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Some of them are as follows: Small intestine bacterial overgrowth (SIBO): The harmful bacteria use the available B12 before it has been absorbed by the small intestine, thereby leading to a deficiency
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Berberine activates AMPK through a different mechanism than MOTS-c (via inhibition of complex I in mitochondria), so concurrent use may create additive rather than synergistic AMPK activation—higher risk of hypoglycemia without proportional metabolic benefit
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