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Digestive issues or diseases that can impair B12 absorption include: Crohn’s disease Celiac disease Chronic pancreatitis SIBO (Small Intestinal Bacterial Overgrowth) A tapeworm (Diphyllobothrium) from raw/undercooked fish or the parasite Giardia Leaky gut or intestinal permeability A Helicobacter pylori infection Low stomach acid which is needed to absorb B12 Low intrinsic factor or parietal cell antibodies Pernicious anemia or other autoimmune conditions How is a B12 Deficiency Diagnosed

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the maximum recommended daily oral dose is significantly lower than the maximum daily parenteral dose (2,3)