Docs Who Lift

Is severe, insatiable hunger a failure of willpower or hardcoded into your biology? In this episode of Docs Who Lift, Dr. Spencer and Dr. Karl Nadolsky speak with obesity specialist Dr. Jesse Richards to uncover Bardet-Biedl Syndrome (BBS), the updated 2024 diagnostic criteria, and how targeted therapies offer hope when standard GLP-1s and willpower aren't enough.

Dr. Spencer Nadolsky and Karl sit down with Dr. Susan Brian to break down one of the most significant proposed changes in women's health in decades, the potential renaming and reclassification of polycystic ovarian syndrome to anovulatory androgen excess, and what that shift means for the millions of women who have been diagnosed, misdiagnosed, or dismissed under the current framework.

Dr. Spencer Nadolsky and Karl bring on Dr. Austin Baraki and Dr. Jordan Feigenbaum from Barbell Medicine to cut through the peptide hype and explain why most of the research peptides people are currently injecting have no randomized controlled trial data in humans, were abandoned by pharmaceutical companies because they failed or showed harm signals, and may not even contain what is on the label. The core message is simple: calling something a short chain amino acids does not make it safe, natural does not mean studied, and having a standard of evidence before putting something in your body is not being close minded it is basic medicine.

Dr. Spencer Nadolsky and Karl sit down with David W, a nurse practitioner who was actually enrolled in the Triumph 1 retatrutide phase 3 trial, to break down data just presented at the American Diabetes Association conference showing average weight loss of up to 30 percent and cardiometabolic benefits that go well beyond anything tirzepatide or semaglutide produce on their own. David went from 240 pounds to 167 in the trial and walks through exactly what the experience felt like from the inside while Spencer and Karl explain what the numbers mean for patients and clinicians waiting for this drug to reach the market.

2:26 PMClaude responded: Dr.Dr. Spencer Nadolsky and Karl break down two brand new randomized controlled trials, Surmount-Maintain and Attain-Maintain, that put hard numbers on what actually happens to patients when they try to lower their tirzepatide dose, switch to oral orforglipron, or come off GLP-1 medicines entirely after significant weight loss. The data confirms what they have been seeing clinically for years: obesity biology fights hard to pull weight back up, only about 17 percent of people can come off these medicines and maintain their results, and for most patients the conversation is not about stopping but about finding the most effective and affordable long-term dosing strategy.

Dr. Spencer Nadolsky and Karl sit down with Dr. Susan Brian, a Yale-trained endocrinologist and certified menopause provider who runs a bone fragility fracture clinic, to break down whether GLP-1 medicines are actually causing bone loss or whether the viral panic around this topic is getting ahead of the evidence. The short answer is that the medicines themselves do not appear to be the problem, the weight loss is, and there is a clear and well-established playbook for protecting your bones while on them.

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 treating real toxic metal exposures, to break down exactly why the heavy metal detox industry is built on tests that are not supported by any medical standard and treatments that can cause genuine harm. If an influencer has ever made you wonder whether lead, mercury, or cadmium is behind your symptoms, this is the episode that puts that fear to rest with actual science.

Dr. Spencer Nadolsky and Karl sit down with Dr. Adam Auton, geneticist at 23andMe, to break down a brand new paper using data from over 27,000 people that identified specific genetic variants in the GLP-1 receptor and GIP receptor that predict both how much weight someone loses on these medications and how likely they are to experience side effects. This is one of the first studies to show that precision medicine for GLP-1 drugs may already be closer than most people think.

Dr. Spencer Nadolsky and Karl sit down with Dr. Henning Langer, a PhD researcher at the Charité in Berlin, to break down his newly published paper combining rodent and human data to look directly at what GLP-1 medicines actually do to skeletal muscle beyond what a DEXA scan can tell you. From mice running to exhaustion on semaglutide to maximum voluntary contraction data in humans, this is the most granular conversation yet on whether these drugs are doing something to muscle that nobody fully understands yet.

Dr. Spencer Nadolsky and Karl sit down with Dr. Stuart Phillips, senior author on the newly updated American College of Sports Medicine position stand on resistance training, to break down what 137 systematic reviews and over 30,000 participants actually tell us about building muscle, getting stronger, and improving function across the lifespan. From rep ranges and training frequency to power development, eccentric loading, and why periodization may matter less than you think, this is the evidence-based conversation that cuts through 17 years of social media noise in one episode.

Dr. Spencer Nadolsky, Karl, and chief science officer Dr. Grant Tinsley sit down with Dr. Steven Heymsfield, physician at the Pennington Biomedical Research Center and lead author on the BELIEVE trial, to break down what happens when you combine bimagrumab with semaglutide and why over 90 percent of weight lost in the combination group was pure fat.

Dr. Spencer Nadolsky sits down with exercise physiologist and menopause researcher Dr. Alyssa Olenick to cut through the pseudoscience targeting women in the fitness space and break down what actually happens to body composition during the menopausal transition. From rep ranges to cortisol myths to why women should train more like men, this is the conversation most coaches are too busy selling pink packets to have.

In this episode of the Docs Who Lift podcast, Dr. Spencer and Dr. Karl welcome exercise physiologist Dr. Lauren to discuss the science behind creatine supplementation. They explore its benefits for high-intensity exercise, debunk common myths, and emphasize the importance of combining creatine with a solid workout regimen for optimal results.

Most "sleep advice" on social media is generic filler. In this deep dive, we break down the difference between sleep hygiene and clinical CBT-I, the truth about how alcohol and caffeine actually metabolize, and why your sleep tracker might be your worst enemy. If you’ve struggled with "busy brain" or middle-of-the-night wakefulness, this is the manual you’ve been looking for.

Dr. Spencer and Dr. Karl sit down with reproductive endocrinologist Dr. Lucky Sekhon to break down what’s actually evidence based in fertility care, how to avoid myths and predatory “add ons,” and what most people misunderstand about PCOS, insulin resistance, and IVF. They also discuss her new book The Lucky Egg, a practical, science backed fertility guide designed to cut through misinformation and help patients make smarter decisions on their path to pregnancy.

Brad Stulberg breaks down how real excellence is not biohacker style optimization or perfectionism, but consistent focus on fundamentals and a worthwhile pursuit that aligns with your values. He explains that progress eventually plateaus, so sustainable success comes from shifting motivation from external scoreboards to intrinsic purpose, curiosity, community, and a broader identity.

Oral GLP 1 Wegovy is finally here, so Spencer and Dr. Karl break down how it actually works, how to dose it, and how they are switching people from injections like Wegovy and Zepbound in real clinic settings. They also walk through new SURMOUNT 4 data on what happens when people stop tirzepatide, including who maintains, who regains, and why a personalized plan matters.

The new U.S. Dietary Guidelines just dropped, and the internet is freaking out over the updated food pyramid. In this episode, we break down what the guidelines actually say, who they’re really written for (hint: mostly policymakers, not everyday people), and why the pyramid graphic can be more confusing than helpful. We also dig into the biggest inconsistencies like the push for more protein and “natural fats,” the mixed messaging on saturated fat, and the messy “processed foods” debate without a clear definition. Bottom line: there’s some reasonable advice here, but a lot of the hype is performative, and the real impact depends on how these guidelines get translated into actual policy like school lunches and federal programs.

We hear “high cortisol” blamed for everything, but your adrenal glands are supposed to make cortisol in a daily rhythm that helps you wake up, fuel exercise, and handle illness. In this episode, we break down what cortisol actually does, how real adrenal disorders like Cushing’s are diagnosed, and why random at home cortisol tests and “adrenal fatigue” claims are usually misleading.

In this episode, Dr. Spencer and Dr. Karl break down some of the strangest and most misunderstood GLP-1 side effects, from slimmer’s paralysis and foot drop to bladder spasms and post-bariatric reactive hypoglycemia. They walk through real patient cases, why these issues happen, and what clinicians and patients can do to spot them early and manage them safely.

In this episode, we sit down with leading lactation researcher Dr. Kaytlin Krutsch break down the first real human data on GLP-1 medications in breast milk. She explains what the studies found, what women should consider before starting these medications postpartum, and why the actual risk may be far lower than most people think.

In this episode, Dr. Spencer and Dr. Karl talk with Dr. Karin Nordin, behavioral change specialist and founder of Body Brain Alliance, about why most advice on motivation, discipline, and habits gets it wrong. They break down the science of behavior change, exploring how identity, self-efficacy, and “future self thinking” can help people finally follow through on healthy routines that last.

In this episode, Dr. Spencer Nadolsky and Dr. Karl engage with Dr. Susan Davis, a leading endocrinologist and researcher in testosterone therapy for women. They explore the complexities of sexual dysfunction, the role of testosterone in women's health, and the nuances of diagnosing and treating low sexual desire. The conversation delves into the importance of understanding psychosocial factors, the limitations of current testosterone testing, and the appropriate dosing and administration of testosterone therapy. Dr. Davis emphasizes the need for evidence-based practices and the importance of individualized patient care in managing women's sexual health.

Dr. Spencer and Dr. Karl sit down with Dr. Sean Wharton, lead author on the OASIS-4 and ATTAIN-1 trials, to unpack the groundbreaking data behind the new oral GLP-1 medications. They discuss how oral semaglutide and orforglipron compare to injectables, what makes these molecules unique, and why 2026 could be the year obesity care changes forever.

Dr. Spencer and Dr. Karl break down the brand-new ACE Obesity Clinical Practice Algorithm, which redefines how clinicians approach obesity as an adiposity-based chronic disease. From de-emphasizing BMI to focusing on personalized health, staging severity, and prioritizing strength training and lifestyle therapy, they unpack what these updates mean for both patients and providers.

In this episode, Dr. Spencer and Dr. Karl sit down with Dr. Kevin Hall and Julia Belluz to break down the science behind metabolism, weight loss, and their new book Food Intelligence. They clear up the myths around the Biggest Loser study, explain why appetite biology matters more than a “broken metabolism,” and explore how our food environment, from ultra-processed diets to cultural norms, shapes health outcomes.

Does menopausal hormone therapy change how women respond to GLP-1 medicines like tirzepatide and semaglutide? In this episode, Dr. Spencer Nadolsky and Dr. Karl Nadolsky sit down with Mayo Clinic’s Dr. Maria Daniela Hurtado Andrade and Dr. Regina Castaneda to discuss their latest research, the nuances behind the findings, and what it means for women navigating menopause and obesity care. Do you also want me to generate a few alternative title options that highlight their names (for authority) while still keeping the engagement factor?

Do women really need to train and eat differently than men? In this episode, Dr. Stacy Sims and Dr. Lauren Colenso-Semple join Spencer and Karl for a spirited debate on fasted training, protein timing, perimenopause, and whether women’s unique physiology calls for unique fitness strategies.

Worried that GLP-1 medications like semaglutide or tirzepatide will make you lose muscle instead of fat? In this episode, we dive into real patient data, resistance training, and protein strategies to separate myth from reality.

Some health companies are selling massive lab panels directly to consumers often with questionable medical value and zero real follow-up. We sit down with the Barbell Medicine crew to expose the risks, the marketing tactics, and the right way to approach lab testing without getting scammed.

ChatGPT said: CVS Caremark just dropped Zepbound from its formulary, forcing countless patients to switch to Wegovy. In this episode, we break down why it happened, how PBMs are calling the shots, and what patients can actually do about it.

Monjaro just dropped hot new trial results and they might show it helps you live longer. We break down the Surpass CVOT, compare it to Trulicity, and explain what this all means for your heart, kidneys, and overall health.

Can higher doses of semaglutide really deliver better results, without the side effects? In this episode of Docs Who Lift, Dr. Spencer Nadolsky and Dr. Karl Nadolsky Jr. sit down with Canadian obesity expert and clinical trialist Dr. Sean Wharton to break down the latest data from the STEP-UP trial. They dig into the science behind tripling the dose of semaglutide, how it compares to drugs like tirzepatide, and what it means for the future of obesity treatment.

Summary In this episode of the Docs Who Live podcast, Dr. Spencer Nadolsky and Dr. Karl Ndolsky Jr. engage with Dr. Jackie Yao and Dr. Michael Blaha from Johns Hopkins to discuss a recent study on obesity. They explore the definitions of clinical and anthropometric obesity, the challenges in classifying obesity, and the implications of the Lancet Commission's criteria. The conversation delves into the nuances of metabolic health, the importance of data sources, and future research directions in understanding obesity and its related health risks.

Drs. Karl and Spencer talk to friend and retina specialist Dr. Eric Brugger about the new report of age-related macular degeneration along with an update on NAION.

In this episode of the Docs Who Lift podcast, Drs. Karl and Spencer. welcome Dr. Beverly Tchang, an associate professor and obesity specialist at Cornell. The conversation delves into the complexities of menopausal hormonal therapy with GLP-1 medicine in women, and the impact of hormonal changes on weight loss. They discuss the nuances of hormonal replacement therapy, the influence of the wellness industry, and the importance of a holistic approach to women's health. Dr. Tchang shares insights from her recent post-hoc analysis on tirzepatide and its effects on women in different reproductive stages, emphasizing the need for more rigorous research in this area.

In this episode of the Docs Who Lift podcast, Drs. Karl, Spencer, and Grant discuss the latest research on muscle growth, body composition, and the effects of GLP-1 receptor agonists. They delve into the role of myostatin in muscle regulation, the implications of recent trials on muscle mass loss, and the importance of exercise in maintaining muscle health. The conversation also touches on MRI data regarding muscle volume and the future of muscle-enhancing medications.

In this episode of the Docs Who Lift podcast, Dr. Spencer Nadolsky and Dr. Karl engage with Dr. Kevin Klatt to discuss the recent MAHA report and its implications for dietary guidelines and nutrition science. They explore the historical context of dietary guidelines, the challenges of funding nutrition research, and the political dynamics surrounding public health recommendations. The conversation highlights the disconnect between public perception and scientific evidence, as well as the need for a more robust investment in nutrition research to address chronic diseases and obesity. In this conversation, the speakers discuss the current state of food policy and nutrition science, highlighting the disconnect between political promises and actual changes in regulations. They critique the focus on superficial issues while neglecting more pressing health concerns, such as obesity and food safety. The conversation emphasizes the need for better funding and research in nutrition, the importance of expert opinions, and the dangers of misinformation in public health messaging.

Drs. Karl and Spencer talk to Dr. Tiffany Moon all about Joy Prescriptions. Learn how to stop chasing perfection and embrace connection.

In this episode of the Docs Who Lift podcast, Dr. Spencer Nadolsky and Dr. Karl discuss the latest findings from the SURMOUNT-5 on Zepbound (tirzepatide) vs. Wegovy (semaglutide,) two leading medications for weight loss and type 2 diabetes. They explore the efficacy, safety, and cost-effectiveness of these drugs, highlighting the significant weight loss outcomes associated with tirzepatide compared to semaglutide. The conversation also delves into the importance of patient stewardship in prescribing these medications, the impact of gender differences on weight loss results, and the need for more affordable options in the market.

In this episode, Spencer and Karl discuss a recent study on semaglutide for treating metabolic dysfunction associated steatotic liver disease (MASH). They explore the implications of the study, the Essence trial, and the potential of new treatments for obesity and liver health. The conversation also touches on the importance of early treatment and the need for more accessible medication options.

Drs. Karl and Spencer chat with return guest Dr. Lauren Semple about creatine, protein, cortisol, fasting exercise, and training in women.

Drs. Karl and Spencer discuss a new study looking at tirzepatide and metabolic rate. They also discuss a patient case of tirzepatide induced anhedonia.

Drs. Karl and Spencer discuss the claim that GLP-1 meds cause more fat cells.

Drs. Karl and Spencer talk to Dr. Kenneth Qiu all about direct medical care - the future of medicine.

Drs. Karl and Spencer discuss with Dr. Grant Tinsley all about the new analysis of how much "lean mass" is lost with tirzepatide, the most powerful medicine available for weight loss.

Drs. Karl and Spencer discuss how bad the Hims and Hers ad was.

Drs. Karl and Spencer chat with NAD metabolism expert Dr. Charles Brenner all about these supposed longevity supplements.

Drs. Karl and Spencer chat with Dr. Fatima Cody Stanford all about obesity, genetics, and her appearance on 60 minutes.

Drs. Karl and Spencer chat about the new Lancet Commission's report on Clinical Obesity along with the new study on high dosed Wegovy.

Drs. Karl and Spencer chat with Dr. Sowa about her book The Ozempic Revolution

Drs. Karl and Spencer discuss the concept of "microdosing" GLP-1 receptor agonists along with talk about the new topline results from REDEFINE which studied the new drug CagriSema.

Drs. Karl and Spencer chat with Dr. Lauren Colenso-Semple all about how the menstrual cycle and how it should affect your workout programming.

Drs. Karl and Spencer discuss the topline results from Surmount 5 which put Zepbound (tirzepatide) against Wegovy (semaglutide) for weight loss. They also discuss some news around compounded GLP-1s.

Drs. Karl and Spencer chat with Dr. Shivani Misra, a metabolic specialist physician researcher from the UK, all about the various forms of diabetes mellitus.

Drs. Karl and Spencer chat with AtlasMD - Dr. Josh Umbehr all about making healthcare cheaper using direct care.

Drs. Karl and Spencer discuss the brand new 3 year study of tirzepatide in those with prediabetes along with a discussion on semaglutide treating osteoarthritis

Drs. Karl and Spencer invite Dr. Andrea Love back to the podcast to discuss a recent Joe Rogan podcast with Calley and Casey Means.

Drs. Karl and Spencer discuss all things cortisol and poke fun at the influencers who try to fear monger exercise due to cortisol increases.

Drs. Karl and Spencer discuss their ideal healthcare delivery system.

Drs. Karl and Spencer discuss BS supplements claiming to be like Ozempic along with discuss some new obesity drugs coming down the pipeline that were announced in phase 1 and 2 trials.

Drs. Karl and Spencer chat with Dr. Jen Gunter all about menopause. Diagnosis, treatment, and much more.

Drs. Karl and Spencer discuss a couple of the controversies at the olympics along with the news about GLP-1 medicines treating Alzheimer's and heart failure.

Drs. Karl and Spencer chat with return guest and bone expert endocrinologist Dr. Rachel Pessah-Pollack all about the new Vitamin D guidelines.

Drs. Karl and Spencer discuss with ophthalmologist Dr. Brugger about the recent study showing a relationship between semaglutide and NAION (nonarteritic anterior ischemic optic neuropathy).

Drs. Karl and Spencer discuss the new SURMOUNT-OSA trial where tirzepatide was used to treat obstructive sleep apnea.

Drs. Karl and Spencer chat with return guest Dr. McGowan about a new procedure called the endoscopic gastric ablation that he just did a trial on.

Drs. Karl and Spencer discuss the recent FLOW trial where semaglutide was found to be kidney protective. They also go off about the costs of these medicines and what to do (including compounding considerations). Click here to see the study

Drs. Karl and Spencer discuss the most recent South Park episode where GLP-1 medicines are discussed along with the dysfunctions of our healthcare system among other issues.

Drs. Karl and Spencer discuss the fallacies of functional medicine. You'll learn what functional medicine is and whether you should seek it out.

Drs. Karl and Spencer respond to Jillian Michaels on the Bill Maher show

Drs. Karl and Spencer discuss with gastroenterologist Dr. McGowan all about endoscopic gastroplasty. See recent study on cost effectiveness of endoscopic gastroplasty vs semaglutide Check out his program

Drs. Karl and Spencer discuss the new studies about GLP-1 medicines and Parkinson's and heart failure along with how these meds are not just weight loss drugs but health promoting medicines. Click here to see the Parkinson's study Click here to see the heart failure study

Drs. Karl and Spencer chat with Kasey Potts all about her journey with lipedema. Learn more about how this condition is diagnosed and treated. Check out her instagram

Drs. Karl and Spencer chat with Dr. Amron all about lipedema. He is a specialized surgeon who treats lipedema daily. Learn about diagnosing and treating this condition that is commonly mistaken with obesity. Check his sites https://www.dramronconsultations.com/ https://www.advancedlipedematreatment.com/

Drs. Karl and Spencer discuss a new study showcasing the importance of exercise during and after GLP-1 medicine use. Click here to see the original study Click here to see the extension study

Drs. Karl and Spencer discuss a recent Mark Hyman podcast where he perpetuated some myths about obesity and GLP-1 receptor agonist medicines.

Drs. Karl and Spencer discuss whether your doctor needs to look a certain way in order to be a good doctor.

Drs. Karl and Spencer chat with Drs. Jess and Andrea all about popular podcasters like Andrew Huberman etc. and the spread of pseudoscience.

Drs. Karl and Spencer chat about their now defunct supplement company along with the ethics of big pharma direct to consumer marketing (including influencers).

Drs. Karl and Spencer chat with Dr. Brianna Durand all about the pelvic floor and incontinence when lifting etc. empower.physio pelvicrehab.org

Drs. Karl and Spencer chat with Dr. Stuart Phillips all about protein. How much do you need to eat for optimal health and body composition and more!

Drs. Karl and Spencer chat with Dr. Nicola Guess all about the evidence behind using continuous glucose monitors in those without type 2 diabetes. Learn whether they are useful for even harmful Read her review paper here

Drs. Karl and Spencer discuss the new SELECT results that show a decrease in cardiovascular events in those taking Wegovy who have a history of cardiovascular disease. See trial below https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

Drs. Karl and Spencer discuss how tirzepatide is now approved for obesity. Learn: When will it be available How much will is cost Any differences compared to Mounjaro Surmount 3 trial

Drs. Karl and Spencer chat with Dr. Kathleen Keller and Yash Adroja all about brain signaling in kids in relation to obesity. Learn all about Dr. Keller's research that sheds light on taste preferences and food choices made by kids.

Drs. Karl and Spencer chat about some of the new tirzepatide studies including SURMOUNT-4 from the EASD

Drs. Karl and Spencer discuss with Dr. Bassin all about her review on exercise and physical activity for type 2 diabetes. Check out her review article

Drs. Karl and Spencer discuss how semaglutide impacts the heart with new trial data available. Learn how semaglutide may reduce risks of heart attacks and also how it impacts your quality of life if you have heart failure.

Drs. Karl and Spencer chat with Dr. Andrea Love all about the microbiome. Find out if it really matters and if there are things to improve it.

Drs. Karl and Spencer chat with Amy Goekel about her history of her eating disorder. Amy has her own podcast where she discusses it is more depth as well https://podcasts.apple.com/us/podcast/the-eating-disorder-diaries/id1666122772

Drs. Karl and Spencer chat with Dr. Andrea Love, a cancer immunologist, about the recent headlines about the WHO listing aspartame as a possible carcinogen.

Drs. Karl and Spencer chat with Dr. Pearl all about internalized bias and her recent study on it Click here to read the study

Drs. Karl and Spencer chat with Dr. Jesse Richards all about BBS (Bardet Biedl Syndrome), an unknown cause of genetic obesity.

Drs. Karl and Spencer sit with Dr. Nagra to discuss the recent WHO news headlines about artificial sweeteners. Find out why you should still drink diet soda instead of regular soda.

Drs. Karl and Spencer discuss with cardiologist Dr. Luke Laffin about his recent study looking at statins versus various supplements touted as cholesterol-lowering. We also discuss the claim about saunas being better than drugs at lowering mortality.

Drs. Karl and Spencer chat with Dr. Angela Fitch, the president of the Obesity Medicine Association and a fellow doc who lifts! They discuss Dr. Fitch's journey into lifting along with the importance of body composition in obesity management. Dr. Fitch is also the CMO of her new company KnownWell. Need an online workout program? Check out LiftRx

Drs. Karl and Spencer bring back Dr. Grant Tinsley, a body composition researcher, to go over the GLP-1 data (semaglutide and tirzepatide) in terms of lean body mass loss. Learn: - How much lean body mass is lost in these trials - How body composition is measured - How is muscle loss assessed - Should you be worried if you're taking a GLP-1 agonist Read Dr. Tinsley's blog Become a Sequence patient (evaluation for GLP-1 agonist)

Drs. Karl and Spencer discuss whether we should call lifestyle measures "medicine".