Browse the evidence

Consistent use of metformin (≥50% of assessments) is independently associated with slower progression of the frailty index in adults with type 2 diabetes, after adjusting for HbA1c and weight loss.

Taking metformin consistently is linked to slower physical decline in people with type 2 diabetes, even after accounting for weight loss and blood sugar levels. Discuss with your doctor if metformin is the right long-term strategy for you.

A lower n-6 to n-3 PUFA ratio (e.g., 5:1) shifts eicosanoid production toward anti-inflammatory mediators (resolvins, protectins), reducing cardiovascular disease risk, whereas the Western diet's high n-6/n-3 ratio promotes inflammation and atherosclerosis.

To reduce cardiovascular risk, aim to lower your intake of omega-6 fatty acids (common in vegetable oils) relative to omega-3s (from fish or algae). A ratio closer to 5:1 or lower is associated with less inflammation and lower CVD risk compared to the typical Western diet ratio.

Modulating the gut microbiome and its metabolites through diet, pharmaceuticals (e.g., GLP-1 agonists, SGLT2 inhibitors), or microbiota therapies (e.g., probiotics, FMT) improves glycemic control and ameliorates Type 2 Diabetes complications by influencing pancreatic islet function, hepatic metabolism, and systemic inflammation.

To leverage the gut-diabetes connection, prioritize high-fiber diets to boost beneficial bacteria that produce short-chain fatty acids (SCFAs) and GLP-1. If lifestyle changes are insufficient, discuss GLP-1 receptor agonists (like semaglutide) or dual agonists (like tirzepatide) with your doctor, as these medications directly exploit the gut-pancreas axis to lower blood sugar and promote weight loss. Probiotics (specifically strains like Akkermansia muciniphila) may offer modest additional benefits, but they are not a replacement for core therapies.

Targeted pharmacotherapy with MC4R agonists (specifically setmelanotide) is efficacious and safe for reducing body weight and hunger in patients with specific genetic causes of obesity, including POMC deficiency, LEPR deficiency, and Bardet-Biedl syndrome (BBS).

If you have been diagnosed with a specific genetic form of obesity (like POMC, LEPR, or BBS deficiency), ask your doctor about setmelanotide. This targeted drug has shown significant weight loss and hunger reduction in clinical trials for your specific genetic profile, unlike standard diets.

Tirzepatide utilization has rapidly displaced other glucose- and weight-lowering medications in the US, with its uptake being steeper and more sustained than previous GLP-1 receptor agonists.

Tirzepatide is currently the fastest-growing and most prescribed glucose- and weight-lowering medication in the US, rapidly replacing older drugs like metformin and other GLP-1s. If you have T2D or obesity, this drug is becoming the standard of care, but access may be difficult due to shortages. Prioritize securing a prescription early if eligible.

Retatrutide, a triple agonist of GLP-1, GIP, and glucagon receptors, achieves up to 24.2% weight loss over 48 weeks.

Retatrutide is an investigational once-weekly injection that targets GLP-1, GIP, and glucagon receptors, achieving up to 24.2% weight loss over 48 weeks in clinical trials. It is not yet fully approved but shows promise for obesity and type 2 diabetes. Potential side effects include gastrointestinal issues and transient heart rate elevations.

GLP-1 Receptor Agonists (GLP-1RAs) improve glycemic control and promote weight loss by enhancing glucose-dependent insulin secretion, inhibiting glucagon, slowing gastric emptying, and reducing appetite via central nervous system pathways.

GLP-1RAs help control blood sugar and promote weight loss by mimicking a gut hormone that tells your body to release insulin when needed, slows down digestion, and reduces appetite. They are generally safe regarding low blood sugar but can cause stomach issues initially. Consistent use and monitoring are key to managing side effects and achieving long-term health benefits.

GLP-1 receptor agonists and SGLT2 inhibitors are effective pharmacological treatments for T2DM and obesity that target shared pathophysiological mechanisms like inflammation and insulin resistance.

If lifestyle changes are insufficient, ask your doctor about GLP-1 agonists or SGLT2 inhibitors. These drugs help manage blood sugar and weight by targeting hormonal pathways, offering an advantage over older medications that may cause weight gain.

GLP-1 receptor agonists (GLP-1RAs) improve hepatic steatosis, liver dysfunction enzymes, and glycemic control in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH).

If you have fatty liver disease (MASLD/MASH), especially with diabetes or obesity, GLP-1 medications (like Semaglutide or Liraglutide) are a proven treatment option. They not only help lower blood sugar and promote weight loss but also directly improve liver health by reducing fat and inflammation. While lifestyle changes are foundational, these medications offer a powerful tool when lifestyle changes alone are insufficient or hard to maintain long-term. Consult your doctor to see if a GLP-1 RA is appropriate for your specific liver condition.

Pioglitazone (30-45 mg) improves hepatic steatosis and inflammation in MASH patients, particularly those with type 2 diabetes, but carries risks of weight gain and bone fractures.

Pioglitazone (30-45mg) improves liver inflammation and fat in MASH, especially for diabetics. However, it causes weight gain and increases fracture risk, so it is used cautiously.

Semolina pasta has a low to medium glycemic index (33-61) due to its dense protein-starch matrix, resulting in slower digestion and lower postprandial glucose response compared to bread or potatoes.

Cook pasta al dente to maintain its low glycemic index. This slows digestion and prevents sharp blood sugar spikes, making it a suitable option for people with diabetes or those managing insulin resistance.

Women with type 2 diabetes have significantly higher cardiovascular risk factor levels (specifically LDL-c and total cholesterol) and lower achievement of treatment targets compared to men, despite receiving equal or higher rates of pharmacological intervention (statins).

If you are a woman with Type 2 Diabetes, your cardiovascular risk profile (specifically cholesterol) is biologically higher than men's, even if you take the same medications. Do not assume that being prescribed a statin means your LDL is at target. You likely need more aggressive monitoring and potentially higher doses or additional therapies to reach the same LDL targets as men. Ask your doctor specifically about your LDL levels, not just whether you are on medication.

A 6-week low-carbohydrate diet (10% carbohydrate) improves microvascular endothelial function (via increased nitric oxide contribution) in women with obesity, regardless of whether caloric restriction is applied.

If you are a woman with obesity, switching to a low-carbohydrate diet (around 10% of calories from carbs) for 6 weeks may improve the health of your small blood vessels (microvasculature) by increasing nitric oxide availability. This benefit happens whether or not you restrict your total calories and lose weight. However, this short-term change did not improve large artery (macrovascular) function. Focus on the quality of carbs and fats rather than just calorie counting for vascular health.

GLP-1 receptor agonists should be discontinued immediately upon confirmation of pregnancy due to the lack of approved safety data, despite current evidence not showing teratogenicity.

Stop taking your GLP-1 medication as soon as you get a positive pregnancy test. Your doctor will likely switch you to insulin or diet management to keep your blood sugar stable, which is the standard of care for diabetes in pregnancy.

Treatment with second-generation antipsychotics (SGAs) significantly increases hunger and appetite, with an odds ratio of 1.51 for appetite increase compared to controls.

If you are taking second-generation antipsychotics (like olanzapine, clozapine, or risperidone), expect an increase in hunger and appetite. This is a known biological side effect linked to how the drug interacts with brain receptors, not a lack of willpower. Discuss this with your prescriber; they may monitor your diet or adjust medication to manage this increased drive to eat.

Discontinuation of anti-obesity medications leads to significant weight regain (approx. 6.9% of lost weight) and return of hunger, indicating AOMs are for chronic management, not short-term fixes.

Do not view these medications as a 6-month fix. They are chronic treatments. If you stop, your biology will push you to regain weight. Plan for long-term use or have a robust maintenance strategy if you must stop, understanding the high risk of regain.

Semaglutide, a GLP-1 receptor agonist, significantly reduces hepatic steatosis, inflammation, and liver stiffness in patients with MAFLD, although its effect on reducing fibrosis stage remains uncertain.

Semaglutide, used for diabetes and obesity, has been shown to significantly reduce liver fat and inflammation in MAFLD patients. However, its ability to reverse liver scarring (fibrosis) is not yet clear. It is available in both injection and oral forms.

SGLT2 inhibitors (flozins) such as dapagliflozin and empagliflozin show promise in reducing liver steatosis and inflammation in MAFLD patients, with several Phase 3 and 4 trials ongoing.

SGLT2 inhibitors like dapagliflozin and empagliflozin are oral diabetes drugs that are being studied for MAFLD. They help reduce liver fat and inflammation, and may also help with weight loss. They are not yet approved specifically for MASH, but trials are ongoing.

Therapeutic reduction of central adiposity via bariatric surgery or incretin-based drugs significantly reduces the risk of heart failure hospitalizations and worsening heart failure events in patients with HFpEF, whereas blood pressure lowering alone yields only modest benefits unrelated to the magnitude of BP reduction.

For HFpEF patients, focusing solely on blood pressure medication is insufficient. Prioritizing significant weight loss through bariatric surgery or incretin-based medications (like semaglutide or tirzepatide) is critical, as these interventions directly reduce the hormonal and mechanical drivers of heart failure, leading to a 50-60% reduction in worsening heart failure events.

Central adiposity (measured by waist-to-height ratio) is a stronger predictor of HFpEF development and severity than systemic hypertension, and adiposity drives hypertension rather than vice versa.

HFpEF patients should prioritize weight loss and visceral fat reduction over aggressive blood pressure targeting alone, as adiposity is the primary driver of the disease process and arterial stiffness.

Metformin is the most effective pharmacological intervention for preventing type 2 diabetes in prediabetic patients, significantly reducing diabetes incidence and improving glucose tolerance compared to lifestyle interventions alone.

If you have prediabetes, metformin is a highly effective, safe, and well-tolerated medication recommended by the American Diabetes Association to prevent diabetes. Start with a low dose (500 mg) to minimize gastrointestinal side effects like diarrhea, and work up to 1000 mg twice daily. Monitor Vitamin B12 levels if taking it long-term. It is particularly useful if you find sustaining strict lifestyle changes difficult.

SGLT2 inhibitors reduce blood glucose and body weight in prediabetic patients by increasing urinary glucose excretion, effectively delaying diabetes development.

SGLT2 inhibitors (like dapagliflozin) lower blood sugar by excreting glucose in urine. They help with weight loss and delay diabetes. Side effects include increased risk of genital yeast infections and ketoacidosis. Monitor kidney function.

Activation of brown adipose tissue (BAT) thermogenesis via sympathetic nervous system signaling increases whole-body energy expenditure and improves metabolic profiles, including lower fasting glucose and reduced visceral adiposity.

You can support your metabolic health by staying active and maintaining a healthy weight. While cold exposure might activate brown fat, it is not a magic bullet for weight loss. Focus on sustainable lifestyle habits that support your body's natural energy regulation systems.

GLP-1 receptor agonists reduce systolic blood pressure by 2–5 mmHg and diastolic blood pressure by 1–3 mmHg, with effects more pronounced than DPP-4 inhibitors.

GLP-1 receptor agonists offer a modest blood pressure benefit (2-5 mmHg systolic) in addition to weight loss. This is a secondary benefit, not a replacement for dedicated antihypertensive therapy if needed.