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Description
As fat cells expand, they begin to produce more NNMT, an enzyme that disrupts normal metabolic function

Pharm Genom

This includes both behavioral and biochemical mechanisms

This suggests either these types of reactions do not occur by some function of the higher dosage, that they do occur but are mitigated by close consideration of electrolyte balance and/or other variables, or that they do occur but are simply not reported

Efficacy should be hedged accordingly the trials tell us what the drug does in a controlled trial population, not what any individual using research material will experience