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Higher readings are not better for fat loss and may indicate that protein is being sacrificed to maintain deep ketosis, which defeats the entire purpose of combining these approaches

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These may include: Poorly controlled diabetes Elevated cardiac risk Significant visceral adiposity Severe obstructive sleep apnea History of anesthesia difficulty Liver fibrosis or advanced fatty liver disease For these individuals, preoperative medical weight loss is not optional but an essential part of achieving a safe surgical outcome

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