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Your metabolism can be running on far less energy than it should, even with "normal" labs, which is often why someone feels cold, tired, foggy, and stuck on the scale all at once, but keeps being told everything looks fine

van Vliet S, Koh HE, Patterson BW, Yoshino M, LaForest R, Gropler RJ, et al

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The results of pharmacological strategies to suppress abnormal microglial activity support the involvement of these cells in the development of disease-induced neuroinflammation and behavioral alterations [116]