Browse the evidence

Metabolic bariatric surgery (MBS) procedures, specifically Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), single anastomosis duodenal-ileal bypass (SADI), and biliopancreatic diversion (BPD), provide superior long-term total body weight loss (TBWL) compared to obesity management medications (OMM) and endoscopic bariatric procedures (EBP).

If you are struggling with obesity and lifestyle changes alone have not provided sufficient long-term results, metabolic bariatric surgery (specifically RYGB, SG, SADI, or BPD) offers the highest probability of significant, sustained weight loss. While newer medications (semaglutide, tirzepatide) are excellent short-to-medium term options and comparable to surgery initially, surgery tends to maintain higher efficacy over the long term (3+ years). Consult a specialist to determine if you are a candidate for these procedures, especially if your BMI is >= 40 kg/m2.

Combined exercise and pharmacotherapy significantly reduces systolic and diastolic blood pressure and triglycerides compared to exercise alone, but does not significantly improve fasting glucose, HDL, or LDL.

While adding medication to exercise improves blood pressure and triglycerides, it may not significantly improve fasting glucose or cholesterol levels (HDL/LDL) compared to medication alone. Focus on the weight loss and blood pressure benefits.

The EMP16 combination therapy significantly improves the Fatty Liver Index (FLI) and reduces visceral adiposity index (VAI) more effectively than conventional orlistat, suggesting specific benefits for liver health beyond general weight loss.

If you have fatty liver or high visceral fat, this specific combination pill (EMP16) may offer better liver health improvements than standard orlistat. It significantly reduces the Fatty Liver Index compared to conventional treatments.

The quality and source of macronutrients (e.g., plant-based proteins, unsaturated fats) are more important for long-term health outcomes than the specific macronutrient ratio (low-carb vs. low-fat).

Don't just count macros; focus on the quality of your food. Replace refined carbohydrates and saturated fats with whole grains, vegetables, nuts, and unsaturated fats. This improves long-term health more than just restricting calories.

High sodium intake is the leading dietary risk factor for mortality globally, responsible for 3 million deaths annually.

High sodium intake is a major driver of early death globally. To protect your health, aim to reduce your sodium intake to the optimal range of 1-3 grams per day, as excessive consumption significantly increases your risk of cardiovascular disease and mortality.

Low intake of whole grains is the leading dietary risk factor for disability-adjusted life years (DALYs) globally, responsible for 3 million deaths.

Not eating enough whole grains is a major contributor to early death and disability. To improve your health, increase your intake of whole grains to the optimal range of 125g per day, as this is a leading factor in preventing chronic disease.

Low intake of fruits is the third leading dietary risk factor for mortality globally, responsible for 2 million deaths.

Not eating enough fruit is a major contributor to early death. To protect your health, increase your fruit intake to the optimal range of 250g per day, as this is a leading factor in preventing chronic disease.

Sleep curtailment (4 hours/night for 2 nights) in healthy young men significantly decreases leptin levels, increases ghrelin levels, and increases hunger and appetite, particularly for calorie-dense, high-carbohydrate foods.

If you are trying to manage your weight, prioritize getting enough sleep. Restricting sleep to 4 hours for just two nights can significantly increase your hunger and cravings for high-calorie, high-carb foods by altering your hunger hormones. This is not just willpower; it is a biological response to sleep loss.

Consumption of industrial trans fatty acids (iTFA) increases the risk of cardiovascular disease and myocardial infarction through pro-inflammatory actions and atherosclerosis development, whereas ruminant trans fatty acids (rTFA) may possess anti-atherogenic properties.

Be mindful of industrial trans fats found in processed foods, as they are strongly linked to heart disease and inflammation. However, do not fear naturally occurring trans fats in animal products (like those from grass-fed animals) as much, as they may not carry the same risks and might even offer some protection against atherosclerosis.

Consumption of n-3 polyunsaturated fatty acids (PUFAs), specifically EPA and DHA, provides cardioprotection by reducing inflammation, preventing microthrombus formation, and improving survival post-ischemia.

Increase your intake of n-3 PUFAs found in fish and marine animals (EPA and DHA) or plant sources like flaxseed (ALA). These fats help reduce inflammation, prevent blood clots, and protect the heart during stress, unlike diets high in n-6 PUFAs which may increase heart attack risk.

Higher intake of fish, marine n-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol, fruit, and fiber is associated with a moderate reduction in coronary heart disease risk.

Increase intake of fish, marine n-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol (in moderation), fruit, and fiber, as these are moderately associated with a lower risk of coronary heart disease.

Modest weight loss (5%) in Type 2 Diabetes improves cardiovascular risk factors (lipids, glucose) but does not necessarily reduce cardiovascular mortality or events.

Losing 5% of your body weight if you have Type 2 Diabetes will likely improve your blood sugar and cholesterol numbers. However, this modest weight loss may not be enough to prevent heart attacks or strokes. More significant weight loss or other interventions might be needed for hard heart outcomes.

Adherence to a Western dietary pattern (high in red/processed meat, refined grains, sweets, and high-fat dairy) is associated with a substantially increased risk of developing type 2 diabetes in men, independent of BMI and physical activity.

To lower your risk of type 2 diabetes, prioritize avoiding a Western dietary pattern. This means significantly reducing your intake of red and processed meats, refined grains, French fries, high-fat dairy, and sweets. Instead, focus on a pattern rich in vegetables, fruits, fish, poultry, and whole grains. This dietary shift is associated with a substantially lower risk, independent of your weight or exercise level.

A high Western dietary pattern score combined with low physical activity or obesity (BMI > 30 kg/m2) is associated with a particularly high risk of type 2 diabetes, significantly higher than either factor alone.

If you are obese or have low physical activity, your risk of type 2 diabetes is drastically amplified if you also eat a Western diet. To minimize this risk, you must address both your dietary pattern (reducing processed meats, refined grains, and sweets) and your lifestyle (increasing physical activity and managing weight). The combination of these factors yields the highest risk, so addressing all is critical.

Adherence to a Prudent dietary pattern (high in vegetables, fruits, fish, poultry, and whole grains) is associated with a modestly lower risk of type 2 diabetes.

Eating a Prudent dietary pattern, which includes more vegetables, fruits, fish, poultry, and whole grains, is associated with a modestly lower risk of type 2 diabetes. While the effect is smaller than the risk increase from a Western diet, it is a beneficial dietary choice for long-term metabolic health.

Higher intake of linolenic acid (an N-3 fatty acid from plants) is inversely associated with the risk of myocardial infarction, independent of other dietary and non-dietary risk factors.

Include sources of linolenic acid (an N-3 fatty acid found in plants) in your diet. This study found a significant inverse association between linolenic acid intake and myocardial infarction risk, suggesting it may offer specific protective benefits for heart health.

Healthy older men require a greater relative protein intake (~0.40 g/kg body mass) per single meal to maximally stimulate myofibrillar protein synthesis compared to younger men (~0.24 g/kg body mass).

If you are an older adult, you likely need to eat more protein per meal than a younger person to maximize muscle building. Aim for roughly 0.4 grams of high-quality protein per kilogram of body weight in a single meal (e.g., ~28g for a 70kg person), rather than the lower amounts often recommended for younger adults.

Caffeine enhances vigilance and cognitive performance during sleep deprivation and extended exhaustive exercise, primarily through CNS adenosine antagonism.

If you are facing a period of sleep deprivation, such as during military operations or intense training camps, caffeine can help you stay alert. A dose of 600-800 mg (or ~4 mg/kg) taken as chewing gum or capsules can maintain vigilance and reaction time when sleep is limited.

Caffeine supplementation does not negatively impact glycogen resynthesis during the recovery phase when co-ingested with carbohydrates.

You can safely consume caffeine after your workout, even if you are taking carbohydrates for recovery. It will not stop your muscles from refueling, and one study showed it might actually help store glycogen 66% faster than carbs alone. Just time it so it doesn't disrupt your sleep.

Metformin is the first-line pharmacological treatment for Type 2 Diabetes, reducing HbA1c by ~1.5% and fasting glucose by ~20%, with additional cardiovascular and potential cancer-preventive benefits.

Metformin is the standard first drug for Type 2 Diabetes. It lowers blood sugar by about 1.5% and helps heart health. Common side effects like stomach upset are usually mild and go away. It is safe for kidneys if your eGFR is above 45. If your kidney function drops below 30, you should not take it.

Replacing saturated fatty acids (SFA) with polyunsaturated fatty acids (PUFA) modestly lowers coronary heart disease (CHD) risk, whereas replacing SFA with carbohydrate yields no benefit.

Do not simply cut saturated fats (like butter or red meat) unless you are replacing them with unsaturated fats (like nuts, seeds, or fish). Replacing saturated fats with refined carbohydrates (like white bread or sugar) offers no heart health benefit. Focus on the quality of the replacement nutrient, not just the reduction of fat.

Regular physical activity improves metabolic flexibility by enhancing substrate switching and energy expenditure, whereas calorie restriction alone improves insulin sensitivity but fails to restore metabolic flexibility.

If you have Type 2 Diabetes or fatty liver, simply losing weight through dieting will improve your insulin sensitivity, but it will not restore your body's ability to efficiently switch between burning fat and sugar (metabolic flexibility). To fix this specific metabolic defect and reduce the risk of liver and heart disease, you must engage in regular physical activity, as diet alone is insufficient for this mechanism.

Intakes of healthful foods generally increase with age, while intakes of less healthful foods generally decrease, suggesting age-related dietary improvements or cohort effects.

Older adults tend to consume more healthful foods and fewer less healthful foods than younger adults. This suggests that dietary habits may improve with age, or that older cohorts have different dietary patterns. Younger individuals may benefit from adopting these healthier eating patterns earlier in life.

A very low-carbohydrate diet improves metabolic syndrome components (HDL, triglycerides, insulin sensitivity) more effectively than low-fat or low-glycemic index diets during weight-loss maintenance, despite potentially increasing stress hormones (cortisol) and inflammation (CRP).

For long-term health markers like cholesterol and blood sugar, a very low-carbohydrate diet may offer better improvements than low-fat or low-glycemic diets after weight loss. However, monitor your stress levels and inflammation, as this diet may increase cortisol and CRP in some individuals.