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The article notes semaglutide and some antibiotics, macrolides especially, can each cause nausea, constipation or diarrhea, so when they overlap the symptoms may worsen and the source becomes ambiguous

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It typically presents as macrocytic megaloblastic anemia and neurological impairments, including sensory and motor disfunctions, predominantly in the lower extremities, ataxia, and in more advanced stages cognitive decline progressing to dementia, as well as psychiatric disturbances (Sanjay et al., 2022

It is also, critically, a determinant of resting metabolic rate, the amount of energy the body burns at rest