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All of these are exceedingly rare

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This thiolate then initiates a nucleophilic attack on the methyl group of the enzyme-bound methylcobalamin

doi: 10.1007/s10096-016-2881-8 24 TilgHAdolphTEGernerRRMoschenAR

The best option for you rests on shared-decision making: Talk with your clinician about what your goals are, what lifestyle changes youre planning on making, potential side effects of medications, and how they will monitor your cholesterol over time