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Furthermore, as with any significant weight loss, adaptive thermogenesis (metabolic adaptation) occurs, whereby the body reduces energy expenditure in response to weight reduction, which would likely counteract any minor metabolic effects

According to an article about cobalamin deficiency in Tufts Universitys catnip newsletter, people with cobalamin deficiency also experience changes with intestinal permeability and absorptive function

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That drop can throw off your cycle, especially if your body is still adjusting

This gives your gut time to adjust to the medication