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A B12-rich diet or supplements can help, but some autoimmune diseases, like pernicious anemia and inflammatory bowel disease, can prevent B12 absorption

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After ingestion, it usually needs to be converted into active coenzyme forms mainly methylcobalamin and adenosylcobalamin before participating in nerve signalling, red blood cell formation, and energy metabolism

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Although uncommon, it is possible to have elevated B12 levels in a blood test, says Sheri Vettel, a registered dietitian nutritionist (RDN) with the Institute for Integrative Nutrition