Browse the evidence

In women, an ILI-associated decrease in estradiol of 14% from baseline to year 1 mediated a decline in whole-body BMD of -1.15 mg/cm2.

Practitioners should consider the hormonal changes in postmenopausal women when implementing weight loss interventions.

In men, an ILI-associated increase of 11% in total testosterone mediated a decline of hip BMD of -1.18 mg/cm2.

Practitioners should consider the hormonal changes in older men when implementing weight loss interventions.

ILI-associated changes in estradiol and total testosterone resulted in whole-body and hip bone loss.

Weight loss interventions may lead to hormonal changes that affect bone health in older adults.

Metformin treatment led to a significant decrease in the IGF-1:IGFBP3 molar ratio by 0.0119 at 3 months compared to self-directed weight loss.

Metformin may effectively reduce the IGF-1:IGFBP3 molar ratio in cancer survivors, indicating a potential benefit in hormonal regulation.

Bioactive compounds influence appetite through multiple pathways.

Practitioners should consider the role of bioactive compounds in appetite regulation.

The melanocortin system is regulated by long-term and short-term regulatory hormones and nutrients.

Understanding the regulation of the melanocortin system can aid in appetite management strategies.

Greater total testosterone levels were associated with better verbal fluency in men.

Practitioners may consider that higher testosterone levels could enhance verbal fluency in men with T2DM.

Metformin may have a role in primary and secondary prevention of cardiovascular disease.

Practitioners may consider metformin for cardiovascular disease prevention in diabetic patients.

Sodium-glucose transporter 2 inhibitors have a role in both primary and secondary prevention of heart failure.

Sodium-glucose transporter 2 inhibitors may be beneficial for preventing heart failure in diabetic patients.

Ghrelin and leptin are not responsible for the satiating effect of chocolate products.

Practitioners should consider that chocolate may not influence appetite through ghrelin and leptin.

Gastric infusion of milk chocolate elicits a greater increase in cholecystokinin (CCK) compared to oral ingestion of milk chocolate and gastric infusion of non-caloric products.

Infusing chocolate may be more effective for increasing CCK than oral consumption.

The circadian system streamlines production of all the essentials for life.

Understanding the role of the circadian system can help practitioners optimize health and wellness strategies.

Many factors can alter hormonal expression, including aging, environmental toxins, disease, nutrition, and stress.

Awareness of these factors can help practitioners address hormonal health.

The chapter will give an overview of the most common endocrine disorders and their impact on wellness.

Practitioners can expect insights into common endocrine issues affecting wellness.

Long-term metformin (850 mg twice daily) and intensive lifestyle interventions do not reduce major cardiovascular events in individuals with prediabetes, despite significantly delaying or preventing the onset of type 2 diabetes.

Taking metformin or following a strict lifestyle program to prevent diabetes does not guarantee protection against heart attacks or strokes, even if you successfully avoid developing diabetes. In this long-term study, these interventions prevented diabetes but did not lower cardiovascular event rates compared to placebo, likely because other risk factors (blood pressure, cholesterol) were managed by standard care. Focus on comprehensive risk management, not just glucose control.

Statin therapy causes a moderate, dose-dependent increase in the diagnosis of new-onset diabetes and worsening glycaemia, with high-intensity regimens producing a 36% relative increase compared to a 10% increase for low/moderate-intensity regimens.

If you are taking statins, be aware that they can slightly raise your blood sugar, especially at higher doses. This increases your risk of being diagnosed with diabetes, particularly if your blood sugar was already near the threshold. However, the heart protection benefits of statins far outweigh this small risk. Regular monitoring of your blood sugar is recommended.

The absolute excess risk of new-onset diabetes from statins is highest in individuals whose baseline glycaemic markers are already close to the diagnostic threshold for diabetes.

If you have pre-diabetes or high-normal blood sugar, your risk of developing diabetes while on statins is higher than someone with normal blood sugar. This does not mean you should stop the statin, but it does mean you should monitor your blood sugar more closely and focus on lifestyle changes to keep your blood sugar in check.

Visceral feedback from the gut activates GCG neurons in the cNTS to promote long-lasting satiety (tens of minutes) that tracks cumulative food intake.

The physical presence of food in your stomach and intestines activates GCG neurons, which promote a feeling of fullness that lasts for tens of minutes. This visceral feedback tracks how much you have eaten, contributing to long-lasting satiety after a meal.

Rare deleterious variants in six specific effector genes (MC4R, PCSK1, POMC, CALCR, BSN, and CORO1A) are significantly associated with BMI at the population level, with CORO1A being a newly identified genetic risk factor for obesity.

Genetic testing can identify individuals with rare variants in genes like CORO1A, MC4R, or PCSK1 who are at higher risk for severe obesity. Knowing this early can guide personalized prevention strategies, such as early lifestyle interventions or targeted pharmacological therapies, before significant weight gain occurs.

Race and geographic region significantly modify the risk of new-onset diabetes in people with HIV, with higher rates observed in South Asia and among Black or African American individuals in high-income regions.

If you are from South Asia or are Black/African American, you may have a higher baseline risk for diabetes. Work with your healthcare provider to monitor your blood sugar and weight closely, as these risks can be managed with lifestyle changes.

SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin) reduce cardiovascular death and heart failure hospitalizations in patients with type 2 diabetes, heart failure, or chronic kidney disease, regardless of baseline glycemic control.

If you have heart failure, kidney disease, or high-risk diabetes, ask your doctor about SGLT-2 inhibitors (like Jardiance, Farxiga, or Invokana). These drugs protect your heart and kidneys, not just your blood sugar. The benefits are proven to reduce hospital stays and death, even if your blood sugar is already well-controlled.

Existing FDA-approved smoking cessation medications (varenicline, nicotine replacement therapy, and bupropion alone) provide only modest attenuation of post-cessation weight gain and do not eliminate it.

Standard smoking cessation drugs like patches, gum, or varenicline will help you quit, but they are not designed to stop you from gaining weight afterward. Expect modest weight changes, but do not rely on them to maintain your weight.

Aggressive blood glucose lowering (targeting HbA1c < 6.5%) in type 2 diabetes does not necessarily reduce cardiovascular risk and may increase overall mortality due to side effects like hypoglycemia and weight gain.

Do not aim for an HbA1c below 6.5% if it requires strong medications that cause low blood sugar or weight gain. The goal is stable, safe blood sugar levels, not the lowest possible number.

SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, sotagliflozin) significantly reduce major adverse cardiovascular events (MACE-3), cardiovascular death, and heart failure hospitalizations in patients with type 2 diabetes and established cardiovascular disease, independent of glycemic control.

If you have Type 2 Diabetes and heart disease or heart failure, SGLT2 inhibitors are a first-line treatment option that protects your heart and reduces hospitalization risk, regardless of your blood sugar levels. Consult your doctor about these specific medications.