While typically an adaptive response, excessive hypertrophy from enzyme induction of hypertrophy can lead to hepatocellular degeneration and necrosis
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However, berberine can also cause GI side effects, potentially compounding dehydration risk when taken alongside tirzepatide
The dual effect can lead to more pronounced weight loss and metabolic improvements
References: (1) Gentinetta, S., et al
At the end of the day, a weight-loss plateau is a normal aspect of metabolic adaptation, not a failure