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A B12 deficiency can be caused by a number of different factors

The peptide upregulates growth hormone receptors on tendon fibroblasts, enhances neurotrophic factor expression, and promotes angiogenesis through the VEGFR2-Akt-eNOS signaling pathway

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If your provider identifies B12 deficiency despite your compounded formulation, they may prescribe additional B12 supplementation, either through separate injections, high-dose oral supplements (1000 mcg daily, which can overcome absorption limitations through passive diffusion), or sublingual formulations