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It is also indicated to improve muscle performance in race horses, fighting cocks, fighting bulls increase in milk production in dairy cows

Who should check with a provider first If you are pregnant, nursing, have kidney disease, or take medications that interact with B12 metabolism (such as metformin), discuss this with a provider before starting

Some worry about the potential for this overstimulation to trigger cancer down the road
High prevalence of somatic oncogenic driver alterations in patients with NSCLC and Li-fraumeni syndrome

So, a single low value may not indicate true deficiency
