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Decreased stomach acid Atrophic gastritis Autoimmune pernicious anaemia Helicobacter pylori Gastrectomy, partial or complete Gastric bypass surgery (weight loss) Intestinal resection Partial or complete ileectomy Gastrointestinal neoplasms Malnutrition Eating disorders anorexia bulimia Inadequate diet Vegetarianism / veganism Malabsorption syndromes Alcoholism Crohns disease Coeliac disease (gluten enteropathy) Dipphyllobothrium infection blind loop syndrome diverticulosis inflammatory bowel disease small bowel overgrowth tropical sprue gastric irradiation ileal irradiation (bladder,cervix, uterus,prostate) Inborn errors of B12 metabolism Transcobalamin II deficiency Pancreatic exocrine insufficiency & Chronic pancreatitis Imerslund Gresbeck syndrome Zollinger Ellison Syndrome Bacterial overgrowth (small bowel) Fish tapeworm Advanced liver disease Drug induced causes Please note

Experiencing memory loss or dementia Issues with concentrating on tasks Persistent lowered mood or depression Mania extreme and uncharacteristically elevated moods Entering non-responsive states, or becoming catatonic Experiencing symptoms associated with schizophrenia Episodes of psychosis, delusions and delirium Other Conditions A variety of other conditions can also cause peripheral neuropathy

There are many key factors to understand when balancing methylation, the interaction of B12 and understanding how other body systems interact with these pathways

If fatigue is part of the story, the team can review whether B12 fits the picture or whether broader evaluation would be smarter