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Common effects usually mild and often worst during titration include nausea, vomiting, diarrhea, constipation, abdominal pain, upset stomach, headache, and fatigue

Her cerebral blood flow was low at 700 ccs per minute (normal 800-1600 ccs/min) done at this visit and likely higher than her first visit for which we do not have data but likely much lower a year ago

Starting at the lower end allows assessment of individual tolerance before increasing if needed

A B12 Supplement is beneficial along with your regular diet