Sorry I have been away but I was at my member event in Mexico.
Patients at high risk for this will have low B12 and low Vitamin D levels with trashed hormone panels. They will have seen alternative health care people and told they have adrenal fatigue, leaky gut and MTHFR defects.
Most of them will not have ever had a proper B12 work up. Most will be told they don’t absorb B 12 very well or that they are vegan. The reality is very different.