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Michael Albert, MD

Jul 4

A triple-agonist just posted 30% weight loss at two years. Surgical-magnitude, from a once-weekly shot.

And I'm convinced it's the least important thing that happened to obesity medicine this year. Here's why the biggest number stopped being the story. 🧵

1/ For three years, we ranked these drugs like a leaderboard:
Semaglutide: ~15%.
Tirzepatide: ~21%.
Then retatrutide crossed 28%.

Every year, a bigger number.
We got very good at asking one question: how much weight comes off? That's now the wrong question.

2/ What actually changed in 2026: the class now pulls four different levers.
🔹GLP-1: eat less, ⬇️ inflammation, ⬇️ glucose
🔹GIP: tolerate more, sharpen insulin response
🔹Glucagon: burn more, clear liver fat
🔹Amylin: eat less through a separate circuit, ⬆️ leptin sensitivity

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Michael Albert, MD

@MichaelAlbertMD

Jun 29

My patient lost almost no weight on semaglutide. His liver healed. His blood pressure dropped. His sleep apnea lifted. His knees stopped hurting. He barely moved the scale and got better everywhere else.

I'd been measuring the wrong thing for years. 🧵

1/ My patient Marcus came to me to lose weight. A year on semaglutide, he'd lost under 5%.

By my specialty's scoreboard: a non-responder. Then I looked at the rest of his chart.

2/ A1c: normal.
Liver enzymes, elevated for years: normal. Blood pressure: down.
The snoring his wife complained about: gone. His knees on the stairs: better.
He lost only a modest amount of weight, but almost every marker of his health improved. anyway.

Read 9 tweets

Michael Albert, MD

@MichaelAlbertMD

May 19

A patient asked me this week if they could stop their obesity medication.

I told them what the data says:
67% of people who stop regain almost everything within a year.

That's not a failure of willpower. That's biology. And we finally have trials that prove it.

1/ ECO 2026 just changed the conversation in obesity medicine. For 3 years, every major meeting asked: how much weight can we lose? Istanbul asked something different: how do we keep it? Here's what we learned. 🧵

2/ SURMOUNT-MAINTAIN published in The Lancet this week. After losing 22% of their weight on tirzepatide, patients were randomized to continue full dose, drop to 5 mg, or switch to placebo. The results were unambiguous.

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Michael Albert, MD

@MichaelAlbertMD

May 11

1/ I'm a physician.
I just left traditional healthcare.

2/ I spent years inside the system.
7-minute visits.
Portal messages answered three days later by someone the patient had never met.

Care fragmented across platforms built around billing codes — not people.

3/ I'm not sure there's any going back.

Last week, I joined Vineyard as Chief Medical Officer and Staff Physician.

It's a direct-care virtual cardiometabolic clinic operating in all 50 states.

No insurance gatekeeping. Built around the patient and physician experience.

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Michael Albert, MD

@MichaelAlbertMD

Apr 8

Every morning I take five things.
A statin. Ezetimibe. Psyllium. Creatine. A multivitamin.

Once a week, I add a sixth: tirzepatide.

No rapamycin. No NMN. No Bryan Johnson protocol.

Here's what the evidence actually says—and why I left everything else out. 🧵

1/ Every morning I take five things.
A statin. Ezetimibe. Psyllium. Creatine. A multivitamin.

Once a week, I add a sixth: tirzepatide.
I used to raise an eyebrow at longevity stacks. Then I realized I'd quietly built one—each addition requiring enough evidence to clear the same bar I hold my prescriptions to.

2/ The plaque that ruptures at 62 was building in the third decade or earlier.

Ference et al. (JACC 2015): Mendelian randomization shows lifetime LDL exposure reduction yields ~3× greater CV risk reduction than RCTs achieving equivalent LDL lowering.

My LDL in 2018: 127. Today: 41.
The compounding logic means earlier is disproportionately better.

Read 9 tweets

Michael Albert, MD

@MichaelAlbertMD

Apr 4

I'm 36. I'm a physician. I take a statin—and ezetimibe—every day.

No symptoms. No cardiac history. Just an honest read of the evidence.

Here's what I found—and why I stopped waiting for a reason to act.

1/ I take a statin and ezetimibe every day.
My LDL in 2018: 127 mg/dL.
My LDL today: 41 mg/dL.

Here's exactly what changed — and why the evidence earned my confidence.🧵

2/ The CTT Collaboration pooled 27 RCTs and 170,000+ patients.
Each 1 mmol/L drop in LDL → ~21% relative reduction in major vascular events.

Even in low-risk people. Even in people who "seem fine."

That's not a secondary prevention story. That's a primary prevention story.

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