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High-dose oral supplements (often 10002000 micrograms daily) or intramuscular injections (typically 1mg hydroxocobalamin) used to treat pernicious anaemia or deficiency states can temporarily elevate serum levels

Another big issue is Hypothyroidism

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Avoid rapid thawing at high temperatures

We consider your stress load, your training volume, your diet, your sleep quality, and your overall metabolic health

You should discuss your goals with your surgeon and have realistic expectations so that your surgeon can determine what is achievable with the procedure depending on your anatomy