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This is why some of those who have had weight loss surgery or surgery to remove part of the stomach have difficulty absorbing the vitamin B12 they need from foods

A lack of intracellular cobalamin leads to reduced enzyme activity and methylmalonic acid accumulation

Vitamin B12 is water-soluble, so excess amounts are generally excreted in the urine

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However, it's important to make sure that everyone, especially those in low- and middle-income countries, can access these medications