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Methionine (2550mg per injection) acts as the primary methyl donor in hepatic fat metabolism, while methylcobalamin (10002500mcg per injection) functions as a cofactor in the methylation cycle

Its overactivation disrupts nicotinamide metabolism, reduces NAD+ levels, promotes hepatic lipid accumulation and lipotoxicity, and represents an important therapeutic target for hepatic metabolic disorders

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Members of Second Natures Mounjaro programme have also reported experiencing this side effect

The potential relationship between tirzepatide and the gut microbiome is not fully understood, making it an appealing area of study