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Dietary factors : Vegans and strict vegetarians : As B12 is found almost exclusively in animal products, those avoiding all animal-derived foods are at high risk unless they consume fortified foods or supplements regularly Older adults : Reduced stomach acid production with age can impair B12 absorption from food, with risk increasing progressively with advancing age Medical conditions affecting absorption : Pernicious anaemia : An autoimmune condition where the body cannot produce intrinsic factor, a protein essential for B12 absorption in the small intestine Gastrointestinal disorders : Crohn's disease, coeliac disease, and other conditions affecting the terminal ileum can impair B12 uptake Post-surgical patients : Those who have undergone gastric bypass or removal of parts of the stomach or small intestine Medication-related risk : Metformin : Commonly prescribed for type 2 diabetes, long-term use can reduce B12 absorption

Chronic kidney disease (CKD), particularly in later stages, is a recognized cause of hypercobalaminemia

And this can only happen when there's adequate acid production in the stomach, which as we get older, tends to be a problem since acid levels decrease with age