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Here are some common causes: Dietary deficiency, mainly in vegans and vegetarians Pernicious anemia, an autoimmune issue with intrinsic factor production Gastric disorders, like atrophic gastritis or gastrectomy Malabsorption conditions, including Crohns disease and celiac disease Certain medications, like proton pump inhibitors and metformin Signs and Symptoms Requiring Medical Intervention Its important to know the signs of vitamin B12 deficiency