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Some reasons your body may not be able to get enough B12 from food include: Anemia Gastritis Crohn’s disease Celiac disease Alcohol use disorder Sjögren’s syndrome Weight loss surgery, or surgery that removes part or all of your stomach A vegan or strict vegetarian diet (as B12 is only found in animal products) Medications, such as metformin and drugs used to treat gastroesophageal reflux disease (GERD), indigestion, and stomach ulcers Pregnancy Your doctor could also order a B12 test based on your symptoms