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This is due to the digestive process, which can break down a portion of the vitamin before it reaches your bloodstream

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Lifelong intramuscular vitamin B12 replacement is recommended for patients with deficiency caused by autoimmune gastritis, pernicious anaemia, total gastrectomy or terminal ileum resection (Table 4),19 because these conditions irreversibly impair gastrointestinal absorption, making oral B12 unreliable or ineffective even at high doses