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Conditions like pernicious anaemia (an autoimmune condition affecting a protein called intrinsic factor vital for B12 absorption), stomach issues (such as from reduced stomach acid or certain medications like proton pump inhibitors), intestinal disorders (like Crohn’s disease or coeliac disease), or even surgical removal of parts of the small intestine (e.g., gastric bypass surgery) can prevent proper absorption

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Sterile water has no preservative and should only be used if you plan to use the entire vial immediately