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Nappo et al, 1999

The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain

however, because only about 620% of B 12 in the blood is active holoTC, even people with total B 12 levels in the normal range may have a functional B 12 deficiency

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The STEP trials (the largest semaglutide studies) tracked participants for 68 weeks and showed that significant weight loss emerged between months two and four, with continued loss through month 12 and beyond