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First, deficiency is common in gut disease chronic enteropathy and exocrine pancreatic insufficiency impair absorption, so cobalamin must be replaced

These include: Metformin (used for diabetes or PCOS) Proton Pump Inhibitors (used for acid reflux or GERD) H2 Blockers Birth control pills Certain antibiotics If youre taking these medications long-term, particularly in combination, regular B12 injections might be beneficial

In vivo , Hong et al