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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

Anyone taking high-dose supplements should make sure to have their vitamin B12 levels tested periodically

We stated in the proposed rule that we believe that the publicly available sources that make representations about the total service and preparation times contradict the RUC-recommended median times based on the survey of 33 burn surgeons