Browse the evidence

A Mediterranean diet is advised for all MASLD patients, with a target of 7-10% weight loss for those with excess weight.

Practitioners should recommend a Mediterranean diet and aim for weight loss in MASLD patients with excess weight.

The Expert Group Statement advocates for an evidence-based approach to nutrition in high-performance tennis.

Practitioners should implement evidence-based nutritional strategies for tennis players.

The statement emphasizes a 'food first' philosophy, prioritizing food over supplements.

Nutritionists should focus on whole foods to meet players' nutrient needs.

Standalone digital health exercise interventions provide no significant benefit on core sarcopenia outcomes (muscle mass, physical performance) in older adults, whereas combined digital interventions (exercise plus nutrition) significantly improve muscle strength and quality of life.

If you are an older adult with sarcopenia, a digital exercise app alone is unlikely to significantly improve your muscle strength or physical function. To see real benefits, you need a program that combines digital exercise guidance with nutritional support. Look for comprehensive digital interventions that include both components.

Individualized strength-oriented fitness programs significantly improve strength preparedness (maximal strength, endurance, speed-strength) in women of early mature age (21-30 years) even under prolonged war-related environmental stress.

If you are living in a high-stress or crisis environment, do not abandon strength training. Instead, individualize your program to your current capacity and stress levels. Focus on gradual progression of resistance and volume. This approach can maintain and even improve your strength and functional stability despite external chaos.

Standardizing dietary interventions by objective diet quality (e.g., HEI-2020) while allowing variable diet types (cultural/personalized) improves adherence and external validity compared to fixed-type, one-size-fits-all interventions.

Focus on the quality of your diet (vegetables, fruits, legumes, nutrient density) rather than forcing yourself into a specific named diet (like Keto or strict Mediterranean) if it clashes with your culture or preferences. Use tools to measure your diet quality objectively. If you can maintain high quality while eating foods you culturally and personally enjoy, you will adhere better and see better long-term health outcomes.

Combining GLP-1/GIP receptor agonists (semaglutide/tirzepatide) with structured resistance training (3-5 days/week) and high protein intake (1.6-2.3 g/kg fat-free mass/day) can preserve or increase lean soft tissue (LST) during significant weight loss, contrary to typical clinical trial outcomes.

If you are taking semaglutide or tirzepatide, do not rely on the medication alone to protect your muscles. You must lift weights 3-5 times a week and eat enough protein (aim for 1.6-2.3 grams per kilogram of your lean body mass). Without this, you risk losing significant muscle along with fat.

Longer-muscle length resistance training (LML-RT) may lead to greater increases in fascicle length (longitudinal hypertrophy) compared to shorter-muscle length resistance training (SML-RT), though evidence is mixed and methodologically limited.

Training at longer muscle lengths may help increase the length of your muscle fibers (fascicles), which can contribute to overall muscle size. However, current measurement methods are imperfect, so prioritize long-length training for overall hypertrophy rather than expecting specific longitudinal gains to be easily quantified.

The Adaptive Ketogenic–Mediterranean Protocol (AKMP) utilizes dynamic, biomarker-guided adjustments to metabolic adaptation (adaptive thermogenesis) to sustain weight loss, whereas GLP-1 agonists fail to counteract the resulting decline in energy expenditure.

If you are using a ketogenic or low-carb approach and hit a weight loss plateau, do not just restrict calories further. Monitor your metabolic markers (like ketones and blood sugar). If you stall, the protocol suggests dynamically adjusting your macronutrients—specifically increasing protein and adjusting fats—to leverage the metabolic advantage of ketosis and counteract the natural drop in energy expenditure that occurs during weight loss.

Supplementation with β-hydroxy β-methylbutyrate (HMB) may preserve fat-free mass and increase muscle strength in individuals undergoing weight reduction, although robust evidence in obesity patients is lacking.

HMB might help preserve muscle during weight loss, especially in older adults or those losing weight quickly. However, evidence is limited for obesity patients. Prioritize protein and exercise first; consider HMB as a potential add-on if affordable and after consulting a healthcare provider.

Natural compounds, specifically oligomeric procyanidins from apple polyphenol extract and tetrahydrofuran from nutmeg, inhibit pancreatic lipase activity in vitro and in animal models, potentially offering safer alternatives to synthetic inhibitors.

Some natural extracts, like those from apples (procyanidins) and nutmeg, show promise in blocking fat-digesting enzymes in lab tests. However, they are not yet proven to be effective or safe for weight loss in humans compared to established treatments. Do not rely on them as a primary weight loss strategy without medical guidance.

HIIT does not significantly improve body mass or BMI in patients with diabesity compared to standard treatment.

Do not expect HIIT to drastically change your weight or BMI if you have diabesity. The primary benefit of this training style for your condition is metabolic (blood sugar and lipids), not weight loss. Manage your expectations regarding the scale.

Tirzepatide use is associated with a probable risk of severe rhabdomyolysis and necrotising myopathy, potentially mediated by GLP-1 receptor effects on skeletal muscle glucose metabolism.

If you are taking tirzepatide (or similar GLP-1 drugs) and experience sudden, severe muscle pain, swelling, or weakness—especially if it doesn't match your activity level—seek medical attention immediately. Ask for a Creatine Kinase (CK) blood test. Stopping the medication and receiving IV fluids can resolve the condition, as seen in this case.

GLP-1 receptor agonists (GLP-1 RAs) improve skeletal muscle mitochondrial morphology, area, and number in animal models of obesity and type 2 diabetes, but their effect on mitochondrial respiration and mass is inconsistent or neutral.

Current evidence for GLP-1 RAs improving muscle mitochondria comes exclusively from animal and cell studies, not humans. While these studies show improved mitochondrial structure, they do not guarantee preserved muscle mass in people. To protect muscle while using GLP-1s for weight loss, prioritize resistance training and adequate protein intake, as the drug's direct benefit to human muscle mitochondria is not yet proven.

Combining extended dosing intervals (e.g., every two weeks) with increased dose sizes (e.g., doubling the mg strength) can maintain nearly 100% of the weight loss efficacy while halving the cost.

If you are on a lower dose of a GLP-1 drug (like 5mg tirzepatide) and find the weekly cost prohibitive, ask your doctor about switching to a higher dose (like 10mg or 15mg) taken every two weeks. This strategy can keep your weight loss results nearly identical to taking the lower dose weekly, but at half the cost. This is only possible if your body can handle the higher individual dose without excessive side effects.

At a population level, distributing GLP-1 medications using extended dosing intervals (q2wk) allows twice as many obese adults to be treated for the same total cost, leading to greater reductions in national obesity rates and mortality.

For policymakers and insurers, extending GLP-1 dosing intervals to every two weeks allows the same budget to treat twice as many people. While each individual might lose slightly less weight, the overall public health benefit (reduced obesity and mortality) is significantly higher. This is a key strategy for making these drugs accessible at a national scale.

Preclinical studies show conflicting results regarding GLP-1 agonists and breast cancer progression: some show inhibition of tumor growth via apoptosis, while others show promotion of growth in aggressive Triple-Negative Breast Cancer (TNBC) cell lines.

Animal studies show mixed results: GLP-1s might slow down some breast cancers but potentially speed up aggressive types (TNBC) in a lab setting. However, large human studies have not found an increased risk of developing breast cancer in people taking these drugs. If you have a history of breast cancer, discuss your specific subtype with your doctor.

Among patients taking oral semaglutide, older adults (65+) achieve significantly better weight loss outcomes than younger adults (<65).

If you are under 65 and taking the oral version of semaglutide, you might not lose as much weight as older patients on the same medication. If weight loss is your primary goal, the injection form is likely a better choice for you, as it provided superior results across all age groups in this study.

Tirzepatide treatment leads to significant weight loss in patients with hypothalamic obesity (HO) resulting from craniopharyngioma resection, despite the condition's historical resistance to standard therapies.

For patients with hypothalamic obesity due to brain tumors or surgery, standard diet and exercise often fail. Tirzepatide, a weekly injection starting at 2.5mg and increasing to 10mg, has shown significant weight loss in case reports. However, adherence is critical, as stopping the medication leads to rapid weight regain. Consult an endocrinologist to discuss if this treatment is appropriate for your specific condition.

Tirzepatide use is associated with novel safety signals including belching, upper respiratory tract infections, and postmenopausal hemorrhage, which are not prominently featured in standard prescribing information.

Be aware that Tirzepatide may be linked to new symptoms not always listed in official documents, such as excessive belching, respiratory infections, or unusual bleeding (especially in postmenopausal women). Report these to your healthcare provider, as they are emerging safety signals.

GLP-1 receptor agonist use may improve specific inflammatory or scarring alopecias (e.g., Folliculitis Decalvans, Central Centrifugal Cicatricial Alopecia) through metabolic modulation and anti-inflammatory effects.

If you have a specific type of hair loss like Folliculitis Decalvans or Central Centrifugal Cicatricial Alopecia, and you are prescribed a GLP-1 agonist for weight or diabetes, it might actually help your hair regrow by improving blood flow and reducing inflammation. This is not guaranteed for everyone, but it is a documented possibility in case studies.

Tirzepatide exacerbates orthostatic intolerance and causes marked tachycardia in patients with Postural Orthostatic Tachycardia Syndrome (POTS).

If you have POTS and are considering tirzepatide, discuss your specific heart rate response risks with your doctor. This case suggests that standard dosing might cause severe tachycardia in POTS patients, so a lower starting dose (e.g., 2.5 mg) and close monitoring of heart rate and orthostatic symptoms are critical to prevent exacerbation.

Tirzepatide use is associated with a potential risk of acute deep vein thrombosis (DVT), particularly in patients with predisposing risk factors such as obesity, rapid weight loss, or dehydration.

If you are taking tirzepatide, be aware of signs of blood clots like swelling, pain, or redness in your arms or legs. While rare, this risk exists, especially if you are losing weight rapidly or are obese. Report these symptoms to your doctor immediately.

Tirzepatide may trigger new-onset atrial fibrillation in susceptible individuals through autonomic activation and sinoatrial node effects, despite its overall cardiometabolic benefits.

If you start tirzepatide and feel palpitations, lightheadedness, or a racing heart, seek medical attention promptly. While the drug improves long-term metabolic health, it can increase heart rate and potentially trigger atrial fibrillation in susceptible individuals. Do not ignore new cardiac symptoms.