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Common causes of B12 deficiency can include: Limited dietary intake (common in strict vegan or vegetarian diets) Pernicious anemia, an autoimmune condition that prevents proper B12 absorption in the stomach Gastrointestinal surgeries that remove part of the stomach or small intestine Age-related declines in stomach acid production Long-term use of certain medications, such as metformin or proton pump inhibitors, which can reduce the body’s ability to properly absorb vitamin B12