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[51] Diagnosis [edit] According to one review: "At present, no 'gold standard' test exists for the diagnosis of vitamin B 12 deficiency and as a consequence the diagnosis requires consideration of both the clinical state of the patient and the results of investigations." [52] The vitamin deficiency is typically suspected when a routine complete blood count shows anemia with an elevated mean corpuscular volume (MCV)

Patients with pernicious anaemia have a slightly increased gastric cancer risk and may require baseline endoscopy if aged 50 or over

Clinical trial data confirmed this directly

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For this reason, identifying strategies that reduce metabolic efficiency has long been of interest in experimental research