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Vitamin B12 deficiency is relatively common, and the main causes of deficiency include: Pernicious anaemia (a medical condition where your own immune system attacks healthy cells in the stomach, preventing the absorption of Vitamin B12) Vegan and Vegetarian diets Episodes of extreme dieting or a poor diet over a long time People taking certain medications, including metformin, anti-convulsants, and antacids Previous bowel surgery or medical conditions affecting the bowel Increasing age Risk factors also includes smoking and alcohol excess The absorption of Vitamin B12 from the diet begins within the mouth, where proteins within the saliva attach to the vitamin to prevent it from being destroyed by the acid in the stomach