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doi: 10.1152/jn.00590.2018 29

Vitamin B12-related acne tends to occur only in dosages in excess of 5 to 10 mg per week. Thats 5,000 to 10,000 micrograms a week, which is well in excess of the 50 micrograms a day or, alternately, the 2,000-microgram single weekly dose that I recommend

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This is because the sustained activation of PI3K-AKT pathway inhibits GSK3, which phosphorylates NRF2 and allows its recognition and ubiquitination by TrCP-CUL1 ubiquitin E3 ligase for degradation