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Average milk levels in mature milk are 200 to 700 pmol/L (270 to 950 ng/L) during the first 28 weeks postpartum in healthy, lactating women with known or presumed adequate vitamin B 12 status and not taking a supplement.[27,28,42-45] Levels are highest during the first 4 weeks postpartum and gradually decrease thereafter.[25,28,29,42-47] Hindmilk levels are 20% to 30% higher than foremilk.[29] In populations with a high prevalence of vitamin B 12 deficiency or insufficient dietary vitamin B 12 intake, reported median or average milk levels are 120 to 160 pmol/L (160 to 220 ng/L) at 6 months postpartum.[30,46] In one study of 210 lactating women from different regions of Cameroon, rates of maternal vitamin B 12 deficiency were 15% to 25% and median milk levels were between 47 and 236 pmol/L (64 and 320 ng/L)

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Lifestyle factors Sleep matters: Poor sleep elevates cortisol, increases hunger, and impairs fat loss

The MHRA advises periodic monitoring of B12 levels in at-risk or symptomatic patients taking metformin

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