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Green et al 26 Severe clinical abnormalities should be treated intensively with B 12 , cyanoB 12 or hydroxyB 12 : HydroxyB 12 is commonly used in Europe, often at intervals of 23 months, as it seems to have better retention than cyanoB 12

Avoid freezing reconstituted solutions, as this can cause aggregation

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Enhance detoxification processes to eliminate toxins that impair cognitive function