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Some factors associated with low intrinsic factor include: Being over 60 Northern European or Scandinavian ancestry A family history of intrinsic factor issues Autoimmune conditions such as Type 1 diabetes Surgeries where part of the stomach has been removed Other factors that may affect intrinsic factor or overall B12 absorption include: Stomach lining inflammation Conditions affecting the small intestine Long-term use of antacids Disruption of gut flora Certain gastrointestinal infections If any of the above apply, holding B12 sublingually for 30 seconds before swallowing may be helpful