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Whilst most of these symptoms are reversible by replenishing your B12 levels through diet or supplementation, some can be permanent particularly when it comes to neurological damage

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52 Inflammation also activates enzyme pathways that increase production of neurotoxins, alters signaling along neural networks by increasing glutamate release in the brain, and may contribute to decreased neuronal growth and plasticity by reducing production of a growth factor called brain-derived neurotrophic factor (BDNF)

It depends on the patients health and the doctors advice