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Rare but serious effects include pancreatitis, gallbladder disease, and, in rodents, C-cell hyperplasia

it's a cascade of subtle and not-so-subtle chemical changes

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How many meals a day should I eat on tirzepatide

All of the above suggest that abnormal dietary intake and defective metabolism of Met could result in the abnormal levels of Met and its metabolites (SAMe and GSH) and accumulation of toxic metabolic intermediates (Hcy, Hcythiolactone, and 3-MTP) in the liver, which in turn affects the functions and the inflammatory responses to damage/infection of the liver (Figure 4)