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GIP receptor activation does not produce the nausea and gastrointestinal distress that limits GLP-1 receptor dose escalation

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This classic sign typically appears in severe, prolonged iron deficiency Brittle nails : Increased fragility with splitting, peeling, or easy breakage at the free edge Pallor of the nail bed : The normally pink nail bed appears pale or white due to anaemia Vertical ridging : Longitudinal lines or grooves running from cuticle to tip, though these are also common with ageing and may not indicate deficiency Slow growth : Reduced nail growth rate compared to normal (approximately 3mm per month), though this is non-specific and occurs with ageing Nail changes occasionally associated with B12 deficiency include: Blue-grey or brown hyperpigmentation : Diffuse darkening of the nail plate, though this is rare Longitudinal melanonychia : Dark vertical bands, particularly in darker-skinned individuals Brittle texture : Similar to iron deficiency, with increased fragility Nail plate thinning : Overall reduction in nail thickness IMPORTANT : A new or changing dark band on a single nail requires urgent medical assessment, as this may indicate subungual melanoma (a form of skin cancer) rather than nutritional deficiency