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[2] [5] Berberine is also associated with gastrointestinal upset, including diarrhoea, constipation, flatulence, and abdominal cramping

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Neurotoxic reactive astrocytes are induced by activated microglia

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The mechanism is not fully understood but may involve immune system activation triggered by the medication itself, changes in metabolic state during rapid weight loss, or interaction with other medications you are taking