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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

Tay YL, Teah YF, Chong YM, Jamil MFA, Kollert S, Adenan MI, et al

- The box isn't travel-proof, as the serum would leak out

doi: 10.2298/AVB0601003L 75 LobleyG

This framework links directly to the therapeutic challenges described earlier: selecting the right patients, proper stratification, ensuring safety during intervention, and monitoring treatment efficacy

Excessive alcohol use activates cytochrome P450 2E1 (CYP2E1), producing harmful reactive oxygen species (ROS) and reducing glutathione, a vital antioxidant