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Malabsorption (inadequate intake of vitamin B12 in the intestine) 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 part of the ileum (part of the small intestine), eg

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However, clinical trials show that these therapies can improve pain, sensation, and nerve function, which means doctors may use them off-label when there is evidence to support their benefit

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