Browse the evidence

Pharmacological activation of AMPK by metformin improves insulin sensitivity and reduces the incidence of type 2 diabetes and cardiovascular events.

If you have type 2 diabetes or are at high risk, discuss metformin with your doctor. It is a widely used medication that helps improve insulin sensitivity and may reduce your risk of heart disease and other complications.

Chronic sleep deficiency (defined as inadequate or mistimed sleep) acts as an independent etiological factor for cardiovascular disease, metabolic disorders (obesity, type 2 diabetes), and increased mortality, distinct from primary sleep disorders.

Prioritize getting 7-8 hours of sleep per night as a non-negotiable health pillar, equivalent to diet and exercise. Chronic sleep restriction (<7 hours) independently increases your risk for heart disease, diabetes, obesity, and early death through hormonal and inflammatory pathways. Addressing sleep deficiency is a high-impact, achievable behavior change for public health.

High dietary fiber intake (specifically insoluble cereal fiber and whole grains) is associated with improved insulin sensitivity and a reduced risk of type 2 diabetes, primarily through gut microbiota-mediated mechanisms such as short-chain fatty acid (SCFA) production.

Prioritize insoluble fiber sources like whole grains and vegetables to support insulin sensitivity. While soluble fiber is beneficial, current evidence suggests insoluble fiber from whole grains may be more critical for preventing type 2 diabetes. Aim to increase intake significantly above current Western averages (often 18-24g/day) toward the recommended 30-35g/day for men and 25-32g/day for women.

Liraglutide is associated with the second-highest probability of achieving ≥5% weight loss but carries the highest odds of discontinuation due to adverse events among the studied agents.

Liraglutide is a highly effective daily injection for weight loss, ranking second only to phentermine-topiramate in success rates. However, it has the highest rate of side-effect-related discontinuation, so you must be prepared for potential gastrointestinal issues.

Transdermal testosterone gel (50-100 mg/day) administered to hypogonadal men for 180 days significantly improves sexual function, mood, lean body mass, muscle strength, and reduces fat mass compared to baseline and a permeation-enhanced testosterone patch.

If you are a hypogonadal man, testosterone gel therapy (50-100mg daily) for 6 months can significantly improve your sexual function, mood, muscle strength, and reduce body fat. The gel causes much less skin irritation than patches. Monitor your levels to ensure the dose is correct.

Anti-inflammatory interventions (including omega-3 fatty acids, exercise, and cytokine antagonists) significantly improve mood and reduce depressive symptoms, but only in individuals with pre-existing heightened inflammation (e.g., high CRP or IL-6 levels).

If you have depression, ask your doctor about testing inflammatory markers like CRP or IL-6. If these are high, treatments like omega-3 supplements (specifically EPA), exercise, or anti-inflammatory medications might be more effective for you than standard antidepressants alone. If your inflammation is low, these treatments may not help, and you should focus on other therapeutic strategies.

High dietary intake of fructose (particularly from HFCS) causes insulin resistance and metabolic dyslipidemia by bypassing the phosphofructokinase regulatory step in glycolysis, leading to uncontrolled hepatic de novo lipogenesis and triglyceride synthesis.

Avoid high-fructose corn syrup and excessive added sugars. While fructose doesn't spike blood sugar like glucose, it drives liver fat production and insulin resistance when consumed in large amounts, contributing to metabolic syndrome.

High fructose consumption reduces satiety signaling by lowering leptin and ghrelin responses compared to glucose, leading to increased caloric intake and weight gain.

Be aware that fructose does not make you feel as full as glucose. This can lead to consuming more calories overall, contributing to weight gain.

Chronic high fructose intake reduces adiponectin levels, contributing to insulin resistance and impaired lipid homeostasis.

Maintaining a healthy weight and limiting fructose can help maintain adiponectin levels, supporting insulin sensitivity.

Obstructive sleep apnoea (OSA) is independently associated with an increased prevalence of metabolic syndrome, characterized by higher blood pressure, fasting insulin, triglycerides, and lower HDL cholesterol, even after adjusting for obesity and other covariates.

If you have Obstructive Sleep Apnoea, you are at a significantly higher risk for metabolic syndrome (high blood pressure, insulin resistance, bad cholesterol) regardless of your weight. Treating the sleep apnea (e.g., with CPAP) is likely necessary to mitigate these specific metabolic risks, not just for sleepiness.

Age-related skeletal muscle loss (sarcopenia) is fundamentally driven by 'anabolic resistance,' a blunted muscle protein synthesis response to nutritional and exercise stimuli, compounded by reduced physical activity.

As you age, your muscles become less sensitive to protein and exercise. To maintain muscle, you likely need to consume more protein per meal and engage in resistance training, as your body's natural response to these stimuli is blunted compared to when you were younger.

Fermentation reduces the glycemic index (GI) of fermented foods through the production of organic acids (lactic, acetic, propionic) which suppress starch-hydrolyzing enzymes and delay gastric emptying.

If you are managing blood sugar, consider incorporating fermented grain products like sourdough bread. The organic acids produced during fermentation can help blunt post-meal glucose spikes compared to unfermented breads.

Initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in patients with type 2 diabetes is associated with a significantly lower risk of hospitalization for heart failure and all-cause death compared to other glucose-lowering drugs, representing a class-wide benefit.

For patients with Type 2 Diabetes, starting an SGLT-2 inhibitor (such as canagliflozin, dapagliflozin, or empagliflozin) is associated with a significantly lower risk of heart failure hospitalization and death compared to other common diabetes medications. This benefit appears to apply to the entire class of drugs, not just one specific brand, and extends to patients without established heart disease. Patients should discuss these cardiovascular benefits with their healthcare provider when selecting a treatment plan.

Pre-sleep ingestion of 30–40 g of casein protein increases overnight muscle protein synthesis and metabolic rate without influencing lipolysis.

If you want to support muscle growth overnight, eat 30–40 grams of casein protein (like cottage cheese or a casein shake) right before bed. It boosts muscle repair and metabolism without hindering fat loss.

Exogenous advanced glycation end products (AGEs) from heat-processed foods contribute significantly to systemic AGE accumulation, promoting oxidative stress, inflammation, and insulin resistance in type 2 diabetes.

Limit high-heat cooking methods like grilling, frying, and baking. Opt for moist-heat cooking (steaming, boiling, poaching) to reduce dietary AGE intake, which may help lower systemic inflammation and improve insulin sensitivity in type 2 diabetes.

Prolonging the nightly fasting interval (≥11-13 hours) is associated with reduced odds of elevated HbA1c, lower inflammatory markers, and reduced breast cancer recurrence risk.

Aim for at least 13 hours of fasting between dinner and breakfast. This simple timing strategy is associated with lower inflammation and potentially better long-term health outcomes, including reduced cancer recurrence risk.

Chronic partial sleep restriction (less than 7 hours per night) increases the risk of type 2 diabetes by inducing insulin resistance and impairing glucose tolerance through hormonal and neural mechanisms.

Prioritize getting 7 or more hours of sleep per night. This is not just about feeling rested; it is a critical metabolic lever. Short sleep directly impairs your body's ability to process glucose and manage insulin, significantly increasing your risk for type 2 diabetes and obesity, independent of diet and exercise.

Sleep loss increases the risk of obesity by dysregulating appetite hormones (decreasing leptin, increasing ghrelin) and increasing orexin-driven hunger, leading to higher caloric intake.

If you are sleeping less than 7 hours, your body is biologically wired to want more food. This is driven by lower leptin (satiety hormone) and higher ghrelin (hunger hormone). Recognize this as a biological signal, not a personal failure, and plan your nutrition accordingly.

Sibutramine and rimonabant produce greater weight loss than orlistat but carry distinct adverse effect profiles: sibutramine increases blood pressure and heart rate, while rimonabant increases the risk of mood disorders.

Sibutramine and rimonabant are more effective for weight loss than orlistat but have distinct risks. Sibutramine can raise blood pressure and heart rate, requiring monitoring. Rimonabant can increase the risk of mood disorders, requiring careful psychiatric screening. These risks must be weighed against the greater weight loss benefits.

SSB consumption increases the risk of type 2 diabetes (T2DM) and cardiovascular disease (CVD) independently of, and mediated by, weight gain.

Even if you are not overweight, limiting SSBs is important for preventing type 2 diabetes and heart disease. The sugars in these drinks can negatively affect your metabolism, insulin response, and blood lipids independently of your weight.

Inulin-type fructans reduce blood triglyceride levels, particularly in individuals with hypertriglyceridemia.

If you have high triglycerides, incorporating inulin-type fructans into your diet may help lower them. It is not a primary treatment for high cholesterol.

Testosterone replacement therapy (200 mg i.m. every 2 weeks) improves insulin sensitivity, glycemic control, and reduces visceral adiposity in hypogonadal men with type 2 diabetes.

If you are a man with type 2 diabetes and low testosterone, testosterone replacement therapy (specifically 200mg injections every two weeks) can significantly improve your body's ability to use insulin, lower your blood sugar levels, and reduce belly fat. This may help you manage your diabetes better and potentially reduce your need for insulin, without negatively affecting your blood pressure. Always consult your doctor to determine if you are hypogonadal and if this therapy is safe for you.

The preventive effect of bariatric surgery on type 2 diabetes is significantly influenced by the presence of impaired fasting glucose, but not by baseline BMI.

For obese patients considering surgery, having impaired fasting glucose is a strong indicator that they will benefit from the procedure in terms of diabetes prevention, regardless of their specific BMI.

The minimal model method, derived from a modified frequently sampled intravenous glucose tolerance test (FSIGT) with tolbutamide, yields an insulin sensitivity index (SI) that is equivalent to the euglycemic glucose clamp, the gold standard, in normal and insulin-resistant nondiabetic subjects.

For clinical or research purposes, the minimal model method using a modified FSIGT (glucose + tolbutamide) is a valid, equivalent alternative to the euglycemic glucose clamp for assessing insulin sensitivity in nondiabetic individuals, offering a less labor-intensive and costly option without sacrificing accuracy.