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Instead, active B12 is much better absorbed through the mucosa membrane (or under the tongue sublingually)

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Avoid tirzepatide if you have a personal or family history of medullary thyroid carcinoma or MEN 2 (boxed warning), a history of pancreatitis, severe gastrointestinal motility disease, or known hypersensitivity to tirzepatide

The link is there but literature is unclear on whether TMAO is a bystander or a mediator (Janeiro et al

Angiogenesis and fibrogenesis in chronic liver diseases