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First-pass metabolism occurs when a large portion of L-arginine gets broken down by the enzyme arginase in your liver and intestines before it can reach your bloodstream

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Liao B et al

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This overlap makes B12 deficiency easy to miss during GLP-1 therapy, because both the patient and the prescriber attribute these symptoms to the medication itself rather than investigating a correctable nutritional deficit

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Nausea, vomiting, and diarrhea are the most frequently reported adverse events, typically mild to moderate in severity and decreasing over time

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