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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

Various secondary alkyl halides are then readily attacked by the modified B 12s to give the corresponding stable cobalamin analogs

The absence of pharmacokinetic or pharmacodynamic interaction studies means healthcare providers must rely on theoretical considerations and the known pharmacology of each component when patients inquire about combination use