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The result is twofold: increased sympathetic outflow that elevates resting metabolic rate by 10–15%, and reduced hedonic drive to eat via dopaminergic modulation of reward pathways

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Conversely, if a patient presents with “pernicious anemia” or severe neurological signs—such as intense tingling in the hands, memory loss, or muscle weakness—the dosage remains the same (usually 1,000 mcg), but the frequency increases significantly