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Physician uncertainty and diagnostic discomfort may confirm patient perceptions of being misunderstood

Gut Microbes 10(6):688695

Other contributing factors include medication interactions (certain psychiatric medications, corticosteroids, and reduced exposure to oral contraceptives during dose escalation), hormonal changes (thyroid dysfunction, menopause), inadequate sleep (less than 7 hours nightly), chronic stress with elevated cortisol, and reduced physical activity as patients become more comfortable at their current weight