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Most likely, the mechanism involves stress from rapid weight loss and reduced calorie intake, leading to telogen effluvium

For very long trips, discuss with your provider whether it's possible to temporarily store medication at your destination using proper refrigeration

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In addition to dietary intake, malabsorption conditions like celiac disease, atrophic gastritis, and inflammatory bowel diseases, all of autoimmune nature and frequently associated with autoimmune thyroid diseases, must be taken into account when vitamin B12 requirements are evaluated [97,98,99]