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This three year trial tested a PRAL diet vs bicarbonate supplementation in CKD patients and showed that the PRAL diet was more effective in preserving GFR and decreasing excretion of beneficial hormones (Goraya et al., 2014)

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Acanthosis nigricans is a common skin condition that often signals an underlying health issue, such as insulin resistance, obesity, or hormonal imbalance

Serious adverse events are rare but include potential insulin resistance with prolonged use beyond 4 weeks and theoretical concerns about IGF-1s mitogenic effects, though no human data confirms increased cancer risk at research doses