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However, indirect mechanismsincluding reduced caloric intake from appetite suppression, gastrointestinal symptoms affecting nutrition, and metabolic changes from weight lossmay contribute to feelings of fatigue

Conversely, calorie restriction, a ketogenic or low-carbohydrate diet, cuts fasting insulin by 3070% and IGF-1 by 1540% 2

Toxins 15 , 242 (2023)

At the very least, they should pay attention to the advice given in the article they cite in their report's footnote 15, which expressly states: "The use of breed-specific VHS values is needed for the VHS method to have a high specificity for normal heart size." We would prefer using a patient-specific VHS value, rather than just breed-specific, but either one is better than a reckless, species-wide "median" VHS value