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If B12 levels are low but still in range indicating a functional deficiency (this is a deficiency but blood tests appear in normal range) then second line testing of homocysteine and MMA can confirm B12 and/or folate deficiency

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Published research has shown that the carrier protein is absent from gastric juice in approximately 90% of post-bypass patients with vitamin B12 deficiency, and in 40% of those without deficiency (8)

This can happen due to low levels of intrinsic factors in the digestive system, digestive conditions, or following a plant-based diet

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F., & Dunn, J