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What causes Vitamin B12 deficiency

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Regarding the hemoglobin level, the pooled effect sizes showed no difference between all routes of administration that could reach statistical significance

Stomach acid and enzymes free vitamin B 12 from food, allowing it to bind to R-protein (formerly known as transcobalamin I and now called haptocorrin), found in saliva and gastric fluids

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Its an essential nutrient, which means your body cant make vitamin B12, and it must come from outside sources