Dr. Spencer

Get Lean, Get Healthy

Obesity Doc Who Lifts

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Can Metformin help with Weight Loss?

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Bottom Line: Yes. About 2 to 9 kg (4 to 20 pounds) according to the studies and this fits my clinical experience.

I want to give my patients the best shot possible when trying to lose weight (and keep it off). This may or may not include giving them medicines along the way. Our bodies are working against us so we must work against them (as safely as possible).

Most approved weight loss medicines work in the brain to help us control our appetites. They can be pricey (unless generic, which are approved for short-term) and their long-term effects are unknown. 

There is one medicine that has been prescribed by weight loss doctors and used by bodybuilders for years despite not being approved for weight loss with a very strong safety record. That medicine is metformin. (Or as my Siri has written in the past, Matt Foreman).

How to take it: Start with 500 mg tablet with breakfast (some say start with dinner). If you tolerate it after about a week or two, try 500 mg with breakfast and dinner. After another week or two go to 1000 mg with breakfast and dinner. 

Who takes it?: It is the first-line drug treatment approved for type 2 diabetes. However, it is also commonly used in PCOS (polycystic ovarian syndrome), prediabetes (and those with insulin resistance), those taking antipsychotics looking to minimize weight gain, and adolescents/adults looking to lose weight some weight loss. There are anecdotal reports of athletes and bodybuilders taking it as well. 

How does it work?: Metformin helps your muscles take in sugar (increases insulin sensitivity) and slows your liver’s sugar production (decreased hepatic gluconeogenesis). The mechanism is likely a peripheral activation of AMPK (AMP-activated protein kinase) and alteration of the gut microbiome and increases in GLP-1. You can read more than you ever wanted to know about the mechanisms here and here.

Is it safe?: Yes. Metformin is one of the safest drugs you can take with a lot of data behind it. It may even be beneficial for heart health and cancer prevention. It is even commonly prescribed among anti-aging doctors.

The worst side effects are gastrointestinal issues (see notes below). A decrease in B12 levels is seen as well (malabsorption). You may want to monitor B12 levels if you have been on it for a long time and also supplement with B12 (and calcium).

If your kidneys are sluggish, you will want to ask your doctor if it is still safe to take. There is a risk of lactic acidosis when your eGFR (glomerular filtration rate) decreases to below 45 mL/min (cut dose in half) and it is NOT to be taken when eGFR goes below 30 mL/min.

Notes: Many patients get upset stomachs. This is why we start low and go up (titrate). If this happens, stick with that lower dose for a while until you tolerate it. If after a few weeks you still don’t tolerate it, try extended-release and before bedtime. Anecdotally I find that instant release does better with appetite control when taken at breakfast.

My Experience and Thoughts

Okay, I don’t want to overhype a medicine that is probably going to only give you modest results at best. However, at the very least if you have prediabetes and/or PCOS, and you want to lose weight, you should likely discuss with your doctor about taking metformin. If you have type 2 diabetes and you can tolerate it, you better be on it as well. It is cheap, safe, and likely to help you. 

For my friends who want to use it for bodybuilding and anti-aging purposes, I don’t see much harm in trying it. If I can get my hands on some (I suppose I can prescribe myself some although you’re not supposed to do that), I will use it.

I have also had good success using it in teenagers who need to lose weight and don’t qualify for the more powerful weight loss medicines. The patients tell me it helps a smidge with their appetites.  

 

Dumbbell Reverse Curls

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Everybody loves doing curls because we want our arms to look nice and sexy.

When we do regular curls, we can really feel the burn and pump in our biceps. The bicep is the muscle that is most visible when you flex them.

There are other muscles in your arm though that you want to be sure not to neglect. These are the brachialis and brachioradialis.  

Doing the reverse curls may target these other muscles without as much stimulation to the biceps so it may be wise to throw a set or two in for good measure when working your arms.

All you need to do is grab your dumbbells and instead of curling them with your palms up (supinated), you keep your palms down (pronated). You will likely need to use less weight than you use when doing regular curls. 

See my video here

 

Dr. Spencer’s Baked Fries

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If you have been following me on Facebook, you will notice that I eat a lot of fries. In fact, I loved French Fries so much as a kid, my parents used to tell me I was going to turn into a “fry fry.”

I found out in middle school that you can’t eat fast food french fries and have the body you want, so I quit eating them as much. In college and medical school, I rarely ever ate them. I wanted abs and clean coronary arteries, so it made sense.

However, I started eating a lower fat higher carbohydrate diet (see part 1, part 2, part 3) and started getting creative. I saw a friend on Facebook post about making fries so I started trying making my own fries that were tasty but low in fat.

The first time I tried, it was a disaster. I used russet potatoes and they fell apart and got burned. The next time I tried, I got white potatoes. These were much better in terms of texture after baking, but the best fries turned out after my brother bought some Yukon gold potatoes.

The Yukon Gold potatoes had the right texture after baking. I don’t know if it was due to the waxier texture or what, but they were the best. 

The baked fries are a perfect addition to lean hamburgers for a Go-To Meal. I try to do this once a week if possible. Don’t worry, white potatoes are not bad for you. In fact, they can be a very healthy part of your diet.

Here is what you do:

  1. Get the Yukon Gold potatoes. Or white if you can’t get the gold.
  2. Preheat oven to 400 degrees f
  3. Start slicing the potatoes up to your preferred size. Smaller cook faster of course and can burn easier so be careful.
  4. Throw them onto a non-stick cookie sheet. Spray with some olive oil and top with salt. If you want to get crazy, start adding some other seasoning like garlic.
  5. Bake for about 30-40 minutes or until they are browned to your liking.
  6. Put on the side of your lean hamburgers and big ass salad 🙂

 

Dumbbell Overhead Shoulder Press

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Dumbbell Overhead Shoulder Press

If you have to do ONE movement for your shoulders (barring pain/restrictions), make this one it.

The overhead dumbbell shoulder pressure is the exercise of choice of many for building and sculpting your shoulders. This is especially true if you cannot do barbell overhead press.

With the dumbbells, you can have more range of motion and really make those shoulders burn. 

You can do them standing or you can do them sitting. Grab a pair of dumbbells (or one as I will show in the video below), hoist them to your shoulders, and start pressing them overhead. Keep your shoulder blades tucked back throughout the exercise to ensure stability (see video).

You don’t have to bring the dumbbells ALL the way down to your shoulders if this causes pain. You can use a shorter range of motion. Also, if you have issues with pushing in a directly vertical motion, you can lean the bench back a smidge (almost like a very inclined bench press). If you don’t have a bench, I would not compensate by leaning back while standing as this can put a lot of strain on your lower back. Just use lighter weight if this is the case.

 

Drink Diet Soda, Get Skinny (or even RIPPED)

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DrinkDiet Soda.Get Skinny(Or Ripped) (1)

My best douchy bathroom selfie

While vaccines may be the number one health topic on the internet that gets people arguing, artificial (or non-nutritive) sweeteners seem like a close second.

I got an angry email the other day regarding my recommendation in my book The Fat Loss Prescription to drink diet sodas instead of regular sodas (if you have to choose) for weight loss. Here is the screenshot:

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The email exchanges went a bit further, ultimately telling me I needed to do my research, which meant reading blog articles written by fringe internet doctors. 

The fact is I actually DID do my research and continue to stay up to date on the topic since it is one that comes up all of the time in the clinic. In fact, my brother, an endocrinologist and fellow obesity specialist, and I wrote an article together and published it on the well respected medical site Medpage Today (Click here to read). 

The gist is that replacing sugar with non-nutritive or artificial sweeteners will likely help you to lose weight. In fact, there is some suggestion that replacing the sugar with these sweeteners may do better than replacing the sugary beverages with WATER. 

Now before you get angry with me like the lady in that email above, I never suggest people actually choose diet drinks over water if they prefer water. However, if someone just doesn’t like water and they don’t mind drinking diet sodas (or other artificially sweetened beverages) instead of their sugar-sweetened beverages, the diet drink is the better choice. 

We can now conclude that people actually LOSE weight when switching from regular sodas to diet sodas.

But what about those media headlines about diet soda being bad?!

There are many observational studies showing ill-effects in those who drink diet sodas. These observational studies (as opposed to interventional or experimental) look at groups of people who drink diet sodas vs. those who don’t drink them. These types of studies cannot prove causation (for the most part), but give us clues on possible effects (and associations) of certain exposures. 

For example, there are observational studies showing those who drink more diet soda have more incidence of metabolic syndrome and vascular disease. This means that for some reason, those who drink diet sodas tend to also have these ill effects compared to those who do NOT drink diet sodas. Many think this is the Big Mac and large fries effect where you order the high-calorie food then go ahead and choose the diet drink. It wasn’t the diet drink that caused the weight gain and weight-related issues.

However, as discussed above, when we actually do experiments with people drinking diet sodas (and these sweeteners in general), these ill effects are not apparent. 

My big ass salad with a side Diet Coke

My big ass salad with a side Diet Coke

Shut up and tell me what to do!

1. I always say that if you have to choose between diet and regular soda, always choose the diet.

2. From what we can tell in interventional trials, artificial sweeteners (and diet sodas) are safe.

3. There is a slew of epidemiological studies showing possible hazards as pointed out.

4. There is actual biological plausibility to sugar-sweetened beverages causing hazards eg endothelial function, increased apoB/cholesterol, increased blood pressure, and weight gain etc. The biological plausibility for artificial sweeteners is not there. At least from what we can tell right now.

5. It’s impossible to control for all of the confounders like weight, smoking, etc. (although they try) regarding diet drinks. Also, the food frequency questionnaires (where the researchers try to get the study participants to recall what they eat and drink) that these studies use aren’t the most reliable. Having said that, it is possible there is some sort of effect over the long haul that is causing the hazards discussed.

6. If worried, just drink water.

At the end of the day, if you’re scared to use these non-nutritive or artificial sweeteners because they seem scary, just stick to water (or unsweetened coffee/tea). If you don’t have weight issues and you like your fresh juice, you can do that too. Hell, if you’re not worried about weight then drink some wine (or a Bloody Mary – my favorite) for all I care.

Just don’t go telling people that artificial sweeteners are the devil. I will continue to have my diet sodas as a treat once in a while and I will tell my patients to do the same if they want (instead of regular) 🙂

 

Goblet Squats

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The first type of squat I teach my patients is called the goblet squat.

The goblet squat is named as such because it looks like you’re holding a goblet. Duh. It was invented by a really cool guy and smart coach named Dan John.

The goblet squat is a great squat exercise if you:

  1. Have only 1 dumbbell or kettlebell at your disposal and/or
  2. Feel uncomfortable with heavier weights on your back (like with a regular back squat)

It’s also great for improving your range of motion and getting your squatting form better altogether. 

All you need is one dumbbell or kettlebell.

Set your feet in the same position where you land after a vertical jump. Try it and see where your feet go.  This is probably a touch wider than shoulder length apart. Your toes will likely be pointed just slightly out.

If you have just the kettlebell, start by holding it by the horns/handle and against your chest. If you have a dumbbell, hold one head with your hands (palms in).

When you squat, you want to focus on getting those elbows between the knees. Push your knees out when you squat and if you have to, push your knees out when at the bottom with your elbows. The cartoon above doesn’t show as good as the video below. 

Keep that curve in your lower back too. You can hang out at the bottom if you want a good stretch. Then come back up.

If you notice your heels coming up at the bottom, bring your feet just slightly wider. 

If you are just starting out, you won’t need that heavy of a weight, but you may actually feel better with more weight than you think to get you down low. 

Again, I realize the cartoon above isn’t going as deep as you should LOL. See my video below.

Double your Veggies and Halve your Starch

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Want one weird trick to lose fat without trying? This is it.

Many of my patients have the standard American dinner, which is a meat, vegetable, and starch. An easy way to cut calories (and carbohydrates) is to literally just take whatever vegetable portion you normally eat and double it while cutting the starch portion you eat in half.

For example, if you have one scoop of vegetables and two scoops of starch, flip it around to two scoops of vegetables and one scoop of starch. See this example:

Double your Veggies and Halve your Starch1

Simple eh? This will ultimately fill you up while helping you drop some pounds over time AND allow you to still have some of that starch you enjoy 😉 .

By the way, last year I posted this picture and people got upset that I was eating macaroni and cheese because of the artificial cheese or something. If someone thinks they are too good for macaroni and cheese, then I don’t want to be friends with them. In memory of Gene Wilder, “Good day sir!”

Dumbbell Incline Bench Rows

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Dumbbell Incline Bench Rows

I have found that many of my patients and online clients ignore their backs. Everyone likes to build their chests and shoulders (and arms), but the back gets neglected.

That’s a shame. For women who like to wear backless dresses, you want some muscle back there to show off (in my opinion anyway). For guys, it adds another element of power.

Pulling exercises work your back and this is a different variation to try. All you need are some dumbbells and a bench that can incline.

It’s pretty simple. You get on the bench with your chest parallel to the incline. Hold the dumbbells in each hand and pull perpendicular to the ground (straight up) while squeezing your shoulder blades together. Hold at the top then go back down.

You won’t be able to do as much as you do with a one-arm dumbbell row, but it still works your back nicely.

See this video of me showing more.

 

The Reason you Should NEVER Eat Bananas

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The Reason you Should NEVER Eat Bananas

I was on Facebook this morning and I saw this article about why you shouldn’t eat bananas for breakfast. It lists a bunch of pseudoscientific reasons for not eating them. Complete BS.

If you like bananas, go ahead and eat them. They are cheap, convenient, tasty, and despite having some natural occurring sugar, they are pretty good for you. If bananas are the worst thing you eat all day, I want to see the rest of your impeccable diet. Chances are you’re eating some other shit that is worse.

Oh by the way, I eat a couple bananas every morning and I am doing OKAY. 

Photo on 8-19-16 at 6.56 AM

Dumbbell Deadlifts

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Deadlifts are one of the BIG 3 (bench, squat, and deadlifts) exercises everyone says you HAVE to do if you’re lifting weights. I don’t necessarily agree with that, BUT I do think deadlifts are a great exercise for functionality, strength, and of course looking better.

The exercise works your backside including your butt (glutes) and legs (hamstrings) along with also your upper back (traps). The problem is that most people recommend doing barbell deadlifts and these may not feel comfortable to everyone. During the barbell deadlift the bar only has so much movement since your legs are a barrier to moving any further back. This may cause some discomfort or pain in people who have various restrictions (like me and my hip).

An alternative? The dumbbell deadlift.

Start with your feet shoulder width apart and with a couple of dumbbells in front of you. Keeping your lower back tight (with that small curve held), hinge your hips back then bend the knees to grab the dumbbells in front of you. 

Keep your shoulders back (don’t let them round forward) and start to go back up first by extending the knees again then hingeing back your hips and thrusting them forward.  Keep your palms facing you.

On the way back down, start with the hip hinge again while keeping the dumbbells in front of you. Remember to hold your shoulders back and keep your lower back curve tight. Once the dumbbells get past your knees, start to bend your knees till you get down to your desired depth.

See this video below of me fumbling around trying to teach it. LOLOL