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For more on the diluents own shelf life, our guide on how long bacteriostatic water lasts is a useful companion read

GI effects are most pronounced

You can try and encourage dietary changes and/or B12 supplements, but because B12 is so important to the nervous system, I almost always provide B12 injections for three months to boost brain repair, followed by a sublingual maintenance formulation

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They also support liver health, which is essential for effectively metabolizing fats