):
You don't have a rodeola deficiency. The rodeola.
Speaker 1 (00:48):
Maybe maybe that will help calm you down to where
you're like, oh, I don't even want to go on
social media. Maybe that's the case, you know, and stuff
like that, but it wasn't the underlying issue. So yes,
make sure that you're eating enough, nourishing your body. The
standard so boring stuff that people just I know.
Speaker 3 (01:09):
Welcome to Cut the Crap with Beth and Matt, the
world's number one no bullshit health and fitness podcast.
Speaker 4 (01:14):
Are you ready to cut the crap with your diet
and exercise, get strong as fuck, and build a healthy
relationship with food.
Speaker 5 (01:19):
Then you've come to the right place.
Speaker 3 (01:21):
Let's go. If you'd like to support us in the podcast,
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(01:43):
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Speaker 4 (01:50):
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Speaker 5 (01:57):
So what the fuck are you waiting for?
Speaker 4 (01:59):
I'll see you in the page.
Speaker 6 (02:02):
How are you? Doctor? Spencer to Dulski, what's up?
Speaker 1 (02:06):
What is up?
Speaker 3 (02:07):
You have been our bucket List guest for I don't
know a few years now. Actually I think Matt reached
out to you. I don't know. I think a few
times we have, but you're hard to get in touch with.
And so when you followed me and then you messaged me,
I'm like and you're like, let's talk, Yes, let's check.
Speaker 6 (02:26):
So I'm so glad you're here.
Speaker 1 (02:28):
It's probably one of those things where I got the
d M and then I said to email me and
then you. Then I didn't do anything, and then you
probably who knows.
Speaker 3 (02:37):
I know, I get like so many different folders in Instagram,
Like there's like the private section, and there's there's you
know what I mean.
Speaker 6 (02:44):
So who knows? Who knows?
Speaker 2 (02:47):
But we're here.
Speaker 4 (02:48):
We're excited to cut the crap with you today. Yes, yes,
we'll do a little intro here. You're ready to ready
to just get.
Speaker 2 (02:57):
Right to it. Yeah, awesome, awesome.
Speaker 4 (03:00):
So today, guys, we are joined by doctor Spencer Nadalski,
a board certified ob City specialist family physician, and it's
also known across the innerwebs as the doctor who Lifts.
If you've ever been confused by the online dumpster fire
that is weight loss advice, doctor Nadelski.
Speaker 5 (03:15):
Is here to cut through the crap.
Speaker 2 (03:16):
With us.
Speaker 5 (03:17):
Perfect, you very much for coming. We appreciate your time.
Thanks for having me absolutely.
Speaker 6 (03:22):
Yeah.
Speaker 4 (03:23):
So Beth and I were talking and we've been following
you for quite some time, and it goes back to
like the meme days, right, Yeah, that's how probably a
lot of people found you early on in the days,
the memes that were just straight to the point and
cutting through all the bullshit out there.
Speaker 1 (03:37):
Yeah, nobody likes memes anymore. Yeah, I know everybody wants reels,
and I'm like, I'm tired.
Speaker 6 (03:42):
I know, I love the memes, like are a good
break from the fucking bullshit.
Speaker 2 (03:47):
I know, you know such it.
Speaker 1 (03:49):
It's different now, and I you know, funny thing is
my I've noticed just a huge like the algorithm. People like, oh,
the algorithm's at work. I'm like, no, it's just adapting.
So they want you to do reels. I'm like, I'm
just tired. I'm like, come on, yeah, these whatever long You've.
Speaker 5 (04:04):
Been online making content for a long time.
Speaker 1 (04:08):
I started doing it in residency. So twenty eleven twelve
is just giving out just stupid simple. Oh I saw
page like residencies where you go after med school, where
you actually take what you learned in med school. Like
med students don't really know anything. They know, I have
a lot of information, but you don't know what you're
doing right, And so that's where you start seeing patients
and having your own patients. But you're not board certified
(04:30):
yet you're licensed. And that's where I started basically going, hey,
I did this with the patient. It was Facebook really
and people, you know, it was just kind of resonated. Nothing,
nothing groundbreaking, didn't go viral because I made up something
about wheat wheat belly.
Speaker 6 (04:47):
You know the guy I mean, I think I had
that book.
Speaker 2 (04:50):
Yeah.
Speaker 1 (04:51):
So many those were like the fads back then, and
I'd always get to be like, I'm not jumping on this,
you know, think about like people like Paul Saladino who
had just a couple thousand followers just a few years
ago and was like and he just you know, people
like that, you can go there are ways, there's a
playbook to go viral and you can be huge. I
refuse to take those you just lose all integrity. So
(05:16):
I appreciate what you guys do and do like legitimate stuff.
Speaker 5 (05:20):
Thank you appreciate that.
Speaker 2 (05:22):
Yeah.
Speaker 3 (05:22):
Likewise, so you are an obesity specialist, yeah, and so
I guess break that down, what does that look like
in your practice?
Speaker 6 (05:31):
What exactly do you do as an obesity specialist.
Speaker 1 (05:35):
Yeah, so it's a newer specialty. The board specially came
out in twenty fourteen, so right when I graduated residency.
The idea is, we had beriatric surgery, you know, and
you can go and do special certifications in that and
get trained and do beriatric surgery. But there was nothing
for like the medical weight loss. You hit a lot
(05:56):
of huckster's and Charlatan's pushing their hCG diets and all
sorts of be twelve shots and stuff that just didn't work,
and making up stuff about hormones and whatever. But there
was no standardized board certification. And then this American bord
of Obesit Medicine came out to try to standardize it.
But a lot of hucksters take the certification and then
(06:18):
use it as a way to promote them. It's just
like you can't even.
Speaker 5 (06:21):
Stop that appeal to authority for some people.
Speaker 2 (06:23):
Huh.
Speaker 1 (06:24):
But the idea is to somewhat at least give some standardization.
But I've seen some really bad players. I'm just like,
come on, don't just give this. It's hard to stop them.
If you take the tests and do all the stuff.
It's like, well whatever, they know what to put on
the tests apparently. But the idea is basically a medical
disease management of weight and obesity as opposed to the
(06:47):
hCG whatever magic beings that people are promoting from their
clinic or whatever like that. So it's to me, it's
more of like a cardio metabolic type of deal supposed
to just like being weight centric. Yes, obesities excess, adiposse,
excess at a post tissue, and we want to eat
people finding ways to eat help them eat fewer calories.
(07:10):
But it's coming at it from an angle of the
medical biological angle, And truly it's the ideal situation is
you have a multidisciplinary What I do is very multidisciplinary.
I work with dietitians, strength coaches. I want to add
in psychologists as well, and then I come in with
(07:31):
the medicines to basically help them biologically when they do
it from a behavior standpoint, that's the gist, but I
like to go beyond and look at their cholesterol and
make sure that everything else is metabolically optimized as opposed
to just like here, lose the weight, see you later, goodbye.
Speaker 2 (07:49):
Yeah, that type of thing.
Speaker 3 (07:51):
So you currently kind of have like the optimal situation
in which a client will come to you and then
you have psychology, you have the strength training, you have
the nutrition, and then you have the weight loss drugs
to help aid in that whole process.
Speaker 2 (08:03):
Yeah. Yeah, that's that's exactly right. I love that.
Speaker 3 (08:07):
Because you know, if someone's going to just a regular doctor,
they're going to be like, well, do you eat twelve
hundred calories?
Speaker 6 (08:13):
Go keto or whatever?
Speaker 3 (08:14):
You know they do, right, And it really is a
multifaceted situation in which people need all these things right,
it's it's mindset, it's behavior, it's you got to get
into the gym.
Speaker 6 (08:24):
So the fact that you have all that is actually
quite amazing.
Speaker 2 (08:28):
Yeah, it's the ideal situation.
Speaker 1 (08:29):
Now the issue, yeah, I had to leave the current system,
so you can't do it in a current like if
you go to your regular primary care doctor, you're going
to get five ten minutes yep, if they have a
dietitian around, but they're not going to refer to a dietitian.
They probably don't even know a dietitian to refer to,
and your insurance might not even pay for it. So
I did something called it's called direct care. It's kind
(08:50):
of a newer movement. It's not concierge care, although we
give what I would call like more concierge like service,
but it's it's kind of like a it's a subscription
and type of things. So it's okay, one hundred and
fifty dollars a month, which people like, oh, that's expensive,
but it's like it's actually less than what you would pay. Well,
you go to the doctor, you pay your co pay,
(09:11):
but they're going to bill your insurance like a couple
hundred dollars for that visit. So what we do is
we bypass the insurance and then it's just this direct relationship.
And the numbers actually work out because so I can
you know, people can text me and whatever, and they
can ask me questions, my dietician can jump in strength
(09:32):
training programs, all these different things. They can get it
all for just the subscription costs. It's in the United States,
everybody wants to use their insurance for things, and I
understand it's a cultural thing, but it ruins it because
the doctor in order to keep the lights on, they're
going to have to churn through patients because then they
have to pay a person to then do all the
billing for them. And so in the end they're not
(09:53):
actually making that two hundred dollars or making a much
smaller cut of that, because then they have to pay
people to make sure they get all that money.
Speaker 2 (09:59):
It's a whole thing. It's the whole thing.
Speaker 1 (10:01):
I was like, oh, yeah, I'm getting out of here,
but I want to do it the way that I
think is right, as opposed to if you're in a
regular primary care clinic, you're seeing twenty thirty people a day,
how are you going to see? How are you going
to give anything good to that person in front of you?
So that's the gist absolutely.
Speaker 4 (10:19):
Like you said, like, we need to figure out ways
to get people to reduce their calorie consumption.
Speaker 2 (10:24):
And yeah, end of the day.
Speaker 4 (10:25):
That's why so many influencers out there like just eat less,
right less, move more. You know, while technically true, it's
not that simple. It's so much more. It's so much
more complicated than that.
Speaker 1 (10:36):
And then you got other influencers who are like, well,
it's your corticol it's.
Speaker 6 (10:41):
You got to stop.
Speaker 1 (10:42):
Well, one of my patients the other day said they're
they're obesity doctor, and I look them up and they
are definitely a quack.
Speaker 2 (10:50):
I was like, oh my god.
Speaker 1 (10:51):
They were promoting the eighth CG diet all sorts of
just non set stuff. But they told her she loves
swimming and they're like, you got to stop swimming. That's
going to make you gain more weight because of the
court Isol.
Speaker 5 (11:01):
I saw your post about that yesterday.
Speaker 1 (11:03):
To people, people thought I was like, no way, and
I was like, no, this I can't say too much
because it's a it's a hip a thing and whatever.
But this patient is higher level education, extremely smart, and
she'd follow me and that was the reason she was like, Okay,
I can't be seeing this doctor. I know this isn't
there's no way this is right. And that was like
(11:24):
the big red flag to her, and there were some
other big red flags in the visits. So but like
this is what people do. They're either not helpful or
they just make up stuff. So it's really truly frustrating.
Speaker 6 (11:37):
It's like when a doubt refer out I believe.
Speaker 5 (11:40):
As coaches, I mean, we were more and more limited
in our scope of practice definitely.
Speaker 6 (11:45):
Yeah.
Speaker 4 (11:45):
Yeah, so you mentioned court is all there. Can we
talk for a few minutes here about hormones, like what
are our hormones actually doing and what's actually happening and
how do they contribute or what role do they play
in weight loss weight game?
Speaker 1 (11:58):
Yeah, there are different types of hormones in the body,
and they have different functions. They help communicate with other
organs of our body. We have hormones that come from
our brain that then communicate with our other organs that
then send out other hormones that then have functions. So
like thyroid, for example, we have these signals that come
from our brain two different spots. You get the hypothalamus
(12:20):
that goes to the petuitary gland. The petuitary gland sends
out something called thyroid stimulating hormone that tells your thyroid
to then send out actual thyroid hormone, which then also
gets converted into more active thyroid hormone in your tissues.
And that's one that controls your metabolic right, And that's
what everybody wants it to be your thyroid because it's like, well,
obviously my metabolism is low, I'm gaining weight. It's got
(12:42):
to be my thyroid. Very likely not your thyroid. It's
relatively rare, although I have hypothyroidism hashimotos But the most
of the weight gain that you see from it, it's
actually from fluid unless you've had it for so long
that you was undiagnosed. But a lot of it fluid.
So that's that's like thyroid hormone. But then there are
(13:03):
other hormones. Like people love to talk about cortisol. It's
a stress it's a stress hormone. Without it, we would die.
Speaker 2 (13:11):
We need it.
Speaker 1 (13:12):
It helps regulate all sorts of things in our body,
anti inflammatory, helps with our blood sugar regulation when we
need it during stress, otherwise we'd literally die. And so
it's a normal physiologic occurrence that our cortisol would go
up after exercise. It's how it works. And when in
(13:32):
the morning when we wake up, our cortisol is higher.
And what people take a little bit of nuggets of
truth and then turn it into a pathological situation where
they then want to sell you something to try to
fix something that's normal, and that's how they make their money.
They make they get viral on TikTok and Instagram or
(13:55):
wherever threads. I don't really care what it is.
Speaker 4 (13:58):
I actually saw something on the yesterday somebody said, don't
exercise because of raises your cortisol. It's like, that is
the stupidest thing I've ever seen it.
Speaker 1 (14:06):
It's it is so it's so frustrating. So there are
there are pathological conditions. There's something called cushion disease cushing syndrome.
You can either have a tumor in your brain that
sends us too much signal to your adrenal glands to
make too much cortisol. Or you can have a tumor
on your adrenal glands that makes too much cortisol itself.
You can also take too much exogenous cortisol in the
(14:28):
form of like prednozone, other types of steroids that are
similar to cortisol. That's actually the most common thing. People
on prednizone for some inflammatory disorder and their their face
kind of gets round. You get you start having more
abdominal obesity. The thing is still even in those pathological conditions,
(14:48):
it doesn't negate thermodynamics because like if you didn't eat anything,
you still you still need substrate to create mass. You know,
So what what the hormone can do is that pathological levels.
It can shift where you store adipose tissue. It changes
enzymes that change where you would store tissues. So you
(15:11):
do see that your arms and legs actually get skinnier,
and then you start storing it more abdominantly. That's pathological level,
I mean magnitudes of levels higher than what we see
compared to physiologic meaning normal everyday differences.
Speaker 4 (15:27):
So where the fat is being stored is just changes.
It's not These things aren't inherently making you gain fat.
Speaker 1 (15:34):
No. The one thing they can do they are related
to potentially appetite changes, so then you could eat more
so than if you're eating more. It can then exacerbate
it or aggravate it. By then you see it stored
in the places you hate. People probably wouldn't hate it
as much as if they stored it in their button thighs.
I suppose it's the belly. Nobody wants the belly fat.
(15:56):
And the other thing is belly fat is common, so
it's got to be the court of al that's the
belly fat hormone. It's really frustrating because don't tell people
to stop exercising. That doesn't even that's not going to
help you unless you're overtraining and you just need a
recovery break because you're just doing too much.
Speaker 5 (16:14):
That that most people aren't overtraining, right, Most people.
Speaker 6 (16:16):
Are not now most.
Speaker 2 (16:20):
An Olympic athlete, that's right, right.
Speaker 4 (16:23):
What we're saying then is it's still calories. Does all
these things impact calories and can make it more difficult
for people? And I think that that's really upsetting for
a lot of people out there.
Speaker 2 (16:31):
That is upsetting.
Speaker 6 (16:33):
Yeah.
Speaker 1 (16:33):
I always say that they're intertwined. I've done so many
memes and reels and whatever. I just and I honestly
repeat the same thing over and over again. But it's, yeah,
they're intertwined.
Speaker 2 (16:44):
Yeah.
Speaker 1 (16:44):
Sure, when it comes down to it, it's it's calorie
deficits and energy balance. But they're intertwined in a way
to where the the hormones like say thyroid can change
the out and then there's other hormones in the body, leptin, grellin,
LP one, all these other different things that can affect
the d how much we want to ingest, and then testosterone, estrogen,
(17:07):
cortisol can change where we store it. That's kind of
the gest they're so intertwined that it's like, well, yeah,
they can affect that, and then how much we eat
can affect those they're intertwined. But absolutely it's not magic.
We understand it pretty well.
Speaker 5 (17:24):
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because you, as a parent, deserve to support your wellbeing
and do something for yourself so you can continue serving
others like the badass that you are. From a lifestyle perspective,
especially with cortisol, right, because exercise isn't acute. Response is
a temporary response. But what about like lifestyle changes. What
can people do there to help, you know, improve their
(19:58):
cort Is all their left in their grilling responses?
Speaker 1 (20:00):
Yeah, so, like I mean, if you're up at night, goodom,
scrolling on whatever your choice of social media, looking at
politics and arguing with people, and then you you're upset,
and then you don't sleep well. The influencer person is
going to try to sell you ashwaganda, rodeola and phosphatidl
(20:21):
seering or some cortisol blocking thing. But really the underlying
issue is that you're not sleeping well. And sure those
things will disturb your your diurnal curves of your cortisol
and whatever. But that wasn't It wasn't the cortisol. That
was the issue. Is the sleep and changes in lifestyle.
Those are not sexy. People do not want to hear that.
(20:42):
They want to hear that it was that it's a
supplement thing. But you don't have a supplement deficient. You
don't have a rodeola deficiency.
Speaker 2 (20:49):
The rodeola.
Speaker 1 (20:50):
Maybe maybe that will help calm you down to where
you're like, oh, I don't even want to go on
social media. Maybe that's the case, you know, and stuff
like that, but it wasn't the underlying issue. So yes,
make sure that you're eating enough nourishing your body. The
standard so boring stuff that people just I know, don't
I mean people, I say, my patients like it. That's
why they come to me because it's like I just
(21:11):
I'm so sick of getting duped by these people selling
me a three hundred dollars detox. I'll never forget. And
in private practice, like about ten years ago, when one
of my patients who they were like medicaid, they but
they paid a chiropractor three hundred dollars for a parasite
detox because they thought that was going to be the issue.
(21:32):
And it was so frustrating because I'm like, yeah, they're
so good at marketing that they'll really really squeeze on
your pain points and turn the turn the knife that
they get you to buy a three hundred dollars detox
when you can't afford that. There's no way they could
afford that.
Speaker 3 (21:48):
Yeah, that's so sad to me. I mean, honestly, I
don't know how these people live with themselves. I don't
know to be so shady and shisty to.
Speaker 2 (21:56):
On a pile of money.
Speaker 6 (21:57):
I think they now play off people. Yeah, it's so fucked.
Speaker 3 (22:01):
I mean I used to be one of those people
that would buy all the supplements and that's why I'm
so adamant about you don't need all this shit. Trust me,
I've spent thousands of my husband's money. I'm still I'm
surprised he's still with me.
Speaker 6 (22:14):
I mean everything, all my hormones were wrong.
Speaker 3 (22:18):
You know, I was taking going to chiropractors this and that,
and where I met Jordan Sayat and He's like, you
just need to start tracking your calories and weighing.
Speaker 6 (22:25):
You're during your food.
Speaker 5 (22:26):
It's not you know, when you were drinking right.
Speaker 3 (22:29):
Yeah, oh yeah, and I was like binge drinking, binge drinking, juicing,
taking supplements and so it's like I can see them
a mile, but it's like I was you.
Speaker 1 (22:37):
That should be your new book, Binge Drink Detox right,
Oh my gosh.
Speaker 3 (22:44):
I would love to actually start talking about some GLP
one since that is I'd really love to actually know
more about it and have our use users are followers
know more about it. So can you talk to us
like I guess how GLP ones came about and how
you use them in your practice, and we could just
go from there.
Speaker 5 (23:04):
I love the.
Speaker 1 (23:04):
Story because it's just really interesting. I've met a few
of the originating scientists and figured it out. They're older now,
but they're just and they're super humble too, not like
the people you see on social media. These are like
brilliant scientists that are just they don't even want to
take the compliment when I'm just like, wow, I love you,
I love you guys. Basically, GLP one a natural occurring
(23:28):
hormone that is released from our testines glucagon like peptide
one after we eat food and general carbohydrate containing food.
They figured this out this incretin effect. They call it
because they inject people with glucos is, like in the
fifties into their veins versus they had people ingest glucose
(23:50):
and they wanted to measure their insulin response, and they
found that people that ingested glucose had a larger insulin
response than those who injected it. And I just I
think that's so cool, because I would think that if
you injected glucose straight into the veins, it would go
directly to your pancreas, which then senses the glucose, which
would then shuttle out all the insulin to get that
(24:12):
glucose into your cells. But no, when they drank it,
there was some sort of effect that made your gluco
or your insulin go higher and have a larger, more
pronounced effect. So they called it the incretin effects, some
sort of intestinal secretion of some hormone incretin.
Speaker 2 (24:31):
And it wasn't until.
Speaker 1 (24:32):
Later on a few decades later where they figured out
the different types of incretins, one of them being GIP,
which is another hormone their studying we can get into that,
but then the other one is GLP one. In the
later eighties they figured it out the glucagon like peptide one.
They teasted it out and figured it out, like, oh okay,
this is one of them that is definitely have any
(24:54):
effect here. The problem is our own body breaks down
natural GLP one within a minute or two. So when
anybody sees all these supplements out there that are claiming
to be GLP one supplements, every single one of them
is nonsense. They're a scam, like they're just they're I
can't believe these I don't even know how meta and
(25:15):
all these people allow people to run ads. I tried
to run an ad the other day for my clinic
and they shut down the whole my whole thing, And
I was like, did you guys even look at this?
And it's probably because I've used one wrong word, and
yet other people are selling just absolute snake.
Speaker 4 (25:30):
It's very I said earlier, there's a whole playbook they've
been they're all falling the same one.
Speaker 3 (25:34):
Yeah.
Speaker 1 (25:35):
Yeah, the bad players will find bad ways to Unfortunately,
the long I do. I think the long I will
win in the long run, but it's a long play
as a player, short play.
Speaker 4 (25:48):
Yeah, yeah, GLP one medications they've been around for quite
some time, like yeah, decades.
Speaker 5 (25:54):
In the early nineties is when they were first started
and being prescribed, right for.
Speaker 1 (25:58):
Two thousand and five is when the first one was approved.
Speaker 5 (26:02):
Got it.
Speaker 1 (26:02):
It was in the nineties, late nineties, early two thousands
when they started figuring out how to do this. Because
so the problem is our own our own GLP one
is broken down within a minute or two. Our own
enzymes break it down so quickly, so it's like, okay,
could we just infuse a bunch of human GLP one
now it'll just be broken down quickly. They did make
drugs that stop the enzyme from breaking it down, so
(26:25):
we get like two to three times more of our
own GLP one. Doesn't actually have much of a weight
loss effect, but it does help with blit sugar control.
But like, so that's why I always say, like, look,
these pharmaceutical drugs that will boost your own GOLP one
don't even have a weight loss effect. So you're all
a bunch of scammers, and you all should be shamed
of themselves and their doctors even promoting this.
Speaker 4 (26:46):
It's really that's really what blows my mind is, Yeah,
we all have a code of ethics to be following here, and.
Speaker 2 (26:53):
You would think. So it is so bad.
Speaker 1 (26:55):
This is I'm so scorned and disenfranchised from everybody. I
just think everybody's a piece of shit.
Speaker 6 (27:02):
I don't blame you because I feel to say what
I think everyone's.
Speaker 2 (27:07):
The other.
Speaker 3 (27:08):
It's it's frightening to be honest. And I'm on your
side on that one. And I'm sure we can agree
that there's.
Speaker 6 (27:13):
A few that we know.
Speaker 1 (27:16):
So basically, what these researchers did they found they found
ways to then go, okay, could we change the molecule
to last long in the body. One scientist specifically found
the HeLa monster that has venom that messes people up.
This heal a little lizard looking thing, and so you know,
you see all the fear mongering around. You're injecting venom.
(27:39):
HeLa monster venom that's going to kill you. No, it's
just a part of it. Of the venom was about
forty percent homologous. It looked forty percent similar to our
own gop one, but it had the benefit of not
being broken down. That was the first one that came out.
It was called xenotide. The trade name is Baietta. Twice
a day injection didn't lead to a lot of weight loss,
(28:01):
but helped a little bit with blood suggers. That was
the first one approved. The very quickly though, within a
year or two, something called leraglutide was approved, and that
was Victosa. If anybody remembers that listening, Victosa for type
two diabetes originally proved for type two diabetes. That's where
they took human GLP one and they modified it. They
(28:22):
put a little thing on it to make it not
be broken down as quickly. That was a once a
day injection. That was like two thousand and eight or
nine or something around there. Two thousand and seven eight nine.
Somewhere around that time they actually studied it and jacked
up the dose. That's in twenty fourteen. That was the
first one approved for weight management, a high dose lyraglutide.
(28:43):
They called that sex Sendah. It was like seven or
eight percent total body weight loss. And I always tell
everybody like, look, we all know good responders from diet
and exercise, but on average, when you put up huge
let's say you put a thousand people on diet and
exercise that all have obesity, the average weight loss is
summer around five to six percent total body weight loss.
(29:04):
So if you're two hundred pounds on average, someone's gonna
lose ten to twelve pounds, and that doesn't seem like
a lot because you see other people they've lost fifty
one hundred pounds. It's just an average. It's an averages thing.
So with sex Senda, it was somewhere around like six
or seven. It was a little bit better than diet
exercise alone intensive diet exercise alone, I should say. It
was expensive too. There's a lot of nausea. People kind
(29:27):
of lost a little bit of weight. So it was like,
all right, this is okay. That was twenty fourteen. It
wasn't for a few years until Ozempic came out. Now
everybody calls every GLP one zempic. It's like Kleenex. It's
not but it's not brand but it's the maglutide. It's
like the younger, better looking brother of liraglutide. It's a
(29:52):
similar one, but they've adjusted it to where now it
lasts about a week in the body. That was Ozempics,
the maglutide that was around two thousand, sixteen seventeen. We
were doing it off label when we could get it,
meaning they didn't have type two diabetes, but we wanted
them to lose weight, but it only went up to
like one milligram, and so people started losing weight with
that one. It was twenty twenty one where they jacked
(30:14):
up the dose of that some maglutide.
Speaker 5 (30:17):
That's kind of start blowing up online.
Speaker 1 (30:19):
That's when it start blowing up online. So that was
a week Govy it went into shortage. The Novo nordisk
I was just on there. I just did an advisory
board for them yesterday, and you know, it was kind
of discussed, like they really dropped the ball on this.
Speaker 2 (30:34):
They don't know how.
Speaker 1 (30:34):
They didn't see the huge boom coming, but they went
into a shortage. It was such a big deal. So
everybody had it then they couldn't get it. It was
a really really frustrating time. That's some magnetide. That one
does around fifteen percent total body weight loss. So now
all of a sudden, we're cooking because we go from that,
you know, five six percent lifestyle then a little bit
(30:58):
better with that liraglutide.
Speaker 2 (30:59):
And there's some older drugs.
Speaker 1 (31:00):
There's one called Cucimia, which combines fentrimine until pyramid older
drugs that gets around ten percent total body weight loss,
so that was decent, But now we're getting fifteen biatric
surgeries around thirty percent, so it's like, wow, now I
got something here. The newest one that's out, and there's
gonna be newer ones that are coming out. It's called urzepetide,
(31:20):
and if you know the brand name Munjaro, which is
for type two diabetes, and then zep bound which is
for weight management. This one is a synthetic peptide that
hits both GLP one receptors and GIP and that's the
other incretin glucose dependent insulinotropic polypeptide. It it's a mouthful,
(31:41):
you don't have to memorize it, but it can hit
both receptors. It's a twin critain or a coreceptor agonist.
That one gets around like twenty one twenty two, a
little bit over twenty percent total body weight loss. So
now we're getting close to what you kind of see
with biatric surgery levels.
Speaker 6 (31:58):
Yeah.
Speaker 1 (31:58):
Well, that's a once weekly injection. And what I always
tell everybody is that patients claim that it's made, they're
not everybody. Most people say like, oh my god, it
stopped me from thinking about food.
Speaker 2 (32:10):
All day.
Speaker 1 (32:10):
Right, it stopped me from craving. It stopped me from
being so hungry and wanting and second serving. I've been
eating so well, I'm eating my broccoli and whatever you
name it whatever good.
Speaker 5 (32:22):
Food noise right, like, which is a newer term and
not a clinical term either.
Speaker 1 (32:26):
Yeah, not a it's not in Yeah, So it's it's
a controversy because we're like, we don't want to just
make a drug to fix something that may not be
an issue. But if somebody's struggling their waiting, they're thinking
about food all day, it's like, okay, this can kind
of at least explain why it works for you. So, yeah,
this ur Zeppetide specifically, I always tell people it these
(32:49):
things help you do all the things you want to do,
but you're just you're just struggling to do them.
Speaker 4 (32:55):
The way I kind of see it, and I think
a lot of a lot of like science based coaches,
even its based coaches and dark such as yourself, say,
levels of laying levels of playing field.
Speaker 5 (33:03):
For people in a way.
Speaker 4 (33:04):
Yeah, right, because people that are, you know, struggling with obesity,
it's not like they haven't tried diet and exercise.
Speaker 5 (33:10):
But yeah, they probably.
Speaker 4 (33:11):
Tried that for so long now, but for one reason
or another, they can't stop thinking about food or or
whatever it might be, right, Like it takes the intensity
of it away.
Speaker 1 (33:20):
Yeah, And you know, people want to say that these
things are like fat burners or magic but like.
Speaker 5 (33:26):
The easy way out.
Speaker 2 (33:27):
Yeah.
Speaker 1 (33:28):
Well, and I was just looking, but some patients swear
up and down they're eating twelve hundred calories. I mean,
like there's three hundred pounds. They think they're eating an
eight hundred or twelve hundred calories. And I'm like, and
they swear up and down, and I don't want to
be the jerk doctor to be like, no, you're not.
Speaker 4 (33:41):
Got to call bullshit, right, Yeah, that's a that would
be that's very upsetting too, because then you don't you
don't want to call them a liar, right right, But
you're very you may they actually may believe that. I mean,
we know there's research out there that humans are just
really bad at estimating their colorak intake, bad, tracking it
even of times too extremely bad.
Speaker 1 (34:01):
And they swear up and down that the medicine has
to do something more than help them eat fewer calories.
But all the data show that maybe there's a benefit
to the metabolic adaptations that you see, so you probably
talked about it. But basically, the metabolic adaptation is when
you lose weight, let's say at least ten percent of
your weight. So you're let's say you're two hundred pounds,
(34:23):
you go down to one hundred and eighty pounds. You
at one hundred and eighty pounds, your your basal or
resting metabolic rate is actually maybe a little bit lower
than what we'd expect based on your body composition and size,
So it could and it's it's not even that much.
It's like it's slightly lower. So it's thought that these
(34:44):
drugs may help minimize that metabolic adaptation, but it hasn't
panned out in humans. And even if that were the case,
it's the equivalent of a few oreos. It's it's one
hundred and two hundred calories. Maybe, yeah, but when they
look at these medicines really just help people eat fewer calories,
and patients claim they're like, nope, I was eating twelve
hundred calories before, I'm eating twelve hundred calories now, and
(35:06):
now I just lost one hundred pounds. I'm like literally
physically impossible. But you know what, I don't want to
argue with you because it doesn't really matter. You're doing fine.
But it's a very hard discussion I have.
Speaker 6 (35:14):
Yeah, yeah, totally. Who is a good candidate for a
GLP one and where if it should they go?
Speaker 3 (35:22):
Yeah, if they are struggling with obesity, because I feel
like and I don't feel I know that people are
going medspas. Oh yeah, you know what I'm saying, Where
would you recommend someone go and not go? Yeah?
Speaker 1 (35:36):
So there's a future state where I could see everybody's
on these things. I just I don't know what's going
to happen. It could be that I'm taking one and
not for weight necessarily, but for maybe cardiovascular prevention. And
everybody's talking about microdosing and small little doses here and there.
We don't ad word. That's a data free zone.
Speaker 5 (35:55):
Maybe they actually want to talk about that a little bit.
Speaker 6 (35:57):
Yeah, I have that on my notes.
Speaker 2 (35:59):
It might it might be fine.
Speaker 1 (36:00):
I'm much more like, hey, you know, hypothetically, it could
be okay, but like, we don't know that. So we
do have good indications for it. It's so for type
two diabetes, clear indication for it. Blood sugger is a
little bit elevated or a lot of bit elevated, clear
indication for one of these medicines. And then we get
(36:21):
into obesity. Now the controversy is, you know, it's all
based on BMI pretty much, and what they're trying to
switch to is more of a what it's called like
a clinical definition of obesity, because like you can have
somebody that's a twenty four twenty five BMI that has
like pre diabetes, hypertension, high cholesterol, all these different things,
(36:44):
and you can have a thirty BMI or thirty two
or thirty five even whatever, and they are like starkly healthy.
Otherwise despite their weight and its possible insurances might not
approve the medicine for that twenty five, despite they need it.
They have too much body fat on their body that's
(37:07):
causing dysfunction, that's causing them harm, whereas the other person
stores their weight just fine, and it's actually, you know,
the weight isn't fun necessarily for that person, but it's
not metabolically harming them. And it may not even be
physically harming them. They may not have any sleep apna
or knee pain or joint issues, and they could but
(37:28):
I'm just kind of trying to make a stark contrast there.
So the guide FDA guidelines are a thirty bmi body
mass index kilograms for meter squared, and that doesn't go
into muscularity or whatever. But it's a thirty bmi. So
technically you would qualify if you had a thirty bmi
regardless of your body composition. A doctor should assess that,
(37:51):
but like they don't always, but or a twenty seven
bmi plus what's called a weight related comorbidity, and this
is anything weight so pre diabetes, type two, diabetes, high
blood pressure, high trigly rides, osteoarthritis, if your knees, obstructive
sleep apnea, those types of weight related issues pcos would
be considered one as well. So those are the indications.
(38:15):
I would say, though, that these medications would be something
for someone who has excess body fat that's causing them
issues of some sort. I think that's reasonable what I
prescribe to somebody with a twenty I'll get these patients.
They come and they're like, I have a twenty two
BMI I want to get down to. Well, they won't
(38:38):
say that, they'll say I have to do the calculation,
but there are a certain weight they're pretty thin, and
they just want to get another ten pounds off. And
I always have to be like, I'm not the person
for you to do this. It's yeah, first, do no harm.
I can't say that this won't harm you, and I
don't think this is going to benefit you other than
from a purely aesthetic vanity.
Speaker 2 (39:00):
Point.
Speaker 1 (39:00):
And I think vanity's fine if we all, like my patients,
all want to look better too.
Speaker 5 (39:05):
I mean, who doesn't look better?
Speaker 1 (39:06):
Yeah, exactly, Yeah, it's more of so I come at
it from that clinical medical standpoint. So then they're going
to go to the medspa place and they will sure
as hell give it to them because they're going to
sell it to them in a form that probably isn't regulated.
They'll sell it right out of their office and inject
them right there and charge them a thousand bucks or
something like that.
Speaker 2 (39:27):
So obviously I.
Speaker 1 (39:28):
Want everybody to so my clinics in all forty eight
different states. It should be in fifty here soon. I'd
love everybody to go there. But like, if you have
a good primary care doctor and you feel like you
have excess body fat, that's beyond what's healthy for your
body and you have some of these weight related issues
(39:49):
and you can look at your BMI again it's on
the it's the FDA label, so like I can't change that.
But your primary care doctor if if they are I
don't want to say smart, because they may be smart,
but just black. They may not understand these medicines. But
if they're open to at least discussing it, they should
(40:11):
be able to do it. But obviously otherwise you'd want
to go to a clinic. Like mind, if you go
to you, if you go to one of these sketchy metspots,
they'll give it to you. It doesn't matter who you are.
And yeah, you don't know what you're going to get
when you can.
Speaker 4 (40:23):
And I think if this coach is Beth myself, like
that's where we take issue with these drugs, right, the
over a prescription of them. Yeah, these corner met spas
people are all necessarily needed them, especially because then.
Speaker 6 (40:35):
They're not getting no guidance.
Speaker 4 (40:36):
They're not getting the guidance right exactly, yes, thank you bet,
they're not getting the nutritional guidance. The behavior change aspect
of like why why do we get here in the
first place, and being under muscled, which is a huge
problem in our society, right, And they're not being prescribed
strength training, and I know that's a very very important thing.
And that's something that you do is have resistance training alongside.
(40:59):
And like you said, the registered itcticians, you get nutrition
support and behavior support.
Speaker 1 (41:03):
That's exactly right. So they'll get they'll get the prescription,
they'll go off, they may have side effects, they they
won't be monitored very closely, and again who knows what's
in what they're actually in jacting.
Speaker 5 (41:14):
They're going to like a compounded pharmacy to get those drugs.
Speaker 1 (41:17):
And yeah, and I've made people get so mad at
me about it all. They're like, you're a big pharmas
shill And I'm like, no, you guys aren't thinking about
this deeply. They're like, no, big pharmass corrupt. I'm like,
and you think little pharma.
Speaker 6 (41:30):
Right, Parma, They're way more corrupt.
Speaker 1 (41:35):
They're doing the they're not doing the research to actually
develop these drugs. They're copying intellectual property just to make
their buck and they're selling it to you directly. It's
it's they're actually making way more money.
Speaker 5 (41:48):
Huge market.
Speaker 1 (41:50):
It's it's it's it's actually insane. So they're not the
good guys. I think they have their place during the shortages.
It was like one of those things where it's like, well, yeah,
need for it. But what they did it was they
exploited the loophole and then started selling it to everybody.
Everybody in the brother, mother, sister, and uncle's, aunts and everybody,
grandma's whoever. Now all those people now that the loopholes closing,
(42:14):
now they're without their medicine. And yeah, they made going.
Speaker 5 (42:19):
Big problem too.
Speaker 4 (42:20):
Yeah, people that have been prescribed these from those medspas
because the compounding pharmacies, right, and what is a nova
neurodisc right, So.
Speaker 1 (42:28):
Novo Nordisk is like the is the smaglotide company that
developed that ozempic and we go be when I lost
it right against there's a bunch of them. They're so
they outsourcing the ofa this compounding place. Tried to sue
them and Eli Lilly, who's the ter zeppetites that bound company.
And I think at the end of the day, though,
(42:50):
they do need to bring these prices down because what
they're going to see these drugs are basically it is
kind of for the rich.
Speaker 2 (42:57):
I mean like I can't.
Speaker 4 (42:57):
I can't even know as they compared to other countries
where it's really hard to argue like that big farmers
not corrupt when we see these drugs available for pennies
bucks dollar compared to hear right, arm.
Speaker 2 (43:07):
Bucks over wherever Brazil or the UK or wherever.
Speaker 4 (43:10):
They have different prices, which that can be true, but
it doesn't negate the fact that these are actually really
powerful drugs that can change people's lives too.
Speaker 1 (43:17):
Yeah, so what they need to do is really get
the prices that well, I think we're going to see it.
We're going to see all these other competitors. I mean,
there's newer, newer drugs coming down through the pipeline and
we're not going to have this kind of duopoly monopoly
type of situation with no NORDICSK and Eli Lilly. Well,
I think, are you know, I like them and that
they develop these but like clearly it's ridiculous and it's
(43:40):
not just them, And there's also these pharmacy benefit managers
who are these in between middlemen so to speak, who
negotiate between the manufacturers and the insurances and they're they're
getting their kickbacks. So instead of yeah, so the jets,
it doubles the price. They everybody loses in the middleman, right, Like, no,
there's no point having them, honestly. So they can make
(44:02):
these drugs for easily one hundred bucks and they'd still
make so much money.
Speaker 4 (44:06):
Honestly, I see those depositions that they have in front
of the congressmen and senators and how they dodge those
questions about why is it not cheaper here? You know,
they don't want they will never answer that question. But
so going back to like, you know, being the crackdown
on these med spas and the over prescription of these meds,
(44:28):
We've seen a lot of headlines and this is one
thing that the influencers out there that are nefarious and
nature like to talk about, is how, oh, you're going
to gain all that weight back after you get off
these meds?
Speaker 5 (44:40):
Right, so let's cut the crap here. What does that
actually look like? Is there some I mean weight gain
if you do step these medications? What should we expect there?
Speaker 4 (44:50):
It's my understanding is these are kind of a forever
drug because they don't really change anything in your body
unless you're taking them permanently.
Speaker 1 (44:58):
No, you're you're right, it's it's similar to I always
use blood pressure medicine. So yeah, let's say you do
all the diet and exercise things that we know help
lower blood pressure, or blood pressure is still one forty
over ninety or something, it's elevated. The doctor says, let's
put you on a blood pressure medicine, something like go
whatever Life Centerprill. There's a bunch of them, and the
blood pressure goes down to one twenty over eighty. And
(45:20):
then they're like, all right, your blood pressure is good.
Let's take you off the medicine. Now, just those biological
things that drive it back up will reoccur with weight.
This is why we call it treating the obesity. There's
a lot of semantics involved here, but whatever, we're treating
what I would call the disregulated appetite because, like we know,
(45:41):
people need to eat fewer calories. These drugs are not
magical in some sort of way where they magically make
you factor.
Speaker 5 (45:49):
Making a twenty eight fifty calories right.
Speaker 2 (45:51):
No, but people people think they are. I mean, this
is why we kind of talk. I just I yeah,
but that's that's how they work.
Speaker 1 (45:58):
So if somebody uses diet exercise to lose weight and
they stop doing whatever it was. So, for example, calorie tracking,
you can switch people off to other ways of trying
to monitor their intake whatever whatever that is. You can
find ways to keep people eating fewer calories, and sometimes
that works. But like with this, we're literally treating the
(46:21):
disregulated appetite whatever it is. You can't feel full after
a normal meal. You you don't feel sat shiated, You're
craving a lot. Despite all the behavior therapies that we do,
and despite all the good and healthy foods that we're
trying to get you to do, and you still keep
thinking about food. So then you put them on the medicine.
They stop that when you stop the medicine. If there
(46:41):
was an underlying biological thing that caused that dysregulated appetite
in the first place, it will likely come back. Now
people that are wrong saying everybody needs to stay in
these forever, because they've actually done it. They've put everybody
on the drug, and then part of the way through
they randomized portion of those to a placebo and then
you see a bunch of them regain their weight, but
(47:02):
not everybody regains their weight, and we hear them you'll
see it on when i'd write post about it. They're like,
I've kept one hundred pounds off. I stopped it a
year ago. But they're few and far between. It's like ten,
maybe ten percent, you know, five, ten, fifteen percent of people.
So it can happen. And what I think in those people,
they must not have had that biological issue in the
first place. Those people probably had you found the right
(47:27):
coaching aspect. I think they probably would have been successful
without it.
Speaker 2 (47:30):
That's my guess. Can't prove it. I don't know how.
Speaker 1 (47:33):
That's a trillion dollar question of who those people are.
But in general, yeah, if you're treating that underlying biological
issue and you remove it, likely it'll come back.
Speaker 2 (47:44):
It would be.
Speaker 1 (47:45):
So the other example would be going back to hypertension.
We do know of people that come off their blood
pressure medicine so and it's because they probably did some
lifestyle changes that allowed them and then continued with those
that allowed them to come off their bloo pressure medicine,
and they continue those lifestyle changes. That's that's that's the key.
So I likely going to have to be on one
(48:06):
of these long term unless in the future they're looking
at editing our genes and all sorts of crazy I like,
there's some crazy shit coming down the pipeline. I don't
even know what knows what the future holds, I don't know.
So that's that's the just for now, though they are long.
Speaker 2 (48:21):
Term for most.
Speaker 3 (48:24):
I have a question about because I've been seeing this
and also in my DMS also another doctor that we know,
I believe that she's also promoting this now microdosing glp
ons from menopause. Yeah, yeah, to get rid of the
menopause visceral belly fat, which we all know comes down
to being in a calorie deficit. Is there data supporting
the microdosing for glpans for menopause? And she also talked
(48:47):
about inflammation and she was throwing them around all these things,
right buzzwords of course, yeah, exactly. And I'm like, I'm
going to ask doctor and adults key about this. I
didn't say that, but that's one of my questions that
I want to talk about because I feel like it's
another thing right that may possibly be misused or maybe
it's not, maybe actually a legitimate I don't know.
Speaker 1 (49:07):
Yeah, So this is where I say, like microdosing, it
just means a smaller dose of what you would use
compared to the clinical doses that are end up going
a lot higher, but you can use lower doses and
they can still have an effect. But so somebody in
menopause that uses a small dose of these to lose
some weight, it's literally because it's going to help them
(49:28):
eat fewer calories. It's not magically burning off the visceral fat.
And they've done this many times, and people thought that
maybe exercise is better than diet when it comes to
reducing visceral fat. That's a thought that's out there, but
very smart physicists, Kevin Hall, you can look up the studies.
He's the guy that did the Biggest Loser. Just a
(49:50):
brilliant yeah, my friend, smart guy, and they actually looked
at it and it looks like it really depends on
how much visceral fat you had in the first place,
and it really doesn't matter. However you create the calorie deficit,
that's what's going to be getting rid of the visceral fat.
So it's not like these medicines target your visceral fat
and somehow melt that melted away. Now, actually, there are
(50:13):
some interesting things about retatritide, which is coming out probably
in a year or two that does actually have receptors
on the liver that may actually preferentially burn or oxidize
liver fat. But either way, in general, these current ones,
if you do a microdose and you lose belly fat,
it's because it's helping you get into a mild calorie deficit.
(50:35):
And like people can get mad about that. Now, when
you talk about inflammation, people throw that word around. It's
an immune system reaction. It's just that we actually need
inflammation again kind of or it's all whatever.
Speaker 5 (50:47):
It's not necessarily a bad thing.
Speaker 1 (50:48):
Yeah, it's like a cute like you sprain your ankle,
all these different you know whatever. But chronic inflammation is bad.
So chronic inflammatory diseases, you get soriatic arth right, whatever,
it's also record arth writ It's all sorts of different things.
And we have anti inflammatory biological medicine. So these these
drugs do have anti inflammatory effects. So but when people
(51:12):
throw around I just have inflammation, it's like what do
you what do you mean?
Speaker 4 (51:15):
You just kind of feelam So then it's fair to
be fair to assume with that anti inflammatory effect, then
we're seeing some water reduction water weight eventually.
Speaker 1 (51:22):
And then when we first start taking that's when they
describe it. That's got to be what they're describing is
that they they're having fluid. But the other thing is
these medicines do have may have like a small diuretic
diuresist type of effect. There could be some things there.
But yeah, maybe they feel in flame, just kind of
achey and whatever. Maybe it's taking care of that some
puffiness maybe, but like, yeah, the visceral fat, it's helping
(51:45):
them get into a lower calorie deficit. But I just
hate it when people, first of all, the people making
those comments, and I know who you're talking about that
just these Charlotte they're just Charlatan's. I know, I know
we have millions of followers. Very frustrating to see because
they're just spreading abs. They're not the people at the
conferences that I go to awarding the they're not doing
(52:06):
the research. They're just making up stuff they'll read. They
don't even know how to read the research papers. You
can tell I go, yeah, if they ever.
Speaker 5 (52:13):
Sight a paper, if you go and read it, it's
probably not saying what they want.
Speaker 6 (52:16):
Oh, I mean the rats study you decided, okay, sounds good.
Speaker 1 (52:20):
If they would have done one of those at Journal
Club during our training, they would have gotten eviscerated, but instead,
now they found a way to monetize it because they
know that if they use these buzz words and present
it in a way, they'll get tons of likes and
they're getting the dopamine rush from it, and then they're
probably making money off of it, so then it perpetuates it.
They're so frustrating because it's like, why can't you just
(52:42):
be honest, Why can't you be normal and honest?
Speaker 2 (52:45):
Like what is it?
Speaker 3 (52:45):
Yeah, that's the frustrating thing to me because as a
fifty two year old menopausal woman and nutrition coach and
stuff like that, I have these people in my DMS like,
this is what's happening. I need this for visceral fat
because this person told me this, and then they feel
like I just this happened overnight.
Speaker 6 (53:01):
I'm a clean eater.
Speaker 3 (53:02):
I'm like, okay, you know the typical Like, you know,
I just gained weight under nowhere and my visceral thought
and now I need GP one microdosing because someone told
me that, and now everything's better. It's like, well it's
really not that difficult.
Speaker 1 (53:15):
But so so this is why I think in the
future I think what we're going to see big pharma
wants to make more money, and this is where it's like, okay,
like I guess capitalism, they whatever. But I think they're
going to probably study smaller doses in everyday people to
look at weight reduction, prevention and longevity purposes.
Speaker 2 (53:35):
I know this, Yeah, I want everybody.
Speaker 3 (53:37):
And I was just saying this morning that I think
that everyone's gonna be on it at some point, like
all of us are just just going to be like,
you know what, because our world is so dopamine hit, right,
It's like.
Speaker 1 (53:49):
We may need this, I think. So I imagine I'll
be on a load. I don't know, a very low dose,
a pytro dose, if you will.
Speaker 4 (53:57):
I don't know, Spencer, if this is outside of your
will house. But I've seen some cool studies out there
related to kind of some of the non weight loss
impacts that he strugts connection, such as alcohol use disorder
and things like that.
Speaker 5 (54:09):
Can you speak to that or is that not something
new You're.
Speaker 2 (54:12):
No, it is.
Speaker 1 (54:13):
I published a paper and jam on alcohol because basically
what I was seeing. I went viral on TikTok for
actually like normal stuff because I go, hey, look you know,
I just right away I was noticing zep bound specific
or Manjaro, i should say, because I was writing a
lot of it off label right when it came out
in twenty twenty two or whatever it was. It's like
one of the first people to start using a lot
(54:34):
of it, and my patients would be like, one of
the weirdest things is I just don't want any more alcohol, right.
I just thought it was, so I was like, really,
that is interesting. We saw it a little bit with
like ozempic and we Goby, but not like with zep Bound.
So then I just I posted about it and just
TikTok people like, oh my god, I'm having the same thing.
And it was kind of one of those things because
(54:55):
it's so new and novel that then everybody started talking
looking all about it. And now we did a study
and now they've actually been randomized trials, because cool. Yeah,
So like randomized trials. There's an effect that these drugs
work up in the brain in various areas that are
related to the rewards center and addictive like behaviors or
(55:18):
addiction behaviors.
Speaker 5 (55:19):
Not just alcoholic drugs. It can ambling maybe.
Speaker 1 (55:23):
Or sorts of stuff potentially sex addiction and biting your
nails and wo what whatever, all sorts of stuff. Some
people don't notice the effect. I will say that they
that it can potentially have too much of a pronounced effect.
I do see some people get lack of a motivation
(55:44):
to do anything because I think they're dopamine and all
of it. That system is dampened down too far. I
see that once in a while. Again another issue with
going to a met spot. They won't they won't monitor that,
they won't even.
Speaker 6 (55:55):
Ask about it.
Speaker 1 (55:56):
So I talked to my patients about it, and they're like,
you know what, I haven't been feeling like I want
to go to the gym or whatever. So then I'm like, okay,
I got a lower dose. We got to work through
this and whatever, make sure that they're doing okay. But yeah,
there's absolutely an effect. So the other thing that there
are non weight effects. So everybody saw it looks like
they reduce heart attacks, and it's got to because they're
(56:18):
losing weight. It's it's likely mostly I think weight independent effects,
meaning they don't have to lose that much weight for
it to reduce risks of heart attacks. That's why I
think what we're going to see is someone like me
or whatever and everybody preventing heart attacks by using just
a low dose of these things without even much loss.
That's what I think, Sorry, idol arthritis, rheumatory darth writis.
(56:43):
I'm seeing patients say again, that's why these are anecdotes.
You need to actually study it. Yeah, right against a placebo.
But they claim that some of these, like trurezepetite, for example,
is more powerful than their other biologic that's super expensive
that they were taking whatever, hum Era, Skyrizzi, whatever, This
(57:04):
was the thing that helped my joint pain the most.
So it's like, okay, there is an anti inflammatory effect.
Had nothing to do with their weight. People are having
periods again without losing their weight because I thought, oh, pcos,
so it's helping them weight, which is helping their pcus.
Now that they didn't even lose weight and they're starting
to have normal periods, I'm like, Okay, clearly there's a
bunch of non weight related things going on here, so
(57:26):
kind of interesting.
Speaker 5 (57:28):
Very intriguing.
Speaker 4 (57:30):
I know we're running out of time here, but I'm
curious too, Like, what can you talk about with the
importance of strength training in all of this because an
appetite control too, because one thing I've seen with clients
and just heard online too is how little a lot
of people are actually eating too, which can be of
obviously harmful long term. So we have to be verally
aware of making sure we're eating adequate calories and macronutrients.
(57:53):
Micronutrients in conjunction with building a strong body.
Speaker 1 (57:56):
Yeah, so you see this with people doing very low
calorie diet and not strength training and they feel like
crap and they're losing a lot of weight. They'll get
really thin unfortunately, can lose strength and muscle. We don't
want people to be frail. So I follow the same
kind of principles of sports nutrition that we've known for
(58:16):
a long time, is that like, okay, I try to
shoot for somewhere of a half of a percent to
a one percent of their total body weight per week.
So if they're two hundred pounds, let's just say that
to be easy, one percent would be two pounds a week,
So I try not to go above that. For each person.
There's water weight loss in the beginning. That's why I
have the dietitians, because like I monitor their weight loss rate,
(58:38):
I have the dietitians there as well, and we have
the strength training. So then if they're losing weight faster
than that, probably not eating enough, So that's one thing.
Then you actually ask them what they're eating and if
you try to get dietary composition of whatever they're eating.
Oh yeah, I'm basically eating bread because that's all I
can tolerate because I don't feel like eating much. It's like,
(59:00):
hold on a second, let's make sure you get some
more protein. It's the goal isn't to just lose weight
just to lose weight. We want to make them healthier
in the long run too. Yeah, that is why you
monitor closely. And if you at the very least monitor
the rate of weight loss, you can kind of estimate
how much you're eating, but you won't be able to
tell how much protein they're eating unless the other thing
(59:20):
you can do is monitor their strength levels too. Obviously
easier said than done sometimes, but that's the gist.
Speaker 5 (59:29):
Awesome, thank you for clarifying that.
Speaker 6 (59:31):
Yeah, you're doing great workout there, doctor Spencer and Adlski.
Thanks one of the good ones.
Speaker 1 (59:37):
Your reels crack me up because I Jordan's like, you
gotta follow that house, like do I know her, and
then I clicked and I was just like cracking up
about I was just like, oh God, that's right down
my uh uh, I love it, my alley.
Speaker 4 (59:52):
Yeah, that's awesome, absolutely amazing. Thank you so much for
coming on here today. Yeah, hopefully people have learned. I
know we've learned some things here. If people want to
learn more about you, potentially work with you in your
clinic or something like that. Where can people find you?
How can they look at.
Speaker 1 (01:00:07):
Yeah, so my clinic is join vineyard dot com like
a vineyard, like you're not drinking wine, but supposed to
be kind of a place you want to hang out.
So join vineyard dot com and then you can get
me on Instagram, doctor Spencer Dodolski. I'm on Facebook, TikTok, threads, Twitter,
all the different places. I have a podcast called Docs
Who Lift, where we promote you know, lifting as exercise
(01:00:30):
and go over all these medicines and detail. My brother's
an endochronologist and yeah, Carl, he's five to five and
looks like me, but shrunken down. I always say he
has he had abs in utero, and abs aren't made
in the kitchen, They're made in the in.
Speaker 2 (01:00:45):
The in the womb.
Speaker 6 (01:00:48):
Oh that's too funny. And I think I remember you talking.
Speaker 3 (01:00:51):
Maybe it was one of the podcasts with your brother,
or you were on somebody's podcast, but remember I remember this,
like years back, you were talking about that you wanted
to create something that you can have nutrition, strength training,
and you wanted like a one stop shop.
Speaker 6 (01:01:04):
And I feel like that. I feel like that's what
you're doing right now, and this is it's like happens.
Speaker 1 (01:01:09):
Yeah, I have to the next step would be doing
potentially brick and mortar clinics. It's just there're a lot
more and so like the overheads a lot higher. So
future state would be like, yeah, everything weather, insurance pace
for I don't know if I'll ever get to that point,
but I want to make it at least accessible for
most people that they're like, this is like a cable
(01:01:29):
subscription or something like that.
Speaker 5 (01:01:30):
Yeah, imagine having Jim at your doctor's office.
Speaker 2 (01:01:34):
Yeah, I'd enjoyed. I'd probably use it the most right exactly.
Speaker 6 (01:01:42):
Thank you so much, doctor Spencer Dadolski. It's been a
pleasure having you on this podcast and keep in touch.
Speaker 2 (01:01:49):
Thank you.
Speaker 6 (01:01:49):
We will be posting this, I think on Friday.
Speaker 2 (01:01:52):
Perfect collaborate or whatever you needed.
Speaker 6 (01:01:55):
Absolutely, thank you.
Speaker 3 (01:01:57):
I hope you enjoyed this episode, so why not share
with a friend who needs to hear it? Send us
a DM on Instagram or email us at cutthcrappod at
gmail dot com, and join our Patreon at Patreon dot
com slash Cut the Crap Podcast. As always, we appreciate
you and thanks for being here.
If you're up at night doom, scrolling on whatever your
choice of social media, looking at politics and arguing with people,
and then you you're upset and then you don't sleep well.
The influencer person is going to try to sell you ashwaganda,
rodeola and phosphatil seering or some cortisol blocking thing. But
(00:21):
really the underlying issue is that you're not sleeping well.
And sure those things will disturb your your diurnal curves
of your cortisol and whatever, but that wasn't It wasn't
the cortisol. That was the issue is the sleep and
changes in lifestyle. Those are not sexy. People do not
want to hear that. They want to hear that it
was it's a supplement thing, but you don't have a
(00:44):
supplement deficient.
Speaker 2 (00:45):
You don't have a rodeola deficiency. The rodeola.
Speaker 1 (00:48):
Maybe maybe that will help calm you down to where
you're like, oh, I don't even want to go on
social media. Maybe that's the case, you know, and stuff
like that, but it wasn't the underlying issue. So yes,
make sure that you're eating enough, nourishing your body. The
standard so boring stuff that people just I know.
Speaker 3 (01:09):
Welcome to Cut the Crap with Beth and Matt, the
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Speaker 4 (01:14):
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Speaker 6 (02:02):
How are you? Doctor? Spencer to Dulski, what's up?
Speaker 1 (02:06):
What is up?
Speaker 3 (02:07):
You have been our bucket List guest for I don't
know a few years now. Actually I think Matt reached
out to you. I don't know. I think a few
times we have, but you're hard to get in touch with.
And so when you followed me and then you messaged me,
I'm like and you're like, let's talk, Yes, let's check.
Speaker 6 (02:26):
So I'm so glad you're here.
Speaker 1 (02:28):
It's probably one of those things where I got the
d M and then I said to email me and
then you. Then I didn't do anything, and then you
probably who knows.
Speaker 3 (02:37):
I know, I get like so many different folders in Instagram,
Like there's like the private section, and there's there's you
know what I mean.
Speaker 6 (02:44):
So who knows? Who knows?
Speaker 2 (02:47):
But we're here.
Speaker 4 (02:48):
We're excited to cut the crap with you today. Yes, yes,
we'll do a little intro here. You're ready to ready
to just get.
Speaker 2 (02:57):
Right to it. Yeah, awesome, awesome.
Speaker 4 (03:00):
So today, guys, we are joined by doctor Spencer Nadalski,
a board certified ob City specialist family physician, and it's
also known across the innerwebs as the doctor who Lifts.
If you've ever been confused by the online dumpster fire
that is weight loss advice, doctor Nadelski.
Speaker 5 (03:15):
Is here to cut through the crap.
Speaker 2 (03:16):
With us.
Speaker 5 (03:17):
Perfect, you very much for coming. We appreciate your time.
Thanks for having me absolutely.
Speaker 6 (03:22):
Yeah.
Speaker 4 (03:23):
So Beth and I were talking and we've been following
you for quite some time, and it goes back to
like the meme days, right, Yeah, that's how probably a
lot of people found you early on in the days,
the memes that were just straight to the point and
cutting through all the bullshit out there.
Speaker 1 (03:37):
Yeah, nobody likes memes anymore. Yeah, I know everybody wants reels,
and I'm like, I'm tired.
Speaker 6 (03:42):
I know, I love the memes, like are a good
break from the fucking bullshit.
Speaker 2 (03:47):
I know, you know such it.
Speaker 1 (03:49):
It's different now, and I you know, funny thing is
my I've noticed just a huge like the algorithm. People like, oh,
the algorithm's at work. I'm like, no, it's just adapting.
So they want you to do reels. I'm like, I'm
just tired. I'm like, come on, yeah, these whatever long You've.
Speaker 5 (04:04):
Been online making content for a long time.
Speaker 1 (04:08):
I started doing it in residency. So twenty eleven twelve
is just giving out just stupid simple. Oh I saw
page like residencies where you go after med school, where
you actually take what you learned in med school. Like
med students don't really know anything. They know, I have
a lot of information, but you don't know what you're
doing right, And so that's where you start seeing patients
and having your own patients. But you're not board certified
(04:30):
yet you're licensed. And that's where I started basically going, hey,
I did this with the patient. It was Facebook really
and people, you know, it was just kind of resonated. Nothing,
nothing groundbreaking, didn't go viral because I made up something
about wheat wheat belly.
Speaker 6 (04:47):
You know the guy I mean, I think I had
that book.
Speaker 2 (04:50):
Yeah.
Speaker 1 (04:51):
So many those were like the fads back then, and
I'd always get to be like, I'm not jumping on this,
you know, think about like people like Paul Saladino who
had just a couple thousand followers just a few years
ago and was like and he just you know, people
like that, you can go there are ways, there's a
playbook to go viral and you can be huge. I
refuse to take those you just lose all integrity. So
(05:16):
I appreciate what you guys do and do like legitimate stuff.
Speaker 5 (05:20):
Thank you appreciate that.
Speaker 2 (05:22):
Yeah.
Speaker 3 (05:22):
Likewise, so you are an obesity specialist, yeah, and so
I guess break that down, what does that look like
in your practice?
Speaker 6 (05:31):
What exactly do you do as an obesity specialist.
Speaker 1 (05:35):
Yeah, so it's a newer specialty. The board specially came
out in twenty fourteen, so right when I graduated residency.
The idea is, we had beriatric surgery, you know, and
you can go and do special certifications in that and
get trained and do beriatric surgery. But there was nothing
for like the medical weight loss. You hit a lot
(05:56):
of huckster's and Charlatan's pushing their hCG diets and all
sorts of be twelve shots and stuff that just didn't work,
and making up stuff about hormones and whatever. But there
was no standardized board certification. And then this American bord
of Obesit Medicine came out to try to standardize it.
But a lot of hucksters take the certification and then
(06:18):
use it as a way to promote them. It's just
like you can't even.
Speaker 5 (06:21):
Stop that appeal to authority for some people.
Speaker 2 (06:23):
Huh.
Speaker 1 (06:24):
But the idea is to somewhat at least give some standardization.
But I've seen some really bad players. I'm just like,
come on, don't just give this. It's hard to stop them.
If you take the tests and do all the stuff.
It's like, well whatever, they know what to put on
the tests apparently. But the idea is basically a medical
disease management of weight and obesity as opposed to the
(06:47):
hCG whatever magic beings that people are promoting from their
clinic or whatever like that. So it's to me, it's
more of like a cardio metabolic type of deal supposed
to just like being weight centric. Yes, obesities excess, adiposse,
excess at a post tissue, and we want to eat
people finding ways to eat help them eat fewer calories.
(07:10):
But it's coming at it from an angle of the
medical biological angle, And truly it's the ideal situation is
you have a multidisciplinary What I do is very multidisciplinary.
I work with dietitians, strength coaches. I want to add
in psychologists as well, and then I come in with
(07:31):
the medicines to basically help them biologically when they do
it from a behavior standpoint, that's the gist, but I
like to go beyond and look at their cholesterol and
make sure that everything else is metabolically optimized as opposed
to just like here, lose the weight, see you later, goodbye.
Speaker 2 (07:49):
Yeah, that type of thing.
Speaker 3 (07:51):
So you currently kind of have like the optimal situation
in which a client will come to you and then
you have psychology, you have the strength training, you have
the nutrition, and then you have the weight loss drugs
to help aid in that whole process.
Speaker 2 (08:03):
Yeah. Yeah, that's that's exactly right. I love that.
Speaker 3 (08:07):
Because you know, if someone's going to just a regular doctor,
they're going to be like, well, do you eat twelve
hundred calories?
Speaker 6 (08:13):
Go keto or whatever?
Speaker 3 (08:14):
You know they do, right, And it really is a
multifaceted situation in which people need all these things right,
it's it's mindset, it's behavior, it's you got to get
into the gym.
Speaker 6 (08:24):
So the fact that you have all that is actually
quite amazing.
Speaker 2 (08:28):
Yeah, it's the ideal situation.
Speaker 1 (08:29):
Now the issue, yeah, I had to leave the current system,
so you can't do it in a current like if
you go to your regular primary care doctor, you're going
to get five ten minutes yep, if they have a
dietitian around, but they're not going to refer to a dietitian.
They probably don't even know a dietitian to refer to,
and your insurance might not even pay for it. So
I did something called it's called direct care. It's kind
(08:50):
of a newer movement. It's not concierge care, although we
give what I would call like more concierge like service,
but it's it's kind of like a it's a subscription
and type of things. So it's okay, one hundred and
fifty dollars a month, which people like, oh, that's expensive,
but it's like it's actually less than what you would pay. Well,
you go to the doctor, you pay your co pay,
(09:11):
but they're going to bill your insurance like a couple
hundred dollars for that visit. So what we do is
we bypass the insurance and then it's just this direct relationship.
And the numbers actually work out because so I can
you know, people can text me and whatever, and they
can ask me questions, my dietician can jump in strength
(09:32):
training programs, all these different things. They can get it
all for just the subscription costs. It's in the United States,
everybody wants to use their insurance for things, and I
understand it's a cultural thing, but it ruins it because
the doctor in order to keep the lights on, they're
going to have to churn through patients because then they
have to pay a person to then do all the
billing for them. And so in the end they're not
(09:53):
actually making that two hundred dollars or making a much
smaller cut of that, because then they have to pay
people to make sure they get all that money.
Speaker 2 (09:59):
It's a whole thing. It's the whole thing.
Speaker 1 (10:01):
I was like, oh, yeah, I'm getting out of here,
but I want to do it the way that I
think is right, as opposed to if you're in a
regular primary care clinic, you're seeing twenty thirty people a day,
how are you going to see? How are you going
to give anything good to that person in front of you?
So that's the gist absolutely.
Speaker 4 (10:19):
Like you said, like, we need to figure out ways
to get people to reduce their calorie consumption.
Speaker 2 (10:24):
And yeah, end of the day.
Speaker 4 (10:25):
That's why so many influencers out there like just eat less,
right less, move more. You know, while technically true, it's
not that simple. It's so much more. It's so much
more complicated than that.
Speaker 1 (10:36):
And then you got other influencers who are like, well,
it's your corticol it's.
Speaker 6 (10:41):
You got to stop.
Speaker 1 (10:42):
Well, one of my patients the other day said they're
they're obesity doctor, and I look them up and they
are definitely a quack.
Speaker 2 (10:50):
I was like, oh my god.
Speaker 1 (10:51):
They were promoting the eighth CG diet all sorts of
just non set stuff. But they told her she loves
swimming and they're like, you got to stop swimming. That's
going to make you gain more weight because of the
court Isol.
Speaker 5 (11:01):
I saw your post about that yesterday.
Speaker 1 (11:03):
To people, people thought I was like, no way, and
I was like, no, this I can't say too much
because it's a it's a hip a thing and whatever.
But this patient is higher level education, extremely smart, and
she'd follow me and that was the reason she was like, Okay,
I can't be seeing this doctor. I know this isn't
there's no way this is right. And that was like
(11:24):
the big red flag to her, and there were some
other big red flags in the visits. So but like
this is what people do. They're either not helpful or
they just make up stuff. So it's really truly frustrating.
Speaker 6 (11:37):
It's like when a doubt refer out I believe.
Speaker 5 (11:40):
As coaches, I mean, we were more and more limited
in our scope of practice definitely.
Speaker 6 (11:45):
Yeah.
Speaker 4 (11:45):
Yeah, so you mentioned court is all there. Can we
talk for a few minutes here about hormones, like what
are our hormones actually doing and what's actually happening and
how do they contribute or what role do they play
in weight loss weight game?
Speaker 1 (11:58):
Yeah, there are different types of hormones in the body,
and they have different functions. They help communicate with other
organs of our body. We have hormones that come from
our brain that then communicate with our other organs that
then send out other hormones that then have functions. So
like thyroid, for example, we have these signals that come
from our brain two different spots. You get the hypothalamus
(12:20):
that goes to the petuitary gland. The petuitary gland sends
out something called thyroid stimulating hormone that tells your thyroid
to then send out actual thyroid hormone, which then also
gets converted into more active thyroid hormone in your tissues.
And that's one that controls your metabolic right, And that's
what everybody wants it to be your thyroid because it's like, well,
obviously my metabolism is low, I'm gaining weight. It's got
(12:42):
to be my thyroid. Very likely not your thyroid. It's
relatively rare, although I have hypothyroidism hashimotos But the most
of the weight gain that you see from it, it's
actually from fluid unless you've had it for so long
that you was undiagnosed. But a lot of it fluid.
So that's that's like thyroid hormone. But then there are
(13:03):
other hormones. Like people love to talk about cortisol. It's
a stress it's a stress hormone. Without it, we would die.
Speaker 2 (13:11):
We need it.
Speaker 1 (13:12):
It helps regulate all sorts of things in our body,
anti inflammatory, helps with our blood sugar regulation when we
need it during stress, otherwise we'd literally die. And so
it's a normal physiologic occurrence that our cortisol would go
up after exercise. It's how it works. And when in
(13:32):
the morning when we wake up, our cortisol is higher.
And what people take a little bit of nuggets of
truth and then turn it into a pathological situation where
they then want to sell you something to try to
fix something that's normal, and that's how they make their money.
They make they get viral on TikTok and Instagram or
(13:55):
wherever threads. I don't really care what it is.
Speaker 4 (13:58):
I actually saw something on the yesterday somebody said, don't
exercise because of raises your cortisol. It's like, that is
the stupidest thing I've ever seen it.
Speaker 1 (14:06):
It's it is so it's so frustrating. So there are
there are pathological conditions. There's something called cushion disease cushing syndrome.
You can either have a tumor in your brain that
sends us too much signal to your adrenal glands to
make too much cortisol. Or you can have a tumor
on your adrenal glands that makes too much cortisol itself.
You can also take too much exogenous cortisol in the
(14:28):
form of like prednozone, other types of steroids that are
similar to cortisol. That's actually the most common thing. People
on prednizone for some inflammatory disorder and their their face
kind of gets round. You get you start having more
abdominal obesity. The thing is still even in those pathological conditions,
(14:48):
it doesn't negate thermodynamics because like if you didn't eat anything,
you still you still need substrate to create mass. You know,
So what what the hormone can do is that pathological levels.
It can shift where you store adipose tissue. It changes
enzymes that change where you would store tissues. So you
(15:11):
do see that your arms and legs actually get skinnier,
and then you start storing it more abdominantly. That's pathological level,
I mean magnitudes of levels higher than what we see
compared to physiologic meaning normal everyday differences.
Speaker 4 (15:27):
So where the fat is being stored is just changes.
It's not These things aren't inherently making you gain fat.
Speaker 1 (15:34):
No. The one thing they can do they are related
to potentially appetite changes, so then you could eat more
so than if you're eating more. It can then exacerbate
it or aggravate it. By then you see it stored
in the places you hate. People probably wouldn't hate it
as much as if they stored it in their button thighs.
I suppose it's the belly. Nobody wants the belly fat.
(15:56):
And the other thing is belly fat is common, so
it's got to be the court of al that's the
belly fat hormone. It's really frustrating because don't tell people
to stop exercising. That doesn't even that's not going to
help you unless you're overtraining and you just need a
recovery break because you're just doing too much.
Speaker 5 (16:14):
That that most people aren't overtraining, right, Most people.
Speaker 6 (16:16):
Are not now most.
Speaker 2 (16:20):
An Olympic athlete, that's right, right.
Speaker 4 (16:23):
What we're saying then is it's still calories. Does all
these things impact calories and can make it more difficult
for people? And I think that that's really upsetting for
a lot of people out there.
Speaker 2 (16:31):
That is upsetting.
Speaker 6 (16:33):
Yeah.
Speaker 1 (16:33):
I always say that they're intertwined. I've done so many
memes and reels and whatever. I just and I honestly
repeat the same thing over and over again. But it's, yeah,
they're intertwined.
Speaker 2 (16:44):
Yeah.
Speaker 1 (16:44):
Sure, when it comes down to it, it's it's calorie
deficits and energy balance. But they're intertwined in a way
to where the the hormones like say thyroid can change
the out and then there's other hormones in the body, leptin, grellin,
LP one, all these other different things that can affect
the d how much we want to ingest, and then testosterone, estrogen,
(17:07):
cortisol can change where we store it. That's kind of
the gest they're so intertwined that it's like, well, yeah,
they can affect that, and then how much we eat
can affect those they're intertwined. But absolutely it's not magic.
We understand it pretty well.
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because you, as a parent, deserve to support your wellbeing
and do something for yourself so you can continue serving
others like the badass that you are. From a lifestyle perspective,
especially with cortisol, right, because exercise isn't acute. Response is
a temporary response. But what about like lifestyle changes. What
can people do there to help, you know, improve their
(19:58):
cort Is all their left in their grilling responses?
Speaker 1 (20:00):
Yeah, so, like I mean, if you're up at night, goodom,
scrolling on whatever your choice of social media, looking at
politics and arguing with people, and then you you're upset,
and then you don't sleep well. The influencer person is
going to try to sell you ashwaganda, rodeola and phosphatidl
(20:21):
seering or some cortisol blocking thing. But really the underlying
issue is that you're not sleeping well. And sure those
things will disturb your your diurnal curves of your cortisol
and whatever. But that wasn't It wasn't the cortisol. That
was the issue. Is the sleep and changes in lifestyle.
Those are not sexy. People do not want to hear that.
(20:42):
They want to hear that it was that it's a
supplement thing. But you don't have a supplement deficient. You
don't have a rodeola deficiency.
Speaker 2 (20:49):
The rodeola.
Speaker 1 (20:50):
Maybe maybe that will help calm you down to where
you're like, oh, I don't even want to go on
social media. Maybe that's the case, you know, and stuff
like that, but it wasn't the underlying issue. So yes,
make sure that you're eating enough nourishing your body. The
standard so boring stuff that people just I know, don't
I mean people, I say, my patients like it. That's
why they come to me because it's like I just
(21:11):
I'm so sick of getting duped by these people selling
me a three hundred dollars detox. I'll never forget. And
in private practice, like about ten years ago, when one
of my patients who they were like medicaid, they but
they paid a chiropractor three hundred dollars for a parasite
detox because they thought that was going to be the issue.
(21:32):
And it was so frustrating because I'm like, yeah, they're
so good at marketing that they'll really really squeeze on
your pain points and turn the turn the knife that
they get you to buy a three hundred dollars detox
when you can't afford that. There's no way they could
afford that.
Speaker 3 (21:48):
Yeah, that's so sad to me. I mean, honestly, I
don't know how these people live with themselves. I don't
know to be so shady and shisty to.
Speaker 2 (21:56):
On a pile of money.
Speaker 6 (21:57):
I think they now play off people. Yeah, it's so fucked.
Speaker 3 (22:01):
I mean I used to be one of those people
that would buy all the supplements and that's why I'm
so adamant about you don't need all this shit. Trust me,
I've spent thousands of my husband's money. I'm still I'm
surprised he's still with me.
Speaker 6 (22:14):
I mean everything, all my hormones were wrong.
Speaker 3 (22:18):
You know, I was taking going to chiropractors this and that,
and where I met Jordan Sayat and He's like, you
just need to start tracking your calories and weighing.
Speaker 6 (22:25):
You're during your food.
Speaker 5 (22:26):
It's not you know, when you were drinking right.
Speaker 3 (22:29):
Yeah, oh yeah, and I was like binge drinking, binge drinking, juicing,
taking supplements and so it's like I can see them
a mile, but it's like I was you.
Speaker 1 (22:37):
That should be your new book, Binge Drink Detox right,
Oh my gosh.
Speaker 3 (22:44):
I would love to actually start talking about some GLP
one since that is I'd really love to actually know
more about it and have our use users are followers
know more about it. So can you talk to us
like I guess how GLP ones came about and how
you use them in your practice, and we could just
go from there.
Speaker 5 (23:04):
I love the.
Speaker 1 (23:04):
Story because it's just really interesting. I've met a few
of the originating scientists and figured it out. They're older now,
but they're just and they're super humble too, not like
the people you see on social media. These are like
brilliant scientists that are just they don't even want to
take the compliment when I'm just like, wow, I love you,
I love you guys. Basically, GLP one a natural occurring
(23:28):
hormone that is released from our testines glucagon like peptide
one after we eat food and general carbohydrate containing food.
They figured this out this incretin effect. They call it
because they inject people with glucos is, like in the
fifties into their veins versus they had people ingest glucose
(23:50):
and they wanted to measure their insulin response, and they
found that people that ingested glucose had a larger insulin
response than those who injected it. And I just I
think that's so cool, because I would think that if
you injected glucose straight into the veins, it would go
directly to your pancreas, which then senses the glucose, which
would then shuttle out all the insulin to get that
(24:12):
glucose into your cells. But no, when they drank it,
there was some sort of effect that made your gluco
or your insulin go higher and have a larger, more
pronounced effect. So they called it the incretin effects, some
sort of intestinal secretion of some hormone incretin.
Speaker 2 (24:31):
And it wasn't until.
Speaker 1 (24:32):
Later on a few decades later where they figured out
the different types of incretins, one of them being GIP,
which is another hormone their studying we can get into that,
but then the other one is GLP one. In the
later eighties they figured it out the glucagon like peptide one.
They teasted it out and figured it out, like, oh okay,
this is one of them that is definitely have any
(24:54):
effect here. The problem is our own body breaks down
natural GLP one within a minute or two. So when
anybody sees all these supplements out there that are claiming
to be GLP one supplements, every single one of them
is nonsense. They're a scam, like they're just they're I
can't believe these I don't even know how meta and
(25:15):
all these people allow people to run ads. I tried
to run an ad the other day for my clinic
and they shut down the whole my whole thing, And
I was like, did you guys even look at this?
And it's probably because I've used one wrong word, and
yet other people are selling just absolute snake.
Speaker 4 (25:30):
It's very I said earlier, there's a whole playbook they've
been they're all falling the same one.
Speaker 3 (25:34):
Yeah.
Speaker 1 (25:35):
Yeah, the bad players will find bad ways to Unfortunately,
the long I do. I think the long I will
win in the long run, but it's a long play
as a player, short play.
Speaker 4 (25:48):
Yeah, yeah, GLP one medications they've been around for quite
some time, like yeah, decades.
Speaker 5 (25:54):
In the early nineties is when they were first started
and being prescribed, right for.
Speaker 1 (25:58):
Two thousand and five is when the first one was approved.
Speaker 5 (26:02):
Got it.
Speaker 1 (26:02):
It was in the nineties, late nineties, early two thousands
when they started figuring out how to do this. Because
so the problem is our own our own GLP one
is broken down within a minute or two. Our own
enzymes break it down so quickly, so it's like, okay,
could we just infuse a bunch of human GLP one
now it'll just be broken down quickly. They did make
drugs that stop the enzyme from breaking it down, so
(26:25):
we get like two to three times more of our
own GLP one. Doesn't actually have much of a weight
loss effect, but it does help with blit sugar control.
But like, so that's why I always say, like, look,
these pharmaceutical drugs that will boost your own GOLP one
don't even have a weight loss effect. So you're all
a bunch of scammers, and you all should be shamed
of themselves and their doctors even promoting this.
Speaker 4 (26:46):
It's really that's really what blows my mind is, Yeah,
we all have a code of ethics to be following here, and.
Speaker 2 (26:53):
You would think. So it is so bad.
Speaker 1 (26:55):
This is I'm so scorned and disenfranchised from everybody. I
just think everybody's a piece of shit.
Speaker 6 (27:02):
I don't blame you because I feel to say what
I think everyone's.
Speaker 2 (27:07):
The other.
Speaker 3 (27:08):
It's it's frightening to be honest. And I'm on your
side on that one. And I'm sure we can agree
that there's.
Speaker 6 (27:13):
A few that we know.
Speaker 1 (27:16):
So basically, what these researchers did they found they found
ways to then go, okay, could we change the molecule
to last long in the body. One scientist specifically found
the HeLa monster that has venom that messes people up.
This heal a little lizard looking thing, and so you know,
you see all the fear mongering around. You're injecting venom.
(27:39):
HeLa monster venom that's going to kill you. No, it's
just a part of it. Of the venom was about
forty percent homologous. It looked forty percent similar to our
own gop one, but it had the benefit of not
being broken down. That was the first one that came out.
It was called xenotide. The trade name is Baietta. Twice
a day injection didn't lead to a lot of weight loss,
(28:01):
but helped a little bit with blood suggers. That was
the first one approved. The very quickly though, within a
year or two, something called leraglutide was approved, and that
was Victosa. If anybody remembers that listening, Victosa for type
two diabetes originally proved for type two diabetes. That's where
they took human GLP one and they modified it. They
(28:22):
put a little thing on it to make it not
be broken down as quickly. That was a once a
day injection. That was like two thousand and eight or
nine or something around there. Two thousand and seven eight nine.
Somewhere around that time they actually studied it and jacked
up the dose. That's in twenty fourteen. That was the
first one approved for weight management, a high dose lyraglutide.
(28:43):
They called that sex Sendah. It was like seven or
eight percent total body weight loss. And I always tell
everybody like, look, we all know good responders from diet
and exercise, but on average, when you put up huge
let's say you put a thousand people on diet and
exercise that all have obesity, the average weight loss is
summer around five to six percent total body weight loss.
(29:04):
So if you're two hundred pounds on average, someone's gonna
lose ten to twelve pounds, and that doesn't seem like
a lot because you see other people they've lost fifty
one hundred pounds. It's just an average. It's an averages thing.
So with sex Senda, it was somewhere around like six
or seven. It was a little bit better than diet
exercise alone intensive diet exercise alone, I should say. It
was expensive too. There's a lot of nausea. People kind
(29:27):
of lost a little bit of weight. So it was like,
all right, this is okay. That was twenty fourteen. It
wasn't for a few years until Ozempic came out. Now
everybody calls every GLP one zempic. It's like Kleenex. It's
not but it's not brand but it's the maglutide. It's
like the younger, better looking brother of liraglutide. It's a
(29:52):
similar one, but they've adjusted it to where now it
lasts about a week in the body. That was Ozempics,
the maglutide that was around two thousand, sixteen seventeen. We
were doing it off label when we could get it,
meaning they didn't have type two diabetes, but we wanted
them to lose weight, but it only went up to
like one milligram, and so people started losing weight with
that one. It was twenty twenty one where they jacked
(30:14):
up the dose of that some maglutide.
Speaker 5 (30:17):
That's kind of start blowing up online.
Speaker 1 (30:19):
That's when it start blowing up online. So that was
a week Govy it went into shortage. The Novo nordisk
I was just on there. I just did an advisory
board for them yesterday, and you know, it was kind
of discussed, like they really dropped the ball on this.
Speaker 2 (30:34):
They don't know how.
Speaker 1 (30:34):
They didn't see the huge boom coming, but they went
into a shortage. It was such a big deal. So
everybody had it then they couldn't get it. It was
a really really frustrating time. That's some magnetide. That one
does around fifteen percent total body weight loss. So now
all of a sudden, we're cooking because we go from that,
you know, five six percent lifestyle then a little bit
(30:58):
better with that liraglutide.
Speaker 2 (30:59):
And there's some older drugs.
Speaker 1 (31:00):
There's one called Cucimia, which combines fentrimine until pyramid older
drugs that gets around ten percent total body weight loss,
so that was decent, But now we're getting fifteen biatric
surgeries around thirty percent, so it's like, wow, now I
got something here. The newest one that's out, and there's
gonna be newer ones that are coming out. It's called urzepetide,
(31:20):
and if you know the brand name Munjaro, which is
for type two diabetes, and then zep bound which is
for weight management. This one is a synthetic peptide that
hits both GLP one receptors and GIP and that's the
other incretin glucose dependent insulinotropic polypeptide. It it's a mouthful,
(31:41):
you don't have to memorize it, but it can hit
both receptors. It's a twin critain or a coreceptor agonist.
That one gets around like twenty one twenty two, a
little bit over twenty percent total body weight loss. So
now we're getting close to what you kind of see
with biatric surgery levels.
Speaker 6 (31:58):
Yeah.
Speaker 1 (31:58):
Well, that's a once weekly injection. And what I always
tell everybody is that patients claim that it's made, they're
not everybody. Most people say like, oh my god, it
stopped me from thinking about food.
Speaker 2 (32:10):
All day.
Speaker 1 (32:10):
Right, it stopped me from craving. It stopped me from
being so hungry and wanting and second serving. I've been
eating so well, I'm eating my broccoli and whatever you
name it whatever good.
Speaker 5 (32:22):
Food noise right, like, which is a newer term and
not a clinical term either.
Speaker 1 (32:26):
Yeah, not a it's not in Yeah, So it's it's
a controversy because we're like, we don't want to just
make a drug to fix something that may not be
an issue. But if somebody's struggling their waiting, they're thinking
about food all day, it's like, okay, this can kind
of at least explain why it works for you. So, yeah,
this ur Zeppetide specifically, I always tell people it these
(32:49):
things help you do all the things you want to do,
but you're just you're just struggling to do them.
Speaker 4 (32:55):
The way I kind of see it, and I think
a lot of a lot of like science based coaches,
even its based coaches and dark such as yourself, say,
levels of laying levels of playing field.
Speaker 5 (33:03):
For people in a way.
Speaker 4 (33:04):
Yeah, right, because people that are, you know, struggling with obesity,
it's not like they haven't tried diet and exercise.
Speaker 5 (33:10):
But yeah, they probably.
Speaker 4 (33:11):
Tried that for so long now, but for one reason
or another, they can't stop thinking about food or or
whatever it might be, right, Like it takes the intensity
of it away.
Speaker 1 (33:20):
Yeah, And you know, people want to say that these
things are like fat burners or magic but like.
Speaker 5 (33:26):
The easy way out.
Speaker 2 (33:27):
Yeah.
Speaker 1 (33:28):
Well, and I was just looking, but some patients swear
up and down they're eating twelve hundred calories. I mean,
like there's three hundred pounds. They think they're eating an
eight hundred or twelve hundred calories. And I'm like, and
they swear up and down, and I don't want to
be the jerk doctor to be like, no, you're not.
Speaker 4 (33:41):
Got to call bullshit, right, Yeah, that's a that would
be that's very upsetting too, because then you don't you
don't want to call them a liar, right right, But
you're very you may they actually may believe that. I mean,
we know there's research out there that humans are just
really bad at estimating their colorak intake, bad, tracking it
even of times too extremely bad.
Speaker 1 (34:01):
And they swear up and down that the medicine has
to do something more than help them eat fewer calories.
But all the data show that maybe there's a benefit
to the metabolic adaptations that you see, so you probably
talked about it. But basically, the metabolic adaptation is when
you lose weight, let's say at least ten percent of
your weight. So you're let's say you're two hundred pounds,
(34:23):
you go down to one hundred and eighty pounds. You
at one hundred and eighty pounds, your your basal or
resting metabolic rate is actually maybe a little bit lower
than what we'd expect based on your body composition and size,
So it could and it's it's not even that much.
It's like it's slightly lower. So it's thought that these
(34:44):
drugs may help minimize that metabolic adaptation, but it hasn't
panned out in humans. And even if that were the case,
it's the equivalent of a few oreos. It's it's one
hundred and two hundred calories. Maybe, yeah, but when they
look at these medicines really just help people eat fewer calories,
and patients claim they're like, nope, I was eating twelve
hundred calories before, I'm eating twelve hundred calories now, and
(35:06):
now I just lost one hundred pounds. I'm like literally
physically impossible. But you know what, I don't want to
argue with you because it doesn't really matter. You're doing fine.
But it's a very hard discussion I have.
Speaker 6 (35:14):
Yeah, yeah, totally. Who is a good candidate for a
GLP one and where if it should they go?
Speaker 3 (35:22):
Yeah, if they are struggling with obesity, because I feel
like and I don't feel I know that people are
going medspas. Oh yeah, you know what I'm saying, Where
would you recommend someone go and not go? Yeah?
Speaker 1 (35:36):
So there's a future state where I could see everybody's
on these things. I just I don't know what's going
to happen. It could be that I'm taking one and
not for weight necessarily, but for maybe cardiovascular prevention. And
everybody's talking about microdosing and small little doses here and there.
We don't ad word. That's a data free zone.
Speaker 5 (35:55):
Maybe they actually want to talk about that a little bit.
Speaker 6 (35:57):
Yeah, I have that on my notes.
Speaker 2 (35:59):
It might it might be fine.
Speaker 1 (36:00):
I'm much more like, hey, you know, hypothetically, it could
be okay, but like, we don't know that. So we
do have good indications for it. It's so for type
two diabetes, clear indication for it. Blood sugger is a
little bit elevated or a lot of bit elevated, clear
indication for one of these medicines. And then we get
(36:21):
into obesity. Now the controversy is, you know, it's all
based on BMI pretty much, and what they're trying to
switch to is more of a what it's called like
a clinical definition of obesity, because like you can have
somebody that's a twenty four twenty five BMI that has
like pre diabetes, hypertension, high cholesterol, all these different things,
(36:44):
and you can have a thirty BMI or thirty two
or thirty five even whatever, and they are like starkly healthy.
Otherwise despite their weight and its possible insurances might not
approve the medicine for that twenty five, despite they need it.
They have too much body fat on their body that's
(37:07):
causing dysfunction, that's causing them harm, whereas the other person
stores their weight just fine, and it's actually, you know,
the weight isn't fun necessarily for that person, but it's
not metabolically harming them. And it may not even be
physically harming them. They may not have any sleep apna
or knee pain or joint issues, and they could but
(37:28):
I'm just kind of trying to make a stark contrast there.
So the guide FDA guidelines are a thirty bmi body
mass index kilograms for meter squared, and that doesn't go
into muscularity or whatever. But it's a thirty bmi. So
technically you would qualify if you had a thirty bmi
regardless of your body composition. A doctor should assess that,
(37:51):
but like they don't always, but or a twenty seven
bmi plus what's called a weight related comorbidity, and this
is anything weight so pre diabetes, type two, diabetes, high
blood pressure, high trigly rides, osteoarthritis, if your knees, obstructive
sleep apnea, those types of weight related issues pcos would
be considered one as well. So those are the indications.
(38:15):
I would say, though, that these medications would be something
for someone who has excess body fat that's causing them
issues of some sort. I think that's reasonable what I
prescribe to somebody with a twenty I'll get these patients.
They come and they're like, I have a twenty two
BMI I want to get down to. Well, they won't
(38:38):
say that, they'll say I have to do the calculation,
but there are a certain weight they're pretty thin, and
they just want to get another ten pounds off. And
I always have to be like, I'm not the person
for you to do this. It's yeah, first, do no harm.
I can't say that this won't harm you, and I
don't think this is going to benefit you other than
from a purely aesthetic vanity.
Speaker 2 (39:00):
Point.
Speaker 1 (39:00):
And I think vanity's fine if we all, like my patients,
all want to look better too.
Speaker 5 (39:05):
I mean, who doesn't look better?
Speaker 1 (39:06):
Yeah, exactly, Yeah, it's more of so I come at
it from that clinical medical standpoint. So then they're going
to go to the medspa place and they will sure
as hell give it to them because they're going to
sell it to them in a form that probably isn't regulated.
They'll sell it right out of their office and inject
them right there and charge them a thousand bucks or
something like that.
Speaker 2 (39:27):
So obviously I.
Speaker 1 (39:28):
Want everybody to so my clinics in all forty eight
different states. It should be in fifty here soon. I'd
love everybody to go there. But like, if you have
a good primary care doctor and you feel like you
have excess body fat, that's beyond what's healthy for your
body and you have some of these weight related issues
(39:49):
and you can look at your BMI again it's on
the it's the FDA label, so like I can't change that.
But your primary care doctor if if they are I
don't want to say smart, because they may be smart,
but just black. They may not understand these medicines. But
if they're open to at least discussing it, they should
(40:11):
be able to do it. But obviously otherwise you'd want
to go to a clinic. Like mind, if you go
to you, if you go to one of these sketchy metspots,
they'll give it to you. It doesn't matter who you are.
And yeah, you don't know what you're going to get
when you can.
Speaker 4 (40:23):
And I think if this coach is Beth myself, like
that's where we take issue with these drugs, right, the
over a prescription of them. Yeah, these corner met spas
people are all necessarily needed them, especially because then.
Speaker 6 (40:35):
They're not getting no guidance.
Speaker 4 (40:36):
They're not getting the guidance right exactly, yes, thank you bet,
they're not getting the nutritional guidance. The behavior change aspect
of like why why do we get here in the
first place, and being under muscled, which is a huge
problem in our society, right, And they're not being prescribed
strength training, and I know that's a very very important thing.
And that's something that you do is have resistance training alongside.
(40:59):
And like you said, the registered itcticians, you get nutrition
support and behavior support.
Speaker 1 (41:03):
That's exactly right. So they'll get they'll get the prescription,
they'll go off, they may have side effects, they they
won't be monitored very closely, and again who knows what's
in what they're actually in jacting.
Speaker 5 (41:14):
They're going to like a compounded pharmacy to get those drugs.
Speaker 1 (41:17):
And yeah, and I've made people get so mad at
me about it all. They're like, you're a big pharmas
shill And I'm like, no, you guys aren't thinking about
this deeply. They're like, no, big pharmass corrupt. I'm like,
and you think little pharma.
Speaker 6 (41:30):
Right, Parma, They're way more corrupt.
Speaker 1 (41:35):
They're doing the they're not doing the research to actually
develop these drugs. They're copying intellectual property just to make
their buck and they're selling it to you directly. It's
it's they're actually making way more money.
Speaker 5 (41:48):
Huge market.
Speaker 1 (41:50):
It's it's it's it's actually insane. So they're not the
good guys. I think they have their place during the shortages.
It was like one of those things where it's like, well, yeah,
need for it. But what they did it was they
exploited the loophole and then started selling it to everybody.
Everybody in the brother, mother, sister, and uncle's, aunts and everybody,
grandma's whoever. Now all those people now that the loopholes closing,
(42:14):
now they're without their medicine. And yeah, they made going.
Speaker 5 (42:19):
Big problem too.
Speaker 4 (42:20):
Yeah, people that have been prescribed these from those medspas
because the compounding pharmacies, right, and what is a nova
neurodisc right, So.
Speaker 1 (42:28):
Novo Nordisk is like the is the smaglotide company that
developed that ozempic and we go be when I lost
it right against there's a bunch of them. They're so
they outsourcing the ofa this compounding place. Tried to sue
them and Eli Lilly, who's the ter zeppetites that bound company.
And I think at the end of the day, though,
(42:50):
they do need to bring these prices down because what
they're going to see these drugs are basically it is
kind of for the rich.
Speaker 2 (42:57):
I mean like I can't.
Speaker 4 (42:57):
I can't even know as they compared to other countries
where it's really hard to argue like that big farmers
not corrupt when we see these drugs available for pennies
bucks dollar compared to hear right, arm.
Speaker 2 (43:07):
Bucks over wherever Brazil or the UK or wherever.
Speaker 4 (43:10):
They have different prices, which that can be true, but
it doesn't negate the fact that these are actually really
powerful drugs that can change people's lives too.
Speaker 1 (43:17):
Yeah, so what they need to do is really get
the prices that well, I think we're going to see it.
We're going to see all these other competitors. I mean,
there's newer, newer drugs coming down through the pipeline and
we're not going to have this kind of duopoly monopoly
type of situation with no NORDICSK and Eli Lilly. Well,
I think, are you know, I like them and that
they develop these but like clearly it's ridiculous and it's
(43:40):
not just them, And there's also these pharmacy benefit managers
who are these in between middlemen so to speak, who
negotiate between the manufacturers and the insurances and they're they're
getting their kickbacks. So instead of yeah, so the jets,
it doubles the price. They everybody loses in the middleman, right, Like, no,
there's no point having them, honestly. So they can make
(44:02):
these drugs for easily one hundred bucks and they'd still
make so much money.
Speaker 4 (44:06):
Honestly, I see those depositions that they have in front
of the congressmen and senators and how they dodge those
questions about why is it not cheaper here? You know,
they don't want they will never answer that question. But
so going back to like, you know, being the crackdown
on these med spas and the over prescription of these meds,
(44:28):
We've seen a lot of headlines and this is one
thing that the influencers out there that are nefarious and
nature like to talk about, is how, oh, you're going
to gain all that weight back after you get off
these meds?
Speaker 5 (44:40):
Right, so let's cut the crap here. What does that
actually look like? Is there some I mean weight gain
if you do step these medications? What should we expect there?
Speaker 4 (44:50):
It's my understanding is these are kind of a forever
drug because they don't really change anything in your body
unless you're taking them permanently.
Speaker 1 (44:58):
No, you're you're right, it's it's similar to I always
use blood pressure medicine. So yeah, let's say you do
all the diet and exercise things that we know help
lower blood pressure, or blood pressure is still one forty
over ninety or something, it's elevated. The doctor says, let's
put you on a blood pressure medicine, something like go
whatever Life Centerprill. There's a bunch of them, and the
blood pressure goes down to one twenty over eighty. And
(45:20):
then they're like, all right, your blood pressure is good.
Let's take you off the medicine. Now, just those biological
things that drive it back up will reoccur with weight.
This is why we call it treating the obesity. There's
a lot of semantics involved here, but whatever, we're treating
what I would call the disregulated appetite because, like we know,
(45:41):
people need to eat fewer calories. These drugs are not
magical in some sort of way where they magically make
you factor.
Speaker 5 (45:49):
Making a twenty eight fifty calories right.
Speaker 2 (45:51):
No, but people people think they are. I mean, this
is why we kind of talk. I just I yeah,
but that's that's how they work.
Speaker 1 (45:58):
So if somebody uses diet exercise to lose weight and
they stop doing whatever it was. So, for example, calorie tracking,
you can switch people off to other ways of trying
to monitor their intake whatever whatever that is. You can
find ways to keep people eating fewer calories, and sometimes
that works. But like with this, we're literally treating the
(46:21):
disregulated appetite whatever it is. You can't feel full after
a normal meal. You you don't feel sat shiated, You're
craving a lot. Despite all the behavior therapies that we do,
and despite all the good and healthy foods that we're
trying to get you to do, and you still keep
thinking about food. So then you put them on the medicine.
They stop that when you stop the medicine. If there
(46:41):
was an underlying biological thing that caused that dysregulated appetite
in the first place, it will likely come back. Now
people that are wrong saying everybody needs to stay in
these forever, because they've actually done it. They've put everybody
on the drug, and then part of the way through
they randomized portion of those to a placebo and then
you see a bunch of them regain their weight, but
(47:02):
not everybody regains their weight, and we hear them you'll
see it on when i'd write post about it. They're like,
I've kept one hundred pounds off. I stopped it a
year ago. But they're few and far between. It's like ten,
maybe ten percent, you know, five, ten, fifteen percent of people.
So it can happen. And what I think in those people,
they must not have had that biological issue in the
first place. Those people probably had you found the right
(47:27):
coaching aspect. I think they probably would have been successful
without it.
Speaker 2 (47:30):
That's my guess. Can't prove it. I don't know how.
Speaker 1 (47:33):
That's a trillion dollar question of who those people are.
But in general, yeah, if you're treating that underlying biological
issue and you remove it, likely it'll come back.
Speaker 2 (47:44):
It would be.
Speaker 1 (47:45):
So the other example would be going back to hypertension.
We do know of people that come off their blood
pressure medicine so and it's because they probably did some
lifestyle changes that allowed them and then continued with those
that allowed them to come off their bloo pressure medicine,
and they continue those lifestyle changes. That's that's that's the key.
So I likely going to have to be on one
(48:06):
of these long term unless in the future they're looking
at editing our genes and all sorts of crazy I like,
there's some crazy shit coming down the pipeline. I don't
even know what knows what the future holds, I don't know.
So that's that's the just for now, though they are long.
Speaker 2 (48:21):
Term for most.
Speaker 3 (48:24):
I have a question about because I've been seeing this
and also in my DMS also another doctor that we know,
I believe that she's also promoting this now microdosing glp
ons from menopause. Yeah, yeah, to get rid of the
menopause visceral belly fat, which we all know comes down
to being in a calorie deficit. Is there data supporting
the microdosing for glpans for menopause? And she also talked
(48:47):
about inflammation and she was throwing them around all these things,
right buzzwords of course, yeah, exactly. And I'm like, I'm
going to ask doctor and adults key about this. I
didn't say that, but that's one of my questions that
I want to talk about because I feel like it's
another thing right that may possibly be misused or maybe
it's not, maybe actually a legitimate I don't know.
Speaker 1 (49:07):
Yeah, So this is where I say, like microdosing, it
just means a smaller dose of what you would use
compared to the clinical doses that are end up going
a lot higher, but you can use lower doses and
they can still have an effect. But so somebody in
menopause that uses a small dose of these to lose
some weight, it's literally because it's going to help them
(49:28):
eat fewer calories. It's not magically burning off the visceral fat.
And they've done this many times, and people thought that
maybe exercise is better than diet when it comes to
reducing visceral fat. That's a thought that's out there, but
very smart physicists, Kevin Hall, you can look up the studies.
He's the guy that did the Biggest Loser. Just a
(49:50):
brilliant yeah, my friend, smart guy, and they actually looked
at it and it looks like it really depends on
how much visceral fat you had in the first place,
and it really doesn't matter. However you create the calorie deficit,
that's what's going to be getting rid of the visceral fat.
So it's not like these medicines target your visceral fat
and somehow melt that melted away. Now, actually, there are
(50:13):
some interesting things about retatritide, which is coming out probably
in a year or two that does actually have receptors
on the liver that may actually preferentially burn or oxidize
liver fat. But either way, in general, these current ones,
if you do a microdose and you lose belly fat,
it's because it's helping you get into a mild calorie deficit.
(50:35):
And like people can get mad about that. Now, when
you talk about inflammation, people throw that word around. It's
an immune system reaction. It's just that we actually need
inflammation again kind of or it's all whatever.
Speaker 5 (50:47):
It's not necessarily a bad thing.
Speaker 1 (50:48):
Yeah, it's like a cute like you sprain your ankle,
all these different you know whatever. But chronic inflammation is bad.
So chronic inflammatory diseases, you get soriatic arth right, whatever,
it's also record arth writ It's all sorts of different things.
And we have anti inflammatory biological medicine. So these these
drugs do have anti inflammatory effects. So but when people
(51:12):
throw around I just have inflammation, it's like what do
you what do you mean?
Speaker 4 (51:15):
You just kind of feelam So then it's fair to
be fair to assume with that anti inflammatory effect, then
we're seeing some water reduction water weight eventually.
Speaker 1 (51:22):
And then when we first start taking that's when they
describe it. That's got to be what they're describing is
that they they're having fluid. But the other thing is
these medicines do have may have like a small diuretic
diuresist type of effect. There could be some things there.
But yeah, maybe they feel in flame, just kind of
achey and whatever. Maybe it's taking care of that some
puffiness maybe, but like, yeah, the visceral fat, it's helping
(51:45):
them get into a lower calorie deficit. But I just
hate it when people, first of all, the people making
those comments, and I know who you're talking about that
just these Charlotte they're just Charlatan's. I know, I know
we have millions of followers. Very frustrating to see because
they're just spreading abs. They're not the people at the
conferences that I go to awarding the they're not doing
(52:06):
the research. They're just making up stuff they'll read. They
don't even know how to read the research papers. You
can tell I go, yeah, if they ever.
Speaker 5 (52:13):
Sight a paper, if you go and read it, it's
probably not saying what they want.
Speaker 6 (52:16):
Oh, I mean the rats study you decided, okay, sounds good.
Speaker 1 (52:20):
If they would have done one of those at Journal
Club during our training, they would have gotten eviscerated, but instead,
now they found a way to monetize it because they
know that if they use these buzz words and present
it in a way, they'll get tons of likes and
they're getting the dopamine rush from it, and then they're
probably making money off of it, so then it perpetuates it.
They're so frustrating because it's like, why can't you just
(52:42):
be honest, Why can't you be normal and honest?
Speaker 2 (52:45):
Like what is it?
Speaker 3 (52:45):
Yeah, that's the frustrating thing to me because as a
fifty two year old menopausal woman and nutrition coach and
stuff like that, I have these people in my DMS like,
this is what's happening. I need this for visceral fat
because this person told me this, and then they feel
like I just this happened overnight.
Speaker 6 (53:01):
I'm a clean eater.
Speaker 3 (53:02):
I'm like, okay, you know the typical Like, you know,
I just gained weight under nowhere and my visceral thought
and now I need GP one microdosing because someone told
me that, and now everything's better. It's like, well it's
really not that difficult.
Speaker 1 (53:15):
But so so this is why I think in the
future I think what we're going to see big pharma
wants to make more money, and this is where it's like, okay,
like I guess capitalism, they whatever. But I think they're
going to probably study smaller doses in everyday people to
look at weight reduction, prevention and longevity purposes.
Speaker 2 (53:35):
I know this, Yeah, I want everybody.
Speaker 3 (53:37):
And I was just saying this morning that I think
that everyone's gonna be on it at some point, like
all of us are just just going to be like,
you know what, because our world is so dopamine hit, right,
It's like.
Speaker 1 (53:49):
We may need this, I think. So I imagine I'll
be on a load. I don't know, a very low dose,
a pytro dose, if you will.
Speaker 4 (53:57):
I don't know, Spencer, if this is outside of your
will house. But I've seen some cool studies out there
related to kind of some of the non weight loss
impacts that he strugts connection, such as alcohol use disorder
and things like that.
Speaker 5 (54:09):
Can you speak to that or is that not something
new You're.
Speaker 2 (54:12):
No, it is.
Speaker 1 (54:13):
I published a paper and jam on alcohol because basically
what I was seeing. I went viral on TikTok for
actually like normal stuff because I go, hey, look you know,
I just right away I was noticing zep bound specific
or Manjaro, i should say, because I was writing a
lot of it off label right when it came out
in twenty twenty two or whatever it was. It's like
one of the first people to start using a lot
(54:34):
of it, and my patients would be like, one of
the weirdest things is I just don't want any more alcohol, right.
I just thought it was, so I was like, really,
that is interesting. We saw it a little bit with
like ozempic and we Goby, but not like with zep Bound.
So then I just I posted about it and just
TikTok people like, oh my god, I'm having the same thing.
And it was kind of one of those things because
(54:55):
it's so new and novel that then everybody started talking
looking all about it. And now we did a study
and now they've actually been randomized trials, because cool. Yeah,
So like randomized trials. There's an effect that these drugs
work up in the brain in various areas that are
related to the rewards center and addictive like behaviors or
(55:18):
addiction behaviors.
Speaker 5 (55:19):
Not just alcoholic drugs. It can ambling maybe.
Speaker 1 (55:23):
Or sorts of stuff potentially sex addiction and biting your
nails and wo what whatever, all sorts of stuff. Some
people don't notice the effect. I will say that they
that it can potentially have too much of a pronounced effect.
I do see some people get lack of a motivation
(55:44):
to do anything because I think they're dopamine and all
of it. That system is dampened down too far. I
see that once in a while. Again another issue with
going to a met spot. They won't they won't monitor that,
they won't even.
Speaker 6 (55:55):
Ask about it.
Speaker 1 (55:56):
So I talked to my patients about it, and they're like,
you know what, I haven't been feeling like I want
to go to the gym or whatever. So then I'm like, okay,
I got a lower dose. We got to work through
this and whatever, make sure that they're doing okay. But yeah,
there's absolutely an effect. So the other thing that there
are non weight effects. So everybody saw it looks like
they reduce heart attacks, and it's got to because they're
(56:18):
losing weight. It's it's likely mostly I think weight independent effects,
meaning they don't have to lose that much weight for
it to reduce risks of heart attacks. That's why I
think what we're going to see is someone like me
or whatever and everybody preventing heart attacks by using just
a low dose of these things without even much loss.
That's what I think, Sorry, idol arthritis, rheumatory darth writis.
(56:43):
I'm seeing patients say again, that's why these are anecdotes.
You need to actually study it. Yeah, right against a placebo.
But they claim that some of these, like trurezepetite, for example,
is more powerful than their other biologic that's super expensive
that they were taking whatever, hum Era, Skyrizzi, whatever, This
(57:04):
was the thing that helped my joint pain the most.
So it's like, okay, there is an anti inflammatory effect.
Had nothing to do with their weight. People are having
periods again without losing their weight because I thought, oh, pcos,
so it's helping them weight, which is helping their pcus.
Now that they didn't even lose weight and they're starting
to have normal periods, I'm like, Okay, clearly there's a
bunch of non weight related things going on here, so
(57:26):
kind of interesting.
Speaker 5 (57:28):
Very intriguing.
Speaker 4 (57:30):
I know we're running out of time here, but I'm
curious too, Like, what can you talk about with the
importance of strength training in all of this because an
appetite control too, because one thing I've seen with clients
and just heard online too is how little a lot
of people are actually eating too, which can be of
obviously harmful long term. So we have to be verally
aware of making sure we're eating adequate calories and macronutrients.
(57:53):
Micronutrients in conjunction with building a strong body.
Speaker 1 (57:56):
Yeah, so you see this with people doing very low
calorie diet and not strength training and they feel like
crap and they're losing a lot of weight. They'll get
really thin unfortunately, can lose strength and muscle. We don't
want people to be frail. So I follow the same
kind of principles of sports nutrition that we've known for
(58:16):
a long time, is that like, okay, I try to
shoot for somewhere of a half of a percent to
a one percent of their total body weight per week.
So if they're two hundred pounds, let's just say that
to be easy, one percent would be two pounds a week,
So I try not to go above that. For each person.
There's water weight loss in the beginning. That's why I
have the dietitians, because like I monitor their weight loss rate,
(58:38):
I have the dietitians there as well, and we have
the strength training. So then if they're losing weight faster
than that, probably not eating enough, So that's one thing.
Then you actually ask them what they're eating and if
you try to get dietary composition of whatever they're eating.
Oh yeah, I'm basically eating bread because that's all I
can tolerate because I don't feel like eating much. It's like,
(59:00):
hold on a second, let's make sure you get some
more protein. It's the goal isn't to just lose weight
just to lose weight. We want to make them healthier
in the long run too. Yeah, that is why you
monitor closely. And if you at the very least monitor
the rate of weight loss, you can kind of estimate
how much you're eating, but you won't be able to
tell how much protein they're eating unless the other thing
(59:20):
you can do is monitor their strength levels too. Obviously
easier said than done sometimes, but that's the gist.
Speaker 5 (59:29):
Awesome, thank you for clarifying that.
Speaker 6 (59:31):
Yeah, you're doing great workout there, doctor Spencer and Adlski.
Thanks one of the good ones.
Speaker 1 (59:37):
Your reels crack me up because I Jordan's like, you
gotta follow that house, like do I know her, and
then I clicked and I was just like cracking up
about I was just like, oh God, that's right down
my uh uh, I love it, my alley.
Speaker 4 (59:52):
Yeah, that's awesome, absolutely amazing. Thank you so much for
coming on here today. Yeah, hopefully people have learned. I
know we've learned some things here. If people want to
learn more about you, potentially work with you in your
clinic or something like that. Where can people find you?
How can they look at.
Speaker 1 (01:00:07):
Yeah, so my clinic is join vineyard dot com like
a vineyard, like you're not drinking wine, but supposed to
be kind of a place you want to hang out.
So join vineyard dot com and then you can get
me on Instagram, doctor Spencer Dodolski. I'm on Facebook, TikTok, threads, Twitter,
all the different places. I have a podcast called Docs
Who Lift, where we promote you know, lifting as exercise
(01:00:30):
and go over all these medicines and detail. My brother's
an endochronologist and yeah, Carl, he's five to five and
looks like me, but shrunken down. I always say he
has he had abs in utero, and abs aren't made
in the kitchen, They're made in the in.
Speaker 2 (01:00:45):
The in the womb.
Speaker 6 (01:00:48):
Oh that's too funny. And I think I remember you talking.
Speaker 3 (01:00:51):
Maybe it was one of the podcasts with your brother,
or you were on somebody's podcast, but remember I remember this,
like years back, you were talking about that you wanted
to create something that you can have nutrition, strength training,
and you wanted like a one stop shop.
Speaker 6 (01:01:04):
And I feel like that. I feel like that's what
you're doing right now, and this is it's like happens.
Speaker 1 (01:01:09):
Yeah, I have to the next step would be doing
potentially brick and mortar clinics. It's just there're a lot
more and so like the overheads a lot higher. So
future state would be like, yeah, everything weather, insurance pace
for I don't know if I'll ever get to that point,
but I want to make it at least accessible for
most people that they're like, this is like a cable
(01:01:29):
subscription or something like that.
Speaker 5 (01:01:30):
Yeah, imagine having Jim at your doctor's office.
Speaker 2 (01:01:34):
Yeah, I'd enjoyed. I'd probably use it the most right exactly.
Speaker 6 (01:01:42):
Thank you so much, doctor Spencer Dadolski. It's been a
pleasure having you on this podcast and keep in touch.
Speaker 2 (01:01:49):
Thank you.
Speaker 6 (01:01:49):
We will be posting this, I think on Friday.
Speaker 2 (01:01:52):
Perfect collaborate or whatever you needed.
Speaker 6 (01:01:55):
Absolutely, thank you.
Speaker 3 (01:01:57):
I hope you enjoyed this episode, so why not share
with a friend who needs to hear it? Send us
a DM on Instagram or email us at cutthcrappod at
gmail dot com, and join our Patreon at Patreon dot
com slash Cut the Crap Podcast. As always, we appreciate
you and thanks for being here.
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