The Arising · Metabolic Health

THE ARISING · LONGEVITY & HEALTHSPAN SUNDAY, OCTOBER 18, 2026 IN THIS EDITION · LONGEVITY & HEALTHSPAN 1 ACOG Now Recommends Hormone Therapy for Many Women With Hot Flashes 2 Cardiologists Urge Doctors to Prescribe Exercise as Routine Heart Care 3 Fasting and Autophagy in Humans: Summary Calls Link Unproven 4 Gut Supplements May Modestly Improve Cognition in Adults Over 60, Review Finds 5 Higher Ultra-Processed Food Intake Linked to Silent Brain Damage on MRI 6 Higher VO2 Max Linked to Lower Depression and Anxiety Risk in UK Biobank 7 Bonn Lab Study Shows Blood Cells From Older Donors Lose Epigenetic Age in a Dish 8 Longer Sleep Linked to Kidney Disease Risk in Type 2 Diabetes LONGEVITY & HEALTHSPAN · WEEKLY READ · 3 MIN JOURNAL OF THE ENDOCRINE SOCIETY · 2 SOURCES Longer Sleep Linked to Kidney Disease Risk in Type 2 Diabetes Sleeping more is usually treated as a good sign. A new study of people with type 2 diabetes suggests that, for kidney health, longer sleep may be a signal worth noticing. he research is a prospective cohort study, a type of observational study in people. It followed 678 Japanese outpatients with type 2 diabetes for anT average of 6.0 years (give or take 2.7 years). It was published in 2026 in the Journal of the Endocrine Society. Observational studies can find links. They cannot show that one thing causes another. The researchers looked at diabetic nephropathy, also called diabetic kidney disease. This is kidney damage caused by long-term diabetes. They counted either new cases or worsening of existing disease as a single combined outcome. During follow-up, 215 of the 678 participants reached that outcome. The team recorded lifestyle habits at the start, and again at year 2 and/or year 5. They averaged each person's measurements up to the point of the outcome or the end of follow-up. Of all the lifestyle factors they examined, average sleep duration was the only one linked to the outcome, according to the study's abstract. THE ARISING · OCTOBER 18, 2026 PAGE 22 The direction mattered. The authors conclude that longer sleep, but not shorter sleep, was associated with a higher risk. The trend held after adjusting for key lifestyle and diabetes-related factors. The link was stronger in older participants and in those who already had microalbuminuria (small amounts of protein in the urine, an early sign of kidney damage) or reduced kidney function. Only the abstract was available to us. It does not give the sleep-hour categories or the size of the risk, so we cannot report them. The authors do not claim long sleep harms the kidneys. In a statement released by the Endocrine Society, study author Tomoya Mita of Juntendo University in Tokyo said longer sleep "may be a readily observable marker of underlying health vulnerability." He also said people should not read the findings as advice to sleep less, because "we cannot establish a causal relationship." The Endocrine Society release also states that diabetic kidney disease affects about 30% to 40% of people with diabetes. FOR YOU What does this mean for personal health? The study did not test sudden changes in sleep. It looked at average sleep over years. Mita said longer sleep may be a useful clue to identify people with diabetes who may need closer attention to their kidney health. Beyond that, any advice here is our editorial suggestion, not a finding of the study: if someone notices a clear, lasting increase in how long they sleep, it may be worth mentioning to a clinician. It may be most relevant to older adults with diabetes and to people whose kidney tests already show early changes. Readers should not change their sleep habits or diabetes care without talking to their clinician. There are limits. All participants were Japanese outpatients with type 2 diabetes, so the results may not apply to other groups. The abstract does not say whether other health conditions could explain the pattern. The weakest point of the argument is that we cannot tell from the abstract what sleep lengths counted as long, or how large the risk was. This differs from the REM sleep study we covered on October 6, which tracked sleep stages and disease risk in nearly 96,000 UK adults. That was a different study with a different design. This one adds that sleep length alone may carry information in a specific group, though both are observational. THE ARISING · OCTOBER 18, 2026 PAGE 23 Next, watch for studies that measure sleep objectively and track changes over time. They could show whether longer sleep helps flag kidney risk in routine diabetes care. Sources: Journal of the Endocrine Society (2026), Endocrine Society / Journal of the Endocrine Society (via Newswise) THE ARISING · OCTOBER 18, 2026 PAGE 24

OCTOBER 17, 2026 Adults with type 2 diabetes who ate as much as they wanted of a low-fat, plant-based diet for 16 weeks lost about 6 kilograms and about a third of their liver fat, without counting a single calorie. That is the finding of a small, single-arm trial in BMJ Open Diabetes Research & Care. The changes were associated with the diet, not shown to be caused by it, and the blood sugar figures come from press coverage rather than the paper's abstract. The trial leaves one big question open: was it the food, or just the weight loss? Changes in liver fat, weight, and metabolic markers make a small dietary study worth examining. Its single-arm design leaves the contribution of diet, weight loss, and support difficult to separate. This was a single-arm clinical trial. Twenty-five adults with type 2 diabetes all followed the same diet, and there was no comparison group. It ran in Washington, DC, between January 2024 and November 2025. Without a control group, the results show what changed, not what caused the change. Participants were asked to eat vegetables, grains, legumes and fruit, and to avoid animal products and added fats. The target mix was about 75% of energy from carbohydrate, 15% from protein and 10% from fat. No meals were provided. A registered dietitian gave weekly group support and individual counseling. Participants were told to eat until full, not to hit a calorie target. They took vitamin B12, kept their usual exercise habits and stayed on their usual medicines unless their own doctors changed them. The researchers used scans to measure fat inside the liver and muscle, a type of fat stored in places where it does not belong. Fat in these organs is linked to insulin resistance, when the body responds poorly to insulin. According to the paper, average body weight fell by 6.0 kg, or 6.6%. Visceral fat, the fat around internal organs, fell. Liver fat dropped by 33.0% (95% confidence interval, 17.3 to 48.7 percentage points of relative change). Other measures moved the same way. Fasting and after-meal measures of insulin resistance and insulin sensitivity improved. So did several measures of beta-cell function, which describes how well the pancreas cells that make insulin respond to rising glucose. Advanced glycation end products, or AGEs, also fell in the skin. AGEs are compounds that form when sugars react with proteins and are linked to inflammation. Lifespan.io, which covered the study, reported further numbers. Average HbA1c, a marker of blood sugar over about three months, fell from 7.6% to 6.6%. Fasting glucose fell from 155 to 116 mg/dL. Participants reported eating about 346 fewer calories a day. LDL cholesterol fell, but HDL cholesterol fell too, and triglycerides did not change significantly. Lifespan.io also said five of the 16 metformin users cut their dose and two stopped it. Those medication changes matter. They make it harder to say how much of the blood sugar improvement came from the diet itself. The calorie drop matters too. Even without a target, people ate less and lost weight, and weight loss alone can improve blood sugar and liver fat. The authors say this directly. Because there was no control group, the changes cannot be attributed to the diet's makeup apart from the lower energy intake and weight loss. They call for randomized trials with comparison groups matched for weight loss or given standard care. The people studied were also a specific group. They had HbA1c between 6.5% and 10.5% and a body mass index between 26 and 40. They were not using insulin, sulfonylureas or weight-loss drugs, including incretin-based therapies. Lifespan.io noted that some lean mass was lost as well. FOR YOU For readers, the practical point is modest. A food-based approach that does not require tracking portions may be associated with weight loss and better metabolic markers in some people with type 2 diabetes. This is our own suggestion, not a finding of the study: do not start this diet, and do not start, stop or change any medication, including reducing or stopping metformin, without talking to your clinician first, since doses may need adjusting. Study lead Hana Kahleova said, per Lifespan.io, that the results show a shift toward plants can reduce liver fat by a third "without anyone having to count a single calorie." The trial design supports the first part of that more firmly than any claim about cause. The next step to watch is a randomized trial that compares this diet with another approach producing the same weight loss, which would show whether the food itself adds anything. A controlled comparison could make the finding more informative. The aim would be an approach people can sustain, with a clearer understanding of why it helps. Sources: BMJ open diabetes research & care (2026), Lifespan.io (study in BMJ Open Diabetes Research & Care) BMJ open diabetes research & care (2026),: https://doi.org/10.1136/bmjdrc-2026-006472 Lifespan.io (study in BMJ Open Diabetes Research &: https://lifespan.io/low-fat-vegan-diet-shows-benefits-in-type-2-diabetes/ ---

OCTOBER 17, 2026 Europe is one step from authorising a once-daily GLP-1 tablet from Eli Lilly for weight loss and type 2 diabetes. The European Medicines Agency's human medicines committee, the CHMP, recommended Foundayo (orforglipron) at its 12-15 October 2026 meeting, according to the agency. Readers should not start or stop any medication, including GLP-1 drugs, without consulting their clinician. How a treatment is taken can matter to its place in care. A committee recommendation for an oral GLP-1 therapy moves that question closer to European health systems and their patients. The committee recommended a marketing authorisation for adults, for weight management and for the treatment of type 2 diabetes. Foundayo is an oral GLP-1 receptor agonist taken as one tablet a day. The EMA describes it as an alternative to injectable and other oral GLP-1 receptor agonists. The applicant is Eli Lilly Nederland B.V. This is a recommendation, not a final approval. The EMA lists the European Commission's decision on Foundayo as pending. Until the Commission acts, the drug cannot be marketed in the EU on the strength of this opinion. The market implications below are our analysis, not the EMA's findings. The EMA's wording shows that regulators see a place for a daily tablet alongside injections and existing pills. If the Commission confirms the opinion, Lilly could compete for European patients who prefer not to inject. How much share it wins will depend on price, reimbursement and supply. The EMA announcement does not address any of these, and this remains uncertain. The wider meeting was favourable for new drugs. The CHMP recommended six new medicines and issued no negative opinions on new medicines this month. For 2026 so far, the EMA's figures show 72 positive and 8 negative opinions on new medicines. Other recommendations included Rasonque (daraxonrasib) for metastatic pancreatic cancer and Fovlussea, a ranibizumab biosimilar for wet age-related macular degeneration and other eye conditions. WHAT TO WATCH NEXT The European Commission's decision on Foundayo, and then whether national health systems agree to pay for it. Patients should discuss any questions about GLP-1 treatment with their own clinician. The Commission's decision, access, and reimbursement will determine the next chapter. Convenience becomes clinically meaningful when it fits an appropriate and workable treatment plan. Source: European Medicines Agency ---