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This dual mechanism appears to produce faster and more pronounced appetite suppression for many patients, along with greater total weight loss

The differential diagnosis should include other melanotic lesions, such as malignant melanoma, pigmented meningioma, and medulloblastoma [ 5 ]

This complex process means that conditions affecting the stomach or intestines can significantly impair B12 absorption, including pernicious anaemia, atrophic gastritis, previous gastric surgery, coeliac disease, Crohn's disease, and long-term use of certain medications (such as metformin, proton pump inhibitors, and H2 antagonists)

Strategies include slower dose titration, eating smaller and more frequent meals (especially on injection days), avoiding high-fat foods that delay gastric emptying further, and ensuring adequate hydration

Our Inflammation and Longevity Medicine hub and article on Inflammation, Brain Health, and Mental Wellbeing explain why inflammatory burden belongs in the cognitive-health conversation

10.1038/mp.2010.136 133 RossignolD