Browse the evidence

Hyponatremia is a risk in ultra-endurance events, particularly when excessive water consumption occurs without adequate sodium replenishment, though it is uncommon in standard marathons.

During long events, monitor sodium intake alongside water. Drinking excessive plain water can lead to hyponatremia, especially in events lasting many hours. Follow event-specific hydration guidelines that account for sodium loss.

Poor diet is a leading cause of global malnutrition and chronic diseases, including diabetes, cardiovascular diseases, and specific cancers, driving 38.3 million deaths annually.

Focus on improving your overall diet quality, as poor dietary patterns are a primary driver of chronic diseases like diabetes and heart disease. Use reliable, individual-level dietary data rather than broad national supply estimates to understand your specific nutritional intake and make informed choices.

A preloaded 10-km treadmill time trial (90-min preload at 65% VO2max followed by a 10-km race) is highly reproducible for measuring endurance performance in trained runners, with a within-subject coefficient of variation of 1.00%.

For researchers studying endurance performance, using a 90-minute preload run at 65% of max oxygen uptake followed by a 10-km time trial on a treadmill provides a highly reliable measure of performance (CV ~1%). To achieve this reliability, you must strictly control the participants' diet (high-carb, low-fat) for 24 hours prior, provide a standardized breakfast 3 hours before the test, and ensure fluid intake is consistent between testing sessions. This protocol is particularly useful for detecting small changes in performance due to nutrition or training interventions in trained runners.

Implementing mandatory food procurement policies in worksites (cafeterias, vending, meetings) significantly improves the availability of healthy food and beverage options, thereby creating a healthier nutrition environment.

If you run a workplace, cafeteria, or vending operation, adopt mandatory procurement standards that prioritize fruits, vegetables, whole grains, and lean proteins while limiting sodium, trans fats, and saturated fats. Ensure these items are consistently available and clearly labeled. This structural change is more effective than education alone for improving population health.

Regular aerobic training reduces platelet activation (P-selectin expression) during acute exercise compared to sedentary individuals, despite higher baseline platelet counts in trained subjects.

If you are currently sedentary, your platelets will activate more during intense exercise than if you were trained. This doesn't mean you shouldn't exercise, but it highlights why gradual training is safer. Start with moderate activity to build your cardiovascular system, which will eventually lower your platelet activation response to stress.

Combining a GLP-1 receptor agonist (GLP-1RA) with an SGLT2 inhibitor provides superior glucose control, greater weight loss, and greater reductions in systolic blood pressure compared to either drug alone.

If your blood sugar remains high despite taking metformin, ask your doctor about combining a GLP-1 receptor agonist (like exenatide) with an SGLT2 inhibitor (like dapagliflozin). This combination lowers blood sugar more effectively than either drug alone, helps you lose more weight, and reduces blood pressure.

Higher consumption of trans-18:2 fatty acids (industrial trans fats) is associated with significantly lower heart rate variability (HRV) and higher heart rate in both older and younger adults, indicating autonomic dysfunction and increased arrhythmic risk.

To protect your heart's electrical health and autonomic function, minimize industrial trans fats (trans-18:2) found in fried foods and baked goods. These are linked to reduced heart rate variability and higher heart rates, which are markers of increased cardiac risk. Unlike industrial trans fats, natural trans fats (trans-18:1) found in dairy and meat do not show these negative effects and may even be beneficial for heart rate variability in older adults.

Physical activity questionnaires (PAQs) and accelerometers demonstrate moderate validity for assessing total physical activity and moderate-to-vigorous physical activity (MVPA) in epidemiologic studies, with PAQs showing particularly strong correlations for vigorous activity.

For researchers and clinicians, using a well-designed physical activity questionnaire (PAQ) is a valid and scalable method for assessing moderate-to-vigorous physical activity in large groups, especially when gold-standard biomarkers like doubly labeled water are too costly. While accelerometers are useful, they may miss certain activities (like swimming or biking) and showed lower validity for vigorous activity compared to PAQs in this study. Combining methods or using validated questionnaires provides a robust estimate of physical activity levels for epidemiological purposes.

Consumption of fermented foods is associated with improved gut microbiome diversity, reduced inflammation, and metabolic health benefits, regardless of whether the product contains live microbes or is pasteurized.

Incorporate a variety of fermented foods (yogurt, kefir, sauerkraut, kimchi) into your diet. You do not need to worry if they are pasteurized; both live and dead microbes (postbiotics) offer benefits. If you have high blood pressure, choose lower-sodium options like yogurt or kefir over salty pickles, and consult your doctor if you are immunocompromised or have histamine intolerance.

Habitual consumption of lower-fat food preparations (specifically roasted chicken) is inversely associated with the liking of high-fat food versions (full-fat chicken and pasta).

If you are trying to reduce fat intake, consistently choosing lower-fat preparations (like roasted chicken) may help retrain your taste preferences. Over time, you may find that full-fat versions taste less appealing or satisfying, making it easier to maintain a lower-fat diet.

Intensive lifestyle intervention (ILI) may be more effective for blood pressure control in individuals with higher BMI (>30 kg/m2), while frequent goal-based pharmacological monitoring may be more effective for those with lower BMI.

For patients with type 2 diabetes and high blood pressure, BMI may influence which treatment works best. Those with a higher BMI (over 30) might benefit more from intensive lifestyle changes, while those with a lower BMI might respond better to frequent monitoring and medication. Discuss your BMI and treatment options with your doctor.

A multidomain intensive lifestyle intervention (ILI) reduces the incidence of self-reported complaints about decision-making and problem-solving abilities in adults with type 2 diabetes who are overweight but not obese.

If you have Type 2 Diabetes and are overweight (but not obese), committing to a structured lifestyle program involving moderate calorie restriction and regular brisk walking (aiming for 175 minutes a week) can help protect your ability to make decisions and solve problems. This benefit was not seen in obese individuals in this study, so weight management strategies should be tailored carefully.

Primary care provider (PCP) referrals significantly increase the likelihood of men proceeding to screening and enrollment in behavioral weight loss trials compared to direct mailings, and PCP involvement is a critical lever for overcoming low male recruitment rates.

If you are a man interested in weight loss, do not rely on unsolicited mailings or ads. The most effective way to join a program is to ask your primary care doctor for a referral. Doctors have the authority to bypass your hesitation and directly connect you to evidence-based support, which significantly increases your chances of actually starting the program.

Omega-3 fatty acids (EPA/DHA) exert antiarrhythmic effects by incorporating into cardiomyocyte membranes and modulating ion channel function.

Consuming omega-3s (from fish or supplements) helps stabilize heart rhythm by changing heart cell membranes. This is a key reason why omega-3s are recommended for heart health.

Modifying the Health Star Rating algorithm to penalize ultra-processed foods (via negative points or score capping) significantly improves alignment with the NOVA classification system, but reduces alignment with current Australian Dietary Guidelines for core food categories like cereals and convenience foods.

Current front-of-pack labels may give a 'health halo' to ultra-processed foods that look nutritious on paper. If you are trying to eat whole foods, look for the NOVA classification or ingredient list complexity, not just the star rating. Be aware that some 'core' foods (like instant oatmeal or plant milks) are ultra-processed and might be penalized by new labeling systems, even if they are currently recommended.

Visceral adiposity, independent of overall BMI, is a significant risk factor for Barrett's esophagus and esophageal adenocarcinoma, mediated by adipokines like leptin and inflammatory cytokines.

Focus on reducing visceral fat through a balanced diet and regular physical activity, even if your overall weight is normal. This can significantly lower your risk of developing Barrett's esophagus and esophageal cancer.

Physical activity attenuates the genetic predisposition to obesity associated with the FTO rs9939609 variant, effectively neutralizing the increased risk of higher BMI and subcutaneous fat area found in carriers of the risk allele.

If you carry the FTO risk gene, you are genetically predisposed to higher BMI, but this risk is not fixed. Regular physical activity and maintaining a healthy energy balance can effectively cancel out this genetic disadvantage. Do not let a genetic test result discourage you; activity is the specific counter-measure for this gene.

Among people with HIV and prediabetes, higher BMI, larger waist circumference, hypertriglyceridemia, and lower CD4 counts are associated with a significantly increased risk of progression to type 2 diabetes.

If you have HIV and prediabetes, your waist size, body weight, and triglyceride levels are strong indicators of your risk of developing full diabetes. Additionally, maintaining a higher CD4 count is protective. You should prioritize lifestyle interventions aimed at weight loss and managing triglycerides, as these are modifiable risk factors that can help prevent progression to diabetes.

Low-carbohydrate diets improve cardiovascular risk markers (triglycerides, HDL, blood sugar, inflammation) and reduce 10-year ASCVD risk scores, despite potential increases in LDL-C in lean individuals.

If you are on a low-carbohydrate diet, expect improvements in triglycerides, HDL, and blood sugar. If your LDL-C rises, discuss with your provider whether it correlates with other risk factors, as overall cardiovascular risk may still decrease.

The 'keto flu' (flu-like symptoms during initial adaptation) can be avoided or alleviated by increasing sodium and mineral intake.

If you feel tired or have headaches when starting a low-carb diet, drink two cups of broth daily to replenish sodium and minerals. This simple step can prevent or alleviate the 'keto flu'.

New antidiabetic drugs with cardiovascular effects (GLP-1ra and SGLT2-in) are underutilized in primary care due to clinical inertia driven by physician uncertainty, guideline complexity, and patient-specific barriers, despite proven efficacy in reducing cardiovascular morbidity and mortality.

For family physicians managing T2D, prioritize prescribing GLP-1 receptor agonists (GLP-1ra) or SGLT2 inhibitors (SGLT2-in) for patients with established cardiovascular disease, heart failure, or chronic kidney disease, regardless of HbA1c levels. Address clinical inertia by using clinical decision support tools and clear guidelines that define specific indications for these drugs. Discuss cost and side effects (e.g., GI issues for GLP-1ra, genital infections for SGLT2-in) openly with patients to improve adherence.

Higher BMI categories (Class I-III obesity) are associated with adverse cardiometabolic profiles, including lower HDL-C, higher triglycerides, higher hsCRP, higher prevalence of hypertension and diabetes, lower physical activity (step counts), and higher mental health distress (PHQ-9/GAD-7 scores) compared to normal weight.

Maintaining a healthy weight is crucial for reducing cardiometabolic risk, but it is not the only factor. Individuals, especially those who are underweight or have obesity, should monitor blood pressure, lipids, inflammation (hsCRP), and mental health. Regular physical activity and managing stress are key components of overall health regardless of BMI category.

A community-based lifestyle intervention program (standard care or intensive) improves lipidemic profiles (cholesterol, triglycerides, HDL) in adults at high risk for type 2 diabetes, with greater effectiveness observed in women, those with higher socioeconomic status, and residents of Southeastern Europe.

If you are at high risk for diabetes, a simple annual health check and counseling session can significantly improve your cholesterol and triglycerides, often matching the results of more intensive programs. However, if you are overweight, live in a region with fewer resources, or struggle with emotional eating and underestimating your weight, you may need more targeted support to see these benefits.

Military operational factors including deployments, restricted food choices, and limited physical exercise opportunities significantly contribute to the development and maintenance of obesity among service members.

If you are in the military, especially in the Navy or on deployment, your environment is designed to promote weight gain through limited fresh food and exercise options. Focus on what you can control within those constraints, such as seeking out fresh food when possible and maximizing movement opportunities, while advocating for better food and exercise access at the unit level.