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Overgrowth of bacteria: Some people develop vitamin B 12 deficiency as a result of conditions that slow the movement of food through the intestines (diabetes, scleroderma, strictures, diverticula), allowing intestinal bacteria to multiply and overgrow in the upper part of the small intestine

This represents a fundamental safety distinction from full-length human growth hormone, which consistently elevates IGF-1 through traditional growth hormone receptor activation