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Dietary Causes Dietary causes include too much grain and not enough roughage, consumption of moldy feedstuffs, diets high in sulfur, cobalt-deficient diets, or consuming certain toxic plants such as bracken ferns

Patients randomized to placebo, pemetrexed, and platinum chemotherapy were offered pembrolizumab as a single agent at the time of disease progression

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In many cases, switching from oral to intramuscular B12 circumvents absorption issues entirely, providing reliable therapeutic levels regardless of gastrointestinal factors or drug interactions

Many patients report that regular B12 supplementation gives them an increased sense of wellbeing