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The peptide chains remain intact

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12 During audiological testing, the patient generally listens for and indicates when they hear tones of various frequencies and intensities, which may be transmitted through the air or through headphones

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