Nutrition & Immune

Ep. #1024: Spencer Nadolsky on Reasons to Use and Avoid Weight Loss Drugs


Mike: Hello, this is Muscle for Life. I am Mike Matthews. Thank you for joining me today for another episode. In this episode, I interview my buddy, Dr. Spencer Naski on weight loss drugs because a lot of people are talking about, well, one drug in particular, semaglutide, also known as Ozempic and Wago, V or Wego.

I guess I, I’m not sure exactly how to pronounce that, but that’s the drug that I am getting asked the most about. And there are a couple of others though that are quite popular and there’s a lot of controversy surrounding these drugs, whether they are a good thing, a bad thing, a good thing for some people under some circumstances, and a bad thing for other people under different circumstances and so on.

And as Spencer specializes in obesity medicine and has prescribed these drugs to many people and seen firsthand both the good and the bad, I thought he would be the perfect guest. And Spencer has been on my show several times before. He is talked about P C O S, thyroid health, heart disease, and he was happy to come back and talk about obesity.

Medicine. And so in this episode, you are going to hear from Spencer on a variety of things related to weight loss. He talks about why some people practically just can’t lose weight and keep it off in any meaningful amount with just diet and exercise. Now, of course they could. It is possible, but again, practically speaking, it does not work well for many people.

And Spencer gets into some of the nuance that is lost. When people take extremes when they say that obesity is purely genetic and there’s nothing that can be done about it whatsoever, and diet and exercise is really just a waste of time for the people with wrong genetics. That’s one extreme. And then you.

The other extreme, which is like the fitness fanatic who says that ultimately a calorie deficit is a calorie deficit. And if you choose to not maintain a calorie deficit, that’s your problem. That is your fault. And if you just had enough discipline, if you just had enough willpower, if you wanted it bad, You could lose the weight, but you don’t, so you can’t.

Spencer also talks about the latest and most effective weight loss drugs and who they are appropriate for, and who they are inappropriate for because there are disadvantages, there are side effects, there are reasons. To not take these drugs like you might just take vitamin C. And Spencer also shares what he believes will be the optimal approach to weight loss medicine.

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Spencer: Always a pleasure. 

Mike: I feel like I need to say that because you don’t always know.

Just like Dr. Jill Biden. Like what? What kind of doctor 

Spencer: are you? Exactly. Yeah. Who is this? Who is this? Neologist Me. Macon woke. Vaxxed and boosted. Boosted up. Let’s just 

Mike: focus on obesity medicine, which is something that I’ve been getting asked more and more about recently, and for reasons you’ll go into particularly semaglutide.

I think I’m pronouncing that correctly. I should have probably checked that. Pronunciation. And so anyway, AB asked a lot about this and this is your area of expertise. And not only from a research perspective and understanding what these drugs are and how they work, but also with patients, right, and, and seeing firsthand results.

And so I wanted to. Bring you back on the show to have a discussion about these drugs, and maybe we could start with what the most popular weight loss, uh, or obesity medicines are right now, and a little bit about just how they work and maybe how effective they 

Spencer: are. people will probably say like, why does anybody ever need an obesity medicine?

Are you kidding me? You just get into a calorie deficit. You eat clean and you eat some chicken and broccoli, and you lose the weight. Well, so the issue is most people understand what to do F from the most part. Now, you know, maybe there’s some little nuances here of how to actually get into a deficit if you.

Don’t really understand, you know, how many calories or whatever in your foods. But like a lot of people have done these types of, of diets and different programs, even with some of the best coaching out there. And if you look at even studies looking at gold standard intensive behavioral therapy where they have.

They’re meeting with a coach once a week. They get the physical activity guidelines and, and even supervised physical activity, both lifting and aerobic exercise and really intense dietary behavioral therapy. There’s a small percentage that do really well with it, and we see ’em, we see ’em on the internet, the people that have lost a million pounds with keto a million pounds with whatever.

And you see the, the highlights. What we don’t see are the majority, unfortunately, don’t do nearly as. If we look at averages, you know, the big, the big study that everybody points to it because it was so big, was called the, called the Look Ahead trial. Thousands of people, and they did this intensive behavioral lifestyle.

And over the course of now we’re getting, you know, past 10 years or whatever, we, you know, you wanna make sure people are losing at least 5% of their weight. But for someone that’s 200 pounds, that’s 20 pounds. Or for 10 pounds, if 10% is 20 pounds, so 10 percent’s really good, five percent’s, okay, so they lost 10 pounds.

And people are like, that’s not great. Over, over 

Mike: what period of time. 

Spencer: So when they look at these studies, it’s generally a, a year long, but then you want to extend it to see how long they’re keeping it off. That’s like a good gold standard trial to look at, to say like, what, what actually happens to people that have this really good lifestyle and, and just the majority of people won’t lose a lot of weight.

What, what people would hope to lose. And so you’re like, well, what’s going on here? Well, when you look at some of the, what they call like the pathophysiology or the reasons people aren’t losing weight, you know, they look in the mechanisms and people get hungry when they’re trying to lose weight and keep it off.

You know, we could, we could debate on, you know, set points and whatever. I actually am friends with some of the scientists that go into that, and there’s some people are like, no, no, there’s no actual set point. Whatever. I. An expert in that, other than I need to understand it a little bit. We just have biological drivers that fight against us.

Our biological drivers are a lot related to appetite. You’ve talked about non-exercise activity thermogenesis in the past. Some of that kind of goes down, but a lot of it is our drive to eat and so, We’re surrounded by yummy high calorie foods all the time. Your coworker brings in donuts and cookies every day and you’re trying to eat well, but there’s only so long that you can stay away with it when you’re, especially when you’re in a calorie deficit trying yourself, cuz you’re, it’s just like your brain’s going, eat that, eat that, and you’re like, no, I’m gonna eat my chicken.

Or whatever the heck, whatever the heck you, I’m gonna drink my protein shake, whatever. Some people are able to. They, they do great, but a majority of people unfortunately just can’t do it. So we look at weight loss medicines as kind of that next step. And the thing is, a lot of people were burned because if you remember Fenfen, which is Phentermine, fenfluramine back in the nineties.

The fenfluramine component caused heart valve issues, valo, and so that burned. A lot of people are very skeptical of weight loss medicine, but these medicines in general, there’s some that work slightly differently, but in general, they work up in the brain to help people with appetite. Phentermine is still around That one’s, that one was around in the fifties, but that’s when they, they combined it with fenfluramine, which was a serotonin, like agonist.

They put it with phentermine, which is kind of a sympathetic amine. They call, it’s kind of like amphetamine like, but it’s not addictive. Works up in the brain nor epinephrine and helps people with appetite. Those were kind of the mainstay drugs. It wasn’t until recently we got into these, now they’re the most popular are these GLP.

Agonists. And the reason they’re so popular is because they’re extremely effective and much safer than previous drugs. The way they basically work is they, we have these, uh, receptors up in the brain, and that’s what controls our hunger, satiety, and even our reward system. The reward system, think of it as like, Hey, I’m full and satiated, but for some reason I want that cookie, like I’m full.

I don’t understand. Why would you want that cookie? Well, that’s part. Reward system, kind of having you go towards that food. These drugs can not only make you feel satiated, but also kind of make you not care to have that cookie or not. GLP one is glucagon, like peptide one, they’re called in Incretins because back in the day, I don’t know if it’s the fifties, I can never remember the exact date, but they injected glucose into the veins versus like ingesting glucose.

And you would think. Ingesting or injecting glucose would spike your insulin a little bit higher and faster than, and more so than ingesting drinking the glucose. But something about drinking the glucose made your insulin go up, and they called it the incretin effect or intestinal secretion. Of insulin.

And then throughout the years they were trying to figure out what, what were these incretins? There’s a few of them, but GLP one was one of ’em, and it wasn’t till the early two thousands or late nineties where they started trying to figure out how to make an agonist of this GLP one. Cuz when you inject just GLP one into people like our own endogenous.

It gets degraded very quickly. So they wanted to see, can we make this so it doesn’t get degraded quickly and actually has an effect. And they wanted to make it for type two diabetes. So the first, um, the first one was approved in 2005, actually called BTA or Exenatide. Injected twice a day, helped people with their blood sugars.

And also, unlike insulin, helps people lose weight. So insulin helps with the blood sugars, but makes people gain weight in. , but these new ones, they actually help the body produce more insulin, but help people lose weight and helps lower blood sugars, which is kind of interesting. 

Mike: And the primary mechanism through which they help right, is re reduction of 

Spencer: appetite.

So that’s for weight loss, but for, for blood sugar, they actually, they actually lower what’s called or block glucagon, lower glucagon. A glucagon is a hormone that increases our blood sugar, you know, if we need it. Because if your blood sugar goes too, Glucagon comes out and helps release blood sugar into our blood.

That’s one of the mechanisms. It helps, uh, it helps augment the pancreas’s effect of releasing insulin. It helps the pancreas. It doesn’t burn it out. It actually protects the, the pancreas as well. So that helps that, but then also helps you lose weight, which can help reduce insulin resistance, so you don’t need as much insulin in the long run.

There throughout the, these years, since 2005, the biota was, you know, twice a day injection, which is kind of annoying. Then they came out with something called Liraglutide, which is Victoza, as people might know it. That was a once a day injection, and then actually in 2000, you know, 14, they. Increased that liraglutide and got it approved as saxenda for specifically obesity.

And now people are losing about 7% of their body weight, which for a lot of people doesn’t seem like a lot, but you know, it can have an effect of course. So that’s again, a 200 pound person losing 14 pounds. 

Mike: And specifically for weight loss, though, the, the mechanism is, is reducing hunger. That, that’s what I’ve heard from people who have used it, reached out and said, Hey, this thing killed my appetite.

Like I was just talking to somebody a couple weeks ago who was telling me that how amazing it was. Now this is something we can get to. This is someone who actually was doing quite well with. Just eating well and exercising and he wanted to lose the last 10 pounds to get his six pack, and he just wanted to make it as easy as possible.

So he is like, yeah, whatever. I’ll just inject this drug. And he was like, wow, I don’t even care to eat food anymore. 

Spencer: This is cool. Yeah. So, you know, I wouldn’t prescribe it to that person, which is interesting. I, I don’t know where they got it from, but, um, yeah, we can totally get into the indication. A friendly doctor, I’m sure.

friendly doctor, a non boosted friendly doc, doctor, so, so, okay. So that was a once a day injection. That was pretty good. Researchers still trying to figure out how do we make this last longer? How do we make it stronger? And eventually there was one called Trulicity or Dulaglutide that never got approved for obesity, but it was pretty good for blood sugars.

That was once. But then Semaglutide came out and got approved as a Ozempic. Semaglutide is the generic name. That’s the one you most people are talking about, and I’ll talk about the one that just came out recently, but Semaglutide once a week injection, they started as ozempic for type two diabetes, but they, and that was only one milligram at first when it got approved.

It’s actually up to two milligrams now for Ozempic. But that, that was a later thing. . They studied in higher doses from one milligram up to 2.4 milligrams and studied it for obesity. Then they published, it was like 2021. The effects, uh, it’s called the step trials, but step one, people losing about 15 or so percent.

So they doubled what was seen in the last GLP one, which was that saxenda or liraglutide stuff. That was once a day. Now we doubled the weight loss effects. The thing is that people. Get worried about like, seems like a crutch or a bandaid, but it, but what it really does is helps you do the things that you already know you should be doing.

And like, you know, probably, Hey, I shouldn’t take an extra serving. You know, I, I should probably keep it as this plate. I should probably eat broccoli instead of the french fries. I should probably eat apples instead of those cookies or donuts. Right. It’s, it’s pretty, pretty straightforward. You know, some of it’s, Again, there’s a little bit of nuance, but most people understand it.

These drugs help you do that without, without having to like, what I call white knuckle it or, or really strain your executive functioning and your brain. It gets rid of that food noise, what people say. There’s like kind of these like little voices going, eat, eat, eat, eat more, eat more, and they basically quiet it down.

And so that’s the newest one. The semaglutide stuff, you only have to inject it once a week. It’s approved as we go V for obesity. And they’re actually, I just posted this, they’re actually studying it to go up to much higher doses of it, but like 7.2 and even 16 milligrams and those with type two diabetes, we’ll see if it has a more of an effect.

And then the most recent one that was released called Manjaro or Tze Peptide, they call it a twin Cretin cuz there’s two. Incretins and there’s GLP one and G I P. Whether the G I P has uh, an effect more on appetite is debated, but that one in obesity, uh, folks with obesity, that actually helped people lose 21%.

So now we just tripled what we saw from the Saxenda in 2014. So in just eight years now, we saw triple the effect and just absolutely remarkable. I’ve never seen anything like it. I’ve lots of patients on these medicines. Granted, that one’s only approved for type two diabetes right now. It’s likely gonna be approved for obesity coming up here soon.

So if you’re listening to this, uh, and it’s approved, um, you know, awesome. But it, it, it probably will be approved but never seen. I’ve never seen anything like it. It’s extraordinary. And we’re getting close to what we see in bariatric surgery, uh, studies, which is 

Mike: pretty. And what are your thoughts? Um, somebody who is very overweight, who, let’s say they haven’t tried anything, let’s say evidence-based.

Uh, they, they maybe tried a couple weird fad diets and maybe they lost a little bit of weight and gained it back, but they’ve never really understood maybe energy balance and macronutrient balance. And they’ve never tried eating a high protein diet as opposed to a high carpi fat. They haven’t tried some simple things, lifestyle modifications that as you mention, Some people do succeed with many people.

It’s not a majority, but in an absolute number. Many people do succeed with a lot of the, the fundamentals that, that we preach. So what are your thoughts on that person? Should they try first to, to, to do it without drugs, without medicine, because. There. There usually is. There’s the giveth and the taketh.

Right. How does that work in the context of these medicines or so far? Does it really look to be like, no, just looks to be all benefits and no real side effects? No long-term 

Spencer: possibilities? I think this is a great nuance question because you know, there’s some of these, you know, big pharma shells if you want to call ’em, that would basically be like, no, everybody needs to be on drugs.

Like just, it’s even stupid. Try diet and exercise. And then there’s other people that are basically like, I can’t believe that we’re using medicine. And the answer is that first, there needs to be patient autonomy. You can discuss the benefits and risks. In general though, if you can get somebody excited about trying an evidence-based way with very intensive coaching, I think it’s worth a shot.

Now the question would be like if this person has like no health problems, just excess. There’s not as much of a a rush if somebody’s like, this guy’s had a heart attack, he’s a walking time bomb, and if we like prolong this any longer, we don’t know how much life he’s gonna have. You know, you could argue, hey, maybe we need to be more aggressive that person.

Maybe we just need to give them the medicine cuz there’s no way in heck this person’s gonna to do it. What I see though, I see most people that have done so many different programs so that a lot of the people that I see are coming to me for medicine. . But if I’m in a general clinic and I’m assessing somebody for weight loss for the first time and they’ve never tried anything, I talk to ’em.

And most people, most people will go, you know what? Let me try this more intensive program first. I think that’s a fine answer. I, I really don’t think it needs to be one way or the other. I think it’s, it’s one of those things where it’s like, look, if somebody’s tried it multiple times, but as you’re saying, if the person’s kind of like naive to the whole, like trying a real like.

Based gold standard type of coaching program. I think it’s totally worth doing that unless they’re at just such a high risk where like, we better get this weight off this person. They don’t have much longer, and that’s, that’s rare. You don’t see that that often. And so I, I think that’s a, that’s a good, great question though.

And I think this is where some people miss the boat, especially when you look at like, Tweets and whatever, and it’s like, this person’s a shill, this person’s ignorant. You know, why can’t we talk about this a little bit more? So, yeah, good question. And, and 

Mike: your comment about my buddy suggests, um, that you wouldn’t consider these drugs for everyone, for anyone.

If anyone, if you, again, if you’re a guy and you’re just 10 pounds away from shredded, just, just take the drug. It’s gonna make it even easier. Why not though? Aside from the ethics of prescribing, but let’s just say you could just go to CVS and just buy the. 

Spencer: Yeah, great question. So these drugs do have side effects, and while they’re very well tolerated for the most part, and the benefits far outweigh the risks for those, for where it’s indicated, nausea is the most common thing you see generally goes away for most people.

Some people get constipation, some people get diarrhea. There’s a worry about gallstones and I think, I think a lot of it has to do with how quickly people lose weight with it, which can increase the risk of gallstones due to the change in composition of the bile, which can form stones and then, and then can get stuck in the little ducks and cause inflammation and, and it can actually cause pancreatitis if the little stone gets in the wrong place.

So there are risks there. The one thing I would say though, It’s kind of the same risk of like somebody who’s doing this weight cycling. If somebody has like 10 pounds to lose and they can’t do it with lifestyle alone and then they use the medicine and lose it, are they gonna stick on the medicine forever?

Probably not. I mean, I, they could, I suppose it’s, we don’t know the, the risks of someone being healthy and, and very lean staying on it. But if I had to guess, I would say the risks are pretty low. But then that person’s taking an expensive medicine. Long term now you could say, well, why not just stop it and cycle it?

Well then they’re weight cycling and you know, I’m sure you’ve had podcasts about weight cycling, but it’s like you risk losing muscle and then you gain some weight back. Sometimes it’s fat. You try to lose the weight again, and then you lose some more muscle and you start changing the body composition unfavorably.

To me that has to be the, the risk can also have 

Mike: negative psychological effects too. People get caught into that yo-yo diet mentality. 

Spencer: To me, that has to be the risk. I, I don’t know if physiologically, other than the weight cycling, you know, like I said, there’s nausea, there’s potential gallbladder things, you know, there’s worry about pancreatitis, whether that’s real or not.

The, the signal they do these studies and look, it’s like, it doesn’t seem like the incidence is different, but, You know, if somebody gets a gallstone because they lost the weight, I, I don’t know. But I would say the, the weight cycling and if you’re willing to stay on it for long term. Some people think though, why do I need to be on this long term?

I would say people that have had weight issues for their whole life likely are gonna have to stay on this drug long term if they start it. I have a feeling that those people who just long-term like chronically. Indefinitely until something else comes out. I mean, like, you know, , you know, are they gonna somehow splice our genes to ch I I don’t even know what could change if they get bariatric surgery.

Obesity vaccine. Yeah, an obesity vaccine. They’re studying all sorts of crazy stuff. I don’t know. Something in the future that could, could change that, you know, bariatric surgery is more permanent. But I, I will say that I have a lot of patients actually had bariatric surgery now coming to me for medicine and they’re gonna have to stay on the medicine with their surgery long term.

But I. There’s a lot of people that had, that were lean, but something happened, A death in the family, A pandemic threw them off. You know what’s interesting about the pandemic? Some people took it and got leaner. Some people, it just threw them off to where they gained weight. And it’s like, I see that a lot of times.

I think those people have a better chance of getting off the medicine because they only had poorer habits during the pandemic and now they’re in this rut, and now you gotta, if they start feeling better, they can get back into their, like 

Mike: for them. Regression to the mean might mean going back to just being kind of lean and fit, right?

Spencer: Yeah. So I think, I think they have a good shot at getting off. I think those, the people that struggle with their weight for a long time, I think their appetite drivers have been there since childhood and they’re gonna have troubles coming off the medicine. My, uh, Clinic online, we, we are trying all these different things cuz there’s not really much guidance around it.

Um, actually, and, 

Mike: and just a follow up question to that, this is inevitably gonna happen for some people, but maybe is it something that could be encouraged so you have a scenario or due to environment and some genetic factors, which we’ll get into? That’s one of my questions when I ask you about, but, so at a young age, they just got used to eating a lot of food and blah, blah blah and they, now, they’re very overweight.

They use this medicine to. Help them lose a lot of weight, which, uh, I think this was clear, but I’m just gonna say for people who are not sure it’s a calorie deficit that drives weight loss. No, no medicine changes that, it just, it just makes it easier for people to sustain a significant calorie deficit.

So, so they do that, which ultimately means they change their eating behavior, like you mentioned. Okay. They started going for the apple versus the cookie because the cookie didn’t appeal nearly, nearly as much as it used to. And now, If both of the things are, let’s say, emotionally equal, it’s easy to go, oh, I’ll take the apple because that’s better for me and I don’t care.

I don’t care about the cookie. I’ll eat the apple. Right? So let’s say you have somebody and, and they, they’re on the medicine and they lose a lot of weight. I mean, it’s certainly possible, right? That they could also use that period to. Create some, some new behaviors like to kind of re-engineer their lifestyle.

So maybe they actually could. Yeah, 

Spencer: this is the controver, not the contr. It’s, it’s just debated because I don’t think anybody knows. But this is what you’re saying is my hypothesis. There have to be people that. If they are able to rewire their habits. There’s some people that have been trying to rewire their habits forever, and I think those are the people that that like, they’ve just been trying forever and they struggle.

I think those people have that true physiologic driver in their brain and the medicine blocks that or dampens it, but I think there’s other people that their habits, they can get rewired from the medicine and then. Come off the medicine, their habits are so good that even if that little bit of that reward and appetite drivers come back, they are so ingrained in their habits, I think that maybe they’ll regain some of their weight just from eating just bigger portions.

Uh, there have to be a subgroup of people that do well, and I There are, there are, there’s a few studies showing that most people do regain their weight. Not all of it necessarily, but. There are people that will maintain and we’re, what we’re doing is I’m weaning people off who want to, and then seeing what happens.

And some people are going, Hey, I’m good. And some people are going, no, my appetite’s back. And then I don’t have to put ’em on a high dose, just a tiny little dose of it. And I actually, instead of every week, I’m extending it to every 10 days or even longer. It’s interesting stuff. And I, you know, that’s what they’d call like the heterogeneity of obesity.

It’s not just one thing and it’s not just, you know, genetics or this and that. It’s, it’s. It’s a lot of different things going on that I don’t think anybody can really explain clearly just yet. Yeah. 

Mike: Theoretically, some people could have success, right? With, okay, so they don’t have the, the, the appetite, they don’t have the reward system firing the way that it normally does.

Maybe use that as an opportunity to just stop buying. The cookies all together because now you don’t really care about the cookies. And if you go for months and months now where you have even a new shopping habit, you buy the foods that you buy, you’ve found those handful of fruits and vegetables and whole grains and lean proteins that you just like to eat and you have improved your relationship with food.

That when you come off the medicine, there’s a fair chance right, that that momentum will, will continue to carry you forward again, like you said, okay, fine. You regain a little bit of weight, but you just don’t go back to the 

Spencer: previous you. Yep. I, there have to be people like that. I, and I hope we’re, you know, we have a huge like, uh, population in our clinic that we’re trying to figure this out.

I’m hoping we can run some studies and si seeing what are the characteristics of. Those people and, and then maybe there’ll be some trials looking at that. 

Mike: I mean, exercise is gonna be big, right? We already 

Spencer: know that. Okay. So yeah, imagine this. People don’t like to exercise cuz they’re in pain. Now all of a sudden you help them lose weight and now the pain’s kind of gone and you help them.

They’re in a smaller body size and now all of a sudden it’s like, I kind of enjoy this. The exercise can then be utilized to help prevent some of that weight regain, or a lot of it. It’s interesting stuff. So I think you’re on the right path. 

Mike: Hey there. If you are hearing this, you are still listening, which is awesome.

Thank you. And if you are enjoying this podcast, or if you just like my podcast in general and you are getting at least something out of it, would you mind sharing it with a friend or a loved one or a not so loved one even who might want to learn something new? Word of mouth helps really big. In growing the show.

So if you think of someone who might like this episode or another one, please do tell them about it. Can you talk to us about some of the primary driving factors of obesity? Uh, there, you, you had mentioned before, we, before we started recording, there was a 60 minutes clip that made the rounds on social media of somebody saying it’s just genetic.

And that turns into an argument f kind of like where people with obesity are just victims of their bodies, and that’s why they just need drugs and. 

Spencer: What are your, what are your thoughts? Yeah, so it’s, it, it’s an interesting, interesting, uh, discussion because, so for anybody listening, I’m sure they saw some, somewhere, a headline or maybe even saw the clip 60 Minutes.

Very, actually a very smart physician researcher, uh, Dr. Fatima Stanford. She’s a, a Harvard physician researcher. Going on 60 minutes and, and it looked like almost like the clips were spliced up, but they, the way it made it seem like is that diet and exercise don’t matter. It’s your genetics. Even if you have good diet and exercise or whatever lifestyle plan that genetics are gonna control you and.

They have no choice. That’s the way they made it seem. And then, you know what’s interesting is then the other people online are going, Hey, this, this doctor looked like she got thousands of dollars from big Pharma last year and she’s talking about these drugs. Like, you know, kind of like I’m talking about these drugs.

And she didn’t even mention, uh, and the environment. And sh basically it sounds like genetics are the number one cause of obesity. So then you got people really upset about it. You know, rightfully so. I, I honestly think, I, I think the media, you know, she probably did a ton of interviews and they probably took small little clips and made it seem the same.

Cuz I know she knows. 

Mike: But, but I mean, the counterargument to that is if she made that statement, which I mean, I saw the clip, she clearly. Did like you wouldn’t say that. You would not say that those words in any context unless you were like quoting someone else and then you were about to followed up with a counter argument.

You know, , 

Spencer: I know. I want to give her the benefit of doubt and say basically like, cuz she is very smart. She knows that envi, I, I actually did a whole Instagram story about it cuz other people were so upset. So I said, cause I also wanted to play devil’s advocate too. So since the 1970s I showed a graph of the prevalence of obesity.

I mean, we see the pictures, you can see the pictures in it. Some people are like, oh, this is fat shaming and whatever. It’s like, no, you see the pictures of the beach of, in the 1960s or seventies and Yeah, and it’s, and so, and you can, I mean, you can look at the statistics on the graph and then you can look at at pictures now, and it’s like, wow, we are.

You know, heavier. And so, you know, I asked the question, did our genetics change? And everybody said, no, no, our genetics didn’t change. I’m like, so what did change? And everybody said, it’s the environment. Okay. So we, we all agree that environment had, like environment caused it. Then I posed the question though.

There are people, and we all know them, there’s people that they don’t give a damn about their health. They’re eating fricking whatever. And yet they stay and sometimes like almost under. And they’re not like one of us. They’re not into fitness to where we, we clearly are fit and we’re, we’re lean, whatever, because we really focus on it.

These people don’t, they have like the worst habits, and yet they’re. They’re lean. And so I asked the question, did the environment cause them to be lean or did the, the genetics? And, and everybody goes, well, okay, now that you put it that way, the genetics, so the genetics caused them to be lean, but these people with obesity, it was the environment.

And so the answer is, you know, the, there’s a gene environment interaction. The jeans that this, I didn’t make this quote up. The jeans load the gun, the environment pulls the trigger and you can see it cuz there’s large variations in weight of what an environment will do. And so some people will say that, but their genes didn’t make you eat.

Like nobody puts that donut in your hand and makes you eat it. And what what I’d describe is though, No, and people know that for the most part, these donuts and chicken nuggets or whatever, french fries aren’t as good as whatever else, but most people live subconsciously just kind of going in and out of their daily.

They’re not, they’re not reading muscle for life, you know, they’re not leading reading, uh, bigger or stronger, whatever. They’re, they’re not into it. So they’re subconscious. They’re living in their environment. They’re eating the cookies that Cookie Carroll and Donut Dan bring in. They’re 

Mike: often also surrounded by people who do the exact same.

Yep. 

Spencer: So they’re surrounded by that. So we all have this different weight variation, and some people don’t. They’re just leaned despite this, and it’s because they’re appetite centers and, and the way they respond to, you know, some of it’s their basal metabolic rate, but it’s not metabolism so much. But a lot of it’s their appetite.

They’re the rewards centers intact. They can have a cookie and whatever. Oh, I don’t care. They can go on and not eat for long periods of time and they can eat small servings and just, that’s just what they do. They subconsciously go through life being lean, whereas most people, uh, go through life and have more genetic, uh, propensity.

Mike: And, and if I can just comment there quickly, cuz I’ve heard from so many of these people over the years, so I’ve heard from people who were those people and they, they would say, So their perception of themselves, right, is that they would eat so much food, so much junk food, eat anything, and stay lean.

However, when I would ask them to keep a food journal, what we’d find out is, yes, there were some large meals, there was a lot of junk food, but if you looked at their actual calories, they had a, they had a lot smaller appetite than they thought they did. They were not eating nearly as many calories as they thought they were.

And even the people around them were perceiving it wrong too, because, See that instance of the, what looked like a binge, but what they wouldn’t see is like the next day they barely ate anything.  

Spencer: Cause they weren’t even hungry and they weren’t doing it purposefully. They just weren’t doing, they weren’t eating.

Mike: Yeah. It was just like, oh yeah, whatever. I was at a restaurant at all, was tasting good and then the next day I accidentally ate 500 calories cause I just wasn’t hungry and I forgot to eat. Yes. 

Spencer: So on my stories, I wanna make sure people don’t take away that like, no, you’re not destined, though. It doesn’t mean that like just because your genes, you could do a polygenic risk score and it looks like all your genes are gonna make you have obese.

That’s not true because when you actually look at the data, You can mitigate or minimize that weight gain. You can, you can basically make, turn out to look like one of us despite your genetics, because you still need to lo, you still need to pull the trigger of that lifestyle, but it requires you to be pretty conscious about it early, adopting healthy habits, hopefully from your, your family.

So anyway, the, whether it’s genetics environment, it’s both, it’s an interaction. Some people have genetics that are just gonna make ’em lean forever. Most people are gonna have more genetics propensity. Gaining weight in this current environment. Okay, here’s the, here’s the other thing. So if you put all these people on an island where they had to fish, basically what it was however many years ago, there’ll still be variations in body sizes, just slightly.

It’ll be small variations. But now we’ve taken ’em and put this environment where we’re now gonna have these huge. Variations in body sizes. So even the people that were being just a little bit larger back in the day when they, you know, had to fish and gather berries, they, they’d still have a larger body size.

Now this, it’s, it’s extreme. It’s extreme. So now we see these BMIs of whatever, 50, 60, uh, and that type of thing there and there. I will say there’s, there’s a difference between monogenic where you have like a deletion in one of the major. Areas that regulate appetite. Those are pretty rare, but those are the type of people where it doesn’t matter the the environment or not, they’re gonna be voraciously hungry.

You hear about people locking their cabinets cuz the kids are going in and eating whatever they have. They’re eating the flour and the peanut butter , it sounds, it’s funny about they have to lock the cabinet, they’ll break down things because of some of these deletions in the. But I’m talking about polygenic obesity, the common obesity that we see where we just have small little gene variations that add up that might increase our appetite.

So if people have more appetite signals, it doesn’t destin to them to be, you know, have obesity. Like you said, if you start, especially if you start early with them and you, you, you surround them and, and as a parent you do the best you can. You know, kids are gonna demand their goldfish and whatever else that they want, and they go to birthday parties.

Interesting enough. Bring my kid to the birthday parties and I’ll notice other kids, they’ll eat couple cupcakes, you know, couple cupcakes, two or three. Sometimes I want another cupcake. And my kid, I swear to God I don’t, I don’t, cuz I don’t wanna cause any food issues. I’m just like, yeah, go ahead. Have, have a cupcake.

Sometimes she’ll eat half of it and be like, okay daddy, I’m full, I’m and I’m done. And I’m just like, that right there is the Ross form of like, Genetics. I, I’m not sure. So blessed.  

Mike: It, it’s kind of like the marshmallow test, right?

Spencer: Yeah. It’s, it’s, it’s super interesting. So the whole point of bringing this up is like, what’s the cause of this?

Of, of course, there, there, there has to be an environmental thing. There’s no doubt about it. You can see the pictures from the 50, you can see the graphs and our genetics did not change, but the genetics absolutely loaded the gun. I say it with the lean people that are lean, even despite this environment.

Their gun wasn’t loaded. So despite the environment trying to pull a trigger, nothing’s gonna come out. So these medicines, it’s a conspiracy theorist dream to see that 60 minutes clip. And I say this in it cuz I, I love my field. I think Dr. Stanford, she’s brilliant. The problem is the way they made the clip, her role with big pharma and all this stuff.

It’s like, oh gosh. They’re really making a, a show out of it. Cuz it looks like, what it looks like is that we just need to put everybody on drugs, which is a valid concern.Right?

Mike: It is. I mean, cuz unfortunately life is, is kind of that simple. Many people are mostly motivated by money. I’m not saying Dr.Vaz, I’m just saying unfortunately that is generally, that’s the rule, right? There are exceptions, but that’s the rule.

Spencer: Yeah. So, so it looks like a, you know, she’s on the new dietary guidelines and she’s brilliant. Like I, and people are like putting expert and they put expert in quotes. I’m like, she deserves the, she deserves the label of being an expert.

However it looks. I, I understand it looks bad as it looks like the whole 60 minutes things, people’s are basically saying it looks like an advertisement for semaglutide or ozempic drug we were talking about earlier. And it makes it seem. Who cares about the environment, diet, and exercise. It’s just genetics.

You’re doomed. We just need drugs. And it’s like, well, hold on a second. Here’s what I would say. I would say, okay, let’s, let’s give the drugs to those who really need it. If I had control, I would be trying to make huge policy changes in, in food. And I don’t, I don’t know how to do this stuff, but I’m just saying like, If we could somehow change our environment back to what it was, I have no idea.

How do we, how do we change our en environment? I have no idea. I have no idea. We, we’d have to dismantle big food and we’d have to dismantle it all, start from scratch. People would be pissed. And the money, the, there’s a lot of money running around. I don’t, I don’t know how you do it, man. I, I have no idea how you do it, but I do know we are not doomed to our genetics if we could just get our environment back to what it was before, which will never happen.

Maybe there’s another way forward it. Think these drugs are amazing. I love them. We should, we should use them for those cases that need ’em. But at the same time, if we can prevent it from happening in the first place, then we wouldn’t necessarily need the drugs other than in more extreme cases. So that’s, that’s the gist and I, that’s the nuance that I think is needed.

and, uh, people aren’t of course doing it like that. . 

Mike: Yeah. And, and, and to, to your point, unfortunately, like, okay, what’s the major change in the environment? Of course part of it is just how easily accessible, highly palatable, high caloric food is, right? I mean, you don’t even, you don’t even have to get up anymore.

You can just, uh, pull up an app and order 5,000 calories of garbage and just eat it sitting, you know what I mean? You don’t have to go. Exactly, and so what is the solution there is should it just be some sort of, kind of top down right. Banning certain things. But that, that, that was gonna be my next question.

Your thoughts on that, that, that these food companies, they certainly have responsibility. You’d have to agree with that, right?

Spencer: I mean, how do you get ’em in check? I have no idea. I don’t know how you get these people in check. 

Mike: How, how do you get them? To care more about public health than profit I is actually part of the problem because now they’ve also created a huge market, a huge demand for these highly processed foods.

And in marketing, and this goes back to Claude Hopkins, turn of the century. You never try to create. Demands create trends. You just work with. Demands are there. If you’re looking from purely a marketing standpoint, it’s too hard to change people’s desires and change their behaviors. You just work with the desires that they have.

So that’s what these companies have done. Now, they probably also. Probably argue that they’ve spent a lot of time and money creating the market as well. It, it’s almost like vice, it’s not that hard to create a market when you’re talking about delicious food that like lights your brain up, you know, it’s kind of like selling drugs.

Just try it. There you go. That’s, that’s why drugs are great. Or I’m talking about street drugs, obviously. Yeah. 

Spencer: I, I, I, exactly. People will be like, well, it’s not like this stuff’s cocaine. Well, you know, these have addictive like properties and if people have the propensity and coming back to genetics.

Mike:Right. Certain people respond differently to that cookie.

Spencer: Yes, exactly. And it, and, and the drivers there, and these scientists, you know, they’re making food people want to eat more of so they can sell more of it. The Pringles, once you pop, you just can’t, I, I don’t know, honestly, like it’s wrong to say that it was only genetics.

It’s wrong to say only, obviously, only environ. I do think though, like if we could somehow revert back to whatever our environment was, I mean, that’s, that can’t happen. So then maybe there’s a way forward where they use technology to then, you know, hopefully get people not to eat. I, but the food companies, they’re not gonna want that.

They’re, they don’t, they want people to eat their stuff. I don’t know. It’s, it’s a great question. We should get, we should get a policymaker, if food companies

Mike:  If they could get on board, I think of, um, one of the major tobacco companies. It might be Philip Morris, like part of their PR is moving toward a tobacco-free future smoke-free or something like that.

And, and I don’t know if that’s more vaping or whatever, it might just be PR and bullshit. But, you know, I think of that if that is true, where they’re, where they’re saying, okay, our entire brand is cigarettes, but we want to help try to move people away from, you know, smoking cigarettes that have hundreds of chemicals in them.

Terrible. One of the worst things you can do for your health toward using other products. I mean, theoretically food companies with the resources that they have available to them may be able to, you couldn’t, you couldn’t do it quickly, but maybe over the course of decades you could actually start to shift people’s preferences toward.

You know, healthier foods, maybe if you applied the same level of diligence and research and money and whatever that they’ve applied to creating these highly processed, delicious foods. You know, I don’t know.  

Spencer: It’s something, it’s really fun. It’s, it’s kind of a fun thought experience. I mean, some could say then, well, what if they make a, an obesity vaccine that basically splices some of these genes and then make ’em have the genes of the lean people.

Uh, I don’t know. Maybe that’s some future. Gatica shit that I’ve never even, I can’t even imagine. But I suppose that’s possible that if they have the genes of those lean people despite this environment, I don’t see that being a solution anytime soon. I don’t know. That’s some scary stuff, but I , I dunno.

Mike: Yeah. I mean, we have to assume that’s at least decades away from. Even being, yeah. Available to anybody 

Spencer: probably. So, yeah, it’s a good thought experiment. I love thinking about it cuz I, you know, I always talk to patients and, and I’m like, look, you also don’t blame the patient though because people say you have to have some self responsibility.

I’m like, I get it. But if you have something nudging you to eat something all day, whereas someone else doesn’t have that nudge, I don’t know if that’s it. It’s not necessarily their fault. I always say it’s still their responsibility right now to, to try to do something about it, but like I wouldn’t blame them or fault them, if that makes sense.

Mike: So, yeah, I mean, minimally it’s not productive, right? I mean, it doesn’t help them because in a way they know that ultimately, of course, they’re. E even if these problems are not necessarily their fault, like the genes that they have are not their fault, of course they know that resolving the problems, it it, it comes down to them, it’s their responsibility.

Spencer: They understand that. Exactly. Yep. I, I, that’s, that’s exactly right. So I, you, you go on an island and you gotta fend for yourself. Like you have no ch you literally have, there’s no other option. You have. You can’t eat the cookies, you can’t eat extra servings cuz you have to fend for yourself and go get it.

So it’s kind of a, kind of inter, you know, and some people may think that’s a little bit shameful, but it’s, it’s just the reality of how our environments shape us. So anyway. Cool. Good discussion. 

Mike: Yeah. Yeah, it was a great discussion. Uh, thanks again for taking the time. I know you have a hard stop coming up here in a few minutes, so why don’t we just wrap up with where people can find you and find your work and learn more about the stuff we’ve discussed today and, and obesity in general, and, um, and health and fitness, you know, all the, all the stuff that you like to educate people on.

 

Spencer: If  people are like, Hey, I’m interested in these weight loss medicines, you can see we have a [email protected] It’s my online clinic. You can take a quiz to see if it’s indicated. It’s a 27 BMI plus a, what’s called a weight-related comorbidity, hypertension, pre-diabetes, that type of thing, or a BMI of 30 and above.

That’s a whole nother discussion. There may be some future improvements of how we diagnose obesity. It shouldn’t be just B M I centric, but that’s kind of how it’s, but anyway, you can take the quiz there. I don’t wanna go off on another tangent. Follow me on Instagram. That’s where I do most of my obesity discussions at Doctrine Nadski.

I’m also on TikTok. I do stupid stuff there that like, TikTok is a whole different , social media that’s like, and that summarizes TikTok, a bunch of stupid stuff. I, I hate it. But, and then I’m also on Twitter. I do some academic stuff, uh, there at Dr. NALs and Facebook of course, as well. But, um, that’s, that’s the gist.

Mike:  Cool. Well, uh, thanks again for taking the time, Spencer. I appreciate it. Thanks, man. Well, I hope you liked this episode. I hope you found it helpful, and if you did subscribe to the show because it makes sure that you don’t miss new episodes. And it also helps me because it increases the rankings of the show a little bit, which of course then makes it a little bit more easily found by other people who may like it just as much as you.

And if you didn’t like something about this episode or about the show in general, or if you. Uh, ideas or suggestions or just feedback to share. Shoot me an email, mike muscle for life.com, muscle f o r life.com and let me know what I could do better or just, uh, what your thoughts are about maybe what you’d like to see me do in the future.

I read everything myself. I’m always looking for new ideas and constructive feedback. So thanks again for listening to this episode, and I hope to hear from you.





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