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• pernicious anemia
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• blood cells that are too large
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• weak muscles; inflammation
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• neurologic symptoms such as numbness in hands and feet
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• blurred vision under stress
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• impaired reflexes
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• gait disturbances, such as difficulty walking a straight line
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• psychiatric symptoms such as irritability, depression, confusion,
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memory disturbances
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• symptoms of anemia including tiredness, shortness of breath,
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labored breathing
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• impotence
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• incontinence
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• white patches of skin
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• hair loss
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• lack of intrinsic factor
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• smoking
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• inadequate nutrition
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• inadequate stomach acid
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• high alcohol consumption
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• significant stress
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• stomach surgery
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• antacids
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• proton pump inhibitors
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• omeprazole
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• metformin
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• many antidepressants
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• gastrointestinal disease
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• any autoimmune condition
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• narcolepsy
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• hypothyroidism
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• rheumatoid arthritis
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• vegans/vegetarians
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