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Instead of asking 'why not stack them,' the question becomes 'what specific outcome justifies adding a second compound with incomplete human safety data?' For research exploring maximal metabolic intervention where single-agent tirzepatide has plateaued, the stack may be defensible

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This is because though cobalamin will take a couple of weeks to reach appropriate levels in the body, especially if deficient, it can last in the body for a long time once it reaches appropriate concentrations