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Besides the anemia, a prolonged lack of B12 could lead to serious neurological damage, even paralysis

Finally, some commonly used drugs (e.g., glucocorticoids and GLP-1RAs) can also affect intra-portal insulin levels that modulate the GH/IGF-I axis either by increasing or decreasing hepatic GH sensitivity, as reflected by the discordant GH and IGF-I levels

Consuming coffee contaminated with mycotoxins might lead to deficiencies in essential vitamins like B12

Asgary et al., 2013)