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Furthermore, the DTI metrics that are used as proxies of myelin integrity do not specifically identify myelin abnormalities, but detect differences in water diffusiona parameter that can be altered by axon packing density, axon caliber, and more confounding factors (Chang et al., 2017)

Conditions like pernicious anaemia (an autoimmune condition affecting a protein called intrinsic factor vital for B12 absorption), stomach issues (such as from reduced stomach acid or certain medications like proton pump inhibitors), intestinal disorders (like Crohns disease or coeliac disease), or even surgical removal of parts of the small intestine (e.g., gastric bypass surgery) can prevent proper absorption