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When investigating elevated B12, additional tests such as active B12 (holotranscobalamin), methylmalonic acid, and homocysteine may help clarify true B12 status

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Gastrointestinal symptoms: Some peptides, especially GLP-1 receptor agonists such as semaglutide or tirzepatide, can slow digestion, which may lead to nausea, vomiting, diarrhea, or constipation