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In the reported cases, the clinical presentation consisted of recurrent episodes of Reye-like encephalopathy, hypoketotic hypoglycemia, and/or cardiomyopathy

This means you might only be getting a tiny fraction of the dose listed on the label

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The primary reasons people become deficient usually fall into two categories: Dietary Factors: Since B12 is mainly found in animal products (meat, fish, dairy, eggs), vegans and strict vegetarians are particularly susceptible if they dont consume fortified foods or specific supplements