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Even when intrinsic factor is not present to aid in the absorption of vitamin B 12 (pernicious anemia) or in other diseases that affect the usual absorption sites in the terminal ileum, oral therapy remains effective

Med Hypotheses 56(4):462471

Additionally, cognitive performance can be affected by other factors, including ones overall mood (101)

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The frequency of maintenance sessions can vary, but they are typically recommended every few months, depending on factors like your skin's response and individual goals