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Dietary shortfall is increasingly common as more clients adopt plant-based eating, because vitamin b12 foods are almost entirely animal-derived: meat, fish, eggs and dairy, with fortified cereals and yeast extracts the main vegan options

The gut microbiome also plays a role in precursor metabolism

It has a clinically significant drug interaction profile, including documented interactions with certain antifungals, antibiotics, and other compounds, and requires provider monitoring during use

548 Additionally, a medication review to adjust or discontinue medications that may impair cognition or balance is recommended to decrease fall risk

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