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The most common cause is pernicious anemia, an auto-immune disorder that affects around one in every 10,000 people

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Ni L, Yuan C, Wu X

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2017 Jun;42(6):1661-1675

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metabolites in cluster 6 (decreased in the papain group uniquely) were enriched in taurine and hypotaurine metabolism and alanine aspartate and glutamate metabolism, implying systemic dysregulation of antioxidant defense mechanisms (Figures 3FH)

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This adjustment phase is usually temporary as the body finds a new set point for its metabolism, but it can be disruptive in the early weeks of treatment

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