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31 Predicting drug elimination based on half-life can go awry when very high doses of drugs are used, 32 as in the case of fluoxetine and the treatment of obsessive-compulsive disorder and when drugs are consumed in overdose

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Chandy posits a similar mechanism at play, suggesting that the swift reparative actions of B12 injections could momentarily overwhelm the body, leading to a temporary intensification of symptoms

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This dietary pattern change may contribute to declining b12 levels as much as or more than any absorption issue