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Over 50: As we age, our bodies naturally produce less of the intrinsic factor needed to absorb B12 from food

Improved pacing tolerance of the ischemic human myocardium after administration of carnitine

Gallbladder Disease: Including gallstones or the need for emergency gallbladder removal (cholecystectomy)

Considering he's a deadly pirate ghost with supernatural powers and is perceived by marine life as an Eldritch Abomination or the devil itself, it's not surprising