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Adherence to Standard Protocols and the Problem with One-Size-Fits-All Guidelines The Core of the Issue: The primary reason for refusal is that the GP surgery is typically following a strict protocol based on established guidelines

In the absence of coenzyme B12, tetrahydrofolate cannot be regenerated from its inactive storage form, 5-methyl tetrahydrofolate, resulting in functional folate deficiency

The therapeutic protocol typically involves initial intensive injections followed by maintenance schedules based on individual blood levels and clinical response

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