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Fatigue can have many causes, including stress, poor sleep, hormone issues, nutritional deficiencies, or other medical concerns

DOI: 10.1080/15563650.2019.1606432 Aroda VR et al, "Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study." Journal of Clinical Endocrinology and Metabolism, Feb

The researchers observed a strong, statistically significant increase in dermal papilla cell growth, along with a higher Bcl2/Bax survival ratio and clear reductions in two deathrelated proteins, caspase3 and PARP, in treated cultures [2]

This depends on how severe the deficiency is and how well the patient responds to treatment

Suggested Use Levels: .3-2%

Generally, B12 shots are well-tolerated