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NAD + is also involved in metabolic switching, or the Warburg effect, in which the main source of energy production is anaerobic glycolysis through fermentation of pyruvate to lactic acid, as opposed to mitochondrial oxidative phosphorylation 340

What can be said is that the triple-agonist mechanism appears to produce a steeper dose-response curve than either the dual-agonist (tirzepatide) or single-agonist (semaglutide) approach