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External and iatrogenic causes: Excessive supplementation: High-dose oral supplements or frequent intramuscular injections (hydroxocobalamin or cyanocobalamin) can elevate serum levels, though this rarely causes problems

Additionally, that study was done in a private practice setting and published in an alternative medicine journal, raising questions about oversight and objectivity

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Sadly, the two have become so interwoven, that faith in a particular political party's paradigm, rather than free thought, has become the norm