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This includes people with: Pernicious anaemia (autoimmune destruction of intrinsic factor-producing cells), typically requiring lifelong IM injections Crohn's disease or surgical resection affecting the terminal ileum Coeliac disease causing malabsorption (may improve with gluten-free diet) Chronic pancreatitis reducing enzyme availability needed for B12 release Vegans and strict vegetarians need reliable B12 sources through fortified foods or supplements, as plant-based diets contain negligible amounts of active B12

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2020;367(6478):eaau6977

Acknowledgements This work was supported by the National Natural Science Foundation of China (no

Serum Cytokines Th1, Th2, and Th17 expression profiling in active lupus nephritis-IV: from a southern Chinese Han population