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Metformin (for diabetes), proton pump inhibitors (such as omeprazole or esomeprazole), and H2 blockers (such as famotidine) can all reduce B12 absorption over time

Expired vitamin solutions may have reduced potency and an increased chance of contamination or chemical breakdown

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Its structure resembles a naturally occurring Body Protective Compound (BPC) originally identified in human gastric juice

The preservative isn't infinitely effective