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6 Sleep-wake homeostasis tells the body when it needs sleep, sending reminders (getting tired) and regulating sleep intensity

This complex process means that conditions affecting the stomach or intestines can significantly impair B12 absorption, including pernicious anaemia, atrophic gastritis, previous gastric surgery, coeliac disease, Crohn's disease, and long-term use of certain medications (such as metformin, proton pump inhibitors, and H2 antagonists)

Normal purging peaks around weeks two through four and resolves by week six to eight

[DOI] [PubMed] [Google Scholar] 52.Ward RE, Huang W, Kostusiak M, Pallier PN, Michael-Titus AT, Priestley JV

Occasionally, they have manifestations of advanced liver disease (ascites, variceal bleeding, or encephalopathy) at the initial presentation with chronic hepatitis