Browse the evidence

High circulating levels of the artificial sweetener erythritol are associated with a significantly increased risk of major adverse cardiovascular events (MACE), including heart attack and stroke, and directly enhance platelet reactivity and thrombosis potential.

If you consume erythritol (a common artificial sweetener in 'keto' products, sugar-free drinks, and baked goods), be aware that it can accumulate in your blood and make your platelets more likely to form clots. This risk is particularly relevant if you have existing heart disease, diabetes, or high blood pressure. While occasional use may not pose a significant risk for healthy individuals, those at higher cardiovascular risk should consider limiting erythritol intake and consulting their doctor, especially given that levels can remain elevated for days after consumption.

Tirzepatide, a dual GIP and GLP-1 receptor agonist, produces clinically significant reductions in HbA1c and body weight in patients with type 2 diabetes, with efficacy superior to the selective GLP-1RA dulaglutide.

For patients with type 2 diabetes, tirzepatide offers superior glucose and weight control compared to existing GLP-1 drugs. To minimize stomach upset, it is crucial to follow the prescribed slow dose-escalation schedule (starting at 2.5mg or 4mg and increasing gradually over 8 weeks). This approach balances high efficacy with better tolerability.

Adopting low glycaemic index (GI) or low glycaemic load (GL) dietary patterns results in small but clinically significant improvements in glycaemic control (HbA1c) and cardiometabolic risk factors (lipids, inflammation, adiposity) for adults with moderately controlled type 1 and type 2 diabetes, even when concurrent with standard pharmacotherapy.

If you have type 1 or type 2 diabetes, switching to a low GI or GL diet can help lower your HbA1c and improve cholesterol and inflammation, even if you are already taking diabetes medication. You don't need to change everything at once; focus on replacing high-GI carbohydrates (like white bread and sugary drinks) with lower-GI options (like legumes and whole grains). This approach is safe, effective, and works alongside your current treatment plan to help you reach your health goals.

Insulin resistance is a major cardiovascular risk factor in subjects without diabetes and serves as a key link between MAFLD/NASH and cardiovascular disease.

Even if you do not have diabetes, insulin resistance associated with fatty liver disease significantly increases your risk of heart disease. Addressing insulin sensitivity through lifestyle changes is crucial for cardiovascular health, regardless of your diabetes status.

Females exhibit greater susceptibility to disuse-induced muscle atrophy compared to males, evidenced by faster onset of muscle loss and greater percent loss of oxidative (Type I) muscle mass during conditions like hindlimb unloading or ICU bed rest.

If you are female, be aware that your muscles may waste away faster than a male's during periods of inactivity (like bed rest or casting). This is partly because you naturally have more 'slow-twitch' muscle fibers, which are more vulnerable to disuse. Prioritize early, gentle movement or specific resistance strategies sooner than you might expect, as your body is biologically predisposed to lose this muscle type faster.

Dietary fiber and probiotic-induced short-chain fatty acids (SCFAs) reduce blood pressure and improve vascular health through G-protein coupled receptor signaling and histone deacetylase inhibition.

Increase your intake of dietary fiber and consider probiotics to boost short-chain fatty acid production. This metabolic shift activates specific receptors (GPR41/43) and enzymes that help lower blood pressure and improve vascular function. Focus on non-starch polysaccharides and low-digestible saccharides found in whole plant foods.

Elevated plasma levels of Trimethylamine-N-oxide (TMAO) are associated with increased risk of cardiovascular disease, thrombosis, and atherosclerosis, primarily through platelet hyper-reactivity and macrophage scavenger receptor stimulation.

High levels of TMAO, produced when gut bacteria metabolize choline and carnitine from foods like red meat and eggs, are linked to higher cardiovascular risk and blood clotting. To mitigate this, balance your intake of these foods with high-fiber diets that may alter microbiota composition, and monitor TMAO levels if you have existing cardiovascular risk factors.

Visceral adiposity, rather than overall body mass index (BMI), is the critical driver of metabolic syndrome comorbidities, including insulin resistance and cardiovascular risk.

Do not rely on BMI alone to assess your health risk. Waist circumference is a better indicator of visceral fat, which drives metabolic syndrome. Even if you are lean, high abdominal fat increases your risk for diabetes and heart disease.

Letrozole is the first-line pharmacological treatment for anovulatory infertility in women with PCOS, offering higher live birth and clinical pregnancy rates compared to Clomiphene Citrate (CC).

If you have PCOS and are struggling with infertility due to lack of ovulation, Letrozole is now the preferred first medication. It works better than the older drug Clomiphene (CC) and has a lower risk of twins and complications. It is often used off-label, so discuss this with your doctor.

Short-term circadian misalignment (simulated night shift) significantly reduces skeletal muscle insulin sensitivity in healthy young men, primarily by decreasing nonoxidative glucose disposal.

If you work night shifts or have an irregular schedule, your body's ability to process glucose in your muscles is impaired, even if you get enough sleep and eat the same amount of food. This happens because your internal biological clock is out of sync with your behavior. To mitigate this, try to keep your meal and sleep times as consistent as possible relative to your work schedule, and be aware that your risk for insulin resistance is higher during periods of circadian disruption.

Specific nutrient intake accelerates the gastric emptying of that specific nutrient (e.g., glucose accelerates glucose emptying, fat accelerates fat emptying) through desensitization of intestinal feedback mechanisms.

If you need to absorb glucose quickly, train your stomach by consuming high glucose loads regularly. Similarly, high-fat diets accelerate fat emptying. This specificity means you should match your training nutrition to your race nutrition strategy.

Treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with a reduced incidence of dementia in patients with type 2 diabetes.

If you have Type 2 Diabetes, discuss GLP-1 receptor agonists (like liraglutide or semaglutide) with your doctor. This paper suggests these medications may lower your risk of developing dementia compared to other diabetes treatments. This is particularly relevant if you are at high cardiovascular risk.

Bariatric surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) significantly increases HDL-C levels and improves HDL functionality (cholesterol efflux capacity and apoA-I exchange rate) in obese patients, particularly with sustained effects observed at 12 months post-surgery.

If you have severe obesity and are considering bariatric surgery, know that it is the most effective way to significantly boost your HDL cholesterol levels and improve how well your HDL functions (specifically its ability to remove cholesterol). Studies show that Roux-en-Y gastric bypass and sleeve gastrectomy can increase HDL-C by 30-32% over five years, far outperforming medical therapy alone. However, full functional benefits, such as improved cholesterol efflux, may take up to 12 months to manifest, so patience and adherence to post-surgical care are crucial.

High plasma levels of Trimethylamine N-Oxide (TMAO) promote atherosclerosis and cardiovascular disease risk by impairing reverse cholesterol transport (RCT) and promoting foam cell formation.

High levels of TMAO, produced when your gut bacteria process nutrients like choline (eggs, meat) and carnitine (red meat), are linked to higher cardiovascular risk. This happens because TMAO impairs your body's ability to remove cholesterol from arteries (Reverse Cholesterol Transport). While you can't easily change your genes, understanding that gut bacteria play a key role suggests that dietary strategies might need to consider microbiome health, not just nutrient content.

Hormonal Replacement Therapy (HRT) reduces visceral fat mass and improves insulin sensitivity in postmenopausal women, particularly when initiated during perimenopause or early menopause.

If you are going through menopause and concerned about weight gain, talk to your doctor about Hormonal Replacement Therapy (HRT). Starting HRT early (during perimenopause or shortly after menopause) can help reduce belly fat and improve how your body handles sugar. However, this should be combined with a healthy diet and exercise, and only done if your doctor determines it is safe for you.

Aerobic exercise training increases skeletal muscle GLUT4 protein levels, which enhances insulin-stimulated muscle glucose disposal.

Regular aerobic exercise increases the amount of GLUT4, a protein that helps move glucose into your muscles. This makes your body more sensitive to insulin and helps manage blood sugar levels more effectively.

In Chinese adults with type 2 diabetes, higher levels of abdominal obesity indices (waist circumference, visceral adiposity index, lipid accumulation product, and Chinese visceral adiposity index) are significantly associated with an increased risk of incident cardiovascular events, with CVAI demonstrating the strongest predictive performance.

For people with type 2 diabetes, monitoring waist circumference or using calculated indices like CVAI is more critical for predicting heart disease risk than BMI alone. Reducing abdominal fat deposition is a key intervention strategy, particularly for those who are not overweight by BMI standards but carry visceral fat.

Ectopic fat accumulation in organs such as the heart, liver, and pancreas is a primary driver of cardiometabolic disease and insulin resistance, often posing a higher risk than classical metrics like BMI.

Focus on reducing visceral and ectopic fat through lifestyle changes rather than just tracking weight. Regular exercise and a balanced diet are effective at reducing hepatic and pancreatic fat, which improves metabolic health even if BMI changes slowly.

Low energy availability (LEA), defined as ≤30 kcal/kg LBM/day, acts as a potent disruptor of the endocrine milieu, triggering acute hormonal, metabolic, and physiological dysregulations in both females and males.

To maintain hormonal health, ensure your daily energy intake minus exercise expenditure, divided by your lean body mass, stays above 30 kcal/kg. This is critical for both men and women exercising regularly.

Anti-Müllerian Hormone (AMH) testing can be used as an alternative to ultrasound for diagnosing PCOS in adults, offering a low-cost, convenient option without evidence of overdiagnosis.

If you are an adult being evaluated for PCOS, ask your doctor if Anti-Müllerian Hormone (AMH) blood testing is a suitable alternative to ultrasound. This may be a more convenient and cost-effective diagnostic option with strong supporting evidence.

LCHF diets improve cardiovascular risk profiles by lowering triglycerides, increasing HDL cholesterol, and reducing small dense LDL particles, even if total LDL cholesterol increases in some individuals.

Monitor your full lipid panel, not just LDL. If your LDL rises, check your triglycerides and HDL. LCHF diets typically lower triglycerides and raise HDL, and shift LDL particles to a less harmful size, which may indicate improved heart health despite a higher LDL number.

Soy isoflavone supplementation improves insulin sensitivity and reduces fasting insulin levels in postmenopausal women, particularly those with metabolic syndrome or hyperinsulinemia.

Postmenopausal women, especially those with metabolic syndrome, may benefit from soy isoflavone supplementation (around 54mg/day) to improve insulin sensitivity and lower fasting insulin levels.

Consumption of probiotic yoghurt containing specific strains (L. acidophilus La5 and B. lactis Bb12) improves glycemic control (fasting blood sugar, HbA1c) and lipid profiles in patients with Type 2 Diabetes.

If you have Type 2 Diabetes, incorporating 300g of probiotic yoghurt daily (specifically with L. acidophilus La5 and B. lactis Bb12) may help lower blood sugar and cholesterol levels. Consult your doctor before making dietary changes.

Oat beta-glucan lowers cholesterol by modulating gut microbiota to increase bile salt hydrolase (BSH) activity, which deconjugates bile acids, reduces their reabsorption, and forces the liver to synthesize new bile acids from cholesterol.

Your gut bacteria play a key role in how oat beta-glucan lowers cholesterol. By feeding specific bacteria that produce bile salt hydrolase, oat beta-glucan helps your body excrete more cholesterol. This happens naturally when you eat oats regularly.