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Patients who report constipation starting in weeks 1-4 fall into two groups by week 6: Group 1 (adapters, ~65% of those with early constipation): Bowel movement frequency has stabilized or started improving by week 6
Furthermore, there is a lack of randomized controlled trials, standardized outcome measures, and long-term follow-up reports
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These shifts compromise intestinal barrier integrity, promote metabolic endotoxemia, and activate toll-like receptor-driven oxidative and inflammatory cascades that propagate IR and HA
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