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Groups at higher risk of deficiency include older adults (due to reduced stomach acid production), people following vegan or strict vegetarian diets (as B12 is naturally found almost exclusively in animal products), individuals with pernicious anaemia or other malabsorption conditions, those taking certain medications such as metformin or proton pump inhibitors long-term, and people with significant nitrous oxide exposure (including recreational use), which can inactivate B12 in the body

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Many patients experience benefits that persist for several months after completing a full treatment cycle, especially when supported by healthy lifestyle habits