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Many providers use Tesofensine as an add-on rather than a replacement because it helps increase energy expenditure while the GLP-1 continues appetite regulation

Shoemaker's research demonstrated that patients with CIRS consistently show severe abnormalities in inflammatory blood markers, including highly elevated TGF-beta1, C4a, and MMP-9, alongside drastically depleted levels of Melanocyte Stimulating Hormone (MSH) and Vasoactive Intestinal Polypeptide (VIP)

One common indicator is persistent fatigue or weakness

Despite this heterogeneity, the current review needed to include more in discussing how it might impact generalizability

So cardiac disease, I mean I think that's entirely true