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Other groups who may benefit include: Patients following gastric surgery (gastrectomy, bariatric procedures) where intrinsic factor production or absorption sites are compromised Individuals with malabsorption disorders such as Crohn's disease, coeliac disease, or chronic pancreatitis Strict vegans and vegetarians with dietary insufficiency, though oral supplementation is usually tried first Elderly patients with atrophic gastritis or reduced gastric acid production Patients on long-term metformin or proton pump inhibitors, which can impair B12 absorption Individuals with nitrous oxide exposure (recreational or medical), which can cause functional B12 deficiency Diagnosis typically involves serum B12 measurement, with levels below approximately 148 pmol/L (though thresholds vary between laboratories) generally indicating deficiency

While these are population-level numbers, the principle applies to individuals as well: routine injection visits for non-deficient patients add up in copays, travel time, and appointment scheduling without delivering additional benefit

Ask him what are the signs of toxicity - and I'm willing to bet you will hear a list of all the B12 deficiency symptoms that he chooses not to recognise as such, even if you mentioned them all 15 years ago to the first GP

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