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For many individuals, oral B12 supplements are ineffective due to such underlying conditions as: Pernicious anemia : People with this condition lack intrinsic factor, a protein required for B12 absorption in the small intestine

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If you have a vegetarian or vegan diet, seek out fortified foods such as cereals, plant-based milk alternatives, and nutritional yeast

[14] Folate levels may modify the presentation of symptoms and disease course

The framing throughout is research literature observation, not therapeutic recommendation