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10.1146/annurev-pathol-011110-130138 47 OsmanI.HeX.LiuJ.DongK.WenT.ZhangF.et al (2019)

Even with healthy habits, it can become more difficult to maintain the same level of energy, body composition, and physical performance that once felt natural

The stated reason is that doses on both sides need to stay appropriate as weight and metabolism change, which only works if neither clinician is operating on stale information

That means calorie restriction itself drove the improvements, not just the drop in body weight [9]

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