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This is due to the fact that older people tend to create less stomach acid that is needed to transform vitamin B12 effectively

Since B12 is found primarily in animal products, including meat, fish, dairy, and eggs, a substantial reduction in food intake can reduce B12 consumption below optimal levels, particularly for patients who were already borderline deficient before starting treatment or whose diets lean toward plant-based foods

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These limitations underscore the need for larger, standardized, phenotype-stratified trials with harmonized reproductive and metabolic endpoints