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Without supplementation, deficiency is nearly universal within 23 years People taking metformin long-term metformin use reduces B12 absorption by 1030% through calcium-dependent ileal uptake disruption [4] People taking PPIs or H2 blockers acid suppression impairs B12 release from food proteins
Deficiency of vitamin B12 may cause tiredness, weakness, constipation, loss of appetite, weight loss and megaloblastic anemia (a condition when red blood cells become larger in size than normal)
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