Six trials totaling roughly 900 participants are summarized in Stier et al
Inadequate dietary intake
They have realistic expectations: they are not expecting a return to the early dramatic phase of GLP-1 weight loss, but rather a renewed period of modest progress through what would otherwise be a flat curve
We know that macrocytosis is a very, very late stage of B12 deficiency and that severely deficient patients may not present with this sign, the administration of folic acid also masks macrocytosis by normalising the size of the blood cells
The answer is thermal degradation, not biological variability
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