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That slowdown signals metabolic adaptation, and that is when a second agent with a different mechanism provides the most benefit

These include diet, medical conditions, and some medicines

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Conditions such as atrophic gastritis (thinning of the stomach lining), Pernicious anemia (which makes it harder for your body to absorb Vitamin B12), Intestinal diseases such as crohns disease, celiac disease, bacterial growth and immune system disorders such as Graves disease or lupus can lead to Vitamin B12 deficiency in the body