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WADA prohibition remains in force for tested athletes regardless of regulatory changes elsewhere

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Urgent situations requiring immediate medical attention include: Severe, persistent abdominal pain (with or without vomiting), which may indicate pancreatitis Signs of gallbladder disease (right upper quadrant pain, nausea) Persistent vomiting leading to inability to keep fluids down or signs of dehydration Specific situations requiring consultation include: Persistent gastrointestinal symptoms (nausea, vomiting, diarrhea) lasting beyond the initial adjustment period Unintended weight loss exceeding clinical targets or occurring too rapidly Signs of nutritional deficiency such as fatigue, weakness, hair loss, brittle nails, or neurological symptoms Difficulty meeting protein or caloric needs through diet alone Consideration of high-dose supplements or specialized nutritional products Use of multiple supplements or herbal products with potential interactions Need for medication adjustments if also taking insulin or sulfonylureas to prevent hypoglycemia Patients who are pregnant, planning pregnancy, or breastfeeding should discuss all medications and supplements with their healthcare provider, as certain products may be contraindicated

Pharmacotherapy, when used in conjunction with lifestyle intervention, has been shown to amplify the positive results of lifestyle intervention alone

10.1038/mi.2011.18 14 DuncanM.DavisonJ

If results of genetic testing are unremarkable, consider other known neurotransmitter disorders (e.g