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Your doctor usually diagnoses B12-deficiency anemia in conjunction with abnormal blood testing results

Epidemiological evidence in some cases hints that the accepted dosages of vitamin B helps only to avoid their marginal deficiency and further benefits could accrue from higher dosages than those provided by RDA (4-5)

In Noonans syndrome genetic defects in the PTPN11 gene may affect this pathway and has been implicated in poor growth and poor response to GH therapy, although reports are conflicting (99, 100)

Metformin and acid-reducing drugs (e.g., omeprazole) can lower B12 absorption over time