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Without supplementation, deficiency is nearly universal within 23 years People taking metformin long-term metformin use reduces B12 absorption by 1030% through calcium-dependent ileal uptake disruption [4] People taking PPIs or H2 blockers acid suppression impairs B12 release from food proteins

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Some other more invasive procedures can have unwanted side effects, such as incontinence or ejaculatory or erection problems

All studies are conducted exclusively in non-clinical, in-vitro research environments