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Journal of Endocrinology and Metabolism
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Extreme deficits (800-1,000 calories below maintenance) are unnecessary and counterproductive because they increase muscle catabolism and metabolic adaptation
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Absorption problems Even with adequate intake, absorption can be reduced by: Certain gastrointestinal conditions affecting the stomach or small intestine Some medications Age-related reduction in stomach acid (which can affect absorption) Autoimmune gastritis (often historically referred to as pernicious anaemia) This is a well-recognised cause of B12 deficiency and may require ongoing management
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