Living database · Updated biweekly
Protocol & Compound Index
Every compound and protocol we've reviewed, graded by evidence quality. Updated with each issue. Click any row for dosing detail.
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, Access = n/a.
| Compound | Category | Class | Evidence | Benefit | Safety | Access | Grade · Score | Updated |
|---|---|---|---|---|---|---|---|---|
| Sleep | Base | Lifestyle | 8.0 | 8.0 | 9.0 | 9.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 9.0 Low (deprivation is high risk). Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A (free). Easy access — over-the-counter or freely available. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Balanced diet (Mediterranean) | Base | Lifestyle | 8.0 | 8.0 | 9.0 | 9.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A (free). Easy access — over-the-counter or freely available. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Protein intake | Base | Macronutrient | 8.0 | 8.0 | 9.0 | 9.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 9.0 Low (high intake safe in healthy kidneys). Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A (dietary). Easy access — over-the-counter or freely available. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Hydration / electrolytes | Base | Lifestyle | 8.0 | 8.0 | 9.0 | 9.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 9.0 Low (overhydration risk at extremes). Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A (free). Easy access — over-the-counter or freely available. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Vitamin D | Base | Vitamin | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (strong for deficiency correction; mixed for supplementation in replete individuals). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med (High if deficient). Modest or context-dependent effect. Safety (25%) 9.0 Low (toxicity only at very high doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Vitamin K2 (MK-7) | Base | Vitamin | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (avoid with warfarin). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| B vitamins (B-complex) | Base | Vitamin | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (for deficiency/homocysteine); Weak (for CVD outcomes in replete people). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med (High in deficient or MTHFR variants). Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Magnesium | Base | Mineral | 8.0 | 6.5 | 9.0 | 10.0 | A- 8.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (for deficiency; BP; T2D markers). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 9.0 Low (diarrhea at high oral doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Zinc | Base | Mineral | 8.0 | 5.0 | 7.0 | 10.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (immune, cold duration); Moderate (reproductive, skin). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (chronic high doses cause copper deficiency). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Iodine | Base | Mineral | 8.0 | 8.0 | 7.0 | 10.0 | A- 8.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (for deficiency prevention). Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (excess causes thyroid dysfunction). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Selenium | Base | Mineral | 8.0 | 5.0 | 7.0 | 10.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (deficiency); Mixed (supplementation in replete). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med (High if deficient). Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (narrow therapeutic window; selenosis at high doses). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Boron | Base | Mineral | 4.0 | 3.5 | 9.0 | 10.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 4.0 Preclinical-Moderate. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 3.5 Low-Med (Varies). Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Iron | Base | Mineral | 8.0 | 8.0 | 3.5 | 10.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (for deficiency). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (if deficient); None (if replete). Large effect size when the claim holds. Safety (25%) 3.5 Med-High (excess is pro-oxidant; hemochromatosis concern). High risk — serious side-effects at studied doses. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Omega-3 (EPA/DHA) | Base | Supplement | 8.0 | 6.5 | 7.0 | 10.0 | A- 7.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (meta-analyses); Mixed (individual RCTs). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 7.0 Low-Med (AFib signal at high doses; bleeding risk with anticoagulants). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC (Rx forms for severe HTG). Easy access — over-the-counter or freely available. Composite 7.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Creatine | Base | Supplement | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (strength/lean mass). Large effect size when the claim holds. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| CoQ10 (ubiquinone/ubiquinol) | Base | Supplement | 8.0 | 6.5 | 9.0 | 10.0 | A- 8.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (heart failure); Moderate (statin myopathy); Weak (general population). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High (in HF); Varies otherwise. Meaningful effect for the studied population. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| NAC (N-acetyl cysteine) | Base | Supplement | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (acetaminophen toxicity, COPD); Moderate (psychiatric — OCD, trichotillomania, bipolar adjunct). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (FDA position fluctuated; now widely sold). Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Choline | Base | Macronutrient Nutrient | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (essential nutrient; deficiency causes liver disease). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (fishy body odor and low BP at very high doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Taurine | Base | Supplement | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (CV/metabolic markers); Preclinical (longevity — contested in humans). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Fiber / psyllium husk | Base | Macronutrient Nutrient | 8.0 | 8.0 | 9.0 | 5.0 | A- 8.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 9.0 Low (gas/bloating; obstruction risk without adequate fluids). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 OTC / dietary. Cash-pay, off-label, or jurisdiction-dependent access. Composite 8.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Collagen peptides | Base | Supplement | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (skin elasticity/hydration; joint pain); Weak (overall body composition). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med (skin/joint) / Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Ashwagandha (Withania somnifera) | Base | Supplement Adaptogen | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (short-term stress/anxiety); Moderate (sleep, testosterone in stressed men). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare hepatotoxicity reports; avoid in thyroid disorders and pregnancy). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Sauna (Finnish/dry) | Protocols Longevity CV/Lipid Recovery | Protocol · Thermal | 8.0 | 8.0 | 7.0 | 9.0 | A- 7.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (observational — Finnish cohort data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (dehydration; caution in severe CV disease and pregnancy). Modest risk — manageable side-effects for most users. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 7.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Cold plunge / cold water immersion | Protocols Mental Health Recovery | Protocol · Thermal | 6.0 | 5.0 | 5.0 | 9.0 | B- 5.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (mood, recovery, BAT); Weak (weight loss, longevity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med (Varies by outcome). Modest or context-dependent effect. Safety (25%) 5.0 Med (cardiac stress in vulnerable populations; cold shock drowning risk). Real risk — monitoring or clinician oversight matters. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 5.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Contrast therapy (hot/cold) | Protocols Recovery | Protocol · Thermal | 6.0 | 5.0 | 7.0 | 9.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (recovery); Preclinical-Moderate otherwise. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med / Varies. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med. Modest risk — manageable side-effects for most users. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Red light therapy / photobiomodulation (PBM) | Protocols Skin/Hair Recovery | Protocol · Light | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (skin, hair, wound healing, pain); Preclinical (cognition, mitochondrial effects). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med (skin/hair) / Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (devices). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Sunlight / circadian light exposure | Protocols Sleep Mental Health Longevity | Protocol · Light | 8.0 | 8.0 | 7.0 | 9.0 | A- 7.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (circadian/mood/vitamin D); Moderate (cardiovascular via skin NO). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (skin cancer risk at high cumulative UV). Modest risk — manageable side-effects for most users. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 7.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Hyperbaric oxygen therapy (HBOT) | Protocols Recovery Longevity | Protocol · Oxygen/Pressure | 6.0 | 5.0 | 5.0 | 3.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (wound healing — approved indication; Hachmo telomere/senescence data); Preclinical otherwise. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med / Varies. Modest or context-dependent effect. Safety (25%) 5.0 Med (barotrauma, oxygen toxicity, fire risk). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Available at specialty clinics. Investigational, research-only, or controlled. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Breathwork (structured breathing) | Protocols Mental Health Recovery | Protocol · Autonomic | 6.0 | 3.5 | 9.0 | 9.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (anxiety, HRV, mood); Weak-Moderate (performance). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (hyperventilation risk with Wim Hof near water). Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Altitude training / intermittent hypoxia (IHT) | Protocols Longevity CV/Lipid | Protocol · Oxygen/Pressure | 8.0 | 5.0 | 7.0 | 9.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (athletic performance — endurance); Preclinical (longevity/metabolic). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med (athletics) / Varies. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (altitude sickness; contraindicated in severe CV/pulmonary disease). Modest risk — manageable side-effects for most users. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Resistance training | Protocols Longevity Muscle Building CV/Lipid | Protocol · Movement | 8.0 | 8.0 | 9.0 | 9.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Zone 2 cardio | Protocols Longevity CV/Lipid Weight loss | Protocol · Movement | 6.0 | 6.5 | 9.0 | 9.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (mitochondrial; performance); Strong indirectly via CRF/VO2 max mortality data. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| VO2 max / HIIT | Protocols Longevity CV/Lipid | Protocol · Movement | 8.0 | 8.0 | 7.0 | 9.0 | A- 7.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (CRF-mortality link). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (caution in symptomatic CV disease). Modest risk — manageable side-effects for most users. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 7.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Blood flow restriction (BFR) training | Protocols Muscle Building Recovery | Protocol · Movement | 8.0 | 8.0 | 7.0 | 10.0 | A- 8.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (muscle hypertrophy at low loads); Moderate (older/rehab populations). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (niche use case). Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (properly set cuffs; risk of bruising; caution in clotting disorders). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC (devices). Easy access — over-the-counter or freely available. Composite 8.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Mobility work / flexibility training | Protocols Recovery | Protocol · Movement | 6.0 | 3.5 | 9.0 | 9.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (injury prevention mixed); Strong (pain/function in older adults). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Intermittent fasting (general) | Protocols Longevity Weight loss | Protocol · Fasting | 6.0 | 5.0 | 7.0 | 9.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (concerns in eating disorders, pregnancy, T1DM). Modest risk — manageable side-effects for most users. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Extended fasting (24-72h+) | Protocols Longevity Weight loss | Protocol · Fasting | 4.0 | 5.0 | 5.0 | 9.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 4.0 Moderate-Preclinical. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 5.0 Med (refeeding syndrome after longer fasts; electrolyte monitoring; muscle loss). Real risk — monitoring or clinician oversight matters. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Time-restricted eating (TRE) | Protocols Longevity Sleep Weight loss | Protocol · Fasting | 6.0 | 5.0 | 9.0 | 9.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (metabolic markers); Mixed (weight loss vs isocaloric control). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Circadian-aligned eating | Protocols Longevity Sleep | Protocol · Fasting | 6.0 | 5.0 | 9.0 | 9.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Fasting-mimicking diet (FMD / ProLon) | Protocols Longevity Weight loss | Protocol · Fasting | 6.0 | 5.0 | 7.0 | 5.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med. Modest risk — manageable side-effects for most users. Access (10%) 5.0 Commercial (ProLon) or DIY. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| PEMF therapy (pulsed electromagnetic field) | Protocols Recovery | Protocol · Other | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (bone non-union — FDA approved); Weak-Preclinical (general wellness). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med / Varies. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (devices). Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Grounding / earthing | Protocols | Protocol · Other | 2.5 | 2.0 | 9.0 | 9.0 | C 4.7 | Apr 2026 |
| Score breakdown Evidence (40%) 2.5 Preclinical-Weak. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 2.0 Low / Varies. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 4.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Meditation / mindfulness | Protocols Mental Health Longevity | Protocol · Other | 8.0 | 6.5 | 9.0 | 9.0 | A- 8.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (anxiety, depression, stress); Moderate (chronic pain, BP, cognition). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 9.0 N/A. Easy access — over-the-counter or freely available. Composite 8.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| HRV-guided training / biofeedback | Protocols Recovery | Protocol · Other | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (performance and recovery); Strong (HRV itself as health biomarker). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med / Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (devices: Oura, Whoop, Garmin, HeartMath). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Semaglutide | Weight loss | Prescription GLP-1 agonist | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 5.0 Med. Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Tirzepatide | Weight loss | Prescription GLP-1/GIP agonist (dual) | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (most effective approved weight loss drug). Large effect size when the claim holds. Safety (25%) 5.0 Med. Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Liraglutide | Weight loss | Prescription GLP-1 agonist | 8.0 | 6.5 | 5.0 | 6.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 5.0 Med. Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Dulaglutide | Weight loss | Prescription GLP-1 agonist | 8.0 | 5.0 | 5.0 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (T2D and CV outcomes); Moderate (as pure weight loss agent). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med. Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Retatrutide | Weight loss | Prescription GLP-1/GIP/glucagon agonist (triple) | 8.0 | 10.0 | 5.0 | 4.0 | B+ 7.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong Phase 2; Phase 3 TRIUMPH program ongoing — readouts expected 2026-2027. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very High (projected 22-24%). Large effect size when the claim holds. Safety (25%) 5.0 Med (awaiting larger safety data). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational (Phase 3). Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Cagrilintide | Weight loss | Supplement Amylin analog | 8.0 | 8.0 | 5.0 | 4.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Ph3 readouts 2025: REDEFINE 1 & 2 published NEJM). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (CagriSema -20.4% in REDEFINE 1; cagrilintide monotherapy -11.5%). Large effect size when the claim holds. Safety (25%) 5.0 Med (similar GI profile to semaglutide; nausea/vomiting/diarrhea common). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational; CagriSema combination filed for approval 2025. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Tesofensine | Weight loss | Prescription Triple monoamine reuptake inhibitor | 6.0 | 8.0 | 5.0 | 4.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (Phase 2; Phase 3 ongoing). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 5.0 Med (BP, HR elevation, insomnia, dry mouth; psychiatric risk). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational (available via some specialty clinics). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Orlistat | Weight loss | Prescription Lipase inhibitor | 8.0 | 3.5 | 7.0 | 10.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 3.5 Low-Med (~3-5 kg above placebo). Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 Low-Med (GI side effects are severe and common; fat-soluble vitamin malabsorption). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC (Alli) / Rx (Xenical). Easy access — over-the-counter or freely available. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Phentermine | Weight loss | Prescription Sympathomimetic | 8.0 | 6.5 | 3.5 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (short-term). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 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. Access (10%) 6.0 Rx (Schedule IV). Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Contrave (bupropion + naltrexone) | Weight loss | Prescription Combination | 8.0 | 5.0 | 5.0 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med (~4-5% weight loss above placebo). Modest or context-dependent effect. Safety (25%) 5.0 Med (seizure risk with bupropion; BP/HR; contraindicated in uncontrolled HTN or seizures). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Setmelanotide | Weight loss | Prescription MC4R agonist | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (in specific genetic indications). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (in genetic obesity); N/A (general obesity). Large effect size when the claim holds. Safety (25%) 5.0 Med (injection site reaction, hyperpigmentation, nausea). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (restricted use). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Pramlintide | Weight loss | Prescription Amylin analog (short-acting) | 8.0 | 3.5 | 5.0 | 6.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (in T2D adjunct); Moderate (weight loss). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 5.0 Med (nausea very common; severe hypoglycemia if used with insulin). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Topiramate | Weight loss | Prescription Anticonvulsant | 8.0 | 5.0 | 3.5 | 6.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (as weight loss agent and combo Qsymia). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med (~6-10% with combo). Modest or context-dependent effect. Safety (25%) 3.5 Med-High (cognitive slowing, paresthesias, kidney stones, teratogenic cleft palate). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx. Standard prescription channel. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Bimagrumab | Weight loss | Prescription Activin receptor antagonist | 6.0 | 6.5 | 5.0 | 4.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (Phase 2 in T2D obesity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 6.5 Moderate-High (unique for preserving/increasing lean mass while losing fat). Meaningful effect for the studied population. Safety (25%) 5.0 Med (minor pancreatitis signal; acne, muscle cramps). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Naltrexone (low dose, LDN) | Weight loss | Prescription Opioid antagonist | 3.0 | 2.0 | 9.0 | 6.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (weight loss); Moderate (chronic pain, fibromyalgia, autoimmune symptoms). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 2.0 Low (for weight loss as standalone). Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (off-label; compounded). Standard prescription channel. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Clenbuterol | Weight loss | Prescription Beta-2 agonist | 8.0 | 8.0 | 2.0 | 5.0 | B- 6.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (in animals/livestock); Moderate (illicit human use — anecdotal). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (acute fat loss) / Varies. Large effect size when the claim holds. Safety (25%) 2.0 High (cardiac hypertrophy, arrhythmias, tremor, insomnia, hypokalemia; reports of cardiac arrest). High risk — serious side-effects at studied doses. Access (10%) 5.0 Not approved in US for human use; Rx elsewhere for asthma; banned in sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| T3 (for fat loss) | Weight loss | Hormone Thyroid hormone | 8.0 | 6.5 | 2.0 | 6.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (for hypothyroidism); Moderate (as performance-enhancing fat loss in euthyroid individuals). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 2.0 High (cardiac arrhythmias, bone loss, muscle catabolism, iatrogenic hyperthyroidism). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx (Cytomel); illicit for performance use. Standard prescription channel. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| DNP (2,4-dinitrophenol) | Weight loss | Prescription Mitochondrial uncoupler | 8.0 | 10.0 | 0.0 | 5.0 | B- 6.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (for fat loss); Strong (for lethality). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very High (fat loss) / High (acute harm). Large effect size when the claim holds. Safety (25%) 0.0 Very High (fatal hyperthermia — core temp can rise uncontrollably; cataracts, hepatotoxicity; MULTIPLE DEATHS every year). Severe risk — fatal-potential or unacceptable harm profile. Access (10%) 5.0 Illegal for human consumption (banned by FDA 1938). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Yohimbine | Weight loss | Prescription Alpha-2 antagonist | 6.0 | 3.5 | 5.0 | 10.0 | C+ 5.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (stubborn fat in lean individuals); Moderate (ED). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 5.0 Med (anxiety, palpitations, BP elevation; dangerous with MAOIs or TCAs). Real risk — monitoring or clinician oversight matters. Access (10%) 10.0 OTC (US) / Rx elsewhere. Easy access — over-the-counter or freely available. Composite 5.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| CLA (conjugated linoleic acid) | Weight loss | Supplement Fatty acid | 4.5 | 2.0 | 7.0 | 10.0 | C 5.1 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 2.0 Low. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 Low-Med (insulin resistance and fatty liver signals at high doses). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Orforglipron | Weight loss | Prescription Oral GLP-1 agonist (small molecule) | 8.0 | 8.0 | 5.0 | 4.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Ph3 ATTAIN-1, ATTAIN-2, ACHIEVE-3 read out 2025). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (10-12% weight loss at 36 mg). Large effect size when the claim holds. Safety (25%) 5.0 Med (GI: nausea/vomiting/diarrhea; non-dose-dependent HR increase; small mild pancreatitis signal — 5 cases in ATTAIN-1). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational (FDA filing expected 2025-2026). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Survodutide | Weight loss | Prescription GLP-1/glucagon agonist (dual) | 8.0 | 8.0 | 5.0 | 4.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong Phase 2; Phase 3 SYNCHRONIZE program ongoing. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (projected from Phase 2). Large effect size when the claim holds. Safety (25%) 5.0 Med (similar GI profile to GLP-1 class; no unexpected signals to date). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational (Phase 3). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Maridebart cafraglutide (MariTide) | Weight loss | Prescription GLP-1 agonist + GIP antagonist | 8.0 | 8.0 | 5.0 | 4.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong Phase 2 (NEJM 2025); Phase 3 enrolling. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 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 (25%) 5.0 Med (GI events common but mitigated by dose escalation). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Investigational (Phase 3). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Mazdutide (IBI362) | Weight loss | Prescription GLP-1/glucagon agonist (dual) | 8.0 | 8.0 | 5.0 | 5.0 | B+ 7.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 High (~16-18% weight loss at 32-48 wk in Chinese trials). Large effect size when the claim holds. Safety (25%) 5.0 Med (similar GI profile to GLP-1 class). Real risk — monitoring or clinician oversight matters. Access (10%) 5.0 Approved in China (June 2025) for chronic weight management; FDA filing TBD. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| NAD+ / NMN / NR | Longevity | Supplement NAD+ precursor | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (raises NAD+ reliably); Weak (functional/outcome endpoints). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Rapamycin (sirolimus) | Longevity | Prescription mTOR inhibitor | 4.5 | 6.5 | 5.0 | 6.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 6.5 Med-High (projected from animal data). Meaningful effect for the studied population. Safety (25%) 5.0 Med (immunosuppression, mouth sores, hyperlipidemia, insulin resistance, wound healing impairment). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (off-label for longevity). Standard prescription channel. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Metformin | Longevity | Prescription Biguanide | 8.0 | 5.0 | 7.0 | 6.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (in T2D); Moderate observationally (non-diabetics); Preclinical (pure anti-aging). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 7.0 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. Access (10%) 6.0 Rx (off-label for longevity). Standard prescription channel. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Acarbose | Longevity | Prescription Alpha-glucosidase inhibitor | 6.0 | 5.0 | 7.0 | 6.0 | B- 6.0 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (human glycemic control); Strong (rodent lifespan especially in males). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med (Varies by gender). Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (GI flatulence is common). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (T2D); often OTC outside US. Standard prescription channel. Composite 6.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Senolytics (D+Q combo) | Longevity | Prescription Senolytic | 6.0 | 5.0 | 5.0 | 6.0 | C+ 5.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (human IPF, DKD — condition-specific improvements); Strong (preclinical). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 5.0 Med (dasatinib has oncology side effect profile: GI, hematologic; intermittent dosing mitigates). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (dasatinib is oncology drug — off-label use). Standard prescription channel. Composite 5.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Fisetin | Longevity | Supplement Senolytic / polyphenol | 4.0 | 5.0 | 9.0 | 10.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 4.0 Preclinical-Moderate (currently in Mayo Clinic Phase 2 trials). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Quercetin | Longevity | Supplement Flavonoid / mild senolytic | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (allergy, BP, exercise endurance); Weak-Moderate as standalone senolytic. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (low oral bioavailability is main limitation). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Spermidine | Longevity | Supplement Polyamine (autophagy inducer) | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (wheat germ extract; synthetic). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Resveratrol | Longevity | Supplement Polyphenol | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Pterostilbene | Longevity | Supplement Polyphenol | 2.5 | 3.5 | 7.0 | 10.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 2.5 Weak-Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med / Varies. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 Low-Med (LDL elevation reported). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Urolithin A | Longevity | Supplement Mitophagy inducer | 6.0 | 6.5 | 9.0 | 10.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (human trials — muscle, immune, biomarkers). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (Mitopure/Timeline). Easy access — over-the-counter or freely available. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| GHK-Cu (copper peptide) | Longevity | Peptide | 6.0 | 6.5 | 9.0 | 10.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (topical for skin); Preclinical-Anecdotal (systemic). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 6.5 Med-High (skin) / Varies. Meaningful effect for the studied population. Safety (25%) 9.0 Low (topical); Med (injected — less studied in humans). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (topical) / Research chemical (injectable). Easy access — over-the-counter or freely available. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Alpha-ketoglutarate (Ca-AKG) | Longevity | Supplement TCA cycle intermediate | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (animal lifespan; observational biomarker studies). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (Rejuvant). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Glycine + NAC (GlyNAC) | Longevity | Supplement Amino acid combo | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Sulforaphane | Longevity | Supplement Nrf2 activator | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (broccoli sprout extract). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Astaxanthin | Longevity | Herbal Carotenoid / antioxidant | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (skin, exercise, cardiovascular markers). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (microalgae-derived). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Berberine | Longevity | Supplement AMPK activator | 6.0 | 5.0 | 7.0 | 10.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (GI upset; potential CYP3A4 drug interactions). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Lithium (microdose) | Longevity | Supplement Alkali metal (trace) | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (mental health, suicide reduction at higher doses); Preclinical-Moderate (longevity at microdoses). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (at microdose); Med-High (at psych doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (lithium orotate); Rx (carbonate). Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Epithalon (epitalon) | Longevity | Peptide Pineal peptide bioregulator | 2.0 | 5.0 | 9.0 | 3.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical; Weak human (Russian clinical tradition). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chemical. Investigational, research-only, or controlled. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Thymalin | Longevity | Peptide Thymic peptide bioregulator | 2.0 | 5.0 | 9.0 | 3.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical; Weak human (Russian clinical tradition). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chemical. Investigational, research-only, or controlled. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| MOTS-c | Longevity | Peptide Mitochondrial-derived peptide | 2.5 | 5.0 | 9.0 | 3.0 | C 4.8 | Apr 2026 |
| Score breakdown Evidence (40%) 2.5 Preclinical-Weak human. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (from limited data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chemical. Investigational, research-only, or controlled. Composite 4.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Humanin | Longevity | Peptide Mitochondrial-derived peptide | 2.0 | 5.0 | 9.0 | 3.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown / Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (limited safety data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chemical. Investigational, research-only, or controlled. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Klotho | Longevity | Supplement Anti-aging protein | 2.0 | 5.0 | 5.0 | 4.0 | D+ 3.7 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies (unknown clinically). Modest or context-dependent effect. Safety (25%) 5.0 Med (limited human data on exogenous administration). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Experimental. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| GDF11 | Longevity | Supplement Circulating factor | 2.0 | 5.0 | 5.0 | 4.0 | D+ 3.7 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (mixed/contested). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies (unknown). Modest or context-dependent effect. Safety (25%) 5.0 Med (limited safety data; growth factor concerns). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Experimental. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| SS-31 (elamipretide) | Longevity | Peptide Mitochondrial peptide | 6.0 | 5.0 | 9.0 | 4.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (mitochondrial disease and heart failure trials). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate (in mitochondrial diseases). Modest or context-dependent effect. Safety (25%) 9.0 Low (injection site reactions most common). Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Investigational (Stealth BioTherapeutics). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Ergothioneine | Longevity | Herbal Fungal amino acid | 3.0 | 5.0 | 9.0 | 10.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Observational (low blood levels linked to cognitive decline and mortality); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| 17-alpha estradiol | Longevity | Research chemical Non-feminizing estrogen | 2.0 | 5.0 | 7.0 | 3.0 | C- 4.1 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (strong male mouse lifespan in ITP). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (limited human safety data). Modest risk — manageable side-effects for most users. Access (10%) 3.0 Research chemical / compounded. Investigational, research-only, or controlled. Composite 4.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| C60 (carbon 60 / buckminsterfullerene) | Longevity | Research chemical Fullerene / antioxidant | 3.0 | 2.0 | 4.0 | 3.0 | D 3.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (single controversial rat study). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 2.0 Low / Varies. Small or unclear effect even in best-case interpretation. Safety (25%) 4.0 Unknown (long-term safety untested). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chemical / OTC. Investigational, research-only, or controlled. Composite 3.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D | ||||||||
| Hydrogen water / molecular hydrogen (H2) | Longevity | Supplement Antioxidant gas | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (exercise, metabolic syndrome, mild cognitive markers). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (tablets, water generators). Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Plasma exchange / young plasma | Longevity | Supplement Dilutional therapeutic | 2.0 | 5.0 | 3.5 | 5.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (Conboy); Very early human (Ambrosia flagged by FDA). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 3.5 Med-High (infection, immune, cost). High risk — serious side-effects at studied doses. Access (10%) 5.0 Research/clinical setting. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Yamanaka factors / partial reprogramming | Longevity | Supplement Epigenetic reprogramming | 2.0 | 5.0 | 3.5 | 5.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (mouse rejuvenation in tissue/organ contexts). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies (unknown). Modest or context-dependent effect. Safety (25%) 3.5 Med-High (cancer/teratoma risk; adventitial cell dedifferentiation). High risk — serious side-effects at studied doses. Access (10%) 5.0 Research only. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Pyrroloquinoline quinone (PQQ) | Longevity | Prescription Mitochondrial biogenesis cofactor | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 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 (25%) 9.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Adderall (amphetamine salts) | Cognitive | Prescription Prescription stimulant | 8.0 | 6.5 | 2.0 | 6.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (ADHD); Moderate (cognitive enhancement — small effect in healthy). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 2.0 High (addiction/dependence potential; BP/HR; anxiety; Schedule II). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx (Schedule II). Standard prescription channel. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Vyvanse (lisdexamfetamine) | Cognitive | Prescription Prescription stimulant | 8.0 | 6.5 | 3.5 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (ADHD; also approved for BED). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 3.5 Med-High (similar to Adderall; lower abuse potential due to prodrug). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx (Schedule II). Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Semax | Cognitive | Peptide Russian peptide | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Russian clinical tradition); Preclinical (strong). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported; limited Western safety data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chemical (Russia Rx). Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Selank | Cognitive | Peptide Russian peptide | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Russian clinical tradition); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chemical (Russia Rx). Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Cerebrolysin | Cognitive | Peptide Neurotrophic peptide mix | 6.0 | 5.0 | 7.0 | 6.0 | B- 6.0 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (acute stroke; vascular dementia); Weak-Moderate (other cognitive indications). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (injection site reactions; rare hypersensitivity). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (EU, Asia, Russia); Not approved in US. Standard prescription channel. Composite 6.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Selegiline (L-deprenyl) | Cognitive | Prescription MAO-B inhibitor | 6.0 | 3.5 | 5.0 | 6.0 | C 5.1 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (Parkinson's disease); Weak-Moderate (longevity/cognitive in healthy). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 5.0 Med (hypotension; insomnia; serotonin syndrome with SSRIs; tyramine reaction at higher doses). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 5.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| L-theanine | Cognitive | Supplement Amino acid (tea-derived) | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (acute attention/calm; combined with caffeine). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| L-tyrosine | Cognitive | Supplement Amino acid | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (acute stress/cold/sleep deprivation performance); Weak (healthy baseline enhancement). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Varies (context-dependent). Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Caffeine | Cognitive | Supplement Methylxanthine / adenosine antagonist | 8.0 | 8.0 | 7.0 | 5.0 | B+ 7.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (acute alertness, attention, reaction time). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (dependence; sleep disruption; anxiety; AF at high doses). Modest risk — manageable side-effects for most users. Access (10%) 5.0 OTC / dietary. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Rhodiola rosea | Cognitive | Herbal Adaptogen | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (fatigue, burnout, mild depression, exercise recovery). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (generally well-tolerated). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Piracetam | Cognitive | Research chemical Racetam | 4.5 | 5.0 | 9.0 | 4.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate (cognitive impairment; cortical myoclonus); Inconclusive (healthy enhancement). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Rx in EU; unscheduled research chem in US (not FDA-approved). Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Aniracetam | Cognitive | Research chemical Racetam | 3.0 | 5.0 | 9.0 | 5.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (anxiolytic/cognitive — mostly older European trials); Preclinical (robust). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 Rx in some EU countries; research chem in US. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Oxiracetam | Cognitive | Research chemical Racetam | 4.5 | 5.0 | 9.0 | 5.0 | B- 5.8 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate (vascular dementia — Italian trials); Preclinical. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 Rx in Italy/China; research chem in US. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Phenylpiracetam (Phenotropil) | Cognitive | Research chemical Racetam | 6.0 | 5.0 | 7.0 | 4.0 | B- 5.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (Russian stroke/asthenia trials); Weak (Western data). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (tolerance develops rapidly; mild stimulant effects). Modest risk — manageable side-effects for most users. Access (10%) 4.0 Rx in Russia; WADA-banned in competition; research chem elsewhere. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Pramiracetam | Cognitive | Research chemical Racetam | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (TBI/Alzheimer's — limited older data); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chem in US. Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Fasoracetam | Cognitive | Research chemical Racetam | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Aevi/Supernus adolescent ADHD Ph2 — mixed results; discontinued Ph3). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (reported in trials). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chem; formerly investigational drug. Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Coluracetam (MKC-231) | Cognitive | Research chemical Racetam | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small BioLineRx MDD Ph2a — discontinued); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (limited data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chem. Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Modafinil | Cognitive | Prescription Wakefulness-promoting | 8.0 | 6.5 | 7.0 | 6.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 7.0 Low-Med (headache, insomnia, rare but serious SJS/TEN; mild dependence potential). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (Schedule IV US). Standard prescription channel. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Armodafinil | Cognitive | Prescription Wakefulness-promoting | 8.0 | 6.5 | 7.0 | 6.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (narcolepsy, shift-work disorder, OSA); Moderate (cognitive). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 7.0 Low-Med (similar profile to modafinil). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (Schedule IV US). Standard prescription channel. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Solriamfetol (Sunosi) | Cognitive | Prescription DNRI / wakefulness-promoting | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (narcolepsy, OSA — TONES Phase 3 program). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong (improves Maintenance of Wakefulness Test by 9-13 minutes). Large effect size when the claim holds. Safety (25%) 5.0 Med (headache, anxiety, BP/HR elevation, decreased appetite; abuse potential — Schedule IV). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (Schedule IV US). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Pitolisant (Wakix) | Cognitive | Prescription H3 receptor inverse agonist | 8.0 | 6.5 | 7.0 | 6.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (narcolepsy with cataplexy — HARMONY trials; OSA daytime sleepiness). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Moderate-Strong. Meaningful effect for the studied population. Safety (25%) 7.0 Low-Med (headache, insomnia, nausea, anxiety; QT prolongation requires baseline ECG; not Schedule classed). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (NOT scheduled — unique among wakefulness drugs). Standard prescription channel. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Guanfacine | Cognitive | Prescription Alpha-2A agonist | 8.0 | 5.0 | 7.0 | 6.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (ADHD, especially with PFC deficits); Moderate (anxiety, tic disorders). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (hypotension, sedation, dry mouth). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Atomoxetine | Cognitive | Prescription Selective NRI | 8.0 | 5.0 | 5.0 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (ADHD — slower onset and smaller effect than stimulants). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (hepatotoxicity warning, cardiovascular effects, suicidal ideation in youth). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Bromantane (Ladasten) | Cognitive | Research chemical Russian psychostimulant/adaptogen | 3.0 | 5.0 | 9.0 | 4.0 | C 5.1 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Russian asthenia trials). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (Russian data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Rx in Russia; research chem elsewhere; banned by WADA. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Noopept (GVS-111) | Cognitive | Peptide Peptide-like | 3.0 | 5.0 | 9.0 | 4.0 | C 5.1 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Russian MCI trials); Preclinical (robust). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (Russian data); unknown long-term. Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Rx in Russia; research chem elsewhere. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| P21 peptide | Cognitive | Peptide Peptide (CNTF analog) | 2.0 | 5.0 | 4.0 | 3.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical only (Iqbal lab mouse work). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (no human safety data). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chem. Investigational, research-only, or controlled. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| DSIP (delta sleep-inducing peptide) | Cognitive | Peptide Neuropeptide | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (inconsistent Russian sleep/alcoholism data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (limited data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research peptide. Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Sunifiram (DM-235) | Cognitive | Research chemical Ampakine-like | 2.0 | 5.0 | 4.0 | 3.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical only. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (no human safety; seizure risk plausible from AMPA PAM activity). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chem; banned in some countries. Investigational, research-only, or controlled. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| IDRA-21 | Cognitive | Research chemical Ampakine | 2.0 | 5.0 | 4.0 | 3.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical only. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (no human safety; AMPA seizure risk concern). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chem. Investigational, research-only, or controlled. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| PRL-8-53 | Cognitive | Research chemical Obscure nootropic | 2.0 | 5.0 | 4.0 | 3.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Very Weak (single 1978 Hansl human trial, n=47). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (essentially no safety data). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chem. Investigational, research-only, or controlled. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Alpha-GPC (alpha-glycerophosphocholine) | Cognitive | Supplement Choline precursor | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (possible GI/headache); emerging observational signal for stroke risk (inconsistent). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (US); Rx in some EU countries. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| CDP-choline (citicoline) | Cognitive | Prescription Choline precursor / membrane substrate | 6.0 | 5.0 | 9.0 | 4.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (very well-tolerated). Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Rx in EU, Asia; OTC in US. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Choline bitartrate | Cognitive | Supplement Choline precursor | 3.0 | 2.0 | 9.0 | 5.0 | C- 4.5 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (not well-studied for cognition specifically); essential nutrient. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 2.0 Low. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (fishy body odor at high doses due to TMA). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 OTC / dietary. Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Huperzine A | Cognitive | Prescription AChE inhibitor (natural) | 6.0 | 5.0 | 7.0 | 5.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (Chinese Alzheimer's and MCI trials); Preclinical (robust). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (cholinergic effects: GI upset, cramping, vivid dreams; bradycardia at high doses). Modest risk — manageable side-effects for most users. Access (10%) 5.0 OTC in US; Rx in China. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Bacopa monnieri | Cognitive | Herbal Ayurvedic adaptogen | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (memory consolidation, learning — multiple RCTs in older adults and children). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (GI upset common; rare sedation). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Lion's mane (Hericium erinaceus) | Cognitive | Herbal Medicinal mushroom | 4.5 | 5.0 | 9.0 | 10.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare dermatitis/respiratory hypersensitivity). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Cordyceps (militaris/sinensis) | Cognitive | Herbal Medicinal mushroom | 6.0 | 5.0 | 9.0 | 8.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (exercise VO2max/endurance); Weak (cognitive). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (well-tolerated). Low risk — minimal side-effect burden in healthy adults. Access (10%) 8.0 OTC. Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Saffron extract (Crocus sativus) | Cognitive | Herbal Herbal (crocin/safranal) | 6.0 | 5.0 | 9.0 | 8.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (safe at supplement doses; toxic >5 g). Low risk — minimal side-effect burden in healthy adults. Access (10%) 8.0 OTC. Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Polygala tenuifolia | Cognitive | Herbal TCM herb | 3.0 | 5.0 | 7.0 | 10.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small Chinese cognitive trials); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (GI irritation, nausea at higher doses). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC (TCM). Easy access — over-the-counter or freely available. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Gotu kola (Centella asiatica) | Cognitive | Herbal Ayurvedic adaptogen | 3.0 | 5.0 | 9.0 | 10.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (mood/anxiety in older adults); Preclinical (neurogenesis, dendritic complexity). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare hepatotoxicity reports at high doses/chronic use). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Methylene blue | Cognitive | Prescription Alternative electron carrier / MAOI | 6.0 | 5.0 | 5.0 | 6.0 | C+ 5.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (Rodriguez 2016 fMRI — ~7% memory retrieval improvement in healthy adults; Telch 2014 — fear extinction/contextual memory). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (serotonin syndrome risk with SSRIs via MAOI activity; G6PD hemolysis; blue discoloration of urine/secretions). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (methemoglobinemia, cyanide poisoning); USP/pharma grade available OTC in many jurisdictions. Standard prescription channel. Composite 5.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| ALCAR (acetyl-L-carnitine) | Cognitive | Prescription Mitochondrial / cholinergic | 6.0 | 5.0 | 7.0 | 10.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (insomnia, agitation at high doses; seizure threshold caution in epilepsy). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Alpha-lipoic acid (ALA) | Cognitive | Prescription Antioxidant / mitochondrial | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare hypoglycemia, thiamine depletion with chronic use). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Phosphatidylserine | Cognitive | Supplement Membrane phospholipid | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (age-related cognitive decline; stress/cortisol blunting; ADHD adjunct). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (GI upset). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Uridine monophosphate | Cognitive | Supplement Nucleotide / membrane substrate | 3.0 | 5.0 | 9.0 | 10.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (bipolar depression with omega-3); Preclinical (Wurtman lab synaptogenesis work). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Sulbutiamine | Cognitive | Prescription Thiamine derivative | 3.0 | 5.0 | 9.0 | 5.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (asthenia — older French/Russian data; fatigue in chronic disease). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare skin reactions; tolerance develops). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 Rx in France; OTC in many countries. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Memantine | Cognitive | Prescription NMDA antagonist | 8.0 | 5.0 | 9.0 | 6.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (moderate-severe Alzheimer's disease); Weak (off-label autism, OCD augmentation). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (well-tolerated; dizziness, headache). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Anti-amyloid mAbs (lecanemab / donanemab / aducanumab) | Cognitive | Prescription Amyloid-beta-targeting monoclonal antibody | 8.0 | 3.5 | 0.0 | 6.0 | C 4.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (amyloid clearance — robust on PET); Weak-Moderate (clinical benefit — Cochrane 2026 meta-analysis found trivial cognitive benefit and small functional benefit; aducanumab withdrawn 2024). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 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 (25%) 0.0 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. Access (10%) 6.0 Rx (lecanemab/Leqembi FDA-approved Jan 2023; donanemab/Kisunla FDA-approved July 2024; aducanumab/Aduhelm WITHDRAWN by Biogen Jan 2024). Standard prescription channel. Composite 4.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Tianeptine | Cognitive | Prescription Atypical antidepressant / mu-opioid agonist | 6.0 | 5.0 | 2.0 | 4.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 2.0 HIGH (mu-opioid agonism = addiction, tolerance, withdrawal, overdose deaths; cardiotoxicity at high doses). High risk — serious side-effects at studied doses. Access (10%) 4.0 Rx in EU/Asia; unscheduled US (FDA warnings; state-level scheduling accelerating). Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Propranolol | Cognitive | Prescription Non-selective beta-blocker | 8.0 | 3.5 | 9.0 | 6.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (bradycardia, hypotension; contraindicated in asthma, severe bradycardia, decompensated HF). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Nicotine | Cognitive | Research chemical Nicotinic acetylcholine receptor agonist | 8.0 | 8.0 | 5.0 | 5.0 | B+ 7.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 5.0 Very High addiction potential with all forms; CV effects; teratogen; vasoconstriction. Real risk — monitoring or clinician oversight matters. Access (10%) 5.0 Unscheduled (nicotine); tobacco/vape products age-restricted. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| NSI-189 | Cognitive | Research chemical Hippocampal neurogenesis | 3.0 | 5.0 | 9.0 | 3.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Ph2 MDD — missed primary endpoint); Preclinical (hippocampal volume increases). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (Ph2 safety); unknown long-term. Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research chem (was investigational drug). Investigational, research-only, or controlled. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| 9-Me-BC (9-methyl-β-carboline) | Cognitive | Research chemical Beta-carboline / neurotrophic | 2.0 | 5.0 | 4.0 | 3.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical only (Polanski lab). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (no human safety data; MAOI/serotonin syndrome risk theoretical). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chem. Investigational, research-only, or controlled. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Dihexa (N-hexanoic-Tyr-Ile-(6) aminohexanoic amide) | Cognitive | Research chemical HGF/c-Met activator | 2.0 | 5.0 | 4.0 | 3.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical only (Harding lab). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (c-Met activation has theoretical oncogenic concerns). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research chem. Investigational, research-only, or controlled. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Agmatine sulfate | Cognitive | Supplement Neuromodulator (decarboxylated arginine) | 3.0 | 5.0 | 7.0 | 10.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small MDD adjunct trials); Preclinical (robust across anxiety, depression, neuropathic pain). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (GI, possible GH elevation). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Tesofensine | Cognitive | Prescription Triple reuptake inhibitor | 3.0 | 6.5 | 3.5 | 5.0 | C- 4.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (cognitive in AD/PD); Strong (obesity — Ph2 weight loss 9-11%). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 3.5 Med-High (tachycardia, BP elevation, insomnia, mood changes). High risk — serious side-effects at studied doses. Access (10%) 5.0 Investigational in multiple jurisdictions; not approved. Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Vinpocetine | Cognitive | Prescription Cerebral vasodilator | 4.5 | 5.0 | 7.0 | 4.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (hypotension, anticoagulant interaction; FDA warning: avoid in pregnancy). Modest risk — manageable side-effects for most users. Access (10%) 4.0 Rx in EU/Asia; OTC US though FDA has warned against supplement sale. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Psilocybin | Cognitive | Research chemical Classic psychedelic / 5-HT2A agonist | 8.0 | 6.5 | 5.0 | 1.0 | B- 6.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 5.0 Med (HPPD rare, 'bad trips', cardiovascular caution; contraindicated with psychosis risk). Real risk — monitoring or clinician oversight matters. Access (10%) 1.0 Schedule I US (DEA); legal in regulated contexts: Oregon (Measure 109), Colorado (Prop 122), decriminalized in some cities; legal for therapy in Australia. Schedule I or otherwise legally restricted. Composite 6.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| LSD (lysergic acid diethylamide) | Cognitive | Research chemical Classic psychedelic / 5-HT2A agonist | 6.0 | 6.5 | 5.0 | 1.0 | C+ 5.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 5.0 Med (HPPD rare, 'bad trips', cardiovascular caution; contraindicated with psychosis risk; flashbacks). Real risk — monitoring or clinician oversight matters. Access (10%) 1.0 Schedule I US; Class A UK. Schedule I or otherwise legally restricted. Composite 5.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Ketamine | Cognitive | Prescription NMDA antagonist | 8.0 | 6.5 | 3.5 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 3.5 Med-High (dissociation, bladder/cystitis with chronic use, dependence, cardiovascular, elevated ICP). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx (Schedule III US); esketamine REMS program. Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| MDMA (3,4-methylenedioxymethamphetamine) | Cognitive | Research chemical Entactogen | 6.0 | 6.5 | 3.5 | 1.0 | C 5.0 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 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. Access (10%) 1.0 Schedule I US; expanded access in Australia for PTSD. Schedule I or otherwise legally restricted. Composite 5.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Ibogaine | Cognitive | Research chemical Iboga alkaloid / NMDA antagonist + kappa-opioid | 4.5 | 8.0 | 2.0 | 1.0 | C- 4.4 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 2.0 HIGH (cardiotoxicity — QT prolongation, deaths from arrhythmia; extensive drug interactions; several days of intense psychedelic experience). High risk — serious side-effects at studied doses. Access (10%) 1.0 Schedule I US; legal in Mexico, Costa Rica, Portugal, some other countries; Gabon/Cameroon sacrament. Schedule I or otherwise legally restricted. Composite 4.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Ayahuasca / DMT | Cognitive | Research chemical Classic psychedelic / 5-HT2A + MAOI combo | 4.5 | 6.5 | 3.5 | 5.0 | C 4.8 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 3.5 Med-High (MAOI-diet/drug interactions; GI purging; CV; psychiatric risk). High risk — serious side-effects at studied doses. Access (10%) 5.0 DMT Schedule I US; ayahuasca religious exemption (UDV, Santo Daime) in US. Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| CILTEP (forskolin + artichoke extract) | Cognitive | Herbal Stack — cAMP/PDE4 | 3.0 | 5.0 | 7.0 | 10.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (no published CILTEP trials; mechanism extrapolated from Tully long-term memory work in Drosophila). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (forskolin — hypotension, GI; PDE4 inhibition — nausea). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC (individual components). Easy access — over-the-counter or freely available. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Phenibut (β-phenyl-GABA) | Cognitive | Research chemical GABA-B agonist (with weak GABA-A activity) | 3.0 | 5.0 | 2.0 | 5.0 | D+ 3.5 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 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 (25%) 5.0 Moderate (acute anxiolysis); Strong negative for chronic use. Modest or context-dependent effect. Safety (25%) 2.0 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. Access (10%) 5.0 Russia (Rx — Anvifen, Noofen); not FDA-approved in US; sold as 'research chemical' supplement; UK/Australia controlled. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Testosterone (TRT / supraphysiological) | Muscle Building | Anabolic Endogenous androgen (AR agonist) | 8.0 | 8.0 | 5.0 | 5.0 | B+ 7.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong (supraphys); Med (TRT). Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 5.0 Rx for hypogonadism (Schedule III US as anabolic steroid); illicit supraphysiological use illegal. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Dianabol (methandrostenolone / methandienone) | Muscle Building | Anabolic Oral anabolic steroid (C17-aa) | 8.0 | 8.0 | 2.0 | 4.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (muscle mass, strength — older clinical data; extensive bodybuilding use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 2.0 High (hepatotoxicity from C17-alkylation; water retention, BP, gyno from aromatization; HPG suppression; estrogenic side effects). High risk — serious side-effects at studied doses. Access (10%) 4.0 Schedule III US; banned sport; Rx history discontinued. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Deca-Durabolin (nandrolone decanoate) | Muscle Building | Anabolic Injectable 19-nor steroid | 8.0 | 8.0 | 2.0 | 4.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (muscle, bone in clinical use — anaemia/wasting indications). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 2.0 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. Access (10%) 4.0 Schedule III US; Rx for anemia/wasting in some countries; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Nandrolone (phenylpropionate / other esters) | Muscle Building | Anabolic Injectable 19-nor steroid | 8.0 | 8.0 | 2.0 | 4.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (same indication family as decanoate). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 2.0 High (same side effect profile as Deca; slightly faster recoverability due to shorter ester). High risk — serious side-effects at studied doses. Access (10%) 4.0 Schedule III US; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Trenbolone | Muscle Building | Anabolic Injectable 19-nor steroid (~5x androgen activity) | 8.0 | 10.0 | 0.0 | 4.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (striking muscle gain and fat loss anecdotally; limited clinical data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very High. Large effect size when the claim holds. Safety (25%) 0.0 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. Access (10%) 4.0 Schedule III US (when diverted for human use); banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Anavar (oxandrolone) | Muscle Building | Anabolic Oral anabolic steroid | 8.0 | 6.5 | 5.0 | 4.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (muscle-preservation during cutting; low-dose clinical uses). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 5.0 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. Access (10%) 4.0 Schedule III US; Rx but rare; expensive genuine product — most illicit is counterfeit. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Winstrol (stanozolol) | Muscle Building | Anabolic Oral/injectable anabolic steroid | 8.0 | 6.5 | 2.0 | 4.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (strength, dry muscle gain, vascularity; used historically for anemia, angioedema). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 2.0 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. Access (10%) 4.0 Schedule III US; Rx history discontinued in most countries; banned sport (Ben Johnson 1988). Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Anadrol (oxymetholone) | Muscle Building | Anabolic Oral anabolic steroid | 8.0 | 10.0 | 0.0 | 4.0 | B- 6.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (mass and strength; aplastic anemia/Fanconi anemia clinical use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very High. Large effect size when the claim holds. Safety (25%) 0.0 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. Access (10%) 4.0 Schedule III US; Rx (anaemia) as Anadrol-50; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Boldenone (Equipoise) | Muscle Building | Anabolic Injectable veterinary anabolic | 6.0 | 8.0 | 3.5 | 4.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (slower gains than testosterone; good for lean mass). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 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. Access (10%) 4.0 Schedule III US (human use); veterinary only officially; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Primobolan (methenolone) | Muscle Building | Anabolic Injectable/oral anabolic | 6.0 | 5.0 | 5.0 | 4.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (muscle preservation in cutting; low virilization in women). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 4.0 Schedule III US; Rx history discontinued; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Masteron (drostanolone) | Muscle Building | Anabolic Injectable DHT-derivative | 6.0 | 6.5 | 3.5 | 4.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (aesthetic effect — dryness, hardness; historical use in breast cancer). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 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. Access (10%) 4.0 Schedule III US; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Ostarine (MK-2866 / enobosarm) | Muscle Building | Anabolic SARM | 6.0 | 5.0 | 5.0 | 4.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (HPG suppression dose-dependent; LFT elevations; reported heart-attack cases in young users — FDA warning 2017). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 NOT FDA-approved; sold as 'research chemical' (gray market); repeated SARMs Control Act bills (2018/2019/2025) have not passed — still not federally scheduled; banned sport (WADA). Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Ligandrol (LGD-4033) | Muscle Building | Anabolic SARM | 4.5 | 5.0 | 5.0 | 4.0 | C 4.7 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (significant HPG suppression despite marketing; elevated LFTs and lipid disturbance; liver injury case reports). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 NOT FDA-approved; gray market; banned sport (WADA). Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| RAD-140 (testolone) | Muscle Building | Anabolic SARM | 3.0 | 6.5 | 3.5 | 4.0 | C- 4.1 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (human data limited); Preclinical (strong anabolic). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 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. Access (10%) 4.0 NOT FDA-approved; gray market; banned sport (WADA). Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| YK-11 | Muscle Building | Anabolic Myostatin inhibitor / SARM-like | 2.0 | 5.0 | 3.0 | 4.0 | D 3.2 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Very Weak (no human clinical trials); Preclinical (in vitro myostatin effects). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 3.0 Unknown-High (steroidal chemistry = likely hepatotoxic; HPG suppression; essentially no human safety data). High risk — serious side-effects at studied doses. Access (10%) 4.0 NOT FDA-approved; gray market; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D | ||||||||
| S-23 | Muscle Building | Anabolic SARM | 2.0 | 5.0 | 3.0 | 4.0 | D 3.2 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Very Weak (human data minimal); Preclinical. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 3.0 Unknown-High (strongest HPG suppression of common SARMs; fertility effects — the original intended indication). High risk — serious side-effects at studied doses. Access (10%) 4.0 NOT FDA-approved; gray market; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D | ||||||||
| ACP-105 | Muscle Building | Anabolic SARM | 2.0 | 5.0 | 4.0 | 4.0 | D+ 3.5 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Very Weak (essentially no human efficacy data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown. Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 NOT FDA-approved; gray market; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| LGD-3303 | Muscle Building | Anabolic SARM | 2.0 | 5.0 | 4.0 | 4.0 | D+ 3.5 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Very Weak (no human clinical development). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (preclinical suggests significant AR activity; no human safety data). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 NOT FDA-approved; gray market; banned sport. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Cardarine (GW501516) | Muscle Building | Anabolic PPAR-delta agonist (not a SARM) | 6.0 | 10.0 | 5.0 | 4.0 | B 6.6 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (endurance, lipid profile in short Ph1); STRONG NEGATIVE (rodent carcinogenicity). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 10.0 Very High (cancer signal). Large effect size when the claim holds. Safety (25%) 5.0 Very High — GSK halted development due to multi-organ carcinogenesis in 2-year rodent studies; WADA banned with unprecedented athlete warning. Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 NOT FDA-approved; gray market; WADA banned with special cancer warning to athletes. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| HGH (recombinant human growth hormone) | Muscle Building | Anabolic Recombinant peptide hormone | 8.0 | 5.0 | 3.5 | 3.0 | C+ 5.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (deficiency indications: pediatric GHD, adult GHD, Turner, wasting); Weak-Moderate (anti-aging claims — Rudman 1990 reanalyses show muscle gain but no functional benefit, increased side effects). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 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. Access (10%) 3.0 Rx for approved indications; off-label/illicit for anti-aging/performance illegal in US (Anti-Drug Abuse Act of 1988 specifically criminalizes non-indicated HGH). Investigational, research-only, or controlled. Composite 5.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| IGF-1 LR3 (long R3 insulin-like growth factor-1) | Muscle Building | Anabolic Modified IGF-1 analog | 8.0 | 5.0 | 2.0 | 3.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (tissue growth in vitro); Weak (human supplementation — essentially no RCTs). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 2.0 High (hypoglycemia — shared with insulin pathway; tumor/oncogenesis concerns via sustained IGF-1R signaling). High risk — serious side-effects at studied doses. Access (10%) 3.0 Research chem (not approved); banned sport. Investigational, research-only, or controlled. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| CJC-1295 (with/without DAC) | Muscle Building | Anabolic GHRH analog | 3.0 | 5.0 | 5.0 | 3.0 | C- 4.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 3.0 Research peptide; not FDA-approved; banned sport. Investigational, research-only, or controlled. Composite 4.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Ipamorelin | Muscle Building | Anabolic Selective ghrelin receptor agonist | 3.0 | 5.0 | 7.0 | 3.0 | C- 4.5 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small human trials for postoperative ileus, safety); anecdotal for recovery/body composition. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (injection site; mild cortisol/prolactin effects; muscle strain from rapid recovery anecdotally). Modest risk — manageable side-effects for most users. Access (10%) 3.0 Research peptide; not FDA-approved; banned sport. Investigational, research-only, or controlled. Composite 4.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| GHRP-2 / GHRP-6 | Muscle Building | Anabolic Ghrelin receptor agonists (earlier generation) | 3.0 | 5.0 | 5.0 | 3.0 | C- 4.0 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (old Ph2 data for various indications; discontinued development); anecdotal. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (hunger spikes, water retention, cortisol/prolactin elevation; older/cruder than ipamorelin). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Research peptide; banned sport. Investigational, research-only, or controlled. Composite 4.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Sermorelin | Muscle Building | Anabolic GHRH(1-29) analog | 6.0 | 5.0 | 7.0 | 5.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (pediatric GHD diagnosis/treatment — historical FDA approval withdrawn by Serono 2008 for commercial reasons); off-label adult anti-aging use. Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (injection site reactions most common; preservation of physiological feedback reduces HPA disruption). Modest risk — manageable side-effects for most users. Access (10%) 5.0 Was FDA-approved (Geref), now compounded only from 503B/503A pharmacies; off-label TRT-like use common. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Tesamorelin | Muscle Building | Anabolic Stabilized GHRH analog | 8.0 | 5.0 | 3.5 | 4.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (HIV lipodystrophy visceral fat reduction); Moderate (NAFLD liver fat — positive Ph2). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 3.5 Med-High (insulin resistance/diabetes worsening — FDA black-box; injection reactions; joint pain; expensive). High risk — serious side-effects at studied doses. Access (10%) 4.0 Rx (Egrifta/Egrifta SV) for HIV lipodystrophy; off-label for visceral fat reduction. Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| MK-677 (ibutamoren) | Muscle Building | Anabolic Oral ghrelin receptor agonist | 6.0 | 5.0 | 3.5 | 3.0 | C 4.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 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. Access (10%) 3.0 Research chemical (not scheduled); banned sport. Investigational, research-only, or controlled. Composite 4.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| BPC-157 (Body Protection Compound-157) | Recovery | Peptide Pentadecapeptide | 2.0 | 5.0 | 5.0 | 4.0 | D+ 3.7 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical only (extensive rodent data, Sikiric group); NO published human RCTs. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 5.0 Unknown long-term (essentially no controlled human safety data). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Not FDA-approved; FDA classified as Category 2 on interim 503A bulks list — prohibited from US compounding pharmacies per Jan 7, 2025 final guidance; WADA-banned; sold as research peptide. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| TB-500 (Thymosin beta-4 fragment) | Recovery | Peptide Synthetic peptide | 2.0 | 5.0 | 5.0 | 4.0 | D+ 3.7 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical; Ph2 stroke and diabetic ulcer trials (RegeneRx) unconvincing. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 5.0 Unknown long-term. Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Not FDA-approved for any indication; Category 2 — compounding prohibited; WADA-banned; veterinary use common in horses. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Thymosin alpha-1 | Recovery | Peptide Immunomodulatory peptide | 8.0 | 5.0 | 9.0 | 4.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (chronic hepatitis B/C — approved in many countries); Moderate (sepsis adjunct); Weak (biohacker 'immune/recovery' use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (well-tolerated in trials; injection site reactions). Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Rx in EU, Asia, Russia (Zadaxin); NOT FDA-approved in US; Category 2 on 503A bulks — compounding prohibited as of Jan 2025. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| LL-37 (cathelicidin) | Recovery | Peptide Antimicrobial peptide | 2.0 | 5.0 | 4.0 | 4.0 | D+ 3.5 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (antimicrobial, wound healing); Very limited human trial data. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (injection not established; pro-inflammatory effects possible at high local concentrations; theoretical autoimmune concerns). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Not FDA-approved; research peptide. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| KPV (Lys-Pro-Val) | Recovery | Peptide Tripeptide (alpha-MSH fragment) | 2.0 | 5.0 | 4.0 | 4.0 | D+ 3.5 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (IBD, wound healing, dermatitis models); Very limited human trials. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown. Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Not FDA-approved; Category 2 on 503A bulks (compounding prohibited); research peptide. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Curcumin (turmeric) | Recovery | Supplement Polyphenol | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (osteoarthritis pain — non-inferiority vs NSAIDs in several trials); Moderate (knee OA, depression adjunct, metabolic markers). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (generally well-tolerated; rare hepatotoxicity reports with novel high-absorption formulations — especially piperine-boosted; possible iron chelation). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Boswellia serrata (AKBA) | Recovery | Prescription Boswellic acid / 5-LOX inhibitor | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (knee osteoarthritis pain — multiple RCTs; inflammatory bowel disease; asthma). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (generally well-tolerated; rare GI upset). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Omega-3 (EPA + DHA) | Recovery | Supplement Polyunsaturated fatty acids | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (triglyceride lowering — prescription doses; secondary CV prevention per REDUCE-IT 4g/day icosapent ethyl); Moderate (rheumatoid arthritis symptoms, post-exercise inflammation). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (fishy reflux, GI; small AF signal in high-dose trials; theoretical bleeding at high doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (supplements); Rx (Vascepa / Lovaza / Epanova). Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| SPMs (specialized pro-resolving mediators) | Recovery | Supplement Lipid signaling molecules | 2.0 | 3.5 | 9.0 | 3.0 | C- 4.2 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Preclinical (robust); Early human (exploratory trials — periodontitis, chronic rhinosinusitis, Alzheimer's). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (early data). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 OTC supplements (Metagenics, others) contain SPM-enriched fish oil fractions. Investigational, research-only, or controlled. Composite 4.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| PEA (palmitoylethanolamide) | Recovery | Prescription Endogenous fatty acid amide | 6.0 | 5.0 | 9.0 | 6.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 9.0 Low (very well-tolerated; rare GI). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (Italy/Spain as Normast/Pelvilen); OTC supplement elsewhere. Standard prescription channel. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Creatine monohydrate | Recovery | Supplement Cellular energy substrate | 8.0 | 8.0 | 10.0 | 10.0 | A 8.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 High. Large effect size when the claim holds. Safety (25%) 10.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| HMB (β-hydroxy β-methylbutyrate) | Recovery | Supplement Leucine metabolite | 6.0 | 3.5 | 10.0 | 10.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Glutamine | Recovery | Supplement Amino acid | 6.0 | 2.0 | 9.0 | 10.0 | B- 6.2 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 2.0 Low. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Collagen peptides (hydrolyzed collagen) | Recovery | Supplement Protein / amino acid source | 6.0 | 3.5 | 10.0 | 10.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Tart cherry (Prunus cerasus) | Recovery | Herbal Anthocyanin-rich fruit extract | 6.0 | 2.0 | 10.0 | 10.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (exercise-induced muscle damage, DOMS reduction; modest sleep onset improvements). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 2.0 Low. Small or unclear effect even in best-case interpretation. Safety (25%) 10.0 Very Low (high natural sugar content if consumed as juice; hypotensive additive with BP meds). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Hyaluronic acid (oral + intra-articular) | Recovery | Supplement Glycosaminoglycan | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (intra-articular: injection site pain, rare pseudosepsis; oral: essentially none). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (oral); Rx (intra-articular — Synvisc, Euflexxa, etc.). Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Pentosan polysulfate (Elmiron) | Recovery | Prescription Semisynthetic heparinoid | 4.5 | 5.0 | 5.0 | 6.0 | C 4.9 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 6.0 Rx (Elmiron — interstitial cystitis); off-label injectable (veterinary zydax) used by some humans. Standard prescription channel. Composite 4.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Suzetrigine (Journavx / VX-548) | Recovery | Prescription Selective Nav1.8 sodium channel inhibitor | 8.0 | 6.5 | 9.0 | 6.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 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 (25%) 9.0 Low (mild constipation, headache, nausea; no respiratory depression; no abuse potential — not scheduled). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (FDA-approved Jan 2025 for moderate-to-severe acute pain). Standard prescription channel. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Glucosamine + chondroitin | Recovery | Supplement Joint matrix substrate | 4.0 | 3.5 | 10.0 | 10.0 | B- 6.0 | Apr 2026 |
| Score breakdown Evidence (40%) 4.0 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 (25%) 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 (25%) 10.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Estradiol (HRT — oral/transdermal/vaginal) | Hormones | Hormone Estrogen replacement | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Progesterone (micronized / oral / vaginal) | Hormones | Hormone Progesterone replacement | 8.0 | 5.0 | 9.0 | 6.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 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. Access (10%) 6.0 Rx (Prometrium oral; vaginal compounded). Standard prescription channel. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| DHEA | Hormones | Hormone Adrenal steroid precursor | 6.0 | 3.5 | 7.0 | 10.0 | B- 6.0 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 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. Access (10%) 10.0 OTC (US); Rx in most other countries. Easy access — over-the-counter or freely available. Composite 6.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Pregnenolone | Hormones | Hormone Neurosteroid / upstream precursor | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (cognitive, mood in small trials — schizophrenia adjunct, bipolar). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (generally well-tolerated; theoretical concern about pushing adrenal/gonadal steroid synthesis unpredictably). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (US); Rx elsewhere. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| T3 (liothyronine) | Hormones | Hormone Active thyroid hormone | 8.0 | 8.0 | 3.5 | 6.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (hypothyroidism — in T4/T3 combo therapy or T3 monotherapy in selected patients); Moderate (treatment-resistant depression augmentation — Cooper-Kazaz 2007). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (supra-TSH-suppressing doses). Large effect size when the claim holds. Safety (25%) 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. Access (10%) 6.0 Rx (Cytomel). Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| T4 / NDT (levothyroxine, desiccated thyroid) | Hormones | Hormone Thyroid hormone replacement | 8.0 | 5.0 | 5.0 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (hypothyroidism). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (over-replacement risks as with T3; NDT has more variable potency between batches). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| HCG (human chorionic gonadotropin) | Hormones | Hormone LH-analog gonadotropin | 8.0 | 5.0 | 7.0 | 6.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (gyno via elevated estradiol; elevated BP; fluid retention; desensitization with chronic high doses). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (compounded in US since Novarel/Pregnyl discontinued); banned sport. Standard prescription channel. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Enclomiphene / Clomiphene | Hormones | Hormone SERM (HPG restart) | 6.0 | 5.0 | 5.0 | 6.0 | C+ 5.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (restoring endogenous testosterone in secondary hypogonadism; post-cycle therapy; fertility preservation). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 Med (mood changes, vision disturbance — rare scintillating scotomata; VTE risk; enclomiphene generally better tolerated than mixed clomiphene). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (clomiphene Rx for female infertility; enclomiphene — Androxal — FDA rejected 2015, currently compounded only). Standard prescription channel. Composite 5.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Anastrozole | Hormones | Hormone Aromatase inhibitor | 8.0 | 5.0 | 5.0 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (adjuvant breast cancer); Moderate (estrogen control during TRT/AAS). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Gonadorelin (GnRH) | Hormones | Hormone Pulsatile GnRH analog | 8.0 | 5.0 | 7.0 | 6.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (hypogonadotropic hypogonadism — pulsatile pumps, fertility induction); Moderate (TRT adjunct for testicular preservation). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Med. Modest or context-dependent effect. Safety (25%) 7.0 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. Access (10%) 6.0 Rx (LutrePulse discontinued; now compounded); Category 1 on 503A bulks — compounding allowed. Standard prescription channel. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Fezolinetant (Veozah) | Hormones | Prescription NK3 receptor antagonist (non-hormonal) | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Phase 3 SKYLIGHT 1 & 2; FDA-approved May 2023). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (~50-65% reduction in moderate-severe VMS frequency at 12 weeks). Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx (FDA-approved 2023). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Elinzanetant (Lynkuet) | Hormones | Prescription NK1/NK3 dual receptor antagonist (non-hormonal) | 8.0 | 8.0 | 7.0 | 6.0 | A- 7.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Phase 3 OASIS 1-4; approved in several countries 2025-2026). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 High (VMS frequency reduction ~60-70%; superior sleep & mood vs fezolinetant in cross-trial comparisons). Large effect size when the claim holds. Safety (25%) 7.0 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. Access (10%) 6.0 Rx (approved EMA/several countries 2025; FDA filing in progress). Standard prescription channel. Composite 7.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Resmetirom (Rezdiffra) | Hormones | Prescription Liver-selective THR-β agonist | 8.0 | 8.0 | 5.0 | 4.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Phase 3 MAESTRO-NASH; FDA-approved March 2024 — first MASH drug). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 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 (25%) 5.0 Med (diarrhea, nausea common; modest LDL/lipid changes; mild reversible LFT elevations; pregnancy contraindicated). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Rx (FDA-approved March 2024 for noncirrhotic MASH with moderate-advanced fibrosis F2/F3). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Romosozumab (Evenity) | Hormones | Prescription Sclerostin antibody (bone anabolic) | 8.0 | 10.0 | 3.5 | 6.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (FRAME, ARCH, BRIDGE Phase 3 — vertebral and clinical fracture reduction). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 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 (25%) 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. Access (10%) 6.0 Rx (FDA-approved 2019 for postmenopausal osteoporosis at high fracture risk). Standard prescription channel. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Rosuvastatin / atorvastatin (statins) | CV/Lipid | Prescription HMG-CoA reductase inhibitor | 10.0 | 10.0 | 7.0 | 6.0 | A+ 8.9 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 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 (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 7.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 8.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A+ | ||||||||
| Ezetimibe | CV/Lipid | Prescription NPC1L1 inhibitor | 8.0 | 5.0 | 10.0 | 4.0 | B+ 7.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 10.0 Very Low (arguably the cleanest lipid-lowering drug — very few side effects). Low risk — minimal side-effect burden in healthy adults. Access (10%) 4.0 Rx (generic). Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| PCSK9 inhibitors (evolocumab / alirocumab / inclisiran) | CV/Lipid | Prescription Monoclonal antibody or siRNA | 8.0 | 10.0 | 9.0 | 6.0 | A 8.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (FOURIER, ODYSSEY OUTCOMES — CV event reduction); Strong (dramatic LDL reduction). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 9.0 Low (injection site reactions; very clean systemic profile). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (expensive at list; list prices now lower — ~$500-600/month after 2018 price cuts). Standard prescription channel. Composite 8.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Bempedoic acid | CV/Lipid | Prescription ACL inhibitor | 7.0 | 5.0 | 5.0 | 4.0 | C+ 5.7 | Apr 2026 |
| Score breakdown Evidence (40%) 7.0 Moderate-Strong (CLEAR Outcomes 2023 — CV event reduction in statin-intolerant). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 5.0 Med (hyperuricemia — gout risk; modest LFT elevations; tendon rupture reports). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Rx (Nexletol; combo with ezetimibe = Nexlizet). Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Icosapent ethyl (Vascepa) | CV/Lipid | Prescription Purified EPA ester | 8.0 | 8.0 | 7.0 | 6.0 | A- 7.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (REDUCE-IT — 25% relative risk reduction of CV events at 4 g/day in statin-treated high-risk patients). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (modest AF/atrial flutter signal at 4 g/day; minor bleeding; burping). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (generic available since 2022). Standard prescription channel. Composite 7.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Niacin (nicotinic acid) | CV/Lipid | Prescription B3 / lipid modifier | 8.0 | 5.0 | 3.5 | 6.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 3.5 Med-High (intense flushing; hepatotoxicity — especially sustained-release forms; gout flares; glucose elevation; itching). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx (Niaspan extended release); OTC (immediate release / 'flush-free' inositol hexanicotinate — largely inactive on lipids). Standard prescription channel. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Berberine | CV/Lipid | Supplement AMPK activator / natural | 6.0 | 5.0 | 7.0 | 10.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (GI upset common — diarrhea, cramping; significant CYP3A4 inhibition → drug interactions; not safe in pregnancy). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Citrus bergamot | CV/Lipid | Herbal Polyphenol extract | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (several Italian RCTs showing LDL, TG reduction; HDL increase). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare GI upset). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Red yeast rice | CV/Lipid | Herbal Natural monacolin K source | 6.0 | 5.0 | 5.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (LDL reduction in observational and RCT data). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 10.0 OTC (US; EU heavily restricted since 2022). Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Nattokinase | CV/Lipid | Prescription Fibrinolytic enzyme | 3.0 | 5.0 | 7.0 | 10.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small Japanese RCTs showing BP, fibrinogen reduction; no CV outcomes data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (bleeding risk — especially additive with anticoagulants/antiplatelets; some preparations show Lp(a) reduction signal). Modest risk — manageable side-effects for most users. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Coenzyme Q10 (ubiquinone/ubiquinol) | CV/Lipid | Supplement Electron transport cofactor | 6.0 | 3.5 | 10.0 | 10.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (heart failure — Q-SYMBIO 2014 mortality reduction); Weak (statin-associated myopathy — mixed RCTs); Weak (migraine prophylaxis); Weak (Parkinson's and other indications). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Aspirin (low-dose) | CV/Lipid | Prescription Irreversible COX-1 inhibitor | 8.0 | 8.0 | 5.0 | 10.0 | B+ 7.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong (secondary); Weak (primary). Large effect size when the claim holds. Safety (25%) 5.0 Med (GI bleeding — dose-dependent; rare intracranial hemorrhage; Reye's syndrome in children). Real risk — monitoring or clinician oversight matters. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Garlic extract (aged / allicin) | CV/Lipid | Herbal Organosulfur polyphenol | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (garlic breath/body odor; mild GI; bleeding additive with anticoagulants). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Lp(a)-lowering therapies (olpasiran / pelacarsen / lepodisiran / zerlasiran / muvalaplin) | CV/Lipid | Supplement RNA-targeted or small-molecule Lp(a) lowering | 8.0 | 10.0 | 7.0 | 4.0 | A- 7.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Lp(a) reduction); Outcomes pending (large CVOT readouts 2026-2028). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 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 (25%) 7.0 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. Access (10%) 4.0 Investigational (pelacarsen Lp(a)HORIZON CVOT readout expected 2026; olpasiran OCEAN(a) Outcomes ongoing). Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Obicetrapib | CV/Lipid | Prescription CETP inhibitor (next-generation) | 8.0 | 8.0 | 7.0 | 4.0 | B+ 7.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 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 (25%) 7.0 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. Access (10%) 4.0 Investigational (NewAmsterdam Pharma; FDA filing expected 2025-2026; PREVAIL CVOT readout expected 2026-2027). Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Probiotics (multi-strain) | Gut | Supplement Live microbial supplement | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (translocation/bacteremia risk in immunocompromised or central-line patients — case reports). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Akkermansia muciniphila (pasteurized) | Gut | Supplement Next-generation probiotic | 6.0 | 3.5 | 9.0 | 8.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (pasteurized form considered safer than live Akkermansia for immunocompromised). Low risk — minimal side-effect burden in healthy adults. Access (10%) 8.0 OTC (Pendulum Glucose Control and similar in US). Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Prebiotics (inulin / FOS / GOS / partially hydrolyzed guar gum) | Gut | Supplement Fermentable fibers | 6.0 | 5.0 | 7.0 | 10.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 7.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Psyllium husk | Gut | Supplement Soluble viscous fiber | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 9.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Digestive enzymes (pancreatin / proteases / lipase) | Gut | Supplement Exogenous digestive enzymes | 8.0 | 3.5 | 9.0 | 10.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (pancreatic insufficiency — chronic pancreatitis, CF, post-Whipple); Weak (generic 'digestion' in healthy individuals). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (in otherwise-healthy; high-dose pancrelipase can cause colonic strictures rarely). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (supplements); Rx (Creon, Zenpep, Pertzye). Easy access — over-the-counter or freely available. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Butyrate (tributyrin / sodium butyrate) | Gut | Supplement Short-chain fatty acid | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (unpleasant smell/taste with sodium butyrate; tributyrin bypasses this; rare GI upset). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Saccharomyces boulardii | Gut | Supplement Probiotic yeast | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare fungemia in immunocompromised or central-line patients — FDA warning). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| FMT (fecal microbiota transplantation) | Gut | Prescription Microbiome transplant | 10.0 | 8.0 | 5.0 | 5.0 | A- 7.8 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 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 (25%) 8.0 Strong (CDI). Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 5.0 Rx only (OpenBiome closed 2024; now via Rebyota or Vowst); DIY FMT illegal and dangerous. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Larazotide acetate (AT-1001) | Gut | Supplement Tight junction regulator | 3.0 | 3.0 | 4.0 | 4.0 | D+ 3.4 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (Ph3 CeD — 9 Meters' trial failed primary endpoint 2022; development suspended). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.0 Weak. Small or unclear effect even in best-case interpretation. Safety (25%) 4.0 Unknown (favorable in trials but Ph3 negative). Real risk — monitoring or clinician oversight matters. Access (10%) 4.0 Not FDA-approved; 9 Meters discontinued development; gray-market research peptide. Cash-pay, off-label, or jurisdiction-dependent access. Composite 3.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → D+ | ||||||||
| Betaine HCl | Gut | Supplement Gastric acid supplementation | 3.0 | 4.0 | 5.0 | 10.0 | C- 4.5 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small trials in hypochlorhydria; no large RCTs); Moderate mechanism. Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 4.0 Weak-Moderate (where hypochlorhydria is real). Modest or context-dependent effect. Safety (25%) 5.0 Med (ulcer/GERD exacerbation; contraindicated with active PUD; heartburn). Real risk — monitoring or clinician oversight matters. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 4.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Rifaximin (Xifaxan) | Gut | Prescription Gut-selective antibiotic | 8.0 | 8.0 | 9.0 | 4.0 | A- 7.9 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong (IBS-D). Large effect size when the claim holds. Safety (25%) 9.0 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. Access (10%) 4.0 Rx. Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| DGL (deglycyrrhizinated licorice) | Gut | Supplement Mucosal protectant | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (older trials in gastric/duodenal ulcer; anti-H. pylori activity). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (with glycyrrhizin removed; still use caution with whole-licorice products at chronic high doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Vitamin D (cholecalciferol / D3) | Immune | Vitamin Secosteroid hormone | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong (deficiency); Moderate (generally). Large effect size when the claim holds. Safety (25%) 9.0 Low (toxicity only at sustained very high intake — 10,000+ IU/day for months; hypercalcemia). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Zinc (picolinate / bisglycinate) | Immune | Supplement Essential mineral | 8.0 | 5.0 | 7.0 | 10.0 | B+ 7.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate (cold). Modest or context-dependent effect. Safety (25%) 7.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Vitamin C (ascorbic acid) | Immune | Supplement Essential vitamin / antioxidant | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 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. Access (10%) 10.0 OTC (oral); Rx (IV high-dose pharmacy compounding). Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Quercetin | Immune | Supplement Flavonoid | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small RCTs for allergies, exercise immunity, URI); Preclinical (antiviral — but human data thin). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Elderberry (Sambucus nigra) | Immune | Herbal Anthocyanin-rich extract | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Echinacea | Immune | Herbal Herbal immune modulator | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (rare hypersensitivity — avoid with ragweed allergy; autoimmune concerns debated but weak evidence). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| N-acetylcysteine (NAC) | Immune | Prescription Glutathione precursor / mucolytic | 8.0 | 5.0 | 9.0 | 6.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (APAP overdose antidote; COPD exacerbations; contrast-induced nephropathy mixed); Moderate (PCOS, fertility; chronic bronchitis); Weak (generic 'detox' use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (GI upset; rotten-egg smell characteristic; bronchospasm with inhaled form). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (IV for APAP overdose; Mucomyst); OTC supplement (restored after FDA 2022 decision not to pursue enforcement action after 2020 warning letters). Standard prescription channel. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Beta-glucans (yeast / mushroom) | Immune | Supplement Polysaccharide PAMP mimetic | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (generally well-tolerated; theoretical hypoglycemia). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Colostrum (bovine) | Immune | Supplement Immunoglobulin-rich milk | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (milk protein allergy; theoretical concerns with unpasteurized products). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Astragalus | Immune | Herbal Adaptogen / TA-65 source | 3.0 | 3.5 | 9.0 | 8.0 | C 5.1 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (chronic HF in Chinese trials; as chemo adjunct); Preclinical (telomerase activation via cycloastragenol). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (well-tolerated; theoretical autoimmune concerns — mostly unfounded). Low risk — minimal side-effect burden in healthy adults. Access (10%) 8.0 OTC. Standard prescription channel. Composite 5.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Lactoferrin (bovine) | Immune | Supplement Iron-binding glycoprotein | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate (iron status); Low-Med (immune). Modest or context-dependent effect. Safety (25%) 9.0 Low (very well-tolerated; theoretical milk-allergy contraindication). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| PT-141 (Bremelanotide / Vyleesi) | Libido | Prescription Melanocortin receptor agonist | 6.0 | 5.0 | 5.0 | 6.0 | C+ 5.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate (HSDD women). Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 6.0 Rx (Vyleesi, on-demand); research peptide gray market for off-label male use. Standard prescription channel. Composite 5.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Melanotan II (MT-II) | Libido | Prescription Non-selective melanocortin agonist | 6.0 | 6.5 | 2.0 | 4.0 | C 4.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (tanning); Moderate (erectile function — Wessells 1998); Moderate (libido). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 6.5 Med-High. Meaningful effect for the studied population. Safety (25%) 2.0 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. Access (10%) 4.0 Not FDA-approved anywhere; research peptide; gray market. Cash-pay, off-label, or jurisdiction-dependent access. Composite 4.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Sildenafil (Viagra) | Libido | Prescription PDE5 inhibitor | 10.0 | 10.0 | 5.0 | 6.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 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 (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx; generics widely available; Hims/Roman-style telehealth. Standard prescription channel. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Tadalafil (Cialis) | Libido | Prescription Long-acting PDE5 inhibitor | 10.0 | 10.0 | 7.0 | 6.0 | A+ 8.9 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 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 (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 7.0 Low-Med (headache, back/muscle pain distinctive of tadalafil, nasal congestion; same nitrate contraindication). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx; generic since 2018. Standard prescription channel. Composite 8.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A+ | ||||||||
| Cabergoline | Libido | Prescription Dopamine D2 agonist | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (hyperprolactinemia); Weak (refractory period reduction — anecdotal biohacker use). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong (for intended medical use). Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx (Dostinex). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Tongkat ali (Eurycoma longifolia) | Libido | Herbal Adaptogen / T-optimizer | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (generally well-tolerated; historical heavy-metal contamination concern — test from reputable brands). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Tribulus terrestris | Libido | Herbal Saponin-containing herb | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (female sexual function — some RCTs show benefit); Very Weak (male testosterone — most RCTs negative). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med (female); Very Low (male T). Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Maca (Lepidium meyenii) | Libido | Herbal Andean cruciferous tuber | 6.0 | 3.5 | 9.0 | 10.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (generally well-tolerated; hypothyroidism caution due to goitrogens — minimal clinical relevance). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Fadogia agrestis | Libido | Herbal Nigerian shrub | 3.0 | 5.0 | 4.0 | 10.0 | C- 4.5 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Essentially zero (no human efficacy data). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Unknown. Modest or context-dependent effect. Safety (25%) 4.0 Unknown (rat study showed hepatic/testicular toxicity at higher doses; no human safety data). Real risk — monitoring or clinician oversight matters. Access (10%) 10.0 OTC (supplement). Easy access — over-the-counter or freely available. Composite 4.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Yohimbine | Libido | Prescription Alpha-2 adrenergic antagonist | 6.0 | 5.0 | 3.5 | 10.0 | C+ 5.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 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. Access (10%) 10.0 OTC (yohimbe bark extract — variable potency); Rx (standardized yohimbine HCl). Easy access — over-the-counter or freely available. Composite 5.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Kisspeptin-10 | Libido | Peptide Hypothalamic peptide | 4.5 | 3.5 | 9.0 | 3.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (well-tolerated in trials); Unknown long-term. Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 Research peptide; not FDA-approved. Investigational, research-only, or controlled. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Finasteride (oral / topical) | Skin/Hair | Prescription 5-alpha reductase inhibitor (type II) | 8.0 | 8.0 | 7.0 | 6.0 | A- 7.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 7.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Dutasteride | Skin/Hair | Prescription 5-alpha reductase inhibitor (type I+II) | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx (Avodart; off-label for AGA in US — approved for AGA in Japan/Korea). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Minoxidil (topical + oral low-dose) | Skin/Hair | Supplement Potassium channel opener / vasodilator | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 9.0 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. Access (10%) 10.0 OTC (topical); Rx (oral). Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Tretinoin (all-trans retinoic acid) | Skin/Hair | Prescription Retinoid — RAR agonist | 10.0 | 10.0 | 5.0 | 6.0 | A 8.4 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (acne, photoaging — gold standard topical anti-aging). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 5.0 Med (irritation, dryness, purging, photosensitivity, teratogenic — do not use in pregnancy). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx (tretinoin); adapalene 0.1% OTC since 2016. Standard prescription channel. Composite 8.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Azelaic acid | Skin/Hair | Supplement Dicarboxylic acid | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (acne, rosacea, melasma, PIH); topical; safe in pregnancy — one of few brightening/acne agents that is. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 9.0 Low (mild burning/tingling; rare depigmentation concerns — generally skin-tone neutral). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (up to 10%); Rx (15-20%; Finacea, Azelex). Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Niacinamide (topical) | Skin/Hair | Supplement Nicotinamide form | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (barrier function, transepidermal water loss, pigmentation evenness, sebum control). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| GHK-Cu (topical) | Skin/Hair | Peptide Copper peptide | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (mild irritation in some; green-blue staining common at high concentrations). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (topical); injectable formerly compounded — now Category 2 on FDA 503A list for injection (prohibited). Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| PRP (platelet-rich plasma — scalp/face) | Skin/Hair | Supplement Autologous growth factor concentrate | 6.0 | 5.0 | 9.0 | 5.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (AGA — multiple RCTs show hair density and caliber improvement); Moderate (cosmetic skin rejuvenation). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (procedure risks — injection site pain, bruising, infection; no systemic safety concern since autologous). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 In-office procedure. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Spironolactone | Skin/Hair | Prescription Aldosterone / androgen receptor antagonist | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (female AGA, hormonal acne, hirsutism). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Latanoprost / bimatoprost (topical — scalp/lashes) | Skin/Hair | Prescription Prostaglandin F2α analog | 8.0 | 5.0 | 7.0 | 4.0 | B 6.6 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (eyelash length/thickness — Latisse); Weak-Moderate (scalp AGA — off-label, case series rather than large RCTs). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Moderate (lashes); Weak (scalp). Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (iris color change — irreversible increase in brown pigmentation, concerning for blue/green eyes; periocular hyperpigmentation; conjunctival hyperemia). Modest risk — manageable side-effects for most users. Access (10%) 4.0 Rx (Latisse — bimatoprost 0.03%). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| SSRIs (sertraline / escitalopram / fluoxetine) | Mental Health | Prescription Selective serotonin reuptake inhibitor | 8.0 | 6.5 | 5.0 | 6.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 6.5 Moderate-Strong. Meaningful effect for the studied population. Safety (25%) 5.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| SNRIs (venlafaxine / duloxetine) | Mental Health | Prescription Dual SERT/NET reuptake inhibitor | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (MDD, GAD, neuropathic pain, fibromyalgia); Moderate (chronic musculoskeletal pain). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 5.0 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). Real risk — monitoring or clinician oversight matters. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Ashwagandha (Withania somnifera) | Mental Health | Herbal Adaptogen | 6.0 | 5.0 | 7.0 | 10.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 7.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Kava (Piper methysticum) | Mental Health | Prescription GABA-A modulator / TRPV1 | 6.0 | 5.0 | 5.0 | 5.0 | C+ 5.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 5.0 Variable by country — OTC US; heavily regulated/banned in UK, Germany, Australia, Canada (though bans partially lifted). Cash-pay, off-label, or jurisdiction-dependent access. Composite 5.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Inositol (myo-inositol / D-chiro-inositol) | Mental Health | Supplement Sugar alcohol / second messenger | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (GI upset at high doses; very well-tolerated otherwise). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| SAM-e (S-adenosylmethionine) | Mental Health | Prescription Methyl donor | 6.0 | 5.0 | 7.0 | 2.0 | C+ 5.6 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (MDD — multiple European and small US RCTs; knee osteoarthritis). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (GI upset; manic switch in bipolar — screen before use; expensive; stability issues in storage). Modest risk — manageable side-effects for most users. Access (10%) 2.0 Rx in EU; OTC in US. Investigational, research-only, or controlled. Composite 5.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| St. John's wort (Hypericum perforatum) | Mental Health | Prescription Natural SSRI-SNRI-like | 8.0 | 5.0 | 5.0 | 10.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (mild-moderate MDD — non-inferior to SSRIs in multiple European RCTs). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 10.0 OTC (US); Rx in Germany (standardized). Easy access — over-the-counter or freely available. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| 5-HTP (5-hydroxytryptophan) | Mental Health | Supplement Serotonin precursor | 3.0 | 3.5 | 5.0 | 10.0 | C- 4.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (depression — small trials; sleep onset). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 5.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 4.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Bupropion (Wellbutrin) | Mental Health | Prescription NDRI | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 5.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Gabapentin / pregabalin | Mental Health | Prescription alpha-2-delta voltage-gated Ca channel modulator | 8.0 | 5.0 | 5.0 | 6.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 5.0 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. Access (10%) 6.0 Rx (pregabalin Schedule V US). Standard prescription channel. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Buspirone | Mental Health | Prescription 5-HT1A partial agonist | 6.0 | 5.0 | 9.0 | 6.0 | B 6.5 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (GAD). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (dizziness, nausea, headache; minimal sedation; no dependence; effect takes 2-4 weeks). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| TMS (transcranial magnetic stimulation) | Mental Health | Supplement Non-invasive neuromodulation | 8.0 | 8.0 | 9.0 | 3.0 | A- 7.8 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 Strong (TRD). Large effect size when the claim holds. Safety (25%) 9.0 Low (scalp discomfort, headache, rare seizures — 0.003% per treatment; contraindicated with intracranial metal/implants). Low risk — minimal side-effect burden in healthy adults. Access (10%) 3.0 In-office; Rx/procedure (covered by many insurers for TRD). Investigational, research-only, or controlled. Composite 7.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Lithium (microdose vs therapeutic) | Mental Health | Mineral Mood stabilizer / geroprotector | 10.0 | 5.0 | 2.0 | 6.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 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 (25%) 5.0 Varies (strong therapeutic; weak microdose). Modest or context-dependent effect. Safety (25%) 2.0 High (therapeutic — narrow therapeutic index, thyroid/renal toxicity, teratogenic); Low (microdose). High risk — serious side-effects at studied doses. Access (10%) 6.0 Rx (lithium carbonate); OTC (lithium orotate microdoses). Standard prescription channel. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Dextromethorphan-bupropion (Auvelity / AXS-05) | Mental Health | Prescription NMDA antagonist + sigma-1 agonist + NDRI | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Phase 3 GEMINI; FDA-approved Aug 2022 for MDD). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 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 (25%) 5.0 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. Access (10%) 6.0 Rx. Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Zuranolone (Zurzuvae) | Mental Health | Hormone GABA-A neurosteroid (positive allosteric modulator) | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 8.0 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 (25%) 5.0 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. Access (10%) 6.0 Rx (Schedule IV; FDA-approved PPD only). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Xanomeline-trospium (KarXT / Cobenfy) | Mental Health | Prescription M1/M4 muscarinic agonist + peripheral antagonist | 8.0 | 8.0 | 5.0 | 6.0 | B+ 7.1 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Phase 3 EMERGENT-2 and EMERGENT-3; FDA-approved Sept 2024). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 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 (25%) 5.0 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. Access (10%) 6.0 Rx (FDA-approved Sept 2024 for schizophrenia). Standard prescription channel. Composite 7.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Melatonin | Sleep | Hormone Pineal hormone | 8.0 | 3.5 | 9.0 | 10.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 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 (25%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 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. Access (10%) 10.0 OTC (US; Rx in UK/EU/Canada where 2mg Circadin is a prescription). Easy access — over-the-counter or freely available. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Magnesium (glycinate / threonate / malate) | Sleep | Supplement Mineral cofactor | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (diarrhea dose-limiting with oxide/citrate; very rare hypermagnesemia in normal renal function). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Glycine | Sleep | Supplement Amino acid / NMDA co-agonist | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate (sleep onset, quality, next-day fatigue — Yamadera 2007, Bannai 2012). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (very well-tolerated; mild sweetness at doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Apigenin | Sleep | Prescription Flavonoid / GABA-A modulator | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (small trials; preclinical sedation/anxiolytic). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (theoretical concerns with anticoagulants; aromatase inhibition not relevant at typical supplement doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Valerian (Valeriana officinalis) | Sleep | Herbal Herbal sedative | 4.5 | 3.5 | 9.0 | 10.0 | B- 5.9 | Apr 2026 |
| Score breakdown Evidence (40%) 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 (25%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (rare hepatotoxicity — case reports disputed as contamination; morning grogginess; paradoxical excitation in some). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| CBD (cannabidiol) | Sleep | Prescription Non-psychoactive cannabinoid | 8.0 | 3.5 | 7.0 | 6.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Dravet/LGS/TSC epilepsy as Epidiolex); Weak-Moderate (sleep — Shannon 2019 case series; anxiety — Bergamaschi 2011 public speaking). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 3.5 Low-Moderate. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 Low-Med (hepatotoxicity — signal in Epidiolex trials; significant CYP450 interactions with warfarin/antiepileptics; sedation; diarrhea). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx (Epidiolex); OTC (supplements with poor regulation). Standard prescription channel. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Trazodone | Sleep | Prescription 5-HT2A antagonist / SARI | 6.0 | 5.0 | 7.0 | 6.0 | B- 6.0 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate (sleep). Modest or context-dependent effect. Safety (25%) 7.0 Low-Med (orthostatic hypotension, dry mouth, priapism — rare but notable emergency, serotonin syndrome with MAOIs). Modest risk — manageable side-effects for most users. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| DORAs (suvorexant / lemborexant / daridorexant) | Sleep | Prescription Orexin receptor antagonists | 8.0 | 8.0 | 7.0 | 4.0 | B+ 7.4 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (chronic insomnia — multiple Ph3 trials; daridorexant has functional daytime improvement data). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 7.0 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. Access (10%) 4.0 Rx (Schedule IV US). Cash-pay, off-label, or jurisdiction-dependent access. Composite 7.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Z-drugs (zolpidem / eszopiclone / zaleplon) | Sleep | Prescription GABA-A alpha-1 positive modulators | 8.0 | 8.0 | 3.5 | 6.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (sleep onset — zolpidem/zaleplon; sleep maintenance — eszopiclone). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 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. Access (10%) 6.0 Rx (Schedule IV US). Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Doxepin (low-dose) | Sleep | Prescription H1 antagonist (low dose) | 6.0 | 5.0 | 9.0 | 4.0 | B- 6.3 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 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. Access (10%) 4.0 Rx. Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Activated charcoal | Detox | Supplement GI adsorbent | 8.0 | 8.0 | 9.0 | 5.0 | A- 8.0 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (acute oral poisonings — standard ED care); Very Weak (generic 'detox' supplementation for healthy people). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong (acute poisoning). Large effect size when the claim holds. Safety (25%) 9.0 Low (black stools expected; constipation; interferes with absorption of medications — dose separation critical). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 OTC / hospital use. Cash-pay, off-label, or jurisdiction-dependent access. Composite 8.0 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Chlorella | Detox | Herbal Single-cell algae | 3.0 | 3.5 | 7.0 | 10.0 | C 4.8 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 4.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Spirulina | Detox | Herbal Cyanobacterium | 3.0 | 3.5 | 7.0 | 10.0 | C 4.8 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 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 (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 4.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Milk thistle (silymarin / silibinin) | Detox | Herbal Hepatoprotective flavonolignan | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (Amanita mushroom poisoning — IV silibinin/Legalon-SIL); Weak (chronic liver disease — mixed trials; hepatitis C — mostly null; NAFLD — small positive signals). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong (Amanita); Weak (general). Large effect size when the claim holds. Safety (25%) 9.0 Low (very well-tolerated; rare GI). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (oral); Rx/compassionate use (IV Legalon-SIL). Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Glutathione (liposomal / IV / S-acetyl) | Detox | Supplement Master intracellular antioxidant | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (IV in APAP overdose and clinical tox); Weak-Moderate (liposomal/oral supplementation — bioavailability issues, modest systemic increases). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Varies. Modest or context-dependent effect. Safety (25%) 9.0 Low (rare sulfur GI issues; IV rare hypersensitivity). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC (oral forms); off-label IV (compounded). Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| DMSA / DMPS (heavy metal chelators) | Detox | Prescription Sulfhydryl chelators | 8.0 | 8.0 | 3.5 | 6.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (confirmed pediatric lead toxicity, severe heavy metal poisoning); Weak (chronic 'low-level' heavy metal burden — provocative urinary testing is invalid science). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong (real toxicity). Large effect size when the claim holds. Safety (25%) 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. Access (10%) 6.0 Rx (DMSA — Succimer / Chemet); DMPS off-label / compounded. Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| EDTA chelation | Detox | Prescription Polyamine chelator | 8.0 | 8.0 | 1.5 | 6.0 | B- 6.2 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (severe lead poisoning); Very Weak (atherosclerosis prevention — TACT 2013 marginal, TACT2 2023 negative for diabetes subgroup). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong (lead). Large effect size when the claim holds. Safety (25%) 1.5 Med-High (hypocalcemia — potentially fatal if infused too fast; renal toxicity; mineral depletion). Severe risk — fatal-potential or unacceptable harm profile. Access (10%) 6.0 Rx (calcium disodium EDTA); OTC 'chelation' suppositories unregulated/unvalidated. Standard prescription channel. Composite 6.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B- | ||||||||
| Calcium-D-glucarate | Detox | Prescription Beta-glucuronidase inhibitor | 3.0 | 3.0 | 9.0 | 10.0 | C+ 5.2 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (breast cancer prevention — rat model; estrogen detoxification — theoretical; some human pharmacokinetic support). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.0 Weak. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (well-tolerated). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.2 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| DIM (diindolylmethane) / I3C | Detox | Herbal Cruciferous phytochemical | 3.0 | 3.0 | 7.0 | 10.0 | C 4.7 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (cervical dysplasia/CIN — small trials; BPH marker changes; estrogen metabolism biomarkers). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.0 Weak. Small or unclear effect even in best-case interpretation. Safety (25%) 7.0 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. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 4.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Modified citrus pectin (MCP) | Detox | Supplement Galactose-rich polysaccharide | 3.0 | 3.5 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 3.0 Weak (lead chelation case series — Eliaz 2006; galectin-3 modulation; early cancer biomarker trials). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 3.5 Low-Med. Small or unclear effect even in best-case interpretation. Safety (25%) 9.0 Low (generally well-tolerated; GI upset occasionally). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Lutein + zeaxanthin | Eye | Herbal Macular carotenoids | 8.0 | 5.0 | 9.0 | 10.0 | A- 7.7 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (AMD progression — AREDS2 formula includes 10 mg lutein + 2 mg zeaxanthin); Moderate (visual performance, glare recovery). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (yellowing of skin at extreme doses; generally very safe). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 7.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A- | ||||||||
| Astaxanthin | Eye | Herbal Carotenoid antioxidant | 6.0 | 5.0 | 9.0 | 10.0 | B 6.9 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 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 (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (well-tolerated; pink skin tinge at extreme doses; caution with anticoagulants at high doses). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 6.9 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| AREDS2 formula | Eye | Supplement Multi-nutrient combination | 8.0 | 8.0 | 9.0 | 10.0 | A 8.5 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (intermediate and late AMD progression — NEI AREDS and AREDS2 trials). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 9.0 Low (copper dosing prevents zinc-induced deficiency; very well-tolerated with modified formula). Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 8.5 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Saffron (Crocus sativus — eye indication) | Eye | Herbal Crocin-rich extract | 6.0 | 5.0 | 9.0 | 8.0 | B 6.7 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (early/intermediate AMD — Falsini 2010, 2012, Piccardi 2012 show ERG improvements). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (at supplement doses; toxic at >5 g). Low risk — minimal side-effect burden in healthy adults. Access (10%) 8.0 OTC. Standard prescription channel. Composite 6.7 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Bilberry (Vaccinium myrtillus) | Eye | Herbal Anthocyanin-rich berry | 2.0 | 5.0 | 9.0 | 10.0 | C+ 5.3 | Apr 2026 |
| Score breakdown Evidence (40%) 2.0 Very Weak (night vision — multiple trials including Cochrane Canter 2004 failed to confirm); Weak (ocular surface dryness, accommodative fatigue). Weak evidence — preclinical, anecdotal, or single-arm only. Benefit (25%) 5.0 Very Weak. Modest or context-dependent effect. Safety (25%) 9.0 Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 10.0 OTC. Easy access — over-the-counter or freely available. Composite 5.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C+ | ||||||||
| Standard annual bloodwork (CBC + CMP) | Diagnostics | Diagnostic Core labs | 10.0 | 10.0 | 10.0 | 6.0 | S 9.6 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (foundational). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low (venipuncture only). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (most insurers cover annual). Standard prescription channel. Composite 9.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → S | ||||||||
| Advanced lipid panel (ApoB + Lp(a)) | Diagnostics | Diagnostic Cardiovascular risk | 10.0 | 10.0 | 10.0 | 6.0 | S 9.6 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (ApoB — better than LDL-C); Very Strong (Lp(a) measurement once). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (may require advocacy — not yet universal standard of care despite guidelines catching up). Standard prescription channel. Composite 9.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → S | ||||||||
| HbA1c / fasting insulin / HOMA-IR | Diagnostics | Diagnostic Glycemic / insulin status | 10.0 | 10.0 | 10.0 | 6.0 | S 9.6 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (HbA1c for diabetes diagnosis/monitoring); Moderate-Strong (fasting insulin/HOMA-IR for early insulin resistance detection before glucose abnormalities). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 9.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → S | ||||||||
| hs-CRP (high-sensitivity C-reactive protein) | Diagnostics | Diagnostic Inflammatory marker | 8.0 | 8.0 | 10.0 | 6.0 | A 8.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (cardiovascular risk stratification — JUPITER, CANTOS). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 8.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Homocysteine | Diagnostics | Diagnostic Methylation / B-vitamin status | 6.0 | 5.0 | 10.0 | 6.0 | B 6.8 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (CV and dementia risk association — causal relationship debated); Strong (deficiency marker for B12/folate). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 6.8 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| Vitamin D (25-OH-D) | Diagnostics | Vitamin Vitamin D status | 8.0 | 8.0 | 10.0 | 6.0 | A 8.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (deficiency/insufficiency identification). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 8.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| Ferritin + iron panel | Diagnostics | Diagnostic Iron status | 10.0 | 10.0 | 10.0 | 6.0 | S 9.6 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (deficiency and overload detection). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 9.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → S | ||||||||
| Thyroid panel (TSH + free T4 + free T3 + antibodies + reverse T3) | Diagnostics | Diagnostic Thyroid function | 10.0 | 8.0 | 10.0 | 6.0 | A+ 9.1 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (TSH for screening); Moderate (full panel adds nuance, particularly for symptomatic patients with 'normal' TSH). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 9.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A+ | ||||||||
| Sex hormones (total/free T, SHBG, E2, LH/FSH, DHEA-S) | Diagnostics | Diagnostic HPG axis | 8.0 | 8.0 | 10.0 | 6.0 | A 8.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong. Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 8.0 Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low. Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx. Standard prescription channel. Composite 8.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A | ||||||||
| DEXA scan (bone density + body composition) | Diagnostics | Diagnostic Imaging | 10.0 | 10.0 | 10.0 | 6.0 | S 9.6 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (bone density screening — osteoporosis); Strong (body composition tracking over time). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 10.0 Very Low (tiny radiation dose — <0.001 mSv). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (bone density covered for screening); body comp often cash-pay ($50-150). Standard prescription channel. Composite 9.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → S | ||||||||
| VO2max testing (cardiopulmonary exercise test) | Diagnostics | Diagnostic Cardiorespiratory fitness | 10.0 | 10.0 | 9.0 | 5.0 | A+ 9.3 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (all-cause mortality prediction — Mandsager 2018 JAMA Network Open; CV outcomes). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 9.0 Low (exertion-related; screen high-risk patients before). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 Cash-pay ($100-500); sports medicine, PT clinics, some health clubs. Cash-pay, off-label, or jurisdiction-dependent access. Composite 9.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A+ | ||||||||
| Coronary artery calcium score (CAC) | Diagnostics | Diagnostic CV imaging | 10.0 | 10.0 | 9.0 | 5.0 | A+ 9.3 | Apr 2026 |
| Score breakdown Evidence (40%) 10.0 Very Strong (CV risk stratification — MESA, FHS; guides statin/aspirin decisions per ACC/AHA). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 10.0 Very Strong. Large effect size when the claim holds. Safety (25%) 9.0 Low (0.7-1.5 mSv radiation; about 6 months of background). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 Cash-pay ($50-300); increasingly insurance-covered in high-risk. Cash-pay, off-label, or jurisdiction-dependent access. Composite 9.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → A+ | ||||||||
| Continuous glucose monitor (CGM — Dexcom / Libre / Stelo) | Diagnostics | Diagnostic Real-time glucose | 8.0 | 5.0 | 9.0 | 6.0 | B+ 7.3 | Apr 2026 |
| Score breakdown Evidence (40%) 8.0 Strong (T1D/T2D management — standard of care); Moderate (dysglycemia and insulin resistance in non-diabetics; behavior modification). Strong human evidence — multiple high-quality trials or meta-analyses. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (skin irritation; data-anxiety/orthorexia concerns in some users). Low risk — minimal side-effect burden in healthy adults. Access (10%) 6.0 Rx (Dexcom, Libre); OTC (Stelo — FDA approved March 2024). Standard prescription channel. Composite 7.3 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B+ | ||||||||
| Whole-body MRI (Prenuvo / Ezra) | Diagnostics | Diagnostic Screening imaging | 4.5 | 5.0 | 5.0 | 3.0 | C 4.6 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate (early tumor detection anecdotal cases); Strong negatives — high false positive rate, no mortality evidence, expensive. Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 5.0 Uncertain. Modest or context-dependent effect. Safety (25%) 5.0 Low physical (no radiation); high psychological (incidentalomas, cascade diagnostics). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Cash-pay only ($1500-2500); not insurance-reimbursed. Investigational, research-only, or controlled. Composite 4.6 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C | ||||||||
| Multi-cancer early detection (Galleri) | Diagnostics | Diagnostic Blood-based cancer screening | 4.5 | 3.0 | 5.0 | 3.0 | C- 4.1 | Apr 2026 |
| Score breakdown Evidence (40%) 4.5 Weak-Moderate (NHS-Galleri 2026 MISSED primary endpoint of reducing late-stage cancers; PATHFINDER 2023 showed workable performance metrics but no mortality data). Mixed or limited evidence — small trials, conflicting results, or thin data. Benefit (25%) 3.0 Weak. Small or unclear effect even in best-case interpretation. Safety (25%) 5.0 Moderate (false positives → extensive cascade workup; false negatives → missed cancer; no mortality benefit established and primary endpoint of NHS-Galleri not met). Real risk — monitoring or clinician oversight matters. Access (10%) 3.0 Cash-pay (~$950); not FDA-approved or insurance-covered in US. Investigational, research-only, or controlled. Composite 4.1 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → C- | ||||||||
| Epigenetic age testing (GrimAge / Horvath / TruAge) | Diagnostics | Diagnostic Biological age | 6.0 | 5.0 | 9.0 | 5.0 | B 6.4 | Apr 2026 |
| Score breakdown Evidence (40%) 6.0 Moderate (mortality and disease prediction in epidemiology — GrimAge strongest); Weak (tracking individual interventions — test-retest variability is problematic). Moderate human evidence — at least one solid RCT or convergent observational data. Benefit (25%) 5.0 Moderate. Modest or context-dependent effect. Safety (25%) 9.0 Low (saliva/blood; psychological impact of result). Low risk — minimal side-effect burden in healthy adults. Access (10%) 5.0 Cash-pay ($200-500 per test). Cash-pay, off-label, or jurisdiction-dependent access. Composite 6.4 0.40·Ev + 0.25·Bn + 0.25·Sf + 0.10·Ax → B | ||||||||
| PM2.5 (fine particulate matter) | Toxins | Air pollutant Air pollution | 10.0 | 10.0 | 5.0 | — | CRITICAL 8.5 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 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 10.0 Very High (population level). Population-level harm magnitude. Prevalence 5.0 High chronic exposure. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | ||||||||
| NO2 (nitrogen dioxide) | Toxins | Air pollutant Air pollution | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (asthma, COPD exacerbation, cardiovascular effects); Moderate (childhood asthma from gas cooking). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High. Population-level harm magnitude. Prevalence 5.0 Med-High chronic. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Ozone (tropospheric) | Toxins | Air pollutant Air pollution | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (respiratory morbidity/mortality, CV effects). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High. Population-level harm magnitude. Prevalence 5.0 Med-High chronic. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Radon | Toxins | Air pollutant Radioactive gas | 10.0 | 10.0 | 5.0 | — | CRITICAL 8.5 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 Very Strong (lung cancer; synergistic with smoking). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10.0 Very High (in exposed homes). Population-level harm magnitude. Prevalence 5.0 Moderate average. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | ||||||||
| Benzene | Toxins | Air pollutant Volatile organic compound | 10.0 | 8.0 | 5.0 | — | HIGH 7.7 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 Very Strong (acute myeloid leukemia, myelodysplasia, aplastic anemia at chronic occupational exposure). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High (chronic). Population-level harm magnitude. Prevalence 5.0 High occupational; lower environmental. Moderate exposure prevalence. Priority 7.7 Magnitude × evidence × prevalence, weighted. | ||||||||
| Formaldehyde | Toxins | Air pollutant VOC / IARC Group 1 | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (nasopharyngeal cancer, leukemia, asthma/irritation). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High chronic (poorly ventilated spaces). Population-level harm magnitude. Prevalence 5.0 High acute in salons; moderate home chronic. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| TCE (trichloroethylene) | Toxins | Air pollutant Chlorinated solvent | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (kidney cancer, non-Hodgkin lymphoma, Parkinson's risk). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High (exposed populations). Population-level harm magnitude. Prevalence 5.0 High occupational/exposed. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Lead | Toxins | Heavy metal Heavy metal / neurotoxicant | 10.0 | 10.0 | 5.0 | — | CRITICAL 8.5 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 Very Strong (IQ deficit, CV mortality, kidney disease — no threshold). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10.0 Very High. Population-level harm magnitude. Prevalence 5.0 High historical; moderate current. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | ||||||||
| Mercury (methylmercury) | Toxins | Heavy metal Heavy metal / neurotoxicant | 8.0 | 5.0 | 5.0 | — | MODERATE 5.9 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (developmental neurotoxicity — Faroe Islands and Seychelles cohorts; CV risk at high intake). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5.0 Moderate. Real but bounded harm magnitude. Prevalence 5.0 Moderate (dietary). Moderate exposure prevalence. Priority 5.9 Magnitude × evidence × prevalence, weighted. | ||||||||
| Arsenic | Toxins | Heavy metal Metalloid / IARC Group 1 | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (skin, lung, bladder cancer; CV disease; developmental effects). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High (exposed). Population-level harm magnitude. Prevalence 5.0 Variable. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Cadmium | Toxins | Heavy metal Heavy metal / nephrotoxicant | 8.0 | 5.0 | 5.0 | — | MODERATE 5.9 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (kidney damage, osteoporosis, lung cancer). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5.0 Moderate. Real but bounded harm magnitude. Prevalence 5.0 Low-Moderate chronic. Moderate exposure prevalence. Priority 5.9 Magnitude × evidence × prevalence, weighted. | ||||||||
| Aluminum | Toxins | Heavy metal Widespread metal | 4.5 | 3.5 | 5.0 | — | MODERATE 4.3 | Apr 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 5.0 Low general; higher occupational. Moderate exposure prevalence. Priority 4.3 Magnitude × evidence × prevalence, weighted. | ||||||||
| BPA / BPS / BPF (bisphenols) | Toxins | Endocrine disruptor | 6.0 | 5.0 | 5.0 | — | MODERATE 5.3 | Apr 2026 |
| Avoidance breakdown Evidence 6.0 Moderate (reproductive, metabolic, neurodevelopmental — mechanistically plausible, human epidemiology mixed). Moderate human evidence — at least one solid RCT or convergent observational data. Magnitude 5.0 Med. Real but bounded harm magnitude. Prevalence 5.0 Low-Moderate chronic. Moderate exposure prevalence. Priority 5.3 Magnitude × evidence × prevalence, weighted. | ||||||||
| Phthalates (DEHP / DBP / BBP / DEP) | Toxins | Endocrine disruptor | 7.0 | 6.5 | 5.0 | — | MODERATE 6.2 | Apr 2026 |
| Avoidance breakdown Evidence 7.0 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 5.0 Moderate chronic ubiquitous. Moderate exposure prevalence. Priority 6.2 Magnitude × evidence × prevalence, weighted. | ||||||||
| PFAS (PFOA / PFOS / GenX) | Toxins | Endocrine disruptor Forever chemicals | 8.0 | 10.0 | 5.0 | — | HIGH 7.9 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 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 10.0 Very High (persistence). Population-level harm magnitude. Prevalence 5.0 Near-universal detectable in US population. Moderate exposure prevalence. Priority 7.9 Magnitude × evidence × prevalence, weighted. | ||||||||
| PBDEs (polybrominated diphenyl ethers) | Toxins | Endocrine disruptor Flame retardant | 8.0 | 5.0 | 3.0 | — | MODERATE 5.3 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (thyroid disruption, neurodevelopmental effects). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5.0 Medium. Real but bounded harm magnitude. Prevalence 3.0 Low-Moderate (declining but persistent). Limited or context-specific exposure. Priority 5.3 Magnitude × evidence × prevalence, weighted. | ||||||||
| Parabens (methyl / propyl / butyl) | Toxins | Endocrine disruptor Preservative / weak estrogen | 4.5 | 3.5 | 3.0 | — | LOW 3.7 | Apr 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 3.0 Low-Moderate. Limited or context-specific exposure. Priority 3.7 Magnitude × evidence × prevalence, weighted. | ||||||||
| Triclosan / triclocarban | Toxins | Endocrine disruptor Antimicrobial | 6.0 | 3.5 | 3.0 | — | MODERATE 4.1 | Apr 2026 |
| Avoidance breakdown Evidence 6.0 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 3.0 Declining (banned uses). Limited or context-specific exposure. Priority 4.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Acrylamide (high-heat cooking) | Toxins | Cooking byproduct Maillard byproduct | 6.0 | 3.5 | 5.0 | — | MODERATE 4.7 | Apr 2026 |
| Avoidance breakdown Evidence 6.0 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 5.0 Moderate dietary. Moderate exposure prevalence. Priority 4.7 Magnitude × evidence × prevalence, weighted. | ||||||||
| Aflatoxins | Toxins | Mycotoxin | 10.0 | 10.0 | 5.0 | — | CRITICAL 8.5 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 Very Strong (hepatocellular carcinoma — synergistic with HBV); Strong (dietary exposure in developing countries). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10.0 Very High in exposed regions. Population-level harm magnitude. Prevalence 5.0 Low in developed countries; high in parts of sub-Saharan Africa and South Asia. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | ||||||||
| Ochratoxin A | Toxins | Mycotoxin | 6.0 | 3.5 | 5.0 | — | MODERATE 4.7 | Apr 2026 |
| Avoidance breakdown Evidence 6.0 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 5.0 Low-Moderate ubiquitous. Moderate exposure prevalence. Priority 4.7 Magnitude × evidence × prevalence, weighted. | ||||||||
| Glyphosate (Roundup) | Toxins | Pesticide Broad-spectrum herbicide | 3.0 | 5.0 | 3.0 | — | LOW 3.8 | Apr 2026 |
| Avoidance breakdown Evidence 3.0 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 5.0 Moderate (disputed). Real but bounded harm magnitude. Prevalence 3.0 Low-Moderate (ubiquitous residue exposure). Limited or context-specific exposure. Priority 3.8 Magnitude × evidence × prevalence, weighted. | ||||||||
| Organophosphate pesticides (chlorpyrifos / malathion) | Toxins | Pesticide Acetylcholinesterase inhibitor | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (acute poisoning; developmental neurotoxicity — Mt Sinai/Rauh work showed IQ deficits). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 High. Population-level harm magnitude. Prevalence 5.0 High occupational/agricultural; moderate dietary. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Neonicotinoids (imidacloprid / clothianidin) | Toxins | Pesticide Neurotoxic insecticide | 8.0 | 5.0 | 5.0 | — | MODERATE 5.9 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (pollinator decline — colony collapse); Weak-Moderate (human developmental concerns). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5.0 Varies (ecosystem vs human). Real but bounded harm magnitude. Prevalence 5.0 Low direct; high ecological. Moderate exposure prevalence. Priority 5.9 Magnitude × evidence × prevalence, weighted. | ||||||||
| DBPs (disinfection byproducts — trihalomethanes, haloacetic acids) | Toxins | Endocrine disruptor Chlorination byproducts | 6.0 | 3.5 | 5.0 | — | MODERATE 4.7 | Apr 2026 |
| Avoidance breakdown Evidence 6.0 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 5.0 Low-Moderate ubiquitous. Moderate exposure prevalence. Priority 4.7 Magnitude × evidence × prevalence, weighted. | ||||||||
| Fluoride (high-dose) | Toxins | Water contaminant Controversial | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 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 8.0 Strong (dental); Disputed (neuro). Population-level harm magnitude. Prevalence 5.0 Low at community doses; higher where natural levels elevated. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Microplastics / nanoplastics | Toxins | Water contaminant Emerging contaminant | 3.0 | 4.0 | 5.0 | — | MODERATE 4.0 | Apr 2026 |
| Avoidance breakdown Evidence 3.0 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 4.0 Emerging. Real but bounded harm magnitude. Prevalence 5.0 Low-Moderate ubiquitous. Moderate exposure prevalence. Priority 4.0 Magnitude × evidence × prevalence, weighted. | ||||||||
| Tobacco smoke (direct / secondhand) | Toxins | Lifestyle exposure Combustion complex | 10.0 | 10.0 | 10.0 | — | CRITICAL 10.0 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 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 10.0 Very Strong. Population-level harm magnitude. Prevalence 10.0 Very High. Widespread, near-universal exposure. Priority 10.0 Magnitude × evidence × prevalence, weighted. | ||||||||
| Alcohol (ethanol) | Toxins | Lifestyle exposure Neurotoxic psychoactive | 10.0 | 10.0 | 5.0 | — | CRITICAL 8.5 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 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 10.0 Very Strong. Population-level harm magnitude. Prevalence 5.0 Varies by consumption. Moderate exposure prevalence. Priority 8.5 Magnitude × evidence × prevalence, weighted. | ||||||||
| PAHs (polycyclic aromatic hydrocarbons — grilled meats, air) | Toxins | Cooking byproduct Combustion carcinogen | 8.0 | 5.0 | 5.0 | — | MODERATE 5.9 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (colorectal, stomach, lung cancer associations; in utero development). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 5.0 Moderate. Real but bounded harm magnitude. Prevalence 5.0 Low-Moderate dietary. Moderate exposure prevalence. Priority 5.9 Magnitude × evidence × prevalence, weighted. | ||||||||
| EMF / RF exposure (cell phones, Wi-Fi) | Toxins | Lifestyle exposure Non-ionizing radiation | 4.5 | 4.0 | 5.0 | — | MODERATE 4.5 | Apr 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 4.0 Weak-Moderate (disputed). Real but bounded harm magnitude. Prevalence 5.0 Low-Moderate chronic. Moderate exposure prevalence. Priority 4.5 Magnitude × evidence × prevalence, weighted. | ||||||||
| Blue light (evening artificial light at night) | Toxins | Lifestyle exposure Circadian disruptor | 8.0 | 5.0 | 5.0 | — | MODERATE 5.9 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 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 5.0 Moderate. Real but bounded harm magnitude. Prevalence 5.0 Low-Moderate chronic. Moderate exposure prevalence. Priority 5.9 Magnitude × evidence × prevalence, weighted. | ||||||||
| Sedentary behavior / sitting | Toxins | Lifestyle exposure Lifestyle | 10.0 | 10.0 | 10.0 | — | CRITICAL 10.0 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 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 10.0 Very Strong. Population-level harm magnitude. Prevalence 10.0 Very High (modern sedentary lifestyle). Widespread, near-universal exposure. Priority 10.0 Magnitude × evidence × prevalence, weighted. | ||||||||
| Chronic sleep deprivation | Toxins | Lifestyle exposure Lifestyle | 10.0 | 10.0 | 10.0 | — | CRITICAL 10.0 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 Very Strong (all-cause mortality; CV; metabolic; cognitive; immune). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 10.0 Very Strong. Population-level harm magnitude. Prevalence 10.0 Very High (~35% of US adults <7 hr/night). Widespread, near-universal exposure. Priority 10.0 Magnitude × evidence × prevalence, weighted. | ||||||||
| Chronic psychological stress | Toxins | Lifestyle exposure Lifestyle | 8.0 | 8.0 | 5.0 | — | HIGH 7.1 | Apr 2026 |
| Avoidance breakdown Evidence 8.0 Strong (CV mortality, depression, metabolic syndrome, infection risk, accelerated aging). Strong human evidence — multiple high-quality trials or meta-analyses. Magnitude 8.0 Strong. Population-level harm magnitude. Prevalence 5.0 Very High prevalence. Moderate exposure prevalence. Priority 7.1 Magnitude × evidence × prevalence, weighted. | ||||||||
| Loneliness / social isolation | Toxins | Lifestyle exposure Lifestyle | 10.0 | 10.0 | 10.0 | — | CRITICAL 10.0 | Apr 2026 |
| Avoidance breakdown Evidence 10.0 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 10.0 Very Strong. Population-level harm magnitude. Prevalence 10.0 Very High (US Surgeon General 2023 advisory declared 'epidemic'). Widespread, near-universal exposure. Priority 10.0 Magnitude × evidence × prevalence, weighted. | ||||||||
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