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The above is usually talked of in terms of 'anaemia', but it does show that there is a complicated link between B12, B6, folic acid, zinc and vitamin D levels, chronic disease (anaemia of chronic disease) and how the body 'manages' serum iron, ferritin, and transferrin iron saturation and keeps these in balance (or not, as in your case)

The SURPASS-3 MRI substudy added another layer, showing tirzepatide actually reduced muscle fat infiltration across all doses, indicating improved muscle quality even as total muscle volume decreased