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As we age, the stomachs production of acid decreases, which is essential for extracting B12 from dietary sources

The five classifications are: Class 1: enzyme deficiency with chronic nonspherocytic hemolytic anemia Class 2: severe enzyme deficiency, less than 10% of normal activity Class 3: moderate to mild enzyme deficiency, 10-60% of normal activity Class 4: very mild or no enzyme deficiency, at least 60% of normal activity Class 5: increased enzyme activity Pathogenic variants in the G6PD gene that result in non-spherocytic hemolytic anemia have all been found to cluster near the carboxy terminal end of the protein, whereas, the pathogenic variants that result in clinically mild symptoms are clustered near the amino terminal end of the protein

PMID:37107209

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Nimphy, J