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Low B12 status (200300 pg/mL) without obvious symptoms affects up to 40% in Western populations [10]

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Polycythemia vera, hereditary cyanide deficiency (Leber optic neuropathy), and allergy to cobalt or cyanide are contraindications

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For body recomposition, this mechanism provides a critical advantage because it creates caloric deficit through increased burning rather than decreased intake alone

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