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Certain people may be at a higher risk of developing a vitamin B12 deficiency, including: Adults age 65 and older, often due to pernicious anemia, atrophic gastritis, and reduced production of enzymes People with pernicious anemia, an autoimmune condition that may cause gastric atrophy People with gastrointestinal disorders (like celiac disease and inflammatory bowel disease) that affect nutrient absorption Anyone who has had bariatric or gastrointestinal surgery Vegetarians and vegans (B12 is only found in animal-based foods) Breastfed infants of vegan mothers If left untreated, a deficiency in B12 can lead to nerve damage

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These changes may cause disordered sympathetic and parasympathetic activity (158, 360) as well as PEM and cognitive dysfunction (29)

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