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Do not vortex or shake vigorously, as mechanical stress can cause peptide aggregation

When symptoms occur, they typically relate to underlying conditions such as liver disease, kidney dysfunction, or haematological disorders that cause the elevation, rather than the high B12 itself

this is the most common cause of vitamin B12 deficiency in the UK a lack of these vitamins in your diet this is uncommon but can happen if you have a vegan diet and do not take vitamin B12 supplements or eat foods fortified with vitamin B12, follow a fad diet or have a generally poor diet for a long time medicine certain medicines, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs Vitamin B12 and folate deficiency are more common in older people, affecting around 1 in 10 people aged 75 or over and 1 in 20 people aged 65 to 74