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A newer 2026 development-focused review describes major formulation, pharmacokinetic, and translation barriers that remain unresolved

Wei, E., Gao, W

Diabetes patients face particular vulnerability due to metformin therapy, which significantly impairs B12 absorption over time

If you live with digestive conditions such as Crohns disease, coeliac disease or IBS, or take medications like metformin or acid reflux tablets long term, your gut may struggle to absorb B12 no matter how well you eat