Dehydration and electrolyte imbalance The gastrointestinal side effects of tirzepatide create a dehydration cascade that many people do not recognize until fatigue is severe
Obesity is associated with low-grade systemic inflammation, characterized by increased levels of inflammatory markers such as Toll-like receptor 4 (TLR4), tumor necrosis factor-alpha (TNF-), IL-6, IL-1 [36], IL 17, leptin [37], and resistin [38]

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doi:10.1007/s11910-013-0394-8 Moharregh-Khiabani D, Linker RA, Gold R, Stangel M (2009) Fumaric Acid and its esters: an emerging treatment for multiple sclerosis
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Vitamin D toxicity had been previously reported in the medical literature but has been exceedingly rare, he said