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People on acid-reducing medications PPIs and H2 blockers impair B12 absorption

Clinical Principle Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately trained clinicians are available, should be offered to patients who present with pelvic floor tenderness

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This is more likely if you have difficulty absorbing vitamin B12 through the digestion system and, therefore, need an injection directly into your muscles and blood