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Early evidence for the potential efficacy of this route was published in 1999, where 18 patients with B12 deficiency treated exclusively with 712 days of 2 mg of sublingual cobalamin daily had 4 times higher B12 levels compared to pre-treatment, reaching therapeutic ranges ( There have also been further studies comparing treatment outcomes from the sublingual route to the more established IM and oral routes

The skin of her face, arms, hands, legs and feet is now normal in appearance in texture, and she no longer has fatigue and malaise, and her energy and activity levels are normal

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