Articles
Weight and metabolism 12 min
IRS Publication 502 counts prescribed drugs as medical expenses, and while the IRS has not named GLP-1 drugs, a GLP-1 prescribed to treat obesity or a related condition fits that rule for HSA or FSA payment. A weight-loss program qualifies only when it treats a disease diagnosed by a physician, such as obesity or hypertension; diet food never does.
Weight and metabolism 14 min
Cigna and UnitedHealthcare approve Wegovy and Zepbound for weight loss at a BMI of 30, or 27 with a weight-related condition, and renew only after a 5% loss; Cigna also wants 3 months of documented diet and lifestyle effort first. The plan must cover weight-loss drugs at all, and Medicaid rules vary sharply by state.
Labs and biomarkers 12 min
There is no single critical hemoglobin. WHO defines severe anemia as under 8 g/dL, hospital labs set their own phone-call limits (median 6.0 g/dL across 48 US hospital lists), and the AABB recommends considering transfusion in stable hospitalized adults under 7 g/dL, with clinicians able to choose 7.5 in cardiac surgery and 8 in orthopedic surgery or cardiovascular disease, and under 10 for patients hospitalized with a heart attack.
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Supplements 12 min
Added to resistance training, creatine gives adults over 50 a small extra gain in strength, and possibly lean mass, over training alone. Taken without training it has shown little effect on muscle, pooled trials found it added nothing to training's effect on bone density, and it raises serum creatinine on kidney tests.
Weight and metabolism 10 min
Costco's member price for Wegovy is $199 for two fills then $349 a month for the pen, and $149 to $299 for the tablets; Ozempic is $199 then $349, or $499 at 2 mg. Every price matches Novo Nordisk's own self-pay price.
Labs and biomarkers 14 min
The ADA uses the same A1C cut points at every adult age and for both sexes: under 5.7 percent normal, 5.7 to 6.4 prediabetes, 6.5 or above diabetes. A1C does drift up with age even when glucose is normal, which makes a borderline result after 60 worth confirming, and age changes the treatment goal for older adults with diabetes, not the normal range.
Weight and metabolism 11 min
SURMOUNT-5 (NEJM, 2025) randomized 751 adults with obesity and no type 2 diabetes to tirzepatide or semaglutide at the maximum tolerated dose for 72 weeks: mean weight loss 20.2 percent against 13.7, waist 18.4 cm against 13.0. It was open-label and Lilly-funded. The labels share their core warnings, nausea led each drug's own trials, and neither label allows a cross-trial side-effect comparison. Cash: Zepbound KwikPen $299 to $699 a month by dose, $449 on 7.5 mg and up with refills within 45 days; Wegovy pen $199 for two new-patient fills, then $349 ($399 for 7.2 mg).
Weight and metabolism 11 min
In the STEP 1 extension, people who lost 17.3 percent on semaglutide 2.4 mg regained 11.6 percentage points in the year after stopping, about two thirds of the loss, and their cardiometabolic gains reverted toward baseline. In SURMOUNT-4, switching from tirzepatide to placebo meant a 14 percent regain from week-36 weight over 52 weeks against a further 5.5 percent loss on the drug. In STEP 4, placebo regained 6.9 percent from week-20 weight over 48 weeks against a 7.9 percent loss on semaglutide. No trial tested a taper. Semaglutide's half-life is about a week, tirzepatide's about five days.
Weight and metabolism 11 min
The Wegovy tablet (25 mg daily) and injection (2.4 mg weekly) share one label. In adults without type 2 diabetes the label says their average semaglutide levels are similar, but the tablet is 1 to 2 percent absorbed and must be taken on an empty stomach with up to 4 ounces of water, 30 minutes before anything else. Its trial: 13.6 percent mean weight loss at 64 weeks against 2.4 on placebo. The injection's: 14.9 percent at 68 weeks against 2.4. In type 2 diabetes the tablet is unstudied for weight loss and gives lower levels. Self-pay: pill from $149 a month, pen $199 for two fills then $349.
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Weight and metabolism 11 min
Novo's self-pay offer prices the Ozempic pen at $349 a month (0.25 to 1 mg) and $499 (2 mg), with $199 for new patients' first two fills through December 31, 2026, and the pill at $149, $199 or $299 by dose. List price is $1,027.51 per pen or bottle, and the pen's falls to $675 on January 1, 2027; self-pay prices do not change. With commercial coverage the card takes the copay to as little as $25 (the card saves at most $100 a month); government beneficiaries are excluded. Every offer requires an on-label prescription, and the label is type 2 diabetes.
Weight and metabolism 13 min
From the Wegovy, Zepbound and Foundayo labels: nausea in 44, 25 to 29 and 26 to 35 percent of people against 16, 8 and 10 on placebo, mostly during dose escalation; 6.8, 4.8 to 6.7 and 6 to 10 percent stopped for side effects against about 3 on placebo. Serious events are rare and measured: pancreatitis at 0.14 to 0.2 cases per 100 patient-years, gallstones in 1 to 2.5 percent, acute kidney injury in 0.2 to 0.5 percent on Zepbound and Foundayo. The boxed warning is thyroid C-cell tumors in rodents, unknown in humans. The labels name the symptoms that mean stop and call.
Weight and metabolism 15 min
The Wegovy label reports hair loss in 3.3 percent of adults on 2.4 mg versus 1 percent on placebo, and 5.8 percent at 7.2 mg, with the rate in women several times the rate in men (8.4 versus 0.2 percent). Zepbound and Foundayo report 4 to 5 percent with the same split. A July 2026 BMJ cohort in type 2 diabetes found a 37 to 68 percent higher hazard than other diabetes drugs at about 7 versus 4 to 5 cases per 1,000 person-years; a September 2026 genetic study points at the receptor itself in predisposed men. Shedding after a trigger regrows within six to nine months, per the AAD.
Labs and biomarkers 8 min
Creatinine reaches urine by filtration and by active tubular secretion. Drugs that block the second route, trimethoprim and cobicistat among them, raise serum creatinine and lower estimated GFR without changing filtration. For creatine supplements the measured rise is small, and the trials behind it did not include people with kidney disease.
Telehealth and online prescriptions 9 min
Online prescribing of controlled substances runs on a temporary DEA rule that expires December 31, 2026. It covers testosterone and stimulants. It does not cover GLP-1s, which are not on the DEA's schedules.
Weight and metabolism 11 min
Part D still cannot pay for a drug prescribed for weight loss, and that has not changed. What changed on July 1, 2026 is that a separate program, the Medicare GLP-1 Bridge, began offering three specific products for a $50 monthly copay outside the Part D benefit. The list is narrower than it sounds, and the $50 does not count toward your out-of-pocket cap.
Weight and metabolism 8 min
On a GLP-1 the binding constraint is not which foods you choose, it is how little food you can face. Semaglutide's own label reports nausea in 44 percent of people and constipation in 24 percent, and the drug delays gastric emptying. Eat protein first, keep fat modest at any single sitting, and treat fluid and fiber as scheduled, not incidental.
Labs and biomarkers 7 min
An A1C below 5.7 percent is normal, 5.7 to 6.4 is prediabetes and 6.5 or above is diabetes. The test measures glucose stuck to hemoglobin over about three months, which means anything that changes the life of a red blood cell changes the result, and several common conditions do.
Labs and biomarkers 6 min
The NIH Office of Dietary Supplements treats serum B12 below 200 or 250 pg/mL as subnormal, and names methylmalonic acid as the most sensitive marker, able to confirm deficiency when serum B12 sits anywhere between 150 and 399 pg/mL. That range is wide, it covers many results reported as normal, and it is the whole reason B12 testing confuses people.
Labs and biomarkers 7 min
WHO's 2024 guideline defines anemia at a hemoglobin below 130 g/L in men and below 120 g/L in non-pregnant women aged 15 to 65. Those cutoffs are the 5th percentile of a healthy population, which means one healthy adult in twenty sits below the line by construction, and WHO itself treats anemia as a sign of something else rather than a diagnosis.
Hormones 10 min
The best longitudinal data says the menopause transition does not accelerate weight gain. Weight climbs through the forties on an unchanged slope and keeps climbing at the same rate through the transition. What changes is composition: fat gain roughly doubles while lean mass starts falling, and visceral fat begins rising at over 6 percent a year.
Labs and biomarkers 13 min
KDIGO defines chronic kidney disease as kidney abnormality present for a minimum of three months, so a single low eGFR cannot make the diagnosis. The classification has two dimensions, kidney function and albuminuria, and most people are only ever shown one of them.
Strength, mobility and aging 11 min
WHO's second-edition dementia risk guideline, published in July 2026, makes exactly one strong recommendation on moderate-certainty evidence for people with normal cognition: physical activity. It also recommends against vitamin B, vitamin E, omega-3 and multivitamin supplements for this purpose, and records insufficient evidence for depression, stroke, brain injury, vision and sleep interventions.
Labs and biomarkers 7 min
The American College of Rheumatology defines asymptomatic hyperuricemia as a serum urate of 6.8 mg/dL or above with no prior gout flare and no tophi, and conditionally recommends against starting any urate-lowering drug for it. That recommendation rests on high certainty evidence, which is rare in this guideline.
Hormones 8 min
A raised TSH with a normal free T4 is called subclinical hypothyroidism, and the largest randomized trial in older adults found levothyroxine produced no improvement in hypothyroid symptoms or tiredness at one year. The AACE and ATA position is that treatment below a TSH of 10 should be tailored to the individual, not automatic.
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