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DiStefano stated, "One concern is whether we're seeing clinically meaningful personalization or changes that primarily allow compounded products to remain on the market." For many of the added ingredients, there is simply not enough evidence showing they improve safety or effectiveness compared to the standard formulation

Document chronic conditions (e.g., diabetes, hypertension, COPD) and time spent to justify higher E/M levels

Enhanced fat metabolism The claim that b12 enhances fat metabolism during weight loss oversimplifies b12's metabolic roles

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