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The daily requirement is the most commonly cited drawback

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This is usually due to: Lower calorie intake Reduced carbohydrate intake Overall lower energy availability You may notice: Slight decreases in strength Less endurance during workouts Reduced muscle pump During this phase, the goal should be: maintaining muscle and strength, not chasing new personal records

In addition to the GI societies, many anesthesiologists also expressed concern over the ASAs recommendations

Ferrell JM, Dilts M, Pokhrel S, Stahl Z, Boehme S, Wang X, et al

Titration should be gradual to minimize side effects, but it typically takes 1620 weeks to reach therapeutic levels