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B12 deficiency, which semaglutide can worsen through reduced intrinsic factor production, causes digestive dysfunction that can amplify GI symptoms including burping

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Figure 2 Animal experiments have demonstrated that acute tryptophan depletion reduces brain tryptophan concentration by 70%, leading to decreased serotonin levels, diminished 5-HT receptor binding (236, 237), and effects on compulsive behavior (238)