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Note that PA isn't caused by not eating foods that contain B12, but rather by your body's inability to absorb B12

In parallel, ketogenic dietary patterns may modulate immune signalling at the gut interface, supporting intestinal mucosal integrity by enhancing mucosal immune function and attenuating inflammatory infiltration, thereby providing a biologically plausible route through which microbiota-mediated changes could translate into downstream effects on cognitive function [117]