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Weight-Loss Surgery Gastrointestinal procedures such as bariatric surgery, or removal of part of the stomach, cause partial or complete loss of the cells that secrete hydrochloric acid and intrinsic factor, reducing B12 absorption

If you are genuinely deficient, many people notice improved energy within a few days to two weeks of starting B12 shots or IV therapy, since injections bypass the gut and raise blood levels quickly

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suggesting that, at high concentrations, IGF-1 has effects not simply mediated by suppressing the effect of GH on hepatic insulin sensitivity [129, 209]