Browse the evidence

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.

In older adults with overweight/obesity and type 2 diabetes, losing weight while simultaneously gaining skeletal muscle mass significantly reduces the risk of adverse cardiovascular events compared to weight gain or weight loss accompanied by muscle loss.

For older adults with excess weight and diabetes, simply losing weight on the scale is not enough to protect the heart. You must preserve or build muscle during weight loss. This likely requires resistance exercise combined with adequate protein intake, rather than dieting alone. Losing weight while losing muscle provides no cardiovascular benefit compared to gaining weight.

Among individuals who lose weight, a higher ratio of skeletal muscle mass loss to total weight loss (SMMC/WC) is associated with a significantly increased risk of cardiovascular events, with risk doubling when muscle loss accounts for approximately 50% of weight loss.

If you are losing weight, monitor how much of that loss is muscle. If you lose muscle equal to half your total weight loss, your cardiovascular risk effectively doubles compared to someone who preserves muscle. To mitigate this, prioritize resistance training and protein intake during caloric restriction.

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.

Dietary iodine intake is primarily derived from dairy products in Canadian adults, and public health policies promoting salt restriction and reduced dairy consumption may inadvertently increase the risk of iodine deficiency.

If you are following a low-sodium diet for blood pressure, be aware that you might be consuming less iodine. Dairy products are a major source of iodine in the Canadian diet. Ensure you are getting enough iodine through other sources like fish, eggs, or supplements if you significantly cut back on dairy and salted foods.

Regional variations in iodine status exist in Canada, with residents of Quebec City and Vancouver having significantly lower iodine status compared to those in Hamilton and Ottawa, driven by differences in dietary habits and environmental exposure to inhibitors.

Where you live affects your iodine status. People in Quebec City and Vancouver were found to have lower iodine levels than those in Hamilton and Ottawa. This is likely due to local dietary differences (less dairy/bread) and higher exposure to inhibitors like smoking. Check your local food sources.

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.

Patients treated with SGAs show higher cravings for fat and carbohydrates compared to other food types, and exhibit small increases in dietary disinhibition and restrained eating.

SGA treatment is associated with increased cravings for fats and carbohydrates, as well as higher dietary disinhibition (loss of control over eating) and restrained eating (strict dieting). This combination can make weight management difficult. Focus on managing cravings and avoiding extreme restriction, which may backfire, by working with a dietitian to create a sustainable eating plan.

One-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) result in significantly greater reductions in areal bone mineral density (aBMD) at the total hip, femoral neck, and lumbar spine compared to sleeve gastrectomy (SG) within the first year post-surgery.

If you are considering bariatric surgery, know that bypass procedures (OAGB and RYGB) lead to greater bone density loss at the hip and spine than sleeve gastrecty (SG) in the first year. This is likely due to malabsorption of calcium and vitamin D. You should discuss bone health monitoring and supplementation strategies with your surgeon, especially if you choose a bypass procedure.

Despite significant losses in absolute muscle strength and lean mass, relative muscle strength (strength per unit of body weight or lean mass) and physical function (sit-to-stand time, 6-minute walk distance) improve significantly within one year of metabolic/bariatric surgery, regardless of the specific surgical procedure.

You will lose some muscle mass and absolute strength after surgery, which is normal. However, because you are losing a lot of body weight, your relative strength (strength for your body size) and physical function (walking, standing up) will likely improve. Focus on maintaining muscle through protein intake and light activity rather than fearing the inevitable loss.

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.

Achieving optimal levels of waist circumference, glomerular filtration rate, and urine albumin-to-creatinine ratio (each weighted 2 points) and glycated hemoglobin/blood pressure (each weighted 1 point) is significantly associated with a lower risk of heart failure in type 2 diabetes.

For individuals with Type 2 Diabetes, managing heart failure risk requires a multi-faceted approach. Prioritize achieving target levels for waist circumference, kidney function (GFR and urine albumin), blood pressure, and blood sugar. The study suggests that controlling waist circumference and kidney markers may offer greater protection against heart failure than controlling blood pressure or blood sugar alone.

Longitudinal improvement in the cardiometabolic health score is significantly associated with a lower risk of heart failure.

If you have Type 2 Diabetes, working to improve your cardiometabolic health over time—such as reducing waist circumference, improving kidney markers, or better controlling blood pressure and blood sugar—can significantly lower your risk of developing heart failure, even if you started with a lower health score.

In older Asian populations, a vegetable-based low-carbohydrate diet (high unsaturated fat/plant protein, low refined carbs) is associated with increased all-cause and cardiovascular disease (CVD) mortality, whereas a meat-based low-carbohydrate diet (high saturated fat/animal protein, refined carbs) is associated with decreased mortality.

For older adults in Asian populations, simply reducing carbohydrates is not enough; the source of the remaining calories is critical. A 'vegetable-based' low-carb diet (emphasizing unsaturated fats and plant proteins while reducing refined carbs) was linked to higher mortality. Conversely, a 'meat-based' low-carb diet (emphasizing animal proteins and saturated fats) was linked to lower mortality. This suggests that for this demographic, replacing refined carbs with animal products may be beneficial, whereas replacing them with plant oils and proteins might not be, potentially due to cooking methods (high-heat frying of plant oils) or specific nutrient profiles.

Iso-caloric substitution of 3% of total energy from animal protein for saturated fat, mono-unsaturated fat, or carbohydrates is associated with a statistically significant increase in all-cause and cardiovascular mortality.

If you are replacing 3% of your daily calories with animal protein (e.g., by eating more meat or dairy) and reducing fats or carbs, this study suggests your risk of dying from heart disease or any cause may increase. To mitigate this, prioritize plant-based proteins or ensure that the animal protein replaces less healthy components like refined sugars or saturated fats, though even then, risk remains elevated compared to plant-based swaps.

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.

Obesity increases the risk and severity of acute pancreatitis (AP) through mechanisms including gallstone formation, hypertriglyceridemia-induced lipotoxicity, and intrapancreatic fat infiltration.

If you have obesity, your risk of acute pancreatitis is significantly higher due to factors like gallstones and fat breakdown products. Losing weight, particularly visceral fat, can reduce this risk.

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.