Dr. Spencer Nadolsky
Appearances
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I was so ravenously hungry and craving. And what my patients described was kind of that. So I could imagine them being, you know, in a 300 pound or 250 pound body with a lot of excess adipose tissue, trying to lose weight and feeling that way. Just that, you know, I was already really lean, but like they're feeling that way at a higher body fat.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. So I went to med school late 2000, so 2007. That's right when these drugs started coming out. You know, Bayeta was the first one, exenatide, but it was for type 2 diabetes. It wasn't on the radar to use these for weight loss. At the time, people were really focusing on basically phentermine. A noradrenergic sympathomimetic drug. It has amphetamine-like properties, but not addictive.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
A little bit of an upper. But yeah, noradrenaline, noradrenergic. And that was basically what people used. I started going early on to obesity medicine conferences, and there was some weird stuff that they were promoting. They got HCG and all sorts of stuff that people were trying to use, HCG diets, but a lot of phentermine.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And if people remember Phen-Phen, Phentermine was one of the components in Phen-Phen, but it was not the bad component. Phenfluramine was the one that caused heart valve issues. And so they took that one off the market, but kept Phentermine around. It had been around since the 1950s. So once I got to residency, which was 2011, right in 2012, Q-Simia was approved and
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And that is a combination of fentramine and topiramate. Topiramate works in GABA. They think that's part of why it works for appetite suppression. But think about different receptors, lower doses of each, so you get fewer side effects. The fentramine can cause people to have insomnia, dry mouth, heart palpitation.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So you try to use lower doses and then add it to something else that has a little bit of appetite suppression, which is topiramate, doesn't work in the same pathway. So that was approved, and that was for chronic patients. And that was, that kind of, you know, the highest dose gets around 10% total body weight loss. So not bad, but side effects.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
The other one was, if you remember, lorcaserin with Belvique. It was actually similar to fenfluramine, but it had the... It had a different serotonergic receptor, more specific. Actually got taken off because of, we don't know why exactly, but some concerns for cancer. Very mild weight loss effect though, around like five or something percent total body weight loss.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
There was Contrave that came out in 2014, bupropion naltrexone combination. Not that great, still out right now, 6%, maybe 5, 6% total body weight loss. And when you think about like good diet and exercise, intensive coaching, you're going to get around five or 6% total body weight loss on average. People are like listening, going, I lost a hundred pounds. And it's like, yeah, yeah.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's exhausting. It's exhausting. Like a game of pickleball could be, I suppose.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Like I'm saying on a population average, we're looking at that, that number. So contrave or bupropion, naltrexone wasn't that great. So it was very frustrating, you know, in residency, I'm like, I'm going to be an obesity doctor. I'm trying, you know, trying to try to do my thing. And those are the drugs that I had. It was 2014 and, I believe it was Saxenda liraglutide, if people remember Victoza.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So liraglutide was the second GLP-1 receptor agonist that came out in like whatever it was, 2009 or something for type 2 diabetes. But 2014, they cranked the dose up to three milligrams. Now liraglutide is a once daily injection. And that high dose liraglutide in 2014, they promoted as Saxenda, it was around like seven or 8% total body weight loss. So like
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's okay, but it's like a $1,200, you know, $1,000 drug for more side effects, daily injections, and overall not that great amount of weight loss. So that was like the, you know, we went from lifestyle, trying behavior, behavior, behavior with some high side effect drugs that some of them, some people responded to. And then you jump all the way from that to bariatric surgery.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
You know, do you get 30% to 40% or more total body weight loss? Pretty drastic. People are like, oh, God, I got to get surgery? It's like, great. So that's why in 2021, when semaglutide Wegovy was approved at that 15% total body weight loss, things changed so much. That's why everybody's like, it's a game changer. Because we were really limited in how we helped people.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It was like resources for intensive coaching. That takes a lot to get people. And then it's very frustrating because Everybody says they know what they do. I mean, my patients aren't idiots. Some people are. Some people are idiots. They don't know what to eat. I remember a patient, I was like, hey, let's try to eat more protein, whatever.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And they came back and they're like, I don't know, I'm eating more protein, but I can't lose weight. And I was like, well, tell me what you're eating. And they're eating a bunch of spare ribs. And I'm not saying this person is idiot, but it was clear that even though I gave a list of the foods, like spare ribs, that was what they were eating for protein.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And it was, you know, along with a bunch of other things. But most people understand that, hey, I should probably eat more broccoli instead of French fries. Like it's just very, very, most people have that. And a lot of these people have been trying for their whole life. And so like for them to come to a weight loss doctor specialist, obesity specialist, and
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
and me basically going okay here's what we need to do i got these other drugs that maybe you're not going to tolerate but like let's really focus on these behaviors they're like i already know these things it's it's it was very frustrating from a doctor's standpoint a clinician standpoint and then also from a patient standpoint it's like so that's why they go and get the 300 a month detox from someone online or whatever that promises to rid them of their fat and then they
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
lose all their money doing that. And it's just very frustrating. So that was what it looked like before these drugs.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And I was like, yeah, that's pretty much it. And I don't even blame... I was just on another podcast. I don't even get mad at these people because I had it myself. I was a young wrestler before. pretty jacked dude and been like, why, why aren't these people just like eating better and exercising? Why? It seems like it's just a, they're lazy and gluttonous or something like that.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It wasn't until, you know, going through med school and then going to conferences, talking to very smart neurobiology experts and researchers and other obesity doctors, and then talking to patients and really seeing the pattern where I started to understand it. And actually it was when I did a bodybuilding competition and got a that brought my calories just to 20.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I'm trying to eat 2,200 calories, which is probably what most people would be like, that seems like a lot. I was starving on 2,200 calories. And I was, I, I couldn't stop myself from eating Pringles. And like, I like started kind of having disordered eating. Like I couldn't, I couldn't stop. I was like, I was so ravenously hungry and craving. And I, and what my patients described was kind of that.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So I could imagine them being you know, in a 300 pound or 250 pound body with a lot of excess adipose tissue, trying to lose weight and feeling that way, just that, you know, I was already really lean, but like they're feeling that way at a higher body fat. That's what made me go like, oh man, I think I missed the mark.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
That's what made me go like, oh man, I think I missed the mark.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And so there's two different things because people think of the disease in two different ways. The disease, the way the AMA kind of described it back in 2013, the criteria of like certain signs and symptoms, certain associated with morbidity, mortality, those types of things, like definition of disease. a disease versus the pathophysiology of what drives it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So right now, there's the Lancet Commission just came out with their whole definition of obesity, and they tried to describe basically preclinical obesity. So basically people that don't have those sequelae or issues from their excess adipose tissue, they're healthy, basically, other than just a lot of adipose tissue.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
that do just fine on a little dose and go through your journey, just fine, no issues. And that does happen. However, I would say it's not rare. It's still uncommon, but common enough when you have hundreds of patients that you see some of these side effects, especially at the higher doses that get brushed off by someone if they don't listen.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Then they talk about clinical obesity and that those are people with, say, like type 2 diabetes or prediabetes, hypertension, some issues arising from the excess adipose tissue. So that's how some people talk about the disease of obesity. But what I think you're getting at and what I like to talk about is that the pathophysiology of what drives that adipose gain. Why is it that some people
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
you know, they just change their habits a little bit and lose the weight and never gain it back versus other people. They try to lose the weight and their body fights them tooth and nail and they essentially just cannot lose the weight or keep it off without some extra tool despite their best efforts and all the the amount of effort that they put into it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So it's that pathophysiology that I think is really what people need to understand because otherwise they just think it's a choice. Yes. You just think they're just like, I don't understand. It's just a calorie deficit. It can't be a disease. And it's like, whoa. I was like, what is choice? Even if it were a choice, that doesn't mean that this person doesn't have a disease.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
For the bros out there, I'm always like, let's say if you knew... that this woman out there had gonorrhea. Let's make it really clear. And you choose to still have intercourse with her and you get gonorrhea. Do you not have a disease because you chose that? No, that doesn't even make sense. You got to think of that. Good point. And then I always talk about like, what about type two diabetes?
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
We don't think of it that way. Do we say people choose to have type two diabetes? No. So the choice thing doesn't have anything to do with it. But going into the pathophysiology though, it's like, If it truly, even if, like, it's not a choice, though. It's not a choice because, like, people would never choose to have obesity. And people are like, well, they're choosing the habits.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They clearly chose an extra serving, an extra helping at dinner when they didn't have to. It's like, no, they're It's the underlying appetite dysregulation or derangement that's driving it. The biology drives the behavior. And of course, the environment. So like, you know, Cali Means and all these other people will say, like, no, we don't need drugs. We need to change our environment.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
We do need to change the environment. The environment will help prevent the obesity from occurring in the first place. But once that obesity develops, their brain... Is changed. Yes. Their genes are changed.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. I describe it as like, think about the circuits in our brain and the circuits in our brain control a lot of our processes in our body. One of them being appetite. In a normal brain, someone that doesn't have obesity or struggles with their appetite, all the circuits are working well. But think about someone that struggles with their obesity and losing that weight and keeping it off.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They're short circuits. They're frayed and fried. And that's why this GLP-1 medicines are so cool, because they seem to recircuit the brain in a way that... And again, it's not necessarily permanent. It recircuits it as long as you're taking the medicines, but it hits the receptors to basically stop the short-circuiting of the brain. So that's the pathophysiology. It's really related to appetite.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And people are like, but it's just energy balance. I'm like, yeah, the appetite drives the energy balance. And so that's the gist.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
For example, the one that I'm seeing more recently and I've made some videos on is anhedonia, just kind of feeling meh, blah. And it actually happened quickly in 2022 when Manjaro came out. We were all using it off-label. Everybody's like, oh, how dare you use that drug off-label? I'm like, well, the Surmount trial was out. It just wasn't available as that found yet.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah, I always like showing the other side of the coin. There are thin people that do not try to be thin. They're just thin. Are they choosing to be thin? No, they're just thin. They're eating crap. And people are like, yeah, but they just must have a faster metabolism.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Well, if you actually look at them, instead of eating five pieces or a whole piece of pizza, a whole pizza pie, they're maybe eating a slice or two and they're good. And they'll go and smoke their cigarettes and whatever. They're fine. And they'll drink some soda. It doesn't matter. They're not choosing to be thin.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So I think when you start thinking about it in terms of how biology works and how it drives our behavior, and of course, yes, the environment is super important because the environment is what changed over the past however many decades. Our biology didn't change, but the environment changed. then changed our biology once we gained the weight. And I think that's what people don't understand.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And I don't think, they just haven't been able to put themselves in those shoes. And again, the only reason that I kind of understand is because I did that bodybuilding thing and I was like, man, I was ravenous at just like a pretty high amount of calories.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It wasn't approved yet, but the Phase 3 trial was out. So we were using it for obesity a lot. And people were feeling tired. And you see it with WeGoV2, the semaglutide. But terzapatide, we were seeing it and people were like, well, it's got to be from the calorie deficit. And that makes sense that people would feel tired from a calorie deficit.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. So here's what they're going to claim. They have some data that shows people stay at a certain job for however many years. What these places don't want to do is go, all right, we'll put in all the amount of money only for the next insurance to benefit from that medicine. So these are the games these insurances play. If we can figure that out, I mean, I don't know.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I have all sorts of different thoughts because some of me feels like, why don't we just make the drugs so cheap that people just pay cash?
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And don't even worry about insurance.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They can figure it out. I know they can.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It doesn't make any sense.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I hate it. It makes me so mad. I'm like, oh, I guess we're all just going to fly to... to the UK just to get these drugs. Just so ridiculous.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So yeah, because here's what I see in the future and people have asked like, could everybody be on these? I think it's possible. And again, I'm not advocating that everybody should be on these. What I'm saying though is like, imagine a world where we're getting so good at like precision medicine and being able to predict
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So like, sure, person that has the indication of obesity, we got to put them on and help them lose the weight. But what if we see that person's child and they're starting to go in that trajectory towards that same diseased obesity state? You could then target that person, put a little low dose and prevent that obesity from occurring in the first place and all the sequela that comes with it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And ideally at a low price. So I do think, and the other thing is you said, why not use this technology? It's the same thing of like, is anybody using a horse and carriage? Sure. And like Pennsylvania, Amish country and things like that. But like, are you using your iPhone? Are you using a telegram? We're using technology. As long as it's safe, of course, that's what you got to make sure.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But I like to embrace it as long as it's good. And, you know, obviously we've been burned in the past. And you got to be careful there, but I say embrace it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They're on all sorts of stuff.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
However, there were people that weren't losing weight, any weight. They didn't feel like any appetite suppression, but they were feeling tired. And so it's kind of like, okay, if they're not losing weight, they're not in a calorie deficit, they don't even feel the appetite suppression, but they're feeling tired, it's probably something beyond the calorie deficit that's making people feel tired.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's weight bias. I think if people really... They really have to think deeply and it doesn't feel good to feel like, oh God, do I not like fat people type of thing? But that's... It's a weight obesity bias. If you really dig deeper, why not help them? I don't know. There's no reason not to.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So the way that I approach is basically I strongly recommend – I give – I have a program called LiftRx. I'm like anything. I don't care if it's one day a week. I don't care if it's 10 – you start off at like 5 to 10 minutes once a week. Please. And I will say most people like they – They want to. They want to.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And again, like you said, there's some people, the knee pain, they never felt like they could. They were just feeling miserable. But after you get them going, it takes some nudging. They start getting more physical activity, like at least walking and things like that. But ideally, if they're losing a large amount of weight, it would be ideal to weight train.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Now, I don't gatekeep because I'm like, I can't force anybody to lose weight. I do think the clinical benefits of losing the adipose... outweigh not losing that at a post if they're not going to strength train, but like strongly encourage, strongly push it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So if I could, you know, be very paternal and make sure everybody does, yeah, everybody would be weight training at least two, three times a week, if not more, but two, three times a week. Yeah.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. So function, functionality, physical function, just living, activities of daily living, making sure that, hey, can you get up the stairs? Hey, maybe you got to pick up your bag of groceries and bring it up the stairs. All those types of things are so important. It goes back to the quality of life thing. And if you're not going to enjoy life, it's not worth it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And when you talk to them, is it like, do you just want to go to sleep tired? For some people it is, but what I'm seeing is just kind of like a lack of motivation. So before... They were going to the gym, they're trying to be healthy, doing all the physical activity stuff. And now all of a sudden they're just kind of like, oh, I don't feel like eating.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I mean, at least in my opinion, I don't know, maybe other people feel differently, but it's not fun to live a not fun life.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
No, I need to see it because it was supposed to be really good about obesity and everything.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
yeah it's you'll still see it right now like i'll get patients that they'll their doctors will be like no no you just need to go running and they're like but i don't feel like running it's miserable if you've got a lot of weight now so i do have some marathoning patients with obesity but it's not common and the last thing they want to do is go for a run that's uncomfortable for them so you get them strength training and it's something they feel comfortable doing like
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
To get discouraged by a doctor to do that, especially when there's great data for it, it's very frustrating. Thankfully, there's a lot more data. Actually, the guidelines say try to strength train a couple days a week, so that's good. It's still being pushed out there.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
AI is going to take over anyway.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's just crazy.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But I also don't feel like working out anymore. And that defeats the whole purpose. We're trying to get people healthier. So despite their adipose tissue or whatever, physical activity has many... I mean, I know you've talked about this all the time.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I love AI. I talk to it all day, all day long. Because I use Claw, ChatGPT, and Grok, and I cross-reference and then reference my other things and make sure that it helps me learn. And it's so smart, but it hallucinates sometimes when you cross-reference. But it's the future. I know it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah, who the hell is going to, the AI is not going to come fix my toilet.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I think the trades are going to get... I agree. I think that's... Unless they get robots, I suppose, but that's future, future, future.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. We'll see. Some of these things are beating. I mean, and I could see it. I've talked to Claude and these things, and it's like, oh, man, this thing is very compassionate when talking to me. I'm like, oh, man, this thing's better than me. I'm done.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. So we're publishing some case studies where we have a prospective trial or I should say a prospective study, not a trial. We're not doing a randomized trial. First, we actually will be doing a randomized trial, but we're showing minimal fat-free mass loss. So For people listening, you can follow my chief science officer, Dr. Grant Tinsley, who's a big-time body composition expert.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But he goes into how DEXA scans don't look at muscle directly, but it's a fat-free mass loss. And when people lift weights and eat adequate amounts of protein, not even overdoing it, but lifting weights, it's minimal. It's minimal. It's 10% or less or sometimes zero or even they gain fat-free mass. It's amazing.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yes, by far.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah, because this is like kind of standard sports medicine literature where the bodybuilders, the athletes... And when you look at that data, you need to send the signal to the muscle. You can give the muscle building blocks, but if you don't have the signal to build, it's not going to build anymore. It can maybe a little bit.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah, physical activity is super important regardless of the number on the scale. So that's like, okay, that started... I saw it so many times. And then I made a video recently about it. And then all of a sudden I got tons of messages from patients because they didn't report it. They didn't even know it was a thing.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But if you're not sending that signal to the muscle to grow or even just stick around, it's gone. So its magnitude is higher of importance now. And if anybody wants, so people like Brad Schoenfeld, Stu Phillips, those guys are kind of pioneers in that stuff. But it actually crosses over to obesity with these medicines. Actually, I was at an obesity conference and we did a debate.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I was going against a guy, John Jakisek, brilliant exercise researcher. And we had to pick sides of resistance training versus aerobic training when it comes to obesity. And back then, it was 2022 or 2023. Yeah, 2022 it was. Had to have been. Yeah, 2022 maybe. And I picked resistance training, of course. And I went through all of it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And back then, these drugs were just kind of coming out and people weren't talking about it as much. But I made the argument that like, look, these medicines will get people walking around and being physical activity. Nothing can replace resistance training. You just can't, you can't replace it with anything. You have to do it. You can't take more protein just to try to make up for it.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It won't do it. You have to send the signal. And now there are actually review papers out that basically I can tell some of these people were in the audience. Cause I'm like, that's, that was almost verbatim of what I said at the, at the debate. And people were kind of like, you know, they, they kind of agreed with me, but, um,
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
At the time, it wasn't like you said, like even 10 years ago for you at these conferences, people like now, whatever, just do aerobic training. But now people like, yeah, no, we don't have drugs yet. They're actually looking for drugs that try to spare muscle mass. And quite frankly, I don't think they're going to be super successful because.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
you actually have to look at the functional component of it. Sure, we can make people block their myostatin and all these different things that they're looking at and prevent them from losing muscle or maybe even make them gain muscle, but you actually still have to use it to make it functional. So I don't think anything's going to replace, not anytime soon, maybe in the future. I can't say never.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Maybe there'll be some drug where it's going to make you super strong and jacked, but beyond obviously. some testosterone derivative of some sort without the metabolic effects.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But some other people did when they come from other places and their doctors or nurse practitioners or whoever was saying like, oh, I think you just have seasonal affective disorder. I think you just need to go see a therapist. And they're like, what are you talking about? I never have seasonal affective disorder. I usually love the winter. This doesn't make any sense.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
We're not talking about GLP-1s being a shortcut, but when it comes to exercise and building, I don't think there isn't a shortcut.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And I was like- That's kind of interesting.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
I mean, the other thing that I've noticed is that people have this number on the scale that they want to see because they think they're going to feel good about their body and they get to it and they're like, you know what? I don't feel good about my body. I'm like, well, you know, I think you're focusing on the number too much. What you really wanted to do was shape it in a certain way.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And they're like, yeah, I think so. And they kind of point out some people or whatever. I'm like, yeah, they're lifting weights. They're shaping it. So whether it's for metabolic purposes or for aesthetic purposes, it's just so important. It's hard, though. You got to start and figure it out and whatever and try not to overdo it, annihilate your body and feel crappy and think of it as punishment.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And I'm like, no, this is the medicine. You're on a high dose and then you pull them back and they go, oh, now I still have the suppression and appetite, but now I've I'm going back to the gym and now all of a sudden a bunch of them are starting to break past their plateaus despite being on a lower dose. So a lot of that type of stuff that I see.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's like, no, you got to learn to enjoy it and have good programming and all that.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Perfect.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's like peanut butter and chocolate. Yeah.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah, so Vineyard is basically a direct care model for online obesity and metabolic care. We remove all the barriers between the doctor and the patient. You also get your own dietician. Our dieticians lift weights, by the way. They're very, like... They're GLP-1 expert dieticians, but they lift weights. We have strength coaches, community group events. We go much more beyond the GLP-1.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
That's what we focus on because that's what people want. But side effect management, lab, cardiometabolic management. I'm a lipidologist, so we do a lot of lipids and that type of thing. Even things like hair loss. You need some minoxidil to help with that. All sorts of stuff to basically... really facilitate and help people. But the big thing is it's a direct care model.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
We have small patient panels so that you get to talk directly to the doctor as opposed to some team member that then relays and you play this game of telephone. So that's joinvineyard.com. That's my new online clinic. And then Instagram, you can see me make funny memes and stuff there. I'm on threads and Twitter threads. I just basically talk crap to people all the time. I basically respond.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
It's such a weird platform, but I'm on TikTok as well. I'm all over the place. We have a podcast called Docs Who Lift with me and my brother, and we just kind of banter back and forth about stuff and promote actually exercise, literally lifting weights as medicine and try to promote the idea of lifting weights really for purposes of getting healthier.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They think I'm paid by Eli, Lily, and Novo. I'm like, no, I don't pay. I purposely do not take money from them just to be able to say this. My brother and I were just talking like, maybe we should take it. Do people care? I'm like, I like to just be holier than thou and be like, nope, I don't take money. See, I don't take money, but...
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They're not coming in.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah. That, that, yeah. If you're not enjoying life anymore, what's the point?
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
That's right. I see that not infrequently. I've actually surveyed on my Instagram and other places, you know, thousands of people taking the survey. And it was like... Some people noticed increases, but around like, I don't know if it was like a third to a half of people said, I know I noticed a decrease despite losing a lot of weight and wanting to have, they want to have that desire.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And of course their husbands are looking at them and going like, oh God, you've, you lost weight. I'm, I'm kind of getting interested. But now the, the, the wife didn't, you know, doesn't feel, and I see it in guys too though. I've seen a few where they're like, nah, they're getting erections and Because their testosterone has increased, but their libido, their drive has decreased.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And it's the motivation factor.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Woman in her mid-30s, she had been on 15 milligrams of Terzapatide Zepbound for multiple months and had plateaued completely for the past three or four months. And I was like, you know what? And she kind of described like, I don't feel like going to the gym anymore. And I was like, you know what, let's pull back on your dose.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Like when you look at the surmount trials, if you've ever pulled them up on your podcast, but the five milligram terzapatide is similar to the highest dose of semaglutide, Wegovi, the 2.4 milligrams. It looks around like 15% or so higher. percent total body weight loss.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
When you look at 10 milligrams versus 15 milligrams of true appetite though, there's like a very sliver difference of weight loss between the two. So that means that they're probably getting very similar appetite reduction between the 10 milligrams and 15 milligrams. Some people do better on that 15 milligrams, but like
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
A lot of times you start going up from that 10 to 15 milligrams, you don't really see much of a difference. And if you don't see much of a difference with the weight, the only thing that can happen, I mean, it's kind of logical that you could potentially see more side effects. And so what we did, we brought her down to the 10 milligrams and she felt so much better.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
She started going to the gym, broke through a plateau, lost 10 pounds, even though she'd been plateaued for months on the highest dose. And this doesn't break the laws of thermodynamics. People are like, it's all calories in, calories out. Yeah, she didn't feel like moving anymore because the drug was... And now I always talk about the drug facilitating behavior change.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But once it gets past that point and now all of a sudden the behavior change isn't occurring because they're... Their dopamine is so dampened down. That's not good either. So, yeah, it was pretty cool. It was really interesting. I was like, please, can I share your story? And that's what I did. And then tons of people started messaging me going, I think that's me.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
And I'm like, holy cow, this might be a bigger problem than people understand.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Yeah.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
You became famous for that. Yeah.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Oh, that's funny.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Very reasonable. And honestly, it's needed sometimes. In other countries, they have clickable pens that you can do. Well, Ozempic actually has a clickable pen, and that's here in the United States. But Wegovy doesn't have it. Zetbound doesn't have it. Manjaro doesn't have it. So you see a lot of people going to the compounding route, which is kind of going by the wayside now.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
But like in other countries, there are quick pens that you can do terzapatide in between doses. And it really is needed. It's more for semaglutide. Semaglutide is not as well tolerated. So it's nice to have that for semaglutide. But even terzapatide, the starting dose is 2.5. And sometimes I'm like, I really wish I could do a one milligram because this person's a high responder to this stuff.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
They're losing weight too quickly, even on the lowest dose. It would be nice to just go a little bit lower, even half of that. But you can. You'd have to You have to get the vials, and the vials are a single-use vial, or you'd have to inject the pen into and make your own bacteriostatic violators. It's ridiculous. And then it starts getting a little bit potentially dangerous there.
The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
So yeah, it would be nice if, and that comes down to, and we can get into the corporate greed, the pharmaceutical greed, but they don't want people splitting them up because otherwise we could just prescribe 15 milligrams of Zepbound or Monjaro and just have them split up into the smaller doses and have it last longer. They don't want that.