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The combination of keto and semaglutide involves enough variables, protein grams, net carbs, electrolytes, ketone levels, body weight, that flying blind leads to suboptimal results

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Options for managing tolerance include a brief dose reduction for 4 to 8 weeks ("drug holiday" at a lower dose, not complete cessation), lifestyle optimization to maximize the medication effect, evaluation for other contributing factors (thyroid function, cortisol, sleep quality, medication interactions), and consideration of adding a complementary compound to address specific aspects of the plateau