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It is not necessary to withhold vitamin B12 therapy until the precise cause of B12 deficiency is established since absorption studies can be performed at any time

Disanto et al., 2016

Some conditions like autoimmune thyroid disease, surgical gland removal, or advanced ovarian failure may limit how far levels normalize, but symptom relief is still often significant

Data compiled by the US Dept of Agriculture showed that at least 40% of Americans routinely consume less than 60% of the recommended daily intake for essential nutrients