Muscle for Life with Mike Matthews - Dr. Spencer Nadolsky on How to Beat PCOS

Episode Date: February 8, 2021

What’s a 4-letter word that you never want to hear your doctor say to you? Ok it’s actually not a word, but an acronym, and I’m referring to PCOS. Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects millions of women. In fact, chances are good that you know someone affected by it, which probably explains why I’m often asked about it via email, Twitter, and Instagram. PCOS has various effects in the body, especially in regards to fertility, but one of the biggest concerns in the fitness space is how it affects weight loss. Specifically, many people believe PCOS is caused by being overweight, and that once you have PCOS, losing weight is nigh impossible. How true is this though? Are you really doomed if you get PCOS and can it truly prevent weight loss? Perhaps more importantly, how can you avoid getting it in the first place? To help shed some light on the truth, I invited Dr. Spencer Nadolsky back on the podcast. In case you’re not familiar with Dr. Nadolsky, he’s a Board Certified Family Medicine Physician, author of “The Fat Loss Prescription,” and a Diplomate of the American Board of Obesity Medicine. He’s also part of Legion Athletics’ Scientific Advisory Board and truly knows his stuff when it comes to hormones, fat loss, and yes, memes (which you can find all over his instagram). In this interview, Dr. Nadolsky discusses … What PCOS is and its symptoms The causes of PCOS and how it might cause or be associated with differences in metabolism, appetite, and mental health The effects of PCOS on hormones and how that relates to fat gain and loss The “secret” to weight loss with PCOS and his dietary tips And more … So, if you want to learn about dealing with and overcoming PCOS, listen to this episode! 10:02 - What is PCOS? 16:56 - What is PCOS’s relation to weight loss? 37:18 - Would you recommend trying natural remedies before going to medicine? 39:11 - What are some dietary advice that you would give to people with PCOS? 42:15 - Any supplements you would recommend? Mentioned on The Show: Dr. Spencer Nadolsky's Instagram: https://www.instagram.com/drnadolsky/ PCOS Templates: https://www.RPstrength.com RP Strength YouTube: https://www.youtube.com/channel/UCfQgsKhHjSyRLOp9mnffqVg?pbjreload=102 Books by Mike Matthews: https://legionathletics.com/products/books/ Want free workout and meal plans? Download my science-based diet and training templates for men and women: https://legionathletics.com/text-sign-up/

Hey, Mike Matthews here, and welcome to another episode of Muscle for Life. Thank you for joining me today. And if you are a woman, what is a four-letter word that you never want to hear your doctor say to you? Okay, it's not a word. It's an acronym. And I'm referring to PCOS, polycystic ovary syndrome. And this is a hormonal disorder that affects millions of women. In fact, chances are good that you know someone who is affected by it. Hopefully you are not affected by it. And its prevalence explains why I have been asked about it so many times over the years and continue to get asked about it. Every week I get at least one or two people, one or two women asking about it. And PCOS, it has various effects in the body, especially in regards to fertility. But one of the biggest concerns in the body composition space in the

fitness game is how it affects weight loss. Specifically, many women believe that PCOS is caused by being overweight and that once you have it, it makes it very hard, if not impossible. Some people believe in some quote unquote experts believe it makes it impossible to get back to a normal weight or a fit weight or a fit body composition. Now, fortunately, that is not true. You are not doomed if you have PCOS. And while it can complicate things a bit, it can't truly prevent weight loss. And so that means that you can work toward getting into better shape and losing unwanted fat and keeping it off with PCOS. There are also things you can do to directly address PCOS.

There are things you can do to make sure you don't get it in the first place if you don't have it right now. And to break everything down, I invited Dr. Spencer Nadolski back onto the show to talk to us about this. And in case you're not familiar with him, he is a board certified family medicine physician. He is the author of the fat loss prescription. And he is also a member of my sports nutrition company, Legion's scientific advisory board. And he is also a member of my sports nutrition company, Legion's Scientific Advisory Board. And he knows his stuff when it comes to hormones, fat loss, and memes as well, if you follow him on Instagram. And in this interview, Dr. Nadolski discusses what PCOS is and what its symptoms are. And he talks about weight loss, of course, with PCOS. And he talks about hormones that have to do with this.

And of course, talks about how to successfully lose weight with PCOS and how to get healthier and happier despite this condition. Also, if you like what I'm doing here on the podcast and elsewhere, definitely check out my health and fitness books, including the number one bestselling weightlifting books for men and women in the world, Bigger Leaner Stronger and Thinner Leaner Stronger, as well as the leading flexible dieting cookbook, The Shredded Chef. Now, these books have sold well over 1 million copies and have helped thousands of people build

their best body ever. And you can find them on all major online retailers like Audible, Amazon, iTunes, Kobo, and Google Play, as well as in select Barnes & Noble stores. And I should also mention that you can get any of the audiobooks 100% free when you sign up for an Audible account. And this is a great way to make those pockets of downtime, like commuting, meal prepping and cleaning more interesting, entertaining, and productive. And so if you want to take Audible up on this offer, and if you want to get one of my audio books for free, just go to www.buylegion.com slash audible and sign up for your account. So again, if you appreciate my work and if you want to see more of it, and if you want to learn time-proven and evidence-based strategies for losing fat,

building muscle and getting healthy and strategies that work for anyone and everyone, regardless of age or circumstances, please do consider picking up one of my best-selling books, Bigger Leaner Stronger for Men, Thinner, Leaner, Stronger for Women, and The Shredded Chef for my favorite fitness-friendly recipes. Dr. Spencer Nadolski's back to share memes. Let's just meme the entire podcast. Can we do that?

You want to just make memes? Let's just do a podcast about how to make the effective meme. I do make jokes with my buddies about, you know, the key to a good meme. And we'd laugh every time because I'm just, someone will try to make effective meme. I do make jokes with my buddies about, you know, the key to a good meme. And we'd laugh every time because I'm just someone will try to make a meme. I'm like, explain why this one's not good. I know which ones of mine will do pretty well and which ones won't. And I still do want I still post some that don't do well. And I know they won't do well. But

I have to post it to show the to meet a part of the audience that I want to reach. But generally, I know it won't do well. And sure enough, it doesn't. Sometimes I have some surprises. So what's the one weird trick? So the biggest thing is, if you're polarizing and make a joke about it, that will go gangbusters. So that's why you'll see liberal meme pages or right wing meme pages and if they just dig into the other side it will rile up their side and then piss off the other side and it just yeah stirring up emotions right i've seen research on that on virality that if you can get people to become angry or if you can get them to laugh or there were like a few emotions that were

highly correlated with sharing right with virality and there were like a few emotions that were highly correlated with sharing, right? With virality. And there were one or two other factors. I don't remember. Yeah. So like, you know, for my group, I know that when I make fun of, let's say, multi-level marketing, like Herbalife, let's say, when I make fun of them and I dig in, like I have a good meme that's politically kind of oriented that I want to share, but I don't think I should because I might get too much blowback, but I think he'll do really well. But whenever I dig into them. Oh, come on. What's the worst that can happen? You lose some followers. You're not going to get canceled. They don't have any. You have to really work to get canceled. Come on.

I've just seen so many instances of the mobs trying to cancel people, but because the people just didn't care and they just kept going, it failed. It just didn't work. Yeah. That's actually really key in that regard, by the way. But yeah, you know, so if you really rally your troops while pissing off another group that will kind of come in, especially if you like tag them with like a hashtag and they'll start popping up in their feed and then they'll come in and they don't follow you and they'll just start trying to like antagonize. And then your followers will go in and just tear them apart it's really interesting that usually does well something like you know it's very machiavellian memeing the machiavellian way machiavellian memes.com when you're too vanilla it does nothing i could give you my like like okay

so if i give like a tips thing and it's pretty straightforward, sometimes it does well. But if I don't present it in an almost like, not an extreme way, but in a way that's just like, this is it. If I don't do that, it's just kind of like, yeah, yeah, of course. Yeah, we got to eat fewer calories or whatever. But if I mock carbs or something like carbs are the cause of obesity. And if I mock that while then shining back to that, it's, you know, energy balance. That's what gets people going

because it loves throwing shade at the low carbers who believe it's insulin or whatever like that. That's the key. It's similar to the key of humor writing in general is actually subtext. It's what you are not saying. That's what really gets people, right? Exactly.

And if you can make it almost like time sensitive. So like if, you know, for example, one of my better ones recently was, you know, people hate artificial sweeteners, they hate vaccines, they hate politics. And, you know, in COVID, the whole thing is polarizing. So I was like, I know everybody hates this. So here's a picture of Donald Trump drinking a diet Coke while talking about the COVID vaccine. And people lost their minds. It was just, and it wasn't, of course he wasn't, but he had a Diet Coke in front of him. I don't even know if it was his, it looked like it was his. He wasn't talking about the COVID.

So like, because everybody hates artificial sweeteners or not everybody, but a lot of people are polarized on the topic. That was just trolling. That was me just trolling and just laughing about it. But yeah, I remember seeing that one, by the way, any listeners who are actually just confused at this point why we were talking about this is go over and check out spencer's instagram page and you will understand there are a lot of memes they can just search for spencer nadolski or probably just nadolski and it'll come up right or if you want yeah yeah yeah and that's what you specialize in memology that's that's probably my biggest specialty i mean really i went to school for lipids, obesity, lifestyle, all this other stuff. Memeology is-

Boring. Boring, lame. Nobody cares about that stuff. You've probably seen the movie Idiocracy, right? Yeah. I love that movie. Yeah. Dr. Alexis.

This is going to be like in the future. This is going to be how medicine is practiced, just through memes. It's so good. Anybody listening who has not seen Idiocracy, you have to see it because it is a foretaste of what is to come. I guess that's kind of redundant because that's literally the definition of a foretaste. But yes, it's a foretaste of our future. It never came out in theaters, strangely. It was slated for theaters and then it was just straight to the movies. A lot of people didn't even know about it, but it's a Mike Judge movie.

So Mike Judge did Beavis and Butthead. He did, I think that, what is that Hank show? I never- Oh, King of the Hill? King of the Hill. Yeah, yeah, yeah. He did that. And what else? He did a couple other things. Anyway, clever guy, funny guy, funny movie. But let's make a hard turn here to the main topic of this interview. And that is PCOS, which is something that I have written a little bit about a long time ago and then haven't really touched on it since. And it is something I do get asked about via emails and DMs fairly often. I know you get asked about it more often than I do. So I thought this would make for a good discussion for women who are dealing with it or maybe who

aren't dealing with it and want to not deal with it or just at least want to understand what it is. And for men who want to understand what it is, or maybe they have a woman in their life who's dealing with it. So here we are. Yeah. Odds are is that you or someone you know has PCOS, it's becoming much more prevalent for multiple reasons. And yeah, let's let's start with what actually is the acronym? What is PCOS? What are you using these acronyms? PCOS, polycystic ovarian syndrome.

And actually, a lot of people are trying to, a lot of these groups, not me, I'm not in one of these big research PCOS groups, but these endocrine groups and world leaders in research here are looking to actually, they want to change the name, but the activists are saying, no, we already have a lot of movement behind this name, so let's keep it the same. It's simply because the PCOS doesn't actually fully explain what's going on at a physiologic or I should say

pathophysiologic level. So polycystic ovarian syndrome, you think, okay, you got a bunch of cysts on your ovaries and you have some issues because of that. And that doesn't really portray the real going on. There's a big miscommunication between your hypothalamus and your pituitary and then your ovaries. So usually you have this communication with your hypothalamus, your pituitary and your ovaries. Each month you have these ongoing signals, LH, luteinizing hormone, FSH, follicle simulating hormone and estrogen and progesterone and how those are in kind of a symphony, have you make periods and can ovulate and all these different things and be fertile, right? So that's the gist of it.

But with polycystic ovarian syndrome, there is a disruption there. And some people want to rename it to what's called metabolic reproductive syndrome. I think that's a better name. But you know, I'm talking my brother's endocrinologist, we talked about this all the time. And in fact, you know, I did this big presentation on it, because really, the whole reason we're doing this talk is to talk about why the mechanisms of PCOS and why some people with PCOS seem to struggle with weight loss. That's when you go on Instagram, you go on the internet, what you'll see is that I can't lose weight because I have PCOS. And we're going to go over kind of the truths and non-truths of that whole thing. But that's usually what you'll see on the internet.

A meme-worthy statement, I'm sure that you... I've made some memes about it. I've definitely made some memes. And I got to be very sensitive because it is, it's a very frustrating. We'll get into it. It's like, you know, people just, there's a stigma behind like obesity and PCOS. They're like, oh, if you have PCOS, it's because you ate too much and now you're fat. And that's why you have PCOS. And that's actually not true. There's a lot of people without obesity at all who have PCOS. Really, the things that define it, the criteria for having it, there's multiple working groups that got together and trying to find a good definition.

But there's something called the Rotterdam criteria. And what they go is, of these three things, you have to have irregular periods, which is a technical term, oligomenorrheahea and ovulation. You're not ovulating. That's one of them. Higher levels of androgens like male hormones, hyperandrogenism, like testosterone. And then the other one is multiple cysts on your ovaries. And you don't actually need that part for the diagnosis. All you need are two of these. So some people do an ultrasound and they don't have cysts and they're actually not necessarily cysts. They can be the follicles that are just being formed throughout your menstrual cycle. If you have irregular periods and you're like, what's going on? It seems like a little bit of facial

hair, more acne. You go to the doctor and they go, you might have PCOS and that you don't even have to do an ultrasound or you could do the ultrasound. And there may not be necessarily these follicles or cysts, but that's just the criteria. Hence the debate over the term itself, because that's kind of weird to be diagnosed with polycystic with no cysts. Exactly. And the other thing is like, it's really hard to understand what I'd call the pathophysiology. What's going on here? Like, I pulled a little quote out. I've pulled out multiple reviews of the leading researchers that look into what causes, you know, PCOS or what people want to call metabolic reproductive syndrome. And the quote is the pathophysiological mechanisms of PCOS are complex and not fully understood. And I

shit you not, that same sentence in some form or fashion is in every single review. It's really hard to describe because there's an environmental thing, there's a genetic thing, there's multiple tissue sensitivities to different insulin and different androgen sensitivities that just change the communication between basically your brain and your ovaries that's going on. We're more and more but the other thing is that makes it weird is that again not everybody with pcos presents the same they think that they want to actually come up with the different phenotypes there's people that are very lean that just have irregular periods and higher androgens and maybe that's why you see some athletes that do well because they have higher androgen levels

because they have pcos but levels because they have PCOS, but they're not having periods. And that's obviously an issue in itself. And then you see others who have high insulin resistance and have obesity that have this. And those are generally the people who come to see me because they want to lose weight. So about 50% of people with PCOS have obesity. And that means that there are many cases where this condition was developed through poor lifestyle and can be improved, right? Like in the case of the woman who has high testosterone levels, naturally, I'm sure there's still something she can do, but that's just a different situation, right? Then somebody who maybe at one point was

fine and then they got too overweight and now, of course, insulin resistance is associated with that. Now they have these other symptoms that lead to this diagnosis. So what they can't do is prove causation. There's just a strong association. What we know is that improving your lifestyle and if you have obesity and PCOS, it does ameliorate or decrease these symptoms and can improve your cycle. And you can't cure it with weight loss, but you can certainly improve your symptoms and improve, like people will get pregnant all of a sudden when they couldn't, they're not total. You have them lose weight. They still likely have the underlying PCOS, but the symptoms are at bay. So like, we can't say that obesity caused the PCOS. There's probably an underlying propensity to it.

The obesity exacerbated or worsened those symptoms. That's why it's so confusing because it's like, well, you know, type two diabetes. Yeah, you can have a propensity to it. But like, if you lose a substantial amount of weight, you can put the diabetes into remission. Some people call it reversal. I wouldn't, I would say remission. I don't think I would ever say PCOS is ever in remission. I would say it's probably still there, the underlying factors, but it's not so aggressive to enough to cause you to not ovulate. That's what I would say. It would be interesting to have a discussion with a few of these leading researchers.

But to me, you can't resolve or reverse PCOS. You can mitigate or minimize the symptoms from it. That's what I would say. And as far as its relation to weight loss, probably should just talk about that quickly because yeah, that is a lot of women. I've heard that many times that they've been told that that is the reason they cannot lose weight. And until they fix it, they're always going to be overweight. And then like you said, oh, but fixing it is hit and miss. And they're now kind of just lost trying all kinds of things, low carb diets and supplements.

And the reason I'm so vocal about this and I've done some presentations on it is because when people get labeled with something and that label was told to them to have an effect on their ability to lose weight successfully, that turns into, it's almost like a nocebo effect. There may indeed be, and I will go over some of these mechanisms that may impede weight loss, but- It becomes like a self-fulfilling prophecy that is fundamentally not true. When you tell somebody they have PCOS and they're not going to be able to lose weight very well, that's it. You're done. You just put a fork in them. They're done because now they've latched onto that. It's the same thing with like, okay, you're having some back pain and someone does an MRI and you have some issues with your discs that may not have

anything to do with the actual pain you're feeling. When you tell them, oh, you got an O5S, whatever. That's one. That's probably what's causing your pain. Boom. You might have just done a lot of harm to that person. I think we need to be careful. The other thing I want to say is that I've had many patients who were told they have PCOS who were misdiagnosed. They were missing their periods due to some other reason, and they just told them they had PCOS. There are actually some really serious underlying conditions that look like PCOS. They're androgen secreting tumors. There's something called Cushing's syndrome or Cushing's and one called Cushing's disease are kind of similar, but those should probably be ruled out or at least screened for what most people feel

before just diagnosing someone with PCOS. I do want to mention that because if you just say someone has PCOS and you don't find those other things, you're going to do great harm. I've also seen women who want to stay very lean and they're spending a lot of time in a calorie deficit and exercising a lot and irregular periods, or they haven't had their period in a while. And then coming to the conclusion that it's PCOS. Yep. And that's dangerous. So why would it be like, so the

most common thing I did, I ran a poll. I mean, I get these comments on, you know, when I talk about calorie deficit, people will say, but I have hypothyroidism, which we talked about last time. That's not a reason not to lose weight unless you're not treated. And that means you just need to get treated, then you're fine. So when I asked, a lot of people say they have PCOS, they struggle to lose weight. And then I did a poll. Why do you feel PCOS is slowing down your weight loss? And I listed a few of the most common reasons that I've seen. They usually just say it's my hormones. What does that mean? That's a nebulous thing. Cause like, what does that actually mean? You know what I mean? It's just just your hormones you kind of give it up to some leave it up to some kind of nebulous term there is it a slower metabolism some people feel they have a slower metabolism we're going to go into

that in a second what about like just appetite that's absolutely reasonable especially for those who have like insulin resistance and kind of this what we call like an inflammatory milieu in their body because of the pcos and because of the androgens and the insulin resistance and kind of this, what we'd call like an inflammatory milieu in their body because of the PCOS and because of the androgens and the insulin resistance that could potentially decrease the communication between your brain, not just from ovulating, but also for appetite regulation, which is what I talk about a lot. And then there's other things that just people don't like talking about, but we're going to get into it is binge eating disorder and depression, talking about, but we're going to get into it is binge eating disorder and depression, which obviously, you know, that's just eating more, but it does need to be talked about because that can be treated as well. And that one can be insidious, right? Because I know you've seen this

many times. I've seen it many times over the years when somebody will come to me and they'll say just kind of vaguely how well they eat and they'll maybe even throw a calorie number out there in terms of daily calories. And then when we get into the details, it turns out that, yeah, maybe they do eat 1300 calories some days of the week, but then there are the sporadic or even semi-regular binges or something that is, let's just say bouts of extreme overeating where obviously if somebody, let's say they're trying to lose weight and let's just say bouts of extreme overeating where obviously if somebody, let's say they're trying to lose weight and let's just say 1300 is a reasonable deficit. This would be a smaller woman, obviously. And then go and eat three to 4,000 calories a couple of times per week.

And then they just don't quite understand energy balance through the lens of the bigger picture of like, okay, let's look at it now in terms of your weekly calories in and calories out. Exactly. So that's actually something, I mean, we could do a whole talk on that sometime, but I can't count the number of patients who, you know, I've been practicing since 2011 and I still have patients that started with me just as a lowly little intern that are still with me. And after a little bit, they're like, you know, I'm eating 1200 calories, but I'm not losing weight. I'm like, well, that's not possible because you're 250 pounds. And I don't say it like that. That's a much better pet side matter. And we can go over,

well, you know, this and that, but it's literally not possible. If you're listening to this podcast, you know, you're not 250 pounds and not losing weight on 1200 calories, literally impossible, unless you are overtly hypothyroid and you have bigger problems because you're about to go into heart failure from being so hypothyroid. Yeah. I was going to say that'd be an extreme case too. It just doesn't happen. So I've had so many of these patients develop a very good rapport, but even still, they won't mention that you screen as much as you can for binge eating. I have these questionnaires and you go over it and they'll be adamant, 1200 calories. I'm not losing weight. I must be broken. One to two years later,

they'll come back because I just leave them alone. I don't want to push them. And they'll say, I want to talk about these episodes I'm having where I think I'm binge eating. And sure enough, they have binge eating disorder. And again, that's a whole nother discussion. We go into the treatment of that, but it's actually very prevalent in PCOS. And that doesn't make you a failure or a bad person. It just needs to be discussed instead of thinking you're broken. You're not broken. It's more prevalent. Mental health issues are higher in PCOS, like depression. It should be addressed. There's so much stigma behind mental health and everything. It's just people think, oh, you lack willpower. There's a ton of stigma

behind mental health, unfortunately. And I wish we could talk about it more. It's just, it's okay if you're binge eating. Let's just talk about how to treat it. But when you look at the literature, there's a higher proportion of women with PCOS that tend to have binge eating. So that would explain part of it. If you're sitting there going like, no, absolutely not.

But when I actually posted this and I was very gentle and discussing it on instagram not like a one of my polarizing memes or something like that it was more like it wasn't a picture of uh trump yeah it wasn't a picture of trump at mcdonald's holding up a sign saying pcos is fake yeah right it wasn't like it was just like hey let's talk about this actually it was really nice there were a lot of women that came out and said, you know what? I suffer from this. And it's like, good, let's have a discussion. The thing is, a lot of fitness pros are jerks about it. It's like, you're just eating too much. And it's like, when you start pointing the finger like that, people shell up and they get a lot of resistance. So the better way is to just kind of be open about it and talk and just say like, look,

it's okay. We all have our issues. We all have our mental stuff and we should treat it as such and just be nice about it. Just don't get jerked. So there are a lot of women that opened up and said that. Now there's other people that are like, no, I don't have that. I promise. But when you start discussing, like we can talk about hunger. So when you look at the appetite differences, there seems to be a hunger and satiety difference that might be impaired with those with PCOS. So yes, and this may play a part in the binge eating thing, by the way, but if nobody's getting fed in a lab, let's say a metabolic lab, which is nobody, unless you're participating in a study, in which case you're like a 0% of the population. Unless you're getting fed in a metabolic kitchen lab and you have a little bit more appetite and hunger

versus someone else. If you just put that person in a similar environment, they're going to eat more. That's just the way it works. Your scoop is going to be a little bit bigger. You're going to go for more servings and almost in a subconscious way. So like, even if you think you're counting, unless you're really like in a metabolic kitchen where somebody else is feeding you, because I don't even trust,

you know, you tracking your own calorie. That doesn't, it's easy to miss things like grabbing chips and stuff like that. Even if you're measuring foods, but you can mismeasure or you can record, you can just simply make a mistake, put the wrong number down. Again, that's another thing with being, you know, just not a jerk. It's like, they're not intentionally lying. It's a lot of it's just subconscious. You know, a lot of it too, is you just don't, you feel bad about it. You don't want to seem like you're not able to adhere. You know, I did a bodybuilding competition once, you know, sending my calories to the coach. And I think I got down to 2,200 calories. That was the lowest, by the way, for me, sending my calories to the coach. And I think I got down to 2200

calories. That was the lowest, by the way, for me, I'm like 215 pounds. So I was eating like an extra carton of strawberries, and not tracking those. And that's what a couple 100 calories, but it adds up. And then that and maybe a few chips in here and there or something I remember going, yeah, I wasn't being truthful. So if I'm doing that, then I can totally understand why someone who just wants to lose 30 pounds of their obesity would not want to tell the truth. So appetite, it's an issue. Insulin resistance causing appetite issues. It's an issue. Yes, it's an energy balance thing. It always comes down to energy balance, but that should be accounted for in PCOS. And that would be a good explanation of at least part of it. The thing that most people

thought was other than hormones, we'll get into hormones in a second. People mentioned a slower metabolism, which it's been studied. So originally they started studying this and it looked like, okay, wait a second, especially those with insulin resistance have a decreased basal metabolic rate. And they looked at just metabolic heart tests. Then it was interesting, they did doubly labeled water. That doesn't look at your basal metabolic, it looks at your total energy expenditure. And it looks like that there wasn't a decrease in energy expenditure. So I think this thing, to me, what I would want to do, there's actually not a good amount of research here. What I would say is I would love to do metabolic ward studies

with those with PCOS who feel that they're diet resistant. And then I'd like to compare it to other people with PCOS. And I'd like to see, like, let's just do it. You have to get a metabolic. These are very expensive studies. I'd like to see, like, let's just do it. You have to get a metabolic. These are very expensive studies. I'd like to, I'd like to test the, these hypotheses and it's still going to come down to energy balance, but I have a feeling, you know, there may be some of these other things present. We could get closer to the truth. What I think is that there may be a difference in basal metabolic rate with those with high insulin resistance with PCOS. It's just

these studies are kind of mixed and it looks like it might be something, but I don't know for sure. If anything, if you're hungrier and you have a slightly lower basal metabolic rate, that would explain a good amount of it. I'm doing here on the podcast and elsewhere, definitely check out my health and fitness books, including the number one bestselling weightlifting books for men and women in the world, Bigger Leaner Stronger and Thinner Leaner Stronger, as well as the leading flexible dieting cookbook, The Shredded Chef. And you're thinking an actual reduction, you're using basal metabolic rate deliberately. So not that they just move around a little bit less, that their metabolism is a bit slower than what would be predicted.

Yeah, what would be expected. That's what some of these studies said, especially with those with insulin resistance. But then when they did the doubly labeled water, which looked at total energy expenditure, total daily energy expenditure, it looked like there wasn't a difference. But I think this needs to be studied a little bit more. I mean, and then what are you going to do about it? Well, obviously we get people to exercise more and whatnot, or we somehow resolve some of that insulin resistance, which may have an effect. I don't know. It just hasn't been studied. You look at these studies, it's like, man, just really people haven't gone further in this because PCOS is relatively prevalent. And I think that

it's a public health issue. We should understand this a little bit more. Maybe it's a lack of funding, probably a little bit of all of it. But now the number one reason why people thought people with PCOS at least thought that weight loss is tougher is the hormones, right? That's what they say. It's just the hormones. So like, what does that actually mean? Well, when people would have higher androgen levels women specifically not men because men if you have more higher androgen levels you generally have more muscle less fat but in women with higher androgen levels you get more changes in tissue specific like insulin sensitivity and this may change where the fat is stored and may

change where the fat is broken down. So this wouldn't be like a total energy, wouldn't be an energy balance difference. It would be more like where you store and gain fat. And so if you are storing more viscerally and less subcutaneously, you won't have a total amount of body weight difference and necessarily a total amount of fat difference, but you may have propensity for that central obesity. And that would take a toll, obviously, on somebody's metabolic health, you know, just biomarkers wise, but also, you know, how you look. And that may give you a body image issue as opposed to like you have some extra fat on your legs. Who cares?

Well, some women care of course people care but usually people care more about the abdomen you know so this may play a role but again hormones just androgen levels shouldn't change like the total energy balance but it can change where you store and that can change yeah how you perceive what's happening that's pretty much it when you combine all those things together there is probably something to it it's just it's really hard i hope they if i had a billion dollars i would love to create my own metabolic ward and i'd like i would do this like metabolic institute and i would do all sorts of dexas and metabolic ward testing and

ct scanning and all mris and all sorts of crazy stuff but sacrifices to moloch you know join the illuminati yeah maybe get invited to the bohemian grove i would love to yeah that would be amazing if i could do all that yeah that would be pretty cool but so what i would say people listening going well i have pcos and i struggle like think about do you feel guilty after you eat a large amount of food you do that multiple times a week you know those types of things binge eating behavior you know there are treatments for that you know we have some medicines and we have cognitive behavioral therapy then do you know there may be a change of where you're storing fat i mean i see it in my patients those with

insulin resistance and and pcos yeah they store store it more centrally. When they start gaining weight, it's more centrally as opposed to peripherally in their legs and hips. I've heard from many women over the years who notice a change as they get older, which makes sense. Similar with menopause. When you go through menopause, you store it more viscerally, abdominally. That's a whole thing. I've made memes about that, but some people get really upset. One of the memes I make is I have a lot of postmenopausal women and pre or peri, I should say. And when you're discussing with them, they're like, I can't lose weight. I think it's my

menopause. And I'm like, well, okay. So then when we really get into it, they drink a bottle of wine at night. So not everybody, of course, people are listening and going, I don't drink a bottle, but I have a lot of these patients. And so I gently have to discuss, OK, that's not going to be conducive to weight loss. But the real underlying issue is why are you drinking the bottle of wine? Do they have alcohol abuse disorder or is it too? It's Trump's fault. It's always Trump's fault. If you want to look down, if it gets down to it, the 2016 election, I had a lot of patients.

I had a lot of upset patients. I mean, like, you know, people were laughing about it on social media, but I had patients that were distraught for a while because of that. So, you know, the underlying issue, if you're drinking a lot of alcohol, yes, is it because you have an underlying alcohol issue or are you treating, self-treating some of the symptoms that occur through menopause? So like irritability and sleep issues. So that's actually another, that's a whole nother thing. You may not like the alcohol.

It just helps calm you down and help you sleep better. You don't know, it kind of disrupts sleep, but you don't know that. So then that's where we start treating those things, or maybe I get hormones, but that's a whole nother thing, not PCOS necessarily. So, so yeah, if you're listening to this, you have PCOS and you're like, okay, what is going on? So binge eating, hormones change where you store it, more rates of depression. Depression does not necessarily cause overeating, but there can be a vicious cycle there. Turning to food just to feel better. Yeah, absolutely. Metabolic rate may be different. Appetite and satiety and cravings may be different.

The thing is like, so then what do you what do you actually do about it do we have to just go keto is that the answer is that the answer to everything just keto literally everything that's how you achieve physical and mental and spiritual perfection that's the key that's how you transcend to the other dimensions in the multiverse so okay so here are the most common things you have to cut's how you transcend to the other dimensions in the multiverse. Okay. So here are the most common things. You have to cut out dairy.

You have to cut out gluten. You got to go keto. You got to do this. There's absolutely no data to support one of these things being the key. I think with those with insulin resistance, there may indeed be a benefit to lower carb. Maybe. But to this date, there's nothing that would actually support that being very truthful because a lot of times they compare, they don't do a good comparison group in these studies. What I'll say is that if you can lose fat, if it's not

too much for you, if you can get into an energy deficit, it doesn't matter what it is, as long as you're taking care of the hunger, whole unprocessprocessed foods things that are kind of common sense if you can lose weight you will likely get some sort of benefit in your symptoms and an energy deficit of some sort doesn't matter what macronutrient profile you're following will result in weight loss now again it's easier said than done i'm not going to say that you know just eat less move more but like we just got to find a way to get you there. And then, you know, if you struggle with binge eating and depression, there's treatments for that, cognitive behavioral therapy, medicines. And then the metabolic rate thing, it's hard to know indeed for that.

It's not going to amount to a lot if there is a difference. Yeah, I think that actually I had a little mental note that it's probably worth mentioning that, right? Because I immediately think of metabolic damage and starvation mode and all of that, which is essentially fake news. So it's probably worth mentioning that even in this case, if there is an actual reduction in BMR, and you can correct me if I'm wrong here, but I would assume that it's not going to be so significant that it's going to impede weight loss. You're not going to see a loss of like 300 calories per day, which would actually be

kind of difficult. Now, yeah, you still could lose weight, of course. If you eat 500 calories a day, now you will lose weight. But that's not a good way of knowing. Yeah, likely not, especially with the doubly labeled water data that shows a total daily energy expenditure wasn't different. Again, I think this stuff needs to be studied some more it's interesting because if it is the case then that would make a big clinical difference i just i don't think so that'd probably be wholly unique

too right there i don't know of any other common condition that can crater your bmr it's still energy balanced so oh for sure yeah it. Yeah. It just, that would, I mean, you can imagine if you're a woman and you only burn a couple thousand, say 1800, 2000 calories per day, and you have some condition, well, you would normally be burning that, but because of some condition, you're actually burning three, 400 calories less. Sure. You still could maintain an energy deficit, but it's going to be no fun. You're not going to feel very good. Yeah, exactly. That would be miserable. That's pretty much the deal. You can still lose weight. You know, we have medicines that are actually, they're studying some of these strong appetite

suppressants that I use for obesity, specifically in PCOS, and they do quite well. So that means that to me, that means that likely appetite is an issue. And I would assume though, you'd recommend that people try simple natural interventions for appetite before turning to medicine though no we should probably just put medicine in the water yeah i think like this is what i always say like if you could somehow it's easier said than done like if you have a like a propensity to for some reason just pushing yourself towards unprocessed foods because of stress and feeling like crap to me it's like yes it's a choice right it's a choice you can always eat i always say

whatever the apple instead of the chips or whatever it is and you can actually not even buy the chips if it's actually you know what i mean you could only buy the apples too i understand completely it's a choice but like you know when i'm stressed i understand like i don't want that freaking apple i want some kettle cooked potato chips salty greasy carby foods that i want to eat 400 calories of which you know an apple whatever it has 100 calories about in an apple that would fill me up more than the stupid chips but if we could get you to at least buy into that for whatever a month or two you don't have to be perfect and you're still having appetite issues, that's where we go. All right, you're basically not losing weight.

It's not happening. It's not in the cards. Then that's where you start thinking about a medicine and targeting that appetite issue in your brain. And that's where we do see a lot of success in that with patients with PCOS. There's been studies specifically on that. That's the bottom line. And so I think my message for those listening to this podcast is that if you have PCOS. There's been studies specifically on that. That's the bottom line. And so I think

my message for those listening to this podcast is that if you have PCOS, you are absolutely not broken in a sense of weight loss. I will say that it's unfortunate and it is tough to deal with. It can injure your life, especially if you want to get pregnant and it's just been a tough time going. I know that can be very stressful and emotional for families. Just know that you're not broken. It's still energy balance. You can still do it. There are medicines if needed to help you if need be too. And what about, do you have any dietary advice or you should at least comment on some of the dietary advice? You've commented on a little bit of it, but for example, I know some people promote fasting or intermittent fasting as a way to improve symptoms specifically to increase insulin

sensitivity. Eating whole grains, I know that is often recommended to help reducing intake of added sugars, staying away from artificial trans fats, know things like that yes we made these like pcos templates for rp and basically we focus on mostly whole foods so our big thing is like lean protein and some people say to stay away from dairy that's ridiculous so you can have greek yogurt you can have sirloin chicken shrimp fish tofu if you want to do tofu. So some sort of lean protein, good adequate amount of that, depending on your weight and stuff, you choose a certain amount of that per meal. And then we really get in the non-starchy vegetables, very few calories, but very filling due to the stretching of your stomach. And then healthy fats, which don't necessarily give you any stretching in your

stomach but do you have more of a biochemical physiologic release of hormones in your body that helps with that probably should highlight omega-3 is there right yeah so like i'm a big fan of i say dietary patterns so instead of just going into the specific nutrients but things like fish fish oil olive oil nuts seeds and like avocados. Those are like the big ones. Avocados would be great too, because they also have fiber in them and it's more of a whole food and nuts, whole food source of fat. And then the carbs that we usually recommend are more satiating filling. So I personally like lentils, legumes, and then more of the whole grains, not like white rice i love white

rice by the way don't get me wrong but oats would be a good option there as well whole grain oats the quicker stuff probably not as good but whatever it's it's all good that's my go-to yeah if you're following that and like look the quantity does matter of course but if you're following just that type of diet and you like you, I swear I'm eating mostly this stuff and I'm still having an issue, then that's where it may really get more physiologic. But when people follow that, I don't see as much of an appetite issue. It's really hard to overeat a pound of broccoli, right? It's hard. It's just not as palatable. It's just not as tasty and it's just not as good. Yeah. By this point in the flow chart, many cases would have been resolved. Yeah.

At least practically speaking, like you said, it may just be in remission, so to speak, or the symptoms now are so slight that they're insignificant in the scheme of things. Like, oh, cool. Now she's pregnant. Great. And she may still have a little bit of whatever is underlying it. But at that point, with all these good habits in place, it's like, yeah, well, whatever. None of our bodies are

perfect. And that's life. Yeah, exactly. That's what I would say. And if you can, obviously, again, it's all easier said than done, but that's kind of the hierarchy there. Any supplements like vitamin D, for example? I know there's research that indicates that vitamin D insufficiency or not getting enough vitamin D can aggravate symptoms. like vitamin d for example i know there's research that indicates that vitamin d insufficiency or not getting enough vitamin d can aggravate symptoms when it comes to vitamin d everybody should be replete at this point like yeah i know but it's worth saying just because right whatever ails you it seems to be that not being replete in vitamin d might have an effect i mean yeah it's true that people that are unhealthy

tend to have lower vitamin Ds. There's a lot of correlation. It's hard. We'd have to take people that are say insufficient or deficient in vitamin D with PCOS. And then we'd have to go randomize them to a placebo or vitamin D and then watch the outcomes. But ideally we could do a randomized crossover where you wash out and then you watch the other. But ideally, we could do a randomized crossover where you wash out and then you watch the other group and see the changes in markers and all this stuff and monitor their weight. It's really hard to do that kind of stuff. But at this point, yeah, vitamin D, trying to think of anything else. There are other supplements like berberine and inositol that may have some effect. People prescribe metformin. But a lot of these things

like you get together the good nutrients and exercise and diet, really hone in on that. You'll have great effects there. Yeah, makes sense. Berberine has other benefits that could be worth taking as you probably saw in the non-bacterial gut support supplement that we just released at Legion. It's called Balance and Curtis was very excited about finally getting his baby berberine into something. We had tried to put in other products, but those were powders. It tastes so bad. It's incredible. It took recharge, which for anybody who uses

recharge, I think it tastes pretty good. So let's say fruit punch recharge. You put some berberine in it and now it is vomit. That's it. it tastes like you just threw up in your mouth i was impressed yeah we had a supplement called glycosol for like 10 years finally did away with it because i'm sick of supplements but it uh is super powerful like more powerful than metformin for type 2 diabetes so berberine berberine something again these i wish i had a billion dollars we could do more of these tests you know it's just it's's underfunded because it may be that that looks like on biomarkers, there's a benefit, but what we'd really want to see is even longer outcomes to see safety and that type of stuff. But berberine seems to be like a drug.

I mean, it's basically a drug. I don't know. Yeah. And I'm excited to just take it every day because of the other benefits, you know, it may enhance the function of healthful gut bacteria. Of course, it improves blood glucose control of healthful gut bacteria. Of course, it improves blood glucose control, which can help stabilize energy levels and it reduces intestinal inflammation. And we've had some really good little success stories coming in,

positive reviews, especially from people, and this is not surprising, but people who were suffering from IBS or IBS-like symptoms and had tried many different things. And with this supplement balance have reported either a great reduction in symptoms or in some cases, a complete elimination of symptoms, which isn't to say that it's going to do that for anybody listening. You could try it. I'm not trying to oversell it, but it's cool to see because it has drug-like effects, but it's a perfectly safe, natural supplement you could take every day forever. Yeah, man. Powerful stuff. That's pretty much the gist of when it comes to PCOS and weight loss. I think as long as people understand that they're not broken, there may be some nudges to push them in the wrong way. I think everybody

should understand that and just not say, eat less, move more. I mean, that's really never helpful no matter what's going on, right? Unless you're just using it in a meme to grab someone's attention so you can actually explain that. Yes. In the end, it obviously, the subtext is correct in that the reason you're not losing weight is a lack of an energy deficit. But why is there a lack of an energy deficit? And that you've been

talking a lot about that. It's not as simple as, well, or at least the advice is, it might be correct, but it's not very practical. It's not useful for someone who understands. Maybe it's useful for someone who doesn't understand energy balance. They've never heard of the term. And then that gives them what they need to just kind of overhaul whatever they're doing in terms of energy in and energy out. But many people, at least who follow you and follow me, they know about energy balance and the reason they are not losing weight. Yes. Okay, fine. They would maybe even agree with you. I guess I am eating too much and not moving enough, but here's why I don't know how to resolve it.

Yeah, exactly. Yep. That's pretty much the gist of why we did't know how to resolve it. Yeah, exactly. Yep. That's pretty much the gist of why we did this podcast. So I like it. I like it. I don't know if there's any other questions about it, but. No, that's great. Those are the bullet points I had that I wanted to go over with you.

So we can just wrap up. Let's finish with where people can find you. You mentioned earlier, but for anybody who missed the preamble, where they can find you on Instagram and then anywhere else, RP Health, anything that you want people to know about? The Instagram's at drnadolski, D-R-N-A-D-O-L-S-K-Y. If you're interested in our PCOS templates, we're going to probably come out with even another edition. It's like more simplified. These are the first ones and they're geared mostly towards our more extreme, like they want to get ripped type of thing but we have pcos templates at

rpstrength.com or renaissance periodization.com and then you just put in your weight and then we'll spit you out some templates that you follow in a sequential manner depending on your weight loss the rp youtube i did a presentation on this if you want to see some of the snippets of this but you know if you listen to this you got the gist of it but that's But if you listen to this, you got the gist of it, but that's there if you want to see more of a PowerPoint presentation on it. Cool, man. Thanks again for taking some time to come edumacate us. And I look forward to the next one. We'll have to brainstorm. Thanks, man. Thanks for having me. All right. Well, that's it for this episode. I hope you enjoyed it and found it interesting

and helpful. And if you did, and you don't mind doing me a favor, please do leave a quick review on iTunes or wherever you're listening to me from in whichever app you're listening to me in because that not only convinces people that they should check out the show, it also increases search visibility and thus it helps more people

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And that's it. Thanks again for listening to this episode. And I hope to hear from you soon.