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The validity of diagnostic vitamin B12 or folic acid blood assays could be compromised by medications, and this should be considered before relying on such tests for therapy

doi: 10.1016/j.cellimm.2013.09.007 110 WeyandCMGoronzyJJ

These results far exceed what is typically achieved through lifestyle modification alone, where sustained weight loss often falls in the 5 to 10% range even with intensive intervention