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The plan can change based on how the patient responds and their health needs

[12] Gastric acid-suppressing agents (proton-pump inhibitors and H-receptor antagonists) diminish dietary B12 liberation from protein complexes, a pharmacodynamic interaction that can exacerbate underlying deficiency

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However, these associations likely reflect underlying disease processes rather than B12 toxicity itselfelevated B12 is often a marker of serious illness rather than its cause