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The following conditions can cause absorption to be inadequate: Overgrowth of bacteria in part of the small intestine Impaired absorption (malabsorption disorders such as celiac disease or certain pancreatic disorders) Inflammatory bowel disease affecting the last part of the small intestine (IBS) Surgery that removes the part of the small intestine where vitamin B12 is absorbed Drugs such as antacids and metformin (used to treat diabetes) Repeated exposure to nitrous oxide (laughing gas) Lack of intrinsic factor Decreased stomach acidity (common among older people) Intrinsic factor may be lacking because abnormal antibodies, produced by an overactive immune system that attacks and destroys the stomach cells that produce intrinsic factor (An autoimmune reaction called autoimmune metaplastic atrophic gastritis.) Intrinsic factor may be lacking because the part of the stomach where intrinsic factor is produced was surgically removed
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This article reports what the clinical literature supports, where evidence is preliminary, what realistic expectations look like, and the genetic variables that shape individual response
