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Unlike metformin, which has a well-documented association with reduced vitamin B12 absorption, tirzepatide has not demonstrated a similar pharmacological mechanism that would directly interfere with B12 metabolism or absorption in the terminal ileum

It is proposed to work by binding GHRH receptors on pituitary somatotroph cells, prompting the pituitary to synthesize and release its own growth hormone in a pulsatile pattern, with the body's somatostatin feedback loop still intact so the effect is self-limiting rather than a constant hormone flood

A 2020 study published in Nutrients has also found that vitamin D deficiency can affect platelet levels and can lead to cardiovascular risks ( 13 )

The cancer connection is currently theoretical but plausible given these biological effects

Yes, if you have a history of cold sores, Fraxel can trigger an outbreak