Obesity, Hormones & GLP-1s: Dr. Spencer Nadolsky on Ozempic, Wegovy, Mounjaro, and Women’s Health

27:31Dr. Spencer Nadolsky:And that's being there. There are rumblings around some of the reporting being done at the FDA about, I've seen some weird stuff, but you never know. You could also have some big pharma propaganda trying to make it look like some of these places are bad. I get it. There's corruption everywhere. So I'm not going to say that big pharma is not corrupt. So you recommend people doing just the name brand is what you're saying? That would be my advice. The safest. That would be my advice. I don't get paid, not yet, by Big Pharma. I am going to be on an advisory board here soon. I never took Big Pharma money, but I asked my patients and followers.

28:12Dr. Spencer Nadolsky:I'm like, what would you think? They're like, well, your haters will just say, see, you're a Big Pharma shill, but we want you to go and try to voice your opinion. I saw that post. To try to get them to lower the cost. So I said, okay, what if I took that money and donated it? So I was like, all right, I'm running some studies. So basically what I'm going to do is take that money. And if people are going through one of my studies and runs out of insurance coverage for the medicine, I will then get them the medicine with that money. So that's what I'm going to do. that's cool i love that um all right so i want to shift the conversation there's 900 tabs open in my brain of where i want to go with this but i really liked the post that you just did with the physician about um mht and how that plays into glp ones and if taking mht helps with, I don't know, more significant weight loss.

29:14Because this is all the conversation in our world is, do you take MHT? Do you not? And then there's that whole pendulum of women that have gone through this, but now we're adding a GLP-1. What do you think?

29:29Dr. Spencer Nadolsky:Yeah. So, I mean, the issue is the Women's Health Initiative that came out, it really pushed like people not to prescribe it at all. That's, that was wrong. And now, but we're seeing menopause influencers and I just, there shouldn't be like, that shouldn't, that shouldn't be a thing. We should just be like evidence-based doctors promoting indicated therapies and going against false information. So women who are struggling and I will never go through menopause. that's the elephant in the room they're like you don't understand well I do understand because I have a ton of patients I have hundreds of women on the stuff and they've been ignored by their other doctors because they were too scared to do it clearly an indication to use menopausal hormonal therapy to alleviate all the symptoms that occur during menopause but I do have a lot of women that never had symptoms and they feel great that went through menopause whatever, lucky them you know so then what you see now is that like in order to promote it even more even without menopausal phasomotor symptoms or anything else like that they're feeling great it's kind of this big push to like take menopausal hormonal therapy to help you lose weight and it's like I don't that's never been studied like that there was a retrospective what we call retrospective So they looked back at the patient charts and it looked like last year, those who took semaglutide by itself, people say semaglutide, it's actually semaglutide.

31:03Dr. Spencer Nadolsky:Nobody pronounces it correctly. I was going to say, now that you're saying it that way, Bill Campbell says it that way. I'm like, I'm saying it wrong. Guaranteed. Guaranteed people are going to say, why should we listen? He's not even pronouncing it right. I'm like, well, screw you. I pronounce it correctly. I talked to Inova Nordisk. This is how it's pronounced. I think it sounds way better that way. Simaglutide. Simaglutide. Anyway, so they look back at the charts. People are like, why? This guy is a real asshole. Simaglutide. They looked at who took simaglutide by itself, and then they looked at, oh, look.

31:37Dr. Spencer Nadolsky:Look at the people that took menopausal hormonal therapy with simaglutide. It looked like the people that took both lost a lot more weight. Now, the thing is, when you look at a retrospective design, they're looking back at just kind of what happened as opposed to what we'd like to do as a prospect of a design and randomized placebo trial. The reason retrospective designs are bad, you can get all these different what's called biases put in. Like, why did that person get prescribed the menopausal hormonal therapy, though? And what makes them different compared to the people that didn't get prescribed it?

32:14Dr. Spencer Nadolsky:there's all sorts of different things. And so that's why you got to do a placebo-blinded trial because then people on a placebo may do just as well. In the study, though, it was tiny. It was a small, tiny, tiny little... There were only 16 people who took the menopausal hormonal therapy with the semaglutide. And so the doctor we had on our podcast, she did an analysis of the SIRMOUT trial, and that's the one looking at trisepatide versus a placebo. And what they did was they looked at the various reproductive phases throughout the women's life. And it looked like no matter what, there wasn't a major difference in how well or how much weight people lost percentage-wise throughout the different reproductive phases.

33:03Dr. Spencer Nadolsky:So premenopausal, perimenopausal, postmenopausal. And they tried to look at differences. It's hard to look at it like who was on the menopausal hormonal therapy versus who wasn't, birth control and all these different things. But it looked like no matter which way you spliced and diced it, there wasn't much of a difference. The thought though, is that maybe estrogen does have this leptin sensitizing maybe effect. So it's because there was maybe a signal in some other studies that post-menopausal women do worse than pre-menopausal. And we all know, well, I don't know, maybe people don't know, Actually, women do better than men on these drugs.

33:41I always make a joke.

33:43Dr. Spencer Nadolsky:You know how the meme is where, man, I only eat basically carrots and lettuce and some chicken all day. My husband cut out looking at French fries, and he lost 10 pounds, and I only lost one. Have you seen that joke? Everybody talks about how their husband can just do whatever and lose 20 pounds while the women just – And it's finally the first time. It's like, wow, women are, they, in every aspect, are beating men with weight loss with these drugs. And the newer drug, retatrutide, everybody calls it retatrutide. Retatrutide. Say it right, people. I mean, unless they change the way it's pronounced, because if it follows the same, terzapatide, semaglutide, liraglutide.

34:28Dr. Spencer Nadolsky:Anyway, that one, too, it looks like similar women do better. So the thought is maybe there's something about the estrogen that is sensitizing. Now, I'm not going to sit here and say that, nope, there's no effect. Stop being silly. It's very possible there's effect. I always just urge caution in saying, look, I wouldn't prescribe menopausal hormonal therapy for the only indication of weight loss only. What I would say, though, if a woman is coming in and clearly has the perimenopausal and menopausal symptoms, unless there's a weird, there's some sort of contraindication that is going on, you prescribe them the hormonal, the menopausal hormonal therapy, regardless.

35:17Dr. Spencer Nadolsky:So, like, here's what I wouldn't do, though. If a woman comes in and she's postmenopausal, she stopped having a period a year ago, she's 51, and wants to go on terzepatide or semaglutide, I wouldn't say, all right, here's your terzepatide and semaglutide. You don't have any symptoms of menopause, vasomotor symptoms, nothing, zero. They're feeling great. I wouldn't go. here's also your menopausal hormonal therapy to augment it. Because we basically have very small, retrospective, non-randomized, placebo-controlled data on it. If they plateaued, let's say, okay, let's say they're 51, they've been on semaglutide, trisepatide, and they got, you know, 10 to 15 % weight loss.

36:04Dr. Spencer Nadolsky:We want them to get 20 for whatever reason. I wouldn't also put them on menopausal hormonal therapy unless they had those symptoms. Because I don't believe that the data is not strong enough. It's possible, though, if they do a randomized trial. And the way that I would set it up, I'm going to be really interested. Someone's probably, I've told somebody's trying to do this trial. I'm going to be interested in the design because what I wouldn't set it up with, imagine you have two groups of postmenopausal women who are both having vasomotor symptoms. Night sweats, irritability, all the different things, all the terrible things that are going on.

36:41Dr. Spencer Nadolsky:you put them both on whatever pick your poison terzepatide and one of them has a terzepatide plus a placebo and the other one has a terzepatide plus menopausal hormonal therapy i wouldn't run it like that that other person that you're confounded because the the people that get the placebo they're not going to have their vasomotor symptoms improved so the only way i would do this uh trial is if you'd have to recruit post-menopausal therapy women or post-menopausal women who don't have any symptoms of menopause, no vasomotor symptoms, nothing. I think that, and then you can do a placebo-blinded terzepatide plus menopausal hormonal therapy versus terzepatide and a placebo.

37:26Dr. Spencer Nadolsky:That's the way that I would run it. I've thought about this a lot over the past few months because I actually think it would be a really cool study because maybe there is an effect. And that's probably a couple of years out until we have a ton of research about that. Yeah, because the other thing that what people will say is that menopausal hormonal therapy, and there are some people saying this, it can prevent heart attacks and heart disease. Well, there's a suggestion that that could happen. We just can't say that definitively the way that the studies have been. So I think if they want to start making that claim, you're going to have to have somebody pay for it.

38:02Dr. Spencer Nadolsky:Because is Big Pharma going to pony up the money to pay for that huge trial when you can get these drugs generically? I don't know. I don't think that that's the issue. Someone's got to pay for it too. I do think it should be done though, because it would be really cool to see. Well, maybe, maybe we go back and the pendulum does swing back and everybody should go on metapausal hormonal therapy. But like, we just can't make those claims right now. I think that it's beautiful though, that it gives women because I, I'm in a different space. Obviously I'm not a physician, but women will come to me and they're just, they're at their wits end.

38:39Like there's all of these changes happening and they're just like help somebody help me just help me. And if you're in the camp that you don't want to take MHT or you're in the camp that you do, it's so refreshing for the women to be like, oh, I don't have to do this. If I don't want to go on this, but I do want to take a GLP one. Great. That works for me. If I, if I do want to take it and you know, whether it changes anything or not, which we don't, It sounds like we don't know at this point. Then there's options. There's not just like one way, which is usually where the confusion comes when we're streamlining one way only to anything.

39:21Yeah, a good physician should be able to have these risk-benefit discussions with the patient.

39:30Dr. Spencer Nadolsky:The system's kind of broken, though. That's why I left the system. I don't call it concierge. It's a direct care model. It's just$150 a month. I try to, you know, with a dietician and a strength coach and all the different things. But like a regular model, you get like five, 10 minutes with your doctor. You see them every once a year. You try to get in. It's a waiting, you know, wait period of three to six months type of thing. So it's really a terrible system because women are like, I get a ton of women that are like, man, I swear I'm not going crazy. the doctor wanted to put me on antidepressants, but it's because they didn't have enough time to explain their symptoms.

40:09Dr. Spencer Nadolsky:And it was menopause. It was literally menopause. It's like, no, so that's, that's the system's broken. I don't, I don't know how to fix it other than I just had to leave. So I was like, all right, whatever. But how long have you done? And it's called Vineyard, right? Yeah. So this one, so I left the system in 2016, um, was with a few startups that had sequence, which was in bought by Weight Watchers that's more of like a again you just it's more of just access to the medicine versus now I'm like no I want a full spectrum cardiometabolic health program where you can spend time with patients they get your own dietician we have a strength training program everything that the person would ever need is in this program now if you like if you're if you have your good PCP and you don't really need them for much and you see them once or twice a year and it's just like refills, you may not find as much value out of my program, but it's like, no, I want to, I know when I message in, I want to get a response within a day and I know it's personalized.

41:10Dr. Spencer Nadolsky:And if I need a next day appointment or jumping on the call with a doctor, that would be like my program. So I started that in January. Just this year? Yeah, it's going really well. People really like it. Again, if you don't value having direct access to a doctor and a dietitian and all that stuff and you don't really need much, some people don't find as much value. But if you're like, no, I want to have someone there when I'm having side effects. I want my Zofran sent in that day. I want like, oh, I'm having hair loss. Oh, we can do some, you know, your various testing. We can put you on minoxidil, all these different things to basically personalize your care.

41:51Wow. Okay, so let's go back to the obesity. Because is this like, this sounds like the population that you've spent a large amount of your time working with. Is there like the obesity gene FTO? And I think there's one, what's the other one? M something?

42:11Dr. Spencer Nadolsky:MC4, there's a bunch of them. So FTO is a small, like, is related. There's polygenic obesity, where you have multiple genes kind of pushing you in one way. And then there's, that's what most people have. Then there's monogenic where you have a mutation in your leptin or your MC4, POMC, or you have a few other, there's a couple other syndromes that are genetic. Those are the things where it's like, the GLP-1 might actually help a little bit, but you may need some other therapies. Like what? What would be other? Yeah, there's one called setmelanotide, msivri. It's only approved for these what's called monogenic obesity issues.

42:54Dr. Spencer Nadolsky:So, and they're upstream in the brain, these upper order neurons that are related to satiety and energy metabolism. So, if you have like a severe mutation or deletion in one of those, like, that's where they're young. Like you see these 200 pounds, young, very young kids, and they're just voracious. It's likely they have that. That's where the parents were getting, you know, accused of child abuse. And it's only been in the past, you know, a couple decades where it's like, and still even people don't understand it very well. But they're like, oh, yeah, that was genetic. Sorry. So hopefully you're not in jail.

43:36Dr. Spencer Nadolsky:You know? Yeah. So those are monogenic. But like you see, most people have just small little variations in their genes that kind of push them in another direction. And people, this is the argument people like, because if you look at the studies, actually, you can prevent obesity in people that have not the monogenic but polygenic forms of obesity. You can prevent the weight gain in the first place. And like, it's not a destiny. If you have a monogenic, you're pretty much destined. And it's almost impossible without treatment to prevent and treat that obesity. But if you have the polygenic, you know, it's not destiny.

44:18Okay. So then this is the million dollar question that people are going to ask.

44:24Dr. Spencer Nadolsky:Trillion probably. But for so for for people, not women, but just people in general out there that are that have the the they're in the camp, you're eating too much and you're not moving enough. And this is how you've become obese. Yeah. OK, so this is this is what I say. I'm like, sure, it's an energy balance thing. Even the people with monogenic obesity, it's an energy balance thing. So it's it's what's causing the energy imbalance, though. And so the people with, let's say, we'll go back to the monogenic just because it's severe. It's like, okay, they have a gene that is giving them a voracious appetite.

45:05Dr. Spencer Nadolsky:Like they have to lock the cabinets sometimes when they're younger. They just, I mean, I see it, brothers and sisters, fraternal twins, young kids. You'll see one who's thinner, who will stop at a birthday party, who will stop at like a half of a cupcake. And then the other twin, who looks, it's like a little bit heavier, eats two cupcakes, maybe three. Same upbringing, same everything else. So clearly there's something going on. So you have certain genes that might push you in a direction in terms of appetite. And that is causing them to eat more. In general, the genetics of obesity are, they're in the central nervous system.

45:49Dr. Spencer Nadolsky:They're related to appetite. People like to moralize appetites. It makes them not feel good. They want it to be their metabolism being lower. But in general, it's appetite related. But the other thing is you can have slower metabolism. Some people have genetics that may, and of course, nurture comes into this as well. But let's say that nurture doesn't. You may have genetics that maybe enjoy physical activity as much. So there's little variations there. But a lot of it's appetite related. Now, the other thing that comes into play is why do some people store fat in certain areas versus other people?

46:27Dr. Spencer Nadolsky:Unfortunately, some people store fat more around their abdomen versus some people store fat in their butt and thighs. Actually, storing fat in your butt and thighs is actually really healthy versus storing in their abdomen. And people have heard that the apple versus the pear shape, but that's genetically determined. determined. So, um, eating, you know, eating too much, moving too little. Yeah, sure. But what's, what's the, what caused that in the first place? And then, you know, someone that stores their fat in a certain way, like it's going to be hard to modify that. And that's, we all have different kind of body shapes.

47:09Dr. Spencer Nadolsky:And so, and then there's other people, there's some people that walk around in life that don't try at all they're not trying to they you we all see them they like shit they don't care about their exercise uh they don't care at all and yet they look great yeah and they don't care and so it's like well that's not really fair and people are like well they have fast metabolisms well no you you'll you if you watch them they may eat some crappy food but that's like all they eat all day and it's a smaller amount than usual. There can be changes in the differences in the metabolism. Actually, there's some interesting genetics of how much they'll absorb.

47:49Dr. Spencer Nadolsky:They may actually poop out more calories, just all sorts of stuff. Yeah. Where it's like, oh man, what the heck? And other people are just like, they look at French fries and they gain five pounds in their abdomen. It's like, thanks a lot. Okay. I had a friend like that. Seriously, the second in high school, she was done eating anything. She was like, well, got to go. And I was like, how many times a day are you going? But super thin and just like never dieted, never had to worry about what she ate. So is that where appetite dysregulation, is that what you're meaning? What do you mean by that?

48:25And can you explain that? Because most listeners won't know.

48:27Dr. Spencer Nadolsky:Yeah. So think about someone that gets done with their meal, a normal sized meal and feels good, doesn't want anything afterwards. Another person, they're eating enough for what their activity and body size is and they want more and they want more and they want high calorie dessert, whatever types of foods afterwards. When it's like, no, this person, they should be done. The appetite dysregulation, we have our environment, these foods are designed in a way that make us want to eat more. Just trying to figure out exactly what about them makes us eat more, but it doesn't matter. We eat more of them.

49:13Dr. Spencer Nadolsky:You know, think about, I always talk about like the, the tort, think about tortilla chips that else, and they're adding a hint of lime. They're doing all sorts of things that you get, you got the savor, you got sweet, you got crunchy, salty, fat, and just in perfect combinations to make us want more. I love that stuff too versus um so we got the environment working against us once we gain that weight though there can be inflammatory changes and they've they've they've kind of seen this with like functional mris and pet scans of the brain to kind of see how it fires and dopamine signals and all these different things it seems to be those with obesity have more of the develop what looks like dysfunction or dysregulation and we can see it when people like when they They lose 100 pounds or whatever, and their appetite just ramps up where it's like, okay, they lost 100 pounds.

50:05Dr. Spencer Nadolsky:Now they're at a weight that should be healthy for their height, let's say. And their appetite makes them want to eat so much more to where they regain a lot of that weight back, if not more. So that's kind of the appetite dysregulation. That's why these medicines work so well. They come and hit the receptors and basically shut off that high appetite level. So, yeah, that's the gist. Well, what did you do before the GLP ones? Because you were a practicing physician before that. Did you have people come in that really weren't eating a ton and still just could not lose weight, that were at an obese weight and they were not moving the needle with diet and exercise.

50:52Dr. Spencer Nadolsky:Yeah, all the time. We have older drugs. There's fentramine, if you've heard of that one. It's a noradrenergic. It's part of the fen-fen craze. Yeah. So fentramine was the component of fen-fen that didn't cause heart valve issues. It was the fenfluramine component that they're like, oh, this thing, it was a serotonergic drug and it hit a receptor on the valves. It doesn't really matter. But fentramine by itself seemed to be safe. But But it's an amphetamine-like. It's got what they call sympathomimetic properties, kind of like an upper. That helped a lot of people. But the upper component gave a lot of side effects.

51:27Dr. Spencer Nadolsky:We had a drug called Contrave. They combined bupropion, which is a dopamine norepinephrine reuptake inhibitor. It helps with depression and smoking cessation. They combine it with naltrexone, which is used for an opioid blocker, used for alcohol cessation. and they work synergistically in the brain to help with appetite. It doesn't work that well, but for some, it did okay. So we had some of these drugs that were okay, and then we had bariatric surgery. So it was frustrating. People would come in and be like, I'm trying really hard. I can't lose the weight. Now the thing is, everybody will say that they're eating 1 ,200 calories, but if they're 300 pounds and they say they're eating 1 ,200 calories, it's not possible.

52:09Dr. Spencer Nadolsky:It's literally impossible. But you see, I hear it all the time, And I can't just sit there and say, you're a liar because that's not nice. Yeah. Yeah. It's not, and that's just, and it's not helpful. So what I usually say, yeah, I know. I bet you're trying really hard because I guarantee they are trying hard. They have a very, what's called a high perceived level of effort, meaning they feel like they're eating 1200 calories. It's not possible that they're eating actually 1200 calories. They're eating a lot more than that. But so that's why these drugs, they basically make it to where that perceived level of effort just lowers so much to where then all of a sudden they are able to eat however many calories.

52:49Dr. Spencer Nadolsky:It's not necessarily 1 ,200, but it could be 1 ,500, 2 ,000, whatever it is. The reason I love these drugs so much is just finally the patients feel like they have hope. They feel good. They can finally do the things that they always wanted to do. and just couldn't and felt like they were gaslit by doctors all the time. Well, I mean, and again, just my own little world here. When I have somebody come into a course that's just, you know, whatever, and I figure out through the numbers that they're obese, I don't want it to be one extra step of them not getting results. Like there's this huge psychological component as well coming in and having one more failure from not being able to do it.

53:38But then these, you know, now in the last couple of courses that I have, there's been a handful or more of women that are on a GLP-1 and they're like, for the first time, I don't have food noise running through my head and now I'm motivated to go to the gym and motivated to eat better. Like it kind of comes full circle. Do you see that?

53:59Dr. Spencer Nadolsky:Yeah, that's exactly. They finally feel like they can do all those things. That's why I feel like it's not cheating to do it. I think it's a tool in your toolbox. And if anything, it motivates people to work harder and eat better. Yeah. Takes all that. It helps the mental space that they had that was committed toward just worrying about food and everything to now they can focus and get things done. So you would put, if you had a family member that was struggling significantly with weight, you would have no problem putting that. Yeah, I have some of them. I try to put them on. They don't listen to me, but I try.

54:40You give it to them for a Christmas present.

54:42Dr. Spencer Nadolsky:You shoot them up when they're sleeping. No, I'm kidding, obviously. But of course, I would only do consent. But no, I did. But yeah. Yeah. No, I absolutely. And are they all the same? Are all of them the same? No. Semaglutide is a GLP-1 receptor agonist only. Terzepatide is a GLP-1, which is glucagon-like peptide, slash GIP, glucagon, or glucose-dependent insulinotropic polypeptide. It's a mouthful every time I always have to think about it. But they hit two different receptors. there's going to be more that hit different receptors. It's going to be quite interesting. So do you feel like people need to try different ones to see what works best for them?

55:31Dr. Spencer Nadolsky:I generally put people to terzepatide first because it's better tolerated, works, it's stronger. But once in a while, they don't tolerate that one. I'll try the Wegovia or semaglutide. But a lot of people that are on semaglutide didn't tolerate it. They actually do better on the terzepatide. So that's my go-to. In the future, it's going to be interesting because I think we're going to see with the different receptors, it'll be more of a game of figuring out what people tolerate best. If we're wrapping this up and really there's, it sounds like there's a few, a small percentage of people that it might not be a good option for.

56:13And probably for the side effects that they're experiencing. So there's no contraindications for someone with like a bad liver. I don't know. Anything like that.

56:24Dr. Spencer Nadolsky:The only contraindications can't be pregnant. I mean, maybe in the future. just put everybody including the baby on it but not right now we don't want to do that uh contraindications medullary thyroid cancer and the reason is because they saw in rats rats have different receptors on their thyroid c cells humans don't have them or don't readily have them but they saw the signal in rats so we don't put it on any with a specific it's a rare type of thyroid cancer medullary thyroid cancer or something called uh multiple endocrine neoplasia type 2. And the reason is that because it also arises medullary thyroid cancer.

57:04Dr. Spencer Nadolsky:Those are like the big contraindications, reasons you can't take it. People are always like, well, I had pancreatitis before. Well, if it was just from your gallbladder, you can get gallstone pancreatitis or alcohol or triglyceride-induced pancreatitis. Not a contraindication. Just some of those things are caution. So also breastfeeding, it's not known. A little bit might get in the milk, but if the baby's getting it orally, it's probably getting broken down. So actually people think that it's probably safe, but on the label of the medicine, it's like caution. I tend to be more risk averse, so I don't do it.

57:41Dr. Spencer Nadolsky:But I think in the future, we're probably going to be like, eh, it's probably fine. But I don't personally just yet. I don't want to get sued. Yeah. Nobody wants to get sued. Okay. So if someone is coming to you, because concierge care, there's a lot of physicians now starting to do concierge care for good reason. For good reason for everything you said. Sick of the health care. I mean, that can range up to$800 to$1 ,000 a telehealth visit. Yeah, some people charge$3 ,500 and a couple of, you know,$1 ,500 or whatever for follow-ups. No, so I want mine to be subscription because I want long-lasting relationships with patients.

58:26Dr. Spencer Nadolsky:Like, instead of just like, all right, I'm going to make a lot of money now. I'm thinking about this as like doctors that care about medicine go into it to develop relationships with patients. And you want to get it makes it my job easier. Once I get to know somebody, I'm like, I can be myself. I don't have to be this sterile doctor or whatever. I can make jokes, you know, laugh and whatever. So that's that's the way I that's why I make it the way I do. OK, so people can find you at Vineyard. What's the what's join? Yeah, join Vineyard dot com. Apparently someone owned Vineyard because it's probably a wine.

59:01Oh, I was thinking Vineyard Vine is the clothing store.

59:04Dr. Spencer Nadolsky:Yeah, well, yeah, there's a whole story of why I chose it. I basically wanted to see them. There's some of these places out there. They're so cheap and it's a race to the bottom. So I want it to be like a little bit higher upscale version of what you see online. And so I was like, Vineyard, that sounds like a classy, nice name and nobody owned it. So I was like, all right, I'm going with that. So that's why I chose the name. And I was like, yeah, be a place where I'd want to hang out with people at a vineyard. Drinking wine, even though if you're taking the medicine, you're not going to be wanting to drink wine.

59:32Dr. Spencer Nadolsky:But like that's kind of the top. Buzzkill. Buzzkill. Let's skip the medicine for a week so we can drink a little bit of wine. But yeah, so joinvineyard.com. I only hire obesity trained doctors. You get direct connection with them. There's no, a lot of these other places, they have a care coordinator. So you're talking to a care coordinator and not the actual doctor. and they sound like bots. So I small patient panels. It's just, it's very, it's supposed to be white glove, but it's not white glove prices where you're paying a thousand dollars a month or whatever. Yeah. Wow. Fascinating. Well, thank you so much, Spencer, for coming on.

1:00:12And, um, I've been wanting to chat with you for a long time. Cause I told you, I met you like 15 years ago at a gym when Alex Bryce was training me.

1:00:22Dr. Spencer Nadolsky:Yeah. You don't remember, but still my strength coach. So it's good. He is? Yeah. Yeah. He's my, he, he does my lift RX program, which everybody gets for free and vineyard. Yeah. He wrote my glutes program. I love it. He's great. He's great. Well, thank you for joining us and thank you for, for your time and for what you are bringing to this space. I, I, I know our, our audience is really going to appreciate it. So thank you so much. Thanks for having me on. Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the body pod with your friends.