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TPE is performed under the care of a licensed medical provider and monitored by healthcare professionals

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While the NIH does not specify a tolerable upper intake level for vitamin B12, a study published in the JAMA Network Open found that high intakes of vitamin B12, such as from daily supplementation of 25 micrograms or higher, increased the risk of bone fracture [3] [4]

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As of 2022, it is included in WADAs prohibited substances list