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People with symptoms of vitamin B12 deficiency It is a good idea for anyone with the following signs and symptoms of a vitamin B12 deficiency or pernicious anemia to consult a doctor: People with gastrointestinal issues Conditions that affect the gastrointestinal tract may affect vitamin B12 release or absorption, including: pernicious anemia, which can lead to gastric atrophy, or damage to the stomach fish tapeworm infestation bowel or pancreatic cancer folic acid deficiency overgrowth of bacteria in the small intestine diabetes thyroid disease Crohns disease celiac disease chronic pancreatitis People who have undergone gastrointestinal surgery, including weight loss, may have fewer cells necessary to secrete stomach acid and intrinsic factor

Together they outperform either alone

Intern Emerg Med 19 , 275293 (2024)

Under a 1997 law, the first passed by Congress to regulate the industry, compounders can only use ingredients that are a component of an approved drug, have whats known as a USP monograph (essentially a third-party certified recipe for a drug used mainly by manufacturers of generics), or are listed as approved substances by the FDA

Effects of gluten on intestinal absorption and permeability during remission of celiac disease