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In the case of pronounced absorption disorders, for example as a result of gastritis or after removal of the small intestine, in Crohn's disease, diverticulosis and the so-called blind-loop syndrome, there is a gradual decrease in the vitamin B12 store in the liver, which can turn into a manifest vitamin B12 deficiency

Others experience it as a loss of pleasure or mild emotional flatness around food. Trial mood scores moved slightly better rather than worse, so the negative experience appears to be a minority signal that standard adverse-event tables do not capture well