According to the NIH Office of Dietary Supplements, functional B12 deficiency is most commonly seen in patients with one or more of the following: Age over 50 stomach acid production declines with age, and stomach acid is required to free B12 from food PPI or H2 blocker use reflux medications suppress the acid needed for B12 absorption Metformin use, which interferes with B12 absorption directly Vegan or vegetarian diets B12 is found almost exclusively in animal products Gut conditions including celiac, IBS, SIBO, and Crohns MTHFR mutations that affect how B12 is metabolized once absorbed Heavy alcohol use The symptoms of low B12 are easy to dismiss: fatigue, brain fog, low mood, tingling in the hands or feet, weakness, and shortness of breath on mild exertion
Always audit your formulary and check your states rules before prescribing anything new
Because it lacks the drug affinity complex, it does not covalently bind serum albumin and its action remains short, which is precisely what makes it useful for studying pulse shape rather than sustained elevation
Chemically, it is a tripeptide compound consisting of 3 amino acids which are glutamic acid, cysteine and glycine [4]
