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Some reasons your body may not be able to get enough B12 from food include: Anemia Gastritis Crohns disease Celiac disease Alcohol use disorder Sjgrens syndrome Weight loss surgery, or surgery that removes part or all of your stomach A vegan or strict vegetarian diet (as B12 is only found in animal products) Medications, such as metformin and drugs used to treat gastroesophageal reflux disease (GERD), indigestion, and stomach ulcers Pregnancy Your doctor could also order a B12 test based on your symptoms

In the single study comparing CA and surgery, Maillot et al [18] reported similar effectiveness between the two techniques, with median symptom-free survival rates of 100% at 12 months and 66.7% (95% CI, 5.4

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More subtle improvements mood, motivation, exercise tolerance may take four to eight weeks to fully develop