Browse the evidence

A ketogenic diet is more effective than low-fat diets for improving glycemic control (HbA1c and HOMA-IR) in patients with type 2 diabetes, but shows comparable effects in non-diabetic patients.

If you have type 2 diabetes and are overweight, switching to a ketogenic diet (very low carb, high fat) is likely to improve your blood sugar control more effectively than a standard low-fat diet. If you do not have diabetes, the blood sugar benefits are similar to low-fat diets, though weight loss may still be superior.

Intermittent energy restriction (IER) significantly reduces fasting insulin levels compared to continuous energy restriction (CER), although the clinical relevance is uncertain.

IER may offer a slight advantage in lowering fasting insulin compared to daily restriction, which could be beneficial for metabolic health. However, since weight loss is the same, do not expect dramatic changes in body composition solely from this hormonal shift.

Among individuals with overweight or obesity who achieve initial weight loss (≥5%) in the first year, long-term maintenance of that weight loss (years 6-15) is significantly greater for those assigned to metformin compared to those assigned to intensive lifestyle intervention (ILS).

If you have prediabetes or are at high risk, achieving even a modest 5% weight loss in the first year is a strong predictor of long-term success. For those who achieve this, adding metformin (if prescribed) may help you keep the weight off better than lifestyle changes alone over the long haul (10+ years). It acts as a maintenance aid rather than just an initial weight loss tool.

Reducing the intake of specific amino acids, particularly leucine and histidine, which are abundant in animal proteins, is associated with decreased fat mass and improved insulin resistance independent of total caloric intake.

Focus on the source of your protein. Plant proteins are naturally lower in leucine and histidine compared to animal proteins. This specific amino acid profile may help improve insulin sensitivity and reduce fat mass, even if total protein intake is adequate.

Achieving and maintaining diabetes remission (HbA1c <48 mmol/mol off glucose-lowering medications) is associated with a significantly lower incidence of Major Adverse Diabetic Events (MADE) compared to those not in remission.

Achieving diabetes remission is not just about feeling better; it actively protects your kidneys, eyes, and nerves from long-term damage. By maintaining remission through weight loss and lifestyle changes, you significantly lower your risk of serious diabetic complications.

Newer GLP-1 receptor agonists (semaglutide) and dual agonists (tirzepatide) significantly outperform older medications and lifestyle interventions alone, achieving weight losses of 12-17%.

Newer injectable medications like semaglutide (2.4mg weekly) and tirzepatide are significantly more effective than older drugs, achieving 12-17% weight loss. They represent a major step forward in pharmacotherapy for obesity.

A ketogenic diet significantly reduces HbA1c levels in overweight T2DM patients, though it does not significantly affect fasting glucose, fasting insulin, or HOMA-IR compared to control diets.

While a ketogenic diet effectively lowers long-term average blood sugar (HbA1c) in T2DM patients, it may not immediately change fasting blood glucose or insulin resistance scores (HOMA-IR) compared to other diets. This suggests the benefit is in sustained glucose regulation rather than acute fasting metrics.

Intermittent fasting (IF) regimens produce weight loss results statistically similar to traditional Caloric Energy Restriction (CER).

You can achieve the same amount of weight loss with intermittent fasting as you can with standard calorie counting. Choose the method that you can stick to long-term.

Adherence to intermittent fasting regimens is generally high (>80%) in short-term studies (≤3 months) but drops significantly in long-term studies (>3 months).

Intermittent fasting is easy to stick to for the first 3 months, but adherence drops significantly thereafter. If you plan to fast long-term, expect a drop in adherence and consider modified approaches (like MADF) to sustain it.

Genetic variants in GLP1R (rs6923761) and TCF7L2 (rs7903146) influence the response to liraglutide, with specific genotypes associated with greater reductions in body fat and weight.

If you are taking liraglutide, your genetic makeup might influence how much fat or weight you lose. Some genetic variants are linked to better outcomes with this drug. This is not a reason to start or stop treatment, but may help explain individual differences in response.

A ketogenic very-low-energy diet (VLED) induces a transient increase in subjective hunger and desire to eat during the first 3 weeks (up to 5% weight loss), despite the presence of ketosis, with appetite suppression only emerging after 10% weight loss.

If you start a ketogenic very-low-energy diet, expect your hunger to increase significantly during the first 3 weeks, even if you are in ketosis. This is a normal, transient phase. Do not mistake this hunger for the diet not working; appetite suppression typically emerges only after you have lost about 10% of your body weight. Preparing for this initial hunger spike can help you stick with the diet.

Upon refeeding (cessation of ketosis) after significant weight loss (10-17%) on a ketogenic diet, hunger feelings and active ghrelin (AG) concentrations increase significantly, potentially undermining long-term weight maintenance.

When you stop the ketogenic diet and return to normal eating, expect your hunger and ghrelin levels to rise significantly. This is a physiological response to losing ketosis and weight. To mitigate this, transition gradually to your maintenance diet rather than stopping abruptly, and be aware that your body will signal for more food.

A 3-month multicomponent mobile health intervention (smartphone app + smart band + brief counseling) produces statistically significant but clinically modest weight loss and body composition improvements in overweight/obese adults compared to brief counseling alone, but these benefits are not maintained at 12 months after device removal.

Using a smartphone app and fitness tracker for 3 months can help you lose a small amount of weight and improve body composition if you are overweight or obese. However, this benefit disappears after 3 months if you stop using the devices. To maintain weight loss, you must transition the habits learned during the 3-month period (like self-monitoring and dietary awareness) into your daily life without relying on the technology.

Consumption of nuts at recommended doses (approx. 28-42.5g/day) does not cause weight gain or increased adiposity in adults, and is associated with a lower incidence of overweight/obesity in long-term prospective cohorts.

You can eat nuts daily without fear of weight gain. Guidelines recommend about 1-1.5 ounces (28-42.5 grams) per day. They are high in calories but also high in fiber and protein, which helps you feel full. If you replace other snacks with nuts, you may actually lose weight or maintain it better than if you ate low-fat, high-carb snacks.

Ipragliflozin treatment for 24 weeks in type 2 diabetes patients reduces body weight primarily through fat mass loss while preserving total muscle mass and bone mineral content.

If you have type 2 diabetes and are already using insulin, adding 50mg of ipragliflozin daily for 24 weeks can help you lose about 2.8 kg of body weight. This weight loss comes mostly from fat, and your overall muscle mass and bone strength are likely to stay the same, which is important for maintaining strength and health.

A 12-week low-calorie diet inducing mild weight loss (approx. 4.8% body weight) significantly increases plasma levels of medium- and long-chain acylcarnitines (e.g., hexanoylcarnitine, octanoylcarnitine) in overweight adults, a change that negatively correlates with reductions in visceral fat area.

For overweight individuals, a sustainable, mild caloric deficit (approx. 300 kcal/day, roughly one-third of a bowl of rice per meal) sustained over 12 weeks is sufficient to reduce visceral fat and increase markers of fatty acid oxidation (acylcarnitines). You do not need extreme restriction to see metabolic benefits; consistency with a modest deficit works.

Time-restricted feeding (TRF) improves insulin sensitivity and glycemic control (including reduced glucose variability and HbA1c) in individuals with overweight or obesity, independent of significant weight loss in some studies.

If you have insulin resistance or pre-diabetes, try shifting your eating window to end earlier in the evening (e.g., 8 PM) and start later in the morning (e.g., 4 PM). This timing aligns with your body's natural circadian rhythms, helping to lower blood sugar spikes and improve how your body uses insulin, even if the scale doesn't move dramatically.

Alternate-Day Fasting (ADF) improves insulin sensitivity (HOMA-IR) more than Continuous Energy Restriction (CER).

If you are using Alternate-Day Fasting, you may see improvements in insulin sensitivity that are not seen with standard calorie restriction. This is a potential metabolic benefit of ADF.

Semaglutide and Liraglutide reduce the risk of Major Adverse Cardiovascular Events (MACEs), whereas Naltrexone/Bupropion increases the risk of elevated blood pressure.

If you have obesity and cardiovascular risks, Semaglutide or Liraglutide are preferred because they reduce MACE risk. Avoid Naltrexone/Bupropion if you have hypertension, as it increases blood pressure risk.

Negative energy balance induced by aerobic exercise or hypocaloric diet produces similar reductions in visceral adipose tissue (VAT) when weight loss is matched, regardless of exercise amount or intensity.

To reduce visceral fat, focus on creating a consistent negative energy balance. Whether you choose to do this through diet, exercise, or both, the key is the total caloric deficit. You do not need to perform high-intensity or high-volume exercise to see significant visceral fat loss; moderate-intensity aerobic exercise is equally effective. Aim for a modest weight loss (around 7%), which can yield a substantial (~25%) reduction in dangerous visceral fat.

Aerobic exercise reduces liver fat (LF) independently of weight loss, although the magnitude of reduction is modest compared to diet-induced weight loss.

Regular aerobic exercise (150-300 minutes/week) reduces liver fat, even if you don't lose weight. This is a key benefit for metabolic health. While diet-induced weight loss produces larger reductions in liver fat, exercise provides a significant independent benefit. Do not stop exercising if the scale doesn't move; your liver is still benefiting.

Three weeks of total meal replacement (TMR) at 1120 kcal/day increases dorsolateral prefrontal cortex (dlPFC) activation and enhances its inhibitory functional connectivity over the nucleus accumbens and orbitofrontal cortex in response to food cues, compared to a typical food-based diet (TD).

If you are struggling with food cravings, a short-term (3-week) period of consuming only meal replacement shakes (around 1120 calories) may help 'reset' your brain's response to food. Unlike eating normal food in portions, this approach appears to strengthen the brain's executive control centers (dlPFC) and their ability to inhibit reward centers (nucleus accumbens) when seeing food. This leads to greater weight loss and reduced cravings compared to just eating less of regular food.

Caloric restriction improves insulin sensitivity and reduces fasting insulin, but has a minor or non-significant impact on fasting glucose levels in balanced groups.

Caloric restriction lowers insulin levels, which improves insulin sensitivity. However, it may not significantly lower fasting blood glucose unless the study groups were balanced at baseline.

Time-restricted eating (TRE) significantly reduces diastolic blood pressure (DBP) in adults with obesity, but does not significantly affect systolic blood pressure (SBP).

If you have high blood pressure, TRE might help lower your diastolic (bottom) number, but don't expect it to significantly change your systolic (top) number. This is a secondary benefit to weight loss, not a primary treatment for hypertension.