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Although vitamin B12 is water-soluble and excess amounts are typically excreted in the urine, the body still stores significant quantities (primarily in the liver) with its levels continuously regulated

One example is the Jarisch-Herxheimer reaction, which may occur in those treated for syphilis or Lyme disease

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Several well-established risk factors increase the likelihood of B12 deficiency

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Many patients notice a steadier mood and clearer head after starting B12 injections, especially if they were running low