Barbell Shrugged - The Fat Loss Prescription w Dr. Spencer Nadolsky, Anders Varner, Doug Larson, and Travis Mash - Barbell Shrugged #506

Episode Date: September 23, 2020

Spencer Nadolsky is a licensed practicing board certified family and bariatric (weight loss) medicine physician. He is a PHD in Lipidology . After a successful athletic career at UNC-Chapel Hill, Nadolsky enrolled in medical school at VCOM (Virginia College of Osteopathic Medicine) with aspirations to change the world of medicine by pushing lifestyle before drugs (when possible). Lifting, eating, laughter, and sleeping are his current first line medicines for whatever ails ya’ (although those don’t cure pneumonia unfortunately).   Nadolsky wrestled in the Heavy Weight division for the UNC Tar Heels for 3 years and was ranked in the top 4 of the nation at one point.  He owes much of his success to nutrition and exercise science and of course hard work. Nadolsky's goal is to use what he learned as an athlete and apply it to his patients to help them get as healthy as possible using lifestyle as medicine.   In this Episode of Barbell Shrugged:   What is fat and what you can do about it? Understanding societal pressure surrounding fat. Behavioral changes to long term health. Why is it so hard to stay in a caloric deficit? Is there a perfect diet?   Dr. Spencer Nadolsky on Instagram Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram ———————————————— Training Programs to Build Muscle: https://bit.ly/34zcGVw   Nutrition Programs to Lose Fat and Build Muscle: https://bit.ly/3eiW8FF   Nutrition and Training Bundles to Save 67%: https://bit.ly/2yaxQxa ———————————————— Please Support Our Sponsors   Legion Athletics Whey Protein, Creatine, and Pre-Workout - Save 20% using code “SHRUGGED”   Fittogether - Fitness ONLY Social Media App   Organifi - Save 20% using code: “Shrugged” at organifi.com/shrugged   www.masszymes.com/shruggedfree  - for FREE bottle of BiOptimizers Masszymes   Garage Gym Equipment and Accessories: https://bit.ly/3b6GZFj Save 5% using the coupon code “Shrugged”

This week on Barbell Stroke, Dr. Spencer Nadolski. We're talking about obesity, fat, calorie deficits to get you out of that state. A whole bunch of things I just never knew about what obesity, fat, and diets were all about. And having an actual PhD Dr. Spencer Nadolski come on the show is so radical because they understand and explain things in like the coolest way and to make it so knowledgeable entertaining fun to learn about a subject that typically is very uncomfortable to talk about this week though want to make sure we thank our sponsors over at Organifi I am currently on the road I have a big family vacation that we were lucky enough to make to come down to

Marcos, Marco Island, Florida. And you want to know what made it into my suitcase and pass through security. The protein I brought did not make it through security. I just want you to know that they didn't like it. Probably looked like cocaine or something. I don't really know what protein powder looks like that TSA wouldn't like, but they definitely took it and put it right in the trash can. But what did make it, probably because it was in the checked bag,

was my Organifi greens. And I just got this sick email from the UPS man that said, you got more Organifi sitting at your house waiting for you. And you know what's in that one? Not just the green, not just the red, not just the gold, but fall is here and pumpkin spice is in the house. Pumpkin spice is coming in hardcore. Pumpkin spice is so lit right now with all of the ashwagandhas and all the vitamins and all the minerals and all the delicious tastes. That's why I like it the most. It's the perfect time of the year.

If you've never tried Organifi, trust me, right now is the moment that you need to go to Organifi.com forward slash shrugged. Check it out. Here's why. Not only do you save 20%, but for three years running, all of the Shrugged family has been on the Organifi kick. They've been on the Organifi kick because for three straight years, they've been the number one sponsor of this show. Yeah, three years. I got more vitamins and minerals in me 100% because of Organifi and the green juice. I wake up every morning and I take it. I'm on vacation and I bring it with me. It's like having a fifth appendage.

It's like having an extra arm just Organifi on me all the time because at any point in time, I need my greens. You think I'm down here in Florida eating salad all the time? No, but I don't want to get less unhealthy. I'm still waking up in the morning and get my training in, and I need to get my vegetables in, but I'm not eating salad all the time? No, but I don't want to get less unhealthy. I'm still waking up in the morning and get my training in and I need to get my vegetables in, but I'm not eating salad. I'm not eating the spinach. I'm not bringing cucumbers with me. You know what I'm bringing? Organifi. So get over to Organifi.com forward slash truck. Trust me, friends. Trust me. You're going to love

it. The green is the go-to year round, but But right now, pumpkin spice, you've got to get in on it. Also, I want to let everybody know that Fit Together, F-I-T-T-O-G-E-T-H-E-R, is having a bodyweight challenge on the app. So get over to your app store, whatever it is, on whatever phone, whatever device you've got. F-I-T-T-O-G-E-T-H-E-R, Fit Together. Go in, download it. We've got a 30-day bodyweight challenge. Cash prizes.

Fit Together is giving away cash prizes. Shrug. Jumping in on that. We're going to be giving away a stay-home super bundle. That's all the bodyweight exercises. There's even some kettlebell programs. There's some bands and bodyweight programs. But strength training, hypertrophy training, kettlebell physique training, and

body weight training, and advanced body weight training. You know why body weight training plans just are no fun? Because people don't know how to program them. People don't know how to put them into a program so that it's actually fun. You just sit there. They're like, oh, here's a great workout. Do one million and three burpees. And since it's two more than you did yesterday, you set a PR. No!

Burpees suck. Burpees are boring. That's why we're doing the Bodyweight Challenge. That's why the Stay Home Super Bundle. Also, P.S. coming your way soon. That's why we're giving away the Super Bundle with it because bodyweight's rad when you know how to program it properly and everyone can do it. That's why we're doing the 30 day challenge starting October 5th. So get over, download fit together app right now.

F I T T O G E T H E R fit together. All one word in the app store and make sure, make sure that you are getting hooked up on the body weight challenge starting October 5th. Make sure you friend me. Get into the Barbell Shrug group, friends. We'll see you at the break. Welcome to Barbell Shrug. My name is Anders Warner.

In the top left, that's Doug Larson. If you're listening in the car, it doesn't mean anything that I just said. The top left, Travis Mash, Dr. Spencer Nadolski. San Diego, California, Pacific Beach, Never Never Land. That's what we used to call it. How old are you? 36.

Yep. You're 10 years too old to be in that place. But the beautiful part about being 36 in the land of 27-year-olds is you actually get to stay 27 forever. That's true. My brother thinks it's a dangerous place to be for me, but I think I can handle it. You can. Just pick your spots. Don't go to Shore Club. No. Man, today we're going to talk about obesity because I've never gone to someone's Instagram profile, as we were talking

about before the show, and it actually says obesity expert. Everybody, typically the majority of people that we have on here know about obesity, but just talk about getting people jacked. I'm actually like really excited to dig into the clinical side of obesity and then kind of how we move away from obesity to getting people to be strong, fit, lean, muscular. It's all a spectrum. Man, why did you pick obesity as something you would go and become an expert in yeah it seems interesting for somebody that's yeah so when i was young i really wanted to be good at sports my dad is a biology teacher and the wrestling coach my brother was four years older than i am really good at sports really into science basically i had to use science

and obviously a work ethic to get really good at sports. Ended up state champ in high school, all-state football, and wanted to go play sports at Division I. Actually, started at Michigan State. We were just talking about where we were at in college, but started at Michigan State to play football. Long story short, ended up wrestling at UNC Chapel Hill for most of my career. How'd that happen? I'm just curious. Okay, so I went to play football at Michigan State. The coach got fired the first year.

I was a fullback. The new coach came in, did a spread offense, said, there's no fullback anymore. He said, you're going to go with the linebackers. I didn't think I was going to make a starting lineup as a linebacker. There was a ton of good guys there. So I actually wrestled for a year at Michigan State, said, I wanted to do both, transferred to UNC because I wanted to

get in-state residency to go to medical school in North Carolina smart said I'm gonna do both transferred had to sit out for football but didn't have to sit out for wrestling tried to do both ended up really you don't have an offseason I had to pick I had to pick which one and i thought my best chances of success were going to be in wrestling and not in football realized it wasn't bo jackson i wish uh i was pretty good but uh had to focus on one so that's what i did it's a heavyweight wrestler at unc at least you're a heavyweight so you didn't have to go from one sport where it's really good to be big to

another sport where it's kind of an advantage to be small. What did you weigh? My heaviest was like 265, but I probably wrestled my best at around 245. What do you weigh now? 220. You look jacked now, so...

Oh, I'm telling you. It's hard to see. 62. How did you do in wrestling i'm just curious i love wrestlers i did well um uh so i have a few records or like i was in the top three for a single season wins i had like 44 wins in one season i was ranked as high as third at one point um in nation. Wow. Didn't get on the podium because really in the end, at nationals, it's one of those, I think probably a mental thing, probably screwed it up, but beat most of the top guys and was top 12 my junior year and then senior year ranked in the top three or four most of the year and just kind of screwed the pooch at

nationals but whatever did you ever consider yeah did you ever consider moving on to mma after your wrestling career so i'm friend i'm i you know i wrestled with rashad evans and my and uh gray maynard and some of those guys who are really good and kane balasquez was in my weight class and i think i did better than he did at one tournament um however you know i don't think i'd want to get punched in the face seems like it hurts i was like i need to go to medical school if i get knocked i don't think i'm i don't think i was going to last um it's grueling those guys are tough i think i probably could have done okay but uh probably best suited into medicine without going in with a few fewer brain cells.

What about the Olympics? You never considered that? Olympics, that would have been a hard rule. Probably wouldn't have made it. I was pretty good, but these guys that are at that elite level, I've such a dedication to go, like, years of your life are gone towards that. And it's like, I don't think I could have done it. But I think I was talented enough, maybe, if I had the will. When I was at the Olympic Training Center, the wrestling was right next door.

I did weightlifting, of course. They were right next door. So they became some of my buddies. But I understand when you say you went to the Nationals and just screwed up and because like such a small line divides you guys at that level, like one bad move and you could go from being the absolute best to like last place because you messed up and some dude who wasn't very good at pin dress or, you know, did something to you because normally like they would always be like, how because you messed up and some dude who wasn't very good pin dress or or you know did something to you because normally like they would always like how'd you do you know well three

to one or two to one or it's like so you guys are awesome athletic wise i was up there in fact probably better than most of those guys but there i i think there were some psychological barriers at certain times that just i don't i can't can't even explain them, but I don't know. That's all sports. Yeah, that's awesome. All right. Yeah. I love wrestling. You pick kind of the long-term route of going to medical school instead of trying to pursue athletics for the rest of your life. Like, did you go into medical school thinking I'm just going to be like a general practitioner or an orthopedic surgeon, or I'm going to work with athletes and kind of be what you are today? Yeah, great question. I thought I was going to be an orthopedic surgeon, but at UNC, I shadowed the orthopod there who was doing everybody's knees

and shoulders and whatever. And after one day, I'm like, I know I want to be a doctor, but I know I don't want to do that. It was something about like, it just, it didn't, I'm kind of cerebral. I wanted to talk through physiology. And quite frankly, I'm probably not enough of a perfectionist to do surgery. I'd probably be like, that's good enough. And then, you know, I'd probably sew their elbow to their nipple. Well, when you see that surgery too, like a knee replacement is like. It was cool. It was just like pure carpentry.

It's not like a human by just banging things into femurs. Yeah, I thought, you know, yeah, I could probably do that. Ortho is not like plastic surgery for sure. And like, everybody's like, you're big and strong. You need to do ortho. I'm like, I guess that's what I need to do. They make a lot of money and they're orthopedic surgeons, you know? And then I, after I saw that, I'm like, that's not what I want to do. What I really wanted to do was basically take the knowledge that I use from nutrition and exercise science and apply it to the general population. Like for some reason to me, I was like, getting good at sports is cool for me. It's cool. And on a personal level, but seeing the transformation of taking someone from just absolutely unhealthy to then all of a

sudden just, wow, you change your whole life around to where you're super healthy now just using nutrition and exercise. That, for some reason, seemed so cool to me. So that's really what I did. Yeah. Where did you go to get your PhD? So I went to Virginia College of Osteopathic Medicines in Blacksburg. Beautiful. So I became a DO instead of an MD.

Do you know the difference? Not really. So in the States, a DO and an MD are equivalent. We're all medical doctors, but it's slightly different in that we learn some more anatomy and kind of almost like physical therapy, manipulation, musculoskeletal type stuff. So you've probably,

you might've even seen DOs in the hospital or even in the clinic. You wouldn't even know. So this place is Blacksburg. It's like Virginia Tech's osteopathic medical school. And, and actually I wrestle, I, I practice with the wrestling team there is really fun. They actually are really good now. Got a good few athletes there. But so I went there. And then I was trying to decide whether I want to do like family medicine, and then kind of specialize further from there or do endocrinology, which is what my brother ended up doing. So endocrinology is like, you know, study of hormones. What I found is that a lot of what you do in endocrine is like, yeah, you do a lot of the diabetes and thyroid and testosterone and stuff like found is that a lot of what you do in endocrine is like, yeah, you do a lot of

the diabetes and thyroid and testosterone and stuff like that. But a lot of it was like thyroid cancers and some of these things that I'm like, those are cool. But I really wanted to take and prevent like teenagers and middle-aged folks from having to go see the specialist. I didn't want to, I didn't want them to have to see the cardiologist. I don't want to have them to see the endocrinologist when their diabetes gets so bad, they're on an insulin pump and you're not going to help them lifestyle wise because they're just so far gone. So I ended up doing family medicine and then after family medicine, so you do four years of medical school and then you do three years of residency or longer, depending on the specialty. And then off of that, you can even specialize further.

So I specialize further into obesity and then something called lipidology, which is like the study of cholesterol. So now I work mostly online. I was in a clinic. Now I kind of set up a telemedicine business. I work with Renaissance Periodization doing online coaching and really trying to help people throw the net wide and helping people improve their lifestyle. What is obesity like from a clinical view? Yeah. How do you define obesity? Because sometimes

when I go into the doctor and they look at my BMI, they go, well, you're overweight. I go, oh, are you serious? You want to tell me I'm overweight? Come at me, bro. Yeah, you got the overweight. I'm going to go in the squat rack. I'll show you. Yeah, that's a great question, and it's actually – it's a problem that is probably an education issue. So anthropometrically, meaning just from BMI, body mass index, kilograms per meter squared, it's a decent screener, meaning if somebody comes in, we can easily check their height, we can easily check their weight, and we can throw it in a calculator and look at their BMI. And it's okay to screen with that, but you shouldn't diagnose obesity strictly off of that,

because in that range of that 25 to 30, which is the over technically the overweight range, and then 30 to 34.9 is class one obesity, 35 to 39.9 is class two obesity, and over 40 BMI is class three, formerly known as morbid obesity. You get people that are obviously over-muscled or have more muscle, more athletic, and the doctor should take that into account when putting diagnoses on your chart. They really should. And so what you're supposed to then do is look at their musculature, and then you can do a waist circumference. And you got to do it right. It's not just your belt size. You have to really go parallel to the ground, right above your iliac crests, parallel. And you know, there's different cutoffs for men and women and also different ethnicities. So you should take

that into account. And then from a clinical perspective, if somebody has medical issues, like issues from their weight, we can even do what's called staging of obesity. So like for you, like your waist is probably pretty lean. You probably don't have a high waist circumference, I assume. And you probably could have saw you had a decent amount of muscle. They shouldn't have diagnosed you with overweight because clinically you probably have no issues from your weight. We'd look at blood sugar, blood pressure, and all sorts of different things like that, cholesterol, and see if there's any actual metabolic abnormalities, any sleep apnea,

any reflux. And if you don't have any of those, your waist circumference isn't enlarged, you have some muscle, don't put overweight on their chart. Yeah, I don't think they actually do it. It's just when you look at the chart and you put the two together and you see it, and then the doctor looks at you and he's like, this doesn't add up. They're not really like writing overweight on there. But clinically, I guess when I think about obesity, I kind of categorize them all as like, you just, you look obese. What is the type one, two, and three? And what, how do you,

how do you determine the categories and risk factors along with each of those? Yeah. So, so there's classes based on just BMI and then there's stages based on how many issues that they have from their weight, how many what we call comorbidities, weight-related diagnoses. Everybody's heard that word by now. Oh, yeah, yeah, yeah. COVID-19 brought the word comorbidities into everyone. Everyone says it now. It's been a good education. How many do you have?

I've got six. I've got a few. I'm breaking records here. So normal weight is somewhere in between, what is it, 18 BMI to 25 BMI. Overweight, just according to BMI, is that 25 and above to 29.9. Then obesity, when it comes to BMI, class one is that 30 to 34.9, class two is 35 to 39.9, and then class three is 40 and above. And then if you want to do the stages that's not based on BMI, you then go, does this person have any comorbidities, any issues related to obesity? If they have zero, then they're a stage zero. If they have one, you know, a few like blood sugar issues, maybe like it's not, you don't have full blown type two diabetes, but your blood sugars are a little bit

higher than what's considered normal. You may put them in a, in a stage one and then the worse it gets, the higher the staging goes. And some, some guidelines, the stages go a little bit higher all the way to stage four. Some of them, it's just basically stage two, stage zero, one, two, some go one, two, three, four. But honestly, it doesn't matter. So the reason we do that is because different obesities probably mean that people are either healthy obesity or at least seem to be healthier obesity versus someone who's like, hey, they don't seem to have a lot of fat on their body, but it's all kind of around in their abdominal region. And they have type two diabetes, high blood sugar. They're probably at a much higher risk than the person that seems to have a lot more fat,

but their fats around their, and they have zero blood pressure, blood sugar issues, cholesterol issues. So that's why we kind of tease it out. It's more to have a much more specific guidance on therapy, because ideally, we'd want everybody lean and mean, probably the best. But if we want to focus on someone, we may want to focus on that person with more issues from their obesity. Yeah, when you start to look at these people and say, you know, whatever stage of obesity they're in, what is kind of the first things that you start

to look at? Like, clearly, there needs to be a massive transformation and there needs to be basically every system in their life is leading to creating a very unhealthy blood panel, lifestyle, everything. So where do you start the conversation with somebody to get them from these, you know, extremely unhealthy levels back to somewhere that's manageable? Yeah, so it depends if they're coming to me strictly for obesity, meaning that they like sought me out because they definitely want to change. They're in that readiness to change. You know, they're a little bit further down the scale. Whereas like before, when I would be in like the general clinic, just seeing patients for a physical, they come in just for their yearly physical or checkup. Then I'd see that I'm like, Oh, this person has a few issues. The way I bring it up is basically like, look, has anybody ever talked to you about using nutrition and maybe some exercise to improve some of these issues that you're having.

And you've got to be very careful. People are very sensitive about their weight. We take obesity sensitivity classes. You hear about doctors going, you're fat? Put down the cookie, stop eating so much, and then you're going to lose weight and you won't die. That works for some individuals, but for the majority of people that actually can be counterproductive.

So we're very sensitive and we bring it up. We ask and we ask if we can talk about it. We can, we ask if we can, it's again, it sounds like, it sounds like so politically correct and whatever, but this is just the way it is i mean i i wish we could just be very direct that would make things a lot easier but it's in order to really get behavior change you have to you have to kind of elicit the response and well it's not something that they don't look at every single day of their life yeah they know it's

happening yep and so some will say you know what I've had some people talk to me a little bit about in the past. And I think I'm ready. Let's talk about it now. Some will say, no, no, nobody's ever really talked to me about it. What can I do? Or some will say, yeah, I've been thinking about it, but I don't really want to talk about it right now. And that's okay. You don't push the issue. Some doctors wag their fingers and say, you got to lose weight or you're going to die. That might make things worse. In other times, the person will just, if you just let it be, they'll come back. Maybe, maybe never, but oftentimes they come back in a few months or even in a year and say, you know what, I'm ready now. So that's why you don't push and whatever. They'll go see another doctor. They're not, you know, if they're not into it at the moment. So you just be very careful.

You know, in your, in your mind or even better, do you know what the research says on this? Like how many people are, are radically overweight, morbidly obese because of purely genetic factors? Like physiologically, it's just not their fault versus they they got there that they got to that point uh due to lifestyle and poor choices for nutrition and sedentary lifestyle yeah it's a it's a mixed thing so the genetics have a large role in the differences in like our bmis they do BMIs. They do. It's mostly lifestyle because our lifestyle, lifestyle can mitigate those differences, but it's really our environment that we've put these people in that just pulls that trigger. So they talk about environment or genetics, load the gun, environment pulls the trigger. So there are what we call like monogenic, like you have a gene

deletion in your leptin receptor or in some of these satiety receptors in our brain. They're pretty rare, but those people like, it's absolutely their genetics. They are going to be voraciously hungry, but those are really rare. Most of them are what we call polygenic. There's multiple genes interacting, going on. And the amount of that can vary from person to person, but there is a large effect from genetics on this. It's just that the environment's really what's pulling that trigger. And you don't say it's necessarily not their fault. It's not necessarily their fault.

It's not necessarily not their fault. It's not necessarily their fault. It's not necessarily not their fault. It's just kind of the nature of this whole complex epidemic. Does that make sense? Epidemic. Yeah. You know, there's a person, have you guys ever heard of the magazine called Fatso? Fatso? No. Yeah. Well, the owner is Marilyn Wan. She is, believe it or not, she's in California, I think San Francisco. And it's all about people celebrating, like being heavy, you know.

And here's the better part of it. She's actually like my wife's cousin. It's crazy. So she's, yeah. So she's the absolute opposite of what i stand for we stand for but it's just like um and the views it's like as long as that's there as long as there's a population that's like uh that would say someone like you is like um like i don't know that you're judging or that you're you know or that anyone who says that at this point that's obesity is judging.

It's like at that point, it's like, man, you're just going to set people up for a lifetime of failure. And no matter what people want to say, here's the bottom line, is that most diseases are related to obesity. It's just the way it is. Talking to Lane, almost everything, diabetes's just, you know, talking to Lane is, you know, like, you know, almost everything, diabetes, cancers,

like early death. You look at it, it's like most people are just heavy. And, you know, and you look at people who live a long time

and they just, they're not. But like, it just, it makes your job hard because we can't be honest. Yeah. What is like the,

the conversation, I guess, it makes it challenging i feel like there's like a a body shaming like yeah revolution that has like happened where we we almost the the media is almost like forced everyone to glorify that you are proud of kind of being overweight without talking about the fact that it's very unhealthy to be overweight. Yeah, just like anything, everybody likes to be black and white. And that's what sells magazines and headlines and clicks. So it's either you got to be shaming people to say you're going to die if you have obesity, or you have to just be like, who cares? Obesity doesn't

actually cause any issues. Let's love our bodies. So the real answer should be that, look, we should love our bodies regardless, and we should practice self-love. But at the same time, we shouldn't just ignore the dangers of having excess adipose tissue. So the data is the data. We should look at it what it is, try to remove our biases from it. There's a lot of stigmatization so stigma obesity stigma is big and i i get into that because like you know so you have a patient with obesity that comes in they just keep complaining of back pain the doctor will say it's because you're fat you got to lose weight and unfortunately if they do that and not treat

the person as a person they may miss cancers and weird things that like, if a normal, if a person with normal weight came in, you wouldn't have just, you wouldn't have just dismissed them. So you have to go, okay, it could be from their weight, but there could be something else. So there's a lot of, you know, we look at these obesity, the obesity stigmatization and all these things. And so they're all important. But, you know, again, people like black and white headlines that just really divide people. I mean, you see it, you see it with this whole pandemic with the COVID and, you know, depending

on what political side you are, people like, people like strong black and white statements. You're an idiot if you wear a mask. You're good if you wear a mask. You're, you know, hydroxychloroquine, all these different things. It's like, can we just, let's just look at the data. Let's just be scientists here. You want a billion people to be scientists? Come on.

I know. I thought, so my brother, he's, you know, he's a smart guy, endocrinologist, wrestler. He was a powerlifting state champ when he was younger. He's similar to me, but he's 5'5". I'm 6'2". He was a good wrestler in college as well. So we thought that at the beginning of this pandemic, we're like, all right, now everybody's going to understand why we need science

and how we got to do this scientifically. And fortunately, it made things, in fact, worse. In fact, I think people don't even trust scientists because of all the things that went on. And this is kind of the scientific process. And it's frustrating because at first it's like, don't wear a mask. I don't know if we have the data. Now we kind of know all these different things. Anyway, it's just silly me for thinking people would actually want to understand science and how this works. I actually listened to a New Yorker podcast from the New Yorker where they were talking about how they systematically kind of like got everyone to go into their house and one of the very first things at the top of the pandemic checklist is do not have politicians speaking on behalf of scientists and the very first thing we did was have a politician speak on behalf of scientists and it like it was just like that's how you undermine everything nobody will trust anything unless the scientist talks it was frustrating

and now nobody trusts the scientist and it's like, oh my God, all right. When you, I guess, over the course of your career, I guess you've probably been professionally doing this for a decade now, 12 years or so, out of school and treating. I graduated medical school in 2011, so getting close there. Yeah. Have you noticed any changes in kind of like where that intervention process happens? Like as far as the age that people are starting to come to you and like teenage obesity kind of rates going up on that? What are kind of the statistics and

the population of people that you see coming to you? Has that changed much? So I have like what's called a selection bias because if I'm in a regular clinic, I have everybody that's coming to me regardless. And now that I'm online and I'm kind of on Instagram, I do get a wide array of people. But the most people that see me or message me tend to be thirties and above, as opposed to before I'd still get teenagers because, uh, they'd come in with their parents and they were just coming, coming in for their checkup. Um, and teenage obesity and adolescent obesity, it's, it's so different because they're going through different life stages that like,

I mean, we all remember them, but it's, it's, it's a different, they don't have control over what they're buying in the, in the household. So it is different. I'd say that like, maybe I should get on TikTok and get all the teenagers. I am on TikTok, but like, I can't stand it. I do some funny things on it, but it's I can't, i don't think i can keep up even though speaking of social media uh whenever i see your instagram it seems like you have a very high affinity for simplicity and a very low tolerant for lack of a better way to explain it's a very low tolerance for silliness does that sound accurate like all the all the silly

fitness stuff you just slam it all the time. Oh, I see what you're saying. In a fun-hearted way. Because I'm kind of silly, but like the silly concepts, it's just – Yeah, for fads and whatever else. Because it's so – I guess what is frustrating to me is I'd have patients come in. They'd have a new parasite detox plan, and it cost them $300, but they couldn't afford just food or whatever.

They'd become, I mean, they literally spent $300. They'd come in. I have this, I have this parasite detox plan. I think this is why I can't lose weight. Meanwhile, there's 300 pounds. And I'd say, no, no, it's so, it was just so frustrating. So that's why I'm just, I hammer them. Cause it's, I, if, if I could take these charlatans or scammers into the wrestling room and beat the hell out of them, I would,

I would love to, cause they're so frustrating. They're the ones making so much money. I see their ads and they do such a good job at marketing. Cause they make it, they make you feel like it's not your fault. The issue is you have parasites. The issue is you're eating too many lectins or whatever.

And they find, they cherry pick a few studies, make it seem clinical, seem legit like they're an expert. And then they just sell you down the river. And then you fail. And then you try the next thing. If I had parasites, wouldn't they be eating the food that I'm eating when I get smaller? What's that? If I had parasites, wouldn't they be eating the food that I'm eating when I get smaller? What's that? If I had parasites, wouldn't I actually get smaller? Yeah, you'd think.

But they don't think that far. And I can't blame the patients. I blame these slick marketers. They are just slick. And I took a lot of marketing courses, and now I understand it. I see it. I see it. And so I'm working with Renaissance Periodization it and so I you know I'm working

with renaissance periodization and they've done a good job I love them because they've made science and just reasonable and lane too I like lane as well we trying to make science and just reasonable science-based diet and exercise sexy it's hard it's hard to do and we'll never be as good as the scammers. But as long as people are scamming, they're eventually become people that are sick of getting scammed and they make their way over. So yeah, it's frustrating. Regarding health, if you're obese, how much of being healthier just comes down to simply losing the body fat regardless of the methods versus eating healthy food and ratcheting down at a sustainable pace yeah there are non-weight related behaviors that are related to health of course cardiorespiratory fitness like

you the bottom line is losing the weight and keeping it off is very tough and it's for a multitude of reasons obviously our environment people are you know if you go to your colleagues at work are pushing donuts and cookies and trying to go out to eat every day you're you get home you have friends and family that are always pushing food in your face you're surrounded by yummy foods not to mention that after you start losing weight your body does have mechanisms that kind of push against you like increased hunger and decreased movement and energy. So it's very tough. However,

having said that, if you just, it doesn't matter what method you use, as long as it's like not cutting off your leg, obviously, if you're whatever method you use from a dietary standpoint to lose five to 10% of your body weight and you have blood sugar, blood pressure, triglyceride, lipid issues, those things will resolve. I don't care if you're drinking soda, soda and a little bit of protein and some vitamins, as long as you're eating a lower-calorie diet, taking in fewer calories than you burn, you will resolve those issues. And it sounds counterintuitive, but you just will. However, sustaining that and keeping it off

is problematic for many. So I would say most issues are from the body fatness, but because it's so tough to lose the weight and keep it off for other people, we may not focus on the body fatness, especially because it can really mess with people's psychologies so then we focus on those things like cardiorespiratory fitness like if you if you have obesity and like well it's really hard for me to lose this weight due to hunger at least we can get you really fit by working out and we can focus on some of those food choices even though you eat a lot of them, and maybe better sleep and whatever. So yeah, most of them just from the adiposity. However, you can still improve some other things

without changing the fat. Yeah, I remember a while back, I want to say it was about two years ago, we interviewed Dr. Gabrielle Lyon. And she brought up a point about changing the conversation away from like, forcing people to lose body fat body fat and really maybe just having a better conversation about increasing lean muscle mass. And that way people aren't just kind of like fighting this thing that they've been fighting their whole life. And you can just reset the lens in which they view their body composition and, and you're going to lose fat.

Have you maybe thought of like better ways of presenting and saying like body fat body fat body fat because people have been hearing this same message from every doctor their entire life yeah kind of like we call them like non-scale victories or if you want to call them non-dexascan or non-fat caliper victories if you want want to say that so i did my first youtube video that i that i just launched was all about where's that at where's that at tell the people uh it's just my youtube channel dr spencer nadolski there it is out using so it's it's it's basically using weight lifting in a comprehensive obesity management program. Now, yeah, I talk about it in terms of fat loss, but I do talk about how lean body mass is extremely important for health

purposes, simply because if you try to lose weight and you lose fat-free mass, your body might fight to gain that fat-free mass and adiposity back. So if you can at least hold on or even gain lean body mass, you may be beneficial. The other thing is people with more muscle tend to be more insulin sensitive. And then you have more stores. So if you have more muscle, you have more place to store sugar, glucose. So those types of things are very important. It can also be something to where it's like, ah, they start getting into it. They start liking the way they feel. They start liking the way they look. Then they may change the way they eat and start losing the body fat. And it may just be a good spark to

get people going. But the non like weight or physique discussion usually is best used for those who have just really struggled with like looking at the scale or looking at the numbers. A lot of people can handle it, but there are, there's a good subset of people that just like, for whatever reason, due to media, due to their upbringing, maybe parents making comments or whatever, they have a real adverse reaction to hearing about scale or body fat percentages. And so just, all right, let's focus on something that's not related to that.

Just start working out, get stronger. And that's a little bit more fun to do. That's way more fun. To wrap that point about Gabrielle Lyons, she really was focusing on muscle mass percentage. Yeah. Is there any way to do that that's kind of logistically feasible and scalable? You'd have to look at probably a DEXA scan, but there are fat-free mass indices,

and they're looking more into that as opposed to just BMI where you can measure kind of your fat-free mass. But in terms of like looking at actual muscle mass, you'd have to get a DEXA scan or something that can actually measure that. But yeah, it's definitely possible because one of the issues is like as we age, you get sarcopenia, you start losing muscle mass, and that can be a real issue with like frailty,

which obviously if you break a hip or you're just not moving well, your life's not going to be as, your quality of life is going to be low. And that doesn't make life any fun anyway. We're going to take a quick break. You know what we're going to do? We're going to thank our friends over at Bioptimizers because there's one phase of sleep that almost everyone fails to get enough of. And this one phase of sleep is responsible for most of your body's daily rejuvenation, repair, controlling hunger, weight loss, hormones, boosting energy, and so much more. I'm talking about the deep sleep, the deepest of sleeps. And if you don't get enough of the deepest sleep, you're probably always going to struggle with

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And if you've already got your rewards points, that's 10% cash back. They're basically paying you to get super jacked by taking the protein. Friends, we got to get back to the show. Buylegion.com forward slash shrugged. I feel like measuring fat-free mass is basically the same thing as measuring fat mass. It's just whatever's left over. But having a ratio of actual pounds of muscle or percentage of muscle to percentage of body fat, I feel like having a ratio like that and having standards for it would be really valuable, but I haven't seen anything even close to that. As we get more tools to measure and as things become a little bit easier and more convenient,

we'll have more data. People are always asking, why do you use BMI and not body fat percentage? It's really because most of our data has been easily done by a BMI. Obviously, if I could just use some x-ray vision as somebody walked in, that would be better data because you could see where they store their body fat, how much body fat, how much bone mass they have, all these different things, as opposed to just kind of a crude marker as bmi but yes the simple answer is we'll get there it's just going to take time isn't the dexa like a pretty easy tool that everyone can use now like it's it's pretty common and you grab the handles you're good to go in so 30 seconds to a minute thinking of

body impedance uh where you grab the handles. Although those are getting better. You see those at the different gyms, the in-body scanners. The dex is where you lay down and the thing goes over here. They don't have those in gyms. No, but they're becoming more regular. Wrong thing. That's okay. When you are – you mentioned a couple times the word lipid yeah and you say it so easily

so smoothly and i don't really know what you're talking about can you break fats uh fats or lipid molecules like cholesterol and that type of thing cholesterol is a funky one with people uh like how do you how what what does that conversation break down to because i mean i think we've gotten past the egg. I hope we've gotten past eggs being unhealthy for you. But cholesterol is definitely one of those words that when people hear it, they freak out a little bit. They don't really understand it. Yeah.

And some of it comes down to the differences between dietary cholesterol, you know, the cholesterol that's actually in our food. So like eggs and whatever, versus that's actually in our food, so like eggs and whatever, versus what's circulating in our blood. And people think that you just eat cholesterol, and then it's circulating in our blood and then causes atherosclerosis or heart disease, plaque buildup. The real answer is that it's quite complicated because our body regulates how much is circulating in our body. And it probably more pertains to not only genetics. Genetics are probably the biggest thing that change how much is circulating in our blood. But then also probably different food components.

Not as much dietary cholesterol as saturated fat. And then it gets more complicated because it depends saturated fat is kind of an umbrella term there are multiple different types of what we call saturated fatty acids that have different in biochemistry that the the carbon chain lengths are different and those all have different effects on our body and then it gets even more complicated than that because it depends on what the food's packaged in. Because, say, for example, butter will have a different effect, even though it has a similar fatty acid profile compared to, like, full-fat yogurt. So they think there's, like, a food matrix effect, meaning that, like, the butter doesn't have the food matrix.

The yogurt does. It has protein, calcium and and these other uh membrane globular um proteins um all i heard was carry gold butter is good okay put your put your so um yeah that's actually a big uh research uh component of mine i'm doing some stuff there it's it's with carry gold butter not carry gold button oh i was like wow this is legit i'm doing some research and you see some ketogenic dieters who get uh just massive changes in their in their blood cholesterol levels and uh really we want to know is like is this as harmful as what most people think it is? Or is it possible

that it's a different context than someone who has genetically high levels of circulating cholesterol? So the ketogenic people are getting bad, they're getting excess cholesterol in the blood? Really bad, like really high. And they feel amazing, these people, especially the people that have the highest. They feel great. And the question is, is everything looks normal except for their LDL cholesterol? Their HDL is high, their triglycerides are low, but their LDL cholesterol, the stuff that in general we think is the main culprit in causing atherosclerosis, it's extremely high, high to the levels of where we see genetic, when people come in with genetic causes of high cholesterol, they're higher than those people even. And so we're like, all right,

bad stuff likely is happening to you guys, but we don't actually have good data on it. So what I'm doing with a few, with a team is that we're going to study it. We're going to see if it is. So it's going to be interesting. I mean, yeah, because people are talking about the keto diet all the time. You go to Twitter and it's like, yeah, there's battles. Oh, they love it. Twitter is the best.

Are you guys seeing it cause disease? Are you seeing the keto dieters? So what we want to know is if they have a more rapid or a more pronounced effect on atherosclerosis, and we can do these images of the heart vessels and see the changes. So we'll know. We'll at least get some data. Oh, wow, boy, that would rock that world, the keto world. We'll see. Sweet. Are you trying to take them down no so so like taking all the keto people down

yeah so i i'm actually i'm like everybody knows me as like i just poke fun at keto people i don't even i don't even have things i'm not even against keto necessarily. For some reason, I just find it so fun to make fun of because they get into this, it becomes their identity and like, it's like, just relax. It's just food. And I also like to get their jimmies rustled. But I have, I have a couple of pro keto people on the team and then I'm, I'm not anti keto, but I definitely make fun of them I'm the lipid guy meaning that like I if if sciences honors if the the history of LDL cholesterol is on our side it should show they have a more

pronounced effect on they should they should have more atherosclerosis and someone that didn't have these pronounced effects on their LDL class. Can you explain atherosclerosis? I can't even say the word. You said it like 12 times. So it's just the buildup of the fatty substance and plaque in your arteries. And the stuff we really worry about is in our heart vessels because if it gets so big or if it becomes unstable, it can rupture, like a little zit comes out, causes your blood to clot,

and then stops blood flow to a certain part of your heart muscle, which can then – you have a heart attack. This is like a common thing for – Yes. So that's the most common – Heart attack. One of the most common causes of the causes of death is is heart disease cardiovascular disease so you were mentioning you were mentioning ldl cholesterol

a minute ago and i always hear the the kind of oversimplified analogy of there's some damage that has happened inside inside of your blood vessels and your ldl are just kind of coming to to patch things up kind of like like they're like the police that respond to the car accident but the car accident was the problem police are just coming to clean things up and help out is is there how much validity is there to that and then it does having super high ldl is there any benefits to that or is it all bad yeah how does all that work that's kind of a the low carbers will say that that's that's kind of their analogy because low carb diets tend to increase LDL cholesterol more so than a low fat diet or any other type of diet. They try to

justify it by saying, look, we don't think this is dangerous. The problem is, is that we have all this other data showing that, Hey, if you have genetic causes of higher LDL cholesterol, even if you don't have disease, they have more incidence of having disease, meaning that it's not going to patch things up. We think it's more of like a passive, just because you have more in your blood, it has more chances to get into your heart vessels to cause the atherosclerosis, as opposed to you have some issues, it's going there to patch it up. Just having more in your blood increases your chances of it getting in and out of your vessels. And what happens is that these little particles get caught inside your vessels. And then there's this whole cascade that occurs where you start the process of

atherosclerosis. So whether it's dangerous or not, from every angle that we look at it, it seems to be dangerous. So I think that if that's the case, then high LDL from a diet has to not be what we call benign, meaning super safe. But we just haven't looked at it in this context yet, so I think it'll just be another cool piece of the puzzle. Whether there are benefits to having higher LDL, that's something a lot of these low carbers are trying to look at. Are there benefits?

So there are immunological, LDL is involved in the immune system and some of our immunological responses. So is it possible that having higher LDL is protective against certain infections? There's not really, and having low LDL is not protective or even dangerous for infection. So that's what some of them claim. There's not a lot of good data to support that. I don't see there being much of a benefit to having a high LDL, but if you listen to a few people, they can try to make the argument. It's just that when we look at these genetic studies to see who just genetically has low LDL, they don't seem to have issues.

And those who have high LDL, they also don't have issues other than higher risk of cardiovascular disease pretty big issue yeah well so it doesn't see it doesn't seem to be like any benefits or anything like that it just seems to be uh this increased risk that's that's the gist of it okay I've also heard somewhere where a lot of people will they'll try to take the onus off of of ldo and they'll put it on oxidative stress and inflammation saying it's oxidized ldl that really is a is the problem and then you have you have all sorry then you have all the particle size yeah um debates in there as well yeah what what's the validity to the oxidative stress and inflammation really being the key factor there

yeah it's it's it's both so like there are people with what we call like the familial hypercholesterolemia where they have very high amounts of LDL cholesterol, but not really much of an oxidative or inflammatory issues. And they still get atherosclerosis. Now the thing is inflammatory chronic inflammation will accelerate the process. So what I would say is they're independent risk factors. You could have lower LDL cholesterol and inflammatory issues and still have atherosclerosis. It doesn't take much LDL cholesterol to start the cascade. So if you have those inflammatory issues like metabolic syndrome from obesity, that's probably one of the biggest culprits now. So like you don't have to have high cholesterol to start atherosclerosis. You just need to have some inflammatory process. So we're, again,

this gets into the black and white thinking. It's like, it's not the LDL, it's inflammation. Or people say it's not inflammation, it's the LDL. Really, it's both. They're all independent risk factors. The lipid centric type of folks will say, look, but if you didn't have LDL, atherosclerosis would not occur. It can't get into the heart vessel, you know, so then even with inflammation, it wouldn't occur. You'd need to have very low LDL levels for that to be the case. But, and that's, while that's true, I think it's, you know, it's a little bit myopic or

whatever you want to say, because they all all these things insulin sensitivity blood pressure cardiometabolic health not just ldl are very important ldl is also important of course they're all important is is what i would say what about the other size knife oh sorry oh sorry yeah go ahead the particle size thing uh is something i like talking about because what they'll say is that you can have these big, big, large LDL particles and those are not dangerous. And then if it's only the little small LDL particles that are dangerous and you see these small LDL particles only in like metabolic syndrome, the truth is the magnitude of difference in size isn't so much to make a difference. They can all fit into your arteries and start atherosclerosis.

We, there, there are other types of particles called chylomicron remnants that are magnitudes larger than the largest LDL particles, and they still get into your arteries and cause atherosclerosis. So like they all can, there may be differences in how much, uh, cause atherosclerosis in the, in the small sizes, but really they all can. Anyway, that's a small side. Would you say any of these diet folks – I'm sorry. I don't want to mess up.

If you're making a point, yeah. Well, here, this kind of wraps up everything that I've just said, all in the same vein. I've heard that if your blood sugar is within the normal healthy range then um again kind of on the theory that ldl isn't as important if your hdl to triglyceride ratio uh is very high then that's kind of like one of the high level things that cholesterol wise puts you in the clear is there any validity to that as the more important ratios it's a it's a surrogate marker it if your hdl is relatively high in the 60s or whatever and and your triglycerides are low,

let's say those are in the 60s, it means you're very insulin sensitive and you're metabolically healthy. Those things aren't necessarily causative or protective in what we'd call the pathophysiology, meaning those aren't necessarily involved in it, but because your levels are like that, it means you're, you're metabolically healthy and you're less likely to have atherosclerosis. So it doesn't protect you 100% because if your LDL was like 400 and your HDL looks great and your, and your, and your triglycerides were nice and low, you'd still be at a high risk just because you have such high of the LDL cholesterol. Those other things aren't going to protect you. But if you're at like a normal level, like, you know, population normal, I should say LDLs, you know, 100, 120, and those other things look really good, probably wouldn't

worry about it as much. To zoom out away from kind of the biochemistry and blood markers and something a little more tangible. If you're a 200 pound male and you have 10% body fat and you're relatively muscular, is this all just stuff that you just don't really need to worry about for the most part? For the most part, yeah, for the most part. I mean, if like your cholesterol is a little bit high, I mean, so the doctors shouldn't just go, oh, your cholesterol is a little bit high. Here's a medicine. We hear stories about that all the time and that's not how they're supposed to do it. They should really look at the person.

They should look at all risk factors. They should do a risk calculation if they really want to show the patient, like, look, your risk is really low. You could take a statin or change this a little bit, and you'd have a very, very minor effect on their long-term differences in heart attacks over their lifetime. That's what they should do. Where it would matter is if they're doing, like I said, a ketogenic diet and they have massive differences in their cholesterol, or if they have genetic differences in their

cholesterol. And you find the genetic causes pretty early. So that's why I'm trying to study these massive differences in the subset of these people that do ketogenic diets. Are they at risk or maybe not? I think they are, but it's possible they're not as much as we think. Did the ketogenic diet just really – Mash, go ahead. We've been cutting you off like seven times. Sorry.

I was just going to say, what about the other groups? I mean, like keto is your focus. With Lane, you know, he pretty much bashes everybody. So, like, he does – he is definitely – he does not discriminate. But, like, so – but, like, the keto, so, like, you know, they sound like that's a legit something that some people should be concerned about with the LDL. But what about, like, the vegans?

I would say all those groups – and I hate to, I just singled them out. It's probably not the time or the place to do that, but, but like, they all seem to take on the identity of like whatever they're doing, whether it's the carnivores, whether it's, sorry, Mark, whether it's the vegans, which is one of my buddies, but like, so like what about the rest is like, is there any of those groups that might be a little bit more healthy because of that group that they're in? Yeah, they all kind of have their identity, right? It's, it's, it's, and that's why I love

making fun of all of them too. Oh, good. You do all of them too. I make fun of everybody, even like once the thing is I have a lot of like macro calorie counters that follow me. And one time I made fun of them and they got pissed. The vegans get really pissed. The keto guys, I make so much fun of them that they're used to it. The people that can't take it, they don't really follow me. I do make fun of the carnivores even though they're actually a small subset of the real population. But because it's like a selection bias online, I have a lot that follow me. And I'm friends with Sean Baker, who's the king of carnivore diets.

But yeah, I would say, I wish I could say like a vegan whole food plant-based diet is probably the healthiest in terms of just complete longevity, absolute lowest risk of heart disease. But I do think that takes away from looking at quality of life. Personally, I don't want to live a life where I'm not having some meat. Personally, I don't want to live a life where I can't have cheese. And personally, yes, you can build muscle on a plant-based vegan diet. It's extremely, extremely hard. But you can do it. You see people do it.

I don't know how many anabolics these guys are taking. I have no idea. But it looks like some people can do it. Seems like a really boring way to do it. It seems like it is. You might be able to do it, but a really boring way to do it it seems like it is and you might be able to do it but it's not gonna be interesting so so yeah and you are like every two years and you'll live the risk of living your risk of of a heart attack will be probably a little bit less and you're in you may have a propensity to live a little bit longer.

But in the end, when you look at like, if you have a mixed omnivore diet, that's just mostly quality foods and you're doing all the things that are helpful for you. In the end, it's all gravy. And, you know, we only have so much time on this planet. So I'd say enjoy it. And that doesn't mean freaking snorting cocaine and whatever, you know, but like. Oh, dang, man. I know. I just dashed your dreams.

But like, you know, I'd say we should enjoy it to the extent of where we can still live a happy, long, quality life. Why vegan though? But why does it make you, why would you say the vegan diet makes you live longer? Dr. With a vegan, not like eating Oreos or whatever, because there's a lot of foods you can be that are technically vegan. Dr. Oreos, as my buddy says. Dr. The best is more of what we call a whole food plant-based diet. It's more

descriptive. It takes the ethics a little bit out of it, although some people claim, no, the ethics are an important part. Whatever. We're looking at just dietary quality. Whole food plant-based is what they call it. And if you look at them, if you do it right, you'll still get adequate protein. You'll still get adequate nutrients. You may have to supplement with things like B12 and maybe some fish oil or krill oil or algae oil, sorry, because those are plants and not animals. But your LDL cholesterol will be just so low. It looks like you're taking a statin.

You'll be lean. If you're doing it correctly, you'll be pretty lean to where you shouldn't have blood sugar issues and you should be able to live a pretty healthy life now again i like to go out to a good restaurant with my wife and friends obviously not right now i'm not going out to restaurants because this pandemic that it really ruined it but uh i i things like that you want to go over to your friends a friend had a you know their crudité board or whatever their their cheese board and some and me, oh, sorry, I can't do that. No, I want to enjoy. I want to have fun. So obviously, if you're doing a whole food plant based diet, you can eat lentils, you can do all these things, your cholesterol and blood sugar and

blood pressure will be amazing. So in general, when you look at some of these epidemiological studies, you look at the blue zones and where these people that tend to live the longest, that tends to be how they eat, although they still have a little bit of animal products usually, a little bit, not a lot. It's mostly plants. But again, I think when you look at the cost-benefit and how much it really matters, I'd probably want to live a more quality of life as opposed to purely longevity. All right, let me ask you this question. You have two humans. They're both genetically equal. They have the same lean body mass.

One eats vegan. One eats more like you, probably macro-based. How much longer does the vegan live? That's a good question. I wish I could answer that. Seven soft days, just soft. That's what I'm saying. Seven days, then I'm like, you know.

So you can make a few arguments. Okay, so you can make a few arguments because times are changing. Like our lifestyles are different. I don't know. I wish I could say, maybe I'd just say for five years. I'm just guessing, maybe a few years. But again, their risk of heart disease would be a few percentages lower than mine, probably. But you start looking at, what like depression and other yeah there's all

sorts of things there that we're not animal but we're not we have social uh we have community we have family it's it's different i don't know i would say my buddy who's a vegan now everything has changed like like his personality has changed and like uh and there's been a lot of depression so like um so like i'm just curious there's been a lot of not i've noticed i don't know if it's just where he is in life or if it's the vegan or any or a combination but i feel like he's definitely like a lot of things have changed and so some are good but a lot are bad and i'm just curious yeah i don't know i again i take everything into account i want i want to live a long, healthy life, but I, it needs to be quality. Otherwise it's like, what the heck was the point? Right, dude. No, no steak.

I think you're one of the first, first people we've had on though, that has kind of recommended leaning towards a more plant-based diet. Yeah. You know, like, again, I can't ignore that. It's strong data when you look at, like, okay, these people, their blood vessels are going to be nice and squeaky clean and whatever. But, like, again, I couldn't do it. Yeah, I don't think I could either. It's interesting that my 200 grams of protein a day from mainly red meat like that makes me think if I'm if that's like and so if it's you know you get you like so this is the thing so the the because I'm a lipid guy I'm'm into cardiometabolic medicine. If you look at red meat, they'll start pulling out all sorts of little potential issues that

aren't lipid related. You know, if you eat lean red meat, like lean sirloin, your lipids won't change. It's really when you get your ribeyes and you start pouring butter all over it. That's where you see the more pronounced changes. But what they'll say is that the heme iron, the iron that's more readily absorbed can cause metabolic issues if you're just getting so much of that. There are a few other things like T-MAL. I'm sure you guys have heard of some of these other metabolites that are created in our gut from eating meat or are in meat and then a few of these other a few of these other glycoproteins that may increase atherosclerosis but like these are all like little

tiny little mechanisms that may play a role but they're not I wouldn't say they have a huge effect to where like I feel comfortable eating a lot of plants, but I still eat a lot of meat with it. And probably my risk is a little bit higher, but I'm willing to take that risk. It's the same thing as like this pandemic right now. So people are like, should I just stay inside all day? Yeah, your risk of getting COVID-19 are going to be much lower, if not zero, if you stay inside all day. But I'm not willing to take that risk at this point anymore. I will do the things to

mitigate my risk of still getting COVID-19 while still enjoying my life. I'm going to not go out to dinner anymore, but I'll still go to the beach and I'll go for walks, be around certain people. I'll wear my mask when I go into various places. So it's all about understanding risk and knowing what risks you want to take to enjoy your life. That's what I think. What is the official scientific data on the masks? Yeah. So right now it's, you know, they'll be like, oh, we don't have randomized control trials to show this. It's really hard to do that. But it looks to be like there's, there are, there, when everybody wears a mask, there seems to be an effect on decreasing transmission. All right, good. All right.

Seems to be the case. How did you get hooked up with the RP guys? Because something about Dr. Mike Isertel and you in the same conversation, I don't know where – it doesn't seem like it matches. He eats like 500 grams of protein a day and then takes goofy selfies with two little clothes on. You're telling me I need to be a little bit more on the vegan side of life. And I love that guy. He's hysterical and one of my favorite interviews we've ever done. Except for my abstain. Yeah, totally. We still have time. We still have time to save it.

So he and Nick Shaw is the owner, uh, and he is the owner. They're both owner, but, uh, Nick's more of the business side. Mike's more of the science guy. And the thing is like, if you look at our recommendations are recommendations, they're very similar. So with RP, we promote a lot of plants. Now, on the same token, they are eking out every little optimization with athleticism and body composition. So they're maximizing that protein so they recommend a lot of meat animal products lean protein and i do too but i actually from a practical side i think we can pull it back scale it back a little bit and still have very good performance results

while while then promoting more longevity and health at the same token and practicality too. I have a lot of patients who try to do a very high protein diet, like you're 400 pounds or 300 pounds and you're recommending a gram or even more of protein per pound of body weight. That means they're eating 300 or more grams of protein per day. Absolutely not needed. It should be based more on like lean body mass. So then they really only need like 200 or 215 or something like that. And it doesn't matter.

They won't have any ill effects from it. So we're very similar. The reason they found me, they kind of wanted me to be more of that general population guy, whereas Mike's like super bodybuilding, build as much muscle mass, which I love muscle mass too, obviously. But he's like the extreme version of me. bodybuilding build as much muscle mass which i love muscle mass too obviously but um he he kind of he's more he's like the extreme version of me but uh slightly quirkier in certain ways and but uh silly and fun yeah i would love to see you two together that would be like a comedy show a scientific comedy show yeah when you're When you're talking about kind of reducing that one gram of protein per pound of body weight, I think when you get into like a 300-pound person, we could all probably agree we should run that off lean body mass.

Like everybody needs to be eating three pounds of meat a day. Um, but there's also like the, like the, the protein synthesis and how people are like digesting food and actually being able to use the protein efficiently. And if you're 300 pounds, you're not using food efficiently when it goes in your mouth. There's, it's going somewhere else. It's just not being stored properly or used properly. So, um, it's being stored. All right. Yeah. But like, um, is, is that part of kind of, if I don't know how to, um, I guess if you are recommending a lower

percentage, does that force your body to become more efficient with what you're putting in it? Um, or, or does that logic not really make sense? Not necessarily. The whole goal of eating more protein, there's a few goals. The goal number one would be, I would say, is to retain your lean body mass. If you're not lifting weights or doing some form of exercise, aerobic training can actually have an effect on retention of lean body mass, but I would never not recommend resistance training. So if you're eating

adequate or even a high amount of protein while lifting weights, you're going to have a much better chance at retaining lean body mass. And the fact is somebody that is 300 pounds and has a lot of adiposity doesn't need that much, as much protein as someone who's leaner to retain their lean body mass. And that's simply because their body will lose fat at a higher rate ratio compared to their lean body mass when they're losing weight, they'll lose more fat. So you don't need as much, you don't need as much protein to retain lean body mass as someone who's like 10% body fat, who needs to retain as much muscle as possible when losing fat. The next part is satiety. There becomes a point where like, you're probably not going to get much better satiety at that much

higher. And also, it's just hard to eat that much. Like, it's just not pleasant. And maybe we need to get over that and maybe decrease the pleasantness or palatability of our diets anyway. But like, you might as well use those calories on, you know, vegetables or, you know, fruit or something like that. So there becomes a point where it's a practical standpoint. Satiety, of course, is important. Then retention of lean body mass. And really, we just don't need as much when we have a lot of adipose tissue. It's become very popular, kind of these fasting protocols, whether it's a 24-hour fast once a week or 16-8. Have you done any research into that? I'm sure you have some research into it,

but anything come out of that? Yeah. The, the, the gist is that like for certain individuals, satiety and appetite are probably the most important part when trying to lose weight and keep it off. Like that's our biggest driver of gaining back weight. Obviously there's a lot of other things that we talked about already, but appetite is. And for some people, intermittent fasting, whether it's time restriction or alternate day fasting, may have an effect on appetite to where not only you're reducing the amount of time you're eating in a day, which reduces your calories, it's a type of restriction, but also your appetite may be better than if you're just chronically restricting your calories every day. So, uh, but this is individual. When you look at the, at the, at who

loses more fat and what it all evens out at the end, when you compare these intermittent fasters compared to someone who with daily chronic, uh, uh, again, we go back to these identities. So you look at like the vegans or whole food plant-based people, the keto people. There's also the fasters. A lot of the fasters tend to be keto people too, but their identity is that like, hey, this is better than cutting calories. Well, you're cutting calories actually. And they're like, hey, this is better than cutting calories. Well, you're cutting calories actually. And they're like, well, we don't have to count our calories. We actually are going to have better results than people that just restrict their calories.

And really when you look at the data, it's probably not true. Again, it's going to come down to preferences. There may be a day where we can check your blood and we're going to know based on DNA and all sorts of markers that like, hey, you know what? I have a feeling that fasting is going to do better for you, but we're not there. It's something that I've had patients do extremely well on when they didn't do people come to you and have just issues where I find that the intermittent fasting thing, when I do it well, it's just nice to not have to eat all the time. Like it's a really good lifestyle thing to, I mean, I've done the plenty of times in my life, the six times a day, we're just eating small meals

throughout the day. And I can't even write like an Instagram post before it's time to eat again. Yeah, I'm not. That's what I did to get bigger. Actually, that's how I got ahead. I ate like seven meals a day because I just had to keep feeding myself. But that tends to not be a great strategy for obesity. Although there are people that lose a ton of weight doing that. It doesn't really matter as much, but I'm with you. I like fewer feeds per day. And if somebody's kind of taking a, you know,

they're reducing their calories 250 a week for three, four weeks in a row, how, if they were to cycle that and actually be on a long-term weight loss strategy, if maybe it's like a year long and they're, your body kind of starts to level out. And if you cut another two 50 and then another two 50, now all of a sudden you're at like this miserable amount of a 200 pound per 250 pound person and they're at 1500 calories a day and they've they've basically starved themselves and their life sucks how do you kind of think about cycling the over a longer period of time versus like a 12 week cut or a 16 week cut um but like in in a year-long process periodizing out how you should go about lowering your calories,

raising them back up to maintenance, and what do those cycles look like? Yeah, good question. You know, I try to instill the long-term picture with each of my patients. I have a guy that's trying to lose, it's about 100 pounds with me, just started a few weeks ago. And he, a lot of times you see a rapid weight loss in the beginning. And really I go as long as about three, maybe six months before we go, okay, you, it's time to take a diet break. Let's focus on that strength. Like we talked about, let's focus on maintaining that weight. And it's a few things. It's physiological. You feel a lot better. Your metabolic rate will come back up and then you'll get stronger. But also people get diet fatigue. It's hard to just keep restricting. So what happens is if you keep going, they think

they're eating 1500 calories, but really they're eating 2500. And it's, it's just, they still have that perceived effort. They still have this perceived thought that they are still on 1,500 calories, but they're actually not. So it just drags it out longer where they're not even losing any weight and they feel like crap. Whereas if they just took a diet break and really said, all right, now I can increase my calories purposely as opposed to subconsciously and not feel like I'm dieting as much, I think.

So I go three months at a time, take a month or two break, take another three months. Sometimes if they have a lot of weight to lose, we go for about six months. Some people can just chronically continue to slowly lose weight over a whole year or even longer. Not the typical way it goes, but, like, really it's working with the individual to see, like, how are you feeling? Are're doing okay. In those two months, what happens? Are they still going to count their calories or are they just going for it? Like they, they should have some sort of

self-monitoring because otherwise you'll start seeing if they, if you don't do it right, they'll just regain the weight. Yeah. Yeah. It's too much. You'll bloom. Yeah. Yeah. You gotta, you gotta be purposeful and go like, okay, I'm, if you know, you're eating about this much during the cut and then I, with each meal, you can add this, this, and this, um, and know you're, you may get a little bit of weight from glycogen and water, but like really over a course of a few weeks, it should stabilize. You should feel really good in the gym. And then all of a sudden you're like, okay, I'm feeling good again. Two months afterwards. Yeah.

Earlier we kind of mentioned the, that you don't like gimmicks and fads and whatnot. Kind of in the same vein. Hold on buddy. I'm on a show. Hold on buddy. Kind of in the same vein. I know obviously fat loss pills and supplements are big business. Is there any efficacy to any supplements regarding fat loss? Are there better and worse? Are they all junk? What are your thoughts? for my videos and stuff that I'm doing. I got my fit tea, right? I got, uh, I got sponsorship. You got a code. You got a code.

I got my, I liked that one. I've fallen for that one. I did this one. I did a video once where I was like, eh, like licking it. And that,

that, that actually did really well. I got my, I got some ketone, like some exogenous ketone. So basically none of them really work. None of them have much of an effect at all. If you combine them all, maybe a kilogram, and these are crappy studies that have been done. The key to these supplements would be if they knock out

your appetite enough that reduces your calories without thinking. That would be one key. The next key would be thermogenesis if it can somehow increase your metabolic rate to where you're not eating any differently but you're burning more calories at rest and there's some you know caffeine and you add in a few of these other things and there may be a small effect but it's very little so in general i don't recommend any of them we have pharmaceutical drugs that really knock out appetite and have been studied for long periods of time that they seem to be safe, but even still those, they have side effects and you can only get them through a doctor and we don't give them to everybody anyway. And then of course, surgery. Surgery is the most potent effect on appetite,

but obviously that's the last case. Are the drugs all going to be some type of like, I don't know, like upper of some kind? Some of them are. Some of them are different. The most common one they used to use is called fentramine. It has like a sympathomimetic effect, kind of amphetamine-like effect. It's not amphetamine, not addictive, but does have a little bit of that norepinephrine, noradrenaline upper kind of feeling. not addictive, but does have a little bit of that nor epinephrine, nor adrenaline, upper kind of feeling. And that does work in a receptor in the brain that decreases your hunger,

takes the edge off. But they don't burn, those don't actually burn fat. People think, oh, it's a fat burner. I'm going to lose weight. They literally just help you eat fewer calories. So then there's other ones. We have these injections now that they mimic a gut hormone that really changes our appetite really powerful stuff and we're going to keep getting better and better molecules that are probably going to knock people's appetites completely out oh that'd be awesome yeah there's a there's a drug called the magromab you know the myostatin gene yeah there you know back in the day t- nation or whatever, they, they, they said, you take the supplement, you're going to block your myostatin. Look at this cow that has a myostatin.

Yeah. You remember that? Well, I, I, when I was, it's funny, just a real quick story. I was, uh, when I was wrestling playing football in high school and I was always telling my dad, Dan, I got to buy this supplement. It's going to make you huge. I made him buy all these things. I feel bad for making him buy this crap. It didn't work, but there's actually a drug they're studying for obesity and type two diabetes called the MagnaMab. And it's, it works. I can't remember exactly. It works on one of the receptors or one of the precursors to myostatin and actually helps build lean body mass. And I

was sitting there watching this presentation. It was a brand new presentation in November. And I'm like, you know what? They may be studying this for obesity, but I guarantee bodybuilders are going to get ahold of this and start using it. And they show these people with type 2 diabetes, they reduce their blood sugars, reduce their body fat, and gain muscle from taking this drug. Yes. And it had the effect. And I was like, that's pretty cool. And so far I don't see any adverse effects.

But anyway. Bro, you want to do a study on someone? Yeah, that's right. I'm here. I'm in. Yeah, absolutely. Since, you know, you eat less protein, or you say you should eat a little bit less protein, let me tell you where you need to go in Pacific Beach to get a one-pound delicious,

the greatest cheeseburger in the entire world at the Big Bear. What's that? No, down at the beach. Where? Oh, my gosh. now I'm doing it. The Big Barron Dirty, Bareback Grill. Bareback, I've seen that place. You haven't been there?

No, I see it. I walk by, I'm like, that looks nice, but there's so many people and I'm like, oh my God. Yeah, there's so many people for a reason. It's a one pound burger, the sweet potato fries. And back when I was banging weights for like way too many hours in a day, you could go in there.

I was like just the 10, the 10% local discount. I felt like such a celebrity walking into the burger joint. Cause we spent way too much money there, but no, it's a bareback grill. It's amazing. Tell them going to Biggie's,

you know, Biggie's is right across the street there. I don't know what that is. It's like a, it's like a burger joint, but I can, I get Turkey, a double patty Turkey burger, but I'm going to have to try

that bareback grill then. Dude, it's my favorite spot. Boys, I got to go. I got to go get fireworks. My in-laws and wife and everything are sitting on the other side of that door, and we're headed to the lake. Doug's got kids going crazy. Where can people find you? Where can they see your memes? Yeah, the memes on Instagram

at drnadalsky, D-R-N-A-D-O-L-S-K-Y. And then also my new YouTube channel, Dr. Spencer Nadolsky. And then, of course, Renaissance Periodization and the sister company RP Health that I run. RP Health. Awesome. Beautiful.

Travis Mash. Mashley.com. Thanks for being on, man. That was awesome. Thanks for having me. Doug Larson. You bet,com. Thanks for being on, man. That was awesome. Yeah. Thanks for having me. Doug Larson. You bet, Spencer. Great to finally get you on the show, buddy. Appreciate it. Yeah, it's awesome.

You can find me on Instagram at Douglas C. Larson. I'm Anders Varner at Anders Varner. We're Barbell Shrugged at Barbell underscore Shrugged. Make sure you get over to BarbellShrugged.com forward slash store. That's where you can find all the programs, e-books, nutrition courses, and mobility to get you stronger. We'll see you guys next week. That's a wrap, friends all the programs, e-books, nutrition courses, and mobility to get you stronger. We'll see you guys next week. That's a wrap, friends.

End of the show. That means you need to go to barbellshrug.com forward slash store. That's where all the programs, nutrition, mobility, making strong people stronger. That's where it's happening. Also, Organifi.com forward slash shrugged. Fit together. Fit together app. F-I-T-T-O-G-E-T-H-E-R. Also, By Legion. By Legion.com forward slash shrugged. Fit together. The fit together app. F-I-T-T-O-G-E-T-H-E-R.

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