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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy)

(PMC) A separate metabolism-focused paper reviewing human trial history makes a similar point: early signals of weight loss were not consistently reproduced in later studies, particularly when intensive diet/exercise protocols were included

Changes to B12 concentrations over time

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