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doi:10.1111/coa.12801 Kim SY, Lee CH, Lim JS, Kong IG, Sim S, Choi HG

Chronic illness, chronic stress, and the systemic inflammation seen in Long COVID and ME/CFS can downregulate the production of both stomach acid and Intrinsic Factor

Key areas of future research will include the signaling pathways and molecular mechanisms involved, endothelial repair, and interactions between endothelial cells and other cell types in sepsis (110)

Another cause of deficiency may be due to medications such as proton pump inhibitors or metformin reducing B12 levels over time

These plans should consider each patients unique needs and risks based on their treatment