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people at higher risk of deficiency include older adults, those with gastrointestinal issues that impair absorption, people whove had gastric surgery, long-term strict vegans who do not supplement, and those on certain acid-reducing medicines

10.1093/hmg/ddx369

This could explain why tirzepatide (which stimulates the GIP pathway in addition to GLP -1) can be administered at higher doses than semaglutide (which only stimulates GLP-1), without amplifying the side effects typical of GLP-1 agonists (nausea, vomiting)

The body needs time to adjust to incretin-based therapy, and rushing that adjustment period does not accelerate long-term results

Its as simple as that