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Common Risk Factors Include: Northern European descent Age over 50 years Autoimmune disorders (e.g., thyroid disease, type 1 diabetes) Long-term use of acid-suppressing medications Strict vegetarian or vegan diets History of gastric or intestinal surgery Pathophysiology of Pernicious Anemia The development of pernicious anemia follows a predictable sequence: Autoimmune destruction of gastric parietal cells Reduced or absent intrinsic factor production Failure to absorb vitamin B12 in the terminal ileum Impaired DNA synthesis in bone marrow Production of large, dysfunctional red blood cells Reduced oxygen-carrying capacity Over time, vitamin B12 deficiency also affects the nervous system , leading to neurological symptoms

There was atrophy of the distal leg muscles

To put it plainly: if low B12 was one of the things holding you back, addressing it can help you show up better for the diet and exercise work that actually drives results

Comparative tolerability of sulphonylureas in diabetes mellitus