Vitamin B12 deficiency is being found much more often than before. Docs are still often not aware. There are 3 major reasons for increasing prevalence: 1. aging population demographics leading to increasing prevalence of decreased stomach acidity; 2. Medications (mostly the antacids like Nexium or Prilosec, but also Metformin and some others); 3. vegan, vegetarian, and plant-based diets. This New England Journal article covers several key facts about what it calls a "common clinical presentation". It is a 57 yo patient with B12 deficiency with a normal serum B12 level. The patient had homocysteine and methylmalonic acid levels that were very high.
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