Living database
Protocol & Compound Index
Every compound and protocol we've reviewed. Updated with each issue. Click any row for scoring detail and a link to the full write up.
Tier key: S Top of class A Strong overall B Solid case C Limited D Weak F Avoid / defer
Avoidance: CRITICAL Universal exposure, severe harm HIGH Common exposure, real harm MODERATE Bounded exposure or harm LOW Limited everyday relevance MINIMAL Background-only
For toxin rows: Magnitude = harm severity,
Prevalence = exposure rate.
| Compound | Category | Class | Evidence | Benefit | Safety | Grade · Score | Updated |
|---|---|---|---|---|---|---|---|
| Sleep | Essentials | Lifestyle | 10 | 8 | 10 | S 9.7 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 10 Very Low. Low risk — minimal side-effect burden in healthy adults. Composite 9.7 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Protein intake | Essentials | Macronutrient | 10 | 8 | 9 | S 9.3 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 9 Low (high intake safe in healthy kidneys). Low risk — minimal side-effect burden in healthy adults. Composite 9.3 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Hydration / electrolytes | Essentials | Lifestyle | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 9 Low (overhydration risk at extremes). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Vitamin K2 (MK-7) | Essentials | Vitamin | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (avoid with warfarin). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| B vitamins (B-complex) | Essentials Cognitive | Vitamin | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (for deficiency/homocysteine); Weak (for CVD outcomes in replete people). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med (High in deficient or MTHFR variants). Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Iodine | Essentials Hormones & Endocrine | Mineral | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (for deficiency prevention). Large effect size when the claim holds. Safety (28%) 7 Low-Med (excess causes thyroid dysfunction). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Selenium | Essentials Hormones & Endocrine Immune & Inflammation | Mineral | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency); Mixed (supplementation in replete). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med (High if deficient). Modest or context-dependent effect. Safety (28%) 7 Low-Med (narrow therapeutic window; selenosis at high doses). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Boron | Essentials | Mineral | 4 | 3.5 | 9 | B- 5.9 | Jun 2026 |
| Score breakdown Evidence (44%) 4 Preclinical-Moderate. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med (Varies). Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 5.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Iron | Essentials | Mineral | 8 | 8 | 3.5 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (for deficiency). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (if deficient); None (if replete). Large effect size when the claim holds. Safety (28%) 3.5 Med-High (excess is pro-oxidant; hemochromatosis concern). High risk — serious side-effects at studied doses. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Omega-3 (EPA/DHA) | Essentials Sleep & Recovery Immune & Inflammation Metabolic Health Mood, Anxiety & Stress Cognitive | Supplement | 8 | 6.5 | 7 | B+ 7.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (CV mortality and events — 2025 Mattumpuram MA 42 studies, n=176,253; triglyceride lowering); Strong (depression — pure-EPA / high-EPA-ratio formulations); Moderate (cognitive in APOE4 carriers — PreventE4 prespecified subgroup); Mixed (general dementia prevention). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 7 Low-Med (dose-dependent AFib signal: ~12% increase at ~1 g/d, ~50% at 1.8-4 g/d per 2025 34-trial MA n=114,326; bleeding risk with anticoagulants at high doses; rancid product GI upset). Modest risk — manageable side-effects for most users. Composite 7.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| CoQ10 (ubiquinone/ubiquinol) | Mitochondria & Cellular Energy Metabolic Health Muscle & Strength Longevity | Supplement | 8 | 6.5 | 9 | A+ 8.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (heart failure — Q-SYMBIO 2014 plus 2024 16-study MA showing 40% HF mortality reduction; 2024 ubiquinol-specific HF MA PMID 39049769); Moderate (statin-associated muscle symptoms — 2025 Aug 2024-search MA n=389 across 7 RCTs found WMD -0.96 reduction in pain intensity p<0.05); Moderate (male fertility — 200 mg/day ubiquinol x 26 wk improved sperm motility 35.8% vs 25.4%); Weak (general population). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High (in HF); Varies otherwise. Meaningful effect for the studied population. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 8.2 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| NAC (N-acetyl cysteine) | Essentials Immune & Inflammation Detox Mood, Anxiety & Stress | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (psychiatric — OCD, trichotillomania, bipolar adjunct; PCOS, fertility; chronic bronchitis); Weak (generic 'detox' use); Strong (acetaminophen/APAP overdose antidote; COPD exacerbations; contrast-induced nephropathy mixed). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (GI upset; rotten-egg smell characteristic; bronchospasm with inhaled form). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Choline | Essentials Cognitive | Macronutrient | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (essential nutrient; deficiency causes liver disease). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (fishy body odor and low BP at very high doses). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Taurine | Essentials Longevity Mitochondria & Cellular Energy Metabolic Health | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (CV/metabolic markers); Preclinical (longevity — contested in humans). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Fiber / psyllium husk | Essentials Metabolic Health Immune & Inflammation | Macronutrient | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 9 Low (gas/bloating; obstruction risk without adequate fluids). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Shilajit | Essentials Mitochondria & Cellular Energy Hormones & Endocrine | Mineral | 6 | 5 | 3 | C 4.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (testosterone — Pandit/Biswas 2016 Andrologia RCT n=60 men aged 45-55, PrimaVie 250 mg BID x 90 days showed total T +20%, free T +19%, DHEAS elevation with preserved LH/FSH); Weak (fertility, fatigue/CFS, exercise recovery — small heterogeneous trials); Weak-Anecdotal (cognitive/Alzheimer — older Indian and Chilean preclinical trials with no Western RCT); Preclinical (mitochondrial CoQ10 stabilization — Bhattacharyya 2012 rat hepatic mitochondria ~40% reduction in ubiquinol oxidation). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (testosterone in middle-aged men); Weak (other claimed indications). Modest or context-dependent effect. Safety (28%) 3 Med-High for raw/unpurified product (heavy-metal contamination is a real and under-appreciated concern — ICP-MS testing of commercial shilajit routinely finds arsenic, lead, mercury, cadmium, chromium, and notably THALLIUM as natural contaminants; thallium mimics potassium and penetrates all tissues; uncharacterized gray-market shilajit is uniquely concerning vs other supplements); Low for verified-pure standardized extract (e.g., PrimaVie with COA); 2024 ConsumerLab analysis found fulvic acid content varies enormously across brands. High risk — serious side-effects at studied doses. Composite 4.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Sauna (Finnish/dry) | Metabolic Health Longevity Sleep & Recovery | Protocol | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (observational — Finnish cohort data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 7 Low-Med (dehydration; caution in severe CV disease and pregnancy). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Cold plunge / cold water immersion | Sleep & Recovery Mood, Anxiety & Stress Metabolic Health | Protocol | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (mood, recovery, BAT); Weak (weight loss, longevity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med (Varies by outcome). Modest or context-dependent effect. Safety (28%) 5 Med (cardiac stress in vulnerable populations; cold shock drowning risk). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Contrast therapy (hot/cold) | Sleep & Recovery | Protocol | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (recovery); Preclinical-Moderate otherwise. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med / Varies. Modest or context-dependent effect. Safety (28%) 7 Low-Med. Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Red light therapy / photobiomodulation (PBM) | Mitochondria & Cellular Energy Sleep & Recovery Immune & Inflammation | Protocol | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (skin, hair, wound healing, pain); Preclinical (cognition, mitochondrial effects). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med (skin/hair) / Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Sunlight / circadian light exposure | Sleep & Recovery Mood, Anxiety & Stress Longevity | Protocol | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (circadian/mood/vitamin D); Moderate (cardiovascular via skin NO). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 7 Low-Med (skin cancer risk at high cumulative UV). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Hyperbaric oxygen therapy (HBOT) | Sleep & Recovery Longevity | Protocol | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (wound healing — approved indication; Hachmo telomere/senescence data); Preclinical otherwise. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med / Varies. Modest or context-dependent effect. Safety (28%) 5 Med (barotrauma, oxygen toxicity, fire risk). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Breathwork (structured breathing) | Mood, Anxiety & Stress Sleep & Recovery | Protocol | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (anxiety, HRV, mood); Weak-Moderate (performance). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (hyperventilation risk with Wim Hof near water). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Altitude training / intermittent hypoxia (IHT) | Metabolic Health Longevity | Protocol | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (athletic performance — endurance); Preclinical (longevity/metabolic). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med (athletics) / Varies. Modest or context-dependent effect. Safety (28%) 7 Low-Med (altitude sickness; contraindicated in severe CV/pulmonary disease). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Resistance training | Muscle & Strength Longevity Metabolic Health | Protocol | 10 | 8 | 9 | S 9.3 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 9.3 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Zone 2 cardio | Metabolic Health Longevity | Protocol | 6 | 6.5 | 9 | B+ 7.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (mitochondrial; performance); Strong indirectly via CRF/VO2 max mortality data. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| VO2 max / HIIT | Metabolic Health Longevity | Protocol | 10 | 8 | 7 | S 8.5 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (CRF-mortality link). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 7 Low-Med (caution in symptomatic CV disease). Modest risk — manageable side-effects for most users. Composite 8.5 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Blood flow restriction (BFR) training | Muscle & Strength Sleep & Recovery | Protocol | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (muscle hypertrophy at low loads); Moderate (older/rehab populations). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (niche use case). Large effect size when the claim holds. Safety (28%) 7 Low-Med (properly set cuffs; risk of bruising; caution in clotting disorders). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Mobility work / flexibility training | Sleep & Recovery | Protocol | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (injury prevention mixed); Strong (pain/function in older adults). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Intermittent fasting (general) | Metabolic Health Longevity | Protocol | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (concerns in eating disorders, pregnancy, T1DM). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Extended fasting (24-72h+) | Metabolic Health Longevity | Protocol | 4 | 5 | 5 | C 4.6 | Jun 2026 |
| Score breakdown Evidence (44%) 4 Moderate-Preclinical. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 5 Med (refeeding syndrome after longer fasts; electrolyte monitoring; muscle loss). Real risk — monitoring or clinician oversight matters. Composite 4.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Time-restricted eating (TRE) | Metabolic Health Sleep & Recovery Longevity | Protocol | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (metabolic markers); Mixed (weight loss vs isocaloric control). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Circadian-aligned eating | Sleep & Recovery Longevity | Protocol | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Fasting-mimicking diet (FMD / ProLon) | Metabolic Health Longevity | Protocol | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med. Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| PEMF therapy (pulsed electromagnetic field) | Sleep & Recovery | Protocol | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (bone non-union — FDA approved); Weak-Preclinical (general wellness). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med / Varies. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Grounding / earthing | Essentials Sleep & Recovery | Protocol | 2.5 | 2 | 9 | C 5 | Jun 2026 |
| Score breakdown Evidence (44%) 2.5 Preclinical-Weak. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low / Varies. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 5 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Meditation / mindfulness | Mood, Anxiety & Stress Longevity Sleep & Recovery | Protocol | 8 | 6.5 | 9 | A+ 8.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (anxiety, depression, stress); Moderate (chronic pain, BP, cognition). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 8.2 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| HRV-guided training / biofeedback | Sleep & Recovery Mood, Anxiety & Stress | Protocol | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (performance and recovery); Strong (HRV itself as health biomarker). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med / Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Cognitive behavioral therapy for insomnia (CBT-I) | Sleep & Recovery Mood, Anxiety & Stress Cognitive | Protocol | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (chronic insomnia — guideline-level first-line therapy; large RCT/meta-analysis base). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 7 Low-Med (temporary sleep restriction can worsen daytime sleepiness early; requires adherence; clinician guidance preferred in bipolar disorder, seizure risk, severe sleep apnea, or safety-sensitive work). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Semaglutide | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 5 Med (GI effects; gallbladder/pancreatitis; altered skin sensation more common at Wegovy HD 7.2 mg). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Tirzepatide | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (most effective approved weight loss drug). Large effect size when the claim holds. Safety (28%) 5 Med. Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Liraglutide | Metabolic Health | Prescription | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med. Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Dulaglutide | Metabolic Health | Prescription | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (T2D and CV outcomes); Moderate (as pure weight loss agent). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med. Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Retatrutide | Metabolic Health | Prescription | 8 | 10 | 5 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 TRIUMPH-1 topline May 2026, n=2,339, 28.3% weight loss at 80wk / 30.3% at 104wk on 12 mg; full publication pending); Strong Phase 2 (Jastreboff 2023). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very High (28.3% mean weight loss at 80wk, 12 mg; 30.3% at 104wk; 45.3% of 12 mg arm reached ≥30% loss). Large effect size when the claim holds. Safety (28%) 5 Med (GI dominant — 12 mg vs placebo at 80wk: nausea 42.4% vs 14.8%, vomiting 25.3% vs 4.8%, diarrhea 32.0% vs 13.5%; AE discontinuation 11.3% vs 4.9%; dysesthesia 12.5% vs 0.9% — novel signal; CV/MACE awaited from TRIUMPH-Outcomes). Real risk — monitoring or clinician oversight matters. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Cagrilintide | Metabolic Health | Supplement | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Ph3 readouts 2025: REDEFINE 1 & 2 published NEJM). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (CagriSema -20.4% in REDEFINE 1; cagrilintide monotherapy -11.5%). Large effect size when the claim holds. Safety (28%) 5 Med (similar GI profile to semaglutide; nausea/vomiting/diarrhea common). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Orlistat | Metabolic Health | Prescription | 8 | 3.5 | 7 | B 6.9 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 3.5 Low-Med (~3-5 kg above placebo). Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (GI side effects are severe and common; fat-soluble vitamin malabsorption). Modest risk — manageable side-effects for most users. Composite 6.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Phentermine | Metabolic Health | Prescription | 8 | 6.5 | 3.5 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (short-term). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (cardiac risk, BP/HR, insomnia, addiction potential, pulmonary hypertension with old fen-phen combo). High risk — serious side-effects at studied doses. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Contrave (bupropion + naltrexone) | Metabolic Health | Prescription | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med (~4-5% weight loss above placebo). Modest or context-dependent effect. Safety (28%) 5 Med (seizure risk with bupropion; BP/HR; contraindicated in uncontrolled HTN or seizures). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Setmelanotide | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (in specific genetic indications). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (in genetic + acquired hypothalamic obesity); N/A (general obesity). Large effect size when the claim holds. Safety (28%) 5 Med (injection site reaction, hyperpigmentation, nausea). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Pramlintide | Metabolic Health | Prescription | 8 | 3.5 | 5 | B- 6.1 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (in T2D adjunct); Moderate (weight loss). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (nausea very common; severe hypoglycemia if used with insulin). Real risk — monitoring or clinician oversight matters. Composite 6.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Topiramate | Metabolic Health Mood, Anxiety & Stress | Prescription | 8 | 5 | 3.5 | B- 5.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (as weight loss agent and combo Qsymia). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med (~6-10% with combo). Modest or context-dependent effect. Safety (28%) 3.5 Med-High (cognitive slowing, paresthesias, kidney stones, teratogenic cleft palate; acute angle-closure glaucoma / acute myopia — rare but vision-threatening). High risk — serious side-effects at studied doses. Composite 5.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Bimagrumab | Metabolic Health Muscle & Strength | Prescription | 6 | 6.5 | 5 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2 in T2D obesity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Moderate-High (unique for preserving/increasing lean mass while losing fat). Meaningful effect for the studied population. Safety (28%) 5 Med (minor pancreatitis signal; acne, muscle cramps). Real risk — monitoring or clinician oversight matters. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Naltrexone (low dose, LDN) | Metabolic Health Immune & Inflammation | Prescription | 3 | 2 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (weight loss); Moderate (chronic pain, fibromyalgia, autoimmune symptoms). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low (for weight loss as standalone). Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Clenbuterol | Metabolic Health | Prescription | 8 | 8 | 2 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (in animals/livestock); Moderate (illicit human use — anecdotal). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (acute fat loss) / Varies. Large effect size when the claim holds. Safety (28%) 2 High (cardiac hypertrophy, arrhythmias, tremor, insomnia, hypokalemia; reports of cardiac arrest). High risk — serious side-effects at studied doses. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| DNP (2,4-dinitrophenol) | Metabolic Health | Prescription | 8 | 10 | 0 | C 5.1 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (for fat loss); Strong (for lethality). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very High (fat loss) / High (acute harm). Large effect size when the claim holds. Safety (28%) 0 Very High (fatal hyperthermia — core temp can rise uncontrollably; cataracts, hepatotoxicity; MULTIPLE DEATHS every year). Severe risk — fatal-potential or unacceptable harm profile. Composite 5.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| CLA (conjugated linoleic acid) | Metabolic Health | Supplement | 4.5 | 2 | 7 | C 5.1 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (insulin resistance and fatty liver signals at high doses). Modest risk — manageable side-effects for most users. Composite 5.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Orforglipron | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 ATTAIN-1/2; FDA approved 2026). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (oral GLP-1; ~10-12% weight loss in Phase 3; convenience advantage). Large effect size when the claim holds. Safety (28%) 5 Med (GI effects common; label warnings for pancreatitis, severe GI reactions, AKI from volume depletion, hypoglycemia, gallbladder disease, aspiration risk). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Survodutide | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 SYNCHRONIZE-1 topline 2026). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (projected from Phase 2). Large effect size when the claim holds. Safety (28%) 5 Med (similar GI profile to GLP-1 class; no unexpected signals to date). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Maridebart cafraglutide (MariTide) | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong Phase 2 (NEJM 2025); Phase 3 enrolling. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (-12.3% to -16.2% at 52 wk in obesity; -8.4% to -12.3% in T2D+obesity). Large effect size when the claim holds. Safety (28%) 5 Med (GI events common but mitigated by dose escalation). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Mazdutide (IBI362) | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Ph3 GLORY-1 in China 2025; approved in China 2025); Moderate (Western trials pending). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (~16-18% weight loss at 32-48 wk in Chinese trials). Large effect size when the claim holds. Safety (28%) 5 Med (similar GI profile to GLP-1 class). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| NAD+ / NMN / NR | Longevity Mitochondria & Cellular Energy | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (raises NAD+ reliably); Weak (functional/outcome endpoints). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Rapamycin (sirolimus) | Longevity | Prescription | 4.5 | 6.5 | 5 | C 5 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Moderate-Weak (human healthspan — PEARL 2025 missed primary); Strong (rodent lifespan — most replicated longevity intervention ever). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 6.5 Med-High (projected from animal data). Meaningful effect for the studied population. Safety (28%) 5 Med (immunosuppression, mouth sores, hyperlipidemia, insulin resistance, wound healing impairment). Real risk — monitoring or clinician oversight matters. Composite 5 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Metformin | Longevity Metabolic Health | Prescription | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (in T2D); Moderate observationally (non-diabetics); Preclinical (pure anti-aging). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI side effects; B12 deficiency with chronic use; lactic acidosis rare; may blunt exercise adaptations). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Acarbose | Longevity Metabolic Health | Prescription | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (human glycemic control); Strong (rodent lifespan especially in males). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med (Varies by gender). Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI flatulence is common). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Senolytics (D+Q combo) | Longevity | Prescription | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (human IPF, DKD — condition-specific improvements); Strong (preclinical). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 5 Med (dasatinib has oncology side effect profile: GI, hematologic; intermittent dosing mitigates). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Fisetin | Longevity Immune & Inflammation | Supplement | 4 | 5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4 Preclinical-Moderate (currently in Mayo Clinic Phase 2 trials). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Spermidine | Longevity Mitochondria & Cellular Energy | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Resveratrol | Longevity Immune & Inflammation Metabolic Health | Supplement | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Pterostilbene | Longevity Immune & Inflammation Metabolic Health | Supplement | 2.5 | 3.5 | 7 | C- 4.5 | Jun 2026 |
| Score breakdown Evidence (44%) 2.5 Weak-Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med / Varies. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (LDL elevation reported). Modest risk — manageable side-effects for most users. Composite 4.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Urolithin A | Mitochondria & Cellular Energy Longevity Muscle & Strength Immune & Inflammation | Supplement | 6 | 6.5 | 9 | B+ 7.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (human trials — muscle, immune, biomarkers). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Alpha-ketoglutarate (Ca-AKG) | Longevity Mitochondria & Cellular Energy | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (animal lifespan; observational biomarker studies). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Glycine + NAC (GlyNAC) | Longevity Mitochondria & Cellular Energy Immune & Inflammation Cognitive Muscle & Strength | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Glycine (longevity / metabolic) | Longevity Metabolic Health | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (ITP mouse lifespan; obesity/MASLD metabolic markers); Weak (human longevity outcomes). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated to tens of g/day; mild GI at high doses; sweet taste). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Sulforaphane | Longevity Immune & Inflammation Detox | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (autism — 2025 meta-analysis n=333 across 6 RCTs significant SRS reduction at both 4-5 and 8-10 weeks; Singh 2014 the canonical anchor); Moderate (airborne carcinogen excretion — Kensler 2014 Qidong China demonstrated bladder excretion of acrolein/benzene/crotonaldehyde metabolites); Moderate (schizophrenia negative symptoms and cognition — 2025 RCT positive in chronic schizophrenia); Weak-Moderate (cancer — early-stage prostate and breast signal especially in GSTM1-positive individuals, limited in advanced disease); Moderate (metabolic markers and inflammation across multiple smaller trials). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated; rare GI symptoms; ~50% of completed sulforaphane trials remain unpublished — publication bias caveat from 2025 JNS comprehensive review). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Epithalon (epitalon) | Longevity Sleep & Recovery | Peptide | 2 | 5 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical; Weak human (Russian clinical tradition). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Pinealon (EDR tripeptide / Glu-Asp-Arg) | Longevity Cognitive Sleep & Recovery | Peptide | 2 | 5 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (rodent neuroprotection and gene expression — Khavinson lab and collaborators); Very weak human (single 2014 Kryzhanovskaya cognitive trial in 45-65 year olds; otherwise Russian clinical tradition only). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (case-series reports; no Western RCT safety data). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Thymalin | Longevity | Peptide | 2 | 5 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical; Weak human (Russian clinical tradition). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| MOTS-c | Longevity Mitochondria & Cellular Energy Metabolic Health Muscle & Strength | Peptide | 2.5 | 5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 2.5 Preclinical-Weak human. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (from limited data). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Humanin | Longevity Mitochondria & Cellular Energy Cognitive | Peptide | 2 | 5 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown / Varies. Modest or context-dependent effect. Safety (28%) 9 Low (limited safety data). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Klotho | Longevity | Supplement | 2 | 5 | 5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies (unknown clinically). Modest or context-dependent effect. Safety (28%) 5 Med (limited human data on exogenous administration). Real risk — monitoring or clinician oversight matters. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| GDF11 | Longevity | Supplement | 2 | 5 | 5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (mixed/contested). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies (unknown). Modest or context-dependent effect. Safety (28%) 5 Med (limited safety data; growth factor concerns). Real risk — monitoring or clinician oversight matters. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| SS-31 (elamipretide) | Mitochondria & Cellular Energy | Peptide | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (mitochondrial disease and heart failure trials). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (in mitochondrial diseases). Modest or context-dependent effect. Safety (28%) 9 Low (injection site reactions most common). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Ergothioneine | Mitochondria & Cellular Energy | Herbal | 4.5 | 5 | 9 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (observational human associations; preclinical mechanism). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| 17-alpha estradiol | Longevity | Research chemical | 2 | 5 | 7 | C- 4.5 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (strong male mouse lifespan in ITP). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 7 Low-Med (limited human safety data). Modest risk — manageable side-effects for most users. Composite 4.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| C60 (carbon 60 / buckminsterfullerene) | Longevity Mitochondria & Cellular Energy | Research chemical | 3 | 2 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (single controversial rat study). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low / Varies. Small or unclear effect even in best-case interpretation. Safety (28%) 4 Unknown (long-term safety untested). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Hydrogen water / molecular hydrogen (H2) | Mitochondria & Cellular Energy | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (metabolic syndrome lipids/glucose; exercise recovery; inflammation markers — multiple 2024-2025 SRs/MAs); Weak-Moderate (respiratory disease adjunct; cancer adjuvant); Preclinical (Parkinson's; RA; neuroprotection). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (no safety signals across 80+ human trials; not on WADA 2024 prohibited list). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Plasma exchange / young plasma | Longevity | Supplement | 3 | 3.5 | 3.5 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (one small human biological-age RCT — Fuentealba/Kiprov, Aging Cell 2025, n=42, surrogate clocks); Preclinical dilution mechanism (Conboy 2020). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med (surrogate biological-age clock reductions in a small RCT; hard-outcome benefit unproven). Small or unclear effect even in best-case interpretation. Safety (28%) 3.5 Med-High (infection, immune, cost). High risk — serious side-effects at studied doses. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Yamanaka factors / partial reprogramming | Longevity | Supplement | 2 | 5 | 3.5 | D 3.1 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (mouse rejuvenation in tissue/organ contexts). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies (unknown). Modest or context-dependent effect. Safety (28%) 3.5 Med-High (cancer/teratoma risk; adventitial cell dedifferentiation). High risk — serious side-effects at studied doses. Composite 3.1 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Pyrroloquinoline quinone (PQQ) | Mitochondria & Cellular Energy | Prescription | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (small RCTs show plasma marker improvements — reduced CRP, improved HDL, reduced lactate; Nakano 2012 showed sleep quality improvement in healthy adults); Preclinical (robust mitochondrial biogenesis). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate (modest effects on mitochondrial markers, sleep, possibly cognition); function-level outcomes thin. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (very well-tolerated in trials up to 60 mg/day; theoretical concern about pro-oxidant activity at very high doses). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Adderall (amphetamine salts) | Cognitive | Prescription | 8 | 6.5 | 2 | C+ 5.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (ADHD); Moderate (cognitive enhancement — small effect in healthy). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 2 High (addiction/dependence potential; BP/HR; anxiety; Schedule II). High risk — serious side-effects at studied doses. Composite 5.4 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Vyvanse (lisdexamfetamine) | Cognitive | Prescription | 8 | 6.5 | 3.5 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (ADHD; also approved for BED). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (similar to Adderall; lower abuse potential due to prodrug). High risk — serious side-effects at studied doses. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Semax | Cognitive | Peptide | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Russian clinical tradition); Preclinical (strong). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported; limited Western safety data). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Selank | Cognitive Mood, Anxiety & Stress | Peptide | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Russian clinical tradition); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Cerebrolysin | Cognitive | Peptide | 4.5 | 5 | 5 | C 4.8 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Moderate-Disputed (acute ischemic stroke — Cochrane 2023 Ziganshina says current RCT data do NOT support routine use and flags non-fatal SAE signal RR 2.39 95% CI 1.10-5.23 across 3 trials n=1335; 2025 Patel MA n=2884 across 14 RCTs reports early-recovery benefit but includes the same industry-sponsored trials); Weak-Moderate (vascular dementia — Cochrane 2019 Cui MMSE and ADAS-cog+ modest benefit across 6 RCTs n=597; field stagnant — no new RCTs since 2019 update); Weak-Moderate (TBI — CAPTAIN I-II MA Poon 2021 n=185 small-to-medium effect at Day 30 and 90; small N; manufacturer-sponsored). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Low-Med (injection site reactions; rare hypersensitivity); newer safety signal: 2023 Cochrane reported ~2.4-fold increase in non-fatal serious adverse events across pooled stroke trials. Real risk — monitoring or clinician oversight matters. Composite 4.8 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Selegiline (L-deprenyl) | Mood, Anxiety & Stress | Prescription | 6 | 3.5 | 5 | C+ 5.2 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Parkinson's disease); Weak-Moderate (longevity/cognitive in healthy). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (hypotension; insomnia; serotonin syndrome with SSRIs; tyramine reaction at higher doses). Real risk — monitoring or clinician oversight matters. Composite 5.2 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| L-theanine | Cognitive Mood, Anxiety & Stress Sleep & Recovery | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (acute attention/calm; combined with caffeine). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| L-tyrosine | Cognitive | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (acute stress/cold/sleep deprivation performance); Weak (healthy baseline enhancement). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Varies (context-dependent). Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Caffeine | Cognitive | Supplement | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (acute alertness, attention, reaction time). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 9 Low (ordinary dietary use; dependence, sleep disruption, anxiety in sensitive users); Very High for pure/bulk powder misuse. Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Rhodiola rosea | Cognitive Mood, Anxiety & Stress Muscle & Strength Mitochondria & Cellular Energy | Herbal | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (fatigue, burnout, mild depression, exercise recovery). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (generally well-tolerated). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Piracetam | Cognitive | Research chemical | 4.5 | 5 | 9 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (cognitive impairment; cortical myoclonus); Inconclusive (healthy enhancement). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Aniracetam | Cognitive | Research chemical | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (anxiolytic/cognitive — mostly older European trials); Preclinical (robust). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Oxiracetam | Cognitive | Research chemical | 4.5 | 5 | 9 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (vascular dementia — Italian trials); Preclinical. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported). Low risk — minimal side-effect burden in healthy adults. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Phenylpiracetam (Phenotropil) | Cognitive | Research chemical | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Russian stroke/asthenia trials); Weak (Western data). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (tolerance develops rapidly; mild stimulant effects). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Pramiracetam | Cognitive | Research chemical | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (TBI/Alzheimer's — limited older data); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Fasoracetam | Cognitive | Research chemical | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Aevi/Supernus adolescent ADHD Ph2 — mixed results; discontinued Ph3). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (reported in trials). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Coluracetam (MKC-231) | Cognitive | Research chemical | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small BioLineRx MDD Ph2a — discontinued); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (limited data). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Modafinil | Cognitive | Prescription | 8 | 6.5 | 7 | B+ 7.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (narcolepsy, shift-work disorder, OSA residual sleepiness); Moderate (cognitive enhancement in sleep-deprived; small effect in rested). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 7 Low-Med (headache, insomnia, rare but serious SJS/TEN; mild dependence potential). Modest risk — manageable side-effects for most users. Composite 7.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Armodafinil | Cognitive | Prescription | 8 | 6.5 | 7 | B+ 7.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (narcolepsy, shift-work disorder, OSA); Moderate (cognitive). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 7 Low-Med (similar profile to modafinil). Modest risk — manageable side-effects for most users. Composite 7.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Solriamfetol (Sunosi) | Cognitive | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (narcolepsy and OSA — TONES Phase 3 program: MWT improvement 9-13 minutes); Strong (adult ADHD — FOCUS Phase 3 March 2025, n=516, 150 mg AISRS -17.7 vs placebo -14.3; response rate 53.5% vs 41.3%; p<0.05). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (Maintenance of Wakefulness Test +9-13 min in OSA/narcolepsy; ~45% mean reduction in adult ADHD symptoms at 150 mg). Large effect size when the claim holds. Safety (28%) 5 Med (dose-related BP/HR elevation — meaningful given OSA/narcolepsy/ADHD populations carry elevated baseline CV risk; headache, anxiety, decreased appetite, insomnia all confirmed in 2024 FAERS pharmacovigilance; Schedule IV abuse potential). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Pitolisant (Wakix) | Cognitive | Prescription | 8 | 6.5 | 7 | B+ 7.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (narcolepsy with cataplexy — HARMONY trials; OSA daytime sleepiness). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Moderate-Strong. Meaningful effect for the studied population. Safety (28%) 7 Low-Med (headache, insomnia, nausea, anxiety; QT prolongation requires baseline ECG; not Schedule classed). Modest risk — manageable side-effects for most users. Composite 7.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Guanfacine | Cognitive | Prescription | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (ADHD, especially with PFC deficits); Moderate (anxiety, tic disorders). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (hypotension, sedation, dry mouth). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Atomoxetine | Cognitive | Prescription | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (ADHD — slower onset and smaller effect than stimulants). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (hepatotoxicity warning, cardiovascular effects, suicidal ideation in youth). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Bromantane (Ladasten) | Cognitive | Research chemical | 4.5 | 5 | 9 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (largest Russian trial: n=728 multicenter asthenia, 50-100 mg/day x 28 days, 76% physician-rated improvement; 3% AE; 0.8% discontinuation; benefits persisted ~1 month after stopping); Preclinical (Mikhaylova 2007 hippocampal synaptic plasticity in rats). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies (Russian asthenia data only). Modest or context-dependent effect. Safety (28%) 9 Low in Russian data (~3% AE, mostly mild GI; theoretical sympathomimetic concerns at supratherapeutic doses; high-dose rat studies show GI and thermoregulatory effects only at >>therapeutic doses). Low risk — minimal side-effect burden in healthy adults. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Noopept (GVS-111) | Cognitive | Peptide | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Russian MCI trials); Preclinical (robust). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (Russian data); unknown long-term. Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| P21 peptide | Cognitive | Peptide | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical only (Iqbal lab mouse work). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (no human safety data). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| DSIP (delta sleep-inducing peptide) | Cognitive Sleep & Recovery | Peptide | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (inconsistent Russian sleep/alcoholism data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (limited data). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Sunifiram (DM-235) | Cognitive | Research chemical | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical only. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (no human safety; seizure risk plausible from AMPA PAM activity). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| IDRA-21 | Cognitive | Research chemical | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical only. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (no human safety; AMPA seizure risk concern). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| PRL-8-53 | Cognitive | Research chemical | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (single 1978 Hansl human trial, n=47). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (essentially no safety data). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Alpha-GPC (alpha-glycerophosphocholine) | Cognitive | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Alzheimer's disease cognition — Italian trials); Weak (healthy enhancement, exercise power output). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (possible GI/headache); emerging observational signal for stroke risk (inconsistent). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| CDP-choline (citicoline) | Cognitive | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (vascular cognitive impairment, post-stroke recovery, age-related cognition); Moderate (glaucoma neuroprotection). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (very well-tolerated). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Choline bitartrate | Cognitive | Supplement | 3 | 2 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (not well-studied for cognition specifically); essential nutrient. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (fishy body odor at high doses due to TMA). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Huperzine A | Cognitive | Prescription | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Chinese Alzheimer's and MCI trials); Preclinical (robust). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (cholinergic effects: GI upset, cramping, vivid dreams; bradycardia at high doses). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Bacopa monnieri | Cognitive | Herbal | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (memory consolidation, learning — multiple RCTs in older adults and children). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (GI upset common; rare sedation). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Lion's mane (Hericium erinaceus) | Cognitive | Herbal | 4.5 | 5 | 9 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (Mori 2009 MCI trial; Docherty 2023 young adults; Li 2020 AD showed ADL but no cognitive benefit). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (rare dermatitis/respiratory hypersensitivity). Low risk — minimal side-effect burden in healthy adults. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Cordyceps (militaris/sinensis) | Cognitive | Herbal | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (exercise VO2max/endurance); Weak (cognitive). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Saffron extract (Crocus sativus) | Mood, Anxiety & Stress | Herbal | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (mild-moderate depression, non-inferiority vs fluoxetine/imipramine); Weak-Moderate (MCI/mild Alzheimer's). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (safe at supplement doses; toxic >5 g). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Polygala tenuifolia | Cognitive | Herbal | 3 | 5 | 7 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small Chinese cognitive trials); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI irritation, nausea at higher doses). Modest risk — manageable side-effects for most users. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Gotu kola (Centella asiatica) | Cognitive | Herbal | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (mood/anxiety in older adults); Preclinical (neurogenesis, dendritic complexity). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (rare hepatotoxicity reports at high doses/chronic use). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Methylene blue | Mitochondria & Cellular Energy Cognitive Longevity | Prescription | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Rodriguez 2016 fMRI — ~7% memory retrieval improvement in healthy adults; Telch 2014 — fear extinction/contextual memory); Moderate-Disputed (TauRx LUCIDITY Phase 3 of hydromethylthionine mesylate HMTM 16 mg/day in MCI/mild-moderate AD — 82% reduction in ADAS-cog13 decline at 18 months vs matched placebo; 35% reduction in brain atrophy; trial-design critique flags absence of true placebo comparator since all participants received background AD therapy). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (serotonin syndrome risk with SSRIs/SNRIs/MAOIs via potent MAO-A inhibition — contraindicated within ~5-week SSRI washout for IV doses ≥1 mg/kg; G6PD deficiency causes severe hemolysis — absolute contraindication; methemoglobinemia at supratherapeutic doses; blue discoloration of urine/saliva/skin; staining of teeth and tongue at oral doses). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| ALCAR (acetyl-L-carnitine) | Cognitive Mitochondria & Cellular Energy | Prescription | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (mild cognitive impairment, age-related cognitive decline); Moderate (diabetic neuropathy pain). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (insomnia, agitation at high doses; seizure threshold caution in epilepsy). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Alpha-lipoic acid (ALA) | Mitochondria & Cellular Energy Metabolic Health Detox | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (diabetic neuropathy symptoms); Weak-Moderate (cognitive in AD — often combined with ALCAR). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (rare hypoglycemia, thiamine depletion with chronic use). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| BAM15 | Mitochondria & Cellular Energy | Research chemical | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (uncoupler class concerns: hyperthermia, narrow safety margin, off-target mitochondrial toxicity). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Phosphatidylserine | Cognitive | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (age-related cognitive decline; stress/cortisol blunting; ADHD adjunct). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (GI upset). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Uridine monophosphate | Cognitive | Supplement | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (bipolar depression with omega-3); Preclinical (Wurtman lab synaptogenesis work). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| MCT oil / ketogenic MCT drink | Cognitive Metabolic Health Mitochondria & Cellular Energy | Supplement | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (MCI / older-adult cognition RCTs); Mixed (healthy cognition and metabolic use). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI upset/diarrhea, calorie load, saturated-fat load; possible LDL-C increase in susceptible users at high intake). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Dietary nucleotide supplementation | Cognitive Longevity Muscle & Strength Immune & Inflammation Mitochondria & Cellular Energy | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (single 2025 older-adult RCT); Weak (replication and hard outcomes). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (limited long-term adult data; theoretical gout/uric-acid caution with high purine load or history of hyperuricemia). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Sulbutiamine | Cognitive | Prescription | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (asthenia — older French/Russian data; fatigue in chronic disease). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (rare skin reactions; tolerance develops). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Memantine | Cognitive | Prescription | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (moderate-severe Alzheimer's disease); Weak (off-label autism, OCD augmentation). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated; dizziness, headache). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| ACD-856 (NeuroRestore) | Cognitive | Supplement | 2 | 5 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (rodent — reversed scopolamine and MK801 memory impairment; pro-cognitive across encoding/consolidation/retrieval; antidepressant-like in forced swim; neuroprotective; anti-inflammatory); Phase 1 SAD and MAD completed (safety/tolerability/PK/QEEG biomarker positive); Phase 2a planned 2025-2026 with EU EIC grant. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown (no Phase 2 efficacy data). Modest or context-dependent effect. Safety (28%) 9 Low (Phase 1 MAD up to 90 mg/day x 7 days well-tolerated; no SAEs; favorable cardiac conduction profile). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Anti-amyloid mAbs (lecanemab / donanemab / aducanumab) | Cognitive | Prescription | 4.5 | 3.5 | 0 | D- 2.6 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (clinical benefit — Cochrane 2026 meta-analysis found trivial cognitive benefit and small functional benefit; aducanumab withdrawn 2024); Strong (amyloid clearance — robust on PET — a surrogate endpoint). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate (clinical benefit appears trivial-to-small clinically while ARIA risk is meaningful). Small or unclear effect even in best-case interpretation. Safety (28%) 0 High (ARIA-E [edema] in ~25% of patients on lecanemab; ~107 more per 1000 vs placebo across class; ARIA-H [hemorrhage]; rare fatal cerebral hemorrhages especially with anticoagulants or APOE4/4 homozygotes; infusion reactions). Severe risk — fatal-potential or unacceptable harm profile. Composite 2.6 0.44·Ev + 0.28·Bn + 0.28·Sf → D- | |||||||
| Tianeptine | Mood, Anxiety & Stress | Prescription | 6 | 5 | 2 | C- 4.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (MDD — EU approval); emerging DEPENDENCE/abuse epidemic particularly in US via OTC supplements. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 HIGH (mu-opioid agonism = addiction, tolerance, withdrawal, overdose deaths; cardiotoxicity at high doses). High risk — serious side-effects at studied doses. Composite 4.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Propranolol | Mood, Anxiety & Stress | Prescription | 8 | 3.5 | 9 | A- 7.7 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (performance anxiety acute use); Moderate (essential tremor, migraine prophylaxis); Weak-Moderate (PTSD memory reconsolidation — mixed data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (bradycardia, hypotension; contraindicated in asthma, severe bradycardia, decompensated HF). Low risk — minimal side-effect burden in healthy adults. Composite 7.7 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Nicotine | Cognitive | Research chemical | 8 | 8 | 0 | C 4.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (acute attention, fine motor, working memory — meta-analyses); Strong negative for long-term health (combustion); Moderate (non-combustible delivery cognitive benefit in non-smokers — Heishman 2010). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 0 Very High addiction potential with all forms; CV effects; teratogen; vasoconstriction. Severe risk — fatal-potential or unacceptable harm profile. Composite 4.8 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| NSI-189 | Cognitive | Research chemical | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Ph2 MDD — missed primary endpoint); Preclinical (hippocampal volume increases). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (Ph2 safety); unknown long-term. Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| 9-Me-BC (9-methyl-β-carboline) | Cognitive | Research chemical | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical only (Polanski/Dresden + Berlin Charité groups). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (no human safety data; theoretical MAOI/serotonin syndrome risk; broader β-carboline class includes co-mutagens and parkinsonian-neurotoxin precursors via N-methyl-β-carbolinium bioactivation — a specific concern for chronic dosing). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Dihexa (N-hexanoic-Tyr-Ile-(6) aminohexanoic amide) | Cognitive | Research chemical | 2 | 5 | 3.5 | D 3.1 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (rodent cognitive models, Harding lab); FAILED in humans via prodrug fosgonimeton (ATH-1017) — LIFT-AD Phase 2/3 n=315 missed primary and secondary endpoints in mild-to-moderate AD Sept 2024. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown (translational signal weakened by clinical-program failure). Modest or context-dependent effect. Safety (28%) 3.5 Med-High (theoretical oncogenic risk from c-Met activation; ~12.7-day half-life means no rapid discontinuation if adverse events emerge; no long-term human safety data for dihexa itself). High risk — serious side-effects at studied doses. Composite 3.1 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Agmatine sulfate | Cognitive | Supplement | 3 | 5 | 7 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small MDD adjunct trials); Preclinical (robust across anxiety, depression, neuropathic pain). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI, possible GH elevation). Modest risk — manageable side-effects for most users. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Tesofensine | Metabolic Health Cognitive | Prescription | 3 | 6.5 | 3.5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (cognitive in AD/PD); Strong (obesity — Ph2 weight loss 9-11%). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (tachycardia, BP elevation, insomnia, mood changes). High risk — serious side-effects at studied doses. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Vinpocetine | Cognitive | Prescription | 4.5 | 5 | 7 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (vascular cognitive impairment — older Hungarian/Eastern European trials; Cochrane inconclusive). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (hypotension, anticoagulant interaction; FDA warning: avoid in pregnancy). Modest risk — manageable side-effects for most users. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Psilocybin | Mood, Anxiety & Stress | Research chemical | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (emerging for treatment-resistant depression — COMP005 met primary endpoint June 2025, COMP006 met primary endpoint Feb 2026; Ph3 programs for approval pursuit); Strong (cancer-related distress — Johns Hopkins/NYU). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (HPPD rare, 'bad trips', cardiovascular caution; contraindicated with psychosis risk). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| LSD (lysergic acid diethylamide) | Mood, Anxiety & Stress | Research chemical | 6 | 6.5 | 5 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (anxiety in life-threatening illness — Gasser 2014); Moderate (MindMed MM120 GAD Ph2b positive 2023); microdose data consistently negative vs placebo. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (HPPD rare, 'bad trips', cardiovascular caution; contraindicated with psychosis risk; flashbacks). Real risk — monitoring or clinician oversight matters. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Ketamine | Mood, Anxiety & Stress | Prescription | 8 | 6.5 | 3.5 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (treatment-resistant depression — rapid onset; esketamine FDA-approved); Strong (anesthesia); Strong (acute suicidality reduction). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (dissociation, bladder/cystitis with chronic use, dependence, cardiovascular, elevated ICP). High risk — serious side-effects at studied doses. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| MDMA (3,4-methylenedioxymethamphetamine) | Mood, Anxiety & Stress | Research chemical | 6 | 6.5 | 3.5 | C 5.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (PTSD psychotherapy — Lykos MAPP1/MAPP2 positive, but FDA REJECTED Aug 2024 citing trial design and therapist misconduct concerns). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (hyponatremia, hyperthermia, cardiovascular; neurotoxicity concerns with high/repeated doses; serotonin syndrome with MAOIs). High risk — serious side-effects at studied doses. Composite 5.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Ibogaine | Mood, Anxiety & Stress | Research chemical | 4.5 | 8 | 2 | C- 4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (opioid withdrawal interruption — observational/open-label; Kentucky approved $42M research fund 2024). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 HIGH (cardiotoxicity — QT prolongation, deaths from arrhythmia; extensive drug interactions; several days of intense psychedelic experience). High risk — serious side-effects at studied doses. Composite 4 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Ayahuasca / DMT | Mood, Anxiety & Stress | Research chemical | 4.5 | 6.5 | 3.5 | C- 4.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (depression — Palhano-Fontes 2019 Brazilian ayahuasca RCT positive); Preclinical (robust neuroplasticity). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (MAOI-diet/drug interactions; GI purging; CV; psychiatric risk). High risk — serious side-effects at studied doses. Composite 4.4 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| CILTEP (forskolin + artichoke extract) | Cognitive | Herbal | 3 | 5 | 7 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (no published CILTEP trials; mechanism extrapolated from Tully long-term memory work in Drosophila). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 7 Low-Med (forskolin — hypotension, GI; PDE4 inhibition — nausea). Modest risk — manageable side-effects for most users. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Methylphenidate / phenidate stimulants | Cognitive | Prescription | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (ADHD); Weak-Moderate (healthy cognitive enhancement). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (BP/HR elevation, appetite/sleep disruption, anxiety, misuse/dependence risk). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Adrafinil / modafinil analog stimulants | Cognitive | Research chemical | 3 | 5 | 4.5 | D+ 3.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (analog-specific human data); Moderate (modafinil-class wakefulness evidence by analogy). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 4.5 Unknown-Med (liver-enzyme concerns for adrafinil, insomnia/anxiety/BP effects, product-quality risk). Real risk — monitoring or clinician oversight matters. Composite 3.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Ephedrine / pseudoephedrine / synephrine stimulants | Cognitive | Prescription | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (weight-loss/stimulant pharmacology); Weak-Mixed (healthy performance). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (BP/HR elevation, arrhythmia/stroke risk at high dose or combinations, anxiety/insomnia). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Other WADA-listed stimulants (designer / anorectic / recreational) | Cognitive | Prescription | 3 | 5 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (healthy cognitive/performance use is compound-specific and often sparse). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 High (cardiovascular, psychiatric, overheating, dependence and contamination risks; several are recreational/illicit drugs). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Matcha (Camellia sinensis) | Cognitive | Supplement | 6 | 3.5 | 7 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (L-theanine + caffeine acute attention — Owen 2008, Einother 2010); Weak-Moderate (chronic green-tea consumption and CV/all-cause mortality in Asian cohorts); Weak (matcha-specific cognitive RCTs are small and short). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (high-dose EGCG extracts >800 mg/day associated with rare hepatotoxicity — EFSA 2018; matcha as drunk powder is well-tolerated; caffeine load; lead/cadmium contamination concern — choose tested ceremonial-grade). Modest risk — manageable side-effects for most users. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Phenibut (β-phenyl-GABA) | Mood, Anxiety & Stress Sleep & Recovery | Research chemical | 3 | 5 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Russian clinical tradition for anxiety, asthenia, post-traumatic stress); Strong negative — physical dependence and severe withdrawal documented in case reports. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Moderate (acute anxiolysis); Strong negative for chronic use. Modest or context-dependent effect. Safety (28%) 2 High (rapid tolerance development; physical dependence; severe withdrawal — Pebis 2019 reviews 31 case reports of withdrawal syndrome including delirium, seizures, psychosis; typical 'biohacker mistake' is using daily and developing dependence in weeks). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Beta-alanine | Muscle & Strength | Supplement | 8 | 6.5 | 9 | A+ 8.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (exercise performance — ISSN position stand and meta-analyses); Weak (general health/longevity). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 9 Low (dose-related paresthesia/tingling; GI upset at high single doses; long-term data mostly in healthy users). Low risk — minimal side-effect burden in healthy adults. Composite 8.2 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Sodium bicarbonate | Muscle & Strength | Supplement | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (high-intensity exercise — ISSN position stand and meta-analyses). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (GI distress/diarrhea is common and performance-limiting; high sodium load; caution in hypertension, kidney disease, heart failure, or sodium-restricted diets). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Testosterone (TRT / supraphysiological) | Muscle & Strength Hormones & Endocrine | Anabolic | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (muscle, bone, sexual function in hypogonadism); Strong (muscle in eugonadal at supraphysiological doses — Bhasin 1996). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (supraphys); Med (TRT). Large effect size when the claim holds. Safety (28%) 5 Med (TRT); High (supraphysiological — erythrocytosis/HCT>54, HPG suppression/infertility, gynecomastia, acne, sleep apnea, prostate/BPH; CV risk NOT increased in TRT per TRAVERSE but unclear at supraphysiological doses). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Dianabol (methandrostenolone / methandienone) | Muscle & Strength | Anabolic | 8 | 8 | 2 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (muscle mass, strength — older clinical data; extensive bodybuilding use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 High (hepatotoxicity from C17-alkylation; water retention, BP, gyno from aromatization; HPG suppression; estrogenic side effects). High risk — serious side-effects at studied doses. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Deca-Durabolin (nandrolone decanoate) | Muscle & Strength | Anabolic | 8 | 8 | 2 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (muscle, bone in clinical use — anaemia/wasting indications). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 High ('deca dick' — long-lasting HPG suppression and ED; progesterone-driven gyno; prolactin elevation; 19-nor metabolites detectable for up to 18 months). High risk — serious side-effects at studied doses. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Nandrolone (phenylpropionate / other esters) | Muscle & Strength | Anabolic | 8 | 8 | 2 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (same indication family as decanoate). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 High (same side effect profile as Deca; slightly faster recoverability due to shorter ester). High risk — serious side-effects at studied doses. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Trenbolone | Muscle & Strength | Anabolic | 8 | 10 | 0 | C 5.1 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (striking muscle gain and fat loss anecdotally; limited clinical data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very High. Large effect size when the claim holds. Safety (28%) 0 Very High (severe night sweats, insomnia, aggression, anxiety; cardiotoxicity — unique renal toxicity signature; prolactin issues; no aromatization but gyno still possible; 'tren cough'). Severe risk — fatal-potential or unacceptable harm profile. Composite 5.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Anavar (oxandrolone) | Muscle & Strength | Anabolic | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (muscle-preservation during cutting; low-dose clinical uses). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (mildest AAS side-effect profile; still HPG suppression, lipid disturbance; hepatotoxicity less than other orals but not absent). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Winstrol (stanozolol) | Muscle & Strength | Anabolic | 8 | 6.5 | 2 | C+ 5.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (strength, dry muscle gain, vascularity; used historically for anemia, angioedema). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 2 High (hepatotoxicity — notorious even for C17-aa class; joint pain/dryness; severe adverse lipid effects — HDL crash; tendon rupture risk). High risk — serious side-effects at studied doses. Composite 5.4 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Anadrol (oxymetholone) | Muscle & Strength | Anabolic | 8 | 10 | 0 | C 5.1 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (mass and strength; aplastic anemia/Fanconi anemia clinical use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very High. Large effect size when the claim holds. Safety (28%) 0 Very High (most hepatotoxic of common AAS; HDL crash; severe water retention and BP; paradoxical 'estrogenic' effects — gyno despite no aromatization; headaches common). Severe risk — fatal-potential or unacceptable harm profile. Composite 5.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Boldenone (Equipoise) | Muscle & Strength | Anabolic | 6 | 8 | 3.5 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (slower gains than testosterone; good for lean mass). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 3.5 Med-High (increased erythrocytosis — notorious for hematocrit elevation; increased appetite; mild estrogenic; long detection window). High risk — serious side-effects at studied doses. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Primobolan (methenolone) | Muscle & Strength | Anabolic | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (muscle preservation in cutting; low virilization in women). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (mildest AAS profile comparable to Anavar; oral form not C17-aa so less hepatotoxic but also less bioavailable; HPG suppression). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Masteron (drostanolone) | Muscle & Strength | Anabolic | 6 | 6.5 | 3.5 | C 5.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (aesthetic effect — dryness, hardness; historical use in breast cancer). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (strong androgenic effects — hair loss in predisposed; aggression; HPG suppression; poor effect on lipids). High risk — serious side-effects at studied doses. Composite 5.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Mesterolone (Proviron) | Muscle & Strength | Anabolic | 3 | 3.5 | 5 | D+ 3.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (idiopathic male infertility — WHO 1989 multicenter RCT n=248 couples x 6 months showed sperm motility/morphology improvement but NO pregnancy benefit); Weak-Moderate (TRT-adjunct SHBG lowering, libido in observational/clinic series); Weak (depression with androgen deficiency). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med (TRT-adjunct SHBG lowering / libido); Weak (monotherapy hypogonadism — much less effective than testosterone). Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (strong androgenic effects — accelerated androgenetic alopecia, acne, BPH risk; HDL crash typical of DHT derivatives; HPG suppression; LOWER hepatotoxicity than C17α-alkylated orals because of the 1α-methyl substitution; prostate concerns in older men). Real risk — monitoring or clinician oversight matters. Composite 3.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Ostarine (MK-2866 / enobosarm) | Muscle & Strength | Anabolic | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (muscle preservation in cachexia; breast cancer Ph3 data); Moderate (athletic muscle gain — widely reported, limited RCTs). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (HPG suppression dose-dependent; LFT elevations; reported heart-attack cases in young users — FDA warning 2017). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Ligandrol (LGD-4033) | Muscle & Strength | Anabolic | 4.5 | 5 | 5 | C 4.8 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (Ph1 single-dose muscle gain; no successful Ph3 in indication). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (significant HPG suppression despite marketing; elevated LFTs and lipid disturbance; liver injury case reports). Real risk — monitoring or clinician oversight matters. Composite 4.8 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| RAD-140 (testolone) | Muscle & Strength | Anabolic | 3 | 6.5 | 3.5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (human data limited); Preclinical (strong anabolic). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (notable HPG suppression; hepatotoxicity case reports; aggression reports; potential neurotoxicity in animal models at high doses). High risk — serious side-effects at studied doses. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| YK-11 | Muscle & Strength | Anabolic | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (no human clinical trials); Preclinical (in vitro myostatin effects). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (steroidal chemistry = likely hepatotoxic; HPG suppression; essentially no human safety data). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| S-23 | Muscle & Strength | Anabolic | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (human data minimal); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (strongest HPG suppression of common SARMs; fertility effects — the original intended indication). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| ACP-105 | Muscle & Strength | Anabolic | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (essentially no human efficacy data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown. Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| LGD-3303 | Muscle & Strength | Anabolic | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (no human clinical development). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (preclinical suggests significant AR activity; no human safety data). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Cardarine (GW501516) | Muscle & Strength Metabolic Health Mitochondria & Cellular Energy | Anabolic | 6 | 10 | 0 | C- 4.2 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (endurance, lipid profile in short Ph1); STRONG NEGATIVE (rodent carcinogenicity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 10 Very High (cancer signal). Large effect size when the claim holds. Safety (28%) 0 Very High — GSK halted development due to multi-organ carcinogenesis in 2-year rodent studies; WADA banned with unprecedented athlete warning. Severe risk — fatal-potential or unacceptable harm profile. Composite 4.2 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| HGH (recombinant human growth hormone) | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 4.5 | 5 | 3.5 | C- 4.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (anti-aging claims — Rudman 1990 reanalyses show muscle gain but no functional benefit, increased side effects); Strong (deficiency indications: pediatric GHD, adult GHD, Turner, wasting). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (carpal tunnel, edema, insulin resistance / overt diabetes, arthralgia; tumor growth promotion concern; cardiomegaly at high chronic doses; expensive — $800-1500/month). High risk — serious side-effects at studied doses. Composite 4.2 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| IGF-1 LR3 (long R3 insulin-like growth factor-1) | Muscle & Strength | Anabolic | 3 | 5 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (human supplementation — essentially no RCTs); Strong (tissue growth in vitro). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 High (hypoglycemia — shared with insulin pathway; tumor/oncogenesis concerns via sustained IGF-1R signaling). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| CJC-1295 (with/without DAC) | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 3 | 5 | 5 | C- 4.1 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Ph1 safety and GH/IGF-1 elevation); one death in Ph2 for unrelated CV event halted ConjuChem program. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (injection site reactions, flushing, HR increase, headache; DAC form chronically elevates GH rather than preserving physiological pulse). Real risk — monitoring or clinician oversight matters. Composite 4.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Ipamorelin | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 3 | 5 | 7 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small human trials for postoperative ileus, safety); anecdotal for recovery/body composition. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (injection site; mild cortisol/prolactin effects; muscle strain from rapid recovery anecdotally). Modest risk — manageable side-effects for most users. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| GHRP-2 / GHRP-6 | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 3 | 5 | 5 | C- 4.1 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (old Ph2 data for various indications; discontinued development); anecdotal. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (hunger spikes, water retention, cortisol/prolactin elevation; older/cruder than ipamorelin). Real risk — monitoring or clinician oversight matters. Composite 4.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Sermorelin | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 4.5 | 5 | 7 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (Vittone 1997 J Clin Endocrinol Metab — n=19 aged 55-71, 10 mcg/kg SC nightly x 16 wk, increased nocturnal GH, IGF-1, lean mass +1.26 kg, skin thickness, well-being); Strong (pediatric GHD diagnostic — historical FDA approval 1997 as Geref); never formally FDA-approved for adult anti-aging use. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (injection site reactions most common; preservation of physiological feedback minimizes HPA disruption; no measurable cortisol or prolactin elevation; theoretical insulin resistance at chronic supraphysiological exposure). Modest risk — manageable side-effects for most users. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Tesamorelin | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 8 | 5 | 3.5 | B- 5.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (HIV lipodystrophy visceral fat reduction); Moderate (NAFLD liver fat — positive Ph2). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (insulin resistance/diabetes worsening — FDA black-box; injection reactions; joint pain; expensive). High risk — serious side-effects at studied doses. Composite 5.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| MK-677 (ibutamoren) | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (IGF-1 elevation, lean mass in elderly); Ph3 failed in hip fracture due to increased heart failure/edema. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (water retention, insulin resistance, hunger, lethargy; hip fracture Ph3 showed excess CHF events; not intended as chronic use). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Other WADA-listed anabolic androgenic steroids (AAS long tail) | Muscle & Strength | Anabolic | 8 | 8 | 2 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (AAS class effect on lean mass/strength); Weak-Very Weak (many obscure designer/prohormone variants individually). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 High (endocrine suppression, dyslipidemia, hypertension, hepatic strain for oral C17-aa agents, psychiatric effects, fertility suppression). High risk — serious side-effects at studied doses. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Andarine (S-4) | Muscle & Strength | Anabolic | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (no robust published human efficacy data for healthy users). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (vision disturbances reported anecdotally, HPG-axis suppression and liver/safety uncertainty as SARM class risks). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Veterinary growth promoters (ractopamine / zilpaterol / zeranol) | Muscle & Strength | Prescription | 3 | 5 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (human performance evidence sparse; livestock lean-mass effects established). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 High (tachycardia, tremor, metabolic/cardiovascular uncertainty, contamination and legal risk). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| EPO / erythropoiesis-stimulating agents (ESAs) | Muscle & Strength | Prescription | 8 | 8 | 2 | C+ 5.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (hematologic effects and endurance-doping rationale); Moderate (performance effect estimates vary by study design). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 High (hypertension, thrombosis, stroke, polycythemia, pure red-cell aplasia with some products). High risk — serious side-effects at studied doses. Composite 5.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| HIF stabilizers / prolyl-hydroxylase inhibitors (roxadustat / daprodustat / vadadustat) | Muscle & Strength | Prescription | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (anemia indications); Weak (healthy endurance/performance use). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (thrombosis/vascular concerns, hypertension, tumor-biology uncertainty, off-label misuse risk). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Artificial oxygen carriers / blood doping methods | Muscle & Strength | Supplement | 6 | 8 | 2 | C 4.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (oxygen delivery biology); Weak (consumer/performance protocols). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 2 High (thrombosis, hypertension, hemolysis, infection/procedural risk, oxygen-carrier toxicity). High risk — serious side-effects at studied doses. Composite 4.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Gene and cell doping (performance-enhancing) | Muscle & Strength | Supplement | 2 | 5 | 0 | F 1.7 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (for healthy performance enhancement). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 0 Very High (oncogenesis, immune reactions, irreversible gene-expression effects, infection/procedural risk). Severe risk — fatal-potential or unacceptable harm profile. Composite 1.7 0.44·Ev + 0.28·Bn + 0.28·Sf → F | |||||||
| Ryanodine stabilizers / fast skeletal muscle troponin activators | Muscle & Strength | Supplement | 2.5 | 5 | 3 | D 3.1 | Jun 2026 |
| Score breakdown Evidence (44%) 2.5 Preclinical-Weak (healthy performance use); Emerging (disease programs). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (limited human safety data for off-label performance use). High risk — serious side-effects at studied doses. Composite 3.1 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Myostatin / activin-pathway inhibitors (non-bimagrumab) | Muscle & Strength | Anabolic | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (selected disease/obesity trials); Weak (healthy enhancement). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (reproductive/endocrine-axis effects, vascular/tissue-remodeling uncertainty, injection biologic risks). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Long-acting GH analogs and GH fragments | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Research chemical | 3 | 3.5 | 3.5 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (performance/anti-aging); Moderate (approved pediatric/adult GH-deficiency indications for some analogs). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 3.5 Med-High (edema, insulin resistance, arthralgia, IGF-1 elevation for GH analogs; unknown risks for fragments). High risk — serious side-effects at studied doses. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Other GH secretagogues / GHRPs | Muscle & Strength Hormones & Endocrine Sleep & Recovery | Anabolic | 3 | 3.5 | 5 | D+ 3.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (healthy users); Moderate (selected approved diagnostic/cachexia contexts). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (appetite changes, edema, glucose effects, cortisol/prolactin effects for some peptides, product-quality risk). Real risk — monitoring or clinician oversight matters. Composite 3.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Growth-factor doping agents (FGF / HGF / PDGF / VEGF / MGF) | Muscle & Strength | Supplement | 2 | 5 | 0 | F 1.7 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (healthy enhancement). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 0 Very High (angiogenesis/tumor-biology concerns, fibrosis/remodeling risk, immune/procedural risk). Severe risk — fatal-potential or unacceptable harm profile. Composite 1.7 0.44·Ev + 0.28·Bn + 0.28·Sf → F | |||||||
| BPC-157 (Body Protection Compound-157) | Sleep & Recovery | Peptide | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical only (extensive rodent data, Sikiric group); NO published human RCTs. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (essentially no controlled human safety data; FDA flagged immunogenicity and peptide-impurity concerns for compounded products). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| TB-500 (Thymosin beta-4 fragment) | Sleep & Recovery | Peptide | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical; Ph2 stroke and diabetic ulcer trials (RegeneRx) unconvincing. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (no established human safety; FDA flagged immunogenicity and peptide-impurity concerns for TB-4 fragment products). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Thymosin alpha-1 | Sleep & Recovery Immune & Inflammation | Peptide | 3 | 5 | 9 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (biohacker 'immune/recovery' use); Moderate (sepsis adjunct); Strong (chronic hepatitis B/C — approved in many countries). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated in trials; injection site reactions). Low risk — minimal side-effect burden in healthy adults. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| LL-37 (cathelicidin) | Sleep & Recovery Immune & Inflammation | Peptide | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (antimicrobial, wound healing); Very limited human trial data. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown (injection not established; pro-inflammatory effects possible at high local concentrations; theoretical autoimmune concerns). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| KPV (Lys-Pro-Val) | Sleep & Recovery Immune & Inflammation | Peptide | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (IBD, wound healing, dermatitis models); Very limited human trials. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 4 Unknown. Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Curcumin (turmeric) | Sleep & Recovery Immune & Inflammation Detox | Supplement | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (osteoarthritis pain — multiple MAs show non-inferiority vs NSAIDs and significant WOMAC/VAS reduction; counter-intuitively 2025 network MA found bioavailability-enhanced forms did NOT outperform conventional in OA — WMD -2.47 vs -3.17); Moderate (NAFLD/MASLD — phytosomal curcumin specifically improved ALT/AST and ultrasound findings in RCTs; 2025 MA pooled ALT -5.61 U/L AST -3.90 U/L); Moderate (depression adjunct; metabolic syndrome markers); Weak (cardiovascular outcomes). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (the formulation paradox — hepatotoxicity case reports are concentrated in HIGH-bioavailability formulations: Italian Phytovigilance / Tuscany cluster, DILIN 10-case US series, Icelandic case reports — most linked to Meriva/phytosome or piperine-boosted products at standard supplement doses; rare idiosyncratic non-infectious cholestatic hepatitis; iron chelation potential; theoretical anticoagulant interactions). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Boswellia serrata (AKBA) | Sleep & Recovery Immune & Inflammation | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (knee osteoarthritis pain — multiple RCTs; inflammatory bowel disease; asthma). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (generally well-tolerated; rare GI upset). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| SPMs (specialized pro-resolving mediators) | Sleep & Recovery Immune & Inflammation | Supplement | 2 | 3.5 | 9 | C 5 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (robust); Early human (exploratory trials — periodontitis, chronic rhinosinusitis, Alzheimer's). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (early data). Low risk — minimal side-effect burden in healthy adults. Composite 5 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| PEA (palmitoylethanolamide) | Sleep & Recovery Immune & Inflammation Mood, Anxiety & Stress | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (chronic pain, neuropathic pain, endometriosis — multiple European RCTs); Weak-Moderate (cognitive/mood). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (very well-tolerated; rare GI). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Creatine | Essentials Sleep & Recovery Cognitive Muscle & Strength Mitochondria & Cellular Energy | Supplement | 10 | 8 | 10 | S 9.7 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (strength, power, muscle mass, exercise capacity — hundreds of RCTs); Moderate (cognitive function under stress/sleep deprivation; depression adjunct; age-related cognitive decline). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 10 Very Low (most-studied supplement; rare GI; older kidney concerns debunked in healthy adults; caution in preexisting renal disease). Low risk — minimal side-effect burden in healthy adults. Composite 9.7 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| HMB (β-hydroxy β-methylbutyrate) | Sleep & Recovery Muscle & Strength | Supplement | 6 | 3.5 | 10 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (muscle preservation in untrained/sarcopenic/bed-rest populations); Weak (benefit in already-trained athletes — minimal). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 10 Very Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Glutamine | Sleep & Recovery Essentials Immune & Inflammation | Supplement | 6 | 2 | 9 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (critical illness/burns/trauma — ICU clinical use); Weak (healthy athlete recovery/immunity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (caution in decompensated liver disease — ammonia accumulation; also signals mTOR which is undesirable for longevity goals). Low risk — minimal side-effect burden in healthy adults. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Collagen peptides | Essentials Sleep & Recovery | Supplement | 6 | 3.5 | 10 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (joint pain in OA and athletes; skin elasticity/hydration; tendon healing emerging data — Shaw 2017 showed improved collagen synthesis with 15 g + vitamin C pre-exercise). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 10 Very Low. Low risk — minimal side-effect burden in healthy adults. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Tart cherry (Prunus cerasus) | Sleep & Recovery Immune & Inflammation Muscle & Strength | Herbal | 6 | 2 | 10 | B+ 7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (exercise-induced muscle damage, DOMS reduction; modest sleep onset improvements). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 10 Very Low (high natural sugar content if consumed as juice; hypotensive additive with BP meds). Low risk — minimal side-effect burden in healthy adults. Composite 7 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Hyaluronic acid (oral + intra-articular) | Sleep & Recovery Muscle & Strength | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (intra-articular injection for knee OA — AAOS recently downgraded recommendation; oral weaker but Moriña 2018 and others show modest joint benefit). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (intra-articular: injection site pain, rare pseudosepsis; oral: essentially none). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Pentosan polysulfate (Elmiron) | Sleep & Recovery Muscle & Strength | Prescription | 4.5 | 5 | 5 | C 4.8 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (veterinary OA in horses/dogs — Zydax well-established); Moderate (interstitial cystitis — FDA-approved Elmiron); Weak (human OA — investigational). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (pigmentary maculopathy with long-term Elmiron use — FDA warning 2020; bleeding risk; vet indication has fewer reported ocular issues). Real risk — monitoring or clinician oversight matters. Composite 4.8 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Suzetrigine (Journavx / VX-548) | Sleep & Recovery | Prescription | 8 | 6.5 | 9 | A+ 8.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 in post-surgical acute pain — abdominoplasty, bunionectomy; FDA-approved January 2025). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Moderate-High for acute pain (numerical rating scale reduction comparable to or modestly less than oxycodone-acetaminophen but without opioid side effects). Meaningful effect for the studied population. Safety (28%) 9 Low (mild constipation, headache, nausea; no respiratory depression; no abuse potential — not scheduled). Low risk — minimal side-effect burden in healthy adults. Composite 8.2 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Glucosamine + chondroitin | Sleep & Recovery Immune & Inflammation Muscle & Strength | Supplement | 4 | 3.5 | 10 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 4 Mixed (GAIT 2006 NEJM negative for primary endpoint but positive for moderate-severe knee OA subgroup; multiple subsequent meta-analyses generally positive for symptom reduction; observational mortality data — Bell 2020 BMJ — show modest all-cause mortality reduction in regular users). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate (small joint pain reduction; NNT high; effect appears to take 8-12 weeks). Small or unclear effect even in best-case interpretation. Safety (28%) 10 Very Low (essentially placebo-tier safety; theoretical glucose tolerance concern from glucosamine in diabetics is unfounded; theoretical anticoagulant interaction with chondroitin is rarely clinically meaningful). Low risk — minimal side-effect burden in healthy adults. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Estradiol (HRT — oral/transdermal/vaginal) | Hormones & Endocrine | Hormone | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (menopause vasomotor symptoms, GSM, bone loss prevention); Moderate (mood, cognition — timing-dependent per KEEPS/ELITE 'window hypothesis'). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 5 Varies by route — oral increases VTE/stroke/GB disease risk modestly; transdermal largely avoids these; breast cancer signal small and mostly requires concurrent progestin; cardiovascular effect depends on age at initiation (<60 or within 10 yr of menopause beneficial). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Progesterone (micronized / oral / vaginal) | Hormones & Endocrine Sleep & Recovery Mood, Anxiety & Stress | Hormone | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (endometrial protection in women on estrogen HRT); Moderate (sleep/anxiety via allopregnanolone; menopausal vasomotor symptoms). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated; sedation from oral route is feature or side effect; progestin-specific breast/VTE signal largely confined to SYNTHETIC progestins — MPA, not bioidentical progesterone). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| DHEA | Hormones & Endocrine Mood, Anxiety & Stress | Hormone | 6 | 3.5 | 7 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (adrenal insufficiency supplementation; vaginal DHEA [prasterone/Intrarosa] for GSM); Weak (generic 'anti-aging' supplementation — mixed RCTs). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (androgenic effects — acne, oily skin, hair; estrogenic effects depending on individual; hormone-sensitive cancer caution). Modest risk — manageable side-effects for most users. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Pregnenolone | Hormones & Endocrine Mood, Anxiety & Stress Sleep & Recovery | Hormone | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (cognitive, mood in small trials — schizophrenia adjunct, bipolar). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (generally well-tolerated; theoretical concern about pushing adrenal/gonadal steroid synthesis unpredictably). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| T3 (liothyronine) | Hormones & Endocrine Metabolic Health | Hormone | 8 | 8 | 3.5 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (hypothyroidism — in T4/T3 combo therapy or T3 monotherapy in selected patients); Moderate (treatment-resistant depression augmentation — Cooper-Kazaz 2007); Moderate (off-label fat loss — metabolically potent but unsafe in euthyroid users). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (supra-TSH-suppressing doses). Large effect size when the claim holds. Safety (28%) 3.5 Med-High (atrial fibrillation, bone loss, cardiac stress; over-replacement thyrotoxicosis; abuse risk for weight loss). High risk — serious side-effects at studied doses. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| T4 / NDT (levothyroxine, desiccated thyroid) | Hormones & Endocrine | Hormone | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (hypothyroidism). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (over-replacement risks as with T3; NDT has more variable potency between batches). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| HCG (human chorionic gonadotropin) | Hormones & Endocrine | Hormone | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (maintaining testicular function during TRT; post-cycle therapy; fertility restoration); moderate (Simeons weight-loss protocol has been repeatedly discredited). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (gyno via elevated estradiol; elevated BP; fluid retention; desensitization with chronic high doses). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Clomiphene citrate | Hormones & Endocrine | Hormone | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (male functional/secondary hypogonadism and fertility preservation; FDA-approved female ovulatory infertility). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (visual symptoms labeled; mood changes; hot flashes; gynecomastia; rare VTE; male use is off-label). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Enclomiphene citrate | Hormones & Endocrine | Hormone | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (secondary hypogonadism; spermatogenesis preservation vs testosterone gel). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (appears cleaner than mixed clomiphene in trials; limited long-term and post-market safety; compounded-product quality risk). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Anastrozole | Hormones & Endocrine | Hormone | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (adjuvant breast cancer); Moderate (estrogen control during TRT/AAS). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (excessive estrogen suppression can harm bones, lipids, libido, mood — 'crashing E2' is a common iatrogenic mistake; joint pain; hot flashes). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Gonadorelin (GnRH) | Hormones & Endocrine | Hormone | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (hypogonadotropic hypogonadism — pulsatile pumps, fertility induction); Moderate (TRT adjunct for testicular preservation). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (injection site; ovarian hyperstimulation syndrome in women on fertility doses; desensitization if not dosed correctly). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Fezolinetant (Veozah) | Hormones & Endocrine | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 SKYLIGHT 1 & 2; FDA-approved May 2023). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (~50-65% reduction in moderate-severe VMS frequency at 12 weeks). Large effect size when the claim holds. Safety (28%) 5 Med (transient ALT/AST elevations 2-3% — REQUIRES baseline & monthly liver monitoring per FDA boxed warning; headache, abdominal pain, insomnia). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Elinzanetant (Lynkuet) | Hormones & Endocrine | Prescription | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 OASIS 1-4; approved in several countries 2025-2026). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (VMS frequency reduction ~60-70%; superior sleep & mood vs fezolinetant in cross-trial comparisons). Large effect size when the claim holds. Safety (28%) 7 Low-Med (no liver monitoring required per OASIS pooled liver-safety analysis 2026; somnolence/headache most common AEs). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Resmetirom (Rezdiffra) | Hormones & Endocrine Metabolic Health Mitochondria & Cellular Energy | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 MAESTRO-NASH; FDA-approved March 2024 — first MASH drug). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (MAESTRO-NASH: significant resolution of steatohepatitis without worsening fibrosis at 52 weeks; ~24-26% achieved primary endpoint vs 9.7% placebo). Large effect size when the claim holds. Safety (28%) 5 Med (diarrhea, nausea common; modest LDL/lipid changes; mild reversible LFT elevations; pregnancy contraindicated). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Romosozumab (Evenity) | Hormones & Endocrine | Prescription | 8 | 10 | 3.5 | B 6.5 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (FRAME, ARCH, BRIDGE Phase 3 — vertebral and clinical fracture reduction). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very High for bone (~73% reduction in new vertebral fractures vs placebo at 12 months in FRAME; superior to alendronate in ARCH). Large effect size when the claim holds. Safety (28%) 3.5 Med-High (boxed FDA warning for major adverse cardiovascular events — ARCH showed CV imbalance vs alendronate; injection-site reactions; hypocalcemia; serious infections rare). High risk — serious side-effects at studied doses. Composite 6.5 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Rosuvastatin / atorvastatin (statins) | Metabolic Health | Prescription | 10 | 10 | 7 | S 8.8 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (primary and secondary CVD prevention — among the most robust drug classes in medicine). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very Strong. Large effect size when the claim holds. Safety (28%) 7 Low-Med (myalgias — mostly nocebo per SAMSON/SAMSON2 trials; rare rhabdomyolysis; small diabetes risk; minor LFT elevations; rare cognitive complaints). Modest risk — manageable side-effects for most users. Composite 8.8 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Ezetimibe | Metabolic Health | Prescription | 8 | 5 | 10 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (IMPROVE-IT added to statin — modest CV benefit); cleaner profile than many alternatives. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 10 Very Low (arguably the cleanest lipid-lowering drug — very few side effects). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| PCSK9 inhibitors (evolocumab / alirocumab / inclisiran) | Metabolic Health | Prescription | 8 | 10 | 9 | S 8.7 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (FOURIER, ODYSSEY OUTCOMES — CV event reduction); Strong (dramatic LDL reduction). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very Strong. Large effect size when the claim holds. Safety (28%) 9 Low (injection site reactions; very clean systemic profile). Low risk — minimal side-effect burden in healthy adults. Composite 8.7 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Bempedoic acid | Metabolic Health | Prescription | 7 | 5 | 5 | B- 5.9 | Jun 2026 |
| Score breakdown Evidence (44%) 7 Moderate-Strong (CLEAR Outcomes 2023 — CV event reduction in statin-intolerant). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (hyperuricemia — gout risk; modest LFT elevations; tendon rupture reports). Real risk — monitoring or clinician oversight matters. Composite 5.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Icosapent ethyl (Vascepa) | Metabolic Health | Prescription | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (REDUCE-IT 4 g/day — 25% RRR of CV events in statin-treated high-risk; RESPECT-EPA 2024 1.8 g — primary missed p=0.055 but coronary secondary HR 0.73 and independent of mineral-oil placebo confound). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 7 Low-Med (dose-dependent AF signal — RESPECT-EPA confirmed new-onset AF 3.1% vs 1.6% p=0.017 at 1.8 g/day; minor bleeding; burping). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Niacin (nicotinic acid) | Metabolic Health | Prescription | 8 | 5 | 3.5 | B- 5.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (lipid effects); Weak (CV outcomes — AIM-HIGH and HPS2-THRIVE both failed to show benefit on top of statin). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (intense flushing; hepatotoxicity — especially sustained-release forms; gout flares; glucose elevation; itching). High risk — serious side-effects at studied doses. Composite 5.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Berberine | Metabolic Health Longevity | Supplement | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (glycemic control — comparable to metformin in small trials; lipid modification — ~0.5 mmol/L LDL reduction). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI upset common — diarrhea, cramping; significant CYP3A4 inhibition → drug interactions; not safe in pregnancy). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Citrus bergamot | Metabolic Health | Herbal | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (several Italian RCTs showing LDL, TG reduction; HDL increase). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (rare GI upset). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Red yeast rice | Metabolic Health | Herbal | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (LDL reduction in observational and RCT data). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (same side effect profile as low-dose lovastatin; contamination with citrinin — a nephrotoxic mycotoxin — is a recurring quality issue; EU capped monacolin K in supplements at 3 mg/day since 2022 effectively eliminating meaningful effect). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Nattokinase | Metabolic Health | Prescription | 3 | 5 | 7 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small Japanese RCTs showing BP, fibrinogen reduction; no CV outcomes data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 7 Low-Med (bleeding risk — especially additive with anticoagulants/antiplatelets; some preparations show Lp(a) reduction signal). Modest risk — manageable side-effects for most users. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Aspirin (low-dose) | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (secondary CV prevention — well established); controversial (primary prevention — ASPREE and ARRIVE showed harm or neutral in low-risk elderly; USPSTF 2022 narrowed recommendations). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (secondary); Weak (primary). Large effect size when the claim holds. Safety (28%) 5 Med (GI bleeding — dose-dependent; rare intracranial hemorrhage; Reye's syndrome in children). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Garlic extract (aged / allicin) | Metabolic Health | Herbal | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (modest BP reduction ~5-10 mmHg SBP in meta-analyses; small LDL reduction); Weak-Moderate (coronary calcium progression slowed in Budoff trials). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (garlic breath/body odor; mild GI; bleeding additive with anticoagulants). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Lp(a)-lowering therapies (olpasiran / pelacarsen / lepodisiran / zerlasiran / muvalaplin) | Metabolic Health | Supplement | 8 | 10 | 7 | A 7.9 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Lp(a) reduction); Outcomes pending (large CVOT readouts 2026-2028). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very High for Lp(a) reduction (olpasiran -92%, zerlasiran -80%, muvalaplin -77%, pelacarsen -54%); cardiovascular outcomes pending. Large effect size when the claim holds. Safety (28%) 7 Low-Med (injection-site reactions with siRNA/ASO; muvalaplin appears well tolerated orally; long-term safety still emerging). Modest risk — manageable side-effects for most users. Composite 7.9 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Obicetrapib | Metabolic Health | Prescription | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (TULIP, ROSE, ROSE2, BROADWAY, BROOKLYN, TANDEM Phase 2/3 — robust LDL reduction); Outcomes pending (PREVAIL CVOT). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (~32-45% LDL-C reduction on top of maximally tolerated statin/ezetimibe; ~140% HDL-C increase; ApoB ~25% reduction). Large effect size when the claim holds. Safety (28%) 7 Low-Med (favorable safety to date; no BP signal like torcetrapib; long-term cardiovascular outcome data pending). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| FGF21 analogs (efruxifermin / pegozafermin / efimosfermin) | Metabolic Health Longevity | Supplement | 6 | 6.5 | 5 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (multiple Phase 2 RCTs in MASH; Phase 3 programs ongoing). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High (histologic MASH and liver-fat signals; clinical outcome benefit unproven). Meaningful effect for the studied population. Safety (28%) 5 Med (GI effects, injection-site reactions, appetite/weight effects; long-term bone and class safety still being defined). Real risk — monitoring or clinician oversight matters. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Probiotics (multi-strain) | Immune & Inflammation | Supplement | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (AAD, C. difficile prevention — Saccharomyces boulardii, specific Lacto strains); Moderate (IBS, atopic dermatitis in children); Weak (general 'wellness'). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (translocation/bacteremia risk in immunocompromised or central-line patients — case reports). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Akkermansia muciniphila (pasteurized) | Immune & Inflammation | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Depommier 2019 — 3-month metabolic benefits in overweight/obese insulin-resistant adults); novel-food-approved in EU 2021. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (pasteurized form considered safer than live Akkermansia for immunocompromised). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Prebiotics (inulin / FOS / GOS / partially hydrolyzed guar gum) | Immune & Inflammation | Supplement | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (bifidogenic effect; mild glycemic improvement; IBS — specific fibers like PHGG are low-FODMAP); Moderate (SCFA production). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 7 Low-Med (gas, bloating, abdominal discomfort — dose-limiting in many people; worsens SIBO/IBS-D in subsets). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| 2'-fucosyllactose (2'-FL human milk oligosaccharide) | Immune & Inflammation Metabolic Health Cognitive Longevity | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (infant-formula safety and microbiome; early older-adult RCT biomarker signal); Weak (hard adult outcomes). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (GI bloating possible; long-term adult outcome data limited; response may depend on baseline Bifidobacterium). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Psyllium husk | Essentials Metabolic Health Immune & Inflammation | Supplement | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (constipation, IBS-C; also modest cholesterol reduction per FDA health claim); Moderate (glycemic control with meals). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 9 Low (rare esophageal obstruction if not taken with sufficient fluid; blood sugar effects mean timing with diabetes meds). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Digestive enzymes (pancreatin / proteases / lipase) | Essentials | Supplement | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (generic 'digestion' in healthy individuals); Strong (pancreatic insufficiency — chronic pancreatitis, CF, post-Whipple). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (in otherwise-healthy; high-dose pancrelipase can cause colonic strictures rarely). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Butyrate (tributyrin / sodium butyrate) | Immune & Inflammation | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (ulcerative colitis — as enema adjunct, some oral data); Weak-Moderate (IBS, IBD maintenance). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (unpleasant smell/taste with sodium butyrate; tributyrin bypasses this; rare GI upset). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Saccharomyces boulardii | Immune & Inflammation | Supplement | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (antibiotic-associated diarrhea prevention; C. difficile recurrence prevention — meta-analyses); Moderate (traveler's diarrhea; H. pylori eradication adjunct). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (rare fungemia in immunocompromised or central-line patients — FDA warning). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| FMT (fecal microbiota transplantation) | Immune & Inflammation | Prescription | 10 | 8 | 5 | A- 7.7 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (recurrent C. difficile — >85% cure rates, supersedes antibiotics); Weak-Moderate (IBS, IBD); Weak (other indications like obesity, autism — largely experimental). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (CDI). Large effect size when the claim holds. Safety (28%) 5 Med (infection transmission risk — FDA 2019 alerts after deaths from MDR organisms; long-term effects of microbiome transfer unknown). Real risk — monitoring or clinician oversight matters. Composite 7.7 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Larazotide acetate (AT-1001) | Immune & Inflammation | Supplement | 3 | 3 | 4 | D+ 3.4 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Ph3 CeD — 9 Meters' trial failed primary endpoint 2022; development suspended). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3 Weak. Small or unclear effect even in best-case interpretation. Safety (28%) 4 Unknown (favorable in trials but Ph3 negative). Real risk — monitoring or clinician oversight matters. Composite 3.4 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Betaine HCl | Essentials | Supplement | 3 | 4 | 5 | C- 4 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small trials in hypochlorhydria; no large RCTs); Moderate mechanism. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 4 Weak-Moderate (where hypochlorhydria is real). Modest or context-dependent effect. Safety (28%) 5 Med (ulcer/GERD exacerbation; contraindicated with active PUD; heartburn). Real risk — monitoring or clinician oversight matters. Composite 4 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Rifaximin (Xifaxan) | Immune & Inflammation | Prescription | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (IBS-D — TARGET 1/2/3 trials, Pimentel; hepatic encephalopathy prevention); Moderate (SIBO treatment). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (IBS-D). Large effect size when the claim holds. Safety (28%) 9 Low (minimal systemic effect; C. diff risk lower than systemic antibiotics but not zero; resistance concerns with repeated courses). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| DGL (deglycyrrhizinated licorice) | Essentials | Supplement | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (older trials in gastric/duodenal ulcer; anti-H. pylori activity). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (with glycyrrhizin removed; still use caution with whole-licorice products at chronic high doses). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| TUDCA (tauroursodeoxycholic acid) | Metabolic Health Detox Mitochondria & Cellular Energy | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (cholestatic liver disease — Ma 2016 multicenter China RCT n=199 TUDCA non-inferior to UDCA in PBC at 500-1500 mg/day with possible superior symptom relief); Moderate (NAFLD/insulin sensitivity — Kars 2010 1750 mg/day x 4 wk improved hepatic and muscle but NOT adipose insulin sensitivity in obese subjects); Weak (other hepatobiliary; neurodegenerative); FAILED in ALS (AMX0035/Relyvrio PHOENIX Phase 3 missed primary ALSFRS-R endpoint p=0.667 April 2024; FDA approval withdrawn August 2025). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (PBC / cholestasis); Weak-Moderate (NAFLD insulin sensitivity); Unknown (biohacker general hepatoprotection). Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated; rare GI symptoms — diarrhea/bloating most common; theoretical interaction with bile acid sequestrants and insulin/insulin sensitizers; avoid in pregnancy/lactation). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| AICAR | Metabolic Health | Supplement | 2 | 8 | 3 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (performance enhancement). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 8 High (animal endurance signal); Unknown (humans). Large effect size when the claim holds. Safety (28%) 3 Unknown-High (limited human enhancement data, metabolic/cardiac uncertainty, research-chemical quality risk). High risk — serious side-effects at studied doses. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| SR9009 / SR9011 | Metabolic Health | Research chemical | 2 | 5 | 3 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (limited human safety data, product-quality risk, metabolic/circadian uncertainty). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Insulin / insulin-mimetics for performance use | Metabolic Health | Anabolic | 3 | 8 | 0 | D- 2.6 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (bodybuilding/performance outcomes); Very Strong (diabetes glucose-lowering). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 8 High (anabolic/nutrient-partitioning potential). Large effect size when the claim holds. Safety (28%) 0 Very High (severe hypoglycemia, seizure, coma, death, weight gain, dosing-error risk). Severe risk — fatal-potential or unacceptable harm profile. Composite 2.6 0.44·Ev + 0.28·Bn + 0.28·Sf → D- | |||||||
| Meldonium | Metabolic Health | Prescription | 4 | 3.5 | 5 | C- 4.3 | Jun 2026 |
| Score breakdown Evidence (44%) 4 Mixed (ergogenic evidence contested). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (cardiovascular/metabolic uncertainty, interactions, legal/sport risk). Real risk — monitoring or clinician oversight matters. Composite 4.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Trimetazidine | Metabolic Health | Prescription | 3 | 3.5 | 5 | D+ 3.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (healthy performance); Moderate (angina/cardiac indication evidence varies by jurisdiction). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (movement disorders/parkinsonism warning, dizziness, GI effects, sport/legal risk). Real risk — monitoring or clinician oversight matters. Composite 3.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Other beta-2 agonists (salbutamol / formoterol / salmeterol / terbutaline) | Metabolic Health | Prescription | 6 | 3.5 | 3.5 | C 4.6 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (ergogenic meta-analysis mixed by dose/route). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 3.5 Med-High (tachycardia, tremor, hypokalemia, arrhythmia risk at high/systemic doses). High risk — serious side-effects at studied doses. Composite 4.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Diuretic weight-cutting / masking agents | Metabolic Health | Prescription | 3 | 5 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (health optimization); Strong (water-cutting/masking use). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 High (dehydration, electrolyte derangement, arrhythmia, kidney injury, hypotension, masking-drug legal risk). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Cinnamon (Cinnamomum cassia / verum) | Metabolic Health | Supplement | 6 | 3.5 | 5 | C+ 5.2 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (HbA1c reduction ~0.1-0.3% in T2DM meta-analyses — Allen 2013, Akilen 2012; effect size modest and heterogeneous); Weak (lipids). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (Cassia variety contains coumarin — chronic high-dose intake is hepatotoxic; EFSA TDI 0.1 mg/kg/day; Ceylon/verum has negligible coumarin and is preferred for daily use). Real risk — monitoring or clinician oversight matters. Composite 5.2 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Allulose | Metabolic Health | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (postprandial glucose attenuation when co-ingested with carbs — Hayashi 2010, Iida 2008, Noronha 2018 meta-analysis); Weak-Moderate (small body-fat reduction in 12-week Korean RCT — Han 2018). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (GI upset and osmotic diarrhea at >0.5 g/kg single dose; well-tolerated below that; GRAS in US since 2012; FDA exempted from 'added sugars' label 2019). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Monk fruit (mogroside V) | Metabolic Health | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (zero glycemic/insulinemic impact — Tey 2017, Lobach 2019); Weak (claimed antioxidant effects largely in vitro). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (GRAS 2010; no toxicology signals; rare hypersensitivity). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Vitamin D | Essentials Immune & Inflammation | Vitamin | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (bone/rickets); Strong (deficiency correction); Weak-Moderate (generic respiratory infection prevention — Jolliffe 2021 meta-analysis modest effect); Weak (cancer/CV outcomes per VITAL 2019). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (deficiency); Moderate (generally). Large effect size when the claim holds. Safety (28%) 9 Low (toxicity only at sustained very high intake — 10,000+ IU/day for months; hypercalcemia). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Zinc | Essentials Immune & Inflammation | Mineral | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency correction); Moderate (cold duration reduction when lozenges started within 24h per Hemilä meta-analyses); Weak (generic immune enhancement in replete individuals). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate (cold). Modest or context-dependent effect. Safety (28%) 7 Low-Med (chronic high doses 40+ mg cause copper deficiency — neurological sequelae; zinc picolinate/denture-cream overuse is a recognized cause of myelopathy). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Vitamin C (ascorbic acid) | Immune & Inflammation | Supplement | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (scurvy prevention/treatment); Moderate (cold duration modest reduction with chronic supplementation — Hemilä); Weak (generic disease prevention); IV high-dose experimental in sepsis (CITRIS-ALI negative) and cancer (adjunctive). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (GI upset at >2 g/day; kidney stones in predisposed; hemolysis with G6PD deficiency at extremely high IV doses). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Quercetin | Immune & Inflammation Longevity | Supplement | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small RCTs for allergies, exercise immunity, URI); Preclinical (antiviral — but human data thin); Weak-Moderate as a standalone senolytic (the senolytic evidence is for the dasatinib + quercetin combination, not quercetin alone). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (very low bioavailability native; enhanced forms — quercetin phytosome, EMIQ — better absorbed; rare renal toxicity reported at chronic high doses). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Elderberry (Sambucus nigra) | Immune & Inflammation | Herbal | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small trials showing shortened flu duration — Zakay-Rones; Tiralongo 2016 cold RCT in travelers); no large confirmatory trials. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (raw/unripe berries contain cyanogenic glycosides — use processed products only; rare theoretical cytokine storm concerns — largely unfounded). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Echinacea | Immune & Inflammation | Herbal | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (cold prophylaxis and duration — highly species- and preparation-dependent; Karsch-Völk 2014 Cochrane mixed). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (rare hypersensitivity — avoid with ragweed allergy; autoimmune concerns debated but weak evidence). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Beta-glucans (yeast / mushroom) | Immune & Inflammation | Supplement | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (upper respiratory infection reduction in small RCTs); Moderate (clinical use of intravenous lentinan in Japan as oncology adjunct). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (generally well-tolerated; theoretical hypoglycemia). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Colostrum (bovine) | Immune & Inflammation | Supplement | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (acute diarrhea, URI in athletes, some gut permeability markers). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (milk protein allergy; theoretical concerns with unpasteurized products). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Astragalus | Immune & Inflammation | Herbal | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (chronic HF in Chinese trials; as chemo adjunct); Preclinical (telomerase activation via cycloastragenol). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (well-tolerated; theoretical autoimmune concerns — mostly unfounded). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Lactoferrin (bovine) | Immune & Inflammation | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (iron deficiency anemia — alternative to iron salts with better tolerability; pediatric respiratory infection prevention); Weak-Moderate (adult URI; emerging COVID-19 data; gut barrier in IBS). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (iron status); Low-Med (immune). Modest or context-dependent effect. Safety (28%) 9 Low (very well-tolerated; theoretical milk-allergy contraindication). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Systemic glucocorticoids (prednisone / dexamethasone / triamcinolone) | Immune & Inflammation | Prescription | 6 | 5 | 2 | C- 4.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (anti-inflammatory medical indications); Weak-Mixed (performance enhancement). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 High (hyperglycemia, hypertension, infection risk, mood/insomnia, bone loss, adrenal suppression, muscle wasting with chronic use). High risk — serious side-effects at studied doses. Composite 4.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Lactobacillus acidophilus | Immune & Inflammation | Supplement | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (antibiotic-associated diarrhea reduction, especially with C. difficile strains; vaginal/urogenital health; mild cholesterol reduction in some meta-analyses); Weak (general 'immune' claims). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (translocation/bacteremia rare but reported in immunocompromised, central-line, or short-bowel patients — case reports). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Reishi (Ganoderma lucidum) | Immune & Inflammation | Herbal | 4.5 | 3.5 | 5 | C 4.6 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (immune modulation, adjuvant in oncology — multiple Chinese RCTs of variable quality); Weak (sleep/anxiety claims — traditional use, sparse RCT data); Weak (cancer prognosis — Cochrane 2016 inconclusive). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (hepatotoxicity case reports with concentrated extracts and powders; rare; bleeding/anticoagulant interaction signal at high doses). Real risk — monitoring or clinician oversight matters. Composite 4.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Maitake (Grifola frondosa) | Immune & Inflammation | Herbal | 3 | 2 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (immune adjuvant in small oncology series — Nanba/Kodama); Weak (glycemic — SX-fraction small RCTs); Weak overall. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (well-tolerated; theoretical hypoglycemia signal with concurrent antidiabetics). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Shiitake (Lentinula edodes) | Immune & Inflammation | Herbal | 6 | 3.5 | 7 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (IV lentinan as gastric cancer adjuvant — approved/used in Japan, multiple Phase III trials); Weak (oral immune claims); Weak (cholesterol). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Moderate (gastric cancer adjunct context); Low (otherwise). Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (shiitake dermatitis from raw or undercooked mushroom — flagellate erythema; well-described; allergic pneumonitis in workers). Modest risk — manageable side-effects for most users. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Ginger (Zingiber officinale) | Immune & Inflammation | Supplement | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (nausea — pregnancy hyperemesis, postoperative, chemotherapy-induced; multiple meta-analyses); Moderate (osteoarthritis pain — Bartels 2015 meta); Weak (CV/lipids). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate (nausea); Low-Med (OA). Modest or context-dependent effect. Safety (28%) 9 Low (heartburn at higher doses; mild antiplatelet effect — caution with anticoagulants at multi-gram chronic doses). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Lycopene | Immune & Inflammation | Herbal | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (prostate cancer — meta-analyses inconsistent; Chen 2015 modest inverse association); Weak (CV — small BP and FMD signals); Weak (skin photoprotection). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (rare carotenoderma at extremely high intake; no AREDS-style smoker concern documented). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| PT-141 (Bremelanotide / Vyleesi) | Hormones & Endocrine | Prescription | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (RECONNECT trials — approved for premenopausal HSDD 2019); Weak (male ED/libido off-label). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (HSDD women). Modest or context-dependent effect. Safety (28%) 5 Med (nausea — 40% in trials, often dose-limiting; flushing; headache; transient BP elevation; skin darkening with repeated use). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Melanotan II (MT-II) | Hormones & Endocrine | Prescription | 6 | 6.5 | 2 | C- 4.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (tanning); Moderate (erectile function — Wessells 1998); Moderate (libido). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 2 High (nausea, flushing, high BP, darkening of existing moles — case reports of melanoma following use; chronic use concerns). High risk — serious side-effects at studied doses. Composite 4.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Sildenafil (Viagra) | Hormones & Endocrine Metabolic Health | Prescription | 10 | 10 | 5 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (erectile dysfunction; also pulmonary arterial hypertension); emerging longevity signal (observational — lower Alzheimer's risk in PDE5i users). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very Strong. Large effect size when the claim holds. Safety (28%) 5 Low-Med (headache, flushing, nasal congestion, dyspepsia, blue-tinge vision; contraindicated with nitrates — fatal hypotension; caution with alpha-blockers). Real risk — monitoring or clinician oversight matters. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Tadalafil (Cialis) | Hormones & Endocrine Metabolic Health Muscle & Strength | Prescription | 10 | 10 | 7 | S 8.8 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (ED; BPH/LUTS; PAH — Adcirca); emerging longevity signal shared with PDE5i class. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very Strong. Large effect size when the claim holds. Safety (28%) 7 Low-Med (headache, back/muscle pain distinctive of tadalafil, nasal congestion; same nitrate contraindication). Modest risk — manageable side-effects for most users. Composite 8.8 0.44·Ev + 0.28·Bn + 0.28·Sf → S | |||||||
| Cabergoline | Hormones & Endocrine | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (hyperprolactinemia); Weak (refractory period reduction — anecdotal biohacker use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (for intended medical use). Large effect size when the claim holds. Safety (28%) 5 Med (cardiac valvulopathy with high chronic doses — well-documented in Parkinson's and pituitary dosing; nausea; orthostatic hypotension; compulsive behaviors). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Tongkat ali (Eurycoma longifolia) | Hormones & Endocrine | Herbal | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (modest testosterone increase in hypogonadal men — Tambi 2012); Weak-Moderate (stress/mood/sexual function). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (generally well-tolerated; historical heavy-metal contamination concern — test from reputable brands). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Tribulus terrestris | Hormones & Endocrine | Herbal | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (female sexual function — some RCTs show benefit); Very Weak (male testosterone — most RCTs negative). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med (female); Very Low (male T). Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Maca (Lepidium meyenii) | Hormones & Endocrine | Herbal | 6 | 3.5 | 9 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (sexual desire in men and women — Dording 2008, Shin 2010); Weak (SSRI-induced sexual dysfunction); Weak (fertility parameters). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (generally well-tolerated; hypothyroidism caution due to goitrogens — minimal clinical relevance). Low risk — minimal side-effect burden in healthy adults. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Fadogia agrestis | Hormones & Endocrine | Herbal | 0 | 5 | 3 | F 2 | Jun 2026 |
| Score breakdown Evidence (44%) 0 None (no published human efficacy trials). No usable evidence at this time. Benefit (28%) 5 Unknown. Modest or context-dependent effect. Safety (28%) 3 Unknown-High (rat study showed hepatic/testicular toxicity at higher doses; no human safety data). High risk — serious side-effects at studied doses. Composite 2 0.44·Ev + 0.28·Bn + 0.28·Sf → F | |||||||
| Yohimbine | Hormones & Endocrine | Prescription | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (ED pre-Viagra — Ernst 1998 meta-analysis showed modest benefit); Weak-Moderate (fat loss — stubborn fat areas with high α2 density, fasted cardio context). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (anxiety, panic attacks, BP spikes, tachycardia, insomnia; contraindicated with anxiety disorders, hypertension, MAOIs; can trigger PTSD flashbacks). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Kisspeptin-10 | Hormones & Endocrine | Peptide | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (Imperial College trials — Dhillo lab — increased sexual brain activity and HPG function; small HSDD Ph2). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (well-tolerated in trials); Unknown long-term. Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Finasteride (oral / topical) | Hormones & Endocrine | Prescription | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (AGA in men — finasteride 1 mg/day preserves hair in most and regrows in ~40-50%; BPH). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 7 Low-Med (sexual side effects — ED, libido, reduced ejaculate volume; mood/cognitive effects debated — 'post-finasteride syndrome' controversial but reported; small decreased PSA affecting screening interpretation; gynecomastia). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Dutasteride | Hormones & Endocrine | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (BPH; off-label AGA — slightly superior to finasteride in Olsen 2006 head-to-head). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 5 Med (same sexual/cognitive concerns as finasteride but potentially more pronounced due to more complete DHT suppression; long half-life ~5 weeks means effects and side effects last longer than finasteride). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Minoxidil (topical + oral low-dose) | Hormones & Endocrine | Supplement | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (AGA both sexes — topical; low-dose oral — Sinclair 2018, Ramos 2020, Randolph 2021). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 9 Low (topical: scalp irritation, unwanted facial hair, post-application shedding 4-8 weeks in; oral: fluid retention, ankle edema, hypertrichosis, rare pericardial effusion at higher doses). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Tretinoin (all-trans retinoic acid) | Longevity | Prescription | 10 | 10 | 5 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (acne, photoaging — gold standard topical anti-aging). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 10 Very Strong. Large effect size when the claim holds. Safety (28%) 5 Med (irritation, dryness, purging, photosensitivity, teratogenic — do not use in pregnancy). Real risk — monitoring or clinician oversight matters. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| GHK-Cu (copper peptide) | Longevity Sleep & Recovery Immune & Inflammation | Peptide | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (topical wound healing, photoaging improvements; scalp hair counts in small studies). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (mild irritation in some; green-blue staining common at high concentrations). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Spironolactone | Hormones & Endocrine | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (female AGA, hormonal acne, hirsutism). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 5 Med (menstrual irregularity, breast tenderness, hyperkalemia risk especially with ACEi/ARB/K-supplements, teratogenic — feminization of male fetus). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| GnRH/LH-axis analogs for testosterone stimulation | Hormones & Endocrine | Peptide | 6 | 5 | 3.5 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (endocrine indications); Weak (healthy testosterone optimization). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 3.5 Med-High (axis suppression/desensitization, fertility effects, mood/libido changes, injection/protocol risk). High risk — serious side-effects at studied doses. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| ACTH / corticotrophin analogs | Hormones & Endocrine | Prescription | 3 | 3.5 | 3.5 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (performance/recovery enhancement). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 3.5 Med-High (hypercortisolism, glucose elevation, mood effects, immune suppression, adrenal-axis disruption). High risk — serious side-effects at studied doses. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Other aromatase inhibitors (letrozole / exemestane / formestane / arimistane) | Hormones & Endocrine | Hormone | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (approved oncology/endocrine contexts); Weak (healthy hormone optimization). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (low estradiol symptoms, bone/lipid effects, joint pain, fertility and mood effects). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Other SERMs / anti-estrogens (tamoxifen / raloxifene / fulvestrant) | Hormones & Endocrine | Hormone | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (approved oncology/bone/menopause indications); Weak (healthy post-cycle optimization). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (VTE risk for some, hot flashes, endometrial effects depending agent, ocular/liver effects, drug interactions). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Osilodrostat | Hormones & Endocrine | Prescription | 3 | 2 | 2 | D- 2.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (performance/body-composition use); Strong (Cushing disease cortisol-lowering indication). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 2 High (adrenal insufficiency, QT prolongation, androgen excess, hypocortisolism symptoms). High risk — serious side-effects at studied doses. Composite 2.5 0.44·Ev + 0.28·Bn + 0.28·Sf → D- | |||||||
| SSRIs (sertraline / escitalopram / fluoxetine) | Mood, Anxiety & Stress | Prescription | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (MDD, GAD, panic, OCD, PTSD, PMDD); effect sizes modest in mild depression (Kirsch debate) but clear in moderate-severe. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Moderate-Strong. Meaningful effect for the studied population. Safety (28%) 5 Med (sexual dysfunction — ~30-50% and may persist after discontinuation as PSSD; emotional blunting; GI; weight changes; discontinuation syndrome; small QT risk — citalopram; bleeding with NSAIDs; serotonin syndrome with MAOIs). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| SNRIs (venlafaxine / duloxetine) | Mood, Anxiety & Stress | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (MDD, GAD, neuropathic pain, fibromyalgia); Moderate (chronic musculoskeletal pain). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 5 Med (similar sexual side effects to SSRIs; more BP elevation at higher doses; severe discontinuation syndrome with venlafaxine due to short half-life; nausea, sweating; GI bleeding risk — increased with NSAIDs/antiplatelets/anticoagulants). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Ashwagandha (Withania somnifera) | Mood, Anxiety & Stress Essentials Sleep & Recovery | Herbal | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (stress/anxiety; small testosterone effect in men per Lopresti 2019; modest muscle/strength gains). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 7 Low-Med (hepatotoxicity — emerging case reports since 2020; thyroid hormone elevation — caution in hyperthyroidism or on levothyroxine; sedating; theoretical concerns with autoimmune conditions). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Kava (Piper methysticum) | Mood, Anxiety & Stress Sleep & Recovery | Prescription | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (generalized anxiety — Pittler-Ernst 2003 Cochrane-era meta; Sarris 2013 KGAT trial). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (hepatotoxicity — real but concentrated in certain extracts/cultivars; 2002 European regulatory action has been partially reversed; noble cultivars and water-extracted products much safer than acetone/ethanol extracts of root bark/peelings). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Inositol (myo-inositol / D-chiro-inositol) | Mood, Anxiety & Stress | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (panic disorder, OCD — Fux 1996/1999; PCOS insulin sensitivity, ovulation — multiple trials). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (GI upset at high doses; very well-tolerated otherwise). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| SAM-e (S-adenosylmethionine) | Mood, Anxiety & Stress | Prescription | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (MDD — multiple European and small US RCTs; knee osteoarthritis). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 7 Low-Med (GI upset; manic switch in bipolar — screen before use; expensive; stability issues in storage). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| St. John's wort (Hypericum perforatum) | Mood, Anxiety & Stress | Prescription | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (mild-moderate MDD — non-inferior to SSRIs in multiple European RCTs). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (massive drug interactions — reduces efficacy of oral contraceptives, immunosuppressants, chemotherapy, anticoagulants, many psychotropics; photosensitivity; serotonin syndrome risk with other serotonergics). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| 5-HTP (5-hydroxytryptophan) | Mood, Anxiety & Stress | Supplement | 3 | 3.5 | 5 | D+ 3.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (depression — small trials; sleep onset). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (serotonin syndrome risk with SSRIs/SNRIs/MAOIs — DO NOT combine; historical eosinophilia-myalgia syndrome from contaminated tryptophan products has fueled ongoing caution). Real risk — monitoring or clinician oversight matters. Composite 3.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Bupropion (Wellbutrin) | Mood, Anxiety & Stress | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (MDD, seasonal affective disorder, smoking cessation; off-label ADHD adjunct, binge eating disorder). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 5 Med (seizure risk dose-dependent — contraindicated in eating disorders or alcohol/benzo withdrawal due to seizure threshold; insomnia; anxiety; BP elevation). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Gabapentin / pregabalin | Mood, Anxiety & Stress Sleep & Recovery | Prescription | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (neuropathic pain — pregabalin more than gabapentin; GAD — pregabalin; partial seizures); Moderate (alcohol withdrawal, sleep, PTSD adjunct — off-label). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (sedation, edema, weight gain, cognitive dulling; withdrawal symptoms with abrupt discontinuation; abuse potential increasingly recognized — pregabalin Schedule V US, gabapentin scheduled in some states; suicidality label). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Buspirone | Mood, Anxiety & Stress | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (GAD). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (dizziness, nausea, headache; minimal sedation; no dependence; effect takes 2-4 weeks). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| TMS (transcranial magnetic stimulation) | Mood, Anxiety & Stress | Supplement | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (treatment-resistant depression — FDA approved since 2008; SAINT 2020 positive Ph2); Moderate (OCD — FDA approved 2018; smoking cessation; migraine; stroke rehab). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (TRD). Large effect size when the claim holds. Safety (28%) 9 Low (scalp discomfort, headache, rare seizures — 0.003% per treatment; contraindicated with intracranial metal/implants). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Electroconvulsive therapy (ECT) | Mood, Anxiety & Stress | Supplement | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (treatment-resistant depression — pooled remission 32-52%, up to 80% with optimized CORE protocol; psychotic depression — best evidence of any class); Strong (catatonia — often life-saving, ~80% response); Strong (acute mania); Moderate (drug-resistant bipolar depression). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (gold standard for severe/treatment-resistant cases). Large effect size when the claim holds. Safety (28%) 5 Med (cognitive side effects are the central decision input — acute confusion and anterograde amnesia common; retrograde autobiographical-memory loss documented in 2024 MA; 71-80% of patients self-report subjective long-term memory deficits in 2024 survey but objective neuropsych testing shows less impairment; mortality ~1 in 10,000 to 50,000 — comparable to general anesthesia). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Lithium (microdose vs therapeutic) | Mood, Anxiety & Stress Longevity | Mineral | 10 | 5 | 2 | B- 6.1 | Jun 2026 |
| Score breakdown Evidence (44%) 10 Very Strong (bipolar disorder prophylaxis — only drug with mortality-reducing evidence in bipolar); Strong (suicide reduction — Cipriani 2013); Weak (microdose cognitive/dementia claims — trace-dose Nunes 2013 AD signal). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Varies (strong therapeutic; weak microdose). Modest or context-dependent effect. Safety (28%) 2 High (therapeutic — narrow therapeutic index, thyroid/renal toxicity, teratogenic); Low (microdose). High risk — serious side-effects at studied doses. Composite 6.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Dextromethorphan-bupropion (Auvelity / AXS-05) | Mood, Anxiety & Stress | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 GEMINI; FDA-approved Aug 2022 for MDD). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (significant Hamilton-D reduction by week 1 — faster than SSRIs; -16 vs placebo -12 at 6 weeks). Large effect size when the claim holds. Safety (28%) 5 Med (dizziness, headache, nausea, somnolence; serotonin syndrome risk with serotonergic agents; bupropion seizure risk in eating disorders or alcohol/benzo withdrawal; CYP2D6 considerations). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Zuranolone (Zurzuvae) | Mood, Anxiety & Stress | Hormone | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 SKYLARK; FDA-approved Aug 2023 for postpartum depression); Moderate-Mixed (MDD broadly — Phase 3 missed primary endpoint in MDD). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High in PPD (rapid response within days, sustained at day 45 in trials); Moderate-Limited (in MDD broadly). Large effect size when the claim holds. Safety (28%) 5 Med (somnolence, dizziness, sedation — driving warning, full label Schedule IV; fetal harm — contraception required for 1 wk after; not curative, courses are 14 days). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Xanomeline-trospium (KarXT / Cobenfy) | Mood, Anxiety & Stress | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3 EMERGENT-2 and EMERGENT-3; FDA-approved Sept 2024). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (PANSS reduction 9.6-11.6 points vs placebo; effect size comparable to atypicals without dopamine D2 blockade). Large effect size when the claim holds. Safety (28%) 5 Med (nausea, vomiting, dyspepsia, constipation, hypertension; the M1/M4 mechanism avoids the metabolic syndrome and EPS of D2-blocker antipsychotics). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Other beta-blockers (atenolol / metoprolol / nadolol) | Mood, Anxiety & Stress | Prescription | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (physiologic tremor/performance-anxiety symptom control); Weak-Mixed (general anxiety outcomes). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 5 Med (bradycardia, hypotension, fatigue, bronchospasm risk, masking hypoglycemia, rebound if abruptly stopped). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| GABA (gamma-aminobutyric acid) | Mood, Anxiety & Stress | Prescription | 3 | 2 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (anxiety/sleep — small EEG studies show acute alpha-wave shift, e.g. Abdou 2006; meta-analyses are small and heterogeneous); Preclinical (gut-brain axis hypothesis). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (rare transient flushing/dyspnea; no dependence signal at typical doses). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Melatonin | Sleep & Recovery Longevity | Hormone | 8 | 3.5 | 9 | A- 7.7 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (circadian phase shifting, jet lag, DSPD); Weak-Moderate (primary insomnia — small effect; better as circadian regulator than sleep inducer). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (vivid dreams, morning grogginess at high doses; supplement product dose accuracy is notoriously poor — Erland 2017 showed 70% of products outside ±10% of label claim). Low risk — minimal side-effect burden in healthy adults. Composite 7.7 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Magnesium | Essentials Sleep & Recovery Mood, Anxiety & Stress | Mineral | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (deficiency correction; sleep quality — Abbasi 2012 modest effect; constipation; migraine prophylaxis). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (diarrhea dose-limiting with oxide/citrate; very rare hypermagnesemia in normal renal function). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Vitamin E (alpha-tocopherol / mixed tocopherols) | Essentials | Vitamin | 8 | 3.5 | 5 | B- 6.1 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency — rare); Weak (CV/cancer prevention — HOPE 2005, SELECT 2008/2011, ATBC 1994); Weak-Moderate (NASH per PIVENS 2010). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (high-dose all-rac-alpha-tocopherol >400 IU/day associated with increased all-cause mortality in Miller 2005 meta-analysis; SELECT showed increased prostate cancer; antagonizes warfarin). Real risk — monitoring or clinician oversight matters. Composite 6.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Vitamin B1 (thiamine) | Essentials | Vitamin | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Wernicke-Korsakoff prevention/treatment, beriberi); Moderate (alcohol use disorder prophylaxis; some signal in diabetic neuropathy via benfotiamine); Weak (fatigue/cognition in replete people). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (for deficiency); Low (otherwise). Large effect size when the claim holds. Safety (28%) 9 Low. Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Vitamin B2 (riboflavin) | Essentials | Vitamin | 8 | 5 | 9 | A 8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (ariboflavinosis); Moderate (migraine prophylaxis — Schoenen 1998 RCT, MIRACLE meta-analyses); Weak (otherwise). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate (migraine); Low (general). Modest or context-dependent effect. Safety (28%) 9 Low (bright yellow urine; no known toxicity). Low risk — minimal side-effect burden in healthy adults. Composite 8 0.44·Ev + 0.28·Bn + 0.28·Sf → A | |||||||
| Vitamin B5 (pantothenic acid) | Essentials | Vitamin | 8 | 2 | 9 | B+ 7.5 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency, extremely rare); Weak (acne — pantothenic acid megadose has small open-label data; cholesterol — pantethine form has modest LDL-lowering signal). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (GI upset at multi-gram doses; pantethine occasionally causes loose stools). Low risk — minimal side-effect burden in healthy adults. Composite 7.5 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Vitamin B6 (pyridoxine / P5P) | Essentials | Vitamin | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency, isoniazid co-therapy, sideroblastic anemia subtypes); Moderate (PMS, hyperemesis gravidarum, homocysteine reduction); Weak (CV outcomes — replete populations). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (chronic intake >200 mg/day causes peripheral sensory neuropathy — typically reversible; one of the few water-soluble vitamins with a real upper limit). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Vitamin B7 (biotin) | Essentials | Vitamin | 8 | 2 | 7 | B 6.7 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (biotinidase deficiency, multiple carboxylase deficiency); Weak (hair/nail growth claims in non-deficient — mostly open-label dermatology series). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 2 Low (for replete). Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (interferes with biotin-streptavidin lab immunoassays — falsely low TSH, falsely high T4, falsely low troponin; FDA warning 2017; recommend pause >24h before labs). Modest risk — manageable side-effects for most users. Composite 6.7 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Vitamin B12 (methylcobalamin / cyanocobalamin / hydroxocobalamin) | Essentials | Vitamin | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency — pernicious anemia, vegan diet, metformin/PPI users, ileal disease, elderly absorption decline); Moderate (homocysteine reduction); Weak (energy/cognition claims in replete people). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (deficiency). Large effect size when the claim holds. Safety (28%) 9 Low (extremely well-tolerated; rare acneiform eruption with high-dose injection). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Vitamin K1 (phylloquinone) | Essentials | Vitamin | 8 | 8 | 9 | A+ 8.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (clotting / neonatal hemorrhagic disease prophylaxis); Weak (vascular/longevity — K2 has the relevant peripheral tissue data, not K1). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong (clotting); Weak (longevity). Large effect size when the claim holds. Safety (28%) 9 Low (avoid in warfarin-treated patients without coordination; Vitamin K1 is the antidote for warfarin overdose). Low risk — minimal side-effect burden in healthy adults. Composite 8.4 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| Calcium (citrate / carbonate) | Essentials | Mineral | 8 | 5 | 5 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency / osteoporosis prevention when paired with vitamin D); Moderate (fracture reduction in deficient elderly); Weak-Negative (CV — Bolland 2010/2011 meta-analyses suggested ~25% increased MI risk with supplemental Ca >500 mg/day not paired with D; subsequent reanalyses contested). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 5 Med (kidney stones in predisposed; possible vascular calcification with high-dose isolated Ca supplementation; constipation; absorption competes with iron and zinc). Real risk — monitoring or clinician oversight matters. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Manganese | Essentials | Mineral | 8 | 2 | 5 | B- 5.9 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (deficiency, rare); Weak (otherwise). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (chronic high inhalation/occupational exposure causes Parkinsonian manganism — welders, miners; oral toxicity in liver impairment; well-water exposure a population issue). Real risk — monitoring or clinician oversight matters. Composite 5.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Glycine | Sleep & Recovery | Supplement | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (sleep onset, quality, next-day fatigue — Yamadera 2007, Bannai 2012; 2023 GeroScience PRISMA SR confirms nervous-system signal but flags small-N and risk of bias). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (very well-tolerated; sweet taste; rare GI upset at high doses). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Apigenin | Sleep & Recovery Mood, Anxiety & Stress | Prescription | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (small trials; preclinical sedation/anxiolytic). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (theoretical concerns with anticoagulants; aromatase inhibition not relevant at typical supplement doses). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Valerian (Valeriana officinalis) | Sleep & Recovery Mood, Anxiety & Stress | Herbal | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (primary insomnia — Cochrane-era Bent 2006 modest effect; chronic use better than acute). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (rare hepatotoxicity — case reports disputed as contamination; morning grogginess; paradoxical excitation in some). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| CBD (cannabidiol) | Sleep & Recovery Mood, Anxiety & Stress Immune & Inflammation | Prescription | 4.5 | 3.5 | 7 | C+ 5.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (sleep — Shannon 2019 case series; anxiety — Bergamaschi 2011 public speaking); Strong (Dravet/LGS/TSC epilepsy as Epidiolex). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (hepatotoxicity — signal in Epidiolex trials; significant CYP450 interactions with warfarin/antiepileptics; sedation; diarrhea). Modest risk — manageable side-effects for most users. Composite 5.4 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Trazodone | Sleep & Recovery | Prescription | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (off-label sleep — most-prescribed off-label hypnotic in US); Strong (MDD at higher doses, though rarely used for this now). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (sleep). Modest or context-dependent effect. Safety (28%) 7 Low-Med (orthostatic hypotension, dry mouth, priapism — rare but notable emergency, serotonin syndrome with MAOIs). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| DORAs (suvorexant / lemborexant / daridorexant) | Sleep & Recovery | Prescription | 8 | 8 | 7 | A- 7.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (chronic insomnia — multiple Ph3 trials; daridorexant has functional daytime improvement data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 7 Low-Med (daytime sleepiness at high doses; rare sleep paralysis, hypnagogic hallucinations, cataplexy-like events; no abuse/dependence signal comparable to Z-drugs; expensive). Modest risk — manageable side-effects for most users. Composite 7.6 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Z-drugs (zolpidem / eszopiclone / zaleplon) | Sleep & Recovery | Prescription | 8 | 8 | 3.5 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (sleep onset — zolpidem/zaleplon; sleep maintenance — eszopiclone). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 Strong. Large effect size when the claim holds. Safety (28%) 3.5 Med-High (complex sleep behaviors — sleep-driving, sleep-eating with amnesia — FDA black box 2019; dependence and withdrawal; next-day impairment; fall/fracture risk in elderly; paradoxical agitation). High risk — serious side-effects at studied doses. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Doxepin (low-dose) | Sleep & Recovery | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (sleep maintenance at low dose; antidepressant at higher doses — 75-300 mg). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (next-morning residual sedation if dosed late or too high; anticholinergic effects only at higher antidepressant doses). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| High-volume IV hydration / infusion clinics | Sleep & Recovery | Supplement | 3 | 3.5 | 5 | D+ 3.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (wellness/recovery use). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (infection, vein injury, electrolyte/glucose errors, fluid overload, masking/anti-doping risk). Real risk — monitoring or clinician oversight matters. Composite 3.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Tramadol / prescription opioid analgesics | Sleep & Recovery | Prescription | 3 | 5 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (performance enhancement); Strong (analgesia in indicated pain contexts). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 2 High (sedation, respiratory depression, dependence, overdose, serotonin/seizure risk for tramadol, impaired coordination). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| THC / cannabis products | Sleep & Recovery | Prescription | 3.5 | 3.5 | 5 | C- 4.1 | Jun 2026 |
| Score breakdown Evidence (44%) 3.5 Weak-Mixed (sleep/anxiety/pain outcomes depend on formulation and indication). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (anxiety/paranoia, impaired driving/cognition, dependence, sleep-architecture changes, psychosis risk in susceptible users). Real risk — monitoring or clinician oversight matters. Composite 4.1 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| Lysine (L-lysine) | Sleep & Recovery | Supplement | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (HSV-1/2 recurrence reduction — Griffith 1987, Thein 1984, Tomblin 2001; small, mostly old RCTs but consistent); Weak (anxiety/stress in combination with arginine); Weak (calcium absorption). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (rare GI upset; theoretical concern with arginine-dependent processes like NO/erectile function at high chronic doses). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Activated charcoal | Detox | Supplement | 2 | 2 | 9 | C 4.8 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (generic 'detox' supplementation for healthy people); Strong (acute oral poisonings — standard ED care). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low (generic detox use — adsorbent stays in the gut); Strong (acute poisoning). Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (black stools expected; constipation; interferes with absorption of medications — dose separation critical). Low risk — minimal side-effect burden in healthy adults. Composite 4.8 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Chlorella | Detox | Herbal | 3 | 3.5 | 7 | C 4.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (dioxin excretion — Morita 1999 breast milk; heavy metal excretion — small studies); Weak (cholesterol, immunity — small studies). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (GI upset; iodine content significant — caution with thyroid issues; vitamin K content — anticoagulant interaction; heavy metal contamination concerns with cheap products — sourcing matters). Modest risk — manageable side-effects for most users. Composite 4.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Spirulina | Detox | Herbal | 3 | 3.5 | 7 | C 4.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (arsenic chronic exposure — one Bangladesh trial; allergic rhinitis symptoms; mild lipid effects); not really a detox agent primarily. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (contamination with microcystins from wild-source or poorly-controlled cultivation — serious hepatotoxicity risk; phenylketonuria contraindication; vitamin K content). Modest risk — manageable side-effects for most users. Composite 4.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Milk thistle (silymarin / silibinin) | Detox | Herbal | 3 | 3 | 9 | C+ 5.4 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (chronic liver disease — mixed trials; hepatitis C — mostly null; NAFLD — small positive signals); Strong (Amanita mushroom poisoning — IV silibinin/Legalon-SIL). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3 Weak (general); Strong (Amanita). Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (very well-tolerated; rare GI). Low risk — minimal side-effect burden in healthy adults. Composite 5.4 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| DHM (dihydromyricetin / ampelopsin) | Detox | Prescription | 2 | 5 | 9 | C+ 5.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (robust rodent data — reduced voluntary alcohol intake; reduced intoxication; reduced anxiety/seizure during withdrawal; Shen 2012 J Neurosci canonical mechanism paper); Weak human (small double-blind placebo-controlled hangover RCT found NO significant effect on hangover severity; pharmacokinetic study found no effect on alcohol metabolism); 2021 PubMed review of 82 hangover products found NONE have peer-reviewed human safety/efficacy data. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown (preclinical robust but human translation lacking). Modest or context-dependent effect. Safety (28%) 9 Low (no serious AEs reported; benzodiazepine-site GABA-A modulation theoretical tolerance/dependence concerns at chronic high doses — not documented; very rare hepatotoxicity case reports for Hovenia dulcis-containing supplements per NIH LiverTox). Low risk — minimal side-effect burden in healthy adults. Composite 5.3 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Glutathione (liposomal / IV / S-acetyl) | Detox | Supplement | 4.5 | 5 | 9 | B 6.4 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (liposomal/oral supplementation — bioavailability issues, modest systemic increases); Strong (IV in APAP overdose and clinical tox). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 5 Varies. Modest or context-dependent effect. Safety (28%) 9 Low (rare sulfur GI issues; IV rare hypersensitivity). Low risk — minimal side-effect burden in healthy adults. Composite 6.4 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| DMSA / DMPS (heavy metal chelators) | Detox | Prescription | 3 | 2 | 3.5 | D 3.1 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (chronic 'low-level' heavy metal burden — provocative urinary testing is invalid science); Strong (confirmed pediatric lead toxicity, severe heavy metal poisoning). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low (chronic 'low-level' burden — no validated indication); Strong (real toxicity). Small or unclear effect even in best-case interpretation. Safety (28%) 3.5 Med-High (mineral depletion — Zn, Cu, other essentials; redistribution of metals to brain with some protocols; hypersensitivity; DMPS removed from UK/Canada due to safety). High risk — serious side-effects at studied doses. Composite 3.1 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| EDTA chelation | Detox | Prescription | 2 | 2 | 1.5 | F 1.8 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Very Weak (atherosclerosis prevention — TACT 2013 marginal, TACT2 2023 negative for diabetes subgroup); Strong (severe lead poisoning). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low (atherosclerosis / 'chelation therapy' — no demonstrated benefit); Strong (lead). Small or unclear effect even in best-case interpretation. Safety (28%) 1.5 Med-High (hypocalcemia — potentially fatal if infused too fast; renal toxicity; mineral depletion). Severe risk — fatal-potential or unacceptable harm profile. Composite 1.8 0.44·Ev + 0.28·Bn + 0.28·Sf → F | |||||||
| Calcium-D-glucarate | Detox | Prescription | 3 | 3 | 9 | C+ 5.4 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (breast cancer prevention — rat model; estrogen detoxification — theoretical; some human pharmacokinetic support). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3 Weak. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (well-tolerated). Low risk — minimal side-effect burden in healthy adults. Composite 5.4 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| DIM (diindolylmethane) / I3C | Detox | Herbal | 3 | 3 | 7 | C 4.6 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (cervical dysplasia/CIN — small trials; BPH marker changes; estrogen metabolism biomarkers). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3 Weak. Small or unclear effect even in best-case interpretation. Safety (28%) 7 Low-Med (GI upset; scalp irritation; body odor shift; dose-dependent headaches; theoretical concerns with breast cancer hormonal modulation — get informed care). Modest risk — manageable side-effects for most users. Composite 4.6 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Modified citrus pectin (MCP) | Detox | Supplement | 3 | 3.5 | 9 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (lead chelation case series — Eliaz 2006; galectin-3 modulation; early cancer biomarker trials). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (generally well-tolerated; GI upset occasionally). Low risk — minimal side-effect burden in healthy adults. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Astaxanthin | Longevity Immune & Inflammation Mitochondria & Cellular Energy | Herbal | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (eye fatigue/accommodative function — Nakamura 2004, Nagaki 2002 in Japanese trials); Weak (skin elasticity, exercise performance). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate. Modest or context-dependent effect. Safety (28%) 9 Low (well-tolerated; pink skin tinge at extreme doses; caution with anticoagulants at high doses). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Luteolin | Longevity | Supplement | 2 | 2 | 9 | C 4.8 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (senolytic synergy with quercetin in mouse models — Zhu 2017, Xu 2018); Weak (human — small open-label autism/cognitive trials with apigenin/luteolin blends; mast-cell activation syndrome anecdote). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (poor oral bioavailability is the main practical limit; theoretical CYP1A2/3A4 interactions at high doses). Low risk — minimal side-effect burden in healthy adults. Composite 4.8 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Cocoa flavanols (Theobroma cacao) | Longevity | Supplement | 8 | 3.5 | 9 | A- 7.7 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (endothelial function, FMD — Hooper 2012 meta-analysis); Moderate (BP — modest 2-5 mmHg reduction); Moderate (CV outcomes — COSMOS 2022 primary endpoint negative but secondary CV death endpoint significant); Weak-Moderate (cognition — Brickman 2014, COSMOS-Mind 2023). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (caffeine and theobromine content modest; cadmium contamination concern with some sourcing — choose tested brands). Low risk — minimal side-effect burden in healthy adults. Composite 7.7 0.44·Ev + 0.28·Bn + 0.28·Sf → A- | |||||||
| Lutein + Zeaxanthin | Longevity | Herbal | 8 | 6.5 | 9 | A+ 8.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (AMD progression reduction in moderate-severe AMD — AREDS2 2013); Moderate (visual function, glare recovery, contrast sensitivity — LAMA 2014, LUTEGA); Moderate (cognition — CARES 2017 in older adults; brain xanthophyll signal in Renzi/Hammond series). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Moderate-High (AMD progression); Moderate (visual function, cognition). Meaningful effect for the studied population. Safety (28%) 9 Low (much safer than beta-carotene — no smoker lung cancer signal in AREDS2; rare yellow skin discoloration at very high intake). Low risk — minimal side-effect burden in healthy adults. Composite 8.2 0.44·Ev + 0.28·Bn + 0.28·Sf → A+ | |||||||
| PM2.5 (fine particulate matter) | Toxins | Air pollutant | 10 | 10 | 8 | CRITICAL 9.4 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (CV mortality, stroke, lung cancer, dementia — GBD2019 ranks top 5 global mortality risk factor). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very High (population level). Population-level harm magnitude. Prevalence 8 High chronic exposure. Widespread, near-universal exposure. Priority 9.4 Magnitude × evidence × prevalence, weighted. | |||||||
| NO2 (nitrogen dioxide) | Toxins | Air pollutant | 8 | 8 | 6.5 | HIGH 7.6 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (asthma, COPD exacerbation, cardiovascular effects); Moderate (childhood asthma from gas cooking). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High. Population-level harm magnitude. Prevalence 6.5 Med-High chronic. Common exposure in modern environments. Priority 7.6 Magnitude × evidence × prevalence, weighted. | |||||||
| Ozone (tropospheric) | Toxins | Air pollutant | 8 | 8 | 6.5 | HIGH 7.6 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (respiratory morbidity/mortality, CV effects). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High. Population-level harm magnitude. Prevalence 6.5 Med-High chronic. Common exposure in modern environments. Priority 7.6 Magnitude × evidence × prevalence, weighted. | |||||||
| Radon | Toxins | Air pollutant | 10 | 10 | 5 | CRITICAL 8.5 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (lung cancer; synergistic with smoking). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very High (in exposed homes). Population-level harm magnitude. Prevalence 5 Moderate average. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | |||||||
| Benzene | Toxins | Air pollutant | 10 | 8 | 8 | CRITICAL 8.6 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (acute myeloid leukemia, myelodysplasia, aplastic anemia at chronic occupational exposure). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High (chronic). Population-level harm magnitude. Prevalence 8 High occupational; lower environmental. Widespread, near-universal exposure. Priority 8.6 Magnitude × evidence × prevalence, weighted. | |||||||
| Formaldehyde | Toxins | Air pollutant | 8 | 8 | 8 | HIGH 8 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (nasopharyngeal cancer, leukemia, asthma/irritation). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High chronic (poorly ventilated spaces). Population-level harm magnitude. Prevalence 8 High acute in salons; moderate home chronic. Widespread, near-universal exposure. Priority 8 Magnitude × evidence × prevalence, weighted. | |||||||
| TCE (trichloroethylene) | Toxins | Air pollutant | 8 | 8 | 8 | HIGH 8 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (kidney cancer, non-Hodgkin lymphoma, Parkinson's risk). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High (exposed populations). Population-level harm magnitude. Prevalence 8 High occupational/exposed. Widespread, near-universal exposure. Priority 8 Magnitude × evidence × prevalence, weighted. | |||||||
| Lead | Toxins | Heavy metal | 10 | 10 | 8 | CRITICAL 9.4 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (IQ deficit, CV mortality, kidney disease — no threshold). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very High. Population-level harm magnitude. Prevalence 8 High historical; moderate current. Widespread, near-universal exposure. Priority 9.4 Magnitude × evidence × prevalence, weighted. | |||||||
| Mercury (methylmercury) | Toxins | Heavy metal | 8 | 5 | 5 | MODERATE 5.9 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (developmental neurotoxicity — Faroe Islands and Seychelles cohorts; CV risk at high intake). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5 Moderate. Real but bounded harm magnitude. Prevalence 5 Moderate (dietary). Moderate exposure prevalence. Priority 5.9 Magnitude × evidence × prevalence, weighted. | |||||||
| Arsenic | Toxins | Heavy metal | 8 | 8 | 5 | HIGH 7.1 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (skin, lung, bladder cancer; CV disease; developmental effects). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High (exposed). Population-level harm magnitude. Prevalence 5 Variable. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | |||||||
| Cadmium | Toxins | Heavy metal | 8 | 5 | 3 | MODERATE 5.3 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (kidney damage, osteoporosis, lung cancer). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5 Moderate. Real but bounded harm magnitude. Prevalence 3 Low-Moderate chronic. Limited or context-specific exposure. Priority 5.3 Magnitude × evidence × prevalence, weighted. | |||||||
| Aluminum | Toxins | Heavy metal | 4.5 | 3.5 | 1 | LOW 3.1 | Jun 2026 |
| Avoidance breakdown Evidence 4.5 Weak-Moderate (Alzheimer's association — long proposed, not convincingly demonstrated); Strong (dialysis encephalopathy in ESRD). Mixed or limited evidence — small trials, conflicting results, or thin data. Magnitude 3.5 Low-Moderate (healthy kidneys excrete effectively). Limited harm magnitude in typical exposure. Prevalence 1 Low general; higher occupational. Limited or context-specific exposure. Priority 3.1 Magnitude × evidence × prevalence, weighted. | |||||||
| BPA / BPS / BPF (bisphenols) | Toxins | Endocrine disruptor | 6 | 5 | 3 | MODERATE 4.7 | Jun 2026 |
| Avoidance breakdown Evidence 6 Moderate (reproductive, metabolic, neurodevelopmental — mechanistically plausible, human epidemiology mixed). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 5 Med. Real but bounded harm magnitude. Prevalence 3 Low-Moderate chronic. Limited or context-specific exposure. Priority 4.7 Magnitude × evidence × prevalence, weighted. | |||||||
| Phthalates (DEHP / DBP / BBP / DEP) | Toxins | Endocrine disruptor | 7 | 6.5 | 5 | MODERATE 6.2 | Jun 2026 |
| Avoidance breakdown Evidence 7 Moderate-Strong (male reproductive tract effects — 'phthalate syndrome'); Moderate (metabolic, neurodevelopmental). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 6.5 Med-High. Significant per-exposure harm. Prevalence 5 Moderate chronic ubiquitous. Moderate exposure prevalence. Priority 6.2 Magnitude × evidence × prevalence, weighted. | |||||||
| PFAS (PFOA / PFOS / GenX) | Toxins | Endocrine disruptor | 8 | 10 | 8 | CRITICAL 8.8 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (kidney/testicular cancer, thyroid disease, immune suppression, elevated cholesterol, lower vaccine response in children). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very High (persistence). Population-level harm magnitude. Prevalence 8 High (near-universal detectable in US population). Widespread, near-universal exposure. Priority 8.8 Magnitude × evidence × prevalence, weighted. | |||||||
| PBDEs (polybrominated diphenyl ethers) | Toxins | Endocrine disruptor | 8 | 5 | 3 | MODERATE 5.3 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (thyroid disruption, neurodevelopmental effects). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5 Medium. Real but bounded harm magnitude. Prevalence 3 Low-Moderate (declining but persistent). Limited or context-specific exposure. Priority 5.3 Magnitude × evidence × prevalence, weighted. | |||||||
| Parabens (methyl / propyl / butyl) | Toxins | Endocrine disruptor | 4.5 | 3.5 | 3 | LOW 3.7 | Jun 2026 |
| Avoidance breakdown Evidence 4.5 Weak-Moderate (endocrine concerns — mechanism clear, clinical significance debated). Mixed or limited evidence — small trials, conflicting results, or thin data. Magnitude 3.5 Low-Med. Limited harm magnitude in typical exposure. Prevalence 3 Low-Moderate. Limited or context-specific exposure. Priority 3.7 Magnitude × evidence × prevalence, weighted. | |||||||
| Triclosan / triclocarban | Toxins | Endocrine disruptor | 6 | 3.5 | 3 | MODERATE 4.1 | Jun 2026 |
| Avoidance breakdown Evidence 6 Moderate (thyroid, microbiome, endocrine); Strong (no hand-washing benefit over plain soap). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 3.5 Low-Med. Limited harm magnitude in typical exposure. Prevalence 3 Declining (banned uses). Limited or context-specific exposure. Priority 4.1 Magnitude × evidence × prevalence, weighted. | |||||||
| DMAA / DMHA stimulant adulterants | Toxins | Supplement adulterant | 8 | 8 | 8 | HIGH 8 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (FDA warnings and adverse-event pattern; cardiovascular toxicity biologically plausible and documented). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High acute hazard in contaminated supplements. Population-level harm magnitude. Prevalence 8 High acute (hypertension, chest tightness, shortness of breath, heart attack risk; often undeclared). Widespread, near-universal exposure. Priority 8 Magnitude × evidence × prevalence, weighted. | |||||||
| Acrylamide (high-heat cooking) | Toxins | Cooking byproduct | 6 | 3.5 | 5 | MODERATE 4.7 | Jun 2026 |
| Avoidance breakdown Evidence 6 Moderate (animal carcinogen; human epidemiology mixed). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 3.5 Low-Med. Limited harm magnitude in typical exposure. Prevalence 5 Moderate dietary. Moderate exposure prevalence. Priority 4.7 Magnitude × evidence × prevalence, weighted. | |||||||
| Aflatoxins | Toxins | Mycotoxin | 10 | 10 | 1 | HIGH 7.3 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (hepatocellular carcinoma — synergistic with HBV); Strong (dietary exposure in developing countries). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very High in exposed regions. Population-level harm magnitude. Prevalence 1 Low in developed countries; high in parts of sub-Saharan Africa and South Asia. Limited or context-specific exposure. Priority 7.3 Magnitude × evidence × prevalence, weighted. | |||||||
| Ochratoxin A | Toxins | Mycotoxin | 6 | 3.5 | 3 | MODERATE 4.1 | Jun 2026 |
| Avoidance breakdown Evidence 6 Moderate (nephropathy — Balkan endemic nephropathy associated; animal carcinogen). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 3.5 Low-Med. Limited harm magnitude in typical exposure. Prevalence 3 Low-Moderate ubiquitous. Limited or context-specific exposure. Priority 4.1 Magnitude × evidence × prevalence, weighted. | |||||||
| Yellow oleander-adulterated weight-loss supplements | Toxins | Supplement adulterant | 8 | 8 | 10 | CRITICAL 8.6 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (FDA analytical testing and adverse-event reports). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High acute hazard where substituted/adulterated. Population-level harm magnitude. Prevalence 10 High acute (arrhythmia, severe GI/neurotoxicity, potentially fatal poisoning). Widespread, near-universal exposure. Priority 8.6 Magnitude × evidence × prevalence, weighted. | |||||||
| Glyphosate (Roundup) | Toxins | Pesticide | 3 | 5 | 3 | LOW 3.8 | Jun 2026 |
| Avoidance breakdown Evidence 3 Disputed (IARC 2A vs EPA/EFSA no carcinogenicity concern); Moderate (human non-Hodgkin lymphoma association — Zhang 2019 meta). Weak evidence — preclinical, anecdotal, or single-arm only. Magnitude 5 Moderate (disputed). Real but bounded harm magnitude. Prevalence 3 Low-Moderate (ubiquitous residue exposure). Limited or context-specific exposure. Priority 3.8 Magnitude × evidence × prevalence, weighted. | |||||||
| Organophosphate pesticides (chlorpyrifos / malathion) | Toxins | Pesticide | 8 | 8 | 8 | HIGH 8 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (acute poisoning; developmental neurotoxicity — Mt Sinai/Rauh work showed IQ deficits). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High. Population-level harm magnitude. Prevalence 8 High occupational/agricultural; moderate dietary. Widespread, near-universal exposure. Priority 8 Magnitude × evidence × prevalence, weighted. | |||||||
| Neonicotinoids (imidacloprid / clothianidin) | Toxins | Pesticide | 8 | 5 | 1 | MODERATE 4.7 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (pollinator decline — colony collapse); Weak-Moderate (human developmental concerns). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5 Varies (ecosystem vs human). Real but bounded harm magnitude. Prevalence 1 Low direct; high ecological. Limited or context-specific exposure. Priority 4.7 Magnitude × evidence × prevalence, weighted. | |||||||
| DBPs (disinfection byproducts — trihalomethanes, haloacetic acids) | Toxins | Endocrine disruptor | 6 | 3.5 | 3 | MODERATE 4.1 | Jun 2026 |
| Avoidance breakdown Evidence 6 Moderate (bladder cancer — Villanueva 2015 meta; reproductive/developmental effects). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 3.5 Low-Med. Limited harm magnitude in typical exposure. Prevalence 3 Low-Moderate ubiquitous. Limited or context-specific exposure. Priority 4.1 Magnitude × evidence × prevalence, weighted. | |||||||
| Fluoride (high-dose) | Toxins | Water contaminant | 8 | 8 | 1 | MODERATE 5.9 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (caries reduction at community-water doses); Emerging (IQ effects at high exposures — NTP 2024 monograph concluded 'with moderate confidence' that high fluoride exposure > 1.5 mg/L associated with lower IQ). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 Strong (dental); Disputed (neuro). Population-level harm magnitude. Prevalence 1 Low at community doses; higher where natural levels elevated. Limited or context-specific exposure. Priority 5.9 Magnitude × evidence × prevalence, weighted. | |||||||
| Microplastics / nanoplastics | Toxins | Water contaminant | 3 | 4 | 3 | LOW 3.4 | Jun 2026 |
| Avoidance breakdown Evidence 3 Emerging (2024 Marfella NEJM — plaque MNP presence associated with 4.5x CV events); Moderate (inflammation, endocrine effects mechanistic). Weak evidence — preclinical, anecdotal, or single-arm only. Magnitude 4 Emerging. Real but bounded harm magnitude. Prevalence 3 Low-Moderate ubiquitous. Limited or context-specific exposure. Priority 3.4 Magnitude × evidence × prevalence, weighted. | |||||||
| Tobacco smoke (direct / secondhand) | Toxins | Lifestyle exposure | 10 | 10 | 10 | CRITICAL 10 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (lung/head-neck/bladder/esophageal/pancreatic/kidney/cervical cancer; CV disease; COPD). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very Strong. Population-level harm magnitude. Prevalence 10 Very High. Widespread, near-universal exposure. Priority 10 Magnitude × evidence × prevalence, weighted. | |||||||
| Alcohol (ethanol) | Toxins | Lifestyle exposure | 10 | 10 | 5 | CRITICAL 8.5 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (7+ cancers — breast, colorectal, liver, esophagus, oral/pharyngeal; CV — 'j-curve' has largely been reanalyzed away; dementia risk). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very Strong. Population-level harm magnitude. Prevalence 5 Varies by consumption. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | |||||||
| Nitrite poppers (amyl/isobutyl nitrite products) | Toxins | Recreational inhalant | 8 | 8 | 10 | CRITICAL 8.6 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (FDA reports of deaths/hospitalizations; toxicology well-established). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High acute hazard with ingestion/inhalation. Population-level harm magnitude. Prevalence 10 Very High acute (hypotension, methemoglobinemia/hypoxemia, arrhythmia, seizure, coma, death). Widespread, near-universal exposure. Priority 8.6 Magnitude × evidence × prevalence, weighted. | |||||||
| Nitrous oxide (recreational inhalation) | Toxins | Recreational inhalant | 8 | 8 | 8 | HIGH 8 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (FDA safety alert; clinical toxicology and neurologic case series). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 High acute and chronic hazard when misused. Population-level harm magnitude. Prevalence 8 High (asphyxiation, loss of consciousness, frostbite, blood clots, B12 deficiency, neuropathy/myelopathy, psychiatric symptoms, death). Widespread, near-universal exposure. Priority 8 Magnitude × evidence × prevalence, weighted. | |||||||
| PAHs (polycyclic aromatic hydrocarbons — grilled meats, air) | Toxins | Cooking byproduct | 8 | 5 | 3 | MODERATE 5.3 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (colorectal, stomach, lung cancer associations; in utero development). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5 Moderate. Real but bounded harm magnitude. Prevalence 3 Low-Moderate dietary. Limited or context-specific exposure. Priority 5.3 Magnitude × evidence × prevalence, weighted. | |||||||
| EMF / RF exposure (cell phones, Wi-Fi) | Toxins | Lifestyle exposure | 4.5 | 4 | 3 | LOW 3.9 | Jun 2026 |
| Avoidance breakdown Evidence 4.5 Weak-Moderate (glioma in heavy cell phone users — Interphone and Hardell cohorts; vs INTERPHONE consortium mixed); Weak (sperm effects from pocket carrying). Mixed or limited evidence — small trials, conflicting results, or thin data. Magnitude 4 Weak-Moderate (disputed). Real but bounded harm magnitude. Prevalence 3 Low-Moderate chronic. Limited or context-specific exposure. Priority 3.9 Magnitude × evidence × prevalence, weighted. | |||||||
| Blue light (evening artificial light at night) | Toxins | Lifestyle exposure | 8 | 5 | 3 | MODERATE 5.3 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (circadian phase shift, sleep onset delay); Moderate (shift work CV/cancer risk — IARC 2A); Weak (direct retinal damage from consumer devices — mostly overblown). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5 Moderate. Real but bounded harm magnitude. Prevalence 3 Low-Moderate chronic. Limited or context-specific exposure. Priority 5.3 Magnitude × evidence × prevalence, weighted. | |||||||
| Sedentary behavior / sitting | Toxins | Lifestyle exposure | 10 | 10 | 10 | CRITICAL 10 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (all-cause mortality — Ekelund 2019 meta; dose-response beyond 8+ hours/day). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very Strong. Population-level harm magnitude. Prevalence 10 Very High (modern sedentary lifestyle). Widespread, near-universal exposure. Priority 10 Magnitude × evidence × prevalence, weighted. | |||||||
| Chronic sleep deprivation | Toxins | Lifestyle exposure | 10 | 10 | 10 | CRITICAL 10 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (all-cause mortality; CV; metabolic; cognitive; immune). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very Strong. Population-level harm magnitude. Prevalence 10 Very High (~35% of US adults <7 hr/night). Widespread, near-universal exposure. Priority 10 Magnitude × evidence × prevalence, weighted. | |||||||
| Chronic psychological stress | Toxins | Lifestyle exposure | 8 | 8 | 10 | CRITICAL 8.6 | Jun 2026 |
| Avoidance breakdown Evidence 8 Strong (CV mortality, depression, metabolic syndrome, infection risk, accelerated aging). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8 Strong. Population-level harm magnitude. Prevalence 10 Very High prevalence. Widespread, near-universal exposure. Priority 8.6 Magnitude × evidence × prevalence, weighted. | |||||||
| Loneliness / social isolation | Toxins | Lifestyle exposure | 10 | 10 | 10 | CRITICAL 10 | Jun 2026 |
| Avoidance breakdown Evidence 10 Very Strong (all-cause mortality — Holt-Lunstad 2010 meta; dementia risk; CV outcomes; mental health). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10 Very Strong. Population-level harm magnitude. Prevalence 10 Very High (US Surgeon General 2023 advisory declared 'epidemic'). Widespread, near-universal exposure. Priority 10 Magnitude × evidence × prevalence, weighted. | |||||||
| Amycretin (zenagamtide) | Metabolic Health | Prescription | 6 | 8 | 5 | B- 5.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 5 Med (dose-dependent GI: nausea, vomiting). Real risk — monitoring or clinician oversight matters. Composite 5.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Eloralintide | Metabolic Health | Prescription | 6 | 8 | 5 | B- 5.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2, Lancet 2025). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 5 Med (mild-moderate GI; near placebo at lower doses). Real risk — monitoring or clinician oversight matters. Composite 5.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Petrelintide (ZP8396) | Metabolic Health | Supplement | 6 | 6.5 | 5 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Med-High (~10.7% weight loss at 42 wk, Phase 2). Meaningful effect for the studied population. Safety (28%) 5 Med (dose-dependent GI: nausea ~20%, mostly mild; low GI-related discontinuation ~1.5%). Real risk — monitoring or clinician oversight matters. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Olezarsen / Plozasiran (ApoC-III inhibitors) | Metabolic Health | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (FCS approval; Phase 3 sHTG). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 5 Med (injection-site reactions; platelet monitoring). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Evinacumab / Zodasiran (ANGPTL3 inhibitors) | Metabolic Health | Prescription | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (HoFH approval); Moderate (broader indications). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (evinacumab: nasopharyngitis, infusion reactions). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| PCSK9 base editing (VERVE-102) | Metabolic Health | Supplement | 3 | 8 | 3.5 | C- 4 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Phase 1b first-in-human). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 8 High. Large effect size when the claim holds. Safety (28%) 3.5 Med-High (first-in-human gene editing; long-term off-target and durability unknown). High risk — serious side-effects at studied doses. Composite 4 0.44·Ev + 0.28·Bn + 0.28·Sf → C- | |||||||
| ER-100 (partial epigenetic reprogramming) | Longevity | Supplement | 2 | 8 | 2 | D 2.9 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (Phase 1 first-in-human dosing began Jun 2026). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 8 High (claimed; unproven in humans). Large effect size when the claim holds. Safety (28%) 2 High (first-in-human reprogramming; oncogenic/dedifferentiation risk theoretical). High risk — serious side-effects at studied doses. Composite 2.9 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| LW-1017 (TRPML1 agonist) | Cognitive | Prescription | 2 | 5 | 5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (Phase 1 first-in-human). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med (unproven in humans). Modest or context-dependent effect. Safety (28%) 5 Med (first-in-human; human safety not yet established). Real risk — monitoring or clinician oversight matters. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Censavudine / TPN-101 (LINE-1 suppression) | Longevity | Prescription | 2 | 5 | 5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical for aging (prior Phase 2 safety in PSP/ALS-FTD). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med (unproven for aging). Modest or context-dependent effect. Safety (28%) 5 Med (clinical safety established in neuro trials; aging use unproven). Real risk — monitoring or clinician oversight matters. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| Estetrol (E4) for menopause | Hormones & Endocrine | Prescription | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (Phase 3). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (estrogen-class thrombotic/breast/endometrial considerations; apparently milder than synthetic estrogens). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Pyrilutamide (KX-826) | Hormones & Endocrine | Prescription | 3 | 5 | 7 | C 4.9 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Phase 2/3; mixed results). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 7 Low-Med (topical; scalp irritation). Modest risk — manageable side-effects for most users. Composite 4.9 0.44·Ev + 0.28·Bn + 0.28·Sf → C | |||||||
| Clascoterone (Winlevi) for hair loss | Hormones & Endocrine | Prescription | 6 | 5 | 9 | B+ 7.1 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (approved for acne; AGA Phase 2). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med. Modest or context-dependent effect. Safety (28%) 9 Low (topical; local skin effects). Low risk — minimal side-effect burden in healthy adults. Composite 7.1 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Lumateperone (Caplyta) | Mood, Anxiety & Stress | Prescription | 8 | 6.5 | 5 | B 6.6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (multiple Phase 3; FDA-approved). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 5 Med (somnolence, dry mouth; metabolic effects near placebo; antipsychotic-class warnings). Real risk — monitoring or clinician oversight matters. Composite 6.6 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Olanzapine + samidorphan (Lybalvi) | Mood, Anxiety & Stress | Prescription | 8 | 6.5 | 3.5 | B- 6 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (approved; registration RCTs). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 6.5 Med-High. Meaningful effect for the studied population. Safety (28%) 3.5 Med-High (olanzapine metabolic/sedation burden only partly mitigated; antipsychotic-class warnings). High risk — serious side-effects at studied doses. Composite 6 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| SGLT2 inhibitors (canagliflozin / empagliflozin / dapagliflozin) | Longevity Metabolic Health | Prescription | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (geroprotector case: animal lifespan + senolytic mechanism); Strong (cardio-renal-metabolic outcomes in disease). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med (large mortality / heart-failure / kidney benefit in at-risk groups; healthy-aging benefit unproven). Modest or context-dependent effect. Safety (28%) 5 Med (genital/urinary infections, euglycemic ketoacidosis, volume depletion; well-characterized). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Centanafadine | Cognitive | Prescription | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (four positive Phase 3 ADHD trials; FDA NDA under priority review). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate (core ADHD symptom reduction; gains in executive function and emotional dysregulation in Phase 3 post-hoc). Modest or context-dependent effect. Safety (28%) 7 Low-Med (decreased appetite, nausea, dry mouth, headache; abuse potential expected low, non-scheduled). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Oveporexton (TAK-861) | Cognitive | Prescription | 8 | 8 | 5 | B 6.8 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (two pivotal Phase 3 trials met all endpoints; FDA NDA priority review). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 8 High (narcolepsy type 1: ~80% cataplexy reduction, large Epworth sleepiness gains; healthy/off-label wakefulness untested). Large effect size when the claim holds. Safety (28%) 5 Med (insomnia, urinary urgency/frequency; earlier orexin-agonist hepatotoxicity not seen with this agent; long-term unknown). Real risk — monitoring or clinician oversight matters. Composite 6.8 0.44·Ev + 0.28·Bn + 0.28·Sf → B | |||||||
| Viloxazine (Qelbree) | Cognitive | Prescription | 8 | 5 | 7 | B+ 7.2 | Jun 2026 |
| Score breakdown Evidence (44%) 8 Strong (FDA-approved; four Phase 3 RCTs across children, adolescents and adults). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (28%) 5 Moderate (ADHD symptom reduction; non-stimulant, generally less potent than amphetamine/methylphenidate but acts within ~1-2 weeks). Modest or context-dependent effect. Safety (28%) 7 Low-Med (somnolence, decreased appetite, headache, irritability; boxed warning for suicidal thoughts; non-scheduled, no abuse potential). Modest risk — manageable side-effects for most users. Composite 7.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B+ | |||||||
| Blarcamesine (ANAVEX 2-73) | Cognitive | Prescription | 3 | 2 | 5 | D+ 3.7 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (Phase 2b/3 AD-004 — modest, subgroup-dependent benefit; EMA recommended refusal Dec 2025). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 2 Low (cognitive/functional benefit small and inconsistent, strongest only in SIGMAR1 wild-type subgroup). Small or unclear effect even in best-case interpretation. Safety (28%) 5 Med (dizziness, confusion at higher doses; long-term safety in dementia populations not established). Real risk — monitoring or clinician oversight matters. Composite 3.7 0.44·Ev + 0.28·Bn + 0.28·Sf → D+ | |||||||
| SLU-PP-332 | Metabolic Health | Research chemical | 2 | 5 | 4 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 2 Preclinical (mouse and cell only — no human trials). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 5 Unknown in humans (mice: increased running capacity, fat loss, improved insulin sensitivity). Modest or context-dependent effect. Safety (28%) 4 Unknown (no human safety data; short half-life; sold as a gray-market research chemical with no quality control). Real risk — monitoring or clinician oversight matters. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| ACE inhibitors / ARBs (telmisartan / losartan / enalapril) | Longevity Metabolic Health | Prescription | 6 | 5 | 7 | B- 6.3 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (geroprotector case: rodent healthspan + RAAS-senescence mechanism + observational cognitive-aging data); Strong (cardiovascular/renal/mortality outcomes in disease). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Med (large mortality and organ-protective benefit in hypertension/HF/CKD; independent healthy-aging benefit plausible but unproven). Modest or context-dependent effect. Safety (28%) 7 Low-Med (ACE-inhibitor cough, hyperkalemia, hypotension, rare angioedema; teratogenic — avoid in pregnancy). Modest risk — manageable side-effects for most users. Composite 6.3 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| NDGA (nordihydroguaiaretic acid) | Longevity | Supplement | 3 | 3.5 | 3.5 | D 3.3 | Jun 2026 |
| Score breakdown Evidence (44%) 3 Weak (animal only — NIA Interventions Testing Program male-mouse lifespan extension; no human longevity data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (28%) 3.5 Low-Unknown (mouse median lifespan extension in males only across ITP cohorts; no human evidence). Small or unclear effect even in best-case interpretation. Safety (28%) 3.5 Med-High (hepatotoxicity — chaparral/creosote supplements have caused human liver failure; kidney cysts in animals). High risk — serious side-effects at studied doses. Composite 3.3 0.44·Ev + 0.28·Bn + 0.28·Sf → D | |||||||
| Enicepatide (CT388) | Metabolic Health | Prescription | 6 | 8 | 5 | B- 5.9 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2 CT388-103; Phase 3 initiated 2026). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 8 High (projected — clinically meaningful Phase 2 weight loss; full figures pending the Jun 2026 readout). Large effect size when the claim holds. Safety (28%) 5 Med (incretin-class GI: nausea, vomiting, diarrhea — dose-dependent). Real risk — monitoring or clinician oversight matters. Composite 5.9 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
| Elecoglipron (AZD5004 / ECC5004) | Metabolic Health | Prescription | 6 | 6.5 | 5 | C+ 5.7 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2 VISTA + SOLSTICE met primary endpoints; Phase 3 planned). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 6.5 Moderate-High (Phase 2 weight loss in obesity; specific figures not yet disclosed). Meaningful effect for the studied population. Safety (28%) 5 Med (incretin-class GI: nausea, vomiting, diarrhea — dose-dependent). Real risk — monitoring or clinician oversight matters. Composite 5.7 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Mazindol ER (Quilience) | Cognitive | Supplement | 6 | 5 | 5 | C+ 5.5 | Jun 2026 |
| Score breakdown Evidence (44%) 6 Moderate (Phase 2 ADHD met all endpoints; Phase 3 AMAZE in narcolepsy underway). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (28%) 5 Moderate (wakefulness + ADHD symptom control; older immediate-release mazindol was an effective anorectic/stimulant). Modest or context-dependent effect. Safety (28%) 5 Med (stimulant-class: appetite suppression, insomnia, raised BP/HR; older mazindol was a controlled anorectic, abuse potential lower than amphetamine). Real risk — monitoring or clinician oversight matters. Composite 5.5 0.44·Ev + 0.28·Bn + 0.28·Sf → C+ | |||||||
| Sarcosine (N-methylglycine) | Cognitive | Prescription | 4.5 | 3.5 | 9 | B- 6.2 | Jun 2026 |
| Score breakdown Evidence (44%) 4.5 Weak-Moderate (small RCTs for schizophrenia negative symptoms and depression; no cognitive-enhancement RCT in healthy people). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (28%) 3.5 Low-Moderate (adjunct benefit on schizophrenia negative symptoms and depression in small trials; healthy-user nootropic effect unproven). Small or unclear effect even in best-case interpretation. Safety (28%) 9 Low (generally well tolerated, mild GI; theoretical caution as an NMDA modulator in psychosis). Low risk — minimal side-effect burden in healthy adults. Composite 6.2 0.44·Ev + 0.28·Bn + 0.28·Sf → B- | |||||||
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