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If usable B12 is inadequate, both accumulate

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Anemia, which results from a shortage of red blood cells, is a common source of physical exhaustion

PMID: 1692663

Occupancy stays low, but each engaged receptor keeps sending its main message longer than it would under a balanced signal (cAMP bias with low receptor internalization). In a head-to-head trial against liraglutide, tirzepatide reduced measured food intake and craving more despite lower GLP-1 occupancy. The effect lowers the drive to eat rather than increasing restraint