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Without adequate phosphatidylcholine, fat and cholesterol accumulate in the liver (see Deficiency)

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[DOI] [PMC free article] [PubMed] [Google Scholar] 564.Tietz NW, Shuey DF

The nausea and appetite suppression share the same mechanism, so temporary nausea often precedes sustained weight loss

Most side effects of Orlistat are only temporary reactions to the unabsorbed fat, so they are a good indication that the medication is working, and they may even decline with continued use
