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Check homocysteine (should be under 9) and MCV (should be 80-92) instead to detect cellular deficiency, even when serum B12 appears normal

Sleeve gastrectomy removes up to 80% of the stomach, dramatically reducing food intake and altering the gastric environment in ways that impair the absorption of key micronutrients including vitamin B12, iron, vitamin D, and folate

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Going 5 days one week and 10 days the next creates fluctuating blood levels that can worsen side effects and reduce effectiveness