Medications such as metformin or proton pump inhibitors can significantly hinder B12 absorption
Dong Rak Kwon and GI Young Park, Effect of Intra-articular Injection of AOD9604 with or without Hyaluronic Acid in Rabbit Osteoarthritis Model, Annals of Clinical and Laboratory Science, Volume 45, July-August 2015
The two compounds produce results on different timescales, and the combined effect unfolds in stages
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The deficiency can arise due to improper diet or the inability to absorb the vitamin through natural means