Introduction:
- Importance Of Vitamin B12 For Overall Health And Well-Being.
- Overview Of Wellhealthorganic’s Approach To Natural Health Supplements.
Understanding Vitamin B12:
- What Is Vitamin B12?
- Role Of Vitamin B12 In The Body’s Functioning.
- Sources Of Vitamin B12 In Natural And Organic Forms.
Benefits Of Vitamin B12:
- Essential Roles In Metabolism And Energy Production.
- Contribution To Nervous System Health And Cognitive Function.
- Importance For Red Blood Cell Production And Oxygen Transport.
Signs And Symptoms Of Vitamin B12 Deficiency:
Vitamin B12, also known as cobalamin, is a water-soluble vitamin involved in metabolism. It is one of eight B vitamins. It is required by animals, which use it as a cofactor in DNA synthesis, and in both fatty acid and amino acid metabolism. It is important in the normal functioning of the nervous system via its role in the synthesis of myelin, and in the circulatory system in the maturation of red blood cells in the bone marrow. Plants do not need cobalamin and carry out the reactions with enzymes that are not dependent on it.
Vitamin B12 is the most chemically complex of all vitamins, and for humans the only vitamin that must be sourced from animal-derived foods or supplements. Only some archaea and bacteria can synthesize vitamin B12. Vitamin B12 deficiency is a widespread condition that is particularly prevalent in populations with low consumption of animal foods. This can be due to a variety of reasons, such as low socioeconomic status, ethical considerations, or lifestyle choices such as veganism.
Foods containing vitamin B12 include meat, shellfish, liver, fish, poultry, eggs, and dairy products. Many breakfast cereals are fortified with the vitamin. Supplements and medications are available to treat and prevent vitamin B12 deficiency. They are usually taken by mouth, but for the treatment of deficiency may also be given as an intramuscular injection.
Vitamin B12 deficiencies have a greater effect on young children, pregnant and elderly people, and are more common in middle and lower developed countries due to malnutrition. The most common cause of vitamin B12 deficiency in developed countries is impaired absorption due to a loss of gastric intrinsic factor (IF) which must be bound to a food-source of B12 in order for absorption to occur. A second major cause is an age-related decline in stomach acid production (achlorhydria), because acid exposure frees protein-bound vitamin. For the same reason, people on long-term antacid therapy, using proton-pump inhibitors, H2 blockers or other antacids are at increased risk.
The diets of vegetarians and vegans may not provide sufficient B12 unless a dietary supplement is taken. A deficiency may be characterized by limb neuropathy or a blood disorder called pernicious anemia, a type of anemia in which red blood cells become abnormally large. This can result in fatigue, decreased ability to think, lightheadedness, shortness of breath, frequent infections, poor appetite, numbness in the hands and feet, depression, memory loss, confusion, difficulty walking, blurred vision, irreversible nerve damage, and many others. If left untreated in infants, deficiency may lead to neurological damage and anemia. Folate levels in the individual may affect the course of pathological changes and symptomatology of vitamin B12 deficiency. Vitamin B12 deficiency in pregnant women is strongly associated with an increased risk of spontaneous abortion, congenital malformations such as neural tube defects, problems with brain development growth in the unborn child.
Vitamin B12 was discovered as a result of pernicious anemia, an autoimmune disorder in which the blood has a lower than normal number of red blood cells, due to a deficiency of vitamin B12. The ability to absorb the vitamin declines with age, especially in people over 60.
Definition:
Vitamin B12 is a coordination complex of cobalt, which occupies the center of a corrin ligand and is further bound to a benzimidazole ligand and adenosyl group. A number of related species are known and these behave similarly, in particular all function as vitamins. This collection of compounds is sometimes referred to as “cobalamins”. These chemical compounds have a similar molecular structure, each of which shows vitamin activity in a vitamin-deficient biological system, they are referred to as vitamers. The vitamin activity is as a coenzyme, meaning that its presence is required for some enzyme-catalyzed reactions.
- adenosylcobalamin
- cyanocobalamin, the adenosyl ligand in vitamin B12 is replaced by cyanide.
- hydroxocobalamin, the adenosyl ligand in vitamin B12 is replaced by hydroxide.
- methylcobalamin, the adenosyl ligand in vitamin B12 is replaced by methyl.
Cyanocobalamin is a manufactured form of B12. Bacterial fermentation creates AdoB12 and MeB12, which are converted to cyanocobalamin by the addition of potassium cyanide in the presence of sodium nitrite and heat. Once consumed, cyanocobalamin is converted to the biologically active AdoB12 and MeB12. The two bioactive forms of vitamin B
12 are methylcobalamin in cytosol and adenosylcobalamin in mitochondria.
Cyanocobalamin is the most common form used in dietary supplements and food fortification because cyanide stabilizes the molecule against degradation. Methylcobalamin is also offered as a dietary supplement. There is no advantage to the use of adenosylcobalamin or methylcobalamin forms for the treatment of vitamin B12 deficiency.
Hydroxocobalamin can be injected intramuscularly to treat vitamin B12 deficiency. It can also be injected intravenously for the purpose of treating cyanide poisoning, as the hydroxyl group is displaced by cyanide, creating a non-toxic cyanocobalamin that is excreted in urine.
“Pseudovitamin B12” refers to compounds that are corrinoids with a structure similar to the vitamin but without vitamin activity. Pseudovitamin B12 is the majority corrinoid in spirulina, an algal health food sometimes erroneously claimed as having this vitamin activity.
Deficiency:
Vitamin B12 deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system. Deficiency at levels only slightly lower than normal can cause a range of symptoms such as fatigue, feeling weak, lightheadedness, dizziness, breathlessness, headaches, mouth ulcers, upset stomach, decreased appetite, difficulty walking (staggering balance problems), muscle weakness, depression, poor memory, poor reflexes, confusion, and pale skin, feeling abnormal sensations, among others, especially in people over age 60. Vitamin B12 deficiency can also cause symptoms of mania and psychosis. Among other problems, weakened immunity, reduced fertility and interruption of blood circulation in women may occur.
The main type of vitamin B12 deficiency anemia is pernicious anemia, characterized by a triad of symptoms:
- Anemia with bone marrow promegaloblastosis (megaloblastic anemia). This is due to the inhibition of DNA synthesis (specifically purines and thymidine).
- Gastrointestinal symptoms: alteration in bowel motility, such as mild diarrhea or constipation, and loss of bladder or bowel control. These are thought to be due to defective DNA synthesis inhibiting replication in tissue sites with a high turnover of cells. This may also be due to the autoimmune attack on the parietal cells of the stomach in pernicious anemia. There is an association with gastric antral vascular ectasia (which can be referred to as watermelon stomach), and pernicious anemia.
- Neurological symptoms: sensory or motor deficiencies (absent reflexes, diminished vibration or soft touch sensation) and subacute combined degeneration of the spinal cord. Deficiency symptoms in children include developmental delay, regression, irritability, involuntary movements and hypotonia.
Vitamin B12 deficiency is most commonly caused by malabsorption, but can also result from low intake, immune gastritis, low presence of binding proteins, or use of certain medications. Vegans—people who choose to not consume any animal-sourced foods—are at risk because plant-sourced foods do not contain the vitamin in sufficient amounts to prevent vitamin deficiency. Vegetarians—people who consume animal byproducts such as dairy products and eggs, but not the flesh of any animal—are also at risk. Vitamin B12 deficiency has been observed in between 40% and 80% of the vegetarian population who do not also take a vitamin B12 supplement or consume vitamin-fortified food. In Hong Kong and India, vitamin B12 deficiency has been found in roughly 80% of the vegan population. As with vegetarians, vegans can avoid this by consuming a dietary supplement or eating B12 fortified food such as cereal, plant-based milks, and nutritional yeast as a regular part of their diet. The elderly are at increased risk because they tend to produce less stomach acid as they age, a condition known as achlorhydria, thereby increasing their probability of B12 deficiency due to reduced absorption.
Nitrous oxide overdose or overuse converts the active monovalent form of vitamin B12 to the inactive bivalent form.
Pregnancy, lactation and early childhood:
The U.S. Recommended Dietary Allowance (RDA) for pregnancy is 2.6 micrograms per day (μg/d), for lactation 2.8 μg/d. Determination of these values was based on an RDA of 2.4 μg/d for non-pregnant women, plus what will be transferred to the fetus during pregnancy and what will be delivered in breast milk.: 972  However, looking at the same scientific evidence, the European Food Safety Authority (EFSA) sets adequate intake (AI) at 4.5 μg/d for pregnancy and 5.0 μg/d for lactation. Low maternal vitamin B12, defined as serum concentration less than 148 pmol/L, increases the risk of miscarriage, preterm birth and newborn low birth weight. During pregnancy the placenta concentrates B12, so that newborn infants have a higher serum concentration than their mothers. As it is recently absorbed vitamin content that more effectively reaches the placenta, the vitamin consumed by the mother-to-be is more important than that contained in her liver tissue.
Women who consume little animal-sourced food, or who are vegetarian or vegan, are at higher risk of becoming vitamin depleted during pregnancy than those who consume more animal products. This depletion can lead to anemia, and also an increased risk that their breastfed infants become vitamin deficient. Vitamin B12 is not one of the supplements recommended by the World Health Organization for healthy women who are pregnant, however vitamin B12 is often suggested during pregnancy in a multivitamin along with folic acid especially for pregnant mothers who follow a vegetarian or vegan diet.
Low vitamin concentrations in human milk occur in families with low socioeconomic status or low consumption of animal products.: 971, 973  Only a few countries, primarily in Africa, have mandatory food fortification programs for either wheat flour or maize flour; India has a voluntary fortification program. What the nursing mother consumes is more important than her liver tissue content, as it is recently absorbed vitamin that more effectively reaches breast milk.: 973  Breast milk B12 decreases over months of nursing in both well-nourished and vitamin-deficient mothers.: 973–974  Exclusive or near-exclusive breastfeeding beyond six months is a strong indicator of low serum vitamin status in nursing infants. This is especially true when the vitamin status was poor during the pregnancy and if the early-introduced foods fed to the still breastfeeding infant are vegan.: 974–975 
Risk of deficiency persists if the post-weaning diet is low in animal products.: 974–975  Signs of low vitamin levels in infants and young children can include anemia, poor physical growth and neurodevelopmental delays.: 975  Children diagnosed with low serum B12 can be treated with intramuscular injections, then transitioned to an oral dietary supplement.
Gastric bypass surgery:
Various methods of gastric bypass or gastric restriction surgery are used to treat morbid obesity. Roux-en-Y gastric bypass surgery (RYGB) but not sleeve gastric bypass surgery or gastric banding, increases the risk of vitamin B12 deficiency and requires preventive post-operative treatment with either injected or high-dose oral supplementation. For post-operative oral supplementation, 1000 μg/d may be needed to prevent vitamin deficiency.
Diagnosis:
According to one review: “At present, no ‘gold standard’ test exists for the diagnosis of vitamin B12 deficiency and as a consequence the diagnosis requires consideration of both the clinical state of the patient and the results of investigations.” The vitamin deficiency is typically suspected when a routine complete blood count shows anemia with an elevated mean corpuscular volume (MCV). In addition, on the peripheral blood smear, macrocytes and hypersegmented polymorphonuclear leukocytes may be seen. Diagnosis is supported based on vitamin B12 blood levels below 150–180 pmol/L (200–250 pg/mL) in adults. However, serum values can be maintained while tissue B12 stores are becoming depleted. Therefore, serum B12 values above the cut-off point of deficiency do not necessarily confirm adequate B12 status. For this reason, elevated serum homocysteine over 15 micromol/L and methylmalonic acid (MMA) over 0.271 micromol/L are considered better indicators of B12 deficiency, rather than relying only on the concentration of B12 in blood. However, elevated MMA is not conclusive, as it is seen in people with B12 deficiency, but also in elderly people who have renal insufficiency, and elevated homocysteine is not conclusive, as it is also seen in people with folate deficiency. In addition, elevated methylmalonic acid levels may also be related to metabolic disorders such as methylmalonic acidemia. If nervous system damage is present and blood testing is inconclusive, a lumbar puncture may be carried out to measure cerebrospinal fluid B12 levels.
Serum haptocorrin binds 80-90% of circulating B12, rendering it unavailable for cellular delivery by transcobalamin II. This is conjectured to be a circulating storage function. Several serious, even life-threatening diseases cause elevated serum HC, measured as abnormally high serum vitamin B12, while at the same time potentially manifesting as a symptomatic vitamin deficiency because of insufficient vitamin bound to transcobalamin II which transfers the vitamin to cells.
Medical uses:
Treatment of deficiency:
Severe vitamin B12 deficiency is initially corrected with daily intramuscular injections of 1000 μg of the vitamin, followed by maintenance via monthly injections of the same amount or daily oral dosing of 1000 μg. The daily dose is far in excess of the vitamin requirement because the normal transporter protein mediated absorption is absent, leaving only very inefficient intestinal passive absorption. Injection side effects include skin rash, itching, chills, fever, hot flushes, nausea and dizziness. Oral maintenance treatment avoids this problem and significantly reduces cost of treatment.
Cyanide poisoning:
For cyanide poisoning, a large amount of hydroxocobalamin may be given intravenously and sometimes in combination with sodium thiosulfate. The mechanism of action is straightforward: the hydroxycobalamin hydroxide ligand is displaced by the toxic cyanide ion, and the resulting non-toxic cyanocobalamin is excreted in urine.
Dietary recommendations:
Some research shows that most people in the United States and the United Kingdom consume sufficient vitamin B12. However, other research suggests that the proportion of people with low or marginal levels of vitamin B12 is up to 40% in the Western world. Grain-based foods can be fortified by having the vitamin added to them. Vitamin B12 supplements are available as single or multivitamin tablets. Pharmaceutical preparations of vitamin B12 may be given by intramuscular injection. Since there are few non-animal sources of the vitamin, vegans are advised to consume a dietary supplement or fortified foods for B12 intake, or risk serious health consequences. Children in some regions of developing countries are at particular risk due to increased requirements during growth coupled with diets low in animal-sourced foods.
The US National Academy of Medicine updated estimated average requirements (EARs) and recommended dietary allowances (RDAs) for vitamin B12 in 1998. The EAR for vitamin B12 for women and men ages 14 and up is 2.0 μg/day; the RDA is 2.4 μg/d. RDA is higher than EAR so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 2.6 μg/day. RDA for lactation equals 2.8 μg/d. For infants up to 12 months the adequate intake (AI) is 0.4–0.5 μg/day. (AIs are established when there is insufficient information to determine EARs and RDAs.) For children ages 1–13 years the RDA increases with age from 0.9 to 1.8 μg/day. Because 10 to 30 percent of older people may be unable to effectively absorb vitamin B12 naturally occurring in foods, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a supplement containing vitamin B12. As for safety, tolerable upper intake levels (known as ULs) are set for vitamins and minerals when evidence is sufficient. In the case of vitamin B12 there is no UL, as there is no human data for adverse effects from high doses. Collectively the EARs, RDAs, AIs and ULs are referred to as dietary reference intakes (DRIs).
The European Food Safety Authority (EFSA) refers to the collective set of information as “dietary reference values”, with population reference intake (PRI) instead of RDA, and average requirement instead of EAR. AI and UL are defined by EFSA the same as in the United States. For women and men over age 18 the adequate intake (AI) is set at 4.0 μg/day. AI for pregnancy is 4.5 μg/day, for lactation 5.0 μg/day. For children aged 1–14 years the AIs increase with age from 1.5 to 3.5 μg/day. These AIs are higher than the U.S. RDAs. The EFSA also reviewed the safety question and reached the same conclusion as in the United States—that there was not sufficient evidence to set a UL for vitamin B12.
The Japan National Institute of Health and Nutrition set the RDA for people ages 12 and older at 2.4 μg/day. The World Health Organization also uses 2.4 μg/day as the adult recommended nutrient intake for this vitamin.
For U.S. food and dietary supplement labeling purposes, the amount in a serving is expressed as a “percent of daily value” (%DV). For vitamin B12 labeling purposes, 100% of the daily value was 6.0 μg, but on May 27, 2016, it was revised downward to 2.4 μg. Compliance with the updated labeling regulations was required by 1 January 2020 for manufacturers with US$10 million or more in annual food sales, and by 1 January 2021 for manufacturers with lower volume food sales. A table of the old and new adult daily values is provided at Reference Daily Intake.
Sources:
Bacteria and archaea:
Vitamin B12 is produced in nature by certain bacteria, and archaea. It is synthesized by some bacteria in the gut microbiota in humans and other animals, but it has long been thought that humans cannot absorb this as it is made in the colon, downstream from the small intestine, where the absorption of most nutrients occurs. Ruminants, such as cows and sheep, are foregut fermenters, meaning that plant food undergoes microbial fermentation in the rumen before entering the true stomach (abomasum), and thus they are absorbing vitamin B12 produced by bacteria.
Other mammalian species (examples: rabbits, pikas, beaver, guinea pigs) consume high-fibre plants which pass through the gastrointestinal tract and undergo bacterial fermentation in the cecum and large intestine. In this hindgut fermentation, the material from the cecum is expelled as “cecotropes” and are re-ingested, a practice referred to as cecotrophy. Re-ingestion allows for absorption of nutrients made available by bacterial fermentation, and also of vitamins and other nutrients synthesized by the gut bacteria, including vitamin B12.
Non-ruminant, non-hindgut herbivores may have an enlarged forestomach and/or small intestine to provide a place for bacterial fermentation and B-vitamin production, including B12. For gut bacteria to produce vitamin B12, the animal must consume sufficient amounts of cobalt. Soil that is deficient in cobalt may result in B12 deficiency, and B12 injections or cobalt supplementation may be required for livestock.
Animal-derived foods:
Animals store vitamin B12 from their diets in their livers and muscles and some pass the vitamin into their eggs and milk. Meat, liver, eggs and milk are therefore sources of the vitamin for other animals, including humans. For humans, the bioavailability from eggs is less than 9%, compared to 40% to 60% from fish, fowl and meat. Insects are a source of B12 for animals (including other insects and humans). Animal-derived food sources with a high concentration of vitamin B12 include liver and other organ meats from lamb, veal, beef, and turkey; also shellfish and crab meat.
Plants and algae:
There is some evidence that bacterial fermentation of plant foods and symbiotic relationships between algae and bacteria can provide vitamin B12. However, the Academy of Nutrition and Dietetics considers plant and algae sources “unreliable”, stating that vegans should turn to fortified foods and supplements instead.
Natural plant and algae sources of vitamin B12 include fermented plant foods such as tempeh and seaweed-derived foods such as nori and laverbread. Methylcobalamin has been identified in Chlorella vulgaris. Since only bacteria and some archea possess the genes and enzymes necessary to synthesize vitamin B12, plant and algae sources all obtain the vitamin secondarily from symbiosis with various species of bacteria, or in the case of fermented plant foods, from bacterial fermentation.
Fortified foods:
Foods for which vitamin B12-fortified versions are available include breakfast cereals, plant-derived milk substitutes such as soy milk and oat milk, energy bars, and nutritional yeast The fortification ingredient is cyanocobalamin. Microbial fermentation yields adenosylcobalamin, which is then converted to cyanocobalamin by addition of potassium cyanide or thiocyanate in the presence of sodium nitrite and heat.
As of 2019, nineteen countries require food fortification of wheat flour, maize flour or rice with vitamin B12. Most of these are in southeast Africa or Central America.
Vegan advocacy organizations, among others, recommend that every vegan consume B12 from either fortified foods or supplements.
Supplements:
Vitamin B12 is included in multivitamin pills; in some countries grain-based foods such as bread and pasta are fortified with B12. In the US, non-prescription products can be purchased providing up to 5,000 μg each, and it is a common ingredient in energy drinks and energy shots, usually at many times the recommended dietary allowance of B12. The vitamin can also be supplied on prescription and delivered via injection or other means.
Sublingual methylcobalamin, which contains no cyanide, is available in 5 mg tablets. The metabolic fate and biological distribution of methylcobalamin are expected to be similar to that of other sources of vitamin B12 in the diet. The amount of cyanide in cyanocobalamin is generally not a concern, even in the 1,000 μg dose, since the amount of cyanide there (20 μg in a 1,000 μg cyanocobalamin tablet) is less than the daily consumption of cyanide from food, and therefore cyanocobalamin is not considered a health risk.
Intramuscular or intravenous injection:
Injection of hydroxycobalamin is often used if digestive absorption is impaired, but this course of action may not be necessary with high-dose oral supplements (such as 0.5–1.0 mg or more), because with large quantities of the vitamin taken orally, even the 1% to 5% of free crystalline B12 that is absorbed along the entire intestine by passive diffusion may be sufficient to provide a necessary amount.
A person with cobalamin C disease (which results in combined methylmalonic aciduria and homocystinuria) may require treatment with intravenous or intramuscular hydroxocobalamin or transdermal B12, because oral cyanocobalamin is inadequate in the treatment of cobalamin C disease.
Nanotechnologies used in vitamin B12 supplementation:
Conventional administration does not ensure specific distribution and controlled release of vitamin B12. Moreover, therapeutic protocols involving injection require health care people and commuting of patients to the hospital thus increasing the cost of the treatment and impairing the lifestyle of patients. Targeted delivery of vitamin B12Â is a major focus of modern prescriptions. For example, conveying the vitamin to the bone marrow and nerve cells would help myelin recovery. Currently, several nanocarriers strategies are being developed for improving vitamin B12Â delivery with the aim to simplify administration, reduce costs, improve pharmacokinetics, and ameliorate the quality of patients’ lives.
Pseudovitamin-B12:
Pseudovitamin-B12 refers to B12-like analogues that are biologically inactive in humans. Most cyanobacteria, including Spirulina, and some algae, such as Porphyra tenera (used to make a dried seaweed food called nori in Japan), have been found to contain mostly pseudovitamin-B12 instead of biologically active B12. These pseudo-vitamin compounds can be found in some types of shellfish, in edible insects, and at times as metabolic breakdown products of cyanocobalamin added to dietary supplements and fortified foods.
Pseudovitamin-B12 can show up as biologically active vitamin B12 when a microbiological assay with Lactobacillus delbrueckii subsp. lactis is used, as the bacteria can utilize the pseudovitamin despite it being unavailable to humans. To get a reliable reading of B12 content, more advanced techniques are available. One such technique involves pre-separation by silica gel and then assessment with B12-dependent E. coli bacteria.
A related concept is antivitamin B12, compounds (often synthetic B12 analogues) that not only have no vitamin action, but also actively interfere with the activity of true vitamin B12. The design of these compounds mainly involve replacement of the metal ion with rhodium, nickel, or zinc; or the attachment of an inactive ligand such as 4-ethylphenyl. These compounds have the potential to be used for analyzing B12 utilization pathways or even attacking B12-dependent pathogens.
- Common Symptoms Of Vitamin B12 Deficiency.
- Groups At Higher Risk Of Deficiency.
- Long-Term Health Implications Of Untreated Deficiency.
Wellhealthorganic’s Vitamin B12 Products:
- Overview Of Wellhealthorganic’s Vitamin B12 Supplements.
- Different Forms Of Vitamin B12 Available (E.G., Methylcobalamin, Cyanocobalamin).
- How To Choose The Right Vitamin B12 Supplement.
Natural Sources Of Vitamin B12:
- Foods Rich In Vitamin B12 Suitable For Organic Diets.
- Vegan And Vegetarian-Friendly Sources Of Vitamin B12.
- Tips For Incorporating Vitamin B12-Rich Foods Into Daily Meals.
Recommended Daily Intake And Safety:
- Recommended Daily Intake Of Vitamin B12 For Different Age Groups.
- Safety Considerations And Potential Interactions With Medications.
- Wellhealthorganic’s Guidelines For Safe And Effective Supplementation.
Health Benefits Beyond Basic Nutrition:
- Impact Of Vitamin B12 On Mood And Mental Health.
- Role In Supporting Cardiovascular Health.
- Potential Benefits For Skin, Hair, And Nails.
Vitamin B12 And Specific Health Conditions:
- Link Between Vitamin B12 And Neurological Disorders.
- Supportive Role In Managing Certain Chronic Conditions.
- Wellhealthorganic’s Holistic Approach To Using Vitamin B12 Supplements.
Tips For Maximizing Vitamin B12 Absorption:
- Factors Influencing Vitamin B12 Absorption.
- Strategies To Enhance Absorption From Supplements And Food.
- Lifestyle Habits That Support Vitamin B12 Utilization.
Conclusion:
- Recap Of The Benefits And Importance Of Vitamin B12.
- Wellhealthorganic’s Commitment To Natural And Organic Vitamin B12 Supplements.
- Encouragement For Readers To Prioritize Vitamin B12 For Optimal Health.
References:
- Credible Sources And Studies Supporting The Benefits Of Vitamin B12.
- Links To Wellhealthorganic’s Resources And Additional Reading Materials.
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