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During long-term human fasting, decreased release of skeletal muscle pyruvate into the bloodstream has been hypothesized to lead to reductive shifts in the malate/pyruvate and pyruvate/lactate in the blood and other tissues throughout the body (Owen et al., 1967, 1969)

Published incidence figures for B12 deficiency after sleeve gastrectomy range from 0% to over 36%, with deficiency sometimes not appearing until two years after surgery (3)