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Another significant cause is poor absorption due to a disease process which affects the stomach or intestines

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Side effects: Common reports include water retention, joint pain, insulin resistance, and in some cases, carpal tunnel symptoms

Progressive weakness, worsening balance problems, or new neurological symptoms require prompt assessment, as these may indicate inadequate treatment or concurrent conditions

At the same time, B12 insufficiency in the liver leads to shrinking of the intestinal cells and malabsorption of nutrients (including B12 itself), leading to a cycle of worsening B12 deficiency