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GSH moderates the ISR gene expression during cystine starvation Activation of the ISR elevates ATF4 to increase expression of genes which contain the amino acid response elements (AARE) 16

Loss of GSH synthesis resulted in a decreased expression of lipogenic enzymes, including SCD1

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lean mass) Follow-Up Every 6-8 Weeks During Active Weight Loss Repeat metabolic labs Body composition reassessment Medication adjustments for blood pressure, diabetes meds as needed Side effect assessment and management Nutritional adequacy check Adherence to protein targets and strength training What I'm Watching For Body composition changes: If you're losing more than 20% of your weight from muscle, we adjust immediately

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