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[1] The cause is unknown in most cases

The endogenous ligands of GLP-1-producing neurons were found to innervate the brainstem raphe nuclei (Llewellyn-Smith et al., 2013)

Avoid pinching too tightly , as excessive pressure can damage capillaries

This is a theoretical rather than documented concern with Pendulum specifically, but it is worth monitoring INR more frequently during the first month if you take warfarin