Methods Number of Prescriptions and Gross Spending Data: This analysis uses 2019 through 2024 State Drug Utilization Data (SDUD) (downloaded in January 2026)
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
Grade: Research Grade
Potency decreases over time even under optimal storage
Selhub J, Morris MS, Jacques PF
Technically, but it wasn't designed for that purpose