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An infection with Helicobacter pylori bacteria can also lead to lower B12 levels

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Cyanocobalamin is a synthetic form of B that contains a cyanide group, whereas hydroxocobalamin is a naturally occurring form produced by bacteria

61 In practice, some patients may be able to switch to very high dose (ie, 2000 mcg daily) oral supplementation instead of continuing parenteral administration, but it is impossible to predict in whom this can be done safely, and many are at risk of worsening symptoms which may become permanent