While the biochemical mechanisms underlying the neurological effects of vitamin B 12 deficiency are not understood, the vitamin deficiency is known to damage the myelin sheath covering cranial, spinal, and peripheral nerves (42, 43)
So, in general, your patients are more likely to have more dramatic weight loss results with a GLP-1 drug if they use it along with healthy lifestyle changes
Further, decreased GSH has been associated with liver disease
This includes individuals with: Diagnosed MASLD or MASH, where GLP-1 therapy may offer therapeutic benefits but requires monitoring Chronic viral hepatitis (hepatitis B or C), particularly if transaminases are elevated Autoimmune hepatitis or other inflammatory liver conditions Cirrhosis or advanced fibrosis, where specialist consultation may be appropriate despite generally not requiring dose adjustment History of drug-induced liver injury from other agents For these patients, baseline comprehensive liver assessmentincluding liver enzymes, synthetic function tests (albumin, INR), and potentially imaging or non-invasive fibrosis markers (such as FIB-4 or ELF)helps establish a reference point for monitoring treatment effects
