Docs Who Lift

Social media decided the FDA just approved BPC-157, TB-500, and four other peptides. That's not what happened, and Dr. Leigh Baxt is the right person to explain why.Baxt is a translational scientist and drug development lead with training from Stanford, Harvard, and Brown. She walks Spencer and Karl through the actual language, which amounts to a double negative. These peptides were not added to the 503A bulks list and they did not become approved drugs. The FDA simply said it won't enforce the restriction on compounding pharmacies making them. Nothing was legalized. No rules changed. For context, only about five or six substances have been added to that list in 25 years, and nearly all of them were topical, not injectable.From there she lays out what real drug development looks like, and it's the clearest explanation of the process this show has run. Years of molecular work before an animal ever sees the compound. Preclinical toxicology and safety pharmacology designed specifically to prove you aren't causing harm. Chronic dosing studies, tumor growth, metastasis. Five or six years and millions of dollars just to earn permission to test in a human. Her number for how often it works: roughly 173 projects for one approved drug.She also dismantles the arguments you've probably heard. Patents aren't the reason pharma isn't developing these, because most of them are patented, and some companies let those patents lapse after walking away, which tells you something. Natural doesn't mean safe, because insulin is natural too. Peer-reviewed basic science is not the same thing as therapeutic development data. And if you go looking at clinical trial registries yourself, she explains what she found when she pulled up the TB-500 listing. One word in that entry is worth the whole segment.The conversation closes on what actually worries her, and it isn't the acute reactions making headlines. It's what shows up in 20 years, and the fact that no oncologist is going to connect it back.Nobody here is defending the FDA as perfect. Spencer's line, borrowed from Ben Goldacre, sums up the episode: 747s aren't perfect, but that doesn't mean magic carpets are the way to fly. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Amanda Thebe is back, and she and Dr. Spencer Nadolsky and Dr. Karl Nadolsky spend this one on something that frustrates all three of them daily: the state of menopause information online.Amanda has spent nearly a decade as a patient advocate in this space. She watched the conversation go from nobody talking about menopause to the topic being completely saturated, and she makes the case that it didn't just get louder, it got manipulated. Her own experience is a big part of why. She walks through what happened at 42 when she couldn't get out of bed, started falling over, was peeing her pants after two uncomplicated births, and spent two years in the Canadian healthcare system getting scans before a gynecologist finally said the word perimenopause. Her first reaction to hearing it is one of the better moments in the episode.The part that will stop you is what came next. Amanda tried hormone therapy and it never worked for her. Every formulation, every dose, cycling on and off for four years, with migraines up to 20 days a month and symptoms that got worse instead of better. When she reached out to a doctor she considered the guru in this space for help, the advice she got back was to ask for an elective hysterectomy on a healthy uterus so she could take estrogen alone. That was the moment she realized there was a grift.From there the conversation covers what hormone therapy is actually indicated for versus what influencers claim, why testosterone is being oversold, the real risks of pellets and unnecessary compounded products, and how venture capital money is reshaping telehealth in ways that put profit ahead of patients. Spencer and Karl also get into what the Women's Health Initiative actually showed and why the pendulum swinging too far the other way created the exact conditions these companies are now exploiting.It's not an anti-hormone-therapy episode. All three of them agree more women should probably be on it, and that it's first line treatment for the things it treats. The point is that fear sells in both directions, and women deserve accurate information and a real choice. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Docs Who Lift finally got a big pharma exec on the show. Dr. Ken Custer is President of Lilly's Cardiometabolic Health, and he came straight from the EASD conference in Milan with fresh data on what's coming after tirzepatide.If you've been waiting on retatrutide, this is the episode. Spencer and Karl get Custer to walk through the new phase 3 results and the tirzepatide plus eluralintide combination, including why stacking these mechanisms seems to deliver more than drug developers usually get. You'll hear how amylin works on a completely different set of brain pathways than GLP-1, why Lilly walked away from one version of the drug in favor of another, and what the early tolerability data looks like. That last part matters if you're one of the people who couldn't handle a GLP-1, or you've been too nervous to try one.The conversation then opens up to the questions patients actually ask. What's next if you hit a wall on tirzepatide and still have weight to lose. Whether these medications will ever be approved for people who aren't sick yet, just heading that direction. And why it's getting harder to run trials at all when everyone can tell whether they're on the real drug.The back half goes behind the curtain. Custer is honest about how often drug development fails, what these trials cost, and what it was like to be in the room the day Lilly chose tirzepatide, a molecule he's now spent 12 years on. He takes on the pricing question directly, explains where coverage is headed, and makes his case for why access is still the biggest problem.It ends where you'd want it to. The gray market, what regulation actually gets you, and how to think about doctors who work with pharma versus the people calling them shills while selling supplements with zero data behind them.Nobody got paid for this one. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. David Allison and Dr. Emily Dhurandhar join Dr. Spencer Nadolsky and Dr. Karl Nadolsky to break down their new research on food noise. Patients on GLP-1s kept describing the same thing: the constant background chatter about food finally went quiet. Allison and Dhurandhar convened an expert panel of physicians, psychologists, statisticians, and eating disorder specialists to define it properly and build a validated questionnaire to measure it.Their definition: persistent, unwanted, unpleasant thoughts about food that harm your social, physical, or mental health. The data revealed three distinct parts. Preoccupation with food, how inescapable it feels, and how distressing it is. That third piece, the dysphoria, is what separates food noise from hunger and cravings. Cravings can be enjoyable. Food noise is not.The conversation covers why food noise correlates with other appetite measures without being the same thing, patients who lose almost no weight on medication but refuse to stop taking it because of the mental relief, and whether food noise alone could justify treatment. They also share where the research is headed, from translations into ten languages and a new adolescent validation to a study testing whether food noise affects driving safety. And they answer the claim that Big Pharma invented the term. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

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.

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.

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.

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.

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.