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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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If low levels of B 12 remain for a long time, the condition also can lead to irreversible damage to nerve cells, which can cause the following symptoms: numbness and tingling in the hands and feet difficulty walking muscle weakness irritability memory loss dementia depression psychosis
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