Browse the evidence

Semaglutide effectively reverses alectinib-induced excessive weight gain in ALK+ NSCLC patients, though discontinuation due to gallstone pancreatitis can lead to weight regain.

If you are on alectinib and gaining significant weight, semaglutide can help you lose it, but you must get a baseline gallbladder ultrasound first. If you develop abdominal pain, stop the drug immediately as it may cause pancreatitis, which will cause you to regain the weight you lost.

The cardiometabolic benefits of semaglutide 2.4 mg are not maintained after treatment discontinuation, with risk factors deteriorating towards baseline levels.

If you stop taking semaglutide 2.4 mg, the improvements in your blood pressure, blood sugar, and cholesterol will likely reverse towards your pre-treatment levels. This suggests that obesity management with this medication requires long-term, continuous use.

Semaglutide treatment in obese patients with type 2 diabetes and severe psoriasis leads to significant improvement in psoriasis severity (PASI) and quality of life, independent of prior biologic therapy failure.

If you have severe psoriasis and type 2 diabetes, ask your doctor about GLP-1 agonists like semaglutide. This case shows it can significantly improve skin lesions and quality of life, even when other treatments failed. It addresses both conditions simultaneously.

Long-acting GLP-1 receptor agonists (GLP-1RAs) significantly reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes, particularly those with established cardiovascular disease or high cardiovascular risk.

If you have type 2 diabetes and are at high risk for heart disease or have existing heart conditions, GLP-1 receptor agonists (like semaglutide or liraglutide) are strongly recommended. These medications not only help control blood sugar but also significantly reduce the risk of heart attacks, strokes, and cardiovascular death. They are considered a standard of care for cardiovascular risk mitigation in this population.

GLP-1RAs reduce the risk of hospitalization for heart failure (HF) and prevent new-onset HF, although they may not reduce readmissions in patients with existing HF.

For patients with type 2 diabetes who are at risk for heart failure, GLP-1RAs can help prevent the initial development of heart failure and reduce the likelihood of being hospitalized for it. However, if you already have heart failure, these medications may not prevent future hospital readmissions, though they still offer other cardiovascular benefits.

Tirzepatide use can cause drug-induced liver injury (DILI) characterized by elevated transaminases, potentially linked to rapid hepatic fat mobilization.

If you are taking tirzepatide and experience unexplained fatigue or abdominal discomfort, ask your doctor to check liver enzymes (ALT/AST). This liver injury is rare and reversible, but monitoring ensures safety. Do not stop the medication without consulting your provider, as the metabolic benefits are significant.

Coadministration of SGLT2 inhibitors and tirzepatide creates a synergistic risk for euglycemic ketoacidosis (EKA), a life-threatening condition characterized by ketone production and acidosis despite normal blood glucose levels.

If you are taking both an SGLT2 inhibitor (like empagliflozin) and tirzepatide, be aware that you are at risk for a rare but serious condition called euglycemic ketoacidosis (EKA). Unlike typical diabetic ketoacidosis, your blood sugar may remain normal, so do not rely on glucose readings alone. If you experience persistent nausea, vomiting, or extreme fatigue, seek medical attention immediately and ask for ketone testing, even if your blood sugar is not high.

Observational studies claiming GLP-1 receptor agonists reduce cancer risk are currently methodologically flawed and cannot support clinical policy due to high risk of bias.

Do not rely on current observational studies to claim that GLP-1 drugs prevent cancer. The existing data is methodologically flawed and cannot yet inform clinical practice or public health policy.

The presence of the rare BDNF p.Thr2Ile variant is associated with a suboptimal response to high-dose tirzepatide treatment, resulting in significantly less weight loss compared to clinical trial averages.

If you have the rare BDNF p.Thr2Ile variant, you might experience less weight loss from tirzepatide than the average patient. Discuss your genetic profile with your doctor to manage expectations and explore alternative treatments.

In high-risk type 2 diabetes patients, GLP-1 receptor agonists and SGLT2 inhibitors reduce major adverse cardiovascular events (MACE), heart failure hospitalization, and chronic kidney disease progression independently of baseline HbA1c levels.

If you have type 2 diabetes and are at high risk for heart or kidney problems, ask your doctor about GLP-1 receptor agonists or SGLT2 inhibitors. These drugs protect your heart and kidneys regardless of your blood sugar levels. This is a key shift in treatment guidelines for high-risk patients.

SGLT2 inhibitors are recommended for type 2 diabetes patients with heart failure with reduced ejection fraction (HFrEF) to reduce hospitalization for heart failure, MACE, and cardiovascular death.

If you have type 2 diabetes and heart failure, especially with reduced ejection fraction, ask your doctor about SGLT2 inhibitors. These drugs are proven to reduce hospitalizations for heart failure and cardiovascular death, offering protection beyond blood sugar control.

SGLT2 inhibitors are recommended for type 2 diabetes patients with chronic kidney disease (CKD) to prevent CKD progression, heart failure hospitalization, MACE, and cardiovascular death.

If you have type 2 diabetes and chronic kidney disease, ask your doctor about SGLT2 inhibitors. These drugs are proven to slow the progression of kidney disease and reduce the risk of heart failure and cardiovascular death, offering protection beyond blood sugar control.

GLP-1 receptor agonists are recommended for type 2 diabetes patients with established atherosclerotic cardiovascular disease (ASCVD) to reduce MACE, with the strongest evidence for dulaglutide.

If you have type 2 diabetes and established cardiovascular disease, ask your doctor about GLP-1 receptor agonists. These drugs are proven to reduce major adverse cardiovascular events, offering protection beyond blood sugar control.

Increased body mass index (BMI) is strongly associated with a higher risk of developing oesophageal adenocarcinoma, colon and rectal cancer in men, biliary tract system cancer, pancreatic cancer, endometrial cancer (premenopausal), kidney cancer, and multiple myeloma.

Maintaining a healthy body weight is a critical, evidence-based strategy for reducing the risk of several major cancers, including colorectal, pancreatic, kidney, and endometrial cancers. This is not just about aesthetics; it is a direct modifiable risk factor. For men, colorectal risk is particularly sensitive to BMI increases. For women, maintaining a healthy weight, especially before menopause, is crucial for endometrial health. Public health guidelines should target these populations for personalized prevention strategies.

Weight gain in adulthood is strongly associated with an increased risk of postmenopausal breast cancer in women who have never used hormone replacement therapy (HRT).

For postmenopausal women, especially those not using hormone replacement therapy, avoiding weight gain in adulthood is a key strategy for reducing breast cancer risk. Each 5 kg of weight gain is linked to an 11% higher risk. This highlights the importance of long-term weight management, not just immediate weight loss.

Waist-to-hip ratio (WHR) is strongly associated with an increased risk of endometrial cancer.

For endometrial cancer risk, where you carry weight is as important as how much you weigh. A higher waist-to-hip ratio is strongly linked to a 21% increased risk for each 0.1 increase. Focus on reducing central adiposity through diet and exercise, not just overall weight loss.

Metformin is the preferred first-line pharmacological monotherapy for type 2 diabetes, to be continued unless contraindicated.

If lifestyle changes alone don't control your blood sugar, metformin is the standard first medication. It is generally well-tolerated and effective. Take it as prescribed unless you have specific health reasons that prevent its use.

Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon, and phytotherapeutics are not recommended for insomnia treatment.

Avoid using antihistamines, antipsychotics, fast-release melatonin, ramelteon, or herbal supplements for treating insomnia, as they are not recommended by current guidelines.

SGLT-2 inhibitors and GLP-1 receptor agonists reduce all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure in patients with type 2 diabetes, with absolute benefits scaling with baseline cardiovascular and renal risk.

If you have type 2 diabetes, especially with existing heart or kidney risks, adding an SGLT-2 inhibitor or GLP-1 agonist to your current regimen significantly reduces your risk of dying from heart or kidney causes. The higher your baseline risk, the greater the absolute benefit. Discuss these specific drug classes with your doctor to leverage these organ-protective effects.

SGLT-2 inhibitors are superior to GLP-1 receptor agonists for reducing hospital admissions for heart failure, while GLP-1 receptor agonists are superior for reducing non-fatal stroke.

Choose your diabetes drug based on your specific health history, not just blood sugar. If you have heart failure, an SGLT-2 inhibitor offers superior protection. If you have a history of stroke, a GLP-1 agonist is likely the better option. Ask your doctor which class aligns with your specific risks.

Resmetirom is a recommended pharmacotherapy for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2), demonstrating histological effectiveness on steatohepatitis and fibrosis.

If you have advanced liver scarring (fibrosis stage 2 or higher) but not cirrhosis, ask your doctor about resmetirom, a medication that can improve liver health.

There is no evidence that lifestyle interventions improve live birth, miscarriage rates, or menstrual regularity in women with PCOS.

Current evidence does not show that lifestyle changes improve menstrual regularity or fertility (live birth) in women with PCOS. While weight loss is beneficial, it should not be relied upon to restore regular cycles or ensure pregnancy.

Body Mass Index (BMI) is a primary mediator for the protective effect of physical activity on endometrial cancer, as adjusting for BMI eliminates the association, whereas it has limited effect on other cancer types.

For endometrial cancer prevention, maintaining a healthy BMI is likely the most critical factor, as the independent benefit of exercise appears to be mediated by weight. However, for other cancers like colon and breast, exercise provides protection even after accounting for BMI. Do not skip exercise thinking you are 'thin enough' to be safe from all cancers.

Caffeine consumption alters sleep architecture by increasing the duration and proportion of light sleep (N1) and decreasing the duration and proportion of deep sleep (N3/N4).

Even if you don't feel tired, caffeine may be stealing your deep sleep. Expect about 11 minutes less deep sleep and 6 minutes more light sleep per night if you consume caffeine close to bedtime. This reduces the restorative quality of your sleep, contributing to next-day fatigue.