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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

This has led to the nickname wolverine stack, reflecting the potential for accelerated recovery

For Tirzepatide users specifically, this combination helps preserve lean mass while the primary medication handles fat reduction

Dosing Equivalency Unknown: There is no established conversion factor between oral and injectable dosing based on human clinical trials