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There is concern that the relatively high protein content in KD could accelerate the decline in renal function, precipitate cardiovascular events, and that weight loss may contribute to osteoporosis and fractures, as well as adversely affect renal function

Plant foods do not naturally contain active B12 some fortified foods (plant milks, nutritional yeast) and supplements can help, but injections bypass any absorption issues entirely

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Understanding why this variability exists requires examining the mechanisms more closely