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Malabsorption (insufficient absorption of vitamin B12 in the intestine) due to insufficient production of intrinsic factor (a protein produced in the lining of the stomach that is needed to absorb vitamin B12), disorders in the end section of the ileum (part of the small intestine), such as sprue, fish tapeworm infestation or blind loop syndrome (change in the course of the intestine after gastric surgery)

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Patients on Specific Medications: Certain medications, like proton pump inhibitors or metformin, can interfere with B12 absorption, making monitoring and supplementation necessary