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In our office, we had a patient who had come in for her appointment after she had just had a gluten exposure (and her reactions were severe)

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However, aside from general awareness, familiarity with treatments that can slow the disease progression was low (15% familiar versus 85% not familiar)

Dietary insufficiency (low animal foods or no fortified foods/supplements) Medication effects (for example, long-term metformin or acid-reducing medications) Absorption conditions (such as pernicious anemia, certain GI conditions, or past stomach/intestinal surgery) Ask your clinician what they think the root cause isbecause take B12 is not the full plan if absorption is impaired