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Keto increases renal excretion of sodium because low insulin reduces sodium reabsorption in the kidneys
doi: 10.1210/clinem/dgz175 4 NauckMAHeimesaatMMOrskovCHolstJJEbertRCreutzfeldtW
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Or if you have a lot of epicardial fat, this could also induce more work for the heart
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