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If similar effects occur in humans, adding niacinamide to a tirzepatide regimen could theoretically amplify fat loss and improve metabolic flexibility

However, the IGF-I gene expression decreased with increasing severity of MASLD, suggesting that reductions of hepatic IGF-I production in patients with MASLD may be related to the severity of the damaged hepatocytes

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The effect is mechanical: tirzepatide slows gastric emptying by 4050%, which increases glutathiones residence time in the acidic stomach where the tripeptide structure degrades before reaching the alkaline small intestine where absorption occurs