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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