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Common indications include: Pernicious anaemia an autoimmune condition where the stomach cannot produce intrinsic factor, a protein necessary for B12 absorption [8] [9] Malabsorption disorders including Crohn's disease, coeliac disease, or following gastric surgery Strict vegan or vegetarian diets with confirmed deficiency though high-dose oral B12 may be sufficient if no malabsorption exists Certain medications such as metformin or proton pump inhibitors that may interfere with B12 absorption [9] [10] Neurological symptoms including peripheral neuropathy, memory problems, or balance difficulties related to deficiency Diagnosis should be confirmed through blood tests measuring serum B12 levels, full blood count, folate, and often anti-intrinsic factor antibodies

doi: 10.1038/nmeth.4197 33 LoveMISonesonCHickeyPFJohnsonLKPierceNTShepherdLet al

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In addition, some consumers who reported adverse reactions purchased the unapproved fat-dissolving drugs online and injected the drugs themselves