With age, it can become more enthusiastically to retain this vitamin. It can occur if you had weight loss
surgery or another operation that eliminated part of your stomach, or if you drink too much.

1) Atrophic gastritis, in which your stomach lining has diminished

2) Pernicious iron deficiency, which makes it difficult for your body to absorb vitamin B12

3) Conditions that influence your small intestine, such as Crohn's disease, celiac disease, bacterial
growth, or a parasite

4) Alcohol misuse or weighty drinking can make it harder for your body to absorb nutrients or prevent
you from eating enough calories. B12 might be glossitis, or a swollen, inflamed tongue.

5) Immune system disorders, for example, Graves' disease or lupus

6) Been taking certain medications that meddle with the absorption of B12. This incorporates some heartburn medicines including proton pump inhibitors (PPIs, for example, esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec OTC), pantoprazole (Protonix), and rabeprazole (Aciphex), H2 Blockers like cimetidine (Tagamet) and famotidine (Pepcid AC); and certain diabetes medicines like metformin (Glucophage).

You can likewise get vitamin B12 deficiency that you follow a vegan diet (which means you doesn’t eat an
animal products, including meat, milk, cheddar, and eggs) or you are a vegetarian who doesn’t eat
sufficient eggs or dairy products to meet your vitamin B12 needs. In both cases, you can add fortified
foods to your diet or take supplements to address this issue.

Additional Test for B- 12 Deficiency

1) Antibodies test:

Your doctor might draw an example of your blood to check for antibodies to intrinsic factor. Their
essence demonstrates pernicious anemia.

2) Methylmalonic acid test:

You might go through a blood test to quantify the presence of a substance called methylmalonic acid.
The level of this substance is higher in people with vitamin B-12 deficiency.

Treatment

Vitamin B12 deficiency can be treated with intramuscular injections of cyanocobalamin or oral vitamin
B12 therapy. Around 10% of the standard injectable dose of 1 mg is retained, which takes into account
fast replacement in patients with severe deficiency or severe neurologic symptoms.

In general, patients with an irreversible reason ought to be dealt with endlessly, while those with a
reversible reason ought to be treated until the deficiency is revised and symptoms resolve. On the off
chance that vitamin B12 deficiency coexists with folate deficiency, vitamin B12 ought to be replaced first
to forestall subacute joined degeneration of the spinal cord.

Oral therapy doesn’t further develop serum methylmalonic acid levels just as intramuscular therapy,
there is also a lack of data on the drawn out advantage of oral therapy when patients don't take daily
bases doses. There is deficient data to suggest different definitions of vitamin B12 replacement (e.g.,
nasal, sublingual, subcutaneous).

Prevention

Many people can prevent vitamin B12 deficiency by eating sufficient meat, poultry, fish, dairy products,
and eggs. By not eating animal products or having a medical condition that limits how well your body
assimilates nutrients, by taking vitamin B12 in a multivitamin or other supplement and foods fortified
with vitamin B12.

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