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However, real-world use reveals higher reported anxiety incidence in some populations, suggesting trial populations may not fully represent all users or that symptom severity goes underreported in structured settings
So people at greatest risk for deficiency include those with low stomach acid (e.g., older adults and people on proton pump inhibitors or antacids) or low IF production (known as pernicious anemia), people on medications that interfere with B12 absorption (such as metformin), people who have had gastric surgery, those with GI conditions that impair nutrient absorption (like celiac or Crohn's disease), and people on vegan and vegetarian diets
Those with certain genetic variations affecting b12 metabolism may benefit from methylcobalamin specifically
Baak LM, Wagenaar N, van der Aa NE, et al
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