Cortisol Explained: What Social Media Gets Wrong About Stress Hormones. What Two leading endocrinologists have to say.

In this in-depth episode, Dr. Chhaya Makhija sits down with board-certified endocrinologist and obesity medicine specialist Dr. Karl Nadolsky to cut through the confusion surrounding hormones, metabolism, and modern wellness culture.

From cortisol panic and thyroid myths to continuous glucose monitors and weight-loss trends, this conversation brings science back into the spotlight. Dr. Nadolsky explains what endocrinology really involves, why so many popular “hormone hacks” are misleading, and how misinformation can actually delay proper diagnosis and care.

This episode is especially valuable for anyone feeling overwhelmed by online health advice or confused by conflicting information around hormones, weight, and metabolic health.

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Transcript

00:00
Number one, is this science or is this fake? Everyone should test cortisol using saliva or Dutch testing. Fake.  One myth about cortisol you wish you could eliminate forever.  I think a good myth is that if people are  seeing anything out there marketed or advertised to treat your cortisol, absolutely run the opposite direction.  One supplement trend that drives you crazy  as an endocrinologist.

00:29
Welcome to Hormones and Hope,  a podcast where we bridge science and wellness  to help transform your health.  I'm your host, Dr. Chhaya Makhija,  or you can call me Dr. Chhaya,  a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.  Each week we dive into the powerful intersection of clinical medicine  and real life lifestyle strategies to help you feel stronger,  live longer.

00:57
and show up as your most vibrant self inside and out. So let's get empowered. Hello, everyone. Welcome to another episode on Hormones and Hope. And I'm excited to start the new year with a very, very, very special guest, Dr. Karl Nadolski. Dr. Nadolski, probably did not know that this episode is going to be one of our first ones for Jan 2026. Happy New Year. Happy New Year.

01:23
And the reason I'm picking this specific guest as well as our topic is because Dr. Ndolsky is a first endocrinologist on our podcast. We've had several medical specialists, we've had patients, we've had our personal trainer coaches sharing a lot of health bites. But today is going to be special because we start the new year with facts,  with science, with evidence, and also helping you to just debunk some myths.

01:50
so that you start your new year with more awareness and the right steps to navigate your health journey. So that's the drum roll for you, Dr. Nadolski.  All right.  And welcome to our podcast.  I also wanted to share that Dr. Nadolski is right now residing in Michigan and very, very kind to schedule this podcast, even with the difference in time zones.

02:15
but he is a triple board certified physician, expert endocrinologist as well as obesity medicine specialist.  And he's pioneered a lot of work,  be it in endocrine society,  in the diabetes and obesity world, a great speaker.  And also if you look through his social media platforms, he's advocating evidence-based science, amazing fun  memes, as well as debunking.

02:40
A lot of  myths that have been created by influencers or so-called hormone specialists who are not endocrinologists. So I'm thoroughly, thoroughly excited, Dr. Nadolski to hear from you today and please share a lot more about yourself, your  medical background, what you enjoy, fun, passion, and then we'll get into our rapid fire.  All right. Yeah, sounds good. Well, so I grew up in West Michigan here  and I went to Michigan state. I was on the wrestling team  and that's

03:08
Part of how  I had some nurturing and the nutrition and exercise sciences before going on to medical school. And then after medical school, I did my internal medicine  and endocrinology fellowship. So internal medicine residency and then endocrine fellowship in the Navy. So the first part of my career was active duty in the U S Navy. did my fellowship at Walter Reed Bethesda right across the street from NIH. And then I was faculty there for a couple of years before.

03:35
Getting out of the military and moving home. was an endocrinologist and obesity specialist for a big conglomerate medical group here in West Michigan. And then for a couple of years started a department with my local hospital system, which unfortunately their finances didn't, it didn't pan out. So, but that provided the opportunity for me to try my own thing. And so now I moved my clinic into one of our big gyms here in Holland, Michigan.

04:02
And we call it the endocrinology or actually we call it the diabetes and endocrinology clinic at the gym.  So it's, it's nice to be here. Even if patients don't get down into the gym, it's at least in principle, that's the concept of being here, focusing on nutrition, exercise. And then of course, all the, all the other things we have to do with the general endocrinology and  weight loss and diabetes and all that stuff. From hobby perspective, I sail a lot. That's my summer sport. Obviously I wrestled it in, in college and.

04:32
help out my local team and  my son and his friends and played football here  in high school back in the day. So I still like to go and support those guys and  watch football and that's about it, I guess.  That is very, very, very cool. know, Dr. Nadolski, the way I knew you was, you know, we have a large endocrinology group for, I think it's also international endocrinologists in the group,  but your workouts.  Can you share something about that?

05:01
Well, I'll tell you what. So what I recommend, and this is what I would, we even have like in our,  new obesity algorithm that we just published. And what I recommend to patients is finding a way to really get rid of the complexity, but be work with consistency. And so I do love my strength training. That's what I've done since I was a little kid. And I do think we need more prioritization of basic fundamental strength training. So I like to really keep it simple. I try to get in as many days as I can with, you know, just

05:31
Real basic splits working on pushing muscles, know, chest, shoulders, triceps, and pulling muscles, you know, rowing and pull ups and that sort of thing. And then basic leg things. don't, I don't do a lot of goofy things. I don't spend a lot of time in the gym anymore now with all these things going on and kids and that sort of thing, but I do try to make it consistent. So if I have 15 minutes, I'd happen to work out a gym now I'll get in and I'll get in kind of what I would recommend to patients as being sort of the minimum.

06:01
recommended dose, let's say I warm up and I get, you know, four to six sets of a bench press in one day. Well, I'll feel better about that than nothing for sure. And then, um, you know, I'm trying to play, be active, get in that basic aerobic activity as much as possible. like to work on stairs. I've had, I've had my hips replaced so I don't do much running at all, but you know, playing in the pool or of course,  in the winter I go and I help out the high school wrestling team. So I still get in and wrestle those guys. So that's the way I get my aerobic exercise in. So.

06:30
Really just basic, consistent, something every day, nothing, nothing fancy though.  You just took the stress out of exercise for everyone here. So  thank you.  Good. That's, that's the key. We just got to just consistency over complexity. Yes, absolutely. Great, great, great advice and so practical. All right, Dr. Nadolski. So we start our podcast usually with rapid fire questions, one-liner answers, or something very direct. And then we dive into.

06:59
learning more from you. So you ready?  All right, I'll do my best and try not to be like the politicians on all the shows that don't answer the questions and they go into all these crazy things. Yes, thank you.  So now we're going to get more clarity. All right, number one, is this science or is this fake? Everyone should test cortisol using saliva or Dutch testing. Fake. As you know, as an endocrinologist, we have certain signs or symptoms or certain risk factors that will

07:28
encourage us to screen the appropriate people in the appropriate ways that have been validated by  the data to find those people who have actual disease. But everyone else? No. That's all fake. Number two,  science or gimmick? Thyroid hormone for people with normal and optimal thyroid hormone values and fatigue. Should we replace it or not?

07:51
Now, definitely a gimmick. mean, we have good data on how to, again, evaluate and screen for people who have actual thyroid disease, but people who have fatigue and other symptoms that don't seem to be from thyroid need a much further, a holistic, comprehensive evaluation into the actual root issue and not the roots that the influencers  use as a kind of a buzzword. Yes. Thank you.

08:16
True or false, ultra processed foods impact blood sugar, weight, hormones  more than people realize.  Probably true to some degree. I think there's a lot of nuance that's confusing about these and the definitions  and some other things, but the basics of it are yes. You know, we know that the basics of ultra processed foods tend to overwhelm our body's energy balance regulation system, ultimately leading to weight gain, obesity, insulin resistance, diabetes, et cetera.

08:45
Thank you. How about continuous glucose monitors? Should everyone wear one of these tubes? Definitely not. Until somebody proves me otherwise that somehow they are helpful for say athletes, because that's what people think. They're just all the data suggests that  they are, there's just no benefit for people without any type of dysglycemia, meaning at least pre-diabetes. And even that's borderline, whether it's helpful or not. There's just

09:15
You know, unfortunately the keto evangelists like to recommend them because they would be fine if people have flat blood sugars drinking butter and eating bacon. But if you eat a banana and make your sugar spike normally, which is normal, then they think that's a problem and it's not. Yes. Thank you. So we're going to dive more into this one.  One myth about cortisol you wish you could eliminate forever. Oh boy. So one myth about cortisol.  I think a good myth is that if people are.

09:44
seeing anything out there marketed or advertised to treat your cortisol absolutely run the opposite direction. have, you and I have people who have real tumors producing cortisol or stimulating cortisol production that's very severe. Most common cause of excess cortisol, you know, causing Cushingoid symptoms is from medications  and giving medication, which we sometimes will do to block cortisol in those situations.

10:14
is not for the faint of heart as some of our mentors  who have done the research on this would say. And so  whether something would actually do that from a supplement or not, I don't know, but it's a waste of money and potentially risky if it does do anything.  And if you have concerns about that, you need a real actual legitimate evaluation.  Thank you. This  was great.  I love it.  Next one, fiber and protein are one of the...

10:41
simplest and the most powerful additions, but most people in the United States of America are not eating enough. I'd definitely say true for the fiber protein. think there are plenty of people who probably don't get enough protein for the situation. Those who are, you know, working on weight loss and then maybe just some other people who are struggling with frailty. But in general, I think the marketing for protein is so high that maybe, maybe there's an over-exaggeration of how much protein people actually need.

11:10
I do think people don't get enough fiber though. And that goes back to the whole processed food issue. I think  we need to eat more vegetables, fruit, beans, legumes, and truly whole  grain things like oats  and whatnot to get more fiber. People definitely need enough protein, but I have a feeling that's not as deficient as, say, fiber.  Right on. If you're watching this on YouTube or listening on the podcast, take this. This is gold right here. Thank you, Dr. Nadolski.

11:39
The next one is also relevant to CGM. So is anyone can safely self-manage a continuous glucose monitor without proper education, right or wrong? Well, I'd say wrong again, because most people who just don't need it, I think are going to be confused and misinterpreted in the right, you know, and then take it into the wrong context of what they're supposed to do with that information.  one, CGMs are not

12:04
perfect anyway. So even people who really, really definitively slam dunk benefit from them. Like those with type one diabetes who require insulin, those with type two diabetes who are on insulin or just not on insulin, they really, really can benefit from it. But the lower the risk you have, the less meaningful the numbers  are, but they're still not perfect. And even if they were,  you'd have to have some significant education on what to do with that information enabled.

12:32
before you could make any meaningful dietary decisions. Like I said, you might think, oh my God, I just got to like not eat any type of carbs, which would then  get rid of fruit, vegetables, beans, legumes that are potentially very good for you. And you could ultimately choose things that are not so hot for you. Now, if somebody educated you on how to, you know, take that with a grain of salt and improve your diet, then sure, but you know, not just on your own, like a cowboy.  Exactly. Thank you.  One supplement.

13:02
that drives you crazy  as an endocrinologist. Definitely anything that says it's for adrenal fatigue. Awesome. Yes,  I would give the same answer if you were asking me this question. Thank you so much. What about hormone balancing programs that are out there?  Is that science or marketing?  Marketing, basically. I mean, certainly there is something to it. You know, people who are having obesity-related

13:30
diseases or exacerbations of their diseases like say, obesity related male hypogonadism or PCOS and females. There is to some degree something about balancing the hormones, but usually when it's used by the influencers out there, that's just, they've stolen that word and now made it basically a red flag for quackery in my opinion. So, so basically it's just a marketing thing, even though we kind of do that in some ways when we're treating patients. Yeah. Thank you so much. These were like,

13:59
Different rapid fire questions because I really want Dr. Nadolski today to give us some eye-opening answers so that you walk with  some more  knowledge about, you know, what's evidence-based science? What are endocrinologists focusing on? So let's learn more, Dr. Nadolski.  One thing I wanted to have you explain from your perspective,  right,  is endocrinology. Like, what is this field?

14:24
and, you know,  at least enumerate certain conditions because you talked about general endocrinology as your own clinical practice. So that there is even more validation as to what we are sharing today, what we are discussing is coming from a perspective which is science, which is evidence-based, which is proven, which is safe for our patients.  Sure. Well, so endocrinology obviously is the study of hormones. And in our case, we are clinical endocrinologists. So we're treating people with

14:54
diseases of their hormone system. What the heck are hormones? I'm always interested in how other people might describe them, but I think the way I would describe that to people is that they're basically chemical messengers throughout the body. We have to have all sorts of processes in our bodies to tell other parts of our body what to do. The hormones travel throughout the body to tell other organs that are distant what to do. They get into the nuclei of cells.

15:23
They engage in,  you know, interact with the genetics and, and protein metabolism and, you know, all these other things.  And that's, you know, certainly very important for a lot of our body's functions. And so of course we would argue it's maybe the most important thing  in, in human biology. Every special maybe perhaps thinks that and, they all do so many different things and we have so many different types of hormones. I'll tell you one thing that drives me crazy out in the influencer world is when people just say, Oh, I got to check my hormones.

15:52
Well, I think a lot of people have taken that to think, I think they talk, they're talking about their sex hormones, you know, like in men testosterone and females, maybe they're, they're estrogen or whatever. But, um, but we have so  many hormones. I don't even know how many  are clinically applicable off the top of my head,  ranging from  our hypothalamus, I call it our control center. That's regulating our temperature, metabolism,  sleep, et cetera. That, and then it controls, of course, our pituitary.

16:20
which has a lot of the famous stimulating hormones like growth hormone and thyroid stimulating hormone as the hormones that stimulate our gonads, that's our  testicles and ovaries and  our adrenal glands. The back of the hormone has the antidiuretic hormone or vasopressin. And then of course all the target glands, the thyroid and the adrenal glands and our  sexual  organs. And then of course, on the other hand, we have our metabolic.

16:47
hormones, so to speak, like our pancreas making insulin and glucagon for our blood sugar regulation.  have hormones that come from our fat cells to help regulate our energy balance, et cetera, like leptin that maybe people are familiar with. And then of course the intestine hormones that play a whole role in the pancreas function and hypothalamus, that would be like the GLP hormones that people hear about now that we have medicines that mimic those.

17:13
We also do a lot of bone metabolism. So the parathyroid glands that  control our calcium levels or concentrations in the blood working on our bones and our kidneys and our vitamin D, which is a hormone essentially its own right.  And, uh, you know, I think people don't realize we have all sorts of different types of hormones, how they're made. know, we have the steroid hormones made from  cholesterol essentially  in its origin. And then, you know, now everyone talks about peptides. Oh, everyone's into peptides. Well.

17:42
We have all sorts of real peptides that are in our, know, insulins of peptide, the GLP, the hormones are peptides. We have medications that are, that are peptides. That's one, another thing I would tell people don't start falling for this. People are selling peptides. Those are drugs. A lot of them haven't been studied enough to be approved for anything yet. And yet they're saying, Oh, everyone's got to be on peptides. That drives me crazy because that seems like that's pretty dangerous. I wouldn't take a drug that's not been researched and approved for anything that I would need it for.

18:12
Anyways, that's  there's my not so quick description of what hormones are. Yes. No, I totally echo that, you know, the, the details that you  provided. And the reason is also, you know,  on this podcast, like I'll share, or if you have her on our YouTube channel, I'll share about endocrinology or the way you described it as the study of hormones and, know, the cross signaling that's happening. But the reason for us to like  understand this again today.

18:39
is because you are debunking those myths as to why the Dutch testing or the way you talked about if thyroid hormone values are perfectly normal, then why you wouldn't need a thyroid hormone prescription,  because that's going to mess the cross signaling and the crosstalk,  and you end up with side effects or more symptoms. So now since we know what endocrinology is, very, very expansive in terms of affecting every part of our cell, and it's not just one organ.

19:07
We talked about the Dutch testing, salary cortisol, the tired hormone optimization, et cetera, cetera, adrenal fatigue that you commented about. So can you walk us through in simple language where everyone can understand the medical truth behind a trend? How can someone who's listening to us or people who don't have a medical background, how do they understand that what's a...

19:34
validated tests for me or how do I seek the right expertise? How do I find someone on the internet or charge GPT, which is more legit,  is scientific and that person or that professional can help me in this hormone or world of influencers? Yeah, you know, that is really tough. mean, I think.

19:54
To be honest, I really think even though we're putting this stuff online to help fight the social media misinformation, et cetera, I think the way to go about it would really be to have a discussion with your general primary care doctor. And ultimately, if you do have a concern for whatever reason about some sort of hormone, just be aware of that. We just talked about all those different hormones. There has to be something more specific that you're looking into. so, you know, I think it goes back to just good old fashioned basic

20:23
medicine where you have to be able to tell your primary care doctor who I know they don't have enough time because of our horrible healthcare system, but you have to start somewhere  and you know, what are your symptoms? Is it possible you have a history plus exam findings that could warrant an evaluation into some specific type of hormone evaluation? Do you have a deficiency like, you know, we're talking about adrenal stuff. So do you have symptoms?

20:52
that would make us think, hey, yeah, you do have a high risk of possibly having either a pituitary deficiency, thus not stimulating your adrenal glands or literally an adrenal gland disease where you're having a deficiency. example,  you and I see patients who have  real primary adrenal insufficiency where their adrenal glands don't work. So they're not making cortisol. And by the way, then they're generally not making aldosterone, which is,  I tell people that's our blood pressure hormone. That's actually under control of the kidneys, by the way.

21:21
You know, so if you're having really profound fatigue, you're losing weight, you're lightheaded, you have low blood pressure. If you have adrenal disease itself, you're going to generally get, I always ask them, are you getting a nice tan this winter, even though you're not outside? And that has to do with negative feedback up in the brain and the, and the, um, the hormones that go up because your adrenal glands aren't working. And it, also stimulates our, um, melanocytes, our skin color cells.

21:48
So there are specific symptoms and signs and  in medicine there are statistically relevant things we screen everybody for because it's so prevalent and we can address those like cholesterol and blood sugar. And if you have certain risks of things like type two diabetes, if you have obesity, family history, then we should be screening you for type two diabetes here and there depending on your risk factors.

22:14
But not everyone should be screened for adrenal disease unless you have  something else because we run the risk of false positives, false negatives, because even the tests that we know have been researched and validated to help us essentially delineate.  that normal or is there something maybe going on that we have to either treat with say surgery or medicine  replacement therapy? Then you run the risk of false positives.

22:41
And then you go down rabbit holes and potentially all sorts of other risks. So these people that are selling, you know, the adrenal fatigue kits, like Dutch testing, all that stuff that those have not been scientifically validated to find any type of actual disease. But ultimately it ends up trying to, usually they're trying to sell some sort of supplement to patients. And hopefully at the same time, what they're actually doing is helping people improve their nutrition, exercise, sleep, which if that's at least the underlying true root.

23:10
issue of whatever the fatigue is, then maybe that person will get better anyways, regardless of paying for supplements that they don't actually need. The bigger risk in my opinion for like adrenal fatigue or telling everyone it's their thyroid when it's not their thyroid causing problems is that now we're missing what might actually be causing fatigue. so, so while again, we're always going to work on the nutrition, exercise, sleep, lifestyle things. If they just tell you, you have something that's not true, like adrenal fatigue.

23:39
you might miss a real problem. mean, one, if you actually have adrenal insufficiency, that's not  a slight problem. That's a big deal that can be very, very life threatening and we need to be all over that. So that's the problem with making up these fake diagnoses and selling people stuff they don't need more than just the wasted money on supplements and  testing kits. There's some real danger in  giving people false premise, I think. Yeah, again, totally echo that. You know, I have

24:07
I've been taking pictures over the years since we've been practicing endocrinology for so long, more than a decade,  is these supplements. If you just flip and look at the ingredients, so many of them will have  animal extracts of thyroid.  Oh yes. I knew you were going to say that. Animal extracts of gonads. And they feel like actual hormones. Yes, all the time. Yes. Those are really dangerous. And yeah, we see that all the time. Yeah. So tell us.

24:35
Tell us more anything that you've encountered and why are they dangerous? Well, yeah, like you said, I mean, you'll see bovine or porcine. So bovine is cow, porcine is pig, and they'll have pituitary gland tissue, thyroid gland tissue, adrenal gland tissue. If that's true and you're actually ingesting another animal's  glandular tissue with their hormones in it, you might run the risk of too much thyroid hormone, which is hard on your heart and your bones. If you're getting too much

25:04
cortisol type from the know hormone from the adrenal glands. Yeah, that can cause you might feel up.  know people might think oh I feel better, that's talk about putting a band-aid on something. That's not necessarily a good thing  and that'll really be hard on your metabolic health. know too much cortisol, too much of that type of hormone is really bad for people's metabolic health.  Increased risk of diabetes, increases blood sugar, it's hard on our bones, hard on our muscles and then

25:34
At the same time, it literally will cause adrenal insufficiency because if you're taking that type of hormone, your hypothalamus, your pituitary and your adrenal glands think they don't have to work. And so then, you know, they kind of go to sleep a little bit and then, and then you really do have adrenal insufficiency.  yeah, or, or, you know, like, let's think about, um, you know, guys who are taking testosterone that don't need it. That's a big marketing thing now too. You know, we've always heard about guys taking anabolic steroids and that causes hypothalamic, pituitary and testicular function to...

26:03
go down and sometimes they can't recover from that. And then now we have guys that are sold drugs because it's promised to be like, uh, know, youthful or whatever it is, even if they don't actually have disease, they might have other things going on, but they're sold the testosterone and now they're on testosterone. Now they're on drugs that they maybe don't need and it might be hard to come off. So that kind of got away from the whole glandular thing, but as far as like people selling, you know, actual hormones, essentially, that's yeah, that's the problem.

26:31
Yeah, anything that's, know, the supplement world that you're listening and this is again for audience, know, pay attention to the ingredients. Like you don't need any hormonal supplement, which has animal hormones. You just don't need it. Just go for the right expertise and right evaluation and then the right treatment. Thank you so much.  This is also close to my heart and I really love that.  There's another great expert who's in academia, who's all in education and trying to  spread the word of

27:00
in evidence safety in this realm of endocrine. So thank you for sharing. Now we're going to switch gears, Dr. Ndolsky. It's still going to be endocrinology. You taught us a lot about continuous glucose monitors and why it could not be a right tool for someone who doesn't know or has the education. Can you explain, like, where is a continuous glucose monitor recommended?

27:23
versus, you we have certain benefits for a certain patient population where it's still not FDA approved. So what do you think those individuals or what kind of conditions would those be in terms of learning or understanding the glucose spikes? How can someone get a right medical guidance? Like what steps they could take or what questions they can ask their primary care physicians or any healthcare professional, or what resources they could look through that would a continuous glucose monitor

27:53
be for me if they don't have diabetes mellitus. Well, so like I said earlier, I mean, the people who absolutely definitively have been proven to benefit from them are obviously people with type 1 diabetes. They don't have pancreas function, they're on insulin  and the continuous glucose monitors have been shown beyond a shadow of a doubt that they help them improve their blood sugar control and reduce the risk of hypoglycemia, which is very dangerous in people who are on insulin. So that's a slam dunk. And of course now

28:21
They are working with the insulin pumps or automated insulin delivery systems where they're using AI algorithms to help really  help perfect and  safely optimize people's blood sugar control. People who have type two diabetes who are using insulin, it's really helpful to help them adjust. Oftentimes help people get off of insulin. they, you know, they have obesity related insulin resistance type two diabetes, they may be on insulin. And then we can use diet exercise and other

28:50
perhaps more globally beneficial medications like the GLP-1, a receptor agonist, et cetera, to help them get off their insulin. But in order to safely do that, a continuous glucose monitor is very helpful for them. So they can see,  well, what foods are making me go up? And it may be very helpful for those people to cut down on carbs and sugars  and other processed foods. Ultimately, we're really trying to treat their obesity, which will lead to not having as bad of...

29:17
glucose intolerance per se. So they don't always have to be completely low carb necessarily,  but certainly when they're trying to get off insulin, can be very helpful. Pre-diabetes, that's a little stickier. think in  theory, it can be helpful. I know one of my mentors at Walter Reed Bethesda, he was one of the early CGM gurus, Dr. Vodersky. He was the president of Endocrine Society years ago.  And he certainly did a lot of research into the continuous glucose monitors. And we talked a lot about the studies he was trying to do in pre-diabetes and

29:47
I think one of them that he did, it just didn't pan out, but we think that perhaps it was because they didn't have necessarily the right education from the dietitians that could have gone along with it to help say, okay, well, all right,  let's replace maybe some carbs that are causing your sugar to go up into a, almost more of a diabetes range while also not replacing them with other unhealthy types of foods or whatever that just don't happen and not make your sugar go up.

30:15
So for people who don't have any dysglycemia,  think, you know, what people will say is that, this will help athletes kind of fine tune what they're doing. But to me,  you know, I just, I don't know, I don't think they're  accurate enough to necessarily do that. And I think if people are going to try to figure out what foods they eat that help them perform in sports as a former athlete, I feel like that could just be trial and error.

30:42
or  look at what the research says about nutrition anyhow, regardless of what your blood sugars are doing.  I think if you want to try it without  going to some extreme, like I said of,  gosh, I better keep my sugars completely flat, like the keto evangelists say, and only drink butter and eat bacon. But with a little bit more nuance and understanding like,  oh, my blood sugar going up to even 140 or whatever here and there, but it recovers very quickly.

31:10
That's okay and safe. And we don't have any reason to think that that's somehow going to harm you. You know, if you can correlate that to how you perform or how fast it goes up and down and then when you need to work out, I could see that coming, you know? And so I think, you know, maybe someday we'll have some sort of research  into that, you know, and so maybe it's more about time, food timing, you know, well, on an individual basis. Well, if I eat a banana, how high does my sugar go up? And at what time do I feel the best and perform the best? Maybe.

31:40
But until that day comes, I don't know, I just wouldn't necessarily encourage it, but people are going to do it. And that would be kind of how I would do it. would definitely say, don't listen to the people who tell you to be afraid of glucose spikes that are within a truly normal range that recovered quickly. Like the famed glucose goddess who has no medical education background. She's a, she's like a math person who somehow decided that she was going to make a ton of money by.

32:08
telling people about keeping their blood sugar flat and avoiding sugar spikes and selling supplements that don't work for that purpose. And now of course, she's being paid by one of the CGM companies to promote their non-diabetes over-the-counter CGM, which again, that's potentially harmful if you follow what she does. But she also, you know, she says some things that are totally fine and good, like, well, eat your vegetables and protein before the starchy carbs. Now that's in our world.

32:35
more meaningful for people maybe would type one diabetes or type two diabetes and that sort of thing. And  actually it can help you end up eating less  ultimately anyhow. But then she takes something that's a uh relatively reasonable thing. Probably doesn't matter that much for people without disease and then says, but by the way, buy myself. And so it's like, ah, it's always something. Yes. Yeah. And you know, we are having this conversation. Just want to remind the audience that you have choices.

33:01
And you are the ones who are making the decision, which is for your health. So here is this knowledge, which is coming from an expert endocrinologist on our podcast. There is no voodoo medicine on our podcast.  And to take it with a grain of salt, that, okay, what are we saying? What are we discussing? And, you know, we are actually involved in clinical practice, seeing our patients.

33:23
and ensuring that patient safety comes first, patient education knowledge comes first. And I also wanted to  express this, Dr. Nadolski, since you're sharing very close to my heart, endocrinology is very close to my heart, is that I always tell my patients that whatever advice or discussion that I'm having today would be applicable if I was asking this question or if I was in your shoes or if I was treating my  members.  So there is a difference between what's happening out in the influencer world

33:53
versus what's happening in our exam room or what we are discussing with our patients. This was so amazing in terms of the wealth of, not information, but this is wealth of knowledge that you're sharing. And just wanted to emphasize that maybe just review this podcast again, or share it with someone who is trying to figure out or trying to navigate to the healthcare system in this hormonal chaos and how to go about it. One more thing I wanted to ask Dr. Nadolsky before we

34:22
know, wind down, would be your expertise also in obesity medicine.  And  you're pioneering, you said you just released the obesity management  algorithm for  physicians out there. What myths,  specific myths that you've come across, either on your channel or  out there, which you would either debunk today with our audience, or you feel like, you know,  this is definitely a great fact.

34:51
that everyone should know about in the medicine or in the obesity medicine world. So probably what we should touch on is the very important concept of obesity as a disease, because we have people, it seems like we have half the people saying, oh my God, it's not a disease. It's just, you know, you're eating too much, not exercising enough. And then to some degree, we almost have the pendulum swing too far in some cases where people think, oh my God, everyone with obesity has a severe disease.

35:20
disease state and everyone needs medicine or surgery. Now that's not true either. And so I think what we need people to know is it's not your fault. That's called internalized weight bias. When the external  society has caused people struggling with obesity to think it is their fault. We have very complex human biology. We have a lot of different genetic predisposition to gaining weight in this environment we live in. That's what really changed, right? I mean, our genetics didn't change.

35:50
but we had the predisposition, but everyone's a little bit different. then this environment. So genetics load the gun, our environment pulls the trigger. There are some very rare,  very specific genes that just cause insatiable hunger from youth and they can't help it. You know, the front part of your brain might say, oh, I'm going to eat vegetables and fish, but the rest of the brain is just driving hunger and inability to feel satiated or satisfied. And then there are cravings. Now those are some severe

36:19
genetic things and we have syndromes that can cause that too. So people who really struggle from youth, those people have to be evaluated a little bit deeper into some of those genetic things because we might need to use some special therapies. But then everyone's different in what we call polygenic, sort of general obesity, all these different genes putting us at risk.  And in this environment, people respond differently. And then people have different, I call them with patients,  monkey wrenches thrown into that equation.

36:48
Things happen to people in life. Maybe we grew up eating well and exercising. Maybe we didn't. Maybe we had sort of a poor environment growing up. And then, you know, we go through puberty. People have different other illnesses, different medications that adversely affect that whole system.  Women have kids and that throws them off. Pregnancies, stress-related things, divorces. You go through menopause that throws a monkey wrench into it. Injuries, all these different things. And then our body works against us.

37:18
And we can tell like from some of these studies where people are on really good therapy, they lose a lot of weight and then they go off of it and they start to regain the weight on average, despite the same efforts being put into it. And then you can tell from a very recent study. In fact, I think that's really cool when they, they looked back at the tersepidide trial looking at this. And then there are these groups of people who have different levels of weight regain. so like, for example, in that one study, 17 % of people who

37:47
switched from medication to go off the medication were actually able to maintain their weight that they had lost on the medicine. So those people maybe don't have as strong of a biological drive to regain the weight. Maybe the medicine helped them just figure out what they had to do for their more appropriate healthy body weight and they were able to maintain it. And then there were some people who regained  more than what they lost and they probably have a very severe underlying biological drive.

38:16
That's very interesting. So is it 17 % in that trial were able to  maintain? Essentially maintain. I mean, a little bit of regain, but you know, that's pretty darn good. And so, so anyways, I guess my point is it's a lot more complicated than people realize. It is a disease process. It drives health problems. And what we really care about is not what the number on the scale is, is what harm is it causing or the risk of it potentially causing, whether it's mental, metabolic or physical health. So, you know, mental health disorders.

38:46
metabolic like diabetes, fatty liver, kidney disease, heart disease, and then physical stuff like arthritis  or a little combination like sleep apnea and stuff like that. Cancers,  we have a lot of obesity related  malignancies that we can prevent by either preventing obesity or treating the obesity before it happens. Yes.  So insightful. Thank you. This is, you know, it's very much, you just.

39:10
clarifying or shining a lot of light here that it is a medical diagnosis which needs appropriate care, appropriate expertise.  And,  you know, I have seen a lot of,  I'm pretty sure you have, where patients come in and they have this sense of guilt  and the shame or  one common statement is, oh my gosh, my doctor's going to get angry because I haven't done anything and my number is the same on the scale.  So you really explained it well in regards to it's not just that, but all the impact.

39:40
or negative impact that it's leading to and the biology are very well explained. Thank you so much. So Dr. Nadolski, before we sign off, please leave our audience with anything that you would want to share in the community, any specific advice,  any fun tip, and then also please let us know about your platforms because I would love the audience to also follow you and learn more about evidence-based endocrinology and obesity medicine.

40:07
So I think, I think my one little tip goes back to talking about the exercise and how exercise isn't great necessarily on average for weight loss. It is pretty good for weight maintenance or preventing weight gain, but  much more important than that is literally again, what's on the inside that counts. so exercise, regardless of the number on the scale is just good for you, both the strength training. So if you gain muscle, you actually gain weight and that's actually very, very good for you. The aerobic activity is very good for you. So consistency over complexity, get it in.

40:37
work with somebody to help find a way to learn how to do some sort of strength training, be active, be physically active, no matter what your weight does. And by the way, some people have to lose weight in order to do exercise. So people are struggling with very severe obesity. They may not be able to move. So we might have to help them with their weight loss before they can do some exercise, but that's just good for you no matter what your weight is, no matter which way we slice it. And to some degree, same with dietary quality. think, you know, working on, you know, the minimally processed food, dietary quality, even if you don't

41:06
necessarily reduce your calorie intake, we can  improve our health with some dietary quality measures. that there may be some individual nuance with that. So I think that's sort of, you know, what I try to get people to know. And then as far as, know, I think you kind of pause a little bit, but I think what you asked for, for like my social media and all that stuff, certainly people can listen to our, our podcasts, the docs who lift podcast. You know, we do  some of the same sort of things pretty informally  and my social media pages are just at Dr. Carl Nadolski. So.

41:36
Thank you so much.  And  I love the name  of your clinic, is  Diabetes and Endocrine Clinic at the gym.  So it just speaks. You don't even have to explain or I don't think that a mission is needed because the mission itself is within it. Thank you so much for this amazing, insightful conversation, Dr. Nadolski. Thanks for having me.  Absolutely. I hope we can converse some more in the near future about debunking even more myths or just bringing more clarity to our audience and to our community. Thank you.

42:05
Thanks for hanging out with me on hormones and hope.  If you've loved this episode, do me a favor,  hit subscribe, share it with someone you care about,  and drop a review if you're feeling generous.  Want more tools to support your hormones and health?  Head over to unifiedendocrinecare.com.  We've got free guides, resources,  and more waiting for you.  Until next time,  stay curious, stay kind to your body, and keep your hormones happy.