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Blood levels take about four weeks to settle after a step. The stomach-slowing effect that drives early nausea builds and then adapts over roughly the same window. And gut symptoms cluster at the first dose and at each increase, then ease with time on a held dose. The label waits for the last step to settle before adding the next

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Some medications prevent the absorption of B12 and if you are vegetarian or vegan, then maintaining enough B12 through your diet is not possible