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Anytime patients tell me they have a reaction from taking B vitamins, like nausea or some kind of digestive symptom, I automatically think that they might have some microbial issue

This can be particularly hard to spot since it doesnt impact the amount of cobalamin measured in the bloodstream (R)

in such settings the risk benefit ratio should be reassessed, and preservative-free preparations considered

This allows time for the body to respond to the injection and ensures any minor injection-site reactions have settled before travelling