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Persisting upper gastrointestinal symptoms between episodes suggest performing an upper endoscopy at any time between episodes to rule out other causes (e.g., coeliac disease, IBD)

They still need community, accountability, and education to sustain progress and results

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When symptoms do occur in the context of high B12, they are usually attributable to an underlying condition rather than the elevated vitamin itself

Less food intake and weight loss can reduce heat generation

Increasing the metabolic rate and using up stored-up energy reserves, leading to faster nutritional depletion