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The expression of intestinal endocrine Lcells is regulated by several key receptors activated by short chain fatty acids (SCFAs), specific endogenous cannabinoids and bile acids, and the activation of these receptors increases the secretion of key intestinal peptides, such as GLP-1, GLP-2 and polypeptide YY (PYY) ( in vitro , leading to an increase in GLP-1 release (Petersen et al., 2014)

This persistent downregulation of Irs2 is especially intriguing, as it may reflect a broader impairment of downstream insulin/IGF-1 signaling, potentially indicating alcohol-induced desensitization to insulin or IGF-1 at the cellular level

For travel periods exceeding 48 hours without refrigeration access, discuss alternative arrangements with your provider

if you experience chest pain, shortness of breath, or fainting, seek emergency evaluation