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This was best summed up in a BMJ editorial last year, which noted that diagnosing B12 deficiency can be "challenging" because no "single specific measurement exists to reliably diagnose or refute the presence of B12 deficiency"

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the degree of improvement in neurologic symptoms depends on the duration and severity of the lesions, although progression of the lesions is immediately arrested

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Some patients experience inadequate weight loss or weight regain years after surgery, prompting consideration of additional interventions