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Several factors can impair B12 absorption: Reduced stomach acid production (achlorhydria or hypochlorhydria), common in older adults and those taking proton pump inhibitors or H2-receptor antagonists long-term, impairs the release of B12 from food proteins Pernicious anaemia , an autoimmune condition destroying parietal cells and reducing intrinsic factor production, completely blocks the primary absorption pathway Gastrointestinal disorders including Crohn's disease, coeliac disease, or surgical removal of stomach or ileum sections directly damage absorption sites Metformin , commonly prescribed for type 2 diabetes, may reduce B12 absorption through unclear mechanisms

Side effects of B12 deficiency can include decreased cognitive function, fatigue, lethargy, feeling faint, depression or irritability, headache, balance issues and more

The Proline-Rich Core and Analytical Handling The GEPPPGKPADDAGLV sequence carries five proline residues, which restricts backbone rotation and is the structural basis for the peptides reported stability in acidic conditions [7]

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They can then change the dose if needed