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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (which can be caused by ingestion of corrosives, extensive tumors, and conditions associated with gastric atrophy, such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy) Structural lesions leading to vitamin B 12 deficiency, including regional ileitis, ileal reactions, and malignancies Competition for vitamin B 12 by intestinal parasites or bacteria

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Dihexa gets attention for how strong its animal data looks, but its research rating is limited and it comes with a proceed-with-caution flag for near-zero human safety data

doi:10.1038/s41598-018-22081-7 (PMID 29483571) Ruf S, Rajagopal S, Kadnur SV, et al

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