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In the vegetarian diet, there are few sources of Cobalamin and its shortage can have serious implications

36:012058 (2016) Tomitori H, Nakamura M, Sakamoto A, Terui Y, Yoshida M, Igarashi K, Kashiwagi K

doi: 10.1080/1028415X.2023.2244260 10
No long-term data specifically addresses this question for peptide nasal sprays
