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Testing may be more relevant when one or more recognized risk factors are present: A vegan, vegetarian, highly restrictive, or very low-calorie diet Avoidance of major food groups because of allergies or intolerances Celiac disease, inflammatory bowel disease, chronic diarrhea, or another malabsorption disorder Bariatric surgery or surgery involving the stomach or small intestine Heavy menstrual bleeding or other ongoing blood loss Pregnancy, breastfeeding, or planning a pregnancy Older age, reduced appetite, or difficulty preparing meals Chronic kidney, liver, pancreatic, or gastrointestinal disease Frequent alcohol use Long-term use of medications that may affect nutrient intake, absorption, or metabolism Unexplained anemia, neuropathy, bone discomfort, muscle weakness, or persistent fatigue High-dose or long-term supplement use Older adults, people with gastrointestinal disorders or surgery, people with pernicious anemia, and those following vegan or vegetarian diets are among the groups at increased risk for vitamin B12 inadequacy