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359 In addition, DOACs are more expensivesometimes much morethan warfarin, which can be a significant barrier to access if patients do not have insurance coverage

Medical conditions affecting absorption warrant particular attention : Pernicious anaemia : an autoimmune condition destroying gastric parietal cells, requiring lifelong B12 injections Gastrointestinal surgery : particularly gastric bypass, gastrectomy, or terminal ileum resection Inflammatory bowel disease : Crohn's disease affecting the terminal ileum impairs absorption Coeliac disease : untreated disease damages the small intestine, reducing B12 uptake Medication use : long-term metformin therapy (MHRA safety alert) or nitrous oxide exposure Symptoms suggesting possible B12 deficiency include : persistent fatigue, weakness, paraesthesia (pins and needles) in hands or feet, glossitis (sore, red tongue), mood changes, memory problems, or unexplained anaemia

Peptide therapies are quickly gaining momentum in the wellness and medical sectors, with demand across the globe expected to exceed $71 billion by 2030

doi: Rubino D, Abrahamsson N, Davies M, et al

2, 3 and 4 for $3,000 a cent an acre