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Nausea, vomiting, diarrhea, constipation, and appetite suppression are common with semaglutide

1,4 Cobalamin deficiency leads to various clinical and metabolic consequences, including vomiting, diarrhoea, weight loss, failure to thrive, nerve disorders, immunodeficiency, and intestinal changes including poor absorption of nutrients and vitamins (including cobalamin itself)

PMID: 39939550 7 The Oral Bioavailability of Vitamin B12 at Different Doses in Healthy Indian Adults

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The mitochondrial workload MOTS-c creates will exhaust available NAD+ faster than baseline metabolism, reducing the magnitude and duration of AMPK's effects