Browse the evidence

Adopting a low-carbohydrate (LC) or very low-carbohydrate ketogenic (VLCK) diet (defined as <50g, 50-100g, or 101-150g carbohydrates per day) improves glycemic control and facilitates the deprescribing of antihyperglycemic medications in patients with Type 2 Diabetes Mellitus (T2DM).

If you have Type 2 Diabetes, reducing your daily carbohydrate intake to under 150 grams (and potentially under 50 grams for ketosis) can significantly improve your blood sugar levels and allow you to reduce or stop diabetes medications. Work with your doctor to adjust your insulin and other drugs to prevent low blood sugar, and ensure you are drinking enough water and getting electrolytes to avoid initial side effects like fatigue or cramps.

Type 2 Diabetes Mellitus can be put into remission (defined as HbA1c < 6.5% for ≥ 3 months without T2DM medications) through the use of therapeutic carbohydrate reduction and subsequent medication deprescription.

If you have Type 2 Diabetes, remission is possible. This means getting your blood sugar (HbA1c) below 6.5% for at least 3 months without taking diabetes medications. This is achieved by strictly limiting carbohydrates and working with your doctor to safely stop or reduce your diabetes drugs. It requires commitment to the diet and close monitoring.

A 12-week dietitian-led telehealth intervention using web-based applications reduces 24-hour systolic blood pressure by approximately 6.7 mmHg, achieving efficacy comparable to a self-directed approach using the same digital tools.

To lower your blood pressure, you can use a structured digital program. If you add weekly check-ins with a dietitian who helps you set goals and stay motivated, you may get an extra benefit in nighttime blood pressure and physical activity, but the core digital tools alone will still significantly lower your daytime blood pressure.

A dietitian-led telehealth intervention significantly reduces sleep (nocturnal) systolic and diastolic blood pressure more effectively than a self-directed digital approach.

If you want to improve your nighttime blood pressure, adding professional coaching to a digital health program is more effective than using the app alone. The dietitian support helps drive the lifestyle changes that specifically lower blood pressure during sleep.

Resistance exercise followed immediately by protein feeding significantly increases phosphorylation of Akt Ser473, p70S6K1 Thr412, and rpS6 Ser235/236 in human skeletal muscle, with the combined stimulus producing greater or more sustained signaling than feeding alone.

To maximize the cellular signaling for muscle growth, combine resistance exercise with protein intake. This study shows that doing both together triggers a stronger and more sustained activation of key muscle-building pathways (mTORC1) than eating protein alone. Specifically, performing resistance training followed by a protein-containing meal leads to higher levels of signaling molecules like Akt and p70S6K1, which are critical for muscle protein synthesis.

Distributing a fixed weekly volume of resistance training across four sessions per week yields greater maximal strength gains than performing the same volume in a single session.

If you are an experienced lifter aiming to maximize your squat strength, split your weekly leg volume across four separate sessions (e.g., one heavy compound lift per day) rather than doing it all in one day. This allows you to handle heavier loads with better technique and less fatigue, resulting in significantly greater strength gains over 8 weeks compared to a single weekly session.

High-frequency (4x/week) and low-frequency (1x/week) resistance training produce equivalent improvements in muscle hypertrophy (muscle thickness) and jump height when weekly volume is equated.

If your primary goal is building muscle size (hypertrophy) or improving jump height, you do not need to train your legs 4 times a week. You can achieve similar muscle growth and power improvements by performing the same total volume of exercises in just one session per week. Focus on hitting your total weekly volume and intensity, regardless of how you split the sessions.

High effort (proximity to failure) is a necessary condition for muscle hypertrophy, particularly when using low loads, whereas high-load training inherently generates high effort.

To build muscle, you must train with high effort, meaning you should stop 0-3 reps before you physically cannot complete another repetition. This is true whether you are lifting heavy weights or light weights. If you use light weights, you MUST go close to failure to get similar growth as heavy weights.

Resistance exercise can be effectively performed using bodyweight, provided the intensity and effort are sufficient to overload the neuromuscular system.

You can build strength and muscle using only your body weight. Ensure you are performing exercises that challenge you (e.g., push-ups, squats) with sufficient intensity. If bodyweight exercises become too easy, increase the difficulty (e.g., elevate feet) rather than assuming you need weights.

A low-carbohydrate, high-fat diet improves cardiometabolic risk markers (specifically LPIR, triglycerides, and HDL-C) during weight-loss maintenance compared to a high-carbohydrate diet, without adversely affecting LDL particle concentration or LDL-C.

If you are maintaining weight loss, switching to a lower-carbohydrate, higher-fat diet (specifically 20% carbs, 60% fat) can improve your metabolic health markers like triglycerides and HDL, and reduce insulin resistance, without raising your LDL cholesterol or particle count. This benefit occurs even if the increased fat includes saturated fat, provided added sugars are kept low.

Semaglutide (Ozempic/Wegovy) promotes significant weight loss (10-15% body weight) and improves glycemic control in adults with type 2 diabetes or obesity through GLP-1 receptor agonism, delayed gastric emptying, and appetite suppression.

Semaglutide is a once-weekly injection that mimics a gut hormone to slow digestion and reduce appetite. It is clinically proven to help people with obesity or type 2 diabetes lose 10-15% of their body weight when combined with diet and exercise. Side effects like nausea are common initially but often subside; starting with a low dose helps manage this. It is not a substitute for lifestyle changes but a tool to facilitate them.

Tirzepatide produces significantly greater weight loss than semaglutide and liraglutide in patients with obesity or type 2 diabetes.

If you are struggling with obesity or type 2 diabetes, tirzepatide (administered weekly at doses up to 15 mg) has demonstrated superior weight loss capabilities compared to semaglutide and liraglutide in clinical trials. To maximize results, combine this pharmacotherapy with lifestyle changes, including a caloric deficit, regular physical activity, and behavioral modifications.

Combining pharmacotherapy with lifestyle changes (diet, exercise, behavioral therapy) significantly enhances long-term weight loss maintenance and prevents weight regain.

Do not rely on medication alone for long-term weight management. Combine your prescribed pharmacotherapy with a balanced diet, regular physical activity, and behavioral interventions like cognitive-behavioral therapy. This integrated approach is essential for maintaining weight loss and preventing regain.

Isometric resistance training (e.g., handgrip) produces greater systolic blood pressure reductions (up to 8 mm Hg) than aerobic or dynamic resistance training.

Incorporate isometric exercises, such as handgrip training, into your routine. Perform 3 sessions per week, holding 30-40% of your maximum grip strength for 2 minutes with 1-minute rests, repeated 4 times. This specific type of exercise can lower blood pressure more effectively than aerobic or dynamic resistance training alone.

Sustained weight loss of at least 10% from maximum weight is recommended for adults with overweight or obesity at moderate or high ASCVD risk to reduce cardiovascular events.

If you are at moderate or high cardiovascular risk, aim to lose 10% of your maximum lifetime weight. This is a higher bar than the 5% target for lower-risk individuals, but it is the threshold shown to significantly reduce the risk of heart attacks and strokes. Discuss with your doctor if pharmacotherapy (like GLP-1s) or surgery is appropriate to help you reach this target.

GLP-1 receptor agonists (GLP-1RA) and related incretin mimetics (e.g., semaglutide, tirzepatide, retatrutide) produce significant weight loss in adults with obesity, achieving reductions comparable to bariatric surgery.

GLP-1 medications like Semaglutide and Tirzepatide are highly effective for weight loss, often achieving 15-24% body weight reduction, which rivals bariatric surgery. They work by increasing satiety and slowing digestion. Because obesity is chronic, these drugs likely need to be taken long-term to maintain weight loss. Side effects are mostly gastrointestinal (nausea), but serious risks exist for those with specific thyroid cancer histories. Consult a doctor to see if you are a candidate.

Lifestyle interventions, specifically achieving 7-10% body weight loss through caloric restriction and physical activity, are the cornerstone for reducing cardiovascular risk and improving hepatic steatosis in patients with metabolic-associated steatotic liver disease (MASLD).

To lower your heart and liver risk, aim to lose 7-10% of your body weight through a calorie-controlled diet (cut 500-1000 calories daily) and regular exercise (150 minutes of moderate activity weekly). Prioritize whole grains, lean proteins, and healthy fats (Mediterranean style), while eliminating sugary drinks and trans fats. Stop drinking alcohol completely, as it harms the liver more than it helps the heart in this condition. Work with a healthcare team to make these changes sustainable.

GLP-1 receptor agonists (specifically semaglutide and tirzepatide) produce substantial weight loss and metabolic improvements in patients with severe mental illness experiencing antipsychotic-induced weight gain, without exacerbating psychiatric symptoms.

For patients with severe mental illness struggling with antipsychotic-induced weight gain, GLP-1 receptor agonists like semaglutide offer a highly effective treatment option that reduces weight significantly without worsening mental health symptoms. While side effects like nausea are common, they are often mild and transient. The main barrier is often cost and insurance coverage, so patients and providers should advocate for access to these medications as a standard part of care for this population.

Orlistat (120 mg twice daily) produces a statistically significant weight reduction (>2.9% vs placebo) and improves cardiovascular risk factors in obese patients, including those with type 2 diabetes.

Orlistat is an approved option for weight loss that works by blocking fat absorption. To maximize results and minimize stomach issues, take 120mg twice daily with meals containing fat, but keep your overall fat intake moderate. You must also take vitamin supplements (A, D, E) separately from the drug to avoid deficiencies.

Long-term maintenance of weight loss requires significantly higher physical activity levels (≥150–250 minutes/week) than those recommended for general health or initial weight loss.

To keep weight off, you need to move significantly more than the standard '150 minutes a week' recommendation. Aim for at least 4 hours of moderate activity (like brisk walking) per week. This higher volume is necessary to counteract your body's natural tendency to regain weight after you've lost it.

High-protein diets (>25% of calories or 1-1.2 g/kg body weight) are superior to other macronutrient compositions for long-term weight maintenance, primarily by preserving fat-free mass and increasing satiety.

To keep weight off, prioritize protein in your diet (aim for 1-1.2 grams per kg of your goal body weight). This helps you feel full and protects your muscles, making it easier to stick to your weight loss goals long-term.

Orlistat, taken at 120 mg three times daily, reduces body weight by 8% over 12 months compared to 5% with placebo, and significantly reduces cardiovascular risk factors like hypertension and LDL cholesterol.

Orlistat (120 mg, 3 times daily) helps you lose about 8% of your body weight over a year by blocking fat absorption. It also lowers blood pressure and LDL cholesterol. You must follow a low-fat diet and take vitamin supplements to avoid side effects like oily stools.

Sibutramine, an appetite suppressant acting on the hypothalamus, is more effective than placebo for weight loss when combined with lifestyle changes, with 22-38% of patients achieving >5% weight loss in 3 months.

Sibutramine helps you lose weight by reducing appetite. About 22-38% of users lose more than 5% of their body weight in 3 months. It is not safe for people with heart problems or high cardiovascular risk. Side effects include increased blood pressure and dry mouth.

Bupropion/Naltrexone combination therapy results in a mean weight loss of 6.1% over 56 weeks in obese or overweight adults, significantly better than placebo (1.3%).

Bupropion/Naltrexone helps you lose about 6% of your body weight over a year. It works by reducing appetite and food cravings. It is not safe for people with seizure disorders, uncontrolled high blood pressure, or those taking certain antidepressants. Side effects like nausea are common but often temporary.