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Using these criteria, 28 of 32 participants (87.5%) qualified as high-TMAO producers (Supplementary Figure 7)

After four weeks, dosing adjustments depend on three markers: patient-reported sustained energy (indicating mitochondrial carnitine sufficiency), weight loss velocity (indicating hepatic lipid mobilisation), and subjective appetite control (indicating phosphatidylcholine-mediated satiety hormone signaling)

Both Semaglutide and Tirzepatide are indicated for long-term weight management for adults with BMI greater than 25

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