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Sleep and stress management Poor sleep amplifies pain perception through multiple mechanisms, including increased cortisol, reduced endogenous opioid activity, and impaired glymphatic clearance of inflammatory mediators

Nakamura specializes in holistic health and weight management via telehealth

Muscle loss reduces your metabolism, makes you look less toned despite the lower number on the scale, and sets you up for rapid weight regain if you ever stop the medication

Progress check-ins, symptom review, lab panels, and dose titration adjustments are built into the program

All participants received regular lifestyle counselling from a dietitian or qualified health professional to help them adhere to healthful, balanced meals, with a deficit of 500 calories per day and at least 150 minutes of physical activity per week