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Addressing underlying causes is essential: Dietary modification and supplementation for vegans/vegetarians Management of gastrointestinal disorders affecting absorption Screening for coeliac disease if indicated Review of medications that may contribute to deficiencypatients should not stop prescribed medications such as metformin or proton pump inhibitors without consulting their doctor For patients on long-term metformin, the MHRA recommends considering vitamin B12 testing in those with symptoms or risk factors for deficiency, with periodic monitoring in at-risk groups

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