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Similarly, Lincoff et al59 conducted an RCT enrolling 17,604 patients aged 45 years or older with pre-existing cardiovascular disease and a BMI of 27 or higher but without a history of diabetes

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There are a few reasons why I believe this

In fact, studies noted around a 4% weight reduction in the first month on average [33][34]

Some patients benefit substantially, while others show no improvement, suggesting that histamine intolerance is not the sole mechanism behind symptoms