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The NIH Office of Dietary Supplements recommends that adults over 50 obtain most of their B12 from supplements or fortified foods, since the crystalline form in supplements does not require stomach acid for absorption
In clinical trials, dose escalation protocols were used to minimize gastrointestinal side effects, starting from lower doses and titrating up to the 10mg maintenance dose over several weeks
Growth Factors 24:2144
In one ME/CFS study, significantly lower levels of adrenocorticotropin (ACTH)/cortisol were found (430)