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The most commonly reported issues include: Caffeine-related effects : Jitters, anxiety, trouble sleeping (contains about as much caffeine as 1.5 cups of coffee per dose) Digestive discomfort : Nausea or upset stomach, particularly when first starting Energy fluctuations : Some users report feeling wired then crashing The nopal cactus fiber can cause bloating or gas in sensitive individuals

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Journal of Translational Medicine 2011, 9:25 Later we conducted a similar analysis based on patients who had rheumatoid arthritis and were treated with IVC