In such cases, supplementation is often recommended
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Groups at higher risk of deficiency include older adults (due to reduced stomach acid production), people following vegan or strict vegetarian diets (as B12 is naturally found almost exclusively in animal products), individuals with pernicious anaemia or other malabsorption conditions, those taking certain medications such as metformin or proton pump inhibitors long-term, and people with significant nitrous oxide exposure (including recreational use), which can inactivate B12 in the body
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As one expert says, Regular monitoring is essential to tailor Vitamin B12 therapy to individual patient needs and prevent over- or under-treatment. Response-Based Dosing Strategies We adjust Vitamin B12 doses based on how well the patient responds
In fact, the absorption of B12 requires that you have adequate stomach acid (among many other factors), which means that if you are taking acid blockers for reflux you are likely reducing your absorption of B12