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Fermented foods (such as tempeh), nori, spirulina, chlorella algae, and unfortified nutritional yeast cannot be relied upon as adequate or practical sources of B-12.39,40 Vegans must regularly consume reliable sourcesmeaning B-12 fortified foods or B-12 containing supplementsor they could become deficient, as shown in case studies of vegan infants, children, and adults

A small cooling pouch or insulated case helps maintain temperature stability during transport, even though the medication tolerates room temperature for this extended window

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