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Nutrient Deficiencies Long-term metformin use can reduce vitamin B12 levels, leading to fatigue

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10.1093/biolre/ioaf123 [DOI] [PubMed] [Google Scholar] Zhu F., Yin S., Yang B., Li S., Feng X., Wang T., et al

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Theoretical concerns with chronic high-dose use include organ enlargement and exacerbation of active malignancy via IGF-1 axis growth signaling

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These responses are normal

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Begin hydration optimization immediately

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