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(b) a low serum concentration of vitamin B12 with a normal folate concentration

Eur J Endocrinol, 139(5), 552561

That conservative approach reduces the risk of adverse effects such as swelling or stiffness that can emerge with higher or prolonged dosing

5 Manufacturers note that purification removes most of the impurity, and this was in vitro work, not a human outcome study, so it should be read as a caution flag rather than a verdict