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The NIH Office of Dietary Supplements lists several groups at higher risk of low B12 status: Adults over 60, particularly those with atrophic gastritis People with pernicious anemia, who lack intrinsic factor People with gastrointestinal conditions such as Crohn's disease or celiac disease Anyone who has had gastric or intestinal surgery, including bariatric procedures Vegans and long-term vegetarians, since B12 occurs naturally in animal foods People on certain long-term medications, including metformin and proton pump inhibitors An NIH analysis of NHANES data from 2007 to 2018 found that about 3.6% of U.S