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It is caused by either lack of intrinsic factors or surgical removal of parts of the digestive system that bypass the small intestine

When adverse effects occurred, they were typically mild and transient, with the most common being mild to moderate headaches (similar frequency to placebo groups), minor injection site reactions (redness, slight swelling), and gastrointestinal effects at higher oral doses (nausea, diarrhea)

J Mahatma Gandhi Univ Med Sci Technol