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Many people initially experience only overwhelming fatigue: the kind where you go to bed exhausted and wake up just as tired

William Castle demonstrated that gastric juice contained an "intrinsic factor" which when combined with meat ingestion resulted in absorption of the vitamin in this condition

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People Who Have Had Gastric Surgery Gastric bypass surgery (like Roux-en-Y), sleeve gastrectomy, or other bariatric procedures significantly reduce the stomachs ability to produce intrinsic factor a protein required to absorb B12 in the small intestine

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