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Some studies reveal short-term spikes in cortisol levels during early fasting stages, while others observe changes in diurnal rhythms or reductions in cortisol levels with ongoing adherence to time-restricted eating [47]

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This poor absorption is driven by extensive first-pass metabolism in the liver and active clearance by P-glycoprotein efflux pumps in the intestines, which actively push the berberine back out into the gut lumen