Muscle for Life with Mike Matthews - Dr. Spencer Nadolsky on Drugs and Medical Issues That Prevent Weight Loss

Episode Date: December 4, 2015

In this podcast I interview Dr. Spencer Nadolsky about various medicines and medical issues that make it hard to lose weight, like birth control (18:50), antidepressants (7:45), PCOS (30:15), hypothyroidism (34:45), menopause (41:08), and more!   SPENCER'S WEBSITE: http://docswholift.com/ ORDER SPENCER'S BOOK: http://goo.gl/2KahIO Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.muscleforlife.com/signup/

Hey, it's Mike, and this podcast is brought to you by my books. Seriously, though, it actually is. I make my living as a writer, so as long as I keep selling books, I can keep writing articles over at Muscle for Life and Legion and recording podcasts and videos like this and all that fun stuff. Now, I have several books, but the place to start is Bigger Leaner Stronger if you're a guy and Thinner Leaner Stronger if you're a girl. Now, these books, they basically teach you everything you need to know about dieting, training, and supplementation to build

muscle, lose fat, and look and feel great without having to give up all the foods you love or grind away in the gym every day doing workouts that you hate. Now you can find my books everywhere. You can buy books online like Amazon, Audible, iBooks, Google Play, Barnes & Noble, Kobo, and so forth. And if you're into audiobooks like me, you can actually get one of my books for free, one of my audiobooks for free with a 30-day free trial of Audible. To do that, go to muscleforlife.com forward slash audiobooks. That's www.muscleforlife.com forward slash audiobooks. And you can see how to do this. Now also, if you like my work in general, then I really think you're going to like what I'm doing with my supplement company, Legion.

Now, as you probably know, I'm not a fan of the supplement industry. I mean, I've wasted who knows how many thousands of dollars over the years on worthless supplements that really do nothing. And I've always had trouble finding products that I actually thought were worth buying and recommending. And well, basically I had been complaining about this for years and I decided to finally do something about it and start making my own products. And not just any products, but really the exact products that I myself have always wanted. So a few of the things that make my supplements unique are one, they're a hundred percent naturally sweetened and flavored. Two, all ingredients are backed by peer-reviewed scientific research that you can verify for yourself because

on our website, we explain why we've chosen each ingredient and we also cite all supporting studies so you can go dive in and check it out for yourself. Three, all ingredients are also included at clinically effective dosages, which are the exact dosages used in the studies proving their effectiveness. This is important, of course, because while something like creatine is proven to help improve strength and help you build muscle faster, if you don't take enough, then you're not going to see the benefits that are seen in scientific research. And four, there are no proprietary blends, which means that you know exactly what you're buying. All our formulations are 100% transparent, both with the ingredients and the dosages. So you can learn more

about my supplements at www.legionathletics.com. And if you like what you see and you want to buy something, use the coupon code podcast, P O D C A S T, and you'll save 10% on your order. All right. Thanks again for taking the time to listen to my podcast and let's get to the show hey spencer thanks for coming on the show again i appreciate it thanks for coming on the show again. I appreciate it. Thanks for having me again. Yeah, yeah, sure thing.

I'm looking forward to talking with you. We're emailing back and forth on some subjects because these things that we're going to talk about in the podcast are things that I have gotten asked many times in emails. And, you know, some of the stuff I have a cursory understanding of. I don't have a great answer for some of it, actually. So I think it's going to be there are things that i haven't touched on which is going to be nice because at this point with doing so many podcasts and writing so many articles it's like sometimes it's hard to find like what's something new that i can talk about right people even care to hear there's only so many times you can talk about eat more vegetables and fruit i know and less and move more and stop eating so much shitty food, please. Yeah, yeah.

Yeah. Yeah, so that's why I emailed you to think of something a little bit different and obviously to talk about my new book that's coming out that kind of has some of this information. Exactly, exactly. So you were just telling me before we got on here that you're talking a bit about just the state of obesity research and kind of the disparity between what is known

scientifically and what is out there in the mainstream and what the average person kind of equates with weight loss or what you have to do to lose weight and so forth. Right. So yeah, I go to these obesity conferences. So I'm what's called an attending physician. I have my board certification and everything like that. But since medical school, I've been going to these obesity conferences, one or two a year. And every time I go, it's the smartest obesity researchers in the world and the smartest physicians that have such success with their patients. And everybody gets together and talks about what's the best way to help their patients lose weight, what's the latest research. And one of the issues I find is that a lot of this information is in these guidelines and research papers and everybody's

talking to each other, the doctors and the researchers, but a lot of this isn't getting into the mainstream media. What you see a lot of times is a lot of fad diet type type stuff why do you think that is you think it's just marketing i mean i've thought about this myself and i figure like i guess it's just marketing and it's kind of just pandering to you know what people uh what's what's seen what sounds the easiest or you know trying to put some new twist on science or history that always that you if you can mix that up and there's the paleo whole thing is like if you can combine what seems to be historical with scientific information then you can convince people of anything not that even paleo eating is all that bad but you know the whole mythology is a little bit is just not accurate but what you think it's just marketing

or it is it's it's a marketing thing It's trying to take sensible information and good information and making it sexy. And do these randomized controlled trials and other types of studies. They know how to write academically in their journals, but that reads like a textbook. It's good for us as clinicians and researchers to read that and discuss it at these meetings, but a lot of times it just doesn't get to the lay public or the general public. Right. So, you know, that's what – Or it just can't rise above the marketing noise that – Right.

So then you get other people, other doctors that will take one little thing, you know, something like sugar or fructose or anything and make a whole book on that and take some truth. Grains or gluten or whatever. Exactly. and can kind of sensationalize it and turn it into a whole you know almost like a cult-like following but in the end it doesn't really matter because it doesn't mean the other principles that yeah we discuss that these meetings are wrong so and then sometimes you know you have a lot of where something can seem to work but the the what the person doesn't understand is why is it working? So it's like, I could tell someone that they're not allowed to eat this long list of fruits and foods, and I can make up some weird list of reasons why, or try to, you know, misrepresent research or whatever. And then all I'm doing is cutting their calorie intake in half

and they lose weight, but they don't understand that it's not because they didn't eat fructose or starchy carbs or they stopped eating carbs at three o'clock in the afternoon or any of that shit. It's just they ate less food. Oh, wow. And then you look like the man for doing it. Exactly. And then it sells the whole, well, it's because it's the no fructose, no starchy carbs after 3 p.m. diet.

Exactly. You got it. So this kind of rolls into then what you're doing what you want what like tell a bit a bit about your book and kind of some of the some of the um topics that you're covering in the book because you know in emailing those are the things i think that we should dive into right yeah so i call it the fat loss prescription you know it's because i'm a doctor and i figure it has to do something with a prescription of some sort. So basically what I wanted to do is take all this information I've learned at these conferences, all the guidelines that we read as an obesity physician, and condense it into a patient-friendly book that literally uses my voice to speak to them about the evidence-based lifestyle, but also, you know,

so the diet and exercise types of stuff and how to do those things and how to lose weight. But it also dives into medical reasons why you can't lose weight. Also medications that may prevent you from losing weight, which is what I think a lot of people should know. They can talk to their doctors if there are alternatives or just to know at least this might be preventing them from losing weight. Yeah, let's talk about some of those things because like sure you have energy balance and you have a high protein diet as the way to go and you should be exercising and you should be doing some resistance training. You should be doing some resistance training. You know, that's the stuff that people like you and me, that's just like, okay, that's going to work for the vast majority of people that don't have any sort of extenuating circumstances. But then, and this is where I get, I've gotten lots of emails regarding medications like antidepressants and stuff and how is, you know, where people are having trouble losing

weight and they're not, they're not stupid. Like they understand what they're doing. They know that they're not passively, they're not accidentally overeating by mismeasuring their food. They're not making the common mistakes that people make. You know what I mean? So I'd love to dive into that and just hear from you because you're dealing with it all the time. A lot more – you deal with that stuff a lot more than I do. So I'm curious to hear from you.

So when I get a patient and I immediately obviously get a history and physical and all this stuff, but I look at their medicines that they're taking, especially when they're coming to me for weight loss. And I know a lot of your followers, I don't know the exact demographic, but I'm assuming anywhere from 20s, 30s. I know you have some 50 and 60-year-olds in there too. I would say it really spans, probably the majority are between 18 and 35. But from 35-ish up to 50s and 60s, there are quite a few. Right. So for women and even guys around that age, a lot of us are getting prescribed antidepressants because we go in, we're feeling tired.

The doctor says, oh, I guess you you're depressed here's an amphetamine you know and it's here's medical cocaine have some yeah i mean so it's it's kind of it's kind of scary because you know and the other thing is younger kids are you know they have adhd or or they just have some sort of mood disorder where they put them on powerful antipsychotics but you're listening to the doctor and they don't call it an antipsychotic. It's just a medicine to help with the mood. Seroquel is one I see a lot that's used a little bit off-label in younger folks to help people sleep. That one can cause a big-time weight gain. And that one's, you know, it's an antipsychotic. It's not commonly prescribed

to just everybody with depression, but I see that a lot. Yep. I've heard from people that on that drug specifically. Yep. And that one, I'm like, holy cow, it's a very powerful antipsychotic, but they get put on it for this off-label use of some sort of mood disorder, helping them sleep. That one will rack on the weight very quickly. And how does that, what's the, why? So I've written about this before and kind of gotten in some arguments, of course, about it because people will say, well, it's just because they're eating more. It's nothing more.

It's just making them eat a little bit more. It's nothing else. Well, not necessarily. There's also some mechanisms that, you know, the whole nutrient partitioning thing it may be driving just fat fat gain as opposed to just making you eat more it may be and can you can you talk a little bit more about that just for people listening like in terms of nutrient nutrition partitioning obviously a little bit about insulin sensitivity and things yeah so so nutrient partitioning where do you when you eat foods and you have these nutrients, macronutrients, whatever, where is the fuel going towards? Is it going towards energy that you expend, your metabolism type of thing?

Is it being stored? And is it being stored as muscle glycogen? Or are you using that energy to store as fat right so um you know from a from your standpoint when we're trying to you know you have some supplements in there like your your recharge uh has a banana leaf in it yeah porcelic acid or salic acid so the goal of that is to nutrient partition um uh your carbohydrates and everything after post-workout into your muscle. So it's basically priming your muscle to soak in the sugar and not store it as fat, basically.

Right. The same thing as what exercise does, your nutrient partition. Whenever you eat, you want that energy to go to your muscle. You don't want it to be stored as fat. Right. Not only do these things, yeah, they do make you hungry and you eat more even without you noticing but there may be some nutrient partitioning into fat cells causing excess uh fat gain that way it's a little bit controversial and there's a there's multiple different types of so then like theoretically

then that would be if you kept your calorie intake exactly the same, right? You didn't raise it at all. Basically, I guess you could think of it as your body weight set point would be your fat level would just rise a little bit. And I mean obviously it shouldn't just rise forever, right? But it would be like now all of a sudden you're just fatter even though you haven't. Yeah, you may feel a little bit more. If you're eating only the same amount see this is why it's controversial yeah sure but you should feel a little bit more

tired because you know what i mean you shouldn't have as much because it's being stored but if you're sedentary maybe you don't even notice it not notice it so and if you always just feel shitty anyways yeah yeah and so and and so i get these patients and there's like yeah the doctor just put me on this when i was younger and I've been on it. It's like, holy cow, we got to get you off of that one. And sometimes I don't because they do sometimes need it, obviously, if they have some psychiatric reason that they need it. But sometimes it's used off-label. So that's a big one that I did want to mention.

The more common ones are the selective serotonin reuptake inhibitors, the SSRIs. Those are the most common. And I guess I was naive to it, but when I finally started actually practicing medicine in residency, so that's after medical school, I noticed, like noticed everybody was on one. It was just like, you're on Sertraline or Zoloft or Celexa or you're on Prozac. And it's kind of like, does everybody just kind of need some pills to make them feel better? Yeah. I will say that.

Yeah, why do, why do. I like caffeine. Right. I will say that, you know, depression is very real and medicines have their place. But if it's a mild depression, I'm very reluctant to just go straight to medicine unless the patient, it's like, nope, I just want that. Because there is cognitive behavioral therapy, which has proven to be just as good as medicine, if not maybe even better, which means you're not taking any medicine. I mean, isn't the research out there that has shown that some of these drugs are no better than placebos?

Yeah. So you might as well just say, here's a sugar pill. It is controversial. I mean, there are real things going on in the brain. Of course. It's controversial. I mean, there are real things going on in the brain. Of course.

And so I think what we're going to find out in the very near future is there's some genomic testing stuff you can do. And based on these tests, they're going to say, you know what, this drug actually may work for you. So those studies may show us a little bit better in the future. I mean, there's got be something said for lifestyle too. I mean, like depending on how the person lives, I mean, you and I would be depressed if we live the way that some people live. Like,

yeah. So is it, it's kind of like, I guess you could just take a drug or you could maybe do something to like feel better in life. Like take care of your body or start exercising. Don't watch five hours of TV and every night, you know what I mean?

Like don't eat shitty food all the time. Right. And those are kind of in those questionable mild depression, like just kind of this slight mood disorder. Whereas when someone's like really depressed and they have the – you can just – if you're around them, they kind of suck you into this dark cloud. Yeah, now I've experienced it. Those are the ones where it's like, okay, yeah, we need to get your medicine.

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

And we wean them off and see how they do. And the thing is, a lot of these patients are trying to lose weight. So these SSRIs, some of them are mixed, some showing maybe some weight loss in the first years, then weight gain. But the one that really does it is called Paxil or paroxetine. So I wanted to mention that in case anybody's on that that listens to your show. And don't stop it, for the love of God. It's just something to talk to your doctor about if you're on one of these medicines.

The medicine I usually try to get people on if they're going to try to go that route is called Welbutrin or Bupropion. I mean, obviously, I try to get people to cognitive behavioral therapy first, but Bupropion actually is a weight, it's approved for weight loss with another medicine combined with it, but it does in these depression studies shows people do lose actual weight with it. It's also used for smoking cessation.

So in case people smoke out there. And then in terms of Paxil, what do you like, you know, what's the story there? Is it also just a similar, like it's not, it's not totally understood, but it's just a thing? Yeah, this one's definitely not understood because the other ones in the same class don't have the same effect for some reason. So I'm not exactly sure why.

And I've looked at multiple reviews on why this happens, and it's kind of debated. And it's fat gain. It's not weight gain. It's not just because you're not gaining muscle or glycogen well i mean even water like you know some of these some drugs mess with your hormones and i've heard from people that have noticed a lot more water retention on certain right exactly it's it's it's thought to be fat gain but that's a good that's a good thought that you know maybe they aren't doing dexas on these people and they it's possible that it's some of it is a hydration status.

Yeah, if it's BIA, then it can be. Right, exactly, exactly. So the other one that everybody asks about is birth control. I'm sure you get that. Absolutely. And so the interesting thing about that is like oral contraceptives. So the mixed oral contraceptives with estrogen and progesterone, those are mixed. A lot of women say, I gained 20 pounds when I started that, and some women tend to lose weight.

It's hard to know. But the one that everybody knows that they gain weight is the Depo shot, the medroxyprogesterone acetate. I don't know if anybody's asked about that. Not that specifically, just birth control pills. Yeah, so it's the shot. And sometimes there's one called the Nexplanon and also the Mirena. The Mirena is an IUD, intrauterine device that has progesterone only. And it's supposed to work locally in the uterus, but there's thought that maybe some of it is systemic and so that has that progesterone weight gain effect too. So something to ask about.

I tend to favor the copper. Yeah, that's what my wife has. Yeah, I favor that one. It's non-hormonal and it seems to be safe. Some women have some cramping issues and some extra bleeding from that. to be safe. Some women have some cramping issues and some extra bleeding from that. She's had one for a while and never on no real issues that I had to share. Good. That's the one that I tend to, hey, if you want to go that route, I would do that.

I'm all in favor of trying to not mess around with hormones. Exactly. That's how we thought about it too. Just it's best for her health. Very effective. I mean, take it out and then she got pregnant real quickly and then, you know, had the kid and then. That's awesome. Yeah. So yeah, those are the most common ones.

The birth control pills mixed, you know, some people will gain weight, but when they start averaging it all out it's like well it's hard to say but definitely the shot that bow shot and uh is that just because you know higher estrogen levels is just generally associated with more fatness and it's one of those things that again because because in the people that i've heard from um again a lot of a lot of these women they know what they're doing with their diet. They understand how it works, which is why they're so like, how? Why? Yeah. And so this one is actually just the progesterone part. So when you take the pills, it's an estrogen and a progesterone.

Yeah. And the shot is just progesterone. It's just progesterone. And I want to say that one works more towards appetite stimulating because that's what there's actually medicines using cancer called magase. To stimulate appetite. Stimulates appetite. But there are probably some definite water changes there too. Yeah. So that kind of compounds it. Because I've heard then from some of these women actually, when they came off, they, or they switched to something else or whatever, and then lost weight quickly. So that kind of led me to,

one of these kind of like, well, I mean, clearly we're dealing more with water, at least in some of the cases than anything else. Exactly. Exactly. Which can be really frustrating though, because that's, it can come fast and they don't understand, they don't know. And you can't diet it away in fact if you try depending on what you're doing like some of the i've heard from women that have gotten

i mean i wouldn't say desperate but they're just like uh okay i guess i need to eat less or i need to exercise more and then that throws cortisol even more out of whack and they you know what i mean it just becomes like a dwindling spiral yep and and that's exactly you know what i try to talk about in this book because it's like everybody's like, you just got to eat less. You got to move more. And it's like, okay, hold on a second. We got to make sure that there's not a reason that these aren't working because it's possible, and I talk about this. It's possible that you're secretive about a binge eating disorder. It's possible you're off by 50 to 100% of your calories.

These studies show dieticians can't even do it right. I've written about it. It can be innocent. It can be like you actually go to measure that cup of oatmeal, but you don't realize that you just put 100 grams of oatmeal when it should have been 80 grams of oatmeal. And that adds up. I mean, as stupid as that sounds, though, okay, now you're, you know, let's say that's 80 calories over for that meal, but you do that again with the peanut butter. You do that again with over and over.

And now all of a sudden you've eaten 500 more calories in the day, even though you feel like you're on your diet and you're like, this is how is this, you know what I mean? Exactly. And those 500 calories will, those will ruin my, the patients that I had. Cause I, you know, I work with patients with very morbid obesity, 300, 400 pounds. Those 500 calories on each day are needed to be away. Exactly.

With these medicines, whether it is strictly if it makes you actually just gain fat by themselves, the nutrient partitioning, or just a little bit extra hungry or extra hunger. Or a little bit of both. Who knows? A little bit of both. Those little things can add up because you may not even notice you're snacking a little bit extra, a little bit extra here and there so it is it's a definite issue cool that's great to uh kind of because again those i i know that there are people listening that are gonna are either running inside themselves or know people that uh that are running into that so it's good for i'm glad that you covered that so what what else so what else is uh on the agenda for the book and you know because we had kind of went over that little list of things and yeah so so you know medical issues you know so i talk about i list pretty much every medicine in there so you know if you want to check it out if you go hey my medicine on there when's the book

out by the way is it it's i'm i want to release it by christmas you know kind of the whole new year's i know how that yeah and you know it's it's a nice it's a nice short read it's about 100 pages it's not long but i literally try to condense. And, you know, it's a nice short read. It's about 100 pages. It's not long, but I literally try to condense everything into this, you know, everything that I know into this one thing. So hopefully it will… Fat loss prescription, right? Yeah, the fat loss prescription. Okay, cool.

So the other things are actual medical issues. Now, this is, again, most people say you just got to eat less, move more. But last time you and I talked a little bit about testosterone. And some guys as they age, and this is, again, controversial, their testosterone will get a little bit lower. And if they get some fat around, especially the visceral fat or the belly fat, and start getting a little bit of insulin resistance and inflammation, their testosterone will go down even lower. And so it's possible that their hypogonadism, or we call it the male obesity-related secondary hypogonadism, that is not helping with their weight loss.

If they were able to lose weight, their testosterone will go up generally. But a lot of times, they cannot do it. They just don't feel motivated. There's not a lot of energy. They just don't want to go to the gym. They don't want to cook. So what do you got to do? You got to make sure you're not missing any other causes

of their hypogonadism other than their lifestyle and visceral fat. But sometimes it may be worth trying a course of it. Again, this is controversial. My brother's an endocrinologist. We talk about it all the time. I talk with the urologists that do it all the time and other family doctors, obesity doctors that do it. That says a slight tangent because I get asked about fairly frequently about trt as well and i've done a little bit of research not not on not i'm not you by any means

um but you know apparently the only thing that could that seemed actually valid is that there's a it there is a a higher risk of prostate cancer uh depend also of course it depends how high you are going with it and that was the only thing where I could say there at least is some evidence of this at a TRT dosage. Again, I might be wrong, though, because it's something that I haven't done a ton of reading on. Yeah, so that used to be the scare because the testosterone pathway, it gets converted into DHT, which fuels the prostate. What they found is, and it was so scary, it was very scary because we thought that, gosh, we're causing prostate cancer. What they actually found is that if you have an underlying prostate cancer and you give

someone testosterone, and this is why we monitor them, it will fuel that cancer. So we now pretty much know that it doesn't cause the cancer, but it can fuel one and make it kind of come out. And so that's why we monitor their prostate. And you wouldn't know that, yet that's why you have to monitor, huh? Yep, exactly. Exactly. And then once, you know, if it shoots up, we go, oh, geez. And then we get them, you know, we have to do biopsies and all that stuff. So that whole thing's been debunked. Youed. The one thing right now with the testosterone is possible cardiac disease. And this is, again, controversial because some people, if they have low testosterone and you give them testosterone, it can improve a lot of these risk factors that go along with their metabolic syndrome.

So their insulin resistance. In fact, I just downloaded a paper and I'm sending it to my brother um we're discussing a little bit and how you can give someone with metabolic syndrome who has low testosterone not someone has normal testosterone syndrome um you give them some testosterone and all of a sudden you alleviate these things almost like as good as a diabetes medication type of thing and you know and some of that um i mean isn't higher testosterone is just generally associated with with better health a leaner physique and better health right i mean exactly exactly so you know so that that was the question if we give this medicine and there are going to be more trials

they just keep doing more trials and look at this. But my preferred method is to see, hey, why don't we try to get you to lose weight and see if we can bump it up? If that fails, if they're just like, you know, I just feel miserable, whatever, I go, you know what, okay, let's give you some testosterone. If they don't want to have kids, if they do still want to have kids, if they're a little bit younger, you can start looking at things like clomiphene or clomid and also like HCG and things like that. But exactly, you know, I don't try to push the hormones. It's just something to keep in the back of the mind.

It's like, you know, this guy's got a lot of weight around his waist. You know, he's got a waist circumference larger than, you know, 39, 40 inches. You start asking about his libido. You start talking about his muscle mass. He's not able to get in the gym. He just doesn't feel good. It's something to consider. Yeah. So we got onto that just from the medical condition of just having low testosterone and how that can kind of mess with weight loss or make it harder to lose weight. What are some other, and that's definitely out there. I mean, I, I hear from the, I hear from, from guys with a low T low T fan. It's, it's, it's here and there. Um, and, and I've, I've heard from quite a few guys that, uh, saw market improvements just by

just tough, getting tough and just being like, I want to, I want to eat that shit, but I'm not going to, I don't want to go to the gym, but I'm going to go. And then after a few months of improving things, they feel way better and now they don't have to force themselves and now they're kind of in the groove, which is nice. And that's my preferred method, if possible. So, very cool. So, another thing is for women especially, well, not especially, for women, PCOS, polycystic ovarian syndrome. I'm sure you've heard a little bit.

Yeah, I've written a little bit about it. Yeah, and so this one's kind of one of those chicken or the egg things, but at least in my experience, and there's going to be some more studies looking into this, because I think what we're going to find is that people, you know, we don't really know enough about PCOS because there seems to be different types of it and how they show up and everything. But it tends to be harder for those with PCOS to lose weight. And sometimes you got to be really aggressive with them. So that's something to consider. So if your periods are a little bit off, you know, you're missing skipping periods, you missing, skipping periods, they're irregular, you might have a little bit excess acne, maybe even a little bit of hair even on your face that's kind of

embarrassing. But talk to your doctor about this because it's very important to know if you have PCOS, there's some things you can do to help. Do you want to explain what that is real quick, just for the listeners? Yeah, so polycystic ovarian syndrome, it's this syndrome where women get a little bit of excess androgens or hormones that are usually thought of as guy hormones, but women have them too. It's the hormones that can cause hair growth and libido and other things too, like testosterone and that type of stuff. And they also get something called insulin resistance, which you talk a lot about. And then you get these, not everybody, but you get these cysts in your ovaries. your ovaries and it and the thing is this is why it's somewhat controversial because it's not known whether if you gain weight and you get this syndrome or if you kind of have this syndrome

you start gaining weight right either way weight loss and diet tend to improve it though so um isn't there also some uh like you'd want to be eating probably lower glycemic carbs, if I remember correctly, maybe even a lower carb diet in general? I tend to push a little bit of a lower carb diet. Now, like I said, there are people that will argue this all day, the vegan type of pushers, which I can't really argue with because it's like you give someone more vegetables, you give them on a lower calorie diet. Exactly. Overall, it's going to be better. Considering the average Western diet, if they start eating more vegetables, their carb intake is going to go down. Generally, you replace the junk.

I say junk. Some people are like, no, there's no such thing as junk food. I'd say junk, but processed foods, refined processed foods, you replace them with vegetables. You're lowering your calories. That's a good fantasy. There's no such thing as a junk food. You know people say that. If it fits your macros,

like I'm going to eat Pop-Tarts every day. I'm going to get 80% of my carbs from just Kellogg's or something. Not to go off on a tangent, but I call a spade a spade. It's like, listen, you just don't put it on a pedestal. It's a junk food junk food you can enjoy it once in a while that's not a big deal that doesn't mean you have to become afraid of it you know it's like come on anyway so it's that point of nutrients like you can't just eat uh you know donuts and and then take a multivitamin and be

like that's the same as eating a bunch of vegetables and fruit and stuff. It's just, no, it's not the same. Exactly, exactly. So yeah, so women listening, you know, so if you have some irregular periods, you got some excess acne, talk to your doctor about that. Because the other thing is I've mentioned in my book, you know, especially if you have a lot of weight gain around your midsection and there's a very rare, very rare condition called Cushing syndrome. It's, it's hypercortisolism and there's something in your body making it. And those two

syndromes can overlap. The one with Cushing syndrome. I've heard from women with that. It's, it's, you will not be able to lose weight unless somebody finds the issue with you. So that's why I kind of talk about both of them. The PCOS thing, the other thing is you can get medicines to help with PCOS. So it's definitely worth talking to your doctor if you have some of these issues. And you have some weight gain and you're having trouble losing the weight. So that's another one I mentioned in there. Of course, the one everybody thinks about is hypothyroidism.

That's exactly what I was going to say. What about the thyroid? That's one. And so I have Hashimoto's thyroiditis myself. It's autoimmune hypothyroidism. So I love talking about it. I almost went into endocrinology. I think I talked about this in the last podcast, maybe a little bit,

but I ended up doing the family medicine and then the obesity medicine route. So I love talking about thyroid. And so come to find out that most people that have obesity have gained weight. It's usually not your thyroid. that have obesity or have gained weight, it's usually not your thyroid. However, if you want to make sure that it's definitely not your thyroid though, because if you miss that, the doctor's going to feel silly and you're going to be frustrated. Yeah, that's what I've always told. Whenever I feel that I think it might be my thyroid, go to a doctor and find out.

Yeah. I think it's worth, you know, in the guidelines of these. There's no reason to try to self-diagnose it off the internet where everything says you have brain cancer. You just don't know. Just go. Yeah, and trust me, before medical school, and even in medical school, I still did that myself. So, yeah, it's worth, I think, everybody that's trying to lose weight,

and especially, you know, it's not. What are some of the symptoms? There might be something up with the thyroid. So yeah, the symptoms are pretty much, you feel a little bit sluggish, which who doesn't at some point of their life. But dry skin, constipation, coarse hair, low heartbeat, even low blood pressure. And you just don't feel well. But it's this dry skin, coarse hair that kind of throws people off. I had a little bit of that too when I first got diagnosed.

I just kind of randomly said, I don't feel right. So the thing is, though, what happens is that people go in and they get this thing called the TSH, the thyroid stimulating hormone. It's the hormone from your brain that tells your thyroid to work. And now this will get controversial because there's a wide range of normal. And if it's at the higher end of normal, the doctor may say it's fine, but it may be something to look a little bit further into or check it again or keep checking it. And when I say the high end of normal, I'm talking about the high threes, fours.

The good range is around one to two, but even in the two range is fine. When you start getting to the threes and fours, you may want to monitor it a little bit closer or look a little bit closer with other hormone testing with your actual thyroid. A lot of doctors will just get this TSH test. It's generally a good screening test, but if you really want to look a little bit further, you want to test the actual thyroid hormones and that's getting what's called a free T4 test and maybe even a free T3, although it's usually a free T4. Those are the actual thyroid hormones. But yeah, if you're trying to lose weight, especially if you're struggling, it's worth getting it checked just to make sure.

And how much – because, again, this is an area that i haven't done a lot of research i've read i've come across it in different things i've read i've read i don't know maybe a handful of papers on it just to just to have a basic understanding and and um from from the stuff that i had read that in terms of like a decrease in basal metabolic rate, it's not that significant unless it's a really bad type of issue. Is that true? Yeah. And so I'm glad you brought that up. So a lot of times, you know, when people come in, I think it's my thyroid.

Yeah. It's, first of all, it's usually not. But if it is, you actually don't gain a ton of weight even if it is your thyroid. Because I think I saw the biggest reduction of BMR I had seen was like 14, 15% or something. But if it is, you actually don't gain a ton of weight even if it is your thyroid. Because I think I saw the biggest reduction of BMR I had seen was like 14%, 15% or something. It's not – yeah, it's really not much. A lot of times, maybe 10, 20 pounds. I mean obviously if it's really bad, they're going to have much more issues.

They could be in a coma type of thing, heart failure type of thing. And just to put in perspective for listeners like if you're if you're basal metabolic rate you know mine is probably about 2100 calories or so 2200 max so if it's a 15 reduction that's significant and if i didn't realize it i can easily i could gain a half a pound of fat a week you know just by that alone so that can add up but it's not like i mean because i've heard from people that afraid that they're, and I've heard people that actually knew they had a thyroid condition or just had recently found out about it. And then we're afraid like they're fucked. Like now their, their metabolism doesn't even work anymore and they can't lose weight. Yeah. So that's, I'm glad you brought that up because I actually, you know, so when I got diagnosed, I still had abs, you know, and people like, there's no way you don't look like you have

hypothyroidism. And plus you're a young guy, which doesn't usually fit the thing. So I got my antibodies tested. Yeah, they were high. I was having destruction of my thyroid from an autoimmune process. But I went on, you know, replacement, Synthroid. And now I'm actually on a combo of Synthroid and Cytomel, which is the T4 and the active T3, just a very little bit. And so yeah, a lot of my patients that have hypothyroidism, I want to make sure if they're trying to lose weight, I optimize it. If you optimize it, especially if you tinker

around with maybe some of the T3 and helping them if they have an issue is converted over, because your body converts the T4 to T3, which is the active stuff. So if you optimize them, they usually do just fine and they're not screwed, you know, trying to lose weight. So definitely, though, if you do have hypothyroidism, you want to optimize it. Get a good doctor that will help you. Don't get a crazy doctor that will put you on a ton of T3 or a ton of armor and try to base it only on your symptoms. But some doctors may be- Or don't listen to the bodybuilder in the gym. Yeah, yeah. Who blasts his thyroid hormones for-

Exactly, exactly. But yeah, no, definitely not screwed. You just got to get a good doctor that will optimize it for you. Like you. That'd be great. Come visit me. Cool. So are there any other medical conditions that just in your experience that you talk about in the book and that you think we should discuss? The only other one that, so there are a bunch of other very rare things. There's some genetic syndromes that you'd want to catch younger in life, some deficiencies in the brain and leptin deficiencies and stuff like that. The only other one that really people bring up a lot of times is menopause. So I don't know if you have

menopausal women, but it's a very common question. So there's some good and the bad the the the bad is that yeah you you you you there there's some weight gain associated um and i don't even know what the good is because menopause is can be really miserable miserable for some women some women go through it just fine they literally felt no issues i guess the other thing that i was going to say was that so they think that well then give me some hormones you know some good bioidentical yeah um let me let me let me stop and ask you what's the story of bioidentical hormones i know that i know i could define them for you but it's that there's an area that's just something that i have these things that are on a list where i'm like here's some

things i want to know more about when i have like i have this never ending to learn more list you know what i mean yeah so okay because the story, oh, these are totally fine for you and they don't have any of the negative effects associated with other hormones. Exactly. When I hear that, I'm just like, that just sounds too good to be true. I don't believe that. Yeah. It is too good. It sounds like marketing.

It is. It is a lot of that. And you could probably have a whole podcast you could get a round table of me and and probably some actually people that are you know doing the research on you know the the bioidentical versus the equine hormones but pretty much is the thought is that you actually give the hormones that are made in your body through you know whatever you know if you want the patch or the cream or whatever you do with the estrogen progesterone as opposed As opposed to what? As opposed to, so they basically do these equine, I always say horse

urine. I was going to say that, I'm talking about horses right now. And so they manufacture these hormones as opposed to and they're very similar in the receptors that they hit. Right. Just not exactly the same. It's not exactly the same. So, you know, especially with the big women's health initiative, the big one that everybody talks about is that, oh, we're killing people.

We didn't even know that when we were putting people on these hormones right at menopause for no reason. So it was a little bit controversial so now they're you got other groups the natural group saying well the bioidenticals wouldn't do that yeah but they're my mom my mom's on them and she has works with some doctor that's all into it and i don't know enough to have a i couldn't i couldn't debate the doctor i don't know enough about it but i've just tried to tell my mom like that sounds like marketing i know at least i know supplements i know bullshit when i hear that sounds like bullshit it is there are there are still risks however you know they do have slightly different bioavailabilities and

they may hit the receptors in different ways um it's just it's well she's been sold on the like they're they're great there's no reason to yeah. Yeah. I will say that if anybody is out there going through menopause or feeling miserable, it's very worth it to talk to a doctor. You can get on these hormones. You talk about the breast cancer risk and all these different risks of clots and type of thing. But if you're miserable with hot flashes and that type of thing, it's worth discussing it. Yeah. I mean it's a quality of life point. Yeah. So what I was going to say is do these hormones help you stop that weight gain at menopause?

Possibly, but it's not a slam dunk. So it's not something I would go seeking at menopause. If you have the symptoms, definitely. But if you don't, don't go asking for the hormones just to stop this possible weight gain. The same lifestyle stuff that you discuss is what you got to do. And unfortunately, it just becomes harder. And that's the bottom line. But if you have these symptoms, the hormones may help. May. That's what I briefly touch on in the book.

And there have been studies done to say whether, hey, do they? And it's a little bit mixed, but maybe worth it if you do have the symptoms, of course. So you had mentioned that as you get older, it just gets harder. That's also just a thing that is, um, is it true? Is it not true? It's something that everyone, everyone knows kind of thing. What are your, what are your thoughts on that? Yeah, absolutely. I mean, and, and is there, can it, can it be preempted by like, let's say, let's say we have people listening in their twenties and their thirties and their forties or whatever, like what can you do to not, to

give yourself the best chance where you don't have to deal with the, you know, deal with that when you get older? So the most important thing is to literally right now, not in a couple of years or whatever, right now, start doing the lifestyle things and build up a good base. And that, you know, that seems obvious, but it's absolutely true. You want to build up as much muscle. You want to be as lean as possible. You can bulk, I guess, if you want to do that type of thing to get the muscle. I mean, if you want to get it done efficiently, it's just...

Exactly. But it's starting right now and building as much muscle as possible because later on in life, it is possible to gain some muscle, but it's not going to be as easy as it is right at this moment at your age. So that's my biggest advice. But my dad was just here. He's 67 now. He came for Thanksgiving,

and he was lifting with me, and he had some vertigo issues, so he couldn't get down on the bench press recently so he couldn't lift but he was doing a lot of outside activity talked about it because he had a body you know like mine and my brother's when he was younger and he wants to get back into it a little bit more and said absolutely you can you know we look at the you see these bodybuilders there's some 70 some year old body-old bodybuilders, and they look fantastic. I've seen pictures, I feel, that look better than people in their 20s.

I absolutely, especially my patients, I'm just like, no, let's get you on a good program, let's get you on a good diet, and just let's blast it right now. Just don't worry about it. You can be the best you. I promise. It's not a reason to give up. Totally. And in terms of why it might get harder as you get older to lose fat, do you think that's mainly hormonal? I mean if you've lost muscle as you age, your BMR is a bit lower.

I mean – It's a little bit of a mix of everything with hormone, that and all that but also you know you're like you said your your metabolic rate starts declining a little bit each year a little bit by a little bit after you know if you don't preserve muscle that is and that's also what to your point you're saying like gain muscle now and keep keep it for the rest of your life but as much as possible and keep using it yeah that will keep you you know and keep thing is, a lot of people start eating just crap, you know, whatever,

there's stress, and life happens, that happens, but whatever you can do to stop doing whatever that is, in which, you know, I talk about in my book, you talk about in your books,

and get back on a good plan, and of course, make sure there's no medical issues, and no medicines that are preventing you from doing it. Just get it done now. Yep. That's all you have to do. I think it done now. Yep. Every after do. I think there's something to be said for,

I've written about it. I know that, um, yeah, there's not a ton of research out there on it. I found some stuff that I was able to read and found interesting just on this body weight set point. Yeah.

And I've, I've experienced it myself and I've, I've emailed and spoken with a lot of people who experienced that the longer you stay lean, the, the easier it is to stay lean essentially um from from a from an appetite standpoint you know uh i guess normalization of leptin and ghrelin and just you get you just get used to being lean yeah and and

even i don't have a great explanation and this might just be more to nutrition, uh, nutrient partitioning, uh, maybe why, but, but like I can like in, you know, Thanksgiving dinner and this is one meal fit. And so it's just one meal, but eat, I mean, until I can't move, I don't even know, 8,000 calories. I'm pretty lean. Like I have ab veins and shit. So I would see a difference and see no difference, none at all, where I'm like, how? I just ate 500 grams of fat in one meal.

And that's what's so cool. So the same thing, my brother, he's always been lean. He's been lifting since – we have YouTube videos of us lifting when he was like seven or eight or whatever. And I was like four or five. That's cool. And like so he's had abs forever. He's always been a little bit leaner than I was because I was a heavyweight wrestler.

I'm pretty lean now. He's exactly the same way. I think a little bit it has to do with maybe some epigenetic type of things. You got that plus you got obviously the nutrient partitioning, the leaner you are, you're better insulin sensitivity and all that type of stuff.

It pays to take care of yourself early and then you coast along as you age. I mean I think that's the real payoff and I've spoken about that a lot and written about that a lot. Just that – you put in all – it's like working for money. You put in all that hard work. You earn that money. You be smart with it and then you have the payoff now of being able to enjoy it and i think it's a very similar with your body you put in all that work you do it smart you do it right and the payoff is that i wouldn't say like oh we just get to cruise you know but but it is kind of like you get to

you get to be a little bit looser with your diet um if you miss a workout it's not you know not that big of a deal when you already have the muscle size that you want and you're just maintaining it, which is kind of where I'm at at this point personally. Yep. Absolutely. So that's the goal, I think. Absolutely. No, you nailed it right there. Cool. So any other weight loss? I mean, I'm trying to think if there's anything else that you've touched on all the big ones. Those are the big ones.

I thought of age because that's one that gets asked fairly frequently. And to that point, I'm sure you've worked with a lot of people in 40s, 50s, 60s. And I've worked with a lot of people, just emailed and heard from a lot of people that are able to do really well. And that's actually the first time that they ever even tried weightlifting was 50 years old. And, you know, went from like a normal looking 50 year old dude, visceral fat, you know, blah, blah, whatever to, you know, they have to put in work. Yeah. It takes a year or so, but you know, a year later they look better than they did in their twenties. Yeah, absolutely. It's not like they were obese in their twenties. They just look like a normal, you know, they look, they would have been happy to have that

body at 55 at 20. Yep. Yep. It's amazing. I love it. Yeah. Yeah. It's super cool.

So yeah, nothing, nothing. I mean, you know, I touched on some other things in the book, but yeah, it's, it kind of puts it all together. And, you know, I figured, you know, your readers or your listeners and readers would probably have a, just for anything, a good resource in case they get put on some medicines or throw on medicines or any possible other things that could be stopping them from getting to their goals. I wanted to kind of condense it into one little book there. Yeah, that's great. And I'll definitely add a link. Once it goes live, I'll add a link, you know, on the post for the podcast.

And so it's going to be – it's the Fat Loss Prescription, Dr. Spencer Nadalsky. And it will be out soon. You said like December. I know how that is. I'm working on doing an update on one of my cookbooks. And, you know, you always say you tell people like – I know. And I keep on – now I'm getting more and more cynical with my own judgment.

You know what I mean? Like whatever, whatever I think is going to be, if I, if I'm thinking four weeks is my initial thought, I say 12. Yeah. That's,

that's probably a good idea. Cause I think I wanted this book out in, in, in the fall, you know, like back in, uh, back in September,

I think. I mean, same. I wanted this cookbook out now. And now it's like, uh, if I get it out in January, I'll be happy. I think we can do that. But that's, you know.

That's life. But once it's done, it's done. Exactly. Everything takes more time and more money than you ever. And that's just the way it is. But yeah, so definitely check it out. Again, if you're listening to this after, you know, December, January-ish, then you'll just see it in the post. But I look forward to reading it myself.

You can send – if you want, you can send me a PDF. I'd love to check it out. Oh, yeah. Absolutely. Before we get off, how can people find you and your work? Like obviously they can go on Amazon to find your book or whatever. Right, right, right. So my personal blog is www.drspencer.com.

I also have a blog with my brother. We promote other doctors who lift. So it's docswholift.com. D-O-C-S-H-W-H-O-L-I-F-T.com. You got a list. Docs who lift. Docs who lift. And then I got my Twitter

and also Facebook. come find me okay great well um thanks again for taking the time spencer it's always a pleasure to talk to you it's nice to you know you know what you're talking about and i and you are living this every day and you're dealing with things that again like that i i hear from it's on the fringes in my world you know what i mean yeah so so it's great to be able to just say, Hey, this guy knows what he's talking about. This is the,

here's your answer. So now I can link them to this podcast forevermore when I get these questions. Awesome, man. I really appreciate you having me on. Hey, it's Mike again.

Hope you liked the podcast. If you did go ahead and subscribe. I put out new episodes every week or two where I talk about all kinds of things related to health and fitness and general wellness. Also head over to my website at www.muscleforlife.com, where you'll find not only past episodes of the podcast, but you'll also find a bunch of different articles that I've written. I release a new one almost every day, actually. I release kind of like four to six new articles a week. And you can also find my books and everything else that I'm involved in over at muscleforlife.com.

All right. Thanks again. Bye.