Browse the evidence

A 12-month very low-carbohydrate ketogenic diet (20–50g carbs/day) produces greater reductions in HbA1c and body weight, and allows for greater discontinuation of diabetes medications, compared to a moderate-carbohydrate calorie-restricted low-fat diet in overweight adults with type 2 diabetes or prediabetes.

If you have Type 2 Diabetes or Prediabetes and are overweight, switching to a very low-carbohydrate ketogenic diet (20-50g carbs/day) for 12 months is likely to lower your blood sugar (HbA1c) and help you lose more weight than a standard low-fat, calorie-restricted diet. Crucially, this approach may allow you to reduce or stop diabetes medications, but this must be done under a doctor's supervision. To succeed, combine the diet with behavioral strategies like mindful eating and regular physical activity.

Combining Endoscopic Gastric Remodeling (EGR) with a GLP-1 Receptor Agonist (GLP-1RA) initiated within 6 months of the procedure yields significantly greater weight loss (23.7% TWL) than EGR monotherapy or sequential therapy.

If you are considering Endoscopic Gastric Remodeling (EGR), ask about starting a GLP-1RA (like semaglutide or liraglutide) within 6 months of the procedure. This specific combination yields significantly better weight loss (approx. 24%) than either treatment alone. Avoid taking other types of weight loss medications for more than 6 months before the procedure, as this is associated with poorer outcomes.

Anti-obesity medication (AOM) administered in primary care settings produces approximately double the weight loss compared to lifestyle interventions alone, achieving an additional ~3 kg reduction.

If you are working with a primary care provider to lose weight, adding an FDA-approved anti-obesity medication to your lifestyle plan can roughly double your weight loss results compared to lifestyle changes alone. However, be prepared for the possibility that you may need to stay on the medication long-term to maintain the loss, as weight regain is common when stopping treatment.

Adjunctive semaglutide therapy significantly enhances total body weight loss and prevents post-balloon weight regain compared to intragastric balloon (IGB) alone in patients with BMI ≥ 27 kg/m².

If you are using an intragastric balloon for weight loss, adding semaglutide (a GLP-1 medication) can significantly increase your total weight loss and help you keep the weight off after the balloon is removed. The study used a specific dosing schedule starting at 0.5mg and going up to 1mg weekly, pausing while the balloon is in place, and restarting after removal. This approach helps overcome the natural weight regain that often happens after balloon removal alone.

A Very Low-Calorie Ketogenic Diet (VLCKD) induces rapid weight loss and improves metabolic parameters in obese patients by inducing physiological ketosis, which suppresses appetite and shifts metabolism toward fat oxidation while preserving lean mass.

To use VLCKD, restrict carbs to under 50g/day and calories to ~800/day for 8-12 weeks, using meal replacements and vegetables. This induces ketosis, which naturally suppresses hunger and burns fat while protecting muscle. You must supplement with electrolytes and vitamins. This is a medical therapy, not a casual diet, and requires monitoring. It is specifically for those with obesity and related health issues, not for everyone.

A continuous care model combining nutritional ketosis (<30g carbohydrates/day) with remote biometric monitoring and medication management significantly improves glycemic control, reduces body weight, and allows for the reduction or elimination of type 2 diabetes medications in adults with T2D over a 1-year period.

To manage Type 2 Diabetes effectively, consider a structured low-carbohydrate approach (under 30g carbs/day) combined with regular monitoring of blood glucose and ketones. Work with a healthcare provider to safely adjust diabetes medications as your numbers improve. Focus on eating enough protein and healthy fats to feel satisfied, and ensure you are getting essential nutrients through supplementation if needed. This approach has been shown to improve blood sugar control, promote weight loss, and reduce the need for diabetes medications over time.

A comprehensive incentive/disincentive program (SNAP-plus) that subsidizes multiple healthy food groups (F&V, nuts, whole grains, fish, plant-based oils) and disincentivizes unhealthy groups (SSBs, junk food, processed meats) yields the largest health gains and net cost savings among the tested interventions.

Support the 'SNAP-plus' model, which uses a broad basket of incentives for healthy foods and disincentives for unhealthy ones. This approach is modeled to save the most money and prevent the most heart disease, making it the most attractive option for policy makers.

Critically ill patients require significantly higher protein intakes (2.0–2.5 g/kg/day) than standard guidelines (1.2–1.5 g/kg/day) to achieve positive nitrogen balance and potentially improve survival.

For critically ill patients without kidney failure, medical teams should consider protein intakes of 2.0–2.5 g/kg/day. This higher dose is necessary to counteract the severe catabolic state of critical illness and achieve positive nitrogen balance, which may support survival.

Resistance training performed at high effort (near failure) significantly reduces all-cause mortality risk, whereas merely meeting volume-based guidelines without achieving high strength levels provides negligible mortality benefit.

To gain the maximum health benefit from resistance training, you must train with high effort, meaning you should perform exercises until you are close to muscular failure, not just 'go through the motions.' You do not need a gym; bodyweight exercises or simple household items can be used. Focus on quality and effort over volume or duration. Simply checking a box for 'muscle strengthening' without challenging your muscles significantly will not reduce your risk of early death.

Advanced training techniques such as supersets, drop sets, and rest-pause training can roughly halve training time compared to traditional training while maintaining volume and inducing similar hypertrophy.

If you are short on time, try pairing exercises (supersets) or reducing rest periods. This can cut your workout time in half while still building muscle, though it may be less effective for pure strength gains.

Resistance training to momentary muscular failure using lighter loads (30% 1RM) maintains muscle hypertrophy and size comparably to heavy loads (80-90% 1RM) during periods of restricted training.

If you only have light weights, lift them until you physically cannot complete another repetition. This maintains muscle size as effectively as heavy weights, though maximum strength gains may be slightly lower.

High protein intake, specifically rich in leucine, mitigates muscle loss and anabolic resistance during periods of reduced physical activity.

Eat 0.4 grams of protein per kilogram of body weight every 4 hours. Ensure these sources are rich in leucine (e.g., whey, meat, eggs) to maximize muscle protein synthesis and prevent muscle loss during inactivity.

High-intensity interval exercise (HIIE) or resistance training can mitigate the negative effects of sleep restriction on muscle protein synthesis, preserving synthesis rates despite sleep loss.

If you know you will have a night of poor sleep, do not skip your workout. High-intensity interval training or resistance exercise can help protect your muscle protein synthesis rates. Think of exercise as a buffer against the negative effects of sleep loss.

A personalized lifestyle coaching program combining multi-omic data with behavioral support produces clinically meaningful improvements in HbA1c comparable to landmark randomized controlled trials.

Making sustainable lifestyle changes through coaching can lower your blood sugar levels (HbA1c) just as effectively as intensive lifestyle programs used in major medical trials. This means that consistent, coached changes to diet and activity can have a powerful impact on your diabetes risk, potentially avoiding or delaying the need for medication.

A 1-year remote lifestyle intervention by dietitians using a mobile app and behavioral counseling techniques produces significant weight loss (median -4.9 kg) and improvements in blood pressure and dietary habits in overweight and obese adults.

To lose weight using this method, you need a registered dietitian who uses a specific mobile app to track your food photos and activity. You will receive frequent coaching (up to 5 times a week initially) focusing on behavioral strategies like goal setting and self-monitoring. The contact frequency decreases over the year as you move from active weight loss to maintenance. This approach works by combining professional guidance with digital self-tracking tools.

Carbohydrate restriction, particularly very-low-carbohydrate (VLC) or ketogenic diets, significantly improves glycemic control (lower HbA1c), reduces insulin requirements, and stabilizes blood glucose profiles in patients with Type 1 Diabetes (T1D) compared to standard high-carbohydrate diets.

For T1D patients, adopting a very-low-carbohydrate diet (under 50g carbs/day) can significantly stabilize blood sugar and reduce the amount of insulin needed. This approach lowers the risk of both high and low blood sugar spikes. However, it requires careful medical supervision to safely reduce insulin doses and avoid hypoglycemia during the transition.

Higher adherence to the Mediterranean diet is associated with a two-fold increased likelihood of maintaining weight loss after an initial reduction of 10% or more.

To maintain weight loss, adopt a Mediterranean-style eating pattern. Prioritize plant foods (fruits, vegetables, legumes, whole grains), use olive oil as your main fat source, and include moderate amounts of fish and dairy. Limit red meat and sweets. This pattern is associated with double the odds of keeping weight off compared to less adherent diets.

Higher fruit consumption (servings per week) is significantly associated with increased odds of weight loss maintenance, whereas other individual Mediterranean diet components (vegetables, legumes, olive oil) were not significant when analyzed in isolation.

Increase your weekly fruit intake. Each additional serving per week is associated with a 3% higher chance of keeping weight off. Focus on whole fruits rather than juices to maximize fiber and satiety benefits.

Higher protein intake is associated with weight loss maintenance, with maintainers consuming significantly more protein (g/kg body weight) than regainers.

Ensure adequate protein intake (approx 0.9-1.0 g/kg body weight) to help maintain weight loss. This may help with satiety and preserving muscle mass.

A 12-week periodic ketogenic diet (30-50g carbs, 130g fat, 60g protein, ~1500 kcal) significantly improves body weight, BMI, waist circumference, fasting blood glucose, fasting insulin, HbA1c, and lipid profiles (TG, TC, LDL) in newly diagnosed overweight/obese T2DM patients compared to routine diabetes diet.

If you are newly diagnosed with Type 2 Diabetes and overweight, a 12-week ketogenic diet (approx. 1500 calories, very low carb) can significantly improve your weight, blood sugar, and cholesterol better than standard diabetes advice. However, it is difficult to sustain long-term due to taste and adherence issues. It serves as an effective short-term intervention to reduce medication needs and improve metabolic health.

Very Low-Calorie Ketogenic Diets (VLCKD) and Protein-Sparing Modified Fasting (PSMF) produce rapid, significant weight loss and preserve lean mass in obese patients, but require strict medical supervision due to risks of gallbladder issues and electrolyte imbalance.

If you have severe obesity and comorbidities, VLCKD or PSMF can help you lose weight faster than standard diets while preserving muscle. However, these are not DIY diets; they require strict medical supervision, supplementation, and monitoring to avoid side effects like gallstones or electrolyte imbalances.

Essential amino acid (EAA) supplementation enriched with leucine effectively augments daily and per-meal protein intake in older adults without suppressing appetite or compromising total energy intake, unlike intact protein sources such as whey.

If you are an older adult struggling to eat enough protein to maintain muscle, try an EAA supplement enriched with leucine (3-15g) taken as a gel or liquid before or between meals. Unlike protein shakes, these won't make you feel too full to eat your regular food, helping you hit your protein goals without losing energy intake. Combine this with resistance exercise for the best results, especially if you have sarcopenia or obesity.

A 12-month web-based weight loss intervention with personalized dietitian and exercise expert feedback leads to greater weight loss, BMI reduction, and waist circumference reduction compared to usual care in men with type 2 diabetes.

For men with type 2 diabetes looking to lose weight, a structured web-based program with regular feedback from dietitians and exercise experts can be an effective and acceptable alternative to traditional face-to-face services. The program involves self-monitoring of diet and activity, goal setting, and personalized feedback over 12 months.

Anti-obesity medications (Liraglutide 3mg, Lorcaserin, Naltrexone/Bupropion, Phentermine/Topiramate) are effective for weight loss in type 2 diabetes when used as adjuncts to lifestyle changes.

If lifestyle changes aren't enough, ask about FDA-approved weight loss drugs like Lorcaserin or Naltrexone/Bupropion. They are safe for diabetics and work best when combined with diet and exercise. Note that if you don't lose at least 5% of your body weight in 3 months, doctors should stop the medication.