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However, some bacteria are able to bypass the protective binding IF, as in the case of Gram-negative anaerobes of the genus Bacteroides [76]

For some, it can take years before a deficiency occurs, for others, symptoms develop much sooner

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We order vitamin B12 and folate testing when a person with Down syndrome we are evaluating has symptoms described above, has a lab abnormality for which follow up testing of vitamin B12 and/or folate is indicated, or the person has a condition in which deficiency is common (e.g., celiac disease)