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cdc.gov/botulism U.S

Conclusion Whilst severe B12 deficiency has a clear clinical picture with characteristic haematological and/or neurological features, establishing mild or borderline deficiency can be problematic as serum levels are maintained at the expense of tissue concentrations, and therefore serum levels of B12 may be in the low normal or borderline range despite a deficiency

The most frequently prescribed drugs reflect our most common chronic conditions: heart disease, high blood pressure, diabetes, thyroid disorders, respiratory illnesses, pain/inflammation, mental health issues, and infections

Its been speculated that oral methylcobalamin or injected hydroxycobalamin may also be preferable in smokers, though it has yet to be conrmed