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[16] Although cyanocobalamin lacks a defined upper-toxicity threshold due to its water solubility and renal elimination, exceptionally high cumulative doses have been temporally associated with acneiform eruptions, altered potassium homeostasis, and theoretical thrombotic risk, emphasizing the importance of evidence-based dosing

As of 1998, the FDA has required that all food manufacturers fortify enriched grain products with folic acid to reduce the risk of congenital neural tube defects

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