Dr. Spencer Nadolsky
speaker
117 appearances
1 recordings
1 series
first heard May 2025
last heard May 2025
Dr. Spencer Nadolsky’s voice in public audio — every appearance, attributed to the second.
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I was so ravenously hungry and craving. And what my patients described was kind of that. So I could imagine them being, you know, in a 300 pound or 250 pound body with a lot of excess adipose tissue, trying to lose weight and feeling that way. Just that, you know, I was already really lean, but like they're feeling that way at a higher body fat.
That's what made me go like, oh man, I think I missed the mark.
It's exhausting. It's exhausting. Like a game of pickleball could be, I suppose.
that do just fine on a little dose and go through your journey, just fine, no issues. And that does happen. However, I would say it's not rare. It's still uncommon, but common enough when you have hundreds of patients that you see some of these side effects, especially at the higher doses that get brushed off by someone if they don't listen.
For example, the one that I'm seeing more recently and I've made some videos on is anhedonia, just kind of feeling meh, blah. And it actually happened quickly in 2022 when Manjaro came out. We were all using it off-label. Everybody's like, oh, how dare you use that drug off-label? I'm like, well, the Surmount trial was out. It just wasn't available as that found yet.
It wasn't approved yet, but the Phase 3 trial was out. So we were using it for obesity a lot. And people were feeling tired. And you see it with WeGoV2, the semaglutide. But terzapatide, we were seeing it and people were like, well, it's got to be from the calorie deficit. And that makes sense that people would feel tired from a calorie deficit.
However, there were people that weren't losing weight, any weight. They didn't feel like any appetite suppression, but they were feeling tired. And so it's kind of like, okay, if they're not losing weight, they're not in a calorie deficit, they don't even feel the appetite suppression, but they're feeling tired, it's probably something beyond the calorie deficit that's making people feel tired.
And when you talk to them, is it like, do you just want to go to sleep tired? For some people it is, but what I'm seeing is just kind of like a lack of motivation. So before... They were going to the gym, they're trying to be healthy, doing all the physical activity stuff. And now all of a sudden they're just kind of like, oh, I don't feel like eating.
But I also don't feel like working out anymore. And that defeats the whole purpose. We're trying to get people healthier. So despite their adipose tissue or whatever, physical activity has many... I mean, I know you've talked about this all the time.
Yeah, physical activity is super important regardless of the number on the scale. So that's like, okay, that started... I saw it so many times. And then I made a video recently about it. And then all of a sudden I got tons of messages from patients because they didn't report it. They didn't even know it was a thing.
But some other people did when they come from other places and their doctors or nurse practitioners or whoever was saying like, oh, I think you just have seasonal affective disorder. I think you just need to go see a therapist. And they're like, what are you talking about? I never have seasonal affective disorder. I usually love the winter. This doesn't make any sense.
And I'm like, no, this is the medicine. You're on a high dose and then you pull them back and they go, oh, now I still have the suppression and appetite, but now I've I'm going back to the gym and now all of a sudden a bunch of them are starting to break past their plateaus despite being on a lower dose. So a lot of that type of stuff that I see.
Yeah. That, that, yeah. If you're not enjoying life anymore, what's the point?
That's right. I see that not infrequently. I've actually surveyed on my Instagram and other places, you know, thousands of people taking the survey. And it was like... Some people noticed increases, but around like, I don't know if it was like a third to a half of people said, I know I noticed a decrease despite losing a lot of weight and wanting to have, they want to have that desire.
And of course their husbands are looking at them and going like, oh God, you've, you lost weight. I'm, I'm kind of getting interested. But now the, the, the wife didn't, you know, doesn't feel, and I see it in guys too though. I've seen a few where they're like, nah, they're getting erections and Because their testosterone has increased, but their libido, their drive has decreased.
And it's the motivation factor.
Woman in her mid-30s, she had been on 15 milligrams of Terzapatide Zepbound for multiple months and had plateaued completely for the past three or four months. And I was like, you know what? And she kind of described like, I don't feel like going to the gym anymore. And I was like, you know what, let's pull back on your dose.
Like when you look at the surmount trials, if you've ever pulled them up on your podcast, but the five milligram terzapatide is similar to the highest dose of semaglutide, Wegovi, the 2.4 milligrams. It looks around like 15% or so higher. percent total body weight loss.
When you look at 10 milligrams versus 15 milligrams of true appetite though, there's like a very sliver difference of weight loss between the two. So that means that they're probably getting very similar appetite reduction between the 10 milligrams and 15 milligrams. Some people do better on that 15 milligrams, but like
A lot of times you start going up from that 10 to 15 milligrams, you don't really see much of a difference. And if you don't see much of a difference with the weight, the only thing that can happen, I mean, it's kind of logical that you could potentially see more side effects. And so what we did, we brought her down to the 10 milligrams and she felt so much better.
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