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doi: 10.1038/nrgastro.2017.88

It is a big difference having a professional doctor in a well-known clinic

Davar D, Wang H, Chauvin JM, Pagliano O, Fourcade JJ, Ka M, et al

Also, vitamin B12 deficiency tends to come on very slowly, so people often go through a long period of being mildly deficient