The difficult part is balance
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Unlike most vitamins, B12 has a uniquely complex absorption pathway: Stomach acid and pepsin release B12 from food proteins B12 binds to R-proteins (haptocorrins) in saliva and stomach Pancreatic enzymes release B12 from R-proteins in the small intestine B12 binds to intrinsic factor (produced by gastric parietal cells) The B12-intrinsic factor complex is absorbed in the terminal ileum A breakdown at any of these five steps causes deficiency which is why B12 deficiency is far more common than dietary intake alone would predict
Another systematic review in children, based on limited evidence from a single, methodologically weak randomized controlled trial, suggested that the parenteral route is more efficacious than the oral route (218)
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Unlike most peptides, it remains stable in gastric acid, which is why early rodent work used intragastric as well as intraperitoneal routes [9]
