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A study by Marsh et al

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Conditions like pernicious anaemia (an autoimmune disorder where your body cant absorb B12 from food), certain stomach conditions, medications that reduce stomach acid, or even gastrointestinal surgeries (like weight loss surgery) can prevent your body from properly taking in B12, even if youre getting enough in your diet

Mar 2020;12(1):138-143

Exogenously, they arise from exposure to environmental factors like ultraviolet (UV) radiation, pollution, tobacco smoke, and industrial chemicals [3]