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Though a B12 deficiency can explain some of her findings, this patient continued to worsen despite B12 supplementation, and normalization of her B12 level suggests her presentation cannot be entirely attributed to vitamin B12 deficiency

8 Treatment eligibility includes adults with obesity disease who have a BMI 35 kg/m and at least 1 of the following conditions hypertension, dyslipidemia, or type 2 diabetesor a BMI 27 kg/m with at least 2 obesity-related health disorders

Patients may look elsewhere If compounded supply falls, some patients may be tempted to buy GLP-1 drugs from sources outside the United States

Fiber feeds microbes

Including proton pump inhibitors and other acid-suppressing medications, metformin, and more