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Thats a tricky question, because it depends on what exactly youre asking

Yet, there is no gold standard blood test, and the manifestation of clinical symptoms is important in the diagnosis of vitamin B 12 deficiency (13)

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Some causes of B12 deficiency are: Pernicious Anemia Autoimmune Diseases Leaky Gut Syndrome Ulcerative Colitis, Crohns and Celiac Disease Small Intestinal Bacterial Overgrowth (SIBO) H Pylori Infection Prolonged Usage of Gastric Reflux meds Vegan and Vegetarian diets MTHFR gene mutations Bariatric Surgeries Excessive Alcohol Consumption B12 and the Methylation Cycle: Methylation is a critical process that happens trillions of times in every cell each minute

8,9 Table 1 Risk Factors for Vitamin B12 Deficiency A multicenter randomized controlled trial of 390 patients with diabetes mellitus showed that those taking 850 mg of metformin three times per day had an increased risk of vitamin B 12 deficiency (number needed to harm = 14 per 4.3 years) and low vitamin B 12 levels (number needed to harm = 9 per 4.3 years) vs

Some NHS/ICB guidance notes oral options for dietary-related deficiency, and that long-term injection schedules depend on the cause