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The lower levels of stomach acid allow the growth of particular bacteria in the stomach that use B12, which reduces the amount of the vitamin available to the body

Optimising treatment outcomes may be facilitated by addressing nutritional deficiencies

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In men especially, low levels may affect: Energy levels Libido and sexual performance Muscle mass and strength Mood and motivation Body composition Bone density However, keep in mind that low energy and low motivation can come from many different causes besides B12 deficiency

People who have had gastrointestinal surgery, such as having part or all of their stomach removed for weight loss