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3rd European evidence-based consensus on the diagnosis and management of Crohns disease 2016: part 1: diagnosis and medical management

The lack of adequate cobalamin in the body hinders the regeneration of tetrahydrofolate, which eventually leads to megaloblastic anemia due to the functional folate deficiency.910 On the other hand, the methylmalonyl-CoA mutase helps to metabolize odd chain fatty acids and branch chain amino acids.5 Cobalamin is also thought to keep the bodys level of sulfhydryl (SH) groups in reduced form

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Finally, a gastric bypass can lead to a deficiency when it disrupts the production of intrinsic factor in the stomach