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The reduced caloric intake, combined with metabolic adaptation, can produce feelings of low energy during the first several weeks at each new dose level

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Moreover, compromised intestinal barrier integrity and gut-derived microbial components such as LPS activate TLR/NF-B/NLRP3 pathways, which not only drive systemic inflammation but also modulate gut-derived tryptophan metabolism and serotonin synthesis, thereby coupling immune regulation with neuromodulatory functions