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In a state of vitamin B 12 deficiency, the cell responds by redirecting folate metabolic pathways to supply increasing amounts of methyltetrahydrofolate

Individuals at risk of vitamin B12 deficiency include older adults, people with gastrointestinal disorders, those who have had gastrointestinal surgeries, individuals on a strict vegan diet, individuals who take metformin for blood sugar control, and people taking proton pump inhibitors for chronic heartburn