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It is synthesized in every cell from the amino acids glutamate, cysteine, and glycine (Lu, Biochimica et Biophysica Acta , 2013)

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People taking heartburn medication, such as proton pump inhibitors, are at a higher risk for B12 deficiency and may benefit from alternative therapies to control/eliminate the heartburn or have regular Nutrient IV therapies and/or Vitamin B12 injections Elderly Vegans Vegetarians People with tapeworms Alcoholics Excessive use of antibiotics Excessive use of anti-convulsant medication Daily consumption of Aspirin may increase the risk for vitamin B12 deficiency