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Despite this critical role, and the negative impact previously noted of B12 deficiency in relation to mitochondrial health, the effects of B12 on skeletal muscle remain underexplored and, to our knowledge, have not been mechanistically evaluated

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The combination with Cagrilintide is not studied in the literature and theoretically: Cagrilintide + Tirzepatide would lead to a three-way appetite suppression (GIP + GLP-1 + amylin), potentially supra-additive, but with the risk of strong nausea and loss of muscle mass Cagrilintide + Retatrutide would be a four-way activation, highly speculative For research it is an alternative, not a combination , choose one strategy