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Conditions like celiac disease, inflammatory bowel disease, gastric surgeries, or chronic use of certain medications can reduce absorption from food and pills.​ If you have ongoing digestive issues, your provider may recommend a combination of gut‑supporting strategies—such as probiotics, a balanced diet, or targeted therapies—along with B12, often using injections to bypass the digestive tract altogether

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According to Phase 3 trial results in the New England Journal of Medicine , this rash affected 0.8% of participants after the first dose, and 0.2% of participants after the second shot

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