Dr. Spencer Nadolsky on testosterone, carbohydrates, and supplements

In this podcast I interview Dr. Spencer Nadolsky from Examine.com and we talk boosting testosterone levels naturally, low-carb vs. high-carb dieting, supplements that actually work, and more…

TRANSCRIPT

Mike Matthews: Spencer, thanks for coming on the show. I appreciate you taking the time on a Sunday, of all days.

Dr. Spencer Nadolsky: That’s right. Thanks for having me on.

Mike: Sure thing. Let’s just start with a quick introduction of who you are, just for the listeners who don’t know and then we’ll get into the fun stuff.

Dr. Nadolsky: Cool, yes. I am actually a Board‑Certified family physician and also obesity medicine physician. I grew up in Michigan. Dad was a biology teacher and also a wrestling and football coach. I grew up with an older brother really in athletics.

The short story is my brother is really good at athletics. I came into high school right after he graduated and went on to wrestle for Michigan State.

I thought I was going to be awesome. I wasn’t great at first. I thought I was going to be good because of my last name.

I got into nutrition and exercise science. By the time I was a junior, I ended up becoming a state champ in wrestling and all‑state football and all that stuff. I started off JV my freshman year, whereas my brother was already a state champ that year.

Mike: You were walking in his shadow.

Dr. Nadolsky: I really got into nutrition and exercise science. It helped that my dad was also a biology and chemistry teacher and into nutrition as well.

Originally I went to play football at Michigan State. Long story short, I ended up wrestling as UNC Chapel Hills heavyweight for three years, did pretty well, and used the same exercise nutrition science to become good at wrestling and football but wanted to use that information and spread it across the general population to improve their health.

I wanted to go to medical school. My brother decided to go to medical school as well. I went to Virginia Tech’s Osteopathic Medical School and decided to use lifestyle as medicine. Four years of medical school, then three years of residency is the training.

I did Family Medicine and now I’m Board Certified in both Family and Obesity Medicine. I’m trying to use the exercise and nutrition science that I used for performance but now for general population for health purposes. This is where I am.

Mike: That’s awesome. What’s your role at Examine.com?

Dr. Nadolsky: I’m their Medical Editor. I was their Director, the head honcho for a little bit. It was too hard to juggle that along with my clinical practice, so I said, “Why don’t I just do the medical editing?” making sure their stuff is clinically relevant, as opposed to bench research stuff.

For example, some random supplement that’s out there may have some pilot study on rats, showing some sort of benefit. I basically sit back and go, “Yeah, but is this really clinically relevant? If I had a patient, would I tell them to do this?”

Mike: Maybe like 7‑keto or something like that…

Dr. Nadolsky: [laughs] Yeah, pretty much.

Mike: Yeah.

Dr. Nadolsky: That’s what I do. I don’t do as much with them anymore, but I’m still there as the Medical Editor, to help them out in that regard.

Mike: That’s cool. I was thinking that for this podcast, that because I’ve talked myself on a lot of different subjects, and had a lot of different people talk on a lot of different subjects, but one area that I don’t think there’s ever really been a podcast on is supplements in general.

I’ve written a lot about it, so I thought that given your involvement in Examine, and just given your knowledge, especially with weight loss ‑ it’s probably a bigger button than muscle building, but those are the two areas that people are most concerned with ‑ that we would dive into some supplement stuff.

Dr. Nadolsky: Yeah, that’s great. A lot of my patients ask about supplements too, so it’s a good thing to have some knowledge in that realm other than Dr. Oz’s recommendations.

Mike: Yeah, but he’s a doctor, man.

Dr. Nadolsky: [laughs] That’s true.

Mike: Let’s start at the top here. I get asked a lot about, just because it’s pushed so much, there’s so much marketing on it these days, on testosterone levels. “Are testosterone levels low? Raising testosterone levels, etc. etc.”

I guess this is a two‑part question.

One is, are there any legitimate natural ways to boost testosterone levels enough that it’s significant in any way? The second part of that is, does that even really matter? In the bigger picture, even if you could increase your testosterone naturally by 10 percent, who cares? Or is it something worthwhile?

Dr. Nadolsky: That’s a great question. My brother is an endocrine fellow right now, and I’d get a lot into endocrinology with my patients. One of the things on the Internet guys ask, and they…”I heard this supplement may increase my testosterone by 10 percent,” or eating more saturated fat, this and that.

The short answer is that basically if you’re within the normal levels, increasing by small percentages in the physiologic range probably won’t matter in the long run. The long answer is that it may depend.

For example, I did a natural body building contest last year. I went from a testosterone level of 600, which is right smack‑dab in the middle of normal range. The normal range is anywhere from 300 to 1,000, so I was right in the middle. I went from 600 down to 240 or 260, I could feel it though, and that was at the end of my cut.

From a clinical standpoint just not eating, people who do intermittent fasting, it’s not the intermittent fasting that’s making their testosterone levels lower, it’s the fact that they’re just intermittent fasting too much. Meaning they’re not even getting enough calories to support their hypothalamic gonadal axis. Their brain is basically not communicating with their testicles anymore because it thinks it’s starving.

Mike: Right, so it’s too big of a calorie deficit or too long of a calorie deficit.

Dr. Nadolsky: Yeah, and it’s not necessarily intermittent fasting, people will think, “Oh, you’re crapping on intermittent fasting.” No, actually it’s working so well that they’re just not getting enough calories overall.

Mike: Yeah, my take on IF has always been, there’s some research out there on the health benefits of fasting but I would argue that you can get a lot of those benefits from exercise alone. But, I have seen working with people, if people have trouble controlling food intake it can help with that. It’s harder to overeat when you only have eight hours to eat all your food.

Dr. Nadolsky: Exactly so that would be a clinical benefit. If you’re not eating enough and you’re on the lower end of testosterone, just increase your caloric intake.

Maybe scaling it back on your workout, actually getting the sleep, instead of five hours a night getting the seven or eight hours of deep, restful sleep, that may have a clinical impact on your testosterone and may increase your gains in the gym and your performance and everything like that. So after a month of going back to my normal diet I went back up to about a 550 testosterone.

Mike: That also makes a good point, it’s not like you permanently damaged your endocrine system by what you did. That’s also another idea out there that if you don’t eat a ton of fat, because low‑carb high‑fat is very trendy right now. If you’re on a lower fat not a low‑fat, maybe something about 0.3 or 0.4 grams of fat per pound of lean mass that’s not enough hormone levels and you’re going to crash your endocrine system, but no, you’re not.

Dr. Nadolsky: Yeah, exactly. That’s another thing, say I had a 600 testosterone and they’re like, “Well, if you eat a little more saturated fat you can increase it 10 percent,” so I go from a 600 to a 660.

Mike: Let’s give you the benefit of the doubt, let’s say 700, the big 700.

Dr. Nadolsky: Yeah, that wouldn’t even do anything. You wouldn’t notice any difference.

Mike: To be clear, you wouldn’t notice any difference in terms of…?

Dr. Nadolsky: In terms of muscle gain, probably well‑being, probably anything related to testosterone or androgen type.

Mike: Sex drive?

Dr. Nadolsky: Yeah, you’re already at a high level, that little bit is not going to matter.

Mike: Where, for listeners who are probably wondering this, would you start noticing it?

Dr. Nadolsky: If you’re in that low to normal, I’m going to say around 300 to 400. Now this gets a little more complicated because then you start calculating free testosterone using sex hormone binding globulin, albumin and all this type of stuff.

Mike: But just to keep it simple. I’m playing readers that write to me, because this is the type of stuff they ask.

Dr. Nadolsky: If you’re in that 300 to 400 range, and you’re not eating a lot and are going up to that 500 you’re going to feel better. It’s possibly not even necessarily from the testosterone, it’s many other things, thyroid partly, and energy, mood from just eating what you want and not being so restricted. You’ll notice if you go from that slightly deficient range to a good normal range, you’ll notice it.

Mike: If you’re normal you have to approach the top of physiological?

Dr. Nadolsky: That’s why, if you end up using super physiologic exogenous hormone, if you took a bunch of AndroGel or something like that on top of the normal range and you’re going to the range above the thousands, then you’ll probably notice something too. But in that physiologic range, at least as far as I know, I haven’t seen any study to say it’s made any difference.

Mike: I have actually seen a study out of McMaster University where basically the conclusion of the study is that, with resistance‑trained men, the small fluctuations or differences in their hormone levels in the bulk hormone levels, it wasn’t just testosterone. It was also growth hormone with IGF‑1. It didn’t even make the program. The guys are in the lower end of the bulk profile, I guess only gained just about as much muscle strength as the people on the high.

The differences weren’t significant but then you look at steroids studies so you start going beyond that. You start pumping 1500, 2000 plus ng/dL and now it really starts to make a difference.

I think that’s just a point to drive home to listeners that these are the little things that you can do. Sure, if you’re switching from a lower fat to a higher fat, yes you will probably see a small increase and there may be some supplements out there that maybe would give you a small increase but what are you doing it for?

Spencer, I’ve seen a poster of yours going from low‑carb to high‑carb and one of my arguments against doing that is, unless you have an insane metabolism and you just get to eat absurd amounts of food, you have to raise your fats, you have to sacrifice your carbs.

If you want to speak on that real quick because I know you have written a whole thing on that. Why is that bad? If you’re weight‑lifting, let’s say you’re a guy or a girl and you’re lifting heavy weights 3 to 5 times a week, you’re doing a bit of cardio.

You’re goal is the same goal as everybody else, you want to be muscular and lean. Why is going higher and higher in fat and lower and lower in carbs counterproductive unless you have some strange body problem that requires it?

Dr. Nadolsky: I think with the whole low‑carb high‑fat push for those with metabolic syndrome type picture, those with insulin resistance who seem to have some improvements with a metabolic profile with going low‑carb that’s spilling over into the healthier crowd who could really benefit from this, the carbohydrates that fuel their work‑outs. You don’t need carbohydrates to do low‑rep high‑weight intensity exercise but once you start getting into that glycogen‑type workout ‑ kind of like a crossfit workout, you’re going to see a big performance decline if you don’t eat the carbohydrates.

Mike: I’ve noticed the difference even in training a lot anywhere between 75 to 85 percent of my one‑rep max. It’s like heavy but it’s not necessarily power‑lifting type of program. I’m not really into the super high reps stuff but even working in that

4 to 6, 5 to 7, 6 to 8 rep range, it pulls on glycogen because if my carbs are low…

Dr. Nadolsky: You’ll feel it.

Mike: If I carb up, I could squat 30 more pounds just by eating a bunch of carbs the night before.

Dr. Nadolsky: The whole thing is to use it for diabetics people with pre‑diabetes and insulin resistance and that type of thing. Now it’s spilling over into higher wall maybe we should use this for athletes and healthier folks.

There is some data for that and maybe it does help some certain people but honestly for the majority of everybody, I wouldn’t eat less carbs and more fat just to improve your performance and health. It’s not a good idea. I’m training for a triathlon and trying to keep my muscles at the same time and these carbs are fueling. I’m actually leaner than I was half‑way through my body building cut at a higher weight.

Mike: That’s nice.

Dr. Nadolsky: Exactly.

Mike: Coming back to testosterone, let’s say there’s somebody who goes and gets blood tested and they are at the lower‑end of normal and they want to do something about it, what are some general things they should look into? It could be in the dietary or nutritional or supplemental.

Obviously you can’t make recommendations unless you know what’s going on with the person, but what are some of the most common things? Like here’s your checklist, you need to check these things out because these are some ways that most people can naturally increase testosterone in a significant way?

Dr. Nadolsky: I have a lot of patients that are like that so it depends. If it’s a younger guy that’s like that, I’m really looking to how many calories their eating just like what we talked about before. If they were all trying to restrict themselves, we take a break from that for sure. The other thing with younger guys is going out and partying a little bit…

Mike: Alcohol

Dr. Nadolsky: Alcohol. Not only that but also not sleeping, having a disruptive circadian rhythm. It’s all over the place. They’re sleeping one day ’til 10 and then they’re up the other day going to work or whatever. It’s all over the place, so we try to talk about that.

The other thing is they may be doing too much exercise. They’re killing their body. They’re going out and doing long runs then all of the sudden, they’re going to a crossfit thing and then they’re going to doing some high‑intensity‑interval training‑late‑in‑the‑day type of thing and they’re not even letting their body rest. They’re not sleeping, they’re working out too hard and they’re not eating enough. That’s pretty much what I see with younger guys.

For older folks, those who are in their 40s, 50s guys, what I see a lot is development of something like sleep apnea, that they’ve gained a little bit too much weight and now they’re snoring. Their brain’s not getting enough oxygen. They’re not actually getting into the deep sleep.

The other thing is, along with that, with the excess weight, there are a lot of causes of the low testosterone. The adipose tissue turns the testosterone into estrogen. The other thing is with a little bit with that extra fat, the adipose tissue, there’s an inflammation going on at the site of brain which is communicating with the testicles, so there are a lot of different things. You look at it.

Younger guys usually, they’re doing too much exercise, not eating enough, not sleeping enough. For the older guys, they just need a healthier lifestyle. If they need a sleep study and get a CPAP, that’s just one thing. If they just need to go from the standard American junk food diet to more of a lower carb Mediterranean type of diet, that can help as well.

Just lose some weight, exercise. Almost like the exact opposite of the younger guys. Eating too little versus eating too much.

Those are pretty much the standard and of course, if they really are in that pathological low testosterone range, you’re going to work that up of course but if they’re on the lower end of normal…

Some doctors may be pushing testosterone. I see it all the time, these doctors…

Mike: It seems to be such a thing these days.

Dr. Nadolsky: I don’t know what the deal is.

Mike: Maybe it’s just easy money, because it’s such a hot button for so many people.

Dr. Nadolsky: It is. What I’ve seen is these patients end up on it for a long time. I ask them, “Why did you get started on this? You could have done this naturally.” They go, “I don’t know, the doctor pushed it.” Then we have to wean them off, which is miserable because your body is not producing it anymore. You can restart them if it hasn’t been too long and they weren’t abusing it.

That’s pretty much it. In terms of supplements, I don’t like supplements for testosterone boosting, in fact Men’s Health got hold of me a few months ago and was asking me about it, some company had their…

Mike: They wanted you to plug one of their “better than steroids” supplements?

Dr. Nadolsky: I think so, it sounded kind of like that.

Mike: Yeah, they push the biggest bullshit products ever.

Dr. Nadolsky: I was kind of like, “Well you’re going to be mad at me, but there’s really nothing out there that’s really that great.” Obviously there are pharmaceutical things that you can use that aren’t testosterone that work really well. I use them a lot with my patients if they are in that low to normal and need some help, but supplements not so much.

Mike: Would you say if somebody has a Vitamin D deficiency is that relevant? Or vitamin or mineral type deficiencies or a zinc deficiency or does that just not happen?

Dr. Nadolsky: If you’re deficient in Vitamin D going into the normal range, which isn’t that hard if you get a little bit of sun and supplement with a 2,000 international units. That’s been shown in some studies maybe to be beneficial. Same thing with zinc, if you’re working out hard and are zinc deficient that is definitely something.

Taking a multivitamin daily may help. At Examine we talk about being more targeted towards the multivitamin mineral supplementation as opposed to just shotgunning it. Looking at that, it’s hard, you can test for zinc and all that stuff. I tend to say if you’re working out hard and sweating a lot it may not be a bad idea to supplement with that.

Mike: One other thing that just came to me as you were talking is, are there any correlations between body fat levels and testosterone production? Obviously as you were saying, as body fat levels rise we know that depresses testosterone levels. As we start getting to the lower end, is there a point where you can be too lean and that is going to mess with your testosterone production or is that not really an issue?

For instance, I myself, I tend to stay around eight percent body fat give or take, it depends on how I’ve eaten on a week to week basis because little things matter. I don’t get blood tested because I don’t have any reason to, I could just do it for fun but I don’t have any symptoms of low testosterone.

It’s just something that I see out there in the random chatter of the fitness space, this idea that it’s unhealthy to be under 10 percent body fat for any period of time. I see that more as an excuse of people who are too undisciplined to do it, what’s your take on that?

Dr. Nadolsky: There is a mechanism, the threshold may be different for different people. For instance, my brother, I don’t know if this is from epigenetics or what, from young age he’s always been lean, very lean with a good six pack and everything like that. He’s gone up and down with his testosterone just when we tested it for whatever reason, due to probably sleep and residency and training.

Other people, if they were that lean they may not be able to support testosterone levels. The mechanism is leptin, I’m sure you’ve heard of leptin. Leptin is secreted by your adipose tissue, so if you get down to a low level of body fat your leptin is going to be very low. There’s a mechanism with your brain and your hypothalamus and pituitary in communication with your testicles that if you don’t have any leptin there’s a decrease in that permissive effect of that communication.

The other thing is that people have been dieting so much to get down to those body fat levels, and so your current caloric intake dictates how much leptin you create as well.

Mike: And carbohydrate intake is relevant also, right?

Dr. Nadolsky: Exactly, so you have a few things that may play a role into it. Those that may have been sitting at a low body fat and maintaining that, they may be fine.

Mike: I’ve also worked my calories up to, I haven’t really tried to push them beyond 3,000 per day, but maybe my average intake is 2,800 a day. I’m 190 pounds.

Dr. Nadolsky: Yeah, you’re probably fine. Someone else if they went down to that level they may not. It is true. People who are contest ready, shredded lean, if someone can maintain that…

Mike: Without drugs? No, they can’t. I’ve tried. I’ve gotten down to, it’s hard to really know because I didn’t get dexa’d, but where there’s not much left, you can’t pinch anything anywhere. I tried to maintain that for a month and I found that I couldn’t get my calories over 2,400 without gaining fat and I didn’t feel good, it just didn’t work.

Dr. Nadolsky: Exactly. If they’re maintaining that it would be questionable whether they’re using exogenous hormones to maintain.

My brother looks pretty good and maintains it with a healthy range, although he is at the lower end of normal a lot of times when we test his testosterone. But other people may have to maintain a higher body fat percentage in order to keep their hypogonadal pituitary axis maintained.

Mike: I guess the takeaway there is if you want to stay very lean and you are maybe experiencing symptoms of low‑T or are worried about it you can go get your blood tested and find out where you’re at.

Like Spencer is saying, you can slowly increase calories, it’s known as reverse dieting where basically the idea is you’re trying to speed up your metabolism. You’re trying to get your body to burn more energy without putting on fat, so that’s kind of how you can work your calories up. But I guess Spencer, some people though their bodies might just not like being at a certain body fat level?

Dr. Nadolsky: Exactly, and I don’t know if it’s truly been teased out on why. There’s definitely epigenetic type of things, even maybe things that your mom did while she was pregnant with you, it gets pretty crazy when you’re diving into that type of stuff.

Mike: Yeah, cool. That’s testosterone, now let’s talk a little bit about building muscle. Of course fat loss and muscle building supplements are the ones where the vast majority of money is spent. So let’s get right to it, are there any supplements that actually directly help you build muscle?

Dr. Nadolsky: Pretty much the standard that I talk about and most everybody talks about, is protein, whey‑protein, leucine branch chain amino acid type of things and creatine, beta‑alanine in a distant.

Mike: Yeah maybe an indirect, because it can increase the workload of your workouts which, if you push yourself, then the more weight you add over time the stronger and bigger you’re going to get.

Dr. Nadolsky: Exactly, whenever anybody asks me about supplements my go to is generally whey‑protein. I know the vegans tend to get mad at me for recommending that because…

Mike: What do you think about a brown rice and pea blend for them?

Dr. Nadolsky: Yeah I think it’s great. A lot of them, in fact one of my doctor buddies is a vegan. He’s a bariatric surgeon, smart guy who is really into nutrition and he just doesn’t think people need that much protein and it’s true I don’t think people need it. If your goal is to gain muscle, if that’s your goal, not necessarily longevity for life, trying to see how long you can live.

Mike: There’s quality of life, and if I make it to 90 I’m happy. Anything beyond that if my body is still working well then I’ll stick around but I want to enjoy myself as well.

Dr. Nadolsky: Exactly, if your goal is to build muscle you need to hit that leucine threshold. Of course Dr. Layman and Layne Norton and all those guys have looked into that threshold and you need good quality protein and I think that’s number one.

Mike: That’s the advantage of whey is because it’s very leucine rich? Or one of the advantages I guess.

Dr. Nadolsky: Exactly, and that’s generally my go to. If somebody says, “What supplements do I take?” It tends to be whey‑protein, because first of all the convenience. People who don’t have very good eating habits we try to focus on that first, but honestly it can be one of the easiest little quick things. I don’t even consider it as a supplement I think of it as food, and I like it.

Mike: Because you have it at the office, at your practice and you’re busy. If you haven’t eaten protein in however many hours and you don’t want to eat 100 grams of protein in meat at dinner.

Dr. Nadolsky: Yeah, I love meat but I don’t want to force feed myself.

Mike: Five ounces and I’m done. I’m fine.

Dr. Nadolsky: I have a shake a day, and that tends to be what my first recommendation to patients is. They all have jobs, unless they’re a housewife, and they’re still taking care of their kids.

Mike: That’s a job, you know that.

Dr. Nadolsky: They’re taking care of kids too. If they’re in the office, or running around, they’ve got to do this and that and don’t have time, it’s always easy to have a jug of protein or a shaker bottle with some powder added into it to add some water later. If they want to do the ready to drink shakes, they’re more expensive but whatever.

Mike: I always question the quality of the protein, I don’t trust any of them to be honest.

Dr. Nadolsky: Yeah and some of them kind of taste, I like the taste of some of them but they have a weird after taste, I don’t know.

Mike: Every week it seems like there’s a news story breaking about how shady this supplement is, you almost can’t trust anybody and I really don’t trust those ready‑made drinks.

Dr. Nadolsky: It’s hard to trust anybody. I have a lot of patients who are housewives, they’re taking care of their kids and running errands and things like that. It’s easy to throw together a shake without having to cook a meal while they’re taking care of their kids and things like that too. With whey‑protein, you can get a blend as well, but whey is generally what I recommend first.

Then pretty much I go to creatine, which is pretty much standard and one of the most studied supplements out there. There are various mechanisms like you said with the beta‑alanine and creatine that can help you work out harder. There’s also some cellular swelling that may help with hypertrophy in and of itself too, so those tend to be my go to.

Mike: Yeah, same. Listeners, in case you’re wondering in terms of dosages of creatine, the normal would be five grams a day, right, Spencer?

Dr. Nadolsky: Yeah.

Mike: Beta‑alanine would be about the same?

Dr. Nadolsky: Yeah, a couple grams, I generally do it once a day, for beta‑alanine I usually do a few grams in my morning shake. Sometimes I do another one after my workout. I hate the tingling but once you…

Mike: I like it.

Dr. Nadolsky: Really? You like it?

Mike: I don’t know, I’m a masochist.

Dr. Nadolsky: I need to rub my scalp. Once I’ve been doing it chronically it goes away.

Mike: I still get it. I have about five grams a day because I have a line of workout supplements and in the pre‑workout there’s five grams of beta‑alanine per serving. I still get it everyday.

Dr. Nadolsky: You get a pretty high dose all at once then, that’s why.

Mike: Yeah, true. If I were to cut that in half and then…

Dr. Nadolsky: Yeah, the thing with beta‑alanine, I take it everyday along with creatine and whey, but some people question the safety and everything like that. I don’t see why it wouldn’t be safe. I don’t have any reason to believe it wouldn’t be safe, along with creatine. The thing with creatine is…

Mike: Creatine is so studied at this point, how could anyone say it’s not safe?

Dr. Nadolsky: I don’t know, the thing is if you see your doctor and you don’t tell him your on creatine and you go and get a basic metabolic panel, one of the levels is creatinine. That looks at basically how well your kidneys are filtering.

One of the by products of creatine, it will switch into creatinine and maybe make your levels point one or two higher than what it would be without the creatine. Add that to the fact that you are working out, and sometimes that can increase it, and then also having a little more muscle, you’ll have higher levels.

It may look like you have decreased functioning kidneys when in fact it’s not real, it’s just because of your supplements.

Mike: I’ve had people write me saying, hey Mike, “My doctor says I might have kidney disease because…” No, I ask them “Did you tell them that you supplement with creatine? Does he know how much protein you eat?

Does he know You’re lifting weights five days a week? Oh, no. And then it comes back like, “Never mind, Doctor says its fine.”

Dr. Nadolsky: You may need to print out some studies for the doctor because they may have never seen that, so if they’re not used to patients that are big lifters and supplementers, they may get scared of that. Something to bring up with your doctor if you do those things.

Mike: Now let’s talk about fat loss. What would be your go to supplements for helping with fat loss? Also, of course, most of the listeners are pretty clued in on the basics of energy balance.

Of course, you’re dieting correctly, you’re in a calorie deficit, you have your protein intake where it needs to be so you can preserve muscle, you’re not beating yourself to death with exercise but you just want to accelerate fat loss.

Dr. Nadolsky: I’ll reiterate that whey protein is one of my go‑to’s simply for the lean mass preservation, because of how crucial that is. As you said, they’re going to need be in a caloric deficit.

I want them having that strong leucine‑rich protein because of how well it helps you retain that lean mass. Beyond that though, I’m a big supporter of caffeine.

The data behind caffeine is very good. Not only for a little bit of a fat loss but just for performance. If you’re in a caloric deficit you’re going to need a little bit of extra help in working out.

For my body building competition, I think I was down to 2200 calories at one point. Right now I’m getting 35 to 4000 calories a day.

You can imagine I was so tired, but the one thing that was able to help me was a little bit of caffeine. The other thing is, are you going to be burning the fat peripherally, meaning actually helping you burn the fat, versus something centrally acting meaning…

Mike: Increasing energy expenditure, yeah.

Dr. Nadolsky: …decreasing your appetite versus actually increasing your peripheral burning. There are some things out there that can help. The caffeine may have both. Some people think it does help with appetite.

Mike: There’s some research that if you raise adrenaline and noradrenaline levels that that alone can decrease appetite.

Dr. Nadolsky: That’s thought to be how maybe caffeine helps. Obviously getting more fiber and helping you fill up your stomach, glucomannan supplements and stuff like that can help with your appetite.

From an actually peripheral fat burning standpoint, Dr. Oz pushes things like raspberry ketone. I don’t know, the data’s not very good behind that. Green coffee bean…

Mike: Yeah. Garcinia cambogia.

Dr. Nadolsky: Yeah. Those types of things. The effects are modest when you start looking at human studies. Green tea extract is pretty good.

That’s one of the more researched things when you pile all of these things together. I tend not to use a lot of them in clinical practice. There are a few drugs that are used for obesity that have a lot of clinical data behind them, and they’re potent.

I’ve got some people maintaining a hundred pound weight loss over a few years. Whereas a supplement I would probably use that maybe in body builders, when they had the last few pounds to lose maybe and anything can help, like yohimbine or something like that.

Mike: Yeah. What about something like synephrine?

Dr. Nadolsky: That can have some of the same central reacting appetite suppression as well, and some of that type of stuff.

Mike: 5‑HTP seems to be good for that as well. A lot of people take it with food.

Dr. Nadolsky: There are some obesity doctors that use that along with something like phentermine which is another centrally acting agent to help with appetite. They hit in a few different receptors in the brain. I’m careful about supplements that have those mechanisms because they’re not studied as well.

As a physician I’ve got to be careful about what I recommend, because you never know what you get when you recommend supplements.

Mike: That’s also a problem. They go out and try to buy it and unfortunately if they get lucky they’re not getting something harmful but it’s just rice flour. [laughs]

Dr. Nadolsky: Yeah. Some reports of supplements have reported fat burners having sibutramine in it, which is a weight loss drug that was taken off the market in 2010 due to cardiac adverse effects and events.

I’m very careful about the fat burners, I pretty much stick to caffeine. 5‑HTP does have some things with especially carb craving and probably some of the central appetite suppressing effect too. I have used yohimbine and forskolin in the past during my body building competition right at the end…

Mike: Also that last stubborn fat, it’s such a bitch.

Dr. Nadolsky: Yeah. They’re the ones that tend to have the most evidence behind them as far as I know for fat burning. I was like, “Well, I’m doing my diet pretty much as well as I can…” You’ve got to be careful with the yohimbine though.

Due to its various adrenergic effects you’ve got to be careful with your blood pressure and other cardiac stuff. If you use it in safe doses. If you do it, I would work with a doctor [laughs] that knows how to use it. Just be very careful, because I’ve seen some bad things happen when people take too high of doses of that.

Mike: Yeah, yeah. I’ve written about yohimbine, and I think the standard dosage is like point one to point two milligrams per kilogram of weight. Start on the low end of that, accept tolerance and don’t abuse it.

I rarely hear from people that get any adverse effects. Some people get a little jittery, and just don’t take it then.

Dr. Nadolsky: Yeah. Exactly. That’s my thing with fat loss. It’s biggest thing is lean mass retention, that’s why I say the whey protein even though people don’t get excited about that.

Once you get down to that level and you just want that extra little bit, you know? I talk about caffeine, yohimbine and forskolin.

Mike: Yeah, that’s funny. The fat loss product that I have, the formulation is, you have synephrine, naringin and hesperidin. Naringin and hesperidin are in the same fruit. the bitter orange extract, and there’s some research on that increasing basal metabolic rate.

5‑HTP, salacin for the blood flow effects, and then forskolin. Then hordenine also is different. What you’re talking about, that’s what we kind of narrowed down as, all right, there is enough research on these to where it’s very likely its going to help and we’ve gotten a lot of feedback, especially from experienced bodybuilders.

What you’re talking about. They know what they’re doing, and they know how their body responds.

They know how to diet. They’ll come back. Probably the most common, from those types of people like you, when you put it all together with caffeine. We left caffeine out of the formulation.

Dr. Nadolsky: You can drink some coffee?

Mike: Yeah, seriously. That’s why. I always hated that about fat loss products. Even if the formulations were OK, I don’t want 200 milligrams of caffeine from pills.

I want a pure workout. I don’t drink coffee, I wish I liked it. I’ve heard from quite a few people prepping for shows where they noticed that with the supplementation, with caffeine they saw about maybe about a half a pound extra weight now a week.

Somewhere between a quarter and half a pound weight loss a week which makes sense when you look at the numbers of what those things should do.

Dr. Nadolsky: Yep, exactly.

Mike: Cool. All right. I guess just to recap people. People go on Amazon, they go look for fat loss products, and they’re going to see garcinia cambogia.

Again, you look at the research on that and it’s just not very good. I don’t think it’s enough to sell it at all. Green coffee extract is also very popular. Would you say don’t waste your money on that?

Dr. Nadolsky: Wouldn’t waste the money. Or raspberry ketone.

Mike: Raspberry ketone. Carnitine had its 15 minutes of fame for fat loss.

Dr. Nadolsky: Yeah. [laughs] It would make sense, but it just doesn’t work.

Mike: Yeah, it’s just one of those things. Like evodiamine. You feel hotter, but it just doesn’t help you lose fat.

Dr. Nadolsky: Yeah. Exactly.

Mike: Which is actually funny. A lot of companies include evodiamine in their fat loss supplements just so you feel like, “Oh this must be doing something.”

Dr. Nadolsky: Yeah, I think that’s why they put a lot of caffeine it in. Pre‑workouts a lot of times have a lot of that. Actually caffeine is one of the best things for workouts.

Mike: Yeah, I love caffeine. Thank god that caffeine doesn’t destroy you as long as you don’t abuse it.

Dr. Nadolsky: It’s one of most well studied and best things out there for workout performance and things like that. A lot of these places put a ton of it in just to make you feel it, and they pixie dust the rest of their…

Mike: It’s the prop blend scam of whatever’s first in the prop blend could be 99, 98 percent of that entire blend and it’s always going to be something cheap that they just load up. Or there are manufacturers out there, I know from being in the business that plenty of manufacturers out there that don’t care, they’ll do anything you want.

Like that thing that came out of New York State, the Attorney General, “Oh, you want house plant and asparagus in your pills? Cool. Sounds good, we don’t care what you sell them as.” You know what I mean?

Dr. Nadolsky: Exactly.

Mike: Now let’s say someones on a budget, which is something I get asked fairly often. They only can afford a few supplements, and they want to build muscle, let’s say. It would be, whey protein, creatine, beta‑alamine would be your…

Dr. Nadolsky: Yep. Those would be my go‑to.

Mike: OK, cool. If someone wants to lose fat, then it would be, whey protein, something with caffeine, and are there one or two other things that you would…

Dr. Nadolsky: Yeah. If they were really on a budget I may still say the creatine even though their weight may stay…

Mike: Yeah, just for retaining lean mass?

Dr. Nadolsky: Yeah, and for continuing your performance. That would probably be my go to. Whey, creatine and caffeine.

Mike: Cool. Then yohimbine if…

Dr. Nadolsky: I hate to even say yohimbine. It’s controversial. I’ve seen such bad things come out.

I’ve used it myself because it wasn’t banned in the competition that I did. I did the natural IMBF or WMBF or whatever it was, so everything was pretty much banned, but yohimbine wasn’t and it has a little bit of good data behind it.

Mike: You have to be in a fasted state, I probably should just mention that. The higher the insulin levels are, the more it doesn’t do anything for fat loss.

Dr. Nadolsky: I think the effects are modest regardless. As far as I understand…

Mike: I’ve used it many times. I’ve noticed that, like you said, once I start getting under 10 percent, and then it starts to slow down, I’ve noticed yomibine and caffeine together has definitely helped, if you’re just trying to squeeze out that half a pound a week.

Dr. Nadolsky: [laughs] I wouldn’t even want anyone to use it unless they’re body building and they’re at that last little bit and…

Mike: It is a very niche product.

Dr. Nadolsky: ..they want an edge. I would still say the whey, creatine, and caffeine. I know it seems so, “Oh, it’s boring.”

Mike: Yeah, but supplementation is boring. You’re right.

Dr. Nadolsky: Tried and true.

Mike: There aren’t that many things you can do to improve performance, build muscle, and lose fat. The majority of it is eating right, resting and putting in the work.

This is how I always pitch it, if you have some money that you want to put into it, there are some things you can buy that are probably worthwhile. If you don’t have the money or you don’t want to then you can still do great.

Dr. Nadolsky: Exactly.

Mike: Cool. OK, awesome. That’s all I’ve got. Where can people find you, find your work?

Dr. Nadolsky: People can find me, I have my own personal blog, it’s Dr Spencer.com, D‑r‑s‑p‑e‑n‑c‑e‑r dot com. I also have a blog with my brother, Docswholift.com.

We try to promote doctors who push exercise and lifting weights. Of course I have a Facebook page, Dr. Spencer Nadolsky, and then Twitter is at DrNadolsky. That’s pretty much it.

Mike: Awesome. Thank you so much for taking the time, Spencer, I really appreciate it.

Dr. Nadolsky: Thanks for having me on. I hope you enjoy a good day down there in Clearwater.

Mike: It’s heating up. Summer is basically here.

Hey, it’s Mike again. I hope you liked the podcast. If you did, go ahead and subscribe.

I put out new episodes every week or so, where I talk about all kinds of things related to health and fitness and general wellness. Also head over to my website at www.muscleforlife.com, where you’ll find not only past episodes of the podcast, but you’ll also find a bunch of different articles that I’ve written.

I release a new one almost every day actually. I release four to six new articles a week. You can also find my books and everything else I’m involved in over at muscleforlife.com. All right, thanks again. Bye.