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It says if a dose fails to produce the expected appetite suppression or metabolic effect after months of consistent response, degradation could be a factor worth checking alongside biological explanations

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Maternal plasma folate, vitamin B12 levels and multivitamin supplementation during pregnancy and risk of Autism Spectrum Disorder in the Boston Birth Cohort. The FASEB Journal 30 (2016): 151-6

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These medications show comparable effectiveness, so factors such as tolerability, contraindications, and cost should be considered when making a choice [22,178]