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The most commonly reported reactions include pain, bruising, or redness at the injection site, mild nausea or stomach upset, diarrhea, and headache

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One study, which also evaluated cognitive function in patients with high MMA concentrations, found no significant effects on the MDD inventory score, but only 30 of the 140 subjects had depression at baseline, which may have diluted any benefits

Risk factors include age, vegan diets, certain diseases, and some medicines