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Vegetarians and vegans represent the highest-risk dietary group, as B12 occurs naturally almost exclusively in animal products

In preclinical literature, tesamorelin has been characterized for its role in modulating the GH/IGF-1 axis and lipid metabolism, which places this blend within investigations into fat metabolism and somatic growth signaling

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For milder vitamin B12 deficiency, where circumstances make delay difficult, there may be room for discussion of enhanced perioperative supplementation (such as intramuscular B12 close to surgery and continued through recovery)