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Appendix G: Taking Vitamin B12 With or Without Food Stephen Walsh summarizes the evidence from four papers on B12 absorption (Doets, 2012

Some diseases that affect the end of the small intestine where vitamin B12 is absorbed may affect the absorption of the vitamin - for example, Crohn's disease

That also means side effects at higher doses are real, and earning your dose over time is not optional it's the strategy

Benefits of medical supervision include baseline health assessment before starting protocols, appropriate bloodwork monitoring, professional guidance on dosing and duration, recognition of potential adverse effects, and integration with other health treatments