Browse the evidence

Combining tirzepatide with low-energy ketogenic therapy (LEKT) produces significantly greater reductions in hepatic steatosis and liver stiffness than combining tirzepatide with a low-calorie diet (LCD), independent of total body weight loss.

If you have MASLD and are using tirzepatide, adding a structured low-energy ketogenic diet (under 30g carbs, ~1200 kcal) for 12 weeks may reduce liver fat and stiffness more effectively than a standard low-calorie diet, even if your total weight loss is similar. This requires strict adherence and monitoring, ideally under medical supervision, to ensure safety and efficacy.

Allostatic load (AL) represents the cumulative physiological stress and cost of adaptation, and can be measured using an Allostatic Load Index (ALindex) to guide nutrition and exercise interventions.

For elite athletes, consider monitoring allostatic load using biomarkers (like CRP, resting heart rate, HDL, waist-to-height ratio, and HbA1c) to assess cumulative stress. This can help adjust training and nutrition to prevent overtraining and injury.

Multivitamin supplementation is recommended for individuals using GLP-1 receptor agonists to address micronutrient insufficiencies resulting from reduced caloric intake and gastrointestinal side effects.

Take a daily multivitamin while on GLP-1RA medication. Because you are eating less, you might not get enough vitamins from food alone. This helps protect your long-term health and prevents deficiencies.

Fiber and Probiotic supplementation can improve bowel regularity and mitigate gastrointestinal side effects (constipation, diarrhea) associated with GLP-1RA treatment.

If you experience constipation or diarrhea from GLP-1RA medication, try taking more than 10 grams of fiber daily and a probiotic supplement. This can help regulate your bowel movements.

The cardiometabolic benefits of exercise, particularly on glucose regulation and inflammation, may be attenuated or dependent on weight loss in individuals with obesity.

Be aware that while exercise is beneficial, achieving weight loss may be necessary to fully improve glucose regulation and inflammation in obesity. However, do not stop exercising if weight loss is difficult; other benefits remain.

High-calorie, high-protein nutritional supplementation and specific supplements (L-alanyl-L-glutamine + PUFAs) can counteract lean mass loss and improve quality of life in heart failure patients, potentially mitigating GLP-1RA-induced sarcopenia.

If you are losing muscle on heart failure medication, ask your doctor about high-protein nutritional supplements. Specific combinations like glutamine and fish oil (PUFAs) have been shown to help increase lean body mass and improve how you feel.

Very Low Calorie Diets (VLCD) produce substantial short-term weight loss (10-17 kg) but suffer from gradual attenuation and weight regain over time unless supported by behavioral interventions.

VLCDs are powerful for rapid short-term loss but require medical supervision and a structured reintroduction phase. Without behavioral support, the weight loss is likely to be partially regained over time.

Intermittent Energy Restriction (IER) strategies (TRE, PF, ADF) produce short-term weight loss comparable to Continuous Energy Restriction (CR), with no significant long-term difference between the two approaches.

Choose an IER method (like Time-Restricted Eating) if it helps you adhere to your calorie goals, but do not expect it to be more effective than continuous calorie restriction in the long run. The key is consistency and adherence.

Longer-muscle length resistance training (LML-RT) produces greater muscle hypertrophy than shorter-muscle length resistance training (SML-RT).

To maximize muscle growth, prioritize exercises that allow you to train at longer muscle lengths (e.g., deep squats, overhead presses, or lengthened partials). While you can still grow with partial ROM, the evidence suggests that loading the muscle in its stretched position yields superior hypertrophy, particularly in the distal regions of the muscle.

Women with type 2 diabetes treated with GLP-1 receptor agonists achieve significantly greater weight loss than men after 12 months, despite similar glycemic control improvements.

If you are a woman with Type 2 Diabetes on a GLP-1 agonist, you are statistically more likely to achieve significant weight loss (over 5% or 10%) than a man on the same medication class, particularly after 6-12 months. This does not mean men won't lose weight, but the magnitude of benefit tends to be greater in women. Glycemic control (HbA1c) improves similarly for both sexes.

Obesity significantly impairs work productivity and daily activities, with over 25% of work time impaired due to obesity status, and this impairment is greater in patients with obesity-related complications.

If you feel like obesity is affecting your work or daily activities, it is likely having a measurable impact. This impairment is a recognized part of the disease burden. Effective treatment of obesity may help reduce this impairment and improve your quality of life and productivity.

Glucagon receptor (GCGR) agonism increases energy expenditure and promotes weight loss, particularly when combined with GLP-1R and/or GIPR agonism in dual or triple receptor agonists.

Current obesity treatments often lead to weight regain because they don't significantly increase energy expenditure. New drugs that activate the glucagon receptor (GCGR), either alone or combined with GLP-1/GIP drugs, are designed to boost energy expenditure and prevent this metabolic slowdown. While early results show significant weight loss (up to 24% in some trials), long-term clinical data is still emerging, and these are prescription medications requiring medical supervision.

In a mixed population of diabetic and non-diabetic patients, liraglutide (up to 3 mg) and semaglutide (up to 1 mg) produce statistically equivalent weight loss, contradicting findings from trials using higher doses or specific diabetic cohorts.

If you are using liraglutide or semaglutide at lower, standard starting-to-maintenance doses (up to 3mg and 1mg respectively), expect similar weight loss results. The perceived superiority of semaglutide in marketing often relies on higher doses (2.4mg) not used in this study. Focus on adherence and titration rather than switching solely for weight loss efficacy at these doses.

Concomitant use of SGLT2 inhibitors significantly enhances weight loss in patients taking GLP-1 receptor agonists, independent of the specific GLP-1 RA used.

If weight loss stalls on a GLP-1 RA, discuss adding an SGLT2 inhibitor. This study found that using both together significantly improved weight loss outcomes compared to using GLP-1 RAs alone, likely due to complementary mechanisms.

Digital dietary interventions specifically lead to greater reductions in body weight, BMI, and fasting blood glucose compared to nondigital dietary interventions.

If you are focusing on diet, using a digital tool (app, wearable) may yield better results for weight loss and blood sugar control than traditional methods like pamphlets or face-to-face counseling alone.

Digital physical activity interventions specifically lead to greater reductions in total cholesterol compared to nondigital physical activity interventions.

If you are focusing on exercise, using a digital tool (app, wearable) may yield better results for cholesterol control than traditional exercise programs alone.

Combined digital interventions (dietary, physical activity, and smoking cessation) significantly decrease BMI compared to nondigital combined interventions.

If you are making multiple lifestyle changes (diet, exercise, quitting smoking), using a digital tool may yield better results for BMI reduction than traditional methods alone.

Myostatin and activin A inhibitors (e.g., bimagrumab, trevogrumab, garetosmab) combined with GLP-1 agonists can increase lean mass and reduce fat mass more effectively than GLP-1 agonists alone.

New drugs targeting myostatin (like bimagrumab) are being tested alongside GLP-1s to build muscle while losing fat. These are currently in clinical trials and not yet widely available.

Semaglutide and tirzepatide reduce 'food noise' (constant, pervasive thoughts about food), thereby lowering the mental burden and executive load required to maintain dietary behavior change.

If you feel constantly distracted by thoughts of food ('food noise') despite trying to diet, this is a recognized barrier, not just a lack of willpower. Medications like semaglutide and tirzepatide may reduce this mental burden, making it easier to make deliberate food choices without constant compulsive thinking. This mental relief is often reported as improving quality of life independently of the scale weight.

Semaglutide and tirzepatide increase self-trust and executive functioning regarding food choices by reducing physiological hunger and emotional compulsion, allowing for more deliberate dietary decisions.

If you know what to eat but struggle to follow through due to hunger, cravings, or emotional eating, these medications may help by reducing the physiological drive and emotional compulsion. This can restore your ability to trust yourself and make deliberate, planned food choices rather than reactive ones.

Tirzepatide (2.5 mg weekly) significantly improves glycemic control and reduces body weight in patients with type 2 diabetes during Ramadan fasting, with a favorable safety profile characterized by mild gastrointestinal side effects and no reported hypoglycemia.

If you have type 2 diabetes and plan to fast during Ramadan, tirzepatide (2.5 mg weekly) can help improve your blood sugar and weight without causing low blood sugar. You might experience mild stomach issues like nausea, but these are usually manageable and do not require stopping the medication or breaking your fast. Consult your doctor to ensure it fits your overall treatment plan.

Discontinuation or interruption of GLP-1 agonist therapy (semaglutide) leads to rapid weight regain and loss of cardiometabolic benefits, with patients regaining approximately two-thirds of lost weight within one year.

If you stop taking semaglutide, you will likely regain about two-thirds of the weight you lost and lose the heart and blood sugar benefits within a year. The drug works only as long as you take it. If you face a supply shortage or side effects, do not just stop; contact your provider immediately to switch to an alternative or manage the transition, as stopping leads to rapid regain.

Mediterranean and low-carbohydrate diets combined with exercise reduce cardiovascular and metabolic risk factors in prostate cancer patients undergoing androgen deprivation therapy (ADT).

If you are undergoing hormone therapy for prostate cancer, adopting a Mediterranean or low-carbohydrate diet alongside regular exercise can help manage metabolic risks like weight gain and blood sugar issues. While the benefits are clear, sticking to these changes long-term can be challenging, so focus on consistency over perfection.

Multidisciplinary care and community involvement improve accountability and outcome durability for prostate cancer patients undergoing ADT.

To maintain the benefits of diet and exercise during ADT, consider engaging with multidisciplinary care teams or community support groups. These resources can help you stay accountable and sustain your progress over time.