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Poor sleep increases cortisol, which impedes weight loss and worsens mood, potentially undermining both medications intended effects

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Anesthesiology 125:133146 Zhang X, Liu S, MG P, Newport GD, Callicott R, Berridge MS, Apana SM, Jr SW, C W (2013) Protective effects of acetyl l-carnitine on inhalation anesthetic-induced neuronal damage in the nonhuman primate

That, together with the Cleveland Clinic studies showing cardiovascular outcome benefits from bariatric surgery, prompted Dr