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Lancet 2023;402:613-26.PubMed 141

Absorption conditions : Certain medical conditions, like pernicious anemia, celiac disease, or gut issues, can hinder B12 absorption and make injections more necessary

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Although there is theoretical concern that collagen and gelatin (including gelatin capsules) derived from cows could be contaminated with the infectious agent that causes mad cow disease, these ingredients are not derived from high-risk tissue and are subject to regulations that make this unlikely