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Usually needs lifelong treatment After stomach or bowel surgery , including gastric bypass or removal of the terminal ileum Crohn’s disease, coeliac disease and other small-bowel conditions Long-term metformin and long-term acid-suppressing medicines , both of which reduce B12 absorption Long-standing strict vegan diets without supplementation, and older adults, in whom absorption declines ⚠ Why deficiency is treated promptly B12 deficiency affects both blood and nerves

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No primary, peer-reviewed paper stating this exact rationale was located for this article, so treat it as the commonly given explanation for the design choice rather than a directly sourced fact