What do we know about health, nutrition, and medicine — and how confident should we be? In this episode, Dr. Gordon Guyatt, the clinician-scientist who coined the term evidence-based medicine and co-created the GRADE framework, breaks down why so much health and nutrition guidance rests on weak foundations. We dig into the hierarchy of evidence, why observational studies so often mislead us, and what went wrong with hormone replacement therapy and antioxidant vitamins. Dr. Guyatt also explains the intense backlash to the NutriRECS red-meat guidelines and why overstating certainty erodes trust in both science and public health.

We also explore the growing influence of health influencers, why acknowledging uncertainty is essential, and how AI could both help and harm evidence-based decision-making. From the limits of nutrition research to the future of trustworthy guidelines, this conversation offers a clear, honest look at what we know — and what we don’t. If you want rigorous, hype-free insight into how evidence should inform health decisions, this episode is for you.

Timestamps

00:00 Introduction 01:10 What evidence-based medicine actually means 04:28 When low-quality evidence misleads (HRT, antioxidants) 07:29 Why most nutrition research is low certainty 11:29 The NutriRECS red-meat guidelines and backlash 17:55 How the nutrition field overstates certainty 21:02 Influencers and misinformation 23:42 AI’s role in evidence-based decision-making 31:58 Why uncertainty and humility matter 32:34 Advice for clinicians and researchers 37:14 How to make recommendations with low-quality evidence

Dr. Gordon Guyatt

X: https://x.com/GuyattGH LinkedIn: https://www.linkedin.com/in/guyattgh McMaster University: https://experts.mcmaster.ca/people/guyatt

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