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For instance, Beiu et al

In hepatocytes, acetyl-CoA is used as a substrate for ketogenesis [37] during extended fasting or limited carbohydrate availability, and the liver adapts to dwindling glycogen stores by increasing -oxidation and by converting the acetyl-CoA to ketone bodies, primarily acetoacetate and its chemically reduced analog -hydroxybutyrate [38]

Given the limitations of the evidence and the constraints of a class-level NMA, a pooled comparison between tirzepatide and the GLP-1RA class was not possible

Natural alternatives show more modest results: lifestyle interventions (diet plus exercise) typically achieve 510% weight loss, while supplement data remains inconsistent and often lacks large randomized controlled trials