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"Nitrous oxide has multiple deleterious effects on cobalamin metabolism and causes decreases in activities of both mammalian cobalamin-dependent enzymes in rats"

Genetic determinants of serum vitamin B12 and their relation to body mass index We found no support for a causal role of decreased serum vitamin B12 levels in obesity

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Peripheral neuropathy, subacute combined degeneration of the spinal cord, or cognitive impairment indicate more advanced deficiency and generally require intensive treatment over extended periods