INS and serum lipopolysaccharide activity: Based on current evidence, we hypothesize that the combined intervention may act through microbiome-mediated pathways—such as increased short-chain fatty acid production, improved intestinal barrier integrity with reduced endotoxemia, and altered bile-acid signaling—thereby contributing to the observed improvements in insulin resistance and lipid profiles; future work should incorporate fecal metagenomics/metabolomics and SCFA/bile-acid profiling to test these mechanisms (Zhang et al., 2022).