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Energy conservation/envelope theory interventions to help patients with myalgic encephalomyelitis/chronic fatigue syndrome

These metabolites accumulate when b12 function becomes inadequate, sometimes before serum b12 drops below normal range

At the same dose, a 74 kg participant had about 1.4 times the exposure of a 110 kg reference, while a 143 kg participant had about 0.8 times. Weight alone does not set the dose, but it helps explain why the trial mean transfers poorly to bodies outside the studied range

Whilst injections bypass gut absorption, conditions like active Crohn's disease or coeliac disease may cause increased metabolic demands that could influence how quickly B12 is utilised

doi: 10.1016/j.pain.2008.07.002 94

Instead of working through gut hormone pathways, it acts directly on the brains neurotransmitter systems specifically by blocking the reuptake of three key brain chemicals: serotonin, dopamine, and noradrenaline