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Some of the most common causes of vitamin B12 malabsorption are: Leaky gut and inflammatory bowel disease Gut dysbiosis (imbalance in gut bacteria) Low stomach acid (hypochlorhydria) The auto immune condition pernicious anaemia - as the body attacks and destroys intrinsic factor, the protein that is essential for B12 absorption Acid suppressant medications Excessive alcohol Vegan or vegetarian diets (plant sources are poorly absorbed) According to various studies 50% of long-term vegetarians and 80% of vegans are extremely low in B12