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This is because the digestive system, stomach acids, and enzymes attack the molecular structure of B vitamins when consumed in the form of tablets or gels

These tests may require specialist laboratory referral Holotranscobalamin (active B12) where available, may be used as a second-line test when standard B12 results are borderline Intrinsic factor antibodies to identify pernicious anaemia, the most common cause in the UK Parietal cell antibodies may be useful if intrinsic factor antibodies are negative but pernicious anaemia is still suspected Thyroid function and folate levels to exclude other causes of similar symptoms According to current UK guidance, patients presenting with neurological symptoms suggestive of B12 deficiency should not have treatment delayed whilst awaiting test results

Maul R, Warth B, Kant J-S et al (2012) Investigation of the hepatic glucuronidation pattern of the Fusarium mycotoxin deoxynivalenol in various species

Other systemic illnesses, such as diabetes and hyperthyroidism, or organ diseases affecting the liver and kidneys, can also contribute to deficiency by either preventing normal absorption or disrupting vitamin storage