Browse the evidence

For patients with Type 2 Diabetes, prolonged cessation of GLP-1 receptor agonists may worsen peri-operative glycaemic control, requiring individualized management and endocrinologist consultation.

If you have Type 2 Diabetes, do not simply stop your GLP-1 drug without a plan. Stopping it can cause your blood sugar to rise dangerously high during surgery. You need a personalized plan from your doctor and likely an endocrinologist to manage your sugar levels during the period you are off the drug.

Long-term metformin therapy (up to 10 years) in overweight-obese women with PCOS and normal baseline glucose homeostasis results in significant initial weight loss, stabilization of body mass, improved menstrual frequency, and reduced androgen levels, with a very low conversion rate to diabetes.

For overweight or obese women with PCOS who have normal blood sugar, metformin (up to 2000mg/day) can help with weight loss, menstrual regularity, and lowering male hormones. The biggest weight loss happens in the first year, after which weight stabilizes. It is generally well-tolerated, but sticking with it long-term is hard because the initial excitement fades. Consistent use helps maintain these benefits and prevents diabetes.

A slow digestion-oriented dietary strategy that delivers nutrients to the distal small intestine and colon sustains GLP-1 secretion, thereby improving glucose homeostasis.

To improve blood sugar control, choose foods that digest slowly. This includes whole grains, viscous fibers, and foods with natural enzyme inhibitors. The goal is to get nutrients to your lower intestine to trigger sustained GLP-1 release, which helps manage glucose levels over a longer period.

In men with obesity and metabolic syndrome, a 12-week weight reduction program significantly decreases the postprandial brain-derived neurotrophic factor (BDNF) increment, with a 6% weight loss threshold predicting a negative BDNF index (postprandial levels lower than fasting).

For men with obesity and metabolic syndrome, losing just 6% of body weight over 12 weeks via a moderate caloric deficit and exercise can significantly normalize the body's post-meal hormonal response (BDNF). This suggests that even modest weight loss can reverse specific metabolic dysregulations related to energy homeostasis, potentially reducing cardiovascular risks associated with high postprandial BDNF.

GLP-1 agonists (specifically liraglutide and exenatide) induce significant weight loss in patients with antipsychotic-induced weight gain (AIWG) without worsening psychiatric symptoms.

For patients gaining weight from antipsychotics, GLP-1 agonists like liraglutide or exenatide are effective tools for weight loss. Liraglutide shows stronger results (-4.7 kg) than exenatide (-2.5 kg). These drugs do not worsen mental health symptoms, making them safe adjuncts to antipsychotic therapy. Side effects like nausea are common but usually manageable.

Female physique competitors face significantly higher risks of Relative Energy Deficiency in Sport (RED-S), menstrual irregularities, and psychological distress compared to male competitors due to the biological demands of extreme leanness.

Female competitors should prioritize health over extreme leanness. Monitor menstrual function and bone health. Use slower weight loss strategies and maintain appropriate off-season body composition to reduce the risk of RED-S and hormonal disruption.

High insulin sensitivity is associated with enhanced metabolic flexibility to lipid (MetFlex-lip) during exercise, characterized by a strong correlation between increased circulating nonesterified fatty acids (NEFA) and increased lipid oxidation (drop in respiratory quotient).

If you have high insulin sensitivity, your body efficiently switches to burning fat when fat is available during exercise. If you have low insulin sensitivity, this switch is impaired, meaning fat availability doesn't reliably drive fat oxidation. For general health, improving insulin sensitivity (via exercise and diet) may improve this metabolic flexibility, even if total fat burned looks similar on a monitor.

Individual metabolic and hormonal adaptations, including somatotype-specific responses and adaptive thermogenesis, drive significant variability in weight management outcomes, rendering the 'calories in, calories out' model insufficient for personalized strategies.

Stop assuming that a calorie is just a calorie for everyone. Your body's hormonal and metabolic response to food and restriction is unique. To succeed, you need to move beyond simple calorie counting and consider personalized strategies like precision nutrition, which may involve analyzing your metabolic profile, hormonal status, and even genetic factors to tailor your diet and exercise.

Somatotypes (ectomorph, mesomorph, endomorph) correspond to distinct metabolic and hormonal profiles that influence individual responses to diet and exercise, suggesting tailored interventions are more effective.

Understand your body type as a starting point for tailoring your approach. Ectomorphs may need high-protein and resistance training to preserve muscle. Mesomorphs may respond well to balanced macronutrients and strength training. Endomorphs may benefit from low-GI diets and stress management to modulate insulin and cortisol. Use this framework to personalize your strategy.

Transdermal testosterone replacement therapy (TRT) increases lean body mass (LBM) in men with spinal cord injury (SCI) and hypogonadism, with effects comparable to or greater than those seen in able-bodied elderly men.

If you have a spinal cord injury and low testosterone, transdermal testosterone therapy (gel or patch) can help you gain muscle mass, potentially more than it does in older able-bodied men. The key is using the right dose to keep your testosterone levels in the normal range, which typically requires daily application and regular blood tests to adjust the dose. While it helps muscle, it may not significantly reduce fat mass in SCI patients, so managing diet and activity remains important.

Semaglutide treatment resolves prediabetes and normalizes HbA1c levels in post-bariatric patients, even in those who did not achieve full diabetes remission post-surgery.

If you had bariatric surgery and still have prediabetes, semaglutide can help normalize your blood sugar levels. In this study, all patients with prediabetes who took semaglutide for a year achieved normal glucose levels. This highlights the importance of ongoing metabolic management after surgery.

Adjuvant pharmacotherapy with anti-obesity medications (AOMs) such as Liraglutide, Lorcaserin, or Naltrexone/Bupropion is effective and well-tolerated for managing weight regain or insufficient weight loss after bariatric surgery.

If you experience weight regain or insufficient weight loss after bariatric surgery, anti-obesity medications (like Liraglutide) can be a safe and effective option. Studies show they are well-tolerated and can help you lose additional weight, serving as a valuable tool for long-term management.

Both constant intensity (CI) and variable intensity (VI) resistance training protocols elicit favorable acute hormonal responses (increased testosterone/cortisol ratio and decreased cortisol) in elderly men, with no significant difference in metabolic or hormonal outcomes between the two methods when loads are equalized.

For elderly men, both constant weight (75% 1RM) and pyramid-style (67-80% 1RM) resistance training produce similar favorable acute hormonal shifts (improved T:C ratio). You do not need to complicate your workout with pyramid schemes to get hormonal benefits; sticking to a constant intensity is equally effective and potentially easier to manage. Focus on consistency and progressive overload over time rather than chasing acute hormonal spikes.

Short sleep duration is associated with increased adiposity (BMI, fat mass index, percent body fat, trunk fat) and decreased lean body mass in adult women, but this association is not observed in adult men.

For women, prioritizing sufficient sleep duration (avoiding the shortest quartile) may help manage body fat and preserve lean mass, as this study found a specific link between short sleep and higher adiposity in women. For men, this specific study did not find a link between sleep duration and body composition, suggesting other factors may be more critical for weight management. Ensure sleep duration is age-appropriate, as sleep needs decrease with age.

Low glycemic index (GI) carbohydrates increase postprandial GLP-1 secretion and decrease GIP secretion compared to high GI carbohydrates, which mediates cardiometabolic health benefits.

Choose carbohydrates that digest slowly (low GI), such as whole grains, legumes, or specific sugars like isomaltulose, over refined sources like white bread or sucrose. This slows nutrient absorption, allowing glucose to reach the lower intestine where it triggers GLP-1 release. GLP-1 improves cardiovascular health, reduces appetite, and protects the heart, whereas rapid digestion triggers GIP, which is linked to fat storage and inflammation.

Oral contraceptive use does not negatively affect body composition (fat-free mass) or strength adaptations (bench press and squat 1RM) in resistance-trained women during an 8-week supervised resistance training program.

If you are a woman who has been strength training for at least two years, using combined oral contraceptives will not stop you from getting stronger or building muscle. You can continue your resistance training and diet as usual; your results should be similar to those who do not use OCs. Consult your doctor for contraceptive choices, but know that performance-wise, it is not a barrier.

GLP-1 receptor agonists (GLP-1 RAs) improve sperm parameters (concentration, motility, morphology) and testosterone levels in obese men with metabolic hypogonadism, primarily through weight loss and direct testicular effects.

If you are obese and struggling with fertility, GLP-1 medications like semaglutide or liraglutide may help improve your sperm count and testosterone levels, not just by helping you lose weight, but potentially by directly supporting testicular function. The key is working with a doctor to start with a low dose and slowly increase it to minimize stomach issues. While these drugs are expensive, the potential for improved fertility and sustained weight loss might justify the cost compared to other treatments.

SGLT2 inhibitors and GLP-1 receptor agonists offer weight loss and glycaemic control, with SGLT2 inhibitors providing cardiovascular protection beyond glucose lowering and GLP-1 agonists showing early evidence of CVD event reduction.

Newer diabetes medications like SGLT2 inhibitors and GLP-1 agonists not only lower blood sugar but also help with weight loss and may protect the heart. They are often preferred for patients who are overweight or have high cardiovascular risk, offering benefits beyond just glucose control.

Semaglutide administration (up to 1 mg weekly) produces significant weight and BMI reduction in obese patients with kidney failure undergoing dialysis, with a side effect profile comparable to non-dialysis populations.

If you are on dialysis and obese, semaglutide injections (starting at 0.25mg and increasing to 1mg weekly) can help you lose significant weight (average 4.6kg in 12 weeks) with manageable side effects like mild nausea. This weight loss may allow you to qualify for kidney transplantation, which offers better survival and quality of life than remaining on dialysis. Consult your nephrologist about this off-label use.

High-fructose corn syrup (HFCS) consumption promotes obesity, type 2 diabetes, and fatty liver more potently than glucose or sucrose alone due to the synergistic activation of the transcription factor ChREBP by equal parts glucose and fructose.

Prioritize whole food sources of carbohydrates (vegetables, fruits, legumes, whole grains) over processed foods containing high-fructose corn syrup. The specific ratio of glucose to fructose in HFCS appears to uniquely drive metabolic dysfunction via ChREBP activation, leading to fatty liver and insulin resistance more than other carbohydrate sources.

Myostatin acts as a negative regulator of muscle hypertrophy and cardiac pathological hypertrophy, and its inhibition or reduction through exercise can promote muscle growth and protect against certain cardiac dysfunctions.

Consistent exercise naturally lowers myostatin, a protein that limits muscle growth. This is one reason why regular resistance training is effective for building muscle.

Tirzepatide, a dual GLP-1/GIP receptor agonist, promotes significant weight loss and improves metabolic parameters in obese patients with PCOS, potentially offering superior tolerability compared to GLP-1R agonists alone due to its imbalanced receptor affinity.

For obese individuals with PCOS, tirzepatide is a once-weekly injection that helps with weight loss and blood sugar control. It works by mimicking hormones that regulate appetite and insulin. While it can cause stomach upset, the dual-action design might make it easier to tolerate than older drugs. It is not a substitute for lifestyle changes but can be a powerful tool when combined with diet and exercise.

Once-weekly subcutaneous semaglutide at 2.4mg reduces the risk of major adverse cardiovascular events (MACE) in overweight or obese individuals with cardiovascular disease who do not have diabetes.

For overweight or obese individuals with cardiovascular disease but no diabetes, once-weekly subcutaneous semaglutide at 2.4mg is being studied for its ability to reduce cardiovascular events. While results from the SELECT trial were pending at the time of this review, the mechanism suggests potential cardiovascular benefits beyond glucose control.

Early Time-Restricted Eating (eTRE) offers specific cardiometabolic benefits (glucose tolerance, insulin sensitivity) independent of weight loss, though practical adherence is low.

If you want metabolic health benefits, try finishing your last meal by 3 PM. However, be aware this is socially difficult and may not be sustainable long-term. If you can't do it, standard timing with good food quality is better than quitting.