Docs Who Lift

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.

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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.

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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.

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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.

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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.

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