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Conditions such as reduced stomach acid, digestive disorders, or certain medications can interfere with this process, meaning someone can consume enough B12 yet still become deficient

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In response to inflammation in the glandular epithelium, some immune cells with normal mitochondria infiltrate the gland, whereas others with dysfunctional swollen mitochondria may increase inflammation in the glandular microenvironment and hence recruit more immune cells, exacerbating tissue destruction