Browse the evidence

Strength training protocols for people with haemophilia are frequently under-reported regarding critical safety and efficacy variables, specifically pain threshold, prophylactic factor coverage, intensity, range of motion, and time under tension.

If you have haemophilia and are doing strength training, ensure your protocol clearly specifies pain limits (like a 0-2/10 scale), how your clotting factor treatment aligns with exercise days, and the exact intensity and range of motion. This transparency is crucial for safety and effectiveness, as current practices often omit these details.

Obesity stigma independently worsens mental and physical health outcomes, increases cortisol and oxidative stress, and promotes weight gain through avoidance of healthcare and unhealthy coping behaviors.

If you have obesity, know that stigma is a major barrier to your health, not a motivator. Avoiding doctors due to fear of judgment often leads to worse health outcomes. Seek providers who use 'people-first' language and focus on your overall well-being rather than just your weight. This reduces stress and improves adherence to treatment.

Implementing patient-centered care and 'people-first' language reduces stigma, improves patient adherence, and enhances therapeutic outcomes in obesity management.

Healthcare providers should use 'people-first' language (e.g., 'patient with obesity' instead of 'obese patient') and focus on the patient's perspective. This builds trust, reduces stigma, and improves the patient's likelihood of adhering to lifestyle, pharmacological, or surgical treatments.

Lowering blood glucose levels reverses glucose toxicity, thereby restoring beta-cell insulin secretion and enabling complete or partial remission of type 2 diabetes.

If you have Type 2 Diabetes, high blood sugar actively suppresses your pancreas's ability to make insulin. This suppression is often reversible. By aggressively lowering your blood glucose levels—through medication, intensive insulin therapy, or dietary changes—you can remove this 'glucose toxicity.' This allows your remaining beta-cells to recover function, potentially leading to remission where you no longer need medication. This is most likely if you have not had diabetes for many years and still have some beta-cell mass left.

Consuming plant-based meat alternatives instead of animal meat reduces dietary acid load, evidenced by lower urinary excretion of sulfate, ammonium, phosphorus, and urea nitrogen, and higher urine pH and citrate levels in healthy adults.

If you are concerned about kidney health or urinary stone risk, switching from animal meat to plant-based meat alternatives (consuming at least 2 servings daily) can help reduce the acid load on your kidneys. This shift lowers harmful urinary acids and increases protective citrate, potentially offering benefits similar to eating more vegetables, without requiring a complete change in taste preferences.

The term 'non-responder' should be restricted to specific organs or physiological functions rather than applied to the whole individual, as exercise-induced adaptation is systemic and a lack of response in one area (e.g., VO2max) does not preclude adaptation in others (e.g., immune function or muscle metabolism).

If you aren't seeing improvements in your main goal (like running faster or lifting heavier), don't assume exercise isn't working for you. Your body is likely adapting in other ways, such as improved immune function, better blood flow, or metabolic health. The 'right' exercise for you might be different from what you are currently doing, so consider adjusting the type or intensity of your training rather than stopping.

In type 2 diabetes patients initiating insulin therapy, pre-insulin weight loss combined with rising or persistently high HbA1c is the strongest predictor of excessive post-initiation weight gain (≥5 kg).

If you are starting insulin and have lost weight recently while your blood sugar numbers were going up, expect to regain that weight. This is likely 'catch-up' weight as your body stops losing sugar through urine. It is a sign the insulin is working to correct your metabolism, not necessarily a failure of your diet. Monitor your weight, but do not let fear of this specific type of gain prevent you from starting life-saving therapy.

Consumption of 5g/day of the human milk oligosaccharide 2'-fucosyllactose (2'-FL) for 6 weeks significantly increases the relative abundance of Bifidobacterium in the gut microbiota of healthy older adults.

For older adults looking to support gut health, consuming 5g of 2'-FL daily for 6 weeks is a well-tolerated intervention that significantly increases beneficial Bifidobacterium levels. While it did not change the primary immune score, it did increase HDL cholesterol and fasting insulin. Users should expect this effect to be reversible upon stopping supplementation.

High-dose 2'-FL supplementation (5g/day) in older adults significantly increases serum levels of Fibroblast Growth Factor 21 (FGF21) and HDL cholesterol, while depleting octanoylcarnitine.

Older adults taking 5g of 2'-FL daily may see improvements in HDL cholesterol and levels of the hormone FGF21, which regulates lipid metabolism. These changes are associated with the bloom of Bifidobacterium in the gut. The intervention is well-tolerated.

Addressing mental health issues, particularly depression and anxiety, through screening and intervention improves glycemic control in patients with Type 2 Diabetes.

If you are struggling with depression or anxiety, talk to your healthcare provider. Treating mental health issues can help you manage your diabetes better and improve your blood sugar levels. Pharmacists can help screen for these issues and refer you to appropriate resources.

Low serum creatinine levels in early pregnancy (10-14 weeks) are associated with a significantly higher incidence of postpartum abnormal glucose metabolism (AGM) in women with a history of gestational diabetes mellitus (GDM).

If you have a history of gestational diabetes, your early pregnancy creatinine level may predict your risk of developing persistent blood sugar issues after birth. Since creatinine reflects muscle mass, and muscle is key for processing glucose, maintaining or building muscle mass through resistance training and adequate protein intake before and during pregnancy may help mitigate this risk. Discuss your creatinine levels with your endocrinologist or obstetrician as part of your GDM management plan.

In individuals with type 2 diabetes who do not carry the haptoglobin (Hp) 2-2 phenotype, maintaining an HbA1c level below 6.5% is associated with a significantly lower risk of coronary artery disease compared to maintaining levels between 7.0% and 7.9%.

If you have type 2 diabetes and do not have the haptoglobin 2-2 genetic variant, aiming for an HbA1c below 6.5% may offer better protection against heart disease than aiming for 7.0-7.9%. This suggests that personalized glycemic targets based on genetic factors could optimize cardiovascular health.

In clinical settings such as hospitals and long-term care, highly processed foods (HPF) are necessary to prevent malnutrition, support recovery, and improve quality of life for residents with poor appetite, chewing, or swallowing difficulties.

In clinical settings, prioritize caloric and nutrient density over strict avoidance of processed foods. Use HPF to help patients with poor appetite or swallowing difficulties meet their nutritional needs and prevent malnutrition, while carefully selecting products to manage sodium content.

Avoiding all highly processed foods (HPF) can lead to unintended nutritional deficiencies, such as inadequate fiber and folic acid, because many healthy foods like whole grain bread and ready-to-eat cereals are classified as HPF.

Do not avoid all processed foods. Include whole grain bread, ready-to-eat cereals, and yogurt in your diet, as they provide essential nutrients like fiber and folic acid. Focus on choosing processed foods low in sodium, saturated fat, and added sugars.

Integrase Strand Transfer Inhibitors (INSTIs), specifically Dolutegravir (DTG) and Bictegravir (BIC), are associated with significant weight gain compared to older antiretrovirals like Efavirenz (EFV) or Protease Inhibitors.

If you are starting HIV treatment, ask your doctor about INSTIs (like Dolutegravir). They are effective but may cause weight gain, especially in women and Black individuals. If weight gain is a major concern, discuss alternatives like TDF-based regimens or older agents like Efavirenz, though these may have other side effects.

The fixed-dose extended-release combination of naltrexone and bupropion (NB-ER) is the most promising pharmacotherapy for facilitating smoking cessation while preventing post-cessation weight gain in individuals with obesity.

If you smoke and have obesity, your fear of gaining weight after quitting is valid and common. Standard cessation drugs often fail to stop this weight gain. Ask your doctor about NB-ER (naltrexone/bupropion extended-release), which targets the brain pathways for both addiction and hunger, offering the best chance to quit smoking without the associated weight gain.

In overweight/obese individuals with type 2 diabetes free from complications, peak oxygen consumption (VO2peak) is impaired due to reduced skeletal muscle oxygenation and blood volume during exercise, despite normal pulmonary function and arterial oxygen transport.

If you have Type 2 Diabetes without complications, your reduced exercise stamina is likely not due to lung problems but rather how your muscles handle blood flow and oxygen during intense effort. To improve your fitness, focus on exercise programs that enhance skeletal muscle perfusion and blood flow, such as combining aerobic exercise with resistance training, rather than focusing on respiratory mechanics.

Obesity increases cardiovascular risk and mortality primarily through visceral adiposity and ectopic fat deposition (pericardial/epicardial), which drive endothelial dysfunction, chronic inflammation, and atherosclerosis, independent of or additive to traditional risk factors like BMI, blood pressure, and cholesterol.

Focus on reducing visceral and ectopic fat, not just total weight. Measures like waist circumference are more predictive of heart disease risk than BMI. Lifestyle interventions, particularly aerobic exercise, can reduce visceral adipose tissue even without significant weight loss, thereby lowering cardiovascular risk.

The updated CG189 NICE guidelines recommend self-measurement of waist-to-height ratio (target ≥0.5) for adults with BMI <35 kg/m2 to assess abdominal fat and health risk, shifting focus from BMI alone.

If your BMI is under 35, measure your waist and divide it by your height. If the number is 0.5 or higher, you have increased health risk from abdominal fat. Share this number with your doctor to discuss next steps, rather than relying on BMI alone.

Societal stigma surrounding obesity negatively impacts psychological, physical, and socioeconomic health, and hinders engagement with obesity services.

Recognize that societal stigma is a major barrier to your health. Healthcare providers are encouraged to approach these topics sensitively and with your permission. You deserve compassionate care regardless of your weight.

Ethnicity-specific BMI cut-offs are required for accurate diagnosis and management of obesity-related risks, particularly for South Asian populations.

If you are of South Asian descent, be aware that your risk for Type 2 Diabetes increases at a lower BMI (around 23.9 kg/m2) compared to the standard 30 kg/m2. Discuss ethnicity-specific risk assessments with your healthcare provider.

Increasing lean body mass (LBM) below 52.26 kg is negatively associated with the risk of osteoarthritis, suggesting a protective effect, whereas increasing LBM above this threshold provides no statistically significant additional benefit.

If you have low muscle mass, building it up to around 52 kg (for women, likely higher for men depending on height/build, but the study uses absolute kg) can significantly lower your risk of developing osteoarthritis. Once you have a substantial amount of lean mass, adding more muscle won't necessarily protect your joints further, but maintaining it is still important for overall health. Focus on resistance training to build muscle if you are currently lean.

Higher levels of moderate and moderate-vigorous physical activity are associated with accelerated thickening rates of the ganglion cell-inner plexiform layer (GCIPL) and macular thickness (MT) across the full course of diabetic retinopathy, suggesting a neuroprotective structural benefit.

Regular exercise helps preserve the physical structure of your retina. Studies show that higher activity levels are linked to better maintenance of retinal layer thickness, which is crucial for preventing vision loss in diabetes. This structural benefit works alongside the risk reduction from morning exercise timing.

Body Mass Index (BMI) partially mediates the protective effect of physical activity on diabetic retinopathy, accounting for 35.7% to 58.7% of the total benefit, indicating that weight loss is a significant but not exclusive mechanism.

Exercise protects your eyes through two main paths: helping you lose weight (which accounts for about half the benefit) and improving your metabolism directly (the other half). Even if you struggle to lose weight, staying active still provides significant protection against diabetic eye disease through improved blood sugar and reduced inflammation.