Nataliia Sanzo RDN, LPN: 0:00

Welcome to another episode of Hashimoto's Nutrition Rx podcast. If you have been told that your metabolism is slow or you ever wonder if GLP-1 medication or peptides could be the missing piece in your healing journey, this episode is for you. I'm joined by Dr Spencer Nadolski, a board-certified obesity and lipid specialist, who is here to clear up the confusion around weight gain, thyroid health and metabolic resistance. We're diving into the truths behind broken metabolism, how thyroid hormones actually influence your body composition, and what is real versus hype when it comes to things like BPC-157, nad+ and others. We also talk about metabolic adaptation, aka starvation mode, the small meals myth and what strategies women with Hashimoto's should focus on when nothing seems to work. This is the kind of conversation that will help you tune out the noise and finally understand what your body really needs. So grab a notebook, maybe a warm cup of tea, and let's get into it, dr Spencer, welcome.

Dr. Spencer. Nadolsky, DO: 1:16

Thanks for having me, and I have Hashimoto's thyroiditis as well. Got diagnosed 20 years ago, so we're in good company.

Nataliia Sanzo RDN, LPN: 1:22

I did not know that and I thought I did my homework.

Dr. Spencer. Nadolsky, DO: 1:26

It's not like I put it on my bio or anything but.

Nataliia Sanzo RDN, LPN: 1:30

Wow, now we feel we're definitely in business Now. I have personal questions for you.

Dr. Spencer. Nadolsky, DO: 1:36

Yeah, there you go.

Nataliia Sanzo RDN, LPN: 1:38

Wow, before we jump into our conversation, I want to officially introduce you for those who don't know who you are. Dr Spencer Nadolsky brings over a decade of expertise in obesity medicine, with a board certification in obesity medicine and lipidology. Since becoming a doctor, he has helped thousands of patients lose weight and improve their quality of life through innovative healthcare delivery platforms. Dr Spencer also has a fun educational social media content where you can laugh and learn at the same time. You can find his clinic at joinvineyardcom. Now that we got the formal introduction out of the way, I would love to jump into a topic that so many people in my community are curious and, honestly, I think, confused about. Dr Spencer, you've talked a lot about GLP-1 medication For someone with thyroid dysfunction or Hashimoto's. Where do these therapies potentially fit in and where are they overhyped?

Dr. Spencer. Nadolsky, DO: 2:47

therapies potentially fit in, and where are they overhyped? Yeah, it's actually. It's a common question because there's a black box warning on all GLP-1 receptor agonist medicine. So the first one was approved in 2005, almost two decades ago basically, and these medicines hit the receptors of some of our cells in our thyroid, called C-cells. The thing is, it was seen in rodents, not humans. Humans don't readily have those receptors, whereas the rodents do have those receptors.

Dr. Spencer. Nadolsky, DO: 3:14

So they saw maybe an increased risk of what's called medullary thyroid cancer, and what people say is, oh, thyroid thyroid. So people with Hashimoto's are always like, well, can I take this medicine or even other types of hypothyroidism, like if they had their thyroid taken out for a goiter or anything else, or if they had nodules, and I was like, yeah, even if you had other types of thyroid cancer, so it's really just medullary thyroid cancer. People with Hashimoto's can absolutely take these. Really just medullary thyroid cancer. People with Hashimoto's can absolutely take these. And it's possible there is some anti-inflammatory beyond the weight loss effects maybe helps with kind of autoimmune disease, but that's the thought. So absolutely, somebody with Hashimoto's could take this medicine. I just want to clear that up because that's always a common question. The thing is, though, right now they're only approved FDA approved for type 2 diabetes and obesity or weight management, and the thing is, type 2 diabetes has very clear diagnostic criteria, so either hemoglobin A1c is 6.5% and above, or a fasting blood sugar is at least like 126 milligrams per deciliter and above, but for obesity, though, or weight management, there's a lot of gray in where this could be indicated.

Dr. Spencer. Nadolsky, DO: 4:36

What a lot of people are doing, though, are using these medicines off-label, meaning they don't have weight issues and they don't have type 2 diabetes, but they feel it's helping with their inflammation of some sort. They just feel better taking these. That's where it's not indicated, however, many people are doing it that way, but I do have a lot of patients with hypothyroidism, and I have some funny not funny, but interesting cases there that we can talk about. Who do? They do extremely well, especially if they're on the right thyroid replacement regimen. For them, hypothyroidism Hashimoto's not a reason you can't take the medicine, and I find that they don't do any worse than the averages that we see. It would be interesting to study that directly, but just my clinical experience.

Nataliia Sanzo RDN, LPN: 5:21

And just to add something to the study about rodents and thyroid cancer don't rodents have more sensitive cells that uptake more of the medication, and that's why they started developing thyroid cancer?

Dr. Spencer. Nadolsky, DO: 5:36

Yeah, they have the receptors. We don't on those specific C cells of the thyroid. That's why we don't see it in humans. They keep monitoring and keep looking closely, but so far so good. They've talked about even taking out that black box warning, because what it does is it scares people. What happens then is that more often people start getting extra thyroid ultrasounds when they shouldn't get it and all sorts of stuff. We'll see. I think in five to 10 years we'll see that black box warning be taken off, but I can't guarantee it.

Nataliia Sanzo RDN, LPN: 6:05

Yes, we'll keep an eye on that for sure. Now, before we went live, I told you that some people wonder why am I, as a dietician, talking about GLP-1 medication and peptides on Hashimoto's podcast? And the truth is that these therapies are becoming more and more common in the real world and my clients are asking about them every single day, and, as a clinical dietician who specializes in Hashimoto's, it's my job to help women make informed and evidence-based decisions, not just about food, but about their overall healing journey. That includes understanding how medications and interventions like GLP-1s or peptides might support, or maybe sometimes stall, their progress when it comes to metabolism, weight and thyroid health. So I think this conversation is so important, regardless of you have weight problems or not. The next thing I wanted to talk about is, or I'm curious about, how can these medications support sustainable metabolic health without further tanking thyroid function or causing lean muscle loss?

Dr. Spencer. Nadolsky, DO: 7:19

Yeah. So these medicines hit receptors. So they work for type 2 diabetes a little bit differently than weight, although part of the effect on the type 2 diabetes and blood sugar regulation is helping people lose weight. Just a little quick background. They're called the Inkerton effect. Basically they injected blood sugar into the veins versus had people drink it, and I would think if you injected it your insulin levels would go higher. But they found that when people drank glucose their insulin levels were higher and they called that the incretin effect, some intestinal secretion of some hormone. It wasn't later until they found the specific types of hormones. So for type 2 diabetes it augments your pancreas' ability to release more insulin. So that helps there.

Dr. Spencer. Nadolsky, DO: 8:09

But for weight specifically, it hits these receptors in the brain that basically make you not think about food anymore, and it's different. It's an appetite suppressant. But it works beyond that in terms of like people, my patients. When they take them they describe feeling like someone who must not struggle with their weight, must feel like where they're not constantly thinking about food, constantly needing extra servings of whatever meal that they ate, constantly craving certain specific foods. So three different things hunger and satiety improve, cravings improve. And then it's also this concept of food noise, which is just thinking about food.

Dr. Spencer. Nadolsky, DO: 8:47

So these medicines come in and basically allow you to do the things that you already have a good idea of what to do and be able to do them. So you do see people, if they use these medicines to basically starve themselves, they'll lose muscle. But that would be like any other way of starving yourself. You basically went on a crash diet and drank like a few protein shakes a day or fasted forever and just basically didn't eat much. You'd lose muscle.

Dr. Spencer. Nadolsky, DO: 9:15

So these medicines just facilitate being able to follow a good, healthy diet and exercise plan. My patients get a resistance training program. They have an awesome dietitian that basically optimizes things. But I could see that other people out there in the world who are just getting a prescription from wherever just to be able to start themselves could potentially lose weight in a way that's not as healthy. So just think of these medicines as a way in terms of weight not the inflammation and all the other non-weight related benefits, but in terms of weight, think of it as just a way to optimize your diet and exercise without feeling as miserable doing it.

Nataliia Sanzo RDN, LPN: 9:55

And you know the reason I get so many clients who come to me while taking the GLP-1 medication, for whatever reason they started, it's because they're not working with the medical doctor, they're not working with the dietician and I know you guys have a dietician on staff in your clinic to guide somebody through this weight loss process, because there is a right and the wrong way to lose the weight.

Nataliia Sanzo RDN, LPN: 10:18

Everybody knows that. So I get my clients on the back end. So I get my clients on the back end, unfortunately, of this medication after six months or maybe 12 months, after they lost the weight, after they lost all of their hair, after they developed chronic constipation, to the point when they go to the bathroom once a week best case scenario. So then we uncover all these problems and it's very hard to fix post fact. So I always tell people if you're thinking about getting on medication again for whatever reason, to decrease TPO antibodies, decrease inflammation, work with the team, reach out to somebody to the real clinic, at least start off the right way, learn the right tools and then maybe you can venture out if you want to. But this is such an important problem that you brought up that it has a lot of side effects. So everybody knows about side effects. Let's talk about the benefits. What are some non-weight benefits in your clinics or in research?

Dr. Spencer. Nadolsky, DO: 11:23

Yeah, so a lot of my patients. They all want to exercise and get better, but their joint pains and just feeling not so good, they think about food all the time. The medicines, I want to say they reduce anxiety, but what I really think happens is that their anxiety comes from thinking about food all the time. So it calms that down, it gives them the mental space to be able to think about exercise and then they're in less pain. So then they feel like they can exercise and make it sustainable, so that there's an effect there.

Dr. Spencer. Nadolsky, DO: 11:55

A lot of people talk about the kind of anti-inflammatory effect. Again, this needs to be studied, but we do know that in terms of reducing heart attacks, there may be an effect from the weight, but there is, I would like to say definitively, a non-weight cardiovascular benefit to the medicines. They don't know exactly why. There are GLP-1 receptors all over the body. They're in the myocytes of the heart, they're in the endothelial area, the arteries, the lining of our arteries, all sorts of different things. It could be partly improving our cholesterol and lipid metabolism, but no matter what, like people have a benefit on reducing risks of heart attacks, beyond the weight loss that occurs to these medicines and those are known. What a lot of unknown.

Dr. Spencer. Nadolsky, DO: 12:50

I have a lot of patients with other kind of autoimmune GI issues, so think about things like Crohn's and ulcerative colitis, psoriatic arthritis, rheumatoid arthritis and one patient again, this is anecdotal they are studying this like directly to where you'd have a placebo versus the active drug. So we're not just, yeah, this is what I see in the clinic and just throwing it out there as benefit. So I always want to make sure I say that. But however, having said that, I had a patient with psoriatic arthritis who was on multiple biologics and having some benefit. It wasn't until they started zep bound, which is terzapatide specifically one of these medicines where they all of a sudden felt big time relief, and it wasn't the weight loss. They hadn't lost much weight at that point. I think we're going to see a lot of non-weight or blood sugar related benefit to these medicines. I really do.

Nataliia Sanzo RDN, LPN: 13:47

I had a McCall McPherson on my podcast a couple of weeks ago. She's a physician assistant and she has a clinic and that's all they do. They specialize in GLP-1 peptides and they're doing their own studies. They measure patients' CRP, which is an inflammatory marker, right Pre-GLP-1 introduction and then post, and even though some people lose this much weight compared to 50 pounds, regardless of the weight loss, the CRP marker goes down. This is incredible. I know they only have a few dozens of clients that they're tracking, but I think it's a good green light that it's helping people reduce the inflammation. Now in my practice because I only work with people with Hashimoto's we measure TPO antibodies and we see drastic reduction in TPO antibodies.

Dr. Spencer. Nadolsky, DO: 14:43

Yeah, I believe it.

Nataliia Sanzo RDN, LPN: 14:46

So I don't know if GLP-1 is the future of addressing Hashimoto's specifically. So I don't know if that's there, but I'm really excited. That's why I want to learn as much as I can to prepare for the next step in the future.

Dr. Spencer. Nadolsky, DO: 15:03

I guarantee there's a lot of studies underway. They're going to find out. Big Pharma wants to make their money. They're going to find a way.

Nataliia Sanzo RDN, LPN: 15:10

And we're here to help. I'm all for progressing.

Dr. Spencer. Nadolsky, DO: 15:14

Yeah, technology.

Nataliia Sanzo RDN, LPN: 15:16

Technology exactly, and I don't care if it's nutrition-related progress or medicine progress. I just want to progress, because Hashimoto was found like what? 115 years ago and we have no improvements in treatments. You probably take the same medication as I do, depending on different dose. This is the only treatment we have. I need more. I need better. I think we deserve answers.

Nataliia Sanzo RDN, LPN: 15:41

We deserve better treatment, I don't care where it's coming from, Ideally, please please Now, if we're talking about possibly treating other comorbidity the weight with microdosing, what is your take on microdosing? Who needs it, who can get it, who shouldn't get it?

Dr. Spencer. Nadolsky, DO: 16:04

Yeah. So here's what I think we'll see eventually. So I do very low doses. I only see those with like obesity, type 2, diabetes related stuff. I could open it up to more. The problem is insurance coverage won't cover it unless you have those indications. So then you can use what's called Lilly Direct. You can get it directly from the man. You go, you skip insurance. But even still, they want to see diagnosis codes where they at least have an overweight diagnosis code they don't want to pay for.

Dr. Spencer. Nadolsky, DO: 16:38

Let's say, if I wanted to go, oh, this person's like a 21 BMI and really lean individual, low body fat and they have ulcerative colitis, let's play around with that I would have to lie and say that they were overweight in order to get that. So I can't do that, because then I could get audited and you can get in big trouble for that. So what other people are doing is a compounding route. Now I don't do the compounding route. It was big and the reason it was big is because there was a big shortage. These medicines were hard to get and because of the shortage there's a law that allows compounding pharmacies to start mass producing these. So now you still have some I call them loopholes to try to customize the doses, but I don't personally do that.

Dr. Spencer. Nadolsky, DO: 17:21

Having said that, though, I do have a lot of patients in that overweight range where we do micro, I would say I don't call them micro doses, because micro doses, I would say, is it's just kind of semantics with the definition, but it'd be like a fourth of the lowest dose. So like terzapotide, for example, the lowest dose is 2.5 milligrams. A fifth of it would be like 0.5 milligrams. If we're going by fifths, to me that would be like a microdose, or a half of that would be 1.25 milligrams.

Dr. Spencer. Nadolsky, DO: 17:47

I have done that with patients but they still are overweight, or just I can justify it that way for coding purposes to Eli Lilly, so I don't get audited and get in big trouble or things like that. But some of these patients, they don't want to lose too much weight, but they technically have an indication and they want to see if it improves their inflammation and all sorts of stuff. And yeah, we see some good stuff. Now here's what I think. I think, eli Lilly, this is going to be big business. Eli Lilly, I don't make money from them, not yet, although maybe they'll offer me some money to do some consulting.

Nataliia Sanzo RDN, LPN: 18:22

We're not non-profit.

Dr. Spencer. Nadolsky, DO: 18:24

Yeah, they may pay me soon. I get offers all the time and have not taken it, although there's one advisory board that I'm doing for Novo Nordisk here soon. But I think what they're going to do they're going to start studying because they want their bag. As I said before, they want this to be a trillion-dollar market and in order to do that and obesity is huge, but imagine, everybody like, maybe I'll take it at some point to reduce a risk of a heart attack in the future despite not having weight to lose they want to study that. They want to study it for longevity, for just overall quality. So I think we're going to see a lot of studies and once those indications start coming out, or at least allowing for off-label uses, I wouldn't have a problem.

Dr. Spencer. Nadolsky, DO: 19:10

The biggest concern for me is we got to make sure that there's a benefit to risk ratio that's positive and if we start putting it in on everybody and we don't really know, so it's possible, we don't know. I think the risks are pretty low If you're looking at things like if you're not making the biggest risk is making people lose weight, too much weight, and you're making them underweight. They go from a really healthy size to like undersized and to where they could become frail. That's like the biggest concern for me is now we're making them less healthy just just to get the scale lower. Type of thing for me is now we're making them less healthy just to get the scale lower type of thing. That's the biggest risk. But if you're monitoring and you're giving low doses and not really changing the scale, if I were to guess I think there's probably benefit. It just needs to be studied. So I think that's where the future is.

Dr. Spencer. Nadolsky, DO: 19:57

I think what we're going to see is this person's at risk for developing obesity and they're not overweight or anything like that right now. But we see their parents, we see they have the genetics there and they're starting to gain weight. Boom, you hit them with one of these medicines to just make them maintain their weight. Now, all of a sudden, that person doesn't go on to develop obesity and doesn't go on to develop those comorbidities related to obesity. Now that now insurance and everybody's saving money. The issue is the cost. The price of the drugs need to come down. They're just ridiculous right now and we're seeing improvements every few months. But until these are like $100, $200 a month, they're still out of reach for most people.

Nataliia Sanzo RDN, LPN: 20:45

They're expensive, but I think people spend a lot of money on things that are unhealthier, so it's all about priority. I agree they're very expensive. Most people that do need them cannot afford them.

Dr. Spencer. Nadolsky, DO: 21:01

That's right.

Nataliia Sanzo RDN, LPN: 21:01

But, yes, the hope is there. Like you said, every month we see improvement in prices, there are policies that are coming in, so we'll see Fingers crossed. Now you mentioned you said longevity. Right, we're looking at living longer, living healthier. So this is one of the most asked questions in my DMs weekly about the peptides, our BPC-157, nad+. Are they helpful or not, and do they have any benefits in the gut? We read a lot about that, so some of my clients are really intrigued, especially those with history of burnout, fatigue, poor recovery, and I recently saw a new peptide, p19, suggested that it can support the thyroid function, that it can actually improve thyroid function. Now there's one study that I could found, so I don't know if you have any insight on it, but what is your take on the peptides?

Dr. Spencer. Nadolsky, DO: 21:59

Yeah, peptides are chains of amino acids in general, so you can go and drink peptides that are that's what we've, we used to do've, yeah, all sorts of different things so like, but there are obviously peptides that can have drug-like effects. So it's not a conspiracy, but it's one of those things where they need to have large, randomized, placebo-blinded, controlled trials to where we need to see that there's a true benefit to risk, and I'm a little bit risk averse when it comes to some of these things. So BPC-157, very small studies, a lot of anecdotal People are claiming that it healed my tendinitis or tendinopathy of 10 years on my elbow in XYZ, or I hurt, injured myself, and last time I got injured it took me months and this time it only took me weeks to recover. There's biological plausibility there. I personally, about 10 years, maybe eight years, it doesn't matter I tried to be PC 157 multiple times because I was getting a tennis type of tennis elbow lateral epicondylitis and it didn't do anything. I was getting it from what's supposed to be the purest pharmacy I could find and whatever. Again, this is anecdotal and then and so now, with understanding the small amounts of studies, I was doing it based off of anecdotal data, which you really shouldn't do, but I was doing it because I was like I want to see everybody's talking about. I didn't notice any difference.

Dr. Spencer. Nadolsky, DO: 23:28

So it's not something I prescribed to patients. It's just one of those things where let's get the data, but who's going to pay for it? Because really the reason big pharma pays for these things because they're going to reap the rewards afterwards. They can spend a half a billion dollars on a huge trial and know that they're going to make that up very easily, especially if it's a positive trial for them. Some of them don't end up, they just have so much money. So therein lies the issue. It's possible, these things are amazing and they have a benefit, but we need the data to ensure safety and efficacy benefit. So those are my thoughts on it. I think there's a big potential for them, but we just need research.

Nataliia Sanzo RDN, LPN: 24:08

Does that apply to NAD plus as well?

Dr. Spencer. Nadolsky, DO: 24:12

Yeah, so I actually had an expert on my podcast, charles Brenner, who was like in that space and basically what he says there's probably no good reason to inject NAD+. No true benefits have been seen. It's not something I recommend to my patients or anything, so I tend to not recommend that.

Nataliia Sanzo RDN, LPN: 24:33

So I actually started. The reason I brought this question up for selfish reasons. I'm a patient myself. I have Hashimoto's and I'm just looking for ways to improve my energy and this and that and my knee pain. So I started using bbc 157 yeah injecting just around the joint where the fatty part is, it helped? I think now my husband said did it help or did three or four weeks pass by?

Dr. Spencer. Nadolsky, DO: 25:00

and it healed yeah, that's exactly so. There's something called regression to the mean, because what you'll see in certain supplements and they'll say look at this thing works. If you look at the way that the trial was done, it was a single arm, meaning there was no placebo control group, it was single arm. So like you could have, yeah, like some people have back pain and be like this worked great. But you or think about it this way People have a cold and you just have one group and you give them all amoxicillin, an antibiotic that won't help with the cold.

Dr. Spencer. Nadolsky, DO: 25:34

And there'll be people that are like, yeah, the pill worked, it worked for me, the antibiotic worked, but it's no, they were going to get over that. That's exactly the reason why you do placebo-blinded, controlled studies, because then you can see the difference in those, because people with the placebo are going to get better. So that's all. There are some people like, no, that doesn't work and it's more, we just don't even have the data to say it. So it's very possible it could have helped, we just don't know.

Nataliia Sanzo RDN, LPN: 25:57

We just don't know. I used it for a very short time, until four weeks. I did not refill it from my doctor because I'm like I don't know if it works, and it's an injection and I feel like I'm going to pass out. Every time I do that, so it's not worth to me, but what?

Dr. Spencer. Nadolsky, DO: 26:16

I do want to say I do NAD+.

Nataliia Sanzo RDN, LPN: 26:17

I do feel it gave me so much energy. It almost gave me a feeling like I'm on drugs, like I was driving to my office at 11 am and I don't know if it's spring or hormones or something. But I feel this heightened sense of happiness which is not normal.

Dr. Spencer. Nadolsky, DO: 26:38

What if there are amphetamines in that? What if they sneak some amphetamines in there?

Nataliia Sanzo RDN, LPN: 26:44

Just like you said, it's coming from my doctor, it's coming from Purist Pharmacy I don't know Commercially rated pilot, so I get drug tested all the time.

Dr. Spencer. Nadolsky, DO: 26:53

Oh yeah, you don't want to mess around. What are you flying? What are you flying?

Nataliia Sanzo RDN, LPN: 26:56

Jets, oh gosh, I fly jets, I fly Gulfstreams, large airplanes. Yes, wow, yes I didn't know that. That's cool. Yeah, it's a little hobby of mine that I do on the side, jeez.

Dr. Spencer. Nadolsky, DO: 27:09

Doesn't sound like a hobby, that's tough.

Nataliia Sanzo RDN, LPN: 27:11

It's more than a hobby, yes, but we fly to Europe all the time, so that's a Holy cow. So I do have to be careful with what I take. And of course I clear it with my doctor. Yeah, you doctors. So nothing came up on the drug test yet.

Nataliia Sanzo RDN, LPN: 27:32

But, yes, people need to be careful with where they're getting that stuff from. I'm my own guinea pig and I don't recommend this to anyone, but I'm just sharing my experience Again, anecdotal, just to make it fun. Now let's talk about something even more fun. Everyone on social media blames their weight gain on slow metabolism. Is it real, and how do we know if we have one?

Dr. Spencer. Nadolsky, DO: 27:56

Yeah. So they've done these types of studies before and they look at a lot of people. This is done in the nineties and whatever. They basically took a bunch of people who claimed that they had a slow metabolism and then they tested their metabolism. There's different ways to do it. You can do a resting metabolic rate, where you breathe into this thing and it looks at your CO2 and all the consumption of your resting metabolic rate through that method. It's an indirect calorimetry, the way they do it. And then there's another way. There's doubly labeled water where they check your urine metabolites through. They call it fat water. They actually add an extra hydrogen to the water and they can see through how you metabolize, how many calories you burn in a day. And they did this before and people were like I swear I'm eating 1200 calories. But it showed that people were eating a lot more than they think. And it really upsets people. We've moralized eating to the point where if you're eating more calories, people call you gluttonous, which isn't true.

Dr. Spencer. Nadolsky, DO: 28:56

But it turns out that and when they've done these correlation studies, most people that gain weight it's not related to their metabolism. Weight it's not related to their metabolism, resting metabolic rate or total daily energy expenditure. So in most cases, it's related to how much we eat and it's related to our appetite. In fact, most of the genes of obesity are in the central nervous system, related to appetite. It's related to our brain and how we regulate intake. So in general, you get some people that will have a slower metabolism all once in a while, but it's all mostly related to intake. Now, somebody with Hashimoto's if that's undiagnosed, your metabolism will be lower, however, actually a lot of the acutely. Anyway, if you were to come off your medicine, a lot of the weight gain quickly is a lot of fluid buildup, but like people this is the story I want to tell is I had a patient that was on trisepatide Zetbound and they gained like 20 pounds in two months and trisepatide specifically.

Dr. Spencer. Nadolsky, DO: 30:00

I never see people gain weight on the medicine that and I was like what about your thyroid? You're on Synthroid. When's the last time it's checked? No, it's been well-controlled. I don't know. I'm like did you feel like you gained fat around your belly, your legs and she's? I don't feel fat. I'm like okay, I think this is fluid. But why would she be gaining fluid? I checked she was floridly hypothyroid, something. The medicine the Zepbound. The trisepatide may have slowed the absorption of it, changed the absorption. It doesn't happen all that often, but I see it from time to time and I added in T3, a little Cytomel, an Uptur Synthroid and the weight just flushed right, basically flushed right off. So anyway, in any event, generally it's not our metabolism, it's how much we eat. If you have Hashimoto's hypothyroidism you do want to get your levels controlled. Obviously that will control your metabolism. But a lot of the weight gain is actually fluid.

Nataliia Sanzo RDN, LPN: 30:57

So anyway, and thank you for bringing up the other, the example about hypothyroidism patient. I think that's why we have to talk about this. Get on live Instagram, whatever to make sure that people with hypothyroidism and Hashimoto's understand that there is more. You can't just go and buy it somewhere online and you have to be managed by an endocrinologist or whoever is managing your medication, because this is a serious things we're talking about. And the fact that she was gaining fluid and was taking that GLP-1 medication. It slows down the absorption right.

Nataliia Sanzo RDN, LPN: 31:37

It slows down the motility of your gut intestine, so it's probably slows down the absorption of whatever you're taking. So, again, there is so much research that needs to be done before we start addressing Hashimoto's with the GLP-1s.

Dr. Spencer. Nadolsky, DO: 31:53

Yeah, close monitoring, that's what I always say.

Nataliia Sanzo RDN, LPN: 31:57

Absolutely. Now, since we're talking about slow metabolism, can high cortisol prevent someone from losing weight?

Dr. Spencer. Nadolsky, DO: 32:04

Because that's all over Instagram someone from losing weight because that's all over Instagram. Yeah. So the gist is that pathological levels and I'm talking about Cushing's disease, cushing's syndrome If you have a tumor in your brain, your pituitary gland, or a tumor in your adrenal glands making you produce an extraordinary high amount of cortisol, yeah, potentially that's where we see it happen. Now the still is. Even if you're in a calorie deficit, meaning you're eating fewer calories and you burn, you could still lose weight. The problem is it shifts where you store the fat. So you see in Cushing's the weight gain behind the neck, the moon faces and central abdominal obesity. But then you start seeing like their arms start getting thinner and their legs start getting thinner. So it really is a big redistribution, nutrient partitioning effect. But cortisol also has an appetite effect on you as well, so it can make it really hard to eat fewer calories. So it's changing where you're storing the fat and whatever, but those are pathological levels. Or the most common thing is people taking prednisone for some sort of inflammatory disorder and they can't come off the prednisone because they need it to help with their inflammatory disorder, whatever it is. So we see that Now, when it comes to physiological difference in cortisol, that's where you start seeing a lot of this the nonsense on social media, where it's like they tell you not to do high intensity interval training because of the cortisol.

Dr. Spencer. Nadolsky, DO: 33:31

That's not true. That's not going to prevent you from losing weight not, and this has been studied really well. That's why it's really frustrating to see these people out there promoting this concept of don't exercise because of cortisol. It's like cortisol goes up. That's a normal physiological response from exercise. What happens, though, is that if you start exercising and not paying attention to your diet, exercise can increase your appetite. That can make it really hard to stick to your diet. Or, if you exercise too hard, you're not recovering well. Then you feel crappy, you're not walking or doing anything else in the day, and you're sure as heck not going to want to eat in a certain way. I always say these physiological differences I wouldn't worry about it so much other than let's fix what's making you stressed out. Stress can make you crave certain things and eat in a certain way. That's not very helpful either. In general, physiological differences not something to worry about.

Nataliia Sanzo RDN, LPN: 34:28

Now talking about metabolism and slow metabolism, and speaking of docs who lift I love that little tagline there what is the best way to increase your metabolism?

Dr. Spencer. Nadolsky, DO: 34:42

Yeah, this is where I don't tell everybody like, look, you got to lift weights and build a ton of muscle, because that's going to really ramp up your metabolism, but in general that is like the only thing that's going to do to increase your metabolism. Sure, you can eat more protein and it takes more to digest that, but that's not really increasing your metabolism. It's just taking more to digest your food. Building muscle and using that muscle then after building it is the only way. Now I'll give a caveat that one of the newer GLP-1 drugs that's coming out, ritatratide, has this component on it called glucagon, and it's likely that glucagon component. So it's GLP-1 and a GIP which is another incretin, that's terzapatide.

Dr. Spencer. Nadolsky, DO: 35:29

Terzapatide is GLP-1 slash GIP. It hits different receptors the ritatrutide, which people call ritatrutide, but it should be ritatrutide. Based on the other pronunciations it doesn't matter. But GLP-1, gip and glucagon, the glucagon component. The glucagon component likely has an effect on energy expenditure. So you might, we might, be seeing it as a metabolism booster, although I've had patients on it because they were in the clinical trials, and they say that the appetite suppressing effects are even much stronger than teresapatide. So how much of a metabolism boosting effect? I don't know, but for right now, building more muscle is the practical way to do it that's what I always tell my clients.

Nataliia Sanzo RDN, LPN: 36:14

There's nothing you can eat or drink or take like a supplement that will truly boost your metabolism, building muscles and, just like you said, you don't have to curl 25 pounds in each hand. Any kind of resistance training will build muscles or keep the tone. That's the only way right now truly to meaningfully boost your metabolism.

Dr. Spencer. Nadolsky, DO: 36:40

That's right.

Nataliia Sanzo RDN, LPN: 36:42

Good point. Now let's bust a myth Does eating small meals every two to three hours speed up your metabolism?

Dr. Spencer. Nadolsky, DO: 36:50

No, it just comes down to what your preferences are. That used to be like the big thing back in the 90s, early 2000s and now it's like. Then they went to fasting, Now it's let's just be reasonable and just pick however many meals you want to eat per day and within a certain amount of calorie and macronutrient and food composition type of thing.

Nataliia Sanzo RDN, LPN: 37:11

Exactly. I always say. People ask me as a clinical, registered dietitian. They're like what's the best diet for Hashimoto's, or for losing weight, or for decreasing inflammation? And like, for decreasing inflammation is a little different. Right, you want anti-inflammatory, mediterranean style diet. But for losing weight, any diet, you can follow any diet and lose weight if you are in calorie deficit. Now, is keto diet a great thing for Hashimoto's? Probably not. You're literally starving your gut microbiome by not eating complex carbohydrates, fibers and all that stuff. But if you're just asking the question, what's the best diet to lose weight? Any diet. Just being the calorie deficit, it just may not be healthy. So it doesn't matter if you do an intermittent fasting, eating five meals a day, two meals a day, it doesn't matter as long as you're in calorie deficit. That's right. It doesn't matter as long as you're in calorie deficit.

Nataliia Sanzo RDN, LPN: 38:08

That's right Now. Let's talk about the last burning question I have. We hear a lot about this metabolic adaptation or starvation mode.

Dr. Spencer. Nadolsky, DO: 38:24

Can you explain what that means and whether it's something average woman trying to lose weight should even be worried about. Yeah, super big myth out there. The idea around metabolic adaptation our metabolism is tied to our body size, and how many calories we burn is related to that, plus our activity levels throughout the day. But metabolic adaptation, though, is when we lose weight. So say we go from 300 pounds to 200 pounds, based off of calculations of what that person's activity and body composition. They should tends to be a little bit lower than what we'd expect if that same person was never 300 pounds and they were just 200 pounds. Let's say that's the example I give. Having said that, it's pretty small. It's 5% to 10% range and it's resting energy expenditure. It's not the total daily energy expenditure that we burn throughout the day.

Dr. Spencer. Nadolsky, DO: 39:29

So what people think with starvation mode is that they think they're eating so few of calories that now their metabolism dropped so far that they're going to start gaining weight from eating fewer calories. We know just like, without doing any studies, we know this doesn't happen. We've seen, unfortunately, concentration camps. It's terrible, but like things like that when you see the commercials on TV about the poor starving kids in Africa and that's true starvation, and you can see that they're not gaining weight. There's nothing to their bodies anymore because they're truly starving. So we know that just like, without doing any study. But they've done tons of studies on this.

Dr. Spencer. Nadolsky, DO: 40:19

What ends up happening is that we end up eating more than we think we are, and the reason is because it becomes so miserable. Our perceived amount of effort is extremely high and so we feel like we're eating a thousand calories. I hear it all the time. I hear it. My patient's 300 pounds. It's where they're up and down. They're eating a thousand 1200 calories and they're not losing weight. It's physically impossible it wouldn't be possible that person's burning, at rest, 2000 or many calories plus their activity levels. Anyway, it's a myth. It's a myth. We do have our metabolisms go down. When we start to diet, eat fewer calories, our metabolisms go down. When we lose weight, our metabolisms go down and we lose weight. It can go down a little bit further than expected, but it doesn't go down so far to where we would start gaining weight.

Nataliia Sanzo RDN, LPN: 41:06

It's definitely. One time I brought up this example to one of my clients and I thought maybe it's an appropriate example. But you said about concentration camps.

Dr. Spencer. Nadolsky, DO: 41:14

Yeah, it's not a good. I hate talking about it, but.

Nataliia Sanzo RDN, LPN: 41:17

I think it brings the point across. And I'm from Ukraine. So there is a war that has been going on for three and a half years and when I see clients that say, oh, I have this high cortisol not Cushing syndrome, none of that stuff like nothing diagnosed, but some cortisol imbalances that shows up on their rhythm right, and they say I have this high cortisol and it prevents me from losing weight or I even gain weight because of this high cortisol. But then I'm like look at the guys at the war. Their cortisol is so high, 24-7 for years and they lose so much weight because they're in calorie deficit. You mentioned that cortisol does. It slows down, it shifts where you store fat, but it will not prevent you from losing weight if you're on calorie deficit. And I think it's so important to keep emphasizing this point to give people realistic expectations.

Dr. Spencer. Nadolsky, DO: 42:19

Yeah, it's not magic, it's science. It doesn't feel good necessarily, but at least it gives an explanation. A lot of people really want to hate to say it believe in magic type of like, up to chance, up to whatever, but when it comes down to it, we have some pretty good answers here yes, now to wrap up our amazing conversation, I want to ask you a few rapid fire questions.

Nataliia Sanzo RDN, LPN: 42:45

I didn't tell you about it, I wanted to be surprised. So it can be yes or no, with no explanation, or however you want to address that, okay.

Dr. Spencer. Nadolsky, DO: 42:54

Yeah.

Nataliia Sanzo RDN, LPN: 42:55

What's one nutrition trend you secretly cannot stand, but everyone else seems to be obsessed with.

Dr. Spencer. Nadolsky, DO: 43:04

The carbs and insulin causing fat. I hate that one. It's dying out, but that's the one I hate the most.

Nataliia Sanzo RDN, LPN: 43:10

I'm with you. Yes, now, if you could only lift weights or do cardio for the rest of your life, which one would you choose?

Dr. Spencer. Nadolsky, DO: 43:17

Easily lift weights.

Nataliia Sanzo RDN, LPN: 43:21

Peptides, GLP-1 or creatinine. You can only keep one in your clinical box.

Dr. Spencer. Nadolsky, DO: 43:27

Oh, GLP-1s Easy.

Nataliia Sanzo RDN, LPN: 43:31

Now biggest medical miss you would erase from the internet right now if you had like a magic wand.

Dr. Spencer. Nadolsky, DO: 43:39

It would be the carbs and insulin and weight gain.

Nataliia Sanzo RDN, LPN: 43:43

Okay, yep, that's a hard one, that's an annoying one too.

Dr. Spencer. Nadolsky, DO: 43:48

Yeah, super annoying.

Nataliia Sanzo RDN, LPN: 43:48

Okay, and finally, most surprising thing, people would never guess about you from your social media.

Dr. Spencer. Nadolsky, DO: 43:56

They probably know I'm pretty goofy. Some people know this, but I was a collegiate wrestler, successful collegiate athlete. Oh, I guess I like telling everybody because I talk about obesity bias and why people have this weight bias. I used to have it very strong, so that's why I understand it very well, so that would be something.

Nataliia Sanzo RDN, LPN: 44:15

That's amazing. Dr Spencer, thank you so much for being here today and sharing your wisdom in such a down to earth and practical ways. I know my community is walking away with a deeper understanding of how metabolism actually works and, just as importantly, what we can stop worrying about, and your insights in GLP-1s, peptides and this metabolic myth are going to help so many women with Hashimoto's feel more empowered, more informed and way less overwhelmed, because I think that's the most important one, and I'm truly grateful for your time and your voice in this space. Don, thank you so much.

Dr. Spencer. Nadolsky, DO: 44:59

Thanks for having me on.

Nataliia Sanzo RDN, LPN: 45:00

So I would love to have you for another podcast episode to dive deep into our listeners' questions, or maybe a specific topic or something that you want to bring up to life.

Dr. Spencer. Nadolsky, DO: 45:12

Perfect, we'll do it.

Nataliia Sanzo RDN, LPN: 45:14

Thank you so much. Bye, Dr Spencer.

Dr. Spencer. Nadolsky, DO: 45:16

Bye-bye.