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Medical conditions that can lead to a B12 deficiency include: Inflammatory bowel disease (IBD) Lymphoma Exocrine pancreatic insufficiency (EPI) Small intestinal bacterial overgrowth (SIBO) Chronic pancreatitis Protein-losing enteropathy (PLE) Gastrointestinal worms Liver disease Kidney disease Gastrointestinal cancer Hereditary cobalamin deficiency and low levels of dietary cobalamin are rare causes of cobalamin deficiency

Despite the uncertainties, interest appears to be growing, possibly influenced by the popularity of FDA-approved GLP-1 weight loss drugs