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Table 1 Common reasons for cobalamin deficiencies

From: Rapid healing of a patient with dramatic subacute combined degeneration of spinal cord: a case report

Diminished supply
 Vegan nutrition
 Alcohol abuse
 Parasitic infections (e.g. fish tapeworm)
 Reduced food intake (older people)
 Pregnancy (relative deficit)
Disruption of cobalamin processing in the stomach
 Gastric bypass/post-gastrectomy
 Chronic gastritis (e.g. induced by alcohol abuse, helicobacter pylori infection)
 Autoimmune gastritis resulting from antibodies reacting with parietal cells (pernicious anaemia)
 Proton pump inhibitors and H2-receptor antagonists (sustained release of cobalamin)
 Metformin, cytostatics, methyldopa, aminoglycosides e.g. (medicinal side effect)
Intestinal resorption problems
 Intestinal bypass/ileal resection
 Pathogenic intestinal flora
 Ulcerating colitis
 Crohn’s disease
 Zollinger-Ellison syndrome
 Imerslund-Gräsbeck syndrome
Defective transport and intracellular metabolism
 Congenital deficiency in transcobalamin II
 Congenital deficiency in various intracellular enzymes