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Malabsorption (insufficient absorption of vitamin B12 in the intestine) due to, insufficient production of intrinsic factor (a protein that is produced in the gastric mucosa and is required for the absorption of vitamin B12), diseases in the terminal ileum (part of the small intestine), e.g

Cellular Microbiol 19(12):e12771 Tegtmeyer N, Harrer A, Schmitt V, Singer BB, Backert S (2019) Expression of CEACAM1 or CEACAM5 in AZ521 cells restores the type IV secretion deficiency for translocation of CagA by Helicobacter pylori

Pull back the plunger slowly to avoid introducing air bubbles into the syringe

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When stress becomes chronic, your adrenal glands can become depleted of these stress hormones, and it can cause imbalances within the NEM system