Browse the evidence

Tirzepatide treatment, particularly during dose escalation, is associated with an increased risk of acute duodenal ulcer perforation in patients with pre-existing untreated Helicobacter pylori infection.

If you are taking tirzepatide and experience persistent or worsening stomach pain, nausea, or vomiting that does not resolve, do not assume it is just a normal side effect. Seek medical attention immediately, especially if you have a history of stomach issues or H. pylori. Early detection of ulcers can prevent perforation.

High-dose tirzepatide (15 mg weekly) can induce severe gastrointestinal side effects (prolonged vomiting and diarrhea) leading to profound electrolyte imbalances (hypokalemia, hypomagnesemia, hypocalcemia), which precipitate life-threatening ventricular fibrillation and cardiac arrest.

If you are on 15mg tirzepatide and have persistent vomiting or diarrhea, do not ignore it. Ask your doctor to check your potassium, magnesium, and calcium levels immediately. Severe GI loss can trigger dangerous heart rhythms even if you have no prior heart history.

Evidence regarding the impact of GLP-1 RAs on total shoulder arthroplasty (TSA) outcomes is limited, heterogeneous, and contradictory, with some studies showing reduced mortality and adverse events while others show increased complications.

For shoulder replacement surgery, the data on GLP-1 RAs is mixed. Some studies show benefits like lower mortality, while others show higher risks of blood clots and pneumonia. Because the evidence is weak and contradictory, your surgical team will likely evaluate your specific case carefully. Do not assume the benefits seen in hip/knee surgery apply here without explicit guidance from your surgeon.

Betaine supplementation may improve body composition based on animal models.

Athletes may consider betaine for potential body composition benefits.

Current literature does not support a beneficial effect of betaine on muscle strength and power in humans.

Athletes should be cautious about expecting strength and power improvements from betaine.

Energy restriction (ER) affects multiple metabolic, physiological, genetic, and cellular adaptation pathways associated with prolonged lifespan.

Practitioners should consider the potential lifespan benefits of energy restriction.

The sustainability of energy restriction and its implementation across different diseases remains challenging.

Practitioners should be aware of the challenges in implementing energy restriction sustainably.

Metabolic surgery (bariatric surgery) is a highly effective treatment for T2DM remission in patients with BMI ≥ 32.5 kg/m2, offering higher remission rates and long-term benefits compared to conventional treatments.

If you have Type 2 Diabetes and a high BMI (32.5 or higher), and lifestyle changes haven't been enough, metabolic surgery might be an option. It can lead to long-term remission of diabetes for many people. Discuss with your doctor if you are a candidate, as it involves surgery and long-term monitoring.

Adherence to a nutrient-dense carnivore diet (high fat, moderate protein, negligible carbohydrates) can induce remission of type 2 diabetes and hypertension in patients with long-standing disease history.

This case suggests that eliminating carbohydrates and eating a diet consisting only of animal products (meat, eggs, fats) may help reverse type 2 diabetes and hypertension, even in long-standing cases. However, this is based on a single patient who also had cancer and refused standard care. Do not attempt this without medical supervision, especially if you have kidney disease or are on medication, as dosages may need adjustment.

Systematic review evidence does not establish a strong or clear association between palm oil consumption and increased risk of cardiovascular disease or CVD-specific mortality.

Current systematic evidence does not support the claim that palm oil consumption increases cardiovascular disease risk. While palm oil contains saturated fats, the review found no strong link to CVD or mortality. Focus on maintaining a healthy overall diet pattern rather than avoiding palm oil specifically.

In patients with type 2 diabetes and high cardiovascular risk (CAC ≥ 100), intensified multifactorial treatment using SGLT2 inhibitors and GLP-1 receptor agonists combined with high-intensity lipid-lowering therapy reduces cardiovascular events compared to standard treatment.

If you have Type 2 Diabetes and a high Coronary Artery Calcification (CAC) score (≥100), current standard care may not be enough. This trial tests whether adding specific heart-protective diabetes medications (SGLT2 inhibitors and GLP-1 agonists) along with aggressive cholesterol and blood pressure management significantly reduces your risk of heart attack, stroke, or heart failure compared to standard care. You should discuss your CAC score and whether intensified therapy is appropriate for your specific risk profile with your doctor.

In patients with Type 2 Diabetes and a CAC score of 0 (very low risk), de-escalating multifactorial treatment targets (e.g., less intensive lipid and blood pressure management) is non-inferior to standard treatment regarding cardiovascular events.

If you have Type 2 Diabetes but a Coronary Artery Calcification (CAC) score of 0, your risk of a cardiovascular event is very low (about 1% over 5 years). This trial investigates whether it is safe to reduce the intensity of your cholesterol and blood pressure medications compared to standard care. If your CAC is 0, you might be able to simplify your medication regimen with your doctor, focusing on glucose control and avoiding side effects, without significantly increasing your heart risk.

Intensive lifestyle interventions focused on weight loss do not reduce cardiovascular morbidity or all-cause mortality in adults with type 2 diabetes and overweight or obesity.

If you have type 2 diabetes and are overweight, focusing intensely on losing weight through strict diet and exercise may not protect your heart or extend your life as much as previously thought. Prioritize sustainable health behaviors and mental well-being over the scale number, as the medical evidence for mortality benefits from weight loss in this specific group is lacking.

Semaglutide effectively reverses alectinib-induced excessive weight gain in ALK+ NSCLC patients, though discontinuation due to gallstone pancreatitis can lead to weight regain.

If you are on alectinib and gaining significant weight, semaglutide can help you lose it, but you must get a baseline gallbladder ultrasound first. If you develop abdominal pain, stop the drug immediately as it may cause pancreatitis, which will cause you to regain the weight you lost.

The cardiometabolic benefits of semaglutide 2.4 mg are not maintained after treatment discontinuation, with risk factors deteriorating towards baseline levels.

If you stop taking semaglutide 2.4 mg, the improvements in your blood pressure, blood sugar, and cholesterol will likely reverse towards your pre-treatment levels. This suggests that obesity management with this medication requires long-term, continuous use.

Semaglutide treatment in obese patients with type 2 diabetes and severe psoriasis leads to significant improvement in psoriasis severity (PASI) and quality of life, independent of prior biologic therapy failure.

If you have severe psoriasis and type 2 diabetes, ask your doctor about GLP-1 agonists like semaglutide. This case shows it can significantly improve skin lesions and quality of life, even when other treatments failed. It addresses both conditions simultaneously.

Whey protein supplementation (total 1.2 g/kg/d) during diet-induced weight loss does not produce clinically important improvements in muscle mass or strength in middle-aged postmenopausal women with obesity.

If you are a postmenopausal woman losing weight, eating more protein (up to 1.2g/kg) than the standard recommendation will not save your muscle mass or strength. You will still lose muscle, and your strength will not improve, regardless of whether you take whey protein supplements. Do not rely on protein alone to preserve muscle during a diet.

Long-acting GLP-1 receptor agonists (GLP-1RAs) significantly reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes, particularly those with established cardiovascular disease or high cardiovascular risk.

If you have type 2 diabetes and are at high risk for heart disease or have existing heart conditions, GLP-1 receptor agonists (like semaglutide or liraglutide) are strongly recommended. These medications not only help control blood sugar but also significantly reduce the risk of heart attacks, strokes, and cardiovascular death. They are considered a standard of care for cardiovascular risk mitigation in this population.

GLP-1RAs reduce the risk of hospitalization for heart failure (HF) and prevent new-onset HF, although they may not reduce readmissions in patients with existing HF.

For patients with type 2 diabetes who are at risk for heart failure, GLP-1RAs can help prevent the initial development of heart failure and reduce the likelihood of being hospitalized for it. However, if you already have heart failure, these medications may not prevent future hospital readmissions, though they still offer other cardiovascular benefits.

Tirzepatide use can cause drug-induced liver injury (DILI) characterized by elevated transaminases, potentially linked to rapid hepatic fat mobilization.

If you are taking tirzepatide and experience unexplained fatigue or abdominal discomfort, ask your doctor to check liver enzymes (ALT/AST). This liver injury is rare and reversible, but monitoring ensures safety. Do not stop the medication without consulting your provider, as the metabolic benefits are significant.

Coadministration of SGLT2 inhibitors and tirzepatide creates a synergistic risk for euglycemic ketoacidosis (EKA), a life-threatening condition characterized by ketone production and acidosis despite normal blood glucose levels.

If you are taking both an SGLT2 inhibitor (like empagliflozin) and tirzepatide, be aware that you are at risk for a rare but serious condition called euglycemic ketoacidosis (EKA). Unlike typical diabetic ketoacidosis, your blood sugar may remain normal, so do not rely on glucose readings alone. If you experience persistent nausea, vomiting, or extreme fatigue, seek medical attention immediately and ask for ketone testing, even if your blood sugar is not high.

Observational studies claiming GLP-1 receptor agonists reduce cancer risk are currently methodologically flawed and cannot support clinical policy due to high risk of bias.

Do not rely on current observational studies to claim that GLP-1 drugs prevent cancer. The existing data is methodologically flawed and cannot yet inform clinical practice or public health policy.

The presence of the rare BDNF p.Thr2Ile variant is associated with a suboptimal response to high-dose tirzepatide treatment, resulting in significantly less weight loss compared to clinical trial averages.

If you have the rare BDNF p.Thr2Ile variant, you might experience less weight loss from tirzepatide than the average patient. Discuss your genetic profile with your doctor to manage expectations and explore alternative treatments.

Continuous Positive Airway Pressure (CPAP) is the recommended first-line treatment for stable ambulatory patients with OHS who also have severe Obstructive Sleep Apnea (OSA).

If you have OHS and severe sleep apnea, CPAP is the standard first treatment. You need to use it every night. While it can be uncomfortable at first, it is necessary to keep your airways open and manage your breathing until weight loss interventions can potentially resolve the underlying syndrome.