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Because of the increased risk, today all vegan associations encourage vegans to take B12 in the form of fortified products, supplements or algae

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Other factors which can cause Pernicious Anemia and/or low B12 besides hypothyroidism Pancreatic insufficiency (when the pancreas is making le ss digestive enzymes) Gastritis (bacterial-caused inflammation which weakens the stomach lining) Stomach Removal (whether partial from Bariatric Surgery, or complete removal) Stomach cancer Active mutation of the Q5R intrinsic factor gene, plus other genes Low levels of folate aka B9 Symptoms of Pernicious Anemia From : The symptoms of pernicious anemia may include weakness, fatigue, an upset stomach, an abnormally rapid heartbeat (tachycardia), and/or chest pains