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Jacques PF, Selhub J, Bostom AG, Wilson PW, Rosenberg IH

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4,5 Dietary insufficiency, pernicious anemia (i.e., an autoimmune process that reduces available intrinsic factor and subsequent absorption of vitamin B 12 1,2,6,7 ), and long-term use of metformin or acid-suppressing medications have been implicated in B 12 deficiency

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Theoretically, the intracellular assimilation of folic acid via dihydrofolate reductase might enhance thymidylate synthetase by bypassing the methylfolate trap, thereby allowing cellular proliferation to progress temporarily