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High-dose supplementationparticularly intramuscular injections that can deliver 1,000 micrograms or morecreates substantially elevated serum B12 levels compared to dietary intake, which may more readily trigger these bacterial changes, though comparative studies between different forms are limited

This is likely due to the role of vitamin B12 in energy production and metabolism

Y.QuM.DuanR.ShiD.JinL.GaoJ.et al (2019)

Atrophic gastritis, a condition that depletes stomach acid, also reduces B12 absorption