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In addition to the GI societies, many anesthesiologists also expressed concern over the ASAs recommendations

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This is usually due to: Lower calorie intake Reduced carbohydrate intake Overall lower energy availability You may notice: Slight decreases in strength Less endurance during workouts Reduced muscle pump During this phase, the goal should be: maintaining muscle and strength, not chasing new personal records

Titration should be gradual to minimize side effects, but it typically takes 1620 weeks to reach therapeutic levels