Browse the evidence

Plant-based diets, particularly those emphasizing nutritious plant foods, are associated with a reduced risk of cognitive impairment and dementia compared to non-vegetarian diets.

Shift your diet to center around plants: vegetables, fruits, whole grains, legumes, nuts, and seeds. This pattern is linked to a significantly lower risk of dementia. Ensure you are eating 'nutritious' plant foods, as less healthy plant-based patterns may not offer the same benefits.

Tirzepatide treatment (5-15 mg once weekly) reduces albuminuria (UACR) without causing adverse changes in estimated glomerular filtration rate (eGFR) in individuals with overweight or obesity, with or without type 2 diabetes.

If you have overweight or obesity, with or without type 2 diabetes, tirzepatide (a weekly injection) has been shown to improve kidney markers (specifically reducing albuminuria) without negatively impacting kidney filtration function. This benefit was observed across different doses (5-15 mg) over 72 weeks, alongside lifestyle changes. This suggests it may be a kidney-protective option for this population, particularly those with existing elevated albuminuria.

Multi-receptor incretin drugs significantly reduce systolic and diastolic blood pressure, with Tirzepatide and Mazdutide showing the most substantial reductions, particularly in non-diabetic populations.

If you have high blood pressure along with overweight or obesity, multi-receptor incretin drugs can help lower both systolic and diastolic blood pressure. This effect is often stronger in people without type 2 diabetes. Discuss with your doctor if these medications could help manage your blood pressure as part of your overall treatment plan.

Diabetes remission, rather than weight loss itself, is the primary driver for reducing the risk of new-onset microvascular complications.

While weight loss is important, achieving diabetes remission (normal blood sugar without medication) is what actually protects against microvascular complications like kidney and eye damage. Weight loss without remission may not provide this specific protection.

Obesity significantly increases the risk of cardiovascular disease, heart failure, and cerebrovascular disease, even in individuals classified as 'metabolically healthy'.

If you have obesity, your risk for heart disease and heart failure is significantly higher than someone with a normal weight, even if your blood pressure and cholesterol are currently normal. You should prioritize cardiovascular health monitoring and weight management strategies to mitigate this elevated risk.

High-intensity interval training (HIIT) engages a unique subset of skeletal muscle signaling networks compared to work-matched moderate-intensity continuous training (MICT), specifically involving kinases and pathways associated with plasma lactate levels.

If you are healthy and untrained, HIIT can trigger unique muscle signaling pathways linked to metabolic health (like lactate response) that moderate continuous training does not, even when the total work done is the same. This suggests HIIT is a potent tool for metabolic adaptation.

High-intensity interval training (HIIT) elicits higher plasma lactate concentrations than work-matched moderate-intensity continuous training (MICT) during the exercise bout.

If you do HIIT, you will produce more lactate than if you did moderate continuous training of the same work. This is expected and part of what drives the unique adaptations.

Semaglutide demonstrates superior efficacy compared to Liraglutide in reducing hemoglobin A1c (HbA1c) levels, though it shows no significant difference in weight loss or fasting blood sugar (FBS) reduction compared to Liraglutide.

If you are managing Type 2 Diabetes without metformin, switching from Liraglutide to Semaglutide is likely to improve your blood sugar control (HbA1c) more effectively. However, do not expect significantly more weight loss from this switch alone, as both drugs appear to offer similar weight reduction benefits.

Semaglutide demonstrates superior efficacy compared to Dulaglutide in reducing both HbA1c and Fasting Blood Sugar (FBS), but shows no significant difference in weight loss or BMI reduction.

If you are using Dulaglutide and your blood sugar (HbA1c and FBS) is not well-controlled, switching to Semaglutide may offer better glycemic results. However, if your primary goal is weight loss, switching is unlikely to yield additional weight reduction compared to staying on Dulaglutide.

Higher estimated glucose disposal rate (eGDR), indicating lower insulin resistance, is independently associated with a reduced risk of incident cardiovascular disease in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3.

For individuals with metabolic risk factors (obesity, high blood pressure, or pre-diabetes), improving insulin sensitivity is a primary strategy for preventing heart disease. While eGDR is a clinical metric, the underlying principle is that reducing insulin resistance—through weight management, physical activity, and dietary quality—lowers cardiovascular risk. This benefit is most pronounced in early stages of metabolic dysfunction (CKM 0-1).

Statin therapy is safe and effective for cardiovascular risk reduction in patients with MASLD and MASH, and elevated transaminases should not prevent prescription.

If you have fatty liver disease (MASLD/MASH), do not avoid statins due to fear of liver damage. Statins are safe, effective for heart health, and may even improve liver markers. Consult your doctor for appropriate intensity based on your overall cardiovascular risk.

Once-weekly semaglutide (2.4 mg) significantly improves health-related quality of life and reduces body weight in obese patients with HFpEF.

If you are obese and have HFpEF, ask your doctor about semaglutide (Ozempic/Wegovy). The STEP-HFpEF trial showed that taking 2.4 mg once weekly significantly improved quality of life and reduced body weight by over 13% compared to placebo.

The Edmonton Obesity Staging System (EOSS) provides a more comprehensive clinical management framework than BMI alone by categorizing obesity based on health complications.

Ask your doctor to use the Edmonton Obesity Staging System (EOSS) to evaluate your health. This focuses on your specific complications rather than just your weight.

Next-generation incretin-based therapies (GLP-1 RAs like semaglutide and dual GLP-1/GIP agonists like tirzepatide) significantly reduce blood pressure and improve cardiovascular outcomes in patients with hypertension, obesity, or type 2 diabetes, acting through both weight loss and direct tissue effects on the cardiovascular system.

If you have high blood pressure, obesity, or type 2 diabetes, ask your doctor about GLP-1 or GLP-1/GIP medications like semaglutide or tirzepatide. These weekly injections not only help with weight loss but also directly lower blood pressure and protect your heart, often allowing you to reduce or stop other blood pressure medications. The benefits extend beyond weight loss through direct effects on your blood vessels and nervous system.

Testosterone therapy preserves lean mass and reduces fat mass when used as an adjunct to incretin-based weight loss medications, potentially counteracting sarcopenia.

Current evidence does not yet support using testosterone to offset muscle loss from GLP-1 weight loss drugs. Resistance exercise and adequate protein intake are the recommended strategies to preserve muscle mass during weight loss.

Genetically modeled GLP-1 and GIP receptor agonism reduces the risk of Non-Alcoholic Fatty Liver Disease (NAFLD) and lowers ALT levels.

Genetic evidence suggests that activating GLP-1 and GIP receptors improves liver health by reducing the risk of NAFLD and lowering ALT levels. This benefit is independent of alcohol consumption, suggesting a direct metabolic effect on the liver.

High intake of saturated fatty acids (SFA) from modern domesticated animal products and dairy increases LDL cholesterol and cardiovascular disease risk compared to ancestral diets rich in unsaturated fatty acids.

Prioritize unsaturated fatty acids (especially omega-3s) and fiber-rich foods over high-fat dairy and fatty cuts of domesticated meat. This shift aligns your diet with evolutionary norms and helps lower LDL cholesterol, reducing cardiovascular risk.

High intake of saturated fatty acids from modern diets is linked to endotoxemia and inflammation, whereas unsaturated fatty acids do not produce this response.

Be aware that high-fat meals, particularly those high in saturated fat, can trigger an inflammatory response (endotoxemia). Choosing unsaturated fats helps avoid this inflammatory spike.

Mono- and multireceptor agonists combining proglucagon-derived peptides enhance efficacy in managing obesity, diabetes, and conditions affecting the kidneys, liver, and heart.

New combination therapies that target multiple receptors (e.g., GLP-1/GIP, GLP-1/Glucagon) are showing enhanced efficacy for managing obesity, diabetes, and cardiometabolic conditions. Discuss these advanced options with your healthcare provider if standard treatments are insufficient.

Viscous fiber supplementation (median dose 8 g/day) leads to modest reductions in body weight and waist circumference in individuals on ad libitum diets, primarily through increased satiety and energy excretion.

If you are not strictly counting calories, adding about 8 grams of viscous fiber daily (found in foods like oats, beans, or supplements) can help modestly reduce body weight and waist size by making you feel fuller and slightly increasing calorie excretion.

Incretin-based pharmacotherapies (GLP-1, GIP, and triple agonists) significantly improve metabolic dysfunction-associated steatohepatitis (MASH) resolution and fibrosis regression compared to placebo, primarily through weight loss and insulin sensitization, with some agents showing direct hepatic benefits.

For patients with MASH, incretin-based therapies like Semaglutide (2.4mg weekly) are highly effective at resolving liver inflammation and improving fibrosis, often outperforming placebo in clinical trials. While gastrointestinal side effects are common, they can be managed with careful dosing and dietary adjustments, making these drugs a viable and potent option for those who struggle with lifestyle changes alone.

Tirzepatide provides clinically meaningful HbA1c reduction and dose-proportional weight loss in older adults (≥65 years) with type 2 diabetes who do not have obesity (BMI < 30 kg/m2), without increasing hypoglycemic risk compared to the general population.

If you are over 65 and have type 2 diabetes but are not obese (BMI under 30), tirzepatide is a viable treatment option. It effectively lowers blood sugar and promotes weight loss without increasing the risk of dangerous low blood sugar, provided you are not already on insulin or sulfonylureas. Be aware that gastrointestinal side effects are common, but generally mild, and discontinuation rates due to side effects are slightly higher in this group than in the general population.

A higher proportion of saturated fatty acids relative to total fat intake (SFA/TFAT) is associated with a 23% increased risk of all-cause mortality, whereas a higher proportion of polyunsaturated fatty acids relative to total fat (PUFA/TFAT) is associated with a 14% reduced risk, mediated partially by the neutrophil percentage-to-albumin ratio (NPAR).

To support longevity, focus on the ratio of fats in your diet rather than just cutting total fat. Ensure that polyunsaturated fats (found in fish, nuts, seeds, vegetable oils) make up a larger proportion of your total fat intake, while saturated fats (found in red meat, butter, cheese) make up a smaller proportion. This shift is associated with lower mortality risk, potentially by reducing systemic inflammation.

GLP-1 receptor agonists (GLP-1RA) and dual/triple incretin agonists significantly improve metabolic dysfunction-associated steatohepatitis (MASH) resolution without worsening fibrosis in patients with MASLD, primarily through indirect mechanisms involving weight loss, improved insulin sensitivity, and reduced hepatic lipogenesis.

If you have fatty liver disease (MASLD/MASH), especially with type 2 diabetes or obesity, GLP-1 based medications (like semaglutide or tirzepatide) are currently the most promising pharmacological treatment. They work by reducing liver fat, inflammation, and improving insulin sensitivity. While they may cause temporary stomach issues, they significantly increase the chance of resolving liver inflammation (MASH). The goal is to stop liver damage progression; fibrosis reversal is still being studied in larger trials. Consult a hepatologist or diabetologist for eligibility.