Philip Pape: 0:01

Do you feel surrounded by doctors who don't understand your fitness goals or who dismiss your lifting and nutrition approach? Imagine walking into your next doctor appointment and having an intelligent conversation about protein intake, lifting heavy and body composition goals, instead of just being told to eat less and exercise more. Today, we're sitting down with a doctor who lifts weights and wants to transform healthcare by combining medicine with real-world fitness experience. You'll learn how to find doctors who actually get it, what to do when they don't and, most importantly, how to take control of your health while working within the medical system. If you're frustrated with the typical medical advice or simply want to optimize your health beyond what typical healthcare offers, this episode will give you the blueprint to bridge the gap between your fitness goals and your medical care. Welcome to Wits and Weights, the podcast that blends evidence and engineering to help you build smart, efficient systems to achieve your dream physique.

Philip Pape: 1:01

I'm your host, philip Pape, and today I'm excited to have Dr Spencer Nadalsky on the show to reveal why healthcare desperately needs more doctors who themselves practice a fitness lifestyle. Now, dr Spencer isn't your typical physician. He's an obesity and lipid specialist who's competed as a heavyweight wrestler and football player before becoming a doctor. He's working hard to connect traditional medicine with accessible lifestyle changes and is a self-proclaimed meme specialist who calls out the charlatans on social media, whether they're doctors or not. He's also the co-host of the Docs who Lift podcast. Today, you'll learn why even well-meaning doctors often don't understand fitness and nutrition, how having physicians who lift weights could transform healthcare, and what it really takes to combine evidence-based medicine with practical training and nutrition. Plus, we might discuss some simple, uncontroversial topics like the root cause of obesity and the future of healthcare. Dr Spencer, welcome to the show.

Dr. Spencer Nadolsky: 1:58

Thanks for having me, buddy.

Philip Pape: 1:59

All right, man. So I've been following your stuff for a while and I definitely encourage folks to check you out, both on Instagram and on threads. Your feed is full of memes about what people say about doctors and what doctors say and things like GLP-1 and all the fun stuff Diet Coke, you name it and you've defended physicians who have good intentions, so we're definitely not here to bash doctors, which you are.

Philip Pape: 2:21

So let's start with the crazy stuff to set the stage. I'm curious what's a ridiculous but typical advice that you hear doctors give, related to, say, exercise or lifting weights?

Dr. Spencer Nadolsky: 2:31

Yeah, I mean, the most common thing that I see is when patients are lifting weights themselves and they go and they're kind of proud about it and the doctor will say, well, you shouldn't do that, that's not good for you, you need to go run instead. And it's like will say, well, you shouldn't do that, that's not good for you, you need to go run instead. And it's like you know to be really patient centric, you should applaud their efforts of whatever they're doing for lifestyle change and the doctor should know that lifting weights is good for them. Unfortunately, I'd say it's actually probably some of the older doctors that are probably on their way out. Kind of the newer line of thinking is like, hey, probably any physical activity at this point is good and lifting weights is is a very healthful thing to do, obviously, as you know. But it's it's so anti-patient and this is kind of what causes some of that distrust in the medical profession is when they kind of wag their finger and say, no, no, you should be doing this, and especially when it's completely wrong. So one of them is the whole like no cardio is better than weights and like, obviously I promote a combination of the two. But more importantly, what will the patient actually do? Go with that? If, like if, a patient told me like I don't want to lift weights at all, it's miserable, I just want to run and be physically active, I'd say, okay, great, you know, maybe you just haven't done some sort of weight lifting or resistance training that was at all enjoyable. And then we go from there. But sometimes they refuse and I wouldn't be like you shouldn't run, you should only lift weights. So when people do that, the opposite, the other thing that I see is, of course, really it's a lot related to nutrition. Some doctors have a plant-based bias, some doctors have a keto uh kind of bias, and so they'll kind of push patients in one way or the other.

Dr. Spencer Nadolsky: 4:19

You know, I I had a more low carb bias. Uh, a lot of my mentors were looking back, they were low carb zealots. When I was going through med school, I mean, like I was hanging out with some of the famous low carb doctors that I now kind of make fun of. It's really funny. I was a student at the time just learning, and now I'm like, okay, but you know, but then going through and actually taking care of patients, and I'd be like, okay, going through and actually taking care of patients and I'd be like, okay, you gotta kind of go low carb and be like, well, no, I actually lost 100 pounds doing this kind of high carb, uh, low fat, plant based type of diet.

Dr. Spencer Nadolsky: 4:52

I'd be like, all right, am I gonna tell this patient that that was stupid and wrong? No, I'm not gonna tell them that, but you'll see it all the time online. So patient will do, let's say, a carnivore diet. They'll feel good about themselves and they'll go in to the doctor and tell them about it and the doctor will wag the finger, hear this patient like I like making fun of keto and carnivore and stuff like that. But I'm not going to tell a patient that they're an idiot for having just probably changed their life around from following it. I'm going to make sure that some of the blood markers are okay because of it can alter some of those unfavorably, but it can improve a lot of markers in their health very favorably and it would be really anti-patient to kind of wag your finger at them.

Dr. Spencer Nadolsky: 5:38

So kind of that dietary dogma that some of these doctors bring in. It's just, it's really too bad. And also I don't even know if I blame the doctors as much as they blame the system. Basically, right now, what we're seeing and this is the threads is kind of hilarious. It's it's. You see it on x as well too.

Dr. Spencer Nadolsky: 5:56

But there's different crowds, uh, at each of these places. And if I say something like hey, seed oils probably aren't as bad as what people are saying, like you can take them or leave them, I don't really care, and what these people are, like you just big pharma shill, like you're clearly getting paid by the government to make a meme. I'm like, if the government's paying me to make memes on threads and what I like, then we got bigger problems because, like they shouldn't be paying me anything to be posting any of this stuff. But there's a lot of this kind of anti-doctor sentiment where I think a lot of it's just the system and I think hopefully in the future we see this taken back by the doctors to kind of overhaul the system. It's a long ways away. We can get into that a little bit, but I think a lot of it's a system.

Philip Pape: 6:44

Yeah, no, I mean everything you say I resonate so hard with. I'm in my forties and just in the time I've been seeing physicians and specialists over the last 20 years and then when I got into lifting like five years ago, I seen that kind of bifurcation between different generations. But but not only that cause, I've had doctors who are like in their 60s, who are super open to learning and being, you know, like you said, patient centric, which that's the root cause of a lot of it. People feel like they're being gaslit and all of that and whatever it is. And then the idea that adherence, sustainability, is probably the most important thing, because if you're just not doing it, going to do it, forget it doesn't matter what you're doing. But there's a big anti-doctor sentiment. What I like about what you call out is people, you know, fear monger over silly things and stuff.

Philip Pape: 7:26

They forget the fundamentals whether it's seed oils or diet soda, whatever, yeah Right.

Philip Pape: 7:31

And it gets a lot of views and likes. So I know you you like take advantage of that, which is fine you know, cause it gets the message out.

Dr. Spencer Nadolsky: 7:36

It's a lot of hate. A lot of hate too, although I guess the hate can bring engagement, which then brings the people that are that enjoy it too. The reason I say it is also is because it's it's like just a sarcastic, like, very like these people are idiots, but I'm going to say this sarcastically, and so that makes the, it makes other people laugh and then it pisses off the, the people that want to piss off. But those people get. They get really mad. I'm like this is just the internet, like you guys are like why are you so mad about this?

Philip Pape: 8:06

I know, and if they met you in person. You know that I always think, like if you met another person who posts something online in person, would you respond that way, because people hide behind this insanity.

Dr. Spencer Nadolsky: 8:17

It's bizarre behavior. I've not seen anything like it.

Philip Pape: 8:20

How does that make you feel like in terms of do you get stressed out or do you lose sleep over some of the negativity? I don't lose sleep.

Dr. Spencer Nadolsky: 8:27

There were. There was a time, probably 10 or so years ago, where once in a while I could lose sleep over it, because it was kind of newer back then and it would really make me mad. My skin's gotten a lot thicker and so, like I'm used to it. Some people it's just like, okay, this person's being very aggressive, I have to block them. Other people I'll restrict them. Other like a lot of some people come in and you can tell they're coming in good faith, like, and they'll even say like you know, I'm not trying to troll you, I really have this genuine question. I will engage in those people and the other people that come in shooting like really hard, sometimes I will, I'll even and some people think this is the wrong thing to do, but I'll respond, quote, respond, so not respond in the thread. I will quote it and make a very sarcastic, passive-aggressive comment and then that one will go gangbusters viral.

Dr. Spencer Nadolsky: 9:28

Some people like you're engaging in the with the trolls, don't feed them. But I think sometimes fighting back and showing like hey, you're not going to, like you can't just try to bully me Like I'm not, I'm not even bullying anybody, I'm just making funny comments. And then people try to come in and harass and bully. I'm like, all right, you want to go, let's go. You have like 30 followers and a private account.

Dr. Spencer Nadolsky: 9:51

But my favorite is looking like there was one the other day where someone's like you just shut up, you're such an idiot, you're a shill, indoctrinated doctor in their thing. It's that their profile. They had like 50 followers. They sell vintage t-shirts. So I said, well, this is interesting, you sell vintage t-shirts. I'm a triple board certified physician and I even said I don't want to appeal to authority, but I'm going to address these concerns so that it makes a sarcastic comment and then I'm able to give an educational lesson during it. But some people are like that's feeding the trolls. I'm like I don't know. I don't know what the right answer is, but I I mean those sometimes make the best topics.

Philip Pape: 10:31

honestly, like I know, if I do an episode and it's coming out maybe for this one called about carbs, like even just with carbs in the title, I think this one's called the number one reason to eat more carbs and it's about how it's anti-catabolic or whatever. I know I'm going to get tons of trolls from that just because people are dead set in their mindset. So I like what you're doing. So, getting back to the specific topic, then I mean, how did you get to this point? If you look at your medical training and practice, where you're like either I've had enough with this and I need to start speaking out, or was there a moment in your training where you thought either something's missing or maybe things are moving in the right direction, but people need to hear about it when it comes to what we think of as traditional medical care.

Dr. Spencer Nadolsky: 11:12

Yeah. So you go through four years of medical school, which honestly I think is probably too long. I think we could actually make it three years. That's a whole nother topic for another day. But I felt like my fourth year of like you could do a lot of electives and I'm, and like I'm ready to go start seeing patients and because that's the way you really learn fair um is actually seeing patients, seeing what happens.

Dr. Spencer Nadolsky: 11:33

You learn all this stuff from med school, in the classroom, but then actually like practicing is. It's so much different if people, you have all this medical knowledge but you don't actually know how to use it. Anyway, that's another, totally another topic. But you go through four years of medical school for the time being and then you go to your, your specialty training. I did family medicine, which is the broadest of all the medicine, and that's three years. Some other specialties are three years. They go up to like eight years if you're doing like neurosurgery, and then after that you can actually do fellowships and then specialize further and then some people are in training forever. But I remember my first year of residency, which is called your internship year. First of all, I knew right away. I was like wow, the practice of medicine. This where we bring people and they take a half day off work to come sit in a waiting room full of the waiting room. Full of not a weight room but a waiting room full of It'd be nice if it was a weight room.

Dr. Spencer Nadolsky: 12:30

Yeah that would be nice.

Dr. Spencer Nadolsky: 12:32

If these people are sick they're coming in for just their physical or whatever, but they're around other sick people coughing and wheezing and then you get like 20 minutes with them. You don't get enough time to actually spend teaching lifestyle to the patient. I knew right away when I started seeing valves like this is an archaic, inefficient, just ridiculous way of practicing medicine. And one of the my first quarterly evaluation from what we call the attending doctors was my advisor. There are multiple advisors at the residency. The comment was that they thought I was a little bit of a zealot in terms of lifestyle and I was like, huh, that's interesting. Like you know not to brag, but my board scores show that I know the pharmacology pretty well here and I know all the pathophysiology. I'm just trying to embrace lifestyles because that that is the right way to do it teaching page like it. In fact, when you look at all the major chronic disease guidelines, people like, oh, they're all big doctors want to do and all these organizations are in cahoots to sell more drugs. And when you look at all the number one recommendations lifestyle it always is, doesn't matter if it's osteoarthritis, doesn't matter if it's sleep apnea, doesn't matter. Obviously cardiovascular disease, hyperlipidemia, hypertension, obesity, all the different things related to lifestyle. The number one thing is like lifestyle changes and then it goes into the pharmacotherapy. But I was told that I was a zealot. My first quarterly evaluation. I called my brother right afterwards. I was pretty upset and he was like, well, you just do what you think is is right and you'll be fine.

Dr. Spencer Nadolsky: 14:18

By my third year, my last like evaluation, they were like you know what? We were wrong. Uh, you're actually a champion for what is the right way to do this. And in fact the they, a lot of those attendings, started getting into lifestyle themselves because I just kept promoting and promoting it. It felt good, felt vindicated. But um, it's a systemic and system issue.

Dr. Spencer Nadolsky: 14:45

So obviously, the people that go into medicine, that matters, because if someone goes into medicine because they're interested in surgery only they might not be into helping people with lifestyle. So they just want to go in and make a lot of money cut. People drive a Porsche. I don't know, that's not the majority of people, but there are people like that. But other people they just, you know, they're smart and they were like what should I do? I should go be a doctor, I guess, I don't know, that's probably a bad reason, but you should see a lot of people that think that way and they're like, oh, this is kind of miserable and not that fun.

Dr. Spencer Nadolsky: 15:18

So first of all it from the very beginning of med school there should be this emphasis of and now people will say doctors need to learn a lot more about nutrition. I don't think doctors need to be the ones knowing the ins and outs all about nutrition and how to deliver it. I think they need to understand that nutrition and exercise just have major impacts on patients and should know behavior change and understand ways of improving the barriers to what patients go through that stop them, prevent them or hinder them from doing those behavior changes. Here's this pathology, it's XYZ disease and here's how to fix it.

Dr. Spencer Nadolsky: 16:11

And just pepper in every bit that they can about lifestyle. It has to start early and it has to be constant. It's just like anything else. And then from there, same thing through residency. It has to be pushed. There has to be ways Now. But on another, system-wide level, even if the doctor wants to do it, we need to find ways to make it easier to implement and this is where some of the new admin maybe I don't know, maybe they'll they'll make this better, but there's there's been some talks about reimbursing, uh, primary care doctors to actually do this. So right now, you're not really incentivized. People are like all doctors want it. They're incentivized to push drugs. Well, we don't get kickbacks. People listening to this I see it all the time and I actually make a post about it every week on threads.

Philip Pape: 16:55

Yeah, you talk about it a lot.

Dr. Spencer Nadolsky: 16:57

And every time the post gets like 500 to 1,000 likes, but there's always comments like yes, you do you hundred to a thousand likes, but there's always comments like, yes, you do, you make money from prescribing drugs.

Philip Pape: 17:08

I go, we don't conferences and yeah, I'm like I personally don't I actually uh, decline all the money.

Dr. Spencer Nadolsky: 17:12

I've been offered a lot. I don't do it just because it's public. I don't want people to think that I'm um, being swayed by big pharma, so I don't. But like doctors in general, you know most doctors aren't speaking for pharmaceutical companies but there's this thought that doctors are getting kickbacks for prescribing meds and that that's why they do it. It's not that. It's that the system incentivizes just doing that and not even talking about lifestyle, cause imagine you have to keep the lights on and the reimbursement keeps going down, down, down. You reimbursements higher for doing a procedure, so like having somebody into the cath lab where they stick the thing up their legs, the catheter up their legs and then inserting a stent what's called a stent, like a little spring thing to open up their arteries. They get a lot of money for that.

Dr. Spencer Nadolsky: 18:02

Ideally we should have prevented that in the first place. But the primary care doctors they need to see a bunch of patients per day to make ends meet, in order to pay for the bills, and that's part of that's also big corporations, big hospital systems owning and doing it so like they force the doctors to do it, whereas if the doctors just owned it themselves and had better reimbursement, they wouldn't have to see a million patients per day. So you're incentivized to just like hey, I die in exercise, fine, but here's this medicine. The other thing is. So let's say they try to do it, they try to do the lifestyle, like me, and during residency. A lot of patients unfortunately don't want to change, they just want the pill, and that's something we have to accept. So what then happens is that doctors who do want to do it get burnt out. But imagine if there is an incentive to continue to push it and it wouldn't burn the doctors out Again. This is like a large systemic change that would need to happen. It's a big undertaking.

Philip Pape: 19:04

Which then raises the question what can we, as in the listeners and people who are actively in control of their own healthcare, do about some of this in the meantime, Because you mentioned some really enlightening things for folks, like one being that the system incentivizes this or that we get it, another being that lifestyle itself has shown to be probably the first and best go-to solution for many, many things, and again, I've seen that personally, I have some little conditions here and there. One of them is an esophageal condition, eoe, and I remember the doctor constantly saying look, there's an elimination diet you can try and that's probably what you want to do. When I saw that I had to eliminate 80% of what I liked, I said no, give me the drug, right, I had to eliminate 80% of what I liked.

Philip Pape: 19:44

I said, no, give me the, give me the drug, right, Like? I mean, the patient will do that, You're right. But the other thing that comes to mind is what about? I have a GP and I'm not going to name him who he's just not in good health, Like I could tell he's not in good health, like physically or otherwise. What do we do about that in terms of, I mean, we're not going to make doctors themselves lift weights and everything and everything, but is there something at the medical school level that can change that? Or what are your thoughts on that, when a doctor itself doesn't seem to be healthy?

Dr. Spencer Nadolsky: 20:09

Yeah, you know it's an interesting thing. So like it's a logical fallacy to say this doctor is not healthy, so they're not a good doctor. Now, having said that, though, if the doctor is not healthy, some of the studies show that they're not as likely to maybe recommend the lifestyle changes there's. Also, potentially patients may not respond as well if they were. Now there's some of that data's mix. I've seen some kind of contradictory information there. So like, let's say, the doctor's struggling with their weight themselves, but they're trying and they try to help their patient, the patient will respond to that. But if, let's say, they just kind of give this lackadaisical and it's clear that they're not putting in a lot of effort, the patient may not respond as favorably to, and or the doctor won't even give that recommendation. So how to change that? I mean, you know I I promote how. Obesity is a disease and we can get into that. That's not a communicable disease where you catch it, although some people think that is possible, but it's. It's not one of those things. It's physiopathophysiological level. It's just more it kind of fits that chronic disease model, kind of like type 2 diabetes. So a lot of people struggle with it. Doctors can struggle with it. But I think if we try to again, starting in medical school, really promote this idea of, like, healthy living and some of these medical schools are, it's kind of this more forward thinking way they're teaching them how to cook, they're teaching them which we all should have cooking skills by the time we're in med school it's after college, but some people just don't know how to. Some people have never touched a weight before. Some people have never done physical activity. So then I do think it's important to doctors should be at least trying to practice what they preach. I don't think they need to look like bodybuilders or anything like that, but they ideally would be trying their best to have their own lifestyle be good. It doesn't mean that if they don't have that, they don't have the brain or the smarts and the right recommendations. Like, for example, there was just a post the other day that said if your doctor can't do a couple pull-ups, you need to find another doctor. And someone was like well, god, I don't care if my oncologist or my whoever can do a couple pull-ups, I want to make sure, I want to know that they're, that they're a good doctor. So, like you know, that's a little bit extreme, it's more so. This like, hopefully that they're trying to live their own healthy lifestyle, and then they're. But we're all kind of human, you know.

Dr. Spencer Nadolsky: 22:56

Yeah, trying to think of some unhealthy things that I do. I sometimes, at night, I'll snack on some like potato chips, because it's like kettle if they're in the house. If they're not in the house, I don't need them. Lime, actually lime, uh, tortilla, hint of lime, tortilla chips. It cannot be in the house. I will, I'll put the kids down, I'll grab a handful with some salsa and it's just, it's so. It's the salty crunchy flavor that's just great.

Philip Pape: 23:20

Yeah, yeah, so anyway I have some beds.

Dr. Spencer Nadolsky: 23:23

I I can't say that I'm perfect by any means, but but, like you know, obviously I live a mostly healthful lifestyle. So, again, ideally, again. But people are behavior, change is tough and most I was just looking at how many people follow the current healthcare guidelines so I posted this on threads about how like people are, like the government doesn't promote exercise, the government doesn't care if you're healthy and I'm like. Well, the cdc has their recommendations for physical activity. It talks about 150 minutes physical activity and that's in addition to two days a week of strength training. Those are pretty like and it's very few people actually get that. I mean it's. I was looking it up. It was around maybe a 25% of people hit those numbers, but I can't even imagine 25% of people actually hit those numbers, cause like like that's two days a week of strength. How many people are actually doing that part? Let alone the 150 minutes of, uh, moderate intensity aerobic training. I just I don't anyway. So, um, but getting people to do it, it's tough, it's just tough.

Philip Pape: 24:27

Yeah, it is tough. I mean, I know sometimes you make fun of nutrition coaches, which I am, and that's cool, cause I get where you're coming from, especially when they say things like you know, doctors don't get any nutrition training and stuff like that. But a lot of us got into this, seeing the behavior change side of it as being the obstacle for a lot of folks. Right, and now you got me thinking. When it comes to GPs, and primary care is potentially being incentivized, I could see that being its own specialty almost, of preventive care, like you get in you have a GP and or a behavior physician, I don't know what you'd call it, but like that, that's an interesting concept because you're right, that would, that would and that would save healthcare a lot of money. That would save insurance companies a lot of money too. I think it's not that they don't get it right, but it's a huge system with a lot of friction in it.

Philip Pape: 25:14

So I mean, what about the lifting part of it? So you're a doc who lifts weights. You talk about it with your brother on the show all the time. I guess the younger doctors are getting more into it. I know one of my surgeons. I had back surgery. He was definitely catering to athletes and you can see it in his language and understanding of it. He knew. So one of the biggest things, Spencer, is when you get injured or you have surgery or you're older, there's all these fears about getting hurt and you shouldn't lift anymore or you shouldn't get back to lifting Right and like. First thing I wanted to do after back surgery was get my deadlift back up and then hit a pr.

Philip Pape: 25:46

You know like and some people be like you're crazy, you can't do that.

Philip Pape: 25:49

So, like, what are your thoughts on that? Again, I don't know how we can change the whole system, but just for the listener who lifts?

Dr. Spencer Nadolsky: 25:56

this is where it has to start med school and and then obviously, if they're doing, if they're a surgeon, they went through training the old guard and this is going to sound ageist, it's like I'm not woke or anything like that, but of course I make. I'm like people online are like you're a woke, elitist, liberal, democrat, doctor and I'm like man, if you knew me, I'm, you know I'm not like that, but like so I'll post and then I'll, you know, get it from the, the right and I'll get it. I'll get heat from the left. So if I post something like you're an ageist, ableist, I'm like no, no, I swear to God, I'm just trying to be reasonable here. But there's an old guard and they're going to retire at some point here and that's going to be a good thing. Like you said, there's some of them have an open mind and some of them are lifting weights and have that forward way of thinking and not stuck in their old ways. But there are a lot that just they're going to need to retire and I hate saying this, but some of them are kind of these old dinosaur folks not saying younger folks are better. It's just that we are able to have gotten more of a bigger array of of understanding of how exercise works, like.

Dr. Spencer Nadolsky: 27:11

So I tore my biceps. I was doing juju. I'm a wrestler, but I was doing jujitsu and someone put me in an arm bar and I curled them up because I didn't know what the heck it was. I didn't know what was going on. I was like what is it? My arm feels stuck. I curled them up, my my felt my biceps just pop and I was like what the hell is that? Anyway, head surgery pretty quickly. And my guy was I've read all these things where they put your arm in this like, basically like a cast type of thing, and you can only use the range of motion. Uh, they, they adjusted the range of motion every however many weeks by like a centimeter. They adjusted the range of motion every however many weeks by like a centimeter. All these different things.

Dr. Spencer Nadolsky: 27:48

My guy was into lifting. He treated a lot of the seals, navy seals, and he was like no man. Like you know, don't be an idiot with it, but like you should be aggressive here I've seen very good things. I went to the physical therapy two times and I was already progressed way past what they'd ever seen, because and I wasn't an idiot about it. I wasn't like doing curls after my surgery but, like I was, I was moving it a lot and, you know, started to do very light back rows and things like that, things that like normally they wouldn't have allowed, and because of that it got strong very quickly. You know. It again, it takes this. People are a little too conservative. You know you don't want to be too aggressive, but I see this all the time where it's like whatever, like a hernia surgery, other types of surgery, like no, you should never lift again more than five pounds. I'm like what, what is that?

Philip Pape: 28:48

didn't even make any sense your body is five pounds, right, yeah, you gotta think, yeah, you gotta think.

Dr. Spencer Nadolsky: 28:54

You gotta think, okay, biomechanically, I think, anatomically, I think, like, from a pathophysiology standpoint, like, why would that make sense? And honestly, if you just think of it logically, you know, yeah, sure, do we need studies to look at what happens over time? Yeah, sure we do. But like, at the same time, it's like you just have some common sense about that. Why would, why would you not be able to do x?

Dr. Spencer Nadolsky: 29:18

You know lifting xyz, or you know if, if it's a some sort, hey, yeah, maybe you shouldn't be doing like the world's power lifting competitions anymore, although, like you know, even at that point some people are going to. You know, that's their passion, it's what gives them purpose. You know, you still want to be kind of that patient centric, but again, I think that I think it would start in in training, uh, especially for the surgeons who are I've seen that so many times and it's like, okay, let's, let's back up and think about this from a very logical standpoint. Let's use science to do it, not be idiots about it. And, yes, we should. You know run trials, but they can be expensive. But I agree with you, it's it's. We see that a lot. Nope, no more XYZ exercise. It's like huh, it doesn't make any sense.

Philip Pape: 30:09

Yeah, I mean, I personally even though this is anecdotal I've never heard of dozens of hundreds of people doing this. That made it worse. I mean, I'm sure somebody went too aggressive, but it's definitely the norm being the opposite, not doing it enough.

Philip Pape: 30:21

And then you get the scar tissue and limited mobility. And then now, a year later, you're trying to do something with this, you know tight tendon or scar tissue, whatever. It's a lot harder to do. It's funny I have a physical therapist. He's remote, he's in New York, I'm in Connecticut, he's a barbell trainer who's also a physical therapist. It's got like a combined practice, like man, if you're a patient, and they kind of can handle both sides, they can walk both sides of it really nicely for you and be aggressive.

Dr. Spencer Nadolsky: 30:48

It's hard to find those types of folks, but yeah, when you do it's like oh God, yeah, yeah.

Philip Pape: 30:53

Yeah, that's what we need More, more, more guys like that, more guys like you out there to do that. So let's talk about the obesity stuff, cause there's definitely a lot of mean material there, but it's also a very serious thing. So I've got some of the quotes from your recent posts, like telling someone with obesity to eat less and move more, similar to telling someone with anxiety just to calm down.

Dr. Spencer Nadolsky: 31:11

Yeah.

Philip Pape: 31:12

Right, or calories matter, but appetite drives the bus. Let's just talk about like okay, what are the myths about obesity? People keep spreading, that doesn't help, and what are the top couple things that we need to understand to be empathetic and also to help ourselves and others with obesity. You know, move forward.

Dr. Spencer Nadolsky: 31:27

Yeah. So whenever I talk about like, let's say, obesity is is the disease? Obesity is more than willpower and discipline People will say, no, you're taking out the personal responsibility. It's just an energy balance problem. They just need to eat fewer calories. I'm like these aren't mutually exclusive. Like energy balance problem, they just need to eat fewer calories. I'm like these aren't mutually exclusive. Like energy balance absolutely is the underlying factor here. That doesn't.

Dr. Spencer Nadolsky: 31:53

The energy balance principles don't tell us what drives the obesity, and that's kind of some straw man type of arguments you see out. There is that like just because energy balance doesn't tell us the why things happen doesn't mean it's still not true type of thing. It's. Energy balance doesn't tell us the why things happen doesn't mean it's still not true type of thing. Energy balance is absolutely true. What goes on with obesity?

Dr. Spencer Nadolsky: 32:14

And a lot of these patients most of these patients have tried to eat fewer calories in some sort of form of fashion whether it's counting calories, a ketogenic diet, vegan, plant-basediterranean, paleo, grapefruit diets unfortunately lots of the different fads and that type of thing and what happens is that over time, as they try to do this, their brain kind of fights back and, in a form of like appetite dysregulation, it increases. They've done this mathematically. There's a really brilliant researcher out there named Kevin Hall who has shown this mathematically and kind of looked at appetite changes and how, when people lose weight, their appetite gets ramped up, up and up and up the more and more you lose weight. Now I'd say this is more individual, because you do see some people like who've lost 100 or 200 pounds and have kept it off for, you know, a few years even sometimes, and they're doing okay.

Philip Pape: 33:13

Oh so, like you know, it's not it's not, like, guaranteed that you're going to have this strong, what I'd call biologically, uh appetite drive which hold on that spencer, because that's important for people to know that right there there are massive differences between people and so many people will put their own perspective on others in that department and I've seen it with clients too, where they have zero appetite at any level of dieting, and others that like just start a calorie deficit and it's like holy crap, what are we gonna do about this?

Dr. Spencer Nadolsky: 33:44

yeah, yeah, individual difference. And this is where because you'll see online in fact you know a lot of the people that have the strongest like obesity bias are those who used to struggle with obesity themselves and have overcome it with lifestyle. Only They'll say, basically, since I did it, everybody can do it. And if you can't do it, it means you're not trying hard enough, you're just lack discipline. And I think you know, if we put ourselves in other people's shoes, it's hard to put ourselves in their shoes. I'm like you know, I think some of some of us listening when you're in elementary school you could probably do things better or worse than other kids in your class. And it's like none of those kids in your class were working hard at whatever they're good at. It's just they were naturally better at something, whether it's math or running or whatever. You can obviously improve with practice.

Dr. Spencer Nadolsky: 34:40

We're not set, you know, genetically determined exactly, but there's genetic differences that in upbringing that change our trajectory. So you can imagine genetic and biological differences of why. I mean, we see it as it's, about 15 or so percent of people will lose a substantial amount of weight and keep it off over the course of a year with just lifestyle alone. And when I say that it's around 15 or so percent total body weight loss or more, you can get up to, you know, maybe 20%, but around 15%. So let's say you're 200 pounds, 10% would be 20 pounds, 15% would be 30 pounds, you get down to 170. So around 15% of people. And so when you look at lifestyle changes, about 15% of people will lose about 15% of their weight. More people lose around 5% of their weight. More people lose around five percent of their weight, which is considered clinically significant.

Dr. Spencer Nadolsky: 35:30

But, like when we're looking at these newer drugs like semaglutide, which is the ozempic Wegovi or manjaro Zepbon, which is terzapatide, those drugs get around 15 percent average body weight loss. We're talking about semaglutide, 20 percent for teriseptide or even a little bit more. And when you look at how many people achieve those results, you're starting to get into like half or three-fourths of those people are starting to lose an average of 15 or more percent total body weight loss Whereas, like, only 15%, a very minority of people lose that amount of weight with lifestyle alone. So what's different about those people that are able to do it biologically? They probably don't have that strong, as as much of a strong driver. Maybe they found some other ways to cope with that, uh, appetite change, but I think it's important for people to know those biological yeah uh differences. I don't even know what started this conversation.

Philip Pape: 36:29

No, no, no, that's perfect because because ultimately I'm going to tie this back to kind of the behavior change and the medical industry and all that but I definitely want people to understand and also not feel totally defeated when they find that their experience is different, especially I mean, we had dr Stephan Guine. You know he talks about, yeah, the brain and you mentioned it as well. A recent study came out too about again confirming, like epigenetics and the importance of during your lifetime, even when you've dieted many times. That seems tends to exacerbate that for a variety of reasons, which is amazing to think about that. When you mentioned, like the drugs versus not the drugs, we try to have a nuanced discussion about that.

Philip Pape: 37:08

Even though people get livid about the GLP-1s and all that, there's a gradient. There's people who desperately need it because nothing else has worked and they have a lot of weight to lose for their health. There's people who maybe have been using it and then were able to sort of clean up their lifestyle because now this massive signal is not there and then they can gradually titrate off of it. And then there's maybe folks that don't need it and fine, there's a fair criticism there and the behavior change piece of it like you talk about diet soda. Let's go there. You talk about how, like you had a patient who swapped all her regular soda for diet soda, lost a bunch of fat and then her type 2 diabetes went into remission, right.

Dr. Spencer Nadolsky: 37:47

Yeah.

Philip Pape: 37:48

Like. I think that's a great example of an accessible change that is not too far right. And then now was that patient on these drugs? No, right?

Dr. Spencer Nadolsky: 37:58

No, no yeah.

Philip Pape: 38:00

So you know, tying that back to the system, the broken system. What do you want listeners to come out of this thinking? If they feel like they're not able to lose the fat, not able to lose the weight, their appetite's always super strong and maybe they aren't willing to go on the drugs. Whatever, what's step one?

Dr. Spencer Nadolsky: 38:17

Yeah, you bring up some good points. What's step one? Okay, so I would say normalize, or understand that you're not a failure if you're unable to do a lifestyle. I think that's people will say they failed lifestyle and it's it's a somewhat of stigmatizing.

Dr. Spencer Nadolsky: 38:37

I've used it in the past because we, you know, you like for you, for example, for your esophagitis, eosinophilic esophagitis let's say you, you took a certain, you did the elimination diet. Uh, what they would write in the note patient failed conservative therapy. Moving on to the steroid or whatever they're using. So with diet and exercise, when trying to lose weight, we'd say patient, uh, failed diet and exercise. And now we've, we've changed it because the patient didn't necessarily fail, they didn't, just didn't respond. So now we say we've changed it because the patient didn't necessarily fail, they didn't, just didn't respond. So now we say they didn't respond to it. So some people don't respond it. And people will say, well, they're not working hard enough, they're not whatever. Instead of shifting the blame to the patient because that's what we do, we're like they clearly not doing it why don't we shift it towards hey, hey, maybe it's. This biological drive is just too hard to overcome. And that doesn't mean take away all person. People are like you. Just want to take away personal responsibility and sell drugs. I'm like I swear. I swear I'm not. I'm just thinking of this differently here. Shift it to more of understanding this biology. So for people out there there, don't think of yourself as a failure if you're unable to do a lifestyle. You try, try your hardest, try your best. There are, you know, people do respond. Don't not think you can, don't think you cannot try, you, try, uh. And then if you aren't responding to it and you do need to lose weight for clinical reasons, you have type two diabetes, sleep apnea, those types of things, and it's like I really need to lose 20% of my weight or 15 or so percent of my weight.

Dr. Spencer Nadolsky: 40:15

There are medicines out there Now the big thing right now is that they're not covered very readily, like 40% of commercial insurances that pay for it, that some of those places are dropping it because it's so expensive. I think we're going to see a lot different in 10 years because the drug costs are going to come lower. More competition is going to drive these drugs lower and lower in terms of cost. So, um, but I would just know that. Just hold out hope that there are therapies out there. Now you don't again. You don't have to take these medicines uh, no one's forcing you to. But that's what I would tell people. Step one, just like don't think of yourself as a failure. Do know that it is possible for some people to use lifestyle only. Do know that there are other therapies out there. If you don't respond to that, that's what I would say. If you don't respond to that.

Heather: 41:04

That's what I would say. Hello, my name is Heather and I am a client of Philip Pace. Just six days after I started this cut, my family and I were in a 7.9 magnitude earthquake here in Adana, turkey. As I tried to process the stress and trauma, my first instinct was to say, oh, you've been through something hard, this is not a good time. But instead I reached out to my coach and he got me under the bar that day and he helped me keep my macros that day.

Heather: 41:29

And not only did I realize that I was doing something fantastic for my body, but I realized that I was doing something fantastic for my mind and that it was going to help me keep the mental clarity that I was going to need to get my family through what really has been a very difficult two months. Here I am on the other side of eight weeks, got my kids through all the things that we have been through, and I weigh 12 pounds less than I did, and I got a new PR on my bench press. I have a long way to go and there are still things that I really want to accomplish, but now I know that I can and I'm really grateful. Thank you, philip.

Philip Pape: 42:05

And when we talk about lifestyle, what? What is the? So I'll tell you my opinion on on lifestyle, just just from again, anecdotally, it seems that being more active and strength training tends to be a catalyst for a lot of people, if they can get into it for other things, even nutrition, like if I have someone say, should I do nutrition?

Philip Pape: 42:22

Like if it's, if it's a thought experiment, fix my nutrition or fix my exercise and start. I'm like, just start lifting weights because you're going to find the nutrition follows it, you're going to want to feel your body. That's just my opinion. How many folks do you think who are being, say, encouraged to take these drugs, are seriously trying or being given the information for lifting and training? You know, building muscle, building straight, that, that piece of it, cause I think that's, I think that's missing in a lot of this.

Dr. Spencer Nadolsky: 42:54

Yeah, so the let's see. So there's two parts to this how many people are being given the information and then how many people are actually following through if they're given that information. So if I had to guess, I would say the minority of people are being given that information. Just based off of my, I don't even know how this would be studied. That you'd have to look at. You'd have to go back and look at large EMR databases and then look at the note of what they said. But even still, even if they put it in their note, did they actually tell them how to do it? Hard to study it. But okay, let's let me give my my guess. Though, if I had to guess, 10 are being told to do it, maybe 20 at the most. I I just can't imagine. I can't imagine it's more than that, because you go to it's it's.

Philip Pape: 43:43

We've already talked about the beginning we talked about it, doctors, just don't all get it.

Dr. Spencer Nadolsky: 43:47

Yeah, so they might say, like you know, make sure you're, I don't know, make sure you're exercising. That might be the the extent of it, specifically weight training. Oh, the, it's got to be small, it's got to be small. And then, and then like, are they giving recommendations beyond, just hey, you should go weight train. I, there's just no way. There's just no way. So it's got to be the minority people. Now let's say that they're a big proponent. Let's say they come to me.

Dr. Spencer Nadolsky: 44:12

I have a program I mean I have I call it lift rx and I I'm like pushing it hard and I, you know, of course I don't force people to do it. I can't force people to do it, but even still, that percentage of actually people when I'm it it's. If I had to guess again, this will be. I have a study that I'll be starting here soon, looking at body composition, because that's what everybody wants to see is like, okay, what's going on here? We're going to look at strength and body compositions after they start these medicines, and the reason it's going to be cool is because I will be pushing, lifting hard. So then, what we're going to do it's not a trial where we do one group gets a placebo, the other one. It's an observational thing.

Dr. Spencer Nadolsky: 44:53

So if in my clinic I'm pushing it hard, regardless, it'll be interesting to see the percentage of people that actually do it and we'll make sure we follow them along. Again, we'll see who doesn't do it versus who does it. But everybody will get very aggressive, like counseling, to do it and we'll we'll make sure we follow them along. It's again, if we'll see who doesn't do it versus who does it, but everybody will get very aggressive, like counseling, to do it. So if I had to guess, I would say 30 to 40, 30 probably actually follow through and start doing it. But I don't know. You know we'll see. We'll see when I publish. Yeah, so like that's small, that's that's not.

Philip Pape: 45:24

Yeah, not enough people are doing it yeah, yeah, no, I bring it up cause it's, it's always on my mind. I wish more people would, and that's I know, all of our mission to do that, and specifically with the, the weight loss drugs. You know, you hear I'll call it misinformation due to a lack of understanding. Like, oh, you lose weight so quickly and you lose all this muscle mass when you look at it, it's, it's probably because your rate of loss tends to be faster on these. Yeah, thus you're hitting into that severe calorie deficit that causes muscle loss. It just like if you did it naturally at that rate, and that's why I bring it up. But anyway, yeah, yeah. So that's why I want people to know about it and know that there's a lot of nuance there. Do you have time for like three real quick?

Philip Pape: 46:02

rapid fire social media questions.

Philip Pape: 46:06

Okay, I rarely do this, but I think it'd be fun. So the first one is what's the most controversial fitness influencer?

Dr. Spencer Nadolsky: 46:11

that's getting it right, at least one that you can think of, so a controversial influencer that's getting it right? Besides you, besides you I don't know if they're well, if they're getting it right. I don't know if they're controversial, but I, I would say I, I really like um uh, ben carpenter. He's my buddy, but he, he's, he's just on point, every single video that he does like he's just on point.

Philip Pape: 46:39

I like him okay yeah, I mean controversy could be like you're controversial in some ways.

Philip Pape: 46:43

You

Philip Pape: 46:44

know what I mean yeah, yeah, you cause.

Philip Pape: 46:46

You cause a lot of uh discussion. Yeah, yeah, that's true. Um, all right. The second one is name the one food labeled as unhealthy all the time by influencers, but it actually can be quite helpful oh yeah, I mean there's so many right the one the one that I'm seeing right now.

Dr. Spencer Nadolsky: 47:04

It's seed oils in general.

Dr. Spencer Nadolsky: 47:07

And I say that there's a lot of nuance there. But, like, when people say that they give a blanket, that seed oils are bad for you, it's like whoa, whoa, whoa, whoa, whoa. What do you mean by that? Well, they cause inflammation. Well, no, the trials show they actually don't. So, like, what are you coming up with? So that's probably the one, and I'm not going to sit here and say they're amazing for you and they're going to help you do X, y, z, but you know, you gotta, you always gotta, compare it to something else. So, um, you know, seed oils I don't, I think it's to me, just for anybody listening I think it's the foods that come packaged with seed oils are the culprit. They're easily overeaten, hyper palatable, ultra processed, increasing excess calories, causing adiposity, excess fat deposition. That's the issue. I'd say the seed oils are. What a red herring is is the term. Yeah, it's like we're, you're focused on this, you're, you're hyper focused on one little's, it's, it's everything else that comes in. Anyway, that's what I would say.

Philip Pape: 48:10

No, that's good, I could have guessed that. I could have guessed that, um, yeah, cause one of my friends, his name is Dustin Lambert. He's a nutrition coach that loves to look at the research and, um, we, you know, or like you said, they're found in processed foods. Same thing with red meat and others, where you have to take away the confounders and the correlations going on, exactly. Um, all right, Last rapid fire. What's more dangerous? Uh, steroid using natty influencers or doctors pushing fad diets?

Dr. Spencer Nadolsky: 48:39

That's great, uh, okay. So the doctors pushing fad diets or natty uh steroid users, and what are they promoting?

Philip Pape: 48:49

steroid using natty influencers. Yeah, this is this kind of a silly one, to be honest um, yeah, I, you know it.

Dr. Spencer Nadolsky: 48:57

It yeah so silly. So I'm just I'm thinking of examples, because there are I don't even I don't, you know some of these people. You don't, I don't know if they're using steroids and they claim they're natty, but some of them might be giving out good information despite not being natty, whereas some of these doctors are are extremely dangerous.

Philip Pape: 49:17

Dangerous Okay.

Dr. Spencer Nadolsky: 49:19

So I'm going to go. What was? What was better or worse? I'm going to say the doctors I'm going to say that the doctor doing the fad diets that's what I would say they're the dangerous ones.

Philip Pape: 49:27

Cool, cool, cool. All right, All right. Last question this is not a rapid fire. It's just what I ask all guests. Is there a question that you wish I'd asked and, if so, what's your answer?

Dr. Spencer Nadolsky: 49:38

No, this has been a great discussion. I just, you know, I think if we all step back, you know, we, we want everybody to be healthier. We want people to lift weights. We want people to eat healthier. There are different ways to skin a cat on and to get there.

Dr. Spencer Nadolsky: 49:56

Uh, I think doctors are, overall, good and want patients to be healthy. You know, we talked about not enough doctors lift and I think that they're wrong, but I still think that they have your best interest. So, uh, I don't want people coming around. Oh, this guy is trash and doctor. I, I like doctor. Doctors are good in general. There's some bad apples, the the fad diet doctors, as mentioned, and some of them, some of these people, I, I swear they're just doing it for fame and and clout on the internet. It's really, really weird and too bad. Um, but for the most part, most doctors out there, just they want people to be good, uh, so I wouldn't fault them for not promoting lifting weights, um, but I would hope that the new crowd, the new wave, the new generation of doctors, understands it. I think so. I think we're seeing that and part of that social media.

Philip Pape: 50:51

So, yeah, there you go. Yeah, I'm seeing it too. That's good. It's a positive message, and if you're listening and you're, you know, taking control of your own health, maybe you're going to inspire doctors to do that. And I've heard stories of that, where the doctors themselves get more educated by patients who are very much into this stuff, from including chiropractors and non-doctors as well Just like, oh, what are you doing A lot more yoga? No, I'm actually lifting weights. Ah, interesting. Yeah, that's cool. Good stuff, good stuff. All right, where do you want folks to find you, dr Spencer?

Dr. Spencer Nadolsky: 51:16

I mean, uh, instagram and threads. I I hate saying X cause, like I don't know, I don't even. I call it Twitter still, but Instagram at Dr, dr Nadolsky, dr N-A-D-O-L-S-K-Y, you can. You can listen to Docs who Lift podcast. I have a podcast with my brother who's an endocrinologist, who's lifts a lot of weights as well.

Philip Pape: 51:40

Yeah, that's all right, All right man, I'll throw those in the show notes. I really appreciate you doing this. For me and the listener it was fun thanks for having me on.