Primary Care Services, Blount LLC

07/26/2026

Weight loss is never only fat.

Somewhere between a fifth and a third of what comes off during weight loss is fat-free mass. In people with type 2 diabetes, already at raised risk of losing muscle as they age, that trade matters more than the number on the scale.

A Danish trial put a dose on it. In a secondary analysis of DOSE-EX, 82 adults with type 2 diabetes were randomized for 16 weeks to standard care, a 25 percent calorie cut alone, the same cut plus exercise three times a week, or the same cut plus exercise six times a week.
Fat came off roughly in proportion to effort.

Against standard care, fat mass fell 3.5 percentage points on diet alone, 6.3 with three sessions, and 8.0 with six. But the gap between three sessions and six was small and did not reach a clear difference. Doubling the training did not reliably buy more fat loss.

Fat-free mass is where the doses separated. It fell 2.7 percent on diet alone and 1.9 percent with three sessions a week, a difference too small to call. Only the six-session arm held on, at 0.2 percent, and only that arm clearly beat dieting alone.

Fat-free mass is everything that is not fat: muscle, bone, organs, body water, and glycogen with the water it binds. In a deficit this steep, some of what registers as a loss is glycogen and water rather than contractile tissue. That cuts both ways. The diet-only losses may overstate real muscle loss, and the preservation at six sessions is a strong signal rather than a direct measurement of muscle.

The wider literature points the same direction. A meta-analysis of resistance training performed inside an energy deficit found lean mass gains blunted compared with the same training without a deficit, while strength gains held up. Its meta-regression put a threshold on it: a deficit near 500 calories a day was enough to prevent lean mass gains altogether. Training does not override the deficit, it competes with it.
The limits are real. A secondary analysis, roughly 20 people per arm, all living with type 2 diabetes, over 16 weeks. One author holds stock in Novo Nordisk.

If the target is fat, three sessions a week captured most of what six delivered. If the target is holding on to lean tissue while eating less, three was not the dose that did it.

Lyngbaek et al., J Sport Health Sci 2025 · PMID 39427878
Murphy and Koehler, Scand J Med Sci Sports 2022 · PMID 34623696

07/21/2026

Every kind of exercise seems to help the aging brain, and the more interesting question is not whether it works but which domains are tied to which types of exercise.

A 2023 systematic review and meta-analysis pooled 54 randomized controlled trials in healthy people and found that while exercise improved cognition across the board, each type of training showed its largest benefit in a different mental domain. The pattern is specific enough to be useful, and modest enough that it should not be oversold.

The analysis was built to be rigorous. It followed PRISMA methodology, drew only on randomized trials, spanned participants from childhood to older age, and scored five separate cognitive domains: global cognition, executive function, memory, attention, and information processing. It also broke each intervention down by its exercise prescription, the frequency, intensity, session length, type, total program length, and progression, so the question was never just "does exercise help" but "which kind, how much, for whom."

Three matches came out of it. Resistance training showed its greatest benefit for executive function, the brain's control system for focus, planning, and self-control. Aerobic exercise showed its greatest benefit for global cognition, overall thinking measured across domains. Mind-body practices like yoga and tai chi showed their greatest benefit for memory. These are the strongest measured pairings, not exclusive effects, and the distinction matters: every type of exercise improved every domain to some degree. What the data describe is a tilt, not a lane. Lifting was not useless for memory and cardio was not useless for focus. Each simply landed hardest in one place.

The benefit was largest in older adults. Across global cognition, executive function, and memory, the oldest participants gained more than any younger group, which fits the broader picture that the aging brain has the most room to move and the most to protect. This is where the practical value concentrates.

On dose, the trials pointed toward a moderate, repeatable pattern rather than an all-out one: the largest cognitive gains clustered around three to four sessions a week, roughly forty-five to sixty minutes each, at moderate intensity. That is an achievable prescription, not a punishing one, and it lines up with what tends to hold across the exercise-and-cognition literature. Treat the specific numbers as the center of gravity the analysis reported, not a precise threshold, since exactly where the benefit peaks varies by domain and by study.

These are specific faculties, executive function, memory, overall processing, not general intelligence, so "exercise makes you smarter" is the wrong summary; "exercise sharpens particular mental skills" is closer.

The participants were healthy, so this is about optimizing normal cognition, not treating impairment or dementia. And this is a meta-analysis of heterogeneous trials, which means the mappings are consistent tendencies pulled from many small studies, not a single decisive experiment. Exercise almost certainly does more than one thing to the brain, and the neat type-to-domain chart is a simplification of a messier, mostly overlapping reality.

Zhang M, Jia J, Yang Y, Zhang L, Wang X. Effects of exercise interventions on cognitive functions in healthy populations: A systematic review and meta-analysis. PMID 37924980.

07/09/2026

Weight-loss drugs protect the number on the scale. That's a different thing from protecting your arteries.

In a year-long study, 130 adults with obesity lost about 13 kg on a low-calorie diet, then were split into four groups to keep it off: exercise, the drug liraglutide, both, or neither. Researchers used ultrasound to measure how thick the artery wall had become, one of the earliest physical signs of arteries clogging, long before anything hurts.

The exercise was ordinary. The standard recommendation of 150 minutes a week, delivered as four sessions: two supervised 45-minute sessions of interval spin cycling plus circuit training, and two on their own, as simple as brisk walking or cycling to work.

Anyone who exercised, with or without the drug, ended up with a thinner artery wall and lower inflammation. Adding the drug to exercise improved the vessel lining on top of that. The drug-only group improved none of it. They kept the weight off, and the drug did that better than exercise did, but on every artery measurement, injecting alone showed nothing.
Why that matters: across pooled studies, every extra 0.1 mm of carotid wall thickness carries roughly 15% higher heart attack risk and 18% higher stroke risk.

This doesn't mean the drugs are bad for your heart. In a trial of more than 17,000 people with obesity and heart disease, semaglutide cut major cardiovascular events from 8.0% to 6.5%. These drugs prevent heart attacks in the right patients. The narrower point stands: here, the artery benefits tracked with training, not the injection.
The limits: these are markers, not events. One year, 130 people, a planned secondary analysis. Whether a thinner wall at 52 weeks means fewer heart attacks in a decade is an assumption, not a result.

Several authors have financial ties to Novo Nordisk, which makes liraglutide. The result runs against their own drug.

If you're maintaining weight loss on one of these drugs and doing nothing else, the scale may be telling a better story than your arteries would.

Sandsdal, Holt et al., Nature Metabolism, 2026. Lorenz et al., Circulation, 2007. Lincoff et al., NEJM, 2023.

07/05/2026

06/24/2026

Support small local businesses, Let's lift each other up!

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04/22/2026

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11/24/2025

We are happy to be offering a limited supply of FREE flu shots thanks to a generous donation from the Red Crescent Clinic of Alabama. If you don’t have insurance that covers it, come in and get one today!

09/17/2025

Flu vaccines are in for the 2025-2026 season. We can offer the vaccine for all types of insurance and have competitive cash prices also. Come in to get vaccinated before flu strikes Alabama, and while you're here, ask our staff if you could benefit from the new COVID vaccine too! You've probably heard that the COVID virus is active right now, vaccination can reduce you chance of catching the virus, or becoming severely ill from COVID.

03/26/2025

Our office will be closed Friday, March 28. We will be available via Klara for urgent matters. Please contact us by Thursday if you need prescriptions refilled before next week. We will see you back for business as usual on Monday, March 31 at 8 am.