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A 2019 case report describes a case of a young woman who was treated for severe pernicious anemia with multiple daily doses of 1 milligram (mg) of cyanocobalamin, a synthetic form of B12

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Yes, B-12 is water-soluble, and any excess is naturally eliminated by the body

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The reduction in red blood cell production is why patients with B12 deficiency report feeling so extremely fatigued (even under the slightest of efforts), sort of like the fatigue you get from altitude sickness