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You may have a deficiency if you are vegan, dont eat enough B12 rich food, or if you have other health conditions which mean you are unable to absorb it properly

10.1007/s10787-017-0330-7 [DOI] [PubMed] [Google Scholar] Masnec S., Kokot A., Zlatar M., Kalauz M., Kunjko K., Radic B., et al

Whilst the intrinsic factor-mediated absorption pathway can only process approximately 1.52 micrograms of B12 at a time, passive diffusion allows absorption of about 1% of higher doses

Nevertheless, the insulin resistance and abdominal adiposity seems to be essential in the pathophysiological process, and for this reason, based on the information available, we propose IGF-1 as a key hormone in the pathophysiology of metabolic syndrome due to its implications in the metabolism of carbohydrates and lipids

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