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Nutrient deficiencies can occur as a result of eating nutrient-poor foods or foods with less bioavailable (easily and readily absorbed and used) nutrients, following a calorie-restricted diet, having inflammation from infections or food sensitivities , taking certain medications , or having an imbalance of gut bacteria

However, there is a lack of clear evidence that reduced serum vitamin B-12 induced by these drugs leads to biochemical or functional vitamin B-12 deficiency, as indicated by circulating methylmalonic acid and homocysteine concentrations, or to the hematologic and neurological manifestations of clinical deficiency

Malabsorption of vitamin B12 resulting from structural or functional damage to the stomach, where intrinsic factor is secreted, or to the ileum, where intrinsic factor facilitates vitamin B12 absorption