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Its deficiency is seen in people with poor nutrition, infection, cancer, surgery, alcohol, pernicious anemia, medications (PPIs or other acid-suppressing drugs), exposure to nitrous oxide (during surgery or recreational use), stomach/intestinal problems such as intestinal dysbiosis, leaky gut or gut inflammation, atrophic gastritis or hypochlorhydria (low stomach acid) and/or nerve damage

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If your B12 level is below 200 pg/mL (picograms per milliliter), you're considered to have a deficiency

Choline supports healthy brain development and aids in fat breakdown [7] , while B12 complements these functions by increasing the body's metabolic rate [3]