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Exercise increases muscle sensitivity to GH, while fasting reduces insulin spikes that can suppress GH secretion

Biomolecules 9:129

Recent research suggests that metformin may also alter the gut microbiota, through the protection of the intestinal barrier, promotion of SCFAs producing bacteria growth, regulation of bile acids plasmatic levels and their excretion, and direct regulation of growth of bacteria with a positive effect on glucose homeostasis (eg., Akkermansia muciniphila ) (Zhang and Hu, 2020)

Sources Chiang PK, Gordon RK, Tal J, Zeng GC, Doctor BP, Pardhasaradhi K, McCann PP

Microorganisms 7 , 681 (2019)

These and other genetic polymorphisms influence how individuals respond to ketogenic diets in terms of thyroid hormone activation, metabolic efficiency, and fat handling