The clearest signals are in blood fats and in vein-related symptoms. Blood pressure and inflammatory markers move favourably mainly in people who already have a metabolic disorder, not in healthy adults. Blood sugar control does not respond. Stomach upset is the main complaint. Absorption depends on gut bacteria, which makes response between people highly variable. (Full Review)
| Marker | Target | Why |
|---|---|---|
| LDL cholesterol | < 100 mg/dL; < 70 mg/dL with existing vascular disease | Primary endpoint with the strongest pooled evidence |
| Total cholesterol | 150–200 mg/dL | Second lipid endpoint reduced in pooled trials |
| Triglycerides | < 100 mg/dL | Reduced in the broader cardiometabolic synthesis |
| High-sensitivity C-reactive protein | < 1.0 mg/L | Tracks the inflammatory effect, the clearest signal after lipids |
| Fasting glucose and insulin | Glucose 70–85 mg/dL; insulin < 6 µIU/mL | Establishes metabolic status, which predicts whether any benefit will appear |
| HbA1c | < 5.4% | Confirms the pooled finding of no glycemic effect at the individual level |
| Alanine aminotransferase and gamma-glutamyl transferase | ALT < 25 U/L (men), < 20 U/L (women); GGT < 20 U/L | The liver-fat endpoint from the fatty liver disease trial |
| Home systolic blood pressure | < 120 mmHg | Detects both the intended reduction and excessive lowering on combined therapy |
| Platelet count | 150–400 × 10⁹/L | Baseline for anyone on antiplatelet or anticoagulant therapy |
| Body weight and waist circumference | Weight: change from own baseline; waist < 94 cm (men), < 80 cm (women) | Tests the pooled weight-gain signal in the individual |
Cadence: Baseline, first recheck at 12 weeks, then at 6 months, then annually once a response is established. Home blood pressure weekly for the first four weeks in anyone on antihypertensive therapy.