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Risk factors that should prompt consideration of B12 deficiency include advancing age (reduced stomach acid production), strict vegan or vegetarian diets, pernicious anaemia, gastrointestinal surgery (particularly gastric bypass or ileal resection), long-term use of certain medications (metformin, proton pump inhibitors, H2-receptor antagonists), nitrous oxide exposure (including recreational use), and conditions affecting the gut such as Crohn's disease or coeliac disease

Some people may have difficulty maintaining healthy B12 levels due to age, dietary patterns, digestive issues, certain medications, or absorption concerns

Intestinal absorption of vitamin B 12 requires successively three different protein molecules: haptocorrin, intrinsic factor and transcobalamin II