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The lack of significant demyelination observed with 3 weeks administration of cuprizone powder may reflect delayed cuprizone intake, rather than a complete lack of efficacy, given the significant loss of mature ASPA+ oligodendrocytes seen in this group

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doi: 10.1001/jamaneurol.2020.3962

Certain populations face higher deficiency risk: vegetarians and vegans (B12 is primarily found in animal products), adults over 50 (decreased stomach acid reduces B12 absorption), individuals with digestive disorders like Crohn's disease or celiac disease, and those taking medications like metformin or proton pump inhibitors