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doi: 10.1016/j.bcp.2011.10.014

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The main causes of a vitamin B12 deficiency are as follows: Malabsorption due to poor intestinal health (inflammation, bacteria, fungal infection, parasites, disturbed intestinal flora) due to a lack of transport molecules (intrinsic factor), genetic diseases (cobalamin disease) or medications that hinder uptake

To prevent it, wait a full 10 seconds after injecting before removing the needle