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Nutritional deficiency is caused by a lack of the vitamin in the diet, whereas acquired deficiency occurs when the intestinal absorption of the vitamin is interfered with by diseases and conditions such as pernicious anemia (an autoimmune disorder affecting intrinsic factor protein produced by gastric parietal cells), chronic atrophic gastritis, Crohn's and celiac diseases, gastric bypass surgery, and medications such as metformin, gastric acid secretion blockers (i.e., proton-pump inhibitors and H2-receptor antagonists), and others (2, 3)

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Controlled testing of this hypothesis in a bowel-resection context failed to show a statistically significant effect (Beck 2014, p=0.15)

littoralis larvae fed on different plants