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This includes confirmed low serum vitamin B12 levels, pernicious anaemia, malabsorption states such as coeliac disease, inflammatory bowel disease, or post-gastric or bariatric surgery, unexplained anaemia, neuropathy or neurological symptoms consistent with vitamin B12 deficiency, a long-term vegan diet with symptoms or low levels, or failure of oral vitamin B12 supplementation

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Possible side effects are expected to be similar to other semaglutide or tirzepatide medications and can include nausea, diarrhea, constipation, abdominal pain, headache, and fatigue

Cyanoglycosides are found in at least 2,000 plants (WHO, 2004) and in many foods such as baked goods, stone fruits and their juices, almonds, legumes, and grains