Proposed, sometimes contradictory, mechanisms for cardiorenal protective effects with SGLT2 inhibitors include enhancement of fuel supply through the production of ketones (the thrifty substrate hypothesis) [118, 119]
Someone with a GIPR rs1800437 variant that strongly activates the glucose-dependent insulinotropic polypeptide pathway, for example, might get more powerful results from tirzepatide than from semaglutide alonewithout ever needing phentermine's cardiovascular stress
Moreover, some NAD + precursors have shown side effects, such as the use of NA at certain doses that might be limited due to skin flushing or induction of insulin resistance 332,333
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CJC-1295/Ipamorelin therapy aims to counteract some of these changes