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Antineoplastics that are antimetabolites for the vitamin may induce inadequate utilization of vitamin B12

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Observed effects in human trials Reported adverse events across the IV and oral trials included headache, fatigue, dizziness, nasopharyngitis, diarrhea, flatulence, increased appetite, nausea, and back pain

None of these pathways directly substitute for another, which is part of why researchers interested in a fuller picture of metabolic regulation may look at all three within the same body of literature not to combine effects, but to understand how separate systems might interact at a mechanistic level

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