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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Appearances
She started going to the gym, broke through a plateau, lost 10 pounds, even though she'd been plateaued for months on the highest dose. And this doesn't break the laws of thermodynamics. People are like, it's all calories in, calories out. Yeah, she didn't feel like moving anymore because the drug was... And now I always talk about the drug facilitating behavior change.
But once it gets past that point and now all of a sudden the behavior change isn't occurring because they're... Their dopamine is so dampened down. That's not good either. So, yeah, it was pretty cool. It was really interesting. I was like, please, can I share your story? And that's what I did. And then tons of people started messaging me going, I think that's me.
And I'm like, holy cow, this might be a bigger problem than people understand.
Yeah.
You became famous for that. Yeah.
Oh, that's funny.
Very reasonable. And honestly, it's needed sometimes. In other countries, they have clickable pens that you can do. Well, Ozempic actually has a clickable pen, and that's here in the United States. But Wegovy doesn't have it. Zetbound doesn't have it. Manjaro doesn't have it. So you see a lot of people going to the compounding route, which is kind of going by the wayside now.
But like in other countries, there are quick pens that you can do terzapatide in between doses. And it really is needed. It's more for semaglutide. Semaglutide is not as well tolerated. So it's nice to have that for semaglutide. But even terzapatide, the starting dose is 2.5. And sometimes I'm like, I really wish I could do a one milligram because this person's a high responder to this stuff.
They're losing weight too quickly, even on the lowest dose. It would be nice to just go a little bit lower, even half of that. But you can. You'd have to You have to get the vials, and the vials are a single-use vial, or you'd have to inject the pen into and make your own bacteriostatic violators. It's ridiculous. And then it starts getting a little bit potentially dangerous there.
So yeah, it would be nice if, and that comes down to, and we can get into the corporate greed, the pharmaceutical greed, but they don't want people splitting them up because otherwise we could just prescribe 15 milligrams of Zepbound or Monjaro and just have them split up into the smaller doses and have it last longer. They don't want that.
Yeah. So I went to med school late 2000, so 2007. That's right when these drugs started coming out. You know, Bayeta was the first one, exenatide, but it was for type 2 diabetes. It wasn't on the radar to use these for weight loss. At the time, people were really focusing on basically phentermine. A noradrenergic sympathomimetic drug. It has amphetamine-like properties, but not addictive.
A little bit of an upper. But yeah, noradrenaline, noradrenergic. And that was basically what people used. I started going early on to obesity medicine conferences, and there was some weird stuff that they were promoting. They got HCG and all sorts of stuff that people were trying to use, HCG diets, but a lot of phentermine.
And if people remember Phen-Phen, Phentermine was one of the components in Phen-Phen, but it was not the bad component. Phenfluramine was the one that caused heart valve issues. And so they took that one off the market, but kept Phentermine around. It had been around since the 1950s. So once I got to residency, which was 2011, right in 2012, Q-Simia was approved and
And that is a combination of fentramine and topiramate. Topiramate works in GABA. They think that's part of why it works for appetite suppression. But think about different receptors, lower doses of each, so you get fewer side effects. The fentramine can cause people to have insomnia, dry mouth, heart palpitation.
So you try to use lower doses and then add it to something else that has a little bit of appetite suppression, which is topiramate, doesn't work in the same pathway. So that was approved, and that was for chronic patients. And that was, that kind of, you know, the highest dose gets around 10% total body weight loss. So not bad, but side effects.
The other one was, if you remember, lorcaserin with Belvique. It was actually similar to fenfluramine, but it had the... It had a different serotonergic receptor, more specific. Actually got taken off because of, we don't know why exactly, but some concerns for cancer. Very mild weight loss effect though, around like five or something percent total body weight loss.
There was Contrave that came out in 2014, bupropion naltrexone combination. Not that great, still out right now, 6%, maybe 5, 6% total body weight loss. And when you think about like good diet and exercise, intensive coaching, you're going to get around five or 6% total body weight loss on average. People are like listening, going, I lost a hundred pounds. And it's like, yeah, yeah.
Like I'm saying on a population average, we're looking at that, that number. So contrave or bupropion, naltrexone wasn't that great. So it was very frustrating, you know, in residency, I'm like, I'm going to be an obesity doctor. I'm trying, you know, trying to try to do my thing. And those are the drugs that I had. It was 2014 and, I believe it was Saxenda liraglutide, if people remember Victoza.
So liraglutide was the second GLP-1 receptor agonist that came out in like whatever it was, 2009 or something for type 2 diabetes. But 2014, they cranked the dose up to three milligrams. Now liraglutide is a once daily injection. And that high dose liraglutide in 2014, they promoted as Saxenda, it was around like seven or 8% total body weight loss. So like
It's okay, but it's like a $1,200, you know, $1,000 drug for more side effects, daily injections, and overall not that great amount of weight loss. So that was like the, you know, we went from lifestyle, trying behavior, behavior, behavior with some high side effect drugs that some of them, some people responded to. And then you jump all the way from that to bariatric surgery.
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