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The deficiency was more severe than expected People with advanced B12 deficiency, especially with neurological symptoms, often feel rough at the start of treatment because the underlying problem was significant

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Key areas of investigation include modulation of the nitric oxide (NO) system through interaction with NOS isoforms, upregulation of growth factor receptors (including VEGFR2 and EGF receptor systems), and engagement of the FAK-paxillin signaling cascade associated with cell migration and adhesion

Most vegans who use fortified foods or a daily supplement maintain normal B12 levels without ever needing an injection