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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

One of the most profound mechanisms of action is B12's ability to actively support the maintenance of the myelin sheath

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doi: 10.3389/fendo.2023.1118691 104 LwinSTOlechnowiczSWZFowlerJAEdwardsCM

If you are deficient in vitamin B12, improvement in symptoms such as tiredness may begin within days to weeks after starting injections

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