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Deficiency after gastric banding is therefore primarily related to: Reduced dietary intake and food tolerance , limiting consumption of B12-rich foods Use of acid-suppressing medicines (PPIs or H2RAs) , which can impair the release of B12 from food proteins and reduce absorption of food-bound B12 Crystalline B12 the form found in supplements and fortified foods does not require acid or pepsin for release

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Pregnant or breastfeeding women should receive B12 supplementation only under the guidance of an obstetrician not at a med spa

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Vegans and "patients with diseases like Crohn's and colitis as well as people with pernicious anemia are also particularly vulnerable to deficiency," added Silverstein