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Several prominent investigators have speculated that the pathology of this disease initiates many years prior to the emergence of clinical symptoms [32-34]
Any disruption along this pathway can lead to deficiency regardless of dietary intake, which is why some patients need supplementation even when they eat B12-rich foods
To make matters worse, doctors cant give naltrexone to patients who have liver disease, which is more common among people with AUD, as heavy drinking often leads to cirrhosis and liver failure
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