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And without the right foundations in place, it usually does

Patients may also have low levels of vitamin B12 if they have had bariatric surgery, are strict vegetarians, or have used antacids or proton pump inhibitors for a prolonged period

For instance, the brain energy consumption accounts for over 20% of the total in order to coordinate with neural activities [6,7,8] and the skeletal muscles can quickly activate metabolic pathways for ATP synthesis during exercise [9]

Dec 1992;6(4):209-21