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This deficiency can be caused by a number of factors, including: An autoimmune disorder that affects the stomach's ability to produce intrinsic factor A genetic flaw that interferes with the body's ability to transport vitamin B12 from the intestine to the bloodstream A low-vitamin B12 diet, like a vegetarian or vegan one Gastrointestinal surgery that involves the removal of a portion of the small intestine or stomach Certain medications that interfere with the absorption of vitamin B12 How does pernicious anemia affect my body

Comment: A few commenters expressed concern about the operational feasibility of the survey timing

History of Gastrointestinal Surgeries: Clients who have undergone gastric bypass or removal of parts of the stomach or small intestine may struggle with B12 absorption and often require injections

Dalrymple SN, Lewis SH, Philman S