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If it is exposed to too much heat or cold, its chemical structure can break down, making it less potent

Yes, if caught early, most of the effects of B12 deficiency can be reversed

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Common clinical drivers include: Vitamin B12 deficiency Folate deficiency Chronic liver disease Alcohol use disorder Medications (e.g., methotrexate) Bone marrow disorders Chronic inflammatory disease Hypothyroidism Key ICD-10 principle: Cell size is a laboratory observation

This explains why some people need surprisingly high doses despite normal absorption