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It is particularly common in individuals with certain risk factors, including those who have undergone gastric or small intestine resections, have inflammatory bowel disease, use metformin or proton pump inhibitors, follow a vegan diet, or are older than 75 years

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Some studies suggest that it may increase endogenous GH secretion and modulate stress-related hormonal responses

In these cases, says Barrient, B12 supplementationeither orally or with injectionsmay help improve symptoms like fatigue, mood changes, weakness, and memory loss