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Increased intestinal permeability has been identified as a factor in a wide range of conditions many of which, on the surface, appear to have nothing to do with the gut: IBS IBD: Ulcerative colitis & Crohn's disease Coeliac disease Type 1 and 2 diabetes Hashimotos thyroiditis Rheumatoid arthritis Alopecia Multiple sclerosis Parkinsons disease Polycystic Ovarian Syndrome (PCOS) Alcoholic liver disease Liver cirrhosis Acute pancreatitis Chronic heart failure Depression (2-5) Chronic Fatigue Syndrome / M.E Psoriasis Acne Long COVID Among many others

This concern is particularly relevant given the increasing popularity of off-label B12 use

As an intracellular antioxidant, it is involved in cellular redox balance and various metabolic processes

Regulation of the hypoxia-inducible factor (HIF) by pro-inflammatory cytokines