The consequences are particularly interesting if one looks at the cells that compose the gut wall: when they burn food for energy (rather than fermenting it for building blocks or energy storage), the level of oxygen near the gut wall drops (von Martels et al., 2017), and the microbiota as a whole becomes more anaerobic and healthier (Byndloss et al., 2017
However, the evidence so far from RCTs for a causal effect of B-vitamins is weak (Table 2) (Reference Charles, Ness and Campbell104Reference Salam, Zuberi and Bhutta108)
The TRIUMPH-4 Phase 3 trial in obesity with knee osteoarthritis later reported 28.7% mean weight loss at 68 weeks with retatrutide 12 mg/week, and identified a dose-related dysesthesia (nerve-tingling) signal in 8.8% of 9 mg and 20.9% of 12 mg patients (Bays et al., 2025)
S7), Christopher Hill and Svet Tzokov for help with the high-pressure freezing and cryo-electron microscopy, and Carolyn Machamer for providing research space for D.M.Z