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Vitamin B12 deficiency can occur less frequently as a result of nutritional habits (strict vegans, breastfed infants born to vegan mothers with reduced dietary intake of animal products), drug interference (metformin, proton pump inhibitors, drug-affected purine, and pyrimidine synthesis), inherited disorders affecting intrinsic factor (IF) and other inherited disorders including methylmalonic acidemia and transcobalamin II deficiency nitrous oxide abuse, Diphyllobothrium latum infection, and pancreatic insufficiency.[] Metformin is considered a cornerstone in the treatment of diabetes and is the most frequently prescribed first-line therapy for individuals with type 2 diabetes

Resnick, K

The most dramatic increase is in the perimenopause population: as of February 2026, 1 in 20 women aged 4554 has an active estrogen-based HRT prescription, a 184% increase across the study period

This is a red flag warning sign of elevated inflammation and tissue degeneration