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reduce high GI carbs late at night Moderate dose to 1020 mg/day Consider cycling 1216 weeks on, 4 weeks off Prolonged IGF-1 elevation may reduce peripheral insulin sensitivity, though the effect is reversible and dose-dependent. Yuen et al., Hormone and Metabolic Research 5

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Then we calculate an additional budget neutrality factor to account for the application of the 10-percent cap on MS-DRG relative weight decreases