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A few primary causes that have been identified are fluctuation of hormones or being pregnant, genes (especially if the condition starts before age 40), and certain medical conditions (3)

Higher doses (above 2mg/day) have not demonstrated proportional efficacy gains in published models and may increase copper ion toxicity risk

People with gastrointestinal conditions : Individuals with conditions such as Crohns disease, celiac disease, or those who have undergone gastrointestinal surgery are at higher risk of B12 deficiency