Browse the evidence

Bariatric surgery procedures (SG, RYGB, BPD/DS) significantly increase the risk of micronutrient deficiencies due to reduced oral intake and malabsorption, necessitating lifelong biochemical monitoring and targeted supplementation.

If you undergo bariatric surgery, you must commit to lifelong blood tests and vitamin/mineral supplementation. This is not optional; surgery changes how your body absorbs nutrients, leading to dangerous deficiencies if not managed. Work with your bariatric team to establish a monitoring schedule (typically every 3-12 months initially, then annually) and adhere strictly to prescribed supplements.

Engaging in 7.5-15 MET hours/week of leisure-time physical activity significantly lowers the risk of seven specific cancer types (colon, breast, endometrial, kidney, myeloma, liver, and non-Hodgkin lymphoma) compared to no activity.

Aim for 7.5 to 15 MET hours of leisure activity per week. This is roughly 2.5 to 5 hours of moderate-intensity activity (like brisk walking) or less time of vigorous activity. This level of activity is associated with a significantly lower risk of colon, breast, endometrial, kidney, myeloma, liver, and non-Hodgkin lymphoma cancers. You do not need to exercise at high intensities to gain these benefits; consistency and total volume matter.

Higher levels of physical activity beyond the recommended 15 MET hours/week do not provide additional cancer risk reduction for curvilinear cancers (kidney, gastric, liver, non-Hodgkin lymphoma), whereas linear cancers (breast, colon, endometrial) continue to show reduced risk with higher activity.

If you already do 15+ MET hours of activity per week, you do not necessarily need to increase it further for cancer prevention, especially for liver, kidney, or gastric cancer risks, as the benefit plateaus. However, for breast and colon cancer, higher levels may still offer additional protection. Focus on consistency rather than excessive volume.

Caffeine consumption reduces total sleep time by an average of 45 minutes and decreases sleep efficiency by 7%, with the magnitude of sleep loss increasing as the dose increases and the time of consumption approaches bedtime.

To protect your sleep, treat caffeine like a timed medication. If you drink a standard cup of coffee (approx. 107mg), stop consuming it at least 8.8 hours before you plan to sleep. If you consume a high-dose pre-workout supplement (approx. 217.5mg), you must stop at least 13.2 hours before bedtime. Consuming caffeine closer to bedtime will significantly reduce your total sleep time and efficiency, regardless of your habitual intake.

Multicomponent non-pharmacological management (combining exercise, education, and weight management) yields larger improvements in pain and function than single interventions for hip and knee osteoarthritis.

For hip or knee osteoarthritis, do not rely on just one treatment. Combine exercise (tailored to your ability), education on self-management, and weight loss support (if needed) into a single plan. This combination works better than any single part alone.

Weight loss interventions (diet, multifocused weight loss, or bariatric surgery) reduce pain and disability in knee osteoarthritis, with bariatric surgery being the most effective pain-reducing intervention.

If you are overweight or obese, losing weight can significantly reduce knee pain and disability. Aim for a 5% weight loss through a combination of diet and exercise. Bariatric surgery is the most effective option for pain reduction if other methods fail.

Subcutaneous semaglutide and SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin) produce the greatest reductions in body weight and systolic blood pressure in patients with type 2 diabetes compared to other glucose-lowering medications.

For patients with type 2 diabetes seeking to lose weight and lower blood pressure, subcutaneous semaglutide and SGLT-2 inhibitors (like empagliflozin or canagliflozin) are the most effective pharmacological options. These drugs offer sustainable benefits over long-term treatment (>= 1 year) and may reduce the need for separate antihypertensive or lipid-lowering medications.

SGLT-2 inhibitors and GLP-1 RAs provide sustainable reductions in body weight and systolic blood pressure for over 52 weeks of treatment, unlike some other agents where effects may diminish.

For long-term management of type 2 diabetes, GLP-1 RAs and SGLT-2 inhibitors are preferred because their benefits on weight and blood pressure are sustained over a year or more. This makes them suitable for patients who need durable control without the weight gain associated with other medications like insulin or sulphonylureas.

Self-reported dietary intake methods (M-BMs) such as 24-hour recalls and food frequency questionnaires are scientifically invalid for establishing diet-disease relations because they measure unverifiable perceptions rather than actual nutrient or caloric consumption.

Do not rely on self-reported food logs or questionnaires to determine your actual nutrient or caloric intake for health decisions. These methods are scientifically invalid for measuring actual consumption. Focus on objective markers (like blood work) or use controlled dietary interventions if precise intake tracking is required, acknowledging that self-reporting is prone to significant error and bias.

Stretching does not meaningfully reduce the risk of sports injuries.

Stop relying on static stretching to prevent injuries. It doesn't work. If you want to stay injury-free, focus on proper technique, gradual progression, and sport-specific dynamic warm-ups instead of static stretching routines.

For patients with type 2 diabetes and established cardiovascular disease, a combination of metformin and a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefits is recommended.

If you have Type 2 Diabetes and existing heart disease, your doctor should prioritize a treatment plan that includes Metformin plus a GLP-1 receptor agonist known to protect the heart. This combination is recommended over other options to reduce the risk of major cardiovascular events like heart attack or stroke.

For patients with Type 2 Diabetes and chronic kidney disease (CKD) or heart failure (HF), a sodium-glucose transporter protein-2 (SGLT-2) inhibitor with proven cardiovascular benefit is advised.

If you have Type 2 Diabetes along with kidney disease or heart failure, ask your doctor about SGLT-2 inhibitors. These medications are specifically advised because they have proven benefits for protecting your heart and kidneys.

Group cognitive behavioural therapy (group-CBT) does not improve long-term weight maintenance or reduce weight regain in overweight or obese adults with type 2 diabetes following a very low calorie diet (VLCD).

If you have type 2 diabetes and have successfully lost weight using a very low calorie diet, adding group cognitive behavioural therapy is unlikely to help you keep the weight off compared to standard diabetes care alone. Standard care includes regular visits with doctors and dietitians, which may already provide enough support for maintenance. Focus on maintaining the dietary habits and physical activity established during the weight loss phase rather than expecting psychological therapy to prevent regain.

Obesity is a chronic, complex, and heterogeneous disease characterized by abnormal or excessive adiposity that impairs health, rather than a simple failure of willpower or lifestyle choice.

Stop viewing obesity as a simple failure of will. It is a chronic disease involving complex biological, genetic, and environmental factors. Focus on treating the underlying causes and improving health markers (like blood pressure and glucose) rather than just chasing weight loss numbers. Seek care from providers who treat you with respect and empathy, not judgment.

Tirzepatide use, particularly with unsupervised dose escalation and caloric restriction, can cause euglycemic ketoacidosis (EKA) in non-diabetic patients.

If you are using tirzepatide, do not self-prescribe or self-escalate doses. Monitor for signs of metabolic acidosis (nausea, vomiting, abdominal pain, fatigue) especially if you are eating very little. Seek immediate medical attention if these symptoms occur, as they can signal euglycemic ketoacidosis, a rare but serious condition.

Tirzepatide treatment in premenopausal women with obesity is hypothesized to increase brown adipose tissue (BAT) volume and activity and induce white adipose tissue (WAT) browning, potentially mitigating the decline in resting energy expenditure typically associated with weight loss.

This paper outlines a clinical trial design, not a consumer guide. It hypothesizes that tirzepatide may help maintain metabolic rate during weight loss by activating brown fat and turning white fat 'beige'. The protocol involves weekly injections starting at a low dose and slowly increasing over 24 weeks, with close monitoring for side effects. No results are available yet.

Semaglutide increases the risk of adverse events, serious adverse events, and discontinuation due to adverse events compared to placebo, primarily driven by gastrointestinal reactions (nausea, diarrhea).

Be aware that semaglutide increases the risk of gastrointestinal side effects like nausea and diarrhea, which can lead to stopping the medication. These side effects are usually temporary and mild to moderate. The risk of discontinuation is higher than with a placebo, so monitoring and managing these symptoms is important for long-term success.

All GLP-1 analogs and agonists are associated with a higher risk of discontinuation due to adverse events compared to placebo, with taspoglutide and high-dose liraglutide having the highest risk.

Be prepared for a higher likelihood of side effects, particularly nausea and vomiting, when starting any GLP-1 medication. This may lead to discontinuation, especially with taspoglutide and high-dose liraglutide. Discuss side effect management strategies with your provider.

Replacing saturated fats with polyunsaturated vegetable oils does not reduce cardiovascular disease, cardiovascular mortality, or total mortality, despite lowering serum cholesterol.

Current evidence from large clinical trials suggests that simply swapping saturated fats for polyunsaturated vegetable oils does not reduce your risk of heart attack or death, even if it lowers your cholesterol numbers. Relying on this substitution as a primary strategy for heart health protection is not supported by the data.

Semaglutide, a long-acting GLP-1 receptor agonist, is hypothesized to reduce arterial stiffness (measured by carotid-femoral pulse wave velocity) and improve cardiometabolic markers in adults with type 1 diabetes.

This paper describes a planned clinical trial, not a finished treatment guideline. It suggests that semaglutide might help people with Type 1 Diabetes who are overweight and have heart risk factors by improving blood vessel stiffness. Patients should discuss this emerging research with their endocrinologist, as the results are not yet available.

Pharmacological therapy should be discontinued if there is a lack of therapeutic response, defined as less than 5% weight loss after 12 weeks of optimal dosing, or if the patient experiences intolerance.

If you've been taking your weight-loss medication at the full dose for 12 weeks and haven't lost at least 5% of your body weight, talk to your doctor about stopping it. Continuing it is unlikely to be effective and may expose you to unnecessary side effects.

Long-term use of semaglutide (GLP-1 RA) may be associated with the development of exocrine pancreatic insufficiency, particularly in patients with concurrent chronic alcohol consumption.

If you are taking semaglutide or similar GLP-1 medications, be aware of potential pancreatic issues, especially if you drink alcohol. Report symptoms like fatty stools (steatorrhea) or abdominal pain immediately. Your doctor should monitor your lipase levels regularly.

SGLT2 inhibitors and GLP-1 receptor agonists provide multi-organ cardiorenal protection beyond glycemic control, with selection prioritized by phenotype (e.g., SGLT2i for heart failure/CKD, GLP-1RA for ASCVD/obesity).

If you have heart, kidney, or metabolic issues, ask your doctor about SGLT2 inhibitors or GLP-1 agonists. These drugs protect your heart and kidneys, not just your blood sugar. Your doctor might even be able to lower your doses of other blood pressure or diabetes pills, reducing your risk of side effects like low blood sugar or dizziness.

Non-steroidal mineralocorticoid receptor antagonists (ns-MRA) like finerenone reduce cardiovascular and renal risks in T2D+CKD patients, with hyperkalemia risk manageable through monitoring.

If you have diabetes and kidney disease, ask about finerenone. It protects your heart and kidneys. Your doctor will check your potassium levels regularly to ensure it is safe for you.