Browse the evidence

Hypertension is the most common modifiable risk factor for stroke in women, with a higher lifetime risk and prevalence in postmenopausal women compared to men, necessitating early and sustained treatment.

Monitor your blood pressure regularly, especially after menopause. Since women are more likely to develop hypertension and have a higher lifetime risk of stroke, keeping your blood pressure in a healthy range is the most effective step you can take to prevent stroke.

Increased body mass index (BMI) is strongly associated with a higher risk of developing oesophageal adenocarcinoma, colon and rectal cancer in men, biliary tract system cancer, pancreatic cancer, endometrial cancer (premenopausal), kidney cancer, and multiple myeloma.

Maintaining a healthy body weight is a critical, evidence-based strategy for reducing the risk of several major cancers, including colorectal, pancreatic, kidney, and endometrial cancers. This is not just about aesthetics; it is a direct modifiable risk factor. For men, colorectal risk is particularly sensitive to BMI increases. For women, maintaining a healthy weight, especially before menopause, is crucial for endometrial health. Public health guidelines should target these populations for personalized prevention strategies.

Weight gain in adulthood is strongly associated with an increased risk of postmenopausal breast cancer in women who have never used hormone replacement therapy (HRT).

For postmenopausal women, especially those not using hormone replacement therapy, avoiding weight gain in adulthood is a key strategy for reducing breast cancer risk. Each 5 kg of weight gain is linked to an 11% higher risk. This highlights the importance of long-term weight management, not just immediate weight loss.

Waist-to-hip ratio (WHR) is strongly associated with an increased risk of endometrial cancer.

For endometrial cancer risk, where you carry weight is as important as how much you weigh. A higher waist-to-hip ratio is strongly linked to a 21% increased risk for each 0.1 increase. Focus on reducing central adiposity through diet and exercise, not just overall weight loss.

Metformin is the preferred first-line pharmacological monotherapy for type 2 diabetes, to be continued unless contraindicated.

If lifestyle changes alone don't control your blood sugar, metformin is the standard first medication. It is generally well-tolerated and effective. Take it as prescribed unless you have specific health reasons that prevent its use.

Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon, and phytotherapeutics are not recommended for insomnia treatment.

Avoid using antihistamines, antipsychotics, fast-release melatonin, ramelteon, or herbal supplements for treating insomnia, as they are not recommended by current guidelines.

SGLT-2 inhibitors and GLP-1 receptor agonists reduce all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure in patients with type 2 diabetes, with absolute benefits scaling with baseline cardiovascular and renal risk.

If you have type 2 diabetes, especially with existing heart or kidney risks, adding an SGLT-2 inhibitor or GLP-1 agonist to your current regimen significantly reduces your risk of dying from heart or kidney causes. The higher your baseline risk, the greater the absolute benefit. Discuss these specific drug classes with your doctor to leverage these organ-protective effects.

SGLT-2 inhibitors are superior to GLP-1 receptor agonists for reducing hospital admissions for heart failure, while GLP-1 receptor agonists are superior for reducing non-fatal stroke.

Choose your diabetes drug based on your specific health history, not just blood sugar. If you have heart failure, an SGLT-2 inhibitor offers superior protection. If you have a history of stroke, a GLP-1 agonist is likely the better option. Ask your doctor which class aligns with your specific risks.

Circadian misalignment between endogenous rhythms and exogenous sleep schedules causes Shift Work Disorder (SWD) and Jet Lag Disorder (JLD), characterized by sleep disturbance and impairment.

If you suffer from shift work or jet lag, the root cause is likely a mismatch between your internal body clock and your external schedule. Diagnosis requires documenting this misalignment, often using sleep logs or actigraphy for at least seven days. Treatment focuses on realigning the clock through scheduled sleep, timed light exposure, or melatonin.

Dim Light Melatonin Onset (DLMO) is a more stable and accurate marker of circadian phase than Core Body Temperature (CBT) because it is less susceptible to masking effects.

For accurate diagnosis of circadian disorders, measuring the Dim Light Melatonin Onset (DLMO) is superior to using Core Body Temperature. DLMO is less affected by daily activities and provides a more stable marker of your internal clock's phase, facilitating more precise treatment planning.

Cardiovascular disease (CVD) is the leading cause of death in NAFLD patients, making cardiovascular screening mandatory regardless of traditional risk factors.

If you have NAFLD, prioritize your heart health. Get regular cardiovascular screenings (blood pressure, cholesterol) as strictly as you monitor your liver.

Resmetirom is a recommended pharmacotherapy for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2), demonstrating histological effectiveness on steatohepatitis and fibrosis.

If you have advanced liver scarring (fibrosis stage 2 or higher) but not cirrhosis, ask your doctor about resmetirom, a medication that can improve liver health.

There is no evidence that lifestyle interventions improve live birth, miscarriage rates, or menstrual regularity in women with PCOS.

Current evidence does not show that lifestyle changes improve menstrual regularity or fertility (live birth) in women with PCOS. While weight loss is beneficial, it should not be relied upon to restore regular cycles or ensure pregnancy.

Testosterone therapy is not recommended for healthy women or those with conditions other than hypoactive sexual desire disorder (HSDD) due to lack of defined syndrome, unclear correlation between levels and symptoms, and insufficient long-term safety data.

Do not seek testosterone therapy for general fatigue, low libido, or 'anti-aging' unless you have been specifically diagnosed with HSDD by a specialist. There is no established 'low T syndrome' in women, and treating based on blood levels alone is not supported by evidence and carries unknown long-term risks.

Dehydroepiandrosterone (DHEA) is not recommended for general use in women due to inadequate indications and lack of evidence for efficacy and long-term safety.

Do not use DHEA supplements for general health, bone density, or cognitive enhancement. There is insufficient evidence to support its efficacy or long-term safety in women.

Bariatric surgery induces T2DM remission through mechanisms that are partially independent of weight loss, including early metabolic effects on HbA1c and insulin sensitivity.

Surgery improves blood sugar control rapidly, often before significant weight loss, by changing how the body processes nutrients and hormones. This 'metabolic' effect is a key reason why diabetes can go into remission even if weight loss is slow initially.

Generalized testosterone therapy is not recommended for women due to inadequate indications and a lack of long-term safety data, despite evidence of short-term efficacy in specific subgroups like surgically menopausal women.

Do not use testosterone therapy for general wellness, libido, or energy in women unless you are part of a specific, well-defined clinical trial or have a rare condition like surgical menopause where short-term benefits have been weighed against unknown long-term risks. The current medical consensus is that the risks outweigh the benefits for the general female population due to a lack of safety data.

Diagnosing androgen deficiency in women is currently not recommended because there is no well-defined clinical syndrome or normative data on testosterone levels across the lifespan.

Do not seek a diagnosis of 'low T' or 'androgen deficiency' based on lab tests alone. The medical community currently lacks the normative data and clinical definitions to diagnose this condition in women. Focus on overall health and symptom management rather than chasing a specific hormone number.

Body Mass Index (BMI) is a primary mediator for the protective effect of physical activity on endometrial cancer, as adjusting for BMI eliminates the association, whereas it has limited effect on other cancer types.

For endometrial cancer prevention, maintaining a healthy BMI is likely the most critical factor, as the independent benefit of exercise appears to be mediated by weight. However, for other cancers like colon and breast, exercise provides protection even after accounting for BMI. Do not skip exercise thinking you are 'thin enough' to be safe from all cancers.

Caffeine consumption alters sleep architecture by increasing the duration and proportion of light sleep (N1) and decreasing the duration and proportion of deep sleep (N3/N4).

Even if you don't feel tired, caffeine may be stealing your deep sleep. Expect about 11 minutes less deep sleep and 6 minutes more light sleep per night if you consume caffeine close to bedtime. This reduces the restorative quality of your sleep, contributing to next-day fatigue.

Caffeine increases sleep onset latency by approximately 9 minutes and wake after sleep onset by approximately 12 minutes.

Caffeine makes it harder to fall asleep and stay asleep. Expect to take about 9 minutes longer to fall asleep and spend 12 minutes more awake during the night. This fragmentation reduces overall sleep efficiency by 7%.