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In addition, as an ectoenzyme, CD38 modulates intracellular NAD + concentration, which is critical for maintaining low glycolytic activity that supports cell proliferation and survival [39]

Instead of asking 'why not stack them,' the question becomes 'what specific outcome justifies adding a second compound with incomplete human safety data?' For research exploring maximal metabolic intervention where single-agent tirzepatide has plateaued, the stack may be defensible

No fluid retention or edema Growth hormone commonly causes water retention, leading to bloating, swelling in extremities, and a puffy appearance

doi: 10.2147/JBM.S474393