Ep. #1024: Spencer Nadolsky on Reasons to Use and Avoid Weight Loss Drugs

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Hey Spencer, thanks for coming on the show again. I appreciate it. 

Dr. Spencer Nadolsky: Thanks for having me again. 

Mike Matthews: Yeah, sure thing. I’m looking forward to, to, to talking to you. We’re emailing back forth on some subjects because these things that we’re going to talk about in the podcast are things that I have gotten asked many times in emails.

And some of the stuff I’m, I have a cursory understanding of. I don’t have a great answer for some of it actually. So this is, I think it’s going to be, I think it’s going to be, there are things that I haven’t touched on, which is going to be nice. Cause at this point with doing so many podcasts and writing so many articles, it’s sometimes it’s hard to find what’s something new that I can talk about that people even care to hear.

Dr. Spencer Nadolsky: It’s only so many times you can talk about eat more vegetables and fruit. 

Mike Matthews: I know and less and move more and stop eating so much shitty food, please. Yeah. Yeah, 

Dr. Spencer Nadolsky: so yeah, so that’s why I tried I emailed you to think of something a little bit different and obviously to Talk about my new book that’s coming out that kind of has some of this information.

Mike Matthews: Exactly. Exactly So you were just telling me before we got on here that you’re talking a bit about just the state of obesity research and kind of [00:04:00] the disparity between the What is known scientifically and what is out there in the mainstream and what the average person kind of equates with weight loss or what you have to do to lose weight and so forth.

Dr. Spencer Nadolsky: So yeah, I go to these obesity conferences, so I’m a, what’s called an attending physician. I have my board certification and everything like that. But since medical school, I’ve been going to these obesity conferences one or two a year. And every time I go, it’s the smartest obesity researchers in the world and the smartest physicians that have such success with their patients.

And everybody gets together and talks about what’s the best way to help their patients lose weight, what’s the latest research. And one of the issues I find is that a lot of this information is in these guidelines and research papers and everybody’s talking to each other, the doctors and the researchers, but a lot of this isn’t getting into the mainstream media.

What you see a lot of times is There’s a lot of fad diet type 

Mike Matthews: [00:05:00] stuff. Why do you think that is? Do you think it’s just marketing? I’ve thought about this myself and I figured I guess it’s just marketing and it’s just pandering to, what people what’s the, what’s seeing what sounds the easiest or, trying to put some new twist on science or history that always, if you can mix that up and there’s the paleo whole thing is if you can combine what seems to be historical with.

Scientific information, then you can convince people of anything, not that even paleo eating is all that bad, the whole mythology is a little bit is just not accurate, but what do you think it’s just marketing or 

Dr. Spencer Nadolsky: it is? It’s a marketing thing. It’s trying to take sensible information. And good information and making it sexy and you’ve done a really good job at that, you have very evidence based information in your articles and books, but you make it sexy and you get results, right?

So these doctors, and researchers are. They’re good at doing the bench research. They have, they do these randomized controlled trials and other types of studies. And they know how to [00:06:00] write academically in their journals. But that doesn’t translate, that reads like a textbook. And it’s good for us as clinicians and researchers to read that and discuss it at these meetings.

But a lot of times it just doesn’t get To the lay public or the general public, 

Mike Matthews: right? 

You just can’t rise above the marketing noise that, 

Dr. Spencer Nadolsky: so then you get other people, other doctors that will take one little thing, something like sugar for fructose or. You know anything and make a whole book on that and take some truth, but grains or gluten or 

Mike Matthews: whatever 

Dr. Spencer Nadolsky: Exactly can sensationalize it and turn it into a whole You know almost like a cult like following but in the end it’s It doesn’t really matter because it doesn’t mean the other principles that we discuss at these meetings are wrong.

Mike Matthews: And then sometimes, you have a lot of where something can seem to work, but what the person doesn’t understand is why is it working. So it’s like I could tell someone. That they’re not allowed to eat this long list of fruits and [00:07:00] foods. And I can make up some weird list of reasons why, or try to, misrepresent research or whatever.

And then all I’m doing is cutting their calorie intake in half and they lose weight, but they don’t understand that it’s not because they didn’t eat fructose or starchy carbs, or they stopped eating carbs at three o’clock in the afternoon or any of that shit. It’s just, they ate less food. Oh wow. And then you look like the man for doing it.

Exactly. And then it sells the whole it’s because it’s the no fructose, no starchy carbs after 3 p. m. Diet. Exactly. You got it. So this kind of rolls into then what you’re doing, what you want, what, tell a bit about your book and kind of some of the topics that you’re covering in the book, because in, in emailing, those are the things I think that we should dive into.

Dr. Spencer Nadolsky: Yeah, so I call it the fat loss prescription. Yeah, it’s because I’m a doctor and I figure it has to do something with a prescription of some sort, but so basically what I wanted to do is take all this information I’ve learned at these conferences, all the guidelines that we read as an obesity physician, and condense it into a patient friendly book that literally [00:08:00] uses my voice to speak to them about the evidence based lifestyle, but also, so the diet and exercise types of stuff and how to do those things and how to lose weight.

But it also dives into medical reasons why you can’t lose weight. Also medications that may prevent you from losing weight, which is what I think a lot of people should know. They can talk to their doctors if there are. Alternatives or or just to know, at least this might be preventing them from losing weight.

Mike Matthews: Yeah. Let’s talk about some of those things because like sure you have energy balance and you have a high protein diet is the way to go and you should be exercising and you should be doing some resistance training. That’s the stuff that people like you and me have. Just okay, that’s going to work for the vast majority of people that don’t have any sort of extenuating circumstances.

But then and this is where I get, I’ve gotten lots of emails regarding medications like antidepressants and stuff and how is, where people are having trouble losing weight and they’re not stupid. Like they understand what they’re doing. They know that they’re not [00:09:00] passively, they’re not accidentally overeating by mismeasuring their food.

They’re not making the common mistakes that people make. You know what I mean? I’d love to dive into that and just hear from you what are, because you’re dealing with it all the time, a lot more than you deal with that stuff a lot more than I do. So I’m curious to hear from you. 

Dr. Spencer Nadolsky: All right.

So when I get a patient and I immediately obviously get a history and physical and all this stuff, but I look at their medicines that they’re. Taking especially when they’re coming to me for weight loss and I know a lot of your followers I don’t know the exact demographic but I’m assuming you know anywhere from 20s 30s But about I know you have some 50 and 60 year olds in there, too 

Mike Matthews: I would say, it’s really spans probably the majority are between 18 and 35, but from, 35 ish up to 50s and 60s, there’s, there are quite a few.

Dr. Spencer Nadolsky: For women and, even guys too at this, around that age, a lot of us are getting prescribed antidepressants because we go in, we’re feeling tired, the doctor says, Oh, you guys, I guess you’re depressed. Here’s an 

Mike Matthews: amphetamine. [00:10:00] Here’s medical cocaine, have some. Yeah, 

Dr. Spencer Nadolsky: So it’s it’s scary because, and the other thing is, younger kids are, they have ADHD or they just have some sort of mood disorder where they put them on powerful antipsychotics, but you’re listening to the doctor and they don’t call it an antipsychotic, it’s just a medicine to help with the mood.

Seroquel is one I see a lot that’s used off a little bit off label and younger. Folks to help people sleep that one can cause a big time weight gain and that one’s, it’s an antipsychotic. It’s not commonly prescribed to just everybody with depression. But I see that a lot.

Mike Matthews: I’ve heard from people that on that drug specifically. 

Dr. Spencer Nadolsky: Yep. And that when I’m like, holy cow, it’s a very powerful antipsychotic, but they get put on it for this off label use of it. Some sort of mood disorder helping them sleep that one will rack on the weight very quickly And how 

Mike Matthews: does that what’s the why 

Dr. Spencer Nadolsky: so I’ve written about this before and gotten in some arguments of course About it because people will say it’s just because they’re [00:11:00] eating more.

It’s nothing more. It’s just making them eat a little bit more It’s nothing else. Not necessarily. There’s also some mechanisms that you know, the whole nutrient partitioning thing it may be driving fat gain as opposed to just making you eat more. It may be. 

Mike Matthews: And can you talk a little bit more about that just for people listening, like in terms of nutrient partitioning, obviously you’re going to talk a little bit about insulin sensitivity and things.

Yeah. 

Dr. Spencer Nadolsky: So nutrient partitioning, where do you, when you eat foods and you have these nutrients, macronutrients, whatever. Where is the fuel going towards? Is it going towards energy that you expend, your metabolism type of thing? Is it being stored? And is it being stored as muscle glycogen?

Or are you using that energy to store As fat, right? From from your standpoint, when we’re trying to, you have some supplements in there, like your recharge has banana leaf in it, porcelain acid or salt gas. And so the goal of that is to nutrient. Partition your carbohydrates and everything after post workout into [00:12:00] your muscle.

So it’s basically priming your muscle to soak in the sugar and not store it as fat, basically. And the same thing is what exercise does. You’re nutrient partitioning. You’re whenever you eat, you want that energy to go to your muscle. You don’t want it to be stored as fat. It’s. Not only do these things, yeah, they do make you hungry and you eat more, even without you noticing, but there may be some nutrient partitioning into fat cells, causing excess fat gain that way.

It’s a little bit controversial and there’s a, there’s multiple different types of So 

Mike Matthews: then theoretically then, that would be, if you kept your calorie intake exactly the same you didn’t raise it at all, basically, I guess you could think of it as your body weight set point would be your fat level would just rise a little bit.

And obviously it shouldn’t just rise forever, right? But it would be like now all of a sudden you’re just fatter, even though you haven’t. 

Dr. Spencer Nadolsky: Yeah. You start, you the, you may feel a little bit more, a little bit more. If you’re eating only the same amount and see, this is why it’s controversial. Yeah, sure.

You should feel a little bit more tired. You know what [00:13:00] I mean? Because it’s being stored, but if 

Mike Matthews: you’re sedentary, maybe you don’t even notice it, 

Dr. Spencer Nadolsky: not notice it. And if you 

Mike Matthews: always just feel shitty anyways. Yeah. 

Dr. Spencer Nadolsky: Yeah. And so I get these patients and there’s yeah, the doctor just put me on this when I was younger and I’ve been on it.

And it’s holy cow, we got to get you off of that one. Or. And sometimes I don’t because they do sometimes need it obviously if they have a some psychiatric reason that they need it But sometimes it’s used off label. So that’s a big one that I did want to mention the more common ones are the Selective serotonin reuptake inhibitors the SSRIs.

That’s those are the most common and I can’t I guess I was naive to it, but when I finally started actually practicing medicine in residency, so that’s after medical school, I noticed like everybody was on one. It’s just Oh you’re on Sertraline or Zoloft or Celexa or you’re on Prozac.

But and it’s like, why does everybody just need some pills to make them feel better? 

Mike Matthews: [00:14:00] Yeah, 

Dr. Spencer Nadolsky: I will say 

Mike Matthews: that just yeah, it’s a why do right? Yeah, I like caffeine 

Dr. Spencer Nadolsky: I will say that, depressions very real and Medicines have their place. But if it’s a mild depression I’m very reluctant to just go straight to medicine unless the patient that’s it’s nope I just want that because there is Cognitive behavioral therapy, which is proven to be just as good as medicine, if not maybe even better, right?

Which means you’re not taking any medicine I 

Mike Matthews: mean isn’t the research out there that has shown that some of these drugs are no better than placebos 

Dr. Spencer Nadolsky: Yeah, you might 

Mike Matthews: as well just say here’s a sugar pill. 

Dr. Spencer Nadolsky: It is it’s controversial there are real things going on in the brain and of course, and so I, I think what we’re going to find out in the very near future is there’s some genomic testing stuff you can do and based on these tests, they’re going to say, you know what, this drug actually may work for you.

So those studies may show us a little bit better in the future. 

Mike Matthews: There’s got to be something said for lifestyle too. Depending on how the person [00:15:00] lives, you and I would be depressed if we live the way that some people live. Yeah, so is it’s like I guess you could just take a drug or you could maybe do something to Feel better in life like take care of your body or start exercising Don’t watch five hours of TV and every night, don’t yeah eat shitty food all the time, 

Dr. Spencer Nadolsky: right?

So and those are in those questionable mild depression like just this slight mood disorder. Whereas when someone’s like really depressed and they have that you can just, if you’re around them, they suck you into this dark cloud. Those are the ones where it’s okay, need to get your medicine.

We got to make sure you’re not suicidal, but those are very important. So a lot of people, they just end up on these pills and I’m always going, did this actually make you feel better? And some of them will say yes. And some of them will say, you know what? I didn’t feel anything. I’ve been on it for a few years and we wean them off.

And see how they do. And the thing is a lot of these patients are trying to lose weight. So we, these SSRIs, there’s some of them are mixed some showing maybe some weight loss in the first years, then weight gain. But [00:16:00] the one that really does it is called Paxil or paroxetine. So I wanted to mention that in case anybody’s on that.

That listens to your show and don’t stop it for the love of God. Don’t, it’s just something to talk to your doctor about. If you’re on one of these medicines the medicine I usually try to get people on, if they’re going to try to go that route is called Wellbutrin or bupropion, obviously I try to get people.

To kind of behavioral therapy first, but bupropion actually is a weight or it’s approved for weight loss with another medicine combined with it. But it does in these depression studies shows people do lose actual weight with it. It’s also used for smoking cessation. So in case people smoke out there.

Mike Matthews: And then in terms of Paxil, what do you like, what’s the story there? Is it also just a similar it’s not totally understood, but it’s just a thing. 

Dr. Spencer Nadolsky: Yeah, this one’s definitely not understood because the other ones in the same class don’t have the same effect for some reason.

So I’m not exactly sure why and I’ve looked at multiple reviews on why this happens and it’s [00:17:00] debated. But 

Mike Matthews: it’s fat gain. It’s not just weight gain. It’s not just because you’re not 

Dr. Spencer Nadolsky: gaining muscle or glycogen. 

Mike Matthews: Even water some of these, some drugs mess with your hormones. And I’ve heard from people that have noticed a lot more water retention on certain.

Dr. Spencer Nadolsky: Exactly. It’s thought to be fat gain, but that’s a good, that’s a good thought that, maybe there aren’t doing DEXs on these people and maybe it’s possible that it’s, some of it is a hydration status. Yeah. 

Mike Matthews: If it’s BIA, then you know, it can be. 

Dr. Spencer Nadolsky: Exactly. Exactly. The other one that everybody asks about is birth control.

I’m sure you get that. Absolutely. And so the interesting thing about that is like oral contraceptives the mixed oral contraceptives with estrogen and progesterone, those are mixed. A lot of women say, I gained 20 pounds when I started that and some women tend to lose weight. It’s just, it’s hard to know.

But the one that everybody knows that they gain weight as the depo shot, the medroxy progesterone acetate, I don’t know if anybody’s asked about that, but it’s not 

Mike Matthews: that specifically just birth control pills. 

Dr. Spencer Nadolsky: Yeah, [00:18:00] so it’s the shot, and sometimes there’s one called the Nexplanon and also the Mirena.

The Mirena is an IUD, intrauterine device, that has progesterone only. And it’s supposed to work locally in the uterus but there’s thought that maybe some of it is systemic, and so that Has that progesterone weight gain effect to something to ask about. I tend to favor the copper.

Yeah, 

Mike Matthews: that’s what my wife has. 

Dr. Spencer Nadolsky: I, I, yeah, I favor that one. It’s non hormonal and it’s, it seems to be safe. Some women have some cramping issues and. And some extra bleeding from that. 

Mike Matthews: She’s had one for a while and never on no real issues that I had to share. 

Dr. Spencer Nadolsky: Good. 

Mike Matthews: Yeah.

Dr. Spencer Nadolsky: And that, yeah that’s the one that I tend to, Hey. If you want to go that route, I would do that. I just I’m all in favor of trying to not mess around with hormones. Exactly. 

Mike Matthews: That’s how that’s how we thought about it too. Just, it’s best for her health. Very effective. Take it out and then she got pregnant real quickly.

And then, had the kid and then. That’s awesome. Yeah. 

Dr. Spencer Nadolsky: [00:19:00] So yeah, those are the common, those are the most common ones. The birth control pills mixed. Some people will gain weight, but when they start averaging it all out, it’s it’s hard to say, but definitely the shot that bow shot.

And 

Mike Matthews: Is that just because, higher estrogen levels is just generally associated with more fatness. And it’s one of those things that again, cause in the people that I’ve heard from again, a lot of these women, they know what they’re doing with their diet. Like they understand how it works, which is why they’re so like, how, why, yeah.

Dr. Spencer Nadolsky: And so this one is actually just the progesterone part. So when you take the pills, it’s an estrogen and a progesterone. Yeah. And the shot is just, it’s just progesterone. And that I want to say that one works more towards appetite stimulating because that’s what there’s there’s actually medicines using cancer called Magace, but so it stimulates 

Mike Matthews: appetite, 

Dr. Spencer Nadolsky: stimulates appetite.

But there, there are probably some definite water changes there too. 

Mike Matthews: Yeah. 

Dr. Spencer Nadolsky: So that’s, that kind of compounds it. But 

Mike Matthews: because I’ve heard then from some of these women actually, when they came off the, or they switched to something else or whatever, [00:20:00] and then lost weight quickly. So that kind of led me to why I was clearly we’re dealing more with water, at least in some of the cases than anything else.

Dr. Spencer Nadolsky: Exactly. Exactly. Which can be 

Mike Matthews: really frustrating though, because that’s, it can come fast and they don’t understand, they don’t know. And you can’t diet it away. In fact, if you try, depending on what you’re doing, like some of the, so I’ve heard from women that have gotten, I wouldn’t say desperate, but they’re just like okay, I guess I need to eat less or I need to exercise more.

And then that throws cortisol even more out of whack and it just becomes like a dwindling spiral. 

Dr. Spencer Nadolsky: Yep. And that’s, Exactly you know what i try to talk about in this book because it’s like everybody’s like you just gotta eat less you gotta move more and it’s okay hold on a second we gotta make sure that there’s not a reason right.

You know that these aren’t working because it’s possible and i talk about this is possible. That you’re secretive about a binge eating disorder. It’s possible you’re off by 50 to 100 percent of your calories. As these studies show dieticians can’t even do it right. And so [00:21:00] it’s, 

Mike Matthews: I’ve written about it.

It’s, it can be innocent. It can be like, you actually go to measure that cup of oatmeal, but you don’t realize that you just put 100 grams of oatmeal when it should have been 80 grams of oatmeal. And that adds up. As stupid as that sounds though, okay, now you’re, let’s say that’s 80 calories over for that meal.

But you do that again with the peanut butter. You do that again with over and over. And now all of a sudden you’ve eaten 500 more calories in the day, even though you feel like you’re on your diet and you’re like, this is how is this, you know what I mean? 

Dr. Spencer Nadolsky: Exactly. And those 500 calories will, those will ruin my, the patients that I had.

Cause I, I work with patients with very morbid obesity, 400, 300, 400 pounds and those 500 calories. On each day or are needed to be away, yeah so exactly and so with these medicines whether it is a Strictly if it makes you actually just gain fat by themselves yeah, you know the nutrient partitioning or just a little bit actually hump extra hungry or extra hunger and or a 

Mike Matthews: little bit of both.

Who knows 

Dr. Spencer Nadolsky: a little bit of both. Those little things [00:22:00] can add up because you just may, you may not even notice you’re snacking, a little bit extra, a little bit extra here and there. So it is, it’s a definite issue. 

Mike Matthews: Cool. That’s great to because again, those, I know that there are people listening that are going to.

are either running into themselves or know people that that are running into that. So it’s good for, I’m glad that you covered that. So what else? So what else is on the agenda for the book and, cause we had, I went over that little list of things and, 

Dr. Spencer Nadolsky: yeah medical issues, so I talk about, I list pretty much every medicine in there and if you want to check it out, if you go, Hey, my medicine on there, when’s 

Mike Matthews: the book out by the way, is it?

Dr. Spencer Nadolsky: It’s, I’m, I want to release it by Christmas, the whole New Year’s 

Mike Matthews: and, 

Dr. Spencer Nadolsky: It’s a nice, it’s a nice short read. It’s about 100 pages. It’s not long, but I literally try to condense everything into. This, everything that I know into this one thing. So hopefully hopefully Fat loss prescription, right?

Yeah, the fat loss prescription. Okay. So the other things are actual medical issues. Now this, this is again, most people say you just got to eat less, move more. [00:23:00] But, last time you and I talked a little bit about testosterone and, some guys as they age, and this is again, controversial, they’re Testosterone will get a little bit lower, and if they get some fat around, especially the visceral fat or the belly fat and start getting a little bit of insulin resistance and inflammation, their testosterone will go down even lower.

And so it’s possible that, their hypogonadism, or their, we call it the male obesity related secondary hypogonadism that is not helping with their weight loss. If they were able to lose weight, Their testosterone will go up generally, but a lot of times they cannot do it.

They just don’t feel motivated. There’s not a lot of energy They just don’t want to go to the gym. They don’t want to cook, you know So what do you got to do? You got to make sure you’re not missing any other causes of their hypogonadism other than their lifestyle. Lifestyle and visceral fat, but sometimes, it may be worth trying a course of it.

Again, this is controversial. My [00:24:00] brother’s an endocrinologist. We talk about it all the time. I talk with the urologists that do it all the time, and other family doctors, obesity doctors that do it. And I tell you. What are, 

Mike Matthews: what are, this is a slight tangent, because I get asked. Yeah. Fairly frequently about TRT as well.

And I’ve done a little bit of research not on, not not you by any means. Apparently the only thing that could, that seemed actually valid is that there’s a, it, there is a higher risk of prostate cancer dependent also, of course, it depends how high you are going with it. And that was the only thing where I could.

Say there at least is some evidence of this at a TRT dosage. But again, I might be wrong though, because it’s something that I haven’t done a ton of reading on. 

Dr. Spencer Nadolsky: Yeah, so that used to be the scare because what, the testosterone pathway, it gets converted into DHT, which fuels the prostate. What they found is, and it was so scary, it was very scary because we thought that, gosh, we’re causing prostate cancer.

What they actually found is that if you have an underlying prostate [00:25:00] cancer. And you give someone testosterone, and this is why we monitor them, it will fuel that cancer. We now pretty much know that it doesn’t cause the cancer, but it can fuel one and make it come out. And that’s why we monitor their prostate.

Mike Matthews: And you wouldn’t know that, yet that’s why you have to monitor, huh? Yep, exactly. 

Dr. Spencer Nadolsky: Exactly. And then once, if it shoots up, we go, oh geez. And then we get them, we have to do biopsies and all that stuff. That, that whole thing’s been debunked. The one thing right now with the testosterone is possible cardiac disease.

And this is, again, controversial because. Some people if they have low testosterone and you give them testosterone it can improve a lot of these risk factors Go along with their metabolic syndrome. So their insulin resistance. In fact, I just downloaded a paper and sending it to my brother we’re discussing a little bit and How you, you can give someone with metabolic syndrome who has low testosterone, not someone has normal testosterone syndrome you give them some testosterone and all of a sudden you [00:26:00] alleviate these things almost like as good as a diabetes medication type of thing.

And and some of that 

Mike Matthews: Isn’t a higher testosterone is just generally associated with. Better health. A leaner physique and better health, right? It’s exactly 

Dr. Spencer Nadolsky: exactly you know So that was the question if we give this medicine and they’re gonna be more trials they just keep doing more trials and look at this but My preferred method is to see hey Why don’t we try to get you to lose weight and see if we can bump it up if that fails if they’re just like I just feel miserable whatever I go know what okay?

Let’s give you some testosterone if they don’t want to have kids if they do still want to have kids if they’re a little bit younger You can start looking at things like Clomiphene or Clomid. And also HCG and things like that. But exactly, I don’t try to push the hormones.

It’s just something to keep in the back of the mind. It’s this guy’s got a lot of weight around his waist. He’s got a waist circumference larger than, 39, 40 inches. You start asking him about his [00:27:00] libido. You start talking about his muscle mass. He’s not able to get in the gym.

He just doesn’t feel good. It’s something to consider. 

Mike Matthews: Yeah. So we got onto that just from the medical condition of just having low testosterone, how that can kind of mess with weight loss or make it harder to lose weight. What are some other, and that’s definitely out there. I hear guys with a low T fan it’s here and there.

And I’ve heard from quite a few guys that saw market improvements just by just tough, getting tough and just being like, I want to eat that shit, but I’m not going to, I don’t want to go to the gym, but I’m going to go. And then after a few months of improving things, it’s, they feel way better and now they don’t have to force themselves.

And now they’re cutting the grooves, which is, and that’s my preferred 

Dr. Spencer Nadolsky: method if 

Mike Matthews: possible. 

Dr. Spencer Nadolsky: Yeah, very cool. So another thing is for for women, especially. Not especially for women PCOS polycystic ovarian syndrome. I’m sure you’ve heard a little bit. 

Mike Matthews: Yeah, I’ve written a little bit about it 

Dr. Spencer Nadolsky: yeah, and so this one’s kind of one of those chicken or the egg things, but At least in my experience and there’s [00:28:00] gonna be some more studies looking into this because I think what we’re gonna find is that people You know, we don’t really know enough about PCOS because there seems to be different type types of it And how they show up and everything, but it tends to be harder for those with PCOS to lose weight.

And sometimes you got to be really aggressive with them. So that’s something to consider. So if your periods are a little bit off, you’re missing, skipping periods you’re, they’re irregular. You might have a little bit excess acne maybe even a little bit of X, some little bit of hair even on your face.

It’s embarrassing. But, talk to your doctor about this because it’s very important to know if you have PCOS. There’s some things you can do to help. Do you want to 

Mike Matthews: explain what that is real quick, just for the listeners? 

Dr. Spencer Nadolsky: Yeah, so polycystic ovarian syndrome, it’s it’s this syndrome where women get a little bit of excess androgens or hormones, usually thought of as guy hormones, but women have them too.

It’s the hormones that can cause hair growth and libido [00:29:00] and other things too. testosterone and that type of stuff. And they also get something called insulin resistance which you talk a lot about. And then you get these, not everybody, but you get these cysts around, around in your ovaries.

And it, and the thing is this is why it’s somewhat controversial because it’s not known whether if you gain weight and you get this syndrome or if you have the syndrome, you start gaining weight. Either way, weight loss and diet tend to improve it though. 

Mike Matthews: Isn’t there also some you’d want to be eating probably lower glycemic carbs, if I remember correctly.

Yeah. Maybe even a lower carb diet in general. I, 

Dr. Spencer Nadolsky: I tend to push a little bit of a lower carb diet now. Yeah. Like I said, there are people that will argue this all day. The vegan type of, pushers, which I can’t really argue with because it’s like you give someone more vegetables, you give them on a lower calorie diet, raw, it’s going to be better.

But 

Mike Matthews: Considering the average Western diet, if they start eating more vegetables, their carbon take is going to go down. Generally 

Dr. Spencer Nadolsky: you [00:30:00] replace the junk and I say junk. Some people are like, no, there’s no such thing as junk food. I say junk, but processed foods, refined, Processed foods, you’re replacing vegetables, you’re lowering your cut, you’re lowering your calories.

Mike Matthews: That’s a good, that’s a good fantasy. There’s no such thing as a junk food. 

Dr. Spencer Nadolsky: People say that. I know. I know. I know. That’s the, 

Mike Matthews: if it fits your macros, like I’m going to eat pop tarts every day, I’m going to get 80 percent of my carbs from just, Kellogg’s or something. 

Dr. Spencer Nadolsky: It’s not to go off on a tangent, but I call a spade.

It’s listen, you just don’t put it on a pedestal. It’s a junk food. You can enjoy it once in a while. That’s not a big deal. That doesn’t mean you have to become afraid of it. It’s come on anyway. So 

Mike Matthews: it’s that point of nutrients. Like you can’t just eat donuts and then take a multivitamin and be like, that’s the same as eating a bunch of vegetables and fruit and stuff.

It’s just, no, it’s not the same. 

Dr. Spencer Nadolsky: Exactly. Exactly. Yeah so women listening so if you have some irregular periods, you got some excess acne to your doctor about that. Because the other thing is I’ve mentioned in my book, and especially if you have a lot of weight gain [00:31:00] around your midsection and there’s a very rare.

Very rare condition called Cushing’s syndrome where it’s hyper cortisol ism. Yeah, and there’s something in your body making it and those two Syndromes can overlap the one with Cushing’s I’ve heard from women with that it’s you will not be able to lose weight unless somebody finds the issue with you.

So that’s why I Talk about both of them. The PCOS thing it’s, the other thing is you can get medicines to help with PCOS. So it’s definitely worth talking to your doctor if you have some of these issues and you have some weight gain and you just, you’re having trouble losing the weight.

So that’s another one I mentioned in there. Of course, the one everybody thinks about is hypothyroidism. That’s 

Mike Matthews: exactly what I was gonna say. What about the thyroid? 

Dr. Spencer Nadolsky: That’s why, and I have Hashimoto’s thyroiditis myself it’s autoimmune hypothyroidism, so I love talking about it.

I almost went into endocrinology, I think I talked about this in your last in the last podcast, maybe a little bit, but I ended up doing the family medicine and then the obesity medicine [00:32:00] route, but I, so I love talking about thyroid and so come to find out that most people that have obesity have gained weight.

It’s usually not your thyroid. If you want to make sure that it’s definitely not your thyroid, though, because if you miss that, the doctor is going to feel silly and you’re going to, be frustrated. 

Mike Matthews: Yeah, that’s what I’ve always told, like, whenever I think it might be my thyroid go to a doctor and find out you just, 

Dr. Spencer Nadolsky: I think it’s worth, in the guidelines of these, there’s no reason 

Mike Matthews: to try to self diagnose it off the internet where everything says you have brain cancer, you just don’t 

Dr. Spencer Nadolsky: know.

Yeah, and trust me before medicals and even men medical school. I still did that myself. So So yeah, it’s worth I think everybody that’s trying to lose weight and especially, it’s not What are 

Mike Matthews: some of the symptoms like it? Yeah, so There might be something up with the thyroid 

Dr. Spencer Nadolsky: So yeah if they’re the symptoms are pretty much you feel a little bit sluggish which who doesn’t that you know at some point of their life, but [00:33:00] dry skin constipation coarse hair heartbeat even low blood pressure and you just don’t feel, you don’t feel well, but it’s a little, it’s this dry skin, coarse hair that’s throws people off.

I, I had a little bit of that too when I first got diagnosed. I just randomly said, I don’t feel, I don’t feel right. So the thing is though, What happens is that people go in and they get this thing called the TSH, the thyroid stimulating hormone. It’s the hormone from your brain that tells your thyroid to work.

And now this will get controversial because it can there’s a wide range of normal and If it’s at the higher end of normal the doctor may say it’s fine But it may be something to look a little bit further into or check it again or keep checking it because and when I say the high end of normal i’m talking about like The threes, the high threes, fours the good range is around one to two, but.

Even in the two range is fine. We [00:34:00] start getting the threes and fours. You may want to monitor it a little bit closer, look a little bit closer in with other hormone testing with your actual thyroid. And so a lot of doctors will just get this TSH test and it’s generally a good screening test, if you’re, if you really want to look a little bit further, you want to test the actual thyroid hormones and that’s getting what’s called a free T4 test and maybe even a free T3, although It’s usually a free t4, which those are the actual thyroid hormones, right?

But yeah, it’s if you’re trying to lose weight and you’re especially if you’re struggling it’s Worth getting it checked just to make sure it’s 

Mike Matthews: And how much because I again, this is an area that I haven’t done a lot of research. I’ve read, I’ve come across it in different things. I’ve read, I don’t know, maybe a handful of papers on it just to have a basic understanding.

And from the stuff that I had read that in terms of a decrease in basal metabolic rate if it’s not that significant, unless it’s a really bad type of issue. Is that true? Yeah. 

Dr. Spencer Nadolsky: Yeah. And so [00:35:00] I’m glad you brought that up. So a lot of times, when people come in, I think it’s my thyroid.

Yeah. It’s first of all, it’s usually not, but if it is, you actually don’t gain a ton of weight, even if it is your thyroid, it’s because I 

Mike Matthews: think I saw the biggest reduction of BMR I had seen was like 14 15 percent or something. It’s 

Dr. Spencer Nadolsky: it’s not. Yeah, it’s it’s really not much. A lot of times, maybe 10 20 pounds.

Obviously, if it’s really bad They’re going to have much more issues. They could be a coma, that’s heart failure type of thing. But, 

Mike Matthews: and just to put in perspective for listeners, like if you’re based on metabolic rate, mine is probably about 2, 100 calories or so, 2, 200 max.

So if it’s a 15 percent reduction, That’s significant. And if I didn’t realize it, I can easily, I could gain a half a pound of fat a week, just by that alone. So that can add up, but it’s not cause I’ve heard from people that were afraid that they’re, and I’ve heard people that actually knew they had a thyroid condition or just had recently found out about it.

And then we’re afraid like they’re fucked. Like now their metabolism doesn’t even work anymore and they can’t lose weight. [00:36:00] 

Dr. Spencer Nadolsky: Yeah. So that’s, I’m glad you brought that up because I, so when I got diagnosed, I still had abs, and people like, there’s no way you don’t look like you have hypothyroidism, plus you’re a young guy which doesn’t usually fit the thing.

So I got my antibodies tested, yeah, they were high, I was having destruction of my thyroid from an autoimmune process, but I went on, replacement Synthroid, and now I’m actually on a combo of Synthroid and Cytomel, which is the T4 and the active T3, just a very little bit. And yeah, a lot of my patients that have hypothyroidism, I want to make sure if they’re trying to lose weight, I optimize it.

If you optimize it. Especially if you tinker around with maybe some of the T3 and helping them if they have any issues, convert it over. Because your body converts the T4 to T3, which is the active stuff. If you optimize them, they usually do just fine and they’re not screwed. Trying to lose weight.

Definitely, though, if you do have hypothyroidism, you want to optimize it. Get a good doctor that will help you. Don’t get a [00:37:00] crazy doctor that will put you on a ton of T3 or a ton of armor and try to base it only on your symptoms. But you, some doctors may be Or don’t 

Mike Matthews: listen to the bodybuilder in the gym.

Yeah. Who blasts his thyroid hormones 

Dr. Spencer Nadolsky: for exactly. But yeah, no, definitely not screwed. You just got to get a good doctor that will optimize it for you. 

Mike Matthews: Like you, 

Dr. Spencer Nadolsky: that’d be great. Come visit me. 

Mike Matthews: Cool. So are there any other medical conditions that just in your experience that you talk about in the book and that you think we should discuss?

Dr. Spencer Nadolsky: The only other one that, so there are a bunch of other very rare things. There’s some genetic syndromes that you’d want to catch younger in life some deficiencies in the brain and. Left in deficiencies and some stuff like that. The only other one that really people bring up a lot of times is menopause.

And so I don’t know if you have menopausal women, but it’s a very common question. And it’s, so there’s some good in the bed. The bad is that, yeah you. There is some weight gain [00:38:00] associated and I don’t even know what the good of it is because menopause is, can be really miserable for some women.

Some women go through it just fine. They literally felt no issues. I guess the other thing that I was going to say was that. So they think that then give me some hormones, the, some good bioidentical. 

Mike Matthews: Yeah. 

Dr. Spencer Nadolsky: Let 

Mike Matthews: me, let me stop and ask you what’s the story of bioidentical hormones.

And I know that I know I could define them for you, but it said there’s an area that there’s just something that have these things that are on a list where I’m like, here’s some things I want to know more about when I have I have this never ending to learn more list. You know what I mean? Yeah. 

Dr. Spencer Nadolsky: Okay.

Cause the 

Mike Matthews: story is, oh, that these are totally fine for you and they don’t have any of the negative effects associated with other hormones. Exactly. And I hear that. I’m just like, that just sounds too good to be true. I don’t believe it. Yeah, 

Dr. Spencer Nadolsky: It’s, it is. It sounds like marketing. It is. It is a lot of that.

And this, you could probably have a whole podcast. You could get a round table of me and probably some actually people that are, doing the research on, the bioidentical versus the equine hormones. [00:39:00] But pretty much is the thought is that you actually give the hormones that are made in your body through.

Whatever, if you want the patch or the cream or whatever you do with the estrogen, progesterone, as 

Mike Matthews: opposed to what, 

Dr. Spencer Nadolsky: as opposed to, so they basically do these equine or they I always say horse urine 

Mike Matthews: horses right now. 

Dr. Spencer Nadolsky: And so they manufacture these hormones as opposed to, and they’re very similar in the receptors that they hit, but 

Mike Matthews: just not exactly the same.

Dr. Spencer Nadolsky: It’s not exactly the same. Especially with this, the big women’s health initiative this, the big one that everybody talks about is that, oh, we’re killing people. We didn’t even know that we’re when we’re putting people on these hormones right at menopause for no reason. So it was a little bit controversial.

So now you got other groups, the natural group saying the bioidenticals wouldn’t do that, but they’re in my mom. 

Mike Matthews: My mom’s on him and she has worked with some doctor that’s all into it and I don’t know enough to have a, I couldn’t debate the doctor. I don’t know enough about it, but I’ve just [00:40:00] tried to tell my mom, like that sounds like marketing.

I know, at least I know supplements, I know bullshit when I hear it, that sounds like bullshit. 

Dr. Spencer Nadolsky: It is. There are still risks, however, they do have slightly different bioavailabilities and they may hit the receptors in different ways it’s just, it’s. She’s been sold 

Mike Matthews: on the they’re great.

There’s no reason to. Yeah. 

Dr. Spencer Nadolsky: Yeah. So I will say that. So if anybody is out there going through menopause, they’re feeling miserable, it is, it’s very worth it to talk to the doctor. You don’t, you can get on these hormones. You talk about the breast cancer risk and all these different risks of clots and type of thing.

But if you’re miserable with hot flashes and that type of thing it’s worth discussing it now. It’s quality of life 

Mike Matthews: point. 

Dr. Spencer Nadolsky: Yeah, actually. So what I was going to say is, so Do these hormones help you stop that weight gain at menopause? Possibly, but not it’s not a, it’s not a slam dunk.

So it’s not something I would go seeking at menopause if you have the symptoms, definitely. [00:41:00] But if you don’t. Go asking for the hormones just to stop this possible weight gain, the same lifestyle stuff that you discuss is what you got to do and unfortunately, it’s just, it becomes harder and that’s the bottom line.

But if you have these symptoms, you could, the hormones may help. May, that’s what I briefly touch on it in the book and there, there’ve been studies done to say whether, Hey, do they, and it’s a little bit mixed, but maybe worth it if you do have the symptoms, of course. 

Mike Matthews: So you had mentioned that as you get older, it just gets harder.

Is that’s also just a thing that is is it true? Is it not true? It’s something that everyone knows kind of thing. What are your thoughts on that? 

Dr. Spencer Nadolsky: Yeah, absolutely. 

Mike Matthews: And can it be preempted by let’s say we have people listening in their twenties and their thirties and their forties or whatever what can you do to not to give yourself the best chance where you don’t have to deal with the, deal with that when you get older.

Dr. Spencer Nadolsky: So the most important thing is to literally right now, not in a couple of years or whatever, right now, start [00:42:00] doing the lifestyle things and build up a good base. And that, that seems obvious, but. It’s absolutely true. You want to build up as much muscle. You want to be, as lean as possible.

If you can bulk, if you want to do that type of thing to get the muscle. But I 

Mike Matthews: mean, it’s if you want to get it done efficiently, it’s just 

Dr. Spencer Nadolsky: exactly. It’s starting right now and building as much muscle as possible because later on in life, it is possible to gain some muscle, but it’s not going to be as easy as it is right at this moment at your age.

So that’s my biggest advice. But, my dad was just here. He’s 67 now. He came for Thanksgiving and he was lifting with me and, he had some vertigo issues. So he Couldn’t get down on the bench press recently, so he couldn’t lift, but he was doing a lot of outside activity.

Talked about it, because he had a body, like mine and my brother’s when he was younger, and he wants to get back into it a little bit more, and I said, absolutely you can, we look at the, you see these bodybuilders, there’s some 70, Some of your old bodybuilders and they just, they look [00:43:00] fantastic.

Mike Matthews: Yeah. 

Dr. Spencer Nadolsky: I’ve seen 

Mike Matthews: pictures of people that look better than people in their twenties. 

Dr. Spencer Nadolsky: I absolutely, especially my patients, I’m just like, Oh, let’s just, let’s get you, let’s get you on a good program. Let’s get you with a good diet and just let’s blast it right now. And then just don’t worry about it.

Don’t, you can be the best you I promise it’s not a reason to give up. 

Mike Matthews: Totally. And in terms of why it might get harder as you get older to lose fat, do you think that’s mainly hormonal? If you’ve lost muscle as you age, your BMR is a bit lower. It’s a, 

Dr. Spencer Nadolsky: it’s a little bit of a mix of everything with hormone, testosterone and that and all that.

But also, you’re, like you said your metabolic rate starts declining a little bit each year, a little bit by a little bit after you don’t 

Mike Matthews: preserve muscle. That is, and that’s also what to your point, you’re saying gain muscle now and keep it for the rest of your life, 

Dr. Spencer Nadolsky: but as much as possible and keep using it.

That will keep you, and keep the thing is a lot of people start eating just crap, whatever their stress and life happens, that happens, but whatever you can do to, [00:44:00] Stop doing whatever that is and which you know, I talk about in my book you talk about in your books And get back on a good plan and of course, make sure there’s no medical issues, no medicines that are preventing you from doing it.

Just get it done now. Yep. Whatever you have to do. 

Mike Matthews: I think there’s something to be said for I’ve written about it. I know that yeah, there’s not a ton of research out there on it. I found some stuff that I was able to read and found interesting just on this body weight set point. Yeah. And I’ve experienced it myself and I’ve emailed and spoken with a lot of people that experience that the longer you stay lean.

The easier it is to stay lean, essentially from from an appetite standpoint, I guess normalization of leptin and ghrelin and just get, you just get used to being lean and even I don’t have a great explanation and this might just be more to nutrition nutrient partitioning maybe why but like I can like in, Thanksgiving.

Dinner, and this is one meal fit. And so it’s just one meal, but eat. Until I can’t move, I don’t even know 8, 000 calories. I’m pretty lean. Like I have ab veins and [00:45:00] shit. So I would see a difference and see no difference. None at all. Where I’m like, how I just ate 500 grams of fat in one meal. 

Dr. Spencer Nadolsky: And that’s, what’s so cool.

The same thing, my brother. He’s always been lean. He’s been lifting since, you, we have YouTube videos of us lifting when he was like seven or eight or whatever. And I was like four or five. That’s cool. And so he’s had abs forever and literally, he’s always been a little bit leaner than I was cause I was a heavyweight wrestler and, but I’m, I’m pretty lean now, but, he’s exactly the same way. And I think a little bit has to do with maybe some epigenetic type of things. Yeah, and so you got that plus you got obviously the nutrient partitioning the leaner you are, you’re better insulin sensitivity and all that stuff type of stuff. It’s, it pays to take care of yourself early and then you coast along as you age.

I 

Mike Matthews: mean, I think that’s the real payoff. And I’ve spoken about that a lot and written a lot that written about that a lot. Just. That you put in all, it’s like working for money. So you put in all that hard work, you earn that money, you’d be smart with it. [00:46:00] And then you have the payoff now of being able to enjoy it.

And I think it’s a very similar with your body. You put in all that work, you do it smart, you do it right. And the payoff is that I wouldn’t say oh, we just get to cruise, but it is like you get to be a little bit looser with your diet. If you miss a workout, it’s not, not that big of a deal when you already have the muscle size that you want and you’re just maintaining it, which is where I’m at this point personally.

Dr. Spencer Nadolsky: Yeah, absolutely. So 

Mike Matthews: that, and that’s the, that, that’s the goal, I think. 

Dr. Spencer Nadolsky: Absolutely. No you nailed it right there. 

Mike Matthews: Cool. Any other weight loss? I’m trying to think if there’s anything else that you’ve touched on all the big ones. Those are the big ones. Last I thought of age.

Cause I, that’s one that gets asked fairly frequently. And to that point, I’ve, I’m sure you’ve worked with, you’ve worked with a lot of people in forties, fifties, sixties, and I’ve worked with a lot of people, just emailed and heard from a lot of people that were able to do really well and where they, that’s actually the first time that they ever even tried weightlifting was 50 years old and, went from a normal looking 50-year-old dude, visceral, fat, blah, blah, whatever, [00:47:00] to, they have to put in work.

Yeah. It takes a year or so, a year later they look better than they did in their twenties. Yeah. Absolutely. It’s not like they were obese in their twenties. They just look like a normal, they look, they would have been happy to have that body 20. 

Dr. Spencer Nadolsky: Yup. Yup. It’s amazing. I love it. 

Mike Matthews: Yeah.

Yeah. It’s super cool. 

Dr. Spencer Nadolsky: So yeah nothing. I touched on some other things in the book, but yeah, it’s, it puts it all together. And I figured, your readers or your listeners and readers We’ll probably have a, just for anything, a good resource in case they get put on some medicines or if they’re on medicines or any possible other things that could be stopping them from getting to their goals.

I wanted to condense it into one little book there. 

Mike Matthews: Yeah, that’s great. And I’ll definitely add a link once it goes live, I’ll add a link on the post for the podcast. And so it’s going to be, it’s the fat loss prescription. Dr. Spencer Nadolsky and it’ll be out soon. You said like December.

I know how that is. I’m working on a, doing an update on one of my cookbooks and you always, you say, you tell people like, and I keep on now I’m getting [00:48:00] more and more cynical with my own judgment. You know what I mean? Whatever, wherever I think is going to be, if I’m thinking four weeks is my initial thought, I say 12.

Dr. Spencer Nadolsky: Yeah. That’s probably a good idea because I think I wanted this book out in, in, in the fall. If I can. Yeah. Yeah. Back in September, I think, 

Mike Matthews: same. I wanted this cookbook out now and now it’s if I get it out in January, I’ll be happy. I think we can do that, but that’s, that’s life.

But once it’s done. Yeah, exactly. Everything takes more time and more money than you ever. Then that’s just the way it is. But yeah, so definitely check it out again. If you’re listening to this after, December, January ish, then you’ll just see it in the post. But I look forward to reading it myself.

Hopefully. You can send. If you want, you can send me a PDF. I’d love to check it out. Oh yeah. Absolutely. Before we get off. How can people find you in your work? Like obviously you can go on Amazon to find your book or whatever. 

Dr. Spencer Nadolsky: So my personal blog is www. drspencer.

com. I also have a blog with my brother. We promote other doctors who lift. So it’s [00:49:00] docswholift. com. D O C S H W H O L I F T dot com. 

Mike Matthews: You can, you got a list. Docs who lift. Docs who lift. Docs 

Dr. Spencer Nadolsky: who lift. And then, I got a my Twitter and also Facebook, come find me. 

Mike Matthews: Okay, great. Thanks again for taking the time, Spencer.

It’s always a pleasure to talk to you. It’s nice to, you know what you’re talking about and I, and you are living this every day and you’re dealing with things that. Again, like that I hear from it’s on the fringes in my world. You know what I mean? 

Dr. Spencer Nadolsky: Yeah. 

Mike Matthews: So it’s great to be able to just say, Hey, this guy knows what he’s talking about.

This is the, here’s your answer. So now I can link them to this podcast forevermore when I get these questions. 

Dr. Spencer Nadolsky: Awesome, man. I really appreciate you having me on. 

Mike Matthews: Hey, it’s Mike again. Hope you liked the podcast. If you did go ahead and subscribe. I put out new episodes every week or two where I talk about all kinds of things related to health and fitness and general wellness.

Also head over to my website at www dot muscle for life. com. Where you’ll find not only past episodes of the podcast, but you’ll also find a bunch of different [00:50:00] articles that I’ve written. I release a new one almost every day. Actually, I release four to six new articles a week. And you can also find my books and everything else that I’m involved in over at muscle for life.

com. All right. Thanks again. Bye.