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If you follow a strict vegan or vegetarian diet, getting enough B12 from food alone can be a real challenge

Toxicity can occur at 10ppm

Authors: We found that oral vitamin B 12 replacement at 1000 g daily was adequate to replace vitamin B 12 levels in patients with pernicious anemia

This is why deficiency becomes increasingly common with age, affecting up to 30% of adults over 60

Several commenters requested that CMS provide additional clarification surrounding why the agency believes that this measure of overall productivity growth across the economy is an adequate proxy for service-level efficiency gains within the Medicare program and stated their belief that it is unreasonable to extrapolate changes in physician productivity from estimates of nonfarm business productivity across the entire economy