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week-0 photos are the only reliable progress marker at week 6
PMID 22616870
This in turn is reliant on certain enzymes (acetlyases and methylases), which are directly controlled by various nutrients, in particular the B vitamins
Once blood levels and symptoms improve, the doctor may discontinue the injections and advise maintaining levels with oral supplements or diet
Energy levels during fasted states often improve noticeably by week 4
How Fast Do B12 Levels Rise After Starting Treatment
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