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Vitamin B12 deficiency is a common, but often undiagnosed, cause of facial pigmentation

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People taking heartburn medication, such as proton pump inhibitors, are at a higher risk for B12 deficiency and may benefit from alternative therapies to control/eliminate the heartburn or have regular Nutrient IV therapies and/or Vitamin B12 injections Elderly Vegans Vegetarians People with tapeworms Alcoholics Excessive use of antibiotics Excessive use of anti-convulsant medication Daily consumption of Aspirin may increase the risk for vitamin B12 deficiency