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Aggressive shaking can cause foaming and protein degradation, which reduces the actual active content below what the label states

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Eat a Balanced Diet While B12 injections provide a significant boost, maintaining a healthy diet rich in other essential nutrients will support overall wellness

Am Fam Physician 83 [PubMed] 6.Langan RC, Goodbred AJ (2017) Vitamin B12 deficiency: recognition and management