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Groups at increased risk of B12 deficiency include: Vegans and strict vegetarians , who avoid all animal products and are at significant risk without supplementation or fortified foods Older adults , in whom reduced stomach acid production impairs B12 absorption People with pernicious anaemia , an autoimmune condition that destroys intrinsic factor-producing cells Those who have undergone gastric surgery , including bariatric procedures, which can reduce intrinsic factor availability Individuals taking long-term metformin for type 2 diabetes, as this medication is associated with reduced B12 absorption — the MHRA has issued specific safety advice on monitoring B12 levels in this group [6] [7] People with conditions affecting the small intestine , such as Crohn's disease or coeliac disease Symptoms of B12 deficiency can include fatigue, weakness, pins and needles, memory difficulties, and a sore or inflamed tongue (glossitis)

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Author Contributions Concept and design: Ryuichi Ohta, Yoshinobu Tabata, Junya Ohara, Yoshinori Ryu Acquisition, analysis, or interpretation of data: Ryuichi Ohta, Yoshinobu Tabata, Junya Ohara, Yoshinori Ryu Drafting of the manuscript: Ryuichi Ohta, Yoshinobu Tabata, Junya Ohara, Yoshinori Ryu Critical review of the manuscript for important intellectual content: Ryuichi Ohta, Yoshinobu Tabata, Junya Ohara, Yoshinori Ryu Supervision: Ryuichi Ohta, Yoshinori Ryu References 1.A comprehensive overview of subacute combined degeneration: MRI diagnostic challenges and treatment pathways