Browse the evidence

GLP-1 receptor agonists are an acceptable adjunct to progestin therapy for fertility preservation in young patients with endometrial cancer or atypical hyperplasia, provided they are framed as medically indicated treatment for cancer and fertility rather than cosmetic weight loss.

If you are a young woman with endometrial cancer or atypical hyperplasia and want to preserve fertility, GLP-1 medications like Semaglutide or Tirzepatide can be a helpful tool alongside progestin therapy. However, you must have a clear, honest conversation with your doctor about the costs, potential side effects, and a plan to keep the weight off after stopping the drug. Framing the medication as a medical treatment for your cancer and fertility, rather than just for weight loss, can help you feel more comfortable and less stigmatized.

Combining obesity management medications (OMM) with metabolic bariatric surgery (MBS) or endoscopic procedures is an inevitable and necessary component of future personalized obesity care, though optimal protocols are currently undefined.

Future obesity care will likely involve combining medications (like GLP-1s) with surgery or endoscopy. This combination is becoming standard to manage weight regain or suboptimal responses, though specific dosing and timing protocols are still being researched.

Post-bariatric surgery weight regain (affecting 15-20% of patients) can be managed with endoscopic interventions or OMM, but optimal dosing and scheduling for these combination therapies remain undefined.

If you regain weight after surgery (affecting 15-20% of patients), you are not out of options. Endoscopic procedures or adding back medications like GLP-1s can help, but doctors currently lack clear guidelines on the best doses and schedules for this specific scenario.

In obese individuals, a combined metabolic index of insulin (INS) and free fatty acids (FFAs) effectively predicts the presence of subclinical left ventricular hypertrophy (LVH), serving as a practical prescreen for early cardiac remodeling risk.

If you are obese, standard blood work might miss early heart strain. Ask your doctor about checking insulin and free fatty acids alongside standard lipids. This combination can flag heart thickening (LVH) before your heart's pumping ability drops, allowing for earlier lifestyle or medical intervention.

Triglycerides (TG) are the most robust independent predictor of the continuous burden of left ventricular mass (LVM) in obesity, whereas insulin and FFAs predict the threshold transition to hypertrophy.

High triglycerides are a strong indicator of increasing heart muscle mass in obesity. Monitoring TG levels can help track the gradual structural load on the heart, even if blood pressure and pumping function seem normal.

Moderate-intensity and high-intensity interval exercise training provide equal cardioprotection against diabetic cardiomyopathy in rats by preventing left ventricular fibrosis and collagen cross-linking.

If you have diabetes or are at risk, both moderate-intensity and high-intensity interval exercise can protect your heart. You do not need to choose high intensity if moderate is more sustainable; both approaches prevent heart damage and fibrosis in this model.

Pyridoxamine supplementation alleviates cardiac fibrosis and oxidative stress in prediabetic rats, preventing left ventricular collagen deposition.

Pyridoxamine may help reduce heart scarring and oxidative stress in prediabetes, but this is based on animal studies. It should not replace lifestyle changes like exercise and diet.

High daily consumption of carbohydrates (>60% of total energy) and simple sugars (>10% of total energy) is associated with a statistically significant increase in breast cancer risk.

To potentially lower breast cancer risk, aim to keep carbohydrate intake below 60% of your total daily energy and ensure simple sugars (added sugars) do not exceed 10% of your total energy. Focus on reducing refined sugars and high-glycemic carbohydrates, as high intake of these is linked to a significantly higher risk of developing breast cancer in this study.

Ketogenic dietary therapies (KDTs) may improve cerebrovascular health and neuroprotection by shifting brain energy metabolism from glucose to ketone bodies (specifically β-hydroxybutyrate), reducing oxidative stress, and modulating inflammatory signaling, though current human evidence is limited and heterogeneous.

If you have cognitive concerns or are aging, a ketogenic diet might offer neuroprotective benefits by shifting your brain's fuel source to ketones, which may reduce inflammation and oxidative stress. However, current human evidence is not strong enough to recommend it broadly. If you try it, consider less restrictive versions like the Modified Atkins Diet for better long-term adherence, and be aware that benefits may take weeks to manifest as your body adapts (keto-adaptation).

Sustained ad libitum consumption of an ultra-processed diet for two weeks does not significantly alter sweet or salty taste detection thresholds or preferences compared to an unprocessed diet.

Eating ultra-processed foods for two weeks does not change your basic ability to taste salt or sugar, nor does it change what you prefer. If you are overeating on these foods, look at factors like eating speed or energy density rather than assuming your taste buds have adapted.

Higher salt taste preference is positively correlated with systolic blood pressure, body weight, and BMI following consumption of an ultra-processed diet.

If you prefer salty foods and eat an ultra-processed diet, you may have higher blood pressure and body weight. Monitoring your salt preference and overall diet quality might be beneficial.

Swearing improves physical performance in short, intense tasks by increasing pain tolerance, state disinhibition, and physiological arousal.

If you are about to perform a short, intense physical task like a heavy lift or a sprint, using a swear word (either aloud or internally) may help you push harder. The effect comes from increased pain tolerance and mental focus. However, be mindful of social contexts where swearing might be inappropriate.

Dermal white adipose tissue (dWAT) loss and fibrotic transformation due to aging and photodamage reduce adiponectin production, leading to compromised skin health, fine lines, and atrophy.

Prioritize skin health by maintaining healthy dermal fat. Avoid aggressive fat-destroying procedures if possible, as loss of dermal white adipose tissue (dWAT) leads to fibrosis, reduced adiponectin, and faster skin aging. Focus on treatments that support or regenerate small, healthy fat cells rather than just removing volume.

GLP-1 receptor agonists (GLP-1RAs) cause facial fat atrophy, sagging, and wrinkling ("Ozempic face") by inhibiting adipocyte differentiation and promoting fibrotic transformation of dWAT.

If using GLP-1RAs, be aware that facial fat loss and skin aging ('Ozempic face') are common side effects. Consider proactive skin care or aesthetic interventions (like fat grafting or regenerative fillers) to counteract fat loss and fibrosis. Monitor facial changes and discuss mitigation strategies with your provider.

Hypertrophic (large) adipocytes promote skin aging by secreting proinflammatory cytokines, downregulating collagen/elastin, and upregulating MMPs, whereas small healthy adipocytes promote skin health via adiponectin.

Maintain a healthy weight to avoid hypertrophic (large) fat cells, which promote skin aging through inflammation and collagen breakdown. Focus on strategies that promote small, healthy fat cells, which support skin structure via adiponectin.

Seasonal variations in glycemic control (HbA1c) and body mass index (BMI) in older adults with type 2 diabetes are preserved and not disrupted by lifestyle modifications associated with the COVID-19 pandemic.

For older adults with type 2 diabetes, do not assume that pandemic-related lifestyle changes (like staying home more) will necessarily disrupt your seasonal blood sugar patterns. The body's seasonal metabolic rhythm (typically better control in autumn, higher in spring) appears robust and may persist even when daily habits change. Focus on managing these known seasonal fluctuations in your treatment plan rather than expecting lifestyle changes to reset your baseline metabolic rhythm.

Long-term adherence to low-carbohydrate diets may attenuate weight loss benefits and potentially increase LDL cholesterol in some individuals, raising cardiovascular risk concerns.

While LCDs work well for short-term weight loss, be aware that benefits may diminish after a year, and some people see their bad cholesterol (LDL) rise. Regular monitoring of lipids and liver health is essential if you stay on this diet long-term.

The weight loss benefit of tirzepatide over semaglutide is significantly attenuated or absent in patients with type 2 diabetes compared to those without diabetes.

For patients with diabetes, the weight loss advantage of tirzepatide over semaglutide seen in non-diabetics may not be present. Consult your doctor to manage expectations regarding weight loss if you have diabetes.

Training to volitional failure, contraction velocity, set configuration, inter-set rest, periodization, time of day, and exercise order do not significantly influence skeletal muscle hypertrophy.

You do not need to obsess over training to failure, specific tempos, exercise order, or rest periods to build muscle. These variables have little to no impact on hypertrophy compared to the main drivers: load, frequency, and volume. Choose what is sustainable for you.

Excessive dietary intake of linoleic acid (LA) leads to the formation of oxidized linoleic acid metabolites (OXLAMs) and alters cardiolipin composition, causing mitochondrial dysfunction and contributing to chronic diseases such as cardiovascular disease, cancer, and Alzheimer's.

Reduce intake of seed oils (soybean, corn, canola, sunflower) to lower linoleic acid consumption. This may help reduce the production of harmful metabolites linked to chronic disease, though the process is slow due to LA's long half-life.

High dietary linoleic acid intake inhibits the conversion of short-chain omega-3 fatty acids (ALA) to long-chain omega-3 fatty acids (EPA/DHA) by inhibiting delta-desaturase enzyme activity.

If you consume high amounts of seed oils, your body's ability to convert plant-based omega-3s (ALA) into active forms (EPA/DHA) is reduced. Consider direct sources of EPA/DHA if you are not consuming fish.

Obesity prevalence has increased significantly in the US since 1980 despite a plateau or decline in national energy intake and stable or increasing physical activity levels since 2000.

Focus on the quality and processing of your food rather than just counting calories. Prioritize minimally processed foods with intact cellular structures (fiber, phytonutrients) and avoid highly processed 'acellular' nutrients. This supports a healthy gut microbiome and metabolic function, which may help regulate body weight more effectively than caloric restriction alone.

Genetic variability in the GLP1R gene can lead to non-response to GLP-1 receptor agonists in some patients with T2DM and obesity.

Some patients with T2DM and obesity do not respond well to GLP-1 receptor agonists due to genetic factors. If you are not seeing results, genetic variability in the GLP-1 receptor might be a cause. Discuss this with your healthcare provider to explore other treatment options or lifestyle interventions.

GLP-1 receptor agonists delay gastric emptying and increase the risk of pulmonary aspiration during general anesthesia, necessitating specific peri-operative management strategies.

If you take a GLP-1 drug (like Ozempic, Wegovy, or Trulicity) and have surgery, tell your anesthesiologist. You likely need to stop the drug for a specific time before surgery (often 3 half-lives, e.g., 1 week for weekly drugs) to prevent stomach contents from entering your lungs while asleep. Do not assume standard fasting rules apply; your stomach may still be full even if you haven't eaten for 12 hours.