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Certain groups face elevated risk of B12 deficiency and should discuss testing with their healthcare provider: Individuals following vegan or strict vegetarian diets without adequate supplementation Older adults (particularly those over 60 years), due to reduced gastric acid production People with gastrointestinal conditions including Crohn's disease, coeliac disease, or those who have undergone gastric or ileal surgery Long-term users of medications affecting B12 absorption, such as metformin (MHRA advises monitoring B12 levels), PPIs, or H2-receptor antagonists Individuals with pernicious anaemia or family history of this autoimmune condition People with exposure to nitrous oxide (recreational or occupational), which can cause functional B12 deficiency Diagnostic testing typically involves serum B12 measurement , though this may not always reflect tissue stores accurately

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[13] [15] There is a risk of oxalate nephropathy or kidney stone formation, particularly in patients with pre-existing renal impairment or those receiving prolonged high-dose therapy