Browse the evidence

Combining resistance training, a hypercaloric diet, and anabolic androgenic steroids (AAS) produces significantly greater fat-free mass and strength gains with minimal fat gain compared to resistance training and hypercaloric diet alone in drug-free individuals.

For drug-free athletes, maximizing muscle growth requires consistent resistance training, adequate protein (1.6-2.2 g/kg), and a slight caloric surplus. This case study shows that adding AAS can triple fat-free mass gains and significantly boost strength with minimal fat gain, but this comes with legal, health, and ethical risks. For natural athletes, focus on progressive overload, volume (12-16 sets/muscle/week), and nutrition; do not expect the same magnitude of rapid recomposition without pharmacological intervention.

GLP-1 receptor agonists (liraglutide) have unclear clinical benefits in non-obese patients with Heart Failure with Reduced Ejection Fraction (HFrEF).

For non-obese HFrEF patients, GLP-1 agonists like liraglutide may not provide significant weight loss or clear clinical benefits based on current small trials. Consult your doctor about the specific relevance of these treatments for your condition.

Bariatric arterial embolization (BAE) produces modest, transient weight loss (mean 7.0% at 4-5 months, 4.2% at 12 months) in patients with BMI ≥30 who have failed nonoperative management and are ineligible or unwilling to undergo metabolic-bariatric surgery.

If you have obesity (BMI ≥30) and haven't been able to lose weight through diet, exercise, or standard medications, and you are not a candidate for or do not want surgery, BAE might be an option. It involves a minimally invasive procedure to block blood flow to part of the stomach, which reduces hunger hormones. Expect modest weight loss (around 4-7%) over the first year, but it requires ongoing support from a weight management program. It is not a standalone fix and results vary significantly between individuals.

GLP-1 receptor agonists (GLP-1RAs) may indirectly improve autoimmune thyroid disease (AITD) outcomes by reducing systemic inflammation, improving insulin sensitivity, and modulating the gut-thyroid axis, rather than through direct thyroidal effects.

If you have thyroid autoimmunity and are considering GLP-1RAs for weight or diabetes, expect that your thyroid medication doses may need adjustment as you lose weight. The drug likely helps your thyroid health indirectly by lowering body-wide inflammation and improving metabolic health, rather than directly attacking thyroid antibodies. There is no strong evidence yet that it cures thyroid disease, but it is generally safe regarding thyroid cancer risk in humans. Work closely with your endocrinologist to monitor your thyroid levels during weight loss.

Women with non-diabetic obesity experience greater cardiovascular benefits from GLP-1 RAs, particularly regarding heart failure hospitalization and stroke reduction, compared to men.

Women with obesity may derive even greater heart protection from GLP-1 medications than men, especially regarding heart failure prevention. This is particularly true for postmenopausal women who are at higher risk for heart failure with preserved ejection fraction (HFpEF). Discussing your specific heart failure risk with your provider is crucial.

State-of-the-art anti-obesity medications (AOMs) like GLP-1 analogues are highly effective appetite suppressants but require continuous use, as discontinuation leads to inevitable weight regain.

Understand that obesity medications like Semaglutide or Tirzepatide are long-term treatments. Stopping them will likely lead to weight regain. Plan for continuous use as part of your long-term health strategy.

Current randomized controlled trial evidence does not demonstrate a statistically significant increase in thyroid cancer risk with the use of incretin-based therapies (GLP-1RAs and dual GIP/GLP-1RAs).

Current high-quality randomized trial data does not support a claim that GLP-1 or GIP/GLP-1 drugs cause thyroid cancer in the general population. However, the evidence is very low certainty because these trials are too short and too small to rule out a rare, long-term risk. Clinicians should continue prescribing these drugs for their proven benefits while adhering to the FDA boxed warning for patients with a specific family history of medullary thyroid cancer.

Preoperative use of GLP-1 receptor agonists is associated with reduced rates of periprosthetic joint infection (PJI) and hospital readmission in patients undergoing total hip and knee arthroplasty, particularly among those with diabetes or morbid obesity.

If you are taking a GLP-1 RA (like Ozempic or Wegovy) before hip or knee replacement surgery, current evidence suggests it may lower your risk of joint infection and hospital readmission, especially if you have diabetes or obesity. However, because these drugs cause rapid weight loss, your surgical team must carefully monitor your nutritional status (e.g., albumin levels) to ensure you are not malnourished, which could increase complication risks. Do not stop the medication without consulting your surgeon, as the net benefit appears positive in many cases, but close monitoring is essential.

Epitalon, a tetrapeptide, extends cellular lifespan by activating telomerase and lengthening telomeres, while also modulating pineal gland function to restore melatonin synthesis.

Epitalon is an investigational peptide that may extend cellular lifespan by activating telomerase and restoring melatonin production. While animal studies show promising lifespan extension, human data is limited to small studies without long-term safety validation. It is not FDA-approved for anti-aging.

BPC-157 and TB-500 enhance tissue repair and angiogenesis in aged tissues, showing promise in small pilot studies for chronic pain and wound healing.

BPC-157 and TB-500 are peptides that may help heal tissues, tendons, and muscles by promoting blood vessel growth and reducing inflammation. Small studies suggest they can relieve chronic pain and heal wounds, but they are not FDA-approved for these uses, and long-term safety is unknown.

Semax enhances neuroplasticity and cognitive function in aging by upregulating BDNF and modulating neurotransmitter systems, showing benefits in stroke recovery and cognitive decline.

Semax is a peptide that may improve brain health by increasing BDNF, a key factor in neuroplasticity. Russian studies suggest it can help stroke recovery and cognitive function, but it is not FDA-approved for these uses, and independent Western validation is lacking.

The American College of Sports Medicine (ACSM) acknowledges that lawful and ethical therapeutic use of anabolic-androgenic steroids (AAS) is now an accepted mainstream treatment for several clinical disorders.

Practitioners should recognize AAS as a legitimate treatment option for certain clinical conditions.

Long-term results with semaglutide and tirzepatide are approaching the success seen with bariatric surgery.

Practitioners should be aware of the effectiveness of semaglutide and tirzepatide in weight management.

Short-term intensive insulin therapy can induce T2DM remission in newly diagnosed patients with high blood glucose levels (HbA1c ≥ 10% and FBG ≥ 11.1 mmol/L) by restoring beta-cell function.

If you were just diagnosed with Type 2 Diabetes and your blood sugar is very high, your doctor might suggest a short course of insulin. This isn't forever; it's used to quickly lower your blood sugar and give your pancreas a break so it can start working better on its own. This is most effective for people recently diagnosed.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) induce significant weight loss and metabolic improvement in patients with Bardet-Biedl syndrome (BBS), a genetic obesity syndrome previously resistant to standard pharmacotherapy.

If you have Bardet-Biedl Syndrome and struggle with severe obesity despite trying other medications, GLP-1 receptor agonists (like semaglutide or liraglutide) combined with dietary changes may be a viable treatment option. This case showed a 33% weight loss and normalized blood sugar, suggesting that genetic obesity is not necessarily resistant to these specific hormonal therapies.

Intentional weight loss in individuals with high adipose tissue stores of persistent organic pollutants (POPs) may lead to long-term cognitive decline due to the mobilization of these neurotoxic chemicals into the circulation and brain.

If you are overweight and have high exposure to environmental toxins (like certain pesticides or industrial chemicals), be aware that rapid or intensive weight loss might temporarily increase the levels of these chemicals in your blood. While weight loss is generally good for heart and metabolic health, this specific mechanism suggests that slow, steady weight loss might be preferable to minimize the spike in circulating toxins, especially if you have existing cardiovascular issues. Focus on reducing external exposure to POPs (dietary sources) alongside weight loss.

Metabolically healthy obesity may confer a lower risk of dementia compared to lean obesity because healthy adipose tissue safely stores neurotoxic persistent organic pollutants (POPs), preventing them from reaching the brain.

For those with obesity, maintaining metabolic health (normal blood sugar, blood pressure, and lipids) is crucial. Healthy fat tissue may act as a 'sink' for environmental toxins, potentially protecting the brain. However, this does not negate the benefits of weight loss if you are metabolically unhealthy. Focus on metabolic health markers and reducing exposure to environmental toxins.

Retatrutide, a triple-hormone receptor agonist (GLP-1/GIP/Glucagon), can cause intractable, secretory diarrhea and acute kidney injury, particularly when used off-label via unregulated online sources with unestablished dosing protocols.

If you are using retatrutide or similar GLP-1 agonists obtained from online sources, be aware that dosing is not standardized and risks are higher. Intractable diarrhea and kidney injury are serious potential side effects. Seek regulated medical care for weight loss management to ensure safe dosing and monitoring.

Higher baseline levels of Myostatin are associated with significant functional decline (Gait Speed and 6MWD) in older adults with sarcopenia, while inflammatory markers (IL-6, hsCRP) show less consistent or no correlation with functional decline.

While not yet a standard clinical test, high Myostatin levels may predict functional decline in sarcopenic older adults. In contrast, common inflammatory markers (CRP, IL-6) did not correlate with functional decline in this study, suggesting they may not be the primary drivers of functional loss in this population.

GLP-1 agonists (e.g., tirzepatide) and metformin show promise in improving asthma outcomes in obese patients by enhancing insulin sensitivity and reducing airway inflammation, though specific FDA approvals for obesity-associated asthma are lacking.

If you have asthma and obesity, discuss with your doctor whether metabolic treatments like GLP-1 agonists might help your asthma symptoms, especially if you have insulin resistance. While not yet approved specifically for asthma, they may improve lung function and reduce inflammation.

High cardiorespiratory fitness induced by prior exercise training likely confers innate immune protection against SARS-CoV-2 by attenuating proinflammatory cytokine storms.

Maintain high cardiorespiratory fitness through regular moderate-to-vigorous aerobic exercise. While this may help mitigate severe inflammatory responses to respiratory viruses like SARS-CoV-2, it is not a substitute for standard preventive measures like vaccination and hygiene.

GLP-1 agonists like semaglutide may reduce the exposure (efficacy) of ALK tyrosine kinase inhibitors like alectinib due to delayed gastric emptying.

Be aware that taking semaglutide might reduce how much cancer medication your body absorbs. However, slow titration (starting low and going slow) may help mitigate this interaction.

Low-carbohydrate and ketogenic diets are not currently recommended for the treatment of Type 1 Diabetes due to lack of long-term safety data and risk of complications like DKA and growth deficits in children.

For Type 1 Diabetes, low-carb and ketogenic diets are not currently recommended by major guidelines due to safety concerns like DKA and unknown long-term effects on growth. While some patients may see short-term improvements in glucose control, the risks are significant. Consult your healthcare provider before considering any drastic dietary changes.

GLP-1 analogs are widely used in Saudi Arabia for diabetes management and show some weight loss efficacy, but there is no trial data for their use in obesity-only patients in the country.

GLP-1 analogs are used in Saudi Arabia for diabetes, but there is no specific trial data for obesity-only patients. Use with caution and monitor weight loss.