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The well-known geriatrician-haematologist Larry Solomon, working at Yale University in the USA, wrote 20 years ago: if I had treated only those people who actually had too low serum B12 and elevated MMA values, then I would not have treated approximately two-thirds of the people with a favourable response to B12 supplementation (note: partly via injections, partly via oral supplementation)

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For example, a lack of both iron and folate can cause severe anemia

Long-term use of metformin, proton pump inhibitors or H2 blockers , which can reduce B12 absorption over years

Appropriate without clinical oversight