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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
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Deficiencies of B12 can manifest themselves as various symptoms
There is no human trial showing that this step-up structure improves results or lowers risk
16Lindenbaum J, Healton EB, Savage DG, et al
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