The Prescription Strength Podcast

"I spent twenty-five years trying to be skinnier and then accidentally got jacked, and I'm happier." That's roughly what Niki Sims, a strength coach at Barbell Logic, posted, and I loved it.

In this episode, I'm joined by Niki to ask whether you can change your body without trying to make it smaller. There are still plenty of old gremlins knocking around for women about shrinking our bodies, and she has years of coaching experience to draw on.

Niki tells me what made her sit down and write that post: being exhausted by stressing over the scale, and seeing old photos of herself and realising she was skinnier than she thought she was at the time. We talk about why you can't work on your muscle and spot-treat fat, why you need to fuel your training if you want to perform, and what Niki says to a new client who wants to be strong but "could still do with losing ten, fifteen, twenty pounds". Her answer starts with why, and then an honest look at what losing those pounds would take.

We also get into the gremlins that never quite go, and the jeans that bring them back. Then there are the people around you, including cake at work and comments that say more about the person making them. We cover the pull of super lean bodies, where weight loss injections fit in, and how we encourage women to get strong without creating another ideal to live up to. Niki also answers a fear I think still exists among women: that if they start lifting heavy weights, they'll end up looking massive.

We finish on what strength gives you outside the gym. For Niki, that means saying yes more often, and making a little change to see what happens.

In this episode:
Why Niki wrote the post
Seeing old photos and realising you were skinnier than you thought
You can't spot-treat fat: the body as a whole system
Strength and still wanting to lose ten pounds
What losing ten pounds would take
There is never an end, and learning to love the boring part
Gremlins and the jeans that weren't made for you
Eating differently, not always eating less
Cake at work and comments that are about the other person
Super lean ideals, weight loss injections and asking how you want to feel
Will lifting make you look massive?
What strength gives you outside the gym

As Niki puts it: "I'm proud of the body that I built."

Find Niki on Instagram at @niki.in.the.gym, and on her podcast, Beast Over Burden.

If you enjoyed this, listen back to my conversation with Tat Armstrong Gray, a personal trainer in East London who found that being smaller felt frail rather than strong: "A Broken Back, Fat Loss and Feeling Fragile. Tat Armstrong Gray": https://pod.link/1762298788/episode/ZWRmY2I4N2MtMTI1OS00NWU2LWFlYmQtOWVhYTIwNWI2NDJh

In this episode, I'm joined by Matt Hussey, a therapist and former journalist behind Griftonomics, who makes videos taking apart the claims of wellness influencers.

Matt trained as a therapist after years as a journalist, and now has a private practice. He started making videos to find a better way of talking about mental health and the internet, and the one that really took off was a two minute piece on Mel Robbins. Around the same time he noticed influencers creeping into his clients' sessions, which led him into the world of wellness grifting.

We talk about what makes someone a grifter, from exploiting anxiety, uncertainty and mistrust for financial gain, to why borrowed authority works so well and why the biggest podcasts so rarely challenge their guests. We look at Mel Robbins, Steven Bartlett and Mindy Pelz, the questions raised about Jay Shetty's monk story, and whether any of them know they are doing it. Matt's view is that many have bought into their own story so completely that it is the truth for them.

We also get into what sits underneath it all: the terms and conditions that mean no refunds and no recourse, Trustpilot reviews being pushed around, and the companies that make the product and then go looking for someone with an audience to put their name on it. I share a sad story from my work as a medical examiner, and we talk about why harm that arrives years later almost never traces back to the person who sold the idea. Matt closes by naming the four things the playbook sells you.

In this episode:
What actually makes someone a grifter
From journalism to therapy, and a video about Mel Robbins
Borrowed authority, and experts on everything
Why big podcasts rarely challenge their guests
Steven Bartlett, Mindy Pelz and the story you tell about yourself
The questions over Jay Shetty's monk story
Do grifters know they are doing it?
Terms and conditions, Trustpilot and what happens in a crisis
The companies that make the product and find the face
Sunscreen, uranium water and harm that never comes back to the seller
From trusting institutions to trusting your gut
The four things the playbook sells

As Matt puts it: a customer that gets what they need and leaves is a bad customer.

Find out more about Matt's work, including Griftonomics: https://linktr.ee/matthussey

If you enjoyed this, listen back to my conversation with Deb Cohen, former BMJ investigative journalist and co-author of Bad Influence: "Bad Influence: How the Internet Hijacked Our Health": https://pod.link/1762298788/episode/Y2MxYjg1OWItYmQ3Yy00MDYzLTliZjYtMWRkNTNhMWQ0ZjE0

In this episode, I'm joined by Tat Armstrong Gray, a personal trainer based in East London, who is here to share her story of recovering from a serious spinal injury through lifting weights.

At about 19, Tat broke two vertebrae in a skiing accident and had a spinal fusion, with a bone graft from her hip to rebuild the one that was shattered.
She has also lived with type 1 diabetes since the age of 14. Over the years that followed, the pain got steadily worse and the weight kept going on, until she could barely walk. At 31 she decided to change that, and went on to lose 30 kilos, and the back pain went away.
Then something surprised her: being smaller felt frail rather than strong, and that is what led her to the weights.

We talk about approaching strength training with a fragile back: finding a trainer who will listen, starting with no weight at all, and learning to tell the pain of getting stronger from the pain that is a warning. She explains why a scaled-down burpee is a good way to measure progress, why technique is everything with a deadlift, and why the advice from a consultant was to be as strong as possible while being as light as possible.

We also talk about what lifting gave back beyond strength: a sense of autonomy over a body with conditions that can't be controlled, an outlet for rage, and needing about half the insulin. And we get into the barriers that stop people starting, from personal training qualifications that barely cover medical conditions, to exercise referral schemes that turn people away for the very things exercise would help, to why she thinks the health at any size message can hold people back.

In this episode:
A skiing accident, two broken vertebrae and a spinal fusion
Living with type 1 diabetes and chronic pain
Losing 30 kilos, and feeling frail rather than strong
Being as strong as you can while being as light as you can
Starting strength training with a fragile back
Good pain, bad pain, and a traffic light system
Why burpees make a good measure of fitness
Autonomy, rage and the mental side of lifting
Why so few people are ever pointed towards the gym
The risks and costs of doing nothing
Health at any size, and why it worries her
Leading by example, for friends and for children

As Tat puts it: fitness people want you in the gym.

If you enjoyed this, listen back to my conversation with Mick Wadge, who started lifting at 85, and his coach Ross Starkie:
"He Started Strength Training at 85. This Is What Happened": https://pod.link/1762298788/episode/NGQ2NmZmNzQtMjI2NS00YzI0LWE2MTktNTRkZmI5ZTAyMTE4

In this episode, I'm joined by Dr Fraser Gordon, consultant physician in the NHS and founder of Xvera Medical, a consultant-led online clinic offering testosterone replacement, perimenopause and menopause care, and weight management.

Fraser started out in pharmacology and research into adverse drug reactions before moving into medicine, and has spent twenty years working at the acute end of the NHS. What finally pushed him into private practice was watching medicine become more commercial: people confidently presenting opinions as established facts, and forgetting the basic scientific and statistical principles that need to sit behind them.

We talk about why simple explanations are so easy to believe, from rhyming sayings to adrenal fatigue, a claim he found convincing at first and says has no real scientific basis. We talk about finding a patient to fit a treatment rather than a treatment to fit the patient, and why a test needs a question before it is done, explained with a police officer, New Year's Eve and a woman in a pink unicorn hat.

We also get into the commercial pressure that comes with owning a private clinic. When his marketing team asked for a target conversion rate of 95%, his answer was that converting nearly everyone would mean the clinic was not doing the right job. Not prescribing, he argues, isn't a failure. We talk about a young stroke patient who would not take a statin but was using anabolic steroids and recreational drugs, and what that says about risk perception and marginal gains. And we talk about menopause care, why he was adamant the clinic had to offer it, and the gaps in what doctors are taught.

In this episode:
From pharmacology to medicine, and why the clinic exists
A finite NHS and an almost infinite demand
Adrenal fatigue, and why simple explanations are so believable
Finding a patient for a treatment, and pretest probability
Home testing kits and scans without a clinical question
GLP-1s, and what happens when the treatment stops
Conversion rates, and why a no can be good care
Treating the person, not just the disease
A young stroke, statins and risk perception
Menopause care, HRT and the gaps in medical training
Checking that the person you see is registered and regulated
The one thing you would fix with a magic wand

As Fraser puts it: it's better medicine, done properly.

Find out more about Xvera Medical: https://xveramedical.com

If you enjoyed this, listen back to my conversation with Roxanne Stevenson Brown, founder of Find Care Compare, about finding your way between NHS and private care: "Who Should I See? Navigating NHS and Private Healthcare": https://pod.link/1762298788/episode/OTM4MjdlYjItMTQyYy00ZjhhLWI3N2YtZDU4NTIzNmY3OGIy

In this episode, I'm joined by Sir Muir Gray, public health doctor and one of the people behind the NHS programme Live Longer Better.

Anti-ageing is booming, and with it the idea that if you optimise yourself enough, you can add years to your life. Muir's take is that ageing itself, the normal biological process, is not the cause of major problems until our late nineties. What causes most of the problems we put down to age is three other things: loss of fitness, disease, and the world we live in.

We talk about why your genes matter much less than was once thought, and why what he calls your exposome, everything you have been exposed to since birth, matters far more. Muir explains why he never uses the word lifestyle, why he wants chairs recognised as an occupational hazard, and why he stands up from his chair 82 times a day.

We also talk about the risk of caring too much. Thirty years ago Muir wrote an article in The Lancet asking whether we care too much for our elders, and he would still like to change the word carer to enabler. And he sets out what actually matters if you are 50 or 60 and want to make a difference to the years ahead: a Mediterranean diet, thirty minutes a day of brisk walking, ten minutes for strength, suppleness and skill, and keeping your brain and your social life busy.

In this episode:
Why ageing itself is not the problem until your late nineties
Genes, the exposome, and what your parents died of
Loss of fitness, and the five S's
Why the NHS is a national disease service
Clubs, communities, and moving a little money out of the NHS
Do we care too much for our elders?
Retirement as a renaissance, and retirement regret
What matters at 50 or 60: diet, activity and staying engaged
Creative health, and staying connected when you can't get out
What a clinician can do in nine seconds

As Muir puts it: it's never too late.

Find out more about Live Longer Better: https://www.livelongerbetter.uk

If you enjoyed this, listen back to my conversation with Christine Hobson, who ran her first marathon in her 60s: "At 50 She Was Struggling. At 73, She's Fitter Than Ever": https://pod.link/1762298788/episode/ZTkyNGE1YTYtZDM3ZC00NzY5LWI0ZTMtNWU3NDlmZDU4ZmRk