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Other concerning symptoms that necessitate medical consultation include: Severe abdominal distension or inability to pass gas/stool (possible ileus or bowel obstruction) Nausea that worsens rather than improves after 812 weeks Inability to maintain adequate nutrition or hydration Unintentional weight loss exceeding clinical targets New or worsening heartburn or reflux symptoms Visual changes (especially with rapid blood sugar improvement) Severe headache or altered mental status Signs of gallbladder disease (right upper quadrant pain, especially after eating) Hypoglycemia symptoms if taking insulin or sulfonylureas Patients should generally not discontinue GLP-1 medications without medical guidance, except in emergencies such as suspected pancreatitis or severe allergic reaction

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Moreover, Sirius Red staining showed that the l-carnitine groups had decreased deposition of type I collagen fibers compared to the ACLT group (Fig

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