Ep. #698: Dr. Spencer Nadolsky on How to Beat PCOS

Mike: Hey, Mike Matthews here and welcome to another episode of Muscle Life. Thank you for joining me today. And if you are a woman, what is a four letter word that you never want to hear your doctor say to you? Okay. It’s not a word, it’s an acronym, and I’m referring to P C O S, polycystic Ovary Syndrome, and this is a hormonal disorder that affects millions of women.

In fact, chances are good that you know someone who is affected by it. Hopefully, you are not affected by it, and it’s prevalence explains why I. Been asked about it so many times over the years and continue to get asked about it. Every week I get at least one or two people, one or two women asking about it, and P C O S.

It has various effects in the body, especially in regards to fertility. But one of the biggest concerns in the body composition space in the fitness game is how it affects weight loss. Specifically. Many women believe that P C O S is caused by being overweight. That once you have it, it makes it very hard, if not impossible.

Some people believe and some quote unquote experts believe it makes it impossible to get back to a normal weight or a fit weight or a fit body composition. Now, fortunately, that is not true. You are not doomed if you have P C O S and while it. Complicate things a bit. It can’t truly prevent weight loss, and so that means that you can work toward getting into better shape and losing unwanted fat and keeping it off with P C O S.

There are also things you can do to directly address P C O S. There are things you can do to make sure you don’t get it in the first place if you don’t have it right now, and to break. Down. I invited Dr. Spencer Naski back onto the show to talk to us about this. And in case you’re not familiar with him, he is a board certified family medicine physician.

He is the author of the Fat Loss Prescription, and he is also a member of my sports nutrition company, legions Scientific Advisory Board, and he knows his stuff when it comes to hormones, fat loss, and memes as well. If you follow him on Instagram, and in this interview, Dr. Naski discuss. P C O S is and what its symptoms are, and he talks about weight loss, of course, with P C O S, and he talks about hormones that have to do with this, and of course, talks about how to successfully lose weight with P C O S and how to get healthier and happier despite.

This condition. Also, if you like what I’m doing here on the podcast and elsewhere, definitely check out my health and fitness books, including the number one best selling weightlifting books for men and women in the world. Bigger, leaner, stronger, and thinner. Leaner, stronger, as well as the leading.

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Thinner, leaner, stronger for women and the shredded chef for my favorite fitness friendly recipes, Dr. Spencer Naski is back to share memes. Let’s just meme the entire podcast. Can we do that? You wanna just 

Dr.Spencer: make memes? Let’s just do a podcast about how to make. The effective meme. I do make jokes with my buddies about, you know, the key to a good meme and we laugh every time cuz I’m just, someone will try to make a meme, I’m like, explain why this one’s not good.

I know which ones of mine will do pretty well and which ones won’t. And I still do want, I still post some that don’t do well and I know they won’t do well, but I have to post it to. To meet a part of the audience that I, I want to reach, but generally I know it won’t do well, and it sure enough it doesn’t.

Sometimes I have some surprises, but So what’s the one weird trick? So the, the biggest thing is if you are like polarizing and make a joke about it, that will go gangbusters. So that’s why, you know, you’ll see like liberal meme pages or right wing. Meme pages, and if they just dig into the other side, it’ll rile up their side and then piss off the other side.

And it 

Mike: just, yeah, stirring up emotions. Right. I’ve seen research on that, on virality that if you can get people to become angry or if you can get them to laugh or there were like a few emotions. That were highly correlated with sharing, right? With virality and there are one or two other factors. I don’t remember.

Yeah. So like, 

Dr.Spencer: you know, for my group, I know that when I make fun of let’s say multi-level marketing like Herbalife, let’s say, when I make fun of them and I dig in, like I have a good meme that’s politically kind of oriented that I want to. Share, but I don’t think I should because I might get too much blowback, but I think you’ll do really well.

But whenever I dig into them, 

Mike: oh, come on. What’s the worst that can happen? You lose some followers. You’re not gonna get canceled. They don’t have, I don’t . You have to really work to get canceled. Come on, . I’ve just seen so many instances of the mobs trying to cancel people, but because the people just didn’t care and they just kept going, it failed.

It just didn’t work. . 

Dr.Spencer: Yeah, that’s actually really key in that regard, by the way. But yeah, you know, so if you really rally your troops while pissing off another group that will kind of come in, especially if you like tag them with like a hashtag and they’ll start popping up in their feed and then they’ll come in, they don’t follow you, and they’ll just start trying to like antagonize and then your followers will go in and just.

Tear them apart. It’s really interesting. That usually does. Well, something like, you know, it’s 

Mike: very, it’s very Machiavellian, meaning the machiavellian way. Machiavellian memes.com. 

Dr.Spencer: Yeah. When you’re too vanilla, it does nothing. I could give you my like, like, okay, so if I give like a tips thing and it’s pretty straightforward, sometimes it does well, but if, if I don’t present it in an almost like, not an extreme way, but in a way that’s just like, this is it.

If I don’t do that, it’s just kind of like, nah. Yeah, of course. Yeah. We gotta eat fewer calories or whatever. But if I mock carbs or something like carbs or the cause of obesity and if I mock that while I’m shining back to that, it’s, you know, energy balance, that’s what gets people going. Cuz it loves throwing shade at the low carber who believe it’s insulin or whatever like that.

That’s the key. 

Mike: That’s similar to the key of humor. Writing in general is actually subtext. It’s what you are not saying. That’s what really gets people. 

Dr.Spencer: Yeah, exactly. And if you can make it almost like time sensitive, so like if, you know, for example, the, one of my better ones recently was, you know, people hate artificial sweeteners, they hate vaccines, they hate politics and you know, and covid o the whole thing is, Polarizing.

So I, I was like, I know everybody hates this. So here’s a picture of Donald Trump drinking a Diet Coke while talking about the Covid vaccine, and people lost their minds. It was just, and it wasn’t, of course he wasn’t even, but he, he had a diet Coke in front of him. I don’t even know if it was his, it looked like it was his, he wasn’t talking about the covid.

So like, Because everybody hates artificial sweeteners, or not everybody, but a lot of people are polarized on the topic. That was just trolling. That was me just trolling and just laughing 

Mike: about it. But yeah, I remember seeing that one. By the way, any listeners who are actually just confused at this point why we were talking about this is go over uh, and check out Spencer’s Instagram page and you will understand there are a lot of memes.

They can just search for Spencer and Alki. You’re probably just an alki and it’ll come up, right? If you want. Yeah, you’ll find it. Yeah. Yeah. And that’s what you specialize in? Ology. 

Dr.Spencer: That’s, that’s probably my biggest specialty. I mean, really, I went to school for, you know, if it’s obesity, lifestyle, all this other stuff.

Ology is boring, boring, lame. 

Mike: Yeah. Who cares about that stuff? You’ve probably seen the movie Idiocy, right? Yeah. I love that movie. Yeah. Dr. Lexus. This is gonna be like in the future, this is gonna be how medicine is practiced, just through memes, you know, . It’s so good. Anybody listening who has not seen Idiocracy, you have to see it because it is a foretaste of what is to come.

I guess that’s kind of redundant cause that’s literally the definition of a foretaste. But yes, it’s a foretaste of our future. It never came out in theaters strangely. It was slated for theaters and then it was just straight to D. So a lot of people didn’t even know about it. But it’s a Mike Judge movie.

So Mike Judge did Beavis and Butthead. He did, I think that, what is that Hank show? I never Oh, king of the Hill. King of the Hill, yeah, yeah, yeah. He did that. And what else did he did a couple other things. Anyway, clever guy, funny guy, funny movie. But let’s make a hard turn here to the main topic of this interview, and that is P C O S, which is something.

I have written a little bit about a long time ago and then haven’t really touched on it since, and it is something I do get asked about via, you know, emails and dms fairly often. And I know you get asked about it more often than I do. So I thought this would make for a good discussion for women who are dealing with it or maybe who aren’t dealing with it and want to not deal with it or just at least wanna understand what it is.

And for men who wanna understand what it is, or maybe they. A woman in their life who’s dealing with it. Um, so here we are. Yeah. Odds 

Dr.Spencer: are is that you or someone you know, has P C O S, uh, it’s becoming much more prevalent for multiple 

Mike: reasons. And yeah. Let’s start with like, what actually is the acronym?

What is 

Dr.Spencer: it? Like, what is P C O S? What are you using? These acronyms. P C O S, polycystic ovarian. And actually, you know, a lot of people are trying to, a lot of these groups, not me, you know, I’m not in one of these big research P CS groups, but these endocrine groups and world leaders in, in research here are looking to actually, they wanna change the name, but you know, the activists are saying, no, we already have a lot of movement behind this name, so let’s keep it the same.

It’s simply because the P C O S doesn’t actually fully explain. What’s going on on a, like a physiologic, or I should say pathophysiologic level. So polycystic ovarian syndrome. You think, okay, you got a bunch of cys on your ovaries and you have some issues because of that, and that doesn’t really portray the the real going on.

There’s a big miscommunication between the. Your hypothalamus and your pituitary and then your ovaries. So usually you have this communication with your hypothalamus and your pituitary and your ovaries. Each month you have these ongoing signals, luteinizing hormone and efforts, H follicles, simulating hormone and estrogen and progesterone and, and how those are in, in kind of a symphony.

Have you make periods and can ovulate and all these different things and be fertile. Right? So that’s the gist of it. But with polycystic ovarian syndrome. There is a disruption there and. Some people want to rename it to what’s called metabolic reproductive syndrome. I think that’s a better name. But you know, I’m talking, my brother’s an endocrinologist.

We talk about this all the time. And in fact, you know, I did this big presentation on it. Cause really the, the whole reason we’re doing this talk is to talk about why. The mechanisms of P C O S and why some people with P C O S seem to struggle with weight loss. That’s when you go on Instagram, you go on the internet.

What you’ll see is that I can’t lose weight because I have P C O S and we’re gonna go over kind of the truths and non-truths of that whole thing. But that’s usually what you’ll see on the internet. But a meme 

Mike: worthy statement, I’m sure that you , 

Dr.Spencer: I’ve made some memes about it. I have definitely made some memes and I gotta be very sensitive cuz it is.

It’s a very frustrating, we’ll get into it. It’s like, you know, people. , there’s a stigma behind like obesity and P C O S. They’re like, oh, if you have P C O S, it’s because you ate too much and now you’re fat and that’s why you have P C O S. And that’s actually not true. There’s a lot of people without obesity at at all who have P C O S really the things that define it.

The criteria for having it. There’s multiple working groups that got together and, and trying to find a good definition. But there’s something called the Rotterdam criteria, and what they go is of these three things, you have to have irregular periods, which is a technical term, oligo, amenia, and ovulation.

You’re not ovulating. That’s one of ’em. Higher levels of androgens, like male hormones, hyperandrogenism. Testosterone. And then the other one is multiple cyt on your ovaries and you don’t actually need that part for the diagnosis. All you need are two of these. So some people do an ultrasound and they don’t have cysts, and they’re actually not necessarily cysts.

They’re, they can be the follicles that are just being formed throughout your menstrual cycle. If you have irregular periods and you’re like, what’s going on? Seems like a little bit of facial hair, more acne. You go to the doctor and they go, you might have P C O S and they, you don’t even have to do an ultrasound.

Or you could do the ultrasound and there may not be necessarily his follicles or cysts. Yeah. But that’s just the 

Mike: criteria, hence the debate over the term itself. Cause that’s kind of weird to be diagnosed with polycystic with no cysts. 

Dr.Spencer: Exactly. And the other thing is like, it’s really hard to understand what I’d call the pathophysiology.

What’s going on here? I pulled a, a little quote out. I’ve pulled out multiple reviews of the leading researchers that look into what causes, you know, P C O S or what people want to call metabolic reproductive syndrome. And the quote is, the pathophysiological mechanisms of P C O S are complex and not fully understood, and I.

Shouldn’t you? Not that same sentence in some form or fashion is in every single review. It’s really hard to describe because there’s an environmental thing, there’s an a genetic thing. There’s multiple tissue sensitivities to different insulin and different androgen sensitivities that just change the communication between your, basically your brain and your ovaries.

That’s going on. We’re learning more and more, but the other thing is that makes it weird, is that, again, not every. With P C O S presents the same. They think that they want to actually come up with a different phenotypes. There’s people that are very lean, that just have irregular periods and higher androgens.

And maybe that’s why you see some athletes that do well, cause they have higher androgen levels because they have P C O S, but they’re not having periods. But you know, and there’s, that’s obviously an issue in itself. Yeah. And then you see others who have high insulin resistance and have obesity that have this.

And those are generally the. who come to see me cuz they wanna lose weight. So about 50% of people with P C O S have 

Mike: obesity and that means that there are many cases where this condition was developed through poor lifestyle and can be improved. Right? Like in the case of the woman who has high testosterone levels, naturally, I’m sure there’s still something she can do.

but that’s just a, a different situation, right? Than somebody who maybe at one point was fine and then they got too overweight, and now of course insulin resistance is associated with that. Now they have these other symptoms that lead to this diagnosis, 

Dr.Spencer: so what they can’t do is prove causation. There’s just a strong association.

What we know is that improving your lifestyle and if you have obesity and P C O S, Does ameliorate decrease these symptoms and can improve your cycle and, and you can’t cure it with weight loss, but you can certainly improve. Your symptoms and improve, like people will get pregnant all of a sudden when they couldn’t.

They’re not total. You have ’em lose weight, they still likely have the underlying P C O S, but the symptoms are at bay. So like we can’t say that obesity caused the P C O S. There’s probably an underlying propensity to it. The obesity exacerbated or worsened those symptoms. So that’s why it’s so confusing cuz it’s like, well, you know, type two diabetes.

Yeah, you can have a propensity to it, but. If you lose a substantial amount of weight, you can put the diabetes into remission. Some people call it reversal. I wouldn’t, I would say remission. I don’t think I would ever say P C O S is ever in remission. I would say it’s probably still there, the underlying factors, but it’s not.

So aggressive to enough to cause you to not ovulate. That’s what I would say. It would be interesting to have a discussion with a few of these leading researchers, but to me, you can’t resolve or reverse P C O S. You can mitigate or minimize the symptoms from it. . That’s what 

Mike: I would say. Okay. And as far as it’s relation to weight loss, probably should just, yeah, talk about that quickly, because yeah, that is a lot of women, I’ve heard that many times that they’ve been told that that is the reason they cannot lose weight and until they fix it, they’re always gonna be overweight.

And then, like you said, oh, but fixing it is hit and miss and they’re now kind of just lost trying all kinds of things. Low carb diets and supplements. 

Dr.Spencer: and the reason I am so vocal about this and have done some presentations on it is because when people get labeled with something and that label was told to them to have an effect on their ability to lose weight successfully, that turns into it’s almost like a nocebo effect.

There may indeed be, and I will go over some of these mechanisms that. Impede weight loss, but 

Mike: it becomes like a self-fulfilling prophecy that is fundamentally not true. 

Dr.Spencer: When you tell somebody they have P C O S and they’re not gonna be able to lose weight very well, that’s it. You’re done. You just put a fork in them, they’re done because now they, they’ve latched onto that.

It’s the same thing with like, okay. You’re having some back pain and someone does an MRI and you have some issues with your discs that may not have anything to do with the actual pain you’re feeling. Yeah, yeah. When you tell ’em, oh, you got an L five s, whatever, that’s one. That’s probably what’s causing your pain.

Boom. You might have just done a lot of harm to that person. I think we need to be careful. The other thing I want to say is, I’ve had many patients who were told they have P C O S who are misdiagnosed. They were missing their periods due to some other reason, and they just told ’em they had P C O S.

There are actually some really serious underlying conditions that look like P C O S. They’re androgen secreting tumors. There’s something called Cushing’s Syndrome or Cushing’s and one called Cushing’s Disease. They’re kind of similar, but those should probably be ruled out or at least screened. What most people feel before just diagnosing someone with P C O S.

I do wanna mention that because if you just say someone has P C O S and you don’t find those other things, you’re gonna do great harm. 

Mike: I’ve also seen women who wanna stay very lean and they’re spending a lot of time in a calorie deficit and exercising a lot and irregular periods, or they haven’t had their period in a while and.

coming to the conclusion that it’s P C O S. Yep. 

Dr.Spencer: And that’s dangerous. So why would it be like, so the most common thing I did, I ran a poll. I mean, I get these comments on, you know, when I talk about calorie deficit, people will say, but I have hypothyroidism, which we talked about last time, that’s, that’s not a reason not to lose weight unless you’re not treated.

And that means you just need to get treated, then you’re fine. So when I ask, a lot of people say they F P C O S, they struggle to lose weight. And then I did a poll. Why do you feel P C O S is slowing down your weight loss? And I listed a few of the most common reasons that I’ve seen. They usually just say It’s my hormones.

What does that mean? That’s a nebulous thing cuz like, what does that actually mean? You know what I mean? Like it is just your hormones. You, you kind of give it up to some, leave it up to some kind of nebulous term there. Is it a slower metabolism? Some people feel they have a slower metabolism. We’re gonna go into that in a second.

What about like, Appetite. That’s absolutely reasonable, especially for those who have like insulin resistance in kind of this what we call like an inflammatory milieu in their body because of the P C O S and because of, uh, the androgens and the insulin resistance that could potentially decrease the communication between your brain, not just from ovulating, but also for appetite regulation, which is what I talk about a lot.

And then there’s other things that just people don’t like talking about, but we’re gonna get into it, is binge eating disorder and depression. Which obviously you know, that’s just eating more. But it does need to be talked about cause that can be treated as well. 

Mike: And that one can be insidious, right?

Because I know you’ve seen this many times. I’ve seen it many times over the years when somebody will come to me and they’ll say, just kind of vaguely how well they eat, and they’ll maybe even throw a calorie number out there in terms of daily calories. And then when we. Get into the details. It turns out that yeah, maybe they do eat 1300 calories some days of the week, but then there are the sporadic or even semi-regular binges or something that is, let’s just say bouts of extreme overeating where obviously if somebody, let’s say they’re trying to lose weight, and let’s just say 1300 is is a reasonable deficit.

This would be a smaller woman. And then go and eat three to 4,000 calories a couple of times per week. And then they just don’t quite understand energy balance through the lens of the bigger picture of like, okay, let’s look at it now in terms of your weekly calories in and calories out. 

Dr.Spencer: Exactly. So that’s actually something, I mean, we could do a whole talk on that sometime, but I, I can’t count the number of patients who, you know, I’ve been, you know, practicing since 2011 and I still have patients.

started with me just as a lowly little intern that are still with me. And after a little bit they’re like, you know, I’m, I’m eating 1200 calories, but I’m not losing weight. I’m like, well, that’s not possible cuz you’re 250 pounds. And I don’t see it like that. That’s a much better pet side matter and we can go over, well, you know, this and that, but it’s literally not possible.

If you’re listening to this podcast, you know, you not 250 pounds and not losing weight on 1200 calories. Literally impossible unless you are overtly hypothyroid. and you have bigger problems cause you’re about to go into heart failure from being so hypothyroid. Yeah, I was gonna say 

Mike: that’d be an extreme case 

Dr.Spencer: too.

It just doesn’t happen. So I’ve had so many of these patients develop a very good rapport, but even still, they won’t mention that you screen as much as you can for binge eating. They have these questionnaires and you go over it and they’ll be adamant, 1200 calories, I’m not losing weight, I must be broken.

One to two years later they’ll come back cuz I just leave ’em alone. I don’t wanna push ’em. And they’ll say, I want to talk about. These episodes I’m having where I think I’m binge eating, and sure enough, they have binge eating disorder and you know, again, that’s a whole nother discussion. We, we go into the treatment of that, but it’s actually very prevalent in P C O S and that’s doesn’t make you a failure or a bad person, that it just needs to be discussed instead of thinking you’re broken, you’re not broken.

It’s more prevalent. mental health issues are higher in P C O S, uh, like depression. It should be addressed. There’s so much stigma behind mental health and everything. It just, people think, oh, you lack willpower. There’s a ton of stigma behind mental health, unfortunately, and I wish we could talk about it more, it’s just, it’s okay if you’re binge eating wishes, talk about how to treat it.

But when you look at the literature, there’s a, a higher proportion of women with P C O S that tend to have binging. So that would explain part of. You’re sitting there going like, no, absolutely not. But when I actually posted this and I was very gentle in discussing it on Instagram, not like a one of my polarizing memes or something like that.

It was more like, it wasn’t a 

Mike: picture of, uh, Trump. Yeah. It wasn’t a picture of Trump at McDonald’s eating, holding up a sign saying P C O S is fake. Yeah, right. It wasn’t 

Dr.Spencer: like that. It was just like, Hey, let’s talk about this. Actually, it was really nice. There were a lot of women that came out and said, you know, I suffer from this and it’s like, good, let’s have a discussion.

You know, the thing is a lot of fitness pros are jerks about, it’s like you’re just eating too much and it’s like when you start pointing the finger like that, people shell up and they get a lot of resistance. So the better way is to just kind of be open about and talk and and just say like, look, it’s okay.

We all have our issues. We all have our mental stuff and we should treat it as such and just be nice about it. Just don’t get jerk. So there are a lot of women that opened up and said that. Now there’s other people that are like, no, I don’t have that. I promise. But when you start discussing, like we can talk about hunger.

So when you look at the appetite differences, there seems to be a hunger and satiety difference that might be impaired with those with P C O S. So yes, and this may play a part in the binge eating thing by the way, but if nobody’s getting fed in a lab, let’s say a metabolic lab, which is nobody, unless you’re participating in a study, in which case you’re like, 0% of the population, unless you’re getting fed in a metabolic kitchen lab and you have a little bit more appetite and hunger versus someone else, if you just put that person in the similar environment, they’re gonna eat more.

That’s just the way it works. Your scoop is gonna be a little bit bigger. You’re gonna go for more servings and almost in a subconscious way. So like even if you think you’re counting, unless you’re really. In a metabolic kitchen where somebody else is feeding you. Cuz I don’t even trust, you know, you tracking your own calorie, that doesn’t, it’s easy to miss things like grabbing chips and stuff like that, even 

Mike: if you’re measuring foods.

Yeah. But you can mismeasure or you can record, you can just simply make a mistake. Put the wrong number down. Yeah. 

Dr.Spencer: And again, that’s another thing with. Being, you know, just not a jerk. It’s like, they’re not intentionally lying. It’s a, some, a lot of it’s just subconscious, you know, A lot of it too is you just don’t, you feel bad about it.

You don’t wanna seem like you’re not able to adhere. You know, I did a bodybuilding competition once I was sending my calories to the coach, and I think I got down to 2200 calories. That was the lowest, by the way, for me. I’m like 215 pounds. So I. was eating like an extra carton of strawberries and not tracking those and that’s what, a couple hundred calories, but it adds up and then that and maybe a few chips in the here and there or something.

I remember going, yeah, I wasn’t being truthful. So if I’m doing that, then I can totally understand why someone who just wants to lose 30 pounds of their obesity would, would not want to tell the truth. So appetite. It’s an issue. Insulin resistance causing appetite issues. It’s an issue. Yes, it’s an energy balance thing.

It always comes down to energy balance, but that should be accounted for in P C O S, and that would be a good explanation of at least part of it. Thing that most people thought was other than hormones. We’ll get into hormones in a second. People mentioned a slower metabolism. Which it’s been studied. So originally they started studying this and it looked like, okay, wait a second.

Especially those with insulin resistance have a, a decreased basal metabolic rate. And they looked at just metabolic heart tests. Then it was interesting, they did doubly labeled water that doesn’t look at your basal metabolic. It looks at your total energy expenditure and it looks. There wasn’t a decrease in energy expenditure.

So I think this thing, to me, what I would want to do, I, there’s actually not a good amount of research here. What I would say is I would love to do metabolic ward studies with those of P C O S who. Feel that they’re diet resistant. And then I’d like to compare it to other people with P C O S and I’d like to see like, let’s just do it.

You have to get a metabolic, these are very expensive studies. I’d like to, I’d like to test the, these hypotheses and it’s still gonna come down to energy balance, but I have a feeling, you know, there may be some of these other things present. We could get closer to the truth. What I think is that there may be a difference in basal metabolic rate with those with high insulin resistance, with P C O S.

It’s just these studies. Kind of mixed, and it looks like it might be something, but I, I don’t know for sure if anything, if you’re hungrier and you have a slightly lower basal metabolic rate, that would explain a good amount of it.

Mike: If you like what I’m doing here on the podcast and elsewhere, definitely check out my health and fitness books, including the number one best selling weightlifting books for men and. In the world, bigger, leaner, stronger and thinner. Leaner, stronger, as well as the leading flexible dieting cookbook, the shredded.

And you’re thinking an actual reduction, you’re using basal metabolic rate deliberately. So not that uh, they just move around a little bit less, that their metabolism is a bit slower than what would be 

Dr.Spencer: predicted. Yeah, what would be expected. That’s what some of these studies said, especially with those with insulin resistance.

But then when they did the doubly labeled water, which looked at total energy expenditure, total daily energy expenditure, it looked like there wasn’t a difference. But I think this needs to be studied a little bit more. I. , and then what are you gonna do about it? Well, obviously we get people to exercise more and and whatnot, or we somehow resolve some of that insulin resistance, which may have an effect.

I don’t know. It just hasn’t been studied. You look at these studies, it’s like, man, this really, people haven’t gone further in this because P C O S is relatively prevalent, and I think that it’s a public health issue. We should understand this a little bit more. Maybe it’s a lack of funding, probably a little bit of all of it, but now the number one reason why people, People with P C O S at least thought that weight loss is tougher, is the hormones right?

That’s what they say. It’s just the hormones. So like what does that actually mean? Well, when people with have higher androgen levels, women specifically, not men, cause men, if you have higher androgen levels, you generally have more muscle, less fat. But in women with higher androgen levels, you get more changes in tissue specific, like insulin sensitivity.

And this may change where the fat is stored and may change where the fat is broken down. So this wouldn’t be like a total energy, wouldn’t be an energy balance difference. It would be more like where you store and gain fat. And so if you are storing more viscerally and less subcutaneously, , you won’t have a total amount of body weight difference and necessarily a total amount of fat difference, but you may have propensity for that central obesity, and that would take a toll, obviously, in somebody’s metabolic health.

You know, just biomarkers wise, but also you know how you look and that may give you a body image issue. As opposed to like, you have some extra fat on your legs, who cares? Well, some women care, of course people care, but usually people care more about the the abdomen, you know? So this may play a role, but again, hormones, just androgen levels shouldn’t change.

Like the total energy balance, but it can change where you store and that can change. 

Mike: Yeah. How you perceive what’s happening. 

Dr.Spencer: That’s pretty much it. When you combine all those things together, there is probably something to it. It’s just, it’s really hard. I hope they, if I had a billion dollars. I would love to create my own metabolic ward, and I’d like, I would do this like Metabolic Institute and I would do all sorts of Dees and metabolic ward testing and CT scanning and all MRIs and all sorts of crazy stuff, but sacrifices 

Mike: to Mullock, you know, , join the Illuminati.

Yeah. Maybe get invited to the Bohemian Grove . 

Dr.Spencer: I would love to. Yeah. That would be amazing if I could do all that. Yeah, that would be pretty cool. But so what I would say, people listen going, oh, I have P C O S and I, I struggle. , like think about, do you feel guilty after you eat a large amount of food? Do you do that multiple times a week?

You know, those types of things. Binge eating behavior, you know, there are treatments for that. Again, we have some medicines and we have cognitive behavioral therapy. Then do you know there may be a change of where you’re storing fat? I mean, I see it in my patients. Those with insulin resistance. And P C O S.

Yeah, they store it more centrally. You know, when they start gaining weight, it’s more centrally as opposed to peripherally in their legs and 

Mike: hips. I’ve heard from many women over the years who notice, uh, change as they get older, which makes sense. 

Dr.Spencer: Similar to menopause, when you go through menopause, you store it more viscerally, abdominally.

Now that’s a whole thing. I’ve made memes about that, but I get some people get really. One of the memes I make is I have a lot of post-menopausal women in pre, or you know, peri I should say. And when you’re discussing with them, they’re like, I can’t lose weight. I think it’s my menopause. And I’m like, well, okay.

So then when we really get into it, they drink a bottle of wine a night. So not everybody, of course, people are listening, going, I don’t drink a bottle of wine, but I have a lot of these patients and so I gently have to discuss, okay, that’s not gonna be conducive to weight loss. But the real underlying issue is why are you drinking the bottle of wine?

And I, you know, do they have alcohol abuse disorder or is it too, it’s Trump’s fault. It’s, it’s always Trump’s fault if you want to look down, if you, if it gets down to it. After the 2016 election, I had a lot of patience. I had a lot of upset patients. I mean, like, you know, people were, were laughing about it on social media, but I, I had patients that were distraught for a while because of that.

So, you know, the underlying issue, if you’re drinking a lot of alcohol Yes. Is it because you have an underlying alcohol issue or. Or are you treating self-treating some of the symptoms that occur through menopause? So like irritability and sleep issues. So that’s actually another, that’s a whole nother thing.

You may not like the alcohol. It just helps calm you down and help you sleep better. You know, it kind of disrupts sleep, but you don’t know that. So then that’s where we start treating those things. Or maybe I give hormones, but that’s a whole nother thing, not P C O S necessarily. So, so yeah, if you listen to this, you have P C O S and you’re like, okay.

What is going on? So binge eating hormones change where you store it. More rates of depression. Depression doesn’t, not necessarily cause overeating, but there can be a, a vicious cycle there. Turning to food just to feel better. Yeah, absolutely. A metabolic rate may be different. Appetite and satiety and cravings may be different.

The thing is like, so then what do you, what do you actually do? Do we have to just go keto? Is that the answer? Is that the answer to everything? Just keto, literally 

Mike: everything. That’s how you achieve physical and mental and spiritual perfection. Keto, that’s the key. That’s how you transcend to the other dimensions in the multiverse.

Yeah, I, 

Dr.Spencer: so, okay, so here are the most common things. You have to cut out dairy, you have to cut out gluten, you gotta go keto, you gotta do this. There’s absolutely no data to support one of these things. The key. I think with those with insulin resistance, there may indeed be a benefit to lower carb maybe, but to this date, there’s nothing that would actually support that being very truthful because a lot of times they compare, they don’t do a good comparison group in these studies, what I’ll say is that if you can lose fat, if it’s not.

Too much for you. If you can get into an energy deficit, it doesn’t matter what it is, as long as you know you’re taking care of the hunger, whole unprocessed foods, things that are kind of common sense. If you can lose weight, you’ll likely get some sort of benefit in your symptoms. And an energy deficit of some sort.

Doesn’t matter what macronutrient profile you’re following will result in weight loss. Now, again, it’s easier said than done. I’m not gonna say that, you know, just eat less, move more, but like we just gotta find a way to get you there. and then, you know, if you struggle with binge eating and depression, there’s treatments for that cognitive behavioral therapy medicines, and then the metabolic great thing.

It’s hard to know indeed for that. It’s not gonna amount to a lot if there is a difference. 

Mike: Yeah, I think that I actually, I had a little mental note that it’s probably worth mentioning that, right? Because I immediately think of metabolic damage and starvation mode and all of that, which is essentially fake news.

So it’s probably worth mentioning that even in this case, if there is. An actual reduction in bmr, and you can correct me if I’m wrong here, but I would assume that it’s not going to be so significant that it’s going to. impede weight loss. You’re not gonna see a a loss of like 300 calories per day, which would actually be kind of difficult now.

Yeah, you still could lose weight. Of course. If you eat 500 calories a day, now you will lose weight. But that’s not 

Dr.Spencer: a good way of going back. Yeah, likely not. Especially with the doubly labeled water data that shows, eh, total daily energy expenditure wasn’t different. Again, I think this stuff needs to be studied.

Samora. It’s interesting cuz if it is the case, then that would make a big clinical difference. I don’t think 

Mike: so. That’d probably be whole unique too, right? I don’t know of any other common. Condition that can crater your B 

Dr.Spencer: M R. Right. It’s still energy balanced though. Oh, for sure. 

Mike: Yeah. It just of that would, I mean, you could imagine if you’re a woman and you only burn a couple thousand, say 1800, 2000 calories per day and you have some condition, well, you would normally be burning that, but because of some condition, you’re actually burning three, 400 calories less.

Sure you still could maintain a, an energy deficit, but it’s gonna be no fun. You’re not gonna feel very good. Yeah, 

Dr.Spencer: exactly. That would be miserable. That’s pretty much the deal. You can still lose weight. You know, we have medicines that are actually, they’re studying some of these strong appetite suppressants that I use for obesity, uh, specifically in P C O S, and they do.

Quite well. So that means that to me, that means that likely appetite is an issue. And I would assume 

Mike: though, you’d recommend that people try simple, natural interventions for appetite before turning to medicine though. No, we should 

Dr.Spencer: probably just put medicine in the water. Yeah. . I, I think like, so this is what I always say, like, if you could somehow it’s, it’s easier said than down.

Like if you have a, like a propensity to for some reason, Pushing yourself towards unprocessed foods because of stress and feeling like crap. To me, it’s like, yes, it’s a choice, right? It’s a choice. You can always eat. I always say whatever the apple instead of the chips or whatever, it’s, 

Mike: and you can actually, uh, not even buy the chips if it’s actually, you know what I mean?

You could only buy the apples 

Dr.Spencer: too. I understand completely. It’s a choice, but like, you know, when I’m stressed, I understand, like, I don’t want that freaking apple. I want some kettle. Potato chips, salty, greasy, carby foods that I want to eat. 400 calories of, which, you know, an apple, whatever, it has a hundred calories about in an apple.

That would fill me up more than the stupid chips. But if we could get you to at least buy into that for whatever a month or two, you don’t have to be perfect. And you’re still having appetite issues. That’s where we go, all right, you’re basically not losing weight. It’s not happening. It’s not in the cards.

Then that’s where you start thinking about a medicine and targeting that appetite issue in your brain, and that’s where we, we do see a lot of success in that with patients with P C O S. There’s been studies specifically on that. That’s the bottom line, and so I think. . My message for those listening to this podcast is that if you have P C O S, you are absolutely not broken in a sense of weight loss.

I will say that there are, you know, it’s unfortunate and it is. It is tough to deal with. It can hinder your life, especially if you want to get pregnant and it’s just. Been a tough time going. I know that can be very stressful and and emotional for families. Just know that you’re not broken. It’s still energy balance.

You can still do it. There are medicines if needed to help you if need be to. And what 

Mike: about you have any dietary advice or you should at least comment on some of the. Dietary advice. You’ve commented on a little bit of it, but for example, I know some people promote fasting or intermittent fasting as a way to improve symptoms, specifically to increase insulin sensitivity.

Eating whole grains, I know that is often recommended to help reducing intake of added sugars, staying away from artificial trans fats, you know, things like that. 

Dr.Spencer: Yeah, so we made these like P C O S templates for RP and, and basically, We focus on mostly whole foods. So our big thing is like lean protein.

And some people say to stay away from dairy, that’s ridiculous. So you can have Greek yogurts, you can have sirloin, chicken, shrimp, fish, tofu if you wanna do tofu. So some sort of lean protein. Good, adequate amount of that. Depending on your weight and stuff, you, you choose a certain amount of that per meal.

And then we really get in the non-starchy vegetables, very few calories, but very filling due to the stretching of your stomach. And then healthy fats, which don’t necessarily give you any stretching in your stomach, but, Do you have more of a biochemical, physiologic release of hormones in your body that helps with, probably 

Mike: should highlight omega-3.

Is there, right? 

Dr.Spencer: Yeah, so like I’m a big fan of, I say dietary patterns, so instead of just going into the specific nutrients, but things like fish, fish oil, olive oil, nuts, seeds, and like avocados, those are like the big ones. Avocados would be great too cuz they also have fiber in them and it’s more of a whole food and nuts, whole food source of fat.

And then the carbs that we usually recommend are are more satiating filling. So I personally like lentils. Legumes, and then more of the whole grains, not like white rice. I love white rice by the way, don’t get me wrong. But oats would be a good option there as well. Whole grain notes. The quicker stuff probably not as good, but whatever.

It’s, it’s all good though. That’s my go-to. Yeah. If you’re following that and like, look, the quantity does matter of course, but if you’re following just that type of diet and you like, you’re like, I swear I’m eating mostly this stuff and I’m still having an issue, then that’s where it may really get more physiologic.

But when, when people follow that, I don’t see as much of an appetite issue. Like if it’s really over hard to over. A pound of broccoli. Right. It’s, it’s just, it’s hard. It’s just not as palatable. It’s just not as tasty and it’s just not as good. 

Mike: Yeah. By this point in the flow chart, many cases would have been resolved.

Yeah. At least practically speaking, like you said, it may just be in remission, so to speak, or the symptoms now are so slight that they’re insignificant in the scheme of things like, oh, cool, now she’s pregnant. Great. And she may still have a little bit of. Whatever is underlying it. But at that point, with all these good habits in place, it’s like, yeah, well, whatever.

None of our bodies are perfect. And that just, that’s life. Yeah, 

Dr.Spencer: exactly. That’s what I would say. And if you can, you know, obviously again, it’s all easier said than done, but that’s kind of the hierarchy there. Any 

Mike: supplements like vitamin D for example. I know there’s research that indicates that, uh, vitamin D insufficiency are not getting enough.

Vitamin D can aggravate symptoms when 

Dr.Spencer: it comes to vitamin D. Everybody should be replete at this point. Like Yeah, 

Mike: I know, but it’s worth saying just because, right? Yeah. 

Dr.Spencer: Whatever ails you, it seems to be that not being replete in vitamin D might have an effect. I mean, yeah, like yeah, it’s true that people that are unhealthy.

Tend to have lower vitamin Ds. There’s a lot of correlation. It’s hard. We’d have to take people that are say, insufficient or deficient in vitamin D with P C O S, and then we’d have to go randomize ’em to a placebo or vitamin D and then watch the outcomes. But ideally we could do a, a randomized crossover where you wash out and then you watch the other group and see the changes in markers and all this stuff and monitor their way.

It’s really hard to do that kind of stuff, but at this point, yeah, vitamin. I’m trying to think of anything else. There are other supplements like berberine and an Acetol that may have some effect. People prescribe metformin, but a lot of these things, like you get together the good nutrients and and exercise and diet, really hone in on that.

You’ll have great effects there. 

Mike: Yeah, makes sense. Berberine. Has other benefits that could be worth taking. As you probably saw in, um, the non bacterial gut support supplement that we just released at Legion, it’s called Balance, and Curtis was very excited about finally getting his baby burberine into something.

We had tried to put it in other products, but those were powders. It tastes so bad, super bitter. It’s incredible. It. recharge, which for anybody uses recharge. Yeah, I think it tastes pretty good. So let’s say fruit punch, recharge. You put some burberine in it and now it is vomit. That’s it. It tastes like you just threw up in your mouth.

I was impressed. 

Dr.Spencer: Yeah, we had a supplement called Glyco for like 10 years. Finally did away with sick of supplements, but, It, uh, is super powerful, like more powerful than Metformin for type two diabetes. So burberine, burberine something again, these, I wish I had a billion dollars. We could do more of these tests.

You know, it’s just, it’s underfunded cuz it, it may be that, that it looks like on biomarkers there’s a benefit, but what we’d really wanna see is even longer. Outcomes to see safety and that type of stuff. But Burberine seems to be like a drug. I mean, it’s basically a drug. I don’t know. Yeah, 

Mike: yeah. No, I’m excited to just take it every day because of the other benefits, you know, it, it may enhance the function of healthful gut bacteria.

Of course, it improves blood glucose control, which can help stabilize energy levels and it reduces intestinal inflammation. And we’ve had some really good little success stories coming in, positive reviews, especially from people and, and this is not surprising, but people. Were suffering from IBS or IB S like symptoms and had tried many different things and with this supplement balance, have reported either a, a great reduction in symptoms or in some cases a complete elimination of symptoms.

Which isn’t to say that that can, it’s gonna do that for anybody listening. You could try it. I’m not trying to oversell it, but it’s cool to see because yeah, it has drug-like effects, but it’s a perfectly safe, natural supplement you could take every day forever. Yeah, 

Dr.Spencer: man. Powerful stuff. That’s pretty much the gist of when it comes to P C O S and weight loss, I think.

I think as long as people understand that they’re not broken, there may be some nudges to push them in the wrong way, and I think everybody should understand that and just not say, eat less, move more. 

Mike: I mean that, that’s really never helpful no matter what’s going on. Right? Unless you’re just using it in a meme to grab someone’s attention.

So you can actually explain that. Yes. In the end. It. Obviously the subtext is correct in that the reason you’re not losing weight is a lack of an energy deficit, but why is there a lack of an energy deficit and that you’ve been talking a lot about that. It’s not as simple as well, or at least the advice is.

Uh, it might be quote unquote, Correct, but it’s not very practical. It’s not useful for someone who understands. Maybe it’s useful for under someone who doesn’t understand energy balance. They’ve never heard of the term and then that gives them what uh, they need to just kind of overhaul whatever they’re doing in terms of energy and an energy out.

But many people, at least who follow you and follow me, they they know about energy balance and the reason they are not losing weight. Yes. Okay, fine. They would maybe even agree with you. I guess I am. Eating too much and not moving enough, but here’s why I don’t know how to resolve it, you 

Dr.Spencer: know? Yeah, exactly.

Yep. That’s pretty much the gist of why we did this podcast, so I like it. I like it. I dunno if there’s any other questions about it, but No, 

Mike: that’s great. Those are the bullet points I had that I wanted to go over with you. So we can just wrap up. Let’s finish with where people can find you. You mentioned earlier, but for anybody who missed the preamble, uh, where they can find you on Instagram and then anywhere else, RP Health, anything that you want people to know.

The 

Dr.Spencer: Instagram’s at Dr. Naski, D R N A D O L K Y. If you’re interested in our P C O S templates, we’re gonna probably come out with even another edition that’s like more simplified. These are the first ones, and they’re geared mostly towards our more extreme, like they want to get ripped type of thing. But, uh, we have P C O S [email protected] or renaissance periodization.com, and then you just put in your weight and then we’ll spit you out some templates that you follow in a sequential manner, depending on your weight loss.

The r p YouTube, I did a presentation on this if you wanna see some of the snippets of this, but you know, if you listen to this you got the gist of it. But that’s there if you wanna see more of a PowerPoint presentation on it. 

Mike: Cool man. Thanks again for taking some time to come edge and I look forward to the next one.

We’ll have to brainstorm. Thanks man. Thanks for having me. All right. Well, that’s it for this episode. I hope you enjoyed it and found it interesting and helpful. And if you did, and you don’t mind doing me a favor, please do leave a quick review on iTunes or. Wherever you’re listening to me from, in whichever app you’re listening to me in, because that not only convinces people that they should check out the show, it also increases search visibility, and thus, it helps more people find their way to me and learn how to get fitter, leaner, stronger, healthier, and happier as well.

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That is the best way to get ahold of me, mike muscle life.com. And that’s it. Thanks again for listening to this episode, and I hope to hear from you.