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Oral B12 supplements have to pass through the gut, and absorption can be limited especially if you have digestive issues, take certain medications like metformin or antacids, or simply have low stomach acid

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But awareness of this mechanism helps you prepare and respond appropriately

People with gastrointestinal issues that affect B-12 absorption, like Crohns disease or celiac disease, pernicious anemia, a history of stomach or bariatric surgery, or heavy alcohol use, may also be at risk for low B-12 levels