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Int J Adv Med 6(3) Soutelo J et al (2020) Relationship between dose of metformin and vitamin B12 deficiency

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It could be cancer destroying healthy cells and releasing B12 back to the blood, a bad liver that can no longer store B12, or an increased production of the transport protein haptocorrin, to which blood B12 binds

In the research community, sustained or supraphysiologic IGF-1 exposure is associated with progressive abdominal distension (sometimes called 'GH gut') and concern for cardiac hypertrophy