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The dual-pathway approach engages both the GHRH axis (upstream stimulation of GH synthesis and release) and the ghrelin axis (amplification of GH pulse amplitude) simultaneously, which published preclinical data suggests produces greater GH elevation than either compound alone

Patients on long-term PPIs should have their B12 status monitored periodically, particularly if other risk factors are present

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The Mediterranean diet also includes wine and fish, moderate amounts of poultry (included in Thistles meat meals), and fermented dairy products.