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Each stage of respiration, from glycolysis in the cytoplasm to the citric acid cycle and oxidative phosphorylation in mitochondria, depends on NAD+/NADH to carry reducing equivalents, thereby driving the production of cellular energy
For post-bariatric patients, this means potentially remaining on Retatrutide indefinitely to maintain its benefits
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Tirzepatide arrived more recently, with Mounjaro approved for diabetes in November 2022 and Zepbound receiving weight management approval in May 2025
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