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B12 is notoriously hard to absorb through the gut, especially as you get older or if you have certain digestive issues

Never inject water directly onto the lyophilized powder

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These symptoms may suggest inadequate B12 replacement, concurrent iron or folate deficiency, or alternative haematological conditions requiring investigation

Vitamin B12, also known as cobalamin, is a water-soluble vitamin that plays an essential role in supporting nerve function, red blood cell formation, DNA synthesis, and energy metabolism