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Epidemiology: High levels of vitamin B12 were found in: Causes: Excessive supplementation (a direct increase in plasma vitamin B12 by excess intake or administration) Increased release of vitamin B12 from tissue stores (liberation from an internal reservoir): Solid tumors (especially hepatic or hematologic malignancies) Liver metastases Increased binding proteins: 7 Excess production: Liver disease (e.g., hepatitis, cirrhosis, hepatocellular carcinoma) damaged hepatocytes release haptocorrin (transcobalamin I) and B12 into circulation Myeloproliferative disorders these increase granulocyte production, which leads to more haptocorrin (transcobalamin I/III), a B12-binding protein produced by proliferating myeloid cells

Vegans, vegetarians, people over the age 50, anyone with stomach/bowel issues like chronic gastritis, leaky gut, IBS or celiac, and anyone who regularly takes medications such as Metformin, PPIs (used for GERD), H2 Receptor Antagonists (used for peptic ulcers), or anything that interferes with stomach acid production are actually at risk for vitamin B12 deficiency, and should supplement B12 regularly

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This response later declines to baseline with long-term use of atenolol