Browse the evidence

The preventive effect of bariatric surgery on type 2 diabetes is significantly influenced by the presence of impaired fasting glucose, but not by baseline BMI.

For obese patients considering surgery, having impaired fasting glucose is a strong indicator that they will benefit from the procedure in terms of diabetes prevention, regardless of their specific BMI.

Gut microbiome composition explains a significant proportion (4-6%) of the variance in blood triglyceride and HDL levels, independent of age, sex, and host genetics.

Your gut bacteria influence your cholesterol and triglyceride levels independently of your genes. While the effect size is moderate, targeting gut health through diet or probiotics may offer a supplementary strategy for managing lipids, particularly HDL and triglycerides.

Higher muscle mass (lean/fat-free mass) significantly increases serum and urinary creatinine levels, whereas serum cystatin C levels remain unaffected by muscle mass variations.

If you have high muscle mass, your standard blood test for kidney function (creatinine) will likely read higher than average, even if your kidneys are healthy. This can lead to false alarms. If you are muscular, ask your doctor to use Cystatin C for a more accurate assessment of your kidney health, as it is not skewed by your muscle mass.

The minimal model method, derived from a modified frequently sampled intravenous glucose tolerance test (FSIGT) with tolbutamide, yields an insulin sensitivity index (SI) that is equivalent to the euglycemic glucose clamp, the gold standard, in normal and insulin-resistant nondiabetic subjects.

For clinical or research purposes, the minimal model method using a modified FSIGT (glucose + tolbutamide) is a valid, equivalent alternative to the euglycemic glucose clamp for assessing insulin sensitivity in nondiabetic individuals, offering a less labor-intensive and costly option without sacrificing accuracy.

Non-alcoholic fatty liver disease (NAFLD) is independently associated with a significantly increased risk of major cardiovascular disease (CVD) events, including fatal and non-fatal outcomes, with risk magnitude increasing with the severity of liver fibrosis.

If you have been diagnosed with NAFLD, you must undergo regular cardiovascular screening, regardless of your cholesterol or blood pressure levels. The presence of fatty liver, especially if fibrosis is present, independently increases your risk of heart attacks and stroke. Aggressive management of cardiometabolic risk factors is essential.

Current dietary guidelines and public health messaging focusing solely on total dietary fiber (TDF) intake quantities are insufficient because they fail to specify which types of fiber or food sources are required to achieve specific health benefits.

Stop counting only the total grams of fiber. Look at the source. To get specific health benefits, you need to consume specific types of fiber from specific foods (like oats for beta-glucans or vegetables for insoluble fiber). Current guidelines often fail to tell you this, so you must look at the food source, not just the number.

There is a significant gap between recommended dietary fiber intakes and actual population intakes across Europe, with few countries providing guidance on specific fiber types to help close this gap.

If you are not meeting your fiber goals, generic advice is likely not enough. Look for specific guidance on which foods to prioritize. The problem is not just lack of will, but lack of clear direction on which fiber sources to target.

Long sleep duration (defined as >8 or >9 hours depending on the study) is significantly associated with increased all-cause mortality and incident cardiovascular disease, stroke, diabetes, and obesity compared to normal sleep duration.

Aim for 7-9 hours of sleep per night. If you consistently sleep more than 9 hours, be aware that this is associated with higher risks of heart disease, stroke, and mortality. Consult a doctor to rule out underlying issues like sleep apnea or depression, as long sleep may be a symptom rather than just a habit.

Gut microbes influence host metabolism and adiposity through signaling pathways involving inflammation (LPS), insulin resistance, and endocrine hormones (GLP-1, GLP-2, PYY).

Your gut bacteria produce substances that signal your brain and body to store fat or become inflamed. A high-fat diet can increase these harmful signals (like LPS), while a diet rich in fiber may support beneficial bacteria that produce hormones (like GLP-1) promoting satiety and metabolic health.

Elevated circulating levels of branched-chain amino acids (BCAAs) are associated with an increased risk of insulin resistance (IR) and type 2 diabetes mellitus (T2DM), acting as biomarkers for these metabolic conditions.

If you are concerned about insulin resistance or type 2 diabetes, simply taking BCAA supplements may not help and could potentially reflect or exacerbate underlying metabolic issues. Focus on overall metabolic health, including diet quality and physical activity, rather than isolated BCAA supplementation, especially if you have obesity or pre-diabetic conditions.

BCAAs, particularly leucine, stimulate muscle protein synthesis via the mTOR signaling pathway, but this effect may be blunted or associated with insulin resistance if circulating BCAA levels are chronically elevated.

BCAAs, especially leucine, do stimulate muscle protein synthesis through the mTOR pathway. However, if you have insulin resistance or obesity, chronically high BCAA levels might contribute to metabolic issues. Focus on a balanced diet and exercise rather than relying solely on BCAA supplements for muscle growth.

Consumption of sugar-sweetened beverages containing fructose or high fructose corn syrup promotes de novo lipogenesis and triggers inflammatory responses leading to hepatocyte apoptosis, directly contributing to the development of nonalcoholic fatty liver disease (NAFLD).

Limit sugar-sweetened beverages, particularly those with high fructose corn syrup or sucrose. The paper links drinking two average servings daily for six months to the development of NAFLD features. Reducing these beverages is a primary dietary intervention to lower liver fat accumulation.

Visceral adiposity is an independent risk factor for developing NAFLD and significant fibrosis, whereas subcutaneous adiposity may be associated with regression of the disease.

Focus on reducing abdominal/visceral fat rather than just total body weight. Measures like waist circumference are strong predictors of NAFLD risk. Losing subcutaneous fat may actually help regress NAFLD, but visceral fat reduction is key to preventing progression.

Long-term adherence to CPAP therapy is associated with a significantly lower risk of developing new-onset hypertension compared to having untreated obstructive sleep apnea (OSA) or no OSA.

If you have Obstructive Sleep Apnea, using CPAP therapy consistently (more than 4 hours per night) is associated with a lower risk of developing high blood pressure over the long term compared to not treating it. While CPAP can be uncomfortable, adherence is key to reducing this cardiovascular risk.

Hypertension is independently associated with an increased prevalence of new diabetes in both men and women, acting as a significant risk factor alongside obesity.

If you have high blood pressure, be aware that your risk of developing diabetes is higher. Regular monitoring of blood sugar levels is recommended to catch any changes early. Managing both conditions through lifestyle and medication is key to long-term health.

Subcutaneous truncal fat is the primary driver of obesity-related insulin resistance in men, whereas intraperitoneal and retroperitoneal fat have a significantly lesser role.

For men, where you store fat matters for insulin sensitivity. Subcutaneous fat in the trunk (abdomen) is a stronger predictor of insulin resistance than visceral (intraperitoneal) or retroperitoneal fat. Focus on reducing overall body fat, as this will likely reduce the metabolically active subcutaneous truncal fat, thereby improving insulin sensitivity.

Fish oil supplements provide a statistically significant but modest reduction in systolic blood pressure (2.3 mmHg) in adults with hypertension.

Taking fish oil supplements containing omega-3 fatty acids (EPA and DHA) can lower systolic blood pressure by about 2.3 mmHg. While the effect is smaller than lifestyle changes, it is a statistically significant benefit. Supplements were taken several times a day, with doses ranging from 0.1 to 17 grams per day.

Moderate carbohydrate intake (50–55% of energy) is associated with the lowest all-cause mortality risk, whereas both low (<40%) and high (>70%) carbohydrate intakes are associated with increased mortality.

Aim for 50–55% of your daily calories from carbohydrates. This range is associated with the lowest risk of death in large long-term studies. Avoid going below 40% or above 70% of calories from carbs, as both extremes are linked to higher mortality.

When carbohydrates are restricted, replacing them with animal-derived protein and fat increases mortality risk, whereas replacing them with plant-derived protein and fat decreases mortality risk.

If you choose to eat fewer carbohydrates, replace them with plant-based proteins and fats (like nuts, vegetables, and whole grains) rather than animal products (like red meat and dairy). This substitution is associated with a lower risk of death.

Creatine supplementation is not deleterious to kidney function in healthy individuals, despite common concerns linking it to kidney damage.

If you have healthy kidneys, you can take creatine safely. It does not damage kidney function, even with long-term use. The common fear of kidney damage is a myth based on confusing creatine with creatinine, a waste product that naturally rises with supplementation.

High-dose niacin (1,500 mg/day) improves the atherogenic lipoprotein profile in type 2 diabetes but may worsen glycemic control, whereas lower doses (1,000 mg/day) have minimal impact on glycemia.

If your doctor prescribes Niacin for your cholesterol, be aware that higher doses might raise your blood sugar levels. Lower doses (1,000mg) seem to have less impact on blood sugar control. Monitor your glucose closely, especially if you are on higher doses, and report any changes to your doctor.

Seven-day estimated-diet records or open-ended food diaries provide individual nutrient intake values most closely associated with 16 days of weighed records, showing no significant differences in average intakes, whereas food-frequency questionnaires are not appreciably better than 24-hour recalls for ranking individuals.

If you need to know your exact nutrient intake for health reasons, a 7-day estimated record or open-ended food diary is far superior to a food-frequency questionnaire or a single 24-hour recall. While food-frequency questionnaires are popular for large studies, they fail to accurately rank individuals' habitual diets. For personal accuracy, spend one week meticulously recording what you eat, using portion size estimates or photos if possible, as this correlates closely with the gold standard of weighed records.

Chronic insomnia combined with objectively measured short sleep duration (≤5 hours) significantly increases the risk of hypertension, whereas insomnia with normal sleep duration (>6 hours) does not.

If you have chronic insomnia, do not rely on how you feel about your sleep. Get an objective measure of your sleep duration (e.g., via actigraphy or sleep study). If you are sleeping less than 5 hours, your risk for high blood pressure is significantly elevated. This risk is not present if you sleep more than 6 hours despite the complaint. Treat this as a medical risk factor, not just a quality-of-life issue.

Long-term Roux-en-Y gastric bypass (RYGB) and vertical banded gastroplasty (VBG) induce durable, BMI-independent alterations in the gut microbiome that causally reduce fat mass deposition and shift host metabolism toward lipid oxidation.

Bariatric surgery (RYGB/VBG) causes long-lasting changes to gut bacteria that actively reduce fat storage and shift the body to burn more fat for energy. These changes persist for years and are not just due to eating less. The microbiome plays a direct causal role in reducing adiposity, independent of final BMI.