Dynamic Dialogue with Danny Matranga - 221: Obesity is a Choice... or is it? With Dr. Spencer Nadolsky

Episode Date: September 14, 2022

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Hey, everybody, welcome in to another exciting guest episode of the Dynamic Dialogue podcast. Today we are talking to Dr. Spencer Nadolski of the Docs Who Lift podcast. He's a member of the Join Sequence team, which is a medical weight loss intervention company. Dr. Spencer is quite funny. He's been on social media forever. He's most famous for his memes, but he's also a practicing medical doctor, a physician who specializes in lipidology, which is basically the kind of enhanced study of blood lipids like cholesterol and obesity. So a guy to talk to when it comes to all things weight loss. And what we're going to talk about today are some of the

differences in the neurology and the neurobiology of people with obesity and a new class of medications that might be effective for weight loss. They can help trainers, coaches, family members, fitness enthusiasts, encourage their friends and family who are maybe wired a little bit differently to help them with their weight loss pursuits. Because one thing's for sure, a lot of people are struggling with their weight and we don't quite know how to reach all of them. So being able to lean on medicine can be quite helpful. So Dr. Nadolski and I talk about lifestyle, about expectations, about medical interventions, for weight loss and about weight loss in this episode. Sit back and enjoy.

All right, Spencer, how you doing, man? Good, good, good. Thanks for having me on, buddy. Absolutely, man. So for those of you who don't know Dr. Spencer Nadolski, I think Good, good, good. Thanks for having me on, buddy. Absolutely, man. So for those of you who don't know Dr. Spencer Nadolsky, I think at this point, if you've been in the fitness game at all on social media, if you don't know him, you know his memes. He makes some of the best, if not most applicable fitness memes I've seen. As a trainer, as a coach, I see these memes and they hit me right in the feels because they're very, very spot on. They're very humorous. And they're very on brand. They're consistent. And one of the things I've always liked about Dr. Nadolsky is that he brings the medicinal bend to fitness communication because there's a lot of

PhDs. There are a lot of really educated, evidence-based practitioners, but there's not a lot of actually practicing physicians or medical doctors who have a fitness background or a history of being in fitness or exercise. And you have a really unique story. We were talking actually off air about where you're currently at now, and you actually went to college in the state you live in now. And if I recall correctly, you wrestled in college. So why don't you tell everybody how you got from, I'm guessing, high school wrestling to a practicing physician, collegiate athlete, slash somebody who's super into fitness and helping people live healthier lives with diet, nutrition, and exercise? Yeah, the gist is that I grew up in a really fitness and academically minded family.

My parents were teachers. My dad was the biology, chemistry teacher and wrestling coach. Brother who's four years older than I am, academically minded, very good at sports. But we had different body styles. His body shape was short and he had abs in utero i say he was just jacked i mean like there's a there's a video of us working out he's like 11 i was like seven you know i'm like screwing around and he's like already jacked as an 11 year old you see some of these jacked 11 year olds and that he was very jacked um so anyway going forward you know i just kind of

relied on my genetics i thought i was going to be really good at sports because he was good but um it didn't work out that way so freshman year he by that time he was already a state champ and he graduated he four-time state finalist two-time state champ in wrestling in michigan which is pretty good wrestling and um you know good at good at football too so a freshman year but I'm like already way taller and thinner and uh you know I you know have muscle and um tone as as people like like to say but clearly not like he was because he was shorter so his weight class was like 100 pounds when he was a freshman and i'm like coming in at 150 where he graduated slightly prepubescent you know type of thing and just

getting beat up by guys he had just beat up the year before yeah they hadn't graduated yet so uh i was like you know what i'm not going to be able to do what he did so i ended up having to fill out into my body shape and so i really got into nutrition and exercise to like basically become who i was i eventually went i got up to 215 pounds by my junior year didn't even start my freshman year by the way he was already a state champ his freshman year i wow had gained a lot of strength and and it was also mindset stuff. You know, like, you know, I didn't have that eye of the tiger. Maybe I didn't, you know, I don't know if I wasn't super aggressive back then. Then you go through puberty, the hormones start kicking in.

I fill out. And then I, then I became a state champ as a junior and then all state football as a senior to where I was like, okay, I kind of wanted to play football. I wanted to do both. I wanted to be like Jackson and Deon Sanders. And I wasn't so, I mean, like I, I went to football, I went to Michigan state to play football, ended up wrestling there as well for a year. But then I was, I, this whole cockamamie scheme, I, when you're young, you think you can do everything. So I want, I was like, no, what? I want to go to this. I wanted to go to East Carolina University for medical school because it was only $6,000 a year. This is a total tangent, but I also had this financial aspirations in my mind. So I was like,

$6,000 a year for medical school. I'll be able to pay that off quickly. But the only way you can get in is if you're in state. So I'm like, I'm going to transfer to UNC. I'm going to get in-state residency. I'm going to wrestle and play football there. So that's what I did. Wow. I played football for a year, but I had to sit out for the year, but I didn't have to sit out for wrestling. And after the first year, it was like not having an off season.

It was very detrimental to trying to i was a fullback and through through yeah through um football season i'm like losing you know it's hard to keep on your weight in season and then you go right from that to wrestling season which it's hard really hard to keep on weight then i was a heavyweight wrestler and then once you stop that you go straight to spring ball and then almost straight straight from spring ball to summer ball it was like i didn't have an off season there's some people that have been able to do it but they do it like towards the end of their career like when they've uh when they're just kind of messing around so anyway i ended up after the first year i

this is total tangential i don't usually go into this much depth but i love it because i can't imagine there's too many people who have even attempted pre-med while simultaneously trying to be a two-sport athlete playing two of the most like physically demanding sports not to mention a fullback i mean your job is quite literally to run full speed into another human being it was so yeah it was so stupid i mean like i'm still trying to think back and why like why did anybody let me do this like this was i you know when you're young i just think you think you can do anything i was really tired and really run down so after the first year i was a sophomore at unc i i um, after spring ball, I remember saying, just thinking to myself, I'm like, how am I going to be able to do this?

I don't think I'm the only way I like, they were like, you also have to win your starting spot. And I was like, I'm not, I don't think I can do this. So I just said, Hey, I'm just going to wrestle. I'm going to keep my full ride or whatever it was wrestling. And, um, cause you can't't you can't actually have a wrestling scholarship while not having a football scholarship i was going to try to use that and then win a football scholarship and just do both you can't you can have a football scholarship and do both

but you can't have a wrestling scholarship and do both sure anyway so i just said you know what i don't know if i can win the starting spot i'm kind of like withering away here i was like 240 now i'm like 220 and like not gonna be a good fullback if i can't keep my weight on and not a good heavyweight uh from how tall i was there are some good heavyweights that are a little bit shorter but um anyway ended up doing really well wrestling wise uh it was senior year junior year i ended up top 12 senior year. I was ranked top three for most of the year and ended up blowing it at nationals, but overall really pretty good career. Then I was, so then let's, now I go to medical school, right?

I didn't make it into ECU by the way. Yes. This is, this is another totally asides tangential story but i remember going on the interview and they i was like so what kind of people do you let into ecu i'm like like thinking they're gonna say like you somebody who just wrestles and does all this stuff and gets good grades and he looked at me he goes not your uh typical anglo-saxon with pearly white teeth and i was like oh shit i was like man i can't believe you just said that because he looked at me like basically not you yeah i was like what anyway

it was kind of weird so i didn't get into ecu i ended up going to vcom which is um it was virginia college of osteopathic medicine at the time it's virginia tech's osteopathic medicine which technically a do instead of an md which in the States, they're identical. But if you go to like Australia, they're like quacks, I think, in Australia and maybe England. I can see that. I mean, every DO I know over here is really good. Yeah, they don't get the same. It's more like chiropractic types, weird stuff over in other countries.

But here we get the same medical training and take the same board exams. So my idea was, though, everybody's like, you're going to be a sports medicine doctor because you're Jack whatever. And I was like, I don't care. And I thought about it, but I was like, I don't care about sports so much. just a very um just a smidgen of just a tiny bit of what i use to propel myself in sports to to prevent and or reverse or treat chronic disease i'm like it's just just having a little just a little bit of a fuck you just give a little bit of a shit to all of a sudden it has amazing results like who cares if you bench press 400 pounds or can run a four whatever 40 440 i don't know whatever sports performance thing we're looking at sure the thing that got me going was like

people lost you know however many pounds and they're off their type 2 diabetes medicines and their knee pain's gone and they don't have sleep apnea anymore it's a little bit more fulfilling yeah a lot more so in a sense that's basically what happened so i ended up i started off doing family medicine which is extremely broad delivering babies i mean i always thought i was going to pull the baby's head off uh i hated delivering babies. It was like the worst thing. I was like, I can't believe people do this, but I'm glad there's people that do it, but it wasn't for me. Anyway, I was delivering babies, you know, helping grandmas, grandpas and everything in between. And then afterwards, specialized further into obesity medicine and then got another specialty and it's called lipidology, which is the of like cholesterol and lipids triglycerides all that stuff so how does it feel to have specialization in the two medicinal let's call them categories that are just rife with the most quacks like it must drive you fucking absolutely insane yeah no the mechanisms that drive obesity and, you know,

blood lipid dysregulation. Every time you go on your phone, you're just probably like, I'm going to have an aneurysm. Yeah. I mean, well, so,

you know, I mean, you can imagine some of the public health type of people due to the COVID stuff. And, you know, it is, it's,

uh, it's, it kind of burned you out. Cause I've, I've been on a crusade to try to go against these quacks. But over the years, I've been doing this for a long time. It's exhausting to the point where it's like, man, I don't know. How do I keep fighting these people?

I need to find other people that can take the torch because at some point it's like, I, it's a lot of energy and these people, the quacks can really, how do you, it's, it's Brandolini's law. It just takes so much more effort to, to go over and they're bullshit than it is to, um,

just come up with the right thing. You know, just, they just come up with just nonsense and they cherry pick. And then you're like, now I have to explain why this person's wrong. And it takes extreme amount of effort, just, they just come up with just nonsense and they cherry pick. And then you're like, now I have to explain why this person's wrong. And it takes extreme amount of effort because they, they're, they're cunning. They're, they're dumb as a fox. You know, they know what they're doing.

Yeah. Um, and they're anyway, so it is extremely frustrating. So over time though, I started on the clinic and, uh and said, you know, this isn't very efficient. I think we need to start using the internet, social media, blogs. I saw it like Precision Nutrition was a company that's out there. John Berardi founded that. And that was kind of before social media. And then all of a sudden, social media started coming out. And I was like, hey, you know, there was kind of before social media and then all of a sudden social media started coming out and I was like, Hey, you know what? This, the same thing could apply to medicine,

telemedicine, and then you could use social media and blogs and whatever to kind of, um, amplify good information and make it efficient. And therefore my patients could then learn more because I'm not, I can only see them for like 15 minutes at a time. So I started, I started doing the social media thing. And then that evolved to where a company wanted me to be telemedicine. So I got out of the clinic in 20, early 2017. And I've been in the cloud ever since doing telemedicine. And then, so my doing, I started doing facebook and that was good but then it was

20 yeah it was like 2016 2017 i started doing instagram and that's where um you know everybody i started doing the infographics i don't know if you remember that it was like dude i i very much remember like the infancy i i don't actually remember where i found your original piece of content that made me follow you but it was at least five years ago had to be very very early on so the infographic so uh i made one like that was organic or what is it regular reese's reese's peanut butter cups versus Justin's organic. Gotta love Justin's. So it was the first one I made and like, I didn't make any more, but that one kind of

went viral and I was like, oh, okay, cool. Well, then Jordan Sia and Carter Good started doing that and they just, they went gangbusters and I, and they, and even Jordan asked if he could use one of that, that same one, the peanut butter cup one, and it just killed it. So they started going gangbusters and i and they even jordan asked if he could use one of that that same one the peanut butter cup one and it just killed it so they started going gangbusters i was like i might as well join in on this i started making infographics so he lee started making infographics and um you know followers just went through the roof the thing is then everybody started doing it and once everybody starts doing it they're not special anymore so um and the other thing is it didn't really fit my personality style i'm like i'm not sterile at all like a normal doctor most people i like making very you know off i don't know like perverted jokes i like making perverted

like silly like this guy's kind of silly jokes because it's just fine light-hearted unless somebody's having a serious heart attack cancer that type of thing i'm very jovial with patients so um i was like you know what memes are way more my style i didn't know i that wasn't i didn't know anything about memes other than like i didn't make them other than i kind of laughed at them sometimes so just like anything it was like i'm not a natural at it. You just start making them. And sometimes people would like them sometimes not. And then over time, I found more of that voice to kind of like, all right, this meme would work for this topic. And there's only so many topics that I talk about. It's, it's, it's, it's so repetitive to where like, there's no new information right so certain memes can fit under a certain topic and you're like this one would work for this one and you just i just keep rotate or kept on rotating and repeating them and that's kind of how um kind of became the meme doctor i mean i you're really good at it like you can definitely tell that you kind of have more of a dark dry sense of humor

that might not be like typical of somebody who works in medicine but i also think that's why the content works because like you said there's some staleness to uh infographs and like 70 of my content is just tweets that i put on instagram yeah those are good which is stale as fuck but memes are are great because i feel like they do break down a barrier with that initial kind of humor and it and i'm as we're all aware some people just can't handle it and they're very sensitive but those people are are almost unreachable but you you know subjects like obesity and weight loss are really sensitive subjects but when i read your comments it's always like shit oh you got me or fuck yeah just tag me next time yes and so you're attacking me like this yeah

yeah and so it's like very clear okay you're using humor to communicate things that really resonate with people based on what you see in practice which is is, it's important. It's a great way to deliver content. And I think it's one of those things that, yeah, maybe one to 2% of people might make a fuss, but it's really exploded for you. And like the number of times I've seen one of your memes and literally laughed out loud, it's been at least 50 times. Like they're really good. You are a memeologist.

Thanks. Yeah. So the other reason I made them as well was for that purpose. I had patients that kept telling me the same thing. And when you're talking one-on-one to a patient, it's extremely hard to be like, it's not your metabolism. You're eating more calories than you burn. You're eating more than you think you are. And it's really hard to tell them that. And I i do i have a very gentle way of telling them and even still they um they may not fully

understand it and then when i make a meme that's pretty much like in your face but also kind of makes light of it then the other key component to this is that I have to put the caption to basically really be almost extra empathetic. Oh, yes. It's very key because if they'll just see the meme. So first of all, if they're my patient, I've never had a patient who saw my meme and got upset. It's usually someone that's not my patient, didn't read the caption. And so it can come off maybe a little bit um uh cold-hearted or or poor bedside manner but it it's supposed to be a conversation like what wait what a second what

is this and then they read the caption like okay this guy is actually a good guy uh and then my patients really appreciate it because they're like and they always say you know what i knew you were talking about me because we just chatted and you made a meme about it. I can't even like the thing is, like you said, what I see in practice, there's no way in hell I'd be able to come up with this stuff without talking to my page. Like, I don't know. Like, I'm just I'm literally repeating what they say and putting it into meme form. It's so true. It's so true. I do the same thing.

I'm no doctor. It's so true. I do the same thing. I'm no doctor, but you know, when I work with clients and we have people in the studio, so much of my content is driven by the problems that people are experiencing. And when newer trainers or newer nutrition coaches reach out and they go like, how do you post content every day? Like I struggle with it. It's like, dude, I'm just repurposing the issues that real people come to me with in a way that is fresh. And I think you hit on something big, which is like, you do have to kind of backload the empathy there with, with the caption, because you post the kind of, uh, inflammatory meme, but then you really cushion the blow with a, with a thoughtful

caption, which, which helps with something that's sensitive. Like, especially when you talk about weight and body fatness, because 70% of Americans are struggling with that. And I think we're closing in on 50% of Americans are going to be obese sooner than later. I mean, it's over 40%. And the last, I don't know how, you know, like how on time this data is, but it was at like 38.7% before the pandemic from the CDC. And then it just went over 40. And I'm like, it's got to be higher than that. If we did 2022 population level data, we're getting close to 50%. Yeah. It's not unfortunately slowing down. It's extremely sensitive. And some people will be like, well, people need to stop being so sensitive.

I'm like, well, telling people to stop being so sensitive, unfortunately, doesn't work. Yeah. Amazing. You know, like, we just need to be like other cultures and point out and shame people. And I'm like, it just doesn't work here. I don't know what it is. We just have a different culture. It's shaming doesn't work.

Sorry. Discrimination and whatever stigma, it doesn't decrease weight. In fact, it probably increases people's weight due to the stress are like, you know, pro judgment, pro shame, when it comes to people's weight are very much resistant to being judged and shamed for any of their ideological beliefs. It's like, Oh, you know, well, you guys are just so judgmental. It's like, did you not just tell me to take a hyperjudgmental approach about somebody's health? Like it's not going to work. And one of the things I tell people all the time is much of the reason people over-consume food is to cope with emotions. If you make them feel shitty, you're probably just going to make them turn even more to food, which I think is a nice segue ultimately to what I want to pick your brain about today, which is, like I told you off air, as a trainer and as a coach, I have blind

spots and I wish it really was as simple as giving people exercise directives and telling them that they need to stick with these things while making these lifestyle changes and eating in a calorie deficit. And like the physics of weight loss makes a ton of sense to me. It really does. It's one of those things though, that it's not always enough. And so one of the things that I've liked about your content is kind of just looking at not just the socioeconomic side of things, but the neurological side of things or the neurobiology of somebody who's dealing with obesity. And so I think a good question to start with would be, you've got a normal weight individual, and then you have an obese or overweight individual. And both people know at some intuitive level that they need to move more and they need to eat less. And for some people, it's a lot easier. It just comes substantially more naturally. what's happening for obese people or non-normal weight individuals at the brain level that makes it so hard to lose weight or at least presents more friction up front because in doing this for

years it's very it's become very clear to me that the machinery in between your ears is a big driving force and it's not universal for everybody yeah I just did a podcast with a neurobiologist, Stefan Guyenet. I don't know if anybody knows the name. Oh, yeah. What's the book called? Hungry Brain. Hungry Brain. There you go.

Clinically, I have to know about this stuff. He did more of the bench research and whatever, some of the more mechanistic. But I do have to know this stuff just to make sure I'm a knowledgeable obesity physician. But the gist of it is we all have these wirings in our body to have a certain amount of body fatness. And our environments kind of lead the pathway to that. Yeah, right. So, for example, if you look at the graphs, it's like somewhere in the 1970s, you just start seeing this uptick of like all the different people that started gaining weight. And it's like, if you think of obesity as just a straight up willpower laziness problem, then what happened back then that we all of a sudden became as a culture, uh, less disciplined and less willpower.

I don't think that that doesn't even, doesn't even seem plausible. and less willpower. I don't think that doesn't even seem plausible. I have very hardworking individual patients, CEOs, whatever, doctors, teachers, any profession, you name it, lawyers, I don't know, pilots who suffer from obesity, who struggle with their obesity. They've lost weight, 30, 50 pounds, whatever,

100 pounds, it doesn't matter tons of pounds multiple times only to regain it over time and and they all say kind of the same thing i don't know i just couldn't i just couldn't stick with it it was too hard some of them will point out that they felt like extremely voraciously hungry once they got down to their weight that they remember being when they're younger and they didn't they weren't hungry back then so basically what happens is that somewhere in the 1970s i don't know our i'd say our food environment starts to change and if we're some of us are wired to have higher appetites and and potentially dysfunctional changes in our reward system. And so there's a difference between feeling full and satiated where it's like, okay, I think I'm pretty full to where they can still eat a piece of cookie or pie or whatever like

that. So that's kind of the reward system. Whereas now we got this homeostatic part of our brain the hypothalamus that makes us feel satiated overall so like let's say for example i can eat some bowl of pasta and i'm good i'm done whereas someone else with obesity um someone who's wired more for obesity would could sit down we could get the same meals and they'd want seconds and then on top of that they may want they may want the the cookie or pie or whatever afterwards they have the strong cravings which isn't necessarily part of that satiation now you know some may say this is all willpower but it's think of it like an itch you just got a scratch and it just feels like it's

getting stronger and stronger telling those people not to sometimes works you can develop habits that that get people out of those situations like if you get people out of that environment it works but there's a lot of people and because of our environment is really hard to get out of i mean what are we going to do send everybody to a an island where they have to fish and um collect freaking coconuts and berries i don't even know whatever yeah berries and fish you have to literally lock people in a cage yeah it's the only way yeah and it's and people think no they just got to actually put their fork down it's like it doesn't it's it's it's it's the same thing as having to go to the bathroom it's the same thing

as as um any biologically driven um habit that we have. We need to eat, and those cravings and appetites get stronger and stronger. So basically, people have different genetics and are wired differently, and you put them in this environment, and some people are resistant to the weight gain, while other people are not. And you can see that pretty clearly. while other people are not. And, um, you can see that pretty clearly. It was, uh, I'd say for good examples, my daughter, um, she likes donuts every once in a while. So we get a treat

and we'll go with another family. And, uh, you know, like I'm sitting there watching her and she's like, Hmm, yeah, give me the chocolate, whatever glazed donut. I don't know whatever it is. And then the other kid will get something similar. The other kid I'm watching, you know, clearly some different genetics in the families and the, you know, the other kid might eat one, maybe they'll try to get more. My daughter ends up eating half and she's like, I'm full now. And I'm like, okay, so this, this, you know, just one anecdote, but you kind of see that. So when people start saying, it's just a willpower

thing, there are many lean people out there who aren't even into fitness. They're not following your Instagram or following mine or anything like that. And they're just eating pizza and whatever. And people like they can eat whatever they want, but it's like, yeah, they can eat whatever they want, but they don't eat as much as you think they are. They stop because they're full. They just live their lives. Whereas other people live their lives passively. And it's just a little bit more at a time, a little bit more. And so I think back to my daughter, I'm just sitting there watching her going like, this is a highly ultra processed, highly palatable food that most people would gobble up. And halfway through the donut, she clearly loved the donut. She loved it.

And then she's like, okay, I'm done. And she threw it away. And I'm like, wow. Whereas like other kids, I'm watching them and they eat one and like, can I have some more snacks and whatever? And I think that that's a good little anecdote to say, like, clearly there's something else going on here. There's clearly environment, but then there's something biologically driven it makes a lot of sense like she clearly has some regulatory

equipment up top that helps her kind of hit the stop currently working it's currently working now you know over time so here's the here's the thing over time there's this thought that once you developed obesity there can become some dysregulation in specifically that reward pathway center the place where you're feeling full but for some reason you have room for pie you're you're stuffed yeah i'm i had just a great big meal but i just i need that sweet whatever sure and so um there's some thought that some people develop a dysregulation there. The other thing is once people start to lose weight, they're like, okay, I'm going to start tracking my calories, macros, whatever.

I'm going to eat X, Y, Z foods. They lose somewhere around like, you know, five, 10% of their weight. They're down 30, you know, 20, 30 pounds. And this is where their, the hunger starts ramping up to where the like that's what kicks them off the consistency it's it's something about like i don't know their body's fighting them so there's some thought that like once you develop the obesity too then when you try to lose weight your body fights against you and so from a you know again we could all just say this is a discipline problem but i can tell you there are naturally thin people that they don't have any discipline in the

world. They're eating crap. Yeah. It's crazy to have to like face the fact that as somebody who has relatively small parents that are pretty lean, I've never had to fucking work hard at all to maintain my body weight, which is like definitely not something that most coaches or trainers will say. Everybody wants credit for their physique. And I I've had to work pretty hard to put some muscle on a, on a relatively small frame,

but at no point in my life have I ever struggled with maintaining my body fatness. And that could very well be due to these kind of differences in how my brain is wired and how I respond to food. But it's always the people, I don't want to say it's always, because there are certainly some people who have lost an admirable amount of weight who champion discipline. And that could be survivorship bias. And there's certainly, you do need to have discipline, but so many of the loudest proponents and this i'm calling myself out like i i used to be very insensitive i used to just i mean i was i started personal training at 18 and i would tell people like listen this is what you need to do as

somebody who's never been greater than 11 body fat in my entire life who had to fucking go to blackstone labs.com to fucking get whatever SARMs, like whatever. I'm sure they're fucking banned by the FTC by now. You're just getting boner pills. But I was just getting anything I could to try to gain any amount of weight. And so here I am on the opposite, probably, you know, from a neurobiology standpoint, I'm on the opposite, screaming discipline to these people who have a completely different genetic hardwiring than me. And now having lived this and worked with enough people,

I've really started to better understand that a lot of those reward mechanisms and the hypothalamic mechanisms that regulate weight are very different. Yes, the physics of weight loss are quite universal, sure. But for somebody who is already overweight, that machinery is stressed that much more. It's that much harder. And those reward pathways are so much more deeply entrenched. Sometimes it can take more than just diet and exercise. Hey guys, taking a break from the show to tell you about our amazing sports nutrition partner, Legion. Legion makes the best evidence-based formulas for sports performance, sports nutrition, recovery, and fat loss. I don't recommend many supplements. In fact, I think you can get the majority of the nutrition you need

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or you can train from home with bands and dumbbells, or Elite Physique, which is a female bodybuilding-focused program where you can train at the gym with equipments designed specifically to help you develop strength, as well as the glutes, hamstrings, quads, and back. I have more teams coming planned for a variety of different fitness levels. But what's cool about this is when you join these programs, you get programming that's updated every single week. The sets to do, the reps to do,

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the people that come into my comments, whenever I start talking about this, they, well, I lost a hundred pounds. I kept it off. And if I listened to you, I'd still be fat type of thing. And I'm just like, listen, you worked extremely hard. I'm not going to discredit you continue to work hard. If you're able to do it, that's fine. But if we look at the facts, most, unfortunately, most people just don't do it. I'm not going to say they can't do it, but whatever it is, they don't. So like, I'm not, I'm just being factual. Like, it's like, I'm not saying you can't, I'm saying that it just doesn't happen for most people. So I think it's worth a shot to try and do all the different things that we know in our best gold standard uh behavioral therapies and and methods but if it

doesn't happen for you biologically why don't we look to some of these tools that you know i do medically um and that's what we can chat about those but definitely basically why not hit those hit those parts of the brain that I'm talking about and basically shut off those signals that make us want to eat more to where then all of a sudden you can do it. Why not? Why not? We all use different, we have different technologies now.

We have iPhones. I love the meme where it's like, oh, my stupid teacher said I'd never have a calculator in my pocket all the time so i have to learn math now look at us we have iphones that can freaking i mean i actually have the stupid dslr cam the huge dslr cameras back yeah 12 or whatever to do my youtube or stupid videos yeah transfer that from now i'm just like 48 megapixel iphone 14 pro bro shits on any camera yeah it's like it's it's amazing and it's like the sound is even like it's it's i don't even have a special microphone necessarily because

it's just like this is this actually does extremely well so yeah one thing i i that really made like i made a connection between recently with like a lot of the people who yes they want credit for having toughened it out. It was like, I lost the weight, damn it. Everybody else should too. What really popped for me a couple weeks ago was when there was some student loan forgiveness. And everybody was like, no, you need to fucking suffer the way I suffered, god damn it. You should not get anything that I didn't get.

And it's like, bro, do you realize the whole enterprise was shitty? We do not all... If we can avoid everybody having to suffer the way you suffer, would that be the goal? It's like some people really have a hard time wrapping their head around anybody having an easier go of things because of technological or scientific advancement. easier go of things because of technological or scientific advancement. And I think the thing that made the reward mechanism click for me kind of out of the blue when I was maybe 20, after two years of basically just telling adults, listen, I know what I'm talking about. This is why you're fat, bro. Just come see me more, eat less. You got to do this shit. And it was like,

not getting anywhere was when i read ramit sati's book and i know he's somebody that both of us actually like his content a lot i don't know if you guys are friends i think you guys are friends but he was somebody that like i realized shit if nobody told me that my spending habits and the way that my brain was wired to spend over save i'd be fucking broke. I'd be broke because I had a proclivity for excessive spending, just like my parents did, who are broke. And so I was like, wow, maybe that genetic proclivity for not saving and being very wasteful with money that I learned and addressed over time, and now I'm in a better spot.

that I learned and addressed over time. And now I'm in a better spot. Like, you know, it's not that much different. Like we have these baked in reward pathways that are kind of unique to each person. And it's like, yes, if everybody could hear to invest $500 a month into the S&P 500 and just do it, we'd all be rich the same way that if everybody just heard eat less,

move more and it registered, we'd all be thin. But clearly it's not the same way that if everybody just heard eat less, move more, and it registered, we'd all be thin. But clearly, it's not the same. It doesn't resonate for everybody in that same way, which kind of leads me to these GLP-1 drugs, which in full transparency, I had no idea about these drugs at all. I had been working with a client based out of Florida online for around a year, and we had done a really good job. She was hitting on all of her check-ins. She was doing great with her sleep, with her hydration. She was eating protein. She was exercising actively, but she had only dropped about 10 pounds, which I'll put it in perspective was only about 3% of her body weight. This was a

pretty large woman. She went to the doctor, they put her on Ozempic, which is, I think, semaglutide. And she dropped 50 pounds in that following year. And I felt some type of way about it. I felt like, okay, we did all this work. She was so disciplined. She was doing everything you said. And she took this drug and it worked in a way that your protocol didn't. And I internalized it a lot. But then I was like, hold on a minute. Who cares? The goal for her was to lose the weight. She's still active. She's still eating more nutrients. She's still exercising. So she's much healthier. But I could not for the life of me grasp how there was a compound that worked like this. And so like this new classification of weight loss drugs, they really blew up within the last year. You can't even get your hands on a lot of these now. I even have one client who I see in person who just got her hands on loraglutide because semaglutide is basically like backordered for, I guess, an eternity. And there's more, I think there's

one called Trizapatide or something like that. Trizapatide, yeah. That's the one I've been shilling out recently. So big pharma bro over here, just fucking sell out totally. But you can't get your hands on these because they work. And I think the best place to start with this would be what are they and how do they work? Yeah. GLP-1 stands for glucagon-like peptide 1. They come from these cells in our intestine. Basically, what happened is like the 1950s or so, they ran some experiments to see what happens if you inject glucose sugar into your veins versus if you ingest it, if you drank it, And then see what happens to your insulin and then your blood sugars, whatever. So they found that, I mean, I would expect that if you injected it straight into your veins,

hit your pancreas, and you're going to have more quicker insulin release, more. Well, I found actually those who ingested it had more. And they called it the time, the incretin effect, meaning the intestinal secretion of insulin, incretin. Kind of silly. So then over the years, they were studying it more and more. And just a couple decades ago, they found in these Gila monsters, these little lizards. Oh, shit. Yeah.

I know exactly. I thought it was Gila monster. Gila? I don't know. Someone told me Gila was gila monster gila i don't know someone told me gila gila gila probably it probably is i think that g is probably silent in these lizards they found that there was one of the exenadin this um the first one that they basically then took and uh turned into uh bietta or exenatide and it was this uh injectable glp-1 agonist that you had to do twice a day and what happened was you know they wanted to help people's blood sugars people's blood

sugars were going uh down further is helping the pancreas make more insulin without burning the pancreas out this was helping with those with type 2 diabetes then they're finding people were like losing weight so then over the years they modified um these this peptide um it's not the same as our own endogenous glp-1 they they you know they found similar kind of acting uh glp-1 agonists and then modified it to where it lasted longer in the body longer half-life hitting the receptors differently then it became once a day where that's like the liraglutide. And then, um, over time they, they got one called dulaglutide, dulaglutide or whatever, and then semaglutide. And now they have terzapatide, but basically these things are hitting these parts of our brain that control eating. Um, and then have down, uh, like down, down the pathway, they hit different parts of our brain that basically control how much we eat or how much

we want to eat and also probably some of the reward pathway there. So we had these older drugs that were like uppers, basically amphetamine-like medicine. I took Adderall when I was a little kid for like every every child that was born male child between 1995 and 2005 took adderall as a kid but that shit nuked my appetite i was like 60 pounds until i was 12 yeah so the uppers definitely work it's just the trade-offs are disgusting yeah so they they had something called fentramine. It works all right, but it's an upper and people get insomnia and anxiety. Yeah.

Jittery. And some of them, they're okay. They don't hit the receptors exactly like these newer drugs. These newer drugs, though, they get to the point where people describe, this is what they say to me um they feel like they should feel they feel like what they imagine a normal thin person feels like and then all of a sudden it's not like they're not fat burners these are people that say that they're eating 1200 calories under 300 pounds and they can't lose weight and i'm like like, it's impossible. It's not possible, but I don't tell them like, you're lying. You're a liar. Stop lying. I just say, okay, you know,

you're working pretty hard to lose weight. I get it. Let's try this medicine. And all of a sudden they lose, you know, a hundred pounds or whatever, whatever it is, 50 or a hundred pounds. The average now for this new one, Terzepetide is, um, it's around 21 percent of their weight wow which it's we're getting close to where it's bariatric surgery i mean that's like quadruple the loraglitide which i think was like five and a half percent yeah six seven pretty it's it's i always tell people it's around three three times more as effective loraglitide was pretty good too people you know i have people that do really great on that. I have a client on it right now and she's just blown away by... She's one of those people that Monday through Friday, she does quite well. And then because of the social stuff that

oftentimes pops up where we live, it's always wine and cheese weekend. And so she's like, I had like a half a glass of wine and i didn't even touch the cheese and i cannot even begin to tell you the last time that ever happened yeah so it hits these parts so even like addiction type of things i they think they're going to start studying it for these because i have patients like i don't feel like drinking alcohol whereas before i'd be like yeah it's kind of like what i did it's like i don't feel like it i don't feel like eating that was like, I don't even feel like it. I don't feel like eating that extra piece. I don't even feel like eating pie. It basically helps people do what they already know they need to do in a way that they don't have to like, it just makes it automatic.

And to where people talk about, you just need to have discipline. It's like, no, some, some people that are naturally thin, they don't have discipline. It just, now this drug basically does it into where their biology normalizes. There's something there. I can only speak for myself here, but I've always gotten credit for having an above-average physique from a leanness standpoint. And people act as though I've done work that I have not done and that I have discipline that I do not have. And, you know, somebody, Oh, well you just must be so dedicated and like, Oh, you, you

probably don't want any of this food. Now give me some of that shit. I'll, I'll eat that shit. You know, I'm not perfect. I've just have, um, mechanisms in my brain that make this less pleasurable. And I have the ability to stop and I work on my feet fucking 10 hours a day and I work out five days a week. So yes, there are a lot of behavioral things that are working for me, but it's not all

discipline. And it was once I started checking that I'm not the most disciplined version of myself. A lot of thin fit people give themselves credit for having this unbelievable diligence and unshakable discipline, but that's not always there. A lot of times it's these underlying mechanisms that are just unfortunately biased more in favor of normal body weight for them. And they kind of, I don't want to say give themselves credit where it's not due because certainly the bodybuilders, competitors, and athletes of the world do have ridiculous discipline, but there's a lot of normal weight individuals who just simply have that stop mechanism baked into

their brain that this kind of medical intervention will give to somebody who just genetically or situationally wasn't born with that machinery. Yeah. These drugs basically level the playing field. And so what are the side effects? Well, most common side effects is a little bit of nausea goes away over time for most people. Some people have like moderate to severe nausea. Once in a while, people can't tolerate it. But over time, they get used to it. Some people get constipated.

It slows down the GI tract. Once in a while, people get diarrhea that I see. Some people get some reflux because it slows down the GI tract. Once in a while, people get diarrhea that I see. Some people get some reflux because it slows down the GI tract, but rarely do I see much more severe side effects than that. It can elevate the heart rate just by a few beats per minute. Some people get a severe elevation. We just monitor that. But overall, I've never seen anything like these drugs. I have hundreds of patients on these things and terzepatide specifically, it's actually only approved for type 2 diabetes right now. Likely in a year, it'll get approved for weight loss specifically. So I use that one off-label at the moment. But yeah, these

things, just discipline in an injection. Why would people be against that? I don't know. It's just technology. We're helping people do what they already, you know, just because other people suffered and, you know, trying to white knuckle it. Yeah, we live in a world or society, especially here in America, where people would rather nobody win than somebody win and them not win. People would rather everybody suffer than somebody not suffer where they've suffered.

win and them not win. People would rather everybody suffer than somebody not suffer where they've suffered. It is quite strange to see so many people in the fitness community who say their primary ambition and desire for getting into fitness is to help people live healthier lives, not be happy or not be encouraged that there's additional options for helping people lose body fat. Because as we all know, being obese is not a long-term ideal health status. And if this can make a difference, why people wouldn't be... I think the general tone should be a little bit more optimistic and a little bit more excited about how these can work in conjunction with healthy lifestyle behaviors, where instead i feel like so much of the sentiment is this is a cop-out this is a lack of discipline yeah imagine

shaming somebody because they have obesity like you just you're just lazy and then they're like struggling and then they use something like this and like well that now you're just cheating and it's like i can't even win yeah i mean so much of it gets, it's like, you know, obesity. Is it a choice or is it not a choice? And if you'd have asked me when I first got into the fitness industry and I had never worked with people, I would have told you that it was definitely a choice due to laziness and an inability to be disciplined. But then you work with clients who see you multiple times a week at five o'clock in the morning, doing everything they can, working hellacious jobs, and they're crying to you about

how bad they want this and it's just not happening for them. And I started to realize like, you're no less disciplined than I am. You might be more disciplined than I am in certain areas, but they have a hard time from a neurobiological standpoint getting that discipline to connect with food because something in that wiring process makes food more favorable, which actually leads me to a question I've wanted to ask you for a while, which is, do you see anything, and this is purely anecdotal, but I've noticed a lot of my clients that really, really struggle with their weight have experienced some kind of psychological trauma, emotional trauma. They struggle with secondary psychological conditions. With your patient population, what kind of individuals do you see struggling with their weight? Are there also some associative psychological issues?

Are there oftentimes traumas? Are some of the things that might set that machinery up to maybe bias more towards obesity and struggling with your weight? Can those be influenced by things early in life? Yeah. that was actually studied at the Kaiser in San Diego area certainly can have an effect and can really change the trajectory of somebody's life. So nature and people like, when I sit here and say genetics, there's also nature and nurture.

Some things when you're younger, it can set metabolic programming. I don't know. It gets really complex. But yes set it can have metabolic programming i don't know it's it's it gets really complex um but yes absolutely can have an effect when i i when i talk to my patients i always ask them you know how long have you struggled what happened many will say they struggled their whole life they don't they can't pinpoint um but other people can pinpoint somebody died got married changed jobs whatever there's certain things that happen that just trigger whatever and then they say and for some reason i'm doing the same things i used to do

and can't lose weight i don't know what it is about it but they um clearly now have you know i don't want to say set point but there's something about everything that's going on. I don't know if it's just their brain or what, but something's wiring them to struggle. And so psychological, for sure, that can happen. Yeah. I've just noticed a disproportionate amount of the clients I work with. When you work with people long enough and they begin to open up about their past, there's like uniquely traumatizing events that, that preceded a substantial amount of weight gain. And I couldn't help but realize like, wow, maybe something happened there where food became, cause it is such an available coping

tool. Maybe food became something that you turn to and, and that, and that wiring made it difficult. And like, again, just going back to the fitness community, like you don't know what somebody's going through or what somebody's been through that might, you know, with, with foods ability to be used as a coping tool, somebody who's struggling with their weight might be struggling with something substantially more challenging at an emotional level and foods just available. Um, and so when you come at these people without empathy and you think that somehow that's actually going to help, it's so much more likely to cause things to backfire. Kind of talking about secondary conditions that can drive dysregulated body composition

or unfavorable body composition. The two that I see the most are insulin resistance and then PCOS, which of course is going to have a component of insulin resistance baked into that. And so I think I'd just first like to talk about insulin and blood sugar. And Kevin Hall's done a ton of work on this that kind of has debunked the insulin hypothesis or the insulin carbohydrate model of obesity, but what role does insulin play in weight and body fatness? Because I've always struggled with this. It's like it does matter, but it's not the primary driver. What role does it play? Because a lot of these drugs are actually, these GLPs are actually marketed to help manage blood sugar through body fat reduction.

Yeah, yeah. Insulin plays a role. It's just, you know, when I fight these people on Twitter, you see these freaking zealots. They're just such, they're just, they're liars too. They're just straight up liars and intellectually dishonest at the best. Other than that, just maybe straight up liars. Insulin plays a role in body fatness, but not nearly as much as how the brain and appetite play a role. So peripherally, insulin may have some small role and that's what they play that up. Basically, it's going to

insulin is the anabolic hormones. When eat carbohydrates your insulin goes up that's how um that's what shuts off uh lipolysis and what turns on adipogenesis or um lipogenesis and so they play that whole mechanistic stuff up but when you really comes when it comes down to it really doesn't matter at least from a carbohydrate standpoint if you um inject exogenous insulin you know not increasing your own insulin from carbohydrate intake physiologically exogenous insulin can increase weight and there's multiple mechanisms i think behind that you know partially if you're needing insulin your blood sugar is a lot of times so high that you're pissing out sugar and then all of a sudden you can use insulin you your blood sugar is a lot of times so high that you're pissing out sugar. And then all of a sudden, if you use insulin, you stop pissing it out.

So you take those calories that you're pissing out and now you're storing them. There's a few other things like that that may make sense. is basically that carbohydrates, the difference in body fatness, we really can't really see it, at least when they do these metabolic ward studies. That's what Kevin Hall does. And the insulin differences, whether insulin plays a role, it does. We know it plays a role, but it's not the main role.

It's mostly energy balance when you really look at it. We should be focusing on what's keeping people satiated in terms of food. So the keto zealots will say that their ketogenic diet keeps them satiated. But other people do keto and they don't feel satiated. So then clearly it doesn't have a major effect. If you did a randomized trial and put somebody on keto versus one of these GLP-1 medicines, it wouldn't even be close.

It's not even close. I'll smoke them. I don't even have to give anybody dietary advice. I'll just go, here's some to your appetite. See you later. Don't even talk to me about nutrition. Not that I would actually do that, but I could. And they would smoke them.

It would be a blowout. smoke them. It would be a blowout. But like you said, GLP-1s actually help the pancreas make more insulin, ironically, and yet people lose weight. So from a standpoint of it preventing people from losing weight, insulin's a very small player. What happens in PCOS, I talk about this often, people talk about this often. People talk about the hormonal changes that just mysteriously make it hard to lose weight. Well, a lot of it's probably appetite-related. Insulin resistance and inflammation and things going on probably dysregulate the appetite. So people eat more than they think.

I have a lot of patients with PCOS that I put on these GLP-1 agonists. And you got to be very sensitive because those people with PCOS have been struggling with their weight and you don't want to just say you're eating too much. It's just hard. We just don't know exactly unless we're getting fed by a lab and monitoring every little parameter

of how many calories we're burning. It's just hard to do practically. That's why these medicines work. They just take all the all the nitpicking and tedious like work out of it that it's just really hard to do on a large on a long long-term basis so those pcos likely appetite dysregulation you see a lot of depression and pcos binge eating and pcos and there are some differences in androgens, which can change maybe where we, in cortisol, maybe where we store the fat.

Sure. So not from a total weight perspective, but body fat regions of where we store. That may be something as well, but overall body fatness and weight still like mostly appetite related. So those with insulin resistance, same thing, appetite related. I could put somebody on a high carb, low calorie diet and they'll lose weight they'll lose the weight and they'll resolve their insulin resistance the problem is how do you get them to keep doing that they got to be satiated so um that's that's why these drugs really help you can put them on a low carb diet

but like if low carb solved everything we would have been solved in the 90s, Atkins and all this stuff. They keep repackaging the same stuff. I like low-carb. I do a lot of low-carb with patients, but it's not going to solve the obesity or insulin resistance epidemic, unfortunately, because you still got to stick to it. Yeah, and so much of that resistance is driven by excess adiposity. So unless the body fat comes down, the insulin sensitivity will never go up. You kind of have to chip away at the body fat. If you just ate no carb, but never lost weight, you probably wouldn't see such positive changes in insulin sensitivity. Because it seems to me from what I understand, a lot of that is driven by

losing the actual body fat. You're exactly right. So the body fat, it drives a lot of this. It can get really complex because where that fat is stored, whether it's in the liver or pancreas and ectopically versus on your hips and thighs, it can make a big difference of the insulin resistance and that type of thing. can make a big difference of the insulin resistance and that type of thing. So last question I have here for you, as somebody who, you know, you're fit, you stay active, I know you do what you can nutritionally, you have a good balance, but what do you see the kind of long-term projection for these drugs and how they're used to encourage a healthy lifestyle? I'll play devil's advocate here, but do you think that there could be a societal trend towards just, hey, fuck it, just everybody's going to be taking

these. It'll become the new opiate that everybody's knocking down their doctor's door to get these so they can eat what they want and lose weight. Or do you think that the kind of long-term time projection is going to position these drugs to not just help people be more normal when it comes to their weight, but also live and encourage healthier, active lifestyles? Or does it play right into the lack of discipline that so many people wanted to? It's a good question. So here's the ideal situation. Somehow we would change our environment to where people wouldn't have to think like back in the 70s or and before that people didn't really have to think about it too much there's of course people did you know like once in a while you know like you get some people that are have some excess weight but like back before we even obsessed over

image and whatever what what did people do they just kind of live their lives and that's what people are doing now except that they're living their lives in this environment that is conducive to overeating totally first of all i would want to say we got to change the environment that's unfortunately if we're going to be realistic that's not going to happen. It's not, it's, it's not going to, as long as we live in the, uh, incentive structure that we live in, it's no food company is going to stop. Yeah. I mean like, yeah. Imagine telling Doritos that, Oh, I can't, whatever, any food like that. Hey bro, these food companies are the problem, but the government better not do nothing

about that shit. The government needs not do nothing about that shit. The government needs to do something about what people are putting in their bodies, except for my body. That's fucking off limits. Yes, exactly. So it's kind of funny. I like to show that hypocrisy often. So nothing's going to happen in terms of environment. Nothing crazy on a large scale.

So then it's like, what should we do? Should we just get these drugs? These drugs are super expensive right now the drug companies want their money back for putting all the r&d efforts into it so they're they're charging arm and a leg it's a thousand dollars a month you know insurance companies pay sometimes them sometimes don't pay i think over time you know hopefully capitalism wins out in terms of like, hey, more competition, which we're seeing now. Novo Nordisk had liraglutide and now semaglutide, which is great. This is Eli Lilly with terzapatide.

There's going to be other ones. We're going to hopefully drive down costs. More insurances are going to pick this up. Costs come down further. Different countries can get these drugs for hundreds of dollars as opposed to thousands of dollars like us can you get them in mexico you can you can so um yeah yes brazil i always hear about brazil it's only a couple hundred dollars i might have to start a side hustle as a trisepatide mule yeah you should i would do that so i think we're gonna

see costs come down and i think you know unfortunately i mean i don't know fortunately unfortunately i just think that's probably going to be the way we go for a lot of these people we can like you know people don't want to be on medicines either so we'll still give our best efforts in terms of lifestyle changes hell like people think I'm a shill for the stuff I am, but let's, I don't, I don't, I'm not in bed with the pharmaceutical companies yet,

but I do have my own telemedicine practice. We're growing quickly. We, it's, um, uh, it's called joint sequence or sequence. And so we have,

uh, you know, we're all in 50 States and people are knocking on our online doors to basically give me this GLP one stuff and we help them do it. But, you know, I have my own lifting weights programs and nutrition programs that I try to get people to do. But ultimately, people have failed those so often that, you know, not offering these medicines as a possible choice, you know, I would say is wrong. So, you know, offer it. People would rather not have to take it,

but they're at their wits ends at this point. And these people, these, I just, I can't even describe it. These, the, the, the amount of weight they lose and how good they feel. It's, it's amazing. So why withhold such a, an awesome treatment? Yeah. So that's, that's kind of the gist. I think we're going to be, they're going to get better. They're only getting better. They're finding different ways to modify the peptides to where it's like amazing. I couldn't agree more. And that's kind of where I've gotten with it as just a personal trainer. I'm, I'm limited in the solutions that I have for clients. And there are a number of clients to whom I've made the recommendation that they look into these compounds and most of them aren't open to it yet. It's not like they're beating down my doors to

get it. A lot of people truly want to exhaust all of the disciplinary avenues at their disposal until they give into medication. This is not a situation where I think you have a bunch of lazy people wanting this drug. I think that that's a misconception. And you know, it's getting to a point where the stigmatization has come down when you have fitness coaches being like, hey, this could be something new that we could try because we've tried a lot of things. So I'm glad we got to have this discussion today, Doc. I think it's really important for people that a lot of people have spent a number of years, if not decades, struggling with their weight. I know many of them personally. If you really care about them, you want them to be successful regardless of what the ultimate

driver is for that success. You want your clients to reach a healthy weight. You want them to do it in a way that allows them to keep the weight off. And for some people, this is a really, really good option. So for people who want to kind of keep up with you, work with you, get their daily dose of memes, what's the best way for them to do that? Yeah, you can. So, you know, it's funny. I've had a dearth of meme templates that I've been looking at. It's like, I don't see as many good ones recently.

So anyway, if you want to find the memes, though, follow me on Instagram. of meme templates that i've been looking i was like i don't see as many good ones recently so i i uh anyway if you want to find the memes though follow me on instagram uh at dr nadolski d-r-n-a-d-o-l-s-k-y if you want some of these glp ones go to join sequence.com and we'll assess you if you if you qualify you have to have a bmi of 30 or bmi of 27 plus one of these like weight related comorbidities such as like uh pcos or um you know high triglycerides blood sugars blood pressure that type of thing um yeah i'm on tiktok too but i do the tikt i like i only talk about obesity there i'm using that basically as a platform for the telemedicine thing whereas like instagram i talk about talk about all things health. I found that works better for some reason for TikTok. I'm not sure exactly why, but. It's that Chinese algorithm, bro. I don't know how it works.

I don't know. I try not to even, I don't even post there that often, but when I do, sometimes the videos go viral and I have to be careful because then we get overloaded with patients. It's a good problem to have, but it's really funny how it works. It's like, man, I didn't even mean for this video to go viral and it just did. I'm like, oh my God. It's a completely new animal. All right, Doc. Well, thanks so much for your time, dude.

Really appreciate it. We'll have you on again soon. Thanks, man.