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Gastric Bypass Surgery: Procedures that remove or bypass parts of the stomach and small intestine dramatically reduce the body's ability to extract B12

Insulin resistance is associated with increased serum concentration of IGF-binding protein-related protein 1 (IGFBP-rP1/MAC25)

This is why some of those who have had weight loss surgery or surgery to remove part of the stomach have difficulty absorbing the vitamin B12 they need from foods