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While tirzepatide slows gastric emptying and reduces caloric intake through incretin receptor activation, 5-amino-1MQ works intracellularly to inhibit nicotinamide N-methyltransferase (NNMT), shifting cellular metabolism toward fat oxidation independent of appetite suppression

For example, people with pernicious anemia might need different doses because they cant make the right proteins

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The irony, as you point out, is that this same rigidness does not apply to other medications that can be prescribed in a more flexible manner

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