Browse the evidence

Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), restores GLP-1 secretion by rapidly delivering nutrients to the distal gut where L-cells are concentrated, leading to increased satiety and weight loss.

Bariatric surgery, like RYGB, works partly by changing how your gut hormones respond to food. By delivering nutrients to the distal gut faster, it triggers a surge in GLP-1, a hormone that promotes satiety. This hormonal reset is a key factor in the weight loss achieved after surgery.

GLP-1 receptor agonists significantly delay gastric emptying and increase residual gastric content, but do not significantly increase the absolute risk of pulmonary aspiration in standard endoscopic procedures.

If you take GLP-1s (like Ozempic or Wegovy) for an endoscopy, expect your stomach to empty slower, but know the risk of lung infection is very low. You likely do not need to stop your medication unless you have specific symptoms or high-risk procedures. Follow extended clear-liquid fasting instructions and use gastric ultrasound if available to ensure safety.

GLP-1 receptor agonists impair colonic preparation and delay capsule transit, increasing the likelihood of inadequate bowel cleansing and the need for repeat colonoscopies.

If you take GLP-1s for a colonoscopy, your bowel prep might be less effective than usual. You may need a more intensive prep regimen (like extended clear liquids or additional laxatives) to ensure the doctor can see clearly. This is common and manageable.

Pharmacological inhibition of angiotensin-converting enzyme (ACE) using enalapril (20 mg/day) during 8 weeks of high-intensity training significantly attenuates exercise-induced increases in lean body mass in healthy adults, while peripheral muscle adaptations and aerobic performance remain unaffected.

If you are taking ACE inhibitors (like enalapril or lisinopril) for blood pressure, be aware that these medications may blunt your muscle growth potential compared to not taking them. This does not mean you cannot build strength or endurance, but your muscle mass gains may be reduced. Focus on consistent training and nutrition, and consult your doctor before making any medication changes.

The ACE I/D genotype is a poor predictor of actual ACE enzyme activity and downstream exercise adaptations because it is in linkage disequilibrium with functional variants and does not consistently correlate with circulating Angiotensin II levels.

Do not rely solely on genetic testing (like ACE I/D) to predict your athletic potential or training response. These tests are often poor predictors of actual performance or muscle growth. Instead, focus on consistent training, proper nutrition, and recovery. If you are curious about your biology, direct measurement of enzyme activity (phenotyping) is more informative than genetic markers alone.

Lifestyle interventions (caloric restriction and exercise) alone are ineffective for long-term obesity treatment because they trigger potent homeostatic adaptive responses (metabolic, hormonal, and appetitive) that defend a higher adipose mass set point and inevitably lead to weight regain.

Stop relying on willpower and calorie counting alone to cure obesity. Your body is biologically fighting to keep its weight at a higher 'set point' through hunger hormones and slowed metabolism. This is not your fault. To achieve lasting weight loss, you likely need medical or surgical interventions that override these biological defenses, as lifestyle changes alone will eventually trigger a rebound effect.

Targeting enteroendocrine L-cells to stimulate endogenous release of GLP-1 and PYY is a viable therapeutic strategy for treating type 2 diabetes and obesity, leveraging the gut's spare hormonal capacity.

Current GLP-1 injections are effective, but research suggests that stimulating your gut's own hormone-producing cells (L-cells) using specific nutrients or future drugs could achieve similar benefits without injections. This involves targeting receptors for fats, amino acids, and bile acids in the intestine to boost natural GLP-1 and PYY release.

SGLT-2 inhibitors reduce cardiovascular and renal risks in type 2 diabetes patients by promoting glucose and sodium excretion, which triggers fatty acid beta-oxidation and depletes ectopic/visceral fat.

If you have Type 2 Diabetes and heart or kidney risks, ask your doctor about SGLT-2 inhibitors. These medications not only lower blood sugar but also help reduce harmful fat around your organs, which protects your heart and kidneys.

Intracerebroventricular administration of the GLP-1 receptor agonist Exendin-4(1-32)K-capric acid (Ex-4c) suppresses food intake and body weight gain in mice by directly activating arcuate pro-opiomelanocortin (POMC) neurons.

This research identifies that a specific GLP-1 agonist (Ex-4c) reduces food intake by directly activating POMC neurons in the hypothalamus. The mechanism involves the closure of KATP channels via PKA-dependent signaling. While this is preclinical data in mice, it supports the broader class of GLP-1 agonists used for obesity treatment by confirming a central neural mechanism involving appetite suppression.

Post-bariatric surgery patients, particularly those undergoing Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion (BPD), are at high risk for postprandial hyperinsulinemic hypoglycemia (PHG) due to accelerated carbohydrate delivery to the small intestine, which triggers excessive GLP-1 secretion and subsequent insulin hypersecretion.

If you have had gastric bypass surgery, be aware that eating simple sugars can cause a dangerous drop in blood sugar 2-3 hours later. This is caused by your body overproducing insulin in response to fast-absorbing carbs. Manage this by strictly limiting simple sugars and focusing on complex carbohydrates and fiber to slow absorption.

Insulin-sensitizing agents (DPP4 inhibitors, SGLT2 inhibitors, GLP-1 analogues) reduce atherosclerosis risk by modulating perivascular adipose tissue (PVAT) biology, specifically by reducing inflammatory adipokines like ceramides and restoring vascular insulin sensitivity.

If you have obesity and heart risk, medications like GLP-1 analogues (e.g., liraglutide) can help your heart vessels directly, not just by helping you lose weight. They reduce harmful fats (ceramides) in your blood that cause inflammation around your arteries. This happens even if your weight doesn't change much, showing that these drugs protect your heart independently of weight loss.

Adherence to a vegan diet increases circulating glycine levels despite lower dietary intake, mediated by the reduction of the gut pathobiont Bilophila wadsworthia and its glycine reductase pathway activity.

If you switch to a vegan diet, your body may naturally increase its levels of glycine, an amino acid linked to better insulin sensitivity and metabolic health. This happens not because you eat more glycine, but because your gut bacteria change to stop consuming it. You don't need to supplement glycine; simply adhering to a whole-food vegan diet appears to trigger this beneficial metabolic shift.

Bariatric surgery induces rapid hormonal changes (increased GLP-1, PYY, decreased ghrelin) and bile acid signaling that drive early satiety and metabolic improvements, independent of caloric restriction.

Bariatric surgery works by changing your body's hormones, not just by making your stomach smaller. You will likely feel full faster and have less hunger due to increased GLP-1 and PYY and decreased ghrelin. This biological shift supports your ability to stick to dietary changes.

Enobosarm increases lean body mass but fails to deliver consistent, clinically meaningful functional gains (e.g., stair-climb power) in cancer cachexia patients, leading to regulatory rejection.

Enobosarm was tested for cancer cachexia and successfully increased muscle mass, but it did not improve physical function enough to gain FDA approval. This highlights that muscle size alone does not guarantee functional improvement in sick populations.

S-309309, a novel oral inhibitor of monoacylglycerol O-acyltransferase 2 (MGAT2), demonstrates acceptable safety and tolerability in healthy adults with or without obesity, with no clinically meaningful differences in pharmacokinetics between obese and non-obese individuals.

S-309309 is an experimental oral medication that inhibits MGAT2 to potentially aid weight management. Early trials show it is safe and well-tolerated in both obese and non-obese adults, with no significant drug interactions or cardiac effects observed at tested doses. It is not yet approved for general use.

Tirzepatide improves renal outcomes, including reducing the risk of macroalbuminuria and slowing the decline in estimated glomerular filtration rate (eGFR), in patients with Type 2 Diabetes.

If you have Type 2 Diabetes and are concerned about kidney health, tirzepatide not only helps control blood sugar and weight but also offers significant protection for your kidneys, reducing the risk of serious renal complications compared to insulin therapy.

Use of GLP-1 receptor agonists is not associated with an increased risk of gastrointestinal cancers and may be associated with reduced risks of colorectal and liver cancers.

Current evidence from large randomized trials indicates that GLP-1 receptor agonists do not increase the risk of gastrointestinal cancers. In fact, they may be associated with a reduced risk of colorectal and liver cancers, particularly in older and obese patients. While these findings are reassuring, cancer was often a secondary endpoint, so long-term monitoring remains important.

The indiscriminate use of tirzepatide for aesthetic purposes and the circulation of unregistered products significantly increase the risk of severe adverse events, including gastrointestinal issues, pancreatitis, and renal failure, while compromising public health surveillance.

Using tirzepatide without a doctor's supervision, especially for aesthetic reasons, carries serious risks like pancreatitis and kidney failure. Unregistered versions from informal markets may be fake or unsafe. Always use this medication under medical guidance with a legitimate prescription.

Disruption of the paracrine regulatory network within pancreatic islets—specifically the loss of somatostatin-mediated inhibition of glucagon and insulin-mediated suppression of glucagon—exacerbates hyperglycemia in Type 2 Diabetes.

Managing diabetes effectively requires looking beyond just insulin levels. If you have Type 2 Diabetes, your body's internal hormonal balance—specifically the signals that tell your liver to release sugar (glucagon) and the signals that tell it to stop (somatostatin)—may be broken. This means that even if you are managing insulin, your blood sugar might remain high because your body is still receiving 'release sugar' signals it shouldn't be. Modern therapies increasingly target these other hormones to restore the full balance.

Daily supplementation with 300 mg of Palmitoylethanolamide (PEA) combined with 8 weeks of resistance training does not improve upper-body maximal strength (1-RM bench press) compared to placebo.

Do not take PEA expecting to get stronger. The study found that people taking the placebo actually got slightly stronger in their bench press than those taking PEA. PEA is useful for pain and power, but not for maximal strength.

Ingesting 90g of glucose before and after resistance training does not augment ribosomal RNA accumulation or ribosome biogenesis markers in moderately trained young adults.

If you are moderately trained, adding 90g of glucose around your resistance training sessions (before and after) does not appear to boost muscle building signals (ribosome biogenesis) beyond what you get from protein and the training itself. You can likely skip the specific glucose timing strategy without losing potential hypertrophic benefits, focusing instead on total protein and training consistency.

In patients with Type 2 Diabetes Mellitus, paracrine signaling in the adult muscle stem cell niche is activated, specifically through the upregulation of the PDGF–miR-501 pathway.

This research identifies a specific molecular pathway (PDGF-miR-501) that is overactive in the muscle stem cell niche of people with Type 2 Diabetes. This activation might contribute to muscle health issues. While this paper doesn't offer a treatment, it highlights a potential target for future therapies aimed at restoring normal signaling in the muscle niche to improve muscle health in diabetic patients.

Bariatric surgery procedures involving duodenal exclusion (Roux-en-Y gastric bypass and biliopancreatic diversion) achieve sustained Type 2 Diabetes remission rates exceeding 60% at 8 years, significantly outperforming adjustable gastric banding.

For patients with severe obesity and Type 2 Diabetes, Rou-en-Y Gastric Bypass (RYGB) or Biliopancreatic Diversion (BPD) offer the best chance for long-term diabetes remission (>60% at 8 years). Adjustable Gastric Banding is less effective for diabetes remission (45.6%) despite weight loss. Patients should prioritize procedures involving duodenal exclusion if T2D remission is a primary goal.

High-sensitivity ELISA assays are required to detect changes in fasting insulin following lifestyle interventions, as standard automated immunoassays (e.g., Immulite 2000) fail to capture these treatment-induced improvements.

If you are tracking insulin levels to monitor the effectiveness of diet or exercise changes, ensure your lab uses a high-sensitivity ELISA assay. Standard automated immunoassays may report normal or unchanged levels even if your insulin has significantly improved, leading you to believe your lifestyle changes are ineffective when they are not.