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Although [detection bias] is a likely explanation, we cannot rule out that these are true increases in risk caused by the promotion of breast tumour growth by GLP-1 agonists, she says

Curr Opin Endocrinol Diabetes Obes (2017)

Supplementation through the injection addresses this gap proactively rather than waiting for deficiency symptoms to appear

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Rare adverse effects with tirzepatide included cholecystitis, which was reported slightly more frequently (0.6%) than with placebo (0%).19 In an RCT of 3731 people with BMI 30, or BMI 27 with untreated dyslipidemia or hypertension, but without diabetes, liraglutide 3 mg daily with health behaviour modification resulted in weight change of 8.0% versus 2.6% with placebo at 56 weeks (estimated treatment difference 5.4%, 95% CI 5.8 to 5.0).20 The most common adverse effects with liraglutide were mild to moderate nausea, diarrhea, and constipation, with discontinuation rates from adverse events of 9.9% in the liraglutide group versus 3.8% in the placebo group.20 Rare adverse effects included gallstones, reported in 0.8% of the liraglutide group versus 0.4% with placebo, with pancreatitis reported in 0.4% of the liraglutide group and less than 0.1% with placebo.20 In an RCT of 1742 patients with BMI 3045, or BMI 2745 with dyslipidemia or hypertension, but without diabetes, naltrexonebupropion 16 mg/180 mg twice daily with health behaviour changes was associated with weight change of 6.1% (standard error [SE] 0.3) versus 1.3% (SE 0.3) with placebo at 56 weeks (estimated treatment difference 4.8%).21 The most common adverse effects with naltrexonebupropion included nausea, headache, constipation, dizziness, vomiting, and dry mouth