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Any symptom in any organ system could potentially be the result of an autonomic disorder

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Gut conditions such as Crohn's or coeliac disease , or stomach/bowel surgery

Shaking creates foam and air bubbles that can denature the peptide through mechanical stress

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Well, normally this vitamin is absorbed in the gut and so a disruption to normal gut function will reduce the amount of vitamin B12 that's being absorbed by the intestines and that will lead to a depletion of the normal body stores, which will then result in a deficiency in this vitamin within the body as a whole