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methionine, one of the key ingredients, may aggravate metabolic acidosis and a compromised liver may be unable to properly metabolize the compounds

They do not share the drawbacks of cyanocobalamin, but seem to have significant benefits

However, indirect factors such as reduced dietary intake from decreased appetite, altered gastric emptying, and concurrent use of metformin may increase the risk of B12 deficiency in some patients

While some vegetarians can get vitamin B12 from dairy, eggs, fortified foods, and supplements, they are still at risk of developing a deficiency