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Annals of the New York Academy of Sciences, 1194(1), 118124

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In contrast, as the topiramate concentration increased, the B/P ratio decreased from 8 to 2, suggesting a significant and saturable topiramate-RBC binding

It tells the pituitary gland to release more GH, which in turn tells the liver to make more insulin-like growth factor 1 (IGF-1) the hormone that drives a lot of GH's downstream effects on tissue growth, fat metabolism and repair