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Folate supplementation must not be started before B12 deficiency is treated, as this can precipitate or worsen neurological complications

If you haven't done it already, I think it's a good idea to track down the local B12 deficiency guidelines used by your ICB (Integrated Care Board) in England (Health Boards in Wales/Scotland)

You may be at risk if you: Are in the elderly age group Follow a vegetarian or vegan diet Have had stomach or intestinal surgery Suffer from digestive issues like celiac disease or Crohns disease Take acid-lowering medications like PPIs or H2 blockers Take metformin for diabetes Are pregnant or breastfeeding Sources of Vitamin B12 B12 is mainly found in animal-based foods : Meat, poultry, fish (especially liver) Eggs and dairy (milk, cheese, curd, paneer) Fortified cereals and plant-based milk (almond or soy milk) Note: B12 is not naturally found in plant foods , so vegetarians need to ensure they get it from dairy or fortified foods

Pernicious anemia is a B12 deficiency anemia caused by the lack of intrinsic factor.[ref] What causes the lack of intrinsic factor in pernicious anemia