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Importantly, serum B12 levels can be misleadingly normal or even elevated in chronic liver disease due to increased levels of binding proteins (such as haptocorrin) and reduced clearance, meaning that total B12 measurements may not accurately reflect tissue B12 status or functional deficiency

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Early initiation of folic acid supplementation (210 mg/kg/day) is recommended, and patients who begin supplementation before the age of 6 years tend to have a better prognosis than those who start supplementation after the age of 6 years [101]

These microbiome changes reversed rapidly, however, when the obese mice were returned to a normal, lean diet 79