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High-Risk Profiles The threshold for testing should be lower if the individual falls into any of these categories: Age 60 or older Long-term use of metformin or proton pump inhibitors (PPIs) Strict vegetarian or vegan diet Family history of pernicious anemia or autoimmune disease Key Clinical Symptoms Neurological and cognitive: tingling, numbness, or a "pins and needles" sensation in the hands or feet

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it is the most fatal (the plague only excepted) that any animal is subject to