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British Journal of haematology

Long-term efficacy is even more uncertain

Vitamin B12 deficiency can also be found in people with poor nutrition, pernicious anemia, infection, cancer, surgery, alcohol, medications (PPIs or other acid-suppressing drugs), exposure to nitrous oxide (during surgery or recreational use), stomach/intestinal problems such as intestinal dysbiosis, leaky gut or gut inflammation, atrophic gastritis or hypochlorhydria (low stomach acid) and/or nerve damage

If you've been taking high doses for months, it's smart to check your levels once in a while

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