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Early studies showed that growth hormone did not directly stimulate the incorporation of sulfate into cartilage, but rather acted through a serum factor, termed 'sulfation factor,' which later became known as 'somatomedin'

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While inconvenient, its much lower than the diarrhea reported in up to 30% of people taking prescription injectables, see Wegovy Medication Guide, which also lists 44% rate of nausea

These conditions indicate prior severe acid damage, and any worsening of reflux could accelerate disease progression