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(Aureli A, et al., International Journal of Molecular Sciences, 2023 PubMed: 38068911 ) B12 and lipid metabolism A review of pre-clinical and clinical evidence found low B12 is associated with adverse lipid profiles including elevated total cholesterol and LDL, particularly in people with type 2 diabetes

Surgical procedures or conditions that affect the gut, such as gastric bypass surgery or celiac disease, can prevent intrinsic factors from binding to B12 and prevent the body from breaking it down before absorbing the vitamin

At a separate -arrestin recruitment pathway at GLP-1R, reta E_max = 40% of native (partial / biased agonism), tirzepatide partial in the same direction, semaglutide full at both pathways

Drop one dose level every 4 weeks (for example, from 10mg to 7.5mg to 5mg to 2.5mg)