Episode 26: The Nuances of Obesity with Dr. Spencer Nadolsky (Part 1)
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- เผยแพร่เมื่อ 8 ก.พ. 2025
- This is part 1 of 2. We'll release the second part next Monday so stay tuned! Some static randomly cropped up at 20:50 and 36:00. It's fixed in the audio only version below:
/ obesitypart1
Find Dr. Spencer Nadolsky @drnadoslky and www.drspencer.com
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As a future family med doc this was very pertinent and helpful- thanks!
I recently started following Dr. Spencer Nadolsky on Instagram after seeing his stuff cross posted and finding it funny. This was a great episode, thanks guys.
Other than the static (I just switched to Soundcloud for the 15 minutes) I preferred this audio where I could hear everybody talking at all time.
Part 1 of 2 on the nearly 2 hour discussion with Dr. Spencer Nadolsky on obesity , exercise prescription in medicine, and the future of lifestyle medicine. Hope y'all like it! (Apologies for some static around 20 min and 36 minutes for 5s)
Youve got me adding carbs back into my diet. I haven't died yet and i feel less like shit, so thats cool.
I was prompted to check what my BMI is and what is was. My highest was about 45.5 and I'm around 27.1 now. Good old overweight category for life, I guess. But yeah, I used to be at class 4 obesity. :-0 It's pretty awesome to not be that anymore.
Indeed Leah! And you look great too, bonus!
Great convo!! Thanks BBM and Dr N!
Great podcast guys thanks 😊
Obese + Beast = OBeast!
If Jordan could join himself, then he'd be joined by the most handsome doctor.
Good podcast boys.
20:50 gave me a huge scare, holy shit :P
I enjoy powerlifting. I used to compete in bench press contests in my 20s. I'm much older now and still lifting weights. You guys are saying eat less move more. For me I have to meet my nutrition requirements: vitamins, minerals, protein, fiber, carbohydrates, and water. If I don't meet my nutrition requirements my lifting suffers and I feel bad. A lot of doctors, my doctor included, wants me to be really skinny and do tons of cardio every day. That's just not me. I like being strong and having muscle.
That’s contextual. They’re saying eat less and move more if you need to lose weight, in particular, obese. If neither of those relate to you then go on living on
The complex biological organism comment made me laugh out loud! Such an interesting topic to listen in on!
I know you don't really like the Texas Method, so does that mean you think I would get better results on something like a HLM DUP? It would probably be set up somewhat similar to the Texas Method but have more volume. What do you think the fastest progression for an intermediate is?
Right before the big dairy talk, it almost sounded like Spencer was about to say what’re you gonna do, not research? 😂
The 7 phases of obesity. Phase 1: Denial, Phase 2: Anger, Phase 3: Ice Cream, Phase 4: Bargaining (for Oreos), Phase 5: Depression, Phase 6: Fat Acceptance (and more ice cream), Phase 7: Death
Jordan, at 20:48 there's an issue with the audio.
Yea I know. Didn't pick it up when I scrubbed through it again before uploading. I may reupload depending on how bad my OCD gets. It's fixed on the audio only version.
Barbell Medicine another small audio issue at 37:37
Robert Maes yep- see the pinned comment.
I thought he was discussing his own supplement your brand and you fuzzed it out...
Best podcasttt! Been waiting for spencer to be on here for so long
Great discussion! I'm learning a lot and wondering how (or if) metabolic rate is impacted by a properly designed caloric-deficit-based diet? I've heard some buzz that a low calorie diet alone becomes less effective over time due to a decrease in metabolic rate, which is partly why people initially lose weight but then gain it back again later. To the contrary I've always thought that proper eating habits would optimize the metabolic rate. Fact or nonsense? I know...it's nuanced. If relevant enough maybe a topic for another conversation?
Pieter Combrink your metabolic rate does tend to decrease but only proportionally to your loss in tissue, that’s why it’s especially important to protect your lean mass when dieting as that tissue has the most value when it comes to preserving your metabolic rate as that’s expensive to maintain. But this isn’t some terrible consequence of dieting, it’s human physiology, once you make yourself a smaller human all things equal you will burn less calories, it doesn’t have to be some crazy low number that gets smaller and smaller but it would make sense that it’s less than what you had to eat to maintain your weight 30 lbs heavier.
Is that waist measurement where I wear my pants or around my belly button like in weightlifting questionaires?
Cranki belly button.
Dangit! LOL
Hey guys, is there any validity to genetic testing to find out carb sensitivity muscle cross section type etc
In my opinion, no.
ready to make brain gainzzz
not sure if airpods or cigarettes in ears
What ever happened to the use of metabolic studies.
37:17 Carnivore diet. In my opinion it's actually a good diet. Short term though, to lose weight. The diet is apetite supressing, which is helpful for a lot of people.
No evidence that it increases fat loss or is more satiating in short term compared to other diets.
Would you release on Google play music?
laughter95 it’s on google play
Yes!!!!!
Genes also play a massive role in obesity. It's not just as simple as fewer calories in and more calories out, so kindly talk to professors who work in in genetics of obesity, professors such as Prof Giles Yeo from Cambridge University, Uk. You have so much to learn before you start acting like obesity experts on social media, maybe leave it to the experts???
but the guest was an obesity dr ....
@@ClydeErwinBarretto One person but as I said obesity is extremely complex.
Yes, it really is that simple.
Big Soda!
he frankly dropped some serious nuances
'Big Soda'
Excess carbs. Problem solved.
The bug diet; please don't start a new dumb fad😉
SLIMFAST AND COCAINE
mark putham Tapeworm therapy is cheaper
@@scottmoyer3854 but nowhere near as much fun
don't world class athletes have BMI around 28? I would guess all three of you have bmi's near 28.
Depends on the sport, of course. Further, just because an athlete has a BMI of X doesn't mean it's necessarily good. That said, my BMI is around 30 at the moment, lol.
Jeez fatty get some excersise
The insulin hypothesis of obesity has not been disproven, not even close. Making irresponsible comments like that and part of the reason we make so little progress on treating obesity. Kevin Hall's comments were pre-mature based on a trial study and flawed analysis of the data, if you're referring to that study. What's the first thing that happens to a patient when you give them insulin... They gain weight if we're going to be simplistic as Kevin Hall's comments.
To shrug off the benefits of increased satiety (biggest misnomer ever) is something common I hear from non-obese people that have not actually had to lose weight and maintain that weight loss. It's like telling someone to hold their breath under water for twenty minutes, and having a magic switch that could shut off the autonomic brain signaling. But hey that switch isn't that important just hold your breath... Go ahead test your will power, 20 minutes is doable and you're a failure and loser if you can't do it. :)
For someone who has insulin resistance and serious obesity, you need to step back and remind yourself... This person is not normal population. While someone with a 38" beer gut considered "skinny-fat" could get away with a minor clean-up of diet and doing some yoga, your Stage 2+ that have multiple failed attempts at weight loss need something more drastic. Whether that's a ketogenic diet + IF, or extended fasting, they will get different results.
Again I'm really just scratching my head here wondering with the amount studies and data out there now. How we can ignore insulin as a major mechanistic hormonal factor of obesity destroys my faith in the medical establishment.
hdoakville while insulin resistance is a real problem and dietary management will vary between individuals, there is no current evidence suggesting the insulin hypothesis has merit. Additionally, many of the points you’ve made here are not well supported- even rebuked by current literature. This is how we came to the conclusions we currently have, but we’ll change them if presented new evidence that is compelling.
There is only one study I'm aware of that is designed to actually interrogate this question; it has been neither proven nor disproven because it was flawed in execution. I would challenge you to find one single study that demonstrates this without serious flaws in design, and quickly debunked confounders. Until we have an accurate methodology to measure aggregate insulin over a long period of time, I'm not even sure it's possible to prove or disprove the theory. So making comments like this is taking a non-critical look at the literature out there.
What we see in nutrition is the same lack of study design that's been pointed out by the SS community on the current affairs of exercise studies. I would ask that you apply the same skepticism and rigor to both sides. You're doing a disservice to a large group of people who have been unsuccessful at weight loss despite enormous long term effort using conventional approaches. You've now become the equivalent of the Doctor that states don't lift more than 10lbs. I have too much respect for you to believe that.
You're asking if there are papers that suggest insulin is not the smoking gun in weight gain or something else? We also have very sensitive assays for measuring insulin levels. I'm not really sure what you're typing about here.
I don't think calling into question all studies' design is a good idea and I am applying skepticism to both sides of the carbohydrate-insulin discussion. It just doesn't hold up under scrutiny that insulin is the key here. Additionally, nowhere have I said that people who have had good results with a low carb diet are wrong or are liars- just that the results are due to calorie restriction via a diet they can comply with. Interestingly, this is what the dat supports as well.
You're making reference to more than one study. I know of exactly one published study that was specifically designed to investigate the insulin hypothesis. It's the now infamous Kevin Hall study. If you can cite others designed with this purpose I'm genuinely interested in reading them. I'm not aware of a single study that tests the insulin hypothesis outside of the Kevin Hall study. Additionally I'm not aware of any method to measure aggregate insulin in a longitudinal study. All current methods of measuring insulin are invasive, and therefore can not provide a total secreted insulin amount over a long duration (or proxy thereof). Think a measurement like A1C only for insulin.
Now let's go on to the second point. Can you show me any studied diet/weight loss regime that has shown in longitudinal studies a sustained weight loss that is kept > 5 years? You'll likely acknowledge the body fights back with lower TDEE, NEAT/NEPA, etc. Now it's a shame that a ketogenic diet and fasting (or combination of the two) is a fairly recent diet trend. Because comparing the two may help also resolve the question. You also have to acknowledge your point works in reverse less calories = less aggregate insulin.
Finally my original comment was really pointed at Dr. Spencer Nadolsky. He made a somewhat snarky comment about "Insulin theory" as if it's open and shut. And every single time I hear that from a Doctor and I ask for the evidence, I never get a link to PubMed.
Ah I see what you're saying now- that the low carbohydrate or ketogenic diet studies that do not specifically measure insulin concentrations provide no evidence on the insulin hypothesis, which I would firmly disagree with particularly given the proposed mechanisms by Attia and Taubes.
Yes, there are people who lose weight and keep it off > 5 years. See AWLR. The "fighting back" is actually an increase in dietary intake and decrease in activity. TDEE changes that are greater than what we predict are typically not the source for weight regain, though maintenance of weight loss is difficult for many due to a variety of factors. It would be reductionistic to suggest that TDEE decreases relative to the "never obese" controls have no influence, but I don't see it being a big contributor.
I agree with Dr. Nadoslky about the insulin hypothesis so you can direct your commentary at me as well. To be clear, I think that suggesting that insulin is the cause of weight gain is incorrect both in mechanism and in subsequent management, i.e. decreasing carbohydrate intake. Insulin levels at meaningful post prandial times are the same in calorie and protein matched meals regardless of carbohydrate intake. Fasting insulin levels quickly normalize in those with insulin resistance upon weight loss regardless of diet and the overall clinical utility of changing a diet to directly optimize insulin dynamics outside of a diabetic patient requiring insulin therapy has not proven useful anecdotally or in the management suggested to do so.
Focusing on insulin is not a terribly good use of resources in my opinion.
As to your last point, I would love to provide you a bevy of links, but you'll need to state your clinical question more clearly. You are saying, "The insulin hypothesis of obesity is real" while the bulk of the evidence suggests this is incorrect, e.g. low carb and high carb diets do about the same for all outcomes provided protein intake is controlled for, keto does no better (even worse overall on occasion) than either for metabolic conditions. This is all relatively clear. Yet, you still say, "There is no evidence." That doesn't make sense to me.
In any event, I'm happy to engage in productive discussion most of the time and would direct you to our forum.