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Those most at risk include vegans and vegetarians, people with digestive conditions such as Crohn's disease, coeliac disease or IBS, those taking long-term metformin or proton pump inhibitors, older adults whose ability to absorb B12 through the gut declines naturally with age, those with pernicious anaemia, and anyone with a history of chronic alcohol use

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The most common skin manifestations include a pale, washed-out complexion from anemia, dryness and cracking (particularly at the corners of the mouth), hyperpigmented patches on the hands or face, and glossitis a swollen, smooth, unusually red tongue

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