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When a tissue-specific gene is totally inactivated by a mutation, it may cause severe disease but will not necessarily have interfered with embryonic development

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That is worth saying plainly, because the same review this page cites (Urbina 2026) found thiamine and cobalamin deficits increase over time on GLP-1 therapy, and that in patients with rapid weight loss, persistent vomiting, or very poor oral intake, suspected thiamine deficiency is a medical urgency

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Acetylcholinesterase inhibition in patients with orthostatic intolerance