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Published January 2, 2022

B.MelloS

These include vitamin B12 deficiency and malabsorption that is caused by the following medical conditions, according to the NIH [1]: Pernicious anemia Tropical sprue Pancreatic insufficiency Surgery in the gastrointestinal tract Certain medications Deficiency in the diet Side effects of B-12 injections Also, according to the NIH, vitamin B-12 injections have some potential side effects, including [1]: Diarrhea Itching Swelling Risk of allergic reaction and anaphylaxis Can Vitamins Aid in Weight Loss

Regul Pept 102:147156 [DOI] [PubMed] [Google Scholar] Shou WZ, Magis L, Li AC, Naidong W, Bryant MS

Your body adapts to the mechanism of action, and while the therapeutic appetite suppression continues, the unpleasant side effects resolve

Aggressive simultaneous protocol (higher risk) Simultaneous start (both from week 1): Tirzepatide standard titration: Same as conservative: 2.5mg 12.5mg over 16 weeks Cagrilintide standard titration (parallel): Weeks 1-4: 0.6mg weekly Weeks 5-8: 1.2mg weekly Weeks 9-12: 1.8mg weekly Week 13+: 2.4mg weekly Aggressive dosing table: Why this is risky: Compounding side effects from start Very difficult to tolerate High dropout risk Unclear if any additional benefit Both hitting stomach simultaneously Potential maximum weight loss: 20-30% body weight (theoretical) Example: 240 lbs 168-192 lbs (48-72 lbs lost) But tolerability extremely questionable Who might attempt: Exceptional GI tolerance Prior success with GLP-1s without nausea Closely monitored by physician Willing to accept high side effect risk Can afford $1,200-2,400/month Understands experimental nature Lower cagrilintide doses with tirzepatide Moderate approach: Tirzepatide: Standard titration to 10-15mg Cagrilintide: Maximum 1.2-1.8mg (lower than standard 2.4mg) Rationale: Tirzepatide doing heavy lifting already Cagrilintide just adds amylin pathway Don't need maximum cagrilintide dose Better tolerability Significantly lower cost Moderate dosing comparison: Verdict: Lower cagrilintide doses (0.6-1.2mg) might be tolerable but benefit questionable