It can mean more binding protein in circulation, vitamin released from injured cells, reduced clearance by the liver or kidneys, recent intake, or analytical interference, where the measured value does not accurately reflect the true B12 status
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IGF-1 sitting elevated for long uninterrupted periods is also worth watching on its own terms, and an elevated IGF-1 is a specific reason we would shorten a course or extend a break
Some will get a satisfactory response with this alone