Browse the evidence

Contrave (naltrexone/bupropion) promotes weight loss (~6% TBWL) and may improve fertility by mitigating PCOS and endometriosis effects, though it is less effective than GLP-1 RAs.

Contrave is an oral option for weight loss that targets food cravings and reward pathways. It typically results in about 6% weight loss. It is less potent than GLP-1 injections but may help with emotional eating. You must stop taking it before trying to conceive.

GLP-1 receptor agonists (e.g., semaglutide, liraglutide) and dual/triple incretin agonists (e.g., tirzepatide, retatrutide) significantly reduce hepatic steatosis and liver enzymes in patients with MASLD, primarily through indirect mechanisms of weight loss and improved insulin resistance, though they may not consistently resolve fibrosis.

If you have MASLD, especially with diabetes or obesity, GLP-1 based therapies (like semaglutide or tirzepatide) are highly effective at reducing liver fat and inflammation. However, do not expect them to reverse advanced scarring (fibrosis) on their own. The benefit comes largely from the weight loss and metabolic control they provide, so they work best when combined with lifestyle changes.

Ketogenic diets produce superior short-term glycemic control (HbA1c reduction) compared to low-carbohydrate diets, but are not superior to other dietary patterns for long-term weight loss or metabolic outcomes.

If you have Type 2 Diabetes, a strict ketogenic diet (20-50g carbs/day) can lower your HbA1c faster than standard low-carb diets in the short term. However, do not expect it to help you lose more weight in the long run compared to other healthy diets. It is a tool for glycemic control, not a magic bullet for weight loss.

A higher variety score of dietary protein sources (consuming appropriate quantities from more of the eight major sources: grains, meat, poultry, fish, egg, legumes) is inversely associated with the risk of new-onset diabetes.

To lower your risk of type 2 diabetes, aim to include a variety of protein sources in your diet rather than relying on just one or two. The study suggests that consuming appropriate amounts from a mix of grains, legumes, fish, poultry, and eggs is associated with a significantly lower risk of developing diabetes compared to a diet with fewer protein sources. You do not need to eliminate any specific source, but rather ensure your diet includes a broad spectrum of these foods.

Total protein intake has a U-shaped association with diabetes risk, where both very low (<10.6% of energy) and very high (≥14.0% of energy) intakes are associated with higher risk compared to moderate intake (10.6-14.0% of energy).

Avoid both very low and very high total protein intakes. The study suggests that getting 10.6% to 14.0% of your daily calories from protein is associated with the lowest risk of developing diabetes. This means you should neither severely restrict protein nor consume excessive amounts, but rather aim for a moderate level.

Specific protein sources have non-linear associations with diabetes risk: fish and legumes show inverse J/L-shaped associations (lower risk with higher intake), while red meat and poultry show J/U-shaped associations (increased risk at high intakes).

Choose your protein sources wisely. Fish and legumes are associated with lower diabetes risk, especially at higher intakes. Red meat and poultry should be consumed in moderation, as high intakes are associated with increased risk. Eggs and whole grains are also beneficial when consumed in appropriate amounts.

High-volume resistance training increases non-myofibrillar protein synthesis rates more than high-load resistance training, suggesting a mechanism for sarcoplasmic hypertrophy.

High-volume training may promote muscle growth through increased non-myofibrillar protein synthesis, which contributes to sarcoplasmic hypertrophy. This suggests that volume-based protocols can drive muscle growth through mechanisms beyond just contractile protein accretion.

In young and middle-aged adults (18-55 years), the combination of obesity, diabetes, and hypertension increases the risk of COVID-19-related mortality to levels comparable to those observed in older adults (56-75 years) without these conditions.

If you are under 55, your age alone does not protect you from severe COVID-19 outcomes if you have obesity, diabetes, or high blood pressure. These conditions combine to elevate your mortality risk to that of an older adult. Prioritize managing these metabolic factors through lifestyle changes and medical care, and ensure you are prioritized for preventive measures like vaccination.

Targeting specific inflammatory pathways (e.g., IL-1, TNFα, IL-6) with pharmacological antagonists can improve insulin sensitivity and glycemic control in patients with obesity and related inflammatory conditions.

In clinical settings, reducing inflammation through targeted medications can help manage blood sugar and insulin resistance in obese patients, especially those with co-existing inflammatory diseases. This supports the broader goal of reducing metabolic risk.

In females with type 2 diabetes, the combination of low fat mass and low muscle mass is synergistically associated with higher glycated hemoglobin (A1C) levels compared to other body composition phenotypes.

If you are a woman with type 2 diabetes, do not assume that being thin means your blood sugar is well-managed. This research shows that having low body fat AND low muscle mass is a specific risk factor for higher blood sugar levels. To improve your A1C, focus on building muscle mass through resistance training, rather than just trying to lose weight or stay thin.

In males with type 2 diabetes, high fat mass is significantly associated with higher A1C, but muscle mass does not significantly influence A1C levels.

If you are a man with type 2 diabetes, your blood sugar levels are more closely linked to your body fat than your muscle mass. While building muscle is healthy, prioritizing fat loss through diet and exercise is likely to have a more direct impact on lowering your A1C levels.

High consumption of ultra-processed foods (UPF) in young adult women is associated with a long-term increase in fat mass and a decrease in lean mass by early middle age.

For women, consistently high intake of ultra-processed foods (over 35% of daily grams) in your 20s predicts higher fat mass and lower muscle mass in your late 30s. To mitigate this, prioritize whole foods and minimize UPFs, as they are linked to unfavorable body composition changes over time.

White common bean extract (WCBE) rich in alpha-amylase inhibitor, taken 1.5g before meals, significantly improves glycemic control (HbA1c) and ameliorates diabetic peripheral neuropathy in type 2 diabetes patients over 4 months by remodeling gut microbiota to enrich SCFA-producing bacteria.

If you have Type 2 Diabetes, taking 1.5 grams of white common bean extract half an hour before each meal may help lower your HbA1c and improve nerve health. This supplement works by blocking starch digestion and feeding beneficial gut bacteria that produce short-chain fatty acids, which help regulate blood sugar. It should be used alongside your prescribed medication and dietary guidance, not as a replacement.

Resistance training in hypoxia (RTH) yields similar muscle hypertrophy and strength gains compared to normoxia when protocols are not optimized for specific covariates.

If you are training in hypoxia, do not expect automatic superior gains in muscle size or strength compared to training in normal air. The overall benefit is negligible unless you specifically optimize your rest intervals and load.

Resistance training in hypoxia enhances strength development (1RM) when using long inter-set rest intervals (≥ 120s) and moderate loads.

To gain strength in hypoxia, use moderate weights and rest for at least 2 minutes between sets. This allows you to maintain the intensity needed for strength adaptations, which hypoxia may support better than normoxia under these specific conditions.

Tirzepatide improves cardiovascular risk factors, including lipid profiles and blood pressure, without increasing cardiovascular event risk in T2DM patients.

Beyond weight loss, Tirzepatide improves heart health markers by lowering bad fats (triglycerides, LDL) and raising good fats (HDL), while also lowering blood pressure. It does not appear to increase heart attack or stroke risk in T2DM patients.

When essential amino acid profiles are equated, a novel plant-based protein matrix provides equivalent benefits to whey protein for body composition, strength, power, and aerobic performance in trained futsal players over an 8-week period.

If you are an athlete consuming enough total protein (over 1.6g/kg body weight per day), the specific source of your protein supplement (plant vs. whey) does not matter for muscle gain, strength, or performance, provided the plant protein is formulated to match the essential amino acid profile of whey. You can choose plant-based options without sacrificing results.

GLP-1 receptor agonists (semaglutide) and dual GLP-1/GIP agonists (tirzepatide) cause significant lean mass loss during weight loss, with semaglutide losing approximately 45% of total weight as lean mass and tirzepatide losing 25.7%, posing a specific risk of frailty and fractures in older populations.

If you are taking semaglutide or tirzepatide, be aware that a significant portion of your weight loss (up to 45% for semaglutide) comes from lean mass, not just fat. This is especially risky if you are over 60. Discuss strategies to preserve muscle, such as resistance training or potentially newer combination therapies, with your provider.

Using a single, universal velocity loss (VL) threshold to prescribe resistance training volume is unreliable and likely leads to variable acute physiological responses and divergent long-term adaptations because the volume of work completed at a given VL threshold varies significantly between individuals.

Do not use a single velocity loss threshold (like 20% or 30%) for everyone in your gym or program. The amount of work you do to hit that speed drop varies wildly between men and women, and between strong and less strong individuals. To ensure consistent training effects, you must individualize velocity loss targets based on sex, training status, and personality traits like emotional stability.

Sex significantly influences the volume of work completed at velocity loss thresholds, with females completing more repetitions than males at the same VL thresholds, while males perform repetitions at higher velocities.

If you are programming for mixed-sex groups, do not assume a 20% velocity loss means the same workload for men and women. Women will likely perform more repetitions to hit that speed drop, while men will maintain higher bar speeds. Adjust your targets or volume expectations based on sex.

Intensive weight loss via energy restriction and increased aerobic exercise induces adaptive thermogenesis (reduced resting energy expenditure beyond mass loss predictions) in both male and female physique athletes.

If you are cutting weight for a competition, expect your metabolism to slow down more than your weight loss would predict. This is a normal biological response called adaptive thermogenesis. It is driven by the energy deficit and increased exercise volume. The good news is that this adaptation is temporary and reverses during recovery.

Male physique athletes lose significantly more lean mass than female athletes during competition preparation, despite similar reductions in fat mass and muscle size.

Men preparing for physique competitions should be aware they may lose more muscle than women during a cut, likely because they reach lower body fat levels. Prioritizing protein and minimizing the depth of the cut may help preserve muscle.

Adaptive thermogenesis is associated with significant hormonal changes, specifically decreased leptin and T3, and reduced resting heart rate.

Low leptin and T3 levels are expected during a cut and contribute to metabolic slowdown. This is a normal hormonal response to energy deficit.

GLP-1RAs reduce food intake and body weight by activating POMC neurons and inhibiting NPY/AgRP neurons in the arcuate nucleus (ARC) of the hypothalamus.

GLP-1 medications also work in the brain's 'hunger center' (arcuate nucleus) by boosting 'stop eating' signals (POMC) and reducing 'start eating' signals (NPY/AgRP). This dual action helps reduce overall food intake and body weight.