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This flowchart neatly illustrates how pernicious anaemiathe autoimmune condition itselfis the root cause of the B12 deficiency, which in turn leads to the wide-ranging symptoms

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+ B12 injections suit vegetarians and vegans who do not eat animal foods, patients with confirmed absorption issues such as pernicious anaemia, coeliac disease or significant IBS, older adults whose stomach acid has dropped with age, and patients on long-term metformin or proton-pump inhibitors that lower B12 absorption

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