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The surgical alterations permanently compromise b12 absorption through multiple mechanisms

The average metformin dose was 1000 mg (500 mg twice daily), although doses ranged from 750 to 2500 mg/day

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Hauptmann J, Johann L, Marini F et al (2020) Interleukin-1 promotes autoimmune neuroinflammation by suppressing endothelial heme oxygenase-1 at the bloodbrain barrier