24-Hour Prediabetes Reversal Challenge

Last Updated: April 10th 2026

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Every claim made in the 24-Hour Prediabetes Reversal Challenge is backed by peer-reviewed research. We prioritize clinical accuracy to ensure your metabolic success. Below, you will find our core claims paired with verified citations, listed in their order of appearance.

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24-Hour Challenge Guidebook: Preface

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A new type 2 diabetes diagnosis adds over $1,000 per month in direct expenses.

Parker ED, et al. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26–43.

Life expectancy decreases with earlier age of type 2 diabetes onset. For example, if you’re around the age of 40 and develop type 2 diabetes, you reduce life expectancy by an average of 10 years!

Emerging Risk Factors Collaboration. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol. 2023;11(10):731–742.

Decades of research show that losing just 5% of body weight reduces type 2 diabetes risk.

Fritsche A, et al. Different Effects of Lifestyle Intervention in High- and Low-Risk Prediabetes: Results of the Randomized Controlled Prediabetes Lifestyle Intervention Study (PLIS). Diabetes. 2021;70(12):2785–2795.

The relative risk of type 2 diabetes decreased by 76% with prediabetes reversal compared to weight loss alone.

Sandforth A, et al. Mechanisms of weight loss-induced remission in people with prediabetes: a post-hoc analysis of the randomised, controlled, multicentre Prediabetes Lifestyle Intervention Study (PLIS). Lancet Diabetes Endocrinol. 2023;11(11):798–810.

24-Hour Challenge Guidebook: Your Call to Action

Liver failure from metabolic issues is more common than from alcohol. Its cause is the same as prediabetes — insulin resistance.

Vargas M, et al. Metabolic disease and the liver: A review. World J Hepatol. 2024;16(1):33–40.
Dai W, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis. Medicine (Baltimore). 2017;96(39):e8179.

One-third of U.S. adults have prediabetes.

Centers for Disease Control and Prevention. National Diabetes Statistics Report. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2022. Available: https://www.cdc.gov/diabetes/data/statistics-report/index.html

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24-Hour Challenge Guidebook: Supernatural Achievement System

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“Progress over perfection” is a timeless principle based on science — performance improvement and learning peak at an 85% success rate.

Wilson RC, Shenhav A, Straccia M, Cohen JD. The Eighty Five Percent Rule for optimal learning. Nat Commun. 2019;10(1):4646.

Research shows that tracking your food intake may double your weight loss.

Hollis JF, et al. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med. 2008;35(2):118–26.

Research shows that what you eat has the most significant impact on weight loss (~80% dietary intake vs. ~20% physical activity).

Garrow JS, Summerbell CD. Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects. Eur J Clin Nutr. 1995;49(1):1–10.

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24-Hour Challenge Guidebook: Phase One: Nutrition-First

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Almost 90% of U.S. adults show signs of insulin resistance and metabolic problems.

Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord. 2019;17(1):46–52.

Storing fat in hips and thighs acts as a protective buffer; differences in capacity explain why some bodies tolerate weight gain without metabolic problems.

Manolopoulos KN, Karpe F, Frayn KN. Gluteofemoral body fat as a determinant of metabolic health. Int J Obes (Lond). 2010;34(6):949–59.

Fatty liver disease results from fat in the liver, and type 2 diabetes arises with fat in the pancreas.

Lim EL, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.

Adequate protein: optimal range appears to be two-fold prior guidelines; ~1.6 g per kg of ideal weight daily across meals.

Volek JS, Kackley ML, Buga A. Nutritional Considerations During Major Weight Loss Therapy: Focus on Optimal Protein and a Low-Carbohydrate Dietary Pattern. Curr Nutr Rep. 2024 May 30. doi: 10.1007/s13668-024-00548-6.
Pasiakos SM, Margolis LM, Orr JS. Optimized dietary strategies to protect skeletal muscle mass during periods of unavoidable energy deficit. FASEB J. 2015;29(4):1136–42.
Matsumoto M, et al. Evaluation of protein requirements using the indicator amino acid oxidation method: a scoping review. J Nutr. 2023;153(12):3472–3489.

Those given olive oil weekly showed 30% fewer cardiovascular events than education alone.

Guasch-Ferré M, et al.; PREDIMED Investigators. The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence? Nutr Metab Cardiovasc Dis. 2017;27(7):624–632.

Avocados are a healthy monounsaturated fat source.

Dreher ML, Davenport AJ. Hass avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738–50.

Almonds have a dose-response effect on coronary heart disease risk factors.

Jenkins DJ, et al. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002;106(11):1327–32.

Tree nuts appear to improve glycemic control in diabetes.

Viguiliouk E, et al. Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLoS One. 2014;9(7):e103376.

Omega-3s from fish, like salmon, are associated with lower coronary heart disease risk.

Whelton SP, He J, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol. 2004;93(9):1119–23.

Omega-3 supplements reduce inflammatory markers (CRP, IL-6, TNF-alpha).

Li K, Huang T, Zheng J, Wu K, Li D. Effect of marine-derived n-3 polyunsaturated fatty acids on C-reactive protein, interleukin 6 and tumor necrosis factor alpha: a meta-analysis. PLOS One. 2014;9(2):e88103.

Lowering carbs can also reduce hunger, making it easier to maintain a calorie deficit. (Carbohydrate-Insulin Model)

Ludwig DS, Ebbeling CB. The Carbohydrate-Insulin Model of Obesity: Beyond “Calories In, Calories Out”. JAMA Intern Med. 2018;178(8):1098–1103.

Reducing carbs to 5% results in more weight loss than 15% or 25%.

Harvey CJDC, et al. Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial. PeerJ. 2019;7:e6273.

Metabolic diseases kill more U.S. adults than heroin does.

Garnett MF, Miniño AM. Drug Overdose Deaths in the United States, 2003–2023. NCHS Data Brief No. 522. Hyattsville, MD: National Center for Health Statistics; 2024. DOI: 10.15620/cdc/170565.
Curtin SC, Tejada-Vera B, Bastian BA. Deaths: Leading Causes for 2022. Natl Vital Stat Rep. 2024;73(10):1–117. DOI: 10.15620/cdc/164020.

Insulin resistance and inflammation feed into each other — a vicious cycle contributing to excess weight and faster aging.

Yang H, et al. HOMA-IR is positively correlated with biological age and advanced aging in the US adult population. Eur J Med Res. 2023;28(1):470.
Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest. 2006;116(7):1793–801.

Higher inflammatory markers are often found with elevated body mass index.

Visser M, et al. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131–5.

Chronic inflammation accelerates cellular aging.

Li X, Li C, Zhang W, Wang Y, Qian P, Huang H. Inflammation and aging: signaling pathways and intervention therapies. Signal Transduct Target Ther. 2023;8(1):239.

Insulin resistance increases cancer risk through increased insulin levels and inflammation.

Chiefari E, et al. Insulin Resistance and Cancer: In Search for a Causal Link. Int J Mol Sci. 2021;22(20):11137.

Eating in a way that resembles a Mediterranean diet may decrease cancer risk.

Morze J, et al. An updated systematic review and meta-analysis on adherence to Mediterranean diet and risk of cancer. Eur J Nutr. 2021;60(3):1561–1586.

Inflammatory markers are a strong predictor of heart attack risk.

Ridker PM, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347(20):1557–65.

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Hormonal Topics: Mastering the Menstrual Cycle

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The first published study testing period products with blood was published in 2024.

DeLoughery E, Colwill AC, Edelman A, Samuelson Bannow B. Red blood cell capacity of modern menstrual products: considerations for assessing heavy menstrual bleeding. BMJ Sex Reprod Health. 2024;50(1):21-26. PMID: 37550075.

The menstrual cycle produces cyclical water retention, and it is more complex than subtracting an average of a pound.

Kanellakis S, Skoufas E, Simitsopoulou E, et al. Changes in body weight and body composition during the menstrual cycle. Am J Hum Biol. 2023;35(11):e23951. PMID: 37395124.

Extended intermittent fasting and very high-fat diets can disrupt the menstrual cycle.

Skoracka K, et al. Female Fertility and the Nutritional Approach: The Most Essential Aspects. Adv Nutr. 2021;12(6):2372-2386. PMID: 34139003.

Hormonal shifts during the menstrual cycle impact energy requirements; insulin sensitivity changes across phases. During the luteal phase, keto and intermittent fasting are not recommended due to higher carbohydrate demands driven by hormonal fluctuations.

Escalante Pulido JM, Alpizar Salazar M. Changes in insulin sensitivity, secretion and glucose effectiveness during menstrual cycle. Arch Med Res. 1999;30(1):19-22. PMID: 10071420.

Stable blood sugar levels contribute to better mental clarity and emotional stability.

Muijs LT, Racca C, Snoek FJ. Glucose variability and mood in adults with diabetes: A systematic review. Endocrinol Diabetes Metab. 2021;4(2):e00152. doi: 10.1002/edm2.152. PMID: 33532604.

Iron, magnesium, zinc, fiber, and healthy fats are essential during the menstrual cycle.

Parazzini F, Di Martino M, Pellegrino P. Magnesium in the gynecological practice: a literature review. Magnes Res. 2017;30(1):1-7. PMID: 28392498.

Overcoming magnesium deficiency appears to decrease specific symptoms of premenstrual syndrome.

Parazzini F, Di Martino M, Pellegrino P. Magnesium in the gynecological practice: a literature review. Magnes Res. 2017;30(1):1-7. PMID: 28392498.

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Hormonal Topics: Fertility and Pregnancy Readiness

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Insulin resistance and excess weight lower pregnancy rates and delay conception. This effect persists even with regular menstrual cycles.

Silvestris E, de Pergola G, Rosania R, Loverro G. Obesity as disruptor of the female fertility. Reprod Biol Endocrinol. 2018;16(1):22. PMID: 29523133.
Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Hum Reprod. 2007;22(2):414-20. PMID: 17095518.
van der Steeg JW, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23(2):324-8. PMID: 18077317.

In males, reversing insulin resistance often leads to higher testosterone levels and improved sperm quality.

Zańko A, Siewko K, Krętowski AJ, Milewski R. Lifestyle, Insulin Resistance and Semen Quality as Co-Dependent Factors of Male Infertility. Int J Environ Res Public Health. 2022;20(1):732. PMID: 36613051.

In females, reversing insulin resistance may normalize ovulatory patterns.

Silvestris E, de Pergola G, Rosania R, Loverro G. Obesity as disruptor of the female fertility. Reprod Biol Endocrinol. 2018;16(1):22. PMID: 29523133.
Rich-Edwards JW, et al. Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology. 2002;13(2):184-90. PMID: 11880759.

Reducing refined carbohydrates may increase the probability of conception.

Willis SK, Wise LA, Wesselink AK, et al. Glycemic load, dietary fiber, and added sugar and fecundability in 2 preconception cohorts. Am J Clin Nutr. 2020;112(1):27-38. PMID: 31901163.

Incorporating whole foods, nuts, olive oil, and fish may help fertility.

Skoracka K, Ratajczak AE, Rychter AM, Dobrowolska A, Krela-Kaźmierczak I. Female Fertility and the Nutritional Approach: The Most Essential Aspects. Adv Nutr. 2021;12(6):2372-2386. PMID: 34139003.
Carlos S, et al. Mediterranean Diet and Health Outcomes in the SUN Cohort. Nutrients. 2018;10(4):439. PMID: 29614726.

Strategies like intermittent fasting, keto, and very low-calorie approaches may decrease fertility and should be considered for discontinuation when trying to conceive.

Skoracka K, et al. Female Fertility and the Nutritional Approach: The Most Essential Aspects. Adv Nutr. 2021;12(6):2372-2386. PMID: 34139003.

Lifestyle changes may not suffice for conditions like polycystic ovarian syndrome, and anatomical issues may need different approaches.

Thurston L, Abbara A, Dhillo WS. Investigation and management of subfertility. J Clin Pathol. 2019;72(9):579-587. PMID: 31296604.

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Hormonal Topics: Thriving Through Menopause

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Menopause symptoms usually last for over seven years, much longer than menstrual irregularities.

Talaulikar V. Menopause transition: Physiology and symptoms. Best Pract Res Clin Obstet Gynaecol. 2022;81:3-7. PMID: 35382992.

Hot flashes and night sweats are the most common symptoms and often impact sleep; fatigue, mental cloudiness, reduced sex drive, and increased anxiety and depression also occur.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.
Talaulikar V. Menopause transition: Physiology and symptoms. Best Pract Res Clin Obstet Gynaecol. 2022;81:3-7. PMID: 35382992.

Hormonal changes during menopause impact metabolism and bone density.

Lobo RA. Metabolic syndrome after menopause and the role of hormones. Maturitas. 2008;60(1):10-8. PMID: 18407440.
Gurka MJ, Vishnu A, Santen RJ, DeBoer MD. Progression of Metabolic Syndrome Severity During the Menopausal Transition. J Am Heart Assoc. 2016;5(8):e003609. PMID: 27487829.

Declining estrogen levels can worsen insulin resistance and metabolic syndrome, increasing the risk of type 2 diabetes, falls, and broken hips.

Lobo RA. Metabolic syndrome after menopause and the role of hormones. Maturitas. 2008;60(1):10-8. PMID: 18407440.
Gurka MJ, et al. Progression of Metabolic Syndrome Severity During the Menopausal Transition. J Am Heart Assoc. 2016;5(8):e003609. PMID: 27487829.
Eshtiaghi R, Esteghamati A, Nakhjavani M. Menopause is an independent predictor of metabolic syndrome in Iranian women. Maturitas. 2010;65(3):262-6. PMID: 19962253.
Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495-505. PMID: 17575306.

A Mediterranean-style diet is associated with maintaining bone strength and muscle mass during menopause.

da Silva TR, Martins CC, Ferreira LL, Spritzer PM. Mediterranean diet is associated with bone mineral density and muscle mass in postmenopausal women. Climacteric. 2019;22(2):162-168. PMID: 30661407.

Adequate calcium and vitamin D intake reduces bone mineral density loss and fracture risk in postmenopausal women.

Liu C, Kuang X, Li K, Guo X, Deng Q, Li D. Effects of combined calcium and vitamin D supplementation on osteoporosis in postmenopausal women: a systematic review and meta-analysis. Food Funct. 2020;11(12):10817-10827. PMID: 33237064.

Weight-bearing exercises, such as walking and resistance training, are crucial for improving and maintaining bone mineral density in postmenopausal women.

Mohebbi R, Shojaa M, Kohl M, et al. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis. Osteoporos Int. 2023;34(7):1145-1178. PMID: 36749350.

Hormonal replacement therapy (HRT) is not recommended in postmenopausal persons for primary prevention of chronic conditions.

US Preventive Services Task Force; Mangione CM, et al. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons. JAMA. 2022;328(17):1740-1746. PMID: 36318127.

For management of moderate to severe menopausal symptoms, estrogen therapy is often the first-line treatment.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.

Estrogen makes the uterine lining grow, and if unopposed, it can raise the risk of uterine cancer; progesterone is usually added to prevent this effect when the uterus is present.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.

The landmark research studies of estrogen therapy for menopausal symptoms examined complications using non-bioidentical forms: the estrogen mix was from horses (conjugated equine estrogen) and they used synthetic progesterone (medroxyprogesterone acetate).

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.
Rymer J, Brian K, Regan L. HRT and breast cancer risk. BMJ. 2019;367:l5928. PMID: 31604711.

For every 1,000 people under hormone replacement treatment (HRT) for menopausal symptoms, there is one extra case of stroke, blood clots, or breast cancer each year.

Rymer J, Brian K, Regan L. HRT and breast cancer risk. BMJ. 2019;367:l5928. PMID: 31604711.

Selective Estrogen Receptor Modulators (SERMs) can protect the uterine lining and bone density, offering an alternative to progesterone in specific instances.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.

Bioidentical transdermal products (estradiol patches, gels, and creams) have gained preference for estrogen therapy; absorption through the skin may decrease the risk of stroke and blood clots.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.

For vaginal dryness and pain, low-dose vaginal estrogen improves symptoms by 60% to 80%.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.

Bioidentical progesterone, as opposed to the synthetic form, may result in a lower relative breast cancer risk.

Rymer J, Brian K, Regan L. HRT and breast cancer risk. BMJ. 2019;367:l5928. PMID: 31604711.

Certain antidepressants can reduce hot flashes in menopause by 40% to 65%.

Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420. PMID: 36749328.

Phytoestrogens are plant compounds with estrogen-like properties (sources include soybeans, flaxseed, legumes, fruits, and vegetables) that improve menopausal symptoms related to decreased estrogen, though to a much lesser degree than hormone replacement therapy (HRT).

Bedell S, Nachtigall M, Naftolin F. The pros and cons of plant estrogens for menopause. J Steroid Biochem Mol Biol. 2014;139:225-36. PMID: 23270754.

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Hormonal Topics: Maximizing Your Testosterone

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Adults with metabolic syndrome have higher rates of sexual dysfunction.

Corona G, Monami M, Rastrelli G, et al. Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med. 2011;8(1):272-83. PMID: 20807333.
Otunctemur A, Dursun M, Ozbek E, et al. Effect of metabolic syndrome on sexual function in pre- and postmenopausal women. J Sex Marital Ther. 2015;41(4):440-9. PMID: 24824329.

Insulin resistance results in a decrease in testosterone.

Corona G, et al. Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med. 2011;8(1):272-83. PMID: 20807333.
Fui MN, Dupuis P, Grossmann M. Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian J Androl. 2014;16(2):223-231. doi: 10.4103/1008-682X.122365.
Wang C, Jackson G, Jones TH, et al. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care. 2011;34(7):1669-1675. PMID: 21709300.

For males, lower testosterone due to metabolic syndrome may lead to erectile dysfunction.

Wang C, et al. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care. 2011;34(7):1669-1675. PMID: 21709300.

For females, metabolic syndrome is associated with lower levels of sexual satisfaction and desire, as well as physical discomfort.

Otunctemur A, et al. Effect of metabolic syndrome on sexual function in pre- and postmenopausal women. J Sex Marital Ther. 2015;41(4):440-9. PMID: 24824329.

Testosterone replacement increases sexual arousal in females, whether pre-, peri-, or postmenopausal.

Burton CS, Mishra K. Pharmacologic therapeutic options for sexual dysfunction. Curr Opin Obstet Gynecol. 2022;34(6):402-408. PMID: 36036468.

Sunlight while walking is beneficial for vitamin D, which is associated with testosterone levels in males.

Monson NR, Klair N, Patel U, et al. Association Between Vitamin D Deficiency and Testosterone Levels in Adult Males: A Systematic Review. Cureus. 2023;15(9):e45856. PMID: 37750061.

Strength training and weight management are potent ways to increase testosterone.

Fui MN, Dupuis P, Grossmann M. Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian J Androl. 2014;16(2):223-231. doi: 10.4103/1008-682X.122365.

Quality sleep and stress management techniques lower stress hormones and protect testosterone production.

Su L, Zhang SZ, Zhu J, Wu J, Jiao YZ. Effect of partial and total sleep deprivation on serum testosterone in healthy males: a systematic review and meta-analysis. Sleep Med. 2021;88:267-273. PMID: 34801825.
Liu PY, Reddy RT. Sleep, testosterone and cortisol balance, and ageing men. Rev Endocr Metab Disord. 2022;23(6):1323-1339. PMID: 36152143.

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Interactive Nutrition Guides: Selecting Protein

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Populations with high fish intake tend to have lower rates of coronary heart disease.

Whelton SP, He J, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol. 2004;93(9):1119-23.

Supplementing with marine-derived omega-3s shows lower inflammatory markers like CRP, IL-6, and TNF-alpha.

Li K, Huang T, Zheng J, Wu K, Li D. Effect of marine-derived n-3 polyunsaturated fatty acids on C-reactive protein, interleukin 6 and tumor necrosis factor alpha: a meta-analysis. PLOS One. 2014;9(2):e88103.

Walnuts, flaxseeds, and chia seeds are excellent plant-based omega-3 sources, but their omega-3s are less absorbable than marine-derived omega-3s.

Burdge GC, Wootton SA. Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Br J Nutr. 2002;88(4):411-20. PMID: 9637947.
Brenna JT, et al. Alpha-linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukot Essent Fatty Acids. 2009;80(2-3):85-91.

Choline helps keep cells healthy and supports nerve communication. Many people need more from their diet to avoid a deficiency.

Zeisel SH, da Costa KA. Choline: an essential nutrient for public health. Nutr Rev. 2009;67(11):615-623.
Sanders LM, Zeisel SH. Choline: Dietary Requirements and Role in Brain Development. Nutr Today. 2007;42(4):181-186.

In individuals with metabolic syndrome, daily whole egg intake showed better cholesterol profiles and less insulin resistance than yolk-free egg substitute.

Blesso CN, Andersen CJ, Barona J, Volek JS, Fernandez ML. Whole egg consumption improves lipoprotein profiles and insulin sensitivity to a greater extent than yolk-free egg substitute in individuals with metabolic syndrome. Metabolism. 2013;62(3):400-410.

The liver makes most cholesterol, and dietary intake is not always impactful. Eggs only seem to increase blood cholesterol levels in approximately 25% of people.

Djoussé L, Gaziano JM. Dietary cholesterol and coronary artery disease: a systematic review. Curr Atheroscler Rep. 2009;11(6):418-422.

Tofu, but not soy milk, correlated with a lower risk of coronary heart disease. Isoflavones likely play a role.

Ma L, et al. Isoflavone Intake and the Risk of Coronary Heart Disease in US Men and Women: Results From 3 Prospective Cohort Studies. Circulation. 2020;141(14):1127-1137.

Soy products contain all nine essential amino acids the body cannot produce, making soy a complete protein. In contrast, legumes and most grains are incomplete proteins

Messina M. Soy: A Complete Source of Protein. Am Fam Physician. 2009;79(1):43-47. PMID: 19145965.

High soy diets show lower fertility and testosterone in male animal models.

Weber KS, Setchell KDR, Stocco DM, Lephart ED. Dietary soy-phytoestrogens decrease testosterone levels and prostate weight without altering LH, prostate 5α-reductase or testicular steroidogenic acute regulatory peptide levels in adult male Sprague-Dawley rats. J Endocrinol. 2001;170(3):591-599. PMID: 11524239.

Studies with phytoestrogen supplements in human males have shown no overt effect on reproductive health.

Mitchell JH, Cawood E, Kinniburgh D, Provan A, Collins AR, Irvine DS. Effect of a phytoestrogen food supplement on reproductive health in normal males. Clin Sci (Lond). 2001;100(6):613-8.

Substitution of red meat with legumes in diabetic patients appears beneficial for cardiometabolic risk factors.

Hosseinpour-Niazi S, Mirmiran P, Hedayati M, Azizi F. Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial. Eur J Clin Nutr. 2015;69(5):592-7.

Legumes are linked to lower coronary heart disease and stroke risk.

Becerra-Tomás N, Papandreou C, Salas-Salvadó J. Legume Consumption and Cardiometabolic Health. Adv Nutr. 2019;10(Suppl_4):S437-S450.

Nitrosamines in processed meats appear to increase the risk of cancer.

Karwowska M, Kononiuk A. Nitrates/Nitrites in Food-Risk for Nitrosative Stress and Benefits. Antioxidants (Basel). 2020;9(3):241.

Many processed meats include celery powder as a 'natural' alternative to nitrite, which results in the same nitrosamine problem and likely increase risk of cancer — celery is naturally high in nitrate and its derived nitrite is biochemically indistinguishable from synthetic sources.

Sebranek JG, Bacus JN. Cured meat products without direct addition of nitrate or nitrite: what are the issues? Meat Sci. 2007;77(1):136-147. doi: 10.1016/j.meatsci.2006.11.021.

Some combined analyses of saturated fat intake are reassuring about cardiovascular risk, while other studies show an increased risk to heart health from saturated fat intake.

Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535-546.
Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015;(6):CD011737.

Conjugated linoleic acid (CLA) in grass-fed beef appears to improve glucose tolerance and prevent insulin resistance.

Ryder JW, et al. Isomer-specific antidiabetic properties of conjugated linoleic acid: improved glucose tolerance, skeletal muscle insulin action, and UCP-2 gene expression. Diabetes. 2001;50(5):1149-1157.
Castro-Webb N, Ruiz-Narváez EA, Campos H. Cross-sectional study of conjugated linoleic acid in adipose tissue and risk of diabetes. Am J Clin Nutr. 2012;96(1):175-181.

Lactase is required to digest lactose, and most individuals are somewhat lactose intolerant.

Deng Y, Misselwitz B, Dai N, Fox M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015;7(9):8020-35.

Based on weak evidence, the galactose component of lactose may have a link to ovarian cancer. Other studies have found no association between galactose consumption and ovarian cancer risk.

Cramer DW, Greenberg ER, Titus-Ernstoff L, et al. A case-control study of galactose consumption and metabolism in relation to ovarian cancer. Cancer Epidemiol Biomarkers Prev. 2000;9(1):95-101.
Fung WL, Risch H, McLaughlin J, et al. The N314D polymorphism of galactose-1-phosphate uridyl transferase does not modify the risk of ovarian cancer. Cancer Epidemiol Biomarkers Prev. 2003;12(7):678-80.

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Interactive Nutrition Guides: Healthy Fat Sources

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Replacing monounsaturated fats with saturated fats impairs insulin sensitivity.

Vessby B, Uusitupa M, Hermansen K, et al. Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia. 2001;44(3):312-319.

Olive oil intake is associated with decreased mortality and lower rates of coronary heart disease and cardiovascular disease.

Buckland G, Mayén AL, Agudo A, et al. Olive oil intake and mortality within the Spanish population (EPIC-Spain). Am J Clin Nutr. 2012;96(1):142-149.
Bendinelli B, Masala G, Saieva C, et al. Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study. Am J Clin Nutr. 2011;93(2):275-283.
Romani A, Ieri F, Urciuoli S, et al. Health Effects of Phenolic Compounds Found in Extra-Virgin Olive Oil, By-Products, and Leaf of Olea europaea L. Nutrients. 2019;11(8):1776.
Guasch-Ferré M, Hu FB, Martínez-González MA, et al. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med. 2014;12:78.

Avocados are a rich source of monounsaturated fats with well-documented potential health effects.

Dreher ML, Davenport AJ. Hass avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738-50.

Almonds show a dose-response improvement in coronary heart disease risk factors including blood lipids and lipoprotein(a).

Jenkins DJ, et al. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002;106(11):1327-32.

Tree nuts appear to improve glycemic control in type 2 diabetes.

Viguiliouk E, et al. Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLoS One. 2014;9(7):e103376.

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Interactive Nutrition Guides: Selecting Carbohydrates

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Three servings of vegetables and two servings of fruit are associated with prolonged life, and lower rates of heart disease, cancer, and lung disease.

Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021;143(17):1642-1654.

Potassium intake from produce offsets the effect of sodium and improves blood pressure.

Morris RC Jr, Sebastian A, Forman A, Tanaka M, Schmidlin O. Normotensive salt sensitivity: effects of race and dietary potassium. Hypertension. 1999;33(1):18-23.

Whole fruits correlate with a lower risk of type 2 diabetes, whereas fruit juice is associated with a higher risk.

Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013;347:f5001.

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24-Hour Challenge Guidebook: Phase Two: 10,000 Rewards

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Greater daily steps associated with lower all-cause mortality.

Saint-Maurice PF, et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. 2020;323(12):1151–1160.

Walking improves blood pressure and mental well-being; organizing walking groups adds structure and appeal.

Hanson S, Jones A. Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. Br J Sports Med. 2015;49(11):710–5.

Morning sunlight during walks also helps regulate your circadian rhythm and improve sleep.

Blume C, Garbazza C, Spitschan M. Effects of light on human circadian rhythms, sleep and mood. Somnologie (Berl). 2019;23(3):147–156.

We influence each other’s habits far more than we recognize — weight gain spreads through a social network.

Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357(4):370–9.

Prolonged sitting is a novel and important predictor of chronic disease risk.

Owen N, Bauman A, Brown W. Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med. 2009;43(2):81–3.

A new type 2 diabetes diagnosis adds over $1,000 per month in direct expenses.

Parker ED, et al. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26–43.

Loss aversion does not appear to materialize for smaller losses — $100 appears to be the tipping point.

Zeif D, Yechiam E. Loss aversion (simply) does not materialize for smaller losses. Judgment and Decision Making. 2022;17(5):1015–1042.

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24-Hour Challenge Guidebook: Phase Three: Inspirational Success

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Being unfit is a more significant predicted health risk than smoking or type 2 diabetes.

Kaminsky LA, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation. 2013;127(5):652–62.

Research shows a lower risk of death in older adults with higher muscle mass (20% lower risk over a 16-year study).

Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014;127(6):547–53.

Grip strength and dementia — someone with 40 kg grip strength appears to have a 40% lower risk of dementia.

Esteban-Cornejo I, et al. Handgrip strength and all-cause dementia incidence and mortality: findings from the UK Biobank prospective cohort study. J Cachexia Sarcopenia Muscle. 2022;13(3):1514–1525.

Strength training improves bone density and preserves cognitive function.

Grgic J, et al. Progressive Resistance Training for Concomitant Increases in Muscle Strength and Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis. Sports Med. 2022;52(7):1939–1960.
Coelho-Junior HJ, Marzetti E, Calvani R, Picca A, Arai H, Uchida M. Resistance training improves cognitive function in older adults with different cognitive status: a systematic review and meta-analysis. Aging Ment Health. 2022;26(2):213–224.

Aim for 7 to 9 hours of sleep each night.

Watson NF, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–4.

Adequate sleep lowers your risk of hypertension, heart disease, type 2 diabetes, and even death. Both too little and too much sleep raise risk of death.

Cappuccio FP, et al. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585–92.
Nagai M, Hoshide S, Kario K. Sleep duration as a risk factor for cardiovascular disease: a review of the recent literature. Curr Cardiol Rev. 2010;6(1):54–61.

Going to bed even one hour earlier can help you combat insulin resistance.

Leproult R, Deliens G, Gilson M, Peigneux P. Beneficial impact of sleep extension on fasting insulin sensitivity in adults with habitual sleep restriction. Sleep. 2015;38(5):707–15.

Sleep loss raises stress hormones — sleep deprivation elevates cortisol the next evening.

Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997;20(10):865–70.

Sleep helps prevent weight gain and curbs your appetite, while sleep deprivation increases hunger and food desire.

Pejovic S, et al. Leptin and hunger levels in young healthy adults after one night of sleep loss. J Sleep Res. 2010;19(4):552–8.
Greer SM, Goldstein AN, Walker MP. The impact of sleep deprivation on food desire in the human brain. Nat Commun. 2013;4:2259.

Quality sleep sharpens focus and memory, while sleep deprivation impairs cognitive performance.

Alhola P, Polo-Kantola P. Sleep deprivation: Impact on cognitive performance. Neuropsychiatr Dis Treat. 2007;3(5):553–67.

Inadequate sleep duration is associated with depression risk.

Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32(9):664–70.

Your body sleeps better in a cool environment. Set the temperature to around 67°F.

Okamoto-Mizuno K, Mizuno K. Effects of thermal environment on sleep and circadian rhythm. J Physiol Anthropol. 2012;31(1):14.

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24-Hour Challenge Guidebook: Bonus Chapter: The Courage to Look Within

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Coronary CT study — over one-third of low-risk adults (no HTN, type 2 diabetes, cholesterol meds, tobacco) had coronary plaque; every 10 mg/dL increase in ApoB linked to a 20% increase in plaque risk.

Faridi KF, et al. Serum Lipoproteins Are Associated with Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors. JACC Adv. 2024;3(7):101049.

Treating even mild hypertension is essential for those with risk factors.

SPRINT Research Group; Wright JT Jr, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103–16.

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Verified Citations