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This complex process means that conditions affecting the stomach or intestines can significantly impair B12 absorption, including pernicious anaemia, atrophic gastritis, previous gastric surgery, coeliac disease, Crohn's disease, and long-term use of certain medications (such as metformin, proton pump inhibitors, and H2 antagonists)

This gradual progression is one reason vitamin B12 deficiency is often missed. By the time injections are recommended, the body usually needs a more direct and reliable way to restore levels

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