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[7] Exposure to nitrous oxide Alcohol use Intestinal dysbiosis Leaky gut and gut inflammation Atrophic gastritis or hypochlorhydria, or low stomach acid Pernicious anaemiaa type of megaloblastic, autoimmune anaemia caused by a lack of intrinsic factor (a protein in the stomach that allows the body to absorb vitamin B12) so that vitamin B12 is not absorbed

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It can also interfere with omeprazole (Prilosec), alprazolam (Xanax), certain statins and some antihistamines, Mayo Clinic reports