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Vitamin B12 deficiency typically becomes clinically significant after several years of continuous metformin therapy, with higher risk in patients taking metformin for more than three years or on doses of 2g or more daily

Jiang J, Pan H, Shen F, Tan Y, Chen S (2023a) Ketogenic diet alleviates cognitive dysfunction and neuroinflammation in APP/PS1 mice via the Nrf2/HO-1 and NF-B signaling pathways