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The principal intestinal bacteria implicated in bile acid metabolism include Bacteroides , Clostridium , Lactobacillus , Bifidobacterium , and Ruminococcus
Poor sleep elevates ghrelin (the hunger hormone) and reduces leptin (the satiety hormone), directly counteracting the appetite-suppressing effects of retatrutide
Their complementary mechanisms therefore provide a strong biological rationale for combination therapy in cardiometabolic risk reduction (Table 1, Supplemental Figure)
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