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Common causes include pernicious anaemia (autoimmune condition), plant-based diets without supplementation, gastrointestinal surgery, and long-term use of metformin or proton pump inhibitors
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Still, through different sub-mechanisms: Sermorelin is a GHRH analog similar in concept to Tesamorelin (though shorter and less stable), while Ipamorelin is a ghrelin-mimetic that stimulates GH release through a separate receptor