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What is the quality of the evidencerandomized trials, observational studies, or anecdotal reports

Nature 500 , 415421 (2013)

Age is significant

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Patients with food-bound cobalamin malabsorption (FBCM) may need to take cobalamin supplements on an empty stomach

They work by stimulating alpha-2 receptors in the brain, which reduce sympathetic outflow and norepinephrine release, thereby decreasing sympathetic activity and leading to effects such as reduced blood pressure, decreased heart rate, and alleviated withdrawal symptoms (92)