Individuals who have had gastrointestinal surgery, such as weight loss surgery, may also have fewer cells through which to secrete stomach acid and intrinsic factor, inhibiting B12 absorption
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Oxidative stress, eryptosis and anemia: a pivotal mechanistic nexus in systemic diseases
The liver stores B12, and these stores can last a significant time (up to several years for non-deficient individuals), but when they are depleted, it takes consistent input to rebuild and maintain them
Both processes peak during fasted states when insulin is suppressed