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Could it be a digestive issue like Crohn's or celiac disease

The B12 component is highly stable, but tirzepatide itself slowly degrades in solution

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See the research here: Acupuncture & Vitamin B12 Ensuring adequate B12 (ideally verified by labs) whether through diet, supplementation, or injections (when needed) is often a helpful adjunct in supporting nerve recovery and combined with acupuncture can enhance recovery improving the odds of more complete recovery