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Studies have shown that people can have high or normal B12 levels in the blood and actually show virtually no B12 in the spinal fluid, meaning the B12 is not being transported from the blood stream into the cells where it should be absorbed and used

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Guo H, Guo J, Xie W, Yuan L, Sheng X

It notes PCPs are increasingly trained to evaluate, prescribe and monitor this therapy, and that straightforward prescribing often happens in primary care