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[DOI] [PubMed] [Google Scholar] 29.Hollanders JJ, et al

If you start this protocol without baseline liver function tests (AST, ALT, GGT) and oxidative stress markers (MDA, GSH levels), you're guessing whether the intervention is working or just shifting fat around without net loss

In Study 4, patients received an initial 8-week low-calorie diet (total energy intake 1,000 to 1,200 kcal/day) followed by 60 weeks of a reduced calorie diet(1200-1800 kcal/day) and increased physical activity (100 mins/week with gradual increase to 200 mins/week)

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The balance sheet adds support, with debt-to-EBITDA under 2x providing financial optionality