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The ad hoc levels of metabolites, such as NAD + , adenine triphosphate (ATP), acetyl-CoA, and S-adenosylmethionine (SAM), and of metabolic hormones such as insulin and leptin, contribute to the temporal control of gene expression

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Cognitive deficits and psychological disturbances caused by the neurological manifestations of B12 deficiency were a common source of distress reported across the literature and online forums