This disulfide reductase system, while bypassing the need for either TrxR or Gsr, and while also being able to use NADH as a source of disulfide reducing power, does not likely generate substantial amounts of NADPH-independent disulfide reducing power
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So people at greatest risk for deficiency include those with low stomach acid (e.g., older adults and people on proton pump inhibitors or antacids) or low IF production (known as pernicious anemia), people on medications that interfere with B12 absorption (such as metformin), people who have had gastric surgery, those with GI conditions that impair nutrient absorption (like celiac or Crohn's disease), and people on vegan and vegetarian diets
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In addition, gut microbiota can also affect the main clinical risk factors of stroke
