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They found that vitamin B12 changed the gene expression of the skin bacteria, which could have led to acne-promoting inflammation

I know you didn't mention that as an issue, but I feel there is some link between B12, cystic acne, mast cell dysfunction, gastroparesis and probably many other symptoms

Amy Yasko, Data from the American College of Nutrition suggests that 83% of our population is lithium deficient and recommend a minimum daily intake of at least 1mg/day. High B12 supplementation or injections, iodine supplementation, and thyroid medication may increase the need for lithium