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The mixed pattern suggests individual variation rather than a consistent drug effect

Chronic kidney disease (CKD), particularly in later stages, is a recognized cause of hypercobalaminemia

Or as Miller puts it, Youve essentially made the person equivalent of having pernicious anemia. Thats because these surgeries can reduce the production of both intrinsic factor and stomach acid, which is necessary for digesting food

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This finding was particularly notable because it occurred despite significant fat loss, demonstrating that the peptides lipolytic effects do not compromise metabolic health