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This can manifest as diffuse darkening across the lip surface but also as localized dark spots, particularly on the lower lip and the vermilion border

23 In addition, high insulin levels resulting from insulin resistance can further increase hyperandrogenism and worsen hormone imbalance

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The Cuban-born runner was a college star at Oregon, then went onto win four major marathon titles in New York and Boston from 1980-82

More recent systematic reviews and meta-analyses published between 2020 and 2022 have broadly confirmed this picture, reporting small, short-term reductions in body weight and body mass index, particularly in older adults and individuals with obesity or metabolic conditions, but with effect sizes that remain clinically modest