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This often occurs in smokers, people with metabolic disease, heavy alcohol drinkers, as a side effect of certain prescription drugs, rheumatoid arthritis and impaired thyroid function

Individuals with risk factors for B12 deficiency including strict vegans, those with gastrointestinal conditions, patients taking long-term metformin or proton pump inhibitors, and older adultsshould discuss screening with their GP, even in the absence of obvious symptoms

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