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The absorption of vitamin B12 is fraught with hurdles: In the stomach, vitamin B12 needs to bind with a protein called Intrinsic Factor to absorb, plus sufficient acid to release it from protein foods

Besides, youre taking too many supplements or eating lots of B12-rich foods

Patients taking certain medications (e.g., chloramphenicol may reduce the effectiveness of B12 therapy) or with risk factors for B12 deficiency (metformin use, proton pump inhibitors, nitrous oxide exposure, vegan diet) should discuss these with their healthcare provider

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