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Causes of vitamin B 12 deficiency can be divided into three classes: nutritional deficiency, malabsorption syndromes, and other gastrointestinal causes (Table 2)

The MHRA recommends monitoring B12 levels in patients on long-term metformin treatment

It appears that long-term treatment for the moderation of the nociplastic alterations in the FM nervous system is needed

Conditions like pernicious anaemia (an autoimmune condition affecting a protein called intrinsic factor vital for B12 absorption), stomach issues (such as from reduced stomach acid or certain medications like proton pump inhibitors), intestinal disorders (like Crohns disease or coeliac disease), or even surgical removal of parts of the small intestine (e.g., gastric bypass surgery) can prevent proper absorption