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All patients provided written informed consent for participation in the study

Sleeve gastrectomy is a weight-loss surgery appropriate for people with higher BMIs over 40 or 35 with comorbid conditions

When weighed against the financial and health costs of weight regain, including renewed medication courses, worsening metabolic disease, and associated healthcare utilization, the maintenance approach frequently wins on pure economics

All products are batch-tested, traceable, and packaged with supporting documentation to ensure quality and regulatory conformity

But caloric restriction, combined with the reduced nutrient density of a smaller total food volume, creates conditions where B vitamins including B12 become limiting factors for mitochondrial energy production