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by Docs Who Lift
Drs. Spencer and Karl Nadolsky talk about nutrition, medicine, and fitness through the lens of two physicians who lift weights. Both doctors are former NCAA division 1 wrestlers who have gone into medicine. Dr. Spencer Nadolsky is a board certified family physician specialized in obesity medicine and lipidology. Dr. Karl Nadolsky is a board certified endocrinologist also specialized in obesity medicine.
Latest Episodes
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- 3 weeks ago48 min
Does Metabolically Healthy Obesity Even Exist?
Dr. Christian Rodriguez joins the show straight from Pennington Biomedical, where he works alongside obesity research legends Eric Ravussin and Steve Heymsfield. He breaks down his new review on metabolically healthy obesity and why the old "zero metabolic syndrome criteria" definitions are so inconsistent. The conversation dives deep into the Lancet Commission's new obesity framework, comparing it to the ACE staging system and picking apart where each one falls short, including the controversial call to leave type 2 diabetes out of the "preclinical" category. Rodriguez also previews his upcoming study on people with a BMI of 60 and above, a group that's rarely studied because researchers aren't sure it's safe. The episode wraps with a candid discussion on GLP-1 stigma and why treating obesity early matters more than chasing a number on the scale. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- Aug 3, 202639 min
Is Your Obesity Genetic? Food Noise and Bardet-Biedl Syndrome Explained
Could your weight gain and non-stop thoughts about food actually come from a rare condition you were born with? In this episode of the Docs Who Lift podcast, Dr. Spencer Nadolsky and Dr. Karl Nadolsky chat with weight expert Dr. Jesse Richards about Bardet-Biedl Syndrome (BBS). This rare condition tricks your brain into thinking your body is starving, even when you have plenty of body fat stored up. They talk about how doctors figure out if someone has BBS, an easy math trick to check your risk, and why normal diets or standard weight-loss shots do not always work for this condition. Plus, you will learn about special medicines that fix the brain's hunger signals when nothing else seems to work! In This Episode, You Will Learn: What Bardet-Biedl Syndrome (BBS) is and why many doctors miss it. Clear physical signs to look for, like extra fingers or toes, vision loss, and weight gain that starts very early in life. An easy formula to check your risk using your weight and your daily thoughts about food. The big difference between normal food cravings and extreme, non-stop hunger. Why special medicines can fix brain signals when regular weight-loss tools fail. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- Jul 7, 202636 min
PCOS Renamed to PMOS? Here's Why and What Changes for You
In this episode they cover why the name polycystic ovarian syndrome has been misleading from the start given that you do not need polycystic ovaries to have the condition and you can have polycystic ovaries without having the condition at all, what the Rotterdam criteria actually are and why having two of three features including irregular periods, elevated androgens, and polycystic ovarian morphology is enough for a diagnosis that covers a wide and sometimes contradictory range of presentations, why a group of international endocrinologists are pushing to rename the condition anovulatory androgen excess to center the diagnosis on the two features that actually matter clinically and remove the ovarian morphology criterion that causes the most confusion, what the four Rotterdam phenotypes look like and why phenotype D which has irregular periods and polycystic ovaries but no elevated androgens is the one the new criteria would exclude from the diagnosis entirely, why some patient advocates are pushing back on the rename out of concern that it erases a community identity that has been built around the PCOS name and what Spencer, Karl, and Dr. Brian think about that tension, how insulin resistance fits into the picture and why it is not part of the diagnostic criteria even though it is present in the majority of patients and drives most of the downstream metabolic risk, why metformin and GLP-1 medicines are doing a lot of heavy lifting for PCOS patients right now and how Dr. Brian approaches treatment decisions in clinical practice, what the data shows on inositol supplementation and why Dr. Brian has more time for it than she does for most supplements in this space, why the androgen piece is so frequently undertreated and how measuring free testosterone versus total testosterone changes what you see in the labs, how birth control fits into the treatment conversation and why it is both overused as a first line fix and genuinely useful when deployed correctly, and what women who have been told they have PCOS should actually be asking their doctor at their next appointment regardless of what the condition ends up being called. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- Jun 17, 202657 min
Are Peptides the New Snake Oil? What the Actual Science Says With Barbell Medicine
Dr. Spencer Nadolsky and Karl bring on Dr. Austin Baraki and Dr. Jordan Feigenbaum from the Barbell Medicine crew for a conversation that cuts through one of the most hyped and least understood topics in the health and fitness space right now: the research peptides that millions of people are injecting into themselves based on anecdotes, social media marketing, and the logic that short chain amino acids are natural so they must be fine. In this episode they cover what peptides actually are from a basic biochemistry standpoint and why calling something a short chain amino acids does not make it a food or a supplement it makes it a drug with all the same questions around safety efficacy dosing and long-term effects that any other drug requires, why the explosion of GLP-1 popularity essentially normalized both injectable medications and the idea that if semaglutide works this well what else is out there leading directly to the current peptide boom, why BPC-157 has no randomized controlled trial data in humans and the three human trials that were started were all terminated early with results never published which is a red flag that would make people furious if it were a vaccine but barely registers in the peptide space, why TB-500 has wound healing data when applied topically but nothing when injected despite being universally marketed as a muscle and tendon healer, why MOTS-C has never been tested in humans at all and yet enormous numbers of people are currently injecting it, why the argument that big pharma would sell these if they worked is actually the correct argument and why most of these compounds were abandoned precisely because they failed in trials or showed harm signals, why biological plausibility is a dangerous standard to rely on given that suppressing arrhythmias seemed biologically obvious until the CAST trial showed it killed people and beta blockers for heart failure seemed obviously wrong until trials showed they were life saving, what a randomized controlled trial actually does that anecdote cannot and why thousands of positive experiences are not equivalent to controlled data, why a JAMA study on SARMs sold as research chemicals found that only 18 of 44 products actually contained what was on the label meaning people may not even be getting the compound they think they are getting, why the doctors on this podcast could have made millions of dollars branding and selling their own peptide lines and have specifically chosen not to, and what standard of evidence they believe should be the minimum before recommending any compound to another human being. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- Jun 8, 202645 min
Retatrutide Phase 3 Results: What the Data Actually Means
Dr. Spencer and Karl Nadolsky sit down with David W, a nurse practitioner and one of the actual patients enrolled in the Triumph 1 retatrutide phase 3 trial, to break down the data that was just presented at the American Diabetes Association conference and explain why everyone in obesity medicine is paying very close attention. In this episode they cover what retatrutide actually is and why adding glucagon agonism to the GLP-1 and GIP dual agonism of tirzepatide creates a meaningfully different drug with direct effects on liver lipid metabolism, insulin sensitivity, blood pressure, and fat catabolism that you do not see with semaglutide or tirzepatide alone, what David's personal experience in the 12 milligram arm looked like from dose escalation through steady state including the GI side effects that faded by month seven and the heartburn that a low dose PPI fixed quickly, how David went from 240 pounds and a BMI of 35 down to 167 pounds by the end of the trial representing roughly 30 percent weight loss which is right at the trial average, what the Triumph 1 obesity trial found at 80 weeks with the nine and 12 milligram doses delivering nearly 26 and 28 percent average weight loss respectively and almost half of patients on the highest dose losing 30 percent or more, why the 104 week extension data showing patients who stayed on 12 milligrams reaching 30.3 percent average weight loss is being compared to bariatric surgery outcomes, what the Transcend type 2 diabetes trial showed with average A1C dropping to 5.9 percent on the 12 milligram dose in patients who were on no other diabetes medication, why the 41 percent triglyceride reduction and 20 percent LDL reduction are particularly interesting given that the mechanism appears to involve multiple pathways in the liver that tirzepatide and semaglutide do not touch, what the 70 percent reduction in WOMAC knee arthritis pain scores and 60 percent reduction in sleep apnea events mean for patients who have been told their only option is surgery, how Spencer plans to use retatrutide clinically once it is approved and which patients he thinks are the right candidates, why the gray market research peptide version currently circulating is something both doctors strongly advise against, and what Triumph 2 and Triumph 3 are measuring and when that data is expected. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- May 25, 202639 min
GLP-1 Maintenance: What Happens When You Lower Your Dose, Switch Medications, or Stop Entirely
Dr. Spencer Nadolsky and Karl break down two brand new randomized controlled trials that put hard numbers on a question they have been navigating clinically for years: what actually happens to patients on GLP-1 medicines when they try to lower their dose, switch to a cheaper option, or come off entirely. In this episode they cover why obesity biology actively fights back against weight loss through hunger hormones, fat cell hormones, and hypothalamic signaling in ways that make maintenance genuinely hard for most people and not a failure of willpower, what the Surmount-4 trial showed about weight regain when people came off tirzepatide after losing an average of 21 percent of their body weight and why that 17 percent who maintained their weight off medication is a number that keeps showing up across multiple studies, what the brand new Surmount-Maintain trial did by reducing some patients from their maximum tolerated dose of tirzepatide down to five milligrams and what that meant for weight outcomes at 112 weeks, why the average line graph in these trials can make it look like everyone on the max dose kept their weight off when the waterfall plots tell a more complicated story with roughly 25 to 30 percent of people on the highest dose still not maintaining 85 percent of their weight loss, what rescue tirzepatide was and why two thirds of placebo patients needed it, what the Attain-Maintain trial tested by switching patients who finished Surmount-5 from tirzepatide or semaglutide over to orforglipron and whether an oral GLP-1 can hold the weight that an injectable one lost, why orforglipron is not yet cost efficient enough for most patients as a maintenance strategy despite the promising data, why Spencer and Karl both see fewer than five percent of their own patients regain significant weight on the maximum tolerated dose and what that gap between clinical experience and trial data might be telling us, the weight independent benefits of GLP-1 medicines including blood sugar control and cardiovascular effects that matter even if weight stays the same, and why people injecting unapproved research peptides like retatrutide without FDA approval or human safety data is something both doctors find genuinely alarming. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- May 18, 202631 min
Are GLP-1 Medicines Shredding Your Bones? Here Is What the Actual Evidence Says With Dr. Susan Brian
Dr. Spencer Nadolsky and Karl sit down with Dr. Susan Brian, a Yale-trained endocrinologist, certified menopause provider, and medical director of a clinic with seven endocrinologists who runs an active bone fragility fracture clinic, to answer the question that has been flooding social media since a viral abstract with two fake bones on a surgical table convinced people their skeletons are quietly dissolving.Follow Dr. Susan here In this episode they cover why the preclinical and mechanistic data on GLP-1 medicines actually points toward bone benefit rather than harm by improving osteoblast activity and reducing osteoclast activity, why the meta-analyses from over two decades of GLP-1 use in type 2 diabetes show reduced fracture risk rather than increased risk, what the recent Israeli retrospective cohort study actually found and why an 11% increased fragility fracture signal in older adults on GLP-1 for diabetes versus other treatments deserves attention without panic, why almost every nutritional deficiency flagged in GLP-1 patients turns out to be vitamin D deficiency that likely predated the medicine, why the degree of weight loss matters far more than the medicine itself and how the one to two pounds per week threshold and the one percent of body weight per week guideline translate into real clinical practice, what the Hansen JAMA 2024 study showed about GLP-1 alone versus GLP-1 with resistance training and why that finding is the single most important takeaway for anyone on these medicines, why Spencer has idiopathic hypercalciuria and was spilling 650 milligrams of calcium per day in his urine before anyone caught it, how romosozumab works and why it is the most powerful bone building medicine available, why Dr. Brian orders baseline bone densities on patients well before the standard screening age and why insurance almost always covers it, and why comparing GLP-1 nutritional risk to bariatric surgery nutritional risk is not even close to an apples to apples comparison. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
- May 5, 202652 min
Heavy Metal Toxicity: Separating Real Risks From Influencer Scams | Dr. Eryn Russo
Dr. Spencer Nadolsky and Karl sit down with Dr. Eryn Russo, a board-certified occupational and environmental medicine physician with nearly 20 years of experience working at Hill Air Force Base, where she deals with real toxic metal exposures every single day. She is one of less than one percent of all board-certified physicians practicing in this specialty, which makes her exactly the person you want explaining why the heavy metal detox content flooding your social media feed is not medicine. It is marketing. In this episode they cover how a proper toxic exposure workup actually happens including detailed exposure history, industrial hygiene testing at the source, biological monitoring, and organ-specific testing that goes far beyond a urine panel mailed to your house, why the provoked urine test being sold by influencers is a complete artifact that artificially concentrates metals in your urine using the same chelation agent they then try to sell you as treatment, the real clinical presentations of lead, mercury, cadmium, arsenic, and chromium six and why none of them look like vague brain fog or fatigue, why the gold standard test for lead is blood not urine and what the actual diagnostic thresholds are for adults versus children, why amalgam fillings and the form of mercury previously used in vaccines are not the toxic forms people need to worry about, the Consumer Reports plant protein lead story and whether parents actually need to be concerned, why Dr. Russo has never once recommended chelation therapy in 20 years of treating workers who actually work with these chemicals daily, and why real chelation therapy carries serious renal and electrolyte risks that make unsupervised use genuinely dangerous. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
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About Docs Who Lift
Drs. Spencer and Karl Nadolsky talk about nutrition, medicine, and fitness through the lens of two physicians who lift weights. Both doctors are former NCAA division 1 wrestlers who have gone into medicine. Dr. Spencer Nadolsky is a board certified family physician specialized in obesity medicine and lipidology. Dr. Karl Nadolsky is a board certified endocrinologist also specialized in obesity medicine.
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