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Anyone with signs and symptoms of a vitamin B12 deficiency or pernicious anemia should consult a doctor

They should be stored at Controlled Room Temperature (20C25C / 68F77F) away from direct sunlight

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Also, since you need stomach acid to absorb B12, long-term use of acid-suppressing proton pump inhibitors (such as Nexium, etc.) can lead to B12 deficiency, as can chronic intestinal conditions such as Crohns disease, celiac disease, and intestinal parasites