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Since 90% of the bodys serotonin originates in the gut, modulating enteric serotonin production could influence central serotonergic tone through vagal afferents that relay gut signals to brain serotonin-producing raphe nuclei

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Seizure medications such as phenytoin and phenobarbital, as well as diabetes medications like metformin, can lower B12 levels over time

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PubMed Gwyer D, Wragg NM, Wilson SL