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Carlos Roldan, M.D., is a pain medicine physician at UT MD Anderson

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[27] Vitamin B 12 deficiency has the potential to influence methylation patterns in DNA, besides other epigenetic modulators such as micro (RNAs), leading to the altered expression of genes

While many people get enough vitamin B12 naturally from their diets, vegetarians and vegans will often need a supplement because they eat little or no animal protein

In certain cases, when symptoms are unusual or to follow-up on abnormal results from the history, exam, and labs, more complex diagnostic tests may be called for, including additional lab work, brain imaging, and others

Pernicious anaemia an autoimmune condition where the stomach fails to produce intrinsic factor, making oral B12 absorption impossible