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In 1994, the Framingham Heart Study reported the prevalence of vitamin B 12 deficiency, as defined by a serum vitamin B 12 level less than 200 pg per mL and elevated levels of serum homocysteine, methylmalonic acid, or both, to be 12 percent among 548 community-dwelling older patients

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This is often due to a limited diet like vegan, certain medical conditions or the use of B12-depleting medications like metformin or proton pump inhibitors

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