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Institute of Medicine (US) Committee on Nutrition, Trauma, and the Brain, Erdman J, Oria M, Pillsbury L

& Wang, G

Serious adverse events are rare but include pituitary axis suppression with long-term high-dose use and worsening insulin resistance in patients with pre-existing glucose issues

Raun et al

The slightly lower result at 12mg (23.2%) likely reflects the smaller sample size at this dose rather than diminishing returns, though further research will clarify this relationship