Browse the evidence

Implementing a ketogenic diet (KD) with very-low carbohydrate intake (<50 g/day) significantly reduces fasting insulin levels and promotes substantial weight loss in patients with obesity and insulin resistance who have experienced weight regain after Roux-en-Y gastric bypass surgery.

If you have had weight loss surgery and are regaining weight, or if you are obese with high insulin but normal blood sugar, standard 'calorie counting' may not be enough. Consider a ketogenic diet (very low carb, high healthy fat) under medical supervision to lower insulin levels, which may help shift your body from storing fat to burning it, potentially leading to significant weight loss and reduced inflammation.

Tirzepatide, a dual GIP/GLP-1 receptor agonist, produces dose-dependent weight loss (up to 20.9% with 15 mg weekly dose) and is recommended for patients targeting 15-20% weight loss.

If you need to lose a significant amount of weight (15-20%), ask your doctor about tirzepatide. It is a once-weekly injection that works by mimicking two gut hormones (GIP and GLP-1). Start at a low dose to minimize side effects, and gradually increase it over several months to find the right dose for you. It is more potent than older GLP-1 drugs.

CagriSema (semaglutide + cagrilintide) produces superior weight loss (22.7% at 68 weeks) compared to semaglutide 2.4 mg alone (16.1%) or cagrilintide alone (11.8%).

If you have obesity and need maximum weight loss, ask your doctor about CagriSema. It combines two hormones (GLP-1 and amylin) into one weekly injection. Clinical trials show it can help you lose nearly 23% of your body weight, which is more than semaglutide or tirzepatide alone. It is currently in Phase 3 trials.

Treatment with glucagon-like peptide-1 receptor (GLP-1R) agonists (exenatide or liraglutide) at clinically relevant doses for at least 20 weeks results in significant weight loss in overweight or obese patients, regardless of type 2 diabetes status.

If you are overweight or obese, GLP-1R agonists like exenatide or liraglutide are proven to help you lose weight, even if you don't have diabetes. You take them by injection (daily or weekly), and while you might feel nauseous at first, this usually passes. The average weight loss is around 3 kg, which is clinically significant. Talk to your doctor about whether these are right for you.

Regular physical activity, including both aerobic and resistance training, improves blood glucose control and insulin action in individuals with type 2 diabetes, with benefits lasting 2-72 hours post-exercise.

Aim for at least 150 minutes of moderate-to-vigorous aerobic exercise per week, spread over at least 3 days, with no more than 2 consecutive days of inactivity. Add resistance training 2-3 days per week. If you take insulin or certain medications, monitor your blood glucose and consult your doctor to adjust medication or carbohydrate intake to prevent hypoglycemia.

Resistance training performed three times per week significantly improves glycemic control (HbA1c) in older adults with type 2 diabetes, comparable to aerobic exercise.

Add resistance training to your routine three days a week. Focus on major muscle groups, doing 3 sets of 8-10 reps with a weight that feels challenging but manageable. This significantly lowers blood sugar and is safe even if you have heart disease risk factors. Start with supervision to ensure proper form.

Blood pressure targets for most nonpregnant adults with T2DM should be <130/80 mmHg, with stricter targets (<1.8 mmol/L LDL-C) for those with atherosclerotic cardiovascular disease.

Manage your blood pressure to below 130/80 mmHg. If you have heart disease, aim for even lower LDL cholesterol (<1.8 mmol/L). This integrated control is crucial for preventing heart and stroke complications.

Benzodiazepines, benzodiazepine receptor agonists, and daridorexant are recommended for short-term treatment of insomnia (≤ 4 weeks), while orexin receptor antagonists may be used for up to 3 months or longer in some cases.

If CBT-I doesn't work well enough, your doctor may prescribe short-term sleep medication (like benzodiazepines or daridorexant) for up to 4 weeks. Do not exceed this duration without medical advice due to tolerance and dependence risks. Orexin antagonists may be used for up to 3 months in some cases.

Regular physical activity, specifically at least 150 minutes per week of moderate-to-vigorous aerobic exercise combined with resistance training, improves blood glucose control and insulin action in individuals with type 2 diabetes.

To manage type 2 diabetes, aim for at least 150 minutes of moderate-to-vigorous aerobic exercise (like brisk walking) per week, spread across at least 3 days, ensuring no more than 2 days pass without activity. Add resistance training (weights or bands) 2-3 days a week. If you take insulin or certain diabetes medications, monitor your blood sugar and consult your doctor about adjusting your dose or eating carbs before/during exercise to prevent lows. If you are sedentary, get a check-up before starting intense exercise.

Timed melatonin administration is indicated to reduce symptoms of jet lag disorder and improve sleep following travel across multiple time zones, with immediate-release formulations in doses of 0.5 to 5 mg showing efficacy.

Take 0.5 to 5 mg of immediate-release melatonin daily. Start up to 3 days before your flight and continue for up to 5 days after arriving at your destination. This helps reset your body clock and improves sleep quality during travel.

Incretin-based therapies (e.g., semaglutide, tirzepatide) are advised for the optimal management of comorbidities like type 2 diabetes or obesity in adults with MASLD.

If you have type 2 diabetes or obesity, talk to your doctor about incretin-based therapies like semaglutide or tirzepatide, which can help manage these conditions and may benefit your liver.

Caffeine consumption reduces total sleep time by an average of 45 minutes and decreases sleep efficiency by 7%, with the magnitude of sleep loss increasing as the dose increases and the time of consumption approaches bedtime.

To protect your sleep, treat caffeine like a timed medication. If you drink a standard cup of coffee (approx. 107mg), stop consuming it at least 8.8 hours before you plan to sleep. If you consume a high-dose pre-workout supplement (approx. 217.5mg), you must stop at least 13.2 hours before bedtime. Consuming caffeine closer to bedtime will significantly reduce your total sleep time and efficiency, regardless of your habitual intake.

Subcutaneous semaglutide and SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin) produce the greatest reductions in body weight and systolic blood pressure in patients with type 2 diabetes compared to other glucose-lowering medications.

For patients with type 2 diabetes seeking to lose weight and lower blood pressure, subcutaneous semaglutide and SGLT-2 inhibitors (like empagliflozin or canagliflozin) are the most effective pharmacological options. These drugs offer sustainable benefits over long-term treatment (>= 1 year) and may reduce the need for separate antihypertensive or lipid-lowering medications.

SGLT-2 inhibitors and GLP-1 RAs provide sustainable reductions in body weight and systolic blood pressure for over 52 weeks of treatment, unlike some other agents where effects may diminish.

For long-term management of type 2 diabetes, GLP-1 RAs and SGLT-2 inhibitors are preferred because their benefits on weight and blood pressure are sustained over a year or more. This makes them suitable for patients who need durable control without the weight gain associated with other medications like insulin or sulphonylureas.

For patients with type 2 diabetes and established cardiovascular disease, a combination of metformin and a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefits is recommended.

If you have Type 2 Diabetes and existing heart disease, your doctor should prioritize a treatment plan that includes Metformin plus a GLP-1 receptor agonist known to protect the heart. This combination is recommended over other options to reduce the risk of major cardiovascular events like heart attack or stroke.

For patients with Type 2 Diabetes and chronic kidney disease (CKD) or heart failure (HF), a sodium-glucose transporter protein-2 (SGLT-2) inhibitor with proven cardiovascular benefit is advised.

If you have Type 2 Diabetes along with kidney disease or heart failure, ask your doctor about SGLT-2 inhibitors. These medications are specifically advised because they have proven benefits for protecting your heart and kidneys.

Tirzepatide use, particularly with unsupervised dose escalation and caloric restriction, can cause euglycemic ketoacidosis (EKA) in non-diabetic patients.

If you are using tirzepatide, do not self-prescribe or self-escalate doses. Monitor for signs of metabolic acidosis (nausea, vomiting, abdominal pain, fatigue) especially if you are eating very little. Seek immediate medical attention if these symptoms occur, as they can signal euglycemic ketoacidosis, a rare but serious condition.

Tirzepatide treatment in premenopausal women with obesity is hypothesized to increase brown adipose tissue (BAT) volume and activity and induce white adipose tissue (WAT) browning, potentially mitigating the decline in resting energy expenditure typically associated with weight loss.

This paper outlines a clinical trial design, not a consumer guide. It hypothesizes that tirzepatide may help maintain metabolic rate during weight loss by activating brown fat and turning white fat 'beige'. The protocol involves weekly injections starting at a low dose and slowly increasing over 24 weeks, with close monitoring for side effects. No results are available yet.

Semaglutide increases the risk of adverse events, serious adverse events, and discontinuation due to adverse events compared to placebo, primarily driven by gastrointestinal reactions (nausea, diarrhea).

Be aware that semaglutide increases the risk of gastrointestinal side effects like nausea and diarrhea, which can lead to stopping the medication. These side effects are usually temporary and mild to moderate. The risk of discontinuation is higher than with a placebo, so monitoring and managing these symptoms is important for long-term success.

Low-intensity aerobic exercise with Blood Flow Restriction (aBFR) affects metabolic parameters differently than control, though specific hormonal outcomes like IGF-1 secretion are not detailed in the abstract.

This study aims to examine metabolic effects of aBFR during aerobic exercise, but results are not available in this abstract. No actionable advice can be derived.

All GLP-1 analogs and agonists are associated with a higher risk of discontinuation due to adverse events compared to placebo, with taspoglutide and high-dose liraglutide having the highest risk.

Be prepared for a higher likelihood of side effects, particularly nausea and vomiting, when starting any GLP-1 medication. This may lead to discontinuation, especially with taspoglutide and high-dose liraglutide. Discuss side effect management strategies with your provider.

Semaglutide, a long-acting GLP-1 receptor agonist, is hypothesized to reduce arterial stiffness (measured by carotid-femoral pulse wave velocity) and improve cardiometabolic markers in adults with type 1 diabetes.

This paper describes a planned clinical trial, not a finished treatment guideline. It suggests that semaglutide might help people with Type 1 Diabetes who are overweight and have heart risk factors by improving blood vessel stiffness. Patients should discuss this emerging research with their endocrinologist, as the results are not yet available.

Long-term use of semaglutide (GLP-1 RA) may be associated with the development of exocrine pancreatic insufficiency, particularly in patients with concurrent chronic alcohol consumption.

If you are taking semaglutide or similar GLP-1 medications, be aware of potential pancreatic issues, especially if you drink alcohol. Report symptoms like fatty stools (steatorrhea) or abdominal pain immediately. Your doctor should monitor your lipase levels regularly.

SGLT2 inhibitors and GLP-1 receptor agonists provide multi-organ cardiorenal protection beyond glycemic control, with selection prioritized by phenotype (e.g., SGLT2i for heart failure/CKD, GLP-1RA for ASCVD/obesity).

If you have heart, kidney, or metabolic issues, ask your doctor about SGLT2 inhibitors or GLP-1 agonists. These drugs protect your heart and kidneys, not just your blood sugar. Your doctor might even be able to lower your doses of other blood pressure or diabetes pills, reducing your risk of side effects like low blood sugar or dizziness.