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Testing is warranted when one or more of the following apply: Significant appetite loss lasting more than 3 months on stimulant therapy Concurrent metformin use Vegetarian or vegan diet Age over 50 (gastric acid and intrinsic factor production decline) History of gastric surgery, celiac disease, or Crohn disease affecting the terminal ileum New-onset fatigue, paresthesias, or cognitive complaints that do not match ADHD symptom patterns Which Labs to Order Serum B12 alone has limited sensitivity