Because safety hasn't been established, the standard advice is to skip it while pregnant or nursing unless a doctor says otherwise (WebMD)

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Check for drug interactions - Some prescription medicines, like metformin, can deplete B12 over time
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Nausea can become a cycle: low appetite leads to low intake, low intake leads to weakness or queasiness, and then food feels even harder to tolerate
This makes it a cornerstone of cellular longevity and overall vitality