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People with symptoms of vitamin B12 deficiency It is a good idea for anyone with the following signs and symptoms of a vitamin B12 deficiency or pernicious anemia to consult a doctor: People with gastrointestinal issues Conditions that affect the gastrointestinal tract may affect vitamin B12 release or absorption, including: pernicious anemia, which can lead to gastric atrophy, or damage to the stomach fish tapeworm infestation bowel or pancreatic cancer folic acid deficiency overgrowth of bacteria in the small intestine diabetes thyroid disease Crohns disease celiac disease chronic pancreatitis People who have undergone gastrointestinal surgery, including weight loss, may have fewer cells necessary to secrete stomach acid and intrinsic factor

In this regimen, lenalidomide can be replaced with cyclophosphamide [76]

However, some people have sensitivities to certain foods, including fruits + veggies

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