Browse the evidence

GLP-1 receptor agonists provide additive kidney benefits when used in combination with SGLT2 inhibitors, addressing residual cardiorenal risk.

If you are already taking an SGLT2 inhibitor for your kidney and heart health, ask your doctor if adding a GLP-1 receptor agonist could provide additional protection. These medications work through different mechanisms and can offer additive benefits, especially if you still have residual risk factors like high blood pressure or albuminuria.

Metabolic bariatric surgery (MBS) is more cost-effective than continuous GLP-1 pharmacotherapy, saving an average of $11,689 per patient over 2 years, while providing a definitive metabolic reset.

Bariatric surgery (like sleeve gastrectomy or gastric bypass) is not just a weight loss tool but a metabolic reset. While it has higher upfront costs, long-term data suggests it saves money compared to staying on GLP-1 medications indefinitely, as drug costs remain high while surgical maintenance costs drop. It works by altering your gut hormones to reduce hunger and improve insulin sensitivity.

Incretin therapies (semaglutide, tirzepatide) achieve MASH resolution and fibrosis improvement primarily through substantial, dose-dependent weight loss.

Semaglutide (2.4 mg weekly) and tirzepatide are weekly injections that reduce liver fat and inflammation by driving significant weight loss. They are highly effective for MASH resolution.

Emerging weight-lowering drugs (GLP-1/GIP/Glucagon agonists, amylin analogues, activin receptor antagonists) reduce cardiovascular risk factors (blood pressure, lipids, inflammation) and major adverse cardiovascular events (MACE) in obese patients, with some effects being independent of weight loss.

If you are obese and have cardiovascular risk factors, emerging drugs like semaglutide and tirzepatide offer significant benefits beyond just weight loss, including reduced risk of heart attacks and strokes. These benefits may come from direct effects on blood vessels and inflammation, not just weight loss. While side effects like nausea are common, they can often be managed. Oral options are becoming available, reducing the need for injections. These drugs are most effective when combined with lifestyle changes, but they can provide substantial help where lifestyle alone has failed.

Combining gut hormone analog medications (e.g., GLP-1/GIP agonists) with naltrexone-bupropion extended-release (NB-ER) provides a mechanistic rationale for improved weight loss in patients who fail to achieve goals with monotherapy, by targeting distinct satiety and reward pathways.

If you are taking a GLP-1 medication (like semaglutide or tirzepatide) and hitting a plateau or struggling with food cravings despite following the dose, ask your doctor about adding NB-ER (naltrexone-bupropion). This combination targets both physical fullness and the brain's reward system, which may help you lose more weight than the single medication alone.

Gut hormone analog medications (liraglutide, semaglutide, tirzepatide) reduce energy intake and alter food preferences primarily through delayed gastric emptying and hypothalamic/brainstem satiety signaling, rather than direct effects on reward centers.

GLP-1 medications like semaglutide work mainly by slowing digestion and signaling fullness to the brain, leading to significant weight loss (up to 21% for tirzepatide). While they may help with cravings, this is likely a secondary effect of weight loss rather than a direct 'craving blocker' action.

NB-ER (naltrexone-bupropion extended-release) reduces food cravings and improves control over eating by acting on central hypothalamic and mesolimbic dopaminergic systems, distinct from the peripheral effects of gut hormone analogs.

NB-ER helps with weight loss by targeting the brain's reward system to reduce cravings and improve self-control, rather than just slowing digestion. It typically leads to 6-12% weight loss over a year, depending on whether you have diabetes.

Tirzepatide is associated with significantly greater lean body mass (LBM) loss compared to semaglutide during routine care, with excess relative LBM losses of 1.1% to 2.0% at 3, 6, 9, and 12 months respectively.

If you are taking tirzepatide, expect to lose more lean muscle mass than if you were taking semaglutide for the same amount of weight loss. This effect increases with higher doses and longer duration. To counteract this, prioritize resistance training and adequate protein intake, and monitor your body composition, not just scale weight.

Patients with baseline musculoskeletal pain (cervicalgia, knee pain) experience significantly greater lean body mass loss during GLP-1 therapy, suggesting mobility limitations exacerbate muscle catabolism.

If you have joint pain, you are at higher risk for losing muscle while losing weight on GLP-1s. This is because pain limits your movement. Try to maintain some level of gentle activity or resistance training that does not aggravate your pain to protect your muscle mass.

Initiating Type 2 Diabetes screening at age 30 is recommended for asymptomatic individuals in the UAE, which is earlier than the standard age of 35, to address the region's high prevalence of prediabetes and diabetes.

If you live in the UAE and are 30 or older, get your blood sugar checked even if you feel healthy. This is not optional; it is the standard of care because diabetes is common and often silent. Early detection lets you fix it before it damages your heart or kidneys.

Individuals with Type 2 Diabetes should undergo annual screening for Cardio-Renal-Metabolic (CRM) risk, including blood pressure, lipid profile, and kidney function, to identify and manage multi-organ dysfunction early.

Once you have diabetes, you need a full health check-up every year, not just a blood sugar test. This includes checking your blood pressure, cholesterol, and kidney function. This annual check is your best defense against heart disease and kidney failure.

Individuals with Type 2 Diabetes should be screened for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) using the FIB-4 index, as nearly 70% of T2D patients are affected.

If you have diabetes, ask your doctor to check your liver health using a simple calculation called FIB-4. This test uses your age and blood results to estimate liver scarring risk. Since 70% of people with diabetes have some degree of liver fat, this check is essential for your overall health.

For each one percent reduction in body weight at eight weeks, there was a 112.6 μmoL/l increase in fasting beta-hydroxybutyrate concentrations.

Weight loss is associated with increased ketone production, which may aid in understanding dietary interventions.

Total, unprocessed, and processed red meat intake are each associated with a modestly higher risk of coronary heart disease (CHD) with hazard ratios of 1.12, 1.11, and 1.15 respectively for one serving per day increment.

Reducing red meat intake may lower the risk of coronary heart disease.

Substituting whole grains and dairy products for total red meat, and eggs for processed red meat, might reduce the risk of CHD.

Encouraging substitutions with whole grains, dairy, and eggs may support heart health.

Avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk.

Encouraging gluten-free diets may inadvertently lead to lower whole grain intake, which could be detrimental to heart health.

Moderately higher adiposity at age 18 years is associated with increased premature death in younger and middle-aged U.S. women.

Practitioners should consider adolescent BMI as a factor in long-term health assessments.

Unhealthy low-carbohydrate-diet and low-fat-diet scores were associated with higher total mortality.

Practitioners should advise against unhealthy low-carb and low-fat diets due to potential mortality risks.

Healthy low-carbohydrate-diet and low-fat-diet scores were associated with lower total mortality.

Practitioners should promote healthy low-carb and low-fat diets for potential mortality benefits.

Greater adherence to the Healthy Eating Index 2015 (HEI-2015) is associated with a 19% lower risk of total mortality (HR 0.81).

Encouraging adherence to the HEI-2015 may help reduce mortality risk in the population studied.

Adherence to the Alternate Mediterranean Diet (AMED) score is associated with a 18% lower risk of total mortality (HR 0.82).

Promoting adherence to the AMED may contribute to lower mortality risk.

All dietary scores examined were significantly inversely associated with death from cardiovascular disease, cancer, and respiratory disease.

Encouraging healthy eating patterns may reduce the risk of major diseases.

Modifiable risk factors collectively contribute to 59% of the population-attributable fraction (PAF) for CVD and 56% for death in China.

Addressing modifiable risk factors could significantly reduce CVD and mortality rates.

ALA intake reduces the incidence of coronary heart disease (CHD).

Practitioners may consider recommending ALA-rich foods for reducing CHD risk.