Several factors can impair B12 absorption: Reduced stomach acid production (achlorhydria or hypochlorhydria), common in older adults and those taking proton pump inhibitors or H2-receptor antagonists long-term, impairs the release of B12 from food proteins Pernicious anaemia , an autoimmune condition destroying parietal cells and reducing intrinsic factor production, completely blocks the primary absorption pathway Gastrointestinal disorders including Crohn's disease, coeliac disease, or surgical removal of stomach or ileum sections directly damage absorption sites Metformin , commonly prescribed for type 2 diabetes, may reduce B12 absorption through unclear mechanisms
These changes are complemented by lowered levels of fibrosis-related biomarkers such as K-18 and pro-C3, indicating supportive liver-related metabolic responses
Understanding what falls within the normal range helps you distinguish between expected adjustment and genuine concern
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Neurological symptoms caused by long-term deficiency may take several weeks to months to fully improve
