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Long-term regulation of energy stores depends on adiposity signals like leptin and insulin, while ghrelin communicates short-term changes in nutritional status

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So, you measure a higher B12, but part of that B12 is inactive, so useless Oral B12 supplementation, even in the form of a multivitamin preparation, may result in serum B12 concentrations just within the ‘normal´ range without abolishing symptoms

REFERENCES Manifestations of fatigue that may occur when status or supplies of these micronutrients are not adequate