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Oxidative stress and inflammatory cytokines can directly disrupt the BBB and damage neuronal tissue, which is likely to cause cognitive dysfunction and increase the risk of depression (116)

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Morning dosing works if breakfast is your primary meal or if evening injections cause sleep disruption due to delayed gastric emptying

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61 In practice, some patients may be able to switch to very high dose (ie, 2000 mcg daily) oral supplementation instead of continuing parenteral administration, but it is impossible to predict in whom this can be done safely, and many are at risk of worsening symptoms which may become permanent

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