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Studies consistently show 10 to 30 percent of metformin users develop low b12 levels over years of use

Vitamin B12 Medicine Interactions Chloramphenicol: bacteriostatic antibiotic can interfere with red blood cell response to supplemental Vit B12 Proton pump inhibitors: omeprazole and lansoprazole, etc., slow gastric acid release and may interfere with VIt B12 absorption from food H2-receptor antagonists: cimetidine, famotidine and ranitidine slow the release of hydrochloric acid into the stomach and interfere with Vitamin B12 absorption from food Metformin: might reduce absorption of Vitamin B12 due to altered intestinal motility, increased bacterial overgrowth, etc

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Genetic variants related to the immune system and autoimmune diseases increases the risk of pernicious anemia

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