GLP-1 receptor agonists have emerged as a groundbreaking tool in obesity treatment. In this episode, Dr. Spencer Nadolsky (an obesity specialist) explains how these medications are now yielding unprecedented weight loss outcomes in people with obesity.  The discussion centers on GLP-1 agonist drugs like semaglutide and tirzepatide: how they work, how much weight loss they can produce, and why they represent a paradigm shift in obesity management.  Importantly, the conversation addresses practical aspects of using these drugs, including managing their side effects and optimizing patients' diet and lifestyle while on therapy. This topic is of great significance to nutrition science, clinical practice, and public health. Obesity is a chronic, relapsing condition that has proven difficult to treat with lifestyle changes alone. The advent of GLP-1 agonists offers new hope by inducing weight loss levels previously seen only with surgical interventions.  Understanding these medications is crucial for healthcare professionals: it enables evidence-based prescribing, proper patient counseling on diet and side effects, and integration of medication with lifestyle interventions.  Discussing safety and long-term use is vital, as millions more patients might use these drugs in coming years. From a public health perspective, GLP-1 agonists prompt debates about access and cost, given their high price and life-changing potential. Timestamps [03:25] Conversation with Dr. Spencer Nadolsky begins [05:24] Mechanism and types of GLP-1 medications [07:55] Efficacy and weight loss results [16:53] Common side effects and management [22:57] Muscle loss concerns and clinical insights [28:09] Addressing nutritional concerns with GLP-1 medications [29:38] Exploring potential benefits beyond weight loss [33:48] Marketing and misconceptions around GLP-1 [36:59] Public health and accessibility issues [43:25] Future research [46:16] Key ideas segment (Premium-only) Related Resources Go to episode page Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Enroll in the next cohort of our Applied Nutrition Literacy course Vineyard – Dr. Nadolsky's Virtual Clinic (US) Instagram: @drnadolsky @sigmanutrition Related episodes: 460: Dr. Priya Sumithran – Body Fat Regulation, Pros & Cons of Weight Loss Interventions, and GLP-1 Receptor Agonists 324: Fatima Cody Stanford, MD – Obesity Treatment & Weight Bias 395: Prof. Carel Le Roux – Current Thinking in Obesity Treatment

Public nutrition policy plays a critical role in shaping population health through laws, guidelines, and programs that influence what people eat. In this episode, Emily Callahan, an expert in nutrition policy, talks about why public nutrition policies often fall short and what "success" looks like. They discuss how evidence-based nutrition interventions can stall due to political or practical barriers, and explore examples ranging from federal food assistance programs to sodium reduction initiatives. Crucially, they address how to evaluate if a policy has worked and highlight emerging strategies (like integrating "food as medicine" into healthcare) that offer hope for better outcomes. This conversation is highly relevant for researchers, clinicians, and nutrition professionals, as it underscores the importance of policy in addressing nutrition challenges at the population level and examines how to design effective, data-driven policies for public health impact. Timestamps [05:09] Understanding public health nutrition policy [08:44] Examples of public nutrition policies [21:27] Challenges in implementing nutrition policies [31:24] Evaluating the success of nutrition policies [34:58] Sustainability and political viability of health policies [38:07] Food Is Medicine: a promising policy target [44:50] Medically tailored meals: evidence and implementation [48:55] The MAHA commission report and its implications [56:42] Future directions in nutrition policy [01:04:49] Key ideas segment (premium-only) Related Resources Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Go to episode page Enroll in the next cohort of our Applied Nutrition Literacy course JAMA Commentary: The MAHA Commission Report and Diet-Related Diseases in Youth – Mozaffarian, Callahan & Frist, 2025 Mozafarrian et al., 2024 – "Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review Tufts' Food Is Medicine Institute

Sodium bicarbonate is one of the most consistently supported ergogenic aids in sports nutrition research, yet its underlying mechanisms and real-world applications remain widely misunderstood. More recent developments have focused on how to optimise both the timing and formulation of supplementation. The "individualised ingestion timing" approach has emerged as a practical strategy, recognising that the time-to-peak blood bicarbonate concentration varies considerably between individuals. Similarly, novel formulations are being explored to address issues with gastrointestinal distress and practicality of dosing. These include topical approaches such as sodium bicarbonate lotion, and commercial products like Maurten's "Bicarb System." In this episode, Prof. Lewis Gough joins to discuss the latest evidence on sodium bicarbonate and performance, its mechanisms, novel delivery systems, and the key directions for future research. Dr. Lewis Gough is a Professor of Nutrition and Physiology at Birmingham City University. He is globally recognized for his research on sodium bicarbonate supplementation in sport, and his work spans applied sport and exercise nutrition, exercise metabolism, acid–base balance, and fatigue. Timestamps [03:12] Professor Gough's academic journey [06:29] Mechanisms of sodium bicarbonate and historical perspective on lactate [11:21] Sodium bicarbonate's role in performance [22:45] Individual responses to sodium bicarbonate [26:53] Timing strategies for sodium bicarbonate [32:38] Individualized approach to sodium bicarbonate timing [36:47] Traditional vs. novel delivery methods [44:27] Practical recommendations for athletes [51:18] Future research directions [01:02:08] Key Ideas segment Resources Go to episode page (w/ links to relevant studies) Subscribe to Sigma Nutrition Premium Join the Sigma email newsletter for free Enroll in the next cohort of our Applied Nutrition Literacy course See all of Sigma's "Recommended Resources"

In this episode, we explore the concept of chronotype, which reflects an individual's biological circadian timing and how it manifests in preferred sleep–wake patterns. Understanding chronotype is important because it differs from simple diurnal preference, which may be shaped by lifestyle or psychological factors rather than biology. We examine how chronotype is measured, from gold-standard laboratory methods to validated questionnaires used in field studies. The discussion also highlights the importance of accounting for sleep debt when estimating true biological timing. Finally, we consider the limitations of consumer devices and the practical implications of assessing chronotype in real-world settings. Timestamps [02:02] Understanding chronotypes [06:26] Measuring chronotypes [15:12] Genetic and environmental influences on chronotypes [28:34] Health implications of chronotypes [52:21] Practical applications Related Resources Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Become a member of Alan Flanagan's Alinea Nutrition Education Hub Enroll in the next cohort of our Applied Nutrition Literacy course Related previous episodes: 495, 470, 469

Creatine is best known as a sports supplement for enhancing muscle strength and high-intensity performance. But could it also improve brain health and cognitive function? Or are such claims overhyped? If creatine can support brain health, it could have implications for aging, neurodegenerative diseases, concussion recovery, and mental fatigue. In this podcast episode, Professor Eric Rawson discusses what current science says about creatine's effects on the brain, including memory, executive function, and protection against neurological stress. Professor Rawson provides context on how creatine works in the body, why the brain might benefit, and what evidence exists so far. Eric Rawson, PhD is Professor and Chair in the Department of Health, Nutrition & Exercise Science at Messiah University. For over twenty years, his research has centered on the interplay between nutrition and skeletal muscle, notably investigating how creatine supplementation affects both muscle and brain function. Timestamps [03:14] Understanding creatine: biochemistry and history [07:55] Creatine supplementation and muscle performance [09:35] Creatine and brain health: emerging research [14:03] Measuring brain creatine: challenges and techniques [19:58] Cognitive benefits of creatine supplementation [26:23] Evaluating the evidence: caution and promise [30:45] Mega dosing and brain health protocols [32:04] Creatine for brain health: context matters [38:54] Creatine for brain injury and aging [51:25] Key ideas segment (Premium-only) Related Resources Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Enroll in the next cohort of our Applied Nutrition Literacy course Links to related studies (see Related Resources section)

Energy expenditure is one of the most fundamental yet often misunderstood aspects of human physiology. A central question is whether there is a ceiling to how many calories we can burn, and what happens when activity levels approach that limit. Grasping these dynamics is essential for health professionals and researchers, as energy balance directly influences body weight regulation, metabolic health, and athletic performance. Emerging research shows that our bodies regulate calorie burn not in a fixed manner, but through adaptation and compensation, revealing that the "calories in vs. calories out" model is far more dynamic than it may first appear. In this episode, we revisit key insights from experts such as Dr. Herman Pontzer, Dr. Brent Ruby, Dr. Mark Hopkins, Dr. Eric Trexler, and Dr. Chris Melby. These perspectives cover how the body adapts to different levels of physical activity, the metabolic adjustments during weight loss (often called adaptive thermogenesis), and the concept of energy flux in weight maintenance. Note: This episode is one of our Premium-exclusive episodes. To listen to the full episode, you'll need to be a Premium subscriber and access the episode on the private Premium feed. Otherwise, you can hear a preview of the episode on the public feed of the podcast. Timestamps [03:36] Contrained model of energy expendiure [12:33] What is the ceiling of human energy expenditure? [13:05] Reconciling energy intake and expenditure [13:32] Variability in metabolic rates [15:16] Adaptive thermogenesis and weight loss [18:37] Metabolic adaptation explained [31:51] Energy flux and weight maintenance Resources Subscribe to Premium Go to sigmanutrition.com Article: The "Calories In, Calories Out" Confusion: A Comprehensive Guide to Understanding Energy Balance Included episodes: 208 – Herman Pontzer, PhD | Constrained Energy Expenditure Model & Evolutionary Biology of Energy Balance 124 – Brent Ruby, PhD | The Human Ceiling of Energy Expenditure 299 – Mark Hopkins, PhD | Compensatory Eating & Activity Energy Expenditure 377 – Herman Pontzer, PhD | Metabolism, Mitochondria & Measuring Energy Expenditure 484 – Eric Trexler, PhD | Is Metabolic Adaptation an Illusion? 318 – Chris Melby, DrPH | Impact of Energy Flux on Weight Management

Recently a new trial was published in Nature Medicine comparing the effect of ultra-processed versus minimally processed diets. Specifically, the UPDATE trial compared these two diets in the context of a healthy dietary pattern (in line with the UK's EatWell Guide). This eight-week randomized, crossover trial generated a lot of discussion and was largely seen as being a really useful addition to the evidence base, and providing answers to some previously unexamined questions. In this episode the study's lead author, Dr. Samuel Dicken, explains the background context for the UPDATE trial, provides an insight into its execution, and puts some of the results in context. There is also a discussion about the current state of evidence more broadly and the leading hypotheses around the mechanisms that drive the observations seen with consuming ultra-processed foods. This episode is particularly noteworthy because it provides fresh evidence on an important question: does following dietary guidelines with minimally processed foods confer extra benefits over following the same guidelines with ultra-processed foods? Timestamps [02:48] Interview with Dr. Samuel Dicken [03:08] Background and research interests of Dr. Samuel Dicken [04:31] Details of the update trial [09:48] Trial design and methodology [15:45] Results and findings of the update trial [18:46] Secondary outcomes and craving control [25:43] Hypotheses and mechanisms behind UPF effects [40:28] Policy implications and future research directions Related Resources Subscribe to Sigma Nutrition Premium Go to episode page Join the Sigma email newsletter for free Enroll in the next cohort of our Applied Nutrition Literacy course Study: Dicken et al., 2025 – Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial LinkedIn: Samuel Dicken X: @SamuelDickenUK

In this episode, Dr. Matthew Facciani explores how social psychology influences health beliefs and the spread of misinformation. The conversation delves into why people adopt certain nutrition or health beliefs so strongly, how identity and group membership shape our interpretation of evidence, and what makes us susceptible to false or misleading health claims. Dr. Facciani's interdisciplinary background (spanning neuroscience, psychology, and sociology) allows him to offer a unique evidence-informed perspective on these issues. The episode centers on understanding the social forces behind health-related attitudes and how we might improve communication and critical thinking in the face of rampant misinformation. This topic is highly relevant for health professionals and researchers because misinformation about nutrition, health, and medicine can lead to poor decisions, vaccine hesitancy, or harmful fad diets. By understanding the psychological drivers that cause people to cling to unscientific beliefs, practitioners can better address patients' concerns and correct false claims. Matthew Facciani is a postdoctoral researcher at The University of Notre Dame in the Computer Science and Engineering Department. He is an interdisciplinary social scientist with a background in neuroscience and psychology and holds a PhD in sociology. His research focuses on media literacy, misinformation, social networks, political polarization, identities, and artificial intelligence. Timestamps [01:41] Interview start [06:57] The role of identities in belief formation [16:01] Health attitudes and political identities [25:28] Improving dialogue and addressing misinformation [31:59] Does fact-checking work? [35:41] Media literacy and pre-bunking [44:03] Optimism and pessimism for the future [52:28] Key ideas segment (premium-only) Related Resources Go to episode page Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Enroll in the next cohort of our Applied Nutrition Literacy course Matthew's book: 'Misguided' Matthew's academic publications Recommended episode: #365: David Robert Grimes, PhD – Conspiracy Theories & Bad Information: Why Are We Susceptible?

Dairy is often treated as a single food group, yet milk, yogurt, cheese, and butter can have very different effects on health. Some evidence links yogurt to favourable outcomes, while butter is known to raise LDL cholesterol. And then there's the paradox of cheese: high in saturated fat, but not consistently associated with higher heart disease risk. These complexities raise the question of whether the "dairy matrix" (the combination of nutrients and food structure) explains why not all dairy acts the same. In this episode, Prof. Jean-Philippe Drouin-Chartier, a nutrition researcher and registered dietitian, is on the show to examine what recent trials and large population studies tell us about dairy foods and cardiometabolic health. The discussion covers blood lipids, blood pressure, glucose metabolism, and how guidelines should interpret this evolving evidence. Timestamps [02:18] Interview start [09:38] Dairy consumption and type 2 diabetes [16:06] Dairy and cardiovascular disease [21:42] Dairy, blood pressure, and hypertension [25:56] Dietary guidelines and dairy [43:30] Key ideas segment (Premium-only) Related Resources Subscribe to Sigma Nutrition Premium Join the Sigma email newsletter for free Website: sigmanutrition.com Enroll in the next cohort of our Applied Nutrition Literacy course Referenced studies linked here  

They're in our oceans, our air, our food, and now even in our bodies. Microplastics, once a distant environmental issue, have become a topic of urgent relevance in medicine, public health, and nutrition. The idea that tiny plastic particles are circulating through the food chain and accumulating in human tissues has sparked headlines, speculation, and concern. But how much of this fear is grounded in solid science? And how much is still unknown? As the research into microplastics rapidly grows, so too does the confusion. Claims range from the plausible to the alarmist, yet the real picture is far more complex. What does current evidence actually tell us about the health implications of microplastic exposure? How do we weigh these emerging signals against the backdrop of other environmental threats we understand much better? And how should scientifically-minded practitioners think about this issue, especially when patients begin asking questions? This is a conversation that calls for clarity, nuance, and a rigorous look at what we know versus what remains speculative. In this episode, Professor Ian Mudway, an environmental toxicologist, discusses the current scientific understanding of microplastics and human health. Timestamps [03:31] The public's fascination with microplastics [08:35] Defining microplastics and nanoplastics [11:35] Environmental presence of microplastics [14:54] Human exposure to microplastics [18:23] Challenges in measuring microplastics [21:38] Public perception vs. scientific reality [27:08] Challenges in microplastic research [29:53] Environmental impact and human health [33:08] Complexities of plastic additives [40:34] Future directions in microplastic research [48:09] Key ideas segment (Premium-only) Resources Subscribe to Sigma Nutrition Premium Join the Sigma email newsletter for free Enroll in the next cohort of our Applied Nutrition Literacy course Gresham College YouTube lectures Go to sigmanutrition.com