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Rising hunger, waist growth, weight gain above about 2 lb per month, persistent heart-rate elevation, or declining strength indicate that the lower dose is not maintaining the prior response

Healthcare system inertia makes systematic changes difficult to implement and sustain

Some patients receive B12 injections weekly or as part of a wellness plan

Nitric oxide neurotoxicity in neurodegenerative diseases

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A number of factors contribute: Different manufacturers use different stabilization/packaging processes (e.g., presence of excipients, vacuum sealing, desiccants)