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Levels lower than 148 pmol/L indicate true deficiency, while levels ranging from 148-221 pmol/L get a marginal status. Screening/testing for vitamin B12 deficiency is recommended in patients with one or more risk factors, such as: gastric or small intestine resections inflammatory bowel disease use of metformin for more than four months use of proton pump inhibitors or histamine H2 blockers for more than 12 months vegans or strict vegetarians adults older than 75 years Treatment How much vitamin B12 do you need to prevent vitamin B12 deficiency