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doi: 10.1016/j.tem.2020.02.006 133 LudwigDSEbbelingCB

Avoid combining with compounds that have overlapping mechanisms unless specifically guided by a medical professional

It is an excellent option for individuals experiencing sluggishness or the effects of everyday stress and environmental exposure

Contact your GP or diabetes specialist nurse if you experience: Severe or worsening cold intolerance that significantly impacts daily activities or quality of life Cold sensitivity accompanied by other symptoms such as extreme fatigue, persistent constipation, unexplained weight gain, depression, cognitive difficulties, or changes in menstrual patterns (which may suggest thyroid dysfunction) Dizziness, palpitations, or shortness of breath alongside feeling cold (potentially indicating anaemia or cardiovascular concerns) Rapid or excessive weight loss (more than 0.5-1 kg weekly sustained over several weeks) Difficulty maintaining adequate nutrition due to severe appetite suppression or persistent nausea Any new or concerning symptoms that develop after starting GLP-1 therapy Your GP may arrange investigations to exclude other causes of cold intolerance, which typically include: Thyroid function tests (TSH, free T4) to assess for hypothyroidism Full blood count to check for anaemia Ferritin and iron studies if anaemia is suspected Vitamin B12 and folate levels , particularly if you're taking metformin (which can reduce B12 levels) or have dietary restrictions Review of weight loss trajectory and nutritional adequacy In most cases, reassurance and practical management strategies will be sufficient