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It is a requirement straight from Eli Lilly, the manufacturer, and reinforced by the FDA prescribing information for both Mounjaro and Zepbound

Satiety signalling pathway research

Delayed Gastric Emptying One of cagrilintide's most pronounced effects is slowing the rate of gastric emptying through activation of amylin receptors in the area postrema and vagal afferent pathways [5] : Central Nervous System Signaling: Activation of AMY1 receptors in the area postrema initiates vagal efferent signals that reduce gastric motility and pyloric relaxation [15] Direct Peripheral Effects: AMY3 receptor activation in the stomach and proximal small intestine may contribute to local motor function regulation [16] Metabolic Consequences: Delayed gastric emptying reduces the rate of glucose appearance in the bloodstream, lowering postprandial glucose excursions without increasing insulin demand [5] In Phase 2 trials, cagrilintide demonstrated dose-dependent reductions in gastric emptying rate, with effects sustained over the week-long dosing interval [9]

Epitalon Epitalon is a synthetic version of the natural peptide Epithalamin, which is produced by the pineal gland (22)