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Every time you puncture the vial's rubber stopper with a syringe, you create a potential entry point for airborne bacteria

Risk increases significantly after 2+ years of use Post-bariatric surgery patients gastric bypass removes or bypasses the sites of intrinsic factor production and B12 absorption People with autoimmune conditions pernicious anemia (anti-intrinsic factor antibodies) and autoimmune gastritis directly block absorption People with GI conditions Crohns disease (especially ileal involvement), celiac disease, SIBO, and chronic H