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Not eating enough protein
This has been referred to as a paradoxical vitamin B12 deficiency, because the B12 is functionally unavailable
Clean the rubber septum of your tirzepatide vial with an alcohol prep pad using a circular motion for 30 seconds, then allow it to air dry completely
In these cases, supplementation may be considered under professional guidance
IMO might be worth encouraging the doctor to query the lab as to exactly what happened there
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