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International journal of endocrinology, 201

In autoimmune disease, the balance tilts heavily toward M1

Tsukamoto K, Jackson IJ, Urabe K, Montague PM, Hearing VJ

They say they look much more sad or tired than they feel. The commonality between those two interventions is that theyre associated with very rapid weight loss, which all three doctors posit could be an exacerbating factor here, leading to a more severe version of what happens with any weight loss, as Somogyi puts it