Browse the evidence

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.

A single measurement of plasma hormone levels can reliably categorize average levels over at least a 3-year period in postmenopausal women.

Practitioners can rely on a single hormone measurement to assess average levels in postmenopausal women over a few years.

Intraclass correlation coefficients (ICCs) for plasma hormone levels ranged from 0.53 to 0.92, indicating good reliability for most hormones.

Practitioners can trust the reliability of hormone level measurements based on ICC values.

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.

Acute exercise triggers a redistribution of blood flow and metabolic substrate utilization across organs, with increased perfusion to working muscles and brain areas controlling movement, while vasoconstriction occurs in visceral organs.

During exercise, your body prioritizes blood flow to your muscles and active brain regions. This is a normal and necessary physiological response that ensures working tissues receive enough oxygen and nutrients.

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.

Bariatric surgery significantly reduces the incidence of mortality and cardiovascular diseases compared to best non-surgical care in patients with obesity.

Bariatric surgery offers a dramatic reduction in mortality and cardiovascular disease risk compared to non-surgical weight loss methods. For patients with obesity, surgery is the most effective intervention for long-term survival and cardiovascular health.

Insulin resistance and impaired insulin secretion are the primary physiological precursors to the development of non-insulin-dependent diabetes mellitus (NIDDM), with insulin resistance preceding hyperinsulinemia and hyperglycemia.

Diabetes risk is driven by how your body handles insulin, not just blood sugar levels. If you have a family history or risk factors, prioritize improving insulin sensitivity through regular physical activity and maintaining a healthy weight, as these factors precede the onset of high blood sugar.

Natural menopause is associated with a significantly increased risk of coronary heart disease in women, with the risk rising sharply in the years immediately following menopause.

After menopause, your risk of heart disease rises significantly. This is a biological shift, not just aging. Prioritize heart-healthy habits like regular exercise, a balanced diet, and regular check-ups to manage this increased risk proactively.

High intake of seafood is associated with a significantly increased risk of gout, with the effect being stronger in men with a body mass index (BMI) less than 25 compared to those with a BMI of 25 or higher.

For men with gout, avoiding seafood is generally recommended. However, this risk appears to be particularly pronounced in men who are not overweight (BMI < 25). If you are overweight, the link between seafood and gout may be less distinct, though avoidance is still prudent. Focus on meat and seafood reduction as primary dietary levers.

Consumption of purine-rich vegetables (peas, beans, lentils, spinach, mushrooms, oatmeal, cauliflower) is not associated with an increased risk of gout.

You do not need to restrict purine-rich vegetables such as spinach, mushrooms, beans, or lentils if you have gout. Unlike meat and seafood, these plant-based foods do not appear to increase your risk of gout attacks.

Dysfunctional adipose tissue, particularly visceral fat, drives CKM syndrome by secreting proinflammatory and prooxidative products that damage arterial, cardiac, and kidney tissues, leading to insulin resistance and systemic inflammation.

Excess visceral fat is not just stored energy; it actively releases harmful substances that damage your heart, kidneys, and blood vessels. Managing your weight, specifically reducing visceral fat, is a key medical strategy to reduce inflammation and protect your organs.

ER stress and mitochondrial dysfunction in adipocytes are central mechanisms linking obesity to systemic insulin resistance and inflammation.

Understanding that cellular stress drives disease highlights the importance of reducing the load on adipocytes through weight loss and metabolic health improvements.