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In addition, this strategy negatively impacts natural body microbiota, directly affecting the patients immune system response to continuous or new bacteria invasion (Konstantinidis et al., 2020)
However, participants were recruited from social media groups that 1) may not be representative of the older population who have a greater vitamin B12 deficiency prevalence and may use primary care frequently and 2) be more exposed to discussions around self-medication
hence, genetic, environmental, and microbial factors take part in the etiology of the disease
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