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This happens when the body does not produce enough intrinsic factor, a protein made in the stomach that is essential for B12 absorption in the gut

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Perry, R.J., Zhang, D., Zhang, X.M., Boyer, J.L

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She says it's about half the serving of food she would have previously ordered

"Your explanations, when taken into consideration with the violations described above and your failure to adequately address your noncompliance, suggest systemic failures with your surveillance, receipt, evaluation, and reporting of ADEs to FDA," the agency wrote