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However, once diagnosed it presents a difficult management problem in patients suffering from pernicious anemia, as there is no substitute
Homocysteine and methylmalonic acid levels in the blood are stronger indicators of proper vitamin B12 activity than homocysteine

This can provide both relief from negative symptoms and a more youthful appearance, depending on the details of your treatment

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doi: 10.1016/j.bmcl.2014.03.065
