Magazine | Type 1 Diabetes and Exercise: Importance, Challenges, and Future Directions

Type 1 Diabetes and Exercise: Importance, Challenges, and Future Directions

Written by Sam Scott · 7 min read

A Global Trend in Diabetes Prevalence

Diabetes is a growing global health challenge. According to the latest International Diabetes Federation statistics, approximately 589 million people worldwide are currently living with diabetes, a number projected to rise to 853 million by 2050. Diabetes manifests in several forms, with type 1 and type 2 being the most prevalent. Type 2 diabetes accounts for about 90% of all cases, half of which are managed with medications that carry a risk of hypoglycaemia, primarily insulin. Type 1 diabetes, affecting an estimated 9 million individuals globally, is the most common endocrine condition among children and young adults.

What is Type 1 Diabetes and what does it mean for those living with the condition?

Type 1 diabetes is a chronic autoimmune condition that targets and destroys the β-cells in the pancreas, which are responsible for producing insulin. Insulin is crucial for regulating blood glucose levels, and without it, the body struggles to manage glucose effectively.

For those living with type 1 diabetes, managing blood glucose levels is a daily challenge. The goal is to spend as much time as possible within a safe target range, typically between 3.9 and 10 mmol/L (70 and 180 mg/dL). Straying outside this range can have serious health implications, making constant vigilance a necessity. This involves a complex interplay of diet, activity, and medication to maintain a healthy, active life.

Living with type 1 diabetes is a 24/7 challenge, with no breaks or days off. It has been estimated that someone living with type 1 diabetes must navigate an additional 200 decisions every single day, from counting carbs and insulin dosing to checking glucose levels. The relentless demands can be overwhelming, significantly impacting quality of life. Beyond daily management, there is an ever-present concern about potential complications such as vision impairment, nerve damage, kidney failure, and an increased risk of heart attacks. These challenges affect both physical health and mental well-being.

Why Physical Activity and Exercise are Important for People with Type 1 Diabetes

Physical activity plays a pivotal role in diabetes care. It aids in weight management, lowers blood glucose levels, and improves insulin sensitivity. Regular exercise also reduces the risk of cardiovascular disease and offers numerous psychological benefits. A proactive approach enhances well-being and is cost-effective for public health systems by reducing long-term treatment costs and diabetes-related complications.

The World Health Organization recommends that people with diabetes engage in 150-300 minutes of moderate or 75-150 minutes of vigorous physical activity per week. Unfortunately, many struggle to meet these guidelines, often due to motivational challenges, logistical difficulties, and limited support. For those on insulin therapy, fear of hypoglycaemia (dangerously low blood glucose levels) and the complexity of managing glucose levels around exercise present additional barriers.

A (very) brief overview of the Effect of exercise on blood glucose in type 1 diabetes

Exercise can lower or raise blood glucose levels. During exercise, blood glucose can decrease due to muscles using glucose as energy and increased insulin sensitivity. However, blood glucose can also increase due to the release of other hormones such as adrenaline. Everyone's diabetes is different, and individuals react differently to exercise. It is crucial for people with diabetes to understand how their blood glucose responds to exercise to manage these fluctuations and prevent hypoglycaemia or hyperglycaemia. Exercise must always be prepared for in advance, and insulin or food adjustments might be needed to stay within the optimal blood glucose range.

But exercising with diabetes is possible with the right level of support.

Managing diabetes and maintaining an active lifestyle is achievable. In my career to date, I’ve had the incredible opportunity to work with elite and professional athletes living with type 1 diabetes across a variety of sports. I’ve also completed doctoral and postdoctoral research focused on helping people with diabetes exercise safely and effectively.

Key Considerations Before and During Your Workout

Here are some key aspects of glucose management before and during exercise:

Starting Blood Glucose Concentration: Check your glucose levels before exercising and understand how to interpret and act on these levels.
Exercise Modality: Consider the type, intensity, and duration of exercise.
Managing Insulin on Board (IOB): Make insulin adjustments as needed and account for insulin already delivered and active in your system.
Nutritional Considerations: Understand the impact of consuming carbohydrates and other macronutrients before and during exercise.
Timing of Exercise: Consider the time of day you exercise and how it relates to the timing of meals.
Impact of Previous Events or Activities: Consider any recent exercise or episodes of hypoglycaemia.
Technology: Tools for monitoring blood glucose levels and managing insulin delivery.

Exercising Under variable or Challenging Conditions for the Athlete with Type 1 Diabetes

Sport can be unpredictable. Factors such as competition stress or changes in environmental conditions can significantly impact glucose management. Even if you are not a competitive athlete, numerous scenarios can dramatically affect your glucose levels or require additional considerations. These may include changes in altitude or temperature during winter sports, variables related to playing recreational sports, or scuba diving while on holiday. When exercise conditions vary, it is essential to be strategic and consider specific factors to manage glucose levels effectively.

Pre-Competition Stress and Hyperglycaemia-Related Anxiety

Athletes often experience stress or anxiety before a competitive event, which, for those living with type 1 diabetes, can significantly impact blood glucose levels. Stress hormones such as adrenaline and noradrenaline trigger a significant increase in glucose levels. In response, athletes might adjust their insulin management or avoid carbohydrates, fearing a further rise in glucose levels. This can backfire, resulting in insufficient fuel consumption during the event and potentially impairing performance.

Competition stress remains understudied and underreported, but it is crucial for athletes to monitor how glucose levels respond to specific stressful situations. Developing a pre-competition strategy tailored to individual needs, including meal timing, insulin management, and starting blood glucose levels, is essential. Sports psychology support can also help reduce stress and prepare the athlete mentally for the event.

Exercising in High Temperatures

In high temperatures, insulin absorption from the injection site may speed up due to the dilation of blood vessels, enhancing blood flow to the skin and extremities for heat dissipation. This increased absorption rate can lead to a more rapid onset of insulin action, elevating the risk of hypoglycaemia. At the same time, the body's demand for glucose may increase due to the increased energy requirements for thermoregulation and the intensified metabolic rate during exercise. These factors make it challenging for individuals with type 1 diabetes to predict their blood glucose response to exercise in hot environments, underscoring the need for vigilant glucose monitoring and proactive management strategies.

Exercising at Altitude

The reduced oxygen levels at altitude can impair physical performance and alter the body's response to insulin, making blood glucose management more complex. The initial stress of high altitude can activate the sympathetic system and trigger the release of counterregulatory hormones, leading to hyperglycaemia. Conversely, after some time at high altitude, the risk of hypoglycaemia increases due to hypoxia-induced enhanced insulin sensitivity with potentially increased glucose uptake by muscles. Additionally, the symptoms of altitude sickness can mimic or mask those of hypoglycaemia, making it difficult to distinguish between the two. Therefore, people with type 1 diabetes must be vigilant in monitoring their blood glucose levels, adjusting insulin doses accordingly, and staying hydrated while exercising at high altitudes.

Exercising in Cold Temperatures

Cold temperatures can slow down insulin absorption from the injection site due to vasoconstriction, which reduces blood flow to the skin and subcutaneous tissue, leading to a delayed onset of insulin action and increasing the risk of hyperglycaemia during exercise. Cold temperatures can also affect the functionality of insulin pumps and continuous glucose monitors (CGMs), potentially leading to device malfunctions or inaccurate readings.

The Future of Diabetes Management and Sport

Digital wearables, such as exercise trackers, hold great potential for enhancing physical activity adoption and improving diabetes care when integrated with diabetes technology. By offering real-time activity data, boosting motivation, and facilitating informed decision-making around exercise and glucose levels, these tools may empower individuals to increase physical activity levels. As the field continues to evolve, addressing current challenges and establishing a robust evidence base will be crucial to maximizing the benefits of these innovative technologies.

By leveraging AI technology and clinical expertise, new tech may empower users to optimise their health and performance, achieving remarkable results. AI-powered platforms have the potential to revolutionise how people with chronic conditions manage their health. By providing personalised, accessible guidance, these platforms empower individuals to take control of their health and achieve their goals.

Published: July 11th, 2025

References

1. T1D Index

2. The Diabetes Atlas

3. Type 1 diabetes

4. Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults

5. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study

6. Physical Activity and Diabetes

7. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review

8. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association

9. Impact of Physical Activity on Glycemic Control and Prevalence of Cardiovascular Risk Factors in Adults With Type 1 Diab...

10. Exercise management in type 1 diabetes: a consensus statement

11. Exercise-induced fall in insulin: mechanism of action at the liver and effects on muscle glucose metabolism

12. Malcolm, G., et al. – Managing diabetes at high altitude: personal experience with support from a Multidisciplinary Physical Activity and Diabetes Clinic

13. Bergford, S., et al. – The Type 1 Diabetes and EXercise Initiative: Predicting Hypoglycemia Risk During Exercise for Participants with Type 1 Diabetes Using Repeated Measures Random Forest

14. Riddell, M. C., et al. – Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: The higher they start, the harder they fall

15. Riddell, M. C.–Peters, A. L. – Exercise in adults with type 1 diabetes mellitus

16. Moser, O., et al. – Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes

17. Brar, G., et al. – Practical considerations for continuous glucose monitoring in elite athletes with type 1 diabetes mellitus: A narrative review

18. Koufakis, T., et al. – The Effects of High Altitude on Glucose homeostasis during short-term and prolonged exposure to high altitudes

19. de Mol, P., et al. – Physical activity at altitude: challenges for people with diabetes: a review

20. Dugan, C. W., et al. – Effects of Simulated High Altitude on Blood Glucose Levels During Exercise in Individuals With Type 1 Diabetes

21. Oberg, D.–Ostenson, C. G. – Performance of glucose dehydrogenase‑ and glucose oxidase‑based blood glucose meters at high altitude and low temperature

22. Hill, N. E., et al. – Continuous Glucose Monitoring at High Altitude‑Effects on Glucose Homeostasis

23. Brubaker, P. L. – Adventure travel and type 1 diabetes: the complicating effects of high altitude

Author: Sam Scott

Sam Scott is the CEO and Co-Founder of Enhance-d, which helps people with diabetes exercise by providing guidance, coaching and community. Sam has a PhD in Exercise Physiology with clinical and applied research experience in the field of obesity, diabetes, and continuous glucose monitoring technology. As an academic, his primary research focus has been on developing strategies to overcome the major barriers to exercise for people living with diabetes.

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Exercise

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13 min read

Top 10 supplements for losing weight

Sorry, but Pizza eats Supplements for Breakfast – what supplements really do for body fat reductionTable of ContentsWhy this article? A little warning against expecting miraclesThe foundation of body fat reduction: energy, nutrition, movementWhy a calorie deficit sometimes isn’t enough: metabolism, genetics, hormones, and moreNo shortcut: what supplements (don’t) doMedical shortcuts and risky experimentsTop 10+ Supplements for weight loss: effects, evidence, risksConclusion: If you do it – do it with a plan, not pill fantasies1. Why this article? A little warning against expecting miraclesI remember a conversation with a friend – let’s call him Tom. Tom wanted to lose weight. Fast. After three days of green shakes and apple cider vinegar capsules, he said frustrated in the café: “I’ve tried everything, nothing works!” – Spoiler: pizza at lunch, iced coffee in the afternoon, chips in the evening. So if you’re looking for the magic supplement that melts body fat like butter in the sun – you’re in the wrong place. But if you want to know what actually helps (and what can support you), then read on.2. The foundation of body fat reduction: energy, nutrition, movementCalorie deficit: essential! You'll lose body fat when you consistently consume fewer calories than you burn: probably 10-25%. You can reduce intake (nutrition) and/or increase output (exercise). But make sure, that you don't run into micronutrient deficiencies (vitamins, minerals and trace elements, fatty acids and amino acids) by limiting your caloric intake as this could lead to situations described in Chapter 3!Nutrition: many paths lead to Rome. Critical is finding a way you can sustain long-term:Keto/Low Carb diet lowers carbs to enhance fat burning.Mediterranean diet: lots of veggies, healthy fats, little sugar – one of the best studied and most sustainable. Heads-up: daily pizza or huge spaghetti carbonara servings don’t really count.Vegan may be low-calorie and rich in fiber/nutrients – or not: fries and chips can be vegan too, but they’re rarely low-calorie or healthy.Most or even all of these diets have at least two principles in common, when it comes to health and healthy metabolism: avoid ultra processed food and sugar! Prioritize natural/organic food, especially vegetables because they contain a lot of fibre, among other things.High protein intake: worth emphasizing: a protein-rich diet helps in multiple ways: increases satiety, protects muscle (key if you're in caloric deficit and training), boosts calorie burn via the thermic effect, reduces cravings, and may increase GLP-1. Bottom line: a high protein intake leads to easier and more sustainable weight loss!Cutting out extras: consciously, not dogmatically: often it’s the snacks – that flavored latte, a cake in the afternoon, a softdrink after work, some chips on the sofa – that tip us over. Removing just one habit saves ~300–500 kcal/day – without major sacrifice.Intermittent fasting: eat less often – give your body some time to tap fat stores. Start by stopping snacking in between your main meals. Than try to skip a meal. Many find it a simple way to eat less and eat more mindfully. But it’s not for everyone – some overeat later and undo the benefit.Blood sugar stabilization: start your meals with fiber and/or protein and end it with (complex) carbs – and your glucose thanks you. Less cravings, steadier energy, better fat burning. And better break your fast and start your day with a savory meal than with a sweet one. Natural helpers:Apple cider vinegar before carb-rich meals significantly can blunt glucose spikes – 1 tbsp in water, ~15 min before eating.Ceylon cinnamon (not Cassia) may improve insulin sensitivity and slow glucose uptake – try it in yogurt, oatmeal, quark.Also, specific “anti-spike” or “glucose-control” supplements are available to take before carb-heavy meals.An even more easy hack: within 30 minutes after eating, move – digestive stroll, squats, whatever signals your body that those carbs are needed to move, not to store them!Spicy spices: ginger, black pepper, capsaicin (e.g., chili) have mild thermogenic effects – upping short-term energy expenditure, circulation, and metabolism. Not a game-changer, but helpful and adds some flavor to bland diet meals.Water: drinking plain water is healthy; studies suggest it supports fat metabolism and weight loss. ~0.5 L about 30 min before meals helps reduce appetite. Avoid sugary soft drinks, (high amounts of) juices and of course: drink no alcohol as it causes stress to your body, disturbs your sleep and your fat burning. Deliberate Cold Exposure: cold showers, ice baths – boost short-term energy use, may activate beige/brown fat which increases metabolism, and build stress resilience. Not for wimps – but can help.Of course: Exercise! Strength training increases muscle mass which increases resting metabolism long-term.Zone-2 cardio effectively burns calories and especially fat.HIIT (e.g. Tabata Intervals) is time efficient and boosts post-workout calorie burn.Some additional hacks:Bit size "Exercise Snacks" throughout the day (e.g. 10 squats every 45 minutes) improve glucose regulation and more. Do "Soleus Push-ups" while sitting at your office desk – they seem to boost metabolism and improve glucose regulation!Wearing weighted vests can help to lose weight and could even help to maintain the reduced weight long term!And move throughout the day: go by feet instead of taking the car or bus/subway for short distances, take the staircase instead of the elevator, etc. If you are waiting for the train or a flight: do some exercise snacks. Make moving a habit!Last but not least: Sleep and recovery! If you sleep poorly, produce lots of cortisol, and run permanently on sympathetic drive – you don’t need any fat-loss pills; you need relaxation first! 3. Why a calorie deficit sometimes isn’t enough: metabolism, genetics, hormones, and more“Eat less, move more” – sounds simple, but often just isn’t. Especially frustrating when you’re doing everything right: counting calories, maintaining a deficit, training – but your body holds onto fat stubbornly.Welcome to the world of metabolic flexibility – or its absence.A flexible metabolism can switch between carb and fat-burning as needed. Many people lose this ability due to years of overeating, chronic stress, lack of sleep, constant snacking. The body can’t efficiently tap stored fat – even when you’re in a caloric deficit.Another limiter: (chronic) inflammation:Inflammatory mediators like TNF-α, IL-6, CRP impair insulin sensitivity: glucose uptake drops, blood sugar stays high, fat burning stalls.They also hamper mitochondrial function: lower energy use, less thermogenesis, reduced fat burning.Beware of the vicious cycle: Visceral fat isn’t just energy storage – it’s hormonally active and releases pro-inflammatory cytokines. To some degree it's the body “disposing or containing” harmful substances there. But when it isn’t reduced, chronic inflammation builds, causing systemic stress and further insulin resistance and metabolic issues.It could also make sense to take a look at your digestive system and esp. at your gut microbiome: an unbalanced microbiome or a leaky gut can impact hormones, lead to low-grade (chronic) inflammation and insulin resistance, to elevated cortisol levels, and to decreased fat oxidation. Also hormonal brakes can lock on:Insulin: slight elevation prevents fat breakdown.Cortisol: stress/inflammation elevate it → blood sugar rises, appetite spikes, muscle breaks down, especially stubborn belly fat resists burning.Leptin & Ghrelin: satiety/hunger hormones go haywire (lack of sleep, crash diets, inflammation) → constant hunger despite sufficient energy.Thyroid hormones: slow metabolism from hormone underperformance makes fat loss harder – even with discipline.Estrogen/Testosterone: they both affect how much and where fat is stored.What could help?If suspected, test inflammation markers, gut microbiome and/or hormones in labs. Then aim for targeted optimization: reduce inflammation, harmonize gut microbiome and/or normalize hormones. And then gradually restore metabolic flexibility:Sleep and stress management: relaxation (e.g. by mindfulness, meditation, yoga, breathwork, … and maybe with the help of adaptogens and other supplements) is not a bonus – it's a prerequisite.Blood sugar stabilization: order of eating, post-meal movement, maybe some specific supplements.Metabolic flexibility training: intermittent fasting, fasted training (especially zone-2), targeted low-carb phases.A caloric deficit is necessary – but useless if your body’s in “bypass mode.” Then you need not more discipline, but a smarter strategy.Also, genetic predispositions (e.g., LEPR, FTO, PPARG, MC4R, ADRB3, ATGL, AMY1, DRD2) can make weight loss easier or harder, or make certain strategies work better for your biology. A DNA test can offer clues – or find your best personal strategy via small experiments.4. No shortcuts: what supplements (don’t) doSupplements aren’t the solution – but they can be a tool to support you reaching your goals. They can:Curb appetiteStabilize blood sugarSupport thermogenesisEnhance digestion & satietyBut: if the foundation isn’t solid, they’re just wasted money.And of course – specific – supplements can also help you to build the foundation by getting rid of micronutrient deficiencies, by lowering (chronic) inflammation, by harmonizing your gut microbiome, and by modulizing your hormones. But that's another story or another article.5. Medical shortcuts and risky experimentsOzempic & co. – effective and prescription-only for a reason! Only under medical guidance!SARMs, peptides, “fat burners” from “gray” markets – experimental, sometimes illegal, often risky.6. Top 10+ Supplements for Weight Loss: Effects, Evidence, RisksQuick note: effects vary widely per individual – see Chapter 3 for why!CaffeineEvidence & EfficacyMany studies show caffeine boosts energy expenditure, increases fat metabolism during exercise, and temporarily suppresses appetite. It can enhance performance in endurance and strength workouts.Risks & Side EffectsAvoid caffeine in the afternoon or later as it disturbs your sleep. High doses can cause jitters, racing heart, sleep issues, and tolerance – especially in stressed individuals or evening consumers. Combining with L‑Theanine or Taurine can reduce jitteriness. Dosage200 to 400 mg before workouts, max 400 mg daily (~4 cups of coffee). Take L‑Theanine at a 1:1 or 2:1 ratio (ex: 200 mg Theanine to 100 mg Caffeine).Green Tea Extract (EGCG)Evidence & EfficacyEGCG offers moderate effects on fat loss and metabolism, especially in combínation with caffeine. Risks & Side EffectsHigh doses risk liver damage, stomach upset. Combined with caffeine, effects may amplify – both good and bad.Dosage300–500 mg daily.BerberineEvidence & EfficacyCan lower blood sugar, boost insulin sensitivity, and produce modest weight loss.Risks & Side EffectsDigestive issues; interacts with metformin, anticoagulants, liver enzymes; not advised in pregnancy.Dosage500 mg, up to three times daily with meals (or 30 min before a meal to blunt glucose spikes).Fiber (Psyllium Husk / Beta Glucan / Glucomannan)Evidence & EfficacyFiber promotes satiety and leads to moderate weight loss over months via reduced calorie intake – also stabilizes blood glucose.Risks & Side EffectsInitial bloating, fullness, occasional diarrhea. Choking hazard if not enough water.DosagePsyllium Husk: 7 to 15 g per day in total, 30 min before a meal with at least 250 ml water. Beta Glucan: about 3 g per 30 g of carbs with 250 ml water, 30 min before a carb rich meal. Glucomannan: 1 g with at least 250 ml water, 30 min before a meal. Start small and increase gradually if your fiber intake was previously low.L‑CarnitineEvidence & EfficacySupports transport of fatty acids to mitochondria, boosts endurance, may aid fat loss when combined with training.Risks & Side EffectsGenerally well-tolerated; may cause mild stomach upset, fishy odor. Potential concerns about TMAO (hint: aged garlic extract could help). Use with caution if you are on thyroid or blood-thinning meds.Dosage1 to 2 g daily, split into 2 to 4 doses, ideally before training.Probiotics Evidence & EfficacySpecific strains like Lactobacillus gasseri and Bifidobacterium breve have shown to reduce visceral fat and measurements. Positive effects seen in 4 to 12 weeks.Risks & Side EffectsSafe for healthy individuals; immunocompromised should be cautious. Possible mild bloating or diarrhea.DosageAt least 1 billion CFUs daily, preferably both strains. For blood sugar, studies suggest better results at 40 billion CFUs/day and more.MCT OilEvidence & EfficacyPromotes ketosis (esp. with fasting), provides quick satiety and energy, supports endurance and fat loss. Pairs well with caffeine in “fat coffee.”Risks & Side EffectsHigh doses may cause nausea, diarrhea, bloating. DosageReplace(!) 15 to 25 g of other fats daily with MCT Oil – don’t just add it to your diet! (Do you remember? Caloric deficit!) Great pre-workout fuel or late-fasting energy boost.5‑HTP (5‑Hydroxytryptophan)Evidence & EfficacyMay reduce cravings – especially emotional eating and serotonin deficiency. Studies show notable appetite reduction.Risks & Side EffectsCan lower blood pressure, cause nausea, headaches; potential serotonin syndrome with antidepressants (SSRIs/MAOIs). Use caution with serotonin-affecting medications.Dosage200 to 300 mg on an empty stomach, up to three times daily, 30 min before meals.Green Coffee ExtractEvidence & EfficacyGreen Coffee contains chlorogenic acid, which may impact glucose metabolism and reduce fat absorption in the gut. Small studies suggest moderate weight and fat loss, reduced appetite, and improved insulin sensitivity – especially in overweight individuals, with stronger effects in women. But data is still limited.Risks & Side EffectsGenerally safe and well tolerated. May contain caffeine – could cause jitters, sleep disturbances, stomach upset. Chlorogenic acid in high amounts may cause digestive issues.Dosage400 to 800 mg extract (standardized to 45–55% chlorogenic acid) daily, for at least 4 weeks.YohimbineEvidence & EfficacyMay mobilize stubborn fat – especially with fasting or fasted training and in synergy with caffeine. Evidence is still limited. Nothing to start with!Risks & Side EffectsA stimulant, that can raise blood pressure, heart rate, nervous system effects – jitters, sleep issues. Not suitable for those with cardiovascular issues, anxiety, or stress.DosageAbout 10 to max 20 mg daily (~0.25 mg/kg body weight), taken on empty stomach (minimum 90 min after food), ideally 30 min pre-training.Almost made the list (but didn’t quite):Yerba Mate – contains caffeine (less if cold brew); may suppress appetite, mobilize fatty acids, increase GLP‑1. Small trials show slight weight loss. Good water/tea alternative to sugary drinks but don't expect too much impact!CLA (Conjugated Linoleic Acid) – meta-analyses show small but significant subcutaneous fat loss. Slight increases in fasting blood sugar & AST; inconsistent anti- vs pro-inflammatory effects.African Mango (Irvingia Gabonensis) – small studies show reduced appetite, moderate weight & waist loss over 8–12 weeks, especially visceral fat. Evidence is still limited.Garcinia Cambogia – studies show modest weight/fat loss and waist reduction, but some case reports of liver damage. Doses vary; hard to define safe/effective amount.Fucoxanthin – only one promising human study so far; not yet replicated.Coleus forskohlii (Forskolin) – some promising but mixed/low-quality studies; effect not convincingly proven.Synephrine (Bitter Orange) – hypothesized to promote fat burning like ephedrine. No high-quality solo studies; long-term safety/efficacy uncertain.Raspberry ketones – no human studies show effect beyond placebo so far; animal studies indicated significant side effects at high doses.7. Conclusion: If you do it – do it with a plan, not pill fantasiesSupplements are tools, not replacements for a solid foundation: calorie deficit, movement, sleep, and stress management are the base. Each addition should be tailored to your health, medications, and goals.Doing everything else the same and popping a few capsules to lose weight is like trying to fix a toxic team culture with a ping-pong table: well-intentioned, but barely effective.And if you do have your basics in order, the right supplement – used smartly – can squeeze out a few more percent or get you there a bit faster.But let’s be clear: only a few percent.

Cancer

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13 min read

When the Doctor Becomes the Patient — A personal story about circulating tumor cells, radical cancer screening and learning to live with uncertainty.

I’m about to do something I’ve never done in writing before. Share something deeply personal.What you are about to read is my experience with aggressive cancer screening. My rational strategies. My emotional roller coaster ride. My story. But first a bit of background.Hi there.You might not know me yet. My name is Johan Hedevåg. I’m a longevity physician and health tech entrepreneur based in Stockholm, where I run Revi Health. Our clinic focuses on stemcells, metabolic & hormonal health and the art of longevity. Why is this relevant?You’re about to find out.Just another day?This story starts on a normal day in April. Ever-changing weather, not unlike most other April days. Little did I know, it would be the beginning of a very special journey. One of hope and despair. Of beauty and cancer.I was evaluating different offerings to include in our ultra high end health check.I had already settled on:Extensive blood workDexa scanFull-body MRIPerformance tests including grip strength and VO²maxUltrasound of all jointsColonoscopyCT-angiogramFull physical with doctorNext on the list of things to evaluate? Liquid biopsy.For those unfamiliar, let’s take a quick detour.What are liquid biopsies?A liquid biopsy is a simple blood draw, aiming to detect signs of early stage cancer.These tests don’t diagnose cancer. But they may detect signs that warrant further investigation — sometimes years before a tumor becomes visible.There are a few technologies available in this space. The main ones look for:Circulating Tumor Cells, CTC.Most tissue release cells into the blood stream, called circulating cells.This technology identifies circulating cells that resist apoptosis — our body’s way of clearing abnormal cells. That resistance is a red flag. These are very likely circulating tumor cells.Next, it dyes the cell surface and looks for specific markers (e.g. EpCAM, PanCK or CD45-) to identify the type of cell and its origin. Is it perhaps an epithelial cell or a mesenchymal cell?Circulating Tumor DNA, ctDNA.Stressed or dying cells release DNA into the blood stream. This is called cell free DNA, cfDNA.This technology detects cfDNA with mutated genes, known to be associated with cancer tumours. These snippets of DNA are called ctDNA.If DNA with a specific mutation is found, its origin can then be determined based on a large database of known mutations. Does it come from the Lungs or from the Pancreas?Moral of the quick detour? Neither technology is perfect but both are very promising.Back to the story.I had decided to evaluate one CTC test, called Trucheck, and one combined CTC and ctDNA test called Trublood. Both tests provided by Datar Cancer Genetics.A patient of mine, who had previously undergone Prostate cancer, asked me to take the Trublood test to see if ctDNA was present (can indicate a higher risk of cancer recurrence). I said yes.The Trucheck test, I took on myself.The process was smooth, both tests were sent to the UK for analysis and I went on to focus on other things.A couple of weeks passed by.A mixed bag of unpleasant feelings. May 12th, 9.53 pm.I was sitting in my living room couch, finishing up some work. I was tired. Bed time was imminent. Just one more email to go through…“Ah, from Datar Cancer Genetics, great.”I clicked on the attached PDF with my name on it, unlocked with the encryption key and started reading. Something caught my eye right away.☑ Circulating Tumor Cells (CTCs) detected, indicating higher risk of presence of cancer.“Wait a minute. That can’t be right.”My head started spinning. It was my first time reading a report like this, was I missing something. I continued to read.☑ Probability of Carcinoma.☑ Organ of origin could not be determined.“What the hell is going on? Clearly this must be a mistake.”My rational mind kicked in. Deep breath. Double and triple check!“Okay. It does say CTCs detected. What’s the plan?”Is it possible that the results got mixed up somehow?Can it be a false positive?Another deep breath. Let’s think this through.“My blood was shipped in the same cooling box as my patient’s. Room for error! Although, I did attach the labels on the test tubes myself and I’m 100% sure I didn’t mess that up. Still, I need to speak to the lab about it.”Keep breathing. Keep thinking.“Trucheck covers 80% of all solid tumours with a specificity of 96-99%. What hides in the missing percentages? What about the specificity for cells with the same markers as mine?”Immunocytochemistry AnalysisI turned to my personally trained chatGPT sparring partner.I'm analysing the results of a liquid biopsy. What's EpCAM and PanCK?Long answer. I focused. Keep reading. Keep processing.“They are surface proteins of epithelial cells. Got it. Remember to breathe.”Does this specific staining impact the overall specificity in any direction?Short answer.“If anything, it means that the specificity is higher.”I stopped breathing.🧠 Realisation 1: It’s very, very likely that I have a cancer tumour.I started breathing again. It was time to become a rational agent.“What’s the plan Johan? What’s the plan?”This is the plan.I held my breath for most of the time when coming up with it.Phase 1: Understand possible tumour origins.Phase 2: Set up a diagnostic protocol.Phase 3: Identify and implement strategies to:Do things that surpress tumour growthAvoid things that promote tumour growthDo things that promote general healthAvoid things harmful to general healthPhase 1: Possible tumour origins.I continued my chatGPT dialogue.If these markers are positive, what are the likely origins of the tumor?A structured answer.Tumor origins by markersGreat, thank you.I then went through my cancer heredity.Father: Malignant melanoma in his 60s. Survived.Mother: No known cancer.Grandfather on father's side: Prostate cancer at the time of death in his early 70s.Grandmother on father's side: Died of Pancreas cancer in her 50s.Uncle on father's side: No known cancer.Grandfather on mother's side: Died of lung cancer in his late 60s.Grandmother on mother's side: Breast cancer in her 60s. Survived.Uncle on mother's side: Colon cancer in his early 60s. Survived.That’s my entire blood related family (excluding my 2 children and my 4 cousins)“Not a pretty list.”🧠 Realisation 2: Most of the plausible cancer types run in my family.“That doesn’t matter. I’m a rational agent. Move on to the next phase 2.”Phase 2: The diagnostic protocol.I listened to myself and got to work.First step of a diagnostic protocol: Understand probability of origin.Second step: Cross run probability of origin with probability of death.Third step: Stack rank selected diagnostic procedures.Fourth step: Execute.I created a first version of a weighted probability estimate of different cancer types. It was based on population prevalence, heredity and personal characteristics (age, gender, lifestyle, medical history etc.).As before, I had the support of my beloved AI companion.Personalized cancer risk estimatesStep 1 was done. Drafts of step 2 and 3 started to take shape. I was not aiming for perfect. Plenty of room to iterate along the way.“I can do this. In fact, I’m in a unique position to do this. One of very few who can act on this information.”Time to take action.But first sleep.I went to bed. It was late and my brain was fried. Didn’t think I would be able to sleep but I passed out within minutes.Next morning.“I slept better than expected. Good. Now execute.”☑️ Action 1: Set up a call with the medical director of Datar Cancer Genetics.☑️ Action 2: Send referral for extensive blood work.☑️ Action 3: Book a dermatology exam.☑️ Action 4: Schedule a colonoscopy.☑️ Action 5: Send referrals for: Full-body MRI, Prostate MRI, Pancreas MRCP, CT Thorax, Testicular ultrasound.All done before lunch. Now what?“Do I just go on with life as normal? What about telling people? My wife? My parents? Surely I can’t tell my kids at this stage?”Wait! Had forgotten about phase 3 of the plan? It was time to implement survival strategies.I pushed away the difficult thoughts of communication and moved on.Phase 3: Strategies to surpress tumour growth and optimise general health.I was already living a very health life but it was time to optimise. I went high and low. Grasping for any straw with a limited downside and at least a theoretical upside.StrategiesDown regulate tumor growth (↓ proliferation, ↓ angiogenesis, ↓ mTOR, ↓ IGF-1)Starve tumor-supporting inputs (↓ glucose, ↓ growth factors, ↓ inflammation)Enhance immune function (↑ innate & adaptive response, ↑ NK cells, ↑ T cells)Boost systemic resilience (↑ mitochondria, ↓ inflammation, ↑ detox)TacticsDietTime-restricted eating (↓ insulin, ↓ IGF-1)3 days of water fasting (↑ autophagy)Low-glycemic diet (↓ glucose, ↓ insulin/IGF-1)<100g carbs/day (starves glycolytic tumors)1.5 - 2g protein (eggs, soybeans, chicken, whey, collagen, lentils) / kg / day.No alcohol (ethanol is carcinogenic and immunosuppressive)Avoid processed meat, charred foods, excess dairy (↓ IGF-1, ↓ inflammation)Broccoli sprouts, kale, arugula, cauliflower, cabbage (↑ detox)Garlic, onions, leeks, shallots (↓ inflammation, ↓ angiogenesis, immune-modulating)Polyphenol-rich berries & fruits (DNA-protective, ↓ oxidation, ↓ angiogenesisFermented foods like kombucha & kimchi (↑ gut-immune axis)Pomegranate (↓ tumor growth and angiogenesis, ↑ apoptosis in cancer cells in vitro)Ginger (↓ inflammation)Exercise & RecoveryZone 2 + VO²max intervals (↑ NK cells, ↑ T-cells)Resistance training (↑ metabolic health, ↓ inflammation)Sleep optimisation (↑ T-cells, cytokine balance)Sauna (heat shock proteins, ↑ detox, immune modulation)Cold exposure (mitochondrial biogenesis, immune priming)SupplementsOmega-3 (↓ pro-inflammatory omega-6, ↓ COX-2)Green tea extract (↓ VEGF, ↓ mTOR)Curcumin (↓ proliferation)Vitamin D3 (↑ immune regulation)Zinc (↑ T-cells)Magnesium glycinate (↓ inflammation, ↑ sleep, mitochondrial support)Creatine monohydrate (↑ muscle mass, ↑ cellular energy)Quercetin phytosome (senolytic, ↓ inflammation)Oral vitamin C (↓ oxidation)CoQ10 (↑ mitochondrial function)GlyNAC (↓ oxidation, redox balance, mitochondrial repairTaurine (↓ oxidation, ↑ mitochondrial function)Whey protein powder & collagen (support muscle mass)Psyllium husk (↑ gut-immune axis)1-MNA (↓ inflammation, endothelial protective effects)TMG (may normalise DNA methylation)PharmaceuticalsLow dose Aspirin (↓ COX-1/2, ↓ platelet aggregation,↓ metastasis)Low dose Mounjaro (↑ insulin sensitivity, ↓ inflammation)Colchicine (↓ inflammation, may reduce metastasis and tumor growth)Future candidatesIntravenous Vitamin C (pro-oxidant in tumor cells, generating hydrogen peroxide that selectively damages cancer cells)This might seem like a very extensive protocol. Thankfully I didn’t have to change basically anything regarding diet, exercise and recovery. Just adding some supplements and pharmaceuticals.24 hours had passed since I first read the results. My survival framework was done. It was time to think about communication.Balancing transparency and protection of others.“I don’t want to tell my wife yet. She’s already dealing with a lot, I don’t want her to have to live with the uncertainty. I’ll tell after the diagnostics are done. But, I need to tell someone or it might be too heavy of a burden.”So, I decided to call a friend. A good friend who happens to be both rational and compassionate. He’s also a fellow physician.Having someone to talk to was incredibly helpful and I’m very grateful for the unconditional support he gave me.Ticking one box after another.Things moved quickly from here.✅ I had a call with the medical director of Datar Cancer Genetics. He basically confirmed my fears. The probability of a test mix up was abysmal, as was the probability of a false positive.They had even run the test twice and gotten the same results. I have CTCs. Not tons of them but both tests clearly exceeded the threshold.There might still be a tiny, tiny possibility that these cells don’t come from a tumour but rather from some rare, undiagnosed inflammatory condition. Unlikely but not impossible.✅ My extensive blood work was basically normal. I did however have a S-CEA of 5. Right on the upper limit. This can be a sign of inflammation but it’s also a main marker used to track the progress of Colon cancer. Scary.✅ The dermatologist didn’t see anything suspicious and the testicular ultrasound was normal.With the new information at hand, I updated the probability matrix.Refined cancer probability matrixFunny how time just keeps moving.14 days had passed.It was time for my colonoscopy. I was probably the first patient they’ve ever had who was hoping that they would find a tumor.The 5 year survival for stage 1 Colon cancer is 91%. I’d take those odds.The colonoscopy was normal. No colon cancer.MRIs, MRCP and CT were scheduled 4 days later.Friday May 30th. One day before my father’s birthday.I spent 3 hours in the MRI and CT machines.The answer from the CT Thorax and Prostate MRI arrived that very same afternoon. No visible lung tumour. No signs of prostate cancer.Bladder and Esophagus cancer felt highly unlikely due to lack of heredity, risk factors and symptoms.Left on the list was pancreatic cancer.The 5 year survival for stage 1 Pancreatic cancer is 30-50%. I don’t like those odds.Friday evening and still no results.Pain and beauty might just be neighbours.The following weekend was emotional. My parents were visiting and we celebrated my dad’s birthday together.My thoughts were all over the place.“I don’t want pancreatic cancer. I want to see my kids grow up. I want to experience new things, generate new memories, learn new skills.”The next minute.“The world is so beautiful. I have lived an amazing life. More fortunate than most. As the wind is blowing in my hair, I wouldn’t want it any other way.”I don’t think anyone noticed.The reveal.Lunch time Monday June 2nd.I was standing by the computer in my home office. An email notification. The new test results had arrived. I once again stopped breathing.I logged into the referral system.“Breathe Johan. You gotta remember to breathe.”I clicked on the result from the full-body MRI and Pancreas MRCP.There are no suspicious findings for cancer or any other structural pathology.I could breathe again. Feelings of relief. The confusion.“So what's the verdict? What's the result? Do I have cancer or not?”The honest answer?I don't know.A false positive can’t be ruled out.The more likely explanation is that I have an extremely early tumour that may or may not materialise into active cancer.Living with uncertainty.Ironically, I have a lot more information now than prior to this situation. I know tons of things that I didn't know before.Yet, my brain tells me that my life is more uncertain.“I don’t know if I have cancer. I just know I have to live like I might. But wasn’t that always true?”Where to go from here?Well, the rational agent in me has created another screening protocol for the foreseeable future.Ongoing cancer screening planUntil that future reveals itself, I'm just gonna have to live in uncertainty.That’s as true for me as it is for you. As it is for everyone.As certainly as constant is the only change, uncertainty is the only certainty.

Ageless: Reclaiming Time, Rhythm, and Ritual in Women’s Longevity

Hormone Balance

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4 min read

Ageless: Reclaiming Time, Rhythm, and Ritual in Women’s Longevity

What if aging wasn’t something to fight or freeze, but something we could redesign on our own terms?For too long, aging has been medicalized, masculinized, and misunderstood, especially when it comes to women. Most longevity frameworks assume male biology as the norm. They overlook the fact that women’s bodies are not linear systems—they are cyclical, transitional, and relational.The truth is: women don’t age like men.And we shouldn’t try to.A Different Rhythm, A Different RealityFrom puberty to post-menopause, women live in rhythm. Hormones fluctuate not just monthly, but also across decades. These shifts impact everything from bone density and sleep to metabolic health, mental clarity, and emotional regulation.Yet the wellness world too often offers blanket advice: intermittent fasting, high-intensity workouts, or strict supplementation routines—without considering whether they support or sabotage women’s hormonal phases.What women need is not optimization. It’s personalization.The Mindset Shift: From “Anti-Aging” to “Pro-Living”We don’t need to resist time.We need to realign with it.Here are three mindset shifts that support longevity in a way that’s both rooted in science and responsive to lived experience:Shift from control to curiosity.Rather than battling every wrinkle or symptom, ask: What is my body communicating? Approaching aging with curiosity rather than fear unlocks more sustainable, embodied health decisions.Redefine success by energy, not output.As hormonal patterns shift, so does how we access energy. Instead of measuring yourself by productivity, ask: What nourishes my energy today? Some days require structure. Others call for softness.Stop chasing balance. Embrace rhythm.Balance suggests a fixed point; rhythm invites flow. Learn to notice your personal cycles, weekly, monthly, seasonal. When are you most creative? When do you need to slow down? Aging well is less about discipline and more about attunement.Actionable Practices for Everyday LongevityLongevity doesn’t live in supplements alone. It lives in how we live.Here are four simple, science-informed practices that can be integrate into daily life:Wake with the sun, not your screen.Morning sunlight within 60 minutes of waking helps regulate circadian rhythms, balance cortisol, and improve sleep quality, all critical for hormonal and cellular health.Align meals with metabolism.As estrogen declines, women become more insulin-sensitive. A nourishing breakfast (with protein + fiber) can stabilize blood sugar and reduce inflammation. Intermittent fasting may work in short cycles, but not every day, especially post-35.Create daily rituals of repair.Micro-moments of rest, breathwork, stretching, journaling, or a midday walk—signal safety to your nervous system. Over time, this reduces the biological wear of chronic stress (also known as allostatic load).Build muscle, not just motivation.Resistance training is key to protecting bone density and metabolic health. Just 2–3 sessions a week can counteract the muscle loss that accelerates after 40, especially during perimenopause.Tech with SoulI believe in the promise of tech, but only when it enhances intuition. Tools like continuous glucose monitors, gut microbiome analysis, or wearables should help women understand their bodies, not override them. The future of women’s health is not just about more data. It’s about deeper meaning.Let’s build systems that honor hormonal rhythms. Let’s design with rest and repair at the center. Let’s elevate the emotional intelligence of our solutions, not just their precision.Designing for Women's TimeWhat if we stopped thinking of aging as a breakdown and started seeing it as a breakthrough?We don’t need to reverse time.We need to relate to it differently.Aging, for women, is not a problem to solve. It’s a pattern to honor. A pulse to attune to. A wisdom we carry, not a condition we fear.Because the real secret to longevity isn’t eternal youth.It’s cyclical living, embodied choices, and remembering to come home to ourselves.