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So, a deficiency not only causes neurological problems, but it makes you anemic

Brown or black pigmentation spreading from the nail bed, matrix and nail plate to the adjacent cuticle and proximal or lateral nail folds (Hutchinsons sign) is a crucial clinical clue to diagnose or exclude melanoma[78]

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Lab review before starting: A baseline IGF-1, fasting glucose, and (where indicated) a thyroid panel sets the framework for response tracking